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Resumo Fundamento O nitrato inorgânico (NO3–) da dieta pode fornecer substrato fisiológico para reduzir o nitrito (NO2–) a óxido nítrico (NO) independente do endotélio. Estudos sugerem que o NO3– inorgânico tem efeitos benéficos na saúde cardiovascular. Objetivos Este estudo avaliou os efeitos agudos de 500 mL de suco de beterraba rico em nitrato (SB; contendo 11,5mmol NO3–) na pressão arterial e na função endotelial em pacientes hipertensos tratados. Métodos Estudo cruzado, randomizado, controlado por placebo foi realizado em pacientes hipertensos tratados (n=37; mulheres=62%) que foram submetidos à avaliação clínica e nutricional, avaliação dos parâmetros hemodinâmicos centrais e reatividade microvascular. O nível de significância foi p<0,05. Resultados A média de idade foi 59±7 anos e das pressões sistólica e diastólica foi de 142±10/83±9 mmHg. Houve aumento significativo na taxa de viabilidade subendocárdica (RVSE; 149±25 vs. 165±30%, p<0,001) e redução na duração da ejeção (DE; 37±4 vs. 34±4%, p<0,001) na fase beterraba, mas nenhuma diferença significativa de RVSE na fase controle. O % de aumento na perfusão (155 vs. 159%, p=0,042) cresceu significativamente na fase beterraba, o que não foi observado na fase controle. Na fase beterraba, a alteração da RVSE apresentou correlação significativa com a alteração da área sob a curva de hiperemia reativa pós-oclusiva (ASC-HRPO) (r=0,45, p=0,012). A mudança na DE mostrou uma correlação significativa com pico de perfusão pós-intervenção (r=-0,37, p=0,031) e ASC-HRPO (r=-0,36, p=0,046). Conclusão A ingestão aguda de SB por pacientes hipertensos resultou em melhora da função endotelial, que foi associada à maior viabilidade subendocárdica e desempenho na contração miocárdica.

Abstract Background The diet’s inorganic nitrate (NO3–) may provide a physiological substrate for reducing nitrate (NO2–) to NO independent of the endothelium. Studies suggest that inorganic NO3– has beneficial effects on cardiovascular health. Objective This study evaluated the acute effects of 500 mL nitrate-rich beetroot juice (BRJ; containing 11.5mmol NO3–) on blood pressure and endothelial function in treated hypertensive patients. Methods A randomized, placebo-controlled, crossover study was conducted in treated hypertensive patients (n=37; women=62%) who underwent clinical and nutritional evaluation and assessment of central hemodynamic parameters and microvascular reactivity. The significance level was p<0.05. Results The mean age was 59±7 years, and mean systolic and diastolic blood pressures were 142±10/83±9mmHg. There was a significant increase in the subendocardial viability ratio (SEVR; 149±25 vs. 165±30%, p<0.001) and reduction in ejection duration (ED; 37±4 vs. 34±4%, p<0.001) in the beetroot phase but no significant SEVR difference in the control phase. The % increase in perfusion (155 vs. 159 %, p=0.042) was significantly increased in the beetroot phase, which was not observed in the control phase. In the beetroot phase, the change in SEVR showed a significant correlation with the change in the area under the curve of post-occlusive reactive hyperemia (AUC-PORH) (r=0.45, p=0.012). The change in ED showed a significant correlation with the post-intervention perfusion peak (r=-0.37, p=0.031) and AUC-PORH (r=-0.36, p=0.046). Conclusions The acute ingestion of BRJ by hypertensive patients resulted in an improvement of endothelial function, which was associated with higher subendocardial viability and performance in myocardial contraction.

https://doi.org/10.36660/abc.20220209

Incidência de transtorno global do desenvolvimento em crianças: características e análise a partir dos CAPSi
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Tomazelli, Jeane

; Girianelli, Vania Reis

; Fernandes, Conceição Santos

Psicologia USP

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2023, Volume 34 elocation e210002

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

Resumo Este artigo descreve a incidência acumulada e as características das crianças de até 12 anos com transtorno global do desenvolvimento (TGD) atendidas no CAPSi. Realizou-se estudo transversal descritivo, utilizando o Registro de Ações Ambulatoriais de Saúde. Avaliou-se a incidência acumulada de TGD no período 2013-2019 e tendência temporal das características das crianças e do atendimento pelo método de Prais-Winsten. Identificaram-se 23.657 registros de primeiro atendimento, mas 10,8% sem seguimento. A incidência acumulada foi de 13,2/10.000, com ampla variação entre municípios e grandes regiões, embora vários sem registro de casos. Observou-se queda no percentual de primeiro atendimento, com incremento médio anual de 17,8%. A maioria das crianças foi atendida no município de residência (96,8%) e recebeu diagnóstico inicial de autismo infantil (30,6%), embora 54,0% sem TGD especificado no primeiro atendimento. Apenas 30,2% foram diagnosticadas até três anos de idade. A garantia do cuidado na atenção especializada e o diagnóstico precoce permanecem como desafios.

