RESUMO: O tumor venéreo transmissível canino (TVTC) é uma neoplasia transmissível de elevada casuística no Brasil. A quimioterapia com sulfato de vincristina é considerada o tratamento de escolha, mas a necessidade de aplicações semanais e acompanhamento hematológico, além dos custos, são obstáculos à adesão dos proprietários ao tratamento. A lomustina é um antineoplásico da classe dos agentes alquilantes e, por ser administrado por via oral, representa um opção de tratamento mais prática e menos onerosa para os proprietários de animais com neoplasias. O objetivo deste estudo foi avaliar a eficácia terapêutica da lomustina em cães acometidos por TVTC. Foram selecionados 12 cães com diagnóstico citopatológico de TVTC genital de ocorrência natural. Os cães foram submetidos ao protocolo experimental com administração de lomustina nas doses de 70 a 85 mg/m2 por via oral a cada 21 dias, totalizando no máximo dois ciclos de administração. Os animais foram reavaliados a cada sete dias até um máximo de +49 dias após a primeira dose de lomustina, para monitorar a regressão das lesões neoplásicas por meio de mensuração das lesões. Entre os 12 cães submetidos ao protocolo, 8/12 obtiveram remissão completa da neoplasia e foram considerados curados (66,6%), 1/12 tiveram resposta parcial ao tratamento (8,33%) e 3/12 tiveram doença estável (25%). Efeitos adversos importantes, como leucopenia neutrofílica grave, foram detectados em 3/12 cães (25%). O estudo clínico indicou que a lomustina pode ser uma opção de tratamento para TVTC.

ABSTRACT: Canine transmissible venereal tumor (TVTC) is a highly casuistic transmissible neoplasm in Brazil. Chemotherapy with vincristine sulfate is considered the treatment of choice, but the need for weekly applications and hematological monitoring, in addition to costs, are obstacles to owners’ adhesion to the treatment. Lomustine is an alkylating class antineoplastic agent, and because it is administered orally, it is a more practical and less costly treatment option for the owners of animals with neoplasms sensitive to the drug. This study evaluated the therapeutic efficacy of lomustine in dogs affected by TVTC. Twelve dogs with cytopathological diagnosis of natural genital TVTC were selected. The dogs were submitted to the experimental protocol with lomustine administration at doses of 70 to 85 mg/m2 orally every 21 days, totaling a maximum of two administration cycles. The animals were reevaluated every 7 days until a maximum of +49 days after the first dose of lomustine, to monitor the regression of neoplastic lesions through measurements. Among the 12 dogs submitted to the lomustine protocol, 8/12 achieved complete remission of the neoplasm and were considered cured (66.6%), 1/12 had partial response to treatment (8.33%) and 3/12 had stable disease (25%). Important adverse effects such as severe neutrophilic leukopenia were detected in 3/12 dogs (25%). The clinical study indicated that lomustine may be a treatment option for TVTC.

ABSTRACT: Canine transmissible venereal tumors (TVT) have a high incidence in Brazil. This is partly due to the large population of stray dogs and the ineffectiveness of epidemiological control programs. This study aimed to describe the epidemiological data, clinical manifestations, and treatments used in dogs affected by TVT. Data were retrospectively collected from the 2015-2020 records of the Veterinary Hospital of the Federal Rural University of Rio de Janeiro. A total of 252 dogs were diagnosed with TVT during the study period. Of these, 81.3% were mixed-breed, 50.4% were males, and 88.9% were young or adult animals. The genital region only was affected in 77.3% of cases. Exclusively extragenital lesions were observed in 22.6% of cases. Among the animals seen, 40.1% received no treatment. Of those treated, 99.3% underwent a vincristine sulfate protocol, and in 77.2%, the treatment resulted in total remission of the neoplasm after 4 to 6 chemotherapy sessions. It was concluded that TVT is a neoplasm most often seen in mixed-breed dogs and located in the genital region, with hemorrhagic secretion being the main clinical sign reported by owners. Vincristine sulfate is currently the most used therapy, with high efficacy. However, despite the good prognosis, there was a high rate of non-adherence or abandonment of treatment, and this is an important factor to be considered and addressed by veterinarians.

