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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.

https://doi.org/10.1590/s1677-5538.ibju.2023.0065

The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
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Falavigna, Maicon

; Araujo, Cintia Laura Pereira de

; Barbosa, Alexandre Naime

; Belli, Karlyse Claudino

; Colpani, Verônica

; Dal-Pizzol, Felipe

; Silva, Rosemeri Maurici da

; Azevedo, Luciano César Pontes de

; Dias, Maria Beatriz Souza

; Amaral, José Luiz Gomes do

; Dorneles, Gilson Pires

; Ferreira, Juliana Carvalho

; Freitas, Ana Paula da Rocha

; Gräf, Débora Dalmas

; Guimarães, Hélio Penna

; Lobo, Suzana Margareth Ajeje

; Machado, Flávia Ribeiro

; Nunes, Michelle Silva

; Oliveira, Maura Salaroli de

; Parahiba, Suena Medeiros

; Rosa, Regis Goulart

; Santos, Vania Cristina Canuto

; Sobreira, Marcone Lima

; Veiga, Viviane Cordeiro

; Xavier, Ricardo Machado

; Zavascki, Alexandre Prehn

; Stein, Cinara

; Carvalho, Carlos Roberto Ribeiro de

Critical Care Science

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sep 2023, Volume 35 N. 3 Pages 243 - 255

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

ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

https://doi.org/10.5935/2965-2774.20230136-en

Avaliação dos dados de mortes por COVID-19 nas bases dos cartórios do RC-Arpen, SIVEP-Gripe e SIM no Brasil em 2020
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Guedes, Ricardo

; Dutra, Gilson José

; Machado, Cecilia

; Palma, Marina Aguiar

Cadernos de Saúde Pública

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2023, Volume 39 N. 3 elocation e00077222

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

Este estudo compara os registros de óbitos por COVID-19 em 2020 para todo o território nacional. Utilizamos três bases distintas: Registro Civil (RC-Arpen), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe). Há discordâncias entre os números de mortes por COVID-19 divulgados pelas diversas bases e essas diferenças variam em cada Unidade da Federação. A base do RC-Arpen é atualizada mais rapidamente que as outras duas bases do Departamento de Informática do Sistema Único de Saúde - DATASUS (SIM e SIVEP-Gripe), além de ser mais indicada para monitoramentos e pesquisas que abrangem períodos mais recentes. Apesar da atualização mais lenta, as bases do DATASUS apresentam números geograficamente similares e divulgam dados mais detalhados sobre as mortes. Esse detalhamento das informações torna as bases do DATASUS mais adequadas para pesquisas que demandam mais informações sobre o paciente e o tratamento.

Este estudio compara los registros de defunciones por COVID-19 en 2020 para todo el territorio brasileño. Se utilizaron tres bases diferentes: Registro Civil (RC-Arpen), Sistema de Información de Mortalidad (SIM) y Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe). Existen discrepancias entre las cifras de muertes por COVID-19 comunicadas por las distintas bases de datos y estas diferencias varían en cada Unidad Federal. La base de datos RC se actualiza más rápidamente que las otras dos bases de datos del Departamento de Informática del Sistema Único de Salud - DATASUS (SIM y SIVEP-Gripe) y es más adecuada para el seguimiento y las encuestas que abarcan periodos más recientes. A pesar de que la actualización es más lenta, las bases de datos del DATASUS presentan cifras geográficamente similares y revelan datos más detallados sobre las muertes. Este detalle de la información hace que las bases de datos del DATASUS sean más adecuadas para investigaciones que requieren más información sobre el paciente y el tratamiento.

