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

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

ABSTRACT Membranous nephropathy is a glomerulopathy, which main affected target is the podocyte, and has consequences on the glomerular basement membrane. It is more common in adults, especially over 50 years of age. The clinical presentation is nephrotic syndrome, but many cases can evolve with asymptomatic non-nephrotic proteinuria. The mechanism consists of the deposition of immune complexes in the subepithelial space of the glomerular capillary loop with subsequent activation of the complement system. Great advances in the identification of potential target antigens have occurred in the last twenty years, and the main one is the protein “M-type phospholipase-A2 receptor” (PLA2R) with the circulating anti-PLA2R antibody, which makes it possible to evaluate the activity and prognosis of this nephropathy. This route of injury corresponds to approximately 70% to 80% of cases of membranous nephropathy characterized as primary. In the last 10 years, several other potential target antigens have been identified. This review proposes to present clinical, etiopathogenic and therapeutic aspects of membranous nephropathy in a didactic manner, including cases that occur during kidney transplantation.

RESUMO A nefropatia membranosa é uma glomerulopatia, cujo principal alvo acometido é o podócito, e acarreta consequências na membrana basal glomerular. Tem maior frequência em adultos, principalmente acima dos 50 anos. A apresentação clínica é a síndrome nefrótica, mas muitos casos podem evoluir com proteinúria não nefrótica assintomática. O mecanismo consiste na deposição de complexos imunes no espaço subepitelial da alça capilar glomerular com subsequente ativação do sistema do complemento. Grandes avanços na identificação de potenciais antígenos alvo têm ocorrido nos últimos vinte anos, e o principal é a proteína “M-type phospholipase-A2 receptor” (PLA2R) com o anticorpo anti-PLA2R circulante, o que possibilita avaliar a atividade e o prognóstico dessa nefropatia. Essa via de lesão corresponde aproximadamente a 70% a 80% dos casos da nefropatia membranosa caracterizada como primária. Nos últimos 10 anos vários outros antígenos alvo potenciais têm sido identificados. Esta revisão se propõe a apresentar de modo didático aspectos clínicos, etiopatogênicos e terapêuticos da nefropatia membranosa, incluídos os casos com ocorrência no transplante renal.

Abstract Background Mohs micrographic surgery is an established technique in the treatment of cutaneous neoplasms. It offers higher cure rates and the main indications are non-melanoma malignant skin tumors. Few studies have been performed on the treatment of rare tumors through this technique. Objective To study rare skin tumors and rare variants of basal cell carcinoma and squamous cell carcinoma submitted to Mohs micrographic surgery in a tertiary service in relation to frequency, disease-free evolution, and applicability of this surgical procedure for this group of tumors. Methods This was a retrospective observational study including rare skin tumors and less common variants of basal cell carcinoma and squamous cell carcinoma treated using Mohs micrographic surgery, between October 2008 and April 2021. Results During the study period, 437 tumors were treated using Mohs micrographic surgery, and 22 (5%) rare skin tumors were selected. The tumors comprised three dermatofibrosarcomas protuberans, two atypical fibroxanthomas, two spiradenomas, two hypercellular fibrohistiocytomas, one primary cutaneous adenocarcinoma, one trichoblastoma, one porocarcinoma, one chondroid syringoma, one cutaneous angiosarcoma, one Merkel cell carcinoma, and one sebaceous carcinoma. Six other cases of rare basal cell carcinoma variants with trichoepitheliomatous differentiation, metatypical basal cell carcinoma, and clear cell squamous cell carcinoma were included. There were no cases of recurrence after an average of six years of follow-up. Study limitations This is a retrospective study on rare neoplasms carried out in a single referral center, and this surgical technique isn’t widely available in the public service. Conclusion This retrospective case series showed that Mohs micrographic surgery is an appropriate treatment for rare skin tumors. They corresponded to 5% of the tumors treated by the technique during a 12-year-period, with no recurrences identified.

