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Sentidos e significados de parentalidade entre homens trans que engravidaram antes da transição de gênero
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Dantas, Daniela dos Santos

; Almeida, Gabriel Ponce de Leão Lima

; Ferreira, Breno de Oliveira

; Therense, Munique

; Neves, André Luiz Machado das

Ciência & Saúde Coletiva

Journal Metrics
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2024, Volume 29 N. 4 elocation e19532023

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

Resumo Buscou-se compreender os sentidos e significados do exercício parental entre homens trans que engravidaram antes da transição de gênero por meio de uma pesquisa qualitativa, na qual participaram cinco interlocutores, cuja análise foi realizada à luz das teorias sociais de gênero. Os resultados demonstraram uma experiência parental sujeitada a um campo de tensão e negociações, além de uma produção subjetiva que oscilava entre a transgressão e a acomodação da perspectiva cultural da sua própria vivência. Identificou-se práticas de violências que reiteraram as vulnerabilidades sociais, deflagraram as fragilidades dos serviços de saúde e provocaram efeitos deletérios em homens trans que engravidam antes da transição de gênero.

Abstract This qualitative study, with five participating interlocutors, sought to understand the senses and meanings of parenting among trans men who became pregnant before gender transition. Analysis was conducted in light of social theories of gender. The results demonstrated an experience of parenthood subject to a field of tensions and negotiations, as well as subjective production that oscillated between transgression and accommodation of the cultural perspective of their own experience. The forms of violence found to be practiced reiterated social vulnerabilities, exposed healthcare service weaknesses and produced harmful effects on transgender men who become pregnant before gender transition.

https://doi.org/10.1590/1413-81232024294.19532023

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease
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Ponce, Daniela

; Cardoso, Marilia Mastrocolla de Almeida

; Rúgolo, Juliana Rodrigues Machado

; Molina, Silvana Andrea

; Andrade, Luis Gustavo Modelli de

; Curado, Daniel da Silva Pereira

Brazilian Journal of Nephrology

Journal Metrics
- Sobre o periódico
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sep 2023, Volume 45 N. 3 Pages 365 - 372

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

ABSTRACT Introduction For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Objectives: Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. Methodology: A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). Results: The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Conclusion: Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.

RESUMO Introdução: Para a redução dos níveis do paratormônio (PTH) estão disponíveis no mercado brasileiro duas classes de medicamentos: ativadores do receptor da vitamina D (não seletivos e seletivos) e calcimiméticos. Dentre os medicamentos supracitados, o SUS disponibiliza calcitriol oral, paricalcitol e cinacalcete. Objetivos: Desenvolver análise de custo-efetividade (CE) e de impacto orçamentário (IO) do cinacalcete versus paricalcitol para pacientes em diálise com HPTS, na perspectiva do SUS. Metodologia: Foi construído um modelo de árvore de decisão para a análise de CE, que considerou o desfecho paratireoidectomia evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, um de demanda aferida e outro de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia (SBN). Resultados: A análise de CE mostrou que o uso de cinacalcete resulta em economia de R$ 1.394,64 ao ano e efetividade incremental de 0,08, em relação a paratireoidectomia evitada. A razão de CE incremental (RCEI) foi de - R$ 17.653,67 por paratireoidectomia evitada para o cinacalcete, já que se mostrou mais efetivo e mais barato comparado ao paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do cinacalcete no SUS estará entre - R$ 1.640.864,62 e R$ 166.368,50 no primeiro ano, considerando os cenários principal e epidemiológico baseado nos dados da SBN. Já ao final de 5 anos após a ampliação do uso, estimou-se um impacto incremental entre - R$ 10.740.743,86 e - R$ 1.191.339,37; considerando os mesmos cenários. Conclusão: Cinacalcete foi dominante para evitar paratireoidectomias, sendo custo-efetivo.