This study compares the death records due to COVID-19 in 2020 for Brazilian territory. Three distinct databases were used: Civil Registry (RC-Arpen), Brazilian Mortality Information System (SIM), and Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). We identified differences between the numbers of deaths due to COVID-19 in these databases, varying in each federative unit. The RC database is updated faster than the other two databases (SIM and SIVEP-Gripe) and it is most suited for monitoring and for studies covering recent periods. Despite the slower update, Brazilian Health Informatics Department (DATASUS) databases present geographically similar numbers and disclose more detailed data on deaths. This detailed information improves the DATASUS databases for studies that require more information about the patient and treatment.

https://doi.org/10.1590/0102-311xpt077222

Avaliação dos dados de mortes por COVID-19 nas bases dos cartórios do RC-Arpen, SIVEP-Gripe e SIM no Brasil em 2020
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Guedes, Ricardo

; Dutra, Gilson José

; Machado, Cecilia

; Palma, Marina Aguiar

Cadernos de Saúde Pública

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2023, Volume 39 N. 3 elocation e00077222

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

https://doi.org/10.1590/0102-311xpt077222

MINIMALLY INVASIVE OSTEOSYNTHESIS FOR CLAVICULAR FRACTURE WITH LOCKED PLATE
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AMARAL, FELIPE MACHADO DO

; MALAVOLTA, EDUARDO ANGELI

; SILVA, FERNANDO BRANDÃO DE ANDRADE E

; ALTOÉ, LEANDRO SOSSAI

; NUNES, CASSIO VELLOSO

; PÉCORA, JOSÉ RICARDO

Acta Ortopédica Brasileira

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2023, Volume 31 N. 2 elocation e263742

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

ABSTRACT Objective: To evaluate the clinical and radiographic results of the surgical treatment of fractures of the middle third of the clavicle, using the technique of minimally invasive plate osteosynthesis (MIPO) with locking. Methods: Prospective case series, evaluating displaced fractures of the middle third of the clavicle submitted to MIPO with locking, with procedures performed by a single surgeon. Patients were evaluated at 12 months using the University of Los Angeles (UCLA) scale and anteroposterior radiographs of the clavicles with 45° cranial and caudal inclination, as well as reporting complications. Results: In total, 15 patients were evaluated. The median of surgical time was 50 minutes (IQR 35). The UCLA scale had a median of 35 (IQR 2) at 12 months. All patients presented fracture healing. Minor complications occurred in three cases (20%), with two (13.3%) evolving with plate prominence and one (6.7%) with local paresthesia, while major complications occurred in only one case (6.7%), with suture dehiscence requiring surgical re-approach. Conclusion: MIPO with locking is a viable option for the treatment of displaced fractures of the middle third of the clavicle, with excellent results according to the UCLA scale, fracture healing in all cases, and a low rate of complications. Level of Evidence IV, Case Series.

RESUMO Objetivo: Avaliar os resultados clínicos e radiográficos do tratamento cirúrgico de fraturas do terço médio da clavícula pela técnica de osteossíntese minimamente invasiva com placa (OMIP) bloqueada. Métodos: Série de casos prospectiva que avaliou fraturas desviadas do terço médio da clavícula submetidas à OMIP bloqueada, com procedimentos realizados por um único cirurgião. Os pacientes foram avaliados aos 12 meses por meio da escala da Universidade da Califórnia em Los Angeles (UCLA) e por radiografias das clavículas em anteroposterior (AP) com inclinação cranial e caudal de 45°, além de relatos de complicações. Resultados: Foram avaliados 15 pacientes. A mediana do tempo cirúrgico foi de 50 minutos (IIQ 35). A escala da UCLA aos 12 meses teve mediana de 35 (IIQ 2). Todos os pacientes apresentaram consolidação da fratura. Complicações menores ocorreram em três casos (20%): dois (13,3%) com proeminência da placa e um (6,7%) com parestesia local. Maiores complicações ocorreram em apenas um caso (6,7%), com deiscência de sutura, necessitando de reabordagem cirúrgica. Conclusão: A OMIP bloqueada se mostrou uma opção viável ao tratamento das fraturas desviadas do terço médio da clavícula, com resultados excelentes de acordo com a escala UCLA, consolidação em todos os casos e baixo índice de complicações. Nível de Evidência IV, Série de Casos.

https://doi.org/10.1590/1413-785220233102e263742

BALB/c and C57BL/6 mouse strains influence gastric function outcomes with administration of cisplatin and dexamethasone
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Gama, Loyane Almeida

