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1.
Nutritional value of babassu cake as a substitute for sugarcane in feeding heifers
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Castro, Kélvia Jácome De
; Borges, Iran
; Miotto, Fabrícia Rocha Chaves
; Pimentel, Patrícia Guimarães
; Gomes, Silas Primola
; Moreira, Guilherme Rocha
; Pinto, Andrea Pereira
; Neiva, Jose Neuman Miranda
.
ABSTRACT The aim of this study was to evaluate intake, digestibility and performance in dairy heifers fed diets containing increasing levels of babassu cake (0, 100, 200 and 300 g kg-1 dry matter - DM) as a substitute for sugarcane treated with calcium oxide. Twenty-four heifers with an initial mean weight of 190.8 + 40.8 kg were used, distributed in a completely randomised design. The dry matter intake (DMI), neutral detergent fibre intake (NDFI) and acid detergent fibre intake (ADFI), as %BW and g BW-0.75 , showed an increasing linear response. The organic matter intake (OMI) showed a linear increase of 40 g day-1, 0.017%BW and 0.66 g BW-0.75 for each 10 g kg-1 increase in babassu cake in the diet. The apparent digestibility of the dry matter (ADDM) and organic matter (ADOM) showed a quadratic response (P < 0.05), with a minimum of 493 g kg-1 DM for 150 g kg-1 DM and 526.5 g kg-1 DM for 320 g kg-1 DM as a substitute for the sugarcane, respectively. The final mean weight was not altered, presenting a value of 299.7 + 45.5 kg. Daily weight gain (DWG) showed a quadratic response, with the highest value at a substitution level of 190 g kg-1 DM. The feed conversion rate of the DM was not affected by the addition of babassu cake, with an average of 4.6 + 0.74 kg DM kg-1 in weight gain. Babassu cake can substitute hydrolysed sugarcane in heifer diets up to 300 g kg-1 DM, with the greatest weight gain seen at a substitution level of 190 g kg-1 DM. 0, 0 (0 100 20 30 kg1 1 kg- oxide Twentyfour Twenty four 1908 8 190. 408 40. used design DMI, DMI (DMI) NDFI (NDFI ADFI, ADFI (ADFI) BW BW0.75 BW075 0.75 75 BW-0.7 OMI (OMI 4 day1, day1 day 1, day-1 0017BW 017 066 66 0.6 diet ADDM (ADDM ADOM (ADOM P 0.05, 005 0.05 05 0.05) 49 15 5265 526 5 526. 32 respectively altered 2997 299 7 299. 455 45 45. DWG (DWG 19 46 6 4. 074 74 0.7 ( 2 3 (DMI (ADFI BW0 BW0.7 BW07 075 BW-0. day- 01 06 0. 00 0.0 52 29 07 BW0. BW-0 BW-
2.
Ingestive behaviour in heifers fed diets with increasing levels of babassu cake
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Castro, Kélvia Jácome De
; Borges, Iran
; Miotto, Fabrícia Rocha Chaves
; Gomes, Silas Primola
; Pimentel, Patrícia Guimarães
; Moreira, Guilherme Rocha
; Pinto, Andrea Pereira
; Neiva, Jose Neuman Miranda
.
ABSTRACT The aim of this study was to assess the effect of increasing levels of babassu cake on the ingestive behaviour of dairy heifers in confinement. Twenty-four heifers with an average initial weight of 190.8 ± 40.8 kg were fed diets containing babassu cake (0, 100, 200, 300 mg kg-1 (dry matter basis) as a substitute for sugar cane, in a completely randomised design with four treatments and six replications. Observations were made every five minutes for 24 hours, assessing rumination, feeding, idle time, sleeping and other activities, in addition to the frequency with which the heifers searched for water, urinated and defecated. The time spent on feeding and rumination decreased by 0.1138% and 0.3106%, respectively, for every 10 g kg-1 substitute, while idle time increased by 0.3368% for every 10 g kg-1 substitute. The time spent sleeping and on other activities was not affected. Longer feeding times were seen whenever feed was offered, with more rumination activity at night. There was no effect on the specific activities (urination, defecation or drinking); however, urination and drinking were affected by the period, and was more frequent during the day. There was a linear increase in intake, and in feed and rumination efficiency for dry matter and neutral detergent fibre, with a reduction in total chewing time. Substituting babassu cake for sugar cane affects both the ingestive behaviour of dairy heifers and the rumination process as it does not stimulate chewing. confinement Twentyfour Twenty 1908 190 8 190. 408 40 40. 0, 0 (0 100 200 30 kg1 1 kg- basis replications 2 hours water defecated 01138 1138 0.1138 03106 3106 0.3106% respectively 03368 3368 0.3368 offered night urination, (urination drinking) however period day intake fibre 19 4 ( 20 3 0113 113 0.113 0310 310 0.3106 0336 336 0.336 011 11 0.11 031 31 0.310 033 33 0.33 01 0.1 03 0.31 0.3 0.
3.
