Resumo Introdução: A doença pulmonar obstrutiva crónica (DPOC) é a terceira causa de mortalidade a nível global. O tratamento foca-se na melhoria da qualidade de vida, atraso da progressão da doença e redução das exacerbações. Neste contexto, o benefício da reabilitação respiratória tem vindo a ser verificado. Esta medida não farmacológica pode ser implementada na comunidade, no contexto dos cuidados de saúde primários. Objetivos: Esta revisão sistemática propôs-se a fazer um levantamento da evidência atual sobre o impacto da reabilitação pulmonar na qualidade de vida dos doentes com DPOC, num contexto de cuidados de saúde primários. Métodos: Foram pesquisados estudos randomizados controlados em três bases de dados. Foi incluída a reabilitação pulmonar realizada na comunidade e excluídas intervenções em contexto hospitalar. Foi considerado como resultado primário a qualidade de vida relacionada com a saúde comparando com a terapêutica padrão da DPOC. A extração e triagem de dados foi efetuada por três autores, de forma independente. Avaliou-se o viés pela Cochrane Risk of Bias Tool. Resultados: Quatro estudos corresponderam aos critérios de pesquisa. Três estudos reportaram benefício em pelo menos um dos resultados. A frequência e duração da reabilitação pareceram ter algum impacto nos resultados. A mortalidade foi mais alta nos grupos de controlo. Os estudos incluídos tinham limitações importantes, nomeadamente a incapacidade de realizar intervenções cegas. Conclusões: A reabilitação pulmonar em cuidados de saúde primários melhora a qualidade de vida e capacidade funcional na DPOC. A duração, frequência e modalidade ótimas da intervenção não estão definidas e poderão depender de características individuais. Embora o paradigma não se altere, espera-se que esta revisão fomente o interesse na intervenção.

Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and its management involves improving quality of life, delaying progression, and minimizing exacerbations. The benefit of pulmonary rehabilitation in COPD has been documented in the literature. This intervention can be applied to a primary healthcare setting, using community resources. Objectives: This systematic review sought to compile current evidence implying the impact of pulmonary rehabilitation in a primary healthcare setting on the quality of life of patients with COPD. Methods: Three databases were searched for randomized controlled trials. We included community-based pulmonary rehabilitation and excluded interventions in a hospital setting. The primary outcome was health-related quality of life; secondary outcomes were functional exercise capacity and mortality. Data extraction and triage were performed independently by three authors, and bias was evaluated using the Cochrane Risk of Bias Tool. Results: Four studies met the search criteria. Three studies reported benefits in at least one of the outcomes; a fourth reported no differences between groups. Rehabilitation frequency and duration seemed to have some impact on all outcomes. Mortality was higher in the control groups when available. The included studies had important limitations, namely the inability to blind interventions. Conclusions: Pulmonary rehabilitation in a primary health care setting benefits the quality of life and functional exercise capacity in COPD patients. Optimal treatment modality, frequency, and duration are yet to be defined and are perhaps reliant on individual patient attributes. Though unable to add to previous findings, we hope this review fosters interest in this potentially life-changing intervention in a primary healthcare context.

ABSTRACT BACKGROUND: Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use. OBJECTIVES: Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption. DESIGN AND SETTING: A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020. METHODS: Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. RESULTS: Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns. CONCLUSION: The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

Abstract Strong acids used in industrial applications as cleaning, descaling, among others, can severely damage metallic structures, requiring corrosion inhibitors to diminish or avoid these issues. Since many conventional compounds used for this purpose may result in environmental and human health issues, eco-friendly compounds such as Schiff bases have been recently investigated. The synthesis of three novel Schiff bases (SBs) was confirmed by infrared spectroscopy (FTIR) and hydrogen nuclear magnetic resonance (1H-NMR). Weight loss measurements were carried out in 1 M HCl over 303K-333K. Furthermore, the combination of these compounds with a surfactant improved the efficiencies, reaching an efficiency of 93%. Optical and scanning electron microscopies confirmed the reduced roughness and pit depths of carbon steel samples. Density-functional theory calculations for neutral forms of SBs revealed that the geometrical and the energetical parameters are similar for the three studied SBs. The geometrical results exhibited more planar structures of protonated species, improving the chemical and physical interactions between aromatic rings and metallic atoms.

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes.

