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1.
[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio
Rassi Jr., Anis
Moraes Oliveira, Gláucia M.
Lemos Correia, Luís Claudio
Novaes Ramos Jr., Alberto
Hasslocher-Moreno, Alejandro Marcel
Luquetti Ostermayer, Alejandro
Sousa, Andréa Silvestre de
Amato Vincenzo de Paola, Angelo
Sobral de Sousa, Antonio Carlos
Pinho Ribeiro, Antonio Luiz
Correia Filho, Dalmo
Moraes de Souza, Dilma do Socorro
Cunha-Neto, Edecio
J. A. Ramires, Felix
Bacal, Fernando
Pereira Nunes, Maria do Carmo
Martinelli Filho, Martino
Ibrahim Scanavacca, Maurício
Magalhães Saraiva, Roberto
Alves de Oliveira Júnior, Wilson
M. Lorga-Filho, Adalberto
de Jesus Benevides de Almeida Guimarães, Adriana
Lopes Latado Braga, Adriana
Sarmento de Oliveira, Adriana
V. L. Sarabanda, Alvaro
Yecê das Neves Pinto, Ana
Assis Lopes do Carmo, André
Schmidt, André
Costa, Andréa Rodrigues da
Ianni, Barbara Maria
Markman Filho, Brivaldo
Eduardo Rochitte, Carlos
Thé Macedo, Carolina
Mady, Charles
Chevillard, Christophe
Bittencourt das Virgens, Cláudio Marcelo
Nery de Castro, Cleudson
De Paoli de Carvalho Britto, Constança Felícia
Pisani, Cristiano
do Carmo Rassi, Daniela
C. Sobral Filho, Dario
Rodrigues Almeida, Dirceu
A. Bocchi, Edimar
T. Mesquita, Evandro
de Souza Nogueira Sardinha Mendes, Fernanda
Pereira, Francisca Tatiana
Sperandio da Silva, Gilberto Marcelo
de Lima Peixoto, Giselle
Glotz de Lima, Gustavo
H. Veloso, Henrique
Turin Moreira, Henrique
Bellotti Lopes, Hugo
Masciarelli Francisco Pinto, Ibraim
Pinto Dias, João Carlos
Bemfica, João Marcos
Silva-Nunes, João Paulo
Soares Barreto-Filho, José Augusto
Kerr Saraiva, José Francisco
Lannes-Vieira, Joseli
Menezes Oliveira, Joselina Luzia
V. Armaganijan, Luciana
Martins, Luiz Cláudio
C. Sangenis, Luiz Henrique
Barbosa, Marco Paulo
Almeida-Santos, Marcos Antônio
Simões, Marcos Vinicius
Shikanai-Yasuda, Maria Aparecida
Vieira Moreira, Maria da Consolação
Higuchi, Maria de Lourdes
Costa Monteiro, Maria Rita de Cássia
Felix Mediano, Mauro Felippe
Maia Lima, Mayara
T. Oliveira, Maykon
Moreira Dias Romano , Minna
Nitz, Nadjar
de Tarso Jorge Medeiros, Paulo
Vieira Alves, Renato
Alkmim Teixeira, Ricardo
Coury Pedrosa, Roberto
Aras, Roque
Morais Torres, Rosália
dos Santos Povoa, Rui Manoel
Rassi, Sérgio Gabriel
Salles Xavier, Sérgio
Marinho Martins Alves , Silvia
B. N. Tavares, Suelene
Lima Palmeira, Swamy
da Silva Junior, Telêmaco Luiz
da Rocha Rodrigues, Thiago
Madrini Junior, Vagner
Maia da Costa , Veruska
Dutra, Walderez
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp;
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
nbsp;
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp;
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp;
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp;
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.
Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou.
A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica.
Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas.
A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica.
A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp;
Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;
2.
Cross-Cultural Translation into Brazilian Portuguese and Validation of the Oral Anticoagulation Knowledge Tool (AKT-Br)
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Mainka, Felipe F.
; Ferreira, Vinicius L.
; Mendes, Antonio M.
; Marques, Gustavo L.
; Correr, Cassyano J.
; Tonin, Fernanda S.
; Pontarolo, Roberto
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
ABSTRACT Introduction: Oral anticoagulants are the treatment of choice for diverse types of coagulation disorders. Warfarin is widely used by the Brazilian population, possibly due to its lower cost than other oral anticoagulants. However, it has a high risk of serious adverse effects if used incorrectly. The Anticoagulation Knowledge Tool (AKT) can assess a patient’s knowledge about her/his oral anticoagulant therapy and can assist health professionals in identifying patients with difficulties in adherence. This study aimed to translate, culturally adapt, and validate the AKT into Brazilian Portuguese. Methods: After a standard forward-backward procedure to translate the AKT into Brazilian Portuguese (AKT-Br), a version of the instrument was applied in three groups (patients, pharmacists, and the general population). The reliability of the AKT-Br was tested using an internal consistency measure and test-retest. The validity of the instrument was confirmed with data from the contrasted groups. All statistical analyses were performed with RStudio. Results: The median scores obtained with the AKT-Br were 29.0, 17.0, and 7.5 for pharmacists, patients, and the general population, respectively (maximum score of 35 points). There was moderate internal consistency for the instrument and test-retest reliability was satisfactory. Analysis of variance for validity of the groups revealed a significant relationship between the total score and the evaluated groups. Conclusion: The ATK-Br is a reliable and valid tool to assess knowledge about oral anticoagulants. AKT-Br can be used in clinical practice as an auxiliary tool to improve patient care through personalised educational interventions.
