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Surgical outcomes of primary intraocular lens implantation for the treatment of aphakia in pediatric cataracts in the Brazilian public health system
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Lottelli, Antonio Carlos

; Silva, Virgilio Figueiredo

; Queiroz, Marjorie Fornazier Nascimento

Arquivos Brasileiros de Oftalmologia

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may 2023, Volume 86 N. 3 Pages 210 - 216

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

ABSTRACT Purpose: To evaluate primary intraocular lens implantation in the treatment of children’s aphakia in the Brazilian public health system and compare the outcomes among different age groups. Methods: Children aged 0-12 years old with unilateral or bilateral congenital/developmental cataracts and underwent primary intraocular lens implantation were included. Results: A total of 108 eyes from 68 children were evaluated, and the children were divided into four age groups (<7 months [mo]; 7 mo-2 years old [y/o]; 2-5 y/o, and >5 y/o) were evaluated. Nineteen eyes (17.59%) presented visual axis opacification as a postoperative complication, which was more frequently observed in the <7 mo age group (37.93%). The difference was significant between the <7 mo and >5 y/o age groups (p=0.002). Visual axis opacification was divided into two categories: pupillary membrane and lens cell proliferation. Eight eyes presented pupillary membrane, whereas 14 showed lens cell proliferation. Out of eight eyes with pupillary membrane, seven occurred in the <7 mo age group. The difference between the <7 mo age group and the 2-5 y/o or >5 y/o age group was significant (p=0.01). Lens cell proliferation was more frequent in the <7 mo and 2-5 y/o age groups, but the difference was significant only between the < 7 mo age group and >5 y/o age group (p=0.040). Glaucoma and glaucoma suspect cases were not observed during the follow-up period. Conclusions: The main complication found in the study was visual axis opacification, which had a higher incidence in children operated on or before the age of 7 months.

RESUMO Objetivo: Avaliar o implante de lente intraocular primária para tratamento da afacia pediátrica no Sistema Único de Saúde (SUS) e comparar os resultados em diferentes faixas etárias. Métodos: Foram incluídas crianças com catarata congênita e do desenvolvimento unilateral ou bilateral de 0-12 anos de idade e submetidas a implante de lente intraocular primária. Resultados: Cento e oito olhos de 68 crianças divididas em quatro grupos de idade (<7m; 7m-2a; 2-5a e > 5a) foram avaliados. Dezenove olhos (17,59%) apresentaram opacificação do eixo visual como complicação pós-operatória. Essa complicação foi mais frequente na faixa etária <7 meses (37,93%). A diferença foi significativa entre os grupos de idade <7 meses e > 5 anos (p=0,002). A opacificação do eixo visual foi dividida em duas categorias: membrana pupilar e proliferação de células do cristalino. Oito olhos apresentaram membrana pupilar e 14 proliferação de células do cristalino. Dos oito olhos com membrana pupilar, sete ocorreram na faixa etária <7 meses. A diferença entre o grupo de idade <7 meses e os grupos de 2-5 anos e > 5 anos foi significativa (p=0,01). A proliferação de células do cristalino foi mais frequente nos grupos de idade <7 meses e 2-5 anos, mas significativa apenas quando comparados o grupo de idade <7 meses com o grupo> 5 anos de idade (p=0,040). Glaucoma e suspeitos de glaucoma não foram observados durante o acompanhamento. Conclusões: A principal complicação encontrada no estudo foi a opacificação do eixo visual. Sua incidência foi maior em crianças operadas antes dos 7 meses de idade.

https://doi.org/10.5935/0004-2749.20230045

Aeromonassp. in freshwater fish and antimicrobial resistance: emerging pathogen
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Silva, Alessandra Almeida da

; Leite, Jackeline Nerone

; Winter, Helen Cristine Leimann

; Furtado, Thamara Larissa de Jesus

; Morais, Natália Marjorie Lazaron

; Faria, Rozilaine Aparecida Pelegrine Gomes de

; Nascimento, Edgar

; Ritter, Daniel Oster

; Lanzarin, Marilu

Ciência Rural

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2023, Volume 53 N. 7 elocation e20220088

