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Hereditary angioedema: a disease seldom diagnosed by pediatricians
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Campos, Régis de Albuquerque

; Valle, Solange Oliveira Rodrigues

; Toledo, Eliana Cristina

Jornal de Pediatria

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apr 2021, Volume 97 Suppl. 1 Pages 10 - 16

Abstract: En | Text: En | PDF: En

Abstract Objectives: To describe the hereditary angioedema to improve awareness of this condition and reduce diagnostic delay. Data sources: Relevant articles in the MEDLINE database through PubMed. Data synthesis: Hereditary angioedema is rare and has an autosomal dominant pattern of inheritance. Its onset occurs mainly in childhood, but there is an important delay in the diagnosis. In the most frequent phenotype, there is a quantitative and/or functional deficiency in the C1esterase inhibitor protein, which regulates the activation of the complement, contact and fibrinolysis systems with greater formation of bradykinin, the main mediator of angioedema. There is a third type, the hereditary angioedema with a normal C1 inhibitor level, which is rare in children. Clinical manifestations are characterized by recurrent angioedema attacks, mainly in the extremities, abdomen and upper airways, which can progress to asphyxia and death. The main triggers are mechanical trauma, infections and stress. The diagnosis is attained by patient clinical picture and decreased serum levels of C4 and C1esterase inhibitor or its function. In hereditary angioedema with a normal C1 inhibitor, there is no change in these parameters, thus requiring a genetic study. Treatment is based on the use of attack medications and long and short-term prophylaxis. Conclusions: Hereditary angioedema is little known by pediatricians due to the significant delay in diagnosis of this condition, whose onset usually begins in childhood. The presence of recurrent angioedema that does not respond to treatment with antihistamines, corticosteroids and adrenaline should increase the diagnostic suspicion.

https://doi.org/10.1016/j.jped.2020.10.011 207 downloads

Hereditary angioedema: how to approach it at the emergency department?
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Serpa, Faradiba Sarquis

; Mansour, Eli

; Aun, Marcelo Vivolo

; Giavina-Bianchi, Pedro

; Chong Neto, Herberto José

; Arruda, Luisa Karla

; Campos, Regis Albuquerque

; Motta, Antônio Abílio

; Toledo, Eliana

; Grumach, Anete Sevciovic

; Valle, Solange Oliveira Rodrigues

einstein (São Paulo)

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2021, Volume 19 elocation eRW5498

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

RESUMO As crises de angioedema são causas comuns de atendimentos nas emergências, e devido ao potencial de gravidade, é importante que os profissionais que atuam nesses serviços conheçam suas causas e abordagem. Os mecanismos envolvidos no angioedema sem urticas podem ser histaminérgicos ou mediados por bradicinina. As causas mais comuns de angioedema mediado por histamina são alimentos, medicamentos, ferroada de insetos e idiopática. Quando o mediador é a bradicinina, os desencadeantes são os inibidores da enzima conversora de angiotensina e fatores relacionados ao angioedema adquirido com deficiência do inibidor de C1 ou angioedema hereditário que são menos comuns, mas muito importantes pela possibilidade de desfecho fatal. O angioedema hereditário é uma doença rara, caracterizada por crises de edema que acometem o tecido subcutâneo e mucosas de vários órgãos, manifestando-se principalmente por crises de angioedema e dor abdominal. Esse tipo de angioedema não responde ao tratamento usual com adrenalina, anti-histamínicos e corticosteroides. Assim, se não identificados e tratados adequadamente, esses pacientes têm risco de morte por edema de laringe estimado em 25% a 40%. O tratamento do angioedema hereditário mudou drasticamente nos últimos anos, com o desenvolvimento de novos e eficientes fármacos para as crises: inibidor de C1 derivado de plasma, inibidor de C1 recombinante humano, antagonista do receptor B2 da bradicinina (icatibanto) e o inibidor da calicreína (ecalantide). No Brasil, até o momento, estão liberados para uso o inibidor de C1 derivado de plasma e o icatibanto. O manejo correto desses pacientes na emergência evita cirurgias desnecessárias e, principalmente, desfechos fatais.

ABSTRACT Angioedema attacks are common causes of emergency care, and due to the potential for severity, it is important that professionals who work in these services know their causes and management. The mechanisms involved in angioedema without urticaria may be histamine- or bradykinin-mediated. The most common causes of histamine-mediated angioedema are foods, medications, insect sting and idiopathic. When the mediator is bradykinin, the triggers are angiotensin-converting enzyme inhibitors and factors related to acquired angioedema with deficiency of C1-inhibitor or hereditary angioedema, which are less common, but very important because of the possibility of fatal outcome. Hereditary angioedema is a rare disease characterized by attacks of edema that affect the subcutaneous tissue and mucous membranes of various organs, manifesting mainly by angioedema and abdominal pain. This type of angioedema does not respond to the usual treatment with epinephrine, antihistamines and corticosteroids. Thus, if not identified and treated appropriately, these patients have an estimated risk of mortality from laryngeal edema of 25% to 40%. Hereditary angioedema treatment has changed dramatically in recent years with the development of new and efficient drugs for attack management: plasma-derived C1 inhibitor, recombinant human C1-inhibitor, bradykinin B2 receptor antagonist (icatibant), and the kallikrein inhibitor (ecallantide). In Brazil, plasma-derived C1 inhibitor and icatibant have already been approved for use. Proper management of these patients in the emergency department avoids unnecessary surgery and, especially, fatal outcomes.

