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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

PET-Saúde Interprofissionalidade e a disponibilidade dos estudantes para a aprendizagem interprofissional
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Marques, Juliana Ferreira Lima

; Costa, Marcelo Viana da

Saúde e Sociedade

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2023, Volume 32 Suppl. 2 elocation e220878pt

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

Abstract Interprofessionality was the central theme of the ninth call for proposals of the Education by Working for Health Program. The objective of this study was to describe the readiness of students who participated in the program for interprofessional learning. The research, of a quantitative approach and descriptive-exploratory perspective, collected data by applying the readiness for interprofessional learning scale (RIPLS), adapted for Brazilian Portuguese. The results indicate an important readiness for teamwork and collaboration. Relevant percentages were also found regarding professional identity, indicating good readiness for interprofessional learning, although aspects related to competition appeared in lower percentages of agreement regarding shared learning and interdependence of professional practices. For user-centered care, results were also found indicating good readiness among participants; however, aspects related to the collaboration of the user in the production of health services still express the tendency of a professional-centered logic. In conclusion, there is a positive readiness for interprofessional education, which needs to be increasingly stimulated in policies and strategies of curricular reforms.

Resumo A interprofissionalidade foi tema central do nono edital do Programa de Educação pelo Trabalho para a Saúde. O objetivo deste estudo foi descrever a disponibilidade dos estudantes que participaram do programa para a aprendizagem interprofissional. A pesquisa, de abordagem quantitativa e de perspectiva descritivo-exploratória, coletou dados através da readiness for interprofessional learning scale, adaptada para o português do Brasil. Os resultados indicam que há disponibilidade para o trabalho em equipe e a colaboração. Também foram encontrados percentuais significativos relacionados à identidade profissional, o que indica disponibilidade para a aprendizagem interprofissional, embora aspectos relacionados à competição tenham aparecido através de percentuais menores de concordância em relação à aprendizagem compartilhada e interdependência das práticas profissionais. Para a atenção centrada no usuário também foram encontrados resultados que indicam boa disponibilidade entre os participantes; porém, aspectos relacionados à colaboração do usuário na produção dos serviços de saúde ainda expressam a tendência de uma lógica centrada nos profissionais. Conclui-se que há disponibilidade positiva para a educação interprofissional, que precisa ser cada vez mais estimulada nas políticas e estratégias de reformas curriculares.

https://doi.org/10.1590/s0104-12902023220878pt

PET-Saúde Interprofissionalidade e a disponibilidade dos estudantes para a aprendizagem interprofissional
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Marques, Juliana Ferreira Lima

; Costa, Marcelo Viana da

Saúde e Sociedade

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2023, Volume 32 Suppl. 2 elocation e220878pt

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

https://doi.org/10.1590/s0104-12902023220878pt

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19
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Barbosa, Hannah Cardoso