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

RESUMO: Aeromonas sp. são bactérias presentes naturalmente no ecossistema aquático e apresentam potencial patogênico, sendo considerados patógenos emergentes em humanos e animais. Ainda, causam perdas consideráveis em piscicultura e, através da água, podem também contaminar inúmeros alimentos. Diante disso o objetivo do trabalho foi quantificar e analisar o perfil de resistência aos antimicrobianos de bactérias do gênero Aeromonas sp. em peixes. Um total de 72 amostras foram adquiridas, sendo duas variedades de peixes (peixe de couro Pseudoplatystoma fasciatum x Leiarius marmoratus e os peixes redondos Colossoma macropomum x Piaractus mesopotamicus e Colossoma macropomum x Piaractus brachypomus), dois tipos (fresco e congelado) e de três estabelecimentos comerciais (supermercado, feira e peixaria). As 55 culturas isoladas de Aeromonas foram avaliadas quanto ao perfil de resistência aos antimicrobianos pelo método de difusão em disco. Os valores encontrados na quantificação de Aeromonas sp. variaram de 4,22 a 6,00 Log UFC/g, e foram identificadas dez espécies diferentes, sendo A. eucrenophila, A. hydrophila, A. caviae, A. media, A. jandaei, A. veronii bv. sobria, A. trota, A. schubertii, A. veronii bv. veronii e A. shigelloides. Entre os 55 isolados, 64,45% apresentaram resistência a Ampicilina-sulbactam, 75% foram sensíveis à gentamicina e ciprofloxacina. Concluiu-se que 100% das amostras avaliadas estavam contaminadas por Aeromonas sp. podendo apresentar risco à saúde do consumidor visto que estas podem ser agentes etiológicos de Doenças Transmitidas por Alimentos (DTAs). O perfil de resistência aos antimicrobianos comprovou a resistência a ampicilina e apresentou multirresistência a diferentes classes de antimicrobianos, demonstrando um problema relacionado à opção de antimicrobiano para tratamento no caso do desenvolvimento de alguma doença.

ABSTRACT: The bacteria Aeromonassp. are naturally reported in aquatic ecosystems and possess pathogenic potential, being considered as emerging pathogens in humans and animals. They also cause considerable losses in fish farming and, through water, can contaminate numerous foods. This study quantified and analyzed the antimicrobial resistance profile of Aeromonassp. in fish. A total of 72 samples of two fish varieties (leather fish, Pseudoplatystomafasciatumx Leiariusmarmoratusand round fish, Colossomamacropomumx Piaractusmesopotamicusand Colossomamacropomumx Piaractusbrachypomus) were purchased from two types of sources (fresh and frozen) and three commercial establishments (supermarket, market, and fishmonger). The 55 isolated Aeromonascultures were evaluated for their antimicrobial resistance profile by the disc diffusion method. Upon quantification, the count of Aeromonassp. ranged from 4.22 to 6.00 Log CFU/g; ten different species, including A. eucrenophila, A. hydrophila, A. caviae, A. media, A. jandaei, A. veroniibv. sobria, A. trota, A. schubertii, A. veroniibv. veronii, and A. shigelloides, were identified. Among the 55 isolates, 64.45% showed resistance to Ampicillin-sulbactam, and 75% were sensitive to gentamicin and ciprofloxacin. It was concluded that 100% of the evaluated samples were contaminated by Aeromonassp., which may present a risk to consumer health since bacteria can be etiological agents of Foodborne Diseases. The antimicrobial resistance profile showed resistance to ampicillin and multi-resistance to different classes of antimicrobials, demonstrating problems with choosing an antimicrobial for treatment of any disease.

https://doi.org/10.1590/0103-8478cr20220088

A simple and cost-effective diagnostic of Macrophomina phaseolina on watermelon by direct PCR
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Silva, Suzana Marjorie Freire e

; Aquino, Gilsivan Sales Medeiros de

; Costa, Tálison Eugênio da

; Brito, Anna Luisa de Carvalho

; Negreiros, Andréia Mitsa Paiva

; Sales Júnior, Rui

; Nagata, Tatsuya

; Holanda, Ioná Araújo Santos

Acta Scientiarum. Agronomy

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2023, Volume 45 elocation e56141

Abstract: En | Text: En | PDF: En

ABSTRACT. Macrophomina phaseolina (Tassi) Goid is the causal agent of charcoal rot and vine decline in cucurbits such as watermelon. Molecular methods have been used for rapid identification. However, a large number of steps used reduces its applicability. This study aimed to detect M. phaseolina in watermelon from producing areas in Northeastern Brazil by direct PCR. Plant tissue samples were collected from seven producing areas and the DNA was extracted using the CTAB method. Amplifications were performed by direct PCR using the MpKFI/MpKRI primers, then the PCR products were subjected to agarose gel electrophoresis and sequenced. Amplicons of 350 bp were observed in stem tissue samples from three areas. The identity of the samples was confirmed by sequencing. This study represents the first molecular diagnosis of M. phaseolina associated with watermelon in Northeastern Brazil. The methodology presented here can be applied for a reliable and simple diagnosis of the pathogen in other crops.

