ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Abstract The objective of this study was to present information on the impacts resulting from Covid-19 on the artisanal coalho cheese production chain about: access to information; socioeconomic; income and government support; healthcare. The interviews were conducted using the Google Forms tool, with milk and artisanal coalho cheese producers in Rio Grande do Norte, Brazil. The producers obtained a lot of information transmitted on television (66%); the majority to adhere to health protocols. There was instability in the production, with an initial need to reduce production resulting from prohibitive measures to trade. The level of demand with regard to the consumer market increased with the quality of milk and cheeses. An allegation of lack of support from the government to maintain the activity was also verified in 78.7% of the interviewees, but 83% had resorted to emergency aid. Therefore, it can be concluded that the challenges imposed by the pandemic are not just sanitary. The study confirmed the need to restructure public services and policies. These results can provide compelling evidence about the rural context in the country.

ABSTRACT BACKGROUND: The high number of patients with end-stage kidney disease (ESRD) on hemodialysis makes it necessary to conduct studies aimed at improving their quality of life. OBJECTIVES: To evaluate brain compliance, using the Brain4care method for intracranial pressure (ICP) monitoring, among patients with ESRD before and at the end of the hemodialysis session, and to correlate ICP with the dialysis quality index (Kt/V). DESIGN AND SETTING: Cross-sectional study conducted at a renal replacement therapy center in Brazil. METHODS: Sixty volunteers who were undergoing hemodialysis three times a week were included in this study. Brain compliance was assessed before and after hemodialysis using the noninvasive Brain4care method and intracranial pressure wave morphology was analyzed. RESULTS: Among these 60 ESRD volunteers, 17 (28%) presented altered brain compliance before hemodialysis. After hemodialysis, 12 (20%) exhibited normalization of brain compliance. Moreover, 10 (83%) of the 12 patients whose post-dialysis brain compliance became normalized were seen to present good-quality dialysis, as confirmed by Kt/V > 1.2. CONCLUSIONS: It can be suggested that changes to cerebral compliance in individuals with ESRD occur frequently and that a good-quality hemodialysis session (Kt/V > 1.2) may be effective for normalizing the patient’s cerebral compliance.

Resumo Fundamento O remodelamento cardíaco patológico se caracteriza por disfunção diastólica e sistólica, levando à insuficiência cardíaca. Neste contexto, o cenário disfuncional do trânsito de cálcio miocárdico (Ca2+) tem sido pouco estudado. Um modelo experimental de estenose aórtica tem sido extensamente utilizado para aprimorar os conhecimentos sobre os principais mecanismos do remodelamento patológico cardíaco. Objetivo Entender o processo disfuncional dos principais componentes responsáveis pelo equilíbrio do cálcio miocárdico e sua influência sobre a função cardíaca na insuficiência cardíaca induzida pela estenose aórtica. Métodos Ratos Wistar de 21 dias de idade foram distribuídos em dois grupos: controle (placebo; n=28) e estenose aórtica (EaO; n=18). A função cardíaca foi analisada com o ecocardiograma, músculo papilar isolado e cardiomiócitos isolados. No ensaio do músculo papilar, SERCA2a e a atividade do canal de Ca2+ do tipo L foram avaliados. O ensaio de cardiomiócitos isolados avaliou o trânsito de cálcio. A expressão proteica da proteínas do trânsito de cálcio foi analisada com o western blot. Os resultados foram estatisticamente significativos quando p <0,05. Resultados Os músculos papilares e cardiomiócitos dos corações no grupo EaO demonstraram falhas mecânicas. Os ratos com EaO apresentaram menor tempo de pico do Ca2+, menor sensibilidade das miofibrilas do Ca2+, prejuízos nos processos de entrada e recaptura de cálcio pelo retículo sarcoplasmático, bem como disfunção no canal de cálcio do tipo L (CCTL). Além disso, os animais com EaO apresentaram maior expressão de SERCA2a, CCTL e trocador de Na+/Ca2+. Conclusão Insuficiência cardíaca sistólica e diastólica devido à estenose aórtica supravalvular acarretou comprometimento da entrada de Ca2+ celular e inibição da recaptura de cálcio pelo retículo sarcoplasmático devido à disfunção no CCTL e SERCA2a, assim como mudanças no trânsito de cálcio e na expressão das principais proteínas responsáveis pela homeostase de Ca2+ celular.

