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ABSTRACT Background: Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. Methods: DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. Conclusion: DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. ClinicalTrials.gov registry: NCT05558098

RESUMO Antecedentes: A doença crítica é um importante ônus permanente da assistência médica em todo o mundo e está associada a altas taxas de mortalidade. Os inibidores do cotransportador de sódio-glicose do tipo 2 têm demonstrado consistentemente benefícios nos desfechos cardiovasculares e renais. Os efeitos dos inibidores do cotransportador de sódio-glicose do tipo 2 em doenças agudas ainda não foram devidamente investigados. Métodos: O DEFENDER é um estudo de iniciativa do investigador, multicêntrico, randomizado, aberto, desenhado para avaliar a eficácia e a segurança da dapagliflozina em 500 participantes adultos com disfunção orgânica aguda hospitalizados na unidade de terapia intensiva. Os participantes aptos serão randomizados 1:1 para receber 10mg de dapagliflozina e o tratamento padrão por até 14 dias ou apenas o tratamento padrão. O desfecho primário é um composto hierárquico de mortalidade hospitalar, início de terapia renal substitutiva e tempo de internação na unidade de terapia intensiva, até 28 dias. O monitoramento da segurança será rigoroso durante todo o estudo. Conclusão: O DEFENDER é o primeiro estudo desenvolvido para investigar o uso de um inibidor do cotransportador de sódio-glicose do tipo 2 em pacientes de unidade de terapia intensiva geral com disfunção orgânica aguda. O estudo fornecerá informações relevantes sobre o uso de medicamentos dessa classe promissora em pacientes críticos. Registro ClincalTrials.gov: NCT05558098

https://doi.org/10.5935/2965-2774.20230129-en

Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil
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LOUREDO, Brendo Vinicius Rodrigues

; CURADO, Maria Paula

; PENAFORT, Paulo Victor Mendes

; DE ARRUDA, José Alcides Almeida

; ABREU, Lucas Guimarães

; MESQUITA, Ricardo Alves

; PINTO-JÚNIOR, Décio dos Santos

; ABRAHÃO, Aline Corrêa

; ANDRADE, Bruno Augusto Benevenuto de

; AGOSTINI, Michelle

; MORAES, Renata Mendonça

; ANBINDER, Ana Lia

; DOURADO, Pedro Henrique Silva

; SANTOS, Teresa Cristina Ribeiro Bartholomeu dos

; PIRES, Fábio Ramoa

; BORDIGNON, Natalia Cristina Trentin

; GONDAK, Rogério Oliveira

; DE OLIVEIRA, Marcia Gaiger

; CARRARD, Vinicius Coelho

; MARTINS, Manoela Domingues

; SOUSA-NETO, Sebastião Silvério

; ARANTES, Diego Antônio Costa

; MENDONÇA, Elismauro Francisco

; CIESLAK-SANCHES, Silvia Roberta

; ANTUNES, Daniella Moraes

; AMARAL-SILVA, Gleyson Kleber do

; MANIERI, Patricia Rubia

; RAMALHO, Luciana Maria Pedreira

; DOS SANTOS, Jean Nunes

; LEONEL, Augusto César Leal da Silva

; PEREZ, Danyel Elias da Cruz

; VERHEUL, Hannah Carmem Carlos Ribeiro Silva

; BARROSO, Keila Martha Amorim

; RODRIGUES, Flávia Luiza Santos

; GONZAGA, Amanda Katarinny Goes

; FERNANDES, Romana Renery

; DE SOUZA, Lélia Batista

; SOUZA, Lucas Lacerda de

; PONTES, Flávia Sirotheau Corrêa

; PONTES, Hélder Antônio Rebelo

; SILVA, Caroline Alfaia

; CÂMARA, Jeconias

; LIBÓRIO-KIMURA, Tatiana Nayara

; SANTOS-SILVA, Alan Roger

; LOPES, Márcio Ajudarte

; ALMEIDA, Oslei Paes de

; ROMAÑACH, Mário José

; VARGAS, Pablo Agustin

Brazilian Oral Research

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2023, Volume 37 elocation e126

Abstract: En | Text: En | PDF: En

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients’ histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil’s Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

https://doi.org/10.1590/1807-3107bor-2023.vol37.0126

Brazilian Thoracic Association Consensus on Sleep-disordered Breathing
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Duarte, Ricardo Luiz de Menezes

