ABSTRACT Objective: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. Methods: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. Results: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. Conclusions: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem.

RESUMO Objetivo: Analisar como a mídia jornalística tem descrito as questões de qualidade de vida (QV), atividade física (AF) e saúde mental (SM) de adolescentes durante a pandemia da COVID-19. Métodos: Trata-se de um estudo descritivo e qualitativo que utilizou a análise de conteúdo. Foram analisadas 62 publicações jornalísticas do total de 8.211 veiculadas pelos jornais mais lidos de cada região brasileira entre dezembro de 2019 e agosto de 2021. Resultados: Os resultados foram agrupados e avaliados em três categorias: QV (n=11), AF (n=9) e SM (n=42). No período analisado as publicações jornalísticas sugerem que os adolescentes apresentaram maior tempo de exposição a telas, contribuindo para uma alimentação inadequada, diminuição da AF e prejuízos na QV. A pandemia também contribuiu com aumento da ansiedade, depressão, solidão e medo resultantes da desorganização mental e emocional causada pela mudança abrupta de rotina. A vulnerabilidade social apresentou-se como um fator agravante nesse contexto. As mídias jornalísticas não deram a atenção necessária aos adolescentes no que se refere às consequências negativas da pandemia na QV, AF e SM. Conclusões: As reportagens analisadas mostraram que a pandemia causou diminuição na interação social, sentimentos de incerteza, medo e o aparecimento/exacerbação de sintomas de ansiedade, estresse e depressão. A vulnerabilidade social apresentou-se como mais um obstáculo a ser enfrentado nesta problemática.

Abstract Introduction Malignant Hyperthermia (MH) is an inherited hypermetabolic syndrome triggered by exposure to halogenated anesthetics/succinylcholine. The lack of knowledge regarding this condition might be associated with the rare occurrence of MH reaction and symptoms. Methods This observational study evaluated 68 patients from 48 families with confirmed or suspected MH susceptibility due to medical history of MH reaction or idiopathic increase of creatine kinase or MH-related myopathies. Participants were assessed by a standardized questionnaire and submitted to physical/neurological examination to assess the characteristics of patients with MH, their knowledge about the disease, and the impact suspected MH had on their daily lives. Results Suspected MH impacted the daily life of 50% of patients, creating difficulties in performing surgical/clinical/dental treatment and problems related to their family life/working/practicing sports. The questionnaire on MH revealed a correct answer score of 62.1 ± 20.8 (mean ± standard deviation) on a scale 0 to 100. Abnormal physical/neurological examination findings were detected in 92.6% of susceptible patients. Conclusions Suspected MH had impacted the daily lives of most patients, with patients reporting problems even before MH investigation with IVCT. Patients showed a moderate level of knowledge about MH, suggesting the need to implement continuing education programs. MH susceptible patients require regular follow-up by a health team to detect abnormalities during physical and neurological examination.

Abstract Background Malignant Hyperthermia (MH) is a pharmacogenetic disorder triggered by halogenated anesthesia agents/succinylcholine and characterized by hypermetabolism crisis during anesthesia, but also by day-to-day symptoms, such as exercise intolerance, that may alert the health professional. Objective The study aimed to analyze the incidence of fatigue in MH susceptible patients and the variables that can impact perception of fatigue, such as the level of routine physical activity and depression. Methods A cross-sectional observational study was carried out with three groups - 22 patients susceptible to MH (positive in vitro muscle contracture test), 13 non-susceptible to MH (negative in vitro muscle contracture test) and 22 controls (no history of MH). Groups were assessed by a demographic/clinical questionnaire, a fatigue severity scale (intensity, specific situations, psychological consequences, rest/sleep response), and the Beck depression scale. Subgroups were re-assessed with the Baecke habitual physical exercise questionnaire (occupational physical activity, leisure physical exercise, leisure/locomotion physical activity). Results There were no significant differences among the three groups regarding fatigue intensity, fatigue related to specific situations, psychological consequences of fatigue, fatigue response to resting/sleeping, depression, number of active/sedentary participants, and the mean time and characteristics of habitual physical activity. Nevertheless, unlike the control sub-group, the physically active MH-susceptible subgroup had a higher fatigue response to resting/sleeping than the sedentary MH susceptible subgroup (respectively, 5.9 ± 1.9 vs. 3.9 ± 2, t-test unpaired, p< 0.05). Conclusion We did not detect subjective fatigue in MH susceptible patients, although we reported protracted recovery after physical activity, which may alert us to further investigation requirements.