Abstract Background Maladaptive cardiac remodelling is characterized by diastolic and systolic dysfunction, culminating in heart failure. In this context, the dysfunctional scenario of cardiac calcium (Ca2+) handling has been poorly studied. An experimental model of aortic stenosis has been extensively used to improve knowledge about the key mechanisms of cardiac pathologic remodelling. Objective To understand the dysfunctional process of the major components responsible for Ca2+ balance and its influence on cardiac function in heart failure induced by aortic stenosis. Methods Male 21-day-old Wistar rats were distributed into two groups: control (sham; n= 28) and aortic stenosis (AoS; n= 18). Cardiac function was analysed by echocardiogram, isolated papillary muscle, and isolated cardiomyocytes. In the papillary muscle assay, SERCA2a and L-type Ca2+ channel activity was evaluated. The isolated cardiomyocyte assay evaluated Ca2+ handling. Ca2+ handling protein expression was analysed by western blot. Statistical significance was set at p <0.05. Results Papillary muscles and cardiomyocytes from AoS hearts displayed mechanical malfunction. AoS rats presented a slower time to the Ca2+ peak, reduced Ca2+ myofilament sensitivity, impaired sarcoplasmic reticulum Ca2+ influx and reuptake ability, and SERCA2a and L-type calcium channel (LTCC) dysfunction. Moreover, AoS animals presented increased expression of SERCA2a, LTCCs, and the Na+/Ca2+ exchanger. Conclusion Systolic and diastolic heart failure due to supravalvular aortic stenosis was paralleled by impairment of cellular Ca2+ influx and inhibition of sarcoplasmic reticulum Ca2+ reuptake due to LTCC and SERCA2a dysfunction, as well as changes in Ca2+ handling and expression of the major proteins responsible for cellular Ca2+ homeostasis.

Abstract Duchenne Muscular Dystrophy (DMD) reproductive alterations and the influence of antioxidant treatments may aid in understanding morphometry testicular quantification. In this context, the aim of the present study was to characterize the intertubular compartment (ITC) morphometry of animal testes in mdx mice supplemented with ascorbic acid (AA). Sixteen mice were used, namely the C57BL/10 (non-dystrophic) and C57BL/10Mdx (dystrophic) lineages, distributed into the following groups: Control (C60), Dystrophic (D60), Control supplemented with AA (CS60), Dystrophic supplemented with AA (DS60). A total of 200 mg/kg of AA were administered to mice for 30 days. Subsequently, the testicles were collected, weighed, and fragmented. The obtained fragments were fixed in Karnovsky's solution (pH 7.2) and embedded in historesin for morphometric and transmission electron microscopy assessments. Leydig cells were hypertrophic in the D60 group, but was reverted by AA supplementation in the DS60 group. The DS60 group also exhibited increased intertubular volume compared to the CS60 group. The ultrastructural images identified multilamellar bodies in dystrophic animals (lipid storage) and telocyte cells (transport substances) in both control and dystrophic animals. Morphometric alterations were, therefore, noted in the intertubular compartment due to Duchenne muscular dystrophy (DMD), with AA administration capable of altering Leydig cells in this condition.

RESUMO Objetivo: Construir um modelo de custo-efetividade para comparar o uso de propofol com o de midazolam em pacientes críticos adultos sob uso de ventilação mecânica. Métodos: Foi construído um modelo de árvore decisória para pacientes críticos submetidos à ventilação mecânica, o qual foi analisado sob a perspectiva do sistema privado de saúde no Brasil. O horizonte temporal foi o da internação na unidade de terapia intensiva. Os desfechos foram custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e custo-efetividade por hora de ventilação mecânica evitada. Foram obtidos os dados do modelo a partir de metanálise prévia. Assumiu-se que o custo da medicação estava incluído nos custos da unidade de terapia intensiva. Conduziram-se análises univariada e de sensibilidade probabilística. Resultados: Pacientes mecanicamente ventilados em uso de propofol tiveram diminuição de sua permanência na unidade de terapia intensiva e na duração da ventilação mecânica, respectivamente, em 47,97 horas e 21,65 horas. Com o uso de propofol, ocorreu redução média do custo de U$2.998,971 em comparação ao uso do midazolam. A custo-efetividade por hora de permanência na unidade de terapia intensiva evitada e por hora de ventilação mecânica evitada foi dominante, respectivamente, em 94,40% e 80,8% do tempo. Conclusão: Ocorreu diminuição significante do custo associado ao uso de propofol, no que se refere à permanência na unidade de terapia intensiva e à duração da ventilação mecânica para pacientes críticos adultos.