Abstract Objectives: to analyze the level of anxiety in high risk pregnant women admitted in the maternity ward of the Hospital Universitário Lauro Wanderley (HULW) of the Federal University of Paraíba. Methods: an observational, descriptive, cross-sectional study of quantitative character, with a sample composed of 100 pregnant women diagnosed as high risk interned at HULW. Data collection was performed using the Beck Anxiety Inventory (BAI), used to assess the level of anxiety the patient is in and the existing symptoms. For the statistical analysis, the Mann Whitney, Kruskal Wallis and Spearman correlation tests were used, considering p<0.05. Results: it was observed that 68% of pregnant women have moderate to high anxiety, with heat, fear of the worst happening, faster heartbeat, emotional instability and nervousness listed as the most common symptoms. The presence of an anxious condition was independent of maternal age, marital status or parity, however the gestational trimester, history of abortions and length of hospital stay were identified as risk factors for anxiety. Conclusion: pregnant women with a high risk diagnosis hospitalized at HULW presented anxiety, thus identifying the need for a multiprofessional support network, such as family assistance.

Resumo Objetivos: analisar o nível de ansiedade em gestantes de alto risco internadas na maternidade do Hospital Universitário Lauro Wanderley (HULW) da Universidade Federal da Paraíba. Métodos: estudo observacional, descritivo, transversal de caráter quantitativo, com amostra composta por 100 gestantes com diagnóstico de alto risco internadas no HULW. A coleta de dados foi realizada por meio do Inventário de Ansiedade de Beck (BAI), utilizado para avaliar o nível de ansiedade do paciente e os sintomas existentes. Para a análise estatística, foram utilizados os testes de Mann Whitney, Kruskal Wallis e correlação de Spearman, considerando p<0,05. Resultados: observou-se que 68% das gestantes apresentam ansiedade moderada a alta, com calor, medo do pior acontecer, batimento cardíaco acelerado, instabilidade emocional e nervosismo listados como os sintomas mais comuns. A presença de ansiedade foi independente da idade materna, estado civil ou paridade, porém o trimestre gestacional, história de aborto e tempo de internação foram identificados como fatores de risco para ansiedade. Conclusão: gestantes com diagnóstico de alto risco internadas no HULW apresentaram ansiedade, identificando-se a necessidade de uma rede de apoio multiprofssional, como o atendimento familiar.

Resumo Introdução: Displasia fibrosa é uma desordem benigna, na qual o osso é substituído por fibrose e trabeculado ósseo imaturo, com distribuição semelhante entre sexos, mais comum nas primeiras décadas de vida. O acometimento do osso temporal pela displasia fibrosa é raro, não há consenso se é mais comum nas formas monostóticas ou poliostóticas. Estenose do meato acústico externo e disacusia condutiva são as manifestações mais comuns. Colesteatoma é também uma complicação comum e o acometimento da cápsula ótica incomum. O tratamento cirúrgico está indicado para controle de dor ou disacusia, otorreia, colesteatoma, deformidade. Objetivos: Descrever a experiência clínica de hospital terciário de referência com casos de displasia fibrosa do osso temporal. Método: Amostragem dos pacientes com diagnóstico de displasia fibrosa do osso temporal, confirmado pela tomografia, atendidos nos ambulatórios de otologia e otorrinolaringologia pediátrica, entre 2015 e 2018. As variáveis avaliadas foram idade, gênero, lateralidade, estenose do meato acústico externo, deformidade, perda auditiva, presença de colesteatoma secundário de meato acústico externo, extensão da lesão e conduta adotada. Resultados: Foram incluídos cinco pacientes, quatro do sexo feminino e um masculino, de 13-34 anos. Três apresentaram a forma poliostótica da displasia fibrosa do osso temporal e dois a forma monostótica. Quatro apresentaram deformidade local e estenose do meato acústico externo, dois desses evoluíram com colesteatoma. Todos manifestaram algum grau de comprometimento auditivo. Todos apresentaram cápsula ótica preservada na tomografia. Duas pacientes estão em observação clínica; duas foram submetidas a timpanomastoidectomia devido a colesteatoma secundário; um foi submetido a ressecção da lesão para controle de progressão da disacusia. Conclusão: Foram descritos cinco casos de displasia fibrosa do osso temporal, desordem rara para a qual o otologista deve estar atento.