Abstract Tooth development depends on a series of reciprocal signaling interactions between the oral epithelium and ectomesenchyme. This study aimed to investigate the role of CK14, a protein involved in Wnt-1/β-catenin signaling, in odontogenesis and the development of odontomas. This cross-sectional, retrospective, immunohistochemical study analyzed 30 compound odontomas, 30 complex odontomas, and 17 tooth germs. Higher immunoexpression of CK14 was observed in odontogenic epithelial cells of tooth germs (p < 0.001) and odontogenic epithelial cells of odontomas (p < 0.001). There was higher immunoexpression of Wnt-1 and β-catenin proteins in epithelial cells of tooth germs (p = 0.002 and p < 0.001, respectively), as well as in the ectomesenchyme of odontomas (p = 0.003 and p < 0.001, respectively). β-Catenin was moderately and significantly correlated with CK14 in the membrane of reduced enamel epithelial cells in odontomas (p = 0.007). Higher immunoexpression of CK14 was observed in the odontogenic epithelium during the bud and cap stages and lower immunoexpression in the internal enamel epithelium during the bell stage. In odontomas, lower expression of Wnt-1/β-catenin and higher immunoexpression of CK14 were found in odontogenic epithelial cells, especially adjacent to the mineralized material resembling the tooth formed in these lesions.

Resumo O desenvolvimento dentário depende de uma série de interações de sinalização recíproca entre o epitélio oral e o ectomesênquima. O objetivo deste estudo foi investigar o papel da CK14 das vias WNT-1/β-catenina na odontogênese e no desenvolvimento de odontomas. Este estudo transversal, retrospectivo, imuno-histoquímico analisou 30 odontomas compostos, 30 odontomas complexos e 17 germes dentários. A CK14 apresentou maior imunoexpressão em células epiteliais odontogênicas de germes dentários (p<0,001) e em células epiteliais odontogênicas de odontomas (p<0,001). A Wnt-1 e a β-catenina apresentaram maior imunoexpressão de proteínas nas células epiteliais dos germes dentários (p = 0,002 e p<0,001, respectivamente), bem como no ectomesênquima dos odontomas (p = 0,003 e p < 0,001, respectivamente). A β-catenina correlacionou-se moderada e significativamente com a CK14 na membrana de células epiteliais reduzidas do esmalte em odontomas (p = 0,007). Maior imunoexpressão da CK14 foi observada no epitélio odontogênico nos estágios de botão e capuz com menor imunoexpressão no epitélio interno do órgão do esmalte no estágio de sino. Nos odontomas, foi observado menor expressão de Wnt-1/β-catenina e maior imunoexpressão da CK14 presente nas células epiteliais odontogênicas, especialmente, vizinhas ao material mineralizado semelhante ao dente formado nessas lesões.

Abstract The hybrids are responsive to phosphorus application, have high use efficiency and can produce high mean yields in environments with low and high phosphorus. The mean PE of these hybrids is high, therefore they are recommended for cultivation in the North and Northwest regions of Rio de Janeiro State, Brazil. application State Brazil

SUMMARY: Introduction and objective: Frontal rhinosinusitis usually resolves with medical therapy. However, when the sinonasal infection persists, the anatomy of this region can lead to severe and life-threatening complications due to infection spreading beyond the sinus namely to the intracranial compartment. This review aims to highlight the more recent developments on the management of frontal rhinosinusitis and its complications, from a practical perspective that is essential to accurately diagnose these complications. Method: A review of the literature was performed by the authors. PubMed database was searched with relevant terms, which included the following: «frontal sinusitis complications», «pediatric frontal sinusitis» and «frontal sinusitis imaging». Relevant scientific treaties were also used as ancillary to this review. A comprehensive review of the English and Portuguese literature was carried out, including papers published between 2000 and 2021. Our inclusion criteria included clinical trials, expert opinion papers, literature reviews, systematic reviews and clinical guidelines. Duplicate articles, case reports or very small sample studies were excluded prior general screening. Results: Twenty-one studies met the inclusion criteria. Most of them concerned the adult population, with four papers directly addressing the pediatric population. Two clinical guidelines, one large retrospective cohort study and two systematic reviews were selected. Twelve clinical review articles and small retrospective studies were selected, comprising most of the papers addressed. Four clinical textbooks were also consulted for this review. Discussion: Morbidity and mortality from complicated sinusitis are mainly related to intracranial involvement. Although the mortality rate was higher before the era of antibiotic therapy, intracranial abscess still carries high mortality. Frontal sinusitis can be complicated by periorbital cellulitis, abscess formation, both periorbital and subperiosteal in the frontal bone anterior wall (Pott puffy tumor), and, rarely, cavernous sinus thrombosis. Intracranial complications include subdural and epidural empyema, meningitis, and intracerebral abscess. These complications will be reviewed in this paper. Conclusions: Complications of frontal sinusitis can be severe and life threatening, mainly due to the proximity of the frontal sinus with the intracranial compartment. Due to its high availability, CT frequently is the first imaging technique performed in the emergency setting. The excellent bone and high-spatial resolution make CT the preferred imaging examination in presurgical planning. However, contrast-enhanced MRI is far superior in soft-tissue evaluation and should be considered whenever an orbitary or intracranial complication is suspected. These complications are mostly treated with intravenous antibiotics and surgical drainage procedures. Early aggressive intervention has decreased morbidity and shortened hospital stay, although significant morbidity and mortality from complications can still occur.

