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au:Barbosa, Alessandra Ferreira

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Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count virus
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Morais, Ana Cléa Cutrim Diniz de

; Ferreira, Alice de Sá

; Barbosa, Carla Déa Trindade Lima, Maria Fernanda Bezerra Fook, Karina Donato Carvalho, Mônika Machado de Muniz, Alessandra Costa de Sales Araújo, Deborah Rocha de Monteiro, Pablo de Matos Araújo, Maria José Abigail Mendes Monteiro, Sally Cristina Moutinho Lopes, Fernanda Ferreira

Revista do Instituto de Medicina Tropical de São Paulo

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2024, Volume 66 elocation e36

Abstract: En | Text: En | PDF: En

ABSTRACT Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence. HPV. . (HPV) Thus assessments screening policies HIVseropositive seropositive count characteristics CD4+ CD4 CD (CD4 CD8 load, , load) (cervical 8 HIVpositive positive therapy HPVDNA, HPVDNA DNA, DNA sites low highrisk groups 659 65 9 65.9% 638 63 63.8 canal 42 4 2 4.2 75 ≥7 copiesmL copies mL HPVDNA. DNA. lowrisk (HPV (CD 6 65.9 63. 4. 7 ≥ 65.

https://doi.org/10.1590/s1678-9946202466036

Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations
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Dutra, Lívia Almeida

; Silva, Pedro Victor de Castro

; Ferreira, João Henrique Fregadolli

; Marques, Alexandre Coelho

; Toso, Fabio Fieni

; Vasconcelos, Claudia Cristina Ferreira

; Brum, Doralina Guimarães

; Pereira, Samira Luisa dos Apóstolos

; Adoni, Tarso

; Rocha, Leticia Januzi de Almeida

; Sampaio, Leticia Pereira de Brito

; Sousa, Nise Alessandra de Carvalho

; Paolilo, Renata Barbosa

; Pizzol, Angélica Dal

; Costa, Bruna Klein da

; Disserol, Caio César Diniz

; Pupe, Camila

; Valle, Daniel Almeida do

; Diniz, Denise Sisterolli

; Abrantes, Fabiano Ferreira de

; Schmidt, Felipe da Rocha

; Cendes, Fernando

; Oliveira, Francisco Tomaz Meneses de

; Martins, Gabriela Joca

; Silva, Guilherme Diogo

; Lin, Katia

; Pinto, Lécio Figueira

; Santos, Mara Lúcia Schimtz Ferreira

; Gonçalves, Marcus Vinícius Magno

; Krueger, Mariana Braatz

; Haziot, Michel Elyas Jung

; Barsottini, Orlando Graziani Povoas

; Nascimento, Osvaldo José Moreira do

; Nóbrega, Paulo Ribeiro

; Proveti, Priscilla Mara

; Castilhos, Raphael Machado do

; Daccach, Vanessa

; Glehn, Felipe von

Arquivos de Neuro-Psiquiatria

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2024, Volume 82 N. 7 elocation s00441788586

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. Objective With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. Methods A total of 25 panelists, including adult and child neurologists, participated in the study. Results The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusion The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system. (AIE antigens symptoms complaints disorders young prognosis Academia ABN Sociedade Infantil SBNI, SBNI , SBNI) method 2 neurologists CSF (CSF tissuebased tissue based TBA (TBA cellbased cell CBA (CBA techniques antimyelin anti myelin antiMOG. antiMOG MOG . (anti-MOG) firstline line IVIG (IVIG plasmapheresis secondline second andor cyclophosphamide thirdline third tocilizumab symptomatic stage antiNmethylDaspartate N methyl D aspartate antiNMDAR NMDAR (anti-NMDAR used scales MiniMental Mini Mental MMSE, MMSE (MMSE) MoCA, MoCA (MoCA) mRS, mRS (mRS) CASE. CASE (CASE) system (anti-MOG (MMSE (MoCA (mRS (CASE

Resumo Antecedentes Encefalites autoimunes (EAIs) são um grupo de doenças inflamatórias caracterizadas pela presença de anticorpos contra antígenos neuronais e gliais, que ocasionam sintomas psiquiátricos subagudos, queixas de memória e distúrbios anormais do movimento. A maioria dos pacientes é jovem, e o atraso no tratamento está associado a pior prognóstico. Objetivo Com o apoio da Academia Brasileira de Neurologia (ABN) e da Sociedade Brasileira de Neurologia Infantil (SBNI), desenvolvemos um consenso sobre o diagnóstico e o tratamento da EAIs no Brasil utilizando a metodologia Delphi. Métodos Um total de 25 especialistas, incluindo neurologistas e neurologistas infantis, foram convidados a participar. Resultados Os especialistas concordaram que os pacientes com critérios de possíveis EAIs devem ser submetidos ao rastreio de anticorpos antineuronais no soro e no líquido cefalorraquidiano (LCR) por meio das técnicas de ensaio baseado em tecidos (tissue-based assay, TBA, em inglês) e ensaio baseado em células (cell-based assay, CBA, em inglês). As crianças também devem ser submetidas ao rastreio de de anticorpo contra a glicoproteína da mielina de oligodendrócitos (anti-myelin oligodendrocyte glycoprotein, anti-MOG, em inglês). O tratamento deve ser iniciado dentro das primeiras 4 semanas dos sintomas, sendo as opções de primeira linha metilprednisolona combinada com imunoglobulina intravenosa (IGIV) ou plasmaférese. O tratamento de segunda linha inclui rituximabe e ciclofosfamida. Bortezomib e tocilizumab são opções de tratamento de terceira linha. A maioria das crises epilépticas nas EAIs são sintomáticas, e os fármacos anticrise podem ser desmamadas após a fase aguda. Em relação à encefalite antirreceptor de N-metil-D-aspartato (anti-N-methyl-D-aspartate receptor, anti-NMDAR, em inglês), os especialistas concordaram que agentes imunossupressores orais não devem ser usados. Os pacientes devem ser avaliados na fase aguda e pós-aguda mediante escalas funcionais e cognitivas, como Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Modified Rankin Scale (mRS), e Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusão Esta pesquisa oferece evidências tangíveis do manejo efetivo de pacientes com EAIs no sistema de saúde Brasileiro. (EAIs gliais subagudos movimento jovem prognóstico ABN (ABN SBNI, SBNI , (SBNI) Delphi 2 infantis participar LCR (LCR tissuebased tissue based assay TBA inglês cellbased cell CBA inglês. . antimyelin anti myelin glycoprotein antiMOG, antiMOG MOG, MOG anti-MOG IGIV (IGIV plasmaférese ciclofosfamida sintomáticas NmetilDaspartato N metil D aspartato antiNmethylDaspartate methyl aspartate receptor antiNMDAR, antiNMDAR NMDAR, NMDAR anti-NMDAR inglês, usados pósaguda pós cognitivas MiniMental Mini Mental MMSE, MMSE (MMSE) MoCA, MoCA (MoCA) mRS, mRS (mRS) CASE. CASE (CASE) Brasileiro (SBNI (MMSE (MoCA (mRS (CASE