Abstract This article describes the accumulated incidence and characteristics of children until 12 years old with global developmental disorder (TGD) treated at CAPSi. A descriptive cross-sectional study was carried out using Register of Outpatient Health Actions. Cumulative incidence of TGD in the period 2013-2019 and the temporal trend of characteristics of children and care were evaluated using the Prais-Winsten method. It were identificated 23,657 records with first care, but 10.8% without follow-up. The cumulative incidence was 13.2/10,000, with wide variation between municipalities and large regions although several without record of cases. There was decrease in the percentage of first appointment, with an average annual increase of -17.8%. Most children were attended to in the municipality of residence (96.8%) and initially diagnosed as autism (30.6%), although 54.0% hadn’t TGD specified in the first appointment. Only 30.2% were diagnosed until three years old. Ensuring care in specialized care and early diagnosis remain challenges.

Resumen Este artículo describe la incidencia acumulada y características de los niños hasta 12 años con trastorno del desarrollo global (TGD) tratados en CAPSi. Se realizó un estudio descriptivo transversal, utilizando Registro de Acciones Ambulatorias de Salud. Se evaluó la incidencia acumulada de TGD en período 2013-2019 y tendencia temporal de características de niños y cuidado, utilizando método Prais-Winsten. Se identificaron 23.657 registros con primera asistencia, pero 10,8% sin seguimiento. La tasa acumulada fue 13,2/10.000, con amplia variación entre municipios y grandes regiones, aunque varias sin registro de casos. No hubo descenso en porcentaje de primeras visitas, con incremento medio anual del -17,8%. La mayoría de niños fueron atendidos en municipio de residencia (96,8%) y diagnosticados de autismo (30,6%), aunque el 54,0% no tenía TGD especificado en primera visita. Solo 30,2% fueron diagnosticados hasta los tres años de edad. Asegurar la atención en cuidados especiales y diagnóstico precoz temprano como desafíos.

https://doi.org/10.1590/0103-6564e210002

The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes
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Oliveira, João Antonio de Queiroz

; Cimini, Christiane

; Almeida, Vania

; Maia, Junia Xavier

; Resende, Raissa Eda

; Gualberto, Leticia Alves

; Santos, Pedro Henrique Lauar

; Gomes, Paulo R.

; Bonisson, Leonardo

; Paixão, Maria Cristina

; Costa, Janaina Moutinho

; Cardoso, Clareci Silva

; Santo, Karla

; Ribeiro, Antonio

; Martins, Maria Auxiliadora

; Marcolino, Milena S.

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20220050

Abstract: En | Text: En | PDF: En

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes.

https://doi.org/10.36660/ijcs.20220050

Profile of the leprosy endemic in the district of Murrupula, Nampula, Mozambique: A population-based study
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Ribeiro, Gabriela de Cássia

; Lages, Daniele dos Santos

; Lages, Ana Thereza Chaves

; Souza, Vânia Brito de

; Marega, Abdoulaye

; Lana, Francisco Carlos Félix

; Rocha, Manoel Otávio da Costa

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0321-2022

Abstract: En | Text: En | PDF: En

ABSTRACT Background: Leprosy is a neglected chronic infection caused by Mycobacterium leprae, that is curable. The magnitude of the disease and severity of the debilitation it causes renders leprosy a public health problem. This study aimed to analyze the endemic profile of leprosy in the Murrupula district and evaluate the socioeconomic, clinical, and serological profiles of leprosy contacts. Methods: A cross-sectional study of patients with leprosy diagnosed between 2013 and 2017 and their household and community contacts was conducted in Murrupula District, Nampula Province, Mozambique. Interviews, simplified dermatoneurological examinations, Mycobacterium leprae flow (ML Flow) tests, and Mitsuda tests were performed. Results: Most of the leprosy cases were multibacillary. The patients had some degree of physical disability. ML Flow positivity was more common in household contacts of the patients diagnosed with leprosy and in community individuals who spontaneously presented for testing. In total, 17 patients were diagnosed with leprosy. Conclusions: This study revealed an active chain of transmission, hidden prevalence, and operational deficiencies in leprosy surveillance and care. The results suggest that the implementation of a public health policy for leprosy prevention and control in Nampula Province is necessary. In future, the possibility of expanding the policy to the entire country should be considered.

