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ABSTRACT Introduction: Lymphopenia is a laboratory marker of poor prognosis and severity of disease in the SARS-CoV-2 infection. This study aims to describe the immune profile of a Brazilian population. Methods: A total of 121 consecutive patients with severe acute respiratory syndrome (SARS) were analyzed between April and June 2020. Routine peripheral blood counts and multiparametric flow cytometry were performed on admission to assess lymphocytes and subsets (CD3, CD4, CD8). Demographic, clinical and laboratory data were collected from hospital sources. Results: The total of 116 patients included 63 (54.3%) males; 76 (62.8%) COVID-19 patients were divided, based on clinical characteristics and mechanical ventilation (MV) use, into moderate (n = 41; no MV) and severe (n = 35; MV) groups. The control group (n = 40) was comprised of patients with SARS of different etiologies. All patients had lymphopenia, with overall lymphocyte counts and their subsets considerably lower in severe patients, when compared to the moderate and controls. Patients with a high neutrophil-to-lymphocyte ratio (> 15.2) and T-cell lymphopenia (CD3 < 593 cells/μL, CD4 < 326 cells/μL, CD8 < 121 cells/μL) had a higher risk of being intubated and progressing to death. A total of 39 patients (95.1%) in the moderate group and 54.3% (n = 19) in the severe group were discharged; 28 patients died. Conclusion: Laboratory assessment of the neutrophil/lymphocyte ratio and T-cell subsets may be predictive of mortality and may be useful for stratifying COVID-19 patients.

https://doi.org/10.1016/j.htct.2022.05.007

The II Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19 Joint Guidelines of the Associação Brasileira de Medicina de Emergência, Associação de Medicina Intensiva Brasileira, Associação Médica Brasileira, Sociedade Brasileira de Angiologia e Cirurgia Vascular, Sociedade Brasileira de Infectologia, Sociedade Brasileira de Pneumologia e Tisiologia and Sociedade Brasileira de Reumatologia
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Falavigna, Maicon

; Araujo, Cintia Laura Pereira de

; Barbosa, Alexandre Naime

; Belli, Karlyse Claudino

; Colpani, Verônica

; Dal-Pizzol, Felipe

; Silva, Rosemeri Maurici da

; Azevedo, Luciano César Pontes de

; Dias, Maria Beatriz Souza

; Amaral, José Luiz Gomes do

; Dorneles, Gilson Pires

; Ferreira, Juliana Carvalho

; Freitas, Ana Paula da Rocha

; Gräf, Débora Dalmas

; Guimarães, Hélio Penna

; Lobo, Suzana Margareth Ajeje

; Machado, Flávia Ribeiro

; Nunes, Michelle Silva

; Oliveira, Maura Salaroli de

; Parahiba, Suena Medeiros

; Rosa, Regis Goulart

; Santos, Vania Cristina Canuto

; Sobreira, Marcone Lima

; Veiga, Viviane Cordeiro

; Xavier, Ricardo Machado

; Zavascki, Alexandre Prehn

; Stein, Cinara

; Carvalho, Carlos Roberto Ribeiro de

Critical Care Science

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Set 2023, Volume 35 Nº 3 Páginas 243 - 255

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

ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

https://doi.org/10.5935/2965-2774.20230136-en

Reply to the letter regarding the article entitled: “Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol” entitled Access AReA study) protocol
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Cacho, Roberta de Oliveira

; Moro, Carla Heloisa Cabral

; Bazan, Rodrigo

; Guarda, Suzete Nascimento Farias da

; Pinto, Elen Beatriz

; Andrade, Suellen Mary Marinho dos Santos

; Valler, Lenise

; Almeida, Kelson James

; Ribeiro, Tatiana Souza

; Jucá, Renata Viana Brígido de Moura

; Minelli, Cesar

; Piemonte, Maria Elisa Pimentel

; Paschoal, Eric Homero Albuquerque

; Pedatella, Marco Túlio Araújo

; Pontes-Neto, Octávio Marques

; Fontana, Ana Paula

; Pagnussat, Aline de Souza

; Conforto, Adriana Bastos

Arquivos de Neuro-Psiquiatria

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Jul 2023, Volume 81 Nº 7 Páginas 703 - 704

