RESUMO
O Centro de Referência e Treinamento DST/Aids-SP da Secretaria de Estado da Saúde de São Paulo, inaugurou, em junho de 2009, em suas dependências, o primeiro ambulatório voltado exclusivamente à saúde integral de travestis e transexuais do país, com ênfase no processo transexualizador do Sistema Único de Saúde (SUS) e nas necessidades dessa população. Este artigo tem por objetivo apresentar as modalidades assistenciais ofertadas no serviço, as demandas da população atendida no ambulatório, suas vulnerabilidades, fatores de risco e resiliência a que está submetida, assim como as considerações e os desafios no campo da política pública voltada à população trans para promover seu acesso à atenção em saúde de forma acolhedora, livre de preconceito, julgamentos morais e práticas discriminatórias.
RESUMO
Galactinol synthase (GolS) catalyzes the first and rate-limiting step in the synthesis of raffinose family of oligosaccharides (RFOs), which serve as storage and transport sugars, signal transducers, compatible solutes and antioxidants in higher plants. The present work aimed to assess the potential functions of citrus GolS in mechanisms of stress response and tolerance. By homology searches, eight GolS genes were found in the genomes of Citrus sinensis and C. clementina. Phylogenetic analysis showed that there is a GolS ortholog in C. clementina for each C. sinensis GolS, which have evolved differently from those of Arabidopsis thaliana. Transcriptional analysis indicated that most C. sinensis GolS (CsGolS) genes show a low-level tissue-specific and stress-inducible expression in response to drought and salt stress treatments, as well as to 'Candidatus Liberibacter asiaticus' infection. CsGolS6 overexpression resulted in improved tobacco tolerance to drought and salt stresses, contributing to an increased mesophyll cell expansion, photosynthesis and plant growth. Primary metabolite profiling revealed no significant changes in endogenous galactinol, but different extents of reduction of raffinose in the transgenic plants. On the other hand, a significant increase in the levels of metabolites with antioxidant properties, such as ascorbate, dehydroascorbate, alfa-tocopherol and spermidine, was observed in the transgenic plants. These results bring evidence that CsGolS6 is a potential candidate for improving stress tolerance in citrus and other plants.
Assuntos
Arabidopsis , Citrus , Antioxidantes/metabolismo , Arabidopsis/genética , Arabidopsis/metabolismo , Citrus/genética , Citrus/metabolismo , Galactosiltransferases , Oligossacarídeos/metabolismo , Filogenia , Plantas Geneticamente Modificadas/genética , Plantas Geneticamente Modificadas/metabolismo , Rafinose/metabolismo , Espermidina/metabolismo , Tocoferóis/metabolismoRESUMO
Resumo Fundamento: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. Objetivos: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. Métodos: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. Resultados: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). Conclusões: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876)
Abstract Background: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. Objective: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. Methods: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. Results: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). Conclusions: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876)
Assuntos
Humanos , Doença da Artéria Coronariana , Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Infarto do Miocárdio , Portugal/epidemiologia , Choque Cardiogênico , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento , Mortalidade HospitalarRESUMO
Abstract This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
Resumo Este consenso representa a primeira colaboração entre três organizações profissionais com foco em nutrição: Associação Brasileira de Nutrição (Asbran), Sociedade Brasileira de Nefrologia (SBN) e Sociedade Brasileira de Nutrição Parenteral e Enteral (Braspen/SBNPE), com o objetivo de identificar a terminologia e instrumentos padronizados internacionalmente para o processo de cuidado em nutrição. O foco é facilitar a condução de treinamentos de nutricionistas que trabalham com pacientes adultos com doenças renais crônicas (DRC). Foram levantadas onze questões relacionadas à triagem, ao processo de cuidado e à gestão de resultados em nutrição. As recomendações foram baseadas em diretrizes internacionais e em bancos de dados eletrônicos, como PubMed, EMBASE(tm), CINHAL, Web of Science e Cochrane. A partir do envio de listas de termos padronizados internacionalmente, vinte nutricionistas especialistas selecionaram aqueles que consideraram muito claros e relevantes para a prática clínica com pacientes ambulatoriais com DRC. Foi calculado o Índice de Validade de Conteúdo (IVC), com 80% de concordância nas respostas. O Grading of Recommendations, Assessment, Development and Evaluation (GRADE) foi usado para atribuir força de evidência às recomendações. Foram selecionados 107 termos de Avaliação e Reavaliação, 28 de Diagnóstico, 9 de Intervenção e 94 de Monitoramento e Aferição em Nutrição. A lista de termos selecionados e identificação de instrumentos auxiliará no planejamento de treinamentos e na implementação de terminologia padronizada em nutrição no Brasil, para nutricionistas que trabalham com pacientes renais crônicos.
