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A Systematic Review of Benefits and Risks of Fetal Surgery for Congenital Cardiac Defects Such as Pulmonary Valve Stenosis and Critical Aortic Stenosis
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Diniz, Ana Maria Bicudo

; Manso, Paulo Henrique

; Santos, Marcelo Volpon

; Rodrigues, Alfredo José

; Sbragia, Lourenço

Brazilian Journal of Cardiovascular Surgery

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2023, Nº ahead

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction: Congenital heart diseases (CHDs) constitute the most prevalent congenital pathology, and they are a consequence of structural and functional abnormalities during fetal development. The etiology of CHD involves the interaction of genetic and environmental factors. Fetal cardiac surgery aims at preventing natural pathways of CHD in utero, mitigating progression to more complex abnormalities. The goal of this review was to demonstrate the benefits and risks of fetal interventions in the two most prevalent CHDs, pulmonary stenosis and pulmonary atresia with an intact ventricular septum, but also critical aortic stenosis and hypoplastic left heart syndrome. Methods: Original and relevant articles were selected by meta-aggregation to perform a qualitative analysis of fetal cardiac interventions for pulmonary stenosis and critical aortic stenosis. The Joanna Briggs Institute’s Qualitative Assessment and Review Instrument (or JBI-QARI) was used for data quality appraisal. Results: Of 61 potential articles, 13 were selected, and nine were finally included. Discussion: The present review demonstrated that fetal cardiac surgery increases right ventricular growth and hemodynamic flow in pulmonary stenosis, whereas in critical aortic stenosis it enables growth of the left ventricle and increases left ventricular pressure. However, it has a high complication rate, along with considerable morbidity and mortality. Conclusion: The benefits of fetal cardiac surgery for pulmonary stenosis and critical aortic stenosis are well-described in the literature; however, there is a significant risk of complications which can be reduced by the surgeon’s technical expertise and well-structured hospital facilities.

https://doi.org/10.21470/1678-9741-2022-0273

A Systematic Review of Benefits and Risks of Fetal Surgery for Congenital Cardiac Defects Such as Pulmonary Valve Stenosis and Critical Aortic Stenosis
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Diniz, Ana Maria Bicudo

; Manso, Paulo Henrique

; Santos, Marcelo Volpon

; Rodrigues, Alfredo José

; Sbragia, Lourenço

Brazilian Journal of Cardiovascular Surgery

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2023, Volumen 38 Nº 3 Paginas 398 - 404

Resumen: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2022-0273

Impact of high-fat diet consumption during prolonged period of pregnancy on placenta structures and umbilical vascular growth in goats
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Bezerra, Alessandra Façanha

; Alves, Juliana Paula Martins

; Fernandes, César Carneiro Linhares

; Cavalcanti, Camila Muniz

; Silva, Maria Raquel Lopes

; Conde, Alfredo José Herrera

; Palomino, Gaby Judith Quispe

; Teixeira, Dárcio Ítalo Alves

; Rego, Aníbal Coutinho do

; Rodrigues, Ana Paula Ribeiro

; Rondina, Davide

Animal Reproduction

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2023, Volumen 20 Nº 2 elocation e20230019

Resumen: En | Texto: En | PDF: En

Abstract This study aimed to verify the impact of high-fat diet consumption for a prolonged period on oxidative stress, fetal growth, umbilical vascular system, and placental structures in pregnant goats. Twenty-two pregnant goats were grouped into the control diet (n= 11) and fat diet (n = 11). Flaxseed meal was added to the fat diet, replacing the corn grain of concentrate, from gestational day 100 to delivery date. Diets were isonitrogenous and isoenergetic, differing in fat content (2.8% vs. 6.3% dry matter). The fat group showed higher feed intake and total plasma lipid levels than the control group (P < 0.001). No difference was found in placentome, and umbilical vascular development. Fat diet-fed goats exhibited a lower systolic peak in the umbilical artery. At delivery, placental traits were similar with the exception of the cotyledon width (P = 0.0075), which was smaller in the fat group and cotyledon surface (P = 0.0047) for multiple pregnancy of fat diet. Cotyledonary epithelium showed more intense staining of lipid droplets and a greater area for lipofuscin staining in the fat group compared to control group (P < 0.001). The mean live weight of the kids was lower in the fat group in the first week after delivery than in control group. Thus, in goats, the continuous administration of a high-fat diet during pregnancy does not appear to modify the fetal-maternal vascular structures but has an impact on a part of the placental structure; therefore, its use must be carefully evaluated.

