bluuebunny/crossref_metadata_2025 huggingface dataset:
Çok Değişkenli ve Farklı Ölçekli Araştırmalarda Örneklem Büyüklüğünün Tespiti
Authors: AKBULUT Ömer
Published: December 2021

Tahmin ve analiz çalışmalarının kalitesini ve sunduğu bilgilerin doğruluğunu etkileyen faktörlerden biri araştırmanın örneklem büyüklüğüdür. Örneklem büyüklüğünü tahmin etmede etkili birçok faktör bulunmaktadır. Bunlar  hatası, testin gücü 1-’ ve etki büyüklüğüdür. Araştırmalarda genellikle çok sayıda bağımlı değişkenin incelenmesi amaçlanmaktadır. Bu durumda her bir değişkenin varyasyonu, dolaysıyla etki büyüklüğü, farklı olduğu için örneklem büyüklüğünün belirlenmesi zorlaşmaktadır. Bu değişkenlerin hem kesikli hem de sürekli değişkenlerden oluşması işi daha da güçleştirmektedir. İstatistiksel anlamlılık çalışmalarında hem yetersiz örneklem hem de gereğinden fazla örneklem hatalara (Alfa ve Beta) neden olabilmektedir. Her iki durumda da mevcut imkânların israfı söz konusudur. Bu makalede tek ve çok değişkenli çalışmalar için gerekli ve yeterli örneklem büyüklüğü hesaplanması rakamlı örnekler ile gösterilmiştir. Örneklem büyüklüğünün belirlenmesinde, güvenilir bilgi, işgücü ve maliyet unsurları da optimize edilmelidir.
Groblja i nalazi 7. i 8. stoljeća i formiranje identiteta u ranosrednjovjekovnoj Hrvatskoj
Authors: Jarak Mirja
Published: December 2021

U radu se raspravlja o grobljima i grobnim nalazima u Dalmaciji, okvirno datiranim u 7. i 8. stoljeće. Daju se podaci o nalazima i interpretacijama paljevinskih grobova te o mnogo zastupljenijim skeletnim grobljima na redove, iz čega se iščitava brzo prihvaćanje ritusa inhumacije od strane novodoseljenoga slavenskog stanovništva. Na primjeru groblja Kašić – Maklinovo brdo predočene su teškoće u pogledu preciznog datiranja pojedinih grobova i periodizaciji cijeloga groblja. Također, ukazano je na mogućnost interpretacije postupnog prihvaćanja kršćanstva, na temelju grobnih nalaza, već tijekom 8. stoljeća. Prstenje s kršćanskim simbolima pokazuje, primjerice, postupnu kristijanizaciju novodoseljenog stanovništva, koje je bilo u neposrednom doticaju s bizantskim gradovima u Dalmaciji. U oblikovanju ranosrednjovjekovnog identiteta slavenskog stanovništva, osim Bizanta, ističe se uloga kasnoantičkog supstrata i, na kraju razmatranog razdoblja, Karolinga.
Groblje, grobovi i dvije crkve u Loboru
Authors: Filipec Krešimir
Published: December 2021

U radu se raspravlja o grobovima oko predromaničke bazilike
u Loboru, Majka Božja Gorska. Glavni je naglasak na grobovima
vezanim uz vrijeme kada je ona već bila srušena. Nakon njenog
rušenja počinje sukcesivno sahranjivanje mrtvih već po ruševini i njenoj unutrašnjosti. Prema arheološkim predmetima, sloj
grobova iznad ruševine mogao bi se datirati kroz cijelo 11. stoljeće, a najkasnije do sredine 13. stoljeća. To je vrijeme kad se
primjećuje određeno blagostanje, ali također praćenje trendova tada prisutnih diljem Panonske nizine i okolnih krajeva, a
koje karakterizira relativno velik broj predmeta u grobovima,
što je sve bilo manje prisutno u ranijem dobu kad se u grobove
nije unosilo gotovo ništa. Dakle, vrijeme diskontinuiteta, kad je
predromanička bazilika bila porušena, a još nije bila sagrađena
kasnoromanička crkva, proteže se od prve trećine 11. do sredine
13. stoljeća. Gledajući kronološki, taj bi se diskontinuitet mogao
povezati s događajima vezanim uz ponovni ulazak Svetoga Rimskog Carstva u vrijeme vladavine Otona III., u drugoj polovini 10.
stoljeća u Panoniju, ili kad su Mađari teoretski prvi put zauzeli
ove prostore južno od rijeke Drave, vjerojatno u doba ugarskog
kralja Stjepana I., ili je možda riječ o vremenu nakon smrti hrvatskog kralja Zvonimira (nakon 1089.), kad su sjevernu Hrvatsku
zauzeli Mađari. Najkasnije se taj diskontinuitet mogao zbiti tek
u vrijeme mongolske provale 1242., ali takvo što bilo bi moguće
samo ako se pojedinim tipovima predmeta produži vijek trajanja do 13. stoljeća.
Nalaz slavonskih banskih i ugarskih denara iz groba 241 s lokaliteta Torčec-Cirkvišče
Authors: Krznar Siniša , Štefan Luka
Published: December 2021

U radu se analizira i interpretira nalaz srednjovjekovnoga srebrnog novca pronađenog tijekom arheoloških istraživanja 2014. godine u grobu 241. Riječ je o 15 primjeraka banskih denara kovanih u vrijeme kraljeva Bele IV., Stjepana V. i Ladislava IV. te šest primjeraka ugarskih denara Stjepana V. Novac je pronađen na području zdjeličnog pojasa pokojnika starosti 30 – 35 godina i najvjerojatnije se nalazio u vrećici od organskog materijala. Na temelju ovih nalaza i stratigrafskih odnosa s drugim grobovima ukop ovog pokojnika može se datirati u posljednju četvrtinu 13. stoljeća.
Engraved gems from Andetrium in the Archaeological Museum in Zagreb
Authors: Kaić Iva
Published: December 2021

