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Abstract In recent decades, there have been significant advances in the diagnosis of diffuse gliomas, driven by the integration of novel technologies. These advancements have deepened our understanding of tumor oncogenesis, enabling a more refined stratification of the biological behavior of these neoplasms. This progress culminated in the fifth edition of the WHO classification of central nervous system (CNS) tumors in 2021. This comprehensive review article aims to elucidate these advances within a multidisciplinary framework, contextualized within the backdrop of the new classification. This article will explore morphologic pathology and molecular/genetics techniques (immunohistochemistry, genetic sequencing, and methylation profiling), which are pivotal in diagnosis, besides the correlation of structural neuroimaging radiophenotypes to pathology and genetics. It briefly reviews the usefulness of tractography and functional neuroimaging in surgical planning. Additionally, the article addresses the value of other functional imaging techniques such as perfusion MRI, spectroscopy, and nuclear medicine in distinguishing tumor progression from treatment-related changes. Furthermore, it discusses the advantages of evolving diagnostic techniques in classifying these tumors, as well as their limitations in terms of availability and utilization. Moreover, the expanding domains of data processing, artificial intelligence, radiomics, and radiogenomics hold great promise and may soon exert a substantial influence on glioma diagnosis. These innovative technologies have the potential to revolutionize our approach to these tumors. Ultimately, this review underscores the fundamental importance of multidisciplinary collaboration in employing recent diagnostic advancements, thereby hoping to translate them into improved quality of life and extended survival for glioma patients.

Resumo Nas últimas décadas, houve avanços significativos no diagnóstico de gliomas difusos, impulsionados pela integração de novas tecnologias. Esses avanços aprofundaram nossa compreensão da oncogênese tumoral, permitindo uma estratificação mais refinada do comportamento biológico dessas neoplasias. Esse progresso culminou na quinta edição da classificação da OMS de tumores do sistema nervoso central (SNC) em 2021. Esta revisão abrangente tem como objetivo elucidar esses avanços de forma multidisciplinar, no contexto da nova classificação. Este artigo irá explorar a patologia morfológica e as técnicas moleculares/genéticas (imuno-histoquímica, sequenciamento genético e perfil de metilação), que são fundamentais no diagnóstico, além da correlação dos radiofenótipos da neuroimagem estrutural com a patologia e a genética. Aborda sucintamente a utilidade da tractografia e da neuroimagem funcional no planejamento cirúrgico. Destacaremos o valor de outras técnicas de imagem funcional, como ressonância magnética de perfusão, espectroscopia e medicina nuclear, na distinção entre a progressão do tumor e as alterações relacionadas ao tratamento. Discutiremos as vantagens das diferentes técnicas de diagnóstico na classificação desses tumores, bem como suas limitações em termos de disponibilidade e utilização. Além disso, os crescentes avanços no processamento de dados, inteligência artificial, radiômica e radiogenômica têm grande potencial e podem em breve exercer uma influência substancial no diagnóstico de gliomas. Essas tecnologias inovadoras têm o potencial de revolucionar nossa abordagem a esses tumores. Em última análise, esta revisão destaca a importância fundamental da colaboração multidisciplinar na utilização dos recentes avanços diagnósticos, com a esperança de traduzi-los em uma melhor qualidade de vida e uma maior sobrevida.

https://doi.org/10.1055/s-0043-1777729

Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale
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Silva, Daniel Villela e

; Alves, Davi da Silveira Barroso

; Nóbrega, Mariana da Rocha Rodrigues

; Ribeiro, Felipe Braga Coelho Gomes

; Franco, Leandro Yukio Yatabe

; Silva, Isadora Rodrigues da

; Joffily, Lucia

; Rocha, Maira da

; Godoy, Paulo Henrique

Brazilian Journal of Otorhinolaryngology

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2023, Volume 89 N. 4 elocation 101283

Abstract: En | Text: En | PDF: En

Abstract Objective To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. Methods Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders—third edition. Performance was assessed using 2 × 2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. Results We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. Conclusion In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. Level of evidence according the guide for authors: level 2.

https://doi.org/10.1016/j.bjorl.2023.101283

Assessing over decadal biomass burning influence on particulate matter composition in subequatorial Amazon: literature review, remote sensing, chemical speciation and machine learning application
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GIODA, ADRIANA

; MATEUS, VINICIUS L.

; HACON, SANDRA S.

; IGNOTTI, ELIANE

; GOMES, RUAN G.S.

; PEDREIRA, MARCOS FELIPE S.

; GODOY, JOSÉ MARCUS

; DALLACORT, RIVANILDO

; LOUREIRO, ANA LÚCIA M.

