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au:LUCAS, FLAVIO OLIVEIRA

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Relationship between learning styles and simulation in surgery
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Mauro, Fernando Henrique de Oliveira

; Fraga, Rogerio de

; Tomasich, Flavio Daniel Saavedra

; Silva, Carla Simone da

; Ribeiro, Jose Henrique Agner

; Rocha, João Lucas Aleixes Sampaio

Revista Brasileira de Educação Médica

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2023, Volume 47 N. 2 elocation e061

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

Abstract: Introduction: It was found that the good performance in conventional techniques was not transferable to minimally-invasive alternatives, and then simulators were created for improved learning. Objective: To assess whether robotic virtual reality simulation conditions ability for laparoscopy in medical students, associating the VARK tool and Mind Styles to determine whether there is a correlation between learning styles and the ability to develop these skills. Methods: Randomization of 3 groups of medical students was performed, where one of the groups performed a simulation of a surgical knot exercise in the laparoscopy box and another, the same exercise on the robot console. The third group did not simulate. All participants took a practical test in the laparoscopy box and their performances were evaluated. Moreover, a pre-test and a post-test were applied, in addition to the VARK and mind styles methods, to assess whether there was a difference in performance between the different learning styles. Results: The practical test scores were relatively homogeneous between the groups and between the Mind Styles and VARK categories, with no significant difference being found between the groups; therefore, it was not possible to demonstrate that learning styles interfered with the results of this study. There was only a significant difference between the pre-test scores of at least one pair of the groups and between the Laparoscopy and Robotics groups, with a p-value of 0.038. Conclusion: There was no statistical significance between learning styles and performance regarding the proposed tasks.

Resumo: Introdução: Constatou-se que o bom desempenho em técnicas convencionais não se transferia para as minimamente invasivas, e, com isso, foram criados os simuladores para melhor aprendizado. Objetivo: Este estudo teve como objetivo avaliar se a simulação em realidade virtual robótica promove habilidade para laparoscopia em acadêmicos de Medicina, associando a ferramenta VARK e o mind styles (GSD) para determinar se há correlação dos estilos de aprendizagem com a capacidade de desenvolver essas habilidades. Método: Realizou-se randomização de três grupos de acadêmicos de Medicina, em que um dos grupos fez simulação de um exercício de nó cirúrgico na caixa de laparoscopia (CL), e outro, o mesmo exercício no console do robô. O terceiro grupo não participou da simulção. Todos os participantes fizeram um teste prático na CL, e as performances deles foram avaliadas. Ademais, foram aplicados um pré-teste e um pós-teste, além do formulário VARK e GSD, para avaliar se havia diferença de performance entre os diferentes estilos de aprendizagem. Resultado: As notas das provas práticas foram relativamente homogêneas entre grupos e entre as categorias de Mind Styles e do VARK. Como não se encontrou diferença significativa entre os grupos, não foi possível demonstrar que os estilos de aprendizagem interferiram nos resultados deste estudo. Houve apenas diferença significativa entre as notas do pré-teste de pelo menos um par de grupos e entre os grupos laparoscopia e robótica com p-valor 0,038. Conclusão: Não houve significância estatística entre os estilos de aprendizagem e o desempenho nas tarefas propostas.

https://doi.org/10.1590/1981-5271v47.2-20220078.ing

Efeitos da solução balanceada em desfechos de curto prazo em pacientes com traumatismo craniencefálico: uma análise secundária do ensaio clínico randomizado BaSICS
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Zampieri, Fernando Godinho

; Damiani, Lucas Petri

; Biondi, Rodrigo Santos

; Freitas, Flávio Geraldo Rezende

; Veiga, Viviane Cordeiro

; Figueiredo, Rodrigo Cruvinel

; Serpa-Neto, Ary

; Manoel, Airton Leonardo de Oliveira

; Miranda, Tamiris Abait

; Corrêa, Thiago Domingos

; Azevedo, Luciano César Pontes de

; Silva, Nilton Brandão da

; Machado, Flavia Ribeiro

; Cavalcanti, Alexandre Biasi

Revista Brasileira de Terapia Intensiva

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dec 2022, Volume 34 N. 4 Pages 410 - 417

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

ABSTRACT Objective: To describe the effects of balanced solution use on the short-term outcomes of patients with traumatic brain injury enrolled in BaSICS trial. Methods: Patients were randomized to receive either 0.9% saline or balanced solution during their intensive care unit stay. The primary endpoint was 90-day mortality, and the secondary outcomes were days alive and free of intensive care unit stay at 28 days. The primary endpoint was assessed using Bayesian logistic regression. The secondary endpoint was assessed using a Bayesian zero-inflated beta binomial regression. Results: We included 483 patients (236 in the 0.9% saline arm and 247 in the balanced solution arm). A total of 338 patients (70%) with a Glasgow coma scale score ≤ 12 were enrolled. The overall probability that balanced solutions were associated with higher 90-day mortality was 0.98 (OR 1.48; 95%CrI 1.04 - 2.09); this mortality increment was particularly noticeable in patients with a Glasgow coma scale score below 6 at enrollment (probability of harm of 0.99). Balanced solutions were associated with -1.64 days alive and free of intensive care unit at 28 days (95%CrI -3.32 - 0.00) with a probability of harm of 0.97. Conclusion: There was a high probability that balanced solutions were associated with high 90-day mortality and fewer days alive and free of intensive care units at 28 days. ClinicalTrials.gov:NCT02875873

