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Delirium severity and outcomes of critically ill COVID-19 patients
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Rego, Luciana Leal do

; Salluh, Jorge Ibrain Figueira

; Souza-Dantas, Vicente Cés de

; Silva, José Roberto Lapa e

; Póvoa, Pedro

; Serafim, Rodrigo Bernardo

Critical Care Science

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dec 2023, Volume 35 N. 4 Pages 394 - 401

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

ABSTRACT Objective: To investigate the impact of delirium severity in critically ill COVID-19 patients and its association with outcomes. Methods: This prospective cohort study was performed in two tertiary intensive care units in Rio de Janeiro, Brazil. COVID-19 patients were evaluated daily during the first 7 days of intensive care unit stay using the Richmond Agitation Sedation Scale, Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Confusion Method Assessment for Intensive Care Unit-7 (CAM-ICU-7). Delirium severity was correlated with outcomes and one-year mortality. Results: Among the 277 COVID-19 patients included, delirium occurred in 101 (36.5%) during the first 7 days of intensive care unit stay, and it was associated with a higher length of intensive care unit stay in days (IQR 13 [7 - 25] versus 6 [4 - 12]; p < 0.001), higher hospital mortality (25.74% versus 5.11%; p < 0.001) and additional higher one-year mortality (5.3% versus 0.6%, p < 0.001). Delirium was classified by CAM-ICU-7 in terms of severity, and higher scores were associated with higher in-hospital mortality (17.86% versus 34.38% versus 38.46%, 95%CI, p value < 0.001). Severe delirium was associated with a higher risk of progression to coma (OR 7.1; 95%CI 1.9 - 31.0; p = 0.005) and to mechanical ventilation (OR 11.09; 95%CI 2.8 - 58.5; p = 0.002) in the multivariate analysis, adjusted by severity and frailty. Conclusion: In patients admitted with COVID-19 in the intensive care unit, delirium was an independent risk factor for the worst prognosis, including mortality. The delirium severity assessed by the CAM-ICU-7 during the first week in the intensive care unit was associated with poor outcomes, including progression to coma and to mechanical ventilation.

RESUMO Objetivo: Investigar como a gravidade do delirium afeta pacientes graves com COVID-19 e sua associação com os desfechos. Métodos: Estudo de coorte prospectivo realizado em duas unidades de terapia intensiva terciárias no Rio de Janeiro (RJ). Os pacientes com COVID-19 foram avaliados diariamente durante os primeiros 7 dias de internação na unidade de terapia intensiva usando a escala de agitação e sedação de Richmond, a Confusion Assessment Method for Intensive Care Unit (CAM-ICU) e a Confusion Assessment Method for Intensive Care Unit-7 (CAM-ICU-7). A gravidade do delirium foi correlacionada com os desfechos e a mortalidade em 1 ano. Resultados: Entre os 277 pacientes com COVID-19 incluídos, o delirium ocorreu em 101 (36,5%) durante os primeiros 7 dias de internação na unidade de terapia intensiva e foi associado a maior tempo de internação na unidade de terapia intensiva em dias (IQ: 13 [7 - 25] versus 6 [4 - 12]; p < 0,001), maior mortalidade hospitalar (25,74% versus 5,11%; p < 0,001) e maior mortalidade em 1 ano (5,3% versus 0,6%, p < 0,001). O delirium foi classificado pela CAM-ICU-7 em termos de gravidade, e escores maiores foram associados à maior mortalidade hospitalar (17,86% versus 34,38% versus 38,46%, IC95%, valor de p < 0,001). O delirium grave foi associado a um risco maior de progressão ao coma (RC de 7,1; IC95% 1,9 - 31,0; p = 0,005) e à ventilação mecânica (RC de 11,09; IC95% 2,8 - 58,5; p = 0,002) na análise multivariada, ajustada por gravidade e fragilidade Conclusão: Em pacientes internados com COVID-19 na unidade de terapia intensiva, o delirium foi fator de risco independente para o pior prognóstico, incluindo mortalidade. A gravidade do delirium avaliada pela CAM-ICU-7 durante a primeira semana na unidade de terapia intensiva foi associada a desfechos desfavoráveis, incluindo a progressão ao coma e à ventilação mecânica.

https://doi.org/10.5935/2965-2774.20230170-en

Frecuencia de eventos cardiovasculares en pacientes con lupus eritematoso sistémico.
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García, Lucila