; Machado, Mariana Pirani Rocha

; Corá, Luciana Aparecida

; Beckmann, Ana Paula Simões

; Alves, Wellington David Luz

; Miranda, José Ricardo de Arruda

; Américo, Madileine Francely

Brazilian Journal of Pharmaceutical Sciences

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2023, Volume 59 elocation e22718

Abstract: En | Text: En | PDF: En

Abstract Our aim was to evaluate the effects of cisplatin and dexamethasone alone and combined on gastric contractility and histomorphometry of BALB/c and C57BL/6 mice. BALB/c and C57BL/6 male mice (8-week-old) were randomly separated into: Control; Cisplatin (7.5 mg/Kg); Dexamethasone (2.0 mg/Kg); and Dexamethasone plus Cisplatin (2.0 mg/Kg of dexamethasone 1-hour prior to 7.5 mg/Kg of cisplatin). Drugs were administered intraperitoneally for three days. Body weight and food intake were evaluated on 2nd day. Alternating Current Biosusceptometry technique was employed to measure gastric contractions on 3rd day. Afterward, mice were killed for gastric histomorphometric analysis. Cisplatin decreased food intake and caused bradygastria in BALB/c mice; however, the amplitude of gastric contractions decreased in both BALB/c and C57BL/6. Dexamethasone and cisplatin combined restored the gastric frequency and food intake only in BALB/c, but drug combination reduced the gastric amplitude of contractions in both strains. Dexamethasone alone increased gastric mucosa thickness in C57BL/6 and decreased muscular thickness in BALB/c. In conclusion, the mouse strains presented differences in acute effects of cisplatin and dexamethasone alone and combined on gastric function. This reinforces the importance of choosing the appropriate mouse strain for studying the acute effects of drugs on the gastrointestinal tract.

https://doi.org/10.1590/s2175-97902023e22718

Bioactive compounds of fractionated palm oil with a higher content of oleic acid
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Guedes, Andréa Madalena Maciel

; Wilhelm, Allan Eduardo

; Moura, José Inácio Lacerda

; Lopes, Ricardo

; Faria-Machado, Adelia Ferreira de

; Antoniassi, Rosemar

Revista Brasileira de Fruticultura

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2023, Volume 45 elocation e-555

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

Abstract BRS Manicoré cultivar is an interspecific hybrid between Elaeis oleifera and Elaeis guineensis(ISH OxG). It has shown high yield potential and genetic resistance to phytosanitary problems in cultivation in Brazil. Studies have indicated differences in the composition of ISH OxG and palm oils, as well as the influence of genotype and environment on palm oil characteristics. The aim of this study was to assess the distribution of fatty acids, carotenoids, and tocochromanols in the olein and stearin fractions of the oil produced by the ISH OxG cultivated in municipality of Una, state of Bahia, Brazil by liquid and gas chromatography. There were significant differences for fatty acids, carotenoids and total tocochromanols between olein and stearin (p<0.05). The olein was richer in oleic acid (59% vs 57%), while stearin was higher in saturated fatty acids (31% vs 29%), alpha and beta-carotene (232 vs 213 mg/Kg, and 347 vs 299 mg/Kg, respectively), alpha-tocotrienol (136 vs 90 mg/Kg), and alpha-tocopherol (52 vs 32 mg/Kg). No difference was observed for gamma-tocotrienol (598 – 450 mg/kg) and delta-tocotrienol; nonetheless, the high content of the former in both fractions was notable. The ISH OxG oil fractions showed distinct patterns, indicating different applications.

