RESUMO Nas últimas décadas, a prevalência da doença renal crônica (DRC) tem aumentado de forma significativa. No estágio terminal da doença, a terapia renal substitutiva (TRS) é tradicionalmente indicada como abordagem terapêutica. Entretanto, em indivíduos idosos, com elevado número de comorbidades ou com limitação funcional significativa, os benefícios da TRS em termos de prolongamento da sobrevida ou de melhora da qualidade de vida tornam-se questionáveis. Nesse cenário, o manejo conservador abrangente (MCA) surge como uma alternativa clínica, centrada nas necessidades, valores e preferências do paciente. O MCA consiste em uma abordagem ativa da DRC sem o início da TRS, integrando os princípios dos cuidados paliativos, com foco no cuidado de suporte renal, na desaceleração da progressão da doença e no controle dos sintomas. Este artigo discute os principais sintomas observados em pacientes com DRC avançada sob manejo conservador e apresenta recomendações práticas para sua abordagem clínica.
ABSTRACT Over recent decades, the prevalence of chronic kidney disease (CKD) has risen markedly. In the terminal stage of the disease, renal replacement therapy (RRT) is traditionally recommended as the standard therapeutic approach. However, in older individuals with a high burden of comorbidities or substantial functional impairment, the benefits of RRT in terms of survival prolongation or improvement in quality of life become uncertain. In this context, comprehensive conservative kidney management (CKM) has emerged as a clinical alternative that is centered on the patient’s needs, values, and preferences. CKM entails an active, nondialytic management strategy for CKD that incorporates palliative care principles, with emphasis on kidney supportive care, slowing disease progression, and symptom control. This article discusses the main symptoms experienced by patients with advanced CKD managed conservatively and provides practical recommendations for their clinical management.
BACKGROUND:Closed-loop systems for automated hypnotic delivery integrate continuous bispectral index (BIS) monitoring with controller algorithms to adjust infusion rates in real time. Unlike earlier syntheses that focused on aggregate control metrics, we frame anaesthetic depth as an asymmetric risk problem by separating exposure to potentially inadequate anaesthesia from exposure to excessive depth of anaesthesia. METHODS:This PROSPERO-registered systematic review (CRD420251208039) searched PubMed, Embase, Cochrane CENTRAL, and Web of Science through November 2025. Randomised trials comparing BIS-guided closed-loop systems with clinician-directed manual control in adult noncardiac surgery were included. The primary outcome was the proportion of time within 10 BIS units of the target. RESULTS:Seventeen trials encompassing 1898 patients were included. Closed-loop systems increased time within the target BIS range by 17.6% (95% confidence interval [CI] 11.8-23.5; P<0.001), corresponding to approximately an additional 20 min of optimal anaesthetic depth during a 2 h procedure. Bilateral safety was shown: time with BIS <40 was significantly reduced (mean difference [MD] -17.2%; 95% CI -26.8 to -7.5; P<0.001), whereas time with BIS >60 was unchanged (MD -0.8%; 95% CI -2.6 to 1.0; P=0.38). Controller performance metrics favoured automation (wobble, MDAPE, global score; all P<0.001). Time to extubation was shorter (MD -1.68 min; P<0.001), with no differences in propofol consumption (P=0.13) or vasopressor use (risk ratio 1.04; P=0.62). CONCLUSIONS:BIS-guided closed-loop systems achieve a bilateral safety profile in anaesthetic depth control, reducing deep anaesthesia without increasing light anaesthesia, with modestly faster recovery and preserved haemodynamic stability. These findings support automated hypnotic control as a strategy to rebalance competing intraoperative risks while maintaining physiological stability. SYSTEMATIC REVIEW PROTOCOL:PROSPERO CRD420251208039.