RESUMEN: Introducción y objetivo: La rinosinusitis frontal suele resolverse con tratamiento médico. Sin embargo, cuando la infección de los senos paranasales persiste, la anatomía de esta región puede dar lugar a complicaciones graves y potencialmente mortales debido a que la infección se propaga más allá del seno, es decir, al compartimento intracraneal. Esta revisión tiene como objetivo resaltar las publicaciones más recientes sobre el manejo de la rinosinusitis frontal y sus complicaciones, desde una perspectiva práctica que es esencial para diagnosticar con precisión estas complicaciones. Método: Se realizó una revisión de la literatura por parte de los autores. Se buscó en la base de datos PubMed con términos relevantes, que incluían los siguientes: «complicaciones de la sinusitis frontal», «sinusitis frontal pediátrica» y «imagen de la sinusitis frontal». Los tratados científicos pertinentes también se utilizaron como complemento de esta revisión. Se llevó a cabo una revisión de la literatura en inglés y portugués, incluidos artículos publicados entre 2000 y 2021. Nuestros criterios de inclusión incluyeron ensayos clínicos, artículos de opinión de expertos, revisiones de literatura, revisiones sistemáticas y guías clínicas. Los artículos duplicados, los informes de casos o los estudios de muestras muy pequeñas se excluyeron antes de la selección general. Resultados: Veintiún estudios cumplieron los criterios de inclusión. La mayoría de ellos se referían a la población adulta, con cuatro artículos dirigidos directamente a la población pediátrica. Se seleccionaron dos guías clínicas, un gran estudio de cohorte retrospectivo y dos revisiones sistemáticas. Se seleccionaron doce artículos de revisión clínica y pequeños estudios retrospectivos, que comprenden la mayoría de los trabajos abordados. También se consultaron cuatro libros de texto clínicos para esta revisión. Discusión: La morbimortalidad por sinusitis complicada se relaciona principalmente con la afectación intracraneal. Aunque la tasa de mortalidad era más alta antes de la era de la terapia con antibióticos, el absceso intracraneal todavía conlleva una alta mortalidad. La sinusitis frontal puede complicarse con celulitis periorbitaria, formación de abscesos, tanto periorbitarios como subperiósticos en la pared anterior del hueso frontal (tumor de Pott) y, en raras ocasiones, trombosis del seno cavernoso. Las complicaciones intracraneales incluyen empiema subdural y epidural, meningitis y absceso intracerebral. Estas complicaciones son revisadas en este artículo. Conclusiones: Las complicaciones de la sinusitis frontal pueden ser graves y potencialmente mortales, principalmente por la proximidad del seno frontal con el compartimento intracraneal. Debido a su alta disponibilidad, la TC es frecuentemente la primera técnica de imagen que se realiza en el ámbito de urgencias. La excelente resolución ósea y la alta resolución espacial hacen de la TC el examen de imagen preferido en la planificación prequirúrgica. Sin embargo, la resonancia magnética con contraste es muy superior en la evaluación de tejidos blandos y debe considerarse siempre que se sospeche una complicación orbitaria o intracraneal. Estas complicaciones se tratan principalmente con antibióticos intravenosos y procedimientos de drenaje quirúrgico. La intervención agresiva temprana ha disminuido la morbilidad y ha acortado la estancia hospitalaria, aunque aún puede ocurrir una morbilidad y mortalidad significativas por complicaciones.

