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[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study
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Alves, Natália Ribeiro de Magalhães

; Kurizky, Patrícia Shu

; Mota, Licia Maria Henrique da

; Albuquerque, Cleandro Pires de

; Esper, Juliana Tomaz

; Campos, Aridne Souza Costa

; Reis, Vitoria Pereira

; Ferro, Henrique Metzker

; Gil-Jaramillo, Natalia

; Brito-de-Sousa, Joaquim Pedro

; Leal, Luana Cabral Leão

; Nóbrega, Otávio de Toledo

; Araújo, Carla Nunes de

; Santos Júnior, Agenor de Castro Moreira dos

; Martins, Gladys Aires

; Martins Filho, Olindo Assis

; Gomes, Ciro Martins

Anais Brasileiros de Dermatologia

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jan 2024, Volume 99 N. 1 Pages 34 - 42

Abstract: En | Text: En | PDF: En

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01–1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29–3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

https://doi.org/10.1016/j.abd.2023.03.002

Correlation between ABO blood type, susceptibility to SARS-CoV-2 infection and COVID-19 disease severity: A systematic review
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Soares, Danyela Martins Bezerra

; Araújo, David Augusto Batista Sá

; Souza, Jorge Luiz de Brito de

; Maurício, Rebeca Bessa

; Soares, Emanuela Martins Bezerra

; Alves Neto, Franklin de Castro

; Pinheiro, Maria Suelly Nogueira

; Gama, Vitor Carneiro de Vasconcelos

; Braga Neto, Pedro

; Nóbrega, Paulo Ribeiro

; Aragão, Gislei Frota

Hematology, Transfusion and Cell Therapy

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dec 2023, Volume 45 N. 4 Pages 483 - 494

Abstract: En | Text: En | PDF: En

ABSTRACT Objectives: To verify the association between the ABO blood type and the risk of SARS-CoV-2 infection and COVID-19 disease severity. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the 2020 PRISMA Checklist and flow diagram, and articles selected for review were analyzed using the Newcastle-Ottawa Quality Rating Scale. The research question was: "Would the ABO blood group influence the risk of infection and clinical course of patients infected with SARS-CoV-2?", The following databases were used: Embase, PubMed, Virtual Health Library (VHL), Web of Science, Science-Direct and Scopus. The protocol for this review was registered in the Prospective Register of Systematic Reviews (PROSPERO), number CRD42021245945. Results: We found 798 articles across PubMed, Embase, Scopus, Web of Science, Science Direct and Virtual Health Library and 54 articles were included in the final analysis. Among 30 studies evaluating the risk of COVID-19 infection, 21 found significant correlations with ABO blood groups, 14 of them revealing an increased risk in blood group A and 15 studies showing a decreased risk in blood group O. Most studies found no significant correlation with disease severity or mortality. Conclusion: The qualitative assessment of available information suggests that blood group A may be a risk factor for COVID-19 infection and that blood group O may have a protective effect. We were unable to determine a clear association between the ABO blood group and mortality. These conclusions are based on highly heterogenous evidence.

https://doi.org/10.1016/j.htct.2022.11.001

Terapias Complementares, Atenção Psicossocial e Atenção Primária: Percepções dos Profissionais sobre a Oferta dos Serviços
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Silva, Pedro Henrique Brito da

; Ferreira, Shirley Kellen

; Oliveira, Ellen Synthia Fernandes de

New Trends in Qualitative Research

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oct 2023, Volume 18 elocation e844