https://doi.org/10.31744/einstein_journal/2021rw5498 369 downloads

O PAPEL DO PROFESSOR DE EDUCAÇÃO FÍSICA NOS ANOS INICIAIS NAS ESCOLAS ESTADUAIS DE ENSINO INTEGRAL DO ESTADO DE SÃO PAULO
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Hess, Cássia Maria

; Neira, Marcos

; Toledo, Eliana

Movimento

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dec 2018, Volume 24 N. 4 Pages 1155 - 1166

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

Resumo Esta pesquisa teve como objetivo identificar e problematizar o papel do professor de Educação Física dos anos iniciais do ensino fundamental, nas escolas de Ensino Integral do Estado de São Paulo. Trata-se de uma pesquisa documental, de abordagem qualitativa, com Análise Temática (BARDIN, 2011). Identificou-se que o professor de Educação Física possui, além de suas atribuições específicas, um papel mais interdisciplinar com o de Arte, com a responsabilidade ainda de acompanhar os alunos no horário de saída e de almoço, e de participar das assembleias e dos agrupamentos por dificuldades. Para complementar a carga horária, o professor de Educação Física deve atuar também como apoio docente. Concluiu-se que os documentos oficiais atribuem ao professor de Educação Física, além de suas atribuições legais, um papel de disciplinador, recreador e auxiliar, com multifunções, conforme a própria história da área identifica.

Abstract This study identifies and discusses the role of Physical Education teachers who work in the early years of elementary school at full time state schools in São Paulo. It is a qualitative documentary study including Thematic Analysis (BARDIN, 2011). The study found that Physical Education teachers, in addition to their specific duties, play a more interdisciplinary role regarding Art. They are also responsible for monitoring students at exit and lunch times and participating in assemblies and so-called ‘difficulty groups’. To complement their workload, they also have to provide teaching assistance. The study finds that official documents determine that these professionals play a disciplinary, a recreational, and an assistant role with multiple functions according to the field’s own history.

Resumen Esta investigación tuvo como objetivo identificar y problematizar el papel del profesor de Educación Física de los años iniciales de la Enseñanza Primaria, en las escuelas públicas de Enseñanza Integral de São Paulo. Se trata de una investigación documental con enfoque cualitativo y Análisis Temático (BARDIN, 2011). Identificamos que el profesor de Educación Física tiene, además de sus atribuciones específicas, un papel más interdisciplinario con el de Arte, con la responsabilidad, además, de acompañar a los alumnos en el horario de la salida y en el almuerzo, y participar en las asambleas y las agrupaciones. Para complementar la carga horaria, el profesor de Educación Física debe actuar también como apoyo docente. Se concluye que los documentos oficiales atribuyen al profesor de Educación Física, además de sus atribuciones legales, un papel de controlador de la disciplina, de recreador y de auxiliar, con multifunciones, conforme la propia historia del área identifica.

https://doi.org/10.22456/1982-8918.81617

Dematerializing physical education in public schools: an indication of permanence
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Hess, Cássia Maria

; Moreira, Evando Carlos

; Toledo, Eliana de

Motriz: Revista de Educação Física

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2018, Volume 24 N. 2 elocation e101820

Abstract: En | Text: En | PDF: En

Abstract AIMS The objective of this study was to identify and analyze the most recurrent difficulties reported by Physical Education teachers of state and municipalized schools of the state of São Paulo, Brazil. METHODS The sample involved 13 cities (12 - Mogi-Mirim Region and 1 - São Paulo city), totaling 73 Physical Education teachers. Its research used a descriptive and exploratory methods and a questionnaire by instrument. The answers were analyzed using content analysis (Bardin, 2011). RESULTS As a result, the most reported difficulty, from both samples, was the lack, in quantity and in quality, of materials. Other difficulties were reported, like: inadequate physical space, indiscipline and demotivation of students. CONCLUSION We conclude that the material problem is a permanent difficulty in this discipline at school.

https://doi.org/10.1590/s1980-6574201800020003 887 downloads

Brazilian Guidelines for Hereditary Angioedema Management - 2017 Update Part 1: Definition, Classification and Diagnosis
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Giavina-Bianchi, Pedro

; Arruda, Luisa Karla

; Aun, Marcelo V.

; Campos, Regis A.

; Chong-Neto, Herberto J.

; Constantino-Silva, Rosemeire N.

; Fernandes, Fátima R.

; Ferraro, Maria F.

; Ferriani, Mariana P.L.

; França, Alfeu T.

; Fusaro, Gustavo

; Garcia, Juliana F.B.