This paper analyses 11 engraved gems from Gornji Muć. They belong to the collection of Roman engraved gems in the Archaeological Museum in Zagreb and were acquired in the 19th century by Mijo Jerko Granić, the priest of Gornji Muć. These gems were found in Gornji Muć, which was the location of the Roman auxiliary fort of Andetrium, and therefore add to our knowledge of Roman gems from military sites in Croatia.
Die Ästhetik der Schoah in Elfriede Jelineks Die Kinder der Toten und Neid. Privatroman
Authors: Ursachi Irina
Published: December 2021

Jelineks Romane Die Kinder der Toten und Neid. Privatroman erinnern an das dunkle Kapitel in der österreichischen Geschichte, nämlich an den „Anschluss“ im März 1938 und die Involviertheit von Österreichern/innen an den Massenverbrechen im Nationalsozialismus.

In diesem Beitrag werden Jelineks Erzähltechniken zur kritischen Darstellung einer Schoah-Ästhetik in den ausgewählten Romanen herausgearbeitet: die Neigung zur abstrakten und unpräzisen Statistik, die Einschübe in die Romanhandlungen, die einer Darstellung der Zeit des Austrofaschismus und des Nationalsozialismus dienen. Anhand der Symbolisierung der Opfer und der Täter/innen wird sowohl die von der Schoah hinterlassene Leere im Gedächtnis gefüllt als auch die Abwesenheit der Opfer repräsentiert.
Eggelte, Brigitte: Gramática Alemana. Salamanca: Ediciones Universidad de Salamanca 2020. 414 ppp
Authors: Sánchez Hernández Paloma
Published: December 2021

Reseña de la obra de Eggelte, Brigitte: Gramática Alemana. Salamanca: Ediciones Universidad de Salamanca 2020. 414 pp.
From technology speculation to value creation: The changing discourse and actants in the construction of IoT on Twitter
Authors: Åkerlund Mathilda , Nylén Daniel
Published: December 2021

The Internet of Things (IoT) is rapidly becoming an important technology, affecting our everyday lives, and is predicted to do so even more extensively in the coming years. Still, the concept remains somewhat fuzzy. As IoT continues to grow in importance and scope, so does the need to understand how the concept is used and what it represents. This study analyzes over nine million tweets over an extended sample period, applying a mixed methods approach to investigate how IoT is understood on Twitter over time, and importantly, the human and non-human actors that were prolific in shaping the discourse. The findings reveal a changing focus within the IoT discourse over time — from a primary technological, engineering perspective to one which highlighted practical implementations and particularly ways of leveraging IoT solutions to cultivate service innovation and generate novel forms of value creation. The scholarly community is not keeping up with this change. Furthermore, the analysis shows that over time, bots become increasingly prominent in tweeting IoT-related content, at the expense of individual Twitter users. This finding puts into new light the question of who shapes emerging technological concepts and the accountability and agency of bots.
feminist data ethics of care for machine learning: The what, why, who and how
Authors: Gray Joanne , Witt Alice
Published: December 2021

This article conceptualises and provides a roadmap for operationalising a feminist data ethics of care framework for the subfield of artificial intelligence (‘AI’) known as ‘machine learning’. After outlining the principles and praxis that comprise our framework, and then using it to evaluate the current state of mainstream AI ethics content, we argue that this literature tends to be overly abstract and founded on a heteropatriarchal world view. We contend that because most AI ethics content fails to equitably and explicitly assign responsibility to actors in the machine learning economy, there is a risk of implicitly reinforcing the status quo of gender power relations and other substantive inequalities, which in turn contributes to the significant gap between AI ethics principles and applied AI ethics more broadly. We argue that our feminist data ethics of care framework can help to fill this gap by paying particular attention to both the ‘who’ and the ‘how’, as well as by outlining a range of methods, approaches, and best practices that societal actors can use now to make interventions into the machine learning economy. Critically, a feminist data ethics of care is unlikely to be achieved in this context, and beyond, unless all stakeholders, including women, men, non-binary and transgender people, take responsibility for this much needed work.
Kiến thức, thực hành kiểm soát nhiễm khuẩn của nhân viên y tế tại Bệnh viện Mắt Trung ương năm 2021 và một số yếu tố liên quan
Authors: Hà Nguyễn Thanh , Dũng Đào Văn
Published: December 2021

Mục tiêu: Mô tả thực trạng kiến thức, thực hành về kiểm soát nhiễm khuẩn (KSNK) của nhân viên y tế (NVYT) tại bệnh viện và xác định một số yếu tố liên quan.

 Phương pháp: Mô tả cắt ngang, thực hiện trên 323 nhân viên y tế tại Bệnh viện Mắt Trung ương(BVMTW) từ 1/2021 đến 6/2021.

Kết quả: Tỷ lệ nhân viên y tế tại BVMTW có kiến thức KSNK đạt yêu cầu là 66,9%, tỷ lệ thực hành KSNK đạt là 81,1%. Một số yếu tố liên quan đến kiến thức KSNK của NVYT như tuổi (OR=2,2; p=0,002); trình độ chuyên môn (OR=1,9;p=0,01); vị trí công tác (OR=2,5;p<0,01). Các yếu tố có liên quan đến thực hành KSNK gồm giới tính (OR=2,06; p=0,01) và vị trí công tác (OR=1,94; p=0,03).