Assuntos
Humanos , Adulto , Insuficiência Renal Crônica , Nefrologia , Avaliação Nutricional , Estado Nutricional , ConsensoRESUMO
BACKGROUND: In patients with acute myocardial infarction (MI), cardiogenic shock (CS), and multivessel disease (MVD) questions remain unanswered when it comes to intervention on non-culprit arteries. OBJECTIVE: This article aims to 1) characterize patients with MI, CS and MVD included in the Portuguese Registry on Acute Coronary Syndromes (ProACS); 2) compare different revascularization strategies in the sample; 3) identify predictors of in-hospital mortality among these patients. METHODS: Observational retrospective study of patients with MI, CS and MVD included in the ProACS between 2010 and 2018. Two revascularization strategies were compared: complete during the index procedure (group 1); and complete or incomplete during the index hospitalization (groups 2-3). The primary endpoint was a composite of in-hospital death or MI. Statistical significance was defined by a p-value <0.05. RESULTS: We identified 127 patients with MI, CS, and MVD (18.1% in group 1, and 81.9% in groups 2-3), with a mean age of 7012 years, and 92.9% of the sample being diagnosed with ST-segment elevation MI (STEMI). The primary endpoint occurred in 47.8% of the patients in group 1 and 37.5% in group 2-3 (p = 0.359). The rates of in-hospital death, recurrent MI, stroke, and major bleeding were also similar. The predictors of in-hospital death in this sample were the presence of left ventricle systolic dysfunction on admission (OR 16.8), right bundle branch block (OR 7.6), and anemia (OR 5.2) (p ≤ 0.02 for both). CONCLUSIONS: Among patients with MI, CS, and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization regarding the occurrence of in-hospital death or MI. (Arq Bras Cardiol. 2021; 116(5):867-876).
FUNDAMENTO: Em doentes com infarto agudo do miocárdio (IAM), choque cardiogênico (CC) e doença multivaso (DMV) persistem dúvidas sobre a intervenção nas artérias não responsáveis. OBJETIVOS: 1) caracterizar a amostra de doentes com IAM, CC e DMV incluídos no Registo Nacional Português de Síndromes Coronárias Agudas (RNSCA); 2) comparar os eventos associados a diferentes estratégias de revascularização; e 3) identificar preditores de mortalidade intra-hospitalar nesta amostra. MÉTODOS: Estudo observacional retrospetivo de doentes com IAM, CC e DMV incluídos no RNSCA entre 2010 e 2018. Compararam-se duas estratégias de revascularização: completa durante o procedimento índice (grupo 1); e completa diferida ou incompleta durante o internamento (grupo 2-3). O endpoint primário foi a ocorrência de reinfarto ou morte intra-hospitalar. A significância estatística foi definida por um valor p < 0,05. RESULTADOS: Identificaram-se 127 doentes com IAM, CC e DMV (18,1% no grupo 1 e 81,9% no grupo 2-3), com idade média de 70 ± 12 anos e 92,9% com IAM com supradesnivelamento do segmento ST. O endpoint primário ocorreu em 47,8% dos doentes do grupo 1 e em 37,5% do grupo 2-3 (p = 0,359). As taxas de mortalidade intra-hospitalar, reinfarto, acidente vascular cerebral e hemorragia major foram também semelhantes nos dois grupos. Os preditores de mortalidade intra-hospitalar nesta amostra foram a presença na admissão de disfunção ventricular esquerda (OR 16,8), bloqueio completo de ramo direito (OR 7,6) e anemia (OR 5,2), (p ≤ 0,02). CONCLUSÕES: Entre os doentes com IAM, CC e DMV, incluídos no RNSCA, não se verificou diferença significativa entre revascularização completa no evento índex e completa diferida ou incompleta durante o internamento, relativamente à ocorrência de morte intra-hospitalar ou reinfarto. (Arq Bras Cardiol. 2021; 116(5):867-876).
Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Mortalidade Hospitalar , Humanos , Portugal/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico , Resultado do TratamentoRESUMO
This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
Assuntos
Nefrologia , Insuficiência Renal Crônica , Adulto , Consenso , Humanos , Avaliação Nutricional , Estado Nutricional , Insuficiência Renal Crônica/terapiaRESUMO
BACKGROUND: This study aimed to validate the Malnutrition Clinical Characteristics (MCC) compared with the Subjective Global Assessment (SGA), considering anthropometric measures, comorbidities, and mortality in critically ill patients. METHODS: This longitudinal observational study included patients admitted to the general intensive care unit (ICU) of a public hospital. SGA was used as the reference standard for diagnosing malnutrition. The inclusion criteria were patients receiving nutrition support therapy and age >18 years. The nutrition therapy was optimized as close as possible to 100% of the patients' energy and protein needs regardless of the access route. Hospital length of stay (LOS), comorbidities on admission, and death were documented during the entire hospitalization of each patient. Body mass index (BMI), midarm circumference (MAC), and calf circumference (CC) were considered anthropometric measures. RESULTS: The convenience sample comprised 102 ICU patients. Comparing the original malnutrition classifications of SGA with MCC, the specificity was 87.5%, sensitivity was 100%, accuracy was 93.3%, positive predictive value was 87.5%, and negative predictive value was 100%. When classified in 2 groups, namely "well-nourished" and "malnourished," specificity and sensitivity were 100% between both groups. Malnourished patients had significantly higher mortality rates (P = .006) and longer LOSs (P <.001). As expected, BMI, MAC, and CC results were similar for SGA and MCC. CONCLUSIONS: MCC was a valid tool for classifying malnutrition in ICU patients. Because the evaluation is fast and does not require expensive equipment that is difficult to handle, it is believed to be practical, low-cost, and easy to use.
Assuntos
Estado Terminal , Desnutrição , Adolescente , Humanos , Unidades de Terapia Intensiva , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Avaliação Nutricional , Apoio NutricionalRESUMO
Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.
Tornar-se pai exige um processo de desenvolvimento pessoal, reorientação interior e adaptação ao novo papel. A literatura sobre este processo tem sido parca, desvalorizando o quão desafiante e problemática pode ser a transição de se tornar pai. Este estudo, de caráter qualitativo, exploratório, descritivo, transversal e retrospetivo procurou compreender as vivências dos homens na transição para a paternidade durante o período pré-natal. Incluiu uma amostra de 10 homens a vivenciar, pela primeira vez, a gravidez da parceira. Recurso à entrevista semiestruturada como técnica de coleta de dados. Análise de dados com técnica de análise de conteúdo, com categorização semântica e abordagem indutiva. Como resultados, emergiram 3 temas: "experienciar da transição", "desenvolvimento da identidade como pai" e "(des)construção de pontes para a transição". Este estudo aprofunda a compreensão desta transição desenvolvimental e desafia a uma reestruturação dos cuidados pré-natais no sentido da inclusão da figura paterna.
Assuntos
Adaptação Psicológica , Relações Pai-Filho , Estudos Transversais , Pai , Feminino , Humanos , Masculino , Gravidez , Pesquisa Qualitativa , Estudos RetrospectivosRESUMO
Resumo Tornar-se pai exige um processo de desenvolvimento pessoal, reorientação interior e adaptação ao novo papel. A literatura sobre este processo tem sido parca, desvalorizando o quão desafiante e problemática pode ser a transição de se tornar pai. Este estudo, de caráter qualitativo, exploratório, descritivo, transversal e retrospetivo procurou compreender as vivências dos homens na transição para a paternidade durante o período pré-natal. Incluiu uma amostra de 10 homens a vivenciar, pela primeira vez, a gravidez da parceira. Recurso à entrevista semiestruturada como técnica de coleta de dados. Análise de dados com técnica de análise de conteúdo, com categorização semântica e abordagem indutiva. Como resultados, emergiram 3 temas: "experienciar da transição", "desenvolvimento da identidade como pai" e "(des)construção de pontes para a transição". Este estudo aprofunda a compreensão desta transição desenvolvimental e desafia a uma reestruturação dos cuidados pré-natais no sentido da inclusão da figura paterna.