; Komninakis, Shirley

; Maia, Luana S.M.

; Mansour, Eli

; Moreno, Adriana S.

; Motta, Antonio A.

; Pesquero, João B.

; Portilho, Nathalia

; Rosário, Nelson A.

; Serpa, Faradiba S.

; Solé, Dirceu

; Takejima, Priscila

; Toledo, Eliana

; Valle, Solange O.R.

; Veronez, Camila L.

; Grumach, Anete S.

Clinics

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2018, Volume 73 elocation e310

Abstract: En | Text: En | PDF: En

Hereditary angioedema is an autosomal dominant disease characterized by recurrent angioedema attacks with the involvement of multiple organs. The disease is unknown to many health professionals and is therefore underdiagnosed. Patients who are not adequately diagnosed and treated have an estimated mortality rate ranging from 25% to 40% due to asphyxiation by laryngeal angioedema. Intestinal angioedema is another important and incapacitating presentation that may be the main or only manifestation during an attack. In this article, a group of experts from the “Associação Brasileira de Alergia e Imunologia (ASBAI)” and the “Grupo de Estudos Brasileiro em Angioedema Hereditário (GEBRAEH)” has updated the Brazilian guidelines for the diagnosis and treatment of hereditary angioedema.

https://doi.org/10.6061/clinics/2018/e310 1717 downloads

Proposal of analytical records for choreographic compositions in gymnastics for all
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SCARABELIM, Maria Letícia Abud

; TOLEDO, Eliana de

Revista Brasileira de Educação Física e Esporte

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mar 2016, Volume 30 N. 1 Pages 159 - 170

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

Resumo A Ginástica para Todos (GPT) é uma prática encontrada no amplo universo da ginástica, e a sua maior forma de expressão se dá por meio de composições coreográficas (CC), por motivos históricos, pedagógicos, entre outros. E os festivais de ginástica vêm se mostrando, em nível internacional, como um fórum privilegiado de mostra das CC, ocorrendo em diferentes contextos de intervenção social, como escolas, clubes, associações, ONGs e universidades. Nesse contexto, nosso objetivo é fornecer um instrumento para registrar e analisar composições coreográficas de GPT, por meio de fichas analíticas. A partir de uma pesquisa bibliográfica e documental, propõe-se um conjunto de oito fichas analíticas, que abordam aspectos gerais e específicos das CC na GPT. Conclui-se que o instrumento proposto possui uma estrutura didática e bem detalhada, alicerçada nas prerrogativas teóricas da área, o que viabiliza seu uso por diferentes perfis de profissionais e praticantes, podendo ser de grande valia para todos os envolvidos nos processos de CC na GPT, como uma ferramenta de registro (inclusive histórico), catalizadora de processos de reflexão e mudanças (caso sejam necessárias).

Abstract Gymnastics for All (GfA) is a practice found in the wide world of gymnastics and its greatest form of expression is through choreographic compositions (CC) due to historical and pedagogical reasons, among other factors. In addition, in the international arena, gymnastics festivals have become a privileged forum to perform CC as they take place in different contexts of social intervention, such as schools, clubs, associations, NGOs, and universities. In this context, our objective is to provide a tool to register and analyze GfA choreographic compositions by means of analytical record system. Based on bibliographical and documentary research, we propose a set of eight aspects that address general and specific aspects of CC in GfA. We conclude that the proposed tool displays a didactic and very detailed structure that is based on the theoretical prerogatives of the area. Not only it is useful to professionals and practitioners with different profiles, but it also holds the power of being of great value to all those involved in the processes of CC in GfA as a tool for recording data (including historical data), which is a catalyst for processes of reflection and changes (whenever they are required).

https://doi.org/10.1590/1807-55092016000100159 1948 downloads

The appreciation of artistic aspects of the Code of Points in rhythmic gymnastics: an analysis of the last three decades
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TOLEDO, Eliana de

; ANTUALPA, Kizzy

Revista Brasileira de Educação Física e Esporte

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mar 2016, Volume 30 N. 1 Pages 119 - 131

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

Resumo Em busca de melhor promover os aspectos artísticos, tendo-se em vista os últimos ciclos olímpicos, o atual Código de Pontuação de Ginástica Rítmica (CPGR) foi submetido a significativas mudanças. É a partir desse contexto que essa pesquisa, de caráter documental e histórico, se desenvolve, tendo como objetivo, analisar as mudanças nos últimos oito ciclos Olímpicos de CPGR (1985-2016), com foco nos aspectos artísticos da modalidade. A partir da análise de diferentes ciclos do CPGR, conclui-se que há conexões de interdependência entre os aspectos artísticos e os técnicos, sendo nítido que quando há uma supervalorização do aspecto técnico há uma desvalorização do artístico. Foi possível identificar fases do CPGR, e portanto, da modalidade. Apesar de manter as suas raízes artísticas (de Dança e Ritmo), a busca pela esportivização e sistematização da modalidade, trouxe uma primeira fase caracterizada pela busca do caráter esportivo e pela padronização dos gestos da GR, baseada na inclusão de novos elementos do corpo no CPGR. A segunda fase se caracteriza por uma retomada do aspecto artístico, confirmando nossa hipótese sobre a grande mudança do último CPGR. Constatamos de maneira geral, que o CPGR atual retoma a relação entre a GR e suas origens, influenciado pela Ginástica Estética (sueca), Rítmica e Dança. Tal condição é observada, uma vez que o atual Código de Pontuação (2013-2016) marca a história da modalidade por dois aspectos: a permissão de rotinas com canto, que não eram permitidas desde a criação do CPGR; e mudanças significativas para a valorização de aspectos artísticos dos rotinas.