https://doi.org/10.1590/2175-8239-jbn-2022-0126en

Comparative analysis of patients’ survival on hemodialysis vs. peritoneal dialysis and identification of factors associated with death
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Vicentini, Carolina Aparecida de Almeida

; Ponce, Daniela

Brazilian Journal of Nephrology

Journal Metrics
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mar 2023, Volume 45 N. 1 Pages 8 - 16

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

Abstract Introduction: There are several studies comparing the outcomes of patients treated with peritoneal dialysis (PD) and hemodialysis (HD), and most are divergent. Methods: This is a cohort study that followed patients with incident PD and HD in a planned and unplanned way, in a dialysis unit of the HCFMB from 01/2014 to 01/2019, until the outcome. We collected clinical and laboratory data. The PD and HD groups, death and non-death outcomes, were compared using the chi-square test for categorical variables and t-test, or Mann-Whitney test for continuous variables. Kaplan Meier curve and log-rank test were used for survival. Multivariate analysis was performed using the Cox regression. The significant difference was p < 0.05. Results: We had 592 patients, 290 treated by HD and 302 by PD. The mean age was 59.9 ± 16.8, with a predominance of males (56.3%), the main underlying disease was diabetes (45%); 29% of the patients died. There was no difference in the survival of patients treated by HD and PD. The oldest age (1.018 (95% CI 1.000-1.037; p=0.046)) was identified as a risk factor for death, while the highest number of infection-free days (0.999 (95% CI 0.999-1.000; p=0.003 )) as a protective factor. Conclusion: The analysis reinforced that the survival of patients on HD and PD was similar. Higher age and shorter infection-free time were associated with death.

Resumo Introdução: Há vários estudos que comparam os desfechos de pacientes tratados por diálise peritoneal (DP) e hemodiálise (HD), e a maioria é divergente. Métodos: Estudo de coorte que acompanhou pacientes incidentes em DP e HD de modo planejado e não planejado em unidade de diálise do HCFMB de 01/2014 a 01/2019, até o desfecho. Foram coletados dados clínicos e laboratoriais. Comparou-se os grupos DP e HD, óbito e não óbito, por meio do teste qui-quadrado para variáveis categóricas e teste t ou Mann-Whitney para as contínuas. Curva de Kaplan Meier e log-rank test foram utilizados para a sobrevida. A análise multivariada foi realizada por Regressão de Cox. A diferença significante foi de p < 0,05. Resultados: Foram estudados 592 pacientes, 290 tratados por HD e 302 por DP. A média de idade foi de 59,9 ± 16,8, com predomínio de sexo masculino (56,3%), principal doença de base, diabetes (45%). Óbito ocorreu em 29% dos pacientes. Não houve diferença na sobrevida de pacientes tratados por HD e DP. A maior idade (1,018 (IC 95% 1,000-1,037; p=0,046)) foi identificada como fator de risco para o óbito, enquanto a maior quantidade de dias livres de infecção (0,999 (IC 95% 0,999-1,000; p=0,003)), como fator de proteção. Conclusão: A análise reforçou que a sobrevida dos pacientes em HD e DP é semelhante. Foram associados ao óbito a maior idade e o menor tempo livre de infecção.

https://doi.org/10.1590/2175-8239-jbn-2021-0242en

Cost-effectiveness analysis of intravenous paricalcitol vs. oral calcitriol in the treatment of hyperparathyroidism secondary to chronic kidney disease
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Cardoso, Marilia Mastrocolla de Almeida