RESUMO Objetivo: Descrever os efeitos do uso de soluções balanceadas nos desfechos de curto prazo de pacientes com traumatismo craniencefálico incluídos no estudo BaSICS. Métodos: Os pacientes foram randomizados para receber solução salina 0,9% ou solução balanceada durante a internação em unidade de terapia intensiva. O desfecho primário foi mortalidade em 90 dias, já os desfechos secundários foram dias de vida e sem internação em unidade de terapia intensiva aos 28 dias. O desfecho primário foi avaliado por regressão logística bayesiana. O desfecho secundário foi avaliado usando regressão beta-binomial inflada de zeros bayesiana. Resultados: Incluímos 483 pacientes (236 no braço de solução salina 0,9% e 247 no braço de solução balanceada). Foram incluídos 338 pacientes (70%) com pontuação na escala de coma de Glasgow ≤ 12. A probabilidade geral de que soluções balanceadas estivessem associadas a maior mortalidade em 90 dias foi de 0,98 (RC de 1,48; ICr95% 1,04 - 2,09). Esse aumento de mortalidade foi particularmente perceptível em pacientes com pontuação na escala de coma de Glasgow abaixo de 6 no momento da inclusão (probabilidade de dano de 0,99). Soluções balanceadas foram associadas a -1,64 dia de vida e sem internação em unidade de terapia intensiva aos 28 dias (ICr95% -3,32 - 0,00) com probabilidade de dano de 0,97. Conclusão: Houve alta probabilidade de que soluções balanceadas estivessem associadas a alta mortalidade em 90 dias, menos dias de vida e sem internação em unidade de terapia intensiva aos 28 dias. ClinicalTrials.gov:NCT02875873

https://doi.org/10.5935/0103-507x.20220261-pt

Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study
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Reis, Flavio Pola dos

; Fernandes, Lucas Matos

; Abdalla, Luis Gustavo

; Campos, Silvia Vidal

; Camargo, Priscila Cilene Leon Bueno de

; Santos, Samuel Lucas dos

; Aguiar, Ivana Teixeira de

; Pires, Juliana Patricia

; Costa, Andre Nathan

; Carraro, Rafael Medeiros

; Teixeira, Ricardo Henrique de Oliveira Braga

; Pêgo-Fernandes, Paulo Manuel

Sao Paulo Medical Journal

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feb 2022, Volume 140 N. 1 Pages 153 - 159

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients’ demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

https://doi.org/10.1590/1516-3180.2021.0842.r1.13102021

Liming and Phosphating on growth, nutritional status and mycorrhizal colonization of yellow strawberry guava
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Benati, Jorge Atílio

; Navroski, Renan

; Barreto, Caroline Farias

; Fischer, Lucas de Oliveira

; Nava, Gilberto

; Franzon, Rodrigo Cezar

; Herter, Flavio Gilberto

; Costa, Murilo Dalla

Scientia Agricola

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2022, Volume 79 N. 5 elocation e20210068

Abstract: En | Text: En | PDF: En

ABSTRACT: Strawberry guava (Psidium cattleyanumm Sabine) is a species native to southern Brazil which exhibits significant potential for economic exploitation. The objective of this study was to evaluate the growth response of strawberry guava subjected to liming and phosphate fertilizer in pre-planting. The treatments consisted of four lime levels: 0; 33.3; 66.6 and 100 % of the dose needed to increase the pH in water to 6.0, and four phosphorus (P) doses: 0; 83.3; 166.6 and 250 kg ha–1 of P2O5. Plant growth parameters were evaluated for three years. In the years 2018 and 2019, the mineral composition of leaves, photosynthethic pigment indices and mycorrhizal colonization on strawberry guava roots were measured. Liming and phosphate fertilizer altered neither plant growth nor the photosynthetic pigment indices and there was no interaction between the factors studied and the remaining variables evaluated. However, liming promoted increases in the Ca and Mg shoot content, and the phosphate fertilizer increased the levels of shoot P in the third year of growth. Mycorrhizal colonization was stronger when the P soil levels were low, which could explain the absence of response to phosphate fertilization on plant growth for the first three years after planting.

https://doi.org/10.1590/1678-992x-2021-0068 139 downloads

Microbiological and microstructural analysis of indwelling bladder catheters and urinary tract infection prevention
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Sousa, Mateus Flávio

; Reis, Luís Guilherme Oliveira

; Baracho, Valéria da Silva

; Oliveira, Sara Luísa de

; Gomes, Gessiane de Fátima

; Lucas, Thabata Coaglio

Revista da Escola de Enfermagem da USP

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2022, Volume 56 elocation e20210552

