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Abstract Sisal (Agave sisalana) is a plant exploited in semi-arid regions of Brazil for fiber production, but the floral scape of sisal (peduncle) is collected and often burned, causing environmental problems, even through irregular disposal. To circumvent this scenario, the objective of this work was to produce reconstituted panels using the sisal arrow and castor-based polyurethane resin. The panels were obtained using 175 g of crushed sisal arrow core with dimensions smaller than 2 mm and adopting 10% castor-based polyurethane resin and The samples were pressed under tension of 2 MPa. The properties of reconstituted panel were evaluated through NBR 14810-1 (ABNT, 2013) and NBR 14810-2 (ABNT, 2018), the physical properties were investigated: moisture, density, thickness swelling and absorption; as well as mechanical properties: MOR, MOE, internal bond and parallel compression. The found results show that the panel is classified as low density (419.8 kg/m³), and with physical and mechanical properties similars to other panels of the same classification in the literature. For average values of MOR and MOE it was found 5.24 MPa and 147.49 MPa, respectively. For internal bonding it was found 0.14 MPa and for parallel compression properties it was found 1.14 MPa.

Resumo O sisal (Agave sisalana) é uma planta explorada nas regiões semiáridas do Brasil para produção de fibras, mas o escapo floral do sisal (flecha) é coletado e frequentemente queimado causando problemas ambientais, até mesmo pelo descarte irregular. Para contornar este cenário, o objetivo deste trabalho foi produzir painéis reconstituídos usando a flecha do sisal e resina poliuretana à base de mamona. Os painéis foram obtidos empregando 175 g do miolo da flecha de sisal triturada com dimensões inferiores a 2 mm e adotando 10% de resina poliuretana à base de mamona e as amostras foram prensadas com tensão de 2 MPa. Avaliou-se no painel reconstituído, através da NBR 14810-1 (ABNT, 2013) e NBR 14810-2 (ABNT, 2018) as propriedades físicas: umidade, densidade, inchamento e absorção; bem como as propriedades mecânicas: MOR, MOE, força de ligação e compressão paralela. Os resultados encontrados mostram que o painel é classificado como de baixa densidade (419,8 kg/m³), e de propriedades físicas e mecânicas semelhantes a outros painéis de mesma classificação da literatura. Para MOR e MOE foram encontrados 5,24 MPa e 147,49 MPa de média, respectivamente. Já os ensaios de tração perpendicular e compressão paralela obtiveram resultados de 0,14 MPa e 1,14 MPa, respectivamente.

https://doi.org/10.1590/s1678-86212024000100709

Biogran Grafting in Rat Tibia Defects - A Model of High Bone Metabolism Site
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Ferreira, Luiza de Almeida Queiroz

; Lehman, Luiz Felipe Cardoso

; Diniz, Marina Gonçalves

; Ferreira, Anderson José

; Silva, Rosangela Maria Ferreira da Costa e

; Silva, Tarcília Aparecida

; Mesquita, Ricardo Alves

; Oliveira, Rafaela Férrer de

; Noronha, Mariana Saturnino

; Leão, Daniel Marques

; Andrade, Ângela Leão

; Domingues, Rosana Zacarias

; Diniz, Ivana Márcia Alves

Brazilian Archives of Biology and Technology

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2024, Volume 67 elocation e24230003