Resumo BRS Manicoré é um híbrido interespecífico entre Elaeis oleifera e (ISH Elaeis guineensisOxG). Em cultivo no Brasil, BRS Manicoré demonstrou alto potencial produtivo e resistência genética a problemas fitossanitários. Estudos têm indicado diferença na composição do óleo dos ISH OxG e da palma de óleo, bem como a influência do genótipo e do ambiente nas características do óleo de palma. O objetivo deste trabalho foi determinar a composição em ácidos graxos, carotenoides e tococromanóis das frações oleína e estearina do óleo produzido a partir do ISH OxG cultivado em Una, Bahia, por cromatografias líquida e gasosa. Houve diferença significativa nos ácidos graxos, nos carotenoides e nos tococromanóis entre oleína e viestearina(p<0,05). Os resultados confirmaram maiores teores de ácido oleico (59% vs 57%) e de ácidos graxos saturados na oleína (31% vs 29%) e maior concentração de e alfa e beta caroteno (232 vs 213 mg/Kg e 347 vs 299 mg/Kg, respectivamente),alfa-tocotrienol (136 vs 90 mg/Kg) e alfa-tocoferol (52 vs 32 mg/Kg) na estearina; não foi observada diferença significativa em gama-tocotrienol (598 – 450 mg/kg) e delta-tocotrienol; entretanto,ressalta-se o elevado teor do primeiro em ambas as frações. O fracionamento de HIE OxGoriginou frações com características distintas e diferentes possíveis aplicações.

https://doi.org/10.1590/0100-29452023555

Asthma and pregnancy
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Carvalho-Pinto, Regina Maria de

; Cançado, José Eduardo Delfini

; Caetano, Lilian Serrasqueiro Ballini

; Machado, Adelmir Souza

; Blanco, Daniela Cavalet

; Garcia, Guilherme Freire

; Figueiredo, Ricardo Gassmann

; Bartholo, Thiago Prudente

Revista da Associação Médica Brasileira

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2023, Volume 69 Suppl. 1 elocation e2023S123

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.2023s123

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia
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Parmera, Jacy Bezerra

; Tumas, Vitor

; Ferraz, Henrique Ballalai

; Spitz, Mariana

; Barbosa, Maira Tonidandel

; Smid, Jerusa

; Barbosa, Breno José Alencar Pires

; Schilling, Lucas Porcello

; Balthazar, Márcio Luiz Figueiredo

; Souza, Leonardo Cruz de

; Vale, Francisco Assis Carvalho

; Caramelli, Paulo

; Bertolucci, Paulo Henrique Ferreira

; Chaves, Márcia Lorena Fagundes

; Brucki, Sonia Maria Dozzi

; Nitrini, Ricardo

; Castilhos, Raphael Machado

; Frota, Norberto Anízio Ferreira

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 73 - 87

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

RESUMO A demência da doença de Parkinson (DDP) e a demência com corpos de Lewy (DCL) representam a segunda causa mais comum de demência neurodegenerativa em pessoas com mais de 65 anos, ocasionando progressivo declínio cognitivo e comprometimento da qualidade de vida. O presente estudo tem como objetivo prover um consenso de especialistas sobre a DDP e DCL, baseado em revisão sistemática da literatura brasileira e revisão não-sistemática de literatura internacional. Ademais, tal estudo visa promover informação e conceder recomendações sobre abordagem diagnóstica, com foco nos níveis de atenção primária e secundária em saúde. Com base nos dados disponíveis, recomendamos que os profissionais realizem pelo menos um breve instrumento cognitivo global, como o Mini-Exame do Estado Mental, contudo de preferência optem pela Avaliação Cognitiva de Montreal e o Exame Cognitivo de Addenbrooke-Revisado. Observa-se uma carência de instrumentos validados para a avaliação precisa das habilidades funcionais em pacientes brasileiros com DDP e DCL. Além disso, mais estudos focando em biomarcadores com coortes brasileiras também são necessários.

ABSTRACT Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) represent the second most common type of degenerative dementia in patients aged 65 years and older, leading to progressive cognitive dysfunction and impaired quality of life. This study aims to provide a consensus based on a systematic Brazilian literature review and a comprehensive international review concerning PDD and DLB. Moreover, we sought to report on and give recommendations about the best diagnostic approaches focusing on primary and secondary care. Based on the available data, we recommend clinicians to apply at least one brief global cognitive instrument to assess PDD, such as the Mini-Mental State Examination and preferably the Montreal Cognitive Assessment and the Addenbrooke’s Cognitive Examination-Revised. Validated instruments to accurately assess functional abilities in Brazilian PD patients are still incipient. Further studies should focus on biomarkers with Brazilian cohorts.

https://doi.org/10.1590/1980-5764-dn-2022-s105pt

10.