RESUMO: O tumor venéreo transmissível (TVT) apresenta elevada incidência no Brasil, relacionada a elevada população de caninos errantes e a ineficácia dos programas de controle epidemiológicos. O objetivo do estudo foi descrever dados epidemiológicos, manifestação clínica e o tratamento empregado em cães acometidos pelo TVT no Hospital Veterinário da Universidade Federal Rural do Rio de Janeiro entre os anos de 2015 e 2020. Foram diagnosticados 252 cães com TVT durante o período do estudo, sendo 81,3% cães sem raça definida, 50,4% machos e 49,6% fêmeas, e com 88,9% animais jovens ou adultos. A região genital foi acometida em 77,3% dos casos. Lesões exclusivamente extragenitais foram observadas em 22,6% dos casos. Quanto ao tratamento, 40,1% dos cães não receberam tratamento. Entre os animais tratados, 99,3% utilizaram protocolo com sulfato de vincristina e em 77,2% o tratamento resultou em remissão total da neoplasia, com a realização de 4 a 6 sessões do quimioterápico. Conclui-se que o TVT é uma neoplasia frequentemente relacionada a cães sem raça definida, localizados na região genital, com secreção hemorrágica sendo o principal sinal clínico reportado pelos proprietários. O sulfato de vincristina é a terapia mais empregada, com alta eficácia. Entretanto, apesar de ser uma neoplasia com bom prognóstico, o alto índice de não adesão ou abandono ao tratamento representa um importante fator a ser considerado e trabalhado pelos médicos veterinários.

Abstract This article discusses how Lima Barreto constructed a politics of the senses, that is, how he reflected on the theme of the body in space in the novel Numa e a Ninfa, although other manuscripts by the author are mobilized for the articulation of the theme. The reports produced by the man from Rio de Janeiro about the parliamentary space allow us to understand how the corporeity of an era - the Rio de Janeiro of the First Republic - gains visibility and sayability in its fortune. Thus, this article points out that Barret’s political criticism, generally located by researchers of his work in the discussion of ethics and the commitment of the aediles with public affairs, allows reflection on the theater of emotions and gestures of the rulers. The gaze and oral expressiveness of the congressmen are evaluated in this article as a way of checking the functioning of the politics of the senses, intended in Barreto’s narratives to deal with the bodies of men and women in and through space. As a result, it was evaluated that the study of expressiveness developed by Barreto, in addition to being a way of seeing the world, translates perceptions that the body is a product of culture that can be modulated by space.

Resumo Este artigo discute como Lima Barreto construiu uma política dos sentidos, isto é, de que forma refletiu sobre o tema do corpo no espaço no romance Numa e a Ninfa, embora outros manuscritos do autor sejam mobilizados para a articulação do tema. Os relatos que o carioca produziu acerca do espaço parlamentar permitem entender como a corporeidade de uma época - o Rio de Janeiro da Primeira República - ganha visibilidades e dizibilidades em sua fortuna. Desse modo, este artigo pontua que a crítica política barretiana, geralmente situada pelos pesquisadores de sua obra na discussão sobre ética e no empenho dos edis com a coisa pública, permite refletir sobre o teatro de emoções e gestualidades dos governantes. O olhar e a expressividade oral dos congressistas são avaliados neste artigo como forma de conferir o funcionamento dessa política dos sentidos, intencionada nas narrativas de Barreto a respeito dos corpos de homens e mulheres no e pelo espaço. Como resultado, avaliou-se que o estudo da expressividade desenvolvido por Barreto, além de ser uma maneira de ver o mundo, traduz percepções de que o corpo é um produto da cultura modulável pelo espaço.