ABSTRACT Objective: To build a cost-effectiveness model to compare the use of propofol versus midazolam in critically ill adult patients under mechanical ventilation. Methods: We built a decision tree model for critically ill patients submitted to mechanical ventilation and analyzed it from the Brazilian private health care system perspective. The time horizon was that of intensive care unit hospitalization. The outcomes were cost-effectiveness per hour of intensive care unit stay avoided and cost-effectiveness per hour of mechanical ventilation avoided. We retrieved data for the model from a previous meta-analysis. We assumed that the cost of medication was embedded in the intensive care unit cost. We conducted univariate and probabilistic sensitivity analyses. Results: Mechanically ventilated patients using propofol had their intensive care unit stay and the duration of mechanical ventilation decreased by 47.97 hours and 21.65 hours, respectively. There was an average cost reduction of US$ 2,998.971 for propofol when compared to midazolam. The cost-effectiveness per hour of intensive care unit stay and mechanical ventilation avoided were dominant 94.40% and 80.8% of the time, respectively. Conclusion: There was a significant reduction in costs associated with propofol use related to intensive care unit stay and duration of mechanical ventilation for critically ill adult patients.

RESUMO Objetivos: analisar as representações sociais da qualidade de vida para jovens que vivem com HIV. Métodos: pesquisa qualitativa, fundamentada na Teoria de Representações Sociais, com 24 jovens que vivem com HIV, acompanhados em serviços especializados do Rio de Janeiro, por meio de entrevistas semiestruturadas e análise apoiada no software IRAMUTEQ. Resultados: a multidimensionalidade da qualidade de vida foi observada revelando as implicações do viver com HIV/aids em relação à rede de apoio familiar e social, momento do diagnóstico, atendimento dos serviços de saúde, terapia antirretroviral e expressões de preconceito. Considerações Finais: Observa-se uma síntese conceitual da qualidade de vida ao ser associada a hábitos de vida saudáveis, às relações interpessoais e aos serviços de saúde e práticas profissionais.

ABSTRACT Objectives: to analyze the social representations of the quality of life of the young people living with HIV. Methods: qualitative survey, based on the Social Representations Theory, with 24 young people living with HIV, monitored in specialized services in Rio de Janeiro, through semi-structured interviews, and the analysis supported by the software IRAMUTEQ. Results: multidimensionality of the quality of life was observed unfolding the implications of living with HIV/aids concerning the familiar and social support network, time of diagnosis, healthcare services, antiretroviral therapy, and prejudice expressions. Final Considerations: a conceptual synthesis of quality of life is observed when it is associated with healthy lifestyle habits, interpersonal relationships, and health services and professional practices.

RESUMEN Objetivos: analizar las representaciones sociales de la calidad de vida para jóvenes que viven con VIH. Métodos: investigación cualitativa, fundamentada en la Teoría de Representaciones Sociales, con 24 jóvenes que viven con VIH, acompañados en servicios especializados de Rio de Janeiro, por medio de entrevistas semiestructuradas y análisis apoyado en el software IRAMUTEQ. Resultados: la multidimensionalidad de la calidad de vida ha sido observada revelando las implicaciones del vivir con VIH/Sida en relación a las redes de apoyo familiar y social, momento del diagnóstico, atención a los servicios de salud, terapia antirretroviral y expresiones de prejuicio. Consideraciones Finales: se observa una síntesis conceptual de la calidad de vida al ser relacionada a hábitos de vida saludables, a las relaciones interpersonales y a los servicios de salud y prácticas profesionales.

