bluuebunny/crossref_metadata_2025 huggingface dataset:
Propriedades mecânicas de dois padrões de sutura e dois tipos de fios aplicados às tenorrafias dos equinos
Authors: Corrêa R.R. , Pereira C.A.M. , Frias N.C. , Baccarelli D.C. , Zoppa A.L.V.
Published: September 2017

RESUMO As lesões traumáticas dos membros que resultam em secções tendíneas são problemas comuns na clínica equina. Diversas complicações têm sido associadas à reparação dos tendões nessa espécie. O objetivo do presente trabalho foi avaliar biomecanicamente dois padrões de sutura e dois diferentes materiais aplicados às tenorrafias. Vinte e quatro peças de tendão flexor digital profundo de equinos foram seccionadas e suturadas em padrão locking loop duplo (grupo 1, com polipropileno; grupo 2, com poliglactina) ou em padrão locking loop simples associado à sutura de epitendão (grupo 3, com polipropileno; grupo 4, com poliglactina). Os corpos de prova foram submetidos a ensaios mecânicos de tração, em que se determinaram valores de força mínima, força máxima e pico de força, além do afastamento observado entre os cotos durante o pico máximo de força. Para avaliação dos resultados, foram utilizados os métodos ANOVA e os não paramétricos de Kruskal-Wallis e Mann-Whitney (P<0,05). Os maiores valores de força máxima foram documentados no grupo 3. Os valores de força mínima foram maiores nos grupos 3 e 4 que nos grupos 1 e 2, mas não diferiram significativamente entre os grupos 3 e 4. Os valores de pico de força foram maiores nos grupos 1 e 2 que no grupo 4, mas não diferiram significativamente no grupo 3. O afastamento foi maior nos grupos 1 e 2 quando comparados aos grupos 3 e 4. O padrão locking loop simples, com sutura de epitendão, atingiu maior resistência quando avaliado afastamento de até 3 milímetros entre os cotos tendíneos, sendo considerado padrão de escolha para aplicação clínica, tendo em vista os resultados obtidos neste trabalho.
Evaluation of the cryosurgery for treatment of squamous cell carcinoma in cats
Authors: Prado L.O.C. , Rossetto V.J.V. , Carvalho L.M.C.R. , Ferreira A.P. , Matsubara L.M. , Rodrigues J.C.Z. , Brandão C.V.S.
Published: September 2017

ABSTRACT The cryosurgery is a very useful therapy for the treatment of a variety of neoplastic and non-neoplastic processes. Nevertheless, it is still poorly described as an option for the treatment of specific cutaneous neoplasms, such as squamous cell carcinoma. The purpose of the present study was to analyze the clinical response of cryosurgery for the treatment of squamous cell carcinoma in cats. For this 13 squamous cell carcinoma lesions were selected in 11 cats, diagnosed through citopathological and/or histopathological examinations. The lesions were frozen using liquid nitrogen spray, and the evaluations were performed in the moment of freeze and approximately every 15 days until the wound was completely healed. The response of cryosurgery was considered complete with tumoral remission on 38.5% of the cats, and partial on 46.1%. The main complications included crusting and nostril stenosis. The presented results suggested that cryosurgery is effective and may be a viable option for the treatment of squamous cell carcinoma in cats. The effectiveness of the therapy; however, depends on the correct selection of the candidates for cryosurgery based on the lesion size, and the attendance to some criteria, such as the freezing time and post-operative care.
Retrospective study of ocular complication following phacoemulsification with intraocular acrylic lens implantation in dogs
Authors: Guimarães T.G. , Honsho C.S. , Mamede F.V. , Dias F.G.G. , Anjos D.S. , Pereira L.F. , Ricordi I. , Jorge A.T.
Published: September 2017

ABSTRACT The aim of this study was to analyze for 120 days, post-operative complications following bimanual phacoemulsification with implantation of hydrophilic or hydrophobic intraocular acrylic lens. The hospital records of 15 dogs were analyzed, and distributed in two groups, being Gfi and Gfo the hydrophilic intraocular lens and hydrophobic intraocular lens group, respectively. On the first day, both groups presented blepharospasm, conjunctival hyperemia and flare. On day 1, fibrin was slightly apparent in two and three eyes of Gfi and Gfo, and on day 7, present in one and two patients from Gfi and Gfo. Synechia was observed on day 1 in one eye from Gfi and Gfo. Two eyes from Gfi developed from 7 to 120 days, and in Gfo, one eye developed from 7 to 90 days, on day 120, two eyes formed them. The presence of posterior capsule opacity of the lens in all periods, there was no statistical significant between the groups. Only one eye, in Gfo, that had no opacity formation. The intraocular pressure of both groups remained within normal range. There was no statistical significance between hydrophilic and hydrophobic intraocular lens, the use of intraocular lens has led to satisfactory results in visual ability.
Performance reprodutiva de leitoas submetidas à inseminação artificial pós-cervical
Authors: Ternus E.M. , Vanz A.R. , Lesskiu P.E. , Preis G.M. , Serafini L. , Consoni W. , Traverso S.D. , Cristani J.
Published: September 2017

