Perfil epidemiológico dos pacientes amputados acompanhados em um grande centro referência em reabilitação de Pernambuco / Epidemiological profile of amputee patients monitored at a large reference rehabilitation center in Pernambuco

A amputação de um membro se reveste de maior dramaticidade e limitações sensório-motoras em pacientes jovens, assim como, na população adulta ou idosa com comorbidades. Objetivo: Traçar o perfil demográfico e epidemiológico dos pacientes atendidos em um grande centro de referência em reabilitação em Pernambuco. Métodos: Realizou-se um estudo de corte transversal com revisão de prontuários ativos. Os resultados foram tratados pelo Microsoft Excel® e o programa utilizado para os cálculos estatísticos foi o IBM® SPSS® na versão 23. Resultados: Observou-se idade média de 48,36 anos, gênero masculino (76,6%), casados (47,7%), ensino fundamental (64,8%) e oriundos de todas as regiões do estado. Quanto à amputação, sem predileção por lado, mais frequente nos membros inferiores transfemoral (55,1%), cotos de comprimento variável e causas vasculares e traumáticas mais frequentes. No exame físico, cotos em condições de reabilitação, utilização de aditamento comunitário ou domiciliar na primeira consulta e sem uso prévio de prótese. Em 83,6% dos casos, os pacientes usavam sua prótese mais de 7h/dia e 58,6% possuíam marcha independente na comunidade, com durabilidade da prótese em até 36 meses (75,8%). Conclusão: A amputação ocorre em idade jovem, sendo os homens mais acometidos, as doenças vasculares e acidentes envolvendo veículos motorizados são as principais causas, as cirurgias ocorrem mais nas diáfises ósseas. O tempo de terapias foi efetivo. Fazem-se necessárias políticas públicas que agilizem o acesso do paciente a centros especializados e desses aos centros de reabilitação e para melhoria dos materiais e componentes que compõem as próteses oferecidas pelo SUS

The amputation of a limb is more dramatic and sensorimotor limitations in young patients, as well as in the adult or elderly population with comorbidities. Objective: This study outlined the demographic and epidemiological profile of patients treated at a large referral rehabilitation center in Pernambuco. Methods: A cross-sectional study was carried out with a review of active medical records. The results were processed by Microsoft Excel® and the program used for the statistical calculations was the IBM® SPSS® version 23. Results: It was observed a mean age of 48.36 years, male gender (76.6%), married (47.7%), elementary education (64.8%) and from all regions of the state. As for amputation, with no predilection for the side, more frequent in the lower limbs transfemoral (55.1%), variable length stumps and more frequent vascular and traumatic causes. On physical examination, stumps in rehabilitation conditions, use of community or home addition in the first consultation and no previous use of prosthesis. In 83.6% of the cases, the patients used their prosthesis more than 7h/day and 58.6% had independent walking in the community, with prosthesis durability of up to 36 months (75.8%). Conclusion: Amputation occurs at a young age, with men being more affected, vascular diseases and accidents involving motor vehicles are the main causes, surgeries occur more in bone diaphyses. The therapy time was effective. Public policies are needed to speed up patient access to specialized centers and from them to rehabilitation centers and to improve the materials and components that make up the prostheses offered by the SUS.

Asymptotic Survival of Genuine Multipartite Entanglement in Noisy Quantum Networks Depends on the Topology.

The study of entanglement in multipartite quantum states plays a major role in quantum information theory and genuine multipartite entanglement signals one of its strongest forms for applications. However, its characterization for general (mixed) states is a highly nontrivial problem. We introduce a particularly simple subclass of multipartite states, which we term pair-entangled network (PEN) states, as those that can be created by distributing exclusively bipartite entanglement in a connected network. We show that genuine multipartite entanglement in a PEN state depends on both the level of noise and the network topology and, in sharp contrast to the case of pure states, it is not guaranteed by the mere distribution of mixed bipartite entangled states. Our main result is a markedly drastic feature of this phenomenon: the amount of connectivity in the network determines whether genuine multipartite entanglement is robust to noise for any system size or whether it is completely washed out under the slightest form of noise for a sufficiently large number of parties. This latter case implies fundamental limitations for the application of certain networks in realistic scenarios, where the presence of some form of noise is unavoidable. To illustrate the applicability of PEN states to study the complex phenomenology behind multipartite entanglement, we also use them to prove superactivation of genuine multipartite nonlocality for any number of parties.

Does admission acetylsalicylic acid uptake in hospitalized COVID-19 patients have a protective role? Data from the Spanish SEMI-COVID-19 Registry.

Acetylsalicylic acid (ASA) is widely used in the treatment and prevention of cardiovascular disorders. Our objective is to evaluate its possible protective role, not only in mortality but also in other aspects such as inflammation, symptomatic thrombosis, and intensive care unit (ICU) admission in hospitalized COVID-19 patients. We realized an observational retrospective cohort study of 20,641 patients with COVID-19 pneumonia collected and followed-up from Mar 1st, 2020 to May 1st, 2021, from the nationwide Spanish SEMI-COVID-19 Registry. Propensity score matching (PSM) was performed to determine whether treatment with ASA affected outcomes in COVID-19 patients. On hospital admission, 3291 (15.9%) patients were receiving ASA. After PSM, 3291 patients exposed to ASA and 2885 not-exposed patients were analyzed. In-hospital mortality was higher in the ASA group (30.4 vs. 16.9%, p < 0.001) in the global sample. After PSM, no differences were found between groups (30.4 vs. 30.3%, p = 0.938). There were no differences in inflammation, symptomatic thrombosis, or ICU admission. In conclusion, ASA intake is not associated with in-hospital mortality or any other health outcome evaluated after applying PSM analysis in a real-world large sample of hospitalized COVID-19 patients.