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1055/s-0043-1771266

Replacing corn silage with extruded forage in sheep feeding
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Silva, Débora Adriana de Paula

; Loreno, Matheus Borges Naves

; Schultz, Erica Beatriz

; Siqueira, Marco Tulio Santos

; Oliveira, Karla Alves

; Macedo Junior, Gilberto de Lima

Acta Scientiarum. Animal Sciences

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2023, Volume 45 elocation e57397

Resumo: En | Texto: En | PDF: En

ABSTRACT. The objective was to evaluate levels of replacement of corn silage with extruded forage (Foragge®) in sheep feeding. Twenty adult Santa Inês ewes in maintenance, and 55.8 kg average weight were housed in metabolic cages, and the treatments consisted of 20, 40, 60 and 80% replacement of corn silage with Foragge® extruded forage with 60% Uruchloa brizantha in the diet. The design was completely randomized, with regression analysis and non-parametric analysis at 5% probability. The supply of up to 80% extruded roughage to replace corn silage increased dry matter intake and digestibility, and fecal output in dry matter (p < 0.05). Also, it increased the efficiency of ingestion, rumination and chewing activities of sheep, but did not alter urinary parameters and energy metabolites (p > 0.05). However, it reduced the concentration of uric acid (p < 0.05). Foragge® extruded roughage can replace corn silage by up to 80% with changes in intake, digestibility, fecal parameters, ingestive behavior and concentration of uric acid and urea, with no modifications in urinary parameters and energy metabolites.

https://doi.org/10.4025/actascianimsci.v45i1.57397

Challenges and alternatives for the production of cyclodextrins from the CGTase enzyme from recombinant Bacillus subtilis WB800
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CROZATTI, Thamara Thaiane da Silva

; LARENTIS, Paula Vitória

; FENELON, Vanderson Carvalho

; MIYOSHI, Juliana Harumi

; BRITO, Júlia Rosa de

; SALINAS, Giovanna da Silva

; MAZZOTTI, Beatriz de Oliveira

; TELES, Giovanni Cesar

; LIMA NETO, Quirino Alves de

; MATIOLI, Graciette

Food Science and Technology

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2023, Volume 43 elocation e104122

Resumo: En | Texto: En | PDF: En

Abstract Cyclodextrins (CDs) have the ability to encapsulate numerous molecules and have applicability in several industrial areas, however, their cost has made their use difficult. To seek alternatives that may enable the use of DCs, the present study evaluated the efficiency of the ultrafiltration process in a continuous system to produce CDs from the enzyme cyclomaltodextrin glucanotransferase (CGTase) from recombinant Bacillus subtilis WB800. The possibility of using the crude enzyme as an alternative means of producing CDs was also evaluated. All strategies evaluated in this research proved to be promising for the production of CDs, with the production of β-CD being the most efficient (average of 15 mmol/L) using crude recombinant enzyme and a temperature of 50 °C. Therefore, the results obtained can contribute to the reduction of stages and costs of production of CDs, favoring their industrial application.

https://doi.org/10.1590/fst.104122

The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil
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Villacorta, Humberto

