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[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

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Publication date: 2022-10-11

Abstract: En Pt

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;

https://doi.org/10.1590/SciELOPreprints.4820

Mudanças recentes e continuidade da dependência tecnológica e econômica na indústria farmacêutica no Brasil
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Rodrigues, Paulo Henrique de Almeida

; Silva, Roberta Dorneles Ferreira da Costa

; Kiss, Catalina

Cadernos de Saúde Pública

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2022, Volume 38 Suppl. 2 elocation e00104020

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

This article presents the results of a study on the pharmaceutical industry in Brazil in the recent period, as part of the multicenter project Health Economic-Industrial Complex, Innovation and Capitalist Dynamics: Structural Challenges for Construction of the Universal Health System in Brazil. The four components studied in the evolution of the Brazilian pharmaceutical industry were: State industrial policies; changes in the financial and shareholding composition of companies with domestic capital; trends in production; and trade balance behavior. The analyses considered the theoretical framework proposed by Luiz Filgueiras and Reinaldo Gonçalves concerning the implementation of a “liberal and peripheral model” in the Brazilian economy since the 1990s. Data were collected and analyzed on the situation with the Product Development Partnerships (PDP) for medicines from 2009 to 2020 from the Annual Industrial Survey (PIA) of the Brazilian Institute of Geography and Statistics (IBGE) from 1996 to 2018 and data on the evolution of the sector’s trade balance from 1996 to 2019. The results show that the State’s agenda for the sector favored the growth in production of generic drugs and over-the-counter drugs and started some technology transfer projects via PDPs for production of biological and synthetic drugs. Despite this evolution, Brazil is still dependent on the importation of chemical and pharmaceutical inputs and finished drugs. This keeps Brazil in a situation of technological and economic vulnerability in relation to global suppliers, besides a growing trade deficit in the sector.

Este artigo apresenta os resultados de pesquisa sobre a indústria farmacêutica no Brasil, no período recente, realizada no âmbito do projeto multicêntrico Complexo Econômico-Industrial da Saúde, Inovação e Dinâmica Capitalista: Desafios Estruturais para a Construção do Sistema Universal de Saúde no Brasil. Os quatro componentes estudados sobre a evolução da indústria farmacêutica no Brasil foram: as políticas industriais do Estado; as mudanças na composição financeira e patrimonial das empresas de capital nacional, a evolução da produção; e o comportamento da balança comercial. As análises levaram em consideração o marco teórico proposto por Luiz Filgueiras e Reinaldo Gonçalves a respeito da implantação de um “modelo liberal e periférico” na economia brasileira a partir dos anos 1990. Foram levantados e analisados dados sobre: a situação das Parcerias de Desenvolvimento Produtivo (PDP) para medicamentos entre 2009 e 2020; da Pesquisa Industrial Anual (PIA), do Instituto Brasileiro de Geografia e Estatística (IBGE), entre 1996 e 2018; e os dados da evolução da balança comercial do setor entre 1996 e 2019. Os resultados evidenciam que a agenda do Estado para o setor favoreceu o crescimento da produção de medicamentos genéricos, dos medicamentos isentos de prescrição (MIP) e deu início a alguns projetos de transferência de tecnologia via PDPs para a produção de medicamentos biológicos e sintéticos. Apesar dessa evolução, o Brasil se mantém dependente da importação de insumos químicos e farmacêuticos e de medicamentos acabados. Isto nos mantém em situação de vulnerabilidade tecnológica e econômica em relação aos fornecedores mundiais, além de um aprofundamento do déficit da balança comercial do setor.

