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ABSTRACT Objective: To systematically review the literature in search of the most suitable and effective nutritional interventions and indications for the nutritional treatment of children and adolescents with cerebral palsy (CP). Data source: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles were selected from seven databases (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Studies from a pediatric group (0 to 18 years old) diagnosed with CP were included and the search strategy included the descriptors: “children” OR “childhood” AND “nutritional therapy” OR “nutritional intervention” OR “nutrition” OR “nutritional support” OR “diet” AND “cerebral palsy” OR “cerebral injury”. Methodological quality was assessed using the checklist for cross-sectional analytical studies, the Newcastle-Ottawa scale or the Cochrane Collaboration tool for clinical trials. Data synthesis: Fifteen studies (n=658) published from 1990 to 2020 met the inclusion criteria. All of them had a low risk of bias. The data showed that children and adolescents with CP have worse nutritional status than those normally developed. Those who received hypercaloric and hyperprotein nutritional supplementation benefited from its use. Studies indicate that enteral nutrition should be considered when nutritional needs are not met by the oral diet, especially in cases where oral motor functions are impaired. In addition, there was a direct relationship between the consistency of food, the level of motor function and nutritional status. Conclusions: Children and adolescents with CP have a greater risk of malnutrition. The use of nutritional supplementation may help with weight gain. In addition, enteral nutrition and modification of food texture have been used to improve the nutritional status of this group.

RESUMO Objetivo: Revisar sistematicamente a literatura em busca das intervenções e indicações nutricionais mais adequadas e eficazes para o tratamento nutricional de crianças e adolescentes com paralisia cerebral (PC). Fontes de dados: Esta revisão foi conduzida de acordo com as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA. Os artigos foram selecionados em sete bases de dados (Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde — Lilacs, Embase, United States National Library of Medicine — PubMed, Scientific Electronic Library Online — SciELO, Scopus, and Web of Science). Foram incluídos estudos de um grupo pediátrico (zero a 18 anos) com diagnóstico de PC e a estratégia de busca incluiu os descritores: “children” OR “childhood” AND “nutritional therapy” OR “nutritional intervention” OR “nutrition” OR “nutritional support” OR “diet” AND “cerebral palsy” OR “cerebral injury”. A qualidade metodológica foi avaliada utilizando a lista de verificação para estudos transversais analíticos, escala Newcastle-Ottawa ou ferramenta da Cochrane Collaboration, para ensaios clínicos. Síntese dos dados: Quinze estudos (n=658) publicados de 1990 a 2020 preencheram os critérios de inclusão. Todos tiveram baixo risco de viés. Os dados mostraram que crianças e adolescentes com PC apresentam pior estado nutricional do que os normalmente desenvolvidos. Aqueles que receberam suplementação nutricional hipercalórica e hiperproteica beneficiaram-se de seu uso. Estudos demonstram que a nutrição enteral deve ser considerada quando as necessidades nutricionais não são supridas pela dieta oral, principalmente nos casos em que as funções oromotoras estão prejudicadas. Além disso, houve relação direta entre a consistência dos alimentos, o nível de função motora e o estado nutricional. Conclusões: Crianças e adolescentes com PC têm maior risco de desnutrição. O uso de suplementação nutricional pode auxiliar no ganho de peso desses pacientes. Além disso, a nutrição enteral e a modificação da textura dos alimentos têm sido artifícios utilizados para a melhora do estado nutricional neste grupo.

https://doi.org/10.1590/1984-0462/2024/42/2022107

Revisores 2023
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Molas de la Quintana, Adriana Beatriz