; Gobbi, Carla

; Quintana, Rosana

; Alba, Paula

; Roverano, Susana

; Álvarez, Analía

; Graf, César

; Pisoni, Cecilia

; Spindler, Alberto

; Gómez, Catalina

; Figueredo, Heber Matías

; Papasidero, Silvia

; Paniego, Raúl

; de la Vega, María Celina

; Civit, Emma

; González Lucero, Luciana

; Martire, María Victoria

; Maldonado Aguila, Rodrigo

; Gordon, Sergio

; Micelli, Marina

; Nieto, Romina

; Rausch, Gretel

; Gongora, Vanina

; Damico, Agustina

; Dubinsky, Diana

; Orden, Alberto

; Zacariaz, Johana

; Romero, Julia

; Pera, Mariana

; Goñi, Mario

; Rillo, Oscar

; Báez, Roberto

; Arturi, Valeria

; González, Andrea

; Vivero, Florencia

; Bedoya, María Eugenia

; Shmid, Marcela

; Caputo, Víctor

; Larroude, María Silvia

; Domínguez, Nadia

; Gómez, Graciela

; Rodríguez, Graciela

; Marín, Josefina

; Collado, Victoria

; Jorfen, Marisa

; Bedran, Zaida

; Curti, Ana

; Gazzoni, María Victoria

; Sarano, Judith

; Finucci Curi, Pablo

; Rojas Tessel, Romina

; Arias Saavedra, Maira

; Sattler, María Emilia

; Machado Escobar, Maximiliano

; Astesana, Pablo

; París, Úrsula

; Vandale, Juan Manuel

; Santa Cruz, María Julia

; Pons-Estel, Bernardo

; García, Mercedes

Revista argentina de reumatología

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oct 2023, Volume 34 N. 2 Pages 43 - 50

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

Resumen Introducción: el progreso en los tratamientos para el lupus eritematoso sistémico (LES) resultó en una disminución de la mortalidad; sin embargo, la enfermedad cardiovascular y las complicaciones infecciosas aún son las principales causas de muerte. La evidencia apoya la participación del sistema inmunológico en la generación de la placa aterosclerótica, así como su conexión con las enfermedades autoinmunes. Objetivos: describir la frecuencia de eventos cardiovasculares (ECV) en el Registro de Lupus Eritematoso Sistémico de la Sociedad Argentina de Reumatología (RELESSAR) transversal, así como sus principales factores de riesgo asociados. Materiales y métodos: estudio descriptivo y transversal para el cual se tomaron los pacientes ingresados en el registro RELESSAR transversal. Se describieron las variables sociodemográficas y clínicas, las comorbilidades, score de actividad y daño. ECV se definió como la presencia de al menos una de las siguientes patologías: enfermedad arterial periférica, cardiopatía isquémica o accidente cerebrovascular. El evento clasificado para el análisis fue aquel posterior al diagnóstico del LES. Se conformaron dos grupos macheados por edad y sexo 1:2. Resultados: 1515 pacientes mayores de 18 años participaron del registro. Se describieron 80 pacientes con ECV (5,3%). En este análisis se incluyeron 240 pacientes conformando dos grupos. La edad media fue de 47,8 (14,4) y 47,6 (14,2) en el grupo con y sin ECV respectivamente. Los pacientes con ECV tuvieron mayor duración del LES en meses, mayor índice de Charlson, mayor SLICC (Systemic Lupus International Collaborating Clinics/American College of Rheumatology), mayor frecuencia de manifestaciones neurológicas, síndrome antifosfolípido, hospitalizaciones y uso de ciclofosfamida. Las únicas variables asociadas en el análisis multivariado fueron el índice de Charlson (p=0,004) y el SLICC (p<0,001). Conclusiones: los ECV influyen significativamente en nuestros pacientes, y se asocian a mayor posibilidad de daño irreversible y comorbilidades.