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

RESUMO Objetivo: Analisar a parte microbiológica e microestrutural dos cateteres vesicais de demora e sua associação com a prevenção de infecção do trato urinário. Método: Transversal, entre junho e dezembro de 2020, em que foram coletadas 42 pontas cateteres vesicais de demora e amostras de urina estéril para análise de cristais em microscopia óptica e de biofilmes em microscopia eletrônica de varredura. Fez-se analise de cultura e especificação do tipo de bactérias. Resultados: Verificou-se que 35,71% das amostras apresentaram o biofilme maduro aderido à ponta do cateter. Destacaram-se biofilmes de Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium e Enterobacter cloacae. A presença do cristal magnésio-amônio-fosfato foi associada à presença de infecção do trato urinário e ao Proteus mirabilis. Verificou-se associação significativa (p = 0,001) entre o uso de antibiótico profilático versus a urocultura >105 UFC/mL. Conclusão: As análises contribuíram para a prática clínica, pois reforçam a elaboração de estratégias efetivas e monitoradas sobre culturas e prevenção de infecção do trato urinário associada ao cateter vesical de demora.

ABSTRACT Objective: To analyze the microbiological and microstructural part of indwelling urinary catheters and their association with urinary tract infection prevention. Method: This is a cross-sectional study, from June to December 2020, in which 42 indwelling urinary catheter tips and sterile urine samples were collected for analysis of crystals in optical microscopy and biofilms in scanning electron microscopy. Culture analysis and specification of the type of bacteria were performed. Results: It was found that 35.71% of the samples had mature biofilm adhered to the catheter tip. Biofilms of Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium and Enterobacter cloacae stood out. The presence of magnesium-ammonium-phosphate crystal was associated with the presence of urinary tract infection and with Proteus mirabilis. There was a significant association (p = 0.001) between the use of prophylactic antibiotics versus urine culture >105 CFU/mL. Conclusion: The analyzes contributed to clinical practice, as it reinforces the development of effective and monitored strategies on cultures and urinary tract infection prevention associated with indwelling urinary catheters.

RESUMEN Objetivo: Analizar la parte microbiológica y microestructural de los catéteres urinarios permanentes y su asociación con la prevención de la infección del tracto urinario. Método: Transversal, de junio a diciembre de 2020, en el que se recolectaron 42 puntas de sonda urinaria permanente y muestras de orina estéril para análisis de cristales en microscopía óptica y biopelículas en microscopía electrónica de barrido. Se realizaron análisis de cultivo y especificación del tipo de bacteria. Resultados: Se encontró que el 35,71% de las muestras presentaban biopelícula madura adherida a la punta del catéter. Se destacaron las biopelículas de Proteus mirabilis, Enterococcus faecalis, Staphylococcus epidermidis, Enterococcus faecium y Enterobacter cloacae. La presencia de cristales de fosfato de magnesio-amonio se asoció con la presencia de infección del tracto urinario y con Proteus mirabilis. Hubo una asociación significativa (p = 0,001) entre el uso de antibióticos profilácticos versus urocultivo >105 UFC/mL. Conclusión: Los análisis contribuyeron a la práctica clínica, ya que refuerzan el desarrollo de estrategias efectivas y monitoreadas sobre cultivos y prevención de la infección del tracto urinario asociada a los catéteres urinarios permanentes.

https://doi.org/10.1590/1980-220x-reeusp-2021-0552

Herbage accumulation and canopy structure during stockpiling of Marandu, Piatã, Xaraés, and Paiaguás brachiariagrass cultivars
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Santos, Manoel Eduardo Rozalino

; Moraes, Lucas Santos de

; Fernandes, Flávio Henrique de Oliveira

; Carvalho, Bruno Humberto Rezende

; Rocha, Gabriel de Oliveira

; Andrade, Carlos Mauricio Soares de

Pesquisa Agropecuária Brasileira

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2021, Volume 56 elocation e02207

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

Resumo: O objetivo deste trabalho foi comparar o acúmulo de forragem e as características estruturais de dosséis durante o período de diferimento das cultivares Marandu, Piatã, Xaraés e Paiaguás de Urochloa brizantha. O delineamento experimental foi inteiramente casualizado, com três repetições. O experimento foi repetido por dois anos (2017 e 2018), sob condição de corte mecânico, e o dossel foi diferido por 90 dias, de março a junho. No primeiro ano, a massa de forragem foi maior para as cultivares Xaraés e Paiaguás; porém, no segundo ano, Xaraés apresentou massa de forragem maior do que a das demais cultivares. O número de perfilhos vegetativos no final do período de diferimento foi maior para Paiaguás, contrariamente ao que foi observado para número de perfilhos reprodutivos. Já a taxa de acúmulo de forragem foi maior para as cultivares Paiaguás e Xaraés. O capim Paiaguás se destaca por sua alta taxa de acúmulo de forragem durante o período de diferimento e por seu maior número de perfilhos vegetativos e menor número de perfilhos reprodutivos do que os das outras cultivares.