3.
Análise Multitemporal do Espelho d’água do Açude Jaburu I por Meio de Ferramentas de Sensoriamento Remoto nos Anos de 2013 a 2020
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Sousa, Ademar Almeida de
; Lira, Marcos Antônio Tavares
; de Oliveira, Ulisses Costa
; Mendes Júnior, Carlos Alberto
.
Resumo Em regiões com influência do clima semiárido é nítida a escassez hídrica, a qual é consequência, dentre outros fatores, de cenários negativos de precipitação que acarretam secas prolongadas. Tais características reverberam negativamente no desenvolvimento socioeconômico da sociedade envolvida. Nesse contexto, o armazenamento de água em açudes pode ser considerado uma alternativa estratégica importante que requer uma atenção especial em busca da mitigação do déficit hídrico nessas regiões. Dessa forma, o presente trabalho teve como objetivo realizar uma análise multitemporal do espelho d’água do Açude Jaburu, localizado nos municípios de Ubajara e Tianguá, Ceará, nos anos de 2013 a 2020. Para isto, foi aplicado o índice Normalizado por Diferença de água (NWDI), tendo sido utilizadas imagens do satélite Landsat 8, Coleção 1 Tier 1, LANDSAT/LC08/C01/T1_RT, calibrado para reflectância do Topo da Atmosfera (TOA), por meio das bandas 3 e 5, com uma resolução espacial original de 30 m. Os principais resultados mostram que os anos que apresentaram maior recuo foram 2014 e 2015 com 192,21 e 175,05 hectares de espelho d’água a menos, respectivamente. Os anos de 2018 e 2019 apresentaram expansão, com 130,86 e 295,65 hectares, respectivamente. Para avaliar os dados abordados neste trabalho em termos de correlação com a pluviosidade na área, utilizou-se o teste de correlação de Spearman, que apresentou valor de p igual a 0.9349, assumindo-se não haver relação entre a pluviometria e a área do espelho d’água. Sugerem-se estudos mais aprofundados na área para compreender quais fatores podem comprometer a disponibilidade hídrica no reservatório, bem como confirmar, por meio de séries maiores, se realmente não há correlação entre a área do espelho d’água e a quantidade de chuva na área. Por fim, verificou-se que as ferramentas de sensoriamento remoto se mostraram eficazes na análise do espelho d’água da área estudada, bem como guardam um potencial positivo para contribuir com o gerenciamento adequado dos recursos hídricos superficiais em região com clima semiárido.
Abstract In regions with the influence of the semi-arid climate, water scarcity is clear, which is a consequence, among other factors, of negative precipitation scenarios that lead to prolonged droughts. Such characteristics reverberate negatively on the socioeconomic development of the society involved. In this context, water storage in dams can be considered an important strategic alternative that requires special attention in search of mitigating the water deficit in these regions. Thus, the present work aimed to carry out a multitemporal analysis of the water mirror of Açude Jaburu, located in the municipalities of Ubajara and Tianguá, Ceará, from 2013 to 2020. For this, the Normalized Index by Difference of Water (NWDI), using images from the Landsat 8 satellite, Collection 1 Tier 1, LANDSAT/LC08/C01/T1_RT, calibrated for Top of Atmosphere (TOA) reflectance, through bands 3 and 5, with a spatial resolution original 30 m. The main results show that the years with the greatest decline were 2014 and 2015 with 192.21 and 175.05 hectares of less water. The years 2018 and 2019 showed expansion, with 130.86 and 295.65 hectares, respectively. To evaluate the data discussed in this work in terms of correlation with rainfall in the area, the Spearman correlation test was used, which presented a p-value equal to 0.9349, assuming that there is no relationship between rainfall and the area of the mirror. of water. Further studies in the area are suggested to understand which factors can compromise the water availability in the reservoir, as well as to confirm, through larger series, if there is really no correlation between the water surface area and the amount of rainfall in the area. Finally, it was found that the remote sensing tools proved to be effective in the analysis of the water surface of the studied area, as well as having a positive potential to contribute to the proper management of surface water resources in a region with a semi-arid climate.
4.
Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review
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das Neves, Maila de C.
; Teixeira, Ananda A.
; Garcia, Flávia M.
; Rennó, Joel
; da Silva, Antônio G.
; Cantilino, Amaury
; Rosa, Carlos E.
; Mendes-Ribeiro, Jeronimo de A.
; Rocha, Renan
; Lobo, Hewdy
; Gomes, Igor E.
; Ribeiro, Christiane C.
; Garcia, Frederico D.
.
Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.
5.
Performance, meat quality, and lipidemia of meat-type quails fed with diets containing essential oils
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Deminicis, Renata Gomes da Silveira
; Meneghetti, Camila
; Garcia Júnior, Antônio Amândio Pinto
; Cruz, Cristiane Leal dos Santos
; Deminicis, Bruno Borges
; Maciel, Bianca Mendes
.
