Introdução: A Doença Hepática Esteatótica Associada à Disfunção Metabólica (MASLD) é a doença hepática crônica mais prevalente no mundo e foi recentemente renomeada para enfatizar seu componente metabólico. Este artigo busca preencher a lacuna de diretrizes específicas para pacientes portadores de obesidade e MASLD que irão ser submetidos à cirurgia bariátrica. Método: Foi realizado uma busca sistemática por guidelines nas plataformas PubMed e Embase. Resultados: Foram encontrados 544 artigos, dos quais 11 foram selecionados conforme critérios de inclusão/exclusão. Todos os 11 guidelines são de sociedades clínicas, portanto, não contemplam algumas interpretações necessárias para o paciente bariátrico. Conclusões: Recomendamos que seja feito o rastreio de todo paciente que será submetido a cirurgia bariátrica e metabólica inicialmente com o score Fibrosis-4 (FIB-4), seguido da elastografia hepática transitória (Vibration-controlled Transient Elastography - VCTE), principalmente para aqueles com FIB4> 1,3. No entanto, a interpretação dos resultados do VCTE em pacientes obesos necessita de mais estudos para delimitar os reais valores de cortes. O Enhanced Liver Fibrosis® (ELF®) mostra-se promissor, mas sua disponibilidade é limitada. A indicação da biópsia hepática durante a cirurgia, precisa ser individualizada, porém é recomendada para aqueles com alteração do FIB4 e/ou da VCTE. O rastreio familiar é recomendado para parentes de pacientes jovens já com fibrose avançada. O transplante hepático é uma opção para pacientes com MASLD avançada, mas o momento ideal para a cirurgia bariátrica em relação ao transplante ainda não está claro. O acompanhamento regular e o exame VCTE são recomendados para monitorar a progressão da doença após a cirurgia.

Introduction: Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the most prevalent chronic liver disease in the world and has recently been renamed to emphasize its metabolic component. This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery. Methods: A systematic search for guidelines was carried out on the PubMed and Embase platforms. Results: Were found 544 articles, of which 11 were selected according to inclusion/exclusion criteria. All 11 guidelines are from clinical societies and therefore do not include some necessary interpretations for bariatric patients. Conclusions: We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (Vibration-controlled Transient Elastography - VCTE), especially for those with FIB4 > 1.3. However, the interpretation of VCTE results in obese patients requires further studies to define the real cutoff values. Enhanced Liver Fibrosis® (ELF®) shows promise, but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but is recommended for those with changes in FIB4 and/or VCTE. Family screening is recommended for relatives of young patients with advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD, but the optimal timing for bariatric surgery in relation to transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery.  

Objetivo: comprender las experiencias en el manejo de la diabetes mellitus de personas que utilizan insulina, para identificar posibles factores que pueden influir en la adhesión al autocuidado y, así, definir sus demandas de aprendizaje para la autogestión de la diabetes. Método: se trata de una investigación cualitativa realizada mediante entrevistas semi-estructuradas individuales en la modalidad online . Las entrevistas fueron grabadas, transcritas y evaluadas en el software Atlas.ti ® mediante el Análisis de Contenido Temático, utilizando como marco teórico el Modelo de Creencias en Salud. Resultados: participaron 11 personas que conviven con diabetes, usuarias de insulina. Se identificaron cuatro categorías: entendimiento sobre la diabetes, cómo lidiar con la diabetes, dificultades relacionadas con el uso de la insulina y adaptación emocional. Conclusión: la percepción sobre la severidad de la enfermedad, sus complicaciones, y de los beneficios de adherirse al tratamiento influye positivamente en la adhesión a los comportamientos de autocuidado. A pesar de que los participantes del estudio han convivido muchos años con la diabetes, no están exentos de dificultades relacionadas con el uso de la insulina y el manejo de la enfermedad, reforzando la importancia de la educación en salud continuada. En este sentido, los hallazgos de este estudio orientan temas educativos importantes a ser trabajados por los profesionales de la salud para la promoción de la autonomía en la autogestión de la diabetes. Objetivo así Método semiestructuradas semi estructuradas grabadas Atlasti Atlas ti Temático Salud Resultados 1 categorías emocional Conclusión enfermedad complicaciones continuada sentido

