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Systemic amyloidosis: an aggressive evolution in a patient with relapsing polychondritis and monoclonal gammopathy of undetermined significance (MGUS) undergoing peritoneal dialysis amyloidosis MGUS (MGUS
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Matos, Thiago Cavalcanti

; Fischer, William George Giusti

; Pereira, Rosa Maria Rodrigues

; Franco, Andre Silva

Autopsy and Case Reports

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2024, Volume 14 elocation e2024518

Abstract: En | Text: En | PDF: En

ABSTRACT Herein, we report the case of primary amyloidosis with multi-organ involvement in a female patient in her 50s. The patient had a history of relapsing polychondritis, chronic kidney disease, and monoclonal gammopathy of undetermined significance (MGUS). The clinical manifestations included neuropathic pain, sensorimotor polyneuropathy, intrahepatic cholestatic liver injury, gastrointestinal symptoms, dysautonomia, and myocardial thickening. Initial histologic evaluations of the abdominal fat pad aspirate and bone marrow biopsy were negative for amyloid deposition. However, due to a high index of suspicion, a second bone marrow biopsy was performed, confirming the presence of the amyloid protein. Given the patient's complex medical history, other types of amyloidosis, such as AA amyloidosis, AL amyloidosis, and ß2-microglobulin amyloidosis, should also be considered as differential diagnoses. The type of amyloid protein was subsequently identified through laser microdissection of amyloid fibrils followed by liquid chromatography–tandem mass spectrometry as AL-lambda (amyloid light-chain) amyloidosis. The patient presented unfavorable evolution, with progressive dysautonomia, being admitted to the ICU, culminating in refractory circulatory shock, and undergoing an empirical broad-spectrum antibiotic therapy. After a few days, she presented pulseless ventricular tachycardia, culminating in her death, before undergoing specific treatment. This article highlights the crucial role of precise identification in guiding appropriate therapeutic strategies for this complex, yet potentially severe, diseases. Herein multiorgan multi organ 50s s polychondritis disease MGUS. MGUS . (MGUS) pain polyneuropathy injury symptoms dysautonomia thickening deposition However suspicion performed patients ß2microglobulin ßmicroglobulin ß2 microglobulin ß diagnoses chromatographytandem chromatography tandem ALlambda lambda lightchain light chain light-chain evolution ICU shock broadspectrum broad spectrum therapy days tachycardia death treatment severe diseases (MGUS

https://doi.org/10.4322/acr.2024.518

Effectiveness and safety of tocilizumab for COVID-19: a systematic review and meta-analysis of randomized clinical trials COVID19 COVID 19 COVID-19 metaanalysis meta analysis COVID1 1 COVID-1 COVID-
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Almeida, Paula Ribeiro Lopes

; Person, Osmar Clayton

; Puga, Maria Eduarda dos Santos

; Giusti, Maria Fernanda

; Pinto, Ana Carolina Pereira Nunes

; Rocha, Aline Pereira

; Atallah, Álvaro Nagib

Sao Paulo Medical Journal

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apr 2023, Volume 141 N. 2 Pages 168 - 176

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Tocilizumab is an anti-human interleukin 6 receptor monoclonal antibody that has been used to treat coronavirus disease 2019 (COVID-19). However, there is no consensus on its efficacy for the treatment of COVID-19. OBJECTIVE: To evaluate the effectiveness and safety of tocilizumab for treating COVID-19. DESIGN AND SETTING: Systematic Review of randomized controlled trials (RCTs), Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. METHODS: We searched MEDLINE via PubMed, EMBASE, CENTRAL, and IBECS for RCTs published up to March 2021. Two authors selected studies and assessed the risk of bias and the certainty of the evidence following Cochrane Recommendations. RESULTS: Eight RCTs with 6,139 participants were included. We were not able to find differences between using tocilizumab compared to standard care on mortality in hospitalized patients with COVID-19 (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.84 to 1.13; 8 trials; 5,950 participants; low-certainty evidence). However, hospitalized patients under tocilizumab plus standard care treatment seemed to present a significantly lower risk of needing mechanical ventilation (risk ratio = 0.78; 95% CI 0.64−0.94 moderate-certainty of evidence). CONCLUSIONS: To date, the best evidence available shows no difference between using tocilizumab plus standard care compared to standard care alone for reducing mortality in patients with COVID-19. However, as a finding with a practical implication, the use of tocilizumab in association to standard care probably reduces the risk of progressing to mechanical ventilation in those patients. REGISTRATION: osf.io/qe4fs. BACKGROUND antihuman anti human 201 COVID19. COVID19 COVID 19 . (COVID-19) However 19. OBJECTIVE SETTING RCTs, , (RCTs) UNIFESP, UNIFESP (UNIFESP) SP, SP (SP) Brazil METHODS PubMed EMBASE CENTRAL 2021 Recommendations RESULTS 6139 139 6,13 included COVID-1 RR (RR 097 0 97 0.97 95 (CI 084 84 0.8 1.13 113 1 13 5950 5 950 5,95 lowcertainty low evidence. evidence) 0.78 078 78 064094 64 94 0.64−0.9 moderatecertainty moderate CONCLUSIONS date implication REGISTRATION osfioqe4fs osfioqefs osf io qe4fs qe fs osf.io/qe4fs 20 COVID1 (COVID-19 (RCTs (UNIFESP (SP 202 613 6,1 COVID- 09 9 0.9 08 0. 1.1 11 595 5,9 0.7 07 7 06409 0.64−0. osfioqe qefs 2 (COVID-1 61 6, 1. 59 5, 0640 0.64−0 (COVID- 064 0.64− (COVID 06 0.64 0.6

https://doi.org/10.1590/1516-3180.2022.0170.r1.01072022

Modelo de madurez para preservación digital basado en conceptos de planificación estratégica
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Bodero Poveda, Elba María