Resumo: En | Texto: En | PDF: En

Abstract We investigated the Biogran on bone repair and metabolism at several time-intervals upon grafting into rat tibia artificial defects. The biomaterial was thoroughly characterized in vitro, and its dissolution behavior upon immersion was assessed in simulated body fluid (SBF) solution for 1, 3, 7, 14, and 30 days. Biogran was also assessed by in vitro hydroxyapatite formation in SBF solution, which is a marker for bioactive behavior. In vivo, distal and proximal bone defects were performed in the Wistar rat's right tibia and filled according to the experimental groups: I) negative control, no filling; II) positive control, 10 mg of autogenous bone; and III) 10 mg of Biogran. Animals were euthanized at 1, 2, 3, 4, 7, and 10 weeks. Bone neoformation was analyzed using histomorphometry (proximal defect), and local levels of bone morphogenetic protein 2 (BMP-2) were measured using the ELISA assay (distal defect). In vitro, the Biogran sample showed a fast dissolution rate within the first 7 days, parallel to the formation of the hydroxyapatite layer. In vivo, the sample was progressively resorbed at a higher rate within the first month until it became almost absent at week 10th. The sample presented similar or higher bone neoformation concerning the autogenous bone. BMP-2 levels were sustained in the Biogran group (around 200 pg/mg) and detected until the last experimental time with a significant difference compared with the controls. Results suggest Biogran is a candidate for hard tissue engineering even in highly active bone remodeling sites.

https://doi.org/10.1590/1678-4324-2024230003

Hierarchical pedotransfer functions for predicting bulk density in Brazilian soils
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Reis, Aline Mari Huf dos

; Teixeira, Wenceslau Geraldes

; Fontana, Ademir

; Barros, Alexandre Hugo Cezar

; Victoria, Daniel de Castro

; Vasques, Gustavo Mattos

; Samuel-Rosa, Alessandro

; Ottoni, Marta Vasconcelos

; Monteiro, José Eduardo Boffino de Almeida

Scientia Agricola

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2024, Volume 81 elocation e20220255

Resumo: En | Texto: En | PDF: En

ABSTRACT Bulk density (BD) is a soil physical property used as a soil quality indicator and variations in this measurement influence soil water content and carbon stock estimates. This study aims to compile a database of samples of bulk density, textural fractions, and organic carbon values, as well as evaluate the accuracy of published pedotransfer functions (PTF) that predict bulk density, and propose a hierarchical PTF to predict the bulk density of Brazilian Soils. The performance of eleven PTFs and the newly proposed PTFs were evaluated and compared using the root mean square error (RMSE) and coefficient of determination (R2) based on a testing soil database collected from the literature. We noticed a slight improvement in accuracy when organic carbon and coarse and fine sand fractions were included as predictors alongside silt and clay. The best results with existing PTFs were obtained by PTF-A in Tomasella and Hodnett (1998) (RMSE = 0.20 g cm–3) and PTF-F in Benites et al. (2007) (RMSE = 0.17 g cm–3). Our proposed PTFs use textural fractions and organic carbon as predictors in a hierarchical form. The proposed PTF-4, which uses fine sand, coarse sand, clay, and organic carbon, presented the lowest value for RMSE (0.14 g cm–3) for BD prediction.

https://doi.org/10.1590/1678-992x-2022-0255

Reperfusion therapy for acute ischemic stroke: where are we in 2023?
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Martins, Sheila Cristina Ouriques

; Pontes- Neto, Octávio Marques

; Pille, Arthur

; Secchi, Thaís Leite

; Alves, Maramélia Araújo de Miranda

; Rebello, Letícia Costa

; Oliveira- Filho, Jamary

; Lange, Marcos Christiano

; Freitas, Gabriel R. de

; Andrade, João Brainer Clares de

; Rocha, Letícia Januzi de Almeida

; Bezerra, Daniel da Cruz

; Souza, Ana Claudia de

; Carbonera, Leonardo Augusto

; Nogueira, Raul Gomes

; Silva, Gisele Sampaio

Arquivos de Neuro-Psiquiatria

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Dez 2023, Volume 81 Nº 12 Páginas 1030 - 1039

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.