; Martins, Maria Auxiliadora Parreiras

; Jesus, Jordana Cristina de

; Meira, Karina Cardoso

; Passaglia, Luiz Guilherme

; Sacioto, Manuela Furtado

; Bezerra, Adriana Falangola Benjamin

; Schwarzbold, Alexandre Vargas

; Maurílio, Amanda de Oliveira

; Farace, Barbara Lopes

; Silva, Carla Thais Cândida Alves da

; Cimini, Christiane Corrêa Rodrigues

; Silveira, Daniel Vitorio

; Carazai, Daniela do Reis

; Ponce, Daniela

; Costa, Emanuel Victor Alves

; Manenti, Euler Roberto Fernandes

; Cenci, Evelin Paola de Almeida

; Bartolazzi, Frederico

; Madeira, Glícia Cristina de Castro

; Nascimento, Guilherme Fagundes

; Velloso, Isabela Vasconcellos Pires

; Batista, Joanna d’Arc Lyra

; Morais, Júlia Drumond Parreiras de

; Carvalho, Juliana da Silva Nogueira

; Ruschel, Karen Brasil

; Martins, Karina Paula Medeiros Prado

; Zandoná, Liege Barella

; Menezes, Luanna Silva Monteiro

; Kopittke, Luciane

; Castro, Luís César de

; Nasi, Luiz Antônio

; Floriani, Maiara Anschau

; Souza, Maíra Dias

; Carneiro, Marcelo

; Bicalho, Maria Aparecida Camargos

; Lima, Maria Clara Pontello Barbosa

; Godoy, Mariana Frizzo de

; Guimarães-Júnior, Milton Henriques

; Mendes, Paulo Mascarenhas

; Delfino-Pereira, Polianna

; Ribeiro, Raquel Jaqueline Eder

; Finger, Renan Goulart

; Menezes, Rochele Mosmann

; Francisco, Saionara Cristina

; Araújo, Silvia Ferreira

; Oliveira, Talita Fischer

; Oliveira, Thainara Conceição de

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20220151

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

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

https://doi.org/10.36660/abc.20220151

Distribution of nutrients and chlorophyll across an equatorial reef region: Insights on coastal gradients
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Barroso, Hortência de Sousa

; Lima, Isabelle de Oliveira

; Bezerra, Antonia Diana Alves

; Garcia, Tatiane Martins

; Tavares, Tallita Cruz Lopes

; Alves, Ravena Santiago

; Souza Junior, Edmilson Ferreira de

; Teixeira, Carlos Eduardo Peres

; Viana, Michael Barbosa

; Soares, Marcelo O.

Ocean and Coastal Research

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2023, Volume 71 Suppl. 2 elocation e23002

Abstract: En | Text: En | PDF: En

Abstract We evaluate how the concentrations of inorganic nutrients and chlorophyll a vary in a heterogeneous area (Equatorial SW Atlantic), covering a gradient from stations closer to the coast to others more distant associated or not with turbid-zone reefs. Vertical temperature (27.9 ± 0.10 °C; mean ± standard deviation) and salinity (36.2 ± 0.14) profles showed that the water column is well mixed (0-30 m depth). The oligotrophic condition was marked by low concentrations of phosphate (0.30 ± 0.22 µM) and dissolved inorganic nitrogen (0.64 ± 0.74 µM). Moreover, dissolved reactive silicon (DSi) was low in most samples (< 2.0 µM), but higher (>10 µM) in nearshore stations, probably related to continental runoff and/or resuspension of the bottom sediments. The pelagic phytoplankton biomass indicated that chlorophyll a (0.25 ± 0.08 µg L-1) was low, positively correlated with light and negatively correlated with nutrients, indicating possible phytoplankton uptake. Chlorophyll a concentrations were lower in stations closer to the coast and higher in some stations near the reefs, indicating that the latter could be more prone to phytoplankton development and depletion of nutrients, especially DSi. Therefore, although oligotrophy is present along this coast, we found some unexpected heterogeneity of nutrient and chlorophyll a distributions, which were probably infuenced by benthic-pelagic coupling due to the presence of extensive reefs, sponge gardens (18-30 m depth), and the proximity to the coast. These results highlight the importance of understanding the heterogeneity of ocean productivity, especially in lesser known low-latitude areas, which showed distinct nutrient and chlorophyll a levels related to the occurrence of tropical reefs that are capable of supporting important fsh stocks and unique biological communities.

https://doi.org/10.1590/2675-2824071.22016hdsb

Estimating soil erodibility in areas under natural and anthropped environments in the southern region of Amazonas State
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Hassane, Abdul Luís

; Campos, Milton César Costa

; Santos, Luís Antonio Coutrim dos

; Silva, Douglas Marcelo Pinheiro da

; Santos, Robson Vinício dos

; Cunha, José Maurício da

; Brito, Wildson Benedito Mendes

; Lima, Alan Ferreira Leite de

; Brito Filho, Elilson Gomes de

; Oliveira, Flávio Pereira de

Bragantia

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2023, Volume 82 elocation e20230042