Abstract: The objective of this work was to compare herbage accumulation and canopy structural characteristics during the stockpiling period of the Marandu, Piatã, Xaraés, and Paiaguás cultivars of Urochloa brizantha. The experimental design was completely randomized, with three replicates. The experiment was repeated for two years (2017 and 2018), under mechanical cutting conditions, and the canopies were stockpiled for 90 days, from March to June. In the first year, forage mass was higher for the Xaraés and Paiaguás cultivars; however, in the second year, Xaraés showed a forage mass higher than that of the other cultivars. The number of vegetative tillers at the end of the stockpiling period was higher for Paiaguás, contrary to what was observed for number of reproductive tillers. The herbage accumulation rate was higher for the Paiaguás and Xaraés cultivars. The Paiaguás grass stands out for its high herbage accumulation rate during the stockpiling period and for its higher number of vegetative tillers and lower number of reproductive tillers than that of the other cultivars.

https://doi.org/10.1590/s1678-3921.pab2021.v56.02207 46 downloads

Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study,
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Prata-Barbosa, Arnaldo

; Lima-Setta, Fernanda

; Santos, Gustavo Rodrigues dos

; Lanziotti, Vanessa Soares

; Castro, Roberta Esteves Vieira de

; Souza, Daniela Carla de

; Raymundo, Carlos Eduardo

; Oliveira, Felipe Rezende Caino de

; Lima, Lucio Flavio Peixoto de

; Tonial, Cristian Tedesco

; Colleti Jr., José

; Bellinat, Ana Paula Novaes

; Lorenzo, Vivian Botelho

; Zeitel, Raquel de Seixas

; Pulcheri, Lucas

; Costa, Fernanda Ciuffo Monte da

; La Torre, Fabíola Peixoto Ferreira

; Figueiredo, Elaine Augusta das Neves

; Silva, Thiago Peres da

; Riveiro, Paula Marins

; Mota, Isabele Coelho Fonseca da

; Brandão, Igor Bromonschenkel

; Azevedo, Zina Maria Almeida de

; Gregory, Simone Camera

; Boedo, Fernanda Raquel Oliveira

; Carvalho, Rosana Novais de

; Castro, Natália Almeida de Arnaldo Silva Rodriguez

; Genu, Daniel Hilário Santos

; Foronda, Flavia Andrea Krepel

; Cunha, Antonio José Ledo A.

; Magalhães-Barbosa, Maria Clara de

Jornal de Pediatria

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dec 2020, Volume 96 N. 5 Pages 582 - 592

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

Resumo Objetivo: Descrever as características clínicas de crianças e adolescentes internados em unidade de terapia intensiva com COVID-19 confirmada. Método: Estudo prospectivo, multicêntrico, observacional, em 19 unidades de terapia intensiva pediátrica. Foram incluídos pacientes entre um mês e 19 anos, admitidos consecutivamente (março a maio de 2020). As características demográficas, clínico-epidemiológicas, o tratamento e os resultados foram coletados. Os subgrupos foram comparados de acordo com as comorbidades, idade < 1 ano e necessidade de ventilação mecânica invasiva. Um modelo de regressão logística multivariável foi utilizado para preditores de gravidade. Resultados: Setenta e nove pacientes foram incluídos (10 com síndrome inflamatória multi-ssistêmica). Mediana de idade, quatro anos; 54% eram do sexo masculino (síndrome inflamatória multissistêmica, 80%); 41% tinham comorbidades (síndrome inflamatória multissistêmica, 20%). Febre (76%), tosse (51%) e taquipneia (50%) foram comuns nos dois grupos. Sintomas graves egastrointestinais e marcadores inflamatórios mais elevados foram mais frequentes na presença de síndrome inflamatória multissistêmica. Infiltrados intersticiais pulmonares foram comuns em ambos os grupos, mas o derrame pleural foi mais prevalente no grupo com síndrome inflamatória multissistêmica (43% vs. 14%). A ventilação mecânica invasiva foi utilizada em 18% (mediana 7,5 dias); antibióticos, oseltamivir e corticosteroides foram utilizados em 76%, 43% e 23%, respectivamente, mas não a hidroxicloroquina. A mediana do tempo de permanência na unidade de terapia intensiva pediátrica foi de 5 dias; duas mortes ocorreram (3%) no grupo não- síndrome inflamatória multissistêmica. Os pacientes com comorbidades eram mais velhos, e as comorbidades foram independentemente associadas à necessidade de ventilação mecânica invasiva(OR 5,5; IC95%, 1,43-21,12; P 0,01). Conclusões: Nas unidades de terapia intensiva pediátrica brasileiras, a COVID-19 apresentou baixa mortalidade, a idade inferior a um ano não foi associada a um pior prognóstico, os pacientes com síndrome inflamatória multissistêmica apresentaram sintomas mais graves, biomarcadores inflamatórios mais elevados e uma grande predominância no sexo masculino, mas apenas a presença de comorbidades e doenças crônicas foi um preditor independente de gravidade.