; Giusti, Marisa Raquel De

; Morales Alarcón, Cristian Hugo

Investigación bibliotecológica

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mar 2023, Volume 37 N. 94 Pages 51 - 73

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

Abstract For long-term digital preservation, entities require a coherent analysis of internal and external aspects that facilitate the constitution of a digital repository, with a solid structure and high maturity characteristics. The present research aims to design a maturity model for long-term digital preservation, which includes the maturity characteristics that a digital repository must have to preserve digital objects at its highest stage, the ISO 16363 audit standard and the most important principles of strategic planning. This model was validated by experts using the Delphi method and a case study on the SEDICI digital repository. The proposed maturity model focuses on a quantitative percentage assessment, its process, the description of its phases, three analysis perspectives and three strategic planning principles were integrated.

Resumen Para la preservación digital a largo plazo, las entidades requieren de un análisis coherente de aspectos internos y externos que faciliten la constitución de un repositorio digital, con una estructura sólida y con altas características de madurez. La presente investigación tiene por objetivo diseñar un modelo de madurez para preservación digital a largo plazo, que incluya las características de madurez que debe poseer un repositorio digital para conservar los objetos digitales en su fase más alta, el estándar de auditoría ISO 16363 y los principios más importantes de la planificación estratégica. Este modelo fue validado por expertos mediante el método Delphi y un caso de estudio en el repositorio digital SEDICI. El modelo de madurez propuesto se centra en una valoración cuantitativa porcentual; se indica su proceso y la descripción de sus fases. Se integraron tres perspectivas de análisis y tres principios de planificación estratégica.

https://doi.org/10.22201/iibi.24488321xe.2023.94.58654

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision cancer
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FAIER, THAIS ANDRESSA SILVA

; QUEIROZ, FABIO LOPES

; LACERDA-FILHO, ANTÔNIO

; PAIVA, RODRIGO ALMEIDA

; FRANÇA NETO, PAULO ROCHA

; CORTES, MARCELO GIUSTI WERNECK

; CARVALHO, ALEXANDRE RIBAS DE

; PEREIRA, BARBARA MARIA TAVARES

Revista do Colégio Brasileiro de Cirurgiões

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2023, Volume 50 elocation e20233435

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

RESUMO Objetivos: o objetivo deste estudo foi avaliar os resultados da cirurgia do câncer de reto, em uma unidade que adota os princípios da excisão total do mesorreto (ETM) com baixa taxa de amputação abdominoperineal (AAP). Métodos: os pacientes com câncer retal extraperitoneal foram submetidos a ETM ou ETM com amputação abdominoperianeal. Pacientes com tumores de reto médio foram submetidos a EMT e pacientes com tumores de reto inferior e sem critérios para AAP foram submetidos a EMT e ressecção interesfincteriana. Aqueles em que o espaço interesfincteriano foi invadido e naqueles com margem distal livre menor que 1cm ou margem radial livre de tumor foram inatingíveis foram submetidos a AAP ou excisão abdominoperineal extraelevadora (ELAPE). Avaliamos as taxas de recorrência local, sobrevida global e envolvimento da margem radial. Resultados: sessenta (89,6%) pacientes realizaram ETM e sete (10,4%) ETM + AAP, dos quais cinco realizaram ELAPE. A recidiva local, em pacientes submetidos a ETM com ressecção anterior baixa, foi de 3,3% e em pacientes submetidos a AAP, 14,3%. A taxa de recorrência local (p=0,286) ou a taxa de recorrência à distância (p=1,000) foi semelhante entre os grupos. Não houve envolvimento das margens radiais. A sobrevida após 120 meses foi semelhante (p=0,239). Conclusão: as neoplasias malignas retais, incluindo aquelas localizadas no reto baixo, podem ser tratadas cirurgicamente com baixo índice de AAP, sem comprometer os princípios oncológicos e com baixo índice de recorrência local. Objetivos (ETM AAP. . (AAP) Métodos abdominoperianeal interesfincteriana cm ELAPE (ELAPE) Resultados 89,6% 896 89 6 (89,6% 10,4% 104 10 4 (10,4% 33 3 3,3 143 14 14,3% p=0,286 p0286 p 0 286 (p=0,286 p=1,000 p1000 1 000 (p=1,000 grupos radiais 12 p=0,239. p0239 p=0,239 239 (p=0,239) Conclusão retais (AAP (ELAPE 89,6 8 (89,6 10,4 (10,4 3, 14,3 p=0,28 p028 28 (p=0,28 p=1,00 p100 00 (p=1,00 p023 p=0,23 23 (p=0,239 89, (89, 10, (10, 14, p=0,2 p02 2 (p=0,2 p=1,0 p10 (p=1,0 (p=0,23 (89 (10 p=0, p0 (p=0, p=1, p1 (p=1, (8 (1 p=0 (p=0 p=1 (p=1 ( p= (p= (p