; Machado-Rugolo, Juliana

; Lima, Silvana Andrea Molina

; Andrade, Luis Gustavo Modelli de

; Curado, Daniel da Silva Pereira

; Ponce, Daniela

Brazilian Journal of Nephrology

Journal Metrics
- Sobre o periódico
- SciELO Analytics

mar 2023, Volume 45 N. 1 Pages 95 - 101

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

Abstract Introduction: Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels. Objectives: To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS). Methodology: We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology. Results: The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73. Conclusion: Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) à doença crônica renal (DRC) é caracterizado por elevados níveis de paratormônio (PTH), hiperplasia das glândulas paratireoides e doença cardiovascular. Para a redução dos níveis do PTH, estão disponíveis no mercado brasileiro os ativadores não seletivos e seletivos do receptor da vitamina D e os calcimiméticos. Objetivos: Desenvolver análise de custo-efetividade (C/E) e de impacto orçamentário (IO) do paricalcitol intravenoso vs. calcitriol oral para pacientes em diálise com HPTS, na perspectiva do Sistema Único de Saúde. Metodologia: Foi construído um modelo de árvore de decisão para a análise de C/E, que considerou o desfecho morte evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, sendo um de demanda aferida e um de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia. Resultados: A análise mostrou que a relação de C/E foi de R$ 1.213,68 ao ano, e uma efetividade incremental de 0,032, referente à morte evitada. A razão de C/E incremental foi de R$ 37.927,50 por morte evitada para o paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do paricalcitol estará entre R$ 1.600.202,28 e R$ 4.128.565,65 no primeiro ano, considerando os cenários principal e o epidemiológico. Já no fim de 5 anos após a ampliação do uso, estimou-se IO incremental entre R$ 48.596.855,50 e R$ 62.90.555,73. Conclusão: O paricalcitol intravenoso tem eficácia superior e segurança semelhante ao comparador calcitriol oral, diminuindo a mortalidade geral dos pacientes em diálise, embora implique maior custo.

https://doi.org/10.1590/2175-8239-jbn-2022-0049en

Infectious and mechanical complications in planned-start vs. urgent-start peritoneal dialysis: a cohort study
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Müller, João Victor Costa

; Ponce, Daniela

Brazilian Journal of Nephrology

Journal Metrics
- Sobre o periódico
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mar 2023, Volume 45 N. 1 Pages 27 - 35

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

Abstract Background: Few studies have compared the infectious and mechanical complications seen in planned-start and urgent-start peritoneal dialysis (PD) patients. Objectives: To compare the incidence and etiology of mechanical and infectious complications in patients offered planned- and urgent-start PD and assess potential differences in patient survival and time on PD. Methods: This retrospective cohort study included patients with chronic kidney disease on planned- and urgent-start PD seen from 2014 to 2020 and compared them for mechanical and infectious complications, clinical outcome, death rates, and need to switch to hemodialysis. Results: Ninety-nine patients on planned-start PD and 206 on urgent-start PD were included. Incidence of exit-site infection (18.9 vs. 17.17%, p=0.71) and peritonitis (24.27 vs. 27.27%, p=0.57) were similar between patients, while pathogens causing peritonitis were different, although non-fermenting Gram-negative bacilli were more commonly seen in the planned-start PD group. Leakage as a mechanical complication and hospitalization were more common among patients needing urgent-start PD (10.68 vs. 2.02%, p=0.0085 and 35.44 vs. 17.17%, p=0.0011, respectively). Patient survival was similar between groups. Cox regression found an association between death and age (HR=1.051, 95% CI 1.026-1.07, p=0.0001) and albumin (HR=0.66, 95% CI 0.501-0.893, p=0.0064), and between peritonitis and a diagnosis of diabetes (HR=2.016, 95% CI 1.25-3.25, p=0.004). Conclusion: Patient survival and time on PD were similar between the planned- and urgent-start PD groups, while leakage was more frequently seen in the urgent-start PD group. Death was associated with lower albumin levels and older age, while peritonitis was associated with diabetes.