Abstract Introduction: progress in treatments for systemic lupus erythematosus (SLE) has resulted in a decrease in mortality; however, cardiovascular and infectious diseases remain the leading causes of death. Evidence supports the involvement of the immune system in the generation of atherosclerotic plaque, as well as its connection to autoimmune diseases. Objectives: to describe the frequency of cardiovascular disease (CVD) in the cross-sectional RELESSAR registry, as well as its associated variables. Materials and methods: a descriptive and cross-sectional study was performed using patients admitted to the cross-sectional RELESSAR registry. Sociodemographic variables, clinical variables, comorbidities, activity and damage scores were described. CVD was defined as at least one of the following: peripheral arterial disease, ischemic heart disease, or cerebrovascular accident. All patients with at least one CVD were included in our analysis (heart attack, central nervous system vascular disease, and peripheral arteries atherosclerotic disease). The event classified for the analysis was that after the diagnosis of SLE. SLE diagnosis was previous to CVD. Two groups matched by age and sex, 1:2 were formed. Results: a total of 1515 patients older than 18 years participated in the registry. Eighty patients with CVD (5.3%) were described in the registry. Two-hundred and forty patients were included, according to two groups. The mean age was 47.8 (SD 14.4) and 47.6 (SD 14.2) in patients with and without CVD, respectively. Patients with CVD had a longer duration of SLE in months, a higher Charlson index, a higher SLICC, increased frequency of neurological manifestations, antiphospholipid syndrome, hospitalizations, and use of cyclophosphamide. The associated variables in the multivariate were the Charlson Index (p=0.004) and the SLICC (p<0.001). Conclusions: CVDs have a significant influence on our patients, being associated with a greater possibility of damage and comorbidities.

https://doi.org/10.47196/rar.v34i2.747

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity disorder attentiondeficit deficithyperactivity
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Lisboa, Bernardo Oppermann

; Caye, Arthur

; Hernandes, Angelo Masson

; da Silva, Antonio Geraldo

; Rieder, Carlos Roberto M.

; Sonuga-Barke, Edmund

; Kestelman, Iane

; Nelson, Jason M.

; Castanho, Marisa Irene Siqueira

; Fonseca, Rochele Paz

; Hinshaw, Stephen P.

; Rohde, Luis Augusto

Brazilian Journal of Psychiatry

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aug 2023, Volume 45 N. 4 Pages 373 - 378

Abstract: En | Text: En | PDF: En

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria. disabilities However advantages context attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity (ADHD evidencebased evidence experience including malingering Finally consulted search Therefore internationally attentiondeficit deficithyperactivity

https://doi.org/10.47626/1516-4446-2022-2999

Cannabis products: medical use products
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Fernandes, César Eduardo

; Dolci, José Eduardo Lutaif

; Navarro, Leonardo Sobral

; Allevato, Marcelo

; Constantino, Clóvis Francisco

; Pereira, Rodrigo Pastor Alves

; Rieder, Carlos Roberto de Mello

; Torino, Flávia

; Bernardo, Wanderley Marques

; Silva, Antônio Geraldo da

Revista da Associação Médica Brasileira

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mar 2023, Volume 69 N. 3 Pages 358 - 364

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1806-9282.2023d693

Análise da resistência à compressão de alvenarias de blocos cerâmicos assentados com argamassa cimentícia e composto polimérico
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Donadello, Matheus

; Ehrenbring, Hinoel Zamis

; Pacheco, Fernanda

; Christ, Roberto

; Tutikian, Bernardo Fonseca

Matéria (Rio de Janeiro)

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2023, Volume 28 N. 1 elocation e13235

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

ABSTRACT The use of polymeric compounds is limited to sealing masonry in Brazil, due to the criteria of the NBR 16590 [1]. However, one must evaluate how much this material can contribute when applied to structural masonry. Thus, this study investigated the operation of a type of polymeric compound when applied in structural masonry, performing chemical and physical characterization tests and adhesion at the interface between block and binder. Besides these, we investigated the axial compressive strength of full-scale walls was investigated. One sample was made with horizontal joints filled with cementitious mortar and two containing polymeric compound, with 2 and 4 fillets for settlement the blocks. The characterization results of the binder material and interface showed that the polymeric compound has greater resilience and better adherence performance when compared to cementitious mortar. In the overall analysis of the system, it was found that masonry built with 4 fillets of polymeric composite achieved the same compressive strength of the sample built with conventional cement mortar (~ 138 kN/m at break), the sample with 2 fillets presented higher vertical deformation, 25% in relation to the others, showing the potential use of the polymeric compound in structural masonry.

RESUMO O uso dos compostos poliméricos se limita às alvenarias de vedação no Brasil, devido aos critérios da NBR 16590 [1]. No entanto, deve-se avaliar o quanto este material pode contribuir quando aplicado em alvenarias estruturais. Sendo assim, esse estudo investigou o funcionamento de um tipo de composto polimérico, quando aplicado em alvenarias estruturais, realizando ensaios de caracterização química e física do material e de aderência na interface entre bloco e o ligante. Além dessas, foram investigadas a resistência à compressão axial de paredes em escala real, sendo uma amostra executada com as juntas horizontais preenchidas por argamassa cimentícia e outras duas contendo composto polimérico, com 2 e 4 filetes para assentamento dos blocos. Os resultados de caracterização do material ligante e interface mostraram que o composto polimérico possui maior resiliência e melhor desempenho à aderência, quando comparado à argamassa cimentícia. Já na análise global do sistema, verificou-se que a alvenaria construída com 4 filetes de composto polimérico atingiu a mesma resistência à compressão da amostra construída com argamassa cimentícia convencional (~138 kN/m na ruptura), a amostra com 2 filetes apresentou maior deformação vertical, 25 % em relação as demais, mostrando o potencial de utilização do composto polimérico em alvenaria estrutural.

