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Abstract Objective The current study delves into the accessibility of genetic evaluations for individuals with orofacial clefts (OC), comparing data between genetics and treatment centers across Brazil. Methods This cross-sectional retrospective study analyzed primary data from 1463 OC individuals registered in the Brazilian Database of Craniofacial Anomalies (BDCA) between 2008 and 2018 without age or sex selection. Diagnostic exam results stemming from research projects until 2023 were considered. Results Of the 1463 individuals with typical OC, 987 were non-syndromic, 462 were syndromic (SOC), 10 presented atypical forms, and three were not specified OC cases. The average age for accessing laboratory diagnosis was 8.5 years among SOC individuals. Notably, more SOC cases were registered in genetics centers than treatment and rehabilitation centers (37.1 % vs. 29 %, p = 0.0015). Those originating from genetics centers accessed diagnosis at an average age of 7.3 years, while those from treatment and rehabilitation centers experienced delays with an average age of 10.7 years (p = 0.0581). Conclusions Irrespective of the center of origin, the data highlight delayed diagnosis and challenges in accessing genetic tests for the syndromic group. Given the widespread reliance on the public health system by most of the Brazilian population, disseminating this data can significantly contribute to shaping an informed perspective on healthcare access. These insights can improve public policies tailored to the unique needs of individuals with OC. , (OC) Brazil crosssectional cross sectional 146 BDCA (BDCA 200 201 selection 202 considered 98 nonsyndromic, nonsyndromic non syndromic, non-syndromic 46 SOC, (SOC) 1 forms 85 8 5 8. Notably 37.1 371 37 (37. vs 2 0.0015. 00015 0.0015 . 0 0015 0.0015) 73 7 3 7. 107 10. 0.0581. 00581 0.0581 0581 0.0581) origin group population access (OC 14 20 9 4 (SOC 37. (37 0001 0.001 001 0058 0.058 058 (3 000 0.00 00 005 0.05 05 ( 0.0 0.

https://doi.org/10.1016/j.jped.2024.07.002

Desempenho de pré-escolares e escolares no protocolo ProNOH: aspectos macroestruturais préescolares pré ProNOH
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Rossi, Natalia Freitas

; Xavier, Ana Carolina

; Rosa, Kriscia Gobi

; Giacheti, Célia Maria

CoDAS

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2024, Volume 36 Nº 1 elocation e20220245

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Investigar se o escore narrativo obtido por meio da aplicação do “Protocolo de Avaliação da Narrativa Oral de História (ProNOH)” permite discriminar os grupos etários estudados, bem como sua relação com o nível de coerência global da história. Método Participaram 97 pré-escolares e escolares com desenvolvimento típico de linguagem, entre 5 e 12 anos, ambos os sexos que frequentavam escola pública. Foi aplicado o “Protocolo de Avaliação da Narrativa Oral de História (ProNOH)” e calculado o escore narrativo na dimensão macroestrutural a partir dos elementos estruturais previstos no modelo da gramática de história. Esses mesmos elementos foram usados para obter o nível de coerência global da história, segundo proposta de análise de Spinillo e Martins (1997). Resultados Diferença estatisticamente significante foi encontrada entre os grupos etários, principalmente entre as idades fronteiriças de 5-6 anos, 7-8 anos, 9-10 anos e 11-12 anos. Correlação positiva e estatisticamente significante foi encontrada com a idade e o escore narrativo e a coerência global, bem como entre o escore narrativo e o nível de coerência global. Conclusão O protocolo mostrou ser útil para identificar o repertório de elementos típicos da gramática de história na narrativa oral como uma medida objetiva que diferenciou a narrativa oral de grupos etários. Os resultados indicaram ainda que o escore narrativo pode ser uma medida norteadora do nível de coerência da história, apesar deste valor não substituir uma análise específica. Protocolo ProNOH (ProNOH) estudados 9 préescolares pré linguagem 1 pública 1997. 1997 . (1997) 56 6 5- 78 7 8 7- 910 10 9-1 1112 11 11-1 específica (ProNOH 199 (1997 91 9- 111 11- 19 (199 (19 (1 (

ABSTRACT Purpose To investigate if the narrative score of the ProNOH protocol allows for discriminating age groups, as well as its relation with the global coherence level of the story. The performance of preschool and schoolchildren on the macrostructure aspects. Methods Participants were 97 preschoolers and schoolchildren with typical language development, aged between five and 12 years old, and both sexes who attended public schools. The “Protocolo de Avaliação da Narrativa Oral de História (ProNOH)” (Protocol for the Evaluation of Oral Storytelling) was applied and the narrative score in the macrostructure dimension was calculated with story grammar elements. These same story elements were used to obtain the global coherence level of the story, as proposed by Spinillo and Martins (1997). Results A statistically significant difference was found between age groups, mainly between the borderline ages of 5-6 years, 7-8 years, 9-10 years, and 11-12 years. Positive and statistically significant correlations were found between the narrative score and global coherence and age, as well as between the narrative score and global coherence. Conclusion The protocol proved to be useful for identifying the repertoire of typical story grammar elements as an objective measure that differs in oral narrative across age groups. The results also indicate that the narrative score can provide an idea about the global coherence of the story, although this value does not replace a specific analysis. groups aspects 9 development 1 old schools Protocolo (ProNOH) Protocol Storytelling 1997. 1997 . (1997) 56 5 6 5- 78 7 8 7- 910 10 9-1 1112 11 11-1 analysis (ProNOH 199 (1997 91 9- 111 11- 19 (199 (19 (1 (

https://doi.org/10.1590/2317-1782/20232022245pt

Adaptação dos acadêmicos de Medicina em currículo PBL e tradicional ao ensino remoto na pandemia
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Coelho, Izabel Cristina Meister Martins