Objective: to understand the experiences with diabetes mellitus management of people who use insulin, in order to identify possible factors that may influence adherence to self-care and thus define their learning demands for diabetes self-management. Method: this is a qualitative study carried out using individual semi-structured interviews online. The interviews were recorded, transcribed and evaluated using Atlas.ti® software by means of Thematic Content Analysis, using the Health Beliefs Model as a theoretical framework. Results: 11 people living with diabetes and using insulin took part in the study. Four categories were identified: understanding diabetes, how to deal with diabetes, difficulties related to insulin use and emotional adaptation. Conclusion: the perception of the severity of the disease, its complications and the benefits of adhering to treatment positively influences adherence to self-care behaviors. Although the study participants have lived with diabetes for many years, they are not exempt from difficulties related to insulin use and disease management, reinforcing the importance of continuing health education. In this sense, the findings of this study guide important educational themes to be worked on by health professionals to promote autonomy in diabetes self-management. Objective selfcare self care selfmanagement. selfmanagement management. self-management Method semistructured semi structured online recorded Atlasti Atlas ti Atlas.ti Analysis framework Results 1 identified adaptation Conclusion behaviors years education sense

Objetivo: compreender as experiências com o manejo do diabetes mellitus de pessoas que utilizam a insulina, para identificar possíveis fatores que podem influenciar na adesão ao autocuidado e, assim, definir suas demandas de aprendizado para a autogestão do diabetes. Método: trata-se de pesquisa qualitativa realizada por meio de entrevistas semiestruturadas individuais na modalidade online . As entrevistas foram gravadas, transcritas e avaliadas no software Atlas.ti ® por meio da Análise de Conteúdo Temática, utilizando-se como referencial teórico o Modelo de Crenças em Saúde. Resultados: participaram 11 pessoas que convivem com diabetes, usuárias de insulina. Foram identificadas quatro categorias: entendimento sobre o diabetes, como lidar com o diabetes, dificuldades relacionadas ao uso da insulina e adaptação emocional. Conclusão: a percepção sobre a severidade da doença, suas complicações, e os benefícios de aderir ao tratamento influencia positivamente na adesão aos comportamentos de autocuidado. Apesar dos participantes do estudo conviverem há muitos anos com o diabetes, eles não são isentos de dificuldades relacionadas ao uso da insulina e ao manejo da doença, reforçando a importância da educação em saúde continuada. Nesse sentido, os achados deste estudo norteiam temas educacionais importantes a serem trabalhados pelos profissionais da saúde para promoção da autonomia na autogestão do diabetes. Objetivo assim Método tratase trata se gravadas Atlasti Atlas ti Temática utilizandose utilizando Saúde Resultados 1 categorias emocional Conclusão doença complicações continuada sentido

Resumo Este trabalho visa abordar o enriquecimento ilícito e lucrativo versus o decrescimento, tema de extrema importância na atualidade, já que busca alternativas à consagração do princípio constitucional da dignidade humana da pessoa, de modo que todos possam ter acesso aos mesmos direitos fundamentais. É necessária uma mudança de pensamento e atuação, abordando-se o decrescimento como um dever anexo ao dever fundamental de proteção ao meio ambiente ecologicamente equilibrado. Nesses termos, a continuidade dos níveis de produção sem a readaptação aos limites estabelecidos pelas autoridades competentes em matéria ambiental se traduz em ato ilícito. Os lucros daí advindos, portanto, constituem enriquecimento sem causa e devem ser destinados aos afetados diretos quando identificados e à sociedade, que suportaram a violação do seu direito difuso ao meio ambiente ecologicamente equilibrado. Utilizou-se de ampla pesquisa bibliográfica interdisciplinar, passando desde o Direito Constitucional até o Direito Ambiental e Penal. atualidade pessoa fundamentais atuação abordandose abordando equilibrado termos advindos portanto sociedade Utilizouse Utilizou interdisciplinar Penal

Abstract This paper aims to scrutinize unjust enrichment from the perspective of degrowth, a topic of profound importance today as it presents alternatives to uphold the constitutional principle of human dignity, ensuring equitable access to fundamental rights for all. It advocates for a paradigm shift in mindset and action, positioning degrowth as an integral duty linked to the fundamental obligation of protecting an ecologically balanced environment. In this context, maintaining production levels without adhering to the environmental limits set by relevant authorities is illegal. Profits derived from such acts thus constitute unjust enrichment and should be reallocated to those directly impacted, when identifiable, and to society at large, which endures the violation of its collective right to an ecologically balanced environment. The study utilizes an extensive interdisciplinary bibliographic approach, spanning from constitutional law through environmental and criminal law. dignity all action environment context illegal impacted identifiable large approach