https://doi.org/10.1055/s-0044-1788586

Padrões do suicídio na região mais populosa de Alagoas, Brasil, 2016-2018 Alagoas Brasil 20162018 2016 2018 2016-201 2016201 201 2016-20 201620 20 2016-2 20162 2 2016-
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Gonzaga, Géssyca Luyse Procópio

; Silva, Alessandra Vieira da

; Ferreira, Efigênia Ferreira e

; Ferreira, Raquel Conceição

; Brum, Evanisa Helena Maio de

; Barbosa, Kevan Guilherme Nóbrega

Jornal Brasileiro de Psiquiatria

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2024, Volume 73 N. 1 elocation e20220108

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To describe the patterns of suicide, relating them to sociodemographic, spatial-temporal and suicide-related aspects in the most populous region of the state of Alagoas (AL), Brazil. Methods: Observational and retrospective study based on suicide data from the Instituto Médico Legal located in Maceió (AL), covering the years between 2016 and 2018. Through binary and multiple logistic regression, a statistical model was determined to identify factors associated with suicide between men and women. Results: From the overall number of reported suicides (n = 172), 71.5% were male victims. The mean age for men was 39.3 years and 34.1 for women. The final logistic regression model identified that black/brown men are 12 times more likely (p < 0.001) to commit suicide than white men. In addition, men are less likely to commit suicide by exogenous intoxication (p < 0.001) or intentional fall (p = 0.01) than by hanging. Men in employment were more likely to commit suicide (p = 0.02). Conclusions: Despite the complexity of the phenomenon under study, it was possible to verify some patterns for the most populous region of the state of Alagoas. The pattern of suicide in the state followed the national scenario, affecting men, adults, young people of black ethnicity (black/brown) in employment, in addition to hanging as the standard mechanism among men. The present study could be the basis for planning interventions focused on preventing the phenomenon, focusing on the determinants of suicide. Objective sociodemographic spatialtemporal spatial temporal suiciderelated related AL, AL , (AL) Brazil Methods 201 2018 women Results n 172, 172 172) 715 71 5 71.5 victims 393 39 3 39. 341 34 1 34. blackbrown brown p 0.001 0001 0 001 0.01 01 0.02. 002 0.02 . 02 0.02) Conclusions scenario adults (black/brown (AL 20 17 7 71. 0.00 000 00 0.0 2 0.

RESUMO Objetivo: Descrever os padrões do suicídio, relacionando-os com aspectos sociodemográficos, espaço-temporais e relacionados ao suicídio na região mais populosa do estado de Alagoas (AL), Brasil. Métodos: Foi delineado um estudo observacional e retrospectivo a partir de dados de suicídio do Instituto Médico Legal localizado em Maceió (AL), compreendendo os anos entre 2016 e 2018. Por meio de regressão logística binária e múltipla foi determinado um modelo estatístico para identificar fatores associados ao suicídio dentre homens e mulheres. Resultados: Do total de suicídios levantados (n = 172), 71,5% eram de vítimas do sexo masculino. A média de idade nos homens foi de 39,3 anos e de 34,1 nas mulheres. O modelo final de regressão logística identificou que homens pretos/pardos tem 12 vezes mais chances (p < 0,001) de cometer suicídio do que os brancos. Além disso homens tem menos chances de se suicidar por intoxicação exógena (p < 0,001) ou queda intencional (p =0,01) do que por enforcamento. Homens em situação empregatícia apresentaram maior chance de suicídio (p = 0,02). Conclusões: Apesar da complexidade do fenômeno em estudo, foi possível verificar alguns padrões para a região mais populosa do estado de Alagoas. O padrão do suicídio no estado seguiu o cenário nacional, afetando homens, adultos, jovens de etnia negra (preta/parda) em situação empregatícia, além do enforcamento como mecanismo padrão entre os homens. O presente estudo poderá ser base para planejamento de intervenções com foco na prevenção do fenômeno, com foco nos determinantes para o suicídio. Objetivo relacionandoos relacionando sociodemográficos espaçotemporais espaço temporais AL, AL , (AL) Brasil Métodos 201 2018 mulheres Resultados n 172, 172 172) 715 71 5 71,5 masculino 393 39 3 39, 341 34 1 34, pretospardos pretos pardos p 0,001 0001 0 001 brancos =0,01 01 0,02. 002 0,02 . 02 0,02) Conclusões nacional adultos preta/parda pretaparda preta parda (preta/parda (AL 20 17 7 71, 0,00 000 00 =0,0 0,0 2 =0, 0, =0