ABSTRACT Objectives: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). Methods: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. Results: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). Conclusion: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates. Objectives surgery (TME APE. . (APE) Methods TMEAPE TME+APE resection cm ELAPE (ELAPE) rates Results 89.6% 896 89 6 (89.6% 10.4% 104 10 4 (10.4% TMELAR LAR TME+LAR 33 3 3.3 143 14 14.3% p=0.286 p0286 p 0 286 (p=0.286 p=1.000 p1000 1 000 (p=1.000 groups margins 12 p=0.239. p0239 p=0.239 239 (p=0.239) Conclusion malignancies (APE (ELAPE 89.6 8 (89.6 10.4 (10.4 3. 14.3 p=0.28 p028 28 (p=0.28 p=1.00 p100 00 (p=1.00 p023 p=0.23 23 (p=0.239 89. (89. 10. (10. 14. p=0.2 p02 2 (p=0.2 p=1.0 p10 (p=1.0 (p=0.23 (89 (10 p=0. p0 (p=0. p=1. p1 (p=1. (8 (1 p=0 (p=0 p=1 (p=1 ( p= (p= (p

https://doi.org/10.1590/0100-6991e-20233435-en

Sustainability in fashion retail: literature review and bibliometric analysis
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Prado, Nátalie Martins

; Silva, Marina Hernandes de Paula e

; Kaneko, Camila Sayuri Kikuti

; Silva, Daiane Vitória da

; Giusti, Gabriela

; Saavedra, Yovana Maria Barrera

; Silva, Diogo Aparecido Lopes

Gestão & Produção

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2022, Volume 29 elocation e13322

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

Resumo O objetivo principal deste estudo foi explorar e analisar a produção científica recente sobre sustentabilidade no varejo de moda. A metodologia foi baseada em uma revisão da literatura e análise bibliométrica dos últimos 12 anos de artigos publicados revisados por pares sobre o tema. Os resultados ilustraram um aumento nas publicações em 2017 e 2018, com grande participação de países como Estados Unidos e China. Os resultados abrangeram uma ampla diversidade de temas relacionados ao varejo de moda, tais como: slow fashion, fast fashion, sustentabilidade na cadeia de suprimentos, produção e consumo sustentável de produtos têxteis e, as principais barreiras, benefícios e tendências para o setor em um futuro próximo. Devido ao aumento dos impactos sociais e ambientais negativos nas últimas décadas, mais estudos relacionados às práticas de sustentabilidade a serem adotadas por esse setor são necessários para identificar potenciais alternativas de solução para o problema. Fizemos uma lista com as 55 práticas mais importantes para promover a sustentabilidade no varejo de moda.

Abstract The main objective of this study was to explore and analyze the recent scientific production on sustainability in the fashion retail sector. The methodology was based on a literature review and bibliometric analysis of the last 12 years of peer-reviewed published papers on the topic. The results illustrated an increase in publications in 2017 and 2018, with large participation from countries such as the United States and China. The findings covered a broad diversity of topics related to fashion retail such as: slow fashion, fast fashion, sustainability in the supply chain, sustainable production and consumption of textile products, and the main barriers, benefits, and trends for this sector in a near future. Due to the increase of negative social and environmental impacts in the last decades more studies related to sustainability practices to be adopted by this sector are required to identify potential alternative solutions for the problem. We did a list with the 55 most important practices to promote sustainability in fashion retail.

https://doi.org/10.1590/1806-9649-2022v29e13322

Effectiveness and safety of tocilizumab for COVID-19: a systematic review and meta-analysis of randomized clinical trials
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Almeida, Paula Ribeiro Lopes

; Person, Osmar Clayton

; Puga, Maria Eduarda dos Santos

; Giusti, Maria Fernanda

; Pinto, Ana Carolina Pereira Nunes

; Rocha, Aline Pereira

; Atallah, Álvaro Nagib

Sao Paulo Medical Journal

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2022, N. ahead

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-3180.2022.0170.r1.01072022

Desenvolvimento Profissional de Professores Orientadores de Estudos em Educação Matemática por Formação Colaborativa
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Giusti, Neura Maria De Rossi

; Reuwsaat, Jutta Cornelia

Sisyphus - Journal of Education

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oct 2021, Volume 9 N. 2 Pages 181 - 204

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

Resumen El artículo tiene como objetivo mostrar cómo los profesores de primaria, en el papel de orientadores de estudio, construyen su desarrollo profesional en una formación colaborativa en servicio. Se realizó una investigación cualitativa basada en la dinámica investigación-acción-formación. El análisis de los hallazgos se realizó con base en el modelo de desarrollo profesional idealizado por Clarke y Hollingsworth, categorizando los cambios de los docentes en los dominios personal, práctico, externo y de consecuencias. Los orientadores de estudio fueron los protagonistas de su desarrollo profesional, ya que movilizaron un conjunto de conocimientos propios que, de manera explícita e implícita, generaron cambios en ellos mismos y en los demás docentes. Los participantes fueron movilizados, durante la capacitación, por la perspectiva de transformación. Si la transformación se extiende a las prácticas educativas futuras, es porque los cambios han sido profundos.