; Jimenez Genchi, Alejandro

; Carrizales, Alexia

; Gotti, Amanda

; Martinez Ortiz, Ana

; Rocío Martínez Yacelga, Ana del

; Camilo Ciantelli, Ana Paula

; Jimenez Figueroa, Andres

; Neumann, Angélica Paula

; Parodi Svartman, Bernardo

; Vazquez Rodriguez, Carolina

; Da Silva, Cecilia

; Baroni, Cecilia

; Lanza Perez, Cintia Beatriz

; Mola, Débora

; Alarcón Rubio, David

; Perales Mejia, Felipe de Jesús

; Sarachu, Gerardo

; Gelpi, Gonzalo

; Sosa, Gustavo

; Viana Batista, Helder

; Moizéis, Heloísa Bárbara Cunha

; Carrasco, Jimena

; Ungaretti, Joaquín

; Moreira, Karen

; Tomatis, Karina

; Oros, Laura Beatriz

; Mazaro, Lisabelle Manente

; Chiavone, Luciana

; Perilla Toro, Lyria Esperanza

; Campagnoli, Mabel Alicia

; Ruiz Barbot, Mabela

; Brenlla, María Elena

; Folle Chavannes, María Ana

; Freytes Frey, Marcela

; Rossal, Marcelo

; Ortiz, Maria Victoria

; Nabergoi, Mariela

; Montenegro, Marisela

; Lladó, Mónica

; Freitas De León, Paribanú

; Solís García, Patricia

; Ruiz Santos, Paul

; Fiorati, Regina Célia

; Martins, Rita de Cássia Andrade

; Dominguez-Lara, Sergio Alexis

; Herranz, Silvana Melisa

; Yoma, Solana María

; Gondim, Sonia Maria Guedes

; Rostagnol, Susana

; Wittke, Tommy

; Ballesteros, Virginia

; Tamayo, William

Psicología, Conocimiento y Sociedad

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dec 2023, Volume 13 N. 3 Pages 116 - 118

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.26864/pcs.v13.n3.rev

Coletivos organizados, ativismo social e narrativas da pandemia em territórios vulneráveis na cidade do Rio de Janeiro, Brasil
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Gutiérrez, Adriana Coser

; Campos, Gastão Wagner de Sousa

; Cunha, Marcela Silva da

; Mattos, Mauricio Pereira de

; Costa, Patricia dos Santos da

; Silva, Rafaela Oliveira Lopes da

; Pereira, Ana Carolina dos Santos Rangel

; Campos, Adilson Rocha

; Guerra, Cyntia Amorim

Ciência & Saúde Coletiva

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2023, Volume 28 N. 12 Pages 3533 - 3542

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

Resumo A pandemia de COVID-19 no Brasil atingiu níveis alarmantes. Na cidade do Rio de Janeiro, ela encontrou um cenário de desmonte da Atenção Primária à Saúde (APS) em meio à uma crise política, o que teve grande impacto nos territórios de maior vulnerabilidade. O objetivo desse estudo é analisar de que forma as favelas e equipes da APS organizaram-se para desenvolver ações comunitárias, ocupando espaços deixados pela falta de outras políticas públicas. Os resultados fazem parte da pesquisa qualitativa multicêntrica “Estratégias de abordagem dos aspectos subjetivos e sociais na Atenção Primária no contexto da pandemia”, onde foram analisados documentos orientadores públicos e 36 entrevistas em profundidade com trabalhadores e usuários da APS, organizadas em grades interpretativas. Como resultado, observou-se que houve iniciativas cogestoras dos trabalhadores e usuários da APS, a partir do surgimento de coletivos organizados e ativismo social, para o enfrentamento da pandemia, independente das normativas da Secretaria Municipal de Saúde e demais instâncias governamentais. A APS se apresentou como único equipamento público nos territórios de alta vulnerabilidade, onde a violência armada esteve presente mesmo durante a pandemia.

Abstract The COVID-19 pandemic has reached alarming levels in Brazil. In Rio de Janeiro city, it arrived in a scenario in which Primary Health Care (PHC) was being dismantled in the midst of a political crisis, which had major impact on the most vulnerable territories. This study examined how favelas and PHC teams organised community-based action and occupy the vacuum left by the lack of public policies. The results form part of the multi-centre qualitative study “Strategies for approaching subjective and social aspects of Primary Care in the pandemic context”, using public guidance documents and 36 in-depth interviews of PHC workers and users, which were categorised into interpretive grids. Co-management initiatives by PHC workers and users were found to have arisen out of organised groups and social activism, to face the pandemic, independently of regulations from the Municipal Health Department and other government bodies. PHC figured as the only public facility in highly vulnerable territories, where armed violence was ongoing even during the pandemic.

https://doi.org/10.1590/1413-812320232812.04812023

Potential of the retention capability of a Neotropical reservoir (São Paulo State, Brazil)
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Bottino, Flavia

; Casali, Simone Pereira

; Cunha-Santino, Marcela Bianchessi

; Calijuri, Maria do Carmo

; Bianchini Júnior, Irineu

Acta Limnologica Brasiliensia

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2023, Volume 35 elocation e4