; Silva, Mariana Xavier e

; Brandão, Adriana Buechner de Freitas

; Veiga, Ana Carolina Bernard

; Tsutida, Carolina Arissa

; Mattei, Maria Paula Miranda

Revista Brasileira de Educação Médica

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2024, Volume 48 Nº 2 elocation e049

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: Em 2020, o mundo foi afetado pelo novo coronavírus, e isso gerou mudanças históricas em diversos setores, incluindo o da educação, que teve que se adaptar rapidamente ao formato online. Objetivo: Este estudo teve como objetivo comparar se houve uma melhor adaptação ao ensino remoto durante a pandemia de Covid-19 dos acadêmicos de Medicina que estudam em currículos PBL quando comparada a de alunos com currículos em modelo disciplinar expositivo. Método: Trata-se de um estudo transversal. Foram incluídos na pesquisa os estudantes matriculados do segundo ao quarto ano do curso de Medicina que tenham preenchido o questionário completamente e cursado pelo menos um semestre de ensino remoto durante o ano de 2020. Resultado: Houve uma diferença significativa entre as metodologias, com maior adaptação dos estudantes que utilizaram o modelo PBL em comparação aos que cursaram no modelo disciplinar expositivo durante a pandemia de Covid-19. Conclusão: Na amostra estudada, o método PBL mostrou-se superior ao método disciplinar, nos quesitos avaliados, na adaptação de estudantes de Medicina ao ensino remoto. Introdução 2020 coronavírus setores educação online Objetivo Covid19 Covid 19 Covid-1 Método Tratase Trata transversal Resultado metodologias Covid19. 19. Conclusão estudada mostrouse mostrou avaliados 202 Covid1 1 Covid- 20 2

ABSTRACT Introduction: In 2020, the new coronavirus pandemic affected the whole world, causing historic changes in several sectors, including education, in which students were forced to quickly adapt to online learning. Objective: This study aimed to compare medical students’ adaptation to remote learning during the COVID-19 pandemic depending on whether they were following a PBL curriculum or a curriculum based on an expository disciplinary model. Method: This was a cross-sectional study. The sample was composed of students enrolled in the 2nd to 4th year of the Medicine course who had fully completed the questionnaire and attended at least one semester of remote learning during 2020. Result: A significant difference was found between the students’ adaptation to remote learning during the Covid-19 pandemic according to their study methodology; students using the PBL model showed better adaptation than those following an expository learning model. Conclusion: The study corroborated the results in the existing literature on the subject, which defends PBL as a better alternative for online learning. Introduction 2020 world sectors education Objective COVID19 COVID 19 COVID-1 Method crosssectional cross sectional nd th Result Covid19 Covid Covid-1 methodology Conclusion subject 202 COVID1 1 COVID- Covid1 Covid- 20 2

https://doi.org/10.1590/1981-5271v48.2-2023-0052

Effect of primary health care on the association between multimorbidity and emergency service utilization: National Health Survey, 2019
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Lamonato, Larissa Carolina Xavier Lacerda

; Sarti, Thiago Dias

; Almeida, Ana Paula Santana Coelho

Revista Brasileira de Epidemiologia

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2024, Volume 27 elocation e240062

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1980-549720240062

Safety of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with rheumatoid arthritis: data from the Brazilian multicentric study safer ChAdOx SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- arthritis SARS-CoV
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Cruz, Vitor Alves

; Guimarães, Camila

; Rêgo, Jozelia

; Machado, Ketty Lysie Libardi Lira

; Miyamoto, Samira Tatiyama

; Burian, Ana Paula Neves

; Dias, Laiza Hombre

; Pretti, Flavia Zon

; Batista, Danielle Cristina Filgueira Alves

; Mill, José Geraldo

; Oliveira, Yasmin Gurtler Pinheiro de

; Gadelha, Carolina Strauss Estevez

; Gouveia, Maria da Penha Gomes

; Moulin, Anna Carolina Simões

; Souza, Bárbara Oliveira

; Aguiar, Laura Gonçalves Rodrigues

; Vieira, Gabriel Smith Sobral

; Grillo, Luiza Lorenzoni

; Lima, Marina Deorce de

; Pasti, Laís Pizzol

; Surlo, Heitor Filipe

; Faé, Filipe

; Moulaz, Isac Ribeiro

; Macabú, Mariana de Oliveira

; Ribeiro, Priscila Dias Cardoso

; Magalhães, Vanessa de Oliveira

; Aguiar, Mariana Freitas de

; Biegelmeyer, Erika

; Peixoto;, Flávia Maria Matos Melo Campos

; Kayser, Cristiane

; Souza, Alexandre Wagner Silva de

; Castro, Charlles Heldan de Moura

; Ribeiro, Sandra Lúcia Euzébio

; Telles, Camila Maria Paiva França

; Bühring, Juliana

; Lima, Raquel Lima de

; Santos, Sérgio Henrique Oliveira Dos

; Dias, Samuel Elias Basualto

; Melo, Natália Seixas de

; Sanches, Rosely Holanda da Silva

; Boechat, Antonio Luiz

; Sartori, Natália Sarzi

; Hax, Vanessa

; Dória, Lucas Denardi

; Rezende, Rodrigo Poubel Vieira de

; Baptista, Katia Lino

; Fortes, Natália Rodrigues Querido

; Melo, Ana Karla Guedes de

; Melo, Tâmara Santos

; Vieira, Rejane Maria Rodrigues de Abreu

; Vieira, Adah Sophia Rodrigues

; Kakehasi, Adriana Maria

; Tavares, Anna Carolina Faria Moreira Gomes

; Landa, Aline Teixeira de

; Costa, Pollyana Vitoria Thomaz da

; Azevedo, Valderilio Feijó

; Martins-Filho, Olindo Assis

; Peruhype-Magalhães, Vanessa

; Pinheiro, Marcelo de Medeiros

; Monticielo, Odirlei André

; Reis-neto, Edgard Torres Dos

; Ferreira, Gilda Aparecida

; Souza, Viviane Angelina de

; Teixeira-Carvalho, Andréa

; Xavier, Ricardo Machado

; Sato, Emilia Inoue

; Valim, Valeria

; Pileggi, Gecilmara Salviato

; Silva, Nilzio Antonio da

Advances in Rheumatology

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2024, Volume 64 elocation 58