https://doi.org/10.1590/0037-8682-0321-2022

Early diagnosis of autism and other developmental disorders, Brazil, 2013–2019
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Girianelli, Vania Reis

; Tomazelli, Jeane

; Silva, Cosme Marcelo Furtado Passos da

; Fernandes, Conceição Santos

Revista de Saúde Pública

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2023, Volume 57 elocation 21

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

RESUMO OBJETIVO Investigar os fatores associados ao diagnóstico precoce do autismo e de outros tipos de transtorno global do desenvolvimento (TGD) de crianças atendidas no Centro de Atenção Psicossocial Infantojuvenil do Sistema Único de Saúde, no período de 2013 a 2019, no Brasil. MÉTODOS Estudo transversal exploratório, com base nos dados do Registro das Ações Ambulatoriais de Saúde (RAAS) do primeiro atendimento de crianças de 1 a 12 anos. Foram estimados o risco relativo bruto (RRb) e ajustado (RRa), e respectivo intervalo de confiança de 95% (IC95%), utilizando o modelo de regressão de Poisson com estimativa de variância robusta. RESULTADOS Das 22.483 crianças incluídas no estudo, a maioria era do sexo masculino (81,9%), residia no mesmo município em que foi diagnosticada (96,8%) e na região Sudeste (57,7%). O diagnóstico precoce foi maior para autismo infantil (RRb= 1,48; IC95% 1,27–1,71), TGD sem designação de subtipo (RRb= 1,55; IC95% 1,34–1,80), outros TGD (RRb= 1,48; IC95% 1,21–1,81) e TGD não especificado (RRb= 1,44; IC95% 1,22–1,69) do que para autismo atípico. As crianças que residiam no mesmo município onde foi realizado o diagnóstico tiveram maior índice de diagnóstico precoce (RRb= 1,31; IC95% 1,10–1,55) do que as demais; bem como aquelas encaminhadas pela atenção básica (RRb= 1,51; IC95% 1,37–1,68) e por demanda espontânea (RRb= 1,45; IC95% 1,31–1,61) do que as oriundas de outros tipos de encaminhamento. O diagnóstico precoce foi maior a partir de 2014 e menor na região Norte quando comparada às demais. Na análise múltipla, a magnitude do RRafoi similar ao do RRb. CONCLUSÕES A identificação precoce de autismo e outros TGD tem melhorado no país, mas ainda representa cerca de 30% dos diagnósticos realizados. As variáveis incluídas no modelo foram significativas, mas ainda explicam pouco do diagnóstico precoce de crianças com autismo e outros TGD.

ABSTRACT OBJECTIVE To investigate the factors associated with the early diagnosis of autism and other types of pervasive developmental disorder (PDD) in children treated at the Psychosocial Care Center for Children and Adolescents of the Unified Health System, from 2013 to 2019,in Brazil. METHODS An exploratory cross-sectional study, based on data from the Record of Outpatient Health Actions (RAAS) of the first appointment of children aged 1 to 12 years. The gross (RRg) and adjusted (RRa) relative risks and respective 95% confidence intervals (95%CI) were estimated using the Poisson regression model with robust variance estimation. RESULTS Of the 22,483 children included in the study, the majority were male (81.9%), lived in the same municipality where they were diagnosed (96.8%) and in the Southeast region (57.7%). Early diagnosis was higher for childhood autism (RRg = 1.48; 95%CI 1.27–1.71) , PDD without subtype designation (RRg = 1.55; 95%CI 1.34–1.80), other PDD (RRg = 1.48; 95%CI 1.21–1.81) and PDD not otherwise specified (RRg = 1.44; 95%CI 1.22–1.69) than for atypical autism. Children residing in the same municipality where the diagnosis was made had a higher rate of early diagnosis (RRg = 1.31; 95%CI 1.10–1.55) than the others; as well as those referred by primary care (RRg = 1.51; 95%CI 1.37–1.68) and by spontaneous demand (RRg = 1.45; 95%CI 1.31–1.61) than those from other types of referral. Early diagnosis was higher from 2014 and lower in the North region than in the other regions. In the multiple analysis, the magnitude of RRa was similar to that of RRg. CONCLUSIONS Early identification of autism and other PDD has improved in Brazil, but it still represents about 30% of the diagnoses made. The variables included in the model were significant, but still explain little of the early diagnosis of children with autism and other PDD.