Abstract Gradual climatic changes caused by mountains’ altitudinal variation promote alterations in the structure of ecological communities. Environmental changes are also expected according to the slope’s position in relation to the sea. In this study, we aimed to compare epiphytic pteridophyte communities along altitudinal gradients on opposite slopes in a section of the Atlantic Forest. We sampled a total of 10 sites in the montane and upper montane zones from the eastern (facing the sea) and western (facing away from the sea) slopes. A total of 1,742 individuals from 62 epiphytic species were recorded. The slopes showed similar epiphytic abundances and richness. Species richness showed a tendency to decrease with an increase in altitude on the western slope, and abundance was higher at intermediate altitudes, with no altitudinal trend in dominance. Conversely, on the eastern slope, there was no clear altitudinal pattern in richness or abundance; however, dominance increased with an increase in altitude from 1,200 to 1,800 m. Species compositions differed among altitudinal zones and between slopes. The eastern slope had lower species richness and no clear altitudinal gradient, although it was better preserved than the western one. Thus, there are differences in the community structure of epiphytic pteridophytes from the forest understory due to altitudinal variation and slope orientation, and these findings corroborate our hypotheses.

Resumo As mudanças climáticas graduais causadas pela variação altitudinal nas montanhas promovem alterações na estrutura das comunidades ecológicas. Mudanças ambientais também são esperadas de acordo com a posição das vertentes em relação ao mar. Neste estudo, nós objetivamos comparar a comunidade de pteridófitas epífitas ao longo dos gradientes altitudinais em vertentes opostas em um trecho de Floresta Atlântica. Amostramos um total de 10 sítios nas faixas montana e alto-montana das vertentes oriental (voltada para o mar) e ocidental (oposta ao mar). Um total de 1,742 indivíduos, distribuídos em 62 espécies epifíticas, foram registrados. As vertentes mostraram valores similares de abundância e riqueza epifítica. A riqueza tendeu a diminuir com o aumento da altitude na vertente ocidental; a abundância foi elevada na altitude intermediária e nenhuma tendência altitudinal na dominância foi observada. Na oriental, não houve nenhum padrão altitudinal claro na riqueza ou abundância em relação à altitude, mas um aumento na dominância de 1,200 a 1,800 m. A composição de espécies diferiu entre as faixas altitudinais e entre as vertentes. A vertente oriental teve menor riqueza e nenhum gradiente altitudinal claro, embora fosse mais preservada que a ocidental. Portanto, existem diferenças na estrutura da comunidade de pteridófitas epífitas do sub-bosque florestal devido à variação altitudinal e orientação das vertentes, e esses resultados corroboram nossas hipóteses.

Resumen Este trabajo tiene el propósito de evaluar las diferencias a nivel taxonómico y tafonómico entre los ensambles de micromamíferos contenidos en egagrópilas de lechucita de las vizcacheras (Athene cunicularia) recuperadas en cuatro nidos muestreados en distintos puntos de un campo ubicado en el Departamento Minas, al noroeste de la provincia de Córdoba, al interior del Chaco Seco. A partir de este estudio nos proponemos explorar y evaluar la influencia de los microambientes (composición y cobertura vegetal) inmediatos a cada nido en la estructura taxonómica de los ensambles de micromamíferos recuperados y, de esta forma, proveer herramientas para reforzar y fortalecer las inferencias paleoambientales en contextos con ocupaciones humanas a escala regional. Para este fin, incorporamos al análisis de las egagrópilas, muestreos e identificación de la vegetación en campo y la aplicación de herramientas de la geomática sobre imágenes satelitales. Los resultados de la comparación entre los distintos análisis indican una variación en la presencia/ausencia de especies de micromamíferos entre los cuatro nidos muestreados. En consonancia con lo anterior, proponemos que la composición general de la estructura del paisaje (vegetación más dispersa vs. vegetación más tupida) sería la causa principal de estas variaciones. Los resultados de los análisis tafonómicos revelaron índices de abundancia relativa elevados, alta fragmentación y proporciones elevadas de restos con modificaciones por digestión. Las intensidades de digestión detectadas fueron de leve a fuerte. No se observaron modificaciones de tipo extrema.

