Abstract Despite having an organized mental health law and policy, a majority of patients with depression remain underreported and undertreated in Brazil. The study aimed to quantitatively map and identify the deficiencies in patient journey touchpoints in terms of awareness, screening, diagnosis, treatment, adherence, and control for depression in Brazil using a semi-systematic approach highlighting the knowledge gaps in the existing literature. A structured search of Embase, MEDLINE, and BIOSIS databases was conducted to identify the relevant studies published in English, Portuguese, and Spanish from 2006 to 2021. An unstructured search was also conducted on Google or government websites with no restrictions. To address the data gaps, anecdotal data were also considered. Weighted or simple means were calculated for the pooled data. Of 3175 articles retrieved, 10 articles met the inclusion criteria. Synthesized evidence indicates that the pooled prevalence of depression in Brazil ranged from 4.1% to 21.8%; 42.4% of patients had awareness of depression, 37.5% underwent screening, 18.7% had a diagnosis, and 54.4% received treatment. No data on adherence and control were available. The study findings highlight the need for more research to accurately estimate the common patient journey touchpoints for depression to achieve better clinical outcomes in Brazil.

Abstract The purpose of this in vitro study was to test the hypothesis that fluoride treatment can prevent dental erosion on fluorotic enamel of different severities. It followed a 3×2 factorial design, considering a) fluorosis severity: sound (TF0, Thylstrup-Fejerskov Index), mild (TF1-2), moderate (TF3-4); and b) fluoride treatment: 0 (negative control) and 1150ppmF. Human molars with the three fluorosis severities (n=16, each) were selected and randomly assigned to the two fluoride treatments (n=8). Enamel blocks (4×4mm) were prepared from each tooth and subjected to a dental erosion cycling model, for 10 days. The daily cycling protocol consisted of erosive challenges (1% citric acid, pH 2.4), interspersed by periods of immersion in artificial saliva, and three 2-minute treatments with either 0 or 1150ppm F. The enamel volume loss (mm3) was calculated by subtracting values obtained by microtomography before and after cycling. Two-Way ANOVA showed no significant interaction between fluorosis severity and fluoride treatment (p=0.691), and no significant effect for either fluorosis severity (TF0 mean±standard-deviation: 13.5(10-2±0.42(10-2, TF1-2: 1.50(10-2±0.52(10-2, TF3-4: 1.24(10-2±0.52(10-2, p=0.416) or treatment (0ppmF: 1.49(10-2±0.53(10-2; 1150ppmF: 1.21(10-2±0.42(10-2; p=0.093), when evaluated independently. Considering the limitations of this in vitro study, the presence and severity of fluorosis in enamel do not appear to affect its susceptibility to dental erosion. Fluoride treatment was not effective in preventing the development of dental erosion in both sound and fluorotic enamel substrates under our experimental conditions.

Resumo Este estudo in vitro foi testou a hipótese de que o tratamento com flúor pode prevenir a erosão dentária no esmalte fluorótico de diferentes severidades. O objetivo deste estudo foi: investigar o efeito protetor dos fluoretos contra a erosão e abrasão simuladas no esmalte fluorótico. Seguiu um desenho fatorial 3×2, considerando a) severidade da fluorose em 3 níveis: hígido (TF0, Índice Thylstrup-Fejerskov), suave (TF1-2), moderada (TF3-4); b) tratamento com flúor: 0 (controle negativo) e 1150ppmF. Molares humanos com as três severidades de fluorose (n=16, cada) foram selecionados e distribuídos aleatoriamente para os dois tratamentos com flúor (n=8). Blocos de esmalte (4×4mm) foram preparados a partir de cada dente e submetidos a um modelo de ciclo de erosão dentária, por 10 dias. O protocolo de ciclagem diária consistiu em seis desafios erosivos de 5 minutos (1% de ácido cítrico, pH 2,4), intercalados por seis períodos de imersão em saliva artificial e três tratamentos de 2 minutos com 0 ou 1150ppmF. O volume do esmalte perdido foi calculado subtraindo o perfil superficial 3D obtido por microtomografia antes e depois da ciclagem. A ANOVA de dois fatores não mostrou interação significativa entre a severidade da fluorose e o tratamento com flúor (p = 0,691) e nenhum efeito significativo para a severidade da fluorose (TF0 média+/desvio padrão: 13,5(10-2±0,42(10-2, TF1-2: 1,50(10-2±0,52(10-2, TF3-4: 1,24(10-2±0,52(10-2, p=0,416) ou tratamento (0: 1,49(10-2±0,53(10-2; 1150ppmF: 1,21(10-2±0,42(10-2, p=0,093), quando avaliados independentemente. Considerando as limitações deste estudo in vitro, a presença e severidade da fluorose no esmalte não parece afetar sua suscetibilidade à erosão dentária. O tratamento com flúor não foi eficaz na prevenção do desenvolvimento da erosão dentária em esmalte hígido e fluorótico, sob as condições experimentais utilizadas.

