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Resumo Introdução: A neoplasia do esófago associa-se a disfagia e perda ponderal, sendo a desnutrição agravada pelo tratamento multimodal. Objetivo: Avaliar o impacto da colocação de gastrostomia percutânea endoscópica (PEG) no estado nutricional de doentes com neoplasia do esófago propostos para quimiorradioterapia (QRT). Métodos: Estudo comparativo com braço prospetivo e contro-lo retrospetivo. Incluídos doentes com neoplasia do esófago propostos para QRT definitiva ou neoadjuvante, com disfagia grau >2 e/ou perda de peso >10%. Colocada PEG (método pull) antes do início de QRT. Avaliada se-menteira tumoral por zaragatoa e histologia. Como controlo, utilizada coorte histórica de doentes sem PEG. Registo ACTRN12616000697482. Resultados: 29 doentes (grupo intervenção, GI) foram comparados com 30 controlos (GC). Sem diferença significativa nos principais outcomes: perda de peso durante a QRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (p = 0.503); mortalidade aos 6 meses após QRT ou cirurgia 17.2% versus 26.7% (p = 0.383); taxa de complicações perioperatórias 54.5% versus 55.6% (p = 1.000); admissões hospitalares não planeadas 34.5% versus 40.0% (p = 0.661). No GC, durante a QRT, 14 (46.7%) apresentaram disfagia graus 3-4, dos quais 12 necessitaram de nutrição por sonda nasogástrica (n = 10), gastrostomia cirúrgica (n = 1) ou dilatação esofágica (n = 1). No GI, 89.7% utilizaram a PEG durante QRT, em algum momento de forma exclusiva em 51.7%. Os eventos adversos foram sobretudo minor (n = 12; 41.4%), sobretudo infeções tardias periestoma; 1 complicação major (laparotomia exploradora por suspeita de interposição de cólon, não confirmada). Sem evidência citológica ou histológica de sementeira tumoral no estoma. Conclusão: Embora não se tenham observado diferenças na perda de peso, complicações cirúrgicas e mortalidade entre grupos, metade dos utentes necessitou de nutrição entérica exclusiva, tornando a colocação de PEG uma alternativa a considerar.

Abstract Introduction: Oesophageal cancer causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment. Aim: The aim of the study was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT). Methods: A comparative study with a prospective arm and a historical cohort was conducted. Oesophageal cancer patients undergoing CRT with dysphagia grade >2 and/or weight loss <10% were submitted to PEG-tube placement (pull method) before CRT. Stoma seeding was evaluated through a swab obtained after placement and, in surgical patients, the resected stoma. A matched historical cohort without PEG placement was used as control (trial ACTRN12616000697482). Results: Twenty-nine patients (intervention group, IG) were compared to 30 patients (control group, CG). Main outcomes did not differ in the IG and CG: weight loss during CRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (p = 0.503); 6-month mortality after CRT or surgery 17.2% versus 26.7% (p = 0.383); perioperative complication rate 54.5% versus 55.6% (p = 1.000); unplanned hospital admissions 34.5% versus 40.0% (p = 0.661). In the CG, during CRT, 14 (46.7%) patients presented with dysphagia grade 3-4, of whom 12 required nasogastric tube feeding (n = 10), surgical gastrostomy (n = 1), and oesophageal dilation (n = 1). In the IG, 89.7% used the PEG tube during CRT, sometimes exclusively in 51.7%. Adverse events were mainly minor (n = 12, 41.4%), mostly late peristomal infections, 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). There was no cytological or histological evidence of stomal tumour seeding. Conclusion: Weight loss, hospital admissions, surgical complications, and mortality were identical in oesophageal cancer patients referred for CRT, regardless of prophylactic PEG. However, half of the patients required exclusive enteral nutritional support, making PEG-tube placement an alternative to consider.

https://doi.org/10.1159/000525853

Análisis de la disponibilidad a pagar por carne de cerdo libre de antibióticos, un enfoque de Experimentos de Elección
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Hernández Valdivia, Miriam Susana

; Melo Guerrero, Enrique

; Valdivia Alcalá, Ramón

; Valenzuela Núñez, Luis Manuel

; Ortiz, Juan Hernández

; Damián, Miguel Ángel Martínez

Revista mexicana de ciencias pecuarias

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sep 2023, Volume 14 N. 3 Pages 658 - 671

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

Resumen Los problemas de salud y la producción de alimentos diferenciados influyen en las decisiones de los consumidores y los orienta a optar por productos con características organolépticas particulares. El objetivo de esta investigación fue estimar las preferencias y disposición a pagar por carne de cerdo libre de antibióticos en el municipio de Texcoco, Estado de México, para determinar la existencia o no de un incentivo para la comercialización de carne de este tipo. Se utilizó el Método de Experimentos de Elección Discreta. Los atributos considerados en el diseño fueron: color, contenido de grasa y presencia de antibióticos. Para ello se aplicó una encuesta a 196 consumidores. Los resultados se analizaron con el software NLOGIT 4.0, mediante un modelo logit mixto. El atributo más valorado fue contenido de antibióticos, lo que significa que los entrevistados estarían dispuestos a pagar una prima adicional de $30.65 MXN/kg de carne de cerdo libre de antibióticos. Se encontró que, a mayor ingreso y a mayor frecuencia de consumo en carne de cerdo, mayor disposición a pagar una prima adicional por carne libre de antibióticos. Se determinó una DAP de $5.78 MXN por carne con grasa normal y de $3.73 MXN más por carne de color rojo. Los consumidores de carne de cerdo del oriente del Estado de México estarían dispuestos a pagar una prima adicional por carne de cerdo libre de antibióticos y aspectos de calidad como contenido de grasa y color.