https://doi.org/10.11606/s1518-8787.2023057004710

Early diagnosis of autism and other developmental disorders, Brazil, 2013–2019
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Girianelli, Vania Reis

; Tomazelli, Jeane

; Silva, Cosme Marcelo Furtado Passos da

; Fernandes, Conceição Santos

Revista de Saúde Pública

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2023, Volume 57 elocation 21

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

https://doi.org/10.11606/s1518-8787.2023057004710

Planejamento e Dimensionamento da Força de Trabalho em Saúde no Brasil: avanços e desafios
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Carvalho, Desirée dos Santos

; Nascimento, Elisabet Pereira Lelo

; Carmona, Silvia Aparecida Maria Lutaif Dolci

; Barthmann, Vânia Maria Corrêa

; Lopes, Maria Helena Pereira

; Moraes, Júlio César de

Saúde em Debate

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dec 2022, Volume 46 N. 135 Pages 1215 - 1237

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

ABSTRACT This study aims to analyze the production of knowledge about Planning and Sizing of the Health Workforce (PDFTS) developed in Brazil, identifying models and methodologies that consider the Guidelines of the Unified Health System (SUS) for the constitution of regionalized care networks. This is an integrative review, including Brazilian studies and full text, in Portuguese, and available in the CAPES, BVS and Google Scholar databases. The searches returned 48,083 documents and, after selection with the PRISMA strategy, 62 studies published between 2011 and 2020 were included. Most of the analyzed productions approach the PDFTS with comparative analyzes between the estimated needs and the current availability, being more frequent the studies of only one professional category, with emphasis on nursing. The findings contribute to the debate on the essentiality of the health workforce for the conformation of networks, by demonstrating that the calculation methods favor the use of indicators and parameters related to the provision of services in specific health facilities, especially hospitals, not operationalizing aspects of regionalization and systemic integration of the Health Care Network.

RESUMO Este estudo visa a analisar a produção de conhecimento acerca do Planejamento e Dimensionamento da Força de Trabalho em Saúde (PDFTS) desenvolvida no Brasil identificando modelos e metodologias que consideram as diretrizes do Sistema Único de Saúde (SUS) para a constituição de redes de atenção regionalizadas. Trata-se de uma revisão integrativa, incluindo estudos brasileiros e com texto completo, em português, disponível nas bases de dados Capes, BVS e Google Acadêmico. As buscas retornaram 48.083 documentos e, após seleção com a ferramenta Prisma, foram incluídos 62 estudos publicados entre 2011 e 2020. A maioria das produções analisadas aborda o PDFTS com análises comparativas entre as necessidades estimadas e a disponibilidade atual, sendo mais frequentes os estudos de apenas uma categoria profissional, com destaque para a enfermagem. Os achados contribuem à promoção do debate sobre a essencialidade da força de trabalho em saúde para a conformação das redes, ao demonstrar que os métodos de cálculo privilegiam o uso de indicadores e parâmetros relacionados à oferta de serviços em estabelecimentos de saúde específicos, especialmente hospitais, não operacionalizando aspectos de regionalização e integração sistêmica da Rede de Atenção à Saúde.

https://doi.org/10.1590/0103-1104202213519

Planejamento e Dimensionamento da Força de Trabalho em Saúde no Brasil: avanços e desafios
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Carvalho, Desirée dos Santos

; Nascimento, Elisabet Pereira Lelo

; Carmona, Silvia Aparecida Maria Lutaif Dolci

; Barthmann, Vânia Maria Corrêa

; Lopes, Maria Helena Pereira

; Moraes, Júlio César de

Saúde em Debate

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dec 2022, Volume 46 N. 135 Pages 1215 - 1237

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

https://doi.org/10.1590/0103-1104202213519

O passado e o futuro da infeção por VIH: um caso clínico
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Leite, Gisela Santos

; Fernandes, Vânia

; Rocha, Rui

Revista Portuguesa de Medicina Geral e Familiar

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oct 2022, Volume 38 N. 5 Pages 512 - 515

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

Abstract The prognosis of the human immunodeficiency virus (HIV) infected patients has significantly improved over the last decades. On the one hand, with the development of antiretroviral therapy (ART), Kaposi sarcoma (KS) has become a rare complication. On the other hand, with the increase in life expectancy of this population, an increased risk of cardiovascular diseases, such as acute myocardial infarction (AMI), persists despite ART and that cannot be fully explained by traditional cardiovascular risk factors. The authors describe a case of an HIV-infected young male, without consistent ART, with a recent diagnosis of KS and AMI. This article highlights the facts that may have led to the occurrence of these diseases, showing that KS is not a disease of the past and demonstrating the risk of cardiovascular diseases in HIV-infected patients.