https://doi.org/10.1590/1984-3143-ar2023-0019

Coronary Artery Bypass Grafting: A Comparative Exercise between Patients from the BYPASS Registry and Patients from a University Hospital
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Almeida, Marcela Accari de

; Arcêncio, Livia

; Giuliani, Gabriel B

; Poli Neto, Omero Benedicto

; Rodrigues, Alfredo José

; Vicente, Walter Vilella de Andrade

; Évora, Paulo Roberto Barbosa

Brazilian Journal of Cardiovascular Surgery

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2023, Volumen 38 Nº 5 elocation e20220026

Resumen: En | Texto: En | PDF: En

ABSTRACT Introduction: The coronary artery bypass grafting (CABG) data provided by the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS) Registry is a Brazilian reality. Objective: To carry out a comparative exercise between the BYPASS Registry published data and data from patients operated on in a randomly chosen period (2013-2015) at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Methods: This is a retrospective study reviewing 173 electronic medical records of CABG patients from the HCFMRP-USP. These data were compared with the BYPASS Registry published data. Chi-square test was used to verify the changes within the prevalence of adequate/inadequate biochemical tests before and after surgery. The sample was divided into groups consistent with cardiopulmonary bypass (CPB) time (CPB ≤ 120 minutes and CPB > 120 minutes). For the complications, prevalence by the chi-square test was adopted. Significant P-values are < 0.05. Results: The comparative operative data of the BYPASS Registry and the HCFMRP-USP patients were quite similar, except for the isolate use of only arterial grafts, which was more frequent on HCFMRP-USP patients (30.8% vs. 15.9%), and the use of radial artery, also more frequent on HCFMRP-USP patients (48.8% vs. 1.1%) Conclusion: The comparative study suggested that the BYPASS Registry should be a reference for CABG quality control.

https://doi.org/10.21470/1678-9741-2022-0026

Janelas Pericárdicas: O Valor Limitado do Diagnóstico da Biópsia Pericárdica não Guiada
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Giuliani, Gabriel Bianco

; Morales, Ismael Alberto Auca

; Okaresnki, Giovane

; Vieira, Gabriel Faioli Nascimento Alves

; Durço, Daniella de Freitas Pereira Angelo

; Rodrigues, Alfredo José

Arquivos Brasileiros de Cardiologia

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2023, Volumen 120 Nº 10 elocation e20230082

Resumen: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Background Pericardial window, in addition to promoting pericardial drainage, can also provide samples of the pericardium for anatomopathological examination. However, such biopsies’ contribution to clarifying the etiology of pericardial effusion has been debated. Objective To analyze the diagnostic value of non-targeted pericardial biopsy obtained from pericardial window procedures. Methods Data from 80 patients who had undergone parietal pericardial biopsies from 2011 to 2020 were retrospectively reviewed. Statistical significance was considered if p < 0.05. Results Fifty patients were male (62.5%,) and 30 were female (37.5%). The median age was 52 years (interquartile range: 29 to 59) and 49 years (interquartile range: 38 to 65), respectively (p = 0.724). The suspected etiology of pericardial effusion was neoplastic in 31.3%, unclear in 25%, tuberculosis in 15%, autoimmune in 12.5%, edemagenic syndrome in 7.5%, and other miscellaneous conditions in 8.8%. The most frequent approach for pericardial drainage and biopsy was subxiphoid (74%), followed by video-assisted thoracoscopy (22%). Overall, in 78.8% of the biopsies, the histopathologic findings were compatible with nonspecific inflammation, and only 13.7% of all biopsies yielded a conclusive histopathological diagnostic. Those suffering from cancer and pericardial effusion had a higher proportion of conclusive histopathologic findings (32% had pericardial neoplastic infiltration). The hospital mortality rate was 27.5%, and 54.5% of the patients who died in the hospital had cancer. No deaths were attributed to cardiac tamponade or the drainage procedure. Conclusion Our results showed that pericardial window is a safe procedure, but it had little value to clarify the pericardial effusion etiology and no impact on the planned therapy for the primary diagnosis besides the cardiac decompression.