Este artículo presenta los resultados de investigación sobre la industria farmacéutica en Brasil, durante el período reciente, realizada en el ámbito del proyecto multicéntrico Complejo Económico-Industrial de la Salud, Innovación y Dinámica Capitalista: Desafíos Estructurales para la Construcción del Sistema Universal de Salud en Brasil. Los cuatro componentes estudiados sobre la evolución de la industria farmacéutica en Brasil fueron: las políticas industriales del Estado; los cambios en la composición financiera y patrimonial de las empresas de capital nacional, la evolución de la producción; y el comportamiento de la balanza comercial. Los análisis tuvieron en consideración el marco teórico propuesto por Luiz Filgueiras y Reinaldo Gonçalves, respecto a la implantación de un “modelo liberal y periférico” en la economía brasileña, a partir del año 1990. Se recabaron y analizaron datos sobre: la situación de las Colaboraciones de Desarrollo Productivo (PDP por su sigla en portugués) para medicamentos entre 2009 y 2020; de la Encuesta Industrial Anual (PIA), del Instituto Brasileño de Geografía y Estadística (IBGE), entre 1996 y 2018; y los datos de la evolución de la balanza comercial del sector entre 1996 y 2019. Los resultados evidencian que la agenda del Estado para el sector favoreció el crecimiento de la producción de medicamentos genéricos, de los medicamentos exentos de prescripción (MIP) y comenzó algunos proyectos de transferencia de tecnología vía PDPs para la producción de medicamentos biológicos y sintéticos. A pesar de esa evolución, Brasil sigue siendo dependiente de la importación de insumos químicos y farmacéuticos y de medicamentos acabados. Esto nos mantiene en una situación de vulnerabilidad tecnológica y económica, en relación con los proveedores mundiales, además de una profundización del déficit de la balanza comercial del sector.

https://doi.org/10.1590/0102-311x00104020

Mudanças recentes e continuidade da dependência tecnológica e econômica na indústria farmacêutica no Brasil
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Rodrigues, Paulo Henrique de Almeida

; Silva, Roberta Dorneles Ferreira da Costa

; Kiss, Catalina

Cadernos de Saúde Pública

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2022, Volume 38 Suppl. 2 elocation e00104020

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

https://doi.org/10.1590/0102-311x00104020

Technical performance of a lateral flow immunoassay for detection of anti-SARS-CoV-2 IgG in the outpatient follow-up of non-severe cases and at different times after vaccination: comparison with enzyme and chemiluminescent immunoassays
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Barreira, Gabriel Acca

; Santos, Emilly Henrique dos

; Pereira, Maria Fernanda Bádue

; Rodrigues, Karen Alessandra

; Rocha, Mussya Cisotto

; Kanunfre, Kelly Aparecida

; Marques, Heloisa Helena de Sousa

; Okay, Thelma Suely

; Eisencraft, Adriana Pasmanik

; Rossi Junior, Alfio

; Fante, Alice Lima

; Cora, Aline Pivetta

; Costa Reis, Amelia Gorete A. de

; Ferrer, Ana Paula Scoleze

; Andrade, Anarella Penha Meirelles de

; Watanabe, Andreia

; Gonçalves, Angelina Maria Freire

; Waetge, Aurora Rosaria Pagliara

; Silva, Camila Altenfelder

; Ceneviva, Carina

; Lazari, Carolina dos Santos

; Abellan, Deipara Monteiro

; Sabino, Ester Cerdeira

; Bianchini, Fabíola Roberta Marim

; Alcantara, Flávio Ferraz de Paes

; Ramos, Gabriel Frizzo

; Leal, Gabriela Nunes

; Rodriguez, Isadora Souza

; Pinho, João Renato Rebello

; Carneiro, Jorge David Avaizoglou

; Paz, Jose Albino

; Ferreira, Juliana Carvalho

; Ferranti, Juliana Ferreira

; Ferreira, Juliana de Oliveira Achili

; Framil, Juliana Valéria de Souza

; Silva, Katia Regina da

; Bastos, Karina Lucio de Medeiros

; Galleti, Karine Vusberg

; Cristofani, Lilian Maria

; Suzuki, Lisa

; Campos, Lucia Maria Arruda

; Perondi, Maria Beatriz de Moliterno

; Diniz, Maria de Fatima Rodrigues

; Fonseca, Maria Fernanda Mota

; Cordon, Mariana Nutti de Almeida

; Pissolato, Mariana

; Peres, Marina Silva

; Garanito, Marlene Pereira

; Imamura, Marta

; Dorna, Mayra de Barros

; Luglio, Michele

; Aikawa, Nadia Emi

; Degaspare, Natalia Viu

; Sakita, Neusa Keico

; Udsen, Nicole Lee

; Scudeller, Paula Gobi

; Gaiolla, Paula Vieira de Vincenzi

; Severini, Rafael da Silva Giannasi

; Rodrigues, Regina Maria

; Toma, Ricardo Katsuya

; Paula, Ricardo Iunis Citrangulo de

; Palmeira, Patricia

; Forsait, Silvana

; Farhat, Sylvia Costa Lima

; Sakano, Tânia Miyuki Shimoda

; Koch, Vera Hermina Kalika

; Cobello Junior, Vilson

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e49

Abstract: En | Text: En | PDF: En

ABSTRACT This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA’s sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible.