https://doi.org/10.1590/0047-2085-2022-0108

Neutrophil/lymphocyte and platelet/lymphocyte ratio in seropositive women for human immunodeficiency virus (HIV) and human papillomavirus (HPV) coinfection Neutrophillymphocyte Neutrophil lymphocyte plateletlymphocyte platelet HIV (HIV HPV (HPV
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Fook, Karina Donato

; Araújo, Maria José Abigail Mendes Muniz, Alessandra Costa de Sales Carvalho, Mônika Machado de Morais, Ana Cléa Cutrim Diniz de Araújo, Deborah Rocha de Guimarães, Sulayne Janayna Araújo Souza, Camila Penha Abreu Barbosa, Carla Déa Trindade Bertolaccini, Maria Fernanda Lima Belfort, Ilka Kassandra Pereira Lopes, Fernanda Ferreira Monteiro, Sally Cristina Moutinho

Revista do Instituto de Medicina Tropical de São Paulo

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2024, Volume 66 elocation e67

Abstract: En | Text: En | PDF: En

ABSTRACT This study aims to investigate the possible association between neutrophil/lymphocyte and platelet/lymphocyte ratio in women with HIV, undergoing antiretroviral treatment, with HPV coinfection. This is a cross-sectional study with HIV positive women; their biological samples were collected for laboratory tests (complete blood count) and oncotic cytology for detection of HPV DNA, by PCR-Nested (PGMY and GP primers). Viral load and CD4 and CD8 T-cells counts were obtained from medical records. The data were analyzed, comparing the two groups: those with coinfection and those without it. From 82 HIV seropositive women, 50% exhibited HPV coinfection and 12.2% of coinfected patients had cervical cell alterations. Quantification of viral load, CD4 and CD8 T-cells count, CD4 / CD8 ratio and neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratio presented significant differences between groups (p<0.05). The predicting power of NLR and PLR in differentiating HIV/HPV coinfection which demonstrated differences between groups (AUC of 0.882 and 0.776 for NLR and PLR, respectively). There is a relation between the neutrophil/lymphocyte and platelet/lymphocyte ratio with HIV/HPV coinfection in women undergoing antiretroviral treatment, suggesting a state of greater and persistent systemic inflammation, reflecting as a biomarker for screening and monitoring these patients. neutrophillymphocyte neutrophil lymphocyte plateletlymphocyte platelet treatment crosssectional cross sectional complete count DNA PCRNested PCR Nested PGMY primers. primers . primers) CD Tcells T cells records analyzed it 8 50 122 12 2 12.2 alterations (NLR (PLR p<0.05. p005 p p<0.05 0 05 (p<0.05) HIVHPV AUC 0882 882 0.88 0776 776 0.77 respectively. respectively respectively) inflammation 5 1 12. p00 p<0.0 (p<0.05 088 88 0.8 077 77 0.7 p0 p<0. (p<0.0 08 0. 07 7 p<0 (p<0. p< (p<0 (p< (p

https://doi.org/10.1590/s1678-9946202466067

Dirofilaria immitis is endemic in rural areas of the Brazilian Amazonas state capital, Manaus capital
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Barbosa, Ulysses Carvalho

; Nava, Alessandra Ferreira Dales Ferreira Neto, José Vicente Dias, Cindy Alves Silva, Viviane Costa da Mesquita, Hugo Guimarães de Sampaio, Raquel Telles de Moreira Barros, Wanilze Gonçalves Farias, Emanuelle de Sousa Silva, Tullio Romão Ribeiro da Crainey, James Lee Tadei, Wanderli Pedro Koolen, Hector Henrique Ferreira Pessoa, Felipe Arley Costa

Revista Brasileira de Parasitologia Veterinária

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2023, Volume 32 N. 2 elocation e000223

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O parasita filarial canino, Dirofilaria immitis, causa doença zoonótica, mas não tem sido registrado em Manaus, capital do estado do Amazonas, há mais de um século. Neste trabalho, foi relatado uma infecção por D. immitis alóctone e 27 autóctones de um levantamento de microfilárias em 766 amostras de sangue em cães domésticos, coletados entre 2017 e 2021 em Manaus. A prevalência de 15,44% (23/149) foi estabelecida em áreas rurais, 1,22% (4/328) para áreas periurbanas e de 0,35% (1/289) para duas clínicas veterinárias localizadas na zona urbana da cidade. Estes dados sugerem, portanto, que nas áreas urbanas de Manaus, nas quais o parasita é provavelmente vetorizado pela mesma espécie de mosquito que, historicamente, transmitiu Wuchereria bancrofti (Culex quinquefasciatus). Também os níveis de prevalência são baixos e, possivelmente, mantidos por um influxo de áreas rurais onde reservatórios silvestres e/ou dinâmicas de transmissão vetorial mais favoráveis mantêm uma prevalência mais elevada. canino zoonótica Manaus Amazonas século trabalho D 2 76 domésticos 201 202 1544 15 44 15,44 23/149 23149 23 149 (23/149 122 1 22 1,22 4/328 4328 4 328 (4/328 035 0 35 0,35 1/289 1289 289 (1/289 cidade sugerem portanto historicamente Culex quinquefasciatus. quinquefasciatus . quinquefasciatus) possivelmente eou ou elevada 7 20 154 15,4 23/14 2314 14 (23/14 12 1,2 4/32 432 32 (4/32 03 3 0,3 1/28 128 28 (1/28 15, 23/1 231 (23/1 1, 4/3 43 (4/3 0, 1/2 (1/2 23/ (23/ 4/ (4/ 1/ (1/ (23 (4 (1 (2 (

