Resumen Este trabajo aborda la problemática representada por los micro y nanoplásticos (MP y NP, respectivamente) en las costas americanas del Océano Pacífico, desde la perspectiva de la Red Micro y Nano Allpa Pacha. Esta red está conformada por científicos de Chile, Perú, Costa Rica, Colombia, Ecuador, Panamá y México, quienes, preocupados por el impacto en el ambiente y su repercusión en la salud, decidieron establecer colaboraciones científicas internacionales para la geolocalización, monitoreo y caracterización de MP y NP presentes en las costas del Océano Pacífico en el continente americano. Se espera aportar datos basados en evidencias científicas y armonizados, que impacten en la enseñanza y en la planificación de medidas de control y regulación de estos contaminantes en nuestros países. En este trabajo se incluyen algunos aspectos de polímeros y plásticos, definiciones de MP’s y NP’s, y sus diversos impactos, la problemática de la toma de muestras, caracterización adecuada, entre otros. Unas de las conclusiones permitieron determinar que hay muchas características de los NP’s y MP’s sin investigar como la interacción con otros productos químicos, el impacto de la morfología en la biodisponibilidad, la formación de adherencias y liberación de las mismas durante su contacto con los compartimentos ambientales, la dependencia de su composición con su comportamiento y destino, entre otras. Asimismo, se determinó que todo aporte a la mitigación del problema de estos materiales debe incluir la concientización, la prevención y la reducción, mediante un enfoque integral de educación y capacitación, y considerando todos los actores de la sociedad, responsables de la problemática generada, bajo un enfoque de evidencia científica. Finalmente, se determinó que el tema aún está en su fase inicial, y la información es reiterativa y auto referenciada.

Abstract This work addresses the micro and nanoplastics (MP and NP, respectively) on the American coasts of the Pacific Ocean from the perspective of the Micro & Nano Allpa Pacha Network. This network is made up of scientists from Chile, Perú, Costa Rica, Colombia, Ecuador, Panama, and Mexico, who, concerned about the impact on the environment and its repercussions on health, decided to establish international scientific collaborations for the geolocation, monitoring, and characterization of MP and NP present on the coasts of the Pacific Ocean in the American continent. It is expected to provide data based on harmonized scientific evidence, which will impact the teaching and planning of control and regulation measures for these pollutants in our countries. This work includes some aspects of polymers and plastics, definitions of MP’s and NP’s and their various impacts, the problem of taking samples, adequate characterization, among others. One of the conclusions determined that are many characteristics of NP’s and MP’s without investigating, such as interaction with other chemical products, the impact of morphology on bioavailability, formation of adhesions and their release during their contact with environmental compartments, the dependence of its composition with its behavior and destiny, among others. Likewise, it was determined that any contribution to mitigating the problem of these materials must include awareness, prevention, and reduction through a comprehensive approach to education and training and considering all actors in society responsible for the problem generated under a scientific evidence approach. Finally, it was determined that the issue is still in its initial phase, and the information is repetitive and self-referenced.

RESUMO Objetivo: Mapear e sintetizar as evidências sobre a adequação do consumo de cálcio dietético e laticínios em crianças brasileiras pré-escolares e escolares. Fontes de dados: As buscas pelas evidências foram realizadas nas bases de dados Medical Literature Analysis and Retrieval System Online (Medline, via PubMed) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs, via Biblioteca Virtual em Saúde — BVS), sem restrição de data ou idioma de publicação. Foram incluídos estudos experimentais ou observacionais que avaliaram crianças brasileiras saudáveis com idade entre dois e 12 anos incompletos. Síntese dos dados: Foram incluídos 18 estudos. Sete de 11 estudos (63,6%) identificaram valores médios da ingesta de cálcio dietético abaixo do recomendado para a idade, principalmente em escolares, com a progressão da faixa etária. Entre os pré-escolares, estudos com pesagem direta dos alimentos apresentaram maiores valores médios de cálcio dietético ingerido comparados aos obtidos com recordatório alimentar. Crianças frequentadoras de creches públicas em regime de meio período tiveram a maior inadequação da ingesta de cálcio. A ingesta de leite e derivados foi menor entre as crianças com idade mais avançada, principalmente em escolares. Conclusões: A inadequação da ingesta de cálcio dietético parece ser prevalente no Brasil, principalmente em escolares. Sendo assim, a avaliação da ingestão de leite e derivados é um ponto a ser observado para a realização de ações corretivas nessa faixa etária.

