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Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.

https://doi.org/10.5935/0103-507x.20210028

Fertility, carbon stock and aggregate stability of an Alfisol under integrated farming systems
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Silva, Pedro Luan Ferreira da

; Oliveira, Flávio Pereira de

; Martins, Adriana Ferreira

; Tavares, Danillo Dutra

; Amaral, André Julio do

Pesquisa Agropecuária Tropical

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2021, Volume 51 elocation e66505

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

ABSTRACT Integrated farming systems are promising strategies for the recovery of pastures and degraded soils. This study aimed to evaluate the effect of integrated farming systems arrangements, after four years of implementation, on the fertility, carbon stock and aggregate stability of an Alfisol, in the semiarid region of the Paraíba state, Brazil. A randomized block experimental design was used, with 5 treatments and 4 replications: Brachiaria decumbens; B. decumbens + Tabebuia impetiginous; B. decumbens + Gliricidia sepium; B. decumbens + Mimosa caesalpiniifolia; and B. decumbens + maize. The soil chemical attributes, fertility, carbon stock and structural and aggregate stability were evaluated in the 0.00-0.10, 0.10-0.20 and 0.20-0.30 m layers. The B. decumbens + maize system presented an organic matter content 11.93 % higher than B. decumbens, and was higher than the other systems evaluated. Concerning the carbon stock in the 0.00-0.10 m layer, in B. decumbens the uptake was 2.66 Mg ha-1 higher than that of the B. decumbens + maize system and, on average, 4.69 Mg ha-1 higher than for the systems with the arboreal component. In the medium-term, B. decumbens is more efficient in adding carbon to the soil. The soil structural stability, aggregate stability index and fertility were not affected by the different arrangements after four years of implementation.

RESUMO Sistemas integrados de produção agropecuária são estratégias promissoras para a recuperação de pastagens e solos degradados. Objetivou-se avaliar o efeito de arranjos com sistemas integrados de produção agropecuária, aos quatro anos de implantação, sobre a fertilidade, estoque de carbono e estabilidade de agregados de um Planossolo Háplico, no semiárido da Paraíba. O delineamento experimental foi de blocos casualizados, com 5 tratamentos e 4 repetições: Brachiaria decumbens; B. decumbens + ipê; B. decumbens + gliricídia; B. decumbens + sabiá; e B. decumbens + milho. Avaliaram-se os atributos químicos e de fertilidade, estoque de carbono, estabilidade estrutural e de agregados do solo nas camadas de 0,00-0,10; 0,10-0,20; e 0,20-0,30 m. O sistema B. decumbens + milho apresentou teor de matéria orgânica 11,93 % maior que B. decumbens e foi superior aos demais sistemas avaliados. Em relação ao estoque de carbono na camada de 0,00-0,10 m, em B. decumbens o aporte foi 2,66 Mg ha-1 maior que em B. decumbens + milho e, em média, 4,69 Mg ha-1 superior aos sistemas com o componente arbóreo. No médio prazo, B. decumbens mostra-se mais eficiente no aporte de carbono ao solo. A estabilidade estrutural, o índice de estabilidade de agregados e a fertilidade do solo não apresentaram alteração, em relação aos arranjos, após quatro anos de implantação.

https://doi.org/10.1590/1983-40632021v5166505

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.

; Marques, Heloisa H.S.

; Gualano, Bruno

; Lindoso, Livia

; Bain, Vera

; Astley, Camilla

; Martins, Fernanda

; Matheus, Denise

; Matsuo, Olivia M.

; Suguita, Priscila

; Trindade, Vitor

; Paula, Camila S.Y.

; Farhat, Sylvia C.L.

; Palmeira, Patricia

; Leal, Gabriela N.

; Suzuki, Lisa

; Odone Filho, Vicente

; Carneiro-Sampaio, Magda

; Duarte, Alberto José S.

; Antonangelo, Leila

; Batisttella, Linamara R.

; Polanczyk, Guilherme V.

; Pereira, Rosa Maria R.

; Carvalho, Carlos Roberto R.

; Buchpiguel, Carlos A.

; Latronico, Ana Claudia

; Seelaender, Marilia

; Silva, Clovis Artur

; Pereira, Maria Fernanda B.