Abstract This research aimed to evaluate the economic viability of different scenarios for the first thinning in Khaya ivorensis monocultures and present an estimate of age and thinning intensity that provide a higher invested capital return. There were carried out 576 simulations considering different implementation and maintenance costs, ages for first thinning, thinning intensities, and recipes for standing wood sale. The Net Present Value (NPV) and Internal Rate of Return (IRR) were calculated. The minimum price for standing wood, which all simulations were economically feasible, was 1 638 R$ m-3 for 10% thinning intensity, from 819 R$ m-3 to 20%, from 546 R$ m-3 for 30%, and 410 R$ m-3 for 40%. The simulations that maximized the NPV values were those with thinning prediction at five years of age. The percentage planning of thinned volume can be carried out by adopting economic criteria such as NPV and IRR. To obtain a return from the capital invested from the first thinning at five years of age, the percentage estimate from the thinned volume can be obtained according to the standing wood sale price for different minimum rates of attractiveness.

Resumo O objetivo da presente pesquisa foi avaliar a viabilidade econômica de diferentes cenários para a realização do primeiro desbaste em monocultivos de Khaya ivorensis e apresentar uma estimativa de idade e intensidade de desbaste que proporcionem maior retorno de capital investido. Foram realizadas 576 simulações considerando diferentes custos de implantação e manutenção, idades para primeiro desbaste, intensidades de desbaste e receitas para a venda de madeira em pé. Calcularam-se o Valor Presente Líquido (VPL) e Taxa Interna de Retorno (TIR). O preço mínimo da madeira em pé para o qual todas as simulações foram viáveis economicamente foi de 1 638 R$ m-3 para uma intensidade de desbaste de 10%, de 819 R$ m-3 para 20%, de 546 R$ m-3 para 30% e 410 R$ m-3 para 40%. As simulações que maximizaram os valores de VPL foram aquelas com previsão de desbaste aos 5 anos de idade. O planejamento do percentual de volume desbastado pode ser realizado adotando critérios econômicos como o VPL e a TIR. Para que haja retorno do capital investido logo no primeiro desbaste aos 5 anos idade, a estimativa percentual do volume desbastado pode ser obtida em função do preço de venda da madeira em pé para diferentes taxas mínimas de atratividade.

Resumo Introdução: Nas últimas duas décadas, a abordagem de tratamento de aneurisma da aorta abdominal (AAA) mudou drasticamente de cirurgia aberta para cirurgia endovascular. A diminuição de cirurgia de AAA convencional , open aneurysm repair (OAR), levanta preocupações relativamente à competência dos futuros cirurgiões vasculares para executar este procedimento complexo e de alto risco. O principal objetivo deste estudo foi avaliar as tendências de tratamento de AAA entre internos de Cirurgia Vascular, ao longo de 15 anos, a nível nacional. Métodos: Identificação dos médicos que terminaram o internato de Angiologia e Cirurgia Vascular entre 2002 e 2017, inclusive, a nível nacional e colheita dos dados através da consulta dos currículos para a prova final de conclusão do internato complementar. Foram avaliados o total de cirurgias por AAA, tanto por OAR e por EVAR e contabilizadas aquelas realizadas como 1º cirurgião. A correlação entre o número de cirurgias abertas de AAA e o ano de conclusão do internato complementar foi testada usando o coeficiente de correlação de Spearman. Resultados: Em Portugal, de 2002-2017, apesar de não se verificar variabilidade no número total de OAR realizados, verificou-se um decréscimo marcado naqueles realizados como 1º cirurgião (rho=-0,363; P<0.02). No final do internato em 2007, um interno de Cirurgia Vascular realizava em média 15 casos de OAR e em 2007 a média foi de apenas 7 casos. Por outro lado, constatou-se um aumento marcado no número total de procedimentos de EVAR (rho=0,478; P<0.02) bem como aqueles realizados como 1ºcirurgião (rho=0,540; P<0.01). Conclusão: O presente estudo revela que os internos de Cirurgia Vascular, a nível nacional, se encontram expostos a progressivamente menos casos de OAR e verifica-se uma diminuição significativa nos procedimentos de OAR como 1º cirurgião.

Abstract Introduction: Surgical site infections are associated with devastating consequences in vascular surgery patients but the data on Methicillin Resistant Staphylococcus aureus (MRSA) infection among those remains scant and conflicting. Most vascular surgery antibiotic prophylaxis assume that all patients submitted to surgery are tested prior to the intervention or that all patients with risk factors for MRSA are presumed to be colonized. However, the costs associated with testing all patients are not negligible, and most of the vascular surgery patients have risk factors for MRSA colonization. The purpose of this study was to evaluate the burden of MRSA clinical infection and its outcome and to adjust clinical practice accordingly. Methods: A retrospective analysis of clinical data from all patients with MRSA isolations that were submitted to vascular surgery in the year 2019 was conducted. The primary endpoint was in-hospital mortality. Secondary endpoints were timing of infection (pre-existent infection or post-surgical infection), need for ICU and length of hospital stay. Results: Out of 1681 patients admitted for surgery in the year 2019 in the vascular surgery ward, only 21 had clinical infection with positive MRSA isolates. All the patients had risk factors for MRSA colonization. Seventeen were admitted for PAD (Rutherford grade 5 or 6). Eight patients had post-operatory infections, whilst the remaining presented with MRSA infection prior to the intervention. Post-operatory infections ranged from superficial incisional in three patients, deep incisional in one patient, and organ/space/prosthesis infection in four patients (of the last group, two had prosthesis infection). There were five deaths, of which two were unrelated to the infection. Of the three deaths probably infection-related, all were post-operatory surgical site infections, and all were organ/space/prosthesis infections (one with prosthesis infection). There was no patient admitted to the ICU that survived. The mean hospital stay was increased by 26 days (31 days, 95% CI, 19-43). Conclusion: Infection by MRSA was less frequent than expected in our population, which may mean that colonization might be smaller than expected. Pre-operative infection was almost always related to chronic wounds and did not increase the risk of post-operative wound infection or death, contrary to post-operative infection, which seems to significantly increase mortality.