Resumo O artigo tem o objetivo de evidenciar como professoras do Ensino Fundamental, no papel de orientadoras de estudos, constroem seu desenvolvimento profissional em uma formação colaborativa em serviço. Foi realizada uma investigação qualitativa alicerçada pela dinâmica investigação-ação-formação. A análise dos dados foi realizada com base no modelo de desenvolvimento profissional idealizado por Clarke e Hollingsworth, categorizando-se as mudanças dos professores nos domínios pessoal, das práticas, externo e das consequências. As orientadoras de estudos foram protagonistas de seu desenvolvimento profissional, pois mobilizaram um conjunto de saberes próprios que, explícita e implicitamente, geraram mudanças em si mesmas e nos demais professores. As participantes foram mobilizadas, no decorrer da formação, para a perspectiva de transformação. Caso a transformação se estenda ao longo de práticas educativas futuras, é porque as mudanças foram profundas.

Abstract The article aims to show how elementary school teachers build their professional development in collaborative in-service education as study advisors. A qualitative investigation was performed based on the dynamics investigation-action-formation. The analysis of the findings was based on Clarke and Hollingsworth's professional development model, categorising the teachers' changes in the personal, practical, external and consequence-related domains. The study advisors were the protagonists of their professional development, as they mobilised part of their own knowledge that, explicitly and implicitly, generated changes in themselves and in the other teachers. Participants were mobilised, during the training, for the perspective of transformation. If the transformation extends to future educational practices, it is because the changes have been profound.

https://doi.org/10.25749/sis.20933 14 downloads

New information of stopover sites for Chloephaga geese in central Patagonia: potential implications for Ruddy-headed Goose (Chloephaga rubidiceps) conservation
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Giusti, María Emilia

; Martín, Lucía B

; Buchanan, Patrick

; Gabarain, Gabriela

; Cossa, Natalia A

; Krapovickas, Juan

; Fasola, Laura

; Roesler, Ignacio

El hornero

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aug 2020, Volume 35 N. 1 Pages 47 - 53

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

Three migratory species of sheldgeese (Chloephaga spp.) make seasonal movements across a large portion of the Argentine territory. All three of these species have been affected by anthropogenic actions which have caused dramatic population drops, especially for the Ruddy-headed Goose (Chloephaga rubidiceps). Although telemetry techniques have rapidly advanced, knowledge of the migratory routes of many Neotropical birds is still incipient. The study of migration routes should be a top priority, especially when conservation and management actions are necessary along the main migratory routes. The goal of this work is to present new evidence of important stopover sites and concentration areas of migratory sheldgeese in eastern Patagonia. We conducted fieldwork during the fall, winter and spring of 2017, all of 2018 and the summer of 2019 in Chubut province, Argentina. We identified one stopover area for sheldgeese within a recently created protected area, the Parque Interjurisdiccional Marino Costero Patagonia Austral (PIMCPA), that could be a key site for the protection of the three species, in particular for the Ruddy-headed Goose. Results will provide input for decision-making processes during the design of future infrastructure projects already planned in eastern Patagonia along the migratory route of several species.

Tres especies de cauquenes (Chloephaga spp.) migratorios realizan movimientos estacionales a lo largo de gran parte del territorio argentino. Todas han sido afectadas por acciones antrópicas, lo cual ha causado declives dramáticos en sus poblaciones, especialmente en el Cauquén Colorado (Chloephaga rubidiceps). Si bien en la actualidad las técnicas de telemetría han avanzado, el conocimiento de las rutas migratorias de muchas aves del Neotrópico aún es incipiente. El estudio de las rutas migratorias debe ser prioritario, principalmente cuando acciones de conservación y manejo son necesarias a lo largo de las mismas. El objetivo del presente trabajo es dar a conocer nuevas evidencias de sitios de escala y áreas de concentración de cauquenes migratorios en el Este de la Patagonia. Trabajamos durante el otoño, invierno y primavera de 2017, todo el año 2018 y verano de 2019 en la provincia de Chubut, Argentina. Identificamos un área de escala para las tres especies, en el Parque Interjurisdiccional Marino Costero Patagonia Austral (PIMCPA), como sitio de gran importancia para la conservación de las tres especies durante la migración, particularmente para el cauquén colorado. Los resultados obtenidos podrían servir en la toma de decisiones durante futuros proyectos de infraestructura planeados en el Este de Patagonia a lo largo de las rutas migratorias de varias especies.