Abstract The canine filarial parasite Dirofilaria immitis has not been reported in Brazil´s Amazonas state capital, Manaus, for over a century. Here, we report one imported and 27 autochthonous D. immitis infections from a microfilarial survey of 766 domestic dog blood samples collected between 2017 and 2021 in Manaus. An Overall prevalence estimate of 15.44% (23/149) was calculated from our two rural collection sites; a prevalence of 1.22% (4/328) was estimated at our periurban collection site, and an overall prevalence of 0.35% (1/289) was calculated from our two urban clinic collections. Our data suggest that in the urban areas of Manaus, where the parasites are very likely vectored by the same species of mosquito that historically vectored Wuchereria bancrofti (Culex quinquefasciatus), prevalence levels are very low and possibly maintained by an influx from rural areas where sylvatic reservoirs and/or more favorable vector transmission dynamics maintain high prevalences. Brazils Brazil s capital Manaus century Here 2 D 76 201 202 1544 15 44 15.44 23/149 23149 23 149 (23/149 sites 122 1 22 1.22 4/328 4328 4 328 (4/328 site 035 0 35 0.35 1/289 1289 289 (1/289 collections Culex quinquefasciatus, quinquefasciatus , quinquefasciatus) andor or prevalences 7 20 154 15.4 23/14 2314 14 (23/14 12 1.2 4/32 432 32 (4/32 03 3 0.3 1/28 128 28 (1/28 15. 23/1 231 (23/1 1. 4/3 43 (4/3 0. 1/2 (1/2 23/ (23/ 4/ (4/ 1/ (1/ (23 (4 (1 (2 (

https://doi.org/10.1590/s1984-29612023018

Validade de conteúdo e confiabilidade de instrumento de avaliação do ambiente alimentar universitário
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Franco, Amanda da Silva

; Canella, Daniela Silva

; Tavares, Letícia Ferreira

; Pereira, Alessandra da Silva

; Barbosa, Roseane Moreira Sampaio

; Oliveira Junior, Gilson Irineu de

; Santos, Claudia Roberta Bocca

; Castro, Inês Rugani Ribeiro de

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2385 - 2396

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O objetivo foi avaliar a validade de conteúdo e a confiabilidade de um instrumento de auditoria para avaliação do ambiente alimentar universitário. Foi desenvolvido checklist para a avaliação de estabelecimentos que comercializavam alimentos e bebidas neste ambiente. A validação de conteúdo abarcou o desenvolvimento do instrumento, a análise por especialistas e a realização do pré-teste. A confiabilidade foi avaliada em uma amostra de conveniência (n=64) de estabelecimentos distribuídos em sete campi de três universidades públicas e foi realizada pelos testes interobservador (TIO) e teste-reteste (TR). Variáveis categóricas e de contagem foram analisadas pelo cálculo da concordância percentual (CP) e dos índices kappa (k) e kappa ajustado pela prevalência e pelo viés (ka) e variáveis contínuas, pelo Coeficiente de Correlação Intraclasse (CCI). O checklist foi composto por 204 itens distribuídos em sete domínios. O desempenho do instrumento foi considerado excelente ou muito bom para 91,3% (CP) dos itens quando avaliados. No TIO 68,3% (k) e 96,5% (ka) tiveram concordância excelente, muito boa ou boa, enquanto no TR 65% tiveram concordância excelente para o k e 96,5% para o ka. O instrumento apresentou validade de conteúdo e confiabilidade satisfatórias.

Abstract This study aimed to evaluate the content validity and reliability of an instrument for evaluating the university food environment. A checklist was developed to assess establishments that sell food and beverages in the university environment. The content validation encompassed the development of the instrument, expert evaluation and pretest performance. Reliability was evaluated using a convenience sample (n=64) of establishments distributed across seven campuses of three public universities and was carried out using interobserver (IO) and test-retest (TR) evaluations. Categorical and count variables were analyzed by calculating the percentage agreement (PA), kappa coefficient (k) and prevalence-adjusted, bias-adjusted kappa (ka), and continuous variables were analyzed by the intraclass correlation coefficient (ICC). The checklist consisted of 204 items distributed in seven domains. The instrument’s performance was considered excellent or very good for 91.3% (PA) of the items when evaluated. For IO, 68.3% (k) and 96.5% (ka) had excellent, very good or good agreement, while for TR, 65% (k) and 96.5% (ka) had excellent agreement. The instrument showed satisfactory content validity and reliability for characterizing the food environment at Brazilian universities.

https://doi.org/10.1590/1413-81232022276.13792021

Validade de conteúdo e confiabilidade de instrumento de avaliação do ambiente alimentar universitário
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Franco, Amanda da Silva

; Canella, Daniela Silva

; Tavares, Letícia Ferreira

; Pereira, Alessandra da Silva

; Barbosa, Roseane Moreira Sampaio

; Oliveira Junior, Gilson Irineu de

; Santos, Claudia Roberta Bocca

; Castro, Inês Rugani Ribeiro de

Ciência & Saúde Coletiva

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jun 2022, Volume 27 N. 6 Pages 2385 - 2396