https://doi.org/10.4025/actasciagron.v45i1.56141

Assessment of the regenerative potential of macro-porous chitosan-calcium simvastatin scaffolds on bone cells
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GALLINARI, Marjorie de Oliveira

; BORDINI, Ester Alves Ferreira

; STUANI, Vitor de Toledo

; CASSIANO, Fernanda Balestrero

; MELO, Camila Correa da Silva Braga de

; ALMEIDA, Juliano Milanezi de

; CINTRA, Luciano Tavares Ângelo

; DE SOUZA COSTA, Carlos Alberto

; SOARES, Diana Gabriela

Brazilian Oral Research

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2023, Volume 37 elocation e018

Abstract: En | Text: En | PDF: En

Abstract This study evaluated the bioactive potential of a macro-porous chitosan scaffold incorporated with calcium hydroxide (CH-Ca) and functionalized with bioactive doses of simvastatin (SV) for bone tissue regeneration. Initially, the bioactive dose of SV in osteoblastic cells (SAOS-2) was determined. For the direct contact experiment, SAOS-2 cells were plated on scaffolds to assess cell viability and osteogenic differentiation. The second assay was performed at a distance using extracts from scaffolds incubated in culture medium to assess the effect of conditioned medium on viability and osteogenic differentiation. The initial screening showed that 1 μM SV presented the best biostimulating effects, and this dose was selected for incorporation into the CH-Ca and pure chitosan (CH) scaffolds. The cells remained viable throughout the direct contact experiment, with the greatest cell density in the CH-Ca and CH-Ca-SV scaffolds because of their higher porosity. The CH-Ca-SV scaffold showed the most intense bio-stimulating effect in assays in the presence and absence of osteogenic medium, leading to an increased deposition of mineralized matrix. There was an increase in the viability of cells exposed to the extracts for CH-Ca, CH-SV, and CH-Ca-SV during the one-day period. There was an increase in ALP activity in the CH-Ca and CH-Ca-SV; however, the CH-Ca-SV scaffold resulted in an intense increase in the deposition of mineralized nodules, approximately 56.4% at 7 days and 117% at 14 days, compared with CH (control). In conclusion, functionalization of the CH-Ca scaffold with SV promoted an increase in bioactivity, presenting a promising option for bone tissue regeneration.

https://doi.org/10.1590/1807-3107bor-2023.vol37.0018

Family Nurse Practitioners: an exploratory study
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Melo, Marjorie Dantas Medeiros

; Silva, Isabelle Pereira da

; Freitas, Luana Souza

; Mesquita, Simone Karine da Costa

; Sonenberg, Andrea

; Costa, Isabelle Katherinne Fernandes

Revista da Escola de Enfermagem da USP

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2023, Volume 57 elocation e20220362

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

ABSTRACT Objective: To understand Family Nurse Practitioners’ practice, educational process and policy in the United States. Method: This is an exploratory, quantitative and qualitative study, developed in 2019 based on clinical observations and interviews with seven Family Nurse Practitioners in the state of New York. The interviews were transcribed and analyzed by the researcher through the observations made and also by the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software. The research was approved under Opinion IRB19-49. Results: Three content partitions emerged in the Descending Hierarchical Classification: 1) Being a nurse practitioner; 2) Educational paths and possibilities for action; and 3) Being political: a path to transformation. It was possible to describe skills and competencies considered outstanding in relation to other professional categories, points of improvement in their educational background and the importance of political representation and being active in role performance. Conclusion: This study highlights the similarities with the nurse working in Primary Care in Brazil and serves as a subsidy in the process of implementing this category in Brazilian Primary Care.

RESUMEN Objetivo: Comprender la práctica, el proceso educativo y la política de las Enfermeras de Familia de Práctica Avanzada en los Estados Unidos. Método: Estudio exploratorio, cuantitativo y cualitativo, desarrollado en 2019 a partir de observaciones clínicas y entrevistas con siete enfermeras de práctica familiar avanzada en el estado de Nueva York. Las entrevistas fueron transcritas y analizadas por el investigador a través de las observaciones realizadas y también por el software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires. La investigación fue aprobada bajo la Opinión IRB19-49. Resultados: Surgieron tres particiones de contenido en la Clasificación Jerárquica Descendente: 1) Ser Enfermero de Práctica Avanzada; 2) Rutas Educativas y posibilidades de acción; y 3) Ser político: un camino hacia la transformación. Fue posible describir competencias y habilidades consideradas sobresalientes en relación a otras categorías profesionales, puntos de mejora en su formación y la importancia de la representación política y ser activo en el desempeño de la función. Conclusión: La realización de este estudio destaca las similitudes con el enfermero que actúa en la Atención Primaria en Brasil y sirve como un subsidio en el proceso de implementación de esta categoría en la Atención Primaria brasileña.