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Posicionamento da Sociedade Brasileira de Cardiologia para Gravidez e Planejamento Familiar na Mulher Portadora de Cardiopatia – 2020
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Avila, Walkiria Samuel

; Alexandre, Elizabeth Regina Giunco

; Castro, Marildes Luiza de

; Lucena, Alexandre Jorge Gomes de

; Marques-Santos, Celi

; Freire, Claudia Maria Vilas

; Rossi, Eduardo Giusti

; Campanharo, Felipe Favorette

; Rivera, Ivan Romero

; Costa, Maria Elizabeth Navegantes Caetano

; Rivera, Maria Alayde Mendonça

; Carvalho, Regina Coeli Marques de

; Abzaid, Alexandre

; Moron, Antonio Fernandes

; Ramos, Auristela Isabel de Oliveira

; Albuquerque, Carlos Japhet da Mata

; Feio, Claudine Maia Alves

; Born, Daniel

; Silva, Fábio Bruno da

; Nani, Fernando Souza

; Tarasoutchi, Flavio

; Costa Junior, José de Ribamar

; Melo Filho, José Xavier de

; Katz, Leila

; Almeida, Maria Cristina Costa

; Grinberg, Max

; Amorim, Melania Maria Ramos de

; Melo, Nilson Roberto de

; Medeiros, Orlando Otávio de

; Pomerantzeff, Pablo Maria Alberto

; Braga, Sérgio Luiz Navarro

; Cristino, Sonia Conde

; Martinez, Tania Leme da Rocha

; Leal, Tatiana de Carvalho Andreuci Torres

Arquivos Brasileiros de Cardiologia

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may 2020, Volume 114 N. 5 Pages 849 - 942

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

https://doi.org/10.36660/abc.20200406 10784 downloads

10.

Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge
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Avila, Walkiria Samuel

; Ribeiro, Veronica Martins

; Rossi, Eduardo Giusti

; Binotto, Maria Angelica

; Bortolotto, Maria Rita

; Testa, Carolina

; Francisco, Rossana

; Hajjar, Ludhmilla Abraão

; Miura, Nana

Arquivos Brasileiros de Cardiologia

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dec 2019, Volume 113 N. 6 Pages 1062 - 1069

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

Resumo Fundamento: A contínua habilidade na conduta das cardiopatias congênitas complexas (CCC) tem permitido o alcance da idade fértil. Contudo, a heterogeneidade das lesões cardíacas na idade adulta limita a estimativa do prognóstico da gravidez. Objetivo: Estudar a evolução materno-fetal das gestantes portadoras de CCC e analisar as variáveis presumíveis de prognóstico. Método: No período de 10 anos, 435 gestantes portadoras de cardiopatias congênitas foram consecutivamente incluídas no Registro do Instituto do Coração (Registro-InCor). Dentre elas, foram selecionadas 42 gestações em 40 mulheres com CCC (24,5 ± 3,4 anos) que haviam sido desaconselhadas a engravidar. As cardiopatias de base distribuíram-se em: transposição das grandes artérias, atresia pulmonar, atresia tricúspide, ventrículo único, dupla via de saída de ventrículo direito, dupla via de entrada de ventrículo esquerdo e outras lesões estruturais. As cirurgias realizadas foram Rastelli, Fontan, Jatene, Senning, Mustard e outros procedimentos combinados, como tunelização, Blalock Taussing e Glenn. Oito pacientes (20%) não haviam sido operadas, e 19 (47,5%) apresentavam hipoxemia. O protocolo de atendimento incluiu: registro da saturação de oxigênio, hemoglobina sérica, hematócrito, ajuste das medicações, anticoagulação individualizada e hospitalização a partir de 28 semanas de gestação, em face da gravidade do quadro clínico e obstétrico. Na análise estatística, o nível de significância adotado foi de 0,05. Resultado: Somente 17 gestações (40,5%) não tiveram complicações maternas nem fetais. Houve 13 problemas maternos (30,9%) e 2 mortes (4,7%) causadas por hemorragia pós-parto e pré-eclâmpsia grave, ambas em pacientes que apresentavam hipoxemia. Houve 7 perdas fetais (16,6%), 17 bebês prematuros (40,5%) e 2 recém-nascidos (4,7%) com cardiopatia congênita. As complicações materno-fetais foram significativamente maiores em pacientes que apresentavam hipoxemia (p < 0,05). Conclusão: O alcance da idade reprodutiva em pacientes com CCC é crescente; contudo, a má evolução materno-fetal desaconselha a gravidez, particularmente nas pacientes que apresentam hipoxemia.

Abstract Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.

https://doi.org/10.5935/abc.20190197 2000 downloads

11.