; Togeiro, Sonia Maria Guimarães Pereira

; Palombini, Luciana de Oliveira

; Rizzatti, Fabíola Paula Galhardo

; Fagondes, Simone Chaves

; Magalhães-da-Silveira, Flavio José

; Cabral, Marília Montenegro

; Genta, Pedro Rodrigues

; Lorenzi-Filho, Geraldo

; Clímaco, Danielle Cristina Silva

; Drager, Luciano Ferreira

; Codeço, Vitor Martins

; Viegas, Carlos Alberto de Assis

; Rabahi, Marcelo Fouad

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20220106

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

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

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

https://doi.org/10.36416/1806-3756/e20220106

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
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Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Gomides Reis, Ana Paula Monteiro

; Reis Neto, Edgard Torres

; Abreu, Mirhelen Mendes

; Albuquerque, Cleandro Pires

; Araújo, Nafice Costa

; Bacchiega, Ana Beatriz

; Bianchi, Dante Valdetaro

; Bica, Blanca

; Bonfa, Eloisa Duarte

; Borba, Eduardo Ferreira

; Brito, Danielle Christinne Soares Egypto

; Duarte, Ângela Luzia Branco Pinto

; Santo, Rafaela Cavalheiro Espírito

; Fernandes, Paula Reale

; Guimarães, Mariana Peixoto

; Gomes, Kirla Wagner Poti

; Kakehasi, Adriana Maria

; Klumb, Evandro Mendes

; Lanna, Cristina Costa Duarte

; Marques, Claudia Diniz Lopes

; Monticielo, Odirlei André

; Mota, Licia Maria Henrique

; Munhoz, Gabriela Araújo

; Paiva, Eduardo Santos

; Pereira, Helena Lucia Alves

; Provenza, José Roberto

; Ribeiro, Sandra Lucia Euzébio

; Rocha Junior, Laurindo Ferreira

; Sampaio, Camila Santana Justo Cintra

; Sampaio, Vanderson Souza

; Sato, Emília Inoue

; Skare, Thelma

; de Souza, Viviane Angelina

; Valim, Valeria

; Lacerda, Marcus Vinícius Guimarães

; Xavier, Ricardo Machado

; Pinheiro, Marcelo Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 60

Abstract: En | Text: En | PDF: En

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

https://doi.org/10.1186/s42358-021-00217-0 22 downloads

Recommendations of the Brazilian Society of Rheumatology for the use of JAK inhibitors in the management of rheumatoid arthritis
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Bonfiglioli, Karina Rossi

; Mota, Licia Maria Henrique da

; Ribeiro, Ana Cristina de Medeiros

; Kakehasi, Adriana Maria

; Laurindo, Ieda Maria Magalhães

; Giorgi, Rina Dalva Neubarth

; Duarte, Angela Luzia Branco Pinto

; Reis, Ana Paula Monteiro Gomides

; Souza, Mariana Peixoto Guimarães Ubirajara e Silva de

; Brenol, Claiton Viegas

; Pinheiro, Geraldo da Rocha Castelar

; Albuquerque, Cleandro Pires de

; Castro, Charlles Heldan de Moura

; Pinto, Gustavo Luiz Behrens

; Verztman, Jose Fernando

; Muniz, Luciana Feitosa

; Bertolo, Manoel Barros

; Pinto, Maria Raquel da Costa

; Louzada Júnior, Paulo

; Cruz, Vitor Alves

; Pereira, Ivanio Alves

; Freitas, Max Vitor Carioca de

; Cruz, Bóris Afonso

; Paiva, Eduardo

; Monticielo, Odirlei

; Provenza, José Roberto

; Xavier, Ricardo Machado

Advances in Rheumatology

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2021, Volume 61 elocation 70

Abstract: En | Text: En | PDF: En

Abstract Rheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017.

https://doi.org/10.1186/s42358-021-00228-x

Tomographic score (RAD-Covid Score) to assess the clinical severity of the novel coronavirus infection
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Ribeiro, Tatiana Figueiredo Guimarães