Resumo Antecedentes: Poucos estudos compararam as complicações infecciosas e mecânicas relacionadas à diálise peritoneal (DP) de início planejado e não planejado. Objetivos: Comparar a incidência e etiologia das complicações mecânicas e infecciosas associadas à DP tanto de início planejado quanto não planejado e avaliar comparativamente a sobrevida da técnica e dos pacientes. Métodos: Estudo de coorte retrospectivo que avaliou pacientes com doença renal crônica em DP não planejada e planejada de 2014 a 2020 quanto às complicações mecânicas e infecciosas e desfechos clínicos óbito ou mudança para hemodiálise. Resultados: Foram avaliados 99 pacientes em DP planejada e 206 em DP não planejada. Foram semelhantes quanto à incidência de Infecção do Orifício de Saída (18,9x17,17%, p=0,71), peritonite (24,27x27,27%, p=0,57) e diferentes quanto aos agentes etiológicos das peritonites, sendo os bacilos Gram-negativos não fermentadores mais frequentes no grupo planejado. Diferiram quanto à complicação mecânica extravasamento e internação, ambas mais frequentes no grupo não planejado (10,68 x 2,02%, p=0,0085 e 35,44 x 17,17%, p=0,0011, respectivamente). Semelhantes quanto à sobrevida dos pacientes e da técnica. À regressão de Cox, associou ao óbito a idade (HR=1,051, IC 95% 1,026-1,07, p=0,0001) e a albumina (HR=0,66, IC 95% 0,501-0,893, p=0,0064), e à peritonite a presença de diabetes (HR=2,016, IC 95% 1,25-3,25, p=0,004). Conclusão: A sobrevida da técnica e dos pacientes foi semelhante nos grupos DP planejada e não planejada, enquanto o extravasamento foi mais frequente no grupo de início não planejado. Associaram-se ao óbito menores valores de albumina e maior idade, e à peritonite, o diabetes.

https://doi.org/10.1590/2175-8239-jbn-2021-0287en

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease
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Ponce, Daniela

; Cardoso, Marilia Mastrocolla de Almeida

; Rúgolo, Juliana Rodrigues Machado

; Molina, Silvana Andrea

; Andrade, Luis Gustavo Modelli de

; Curado, Daniel da Silva Pereira

Brazilian Journal of Nephrology

Journal Metrics
- Sobre o periódico
- SciELO Analytics

2023, N. ahead

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

https://doi.org/10.1590/2175-8239-jbn-2022-0126en

Quiste mesentérico gigante, un hallazgo incidental. Reporte de caso.
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Almeida Cabrera, Myrka Daniela

; Robles Fernandes, Louis Fernando

; Ibarra Ponce de León, Roberto Alfredo

Anales de la Facultad de Medicina

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2023, Volume 10 N. 1 elocation e404

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

RESUMEN: Se presenta el caso de un hombre de 58 años de edad, sin antecedentes de importancia para la presencia de hepatopatía, quien presentó distensión abdominal progresiva que no respondió al manejo a base de diuréticos, diagnosticado incidentalmente a través de estudios de imagen con un quiste mesentérico gigante, el cual constituye un tumor raro, con pocos reportes de caso en la literatura, según lo referido es más frecuente en el sexo femenino, su etiología aun es desconocida, su diagnóstico generalmente se realiza a través de estudios de imagen y el tratamiento consiste en la escisión quirúrgica completa ya que su drenaje constituye un medio ineficaz por el alto riesgo de recurrencia.

ABSTRACT: We present the case of a 58-year-old man, with no history of significant hepatopathy, who presented progressive abdominal distension that did not respond to diuretics, diagnosed incidentally through imaging studies with a giant mesenteric cyst, which is a rare tumor, Its etiology is still unknown, its diagnosis is generally made through imaging studies and the treatment consists of complete surgical excision since its drainage is an ineffective means due to the high risk of recurrence.

RESUMO: Apresentamos o caso de um homem de 58 anos, sem historial de hepatopatia significativa, que apresentava uma distensão abdominal progressiva que não respondia a uma gestão baseada em diuréticos, diagnosticada incidentalmente através de estudos de imagem com um cisto mesentérico gigante, que é um tumor raro, A sua etiologia é ainda desconhecida, o seu diagnóstico é geralmente feito através de estudos de imagem e o tratamento consiste na excisão cirúrgica completa, uma vez que a drenagem é um meio ineficaz devido ao elevado risco de recidiva.

https://doi.org/10.25184/anfamed2023v10n1a7

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

Impact of colloids or crystalloids in renal function assessed by NGAL and KIM-1 after hysterectomy: randomized controlled trial
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Santos, Murillo G.