SUMMARY: Introduction: Acute frontal rhinosinusitis is defined as an acute infection of the frontal sinus. Spreading of this infection to surrounding structures is uncommon but, when present, carries significant morbidity and mortality. Description: In this case report, we present two unusual cases of frontal rhinosinusitis complications. Firstly, we describe a case of acute rhinosinusitis with orbital complications caused by a frontoethmoidal osteoma. In the second case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis complicated with an abscess. After appropriate treatment, both patients were free of infection at follow-up, without complications. Discussion: In the first case we presented, a frontoethmoidal osteoma gave rise to rhinosinusitis with orbital complications. These benign tumors rarely cause symptoms, but when large enough, sinus outflow can be blocked, making the osteoma clinically relevant. Osteomas can induce frontal rhinosinusitis, giving rise, among other conditions, to the development of orbital complications like periorbital cellulitis or the formation of a periorbital abscess. Diagnosis of osteoma is usually straightforward on computed tomography and surgical treatment is only indicated for large tumors, rapid growth, intracranial or orbitary extension. In the second clinical case, the infection extended to the underlying bone and through the skull causing osteomyelitis and focal meningitis with abscess formation. In this patient, a Draf Type IIa procedure was performed for the frontal abscess drainage, followed by proper antibiotic and anti-inflammatory therapy. Conclusions: Complications of frontal rhinosinusitis are uncommon but require immediate attention and aggressive treatment to avoid morbidity and mortality. In these cases, our patients were properly treated with good outcomes, avoiding potentially more dangerous complications.

RESUMEN: Introducción: La rinosinusitis frontal aguda se define como una infección aguda del seno frontal. La propagación de esta infección a las estructuras circundantes es poco común, pero, cuando está presente, conlleva una morbilidad y mortalidad significativas. Descripción: En este reporte presentamos dos casos inusuales de complicaciones de rinosinusitis frontal. En primer lugar, describimos un caso de rinosinusitis aguda con complicaciones orbitarias por osteoma frontoetmoidal. En el segundo caso, la infección se extendió al hueso subyacente y a través del cráneo causando osteomielitis y meningitis focal complicada con un absceso. Tras el tratamiento adecuado, ambos pacientes quedaron libres de infección en el seguimiento, sin complicaciones. Discusión: En el primer caso que presentamos, un osteoma frontoetmoidal dio lugar a una rinosinusitis con complicaciones orbitarias. Estos tumores benignos rara vez causan síntomas, pero cuando son lo suficientemente grandes, el flujo de salida del seno puede bloquearse, lo que hace que el osteoma sea clínicamente relevante. De hecho, los osteomas pueden inducir una rinosinusitis frontal, dando lugar, entre otras condiciones, al desarrollo de complicaciones orbitarias como celulitis periorbitaria o formación de un absceso periorbitario. El diagnóstico de osteoma suele ser sencillo mediante tomografía computarizada y el tratamiento quirúrgico solo está indicado para tumores grandes, de crecimiento rápido, con extensión intracraneal u orbitaria. En el segundo caso clínico, la infección se extendió al hueso subyacente y a través del cráneo provocando osteomielitis y meningitis focal con formación de abscesos. En este paciente, se realizó un procedimiento Draf Tipo IIa para el drenaje del absceso frontal, seguido de una adecuada terapia antibiótica y antiinflamatoria. Conclusiones: Las complicaciones de la rinosinusitis frontal son poco frecuentes, pero requieren atención inmediata y un tratamiento agresivo para evitar la morbilidad y la mortalidad. En estos casos, nuestros pacientes fueron tratados adecuadamente con buenos resultados, evitando complicaciones potencialmente más peligrosas.