Resumo: En | Texto: En | PDF: En

Abstract Background Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. Objective To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. Methods This data are from the study “Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Results A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. Conclusion In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity. immunemediated immune mediated (IMRDs COVID19 COVID 19 COVID-1 risks (RA outcomes comorbidities However SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- Safety Diseases, Diseases Brazil (AEs ChAdOx Oxford/AstraZeneca OxfordAstraZeneca Oxford AstraZeneca (Oxford/AstraZeneca Sinovac/Butantan. SinovacButantan Sinovac/Butantan . Sinovac Butantan (Sinovac/Butantan) diary 18 include 90 female 10 79 46,7%, 467 46,7% , 46 7 (46,7%) 39,4%, 394 39,4% 39 4 (39,4%) 30,5% 305 30 5 (30,5% 26,6%, 266 26,6% 26 6 (26,6%) 66% 66 (66 3 % 0.001 0001 0 001 62% 62 (62 22 22% 45% 45 (45 20 20% 37%, 37 37% (37%) 31%, 31 31% (31%) 23%, 23 23% (23%) 21% 21 (21% 18%. 18% (18%) 41,4% 414 41 (41,4 25 25% 0.02 002 02 51,4% 514 51 (51,4 27 27% related level summary COVID1 1 COVID- SARS-CoV (Sinovac/Butantan 9 46,7 (46,7% 39,4 (39,4% 30,5 (30,5 26,6 (26,6% (6 0.00 000 00 (4 (37% (31% (23% (21 (18% 41,4 (41, 0.0 51,4 (51, 46, (46,7 39, (39,4 30, (30, 26, (26,6 ( (37 (31 (23 (2 (18 41, (41 0. 51, (51 (46, (39, (30 (26, (3 (1 (5 (46 (39 (26

https://doi.org/10.1186/s42358-024-00397-5

Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil COVID19 COVID 19 COVID-1 immunemediated immune mediated patients Argentina COVID1 1 COVID-
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Martinez-Martinez, Marco Ulises

; Isnardi, Carolina Ayelen

; Alpizar-Rodriguez, Deshiré

; Pons-Estel, Guillermo Javier

; Virasoro, Belén María

; Alfaro, María Agustina

; Petkovic, Ingrid

; Quintana, Rosana

; Berbotto, Guillermo

; Salinas, María Jezabel Haye

; Ornella, Sofía

; Pera, Mariana

; Colunga-Pedraza, Iris Jazmín

; Irazoque-Palazuelos, Fedra

; Reyes-Cordero, Greta

; Rodriguez-Reyna, Tatiana S

; Veloz-Aranda, Jose Antonio

; Skinner-Taylor, Cassandra Michele

; Juárez-Mora, Ingrid Maribel

; Silveira, Luis H.

; Marques, Claudia Diniz Lopes

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Gomides, Ana Paula

; Reis-Neto, Edgard Torres dos

; Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Mota, Licia Maria Henrique da

; Pinheiro, Marcelo Medeiros

; Calderaro, Débora Cerqueira

Advances in Rheumatology

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2024, Volume 64 elocation 78

Resumo: En | Texto: En | PDF: En

Abstract Background SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil. Methods Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19. Results A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality. Conclusion These findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- issue view social political States Europe China countries immunemediated immune mediated (IMRD Argentina registries SARCOVID SAR COVID , (Argentina) CMR (Mexico ReumaCoVBrasil ReumaCoV Brasil Brazil, (Brazil) combined recruited provincestate province state province/state density inhabitant income unemployment index MHDI, MHDI (MHDI) COVID19. COVID19 19. 19 474 included 253 53.4% 534 53 4 (53.4% SARCOVID, COVID, 116 24.6% 246 24 6 (24.6% 104 22.0% 220 22 0 (22.0% ReumaCoVBrasil. Brasil. COVID-1 54 5 5.4% analysis 100 activity Thus pandemic SARS-CoV (Argentina (Brazil (MHDI COVID1 1 47 25 53.4 (53.4 11 24.6 (24.6 10 22.0 (22.0 COVID- 5.4 53. (53. 24. (24. 22. (22. 5. (53 (24 (22 (5 (2 (

https://doi.org/10.1186/s42358-024-00418-3

Effect of primary health care on the association between multimorbidity and emergency service utilization: National Health Survey, 2019 utilization Survey 201 20 2
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Lamonato, Larissa Carolina Xavier Lacerda

; Sarti, Thiago Dias

; Almeida, Ana Paula Santana Coelho

Revista Brasileira de Epidemiologia

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2024, Volume 27 elocation e240062