; Ávila, Diane Xavier de

; Souza, Tulio Possati de

; Souza, Ana Luíza Carraro de

; Meyas, Gabriel Alverca

; Santos, Mayara Cristina Villela

; Mendonça, Jonatas da Costa

; Costa, Luciene Maria Mendes da

; Sousa, Beatriz de Paula

; Oliveira, Maria Victoria Borges de

; Guimarães, Júlia Correia Cardoso

; Melo, Ulisses

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20220041

Resumo: En | Texto: En | PDF: En

Abstract Background Cardiovascular risk factors are prognostic factors in coronavirus disease 2019 (COVID-19) and have been scarcely studied in Brazil. Objective The aim of this study was to assess the impact of cardiovascular risk factors on the outcomes of patients admitted for COVID-19. Methods From July 2020 to February 2021, 200 patients from two public hospitals were enrolled. Patients were included if they had typical symptoms or signs of COVID-19, a positive real-time polymerase chain reaction test (RT-PCR) for COVID-19, and an age above 18 years. This is a prospective, observational, and longitudinal study. Data were collected within 24 h of admission. The primary endpoint was a combination of hospital lethality, mechanical ventilation, hemodialysis, or length of hospital stay >28 days. Continuous variables were compared with the Student’s t-test for independent samples or the Mann-Whitney test. For comparisons of proportions, the χ 2 test was applied. ROC curves and survival curves were constructed. Multivariate logistic regression was performed to identify independent predictors of events. The level of significance was 0.05. Results There were 98 (49%) events during the hospital course, and 72 (36%) died in the hospital. Patients with a primary endpoint were older and more likely to have a history of hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Vital signs at admission associated with events were diastolic blood pressure, respiratory rate, and oxygen saturation in ambient air (O 2 Sat). Serum creatinine >1.37 mg/dL at admission had a sensitivity of 51.6 and a specificity of 82% to predict the primary endpoint, with an area under the curve (AUC) of 0.68. In multivariate analysis, age, diabetes, CKD, and COPD were independent predictors of the primary endpoint. Age and CKD were independent predictors of in-hospital lethality. Conclusion Cardiovascular risk factors, such as diabetes and CKD, were related to a worse prognosis in patients hospitalized with COVID-19 in this sample from two public hospitals in the state of Rio de Janeiro.

https://doi.org/10.36660/ijcs.20220041

Structure and mechanical behavior of lignosulfonate-treated piassava (Attalea funifera) fibers
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Agrize, Paula Lage

; da Silva, Beatriz Dantas Lourenço

; Carvalho Veiga, Betina

; Rocha, Camila Aparecida Abelha

; Garcia Filho, Fabio da Costa

; Braga, Fábio de Oliveira

Matéria (Rio de Janeiro)

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2023, Volume 28 Nº 2 elocation e20230041

Resumo: En | Texto: En | PDF: En

ABSTRACT The use of natural lignocellulosic fiber (NLF) biocomposites for the construction industry has been growing over the years, due to technical and environmental advantages. However, fiber-matrix incompatibility remains a major challenge. Various surface treatments have been investigated to improve fiber-matrix bonding, including sodium lignosulfonate (SLS), a potentially effective and environmentally friendly chemical. In this study, SLS treatment protocols were applied to piassava fibers to evaluate their influence on the fibers. Thermogravimetric Analysis (TG/DTG), X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM/EDS), Fourier-transform Infrared Spectroscopy (FTIR), moisture absorption measurements and tensile tests were performed to characterize the modifications. Results demonstrated, for the first time, the efficiency of SLS to remove extractives from the piassava surface. In general, partial degradation of the cellulosic structure was observed, noticeable by the slight drop in crystallinity index (from 42.80 to 39.82%), and an increase in the TG residual mass (from 21.35 to 31.90%), along with changes in DTG curves. However, a particular SLS treatment using ultrasonic bath was able to fully clean the surface preserving the cellulosic structure, and increasing the strength of fibers (from 386 ± 140 MPa to 524 ± 126 MPa).

https://doi.org/10.1590/1517-7076-rmat-2023-0041

Chikungunya virus infection in the southernmost state of Brazil was characterised by self-limited transmission (2017-2019) and a larger 2021 outbreak
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Gregianini, Tatiana Schäffer