ABSTRACT Objective: The objective of this study was to map and synthesize evidence on the adequacy of dietary calcium intake and dairy products in Brazilian preschoolers and schoolchildren. Data source: Evidence searches were performed in the MEDLINE (via PubMed) and Latin American and Caribbean Health Sciences Literature (LILACS; via BVS) databases, with no restriction on date or language of publication. Experimental or observational studies that evaluated healthy Brazilian children between 2 and 12 incomplete years old were included. Data synthesis: A total of 18 studies were included. Seven of 11 studies of 11 studies (63.6%) identified mean values of dietary calcium intake below the age recommendation, especially in schoolchildren, with the progression of the age group. Among preschoolers, studies with direct weighing of food showed higher mean values of dietary calcium ingested compared to those with dietary recall. Children attending public daycare centers on a part-time basis tended to have inadequate calcium intake. The consumption of milk and dairy products was lower among older children, especially schoolchildren. Conclusions: Inadequate dietary calcium intake seems to be prevalent in Brazil during childhood, especially among schoolchildren. Therefore, the evaluation of milk and dairy products intake must be considered in order to desgn appropriate corrective actions.

RESUMEN Se realizó una caracterización físico-química de los efluentes procedentes de industrias del sector educación, metalmecánico, lácteos y confitería de la ciudad de Manizales, Caldas; posteriormente se obtuvieron aislamientos, en medios diferenciales suplementados, de bacterias con potencial para la producción de biopolímeros a los cuales se les aplicó pruebas para la caracterización morfológica, bioquímica y molecular. Los parámetros físico químicos obtenidos de los efluentes industriales demuestran diferencias entre ellos, ya que cada industria genera diferentes residuos aportando una determinada contaminación al efluente, se obtuvieron 73 aislamientos productores de exopolisacáridos (EPS) y 101 productores de polihidroxialcanoatos (PHA), con características morfológicas y bioquímicas variables. El estudio muestra que los efluentes industriales son una gran fuente de bacterias de interés para la producción de diversos polímeros microbianos; principalmente aquellos que producen polímeros tipo biopoliésteres intracelulares como PHA, debido a su variabilidad físico-química y nutricional permitiendo que los microorganismos se adapten a diversas características medioambientales y de composición.

ABSTRACT A physical-chemical characterization of effluents from industries in the education, metal-mechanic, dairy and confectionery sectors of the city of Manizales, Caldas; Later isolates were obtained, in differential media supplemented, from bacteria with potential for the production of biopolymers to which they were applied tests for morphological, biochemical and molecular characterization. The physical chemical parameters obtained from the industrial effluents show a difference between them, since each industry generates different waste contributing a certain contamination to the effluent, 73 isolates producing exopolysaccharides (EPS) and 101 producers of polyhydroxyalkanoates (PHA) were obtained, with morphological characteristics and variable biochemistry. The study shows that industrial effluents are a great source of bacteria of interest for the production of various microbial polymers; mainly those that produce polymers like intracellular biopolyesters such as PHA, due to their physical-chemical and nutritional variability allowing the microorganisms to adapt to diverse environmental and compositional characteristics.

ABSTRACT Objective: To evaluate the factors associated with a positive cervical cytology result in the Pap smear test in a sample of Peruvian women from Lima, Peru - 2013. Methods: We conducted an analytical cross-sectional study including women from 21 to 64 years and we used the Pap smear test to evaluate cervical cytology. We included sociodemographic and medical history variables obtained from medical records of the patients. We elaborated generalized linear models from Poisson family with robust variances to evaluate the factors associated with positive cytology. The association measure reported was the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). Results: We analyzed 11110 women with a mean age of 41.5 ± 10.9 years and a prevalence of a positive Pap smear test of 2.8%. In the adjusted model, we found that women between 21 and 30 years old (aPR=1.97; 95%CI:1.30-3.00), 31 to 40 years (aPR=2.56; 95%CI:1.76 -3.72) and 41 to 50 years (aPR=2.16; 95%CI:1.47-3.17), single (aPR=1.41; 95%CI:1.10-1.83), widowed or divorced (aPR=1.90; 95%CI:1.27-2.87), with a sexual life onset before 16 years (aPR=1.30; 95%CI:1.01- 1.68) or between 16 and 19 years (aPR=1.69; 95%CI:1.22-2.36) had a greater prevalence of a positive cervical cytology result. Conclusions: Cervical cancer is a public health problem in Peru, then, identifying the factors associated will allow us to improve screening strategies and prioritize groups at higher risk.