https://doi.org/10.1590/s1517-707620230001.1335

Comportamento à flexão de vigas de madeira reforçadas com perfis de aço fixados com diferentes parafusos: análise experimental e computacional
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Ehrenbring, Hinoel Zamis

; Vidal, Marcelo

; Aires, Rafael Hannich

; Christ, Roberto

; Braatz, Simone

; Schneider, Diego

; Tutikian, Bernardo Fonseca

; Pacheco, Fernanda

Matéria (Rio de Janeiro)

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2023, Volume 28 N. 1 elocation e20220308

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

ABSTRACT This paper verified the structural behavior of three configurations of composite beams of wood and steel profiles, analytically by the mixed section homogenization method (MHSM), by experimental tests and simulated by the finite element method (FEM). Unreinforced wooden beam (V-SR), with bent steel sheet profiles fixed with stud (V-PRI) and self-tapping (V-AUT) screws were analyzed. The flexural behavior was analyzed by 3 points of these elements, represented by the load and displacement. It was found that the beam failure form was the same in all configurations, occurring in the tensioned part, without lateral buckling of the steel profiles or plastic deformation of the screws. It was noted that the insertion of steel profiles caused an increase in the strength of the composite beams, being 100% in the V-PRI sample and 32% in the V-AUT. The FEM simulations showed values closer to the bending behavior of the V-SR and V-PRI beams in the elastic regime (ELS). The experimental results of the V-AUT beams were more compatible with the mixed section homogenization model.

RESUMO Este artigo verificou o comportamento estrutural à flexão de três configurações de vigas mistas de madeira e perfis de aço, por meio do método de homogeneização da seção mista, ensaios experimentais e simulação computacional. Foram analisadas viga de madeira sem reforço (V-SR), com perfis de chapa de aço dobrada fixada com parafuso tipo prisioneiro (V-PRI) e autoatarraxante (V-AUT). Foram realizados ensaios de flexão por 3 pontos, obtendo a força de ruptura e deslocamentos. Verificou-se que a forma ruptura das vigas foi similar em todas as configurações, ocorrendo na parte tracionada, sem apresentar flambagem lateral dos perfis de aço ou deformação plástica dos parafusos. Notou-se que a inserção dos perfis de aço ocasionou um aumento na resistência das vigas mistas, sendo de 100% nas vigas com perfis de chapa de aço dobrada fixada com parafuso tipo prisioneiro (V-PRI) e de 32% nas vigas com perfis de chapa de aço dobrada fixada com parafuso tipo autoatarraxante (V-AUT). As simulações pelo método dos elementos finitos apresentaram valores mais próximos ao comportamento na flexão das vigas V-SR e V-PRI no regime elástico (ELS). O método de homogeneização da seção mista mostrou-se mais próximo dos resultados experimentais nas vigas de madeira reforçadas (V-PRI e V-AUT).

https://doi.org/10.1590/1517-7076-rmat-2022-0308

Analysis of the thickness of conjunctival autograft in pterygium surgery with the Moscovici dissection technique compared with manual dissection
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Moreno, Celso Busnelo

; Cruz, João Carlos Gonçalves

; Soares, Paula Virginia Brom dos Santos

; Barboza, Guilherme Novoa Colombo

; Barboza, Luiz Roberto Colombo

; Barboza, Marcello Novoa Colombo

; Moscovici, Bernardo Kaplan

Revista Brasileira de Oftalmologia

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2023, Volume 82 elocation e0042

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

ABSTRACT Objective Compare the thickness of conjunctival autografts in pterygium surgery using the Moscovici dissection technique with manual dissection and assess the difficulty of the techniques. Methods In this randomized clinical trial, 30 eyes of 30 patients undergoing pterygium surgery were divided into the Moscovici Dissection Technique Group and the Manual Dissection Group. The patients were treated at the Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brazil). Optical coherence tomography was performed to measure graft thickness three months postoperatively. Three images were obtained from each eye, and three measurements were taken at a distance of 1.5mm perpendicular to the limbus in each capture. The surgeon graded the difficulty of obtaining the graft with the technique performed from one (lowest difficulty) to four (highest difficulty). Results We found statistically significant difference between the difficulty of the two techniques and the mean conjunctival autograft thickness in the two groups (p=0.01 e p=0.05, respectively). The average difficulty rating for the Moscovici Dissection Technique Group (Air Group) was 1.47, while that for the Manual Dissection Group (MD group) was 2.20. The mean thickness of the three measurements was 252µ in the Air Group and 298µ in the MD Group, with medians of 250µ and 278µ, respectively. Conclusion Our study showed that the Moscovici technique results in thinner grafts and can be performed with greater surgical ease.