Abstract In pursuit of promoting the artistic aspects, the current Rhythmic Gymnastics Code of Points (RGCP) has been submeted significant changes that motivated this research, documentary and historical in character, which aimed to analyze the last eight Olympic cycles of RGCP. The research method used in this study is documentary and characterized by the information found in documents (RGCP) that had not received any scientific treatment. From the analysis of different RGCP cycles, we found artistic aspects, and their connection with RG technical requirements. We observed that the RG has distinct stages (technical aspects, flexibility etc). While retaining its artistic roots (from Dance and Rhythm), in pursuit of sportivization and systematization of the sport, the first stage was characterized by a search for the sportivization and standardization of the modality based on the inclusion of new body elements in the RGCP . The second stage confirms our previous hypothesis, that in the last RGCP the artistic component had undergone few changes. We noticed, in an overview, that at the present time the current RGCP brings back the relationship between RG and its origins, influenced by Aesthetic Gymnastics (Swedish), Rhythmic and Dance. Condition observed once the current Code of Points (2013-2016) marks the story of sports, by two aspects: the permissiveness of routines with singing wich has not allowed since since the creation the RGCP and significant changes to the appreciation of the routines’ artistic aspects.

https://doi.org/10.1590/1807-55092016000100119 5941 downloads

Esportes de raquete para deficientes intelectuais leves: uma proposta fundamentada na pedagogia do esporte
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Guioti, Tiago Del Tedesco

; Toledo, Eliana de

; Scaglia, Alcides José

Revista Brasileira de Educação Especial

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sep 2014, Volume 20 N. 3 Pages 357 - 370

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

a prática dos esportes de raquetes ainda parece ser inexistente em diferentes instituições brasileiras de ensino, formais e não formais, e não são oportunizadas para pessoas com necessidades especiais. Assim, o objetivo deste trabalho é ofertar uma proposta pedagógica para a vivência destes esportes para alunos com deficiência intelectual leve. A proposta fundamentou-se em princípios como normalização, socialização e da diminuição do sentimento de preconceito. Ela está composta por itens descritos no manuscrito, que ser referem desde a apresentação desse esporte para os alunos até a consecução das atividades a serem desenvolvidas. Conclui-se que a proposta pedagógica é uma aproximação entre os esportes de raquete e alunos com deficiência intelectual, e que está alicerçada nas prerrogativas da Pedagogia do Esporte.

The practice of racket sports still seems to be nonexistent in various Brazilian educational institutions, both formally and informally, and they are not provided for people with special needs. The objective of this work is to offer a pedagogical proposal for experiencing such sports for students with mild intellectual disabilities. The proposal was based on principles such as standardization, socialization and decreased feelings of discrimination. The proposal is made up of items described in the manuscript, beginning with presenting the sport to the students and going on to carrying out various activities needed for proficiency. We conclude that the pedagogical proposal is a means to bring together racquet sports and students with intellectual disabilities, and this is based on the prerogatives of Sport Pedagogy.

https://doi.org/10.1590/S1413-65382014000300004 7770 downloads

Icatibant, an inhibitor of bradykinin receptor 2, for hereditary angioedema attacks: prospective experimental single-cohort study
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Campos, Regis Albuquerque

; Valle, Solange Oliveira Rodrigues

; França, Alfeu Tavares

; Cordeiro, Elisabete

; Serpa, Faradiba Sarquis

; Mello, Yara Ferreira

; Malheiros, Teresinha

; Toledo, Eliana

; Mansour, Elie

; Fusaro, Gustavo

; Grumach, Anete Sevciovic

Sao Paulo Medical Journal

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2014, Volume 132 N. 5 Pages 261 - 265