; Rstom, Ricardo Arroyo

; Barbosa, Paula Nicole Vieira Pinto

; Almeida, Maria Fernanda Arruda

; Costa, Marina Martini

; Oliveira Filho, Edivaldo Nery de

; Barros, André Santos

; Pereira, Talita Rombaldi

; Velludo, Silvio Fontana

; Machado, Fabrício Próspero

Brazilian Journal of Infectious Diseases

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2021, Volume 25 N. 4 elocation 101599

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives: The severity of pulmonary Covid-19 infection can be assessed by the pattern and extent of parenchymal involvement observed in computed tomography (CT), and it is important to standardize the analysis through objective, practical, and reproducible systems. We propose a method for stratifying the radiological severity of pulmonary disease, the Radiological Severity Score (RAD-Covid Score), in Covid-19 patients by quantifying infiltrate in chest CT, including assessment of its accuracy in predicting disease severity. Methods: This retrospective, single-center study analyzed patients with a confirmed diagnosis of Covid-19 infection by real-time reverse-transcriptase polymerase chain reaction, who underwent chest CT at hospital admission between March 6 and April 6, 2020. CT scans were classified as positive, negative, or equivocal, and a radiological severity score (RAD-Covid Score) was assigned. Clinical severity was also assessed upon hospital admission. Results: 658 patients were included. Agreement beyond chance (kappa statistic) for the RAD-Covid Score was almost perfect among observers (0.833), with an overall agreement of 89.5%. The RAD-Covid Score was positively correlated with clinical severity and death, i.e., the higher the RAD-Covid Score, the greater the clinical severity and mortality. This association proved independent of age and comorbidities. Accuracy of this score was 66.9%. Conclusions: The RAD-Covid Score showed good accuracy in predicting clinical severity at hospital admission and mortality in patients with confirmed Covid-19 infection and was an independent predictor of severity.

https://doi.org/10.1016/j.bjid.2021.101599 33 downloads

Fertilization and Irrigation Affect Soil Carbon under Eucalyptus Plantation in the Cerrado
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Fialho, Ricardo Cardoso

; Teixeira, Rafael da Silva

; Teixeira, Ana Paula Mendes

; Reis, Thalles Guimarães

; Silva, Ivo Ribeiro da

Floresta e Ambiente

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2019, Volume 26 N. 4 elocation e20170679

Abstract: En | Text: En | PDF: En

ABSTRACT This study aimed: i) to evaluate the influence of fertilization and irrigation management on eucalyptus plantations for soil carbon (C) dynamics; ii) to evaluate the impact of fertilization and irrigation management on eucalyptus plantations in the C allocation in depth compared to the Cerrado biome. This study was carried out in an eucalyptus plantation at the end of the third rotation (7 years), which received different fertilizations and irrigations, and a Cerrado area was used as reference. Soil samples were collected in trenches and the gases (CO2 and CH4) on the surface. The total organic carbon (TOC) is more influenced by the availability of water than nutrients. Soils under eucalyptus stands are more efficient at C stocks in depth than the Cerrado and act as a liquid drain of CO2 and CH4 from the atmosphere.

https://doi.org/10.1590/2179-8087.067917 614 downloads

Protests as “Events”: The Symbolic Struggles in 2013 Demonstrations in Turkey and Brazil
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Mendonça, Ricardo Fabrino

; Ercan, Selen A.

; Ozguc, Umut

; Reis, Stephanie Lorraine Gomes

; Simões, Paula Guimarães

Revista de Sociologia e Política

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2019, Volume 27 N. 69 elocation e001