Abstract Introduction Malignant Hyperthermia (MH) is a pharmacogenetic, hereditary and autosomal dominant syndrome triggered by halogenates/succinylcholine. The In Vitro Contracture Test (IVCT) is the gold standard diagnostic test for MH, and it evaluates abnormal skeletal muscle reactions of susceptible individuals (earlier/greater contracture) when exposed to caffeine/halothane. MH susceptibility episodes and IVCT seem to be related to individual features. Objective To assess variables that correlate with IVCT in Brazilian patients referred for MH investigation due to a history of personal/family MH. Methods We examined IVCTs of 80 patients investigated for MH between 2004‒2019. We recorded clinical data (age, sex, presence of muscle weakness or myopathy with muscle biopsy showing cores, genetic evaluation, IVCT result) and IVCT features (initial and final maximum contraction, caffeine/halothane concentration triggering contracture of 0.2g, contracture at caffeine concentration of 2 and 32 mmoL and at 2% halothane, and contraction after 100 Hz stimulation). Results Mean age of the sample was 35±13.3 years, and most of the subjects were female (n=43 or 54%) and MH susceptible (60%). Of the 20 subjects undergoing genetic investigation, 65% showed variants in RYR1/CACNA1S genes. We found no difference between the positive and negative IVCT groups regarding age, sex, number of probands, presence of muscle weakness or myopathy with muscle biopsy showing cores. Regression analysis revealed that the best predictors of positive IVCT were male sex (+12%), absence of muscle weakness (+20%), and personal MH background (+17%). Conclusions Positive IVCT results have been correlated to male probands, in accordance with early publications. Furthermore, normal muscle strength has been confirmed as a significant predictor of positive IVCT while investigating suspected MH cases.

Abstract The objective was to understand the difficulties and potential of a Mental Health (MH) network aimed at children and adolescents, identifying how professionals understand and operationalize the principles of the policy of SM for children and adolescents. Five Focus Groups were held, with the participation of 43 workers. We used lexical analysis through the Iramuteq software, originating four classes: “What is being a child and adolescent?”; “What do children and adolescents suffer from?”; “On the relationship between services” and “Potentials and challenges of the Mental Health Network”. Difficulties in sharing care were identified, articulating the network outside of oneself. Capsij is perceived as a priority for user embracement, and there is still difficulty in providing care in MH in Primary Care (AB). It is concluded that the complexity of care in MS for children and adolescents imposes the need to continue strategies to strengthen the AB and intersectoral actions aimed at an expanded clinic.

Resumen El objetivo fue comprender las dificultades y potencialidades de una red de Salud Mental (SM) para niños y adolescentes, identificando cómo los profesionales entienden y operacionalizan los principios de la política de SM para la niñez y adolescencia. Se realizaron cinco Grupos Focales, en los que participaron 43 trabajadores. Se utilizó el análisis léxico a través del software Iramuteq, originando cuatro clases: “¿Qué es ser niño y adolescente?”; “¿Qué padecen los niños y adolescentes?”; “Sobre la relación entre servicios” y “Potencialidades y desafíos de la Red de Salud Mental”. Se identificaron dificultades a la hora de compartir los cuidados, articulando la red para fuera de sí. El Capsij se percibe como una prioridad para la acogida, existiendo aún dificultades para implementar los cuidados en SM en Atención Primaria (AP). Se concluye que la complejidad de la atención en SM para niños y adolescentes impone la necesidad de continuidad de las estrategias de fortalecimiento de la AP y de acciones intersectoriales, visando una clínica ampliada.