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Verificar o efeito da Atenção Primária à Saúde (APS) na associação entre multimorbidade e utilização dos serviços de emergência em adultos do Brasil. Métodos: Trata-se de um estudo transversal, de base domiciliar em âmbito nacional, sendo utilizados dados da Pesquisa Nacional de Saúde (PNS) de 2019. A regressão de Poisson foi aplicada para avaliar a utilização do serviço de emergência entre pessoas com multimorbidade. Também foi avaliada a interação das variáveis cobertura de Saúde da Família e orientação para a APS nessas associações. Resultados: A prevalência de multimorbidade foi de 31,2% (IC95% 30,9–31,5), a cobertura de Saúde da Família foi de 71,8% (IC95% 71,4–72,0) e a baixa orientação dos serviços para a APS foi de 70% (IC95% 69,1–70,9). O uso do serviço de emergência apresentou uma prevalência de 2,0% (IC 95% 1,9–2,0), sendo duas vezes maior entre indivíduos com multimorbidade (3,1; IC95% 2,9–3,3) em comparação com aqueles sem essa condição (1,4; IC95% 1,3–1,5). No entanto, pessoas com multimorbidade e cobertura de Saúde da Família apresentaram prevalência de utilização de serviços de emergência 20% menor do que aquelas sem cobertura de Saúde da Família (RP 0,8; IC95% 0,6–0,9). A associação entre o uso do serviço de emergência e a multimorbidade não foi modificada pela avaliação do serviço, como altamente orientado para a APS (p=0,956). Conclusão: O estudo evidenciou que a cobertura de Saúde da Família exerceu um efeito positivo na associação entre multimorbidade e utilização dos serviços de emergência. Objetivo (APS Brasil Métodos Tratase Trata se transversal nacional PNS (PNS 2019 associações Resultados 312 31 2 31,2 IC95 IC (IC95 30,9–31,5, 309315 30,9–31,5 , 30 9 5 30,9–31,5) 718 71 8 71,8 71,4–72,0 714720 4 72 0 70 69,1–70,9. 691709 69,1–70,9 . 69 1 69,1–70,9) 20 2,0 95 1,9–2,0, 1920 1,9–2,0 1,9–2,0) 3,1 3 (3,1 2,9–3,3 2933 1,4 14 (1,4 1,3–1,5. 1315 1,3–1,5 1,3–1,5) entanto RP 0,8 08 0,6–0,9. 0609 0,6–0,9 6 0,6–0,9) p=0,956. p0956 p p=0,956 956 (p=0,956) Conclusão 201 31, IC9 (IC9 30931 30,9–31, 7 71, 71,4–72, 71472 69170 69,1–70, 2, 192 1,9–2, 3, (3, 2,9–3, 293 1, (1, 131 1,3–1, 0, 060 0,6–0, p095 p=0,95 (p=0,956 3093 30,9–31 71,4–72 7147 6917 69,1–70 19 1,9–2 (3 2,9–3 29 (1 13 1,3–1 06 0,6–0 p09 p=0,9 (p=0,95 309 30,9–3 71,4–7 714 691 69,1–7 1,9– ( 2,9– 1,3– 0,6– p0 p=0, (p=0,9 30,9– 71,4– 69,1– 1,9 2,9 1,3 0,6 p=0 (p=0, 30,9 71,4 69,1 p= (p=0 30, 69, (p= (p

ABSTRACT Objective: To examine the effect of Primary Health Care (PHC) on the association between multimorbidity and emergency service utilization among adults in Brazil. Methods: This is a cross-sectional, nationwide household-based study using data from the 2019 National Health Survey. Poisson regression was used to assess emergency service utilization among individuals with multimorbidity. The interaction of variables such as Family Health coverage and orientation to PHC in these associations was also evaluated. Results: The prevalence of multimorbidity was 31.2% (95%CI 30.9–31.5), Family Health coverage was 71.8% (95%CI 71.4–72.0), and low orientation of services toward PHC was 70% (95%CI 69.1–70.9). Emergency service utilization had a prevalence of 2.0% (95%CI 1.9–2.0), being twice as high among individuals with multimorbidity (3.1; 95%CI 2.9–3.3) compared to those without this condition (1.4; 95%CI 1.3–1.5). However, individuals with multimorbidity and Family Health coverage had a 20% lower prevalence of emergency service utilization than those without Family Health coverage (PR 0.8; 95%CI 0.6–0.9). The association between emergency service utilization and multimorbidity was not modified by the evaluation of the service as highly oriented toward PHC (p=0.956). Conclusion: The study showed that Family Health coverage exerted a positive effect on the association between multimorbidity and emergency service utilization. Objective (PHC Brazil Methods crosssectional, crosssectional cross sectional, sectional cross-sectional householdbased household based 201 Survey evaluated Results 312 31 2 31.2 95CI CI 95 30.9–31.5, 309315 30.9–31.5 , 30 9 5 30.9–31.5) 718 71 8 71.8 71.4–72.0, 714720 71.4–72.0 4 72 0 71.4–72.0) 70 69.1–70.9. 691709 69.1–70.9 . 69 1 69.1–70.9) 20 2.0 1.9–2.0, 1920 1.9–2.0 1.9–2.0) 3.1 3 (3.1 2.9–3.3 2933 1.4 14 (1.4 1.3–1.5. 1315 1.3–1.5 1.3–1.5) However PR 0.8 08 0.6–0.9. 0609 0.6–0.9 6 0.6–0.9) p=0.956. p0956 p p=0.956 956 (p=0.956) Conclusion 31. 30931 30.9–31. 7 71. 71472 71.4–72. 69170 69.1–70. 2. 192 1.9–2. 3. (3. 2.9–3. 293 1. (1. 131 1.3–1. 0. 060 0.6–0. p095 p=0.95 (p=0.956 3093 30.9–31 7147 71.4–72 6917 69.1–70 19 1.9–2 (3 2.9–3 29 (1 13 1.3–1 06 0.6–0 p09 p=0.9 (p=0.95 309 30.9–3 714 71.4–7 691 69.1–7 1.9– ( 2.9– 1.3– 0.6– p0 p=0. (p=0.9 30.9– 71.4– 69.1– 1.9 2.9 1.3 0.6 p=0 (p=0. 30.9 71.4 69.1 p= (p=0 30. 69. (p= (p

https://doi.org/10.1590/1980-549720240062

Alternativas de modelagem para a estimativa da altura de árvores de eucalipto
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Lafetá, Bruno Oliveira