RESUMO Objetivo Comparar a espessura de autoenxertos conjuntivais em cirurgia de pterígio utilizando a técnica de dissecção de Moscovici com a de dissecção manual e avaliar a dificuldade das técnicas. Métodos Neste ensaio clínico randomizado, 30 olhos de 30 pacientes submetidos à cirurgia de pterígio foram divididos em um Grupo de Técnica de Dissecção de Moscovici e um Grupo de Dissecção Manual. Os pacientes foram tratados e avaliados no Hospital Oftalmológico Visão Laser (Santos, São Paulo, Brasil). A tomografia de coerência óptica foi realizada para medir a espessura do enxerto 3 meses após a cirurgia. Três imagens foram obtidas de cada olho, e três medidas foram realizadas a uma distância de 1,5mm perpendicular ao limbo em cada captura. O cirurgião classificou a dificuldade de obtenção do enxerto com a técnica realizada de um (menor dificuldade) para quatro (maior dificuldade). Resultados Encontramos diferenças estatisticamente significantes entre a dificuldade das duas técnicas e a espessura média do autoenxerto conjuntival nos dois grupos (p=0,01 e p=0,05, respectivamente). A classificação média de dificuldade para o Grupo de Técnica de Dissecção de Moscovici foi de 1,47, enquanto a do Grupo de Dissecção Manual foi de 2,20. A espessura média das três medidas foi de 252μ no Grupo de Técnica de Dissecção de Moscovici e de 298μ no Grupo de Dissecção Manual, com medianas de 250μ e 278μ, respectivamente. Conclusão Nosso estudo mostrou que a técnica de Moscovici resulta em enxertos mais finos e pode ser realizada com maior facilidade cirúrgica.

https://doi.org/10.37039/1982.8551.20230042

Effect of firing temperature and mineral composition on the mechanical properties of silty clays
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Christ, Roberto

; Bourscheid, Ismael

; Pacheco, Fernanda

; Silva, Michele Goulart da

; Ehrenbring, Hinoel Zamis

; Silva, Andrea Brum da

; Tutikian, Bernardo Fonseca

Matéria (Rio de Janeiro)

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2023, Volume 28 N. 3 elocation e20230181

Abstract: En | Text: En | PDF: En

ABSTRACT The physical and mechanical properties of ceramic blocks are affected by the firing process of the primary raw material, in this case, clay or clay minerals. Consequently, this study sought to characterize different types of silty clays for ceramic block production and determine the effect of firing time and mineral content on their mechanical and physical properties. Characterization was conducted in two stages: pre and post-firing. Pre-firing evaluations were granulometric distribution, Attenberg limits, chemical composition, mineral composition and thermal behavior. Post-firing evaluation made use of 30 specimens subjected to temperatures of 800 °C, 900 °C and 1,000 °C. Results showed that firing temperatures greatly affected mechanical properties. Higher burn temperatures increased tensile strength and reduced water absorption while causing linear shrinkage. This increase in shrinkage raised the possibility of damage to the ceramic material and reduction of overall quality.

https://doi.org/10.1590/1517-7076-rmat-2023-0181

Radioterapia Estereotáxica para Tratamento de Taquicardia Ventricular Recorrente na Doença de Chagas: Relato do Primeiro Caso na América Latina Chagas
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Scanavacca, Mauricio I.

; Pisani, Cristiano F.

; Salvajoli, Bernardo

; Kulchetscki, Rodrigo M.

; Mayrink, Marina P.

; Salvajoli, João Victor

; Kalil, Roberto

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20220614

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

https://doi.org/10.36660/abc.20220614

10.

Guidelines on the diagnosis and management of multiple myeloma treatment: Associac ao Brasileira de Hematologia e Hemoterapia e Terapia Celular Project guidelines: Associação Médica Brasileira - 2022. Part I
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Maiolino, Angelo

; Crusoé, Edvan de Queiroz

; Martinez, Gracia Aparecida

; Braga, Walter Moisés Tobias

; Farias, Danielle Leão Cordeiro de

; Bittencourt, Rosane Isabel

; Pinto Neto, Jorge Vaz

; Ribeiro, Glaciano Nogueira

; Bernardo, Wanderley Marques

; Tristão, Luca

; Magalhaes, Roberto J.P.