RESUMO: Objetivou-se com este estudo avaliar o efeito do uso dos óleos essenciais (OLES) de Mentha piperita e Melaleuca alternifolia em codornas de corte. Para o estudo do desempenho foi utilizado o delineamento inteiramente ao acaso, com quatrotratamentos e oito repetições, sendo sete aves por repetição. Para o estudo da lipidemia utilizou-se o delineamento inteiramente casualizado em esquema fatorial: 4x2, consistindo em quatro tratamentos e duas condições de coleta, com oito repetições, sendo uma ave por repetição. As variáveis analisadas foram: ganho de peso, consumo ração, conversão alimentar, rendimento de carcaça, colesterol, HDL, triglicerídeos, pH, capacidade de retenção de água, perda de peso por cozimento, luminosidade na carne do peito de codornas. Os dados obtidos foram analisados quanto à homocedasticidade e normalidade, as médias foram submetidas à análise de variância. O uso de OLES de M. piperita e M. alternifolia na dieta de codornas de corte pode proporcionar desempenhos zootécnicos, rendimentos de carcaça e características de qualidade da carne comparáveis ao uso de antibióticos melhoradores de desempenho. A redução no nível de colesterol HDL foi notada nas aves tratadas com Bacitracina de zinco e com os OLES de M. piperita e M. alternifolia, em 8,12; 16,52 e 3,36% respectivamente. O uso da Bacitracina de zinco, da M. piperita e da M. alternifolia associado às diferentes condições de coleta não aumentaram os valores séricos de LDL, VLDL. Os coeficientes de variação aferidos na condição “após 12 horas de jejum” apresentaram-se 86% inferiores à condição “sem jejum”.
ABSTRACT: This study evaluated the effect of essential oil (ESOL) of Mentha piperita and Melaleuca alternifolia on meat-type quails. To examine performance, a completely randomized design was used, with four treatments and eight repetitions each, using seven birds per repetition. To assess lipidemia, a completely randomized design in a 4 × 2 factorial scheme was used, with four treatments and two collection conditions using eight repetitions and one bird per repetition. Weight gain, feed intake, feed conversion, carcass yield, cholesterol, high-density lipoporteins, triglycerides, pH, and brightness of quail breast meat were assessed. The data were analyzed for homoscedasticity and normality, and the means were subjected to analysis of variance. Adding M. piperita and M. alternifolia ESOL to the diets of meat-type quails can improve performance, carcass yield, and meat quality characteristics, comparable to the use of performance-enhancing antibiotics. The use of zinc bacitracin, M. piperita, and M. alternifolia under different collection conditions did not increase the serum levels of low-density and very low-density lipoproteins. The variation coefficients measured after 12 hours of fasting were 86% lower than without fasting.
6.
COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience
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Gomes, Walter J.
; Rocco, Isadora
; Pimentel, Wallace S.
; Pinheiro, Aislan H. B.
; Souza, Paulo M. S.
; Costa, Luiz A. A.
; Teixeira, Marjory M. P.
; Ohashi, Leonardo P.
; Bublitz, Caroline
; Begot, Isis
; Moreira, Rita Simone L
; Hossne Jr, Nelson A.
; Vargas, Guilherme F.
; Branco, João Nelson R.
; Teles, Carlos A.
; Medeiros, Eduardo A. S.
; Sáfadi, Camila
; Rampinelli, Amândio
; Moratelli Neto, Leopoldo
; Rosado, Anderson Rosa
; Mesacasa, Franciele Kuhn
; Capriata, Ismael Escobar
; Segalote, Rodrigo Coelho
; Palmieri, Deborah Louize da Rocha Vianna
; Jardim, Amanda Cristina Mendes
; Vianna, Diego Sarty
; Coutinho, Joaquim Henrique de Souza Aguiar
; Jazbik, João Carlos
; Coutinho, Henrique Madureira da Rocha
; Kikuta, Gustavo
; Almeida, Zely Sant'Anna Marotti de
; Feguri, Gibran Roder
; Lima, Paulo Ruiz Lucio de
; Franco, Anna Carolina
; Borges, Danilo de Cerqueira
; Cruz, Felipe Ramos Honorato De La
; Croti, Ulisses Alexandre
; Borim, Bruna Cury
; Marchi, Carlos Henrique De
; Goraieb, Lilian
; Postigo, Karolyne Barroca Sanches
; Jucá, Fabiano Gonçalves
; Oliveira, Fátima Rosane de Almeida
; Souza, Rafael Bezerra de
; Zilli, Alexandre Cabral
; Mas, Raul Gaston Sanchez
; Bettiati Junior, Luiz Carlos
; Tranchesi, Ricardo
; Bertini Jr, Ayrton
; Franco, Leandro Vieira
; Fernandes, Priscila
; Oliveira, Fabiana
; Moraes Jr, Roberto
; Araújo, Thiago Cavalcanti Vila Nova de
; Braga, Otávio Penna
; Pedrosa Sobrinho, Antônio Cavalcanti
; Teixeira, Roberta Tavares Barreto
; Camboim, Irla Lavor Lucena
; Gomes, Eduardo Nascimento
; Reis, Pedro Horigushi
; Garcia, Luara Piovan
; Scorsioni, Nelson Henrique Goes
; Lago, Roberto
; Guizilini, Solange
.