; Pimenta, Ivelton Alves

; Santos, Milene Alves dos

; Brenda, Heloisa

; Rodrigues, Xavier

; Fontan, Ivan da Costa Ilhéu

; Ferraro, Ana Carolina

; Vieira, Diego dos Santos

Revista Forestal Mesoamericana Kurú

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Dez 2023, Volume 20 Nº 47 Páginas 1 - 8

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo O objetivo do presente trabalho foi avaliar alternativas para a modelagem hipsométrica generalista de eucalipto via regressão linear, com a inclusão de índices de competição independentes da distância como variável preditora. Os dados utilizados foram provenientes de 34 parcelas distribuídas em quatro unidades de manejo florestal com 72 meses de idade. Calcularam-se 7 índices de competição independentes da distância. Avaliou-se o desempenho preditivo de 16 modelos hipsométricos generalistas, sendo propostos 14 modelos de dupla entrada (DAP e índice de competição). Todas as equações geradas foram biologicamente consistentes. Diante da ausência de informações da altura de árvores dominantes, a modelagem generalista pode ser melhor viabilizada com a inclusão do índice IC4, que representa a área basal de árvores vizinhas competidoras. Conclui-se que a inclusão de índices de competição em modelos hipsométricos ampliam a capacidade de generalização de equações para talhões de eucalipto com distintas capacidades produtivas. O índice de competição IC4 favorece a qualidade de ajuste e desempenho preditivo da modelagem hipsométrica nos sítios estudados.

Abstract This study aimed to evaluate alternatives for general hypsometric modeling of eucalypt through linear regression, with inclusion of distance-independent competition indices as a predictor variable. The data was collected from 34 plots distributed in four 72-month-old forest management units. Seven distance-independent competition indices were calculated. The study evaluated the predictive performance of 16 general hypsometric models, and 14 double-entry models (DAP and competition index) were proposed. All equations generated were biologically consistent. Given the lack of information on the height of dominant trees, general modeling can be better employed with inclusion of the IC4 index, which represents basal area of neighboring competing trees. It is concluded that the inclusion of competition indices in hypsometric models increases generalization capacity of equations for eucalyptus stands with different productive capacities. The IC4 competition index enhances fit quality and predictive performance of the hypsometric modeling in the study sites.

https://doi.org/10.18845/rfmk.v20i47.6816

Maternal-fetal outcomes of women with hypertensive disorders of pregnancy Maternalfetal Maternal fetal
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Xavier, Ivete Matias

; Simões, Ana Carolina Zimmermann

; Oliveira, Ronnier de

; Barros, Yasha Emerenciano

; Sarmento, Ayane Cristine Alves

; Medeiros, Kleyton Santos de

; Costa, Ana Paula Ferreira

; Korkes, Henri

; Gonçalves, Ana Katherine

Revista da Associação Médica Brasileira

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2023, Volume 69 Nº 6 elocation e20230060

Resumo: En | Texto: En | PDF: En

SUMMARY OBJECTIVE: The objective of this study was to determine adverse maternal and perinatal outcomes in pregnant women with hypertensive disorders of pregnancy. METHODS: An analytical cross-sectional study was conducted on women admitted with hypertensive disorders of pregnancies to a university maternity hospital from August 2020 to August 2022. Data were collected using a pretested structured questionnaire. Variables associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. RESULTS: Of 501 women with pregnancies, 2, 35, 14, and 49% had eclampsia, preeclampsia, chronic hypertension, and gestational hypertension, respectively. Women with preeclampsia/eclampsia had significantly higher risks of cesarean section (79.4 vs. 65%; adjusted RR, 2,139; 95%CI, 1,386–3,302; p=0.001) and preterm delivery at <34 weeks’ gestation (20.5 vs. 6%; adjusted RR, 2.5; 95%CI, 1.19–5.25; p=0.01) than those of women with chronic/gestational hypertension. Risks of prolonged maternal hospitalization (43.9 vs. 27.1%), neonatal intensive care unit admission (30.7 vs. 19.8%), and perinatal mortality (23.5 vs. 11.2%) were higher among women with preeclampsia/eclampsia. CONCLUSIONS: Women with preeclampsia/eclampsia had a higher risk of adverse maternal and neonatal outcomes than those with chronic or gestational hypertension. This major maternity care center requires strategies for preventing and managing preeclampsia/eclampsia to improve pregnancy outcomes. OBJECTIVE METHODS crosssectional cross sectional 202 2022 questionnaire regression RESULTS 50 2 35 14 49 eclampsia preeclampsia hypertension respectively preeclampsiaeclampsia 79.4 794 79 4 (79. vs 65% 65 RR 2,139 2139 139 95CI CI 95 95%CI 1,386–3,302 13863302 1 386 3 302 p=0.001 p0001 p 0 001 34 <3 weeks 20.5 205 20 5 (20. 6% 6 2.5 25 1.19–5.25 119525 19 p=0.01 p001 01 chronicgestational 43.9 439 43 9 (43. 27.1%, 271 27.1% , 27 27.1%) 30.7 307 30 7 (30. 19.8%, 198 19.8% 8 19.8%) 23.5 235 23 (23. 11.2% 112 11 CONCLUSIONS 79. (79 2,13 213 13 1,386–3,30 1386330 38 p=0.00 p000 00 < 20. (20 2. 1.19–5.2 11952 p=0.0 p00 43. (43 27.1 30. (30 19.8 23. (23 11.2 (7 2,1 21 1,386–3,3 138633 (2 1.19–5. 1195 p=0. p0 (4 27. (3 19. 11. ( 1,386–3, 13863 1.19–5 119 p=0 1,386–3 1386 1.19– p= 1,386– 138 1.19 1,386 1.1 1,38 1. 1,3 1,

https://doi.org/10.1590/1806-9282.20230060

10.