Abstract Health issues and the production of differentiated foods influence the consumers' decisions and lead them to opt for products with particular organoleptic characteristics. The objective of this research was to estimate the preferences and willingness to pay for antibiotic-free pork in the municipality of Texcoco, State of Mexico, in order to determine the existence or absence of an incentive for the commercialization of antibiotic-free pork. The Discrete Choice Method of Experiments was used. The attributes considered in the design were: color, fat content, and presence of antibiotics. A survey of 196 consumers was carried out for this purpose. The results were analyzed with the NLOGIT 4.0 software, using a mixed logit model. The most valued attribute was antibiotic content, which means that respondents would be willing to pay an additional premium of $30.65 MXN/kg for antibiotic-free pork. It was found that the higher the income and the higher the frequency of pork consumption, the greater the willingness to pay an additional premium for antibiotic-free meat. A WTP of $5.78 MXN was determined for meat with normal fat, and of $3.73 MXN for red meat. Pork consumers in the eastern part of the State of Mexico would be willing to pay an additional premium for antibiotic-free pork and for such quality aspects as fat content and color.

https://doi.org/10.22319/rmcp.v14i3.6062

Dinámica del uso de suelo y vegetación en paisajes altamente modificados por actividades agropecuarias en el sur de México
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Maza-Villalobos, Susana

; Alvarado Sosa, Edith

; Arriaza Rodríguez, Ana Deysi

; Infante, Francisco

; Castillo-Santiago, Miguel Ángel

Botanical Sciences

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jun 2023, Volume 101 N. 2 Pages 374 - 386

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

Abstract Background: The identification of land-uses (e.g., crop types) that generate the loss of different vegetation types, degradation trends, and biodiversity loss has been poorly explored in most studies on land-use dynamics in agricultural landscapes. Questions: What areas are occupied by the different land-use types and vegetation? What are the permanence, rate of change, and loss rate of the different land-use types and vegetation? What kind of land-uses and vegetation is driving the observed changes? Study area and dates: The Soconusco region of Chiapas, Mexico. Analysis period, 2000-2017. Methods: Land-use cover maps were created using Google Earth images and employing the image interpretation method and field verification. Matrixes of permanence and transition were created, and relative change rates and loss area were calculated for the different land-uses types and vegetation. Results: Agricultural activity and natural vegetation were the categories with the largest surface and permanence. The agricultural activity showed the highest annual rates of gain, and it was promoted by the expansion of economically important crops, mainly mango and the African oil palm. Natural vegetation had the highest annual loss rate, mainly for tular and secondary vegetation that changed to agricultural areas. Conclusions: Considering the limited secondary forest formation and the high permanence and increment of agricultural areas, it is important to consider actions that diversify these agricultural landscapes.

Resumen Antecedentes: La identificación de los usos de suelo particulares (e.g., tipo de cultivo) que generan la pérdida de los diferentes tipos de vegetación, las tendencias de degradación y la pérdida de biodiversidad ha sido limitadamente explorada en estudios sobre dinámica del uso de suelo en paisajes agropecuarios. Preguntas: ¿Cuáles son las superficies ocupadas por los diferentes usos de suelo y vegetación? ¿cuál es la permanencia, tasa de cambio y tasa de pérdida de los diferentes usos de suelo y vegetación? ¿qué usos de suelo dirigen los cambios observados? Área de estudio y fechas: Soconusco, Chiapas, México. Período: 2000-2017. Métodos: Se usaron imágenes de Google Earth, el método de fotointerpretación y la verificación en campo para generar mapas de cambio de uso de suelo y vegetación. Se crearon matrices de permanencia/transición y se calcularon tasas de cambio relativo y de pérdida de superficie para los diferentes usos de suelo y vegetación. Resultados: La zona de actividad agropecuaria y la vegetación natural fueron las categorías con mayor superficie y permanencia. La mayor tasa de ganancia anual de superficie se observó en la zona de actividad agropecuaria, influenciada por el incremento de cultivos de importancia económica (mango y palma africana). La mayor tasa de pérdida anual se registró en la vegetación natural, y fue dirigida principalmente por la transición de tular y de vegetación secundaria hacia zonas agropecuarias. Conclusiones: Ante la limitada formación de vegetación secundaria y la alta permanencia/incremento de zonas agropecuarias, es importante considerar acciones que diversifiquen estos paisajes agropecuarios.

https://doi.org/10.17129/botsci.3148

DECANNULATION IN PATIENTS UNDERGOING HEAD AND NECK CANCER SURGERY: RAPID SYSTEMATIC REVIEW
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Frade, Ana Inês de Almeida

; Moreira, José Manuel Afonso

; Pires, Lucinda de Lurdes Ramalho

; Duarte, Marta I. S. Mendes Esteves

; Cunha, Tiago Filipe Santos

; Miguel, Susana Sofia Abreu

Revista Onconews

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jun 2023, N. 46 elocation e0138

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

Abstract: Introduction: Tracheotomy is commonly used in patients with head and neck cancer undergoing major surgery. Purpose: To identify the nursing interventions in the safe decannulation process in patients undergoing head and neck cancer surgery. Methods: Rapid systematic review on MEDLINE and CIHNAL, January 2023. Results: Seven studies met the inclusion criteria. The nursing interventions was grouped into before, during and after the decannulation. Conclusion: Literature review shows the need for a structured nursing process supporting safe decannulation. The team must ensure that the reason for performing the tracheotomy were resolved and that no anesthetic or surgical procedure is foreseen shortly. These are essential factors associated with the state of consciousness, deflated tube cuff and tube cap tolerance prior decannulation. The literature highlights the need for experienced teams, including nurses, to ensure the safe decannulation process.