Abstract: En | Text: En | PDF: En

ABSTRACT Amazonian soils have been suffering severe changes resulting from human activities in the region, causing significant changes in soil attributes that can contribute to greater susceptibility to erosion processes. Therefore, the present work aimed to estimate the erodibility in natural and anthropic environments in the southern region of the Amazon. Eight areas in the region were selected, including areas of native forest, savannah, cerradão, pasture and reforestation, delimiting 32 sampling points per area, with collections at a depth of 0.00-0.20 m, totaling 256 samples. Next, texture analysis and quantification of soil organic carbon were performed, and then erodibility was estimated by indirect prediction methods, Tukey’s test, Pearson’s correlation and factorial analysis of principal components. According to the results obtained, it was observed that the evaluated areas of native forest 1 and 2, cerradão and pasture present high susceptibility to erosion in relation to the cerrado, reforestation with genipap, teak and mixed areas. Therefore, it was noted that the high level of erodibility is associated with a greater predominance of sand fraction, K factor, Ki Kr and low clay content, as well as with the management employed in the areas.

https://doi.org/10.1590/1678-4499.20230042

Additives and storage time for silage of pineapple crop waste
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Freitas, Roberta Santos de

; Guim, Adriana

; Mello, Alexandre Carneiro Leão de

; Ferreira, Marcelo de Andrade

; Clemente, João Vitor Fernandes

; Silva, Salmo Olegário Lima da

; Farias, Lucas Lemos de

; Medeiros, Rodrigo Barbosa de

; Silva, Tomás Guilherme Pereira da

; Silva, Pedro Henrique Ferreira da

Pesquisa Agropecuária Brasileira

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2023, Volume 58 elocation e03211

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

Abstract The objective of this work was to evaluate the effects of additives and storage time on the quality and aerobic deterioration of silages of pineapple crop waste. A completely randomized design was used, in a 3×3 factorial arrangement, with three treatments: pineapple waste silage without additives or with the addition of cornmeal or wheat bran (20% fresh matter) at three storage times (60, 90, and 120 days). After each storage time, losses and aerobic deterioration were quantified, chemical composition was analyzed, and digestibility assays were performed. The storage time of 120 days resulted in higher dry matter losses in all treatments. The additives incremented the dry matter contents of the pineapple-based silages, which went from 182.1 g kg−1 (control silage) to 298.7 and 297.6 g kg−1 (cornmeal and wheat bran, respectively). The control silage with the addition of cornmeal showed the highest dry matter digestibility (739.7 g kg−1) and lowest neutral detergent fiber content (251.9 g kg−1). The production of CO2 started to increase on the first day of air exposure in silages without additives, but only after six days in those with additives. Including cornmeal as an additive in the silage of pineapple crop waste improves its digestibility and reduces its deterioration speed.

Resumo O objetivo deste trabalho foi avaliar os efeitos de aditivos e tempos de armazenamento sobre a qualidade e a deterioração aeróbia de silagens de resíduos de cultura do abacaxi. Utilizou-se um delineamento inteiramente casualizado, em arranjo fatorial 3×3, com três tratamentos: silagem de resíduos culturais de abacaxi sem aditivo ou aditivada com fubá de milho ou farelo de trigo (20% da matéria fresca), em três tempos de armazenamento (60, 90 e 120 dias). Após cada tempo de armazenamento, realizaram-se quantificações de perdas e deterioração aeróbia, análises da composição química e ensaios de digestibilidade. O tempo de armazenamento por 120 dias resultou em maiores perdas de matéria seca em todos os tratamentos. Os aditivos incrementaram os teores de matéria seca das silagens à base de abacaxi, que passaram de 182,1 g kg−1 (silagem controle) para 298,7 e 297,6 g kg−1 (fubá de milho e farelo de trigo, respectivamente). A silagem controle adicionada de fubá de milho apresentou maior digestibilidade da matéria seca (739,7 g kg−1) e menor teor de fibra em detergente neutro (251,9 g kg−1). A produção de CO2 aumentou a partir do primeiro dia de exposição ao ar nas silagens não aditivadas, mas apenas a partir do sexto dia nas aditivadas. A inclusão do fubá de milho como aditivo na silagem de resíduos de abacaxi melhora sua digestibilidade e reduz sua velocidade de deterioração.