Diagnóstico da demência frontotemporal: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia
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Souza, Leonardo Cruz de

; Hosogi, Mirna Lie

; Machado, Thais Helena

; Carthery-Goulart, Maria Teresa

; Yassuda, Mônica Sanches

; Smid, Jerusa

; Barbosa, Breno José Alencar Pires

; Schilling, Lucas Porcello

; Balthazar, Marcio Luiz Figueredo

; Frota, Norberto Anízio Ferreira

; Vale, Francisco Assis Carvalho

; Caramelli, Paulo

; Bertolucci, Paulo Henrique Ferreira

; Chaves, Márcia Lorena Fagundes

; Brucki, Sonia Maria Dozzi

; Nitrini, Ricardo

; Bahia, Valéria Santoro

; Takada, Leonel Tadao

Dementia & Neuropsychologia

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sep 2022, Volume 16 N. 3 Pages 40 - 52

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

RESUMO A “demência frontotemporal” (DFT) é uma síndrome clínica, cujo denominador comum é o acometimento focal dos lobos frontais e/ou temporais. A DFT tem três fenótipos clínicos distintos: a variante comportamental e dois subtipos linguísticos, a saber, a afasia progressiva primária não-fluente/agramática (APP-NF/A) e a afasia progressiva primária semântica (APP-S). A DFT é a segunda causa mais comum de demência em indivíduos com idade inferior a 65 anos, após a doença de Alzheimer. O presente artigo apresenta recomendações para diagnóstico da DFT no cenário brasileiro, considerando os três níveis de complexidade do sistema de saúde: atenção primária à saúde e níveis secundários. São propostos protocolos de investigação diagnóstica abrangendo testagem cognitiva, avaliação comportamental, avaliação fonoaudiológica, exames laboratoriais e de neuroimagem.

ABSTRACT “Frontotemporal dementia” (FTD) is a clinical syndrome characterized by the focal involvement of the frontal and/or temporal lobes. FTD has three clinical phenotypes: the behavioral variant and two linguistic subtypes, namely, non-fluent/agrammatic primary progressive aphasia (PPA-NF/A) and semantic PPA (PPA-S). FTD is the second most common cause of dementia in individuals under the age of 65 years. This article presents recommendations for the diagnosis of FTD in the Brazilian scenario, considering the three levels of complexity of the health system: primary health care, secondary and tertiary levels. Diagnostic guidelines are proposed, including cognitive testing, behavioral and language assessments, laboratory tests, and neuroimaging.

https://doi.org/10.1590/1980-5764-dn-2022-s103pt

11.

Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19: Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia
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Falavigna, Maicon

; Stein, Cinara

; Amaral, José Luiz Gomes do

; Azevedo, Luciano Cesar Pontes de

; Belli, Karlyse Claudino

; Colpani, Verônica

; Cunha, Clóvis Arns da

; Dal-Pizzol, Felipe

; Dias, Maria Beatriz Souza

; Ferreira, Juliana Carvalho

; Freitas, Ana Paula da Rocha

; Gräf, Débora Dalmas

; Guimarães, Hélio Penna

; Lobo, Suzana Margareth Ajeje

; Monteiro, José Tadeu

; Nunes, Michelle Silva

; Oliveira, Maura Salaroli de

; Prado, Clementina Corah Lucas

; Santos, Vania Cristina Canuto

; Silva, Rosemeri Maurici da

; Sobreira, Marcone Lima

; Veiga, Viviane Cordeiro

; Vidal, Ávila Teixeira

; Xavier, Ricardo Machado

; Zavascki, Alexandre Prehn

; Machado, Flávia Ribeiro

; Carvalho, Carlos Roberto Ribeiro de

Revista Brasileira de Terapia Intensiva

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mar 2022, Volume 34 N. 1 Pages 1 - 12