; MORAIS, FERNANDO

; ARTAXO, PAULO

Anais da Academia Brasileira de Ciências

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2023, Volume 95 Suppl. 2 elocation e20220932

Abstract: En | Text: En | PDF: En

Abstract A study on aerosols in the Brazilian subequatorial Amazon region, Tangará da Serra (TS) and Alta Floresta (AF) was conducted and compared to findings in an additional site with background characteristics (Manaus, AM). TS and AF counties suffer from intense biomass burning periods in the dry season, and it accounts for high levels of particles in the atmosphere. Chemical characterization of fine and coarse particulate matter (PM) was performed to quantify water-soluble ions (WSI) and black carbon (BC). The importance of explanatory variables was assessed using three machine learning techniques. Average concentrations of PM in AF and TS were similar (PM2.0, 17±10 µg m-3 (AF) and 16±11 µg m-3 (TS) and PM10-2.0, 13±5 µg m-3 (AF) and 11±7 µg m-3 (TS)), but higher than the background site. BC and SO4 2- were the prevalent components as they represented 27%–68% of particulates chemical composition. The combination of the machine learning techniques provided a further understanding of the pathways for PM concentration variability, and the results highlighted the influence of biomass burning for key sample groups and periods. PM2.0, BC, and most WSI presented higher concentrations in the dry season, providing further support for the influence of biomass burning.

https://doi.org/10.1590/0001-3765202320220932

Cognitive assessment of Brazilian patients with multiple sclerosis: weighing the impact of disability and depressive symptoms
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Andrade, Patricia Semionato

; Cerqueira, Ana Cláudia Rodrigues de

; Colodetti, Ana Carolina

; Schmidt, Felipe da Rocha

; Barreiros, José Maurício Godoy

; Teixeira, Antônio Lúcio

; Souza, Leonardo Cruz de

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 276 - 283

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A esclerose múltipla (EM) é a doença desmielinizante mais comum do sistema nervoso central. A cognição não é rotineiramente avaliada nos pacientes apesar da ocorrência frequente de queixas ou disfunção cognitivas. Objetivo: Comparar o perfil de pacientes com EM com controles pareados por idade, sexo e escolaridade e investigar a potencial influência de parâmetros clínicos na cognição. Métodos: Trinta e cinco pacientes com EM (idade média±desvio padrão [DP] 37,9 anos±11,44, H/M: 12/23) e 33 controles saudáveis (idade média±DP 38,8 anos±12,6, H/M: 12/21) foram incluídos neste estudo. Todos os participantes passaram por avaliação clínica estruturada e por testagem cognitiva com os seguintes instrumentos: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span e testes de fluências verbais (letras F, A e S e categoria-animais). A psicopatologia foi investigada com a Mini International Neuropsychiatric Interview e com o Beck Depression Inventory (BDI). A Expanded Disability Status Scale (EDSS) foi aplicada nos pacientes. Resultados: Pacientes tiveram desempenho pior que os controles na maioria dos testes — 70% deles tiveram déficit cognitivo. A função cognitiva mais frequentemente afetada foi memória episódica (45,7%), seguida por fluência verbal (42,8%) e velocidade de processamento (22,8%). A pontuação no SDMT correlacionou-se inversamente com a gravidade da doença, medida pela EDSS. A depressão não influenciou o desempenho cognitivo nesta série de pacientes. Conclusões: Declínio cognitivo é comum em pacientes com EM. Enquanto o déficit motor se associou com a velocidade de processamento, a depressão não influenciou o desempenho cognitivo.

ABSTRACT Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Cognition is not routinely assessed in patients with MS though they frequently have cognitive complaints or dysfunction. Objective: The aim of this study was to compare the cognitive status of patients with MS with age, sex, and schooling matched controls and to evaluate the potential influence of clinical parameters on cognition. Methods: A total of 35 patients with MS (mean±SD age 37.9 years±11.44, M/F: 12/23) and 33 healthy controls (mean±SD age 38.8 years±12.6, M/F: 12/21) were enrolled in this study. All subjects underwent a structured clinical assessment and the cognitive tools are as follows: Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, and Verbal Fluency Tests (letters F, A, and S and animal category). Psychopathology was assessed with the Mini International Neuropsychiatric Interview and the Beck Depression Inventory (BDI). The Expanded Disability Status Scale (EDSS) was used for patients. Results: Patients performed worse than controls in almost all tests, with approximately 70% of patients presenting cognitive impairment. The most affected cognitive domain was episodic memory (45.7%), followed by verbal fluency (42.8%) and information processing speed (22.8%). SDMT was inversely correlated with disease severity, as assessed by the EDSS. Depression did not influence cognitive performance in this cohort. Conclusions: Cognitive dysfunction is common among patients with MS. While motor impairment was associated with information processing speed, depression did not influence cognitive performance.

https://doi.org/10.1590/1980-5764-dn-2021-0050

Hepatitis autoinmune en pediatría, una revisión del Grupo de Trabajo de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (LASPGHAN)
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Ramonet, Margarita

; Ramirez-Rodriguez, Nelson

; Alvarez Chávez, Felipe

; Arregla, María C.