Kết luận: Kiến thức và thực hành KSNK của NVYT BVMTW khảo sát năm 2021 đạt yêu cầu khá tốt, tương ứng 66,9% và 81,1%.
THỰC TRẠNG TRẦM CẢM, LO ÂU, STRESS Ở SINH VIÊN CAO ĐẲNG ĐIỀU DƯỠNG CHÍNH QUY TRƯỜNG CAO ĐẲNG Y TẾ BẠCH MAI VÀ MỘT SỐ YẾU TỐ LIÊN QUAN NĂM 2021
Authors: Điệp Phùng Quốc , Thăng Chu Văn , Hạnh Nguyễn Thị Thúy , Thu Bùi Minh
Published: December 2021

Mục tiêu:

- So sánh tỷ lệ hiện mắc trầm cảm, lo âu và stress ở sinh viên cao đẳng điều dưỡng chính quy các khóa học của trường Cao đẳng Y tế Bạch Mai năm 2021.

- Phân tích một số yếu tố liên quan đến trầm cảm, lo âu và stress của sinh viên cao đẳng điều dưỡng chính quy trường Cao đẳng Y tế Bạch Mai năm 2021.

Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang được thực hiện trên 488 sinh viên cao đẳng điều dưỡng chính quy, trường Cao đẳng Y tế Bạch Mai, phỏng vấn bằng thang đo DASS- 21.

Kết quả và kết luận: Tỷ lệ sinh viên mắc trầm cảm, lo âu, stress lần lượt là 8,2%; 10,1%; 4,5%. Tỷ lệ trầm cảm, lo âu, stress cao nhất ở năm thứ nhất. Tỷ lệ trầm cảm, lo âu, stress ở mức độ nhẹ là cao nhất.

Các yếu tố có khả năng là nguy cơ của trầm cảm, lo âu và stress bao gồm: Sinh viên năm đầu; kinh tế gia đình khó khăn; học lực trung bình hoặc yếu; không hài lòng về ngành học; có uống rượu bia,hút thuốc lá/thuốc lào; kết thúc một mối quan hệ gần gũi (tình bạn); có bất đồng với cha mẹ.
Factors Affecting Productivity of Refuse Compactor Vehicles in India
Authors: Shah Khant , Pandit Devanshu
Published: December 2021

Shift towards mechanization in the municipal solid waste management (MSWM) is aimed at improving health wellbeing of the workers who are manually handling waste. With huge investment and operating costs, proper evaluation and monitoring of the performances of these equipment is essential.
Identifying and rating the factors which impact the performance of equipment is the first step towards improving efficiency of a system. This research identifies the critical factors and issues in the operation optimization of refuse compactor vehicles. Interviews with experts and field studies
helped in identification of 30 factors which were divided in five categories. The research uses analytical hierarchy process (AHP) for finding out the priority vectors of thus identified factors and categories. The study also highlights equipment selection parameters for the best suited model
and make.
Impact of Reinsurance on Performance of Nepalese Insurance Companies
Authors: Maharjan Rajendra
Published: December 2021

Reinsurance is considered as backbone of the insurance industry in developed and developing countries as it indirectly injects capital and Nepalese insurance companies are no exception. Thus, this study is aims to find out whether the use of reinsurance arrangement lead to positive effect or not? Three portfolios have been formed life, nonlife and industry. The study used 11 years unbalanced cross sectional secondary data from 2007/08 to 2017/18. The sample of the study consists of seven from life and nine from nonlife with 138 firm years’ observations. The dependent variable performance is measured by profitability (ROA and ROE) and solvency while reinsurance ceded as explanatory variable. Capital employed and size of the firm are considered as control variables. The study employed descriptive cum causal comparative research design. Regression analysis has been performed to see the effect of reinsurance on firm performance.

The result depicts that reinsurance has a positive and significant impact on performance of insurance companies. This finding indicates that reinsurance improves the cost efficiency of primary insurers. Further, reinsurance is a complement for capital in order to enhance solvency while negative relation indicating solvency of the insurers increases with the level of used reinsurance, to the extent that reinsurance and capital can be substitutes of each other. Thus, this study concludes that primary insurers can benefit from reinsurance as its relief on capital, diversify risk and in turn helps to earn profitability by sharing the risk with reinsurers.

Key words: Reinsurance, Profitability, Solvency, Capital, Premium
International Experience in Business Processes Improving on the Base of Architectural Approach
Authors: Fici Luigi , Malyzhenkov Pavel , Masi Maurizio , Rossi Fabrizio
Published: December 2021

Standardization is the pinnacle of the quality management instruments, which is vital for satisfying customer needs and ensuring sustainable development of business. The ISO 9001:2015 (Quality Management Systems, QMS) standard requires organizations to use the process approach. This paper proposes to use architectural approach for analysis and improvement of business processes for implementation of the ISO 9001:2015 standard.

Keywords: business process, enterprise architecture, architectural approach, ISO 9001:2015, quality management system, standardization
Mortality Rate of CNS neoplasms in childhood in Brazil
Authors: Farias Nathália dos Santos , Silveira Beatriz Silva , Andrade Isabela Mascarenhas de , Magalhães Lara Cordeiro , Weber Maria Luísa Sousa , Pereira Maria Clara Cotrim
Published: December 2021

Background: The variety of tumors of the Central Nervous System (CNS) during childhood is related to heterogenous clinical manifestations and to an important mortality rate (MR). In Brazil, CNS tumors represent the second most incident cancer during childhood and the main cause of death of children between ages 0-9. Objectives: To describe the number of hospitalizations and the MR of CNS neoplasms by childhood age group in Brazil. Design and Methods: This is a descriptive ecological study based on secondary data, obtained from DATASUS. Data were collected regarding the number of hospitalizations and MR by childhood age group due to neoplasm of the CNS in Brazil between the years 2009-2019. Results: A total of 38192 hospitalizations happened, resulting in 5.91% of MR. The highest value of brain’s neoplasms MR was found in children up to 1 year old (9,34%), but when it comes to number of hospitalizations, the group between ages 5-9 had the highest number, both in neoplasms of the brain (9364) and of other parts of the CNS (1767). Conclusions: The present study pointed out that the childhood age group with the lowest number of hospitalizations (less than 1 year) presented simultaneously the highest MR of CNS tumors.
Therapeutic impact of hypothermia in traumatic brain injury management: systematic review
Authors: Oliveira Diogo Abrantes de , Rezende Enzo Tibiriçá de , Maior Larissa Rodrigues Sotto- , Caires Nathália Vieira , Miquelito Vanessa Teixeira , Teixeira Alexandre Jahara Moreira Gomes , Egídio Arthur Neves , Cyranka Carolina Mendonça , Pellegrin Guilherme Rufino Marques , Cruz Leandro de Souza
Published: December 2021