; Sallum, Adriana M. E.

; Brentani, Alexandra V. M.

; Neto, Álvaro José S.

; Ihara, Amanda

; Santos, Andrea R.

; Canton, Ana Pinheiro M.

; Watanabe, Andreia

; Santos, Angélica C. dos

; Pastorino, Antonio C.

; Franco, Bernadette D. G. M.

; Caruzo, Bruna

; Ceneviva, Carina

; Martins, Carolina C. M. F.

; Prado, Danilo

; Abellan, Deipara M.

; Benatti, Fabiana B.

; Smaria, Fabiana

; Gonçalves, Fernanda T.

; Penteado, Fernando D.

; Castro, Gabriela S. F. de

; Gonçalves, Guilherme S.

; Roschel, Hamilton

; Disi, Ilana R.

; Marques, Isabela G.

; Castro, Inar A.

; Buscatti, Izabel M.

; Faiad, Jaline Z.

; Fiamoncini, Jarlei

; Rodrigues, Joaquim C.

; Carneiro, Jorge D. A.

; Paz, Jose A.

; Ferreira, Juliana C.

; Ferreira, Juliana C. O.

; Silva, Katia R.

; Bastos, Karina L. M.

; Kozu, Katia

; Cristofani, Lilian M.

; Souza, Lucas V. B.

; Campos, Lucia M. A.

; Silva Filho, Luiz Vicente R. F.

; Sapienza, Marcelo T.

; Lima, Marcos S.

; Garanito, Marlene P.

; Santos, Márcia F. A.

; Dorna, Mayra B.

; Aikawa, Nadia E.

; Litvinov, Nadia

; Sakita, Neusa K.

; Gaiolla, Paula V. V.

; Pasqualucci, Paula

; Toma, Ricardo K.

; Correa-Silva, Simone

; Sieczkowska, Sofia M.

; Imamura, Marta

; Forsait, Silvana

; Santos, Vera A.

; Zheng, Yingying

Clinics

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2021, Volume 76 elocation e3511

Abstract: En | Text: En | PDF: En

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

https://doi.org/10.6061/clinics/2021/e3511

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine
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Helito, Alberto C.

; Lindoso, Livia

; Sieczkowska, Sofia M.

; Astley, Camilla

; Queiroz, Ligia B.

; Rose, Natalia

; Santos, Claudia Renata P.

; Bolzan, Thalis

; Peralta, Rita María I.A.

; Franco, Ruth R.

; Cominato, Louise

; Pereira, Rosa Maria R.

; Tannuri, Uenis

; Campos, Lucia Maria A.

; Lourenço, Benito

; Toma, Ricardo K.

; Medeiros, Karina

; Watanabe, Andréia

; Grangeiro, Patricia Moreno

; Farhat, Sylvia C.

; Casella, Caio B.

; Polanczyk, Guilherme V.

; Gualano, Bruno

; Silva, Clovis A.

; Sallum, Adriana M. E.

; Iraha, Amanda Y.

; Ihara, Bianca P.

; Mazzolani, Bruna C.

; Martinez, Claudia A.

; Strabelli, Claudia A. A.

; Fonseca, Claudia B.

; Lima, Dandara C. C.

; Setoue, Debora N. D.

; Roz, Deborah F. P.

; Smaira, Fabiana I.

; Roschel, Hamilton

; Miyatani, Helena T.

; Marques, Isabela G.

; Oba, Jane

; Ferreira, Juliana C. O.

; Simon, Juliana R.

; Kozu, Katia

; Saccani, Ligia P.

; Martiniano, Lorena V. M.

; Miranda, Luana C. A.

; Silva, Luiz E. V.

; Laurentino, Moisés F.

; Aikawa, Nadia E.

; Sakita, Neusa K.

; Tanigava, Nicolas Y.

; Pereira, Paulo R. A.

; Palmeira, Patrícia

; Angelo, Simone S.

; Lavorato, Sofia S. M.

; Bernardes, Tamires M.

; Franco, Tathiane C.

; Viana, Vivianne S. L.

; Barros, Vera P. M. F. R.