OBJECTIVES:To investigate the effects of galactomannan extracted from Caesalpinia ferrea seeds on dentin permeability and its cytocompatibility with oral cells. DESIGN:Sixty dentin discs were treated with EDTA for 5 min and, after determining maximum permeability, randomly assigned to four groups (n = 12): distilled water (DW), potassium oxalate (PO), 1% juca seed galactomannan (JSG1), and 2% juca seed galactomannan (JSG2). Dentin permeability was measured again after treatment and after a 5-day erosive-abrasive cycle (four daily immersions in 0.3% citric acid for 5 min, followed by 60 min in artificial saliva, with brushing after the first and last challenges). Treatments were reapplied daily. The percentage of dentin permeability (%Lp) was calculated relative to maximum permeability. Surface morphology was examined by scanning electron microscopy (SEM), and cytotoxicity was tested in human gingival fibroblasts (HGF) and dental pulp stem cells (DPSC). Data were analyzed using ANOVA and Bonferroni test (p < 0.05). RESULTS:After treatment, no significant differences in permeability were observed among groups (p > 0.05). Following cycling, JSG2 showed significantly lower permeability than DW (p < 0.05). Only DW exhibited a significant increase in permeability over time (p < 0.05). SEM images revealed that PO and JSG2 maintained partially obliterated tubules even after cycling. Cytotoxicity assays showed cell viability near 100% for HGF and 88% for DPSC at the highest juca seed galactomannan (JSG) concentration, confirming cytocompatibility. CONCLUSIONS:JSG at 2% concentration partially occluded dentinal tubules, preserved dentin permeability under erosive-abrasive conditions, and demonstrated cytocompatibility with HGF and DPSC.
Abstract Introduction Screening for erectile dysfunction (ED) in primary care requires simple tools, particularly where educational levels are low and multi-item instruments such as the International Index of Erectile Function (IIEF) may be impractical. Likert-type visual scales for erection hardness are widely and intuitively used, but few have been formally validated. The Erection Hardness Score (EHS; 1–4) is the most common visual scale, yet it provides only categorical, subjective grades of rigidity. The Eretometer is a 0–10 visual penile rigidity scale proposed as a continuous alternative to EHS Objective To evaluate the diagnostic accuracy, correlation, and reliability of the Eretometer as an index test, using the EHS as the reference standard. Methods We conducted a cross-sectional diagnostic accuracy study, designed and reported according to STARD recommendations, including 280 men aged 18–80 years from primary care and urology clinics. Erectile rigidity was self-assessed using the EHS (reference standard; moderate-to-severe ED = EHS ≤2) and the Eretometer (0–10 visual scale inspired by the Orgasmometer-F). Sociodemographic data and comorbidities were recorded. Spearman’s correlation and linear regression were used to evaluate the association and agreement. Receiver operating characteristic (ROC) analysis estimated area under the curve (AUC) and the optimal Eretometer cutoff for EHS ≤2. Test–retest reliability and internal consistency (Cronbach’s α) were examined in a subsample.in accordance with STARD recommendations, involving Results Median age was 54 years (interquartile range [IQR] 45–63); 62% had ≤8 years of schooling. Median EHS was 3 (IQR 2–4) and median Eretometer score 6.5 (IQR 5–8). The Eretometer correlated strongly with the EHS (ρ = 0.82; p < 0.001). For detecting EHS ≤2, the Eretometer showed an AUC of 0.94 (95% confidence interval 0.91–0.97); a cutoff of ≤5 yielded 89% sensitivity and 86% specificity. Test–retest reliability was excellent (r = 0.91), and internal consistency was high (Cronbach’s α = 0.88). Conclusions The Eretometer showed strong correlation and diagnostic agreement with the EHS and appears to be a valid, reliable visual tool for assessing penile rigidity. Its continuous 0–10 format offers finer discrimination of erectile function than categorical scales and may be particularly useful for ED screening and counseling in settings with low literacy, while remaining applicable to broader male populations. It demonstrated a strong correlation and diagnostic agreement with the EHS, indicating it to be a valid and Disclosure No