Brazilian Journal of Cardiovascular Surgery
- Journal Metrics
Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.
7.
Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de
; Hammond, Naomi
; Li, Yang
; Azevedo, Luciano Cesar Pontes de
; Cavalcanti, Alexandre Biasi
; Taniguchi, Leandro
; Gobatto, André
; Japiassú, André Miguel
; Bafi, Antonio Tonete
; Mazza, Bruno Franco
; Noritomi, Danilo Teixeira
; Dal-Pizzol, Felipe
; Bozza, Fernando
; Salluh, Jorge Ibrahin Figueira
; Westphal, Glauco Adrieno
; Soares, Márcio
; Assunção, Murillo Santucci César de
; Lisboa, Thiago
; Lobo, Suzana Margarete Ajeje
; Barbosa, Achilles Rohlfs
; Ventura, Adriana Fonseca
; Souza, Ailson Faria de
; Silva, Alexandre Francisco
; Toledo, Alexandre
; Reis, Aline
; Cembranel, Allan
; Rea Neto, Alvaro
; Gut, Ana Lúcia
; Justo, Ana Patricia Pierre
; Santos, Ana Paula
; Albuquerque, André Campos D. de
; Scazufka, André
; Rodrigues, Antonio Babo
; Fernandino, Bruno Bonaccorsi
; Silva, Bruno Goncalves
; Vidal, Bruno Sarno
; Pinheiro, Bruno Valle
; Pinto, Bruno Vilela Costa
; Feijo, Carlos Augusto Ramos
; Abreu Filho, Carlos de
; Bosso, Carlos Eduardo da Costa Nunes
; Moreira, Carlos Eduardo Nassif
; Ramos, Carlos Henrique Ferreira
; Tavares, Carmen
; Arantes, Cidamaiá
; Grion, Cintia
; Mendes, Ciro Leite
; Kmohan, Claudio
; Piras, Claudio
; Castro, Cristine Pilati Pileggi
; Lins, Cyntia
; Beraldo, Daniel
; Fontes, Daniel
; Boni, Daniela
; Castiglioni, Débora
; Paisani, Denise de Moraes
; Pedroso, Durval Ferreira Fonseca
; Mattos, Ederson Roberto
; Brito Sobrinho, Edgar de
; Troncoso, Edgar M. V.
; Rodrigues Filho, Edison Moraes
; Nogueira, Eduardo Enrico Ferrari
; Ferreira, Eduardo Leme
; Pacheco, Eduardo Souza
; Jodar, Euzebio
; Ferreira, Evandro L. A.
; Araujo, Fabiana Fernandes de
; Trevisol, Fabiana Schuelter
; Amorim, Fábio Ferreira
; Giannini, Fabio Poianas
; Santos, Fabrício Primitivo Matos
; Buarque, Fátima
; Lima, Felipe Gallego
; Costa, Fernando Antonio Alvares da
; Sad, Fernando Cesar dos Anjos
; Aranha, Fernando G.
; Ganem, Fernando
; Callil, Flavio
; Costa Filho, Francisco Flávio
; Dall´Arto, Frederico Toledo Campo
; Moreno, Geovani
; Friedman, Gilberto
; Moralez, Giulliana Martines
; Silva, Guilherme Abdalla da
; Costa, Guilherme
; Cavalcanti, Guilherme Silva
; Cavalcanti, Guilherme Silva
; Betônico, Gustavo Navarro
; Betônico, Gustavo Navarro
; Reis, Hélder
; Araujo, Helia Beatriz N.
; Hortiz Júnior, Helio Anjos
; Guimaraes, Helio Penna
; Urbano, Hugo
; Maia, Israel
; Santiago Filho, Ivan Lopes
; Farhat Júnior, Jamil
; Alvarez, Janu Rangel
; Passos, Joel Tavares
; Paranhos, Jorge Eduardo da Rocha
; Marques, José Aurelio
; Moreira Filho, José Gonçalves
; Andrade, Jose Neto
; Sobrinho, José Onofre de C
; Bezerra, Jose Terceiro de Paiva
; Alves, Juliana Apolônio
; Ferreira, Juliana
; Gomes, Jussara
; Sato, Karina Midori
; Gerent, Karine
; Teixeira, Kathia Margarida Costa
; Conde, Katia Aparecida Pessoa
; Martins, Laércia Ferreira
; Figueirêdo, Lanese
; Rezegue, Leila
; Tcherniacovsk, Leonardo
; Ferraz, Leone Oliveira
; Cavalcante, Liane
; Rabelo, Ligia
; Miilher, Lilian
; Garcia, Lisiane
; Tannous, Luana
; Hajjar, Ludhmila Abrahão
; Paciência, Luís Eduardo Miranda
; Cruz Neto, Luiz Monteiro da
; Bley, Macia Valeria
; Sousa, Marcelo Ferreira
; Puga, Marcelo Lourencini
; Romano, Marcelo Luz Pereira
; Nobrega, Marciano
; Arbex, Marcio
; Rodrigues, Márcio Leite
; Guerreiro, Márcio Osório
; Rocha, Marcone
; Alves, Maria Angela Pangoni
; Alves, Maria Angela Pangoni
; Rosa, Maria Doroti
; Dias, Mariza D’Agostino
; Martins, Miquéias
; Oliveira, Mirella de
; Moretti, Miriane Melo Silveira
; Matsui, Mirna
; Messender, Octavio
; Santarém, Orlando Luís de Andrade
; Silveira, Patricio Júnior Henrique da
; Vassallo, Paula Frizera
; Antoniazzi, Paulo
; Gottardo, Paulo César
; Correia, Paulo
; Ferreira, Paulo
; Torres, Paulo
; Silva, Pedro Gabrile M. de Barros e
