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1.
Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer
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Tobias-Machado, Marcos
; Ornellas, Antonio A.
; Hidaka, Alexandre K.
; Medina, Luis G.
; Mattos, Pablo A. L.
; Besio, Ruben S.
; Abreu, Diego
; Castro, Pedro R.
; Nishimoto, Ricardo H.
; Astigueta, Juan
; Dourado, Aurus
; Machado, Roberto D.
; Magnabosco, Wesley J.
; Corona-Montes, Victor
; Villoldo, Gustavo M.
; Zampolli, Hamilton C.
; Taha, Anis
; Auad, Pericles R.
; Faria, Eliney F.
; Arantes, Paulo B. O.
; Tavares, Alessandro
; Nascimento, Francisco S. M. S.
; Brazão Jr., Eder S.
; Rocha, Maurício M.
; Costa, Walter H.
; Panico, Vinicius
; Reis, Leonardo O.
; Almeida-Carrera, Roberto J.
; Silva, Rafael C.
; Zequi, Stênio C.
; Calixto, José R. R.
; Sotelo, Rene
.
ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
2.
Effects of atmospheric low-level jets on the mixing process of a large tropical reservoir
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REIS, ANDRÉ L.
; PACHECO, FELIPE S.
; PIMENTA, FELIPE M.
; PASSOS, ROBSON B.
; FISCH, GILBERTO
; MENDONÇA, JOSÉ C.
; ASSIREU, ARCILAN T.
.
Abstract Changes in the physical and biogeochemical properties of water columns are frequently associated with cold fronts and mesoscale convective systems due to increased cloud cover. The effects of low-level jet (LLJ) events on thermal stratification and water quality, however, remain undescribed, particularly for tropical reservoirs. Here, water temperature time series are combined with meteorological data, LIDAR observations, ERA5 reanalysis data, and hydrodynamical modeling to investigate the impact of an event of LLJ over the Furnas hydropower reservoir in Brazil. The LLJ event was characterized by dry, intense, and persistent winds (~10 m s-1) blowing for more than 12 hours over the main fetch of the reservoir. In the downwind side of the lake, the surface mixed layer depth increased by 50% during the LLJ event. The changes to the water column were produced by a combination of wind-induced upwelling, shear-driven mixing, and nocturnal convective overturning, different from the heat balance expected during passing cold fronts and mesoscale convective systems. The results suggest that both momentum and heat fluxes during LLJ events need to be accounted for in lake modelings to reproduce the vertical mixing process.
3.
Deep sea ecosystem exploration and ‘health check’: sampling strategy and methods applied during the iAtlantic_BR10_Petrobras cruise in the Santos Basin, Southwest Atlantic
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Perez, Jose Angel A.
; Barros Neto, Halésio M.C. de
; Arantes, Renata C.M.
; Gaurisas, Daniela Y.
; Silva, Camila F.
; Alves, Fernanda Maria M.
; Costa, Júlia A.
; Eloi, Paula D.C.
; Fonseca, Thayse S.
; Gavazzoni, Lucas
; Lonskis, Isabella da S.
; Nardi, Ricardo U.
; Nascimento, Pedro O.
; Rodrigues, João Vitor M.
; Santos, Ana Lara F. dos
; Santos, Edson C. dos
; Schroeder, Rafael
; Silva, Luis Carlos da
; Souza, Fernanda dos S.S. de
; Bernardino, Ângelo F.
; Cavalcanti, Guarani H.
; Lindner, Alberto
; Mahiques, Michel M. de
; Millo, Christian
; Reis, Priscila
; Sweetman, Andrew K.
; Roberts, J. Murray
.
Abstract The iAtlantic Project has established an international collaborative strategy to improve mapping and characterization of deep and open ocean ecosystems in understudied regions of the Atlantic and evaluate their health. In December 2022, the first iAtlantic expedition in the South Atlantic set off to map and explore seafloor ecosystems in the Santos Basin slope (200-1,000 m depths) in collaboration with the Petrobras ‘Santos Basin - Regional Characterization Project.’ The 17-day ‘iAtlantic_BR10-Petrobras’ cruise was conducted on board the research vessel NPqHOc Vital de Oliveira (Brazilian Navy) and performed (a) water column structure characterization, (b) seafloor morphology mapping, (c) description of benthic habitats and communities by seafloor imagery and biological/ geological sampling, and (d) ex-situ experiments to assess the functioning of sedimentary ecosystems and their responses to climate-related environmental changes. This study describes the rationale behind the iAtlantic_BR10-Petrobras cruise science plan, reports its sampling strategy and methods, and summarizes its collected data and preliminary results.