; Salvato, Richard Steiner

; Barcellos, Regina Bones

; Godinho, Fernanda Marques

; Ruivo, Amanda Pellenz

; de Melo, Viviane Horn

; Schroder, Júlio Augusto

; Martiny, Fernanda Letícia

; Möllmann, Erica Bortoli

; Favreto, Cátia

; Baethgen, Ludmila Fiorenzano

; Ferreira, Vithoria Pompermaier

; de Lima, Lívia Eidt

; Piazza, Cláudia Fasolo

; Machado, Taís Raquel Marcon

; Becker, Irina Marieta

; Ramos, Raquel Rocha

; Frölich, Guilherme Carey

; Rossetti, Alana Fraga

; Almeida, Lucas da Cunha

; Rodrigues, Tahiana Machado Antunes

; Bragança, Isabella Tabelli

; Campos, Aline Alves Scarpellini

; Manzoni, Verônica Baú

; Machado, Lais Ceschini

; da Silva, Luisa Maria Inácio

; de Oliveira, André Luiz Sá

; Paiva, Marcelo Henrique Santos

; Nunes, Zenaida Marion Alves

; de Almeida, Paula Rodrigues

; Demoliner, Meriane

; Gularte, Juliana Schons

; da Silva, Mariana Soares

; Filippi, Micheli

; Pereira, Vyctoria Malayhka de Abreu Góes

; Spilki, Fernando Rosado

; da Veiga, Ana Beatriz Gorini

; Wallau, Gabriel Luz

Memórias do Instituto Oswaldo Cruz

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2023, Volume 118 elocation e220259

Resumo: En | Texto: En | PDF: En

BACKGROUND Chikungunya is a mosquito-borne virus that has been causing large outbreaks in the Americas since 2014. In Brazil, Asian-Caribbean (AC) and East-Central-South-African (ECSA) genotypes have been detected and lead to large outbreaks in several Brazilian states. In Rio Grande do Sul (RS), the southernmost state of Brazil, the first cases were reported in 2016. OBJECTIVES AND METHODS We employed genome sequencing and epidemiological investigation to characterise the Chikungunya fever (CHIKF) burden in RS between 2017-2021. FINDINGS We detected an increasing CHIKF burden linked to travel associated introductions and communitary transmission of distinct lineages of the ECSA genotype during this period. MAIN CONCLUSIONS Until 2020, CHIKV introductions were most travel associated and transmission was limited. Then, in 2021, the largest outbreak occurred in the state associated with the introduction of a new ECSA lineage. CHIKV outbreaks are likely to occur in the near future due to abundant competent vectors and a susceptible population, exposing more than 11 million inhabitants to an increasing infection risk.

https://doi.org/10.1590/0074-02760220259

Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association
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Urban, Linei Augusta Brolini Delle

; Chala, Luciano Fernandes

; Paula, Ivie Braga de

; Bauab, Selma di Pace

; Schaefer, Marcela Brisighelli

; Oliveira, Ana Lúcia Kefalás

; Shimizu, Carlos

; Oliveira, Tatiane Mendes Gonçalves de

; Moraes, Paula de Camargo

; Miranda, Beatriz Medicis Maranhão

; Aduan, Flávia Engel

; Rego, Salete de Jesus Fonseca

; Canella, Ellyete de Oliveira

; Couto, Henrique Lima

; Badan, Gustavo Machado

; Francisco, José Luis Esteves

; Moraes, Thaís Paiva

; Jakubiak, Rosangela Requi

; Peixoto, João Emílio

Revista Brasileira de Ginecologia e Obstetrícia

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2023, Volume 45 Nº 8 Páginas 480 - 488

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

Abstract Objective To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. Methods Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. Recommendations Annual mammography screening is recommended for women at usual risk aged 40–74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.

Resumo Objetivo Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Métodos Foram pesquisadas evidências científicas publicadas nas bases de dados Medline EMBASE Biblioteca Cochrane EBSCO CINAHL e Lilacs entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências por consenso do comitê de especialistas das três entidades. Recomendações A mamografia anual é recomendada para mulheres com risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para aqueles com expectativa de vida superior a sete anos. Mulheres com risco maior do que o normal incluindo aquelas com mamas densas com história pessoal de hiperplasia lobular atípica carcinoma lobular in situ clássico hiperplasia ductal atípica tratamento para câncer de mama ou irradiação de tórax antes dos 30 anos ou ainda portadoras de doença genética mutação ou com forte histórico familiar beneficiam-se de triagem complementar e devem ser considerados individualmente. A tomossíntese é uma forma de mamografia e deve ser considerada na triagem sempre que acessível e disponível.

https://doi.org/10.1055/s-0043-1772498

10.

Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations
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Urban, Linei Augusta Brolini Delle

; Chala, Luciano Fernandes

; Paula, Ivie Braga de

; Bauab, Selma di Pace

; Schaefer, Marcela Brisighelli

; Oliveira, Ana Lúcia Kefalás

; Shimizu, Carlos

; Oliveira, Tatiane Mendes Gonçalves de

; Moraes, Paula de Camargo

; Miranda, Beatriz Medicis Maranhão

; Aduan, Flávia Engel

; Rego, Salete de Jesus Fonseca

; Canella, Ellyete de Oliveira

; Couto, Henrique Lima

; Badan, Gustavo Machado

; Francisco, José Luis Esteves

; Moraes, Thaís Paiva

; Jakubiak, Rosangela Requi

; Peixoto, João Emílio

Radiologia Brasileira

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2023, Volume 56 Nº 4 Páginas 207 - 214

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

Abstract Objective: To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities. Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.

Resumo Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline (PubMed), Excerpta Medica (Embase), Cochrane Library, Ebsco, Cinahl e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos, ou ainda portadoras de mutação genética ou com forte história familiar, se beneficiam do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível.

https://doi.org/10.1590/0100-3984.2023.0064-en

11.

Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol
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Cacho, Roberta de Oliveira

; Moro, Carla Heloisa Cabral

; Bazan, Rodrigo

; Guarda, Suzete Nascimento Farias da

; Pinto, Elen Beatriz

; Andrade, Suellen Mary Marinho dos Santos

; Valler, Lenise

; Almeida, Kelson James

; Ribeiro, Tatiana Souza

; Jucá, Renata Viana Brígido de Moura

; Minelli, Cesar

; Piemonte, Maria Elisa Pimentel

; Paschoal, Eric Homero Albuquerque

; Pedatella, Marco Túlio Araújo

; Pontes Neto, Octávio Marques

; Fontana, Ana Paula

; Pagnussat, Aline de Souza

; Conforto, Adriana Bastos

Arquivos de Neuro-Psiquiatria

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Out 2022, Volume 80 Nº 10 Páginas 1067 - 1074

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

Abstract Background Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. Objective To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. Methods The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). Trial Status The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022. Conclusion The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.

Resumo Antecedentes Grande parte da população brasileira depende de saúde pública e o acidente vascular cerebral (AVC) é uma das principais causas de incapacidade neste país de dimensões continentais. As informações sobre o acesso à reabilitação após AVC em instalações públicas no Brasil são limitadas. Objetivo Fornecer informações abrangentes sobre o Acesso à Reabilitação pós-AVC (estudo AReA) nos primeiros 6 meses após a alta hospitalar da rede pública. Métodos Serão coletadas informações de 17 centros de saúde públicos em 16 cidades brasileiras das cinco macrorregiões do país. Cada centro incluirá 36 participantes (n = 612). Os critérios de inclusão são: idade ≥ 18 anos; AVC isquêmico ou hemorrágico, com tempo de lesão entre 6 meses e 1 ano; admissão em hospital público na fase aguda; qualquer comprometimento neurológico pós-AVC; paciente ou cuidador capaz de fornecer consentimento informado e responder à pesquisa. Os pacientes só podem ser recrutados em ambulatórios públicos de neurologia ou medicina interna. Os resultados serão avaliados por um questionário padrão sobre encaminhamentos de reabilitação, o programa de reabilitação (estado atual, duração em meses, número de sessões por semana) e instruções recebidas. Além disso, os pacientes serão questionados sobre as preferências de locais de reabilitação (hospitais, clínicas ou casa). Status do estudo O estudo está em andamento. O recrutamento começou em 31 de janeiro de 2020 e está previsto para continuar até junho de 2022. Conclusão O estudo AReA preencherá uma lacuna no conhecimento sobre o acesso à reabilitação para AVC no sistema público de saúde em diferentes regiões brasileiras.

https://doi.org/10.1055/s-0042-1758558

12.