; Foernges, Rafael
; Gomes, Rafael
; Moraes, Rafael
; Nonato filho, Raimundo
; Borba, Renato Luis
; Gomes, Renato V
; Cordioli, Ricardo
; Lima, Ricardo
; López, Ricardo Pérez
; Gargioni, Ricardo Rath de Oliveira
; Rosenblat, Richard
; Souza, Roberta Machado de
; Almeida, Roberto
; Narciso, Roberto Camargo
; Marco, Roberto
; waltrick, Roberto
; Biondi, Rodrigo
; Figueiredo, Rodrigo
; Dutra, Rodrigo Santana
; Batista, Roseane
; Felipe, Rouge
; Franco, Rubens Sergio da Silva
; Houly, Sandra
; Faria, Sara Socorro
; Pinto, Sergio Felix
; Luzzi, Sergio
; Sant’ana, Sergio
; Fernandes, Sergio Sonego
; Yamada, Sérgio
; Zajac, Sérgio
; Vaz, Sidiner Mesquita
; Bezerra, Silvia Aparecida Bezerra
; Farhat, Tatiana Bueno Tardivo
; Santos, Thiago Martins
; Smith, Tiago
; Silva, Ulysses V. A.
; Damasceno, Valnei Bento
; Nobre, Vandack
; Dantas, Vicente Cés de Souza
; Irineu, Vivian Menezes
; Bogado, Viviane
; Nedel, Wagner
; Campos Filho, Walther
; Dantas, Weidson
; Viana, William
; Oliveira Filho, Wilson de
; Delgadinho, Wilson Martins
; Finfer, Simon
; Machado, Flavia Ribeiro
.
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.
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.
https://doi.org/10.5935/0103-507x.20210028
273 downloads
8.
Distribution of Meloidogyne species in carrot in Brazil
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Cunha, Tiago Garcia da
; Visôtto, Liliane Evangelista
; Pinheiro, Letícia Mendes
; God, Pedro Ivo Vieira Good
; Rosa, Juliana Magrinelli Osório
; Oliveira, Cláudio Marcelo Gonçalves
; Lopes, Everaldo Antônio
.
RESUMO: Os nematoides-das-galhas (RKN - Meloidogyne spp.) são uma das mais sérias ameaças à produção de cenoura no mundo. No Brasil, as cenouras são cultivadas ao longo do ano, e as perdas econômicas devido à RKN são frequentemente relatadas. Como pouco se sabe sobre a distribuição de espécies RKN em campos de cenoura no Brasil, coletamos amostras de plantas e solo de 35 campos em seis estados. Baseado na morfologia do padrão perineal, fenótipos de esterase e/ou PCR espécie-específica, três espécies de Meloidogyne foram identificadas: 60% dos campos estavam infestados por Meloidogyne incognita, M. javanica foi encontrada em 42,9% das áreas, enquanto M. hapla foi detectada em 17,1% dos campos de cenoura. Populações mistas foram encontradas em 20% das áreas, com predominância de M. incognita + M. javanica. A combinação de técnicas morfológicas, bioquímicas e moleculares é uma abordagem útil para identificar espécies de RKN.
ABSTRACT: Root-knot nematodes (RKN - Meloidogyne spp.) are one of the most serious threats to carrot production worldwide. In Brazil, carrots are grown throughout the year, and economic losses due to RKN are reported. Since little is known on the distribution of RKN species in carrot fields in Brazil, we collected plant and soil samples from 35 fields across six states. Based on the morphology of perineal patterns, esterase phenotypes and species-specific PCR, three Meloidogyne species were identified: 60% of the fields were infested with Meloidogyne incognita, M. javanica was reported in 42.9% of the areas, whereas M. hapla was detected in 17.1% of carrot fields. Mixed populations were reported in 20% of the areas with a predominance of M. incognita + M. javanica. The combination of morphological, biochemical, and molecular techniques is a useful approach to identify RKN species.
https://doi.org/10.1590/0103-8478cr20200552
508 downloads
9.
Expression of NLRP3 inflammasome in leprosy indicates immune evasion of Mycobacterium leprae
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Mendes, Ana Luisa Gomes
; Joaquim, Heloísa Di Matteo
; Zamae, Mara Inês Stefanini
; Assis, Ramon Meira
; Peixoto, Jéssica Renata de Moura
; de Araújo, Margarida Maria Gomes
; Guedes, Antônio Carlos Martins
; Oliveira, Edward José
; Magalhães, Vanessa Peruhype
; Pascoal-Xavier, Marcelo Antônio
.