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

CONTEXTO E OBJETIVO: O angioedema hereditário (AEH) com deficiência de inibidor de C1 manifesta-se por episódios recorrentes de edema envolvendo pele, trato respiratório superior e gastrointestinal. Pode ser letal por asfixia. O objetivo foi avaliar a resposta à terapia dos ataques com icatibanto, inibidor do receptor de bradicinina, recentemente introduzido no Brasil.TIPO DE ESTUDO E LOCAL: Estudo experimental prospectivo de coorte, sem grupo controle, da eficácia e segurança do icatibanto em paciente com AEH.MÉTODOS: Pacientes com diagnóstico confirmado de AEH foram incluídos de acordo com os sintomas, independentemente do tempo de início do ataque. Icatibanto foi administrado segundo protocolo aprovado no Brasil. A gravidade do sintoma foi estabelecida continuamente e os eventos adversos foram monitorados.RESULTADOS: 24 ataques em 20 pacientes com AEH foram tratados (19 F:1 M; 19-55 anos; mediana 29 anos). Os sintomas foram: edema subcutâneo (22/24), dor abdominal (15/24) e obstrução de vias aéreas superiores (10/24). O tempo para o início do alívio foi: 5-10 minutos, 5/24 (20,8%); 10-20, 5/24 (20,8%); 20-30, 8/24 (33,4%); 30-60, 5/24 (20,8%) e 2 horas, 1/24 (4,3%). O tempo para a resolução completa variou de 4,3-33,4 horas. Somente efeitos adversos nos locais das injeções foram relatados. Eritema leve a moderado e/ou sensação de ardor foram relatados por 15/24 pacientes, prurido em 3, e 6 não tiveram efeitos adversos.CONCLUSÃO: Pacientes com AEH tipo I receberam icatibanto com pronta resposta; a maioria teve melhora na gravidade dos sintomas em 30 minutos. Eventos adversos locais ocorreram em 75% dos pacientes.

CONTEXT AND OBJECTIVE: Hereditary angioedema (HAE) with C1 inhibitor deficiency manifests as recurrent episodes of edema involving the skin, upper respiratory tract and gastrointestinal tract. It can be lethal due to asphyxia. The aim here was to evaluate the response to therapy for these attacks using icatibant, an inhibitor of the bradykinin receptor, which was recently introduced into Brazil.DESIGN AND SETTING: Prospective experimental single-cohort study on the efficacy and safety of icatibant for HAE patients.METHODS: Patients with a confirmed HAE diagnosis were enrolled according to symptoms and regardless of the time since onset of the attack. Icatibant was administered in accordance with the protocol that has been approved in Brazil. Symptom severity was assessed continuously and adverse events were monitored.RESULTS: 24 attacks in 20 HAE patients were treated (female/male 19:1; 19-55 years; median 29 years of age). The symptoms were: subcutaneous edema (22/24); abdominal pain (15/24) and upper airway obstruction (10/24). The time taken until onset of relief was: 5-10 minutes (5/24; 20.8%); 10-20 (5/24; 20.8%); 20-30 (8/24; 33.4%); 30-60 (5/24; 20.8%); and 2 hours (1/24; 4.3%). The time taken for complete resolution of symptoms ranged from 4.3 to 33.4 hours. Adverse effects were only reported at injection sites. Mild to moderate erythema and/or feelings of burning were reported by 15/24 patients, itching by 3 and no adverse effects in 6.CONCLUSION: HAE type I patients who received icatibant responded promptly; most achieved improved symptom severity within 30 minutes. Local adverse events occurred in 75% of the patients.

https://doi.org/10.1590/1516-3180.2014.1325652 3576 downloads

10.

Evaluación de métodos fenotípicos para la detección de metalobetalactamasas en aislados clínicos de Pseudomonas aeruginosa
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Perozo Mena, Armindo José

; Castellano González, Maribel Josefina

; Chávez Kathyuska, Tutaya

; Ling Toledo, Eliana

; Arraiz, Nailet

Kasmera

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dec 2013, Volume 41 N. 2 Pages 115 - 126

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

Pseudomonas aeruginosa es considerado uno de los patógenos nosocomiales más importantes, siendo común su aislamiento en pacientes de unidades de cuidados intensivos, en quienes además suele presentar multirresistencia, esto limita enormemente las opciones terapéuticas para el tratamiento del paciente, lo que constituye un problema ya que no se disponen de drogas efectivas para el tratamiento. El presente trabajo tiene como objetivo evaluar cuatro métodos fenotípicos para la detección de metalo-beta-lactamasas (método de sinergia del doble disco con EDTA, método del disco combinado de imipenem y meropenem con EDTA, método de E-Test-MBL y el método de Hodge modificado), con un método de referencia (PCR), para determinar el método fenotípico o combinación de estos que sea más valido y seguro para su implementación en los laboratorios de bacteriología de rutina. La sensibilidad y especificidad de los métodos fenotípicos empleados fue buena (más de 90%), de los métodos empleados, el test de Hodge modificado fue el que proporcionó mejores resultados en la detección de aislados de P. aeruginosa productores de MBL (menor tasa de falsos positivos y negativos), al analizar los diferentes métodos combinados para determinar cuál es la asociación con mayor sensibilidad y especificidad, el método del doble disco asociado con el test de Hodge modificado reunieron estas características, estos resultados sugieren que estos dos métodos se deben emplear de rutina en un laboratorio de Bacteriología, por ser fáciles de realizar, económicos, sensibles y específicos.