Resumo Fundamento A janela pericárdica, além de promover a drenagem pericárdica, também pode fornecer amostras do pericárdio para exame anatomopatológico. No entanto, a contribuição dessas biópsias para a elucidação da etiologia do derrame pericárdico tem sido debatida. Objetivo Analisar o valor diagnóstico da biópsia pericárdica não guiada obtida de procedimentos de janela pericárdica. Métodos Foram revisados retrospectivamente dados de 80 pacientes submetidos a biópsia pericárdica parietal de 2011 a 2020. A significância estatística foi considerada quando p < 0,05. Resultados Cinquenta pacientes eram do sexo masculino (62,5%) e 30 do sexo feminino (37,5%). A mediana de idade foi de 52 anos (intervalo interquartil: 29 a 59) e 49 anos (intervalo interquartil: 38 a 65), respectivamente (p = 0,724). A etiologia suspeita do derrame pericárdico foi neoplásica em 31,3%, incerta em 25%, tuberculose em 15%, autoimune em 12,5%, síndrome edemigênica em 7,5% e outras condições diversas em 8,8%. A abordagem mais frequente para drenagem pericárdica e biópsia foi a subxifoide (74%), seguida pela videotoracoscopia (22%). Em 78,8% das biópsias, os achados histopatológicos foram compatíveis com inflamação inespecífica, e apenas 13,7% de todas as biópsias produziram um diagnóstico histopatológico conclusivo. Aqueles que sofriam de câncer e derrame pericárdico apresentaram maior proporção de achados histopatológicos conclusivos (32% apresentavam infiltração neoplásica pericárdica). A taxa de mortalidade hospitalar foi de 27,5% e 54,5% dos pacientes que morreram no hospital tinham câncer. Nenhuma morte foi atribuída ao tamponamento cardíaco ou ao procedimento de drenagem. Conclusão Nossos resultados mostraram que a janela pericárdica é um procedimento seguro, mas teve pouco valor para esclarecer a etiologia do derrame pericárdico e nenhum impacto na terapia planejada para o diagnóstico primário além da descompressão cardíaca.

https://doi.org/10.36660/abc.20230082

Comparison of the outcomes of flexible ureteroscopy and mini-percutaneous nephrolithotomy for the treatment of kidney stones: a matched-pair analysis
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Rodrigues, Jose Eduardo Castro Matheus

; Vicentini, Fabio Carvalho

; Danilovic, Alexandre

; Marchini, Giovanni Scala

; Torricelli, Fabio Cesar Miranda

; Batagello, Carlos Alfredo

; Mazzucchi, Eduardo

; Nahas, William Carlos

Revista da Associação Médica Brasileira

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Oct 2022, Volumen 68 Nº 10 Paginas 1481 - 1485

Resumen: En | Texto: En | PDF: En

SUMMARY OBJECTIVE: Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy. METHODS: A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19. RESULTS: A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both). CONCLUSIONS: Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.

https://doi.org/10.1590/1806-9282.20221177

Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022
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Samesima, Nelson

; God, Epotamenides Good

; Kruse, Jose Claudio Lupi

; Leal, Marcelo Garcia

; Pinho, Claudio

; França, Francisco Faustino de A. C.

; Pimenta, João

; Cardoso, Acácio Fernandes

; Paixão, Adail

; Fonseca, Alfredo

; Pérez-Riera, Andrés R.

; Ribeiro, Antonio Luiz Pinho

; Madaloso, Bruna Affonso

; Luna Filho, Bráulio

; Oliveira, Carlos Alberto Rodrigues de

; Grupi, César José

; Moreira, Dalmo Antonio Ribeiro

; Kaiser, Elisabeth

; Paixão, Gabriela Miana de Mattos

; Feitosa Filho, Gilson

; Pereira Filho, Horacio Gomes

; Grindler, José

; Aziz, José Luiz

; Molina, Marcos Sleiman

; Facin, Mirella

; Tobias, Nancy M. M. de Oliveira

; Oliveira, Patricia Alves de

; Sanches, Paulo César R.

; Teixeira, Ricardo Alkmin

; Atanes, Severiano Melo

; Pastore, Carlos Alberto

Arquivos Brasileiros de Cardiologia

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Oct 2022, Volumen 119 Nº 4 Paginas 638 - 680

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20220623

Ediacaran-Cambrian microbialites of the Southern Amazon Craton: relation with the metazoan rise, sea-level changes, and global tectonics
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Nogueira, Afonso César Rodrigues