Resumo Nas últimas três décadas, o tratamento do AVC sofreu transformações significativas, impulsionadas principalmente pela introdução das terapias de reperfusão e pela organização dos serviços de AVC. Os pacientes que recebem tratamento em um serviço de AVC bem estruturado têm uma probabilidade muito maior de resultados favoráveis, diminuindo assim a incapacidade funcional e a mortalidade. Neste artigo, revisamos as evidências científicas para as terapias de reperfusão do AVC, incluindo trombólise e trombectomia e sua implementação no sistema público de saúde no Brasil.

https://doi.org/10.1055/s-0043-1777721

Posicionamento do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia sobre o Uso do Strain Miocárdico na Rotina do Cardiologista – 2023
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Almeida, André Luiz Cerqueira

; Melo, Marcelo Dantas Tavares de

; Bihan, David Costa de Souza Le

; Vieira, Marcelo Luiz Campos

; Pena, José Luiz Barros

; Del Castillo, José Maria

; Abensur, Henry

; Hortegal, Renato de Aguiar

; Otto, Maria Estefania Bosco

; Piveta, Rafael Bonafim

; Dantas, Maria Rosa

; Assef, Jorge Eduardo

; Beck, Adenalva Lima de Souza

; Santo, Thais Harada Campos Espirito

; Silva, Tonnison de Oliveira

; Salemi, Vera Maria Cury

; Rocon, Camila

; Lima, Márcio Silva Miguel

; Barberato, Silvio Henrique

; Rodrigues, Ana Clara

; Rabschkowisky, Arnaldo

; Frota, Daniela do Carmo Rassi

; Gripp, Eliza de Almeida

; Barretto, Rodrigo Bellio de Mattos

; Silva, Sandra Marques e

; Cauduro, Sanderson Antonio

; Pinheiro, Aurélio Carvalho

; Araujo, Salustiano Pereira de

; Tressino, Cintia Galhardo

; Silva, Carlos Eduardo Suaide

; Monaco, Claudia Gianini

; Paiva, Marcelo Goulart

; Fisher, Cláudio Henrique

; Alves, Marco Stephan Lofrano

; Grau, Cláudia R. Pinheiro de Castro

; Santos, Maria Veronica Camara dos

; Guimarães, Isabel Cristina Britto

; Morhy, Samira Saady

; Leal, Gabriela Nunes

; Soares, Andressa Mussi

; Cruz, Cecilia Beatriz Bittencourt Viana

; Guimarães Filho, Fabio Villaça

; Assunção, Bruna Morhy Borges Leal

; Fernandes, Rafael Modesto

; Saraiva, Roberto Magalhães

; Tsutsui, Jeane Mike

; Soares, Fábio Luis de Jesus

; Falcão, Sandra Nívea dos Reis Saraiva

; Hotta, Viviane Tiemi

; Armstrong, Anderson da Costa

; Hygidio, Daniel de Andrade

; Miglioranza, Marcelo Haertel

; Camarozano, Ana Cristina

; Lopes, Marly Maria Uellendahl

; Cerci, Rodrigo Julio

; Siqueira, Maria Eduarda Menezes de

; Torreão, Jorge Andion

; Rochitte, Carlos Eduardo

; Felix, Alex

Arquivos Brasileiros de Cardiologia

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Dez 2023, Volume 120 Nº 12 elocation e20230646

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20230646

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease
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Ponce, Daniela

; Cardoso, Marilia Mastrocolla de Almeida

; Rúgolo, Juliana Rodrigues Machado

; Molina, Silvana Andrea

; Andrade, Luis Gustavo Modelli de

; Curado, Daniel da Silva Pereira

Brazilian Journal of Nephrology

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Set 2023, Volume 45 Nº 3 Páginas 365 - 372

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

ABSTRACT Introduction For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Objectives: Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. Methodology: A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). Results: The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Conclusion: Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.