Abstract Objective: To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. Method: Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March-May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. Results: Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43-21.12; p = 0.01). Conclusions: In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.

https://doi.org/10.1016/j.jped.2020.07.002 2718 downloads

Plano de análise estatística para o estudo Balanced Solution versus Saline in Intensive Care Study (BaSICS)
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Damiani, Lucas Petri

; Cavalcanti, Alexandre Biasi

; Biondi, Rodrigo Santos

; Freitas, Flávio Geraldo Rezende de

; Figueiredo, Rodrigo Cruvinel

; Lovato, Wilson José

; Amêndola, Cristina Prata

; Serpa Neto, Ary

; Paranhos, Jorge Luiz da Rocha

; Veiga, Viviane Cordeiro

; Guedes, Marco Antonio Vieira

; Lúcio, Eraldo de Azevedo

; Oliveira Júnior, Lúcio Couto

; Lisboa, Thiago Costa

; Lacerda, Fabio Holanda

; Miranda, Tamiris Abait

; Maia, Israel Silva

; Grion, Cintia Magalhães Carvalho

; Machado, Flavia Ribeiro

; Zampieri, Fernando Godinho

Revista Brasileira de Terapia Intensiva

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dec 2020, Volume 32 N. 4 Pages 493 - 505

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

RESUMO Objetivo: Relatar o plano de análise estatística (primeira versão) para o estudo Balanced Solutions versus Saline in Intensive Care Study (BaSICS). Métodos: O estudo BaSICS é um ensaio multicêntrico fatorial e randomizado que avaliará os efeitos da administração dos fluidos Plasma-Lyte 148 em comparação com solução salina 0,9% como fluido de escolha em pacientes críticos, assim como os efeitos de uma velocidade de infusão lenta (333mL/hora) em comparação com uma velocidade de infusão rápida (999mL/hora) durante desafios com volume, em importantes desfechos do paciente. O tipo de fluido será mantido cego para os investigadores, pacientes e nas análises. Não será possível, entretanto, ocultar dos investigadores a velocidade de infusão, mas os procedimentos de análise serão mantidos cegos quanto a esse aspecto. Resultados: O estudo BaSICS terá como parâmetro primário a mortalidade em 90 dias, que será testada com utilização de modelos de risco proporcional de Cox de efeitos mistos, considerando os centros de estudo como variável randômica (modelos de fragilidade) ajustada por idade, disfunção de órgãos e tipo de admissão. Os parâmetros secundários importantes incluem terapia de substituição renal até 90 dias, insuficiência renal aguda, disfunção de órgãos nos dias 3 e 7 e dias sem ventilação mecânica em 28 dias. Conclusão: Este artigo fornece detalhes referentes à primeira versão do plano de análise estatística para o estudo BaSICS e orientará a análise do estudo após a conclusão do seguimento.

Abstract Objective: To report the statistical analysis plan (first version) for the Balanced Solutions versus Saline in Intensive Care Study (BaSICS). Methods: BaSICS is a multicenter factorial randomized controlled trial that will assess the effects of Plasma-Lyte 148 versus 0.9% saline as the fluid of choice in critically ill patients, as well as the effects of a slow (333mL/h) versus rapid (999mL/h) infusion speed during fluid challenges, on important patient outcomes. The fluid type will be blinded for investigators, patients and the analyses. No blinding will be possible for the infusion speed for the investigators, but all analyses will be kept blinded during the analysis procedure. Results: BaSICS will have 90-day mortality as its primary endpoint, which will be tested using mixed-effects Cox proportional hazard models, considering sites as a random variable (frailty models) adjusted for age, organ dysfunction and admission type. Important secondary endpoints include renal replacement therapy up to 90 days, acute renal failure, organ dysfunction at days 3 and 7, and mechanical ventilation-free days within 28 days. Conclusion: This manuscript provides details on the first version of the statistical analysis plan for the BaSICS trial and will guide the study’s analysis when follow-up is finished.

https://doi.org/10.5935/0103-507x.20200081 561 downloads

Atualização das Diretrizes Brasileiras de Valvopatias – 2020
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Tarasoutchi, Flavio

; Montera, Marcelo Westerlund

; Ramos, Auristela Isabel de Oliveira

; Sampaio, Roney Orismar

; Rosa, Vitor Emer Egypto

; Accorsi, Tarso Augusto Duenhas

; Santis, Antonio de

; Fernandes, João Ricardo Cordeiro

; Pires, Lucas José Tachotti

; Spina, Guilherme S.

; Vieira, Marcelo Luiz Campos

; Lavitola, Paulo de Lara

; Ávila, Walkiria Samuel

; Paixão, Milena Ribeiro

; Bignoto, Tiago

; Togna, Dorival Júlio Della

; Mesquita, Evandro Tinoco

; Esteves, William Antônio de Magalhães

; Atik, Fernando

; Colafranceschi, Alexandre Siciliano

; Moises, Valdir Ambrósio

; Kiyose, Alberto Takeshi

; Pomerantzeff, Pablo M. A.

; Lemos, Pedro A.

; Brito Junior, Fabio Sandoli de

; Weksler, Clara

; Brandão, Carlos Manuel de Almeida

; Poffo, Robinson

; Simões, Ricardo

; Rassi, Salvador

; Leães, Paulo Ernesto

; Mourilhe-Rocha, Ricardo

; Pena, José Luiz Barros

; Jatene, Fabio Biscegli

; Barbosa, Márcia de Melo

; Abizaid, Alexandre

; Ribeiro, Henrique Barbosa

; Bacal, Fernando

; Rochitte, Carlos Eduardo

; Fonseca, José Honório de Almeida Palma da

; Ghorayeb, Samira Kaissar Nasr

; Lopes, Marcelo Antonio Cartaxo Queiroga

; Spina, Salvador Vicente

; Pignatelli, Ricardo H.