Background: Traumatic brain injury(TBI) is an important component of mortality rate(MR) among young adults. Hypothermia(HT) is a treatment with questionable efficacy, given existing discordant views. Objective: investigate the performance of HT in TBI. Methods: Randomized controlled trials(RCT) from PUBMED, over the last five years, were analysed through the descriptors “Traumatic brain injury”; “Therapeutic hypothermia” and its MeSH variations. RCTs in individuals over 19 were included. After criteria were applied, four were selected for this review. This systematic review was submitted for registration on the PROSPERO plataform(ID: 253817). Results: Eurotherm3235 segregated n=387 to a group subjected to HP and another to standard treatment, evaluating them through the Glasgow Scale. The RCT was interrupted due potential damage to the participants, and showed greater MR(p <0.05) in the experimental group (EG). The POST-HOC of the B-HYPO sorted n=129 into a control group on fever management, and another group subjected to HT, separating them according to the injury. The patients with minor severity from the EG showed higher MR(p <0.05). The RCT from Chunhai T et al.(n=60) subjected to decompressive hemicraniectomy, which were divided into those who received HT, and a control group, displaying an inferior MR in the EG (p<0.05). Feng JZ et al. with n=14 subjected the EG to HT, and analysed the participants through the magnetic resonance metabolomics, showing lesser MR and better recovery in the EG(p<0.05). Conclusion: The studies indicated disparate results. However, those with larger samples indicated worse prognosis between patients subjected to HT.
Preliminary study on the number of deaths from neurodegenerative diseases in former Brazilian soccer players.
Authors: Xavier Lais de Paiva , Moreira Gabriella de Andrade , Cherain Luana Maria Amaral , Souza Lucas Ferreira Flávio , Novaretti Tânia Maria da Silva , Rigolin Valdeci de Oliveira Santos
Published: December 2021

Background: Neurodegenerative diseases have been reported in contact sports athletes. However, soccer has not been well characterized. Concerns were raised about the risk of neurodegenerative diseases being related to professional players in this sport. Objectives: To compare mortality from neurodegenerative diseases among Brazilian soccer players with the general population of the country. Methods: We conducted a retrospective cohort study. Causes of death were obtained from Brazilian teams’ databases and online content/public domain. Results: Among 1331 soccer players, 400 died. Acute Myocardial Infarction and Neoplasms were the highest causes of death, 58 and 53, respectively. We obtained a total of 35 deaths caused by neurodegenerative diseases. Alzheimer’s disease (18 deaths) and Stroke (14 deaths) were the most prevalent causes. These results are similar to the causes most found in the general population of Brazil: ischemic heart disease, cerebrovascular disease, airway infections and Alzheimer’s, in that order. This research had the following aspects as a limitation: the sources used were laymen, so the causes of death were not presented in a technical way in some moments; furthermore, the sampling space, still reduced, presented itself as another limitation. Conclusion: Preliminary results showed no correlation between soccer in Brazil and the higher occurrence of neurodegenerative diseases. The data sources and the sample space that were used may have contributed to such conclusions. These observations need to be confirmed on a larger scale with the prolongation of the study.
Cauda equina and conus medullaris syndromes due to Spinal Cord Schistosomiasis: a case report
Authors: Albernaz Lucas Cardoso Siqueira , Leite Izabel Feitosa da Mata , Moraes Guilherme de Aguiar , Moreira Neto Adelina Mouta , Medeiros Matheus de Campos
Published: December 2021

Context: Schistosomiasis is a prevalent disease in Brazil whose medullary form can be a serious and disabling condition. Diagnosis is clinical and laboratorial, based on neurological symptoms besides Schistosoma infection exams. Spinal Cord Schistosomiasis (SCS) can be associated with cauda equina syndrome (CES) adding “saddle” anesthesia and low back pain as symptoms. Case Report: A 22- year-old male presenting progressive bilateral and proximal pelvic weakness associated with urinary and fecal incontinence besides mild low back pain during 4 months. Patient reports daily swimming practice in rivers. Neurological examination revealed grade 3 weakness of the proximal muscles, patellar hyporeflexia, saddle anesthesia and hypotonia of the proximal muscles. Magnetic resonance imaging of the lumbar spine showed conus medullaris fusiform enlargement, associated with T2 and STIR hyperintensity (edema), hyposignal in T1, findings suggestive of an inflammatory / infectious etiology. Laboratory tests revealed a complete blood count with mild leukocytosis and eosinophilia; positive IgG serology for schistosomiasis; increased protein levels in the cerebrospinal fluid; stool analysis was normal. The diagnosis of CES and conus medullaris syndrome due to SCS was established and treatment with prednisone and praziquantel was initiated, with significant improvement in clinical symptoms. Conclusion: This case emphasizes the importance of early diagnosis and the initiation of appropriate therapy in order to prevent irreversible injuries in cases of CES and conus medullaris syndrome, both conditions of high morbidity that are often overlooked.
Epidemiological aspects of Meningites in Brazil: a comparison between regions
Authors: Ayin Andrea Alexandra Narro , Pinho Rafaela Seixas , Souza Aline Cristine Passos de , Souza Viviane Nazaré Lopes de
Published: December 2021