Abstract The purpose of this study is to evaluate the taxonomic and taphonomic differences between the micromammal assemblages contained in pellets of burrowing owls (Athene cunicularia) recovered from four nests sampled at different points of a field located in Minas Department, northwest of the province of Córdoba, within the dry Chaco. Thus, we propose to explore and evaluate the influence of the microenvironments (composition and vegetation cover) immediately surrounding each nest on the taxonomic structure of the recovered micromammal assemblages, providing tools to reinforce paleoenvironmental inferences in contexts with human occupations at a regional scale. In addition to the analysis of the pellets, we incorporated sampling and field identification of vegetation along with the application of geomatics tools on satellite images. The results of the comparison between the different analyses indicate a variation in the presence/absence of micromammal species between the four nests sampled. In line with the above, we propose that the general composition of the landscape structure (sparser vegetation vs. denser vegetation) would be the main cause of these variations. The results of the taphonomic analyses revealed high relative abundance indices, high fragmentation and high proportions of digested remains. The intensities of digestion ranged from light to heavy. No extreme modifications were observed.

ABSTRACT Objective: Describe the clinical and laboratory characteristics and the transfusion strategy of patients at Hospital Israelita Albert Einstein with platelet refractoriness and identify their etiological characteristics. Standardize the platelet immunofluorescence technique by flow cytometry as a test for platelet compatibility in immune platelet refractoriness in transfusion support. Methods: Review of medical records of refractory platelet patients followed at HIAE from January 2011 to May 2017. Clinical-demographic data, laboratory data and identification of the use of compatible genotyped platelets for patients in need of transfusion therapy were collected. The analyzed patients were classified according to the etiology of their platelet refractoriness. To standardize the FC-PIFT technique, blood group O platelets were incubated with serum from blood group AB donors and anti-IgG monoclonal antibody to determine the negative control. In order to verify the influence of the ABO system, monoclonal anti-IgG antibodies were incubated with blood group A or B platelets and with blood group O donor serum with isohemagglutinins below and above 1/64. Results: A total of 47 patients were evaluated, a 51% (24/47) preponderance of associated immune and non-immune factors (NIPR + IPR). The most common causes of NIPR + IPR were splenomegaly (54%) and the development of HLA antibodies (88%), consistent with the literature. For patients who required therapeutic transfusion, only a small portion received compatible genotyped platelets. Conclusion: Although 60% of patients could benefit from the therapeutic transfusion of genotyped platelets, only 10% were actually transfused with this type of blood component. This reaffirms the need for investments in a bank of genotyped platelet donors.

ABSTRACT Introduction: Platelet antibody identification is indispensable for diagnosing the human platelet antigen (HPA) or human leukocyte antigen (HLA) immunization, mostly because it can restrict the compatibility and results of transfusions. Correct detection of these antibodies is of utmost importance for the diagnosis and treatment. Method: We present 16 platelet alloimmunization results, comparing two tests with different technologies: the MAIPA (monoclonal antibody immobilization of platelet antigens), as a reference technique, and a bead-based assay, the Pak-Lx. Results: Eleven samples (68.75%) showed agreement in both techniques. Two tests were false negatives in the Pak-Lx: a pan-reactivity in GPIIbIIIa and an anti-HPA-9b. On the other hand, the Pak-Lx was more sensitive to detect a decreasing anti-HPA-5b. The Pak-Lx found an anti-HPA-2b positive, but with a low median fluorescent intensity (MFI), suggesting a false-positive result. Moreover, in one case, the MAIPA was negative for a positive Pak-Lx HLA. Conclusion: Antibody platelet diagnosis can sometimes be challenging. The methods seemed similar, the Pak-Lx being faster and simpler than the MAIPA, and they can be complementary to solve clinical issues.