RESUMO Objetivo: Compreender sobre a prática, processo educacional e política dos Enfermeiros de Prática Avançada da Família dos Estados Unidos. Método: Estudo exploratório, quanti-qualitativo, desenvolvido em 2019 a partir de observações clínicas e entrevistas com sete Enfermeiros de Prática Avançada da Família no estado de Nova Iorque. As entrevistas foram transcritas e analisadas pela pesquisadora mediante as observações realizadas e também pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionneires. A pesquisa foi aprovada sob Parecer IRB19-49. Resultados: Três partições de conteúdo emergiram na Classificação Hierárquica Descendente: 1) O ser Enfermeiro de Prática Avançada; 2) Rotas Educacionais e possibilidades de atuação; e 3) Ser político: um caminho para transformação. Foi possível descrever competências e habilidades consideradas destaque em relação a outras categorias profissionais, pontos de melhorias na sua formação educacional e a importância da representação política e do ser ativo no desempenho da função. Conclusão: A realização deste estudo realça as similaridades com o enfermeiro atuante na Atenção Primária no Brasil e serve como subsídio no processo de implementação dessa categoria na Atenção Primária brasileira.

https://doi.org/10.1590/1980-220x-reeusp-2022-0362en

Association of salivary alpha-2-macroglobulin with glycemia and glycated hemoglobin in type 2 diabetes mellitus: a systematic review and meta-analysis study
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Caixeta, Douglas Carvalho

; Pennisi, Pedro Rogério Camargos

; Moura, Douglas Vieira

; Nunes, Marjorie Adriane Costa

; Espindola, Foued Salmen

; Blumenberg, Cauane

; Paranhos, Luiz Renato

; Sabino-Silva, Robinson

Sao Paulo Medical Journal

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dec 2022, Volume 140 N. 6 Pages 818 - 828

Abstract: En | Text: En | PDF: En

Abstract BACKGROUND: Chronically elevated alpha-2-macroglobulin (A2MG) in the blood has been correlated with diabetes and the HbA1c profile; however, no systematic review has been conducted to evaluate the association of A2MG salivary levels and glycemia or HbA1c levels in diabetes mellitus type 2 (DM2) patients. OBJECTIVE: To evaluate whether A2MG salivary levels are related to the glycemia or HbA1c levels in DM2 patients. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia (UFU), Brazil. METHODS: Eight databases were used as research sources. The eligibility criteria included studies that reported data regarding mean salivary A2MG and the correlation between glycemia and/or HbA1c levels of DM2 subjects (uncontrolled and well-controlled) and non-diabetic subjects. The risk of bias of the studies selected was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for use in JBI systematic reviews. Pooled correlation coefficients were estimated using the Hunter-Schmidt method. Study estimates were weighted according to their sample size, and heterogeneity was calculated using the chi-square statistic. RESULTS: Four studies on DM2 patients were included in this systematic review after careful analysis of 1482 studies. Three studies compared A2MG with HbA1c and glycemia. Overall, the correlation between A2MG and HbA1c was strong (r = 0.838). In contrast, the correlation between A2MG and glycemia was low (r = 0.354). CONCLUSION: The strong association between HbA1C and salivary A2MG suggests that this salivary protein has the potential to be a surrogate for HbA1C, if corroboratory further evidence is obtained through large-scale studies.

https://doi.org/10.1590/1516-3180.2021.0816.r2.19052022

Leitura e apropriação em Adília, poeta-colecionadora
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Sales, Paulo Alberto da Silva

; Alves, Ida

Alea: Estudos Neolatinos

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aug 2022, Volume 24 N. 2 Pages 215 - 231

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

Resumo Análise da poesia de Adília Lopes e discussão sobre como o gesto de leitura, segundo a perspectiva do arquivo contemporâneo, desconstrói os significados originais para a criação de novos acontecimentos textuais. Nos processos de reescrituras adilianas, destacam-se as práticas de apropriação e desvio de arquivos que revelam modos distintos de leitura. O deslocamento de citações, o mosaico de fragmentos de discursos e de memórias constitui uma poética sampleada, bem como a figuração de uma poeta-colecionadora. Demonstração de como, em sua escrita, o gesto de remontagem e de reproposição citacional promove, por meio do desvio irônico, uma poética do “gênio não-original”, como analisa Marjorie Perloff, e/ou uma “escrita não-original”, na perspectiva de Kenneth Goldsmith, bem como um trabalho de leitura, como pensa Roland Barthes.