; Zheng, Yingying

Clinics

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2021, Volume 76 elocation e3501

Abstract: En | Text: En | PDF: En

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality.

https://doi.org/10.6061/clinics/2021/e3501

COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro

; Uchôa, Caroline Louise Mesquita

; Mazzoco, Marina Flaborea

; Cruz, Isabella D'Andrea Garcia da

; Echegaray, Mariana V.F.

; Humes, Eduardo de Castro

; Silveira, Júlia Belizário

; Santi, Talita Di

; Miguel, Euripedes Constantino

; Corchs, Felipe

; Fatori, Daniel

; Campello, Guilherme

; Oliveira, Gabriel M. de

; Argolo, Felipe C.

; Ferreira, Felipe de M.

; Machado, Gustavo

; Argeu, Adriana

; Oliveira, Graça Maria Ramos de

; Serafim, Antônio de Pádua

; Siqueira, Luciana de Lima

; Rossi, Luciane de

; Rios, Izabel Cristina

; Oliveira, Talita Rodrigues de

; Antoniazzi, Leilane C. K.

; Gagliotti, Daniel Augusto Mori

; Abelama Neto, Emílio

; Oliveira Junior, Paulo Novais de

; Correia, Aline Villalobo

; Gonçalves, Luca Schilling

; Tortato, Liana Silva

; Busato, Wagner Machado Moraes

; Guimarães-Fernandes, Flávio

; Alves, Marcos

; Leite Netto, Oswaldo Ferreira

; Schoueri, Patrícia de Campos Lindenberg

; Roque, Márcio de Assis

; Merlin, Silvia Stahl

; Boer, Giovana Cardoso Machado

; Sallet, Paulo Clemente

; Malbergier, André

; Spedo, Mariana Abrahão

; Kamitsuji, Carla Satie

; Faria, Elizabeth de

; Moreira, Moacyr Vergara de Godoy

; Kaufman, Arthur

; Abdo, Carmita

; Scanavino, Marco de Tubino

; Lancman, Selma

; Tavares, Hermano

; Polanczyk, Guilherme

; Brunoni, André R.

; Forlenza, Orestes V.

; Barros-Filho, Tarcísio Eloy Pessoa de

Clinics

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2021, Volume 76 elocation e2631

Abstract: En | Text: En | PDF: En

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

https://doi.org/10.6061/clinics/2021/e2631

SPATIAL VARIABILITY OF RESISTANCE TO PENETRATION IN SOIL UNDER SUGARCANE CROPS WITH DIFFERENT HARVEST METHODS
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SOUZA, MAIRA DA CUNHA

; OLIVEIRA, FLAVIO PEREIRA DE

; SILVA, JOSÉVALDO RIBEIRO

; MARTINS, ADRIANA FERREIRA

; SILVA, PEDRO LUAN FERREIRA DA

Revista Caatinga

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apr 2020, Volume 33 N. 2 Pages 480 - 489

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

ABSTRACT The objective of this work was to evaluate the spatial variability of resistance to penetration in soil under sugarcane crops subjected to different harvest methods in the North Coast microregion of the state of Paraiba, Brazil. The study was conducted in a Typic Hapludult under sugarcane crops, at the farms Santa Emília-II and Maria da Luz-I of the company Miriri Food and Bioenergy S/A, in the municipalities of Rio Tinto and Capim, respectively, state of Paraíba, Brazil. Three sugarcane areas with different harvest methods (manual, mechanized, and manual/mechanized) were selected. The sampling was done in plots of 100 × 100 m, using a grid of 20 × 20 m, covering planting rows and interrows; each intersection point of the grid was georeferenced, and the soil mechanic resistance to penetration was evaluated with the aid of an impact penetrometer (IAA/Planalsucar-Stolf) up to the depth of 0-0.6 m. Soil disturbed and undisturbed samples from the 0.0-0.1 and 0.1-0.2 m layers were collected for analyses of soil moisture, texture, clay dispersed in water, flocculation degree. A pure nugget effect was found in the 0.0-0.1 and 0.4-0.5 m soil layers in the rows of the areas with manual/mechanized harvest. The spherical model was found for most conditions evaluated. The results for the areas were similar, with amplitude of 25-49 m, indicating that the harvest management had no effect on the soil resistance to penetration. No compacted areas were found, and the spatial dependency of the resistance to penetration was characterized as moderate to strong.