https://doi.org/10.1590/s1678-9946202264049

Checklist of the dipterofauna (Insecta) from Roraima, Brazil, with special reference to the Brazilian Ecological Station of Maracá
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Riccardi, Paula Raile

; Fachin, Diego Aguilar

; Ale-Rocha, Rosaly

; Amaral, Edna Maria

; Amorim, Dalton de Souza

; Gil-Azevedo, Leonardo Henrique

; Capellari, Renato Soares

; Carmo, Daniel Dias Dornelas do

; Carvalho, Claudio José Barros de

; Ferro, Gustavo Borges

; Flores, Heloísa Fernandes

; Gomes, Lucas Roberto Pereira

; Gottschalk, Marco Silva

; Lamas, Carlos José Einicker

; Lampert, Silvana

; Marinho, Marco Antonio Tonus

; Marques, Dayse Willkenia Almeida

; Mello, Ramon Luciano

; Mello-Patiu, Cátia Antunes de

; Menezes, Marco Antônio

; Morales, Mírian Nunes

; Oliveira, Sarah Siqueira de

; Pereira, Thalles Platiny Lavinscky

; Pereira-Colavite, Alessandre

; Pirani, Gabriela

; Rafael, José Albertino

; Santos, Josenilson Rodrigues dos

; Savaris, Marcoandre

; Schelesky-Prado, Daniel de Castro

; Silva, Vera Cristina

; Sousa, Viviane Rodrigues de

; Urso-Guimarães, Maria Virginia

; Vargas, Laura Viana

; Yamaguchi, Carolina

; Falaschi, Rafaela Lopes

Papéis Avulsos de Zoologia

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2022, Volume 62 elocation e202262014

Abstract: En | Text: En | PDF: En

Abstract Roraima is a Brazilian state located in the northern portion of the Amazon basin, with few studies regarding its biodiversity. The Ecological Station of Maracá (Brazil, state of Roraima) harbors the third largest Brazilian pluvial island and is composed of a transitional landscape of savanna and Amazon rainforest components. Despite its ecological importance and strategic localization, few studies covered the dipterofauna of this locality. An updated checklist addressing 41 families of true flies (Diptera) occurring in Roraima is presented based on the literature and the specimens collected during a field expedition that occurred in 2015. This checklist brings several improvements such as new records of 165 taxa to the state of Roraima, 29 taxa to Brazil, and 259 morphotypes, mostly likely representing undescribed species.

https://doi.org/10.11606/1807-0205/2022.62.014

Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers
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Bocchi, Edimar Alcides

; Moreira, Henrique Turin

; Nakamuta, Juliana Sanajotti

; Simões, Marcus Vinicius

; Casas, Alberto de Almeida Las

; Costa, Altamiro Reis da

; Assis, Amberson Vieira de

; Durães, André Rodrigues

; Pereira-Barretto, Antonio Carlos

; Ravessa, Antonio Delduque de Araujo

; Macedo, Ariane Vieira Scarlatelli

; Biselli, Bruno

; Pinto, Carolina Maria Nogueira

; Filho, Conrado Roberto Hoffmann

; Costantini, Costantino Roberto

; Almeida, Dirceu Rodrigues

; Santos Jr, Edval Gomes dos

; Soliva Junior, Erwin

; Figueiredo, Estevão Lanna

; Albuquerque, Felipe Neves de

; Paulitsch, Felipe

; Neuenschwander, Fernando Carvalho

; Figueiredo Neto, José Albuquerque de

; Brito, Flavio de Souza

; Lopes, Heno Ferreira

; Villacorta, Humberto

; Souza Neto, João David de

; Sepulveda, João Mariano

; Ayoub, José Carlos Aidar

; Vilela-Martin, José F.