https://doi.org/10.1590/s1678-3921.pab2023.v58.03211

ICD indication in hypertrophic cardiomyopathy: which algorithm to use?
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Santos-Veloso, Marcelo Antônio Oliveira

; Chaves, Ândrea Virgínia Ferreira

; Calado, Eveline Barros

; Markman, Manuel

; Bezerra, Lucas Soares

; Lima, Sandro Gonçalves de

; Markman Filho, Brivaldo

; Oliveira, Dinaldo Cavalcanti de

Revista da Associação Médica Brasileira

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aug 2022, Volume 68 N. 8 Pages 1059 - 1063

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: This study aimed to evaluate the agreement in the indication of implantable cardioverter-defibrillators in patients with Hypertrophic cardiomyopathy, as per the 2014 European Society of Cardiology and 2020 American Heart Association recommendations, and evaluate fragmented QRS as a predictor of cardiovascular outcome. METHODS: Retrospective cohort with 81 patients was evaluated between 2019 and 2021. Patients with hypertrophic cardiomyopathy ≥16 years old were included. Exclusion criteria include secondary myocardiopathy and follow-up <1 year. Kappa coefficient was used to determine the agreement. Survival and incidence curves were determined by Kaplan-Meier method. A p<0.05 was considered significant. RESULTS: The fragmented QRS was identified in 44.4% of patients. There were no differences between patients with and without fragmented QRS regarding clinical parameters, echocardiography, fibrosis, and sudden cardiac death risk. During follow-up of 4.8±3.4 years, there was no sudden cardiac death, but 20.6% patients with implantable cardioverter-defibrillator had at least one appropriate shock. Three of the seven appropriate shocks occurred in European Society of Cardiology low- to moderate-risk patients. Three shocks occurred in moderate-risk patients and four in American Heart Association high-risk patients. Overall recommendations agreement was 64% with a kappa of 0.270 (p=0.007). C-statistic showed no differences regarding the incidence of appropriate shock (p=0.644). CONCLUSION: sudden cardiac death risk stratification algorithms present discrepancies in implantable cardioverter-defibrillator indication, both with low accuracy.

https://doi.org/10.1590/1806-9282.20220199

Analysis of the time series of pertussis in Brazil from 2010 to 2019
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Silva, Luís Roberto da

; Ferreira, Ricardo José

; Arruda, Laís Eduarda Silva de

; Vasconcelos, Alan Dias de

; Freitas, Marcelo Victor de Arruda

; Santos, Isadora Sabrina Ferreira dos

; Silva, José Thiago de Lima

; Silva, Maria Graziele Gonçalves

; Teixeira, Camila Maria Barros

; Lira, Guilherme

; Oliveira, Emília Carolle Azevedo de

Revista Brasileira de Saúde Materno Infantil

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jul 2022, Volume 22 N. 3 Pages 537 - 547

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

Resumo Objetivos: analisar uma década do comportamento espaço-temporal da coqueluche no Brasil e as suas características epidemiológicas. Métodos: estudo ecológico de série temporal dos casos e óbitos por coqueluche do Sistema de Informação de Agravos de Notificação no Brasil (2010-2019). Utilizou-se o método de análise linear generalizada de Prais-Winsten e a análise de Kernel. Resultados: notificaram-se 32.849 casos, desses 466 (1,42%) evoluíram para óbito, com prevalência de 1,63/100.000 habitantes e coeficiente de mortalidade de 0,023/100.000 habitantes. Na análise temporal, evidenciou-se o comportamento cíclico da coqueluche com variações de tendência no período em 2014. A maioria dos casos ocorreu em menores de 1 ano (60,16%, p<0,01), sexo feminino (55,28%, p=0,066) e brancos (48,42%, p=0,14). A maior parcela dos óbitos foi em crianças <1 ano (98,07, p<0,01), sexo feminino (56,01%, p=0,066) e brancos (43,78%, p=0,14). No Kernel da prevalência, destacaram-se as regiões Sul, Sudeste e Nordeste com alta densidade; enquanto para mortalidade, sobressaíram-se Sudeste e Nordeste. Conclusão: observou-se o comportamento cíclico da coqueluche, com tendência de decréscimo nos últimos anos e a concentração de casos no público infantil. O que reforça a importância de fortalecer o processo de imunização da população.