; Pontes, João Paulo Jordão

; Gonçalves Filho, Saulo

; Lima, Rodrigo M.

; Thom, Murilo M.

; Módolo, Norma Sueli P.

; Ponce, Daniela

; Navarro, Lais Helena

Brazilian Journal of Anesthesiology

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dec 2022, Volume 72 N. 6 Pages 720 - 728

Abstract: En | Text: En | PDF: En

Abstract Background Hydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting. Methods This prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function. Results Seventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p= 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p= 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p= 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups. Conclusion HES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.

https://doi.org/10.1016/j.bjane.2021.10.009

10.

Toxicity of secondary treated sewage disinfected with chlorine gas and hypochlorite to zebrafish Danio rerio
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Ponce-Palomera, Kevin Omar

; Guerrero-Galván, Saúl Rogelio

; Vega-Villasante, Fernando

; Rodríguez-Partida, Daniela

Latin american journal of aquatic research

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nov 2022, Volume 50 N. 5 Pages 753 - 759

Abstract: En | Text: En | PDF: En

ABSTRACT. The sewage contains toxic chemical compounds that secondary treatment plants do not eliminate, and chlorine is usually added for disinfection before discharge. Chlorine reacts with sewage compounds forming other toxic compounds. The objective of this study was to evaluate the toxicity of treated sewage from a secondary treatment plant using Danio rerio embryos. Three types of treated sewage were tested, one disinfected with chlorine gas (dCl2), another with sodium hypochlorite (dClO), and the plant discharge, which is a mixture of the two sewage disinfection methods (mCl) with a proportion of 70% of dCl2 and 30% of dClO. To estimate the median lethal dilution treated sewage was diluted with dechlorinated tap water at 20, 40, 60, and 80%. Two additional points were made with pure treated sewage and pure dechlorinated tap water. Embryos were exposed 1 h after fertilization (hpf) to 144 hpf. The dCl2 and the mCl were lethal at 60 and 72 hpf, respectively, while the dClO did not show lethality. The embryos exposed to the mCl showed heart failure and slower blood circulation. Those exposed to dCl2 showed teratogenic effects such as pericardial edema and spinal curvature, while those exposed to dClO presented malformations such as incomplete eye development and otolith formation absence.

https://doi.org/10.3856/vol50-issue5-fulltext-2893

11.

COLONIZACIÓN HUMANA DE TIERRA DEL FUEGO: CONTEXTOS ARQUEOLÓGICOS PRETRANSGRESIVOS EN LA COSTA NORTE DEL CANAL BEAGLE
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Zangrando, Atilio Francisco J.

; Tivoli, Angélica M.

; Ponce, Juan Federico

; Alunni, Daniela V.

; Ropero, María del Carmen Fernández

; Martinoli, María Paz

Chungará (Arica)

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sep 2022, Volume 54 N. 3 Pages 557 - 577

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

Abstract: We address some predictions derived from the biogeographic model proposed by Luis Borrero (1989-90) in order to analyze the earliest human occupations identified on the north coast of the Beagle Channel (8600-6500 cal. years BP). We examined the chronological, stratigraphic and archaeological information from the basal deposits of Imiwaia I, Binushmuka I and Túnel I to explore the formational processes and temporal structure of the archaeological contexts during the maximum extension of the Holocene marine transgression. Continuous human activity is inferred from 8600 cal. years BP on the southern coast of Tierra del Fuego. The structures of the earliest archaeological deposits indicate low-intensity and discrete occupations over time. The archaeological signal remains weak until the Holocene marine transgression reached its maximum level at approximately 7000 cal. years BP, when the formation of multicomponent archaeological deposits (shell middens) becomes visible in the region. Lastly, we discuss the implications of this information for the colonization of the Fuegian archipelago.