; Santos, Renan Fernandes dos

; Romero, Guilherme Raffaeli

; Bandeira, José

; Riccomini, Claudio

; Barrera, Ivan Alfredo Romero

; Silva, Pedro Augusto Santos da

; Soares, Joelson Lima

; Fairchild, Thomas

; Nogueira, Anna Andressa Evangelista

; Góes, Ana Maria

; Oliveira, Rick Souza de

; Medeiros, Renato Sol Paiva de

; Andrade, Luiz Saturnino de

; Brito, Ailton da Silva

; Oliveira, Pedro Guilherme Assunção

; Sodré, Argel de Assis Nunes

; Carvalho, Davi Ferreira de

; Truckenbrodt, Werner

Brazilian Journal of Geology

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2022, Volumen 52 Nº 2 elocation e20210065

Resumen: En | Texto: En | PDF: En

Abstract Microbialites are the most abundant life evidence in Precambrian sedimentary rocks. They are produced by microbial interaction activity and sedimentary processes reflecting paleoenvironmental conditions. The Ediacaran-Cambrian carbonate and siliciclastic successions in the Southern Amazon Craton in Central Brazil, provide a key opportunity to understand how the metazoan life coexisted with the microbial communities. The spatial and temporal distribution of microbialites as well as morphological and paleoenvironmental changes have been assessed, reinterpreting previous works and including new data from the Araras-Alto Paraguai and Corumbá basins. The deposition was controlled by subsidence and sea-level changes that affected these basins, considered extensions of epicontinental seas during the Gondwana assembly. The stromatolites are restricted to coastal deposits and experienced thriving flourishment intervals after the Marinoan Glaciation (635 Ma). Post-glacial transgression was marked by microbial colonization in shallow platforms represented by stratiform and giant domical stromatolites in the Araras-Alto Paraguai Basin. The continuity of the transgression generated a moderately deep aragonite sea at about 622 Ma. A progressive sea-level fall caused the implantation of coastal environments under greenhouse conditions with tidal flat and sabkha settings colonized by centimetric-scale stromatolites. The sea retreat was accompanied by progressive uplift, causing a moderate inversion of the basin and erosion of the succession until ~560 Ma with the deposition of the last preserved tidal flat deposits with the occurrence of thrombolites. The subsiding Corumbá Basin was the site of microbially-induced deposition of carbonates in a shallow platform connected to an offshore setting with the proliferation of metazoan straddling the Ediacaran-Cambrian boundary. Microbial communities were restricted to lagoon deposits during the Lower Cambrian transgression in the Araras-Alto Paraguai Basin and the last phase refers to the sea retreat towards southeast, developing a fluvial system connected with the arid and evaporitic tidal flats colonized by microbialites that lasted until the upper Cambrian. Except for the post-glacial stromatolites, the columnar and domal microbialite indicate that the coastal settings dominated the Ediacaran-Cambrian transition. The preservation of microbialites in the post-glacial intervals can be associated with the Mg-Ca-CO3 oversaturation in dolomitic platforms. The rapid calcification and ability to resist the dissolution and replacement have increased the stromatolites’ preservation potential reported here, where its well-preserved occurrence in tidal flats and sabkha occurs due to intense early diagenetic silicification. The change from carbonate accumulation to siliciclastic-rich environments contributed to the demise of microbially-induced strata. In general, the scarce coexistence between coastal stromatolite and metazoan-bearing marine deposits makes it challenging to establish a competitive relationship between these organisms, as previously postulated.

https://doi.org/10.1590/2317-4889202220210065

Geochemistry of a spheroidal weathering profile in a tropical mountainous landscape, Rio de Janeiro, Brazil
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SILVEIRA, CARLA S.

; RODRIGUES, JULIANA G.

; ARARIPE, DENISE R.

; BERNEDO, ALFREDO V.B.

; MANTOVANO, JOSÉ L.

Anais da Academia Brasileira de Ciências

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2022, Volumen 94 elocation e20210544

Resumen: En | Texto: En | PDF: En

Abstract Boulders are an important material in debris flow and their source is coupled with spheroidal weathering profiles that produce corestones. The goal of this work was to establish the geochemical transformations that produced corestones and distinguished them from the surrounding grus in two tropical granite weathering profiles (P1 and P2). Sampling was not performed in a vertical profile; instead, we gathered 13 (P1) to 16 (P2) samples displaying different weathering degrees (corestone and saprolite) and spatial positions in the profiles. We conducted the geochemistry (EDXRF/EDX and INAA) and mineralogy (petrography and XRD) of the samples. The CIA values ranged from 46 (corestones) to 93 (saprolite). Granite spheroidal weathering under a tropical mountainous slope develops mostly due to feldspar weathering (foremost plagioclase) in the following sequence: porosity growth, kaolinite, and gibbsite crystallization. Zircon weathering stability and its probable mobility as grain along the weathering profile play an important role in REE concentration. Spheroidal weathering is mainly a lixiviation process, yet specific locations (below the individualized corestones) presented REE enrichment due to translocation. They are hosted mainly by clay minerals and, to some extent, by amorphous Fe oxyhydroxide. The evolution of spheroidal weathering results in a vertical patchy weathering profile.

https://doi.org/10.1590/0001-3765202220210544

10.

LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE
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Castro, Gustavo Rodrigues Alves

; Zilles, Andressa

; Gazzola, Larissa Dill

; Barros, Renar Brito

; Sadowski, José Alfredo

; Guetter, Camila Roginski

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2022, Volumen 35 elocation e1695

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO RACIONAL: Atualmente o tratamento da hérnia inguinal pode ser laparoscópico totalmente extraperitoneal ou transabdominal pré-peritoneal, ambas as técnicas utilizam tela e são amplamente empregadas. O sucesso do procedimento cirúrgico é medido pelo menor número de complicações, retorno rápido às atividades cotidianas, presença ou não de dor crônica e pelo grau de satisfação do paciente no pós-operatório. OBJETIVOS: Avaliar e comparar a presença de dor crônica e qualidade de vida no pós operatório tardio de pacientes submetidos às duas técnicas de cirurgias laparoscópicas de correção de hérnia inguinal. MÉTODOS: O estudo consistiu em uma abordagem quantitativa transversal retrospectiva. Foi realizada análise de prontuários e aplicação de questionário SF-36 e Escala Visual Analógica para avaliação de qualidade de vida e dor crônica em pacientes submetidos a hernioplastia inguinal laparoscópica entre janeiro de 2017 a fevereiro de 2021. RESULTADOS: Foram analisados 167 prontuários com mais de 3 meses de pós-operatório. Dentre as complicações precoces avaliadas, o seroma foi mais comumente diagnosticado no grupo transabdominal pré-peritoneal (p=0,04). Posteriormente, 40 dos 167 pacientes responderam ao instrumento de pesquisa composto por SF-36 e Escala Visual Analógica. A média para dor crônica, mensurada através da Escala Visual Analógica, foi de 1,29 para transabdominal pré-peritoneal versus totalmente extraperitoneal com 1,68 (p=0,92). Já nos domínios avaliados pelo SF-36 não houve diferença significativa entre as amostras (p>0,05). CONCLUSÕES: As técnicas totalmente extraperitoneal e transabdominal pré-peritoneal apresentam resultados semelhantes no pós-operatório tardio com base na qualidade de vida e dor crônica. As técnicas também são comparáveis em termos das principais complicações pós-operatórias precoces, exceto para seroma, que apresentou maior incidência em pacientes submetidos a transabdominal pré-peritoneal.

ABSTRACT BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

https://doi.org/10.1590/0102-672020220002e1695

11.

Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system
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Becker, Jefferson

