Abstract This article proposes a comparative analysis between public and regulatory policies for implementing microgeneration and mini generation in Brazilian and German markets. The research was developed based on scientific texts and legal orders. Distributed microgeneration and mini generation are becoming a reality in Brazil. The current regulatory framework for distributed generation, effective from January 2022, promises to update the legislation and promote renewable energy. Since Brazilian legislation is still in its infancy, it is essential to compare it with other places where laws and regulations have already undergone several changes so we can learn from its mistakes and successes.

Resumo A inserção do cateter venoso central (CVC) para hemodiálise pode ser complicada em pacientes com anatomia anômala dos vasos. Nesses casos, o conhecimento detalhado da anatomia do vaso torácico é necessário para identificar a localização exata do cateter. A colocação venosa central sob controle de ultrassom tem reduzido significativamente as complicações associadas à punção às cegas e permite uma punção apropriada do vaso desejado, mas o CVC ainda pode ficar mal posicionado se seguir uma rota anômala. Aqui, relatamos um caso de cateter de diálise colocado em uma veia cava superior esquerda, apenas diagnosticado após estudo de tomografia computadorizada. (CVC vasos casos desejado Aqui esquerda computadorizada

Abstract Hemodialysis central venous catheter (CVC) insertion can be complicated in patients with anomalous vessel anatomy. In such cases detailed knowledge of thoracic vessel anatomy is necessary to identify the exact location of the catheter. Central venous placement under ultrasound control has significantly reduced the complications associated with blind puncture and allows an appropriate puncture of the desired vessel, but the CVC can still get misplaced if it follows an anomalous route. Herein, we report a case of dialysis catheter placed into a left sided superior vena cava, only diagnosed after CT scan study. (CVC route Herein cava study

RESUMO Introdução: Receptores de transplante renal são um subgrupo de doentes com maior risco de apresentar formas críticas de infecção por Síndrome Respiratória Aguda Grave pelo Coronavirus-2 (SARS-CoV-2) e piores outcomes devido ao tratamento imunossupressor. Aqui, apresentamos dados de uma coorte de um único centro de receptores de transplante renal com infecção por SARS-CoV-2. Métodos: Num estudo prospectivo, características basais, características clínicas, adaptação da terapêutica antiviral e de imunossupressão foram comparados entre doentes seguidos em ambulatório e doentes hospitalizados durante um período de um ano. Resultados: Foram analisados setenta e sete receptores de transplante renal, incluindo doentes de ambulatório e hospitalizados, com idade média de 57,7 (IIQ 49,7-64,9) anos. Vinte e oito (36,4%) foram tratados em ambulatório enquanto 49 (63,6%) doentes necessitaram de internação hospitalar. Entre os doentes hospitalizados, 18,4% foram admitidos na UTI, 49% apresentaram LRA, e 20,4% morreram. Foram realizados ajustes de imunossupressão em 95,9% dos pacientes hospitalizados, com dose de antimetabólitos ajustada em 83,7%, inibidores de mTOR em 14,3%, inibidores de calcineurina em 12,2%, e terapia com corticosteroides em 81,6%. Conclusão: Entre os pacientes hospitalizados, a optimização da terapêutica imunossupressora incluiu redução ou retirada de antimetabólito e aumento da dose de corticosteroides. A LRA ocorreu em quase metade dos pacientes e a mortalidade em pacientes hospitalizados atingiu 20%, refletindo uma maior gravidade da doença em relação à população em geral.