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232022276.13792021

Recommendations by the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and the Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) on vaccination in general and specifically against SARS-CoV-2 for patients with demyelinating diseases of the central nervous system
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Becker, Jefferson

; Ferreira, Lis Campos

; Damasceno, Alfredo

; Bichuetti, Denis Bernardi

; Christo, Paulo Pereira

; Callegaro, Dagoberto

; Peixoto, Marco Aurélio Lana

; Sousa, Nise Alessandra De Carvalho

; Almeida, Sérgio Monteiro De

; Adoni, Tarso

; Santiago-Amaral, Juliana

; Junqueira, Thiago

; Pereira, Samira Luisa Apóstolos

; Gomes, Ana Beatriz Ayroza Galvão Ribeiro

; Pitombeira, Milena

; Paolilo, Renata Barbosa

; Grzesiuk, Anderson Kuntz

; Piccolo, Ana Claudia

; D´Almeida, José Arthur Costa

; Gomes Neto, Antonio Pereira

; Oliveira, Augusto Cesar Penalva De

; Oliveira, Bianca Santos De

; Tauil, Carlos Bernardo

; Vasconcelos, Claudia Ferreira

; Kaimen-Maciel, Damacio

; Varela, Daniel

; Diniz, Denise Sisterolli

; Oliveira, Enedina Maria Lobato De

; Malfetano, Fabiola Rachid

; Borges, Fernando Elias

; Figueira, Fernando Faria Andrade

; Gondim, Francisco De Assis Aquino

; Passos, Giordani Rodrigues Dos

; Silva, Guilherme Diogo

; Olival, Guilherme Sciascia Do

; Santos, Gutemberg Augusto Cruz Dos

; Ruocco, Heloisa Helena

; Sato, Henry Koiti

; Soares Neto, Herval Ribeiro

; Cortoni Calia, Leandro

; Gonçalves, Marcus Vinícius Magno

; Vecino, Maria Cecilia Aragón De

; Pimentel, Maria Lucia Vellutini

; Ribeiro, Marlise De Castro

; Boaventura, Mateus

; Parolin, Mônica Koncke Fiuza

; Melo, Renata Brant De Souza

; Lázaro, Robson

; Thomaz, Rodrigo Barbosa

; Kleinpaul, Rodrigo

; Dias, Ronaldo Maciel

; Gomes, Sidney

; Lucatto, Simone Abrante

; Alves-Leon, Soniza Vieira

; Fukuda, Thiago

; Ribeiro, Taysa Alexandrino Gonsalves Jubé

; Winckler, Thereza Cristina D’ávila

; Fragoso, Yara Dadalti

; Nascimento, Osvaldo José Moreira Do

; Ferreira, Maria Lucia Brito

; Mendes, Maria Fernanda

; Brum, Doralina Guimarães

; Glehn, Felipe Von

Arquivos de Neuro-Psiquiatria

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nov 2021, Volume 79 N. 11 Pages 1049 - 1061

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O DC de Neuroimunologia da ABN e o BCTRIMS trazem, nesse documento, as recomendações sobre vacinação da população com doenças desmielinizantes do sistema nervoso central (SNC) contra infecções em geral e contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), causador da COVID-19. Destaca-se a gravidade do atual momento frente ao avanço da COVID-19 em nosso País, o que torna mais evidente e importante a criação de guia de referência para orientação aos médicos, pacientes e autoridades de saúde pública quanto à vacinação, meio efetivo e seguro no controle de determinadas doenças infecciosa. O DCNI/ABN e o BCTRIMS recomendam que os pacientes com doenças desmielinizantes do SNC (ex., EM e NMOSD) sejam constantemente monitorados, quanto a atualização do seu calendário vacinal, especialmente, no início ou antes da mudança do tratamento com uma droga modificadora de doença (DMD). É importante também salientar que as vacinas são seguras e os médicos devem estimular o seu uso em todos os pacientes. Evidentemente, deve ser dada especial atenção às vacinas com vírus vivos atenuados. Por fim, é importante que os médicos verifiquem qual DMD o paciente está em uso e quando foi feita a sua última dose, pois cada fármaco pode interagir de forma diferente com a indução da resposta imune.

ABSTRACT The Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology (DCNI/ABN) and Brazilian Committee for Treatment and Research in Multiple Sclerosis and Neuroimmunological Diseases (BCTRIMS) provide recommendations in this document for vaccination of the population with demyelinating diseases of the central nervous system (CNS) against infections in general and against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. We emphasize the seriousness of the current situation in view of the spread of COVID-19 in our country. Therefore, reference guides on vaccination for clinicians, patients, and public health authorities are particularly important to prevent some infectious diseases. The DCNI/ABN and BCTRIMS recommend that patients with CNS demyelinating diseases (e.g., MS and NMOSD) be continually monitored for updates to their vaccination schedule, especially at the beginning or before a change in treatment with a disease modifying drug (DMD). It is also important to note that vaccines are safe, and physicians should encourage their use in all patients. Clearly, special care should be taken when live attenuated viruses are involved. Finally, it is important for physicians to verify which DMD the patient is receiving and when the last dose was taken, as each drug may affect the induction of immune response differently.

https://doi.org/10.1590/0004-282x-anp-2021-0162 1 downloads

Performance of cover crops under two irrigation regimes in the Coastal Tablelands region of Brazil
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Nicole, Lucas Rodrigues

; Cardoso, Dione Pereira Pires, Fábio Ribeiro Bonomo, Robson Netto, Benedicto Barbosa Belo, Alessandra Ferreira