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

RESUMO Objetivos: Há diversas terapias sendo utilizadas ou propostas para a COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é elaborar recomendações para subsidiar decisões sobre o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: Um grupo de 27 membros, formado por especialistas, representantes do Ministério da Saúde e metodologistas, integra essa diretriz. Foi utilizado o método de elaboração de diretrizes rápidas, tomando por base a adoção e/ou a adaptação de recomendações a partir de diretrizes internacionais existentes (GRADE ADOLOPMENT), apoiadas pela plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Foram geradas 16 recomendações. Entre elas, estão recomendações fortes para o uso de corticosteroides em pacientes em uso de oxigênio suplementar, para o uso de anticoagulantes em doses de profilaxia para tromboembolismo e para não uso de antibacterianos nos pacientes sem suspeita de infecção bacteriana. Não foi possível fazer uma recomendação quanto à utilização do tocilizumabe em pacientes hospitalizados com COVID-19 em uso de oxigênio, pelas incertezas na disponibilidade e de acesso ao medicamento. Foi feita recomendação para não usar azitromicina, casirivimabe + imdevimabe, cloroquina, colchicina, hidroxicloroquina, ivermectina, lopinavir/ ritonavir, plasma convalescente e rendesivir. Conclusão: Até o momento, poucas terapias se provaram efetivas no tratamento do paciente hospitalizado com COVID-19, sendo recomendados apenas corticosteroides e profilaxia para tromboembolismo. Diversos medicamentos foram considerados ineficazes, devendo ser descartados, de forma a oferecer o melhor tratamento pelos princípios da medicina baseada em evidências e promover economia de recursos não eficazes.

ABSTRACT Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.

https://doi.org/10.5935/0103-507x.20220001-pt

12.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes

; Melo, Ana Karla Guedes de

; Cruz, Vítor Alves

; Souza, Viviane Angelina de

; Carvalho, Joana Starling de

; Machado, Ketty Lysie Libardi Lira

; Valadares, Lilian David de Azevedo

; Reis Neto, Edgard Torres dos

; Rezende, Rodrigo Poubel Vieira de

; Guimarães, Maria Fernanda Brandão de Resende

; Ferreira, Gilda Aparecida

; Braz, Alessandra de Sousa

; Vieira, Rejane Maria Rodrigues de Abreu

; Pinheiro, Marcelo de Medeiros

; Ribeiro, Sandra Lúcia Euzébio

; Bica, Blanca Elena Gomes Rios

; Baptista, Kátia Lino

; Costa, Izaias Pereira da

; Marques, Claudia Diniz Lopes

; Lopes, Maria Lúcia Lemos

; Martinez, José Eduardo

; Giorgi, Rina Dalva Neubarth

; Mota, Lícia Maria Henrique da

; Loures, Marcos Antônio Araújo da Rocha

; Paiva, Eduardo dos Santos

; Monticielo, Odirlei André

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Pileggi, Gecilmara Cristina Salviato

Advances in Rheumatology

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2022, Volume 62 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

https://doi.org/10.1186/s42358-022-00234-7

13.

Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)
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Falavigna, Maicon

; Belli, Karlyse Claudino

; Barbosa, Alexandre Naime

; Zavascki, Alexandre Prehn

; Nastri, Ana Catharina de Seixas Santos

; Santana, Christiane Machado

; Stein, Cinara

; Gräf, Débora Dalmas

; Cadegiani, Flavio Adsuara

; Guimarães, Hélio Penna

; Monteiro, José Tadeu

; Ferreira, Juliana Carvalho

; de Azevedo, Luciano Cesar Pontes

; Magri, Marcelo Mihailenko Chaves

; Sobreira, Marcone Lima

; Dias, Maria Beatriz Gandra de Souza

; de Oliveira, Maura Salaroli

; Corradi, Mirian de Freitas Dal Ben

; Rosa, Regis

; Heinzelmann, Ricardo Souza

; da Silva, Rosemeri Maurici

; Belfort Junior, Rubens

; Cimerman, Sergio

; Colpani, Verônica

; Veiga, Viviane Cordeiro

; de Carvalho, Carlos Roberto Ribeiro

Brazilian Journal of Infectious Diseases

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2022, Volume 26 N. 2 elocation 102347

