Background Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-CoV-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. Methods Parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution), twice daily, for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. ClinicalTrials Identifier NCT04343729. Findings From April 18 to June 16, 2020, 647 patients were screened, 416 randomized, and 393 analyzed as mITT, MP in 194 and placebo in 199 individuals. SARS-CoV-2 infection was confirmed by RT-PCR in 81.3%. Mortality at day 28 was not different between groups. A subgroup analysis showed that patients over 60 years in the MP group had a lower mortality rate at day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until day 7. Conclusion The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.

As mulheres empreendedoras são definidas como mulheres inovadoras, que, ao dar início a uma atividade empresarial são desafiadas a demonstrarem suas competências ao lidar com vários obstáculos. Diante disso, a questão norteadora do artigo é: quais tipos de características e competências as mulheres empreendedoras devem possuir para manter seu empreendimento em meio às dificuldades? O objetivo é identificar os principais desafios enfrentados por essas mulheres empreendedoras, assim como, suas características e competências. Para isso, a metodologia escolhida para o estudo foi a pesquisa bibliográfica, de natureza qualitativa e fins explicativos, que permitiu analisar e deduzir os documentos de forma crítica, de modo que pudessem ser justificados ou explicados objetivamente dentro do assunto abordado. Como resultado, pode-se concluir que as mulheres empreendedoras são inovadoras, e as competências que lhes auxiliam no enfrentamento dos desafios do empreendimento estão relacionadas à habilidade natural do cérebro feminino em desenvolver multitarefas. Já com relação aos maiores desafios pode ser observado a discriminação, a necessidade de dupla jornada, e conciliar o empreendimento a realidade familiar.

INTRODUÇÃO: excesso de gordura localizada é considerado como um sério problema de saúde pública devido ao fato de que pode atingir diferentes pessoas, independente da cor, idade ou classe social. Com a localização  como: em região abdominal, chamado de obesidade androide e em região de pernas e quadril, chamado de obesidade ginóide. Em busca procedimentos estéticos não invasivos para resolução do acúmulo da gordura localizada, em centros e clínicas de estética que ofereçam procedimentos eficazes e seguros, muitos recorrem  a criolipólise. OBJETIVO: Apresentar  a fundamentação de técnicas , descrevendo os mecanismos  e analisando os resultados de pesquisas referentes a criolipólise. METODOLOGIA: Trata-se de uma revisão narrativa de literatura, cuja busca dos artigos foi realizada nas bases de dados: Pubmed, Scielo, Lilacs. A triagem seguiu a combinação das palavras chaves em inglês e português: criolipólise or cryolipolysis;  lipocitos or lipocytes and lipodistrofia  or lipodystrophy. Para inclusão dos estudos foram utilizados os seguintes critérios: estudos de corte transversal, estudos experimentais, ensaios clínicos  randomizados publicados entre 2013 a 2023. RESULTADOS: Foram encontrados 222 artigos estudos nos diferentes bancos de dados, sendo 2 eliminados devido à duplicação, após 191 estudos foram retirados por serem revisão da literatura, em seguida 3 foram excluídos por não fazerem parte do tema proposto. Sendo 30 estudos avaliados de forma integral e inclusos neste presente estudo. CONCLUSÃO: A criolipólise é um tratamento eficaz e seguro podendo ser utilizado para redução de gorduras localizados em diversas regiões do corpo, mostrando resultados positivos em apenas uma sessão, tendo como complemento o acompanhamento de massagens e produtos que estimulam a quebra de gordura, podendo ainda ser associado a tratamentos pós cirúrgicos.

BackgroundEarly Mobility (EM) has been recognized as a feasible and safe intervention that improves functional outcomes in hospitalized patients. The International Classification of Functioning, Disability and Health (ICF) supports understanding of functioning and disability in multidimensional concepts and efforts have been taken to apply ICF in a hospital environment. EM protocols might be linked with the ICF component of activity and participation. The correlations between ICF, EM, and functional scales might help the multidisciplinary team to conduct the best rehabilitation program, according to patients' functional demands.ObjectivesThe primary outcome is to analyze the activity level of neurological inpatients on admission and delivery after a Neurological Early Mobility Protocol (NEMP) at intermediate care settings in a public hospital in Brazil using Activity Level categories, HPMQ, and MBI scores. The secondary outcome is to analyze the ICF performance qualifier, specifically in the activity domain, transposing HPMQ and MBI scores to the corresponding ICF performance qualifiers.DesignAn international prospective study.MethodsNEMP was used to promote patients' mobility during a hospital stay in neurological ward settings. First, patients were categorized according to their Activity Levels (ALs) to determine the NEMP phase to initiate the EM protocol. ALs also were evaluated in the first and last sessions of NEMP. Thereafter, the Hospitalized Patient Mobility Questionnaire (HPMQ) was applied to identify whether patients needed assistance during the performance of hospital activities as well as the Modified Barthel Index (MBI). Both measures were applied in NEMP admission and discharge, and the Wilcoxon Signed Rank Test was used to compare data in these two time points. HPMQ and MBI scores were re-coded in the correspondent ICF performance qualifier.ResultsFifty-two patients were included with age of 55 ± 20 (mean ± SD) years and a length of hospital stay of 33 ± 21 days. Patients were classified along ALs categories at the admission/discharge as follows: AL 0 n = 6 (12%)/n = 5 (9%); AL 1 n = 12 (23%)/n = 6 (12%); AL 2 n = 13 (25%)/n = 8 (15%); AL 3 n = 10 (19%)/n = 13 (25%); AL 4 n = 11 (21%)/n = 20 (39%). HPMQ data revealed progressions for the activities of bathing (p < 0.001), feeding (p < 0.001), sitting at the edge of the bed (p < 0.001), sit to stand transition (p < 0.001), orthostatism (p < 0.001) and walking (p < 0.001). Transposing HPMQ activities into ICF performance qualifiers, improvements were shown in bathing (d510.3 to d510.1—severe problem to mild problem) and sitting at the edge of the bed (d4153.2 to d4153.1—moderate problem to mild problem). At MBI score were observed an average of 36 [IQR−35. (95% CI 31.5; 41.1)] on NEMP admission to 52 at discharge [IQR−50 (95% CI 43.2; 60.3)] (p < 0.001). Recoding MBI scores into ICF there were improvements from severe problem (3) to moderate problem (2).LimitationsThe delay in initiating NEMP compared to the period observed in the literature (24–72 h). The study was carried out at only one center.ConclusionsThis study suggests that neurological inpatients, in a public hospital in Brazil had low activity levels as could be seen by MBI and HPMQ scores and in the ICF performance qualifier. However, improvements in the evaluated measures and ICF activity domain were found after NEMP. The NEMP protocol has been initiated much longer than 72 h from hospital admission, a distinct window than seen in the literature. This enlargement period could be a new perspective for hospitals that are not able to apply mobility in the earliest 24–72 h.

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