RESUMO Pacientes oncológicos desenvolvem problemas cardíacos frequentes devido à toxidade dos quimioterápicos, com consequente impacto na capacidade funcional (CF) e na qualidade de vida (QV). O treinamento muscular inspiratório (TMI) pode ser um recurso terapêutico viável, já que estudos de causa-efeito demonstraram melhora da CF e da QV em outras populações. Contudo, seu efeito ainda não foi avaliado em pacientes cardio-oncológicos. Assim, o objetivo deste estudo foi descrever o efeito de um programa de TMI sobre a CF e a QV de uma paciente com cardiotoxicidade: LDM, com 41 anos, mulher e sedentária, que desenvolveu insuficiência cardíaca após tratamento quimioterápico. A QV foi avaliada pelo teste de Minnesota. Foram avaliados também a força muscular inspiratória dinâmica (S-Index) e o limiar glicêmico (LG) dos músculos inspiratórios. O LG foi determinado pela glicemia capilar por meio do glicosímetro digital (Accu-Chek - Roche) no menor valor da glicemia da carga correspondente ao teste muscular inspiratório incremental (TMII). A progressão da carga foi realizada a cada duas semanas. Ao final de dois meses, todos os testes foram reaplicados. No teste de Minnesota, os valores relacionados à CF, antes e após o TMI, foram de 36 vs. 8 (melhora de 78%); aos aspectos clínicos e psicológicos foram de 32 vs. 7 (melhora de 78%), a S-Index foram de 41 vs. 51cmH2O (melhora de 24%). O TMI melhorou a CF e a QV de uma paciente cardio-oncológica, configurando-se como um recurso terapêutico viável para essa população.

ABSTRACT Cancer patients develop frequent cardiac problems due to chemotherapy toxicity, which impacts functional capacity (FC) and quality of life (QoL). Inspiratory Muscle Training (IMT) may be a viable therapeutic resource since cause-effect studies have shown improvement in FC and QoL in other populations. However, its effect was not evaluated in cardio-oncology patients. The study aimed to describe the effect of an IMT program on the FC and QoL of a patient with cardiotoxicity, LDM, aged 41 years, female and, sedentary that developed heart failure after chemotherapy. The QoL was evaluated by the Minnesota test. Dynamic Inspiratory Muscle Strength (S-Index) and Glycemic Threshold (GT) of the inspiratory muscles were also evaluated. The GT was determined by capillary glycemia with a digital glucometer (Accu-Chek - Roche), at the lowest value of glycemia of the load corresponding to the Incremental Inspiratory Muscle Test (IIMT). The load progression was performed every two weeks. After two months, all tests were reapplied. In the Minnesota test, the values related to FC, pre and post IMT, were 36 v. 8 (78% improvement); the clinical and psychological aspects 32 v. 7 (78% improvement); S-Index was 41 v. 51cmH2O (24% improvement). IMT improved the FC and QoL of a cardio-oncology patient, configuring itself as a possible and viable therapeutic resource for this population.

RESUMEN Los pacientes con cáncer desarrollan problemas cardíacos frecuentes debido a la cardiotoxicidad de la quimioterapia, con el consiguiente impacto en la capacidad funcional (FC) y la calidad de vida (CV). El entrenamiento muscular inspiratorio (IMT) puede ser un recurso terapéutico viable, ya que los estudios de causa-efecto han demostrado una mejora en la FC y la CV en otras poblaciones. Sin embargo, su efecto aún no se ha evaluado en pacientes cardio-oncológicos. Por lo tanto, el objetivo de este estudio fue describir el efecto de un programa de IMT sobre la FC y la CV de un paciente con cardiotoxicidad: LDM, 41 años, mujer y sedentaria, que desarrolló insuficiencia cardíaca después del tratamiento de quimioterapia. La CV se evaluó mediante la prueba de Minnesota. También se evaluaron la fuerza muscular inspiratoria dinámica (índice S) y el umbral glucémico (LG) de los músculos inspiratorios. El LG se determinó por glucemia capilar mediante el glucómetro digital (Accu-Chek - Roche) al valor más bajo de la carga glucélica correspondiente a la prueba muscular inspiratoria incremental (IMI). La progresión de la carga se realizó cada dos semanas. Después de dos meses, todas las pruebas se volvieron a aplicar. En la prueba de Minnesota, los valores relacionados con la FC, antes y después de THE, fueron 36 vs. 8 (78% de mejora); los aspectos clínicos y psicológicos fueron 32 vs. 7 (mejora del 78%), el índice S fue de 41 vs. 51cmH2O (mejora del 24%). El IMT mejoró la FC y la CV de un paciente cardio-oncológico, constituyendo un recurso terapéutico viable para esta población.