Revista Ceres

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aug 2021, Volume 68 N. 4 Pages 301 - 309

Abstract: En | Text: En | PDF: En

ABSTRACT There is currently a lack of information regarding the performance of cover crops grown in the Coastal Tablelands region in the North of the Brazilian state of Espírito Santo, where zero tillage is increasingly being adopted. The objective of this study was to evaluate the agronomic performance of six cover crops (ruzi grass, jack bean, and the millets ADR 300, ADR 500, ADRf 6010, and BRS 1501) under two irrigation regimes. A field experiment setup was based on randomized blocks with split plots and four repetitions. Shoot dry matter content, plant height, leaf area, chlorophyll fluorescence, and root growth of the cover crops were evaluated. The irrigation regime influences the agronomic performance of most of the cover crops, with the exception of jack bean and ADRf 6010 millet, which were tolerant to water deficiency, based on our evaluations of the variables shoot dry matter, plant height, and leaf area. In terms of biomass production, ADRf 6010 millet is the most suitable crop for use in conservation systems under conditions of water stress in this region.

https://doi.org/10.1590/0034-737x202168040007 20 downloads

10.

Effects of resistance training on postural control in Parkinson’s disease: a randomized controlled trial
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CHEN, Janini

; CHIEN, Hsin Fen

; FRANCATO, Debora Cristina Valente

; BARBOSA, Alessandra Ferreira

; SOUZA, Carolina de Oliveira

; VOOS, Mariana Callil

; GREVE, Julia Maria D'Andréa

; BARBOSA, Egberto Reis

Arquivos de Neuro-Psiquiatria

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jun 2021, Volume 79 N. 6 Pages 511 - 520

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: A instabilidade postural afeta o controle postural desde os estágios iniciais da doença de Parkinson (DP). A literatura descreve benefícios do programa de fortalecimento muscular no equilíbrio, na capacidade funcional, porém poucos estudos investigaram seus efeitos no controle postural na DP. Objetivo: Investigar os efeitos de um programa de três meses de fortalecimento nas medidas da posturografia estática (PE) e nos testes clínicos na DP. Métodos: Participaram do ensaio aleatório controlado 74 pacientes, designados em um dos seguintes grupos: fortalecimento utilizando aparelhos de musculação (gmusc); fortalecimento com pesos livres e elásticos (gpeso); e grupo controle. As avaliações ocorreram antes da intervenção, 3 e 6 meses após intervenção. Foram avaliados alterações nas medidas da PE nas condições de olhos abertos, olhos fechados e dupla tarefa (desfecho primário), efeitos sobre sintomas motores, equilíbrio por meio de escalas clínicas, posturografia dinâmica e percepção da qualidade de vida (desfechos secundários). Resultados: Não houve interações significativas nas medidas da PE entre os grupos. As pontuações motoras da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III) diminuíram em ambos os grupos de fortalecimento (p<0,05). Houve melhora da percepção da qualidade de vida para o domínio mobilidade no gmusc, assim como ganhos nas pontuações dos testes funcionais no gpeso, mantido no seguimento após seis meses (p<0,05). Conclusões: O programa de fortalecimento não altera o controle postural medida pela PE. Apesar disso, ambos os grupos de fortalecimento apresentaram melhor desempenho motor, efeitos positivos a médio prazo no equilíbrio no gpeso e melhor desempenho na qualidade de vida no gmusc.

ABSTRACT Background: Postural instability affects Parkinson’s disease (PD) patients’ postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients’ postural control. Objective: To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. Methods: Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). Results: There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). Conclusions: This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.

https://doi.org/10.1590/0004-282x-anp-2020-0285 548 downloads

11.

Is virtual reality beneficial for dual-task gait training in patients with Parkinson's disease? A systematic review
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Freitag, Fernanda

; Brucki, Sonia Maria Dozzi Barbosa, Alessandra Ferreira Chen, Janini Souza, Carolina de Oliveira Valente, Débora Francato Chien, Hsin Fen Bedeschi, Cynthia Voos, Mariana Callil

Dementia & Neuropsychologia

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sep 2019, Volume 13 N. 3 Pages 259 - 267

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Essa revisão sistemática examinou as evidências sobre os efeitos da realidade virtual (RV) no treinamento de marcha com tarefa-dupla na doença de Parkinson (DP). Métodos: esse estudo (registro PROSPERO: CRD42019114736) visou responder à questão: “A RV é benéfica no treinamento de marcha com tarefa-dupla em pacientes com DP?” A busca, de 2008 a 2018, foi feita nos bancos de dados Medline/PubMed e Web of Science/Web of Knowledge. Os descritores foram Parkinson, treinamento de marcha, realidade virtual e jogos eletrônicos. Foram encontrados 55 artigos e eliminadas 11 revisões sistemáticas, 11 cartas ao editor, resumos de pôsteres ou conferências e 17 estudos que não avaliaram os efeitos do treinamento da marcha em RV. Três outros estudos (encontrados nas referências dos estudos selecionados) foram incluídos porque também abordaram o treinamento de marcha com dupla tarefa de RV em DP. Portanto, 19 estudos foram incluídos e analisados. Resultados: todos os estudos relataram melhora da marcha após o treinamento com RV. Muitas escalas clínicas foram usadas e foi difícil comparar os efeitos de cada protocolo. Conclusão: RV deve fazer parte dos protocolos de reabilitação em DP. O treinamento com RV é eficaz, embora recomendações específicas ainda não tenham sido estabelecidas.