; Cardoso, Juliano Novaes

; Uemura, Laercio

; Moura, Lidia Zytynski

; Maia, Lilia Nigro

; Oliveira, Lucia Brandão de

; Maia, Lucimir

; Silva, Luís Beck da

; Gowdak, Luís Henrique Wolff

; Danzmann, Luiz Claudio

; Andrade, Marcus

; Braile-Sternieri, Maria Christiane Valeria Braga

; Moreira, Maria da Consolação Vieira

; França Neto, Olimpio R

; Filho, Otavio Rizzi Coelho

; Esteves, Paulo Frederico

; Raupp-da-Rosa, Priscila

; Silva, Ricardo Jorge de Queiroz e

; Mourilhe-Rocha, Ricardo

; Viégas, Ruy Felipe Melo

; Rassi, Salvador

; Mangili, Sandrigo

; Kaiser, Sergio Emanuel

; Martins, Silvia Marinho

; Kawabata, Vitor Sergio

Clinics

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2021, Volume 76 elocation e1991

Abstract: En | Text: En | PDF: En

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

https://doi.org/10.6061/clinics/2021/e1991

Vulnerabilidade e resposta social à pandemia de Covid-19 em territórios metropolitanos de São Paulo e da Baixada Santista, SP, Brasil
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Nasser, Mariana Arantes

; Calazans, Marília Oliveira

; Fegadolli, Claudia

; Oliveira, Sandro Barbosa de

; Rodrigues, Joana de Fátima

; Costa, Rosangela Calado da

; Santos, Eduardo Henrique Moraes

; Zanchetta, Giovanna Moreira

; Furtado, Lumena Almeida Castro

Interface - Comunicação, Saúde, Educação

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2021, Volume 25 Suppl. 1 elocation e210125

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

Este artigo analisa a vulnerabilidade e o enfrentamento à pandemia de Covid-19 em 16 territórios metropolitanos de São Paulo e da Baixada Santista (São Paulo, Brasil), objetos de pesquisa participante desenvolvida por estudo de casos múltiplos, sob o referencial teórico da vulnerabilidade e dos direitos humanos, em 2020. As condições socioeconômicas são distintas entre os territórios. A vulnerabilidade à infecção e à doença pelo coronavírus é relacionada a fatores individuais, sociais e programáticos: informações, percepções e possibilidades de proteção; convivência familiar/interpessoal, moradia, trabalho e violência; e acesso a cuidados de saúde e programas sociais. As redes de solidariedade, formadas principalmente por associações comunitárias e movimentos sociais, enfocam superar a fome, gerar renda e acessar direitos. Para a resposta social, é fundamental reconhecer as necessidades específicas, as experiências potentes e a centralidade do caminhar conjunto de sujeitos e coletivos em cada território.

This paper analyzes vulnerability and the tackling of the Covid-19 pandemic in 16 metropolitan territories of São Paulo and Baixada Santista (State of São Paulo, Brazil), objects of a participatory research developed in 2020 through a multiple-case study, in light of the theoretical framework of vulnerability and human rights. Socioeconomic conditions are different between territories. Vulnerability to coronavirus infection and disease is related to individual, social and programmatic factors: information, perceptions and possibilities of protection; family/interpersonal coexistence, housing, work and violence; and access to healthcare and social programs. Solidarity networks, formed mainly by community associations and social movements, focus on overcoming hunger, generating income and accessing rights. For the social response, it is essential to recognize specific needs, powerful experiences and the centrality of the joint walk of individuals and collectives in each territory.

Este artículo analiza la vulnerabilidad y el enfrentamiento a la pandemia de Covid-19 en 16 territorios metropolitanos de São Paulo y de la Región de la Baixada Santista (São Paulo, Brasil), objetos de investigación participante, desarrollada por estudio de casos múltiples, bajo el referencial teórico de la vulnerabilidad y de los derechos humanos, en 2020. Las condiciones socioeconómicas son distintas entre los territorios. La vulnerabilidad a la infección y enfermedad por el coronavirus se relaciona a factores individuales, sociales y programáticos: informaciones, percepciones y posibilidades de protección; convivencia familiar/interpersonal, vivienda, trabajo y violencia; y acceso a cuidados de salud y programas sociales. Las redes de solidaridad, formadas principalmente por asociaciones comunitarias y movimientos sociales, se enfocan en superar el hambre, generar renta y tener acceso a derechos. Para la respuesta social, es fundamental reconocer las necesidades específicas, las experiencias potentes y la centralidad del caminar conjunto de sujetos y colectivos en cada territorio.

https://doi.org/10.1590/interface.210125

Vulnerabilidade e resposta social à pandemia de Covid-19 em territórios metropolitanos de São Paulo e da Baixada Santista, SP, Brasil
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Nasser, Mariana Arantes