; Boldrini, Gustavo

; Botero Osorio, Verónica

; Cuarterolos, Miriam

; Godoy, Marcela

; Alonso Medina Monroy, Fernando

; Oropeza, Gabriela

; Pérez Carus, Rosana

; Pérez Rodríguez, Diana

; Reynoso-Zarzosa, Fátima Azereth

; Ciocca, Mirta

Archivos argentinos de pediatría

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aug 2022, Volume 120 N. 4 Pages 1 - 10

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.5546/aap.2022.281

Uso de denosumab para el quiste óseo aneurismático de columna. Reporte de un caso y revisión bibliográfica
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Lanari Zubiaur, Felipe

; Godoy Adaro, Alfredo O.

; Bazán, Pedro L.

Revista de la Asociación Argentina de Ortopedia y Traumatología

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dec 2021, Volume 86 N. 6 Pages 821 - 828

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Los tumores vertebrales de columna tienen una frecuencia muy baja. La incidencia de quiste óseo aneurismático es del 1-4% de todos los tumores. Su ubicación predominante es la columna lumbar, en mayor medida, en el arco posterior. Según estudios publicados, esta enfermedad se comporta de forma agresiva, por la compresión radicular que genera debido a su expansión. Si bien hay bibliografía sobre el tratamiento quirúrgico del tumor y su resección en bloque y embolización, no hay experiencias sobre el tratamiento con anticuerpos monoclonales. Existen muy pocos artículos que corroboren un tratamiento para las recidivas o los quistes óseos aneurismáticos inoperables o intralesionales, los cuales dejan la posibilidad abierta a otras técnicas. Presentamos el caso de una mujer de 38 años con lumbocruralgia. En los estudios, se detecta una tumoración, y la biopsia por punción y las imágenes confirman que se trata de un quiste óseo aneurismático. Se planifica el tratamiento con embolización preoperatoria y exéresis intracompartimental mediante cirugía posterior con liberación del saco dural. A los seis meses, el tumor recidiva. Se indica tratamiento con denosumab por dos años, se realizan controles periódicos y se constata la remisión de los síntomas y la mejoría de las imágenes.

Abstract Vertebral tumors of the spine have a very low frequency. The incidence of aneurysmal bone cyst (ABC) ranges between 1% and 4% of all tumors. Its predominant location is the lumbar spine, to a greater extent, in the posterior arch. According to published studies, this condition behaves aggressively, due to the root compression generated by its expansion. While there is literature on the surgical treatment of the tumor and its en bloc resection and embolization, there is no experience on the treatment with monoclonal antibodies. There are very few published articles that corroborate a treatment for recurrences or for inoperable or intralesional aneurysmal bone cysts, which leave the possibility open to other techniques. We present the case of a 38-year-old woman with lumbar pain radiating to the thigh. In studies, a tumor was detected, and the needle biopsy and imaging confirmed that it was an aneurysmal bone cyst. We planned the treatment with preoperative embolization and intracompartmental excision by subsequent surgery with the release of the dural sac. At six months, tumor recurrence was observed. Treatment with denosumab was indicated for two years, periodic controls were carried out and the remission of symptoms and improvement in the images were verified.

https://doi.org/10.15417/issn.1852-7434.2021.86.6.1121

Weight-bearing cone-beam computed tomography in the foot and ankle specialty: where we are and where we are going - an update
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Godoy-Santos, Alexandre Leme

; Bernasconi, Alessio

; Bordalo-Rodrigues, Marcelo

; Lintz, François

; Lôbo, Carlos Felipe Teixeira

; Netto, Cesar de Cesar

Radiologia Brasileira

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jun 2021, Volume 54 N. 3 Pages 177 - 184

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A tomografia computadorizada (TC) de feixe cônico é aplicada na área da odontologia e medicina há cerca de duas décadas, e seu uso na especialidade do tornozelo e pé cresceu de forma exponencial nos últimos anos. A literatura demonstra como a TC de feixe cônico permite obter imagens com apoio do peso corporal total - weight-bearing cone-beam computed tomography - com cortes nos três planos e modelos tridimensionais semelhantes às TCs, associada a menor exposição à radiação, técnica que revolucionou o diagnóstico, o entendimento de diferentes lesões e o planejamento cirúrgico nessa área do conhecimento. As mensurações tridimensionais automáticas e semiautomáticas, a segmentação óssea, o mapeamento das distâncias e orientações articulares e a possibilidade de produção de implantes customizados são o interesse dos estudos em andamento na cirurgia do tornozelo e pé relacionados a essa ferramenta emergente. O objetivo deste artigo é mostrar a evolução do método, atualizar as especialidades de interface sobre uso na prática clínica atual e indicar para onde a comunidade científica está caminhando.