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

Abstract: Aim Man-made reservoirs lead to several changes in their downstream rivers that depend on the hydraulic characteristics of the reservoirs. However, their multiple uses can also provide facilities that influence the ecosystem services that they provide. This study addressed the potential ability of a Neotropical reservoir to trap chemical species aiming to assess the role of these ecosystems to mitigate pollution. Methods Retention capability modeling was examined for a small subtropical reservoir with high hydraulic retention time (> 100 days). The temporal ranges of 9 physical and chemical water variables over a five-year period were used to calculate the mass balance and to determine the retentive capability (alpha parameter) of the Itupararanga Reservoir (São Paulo State, Brazil). To explain the long-term mass balance of these variables, it was assumed that the reservoir is a completely mixed system with a step input. Results The highest values of parametrized alpha (high retention capability) occurred in wet months (up to 500 mm) for all variables. High reaction rate constants (k) and low hydraulic flushing suggested that sink processes prevail over the export ones, mainly for total phosphorus. The rainfall pattern showed minor importance for trapping elements. Conclusions In the Neotropics, hydraulic characteristics of the ecosystem (e.g., low area:volume ratio) are a tool for pollution management in man-made reservoirs.

Resumo: Objetivo Os reservatórios artificiais desencadeiam várias mudanças em seus rios a jusante que dependem das características hidráulicas dos reservatórios. No entanto, seus múltiplos usos também podem fornecer recursos que influenciam os serviços ecossistêmicos que eles fornecem. Este estudo abordou a capacidade potencial de um reservatório Neotropical em capturar espécies químicas, com o objetivo de avaliar o papel desses ecossistemas na mitigação da poluição. Métodos A modelagem da capacidade de retenção foi examinada para um pequeno reservatório subtropical com alto tempo de retenção hidráulica (> 100 dias). As variações temporais de 9 variáveis físicas e químicas da água ao longo de um período de cinco anos foram usados para calcular o balanço de massa e determinar a capacidade retentiva (parâmetro alfa) do reservatório Itupararanga (estado de São Paulo, Brasil). Para explicar o balanço de massa de longo prazo dessas variáveis, foi assumido que o reservatório seja um sistema completamente misturado com uma entrada em degrau. Resultados Os maiores valores de assimilação (i.e., alta capacidade de retenção) ocorreram nos meses úmidos (até 500 mm) para todas as variáveis. Altos coeficientes de reação (k) e baixa descarga hidráulica sugerem que os processos de sumidouro prevalecem sobre os de exportação, principalmente para fósforo total. O padrão de precipitação mostrou menor importância para o aprisionamento dos elementos. Conclusões Nos Neotrópicos, as características hidráulicas do ecossistema (e.g., baixa relação área: volume) são uma ferramenta para o gerenciamento da poluição em reservatórios artificiais.

https://doi.org/10.1590/s2179-975x6922

Ensino remoto emergencial na Medicina: aspectos positivos e negativos no ensino e na aprendizagem em tempos de pandemia
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Paulino, Joao Lucas Paiva

; Freire, Marcela de Oliveira Torres Bezerra

; Ribeiro, Louise Helena de Freitas

; Nascimento, Ellany Gurgel Cosme do

; Cunha, Andrea Taborda Ribas da

; Fernandes, Thales Allyrio Araújo de Medeiros

Revista Brasileira de Educação Médica

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2023, Volume 47 N. 1 elocation e048

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

Abstract: Introduction: Distance learning emerged as an emergency tool used in Higher Education during the COVID-19 pandemic. These circumstances led to the increased use of Information and Communication Technologies (ICTs) for teaching and learning in Medicine courses. Objective: To conduct an integrative review to clarify the main positive and negative aspects found in the exercise of medical education in these atypical conditions. Method: Articles were searched on the following databases: Virtual Health Library (VHL), Embase, Education Resources Information Center (ERIC), Medline (via PubMed), Scopus and Web of Science Result: At the end of the screening and selection processes, 69 articles were included, from which information was extracted regarding the characteristics, positive and negative aspects of each remote medical teaching experience offered during the pandemic. Among the main positive aspects, we highlight the positive evaluation of the curricular component by the students, greater student autonomy, greater participation and communication among students and the absence of any learning deficit. The main negative points include the suspension of practical classes, complications arising from the use of technologies (connectivity, training and organization) and lack of social contact. Conclusion: It is observed that student autonomy and self-discipline is a crucial factor in taking full advantage of the distance learning approach, and perhaps the classic face-to-face student was not prepared for such a sudden change. Still, it is clear that, due to the urgency of implementing this new form of learning, distance learning has not had enough time to mature and be perfected to the point of being considered a medical education strategy applicable in the long term. Distance learning was crucial for the continued training of new doctors for an extended period of time. However, it needs to be reassessed and improved as a pedagogical strategy that uses ICTs for medical education.