Abstract Introduction: Phlegmasia cerulea (PC) is a severe form of deep vein thrombosis. In the setting of massive venous thrombosis and severe ischemia, catheter-directed thrombolysis (CDT) or trombectomy is mandatory. We report three cases of women with PC managed with venous thrombectomy after failure of CDT. Case reports: 1: 20 years-old, with recent intake of oral contraceptive, referred with acute onset of limb swelling, pain and a cold left lower extremity associated with foot pallor, paresthesia and numbness. Doppler ultrasound revealed occlusive thrombosis of the entire deep venous system and the great saphenous vein (GSV). Anticoagulation (AC) and CDT were started. However due to increasing levels of transaminases, creatine kinase and myoglobin, CTD was stopped and venous thrombectomy was proposed. A retrievable inferior vena cava filter (IVC) was implanted and venous surgical trombectomy. The completion venography showed a Cockett compression that was treated with stenting of the left iliac vein. Thrombophilia tests were positive for anticardiolipin antibodies an hyperhomocysteinemia. At 3-years follow-up, the patient is asymptomatic and under AC. The 3-year Doppler showed normal patency for the iliac stent and a mild femoropopliteal vein insuffiency. 2: 19 year-old, taking oral contraceptives, with acute onset of PCD with acute thrombus in the left iliac, femoral, popliteal veins. CDT was started at admittance but stopped after two days because of very low values of serum fibrinogen and persistence of occlusive thrombus in the iliac vein. A retrievable IVC filter was placed and the thrombus removed with surgical thrombectomy. Phlebography showed no significant residual thrombus and no signs of compression were present. At 1 month follow-up, the patient presented without leg edema or venous claudication symptoms. Thrombophilia testing is awaited. 3: 54 year-old who presented with low back pain, worsening left leg pain and swelling with a cyanosed and colder foot. At doppler ultrasound there were monophasic arterial flow in the left leg. After exclusion of arterial embolism, the first therapeutic approach was CDT, but it was also stopped due to very low fibrinogen levels and an ineffective thrombus lysis in venography controls. After implantation of a retrievable IVC, surgical thrombectomy via femoral vein was performed, with successful thrombus removal. Venography showed Cockett syndrome and a stent was implanted. At 6 months the patient remained without major symptoms, and Doppler confirmed stent patency with non residual obstruction or venous insufficiency. Conclusion: Awareness and timely diagnosis of phlegmasia cerulea is necessary to ensure prompt intervention to prevent loss of limb. When CDT is not effective, surgical thrombectomy remains successfully alternative. Iliac venous stenting complement is also crucial to treat associated Cockett syndrome. Endovascular thrombectomy devices may be a reasonable alternative to surgical thrombectomy.

RESUMO: O girassol produz aquênios e óleo de qualidade, além de servir para produção de silagem, forragem e biodiesel. A modelagem de crescimento permite conhecer o padrão de crescimento da cultura e otimizar o manejo. O objetivo deste trabalho foi caracterizar o crescimento da cultivar de girassol Rhino por meio dos modelos Logístico e Gompertz e fazer considerações a respeito do manejo com base em pontos críticos. Os dados utilizados são oriundos de três ensaios de uniformidade com a cultivar de girassol confeiteiro Rhino, conduzidos na área experimental da Universidade Federal de Santa Maria, Campus Frederico Westphalen, na safra 2019/2020. Foram realizadas 14, 12 e 10 avaliações semanais de altura em 10 plantas, respectivamente, no primeiro, segundo e terceiro ensaio. Os dados foram ajustados em função da soma térmica acumulada. Os parâmetros foram estimados por meio do método dos mínimos quadrados ordinários, usando o algoritmo de Gauss-Newton. A qualidade de ajuste dos modelos aos dados foi medida pelo coeficiente de determinação ajustado, critério de determinação de Akaike, critério bayesiano de informação, e por meio da não linearidade intrínseca e paramétrica. Foram determinados os pontos de inflexão (IP), máxima aceleração (MAP), máxima desaceleração (MDP) e desaceleração assintótica (ADP). As análises estatísticas foram realizadas com Microsoft Office Excel® e o software R. Os modelos descreveram de forma satisfatória a curva de crescimento da altura do girassol, fornecendo parâmetros com interpretações práticas. O modelo Logístico apresenta melhor qualidade de ajuste, sendo o mais adequado para caracterização da curva de crescimento. Os pontos críticos estimados fornecem informações importantes para o manejo da cultura. As plantas daninhas devem ser controladas até o MAP. As aplicações de fertilizantes em cobertura devem ser realizadas entre MAP e IP. O ADP é um indicador de maturidade, após atingir este ponto, as plantas podem ser colhidas para a produção de silagem sem perda de volume e qualidade.