Contribuições da Geometria Dinâmica na Introdução ao Estudo de Perspectiva para Alunos do Ensino Médio
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Galvão, Maria Elisa Esteves Lopes

; Souza, Vera Helena Giusti de

; Bastos, Lucas Cunha

Bolema: Boletim de Educação Matemática

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aug 2019, Volume 33 N. 64 Pages 790 - 810

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

Resumo Neste artigo, teve-se por objetivo investigar as contribuições de uma proposta interventiva de ensino de Geometria, baseada nas ideias básicas da perspectiva, para ampliar o repertório de representações planas e as habilidades de visualização de dez alunos do Ensino Médio de uma escola pública brasileira do Ceará. Com base no desenvolvimento histórico de técnicas para a representação plana de figuras espaciais e orientados metodologicamente pelo Design Experiment, elaboraram-se atividades para, em três encontros, analisar pinturas e imagens de várias épocas e utilizar um ambiente de Geometria Dinâmica para explorar técnicas de construção de imagens em perspectiva. Procurou-se suporte teórico nos estudos de Parzysz e de Gutiérrez sobre representações planas de figuras espaciais, particularmente nas ideias de polo do “visto” e polo do “sabido”. A análise qualitativa dos dados evidenciou que o uso de um software pode despertar interesse por construções geométricas e por Geometria e mostrou que houve limitações no aprendizado de novos conceitos relativos às representações, principalmente os baseados nos previamente estabelecidos desses participantes. Por outro lado, o uso do software permitiu que alguns participantes se conscientizassem da importância do conhecimento das regras de representação para a interpretação de imagens em perspectiva, o que mostra que um trabalho dessa natureza, a longo prazo, pode promover aprendizagem e visualização em Geometria.

Abstract The objective was to investigate contributions of an interventional proposal using perspective initial ideas for Geometry teaching, in order to expand the repertoire of plane representations and spatial visualization abilities for ten Brazilian High School students. Based on the historical development of techniques for bidimensional representations of spatial figures and methodologically oriented by Design Experiment procedures, activities have been developed in three meetings, at first to analyze paintings and images from various times and, afterwards, using the Dynamic Geometry environment to explore techniques for constructing images in perspective. We sought theoretical support in Parzysz and Gutiérrez's studies on bidimensional representations of spatial figures, particularly on the ideas of "seeing" and "knowing" poles. Qualitative data analysis showed that using a software may provoke interest on geometric constructions and Geometry study, although there were limitations in learning new concepts, especially those based on those participants previous ones. On the other hand, using the software has allowed some participants to become aware of the importance of knowing the representation rules for the interpretation of images in perspective, which shows that a long-term work of this nature can promote learning and visualization in Geometry.

https://doi.org/10.1590/1980-4415v33n64a17 1282 downloads

12.

Biodiversidad de insectos polinizadores y depredadores en agroecosistemas vitícolas de Mendoza, Argentina: Consideraciones para el manejo del hábitat
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López García, Guillermo Pablo

; Mazzitelli, María Emilia

; Fruitos, Andrea

; González, Marcela

; Marcucci, Bruno

; Giusti, Romanela

; Alemanno, Valeria

; del Barrio, Lucía

; Portela, José

; Debandi, Guillermo

Revista de la Facultad de Ciencias Agrarias. Universidad Nacional de Cuyo

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jun 2019, Volume 51 N. 1 Pages 309 - 322

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

This study exposes first results about the influence of habitat management with native vegetation on the ecosystem services offered by pollinators and pest controller insects, in vineyards of Mendoza, Argentina. The work was carried out in three vineyards located in Gualtallary, department of Tupungato, which present biological corridors and inter-row coverings with different proportions of native vegetation. In order to determine relevant groups of beneficial insects present, samples with entomological net were taken in corridors and vineyards. The specimens captured were identified and richness, diversity and abundance of pollinating insects (Apidae, Andrenidae, Colletidae, Halictidae, Megachilidae and Syrphidae) were estimated, as well as of certain groups of predatory insects (Coccinellidae, Nabidae, Reduviidae, Geocoridae, Anthocoridae, Chrysopidae, Hemerobiidae, Crabronidae and Sphecidae), which were found in those environments. Results suggest that habitat management with intentional provision of native vegetation covers, and particularly with attracting flowering forbs, is potentially efficient to increase biodiversity of the functional groups studied and, therefore, maintain the ecosystem services offered by them.

El presente estudio expone los primeros resultados obtenidos acerca de la influencia del manejo de hábitat con vegetación nativa sobre los servicios ecosistémicos ofrecidos por insectos polinizadores y controladores de plagas, en viñedos de la provincia de Mendoza, Argentina. El trabajo se realizó en tres viñedos situados en Gualtallary, departamento de Tupungato, los cuales presentan corredores biológicos con diferentes proporciones de vegetación nativa y un manejo del espacio interfilar con coberturas. Con el objetivo de determinar los grupos relevantes de insectos benéficos en corredores y en viñedos, se realizaron muestreos con red entomológica. Se identificaron las especies colectadas y se estimó la riqueza, diversidad y abundancia de insectos polinizadores (Apidae, Andrenidae, Colletidae, Halictidae, Megachilidae y Syrphidae), así como de ciertos grupos de insectos depredadores (Coccinellidae, Nabidae, Reduviidae, Geocoridae, Anthocoridae, Chrysopidae, Hemerobiidae, Crabronidae y Sphecidae), que se encontraron en esos ambientes. Los resultados sugieren que el manejo de hábitat con provisión intencional de coberturas de vegetación nativa, y en particular de especies con flores atractivas para insectos, es potencialmente eficiente para favorecer la biodiversidad de los grupos funcionales estudiados y, por lo tanto, el mantenimiento de los servicios ecosistémicos ofrecidos por estos.