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

Resumo Introdução: O conceito de “acontecimento” oferece uma perspectiva interessante para a compreensão de disputas discursivas nos protestos e sobre eles. Por “acontecimento”, entendemos rupturas da continuidade da experiência que alimentam disputas políticas pela reinterpretação de passados e futuros. Partindo do conceito e de sua utilidade para a leitura de disputas simbólicas, este artigo busca analisar os protestos de 2013 no Brasil e na Turquia. Investigamos como as razões a alicerçar tais protestos foram enquadradas e como esses enquadramentos mudaram ao longo do tempo, abrindo novas interpretações de passado e provendo novas possibilidades de imaginação do futuro. Materiais e Métodos: Dados foram gerados a partir de quatro páginas do Facebook, coletando mensagens postadas ao longo dos primeiros 30 dias de protestos em cada um dos países. No caso brasileiro, coletamos os posts de: (1) Passe Livre São Paulo (301.787 likes), o grupo que iniciou a onda de protestos; e (2) O Gigante Acordou (155.690 likes), um coletivo que emergiu durante os protestos, representando perspectivas nacionalistas. Ao todo, foram coletados 626 posts em ambas as páginas. No caso turco, analisaram-se posts que apareceram em: (1) Taksim Dayanismasi (82.479 likes), uma associação que teve papel significativo na organização e mobilização dos protestos do Gezi Park; e (2) Recep Tayyip Erdogan (6.957.408 likes), uma página pró-governo e essencialmente anti-protestos. Codificamos cada post indutivamente, enfocando, particularmente, o modo como eles enquadraram as causas dos protestos. Identificamos, então, a frequência de cada enquadramento nos 30 dias iniciais dos protestos e exploramos se, e como, isso se transformou ao longo do tempo. Resultados: A análise revelou a existência de viradas significativas na forma como as causas dos protestos foram enquadradas em ambos os países, mas com implicações distintas. Enquanto no Brasil, a “transformação de quadro” observada minou o foco inicial dos manifestantes, na Turquia, observa-se uma situação de “expansão do quadro”, com a tematização de questões mais amplas como causas dos protestos, como a natureza autoritária do regime e as restrições a direitos democráticos no país. Discussão: O artigo oferece uma maneira de analisar protestos com base na lente conceitual do “acontecimento”, esclarecendo o papel das mídias sociais no contexto das lutas simbólicas em torno dos protestos. Além disso, ele abre debate sobre as disputas de enquadramento a atravessar desdobramentos contemporâneos da democracia em ambos os países.

Abstract Introduction: The concept of “event” offers a valuable lens to understand the discursive contestations in and around protests. Events create ruptures that disturb the logic of continuity and open up new way of thinking and talking about the past and the future. Drawing on this concept, this article analyzes the 2013 protests in Turkey and Brazil. It investigates how the causes of these protests were framed and debated in each country and how these frames shifted over time by opening up new interpretations of the past and the future. Materials and Methods: Data is generated from four Facebook pages capturing the messages posted during the first 30 days of protests in each country. In the Brazilian case, we collected the posts of: (1) Passe Livre São Paulo (301,787 likes), the group that started the wave of protests; and (2) O Gigante Acordou (155,690 likes), a collective that emerged during the protests, representing nationalist perspectives. In total, 626 posts were collected from both pages. In the Turkish case, we analyzed posts that appeared on the pages of : (1) Taksim Dayanismasi (82,479 likes), an association that played a significant role in organizing and mobilizing Gezi Park protests; and (2) Recep Tayyip Erdogan (6,957,408 likes), a pro-government and inherently anti-protest page. We coded each post inductively focusing particularly on the way they framed the causes of the protests. We then identified the number of times each frame was mentioned during the first 30 days of the protests and explored whether and how frames changed over time. Results: Our analysis reveals a significant shift in the way the causes of the protests were framed over time in both countries, yet with different implications. While in Brazil, we observe a frame transformation undermining the initial rationale of the protests, in Turkey we see a frame extension and the emergence of broader issues as the real causes of protests, such as the authoritarian nature of the regime and the restriction of democratic rights in this country. Discussion: The article offers a way of analysing protests based on a conceptual lens of event. It sheds light on the role of social media as a platform for symbolic struggles over the protests. Furthermore, the article opens up a debate about the developments of democracy in both countries.

https://doi.org/10.1590/1678987319276901 2531 downloads

Immunogenicity and safety of the combined vaccine for measles, mumps, and rubella isolated or combined with the varicella component administered at 3-month intervals: randomised study
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Santos, Eliane Matos dos

; Noronha, Tatiana Guimarães

; Alves, Isabelle Soares

; Cruz, Robson Leite de Souza

; Ferroco, Clara Lucy de Vasconcellos

; Brum, Ricardo Cristiano

; Oliveira, Patricia Mouta Nunes de

; Siqueira, Marilda Mendonça

; Lima, Mariza Cristina

; Ramos, Francisco Luzio de Paula

; Bragagnolo, Camila de Marco

; Camacho, Luiz Antonio Bastos

; Maia, Maria de Lourdes de Sousa

Memórias do Instituto Oswaldo Cruz

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2019, Volume 114 elocation e180517

