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National Primary Care Policy (2017) and the roles of community health workers
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Dias, Juliana Roza

; Acioli, Sonia

; Corrêa, Vanessa de Almeida Ferreira

; Souza, Inês Leoneza de

; Rafael, Ricardo de Mattos Russo

; Rodrigues, Paulo Henrique de Almeida

; Bohusch, Glaucia

Revista Brasileira de Enfermagem

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2025, Volume 78 N. 1 elocation e20240230

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

RESUMO Objetivo: Analisar as novas atribuições dos agentes comunitários de saúde preconizadas pela Política Nacional de Atenção Básica (PNAB) de 2017 sob a ótica dos enfermeiros e dos agentes comunitários de saúde. Métodos: Estudo qualitativo com enfermeiros e agentes comunitários de saúde de equipes de Saúde da Família, por meio de entrevistas semiestruturadas entre agosto de 2021 e abril de 2022. Os dados foram submetidos à análise de conteúdo temática. Resultados: Identificamos profissionais que defenderam que as atribuições dos agentes comunitários visam o aumento da autonomia e valorização profissional desses trabalhadores. Outros apontaram para a perda da originalidade do trabalho, para o exercício ilegal da profissão de enfermeiro ou de técnico de enfermagem. Considerações Finais: A PNAB-2017 atribui a esses trabalhadores uma ênfase na execução de tarefas, contribuindo para a mecanização das ações, reforçando o modelo biomédico e descaracterizando o papel do agente comunitário na promoção da saúde na Atenção Primária.

ABSTRACT Objective: To analyze the new roles of community health workers as outlined in the 2017 National Primary Care Policy (PNAB) from the perspectives of both nurses and community health workers. Methods: This qualitative study involved nurses and community health workers from Family Health teams, conducted through semi-structured interviews via videoconference between August 2021 and April 2022. The data were analyzed using thematic content analysis. Results: We identified professionals who argued that the new roles for community health workers aim to increase their autonomy and professional recognition. Others highlighted concerns about the loss of originality in their work and the potential for the illegal practice of nursing or nursing technician duties. Final Considerations: The 2017 PNAB emphasizes task execution for these workers, contributing to the mechanization of activities, reinforcing the biomedical model, and undermining the role of community health workers in promoting health within Primary Care.

RESUMEN Objetivo: Analizar las nuevas atribuciones de los agentes comunitarios de salud preconizadas por la Política Nacional de Atención Básica (PNAB) de 2017 desde la perspectiva de los enfermeros y los agentes comunitarios de salud. Métodos: Se trata de un estudio cualitativo con enfermeros y agentes comunitarios de salud de equipos de Salud de la Familia, mediante entrevistas semiestructuradas realizadas por videoconferencia entre agosto de 2021 y abril de 2022. Los datos fueron analizados a través del análisis de contenido temático. Resultados: Identificamos profesionales que defendieron que las atribuciones de los agentes comunitarios de salud buscan aumentar la autonomía y el reconocimiento profesional de estos trabajadores. Otros señalaron la pérdida de la originalidad del trabajo y el ejercicio ilegal de la profesión de enfermero o técnico de enfermería. Consideraciones Finales: La PNAB-2017 asigna a estos trabajadores un énfasis en la ejecución de tareas, contribuyendo a la mecanización de las acciones, reforzando el modelo biomédico y desfigurando el papel del agente comunitario en la promoción de la salud en la Atención Primaria.

https://doi.org/10.1590/0034-7167-2024-0230

National Primary Care Policy (2017) and the roles of community health workers
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Dias, Juliana Roza

; Acioli, Sonia

; Corrêa, Vanessa de Almeida Ferreira

; Souza, Inês Leoneza de

; Rafael, Ricardo de Mattos Russo

; Rodrigues, Paulo Henrique de Almeida

; Bohusch, Glaucia

Revista Brasileira de Enfermagem

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2025, Volume 78 N. 1 elocation e20240230

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

https://doi.org/10.1590/0034-7167-2024-0230

Nonlinear thermal analysis of timber cross-sections via CS-ASA/FA and GiD coupling
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Segundo, Jackson Silva da Rocha

; Ferreira, Caroline Aparecida

; Silveira, Ricardo Azoubel da Mota

; Barros, Rafael Cesário

; Pires, Dalilah

; Lemes, Ígor José Mendes

REM - International Engineering Journal

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2025, Volume 78 N. 1 elocation e240019

Abstract: En | Text: En | PDF: En

Abstract In fires, situations in which high temperatures are evident, it is noticed that the materials have their physical and resistance properties deteriorated. In the structural systems considered under these fire conditions, there is a considerable loss of load capacity and strength. Therefore, the temperature progression evaluation in the structural elements’ cross-sections is essential for understanding their behavior under high temperature. Thermal analysis allows determining the complete temperature field in the element cross-section from boundary conditions provided by some adopted fire model, taking into account the variation in the material thermal properties with the temperature increase. Timber, being a combustible material, requires knowledge and adequate modeling of its behavior and performance when kept in a fire situation. This anisotropic material, with fibers containing irregular flammable knots, has been widely used in civil construction. Thus, this research aims to carry out numerical thermal analysis through the Computational System for Advanced Structural Analysis/Fire Analysis (CS-ASA/FA), with the preand post-processing graphical tools provided by the GiD platform, of timber structural elements’ cross-sections used in civil construction. The results obtained are compared with those of literature, demonstrating the ability of this CS-ASA/FA module and GiD coupling to provide the necessary information for the evaluation of timber cross-sections in a fire situation.