Diretrizes Brasileiras de Medidas da Pressão Arterial Dentro e Fora do Consultório – 2023 202 20 2
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Feitosa, Audes Diogenes de Magalhães
; Barroso, Weimar Kunz Sebba
; Mion Junior, Decio
; Nobre, Fernando
; Mota-Gomes, Marco Antonio
; Jardim, Paulo Cesar Brandão Veiga
; Amodeo, Celso
; Oliveira, Adriana Camargo
; Alessi, Alexandre
; Sousa, Ana Luiza Lima
; Brandão, Andréa Araujo
; Pio-Abreu, Andrea
; Sposito, Andrei C.
; Pierin, Angela Maria Geraldo
; Paiva, Annelise Machado Gomes de
; Spinelli, Antonio Carlos de Souza
; Machado, Carlos Alberto
; Poli-de-Figueiredo, Carlos Eduardo
; Rodrigues, Cibele Isaac Saad
; Forjaz, Claudia Lucia de Moraes
; Sampaio, Diogo Pereira Santos
; Barbosa, Eduardo Costa Duarte
; Freitas, Elizabete Viana de
; Cestario, Elizabeth do Espirito Santo
; Muxfeldt, Elizabeth Silaid
; Lima Júnior, Emilton
; Campana, Erika Maria Gonçalves
; Feitosa, Fabiana Gomes Aragão Magalhães
; Consolim-Colombo, Fernanda Marciano
; Almeida, Fernando Antônio de
; Silva, Giovanio Vieira da
; Moreno Júnior, Heitor
; Finimundi, Helius Carlos
; Guimarães, Isabel Cristina Britto
; Gemelli, João Roberto
; Barreto-Filho, José Augusto Soares
; Vilela-Martin, José Fernando
; Ribeiro, José Marcio
; Yugar-Toledo, Juan Carlos
; Magalhães, Lucélia Batista Neves Cunha
; Drager, Luciano F.
; Bortolotto, Luiz Aparecido
; Alves, Marco Antonio de Melo
; Malachias, Marcus Vinícius Bolívar
; Neves, Mario Fritsch Toros
; Santos, Mayara Cedrim
; Dinamarco, Nelson
; Moreira Filho, Osni
; Passarelli Júnior, Oswaldo
; Vitorino, Priscila Valverde de Oliveira
; Miranda, Roberto Dischinger
; Bezerra, Rodrigo
; Pedrosa, Rodrigo Pinto
; Paula, Rogerio Baumgratz de
; Okawa, Rogério Toshiro Passos
; Póvoa, Rui Manuel dos Santos
; Fuchs, Sandra C.
; Lima, Sandro Gonçalves de
; Inuzuka, Sayuri
; Ferreira-Filho, Sebastião Rodrigues
; Fillho, Silvio Hock de Paffer
; Jardim, Thiago de Souza Veiga
; Guimarães Neto, Vanildo da Silva
; Koch, Vera Hermina Kalika
; Gusmão, Waléria Dantas Pereira
; Oigman, Wille
; Nadruz Junior, Wilson
.
4.
Risk Factors for Acute Rheumatic Disease: Exploring Factors at Individual and Collective Levels Disease
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Mendoza, Renata Fonseca
; Mutarelli, Antonio
; Mendoza, Bernardo Fonseca
; Barbosa, José Augusto Almeida
; Oliveira, Rodrigo Liberato de
; Nascimento, Bruno Ramos
; Pantaleão, Alexandre Negrão
; Fonseca, Isabella Moreira Gonzalez
; Oliveira, Matheus Assunção Rabello de
; Pinto, Airandes de Sousa
; Beaton, Andrea
; Nunes, Maria Carmo Pereira
.
Revista da Sociedade Brasileira de Medicina Tropical
- Journal Metrics
ABSTRACT Acute rheumatic fever (ARF) is a complex disease with several clinical manifestations. Its most significant long-term complication is valvular heart damage, commonly referred to as chronic rheumatic heart disease. The risk of ARF varies globally, with over 80% of cases occurring in low- and middle-income countries, highlighting the role of socioeconomic factors. A comprehensive understanding of the risk factors associated with ARF and its clinical, genetic, and sociodemographic mediators can help clinicians identify high-risk individuals, develop effective management strategies, enhance target screening and active case-finding initiatives, and ultimately improve patient outcomes. This review aimed to provide an overview of ARF and its global burden, focusing on the established and potential risk factors associated with its development. (ARF manifestations longterm long term damage globally 80 low middleincome middle income countries genetic highrisk high individuals strategies casefinding case finding initiatives outcomes burden development 8
5.
Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19 COVID19 COVID 19 COVID-1 COVID1 1 COVID-
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Carvalho, Taisa Moitinho de
; Lourenção, Luciano Garcia
; Pinto, Maria Helena
; Viana, Renata Andrea Pietro Pereira
; Moreira, Ana Maria Batista da Silva Gonçalves
; Mello, Leticia Pepineli de
; Medeiros, Gilney Guerra de
; Gomes, Antonio Marcos Freire
.