RESUMO O objetivo deste trabalho foi avaliar a variabilidade espacial da resistência a penetração em solo sob diferentes condições de colheita de cana-de-açúcar na microrregião do Litoral Norte paraibano. O estudo foi realizado em Argissolo Acinzentado cultivado com cana-de-açúcar, nas fazendas Santa Emília II e Maria da Luz I, pertencentes à Usina Miriri e Bioenergia S/A, nos municípios de Rio Tinto e Capim, estado da Paraíba no Brasil. Selecionou-se três áreas: Colheita manual; Colheita mecanizada e; Colheita manual e mecanizada. As coletas se procederam em parcelas de 100 x 100 m, sob grid de amostragem de 20 x 20 m, contemplando linhas e entrelinhas de plantio, sendo cada ponto de cruzamento da malha amostral georreferenciado, e levantada a sua resistência mecânica à penetração com auxílio de um penetrômetro de impacto modelo IAA/Planausucar-Stolf na profundidade de 0-0,6 m. Foi procedida coleta de amostra deformadas e indeformadas nas profundidade de 0-0,1 e 0,1-0,2 m para análises das seguintes variáveis: Umidade do solo, Textura, Argila dispersa em água, Grau de floculação. Observou-se efeito pepita puro nas camadas de 0-0,1 e 0,4-0,5 m na linha da área de colheita manual e mecanizada. Na maioria das condições analisadas constatou-se o modelo esférico. Os alcances foram semelhantes para áreas, com amplitude de 25 a 49 m, indicando que o manejo de colheita, no período estudado, não exerceu influência para a resistência à penetração. Não foram observadas áreas compactadas e a dependência espacial da resistência à penetração foi caracterizada como moderada a forte.

https://doi.org/10.1590/1983-21252020v33n220rc

Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.

; Ho, Yeh-Li

; Besen, Bruno A.M.P.

; Malbuisson, Luiz M.S.

; Taniguchi, Leandro U.

; Mendes, Pedro V.

; Costa, Eduardo L.V.

; Park, Marcelo

; Daltro-Oliveira, Renato

; Roepke, Roberta M.L.

; Silva Jr, João M.

; Carmona, Maria José C.