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

Resumo Nos últimos anos, as Práticas Integrativas e Complementares têm ganhado destaque no Sistema Único de Saúde devido à busca por abordagens médicas alternativas que priorizam as necessidades dos pacientes. Porém, a pesquisa relacionada à integração dessas práticas na rede de atenção à saúde, especialmente em níveis primários e de saúde mental, ainda é limitada e requer uma análise mais aprofundada. Objetivo: Compreender as percepções dos profissionais de saúde que oferecem Práticas Integrativas e Complementares na Atenção Primária à Saúde e nos Centros de Atenção Psicossocial da Região Metropolitana de Goiânia, Goiás, Brasil. Métodos: Trata-se de uma pesquisa descritiva, exploratória e de abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 65 profissionais ofertantes de Práticas Integrativas e Complementares. As entrevistas foram audiogravadas, transcritas e analisadas conforme Análise de Conteúdo Temática. Resultados: Os resultados revelam percepções comuns entre os profissionais de saúde que trabalham com Práticas Integrativas e Complementares, tanto na Atenção Primária quanto nos Centros de Atenção Psicossocial. Eles destacam as mudanças nos relacionamentos profissionais-usuários após a implementação das Práticas Integrativas e Complementares. A integração das Práticas Integrativas e Complementares com a Atenção Psicossocial e a Atenção Primária estreita os laços com os pacientes, melhora a compreensão de suas necessidades e reduz a dependência de intervenções médicas tradicionais. Além disso, as Práticas Integrativas e Complementares incentivam o autocuidado, envolvem a família e a comunidade no processo de saúde-doença e têm impacto positivo na saúde mental dos usuários. Considerações finais: Os participantes deste estudo enfatizam a importância das Práticas Integrativas e Complementares na reformulação de princípios essenciais para a prestação de cuidados nos serviços de saúde pública no Brasil. Esses resultados podem orientar o desenvolvimento de estratégias de gestão para fortalecer abordagens médicas não convencionais no Sistema Único de Saúde, promovendo uma abordagem mais centrada no paciente e nas necessidades individuais de saúde.

Abstract In recent years, Integrative and Complementary Practices (ICPs) have gained prominence within the Brazilian Unified Health System (SUS) due to the increasing interest in alternative medical approaches that prioritize patients' needs. However, research regarding the integration of these practices within the healthcare network, particularly at the primary and mental health care levels, remains limited and calls for more in-depth analysis. Objective: To comprehend the perceptions of healthcare professionals offering Integrative and Complementary Practices in Primary Health Care and Psychosocial Care Centres in the Metropolitan Region of Goiânia, Goiás, Brazil. Methodology: This is a descriptive, exploratory, and qualitative research study. Semi-structured interviews were conducted with 65 professionals who provide Integrative and Complementary Practices. The interviews were audio-recorded, transcribed, and analysed using Thematic Content Analysis. Results: The results reveal common perceptions among healthcare professionals working with Integrative and Complementary Practices, both in Primary Health Care and Psychosocial Care Centres. They emphasize changes in the professional-patient relationships following the implementation of Integrative and Complementary Practices. The integration of Integrative and Complementary Practices with Psychosocial and Primary Care strengthens bonds with patients, enhances the understanding of their needs, and reduces reliance on traditional medical interventions. Furthermore, Integrative and Complementary Practices promote self-care, involve families and communities in the health-disease process, and have a positive impact on users' mental health. Concluding Remarks: Participants in this study underscore the significance of Integrative and Complementary Practices in reshaping fundamental principles for healthcare delivery in Brazil's public health services. These findings can guide the development of management strategies to bolster non-conventional medical approaches within the Brazilian Unified Health System, thereby promoting a more patient-centered approach tailored to individual health needs.

https://doi.org/10.36367/ntqr.18.1023.e844

Reabilitação Pós-Covid-19: Percepções dos Usuários Atribuídas a Oferta dos Serviços na Atenção Primária à Saúde
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Gomes, Haline Rachel Lino

; Silva, Pedro Henrique Brito da

; Lima, Sandra Cristhyna Rodrigues de

; Batista, Sandro Rogério Rodrigues

; Oliveira, Ellen Synthia Fernandes de

New Trends in Qualitative Research

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oct 2023, Volume 18 elocation e902