RESUMEN Objetivo: Evaluar los factores asociados a un resultado de citología cervical positiva en la prueba de Papanicolau en una muestra de mujeres peruanas en Lima, Perú - 2013. Material y métodos: Se realizó un estudio transversal analítico que incluyó a mujeres con edades entre 21 a 64 años y empleó la prueba de Papanicolaou para evaluar la citología cervical. Se incluyó factores sociodemográficos y antecedentes de la mujer obtenidos de la historia clínica de las pacientes. Se realizaron modelos lineales generalizados de familia Poisson con varianzas robustas para evaluar los factores asociados a la citología positiva. La medida de asociación reportada fue la razón de prevalencia (RP) con sus respectivos intervalos de confianza al 95% (IC95%). Resultados: Se incluyeron a 11110 mujeres en el análisis con una edad media de 41,5±10,9 años y la prevalencia de un resultado positivo en la prueba de Papanicolau fue de 2,8%. En el modelo ajustado, se halló que tener entre 21 a 30 años (RPa=1,97;IC95%:1,30-3,00), 31 a 40 años (RPa=2,56;IC95%:1,76-3,72) y 41 a 50 años (RPa=2,16;IC95%:1,47-3,17), ser soltera (RPa=1,41;IC95%:1,10-1,83), viuda o divorciada (RPa=1,90;IC95%:1,27-2,87), haber tenido inicio de vida sexual antes de los 16 años (RPa=1,30;IC95%:1,01-1,68) o entre los 16 a 19 años (RPa=1,69;IC95%:1,22-2,36) se asoció a una mayor probabilidad de presentar un resultado de citología cervical positivo. Conclusiones: El cáncer de cuello uterino representa un problema de salud pública en Perú, por lo que identificar sus factores asociados es útil para mejorar las estrategias de tamizaje, priorizando grupos de mayor riesgo.

OBJECTIVE: To test the hypothesis that intravenous use of methotrexate associated with lipid nanoemulsions can achieve superior anti-inflammatory effects in the joints of rabbits with antigen-induced arthritis compared with commercial methotrexate. METHODS: Arthritis was induced in New Zealand rabbits sensitized with methylated bovine serum albumin and subsequently intra-articularly injected with the antigen. A nanoemulsion of methotrexate labeled with 3H-cholesteryl ether (4 mg/kg methotrexate) was then intravenously injected into four rabbits to determine the plasma decaying curves and the biodistribution of the methotrexate nanoemulsion by radioactive counting. Additionally, the pharmacokinetics of the methotrexate nanoemulsion were determined by high-pressure liquid chromatography. Twenty-four hours after arthritis induction, the animals were allocated into three groups, with intravenous injection with saline solution (n=9), methotrexate nanoemulsion (0.5 µmol/kg methotrexate, n=7), or commercial methotrexate (0.5 µmol/kg, n=4). The rabbits were sacrificed 24 h afterward. Synovial fluid was then collected for protein leakage and cell content analyses and synovial membranes were collected for histopathological analysis. RESULTS: The methotrexate nanoemulsion was taken up mainly by the liver and the uptake by arthritic joints was two-fold greater than that by control joints. The methotrexate nanoemulsion treatment reduced leukocyte influx into the synovial fluid by nearly 65%; in particular, mononuclear and polymorphonuclear cells were reduced by 47 and 72%, respectively. In contrast, cell influx was unaffected following treatment with commercial methotrexate. Protein leakage into the arthritic knees of the rabbits was also more limited following methotrexate nanoemulsion treatment than following commercial methotrexate treatment. CONCLUSIONS: The intravenous methotrexate nanoemulsion showed anti-inflammatory effects on the synovia of arthritic joints that were clearly superior to the effects of a commercial methotrexate preparation. This result is conceivably due to greater methotrexate uptake by the joints when the drug is associated with a nanoemulsion.