Abstract Cone-beam computed tomography (CBCT) has been applied in dentistry and medicine for nearly two decades. Its application in the foot and ankle specialty has grown exponentially in recent years. Weight-bearing CBCT allows clinicians to obtain weight-bearing images that can be viewed in all three planes and to construct three-dimensional models, similar to those constructed from traditional CT scans, as well as exposing patients to less radiation than do traditional CT scans. This technology has revolutionized diagnoses, improving the understanding of various lesions and surgical planning in the foot and ankle specialty. Ongoing studies of the use of weight-bearing CBCT in foot and ankle surgery are focused on fully automated and semi-automated three-dimensional measurements, as well as bone segmentation, mapping of the distances/orientation of the joints, and the production of customized implants. The aims of this review article are to show the evolution of this emerging tool in the foot and ankle specialty, to update those in related specialties on its use in current clinical practice, and to indicate where the research community is heading.

https://doi.org/10.1590/0100-3984.2020.0048 254 downloads

Neurología hospitalaria y COVID-19: serie de 96 pacientes evaluados en un hospital universitario
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Godoy-Santín, Jaime

; Bravo-Grau, Sebastián

; Nuñez, Felipe

; Aguilar, Cecilia

; Gutiérrez, Diego

; Miranda, Héctor

; Sandoval-Rubio, Patricio

; Ramos, Bernardita

; García A., Lorena

; Andresen, Max

; Mellado, Patricio

Revista médica de Chile

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apr 2021, Volume 149 N. 4 Pages 527 - 532

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Background: There are multisystemic consequences secondary to SARS- CoV-2 infection. Aim: To characterize neurological complications in patients admitted due to SARS-CoV-2 infection. Methods: Review of medical records of patients aged over 15 years with COVID-19 evaluated by the neurology team between April and August 2020 at a university hospital. Severity of the infection, referral reasons, neurological diagnoses and laboratory results were registered. The diagnoses were defined by consensus among the members of the hospital neurology group. Cerebrovascular and inflammatory diseases of the central and peripheral nervous system were defined as “probably associated” or “possibly associated” to COVID-19. Results: Ninety-six patients had at least 1 new neu- rological complication. 74% were admitted due to pneumonia and 20% due to a neurological disease. The most common reasons for neurological referral were impaired consciousness (39%), focal neurological deficit (24%), headache (9%) and seizures (5%). The most relevant neurological diagnoses were delirium in 48 patients, stroke in 24, critical illness polyneuropathy and myopathy in 17, seizures in 14, brachial plexopathy in 3, compressive neuropathies in 5, encephalitis in 1, possible vasculitis in 1 and Guillain-Barré syndrome in 1. Stroke and epilepsy were associated with increased length of hospital stay, but without differences in mortality. Conclusions: The spectrum of neurological complications of COVID-19 is wide. There are clinical entities typical of critically ill patients and also diseases associated directly and indirectly with the SARS-CoV2 infection.

https://doi.org/10.4067/s0034-98872021000400527 422 downloads

WEIGHT-BEARING CONE BEAM CT SCANS AND ITS USES IN ANKLE, FOOT, AND KNEE: AN UPDATE ARTICLE
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LÔBO, CARLOS FELIPE TEIXEIRA

; BORDALO-RODRIGUES, MARCELO

; Godoy-Santos, Alexandre Leme

; Gobbi, Riccardo Gomes

; Cesar Netto, Cesar de

; Burssens, Arne

; Lintz, François

; Barg, Alexej

Acta Ortopédica Brasileira

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apr 2021, Volume 29 N. 2 Pages 105 - 110

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Os exames de imagem são essenciais no diagnóstico, planejamento cirúrgico e avaliação pós-cirúrgica das patologias que envolvem pé, tornozelo e joelho. A interpretação acurada utilizando as tecnologias de diagnóstico por imagem disponíveis é crucial para os cirurgiões ortopédicos na sua prática clínica. Embora as radiografias convencionais estejam entre as modalidades de diagnóstico por imagem mais utilizadas, elas estão sujeitas a erros por várias razões técnicas e sobreposição de estruturas ósseas. Apesar de a tomografia computadorizada (TC) fornecer imagens de alta qualidade, ela falha em não considerar a carga corporal fisiológica. A TC de feixe cônico com carga vem sendo utilizada com sucesso desde a última década, superando a limitação da TC convencional. Além de ser econômica e segura, possibilita a aquisição de imagens de alta resolução, com carga, permitindo, assim, uma interpretação correta e equiparável. O objetivo principal dessa revisão é proporcionar uma discussão e descrição ampla de TC com carga, incluindo qualidade de imagem, custos financeiros, tempo consumido em exames, e suas aplicações em patologias comuns do pé, tornozelo e joelho. A TC com carga vem crescendo em popularidade, e é tema de um número extenso de pesquisas científicas, sendo necessário que radiologistas e cirurgiões ortopédicos entendam suas aplicações para melhor uso futuro. Nível de Evidência III, Revisão sistemática de Estudos de Nível III.