Abstract Objectives: to analyze a decade of spatio-temporal behavior of pertussis in Brazil and its epidemiological characteristics. Methods: ecological time series study of pertussis cases and deaths from the Notifable Diseases Information System in Brazil (2010-2019). The method of generalized linear analysis of Prais-Winsten and the Kernel analysis were used. Results: 32,849 cases were reported, of which 466 (1.42%) evolved to death, with a prevalence of 1.63/100,000 inhabitants and a mortality rate of 0.023/100,000 inhabitants. In the temporal analysis, the cyclical behavior of pertussis was evidenced, with trend variations in the period in 2014. Most cases occurred in children under 1 year of age (60.16%, p<0.01), sex female (55.28%, p=0.066) and white (48.42%, p=0.14). The largest share of deaths was in children aged <1 year (98.07, p<0.01), females (56.01%, p=0.066) and whites (43.78%, p=0.14). In the Kernel of prevalence, the South, Southeast and Northeast regions stood out with high density; while for mortality, the Southeast and Northeast stood out. Conclusions: the cyclical behavior of pertussis was observed, with a decreasing trend in recent years and the concentration of cases in children. This reinforces the importance of strengthening the population’s immunization process.

https://doi.org/10.1590/1806-9304202200030006

10.

Evaluation of cerebral hemodynamics by transcranial Doppler ultrasonography and its correlation with intracranial pressure in an animal model of intracranial hypertension
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SOARES, Matheus Schmidt

; ANDRADE, Almir Ferreira de

; BRASIL, Sérgio

; DE-LIMA-OLIVEIRA, Marcelo

; BELON, Alessandro Rodrigo

; BOR-SENG-SHU, Edson

; NOGUEIRA, Ricardo de Carvalho

; GODOY, Daniel Agustin

; PAIVA, Wellingson Silva

Arquivos de Neuro-Psiquiatria

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apr 2022, Volume 80 N. 4 Pages 344 - 352

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

RESUMO Antecedentes: O Doppler transcraniano (DTC) é uma técnica não invasiva para a avaliação da hemodinâmica cerebral, porém existem controvérsias na literatura sobre sua aplicabilidade preditiva em situações de elevada pressão intracraniana (PIC). Objetivo: Investigar o fluxo sanguíneo cerebral pelo DTC e correlacioná-lo com as variações da PIC na fase aguda da hipertensão intracraniana em modelo animal. Métodos: Dois grupos de animais (suínos) foram submetidos a hipertensão intracraniana secundária à indução de diferentes volumes de hematoma, por meio da insuflação de balão intracraniano controlado com 4 e 7 mL de solução salina fisiológica (grupos A e B, respectivamente). Em seguida, administrou-se infusão venosa de solução salina hipertônica (SSH 3%). Foram coletados os valores dos parâmetros de PIC e DTC (velocidade sistólica [FVs], diastólica [FVd] e média [FVm] do fluxo sanguíneo cerebral), bem como o índice de pulsatilidade (IP). Comparações entre os parâmetros do DTC e o monitoramento da PIC foram realizadas. Resultados: Vinte porcos foram estudados, dez no grupo A e dez no grupo B. Correlação significativa entre IP e PIC foi obtida, principalmente logo após a elevação abrupta da PIC. Não houve correlação entre PIC e FVs, FVd ou FVm separadamente. Também não houve alteração significativa na PIC após a infusão de SSH. Conclusões: Esses resultados demonstram o potencial do IP como um bom parâmetro para a avaliação de pacientes com suspeita de elevação da PIC.