Resumen Este trabajo pretende abordar el enriquecimiento ilícito y lucrativo frente al decrecimiento, un tema de extrema importante en la actualidad por buscar alternativas a la consagración del principio constitucional de la dignidad humana, para que todos puedan acceder a los mismos derechos fundamentales. Es necesario un cambio de pensamiento y de acción, planteando el decrecimiento como un deber fundamental de proteger el ambiente ecológicamente equilibrado. En esos términos, mantener los niveles de producción sin reajustarse a los límites fijados por las autoridades ambientales competentes es un acto ilícito. Los beneficios resultantes, por tanto, constituyen un enriquecimiento injusto y deben asignarse a los directamente afectados cuando sean identificados y a la sociedad, que ha soportado el peso de la violación de su derecho difuso a un ambiente ecológicamente equilibrado. Se ha recurrido a una amplia investigación bibliográfica interdisciplinar, que abarca desde el Derecho constitucional hasta el Derecho ambiental y penal. humana fundamentales acción equilibrado términos resultantes tanto sociedad interdisciplinar penal

ABSTRACT BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease in the world and was recently renamed to emphasize its metabolic component. AIMS: This article seeks to fill the gap in specific guidelines for patients with obesity and MASLD who will undergo bariatric surgery. METHODS: A systematic search for guidelines was carried out on PubMed and Embase platforms. RESULTS: A total of 544 articles were found, of which 11 were selected according to inclusion and exclusion criteria. All 11 guidelines are from clinical societies; therefore, they do not include some necessary interpretations for bariatric patients. CONCLUSIONS: We recommend that every patient undergoing bariatric and metabolic surgery be screened initially with the Fibrosis-4 (FIB-4) score, followed by transient hepatic elastography (vibration-controlled transient elastography, VCTE), especially for those with FIB-4>1.3. However, interpreting VCTE results in obese patients requires further studies to define the actual cutoff values. Enhanced Liver Fibrosis® shows promise but its availability is limited. The indication for liver biopsy during surgery needs to be individualized but it is recommended for those with changes in FIB-4 and/or VCTE. Family screening is recommended for relatives of young patients with already advanced fibrosis. Liver transplantation is an option for patients with advanced MASLD but the optimal timing for bariatric surgery with transplantation is still unclear. Regular follow-up and VCTE examination are recommended to monitor disease progression after surgery. BACKGROUND dysfunctionassociated dysfunction associated (MASLD component AIMS METHODS platforms RESULTS 54 found 1 criteria societies therefore CONCLUSIONS Fibrosis4 Fibrosis 4 Fibrosis- FIB4 FIB (FIB-4 score vibrationcontrolled vibration controlled VCTE, , VCTE) FIB4>1.3. FIB413 4>1.3. 3 FIB-4>1.3 However values limited FIB- andor or fibrosis unclear followup follow up 5 (FIB- FIB4>1.3 FIB41 413 4>1.3 FIB-4>1. (FIB FIB4>1. 41 4>1. FIB-4>1 FIB4>1 4>1 FIB-4> FIB4> 4>