RESUMO Introdução: Para a redução dos níveis do paratormônio (PTH) estão disponíveis no mercado brasileiro duas classes de medicamentos: ativadores do receptor da vitamina D (não seletivos e seletivos) e calcimiméticos. Dentre os medicamentos supracitados, o SUS disponibiliza calcitriol oral, paricalcitol e cinacalcete. Objetivos: Desenvolver análise de custo-efetividade (CE) e de impacto orçamentário (IO) do cinacalcete versus paricalcitol para pacientes em diálise com HPTS, na perspectiva do SUS. Metodologia: Foi construído um modelo de árvore de decisão para a análise de CE, que considerou o desfecho paratireoidectomia evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, um de demanda aferida e outro de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia (SBN). Resultados: A análise de CE mostrou que o uso de cinacalcete resulta em economia de R$ 1.394,64 ao ano e efetividade incremental de 0,08, em relação a paratireoidectomia evitada. A razão de CE incremental (RCEI) foi de - R$ 17.653,67 por paratireoidectomia evitada para o cinacalcete, já que se mostrou mais efetivo e mais barato comparado ao paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do cinacalcete no SUS estará entre - R$ 1.640.864,62 e R$ 166.368,50 no primeiro ano, considerando os cenários principal e epidemiológico baseado nos dados da SBN. Já ao final de 5 anos após a ampliação do uso, estimou-se um impacto incremental entre - R$ 10.740.743,86 e - R$ 1.191.339,37; considerando os mesmos cenários. Conclusão: Cinacalcete foi dominante para evitar paratireoidectomias, sendo custo-efetivo.

https://doi.org/10.1590/2175-8239-jbn-2022-0126en

Female-pattern hair loss: therapeutic update
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Ramos, Paulo Müller

; Melo, Daniel Fernandes

; Radwanski, Henrique

; Almeida, Rita Fernanda Cortez de

; Miot, Hélio Amante

Anais Brasileiros de Dermatologia

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Ago 2023, Volume 98 Nº 4 Páginas 506 - 519

Resumo: En | Texto: En | PDF: En

Abstract Female androgenetic alopecia or female-pattern hair loss (FPHL) is highly prevalent and has a great impact on the quality of life. The treatment is a routine challenge in dermatological practice, as many therapeutic options have a limited level of evidence and often do not meet patients expectations. Lack of knowledge of the pathogenesis of the hair miniaturization process and the factors that regulate follicular morphogenesis restricts the prospect of innovative therapies. There is also a lack of randomized, controlled studies with longitudinal follow-up, using objective outcomes and exploring the performance of the available treatments and their combinations. Topical minoxidil, which has been used to treat female pattern hair loss since the 1990s, is the only medication that has a high level of evidence and remains the first choice. However, about 40% of patients do not show improvement with this treatment. In this article, the authors critically discuss the main clinical and surgical therapeutic alternatives for FPHL, as well as present camouflage methods that can be used in more extensive or unresponsive cases.

https://doi.org/10.1016/j.abd.2022.09.006

Correlation between the event of the COVID-19 pandemic and symptoms of anxiety, depression and temporomandibular disorder in university students: cross-sectional study
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Soares, Lélio Fernando Ferreira

; Castro, Jordanna Victtória

; Andrade, Loren dos Santos

; Ramos, Marcela de Come

; Almeida, Daniel Augusto de Faria

; Haddad, Marcela Filié

BrJP

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Jul 2023, Volume 6 Nº 3 Páginas 269 - 276

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

ABSTRACT BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has been shown to be a probable aggravator of psychological responses such as anxiety and depression. This study aimed to assess the correlation between symptoms of anxiety and depression during the COVID-19 pandemic and the existence of symptoms associated with temporomandibular dysfunction (TMD) in a Brazilian university population. METHODS: This epidemiological, cross-sectional clinical study evaluated its variables of interest using the COVID-19 Fear Scale, Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Diagnostic Criteria for Temporomandibular Dysfunction (DC/TMD) and Oral Behavior Checklist (OBC) questionnaires. RESULTS: A total of 373 participants (females = 273) with a mean age of 23.8±5.45 years were included in this study. In addition, 78.2% of participants with anxiety symptoms and 54.5% of participants with depression symptoms reported a high level of TMD-related parafunction (p<0.01). The presence of anxiety symptoms increased the odds of developing intense fear of COVID-19 by 14.9 times (p<0.001) and the odds of developing moderate fear of COVID-19 by 3.5 times (p<0.001). The presence of an intense fear of COVID-19 increased the chances of developing anxiety symptoms by 17.15 times (p<0.001), while the presence of a moderate fear increased these chances by 3.12 times (p<0.001). In addition, the presence of intense (p=0.01) or moderate (p=0.018) COVID-19 fears increased the odds of developing TMD-related pain symptoms by 2.47 and 1.84 times, respectively, in this population. CONCLUSION: The presence of painful TMD symptoms was possibly influenced by fear of COVID-19. This, in turn, was related to the presence of anxiety and depression symptoms reported by the target population of this study.