; Carvalho, Carlos Roberto Ribeiro

; Hirota, Adriana

; Kanasiro, Alberto Kendy

; Crescenzi, Alessandra

; Fernandes, Amanda Coelho

; Miethke-Morais, Anna

; Bellintani, Arthur Petrillo

; Canasiro, Artur Ribeiro

; Carneiro, Bárbara Vieira

; Zanbon, Beatriz Keiko

; Batista, Bernardo Pinheiro De Senna Nogueira

; Nicolao, Bianca Ruiz

; Besen, Bruno Adler Maccagnan Pinheiro

; Biselli, Bruno

; Macedo, Bruno Rocha De

; Toledo, Caio Machado Gomes De

; Pompilio, Carlos Eduardo

; Carvalho, Carlos Roberto Ribeiro De

; Mol, Caroline Gomes

; Stipanich, Cassio

; Bueno, Caue Gasparotto

; Garzillo, Cibele

; Tanaka, Clarice

; Forte, Daniel Neves

; Joelsons, Daniel

; Robira, Daniele

; Costa, Eduardo Leite Vieira

; Silva Júnior, Elson Mendes Da

; Regalio, Fabiane Aliotti

; Segura, Gabriela Cardoso

; Marcelino, Gustavo Brasil

; Louro, Giulia Sefrin

; Ho, Yeh-Li

; Ferreira, Isabela Argollo

; Gois, Jeison de Oliveira

; Silva Junior, Joao Manoel Da

; Reusing Junior, Jose Otto

; Ribeiro, Julia Fray

; Ferreira, Juliana Carvalho

; Galleti, Karine Vusberg

; Silva, Katia Regina

; Isensee, Larissa Padrao

; Oliveira, Larissa dos Santos

; Taniguchi, Leandro Utino

; Letaif, Leila Suemi

; Lima, Lígia Trombetta

; Park, Lucas Yongsoo

; Chaves Netto, Lucas

; Nobrega, Luciana Cassimiro

; Haddad, Luciana

; Hajjar, Ludhmila

; Malbouisson, Luiz Marcelo

; Pandolfi, Manuela Cristina Adsuara

; Park, Marcelo

; Carmona, Maria José Carvalho

; Andrade, Maria Castilho Prandini H De

; Santos, Mariana Moreira

; Bateloche, Matheus Pereira

; Suiama, Mayra Akimi

; Oliveira, Mayron Faria de

; Sousa, Mayson Laercio

; Louvaes, Michelle

; Huemer, Natassja

; Mendes, Pedro

; Lins, Paulo Ricardo Gessolo

; Santos, Pedro Gaspar Dos

; Moreira, Pedro Ferreira Paiva

; Guazzelli, Renata Mello

; Reis, Renato Batista Dos

; Oliveira, Renato Daltro De

; Roepke, Roberta Muriel Longo

; Pedro, Rodolpho Augusto De Moura

; Kondo, Rodrigo

; Rached, Samia Zahi

; Fonseca, Sergio Roberto Silveira Da

; Borges, Thais Sousa

; Ferreira, Thalissa

; Cobello Junior, Vilson

; Sales, Vivian Vieira Tenório

; Ferreira, Willaby Serafim Cassa

Clinics

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2020, Volume 75 elocation e2294

Abstract: En | Text: En | PDF: En

OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.

https://doi.org/10.6061/clinics/2020/e2294

Autoimmune hepatitis in 828 Brazilian children and adolescents: clinical and laboratory findings, histological profile, treatments, and outcomes
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Porta, Gilda

; Carvalho, Elisa de

; Santos, Jorge L.

; Gama, Jorge

; Borges, Cristian V.

; Seixas, Renata B.P.M.

; Ferreira, Alexandre R.

; Miura, Irene K.

; Silveira, Themis R.

; Silva, Luciana R.

; Fagundes, Eleonora D.T.

; Bellomo-Brandao, Maria A.

; Sawamura, Regina

; Vieira, Sandra M.

; Melere, Melina U.

; Marques, Cibele D.F.

; Pugliese, Renata P.

; Danesi, Vera L.

; Porta, Adriana

; Marsillac, Marise E.

; Valladares, Marcia A.

; Menezes, Daniela G.

; Kieling, Carlos

; Paula, Mariana N. de

; Vasconcelos, Juliana R.

; Ferreira, Cristina T.

; Perin, Nilza

; Resende, Leonardo R.

; Maia, Jussara

; Tommaso, Adriana M.A. De

; Hessel, Gabriel

Jornal de Pediatria

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aug 2019, Volume 95 N. 4 Pages 419 - 427

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

Abstract Objective: This large study with a long-term follow-up aimed to evaluate the clinical presentation, laboratory findings, histological profile, treatments, and outcomes of children and adolescents with autoimmune hepatitis. Methods: The medical records of 828 children and adolescents with autoimmune hepatitis were reviewed. A questionnaire was used to collect anonymous data on clinical presentation, biochemical and histological findings, and treatments. Results: Of all patients, 89.6% had autoimmune hepatitis-1 and 10.4% had autoimmune hepatitis-2. The female sex was predominant in both groups. The median age at symptom onset was 111.5 (6; 210) and 53.5 (8; 165) months in the patients with autoimmune hepatitis 1 and autoimmune hepatitis-2, respectively. Acute clinical onset was observed in 56.1% and 58.8% and insidious symptoms in 43.9% and 41.2% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively. The risk of hepatic failure was 1.6-fold higher for autoimmune hepatitis-2. Fulminant hepatic failure occurred in 3.6% and 10.6% of the patients with autoimmune hepatitis-1 and autoimmune hepatitis-2, respectively; the risk was 3.1-fold higher for autoimmune hepatitis-2. The gamma globulin and immunoglobulin G levels were significantly higher in autoimmune hepatitis-1, while the immunoglobulin A and C3 levels were lower in autoimmune hepatitis-2. Cirrhosis was observed in 22.4% of the patients; biochemical remission was achieved in 76.2%. The actuarial survival rate was 93.0%. A total of 4.6% underwent liver transplantation, and 6.9% died (autoimmune hepatitis-1: 7.5%; autoimmune hepatitis-2: 2.4%). Conclusions: In this large clinical series of Brazilian children and adolescents, autoimmune hepatitis-1 was more frequent, and patients with autoimmune hepatitis-2 exhibited higher disease remission rates with earlier response to treatment. Patients with autoimmune hepatitis-1 had a higher risk of death.