Resumo Objetivou-se conhecer as dificuldades e potencialidades de uma rede de Saúde Mental (SM) voltada a crianças e adolescentes, identificando como profissionais compreendem e operacionalizam os princípios da política de SM infantojuvenil. Foram realizados cinco Grupos Focais, com participação de 43 trabalhadores. Utilizou-se da análise lexical por meio do software Iramuteq, originando quatro classes: “O que é ser criança e adolescente?”; “Do que sofrem as crianças e adolescentes?”; “Sobre a relação entre os serviços” e “Potencialidades e desafios da Rede de Saúde Mental”. Identificou-se dificuldades em compartilhar o cuidado, articulando a rede para fora de si. O Capsij é percebido como prioritário para o acolhimento, havendo, ainda, dificuldade em efetivar os cuidados em SM na Atenção Básica (AB). Conclui-se que a complexidade da atenção em SM para crianças e adolescentes impõe a necessidade de continuidade de estratégias de fortalecimento da AB e de ações intersetoriais visando uma clínica ampliada.

Abstract Objective to describe the experience of the health team in the implementation of a flowchart in an Emergency Care Unit (ECU) during the COVID-19 pandemic. Method descriptive study with experience report on the implementation of a flowchart of care during the COVID-19 pandemic, in a ECU in Ceará, Brazil, between March and July 2020, where around 116 professionals were involved, performing actions such as registration, risk classification, clinical evaluation and physical examination, immediate notification, collection of laboratory tests, collection of nasopharynx swab, hospitalization and insertion in the transfer regulation center, based on the Ministry of Health (MH). Results the increase in cases of COVID-19 brought the need to reorganize the flow of care in health services and one of the strategies performed in the ECU occurred through the implementation of a flowchart that ensured agility in the dynamics of care provided to the user with respiratory symptoms, allowing clinical management and application of appropriate sanitary measures, as the MH governs, as well as the early diagnosis of cases of infection by the new coronavirus. Conclusion and implications for the practice the implementation of the flowchart streamlined the identification of possible positive cases, reduced the time to start care for this patient, and the exposure of the patient and health professional.

Resumen Objetivo describir la experiencia del equipo de salud en la implementación de un diagrama de flujo en una unidad de atención de emergencia (UPA) durante la pandemia de COVID-19. Método estudio descriptivo con relato de experiencia sobre la implementación de un flujograma de atención durante la pandemia de COVID-19, en una UPA en Ceará, entre marzo y julio de 2020, donde participaron alrededor de 116 profesionales, realizando acciones como registro, clasificación de riesgos, evaluación clínica y examen físico, notificación inmediata, recolección de pruebas de laboratorio, recolección de hisopado de nasofaringe, hospitalización e inserción en el centro de regulación de transferencia, basado en el Ministerio de Salud (MS). Resultados el aumento de casos de COVID-19 trajo la necesidad de reorganizar el flujo de atención en los servicios de salud y una de las estrategias realizadas en las UPAs ocurrió a través de la implementación de un diagrama de flujo que aseguró agilidad en la dinámica de atención prestada al usuario con síntomas respiratorios, permitiendo el manejo clínico y la aplicación de medidas sanitarias adecuadas, como rige la MS, así como el diagnóstico precoz de los casos de infección por el nuevo coronavirus. Conclusión e implicaciones para la práctica la implementación del diagrama de flujo agiliza la identificación de posibles casos positivos, reduce el tiempo para iniciar la atención de este paciente y la exposición del paciente y del profesional de la salud.