Abstract Introduction: Fibrous dysplasia is a benign disorder, in which normal bone is replaced by fibrosis and immature bone trabeculae, showing a similar distribution between the genders, and being more prevalent in the earlier decades of life. Fibrous dysplasia of the temporal bone is a rare condition, and there is no consensus as to whether it is more common in monostotic or polyostotic forms. External auditory meatus stenosis and conductive dysacusis are the most common manifestations, with cholesteatoma being a common complication, whereas the involvement of the otic capsule is an unusual one. Surgical treatment is indicated to control pain or dysacusis, otorrhea, cholesteatoma, and deformity. Objectives: To describe the clinical experience of a tertiary referral hospital with cases of fibrous dysplasia of the temporal bone. Methods: Sampling of patients diagnosed with fibrous dysplasia of the temporal bone, confirmed by tomography, treated at the pediatric otology and otorhinolaryngology outpatient clinics, between 2015 and 2018. The assessed variables were age, gender, laterality, external auditory meatus stenosis, deformity, hearing loss, presence of secondary cholesteatoma of the external auditory meatus, lesion extension and management. Results: Five patients were included, four females and one male, with age ranging from 13 to 34 years. Three had the polyostotic form and two the monostotic form of fibrous dysplasia of the temporal bone. Four patients had local deformity and external auditory meatus stenosis, two of which progressed to cholesteatoma. All patients showed some degree of hearing impairment. All had preserved otic capsule at the tomography. Two patients are currently undergoing clinical observation; two were submitted to tympanomastoidectomy due to secondary cholesteatoma; one was submitted to lesion resection, aiming to control the dysacusis progression. Conclusion: Five cases of fibrous dysplasia of the temporal bone were described, a rare disorder of which the otologist should be aware.

Resumo Introdução Timpanoplastia é o procedimento cirúrgico voltado para a reconstrução da membrana timpânica e restauração do mecanismo condutor do som. Pode ser executada através de diversos tipos de acesso e de enxertos e é considerada bem-sucedida quando obtém fechamento completo da perfuração timpânica e melhoria na condução sonora. Objetivo Descrever a prevalência de sucesso no fechamento completo das perfurações timpânicas e os resultados auditivos das timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay. Metodologia Estudo retrospectivo desenvolvido em hospital terciário de referência. Pacientes com perfurações timpânicas centrais e com cadeias ossiculares íntegras submetidos a timpanoplastias endoscópicas com enxerto de cartilagem de tragus inlay foram incluídos. Foram avaliados o índice de integridade do neotímpano e os parâmetros auditivos pré e pós-operatórios foram comparados com o teste t de Student pareado. Resultados Foram identificadas 83 timpanoplastias endoscópicas com cartilagem inlay, 63 (76%) obtiveram neotímpano íntegro e 20 (24%), perfurações residuais. O gap aéreo-ósseo pré-operatório foi, em média, 18 ± 8,9 dBNA e o pós-operatório 11 ± 10 dBNA (p = 0,0005), sofreu redução em 71% e recuperação completa em 27%. O SRT pré-operatório médio foi 35 ± 13,5 e o pós-operatório 27 ± 14,4 (p = 0,0002). A média tritonal pré-operatória foi 34 ± 14,3 e a pós-operatória 24 ± 15 (p = 0,0002). Conclusão Nesta casuística, as timpanoplastias endoscópicas com cartilagem de tragus inlay apresentaram fechamento completo da perfuração timpânica em 76% dos casos, com melhoria significativa dos parâmetros auditivos.