; Ferreira, Lis Campos

; Damasceno, Alfredo

; Bichuetti, Denis Bernardi

; Christo, Paulo Pereira

; Callegaro, Dagoberto

; Peixoto, Marco Aurélio Lana

; Sousa, Nise Alessandra De Carvalho

; Almeida, Sérgio Monteiro De

; Adoni, Tarso

; Santiago-Amaral, Juliana

; Junqueira, Thiago

; Pereira, Samira Luisa Apóstolos

; Gomes, Ana Beatriz Ayroza Galvão Ribeiro

; Pitombeira, Milena

; Paolilo, Renata Barbosa

; Grzesiuk, Anderson Kuntz

; Piccolo, Ana Claudia

; D´Almeida, José Arthur Costa

; Gomes Neto, Antonio Pereira

; Oliveira, Augusto Cesar Penalva De

; Oliveira, Bianca Santos De

; Tauil, Carlos Bernardo

; Vasconcelos, Claudia Ferreira

; Kaimen-Maciel, Damacio

; Varela, Daniel

; Diniz, Denise Sisterolli

; Oliveira, Enedina Maria Lobato De

; Malfetano, Fabiola Rachid

; Borges, Fernando Elias

; Figueira, Fernando Faria Andrade

; Gondim, Francisco De Assis Aquino

; Passos, Giordani Rodrigues Dos

; Silva, Guilherme Diogo

; Olival, Guilherme Sciascia Do

; Santos, Gutemberg Augusto Cruz Dos

; Ruocco, Heloisa Helena

; Sato, Henry Koiti

; Soares Neto, Herval Ribeiro

; Cortoni Calia, Leandro

; Gonçalves, Marcus Vinícius Magno

; Vecino, Maria Cecilia Aragón De

; Pimentel, Maria Lucia Vellutini

; Ribeiro, Marlise De Castro

; Boaventura, Mateus

; Parolin, Mônica Koncke Fiuza

; Melo, Renata Brant De Souza

; Lázaro, Robson

; Thomaz, Rodrigo Barbosa

; Kleinpaul, Rodrigo

; Dias, Ronaldo Maciel

; Gomes, Sidney

; Lucatto, Simone Abrante

; Alves-Leon, Soniza Vieira

; Fukuda, Thiago

; Ribeiro, Taysa Alexandrino Gonsalves Jubé

; Winckler, Thereza Cristina D’ávila

; Fragoso, Yara Dadalti

; Nascimento, Osvaldo José Moreira Do

; Ferreira, Maria Lucia Brito

; Mendes, Maria Fernanda

; Brum, Doralina Guimarães

; Glehn, Felipe Von

Arquivos de Neuro-Psiquiatria

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Nov 2021, Volumen 79 Nº 11 Paginas 1049 - 1061

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

https://doi.org/10.1590/0004-282x-anp-2021-0162 1 descargas

12.

Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents
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Prezotti, José Antonio

; Henriques, João Victor T.

; Favorito, Luciano A.

; Canalini, Alfredo F.

; Machado, Marcos G.

; Brandão, Thulio B. V.

; Barbosa, Akemi M. V.

; Moromizato, Julyana K. M.

; Anzolch, Karin M. J.

; Fernandes, Roni de C.

; Rodrigues, Fransber R. A.

; Bellucci, Carlos H. S.

; Silva, Caroline S.

; Pompeo, Antonio Carlos L.

; Bessa Jr., Jose de

; Gomes, Cristiano M.

International braz j urol

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Ago 2021, Volumen 47 Nº 4 Paginas 753 - 776

Resumen: En | Texto: En | PDF: En

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents’ concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 – 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents’ concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents’ losses.

https://doi.org/10.1590/s1677-5538.ibju.2021.99.09 170 descargas

13.

Establishment of paiaguas palisadegrass in monoculture or in an integration system with other crops
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Santos Filho, José Ricardo dos

; Sousa, Bráulio Maia de Lana

; Fagundes, Jailson Lara

; Backes, Alfredo Acosta

; Silva, José William Teles

; Andrade, Gabriela Santos

; Santos, Anna Luiza Hora dos

; Florêncio, Rafaela Stefanny Rodrigues

; Silva, Vinícius Conceição da

Ciência Animal Brasileira

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2021, Volumen 22 elocation e-68211

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivou-se avaliar características produtivas e estruturais do capim paiaguás implantado em monocultivo e em integração com culturas agrícolas em 2018 e 2019. Os tratamentos avaliados foram: capim paiaguás (CP) em monocultivo e CP integrado com milho, CP integrado com sorgo e CP integrado com soja. O delineamento experimental utilizado foi o de bloco ao acaso, com 4 repetições (parcelas de 160 m²). Foram avaliadas a altura, a densidade populacional de perfilhos, a produção de massa seca e densidade volumétrica da massa seca total, de folhas, colmos e material morto. Os dados foram analisados pelo teste de Tukey a 5% de probabilidade. A produção de massa seca total foi maior no cultivo integrado em relação ao monocultivo. O capim paiaguás em integração com milho apresentou menores produções de massa seca total, de lâmina foliar e de colmos. A porcentagem de lâminas foliares foi maior no capim paiaguás integrado em 2018 e em monocultivo e integrado com milho e soja em 2019. Maiores porcentagens de colmos foram registradas no capim paiaguás em monocultivo em 2018 e em integração com sorgo em 2018 e 2019. De maneira geral, maiores alturas foram encontradas no capim paiaguás em monocultivo e menores no integrado com o milho. As maiores densidades populacionais de perfilhos foram registradas no capim paiaguás em monocultivo e menores no capim paiaguás integrado com milho e sorgo. A integração com culturas agrícolas reduz a produção do capim paiaguás. A cultura agrícola acompanhante altera a composição da forragem produzida pelo capim paiaguás.