RESUMO O objetivo deste trabalho foi avaliar o desempenho reprodutivo de nulíparas submetidas à inseminação artificial pós-cervical (IAPC) comparada à inseminação artificial tradicional (IAT). Foram avaliados ocorrência de sangramento, ocorrência de refluxo, dificuldade no transpasse da cérvix e total de células refluídas até 30 minutos após inseminação. Fêmeas submetidas à IAPC (n=279) foram inseminadas com doses de 1,5 x 109 diluídas em 45mL, e fêmeas submetidas à IAT (n=273) inseminadas com doses de 2,5 x 109 em 80mL. O transpasse da cérvix foi possível em 91,04% (254/279) das leitoas. A dificuldade no transpasse foi de 41,58% (116/279), não comprometendo o desempenho reprodutivo (P>0,05). Presença de sangramento não afetou a taxa de parto nem o número de leitões nascidos para ambos os tratamentos (P>0,05). O percentual de espermatozoides presentes no refluxo foi maior na IAT, não sendo observada diferença no tamanho de leitegada de acordo com o percentual de espermatozoides no refluxo (P>0,05) e no número de leitões nascidos totais (11,63 e 11,81) entre os tratamentos IAT e IAPC, respectivamente. Pode-se realizar IAPC em leitoas sem causar redução no desempenho, utilizando-se doses com 1,5 x 109 células espermáticas.
Cloprostenol administration in the first week postpartum reduces expression of oxytocin receptors in the endometrium in Holstein-Zebu cows
Authors: Camargos A. , Wohlres-Viana S. , Costa I.F. , Camargo L.S. , Ferreira J.C. , Ramos A.A. , Oba E.
Published: September 2017

ABSTRACT The present study investigated the hormonal profile and expression of prostaglandin F2α (PGF2α), oxytocin and estrogen receptors in uterine tissues of postpartum cows treated with cloprostenol. Twenty Holstein-Zebu crossbred cows were treated with saline solution (treatment CONT) or cloprostenol (treatment CLO), both administered two and five days postpartum. Blood samples were collected on days two, seven, 14, 21 and 28 postpartum for progesterone, PGF2α metabolite (PGFM) and estradiol determination, and endometrial biopsy was performed in order to quantify the expression of oxytocin receptor (OXTR), prostaglandin F receptor (PTGFR) and estrogen receptor 1 (ERS1) genes. In the CLO treatment, expression of OXTR was reduced (P<0.05) but no difference (P>0.05) between treatments was found for PTGFR and ERS1 expression. Estrogen concentrations increased progressively until day 14 (P<0.05) and the highest OXTR expression and lowest PTGFR expression were observed on day 14 (P<0.05) in both treatments. Serum PGFM concentrations were high throughout the experiment. In conclusion, cloprostenol administration at days two and five of postpartum seems to reduce OXTR expression in the endometrium in crossbred cows.
Morfologia e dinâmica testicular em cutias - Dasyprocta prymnolopha ) adultas
Authors: Menezes D.J.A. , Silva A.R.N. , Vieira F.A.S. , Silva Neto R.B. , Oliveira M.F. , Illera M.J. , Assis Neto A.C. , Santos J.R.S. , Carvalho M.A.M.
Published: September 2017

RESUMO Este trabalho objetivou apresentar a caracterização da morfologia do testículo de cutia (Dasyproctaprymnolopha) macho, com o intuito de colaborar com o conhecimento da morfofisiologia reprodutiva da espécie. Foram utilizados testículos de 47 animais, com idade entre um e dois anos, pesos homogêneos (2,08 ± 0,23kg), oriundos do Núcleo de Estudos e Preservação de Animais Silvestres do Centro de Ciências Agrárias da Universidade Federal do Piauí. As estruturas foram dissecadas, descritas, e fragmentos foram processados para a microscopia de luz, sendo, posteriormente avaliada a atividade gonadal. Observou-se que os testículos são órgãos elipsoides alongados, podendo ser encontrados na região inguinal ou na cavidade abdominal, não apresentando um escroto bem delimitado. Verificou-se também parênquima com característica histológica padrão para o órgão em mamíferos, com a identificação de oito tipos de associações celulares, caracterizando os estádios do ciclo do epitélio seminífero, com menor e maior frequência dos estádios 3 e 5, respectivamente.
Motivating factors in hospital environmental management programs: a multiple case study in four private Brazilian hospitals
Authors: Krüger Jan , Araújo Claudia , Curi Guilherme
Published: September 2017

Abstract Environmental responsibility has been a widespread and relatively recent research theme in the healthcare sector. Considering that the greater life expectancy increases the need for healthcare services and that these services produce negative environmental externalities on human health, it is important to understand the relationship between environmental responsibility and the healthcare sector. This article aims to investigate what motivates hospital managers to adopt environmental responsibility programs and to identify the actions implemented by them. A multiple case study was conducted involving four Brazilian hospitals based in Rio de Janeiro and São Paulo. The results indicate that the main drivers are competitive, ethical and regulatory and that the competitive and regulatory motivators have the potential to establish a baseline for environmental performance that varies across ownership type (public or private). The results also indicate that the comprehensiveness of environmental actions is related to organizational resilience and to the motivators that drive hospitals to adopt those actions. Two conceptual models are proposed to illustrate these findings and offer bases for further research.
Calores específicos dos gases ideais degenerados
Authors: Caruso Francisco , Oguri Vitor , Silveira Felipe
Published: September 2017

A partir de argumentos baseados no princípio da incerteza de Heisenberg e no princípio de exclusão de Pauli, estimam-se os calores específicos molares dos gases ideais degenerados em baixas temperaturas, com resultados compatíveis com o princípio de Nerst-Planck (a 3ª lei da Termodinâmica). É apresentado, ainda, o fenômeno da condensação de Bose-Einstein com base no comportamento do calor específico de gases de bósons massivos e não relativísticos.
Nas malhas da justiça: uma análise dos dados oficiais de indiciados por drogas em Belo Horizonte (2008-2015)
Authors: Ribeiro Ludmila Mendonça Lopes , Rocha Rafael Lacerda Silveira , Couto Vinícius Assis
Published: September 2017