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

Resumo Introdução: A Secretaria de Estado da Saúde de Goiás (SES-GO), Brasil, elaborou um programa de reabilitação voltado para a Atenção Primária e tem por finalidade a recuperação dos usuários que apresentam consequências funcionais após a COVID-19. Por conseguinte, as avaliações dos protocolos propostos são importantes para subsidiar ações e políticas públicas de saúde para a oferta dos serviços de reabilitação à população. Objetivo: Compreender as percepções dos usuários do programa de reabilitação da Secretaria de Estado da Saúde de Goiás quanto aos serviços de acompanhamento oferecidos para sua recuperação pós-COVID-19 na Atenção Primária à Saúde. Métodos: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa. Realizou-se a aplicação de uma pergunta norteadora a 18 usuários, de duas cidades da Região Metropolitana de Goiânia. As respostas foram redigidas pela pesquisadora e tratadas com a análise de conteúdo temática. Resultados: Da análise, surgiram duas categorias temáticas, quais sejam: percepções dos efeitos na funcionalidade e; percepções dos efeitos terapêuticos atribuídas pelos usuários após o programa de reabilitação idealizado pela Secretaria de Saúde do Estado de Goiás. A melhora física potencializa a sua participação no convívio social, o que proporciona benefícios nos seus aspectos emocionais. As diferenças foram perceptíveis pelos usuários em comparação com os momentos em que não tinham realizado nenhum procedimento terapêutico antes da proposta idealizada pela SES-GO. A autoeficácia foi outro elemento latente nas respostas dos usuários referente à implementação do programa. A satisfação dos usuários com a proposta é externada pelos usuários, sendo um fator essencial para evidenciar a sua qualidade. Considerações finais: O programa de reabilitação pode ser um aliado imprescindível ao levar em consideração os aspectos do modelo biopsicossocial na recuperação dos usuários. Esses resultados podem implicar na ampliação do programa de reabilitação proposto pela SES-GO junto às Secretarias Municipais de Saúde.

Abstract Introduction: The State Department of Health of Goiás (SES-GO), Brazil, developed a rehabilitation program aimed at Primary Care and aims at the recovery of users who have functional consequences after COVID-19. Therefore, the evaluation of the proposed protocols is important to support public health actions and policies for the provision of rehabilitation services to the population. Methods: This is a descriptive, exploratory study with a qualitative approach. A guiding question was applied to 18 users, from two cities in the Metropolitan Region of Goiânia. The answers were written by the researcher and treated with thematic content analysis. Results: From the analysis, two thematic categories emerged, namely: perceptions of the effects on functionality and; perceptions of therapeutic effects attributed by users after the rehabilitation program designed by the Health Department of the State of Goiás. Physical improvement enhances their participation in social life, which provides benefits in their emotional aspects. The differences were noticeable by the users in comparison with the moments when they had not performed any therapeutic procedure before the proposal idealized by SES-GO. Self-efficacy was another latent element in users' responses regarding program implementation. The users' satisfaction with the proposal is expressed by the interviewees, being an essential factor to demonstrate its quality. Final Consideration: The rehabilitation program can be an essential ally when considering aspects of the biopsychosocial model in the recovery of users who have had the consequences of COVID-19. These results may imply the expansion of the rehabilitation program proposed by the Health Department of Goiás to other local and regional Health Departments.

https://doi.org/10.36367/ntqr.18.2023.e902

Automatic Detection of Vehicular Traffic Elements based on Deep Learning for Advanced Driving Assistance Systems
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Cleofas-Sánchez, Laura

; Posadas-Durán, Juan Pablo Francisco

; Martínez-Ortiz, Pedro

; Loyo-Desiderio, Gilberto

; Ruvalcaba-Hernández, Eduardo Alberto

; González Brito, Omar

Computación y Sistemas

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sep 2023, Volume 27 N. 3 Pages 643 - 651

Abstract: En | Text: En | PDF: En

Abstract: This paper presents a prototype of an automobile driver assistance system based on YOLOv3. The system detects car types, traffic signs, and traffic lights in real-time and warns the driver accordingly. In the learning phase of the YOLO algorithm, the standard weights are learned first, followed by transfer learning to the objects of interest. The retraining phase uses 2,800 images obtained from the Internet of three countries of the real-life, and the testing phase uses real-time videos of Mexico City roads. In the validation phase, the proposed system achieves 95%, 37%, and 40% performance on the compiled dataset for the detection of road elements. The results obtained are comparable and in some cases better than those reported in previous works. Using a Raspberry Pi 4, the prototype was tested in real-life, generating visual and audible warnings for the driver, with an object recognition rate of 0.4 fps. A mean average precision (mAP) of 53% was reached by the proposed system. The experiments showed that the prototype achieved a poor recognition rate and required high computational processing for object recognition. However, YOLO is a model that can have good performance on low-resource hardware.

https://doi.org/10.13053/cys-27-3-4508

Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks
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Brito, Mariana

; Nunes, Gonçalo

; Luz, Carlos

; Oliveira, Gabriel

; Marques, Pedro Pinto

; Fonseca, Jorge

GE-Portuguese Journal of Gastroenterology

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aug 2023, Volume 30 Suppl. 1 Pages 45 - 51