Os Programas de Residência Multiprofissional buscam romper com os paradigmas em relação à formação de profissionais para o Sistema Único de Saúde (SUS) e contribuir para qualificar os serviços de saúde a partir de ações inovadoras. Entretanto, características específicas desses programas podem agregar estressores aos residentes e, levarem à Sídrome de Burnout. Dessa forma, verificou-se a ocorrência da Síndrome de Burnout nos Residentes Multiprofissionais da Universidade Federal de Santa Maria. Este estudo trata-se de um estudo descritivo, transversal e quantitativo. Aplicaram-se um formulário de dados sociodemográficos e o Versão Human Service Survey do Marlash Burnout Inventory em 37 residentes, entre abril e junho de 2011. Observou-se que 37,84% apresentaram Alta Exaustão Emocional; 43,24%, Alta Despersonalização; e 48,65%, Baixa Realização Profissional. Na associação dos domínios, verificou-se que 27% apresentaram indicativo para Síndrome de Burnout. Os residentes pesquisados estão expostos aos estressores da profissão e da formação, o que pode favorecer a ocorrência da síndrome nesses profissionais.

The multiprofessional residency programs seek to break paradigms regarding the education and training of professionals for the Unified Health System (Sistema Único de Saúde - SUS) and contribute to qualify health services by promoting innovative strategies. However, specific features of these programs can add stress to residents and lead to the Burnout Syndrome. Therefore, we assessed the occurrence of burnout syndrome among the multiprofessional residents at the Federal University of Santa Maria. This is a descriptive, cross-sectional and quantitative study. A sociodemographic data form and the Version Human Service Survey of Marlash Burnout Inventort were administered to 37 residents between April and June of 2011. It was observed that 37.84% presented with High Emotional Stress, 43.24% with High Depersonalization and 48.65% with Low Professional Fulfillment. In terms of the association between domains, it was found that 27% of the residents presented with signs of Burnout Syndrome. The studied residents will be exposed to the stressors of the profession and education/training, which may favor the occurrence of the syndrome in these professionals.

Los Programas de Residencia Multiprofesional buscan romper los paradigmas relativos a la formación de profesionales para el Sistema Único de Salud (SUS) y contribuir a calificar los servicios de salud con acciones innovadoras. Sin embargo, las características específicas de estos programas se pueden añadir estrés a los residentes y llevar a la Síndrome Burnout. Se verificó la presencia de Síndrome de Burnout en los Residentes Multiprofesionales de la Universidad Federal de Santa Maria. Estudio descriptivo, transversal, cuantitativo. Se aplicó un formulario de datos sociodemográficos y el Versión Human Service Survey del Marlash Burnout Inventory a 37 residentes de abril a junio de 2011. Se observó que 37,84% presentaba Alto Agotamiento Emocional, 43,4% Alta Despersonalización y 48,65% Baja Realización Profesional. En la asociación de dominios, se verificó que 27% presentaba indicativo de Síndrome de Burnout. Los residentes investigados están expuestos a los estresores de la profesión y de la formación, lo cual puede favorecer la aparición del síndrome entre ellos.

The multiprofessional residency programs seek to break paradigms regarding the education and training of professionals for the Unified Health System (Sistema Único de Saúde - SUS) and contribute to qualify health services by promoting innovative strategies. However, specific features of these programs can add stress to residents and lead to the Burnout Syndrome. Therefore, we assessed the occurrence of burnout syndrome among the multiprofessional residents at the Federal University of Santa Maria. This is a descriptive, cross-sectional and quantitative study. A sociodemographic data form and the Version Human Service Survey of Marlash Burnout Inventort were administered to 37 residents between April and June of 2011. It was observed that 37.84% presented with High Emotional Stress, 43.24% with High Depersonalization and 48.65% with Low Professional Fulfillment. In terms of the association between domains, it was found that 27% of the residents presented with signs of Burnout Syndrome. The studied residents will be exposed to the stressors of the profession and education/training, which may favor the occurrence of the syndrome in these professionals.

Los Programas de Residencia Multiprofesional buscan romper los paradigmas relativos a la formación de profesionales para el Sistema Único de Salud (SUS) y contribuir a calificar los servicios de salud con acciones innovadoras. Sin embargo, las características específicas de estos programas se pueden añadir estrés a los residentes y llevar a la Síndrome Burnout. Se verificó la presencia de Síndrome de Burnout en los Residentes Multiprofesionales de la Universidad Federal de Santa Maria. Estudio descriptivo, transversal, cuantitativo. Se aplicó un formulario de datos sociodemográficos y el Versión Human Service Survey del Marlash Burnout Inventory a 37 residentes de abril a junio de 2011. Se observó que 37,84% presentaba Alto Agotamiento Emocional, 43,4% Alta Despersonalización y 48,65% Baja Realización Profesional. En la asociación de dominios, se verificó que 27% presentaba indicativo de Síndrome de Burnout. Los residentes investigados están expuestos a los estresores de la profesión y de la formación, lo cual puede favorecer la aparición del síndrome entre ellos.

