ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.

RESUMO O sono é essencial para o adequado funcionamento de todos os indivíduos. Os distúrbios respiratórios do sono ocorrem em todas as faixas etárias, constituindo motivo frequente de consulta médica. O objetivo deste consenso foi atualizar os conhecimentos sobre os principais distúrbios respiratórios do sono tanto na população adulta quanto na pediátrica, com ênfase na apneia obstrutiva do sono. A apneia obstrutiva do sono é uma doença extremamente prevalente, porém frequentemente subdiagnosticada. Associa-se frequentemente a uma série de comorbidades, notadamente cardiovasculares, metabólicas e neurocognitivas, que impactam significativamente na qualidade de vida e na mortalidade. Por conta disso, o Departamento de Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 especialistas com reconhecida e comprovada experiência em distúrbios respiratórios do sono para a elaboração deste documento.

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

RESUMO OBJETIVO Analisar determinantes para a ocorrência da leishmaniose visceral humana vinculados às condições de vulnerabilidade. MÉTODOS Estudo ecológico, cuja unidade de análise espacial foi a Unidade de Análise Territorial em Araguaína, TO, de 2007 a 2012. Foi realizada análise da situação sociodemográfica e de infraestrutura urbana no município. Indicadores primários normalizados foram calculados e utilizados na construção de indicadores de vulnerabilidade de estrutura social, de estrutura domiciliar e de infraestrutura urbana. A partir deles, foi composto um índice de vulnerabilidade. A estimativa de Kernel foi utilizada para avaliar a densidade de casos de leishmaniose visceral humana, com base nas coordenadas dos casos. O I-Moran Global Bivariado foi empregado para verificar a existência de autocorrelação espacial entre a incidência de leishmaniose visceral humana e os indicadores e índice de vulnerabilidade. I-Moran Local Bivariado foi utilizado para identificar clusters espaciais. RESULTADOS Foi observado um padrão de disseminação centrífuga da leishmaniose visceral humana no município, em que surtos da doença atingiram progressivamente áreas centrais e periurbanas. Houve correlação entre maiores incidências de leishmaniose visceral humana e piores condições de vida. Foram observados clusters estatisticamente significativos entre as incidências de leishmaniose visceral humana nos dois períodos analisados (2007 a 2009 e 2010 a 2012) e os indicadores e índice de vulnerabilidade. CONCLUSÕES O ambiente em áreas circunscritas contribui como fator de proteção ou aumenta a vulnerabilidade local à ocorrência de leishmaniose visceral humana. O uso de metodologia que analisa as condições de vida da população e distribuição espacial da leishmaniose visceral humana é essencial na identificação de áreas mais vulneráveis à disseminação/manutenção da doença.

ABSTRACT OBJECTIVE To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability. METHODS This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran’s I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran’s I was used to identify spatial clusters. RESULTS We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability. CONCLUSIONS The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease.

RESUMO OBJETIVO Analisar determinantes para a ocorrência da leishmaniose visceral humana vinculados às condições de vulnerabilidade. MÉTODOS Estudo ecológico, cuja unidade de análise espacial foi a Unidade de Análise Territorial em Araguaína, TO, de 2007 a 2012. Foi realizada análise da situação sociodemográfica e de infraestrutura urbana no município. Indicadores primários normalizados foram calculados e utilizados na construção de indicadores de vulnerabilidade de estrutura social, de estrutura domiciliar e de infraestrutura urbana. A partir deles, foi composto um índice de vulnerabilidade. A estimativa de Kernel foi utilizada para avaliar a densidade de casos de leishmaniose visceral humana, com base nas coordenadas dos casos. O I-Moran Global Bivariado foi empregado para verificar a existência de autocorrelação espacial entre a incidência de leishmaniose visceral humana e os indicadores e índice de vulnerabilidade. I-Moran Local Bivariado foi utilizado para identificar clusters espaciais. RESULTADOS Foi observado um padrão de disseminação centrífuga da leishmaniose visceral humana no município, em que surtos da doença atingiram progressivamente áreas centrais e periurbanas. Houve correlação entre maiores incidências de leishmaniose visceral humana e piores condições de vida. Foram observados clusters estatisticamente significativos entre as incidências de leishmaniose visceral humana nos dois períodos analisados (2007 a 2009 e 2010 a 2012) e os indicadores e índice de vulnerabilidade. CONCLUSÕES O ambiente em áreas circunscritas contribui como fator de proteção ou aumenta a vulnerabilidade local à ocorrência de leishmaniose visceral humana. O uso de metodologia que analisa as condições de vida da população e distribuição espacial da leishmaniose visceral humana é essencial na identificação de áreas mais vulneráveis à disseminação/manutenção da doença.

ABSTRACT OBJECTIVE To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability. METHODS This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran’s I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran’s I was used to identify spatial clusters. RESULTS We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability. CONCLUSIONS The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease.