RESUMO JUSTIFICATIVA E OBJETIVOS: A pandemia de COVID-19 mostrou-se um provável agravante de respostas psicológicas como ansiedade e depressão. Este estudo teve como objetivo avaliar a correlação entre sintomas de ansiedade e depressão durante o período da pandemia de COVID-19 e a existência de sintomas associados à disfunção temporomandibular (DTM) em uma população universitária brasileira. MÉTODOS: Este estudo clínico epidemiológico e transversal avaliou as suas variáveis de interesse por meio dos questionários Escala de Medo do COVID-19, Escala Hospitalar de Ansiedade e Depressão (HADS-A e HADS-D), Critérios Diagnósticos para Disfunção Temporomandibular (DC/DTM) e Checklist de Comportamentos Orais (OBC). RESULTADOS: Ao todo, 373 participantes (sexo feminino = 273), com média de idade de 23,8±5,45 anos foram incluídos neste estudo. Ademais, 78,2% dos participantes com sintomas de ansiedade e 54,5% dos participantes com sintomas de depressão reportaram alto nível de parafunção relacionada à DTM (p<0,01). A presença de sintomas de ansiedade aumentou em 14,9 vezes as chances de desenvolvimento de um quadro de medo intenso do COVID-19 (p<0,001) e de um quadro de 3,5 vezes nas chances de desenvolvimento de medo moderado do COVID-19 (p<0,001). A presença de um medo intenso do COVID-19 aumentou em 17,15 vezes as chances de desenvolvimento de sintomas de ansiedade (p<0,001), enquanto a presença de um medo moderado aumentou essas chances em 3,12 vezes (p<0,001). Ademais, a presença de medos intensos (p=0,01) ou moderados (p=0,018) do COVID-19 aumentou 2,47 e 1,84 vezes, respectivamente, as chances de desenvolvimento de sintomatologias dolorosas relacionadas à DTM nessa população. CONCLUSÃO: A presença dos sintomas dolorosos da DTM foi possivelmente influenciada pelo medo do COVID-19. Isso, por sua vez, esteve relacionado à presença de sintomas de ansiedade e de depressão, reportados pela população-alvo deste estudo.

https://doi.org/10.5935/2595-0118.20230070-en

Parallel grafting technique for a complex zone 6 aortic pseudoaneurysm treatment
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Mendes, Daniel Azevedo

; Machado, Rui

; Pereira, Carlos

; Castro, João

; Almeida, Rui

Angiologia e Cirurgia Vascular

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Jun 2023, Volume 19 Nº 2 Páginas 42 - 45

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Endovascular reconstruction of the thoracoabdominal aorta is highly complex due to the need to preserve the main visceral branches. Optimal treatment with fenestrated and branched aneurysm aortic repair (F/B-EVAR) is usually not possible in urgent situations. Parallel grafting technique as an “off-the-shelf” solution have been described with good short and medium-term results. Case report: A 44-year-old male, born in Guinea Bissau, presents to the emergency department with epigastric pain radiating to the dorsum. The patient had a history of large vessel vasculitis secondary to Bechet’s disease (HLA B51 allele positivity) and previous thoracic aneurysm aortic repair (TEVAR) to treat a paraceliac aortic pseudoaneurysm. Computed tomography angiography (CTA) demonstrated a pseudoaneurysm with approximately 10 cm diameter at zone 6 immediately distal to the previous endoprosthesis. The pseudoaneurysm was excluded with a parallel grafting technique using a 31mm aortic endoprosthesis with a periscope graft for the right renal artery in a “sandwich-like” configuration and a chimney graft for the superior mesenteric artery (SMA). Postoperative CTA confirmed the exclusion of the pseudoaneurysm and permeable bridging stents. Conclusion: The pathology of the thoracoabdominal aorta is technically demanding, requiring experience and detailed planning. The complexity increases in emergency cases. Our case highlights that the parallel grafting technique should be encouraged in life-threatening scenarios as a readily available solution for complex aortic repair, even in a reconstructed aorta.

https://doi.org/10.48750/acv.496

10.