Os Programas de Residência Multiprofissional buscam romper com os paradigmas em relação à formação de profissionais para o Sistema Único de Saúde (SUS) e contribuir para qualificar os serviços de saúde a partir de ações inovadoras. Entretanto, características específicas desses programas podem agregar estressores aos residentes e, levarem à Sídrome de Burnout. Dessa forma, verificou-se a ocorrência da Síndrome de Burnout nos Residentes Multiprofissionais da Universidade Federal de Santa Maria. Este estudo trata-se de um estudo descritivo, transversal e quantitativo. Aplicaram-se um formulário de dados sociodemográficos e o Versão Human Service Survey do Marlash Burnout Inventory em 37 residentes, entre abril e junho de 2011. Observou-se que 37,84% apresentaram Alta Exaustão Emocional; 43,24%, Alta Despersonalização; e 48,65%, Baixa Realização Profissional. Na associação dos domínios, verificou-se que 27% apresentaram indicativo para Síndrome de Burnout. Os residentes pesquisados estão expostos aos estressores da profissão e da formação, o que pode favorecer a ocorrência da síndrome nesses profissionais.

The Multidisciplinary Residency Program aims to adapt the guidelines and principles of the SUS(Brazilian Government Health System)for the training of health workers and thus contribute to the improvement of health services. It was identified the sociodemographic, professional and academic multidisciplinary Residents profile of a university hospital in RS. It is a descriptive and quantitative study. The MBI was applied to 37 residents in 2011.There was the predominance of the female sex (83.78%), unmarried (81.08%), without children (94.6%), aged between 25 and 29 years (51.35%), joined RMS in one year after the completion of the undergraduate course (41.66%), work in hospital emphasis (66.67%), are satisfied with the residence (58.82%) and thought about quitting 62.16%.Of the total, 59.46% have work experience and study on average 111.4 minutes a day. The profile identified, young, single, with the studying habit associated to work activities favoring the formation of professional features to work with the SUS.

El Programa de Residencia Multidisciplinaria busca adaptar directrices y principios del Sistema Único de Salud a la formación de trabajadores y así contribuir a la mejoría de los servicios de salud. Se identificaron el perfil sociodemográfico, profesional y académico de los residentes multidisciplinarios de un hospital universitario del Rio Grande do Sul, Brasil. Estudio descriptivo y cuantitativo, que aplicó el protocolo de investigación a 37 residentes en 2011. Predominaron el sexo femenino (83,78%), solteros (81,08%), sin hijos (94,6%), con edades entre 25 y 29 años (51,35%), ingresaron en el Programa en un año después de la conclusión del curso (41,66%), trabajan en la énfasis hospitalaria (66,67%), están satisfechos con la residencia (58,82%), mientras que 62,16% desearon salir. Del total, 59,46% tiene experiencia profesional y estudian, en promedio, 111,4 minutos/día. El perfil identificado, jóvenes, solteros, con el hábito de estudiar, asociado al trabajo, favorece la formación para trabajar en el Sistema de Salud.

O Programa de Residência Multiprofissional objetiva adaptar as diretrizes e princípios do Sistema Único de Saúde à formação dos trabalhadores da área da saúde e assim, contribuir para a qualificação dos serviços de saúde. Identificou-se o perfil sociodemográfico, profissional e acadêmico dos Residentes Multiprofissionais de um hospital universitário do Rio Grande do Sul. Estudo descritivo e quantitativo. Aplicou-se o Protocolo de Pesquisa a 37 residentes em 2011. Predominaram aqueles do sexo feminino (83,78%), solteiros (81,08%), sem filhos (94,6 %), na faixa etária entre 25 e 29 anos (51,35%), ingressaram na RMS um ano após a conclusão do curso de graduação (41.66%), atuam na ênfase hospitalar (66,67%), estão satisfeitos com a residência (58,82%), embora 62,16% pensaram em desistir. Do total, 59,46% possui experiência profissional e estudam em média 111,4 minutos/dia. O perfil identificado, jovens, solteiros, com hábito de estudar associado às atividades laborais favorece a formação de profissionais com características para atuar no SUS.