ABSTRACT Introduction: Kidney transplant recipients are a subgroup of patients at higher risk of critical forms of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and poor outcomes due to immunosuppression treatment. Herein, we present data from a single center cohort of kidney transplant recipients with SARS-CoV-2 infection. Methods: In a prospective study, baseline characteristics, clinical features, antiviral and immunosuppression management were compared between outpatients and hospitalized patients, during a one-year period. Results: Seventy-seven kidney transplant recipients were analyzed, including outpatients and hospitalized patients, with a median age of 57.7 (IQR 49.7-64.9) years. Twenty-eight (36.4%) were managed as outpatients, while 49 (63.6%) patients required hospital admission. Among hospitalized patients, 18.4% were admitted in ICU, 49% had AKI, and 20.4% died. Immunosuppression adjustments were performed in 95.9% of hospitalized patients, with dose of anti-metabolites adjusted in 83.7%, mTOR inhibitors in 14.3%, calcineurin inhibitors in 12.2%, and corticosteroid therapy in 81.6%. Conclusion: Among hospitalized patients, immunosuppression management included reduction or withdrawal of anti-metabolite and increase of corticosteroid dose. AKI occurred in almost half of patients and mortality in hospitalized patients reached 20%, reflecting greater disease severity than the general population.

ABSTRACT Introduction: The severe acute respiratory syndrome coronavirus 2 pandemic caused a negative impact on transplantation worldwide. One of the complexities is the management of the immunosuppression and anti-viral medication in transplant recipients. Herein we describe our experience managing five patients with coronavirus disease 2019 (COVID-19) immediately after kidney transplant. Description: we describe a series of five transplant recipients. Two were submitted to a low immunological risk induction immunosuppression: one developed severe disease, the other developed critical disease. The remaining three were submitted to a high immunologic risk immunosuppression: one developed mild disease, but approximately two months after diagnosis developed moderate COVID-19; another developed severe COVID-19; the remaining patient developed critical illness and perished. Both patients with critical COVID-19 developed bacterial and fungal superinfections in the Intensive Care Unit. All eligible patients were submitted to remdesivir and dexamethasone. The anti-metabolite was reduced or suspended. Despite worsening kidney function during the acute phase, kidney replacement therapy was only needed in one patient and the average serum creatinine at the time of discharge was lower that the pre-COVID-19 nadir. Discussion: There is still no definitive answer on whether solid organ transplant recipients carry a higher risk for morbimortality. Risk factors for the general population can also affect their outcome. The prolonged viral shedding in recipients may explain the irregular evolution of the patient who developed COVID-19 months after the initial diagnosis. The reduction of immunosuppression can be problematic in early post-transplant, but no apparent signs of rejection were noted. Literature addressing this specific context is scarce and studies are needed to clarify the optimal management of these patients.

ABSTRACT Introduction: Brazil expanded the pesticide market and Rio Grande do Sul stands out as the largest marketing state since 2014. The rural population, socioeconomic and environmental factors, as well as exposure to pesticides can cause prematurity and low weight at birth. Objective: To verify the association between the commercialization of pesticides and the occurrence of prematurity, low weight at birth and socioeconomic factors. Methods: Ecological study carried out, in the years 2017 and 2018, with 496 municipalities of Rio Grande do Sul State, Brazil. The population was made up of the live births by maternal residence and reported in the Live Births Information System. Information regarding the commercialization of pesticides was obtained from the Integrated System for Pesticide Management. The municipalities were classified into four groups of increasing order, based on marketing quartiles. Statistical analyses were carried out in the program IBM SPPS (version 21.0); considering a significance level of 5% (P < 0.05), nonparametric tests were applied, as well as variables by median and interquartile range. Results: There was an association between the commercialization of pesticides, municipal human development index, rural population and Gini Index (P < 0.001). Regarding the rates of prematurity and low weight at birth, no association was evidenced, despite a higher trend of medians of prematurity and low birth weight in the group with the highest commercialization (P > 0.05). Conclusion: Consumption of pesticides, decrease in access to education and healthcare services, as well as unsafe work settings, can contribute to the occurrence of premature and underweight newborns.