Pseudomonas aeruginosa is considered one of the most important nosocomial pathogens. Its isolation is commonin intensive care unit patients who also usually have multi-resistance. This greatly limits therapeutic options, since no effective drugs are available for treatment. The study aims to evaluate four phenotypic methods for detecting metallo-beta-lactamases. The double disc synergy with EDTA method, combined imipenem and meropenem disk with EDTA method, the E-Test-MBL method and the modified Hodge method, along with a reference method (PCR), are used to determine the phenotypic method or a combination of these is used that is more valid and safe for implementation in routine bacteriology laboratories. The sensitivity and specificity of the phenotypic methods used was good (over 90%); the modified Hodge test obtained the best results in detecting MBL-producing P. aeruginosa isolates (lower rate of false positive and negative). On analyzing the different combined methods for determining the association with greater sensitivity and specificity, the double disc method associated with the modified Hodge test met these characteristics. Results suggest that these two methods should be routinely used in a bacteriology laboratory, since they are easy to perform, sensitive, specific and economical.

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11.

Panorama da ginástica artística feminina brasileira de alto rendimento esportivo: progressão, realidade e necessidades
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Schiavon, Laurita Marconi

; Paes, Roberto Rodrigues

; Toledo, Eliana de

; Deutsch, Silvia

Revista Brasileira de Educação Física e Esporte

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sep 2013, Volume 27 N. 3 Pages 423 - 436

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

Os resultados das atletas brasileiras da Ginástica Artística feminina nos últimos 10 anos, refletidos principalmente nas competições de nível internacional, apontam para uma expressiva evolução do esporte no país. Assim, este artigo tem o propósito de apresentar dados acerca desta transformação, principalmente a partir da participação das ginastas em Jogos Olímpicos (desde 1980), e estabelecer reflexões em relação ao desenvolvimento da modalidade no país. A partir de uma pesquisa bibliográfica e documental, estes dados foram obtidos, reunidos e contextualizados com outras informações já disponíveis na literatura. Ao analisá-los foi possível não só apontar com especificidade como se deu esta evolução, como também apresentar uma realidade deflagradora de um processo ainda imaturo de desenvolvimento do esporte no país, que não condiz em grande parte com o que é posto pela mídia (de que a modalidade está em pleno avanço e de forma estruturada).

The Brazilian Women's Artistic Gymnastics results in international championships are refl ecting the high level of the athletes in the modality and expressing the evolution of this sport in Brazil in the last 10 years. Therefore, this article has the goal to present data about such evolution since the fi rst participation of the Brazilian gymnasts in the Olympic Games (1980), and to refl ect the development of the modality in Brazil. The data have been collected through a bibliographic and documental research. The data analysis showed a unstructured and immature process of the development of this sport in Brazil, revealing a very different reality from what has been exposed in the media.

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12.

Hereditary angioedema: quality of life in Brazilian patients
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Gomide, Maria Abadia Consuelo M. S.

; Toledo, Eliana

; Valle, Solange Oliveira Rodrigues

; Campos, Regis A.

; França, Alfeu T.

; Gomez, Nieves Prior

; Andrade Jr., Heitor Franco

; Caballero, Teresa

; Grumach, Anete S.

Clinics

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jan 2013, Volume 68 N. 1 Pages 81 - 83

Abstract: En | Text: En | PDF: En

OBJECTIVE: Hereditary angioedema is a serious medical condition caused by a rare autosomal dominant genetic disorder and it is associated with deficient production or dysfunction of the C1 esterase inhibitor. In most cases, affected patients experience unexpected and recurrent crises of subcutaneous, gastrointestinal and laryngeal edema. The unpredictability, intensity and other factors associated with the disease impact the quality of life of hereditary angioedema patients. We evaluated the quality of life in Brazilian hereditary angioedema patients. METHODS: Patients older than 15 years with any severity of hereditary angioedema and laboratory confirmation of C1 inhibitor deficiency were included. Two questionnaires were used: a clinical questionnaire and the SF-36 (a generic questionnaire). This protocol was approved by the Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The SF-36 showed that 90.4% (mean) of all the patients had a score below 70 and 9.6% had scores equal to or higher than 70. The scores of the eight dimensions ranged from 51.03 to 75.95; vitality and social aspects were more affected than other arenas. The internal consistency of the evaluation was demonstrated by a Cronbach's alpha value above 0.7 in seven of the eight domains. CONCLUSIONS: In this study, Brazilian patients demonstrated an impaired quality of life, as measured by the SF-36. The most affected domains were those related to vitality and social characteristics. The generic SF-36 questionnaire was relevant to the evaluation of quality of life; however, there is a need for more specific instruments for better evaluation.

https://doi.org/10.6061/clinics/2013(01)OA13 1965 downloads

13.