620 downloads

13.

Modelos de manejo del espacio interfilar en viñedos: percepciones acerca de su valor como proveedores de servicios ecosistémicos
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Fruitos, Andrea

; Portela, José Antonio

; Del Barrio, Lucía

; Mazzitelli, María Emilia

; Marcucci, Bruno

; Giusti, Romanela

; Alemanno, Valeria

; Chaar, Javier

; López García, Guillermo

; González Luna, Marcela

; Aquindo, Natalia

; Debandi, Guillermo

Revista de la Facultad de Ciencias Agrarias. Universidad Nacional de Cuyo

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jun 2019, Volume 51 N. 1 Pages 261 - 272

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

Currently, in the main wine region of Argentina there are several management techniques of the vineyard, which impact on biodiversity and the supply of ecosystem goods and services. We wanted to investigate the perception degree that technicians and local grapevine growers have on the effects of inter-row management practices on the provision of ecosystem services, as well as their associated costs. Through interviews, we asked about the degree of contribution that the five inter-row management techniques identified over the main vine productive areas of Mendoza, have on 33 environmental, cultural and productive key variables. The perception values obtained were contrasted with current scientific knowledge to identify the degree of adequacy between them. Finally, by means of data triangulation, causal loop diagrams were constructed in order to explain the operation of the models from a complex system dynamics approach. Results show that local growers and technicians perceive greater environmental benefits in those managements with vegetation cover, particularly the permanent ones and those incorporating native species, in coincidence with the scientific evidence. Likewise, the causal loop diagrams show a greater complexity of relationships in these management techniques that could evidence a greater resilience of the agroecosystems and better possibilities of conserving the native biodiversity and its ecosystem services.

Actualmente, en la principal región vitícola de Argentina conviven diversos manejos técnicos del viñedo, que impactan sobre la biodiversidad y la oferta de bienes y servicios ecosistémicos. Quisimos investigar en qué grado los referentes de la producción vitícola perciben los efectos de las prácticas de manejo del espacio interfilar sobre la provisión de servicios ecosistémicos, como también los costos asociados. A través de entrevistas, se consultó acerca del grado de contribución que poseen cinco esquemas de manejo identificados en las principales áreas productivas, sobre 33 variables (ambientales, culturales y productivas). Los valores de percepción obtenidos fueron contrastados con el conocimiento científico actual para identificar el grado de adecuación entre ellos. Finalmente, mediante triangulación de datos se construyeron diagramas causales, para explicar el funcionamiento de los modelos desde un enfoque de dinámica de sistemas complejos. Los resultados muestran que los referentes locales perciben mayores beneficios ambientales en prácticas de manejo con coberturas vegetales, en particular las permanentes y con especies nativas, en coincidencia con la evidencia científica. Asimismo, los diagramas causales muestran una mayor complejidad de relaciones en estos manejos, que evidenciarían una mayor resiliencia de los agroecosistemas y mejores posibilidades de conservar la biodiversidad nativa y sus servicios ecosistémicos.

197 downloads

14.

Double blinded randomized clinical trial to assess the effectiveness of several preparations for colonoscopy
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Cortes, Bruno Giusti Werneck

; Cabral, Raquel Martins

; Carmo, Guilherme Augusto Alves do

; Queiroz, Fábio Lopes de

; Leite, Sinara Mônica de Oliveira

; Andrade, Amanda Cristina de Souza

; Ferreira, Alexandre Silluzio

; Alcici, Marta Eugênia

; Cortes, Maria da Conceição Juste Werneck

Journal of Coloproctology (Rio de Janeiro)

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dec 2018, Volume 38 N. 4 Pages 302 - 308

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

RESUMO Introdução: a colonoscopia é o padrão ouro de triagem para pesquisa de várias doenças colônicas. A excelência de preparação é um fator determinante para uma colonoscopia de qualidade. Objetivo: Comparar a qualidade das preparações do cólon para colonoscopia com diferentes tipos de medicamentos laxantes em um hospital público de Belo Horizonte, Brasil. Método: Foi realizado um ensaio clínico randomizado duplo cego prospectivo de junho de 2016 a março de 2017. Um total de 117 pacientes foi randomizado em quatro grupos para receber um tipo de preparação (picossulfato sódico, manitol, lacticol, lactulose). Os pacientes responderam a um questionário e amostras de sangue periférico foram coletadas antes e depois da preparação. A qualidade da limpeza foi acessada de acordo com a Boston Bowel Preparation Scale. Resultados: 99,1% dos pacientes tomaram a dose recomendada e 79,5% relataram boa tolerabilidade. Os endoscopistas realizaram colonoscopia completa em 89,7%, com taxa de polipectomia de 47%. A taxa de eficácia total das soluções foi de 88%. Não houve diferenças estatisticamente significantes entre os grupos (p = 0,271). Em relação aos parâmetros laboratoriais, foram observadas diferenças nos valores pré e pós-teste de sódio, cloro e creatinina, mas sem exceder os valores de referência. Conclusão: As quatro preparações foram eficazes para limpeza do cólon, com boa aceitação, diferindo apenas quanto aos custos.