Resumo: Introdução: A traqueostomia é habitualmente utilizada em doentes com cancro de cabeça e pescoço submetidos a cirurgias major. Objetivo: Identificar as intervenções de enfermagem no processo de remoção da cânula com segurança em doentes submetidos a cirurgia oncológica de cabeça e pescoço. Métodos: Revisão sistemática rápida no MEDLINE e CINHAL, janeiro de 2023. Resultados: Sete estudos preencheram os critérios de inclusão. As intervenções de enfermagem foram agrupadas em: antes, durante e após a remoção da cânula. Conclusão: A revisão da literatura mostra a necessidade de um processo de enfermagem estruturado que apoie a remoção segura da cânula. A equipa deve garantir que o motivo da realização da traqueotomia esteja resolvido e que nenhum procedimento anestésico ou cirúrgico esteja previsto para breve. Estes são alguns dos fatores essenciais, associados ao estado de consciência, cuff desinsuflado e tolerância à oclusão da cânula de traqueotomia, antes da sua remoção. A literatura destaca a necessidade de equipas experientes, incluindo enfermeiros, para garantir que o processo de remoção da cânula seja seguro.

https://doi.org/10.31877/on.2023.46.04

Cap-Assisted Endoscopic Mucosal Resection for Rectal Neuroendocrine Tumors: An Effective Option
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João, Mafalda

; Alves, Susana

; Areia, Miguel

; Elvas, Luís

; Brito, Daniel

; Saraiva, Sandra

; Martins, Raquel

; Cadime, Ana Teresa

GE-Portuguese Journal of Gastroenterology

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apr 2023, Volume 30 N. 2 Pages 25 - 32

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

Abstract Introduction: The incidence of rectal neuroendocrine tumors (r-NETs) is increasing, and most small r-NETs can be treated endoscopically. The optimal endoscopic approach is still debatable. Conventional endoscopic mucosal resection (EMR) leads to frequent incomplete resection. Endoscopic submucosal dissection (ESD) allows higher complete resection rates but is also associated with higher complication rates. According to some studies, capassisted EMR (EMR-C) is an effective and safe alternative for endoscopic resection of r-NETs. Aims: This study aimed to evaluate the efficacy and safety of EMR-C for r-NETs ≤10 mm without muscularis propria invasion or lymphovascular infiltration. Methods: Single-center prospective study including consecutive patients with r-NETs ≤10 mm without muscularis propria invasion or lymphovascular invasion confirmed by endoscopic ultrasound (EUS), submitted to EMR-C between January 2017 and September 2021. Demographic, endoscopic, histopathologic, and follow-up data were retrieved from medical records. Results: A total of 13 patients (male: 54%; n = 7) with a median age of 64 (interquartile range: 54-76) years were included. Most lesions were located at the lower rectum (69.2%, n = 9), and median lesion size was 6 (interquartile range: 4.5-7.5) mm. On EUS evaluation, 69.2% (n = 9) of tumors were limited to muscularis mucosa. EUS accuracy for the depth of invasion was 84.6%. We found a strong correlation between size measurements by histology and EUS (r = 0.83, p < 0.01). Overall, 15.4% (n = 2) were recurrent r-NETs and had been pretreated by conventional EMR. Resection was histologically complete in 92% (n = 12) of cases. Histologic analysis revealed grade 1 tumor in 76.9% (n = 10) of cases. Ki-67 index was inferior to 3% in 84.6% (n = 11) of cases. The median procedure time was 5 (interquartile range: 4-8) min. Only 1 case of intraprocedural bleeding was reported and was successfully controlled endoscopically. Follow-up was available in 92% (n = 12) of cases with a median follow-up of 6 (interquartile range: 12-24) months with no evidence of residual or recurrent lesion on endoscopic or EUS evaluation. Conclusion: EMR-C is fast, safe, and effective for resection of small r-NETs without high-risk features. EUS accurately assesses risk factors. Prospective comparative trials are needed to define the best endoscopic approach.

Resumo Introdução: Os tumores neuroendócrinos do reto (r-NETs) apresentam incidência crescente. A maioria dos tumores de pequenas dimensões pode ser excisada endoscopicamente, no entanto, a abordagem ótima é controversa. A mucosectomia convencional associa-se, frequentemente, a resseção endoscópica incompleta. A disseção endoscópica submucosa (ESD) permite elevadas taxas de resseção completa, mas é tecnicamente complexa e associa-se a maior número de complicações. Alguns estudos sugerem a mucosectomia assistida por cap (EMR-C) como uma alternativa eficaz e segura. Objetivo: Este estudo pretendeu avaliar a eficácia e segurança da mucosectomia com cap na resseção de r-NETs com dimensões ≤10 mm, sem invasão da muscularis própria nem infiltração linfovascular. Material e Métodos: Estudo prospetivo unicêntrico incluindo consecutivamente r-NETs com ≤10 mm, sem invasão da muscularis própria ou linfovascular confirmada em ultrassonografia endoscópica (EUS), submetidos a mucosectomia assistida cap entre janeiro de 2017 e setembro de 2021. Colheita de dados demográficos, clínicos e histopatológicos através de registos médicos eletrónicos. Resultados: Incluídos 13 doentes (género masculino: 54%; n = 7) com idade mediana de 64 (intervalo interquartil [IIQ]: 54-76) anos. A maioria das lesões localizava-se no reto inferior (69.2%; n = 9) e apresentava tamanho mediano de 6 (IIQ: 4.5-7.5) mm. Na avaliação por EUS, 69.2% (n = 9) encontravam-se limitados à muscularis mucosa. A acuidade da EUS na avaliação do envolvimento das camadas da parede retal foi de 84.6% e o tamanho avaliado por EUS correlacionou-se fortemente com o medido na histologia (r = 0.83, p < 0.01). Dois casos (15.4%) corresponderam a recorrências de mucosectomias convencionais prévias. A resseção foi macroscópica e histologicamente completa em 92% (n = 12) dos casos. A análise histológica revelou 76.9% (n = 10) tumores de grau 1. O índice Ki-67 foi inferior a 3% em 84.6% (n = 11) dos casos. O tempo mediano de procedimento foi 5 (IIQ: 4-8) minutos. Verificou-se apenas um caso de hemorragia intraprocedimento resolvida endoscopicamente. O seguimento de 92% dos casos (n = 12) com mediana de 6 (IIQ:12-24) meses não revelou lesão residual ou recorrên-cia em avaliações endoscópica e ultrassonográfica. Discussão/Conclusão: A EMR-C é uma técnica endoscópica segura, rápida e efetiva para a resseção de r-TNEs pequenos sem fatores de alto risco. A EUS apresenta elevada acuidade na avaliação dos fatores de risco. Estudos comparativos prospetivos são necessários para estabelecimento da abordagem endoscópica mais profícua.