Genuine Multipartite Nonlocality Is Intrinsic to Quantum Networks.

Quantum entanglement and nonlocality are inextricably linked. However, while entanglement is necessary for nonlocality, it is not always sufficient in the standard Bell scenario. We derive sufficient conditions for entanglement to give rise to genuine multipartite nonlocality in networks. We find that any network where the parties are connected by bipartite pure entangled states is genuine multipartite nonlocal, independently of the amount of entanglement in the shared states and of the topology of the network. As an application of this result, we also show that all pure genuine multipartite entangled states are genuine multipartite nonlocal in the sense that measurements can be found on finitely many copies of any genuine multipartite entangled state to yield a genuine multipartite nonlocal behavior. Our results pave the way toward feasible manners of generating genuine multipartite nonlocality using any connected network.

Resource Theory of Entanglement with a Unique Multipartite Maximally Entangled State.

Entanglement theory is formulated as a quantum resource theory in which the free operations are local operations and classical communication (LOCC). This defines a partial order among bipartite pure states that makes it possible to identify a maximally entangled state, which turns out to be the most relevant state in applications. However, the situation changes drastically in the multipartite regime. Not only do there exist inequivalent forms of entanglement forbidding the existence of a unique maximally entangled state, but recent results have shown that LOCC induces a trivial ordering: almost all pure entangled multipartite states are incomparable (i.e., LOCC transformations among them are almost never possible). In order to cope with this problem we consider alternative resource theories in which we relax the class of LOCC to operations that do not create entanglement. We consider two possible theories depending on whether resources correspond to multipartite entangled or genuinely multipartite entangled (GME) states and we show that they are both nontrivial: no inequivalent forms of entanglement exist in them and they induce a meaningful partial order (i.e., every pure state is transformable to more weakly entangled pure states). Moreover, we prove that the resource theory of GME that we formulate here has a unique maximally entangled state, the generalized GHZ state, which can be transformed to any other state by the allowed free operations.

Thirty-day outcomes in patients with acute pulmonary embolism who discontinued anticoagulant therapy before 90 days.

BACKGROUND: The contemporary natural history of patients with acute pulmonary embolism (PE) not receiving (or early discontinuing) anticoagulant therapy has not been consistently evaluated. OBJECTIVE: To assess the rate of the composite outcome of PE-related death, sudden death, or recurrent thromboembolism (VTE) within 30 days in all PE patients in whom anticoagulation was not administered or discontinued prematurely (<90 days of anticoagulation). METHODS: We used the RIETE database to assess the incidence rates (per 100 person-days) of the composite outcome within the subsequent 30 days. The risk of these events was compared to PE patients who were anticoagulated for ≥90 days. RESULTS: Of 34,447 PE recruited from 2001 to 2017, 47 (0.14%) did not receive anticoagulants and 1348 (3.91%) discontinued it before 90 days. Fatal PE developed in 25 (53%) of those without any anticoagulation and in 45 (3.33%) with premature discontinuations. Sudden death or non-fatal recurrent VTE occurred in 6 (0.45%) and 24 (1.48%) patients, respectively. The incidence of the primary outcome declined logarithmically from 6.36 per 100 patient-days in untreated patients to 0.32-0.13 in those treated for 8-90 days. During the first week of follow-up, the incidence rate was 13.9 and 0.60-0.31 per 100 patient-days, respectively. The adjusted odds of the primary outcome was 27 fold higher in untreated than in treated patients, and progressively decreased to 2.5-7 fold higher in patients treated for at least 7 days. CONCLUSION: The incidence of the composite outcome was highest during the first week, and inversely and logarithmically correlated with the duration of anticoagulant therapy.

Structure of multidimensional entanglement in multipartite systems.

We explore the structure of multipartite quantum systems which are entangled in multiple degrees of freedom. We find necessary and sufficient conditions for the characterization of tripartite systems and necessary conditions for any number of parties. Furthermore we develop a framework of multilevel witnesses for efficient discrimination and quantification of multidimensional entanglement that is applicable for an arbitrary number of systems and dimensions.

Prevalência de doença tireoideana em pacientes com diabetes tipo 1 / Prevalence of thyroid disease in patients with type 1 diabetes

INTRODUÇÄO: O diabetes mellitus tipo 1 (DM1) freqüentemente se acompanha de outras doenças autoimunes, principalmente doença autoimune da tireóide (DAT). OBJETIVO: Determinar a prevalência de DAT em pacientes com DM1 e investigar possível relacionamento com outros fatores. MÉTODOS: Em 126 pessoas com DM1, foram mensurados TSH, T4 livre, anticorpo anti-peroxidase e hemoglobina A1c. RESULTADOS: DAT foi encontrada em 26 pacientes (20,6 por cento), sendo 11 (8,7 por cento) com hipotireoidismo clínico, 6 (4,8 por cento) com hipotireoidismo subclínico e 9 (7,1 por cento) com tireoidite sem disfunçäo tireoideana. Em um paciente (0,8 por cento), a DAT (hipertireoidismo) precedeu o DM1. Houve relaçäo entre DAT e idade atual e no diagnóstico do DM1. Näo foram encontradas significâncias para sexo, grupo racial, duraçäo do DM, paridade e local de moradia. CONCLUSÖES: A prevalência de DAT é bastante alta para justificar seu rastreamento e está relacionada com a idade atual e a idade do diagnóstico do DM1