Resumo O prognóstico dos doentes com infeção pelo vírus da imunodeficiência humana (VIH) melhorou consideravelmente nas últimas décadas. Por um lado, com o aparecimento da terapia antirretroviral (TAR), o sarcoma de Kaposi (SK) passou a ser uma complicação rara na atualidade. Por outro, com o aumento da esperança média de vida desta população observa-se um risco acrescido de doenças cardiovasculares, como o enfarte agudo do miocárdio (EAM), que persiste mesmo com o tratamento e não pode ser explicado apenas pelos fatores de risco cardiovasculares tradicionais. Os autores descrevem um caso clínico de um jovem com infeção pelo VIH, sem realização de TAR de forma consistente, com diagnóstico recente de SK e EAM. Este artigo aponta factos que poderão ter conduzido à ocorrência destas doenças, mostrando que o SK não é uma doença que ficou no passado e salientando o risco atual de complicações cardiovasculares nos doentes com infeção por VIH.

https://doi.org/10.32385/rpmgf.v38i5.13121

10.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study
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Silva, Laís Araújo Tavares

; Oliveira, Maria Inês Couto de

; Costa, Ana Carolina Carioca da

; Santos, Samira Fernandes Morais dos

; Gama, Silvana Granado Nogueira da

; Fonseca, Vânia de Matos

Jornal de Pediatria

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sep 2022, Volume 98 N. 5 Pages 463 - 470

Abstract: En | Text: En | PDF: En

Abstract Objective To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. Method Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. Results In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. Conclusions Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

https://doi.org/10.1016/j.jped.2021.12.009

11.

Tolerance of cerrado baru tree (Dipteryx alata) submitted to different doses of glyphosate
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Bernardes, Amanda Munielly Alves

; Moura, Thamires Marques

; Alves, Estenio Moreira

; Dias, Maristela Aparecida

; Diniz, Vânia Sardinha dos Santos

; Santos, Darliane de Castro

Revista Ceres

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aug 2022, Volume 69 N. 4 Pages 470 - 475

Abstract: En | Text: En | PDF: En

ABSTRACT Baru tree (Dipteryx alata Vogel.) is a been an alternative to establish an Integration Crop-Livestock-Forestry Systems (ICLFS), combining native species preservation with sustainable food production. However, the management procedure of herbicides for weed control is one of the major limiting factors to include tree components within ICLFS. Thus, the study evaluated the tolerance of D. alata submitted to different concentrations of glyphosate on the plants, to make the introduction of this forest species in ICLFS. The treatments comprised different doses glyphosate: 0.0 (control); 960; 1920; 2880 and 3840 g a.e ha-1. Shoot height, stem diameter, shoot dry weight, root dry weight and total dry weight, as well as Dickson Quality Index and phytotoxicity were assessed. The phytotoxicity in plants varies according to the applied doses of glyphosate, with progressive yellowing in the leaves up to well-developed necrosis and leaf senescence in the highest doses. All doses tested reduced the biometric and qualitative attributes of D. alata seedlings, demonstrating that no treatment was selective, although the plants are tolerant at dose 960 g a.e ha-1 tested. Increases in doses of glyphosate do not cause the death of seedlings D. alata that shows a great potential to compose ICLFS.

https://doi.org/10.1590/0034-737x202269040012

12.