Abstract We present a zooarchaeological analysis of a modern collection of 24 guanacos (Lama guanicoe), a product of the hunting, processing, consumption and disposal of the animals in a field located in the northwest of the province of Córdoba, Argentina. To the previous analyses, we add information obtained through semi-structured interviews (n=50), sometimes with the participation of two or three interlocutors, open and in-depth (n=16), and participant observation with local residents (N=8), in an attempt to contribute to the understanding of human-guanaco relations through an archaeology of the contemporary past (late 20th century to present). Our results show changes and continuities regarding the hunting, processing and use of these ungulates. In light of our results, we also discuss the symbolic and medicinal value of the species for the local community. Finally, we draw attention to how the socioeconomic and ecological changes associated with the Anthropocene have endangered guanacos at a provincial scale. Thus, we underscore the importance of addressing an archaeology of the contemporary era which contributes to biocultural conservation in the area.

Resumen: Se presentan análisis zooarqueológicos de una colección moderna de 24 guanacos (Lama guanicoe), producto de la cacería, procesamiento, consumo y descarte de los animales en un campo del noroeste de la Provincia de Córdoba, Argentina. A lo anterior, se suma información obtenida a través de entrevistas semiestructuradas (n=50), en ocasiones con la participación de dos o tres interlocutores, abiertas, en profundidad (n=16), y observaciones participantes con pobladores locales (N=8), con el objetivo de aportar a la comprensión de las relaciones humano-guanacos desde una arqueología del pasado contemporáneo (fines del siglo XX hasta la actualidad). Nuestros resultados ponen en evidencia cambios y continuidades respecto a las prácticas de cacería, procesamiento y el aprovechamiento de estos ungulados. Además, el valor simbólico y medicinal de la especie para la comunidad local es discutido a la luz de los resultados que se presentan. Por último, se destaca que los cambios socioeconómicos y ecológicos característicos del Antropoceno han puesto al guanaco en peligro de extinción a nivel provincial. De esta manera, se destaca la importancia de realizar una arqueología del pasado contemporáneo que contribuya a la conservación biocultural en el área.

RESUMO: A propagação seminal de pequizeiro acarreta grande variabilidade na taxa de germinação e no genótipo das mudas produzidas, mostrando a necessidade do desenvolvimento de técnicas para a propagação vegetativa dessa espécie, como a alporquia. Os objetivos deste estudo foram avaliar a eficácia da alporquia, bem como o efeito do diâmetro do caule e da planta-mãe na sobrevivência, no calejamento e no enraizamento de alporques de pequizeiro. O processo de alporquia foi realizado em meados de dezembro de 2019, nos seguintes diâmetros de caule: inferior a 15 mm; 15-19 mm; 20-24 mm; 25-29 mm e superior a 29 mm. Os tratamentos foram testados em quatro repetições de 10 alporques. Após três meses, avaliaram-se as porcentagens de sobrevivência, de calejamento e de enraizamento, além do vigor de enraizamento. As porcentagens de sobrevivência e de calejamento nos alporques, independentemente da planta matriz, foram superiores a 85%, mostrando o grande potencial dessa técnica na reprodução de pequizeiro. A taxa de diferenciação de calos em raízes variou entre as matrizes. Considerando os parâmetros avaliados, diâmetros de caule de 20 a 24 mm são os mais adequados para a alporquia em pequizeiro. Esses resultados indicam o potencial da técnica de alporquia para a produção comercial de mudas de pequizeiro.

ABSTRACT: Seed propagation of pequizeiro (Caryocar brasiliense) has many disadvantages, including low germination rates and high genetic variability of the resulting plants. Therefore, vegetative propagation techniques, such as the air layering process, are potentially important for this species. This study evaluated the effects of stem diameter and parental plant on the air layering efficacy of pequizeiro. The air layering process was carried out in mid-December 2019, in the following stem diameters: less than 15 mm; 15-19 mm; 20-24 mm; 25-29 mm and above 29 mm. The treatments comprised four replicates of 10 air layers. After 3 months, the percentages of survival, callus formation and rooting were evaluated, in addition to the rooting vigor. The percentages of survival and callus formation observed in the air layering, regardless the parental plant, were higher than 85%, showing the high potential of this technique in the propagation of pequizeiro. The callus differentiation rate in roots varied between the parental plants. Considering the evaluated parameters, stem diameters ranging from 20 to 24 mm are the most suitable ones for the air layering process in pequizeiro. These results indicated the high potential of the air layering technique for the commercial propagation of pequizeiro.