https://doi.org/10.1590/0370-44672024780019

Saturated hydraulic conductivity and steady-state infiltration rate database for Brazilian soils
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Ottoni, Marta Vasconcelos

; Teixeira, Wenceslau Geraldes

; Reis, Aline Mari Huf dos

; Pimentel, Letícia Guimarães

; Souza, Luciana Rodrigues

; Albuquerque, Jackson Adriano

; Melo, Valdinar Ferreira

; Cavalieri-Polizeli, Karina Maria Vieira

; Reichert, José Miguel

; Viana, João Herbert Moreira

; Fontana, Ademir

; Medrado, Lucas de Castro

; Santos, Glenio Guimarães

; Amaral, Luís Gustavo Henriques do

; Anjos, Lúcia Helena Cunha dos

; Araújo Filho, José Coelho de

; Bhering, Silvio Barge

; Brito, Gabrielle Fernandes de

; Valle, Pedro Gomes de Campos do

; Campos, Pablo Nieto

; Costa, Adriana Monteiro da

; Marques, Jean Dalmo de Oliveira

; Martins, Alba Leonor da Silva

; Nascimento, Michele Bruna de Souza do

; Noronha, Norberto Cornejo

; Oliveira, Ricardo Duarte de

; Portela, Jeane Cruz

; Serafim, Milson Evaldo

; Silva, Marlen Barros e

; Rodrigues, Sueli

; Almeida, Wilk Sampaio de

; Moraes, Margareth Lopes de

; Curi, Nilton

Revista Brasileira de Ciência do Solo

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2025, Volume 49 elocation e0240003

Abstract: En | Text: En | PDF: En

ABSTRACT Soil saturated hydraulic conductivity (Ksat) and steady-state infiltration rate (SSIR) are essential and necessary soil properties for different geoscience applications. Values of these hydraulic properties for the Brazilian territory are difficult to access and are dispersed in research efforts carried out around the country. This study developed an easy-to-manipulate, freely accessible database of soil saturated hydraulic conductivity, comprising field and laboratory analyses, and steady-state infiltration rates for Brazilian soils. This database was named Ksat-SSIR-DB. One analysis of the Ksat-SSIR-DB aimed to evaluate its coverage in Brazilian territory and in different soil groups. Average values of these hydraulic properties were also presented for textural classes, with values compared to those reported in international literature, and for other groupings, such as soil class, land use class, and porosity class. The variability of Ksat data in these groupings and in their combinations were also analyzed. The Ksat-SSIR-DB showed broad national coverage, comprising a total of 2,579 records, corresponding to 409 sampling sites, with Ksat and/or SSIR data and other associated soil information. A significant difference was observed between Ksat values for the vast majority of Brazilian clayey and very clayey soils compared to soils from the same textural groups from temperate regions. The two groupings that presented the lowest variability in terms of Ksat standard deviation values were the combination of textural classes with soil classes at the second category level of SiBCS (Brazilian Soil Classification System), and porosity classes with soil classes at the second category level of SiBCS. The Ksat-SSIR-DB has enormous potential for developing and testing Ksat pedotransfer functions in Brazilian soils, serving as a reference source for different geoenvironmental applications and, in particular, for modeling land surface processes. It is open access and can be accessed at https://www.sgb.gov.br/ksat-ssir-dbbase-de-dados-de-condutividade-hidraulica-saturada-e-de-taxa-de-infiltracao-basica-emsolos-brasileiros, which also includes the python script for data analysis.

https://doi.org/10.36783/18069657rbcs20240003

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data
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Pachito, Daniela V.

; Longato, Mauricio

; Cordeiro, Guilherme

; Almeida, Paulo H.R.F.

; Ferreira, Ricardo Macarini

; Burian, Ana Paula N.

Brazilian Journal of Infectious Diseases

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2025, Volume 29 elocation 104482

Abstract: En | Text: En | PDF: En

Abstract Introduction Community-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. Methods Retrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. Results A total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. Conclusions Our findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

https://doi.org/10.1016/j.bjid.2024.104482

Joint statement on evidence-based practices in mechanical ventilation: suggestions from two Brazilian medical societies
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Ferreira, Juliana Carvalho