RESUMO RACIONAL: A doença hepática esteatótica associada à disfunção metabólica (MASLD) é a doença hepática crônica mais prevalente no mundo e foi recentemente renomeada para enfatizar seu componente metabólico. OBJETIVOS: Este artigo busca preencher a lacuna de diretrizes específicas para pacientes portadores de obesidade e MASLD que irão ser submetidos à cirurgia bariátrica. MÉTODOS: Foi realizado uma busca sistemática por diretrizes nas plataformas PubMed e Embase. RESULTADOS: Foram encontrados 544 artigos, dos quais 11 foram selecionados conforme critérios de inclusão/exclusão. Todas as 11 diretrizes são de sociedades clínicas, portanto, não contemplam algumas interpretações necessárias para o paciente bariátrico. CONCLUSÕES: Recomendamos que seja feito o rastreio de todo paciente que será submetido a cirurgia bariátrica e metabólica inicialmente com o score Fibrosis-4 (FIB-4), seguido da elastografia hepática transitória (vibration-controlled transient elastography — VCTE), principalmente para aqueles com FIB-4>1,3. No entanto, a interpretação dos resultados do VCTE em pacientes obesos necessita de mais estudos para delimitar os reais valores de cortes. O Enhanced Liver Fibrosis® mostra-se promissor, mas sua disponibilidade é limitada. A indicação da biópsia hepática durante a cirurgia, precisa ser individualizada, porém é recomendada para aqueles com alteração do FIB-4 e/ou da VCTE. O rastreio familiar é recomendado para parentes de pacientes jovens já com fibrose avançada. O transplante hepático é uma opção para pacientes com MASLD avançada, mas o momento ideal para a cirurgia bariátrica em relação ao transplante ainda não está claro. O acompanhamento regular e o exame VCTE são recomendados para monitorar a progressão da doença após a cirurgia. RACIONAL (MASLD metabólico OBJETIVOS MÉTODOS Embase RESULTADOS 54 artigos 1 inclusãoexclusão inclusão exclusão inclusão/exclusão clínicas portanto bariátrico CONCLUSÕES Fibrosis4 Fibrosis 4 Fibrosis- FIB4, FIB4 FIB , (FIB-4) vibrationcontrolled vibration controlled VCTE, VCTE) FIB4>1,3. FIB413 4>1,3. 3 FIB-4>1,3 entanto cortes mostrase mostra se promissor limitada individualizada FIB- eou ou avançada claro 5 (FIB-4 FIB4>1,3 FIB41 413 4>1,3 FIB-4>1, (FIB- FIB4>1, 41 4>1, FIB-4>1 (FIB FIB4>1 4>1 FIB-4> FIB4> 4>

ABSTRACT The use of Global Navigation Satellite System (GNSS) for air and terrestrial navigation and for many applications is increasing in the last decades. However, the Earth’s ionosphere causes GNSS signal delay due to the total electron content (TEC) and scintillation in the signal phase and amplitude. This scintillation can give rise to deleterious effects in the GNSS positioning. So, it is important to assess the effects of the ionosphere over the GNSS signal. To achieve this goal, it is necessary to have a large spatial and temporal coverage of data from many different sounders, being the GNSS receivers of great importance due to their global coverage and availability. In this work, we present a retrospective of the scintillation monitoring networks in Brazil and their characteristics. As the RBMC network managed by the IBGE provides TEC and as rate of TEC index (ROTI) is well correlated with ionospheric irregularities, we present also the RBMC network description. These RBMC GNSS receivers provide data in regions with scarcity of scintillation monitors. The description of the Ionospheric Scintillation Monitoring Receivers (ISMR) Query Tool, that is a web software that has been supporting research on the ISMR data, is also presented. (GNSS decades However Earths Earth s (TEC amplitude positioning So goal sounders availability work characteristics ROTI (ROTI irregularities monitors (ISMR Tool presented

Abstract Cnesterodon hypselurus is a small fish that has a restricted distribution in southern Brazil, including headwaters of the Tibagi and Itararé river basins (Upper Paraná River). This study reported C. hypselurus in a headwater of Cinzas River basin, where there were no previous records of this species, and employed microsatellite loci and mitochondrial haplotypes in a population genetic analysis. A total of 57 specimens was analyzed, including 30 from Cinzas River basin, 25 from Itararé River basin and two from Tibagi River basin. Results indicated low genetic diversity levels (HE = 0.334 and h = 0.246) for the sample from Cinzas River, suggesting reflections of a founder effect after the species had dispersed from one watershed to another, possibly by headwater captures. Since different populations were detected between the Cinzas and Itararé rivers (DEST = 0.248, P-value < 0.05) and other occurrence sites are still unknown in the Cinzas River basin, the data herein have great relevance and should be taken into account in future management and conservation actions, as well as in evolutionary studies of C. hypselurus. Brazil Upper River. . River) C analysis 5 analyzed 3 2 HE 0334 0 334 0.33 0.246 0246 246 another captures DEST 0248 248 0.248 Pvalue P value 0.05 005 05 actions 033 33 0.3 0.24 024 24 0.0 00 03 0. 0.2 02