Abstract Introduction Tympanoplasty is the surgical procedure aimed at the reconstruction of the tympanic membrane and restoration of the sound conducting mechanism. It can be performed with several types of access and grafts and is considered successful when it achieves complete closure of the tympanic perforation and sound conduction improvement. Objective To describe the prevalence of successful closure of tympanic perforations and auditory results of endoscopic tympanoplasty with an inlay tragus cartilage graft. Methods Retrospective study developed at a tertiary referral hospital. Patients with central tympanic perforations and intact ossicular chains operated with endoscopic tympanoplasty with inlay tragus cartilage graft were included. The neo-tympanum integrity index was evaluated, and the preoperative and postoperative auditory parameters were compared using the paired Student's t-test. Results We identified 83 endoscopic tympanoplasties with inlay cartilage, of which 63 (76 %) had an intact neo-tympanum and 20 (24 %) had residual perforations. The preoperative air-bone gap was, on average, 18 ± 8.9 dBHL, and the postoperative 11 ± 10 dBHL (p = 0.0005), showing reduction in 71 % and complete recovery in 27 %. The mean preoperative speech recognition threshold was 35 ± 13.5 and the postoperative SRT was 27 ± 14.4 (p = 0.0002). The preoperative tritonal mean was 34 ± 14.3 and the postoperative was 24 ± 15 (p = 0.0002). Conclusion In this series, endoscopic tympanoplasties with inlay tragus cartilage graft showed a 76 % prevalence of complete closure of the tympanic perforation, with significant improvement in the auditory parameters.

Abstract This study aimed to evaluate the feasibility of producing low-sugar mango jams enriched with curcumin-loaded lipid microparticles (CLM). The jams were incorporated with babacu oil and tristearin lipid microparticles encapsulating curcumin, using tween 80 and span 60 as surfactants. The jams were characterized by physicochemical and sensory tests along 30 days of storage, and the results revealed CLM incorporation had only a small influence on the macroscopic homogeneity and pH of the jams. Up to 4 g/100 g of incorporation of CLM, the color intensity and colorimetric stability of the jams were enhanced. The incorporation of CLM led to the jams to be classified, rheologically, as emulsion filled gels, and the small deformation rheology tests revealed the CLM acted as active fillers. However, the incorporation of 10 g CLM/100 g jam led to a non-reproducibility of the data obtained for frequency sweep experiments. Sensory evaluation (affective tests) indicated a high acceptation of the curcumin enriched mango jams, in terms of flavor, odor, spreadability, texture and color, both at the beginning and end of the storage period of 30 days.

ABSTRACT Objective To analyze the morphological and functional characteristics of primary macronodular adrenal hyperplasia (PMAH) nodules carrying or not carrying ARMC5 mutations and the consequences of the presence of mutations in terms of the pattern of macronodule composition and functional state. Subjects and methods The analyses were performed by hematoxylin-eosin staining, immunohistochemistry, microdissection of spongiocyte tissue and RT-qPCR of histological sections from 16 patients diagnosed with PMAH with germline (5) or germline/somatic mutations (5) and without mutations (6) in the ARMC5 gene. Results Hyperplastic nodules were predominantly composed of spongiocytes in mutated and nonmutated sections. ARMC5 mRNA expression in spongiocytes was higher in ARMC5-mutated nodules than in ARMC5-nonmutated nodules, and homogenous ARMC5 protein distribution was observed. The presence of arginine-vasopressin receptor (AVP1AR) and ectopic ACTH production were observed in both cell populations regardless of ARMC5 mutations; the numbers of serotonin receptor (5HT4R)- and proliferating cell nuclear antigen (PCNA)-positive cells were higher in macronodules carrying ARMC5 mutations than in those without mutations. Conclusions Our results suggest that the presence of ARMC5 mutations does not interfere with the pattern of distribution of spongiocytes and compact cells or with the presence of AVP1AR, gastric-inhibitory polypeptide receptor (GIPR) and ectopic ACTH. Nevertheless, the higher numbers of PCNA-positive cells in mutated nodules than in nonmutated nodules suggest that mutated ARMC5 can be related to higher proliferation rates in these cells. In conclusion, our results provide more information about the crosstalk among abnormal GPCRs, ectopic ACTH in steroidogenesis and the ARMC5 gene, which may be relevant in understanding the pathogenesis and diagnosis of patients with PMAH.