ABSTRACT Objective: Low platelet reactivity levels are associated with higher risk of bleeding in patients receiving dual antiplatelet therapy relative to patients with optimal platelet blockade. This study set out to evaluate the prevalence of low platelet reactivity in patients with acute myocardial infarction treated with ticagrelor and aspirin. Methods: Patients admitted with acute myocardial infarction who were already undergoing dual antiplatelet therapy with aspirin and ticagrelor were enrolled. Blood samples were collected 1 hour before and 2 hours after the maintenance dose of ticagrelor to investigate trough and the peak effects of the drug respectively. Platelet reactivity was measured by three methods: Multiplate®, PFA-100® with Innovance® PFA-P2Y cartridge and PFA-100® with Collagen/ADP cartridge. Platelet reactivity was assessed in the presence of peak levels of ticagrelor and defined according to previously validated cut-offs for each method (<19 AUC, >299 seconds and >116 seconds respectively). The level of significance was set at p<0.05. Results: Fifty patients were enrolled (44% with ST-elevation). Median duration of DAPT was 3 days (interquartile range, 2-5 days). On average, peak and trough platelet reactivity were markedly low and did not differ between different methods. Low platelet reactivity was common, but varied according to analytic method (PFA-100®/Innovance®PFA-P2Y: 86%; Multiplate®: 74%; PFA-100®/Collagen/ADP: 48%; p<0.001). Conclusion: Low platelet reactivity was very common in patients with acute myocardial infarction submitted to dual antiplatelet therapy with ticagrelor and aspirin. Findings of this study justify the investigation of less intensive platelet inhibition strategies aimed at reducing the risk of bleeding in this population, such as lower dose regimens or monotherapy with P2Y12 inhibitors.

Resumo O tumor venéreo transmissível canino (TVTC) é uma neoplasia transmitida principalmente através da cópula, com elevada incidência em cães errantes no Brasil. No processo de evolução tumoral do TVTC, são reconhecidas as fases de progressão, estacionária e de regressão. O estado imunológico do hospedeiro está relacionado ao comportamento biológico da doença, contudo, a observação de regressão espontânea em casos de TVTC de ocorrência natural é incomum. Foi atendida uma paciente canina, resgatada da rua, por apresentar massa ulcerada na genitália externa e infestação por carrapatos. Foram realizados exame citopatológico, que diagnosticou TVTC, e exames laboratoriais que evidenciaram anemia discreta e grave trombocitopenia. Com isso e diante da impossibilidade de realizar outros exames, foi também estabelecido o diagnóstico presuntivo de erlichiose monocítica canina (EMC) e instituído tratamento para a hemoparasitose. Durante o acompanhamento, foi observada rápida melhora dos sinais clínicos e das alterações laboratoriais, bem como a redução espontânea da massa tumoral. Em sequência, foi realizada nova avaliação citopatológica do TVTC e verificado o aumento quantitativo de linfócitos maduros e plasmócitos, em meio as células tumorais, achado compatível com a fase estacionária da doença. A partir desse momento, optou-se por realizar apenas acompanhamento clínico e avaliação citopatológica da neoplasia. Foram observados contínua remissão clínica e achados microscópicos compatíveis com a fase de regressão do tumor, até sua remissão completa. Pondera-se que a melhora na saúde geral da paciente após o tratamento da EMC esteja relacionada à regressão espontânea do TVTC, e que realização simultânea de exames clínico e citopatológico seriados pode ser viável e útil ao acompanhamento das fases de evolução do TVTC.