Resumo: Introdução: O ensino remoto surgiu como ferramenta emergencial no processo de educação superior durante a pandemia da Covid-19. Nesse cenário, amplia-se a possibilidade de ensinar e aprender por meio das tecnologias da informação e comunicação (TIC) nos cursos de Medicina. Objetivo: Este estudo teve como objetivo realizar uma revisão integrativa que esclareça os principais aspectos positivos e negativos encontrados no exercício do ensino médico, nessas condições atípicas. Método: A busca dos artigos se deu nas seguintes bases: Biblioteca Virtual em Saúde (BVS), Embase, Education Resources Information Center (ERIC), Medline (via PubMed), Scopus e Web of Science. Resultado: Ao final dos processos de triagem e seleção, incluíram-se 69 artigos, dos quais foram extraídas informações quanto às características dos aspectos positivos e negativos de cada experiência de ensino remoto médico ofertado nesse período pandêmico. Entre os principais aspectos positivos, destacam-se a avaliação positiva do componente curricular pelos estudantes, a maior autonomia do aluno, a maior participação e comunicação entre os alunos, e a ausência de déficit de aprendizado. Entre os principais pontos negativos, observam-se a suspensão das aulas práticas, as complicações decorrentes do uso das tecnologias (conectividade, capacitação e organização) e a ausência de contato social. Conclusão: Observa-se que a autonomia e a autodisciplina discentes são fatores cruciais para o aproveitamento pleno de abordagem de aprendizagem remotamente, e talvez o aluno presencial clássico não estivesse preparado para tal mudança brusca. Ainda, percebe-se que, pela urgência de implantação dessa nova forma de aprendizagem, o ensino remoto não tenha tido tempo e maturidade o suficiente para que fosse aperfeiçoado ao ponto de ser considerado uma estratégia de educação médica aplicável em longo prazo. O ensino remoto foi crucial para que a formação de novos médicos não fosse descontinuada por um período de tempo tão extenso. Porém, o ensino remoto precisa ser reavaliado e aperfeiçoado como estratégia pedagógica que utiliza TIC para o ensino médico.

https://doi.org/10.1590/1981-5271v47.1-20220233

Genetic divergence of cassava genotypes from Petrolina
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Santos, André Luiz Pinto dos

; Moreira, Guilherme Rocha

; Gomes, Diego Alves

; Figueiredo, Marcela Portela Santos de

; Costa, Maria Lindomárcia Leonardo da

; Cunha Filho, Moacyr

; Saliba, Eloísa de Oliveira Simões

; Albuquerque, Cristiane Rocha

Acta Scientiarum. Animal Sciences

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2023, Volume 45 elocation e58051

Abstract: En | Text: En | PDF: En

ABSTRACT. This study aimed to evaluate cassava genotypes to identify the ones with the best nutritional values for ruminant diets. Nine genotypes were used: Amansa Burro (BGM 549), Aramaris (BGM 116), Brasília, Cambadinha (BRS Guaíra), Curvelinha, Engana Ladrão (BGM 1269), Trouxinha (BGM 1468), BRS Gema de Ovo, and BRS Dourada. A completely randomized block experimental design with nine treatments (genotypes) and three blocks (replicates) were employed. The roots were analyzed for dry matter production (DMP) in tonnes per hectare, crude protein (CP), neutral detergent fiber (NDF), acid detergent fiber (ADF), starch, and in vitro dry matter digestibility (IVDMD). The multivariate analysis was carried out using Ward’s hierarchical agglomerative clustering based on Mahalanobis distance. The groups formed were evaluated by Scott-Knott test. The group formed by genotype Engana Ladrão was chosen as the best one for having the highest DMP t ha-1 and IVDMD values and the lowest NDF and ADF contents.

https://doi.org/10.4025/actascianimsci.v45i1.58051

Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review
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Antonini, Marcela

; Silva, Ingred Evangelista da

; Elias, Henrique Ciabotti

; Gerin, Larissa

; Oliveira, Aliete Cunha

; Reis, Renata Karina

Revista Brasileira de Enfermagem

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2023, Volume 76 N. 3 elocation e20210963

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

ABSTRACT Objectives: to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. Methods: an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. Results: all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. Conclusions: the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.