4.
Impacts of the antartic ozone hole influence events over southern Brazil in October 2015
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SOUZA, ALANNA M. DE
; PERES, LUCAS V.
; BITTENCOURT, GABRIELA D.
; PINHEIRO, DAMARIS K.
; LOPES, BIBIANA C.
; ANABOR, VAGNER
; LEME, NEUSA M.P.
; MARTINS, MARIA PAULETE P.
; SILVA, RODRIGO DA
; REIS, GABRIELA C.G. DOS
; REIS, MARCO ANTÔNIO G. DOS
; BAGESTON, JOSÉ V.
; BENCHERIF, HASSAN
.
Anais da Academia Brasileira de Ciências
- Journal Metrics
Abstract The impact of the Antarctic Ozone Hole Influence over Southern Brazil in October 2015 was analyzed using daily mean data of the Total Column Ozone (TCO), Ultraviolet Index (UVI) and Radiative Cloud Fraction (RCF) from the Ozone Monitoring Instrument satellite instrument. Vertical profiles and fields of ozone content and Potential Vorticity available from the European Centre for Medium-Range Weather Forecast reanalysis, air masses backward trajectories from the HYbrid Single-Particle Lagrangian Integrated Trajectory model and channel 3 water vapor images from the Geostationary Operational Environmental Satellite GOES-13 were also analyzed. The five identified events showed an -7.4±2.3% average TCO reduction, leading to an +16.6±54.6% UVI increase even with a predominance of partly cloudy days. Other impacts were observed in the ozone profiles, where the most significant anomalies occurred from 650 K reaching 1.2 ppmv at the 850 K level. In the ozone fields at 700 K, the presence of a polar origin tongue was observed causing negatives anomalies between -0.2 and 0.4 ppmv in a transient system format forced with eastward-traveling Rossby waves passing through the Southern of Brazil and Uruguay.
5.
Estudo do Universo de Friedmann partindo de conceitos Newtonianos
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Reis, Patrício D.C. dos
; Seifert, Evandro G.
; Gabrick, Enrique C.
; Jantsch, Rudinei C.S.
; Iarosz, Kelly C.
; Batista, Antonio M.
; Trobia, José
.
Neste trabalho, realizamos um estudo numérico para o modelo cosmológico de Friedmann partindo de conceitos Newtonianos. Originalmente, esse modelo foi construído utilizando o ferramental matemático da Relatividade Geral, que possui grande nível de complexidade e não é acessível para os estudantes dos níveis iniciais da graduação. Sendo assim, a abordagem desse modelo através de conceitos Newtonianos torna acessível a compreensão de alguns conceitos básicos da Cosmologia. Além disso, também é possível que o estudante utilize esse material como uma introdução aos estudos dos métodos numéricos e computacionais. Na descrição de um Universo expansivo, as equações diferenciais são resolvidas numericamente pelo Método de Runge-Kutta de quarta ordem. Os resultados apresentados pelos gráficos das soluções numéricas condizem com os dados observacionais, descrevendo qualitativamente as eras pelas quais o Universo passou. Como motivação para o estudante, disponibilizamos as rotinas computacionais em C, Octave e Simulink.
In this work, we study Friedmann’s cosmological model from a numerical approach. To obtain Friedmann’s equations, we use Newtonian concepts. In general, this model has been constructed using the mathematical tools of General Relativity, which have a high level of complexity and are not easily approachable to initial-grade undergraduate students. For this reason, the approach of this model using Newtonian concepts makes the understanding of basic cosmology concepts. Furthermore, it is also possible to make the student use this work as an introduction to numerical and computational methods. Describing an expansive Universe, the differential equations are solved by the fourth-order Runge-Kutta method. The results shown by the numerical solution agree with the observational data, describing the ages of the Universe. As motivation for the student, we provided access to the computational routines in C, Octave, and Simulink.