BACKGROUND Leprosy is an infectious-contagious disease caused by Mycobacterium leprae that remain endemic in 105 countries. This neglected disease has a wide range of clinical and histopathological manifestations that are related to the host inflammatory and immune responses. More recently, the inflammasome has assumed a relevant role in the inflammatory response against microbiological agents. However, the involvement of inflammasome in leprosy remains poorly understood. OBJECTIVES The aim is to associate biomarkers of inflammasome with the different immunopathological forms of leprosy. METHODS We performed an observational, cross-sectional, and comparative study of the immunophenotypic expression of inflammasome-associated proteins in immunopathological forms of leprosy of 99 skin lesion samples by immunohistochemistry. The intensity and percentage of NLRP3, Caspase-1, Caspases-4/5, interleukin-1β and interleukin-18 immunoreactivities in the inflammatory infiltrate of skin biopsies were evaluated. FINDINGS Strong expression of NLRP3 and inflammatory Caspases-4/5 were observed in lepromatous leprosy (lepromatous pole). In addition, were observed low expression of caspase-1, interleukin-1β, and interleukin-18 in tuberculoid and lepromatous leprosy. The interpolar or borderline form showed immunophenotype predominantly similar to the lepromatous pole. MAIN CONCLUSIONS Our results demonstrate that the NLRP3 inflammasome is inactive in leprosy, suggesting immune evasion of M. leprae.
https://doi.org/10.1590/0074-02760190324
1043 downloads
10.
SÍNTESE E AVALIAÇÃO DAS ATIVIDADES FOTOPROTETORA, CITOTÓXICA E ANTIVIRAL CONTRA O ZIKA VÍRUS DE DERIVADOS TRIAZÓLICOS DA BENZOFENONA
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Lima, Ângela M. A.
; Teixeira, Róbson R.
; Silva, Bianca F. da
; Siqueira, Raoni P.
; Silva, Ítalo E. P. da
; Santos, Edjon G.
; Fernandes, Maria Cecília
; Gonçalves, Victor Hugo Sousa
; Bressan, Gustavo C.
; Mendes, Tiago Antonio de Oliveira
; Paula, Sérgio O. de
; Costa, Adílson Vidal
; Santos, Marcelo H. dos
.
The benzophenones are synthetic and natural compounds presenting a variety of activities, including photoprotective, cytotoxic and antiviral. It is herein described the preparation of a series of twenty-seven benzophenone derivatives bearing 1,2,3-triazole functionalities and the evaluation of their photoprotective, cytotoxic and antiviral on Zika Virus (ZIKV) activities. The compounds were prepared in three steps, namely reduction of benzophenone, alkylation of diphenylmethanol and CuAAC reactions. The in vitro evaluation of the photoprotective activity revealed that the most active derivative 4-((benzhydryloxy)methyl)-1-(4-nitrobenzyl)-1H-1,2,3-triazole (4k) displayed UVB sun protection factor equal to 6,9±0,53, which make this compound a possible candidate to be used in formulations for photoprotective applications. In terms of cytotoxicity, the compounds were evaluated against MDA-MB-231 and B16F10 cell lines. It was observed that the compounds were more active against MDA-MB-231 cells and three of them were capable of reducing cell viability by approximately 55% at 100 µmol L-1. In the antiviral screening against ZIKV, compound 4-(3-benzhydryloxy)propyl)-1-(3-methylbenzyl)-1H-1,2,3-triazole (5j) was the most effective in mantaining Vero cell viability.
https://doi.org/10.21577/0100-4042.20170365
1170 downloads
11.
Pharmacotherapy problems in cardiology patients 30 days post discharge from a tertiary hospital in Brazil: a randomized controlled trial
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Bonetti, Aline F.
; Bagatim, Bruna Q.
; Bottacin, Wallace Entringer
; Mendes, Antonio M.
; Rotta, Inajara
; Reis, Renata C.
; Fávero, Maria Luiza D.
; Fernandez-Llimos, Fernando
; Pontarolo, Roberto
.
OBJECTIVES: This is a randomized controlled trial that aims to evaluate the impact of pharmacist-led discharge counseling on reducing pharmacotherapy problems in the 30-day postdischarge period of cardiology patients from a tertiary hospital in Brazil. METHODS: At discharge, two cardiovascular pharmacy residents performed a medication counseling session with the intervention group, and the follow-up was performed by telephone (3 and 15 days after discharge). The number of pharmacotherapy problems was evaluated during a pharmacist-led ambulatory consultation 30 days after discharge. RESULTS: A total of 66 and 67 patients were randomized to the intervention and control groups, respectively, but only 51 patients were analyzed in each group, all with similar baseline characteristics. The intervention group had significantly fewer pharmacotherapy problems compared to the control (p<0.001), and 100% of the patients had at least one problem. We observed five problems significantly more frequently in the control group: “incorrect time of taking” (p=0.003), “use higher dose of medication” (p=0.007), “use lower dose of medication” (p=0.014), “restart discontinued medication” (p=0.011), and “underdosing prescription” (p=0.009). Simvastatin, enalapril, carvedilol, and atorvastatin were the medications more associated with pharmacotherapy problems. CONCLUSIONS: We concluded that pharmacist-led discharge counseling should be an indispensable service, as patients exhibited less pharmacotherapy problems in the 30-day postdischarge period, especially related to drug administration and adherence.
https://doi.org/10.6061/clinics/2019/e1091
1109 downloads
12.