RESUMEN Objetivos: identificar y sintetizar evidencias científicas sobre las barreras y dificultades para el uso y la adherencia a la Profilaxis Pre-Exposición (PrEP) para el VIH. Métodos: revisión integrativa de la literatura, utilizando las bases de datos MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier y Scopus (Elsevier). Resultados: todos (100%) de los artículos incluidos identificaron que los usuarios de PrEP experimentan algún tipo de barrera estructural relacionada con los servicios de salud, como la larga distancia de las unidades, la logística subóptima para la toma de pastillas y la resistencia profesional a prescribir la PrEP. Además, el 63,21% identificó barreras sociales, como el estigma sobre la sexualidad y el VIH, además de las barreras individuales como el consumo de alcohol, los efectos adversos y las preocupaciones sobre la toxicidad a largo plazo. Conclusiones: las barreras para el uso de la PrEP son multifactoriales. Se necesitan intervenciones eficaces para ayudar a los usuarios de la PrEP a acceder, adherirse y conservar los servicios de salud.

RESUMO Objetivos: identificar e sintetizar as evidências científicas sobre as barreiras e dificuldades para o uso e adesão da Profilaxia Pré-exposição (PrEP) para o HIV. Métodos: revisão integrativa da literatura, utilizando as bases de dados MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier e Scopus (Elsevier). Resultados: todos (100%) os artigos incluídos identificaram que os usuários da PrEP experimentam algum tipo de barreira estrutural relacionada aos serviços de saúde, como longa distância das unidades, logística subótima para retirada de pílulas e resistência profissional para prescrição da PrEP. Ademais, 63,21% identificaram barreiras sociais, como estigma sobre a sexualidade e HIV, além de barreiras individuais, como uso de álcool, efeitos adversos e preocupações com a toxicidade a longo prazo. Conclusões: multifatoriais são as barreiras para o uso da PrEP. Intervenções efetivas são necessárias para apoiar os usuários da PrEP no acesso, adesão e retenção nos serviços de saúde.

https://doi.org/10.1590/0034-7167-2021-0963

Funga Capixaba: Ascomycota and lichen-forming fungi
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Fraga Junior, Carlos Augusto Vidigal

; Gumboski, Emerson Luiz

; Feuerstein, Shirley da Cunha

; Cáceres, Marcela Eugenia da Silva

; Aptroot, André

; Magnago, Altielys Casale

Rodriguésia

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2023, Volume 74 elocation e00692022

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

Abstract The “Funga Capixaba” have been overlooked for a very long time, leading to a gap in the local mycological knowledge. In order to create a preliminary and updated list of Ascomycetes and lichen-forming fungi from Espírito Santo state, Brazil we reviewed all specimens deposited in the VIES Herbarium and key references of former mycological studies. In our list, we report a total of 528 species belonging to 173 genera and 65 families. 422 are new records for Espírito Santo state, six species, Mazaediothecium uniseptatum, Cratiria chloraceus, Lecanora glaucoidea, Pyrenula montocensis, and P. oleosa, are new records both for the neotropics and Brazil, and Lobariella pseudocrenulata is also new to Brazil. We have increased the number of accepted macrofungi species names from 85 to 528, which makes the Espírito Santo state the 10th highest in terms of known fungal diversity among Brazilian states. An updated and preliminary list of macroscopic Ascomycota including lichen-forming fungi from Espírito Santo, comments, and a brief overview about the local mycology are provided.