Resumo Objetivo descrever a experiência da equipe de saúde na implementação de um fluxograma em Unidade de Pronto-Atendimento (UPA) durante a pandemia da COVID-19. Método estudo descritivo com relato de experiência sobre a implementação de um fluxograma de atendimento durante a pandemia da COVID-19, em uma UPA no Ceará, entre os meses de março a julho de 2020, onde estiveram envolvidos em torno de 116 profissionais, realizando as ações do tipo: cadastro, classificação de risco, avaliação clínica, exame físico, notificação imediata, coleta de exames laboratoriais, coleta de swab de nasofaringe, internação e inserção na central de regulação de transferência, com base no Ministério da Saúde(MS). Resultados o aumento dos casos da COVID-19 trouxe a necessidade de reorganizar o fluxo de atendimento nos serviços de saúde, e uma das estratégias realizadas nas UPAs, ocorreu por meio da implementação de um fluxograma que garantisse a agilidade na dinâmica da assistência prestada ao usuário com os sintomas respiratórios, permitindo o manejo clínico e a aplicação das medidas sanitárias adequadas, conforme rege o MS, bem como o diagnóstico precoce dos casos de infecção pelo novo coronavírus. Conclusão e implicações para a prática a implementação do fluxograma agilizou a identificação de possíveis casos positivos, reduziu o tempo para o início do atendimento a este paciente, e a exposição do paciente e do profissional de saúde.

SUMMARY The drugs assessed by the Spanish Agency for Medicines and Health Products or European Medicines Agency made public from January to March of 2022, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product.

RESUMEN Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentos y Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de enero a marzo de 2022, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento.

RESUMEN Se reseñan los medicamentos evaluados y con dictamen positivo por comisión de expertos de la Agencia Española de Medicamentos y Productos Sanitarios o de la Agencia Europea del Medicamento hechos públicos de septiembre a diciembre de 2021, y considerados de mayor interés para el profesional sanitario. Se trata de opiniones técnicas positivas que son previas a la autorización y puesta en el mercado del medicamento.

SUMMARY The drugs assessed by the Spanish Agency for Medicines and Health Products or European Medicines Agency made public from September to December of 2021, and considered of interest to the healthcare professional, are reviewed. These are positive technical reports prior to the authorization and placing on the market of the product.

RESUMO Objetivou-se identificar a evidência quanto às associações entre atividade física (AF) e saúde mental (SM) em adolescentes escolarizados brasileiros. Trata-se de um estudo de Revisão Sistemática. Os estudos foram selecionados em português e inglês e identificados por meio de uma busca sistemática em seis bases de dados eletrônicas: PubMed, Web of Science, SPORTDiscus/Ebsco, ScIELO, ERIC, e LILACS, que compreendeu publicações até o final de 2019. Os critérios de inclusão foram: estudos com um desenho de coorte, descritivo de caráter exploratório, transversal, ou qualitativos; realizados com crianças e adolescentes; estudos que analisaram a relação entre AF e SM; estudos que investigaram adolescentes que praticavam AF nas escolas; estudos realizados no Brasil e os que obtiveram a pontuação mínima estabelecida de 60% conforme os critérios da qualidade metodológica do instrumento STROBE. A Educação Física oferecida no currículo da educação básica tem um efeito protetor sobre a SM no ambiente escolar. Além disso, mais de 300 min/semana de AF foi associado positivamente com a SM. Algumas associações foram negativas entre a AF e a SM, tais como: tempo excessivo de TV; isolamento social; insatisfação com o peso corporal. A AF escolar está associada positivamente à SM por promover bem-estar físico e psicológico, impactando na redução dos índices de problema de insônia, atenuando a solidão e melhorando a aparência física.

ABSTRACT The aim of this study was to identify evidence regarding associations between School Physical Activity (PA) and Mental Health (MH) in Brazilian school-aged adolescents. This is a systematic review study. Studies were selected in Portuguese and English and identified by a systematic search in six electronic databases: PubMed, Web of Science, SPORTDiscus / Ebsco, ScIELO, ERIC, and LILACS, which comprised publications until 2019. Inclusion criteria were: studies with cohort, descriptive, cross-sectional or qualitative design; performed with children and adolescents; studies that analyzed the relationship between PA and MH; studies that investigated adolescents who practiced PA in schools; studies carried out in Brazil; and studies that reached minimum of 60% of methodological quality criteria according to STROBE. Physical education, as curricular activity in basic education, has protective effect on MH in the school setting. In addition, more than 300 min/week of PA was positively associated with MH; while associations between PA and excessive TV time; social isolation; and body weight dissatisfaction were negatively associated. School PA is positively associated with MH as it promotes physical and psychological well-being, impacting on the reduction of insomnia rates, attenuating loneliness and improving physical appearance.