Abstract The objective of this study was to evaluate the productive and structural characteristics of Paiaguas palisadegrass established in monoculture and intercropped with agricultural crops in 2018 and 2019. The evaluated treatments were: Paiaguas palisadegrass (PP) in monoculture, PP intercropped with maize, PP intercropped with sorghum, and PP intercropped with soybean. The experimental design used was a randomized block, with 4 replications (plots of 160 m²). Sward height, tiller density, dry mass production, and bulk density of total dry matter, of leaves, of stems, and of dead material were evaluated. The data were analyzed using the Tukey test at 5% probability. The total dry mass was higher in intercropping than in monoculture. Paiaguas palisadegrass intercropped with maize showed lower productions of total dry mass, leaf blade, and stems. The percentage of leaf blades was higher in Paiaguas palisadegrass intercropped in 2018 and in monoculture and intercropped with maize and soybean in 2019. Higher percentages of stems were registered in Paiaguas palisadegrass in monoculture in 2018 and in intercropping with sorghum in 2018 and 2019. In general, higher heights were found in Paiaguas palisadegrass in monoculture and smaller when intercropped with maize. The highest tiller densities were observed in Paiaguas palisadegrass in monoculture and the lowest in Paiaguas palisadegrass intercropped with maize and sorghum. Intercropping with agricultural crops reduces the production of Paiaguas palisadegrass. The accompanying agricultural crops alter the composition of the forage produced by the Paiaguas palisadegrass.

https://doi.org/10.1590/1809-6891v22e-68211 242 descargas

14.

Fragilidade entre Pacientes não Idosos Submetidos à Cirurgia Cardíaca
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Bottura, Camila

; Arcêncio, Livia

; Chagas, Hannah Miranda Araújo

; Evora, Paulo Roberto Barbosa

; Rodrigues, Alfredo José

Arquivos Brasileiros de Cardiologia

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Oct 2020, Volumen 115 Nº 4 Paginas 604 - 610

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: Geralmente vista como uma característica da velhice, a fragilidade também pode ocorrer em pessoas não idosas, principalmente naquelas que sofrem de doenças crônicas. A fragilidade pode aumentar o risco operatório. Objetivos: Determinar a prevalência de fragilidade em pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) e/ou troca ou reconstrução valvar e/ou cirurgia valvar, bem como a influência da fragilidade nos desfechos pós-operatórios. Métodos: Nosso estudo incluiu 100 adultos que foram submetidos a operações cardíacas eletivas consecutivas. A fragilidade foi avaliada por meio da escala de Fried. Os pacientes também realizaram um teste de caminhada de 6 minutos, e medimos as pressões inspiratória e expiratória máximas. Um valor de p < 0,05 foi considerado significativo. Resultados: De uma coorte de 100 pacientes, com base nos critérios de fragilidade de Fried, 17 pacientes (17%) foram considerados frágeis, 70 (70%) pré-frágeis e apenas 13 (13%) não frágeis. Entre os portadores de valvopatia, 11 (18,6%) foram considerados frágeis e 43 (73%) pré-frágeis. Cinquenta e três por cento dos pacientes considerados frágeis tinham menos de 60 anos (mediana=48 anos). As diferenças no fenótipo de fragilidade entre os pacientes com valvopatia e doença arterial coronariana não foram estatisticamente significativas (p=0,305). A comparação entre pacientes não frágeis, pré-frágeis e frágeis não mostrou diferença significativa na distribuição das comorbidades e do estado funcional cardíaco, independentemente da doença cardíaca. No entanto, a mortalidade hospitalar mostrou-se significativamente maior em pacientes frágeis (29,4%, p=0,026) que em pacientes pré-frágeis (8,6%) e não frágeis (0%). Conclusões: A fragilidade é prevalente mesmo entre pacientes não idosos submetidos a CRM ou cirurgia cardíaca valvar e está associada a maior mortalidade hospitalar pós-operatória.