ABSTRACT This systematic review examined the evidence about the effects of virtual reality (VR) on dual-task gait training in Parkinson's disease (PD). Methods: this study (PROSPERO registration CRD42019114736) aimed to answer the question: “Is VR beneficial for dual-task gait training in patients with PD?” We searched for studies from 2008 to 2018 on Medline/PubMed and Web of Science/Web of knowledge databases. The keywords were Parkinson AND gait training AND virtual reality OR Parkinson AND gait training AND game. A total of 55 articles were retrieved, of which 11 systematic reviews, 11 opinions, letters to the editor, posters or conferences abstracts and 17 studies not evaluating the effects of VR gait training were excluded. Three further studies addressing VR dual-task gait training in PD (found in references of studies selected) were also included. Therefore, 19 studies were included and analysed. Results: all studies reported gait improvement after VR training. Many clinical scales were used, hampering comparison of the effects of each protocol. Conclusion: VR dual-task gait training should be part of rehabilitation protocols for PD. The studies showed that VR training was effective, although specific guidelines have not yet been established.

https://doi.org/10.1590/1980-57642018dn13-030002 3431 downloads

12.

Sensory evaluation of fermented dairy beverages supplemented with iron and added by Cerrado fruit pulps
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FIGUEIREDO, Julliane Souza Barbosa SANTOS, Grazielle Layanne Mendes LOPES, João Pedro Antunes FERNANDES, Larissa Bessa SILVA, Fabiane Neves FARIA, Raquel Borges ROCHA, Ana Carolina Santos FARIAS, Paula Karoline Soares LIMA, William James Nogueira DURÃES, Carla Adriana Ferreira XAVIER, Alessandra Rejane Ericsson de Oliveira CARVALHO, Bruna Mara Aparecida de CARELI, Roberta Torres ALMEIDA, Anna Christina de BRANDI, Igor Viana

Food Science and Technology

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jun 2019, Volume 39 N. 2 Pages 410 - 414

Abstract: En | Text: En | PDF: En

Abstract Anemia due to iron deficiency is the most common in the world being characterized as a significant public health issue. Therefore, its prevention and treatment are considered important before it becomes either chronic or grievous; the interventions with superior potential are the medical supplementation with iron salts as well as food mineral enhancement. The objectives of this study were to develop fermented dairy beverages supplemented with iron and added by Cerrado fruit pulps: cagaita (Eugenia dysenterica ), coquinho-azedo (Butia capitata), tamarindo (Tamarindus indica), and umbu ( Spondias tuberosa). In addition, the research intended to evaluate the acceptance of these beverages by children and adolescents from public schools in the city of Montes Claros (MG). The methodology consisted in the production of dairy beverages followed by the evaluation of their quality through physicochemical and microbiological analyses. Posteriorly, children and adolescents assessed the sensorial acceptance. The analyses performed presented satisfactory results for physicochemical and microbiological properties regarding the acceptance of the product. The cagaita and coquinho azedo based dairy beverages were the most accepted whether compared with tamarindo and umbu beverages. The fermented dairy beverage supplemented with iron and added by Cerrado fruits come up as a feasible alternative for dietary supplementation, and can promote beneficial effects in human health due to their sensorial acceptance.

https://doi.org/10.1590/fst.32616 1047 downloads

13.

Characterization of diploid Arachis interspecific hybrids for pest resistance
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Paula, Ailton Ferreira de

; Dinato, Naiana Barbosa

; Vigna, Bianca Baccili Zanotto

; Fávero, Alessandra Pereira

Bragantia

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mar 2019, Volume 78 N. 1 Pages 96 - 108

Abstract: En | Text: En | PDF: En

ABSTRACT In Brazil, the thrips (Enneothrips flavens Moulton) and rednecked peanutworm (Stegasta bosquella Chambers) are considered key pests for the peanut crop. Wild species show resistance to both of these pests, and can be used in breeding programs. The production of the sterile interspecific hybrids is necessary, which could be colchicine treated to get a synthetic amphidiploid with the same or similar genomic configuration of cultivated peanut. In this context, this study proposed the hybridization of wild pest-resistant species in 18 distinct combinations, obtaining the interspecific hybrids of Arachis and completing their characterization by (i) the reproductive characterization through pollen stainability with 2% acetocarmine (AC) solution with glycerin and 0.25% tetrazolium solution (TZ), (ii) the molecular certification of hybridization using microsatellite markers, and (iii) the morphological characterization using 61 morphological traits with Principal Component Analysis. Using reproductive, morphological and molecular characterizations, we identified six hybrid plants of the following crosses: three fromA. magna V 13751 × A. kuhlmannii V 9243, two from A. magna V 13751 × A. kempff-mercadoi V 13250, and one from A. magna K 30097 ×A. kuhlmannii V 7639. Amphidiploids can be reached based on these diploid plants and they can be used in breeding programs aiming pest resistance introgression.

https://doi.org/10.1590/1678-4499.2018130 763 downloads

14.