Resumo O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho. Paulo COVID19. COVID19 COVID 19. 19 COVID-19 transversal correlacional 202 2021 (UWES QVT, , Walton r≥0.70 r070 r 0 70 (r≥0.70 r=0,88 r088 88 (r=0,88 p=<0,001 p0001 p 001 r≥0.40≤0.69 r040069 40 69 (r≥0.40≤0.69 (QVT r=0,40 r040 (r=0,40 p=<0,001, r=0,41 r041 41 (r=0,41 r≤0.39 r039 39 (r≤0.39 Concluiuse Concluiu se COVID19, 19, COVID1 1 COVID-1 20 r≥0.7 r07 7 (r≥0.7 r=0,8 r08 8 (r=0,8 p=<0,00 p000 00 r≥0.40≤0.6 r04006 4 6 (r≥0.40≤0.6 r=0,4 r04 (r=0,4 r≤0.3 r03 3 (r≤0.3 COVID- 2 r≥0. r0 (r≥0. r=0, (r=0, p=<0,0 p00 r≥0.40≤0. r0400 (r≥0.40≤0. r≤0. (r≤0. r≥0 (r≥0 r=0 (r=0 p=<0, p0 r≥0.40≤0 (r≥0.40≤0 r≤0 (r≤0 r≥ (r≥ r= (r= p=<0 r≥0.40≤ (r≥0.40≤ r≤ (r≤ (r p=< r≥0.40 (r≥0.40 p= r≥0.4 (r≥0.4
Abstract This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton’s model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life. workrelated related State COVID19 COVID 19 COVID-1 pandemic descriptive correlational crosssectional cross sectional 202 2021 Wellbeing Well being Utrecht Workrelated (WRQoL scale Waltons Walton s model r≥0.70 r070 r 0 70 (r≥0.70 r=0.88 r088 88 (r=0.88 p=<0.001 p0001 p 001 p=<0.001) r≥0.40≤0.69 r040069 40 69 (r≥0.40≤0.69 WRQOL (WRQOL r=0.40 r040 (r=0.40 p<0.001, p<0.001 , r=0.41 r041 41 (r=0.41 r≤0.39 r039 39 (r≤0.39 COVID1 1 COVID- 20 r≥0.7 r07 7 (r≥0.7 r=0.8 r08 8 (r=0.8 p=<0.00 p000 00 r≥0.40≤0.6 r04006 4 6 (r≥0.40≤0.6 r=0.4 r04 (r=0.4 p<0.00 r≤0.3 r03 3 (r≤0.3 2 r≥0. r0 (r≥0. r=0. (r=0. p=<0.0 p00 r≥0.40≤0. r0400 (r≥0.40≤0. p<0.0 r≤0. (r≤0. r≥0 (r≥0 r=0 (r=0 p=<0. p0 r≥0.40≤0 (r≥0.40≤0 p<0. r≤0 (r≤0 r≥ (r≥ r= (r= p=<0 r≥0.40≤ (r≥0.40≤ p<0 r≤ (r≤ (r p=< r≥0.40 (r≥0.40 p< p= r≥0.4 (r≥0.4
6.
Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19
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Carvalho, Taisa Moitinho de
; Lourenção, Luciano Garcia
; Pinto, Maria Helena
; Viana, Renata Andrea Pietro Pereira
; Moreira, Ana Maria Batista da Silva Gonçalves
; Mello, Leticia Pepineli de
; Medeiros, Gilney Guerra de
; Gomes, Antonio Marcos Freire
.
Resumo O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho.
Abstract This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton’s model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life.
7.
[SciELO Preprints] - Brazilian Guidelines for In-office and Out-of-office Blood Pressure Measurement – 2023
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Feitosa, Audes Diógenes de Magalhães
Barroso, Weimar Kunz Sebba
Mion Júnior, Décio
Nobre, Fernando
Mota-Gomes, Marco Antonio
Jardim, Paulo Cesar Brandão Veiga
Amodeo, Celso
Camargo, Adriana
Alessi, Alexandre
Sousa, Ana Luiza Lima
Brandão, Andréa Araujo
Pio-Abreu, Andrea
Sposito, Andrei Carvalho
Pierin, Angela Maria Geraldo
Paiva, Annelise Machado Gomes de
Spinelli, Antonio Carlos de Souza
Machado, Carlos Alberto
Poli-de-Figueiredo, Carlos Eduardo
Rodrigues, Cibele Isaac Saad
Forjaz, Cláudia Lúcia de Moraes
Sampaio, Diogo Pereira Santos
Barbosa, Eduardo Costa Duarte
Freitas, Elizabete Viana de
Cestário , Elizabeth do Espírito Santo
Muxfeldt, Elizabeth Silaid
Lima Júnior, Emilton
Campana, Erika Maria Gonçalves
Feitosa, Fabiana Gomes Aragão Magalhães
Consolim-Colombo, Fernanda Marciano
Almeida, Fernando Antônio de
Silva, Giovanio Vieira da
Moreno Júnior, Heitor
Finimundi, Helius Carlos
Guimarães, Isabel Cristina Britto
Gemelli, João Roberto
Barreto Filho, José Augusto Soares
Vilela-Martin, José Fernando
Ribeiro, José Marcio
Yugar-Toledo, Juan Carlos
Magalhães, Lucélia Batista Neves Cunha
Drager, Luciano Ferreira
Bortolotto, Luiz Aparecido
Alves, Marco Antonio de Melo
Malachias, Marcus Vinícius Bolívar
Neves, Mario Fritsch Toros
Santos, Mayara Cedrim
Dinamarco, Nelson
Moreira Filho, Osni
Passarelli Júnior, Oswaldo
Valverde de Oliveira Vitorino, Priscila Valverde de Oliveira
Miranda, Roberto Dischinger
Bezerra, Rodrigo
Pedrosa, Rodrigo Pinto
Paula, Rogério Baumgratz de
Okawa, Rogério Toshiro Passos
Póvoa, Rui Manuel dos Santos
Fuchs, Sandra C.