https://doi.org/10.1159/000525964

Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina
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Vizcaychipi, Katherina A.

; Giménez, Mabel D.

; Casas, Natalia

; Lloveras, Susana

; Cicuttin, Gabriel L.

; Lamattina, Daniela

; Marx, Javier

; Pedrozo, Williams

; Rinas, Miguel

; Matteo, Karen E. De

; Couto, Esteban

; Martínez, Álvaro A. Faccini

; Armitano, Rita

Revista argentina de microbiología

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mar 2023, Volume 55 N. 1 Pages 111 - 120

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

Resumen Se informa un caso autóctono de rickettsiosis por Rickettsia parkeri, ocurrido en junio del 2018 en la zona selvática del Parque Provincial Urugua-í, Misiones, Argentina, región sin registros previos de esta enfermedad en humanos. Se describen los aspectos epidemiológicos, ecológicos, clínicos y de laboratorio necesarios para el diagnóstico oportuno y el tratamiento adecuado. Se resalta el hecho de considerar a las rickettsiosis como diagnóstico diferencial ante un paciente con síndrome febril agudo exantemático; el antecedente epidemiológico de exposición al vector característico de la región, garrapatas del género Amblyomma, es un elemento fundamental.

Abstract We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

https://doi.org/10.1016/j.ram.2022.06.003

Obstetric and Perinatal Outcomes in Pregnant Women with Lupus: Retrospective Study in a Portuguese Tertiary Center
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Jorge, Inês Ferreira

; Frade, Joana Mourão Vieitez

; Capela, Susana Paula Leonardo Dias Abreu

; Graça, André Laboreiro Ferreira Mendes da

; Grilo, Maria Luísa Aleixo Gomes Pinto

; Centeno, Ana Mónica Miguel Mendonça de Castro

Revista Brasileira de Ginecologia e Obstetrícia

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2023, Volume 45 N. 10 Pages 568 - 574

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

Abstract Objective Pregnancy in women with lupus poses a higher risk of complications compared with the general population. The present study aimed to determine and describe the obstetric and neonatal outcomes of pregnant women with lupus. Materials and Methods We conducted an observational retrospective study of pregnant women with the diagnosis of lupus, who were selected and followed at the Maternal-Fetal Medicine Clinic of our institution between January 2013 and July 2018. We analyzed 59 pregnancies and 52 newborns, and collected data regarding sociodemographic features, the preconception period, pregnancy, childbirth, postpartum and the newborn. A descriptive analysis of the variables was performed. Results In 58% of the cases, the pregnancy was uneventful. We registered flares in 25% of the cases, preeclampsia in 3%, fetal growth restriction in 12%, gestational loss in 10%, preterm labor in 10%, postpartum complications in 20%, and small for gestational age newborns in 17% of the cases. Conclusions Most pregnancies in women with lupus have favorable obstetric and neonatal outcomes. Prenatal counseling, adequate multidisciplinary surveillance, and optimized treatment of the disease are fundamental pillars for these good results.

Resumo Objetivo A gravidez em mulheres com lúpus representa um risco maior de complicações em comparação com a população em geral. O presente estudo teve como objetivo determinar e descrever os resultados obstétricos e neonatais de gestantes com lúpus. Materiais e Métodos Realizamos um estudo retrospectivo observacional de gestantes com diagnóstico de lúpus, selecionadas e acompanhadas no Ambulatório de Medicina Materno-Fetal de nossa instituição entre janeiro de 2013 e julho de 2018. Analisamos 59 gestações e 52 recém-nascidos e coletamos dados referentes às características sociodemográficas, período pré-concepcional, gravidez, parto, pós-parto e nascimento. Foi realizada uma análise descritiva das variáveis. Resultados Em 58% dos casos, a gravidez transcorreu sem intercorrências. Registramos surtos em 25% dos casos, pré-eclâmpsia em 3%, restrição do crescimento fetal em 12%, perda gestacional em 10%, trabalho de parto prematuro em 10%, complicações pós-parto em 20% e recém-nascidos pequenos para a idade gestacional em 17% dos casos. Conclusões A maioria das gestações em mulheres com lúpus tem resultados obstétricos e neonatais favoráveis. Aconselhamento pré-natal, vigilância multidisciplinar adequada e tratamento otimizado da doença são pilares fundamentais para esses bons resultados.

https://doi.org/10.1055/s-0043-1772481

A participação de mães surdas na vida escolar dos filhos ouvintes
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Barbosa, Susana

; Silveira-Maia, Mónica

; Sanches-Ferreira, Manuela

; Santos, Miguel

; Alves, Sílvia

Educação e Pesquisa

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2023, Volume 49 elocation e258881

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

Abstract The challenge of understanding the social and academic needs of deaf children in the educational context has been the subject of deep analysis in the literature, but the same does not happen in relation to deaf mothers and the performance of their role as responsible for the education of their children. Often, mothers who are deaf face communicational and attitudinal barriers, requiring adjustments in the family-school relationship, in order to guarantee them the fundamental right to participate in school decisions and in the school life of their students. This study aimed to explore the perspective of mothers who are deaf on their involvement in the school life of their hearing children, in order to identify areas of political action and practices for mobilizing facilitators of family-school relationships. For this, a focus group was held with 10 mothers who are deaf, whose children attended basic education – 1st and 2nd cycles – in Portuguese public schools. The results suggest that, despite the mothers’ willingness and commitment to get involved in their children’s school life, this participation is restricted by the way in which communication and the family-school relationship is traditionally structured. The perceived barriers are associated with the avoidance of situations of interaction with the school, in addition to the concern for the lack of knowledge of their children’s school life. The widespread existence of interpreters in schools or the training of the school community for the use of sign language are some of the changes discussed by mothers who are deaf in achieving their right to participate in the school life of their children.