; Saraiva, José Francisco Kerr

Arquivos Brasileiros de Cardiologia

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oct 2020, Volume 115 N. 4 Pages 720 - 775

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

https://doi.org/10.36660/abc.20201047 17824 downloads

10.

Increased levels of reactive oxygen species in platelets and platelet-derived microparticles and the risk of respiratory failure in HIV/AIDS patients
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Gama, Wellington Mota

; Oliveira, Lucas Barbosa

; Chaves, Yury Oliveira

; Ribeiro, Flavio

; Almeida, Taynná Vernalha Rocha

; Baptista, Barbara Jose Antunes

; Santana, Monique Freire

; Ferreira, Luis Carlos

; Lacerda, Marcus Vinicius Guimaraes

; Nogueira, Paulo Afonso

Memórias do Instituto Oswaldo Cruz

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2020, Volume 115 elocation e200082

Abstract: En | Text: En | PDF: En

Respiratory failure (RF) is the main cause of hospital admission in HIV/AIDS patients. This study assessed comorbidities and laboratory parameters in HIV/AIDS inpatients with RF (N = 58) in relation to those without RF (N = 36). Tuberculosis showed a huge relative risk and platelet counts were slightly higher in HIV/AIDS inpatients with RF. A flow cytometry assay for reactive oxygen species (ROS) showed lower levels in platelets of these patients in relation to the healthy subjects. However, when stimulated with adrenaline, ROS levels increased in platelets and platelet-derived microparticles of HIV/AIDS inpatients, which may increase the risk of RF during HIV and tuberculosis (HIV-TB) coinfection.

https://doi.org/10.1590/0074-02760200082 503 downloads

11.

How different soil moisture levels affect the microbial activity
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Denardin, Luiz Gustavo de Oliveira

; Alves, Lucas Aquino

; Ortigara, Cícero

; Winck, Bruna

; Coblinski, João Augusto

; Schmidt, Marcelo Raul

; Carlos, Filipe Selau

; Toni, Cézar Augusto Gama de

; Camargo, Flávio Anastácio de Oliveira

; Anghinoni, Ibanor

; Clay, David

Ciência Rural

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2020, Volume 50 N. 6 elocation e20190831

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

RESUMO: Os solos de várzea são caracterizados pela alta suscetibilidade à saturação por água. Esta condição anaeróbica é geralmente encontrada em solos arrozeiros e altera o processo de decomposição dos compostos orgânicos do solo. O objetivo deste estudo foi avaliar a atividade microbiana e enzimática de um solo de várzea sob diferentes teores de umidade no solo. Um Planossolo historicamente cultivado com arroz irrigado foi utilizado para avaliar a atividade microbiana e enzimática em tratamentos com diferentes níveis de umidade do solo, sendo: i) 60% de capacidade de campo (CC) (60%CC); ii) 100% da CC (100%CC); iii) solo inundado com uma camada de água de 2 cm acima da superfície do solo; e iv) solo mantido a 60%CC com inundação após 29 dias da incubação. A maior atividade microbiana do solo foi observada no tratamento 100%CC, sendo 41% maior que o tratamento 60%CC e 2% maior que tratamento inundado. Os dados da atividade enzimática pela hidrólise do diacetato de fluoresceína (FDA) corroboraram a maior liberação de CO2 nos tratamentos com maior umidade do solo. Diferentemente dos resultados encontrados, as principais metodologias para avaliação da atividade microbiana ainda recomendam manter o solo com umidade próxima a 60% da CC. No entanto, em solos de várzea com históricos de cultivos de arroz, a manutenção de umidade próxima a 60% da CC pode limitar a atividade microbiana. A técnica de respiração do solo pode ser usada para avaliar a atividade microbiana em condições de solo inundado. No entanto, mais estudos devem ser realizados para entender o efeito do histórico de cultivo na comunidade microbiana nesses ambientes.

ABSTRACT: The lowland soils are characterized by high susceptibility to water saturation. This anaerobic condition is usually reported in paddy fields and alters the decomposition process of soil organic compounds. The aim of this study was to evaluate the soil microbial and enzymatic activity of a lowland soil at different soil moisture contents. A poorly drained Albaqualf cultivated with irrigated rice was used to evaluate microbial and enzymatic activity in treatments with different levels of soil moisture, being: i) 60% of field capacity (FC) (60%FC); ii) 100% of FC (100%FC); iii) flooded soil with a 2 cm water layer above soil surface, and iv) soil kept at 60%FC with late flood after 29 days the incubation. The greater soil microbial activity was observed in the 100%FC treatment, being 41% greater than 60%FC treatment and only 2% higher than flooded treatment. The enzymatic activity data by fluorescein diacetate (FDA) hydrolysis corroborated the higher CO2 release in treatments with higher soil moisture content. Differently from the results reported, the main methodologies to evaluate microbial activity still recommend maintenance of the soil with a moisture content close to 60% of the FC. However, in lowland soil with history of frequent paddy fields, the maintenance of moisture close to 60% of the FC can limit the microbial activity. The soil respiration technique can be used to evaluate the microbial activity in flooded soil conditions. However, further studies should be conducted to understand the effect of the cultivation history on the microbial community of these environments.

https://doi.org/10.1590/0103-8478cr20190831 1875 downloads

12.