Detección fenotípica de metalobetalactamasas en aislados clínicos de Pseudomonas aeruginosa
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Perozo, Mena

; Armindo, José

; Castellano González, Maribel Josefina

; Ling Toledo, Eliana

; Arraiz, Nailet

Kasmera

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jul 2012, Volume 40 N. 2 Pages 113 - 121

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

Pseudomonas aeruginosa, es considerado uno de los más importantes gérmenes hospitalarios, siendo común su aislamiento en pacientes hospitalizados, adicionalmente, este microorganismo presenta una marcada multiresistencia, lo que incrementa la mortalidad. El tratamiento de estos pacientes suele ser difícil, ya que además de su resistencia natural, Pseudomonas puede adquirir mecanismos de resistencia para prácticamente la totalidad de los antimicrobianos disponibles para su tratamiento, por lo que cada vez es más frecuente y necesario el empleo de antibióticos como los carbapenems, lo que facilita la adquisición de mecanismos de resistencia a estas drogas. El presente estudio intenta determinar la producción de metalobetalactamasas (MBL) en aislados clínicos de Pseudomonas aeruginosa, utilizando para ello dos métodos fenotípicos. Se utilizó el método del doble disco (MDD) y el test de Hodge modificado (MHT). Se analizaron 726 aislados clínicos de P. aeruginosa, el 20,11% (146) de estos fueron resistentes a imipenem (IPM) y meropenem (MEM), por lo que se les realizaron los dos métodos fenotípicos, de los 146 aislados resistentes a carbapenems, 139 fueron positivas para el MDD, mientras que 144 lo fueron para el MHT, estos dos métodos permitieron confirmar la presencia de una carbapenemasa tipo MBL en el 98,63% de los aislados de P. aeruginosa, por otra parte, cinco aislados no fueron positivos para el MDD pero si para el MHT, lo que indicaría la presencia de carbapenemasas no MBL en estos aislado, también se obtienen 2 aislados que a pesar de ser IPM y MEM resistentes fueron negativos por los dos métodos fenotípicos utilizados, esto indicaría la presencia de un mecanismo de resistencia no enzimático que confiere resistencia a carbapenems. La utilización de métodos fenotípicos para la detección de MBL en aislados de P. aeruginosa es una opción bastante aceptable para utilizar en laboratorios de rutina donde pruebas especializadas de biología molecular no están

Pseudomonas aeruginosa is considered one of the most important hospital germs; its isolation is common in hospitalized patients. In addition, this microorganism has a marked multi-resistance, which increases mortality. Treatment of these patients is often difficult, since in addition to its natural resistance, Pseudomonas can obtain resistance mechanisms to virtually all antimicrobial drugs available for its treatment; due to this, its appearance is increasingly frequent and necessitates the use of antibiotics such as carbapenems, which facilitates the acquisition of resistance mechanisms to these drugs. This study attempts to determine the production of metallo-beta-lactamase (MBL) in clinical isolates of Pseudomonas aeruginosa, utilizing two phenotypic methods: the double disc method (MDD) and the modified Hodge test (MHT). 726 clinical isolates of P. aeruginosa were analyzed; 20.11% (146) of these were resistant to imipenem (IPM) and meropenem (MEM); 139 were positive for the MDD, while 144 were positive for the MHT. These two methods permitted confirming the presence of an MBL-type carbapenemase in 98.63% of P. aeruginosa isolates; five isolates were negative for the MDD but positive for the MHT, indicating the presence of non-MBL-type carbapenemase in these isolates. Also, 2 isolates were obtained that, despite being resistant to IPM and MEM, were negative according to the two phenotypic methods used; this would indicate the presence of a non-enzymatic resistance mechanism conferring resistance to carbapenems. The use of phenotypic methods for detecting MBL in P. aeruginosa isolates is quite an acceptable option for use in routine laboratories where specialized molecular biology tests are not available.

2350 downloads

14.

Association between obesity and asthma among teenagers
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Bertolace, Maria do Pilar Carneiro

; Toledo, Eliana

; Jorge, Patrícia Polis de Oliveira

; Liberatore Junior, Raphael Del Roio

Sao Paulo Medical Journal

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sep 2008, Volume 126 N. 5 Pages 285 - 287

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

CONTEXTO AND OBJETIVO: Obesidade e asma são sérios e crescentes problemas em nossa sociedade. Como o tecido adiposo produz substâncias inflamatórias, o objetivo foi estimar a prevalência de asma entre os estudantes (Fase 1), e verificar uma hipótese de associação entre obesidade e asma (Fase 2), em escolares de São José do Rio Preto, São Paulo. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado pela Faculdade de Medicina de São José do Rio Preto (Famerp), São Paulo. MÉTODOS: O estudo foi realizado em duas etapas sucessivas e dependentes. A Fase I, em estudo transversal de prevalência com 4.103 escolares (13-14 anos de idade), para determinar a prevalência e a gravidade da asma. A Fase II, transversal analítico, com 431 (190 asmáticos e 231 não asmáticos), provenientes do grupo da Fase I, avaliou a associação entre obesidade, classificada por índice de massa corporal (IMC) e asma. As amostras foram selecionadas aleatoriamente. Para os diagnósticos de asma e obesidade foram empregados os critérios do International Study of Asthma and Allergies in Childhood (ISAAC) e a tabela do Centers for Disease Control (CDC) 2000. Os dados obtidos foram analisados utilizando o teste t de Student. RESULTADOS: Notou-se que 5,6% do grupo analisado na Fase I são asmáticos; e observou-se um aumento do IMC de asmáticos (21,8 kg/m²) em relação ao dos não-asmáticos (21,73 kg/m²). No entanto, o valor de p obtido foi de 0,766. CONCLUSÃO: Neste estudo não foi encontrada uma associação entre IMC elevado e prevalência de asma, no grupo estudado.