; Calazans, Marília Oliveira

; Fegadolli, Claudia

; Oliveira, Sandro Barbosa de

; Rodrigues, Joana de Fátima

; Costa, Rosangela Calado da

; Santos, Eduardo Henrique Moraes

; Zanchetta, Giovanna Moreira

; Furtado, Lumena Almeida Castro

Interface - Comunicação, Saúde, Educação

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2021, Volume 25 Suppl. 1 elocation e210125

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

https://doi.org/10.1590/interface.210125 245 downloads

Hesio Cordeiro no I Simpósio sobre Política Nacional de Saúde da Câmara de Deputados, 1979
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Rodrigues, Paulo Henrique de Almeida

Physis: Revista de Saúde Coletiva

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2021, Volume 31 N. 3 elocation e310303

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/s0103-73312021310303

10.

Hesio Cordeiro no I Simpósio sobre Política Nacional de Saúde da Câmara de Deputados, 1979
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Rodrigues, Paulo Henrique de Almeida

Physis: Revista de Saúde Coletiva

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2021, Volume 31 N. 3 elocation e310303

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/s0103-73312021310303

11.

Sensory characteristics of structured guava (Psidium guajava): comparison of optimized descriptive profile, cata and sensory acceptance methods
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COSTA, Juliana Nascimento da

; BRITO, Samuel Almeida

; LEAL, Amanda Rodrigues

; RODRIGUES, Delane da Costa

; NASCIMENTO, Luís Gustavo Lima

; FIGUEIREDO, Raimundo Wilane

; MATA, Paulina

; SOUSA, Paulo Henrique Machado de

Food Science and Technology

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dec 2020, Volume 40 Pages 496 - 502

Abstract: En | Text: En | PDF: En

Abstract This work aimed a sensory characteristics of structured guava elaborated with hydrocolloids agar and combinations of LA and HA gellan. The methods used were Optimized Descriptive Profile (ODP), CATA and Sensory Acceptance Tests. For the ODP, 18 semi-trained judges selected 12 sensory attributes and evaluated the samples using 9 cm unstructured scales. Sensory acceptance and CATA tests were performed by 100 untrained panelists. Sensory tests expressed medium acceptability indexes and similar results for all samples. The highest frequency CATA attributes were Homogeneous, Brightness, Pinkish red color, Guava aroma and Sour taste. The characteristics from ODP were Brightness, Sweet taste, Sour taste, Guava flavor, Firm and Sandy texture. Comparing the three methods, in the CATA and sensory acceptance, tasters did not identify differences between the samples in relation to the type of hydrocolloid, but with the ODP method they could achieve this.

https://doi.org/10.1590/fst.25819 854 downloads

12.

The case of eculizumab: litigation and purchases by the Brazilian Ministry of Health
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Caetano, Rosângela

; Rodrigues, Paulo Henrique Almeida

; Corrêa, Marilena C Villela

; Villardi, Pedro

; Osorio-de-Castro, Claudia Garcia Serpa

Revista de Saúde Pública

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2020, Volume 54 elocation 22

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

RESUMO OBJETIVOS O estudo examinou as aquisições de eculizumabe, um anticorpo monoclonal de alto custo utilizado no tratamento de doenças raras, pelos órgãos federais brasileiros, em termos das quantidades compradas, gastos e preços. MÉTODOS Foram analisadas compras de eculizumabe realizadas entre março de 2007 e dezembro de 2018, por meio de dados secundários extraídos do sistema de compras do governo federal (Siasg). Foram examinados o número de compras, quantidades adquiridas, número de doses diárias definidas por 1.000 habitantes por ano, gastos anuais e preços praticados. Os preços foram corrigidos pelo índice nacional de preços ao consumidor amplo para dezembro de 2018. Regressão linear foi utilizada para análises de tendência. RESULTADOS Todas as aquisições por órgãos federais foram realizadas pelo Ministério da Saúde. As compras se iniciaram em 2009, sendo efetuadas por dispensa de licitação e para atendimento de demanda judicial. Houve tendência crescente no número de compras e quantidades adquiridas ao longo do tempo. Foram realizadas 283 compras, totalizando 116.792 unidades adquiridas, 28,2% compradas em 2018. Os gastos totais contratados corrigidos somaram mais de R$ 2,44 bilhões. Após a aprovação do registro pela Agência Nacional de Vigilância Sanitária, o preço médio ponderado caiu aproximadamente 35%, para valores abaixo dos preços estabelecidos pela Câmara de Regulação do Mercado de Medicamentos. CONCLUSÃO O eculizumabe representou gastos extremamente significativos para o Ministério da Saúde no período. Todas as compras foram feitas para atendimento de demandas judiciais, fora do ambiente competitivo. Seu registro promoveu queda importante nos preços praticados. O estudo aponta a relevância do registro sanitário e da necessidade de monitoramento e auditoria permanentes das compras de medicamentos para atendimento de demandas judiciais.