6.
Atualização da Diretriz Brasileira de Hipercolesterolemia Familiar – 2021
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Izar, Maria Cristina de Oliveira
; Giraldez, Viviane Zorzanelli Rocha
; Bertolami, Adriana
; Santos Filho, Raul Dias dos
; Lottenberg, Ana Maria
; Assad, Marcelo Heitor Vieira
; Saraiva, José Francisco Kerr
; Chacra, Ana Paula M.
; Martinez, Tania L. R.
; Bahia, Luciana Ribeiro
; Fonseca, Francisco Antonio Helfenstein
; Faludi, Andre Arpad
; Sposito, Andrei C.
; Chagas, Antônio Carlos Palandri
; Jannes, Cinthia Elim
; Amaral, Cristiane Kovacs
; Araújo, Daniel Branco de
; Cintra, Dennys Esper
; Coutinho, Elaine dos Reis
; Cesena, Fernando
; Xavier, Hermes Toros
; Mota, Isabela Cardoso Pimentel
; Giuliano, Isabela de Carlos Back
; Faria Neto, José Rocha
; Kato, Juliana Tieko
; Bertolami, Marcelo Chiara
; Miname, Marcio Hiroshi
; Castelo, Maria Helane Costa Gurgel
; Lavrador, Maria Sílvia Ferrari
; Machado, Roberta Marcondes
; Souza, Patrícia Guedes de
; Alves, Renato Jorge
; Machado, Valeria Arruda
; Salgado Filho, Wilson
.
https://doi.org/10.36660/abc.20210788
231 downloads
7.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.
Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
8.
Implante Percutâneo Transeptal de Bioprótese em Disfunção de Prótese Valvar Cirúrgica Mitral – Experiência Multicêntrica Brasileira
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Nicz, Pedro Felipe Gomes
; Melo, Pedro Henrique M. Craveiro de
; Brito, Pedro Henrique Ferro de
; Lima, Eliane Nogueira
; Silva, Ricardo Cavalcante e
; Prudente, Maurício Lopes
; Fernandes, Fernando Henrique
; Deininger, Maurilio Onofre
; Lopes, Marcelo Antônio Cartaxo Queiroga
; Petrucci, Fúlvio Soares
; Reis Filho, Fernando Roquette
; Marino, Marcos Antonio
; Bernardes, Rodrigo de Castro
; Melo, Eduardo Pessoa de
; Oliveira, Marco Antonio Praça
; Mangione, José Armando
; Mangione, Fernanda Marinho
; Falcão, Carlos Henrique Eiras
; Martins, Estêvão Carvalho de Campos
; Lunardi, Walter
; Bacal, Fernando
; Tarasoutchi, Flávio
; Brito Jr, Fábio Sândoli de
.
Resumo Fundamento A intervenção percutânea em pacientes com disfunção de prótese biológica mitral apresenta-se como uma alternativa ao tratamento cirúrgico convencional. Objetivo Relatar a primeira experiência brasileira de implante transcateter de bioprótese valve-in-valve mitral via transeptal (TMVIV-via transeptal). Métodos Foram incluídos pacientes portadores de disfunção de bioprótese cirúrgica submetidos ao TMVIV-transeptal em 12 hospitais brasileiros. Foram considerados estatisticamente significativos valores de p<0,05. Resultados Entre junho/2016 e fevereiro/2019, 17 pacientes foram submetidos ao TMVIV-via transeptal. A mediana de idade foi 77 anos (IIQ,70-82), a mediana do escore STS-PROM foi 8,7% (IIQ,7,2-17,8). Todos os pacientes tinham sintomas limitantes de insuficiência cardíaca (CF≥III), tendo 5 (29,4%) sido submetidos a mais de uma toracotomia prévia. Obteve-se sucesso do TMVIV-via transeptal em todos os pacientes. A avaliação ecocardiográfica demonstrou redução significativa do gradiente médio (pré-intervenção, 12±3,8 mmHg; pós-intervenção, 5,3±2,6 mmHg; p<0,001), assim como aumento da área valvar mitral (pré-intervenção, 1,06±0,59 cm2; pós-intervenção, 2,18±0,36 cm2; p<0,001) sustentados em 30 dias. Houve redução significativa e imediata da pressão sistólica de artéria pulmonar, com redução adicional em 30 dias (pré-intervenção, 68,9±16,4 mmHg; pós-intervenção, 57,7±16,5 mmHg; 30 dias, 50,9±18,7 mmHg; p<0,001). Durante o seguimento, com mediana de 162 dias (IIQ, 102-411), observou-se marcada melhora clínica (CF≤II) em 87,5%. Um paciente (5,9%) apresentou obstrução de via de saída de ventrículo esquerdo (VSVE), evoluindo para óbito logo após o procedimento, e outro morreu aos 161 dias de seguimento.Conclusão: A primeira experiência brasileira de TMVIV-transeptal demonstra a segurança e a efetividade dessa nova técnica. A obstrução da VSVE é uma complicação potencialmente fatal, reforçando a importância da seleção dos pacientes e do planejamento do procedimento. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Abstract Background Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients’ selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
https://doi.org/10.36660/abc.20190252
748 downloads
9.