ABSTRACT: Sunflower produces achenes and oil of good quality, besides serving for production of silage, forage and biodiesel. Growth modeling allows knowing the growth pattern of the crop and optimizing the management. The research characterized the growth of the Rhino sunflower cultivar using the Logistic and Gompertz models and to make considerations regarding management based on critical points. The data used come from three uniformity trials with the Rhino confectionery sunflower cultivar carried out in the experimental area of the Federal University of Santa Maria - Campus Frederico Westphalen in the 2019/2020 agricultural harvest. In the first, second and third trials 14, 12 and 10 weekly height evaluations were performed on 10 plants, respectively. The data were adjusted for the thermal time accumulated. The parameters were estimated by ordinary least square’s method using the Gauss-Newton algorithm. The fitting quality of the models to the data was measured by the adjusted coefficient of determination, Akaike information criterion, Bayesian information criterion, and through intrinsic and parametric nonlinearity. The inflection points (IP), maximum acceleration (MAP), maximum deceleration (MDP) and asymptotic deceleration (ADP) were determined. Statistical analyses were performed with Microsoft Office Excel® and R software. The models satisfactorily described the height growth curve of sunflower, providing parameters with practical interpretations. The Logistics model has the best fitting quality, being the most suitable for characterizing the growth curve. The estimated critical points provide important information for crop management. Weeds must be controlled until the MAP. Covered fertilizer applications must be carried out between the MAP and IP range. ADP is an indicator of maturity, after reaching this point, the plants can be harvested for the production of silage without loss of volume and quality.

Resumo O objetivo deste trabalho foi estimar parâmetros genéticos e fenotípicos associados à precocidade, e selecionar progênies de soja (Glycine max) que associem alta produtividade de grãos e precocidade. Progênies F3:4 e F3:5 foram avaliadas durante os anos agrícolas de 2016/2017 e 2017/2018, em cinco ambientes. Dados de dias para o florescimento, dias para maturação plena e produtividade de grãos foram coletados e analisados via abordagem de modelos mistos. Foram estimados parâmetros genéticos e fenotípicos, ganhos esperados e realizados com a seleção, e respostas correlacionadas. Os componentes variância genética e interação genótipos por ambientes foram significativos. A herdabilidade oscilou de 50,14%, para produtividade, a 90.37%, para maturação plena. O ganho realizado para maturação plena variou de −0.17 a −2.57%. Observou-se correlação positiva entre os três caracteres avaliados. A seleção de 5,0% das progênies mais precoces reduziria a média produtiva em cerca de 5,02%, mas também reduziria o tempo até maturação plena de 125 para 119 dias, em detrimento de 210,5 kg ha−1 do potencial produtivo. Cinco progênies apresentaram maturação plena até 120 dias. A progênie 51 superou o parental mais produtivo (NK 7074 RR), com rendimento de grãos de 4.975 kg ha−1 e 128 dias até maturação plena.

Abstract The objective of this work was to estimate genotypic and phenotypic parameters associated with early maturity, and to select soybean (Glycine max) progenies that are high yielding and early maturing. F3:4 and F3:5 progenies were evaluated during the 2016/2017 and 2017/2018 crop years in five environments. Data on days to full maturity, days to flowering, and grain yield were collected and analyzed using the mixed model approach. Genotypic and phenotypic parameters, expected and achieved selection gains, and correlated responses were estimated. The components genetic variation and genotype x environment interaction were significant. Heritability fluctuated from 50.14%, for grain yield, to 90.37%, for full maturity. The achieved genetic gain for full maturity ranged from −0.17 to −2.57%. A positive correlation was observed among the three evaluated traits. The selection of 5.0% of the earliest-maturing soybean progenies would reduce mean grain yield by about 5.02%, but also reduce time to reach full maturity from 125 to 119 days, in detriment of 210.5 kg ha−1 potential yield. Five progenies reached full maturity up to 120 days. Progeny 51 overperformed the more productive parent (NK 7074 RR), with a grain yield of 4,975 kg ha−1 and 128 days to full maturity.

Abstract Ice-free areas of Antarctica represent an important study region that helps us understand how human activity affects plant communities and soil properties. The goal of this study was to determine the changes in plant composition and soil properties around a whale bone skeleton (WB) near Ferraz Station, King George Island, Antarctica from 1972 to 2020 (48 years). The WB was assembled in 1972 by Jacques-Yves Cousteau and his team. It is located in a large moss field and visited by many tourists. We studied the plant composition and development based on historical and recent photographs and phytosociological studies from 1986 to 2020. The soil was sampled in February 2009 to determine general properties. The results showed that human activity surrounding the WB directly affected the plant community composition and soil properties. The Syntrichia cushions were positively affected by the calcium deposits from bone dissolution. The principal component analysis revealed that mineralization of the bones increased soil nutrient assembly. A strong phosphatization process was observed in the WB area, similar to that in ornithogenic soils. The WB on the marine terrace enhanced soil fertility and changed the plant community.

Abstract This study evaluated the orofacial antinociceptive effect of (S)-(-)-perillyl alcohol (PA) associated with codeine (C) and investigated the possible molecular anchorage mechanisms of PA. Mice (n = 5 per group) were treated with PA alone and associated with codeine and assigned to the following groups: 75.0 mg/kg PA; 75.0 mg/kg PA + C 30 mg/kg; PA 37.5 mg/kg + C 15.0 mg/kg; C 30.0 mg/kg; and control. Nociception was induced by formalin, capsaicin, and glutamate, and was quantified based on the duration (in seconds) of face grooming. The possible mechanisms of action were evaluated by molecular docking study. In the formalin test, PA75/C30 presented an effect in the neurogenic (p < 0.0001) and inflammatory (p < 0.005) phases. Mice treated with PA75 (p < 0.0001) and PA75/C30 (p < 0.0005) showed a reduced nociceptive behavior in the capsaicin test. Glutamate-induced nociception also was blocked by PA75 (p < 0.0005) and C30 (p < 0.0005). The molecular anchorage analysis indicated high negative binding energy values for the evaluated receptors, especially glutamate receptors (AMPA -79.57 Kcal/mol, mGLUR6 -71.25, and NMDA -66.33 Kcal/mol). PA associated with codeine showed orofacial antinociceptive activity, with theoretical evidence of interaction with glutamate receptors.