; Hungria, Vania Tietsche de Moraes

Hematology, Transfusion and Cell Therapy

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sep 2022, Volume 44 N. 3 Pages 410 - 418

Abstract: En | Text: En | PDF: En

https://doi.org/10.1016/j.htct.2022.06.003

11.

The effects of macronutrients composition on hormones and substrates during a meal tolerance test in drug-naive and sitagliptin-treated individuals with type 2 diabetes: a randomized crossover study
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Schreiber, Cristina da Silva

; Rafacho, Alex

; Silverio, Renata

; Betti, Roberto

; Lerário, Antonio Carlos

; Lotenberg, Ana Maria Pita

; Rahmann, Klara

; Oliveira, Carolina Piras de

; Wajchenberg, Bernardo Léo

; Luz, Protásio Lemos da

Archives of Endocrinology and Metabolism

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jun 2022, Volume 66 N. 3 Pages 312 - 323

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives: To evaluate the effect of sitagliptin treatment in early type 2 diabetes mellitus (T2DM) and the impact of different macronutrient compositions on hormones and substrates during meal tolerance tests (MTT). Materials and methods: Half of the drug-naive patients with T2DM were randomly assigned for treatment with 100 mg of sitagliptin, q.d., or placebo for 4 weeks and then submitted to 3 consecutive MTT intercalated every 48 h. The MTTs differed in terms of macronutrient composition, with 70% of total energy from carbohydrates, proteins, or lipids. After 4 weeks of washout, a crossover treatment design was repeated. Both patients and researchers were blinded, and a repeated-measures ANOVA was employed for statistical analysis. Results: Sitagliptin treatment reduced but did not normalize fasting and post-meal glucose values in the three MTTs, with lowered area-under-glucose-curve values varying from 7% to 15%. The sitagliptin treatment also improved the insulinogenic index (+86%) and the insulin/glucose (+25%), glucagon-like peptide-1/glucose (+46%) incremental area under the curves. Patients with early T2DM maintained the lowest glucose excursion after a protein- or lipid-rich meal without any major change in insulin, C-peptide, glucagon, or NEFA levels. Conclusion: We conclude that sitagliptin treatment is tolerable and contributes to better control of glucose homeostasis in early T2DM, irrespective of macronutrient composition. The blood glucose excursion during meal ingestion is minimal in protein- or fat-rich meals, which can be a positive ally for the management of T2DM. Clinical trial no: NCT00881543

https://doi.org/10.20945/2359-3997000000478

12.

A Sonotrombólise Promove Melhora dos Índices de Motilidade e Perfusão do Ventrículo Esquerdo após o Infarto Agudo do Miocárdio
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Tavares, Bruno G.

; Aguiar, Miguel Osman

; Tsutsui, Jeane

; Oliveira, Mucio

; Soeiro, Alexandre de Matos

; Nicolau, José

; Ribeiro, Henrique

; PoChiang, Hsu

; Sbano, João

; Rochitte, Carlos Eduardo

; Lopes, Bernardo

; Ramirez, José

; Kalil Filho, Roberto

; Mathias, Wilson

Arquivos Brasileiros de Cardiologia

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apr 2022, Volume 118 N. 4 Pages 756 - 765

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

Resumo Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10% vs. 44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10% vs. 48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39 vs. 1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36 vs. 1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47 vs. 6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31 vs. 6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.

Abstract Background It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment–elevation myocardial infarction (STEMI). Objective To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01). Conclusion Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.

https://doi.org/10.36660/abc.20200651

13.

Lupus en Argentina. .
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Quintana, Rosana