Resumo Objetivo Avaliar a associação entre índice glicêmico (IG) dietético e presença de excesso de peso em gestantes no primeiro trimestre de gestação. Métodos Estudo transversal realizado com 217 gestantes atendidas no Ambulatório de Medicina Materno-Fetal do Hospital Geral de Fortaleza, Fortaleza, CE, para realização de exames ultrassonográficos de rotina no período entre 11 e 13 semanas e 6 dias de gestação. Peso e altura foram obtidos para o cálculo do índice de massa corporal (IMC) gestacional. As mulheres foram questionadas quanto ao peso corporal habitual anterior à gestação, considerado o peso pré-gestacional. O IG e a carga glicêmica (CG) das suas dietas foram calculados e divididos em tercis. As associações foram investigadas por análise de variância (ANOVA, na sigla em inglês) ou pelos testes Kruskal-Walls e qui-quadrado (χ2). Resultados O grupo tinha alto percentual de excesso de peso pré-gestacional (39,7%) e gestacional (40,1%). Houve menor consumo de fibras totais (p = 0,005) e fibras insolúveis (p = 0,008) no tercil de maior valor de IG. No terceiro tercil, o IG da dieta foi associado ao excesso de peso dasmulheres no primeiro trimestre de gestação, tanto no modelo bruto como no modelo ajustado para idade, consumo total de energia e de ácidos graxos saturados. No entanto, não se observou esta associação emrelação à CG. Conclusão O alto IG da dieta consumida foi associado ao excesso de peso das mulheres no primeiro trimestre da gestação.

Abstract Objective To assess the association between dietary glycemic index (GI) and excess weight in pregnant women in the first trimester of pregnancy. Methods A cross-sectional study in a sample of 217 pregnant women was conducted at the maternal-fetal outpatient clinic of the Hospital Geral de Fortaleza, Fortaleza, state of Ceará, Brazil, for routine ultrasound examinations in the period between 11 and 13 weeks + 6 days of gestation.Weight and height were measured and the gestational body mass index (BMI) was calculated. The women were questioned about their usual body weight prior to the gestation, considering the prepregnancy weight. The dietary GI and the glycemic load (GL) of their diets were calculated and split into tertiles. Analysis of variance (ANOVA) or Kruskal-Walls and chi-squared (χ2) statistical tests were employed. A crude logistic regression model and a model adjusted for confounding variables known to influence biological outcomes were constructed. A p-value < 0.05 was considered significant for all tests employed. Results The sample group presented a high percentage of prepregnancy and gestational overweight (39.7% and 40.1%, respectively). InthetertilewiththehigherGIvalue, therewasa lower dietary intake of total fibers (p = 0.005) and of soluble fibers (p = 0.008). In the third tertile, the dietary GI was associated with overweight in pregnant women in the first trimester of gestation, both in the crude model and in the model adjusted for age, total energy intake, and saturated fatty acids. However, this association was not observed in relation to the GL. Conclusion A high dietary GI was associated with excess weight in women in the first trimester of pregnancy.