Abstract This paper presents an analysis of Adília Lopes’ poetry, arguing how the act of reading, from the perspective of the contemporary archive, deconstructs the original meanings to create new textual events. In Adília’s rewriting processes, the appropriation and deviation practices of archives that reveal many different ways of reading stand out. The displacement of quotations and the mosaic of discourse fragments and memories constitute a sampled poetic as well as a figuration of a collector poet. It demonstrates how, in her writing, the act of reassembling and repurposing quotations promotes, through ironic deviation, a poetics of “unoriginal genius”, as proposed by Marjorie Perloff, and/or a “uncreative writing”, as in Kenneth Goldsmith’s perspective, or or even a reading work, following Roland Barthes’ notion.

Resumen Análisis de la poesía de Adília Lopes discutiendo cómo el gesto de lectura, desde la perspectiva del archivo contemporáneo, pasa a hacer la desconstrucción de los significados originales para crear nuevos acontecimientos textuales. En los procesos de reescrituras adilianas, se subrayan las prácticas de apropiación y desvíos de archivos que revelan distintos modos de lectura. El desplazamiento de citaciones, el mosaico de fragmentos de discursos y de las memorias constituye una poética sampleada, así como la figuración de una poeta-coleccionista. Demostración de cómo, en su escrita, el gesto de reensamblaje y de reproposición citacional promueve, por medio de la desviación irónica, una poética del “genio no original” como muestra Marjorie Perloff, y/o una “escrita no-original”, de acuerdo con la perspectiva de Kenneth Goldsmith, así como un trabajo de lectura, como piensa Roland Barthes.

https://doi.org/10.1590/1517-106x/202224212

Public hearings at the Brazilian Supreme Court: from strategic litigation to resolution
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Silva, Eduardo Moreira da

; Ribeiro, Antonio Carlos Andrade

; Marona, Marjorie

; Magalhães, Lucas Fernandes de

Opinião Pública

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aug 2022, Volume 28 N. 2 Pages 462 - 486

Resumo O artigo busca avançar na agenda de investigações sobre o poder judiciário, aproximando as pesquisas sobre resolução de conflitos nos tribunais constitucionais àquelas sobre a mobilização de leis por grupos de interesse e movimentos sociais. As Audiências Públicas (APs) realizadas pelo Supremo Tribunal Federal são analisadas como arenas estratégicas de processamento de temas contenciosos nas quais atores diversos têm oportunidades de contribuir com as práticas jurídicas. O objetivo central do artigo é identificar os mecanismos de conexão e de transmissão das deliberações presentes nas audiências públicas realizadas pelo Supremo Tribunal Federal (STF) no período de 2007 a 2019. O problema de pesquisa foi formulado com o propósito de se investigar e analisar como a sociedade civil atua no âmbito do Supremo Tribunal Federal. O resultado do artigo confirma as organizações da sociedade civil como principal conector das APs realizadas no STF, pois representam cerca de 40% das organizações presentes, simultaneamente, em mais de duas audiências.

We intend to advance the research agenda on the judiciary by bringing research on conflict resolution in constitutional courts closer to that on the mobilization of laws by interest groups and social movements. The Public Hearings (PAs) held by the Supreme Court are analyzed as strategic arenas for processing contentious issues in which diverse actors have opportunities to contribute to legal practices. The central objective of the article is to identify the mechanisms of connection and transmission of deliberations present in the public hearings held by the Supreme Court (STF) in the period from 2007 to 2019. The research problem was formulated with the purpose of investigating and analyzing how civil society acts within the Supreme Court. Finally, this article’s main result confirms civil society organizations as the main connector of the APs held at the STF, as they represent about 40% of the organizations present, simultaneously, in more than two hearings.

Resumen El artículo busca avanzar en la agenda de investigaciones sobre el Poder Judicial integrando las investigaciones sobre resolución de conflictos en los tribunales constitucionales con aquellas sobre la movilización de leyes por grupos de interés y movimientos sociales. Las Audiencias Públicas (AP) realizadas por la Suprema Corte Federal (STF) son analizadas como espacios estratégicos para la tramitación de asuntos contenciosos en los que diferentes actores tienen oportunidades de contribuir a las prácticas legales. El objetivo principal del artículo es identificar los mecanismos de conexión y transmisión de las deliberaciones presentes en las audiencias públicas celebradas por el STF en el período de 2007 a 2019. El problema de investigación se formuló con el propósito de investigar y analizar cómo la sociedad civil opera dentro del ámbito de la Corte Suprema Federal. El resultado del artículo confirma que las organizaciones de la sociedad civil son el principal conector de las Audiencias Públicas realizadas en el STF, ya que representan alrededor del 40% de las organizaciones presentes, simultáneamente, en más de dos APs.