RESUMO Introdução: o câncer de mama é a neoplasia maligna mais comum em mulheres no mundo. A cirurgia tem sido o tratamento tradicional e, geralmente consiste em mastectomia com linfadenectomia, podendo causar dor pós-operatória. Por isso, buscamos estudar técnicas anestésicas regionais que possam minimizar esse efeito, como o bloqueio interpeitoral (PEC). Métodos: estudo controlado randomizado com 82 pacientes com câncer de mama submetidos à mastectomia com linfadenectomia de Janeiro de 2020 a Outubro de 2021, em hospital oncológico. Intervenções: dois grupos randomizados (controle - anestesia geral exclusiva e grupo PECS - anestesia geral e bloqueio PEC com levobupivacaína/ropivacaína). Aplicou-se um questionário com Escala Visual Analógica da dor 24h pós-cirurgia. Utilizamos os testes de Shapiro-Wilk, Mann-Whitney e Quiquadrado e analisamos os dados em R versão 4.0.0. Estudo registrado em Ensaios Clínicos Brasileiros (REBec). Resultados: no grupo PEC, 50% não apresentava dor 24 horas após a cirurgia enquanto no grupo controle, 42,86% negava quadro álgico. A maioria que apresentou dor classificou-a como dor leve (EVA de 1 a 3) - (42,50%) grupo PEC e (40,48%) controle (p=0,28). Apenas 17,50% consumiram opioides no grupo PEC, semelhante ao grupo controle com 21,43%. (p=0,65), (17,50%) grupo PEC e (21,43%) grupo controle (p=0,65). Houve baixo índice de complicações como PONV (náuseas, vômitos, cefaleia) em ambos os grupos. Na análise de subgrupo, não houve diferença estatística entre os grupos que usaram Levobupivacaína ou Ropivacaína quanto a dor pós-operatória e o consumo de opioides. Discussão: o grupo estudado apresentou baixa taxa de dor no pós-operatório e isso influenciou na análise estatística. Não houve diferença estatística quanto a dor pós-operatória entre grupos. Conclusão: não foi possível demonstrar melhores resultados com a associação do bloqueio PEC com analgesia intravenosa total. São necessários novos estudos para avaliar a eficácia do bloqueio anestésico no intraoperatório e pós-operatório.

ABSTRACT Objective: Breast cancer is the most common malignant neoplasm in women worldwide. Surgery has been traditional treatment and, generally, it´s mastectomy with lymphadenectomy, that can causes postoperative pain. Therefore, we seek to study regional anesthesic techniques that can minimize this effect, such as the interpectoral block (PECS). Methods: randomized controlled study with 82 patients with breast cancer who underwent mastectomy with lymphadenectomy from January 2020 to October 2021 in oncology hospital. Interventions: two randomized groups (control - exclusive general anesthesia and PECS group - received PECS block with levobupivacaine/ropivacaine and general anesthesia). We applied a questionnaire with Numeric Rating Scale for pain 24h after surgery. We used Shapiro-Wilk, Mann-Whitney and Chi-square tests, and analyzed the data in R version 4.0.0 (ReBEC). Results: in the PECS group, 50% were pain-free 24h after surgery and in the control group it was 42.86%. The majority who presented pain classified it as mild pain (VAS from 1 to 3) - (42.50%) PECS group and (40.48%) control group (p=0.28). Only 17.50% consumed opioids in the PECS group, similar to the control group with 21.43%. (p=0.65). There was a low rate of complications such as PONV in both groups. In the subgroup analysis, there was no statistical difference between the groups that used levobupivacaine or ropivacaine regarding postoperative pain and opioid consumption. Discussion: the studied group had a low rate of pain in the postoperative period and it influenced the statistical analysis. There wasn´t difference in postoperative pain in groups. Conclusion: was not possible to demonstrate better results with the association of the PECS block with total intravenous analgesia. Need further studies to assess the efficacy of the nerve block.

This paper communicates the result of a study that produced reflections and analyses on contemporary Black women. Its main goal is to analyze the relationship among the concepts of representativeness, subjectivity and resistance from the narratives of young Black women. This research used a methodological approach that prioritized monitoring five young women from a social protection organization. Activities included participant observation and interventions in the form of workshops. Concerning the theoretical framework, the research was connected with the field of sociology of education, with an emphasis on ethnic-racial studies. The main argument of this paper is that Black female bodies are a political presupposition of social resistance to sexism and racism in society.

Este texto comunica el resultado de un estudio que produjo reflexiones y análisis sobre mujeres negras en la contemporaneidad. Su objetivo es analizar la relación existente entre los conceptos de representatividad, subjetividad y resistencia, a partir de las narrativas de mujeres negras jóvenes. La investigación realizó un procedimiento metodológico que priorizó el acompañamiento de cinco jóvenes en una organización de protección social. Las actividades incluyeron observación participante e intervenciones en forma de talleres. Como referencial teórico, la pesquisa estuvo vinculada al campo de la sociología de la educación, con énfasis en los estudios étnico-raciales. El argumento central del trabajo es que los cuerpos negros femeninos son un presupuesto político de resistencia social al machismo y al racismo en la sociedad.