Association between sarcopenic obesity, muscle strength and risk of cardiovascular and cardiometabolic diseases in the elderly: A systematic review
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SILVA NETO, Luiz Sinésio

; MEDEIROS, Alessandra

; TRAVASSOS, Andreia

; OSÓRIO, Neila Barbosa

; NUNES, Genildo Ferreira

Revista de Nutrição

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2019, Volume 32 elocation e180237

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Descrever os achados da literatura sobre a associação entre obesidade sarcopenia, força muscular e fatores de risco e/ou doenças cardiometabólicas ou doenças cardiovasculares em idosos. Foi realizada uma busca nas bases Medical Literature Analysis and Retrievel System Online, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, e Periódicos Capes, nos idiomas inglês, espanhol e português, com as seguintes chaves de busca: “obesity sarcopenic” OR “sarcopenic obesity” no título AND “cardiometabolic disease” OR “cardiovascular disease” OR “metabolic syndrome” OR insulin resistance” no título/resumo AND “aged” em todos os campos e com a variação de utilização do descritor “muscle strenght” em todos os campos do trabalho. A seleção dos artigos seguiu os seguintes critérios de exclusão: trabalhos que avaliam apenas sarcopenia e risco de doenças cardiovasculares/doenças cardiometabólicas em idosos; trabalhos que avaliam apenas obesidade e risco de doenças cardiovasculares/doenças cardiometabólicas em idosos; trabalhos que apresentam avaliações sem apresentar o método utilizado; estudos realizados em animais e outros que não estejam em português, inglês ou espanhol. A estratégia de busca identificou 235 publicações nas bases de dados e, após a utilização dos critérios de inclusão e exclusão, foram inseridos 17 artigos para análise nessa revisão. Houve heterogeneidade de métodos na identificação da obesidade sarcopênica, tendo sido utilizado o corte transversal na maioria dos estudos. Foi possível verificar a associação de obesidade sarcopênica com os fatores de risco e/ou doenças cardiovasculares ou doenças cardiometabólicas em 16 estudos. A obesidade sarcopênica está associada a fatores de risco e/ou doenças cardiometabólicas ou doenças cardiovasculares em idosos. O estabelecimento de uma definição robusta de obesidade sarcopênica em idosos é necessário para estudos e intervenções clínicas.

ABSTRACT To describe the findings in the literature about the association between sarcopenic obesity, muscle strength and risk factors and/or cardiometabolic or cardiovascular diseases in the elderly. A research was carried out in the following databases: Medical Literature Analysis and Retrievel System Online, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin America and Caribbean Health Sciences Literature) and Capes Journals, using the following search terms in English, Spanish and Portuguese: “obesity sarcopenic” OR “sarcopenic obesity” in the title AND “cardiometabolic disease” OR “cardiovascular disease” OR “metabolic syndrome” OR “insulin resistance” in the title/abstract AND “aged” in all fields of search with the variation of the “muscle strength” descriptor in all fields of this research. Articles were selected according to the following exclusion criteria: studies evaluating only sarcopenia and the risk of cardiometabolic/cardiovascular disease in the elderly, studies evaluating only obesity and the risk of cardiometabolic/cardiovascular disease in the elderly, studies that did not present the used method, studies in animals and studies that were not in Portuguese, English or Spanish. The researchers of the present study found a heterogeneity of methods for the identification of sarcopenic obesity, and a transversal cohort was used in most of the studies. It was possible to verify the association of sarcopenic obesity with risk factors and/or cardiometabolic or cardiovascular disease. Sarcopenic obesity is associated with risk factors and/or cardiometabolic or cardiovascular disease in the elderly. Establishing a robust definition of sarcopenic obesity in the elderly is necessary for further clinical studies and interventions.

https://doi.org/10.1590/1678-9865201932e180237 1739 downloads

15.

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis
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Marques, Vanessa Daccach Passos, Giordani Rodrigues dos Mendes, Maria Fernanda Callegaro, Dagoberto Lana-Peixoto, Marco Aurélio Comini-Frota, Elizabeth Regina Vasconcelos, Cláudia Cristina Ferreira Sato, Douglas Kazutoshi Ferreira, Maria Lúcia Brito Parolin, Mônica Koncke Fiuza Damasceno, Alfredo Grzesiuk, Anderson Kuntz Muniz, André Matta, André Palma da Cunha Oliveira, Bianca Etelvina Santos de Tauil, Carlos Bernardo Maciel, Damacio Ramón Kaimen Diniz, Denise Sisteroli Corrêa, Eber Castro Coronetti, Fernando Jorge, Frederico M. H. Sato, Henry Koiti Gonçalves, Marcus Vinícius Magno Sousa, Nise Alessandra de C. Nascimento, Osvaldo J. M. Gama, Paulo Diniz da Domingues, Renan Simm, Renata Faria Thomaz, Rodrigo Barbosa Morales, Rogério de Rizo Dias, Ronaldo Maciel Apóstolos-Pereira, Samira dos Machado, Suzana Costa Nunes Junqueira, Thiago de Faria Becker, Jefferson

Arquivos de Neuro-Psiquiatria

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aug 2018, Volume 76 N. 8 Pages 539 - 554

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O crescent arsenal terapêutico na esclerose múltipla (EM) tem permitido tratamentos mais efetivos e personalizados, mas a escolha e o manejo das terapias modificadoras da doença (TMDs) tem se tornado cada vez mais complexos. Neste contexto, especialistas do Comitê Brasileiro de Tratamento e Pesquisa em Esclerose Múltipla e do Departamento Científico de Neuroimunologia da Academia Brasileira de Neurologia reuniram-se para estabelecer este Consenso Brasileiro para o Tratamento da EM, baseados no entendimento de que neurologistas devem ter a possibilidade de prescrever TMDs para EM de acordo com o que é melhor para cada paciente, com base em evidências e práticas atualizadas. Por meio deste documento, propomos recomendações práticas para o tratamento da EM, com foco principal na escolha e no manejo das TMDs, e revisamos os argumentos que embasam as estratégias de tratamento na EM.

ABSTRACT The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.

https://doi.org/10.1590/0004-282x20180078 8891 downloads

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