; García, Lucila

; Gobbi, Carla

; Alba, Paula

; Roverano, Susana

; Álvarez, Analia Patricia

; Graf, César Enrique

; Pisoni, Cecilia

; Spindler, Alberto

; Gómez, Catalina

; Figueredo, Heber Matías

; Papasidero, Silvia

; Paniego, Raúl

; de la Vega, María Celina

; Civit, Emma

; González Lucero, Luciana

; Martire, María Victoria

; Aguila Maldonado, Rodrigo

; Gordon, Sergio

; Micelli, Marina

; Nieto, Romina

; Rausch, Gretel

; Gongora, Vanina

; Damico, Agustina

; Rodríguez Gil, Gustavo

; Dubinsky, Diana

; Orden, Alberto

; Zacariaz, Johana

; Romero, Julia

; Pera, Mariana

; Goñi, Mario

; Rillo, Oscar

; Báez, Roberto

; Arturi, Valeria

; González, Andrea

; Vivero, Florencia

; Bedoya, María Eugenia

; Shmid, María Marcela

; Caputo, Víctor

; Larroude, Maria Silvia

; Domínguez, Nadia

; Gómez, Graciela Noemí

; Rodríguez, Graciela Nora

; Marín, Josefina

; Collado, Victoria

; Jorfen, Marisa

; Bedran, Zaida

; Curti, Ana

; Gazzoni, María Victoria

; Sarano, Judith

; Zelaya, Marcos

; Sacnun, Mónica

; Finucci Curi, Pablo

; Rojas Tessel, Romina

; Arias Saavedra, Maira

; Sattler, María Emilia

; Machado Escobar, Maximiliano Augusto

; Astesana, Pablo

; Paris, Úrsula

; Virasoro, Belén María

; Santa Cruz, María Julia

; Allievi, Alberto

; Vandale, Juan Manuel

; Hojberg, Noelia Giselle

; Pons-Estel, Bernardo

; Pons-Estel, Guillermo

; García, Mercedes Argentina

Revista argentina de reumatología

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mar 2022, Volume 33 N. 1 Pages 14 - 25

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

resumen está disponible en el texto completo

Abstract Introduction: lupus is a complex disease and often difficult to approach. Achieving remission is one of the objectives, incorporating therapeutic options. Objectives: to describe the characteristics of the patients and the use of belimumab, according to the status of the disease. Materials and methods: cross-sectional study. Patients of the RELESSAR registry. Stratification: Remission: SLEDAI=0 and without corticosteroids. Low disease activity SLEDAI> 0 and ≤4 and without corticosteroids and non-optimal control: SLEDAI> 4 and any dose of corticosteroids. Results: a total of 1,277 patients were included, 23.4% in remission, 12.6% in low disease activity and 63.8% in non-optimal control. The last group was younger and had a shorter duration of the disease. They had higher activity and chronicity indices and greater use of immunosuppressants. Only 22.3% of the patients with potential criteria for the use of belimumab (activity disease despite standard treatment) were receiving it. The variables associated with hospitalizations were: corticosteroids, cyclophosphamide and higher SLICC. Those associated with severe infection: mycophenolate mofetil, azathioprine, corticosteroids, and higher SLICC. Conclusions: the complexity of the management of these patients is reflected, visualizing structural aspects such as inequality. The use of belimumab could be beneficial in selected patients.

https://doi.org/10.47196/rar.v33i1.602 101 downloads

14.

Copper Induces Damage, Oxidative Stress and Cell Death in Endothelium of Chronic Intoxicated Wistar Rats
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Fernández-Rodarte, Bernardo A

; Soto-Domínguez, Adolfo

; González-Navarro, Alejandro

; Mellado-Ayala, Maximiliano

; Piña-Mendoza, Edgar I

; Rodríguez-Rocha, Humberto

; Montes-de-Oca-Luna, Roberto

; Guerra-Leal, Jesús D

; Guzmán-López, Santos

; Elizondo-Omaña, Rodrigo E

International Journal of Morphology

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feb 2022, Volume 40 N. 1 Pages 10 - 17

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

SUMMARY: Reactive Oxygen Species (ROS) are part of the functional balance of various systems, they can generate cellular damage by oxidative stress associated with disease processes such as atherosclerosis, cardiovascular disease, diabetes, and aging. Some studies report that copper induces damage to the endothelium, which could be associated with cardiovascular pathologies. This study was an experimental comparative, prospective, longitudinal, and controlled clinical trial in a murine animal model. Twenty-four male Wistar rats were included, the distribution of the groups was time-depending chronic exposition to copper, and a control group. Results show gradual alterations in the groups treated with copper: areas with loss of the endothelium, signs of disorganization of smooth muscle fibers in the tunica media, as well as areas with the fragmentation of the elastic sheets. A significant statistical difference was observed in the active- Caspase-3 analysis expression in the aortic endothelium and endothelium of the capillaries and arterioles of the lung between the control group vs 300 ppm of copper. Expression of eNOS was detected in the endothelium of the aorta and vessels of the lung. Our study shows histological changes in the walls of the great vessels of intoxicated rats with copper, and the increment of inflammatory cells in the alveoli of the study model, mainly at a high dose of copper exposition. These results will be useful to understand more about the mediators involved in the effect of copper over endothelium and cardiovascular diseases in chronic intoxication in humans.