Resumo Objetivo: Este estudo com acompanhamento de longo prazo visou a avaliar o quadro clínico, os achados laboratoriais, o perfil histológico, os tratamentos e os resultados de crianças e adolescentes com hepatite autoimune. Métodos: Foram analisados os prontuários médicos de 828 crianças e adolescentes com HAI. Foi usado um questionário para coletar os dados anônimos sobre o quadro clínico, os achados bioquímicos e histológicos e os tratamentos. Resultados: De todos os pacientes, 89,6% tinham hepatite autoimune-1 e 10,4% hepatite autoimune-2. O sexo feminino foi predominante nos dois grupos. A idade média no início dos sintomas foi 111,5 (6; 210) e 53,5 (8; 165) meses nos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. Foi observado início clínico agudo em 56,1% e 58,8% e sintomas insidiosos em 43,9% e 41,2% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente. A probabilidade de insuficiência hepática foi 1,6 vezes maior para hepatite autoimune-2; 3,6% e 10,6% dos pacientes com hepatite autoimune-1 e hepatite autoimune-2, respectivamente, apresentaram insuficiência hepática fulminante; o risco foi 3,1 vezes maior para hepatite autoimune-2. Os níveis de gamaglobulina e imunoglobulina G foram significativamente maiores nos pacientes com hepatite autoimune-1, ao passo que os níveis de imunoglobulina A e C3 foram menores em pacientes com hepatite autoimune-2; 22,4% dos pacientes apresentaram cirrose e a remissão bioquímica foi atingida em 76,2%. A taxa de sobrevida atuarial foi de 93,0%. Um total de 4,6% pacientes foram submetidos a transplante de fígado e 6,9% morreram (hepatite autoimune-1: 7,5%; hepatite autoimune-2: 2,4%). Conclusões: Nesta grande série clínica de crianças e adolescentes brasileiros, a hepatite autoimune-1 foi mais frequente e os pacientes com hepatite autoimune-2 mostraram maiores taxas de remissão da doença com respostas mais rápidas aos tratamentos. Os pacientes com hepatite autoimune-1 apresentaram maior risco de óbito.

https://doi.org/10.1016/j.jped.2018.04.007

Lower genital tract infections in young female juvenile idiopathic arthritis patients
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Ferreira, Gabriela R. V.

; Tomioka, Renato B.

; Queiroz, Ligia B.

; Kozu, Katia

; Aikawa, Nadia E.

; Sallum, Adriana M. E.

; Serafini, Paulo

; Tacla, Maricy

; Baracat, Edmund C.

; Pereira, Rosa M. R.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2019, Volume 59 elocation 50

Abstract: En | Text: En | PDF: En

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

https://doi.org/10.1186/s42358-019-0092-6

10.

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
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Pileggi, Gecilmara Salviato

; Mota, Licia Maria Henrique Da

; Kakehasi, Adriana Maria

; Souza, Alexandre Wagner De

; Rocha, Aline

; Melo, Ana Karla Guedes de

; Fonte, Caroline Araujo M. da

; Bortoletto, Cecilia

; Brenol, Claiton Viegas

; Marques, Claudia Diniz Lopes

; Zaltman, Cyrla

; Borba, Eduardo Ferreira

; Reis, Enio Ribeiro

; Freire, Eutilia Andrade Medeiros

; Klumb, Evandro Mendes

; Christopoulos, Georges Basile

; Laurindo, Ieda Maria M.

; Ballalai, Isabella

; Costa, Izaias Pereira Da

; Michelin, Lessandra

; Valadares, Lilian David de Azevêdo

; Chebli, Liliana Andrade

; Lacerda, Marcus

; Toscano, Maria Amazile Ferreira

; Yazbek, Michel Alexandre

; Vieira, Rejane Maria R. De Abreu

; Magalhães, Renata

; Kfouri, Renato

; Richtmann, Rosana

; Merenlender, Selma Da Costa Silva

; Valim, Valeria

; Assis, Marcos Renato De

; Kowalski, Sergio Candido

; Trevisani, Virginia Fernandes Moça

Advances in Rheumatology

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2019, Volume 59 elocation 17

Abstract: En | Text: En | PDF: En

Abstract Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.

https://doi.org/10.1186/s42358-019-0056-x

11.