Abstract: The Permanent Protection Areas (PPA) are relevant to ensure vegetation around the drainage network. This paper presents an automated methodology for the extraction of drainage from the river and automated generation of PPA, and analysis of environmental adequacy. The methodology is based on geoprocessing and remote sensing techniques applied to RapidEye satellite images. The analyzed area covers a portion of the Paraíba do Sul river basin, located in the city of São José dos Campos (Southern Brazil). Land use and land cover were determined using a digital classifier and estimated within the APP of four rural properties bordering the river. The digital classification of the RapidEye images was evaluated based on the visual interpretation of high spatial resolution airborne orthophotos, as well as through random points that enabled the generation of the Kappa index and global accuracy, showing high agreement. The analysis shows the inadequate land use practice in some properties analyzed, indicating changes in the areas of PPA over the years analyzed. The results of this research show that the proposed methodology can be used for supervision purposes in properties declared in the Rural Environmental Registry (CAR), thus assisting in the decision-making process.

ABSTRACT: The purpose of the present study was to evaluate the day and the time of sample collection of an experimental challenge with Eimeria maxima (EM) and Eimeria acervulina (EA) in broiler chickens. One- day old male Cobb-Vantress broiler chickens were randomly allocated to one of three groups with ten replicates (n=8 chickens/replicate). Chickens were placed in battery cages with a controlled age- appropriate environment: Group 1) Negative control (no challenge or treatment); 2) Challenge control (Eimeria challenge only); 3) Challenge + Salinomycin. Challenged chickens were orally gavaged with the mixed culture of EM/EA (10,000 sporulated EM containing 4% wild-type EA) at 14 days of age. Performance parameters were recorded at days 7, 14, 20, and 23. Lesions scores were recorded post-mortem on days 20 and 23. Oocyst per gram (OPG) was performed on days six, seven, and eight post-challenge, and samples were collected at 9:00 AM and 6:00 PM on each day, respectively. Oocyst counts were significantly different (P < 0.05) between morning and afternoon on day six post coccidia challenge. The results of this study show that the day and the time at which samples are collected can have a significant effect on the reliability and validity of data.

RESUMEN: El propósito del presente estudio fue evaluar el día y la hora de recolección de la muestra de un desafío experimental con Eimeria maxima (EM) y Eimeria acervulina (EA) en pollos de engorde. Los pollos de engorde macho Cobb-Vantress de un día de edad se asignaron aleatoriamente a uno de tres grupos con diez réplicas (n = 8 pollos / réplica). Los pollos se colocaron en jaulas de batería con un entorno controlado apropiado para la edad: Grupo 1) Control negativo (sin desafío o tratamiento); 2) Control de desafío (solo desafío Eimeria); 3) Desafío + salinomicina. A los 14 días de edad, los pollos fueron desafiados por vía oral con el cultivo mixto de EM/EA (10,000 EM esporulados que contenían 4% de EA de tipo salvaje). Los parámetros de rendimiento se registraron en los días 7, 14, 20 y 23. Los puntajes de las lesiones se registraron post mortem en los días 20 y 23. El oocisto por gramo (OPG) se realizó en los días seis, siete y ocho después del desafío, y muestras se recolectaron a las 9:00 a.m y a las 6:00 p.m. de cada día, respectivamente. Los recuentos de oocistos fueron significativamente diferentes (P < 0.05) entre la mañana y la tarde en el día seis después del desafío con coccidios. Los resultados de este estudio muestran que el día y la hora en que se recolectan las muestras pueden tener un efecto significativo en la confiabilidad y validez de los datos.

Abstract Fusariosis is a superficial or systemic infection, which occurs mainly in immunocompromised hosts, especially in patients with hematological neoplasia; 70%–75% of the cases present cutaneous manifestations. The disseminated form is rare and difficult to diagnose; even with specific treatment, the evolution is usually fatal. Currently, it is considered an emerging disease; in some centers, it is the second most common cause of invasive mycosis, after aspergillosis. The authors describe a case of a female patient with idiopathic bone marrow aplasia and disseminated fusariosis, who initially appeared to benefit from voriconazole and amphotericin B; however, due to persistent neutropenia, her clinical condition deteriorated with fatal evolution.