Resumo O desafio de entender as necessidades sociais e acadêmicas de crianças surdas no contexto educativo tem sido alvo de profunda análise na literatura, mas o mesmo não acontece em relação às mães surdas e ao desempenho do papel de responsáveis pela educação dos seus filhos. Com frequência, as mães surdas enfrentam barreiras de natureza comunicacional e atitudinal, tornando necessárias adequações na relação família-escola, de modo a lhes garantir o direito fundamental de participar nas decisões da escola e da vida escolar dos seus educandos. Assim, com este estudo pretendeu-se explorar a perspectiva de mães surdas sobre o seu envolvimento na vida escolar dos seus filhos ouvintes procurando identificar linhas de ação política e do domínio das práticas que visem a mobilização de facilitadores da relação família-escola. Para isso, realizou-se um grupo focal com 10 mães surdas, cujos filhos frequentavam o ensino básico – 1.º e 2.º ciclos –, de escolas públicas portuguesas. Os resultados sugerem que, apesar da vontade e do empenho das mães surdas para se envolverem na vida escolar dos filhos, esta participação é restringida pela forma como a comunicação e a relação família-escola está tradicionalmente estruturada. As barreiras sentidas estão associadas ao evitamento de situações de interação com a escola, acrescido da preocupação pelo desconhecimento da vida escolar dos seus filhos. A existência generalizada de intérpretes nas escolas ou a formação/capacitação da comunidade escolar para o uso de língua gestual são algumas das mudanças discutidas pelas mães surdas na consecução do seu direito à participação na vida escolar dos seus filhos.

https://doi.org/10.1590/s1678-4634202349258881por

Endoscopic Reconstruction of an Oral Feeding Route Using a Rendezvous Approach
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Campos, Sara Teles de

; Rio-Tinto, Ricardo

; Fidalgo, Paulo

; Bispo, Miguel

; Marques, Susana

; Devière, Jacques

GE-Portuguese Journal of Gastroenterology

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dec 2022, Volume 29 N. 6 Pages 50 - 55

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

Abstract Background: The approach to esophageal obstruction or discontinuity remains challenging and often involves complex reconstructive surgeries. The rendezvous endoscopic technique might be interesting in cases of complete esophageal obstruction. Case Presentation: Herein we describe a successful case of endoscopic recanalization of the esophageal lumen in a patient with a long-standing esophageal discontinuity resulting from several surgeries and chemoradiation for a squamous cell carcinoma of the hypopharynx, ending in a major cervical amputation, construction of a neopharynx, and definitive surgical closure of the superior esophagus with a PEG placement. With a rendezvous technique (peroral and through the gastrostomy) and under radiographic guidance, puncture from the neopharynx into the distal esophagus was performed, followed by balloon dilation and covered metal stent placement in order to reconstruct a neoesophagus. Five weeks later, the stent was removed (using a stent-in-stent technique). No complications occurred. The patient has been able to eat soft food and is being kept under regular endoscopic surveillance to control/treat a luminal stenosis of the neoesophagus. Conclusions: This case report illustrates a successful endoscopic treatment of post-surgical complete esophageal obstruction. This approach should be considered in the therapeutic armamentarium of these difficult clinical settings.

Resumo Introdução: A abordagem da descontinuidade esofágica permanece desafiante e frequentemente envolve cirurgias reconstrutivas complexas. A técnica endoscópica de rendez-vous pode ser interessante em casos de obstrução esofágica completa. Apresentação do caso: Descrevemos um caso de sucesso de recanalização endoscópica do lúmen esofágico de um doente com descontinuidade esofágica de longa duração, em resultado de múltiplas cirurgias e quimioradiação por um carcinoma pavimento-celular da hipofaringe, que resultou numa amputação cervical major, construção de uma neofaringe e encerramento cirúrgico definitivo do esófago com colocação de PEG. Por técnica de rendez-vous (peroral e por gastrostomia) e sob apoio radiológico, foi realizada punção da neofaringe, seguido de dilatação com balão e colocação de prótese metálica coberta para criar um neo-esófago. Cinco semanas depois, a prótese foi removida (por técnica stent-in-stent). Não ocorreram complicações. O doente tem mantido capacidade de ingerir comida pastosa e é submetido a vigilância regular endoscópica para controlar/tratar uma estenose do lúmen do neo-esófago. Conclusão: Este caso ilustra o tratamento endoscópico bem-sucedido de um doente com obstrução pós-cirúrgica completa do esófago. Esta abordagem deverá ser considerada no arsenal terapêutico destes quadros clínicos complexos.

https://doi.org/10.1159/000518913

10.