INFLUENCE OF LOW AND HIGH GLYCEROL CONCENTRATIONS ON WETTABILITY AND FLEXIBILITY OF CHITOSAN BIOFILMS
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Pinto, Erveton P.

; Tavares, Walter de S.

; Matos, Robert S.

; Ferreira, Adriana M.

; Menezes, Rodrigo P.

; Costa, Marcelo Eduardo H. M. da

; Souza, Tiago M. de

; Ferreira, Irlon M.

; Sousa, Franscisco Fábio O. de

; Zamora, Robert Ronald M.

Química Nova

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dec 2018, Volume 41 N. 10 Pages 1109 - 1116

Abstract: En | Text: En | PDF: En

The use of chitosan biofilm in biomedical fields has a vast therapeutic potential due to useful properties such as biodegradability and antimicrobial activity, however, to achieve successful application some physicochemical properties need to be improved. In this context, the addition of glycerol to this biofilm is an alternative to improve its wettability and flexibility. Thus, low and high concentrations of plasticizer were added to this biomaterial for later characterization regarding its wettability, microstructure, mechanical and chemical properties. Glycerol addition to chitosan resulted in biofilms with more homogeneous surfaces, increased wettability, and increased flexibility, without significant changes in its chemical structure.

https://doi.org/10.21577/0100-4042.20170287

12.

Factors associated with the prevalence of helminths in Mangalarga Marchador horses in southern of Minas Gerais, Brazil
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Rosa, Marina H.F.

; Garcia, Adriana M.

; Daher, Débora O.

; Lima, Imara G.

; Félix, Marcelle B.

; Capellari, Luiz A.

; Ferreira, Fernando

; Rocha, Christiane M.B.M.

Pesquisa Veterinária Brasileira

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jun 2018, Volume 38 N. 6 Pages 1097 - 1104

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

ABSTRACT: Horses are highly susceptible to parasitism. Helminth infections cause great harm to the animals and to their breeders. This study aimed at evaluating socioeconomic, cultural and management factors associated with the prevalence of gastrointestinal helminths of horses. A total of 40 farmas the Mangalarga Marchador horse breed were visited in southern Minas Gerais, Brazil, where interviews were conducted. Horse feces were collected on the farms and coproparasitological laboratory tests were conducted to quantify the infection and to identify parasites. Data were tabulated in Epidata and analyzed using the SPSS 20.0 software. A great similarity between breeds was observed, specifically in their profiles, as well as in their animal management techniques and in their parasite control habits. The cyathostome was the most prevalent helminth, followed by Oxyuris and large strongyles. The farms which prioritize only equine production are less likely to have animals with massive helminth infection.

RESUMO: Os equinos são animais muito susceptíveis ao parasitismo. As helmintoses causam grandes prejuízos tanto para os animais, quanto para os criadores. Este estudo teve como objetivo avaliar os fatores sócio-econômicos-culturais e de manejo associados à prevalência de helmintos gastrointestinais de equinos. Foram visitados 40 criatórios de equinos Mangalarga Marchador no Sul de Minas Gerais, nos quais foram realizadas entrevistas. Foram coletadas fezes dos animais nas propriedades e realizados exames laboratoriais coproparasitológicos a fim de quantificar a infecção dos animais e identificar os parasitos. Os dados foram tabulados no Epidata e analisados no software SPSS 20.0. Observou-se uma grande semelhança no perfil dos criadores, assim como na caracterização da propriedade, manejo e controle de parasitos. Os ciatostomíneos foram os helmintos mais prevalentes, seguidos pelo Oxyuris e os grandes estrôngilos. As propriedades que priorizam a equinocultura têm menor chance de apresentar animais com infecção maciça.

https://doi.org/10.1590/1678-5150-pvb-5177

13.

Autoimmune hepatitis in 847 childhoodonset systemic lupus erythematosus population: a multicentric cohort study
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Balbi, Verena A.

; Montenegro, Bárbara

; Pitta, Ana C.