Resumo Fundamento A obesidade é um fator de risco para complicações médicas, incluindo o sistema cardiovascular. Há informações limitadas sobre o colágeno no coração obeso. Nosso estudo anterior demonstrou uma redução dos níveis proteicos de colágeno miocárdico tipo I em ratos obesos alimentados com uma dieta com alto teor de gordura durante 34 semanas. No entanto, os mecanismos responsáveis pelos níveis baixos não estão completamente elucidados. Objetivo O objetivo deste estudo foi testar a hipótese de que a redução do colágeno tipo I está associada ao aumento da atividade da metaloproteinase-2 (MMP-2), a qual está ligada à elevação de leptina no miocárdio de ratos obesos. Métodos Ratos Wistar machos com 30 dias de idade foram randomizados em dois grupos: controle (dieta padrão) e obeso (dieta com alto teor de gordura), e alimentados durante 34 semanas. Foram avaliados as características gerais dos animais e os perfis metabólicos e endócrinos. Foram avaliados as expressões proteicas miocárdicas de colágeno tipo I, leptina e inibidores teciduais de metaloproteinases (TIMP), bem como a atividade da MMP-2. O teste de correlação de Pearson foi aplicado para determinar as associações entre variáveis. O nível de significância foi de 5%. Resultados Os animais obesos apresentaram índice de adiposidade mais elevado em comparação ao controle. Foram observadas comorbidades como intolerância à glicose, hiperinsulinemia, resistência à insulina, hiperleptinemia e hipertensão nos ratos obesos. A obesidade reduziu o colágeno tipo I, TIMP-1 e TIMP-2, e aumentou a leptina e a MMP-2 no miocárdio. Houve uma correlação negativa entre o colágeno tipo I e a MMP-2 e uma correlação positiva entre a leptina e a MMP-2. Conclusão Foi confirmada a hipótese de que a redução do colágeno tipo I está associada ao aumento da atividade da MMP-2 e da expressão de leptina no miocárdio de ratos obesos. (Arq Bras Cardiol. 2020; 115(1):61-70)

Abstract Background Obesity is a risk factor for medical complications, including the cardiovascular system. There is limited information on collagen in the heart in obesity. Our previous study showed decreased protein levels of myocardial collagen type I in obese rats fed a high-fat diet for 34 weeks. However, the mechanisms responsible for low levels are not fully elucidated. Objective The purpose of this study was to test the hypothesis that the reduction in collagen type I is associated with increased metalloproteinase-2 (MMP-2) activity, which is linked to elevated leptin in the myocardium of obese rats. Methods Thirty-day-old male Wistar rats were randomized into two groups, control (standard diet) and obese (high-fat diet), and fed for 34 weeks. The general animal characteristics and metabolic and endocrine profiles were evaluated. Myocardial protein expressions of collagen I, leptin, tissue inhibitors of metalloproteinases (TIMP), and MMP-2 activity were assessed. Pearson correlation was employed to determine the associations between variables. The level of significance was 5%. Results The obese animals had increased adiposity index compared to control. Comorbidities such as glucose intolerance, hyperinsulinemia, insulin resistance, hyperleptinemia, and hypertension were observed in obese rats. Obesity reduced collagen I, TIMP-1, and TIMP-2, and it increased leptin and MMP-2 in the myocardium. There was a negative correlation between collagen I and MMP-2 and a positive correlation between leptin and MMP-2. Conclusion The hypothesis was confirmed; the reduction in collagen type I is associated with increased MMP-2 activity and leptin expression in the myocardium of obese rats. (Arq Bras Cardiol. 2020; 115(1):61-70)

RESUMO O tumor de células gigantes (TCG), um tumor benigno com agressão local, corresponde a 5% dos tumores primários. Quinze por cento desses estão localizados no sacro. A ressecção em bloco é um tratamento eficaz, mas quando não pode ser realizada, o Denosumabe pode ser indicado como tratamento alternativo. Os objetivos desse estudo consistem em justificar a indicação; determinar a melhor dose e tempo de uso e reconhecer a necessidade de cirurgia pós-tratamento. Métodos Foi realizada uma busca sistemática de ensaios clínicos, sendo que foram selecionados 25 artigos, dos quais dez atenderam aos critérios de inclusão. O uso do Denosumabe é justificado em estágios avançados, com uma dose de 120 mg administrada por via subcutânea, a cada 7 dias no primeiro mês e, depois, mantida a cada 4 semanas, durante 2,5 a 13 meses. Os eventos adversos são leves e podem ser observados em 84% dos pacientes. Com o Denosumabe, a cirurgia pode ser menos agressiva ou nem necessária. A bibliografia justifica a indicação de Denosumabe em estágios avançados do TCG, com dose de 120 mg administrada por via subcutânea; não há consenso quanto à dose de manutenção, a qual é uma dose semanal no primeiro mês e depois a cada quatro semanas durante 2,5 a 13 meses. As complicações são frequentes, porém leves. Nível de evidência III; Revisão sistemática.