RESUMEN: Las Especies Reactivas de Oxígeno (ROS) son parte del equilibrio funcional de varios sistemas, pueden generar daño celular por estrés oxidativo asociado a procesos patológicos como aterosclerosis, enfermedades cardiovasculares, diabetes y envejecimiento. Algunos estudios informan que el cobre induce daños en el endotelio, lo que podría estar asociado a patologías cardiovasculares. Este estudio fue un ensayo clínico experimental comparativo, prospectivo, longitudinal y controlado en un modelo animal murino. Se incluyeron veinticuatro ratas Wistar macho, la distribución de los grupos fue la exposición crónica al cobre en función del tiempo y un grupo de control. Los resultados muestran alteraciones graduales en los grupos tratados con cobre: áreas con pérdida del endotelio, signos de desorganización de las fibras musculares lisas en la túnica media, así como áreas con la fragmentación de las láminas elásticas. Se observó una diferencia estadística significativa en la expresión del análisis de caspasa-3 activa en el endotelio aórtico y el endotelio de los capilares y arteriolas del pulmón entre el grupo de control frente a 300 ppm de cobre. Se detectó expresión de eNOS en el endotelio de la aorta y los vasos del pulmón. Nuestro estudio muestra cambios histológicos en las paredes de los grandes vasos de ratas intoxicadas con cobre, y el incremento de células inflamatorias en los alvéolos del modelo de estudio, principalmente a una alta dosis de exposición de cobre. Estos resultados serán útiles para comprender más sobre los mediadores involucrados en el efecto del cobre sobre el endotelio y las enfermedades cardiovasculares en la intoxicación crónica en humanos.

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15.

Sistemas de integração lavoura-pecuária-floresta no estado de São Paulo: estudo multicasos com adotantes pioneiros
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Vinholis, Marcela de Mello Brandão

; Carrer, Marcelo José

; Souza Filho, Hildo Meirelles de

; Bernardo, Roberto

Revista de Economia e Sociologia Rural

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2022, Volume 60 N. 1 elocation e234057

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

Resumo: Pastagens degradadas têm baixa produtividade e impactos ambientais negativos. Sistemas que integram pecuária, lavoura e/ou floresta apresentam-se como uma alternativa para reverter esse cenário, mas sua adoção é heterogênea entre os produtores rurais. O objetivo deste estudo é investigar os fatores que influenciaram as primeiras decisões de adoção e a difusão a partir dos adotantes pioneiros. Três casos de adotantes pioneiros do estado de São Paulo foram investigados por meio de análise descritivo-exploratória. Os resultados mostram que instituições que atuam como intermediárias entre produtores rurais e outras instituições do sistema inovação têm um papel relevante na adoção, adaptação e difusão dos sistemas de integração. Cooperativas agropecuárias, associações de produtores rurais e serviços de extensão rural são exemplos de instituições intermediárias que cumpriram esse papel ao exercerem várias funções: auxiliaram no fluxo de informações, forneceram orientação técnica, apoiaram a comercialização e facilitaram o acesso ao financiamento e aos mecanismos de gestão de risco. Adicionalmente, identificou-se que as características pessoais do produtor pioneiro como experiência em atividades agropecuárias e sua capacidade de inovação (curiosidade por novidades, comunicação interpessoal e tolerância ao risco) também foram importantes para a adoção e adaptação dos sistemas de integração.

Abstract: Degraded pastures have low productivity and negative environmental impacts. Farming systems that integrate cattle breeding, crop, and/or forest are alternatives to reverse this scenario; however, their adoption is heterogeneous among farmers. This study aims to investigate factors that influenced the first decisions made concerning the adoption and the diffusion of these systems from early adopters. Three cases of early adopters from the state of São Paulo were investigated through descriptive-exploratory analysis. The results show that institutions that act as intermediaries between farmers and other institutions of the innovation system have a relevant role in the adoption, adaptation, and diffusion of integrated systems. Agricultural cooperatives, farmers’ associations, and rural extension services are examples of intermediary institutions that fulfill this role assuming several functions: they help in the flow of information, provide technical guidance, support trade, and facilitate access to credit and risk reduction managerial tools. Additionally, it was identified that early adopters’ characteristics such as the experience in agricultural activities and their innovation capacity (novelty seeking, interpersonal communication, and risk tolerance) were also important for the adoption and, adaptation of integrated systems.

https://doi.org/10.1590/1806-9479.2021.234057 449 downloads

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