ABSTRACT Imaging plays a key role in the preoperative diagnosis, surgical planning, and postsurgical assessment of the foot, ankle, and knee pathologies. Interpreting diagnostic imaging accurately is crucial for the clinical practice of orthopedic surgeons. Although among the most used imaging modalities, radiographic assessments are amenable to errors for various technical reasons and superposition of bones. Computed tomography (CT) is a conventional imaging procedure that provides high-resolution images, but fails in considering a truly weight-bearing (WB) condition. In an attempt to overcome this limitation, WB cone beam CT technology has being successfully employed in the clinical practice for the past decade. Besides economically viable and safe, the WB cone beam CT considers WB conditions and provides high-quality scans, thus allowing an equitable and correct interpretation. This review aims to address extensive description and discussion on WBCT, including imaging quality; costs; time consumption; and its applicability in common foot, ankle, and knee, conditions. With this technology increasing popularity, and considering the extensive literature on medical research, radiologists and orthopedic surgeons need to understand its potential applications and use it optimally. Level of Evidence III, Systematic review of level III studies.

https://doi.org/10.1590/1413-785220212902236939 195 downloads

10.

Associação entre Terapia com Estatinas e Menor Incidência de Hiperglicemia em Pacientes Internados com Síndromes Coronarianas Agudas
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Furtado, Remo Holanda de Mendonça

; Genestreti, Paulo Rizzo

; Dalçóquio, Talia F.

; Baracioli, Luciano Moreira

; Lima, Felipe Galego

; Franci, André

; Giraldez, Roberto R. C. V.

; Menezes, Fernando R.

; Ferrari, Aline Gehlen

; Lima, Viviane Moreira

; Pereira, Cesar A. C.

; Nakashima, Carlos Alberto Kenji

; Salsoso, Rocio

; Godoy, Lucas Colombo

; Nicolau, José C.

Arquivos Brasileiros de Cardiologia

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feb 2021, Volume 116 N. 2 Pages 285 - 294

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento O maior risco de se desenvolver diabetes com o uso de estatinas é um desafio para a segurança do uso dessa classe de medicamentos em longo prazo. No entanto, poucos estudos analisaram essa questão durante síndromes coronarianas agudas (SCA). Objetivos Investigar a associação entre início precoce da terapia com estatina e níveis de glicemia em pacientes admitidos com SCA. Métodos Este foi um estudo retrospectivo de pacientes hospitalizados por SCA. Pacientes que nunca haviam usado estatinas foram incluídos e divididos segundo uso ou não de estatina nas primeiras 24 horas de internação. O desfecho primário foi a incidência de hiperglicemia na internação (definida como pico de glicemia > 200mg/dL). Modelos de regressão logística e modelos lineares multivariados foram usados para ajuste quanto a fatores de confusão e um modelo de pareamento por escore de propensão foi desenvolvido para comparações entre os dois grupos de interesses. Um valor de p menor que 0,05 foi considerado estatisticamente significativo. Resultados Um total de 2357 pacientes foram incluídos, 1704 deles alocados no grupo que receberam estatinas e 653 no grupo que não receberam estatinas nas primeiras 24 horas de internação. Após os ajustes, uso de estatina nas primeiras 24 horas foi associado com uma menor incidência de hiperglicemia durante a internação (OR ajustado = 0,61, IC95% 0,46-0,80; p < 0,001) e menor necessidade de uso de insulina (OR ajustado = 0,56, IC 95% 0,41-0,76; p < 0,001). Essas associações mantiveram-se similares nos modelos de pareamento por escore de propensão, bem como após análises de sensibilidade, como exclusão de pacientes que desenvolveram choque cardiogênico, infecção grave ou pacientes que foram a óbito durante a internação hospitalar. Conclusões Entre os pacientes internados com SCA que não receberam estatinas previamente, a terapia precoce com estatina associou-se independentemente com menor incidência de hiperglicemia durante a internação. (Arq Bras Cardiol. 2021; 116(2):285-294)