Transtorno do Desenvolvimento da Coordenação: desconhecido por pais e professores
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Santos, Viviane Aparecida Pereira dos

; Vieira, José Luiz Lopes

; Souza, Vânia de Fátima Matias de

; Ferreira, Luciana

Ensaio: Avaliação e Políticas Públicas em Educação

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jul 2022, Volume 30 N. 116 Pages 598 - 619

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

Resumo O estudo teve como objetivo analisar dificuldades de aprendizagem sob a perspectiva dos transtornos das habilidades motoras, a partir da percepção de pais e de professores considerando o comportamento motor, emocional, acadêmico e atividades diárias de crianças com provável Transtorno do Desenvolvimento da Coordenação (TDC). Participaram 42 pais, 32 professores e 42 pré-escolares. Como instrumentos foram utilizados o Movement Assessment Battery for Children-2 (MABC-2) e questionários de percepção dos pais e dos professores sobre o desenvolvimento da criança. Os dados foram analisados usando o teste Shapiro Wilk, Wilcoxon, “U” de Mann-Whitney e Regressão Logística Binária. Os resultados demonstraram que professores percebem melhor as dificuldades nas habilidades motoras das crianças com persistência do TDC (pTDC) ou variação do TDC (vTDC) e percebem melhor as dificuldades emocionais, acadêmicas e de atividades diárias. Conclui-se que os professores percebem melhor as dificuldades apresentadas por crianças com pTDC e a variação no diagnóstico do transtorno interfere na percepção da dificuldade motora das crianças.

Abstract The study aimed to analyze learning difficulties from the perspective of motor skills disorders considering the perception of parents and teachers about the motor, emotional, academic and daily activities of children with probable Developmental Coordination Disorder (DCD). 42 parents, 32 teachers and 42 preschoolers participated. As instruments, the Movement Assessment Battery for Children (MABC-2) and questionnaires for parents and teachers about child’s development were used. Data were analyzed using Shapiro Wilk, Wilkoxon, Mann-Whitney “U” test and Binary Logistic Regression. The results showed that teachers better understand the difficulties in motor skills of children with persistent DCD (pDCD) or variation on DCD (vDCD) and better understand the emotional, academic difficulties and the difficulties related to daily activities. In conclusion, teachers show a better perception of the difficulties presented by children with pDCD and the variation in the diagnosis of DCD interferes in the perception of the children’s motor difficulties.

Resumen El estudio tuvo como objetivo analizar las dificultades de aprendizaje desde la perspectiva de los trastornos de la motricidad, desde la percepción de padres y maestros considerando la conducta motora, emocional, académica y las actividades diarias de los niños con probable Trastorno de Coordinación del Desarrollo (TCD). Participaron 42 padres, 32 maestros y 42 niños en edad preescolar. Los instrumentos que utilizados fueron el Movement Assessment Battery for Children-2 (MABC-2) y cuestionarios sobre la percepción de padres y maestros sobre el desarrollo del niño. Los datos se analizaron mediante la prueba de Shapiro Wilk, Wilcoxon, “U” de Mann-Whitney y de Regresión Logística Binaria. Los resultados mostraron que los maestros perciben mejor las dificultades en las habilidades motoras de los niños con persistencia del TDC (pTDC) o variación del TDC (vTDC) y perciben mejor las dificultades emocionales, académicas y de actividades diarias. Se concluye que los docentes perciben mejor las dificultades que presentan los niños con pDCD y la variación en el diagnóstico del trastorno interfiere en la percepción de la dificultad motora de los niños.

https://doi.org/10.1590/s0104-40362021002902921

13.

Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19: Diretriz conjunta da Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia e Sociedade Brasileira de Reumatologia
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Falavigna, Maicon

; Stein, Cinara

; Amaral, José Luiz Gomes do

; Azevedo, Luciano Cesar Pontes de

; Belli, Karlyse Claudino

; Colpani, Verônica

; Cunha, Clóvis Arns da

; Dal-Pizzol, Felipe

; Dias, Maria Beatriz Souza

; Ferreira, Juliana Carvalho

; Freitas, Ana Paula da Rocha

; Gräf, Débora Dalmas

; Guimarães, Hélio Penna

; Lobo, Suzana Margareth Ajeje

; Monteiro, José Tadeu

; Nunes, Michelle Silva

; Oliveira, Maura Salaroli de

; Prado, Clementina Corah Lucas

; Santos, Vania Cristina Canuto

; Silva, Rosemeri Maurici da

; Sobreira, Marcone Lima

; Veiga, Viviane Cordeiro

; Vidal, Ávila Teixeira

; Xavier, Ricardo Machado

; Zavascki, Alexandre Prehn

; Machado, Flávia Ribeiro

; Carvalho, Carlos Roberto Ribeiro de

Revista Brasileira de Terapia Intensiva

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mar 2022, Volume 34 N. 1 Pages 1 - 12