Culture media for the multiplication of wild Manihot species
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Sá, Jucieny Ferreira de
; Sampaio, Emília dos Santos
; Mendes, Maria Inês de Souza
; Santos, Karen Cristina Fialho dos
; Sousa, Antônio da Silva
; Ledo, Carlos Alberto da Silva
.
RESUMO O sistema de propagação da mandioca é vagaroso e favorece a transmissão de doenças para sucessivas gerações. A micropropagação é uma alternativa para disponibilizar uma maior quantidade de plantas isentas de pragas e patógenos. Portanto, o objetivo desse estudo foi verificar o efeito de meios de cultura na multiplicaçãoin vitrode cinco espécies silvestres deManihot. O experimento foi realizado no delineamento experimental inteiramente ao acaso, em esquema fatorial 5 (espécies silvestres deManihot) x 6 (meios de cultura), com 11 repetições. Os explantes consistiram de segmentos nodais das espéciesManihot flabellifolia,M. tristis,M. caerulescens,M. chlorostictaeM. jacobinensis, com 1 cm de tamanho e uma gema lateral. Colocou-se um segmento por tubo de ensaio, contendo 10 mL dos meios de cultura MS 0,01, 17N, 12A3, 4E, 8S e WPM, mantendo-os durante 90 dias em sala de crescimento com irradiância de 30 µmol m-2 s-1, temperatura de 27± 1 °C e fotoperíodo de 16 horas. Foram analisadas as variáveis altura de planta (cm), número de folhas verdes, número de folhas senescentes, número de brotos, número de microestacas, massas fresca e seca de parte aérea (mg), massas fresca e seca de raízes (mg) e massa de calo (mg). O meio de cultura 12A3 não foi responsivo para nenhuma das espécies, no entanto, considerando-se às variáveis altura de planta e número de microestacas os demais meios podem ser utilizados na multiplicação in vitro das espécies estudadas, e possivelmente, podem ser utilizados na micropropagação de outras espécies silvestres do gêneroManihot.
ABSTRACT The cassava propagation system is slow and favors disease transmission through successive generations. Micropropagation is an alternative to overcome the aforementioned limitations, besides allowing the generation of a larger number of pest- and pathogen-free plants. Therefore, the aim of the present study is to investigate the effect of culture media on the multiplication in vitro of five wild Manihot species. The experiment followed a completely randomized design, at factorial arrangement 5 (wild Manihot species) x 6 (culture media), with 11 repetitions. Explants consisted in nodal segments (91 cm long and one lateral bud) of species Manihot flabellifolia, M. tristis, M. caerulescens, M. chlorosticta and M. jacobinensis, which were extracted in vitro from the collection of wild cassava species. One segment was placed in each test tube added with 10 mL of MS media 0.01, 17N, 12A3, 4E, 8S and WPM, and kept for 90 days in growth room under 30 μmol m-2 s-1irradiance, temperature 27 ± 1 °C and 16h photoperiod. Variables plant height (cm), number of green leaves, number of senescent leaves, number of shoots, number of microcuttings, fresh and dry shoot mass, fresh and dry root mass (mg) and callus mass (mg) were analyzed. Our results showed that the culture medium 12A3 was not responsive to any of the species; however, if one takes into consideration variables plant height and number of microcuttings, this medium can possibly be used in the micropropagation of other wild species belonging to genus Manihot.
https://doi.org/10.1590/1413-70542018426024718
1053 downloads
13.
Impact of discharge medication counseling in the cardiology unit of a tertiary hospital in Brazil: A randomized controlled trial
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Bonetti, Aline F.
; Bagatim, Bruna Q.
; Mendes, Antonio M.
; Rotta, Inajara
; Reis, Renata C.
; Fávero, Maria Luiza D.
; Fernandez-Llimós, Fernando
; Pontarolo, Roberto
.
OBJECTIVES: This study aimed to evaluate the impact of pharmacist-provided discharge counseling on mortality rate, hospital readmissions, emergency department visits, and medication adherence at 30 days post discharge. METHODS: This randomized controlled trial was approved by the local ethics committee and included patients aged 18 years or older admitted to the cardiology ward of a Brazilian tertiary hospital. The intervention group received a pharmacist-led medication counseling session at discharge and a telephone follow-up three and 15 days after discharge. The outcomes included the number of deaths, hospital readmissions, emergency department visits, and medication adherence. All outcomes were evaluated during a pharmacist-led ambulatory consultation performed 30 days after discharge. RESULTS: Of 133 patients, 104 were included in the analysis (51 and 53 in the intervention and control groups, respectively). The intervention group had a lower overall readmission rate, number of emergency department visits, and mortality rate, but the differences were not statistically significant (p>0.05). However, the intervention group had a significantly lower readmission rate related to heart disease (0% vs. 11.3%, p=0.027), despite the small sample size. Furthermore, medication counseling contributed significantly to improved medication adherence according to three different tools (p<0.05). CONCLUSIONS: Pharmacist-provided discharge medication counseling resulted in better medication adherence scores and a lower incidence of cardiovascular-associated hospital readmissions, thus representing a useful service for cardiology patients.
https://doi.org/10.6061/clinics/2018/e325
1458 downloads
14.