RESUMO O presente artigo parte de debate ocorrido na segunda metade do século XIX na historiografia brasileira a respeito de qual deveria ser o ponto de partida de uma narrativa da história do Brasil: a Europa (por meio do contexto da expansão europeia e das Grandes Navegações) ou a América (descrevendo-se, primeiramente, o território e as populações indígenas). Este debate envolvia a questão de definir os “antecedentes” da história do Brasil, assumindo para a história uma lógica narrativa dotada de implicações. O processo histórico assim escolhido definia um “centro” para a história do Brasil, que poderia ser “interno” (território e populações indígenas) ou “externo” (Europa, ou processo de expansão do capitalismo comercial). Aqui, buscamos analisar as implicações dessa tríade teórica antecedentes-processo-centro na historiografia de formação brasileira à luz, por fim, de reavaliações possíveis do lugar e papel das populações indígenas e da natureza na história.

ABSTRACT This paper follows a late nineteenth-century debate in Brazilian historiography about the proper starting point for narratives of Brazilian history: Europe (European expansion and the great voyages of early modern period) or America (with descriptions of the territory and native peoples). This debate centered on defining the “antecedents” of Brazilian history, which would fit a narrative logic with particular implications. The chosen historical process would, in its turn, would help identify a “center” for Brazilian history, which could either be “internal” (territory and its earlier occupants) or “external” (Europe and the expansion of commercial capitalism). This article analyzes the theoretical trio of “antecedents-process-center” during a formative moment in Brazil’s historiography with attention to possible re-evaluations of the place and role of indigenous peoples and nature in history.

RESUMEN El presente artículo parte del debate ocurrido en la segunda mitad del siglo XIX en la historiografía brasileña sobre cuál debería ser el punto de partida de una narrativa de la historia del Brasil: Europa (por medio del contexto de expansión europea y de las Grandes Navegaciones) o América (describiéndose, principalmente, el territorio y las poblaciones indígenas). Este debate envolvía la cuestión de definir los “antecedentes” de la historia de Brasil, asumiendo para la historia una lógica narrativa dotada de implicaciones. El proceso histórico así escogido definía un “centro” para la historia de Brasil, que podría ser “interno” (territorio y poblaciones indígenas) o “externo” (Europa, o proceso de expansión del capitalismo comercial). Aquí buscamos analizar las implicaciones de esa trilogía teórica antecedentes-proceso-centro en la historiografía brasileña a la luz, por fin, de las revaluaciones posibles del lugar y el papel de las poblaciones indígenas y de la naturaleza en la historia.

Resumo Introdução: A perturbação obsessivo-compulsiva é uma patologia heterogénea em que podem surgir períodos de perceção alterada ou ideias delirantes. De igual forma, indivíduos com perturbações psicóticas podem apresentar sintomas obsessivo-compulsivos. Caso clínico: Um adolescente do sexo masculino recorreu ao Serviço de Urgência (SE) por sintomatologia obsessiva com três meses de evolução. Regressou ao SE após três semanas por agravamento do quadro e relato de ideias delirantes, tendo sido internado para clarificação do diagnóstico. Nunca foram objetivados sintomas positivos durante o internamento. Em consulta de seguimento, o jovem relatou um episódio de aparente perceção delirante que associou ao início da sintomatologia, levantando novamente a dúvida quanto à presença de um episódio psicótico. Discussão/Conclusões: A distinção entre perturbação obsessivo-compulsiva e psicose nem sempre é clara, e a comorbilidade entre ambas é significativa. É necessária uma avaliação meticulosa do doente para um diagnóstico precoce e intervenção apropriada.

Abstract Introduction: Obsessive-compulsive disorder is an heterogeneous condition in which periods of altered perception or delusions may arise. Similarly, individuals with psychotic disorders may have obsessive-compulsive symptoms. Case report: A male adolescent presented to the Emergency Department (ED) with obsessive symptomatology with three months of evolution. Three weeks later, he returned to the ED showing symptom worsening and reporting delusions, being admitted to the inpatient unit to clarify the diagnosis. No positive symptoms were reported during hospitalization. During follow-up, the patient reported an episode of apparent delusional perception that he associated with the beginning of symptoms, again raising the question of whether a psychotic episode was present. Discussion/Conclusions: The distinction between obsessive-compulsive disorder and psychosis is not always clear, with obsessive-compulsive disorder being a significant comorbidity in patients with a first psychotic episode. Close patient assessment is required for early diagnosis and appropriate intervention.