Abstract: En | Text: En | PDF: En

ABSTRACT Background Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil. Methods A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method. Results Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation. Conclusion To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.

https://doi.org/10.1016/j.bjid.2022.102347

14.

Cognitive Impairment and Quality of Life of Patients Subjected to Hematopoietic Stem Cell Transplantation
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Machado, Celina Angélica Mattos

; Marques, Angela da Costa Barcellos

; Silva, Luana Aparecida Alves da

; Koller, Francisco Jose

; Guimarães, Paulo Ricardo Bittencourt

; Kalinke, Luciana Puchalski

Aquichan

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jun 2021, Volume 21 N. 2 elocation e2126

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

RESUMEN Objetivo: evaluar y correlacionar la calidad de vida general y la función cognitiva de pacientes adultos con cáncer hematológico sometidos al trasplante de células madre hematopoyéticas autólogo y alogénico hasta tres años luego del tratamiento. Materiales y método: estudio longitudinal, observacional y analítico con 55 pacientes, en un hospital de referencia en Latinoamérica, de septiembre del 2013 a febrero del 2019, con el instrumento Quality of Life Questionnarie-Core 30, analizado con las pruebas coeficiente de correlación de Spearman y el Generalized Linear Mixed Model. Resultados: la calidad de vida general en el trasplante autólogo y alogénico presentaron descenso en la fase de pancitopenia (59,3 y 55,3, respectivamente). Hubo disfunción cognitiva en el grupo autólogo posteriormente al trasplante dos años (61,90) y el grupo alogénico (74), en la pancitopenia. En el grupo autólogo, se observa correlación positiva (0,76) y significativa (p < 0,04) entre el dominio cognitivo y la calidad de vida en el post-trasplante dos años. En el alogénico, hubo correlación positiva (0,55) y significativa (p < 0,00) desde el post-trasplante 180 días. Conclusiones: la calidad de vida y la función cognitiva presentan compromiso y hay correlación luego del trasplante de células madre hematopoyéticas para ambos grupos, autólogo y alogénico.

ABSTRACT Objective: To assess and correlate overall quality of life and the cognitive function of adult patients with hematologic cancer subjected to autologous and allogeneic hematopoietic stem cell transplantations up to three years after treatment. Materials and method: A longitudinal, observational, and analytical study was conducted with 55 patients in a reference hospital in Latin America, from September 2013 to February 2019, with the Quality of Life Questionnaire-Core 30, analyzed with the Spearman’s correlation coefficient and Generalized Linear Mixed Model tests. Results: Overall quality of life in autologous and allogeneic transplantations presented a decline in the pancytopenia phase (59.3 and 55.3, respectively). There was impairment of the cognitive function in the autologous group in post-transplantation after two years (61.90) and, in the allogeneic group (74), in pancytopenia. In the autologous group, a positive (0.76) and significant (p < 0.04) correlation is observed between the cognitive domain and quality of life in post-transplantation after two years. In the allogeneic group, there was a positive (0.55) and significant (p < 0.00) correlation from 180 days after transplantation. Conclusions: Quality of life and the cognitive function present impairment and there is a correlation after the hematopoietic stem cell transplantation for both groups: autologous and allogeneic.