Résumé L'article cherche à faire progresser l'agenda des enquêtes sur le pouvoir judiciaire en intégrant les recherches sur la résolution des conflits dans les cours constitutionnelles à celles sur la mobilisation des lois par les groupes d'intérêt et les mouvements sociaux. Les audiences publiques (AP) organisées par la Cour fédérale suprême sont analysées comme des arènes stratégiques pour le traitement des questions litigieuses dans lesquelles différents acteurs ont la possibilité de contribuer aux pratiques juridiques. L'objectif principal de l'article est d'identifier les mécanismes de mise en relation et de transmission des délibérations présentes lors des auditions publiques tenues par le Tribunal Fédéral (STF) entre 2007 et 2019. Le problème de recherche a été formulé dans le but d'enquêter et d'analyser comment la société opère dans le cadre de la Cour suprême fédérale. Le résultat du article confirme que les organisations de la société civile sont le principal connecteur des auditions publiques tenues au STF, puisqu'elles représentent environ 40% des organisations présentes, simultanément, dans plus de deux AP.

https://doi.org/10.1590/1807-01912022282462

Association of salivary alpha-2-macroglobulin with glycemia and glycated hemoglobin in type 2 diabetes mellitus: a systematic review and meta-analysis study
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Caixeta, Douglas Carvalho

; Pennisi, Pedro Rogério Camargos

; Moura, Douglas Vieira

; Nunes, Marjorie Adriane Costa

; Espindola, Foued Salmen

; Blumenberg, Cauane

; Paranhos, Luiz Renato

; Sabino-Silva, Robinson

Sao Paulo Medical Journal

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2022, N. ahead

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-3180.2021.0816.r2.19052022

10.

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF CROHN’S DISEASE IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)
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IMBRIZI, Marcello

; BAIMA, Júlio Pinheiro

; AZEVEDO, Matheus Freitas Cardoso de

; ANDRADE, Adriana Ribas

; QUEIROZ, Natália Souza Freitas

; CHEBLI, Júlio Maria Fonseca

; CHEBLI, Liliane Andrade

; ARGOLLO, Marjorie Costa

; SASSAKI, Ligia Yukie

; PARRA, Rogerio Serafim

; QUARESMA, Abel Botelho

; VIEIRA, Andrea

; DAMIÃO, Adérson Omar Mourão Cintra

; MORAES, Antonio Carlos da Silva

; FLORES, Cristina

; ZALTMAN, Cyrla

; VILELA, Eduardo Garcia

; MORSOLETTO, Eloá Marussi

; GONÇALVES FILHO, Francisco de Assis

; PENNA, Francisco Guilherme Cancela e

; SANTANA, Genoile Oliveira

; ZABOT, Gilmara Pandolfo

; PARENTE, José Miguel Luz

; COSTA, Marcia Henriques de Magalhães

; ZERÔNCIO, Marco Antonio

; MACHADO, Marta Brenner

; CASSOL, Ornella Sari

; KOTZE, Paulo Gustavo

; FRÓES, Renata de Sá Brito

; MISZPUTEN, Sender Jankiel

; AMBROGINI JUNIOR, Orlando

; SAAD-HOSSNE, Rogério

; COY, Cláudio Saddy Rodrigues

Arquivos de Gastroenterologia

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2022, Volume 59 Suppl. 1 Pages 20 - 50

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

ABSTRACT Background: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn’s disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. Objective: To guide the safest and effective medical treatments of adults with CD. Methods: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.

RESUMO Contexto: A doença inflamatória intestinal (DII) é uma doença imunomediada que inclui a doença de Crohn (DC) e a retocolite ulcerativa. A DC é caracterizada por um envolvimento intestinal transmural da boca ao ânus com sintomas recorrentes e remitentes que podem levar a danos intestinais progressivos e incapacidade ao longo do tempo. Objetivo: Orientar os tratamentos médicos mais seguros e eficazes de adultos com DC. Métodos: Este consenso foi desenvolvido por autores que representam gastroenterologistas e cirurgiões brasileiros especialistas em doenças colorretais (GEDIIB, Organização Brasileira de Doença de Crohn e Colite). Uma revisão sistemática das evidências mais recentes foi realizada para apoiar as recomendações/declarações. Todas as recomendações e declarações incluídas foram endossadas em um painel Delphi modificado pelas partes interessadas e especialistas em DII com uma concordância de pelo menos 80% ou mais. Resultados e conclusão: As recomendações médicas (intervenções farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso é direcionado a clínicos gerais, gastroenterologistas e cirurgiões interessados em tratar e gerenciar adultos com DC e apoia a tomada de decisões de companhias de seguro de saúde, agências reguladoras e líderes ou administradores de instituições de saúde.

https://doi.org/10.1590/s0004-2803.2022005s1-02

11.