Inuzuka, Sayuri
Ferreira-Filho, Sebastião R.
Paffer Fillho, Silvio Hock de
Jardim, Thiago de Souza Veiga
Guimarães Neto, Vanildo da Silva
Koch, Vera Hermina
Gusmão, Waléria Dantas Pereira
Oigman, Wille
Nadruz, Wilson
Hypertension is one of the primary modifiable risk factors for morbidity and mortality worldwide, being a major risk factor for coronary artery disease, stroke, and kidney failure. Furthermore, it is highly prevalent, affecting more than one-third of the global population.
Blood pressure measurement is a MANDATORY procedure in any medical care setting and is carried out by various healthcare professionals. However, it is still commonly performed without the necessary technical care. Since the diagnosis relies on blood pressure measurement, it is clear how important it is to handle the techniques, methods, and equipment used in its execution with care.
It should be emphasized that once the diagnosis is made, all short-term, medium-term, and long-term investigations and treatments are based on the results of blood pressure measurement. Therefore, improper techniques and/or equipment can lead to incorrect diagnoses, either underestimating or overestimating values, resulting in inappropriate actions and significant health and economic losses for individuals and nations.
Once the correct diagnosis is made, as knowledge of the importance of proper treatment advances, with the adoption of more detailed normal values and careful treatment objectives towards achieving stricter blood pressure goals, the importance of precision in blood pressure measurement is also reinforced.
Blood pressure measurement (described below) is usually performed using the traditional method, the so-called casual or office measurement. Over time, alternatives have been added to it, through the use of semi-automatic or automatic devices by the patients themselves, in waiting rooms or outside the office, in their own homes, or in public spaces. A step further was taken with the use of semi-automatic devices equipped with memory that allow sequential measurements outside the office (ABPM; or HBPM) and other automatic devices that allow programmed measurements over longer periods (HBPM).
Some aspects of blood pressure measurement can interfere with obtaining reliable results and, consequently, cause harm in decision-making. These include the importance of using average values, the variation in blood pressure during the day, and short-term variability. These aspects have encouraged the performance of a greater number of measurements in various situations, and different guidelines have advocated the use of equipment that promotes these actions. Devices that perform HBPM or ABPM, which, in addition to allowing greater precision, when used together, detect white coat hypertension (WCH), masked hypertension (MH), sleep blood pressure alterations, and resistant hypertension (RHT) (defined in Chapter 2 of this guideline), are gaining more and more importance.
Taking these details into account, we must emphasize that information related to diagnosis, classification, and goal setting is still based on office blood pressure measurement, and for this reason, all attention must be given to the proper execution of this procedure.
La hipertensión arterial (HTA) es uno de los principales factores de riesgo modificables para la morbilidad y mortalidad en todo el mundo, siendo uno de los mayores factores de riesgo para la enfermedad de las arterias coronarias, el accidente cerebrovascular (ACV) y la insuficiencia renal. Además, es altamente prevalente y afecta a más de un tercio de la población mundial.
La medición de la presión arterial (PA) es un procedimiento OBLIGATORIO en cualquier atención médica o realizado por diferentes profesionales de la salud. Sin embargo, todavía se realiza comúnmente sin los cuidados técnicos necesarios. Dado que el diagnóstico se basa en la medición de la PA, es claro el cuidado que debe haber con las técnicas, los métodos y los equipos utilizados en su realización.
Debemos enfatizar que una vez realizado el diagnóstico, todas las investigaciones y tratamientos a corto, mediano y largo plazo se basan en los resultados de la medición de la PA. Por lo tanto, las técnicas y/o equipos inadecuados pueden llevar a diagnósticos incorrectos, subestimando o sobreestimando valores y resultando en conductas inadecuadas y pérdidas significativas para la salud y la economía de las personas y las naciones.
Una vez realizado el diagnóstico correcto, a medida que avanza el conocimiento sobre la importancia del tratamiento adecuado, con la adopción de valores de normalidad más detallados y objetivos de tratamiento más cuidadosos hacia metas de PA más estrictas, también se refuerza la importancia de la precisión en la medición de la PA.