ABSTRACT Background: Transcranial Doppler has been tested in the evaluation of cerebral hemodynamics as a non-invasive assessment of intracranial pressure (ICP), but there is controversy in the literature about its actual benefit and usefulness in this situation. Objective: To investigate cerebral blood flow assessed by Doppler technique and correlate with the variations of the ICP in the acute phase of intracranial hypertension in an animal model. Methods: An experimental animal model of intracranial hypertension was used. The experiment consisted of two groups of animals in which intracranial balloons were implanted and inflated with 4 mL (A) and 7 mL (B) for controlled simulation of different volumes of hematoma. The values of ICP and Doppler parameters (systolic [FVs], diastolic [FVd], and mean [FVm] cerebral blood flow velocities and pulsatility index [PI]) were collected during the entire procedure (before and during hematoma simulations and venous hypertonic saline infusion intervention). Comparisons between Doppler parameters and ICP monitoring were performed. Results: Twenty pigs were studied, 10 in group A and 10 in group B. A significant correlation between PI and ICP was obtained, especially shortly after abrupt elevation of ICP. There was no correlation between ICP and FVs, FVd or FVm separately. There was also no significant change in ICP after intravenous infusion of hypertonic saline solution. Conclusions: These results demonstrate the potential of PI as a parameter for the evaluation of patients with suspected ICP elevation.

https://doi.org/10.1590/0004-282x-anp-2020-0591

11.

Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case–control study
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Braga, Fernanda Nogueira Holanda Ferreira

; Medeiros, Marta Maria das Chagas

; Viana Junior, Antonio Brazil

; Lima, Matheus Eugênio de Sousa

; Barros, Levi Coelho Maia

; Pontes, Marcelo Ximenes

; Lima, Allysson Wosley de Sousa

; Fernandes, Paula Frassinetti Castelo Branco Camurça

Advances in Rheumatology

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2022, Volume 62 elocation 2

Abstract: En | Text: En | PDF: En

Abstract Background: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10–25% of patients progressing to end-stage renal disease (ESRD). Objective: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. Methods: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. Results: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). Conclusions: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.

https://doi.org/10.1186/s42358-021-00232-1

12.

Molecular characterization of nontuberculous Mycobacteria in a tuberculosis and HIV reference unit in the State of Amazonas, Brazil
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Lima, Ana Carolina de Oliveira de

; Schmid, Karen Barros

; Melo, Hilda Ferreira de

; Athayde, Rafaella Christine

; Monte, Rossiclea Lins

; Almeida, Isabela Neves de

; Miranda, Silvana Spíndola de

; Kritski, Afrânio

; Rossetti, Maria Lucia

; Cordeiros-Santos, Marcelo

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0613-2021

Abstract: En | Text: En | PDF: En

ABSTRACT Background: In recent years, the prevalence of nontuberculous mycobacterial (NTM) infections has increased in different regions of the world. The American Thoracic Society (ATS) recommends standardized identification criteria, reinforcing the need for faster and less complicated clinical and laboratory techniques. Methods: In this retrospective study, NTM species isolated from pulmonary, extrapulmonary, and disseminated samples from patients treated at a TB/HIV reference unit in the State of Amazonas from 2011 to 2014 were identified through a combination of molecular techniques. Results: To identify the molecular technique, 50 cryopreserved NTM cultures were recovered and subcultivated in culture medium. The potentially pathogenic NTM species identified were M. avium, M. intracellulare, M. kansasii, M. chelonae, M. abscessus, M. fortuitum, and M. peregrinum. Results of GenoType® showed moderate agreement with those of genomic sequencing (kappa = 0.60), whereas the results obtained by the PRA-hsp65 technique disagreed with the results obtained by sequencing (kappa = 0.49). Conclusions: Our findings highlight that GenoType CM is a good method for the identification of NTM, as well as the need for the application of standardized criteria, such as those set forth by the ATS.

https://doi.org/10.1590/0037-8682-0613-2021

13.