ABSTRACT The objective of the study was to assess the effects of including 0, 79.8, 159.8, and 240.0 g kg-1 crude glycerin in the total diet dry matter on the 84 days feedlot performance, nutrient digestibility, blood parameters, and carcass characteristics of crossbred dairy steers. Experimental diets were composed of 98.5 g kg-1 of sorghum silage and 901.5 g kg-1 of concentrate. Twenty-four crossbred dairy steers (337.3±39.8 kg body weight and 15 months of age) were distributed in a completely randomized design with four treatments and six replicates. The intake and digestibility of the dry matter and nutrients were not altered by including crude glycerin in the diet. Crude glycerol levels did not affect the final weight (430.2 kg), daily weight gain (1.38 kg day-1), total weight gain (97.2 kg), hot carcass weight (218.9 kg), cold carcass weight (215.2 kg), hot carcass yield (0.50 kg 100 kg-1 BW), longissimus dorsi area (62.86 cm²), subcutaneous fat thickness (4.05 mm), and carcass physical composition. Concentrations of serum glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and creatinine were not altered by including crude glycerin in the diet. Crude glycerin can be added to high concentrate diet up to 240 g kg-1 without changing the animal performance, apparent digestibility of nutrients, the main carcass characteristics, and blood parameters of finishing crossbred dairy steers.

Neste trabalho é determinada a região de aplicação do reforço com fibras de carbono em lajes de concreto utilizando-se um procedimento de otimização topológica. Embora o procedimento seja aplicado em lajes, a técnica pode ser usada em qualquer estrutura de concreto armado a ser reforçada. As simulações numéricas foram feitas através do Método dos Elementos Finitos, associadas ao procedimento automático de otimização topológica, para indicação da região ótima de posicionamento do reforço. A influência de alguns aspectos do comportamento estrutural da laje no resultado da otimização é apresentada: fissuração do concreto; condições de apoio e de carregamento; e taxa de reforço. Foram verificados os ganhos em termos de rigidez e de resistência das peças reforçadas. A comparação com técnicas convencionais de reforço mostrou que a otimização topológica pode ser uma ferramenta bastante útil para a definição da região do reforço, podendo levar a uma economia de material.

This study proposes a topology optimization procedure as a tool to find the region of application of carbon-fiber reinforcement in concrete slabs. Although the procedure is applied to slabs, the technique can be used for the reinforcement of any concrete structure. Numerical simulations were performed using the Finite Element Method in combination with an automated topology optimization procedure in order to indicate the optimal region for the placement of the reinforcement. The influence of some aspects of the structural behavior of the slab on the optimization results is presented: concrete cracking, load and support conditions and reinforcement rates. Gains were found in the stiffness and strength of the reinforced structures. A comparison with conventional reinforcement techniques demonstrates that topology optimization can be a useful tool for determining the region of reinforcement, allowing material cost savings.

The objective of the present study was to evaluate the effects of corn milling and the inclusion of babassu mesocarp bran (BMB) on productive performance, digestibility of dietary nutrients, and blood parameters of dairy crossbred (Holstein-Gyr) bulls finished in confinement. Twenty-four bulls were fed four different experimental diets, containing two levels of inclusion of BMB (0 and 41.24%) and corn supplied in two different forms (ground and whole), for 98 days (77 days of data collection and 21 days of adaptation). The intakes and digestibility coefficients of the dry matter (DM) and nutrients were determined. There were no significant interaction effects of the BMB inclusion level and the form of corn used on the performance and digestibility variables. The intakes of DM, crude protein (CP), and neutral detergent fibre (NDF) increased with the inclusion of BMB in the diets. However, the inclusion of BMB in the diets decreased the ether extract intake, the NDF apparent digestibility, and the feed efficiency of DM and CP. Dry matter and NDF intakes also increased with the use of ground corn in the diet, which promoted an increase in the intake of total digestible nutrients (TDN), digestibility of non-fibrous carbohydrates, and average daily gain. However, the supply of ground corn reduced the feed efficiency of TDN. The remaining measured variables did not vary with the tested diets. The levels of plasma protein and albumin remained normal, but glucose concentrations were always high, irrespective of the tested diet. The form of corn supplied and the level of BMB inclusion had a significant interaction effect on the levels of triglycerides, urea, aspartate aminotransferase, and alkaline phosphatase. Babassu mesocarp bran can be included up to 41.24% in the diet of confined bulls without a negative effect on the animal weight gain. Corn should be supplied ground because this form improves the performance of crossbred bulls

Apresentamos imagens de tomografia computadorizada de um paciente de 83 anos de idade com histiocitoma fibroso benigno profundo, na face lateral da perna esquerda, com evolução de longa data. À tomografia computadorizada observamos massa bem delimitada, ovalada, e que apresentava intenso realce periférico com uso do meio de contraste iodado. Este é um tumor de partes moles pouco freqüente e com raros relatos dos seus aspectos de imagem.

We present the computed tomography images of an 83-year-old male patient with a deep benign fibrous histiocytoma at the lateral aspect of the left leg. Computed tomography images showed a well-defined mass with marked peripheral enhancement by iodinated contrast medium. Only few reports of this rare soft tissue tumor can be found in the literature.