La medición de la PA (descrita a continuación) generalmente se realiza mediante el método tradicional, la llamada medición casual o de consultorio. Con el tiempo, se han agregado alternativas a través del uso de dispositivos semiautomáticos o automáticos por parte del propio paciente, en salas de espera o fuera del consultorio, en su propia residencia o en espacios públicos. Se dio un paso más con el uso de dispositivos semiautomáticos equipados con memoria que permiten mediciones secuenciales fuera del consultorio (AMPA; o MRPA) y otros automáticos que permiten mediciones programadas durante períodos más largos (MAPA).
Algunos aspectos en la medición de la PA pueden interferir en la obtención de resultados confiables y, en consecuencia, causar daños en las decisiones a tomar. Estos incluyen la importancia de usar valores promedio, la variación de la PA durante el día y la variabilidad a corto plazo. Estos aspectos han alentado la realización de un mayor número de mediciones en diversas situaciones, y diferentes pautas han abogado por el uso de equipos que promuevan estas acciones. Los dispositivos que realizan MRPA o MAPA, que además de permitir una mayor precisión, cuando se usan juntos, detectan la hipertensión de bata blanca (HBB), la hipertensión enmascarada (HM), las alteraciones de la PA durante el sueño y la hipertensión resistente (HR) (definida en el Capítulo 2 de esta guía), están ganando cada vez más importancia.
Teniendo en cuenta estos detalles, debemos enfatizar que la información relacionada con el diagnóstico, la clasificación y el establecimiento de objetivos todavía se basa en la medición de la presión arterial en el consultorio, y por esta razón, se debe prestar toda la atención a la ejecución adecuada de este procedimiento.
A hipertensão arterial (HA) é um dos principais fatores de risco modificáveis para morbidade e mortalidade em todo o mundo, sendo um dos maiores fatores de risco para doença arterial coronária, acidente vascular cerebral (AVC) e insuficiência renal. Além disso, é altamente prevalente e atinge mais de um terço da população mundial.
A medida da PA é procedimento OBRIGATÓRIO em qualquer atendimento médico ou realizado por diferentes profissionais de saúde. Contudo, ainda é comumente realizada sem os cuidados técnicos necessários. Como o diagnóstico se baseia na medida da PA, fica claro o cuidado que deve haver com as técnicas, os métodos e os equipamentos utilizados na sua realização.
Deve-se reforçar que, feito o diagnóstico, toda a investigação e os tratamentos de curto, médio e longo prazos são feitos com base nos resultados da medida da PA. Assim, técnicas e/ou equipamentos inadequados podem levar a diagnósticos incorretos, tanto subestimando quanto superestimando valores e levando a condutas inadequadas e grandes prejuízos à saúde e à economia das pessoas e das nações.
Uma vez feito o diagnóstico correto, na medida em que avança o conhecimento da importância do tratamento adequado, com a adoção de valores de normalidade mais detalhados e com objetivos de tratamento mais cuidadosos no sentido do alcance de metas de PA mais rigorosas, fica também reforçada a importância da precisão na medida da PA.
A medida da PA (descrita a seguir) é habitualmente feita pelo método tradicional, a assim chamada medida casual ou de consultório. Ao longo do tempo, foram agregadas alternativas a ela, mediante o uso de equipamentos semiautomáticos ou automáticos pelo próprio paciente, nas salas de espera ou fora do consultório, em sua própria residência ou em espaços públicos. Um passo adiante foi dado com o uso de equipamentos semiautomáticos providos de memória que permitem medidas sequenciais fora do consultório (AMPA; ou MRPA) e outros automáticos que permitem medidas programadas por períodos mais prolongados (MAPA).
Alguns aspectos na medida da PA podem interferir na obtenção de resultados fidedignos e, consequentemente, causar prejuízo nas condutas a serem tomadas. Entre eles, estão: a importância de serem utilizados valores médios, a variação da PA durante o dia e a variabilidade a curto prazo. Esses aspectos têm estimulado a realização de maior número de medidas em diversas situações, e as diferentes diretrizes têm preconizado o uso de equipamentos que favoreçam essas ações. Ganham cada vez mais espaço os equipamentos que realizam MRPA ou MAPA, que, além de permitirem maior precisão, se empregados em conjunto, detectam a HA do avental branco (HAB), HA mascarada (HM), alterações da PA no sono e HA resistente (HAR) (definidos no Capítulo 2 desta diretriz).
Resguardados esses detalhes, devemos ressaltar que as informações relacionadas a diagnóstico, classificação e estabelecimento de metas ainda são baseadas na medida da PA de consultório e, por esse motivo, toda a atenção deve ser dada à realização desse procedimento.
8.
Does Postpartum Hypopituitarism Influence the Craniofacial Pattern? A Case-Control Study with Sheehan’s Syndrome Patients
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Cavalcante, Davi de Sá
; Quidute, Ana Rosa Pinto
; Martins, Manoel Ricardo Alves
; Carvalho, Francisco Samuel Rodrigues
; Cid, Adília Mirela Pereira
; Silva, Paulo Goberlanio de Barros
; Aguiar, Andrea Silvia Walter de
; Ribeiro, Thyciana Rodrigues
; Costa, Fábio Wildson Gurgel
.