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

Resumo Introdução: A deiscência anastomótica (DA) é uma complicação grave no pós-operatório precoce da esofagectomia e gastrectomia total, pela sua elevada mortalidade. As próteses metálicas autoexpansíveis (PMAE) desempenham um papel fundamental no tratamento das DA. Na literatura, há apenas um caso descrito sobre a utilização de um Mega-Stent no contexto de DA, que não complicação bariátrica. Os autores reportam uma série de dois casos com diferente aplicação do Mega-Stent esofágico no tratamento de DA. Descrição do caso: Caso 1: Homem de 67 anos, submetido a esofagectomia por carcinoma epidermóide do esófago distal. O período pós-operatório precoce foi complicado de DA com fístula gastro-pleural. Inicialmente foi colocado um clip OTSC no orifício da deiscência com insucesso técnico e clínico, sendo posteriormente utilizado o Mega-Stent, posicionado desde o esófago até ao bulbo duodenal. Estudos contrastados posteriores confirmaram resolução da DA. Caso 2: Mulher de 86 anos, submetida a gastrectomia total com reconstrução em Y-Roux e esofagojejunostomia por adenocarcinoma gástrico, complicada de DA. Neste contexto foi colocada uma PMAE parcialmente coberta (PMAE-PC) sobre a área da anastomose. A tomografia computorizada subsequente demonstrou persistência de extravasamento. Foi colocada uma segunda PMAE-PC, com posterior resolução da DA. Semanas depois, ambas as PMAE-PC apresentavam tecido de granulação nos topos, tendo sido colocado o Mega-Stent (técnica stent-in-stent) e decorridas duas semanas, todas as próteses foram facilmente extraídas, confirmando-se sucesso no tratamento da DA. Discussão/conclusão: A utilização de PMAE nas DA constitui uma técnica terapêutica segura e bem estabelecida, contudo passível de apresentar limitações tais como a migração ou incapacidade de cobrir totalmente DA de maiores dimensões. O Mega-Stent esofágico pode constituir uma ferramenta útil na terapêutica endoscópica destes doentes.

Abstract Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report: Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL. Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion: SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

https://doi.org/10.1159/000524420

Sobrepeso y obesidad autopercibidos en estudiantes universitarios. Caso: Medicina-Escuela Superior Politécnica de Chimborazo, Ecuador
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Flores-Brito, Pedro Renato

; Reinoso-Guadalupe, Daniel Renato

; Rosero-Ordóñez, Shirley Fernanda

Revista Arbitrada Interdisciplinaria de Ciencias de la Salud. Salud y Vida

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jun 2023, Volume 7 N. 13 Pages 4 - 14

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

ABSTRACT Objective: To describe self-perceived overweight and obesity in university students. Case Medical School, Ecuador. Methodology: The positivist paradigm was used from the quantitative perspective, with a non-experimental design, the type of research is field and descriptive level application of a questionnaire to a group of university students, a questionnaire was structured with the Kobotoolbox tool, which had a total of 27 questions containing socio demographic issues and specific topics to analyze the presence of obesity and overweight. Results: The more class time, the more screen time, the less physical activity. Conclusion: It is shown that being sedentary increases in 2.8 times the probability of being overweight, although it is not significantly significant, it becomes a risk factor to be considered.

RESUMEN Objetivo: Describir el Sobrepeso y obesidad autopercibidos en estudiantes universitarios. Caso: Medicina-Escuela Superior Politécnica de Chimborazo, Ecuador. Metodología: Se empleó el paradigma positivista desde la perspectiva cuantitativa, con un diseño no experimental, el tipo de investigación es de campo y el nivel descriptivo, con aplicación de un cuestionario a un grupo de estudiantes universitarios de Medicina, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador; se estructuró un cuestionario con la herramienta Kobotoolbox, misma que contó con un total de 27 preguntas que contenían temas socio demográficos y temas específicos para analizar la presencia de obesidad y sobrepeso. Resultados: Mientras más tiempo de clases más tiempo de pantalla y esto da menos actividad física. Conclusión: Se demuestra que ser sedentario aumenta en 2,8 veces la probabilidad de sufrir sobrepeso, aunque no es determinante, se convierte en un factor de riesgo a ser considerado.

https://doi.org/10.35381/s.v.v7i13.2296

Evaluación de riesgo suicida en estudiantes universitarios
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Rosero-Ordóñez, Shirley Fernanda