Resumo Este trabalho teve como objetivo conhecer perfil diagnóstico de usuários do SUS com relação à fitoterapia. Trata-se de um estudo observacional transversal, com coleta de dados realizada no Município de Marechal Deodoro, por meio de um questionário semi-estruturado com perguntas relativas a dados socioeconômicos, utilização e conhecimentos sobre plantas medicinais e fitoterápicos e satisfação com o uso de plantas medicinais (PM) e medicamentos fitoterápicos (MF). Entre os usuários abordados, 87,08% utilizam plantas medicinais frequentemente, principalmente a erva cidreira (Melissa officinalis L.). Também foi observado que as plantas são geralmente usadas como calmante (16,05%) e na forma de chá (68,35%). 82,51% dos entrevistados afirmam ter adquirido o conhecimento sobre fitoterapia através de algum familiar e 85,56% fazem uso das PM e MF sem ter recebido algum tipo de informativo sobre o seu uso. 61% das plantas descritas pelos usuários teve seu uso e terapêutica coincidente com o citado em literatura específica. Com relação a satisfação através do tratamento com PM e MF observou-se que 56,80% estão satisfeitos. O uso de plantas medicinais por parte dos usuários é bastante frequente, principalmente pelo conhecimento acumulado ao longo de gerações. Portanto, se faz necessária maior atenção a esse aspecto de utilização, visando evitar possíveis reações adversas advindas do uso incorreto.

Abstract This study aimed to assess diagnosis of Unique Health System (SUS) users profile with regard to herbal medicine. This is a cross-sectional study with observational data collection conducted in the city of Marechal Deodoro, through a semi-structured questionnaire with questions related to socioeconomic data, use, and knowledge of medicinal plants and herbal medicines and satisfaction with the use of medicinal herbs (MH) and interactions of phytotherapeutic drugs (PD). Among the topics, 86.89% of users used herbal medicines often, especially lemon balm (Melissa officinalis L.). It was also observed that the plants are generally used as a sedative (21.74%) and as tea (87.84%). 82.32% of respondents claim to have acquired the knowledge of herbal medicine through a family member and 85.36% make use of medicinal plants without having received any information on the use of MH and PD. 61% of the plants described that coincided with the form of use and therapeutic properties found in the literature. With regard to satisfaction by treatment with MH and PD, it was found that 56.67% are satisfied. Therefore, it is necessary to pay attention to this aspect of usage, in order to avoid possible drug interactions or adverse reactions resulting from the incorrect use.

Resumo Dois modelos destinados a estimar a radiação solar incidente na superfície terrestre foram calibrados em seis localidades no nordeste do Pará (Belém, Cametá, Conceição do Araguaia, Marabá, Soure e Tucuruí). O primeiro é a equação de Angröm-Prescott (AP), que requer observações do número de horas de brilho solar. O segundo modelo é uma versão modificada da fórmula de radiação de Hargreaves (MH), que requer observações da temperatura máxima e mínima diárias. Ambos os modelos foram calibrados para estimar a radiação solar diária e mensal. A calibração de ambas as equações para cada estação (i.e., estação menos chuvosa e estação chuvosa) em cada localidade foi também realizada. AP tem desempenho cerca de 74% maior que MH para estimativas diárias (excluindo Soure) e 83% para estimativas mensais (excluindo Soure e Tucuruí). O uso de equações calibradas para cada estação aumenta em 0,68% o desempenho de AP e também aumenta o desempenho de MH, medido pelo índice de desempenho, na maior parte das localidades, nas estimativas de radiação solar diária. O desempenho de ambos os modelos é muito maior quando estimando a radiação solar mensal em relação a radiação solar diária, com aumento do índice de desempenho de, em média, 10,95% para AP.