Numerical Prediction for the Effects of Welding Interpass Temperature on the Thermal History and Microstructure of Duplex Stainless Steels
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Xavier, Carlos Roberto

; Delgado Junior, Horácio Guimarães

; Rebello, Matheus Gomes

; Lisbôa, Raí Ramos

; Silva, Ana Carolina Martins

; Castro, José Adilson de

Materials Research

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2023, Volume 26 elocation e20220529

Resumo: En | Texto: En | PDF: En

Numerical simulation was used to predict the thermal behavior and the resulting microstructure at the heat-affected zone (HAZ) of a 170 mm diameter and 3.5 mm thickness super duplex stainless steel (SDSS) UNS S32750 tube. In order to evaluate the thermal response from the model, a usual welding situation involving interpass temperature (IT) and its influence on the HAZ microstructure was exploited. Thus, two superimposed autogenous welding passes were simulated, the first clockwise with the tube in the room temperature and the second, counterclockwise, with the tube at the temperature of 250oC. Even subjected to successive thermal cycles and high interpass temperature, the proportion and morphology of the phases at the HAZ and Fusion Zone (FZ) did not present significant differences when comparing the two welding passes. Meanwhile, nitrogen losses should be avoided during welding in order to obtain a balanced microstructure in DSS welds, contributing to guarantee satisfactory toughness in addition to resistance to pitting corrosion. The predictions from the simulation were validated by using experimental results obtained from the autogenous TIG (Tungsten Inert Gas) process. heataffected heat affected (HAZ 17 35 3 5 3. SDSS (SDSS S S3275 model IT (IT exploited Thus simulated second counterclockwise 250oC oC FZ (FZ Meanwhile welds corrosion Tungsten Gas process 1 S327 S32 S3

https://doi.org/10.1590/1980-5373-mr-2022-0529

11.

Permanent health education in the context of obesity: a scoping review obesity
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Magalhães, Carolina Gusmão

; Ceccim, Ricardo Burg

; Silva, Lígia Amparo Santos da

; Santos, Verena Macedo

; Pereira, Emile Miranda

; Santos, Ana Artur Francisco Mussa

; Xavier Júnior, Gesner Franscisco

; Martins, Poliana Cardoso

; Santana, Mônica Leila Portela de

Revista de Saúde Pública

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2023, Volume 57 elocation 5

Resumo: En | Texto: En | PDF: En

ABSTRACT OBJETIVE To map the international literature on Permanent Health Education initiatives to care for people with obesity. METHODS In total, six databases were searched without any language or publication period restriction according to the Joana Briggs Institute manual for evidence synthesis and the Prisma extension for scoping reviews (Prisma-ScR). Articles were independently analyzed by four reviewers and data, by two authors, which were then analyzed and discussed with our research team. RESULTS After screening 8,780 titles/abstracts and 26 full texts, 10studies met our eligibility criteria. We extracted data on methodologies, themes, definitions of obesity, outcomes, and gaps. Most initiatives came from North American countries without free or universal health systems and lasted a short period of time (70%), had multidisciplinary teams (70%), and addressed sub-themes on obesity approaches (90%). Results included changes in participants’ understanding, attitude, and procedures (80%) and gaps which pointed to the sustainability of these changes (80%). CONCLUSION This review shows the scarce research in the area and a general design of poorly effective initiatives, with traditional teaching methodologies based on information transmission techniques, the understanding of obesity as a disease and a public health problem, punctual actions, disciplinary fragmentation alien to the daily work centrality, and failure to recognize problems and territory as knowledge triggers and to focus on health care networks, line of care, the integrality of care, and food and body cultures. total PrismaScR. PrismaScR ScR . (Prisma-ScR) authors team 8780 8 780 8,78 titlesabstracts titles abstracts 2 texts studies criteria themes outcomes 70%, 70 70% , (70%) subthemes sub 90%. 90 90% (90%) participants attitude 80% 80 (80% 80%. techniques problem actions centrality networks cultures (Prisma-ScR 878 78 8,7 7 (70% 9 (90% (80 87 8, (70 (90 (8 (7 (9 (

https://doi.org/10.11606/s1518-8787.2023057004244

12.

Cognitive evaluation in Parkinson’s disease: applying the Movement Disorder Society recommendations in a population with a low level of formal education Parkinsons Parkinson s disease
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Rocha, Natalia Pessoa

; Carreira, Eduarda Xavier

; Almeida Prado, Ana Carolina de

; Tavares, Fabíola

; Tavares, Mayra

; Cardoso, Francisco

; Jaeger, Antônio

; Souza, Leonardo Cruz de

; Teixeira, Antônio Lucio

Arquivos de Neuro-Psiquiatria

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2023, Volume 81 Nº 2 Páginas 119 - 127