Resumo A “Funga Capixaba” foi por muito tempo pouco explorada levando a uma lacuna no conhecimento micológico local. Com o intuito de criar uma lista preliminar e atualizada de Ascomicetos e fungos liquenizados do estado do Espírito Santo, Brasil, nós revisamos todos os espécimes depositados no herbário VIES além de diversas referências sobre estudos micológicos locais. Em nossa lista, reportamos um total de 528 espécies pertencentes a 173 gêneros e 64 famílias. 422 são novos registros para o estado do Espírito Santo, sendo seis espécies Mazaediothecium uniseptatum, Cratiria chloraceus, Lecanora glaucoidea, Pyrenula montocensis e P. oleosa novos registros tanto para o Brasil como para o Neotrópico e Lobariella pseudocrenulata um novo registro para o Brasil. Elevamos o número de nomes de espécies reportadas de 85 para 528, o que faz o Espírito Santo saltar para a 10ª posição em termos de conhecimento da diversidade fúngica entre os estados brasileiros. Fornecemos uma lista atualizada ainda que preliminar de Ascomicetos e fungos liquenizados macroscópicos ocorrentes no Espírito Santo, além de comentários e um panorama sobre a micologia local.

https://doi.org/10.1590/2175-7860202374044

Coletivos organizados, ativismo social e narrativas da pandemia em territórios vulneráveis na cidade do Rio de Janeiro, Brasil
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Gutiérrez, Adriana Coser

; Campos, Gastão Wagner de Sousa

; Cunha, Marcela Silva da

; Mattos, Mauricio Pereira de

; Costa, Patricia dos Santos da

; Silva, Rafaela Oliveira Lopes da

; Pereira, Ana Carolina dos Santos Rangel

; Campos, Adilson Rocha

; Guerra, Cyntia Amorim

Ciência & Saúde Coletiva

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2023, Volume 28 N. 12 Pages 3533 - 3542

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

https://doi.org/10.1590/1413-812320232812.04812023

10.

Shared decision-making and specific informed consent in patients with aortic aneurysms
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Cunha, Marcela Juliano Silva

; Teivelis, Marcelo Passos

; Mendes, Cynthia de Almeida

; Baptistella, Conrado Dias Pacheco Annicchino

; Sant´Anna, Pedro Vasconcelos Henry

; Wolosker, Nelson

einstein (São Paulo)

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2023, Volume 21 elocation eAO0197

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery.

https://doi.org/10.31744/einstein_journal/2023ao0197

11.

Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis
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Ávila, Marcela Ignacchiti Lacerda

; Marques, Marcela Gaiotti

; Rocha, Maria Eduarda Araújo Machado da

; Santos, Flávia Cunha dos

; Ochtrop, Manuella Lima Gomes

; Jesús, Nilson Ramires de

; Jesús, Guilherme Ribeiro Ramires de

; Elias, Camila Souto Oliveira

Advances in Rheumatology

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2023, Volume 63 elocation 35

Abstract: En | Text: En | PDF: En

Abstract Objective Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. Methods This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. Results In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. Conclusion Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.

https://doi.org/10.1186/s42358-023-00314-2

12.

The essential role of thoracic duct embolization in management of traumatic iatrogenic chylothorax
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Schmid, Bruno Pagnin

; Gilberto, Guilherme Moratti

; Cunha, Marcela Juliano Silva

; Valle, Leonardo Guedes Moreira

; Foronda, Gustavo

; Arrieta, Santiago Raul

; Nasser, Felipe

; Garcia, Rodrigo Gobbo

Jornal Vascular Brasileiro

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2023, Volume 22 elocation e20230101

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

Abstract This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI.

Resumo Este estudo objetiva descrever uma série de casos de pacientes submetidos a embolização do ducto torácico (EDT) para tratamento de quilotórax iatrogênico (QI). Três pacientes foram incluídos. Caso 1: um homem de 49 anos com linfoma folicular apresentou QI após ressecção de uma massa paravertebral por toracoscopia vídeo-assistida e foi submetido a EDT com micromolas e n-butil-cianoacrilato (NBCA). Caso 2: um homem de 68 anos com amiloidose cardíaca apresentou QI após ser submetido a transplante cardíaco e foi submetido a EDT com micromolas e copolímero de etileno e álcool vinílico. Caso 3: um paciente de 6 anos com malformação cardíaca congênita apresentou QI após cirurgia de Fontan e foi submetido a EDT com NBCA. Todas as lesões foram identificadas durante a linfangiografia, e a EDT foi realizada com sucesso. A EDT é uma técnica segura e valiosa, que pode oferecer um tratamento minimamente invasivo em casos de QI.

https://doi.org/10.1590/1677-5449.20230101

13.