Abstract: En | Text: En | PDF: En

BACKGROUND Field testing required to license the combined measles, mumps, and rubella (MMR) vaccine must take into account the current recommendation of the vaccine in Brazil: first dose at 12 months and second dose at 15 months of age in combination with a varicella vaccine. OBJECTIVES This study aimed to evaluate the clinical consistency, immunogenicity, and reactogenicity of three batches of MMR vaccine prepared with active pharmaceutical ingredients (API) from Bio-Manguinhos, Fiocruz (MMR-Bio), and compare it to a vaccine (MMR produced by GlaxoSmithKline) with different API. METHODS This was a phase III, randomised, double-blind, non-inferiority study of the MMR-Bio administered in infants immunised at health care units in Pará, Brazil, from February 2015 to January 2016. Antibody levels were titrated by immunoenzymatic assays. Adverse events were recorded in diaries. FINDINGS Seropositivity levels after MMR-Bio were 97.6% for measles, 84.7% for mumps, and 98.0% for rubella. After the MMRV vaccine, seroconversion rates and GMT increased substantially for mumps. In contrast, approximately 35% of the children had no detectable antibodies to varicella. Systemic adverse events were more frequent than local events. CONCLUSION The demonstration of batch consistency and non-inferiority of the Bio-MMR vaccine completed the technology transfer. This is a significant technological achievement with implications for immunisation programs.

https://doi.org/10.1590/0074-02760180517 2186 downloads

10.

2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis
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Mota, Licia Maria Henrique da

; Kakehasi, Adriana Maria

; Gomides, Ana Paula Monteiro

; Duarte, Angela Luzia Branco Pinto

; Cruz, Bóris Afonso

; Brenol, Claiton Viegas

; Albuquerque, Cleandro Pires de

; Pinheiro, Geraldo da Rocha Castelar

; Laurindo, leda Maria Magalhães

; Pereira, Ivanio Alves

; Bertolo, Manoel Barros

; Souza, Mariana Peixoto Guimarães Ubirajara Silva de

; Freitas, Max Vitor Carioca de

; Louzada-Júnior, Paulo

; Xavier, Ricardo Machado

; Giorgi, Rina Dalva Neubarth

Advances in Rheumatology

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2018, Volume 58 elocation 2

Abstract: En | Text: En | PDF: En

Abstract The objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission.

https://doi.org/10.1186/s42358-018-0005-0 2130 downloads

11.

Characterization of the unhealthy and hazardous situations under the forensic expert survey and safety management in quarries
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Paula, Ricardo Guimarães de

; Silva, Lineu Azuaga Ayres da

; Silva, Anna Luiza Marques Ayres da

REM - International Engineering Journal

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sep 2016, Volume 69 N. 3 Pages 361 - 366

Abstract: En | Text: En | PDF: En

Abstract In the typical activities of quarries, it is common for the employees to be exposed to diverse risk factors, pertaining to their health or physical integrity. This kind of exposition, in Brazil, entitles these employees to additional payments, defined in law from different technical parameters. The controversies concerning the payment of these premiums between the employers and the employees, like the other conflicts between capital and labor, are solved in Brazil by the Labor Courts, and the forensic expert survey is one of the main tools used by the judges. This study aimed to characterize the unhealthy or hazardous situations in quarries using the forensic expert survey, focusing on the concepts and the legal definitions of the unhealthy or hazardous situations in labor activities, as well as the main aspects of the expert evidence technique and the judicial proceeding. This analysis revealed that most of the functions in quarries mean exposure to hazards, requiring appropriate management

https://doi.org/10.1590/0370-44672015690011 1343 downloads

12.

Percepção de agricultores familiares do Programa de Aquisição de Alimentos (PAA) sobre o significado de fazer parte do PAA e a sua compreensão sobre conceitos relacionados à alimentação, nutrição e saúde
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Batista, Lucimar Moreira Guimarães

; Ribeiro, Sônia Machado Rocha

; Santos, Ricardo Henrique Silva

; Araújo, Raquel Maria Amaral

; Ribeiro, Andréia Queiroz

; Priore, Sílvia Eloiza

; Lúcia, Ceres Mattos Della

; Lana, Rogério de Paula

; Gasparoni, Gisely Peron

Saúde e Sociedade

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jun 2016, Volume 25 N. 2 Pages 494 - 504