Resumo Neste artigo procuramos compreender como as Varas Criminais de Tóxicos da cidade de Belo Horizonte aplicam a Lei de Drogas (Lei 11.343/2006). Levando em conta as reconhecidas limitações inerentes aos registros oficiais, nosso objetivo é problematizar os limites e as possibilidades de entendimento do que ocorre com o indivíduo uma vez nas malhas da justiça a partir do banco de dados cedido pelo Tribunal de Justiça de Minas Gerais, referente a todos os procedimentos enquadrados na Lei de Drogas e encerrados na capital, entre janeiro de 2008 e setembro de 2015. Argumentamos que as Varas de Tóxicos funcionam como justiça em linha de montagem, especialmente, nos casos iniciados por flagrante, ainda que isso signifique supressão de direitos do acusado.
Programa de Aprimoramento e Revitalização do Conhecimento na Enfermagem e Saúde
Authors: Silva Luiz Anildo Anacleto da , Soder Rafael Marcelo , Oliveski Cínthia Cristina , Frizzo Mirian Natali
Published: September 2017

Objetivo deste trabalho foi compreender como a aprendizagem significativa pode contribuir para a construção do conhecimento e formação na perspectiva de estudantes de Enfermagem. Trata-se de uma pesquisa qualitativa, descritiva e exploratória. Os sujeitos da pesquisa foram 12 estudantes de um curso de Enfermagem participantes de um programa de ensino. Os resultados permitiram a construção de duas categorias: contribuições na formação em Enfermagem e na construção do conhecimento. Conclui-se que o oferecimento de programas educativos com metodologias alternativas contribui para a construção do conhecimento, formação e Enfermagem. Um dos principais fatores contributivos refere-se à possibilidade da construção coletiva, proporcionando aos estudantes uma participação ativa, crítica e reflexiva nas atividades educativas.
Effects of IFRS adoption on tax avoidance
Authors: Braga Renata Nogueira
Published: September 2017

ABSTRACT This study investigates the association between mandatory International Financial Reporting Standards (IFRS) adoption and corporate tax avoidance. In this study, tax avoidance is defined as a reduction in the effective corporate income tax rate through tax planning activities, whether these are legal, questionable, or even illegal. Three measures of tax avoidance are used and factors at the country and firm level (that have already been associated with tax avoidance in prior research) are controlled. Using samples that range from 9,389 to 15,423 publicly-traded companies from 35 countries, covering 1999 to 2014, it is found that IFRS adoption is associated with higher levels of corporate tax avoidance, even when the level of book-tax conformity required in the countries and the volume of accruals are controlled, both of which are considered potential determinants of this relationship. Furthermore, the results suggest that after IFRS adoption, firms in higher book-tax conformity environments engage more in tax avoidance than firms in lower book-tax conformity environments. It is also identified that engagement in tax avoidance after IFRS adoption derives not only from accruals management, but also from practices that do not involve accruals. The main conclusion is that companies engage more in tax avoidance after mandatory IFRS adoption.
[A] destruição animot [relações entre a filosofia e a psicanálise em Derrida]
Authors: Galvão Jr João C.
Published: September 2017

RESUMO: Trabalhamos com o quase conceito animot de Derrida, narrando sua experiência trágica entre o pensamento poético e o saber filosófico, e sua leitura deste quase conceito na teoria psicanalítica, forjando no pensamento da diferença a cena da escritura - inconsciente como escritura - e este outro do outro {que chama} {de} animot, que só se distingue na escritura e não da voz revelada. Nessa leitura, para {o} animot tudo é permitido.
Effects of Organizational Values on Quality of Work Life
Authors: Campos Maria Isabel de , Rueda Fabián Javier Marín
Published: September 2017

Abstract: Quality of work life (QWL) is a topic studied globally due to its relevance for workers’ health and organizational results. This study investigated the effects of person-organization fit (POF) with regard to workers’ perceived and desired organizational values (OV) on QWL. The sample consisted of 213 Brazilians working in companies of different sizes and from different sectors. The quadratic polynomial regression model with surface analysis charts was used. The hypothesis that QWL is affected by satisfaction with OV was confirmed. The surface analysis charts revealed that some of the relationships between variables are non-linear. The conclusion is that these findings can help organizations to reflect on declared values and those actually put into practice in order to develop strategies intended to promote greater congruence from the perspective of employees, positively affecting QWL.
Avaliação Institucional em Polos do Sistema Universidade Aberta do Brasil
Authors: Martins Alexciano de Sousa , Nascimento Valdriano Ferreira do , Sousa Fabiana Martins de
Published: September 2017

Resumo: O estudo quis conhecer a avaliação institucional em polos de educação a distância, do sistema Universidade Aberta do Brasil (UAB), analisando os polos do estado do Ceará. O sistema UAB do Ministério da Educação do Brasil possibilita a oferta de cursos de nível superior conveniados com universidades públicas. O Ceará conta com polos UAB desde 2006, que formam professores e outros profissionais, inclusive em regiões desprovidas de ensino superior público. Objetivou-se discutir a importância da avaliação institucional nos polos do programa Universidade Aberta do Brasil por meio de uma pesquisa de campo de caráter exploratório e descritivo. Evidenciou-se que a avaliação institucional nos polos é ínfima e desalinhada com a legislação em vigor e, em razão disso, foram elencadas sugestões de como desenvolver a prática avaliativa.
Flora das cangas da Serra dos Carajás, Pará, Brasil: Tectariaceae
Authors: Viveros Raquel Stauffer , Salino Alexandre
Published: September 2017