ABSTRACT Giant Cell Tumor (GCT), a benign tumor with local aggression, corresponds to 5% of primary tumors. Fifteen percent of these are located in the sacrum. En bloc resection is an effective treatment, but when it cannot be performed, Denosumab may be indicated as an alternative treatment. The objectives of this work are: to justify the indication; determine the best dose and time of use; and recognize the need for post-treatment surgery. Methods A systematic search of clinical trials. Twenty-five articles were selected, ten of which met the inclusion criteria. The use of Denosumab is justified in advanced stages, with a dose of 120 mg administered subcutaneously, every 7 days in the first month and then maintained every 4 weeks, for 2.5 to 13 months. Adverse events are mild and can be observed in 84% of patients. With Denosumab, surgery may be less aggressive or even unnecessary. The bibliography justifies the indication of Denosumab in advanced stages of GCT, with a dose of 120 mg administered subcutaneously; there is no consensus as to the maintenance dose, which is a weekly dose in the first month and then every four weeks for 2.5 to 13 months. Complications are frequent but mild. Level of evidence III; Systematic review.

RESUMEN El tumor de células gigantes (TCG), un tumor benigno con agresión local, corresponde a 5% de los tumores primarios. Quince por ciento de éstos están localizados en el sacro. La resección en bloque es un tratamiento eficaz, pero cuando no puede ser realizada, el Denosumab puede ser indicado como tratamiento alternativo. Los objetivos de este estudio consisten en justificar la indicación, determinar la mejor dosis y tiempo de uso, y reconocer la necesidad de cirugía postratamiento. Métodos Fue realizada una búsqueda sistemática de ensayos clínicos, siendo que fueron seleccionados veinticinco artículos, de los cuales diez atendieron los criterios de inclusión. El uso de Denosumab está justificado en etapas avanzadas, con una dosis de 120 mg administrada por vía subcutánea, a cada 7 días en el primer mes y, después, mantenida a cada 4 semanas, durante 2,5 a 13 meses. Los eventos adversos son leves y pueden observarse en 84% de los pacientes. Con el Denosumab, la cirugía puede ser menos agresiva o ni necesaria. La bibliografía justifica la indicación de Denosumab en etapas avanzados de TCG, con dosis de 120 mg administrada por vía subcutánea; no hay consenso cuanto a la dosis de mantenimiento, la cual es una dosis semanal en el primer mes y después a cada cuatro semanas durante 2,5 a 13 meses. Las complicaciones son frecuentes, aunque leves. Nivel de evidencia III; Revisión Sistemática.

Resumo Fundamento A fraqueza muscular inspiratória contribui para a intolerância ao exercício e diminuição da qualidade de vida dos pacientes com insuficiência cardíaca. Estudos com treinamento da musculatura inspiratória demonstram melhora da força muscular inspiratória, da capacidade funcional e da qualidade de vida. Porém, pouco se sabe sobre a resposta hemodinâmica central (RHC) durante o exercício inspiratório (EI). Objetivo Avaliar a RHC em uma única sessão de EI com diferentes cargas (placebo, 30 e 60%) na insuficiência cardíaca. Métodos Ensaio clínico randomizado placebo-controlado, em pacientes com insuficiência cardíaca com fração de ejeção reduzida, classe funcional II e III. Vinte pacientes, com idade de 65±11 anos, completaram uma sessão única de exercício inspiratório, em 3 ciclos de 15 minutos, com washout de 1 hora, envolvendo cargas de 30% (C30), 60% (C60) e placebo, utilizando um resistor de carga linear ( PowerBreathe Light ). O estudo hemodinâmico não invasivo foi realizado por bioimpedância cardiotorácica ( Niccomo™CardioScreen® ). Análise estatística foi feita com o Teste t de Student e a correlação de Pearson, considerado significante p≤0,05. Resultados Foi observado aumento da frequência cardíaca (FC) com a C30 (64±15 vs 69±15 bpm; p=0,005) e C60 (67±14 vs 73±14 bpm, p=0,002). No volume sistólico (VS), observou-se diminuição com a C30 (73±26 vs 64±20 ml; p=0,004). O débito cardíaco (DC) apresentou aumento apenas com a C60 (4,6±1,5 vs 5,3±1,7 l/min; p=-0,001). Conclusão Quando utilizada a carga de 60%, em uma sessão única de EI, foram observadas alterações na RHC. A FC e o DC aumentaram, assim como as escalas de Borg e sensação subjetiva de dispneia. Já a carga de 30% promoveu diminuição do VS. (Arq Bras Cardiol. 2020; 114(4):656-663)