; Vianna, Arthur Oswaldo de Abreu

; Pinheiro, Bruno Valle

; Maia, Israel Silva

; Baldisserotto, Sérgio Vasconcellos

; Isola, Alexandre Marini

; Cavalcanti, Alexandre Biasi Gama, Ana Maria Casati Nogueira da Rocha, Angelo Roncalli Miranda Oliveira, Antonio Gonçalves de Serpa Neto, Ary Farias, Augusto Manoel de Carvalho Orlando, Bianca Rodrigues Esteves, Bruno da Costa Mazza, Bruno Franco Silveira, Camila de Freitas Martins Soares Carvalho, Carlos Roberto Ribeiro de Toufen Junior, Carlos Barbas, Carmen Silvia Valente Teixeira, Cassiano Silveira, Débora Dutra da Medeiros, Denise Machado Parolo, Edino Costa, Eduardo Leite Vieira Caser, Eliana Bernadete Oliveira, Ellen Pierre de Banholzer, Eric Grieger Carvalho, Erich Vidal Amorim, Fabio Ferreira Saddy, Felipe Gonçalves, Fernanda Alves Ferreira Galas, Filomena Regina Barbosa Gomes Zanatta, Giovanna Carolina Gardini Silva, Gisele Sampaio Westphal, Glauco Adrieno Matos, Gustavo Faissol Janot de Souza, João Claudio Emmerich de Silva Junior, João Manoel Valiatti, Jorge Luis dos Santos Nascimento Junior, José Ribamar do Rocco, Jose Rodolfo Hajjar, Ludhmila Abrahão Forgiarini Junior, Luiz Alberto Malbuisson, Luiz Marcelo Sá Holanda, Marcelo Alcantara Amato, Marcelo Britto Passos Park, Marcelo Oliveira, Marco Antonio da Rosa e Reis, Marco Antonio Soares Tavares, Marcos Soares Souza, Mario Henrique Dutra de Damasceno, Marta Cristina Pauleti Lira-Batista, Marta Maria da Silva Pattacini, Max Morais Assunção, Murillo Santucci Cesar de Oliveira, Neymar Elias de Franzosi, Oellen Stuani Rocco, Patricia Rieken Macedo Caruso, Pedro Silva, Pedro Leme Mendes, Pedro Vitale Duarte, Pericles Almeida Delfino Santa Neto, Renato Fabio Alberto Della Rodrigues, Ricardo Goulart Cordioli, Ricardo Luiz Palazzo, Roberta Fittipaldi Goldwasser, Rosane Pinheiro, Sabrina dos Santos Justino, Sandra Regina Nemer, Sergio Nogueira Oliveira, Vanessa Martins de Silva, Vinicius Zacarias Maldaner da Nedel, Wagner Luis Bellissimo-Rodrigues, Wanessa Teixeira Oliveira Filho, Wilson de

Critical Care Science

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2025, Volume 37 elocation e20250242en

Abstract: En | Text: En | PDF: En

ABSTRACT Mechanical ventilation can be a life-saving intervention, but its implementation requires a multidisciplinary approach, with an understanding of its indications and contraindications due to the potential for complications. The management of mechanical ventilation should be part of the curricula during clinical training; however, trainees and practicing professionals frequently report low confidence in managing mechanical ventilation, often seeking additional sources of knowledge. Review articles, consensus statements and clinical practice guidelines have become important sources of guidance in mechanical ventilation, and although clinical practice guidelines offer rigorously developed recommendations, they take a long time to develop and can address only a limited number of clinical questions. The Associação de Medicina Intensiva Brasileira and the Sociedade Brasileira de Pneumologia e Tisiologia sponsored the development of a joint statement addressing all aspects of mechanical ventilation, which was divided into 38 topics. Seventy-five experts from all regions of Brazil worked in pairs to perform scoping reviews, searching for publications on their specific topic of mechanical ventilation in the last 20 years in the highest impact factor journals in the areas of intensive care, pulmonology, and anesthesiology. Each pair produced suggestions and considerations on their topics, which were presented to the entire group in a plenary session for modification when necessary and approval. The result was a comprehensive document encompassing all aspects of mechanical ventilation to provide guidance at the bedside. In this article, we report the methodology used to produce the document and highlight the most important suggestions and considerations of the document, which has been made available to the public in Portuguese.

https://doi.org/10.62675/2965-2774.20250242-en

TB antigen-based skin tests and QFT-Plus for Mycobacterium tuberculosis infection diagnosis in Brazilian healthcare workers: a cost-effectiveness analysis
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Souza, Fernanda Mattos de

; Steffen, Ricardo E.

; Pinto, Márcia Ferreira Teixeira

; Prado, Thiago Nascimento do

; Maciel, Ethel Leonor Noia

; Trajman, Anete

Cadernos de Saúde Pública

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2025, Volume 41 N. 1 elocation e00178623

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

This study aimed to analyze the cost-effectiveness of three tuberculosis (TB) antigen-based skin tests (TBST) (Diaskintest, C-TST, and Cy-TB) and QFT-Plus for TB infection diagnosis compared to the current standard of care, PPD Rt-23 tuberculin skin test (TST), among healthcare workers in Brazil. A state-transition Markov model was employed, simulating a cohort of healthcare workers (five annual cycles) for testing and treating TB infection with three months of weekly doses of rifapentine and isoniazid (3HP) under the Brazilian public health system perspective. Effects (TB disease averted) and costs for screening and treating TB infection were discounted at 5%. Incremental cost-effectiveness per TB averted was estimated. One-way and probabilistic sensitivity analysis were performed. Brazil, an upper-middle-income country with a high burden of TB, shows one of the largest universal public health systems and provides free-of-charge diagnosis and treatment for TB and TB infection. TST is the standard of care, whereas QFT-Plus is available for very high-risk populations. The three new TBST are under validation for eventual incorporation. Patients or participants: a hypothetical cohort of 10,000 healthcare workers, working at any level of healthcare service, and negative TST results in the previous year of both sexes with a baseline negative TST result. Diaskintest, C-TST, Cy-TB, and QFT-Plus were found to show a higher specificity. Costs with QFT-Plus were higher due to equipment, human labor, and test price. Diaskintest was the most cost-saving strategy, followed by Cy-TB for TB preventive treatment with 3HP. In the Brazilian scenario, Diaskintest and Cy-TB are the most cost-effective tests for sequential testing of healthcare workers.