Resumo Este estudo trata dos táxons de Tectariaceae encontrados nas formações ferríferas da Serra dos Carajás, estado do Pará, com descrições, imagens, distribuição geográfica e comentários. Na área estudada foram registrados dois gêneros e duas espécies: Tectaria heracleifolia e Triplophyllum glabrum.
Flora das cangas da Serra dos Carajás, Pará, Brasil: Cleomaceae
Authors: Soares Neto Raimundo Luciano
Published: September 2017

Resumo Neste estudo são retratadas as espécies de Cleomaceae que foram registradas para as cangas da Serra dos Carajás, no estado do Pará. São apresentadas descrições morfológicas, ilustração, imagens e comentários sobre as espécies. Foram registradas duas espécies para a área de estudo: Melidiscus giganteus e Tarenaya spinosa, ambas com ampla distribuição na região Neotropical.
Flora das cangas da Serra dos Carajás, Pará, Brasil: Clusiaceae
Authors: Alencar Ana Cláudia , Marinho Lucas Cardoso
Published: September 2017

Resumo Apresentamos o tratamento de Clusiaceae para a flora das cangas da Serra dos Carajás, Pará, Brasil. São reconhecidas três espécies de Clusia: C. nemorosa, C. panapanari e C. aff. weddelliana, além de Garcinia madruno e Symphonia globulifera. Clusia aff. weddelliana apresenta algumas diferenças marcantes com os demais espécimes provenientes de outras localidades do Pará. São apresentadas descrições, ilustrações e comentários taxonômicos sobre as espécies.
Flora das cangas da Serra dos Carajás, Pará, Brasil: Olacaceae
Authors: Meirelles Julia , Fernandes Júnior Aluisio José
Published: September 2017

Resumo Apresentamos o tratamento taxonômico de Olacaceae para as formações de canga da Serra dos Carajás, onde foram registrados dois gêneros e duas espécies: Heisteria ovata e Ximenia americana. Este trabalho inclui uma chave de identificação, as descrições, os comentários e as ilustrações das espécies.
Flora das cangas da Serra dos Carajás, Pará, Brasil: Oxalidaceae
Authors: Hall Climbiê Ferreira , Meirelles Julia , Fiaschi Pedro
Published: September 2017

Resumo Apresentamos o tratamento taxonômico de Oxalidaceae para as cangas da Serra dos Carajás (Pará, Brasil). Foram registradas duas espécies: Oxalis barrelieri e O. mucronulata. São apresentadas descrições, comentários e ilustrações das espécies.
The work process and care production in a Brazilian indigenous health service
Authors: Ribeiro Aridiane Alves , Aciole Giovanni Gurgel , Arantes Cássia Irene Spinelli , Reading Jeff , Kurtz Donna L.M. , Rossi Lídia Aparecida
Published: September 2017

Abstract Objective: To understand the constitutive elements of the work process and care production in an Indigenous Health Support Service. Methods: Case study. Systematic observation and semi-structured interviews were conducted in January and February of 2012. The participants were 10 nursing professionals of an Indigenous Health Support Center, located in Mato Grosso do Sul state, Brazil. The work process was used as a conceptual and analytical category. Results: Through interpretative analysis, the data were organized into three categories. The results showed that care production was focused on procedures and guided by rigid institutional rules and bureaucracy. The prioritization of institutional rules and procedures was detrimental to the provision of person-centered care. Conclusion: The temporary employment contracts and rigid bureaucratic organization generated a tense work environment. These aspects do not maximize the efforts of the nursing staff to provide person-centered care.
Padrões da Regeneração Natural na Região de Mar de Morros, Pinheiral-RJ
Authors: Santos Gilsonley Lopes dos , Pereira Marcos Gervasio , Delgado Rafael Coll , Moraes Luiz Fernando Duarte de
Published: September 2017

RESUMO A Floresta Atlântica é o ecossistema brasileiro submetido a processos de degradação ambiental mais acentuado, mesmo assim, em alguns ambientes o processo de regeneração natural pode ser observado. O objetivo deste estudo foi avaliar o padrão da regeneração natural dos fragmentos florestais do Médio Vale Paraíba do Sul quanto aos fatores topográficos e identificar áreas potenciais ao processo de regeneração. O mapeamento dos fragmentos florestais foi obtido a partir de imagens do sensor Thematic Mapper (1994 e 2011). Para os fatores topográficos foram utilizadas as cartas topográficas do IBGE. O processo de regeneração natural na área de estudo é influenciado pelos fatores topográficos e acontece principalmente nos ambientes com superfície plana, declividade variando de ondulada a forte ondulada, orientação da vertente variando de SE (sudeste) a SW (sudoeste) e radiação solar global entre 150000 e 1700000 Watts. Na sub-bacia do ribeirão Cachimbal, os ambientes favoráveis à regeneração natural não são suficientes para que a sub-bacia tenha sua cobertura florestal original restabelecida, por representar apenas 1,2% da área da sub-bacia hidrográfica, o que remete à necessidade de intervenção antrópica.
Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea
Authors: Yamashita Renata Paciello , Rissato Camila Tomazi , Scarmagnani Rafaeli Higa , Fukushiro Ana Paula , Trindade Inge Elly Kiemle
Published: September 2017