Abstract Background Increased risk of new-onset diabetes with statins challenges the long-term safety of this drug class. However, few reports have analyzed this issue during acute coronary syndromes (ACS). Objective To explore the association between early initiation of statin therapy and blood glucose levels in patients admitted with ACS. Methods This was a retrospective analysis of patients hospitalized with ACS. Statin-naïve patients were included and divided according to their use or not of statins within the first 24 hours of hospitalization. The primary endpoint was incidence of in-hospital hyperglycemia (defined as peak blood glucose > 200 mg/dL). Multivariable linear and logistic regression models were used to adjust for confounders, and a propensity-score matching model was developed to further compare both groups of interest. A p-value of less than 0.05 was considered statistically significant. Results A total of 2,357 patients were included, 1,704 of them allocated in the statin group and 653 in the non-statin group. After adjustments, statin use in the first 24 hours was associated with a lower incidence of in-hospital hyperglycemia (adjusted OR=0.61, 95% CI 0.46-0.80; p < 0.001) and lower need for insulin therapy (adjusted OR = 0.56, 95% CI 0.41-0.76; p < 0.001). These associations remained similar in the propensity-score matching models, as well as after several sensitivity analyses, such as after excluding patients who developed cardiogenic shock, severe infection or who died during index-hospitalization. Conclusions Among statin-naïve patients admitted with ACS, early statin therapy was independently associated with lower incidence of in-hospital hyperglycemia. (Arq Bras Cardiol. 2021; 116(2):285-294)

https://doi.org/10.36660/abc.20200128 548 downloads

11.

Probing for congenital nasolacrimal duct obstruction: a systematic review and meta-analysis of randomized clinical trials
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Farat, Joyce Godoy

; Schellini, Silvana Artioli

; Dib, Regina El

; Santos, Felipe Gasparini dos

; Meneghim, Roberta Lilian Fernandes Sousa

; Jorge, Eliane Chaves

Arquivos Brasileiros de Oftalmologia

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jan 2021, Volume 84 N. 1 Pages 91 - 98

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: A sondagem lacrimal tem sido o tratamento de escolha para a obstrução lacrimonasal congênita que não apresenta resolução espontânea. Contudo, não há consenso sobre qual é a melhor época para a realização da sondagem e se ela é melhor do que outras terapias. O objetivo foi avaliar a efetividade da sondagem lacrimal no tratamento da obstrução lacrimonasal congênita. Método: Uma revisão sistemática da literatura foi realizada usando as plataformas eletrônicas PubMed, EMBASE, CENTRAL, clinicaltrials.gov e LILACS até o período de dezembro de 2019. Foram considerados ensaios clínicos randomizados envolvendo crianças com obstrução lacrimonasal congênita submetidas a sondagem lacrimal. A extração dos dados e avaliação do risco de viés foram feitas por dois autores independentemente. A análise da qualidade da evidência para cada desfecho foi realizada por meio do sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Resultados: Quatro ensaios clínicos randomizados foram incluídos, envolvendo 423 participantes. A metanálise mostrou que não houve diferença estatística na resolução da obstrução lacrimonasal congênita entre o grupo submetido à sondagem lacrimal precoce e o submetido à observação/sondagem tardia (2 estudos; risco médio 1.00 [intervalo de confiança de 95% 0.76, 1.33] p=0,99, I2=79%, baixa certeza de evidência). Um estudo evidenciou melhores resultados da intubação bicanalicular com silicone em comparação a sondagem tardia no subgrupo das obstruções lacrimonasais congênitas complexas, (1 estudo; risco médio 0.56 [intervalo de confiança de 95% 0.34, 0.92] p=0,02, moderada certeza de evidência). Conclusões: Há evidências de baixa qualidade de que a sondagem precoce tem a mesma taxa de sucesso que a sondagem tardia. Evidências de moderada certeza sugerem que a sondagem tardia tem menor chance de sucesso do que a intubação bicanalicular com silicone em casos de obstruções lacrimonasais congênitas complexas.