Abstract Two models aimed to estimate solar irradiance were calibrated in six locations in Northeastern Pará (Belém, Cametá, Conceição do Araguaia, Marabá, Soure, and Tucuruí). The first one is the equation of Angström-Prescott (AP), which requires observations of sunshine duration hours. The second model is a modified version of Hargreaves' radiation formula (MH), which requires observations of daily maximum and daily minimum air temperatures. Both models were calibrated to estimate daily and monthly solar radiation. The calibration of both equations for each season (i.e., dry season and wet season) in each location was also tested. AP has an average performance about 74% higher than MH for daily estimates (excluding Soure) and 83% higher than MH for monthly estimates (excluding Soure and Tucuruí). The use of seasonally calibrated equations slightly improves the performance of AP, measured by the performance index, by 0.68% and improves the performance of MH in most locations, when estimating daily solar radiation. The performance of both models is much higher when estimating monthly solar radiation than daily solar radiation, with an increase of the performance index of 10.95% for AP.

RESUMEN El presente trabajo pretende demostrar las ventajas de considerar el régimen de flujo transitorio en el análisis de estabilidad de talud aguas arriba para la situación de reducción rápida de una presa de tierra homogénea. Se llevaron a cabo análisis de estabilidad de taludes aguas arriba, considerando la presión de poro / succión para análisis de flujo transitorio que simula la reducción rápida del embalse. Los análisis comprendieron diferentes geometrías del talud aguas arriba (de 1V: 1.1H a 1V: 2.5H), alturas que varían de 10 m a 50 m, así como varios materiales de baja permeabilidad (SM, SM-SC, SC, ML, ML-CL, CL, MH y CH). Además, las ecuaciones que relacionan el factor de seguridad con dichos taludes o la altura de la presa se ajustaron a los datos de análisis, para definir el talud mínimo para una determinada altura de la presa o la altura máxima para un determinado talud aguas arriba. Los resultados han demostrado que: teniendo en cuenta la condición de flujo transitorio, incluida la succión, en el análisis de estabilidad de taludes de la situación de reducción rápida, aumenta el factor de seguridad en relación con el análisis simplificado que generalmente se adopta. Esto también ha resultado en taludes mucho más pronunciados, para un factor de seguridad de 1,1, que los recomendados por la Oficina de Reclamación de los E.E.U.U. (USBR), sugiriendo la importancia de realizar análisis de flujo transitorio para las situaciones de reducción rápida y considerando sus resultados en el análisis de estabilidad.

ABSTRACT The present work intends to demonstrate the advantages of considering transient flow regime in the stability analysis of the upstream slope for the rapid drawdown situation of a homogeneous earth dam. Upstream slope stability evaluations were carried out, considering pore pressure and suction from transient flow analysis while simulating rapid drawdown of the reservoir. The evaluations comprised different geometries of the upstream slope (from 1V:1.1H to 1V:2.5H) and heights varying from 10 m to 50 m, as well as several low permeability materials (SM, SM-SC, SC, ML, ML-CL, CL, MH and CH). In addition, equations relating the safety factor to such slopes or dam height were adjusted to the analysis data, in order to define the minimum slope for a certain dam height or the maximum height for a given upstream slope. The results have shown that, considering the transient flow condition, including suction, within the slope stability analysis of the rapid drawdown situation, increases the safety factor in relation to the simplified analysis that is usually adopted. This also results in much steeper slopes (for a safety factor of 1,1) than the ones recommended by the U.S. Bureau of Reclamation (USBR), suggesting the importance of performing transient flow analysis for rapid drawdown situations and considering its results instability analysis.