RESUMO Introdução A palatoplastia secundária com veloplastia intravelar (VI) pode ser realizada previamente ao retalho faríngeo (RF), para o tratamento cirúrgico da insuficiência velofaríngea em pacientes com fissura palatina. Esta abordagem cirúrgica tem como finalidade melhorar as condições velofaríngeas, evitando, assim, a indicação de um retalho faríngeo largo e seus efeitos indesejáveis sobre a respiração. Objetivo Investigar os efeitos do retalho faríngeo realizado após a veloplastia intravelar para tratamento da insuficiência velofaríngea sobre a nasalidade e a respiração. Métodos Análise dos resultados pós-cirúrgicos da nasalidade de fala e da respiração de 50 indivíduos com fissura de palato reparada e insuficiência velofaríngea, sendo 23 submetidos ao retalho faríngeo após a veloplastia intravelar (Grupo VI+RF) e 27 submetidos unicamente ao retalho faríngeo (Grupo RF). A nasalidade foi determinada pela nasometria e o efeito da cirurgia sobre a respiração foi analisado pela medida da área de secção transversa mínima nasofaríngea, obtida pela técnica fluxo-pressão e pelo levantamento das queixas respiratórias, utilizando questionário específico. A comparação estatística entre os grupos foi realizada por meio do teste Mann-Whitney e teste t de Student, considerando significante o valor de p<0,05. Resultados Verificou-se que não houve diferença entre os grupos para os resultados de nasalidade, da medida da área nasofaríngea e do levantamento de queixas respiratórias. Conclusão Ambas as abordagens para tratamento cirúrgico da insuficiência velofaríngea mostraram resultados equivalentes, no que se refere à eliminação da hipernasalidade, bem como à condição da respiração, sugerindo que a realização do retalho faríngeo após a veloplastia intravelar não levou a melhores resultados de ressonância de fala e não favoreceu a respiração.
O MODELO INTERSUBJETIVO DO SI MESMO PRODUZIDO SOCIALMENTE: MEAD, EDUCAÇÃO E LUTA POR RECONHECIMENTO
Authors: Vitorino Artur José Renda , Silva Bruna Coden da
Published: September 2017

RESUMO: A partir das interpretações dos filósofos Jürgen Habermas e Axel Honneth do modelo intersubjetivo do si mesmo produzido socialmente, conforme elaborado por G. H. Mead, defende-se a necessidade de incorporar os preceitos de intersubjetividade, reconhecimento e democracia em uma concepção de educação que, com base no pensamento cooperativo e comunitário, ensine o agir democrático - orientado para a resolução consensual de problemas e embasado no reconhecimento intersubjetivo entre os indivíduos.
IMPORTANCE OF MEASURING LEVELS OF INFLIXIMAB IN PATIENTS TREATING INFLAMMATORY BOWEL DISEASE IN A BRAZILIAN COHORT
Authors: KAMPA Katia Cristina , MORSOLETTO Daphne Benatti Gonçalves , LOURES Marcela Rocha , PISSAIA JUNIOR Alcindo , NONES Rodrigo Bremer , IVANTES Cláudia Alexandra Pontes
Published: September 2017

ABSTRACT BACKGROUND: Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases. In such pathologies, there is an increased production of alpha tumor necrosis factor (TNF-α). Patients, in whom the conventional immunosuppressant treatment fails, require the use of immunobiological therapy, such as anti-TNF-α, a monoclonal antibody. Infliximab is an anti-TNF-α drug, a chimerical immunoglobulin, with a murine component, which is responsible for the generation of immunogenicity against the drug and formation of anti-TNF-α antibodies. The presence of anti-drug antibodies may be responsible for adverse events and reduction of the drug’s effectiveness. Patients with inflammatory bowel diseases undergoing therapy with biological medication, such as infliximab, can relapse overtime and this may not be translated into clinical symptoms. Thus, there is a need for a method to evaluate the efficacy of the drug, through the measurement of serum infliximab levels, as well as antibodies research. OBJECTIVE: This study aimed to measure serum infliximab levels and anti-infliximab antibodies in patients with inflammatory bowel diseases post-induction phase and during maintenance therapy, and describe the therapeutic modifications that took place based on the serum levels results. METHODS: It was a retrospective study, that included forty-five patients, with a total of 63 samples of infliximab measurement. RESULTS: Twenty-one patients had an adequate infliximab serum level, 31 had subtherapeutic levels and 11 had supratherapeutic levels. Seven patients had their medication suspended due to therapeutic failure or high levels of antibodies to infliximab. CONCLUSION: In conclusion, only a third of the patients had adequate infliximab levels and 36% presented with subtherapeutic levels at the end of the induction phase. Therapy optimization occurred based in about 46% of the samples results, demonstrating the importance of having this tool to help the clinical handling of patients with inflammatory bowel diseases ongoing biologic therapy.
SAFETY PROFILE OF ANTI-TNF THERAPY IN CROHN’S DISEASE MANAGEMENT: A BRAZILIAN SINGLE-CENTER DIRECT RETROSPECTIVE COMPARISON BETWEEN INFLIXIMAB AND ADALIMUMAB
Authors: BAU Mariella , ZACHARIAS Patricia , RIBEIRO Diogo Araújo , BOARON Larissa , STECKERT FILHO Alvaro , KOTZE Paulo Gustavo
Published: September 2017