Supporting people with severe mental health conditions during the COVID-19 pandemic: considerations for low- and middle-income countries using telehealth case management
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Salum, Giovanni A.
; Rehmenklau, Jaqueline F.
; Csordas, Michele C.
; Pereira, Flavia P.
; Castan, Juliana U.
; Ferreira, Anderson B.
; Delgado, Vera B.
; Bolzan, Liana de M.
; de Lima, Miguel A.
; Blauth, Juarez H.
; dos Reis, José R.
; Rocha, Paula B.
; Guerra, Tadeu A.
; Saraiva, Izabela M.
; Gramz, Bruna de C.
; Ronchi, Bruna R.
; Ribeiro, Bruna L.
; Konig, Dienifer F.
; Grevet, Eugênio H.
; de Pinho, Leandro B.
; Schneider, Jacó F.
; Eustáquio, Paula R.
; Ramos, Márcia Z.
; Marques, Myriam F.
; Axelrud, Luiza K.
; Baeza, Fernanda L.
; Lacko, Sara E.
.
https://doi.org/10.1590/1516-4446-2020-1078
1141 downloads
10.
Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil
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Aquino, Estela M. L.
; Silveira, Ismael Henrique
; Pescarini, Julia Moreira
; Aquino, Rosana
; Souza-Filho, Jaime Almeida de
; Rocha, Aline dos Santos
; Ferreira, Andrea
; Victor, Audêncio
; Teixeira, Camila
; Machado, Daiane Borges
; Paixão, Enny
; Alves, Flávia Jôse Oliveira
; Pilecco, Flávia
; Menezes, Greice
; Gabrielli, Ligia
; Leite, Luciana
; Almeida, Maria da Conceição Chagas de
; Ortelan, Naiá
; Fernandes, Qeren Hapuk R. Ferreira
; Ortiz, Renzo Joel Flores
; Palmeira, Raquel Nunes
; Pinto Junior, Elzo Pereira
; Aragão, Erika
; Souza, Luis Eugenio Portela Fernandes de
; Barral Netto, Manoel
; Teixeira, Maria Glória
; Barreto, Mauricio Lima
; Ichihara, Maria Yury
; Lima, Raíza Tourinho dos Reis Silva
.
Resumo A pandemia de COVID-19 tem desafiado pesquisadores e gestores a encontrar medidas de saúde pública que evitem o colapso dos sistemas de saúde e reduzam os óbitos. Esta revisão narrativa buscou sistematizar as evidências sobre o impacto das medidas de distanciamento social na epidemia de COVID-19 e discutir sua implementação no Brasil. Foram triados artigos sobre o efeito do distanciamento social na COVID-19 no PubMed, medRXiv e bioRvix, e analisados atos do poder público nos níveis federal e estadual para sumarizar as estratégias implementadas no Brasil. Os achados sugerem que o distanciamento social adotado por população é efetivo, especialmente quando combinado ao isolamento de casos e à quarentena dos contatos. Recomenda-se a implementação de medidas de distanciamento social e de políticas de proteção social para garantir a sustentabilidade dessas medidas. Para o controle da COVID-19 no Brasil, é imprescindível que essas medidas estejam aliadas ao fortalecimento do sistema de vigilância nos três níveis do SUS, que inclui a avaliação e uso de indicadores adicionais para monitorar a evolução da pandemia e o efeito das medidas de controle, a ampliação da capacidade de testagem, e divulgação ampla e transparente das notificações e de testagem desagregadas.