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

Resumo A agricultura familiar possui um reconhecido potencial econômico, ambiental e social que nos últimos anos tem sido prestigiado e fortalecido por programas governamentais que incentivam a produção e o beneficiamento de seus produtos, sendo assim, ações de Segurança Alimentar e Nutricional (SAN) podem ser implementadas, aumentando a disponibilidade de alimentos e a variabilidade de nutrientes à população, favorecendo a comercialização deles em nível local e regional, além de contribuir para hábitos alimentares saudáveis e, consequentemente, melhorar a qualidade da alimentação. O Programa de Aquisição de Alimentos (PAA) foi instituído pelo artigo 19 da Lei nº 10.696 em 2003, como uma das ações do Programa Fome Zero, seu objetivo principal é o fortalecimento da agricultura familiar. O objetivo deste trabalho foi identificar as percepções dos agricultores sobre o significado de fazer parte do PAA e a sua compreensão sobre conceitos relacionados à alimentação, nutrição e saúde, por meio de uma pesquisa qualitativa. Os resultados do estudo foram maior acesso a informações como saúde, alimentação, formas de produção e manejo, economia, direitos e deveres, entre outras; melhora de renda e investimentos familiares; melhora da autoestima/valorização pessoal e estímulo à interação dos agricultores familiares. Nesse contexto, faz-se necessário que o PAA se torne cada vez mais um instrumento fortalecedor da agricultura familiar, das ações de saúde e de SAN e nutricional de forma permanente como proposto em sua lei de criação.

Abstract Family agriculture has a recognized economic, environmental and social potential, which in recent years has been prestigious and strengthened by government programs that encourage the production and processing of their products, thus Food and Nutrition Security actions can be implemented, increasing the availability of food and the variability of nutrients to the population, favoring the their marketing at local and regional levels, contributing to healthy eating habits and thus improving the quality of food. The Programa de Aquisição de Alimentos (PAA) [Food Acquisition Program] was established by the article 19 of Law nº 10.696 in 2003 as one of the actions of the Programa Fome Zero [Zero Hungry Program] your main goal is the strengthening of family agriculture. The objective of this study was to identify the perceptions of farmers on the meaning of being part of the PAA and their understanding of concepts related to food, nutrition and health through a qualitative research. The results of this study were greater access to information such as health, food, forms of production and management, economics, rights and duties, among others; improved income and family investments; improved self-esteem/self-worth and stimulate the interaction of family farmers. In this context, it is necessary that the PAA increasingly become an empowering tool of agriculture family in the health care and Food and Nutrition Security permanently as proposed in his law of creation.

https://doi.org/10.1590/S0104-12902016150258 4475 downloads

13.

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Batista, Lucimar Moreira Guimarães

; Ribeiro, Sônia Machado Rocha

; Santos, Ricardo Henrique Silva

; Araújo, Raquel Maria Amaral

; Ribeiro, Andréia Queiroz

; Priore, Sílvia Eloiza

; Lúcia, Ceres Mattos Della

; Lana, Rogério de Paula

; Gasparoni, Gisely Peron

Saúde e Sociedade

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jun 2016, Volume 25 N. 2 Pages 494 - 504

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

https://doi.org/10.1590/S0104-12902016150258 292 downloads

14.

Carrapatos (Acari: Ixodidae) em mamíferos silvestres do Parque Nacional da Serra da Canastra e arredores, Minas Gerais, Brasil
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Martins, Thiago Fernandes

; Arrais, Ricardo Corassa

; Rocha, Fabiana Lopes

; Santos, Jean Pierre

; Júnior, Joares Adenilson May

; Azevedo, Fernanda Cavalcanti de

; Paula, Rogério Cunha de

; Morato, Ronaldo Gonçalves

; Rodrigues, Flávio Henrique Guimarães

; Labruna, Marcelo Bahia

Ciência Rural

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feb 2015, Volume 45 N. 2 Pages 288 - 291