RESUMEN: Este estudio tuvo como objetivo evaluar los aspectos morfológicos craneofaciales de los pacientes con síndrome de Sheehan (SHS). Se realizó un estudio observacional con 19 mujeres diagnosticadas con SHS y 19 controles asociados por edad y sexo. Se obtuvieron radiografías cefalométricas laterales y se analizaron 30 medidas lineales y angulares mediante el software Radiocef Studio 2. La edad media de los pacientes fue de 65,47 ± 10,19 años. Los principales hallazgos fueron proposición maxilar (52,63 %) y mandíbula (52,63 %) con respecto a la base del cráneo, prognatismo mandibular en 73,68 %, patrón de crecimiento profundo en 42,1 %, aumento del plano mandibular en 36,84 % y reducción de la altura facial anterior. El grupo SHS mostró diferencias estadísticamente significativas en SNB (p=0,026), N-Me (p=0,006), longitud del paladar blando (p=0,011) y Ena-Me (p<0,001) en comparación con los controles. El análisis de la puntuación de la desviación estándar reveló valores alterados en relación con las longitudes maxilares y mandibulares totales. El SHS mostró una morfología craneofacial alterada, caracterizada por prognatismo maxilomandibular, tipo braquifacial, aumento del plano mandibular y reducción de la longitud del velo del paladar. Este estudio informa hallazgos novedosos en SHS.
ABSTRACT: This study aimed to assess the craniofacial morphologic aspects of Sheehan’s syndrome (SHS) patients.An observational study was performed with 19 women diagnosed with SHS and 19 controls matched by age and sex. Lateral cephalometric radiographs were obtained, and 30 linear and angular measurements were analyzed using the Radiocef Studio 2 software. The mean age of patients was 65.47 ± 10.19 years. The main findings were propositioned maxilla (52.63 %) and mandible (52.63 %) relative to the cranial base, mandibular prognathism in 73.68 %, deep growth pattern in 42.1 %, increased mandibular plane in 36.84 %, and reduction in anterior facial height. The SHS group showed statistically significant differences in SNB (p=0.026), N-Me (p=0.006), soft palate length (p=0.011), and Ena-Me (p<0.001) in comparison with controls. The standard deviation score analysis revealed altered values in relation to total maxillary and mandibular lengths. SHS showed altered craniofacial morphology, characterized by maxillo- mandibular prognathism, brachyfacial type, increased mandibular plane, and reduction in soft palate length. This study reports novel findings in SHS.
9.
Inspiratory Muscle Strength in Chagas Cardiomyopathy: A Systematic Scoping Review Cardiomyopathy
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Mazzoli-Rocha, Flavia
; Diniz, Clara Pinto
; Rezende, Daniel Pereira Redes de
; Mendes, Fernanda de Souza Nogueira Sardinha
; Hasslocher-Moreno, Alejandro Marcel
; Sousa, Andréa Silvestre de
; Saraiva, Roberto Magalhães
; Borghi-Silva, Audrey
; Mediano, Mauro Felippe Felix
; Alexandre, Dângelo José de Andrade
.
Revista da Sociedade Brasileira de Medicina Tropical
- Journal Metrics
ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries. myocarditis disease (IMS . (CC) However scarce diagnosis HF. (HF) pretraining pre period open centers results crosssectional, crosssectional cross sectional, sectional cross-sectional cohort manovacuometer values volunteers conclusion countries (CC (HF
10.
Psychometric properties of an oral health literacy scale for people living with diabetes
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MARTINS, Andréa Maria Eleutério de Barros Lima
; SANTOS, Ana Maria Rodrigues
; ALENCAR, Gizelton Pereira
; SOUZA, João Gabriel Silva
; SOARES, Maria Alice Aguiar
; MARTINS, Maria Barros Lima
; SILVEIRA, Marise Fagundes
; MAIA, Melissa Barral
; FARIAS, Paula Karoline Soares
; FERREIRA, Raquel Conceição
; PINTO, Rodrigo Alves
; CRESPO, Thaisa Soares
; FERREIRA, Efigênia Ferreira e
.
Abstract This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability. 23 1 questionnaire chisquare chi square X2/df, X2df Xdf X2/df , X2 df X (X2/df) CFI, (CFI) goodnessoffit GFI, GFI (GFI) rootmeansquare root mean RMSEA. . (RMSEA) (AVE CR. (CR) 95 point threedimensional three dimensional (X 2.459 2459 2 459 0.988 0988 0 988 0.981 0981 981 0.078. 0078 0.078 078 (0.078) adequate Access Understandappraise Understand appraise Understand/appraise 0831 831 0.831 0954 954 0.95 0893 893 0.893 0962 962 0.962 0822 822 0.822 respectively 418 41 8 41. 481 48 48.1% access, access (access understandappraise understand understand/appraise apply understandability (X2/df (CFI (GFI (RMSEA (CR 9 2.45 245 45 0.98 098 98 007 0.07 07 (0.078 083 83 0.83 095 0.9 089 89 0.89 096 96 0.96 082 82 0.82 4 48.1 2.4 24 09 00 0.0 (0.07 08 0.8 0. 48. 2. (0.0 (0. (0 (
11.