Resumo Cnesterodon hypselurus é um pequeno peixe que possui distribuição restrita no sul do Brasil, incluindo cabeceiras das bacias dos rios Tibagi e Itararé (alto rio Paraná). Este estudo reportou C. hypselurus na cabeceira da bacia do rio das Cinzas, onde não havia registros prévios desta espécie, e empregou locos microssatélites e haplótipos mitocondriais em uma análise genética de populações. Um total de 57 espécimes foi analisado, incluindo 30 do rio das Cinzas, 25 da bacia do rio Itararé e dois da bacia do rio Tibagi. Os resultados indicaram baixos níveis de diversidade genética (HE = 0,334 e h = 0,246) para a amostra do rio das Cinzas, sugerindo reflexos de um efeito fundador após a espécie ter dispersado de uma bacia para a outra, possivelmente a partir de captura de cabeceiras. Uma vez que diferentes populações foram detectadas entre os rios das Cinzas e Itararé (DEST = 0,248, valor de P < 0,05) e que outros pontos de ocorrência ainda são desconhecidos na bacia do rio das Cinzas, os dados do presente estudo mostram grande relevância e deveriam ser considerados em futuras ações de manejo e conservação, bem como em estudos evolutivos de C. hypselurus. Brasil alto Paraná. Paraná . Paraná) C 5 analisado 3 2 HE 0334 0 334 0,33 0,246 0246 246 outra DEST 0248 248 0,248 0,05 005 05 conservação 033 33 0,3 0,24 024 24 0,0 00 03 0, 0,2 02

Abstract Located in the port area of Rio de Janeiro, the Morro da Providência plays a central role in the usual analyses of the development of the favelas in the city. Generally associated with the arrival of troops returning from the Canudos War in the mid-1890s, the formation of the community that settled there has often been taken as the starting point of the phenomenon that would come to define the stigmas that have marked this type of informal housing in the city’s hills ever since. Since they are thought primarily from the perspective of the State, however, these analyses leave aside the experience of other groups involved in this history, such as the low-income workers who began to see that hill as an alternative for a home from the second half of the 19th century on. By following their experience, this article intends to bring new elements to think about the process of social construction of that space throughout that period. Janeiro city mid1890s, mid1890s mids mid 1890s, 1890s s mid-1890s citys since State however history lowincome low income th on period

Resumo Localizado na região portuária do Rio de Janeiro, o Morro da Providência tem papel central nas análises habituais sobre a formação das favelas na cidade. Associada em geral à chegada das tropas que voltavam da Guerra de Canudos, em meados da década de 1890, a formação da comunidade ali instalada foi muitas vezes tomada como ponto de início do fenômeno que viria a definir os estigmas que marcam, desde então, esse tipo de moradia informal nos morros da cidade. Por serem pensadas prioritariamente a partir da perspectiva do Estado, no entanto, tais análises deixaram de lado a experiência de outros sujeitos envolvidos nesta história, como os trabalhadores de baixa renda que passaram a ver naquele morro uma alternativa de moradia a partir da segunda metade do século XIX. Ao acompanhar sua experiência, este artigo pretende trazer novos elementos para pensar o processo de construção social daquele espaço ao longo daquele período. Janeiro cidade Canudos 1890 marcam então Estado entanto história XIX período 189 18 1

ABSTRACT This study aimed to explore the efficacy of utilizing wastewater from fish farming tanks for fertigating lettuce crops as an alternative to inappropriate disposal methods. A randomized block experimental design was employed in a 3 x 8 factorial scheme, comprising three treatments: two varying percentages of wastewater (50% and 100%), alongside a control treatment employing only well water, with eight replications each. The trial was conducted in a field under protected cultivation, within a low tunnel-type structure. Biometric parameters of the lettuce plants were analyzed, including stem diameter, plant height, stem length, head diameter, root length, leaf fresh matter, leaf dry matter, stem fresh matter, stem dry matter, root fresh matter, root dry matter, leaf count, fresh shoot mass, and commercial productivity. Significant results were observed with the application of 100% wastewater treatment up to 20 days after transplanting (DAT), particularly for the biometric variables: plant head diameter (average 37.4 cm) and leaf count (average 13.7 units) at 36 DAT, of crisp lettuce Grand Rapids loose leaf seedlings. The reuse of wastewater during the experiment showed promising potential in replacing chemical fertilizers throughout the crop cycle. This practice facilitates the repurposing of water from fish farming, providing farmers with an alternative income source during the fish development phase, and mitigates improper wastewater disposal. methods scheme treatments 50% 50 (50 100%, 100 , 100%) each cultivation tunneltype tunnel type structure analyzed height length matter mass productivity 2 DAT (DAT) variables average 374 37 4 37. cm 137 13 7 13. units seedlings cycle phase 5 (5 10 (DAT 1 (