O que mudou entre os períodos de pico e de platô durante a primeira onda do SARS-CoV-2? Estudo multicêntrico português em unidades de cuidados intensivos
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Pereira, Rui Antunes

; Sousa, Marta

; Cidade, José Pedro

; Melo, Luís

; Lopes, Diogo

; Ventura, Sara

; Aragão, Irene

; Lima Neto, Raul Miguel de Freitas

; Molinos, Elena

; Marques, Ana

; Cardoso, Nelson

; Marino, Flávio

; Monteiro, Filipa Brás

; Oliveira, Ana Pinho

; Silva, Rogério C

; Real, André Miguel Neto

; Banheiro, Bruno Sarmento

; Reis, Renato

; Adão-Serrano, Maria

; Cracium, Ana

; Valadas, Ana

; Ribeiro, João Miguel

; Póvoa, Pedro

; Tapadinhas, Camila

; Mendes, Vítor

; Coelho, Luís

; Maia, Raquel

; Freitas, Paulo Telles

; Ferreira, Isabel Amorim

; Ramires, Tiago

; Val-Flores, Luís Silva

; Cascão, Mariana

; Alves, Rita

; Rodeia, Simão C

; Barrigoto, Cleide

; Cardiga, Rosa

; Silva, Maria João Ferreira da

; Vale, Bruno

; Fonseca, Tatiana

; Rios, Ana Lúcia

; Camões, João

; Pérez, Danay

; Cabral, Susana

; Ribeiro, Maria Inês

; Mendes, João João

; Gouveia, João

; Fernandes, Susana Mendes

Revista Brasileira de Terapia Intensiva

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dec 2022, Volume 34 N. 4 Pages 433 - 442

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

ABSTRACT Objective: To analyze and compare COVID-19 patient characteristics, clinical management and outcomes between the peak and plateau periods of the first pandemic wave in Portugal. Methods: This was a multicentric ambispective cohort study including consecutive severe COVID-19 patients between March and August 2020 from 16 Portuguese intensive care units. The peak and plateau periods, respectively, weeks 10 - 16 and 17 - 34, were defined. Results: Five hundred forty-one adult patients with a median age of 65 [57 - 74] years, mostly male (71.2%), were included. There were no significant differences in median age (p = 0.3), Simplified Acute Physiology Score II (40 versus 39; p = 0.8), partial arterial oxygen pressure/fraction of inspired oxygen ratio (139 versus 136; p = 0.6), antibiotic therapy (57% versus 64%; p = 0.2) at admission, or 28-day mortality (24.4% versus 22.8%; p = 0.7) between the peak and plateau periods. During the peak period, patients had fewer comorbidities (1 [0 - 3] versus 2 [0 - 5]; p = 0.002) and presented a higher use of vasopressors (47% versus 36%; p < 0.001) and invasive mechanical ventilation (58.1 versus 49.2%; p < 0.001) at admission, prone positioning (45% versus 36%; p = 0.04), and hydroxychloroquine (59% versus 10%; p < 0.001) and lopinavir/ritonavir (41% versus 10%; p < 0.001) prescriptions. However, a greater use of high-flow nasal cannulas (5% versus 16%, p < 0.001) on admission, remdesivir (0.3% versus 15%; p < 0.001) and corticosteroid (29% versus 52%, p < 0.001) therapy, and a shorter ICU length of stay (12 days versus 8, p < 0.001) were observed during the plateau. Conclusion: There were significant changes in patient comorbidities, intensive care unit therapies and length of stay between the peak and plateau periods of the first COVID-19 wave.

RESUMO Objetivo: Analisar e comparar as características de pacientes críticos com a COVID-19, a abordagem clínica e os resultados entre os períodos de pico e de platô na primeira onda pandêmica em Portugal. Métodos: Este foi um estudo de coorte multicêntrico ambispectivo, que incluiu pacientes consecutivos com a forma grave da COVID-19 entre março e agosto de 2020 de 16 unidades de terapia intensiva portuguesas. Definiram-se as semanas 10 - 16 e 17 - 34 como os períodos de pico e platô. Resultados: Incluíram-se 541 pacientes adultos com mediana de idade de 65 [57 - 74] anos, a maioria do sexo masculino (71,2%). Não houve diferenças significativas na mediana de idade (p = 0,3), no Simplified Acute Physiology Score II (40 versus 39; p = 0,8), na pressão parcial de oxigênio/fração inspirada de oxigênio (139 versus 136; p = 0,6), na terapia com antibióticos na admissão (57% versus 64%; p = 0,2) ou na mortalidade aos 28 dias (24,4% versus 22,8%; p = 0,7) entre o período de pico e platô. Durante o período de pico, os pacientes tiveram menos comorbidades (1 [0 - 3] versus 2 [0 - 5]; p = 0,002); fizeram mais uso de vasopressores (47% versus 36%; p < 0,001) e ventilação mecânica invasiva na admissão (58,1% versus 49,2%; p < 0,001), e tiveram mais prescrição de hidroxicloroquina (59% versus 10%; p < 0,001), lopinavir/ritonavir (41% versus 10%; p < 0,001) e posição prona (45% versus 36%; p = 0,04). Entretanto, durante o platô, observou-se maior uso de cânulas nasais de alto fluxo (5% versus 16%; p < 0,001) na admissão, remdesivir (0,3% versus 15%; p < 0,001) e corticosteroides (29% versus 52%; p < 0,001), além de menor tempo de internação na unidade de terapia intensiva (12 versus 8 dias; p < 0,001). Conclusão: Houve mudanças significativas nas comorbidades dos pacientes, nos tratamentos da unidade de terapia intensiva e no tempo de internação entre os períodos de pico e platô na primeira onda da COVID-19.

https://doi.org/10.5935/0103-507x.20210037-pt

11.