Abstract The canine transmissible venereal tumor (TVTC) is a neoplasm transmitted mainly through copulation and with a high incidence in stray dogs in Brazil. In the process of tumor evolution of TVTC, the progression, stationary and regression phases are recognized. The host immunity is related to the disease’s biological behavior, however, spontaneous regression observation in cases of naturally occurring TVTC is uncommon. A canine patient was attended, after beeing rescued from the street, due to an ulcerated mass in the external genitália and tick infestation. Cytopathological examination, which diagnosed TVTC, and laboratory tests that showed mild anemia and severe thrombocytopenia were performed. In view of the impossibility of carrying out other exams, it was made the presumptive diagnosis of canine monocytic ehrlichiosis (CME), and treatment was instituted. During follow-up it was observed quick improvement in clinical signs and laboratory changes, as well as a reduction in tumor mass. A new cytopathological evaluation was carried out, and was verified increase in mature lymphocytes and plasmocytes in the midst of the tumor cells, finding compatible with the stationary phase of the disease. From that moment on, it was decided to perform only clinical and cytopathological follow-up. In the following evaluations, continuous clinical remission and cytopathological findings compatible with those described in the regression phase were observed, until its complete remission. It is considered that the improvement in the general health of the patient after the treatment of CME is related to the spontaneous regression of TVTC, and that simultaneous performance of serial clinical and cytopathological exams may be feasible and useful for monitoring the stages of evolution of TVTC.

ABSTRACT BACKGROUND: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.

RESUMO RACIONAL: A pesquisa em cirurgia robótica assistida cresceu dramaticamente nas últimas duas décadas e as vantagens sobre a videolaparoscopia tradicional têm sido amplamente debatidas. Para as hérnias, o sistema robótico pode aumentar as estratégias intraoperatórias, principalmente em hérnias complexas ou hérnias incisionais. OBJETIVOS: Comparar as diferenças de custo direto entre a hernioplastia incisional robótica e a laparoscópica e determinar cada fonte de gasto que pode estar relacionada ao aumento de custos em um programa de robótica na perspectiva de uma instituição pública brasileira. MÉTODOS: Investigar as diferenças nos custos diretos dos dados gerados a partir de um protocolo de ensaio clínico (ReBEC: RBR-5s6mnrf). Pacientes com hérnia incisional foram aleatoriamente designados para serem submetidos a reparo robótico ou laparoscópico (RVIHR). Os custos foram descritos na moeda brasileira (R$). RESULTADOS: Dezenove pacientes submetidos à cirurgia robótica foram comparados com dezoito submetidos à cirurgia laparoscópica. O valor gasto com tempo de centro cirúrgico (Robótica: 2.447,91±644,79; Robótica: 1.989,67±763,00; p=0,030), gases medicinais inalados em centro cirúrgico (Robótica: 270,57±211,51; Robótica: 84,55±252,34; p=0,023), recursos humanos em centro cirúrgico (Robótica: 3.164,43±894,97; Laparoscópica: 2.120,16±663,78; p<0,001), recursos materiais (Robótica : 3.204,32±351,55; Robótica: 736,51±972,32; p<0,001) e medicamentos (Robótica: 823,40±175,47; Robótica: 288,50 ± 352,55; p<0,001) para cirurgia robótica foi maior que cirurgia laparoscópica, implicando em maior custo total para cirurgia robótica (Robótica: 14.712,24±3.520,82; Laparoscópica: 10.295,95±3.453,59; p<0,001). Não foi observada diferença significativa nos custos relacionados à permanência hospitalar, recursos humanos em UTI e enfermaria, exames diagnósticos e telas. CONCLUSÕES: O sistema robótico adiciona um custo global significativo à hernioplastia incisional laparoscópica tradicional. O custo dos dispositivos médicos e robóticos, além de tempos cirúrgicos mais prolongados, são os principais fatores que impulsionam a diferença nos custos.