Este estudio tuvo como objetivo analizar el costo-efectividad de tres pruebas cutáneas basadas en antígenos de tuberculosis (TB) (Diaskintest, C-TST, Cy-TB) y QFT-Plus para diagnosticar la infección por TB comparándolas con el estándar de atención actual, PPD Rt-23 prueba de la tuberculina (TT), entre profesionales de la salud en Brasil. Se trata de un modelo de Markov de transición de estado, que simula una cohorte de profesionales de la salud (cinco ciclos anuales) para pruebas y tratamiento de la infección por TB con dosis semanales de rifapentina e isoniazida durante tres meses (3HP) desde la perspectiva del sistema de salud pública brasileño. Los efectos (TB evitada) y los costos de detección y tratamiento de la infección se descontaron en un 5%. Se calculó el costo-efectividad incremental por TB evitada. Se realizaron análisis de sensibilidad unidireccionales y probabilísticos. Brasil, un país de ingresos medianos altos con una alta carga de TB, tiene uno de los mayores sistemas de salud pública universal y ofrece diagnóstico y tratamiento gratuitos para la TB. El TT es la atención estándar, QFT-Plus está disponible para poblaciones de muy alto riesgo. Las tres nuevas pruebas cutáneas se encuentran en proceso de validación para su eventual incorporación. Una cohorte hipotética de 10.000 profesionales de la salud, trabajando en cualquier nivel de atención, y resultados de TT negativos en el año anterior de ambos sexos con resultado de TT negativo en la línea de base. Diaskintest, C-TST, Cy-TB y QFT-Plus tienen mayor especificidad. Los costos con QFT-Plus fueron mayores debido a: equipo, mano de obra y costo de las pruebas. Diaskintest fue la estrategia más rentable, seguida de Cy-TB para tratamiento preventivo de la TB con 3HP. En el escenario brasileño, Diaskintest y Cy-TB son las pruebas más rentables para realizar pruebas secuenciales a los profesionales de la salud.

Este estudo objetivou analisar o custo-efetividade de três testes cutâneos baseados em antígenos de tuberculose (TB) (Diaskintest, C-TST, Cy-TB) e QFT-Plus para diagnóstico de infecção por TB comparando-os ao padrão de atendimento atual, PPD Rt-23 teste tuberculínico (TT), entre profissionais de saúde no Brasil. Trata-se de um modelo de Markov de transição de estado, simulando uma coorte de profissionais de saúde (cinco ciclos anuais) para testagem e tratamento de infecção por TB com doses semanais de rifapentina e isoniazida por três meses (3HP) sob a perspectiva do sistema público de saúde brasileiro. Os efeitos (TB evitada) e os custos de triagem e tratamento da infecção foram descontados em 5%. O custo-efetividade incremental por TB evitada foi calculado. Foram realizadas análises de sensibilidade unidirecionais e probabilísticas. O Brasil, um país de renda média-alta com alta carga de TB, possui um dos maiores sistemas públicos universais de saúde e oferece diagnóstico e tratamento gratuitos para TB. O TT é o atendimento padrão, o QFT-Plus está disponível para populações de risco muito elevado. Os três novos testes cutâneos estão em validação para eventual incorporação. Uma coorte hipotética de 10 mil profissionais de saúde, trabalhando em qualquer nível de atendimento, e resultados negativos de TT no ano anterior de ambos os sexos com um resultado de TT negativo na linha de base. Diaskintest, C-TST, Cy-TB e QFT-Plus têm maior especificidade. Os custos com o QFT-Plus foram maiores devido: equipamento, mão de obra e custo da testagem. O Diaskintest foi a estratégia de maior economia, seguido pelo Cy-TB para tratamento preventivo da TB com 3HP. No cenário brasileiro, Diaskintest e Cy-TB são os testes mais custo-efetivos para testagem sequencial de profissionais da saúde.

https://doi.org/10.1590/0102-311xen178623

Práxis como transformação: ética, política e direito entre o sujeito e a natureza transformação ética
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Ferreira, Bruna Mariz Bataglia

; Vestena, Carolina Alves

; Cunha, José Ricardo

Revista Direito e Práxis

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sep 2024, Volume 15 N. 3 elocation e87135