ABSTRACT Two trials were carried out to evaluate the effect of groups of organic minerals with different chemical characteristics on the performance, egg quality, biometry of digestive organs, and bone quality of laying hens in the first and second laying cycles. In the first cycle, 180 layers at 72 weeks were used in a completely randomized design (CRD) with four treatments and five replicates with nine birds each. In the second cycle, 216 layers at 94 weeks of age were used in a CRD with four treatments and six replicates with nine birds each. Birds were fed the following diets: treatment 1 - basal diet (inorganic minerals); treatment 2 - basal diet + amino acid chelated minerals (Cu, Fe, Mn, and Zn) + selenium yeast; treatment 3 - basal diet + mineral-amino acid complex (Mn, Zn, and Cu); and treatment 4 - basal diet + metal chelate (Mn, Zn, and Cu) + methionine hydroxy analogue. The following performance variables were evaluated: feed intake (g/bird/day), egg production (%), egg weight (g), egg mass (g/bird/day), conversion per mass (kg/kg), and conversion per dozen eggs (kg/dz). In the egg, the percentages of albumen, yolk, and shell; eggshell thickness (mm); and specific gravity (g/cm3) were determined. The relative weights (%) of the proventriculus, gizzard, liver, pancreas, and intestines were also measured. Lastly, in the tibiae, the weight (g), length (mm), resistance (kgf/cm2), deformity (mm), Seedor index (mg/mm), and mineral matter content (g/kg) were measured. The variables were not influenced by the groups of organic minerals used. Groups of organic minerals with different chemical characteristics can be used in layer diets without affecting their performance, egg quality, digestive organs, or bone quality.

RESUMO O estudo desenvolveu um protocolo sensorial baseado no Método do Índice de Qualidade (IQ), estimando a vida útil do tambaqui, Colossoma macropomum, inteiro e conservado em gelo, avaliando e determinando as principais alterações físico-químicas, microbiológicas, os parâmetros sensoriais e suas alterações durante o armazenamento em gelo. Noventa e seis peixes foram avaliados no dia 1, 3, 5, 8, 10, 12, 15, 17, 19 e 22 de armazenamento em gelo. O índice de qualidade desenvolvido (IQ) apresentou quatro principais atributos de qualidade com um total de 29 pontos de demérito. O muco e odor da pele, assim como a aparência geral e elasticidade ventral, apresentaram uma maior importância para o modelo estatístico aplicado, enquanto que os olhos, muco das brânquias e elasticidade dorsal mostraram menor significância para o IQ do tambaqui. O pH apresentou poucas variações durante o armazenamento em gelo. As bases nitrogenadas voláteis totais, bem como a contagem total de bactérias específicas de deterioração, apresentaram correlação linear com o tempo de armazenamento. O IQ mostrou-se eficiente para avaliar a qualidade do tambaqui e as perdas da qualidade sensorial ao longo do período de armazenamento. Os resultados sugerem que o tambaqui, Colossoma macropomum, inteiro e conservado em gelo é considerado adequado para consumo até o 22° dia de armazenamento.

ABSTRACT The study developed a sensory scheme based on the Quality Index (QI) and estimated the shelf-life for whole tambaqui, Colossoma macropomum (Cuvier, 1818), stored in ice, assessing and determining the most appropriate chemical, physical, bacteriological and quality sensory parameters and their changes during storage time. Ninety six fish were evaluated at 1, 3, 5, 8, 10, 12, 15, 17, 19 and 22 days of ice-storage. The developed quality index (QI) showed four main quality attributes with a total of 29 demerit scores. The skin mucus and odor, as well as general appearance and ventral elasticity had a great importance for the statistical model applied, while eyes, gill mucus and dorsal elasticity showed lower significance for tambaqui QI. The pH showed few variations during the ice storage. Nitrogen bases, as well as the total count of specific spoilage bacteria, had a linear correlation with storage time. The QI proved to be efficient to assess tambaqui quality and loss of sensory quality over the storage period. The results suggest that whole, ice-stored Colossoma macropomum is fit for consumption until the 22nd day.