Background: Meningites are an inflammation of the meninges, more caused by virus, however, they are severe when caused by bacterias Objectives: Analyze data regarding the epidemiology of meningites in Brazil. Methods: Ecological study based on data of incidence and mortality by brazilian regions, sex and age affected by meningitis, between the year 2015 to 2020, available on Datasus. Results: In the north were reported 1.027 cases, Pará the winner; in the southeast were found 10.882 cases, and São Paulo was the most responsible; in the northeast, 12.435 cases were recorded, with the largest number in Bahia; in the South, 19.299 cases were observed, Paraná with the greatest number; finally, the midwest with 916 cases, Goiás was the winner. 8.056 deaths were reported, with the record in the southeast region, with 51,7% of total deaths, followed by the northeast (17,3%), South 16,9%), north (7,9%) and the midwest (5,9%). There was a predominance of the diasease in males (87.189 cases) over females (51.858 cases). The age groups most affected were between 20-39 years old, followed by 1-4 years old. The most affected race were whites, with 49.648 cases, followed by browns with 26.235 cases. Conclusion: The southestern region has higher mortality from meningitis and the South a higher incidence. The white race was the most affected and the age group between 20-39 years old.
Manifestations of COVID-19 infection in patients with Multiple sclerosis and Neuromyelitis optica
Authors: Crivelaro Julia , Piccolo Ana Claudia , Andrade Ana Carolina Amaral de , Aguera Henrique , Dallana Julia , Zambon Amélia
Published: December 2021

Introduction: The pandemic caused by the new SARS-Cov2 coronavirus, raised concerns about the impact of COVID19 on patients with autoimmune diseases such as Multiple Sclerosis (MS) and the Neuromyelitis Optic Spectrum (ENMO), undergoing treatment with immunosuppressive, immunomodulatory and monoclonal antibodies. Objective: To analyze the clinical evolution of COVID19 in patients diagnosed with MS and ENMO. Methods: retrospective study including patients diagnosed with MS and ENMO at the demyelinating disease outpatient clinic at Hospital Santa Marcelina, who were diagnosed with COVID 19 from April 2020 to April 2021. Results: 27 patients were included, with a mean age of ± 41.74 years (21 - 63 years), four with ENMO (14.81%) and twenty-three (85.19%) with Multiple Sclerosis (91.3 % with Sending MS - Recurrent (RR), and 8.7% with Secondary MS - Progressive (SP)). No patient had an outbreak, and only one (3.7%) had a pseudo-outbreak, 21 patients (77.8%) had nasal / oropharyngeal swab with positive RT-PCR for SARS-Cov2, 02 patients had negative RT-PCR and positive IgG (7 , 4%), and 04 patients (14.8%) with RT-PCR and serology not performed (presumed diagnosis of COVID19). Twenty patients (74%) had mild symptoms of COVID19, two (7.5%) with moderate symptoms, and another five (18.5%) with severe symptoms (admitted to the ICU), none of whom died. Four patients (14.8%) had an altered chest tomography (ground-glass pattern). Seven patients (34%) had some clinical or psychiatric comorbidity. Conclusion: The manifestations and complications of COVID-19 in this group of patients were similar to those presented by the general population.
Transcutaneous electrical nerve stimulation (TENS) in the management of post-thoracotomy pain: A systematic review
Authors: Lellis Caio de Almeida , Silva Kamylla Lohannye Fonseca e , Silva Junior Weldes Francisco da
Published: December 2021

Introduction: Thoracotomy is considered one of the most painful operative procedures in surgical practice, and postoperative pain control is a challenge. Objectives: To evaluate transcutaneous electrical nerve stimulation (TENS) as a form of treatment for post-thoracotomy pain. Design and setting: A systematic review conducted at the Pontifical Catholic University of Goiás. Methods: A systematic literature review was performed in the PubMed and Lilacs databases with the terms: “Post-thoracotomy pain AND (Transcutaneous Electric Nerve Stimulation OR TENS)”, being selected randomized controlled trials, clinical trials and case reports. Studies that did not fit the objectives were excluded. Results: TENS was shown to be a safe and effective therapy in the management of acute post-thoracotomy pain in the emergency department; however, the technique did not decrease the length of hospital stay or early pulmonary complications. One such study pointed to decreased shoulder flexion pain in patients undergoing axillary thoracotomy for lung resection, with pain sensation significantly decreased in the experimental group. In consonance, other trials emphasized the importance of the association of TENS with pharmacological therapy already employed in the emergency department, because patients who received fentanyl and bupivacaine associated with TENS perceived an immediate reduction in pain intensity at rest. Conclusion: TENS has proven to be a very effective and safe therapy in the treatment of postoperative pain in patients undergoing thoracotomy, improving their quality of life and reducing the consumption of analgesics.
Relationship between the quantity of treatments and the incidence of spina bifida in Brazil
Authors: Boas Gustavo Sampaio Vilas- , Oliveira Isadora Abreu , Oliveira Beatriz Gusmão , Rios Ana Carolina Pachêco de Menezes , Carvalho Thaís Machado Belitardo de , Souza Matheus Campos Ribeiro de , Loula Lanna Victória , Lima Raissa Barreto , Barreto Gustavo Bomfim , Sousa Giovanna Carvalho , Fonseca Rafaela Sandes , Lordêllo Louise Seixas , Oliveira Lara Teixeira de
Published: December 2021