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)
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BAIMA, Júlio Pinheiro

; IMBRIZI, Marcello

; ANDRADE, Adriana Ribas

; CHEBLI, Liliane Andrade

; ARGOLLO, Marjorie Costa

; QUEIROZ, Natália Sousa Freitas

; AZEVEDO, Matheus Freitas Cardoso de

; VIEIRA, Andrea

; COSTA, Marcia Henriques de Magalhães

; FRÓES, Renata de Sá Brito

; PENNA, Francisco Guilherme Cancela e

; QUARESMA, Abel Botelho

; DAMIÃO, Aderson Omar Mourão Cintra

; MORAES, Antonio Carlos da Silva

; SANTOS, Carlos Henrique Marques dos

; FLORES, Cristina

; ZALTMAN, Cyrla

; VILELA, Eduardo Garcia

; MORSOLETTO, Eloá

; GONÇALVES FILHO, Francisco de Assis

; SANTANA, Genoile Oliveira

; ZABOT, Gilmara Pandolfo

; PARENTE, José Miguel Luz

; SASSAKI, Ligia Yukie

; ZERÔNCIO, Marco Antonio

; MACHADO, Marta Brenner

; CASSOL, Ornella Sari

; KOTZE, Paulo Gustavo

; PARRA, Rogerio Serafim

; MISZPUTEN, Sender Jankiel

; COY, Cláudio Saddy Rodrigues

; AMBROGINI JUNIOR, Orlando

; CHEBLI, Júlio Maria Fonseca

; SAAD-HOSSNE, Rogério

Arquivos de Gastroenterologia

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2022, Volume 59 Suppl. 1 Pages 51 - 84

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

ABSTRACT Background: Inflammatory bowel diseases are immune-mediated disorders that include Crohn’s disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. Objective: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. Methods: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn’s Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

RESUMO Contexto: As doenças inflamatórias intestinais são doenças imunomediadas que incluem a doença de Crohn (DC) e a retocolite ulcerativa (RCU). A RCU é uma doença progressiva que acomete a mucosa colorretal causando sintomas debilitantes levando a alta morbidade e incapacidade laboral. Como consequência da inflamação crônica do cólon, a RCU também está associada a um risco aumentado de câncer colorretal. Objetivo: Este consenso visa fornecer orientações sobre o manejo médico mais eficaz de pacientes adultos com RCU. Métodos: As recomendações do consenso foram desenvolvidas por gastroenterologistas e cirurgiões colorretais referências no Brasil (membros da Organização Brasileira para Doença de Crohn e Colite [GEDIIB]). Uma revisão sistemática, incluindo as evidências mais recentes, foi conduzida para apoiar as recomendações. Todas as recomendações foram endossadas pelas partes interessadas/especialistas em doença inflamatória intestinal usando um Painel Delphi modificado. O nível de concordância para alcançar consenso foi de 80% ou mais. Resultados e conclus ão: As recomendações médicas (farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso foi direcionado a clínicos gerais, gastroenterologistas e cirurgiões que tratam pacientes com RCU e apoia os processos de tomada de decisão por companhias de seguro de saúde, agências reguladoras, líderes institucionais de saúde e administradores.

https://doi.org/10.1590/s0004-2803.2022005s1-03

12.

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease
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Rotta, Carlos Mateus

; Drago, Stephanie

; Sousa Jr, Afonso Henrique da Silva e

; Martinez, Carlos Augusto Real

; Bernardino, Marjorie Cristina da Cruz

Journal of Coloproctology (Rio de Janeiro)

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jul 2021, Volume 41 N. 3 Pages 234 - 241

Abstract: En | Text: En | PDF: En

Abstract The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with highmucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence. Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD.

https://doi.org/10.1055/s-0041-1735544 13 downloads

13.