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

O presente estudo relata ixodídeos em mamíferos silvestres no Parque Nacional da Serra da Canastra e arredores, no estado de Minas Gerais, Brasil. De julho de 2005 a junho de 2014, foram coletadas 58 larvas, 133 ninfas e 43 carrapatos adultos em 40 eventos de captura de mamíferos de vida livre do Parque e arredores. Nos hospedeiros da ordem Carnivora, foram identificados Amblyomma ovale Koch, 1844, Amblyomma sculptum Berlese, 1888, Amblyomma tigrinum Koch, 1844, Dermacentor nitens Neumann, 1897 e Rhipicephalus microplus (Canestrini, 1888). Em hospedeiros da ordem Xenarthra, foram identificados espécimes de Amblyomma pseudoconcolor Aragão, 1908 e A. sculptum. Este estudo relata os primeiros registros dos ixodídeos D. nitens e R. microplus parasitando Lycalopex vetulus, e A. ovale em Leopardus tigrinus no país. Os achados do presente estudo indicam a proximidade entre os animais domésticos e silvestres causada pela expansão agropecuária no território brasileiro

This research reports ticks on wild mammals from the Serra da Canastra National Park and surrounding areas, in Minas Gerais state, Brazil. From July 2005 to June 2014, 58 larvae, 133 nymphs and 43 adult ticks were collected in 40 capture events of free-living mammals at the Park and surrounding areas. The tick species Amblyomma ovale Koch, 1844, Amblyomma sculptum Berlese, 1888, Amblyomma tigrinum Koch, 1844, Dermacentor nitens Neumann, 1897, and Rhipicephalus microplus (Canestrini, 1888) were identified on hosts of the order Carnivora. Specimens of Amblyomma pseudoconcolor Aragão, 1908 and A. sculptum were identified on the hosts of the order Xenarthra. We provide the first records of D. nitens and R. microplus ticks parasitizing Lycalopex vetulus, and A. ovale on Leopardus tigrinus in Brazil. The findings of this research indicate the sharing of environment by domestic and wild animals caused by agricultural expansion in the Brazilian landscape

https://doi.org/10.1590/0103-8478cr20140734 5625 downloads

15.

Análise da qualidade do encolamento de partículas de painéis OSB em condições de laboratório
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César, Antônia Amanda da Silva

; Mendes, Lourival Marin

; Bufalino, Lina

; Protásio, Thiago de Paula

; Guimarães Junior, José Benedito

; Mori, Fábio Akira

; Mesquita, Ricardo Gabriel de Almeida

CERNE

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dec 2014, Volume 20 N. 4 Pages 501 - 508

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

Objetivou-se, neste trabalho, avaliar a qualidade do encolamento de partículas "strand" e a influência desse processo na qualidade final da colagem em painéis OSB. Realizou-se a mensuração das dimensões e determinação da massa de 658 partículas antes e após o processo de encolamento. As variáveis gramatura (g.m-2) e a quantidade efetiva de adesivo aplicado (%) foram avaliadas. Aplicaram-se os teores de 6, 9 e 12 % de adesivo fenol-formaldeído em partículas de Pinus oocarpa e Eucalyptus grandis. Foi realizado o teste de tração perpendicular nos painéis produzidos. O processo de encolamento de partículas "strand" em laboratório é heterogêneo, o que dificultou analisar a influência das variáveis de processamento sobre a quantidade efetiva de adesivo aplicado e gramatura. Foi verificado que painéis OSB produzidos com a espécie Pinus oocarpa apresentaram menor gramatura de partículas em relação aos painéis de Eucalyptus grandis. Esse resultado foi atribuído a menor densidade básica da madeira de Pinus oocarpa. Observou-se que maiores gramaturas na partícula estão, positivamente, relacionadas com a resistência à tração perpendicular.

This work aimed to evaluate the quality of strand particles gluing and its influence on the final bonding quality in OSB panels. The measurement of the dimensions and determination of the mass of 658 particles were made before and after the gluing process. The variables glue amount (g.m-2) and effective amount of adhesive applied (%) were evaluated. Phenol-formaldehyde adhesive was applied at 6, 9 and 12% contents in Pinus oocarpa and Eucalyptus grandis particles. Perpendicular tension strength test was conducted in the panels produced. The gluing process in laboratorial conditions is heterogeneous, which hinders the analysis of the influence of the processing variables on the effective amount of adhesive applied and glue amount. It was verified that OSB panels made from Pinus oocarpa species presented lower glue amount per particle in relation to Eucalyptus grandis species. This result was attributed to the lower basic density of Pinus oocarpa wood. Increases in glue amount of particles are related to increases in perpendicular tension strength.

https://doi.org/10.1590/01047760201420041281 1948 downloads

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