The present paper analyzes the coping strategies of women who suffer intimate partner violence. Maladaptive and adaptive strategies are differentiated on the basis of their impact on health and quality of life. The results of a first qualitative exploration of these strategies in our population are presented. The methodology was based on in-depth interviews to 8 women who were coping with or had already overcome violence in their couple. The dynamics of self-help groups specifically oriented to this issue have been observed as well. The total sample was formed by 12 women, whose age ranged from 35 to 69, attending to centers specialized in domestic violence. Results highlight the relevance of psychosocial support for an adaptive coping.

El objetivo del presente estudio es analizar aquellas estrategias de afrontamiento presentes en las mujeres que sufren violencia doméstica. Se diferencian las estrategias que resultarían disfuncionales de aquellas funcionales o adaptativas por su impacto en la salud y en la calidad de vida de las mujeres. Se presentan los resultados de una primera exploración cualitativa acerca de estas estrategias en nuestra población. La metodología se basó en entrevistas en profundidad a 8 mujeres que se encuentran en proceso de afrontamiento o que ya han superado la situación de violencia en su pareja. Asimismo, se utilizó la observación de dinámicas de grupos de autoayuda específicamente orientados a esta conflictiva. La muestra total estuvo conformada por 12 mujeres de entre 35 y 69 años, asistentes a centros especializados en la problemática. Los resultados destacan la relevancia del apoyo psicosocial para el afrontamiento adaptativo de esta problemática.

OBJETIVO: Este estudo de campo objetivou identificar as alterações ultrassonográficas e hemodinâmicas indicativas da morbidade da esquistossomose mansônica em áreas endêmicas. MATERIAIS E MÉTODOS: Foram examinados pela ultrassonografia Doppler 554 pacientes esquistossomóticos em três áreas com níveis distintos de endemicidade: baixa endemicidade (n = 109); média endemicidade (n = 255) e alta endemicidade (n = 190). Para o estudo ultrassonográfico foi utilizado o protocolo da Organização Mundial da Saúde (Niamey Working Group, 2000). Pelo Doppler foram avaliados: vasos portais, artérias hepática e esplênica, veias hepáticas e vasos colaterais. RESULTADOS: Houve correlação significativa entre a frequência das alterações ultrassonográficas e o nível de endemicidade das áreas, exceto a hipertrofia do lobo esquerdo. As veias hepáticas apresentaram padrão de fluxo alterado em 23,7% dos casos, alteração esta relacionada à presença e à intensidade de espessamento periportal. A artéria hepática não apresentou alterações nos parâmetros avaliados. Os vasos colaterais foram identificados apenas na área de alta endemicidade. A artéria esplênica apresentou alterações (aumento do calibre, da velocidade e do índice de resistência) mais frequentes na área de alta endemicidade, com diferença significativa entre os grupos. CONCLUSÃO: A ultrassonografia Doppler mostrou-se ferramenta auxiliar importante no estudo da morbidade relacionada à esquistossomose mansônica, contribuindo para definição mais precisa do perfil da doença nas áreas endêmicas.

OBJECTIVE: The present field research was aimed at identifying sonographic and hemodynamic findings indicative of the presence of schistosomiasis mansoni in endemic areas. MATERIALS AND METHODS: Doppler sonography was performed in 554 patients with schistosomiasis in three areas with different endemicity levels: low (n = 109), medium (n = 255) and high endemicity (n = 190). The World Health Organization (Niamey Working Group, 2000) protocol was adopted for sonographic evaluation. Doppler study included portal vessels, hepatic and splenic arteries, hepatic veins and collateral vessels. RESULTS: A significant correlation was observed between the frequency of sonographic findings, except for left lobe hypertrophy, and the areas endemicity levels. Altered hepatic veins flow pattern was observed in 23.7% of cases, such abnormality being related to the presence and intensity of periportal thickening. Hepatic arteries did not present any alteration as related to the evaluated parameters. Collateral vessels were identified only in the patients from the high-endemicity area. The splenic artery presented alterations (increase in caliber, flow velocity and resistive index), most frequently in the high-endemicity area, with significant difference between groups. CONCLUSION: Doppler sonography has shown to be a relevant auxiliary tool in the study of the morbidity related to schistosomiasis mansoni, contributing for a more accurate description of the disease profile in endemic areas.