Este texto comunica o resultado de um estudo que produziu reflexões e análises sobre mulheres negras na contemporaneidade. Seu objetivo é analisar a relação existente entre os conceitos de representatividade, subjetividade e resistência a partir das narrativas de jovens mulheres negras. A investigação fez uso de um procedimento metodológico que priorizou acompanhar cinco jovens em uma organização de proteção social. As atividades incluíram observação participante e intervenções na forma de oficinas. Como referencial teórico, a pesquisa esteve vinculada ao campo da sociologia da educação, com destaque para os estudos étnico-raciais. O argumento central do trabalho é o de que corpos negros femininos são um pressuposto político de resistência social ao machismo e ao racismo na sociedade.&nbsp;

ABSTRACT Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.

Resumo Introdução: A endoprótese Nellix® (Endologix Inc., Irvine CA) é composta por dois stents expansíveis por balão envolvidos por endobags preenchidos por um polímero, obliterando assim o saco aneurismático - Endovascular Aneurysm Sealing (EVAS). Inicialmente, pelas suas propriedades, foi introduzida com instruções para uso (IFU) alargadas, possibilitando a utilização em Aneurismas da Aorta Abdominal (AAA) de anatomia mais complexa. Porém, durante a experiência com esta endoprótese, foi descrito um elevado número de complicações, levando à restrição progressiva das IFU. Atualmente, o seu uso livre foi descontinuado e apenas está disponível em centros selecionados e para efeitos investigacionais. O objetivo deste estudo é reportar os resultados institucionais da utilização da endoprótese Nellix® no contexto de AAA. Material e Métodos: Realizou-se um estudo retrospectivo referente a doentes tratados a AAA utilizando a endoprótese Nellix® numa instituição terciária universitária. Foram incluídos todos os casos eletivos e urgentes, identificados através da consulta de registos clínicos da instituição. Foram excluídos casos de aneurisma toraco-abdominal. Os dados referentes às características de base, procedimento realizado, curso do internamento e seguimento pós hospitalar foram obtidos por consulta dos processos clínicos. Foram analisados como endpoints o sucesso técnico e clínico aos 30 dias, assim como complicações e intervenções secundárias a médio e longo prazo. Resultados: Entre 2015 e 2017, a esta endoprótese foi utilizada em 12 doentes, 9 homens e 3 mulheres, com média de 71(±8) anos. As comorbilidades mais frequentemente associadas foram HTA (n=12), tabagismo (n=7), cardiopatia isquémica (n=7), DAOP (n=6) e DRC (n=6). Em todos os doentes a indicação foi aneurisma primário degenerativo, com uma excepção, cuja indicação foi a presença de endoleak (EL) tipo 1a pós-EVAR prévio. Dez doentes foram submetidos a cirurgia eletiva e dois a cirurgia urgente, ambos por aneurisma sintomático. Três eram aneurismas aortoilíacos e os restantes aórticos (n=9), sendo que 3 tinham envolvimento de pelo menos uma artéria renal. Nove doentes foram submetidos a EVAS sem procedimentos complementares; os restantes a EVAS com chimney (ChEVAS) para as renais e/ou artéria mesentérica superior (n=3). O diâmetro médio pré-operatório era de 57mm (±6.5mm). Num doente tratou-se concomitantemente um aneurisma popliteu através do implante de stent coberto. Aos 30 dias verificou-se o óbito em 2 doentes submetidos a ChEVAS. As complicações mais frequentes foram Insuficiência Respiratória (n=3) e LRA com necessidade de diálise (n=3), sendo que em dois houve oclusão intencional das artérias renais (doentes com DRC terminal em pré-diálise). Neste período, houve uma reintervenção, por isquémia aguda de membro por trombose aguda de stent popliteu, tratada com sucesso com trombólise dirigida por catéter.Após os 30 dias, verificou-se o óbito em 4 doentes (sobrevivência aos 2 anos de 60%, SE=.154). As complicações verificadas foram EL tipo 1a (n=3), EL 1b (n=1) e trombose de stent aórtico (n=1). Dois doentes foram submetidos a intervenção secundária: um submetido a pontagem femoro-femoral cruzada por trombose de stent e outro a explantação protésica e reconstrução in-situ através de pontagem aorto-bifemoral. No último, verificou-se o óbito no pós-operatório precoce. Dois doentes aguardam intervenção secundária por EL tipo 1a e crescimento do saco. O diâmetro médio do saco aneurismático no último exame ou pré-intervenção secundária era 59mm (±10.6mm). O tempo médio de follow-up é de 2.3(±1.6) anos. Conclusões: Na nossa instituição, a utilização da endoprótese Nellix® está associada a elevada taxa de complicações perioperatórias e a médio prazo, com elevada taxa de complicações relacionadas com o aneurisma, sendo o EL tipo 1a a mais frequente. Apesar de atualmente o uso livre da endoprótese estar descontinuado, os doentes que foram submetidos previamente a EVAS carecem de um plano de vigilância específico e mais intensivo, para deteção e correção atempada de complicações.