ABSTRACT Purpose: Lacrimal probing is the treatment of choice for congenital nasolacrimal duct obstruction that does not have a spontaneous resolution; however, there is no consensus about the best time for probing and if it is superior to other therapies. The present study aimed to evaluate the effectiveness of lacrimal probing compared with other treatments/no intervention to treat congenital nasolacrimal duct obstruction. Methods: A systematic review of literature in PubMed, EMBASE, CENTRAL, clinicaltrials.gov, and LILACS databases up to December 2019 was performed. Randomized clinical trials that enrolled children diagnosed with congenital nasolacrimal duct obstruction and undergoing lacrimal probing were considered. Data extraction and a risk of bias assessment were conducted independently and in duplicate. The overall quality of evidence for each outcome was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation classification system. Results: Four randomized clinical trials involving 423 participants were eligible. No statistically significant differences were observed in resolution rates between early probing and observation/late probing (two studies; risk ratio 1.00 [95% confidence interval 0.76-1.33]; p=0.99; low certainty evidence). One study reported better resolution rates with bicanalicular silicone stent intubation compared with late probing in the complex congenital nasolacrimal duct obstruction cases subgroup (risk ratio 0.56 [95% confidence interval 0.34-0.92]; p=0.02; moderate certainty evidence). Conclusions: Low certainty evidence suggests that early probing has the same success rate as late probing. Evidence of moderate certainty suggests that late probing has a lower success rate than bicanalicular silastic intubation in patients with complex congenital nasolacrimal duct obstructione.

https://doi.org/10.5935/0004-2749.20210005 477 downloads

12.

Technological Development of Automation Solutions for the Energy Industry
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Otto, Rodrigo Bueno

; Szollosi, Carlos Henrique

; Lorenzetti, Felipe

; Silva, Felipe Pinheiro da

; Braggio, Almir Augusto

; Terada, Galileu Godoy

Brazilian Archives of Biology and Technology

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2021, Volume 64 N. spe elocation e21210159

Abstract: En | Text: En | PDF: En

Abstract The Innovation Centers are one of the arms of a nation's technological development. Due to their characteristics and objectives, these centers are equipped with laboratories, equipment and researchers capable of developing a product from basic research to the installation of the solution in the field. Entering the context of Innovation Centers and knowing how to correctly position the level of technological maturity is one of the challenges to be understood and explored. In order to advance the market phase, it is recommended to form alliances with technology-based companies to provide both production and commercialization of these technologies, even more if it is possible to create a spinoff from these centers, to take advantage of the experience, knowledge and skills already acquired over time.

https://doi.org/10.1590/1678-4324-75years-2021210159 252 downloads

13.

COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro

; Uchôa, Caroline Louise Mesquita

; Mazzoco, Marina Flaborea

; Cruz, Isabella D'Andrea Garcia da

; Echegaray, Mariana V.F.

; Humes, Eduardo de Castro

; Silveira, Júlia Belizário

; Santi, Talita Di

; Miguel, Euripedes Constantino

; Corchs, Felipe

; Fatori, Daniel

; Campello, Guilherme

; Oliveira, Gabriel M. de

; Argolo, Felipe C.

; Ferreira, Felipe de M.

; Machado, Gustavo

; Argeu, Adriana

; Oliveira, Graça Maria Ramos de

; Serafim, Antônio de Pádua

; Siqueira, Luciana de Lima

; Rossi, Luciane de

; Rios, Izabel Cristina

; Oliveira, Talita Rodrigues de

; Antoniazzi, Leilane C. K.

; Gagliotti, Daniel Augusto Mori

; Abelama Neto, Emílio

; Oliveira Junior, Paulo Novais de

; Correia, Aline Villalobo

; Gonçalves, Luca Schilling

; Tortato, Liana Silva

; Busato, Wagner Machado Moraes

; Guimarães-Fernandes, Flávio

; Alves, Marcos

; Leite Netto, Oswaldo Ferreira

; Schoueri, Patrícia de Campos Lindenberg

; Roque, Márcio de Assis

; Merlin, Silvia Stahl

; Boer, Giovana Cardoso Machado

; Sallet, Paulo Clemente

; Malbergier, André

; Spedo, Mariana Abrahão

; Kamitsuji, Carla Satie

; Faria, Elizabeth de

; Moreira, Moacyr Vergara de Godoy

; Kaufman, Arthur

; Abdo, Carmita

; Scanavino, Marco de Tubino

; Lancman, Selma

; Tavares, Hermano

; Polanczyk, Guilherme

; Brunoni, André R.

; Forlenza, Orestes V.

; Barros-Filho, Tarcísio Eloy Pessoa de

Clinics

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2021, Volume 76 elocation e2631

Abstract: En | Text: En | PDF: En

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

https://doi.org/10.6061/clinics/2021/e2631

14.