Effects of specific hypnotic suggestions on mechanical and thermal sensitivity of healthy volunteers: randomized and double-blind study
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Oliveira, Victória Regina da Silva

; Oliveira, Inaeh de Paula

; Eng, Beatriz Magalhães

; Teixeira, Manoel Jacobsen

; Puentes, Fabio

; Dale, Camila Squarzoni

BrJP

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Out 2022, Volume 5 Nº 4 Páginas 320 - 331

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

ABSTRACT BACKGROUND AND OBJECTIVES: Hypnotic suggestions for hypoalgesia or analgesia are efficient for relieving different pain conditions, presenting few or no side effects. However, little is known about its direct effect on the modulation of peripheral nociception. The goal of this study was to evaluate the mechanical and thermal response after specific hypnotic suggestions in healthy volunteers. METHODS: This is a randomized double-blinded controlled trial that aimed to evaluate both mechanical and thermal nociception after specific hypnotic suggestions in healthy volunteers. For this, twenty-seven participants were enrolled, according to the following eligibility criteria: age between 18-65 years and absence of pain complaints or psychological disorders. After signed Free Informed Consent Term (FICT) the participants were divided by a computer-generated randomization in three groups: sham group (no induction of hypnosis), hypnosis-induced pain group and hypnosis-induced analgesia group. Susceptibility to hypnosis was assessed through the Waterloo-Stanford Group C (WSGC) scale of hypnotic susceptibility and outcomes included evaluation of questionnaires (Hospital Anxiety and Depression Scale and Short Form Brief Pain Inventory) as well as the examination of mechanical and thermal nociception through the Quantitative Sensory Testing (QST), a tool widely used to investigate somatosensory sensitivity by assessing functions of small A-δ and C nerve sensory fibers, before and after specific hypnotic suggestion for pain and analgesia made by a qualified hypnotherapist. RESULTS: Data demonstrated that specific hypnotic suggestions induced significant changes in mechanical and thermal sensitivity. The pain group revealed an increase in mechanical hyperalgesia and allodynia, while the analgesia group increased pain thresholds to thermal stimulations, being conditioned to withstand temperature changes after hypnosis, demonstrating a modulatory effect for both pain and analgesia sensations in healthy volunteers. CONCLUSION: The evidence presented in this study supports the use of the hypnosis technique as an auxiliary tool in clinical practice. HIGHLIGHTS Specific hypnotic suggestions can modulate peripheral nociception in healthy subjects. Data show a modulatory effect for both pain and analgesia sensations. Hypnosis can be considered a feasible technique for the clinical pain management.

RESUMO JUSTIFICATIVA E OBJETIVOS: Sugestões hipnóticas de hipoalgesia ou analgesia são eficientes para aliviar diferentes quadros álgicos, apresentando poucos ou nenhum efeito colateral. No entanto, pouco se sabe sobre seu efeito direto na modulação da nocicepção periférica. O objetivo deste estudo foi avaliar a resposta mecânica e térmica após sugestões hipnóticas específicas em voluntários saudáveis. MÉTODOS: Este é um estudo randomizado e duplo-cego que visou avaliar a nocicepção mecânica e térmica após sugestões hipnóticas específicas em voluntários saudáveis. Para isso, vinte e sete participantes foram selecionados, de acordo com os seguintes critérios de elegibilidade: idade entre 18 e 65 anos e ausência de distúrbios psicológicos e de queixas de dor. Após a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE), os participantes foram divididos por randomização gerada por computador em três grupos: grupo sham (sem indução de hipnose), grupo dor induzida por hipnose e grupo analgesia induzida por hipnose. A suscetibilidade à hipnose foi avaliada através da escala Waterloo-Stanford Group C (WSGC) de suscetibilidade hipnótica e os resultados incluíram a avaliação de questionários (Escala Hospitalar de Ansiedade e Depressão e Inventário Breve de Dor), bem como o exame de nocicepção mecânica e térmica através do Teste Sensorial Quantitativo (QST), uma ferramenta amplamente utilizada para investigar a sensibilidade somatossensorial por meio da avaliação das funções das fibras sensoriais finas dos nervos A-δ e C, antes e após sugestão hipnótica específica para dor e analgesia aplicada por um hipnoterapeuta qualificado. RESULTADOS: Os dados mostraram que as sugestões hipnóticas específicas induziram mudanças significativas na sensibilidade mecânica e térmica dos indivíduos. O grupo dor revelou aumento da hiperalgesia mecânica e da alodinia, enquanto o grupo analgesia aumentou os limiares de dor por estímulos térmicos, sendo condicionado a suportar mudanças de temperatura após a hipnose, demonstrando efeito modulador tanto para as sensações de dor quanto de analgesia em voluntários saudáveis. CONCLUSÃO: As evidências apresentadas neste estudo sustentam o uso da técnica de hipnose como ferramenta auxiliar na prática clínica. DESTAQUES Sugestões hipnóticas específicas podem modular a nocicepção periférica em sujeitos saudáveis. Os dados mostram um efeito modulador tanto para as sensações de dor quanto de analgesia. A hipnose pode ser considerada uma técnica viável para o manejo clínico da dor.