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

Resumo Face a um diagnóstico da crise múltipla, que envolve uma dimensão socioambiental, é dever de um projeto político transformador se voltar para as diferentes formas de regulação social, as quais forjam o enquadramento social de nossas maneiras de produzir e de experienciar as relações com o mundo, seja na cultura, seja na natureza. O presente artigo introduz o dossiê “Direito e Práxis 15 anos: Perspectivas para o horizonte da crítica do direito” e propõe uma reflexão político-filosófica sobre o papel do direito enquanto dimensão institucional da crise múltipla e possibilidade de articulação de alternativas. Para isso, o trabalho retoma os fundamentos do conceito de filosofia da práxis com base na obra gramsciana e suas recepções no debate brasileiro e internacional. Em seguida, propõe outro olhar para a filosofia da práxis em diálogo com a filosofia da libertação, a partir de uma perspectiva ética de radical alteridade - sob a inflexão da virada ecológica - como forma de superação do conceito tradicional de sujeito de direitos. Por fim, o trabalho conclui com uma análise sobre o papel do direito como um campo de disputas, visando contribuir com uma abordagem do fenômeno jurídico que sugere a abertura para o imaginário de um futuro que integre o humano e natureza para além de uma visão limitada das relações sociais forjada sob os paradigmas egocêntrico e antropocêntrico. socioambiental mundo cultura Direito 1 anos políticofilosófica filosófica alternativas isso internacional seguida libertação direitos fim disputas antropocêntrico

Abstract Given a diagnosis of the multiple crises, which involves a socio-environmental dimension, it is the task of a transformative political project to turn its attention to the different forms of social regulation, which forge the social framework of our ways of producing and experiencing relations with the world, whether in culture or nature. This article introduces the dossier ‘Law and Praxis 15 years: Perspectives for the horizon of the critique of law’ and proposes a political-philosophical reflection on the role of law as an institutional dimension of the multiple crises and the possibility of articulating alternatives. To this purpose, the paper intends to contribute to the foundations of the concept of the philosophy of praxis based on Gramsci's work and its reception in the Brazilian and international debates. It then proposes a new gaze to the philosophy of praxis in dialogue with the philosophy of liberation, from an ethical perspective of radical alterity - under the inflexion of the ecological turn - to overcome the traditional concept of the subject of rights. Finally, the paper concludes with an analysis of the role of law as a field of disputes, with the aim of contributing to an approach to the legal phenomenon that suggests opening up to the imagination of a future that integrates humans and nature, beyond a limited view of social relations from egocentric and anthropocentric paradigms. socioenvironmental socio environmental regulation world nature Law 1 years politicalphilosophical philosophical alternatives purpose Gramscis Gramsci s debates liberation rights Finally disputes paradigms

https://doi.org/10.1590/2179-8966/2024/87135

Pioderma gangrenoso como diagnóstico diferencial de isquemia crónica crítica de miembros inferiores
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Manganiello, Carlos F.

; Ferreira, L. Mariano

; Callegari, Mariana S.

; Suarez, Leandro

; Gorosito, Delfina

; Mura, Ricardo La

Revista argentina de cardiología

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sep 2024, Volume 92 N. 4 Pages 294 - 296

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.7775/rac.es.v92.i4.20808

10.

Diretriz Brasileira de Ergometria em Crianças e Adolescentes – 2024 202 20 2
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Carvalho, Tales de

; Freitas, Odilon Gariglio Alvarenga de

; Chalela, William Azem

; Hossri, Carlos Alberto Cordeiro

; Milani, Mauricio

; Buglia, Susimeire

; Falcão, Andréa Maria Gomes Marinho

; Costa, Ricardo Vivacqua Cardoso

; Ritt, Luiz Eduardo Fonteles

; Pfeiffer, Maria Eulália Thebit

; Silva, Odwaldo Barbosa e

; Imada, Rodrigo

; Pena, José Luiz Barros

; Avanza Júnior, Antônio Carlos

; Sellera, Carlos Alberto Cyrillo

; Ferreira, Ana Luíza Guimarães

Arquivos Brasileiros de Cardiologia

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aug 2024, Volume 121 N. 8 elocation e20240525

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

Classes de Recomendação Classe I: Condições para as quais há evidências conclusivas e, na sua falta, consenso geral de que o procedimento é seguro e útil/eficaz. Classe II: Condições para as quais há evidências conflitantes e/ou divergência de opinião sobre a segurança e utilidade/eficácia do procedimento. Classe IIa: Peso ou evidência/opinião a favor do procedimento. A maioria aprova. Classe IIb: Segurança e utilidade/eficácia menos estabelecidas, havendo opiniões divergentes. Classe III: Condições para as quais há evidências e/ou consenso de que o procedimento não é útil/eficaz e, em alguns casos, pode ser prejudicial. Níveis de Evidência Nível A: Dados obtidos a partir de múltiplos estudos randomizados de bom porte, concordantes e/ou de metanálise robusta de estudos randomizados. Nível B: Dados obtidos a partir de metanálise menos robusta, a partir de um único estudo randomizado e/ou de estudos observacionais. Nível C: Dados obtidos de opiniões consensuais de especialistas. I falta útileficaz útil eficaz II eou utilidadeeficácia utilidade eficácia IIa evidênciaopinião evidência aprova IIb estabelecidas divergentes III casos prejudicial porte B observacionais C especialistas