RESUMEN Introducción: Brasil expandió el mercado de agrotóxicos y Río Grande do Sul se destaca como mayor comercializador desde 2014. La población rural, factores socioeconómicos, ambientales y la exposición a agrotóxicos pueden ocasionar la prematuridad y bajo peso al nacer. Objetivo: Verificar la asociación entre la comercialización de agrotóxicos y la ocurrencia de prematuridad, bajo peso al nacer y factores socioeconómicos. Métodos: Estudio ecológico con 496 municipios del estado do Río Grande do Sul, Brasil, en los años 2017 y 2018. La población fueron los nacidos vivos por residencia materna, notificados en el Sistema de Informaciones Sobre Nacidos Vivos. La comercialización de agrotóxicos fue obtenida del Sistema Integrado de Gestión de Agrotóxicos. Se clasificaron los municipios en cuatro grupos de orden creciente, con base en cuartiles de comercialización. Se realizaron análisis de estadísticas en el programa IBM SPPS versión 21.0, considerando nivel de significancia de 5 % (p < 0,05), se aplicaron pruebas no paramétricas y las variables por mediana y rango intercuartilíco. Resultados: Hubo asociación entre comercialización de agrotóxicos, Índice de Desenvolvimiento Humano Municipal, población rural e Índice de Gini (p < 0,001). En cuanto a las tasas de prematuridad y de bajo peso al nacer, no fue evidenciada asociación, a pesar de haber tendencia mayor de medianas de prematuridad y bajo peso al nacer en el grupo con mayor comercialización (p > 0,05). Conclusión: El consumo de agrotóxicos, la disminución de acceso a educación, servicios de salud y ambientes inseguros de trabajo, pueden contribuir para surgimiento de recién-nacidos prematuros y con bajo peso.

ABSTRACT Systemic lupus erythematosus and ANCA-associated vasculitis overlap syndrome is rare and complex. Moreover, the mechanisms that explain the interaction between these two conditions are still unclear. The authors describe the case of a patient who had myeloperoxidase ANCA-associated vasculitis as the initial diagnosis, with biopsy-proven pauci-immune crescentic glomerulonephritis, attaining complete remission after immunosuppression. Five years later, Systemic Lupus Erythematosus was diagnosed and a second kidney biopsy showed a pattern of lupus nephritis class III. While on immunosuppression treatment, the patient developed a progressive elevation of liver enzymes and was later diagnosed with primary biliary cholangitis. It seems that in this case, the overlap of Systemic Lupus Erythematosus and ANCA-associated vasculitis may be part of a poliautoimmune syndrome suggested by association with a third autoimmune disease.

Abstract: Due to waterway transport efficiency, mainly for commercial trades, the use of sea/river routes has grown recently. So, the importance of producing high quality nautical charts stands out. A nautical chart is the hydrographic survey final product and its accuracy depends on data quality collected, primarily of the vertical quality (depth). In this sense, despite the theoretical and practical difficulty in obtaining homologous points in hydrographic surveys, even when performing check lines, bathymetric data must always be delivered with a statistically proven confidence level. Thus, this study has two main objectives: i) to propose a method, called Point to Point (P2P), for obtaining “homologous points” for hydrographic surveys carried out with multibeam systems, without resorting to mathematical and/or statistical interpolations, called Point to Point (P2P); ii) to quantify the magnitude of the difference between the statistical evaluation using check lines (CL) and by overlapping successive sounding lines (SL), applying the P2P method. The results showed that P2P is easy to application, provide low computation effort, is robust and consistent. Besides that, was possible to applied successive regular lines to get a validation of the hydrographic survey.