Parallel grafting technique for a complex zone 6 aortic pseudoaneurysm treatment
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Mendes, Daniel Azevedo

; Machado, Rui

; Pereira, Carlos

; Castro, João

; Almeida, Rui

Angiologia e Cirurgia Vascular

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Jun 2023, Volume 19 Nº 2 Páginas 94 - 97

Resumo: En | Texto: En | PDF: En

https://doi.org/10.48750/acv.496

11.

The drag coefficient variations across different speeds in able-bodied, transradial and transtibial amputee cyclists by numerical simulations
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Forte, Pedro

; Morais, Jorge Estrela

; Branquinho, Luís

; Neiva, Henrique Pereira

; Monteiro, António Miguel

; Barbosa, Tiago Manuel

; Silva, António José

; Marinho, Daniel Almeida

Motricidade

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Mar 2023, Volume 19 Nº 1 Páginas 78 - 83

Resumo: En | Texto: En | PDF: En

Abstract Drag crisis has been described as a drop in the drag coefficient (Cd). This procedure was lately assessed in able-bodied cyclists in time trial position by computational fluid dynamics (CFD). Therefore, the aim of this study was to assess the phenomenon of the drag crisis by computer fluid dynamics in transradial and transtibial amputee cyclists in the upright position. A male elite-level cyclist was recruited for this research. The subject was scanned (3D geometry with a 3D Scan) with his competition bicycle, helmet, suit, and shoes. Consequently, transradial and transtibial 3D models were created editing the able-bodied 3D model. To perform the CFD analyses, a domain measuring 7 x 2.5 x 2.5 m (length, width and height, respectively) was created around each bicycle-cyclist model. The domains were meshed with more than 42 million elements. Numerical simulations by CFD were performed in fluent numerical for speeds between 1 m/s and 13 m/s, with increments of 1 m/s. The total Cd decreased with speed. It ranged from 0.84 to 0.55 in the able-bodied, 0.86 to 0.64 in the transradial and 0.90 to 0.61 in the transtibial. The drag crisis phenomenon was observed between 1m/s and 4m/s in all models.

https://doi.org/10.6063/motricidade.27479

12.

The effects of preventive shoulder exercises in electromyographic and pain levels in child swimming athletes: a before-after analysis
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Bona, Renata Luísa

; Biancardi, Carlo Massimo

; Bonezi, Artur

; Forte, Pedro

; Marinho, Daniel Almeida

Motricidade

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Mar 2023, Volume 19 Nº 1 Páginas 70 - 77

Resumo: En | Texto: En | PDF: En

Abstract The aim of this study was to evaluate maximum voluntary contraction through surface electromyography in stabilizer shoulder muscles, as well as the clinical evaluation of shoulder injury in the pre, post, and detraining stages of specific training in child swimmers. Twelve competitive swimmers volunteered for this study. Anthropometric measurements, clinical examination, electromyography (with Delsys® data acquisition system), and pain intensity levels were performed. Clinical examination and EMG data were compared using repeated-measures ANOVA with Bonferroni correction pre, post, and after detraining. The intervention program lasted for 12 weeks. The pain group presented higher pain intensity values compared to the post-intervention program. Most of the tests presented lower values at the detraining compared to the baseline. After the intervention, pain levels significantly decreased in five tests. Muscle strengthening work is highly recommended because it improves the swimmer’s shoulder performance, reducing injuries and decreasing pain intensity after 12 weeks of intervention.

https://doi.org/10.6063/motricidade.27461

13.

Outcomes of kidney autotransplantation technique in the treatment of different vascular disorders: an updated narrative review
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Mendes, Daniel A.