; Reinoso-Guadalupe, Daniel Renato

; Flores-Brito, Pedro Renato

Revista Arbitrada Interdisciplinaria de Ciencias de la Salud. Salud y Vida

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jun 2023, Volume 7 N. 13 Pages 15 - 27

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

ABSTRACT Objective: The general objective of the research was to describe the evaluation of suicidal risk in university students. Methodology: A quantitative, non-experimental, cross-sectional research was carried out; within the goals set out in this study, the manipulation of the variables to be studied was not contemplated. The study had a descriptive observational scope, with the goal of recording, analyzing and interpreting the current nature of the population studied. The survey was sent through the Google Forms platform. The survey was sent to 77 medical students of the Escuela Superior Politécnica de Chimborazo, Ecuador (ESPOCH). Results: It was found that 66.66% presented low suicidal risk, 14.66% medium risk and 18.66% corresponded to high risk according to the SAD PERSONS scale. In conclusion: The research shows that the population of medical students presents some level of suicidal risk. The problem described should be deepened to clarify the consequences.

RESUMEN Objetivo: El objetivo general de la investigación fue describir la evaluación de riesgo suicida en estudiantes universitarios. Metodología: Se realizó una investigación de tipo cuantitativo, no experimental de corte transversal. Dentro de las metas planteadas en este estudio no se contempla la manipulación de las variables a estudiar. El estudio tuvo un alcance descriptivo observacional, teniendo como meta el registro, análisis e interpretación de la naturaleza actual de la población estudiada. Mediante la plataforma Google Forms se envió la encuesta a 77 estudiantes de Medicina, de la Escuela Superior Politécnica de Chimborazo, Ecuador. (ESPOCH). Resultados: Se obtuvo que el 66.66% presenta riesgo suicida bajo, 14.66% riesgo medio y 18.66% corresponde a riesgo alto según la escala de SAD PERSONS. En conclusión: La investigación muestras que la población de estudiantes de Medicina, presenta algún nivel de riesgo suicida. La problemática descrita debe ser profundizada para esclarecer las consecuencias.

https://doi.org/10.35381/s.v.v7i13.2297

10.

Efficacy and Safety of Laparoscopic Endoscopic Cooperative Surgery in Upper Gastrointestinal Lesions: A Systematic Review and Meta-Analysis
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Brito, Sara Oliveira de

; Libânio, Diogo

; Pinto, Cláudia Martins Marques

; Teixeira, João Pedro Pinho Osório de Araújo

; Teixeira, João Paulo Meireles de Araújo

GE-Portuguese Journal of Gastroenterology

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feb 2023, Volume 30 N. 1 Pages 4 - 19

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

Abstract Background and Aims: Laparoscopic and endoscopic cooperative surgery (LECS) combines advantages of endoscopy and laparoscopy in order to resect upper gastrointestinal lesions. Our aim was to evaluate the efficacy and safety of LECS in patients with EGJ (esophagogastric junction), gastric and duodenal lesions, as well as to compare LECS with pure endoscopic and pure laparoscopic procedures. Methods: PubMed, Scopus, and ISI Web of Knowledge were searched. Efficacy (R0, recurrence) and safety (conversion rate, procedure and hospitalization time, adverse events, mortality) outcomes were extracted and pooled (odds ratio or mean difference) using a random-effects model. Study quality was assessed with Newcastle-Ottawa Scale and heterogeneity by Cochran’s Q test and I2 . Subgroup analysis according to location was performed. Results: This meta-analysis included 24 studies/1,336 patients (all retrospective cohorts). No significant differences were found between LECS and preexisting techniques (endoscopic submucosal dissection (ESD)/laparoscopy) regarding any outcomes. However, there was a trend to shorter hospitalization time, longer procedure duration, and fewer adverse events in LECS versus Laparoscopy and ESD. R0 tended to be higher in the LECS group. Hospitalization time was significantly shorter in gastric versus EGJ lesions (mean 7.3 vs. 13.7 days, 95% CI: 6.6-7.9 vs. 8.9-19.3). There were no significant differences in conversion rate, adverse events, or mean procedural time according to location. There was a trend to higher conversion rate and longer procedure durations in EGJ and higher rate of adverse events in duodenal lesions. Conclusion: LECS is a valid, safe, and effective treatment option in patients with EGJ, gastric, and duo-denal lesions, although existing studies are retrospective and prone to selection bias. Prospective studies are needed to assess if LECS is superior to established techniques. Key Messages: LECS is safe and effective in the treatment of upper gastrointestinal lesions, but there is no evidence of superiority over established techniques.