Effect of endodontic sealers on push-out bond strength of CAD-CAM or prefabricated fiber glass posts pushout push out CADCAM CAD CAM
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PINTO, Andréa Pereira de Souza
; FRANÇA, Fabiana Mantovani Gomes
; BASTING, Roberta Tarkany
; TURSSI, Cecilia Pedroso
; RODRIGUES JÚNIOR, José Joatan
; AMARAL, Flávia Lucisano Botelho
.
Abstract This study aimed to evaluate the effect of endodontic sealer (ES) on bond strength (BS) of prefabricated or milled-CAD-CAM (computer-aided design and computer-aided manufacturing) glass-fiber-posts (GFP). Canals of 90 single-rooted teeth were prepared for filling by the single-cone technique with gutta-percha and one of the following ES: AH Plus (epoxy resin), Endofill (zinc-oxide and eugenol), and Bio-C Sealer (calcium-silicate). After post-space preparation, tooth-specimens were equally divided in half according to type of GFP to be used. In the half to receive milled-CAD-CAM posts, tooth specimens were molded with acrylic resin to obtain replicas. These were scanned to enable the laboratory to produce the milled-CAD-CAM GFPs (Fiber CAD Lab, Angelus) by the subtractive technique. The other half of samples received prefabricated GFPs (Exacto, Angelus) (n=15). The GFPs were cemented with dual-cure resin cement (Panavia F2.0, Kuraray). Each root was sectioned into two slices per root region (cervical, middle, apical) that were subjected to the push-out BS test, in a universal testing machine. Failure mode (FM) was classified by scores. The BS data were submitted to generalized linear model analyses, while FM was analyzed using the chi-square test (a=0.05). BS showed no significant difference among the three ES (p > 0.05). BS was significantly higher for prefabricated (mean 10.84 MPa) versus milled-CAD-CAM GFPs (mean 6.94 MPa) (p <0.0001), irrespective of ES. The majority showed mixed failures. It could be concluded that type of ES did not affect BS of GFPs to dentin, and prefabricated-GFPs had higher bond-strength than customized-milled-CAD-CAM GFPs. (ES (BS milledCADCAM milled CAM computeraided computer aided manufacturing glassfiberposts glass fiber posts GFP. . (GFP) 9 singlerooted single rooted singlecone cone guttapercha gutta percha epoxy resin, , resin) zincoxide zinc oxide eugenol, eugenol eugenol) BioC Bio C calciumsilicate. calciumsilicate calcium silicate (calcium-silicate) postspace post space preparation toothspecimens used replicas Fiber Lab Angelus Exacto, Exacto (Exacto n=15. n15 n n=15 15 (n=15) dualcure dual cure Panavia F20 F F2 0 F2.0 Kuraray. Kuraray Kuraray) cervical, cervical (cervical middle apical pushout push out machine (FM scores analyses chisquare chi square a=0.05. a005 a=0.05 05 (a=0.05) p 0.05. 005 0.05 0.05) mean 1084 10 84 10.8 MPa 694 6 94 6.9 <0.0001, 00001 <0.0001 0001 <0.0001) failures dentin prefabricatedGFPs bondstrength customizedmilledCADCAM customized (GFP (calcium-silicate n1 n=1 1 (n=15 F2. a00 a=0.0 (a=0.05 00 0.0 108 8 10. 69 6. 0000 <0.000 000 n= (n=1 a0 a=0. (a=0.0 0. <0.00 (n= a=0 (a=0. <0.0 (n a= (a=0 <0. (a= <0 (a <
12.
Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio
; Rassi Jr, Anis
; Oliveira, Gláucia Maria Moraes
; Correia, Luís Claudio Lemos
; Ramos Júnior, Alberto Novaes
; Luquetti, Alejandro Ostermayer
; Hasslocher-Moreno, Alejandro Marcel
; Sousa, Andréa Silvestre de
; Paola, Angelo Amato Vincenzo de
; Sousa, Antônio Carlos Sobral
; Ribeiro, Antonio Luiz Pinho
; Correia Filho, Dalmo
; Souza, Dilma do Socorro Moraes de
; Cunha-Neto, Edecio
; Ramires, Felix Jose Alvarez
; Bacal, Fernando
; Nunes, Maria do Carmo Pereira
; Martinelli Filho, Martino
; Scanavacca, Maurício Ibrahim
; Saraiva, Roberto Magalhães
; Oliveira Júnior, Wilson Alves de
; Lorga-Filho, Adalberto Menezes
; Guimarães, Adriana de Jesus Benevides de Almeida
; Braga, Adriana Lopes Latado
; Oliveira, Adriana Sarmento de
; Sarabanda, Alvaro Valentim Lima
; Pinto, Ana Yecê das Neves
; Carmo, Andre Assis Lopes do
; Schmidt, Andre