; Machado, Rui

; Veterano, Carlos

; Rocha, Henrique

; Castro, João

; Pinelo, Andreia

; Almeida, Henrique

; Almeida, Rui

Angiologia e Cirurgia Vascular

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Mar 2023, Volume 19 Nº 1 Páginas 38 - 43

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Kidney autotransplantation (KAT) is a versatile surgical technique used to treat multiple diseases affecting the kidney. This procedure allows the reconstruction of the renal artery or vein with optimal surgical exposure reducing warm ischemia time compared to open direct repair. Although infrequently reported nowadays and despite the growing use of endovascular treatments, KAT still has a place in treating complex kidney vascular conditions. Methods: We performed a literature review using the MEDLINE®, SCOPUS, and Web of Science databases with the combination of the terms: “kidney autotransplantation,” “renal artery,” “renal vein,” “aorta,” “aneurysm,” and “nutcracker syndrome.” All relevant English-language studies published between January 1990 and June 2022 reporting the outcomes of the KAT technique in vascular disorders were included. Results: A total of 32 articles were included. Ex-vivo repair and KAT is widely described in treating renal artery aneurysms (RAA), with a reported technical success rate of 99.9%, a complication rate ranging from 6.9 to 9.4%, and a graft loss rate of up to 4.1%. The use of the laparoscopic technique for harvesting the kidney was variable throughout the series published, and heterotopic KAT was performed in most treated patients. Ex-vivo repair and KAT was successfully used after failed endovascular therapy and is a viable option in women of childbearing age with bilateral complex RAA. Concerning renal artery stenosis associated with different etiologies (fibromuscular dysplasia, Takayasu's arteritis, and neurofibromatosis type 1), significant reduction of blood pressure and the number of anti-hypertensive drugs have been reported in most patients after KAT. Results of arterial hypertension improvement associated with RAA after KAT are more variable. The use of KAT in treating nutcracker syndrome is reported with good results, even after left renal vein transposition or venous stenting failure. Other reports exist on the successful use of KAT for treating renal vein aneurysms and as an adjunct in open surgical or hybrid aortic reconstructions. Conclusion: Renal autotransplantation is a useful technique in the treatment of kidney vascular disorders with good overall results reported in the literature. It may be an essential adjunct in open surgical or hybrid treatments for abdominal and thoracoabdominal aortic diseases. Defining the patients who would benefit from this technique as a preferential treatment choice in different renal vessel disorders would be necessary.

https://doi.org/10.48750/acv.497

14.

Challenges of Multidrug-resistant New Delhi Metallo-beta-Lactamase (NDM-1)-producing Enterobacteriaceae in Kidney Transplant Patients
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Foresto, Renato Demarchi

; Menezes, Lucas Marengo

; Nishimura, Laura Tomoko

; Cristelli, Marina Pontello

; Viana, Laila Almeida

; Santos, Daniel Wagner de Castro Lima

; Requião-Moura, Lúcio R.

; Tedesco-Silva, Helio

; Medina-Pestana, Jose

Brazilian Journal of Nephrology

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Mar 2023, Volume 45 Nº 1 Páginas 116 - 120

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Background: The emergence of multidrug-resistant NDM-1-producing enterobacteriaceae strains has become a threat to inpatients, especially to immunosuppressed ones, such as kidney transplant recipients. NDM-1 is a carbapenemase that makes gram-negative bacteria resistant to many types of antibiotics. The incidence of carbapenemase-producing enterobacteria infection in solid organ transplant recipients is around 3 to 10%, with a mortality rate of up to 30%. Methods: We present a case series of 4 patients with NDM-1-producing enterobacteria isolated in urine cultures or rectal swabs. We also conducted a cross-sectional study 30 days after patient identification, collecting surveillance cultures (rectal swab) from all inpatients to assess the extent of spread of this resistance mechanism; a total of 101 patients were included. Results: Two patients were adequately treated with negative control cultures. The other two patients were not treated because they were asymptomatic and had subsequent negative urine cultures. No new colonization was identified in the cross-sectional screening, and no new cases of urinary NDM-1 infection were recorded after a 4-year follow-up. Conclusion: Surveillance for infections caused by multidrug-resistant strains in hospitals treating immunosuppressed patients should be continued and prompt action should be taken in cases of outbreaks of multidrug-resistant infections.