https://doi.org/10.5935/2595-0118.20220059-en

13.

Desenhando Memórias em Espaços Solidários: um registro de emoções no abrigo de idosos Vila Vicentina
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Andrade, Ana Beatriz Pereyra de

; Magalhaes, Ana Maria Rebello

; Mathias, Ariadne Franco

; Melara, Lucas Furio

; Oliveira, Paula Rebello Magalhaes de

Cuadernos del Centro de Estudios en Diseño y Comunicación. Ensayos

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Ago 2022, Nº 109 Páginas 184 - 201

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

Resumen El artículo propone reflexiones sobre las relaciones interdisciplinarias que consideran el espacio, la emoción y la memoria. Explora aspectos de la influencia cultural y de responsabilidad social del Diseño en la actualidad, las posibilidades de diálogo con otras áreas del conocimiento y de la capacidad de tejer relaciones entre saberes. Se pone en escena una experiencia proyectual creativa en el campo del diseño social, cuyos principios teóricos y prácticas metodológicas fundamentaron un ensayo fotográfico. La experiencia única resultó en el libro “Viejos recuerdos, memorias de vida”, inspirado en los informes afectivos de catorce personas ancianas alojadas en la Vila Vicentina, un espacio de «un evento solidario”. Aunque desplazados de sus orígenes, el sentido de la realidad no se pierde y el nuevo espacio se convierte en definitivo, para que las reminiscencias del pasado convivan con el presente y propongan una mirada al futuro.

Abstract The article proposes reflections on interdisciplinary relationships that consider space, emotion and memory. It explores aspects of design’s cultural influence and social responsibility, possibilities for dialogue with other areas of knowledge, and the ability to weave relationships between knowledge. A creative project experience in the field of Social Design is set in motion, whose theoretical principles and methodological practices underlie a photographic essay. The unique experience resulted in the book “Old memories, memories of life”, inspired by the affective reports of fourteen elderly people housed in Vila Vicentina, a space of ‘a solidarity happening’. Although displaced from their origins, the sense of reality is not lost and the new space becomes definitive for reminiscences of the past to live with the present and propose a look to the future.

Resumo O artigo propõe reflexões acerca das relações interdisciplinares que consideram espaço, emoção e memória. Explora aspectos da influência cultural e responsabilidade social do Design na atualidade, possibilidades de diálogo com outras áreas do conhecimento e capacidade de tecer relações entre saberes. Coloca-se em cena uma experiência projetual criativa na área do Design Social, cujos princípios teóricos e práticas metodológicas fundamentaram um ensaio fotográfico. A vivência singular resultou no livro “Velhas lembranças, memórias de vida”, inspirado nos relatos afetivos de quatorze idosos abrigados na Vila Vicentina, espaço de ‘um acontecer solidário’. Embora deslocados de suas origens, a sensação de realidade não se perde e o novo espaço torna-se definitivo para que reminiscências do passado convivam com o presente e proponham um olhar para o futuro.

https://doi.org/10.18682/cdc.vi109.4221 36 downloads

14.