Classes of Recommendation Class I: Conditions for which there is conclusive evidence and, failing that, general agreement that a given procedure is safe and useful/effective. Class II: Conditions for which there is conflicting evidence and/or a divergence of opinion about the safety and usefulness/efficacy of a procedure. Class IIa: Weight or evidence/opinion in favor of the procedure. Most approve. Class IIb: Safety and usefulness/efficacy less well established, with divergence of opinions. Class III: Conditions for which there is evidence and/or general agreement that a procedure is not useful/effective and, in some cases, may be harmful. Levels of Evidence Level A: Data derived from multiple large, concordant randomized trials and/or robust meta-analyses of randomized trials. Level B: Data derived from less robust meta-analyses, from a single randomized trial and/or from observational studies. Level C: Data derived from consensus opinion of experts. I usefuleffective useful effective II andor usefulnessefficacy usefulness efficacy IIa evidenceopinion approve IIb established opinions III cases harmful A large metaanalyses meta analyses B metaanalyses, analyses, studies C experts

https://doi.org/10.36660/abc.20240525

11.

Intervenções de Enfermagem de reabilitação ao paciente com lesão medular: Protocolo de Revisão de escopo
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Xavier, Amanda Sarkis Moor Santos

; Pereira, Juarez de Souza

; Monteiro, Ricardo da Silva

; Cruz, Vanessa Vianna

; Silva, Hilmara Ferreira da

; Machado, Wiliam César Alves

Revista Portuguesa de Enfermagem de Reabilitação

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jun 2024, Volume 7 N. 1 elocation e358

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

ABSTRACT Introduction: Spinal cord injury is any injury to the structures contained in the spinal canal (medulla, conus medullaris and cauda equina), which can lead to motor, sensory, autonomic and psycho-affective changes that cause physical, psychological and social repercussions. Studies indicate a fragility in the health care provided to patients with this type of disabling injury, in the context of Primary Health Care and the need for ongoing education actions on the subject of rehabilitation for Nurses. Despite being the gateway to health services and the first level of care for users within their territory, within their homes, these users still experience difficulties such as professional disqualification for providing comprehensive care to patients with spinal cord injuries. The aim of the study is to develop a scoping review protocol that will seek to identify and synthesize the available scientific evidence on nursing interventions focused on autonomy for daily activities of people with spinal cord injury in Primary Health Care. Methodology: The method proposed by JBI (Joanna Briggs Institute) will be used and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) extension will be used to systematize the information through the PRISMA ScR (Extension for Scoping Reviews) checklist, ensuring greater transparency and methodological rigor. This protocol will be indexed on the Open Science Framework platform. Results: The search for texts will be carried out in nine databases and gray literature. Three reviewers will carry out the analysis and selection of studies, with the help of the PRISMA Flow Diagram manager. Discrepancies will be resolved by a fourth reviewer. The data will be extracted according to the systematized form for data collection regarding the Scope Review and organized in Excel software, and the conclusions of the studies will be analysed with the help of software. Discussion: The results will be presented in a tabular and narrative format, aiming to achieve the objective and review question of this protocol. Conclusion: It is expected that the study will strengthen rehabilitation in Nursing practices in Primary Health Care by elucidating the need for training Specialist Nurses in Rehabilitation Nursing (SNRN) in Health Education actions.

RESUMEN Introducción: La lesión medular es cualquier lesión de las estructuras contenidas en el canal raquídeo (médula, cono medular y cola de caballo), que puede provocar cambios motores, sensoriales, autonómicos y psicoafectivos que provocan repercusiones físicas, psicológicas y sociales. Estudios señalan fragilidad en la atención a la salud brindada a los pacientes con este tipo de lesión incapacitante, en el contexto de la Atención Primaria de Salud y la necesidad de acciones de educación continua en materia de rehabilitación del Enfermero. A pesar de ser la puerta de entrada a los servicios de salud y el primer nivel de atención para los usuarios dentro de su territorio, dentro de sus hogares, estos usuarios aún experimentan dificultades como la inhabilitación profesional para brindar atención integral a pacientes con lesiones medulares. El objetivo del estudio es desarrollar un protocolo de revisión de alcance que buscará identificar y sintetizar la evidencia científica disponible sobre intervenciones de enfermería centradas en la autonomía para las actividades diarias de personas con lesión medular en Atención Primaria de Salud. Metodología: Se utilizará el método propuesto por JBI (Joanna Briggs Institute) y se utilizará la extensión PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) para sistematizar la información a través de la lista de verificación PRISMA ScR (Extension for Scoping Reviews), garantizando una mayor transparencia y rigor metodológico. Este protocolo estará indexado en la plataforma Open Science Framework. Resultados: La búsqueda de textos se realizará en nueve bases de datos y literatura gris. Tres revisores realizarán el análisis y selección de estudios, con la ayuda del gestor del Diagrama de Flujo PRISMA. Las discrepancias serán resueltas por un cuarto revisor. Los datos serán extraídos según el formulario sistematizado de recolección de datos de la Revisión de Alcance y organizados en software Excel, y las conclusiones de los estudios serán analizadas con ayuda de software. Discusión: Los resultados se presentarán en formato tabular y narrativo, con el objetivo de lograr el objetivo y la pregunta de revisión de este protocolo. Conclusión: Se espera que el estudio fortalezca la rehabilitación en las prácticas de Enfermería en la Atención Primaria de Salud, al dilucidar la necesidad de formación de Enfermeros Especialistas en Enfermería de Rehabilitación (EEER) en acciones de Educación en Salud.