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

RESUMO Objetivos: Há diversas terapias sendo utilizadas ou propostas para a COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é elaborar recomendações para subsidiar decisões sobre o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: Um grupo de 27 membros, formado por especialistas, representantes do Ministério da Saúde e metodologistas, integra essa diretriz. Foi utilizado o método de elaboração de diretrizes rápidas, tomando por base a adoção e/ou a adaptação de recomendações a partir de diretrizes internacionais existentes (GRADE ADOLOPMENT), apoiadas pela plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Foram geradas 16 recomendações. Entre elas, estão recomendações fortes para o uso de corticosteroides em pacientes em uso de oxigênio suplementar, para o uso de anticoagulantes em doses de profilaxia para tromboembolismo e para não uso de antibacterianos nos pacientes sem suspeita de infecção bacteriana. Não foi possível fazer uma recomendação quanto à utilização do tocilizumabe em pacientes hospitalizados com COVID-19 em uso de oxigênio, pelas incertezas na disponibilidade e de acesso ao medicamento. Foi feita recomendação para não usar azitromicina, casirivimabe + imdevimabe, cloroquina, colchicina, hidroxicloroquina, ivermectina, lopinavir/ ritonavir, plasma convalescente e rendesivir. Conclusão: Até o momento, poucas terapias se provaram efetivas no tratamento do paciente hospitalizado com COVID-19, sendo recomendados apenas corticosteroides e profilaxia para tromboembolismo. Diversos medicamentos foram considerados ineficazes, devendo ser descartados, de forma a oferecer o melhor tratamento pelos princípios da medicina baseada em evidências e promover economia de recursos não eficazes.

ABSTRACT Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use.

https://doi.org/10.5935/0103-507x.20220001-pt

14.

Ovarian Tissue Culture to Preserve Fertility in Transgender Male Patients after Hormonal Treatment
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Bottini, Alessandra Leal

; Reis, Vânia Marisia Santos Fortes dos

; Capp, Edison

; Silva, Ilma Simoni Brum da

; Kliemann, Lúcia Maria

; Corleta, Helena von Eye

Revista Brasileira de Ginecologia e Obstetrícia

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mar 2022, Volume 44 N. 3 Pages 251 - 257

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

Resumo Objetivo Avaliar as características reprodutivas e histológicas de tecido ovariano cultivado a fresco de pacientes transexuais masculinos. Métodos Estudo experimental in vitro e piloto, no qual amostras foram coletadas durante a cirurgia de redesignação de sexo para pacientes transexuais masculinos. O córtex ovariano foi cortado em fragmentos de 2mm, 3mm, e 4mm, e colocado em placa de 96 poços própria para cultivo nos dias 0, 2, 4, 6 e 8, quando a histologia foi analisada. Resultados Hiperplasia estromal foi observada em todas as amostras, e não esteve associada à obtenção de folículos primordiais ou primários. A redução periférica no número de células também foi um achado recorrente. Folículos primordiais e primários foramidentificados com padrão heterogêneo emfragmentos domesmo paciente e em fragmentos de pacientes diferentes, não sendo encontrados folículos em estágios mais avançados de desenvolvimento (secundários e antrais). Houve associação entre o diâmetro dos fragmentos ovarianos e a identificação dos folículos primários (p=0,036). O número de dias de cultura esteve associado a sinais histológicos de lesão tecidual nos fragmentos (p=0,002). O número total de folículos identificados nas amostras de 2mm de diâmetro foi significativamente menor do que nas de 4mm de diâmetro (p=0,031). Conclusão O diâmetro de 4mm parece ser mais adequado para a cultura de tecido ovariano com a vantagem de fácil manejo. Mesmo após exposição prolongada à testosterona, os fragmentos ovarianos apresentavam folículos primordiais e primários, e manteve a viabilidade ao longo dos dias de exposição à cultura. No futuro, o congelamento da cortical do ovário de pacientes transgêneros que se submeterão à cirurgia de redesignação sexual poderia ser uma opção interessante para a preservação da fertilidade.