Biochemical markers and anthropometric profile of children enrolled in public daycare centers
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Lourenção, Luiz Felipe de Paiva

; Paula, Nara Cristina de

; Cardoso, Maria Angélica

; Santos, Paula Ribeiro

; Oliveira, Izabela Regina Cardoso de

; Fonseca, Fernando Luiz Affonso

; Veiga, Glaucia Luciano da

; Alves, Beatriz da Costa Aguiar

; Graciano, Miriam Monteiro de Castro

; Pereira-Dourado, Stela Márcia

Jornal de Pediatria

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Jul 2022, Volume 98 Nº 4 Páginas 390 - 398

Resumo: En | Texto: En | PDF: En

Abstract Objective: The nutritional status resultant from dietary habits along with socioeconomic conditions and the school environment are directly related to the individual's health condition not only in their childhood but also throughout adulthood. The aim of this study was to evaluate the effects of socioeconomic factors on the anthropometric profile and to analyze a probable association between this profile and biochemical markers in children attending public daycare centers. Methods: It is a transversal study developed in a probability sample of clusters of children from 6 months to 5 years old. Anthropometric and socioeconomic data were gathered at the CMEIs, questionnaires on the nutritional status were applied and blood was collected at the Family Health Units (USFs). Results: Female children are three times more likely to be underweight; in families with five members, it is 1/3 more likely that children of higher-educated parents are overweight. Among the results of the biochemical tests, hypervitaminosis A was a relevant aspect, positively correlating with copper (p=0.005) and zinc (p=0.008). Conclusion: Therefore, since the influence of the family is an important predictor of overweight and its future outcomes related to nutritional deficiencies and inadequate dietary intake, educational interventions are vital as a way to pave the path to prevention.

https://doi.org/10.1016/j.jped.2021.09.006

15.

Brazilian practice guidelines for stroke rehabilitation: part II
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Minelli, Cesar

; Luvizutto, Gustavo José

; Cacho, Roberta de Oliveira

; Neves, Luciana de Oliveira

; Magalhães, Sheila Cristina Sayuri Abe

; Pedatella, Marco Túlio Araújo

; Mendonça, Lucia Iracema Zanotto de

; Ortiz, Karin Zazo

; Lange, Marcos Christiano

; Ribeiro, Priscila Watson

; Souza, Luciane Aparecida Pascucci Sande de

; Milani, Cristiano

; Cruz, Daniel Marinho Cezar da

; Costa, Rafael Dalle Molle da

; Conforto, Adriana Bastos

; Carvalho, Fernanda Martins Maia

; Ciarlini, Bruna Silva

; Frota, Norberto Anizio Ferreira

; Almeida, Kelson James

; Schochat, Eliane

; Oliveira, Tatiana de Paula

; Miranda, Camila

; Piemonte, Maria Elisa Pimentel

; Lopes, Laura Cardia Gomes

; Lopes, Camila Galvão

; Tosin, Michelle Hyczy de Siqueira

; Oliveira, Bianca Campos

; Oliveira, Beatriz Guitton Renaud Baptista de

; Castro, Shamyr Sulyvan de

; Andrade, João Brainier Clares de

; Silva, Gisele Sampaio

; Pontes-Neto, Octávio Marques

; Carvalho, João José Freitas de

; Martins, Sheila C. Ouriques

; Bazan, Rodrigo

Arquivos de Neuro-Psiquiatria

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Jul 2022, Volume 80 Nº 7 Páginas 741 - 758

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

Abstract The Brazilian Practice Guidelines for Stroke Rehabilitation – Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

Resumo As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderênciaao usode medicamentos, cuidados paliativos,ofuturodareabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

https://doi.org/10.1055/s-0042-1757692

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