O esporte como auxílio à educação: análise do Projeto Vilas Olímpicas e Escolas (VIES)
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Melo, Leonardo Bernardes Silva de

; Rocha, Hugo Paula Almeida da

; Ribeiro, Leonardo Gonçalves

; Souza, Marcel Lima Lessa de

; Silva, José Edmilson da

; Lima, Michel Leonardo Ferreira de

; Leite, Marcelo Bittencourt

; Soares, Antonio Jorge Gonçalves

Revista Brasileira de Ciências do Esporte

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2022, Volume 44 elocation e20220074

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

RESUMO O objetivo do artigo foi diagnosticar o rendimento acadêmico dos estudantes da Rede Pública Municipal, que participaram do Projeto Vilas Olímpicas e Escolas (VIES). A amostra foi composta por 1.118 alunos (474 meninas e 644 meninos do Ensino Fundamental), de 30 escolas participantes do VIES. Analisamos as informações dos relatórios mensais das Organizações Sociais responsáveis pelos contratados de gestão das Vilas Olímpicas, com os indicadores de rendimento escolar do público-alvo. Comparamos os rendimentos bimestrais entre alunos VIES e não VIES de toda Rede de Ensino Público Municipal. Uma análise preliminar constatou que os alunos acompanhados pelo VIES apresentaram rendimento escolar médio superior ao grupo que não realizava atividades sistemáticas nas Vilas Olímpicas.

ABSTRACT This article aims to diagnose the academic performance of students from municipal public schools who participated in the Vilas Olímpicas e Escolas Project (VIES). The sample consisted of 1,118 students from 30 schools participating in the VIES. We analyzed the information in the monthly reports of the social organizations responsible for the management contractors of Vilas Olímpicas and cross-referenced it with the school performance indicators. We compared the bimonthly academic performance between the VIES and non-VIES students from the entire municipal network. The preliminary analysis found that the students monitored by the VIES had a higher average school performance than the group that did not perform systematic activities in the sports center of the city of Rio de Janeiro.

RESUMEN El objetivo del artículo fue diagnosticar el rendimiento académico de los estudiantes del sistema escolar público municipal que participaron en el Proyecto Villas Olímpicas y Escuelas (VIES). La muestra estuvo conformada por 1118 estudiantes de 30 escuelas participantes del VIES. Analizamos los informes mensuales elaborados por la dirección de las Villas Olímpicas y los indicadores de rendimiento de los estudiantes. Comparamos el rendimiento escolar de los estudiantes participantes de VIES con aquellos que no participaron y estaban matriculados en el sistema escolar público municipal. El análisis constató que los estudiantes monitoreados por el VIES tuvieron un rendimiento escolar promedio superior a los demás estudiantes del sistema público municipal.

https://doi.org/10.1590/rbce.44.e20220074

14.

THE EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION IN ASSOCIATION WITH WHEY PROTEIN SUPPLEMENTATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
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MENDONÇA, GABRIELA OTÍLIA

; SEVERINO, MARIA LUIZA BIANCHINI

; OLIVEIRA, KELLE MOREIRA DE

; OLIVEIRA, MARCELO LIMA DE

; SOUZA, GIOVANE GALDINO DE

; SIMÃO, ADRIANO PRADO

; LOBATO, DANIEL FERREIRA MOREIRA

; ANDRADE, RANIELLY ALVES

; FRANCO, RICARDO ZENUN

; CRUZ, MARCELO STEGMANN DA

; CARVALHO, LEONARDO CÉSAR

Acta Ortopédica Brasileira

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dec 2021, Volume 29 N. 6 Pages 316 - 322