Resumo Introdução e objetivos: A Cirurgia cooperativa laparoscópica e endoscópica (LECS) combina vantagens da endoscopia e laparoscopia na resseção de lesões gastrointestinais superiores. O nosso objetivo é avaliar a eficácia e segurança da LECS em pacientes com lesões na junção esofagogástrica (EGJ), estômago e duodeno, e comparar a LECS com procedimentos puramente endoscópicos e laparoscópicos. Métodos: PubMed, Scopus, ISI Web of Knowledge foram pesquisadas. Dados sobre eficácia (R0, recorrência) e segurança (taxa de conversão, duração do procedimento e hospitalização, recorrência, eventos adversos, mortalidade) foram colhidos e agrupados (odds ratio ou média das diferenças), usando modelo de efeitos randomizados. Qualidade dos estudos foi avaliada pela Escala Newcastle-Ottawa e heterogeneidade pelos testes Q da Cochran e I2. Foi realizada análise de subgrupos, consoante a localização. Resultados: Esta meta-análise incluiu 24 estudos/1336 pacientes (todos coortes retrospetivos). Não encontramos diferenças significativas entre LECS e as técnicas pré-existentes (Dis-seção endoscópica da submucosa (ESD)/Laparoscopia) em nenhum aspeto. Porém, encontramos uma tendência para hospitalização mais curta, procedimentos mais longos e menos efeitos adversos na LECS versus Laparoscopia e ESD. R0 tende a ser maior no grupo LECS. Hospitalização foi significativamente menor em lesões gástricas versus EGJ (média 7.3 vs. 13.7 dias, 95% CI: 6.6-7.9 vs. 8.9-19.3). Não encontramos diferenças significativas na taxa de conversão, eventos adversos nem tempo médio de procedimento. Porém encontramos uma tendência para taxas de conversão maiores e procedimentos mais lon-gos na EGJ e maior taxa de eventos adversos no duodeno. Conclusão: LECS é um tratamento válido, seguro e eficaz em pacientes com lesões na EGJ, estômago e duodeno, apesar dos estudos retrospetivos existentes estarem propensos a viés de seleção. São necessários estudos prospetivos para avaliar a superioridade da LECS face às técnicas existentes. Mensagens-chave: LECS é um tratamento seguro e eficaz para lesões gastrointestinais superiores, mas sem evidência de superioridade face às técnicas existentes.

https://doi.org/10.1159/000526644

11.

Anticaries potential of a fluoride foam
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Benedito, Larissa Caroliny de Brito

; Pedro Ricomini-Filho, Antônio

; Tabchoury, Cinthia Pereira Machado

; Cury, Jaime Aparecido

Brazilian Dental Journal

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feb 2023, Volume 34 N. 1 Pages 89 - 98

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

Abstract Foam has been used worldwide as a vehicle for the professional application of fluoride and hypothetically should have the same anticaries potential as conventional fluoride gel (F-gel) in terms of the formation of reaction products with enamel. Thus, the ability of Flúor Care® foam (FGM, Joinville, SC, Brazil, 12,300 ppm F, acidulated) to react with enamel was evaluated in comparison with Flúor gel® (DFL, Rio de Janeiro, RJ, Brazil, 12,300 ppm F, acidulated). Slabs (n=10/group) of sound enamel and with caries lesion were used, in which the concentrations of total fluoride (TF), and loosely (CaF2-like) and firmly (FAp) bound types were determined. The importance of agitation during application was previously tested. The determinations were made with fluoride ion-specific electrode and the results were expressed in μg F/cm² of the treated enamel area. ANOVA and Tukey tests were used to analyze the difference among treatments, independently for sound and carious enamel. The agitation of the products during application significantly increased the reactivity of the foam (p<0.05), but not that of the gel (p>0.05). The foam did not differ from F-gel (p>0.05) concerning the formation of TF and CaF2-like in sound or carious enamel. Regarding FAp, the foam did not differ from F-gel (p>0.05) in the carious enamel, but the concentration in the sound was lower (p<0.05). The results show that this commercial fluoride foam tested needs to be agitated during application to improve its reactivity with enamel, which raises a question about other brands.