Abstract Background: Usually viewed as a characteristic of old age, frailty may also occur in non-elderly people, primarily in those suffering from chronic disease. Frailty may increase operative risk. Objectives: To determine the prevalence of frailty patients undergoing coronary artery bypass (CABG) and/or heart valve replacement or reconstruction and/or heart valve surgery, as well as the influence of frailty on postoperative outcomes. Methods: Our study comprised 100 adults who underwent consecutive elective cardiac operations. Frailty was assessed using the Fried scale. Patients also performed a 6-minute walk test, and we measured maximal inspiratory and expiratory pressures. A p value <0.05 was considered significant. Results: Of a cohort of 100 patients, based on the Fried frailty criteria, 17 patients (17%) were considered frail, 70 (70%) pre-frail and only 13 (13%) were non-frail. Among patients with valvular heart disease, 11 (18.6%) were considered frail and 43 (73%) pre-frail. Fifty three percent of the patients considered frail were less than 60 years old (median=48 years old). The differences in frailty phenotype between patients with valvular heart disease and coronary artery disease were not statistically significant (p=0.305). A comparison between non-frail, pre-frail, and frail patients showed no significant difference in the distribution of comorbidities and cardiac functional status, regardless of their cardiac disease. However, hospital mortality was significantly higher in frail patients (29.4%, p=0.026) than in pre-frail patients (8.6%) and non-frail patients (0%). Conclusions: Frailty is prevalent even among non-elderly patients undergoing CABG or valvular heart surgery and is associated with higher postoperative hospital mortality.

https://doi.org/10.36660/abc.20190082 1010 descargas

15.

Recording acute pain in hospitalized patients
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Gimenes, Amanda Brassaroto

; Lopes, Camila Takáo

; Rodrigues-Neto, Alfredo José Alves

; Salvetti, Marina de Góes

BrJP

Métricas del periódico
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Sep 2020, Volumen 3 Nº 3 Paginas 245 - 248

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO JUSTIFICATIVA E OBJETIVOS: Os enfermeiros têm posição privilegiada para realizar a avaliação e o manejo da dor e utilizam intervenções farmacológicas e não farmacológicas. O objetivo deste estudo foi comparar os registros hospitalares de dor em pacientes internados com relato álgico em estudo prévio e analisar a presença do Diagnóstico de Enfermagem “Dor Aguda” e as Intervenções e Atividades de Enfermagem prescritas para o manejo da dor. MÉTODOS: Estudo transversal com coleta de dados retrospectiva. Utilizou-se como critério de seleção da amostra o relato de dor referida em entrevista de estudo anterior. Foram analisados os prontuários com a finalidade de verificar os registros de intensidade de dor aguda, presença do Diagnóstico de Enfermagem “Dor Aguda” e cuidados de enfermagem prescritos para pacientes adultos internados. RESULTADOS: A amostra do presente estudo consistiu em 63 pacientes adultos, com tempo médio de internação de 12 dias. Observou-se disparidade entre os registros de prontuário e os dados sobre a dor coletados previamente, indicando subnotificação da dor. O Diagnóstico de Enfermagem “Dor Aguda” foi identificado em 60,3% dos casos e as Intervenções e Atividades de Enfermagem foram pautadas no alívio farmacológico da dor (36,5%). CONCLUSÃO: Os registros de dor no prontuário do hospital não refletiram os relatos de dor observados em estudo prévio. Foi verificada a subnotificação da dor e as Intervenções e Atividades de Enfermagem elencadas pelos enfermeiros privilegiaram a avaliação e o tratamento farmacológico da dor. Esses achados sugerem a necessidade de treinamento contínuo da Equipe da Enfermagem com ênfase na avaliação e manejo não farmacológico da dor.

ABSTRACT BACKGROUND AND OBJECTIVES: Nurses are in a good position to carry out pain assessment and management, as well as to perform pharmacological and non-pharmacological interventions. The aim of this study was to compare hospital pain records in hospitalized patients with pain reports from a previous study and to analyze the presence of the “Acute Pain” Nursing Diagnosis and the Nursing Interventions prescribed for pain management. METHODS: Cross-sectional study with retrospective data collection. As a criteria for sample selection, the pain report referred to in a previous study interview was used. The medical records were analyzed in order to verify the registries of acute pain intensity, presence of the “Acute Pain” Nursing Diagnosis and nursing interventions prescribed for adult hospitalized patients. RESULTS: The sample of the present study consisted of 63 adult patients, with a mean hospital stay of 12 days. There was a disparity between medical records and pain data collected previously, indicating pain underreporting. The “Acute Pain” Nursing Diagnosis was identified in 60.3% of cases and Nursing Interventions were based on pharmacological pain relief (36.5%). CONCLUSION: The information in the hospital’s medical records did not reflect the pain reports observed in a previous study. There was underreporting of pain and the Nursing Interventions listed by nurses privileged the assessment and pharmacological treatment of pain. These findings suggest the need for continuous training of the Nursing Team with an emphasis on non-pharmacological pain assessment and management.

https://doi.org/10.5935/2595-0118.20200178 641 descargas

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