RESUMO Objetivo Descrever e interpretar a experiência de amamentar entre mulheres que realizaram a cirurgia de mamoplastia antes da maternidade. Método Estudo descritivo, de abordagem qualitativa, desenvolvido com mulheres atendidas em um Banco de Leite Humano, entre 2014 e 2015. A análise de dados baseou-se no método de análise de conteúdo e fundamentou-se na Teoria Interativa de Amamentação. Resultados Participara 13 mulheres. Emergiram quatro categorias: (In)Sucesso na Amamentação Exclusiva: influência das condições biológicas materna e da criança; Sentimentos maternos: percepção sobre amamentação; Tomada de decisão na continuidade da amamentação ou uso de complemento; Papel dos profissionais de saúde na proteção, promoção e apoio a amamentação: (Des)Informação sobre as implicações da cirurgia. Conclusão As condições biológicas desfavoráveis das mulheres que realizaram mamoplastia geraram experiências de insucesso com a amamentação exclusiva e limitaram sua tomada de decisão, a despeito do desejo de amamentar.

ABSTRACT Objective To describe and interpret the experience of breastfeeding among women who underwent mammoplasty surgery prior to motherhood. Method A descriptive, qualitative study developed with women attended at a Human Milk Bank between 2014 and 2015. Data analysis was based on the content analysis method and supported by the Interactive Theory of Breastfeeding. Results 13 women participated in the study. Four categories emerged: 1) Success (or lack thereof) in Exclusive Breastfeeding: influence of maternal and child biological conditions; 2) Maternal feelings: perception about breastfeeding; 3) Decision making on the continuity of breastfeeding or the use of formula; 4) The role of health professionals in protecting, promoting and supporting breastfeeding: Information (or lack thereof) on the implications of the surgery. Conclusion Unfavorable biological conditions of the women who underwent mammoplasty generated unsuccessful experiences in exclusive breastfeeding and limited their decision-making, despite their desire to breastfeed.

RESUMEN Objetivo Describir e interpretar la experiencia de amamantar entre mujeres que realizaron la cirugía de mamoplastía antes de la maternidad. Método Estudio descriptivo, de abordaje cualitativo, desarrollado con mujeres atendidas en un Banco de Leche Materna, entre 2014 y 2015. El análisis de datos se basó en el método de análisis de contenido y se fundó en la Teoría Interactiva de la Lactancia. Resultados Participaron 13 mujeres. Emergieron cuatro categorías: Éxito o fracaso en la Lactancia Exclusiva: influencia de las condiciones biológicas materna y del niño; Sentimientos maternos: percepción acerca de la lactancia; Toma de decisión en la continuidad de la lactancia o uso de complemento; Papel de los profesionales sanitarios en la protección, promoción y apoyo a la lactancia: (Des)Información acerca de la implicaciones de la cirugía. Conclusión Las condiciones biológicas desfavorables de las mujeres que realizaron mamoplastía generaron experiencias de fracaso con la lactancia exclusiva y limitaron su toma de decisión, a pesar del deseo de amamantar.

ABSTRACT Objective To describe and interpret the experience of breastfeeding among women who underwent mammoplasty surgery prior to motherhood. Method A descriptive, qualitative study developed with women attended at a Human Milk Bank between 2014 and 2015. Data analysis was based on the content analysis method and supported by the Interactive Theory of Breastfeeding. Results 13 women participated in the study. Four categories emerged: 1) Success (or lack thereof) in Exclusive Breastfeeding: influence of maternal and child biological conditions; 2) Maternal feelings: perception about breastfeeding; 3) Decision making on the continuity of breastfeeding or the use of formula; 4) The role of health professionals in protecting, promoting and supporting breastfeeding: Information (or lack thereof) on the implications of the surgery. Conclusion Unfavorable biological conditions of the women who underwent mammoplasty generated unsuccessful experiences in exclusive breastfeeding and limited their decision-making, despite their desire to breastfeed.