Purpose: The aim of this study is to characterize a Portuguese Intensive Care Unit experience in therapeutic plasma exchange in critically ill patients. Methods: We performed a retrospective analysis of the patients treated with therapeutic plasma exchange between 2000 and 2019. Data on patient characteristics, therapeutic plasma exchange prescription, adjuvant therapy used, adverse events and outcome under treatment were collected. Results: A total of 101 therapeutic plasma exchange procedures in 20 patients were studied. Mean number of therapeutic plasma exchange sessions per patient was 5.1±1.3. The most frequent indications to begin this treatment were myasthenia gravis (25.0%) and anti-neutrophil-cytoplasmic antibody-associated vasculitis (15.0%). There were 45.5% adverse events and the most frequent was hypotension (15.2%). 98% of the complications were mild-to-moderate. The outcome was favorable in 60.0% of patients. Conclusion: Therapeutic plasma exchange is an effective and safe therapy in many diseases that had high morbidity and mortality prior to the use of this technique.

Abstract: This work presents a new methodology for extracting 3D homologous points from a DEM/DSM for relative evaluation of positional accuracies, from terrain features such as ridgelines and hydrography. Firstly, it extracts 3D intersection points between the linear features and then it performs a selection of these homologous points. A discussion regarding the spatial resolution effect of the DEM/DSM on the proposed methodology is carried out. As case study, the planimetric and altimetric positional accuracies evaluation of SRTM (X-band) and Aster GDEM (version 2) DSMs was conducted using, as reference, a DSM obtained via photogrammetry. The SRTM and Aster GDEM (version 2) DSMs showed similar classifications, that is, Class A for the altimetry and Class B for the planimetry at the 1:100,000 scale, according to the Brazilian technical standard of positional accuracy.

Abstract Currently, during the operation in shallow waters, scanning systems, such as multibeam systems, are capable of collecting thousands of points in a short time, promoting a greater coverage of the submerged bottom, with consequent increase in the detection capacity of objects. Although there has been an improvement in the accuracy of the depths collected, traditional processing, that is, manual, is still required. However, mainly due to the increased mass of data collected, manual processing has become extremely time-consuming and subjective, especially in the detection and elimination of spikes. Several algorithms are used to perform this task, but most of them are based on statistical assumptions hardly met and/or verified, such as spatial independence and normality. In this sense, the goal of this study is to present the SODA (Spatial Outlier Detection Algorithm) methodology, a new method for detection of spikes designed to treat bathymetric data collected through swath bathymetry systems. From computational simulation, promising results were obtained. SODA, in some cases, was capable to identify even 90% of spikes inserted on simulation, showing that the methodology is efficient and substantial to the bathymetric data treatment.

Abstract: The amount of data produced in an echosounder has increased dramatically with scanning systems such as multibeam echo sounders and interferometric sonars, providing a considerable improvement in the submerged terrain representation, especially when it comes to detecting hazardous objects to the navigator. However, the available processing algorithms did not come along with this evolution; manual processing or, at least, constant intervention is usually necessary, which makes this task arduous with a high degree of subjectivity. In addition, statistical inconsistencies do not appear to be uncommon in most of the algorithms and filters available. Thus, SODA (Spatial Outliers Detection Algorithm) was recently presented, being a methodology directed, at first, to echosounder data treatment. Considering this, this article aims to evaluate the SODA efficiency for real data treatment from a multibeam sonar. SODA, in some cases, was capable to identify up to 74% of spikes with the δ-Method, which means that this technique detected 28 out of the 38 confirmed spikes in the data set, reassuming the methodology strength regarding the search for spikes in echosounder data.

Resumo: As demandas por dados geoespaciais referentes à malha viária são constantes, visto a gama de aplicações que necessitam desse tipo de dado. Destaca-se a importância destes dados nos ciclos de atualização de bases cartográficas, pois podem ser obtidos utilizando processos automatizados de extração de feições em imagens digitais, de forma mais precisa, rápida e menos onerosa, comparados aos métodos tradicionais. Nesse sentindo, este trabalho teve como objetivo a extração da malha viária em imagens RapidEye por meio do desenvolvimento de uma metodologia semiautomática híbrida, utilizando técnicas de classificação de imagem baseada em objetos e operadores morfológicos. A metodologia foi testada em três áreas distintas, com imagens adquiridas em épocas diferentes e o processo de extração avaliado por meio de métricas obtidas da correspondência linear. Foram alcançados em termos de corretude e completude os valores de 92,23% e 85,15% para a área 1, os valores de 79,16% e 81,06% na área 2, e os valores de 82,05% e 92,22% para a área 3, respectivamente. Os resultados demonstraram que o método proposto apresentou bom desempenho para a extração semiautomática de vias em imagens RapidEye, sendo uma alternativa para auxiliar na aquisição e atualização de base de dados da malha viária.