A novel balloon-assisted technique to secure visceral catheterization during a chimney endovascular repair of a ruptured abdominal aortic aneurysm in a centenarian patient
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Galastri, Francisco Leonardo

; Valle, Leonardo Guedes Moreira

; Cunha, Marcela Juliano Silva

; Schmid, Bruno Pagnin

; Garcia, Rodrigo Gobbo

; Lewi, David Salomão

; Affonso, Breno Boueri

; Nasser, Felipe

Jornal Vascular Brasileiro

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2023, Volume 22 elocation e20230018

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

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents.

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos.

https://doi.org/10.1590/1677-5449.202300182

14.

Radiological characteristics of hepatocellular carcinoma that achieved complete response after chemoembolization with drug-eluting beads for liver transplantation planning
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Valle, Leonardo Guedes Moreira

; Cunha, Marcela Juliano Silva

; Schmid, Bruno Pagnin

; Falsarella, Priscila Mina

; Rezende, Marcelo Bruno de

; Felga, Guilherme Eduardo Gonçalves

; Ogawa, Renata Emy

; Garcia, Rodrigo Gobbo

; Affonso, Breno Boueri

; Nasser, Felipe

; Galastri, Francisco Leonardo

einstein (São Paulo)

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2023, Volume 21 elocation eAO0307

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. Methods This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. Results Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. Conclusion HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation.

https://doi.org/10.31744/einstein_journal/2023ao0307

15.

Reviewing the organic matter processing by wetlands
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Cunha-Santino, Marcela Bianchessi da

; Bianchini Júnior, Irineu

Acta Limnologica Brasiliensia

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2023, Volume 35 elocation e19

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

Resumo Objetivo Os processos de ciclagem em áreas úmidas são altamente dinâmicos e envolvem interações complexas entre processos hidrológicos, transformações biogeoquímicas e comunidades microbianas. Esta revisão avaliou as interações entre os elementos no contexto dos ciclos biogeoquímicos e as possíveis rotas em que a matéria orgânica é processada em solos alagados. Métodos Nessa revisão foram abordados os processos de entrada e ciclagem de matéria orgânica em solos inundados. Utilizamos um levantamento bibliográfico não sistemático para indicar as possíveis rotas biogeoquímicas de processamento da matéria orgânica em solos alagados. Resultados Exploramos processos hidrológicos, disponibilidade de oxigênio, rotas biogeoquímicas do processo de matéria orgânica e as entradas e exportações de matéria orgânica em solos alagados de áreas úmidas. Conclusões A degradação anaeróbica dos recursos orgânicos ocorre predominantemente em solos submersos. Em condições de manutenção das taxas naturais de produção primária e adução de detritos alóctones, o armazenamento de detritos orgânicos em solos alagados prevalece sobre a mineralização. A importância da hidrologia para a exportação de carbono orgânico é evidente. Nas áreas úmidas, a exportação de matéria orgânica está predominantemente associada à matéria orgânica dissolvida e a produção de metano. hidrológicos microbianas inundados oxigênio submersos alóctones mineralização evidente metano

Abstract Aim Cycling processes in wetlands are highly dynamic and involve complex interactions between hydrological processes, biogeochemical transformations, and microbial communities. This review attempts to assess the interactions between elements within biogeochemical cycles and the possible routes in which organic matter is processed in waterlogged soils. Methods The input and cycling of organic matter in flooded soils were approached in this review. We used a non-systematic literature survey to indicate the possible biogeochemical routes of organic matter processing in waterlogged soils. Results We explore hydrological processes, oxygen availability, biogeochemical routes of the organic matter process, and the inputs and exports of organic matter in flooded soils from wetlands. Conclusions The anaerobic degradation of organic resources predominantly occurs within submerged soils. Under conditions of maintenance of natural rates of primary production and allochthonous detritus input, storing organic detritus in flooded soils prevails over mineralization. The importance of hydrology for the export of organic carbon is evident. In wetlands, the export of organic matter is predominantly associated with dissolved organic matter and methane production. transformations communities nonsystematic non systematic availability process mineralization evident

https://doi.org/10.1590/s2179-975x3423

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