No remodelamento que se segue às sobrecargas de volume não é descrito o aumento de fibrose miocárdica. Após o infarto, entretanto, há hipertrofia do miocárdio remoto com acúmulo de fibrose, particularmente no subendocárdio. Na fístula aorto-cava, tal como no infarto, é possível que a queda da pressão de perfusão coronariana interfira com a fibrose cardíaca. OBJETIVO: Investigar o papel das mudanças hemodinâmicas agudas sobre a fibrose cardíaca na fístula aorto-cava. MÉTODO: Ratos Wistar submetidos a fístula aorto-cava, seguidos por 4 e 8 semanas, constituíram 4 grupos, fístula aorto-cava 4 e fístula aorto-cava 8 (10 ratos cada) e seus respectivos controles (sham-operated controls - Sh), Sh4 e Sh8 (8 ratos cada). A hemodinâmica foi realizada 1 semana após a cirurgia. A hipertrofia e a fibrose foram quantificadas ao final do seguimento pelo diâmetro dos miócitos e pela fração de volume do colágeno. RESULTADOS: Comparados com Sh4 e Sh8, a pressão de pulso, a pressão diastólica final do ventrículo esquerdo e a +dP/dt foram maiores em fístula aorto-cava 4 e fístula aorto-cava 8, enquanto a -dP/dt foi similar. A pressão estimada da perfusão coronariana (mmHg) foi menor em fístula aorto-cava 8 (52,6±4,1) do que em Sh8 (100,8±1,3), mas comparável entre fístula aorto-cava 4 (50,0±8,9) e Sh4 (84,8±2,3). O diâmetro dos miócitos foi maior em fístula aorto-cava 8 e a fibrose intersticial e subendocárdica maior em fístula aorto-cava 4 e fístula aorto-cava 8. Houve correlação inversa e independente da pressão de perfusão coronariana com a fibrose subendocárdica (r²=0,86; p<0,0001) e das pressões sistólica (r²=0,73; p=0,0035) e diastólica final do ventrículo esquerdo (r²=0,55; p=0.0124) com a fibrose intersticial. CONCLUSÃO: A queda precoce da pressão de perfusão coronariana e o aumento das pressões ventriculares após a fístula aorto-cava associam-se com fibrose miocárdica subseqüente.

Left ventricular hypertrophy following volume overload is regarded as an example of cardiac remodeling without increased fibrosis accumulation. However, infarction is associated with increased fibrosis within the noninfarcted, hypertrophied myocardium, particularly in the subendocardial regions. It is conceivable to suppose that, as also occurs postinfarction, low coronary driving pressure may also interfere with accumulation of myocardial fibrosis following aortocaval fistula. PURPOSE: To investigate the role of acute hemodynamic changes in subsequent deposition of cardiac fibrosis in response to aortocaval fistula. METHOD: Aortocaval fistula were created in 4 groups of Wistar rats that were followed over 4 and 8 weeks: aortocaval fistula 4 and aortocaval fistula 8 (10 rats each) and their respective controls (sham-operated controls - Sh), Sh4 and Sh8 (8 rats each). Hemodynamic measurements were performed 1 week after surgery. Hypertrophy and fibrosis were quantified by myocyte diameter and collagen volume fraction at the end of follow up. RESULT: Compared with Sh4 and Sh8, pulse pressure, left ventricular end-diastolic pressure, and +dP/dt were higher in aortocaval fistula 4 and aortocaval fistula 8, but -dP/dt was similar. Coronary driving pressure (mm Hg), used as an estimate of perfusion pressure, was lower in aortocaval fistula 8 (52.6 ± 4.1) than in Sh8 (100.8 ± 1.3), but comparable between aortocaval fistula 4 (50.0 ± 8.9) and Sh4 (84.8 ± 2.3). Myocyte diameter was greater in aortocaval fistula 8, whereas interstitial and subendocardial fibrosis were greater in aortocaval fistula 4 and aortocaval fistula 8. Coronary driving pressure correlated inversely and independently with subendocardial fibrosis (r² = .86, P <.001), whereas left ventricular systolic pressure (r² = 0.73, P = .004) and end-diastolic pressure (r² = 0.55, P = 012) correlated positively and independently with interstitial fibrosis. CONCLUSION: Coronary driving pressure falls and ventricular pressures increase early after aortocaval fistula and are associated with subsequent myocardial fibrosis deposition.