RESUMO O transplante de pulmão é a modalidade mais eficaz de tratamento de pacientes com doenças pulmonares terminais. Infelizmente, muitas pessoas não podem se beneficiar dessa terapia, porque não há doadores suficientes. Neste artigo de revisão e atualização, discutimos a doação após morte circulatória (DMC), uma estratégia indubitavelmente essencial para aumentar o total de doadores. No entanto, há considerações éticas e legislativas no processo de DMC que diferem daquelas da doação após morte encefálica (DME). Os aspectos fundamentais da DMC são o conceito de fim da vida, a cessação de tratamentos fúteis e a retirada de terapias de suporte vital, entre outros. Além disso, esta revisão apresenta uma justificativa para o uso de pulmões provenientes de doadores em morte circulatória e fornece algumas definições importantes, destacando as principais diferenças entre DMC e DME, incluindo aspectos fisiológicos pertinentes a cada categoria. A capacidade única dos pulmões de manter a viabilidade celular sem circulação, contanto que os alvéolos recebam oxigênio - um aspecto essencial da DMC - também é discutida. Também apresentamos aqui uma revisão atualizada da experiência clínica com DMC para transplante de pulmão em centros internacionais, os avanços recentes da DMC e alguns dilemas éticos que merecem atenção.

ABSTRACT Lung transplantation is the most effective modality for the treatment of patients with end-stage lung diseases. Unfortunately, many people cannot benefit from this therapy due to insufficient donor availability. In this review and update article, we discuss donation after circulatory death (DCD), which is undoubtedly essential among the strategies developed to increase the donor pool. However, there are ethical and legislative considerations in the DCD process that are different from those of donation after brain death (DBD). Among others, the critical aspects of DCD are the concept of the end of life, cessation of futile treatments, and withdrawal of life-sustaining therapy. In addition, this review describes a rationale for using lungs from DCD donors and provides some important definitions, highlighting the key differences between DCD and DBD, including physiological aspects pertinent to each category. The unique ability of lungs to maintain cell viability without circulation, assuming that oxygen is supplied to the alveoli-an essential aspect of DCD-is also discussed. Furthermore, an updated review of the clinical experience with DCD for lung transplantation across international centers, recent advances in DCD, and some ethical dilemmas that deserve attention are also reported.

ABSTRACT This study represents the first overview of the epidemiological dynamics of SARS-CoV-2 in Espirito Santo (ES) State, Brazil, filling in knowledge on this topic, observing data collected in the State, and aiming at understanding the epidemiological dynamics of the virus in ES, as well as its possible routes of transmission and dissemination. . Our results highlight that, so far, nine lineages have been identified with ES State. The B.1.1.33 lineage was the first with the highest occurrence in ES, remaining predominant until September 2020. The second predominant lineage was Gamma, representing 45% of the samples. The Delta lineage appears on the State scene, proving to be the next dominant lineage. This research allowed us to understand how the lineages advanced and were distributed in the State, which is important for future work, also making it possible to guide sanitary control measures. Data analyses were made through the GISAID database for ES State showed that the pandemic in the State has been evolving dynamically with lineage replacements over the months since the first notification.

Resumo A utilização de matérias-primas funcionais vem crescendo nos últimos anos e tem como objetivo fornecer, além de nutrientes essenciais, compostos associados a efeitos benéficos à saúde. Dentre os ingredientes com alegações funcionais, a inulina tem sido considerada uma importante fibra alimentar. Além disso, o conhecimento e a utilização de Plantas Alimentícias Não Convencionais (PANCs) vêm recebendo destaque, valorizando a biodiversidade e a alimentação mais sustentável. Assim, o presente estudo teve como objetivo desenvolver sorvetes utilizando matérias-primas não convencionais, a planta ora-pro-nóbis e a inulina, a fim de produzir alimento funcional e inovador. Foram elaboradas duas formulações de sorvetes, que se diferenciaram apenas pela quantidade de inulina. Na Formulação 1 (F1), o sorvete de ora-pro-nóbis recebeu adição de 3% de inulina e, na Formulação 2 (F2), o sorvete de ora-pro-nóbis recebeu adição de 6% de inulina. Foram realizadas análises físico-químicas e de aminoácidos das folhas de ora-pro-nóbis. Posteriormente, foram conduzidas as análises microbiológicas, físico-químicas e sensoriais das formulações de sorvete. Os resultados foram comparados estatisticamente pelo método t-Student com nível de significância de (p˂0,05). O teor proteico das formulações foi elevado, 10,54 ± 2,20% para F1 e 12,13 ± 0,57% para F2. Não houve diferença significativa nos conteúdos de lipídios, cinzas, proteínas e fibra bruta entre as formulações. As amostras estão de acordo com os padrões microbiológicos estabelecidos pela legislação. Com relação à análise de incorporação de ar, a F2 apresentou valor superior (41,26 ± 0,13%) comparada à F1 (36,36 ± 0,17%). Além disso, a F2 apresentou menor taxa de derretimento (1,20 g/minuto) que a F1 (3,38 g/minuto). Os sorvetes apresentaram boa aceitação sensorial e podem servir como opção de consumo para as pessoas que procuram um produto saudável e com elevado teor de proteínas.