Resumen: Partimos de algunas predicciones derivadas del modelo biogeográfico propuesto por Luis Borrero (1989-90) para analizar las ocupaciones humanas más tempranas identificadas en la costa norte del Canal Beagle (8600-6500 años cal. AP). Examinamos la información cronológica, estratigráfica y la composición de los depósitos basales de Imiwaia I, Binushmuka I y Túnel I con el fin de explorar los procesos de formación y estructura temporal de los contextos arqueológicos en momentos previos al máximo alcance de la transgresión marina del Holoceno. Se observa una actividad humana continua en la costa sur de Tierra del Fuego desde hace al menos 8600 años cal. AP. Las estructuras de los depósitos más tempranos marcan ocupaciones con baja intensidad y discretas en el tiempo. La señal arqueológica se mantiene débil hasta que la transgresión marina del Holoceno alcanzó su máximo nivel en un momento cercano a los 7000 años cal. AP, cuando la formación de depósitos arqueológicos multicomponentes (concheros) comenzó a hacerse visible en la región. Por último, se discuten las implicaciones de esta información para el poblamiento del archipiélago fueguino.

https://doi.org/10.4067/s0717-73562022005000401

12.

Acute kidney injury and renal replacement therapy: terminology standardization
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Reis, Thiago

; Colares, Vinicius Sardão

; Rocha, Eduardo

; Younes-Ibrahim, Mauricio

; Lima, Emerson Quintino de

; Andrade, Lucia da Conceição

; Ponce, Daniela

; Suassuna, José H. Rocco

; Yu, Luis

Brazilian Journal of Nephrology

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sep 2022, Volume 44 N. 3 Pages 434 - 442

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

Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.

Abstract The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.

https://doi.org/10.1590/2175-8239-jbn-2021-0284en

13.

Factibilidad, eficacia y satisfacción lograda por la intervención transdisciplinaria de un comité de ética clínico-hospitalario. Un estudio cualicuantitativo
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Selandari, Jorge O.

; Portilla, Manuela de la

; Ciruzzi, M. Susana

; Couceiro, Claudia

; García, Hernán O.

; Iervolino, M. de los Ángeles

; Marín, Daniela N.

; Miranda, Carina

; Novali, Luis

; Ortega, Laura

; Ponce, Corina

; Puccar, Pablo

; Quintana, Susana G.

; Rodríguez, Estela

; Ledesma, Fernanda

Archivos argentinos de pediatría

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feb 2022, Volume 120 N. 1 Pages 41 - 50

Abstract: Es | Text: Es | PDF: Es

RESUMEN Introducción . Las funciones del Comité de Ética Clínica (CEC) son educativas, normativas, consultivas, mediadoras y reflexivas. Como cualquier servicio de salud, las consultas de casos a un CEC deben ser sujetas a revisión y mejora de la calidad. Los objetivos fueron evaluar la factibilidad, la efectividad y la satisfacción de las recomendaciones ético-asistenciales dadas por el CEC, y evaluar su impacto en el equipo tratante y en la familia. Población y métodos . Estudio descriptivo, retrospectivo, cualicuantitativo, de casos clínicos presentados en el Comité de Ética Clínica del hospital desde el 1 de enero de 2013 hasta el 31 de diciembre de 2017, según datos del libro de actas, historias clínicas, registros de la Oficina de Comunicación a Distancia y entrevistas semiestructuradas al equipo de salud. Resultados. Se analizaron 108 casos (106 pacientes), 73 casos con encuesta y registros, y 35 solamente con registros. Los motivos principales más frecuentes de consulta fueron los siguientes: adecuación del esfuerzo terapéutico (46/42,6 %), compromiso neurológico grave (15/13,9 %), calidad de vida del paciente (11/10,2 %), conflictos entre el paciente, la familia y el sistema de salud (7/6,5 %), y rechazo del tratamiento por la familia (6/5,6 %). Se hallaron niveles altos de satisfacción (> 95 %) y niveles moderados de factibilidad (> 74 %) y efectividad (> 85 %). Solo en 50/108 casos (46,3 %) quedó registro en la historia clínica de la consulta al CEC y el 44 % de los profesionales opinó que la consulta tuvo un impacto positivo en la familia y en el paciente. Conclusiones . Los resultados contribuyeron a descubrir oportunidades de mejora, especialmente en la documentación y en la comunicación en el proceso de consulta.