High Chromium Cast Iron (HCCI) has demonstrated its effectiveness as a potential material for applications in severe environments due to its remarkable wear resistance attributed to the volumetric fraction of carbides in the microstructure. This study investigates a novel high-alloyed composition of white cast iron named High Entropy White Cast Iron (HEWCI), which merges the concepts of HCCI and high entropy alloys. Specifically designed chemical compositions incorporating Vanadium (V), Molybdenum (Mo), and Nickel (Ni) were employed to enhance its wear resistance properties. The solidification path, microstructural characterization, and wear responses of HEWCI were evaluated. XRD and SEM techniques were carried out for characterization purposes. Linearly reciprocating ball-on-flat sliding wear tests were conducted using a high-frequency reciprocation rig (HFRR) tribometer, assessing wear volume, linear wear rate, specific wear rate (κ), and coefficient of friction (COF). The results revealed microstructural refinement and precipitation of new carbides through V, Ni, and Mo additions. This approach demonstrates that adding carbide-forming elements and refining the microstructure are promising strategies for enhancing wear performance in HEWCI alloys. (HCCI highalloyed alloyed HEWCI, , (HEWCI) alloys V (V) Mo, (Mo) Ni (Ni properties path evaluated purposes ballonflat ball on flat highfrequency frequency HFRR (HFRR tribometer volume κ, κ (κ) COF. COF . (COF) additions carbideforming carbide forming (HEWCI (V (Mo (κ (COF

ABSTRACT Cardiovascular disease is the main cause of death in patients with chronic kidney disease (CKD). Several heart conditions have been associated with CKD, including myocardial and pericardial diseases. This paper describes a case of Dialysis-related constrictive pericarditis in a patient diagnosed with sudden hypotension during a hemodialysis session. A 65-year-old man diagnosed with hypertension, diabetes, obesity, and cirrhosis on hemodialysis for two years complained of symptoms during one of his sessions described as malaise, lipothymia, and confusion. The patient had a record of poor compliance with the prescribed diet and missed dialysis sessions. He was sluggish during the physical examination, and presented hypophonetic heart sounds, a blood pressure of 50/30mmHg, and a prolonged capillary refill time. The patient was referred to the intensive care unit and was started on antibiotics and vasoactive drugs. His workup did not show signs of infection, while electrocardiography showed low QRS-wave voltage. His echocardiogram showed signs consistent with a thickened pericardium without pericardial effusion. Cardiac catheterization showed equalization of diastolic pressures in all heart chambers indicative of constrictive pericarditis. The patient underwent a pericardiectomy. Examination of surgical specimens indicated he had marked fibrosis and areas of dystrophic calcification without evidence of infection, consistent with Dialysis-related constrictive pericarditis. Hypotension for unknown causes must be considered in the differential diagnosis of dialysis patients. CKD. CKD . (CKD) diseases Dialysisrelated Dialysis related session 65yearold yearold 65 year old hypertension diabetes obesity malaise lipothymia confusion examination sounds 5030mmHg mmHg 50 30mmHg 50/30mmHg time drugs infection QRSwave QRS wave voltage effusion pericardiectomy (CKD 6 5