ABSTRACT BACKGROUND: Infliximab and adalimumab are considered effective drugs in the management of Crohn’s disease. However, due to significant immunossupression, they can cause important adverse events, mostly infections. OBJECTIVE: The aim of this study was to quantify and describe adverse events derived from adalimumab and infliximab use in Crohn’s disease patients, and to compare the safety profile between these two agents. METHODS: This was an observational, single-center, longitudinal, retrospective study with Crohn’s disease patients under infliximab or adalimumab therapy. Variables analyzed: demographic characteristics (including the Montreal classification), type of agent used, concomitant immunomodulators, presence and types of adverse events observed. Patients were allocated in two groups (infliximab and adalimumab) and had their adverse events accessed and subsequently compared. RESULTS: A total of 130 patients were included (68 in infliximab and 62 in adalimumab groups, respectively). The groups were fully homogeneous in all baseline characteristics, with a median follow-up of 47.21±36.52 months in the infliximab group and 47.79±35.09 in the adalimumab group (P=0.512). Adverse events were found in 43/68 (63.2%) and 40/62 (64.5%) in each group, respectively (P=0.879). There were no differences between the groups regarding infections (P=0.094) or treatment interruption (P=0.091). There were higher rates of infusion reactions in the infliximab group (P=0.016). Cephalea and injection site reactions were more prevalent in adalimumab patients. CONCLUSION: Adverse events were found in approximately two thirds of Crohn’s disease patients under anti-TNF therapy, and there were no significant differences between infliximab or adalimumab.
HISTOLOGICAL FEATURES OF EOSINOPHILIC ESOPHAGITIS IN CHILDREN AND ADOLESCENTS
Authors: CARRASCO Adriana Elisabeth Aguiar Benavides , MACHADO Rodrigo Strehl , PATRÍCIO Francy Reis da Silva , KAWAKAMI Elisabete
Published: September 2017

ABSTRACT BACKGROUND: Eosinophilic esophagitis is an emerging disease featured by eosinophilic esophageal infiltrate not responsive to proton pump inhibitors. OBJECTIVE: To characterize histological features of children and adolescents with eosinophilic esophagitis. METHODS: Cross-sectional study in a tertiary hospital. Biopsies from each esophageal third from 14 patients (median age 7 years) with eosinophilic esophagitis were evaluated. Histological features evaluated included morphometry of esophageal epithelium, esophageal density (per high power field), extracellular eosinophilic granules, eosinophilic microabscesses, surface disposition of eosinophils, epithelial desquamation, peripapillary eosinophilia, basal layer hyperplasia and papillary elongation. RESULTS: Several patients presented a normal esophageal macroscopy in the upper digestive endoscopy (6, 42.8%), and the most common abnormality were vertical lines (7, 50%) and whitish spots over esophageal mucosa (7, 50%). Basal layer hyperplasia was observed in 88.8%, 100% e 80% of biopsies from proximal, middle and lower esophagus, respectively (P=0.22). Esophageal density ranges from 0 to more than 50 per hpf. Extracellular eosinophilic granules (70%-100%), surface disposition of eosinophils (60%-93%), epithelial desquamation (60%-100%), peripapillary eosinophilia (70%-80%) were common, but evenly distributed among each esophageal third. Just one patient did not present eosinophils in the lower third, four in the middle third and four in the upper esophageal third. CONCLUSION: In the absence of hypereosinophilia, other histological features are present in eosinophilic esophagitis and may contribute to diagnosis. Eosinophilic infiltrate is focal, therefore multiple biopsies are needed for diagnosis.
Comparative study on gastrostomy and orally nutrition of children and adolescents with tetraparesis cerebral palsy
Authors: CASELLI Thaisa Barboza , LOMAZI Elizete Aparecida , MONTENEGRO Maria Augusta Santos , BELLOMO-BRANDÃO Maria Angela
Published: September 2017

ABSTRACT BACKGROUND: Gastrostomy tube feeding (GTF) is indicated for children with feeding difficulties due to tetraspastic cerebral palsy, although there are no definitive conclusions about the benefits of GTF. OBJECTIVE: To compare nutritional status and diet of pediatric patients with tetraparesis cerebral palsy who are fed by GTF with those fed orally (PO). METHODS: A transversal and descriptive study on 54 patients with spastic tetraparesis was held. The referred parameters were: weight, knee height and estimated height, cutaneous folds and circumferences. The Frisancho reference was used to compare the skin folds and body circumferences. The Brooks et al. curve was adopted as a reference for weight, height, and BMI. Food inquiry was performed using the Habitual Dietary Recall method. The total energetic value (TEV) of macronutrients and fibers was performed by Avanutri® version 4.0, a nutrition software program. The differences of nutritional parameters between the GTF and the PO groups were calculated by chi-squared and Fisher’s exact tests, and the comparison between the groups for variable numbers was performed using the Mann-Whitney test. The significance level adopted was 5%. RESULTS: The PO group presented more individuals in the malnourished range (24.14%) and high levels of adipose and thin mass depletion. The ingestion of lipids was larger in the GTF group, even though the proteins and fibers were higher in the PO group. The comparison between the diets in the GTF group indicated that the mixed diet (industrialized and artisanal) supplied a greater contribution of proteins and fibers. CONCLUSION: Comparing the groups, the tetraparesis cerebral palsy patients fed orally have a greater impairment of their nutritional status, even though they have higher intakes of protein and fiber than those patients fed by gastrostomy, demonstrating a consistent argument for the use of gastrostomy.
Investigação sorológica de Rickettsia rickettsii e Coxiella burnetii em caprinos e ovinos no entorno do Parque Nacional da Serra das Confusões, Piauí
Authors: Guimarães Maíra F. , Araujo Andreina de C. , Freire Davi P. , Machado Dália M.R. , Martins Nara N.V.M. , Moraes-Filho Jonas , Horta Mauricio C.
Published: September 2017