Endoscopic Management of Symptomatic Duodenal Duplication Cysts: Two Case Reports
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Campos, Sara Teles de

; Rio-Tinto, Ricardo

; Bispo, Miguel

; Marques, Susana

; Fidalgo, Paulo

; Devière, Jacques

GE-Portuguese Journal of Gastroenterology

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oct 2022, Volume 29 N. 5 Pages 58 - 63

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

Abstract Background: Duodenal duplication cysts (DDCs) are rare congenital anomalies typically manifesting during childhood. Clinical manifestations are uncommon in adulthood. DDCs were classically treated surgically, but endoscopic treatment has been increasingly reported. Endoscopic cyst marsupialization establishes a communication between the cyst cavity and the duodenal lumen so that the cystic content can be drained continuously into the duodenum. We herein describe two cases of symptomatic DDCs diagnosed in adulthood and submitted to endoscopic marsupialization using different techniques and devices. Case Summary: Case 1: A 23-year-old female patient was admitted with the diagnosis of acute pancreatitis. Endoscopic ultrasound revealed a 35-mm duodenal subepithelial lesion whose proximal limit was immediately distal to the ampulla of Vater and filled with fluid and calcifications. Using a duodenoscope, deroofing of the lesion was made with a diathermic snare. Pathology confirmed the diagnosis of DDC. Case 2: A 41-year-old female, submitted to laparoscopic cholecystectomy 1 month earlier due to suspected lithiasic acute pancreatitis, was admitted due to suspicion of iatrogenic biliary fistula. An endoscopic retrograde cholangiopancreatography was performed and the bile leak was treated. Immediately distal to the papillary orifice, a 20-mm subepithelial lesion was also detected. A biopsy forceps was used to fenestrate its wall, allowing the exit of mucous fluid and stones, and a sphincterotome was used to expand the incision. No recurrence was documented in both cases. Conclusion: These cases highlight DDC as a potential cause for acute pancreatitis in adults and endoscopy as an easy treatment option.

Resumo Introdução: Os quistos de duplicação duodenais (QDD) são anomalias congénitas raras que tipicamente se manifestam durante a infância. As manifestações clínicas são pouco frequentes em adultos. Os QDD eram classicamente tratados cirurgicamente, mas o tratamento endoscópico tem sido crescentemente reportado. A marsupialização endoscópica do quisto estabelece uma comunicação entre a cavidade do quisto e o lúmen duodenal, permitindo que o conteúdo do quisto drene continuamente para o duodeno. Reportamos 2 casos de QDD diagnosticados em adultos e submetidos a marsupialização endoscópica, utilizando diferentes técnicas e dispositivos. Casos clínicos: Caso 1: Doente do sexo feminino, 23 anos, internada por pancreatite aguda. Por ecoendoscopia documentou-se lesão subepitelial duodenal com 35 mm com limite proximal imediatamente distal à ampola de Vater, preenchida por líquido e calcificações. Usando um duodenoscópio, foi feita marsupialização da lesão com ansa diatérmica. Histologia confirmou o diagnóstico de QDD. Caso 2: Doente do sexo feminino, 41 anos, submetida a colecistectomia laparoscópica 1 mês antes por suspeita de pancreatite aguda litiásica, foi internada por suspeita de fístula biliar iatrogénica. Por CPRE confirmou-se fuga biliar que foi tratada. Imediatamente distal ao orifício papilar, foi também detetada uma lesão subepitelial com 20 mm. Uma pinça de biopsia foi usada para fenestrar a sua parede, permitindo a saída de fluido mucoso e cálculos e um esfincterótomo foi usado para expandir a incisão. Não se registou recorrência em nenhum dos casos. Conclusão: Estes casos destacam os QDD como causa potencial de pancreatite aguda em adultos e a endoscopia como possível opção terapêutica.

https://doi.org/10.1159/000518586

12.

Project management, design of a set for application in housing construction
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Mateus-Tuberquia, Bairon

; Valencia-Rodríguez, Susana María

; Rojas-López, Miguel David

DYNA

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sep 2022, Volume 89 N. 223 Pages 159 - 167

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

Abstract The construction sector projects contribute to the economic growth of the country, however, planning and follow-up become a critical problem presenting economic losses. Housing construction projects grow through public or private investment, solving the demand for housing, involving various economic, social, labor and managerial aspects. The leading managers of this type of projects are civil engineers with technical experience who usually do not know the principles of management and administration, which allow the correct execution. This article presents the design process of a game to teach project management in housing construction, through a mixed methodology with qualitative and quantitative aspects taking different references, starting with the theoretical support that presents concepts associated with projects and the importance of teaching and reinforcing concepts by implementing serious games, allowing the design of a new tool for teaching project management applicable in academic and professional environments.

Resumen Los proyectos del sector constructor contribuyen al crecimiento económico del país, sin embargo, la planeación y seguimiento se convierten en problema critico presentando pérdidas económicas. Los proyectos en construcción de vivienda crecen mediante inversión pública o privada, solucionando la demanda de vivienda, involucrando diversos aspectos económicos, sociales, laborales y gerenciales. Los gerentes líderes de este tipo de proyectos son ingenieros civiles con experiencia técnica que suelen desconocer principios de gestión y administración, los cuales, permiten la correcta ejecución. En este artículo se presenta el proceso de diseño de un juego para enseñar gerencia de proyectos en construcción de vivienda, mediante metodología mixta con aspectos cualitativos y cuantitativos tomando diferentes referentes, iniciando con el soporte teórico que presenta conceptos asociados a proyectos y la importancia de enseñar y reforzar conceptos implementando juegos serios, permitiendo diseñar una nueva herramienta para la enseñanza de gerencia de proyectos aplicable en ámbitos académicos y profesionales.

https://doi.org/10.15446/dyna.v89n223.101561

13.

Investigación, monitoreo y manejo para la conservación y uso sostenible de los arrecifes coralinos en el Parque Nacional Guanahacabibes
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Cobián Rojas, Dorka

; Márquez Llauger, Lázaro

; Chevalier Monteagudo, Pedro Pablo

; Perera Valderrama, Susana

; González Méndez, Juliett

; Caballero Aragón, Hansel

; Corrada Wong, Raúl Igor

; Borrego Fernández, Osmani

; Pino Prieto, Miguel Adrián

; Viera, Leandro Rodríguez

; González Díaz, Patricia

; Navarro Martínez, Zenaida M.