Abstract The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.
https://doi.org/10.1590/1413-81232020256.1.10502020
73073 downloads
11.
Recommendations from the Brazilian Society of Nephrology for approaching Covid-19 Diagnostic Testing in Dialysis Units
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Moura-Neto, José A.
; Palma, Lilian M. P.
; Marchiori, Gabriel F.
; Stucchi, Raquel S. B.
; Misael, Ana Maria
; D’Avila, Ronaldo
; Silva, Dirceu Reis da
; Andreoli, Maria Claudia Cruz
; Kraychete, Angiolina
; Bastos, Kleyton
; Nascimento, Marcelo Mazza do
.
RESUMO A pandemia da Covid-19 trouxe desafios ao sistema de saúde em diversas esferas: diagnóstico, tratamento e medidas para evitar a disseminação da doença. Com a maior disponibilização e variedades de testes diagnósticos, torna-se fundamental sua adequada interpretação. Este posicionamento pretende orientar unidades de diálise em relação ao uso de critérios clínicos e testes diagnósticos para a tomada de decisão referente à descontinuação do isolamento de pacientes com suspeita ou confirmação de Covid-19, assim como para o retorno às atividades laborais de colaboradores com suspeita ou confirmação de Covid-19.
ABSTRACT The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.
https://doi.org/10.1590/2175-8239-jbn-2020-s102
1677 downloads
12.
Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.
; Ho, Yeh-Li
; Besen, Bruno A.M.P.
; Malbuisson, Luiz M.S.
; Taniguchi, Leandro U.
; Mendes, Pedro V.
; Costa, Eduardo L.V.
; Park, Marcelo
; Daltro-Oliveira, Renato
; Roepke, Roberta M.L.
; Silva Jr, João M.
; Carmona, Maria José C.
; Carvalho, Carlos Roberto Ribeiro
; Hirota, Adriana
; Kanasiro, Alberto Kendy
; Crescenzi, Alessandra
; Fernandes, Amanda Coelho
; Miethke-Morais, Anna
; Bellintani, Arthur Petrillo
; Canasiro, Artur Ribeiro
; Carneiro, Bárbara Vieira
; Zanbon, Beatriz Keiko
; Batista, Bernardo Pinheiro De Senna Nogueira
; Nicolao, Bianca Ruiz
; Besen, Bruno Adler Maccagnan Pinheiro
; Biselli, Bruno
; Macedo, Bruno Rocha De
; Toledo, Caio Machado Gomes De
; Pompilio, Carlos Eduardo
; Carvalho, Carlos Roberto Ribeiro De
; Mol, Caroline Gomes
; Stipanich, Cassio
; Bueno, Caue Gasparotto
; Garzillo, Cibele
; Tanaka, Clarice
; Forte, Daniel Neves
; Joelsons, Daniel
; Robira, Daniele
; Costa, Eduardo Leite Vieira
; Silva Júnior, Elson Mendes Da
; Regalio, Fabiane Aliotti
; Segura, Gabriela Cardoso
; Marcelino, Gustavo Brasil
; Louro, Giulia Sefrin
; Ho, Yeh-Li
; Ferreira, Isabela Argollo
; Gois, Jeison de Oliveira
; Silva Junior, Joao Manoel Da
; Reusing Junior, Jose Otto
; Ribeiro, Julia Fray
; Ferreira, Juliana Carvalho
; Galleti, Karine Vusberg
; Silva, Katia Regina
; Isensee, Larissa Padrao
; Oliveira, Larissa dos Santos
; Taniguchi, Leandro Utino
; Letaif, Leila Suemi
; Lima, Lígia Trombetta
; Park, Lucas Yongsoo
; Chaves Netto, Lucas
; Nobrega, Luciana Cassimiro
; Haddad, Luciana
; Hajjar, Ludhmila
; Malbouisson, Luiz Marcelo
; Pandolfi, Manuela Cristina Adsuara
; Park, Marcelo
; Carmona, Maria José Carvalho
; Andrade, Maria Castilho Prandini H De
; Santos, Mariana Moreira
; Bateloche, Matheus Pereira
; Suiama, Mayra Akimi
; Oliveira, Mayron Faria de
; Sousa, Mayson Laercio
; Louvaes, Michelle