Abstract Objective To evaluate the reproductive and histological characteristics of fresh cultured ovarian tissue from transgender male patients. Methods An in vitro pilot study in which samples were collected during sex reassignment surgery for transgender male patients. The ovarian cortex was cut into fragments of 2 mm, 3mm, and 4 mm, and placed in a 96-well plate suitable for cultivation at days 0, 2, 4, 6, and 8, when the histology was analyzed. Results Stromal hyperplasia was observed in all samples, and it was not associated with the obtainment of primordial or primary follicles. Peripheral reduction in cell count was also a recurrent finding. Primordial and primary follicles were identified with a heterogeneous pattern in fragments from the same patient and from different patients, and follicles in more advanced stages of development (secondary and antral) were not found. There was an association between the diameter of the ovarian fragments and the identification of primary follicles (p=0.036). The number of days in culture was associated with histological signs of tissue damaging in the fragments (p=0.002). The total number of follicles identified in the samples with 2mm in diameter was significantly lower than in those that measured 4mm in diameter (p=0.031). Conclusion A diameter of 4mm is suitable for ovarian tissue culture with the benefit of ease of handling. Even after prolonged exposure to testosterone, the ovarian fragments presented primordial and primary follicles, maintaining viability throughout the days they were exposed to the culture. Freezing the ovarian cortex of transgender patients who will undergo surgery for gender reassignment would be an interesting option, in the future, for the preservation of fertility.

https://doi.org/10.1055/s-0042-1742410

15.

Influence of clinical factors, IL4 and IL6 genes polymorphisms in functional healing in late replantation
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Roskamp, Liliane

; Souza, Cleber Machado

; Ignácio, Sergio Aparecido

; Perin, Camila Paiva

; Mattos, Natanael Henrique Ribeiro

; Sunye, Isabela Roskamp

; Santos, Letícia Capote

; Westphalen, Vania Portela Ditzel

; Jacob, Carolina da Silveira

; Baratto-Filho, Flares

Brazilian Dental Journal

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feb 2022, Volume 33 N. 1 Pages 13 - 21

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

Resumo Para investigar a influência genética em uma amostra de dentes reimplantados, é necessário observar os fenótipos extremos, como os dentes que sofreram cura funcional e os extraídos devido à reabsorção radicular externa severa. Assim, este estudo teve como objetivo investigar a associação da idade dos pacientes, desenvolvimento radicular dos dentes, assim como o meio de transporte até o reimplante e polimorfismos nos genes da interleucina 4 (IL4) e da interleucina 6 (IL6) com dentes que apresentaram cura funcional ou extração, em um grupo cujas técnicas de reimplante não seguiu a International Association of Dental Traumatology (IADT) 2012. Foram incluídos 43 dentes avulsionados e reimplantados que não seguiram as diretrizes do IADT, e tiveram cura funcional ou foram extraídos. As radiografias periapicais utilizadas para este estudo foram feitas logo após o reimplante dentário e após 1 ano. Para a análise genotípica dos genes IL4 e IL6, foi extraído DNA de células da mucosa oral. PCR em tempo real realizou a análise dos polimorfismos dos genes. As variáveis clínicas e genéticas foram analisadas pelos testes Qui-quadrado e “Z”. Valores de p <0,05 foram considerados significativos. Os resultados mostraram que a cura ou perda dos dentes está associada ao meio de armazenamento e polimorfismos no gene rs2243268 da IL-4. Como conclusão, o alelo C rs2243268 do gene IL4 pode ter uma relação positiva com a cura functional do dente reimplantado. Manter o dente seco está associado a uma perda rápida de dentes avulsionados e reimplantados que não seguiram o IADT 2012.

Abstract To investigate the genetic association in a sample of replanted teeth, it is necessary to observe the extreme phenotypes, such as, teeth that underwent functional healing and those extracted due to severe external root resorption. Thus, this study aimed to investigate the association of age of the patients, root development, storage media, and polymorphisms in the interleukin 4 (IL4) and interleukin 6 (IL6) genes with teeth that presented extreme outcomes, as functional healing or extraction, in a group whose replantation techniques did not follow the International Association of Dental Traumatology (IADT) 2012 guidelines. Forty-three avulsed and replanted teeth that did not follow IADT 2012 guidelines and underwent functional healing or were extracted were included. Periapical radiographs employed for this study were taken soon after tooth replantation and after 1 year. For genotypic IL4 and IL6 genes analysis, DNA of oral mucosa cells was extracted. Real-time- PCR performed for genotyping polymorphisms in IL4 and IL6 genes. Clinical and genetic variables were analyzed by the Chi-square test and the “Z” test. P values < .05 were considered significant. The results showed that functional healing and extraction were associated with storage media and with the rs2243268 of IL- 4 gene polymorphisms. As conclusion, the C rs2243268 allele of IL4 gene may have a positive relationship with functional healing teeth that were replanted not following the 2012 IADT guidelines. Keeping the tooth dry is associated to a fast loss of avulsed and replanted teeth after 1-year follow-up.

https://doi.org/10.1590/0103-6440202204683

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