Abstract The use of functional raw materials has been growing in recent years, and it aims to provide, in addition to essential nutrients, compounds associated with beneficial health effects. Among the ingredients with functional claims, inulin has been considered an important dietary fiber. In addition, the knowledge and use of unconventional food plants (in Portuguese Plantas Alimentícias Não Convencionais (PANCs)) have been receiving prominence, thus valuing biodiversity and more sustainable food. This study aimed to develop ice cream using unconventional raw materials, i.e., the plant ora-pro-nóbis and inulin, in order to produce functional and innovative food. Two ice cream formulations were elaborated, which differed from each other only by the amount of inulin. In Formulation 1 (F1), ora-pro-nóbis ice cream received the addition of 3% inulin; and in Formulation 2 (F2), ora-pro-nóbis ice cream received the addition of 6% inulin. In addition, physicochemical and amino acid analyses of ora-pro-nóbis leaves were performed. Subsequently, microbiological, physicochemical and sensory analyses of ice cream formulations were conducted. The results were statistically compared by the t-Student method with significance level of (p < 0.05). The protein content of the formulations was high, 10.54 ± 2.20% for F1 and 12.13 ± 0.57% for F2. There was no significant difference in the contents of lipids, ash, proteins, and crude fiber between the formulations. The samples are in accordance with the microbiological standards established by legislation. Regarding the analysis of air incorporation, F2 had a higher value (41.26 ± 0.13%) compared to F1 (36.36 ± 0.17%). In addition, F2 had a lower melting rate (1.20 g/minute) than F1 (3.38 g/minute). It was concluded that ice cream had good sensory acceptance. The ice creams presented good sensory acceptance and they can be a consumer choice for people looking for a healthy product with high protein content.

Resumo A Mata Atlântica é um dos centros de diversidade de Melastomataceae no mundo, e estudos têm mostrado uma grande riqueza de espécies no Espírito Santo, estado que já foi inteiramente coberto por esse domínio fitogeográfico. Este trabalho apresenta um levantamento florístico das espécies de Melastomataceae no Parque Natural Municipal de São Lourenço, localizdo no município de Santa Teresa, assim como uma chave de identificação para as espécies, descrições detalhadas, comentários sobre distribuição, habitat e fenologia, além de fotografias e ilustrações. Foram realizadas expedições durante os anos de 2019 e 2020 para a coleta de espécimes botânicos, além da consulta de amostras previamente depositadas nos herbários FLOR, HUEFS, MBM, MBML, NY, RB, UPCB, US e VIES. A família é representada por 10 gêneros e 56 espécies na região, com Miconia possuindo 42 espécies, Pleroma seis e os gêneros Aciotis, Acisanthera, Bertolonia, Chaetogastra, Henriettea, Meriania, Microlicia e Mouriri representados por apenas uma espécie cada.

Abstract The Atlantic Forest is one of the diversity centers of Melastomataceae in the world, and studies have been showing the great richness of its species in Espírito Santo, a state that once was entirely covered by this phytogeographic domain. We present here a floristic survey of the species of Melastomataceae in a protected area in this state, the Municipal Natural Park of São Lourenço, located at the municipality of Santa Teresa. We also present an identification key for the species, detailed descriptions, comments on distribution, habitat and phenology, photographs and illustrations. A thorough sampling was based on several expeditions during 2019 and 2020; in addition, we analyzed all specimens collected in the area and deposited in the herbaria FLOR, HUEFS, MBM, MBML, NY, RB, UPCB, US and VIES. The family has 10 genera and 56 species in the area, with Miconia having 42 species, Pleroma six and the genera Aciotis, Acisanthera, Bertolonia, Chaetogastra, Henriettea, Meriania, Microlicia and Mouriri represented by only one species each.