Resumo A espuma tem sido utilizada mundialmente como veículo para aplicação profissional de fluoreto e hipoteticamente deveria ter o mesmo potencial anticárie que o gel fluoretado convencional (F-gel) em termos de formação de produtos de reação com o esmalte. Assim, a capacidade da espuma Flúor Care® (FGM, Joinville, SC, Brasil, 12.300 ppm F, acidulada) de reagir com o esmalte foi avaliada em comparação com o Flúor gel® (DFL, Rio de Janeiro, RJ, Brasil 12.300 ppm F, acidulado). Foram utilizados blocos (n=10/grupo) de esmalte hígido e com lesão de cárie, nos quais foram determinadas as concentrações de flúor total (FT), e os tipos de flúor fracamente (tipo-CaF2) e firmemente (FAp) ligados ao esmalte. A importância da agitação durante a aplicação foi previamente testada. As determinações foram feitas com eletrodo íon específico para fluoreto e os resultados foram expressos em μg F/cm² da área tratada do esmalte. A diferença entre os tratamentos foi analisada por ANOVA e Tukey (α=5%), independentemente para esmalte hígido e cariado. A agitação dos produtos durante a aplicação aumentou significativamente a reatividade da espuma (p<0,05), mas não a do gel (p>0,05). A espuma não diferiu do F-gel (p>0,05) quanto à formação de FT e tipo-CaF2 no esmalte hígido ou cariado. Em relação à FAp, a espuma não diferiu do F-gel (p>0,05) no esmalte cariado, mas a concentração no hígido foi menor (p<0,05). Os resultados mostram que esta espuma fluoretada comercial testada precisa ser agitada durante a aplicação para melhorar sua reatividade com o esmalte, o que levanta questão sobre outras marcas.

https://doi.org/10.1590/0103-6440202305287

12.

Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos
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Flor, Taiana Brito Menêzes

; Miranda, Nirond Moura

; Sette-de-Souza, Pedro Henrique

; Noro, Luiz Roberto Augusto

Ciência & Saúde Coletiva

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jan 2023, Volume 28 N. 1 Pages 281 - 290

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

Resumo Objetivou-se analisar a formação em Programas de Residência Multiprofissional em Atenção Básica (PRMAB) no Brasil a partir dos egressos de 20 Programas no período de 2015 a 2019. Trata-se de um estudo transversal que analisou as dimensões Abordagem Pedagógica (AP) e Cenários de Educação em Serviço (CES) com escala do tipo Likert. Participaram do estudo 365 egressos de programas instalados em 12 estados da federação. Na dimensão AP (α de Cronbach=0,94) destacaram-se os critérios sobre a concepção ampliada do cuidado e formação pautada em cuidado integral (P50=10), enquanto os com pior desempenho se relacionavam à preceptoria (P50=7). Quanto aos CES (α de Cronbach=0,90), foram reveladas potencialidades para as atividades educativas em grupo (P50=9) e fragilidades para critérios relativos à suficiência de espaço físico nas unidades de saúde (P50=6), participação dos residentes em Conselhos (P50=6) e articulação com Programas de Residência Médica (P50=5). A formação nos PRMAB mostra-se sintonizada com os atuais paradigmas da atenção à saúde, com ênfase na integralidade e prevenção. Contudo, os Programas carecem de investimento na formação de preceptores e melhoria de fragilidades no âmbito dos cenários de prática.

Abstract The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach’s α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach’s α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil’s public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

https://doi.org/10.1590/1413-81232023281.11292022

13.

Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos
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Flor, Taiana Brito Menêzes

; Miranda, Nirond Moura

; Sette-de-Souza, Pedro Henrique

; Noro, Luiz Roberto Augusto

Ciência & Saúde Coletiva

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jan 2023, Volume 28 N. 1 Pages 281 - 290

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

https://doi.org/10.1590/1413-81232023281.11292022

14.