ABSTRACT Introduction: Colonoscopy is the screening gold standard to investigate several conditions in the colon. The excellence of preparation is a determining factor for a quality colonoscopy. Objective: Compare the quality of colon preparations for colonoscopy with different kinds of laxative medications in a public hospital of Belo Horizonte, Brazil. Method: A prospective double blind randomized clinical trial was conducted from June 2016 to March 2017. A total of 117 Patients were randomised in four groups to receive a type of preparation (Sodium picosulfate, Mannitol, Lactitol, Lactulose). The patients answered a questionnaire and peripheral blood samples were collected before and after the preparation.The quality of the cleansing was accessed according to the Boston Bowel Preparation Scale. Results: 99.1% of patients have taken the recommended dose and 79.5% reported a good tolerability. Endoscopists performed complete colonoscopy in 89.7%, with an polipectomy rate of 47%. The total effectiveness rate of the solutions were 88%. There were no statistically significant differences between groups (p = 0.271). Regarding the laboratory parameters, differences were seen in the pre- and post-test values of sodium, chlorine and creatinine but without exceeding reference values. Conclusion: The four preparations were effective for colon cleansing, with good acceptance, differing only as for costs.

https://doi.org/10.1016/j.jcol.2018.07.001 741 downloads

15.

Usefulness of rapid urease test samples for molecular analysis of clarithromycin resistance in Helicobacter pylori
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Baroni, María R

; Bucci, Pamela

; Giani, Rita N

; Giusti, Antonela

; Tedeschi, Fabian A

; Salvatierra, Emiliano

; Barbaglia, Yanina

; Jimenez, Félix

; Zalazar, Fabian E

Revista argentina de microbiología

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dec 2018, Volume 50 N. 4 Pages 359 - 364

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

Helicobacter pylori is a gastric pathogen that is widely recognized as a causative agent of gastric disease. Its eradication is variable, mainly due to increased resistance to clarithromycin. Our objective was: to evaluate (i) if the biopsy specimen used for the rapid urease test is a useful sample to detect resistance to clarithromycin by PCR-RFLP and (ii) the distribution of A2142G and A2143G point mutations in the 23S rRNA gene, in relation to virulence factors in our region. Gastric specimens were collected from adult dyspeptic patients (n = 141) and H. pylori was investigated by the rapid urease test, histopathological analysis and PCR for the hsp60 gene. Clarithromycin resistance was detected by PCR-RFLP in 62 H. pylori (+) paired biopsy specimens submitted to molecular analysis and the rapid urease test. H. pylori virulence factors were analyzed by multiplex PCR using specific primers for the cagA, vacA and babA2 genes. Thirteen out of 62 strains (20.9%) were resistant to clarithromycin: 6/13 (46.2%) harbored the A2143G mutation whereas 7/13 (53.8%) carried the A2142G point mutation. vacA m1s1 was the most frequent genotype among the resistant strains. In conclusion, the biopsy specimens used for the rapid urease test were suitable samples for clarithromycin resistance detection in patients infected with H. pylori, which became especially useful in cases where the number or size of the biopsies is limited. In addition, this is the first report of a molecular analysis for clarithromycin resistance performed directly from gastric biopsies in our region.

Helicobacter pylori es un patógeno ampliamente reconocido como causante de enfermedad gástrica. Su erradicación es variable, principalmente debido al incremento de la resistencia a claritromicina. Nuestros objetivos fueron evaluar la utilidad de la biopsia usada para realizar el test rápido de ureasa en la detección de resistencia a claritromicina por PCR-RFLP y conocer la distribución de las mutaciones puntuales A2142G y A2143G en el gen ARNr 23S, en relación con los factores de virulencia en nuestra región. Se recolectaron muestras gástricas (n=141) provenientes de pacientes adultos dispépticos y se investigó la presencia de H. pylori mediante el test rápido de ureasa, análisis histopatológico y PCR para el gen hsp60. La resistencia a claritromicina se analizó por PCR-RFLP en 62 muestras pareadas de biopsias gástricas H. pylori+ destinadas al análisis molecular y al test rápido de ureasa. Los factores de virulencia de H. pylori fueron analizados mediante PCR multiplex usando oligonucleótidos específicos para los genes cagA, vacA y babA2. Trece de 62 cepas (20,9%) fueron resistentes a claritromicina, 6/13 (46,2%) llevaron la mutación A2143G, mientras que 7/13 (53,8%) presentaron la mutación A2142G. El genotipo vacA s1m1 fue el más frecuente entre las cepas resistentes a claritromicina. En conclusión, las biopsias destinadas al test rápido de ureasa fueron muestras apropiadas para la detección de la resistencia a claritromicina en pacientes infectados con H. pylori. Esto es especialmente útil en aquellos casos en los que el número o el tamaño de las muestras son limitados. Además, este es el primer reporte de estudio de resistencia a claritromicina (mediante técnicas moleculares), directamente de biopsias gástricas en nuestra región.

https://doi.org/10.1016/j.ram.2017.11.005 190 downloads

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