RESUMO A doença cardiovascular é a principal causa de morte em pacientes com doença renal crônica (DRC). Várias formas de acometimento cardíaco têm sido associadas. à DRC, incluindo doenças miocárdicas e pericárdicas. Este artigo descreve um caso de pericardite constritiva relacionada a em um paciente diagnosticado com hipotensão súbita durante uma sessão de hemodiálise. Um homem de 65 anos com diagnósticos prévios de hipertensão, diabetes, obesidade e cirrose em hemodiálise por dois anos queixou-se de sintomas durante uma de suas sessões, descritos como mal-estar, lipotímia e confusão mental. Apresentava histórico de baixa adesão à dieta prescrita e faltas frequentes às sessões de diálise. Ele estava fraco durante o exame físico e apresentava bulhas cardíacas hipofonéticas, pressão arterial de 50/30mmHg e tempo de enchimento capilar prolongado. O paciente foi encaminhado para a unidade de terapia intensiva e iniciou o tratamento com antibióticos e drogas vasoativas. Investigação laboratorial não mostrou sinais de infecção, enquanto o eletrocardiograma mostrou baixa voltagem de complexo QRS. Seu ecocardiograma evidenciou sinais consistentes com um pericárdio espessado, sem derrame pericárdico. O cateterismo cardíaco mostrou equalização das pressões diastólicas em todas as câmaras cardíacas, indicativo de pericardite constritiva. O paciente foi submetido a uma pericardiectomia. O exame anatomopatológico mostrou sinais de acentuada fibrose acentuada fibrose e áreas de calcificação distrófica sem evidência de infecção, consistente com pericardite constritiva relacionada a por diálise. A hipotensão por causas desconhecidas deve ser considerada no diagnóstico diferencial de pacientes em diálise. DRC. DRC . (DRC) associadas pericárdicas 6 hipertensão diabetes queixouse queixou se malestar, malestar mal estar, estar mal-estar mental diálise hipofonéticas 5030mmHg mmHg 50 30mmHg prolongado vasoativas infecção QRS espessado pericárdico pericardiectomia (DRC 5

Resumen Objetivo: Documentar la evidencia de la conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil. Método: Se realizó una revisión sistemática exploratoria de bases de datos electrónicas LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science, Clinical Trials, REBEC y Cochrane para identificar estudios publicados hasta el 20 de octubre de 2021. Los estudios incluidos abordaban la conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil, independientemente de las condiciones clínicas y los resultados evaluados. Resultados: Se recuperaron un total de 168 estudios, tres de los cuales cumplieron los criterios de inclusión. La mayoría de los estudios realizaban la conciliación de la medicación dirigida por el farmacéutico en las admisiones al servicio de urgencias, pero ésta no era la principal atribución farmacéutica en ese contexto. Los errores de medicación fueron identificados durante el proceso de conciliación de medicamentos, siendo la omisión de medicamentos el error más reportado. Los estudios no hacían referencia a la importancia de recabar un historial farmacológico lo más completo posible ni a los resultados humanísticos, económicos y clínicos de la conciliación de medicamentos dirigida por farmacéuticos. Conclusiones: Esta revisión sistemática exploratoria reveló la falta de evidencia sobre el proceso de conciliación de medicamentos dirigido por farmacéuticos en los servicios de urgencias de Brasil. Los hallazgos sugieren la necesidad de seguir investigando sobre este asunto.

Abstract Objective: This scoping review aimed to map the evidence of pharmacist-led medication reconciliation in hospital emergency services in Brazil. Method: We performed a scoping review by searching electronic databases LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science, Clinical trials, REBEC e Cochrane and conducting a manual search to identify studies published up to 20 October 2021. Studies that addressed pharmacist-led medication reconciliation in hospital emergency services in Brazil, regardless of clinical conditions, and outcomes evaluated, were included. Results: A total of 168 studies were retrieved, with three matching the inclusion criteria. Most studies performed pharmacist-led medication reconciliation at emergency department admissions, but it was not the primary pharmaceutical attribution in this setting. Medication errors were identified during the medication reconciliation process, being drug omission the most reported. Studies did not describe the concerns in collecting the best medication history from patients and the humanistic, economic, and clinical outcomes of pharmacist-led medication reconciliation. Conclusions: This scoping review revealed the lack of evidence about the pharmacist-led medication reconciliation process in the emergency setting in Brazil. The findings suggest the need for future studies in this context.

Resumo Objetivos: descrever o perfil de utilização de medicamentos e de adesão, e a associação com as características clínicas e sociodemográficas de gestantes de alto risco atendidas em um hospital universitário. Métodos: trata-se de um estudo transversal com dados coletados mediante um questionário estruturado aplicado à 386 gestantes. Resultados: a maior parte das participantes era acompanhada apenas pelo ginecologista (75,1%), iniciou o pré-natal no primeiro trimestre gestacional (86,8%), não planejou a gravidez (61,9%) e realizou em média 8,2 (DP=4,4) consultas de pré-natal. Os diagnósticos mais frequentes foram hipertensão arterial (20,5%) e diabetes mellitus (19,7%). A prevalência de uso de medicamentos foi 99,7%, com média de 5,1 (DP=2,1) medicamentos por mulher e 12,7% de automedicação. Os antianêmicos (88,9%) e analgésicos (63,2%) foram as classes farmacológicas mais prevalentes e 17,9% das gestantes referiram uso de fármacos com risco gestacional relevante. Apenas 36,5% das gestantes foram consideradas aderentes ao tratamento, 32,9% declararam desconhecer a indicação dos medicamentos em uso e 42% não receberam orientações sobre o uso de medicamentos durante a gestação. Não há evidências de associação entre o número de medicamentos utilizados e os aspectos clínicos e sociodemográficos. Conclusão: é necessário desenvolver estratégias para melhorar o atendimento desta população e o uso racional de medicamentos, com ênfase no fortalecimento do cuidado multiprofssional.

Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.

ABSTRACT The chronic hepatitis C (CHC) treatment is currently based on the use of direct-acting antivirals (DAAs), and patients infected with hepatitis C virus genotype 3 (GT3) have emerged as a more difficult-to-cure population. The NS5A inhibitor daclatasvir (DCV) and sofosbuvir (SOF), an NS5B viral polymerase inhibitor, are among the drugs that compose more effective and safer treatment regimens. The virus genetic variability is related to resistance-associated substitutions (RASs) that adversely impact DAAs effectiveness. The aims of this study were to analyze the association of NS5A and NS5B RASs and other clinical factors with DAAs regimens effectiveness in patients with GT3 CHC infection. This was a prospective cohort study performed in a Brazilian university hospital. Individuals older than 18 years with GT3 CHC treated with SOF + DCV ± ribavirin (RBV) or SOF + peginterferon (PEG) + RBV were included. Blood samples were collected at baseline and post-treatment. A total of 121 patients were included. Sustained virological response rates were 87.6% for the SOF + DCV ± RBV group and 80.0% for the SOF + PEG + RBV arm. Cirrhosis, prior treatment with interferon/PEG + RBV, and baseline NS5A RAS were associated with higher risk of treatment failure. The NS5A analysis suggested that A30K, Y93H, and RAS at site 62 were related to failure. Interestingly, a likely compensatory effect was shown between A30K and A62T. Emergence of Y93H was always associated with RAS at position 62. The RASs dynamics comprehension is an important tool to indicate more effective treatment for GT3 patients. (CHC directacting direct acting DAAs, , (DAAs) GT (GT3 difficulttocure difficult cure population NSA NS (DCV SOF, (SOF) NSB B resistanceassociated resistance (RASs infection hospital 1 (RBV (PEG included posttreatment. posttreatment post treatment. post-treatment 12 876 87 6 87.6 800 80 0 80.0 arm Cirrhosis interferonPEG interferon failure AK K YH Y H Interestingly A62T AT T (DAAs (GT (SOF 8 87. 80.

Abstract Brazilian pharmacists’ education and training aims to prepare them for the various activities they will undertake during professional practice, especially in the national health system (SUS). By using an exploratory transversal study based on a validated questionnaire, we have characterized the educational and training background of pharmacists working in SUS municipal units in Ribeirão Preto, State of São Paulo (SP), Brazil, and the frequency with which these professionals carry out several activities. Pharmacists working in these municipal outpatient units (N=44) graduated between 1981 and 2014 (56.8% of them graduated from public state or federal institutions), are predominantly female (84%), and are aged 25-57 years; 34% of these pharmacists have a “Generalist” degree, and 90.9% attended postgraduate programs, mostly specialization (75%). All the pharmacists pointed out the need for continuing education. The frequency with which they carry out activities varies, but those involving direct contact with patients predominate. Consultations, therapeutic follow-up, case discussions, and health promotion activities take place only occasionally. We concluded that pharmacists who work in the municipality of Ribeirão Preto, SP, are very much involved with dispensing, but not with health education or pharmacotherapeutic follow-up, so investing in education and training in these areas is necessary. practice SUS. . (SUS) questionnaire Preto SP , (SP) Brazil N=44 N44 N 44 (N=44 198 201 56.8% 568 56 8 (56.8 institutions, institutions institutions) 84%, 84 84% (84%) 2557 25 57 25-5 years 34 Generalist “Generalist degree 909 90 9 90.9 programs 75%. 75 75% (75%) varies predominate Consultations followup, followup follow up, up follow-up discussions occasionally dispensing necessary (SUS (SP N=4 N4 4 (N=4 19 20 56.8 5 (56. (84% 255 2 25- 3 90. 7 (75% N= (N= 1 56. (56 (84 (75 (N (5 (8 (7 (