Extracorporeal Membrane Oxygenation and Lung Transplantation: Initial Experience at a Single Brazilian Center
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Pola-dos-Reis, Flávio

; Samano, Marcos Naoyuki

; Abdalla, Luis Gustavo

; Carvalho, Guilherme Vieira Soares de

; Fernandes, Lucas Matos

; Gomes-Júnior, Oswaldo

; Carraro, Rafael Medeiros

; Camargo, Priscila Cilene Leon Bueno de

; Teixeira, Ricardo Henrique Oliveira Braga

; Afonso-Júnior, José Eduardo

; Pêgo-Fernandes, Paulo Manoel

Clinics

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2020, Volume 75 elocation e1698

Abstract: En | Text: En | PDF: En

OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.

https://doi.org/10.6061/clinics/2020/e1698 356 downloads

13.

RECOMMENDATIONS FOR INVASIVE PROCEDURES IN PATIENTS WITH DISEASES OF THE LIVER AND BILIARY TRACT: REPORT OF A JOINT MEETING OF THE BRAZILIAN SOCIETY OF HEPATOLOGY (SBH), BRAZILIAN SOCIETY OF DIGESTIVE ENDOSCOPY (SOBED) AND BRAZILIAN SOCIETY OF INTERVENTIONAL RADIOLOGY AND ENDOVASCULAR SURGERY (SOBRICE)
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SCHIAVON, Leonardo de Lucca

; EJIMA, Flávio Hayato

; MENEZES, Marcos Roberto de

; BITTENCOURT, Paulo Lisboa

; MOREIRA, Aírton Mota

; FARIAS, Alberto Queiroz

; CHAGAS, Aline Lopes

; ASSIS, André Moreira de

; MATTOS, Ângelo Zambam de

; SALOMÃO, Bruno Chaves

; TERRA, Carlos

; MARTINS, Fernanda Prata Borges

; CARNEVALE, Francisco Cesar

; REZENDE, Guilherme Ferreira da Motta

; PAULO, Gustavo Andrade de

; PEREIRA, Gustavo Henrique Santos

; MOTTA-LEAL-FILHO, Joaquim Maurício da

; MENESES, Juliana de

; COSTA, Lucas Santana Nova da

; CARNEIRO, Marcos de Vasconcelos

; ÁLVARES-DA-SILVA, Mário Reis

; SOARES, Mayra Veloso Ayrimoraes

; PEREIRA, Osvaldo Ignácio

; XIMENES, Rafael Oliveira

; DURANTE, Renata Filardi Simiqueli

; FERREIRA, Valério Alves

; LIMA, Vinícius Machado de

Arquivos de Gastroenterologia

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jun 2019, Volume 56 N. 2 Pages 213 - 231

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

RESUMO As doenças do fígado e das vias biliares são causas comuns de morbidade e mortalidade. Procedimentos invasivos com finalidade diagnóstica e terapêutica são frequentemente recomendados nos casos de doenças hepatobiliares. O reconhecimento das indicações e limitações das técnicas comumente empregadas é crucial para uma adequada seleção dos pacientes, maximizando os resultados positivos e reduzindo o risco de complicações. Em 2018, a Sociedade Brasileira de Hepatologia (SBH), em colaboração com a Sociedade Brasileira de Radiologia Intervencionista e Cirurgia Endovascular (SOBRICE) e a Sociedade Brasileira de Endoscopia Digestiva (SOBED) realizaram um encontro exclusivamente voltado para a discussão dos procedimentos invasivos nas doenças hepatobiliares. Este texto resume as principais recomendações discutidas durante o evento, e tem a intenção de auxiliar clínicos, gastroenterologistas, hepatologistas, radiologistas e endoscopistas no uso adequado dos procedimentos invasivos para manejo de pacientes com doenças hepatobiliares.

ABSTRACT Liver and biliary tract diseases are common causes of morbidity and mortality worldwide. Invasive procedures are usually performed in those patients with hepatobiliary diseases for both diagnostic and therapeutic purposes. Defining proper indications and restraints of commonly used techniques is crucial for proper patient selection, maximizing positive results and limiting complications. In 2018, the Brazilian Society of Hepatology (SBH) in cooperation with the Brazilian Society of Interventional Radiology and Endovascular surgery (SOBRICE) and the Brazilian Society of Digestive Endoscopy (SOBED) sponsored a joint single-topic meeting on invasive procedures in patients with hepatobiliary diseases. This paper summarizes the proceedings of the aforementioned meeting. It is intended to guide clinicians, gastroenterologists, hepatologists, radiologists, and endoscopists for the proper use of invasive procedures for management of patients with hepatobiliary diseases.

https://doi.org/10.1590/s0004-2803.201900000-42 2181 downloads

14.