ABSTRACT OBJECTIVES This study examined the purchases of eculizumab, a high-cost monoclonal antibody used in the treatment of rare diseases by Brazilian federal agencies, in terms of purchased quantities, expenditures, and prices. METHODS Eculizumab purchases made between March 2007 and December 2018 were analyzed, using secondary data extracted from the Federal Government Purchasing System (SIASG in Portuguese). The following aspects were assessed: number of purchases, purchased quantities, number of daily doses defined per 1,000 inhabitants per year, annual expenditures, and prices. The prices were adjusted by the National Broad Consumer Price Index for December 2018. Linear regression was used for trend analysis. RESULTS All acquisitions by federal agencies were made by the Brazilian Ministry of Health. The purchases began in 2009 with tender waiver to comply with legal demand. There was an increasing trend in the number of purchases and quantities acquired over time. Two hundred and eighty-three purchases were made, totaling 116,792 units purchased, 28.2% of them in 2018. The adjusted total expenses summed more than R$ 2.44 billion. After market approval by the Brazilian Health Regulatory Agency, the weighted average price fell approximately 35%, to values under the Medicines Market Chamber of Regulation established prices. CONCLUSION Eculizumab represented extremely significant expenditures for the Brazilian Ministry of Health during the period. All purchases were made to meet demands from lawsuits, outside the competitive environment. The market approval of eculizumab promoted an important price reduction. This study indicates the relevance of licensing and the need for permanent monitoring and auditing of drug purchases to meet legal demands.

https://doi.org/10.11606/s1518-8787.2020054001693

13.

Forage cactus (Opuntia ficus-indica Mill) meal in rabbit diets in the growth phase
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PASCOAL, Leonardo Augusto Fonseca

; SILVA, Kivia Alessandra Gouveia da

; WATANABE, Pedro Henrique

; BRITO, José Mares Felix

; SILVA, Jordanio Fernandes da

; DANTAS JUNIOR, Paulo Rodrigues

; SILVA, David Rwbystanne Pereira da

; BRITO, Mariany de Souza

; BEZERRA, Ana Patricia Almeida

; ALMEIDA, Jonathan Mádson dos Santos

Revista Brasileira de Saúde e Produção Animal

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2020, Volume 21 elocation e2121102020

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

RESUMO Foram realizados dois ensaios experimentais para avaliar a inclusão do farelo de palma forrageira em dietas para coelhos durante a fase de crescimento. No primeiro ensaio foram utilizados 14 coelhos machos Nova Zelândia vermelha, alojados em gaiolas metálicas, e distribuídos em delineamento inteiramente ao acaso, com dois tratamentos e sete repetições com um animal por unidade experimental. Foram determinadas a digestibilidade dos nutrientes e a energia digestível do farelo de palma pelo método da coleta total de fezes. O farelo de palma forrageira apresentou 92,24% de MS, 5,63% de PB e 2.347 kcal de ED/kg. No segundo ensaio foi testada a inclusão de 0, 10, 20 e 30% de farelo de palma forrageira na dieta de coelhos e avaliado o desempenho produtivo, as características de carcaça, vísceras e a viabilidade econômica. Para tanto, foram utilizados 40 coelhos machos da raça Nova Zelândia vermelha, distribuídos em gaiolas metálicas, em delineamento inteiramente ao acaso, com quatro tratamentos, cinco repetições e dois animais por unidade experimental. Não se observou influência (P>0,05) da inclusão em níveis do farelo de palma sobre o desempenho produtivo, as características de carcaça e a viabilidade econômica. O farelo de palma pode ser incluído em até de 30% na dieta de coelhos em crescimento.