ABSTRACT Objective: Low levels of neutrophils can be an intrinsic condition, with no clinical consequences or immunity impairment. This condition is the benign constitutional neutropenia (BCN), defined as an absolute neutrophils count (ANC) ≤2000 cells/mm. Diagnosis of BCN is of exclusion where patients are submitted to blood tests and possibly to invasive diagnostic search until secondary causes of neutropenia are ruled out. The natural history of the disease suggests benign evolution and Brazilian study showed an overall frequency of 2.59%. The main mechanisms include reduced neutrophil production, increased marginalization, extravasation to the tissues and immune destruction. Genetic studies showed strong association between the single nucleotide variant rs2814778 located on chromosome 1q23.2 in the promoter region of the atypical chemokine receptor 1 (Duffy blood group system) gene (ACKR1, also termed DARC) and BCN. The aim of this study is to evaluate FY phenotypes and genotypes including the analysis of the rs2814778 SNP in Brazilian patients with BCN in order to determine an effective diagnostic tool, allowing reassurance of the patient and cost reduction in their care. Methods: Case control study, with 94 individuals (18 patients and 76 controls). Phenotyping was performed by gel test and genotyping was performed by PCR-RFLP. Results: White blood cell (WBC) and absolute neutrophils (AN) counts showed lower levels in patients compared to controls. In the patient group 83.3% were genotyped as FY*B/FY*B. The SNP rs2814778 (-67T > C) was identified in 77.8% of the patients genotyped as FY*B-67C/FY*B-67C. In the control group, 72.7% were homozygous for the wild type and 23.3% were heterozygous. Conclusion: This study reinforces that FY phenotyping and genotyping can be used to detect most people with BCN, avoiding excessive diagnostic investigation. Besides, this procedure may reduce health costs and be reproductible in clinical practice.

Resumo Este trabalho está inserido no contexto da atual agenda de reformas que envolve a Previdência Social no Brasil. O objetivo geral visou compreender, por meio da Teoria dos Múltiplos Fluxos, de John Kingdon (1984, 2003), como a Previdência tornou-se um elemento da Seguridade no âmbito das políticas públicas na Constituição Federal de 1988 (CF/88). Em termos metodológicos, a pesquisa é predominantemente documental e bibliográfica, com abordagem qualitativa e utilização da técnica de análise de conteúdo categorial de grade fechada. A análise dos fluxos (problemas, soluções, política) com a inserção da influência internacional como um fluxo analítico indicou que a Previdência Social enquanto um problema público da década de 1980 estava atrelada a fatores econômicos e de gestão. Quando esse problema tocou a agenda pública, distintas alternativas foram formuladas, incluindo a ideia de expansão da cobertura social por meio da criação da Seguridade Social.

Abstract This study considers the current agenda of reforms in the Brazilian pension system and aims to understand how the pension system became an element of social security in the 1988 Brazilian Federal Constitution. The methodology is qualitative, predominantly documentary and bibliographical. The research uses content analysis, determining the coding categories before the data analysis, based on John Kingdon’s (1984, 2003) multiple stream framework (problems, policies, and politics), including the. category “international influence.” The study showed that the pension system was a public problem tied to economic and management factors in the 1980s. When the problem entered the public agenda, different policies were formulated, including expanding social welfare through creating a social security system.

Resumen Este trabajo se inserta en el contexto de la agenda actual de reformas que involucra la previsión social en Brasil. El objetivo general era comprender cómo la previsión se convirtió en un elemento de la seguridad en el ámbito de las políticas públicas de la Constitución Federal de 1988, a través de la teoría de múltiples corrientes de John Kingdon (1984, 2003). En términos metodológicos, la investigación es predominantemente documental y bibliográfica, con un enfoque cualitativo, se utilizó la técnica de análisis de contenido categórico de rejilla cerrada. El análisis de los flujos (problemas, soluciones, política) con la inserción de influencia internacional indicó que la previsión social como un problema público de la década de 1980 estaba vinculada a factores económicos y de gestión. Cuando este problema llegó a la agenda pública, se formularon diferentes alternativas, incluida la idea de ampliar la cobertura social a través de la creación de la seguridad social.