RESUMO: As doenças causadas por bactérias dos gêneros Rickettsia e Coxiella possuem como vetores artrópodes hematófagos, na sua maioria carrapatos, que atuam diretamente na transmissão de patógenos responsáveis por enfermidades de grande impacto na medicina veterinária e humana. O presente estudo objetivou realizar uma investigação sorológica de Rickettsia rickettsii e Coxiella burnetii em caprinos e ovinos criados no entorno do Parque Nacional da Serra das Confusões (PNSC), localizado no estado do Piauí, região nordeste do Brasil. Amostras de soro de 202 caprinos e 153 ovinos foram testadas pela Reação de Imunofluorescência Indireta (RIFI) para detecção de anticorpos anti-R. rickettsii e anti-C. burnetii, sendo consideradas positivas quando apresentaram títulos ≥ 64. Carrapatos em fase de parasitismo foram coletados e identificados. Todas as amostras de caprinos e ovinos foram soronegativas para antígenos de R. rickettsii. Foi verificado soropositividade em 2% (3/153) das amostras de ovinos para C. burnetii, com títulos variando de 64 a 4.096. As amostras de caprinos não foram reagentes ao referido antígeno. Não foi observado parasitismo em caprinos por carrapatos. No total, foram coletados 56 carrapatos parasitando 15 ovinos (9,8%), todos identificados como Rhipicephalus microplus. O estudo demonstrou a ausência de anticorpos anti-R. rickettsii nas amostras de caprinos e ovinos, ausência de anticorpos anti-C. burnetii em caprinos; e possibilitou o primeiro relato da ocorrência sorológica de C. burnetii em ovinos nesta região do Brasil.
Giant esophageal epiphrenic diverticulum: presentation and treatment
Authors: Santos Marcelo Protásio dos , Akerman Denise , Santos Caio Pasquali Dias dos , Santos Filho Paulo Vicente dos , Radtke Marcos Claudio , Beraldo Fernando Bray , Gonçalves José Eduardo
Published: September 2017

ABSTRACT Epiphrenic diverticulum is a rare disease associated with esophageal motor disorders that is usually asymptomatic and has a well-established surgical indication. We report a case of giant epiphrenic diverticulum in a 59-year-old symptomatic woman who was diagnosed after underwent complementary exams. Because of her symptoms, the surgical treatment was chosen, and esophageal diverticulectomy was performed along with laparoscopic cardiomyotomy and anterior partial fundoplication.
Yolk sac primary tumor of mediastino: a rare case in a young adult
Authors: Silva Lorena Luryann Cartaxo da , Vergilio Fernanda Sasaki , Yamaguti Diva Carvalho Collarile , Cruz Isabela Azevedo Nicodemos da , Queen Joana Angrisani Granato
Published: September 2017

ABSTRACT Germ cell tumors are rare neoplasms that mostly occur in the gonads, although they can also affect other body sites, especially the anterior mediastinum (50 to 70% of all extragonadal germ cell tumors). We report a case of a primary mediastinal yolk sac tumor, a rare and aggressive germ cell tumors subtype. This was a 38-year-old man who was admitted to Hospital do Servidor Público Estadual “Francisco Morato de Oliveira”, complaining about dyspnea and dry cough for 1 year. The computed tomography scan of his chest revealed a large mass in the anterior mediastinum with heterogeneous enhancement to the contrast associated with pleural effusion. There were also high serum levels of alpha-fetoprotein. After neoadjuvant chemotherapy, the patient underwent surgical resection of the mass, followed by pathological examination, which confirmed a primary mediastinal yolk sac tumor, a nonseminomatous subtype of germ cell tumors. Primary mediastinal yolk sac tumors have poor prognosis, despite advances in therapy with surgical resection and cisplatin-based chemotherapy. This poor prognosis is due to the degree of invasion and unresectability in most patients by the time of the diagnosis.
Periprosthetic humeral fractures after reverse shoulder arthroplasty. Case report
Authors: Wajnsztejn Andre , Foni Noel Oizerovici , Oizerovici Dan , Pires Robinson Esteves Santos , Ejnisman Benno
Published: September 2017

ABSTRACT Periprosthetic fractures is a severe complication after joint replacement. The rapidly increase of reverse shoulder arthroplasty surgeries, periprosthetic humeral fractures, which are described as rare, may increase in the near future. We report the case of displaced humeral fracture bellow the stem of reverse shoulder prosthesis. The patient was an 85-year-old woman who had a total shoulder replacement 6 years previously. The surgical solution consisted of plate osteossynthesis and cerclage. This report describes an unprecedented case in Brazilian literature; and gives an overview of the existing literature including this injury classification.
Sleep quality in medical students: a comparison across the various phases of the medical course
Authors: Corrêa Camila de Castro , Oliveira Felipe Kazan de , Pizzamiglio Diego Scherlon , Ortolan Erika Veruska Paiva , Weber Silke Anna Theresa
Published: September 2017

ABSTRACT Objective: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course. Methods: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups. Results: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C. Conclusions: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students.
Pneumonia mortality trends in all Brazilian geographical regions between 1996 and 2012
Authors: Ferraz Rosemeire de Olanda , Oliveira-Friestino Jane Kelly , Francisco Priscila Maria Stolses Bergamo
Published: September 2017