; Schmidt, Ana R.

; Farhat, Sylvia C.

; Coelho, Laila P.

; Ferreira, Juliana C. O.

; Pereira, Rosa M. R.

; Terreri, Maria T.

; Saad-Magalhães, Claudia

; Aikawa, Nadia E.

; Sakamoto, Ana P.

; Kozu, Kátia

; Campos, Lucia M.

; Sallum, Adriana M.

; Ferriani, Virginia P.

; Piotto, Daniela P.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2018, Volume 58 elocation 43

Abstract: En | Text: En | PDF: En

Abstract Objective: To evaluate autoimmune hepatitis (AIH) in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. Methods: This retrospective multicenter study included 847 patients with cSLE, performed in 10 Pediatric Rheumatology services of São Paulo state, Brazil. AIH was defined according to the International Autoimmune Hepatitis Group criteria (IAHGC). The statistical analysis was performed using the Bonferroni's correction (p < 0.0033). Results: AIH in cSLE patients confirmed by biopsy was observed in 7/847 (0.8%) and all were diagnosed during adolescence. The majority occurred before or at cSLE diagnosis [5/7 (71%)]. Antinuclear antibodies were a universal finding, 43% had concomitantly anti-smooth muscle antibodies and all were seronegative for anti-liver kidney microsomal antibodies. All patients with follow-up ≥18 months (4/7) had complete response to therapy according to IAHGC. None had severe hepatic manifestations such as hepatic failure, portal hypertension and cirrhosis at presentation or follow-up. Further comparison of 7 cSLE patients with AIH and 28 without this complication with same disease duration [0 (0–8.5) vs. 0.12 (0–8.5) years, p = 0.06] revealed that the frequency of hepatomegaly was significantly higher in cSLE patients in the former group (71% vs. 11%, p = 0.003) with a similar median SLEDAI-2 K score [6 (0–26) vs. 7 (0–41), p = 0.755]. No differences were evidenced regarding constitutional involvement, splenomegaly, serositis, musculoskeletal, neuropsychiatric and renal involvements, and treatments in cSLE patients with and without AIH (p > 0.0033). Conclusions: Overlap of AIH and cSLE was rarely observed in this large multicenter study and hepatomegaly was the distinctive clinical feature of these patients. AIH occurred during adolescence, mainly at the first years of lupus and it was associated with mild liver manifestations.

https://doi.org/10.1186/s42358-018-0043-7

14.

Financeirização e dinâmica do capitalismo contemporâneo. Notas de apresentação
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Prates, Daniela M.

; Oliveira, Giuliano C.

; Ferreira, Adriana N.

; Baltar, Carolina T.

Economia e Sociedade

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dec 2017, Volume 26 N. spe Pages i - vi

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

https://doi.org/10.1590/1982-3533.2017v26n4art01

15.

"Sweet Chemistry": a Green Way for Obtaining Selenium Nanoparticles Active against Cancer Cells
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Vieira, Adriana P.

; Stein, Erika M.

; Andreguetti, Daniel X.

; Cebrián-Torrejón, Gerardo

; Doménech-Carbó, Antonio

; Colepicolo, Pio

; Ferreira, Ana Maria D. C.

Journal of the Brazilian Chemical Society

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oct 2017, Volume 28 N. 10 Pages 2021 - 2027

Abstract: En | Text: En | PDF: En

We present an environment friendly synthesis of selenium nanoparticles and the study of their cytotoxic activity against uterine sarcoma cancer and fibroblasts cells. Amorphous selenium (a-SeNPs) and trigonal selenium (t-SeNPs) were synthesized using D-fructose as the reducing agent and characterized by high-resolution transmission electron microscopy (HRTEM), energy-dispersive X-ray spectroscopy (EDX), powder X-ray diffraction analysis (XRD), inductively coupled plasma optical emission spectrometry (ICP OES), dynamic light scattering (DLS) to obtain zeta potential values and cyclic voltammetry (CV). Particularly, a-SeNPs presented high toxicity toward the resistant cancer cell line MES-SA/Dx5 and its parental MES-SA line. However, they are not toxic against P4 fibroblast cells in comparative studies.

https://doi.org/10.21577/0103-5053.20170025

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