ABSTRACT Two experimental tests were carried out to evaluate the inclusion of forage cactus meal in diets for rabbits during the growth phase. In the first test 14 male New Zealand red rabbits were used, housed in metal cages, and distributed in a completely randomly design with two treatments and seven replicates with one animal per experimental unit. The digestibility of the nutrients and the digestible energy of the forage cactus meal were determined by the total feces collection method. The forage cactus meal presented 92.24% of DM, 5.63% of CP and 2,347 kcal of DE/kg. In the second test the inclusion of 0, 10, 20 and 30% forage cactus meal in the rabbit diet was tested for productive performance, carcass characteristics, viscera and economic viability. Thus, 40 male rabbits of the New Zealand red breed were used, distributed in metal cages, completely random designed with four treatments, five replicates and two animals per experimental unit. No influence of inclusion levels (P>0.05) on performance variables, housing characteristics or economic viability was observed. The forage cactus meal can be included in up to 30% in the diets of growing rabbits.

https://doi.org/10.1590/s1519-99402121102020

14.

O processo de desmonte da Secretaria de Estado da Saúde do Rio de Janeiro e sua invisibilidade
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Peres, Ana Maria Auler Matheus

; Sant’Ana, Denise Rangel

; Rodrigues, Paulo Henrique de Almeida

Physis: Revista de Saúde Coletiva

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2020, Volume 30 N. 3 elocation e300315

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.1590/s0103-73312020300315

15.

Conjugated linoleic acid as a potential bioactive molecule to modulates gamete and embryo cryotolerance
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Freitas, Danielle Storino

; Lopes, Guilherme Antonio de Gouvêa

; Nascimento, Barbara Rodrigues

; Pereira, Luiza Aparecida Ansaloni Chagas

; Batista, Ribrio Ivan Tavares Pereira

; Campos Junior, Paulo Henrique Almeida

Ciência Animal Brasileira

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2020, Volume 21 elocation e-63574

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

Resumo O ácido linoleico conjugado (CLA) é uma mistura de isômeros posicionais do ácido linoleico encontrado em carne e laticínios de ruminantes. É um tipo de gordura trans muito utilizada por atletas para como suplemento alimentar devido a um suposto efeito de maximizar a utilização das reservas de gordura corporal. O interesse na suplementação de dietas e meios de cultura com o CLA é uma área emergente, exigindo estudos para elucidar seus benefícios nos parâmetros reprodutivos e na criopreservação. Dessa forma, o objetivo dessa revisão foi discutir os efeitos do CLA na criotolerância de oócitos, espermatozóides e embriões. Alguns estudos já demonstraram seu uso na criopreservação da linhagem germinativa. Entre esses, foi observado que a suplementação de CLA durante a maturação in vitro de oócitos pode aumentar sua viabilidade pós-congelamento e capacidade de desenvolvimento. Em relação ao uso de CLA no esperma, existem poucos estudos e seus resultados ainda são inconclusivos. Por último, estudos sobre a suplementação de CLA em meios de cultura de embriões mostraram resultados promissores, indicando que essa molécula bioativa é capaz de modular a captação de lipídios em blastômeros. No total, essas descobertas demonstram o potencial uso do CLA como uma molécula bioativa para melhorar a linha germinativa e a criotolerância ao embrião e abrir novas perspectivas no campo da reprodução humana e animal.

Abstract Conjugated linoleic acid (CLA) is a mixture of positional isomers of linoleic acid found in meat and dairy products from ruminants. It is a trans fat widely used by athletes as a food supplement, due to a supposed effect of maximizing the use of body fat reserves. The interest in diet and culture media supplementation with CLA is an emerging area, demanding studies in order to elucidate its benefits in the reproductive parameters, as well as in cryopreservation. Therefore, the aim of this review was to discuss the effects of CLA on the oocytes, sperm and embryos cryotolerance. Some studies have already demonstrated its use in cryopreservation of germline. Among those, it was observed that CLA supplementation during oocyte in vitro maturation can increase their viability post-freezing and developmental capacity. Regarding the use of CLA on sperm, there are few studies and their results are still inconclusive. Finally, studies about CLA supplementation on embryo culture media have shown promising results, indicating that this bioactive molecule is able to modulate lipid uptake on blastomeres. Altogether, these findings demonstrate the potential use of CLA as a bioactive molecule to improve germline and embryo cryotolerance and open new perspectives on human and animal reproduction field.

https://doi.org/10.1590/1809-6891v21e-63574

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