RESUMO Introdução: A lesão da medula espinal é toda injúria às estruturas contidas no canal medular (medula, cone medular e cauda equina), podendo levar a alterações motoras, sensitivas, autonômicas e psicoafetivas e que causam repercussões físicas, psíquicas e sociais. Estudos apontam uma fragilidade na assistência à saúde do paciente com este tipo de lesão incapacitante, no contexto da Atenção Primária à Saúde e a necessidade de ações de educação permanente sobre o tema de reabilitação aos Enfermeiros. Apesar de ser a porta de entrada aos serviços de saúde e o primeiro nível de atenção ao usuário inserido em seu território, dentro de sua residência, esses usuários ainda vivenciam dificuldades como a desqualificação profissional para o atendimento integral ao paciente com lesão da medula espinal. O objetivo do estudo é desenvolver um protocolo de revisão de escopo que buscará identificar e sintetizar as evidências científicas disponíveis sobre as intervenções de enfermagem focadas na autonomia para atividades cotidianas de pessoas com lesão medular na Atenção Básica de Saúde. Metodologia: Será utilizado o método proposto pelo JBI (Joanna Briggs Institute) e para sistematização das informações será utilizada a extensão PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) através do check list PRISMA ScR (Extension for Scoping Reviews), garantindo maior transparência e rigor metodológico. O presente protocolo será indexado na plataforma Open Science Framework. Resultados: A busca dos textos será efetuada em nove bases de dados e na literatura cinzenta. Três revisores efetuarão a análise e seleção dos estudos, com auxílio do gerenciador de Diagrama de Fluxo PRISMA. Divergências serão dirimidas por um quarto revisor. Os dados serão extraídos conforme Ficha sistematizada para coleta dos dados referente à Revisão de Escopo e organizados no software Excel, e as conclusões dos estudos serão analisadas com auxílio de software. Discussão: Os resultados serão apresentados de modo tabular e narrativo, visando alcançar objetivo e questão de revisão deste protocolo. Conclusão: Espera-se que o estudo fortaleça a reabilitação nas práticas de Enfermagem na Atenção Primária à Saúde elucidando a necessidade de formação de Enfermeiros Especialistas em Enfermagem de Reabilitação (EEER) nas ações de Educação em Saúde.

https://doi.org/10.33194/rper.2024.358

12.

Portuguese Pancreatic Club Perspectives on Pancreatic Neuroendocrine Neoplasms: Diagnosis and Staging, Associated Genetic Syndromes and Particularities of Their Clinical Approach
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Ferreira-Silva, Joel Meireles, Sara Falconi, Massimo Fernandes, Alexandra Vilas-Boas, Filipe Bispo, Miguel Rio-Tinto, Ricardo Rodrigues-Pinto, Eduardo

GE-Portuguese Journal of Gastroenterology

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jun 2024, Volume 31 N. 3 Pages 3 - 12

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

Abstract Pancreatic neuroendocrine neoplasms (panNENs) have been historically regarded as rare, but their incidence has raised more than 6-fold over the last 3 decades, mostly owing to improvement in the detection of small asymptomatic tumours with imaging. Early detection and proper classiﬁcation and staging are essential for the prognosis and management of panNENs. Histological evaluation is mandatory in all patients for the diagnosis of panNEN. Regarding localization and staging, multiphasic contrast-enhanced computer tomography is considered the imaging study of choice. Nevertheless, several other diagnostic modalities might present complementary information that can help in diagnosis and staging optimization: magnetic resonance imaging, somatostatin receptor imaging using positron emission tomography in combination with computed tomography (PET/CT), PET/CT with ﬂuorodeoxyglucose (18F-FDG), and endoscopic ultrasound. Approximately 10%of panNENs are due to an inherited syndrome, which includes multiple endocrine neoplasia type 1, von Hippel-Lindau disease, neuroﬁbromatosis type 1 (NF-1), tuberous sclerosis complex, and Mahvash disease. In this review, the Portuguese Pancreatic Club summarizes the classiﬁcation, diagnosis, and staging of panNENs, with a focus on imaging studies. It also summarizes the characteristics and particularities of panNENs associated with inherited syndromes.