RESUMO Objetivo: avaliar e correlacionar a qualidade de vida geral e a função cognitiva de pacientes adultos com câncer hematológico submetidos ao transplante de células-tronco hematopoéticas autólogo e alogênico até três anos após o tratamento. Materiais e método: estudo longitudinal, observacional e analítico com 55 pacientes, num hospital de referência na América Latina, de setembro de 2013 a fevereiro de 2019, com o instrumento Quality of Life Questionnarie-Core 30, analisado com os testes coeficiente de correlação de Spearman e o Generalized Linear Mixed Model. Resultados: a qualidade de vida geral no transplante autólogo e alogênico apresentaram declínio na fase de pancitopenia (59,3 e 55,3, respectivamente). Houve comprometimento da função cognitiva no grupo autólogo no pós-transplante dois anos (61,90) e no grupo alogênico (74), na pancitopenia. Observa-se, no grupo autólogo, correlação positiva (0,76) e significativa (p < 0,04) entre o domínio cognitivo e a qualidade de vida no pós-transplante dois anos. No grupo alogênico, houve correlação positiva (0,55) e significativa (p < 0,00) a partir do pós-transplante 180 dias. Conclusões: a qualidade de vida e a função cognitiva apresentam comprometimento e há correlação após o transplante de células-tronco hematopoéticas para ambos os grupos, autólogo e alogênico.

https://doi.org/10.5294/aqui.2021.21.2.6 43 downloads

15.

Visión extensionista de apoyo didáctico a la educación a distancia. Intercambio académico entre la Cujae y la UPM
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Portero Ricol, Ada Esther

; González Moreno, Maritza

; Rueda Pizarro, María José

; Machado Jardo, Ricardo

; Ruiz Pardo, Marcelo

Referencia Pedagógica

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apr 2021, Volume 9 N. 1 Pages 144 - 159

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

Abstract This article shows an experience arising from an academic exchange between the Higher Polytechnic University of Madrid and the Technological University of Havana, Cujae as an extension of university education during the exceptional situation that the COVID 19 pandemic imposed to the face-to-face teaching modality in 2020. The isolation conditions caused by COVID 19, officially recognized worldwide brought about new teaching forms and methods to be used or the use of the existing ones in different ways. The impossibility of carrying out the programmed exchange between students and professors of the UPM and Cujae, led to seeking other alternatives to carry out this exchange. This experience, derived specifically from the training process at Cujae Architecture career through an academic exchange with the Higher Polytechnic University of Madrid. University cultural promotion (university Extension methodology) was the main methodology proposed. Key results were obtained such as the distance interuniversity communication process; a “cujaeña” university extension activity that enriches the didactics of the teaching-learning process of a teacher-student group at the UPM, through the cultural promotion of Havana architecture. It is concluded that the distance modality favored the implementation of new ways for the academic exchange with renewing glances in the management of university substantive processes, benefiting the integrality of the university extension.

Resumen Este artículo muestra una experiencia de extensión universitaria surgida de un intercambio académico entre la Universidad Politécnica de Madrid (UPM) y la Universidad Tecnológica de La Habana (Cujae), en medio de la situación excepcional que impuso la pandemia durante el año 2020 a la modalidad presencial en la docencia. Las condiciones de aislamiento provocadas por el COVID 19, reconocidas oficialmente a escala mundial a finales del 2019, hicieron posible el uso de nuevas formas y métodos de enseñanza o el empleo de las ya existentes de manera diferente. La imposibilidad de realizar el intercambio académico programado entre estudiantes y profesores de la UPM y la CUJAE de manera presencial propició la búsqueda de alternativas para no cancelar este intercambio. Esta experiencia de extensión universitaria integral a distancia se deriva específicamente del proceso de formación en la carrera de Arquitectura de la Cujae mediante un intercambio académico con la UPM. La metodología fundamental expuesta es la promoción cultural universitaria (metodología de la extensión). Los principales resultados obtenidos son: el proceso de comunicación interuniversitario a distancia; una actividad extensionista “cujaeña” que enriquece la didáctica del proceso-enseñanza aprendizaje de un colectivo docente-estudiantil en la UPM, mediante la promoción cultural de la arquitectura habanera. Se concluye que la modalidad del trabajo a distancia favoreció la implementación de nuevas vías para el intercambio académico con miradas renovadoras en la gestión de los procesos sustantivos universitarios beneficiando la integralidad de la extensión.

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