Abstract Background Inspiratory muscle weakness contributes to exercise intolerance and decreased quality of life in patients with heart failure. Studies with inspiratory muscle training show improvement in inspiratory muscle strength, functional capacity and quality of life. However, little is known about the central hemodynamic response (CHR) during inspiratory exercise (IE). Objective To evaluate CHR in a single IE session with different loads (placebo, 30% and 60%) in heart failure. Methods Randomized placebo-controlled clinical trial in patients with heart failure with reduced ejection fraction, functional class II and III. Twenty patients aged 65 ± 11 years completed a single session of inspiratory exercise, in 3 cycles of 15 minutes, with a 1-hour washout, involving loads of 30% (C30), 60% (C60) and placebo, using a linear load resistor (PowerBreathe Light). The noninvasive hemodynamic study was performed by cardiothoracic bioimpedance (Niccomo™ CardioScreen®). Statistical analysis was performed with Student’s t-test and Pearson’s correlation, and P≤0.05 was considered significant. Results An increase in heart rate (HR) was observed with C30 (64 ± 15 vs 69 ± 15 bpm; p = 0.005) and C60 (67 ± 14 vs 73 ± 14 bpm, p = 0.002). A decrease was observed in systolic volume (SV) with C30 (73 ± 26 vs 64 ± 20 ml; p = 0.004). Cardiac output (CO), on its turn, increased only with C60 (4.6 ± 1.5 vs 5.3 ± 1.7 l/min; p = -0.001). Conclusion When using the 60% load, in a single IE session, changes in CHR were observed. HR and CD increased, as did the Borg scales and subjective sensation of dyspnea. The 30% load reduced the SV. (Arq Bras Cardiol. 2020; 114(4):656-663)

RESUMO Objetivo Verificar a prevalência das anomalias dentárias de número, posição e forma, além da presença de alterações ósseas, por meio de radiografias panorâmicas. Métodos Levantamento das anomalias dentárias e alterações ósseas em crianças de 6 a 12 anos, com radiografia panorâmica registrada no Banco de Imagens Radiográficas da Universidade Federal do Espírito Santo nos anos de 2012 a 2016. Foram registradas informações clínico-demográficas referentes aos pacientes atendidos. As fichas clínicas foram recuperadas para obtenção da história médica de síndromes ou outras doenças que interfiram nas anomalias e alterações. Foram realizados os testes estatísticos qui-quadrado ou exato de Fischer. Resultados Foram encontradas 83 radiografias panorâmicas que mostravam algum tipo de alteração em 301 analisadas. Foram descritas 169 anomalias ou alterações (média de 2,04±1,38 anomalias/paciente), envolvendo 201 dentes. A anomalia mais prevalente foi a impactação (26,63%) que afetou mais os caninos, seguida da hipodontia (24,26%) que ocorreu mais em segundos pré-molares, em ambas o sexo feminino foi mais acometido. A hiperdontia e as lesões radiolúcidas tiveram a mesma prevalência (18,93%), os dentes mais acometidos foram da região ântero-superior e os primeiros molares inferiores, respectivamente. As menos prevalentes foram dilaceração (7,69%), taurodontia (2,37%) e lesões radiopacas (1,18%). As anomalias ósseas estavam significativamente mais em mandíbula e na região posterior, o que confirma a prevalência em molares inferiores. Conclusão Não houve diferença estatisticamente significativa em relação ao gênero. Mas houve alta prevalência de anomalias e alterações na população estudada, o que denota a importância do diagnóstico por meio desse importante exame complementar.