CONTEXT AND OBJECTIVE: Obesity and asthma are serious and growing problems. Since adipose tissue produces inflammatory substances, the aim of this study was to estimate the prevalence of asthma among students at schools in São José do Rio Preto (Phase 1), and to corroborate the hypothesis for an association between obesity and asthma among these students (Phase 2). DESIGN AND SETTING: Cross-sectional study at Faculdade de Medicina de São José do Rio Preto (Famerp). METHODS: The study consisted of two successive and dependent stages. Phase I was a cross-sectional study on 4103 randomly selected students (13-14 years old), to determine the prevalence and severity of asthma. Phase II was an analytical cross-sectional study on 431 students (190 asthmatics and 231 non-asthmatics) from Phase I, to evaluate the hypothesis of an association between obesity measured by the body mass index (BMI) and asthma. To diagnose asthma and obesity, the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) and the chart from the Centers for Disease Control (CDC; 2000) were used. The data were analyzed using Student's t test. RESULTS: We found that 5.6% of the students analyzed in Phase I were asthmatic. The BMI among the asthmatic students (21.84 kg/m²) was higher than the BMI among the non-asthmatics (21.73 kg/m²), although the p value was 0.766. CONCLUSION: In our study group, we did not find any association between increased BMI and the prevalence of asthma.

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15.

Phadiatop® no diagnóstico de alergia respiratória em crianças: Projeto Alergia (PROAL)
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Naspitz, Charles K.

; Solé, Dirceu

; Aguiar, Maria Cecília

; Chavarria, Maria Letícia

; Rosário Filho, Nelson

; Zuliani, Antônio

; Toledo, Eliana C.

; Barreto, Bruno A. P.

; Souza, Leda S. F.

Jornal de Pediatria

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jun 2004, Volume 80 N. 3 Pages 217 - 222

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

OBJETIVO: Avaliar a positividade do Phadiatop® em crianças acompanhadas em serviços brasileiros de alergologia e compará-la aos resultados de IgE sérica específica a alérgenos inalantes e alimentares. CASUÍSTICA E MÉTODO: Em 457 crianças acompanhadas em serviços de alergia pediátrica e um grupo de crianças controle não-alérgicas (n = 62), distribuídas em cinco faixas etárias, foram determinados em amostra de soro: Phadiatop® e IgE específica (RAST) a alérgenos inalantes e alimentares (UniCAP - Pharmacia®). RESULTADOS: O Phadiatop® foi positivo em 305 crianças atópicas (67,6%) e em 25,8% das controles (p < 0,001). Entre as crianças atópicas, a distribuição de positividade variou de acordo com a faixa etária: 7,9% (24/305) entre as abaixo de 2 anos, 15,4% (47/305) nas de 2 a 3 anos, 22,0% (67/305) nas de 3 a 4 anos, 19,3% (59/305) nas de 4 a 5 anos e 35,4% (108/305) nas de 5 a 12 anos. Não houve concordância entre os alérgenos alimentares e a presença de Phadiatop® positivo. O estudo da relação entre os RAST positivos para alérgenos inalados e o Phadiatop® positivo mostrou melhores índices com os ácaros domiciliares (D. pteronyssinus, D. farinae e Blomia tropicalis). CONCLUSÕES: O Phadiatop®é método útil no diagnóstico de alergia aos ácaros domiciliares.

OBJECTIVES: To evaluate the positivity of Phadiatop® in children from several Brazilian pediatric allergology centers and to compare its results with the presence of serum specific IgE to inhalant and food allergens. PATIENTS AND METHOD: Phadiatop® and serum specific IgE levels (RAST) to inhalant and food allergens (UniCAP - Pharmacia®) were measured in 457 children from several pediatric allergy centers and in a non-allergic control group (n = 62), distributed across five age groups. RESULTS: Phadiatop was positive in 305 atopic children (67.6%) and in 25.8% of controls (p < 0.001). Among atopic children the distribution of positive test varied according to age: 7.9% (24/305) among under 2 year-olds, 15.4% (47/305) in 2 to 3 year-olds, 22% (67/305) in 3 to 4 year-olds, 19.3% (59/305) in 4 to 5 year-olds and 35.4% (108/305) in 5 to 12 year-olds. No concordance between food allergens and Phadiatop® was observed. Analysis of the relationship between positive inhaled allergen RASTs and positive Phadiatop® showed best indices with house dust mites (D. pteronyssinus, D. farinae and Blomia tropicalis). CONCLUSIONS: Phadiatop® is a useful tool for diagnosing domestic mite allergy.

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