Le mort hante le vif. A questão da ficção e o lugar do sujeito na literatura de Annie Ernaux
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Brito, Pedro Gomes Dias

Alea: Estudos Neolatinos

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jan 2023, Volume 25 N. 1 Pages 326 - 342

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

Abstract Annie Ernaux has been the subject of considerable attention in the Brazilian publishing landscape, especially after her 2022 Nobel Prize in Literature and the recent translations of five of her books published by Fósforo. In this essay, I intend to explore the apparently contradictory place that fiction occupies in her work: in a series of interviews (ERNAUX, 2011), Ernaux argues that her literary production involves, at the same time, the incorporation and the questioning of the fictional. To flesh out my argument, I will examine two long excerpts from The Years (2008), proposing a dialogue with Wolfgang Iser, Ivan Jablonka, Luiz Costa Lima, and Pierre Bourdieu. My goal will be to show that the project of a sentence "full of real things" cannot be detached from a certain fictional elaboration; after all, it is the perspectivation through fiction that allows putting life and facts in parentheses in order to better approach them and better think of them.

Résumé Annie Ernaux s'impose de plus en plus dans le paysage éditorial brésilien, notamment après le Nobel de littérature 2022 et les récentes traductions de cinq de ses livres, publiées par la maison d’édition Fósforo. J'ai l'intention d'explorer dans cet essai la place apparemment contradictoire que la fiction occupe dans son œuvre : dans une série d'entretiens (ERNAUX, 2011), l'auteure soutient que sa production littéraire implique, à la fois, l'incorporation et la mise en question du fictionnel. Pour ce faire, j'examinerai deux longs extraits de Les années (2008), en proposant un dialogue avec Wolfgang Iser, Ivan Jablonka, Luiz Costa Lima et Pierre Bourdieu. Mon objectif sera de montrer que le projet d'une phrase "pleine de choses réelles" ne peut se détacher d'une certaine élaboration fictionnelle, après tout, c'est la mise en perspective par la fiction qui permet de mettre la vie et les faits entre parenthèses pour mieux les approcher et mieux les penser.

Resumo Annie Ernaux vem ganhando um destaque cada vez maior na paisagem editorial brasileira, sobretudo após o Nobel de Literatura 2022 e as recentes traduções de cinco de seus livros pela editora Fósforo. Pretendo explorar, neste ensaio, o lugar aparentemente contraditório que a ficção ocupa em sua obra: em uma série de entrevistas (ERNAUX, 2011), a autora defende que sua produção literária implica, a um só tempo, a incorporação e o questionamento do ficcional. Para dar corpo ao meu argumento, examinarei dois longos trechos de um livro de Ernaux, Os anos (2008), propondo um diálogo com Wolfgang Iser, Ivan Jablonka, Luiz Costa Lima e Pierre Bourdieu. Meu objetivo é mostrar que o projeto de uma frase “cheia de coisas reais” não consegue se desvencilhar de certa elaboração ficcional, afinal, é a perspectivação pela via da ficção que permite colocar a vida e os fatos entre parênteses para melhor se aproximar deles e melhor pensá-los.

https://doi.org/10.1590/1517-106x/202325118

15.

Diagnosis of the impact of Covid-19 on artisanal cheese production in the semi-arid region of Brazil
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BEZERRA, Joadilza da Silva

; RANGEL, Adriano Henrique do Nascimento

; MARQUES JÚNIOR, Sérgio

; SALES, Danielle Cavalcanti

; GALVÃO JÚNIOR, José Geraldo Bezerra

; BRITO, Acácio Sanzio de

; MEDEIROS, Pedro Alexandro Azevedo de

; ARAUJO, José Rangel de

; MENDONÇA, Fabio de Souza

Food Science and Technology

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2023, Volume 43 elocation e83322

Abstract: En | Text: En | PDF: En

Abstract The objective of this study was to present information on the impacts resulting from Covid-19 on the artisanal coalho cheese production chain about: access to information; socioeconomic; income and government support; healthcare. The interviews were conducted using the Google Forms tool, with milk and artisanal coalho cheese producers in Rio Grande do Norte, Brazil. The producers obtained a lot of information transmitted on television (66%); the majority to adhere to health protocols. There was instability in the production, with an initial need to reduce production resulting from prohibitive measures to trade. The level of demand with regard to the consumer market increased with the quality of milk and cheeses. An allegation of lack of support from the government to maintain the activity was also verified in 78.7% of the interviewees, but 83% had resorted to emergency aid. Therefore, it can be concluded that the challenges imposed by the pandemic are not just sanitary. The study confirmed the need to restructure public services and policies. These results can provide compelling evidence about the rural context in the country.

https://doi.org/10.1590/fst.83322

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