Background: Spina bifida is the second leading cause of motor disability in childhood. Therefore, it’s important to know if the therapeutic offer for spina bifida is fulfilling its demand. Objectives: To evaluate the relationship between the number of treatments and the incidence of spina bifida in Brazil, between 2016 and 2019. Design and Setting: Descriptive, retrospective study, with secondary data collected in the Hospital Information System of SUS (SIH / SUS) and the Information System of Live Births (SINASC), between 2016 and 2019, in Brazil. Methods: Variables used: frequency of spina bifida by live births and quantity of treatments. Results: In 2016, the frequency of spina bifida by live births was 746 and the number of procedures for treating the disease was 360, resulting in a 0.48 ratio between the treatment quantity and the affected live births. In 2017, the frequency was 711 and the procedure quantity was 337, with a 0.47 proportion. In 2018, the frequency was 726, the procedure quantity 294, with a 0.4 proportion. In 2019, the frequency decreased to 694, with 288 procedures, and a 0.41 proportion. In total, there were 2,877 live births with spina bifida and 1,300 hospital procedures, with a proportion of 0.45. Conclusions: The study shows a clear disparity between the frequency of spina bifida and the procedure quantity for this condition. In addition, the number of procedures was decreased, without a proportional declination in the disease incidence, indicating a need for greater public investment for such treatments.
Epidemiological overview of epilepsy by Brazilian macro-regions
Authors: Neeser Natália Guerreiro Costa , Santos Caio Lopes Pereira , Coutinho Gabriela Malta , Lima Rebeca Menezes de Oliveira , Bahia Tauá Vieira
Published: December 2021

Introdution: Studying the epidemiology of epilepsy is important for the knowledge of this disease in the national territory, and also to improve the Public System. Objectives: Describe the epidemiological profile of epilepsy in Brazilian regions between 2010 and 2019. Methods: Refers to an ecological study with secondary data from the Ministry of Health, through DATASUS. The period investigated was from January 2010 to December 2019, in Brazilian regions. The variables explored were region, sex, number of hospitalizations, average length of stay and mortality rate. Results: 507,443 hospitalizations were identified, with the highest numbers of cases being in the Southeast (44.34%) and the lowest in the North (5.43%). There was a predominance of hospitalizations in males (58%).The mortality rate varied between 2.97 (Northeast) and 1.44 (South). Southeast had the longest stay (6.8 days) and the shortest was in the South (4.4 days). Conclusions: After analyzing this study, males have the highest rate of hospitalization and the Southeast has the highest number of hospitalizations and average length of stay for epilepsy, which may be associated with the fact that this region has the largest absolute population. Although, the Northeast had the highest mortality rate, a situation possibly related to a lower integration of the health system compared to the other regions.
Non-epileptic seizure caused by selective serotonin reuptake inhibitors (SSRI) - case report
Authors: Silva André Douglas Marinho da , Silva Ana Caroline Fonseca , Almendro Lucas Pablo , Dantas Pedro da Cunha
Published: December 2021

Context: Seizures are the most frequent clinical emergency neurological manifestation, corresponding to 1-5% of the visits, except for trauma. Several conditions have the potential to reduce the seizure threshold, and the use of antidepressant drugs as selective serotonin reuptake inhibitors is one of those reported. The seizure triggering risk related to SSRIs use is low, being 0.1%, perceptibly lower than that of tricyclic antidepressants, with a 1% rate. Case report: Male patient, previously healthy, 23-year-old, was seen at the Emergency Room in Rio Branco after a generalized seizure lasting 3 minutes. Complementary exams, including computed tomography, were all normal. Magnetic resonance imaging of the skull without atypical findings and electroencephalogram showed dysrhythmia by waves and discrete spicules. Patient reported using escitalopram (esc) 20mg for 3 months after 10mg progression dose, in use for 1 year, without clinical improvement. Due to the seizure event, medication management was switched for sertraline 50mg intake. After 2 months, the patient had a new generalized seizure, preceded by prolonged depersonalization. Complementary exams were normal, 10mg of esc was reestablished and the patient ceased with the seizures. Conclusions: The diagnostic hypothesis: patient’s seizure threshold is low, and seizures are triggered by SSRI higher doses adverse effect. Due to case rarity and SSRI efficacy and tolerance, it is suggested to encourage the discussion about administration safety of these drugs.
Use of eye biomarkers in pre-clinical diagnosis of Alzheimer’s Disease
Authors: Faria Luísa França de , Paula Fernanda Roberti Gil de , Alves Gabriel Roncalli Soalheiro Prado , Braga Luiz Filipe de Oliveira , Machado Lilian Caiafa Ferreira , Melgaço Nathalia Polliana Rodrigues , Correia Rafaela Charles , Cunha Vitória Aparecida , Magalhães Daiane
Published: December 2021

Background: Alzheimer’s disease (AD) has an unknown etiology, but the main pathophysiological hypothesis consists of the accumulation of extracellular beta- amyloid (Aβ) plaques and the formation of intracellular neurofibrillary tangles of phosphorylated tau1,2. As brain changes follow the appearance of clinical symptoms, there is a difficulty in making the diagnosis and early treatment3,4. The detection of biomarkers in the retina guaranteed the preclinical diagnosis of AD, in an efficient and economical way5. Objectives: To highlight the application of ocular biomarkers in the early diagnosis of AD. Methods: This is a narrative review with search in the sources PubMed, Cochrane and TripDatabase using descriptors: “Alzheimer Disease”, “Biomarkers” and “Retina”. Seven articles were used, published from 2017 to 2021. Results: In patients with pre-clinical AD, accumulation of Aβ was detected with the formation of specifically smaller retinal plaques when compared to brain plaques, but quantitatively equivalent to the load of this protein in the brain and the severity of this pathology6. Thus, associated with the great advance in retinal imaging exams, AD can be diagnosed early by analyzing the structure of the retina and ocular blood flow in a non-invasive and efficient manner5,7. Instruments and systems for conducting eye exams, such as optical coherence tomography and retinography, are increasingly present in medical services, which makes it possible to carry out regular and constant tests in the population1,5. Conclusions: Further studies are required to verify the long- term application of ocular biomarkers in medical practice.
Experience of hypothermia as a therapeutic alternative for severe hypoxic-ischemic encephalopathy in a neonatal intensive care unit in Belo Horizonte
Authors: Silva Matheus Henrique de Freitas , Wandeck Karina Santos , Cordeiro Sílvia Santiago , Oliveira Ruth Lira , Silva Síura Aparecida Borges
Published: December 2021