VIDA-Nursing v1.0: immersive virtual reality in vacuum blood collection among adults
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Souza-Junior, Valtuir Duarte De

; Mendes, Isabel Amélia Costa

; Tori, Romero

; Marques, Leonardo Prates

; Mashuda, Felipe Kenzo Kusakawa

; Hirano, Leonardo Akira Fattore

; Godoy, Simone De

Revista Latino-Americana de Enfermagem

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2020, Volume 28 elocation e3263

Abstract: En Es Pt | Text: En Es Pt | PDF: En | PDF: Es | PDF: Pt

Objective: to develop and validate the first immersive virtual reality simulation addressing vacuum blood collection in adult patients - VIDA-Nursing v1.0. Method: methodological study to validate 14 steps of the vacuum blood collection procedure in adults, designed to develop the immersive virtual reality simulator VIDA-Nursing v1.0. It was assessed by 15 health workers and 15 nursing undergraduate students in terms of visual, interactive, movement simulation reality, teaching and user-friendly aspects. Results: the workers considered 79.6% of the items to be valid, while the students considered 66.7% of the items valid; most of the demands can be implemented in the system by improving future versions. Conclusion: the simulator was considered a promising and innovative tool to teach vacuum blood collection in adults as it can be combined with other resources currently used to introduce this topic and technique in the education of undergraduate nursing students.

Objetivo: desarrollar y validar la primera versión del simulador de realidad virtual inmersivo en el procedimiento de recolección de vacío de sangre en pacientes adultos: VIDA-Enfermería v1.0. Método: estudio con diseño metodológico para validar 14 pasos del procedimiento de extracción de sangre al vacío en adultos, diseñado para el desarrollo del simulador inmersivo de realidad virtual VIDA-Enfermería v1.0, que fue evaluado por 15 profesionales de la salud y 15 estudiantes universitarios de enfermería con relación a los aspectos visual, interactiva, realidad de movimiento, pedagógico y esfuerzo de uso. Resultados: en general, el 79.6% de los ítems evaluados por los profesionales y el 66.7% de los ítems evaluados por los estudiantes de pregrado se consideraron válidos, y la mayoría de las necesidades de mejoras del sistema están sujetas a corrección en el incremento de las próximas versiones. Conclusión: el simulador fue considerado como una herramienta prometedora e innovadora para enseñar la extracción de sangre al vacío en adultos, como una estrategia que se combina con los recursos utilizados actualmente en la educación de estudiantes de enfermería que están comenzando a estudiar el tema y la técnica.

Objetivo: desenvolver e validar a primeira versão do simulador de realidade virtual imersiva no procedimento de coleta de sangue a vácuo no paciente adulto - VIDA-Enfermagem v1.0. Método: estudo com delineamento metodológico para validar 14 etapas do procedimento de coleta de sangue a vácuo no adulto, projetadas para o desenvolvimento do simulador de realidade virtual imersiva VIDA-Enfermagem v1.0, o qual foi avaliado por 15 profissionais da saúde e 15 graduandos de enfermagem em relação aos aspectos visual, interativo, realidade de simulação do movimento, pedagógico e esforço de utilização. Resultados: de maneira geral foram considerados válidos 79,6% dos itens avaliados pelos profissionais e 66,7% dos itens avaliados pelos graduandos, sendo que a maioria das necessidades de melhorias do sistema é passível de correção no incremento das próximas versões. Conclusão: o simulador foi considerado como ferramenta promissora e inovadora para o ensino da coleta de sangue a vácuo no adulto, enquanto estratégia a ser combinada com recursos utilizados atualmente na educação de graduandos de enfermagem que estão iniciando o estudo da temática e da técnica.

https://doi.org/10.1590/1518-8345.3685.3263 34 downloads

15.

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA
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COIMBRA, Felipe Jose F

; TORRES, Orlando Jorge M

; ALIKHANOV, Ruslan

; AGARWAL, Anil

; PESSAUX, Patrick

; FERNANDES, Eduardo de Souza M

; QUIREZE-JUNIOR, Claudemiro

; ARAUJO, Raphael Leonardo C

; GODOY, André Luis

; WAECHTER, Fabio Luis

; RESENDE, Alexandre Prado de

; BOFF, Marcio Fernando

; COELHO, Gustavo Rego

; REZENDE, Marcelo Bruno de

; LINHARES, Marcelo Moura

; BELOTTO, Marcos

; MORAES-JUNIOR, Jose Maria A

; AMARAL, Paulo Cezar G

; PINTO, Rinaldo Danesi

; GENZINI, Tercio

; LIMA, Agnaldo Soares

; RIBEIRO, Heber Salvador C

; RAMOS, Eduardo José

; ANGHINONI, Marciano

; PEREIRA, Lucio Lucas

; ENNE, Marcelo

; SAMPAIO, Adriano

; MONTAGNINI, André Luis

; DINIZ, Alessandro

; JESUS, Victor Hugo Fonseca de

; SIROHI, Bhawna

; SHRIKHANDE, Shailesh V

; PEIXOTO, Renata D`Alpino

; KALIL, Antonio Nocchi

; JARUFE, Nicolas

; SMITH, Martin

; HERMAN, Paulo

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2020, Volume 33 N. 1 elocation e1496

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

https://doi.org/10.1590/0102-672020190001e1496 2194 downloads

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