Resumo Este trabalho mostra uma analise das simulações obtidas no banco de dados do PMIP3 (Paleoclimate Modelling Intercomparison Project Phase IIII) para o período pré-industrial com os dados observados pelo CMAP (Climate Prediction Center Merged Analysis of Precipitation) e Climatic Reserch Unit (CRU) para a precipitação pluviométrica em mm/mês e os dados de reanálise do NCEP/NCAR para a temperatura do ar a 2 m acima da superfície em graus Celsius, para as região do Nordeste Brasileiro (NEB) (46° W - 34° W; 16° S - 2° S), a fim de encontrar um conjunto de modelos com representação realista do clima do presente. Em seguida, uma comparação é feita entre os resultados das simulações desses modelos para o período pré-industrial (PI) e o Holoceno médio (HM, ~6.000 anos atrás), a fim de identificar possíveis mudanças climáticas entre esses períodos sobre a América do Sul. Esses modelos do PMIP3 sugerem que houve diferenças importantes entre o clima atual e o do Holoceno Médio no que diz respeito à intensidade da monção da América do Sul (monção mais fraca no HM do que no presente).

Abstract The present work shows a comparison between simulation data from PMIP (Paleoclimate Modelling Intercomparison Project Phase III) for the pre-industrial climate against observations from CMAP (Climate Prediction Center Merged Analysis of Precipitation) and Climatic Reserch Unit (CRU) for precipitation and reanalysis data from NCEP/NCAR for the 2 m air temperature over the following regions: Northeast Brazil (NEB) (46° W - 34° W: 16° S - 2° S), in order to find a subset of models with a realistic representation of current climate. Following, a comparison was done between results for the pre-industrial (PI) period and the mid-Holocene (MH, ~6.000 years before present), with the objective of identifying possible climatic changes between those two periods over South America. Among the twenty-two models in PMIP3 dataset, ten models were selected for analysis, since the show, for the pre-industrial period, a better representation of observed features, such as the annual cycle over the regions and spatial patterns typical of the current climatology of South America. Those PMIP3 models suggest that current climate and MH climate exhibit important differences regarding the intensity of the South America monsoon system (weaker MH monsoon compared to present).

Introdução: A hematúria microscópica (HM) é definida pela presença de pelo menos três eritrócitos por campo de alta potência no estudo do sedimento urinário, devidamente coletado e sem evidência de infeção. Este achado laboratorial é muitas vezes detetado acidentalmente pelos médicos de família (MF), pelo que a sua abordagem diagnóstica não deve ser menosprezada. Classifica-se em assintomática/sintomática, transitória/persistente e pode ser de causa benigna ou maligna. Objetivos: Abordar a avaliação do adulto com o achado incidental de HM, criando um algoritmo que assista o MF no diagnóstico diferencial e orientação clínica. Métodos: Pesquisa de meta-análises, artigos de revisão e normas de orientação clínica (NOC) publicados desde 2010 em português e inglês. Bases de dados: PubMed, Cochrane Library, DARE, NICE, UpToDate, Medscape. Termos MeSH: hematuria, microscopic findings e adult. Pesquisa livre na American Urological Association e na European Association of Urology. Resultados: Obtiveram-se 265 artigos na pesquisa. Após remoção de duplicados, exclusão pelo título/resumo e pelo cumprimento dos critérios de inclusão e exclusão pré-definidos, foram selecionados: uma NOC e dois artigos de revisão. Com base nestes artigos foi elaborado um algoritmo que sintetiza, de forma prática, a abordagem da HM no adulto. Após excluída a possibilidade de contaminação da amostra de urina, a história clínica dirigida e o exame físico pode dar pistas para um diagnóstico específico. Se assintomática, a HM deverá ser confirmada através de um novo exame do sedimento urinário, em conjunto com uma urocultura e avaliação da função renal. Caso o novo exame laboratorial seja negativo, estamos perante uma HM transitória, que deverá ser abordada consoante o risco do doente para patologia maligna. Caso a HM seja mantida, o restante exame do sedimento (presença de proteínas, eritrócitos dismósficos, cilindros e/ou coágulos) determina a origem glomerular ou extraglomerular. Perante uma HM extraglomerular, a abordagem será definida em função dos fatores de risco para doença maligna. A HM glomerular obriga à referenciação para consulta de nefrologia. Discussão: A hematúria microscópica é um sinal laboratorial que poderá indiciar patologia renal e/ou urológica. Uma correta avaliação do doente com uma HM prende-se com a necessidade de determinar a sua etiologia, da qual dependerá a subsequente abordagem. Sendo um achado laboratorial frequente na consulta de MGF, o MF deverá estar sensibilizado para as suas principais causas, referenciando para a especialidade hospitalar sempre que indicado.