Anales de la Academia de Ciencias de Cuba

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aug 2022, Volume 12 N. 2 elocation e1051

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

ABSTRACT Introduction: The most significant results obtained in the course of 10 years of research, monitoring and management in the coral reefs of the Guanahacabibes National Park (PNG) are presented. The most studied zoological groups have been the coral and fish communities. In the same way, the lionfish has been deeply investigated due to the negative impact caused on invertebrates and native fish due to its status as an exotic and invasive species. Methods: The samplings have been carried out based on methodologies developed and validated by experts at the national and international level. Results: The results show that the reefs are among the most conserved and diverse in the Caribbean, even though they do not escape the degradation process faced by most of these ecosystems due to the effects of climate change. Fish populations of commercial and ecological importance (groupers, snappers, sharks, parrotfish and surgeonfish) have high density and biomass values due to the protective effect of the area. Data on bleaching events in coral communities and their resilient power are presented. The results of the reef restoration project with the Acropora cervicornis species are presented as well as the positive effect that the holding of 5 lionfish fishing tournaments has had on the control of this invasive species. Also, the tools, strategies and regulations established in the PNG management plan are shown, focused on nature tourism that has been increasing in recent years.

RESUMEN Introducción: Se presentan los resultados más significativos obtenidos en el transcurso de 10 años de investigación, monitoreo y manejo en los arrecifes coralinos del Parque Nacional Guanahacabibes (PNG). Los grupos zoológicos más estudiados han sido las comunidades de corales y peces. De igual manera, el pez león ha sido investigado a profundidad debido al impacto negativo que provoca en los invertebrados y peces nativos por su condición de especie exótica e invasora. Métodos: Los muestreos se han realizado a partir de metodologías elaboradas y validadas por expertos a nivel nacional e internacional. Resultados: Los arrecifes se encuentran entre los más conservados y diversos del Caribe, aun cuando no escapan del proceso de degradación que afrontan la mayoría de estos ecosistemas por los efectos del cambio climático. Las poblaciones de peces de importancia comercial y ecológica (meros, pargos, tiburones, loros y barberos) cuentan con elevados valores de densidad y biomasa debido al efecto protector del área. Se exponen datos de los eventos de blanqueamientos en las comunidades de corales y su poder resiliente. Se presentan los resultados del proyecto de restauración de arrecifes con la especie Acropora cervicornis, así como el efecto positivo que ha tenido la realización de 5 torneos de pesca de pez león en el control de esta especie invasora. También, se muestran las herramientas, estrategias y regulaciones establecidas en el plan de manejo del PNG, enfocadas en el turismo de naturaleza que ha ido en incremento en los últimos años.

14.

EFFECT OF REACTION CONDITIONS ON PARTICLE SIZE OF ZNO NANOPARTICLES VIA CONTROLLED PRECIPITATION METHOD AND IN-VITRO ANTIBACTERIAL CAPACITY
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Toscano, Miguel A. Pedroza

; Peña, Rodolfo Salazar

; Velasco, Martín Rabelero

; Montalvo, José J. Ibarra

; Guzmán, Jesús A. Aréchiga

; Cuenca, Susana López

Química Nova

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aug 2022, Volume 45 N. 8 Pages 901 - 905

Abstract: En | Text: En | PDF: En

High-yield ZnO spheroidal nanoparticles with an average diameter around 23 nm (≈ 25% frequency) and 30 nm (≈ 28% frequency) were obtained by controlled semicontinuous precipitation at low temperatures. This synthesis was obtained from hydrozincite (Zn5(CO3)2(OH)6) as primary nanoparticles. The Zn5(CO3)2(OH)6 nanoparticles were synthesized by hydrolysis of Zn(NO3)2 in aqueous solution of (NH4)2CO3 and later, the precipitation becomes. Two temperatures of 60 and 70 °C in combination with three times of reaction were tested; followed by calcination of the precipitate at 400 °C. This range of sizes of nanoparticles is comparable with those obtained by other methods reported in the literature, such as microemulsions, however, here the advantage was not using solvents or surfactants. The ZnO nanoparticles were characterized by energy dispersive X-ray spectroscopy coupled to a scanning electron microscopy (SEM-EDS), transmission electronic microscopy (TEM), and X-ray diffraction. The antibacterial activity of the films against Gram-positive (S. aureus) and Gram-negative (E. coli.) bacteria was investigated using the disc diffusion method. The best results were found in the inhibition zone for Gram-positive bacteria, when the concentration of ZnO NPs incorporated was 3 mg disc-1.

https://doi.org/10.21577/0100-4042.20170881

15.

Enfermedad relacionada a IgG4. Serie clínica de pacientes chilenos
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Cuéllar, María C.

; Gutiérrez, Miguel

; Herrera, Alejandra

; Elgueta, Fabián

; Wurmann, Pamela

; Badilla, Natalia

; Mansilla, Bellanides

; Basualdo, Javier

; Vega, Jorge

; Erlij, Daniel

; Labarca, Cristian

; Vergara, Cristian

; Mezzano, Verónica

; Méndez, Ignacio

; Stange, Lilith

; Michalland, Susana

; Silva, Francisco

; Jara, Aquiles

; Goecke, Annelise

; Burgos, Paula

; Iruretagoyena, Mirentxu

; Fernández, Cristina

; Landeros, Carolina

; Neira, Óscar

Revista médica de Chile

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jun 2022, Volume 150 N. 6 Pages 705 - 710

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

Background: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. Aim: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. Material and Methods: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. Results: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. Conclusions: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.

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