Evidências de validade da Escala de Segurança Alimentar e Nutricional para adolescentes (ESANa)
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Vale, Marjorie Rafaela Lima do

; Santos, Walberto Silva dos

; Pontes Junior, José Airton de Freitas

; Diniz, Renata Belizário

; Ávila, Maria Marlene Marques

Ciência & Saúde Coletiva

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jan 2021, Volume 26 N. 1 Pages 255 - 264

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

Resumo O objetivo do trabalho foi desenvolver uma escala válida e fidedigna para a avaliação de insegurança alimentar e nutricional especificamente em adolescentes. A versão inicial da escala foi composta por duas subescalas: percepção de insegurança alimentar e percepção de segurança nutricional. Os itens elaborados foram submetidos à análise de conteúdo por peritos em segurança alimentar e nutricional (n = 4) e à análise semântica por adolescentes selecionados por conveniência e oriundos da população alvo (n=20). Após ajustes, a versão final da escala foi aplicada junto a adolescentes escolares (n = 425) com idade entre 12 e 18 anos (m = 14,32±0,96; CV = 6,7%). Após realização de análise fatorial exploratória, um modelo de dois fatores foi o que se mostrou mais adequado. As subescalas avaliadas apresentaram valores modestos do coeficiente alfa (0,69 e 0,60, respectivamente). Consumo diário de frutas, verduras e refrigerantes se mostrou significativamente associado a escores mais elevados na escala de percepção de segurança alimentar e nutricional. Sugere-se a viabilidade de combinar itens com base no acesso a alimentos com outros relacionados a atitudes e práticas de alimentação saudável de modo a obter um retrato mais aproximado das necessidades dos adolescentes e melhor orientar políticas públicas.

Abstract This study aimed to develop a valid and reliable scale for assessing food and nutritional insecurity, specifically in adolescents. The initial version of the scale consisted of two subscales: perception of food insecurity and perception of nutritional security. The items were submitted to content analysis (n = 4) by a group of food and nutrition security experts, and semantic analysis (n = 20) by a group of adolescents conveniently sampled from the target population. After adjustments, the final version of the scale was applied to adolescent students (n = 425) aged 12 to 18 years (m = 14.32±0.96; CV = 6.7%). A two-factor model was the most appropriate after performing exploratory factor analysis. The subscales showed modest values of the alpha coefficient (0.69 and 0.60, respectively). Daily consumption of fruits, vegetables and soft drinks was significantly associated with higher scores in the food and nutrition security perception scale. Therefore, it is recommended to combine food access-based items with other aspects related to attitudes and behaviors towards healthy eating in order to achieve a more accurate picture of adolescent’s needs and better guide public policies.

https://doi.org/10.1590/1413-81232020261.35892018 986 downloads

14.

Evidências de validade da Escala de Segurança Alimentar e Nutricional para adolescentes (ESANa)
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Vale, Marjorie Rafaela Lima do

; Santos, Walberto Silva dos

; Pontes Junior, José Airton de Freitas

; Diniz, Renata Belizário

; Ávila, Maria Marlene Marques

Ciência & Saúde Coletiva

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2021, Volume 26 N. 1 Pages 255 - 264

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

https://doi.org/10.1590/1413-81232020261.35892018

15.

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study
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Gonçalves, Fabio Augusto Rodrigues

; Besen, Bruno Adler Maccagnan Pinheiro

; Lima, Clarice Antunes de

; Corá, Aline Pivetta

; Pereira, Antônio José Rodrigues

; Perazzio, Sandro Félix

; Gouvea, Christiane Pereira

; Fonseca, Luiz Augusto Marcondes

; Trindade, Evelinda Marramon

; Sumita, Nairo Massakazu

; Duarte, Alberto José da Silva

; Lichtenstein, Arnaldo

; Bonfa, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

; Perondi, Beatriz

; Miethke-Morais, Anna

; Montal, Amanda C.

; Harima, Leila

; Fusco, Solange R. G.

; Silva, Marjorie F.

; Rocha, Marcelo C.

; Marcilio, Izabel

; Rios, Izabel Cristina

; Kawano, Fabiane Yumi Ogihara

; Jesus, Maria Amélia de

; Kallas, Ésper George

; Carmo, Carolina

; Tanaka, Clarice

; Souza, Heraldo Possolo de

; Marchini, Julio F. M.

; Carvalho, Carlos

; Ferreira, Juliana C.

; Levin, Anna Sara Shafferman

; Oliveira, Maura Salaroli

; Guimarães, Thaís

; Lázari, Carolina dos Santos

; Sabino, Ester

; Magri, Marcello M. C.

; Barros-Filho, Tarcisio E. P.

; Francisco, Maria Cristina Peres Braido

; Costa, Silvia F.

Clinics

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2021, Volume 76 elocation e3547

Abstract: En | Text: En | PDF: En

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

https://doi.org/10.6061/clinics/2021/e3547

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