; Costa, Andréa Rodrigues da
; Ianni, Barbara Maria
; Markman Filho, Brivaldo
; Rochitte, Carlos Eduardo
; Macêdo, Carolina Thé
; Mady, Charles
; Chevillard, Christophe
; Virgens, Cláudio Marcelo Bittencourt das
; Castro, Cleudson Nery de
; Britto, Constança Felicia De Paoli de Carvalho
; Pisani, Cristiano
; Rassi, Daniela do Carmo
; Sobral Filho, Dário Celestino
; Almeida, Dirceu Rodrigues de
; Bocchi, Edimar Alcides
; Mesquita, Evandro Tinoco
; Mendes, Fernanda de Souza Nogueira Sardinha
; Gondim, Francisca Tatiana Pereira
; Silva, Gilberto Marcelo Sperandio da
; Peixoto, Giselle de Lima
; Lima, Gustavo Glotz de
; Veloso, Henrique Horta
; Moreira, Henrique Turin
; Lopes, Hugo Bellotti
; Pinto, Ibraim Masciarelli Francisco
; Ferreira, João Marcos Bemfica Barbosa
; Nunes, João Paulo Silva
; Barreto-Filho, José Augusto Soares
; Saraiva, José Francisco Kerr
; Lannes-Vieira, Joseli
; Oliveira, Joselina Luzia Menezes
; Armaganijan, Luciana Vidal
; Martins, Luiz Cláudio
; Sangenis, Luiz Henrique Conde
; Barbosa, Marco Paulo Tomaz
; Almeida-Santos, Marcos Antonio
; Simões, Marcos Vinicius
; Yasuda, Maria Aparecida Shikanai
; Moreira, Maria da Consolação Vieira
; Higuchi, Maria de Lourdes
; Monteiro, Maria Rita de Cassia Costa
; Mediano, Mauro Felippe Felix
; Lima, Mayara Maia
; Oliveira, Maykon Tavares de
; Romano, Minna Moreira Dias
; Araujo, Nadjar Nitz Silva Lociks de
; Medeiros, Paulo de Tarso Jorge
; Alves, Renato Vieira
; Teixeira, Ricardo Alkmim
; Pedrosa, Roberto Coury
; Aras Junior, Roque
; Torres, Rosalia Morais
; Povoa, Rui Manoel dos Santos
; Rassi, Sergio Gabriel
; Alves, Silvia Marinho Martins
; Tavares, Suelene Brito do Nascimento
; Palmeira, Swamy Lima
; Silva Júnior, Telêmaco Luiz da
; Rodrigues, Thiago da Rocha
; Madrini Junior, Vagner
; Brant, Veruska Maia da Costa
; Dutra, Walderez Ornelas
; Dias, João Carlos Pinto
.
13.
Ciência da disseminação e implementação em países de língua portuguesa: por que considerar? portuguesa considerar
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Sala, Danila Cristina Paquier
; Okuno, Meiry Fernanda Pinto
; Buccini, Gabriela
; Hankins, Jane Silva
; Câmara, Alice Barros
; Vieira, Ana Claudia
; Horta, Ana Lucia de Moraes
; Varela, Andrea Liliana Vesga
; Trapé, Carla Andrea
; Treichel, Carlos Alberto dos Santos
; Luizaga, Carolina Terra de Moraes
; Oliveira, Cintia de Freitas
; Luquine Jr, Cézar D
; Bonfim, Daiana
; Melo, Daiane Sousa
; Fatori, Daniel
; Bernardo, Debora
; Silva, Flávio Dias
; Paiva Neto, Francisco Timbó de
; Sousa, Girliani Silva de
; Relvas, Gláubia Rocha Barbosa
; Eshriqui, Ilana
; Chavez, Leidy Janeth Erazo
; Almeida, Leticia Yamawaka de
; Godoi, Lídia Pereira da Silva
; Belotti, Lorrayne
; Corrêa, Lucas Hernandes
; Cordeiro, Luciana
; Hespanhol, Luiz
; Juskevicius, Luize Fábrega
; Padoveze, Maria Clara
; Bueno, Mariana
; Siqueira, Marina Martins
; Bortoli, Maritsa Carla de
; Louvison, Marília Cristina Prado
; Cardoso, Marília Mastrocolla de Almeida
; Becker, Natália
; Tanaka, Oswaldo Yoshimi
; Costa, Paula Cristina Pereira da
; Bomfim, Rafael Aiello
; Luz, Reginaldo Adalberto
; Gimbel, Sarah
; Dias, Sónia
; Castral, Thaíla Corrêa
; Domingos, Thiago da Silva
; Baumann, Ana A.
.
14.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
15.
Differentials in death count records by databases in Brazil in 2010
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Diógenes, Victor Hugo Dias
; Pinto Júnior, Elzo Pereira
; Gonzaga, Marcos Roberto
; Queiroz, Bernardo Lanza
; Lima, Everton E. C.
; Costa, Lilia Carolina C. da
; Rocha, Aline S.
; Ferreira, Andrêa J. F.
; Teixeira, Camila S. S.
; Alves, Flávia Jôse O.
; Rameh, Leila
; Flores-Ortiz, Renzo
; Leyland, Alastair
; Dundas, Ruth
; Barreto, Maurício L.
; Ichihara, Maria Yury Travassos
.
ABSTRACT OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP – Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM – Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.
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