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

RESUMO Objetivo: Analisar os efeitos da estimulação elétrica neuromuscular do quadríceps femoral associado ou não à suplementação com whey protein na atividade eletromiográfica e distribuição de massa corporal em voluntários submetidos à reconstrução do ligamento cruzado anterior. Métodos: 24 voluntários foram divididos em três grupos: controle basal, whey protein associado com estimulação elétrica neuromuscular e estimulação elétrica neuromuscular isolada. Resultados: Na avaliação pós-operatória, durante o miniagachamento, o grupo controle basal demonstrou diminuição da atividade eletromiográfica do vasto medial (p = 0,005, olhos abertos; p = 0,003, olhos fechados), vasto lateral (p = 0,005, olhos abertos; p = 0,020, olhos fechados) e reto femoral (p = 0,075, olhos abertos; p = 0,074, olhos fechados) e da distribuição de massa corporal no membro operado (p < 0,001, olhos abertos; p < 0,001, olhos fechados) e membro lesionado (p < 0,001, olhos abertos; p < 0,001, olhos fechados). Conclusão: O uso precoce de estimulação elétrica neuromuscular do quadríceps femoral, independentemente do uso de whey protein, foi eficaz para manter a atividade eletromiográfica dos músculos vasto medial e vasto lateral, e prevenir assimetrias na distribuição de massa corporal 15 dias após a reconstrução do ligamento cruzado anterior. Nível de Evidência I, Ensaio randomizado de alta qualidade.

ABSTRACT Objective: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. Methods: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. Results: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). Conclusion: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial.

https://doi.org/10.1590/1413-785220212906237983 7 downloads

15.

Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021
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Nicolau, José Carlos

; Feitosa Filho, Gilson Soares

; Petriz, João Luiz

; Furtado, Remo Holanda de Mendonça

; Précoma, Dalton Bertolim

; Lemke, Walmor

; Lopes, Renato Delascio

; Timerman, Ari

; Marin Neto, José A.

; Bezerra Neto, Luiz

; Gomes, Bruno Ferraz de Oliveira

; Santos, Eduardo Cavalcanti Lapa

; Piegas, Leopoldo Soares

; Soeiro, Alexandre de Matos

; Negri, Alexandre Jorge de Andrade

; Franci, Andre

; Markman Filho, Brivaldo

; Baccaro, Bruno Mendonça

; Montenegro, Carlos Eduardo Lucena

; Rochitte, Carlos Eduardo

; Barbosa, Carlos José Dornas Gonçalves

; Virgens, Cláudio Marcelo Bittencourt das

; Stefanini, Edson

; Manenti, Euler Roberto Fernandes

; Lima, Felipe Gallego

; Monteiro Júnior, Francisco das Chagas

; Correa Filho, Harry

; Pena, Henrique Patrus Mundim

; Pinto, Ibraim Masciarelli Francisco

; Falcão, João Luiz de Alencar Araripe

; Sena, Joberto Pinheiro

; Peixoto, José Maria

; Souza, Juliana Ascenção de

; Silva, Leonardo Sara da

; Maia, Lilia Nigro

; Ohe, Louis Nakayama

; Baracioli, Luciano Moreira

; Dallan, Luís Alberto de Oliveira

; Dallan, Luis Augusto Palma

; Mattos, Luiz Alberto Piva e

; Bodanese, Luiz Carlos

; Ritt, Luiz Eduardo Fonteles

; Canesin, Manoel Fernandes

; Rivas, Marcelo Bueno da Silva

; Franken, Marcelo

; Magalhães, Marcos José Gomes

; Oliveira Júnior, Múcio Tavares de

; Filgueiras Filho, Nivaldo Menezes

; Dutra, Oscar Pereira

; Coelho, Otávio Rizzi

; Leães, Paulo Ernesto

; Rossi, Paulo Roberto Ferreira

; Soares, Paulo Rogério

; Lemos Neto, Pedro Alves

; Farsky, Pedro Silvio

; Cavalcanti, Rafael Rebêlo C.

; Alves, Renato Jorge

; Kalil, Renato Abdala Karam

; Esporcatte, Roberto

; Marino, Roberto Luiz

; Giraldez, Roberto Rocha Corrêa Veiga

; Meneghelo, Romeu Sérgio

; Lima, Ronaldo de Souza Leão

; Ramos, Rui Fernando

; Falcão, Sandra Nivea dos Reis Saraiva

; Dalçóquio, Talia Falcão

; Lemke, Viviana de Mello Guzzo

; Chalela, William Azem

; Mathias Júnior, Wilson

Arquivos Brasileiros de Cardiologia

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jul 2021, Volume 117 N. 1 Pages 181 - 264

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

https://doi.org/10.36660/abc.20210180 3052 downloads

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