Abstract Introduction: Nellix® endoprosthesis (Endologix Inc., Irvine, CA) is composed by two ballon-expandable stents surrounded by endobags, which are filled with a polymer, thus obliterating the aneurysmal sac - Endovascular Aneurysm Sealing (EVAS). Initially, due to its properties, was introduced with extended IFU, allowing the use in more complex abdominal aortic aneurysms. However, during the initial experience with this endoprosthesis, a high number of poor outcomes have been described, leading to the progressive restriction of IFU. Currently, it has been discontinued and is only available in selected centers for clinical research purposes. Our study aim to report the institutional results of the use of the Nellix® endoprosthesis in the treatment of AAA. Material and Methods: A retrospective study was designed, including patients with AAA treated with Nellix® endoprosthesis treated at a universitary tertiary care facility. Elective and urgent patients we&apos;re included, and patients we&apos;re identified through the institutional files. Thoraco-abdominal aneurysm we&apos;re excluded. Data about baseline characteristics, surgery, hospitalization course and follow-up post discharge was obtained by consulting personal clinical files. Primary endpoints are technical and clinical success at 30 days, as complications and secondary interventions at mid and long-term. Results: Between 2015 and 2017, this endoprosthesis was used in 12 patients, 9 male and 3 female, with a mean age of 71 (±8) years. The most common comorbidities associated we&apos;re hypertension (n=12), current or former tobacco use (n=7), coronary heart disease (n=7), peripheral artery disease (n=6) and chronic kidney disease (n=6) In all patients, the treatment indication was primary degenerative aneurysm, with one exception, which was the presence of type 1a EL after EVAR. Ten patients underwent elective and 2 urgent surgery due to symptomatic aneurysm. Three we&apos;re aortoiliac aneurysms and the remaining aortic aneurysms (n=9) with three having involvement of at least one renal artery. Nine patients underwent conventional EVAS; the remaining EVAS with chimney (ChEVAS) for the renal artery(ies) or superior mesenteric artery (n=3). The average preoperative diameter was 57(±6.5) mm. One patient was simultaneously submitted to endovascular repair of a popliteal artery aneurysm with covered stent. By 30 days, death occurred in 2 patients, all submitted to ChEVAS. The most common post-operative complications we&apos;re respiratory failure (n=3), AKI with dialysis (n=3), being that in two patients there was intentional covering of the renal arteries (patients with pre-dialysis CKD). In this time frame, we verified one reintervention: catheter-directed thrombolysis for acute limb ischemia due to popliteal covered stent thrombosis. After 30 days, 4 deaths occured (2 year survival 60%, SE 0.154). The most common complications were type 1a EL(n=3), type 1b EL(n=1) and aortic stent thrombosis (n=1). Two patients have already been reintervened: one submitted to femoro-femoral crossover bypass and the other to surgical endoprosthesis explantation and in situ reconstruction aortobifemoral bypass. The last was deceased in the early postoperative period. Two patients are waiting reintervention for type Ia EL and aneurysmal sac growth. The average sac diameter in last follow-up or before secondary intervention was 59(±10.6) mm. Mean follow-up time is 2,3(±1,6) years. Conclusions: In our institution, the use of Nellix® endoprosthesis is associated with a high rate of perioperative morbidity and mid to long-term aneurysm-related complications, being type Ia EL the most common. Although the free use of the endoprosthesis is currently discontinued, patients who have previously undergone EVAS lack a specific and more intensive surveillance plan for the timely detection and correction of complications.

Resumo Introdução: A doença do coronavírus de 2019 (COVID-19) e consequente período de confinamento teve um impacto significativo no sistema nacional de saúde, com restrições em toda a actividade clínica - actividade assistencial na consulta, exames complementares de diagnóstico e número e tipo de intervenções cirúrgicas. A apreensão dos doentes em recorrer aos cuidados médicos e aos hospitais levou a admissões tardias, e na nossa percepção, a apresentações mais graves da patologia de base, nomeadamente na Isquémia Crítica de Membro (ICM). A necessidade de testar os doentes previamente a uma cirurgia não-emergente aumentou o tempo de referenciação inter- e intra-hospitalar, o que, somando à diminuição dos tempos cirúrgicos e da disponibilidade de vagas em unidades de cuidados intensivos, potencialmente prejudicou os resultados. O objectivo deste estudo é avaliar objetivamente o tipo de patologia que foi tratado durante o estado de emergência e comparar o desfecho dos procedimentos cirúrgicos com o mesmo período em 2018 e 2019. Métodos: Foi realizada uma análise retrospectiva dos processos clínicos dos doentes submetidos a cirurgia nos meses de Março e Abril do ano de 2020 e foi feita a comparação com o mesmo período dos dois anos prévios. O endpoint primário foi mortalidade aos 30 dias ou intra-hospitalar. Os endpoints secundários foram classificação patológica e do grau de isquémia, taxa de amputação, nível de amputação, tipo de cirurgia (aberta, endovascular ou híbrida), tempo de internamento e re-intervenção. Resultados: Foram operados 98 doentes no Período COVID (PC) comparado com 286 no Período Não-COVID (PNC). Não houve diferenças estatisticamente significativas na idade (70 anos (17-98) no PC vs. 69 (17-92) no PNC, p=.13) ou sexo dos doentes operados (76% masculino (n=74) no PC vs. 70% (n=196) no PNC, p=.26). Também não houve diferença estatisticamente significativa na mortalidade (5% (n=5) no PC vs. 5% (n=13) no PNC, p=.88). Houve uma diminuição estatisticamente significativa da cirurgia aberta (43% (n=42) no PC vs. 57% (n=164) no PNC, p=.04). Não houve diferenças significativas no tempo de internamento hospitalar (10 (0-77) dias no PC vs. 7 (0-118) no PNC, p=.6) e na taxa de re-intervenção (18% (n=18) no PC vs. 16% (n=45) no PNC, p=.58). A Doença Arterial Periférica (DAP) correspondeu a 75% (n=73) das admissões no PC, vs. 48% (n=137) no grupo PNC (p=.02). A ICM correspondeu a 99% (n=70) das admissões por DAP no PC, vs. 93% (n=114) no PNC (p=.1), com um aumento significativo da proporção de doentes cuja apresentação na admissão foi de grau 5 ou 6 de Rutherford (81% (n=57) vs. 68% (n=77), p=.03). Houve ainda uma diminuição sem significado estatístico da taxa de amputação (35% (n=25) no PC vs. 40% (n=49) no PNC, p=.49) com um aumento não significativo da taxa de amputação major (52% (n=13) no PC vs. 39% (n=19) no PNC, p=.27). O segundo grupo de patologia mais tratado foi a doença aneurismática da aorta e artérias ilíacas, mas houve uma diminuição estatisticamente significativa do número de doentes tratados (5% (n=5) no PC vs. 13% (n=36) no PNC, p=.05). Todos os aneurismas da aorta tratados durante o PC estavam em rotura (100% (n=5) vs. 42% (n=15) in the NCP, p=0.2). Não houve diferenças significativas entre os grupos na mortalidade por reparação urgente de aneurismas (60% (n=3) no PC vs. 47% (n=7) no PNC, p=.77). Conclusão: As restrições impostas pela COVID-19 manifestaram-se principalmente no tipo de patologia tratado e no número de doentes operados. A apresentação mais grave da patologia de base, manifestada por graus de isquémia crítica mais avançados, não aumentou a mortalidade nem se reflectiu de forma significativa nas taxas de amputação. A doença aneurismática da aorta foi a segunda patologia mais tratada, mas com uma diminuição significativa do número total de casos, sem diferença significativa na mortalidade.