Abstract: The demand for geospatial data concerning road network is constant, due to the wide variety of application which needs this type of data. It stands out the importance of this data in cartography update cycles, that can be obtained using automated processes of feature extraction in digital images, which are more accurate, fast and less costly than the traditional methods. In this sense, this work aimed the road network extraction from RapidEye satellite imagery, by developing a hybrid methodology using techniques of object-based image classification and morphological operators. The methodology was tested in three different sites, with images acquired in distinct dates, and the extraction process was evaluated through metrics obtained from the linear matching procedure. By the proposed extraction process, were achieved in terms of correctness and completeness the values of 92.23% and 85.15% for test site 1, the values of 79.16% and 81.06% for test site 2, and the values of 82.05% and 92.22% for test site 3, respectively. The results shown that the proposed methodology presented a good performance for semi-automatic road network extraction from Rapideye images, representing an alternative to auxiliary road network database acquisition and updating.

Resumo Introdução: Devido à subjetividade do diagnóstico do zumbido e a suas diversas etiologias, o estabelecimento de um tratamento eficaz é complexo. Nesse contexto surge a transcranial direct current stimulation, uma opção não invasiva, acessível para grande parte dos pacientes, e que tem apresentado bons resultados no tratamento de outros sintomas como dor crônica. Objetivo: Avaliar a resposta terapêutica do zumbido ao transcranial direct current stimulation. Método: Foi realizada uma revisão sistemática da literatura, por meio dos seguintes descritores: zumbido, transcranial direct current stimulation e ensaio clínico randomizado. A pesquisa foi realizada nas bases de dados MEDLINE/PubMed, Lilacs, Scielo. Os critérios de inclusão foram: pacientes maiores de 18 anos sem outras comorbidades associadas, que tiveram diagnóstico estabelecido por um especialista ou por meio da aplicação de escalas e critérios previamente validados aplicados por médico não especialista. Resultados: Foram encontrados 4.165 estudos, sendo selecionado após a aplicação dos critérios de inclusão um total de seis, obtendo-se uma amostra de 602 pacientes. A partir dos critérios definidos, houve uma resposta positiva ao transcranial direct current stimulation em 14.86% dos participantes. Conclusão: Baseada na presente revisão, não há ainda uma resposta terapêutica do zumbido ao transcranial direct current stimulation.

Abstract Introduction: Due to the subjectivity of the tinnitus diagnosis and its diverse etiologies, establishing an effective treatment is complex. In this context, transcranial direct current stimulation, a noninvasive option, is available for most patients and has shown good results in the treatment of other symptoms such as chronic pain. Objective: To evaluate the therapeutic response of tinnitus to transcranial direct current stimulation. Methods: A systematic review of the literature was performed using the following descriptors: tinnitus, transcranial direct current stimulation and randomized clinical trial. The research was carried out in the MEDLINE/PUBMED, Lilacs, and Scielo databases. The inclusion criteria were: patients over 18 years of age with no associated comorbidities, who had a diagnosis established by a specialist or through the application of previously validated scales and criteria applied by a non-specialist physician. Results: A total of 4165 studies were found, and a total of six were selected after the inclusion criteria were applied, obtaining a sample of 602 patients. Based on the defined criteria, there was a positive response to transcranial direct current stimulation in 14.86% of the participants. Conclusion: Based on literature studied, there is no therapeutic response of tinnitus to transcranial direct current stimulation.