; Huemer, Natassja
; Mendes, Pedro
; Lins, Paulo Ricardo Gessolo
; Santos, Pedro Gaspar Dos
; Moreira, Pedro Ferreira Paiva
; Guazzelli, Renata Mello
; Reis, Renato Batista Dos
; Oliveira, Renato Daltro De
; Roepke, Roberta Muriel Longo
; Pedro, Rodolpho Augusto De Moura
; Kondo, Rodrigo
; Rached, Samia Zahi
; Fonseca, Sergio Roberto Silveira Da
; Borges, Thais Sousa
; Ferreira, Thalissa
; Cobello Junior, Vilson
; Sales, Vivian Vieira Tenório
; Ferreira, Willaby Serafim Cassa
.
OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
https://doi.org/10.6061/clinics/2020/e2294
1957 downloads
13.
Cerrado physiognomies in Chapada das Mesas National Park (Maranhão, Brazil) revealed by patterns of floristic similarity and relationships in a transition zone
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FERRAZ, TIAGO M.
; SARAIVA, RAYSA VALÉRIA C.
; LEONEL, LÉO V.
; REIS, FELIPE F. DOS
; FIGUEIREDO, FÁBIO AFONSO M.M.A.
; REIS, FABRÍCIO DE O.
; SOUSA, JOSÉ ROBERTO P. DE
; MUNIZ, FRANCISCA HELENA
.
Abstract The Chapada das Mesas National Park is a federal reserve located in the State of Maranhão, in an ecotonal region of the Brazilian Northeast Cerrado. Aiming to assess the influence of biogeographic patterns and support restoration actions for regions where information is scarce, we analyzed the floristic composition of savanna and forest Cerrado physiognomies, the floristic relationships with other Brazilian Cerrado areas and investigated the floristic relationships between the Cerrado and the Amazon, and the Caatinga and Atlantic Forest biomes. A total of 242 species in 181 genera and 64 families are recorded in our study. Fabaceae was the most representative family. We report 50 new records of species for Maranhão, four new records for the Cerrado biome and one vulnerable species. The separation of the gallery forest from cerradão and typical cerrado by ordination shows the influence of water availability and soil characteristics on floristic composition. In Cerrado ecotonal regions, such as Mato Grosso and Maranhão, the presence of species shared with the Amazon is expressive. In addition to the Amazon, physiognomies had greater floristic connection with the Caatinga flora. Our data demonstrates that the marginal areas of the Brazilian Cerrado may present high species diversity.
https://doi.org/10.1590/0001-3765202020181109
969 downloads
14.
Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil
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Aquino, Estela M. L.
; Silveira, Ismael Henrique
; Pescarini, Julia Moreira
; Aquino, Rosana
; Souza-Filho, Jaime Almeida de
; Rocha, Aline dos Santos
; Ferreira, Andrea
; Victor, Audêncio
; Teixeira, Camila
; Machado, Daiane Borges
; Paixão, Enny
; Alves, Flávia Jôse Oliveira
; Pilecco, Flávia
; Menezes, Greice
; Gabrielli, Ligia
; Leite, Luciana
; Almeida, Maria da Conceição Chagas de
; Ortelan, Naiá
; Fernandes, Qeren Hapuk R. Ferreira
; Ortiz, Renzo Joel Flores
; Palmeira, Raquel Nunes
; Pinto Junior, Elzo Pereira
; Aragão, Erika
; Souza, Luis Eugenio Portela Fernandes de
; Barral Netto, Manoel
; Teixeira, Maria Glória
; Barreto, Mauricio Lima
; Ichihara, Maria Yury
; Lima, Raíza Tourinho dos Reis Silva
.