Abstract Introduction/Objectives: The Corona Virus Disease of 2019 (COVID-19) has taken a major toll on the public health system, with restrictions in all clinical activity, from consultations and exams to number and type of surgeries. Patients apprehension to resort to medical aid and hospitals leads to late admissions and, in our perception, more severe presentations of the underlying pathology, namely, in Chronic limb threatening ischemia (CLTI). Need for testing prior to non-emergent surgery causes larger delays in the referral of patients, and this, added to the reduction of surgical times and ICU availability, potentially results in worse outcomes. The aim of this study was to objectively evaluate the type pathology that was treated during the emergency state and to compare the outcome of the surgical procedures with the same period of 2018 and 2019. Methods: A retrospective analysis of the patient charts from patients submitted to surgery in the months of March and April of the year 2020 was conducted and compared to the same period on the previous two years. The primary endpoint was death at 30 days or during hospital stay and the secondary endpoints were pathology classification, grade of ischemia, amputation, amputation level, type of surgery (endovascular, conventional or hybrid), time of hospital stay and reintervention. Results: There were 98 patients submitted to surgery in the COVID period (CP), compared to 286 in the Non-COVID period (NCP). There was no significant difference in the age (70 years (17-98) in the CP vs. 69 (17-92) in the NCP, p=.13) or sex profile of the patients (76% male (n=74) in the CP vs. 70% (n=196) in the NCP, p=.26). There was no statistical difference in mortality (5% (n=5) in the CP vs. 5% (n=13) in the NCP, p=.88). There was a statistically significant decrease in conventional surgery (43% (n=42) in the CP vs. 57% (n=164) in the NCP, p=.04), but no statistically significant difference in length of hospital stay(10 (0-77) days in the CP vs. 7 (0-118) in the NCP, p=.6), and reintervention (18% (n=18) in the CP vs. 16% (n=45) in the NCP, p=.58). PAD corresponded to 75% (n=73) of the admissions in the CP vs. 48% (n=137) in the NCP, p=.02. CLTI corresponded to 99% (n=70) of the PAD population in the CP, vs. 93% (n=114) in the NCP, p=.1, with a significant increase in the number of patients presenting with Rutherford Grades 5 and 6 (81% (n=57) in the CP, vs. 68% (n=77) in the NCP, p=.03). There was a non-significant decrease in amputation rate (35% (n=25) vs. 40% (n=49), p=.49) and increase of major limb amputation (52% (n=13) vs. 39% (n=19), p=.27). The second most frequent pathology was aneurysmal aortic and iliac disease, but there was a statistically significant reduction in the number of patients treated (5% (n=5) in the CP vs. 13% (n=36) in the NCP, p=.05). All aortic aneurysms treated in 2020 were ruptured (100% (n=5) vs. 42% (n=15) in the NCP, p=0.2). There was no significant difference in mortality in urgent aortic aneurysm repair between groups (60% (n=3) in the CP vs. 47% (n=7) in the NCP, p=.77). Conclusions: COVID-19 restrictions manifested mainly in the type of pathology treated and the number of patients operated on. The gravity of the underlying pathology, manifested by more serious wounds and advanced CLTI at presentation, did not increase mortality nor was reflected on limb amputations rates. Aortic and iliac aneurismal disease was the second most common pathology treated but with a significant decrease in total number of cases and no significant difference in mortality.