Brazilian guidelines for the clinical management of paracoccidioidomycosis
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Shikanai-Yasuda, Maria Aparecida
; Mendes, Rinaldo Pôncio
; Colombo, Arnaldo Lopes
; Queiroz-Telles, Flávio de
; Kono, Adriana Satie Gonçalves
; Paniago, Anamaria M. M
; Nathan, André
; Valle, Antonio Carlos Francisconi do
; Bagagli, Eduardo
; Benard, Gil
; Ferreira, Marcelo Simão
; Teixeira, Marcus de Melo
; Silva-Vergara, Mario León
; Pereira, Ricardo Mendes
; Cavalcante, Ricardo de Souza
; Hahn, Rosane
; Durlacher, Rui Rafael
; Khoury, Zarifa
; Camargo, Zoilo Pires de
; Moretti, Maria Luiza
; Martinez, Roberto
.
Revista da Sociedade Brasileira de Medicina Tropical
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Abstract Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients’ sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.
https://doi.org/10.1590/0037-8682-0230-2017
10753 downloads
15.
Hypertriglyceridemic Pancreatitis: Conventional Treatment Versus Therapeutic Plasma Exchange
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Ferreira, Diana M.
; Lobo, Filipe
; Fonseca, João Pedro
; Mendes, Patrícia A.
; Aragão, António
; Ferreira, Manuela
; Tomaz, Jorge
; Carvalho, Armando de
.
Introdução:A pancreatite aguda (PA) por hipertrigliceridemia (HTG) pode ser tratada com troca plasmática terapêutica (TPT), com redução rápida dos valores de triglicerídeos. Contudo, não existem estudos comparativos definitivos que comprovem o real benefício desta terapêutica. Objetivo: Comparação dos métodos de tratamento (troca plasmática terapêutica versus convencional) em doentes com PA HTG, durante um período de 12 anos (2000-2012). Métodos: Estudo retrospetivo descritivo e inferencial de 37 doentes, avaliando: sexo, idade, antecedentes pessoais, gravidade, valores de TG e evolução consoante o tratamento (“TPT” ou terapêutica convencional “C”). Resultados: Os dois grupos TPT e C mostraram-se homogéneos quanto ao sexo (p = 0,647), idade (43,5 ± 9,74 anos TPT versus 45,30 ± 9,90 anos C; p = 0.320), pancreatite prévia (40% TPT vs 40,7% C; p = 1,0) alcoolismo crónico (50% TPT vs 70,4% C; p = 0,275) e gravidade pelo score de APACHE II (p = 0,054) e Ranson às 48 horas (p = 0,258). Dos doentes 45,95% apresentava mais de um fator de risco secundário para HTG. O grupo TPT apresentou maiores valores de TG à admissão: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0,001). Não se verificaram diferenças na duração do internamento 14,2 ± 6,8 dias vs 13,5 ± 9,0 dias (p = 0,56) ou na taxa de mortalidade (p = 0,47). À data de alta a redução dos TG foi superior no grupo TPT: 4433,70 ± 2896,08 mg/dL - 91,41% vs 1582,95 ± 2051,06 mg/dL – 83,92% (p = 0,002). De referir seis intercorrências minor durante a troca plasmática terapêutica. Discussão/Conclusões: Apesar do viés de seleção (estudo retrospetivo), foi constatada uma maior redução dos TG por esta técnica. As intercorrências inerentes à técnica de troca plasmática terapêutica foram de simples resolução.
Introduction:Acute pancreatitis (AP) induced by hypertriglyc-eridemia (HTG) can be treated with therapeutic plasma exchange (TPE), resulting in rapid reduction of triglyceride level. However, there are no definitive comparative studies that prove the real benefits of this therapy. Objectives: Comparison of treatment methods (TPE versus conventional) in patients with HTG AP during a period of 12 years (2000-2012). Methods:Retrospective, descriptive and inferential analysis of 37 patients, evaluating: gender, age, personal pathologic history, severity of disease, HTG values and evolution depending on treatment with therapeutic plasma exchange (“TPE”) or with conventional therapy (“C”). Results:Both groups TPE and C demonstrated homogeneity considering gender (p = 0.647), age (43.5 ± 9.74 years TPE vs 45.30 ± 9.90 years C; p = 0.320), prior AP episode (40% TPE vs 40.7% C; p = 1.0), chronic alcohol consumption (50% TPE vs 70.4% C; p = 0.275) and severity disease scores: APACHE II (p = 0.054) and Ranson (p = 0.258). More than one secondary HTG risk factor was presented in 45.95% of patients. TPE group presented higher TG levels at admission: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0.001). No significant statistical differences were observed considering length of hospital stay [14.2 ± 6.8 days vs 13.5 ± 9.0 days (p = 0.56)] or mortality rate (p = 0.47). At discharge, TG reduction was greater in TPE group: 4433.70 ± 2896.08 mg/dL – 91.41% vs 1582.95 ± 2051.06 mg/dL – 83,92% (p = 0.002). Six minor complications associated to TPE occurred. Discussion/Conclusion: Despite the selection bias (retrospective study), a greater TG reduction was observed with TPE technique. Complications associated with the technique were simple to resolve.
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