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Antecedentes O diagnóstico de distúrbios cognitivos na doença de Parkinson (DP) pode ser muito desafiador. Com o objetivo de estabelecer procedimentos diagnósticos uniformes e confiáveis, a Sociedade Internacional da Doença de Parkinson e Distúrbios do Movimento (MDS, na sigla em inglês) encomendou forças-tarefa para delinear critérios diagnósticos para comprometimento cognitivo leve (CCL) e demência na DP. Objetivos Investigar a aplicabilidade das recomendações da MDS para avaliação cognitiva em uma amostra brasileira de pacientes com DP de baixa escolaridade. Métodos Um total de 41 pacientes com DP foram submetidos a uma avaliação neuropsicológica abrangente com base nos testes propostos pela MDS, que incluiu o Miniexame do Estado Mental, a Escala de Avaliação de Demência de Mattis (MDRS, na sigla em inglês), o teste de trilhas (TMT, na sigla em inglês) partes A e B, além da avaliação das habilidades de linguagem e memória. Características neuropsiquiátricas e de funcionamento diário também foram avaliadas. Análises de correlação de Spearman foram utilizadas para avaliar a associação entre os escores obtidos nas escalas cognitivas e variáveis demográficas/clínicas. Resultados Apesar de nenhum dos participantes ter diagnóstico formal de demência, 50% apresentaram algum grau de comprometimento cognitivo ao levar em consideração os resultados da MDRS. Vale ressaltar que um número notável de pacientes não conseguiu completar a avaliação neuropsicológica completa. A parte B do TMT foi a tarefa mais difícil, sendo realizada por apenas 22 participantes (54%). Como esperado, quanto maior o nível educacional, melhor o desempenho nos testes cognitivos. Melhor função motora também foi associada a melhores escores em cognição. Conclusões Adotando critérios rígidos de inclusão/exclusão e uma avaliação clínica abrangente, encontramos limitações marcantes para as recomendações da MDS quando considerados indivíduos com baixa escolaridade. É necessária uma revisão das diretrizes atuais considerando as diferenças entre as populações, principalmente relacionadas ao nível educacional. (DP desafiador confiáveis (MDS inglês forçastarefa forças CCL (CCL escolaridade 4 Mental MDRS, MDRS (MDRS inglês, , TMT, (TMT memória avaliadas demográficasclínicas demográficas clínicas demográficas/clínicas 50 completa difícil 2 54%. 54 54% . (54%) esperado educacional cognição inclusãoexclusão inclusão exclusão populações 5 (54% (54 (5 (

Abstract Background The diagnosis of cognitive disorders in Parkinson disease (PD) can be very challenging. Aiming at establishing uniform and reliable diagnostic procedures, the International Parkinson’s Disease and Movement Disorder Society (MDS) commissioned task forces to delineate diagnostic criteria for mild cognitive impairment (MCI) and dementia in PD. Objectives To investigate the applicability of the MDS recommendations for cognitive evaluation in a Brazilian sample of patients with PD with low levels of formal education. Methods A total of 41 patients with PD were subjected to a comprehensive neuropsychological evaluation based on tests proposed by the MDS, which included the Mini-Mental State Examination, the Mattis Dementia Rating Scale (MDRS), the Trail Making Test (TMT) parts A and B, in addition to language and memory skills assessment. Neuropsychiatric and daily functioning features were also evaluated. Spearman correlation analyses were used to evaluate the association between the scores obtained in the cognitive scales and demographic/clinical variables. Results Although none of the participants had a formal diagnosis of dementia, 50% presented some degree of cognitive impairment when considering the results of the MDRS. Of note, a noticeable number of patients was not able to complete the full neuropsychological assessment. The TMT part B was the most difficult task, being completed by only 22 participants (54%). As expected, the greater the educational level, the better the performance on the cognitive tests. Better motor function was also associated with better scores in cognition. Conclusions Adopting strict inclusion/exclusion criteria and a comprehensive clinical evaluation, we found remarkable limitations for the MDS recommendations when individuals with low educational levels are considered. A revision of the current guidelines is necessary considering differences among populations, especially related to formal education. (PD challenging procedures Parkinsons s (MDS MCI (MCI education 4 MiniMental Mini Mental Examination MDRS, MDRS , (MDRS) (TMT assessment evaluated demographicclinical demographic variables 50 note 2 54%. 54 54% . (54%) expected level cognition inclusionexclusion inclusion exclusion considered populations (MDRS 5 (54% (54 (5 (

https://doi.org/10.1055/s-0042-1759761

13.

Permanent health education in the context of obesity: a scoping review
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Magalhães, Carolina Gusmão

; Ceccim, Ricardo Burg

; Silva, Lígia Amparo Santos da

; Santos, Verena Macedo

; Pereira, Emile Miranda

; Santos, Ana Artur Francisco Mussa

; Xavier Júnior, Gesner Franscisco

; Martins, Poliana Cardoso

; Santana, Mônica Leila Portela de

Revista de Saúde Pública

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2023, Volume 57 elocation 5

Resumo: En | Texto: En | PDF: En

https://doi.org/10.11606/s1518-8787.2023057004244

14.

Sowing time and substrate in the production of ipê-mirim seedlings ipêmirim ipê mirim
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Ferraz, Marcos Vieira

; Souza, Antonio Maricélio Borges de

; Costa, Carla Rafaele Xavier

; Muniz, Ana Carolina Corrêa

; Loureiro, Eduardo Akira Suzuki de Andrade

; Pivetta, Kathia Fernandes Lopes

Ornamental Horticulture

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Dez 2022, Volume 28 Nº 4 Páginas 459 - 467

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Tecoma stans, popularmente conhecida como ipê-mirim é uma espécie arbórea pertencente à Família Bignoniaceae. Nativa nas Américas e Antilhas, é amplamente utilizada no Brasil, no paisagismo e na arborização urbana. A produção de suas mudas é feita por sementes e são vários os fatores que interferem neste processo e no seu posterior desenvolvimento como a época de semeadura e o substrato. O objetivo deste trabalho foi avaliar o efeito da época de semeadura e do substrato na produção de mudas de Tecoma stans. Os experimentos foram conduzidos em viveiro. O delineamento experimental foi inteiramente casualizado. Os tratamentos foram arranjados em esquema fatorial 2 × 6 sendo duas épocas de semeadura (outono e primavera) e seis substratos (SC1; SC2; SC3; SC4; areia e vermiculita); foram quatro repetições e dez plântulas por parcela. Avaliou-se a porcentagem de emergência e variáveis morfológicas. As médias foram comparadas entre si por meio do teste de Tukey (p < 0,05). Verificou-se diferença significativa entre as épocas do ano mostrando que a porcentagem de emergência foi superior na primavera (89%). As mudas de Tecoma stans se mostraram ser dependentes de nutrientes tanto na emergência da plântula como no posterior desenvolvimento das mudas, já que estes possuem nutrientes em sua composição, com destaque superior para SC1. ipêmirim ipê mirim Bignoniaceae Antilhas Brasil urbana viveiro casualizado outono SC1 SC (SC1 SC2 SC3 SC4 vermiculita vermiculita) parcela Avaliouse Avaliou morfológicas p 0,05. 005 0,05 . 0 05 0,05) Verificouse Verificou 89%. 89 89% (89%) composição (SC 00 0,0 8 (89% 0, (89 (8 (