https://doi.org/10.5546/aap.2022.30

14.

Amauropelta yabotiensis (Thelypteridaceae), a new species from Biosphere Yabotí Reserve (Misiones, Argentina) and its taxonomic relationships
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YAÑEZ, AGUSTINA

; MARQUEZ, GONZALO J.

; TERRAZA, DANIELA OCAMPO

; PONCE, M. MÓNICA

Anais da Academia Brasileira de Ciências

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2022, Volume 94 N. 3 elocation e20201870

Abstract: En | Text: En | PDF: En

Abstract The Yabotí Biosphere Reserve (Prov. Misiones, Argentina) with 221,155 ha, represents one of the southernmost relicts of the Paranaense forest. Currently, a project is being developed in the area to inventory and describe the ferns and lycophytes. As a result of these studies, we identify a new species of Amauropelta, A. yabotiensis. Within this genus, it belongs to the group of species with uncinate hairs and presents a unique combination of diagnostic features, including the type of pubescence on the rhizome scales, the shape of the fronds and segments and type of venation. Here, we described and illustrated the species and we analyzed its taxonomic affinities and geographic distribution. Additionally, we provided a distribution map and a key to distinguish it from other Amauropelta species from Misiones province. With this new finding, we highlighted the importance of the Yabotí Reserve as a reservoir of biodiversity in the region.

https://doi.org/10.1590/0001-3765202220201870

15.

Comprensión de textos escritos a través del trabajo colaborativo en la Educación Básica
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Peña Rañileo, Karen

; Ponce Godoi, Arlet

; Montecinos Herrera, Dyanett

; Torres Reinoso, Daniela

; Catalán Montiel, Paz

; Villagra Bravo, Carolina

Revista de estudios y experiencias en educación

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apr 2021, Volume 20 N. 43 Pages 455 - 475

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

Abstract: This pedagogical innovation experience focused on the development of reading comprehension skills, using discontinuous or multimodal texts through collaboration as a learning strategy and competence among students in the second cycle of elementary education in the city of Temuco. During the pedagogical experience, collaboration was carried out as a learning strategy and proficiency using discontinuous or multimodal texts. This is documented through different actions developed by five student-teachers studying Pedagogy in Primary Education at the Catholic University of Temuco, detailing the participants’ evaluations of the experience. Finally, the elements that encouraged and favored the integration of collaborative work and the reading of different discontinuous texts as a regular practice in the classroom were systematized.

Resumen: La presente experiencia de innovación pedagógica se centró en el desarrollo de habilidades de comprensión lectora, utilizando textos discontinuos o multimodales a través de la colaboración como estrategia y competencia de aprendizaje entre estudiantes de segundo ciclo de educación básica de la ciudad de Temuco. En ella, se especificaron las diferentes acciones realizadas por cinco futuras profesoras de la carrera de Pedagogía en Educación Básica con Mención de la Universidad Católica de Temuco, las cuales consideraron en sus planificaciones el contexto, las necesidades e intereses de las y los estudiantes de cada curso, a su vez, se detallan las valoraciones de los participantes sobre la experiencia. Finalmente, se sistematizaron los elementos que permitieron impulsar y favorecer la incorporación del trabajo colaborativo y la lectura de diversos textos discontinuos como una práctica habitual en el aula.

https://doi.org/10.21703/rexe.20212043pena24 564 downloads

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