RESUMO

The increasing mortality of COVID-19 can aggravate soil contamination by metals, harmful to the health of the population, requiring new projects for future cemeteries capable of mitigating these impacts to the environment, justifying the importance of studying the concentrations of metals in the soil of urban cemeteries. The paper analyzed the levels of metals in the soil of urban cemeteries in the City of Carazinho, in the state of Rio Grande do Sul, located in southern Brazil, considering the increase in deaths by COVID-19, for the purpose of future projects for cemeteries aimed at mitigating the impacts generated on the environment. The soils of the three urban cemeteries in Carazinho were sampled, with 5 internal and external points, with 3 repetitions at depths of 0-20 and 20-40 cm, adding 180 samples to measure the concentrations of Fe, Mn, Cu, Zn, Cr and Pb (g kg-1), considering the analytical sequence: (1) analysis in triplicate with mean deviation (RDS); (2) R2 of the analytical curve; (3) traceability of the pattern of each metal; (4) quantification limit of each metal (QL), with the performance of nitroperchloric digestion of the samples and the determinations of metals by flame modality atomic absorption spectrometry. Quantitative data on deaths by COVID-19 were analyzed by univariate modeling of time series, in the integrated autoregressive moving averages model. The results of this study were made available to fifteen architects, who attributed future solutions for environmentally sustainable cemeteries. The results showed high levels of copper (Cu) and iron (Fe) in the soil of the cemeteries studied. Considering the increase in deaths and subsequent burials per COVID-19 revealed a prediction for the death toll of 6,082,306 for June 9, 2022, it is assumed that metal contamination can reach even higher levels. To mitigate these levels of contamination by metals, 80% of the architect respondents expressed their preference for a vertical cemetery, with treatment of gases and effluents to mitigate environmental impacts.

RESUMO

BACKGROUND: Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS: The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS: It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.

Assuntos

RESUMO

Birds are considered efficient bioindicators, by their behavioral characteristics, diversified diet, and use of several vegetation layers, including in contaminated environments. The accumulation of contaminants can harm the reproductive process and survival of species, in addition to causing severe metabolic disorders. Air pollution can also affect the birds' health. Micronucleus analysis, a technique able to evaluate the organisms' sensitivity to contaminant agents, has been regarded as a practical tool for evaluating and monitoring the clastogenic and aneugenic effects caused by pollutants. The purpose of this study was to evaluate the presence of micronuclei in bird species that use forest environments and their surroundings; and to verify if the frequency and amount of micronuclei varies between species, areas and populations. Birds transiting between the Brazilian Cerrado forest and open formations were analyzed, coming from four forest fragments of Triângulo Mineiro, two close to urban areas and two more distant. Birds were captured with mist-nets for collecting blood extensions, which were used for counting micronuclei. In total, 103 individuals of 21 species were captured, and the micronucleus rate for every 5000 erythrocytes analyzed was 1.30. Only six populations had sampling sufficiency. There was no difference between the number of individuals with and without micronuclei (χ²=3.18, df=1, p=0.08). In areas closer to the urban perimeter, the micronuclei averages in birds were greater compared to the most isolated areas (H=27.534, df=3, p<0,001). In São José, the individuals of Myiothlypis flaveola presented a number of micronuclei significantly greater than the Galheiro and Água Fria (H=9.601, df=2, p=0.008). M. flaveola clearly reflected the area quality. The micronuclei analysis in birds was effective for evaluating the area quality as well as the intensity with which the birds respond to impacts caused by the surrounding matrix.

Assuntos

RESUMO

Frequent migraine attacks require prophylactic treatment. Anticonvulsants have been suggested due to the progressive knowledge that cortical hyperexcitability is involved in migraine pathophysiology. Topiramate is one of these drugs and its efficacy has been demonstrated in several studies. The aim of this study is to evaluate the adherence and response to topiramate in migraineurs under treatment in a tertiary center. During a 2-year period, all of the patients receiving topiramate for migraine were evaluated after 3 months. The parameters evaluated were adherence to treatment, frequency reduction of attacks >50% and adverse events. Among 175 patients included, 134 (76.6%) returned. Among the 134 patients evaluated, 82 (61.2%) revealed frequency reduction >50% and 105 (78.4%) patients presented weight loss (average 3.4Kg). The most frequent side effects were paresthesias (39.6%); emotional disturbances (including depression, irritability and anxiety) in 17,9%; thinking impairment (12.7%); memory disturbances (12.7%) and altered taste (11.9%). Despite methodological limitations we concluded that adherence to its use and efficacy occurred in most of the patients. In addition, the side effect profile was acceptable. Further controlled studies are necessary to confirm these observations.

Assuntos

RESUMO

Crises freqüentes de migrânea requerem tratamento preventivo. Alguns anticonvulsivantes têm sido preconizados baseado na importância progressiva da hiperexcitabilidade cortical na fisiopatologia da migrânea. O topiramato é um desses medicamentos e sua eficácia foi demonstrada em estudos recentes. O objetivo deste estudo foi avaliar a aderência e resposta ao uso do topiramato em pacientes em tratamento em uma clínica especializada. Durante dois anos todos os pacientes para os quais o topiramato foi prescrito deveriam ser avaliados após três meses. Grau de aderência, redução da freqüência da cefaléia superior a 50 por cento e efeitos adversos foram avaliados. Entre 175 pacientes incluídos, 134 (76,6 por cento) aderiram ao seu uso. Houve redução da freqüência >50 por cento em 82 (61,2 por cento) dos pacientes. Em 105 (78,4 por cento) pacientes ocorreu emagrecimento médio de 3,4 Kg e os efeitos colaterais mais observados foram parestesias (39,6 por cento); distúrbios emocionais (17,9 por cento); distúrbios do raciocínio (12,7 por cento); distúrbios da memória (12,7 por cento) e alterações no paladar em 11,9 por cento dos pacientes estudados. Concluímos que o topiramato foi eficaz e houve aderência ao seu uso na maioria dos pacientes. Além disso, sua tolerabilidade foi aceitável. Estudos controlados são necessários para confirmar estas observações.

Assuntos

RESUMO

Grande parte dos pacientes com cefaléia diária atendidos em clínicas especializadas apresentam história de migrânea. Alguns autores referem-se a esta cefaléia como migrânea transformada, destacando sua menor intensidade e características clínicas diferentes das migrâneas. O objetivo deste estudo foi avaliar a apresentação clínica da cefaléia diária em pacientes com história de migrânea antes de sua transformação em diária. Foram estudados retrospectivamente 215 pacientes. Observamos que porcentagem elevada dos pacientes com migrânea transformada apresentava dor em pressão ou peso, característica da cefaléia tipo tensional crônica. O caráter latejante ainda permaneceu como um achado importante, especialmente naqueles pacientes com ataques intermitentes de migrânea típica.

Assuntos