Resumo A pandemia de COVID-19 tem desafiado pesquisadores e gestores a encontrar medidas de saúde pública que evitem o colapso dos sistemas de saúde e reduzam os óbitos. Esta revisão narrativa buscou sistematizar as evidências sobre o impacto das medidas de distanciamento social na epidemia de COVID-19 e discutir sua implementação no Brasil. Foram triados artigos sobre o efeito do distanciamento social na COVID-19 no PubMed, medRXiv e bioRvix, e analisados atos do poder público nos níveis federal e estadual para sumarizar as estratégias implementadas no Brasil. Os achados sugerem que o distanciamento social adotado por população é efetivo, especialmente quando combinado ao isolamento de casos e à quarentena dos contatos. Recomenda-se a implementação de medidas de distanciamento social e de políticas de proteção social para garantir a sustentabilidade dessas medidas. Para o controle da COVID-19 no Brasil, é imprescindível que essas medidas estejam aliadas ao fortalecimento do sistema de vigilância nos três níveis do SUS, que inclui a avaliação e uso de indicadores adicionais para monitorar a evolução da pandemia e o efeito das medidas de controle, a ampliação da capacidade de testagem, e divulgação ampla e transparente das notificações e de testagem desagregadas.
Abstract The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.
15.
Uso de VANT para Prospecção Eólica em Sistemas Aquáticos: Desenho Amostral e Avanços Instrumentais
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Assireu, Arcilan T.
; Mendonça, José C.
; Freitas, Ramon M.
; Reis, André L.
; Pellegrini, Cláudio C.
; Pimenta, Felipe M.
.
Resumo O Projeto “uso de VANT para prospecção eólica em sistemas aquáticos” consistiu num esforço multi-instrumental e multi-institucional para estudar a camada limite atmosférica influenciada por extensos corpos d’água e pelas feições do entorno como colinas, rampas e mudanças abruptas de rugosidade. Dois trabalhos de campo foram conduzidos em setembro e novembro de 2016 ao longo do sistema aquático e no seu entorno. Durante os experimentos foram utilizadas duas torres anemométricas, uma instalada sobre uma ilha e outra sobre uma colina. Além disso, um sistema flutuante para prospecção eólica, desenvolvido no âmbito do projeto, foi utilizado para hospedar uma torre de 10 m e um LIDAR Doppler que possibilitou o levantamento de perfis a 200 m, algo inédito em sistemas aquáticos continentais brasileiros. O perfil vertical de temperatura e umidade foi levantado por balões cativos e, um VANT, adaptado para realizar perfis verticais do vento foi utilizado pela primeira vez no Brasil, e é objetivo deste trabalho apresentar os detalhes de seu desenvolvimento bem como da validação dos respectivos dados. Este artigo tem como objetivo também apresentar um visão geral sobre o projeto e descrever a instrumentação e desenho amostral utilizado. Artigos adicionais, submetidos para esta revista, consideram diferentes aspectos da pesquisa e trazem resultados inéditos sobre escoamentos sobre colinas, a influência do fetch nestes sistemas e os aspectos moduladores da estabilidade atmosférica nestes ambientes.
Abstract The Project “unmanned aerial vehicles to wind assessment in aquatic systems” was a multi-institutional and multi-instrument experiment carried out to measure, in detail, the spatial characteristics of mean wind over a large tropical aquatic system and how is the flow modulated by hill, ramp and abrupt roughness change. Two field experiments were conducted during September and November 2016 in the Furnas reservoir and surrounding, an extensive (~1,250 km2) Brazilian typical reservoir. During the experiments, two towers were deployed on a hill and isle, and on the anchored buoy was installed a 10 m mast and a Doppler Lidar with a stabilizing mechanism. Vertical profile of temperature and humidity was obtained by attach sensor to tethered balloon. The present paper provides an overview of the Project as a whole, including a detailed description of the study area and the instrumentation and attempts to prove the viability of using an unmanned 6-motors rotorcraft, commonly known as a hexacopter, as a promising low-cost alternative to traditional platforms for vertical profiling in the atmospheric boundary layer.
https://doi.org/10.1590/0102-77863340037
925 downloads
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