Poly (Methyl Methacrylate)-SiC Nanocomposites Prepared Through in Situ Polymerization
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Tommasini, Flávio James

; Ferreira, Leonardo da Cunha

; Tienne, Lucas Galhardo Pimenta

; Aguiar, Vínícius de Oliveira

; Silva, Marcelo Henrique Prado da

; Rocha, Luiz Felipe da Mota

; Marques, Maria de Fátima Vieira

Materials Research

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2018, Volume 21 N. 6 elocation e20180086

Abstract: En | Text: En | PDF: En

In this study, polymeric nanocomposites based on poly(methyl methacrylate) (PMMA) and silicon carbide (SiC) nanoparticles were prepared by radical mass polymerization in the presence of filler. Nanoparticles of SiC with and without surface treatment with organosilane were obtained .The nanocomposites were characterized by X-ray fluorescence (XRF), infrared spectroscopy (FTIR), thermogravimetry (TGA) and Field Emission Gun Scanning Electron Microscopy (FEG SEM) with an energy dispersive x-ray spectroscopy (EDS) detector. The produced nanocomposites showed well-dispersed SiC incorporation in the PMMA matrix. The results pointed that the surface treatment on SiC fillers was successful on enhancing the interaction between the organic matrix and the inorganic filler.

https://doi.org/10.1590/1980-5373-mr-2018-0086 3973 downloads

15.

Prevalence of chronic kidney disease in a city of southeast Brazil
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Alves, Lucas Ferreira

; Abreu, Thalles Trindade de

; Neves, Núbia Chouchounova Silva

; Morais, Flávio Augusto de

; Rosiany, Isabela Lourdes

; Oliveira Júnior, Wander Valadares de

; Pinto, Sérgio Wyton Lima

; Otoni, Alba

Brazilian Journal of Nephrology

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jun 2017, Volume 39 N. 2 Pages 126 - 134

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

Resumo Introdução: A doença renal crônica (DRC) é um impactante problema de Saúde Pública nos dias atuais no Brasil e no mundo. Objetivo: Investigar a prevalência estimada de doença renal crônica em pacientes diabéticos e hipertensos de alto risco cardiovascular cadastrados no Hiperdia em um município do sudeste do Brasil. Métodos: Estudo transversal realizado entre maio de 2014 e agosto de 2015. Incluídos de forma aleatória 243 pacientes com diabetes e/ou hipertensão de alto risco cardiovascular que foram referenciados da atenção básica em saúde para o Hiperdia. A DRC foi classificada com base na causa, na categoria da taxa de filtração glomerular (TFG) e razão albumina/creatinina (RAC). Foram consideradas anormalidades TFG < 60 mL/min/1,73m2 e/ou RAC ≥ 30 mg/g. Os dados foram coletados em dois momentos: no início do estudo e seis meses após a primeira coleta. Resultados: Dos 243 pacientes, 89 (36,6%) apresentaram alteração nos marcadores de função renal na primeira coleta. Destes, 60 pacientes apresentaram TFG < 60 mL/min/1,73 m2 e em 25 a TFG foi < 45 mL/min/1,73 m2. A RAC foi ≥ 30 mg/g em 43 pacientes e, em oito destes, os valores foram > 1000 mg/g. Em 15 pacientes foram encontradas ambas as alterações estudadas. Dos 89 participantes com alteração dos marcadores de função renal na primeira coleta, 63 realizaram a segunda coleta e 42 mantiveram as alterações, sendo diagnosticados com DRC. Nenhum desses pacientes tinha o conhecimento prévio desse diagnóstico e da necessidade da consulta com o nefrologista. Conclusão: A prevalência de DRC foi de 17,3% da doença na população estudada.

Abstract Introduction: Chronic kidney disease (CKD) is a worldwide public health alarming problem. Objective: This study investigated the estimated prevalence of kidney disease in diabetic and high-risk hypertensive patients to cardiovascular disease registered in Hiperdia program of a city of southeast of Brazil. Methods: It is a transversal study conducted between May 2014 and August 2015. The study has included randomly 243 diabetic and high-risk hypertensive patients to cardiovascular disease which were originally referred from primary health care to the Hiperdia. CKD was classified based on cause, Glomerular Filtration Rate (GFR), and albumin creatinine ratio (ACR). Were considered abnormalities GFR < 60 mL/min/1.73m2 and/or ACR ≥ 30 mg/g. Results: Of the 243 patients, 89 (36.6%) showed alterations in renal function markers in the first collection. Of these, 60 patients had a GFR < 60 mL/min/1.73 m2 and 25 the GFR was < 45 mL/min/1.73 m2. The ACR was ≥ 30 mg/g in 43 patients and eight of the values were > 1000 mg/g. In 15 patients studied were found both changes. Of the 89 participants with abnormal renal function markers in the first collection 63 held the second test and 42 kept the changes being diagnosed with CKD. None of these patients had prior knowledge of the diagnosis of kidney disease and the need for consultation with the nephrologist. Conclusion: The prevalence of CKD was 17.3% of disease in the population studied.

https://doi.org/10.5935/0101-2800.20170030 5429 downloads

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