ABSTRACT Objective To verify the prevalence of dental anomalies in terms of number, position and shape, and the presence of bone alterations, through analysis of panoramic radiographs. Methods This study evaluated dental anomalies and bone alterations in children aged 6 to 12 years-old, detected on panoramic radiographies recorded in the radiographic database of the Federal University of Espírito Santo between 2012 and 2016. Clinical and demographic information were registered. Dental records were retrieved to obtain the medical history involving syndromes or other diseases that may interfere with the anomalies and alterations. Chi-square and exact Fischer’s statistical tests were performed. Results There were alterations in 83 out of 301 panoramic radiographs analyzed. There were 169 anomalies or alterations (mean of 2,04±1,38 anomalies/patient), involving 201 teeth. The most prevalent anomaly was tooth impaction (26.63%), which affected the canines more frequently, followed by hypodontia (24.26%), more often found in the second premolar, and both affected mostly females. Hyperdontia and radiolucent lesions showed the same prevalence (18.93%), the most affected teeth were those of the anterosuperior region and the first mandibular molars, respectively. The least prevalent anomalies were dilaceration (7.69%), taurodontism (2.37%) and radiopaque lesions (1.18%). Bone alterations were significantly more found in mandible and in the posterior region, which confirms the prevalence in the lower molars. Conclusion Although there was no statistically significant difference regarding sex, there was a high prevalence of anomalies and alterations in our study population, which indicates the importance of its diagnosis by means of a panoramic x-ray examination.

Resumo A doença renal crônica (DRC) promove alterações morfofuncionais dos músculos esqueléticos, gerando redução da capacidade físico-funcional (CF) e pior qualidade de vida (QV). O treinamento resistido intradialítico (TRI) é considerado uma ação pragmática para atenuar tais complicações. Contudo, nota-se baixa inserção do TRI nos centros de tratamento em nefrologia. O objetivo deste estudo foi avaliar a eficácia e a segurança de uma proposta metodológica de TRI de fácil execução e de baixo custo. Métodos: 43 pacientes (52,8±13,85 anos), com tempo em HD entre cinco e 300 meses, foram acompanhados entre abril de 2014 e julho de 2017. A eficácia do TRI foi mensurada pela CF, avaliada pela força muscular (FM) e pela velocidade de caminhada usual (VCU) e pela QV. Como critério de segurança adotou-se a ocorrência de intercorrências clínicas. O protocolo de TRI consistiu em exercícios de moderada a alta intensidade para os principais grupos musculares, realizados três vezes por semana. Resultados: o tempo médio de acompanhamento foi de 9,3 ± 3,24 meses, totalizando 4.374 sessões de TRI. A aderência ao protocolo foi de 96,5 ± 2,90, e os pacientes apresentaram melhora significativa da FM (de 27,3±11,58 Kgf para 34,8±10,77 Kgf) e da VCU (de 0,99 ± 0,29 m/s para 1,26 ± 0,22 m/s). Quanto à QV, tanto os domínios do componente físico quanto do emocional aumentaram significativamente. Conclusão: o TRI promoveu aumento significativo da CF e melhora de todos os domínios da QV, e não foram observadas intercorrências importantes com a realização dos exercícios intradialíticos.

Abstract Chronic kidney disease (CKD) alters the morphology and function of skeletal muscles, thereby decreasing patient physical capacity (PC) and quality of life (QoL). Intradialytic resistance training (IRT) is a pragmatic tool used to attenuate these complications. However, IRT has not been strongly adopted in nephrology care centers. This study aimed to assess the efficacy and safety of a low-cost, easy-to-use IRT protocol. Methods: The study enrolled 43 patients (52.8 ± 13.85 years) on HD for five to 300 months followed from April 2014 to July 2017. The efficacy of IRT was assessed based on PC - derived from muscle strength (MS) and preferred walking speed (PWS) - and QoL. The occurrence of adverse events was used as a measure of safety. The IRT protocol consisted of exercises of moderate to high intensity for the main muscle groups performed three times a week. Results: The mean follow-up time was 9.3 ± 3.24 months, for a total of 4,374 sessions of IRT. Compliance to the protocol was 96.5 ± 2.90%, and patients presented significant improvements in MS (from 27.3 ± 11.58 Kgf to 34.8 ± 10.77 Kgf) and PWS (from 0.99 ± 0.29 m/s to 1.26 ± 0.22 m/s). Physical and emotional components of QoL also increased significantly. Conclusion: IRT led to significant increases in PC and higher scores in all domains of QoL. Important adverse events were not observed during intradialytic resistance training.