Introduction: Therapeutic hypothermia (TH) is an effective treatment alternative in newborns (NB) with moderate to severe hypoxic-ischemic encephalopathy (HIE). It is suggested that hypothermia, initiated in the first 6 hours after the hypoxic insult, by reducing brain metabolism, decreases cytotoxic edema, free radical production, neuronal excitability, the synthesis and release of neurotransmitters, nitric oxide and cytokines and apoptosis, mechanisms responsible for the late neurological lesions of EHI. Thus, TH improves survival and neurological prognosis in these newborns. Materials: Review of medical records of newborns submitted to TH in the period from 01/01/15 to 12/31/2015. Discussion: The TH protocol was implemented in the Unit from 01/01/2015, for all newborns older than 35 weeks, with evidence of moderate to severe HIE. TH starts in the first 6 hours of life and is performed for a period of 72 hours, after which rewarming begins, in the next 24 hours. In 2015, five newborns were submitted to the protocol. One of them died, on the fifth day of life, due to refractory shock and multiple organ failure. The other four newborns would be followed up on an outpatient basis. There was no need to stop hypothermia before 72 hours due to adverse events. The main events observed were bradycardia and shock, responsive to amines. Conclusion: The experience with TH showed good results in the medium term in newborns with moderate to severe HIE. The adverse events observed during the procedure were manageable, which suggests that TH can be an effective and safe alternative.
Epidemiological profile of registered meningitis cases by notification region in Brazil in the period of 2015-2020
Authors: Sá Fernanda Hora Gomes de , Souza Anna Carolina Moreira Silva , Garcia Catharine Conceição Martinez , Brandão Liz Lustoza , Peixoto Ricardo Britto , Miranda Sandrine Cordeiro
Published: December 2021

Background: Meningitis is a brazilian public health problem due to annual outbreaks¹. Meningitis morbimortality rate is still relevant and the epidemiological description contributes to preventive actions¹,². Objectives: Describe the epidemiological profile of meningitis cases reported by region in Brazil between 2015-2020. Design and setting: A retrospective descriptive study of meningitis cases. The data were obtained from Sistema de Informações de Agravos de Notificação (SINAN). Methods: Information on age, sex, race, etiology, serogroup and case evolution were collected. Results: Between 2015-2020, 87,189 cases of meningitis were reported, among which 58.9% were male. The majority of cases occurred in the Southeast (53.8%). The white race stood out in the South and Southeast, and the mixed race in the North, Northeast and Midwest. The 20-29 age group was the most prevalent, with the exception of the Southeast, where the predominance was 1-4-year-olds. Viral meningitis was the most frequent (47.2%), except in the Midwest, where non-primary meningitis (31.1%) was the main agent. Serotype C (57.8%) was the most prevalent across all regions. Hospital discharge was the main evolution (77.5%), especially in South (79.6%) and Southeast (77.5%). However, the highest death rate occurred in the North (14,6%) and Midwest (12.2%). Conclusions: Male and young people are more affected by meningitis. Despite a higher incidence in the Southeast region, the North has a higher proportion of deaths, revealing a public health problem.
Analysis of the potential prognostic of ELAVL2, FOCAD and MLLT3 in glioblastoma
Authors: Gonçalves Paola Gyuliane
Published: December 2021

Background: There is a crucial demand to identify molecular markers for cancer to improve the personalized treatment, diagnosis and prognosis. Our research group described a frequently deleted region (chr9p22.1-p21.3) in gliomas, with genes potentially important in the development of this tumor type, including ELAVL2, FOCAD and MLLT3. Objectives: Therefore, the aim of this study was to analyze the expression of those genes as potential biomarkers for glioblastoma (GBM) prognosis. Design and setting: The study was retrospective with samples collected at Barretos Cancer Hospital. Methods: Immunohistochemistry reactions were performed for ELAVL2, FOCAD and MLLT3 proteins in 83 GBM samples. The reactions were evaluated using scores of intensity and extension, ranging from 0 to 6 in total. Patients with expression scores between 0 and 2 were considered negative for the expression of the specific gene, and those with scores between 3 and 6 were considered positive. Clinicopathological and molecular data from patients (age, gender, tumor location, KPS, and overall survival) were correlated with the expression of each gene. Results: ELAVL2-expressing tumors showed a trend to develop in the temporal lobe (P=0.052), whereas they were not found in the frontal lobe. Patients with FOCAD expression were older (>45y.o., p<0.001). Overall survival was not influenced by ELAVL2 or FOCAD expression. Patients with MLLT3 expression presented a marginal improved overall survival (p=0.077) when compared with patients without expression. Conclusion: Although there was a correlation of ELAVL2 and FOCAD with tumor location and age, respectively, these genes did not show prognostic potential in glioblastomas. MLLT3 showed potential prognostic, albeit more studies are warranted with larger cohorts.
Deaths due to meningococcal infection in Brazil: analysis from 2009 to 2019
Authors: Santos Raimundo Maurício dos , Figur Felipe Eberhart , Colcenti Igor José , Wegner Gustavo Roberto Minetto , Paulino Sarah Gondim Santos , Brum Sara Julia Zorzi de , Rabello Renata dos Santos , Lindemann Ivana Loraine , Dozza Ana Luísa Casado Brasil
Published: December 2021