Resumo Histórico: O surgimento de cepas multirresistentes de enterobacteriaceae produtoras de NDM-1 tornou-se uma ameaça para pacientes hospitalizados, especialmente para os imunossuprimidos, como os receptores de transplante renal. NDM-1 é uma carbapenemase que torna as bactérias gram-negativas resistentes a muitos tipos de antibióticos. A incidência de infecção por enterobactérias produtoras de carbapenemas em receptores de transplante de órgãos sólidos é de cerca de 3 a 10%, com uma taxa de mortalidade de até 30%. Métodos: Apresentamos uma série de casos de 4 pacientes com enterobactérias produtoras de NDM-1 isoladas em culturas de urina ou esfregaços retais. Também realizamos um estudo transversal 30 dias após a identificação do paciente, coletando culturas de vigilância (esfregaço retal) de todos os pacientes internados para avaliar a extensão de disseminação deste mecanismo de resistência; foram incluídos um total de 101 pacientes. Resultados: Dois pacientes foram tratados adequadamente com culturas de controle negativo. Os outros dois pacientes não foram tratados porque eram assintomáticos e tiveram culturas de urina negativas subsequentes. Não foi identificada nenhuma nova colonização na triagem transversal, e não foram registrados novos casos de infecção urinária por NDM-1 após um acompanhamento de 4 anos. Conclusão: A vigilância de infecções causadas por cepas multirresistentes em hospitais que tratam pacientes imunossuprimidos deve ser continuada e devem ser tomadas medidas imediatas em casos de surtos desses tipos de infecções.

https://doi.org/10.1590/2175-8239-jbn-2021-0033

15.

Cost-effectiveness analysis of intravenous paricalcitol vs. oral calcitriol in the treatment of hyperparathyroidism secondary to chronic kidney disease
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Cardoso, Marilia Mastrocolla de Almeida

; Machado-Rugolo, Juliana

; Lima, Silvana Andrea Molina

; Andrade, Luis Gustavo Modelli de

; Curado, Daniel da Silva Pereira

; Ponce, Daniela

Brazilian Journal of Nephrology

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Mar 2023, Volume 45 Nº 1 Páginas 95 - 101

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Introduction: Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels. Objectives: To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS). Methodology: We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology. Results: The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73. Conclusion: Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) à doença crônica renal (DRC) é caracterizado por elevados níveis de paratormônio (PTH), hiperplasia das glândulas paratireoides e doença cardiovascular. Para a redução dos níveis do PTH, estão disponíveis no mercado brasileiro os ativadores não seletivos e seletivos do receptor da vitamina D e os calcimiméticos. Objetivos: Desenvolver análise de custo-efetividade (C/E) e de impacto orçamentário (IO) do paricalcitol intravenoso vs. calcitriol oral para pacientes em diálise com HPTS, na perspectiva do Sistema Único de Saúde. Metodologia: Foi construído um modelo de árvore de decisão para a análise de C/E, que considerou o desfecho morte evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, sendo um de demanda aferida e um de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia. Resultados: A análise mostrou que a relação de C/E foi de R$ 1.213,68 ao ano, e uma efetividade incremental de 0,032, referente à morte evitada. A razão de C/E incremental foi de R$ 37.927,50 por morte evitada para o paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do paricalcitol estará entre R$ 1.600.202,28 e R$ 4.128.565,65 no primeiro ano, considerando os cenários principal e o epidemiológico. Já no fim de 5 anos após a ampliação do uso, estimou-se IO incremental entre R$ 48.596.855,50 e R$ 62.90.555,73. Conclusão: O paricalcitol intravenoso tem eficácia superior e segurança semelhante ao comparador calcitriol oral, diminuindo a mortalidade geral dos pacientes em diálise, embora implique maior custo.

https://doi.org/10.1590/2175-8239-jbn-2022-0049en

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