ABSTRACT Objective: To analyze the temporal trends in pneumonia mortality rates (standardized by age, using the 2010 population of Brazil as the standard) in all Brazilian geographical regions between 1996 and 2012. Methods: This was an ecological time-series study examining secondary data from the Mortality Database maintained by the Information Technology Department of the Brazilian Unified Health Care System. Polynomial and joinpoint regression models, and corresponding 95% CIs, were used for trend analysis. Results: The pneumonia mortality rates in the South, Southeast, and Central-West showed a decreasing behavior until 2000, followed by increases, whereas, in the North and Northeast, they showed increasing trends virtually throughout the period studied. There was variation in annual percent change in pneumonia mortality rates in all regions except the North. The Central-West had the greatest decrease in annual percent change between 1996 and 2000, followed by an increase of the same magnitude until 2005. The 80 years and over age group was the one most influencing the trend behavior of pneumonia mortality rates in all regions. Conclusions: In general, pneumonia mortality trends reversed, with an important increase occurring in the years after 2000.
Laryngotracheobronchial papillomatosis: chest CT findings
Authors: Fortes Helena Ribeiro , Ranke Felipe Mussi von , Escuissato Dante Luiz , Araujo Neto Cesar Augusto , Zanetti Gláucia , Hochhegger Bruno , Irion Klaus Loureiro , Souza Carolina Althoff , Marchiori Edson
Published: September 2017

ABSTRACT To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis. Methods: This was a retrospective study involving patients ranging from 2 to 72 years of age. The evaluation of the CT scans was independently performed by two observers, and discordant results were resolved by consensus. The inclusion criteria were presence of abnormalities on the CT scans, and the diagnosis was confirmed by anatomopathological examination of the papillomatous lesions. Results: The most common symptoms were hoarseness, cough, dyspnea, and recurrent respiratory infections. The major CT findings were nodular formations in the trachea, solid or cavitated nodules in the lung parenchyma, air trapping, masses, and consolidation. Nodular formations in the trachea were observed in 14 patients (87.5%). Only 2 patients had lesions in lung parenchyma without tracheal involvement. Only 1 patient had no pulmonary dissemination of the disease, showing airway involvement only. Solid and cavitated lung nodules were observed in 14 patients (87.5%) and 13 (81.2%), respectively. Masses were observed in 6 patients (37.5%); air trapping, in 3 (18.7%); consolidation in 3 (18.7%); and pleural effusion, in 1 (6.3%). Pulmonary involvement was bilateral in all cases. Conclusions: The most common tomography findings were nodular formations in the trachea, as well as solid or cavitated nodules and masses in the lung parenchyma. Malignant transformation of the lesions was observed in 5 cases.
Endothelial Epas1 Deficiency Is Sufficient To Promote Parietal Epithelial Cell Activation and FSGS in Experimental Hypertension
Authors: Luque Yosu , Lenoir Olivia , Bonnin Philippe , Hardy Lise , Chipont Anna , Placier Sandrine , Vandermeersch Sophie , Xu-Dubois Yi-Chun , Robin Blaise , Lazareth Hélène , Souyri Michèle , Guyonnet Léa , Baudrie Véronique , Camerer Eric , Rondeau Eric , Mesnard Laurent , Tharaux Pierre-Louis
Published: September 2017

FSGS, the most common primary glomerular disorder causing ESRD, is a complex disease that is only partially understood. Progressive sclerosis is a hallmark of FSGS, and genetic tracing studies have shown that parietal epithelial cells participate in the formation of sclerotic lesions. The loss of podocytes triggers a focal activation of parietal epithelial cells, which subsequently form cellular adhesions with the capillary tuft. However, in the absence of intrinsic podocyte alterations, the origin of the pathogenic signal that triggers parietal epithelial cell recruitment remains elusive. In this study, investigation of the role of the endothelial PAS domain-containing protein 1 (EPAS1), a regulatory α subunit of the hypoxia-inducible factor complex, during angiotensin II–induced hypertensive nephropathy provided novel insights into FSGS pathogenesis in the absence of a primary podocyte abnormality. We infused angiotensin II into endothelial-selective Epas1 knockout mice and their littermate controls. Although the groups presented with identical high BP, endothelial-specific Epas1 gene deletion accentuated albuminuria with severe podocyte lesions and recruitment of pathogenic parietal glomerular epithelial cells. These lesions and dysfunction of the glomerular filtration barrier were associated with FSGS in endothelial Epas1-deficient mice only. These results indicate that endothelial EPAS1 has a global protective role during glomerular hypertensive injuries without influencing the hypertensive effect of angiotensin II. Furthermore, these findings provide proof of principle that endothelial-derived signaling can trigger FSGS and illustrate the potential importance of the EPAS1 endothelial transcription factor in secondary FSGS.
Concept and Development of Resident Training Program for General Competencies
Authors: Lee Sun Woo
Published: September 2017

Resident training programs in South Korea lag far behind that of advanced countries. Given the problems the current system in South Korea has, it is time to consider a new resident training system, resident training for general competencies. Training for the general competencies was practiced in medical fields in advanced countries such as the USA, Canada, and the UK as early as 20 years ago. This system has rendered itself a key component of resident training. Although a few theoretical procedures on general competencies have been practiced in South Korea, the awareness of this concept is still very weak, and the application of the theory to actual training is a long way off from becoming effective. It is urgent for South Korea to adopt competency- and outcome-based training for general competencies. To this end, the knowledge of the concept of this type of training should be improved. Also, the system should be carefully designed to cover a doctor’s whole career, and be applied immediately. The competency- and outcome-based training for general competencies is a system that assures high level qualifications. It reflects the needs of our society under the recognition that a professional organization should be committed and accountable in order to respond to social demands. As the benefits of the new training system reach the public and medical care consumers, training-related expenses should be borne by social costs.