Resumo As neoplasias neuroendócrinas pancreáticas (panNENs) são historicamente consideradas raras, embora a sua incidência tenha aumentado mais de 6 vezes nas últimas três décadas, principalmente devido à otimização do diagnóstico de tumores pequenos e assintomáticos em exames de imagem. A deteção precoce, a classiﬁcação e o estadiamento adequados são essenciais para o prognóstico e abordagem dos panNENs. A avaliação histológica é obrigatória em todos os doentes para o diagnóstico de panNENs. Para a localização e estadiamento, a TC multifásica com contraste é considerada o estudo de imagem de eleição. Contudo, várias outras modalidades diagnósticas podem apresentar informações complementares que podem auxiliar no diagnóstico e na otimização do estadiamento: ressonância magnética, PET/CT dos receptores da somatostatina, PET/CT [1⁸F]FDG e ecoendoscopia. Aproximadamente 10% dos panNENs estão relacionados com síndromes hereditários, que incluem neoplasia endócrina múltipla tipo 1 (MEN1), doença de von Hippel-Lindau (VHL), neuroﬁbromatose tipo 1 (NF1), complexo de esclerose tuberosa (TSC) e doença de Mahvash. Neste artigo, o Clube Português de Pâncreas aborda a classiﬁcação, diagnóstico e estadiamento de panNENs, com foco nos estudos de imagem, bem como resume as características e particularidades dos panNENs associados aos síndromes hereditários.

https://doi.org/10.1159/000534641

13.

Brucellar Spondylodiscitis - A Case Report
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Guilarde, Adriana Oliveira

; Teles-Filho, Ricardo Vieira

; Borges, Moara Alves Santa Barbara

; Viggiano, Giovanni Ferreira

; Costa, Paulo Sérgio Sucasas da

; Afiune, Gustavo Abrahão

Acta Radiológica Portuguesa

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apr 2024, Volume 36 N. 1 Pages 35 - 36

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

Abstract Brucellosis, a disease caused by bacteria of the genus Brucella, presents a wide range of symptoms in humans, which makes diagnosis challenging, especially when atypical manifestations occur. This article reports a rare case of spondylodiscitis and highlights the importance of investigating brucellosis in patients with prolonged spondylodiscitis who do not respond to conventional antibiotic treatments. Furthermore, it highlights the need for a complete epidemiological e radiologic analysis and the performance of specific serological tests for an accurate diagnosis of the underlying cause. Early suspicion, based on a detailed history and careful diagnosis, together with advances in imaging techniques, is crucial for planning effective treatment.

Resumo A brucelose, uma doença causada por bactérias do gênero Brucella, apresenta uma ampla gama de sintomas em seres humanos, o que torna o diagnóstico desafiador, especialmente quando ocorrem manifestações atípicas. Este artigo relata um caso raro de espodilodiscite e ressalta a importância de investigar a brucelose em pacientes com espodilodiscite prolongada que não respondem aos tratamentos antibióticos convencionais. Além disso, destaca a necessidade de uma análise epidemiológica e radiológica completa e a realização de testes sorológicos específicos para um diagnóstico preciso da causa subjacente. A suspeita precoce, baseada em uma anamnese detalhada e em um diagnóstico cuidadoso, juntamente com os avanços nas técnicas de imagem, é crucial para o planeamento de um tratamento eficaz.

https://doi.org/10.25748/arp.31290

14.

Unfractionated heparin in ruptured aortic aneurysms - narrative review
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Ribeiro, Tiago F. Correia, Ricardo Bento, Rita Pais, Fábio Ferreira, Rita Soares Gonçalves, Frederico Bastos Amaral, Carlos Ferreira, Maria Emília

Angiologia e Cirurgia Vascular

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mar 2024, Volume 20 N. 1 Pages 25 - 27

Abstract: En | Text: En | PDF: En

Abstract Introduction: Portuguese estimates point out that nearly 20% of aortic aneurysms are treated in a ruptured setting, with in-hospital mortality reaching up to 50%. Although unfractionated heparin (UFH) is routine during elective surgery, this technical point is debatable when treating ruptured aneurysms. The authors aimed to review the literature on the topic of intraoperative heparinization with UFH within the intraoperative period of ruptured aortic aneurysms. Methods: A MEDLINE and Scopus database search using the terms “unfractionated heparin," “aortic aneurysm," and “ruptured aortic aneurysm” was performed. No time or language limitations were imposed. The last search was run in July 2023. Manuscripts were considered irrespective of study design. Additional articles of scientific interest for the purpose of this non-systematic review were included by cross-referencing. Results: In the rupture setting, UFH usage rates have widely varied throughout time and geographical sites, and they are reported to be as low as 16%. Overall, the evidence of UFH in clinical practice in this scenario is limited. Notwithstanding, there is some evidence from observational studies of an increased pro-coagulant activity in this clinical scenario, favoring a theoretical physiologic benefit. A prospective, non-randomized study of 131 OSR patients found that patients treated with UFH had improved 30-day survival (84% vs 67%, P=0.001). Non-significant differences in blood product usage were noted. Therefore, societal guideline recommendations about intraoperative UFH in ruptured aortic aneurysms are often missing. Conclusion: UFH may potentially reduce death after open repair of rAAA. These findings should be carefully interpreted, as the evidence is scarce and heterogeneous and only portrays open repair.

https://doi.org/10.48750/acv.564

15.

Endoleak tipo 2 “maligno”: una entidad ya conocida, pero con un comportamiento más agresivo
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Ferreira, L. Mariano

; Ferrer, Miguel

; Aloy, Leonela

; Dávila, Oscar

; Diluca, Pablo

; Mura, Ricardo La Lylyk, Pedro

Revista argentina de cardiología

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mar 2024, Volume 92 N. 1 Pages 75 - 78

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.7775/rac.es.v92.i1.20733

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