Background: Meningococcal disease is an acute and rapidly fatal infection caused by the bacterium Neisseria meningitidis. It can cause meningitis and severe meningococcemia, being more frequent in children and young adults. Transmission occurs through direct contact with oral nasal secretions. Objectives: Describe the mortality rate and characteristics of patients who died of meningococcal infection in Brazil. Design and setting: Descriptive ecological study conducted with data accessed from SIM - DATASUS. Methods: National notifications from 2009 to 2019 were included and the variables to be analyzed. The frequencies and the mortality rate were calculated. Results: 3,383 deaths were reported and there was a 37% decrease in the period, from 0.24 / 100,000 inhabitants in 2009 to 0.09 / 100,000 in 2019. Most cases occurred in males (55.5%), aged 1 to 9 years (29.1%), non-white skin color (49.3%), 1 to 7 years of schooling (54%) and single marital status (67.4%). Conclusions: The number of deaths from meningococcal infection declined in the period. In an effort to promote a more significant reduction in mortality rates, there is a need for continuous diagnosis and early treatment, in addition to prevention through vaccination.
Lowering of the level of consciousness by bilateral paramedian thalamic infarction due to Percheron’s ischemia (Percheron’s syndrome): a case report
Authors: Mada Mariana Sandy
Published: December 2021

Context: Ischemia of Percheron’s artery(PA) is a rare neurological occurrence that results in bilateral paramedian thalamic infarction that may affect the midbrain. Among the symptoms are altered mental status, vertical ocular palsy, and memory changes, as well as hemiplegia, cerebellar ataxia, and movement disorders. Objective: To elucidate a case of stroke of the mesencephalic trunk in an uncommon anatomical variant of the thalamus-perfurans arteries Method:Daily neurological and laboratory evaluation in addition to complementary examinations such as skull CT and skull MRI. We also performed a qualitative analysis of articles in Portuguese and English journals indexed in the following databases: PubMed (Public Medical Literature Analysis), Lilacs (Latin American and Caribbean Literature on Health Sciences) and Scielo (Scientific Eletronic Library Online). Case report: A 67 year old male presented with mild to moderate headache for 2 days, reporting chronic cough and decreased level of consciousness for 1 day. He was intubated (Glasgow 6) and sedated for diagnostic elucidation. The CT shows mild cerebral edema and MRI shows bilateral thalamic infarction affecting the PA. The clinical picture evolves to ischemic stroke of the mesencephalic trunk. Discussion: The bilateral infarction of the Percheron artery, as presented in this case, the neurological and neuropsychological manifestations are more severe such as akinetic mutism, thalamic dementia and loss of self psychic activation(Robot Syndrome). In these cases, the neuropsychological disturbance is best noticed when the patient regains consciousness. Conclusion: In the presence of a clinical presentation suggestive of bilateral thalamic infarction, the Percheron Syndrome hypothesis should be suspected.
Continuous Hemicrania After Clipping of Internal Carotid Aneurism: Case Report
Authors: Ximenes Marcelo Tognato , Picon Isabella Silva , Riso Ivy Liger , Florencio Anielle Melina , Domingues Renan Barros
Published: December 2021

Context: The trigeminal autonomic cephalalgias (TACs) are primary headaches, however there are some reports of patients with TAC phenotypes related to vascular or neoplastic lesions. We discuss here the case of a patient presenting a headache with a pattern of continuous hemicrania developed after aneurysm clipping surgery. Case report: Male, 37 years old, presented with periodic migraine since childhood, worsening after surgical approach of a ruptured right internal carotid artery aneurysm in 2014. Developed structural epilepsy after the surgical approach. Headache begins in the right occipital region radiating to right hemicranium, of severe intensity, pulsatile, intermittent, lasting 2 hours, partial improvement between crises, with persistence of mild to moderate pain between crises. Exacerbations were accompanied by ocular hyperemia and ipsilateral lacrimation, little improvement with analgesics. Normal neurological examination. Presented total control of the pain after the introduction of indomethacin. Conclusion: Continuous hemicrania is a primary headache with a therapeutic response to indomethacin, classified in the TACs group. Secondary cases may be related to trauma, craniotomy, expansive intracranial injury, among others. The patient presented with these headaches after a surgical approach to clip a ruptured aneurysm. Previous headaches had another pattern. There is a previous report of continuous hemicrania related to an aneurysm of the anterior communicant. This extremely rare case illustrates the importance of testing with indomethacin when this phenotype is present, even in the presence of a triggering factor.
VIOLENCIA Y ACOSO LABORAL EN EL PERSONAL DE ENFERMERÍA COMO ENFERMEDAD MULTIRRESISTENTE
Authors: Valenzuela Bustamante Yessica Lidia
Published: December 2021

El estrés que se vive a diario en la sociedad, por diversos motivos, puede exacerbar con mayor intensidad la violencia tanto física, moral y psicológica, entre otras. Esta situación se extrapola en lo laboral; lo cual también, atañe al área de la salud especialmente al personal de enfermería, quienes presentan una mayor vulnerabilidad.

El objetivo de este artículo es reflexionar sobre el impacto que genera la violencia y acoso laboral en el personal de enfermería y el efecto negativo que puede provocar a la víctima, sobre todo a largo plazo realizando una analogía con una enfermedad multirresistente.

En este artículo se exponen las características de los factores que influyen en la violencia y acoso laboral; el acosador o agresor, la víctima y las condiciones de trabajo. Por lo tanto, se transforma en una necesidad abordar estos tres factores para frenar y disminuir el acoso. La evidencia, revela que el personal de enfermería ha sufrido algún tipo de violencia y acoso laboral entre un 19 - 44% y los mayores porcentajes son de parte de familiares y compañeros de trabajo (personal de enfermería y jefatura).

En conclusión, en base a la reflexión realizada, la violencia y acoso laboral entre y hacia el personal de enfermería es un tema relevante y requiere urgentemente de estudio y análisis del profundo daño e impacto que genera.