RESUMEN Objetivo Describir e interpretar la experiencia de amamantar entre mujeres que realizaron la cirugía de mamoplastía antes de la maternidad. Método Estudio descriptivo, de abordaje cualitativo, desarrollado con mujeres atendidas en un Banco de Leche Materna, entre 2014 y 2015. El análisis de datos se basó en el método de análisis de contenido y se fundó en la Teoría Interactiva de la Lactancia. Resultados Participaron 13 mujeres. Emergieron cuatro categorías: Éxito o fracaso en la Lactancia Exclusiva: influencia de las condiciones biológicas materna y del niño; Sentimientos maternos: percepción acerca de la lactancia; Toma de decisión en la continuidad de la lactancia o uso de complemento; Papel de los profesionales sanitarios en la protección, promoción y apoyo a la lactancia: (Des)Información acerca de la implicaciones de la cirugía. Conclusión Las condiciones biológicas desfavorables de las mujeres que realizaron mamoplastía generaron experiencias de fracaso con la lactancia exclusiva y limitaron su toma de decisión, a pesar del deseo de amamantar.

RESUMO Objetivo Descrever e interpretar a experiência de amamentar entre mulheres que realizaram a cirurgia de mamoplastia antes da maternidade. Método Estudo descritivo, de abordagem qualitativa, desenvolvido com mulheres atendidas em um Banco de Leite Humano, entre 2014 e 2015. A análise de dados baseou-se no método de análise de conteúdo e fundamentou-se na Teoria Interativa de Amamentação. Resultados Participara 13 mulheres. Emergiram quatro categorias: (In)Sucesso na Amamentação Exclusiva: influência das condições biológicas materna e da criança; Sentimentos maternos: percepção sobre amamentação; Tomada de decisão na continuidade da amamentação ou uso de complemento; Papel dos profissionais de saúde na proteção, promoção e apoio a amamentação: (Des)Informação sobre as implicações da cirurgia. Conclusão As condições biológicas desfavoráveis das mulheres que realizaram mamoplastia geraram experiências de insucesso com a amamentação exclusiva e limitaram sua tomada de decisão, a despeito do desejo de amamentar.

RESUMO Foi realizado um estudo de avaliabilidade do Projeto de Mobilização Social para Prevenção e Controle da Dengue no Estado da Bahia, assim como foi descrito o modelo de intervenção prático. Foram conduzidas entrevistas junto a informantes-chave, análise documental e observação participante. Os resultados apontam que o Projeto pode ser considerado implementado, e seus principais resultados se situaram em torno da mudança do enfoque sobre dengue na pauta da mídia, bem como da maior integração dos entes federados e entre os Agentes Comunitários de Saúde e os Agentes de Endemias. Aspectos relacionados ao contexto municipal foram vistos como obstáculos para o alcance dos resultados esperados.

ABSTRACT An evaluability study of the Project Social Mobilization for Dengue Prevention and Control in the State of Bahia was performed, and the practical intervention model was described. Data collection involved interviews with key informants, documentary analysis and participant observation. The results indicate that the Project can be considered implemented, and its main results are related to the change of focus on dengue in the media's agenda, as well as a greater integration of federal entities, and between the Community Health Workers and the Endemic Agents. Aspects related to the municipal context were seen as obstacles to the achievement of the expected results.

RESUMO Foi realizado um estudo de avaliabilidade do Projeto de Mobilização Social para Prevenção e Controle da Dengue no Estado da Bahia, assim como foi descrito o modelo de intervenção prático. Foram conduzidas entrevistas junto a informantes-chave, análise documental e observação participante. Os resultados apontam que o Projeto pode ser considerado implementado, e seus principais resultados se situaram em torno da mudança do enfoque sobre dengue na pauta da mídia, bem como da maior integração dos entes federados e entre os Agentes Comunitários de Saúde e os Agentes de Endemias. Aspectos relacionados ao contexto municipal foram vistos como obstáculos para o alcance dos resultados esperados.

ABSTRACT An evaluability study of the Project Social Mobilization for Dengue Prevention and Control in the State of Bahia was performed, and the practical intervention model was described. Data collection involved interviews with key informants, documentary analysis and participant observation. The results indicate that the Project can be considered implemented, and its main results are related to the change of focus on dengue in the media's agenda, as well as a greater integration of federal entities, and between the Community Health Workers and the Endemic Agents. Aspects related to the municipal context were seen as obstacles to the achievement of the expected results.