Introduction: Microscopic hematuria (MH) is defined by the presence of at least three erythrocytes per high power field in the urine sediment, when properly collected, and without evidence of infection. This laboratory finding is often accidently detected by family physicians (FP), therefore its diagnostic approach should not be overlooked. MH can be classified as asymptomatic/symptomatic, transient/persistent and may be of benign or malignant nature. Objectives: To discuss the clinical evaluation of MH in adulthood, and to create an algorithm to guide FP on the differential diagnosis and clinical management. Methods: Search of meta-analysis, review articles and clinical guidelines (CG) published since 2010, in Portuguese and English. Databases: PubMed, Cochrane Library, DARE, NICE, UpToDate, Medscape. MeSH Keywords: ‘Hematuria’, ‘Microscopic findings’ and ‘Adult’. Free search in the American Urological Association and European Association of Urology. Results: A total of 265 articles were obtained. After duplicates’ removal, title screening, abstract screening and assessment of inclusion and exclusion criteria, one CG and two review articles were selected. Using the selected articles, we created an algorithm that synthesizes, in a practical way, the clinical management of MH in an adult patient. After excluding the possibility of contamination of the urine sample, the medical history and the physical examination of the urine sediment, combined with urine culture and the evaluation of kidney function, can provide clues for a specific diagnostic. In an asymptomatic patient, MH should be confirmed by performing a new urine sediment analysis, combined with urine culture and evaluation of kidney function. If the second laboratory test is negative, it is diagnosed as transient MH, which should be managed according to the patient’s risk for malignant disease. If MH is maintained, further information obtained from the sediment analysis (presence of proteins, dysmorphic erythrocytes, cylinders and/or clots) determines if the cause is glomerular or extra-glomerular. In the presence of extra-glomerular HM, the clinical management will depend on the presence of risk factors for malignant disease. Appointment referral to nephrology is mandatory in case of glomerular HM. Discussion: Microscopic hematuria is a laboratory sign that may indicate the presence of renal or/and urological pathology. A correct evaluation of the patient with MH shall include the determination of its etiology, upon which the subsequent clinical management will depend. As a frequent laboratory finding in primary care, FP should be aware of its main causes, and refer to secondary care whenever indicated.

Abstract INTRODUCTION: The drugs available for visceral leishmaniasis (VL) treatment in Brazil have specific characteristics in terms of operability, effectiveness, toxicity, and cost. The aim of this study was to estimate the direct costs of therapies recommended by the Ministry of Health (MH) for VL treatment in Brazil. METHODS: The analytical perspective used was that adopted by the Brazilian Public Health System. Three drugs and four regimens were included: 1) N-methyl glucamine antimoniate intramuscularly at 20mg per kg per day for 30 days; 2) N-methyl glucamine antimoniate intravenously at 20mg per kg per day for 30 days; 3) amphotericin B deoxycholate at 1mg per kg per day for 21 days; and 4) liposomal amphotericin B at 3mg per kg per day for a 7 days treatment. RESULTS: The estimated direct costs of treatment for an adult patient using N-methylglucamine antimoniate administered via the intramuscular and intravenous routes were USD 418.52 and USD 669.40, respectively. The estimated cost of treatment with amphotericin B deoxycholate was USD 1,522.70. Finally, the estimated costs of treatment with liposomal amphotericin B were USD 659.79, and USD 11,559.15 using the price adopted by the WHO and the Drug Regulation Board, respectively. CONCLUSIONS: This analysis indicates the economic feasibility of replacing N-methyl glucamine antimoniate with liposomal amphotericin B, which allows a shorter treatment period with less toxicity compared with other treatments, provided that the purchase value used by the WHO and transferred to the MH is maintained.