Abstract Tecoma stans is popularly known as ipê-mirim in Brazil. This species belongs to the Bignoniaceae family and it is native to Americas and Antilles, where it is widely used in landscaping as urban tree. The seedlings are produced from seeds and there are several factors that influences its development, such as the sowing time and the substrate. This work aimed to understand the effect of the sowing time and substrates on the production of Tecoma stans seedlings. The experiments were carried out in a nursery. The experimental design was completely randomized. The substrates were arranged in a 2 × 6 factorial scheme, two sowing times (autumn and spring) and six commercial substrates (SC1; SC2; SC3; SC4; sand and vermiculite) under four replicates and ten seedlings per plot. The means were compared to each other using the Tukey test (p < 0.05). There was a significant difference between the seasons of the year, showing that the percentage of emergence was higher in spring (89%). The seedlings of Tecoma stans were shown to be nutrient-dependent both in the emergence of the seedling and in the subsequent development of the seedlings, since the highest averages of the studied characteristics were obtained in the commercial substrates, as they have nutrients in their composition, with greater emphasis on SC1. ipêmirim ipê mirim Brazil Antilles tree substrate nursery randomized scheme autumn SC1 SC (SC1 SC2 SC3 SC4 vermiculite plot p 0.05. 005 0.05 . 0 05 0.05) year 89%. 89 89% (89%) nutrientdependent nutrient dependent composition (SC 00 0.0 8 (89% 0. (89 (8 (

https://doi.org/10.1590/2447-536x.v28i4.2473

15.

[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio Rassi Jr., Anis Moraes Oliveira, Gláucia M. Lemos Correia, Luís Claudio Novaes Ramos Jr., Alberto Hasslocher-Moreno, Alejandro Marcel Luquetti Ostermayer, Alejandro Sousa, Andréa Silvestre de Amato Vincenzo de Paola, Angelo Sobral de Sousa, Antonio Carlos Pinho Ribeiro, Antonio Luiz Correia Filho, Dalmo Moraes de Souza, Dilma do Socorro Cunha-Neto, Edecio J. A. Ramires, Felix Bacal, Fernando Pereira Nunes, Maria do Carmo Martinelli Filho, Martino Ibrahim Scanavacca, Maurício Magalhães Saraiva, Roberto Alves de Oliveira Júnior, Wilson M. Lorga-Filho, Adalberto de Jesus Benevides de Almeida Guimarães, Adriana Lopes Latado Braga, Adriana Sarmento de Oliveira, Adriana V. L. Sarabanda, Alvaro Yecê das Neves Pinto, Ana Assis Lopes do Carmo, André Schmidt, André Costa, Andréa Rodrigues da Ianni, Barbara Maria Markman Filho, Brivaldo Eduardo Rochitte, Carlos Thé Macedo, Carolina Mady, Charles Chevillard, Christophe Bittencourt das Virgens, Cláudio Marcelo Nery de Castro, Cleudson De Paoli de Carvalho Britto, Constança Felícia Pisani, Cristiano do Carmo Rassi, Daniela C. Sobral Filho, Dario Rodrigues Almeida, Dirceu A. Bocchi, Edimar T. Mesquita, Evandro de Souza Nogueira Sardinha Mendes, Fernanda Pereira, Francisca Tatiana Sperandio da Silva, Gilberto Marcelo de Lima Peixoto, Giselle Glotz de Lima, Gustavo H. Veloso, Henrique Turin Moreira, Henrique Bellotti Lopes, Hugo Masciarelli Francisco Pinto, Ibraim Pinto Dias, João Carlos Bemfica, João Marcos Silva-Nunes, João Paulo Soares Barreto-Filho, José Augusto Kerr Saraiva, José Francisco Lannes-Vieira, Joseli Menezes Oliveira, Joselina Luzia V. Armaganijan, Luciana Martins, Luiz Cláudio C. Sangenis, Luiz Henrique Barbosa, Marco Paulo Almeida-Santos, Marcos Antônio Simões, Marcos Vinicius Shikanai-Yasuda, Maria Aparecida Vieira Moreira, Maria da Consolação Higuchi, Maria de Lourdes Costa Monteiro, Maria Rita de Cássia Felix Mediano, Mauro Felippe Maia Lima, Mayara T. Oliveira, Maykon Moreira Dias Romano , Minna Nitz, Nadjar de Tarso Jorge Medeiros, Paulo Vieira Alves, Renato Alkmim Teixeira, Ricardo Coury Pedrosa, Roberto Aras, Roque Morais Torres, Rosália dos Santos Povoa, Rui Manoel Rassi, Sérgio Gabriel Salles Xavier, Sérgio Marinho Martins Alves , Silvia B. N. Tavares, Suelene Lima Palmeira, Swamy da Silva Junior, Telêmaco Luiz da Rocha Rodrigues, Thiago Madrini Junior, Vagner Maia da Costa , Veruska Dutra, Walderez

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Data de publicação: 2022-10-11

Resumo: En Pt

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.

Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;

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

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