Abstract Becoming a father requires a process of personal development, inner reorientation, and adaptation to a new role. The literature on this process has been sparse, devaluing how challenging and problematic the transition to becoming a father can be. This qualitative, exploratory, descriptive, cross-sectional and retrospective study sought to understand the experiences of men in the transition to fatherhood during the prenatal period. It included a sample of 10 men experiencing, for the first time, a partner's pregnancy. The data collection technique used was semi-structured interviews. The content analysis technique with semantic categorization and an inductive approach was used to analyze the data. As a result, 3 topics emerged: "experiencing the transition," "development of the father identity" and "(de)constructing bridges for the transition". This study deepens the understanding of this developmental transition and challenges the restructuring of prenatal care towards the inclusion of the father figure.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adaptação Psicológica , Relações Pai-Filho , Estudos Transversais , Estudos Retrospectivos , Pesquisa Qualitativa , PaiRESUMO
OBJETIVOS: Analisar os dados de gestações com risco de toxoplasmose congênita e investigar a evolução dos recém-nascidos, em um hospital de nível II em Portugal. MÉTODOS: Um estudo transversal retrospetivo incluiu recém-nascidos com risco de toxoplasmose congênita e suas mães, cujo parto ocorreu entre janeiro de 2000 e dezembro de 2015. Os critérios de inclusão foram mãe com soroconversão para toxoplasmose durante a gestação ou primeira amostra sérica com IgM e IgG específicas positivas. O diagnóstico de toxoplasmose congênita foi definido por IgM específica positiva ao nascimento e/ou reação em cadeia da polimerase positiva no líquido amniótico e/ou persistência de IgG específica até os 12 meses de vida. A toxoplasmose congênita foi definida como sintomática quando os achados clínicos foram atribuídos à doença. Os testes Qui-quadrado ou Exato de Fisher foram usados para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Ocorreram 39.585 nascimentos vivos no período em estudo e foram identificados 98 casos com risco de toxoplasmose congênita, dos quais 89 completaram o seguimento. A prevalência de IgG para T. gondii nas gestantes foi de 26% (intervalo de confiança [IC] 95% 24-27%). Foram confirmados 22 casos de toxoplasmose congênita (5,6 por 10.000 nascidos vivos, IC95% 3,5-8,5 por 10.000). Dos 22 recém-nascidos, 18 (82%, IC95% 61-93%) eram sintomáticos. Os achados clínicos mais frequentes foram calcificação intracraniana (64%), hepatomegalia e/ou elevação das transaminases (32%) e retinocoroidite (14%). As lesões cerebrais foram mais frequentes quando a infeção materna foi documentada no primeiro e segundo trimestres em comparação com o terceiro (p=0,018). Em 31 casos (35%), as gestantes foram tratadas desde o momento do diagnóstico até o parto com espiramicina, não se tendo encontrado diferenças relativamente à taxa de transmissão vertical ou ao aparecimento de manifestações clínicas entre os recém-nascidos de mães tratadas e não tratadas. CONCLUSÕES: A prevalência de toxoplasmose congênita foi superior à reportada em outros países da Europa. A prevalência de calcificações intracranianas foi maior do que a descrita na literatura, enquanto que a de retinocoroidite e estrabismo foi menor. As alterações cerebrais nos recém-nascidos foram mais frequentes nas infecções de primeiro e segundo trimestre. Não houve diferença na taxa de transmissão vertical e na ocorrência de manifestações clínicas entre os recém-nascidos cujas mães receberam espiramicina na gestação ou não receberam tratamento.
AIMS: To analyze the data on pregnancies with risk of congenital toxoplasmosis and to investigate the newborns' outcome, in a level II hospital in Portugal. METHODS: A cross-sectional retrospective study included newborns at risk for congenital toxoplasmosis and their mothers, whose delivery occurred between January 2000 and December 2015. The inclusion criteria were mother with seroconversion to toxoplasmosis during pregnancy or first serum sample with positive specific IgM and IgG. The diagnosis of congenital toxoplasmosis was defined by positive specific IgM at birth and/or polymerase chain reaction positive in amniotic fluid and/or persistence of specific IgG up to 12 months of life. Congenital toxoplasmosis was defined as symptomatic when clinical findings were attributed to the disease. Chi-square or Fisher's exact tests were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: There were 39,585 live births in the study period and 98 cases with risk of congenital toxoplasmosis were identified, of which 89 completed the follow-up. The prevalence of anti-T. gondii IgG in the pregnant women was 26% (95% confidence interval [CI] 24-27%). Twenty-two cases of congenital toxoplasmosis (5.6 per 10,000 live births, 95%CI 3.5-8.5 per 10,000) were confirmed. Of the 22 newborns, 18 (82%, 95%CI 61-93%) were symptomatic. The most frequent clinical findings were intracranial calcification (64%), hepatomegaly and / or elevation of transaminases (32%) and retinochoroiditis (14%). Cerebral lesions were more frequent when maternal infection was documented in the first and second trimester compared to the third trimester (p=0.018). In 31 cases (35%), the pregnant women were treated from the time of diagnosis until delivery with spiramycin, and no differences were found regarding the rate of vertical transmission or the appearance of clinical manifestations among the newborns of treated and non-treated mothers treated. CONCLUSIONS: The prevalence of congenital toxoplasmosis was higher than that reported in other European countries. The prevalence of intracranial calcifications was higher than that described in the literature, whereas retinochoroiditis and strabismus occurrence was lower. Brain lesions in newborns were more frequent in first- and second-trimester infections. There was no difference in the rate of vertical transmission and in the occurrence of clinical manifestations among newborns whose mothers received spiramycin during gestation and those whose mothers did not receive treatment.
Assuntos
Toxoplasmose Congênita , Pediatria , Recém-Nascido , MedicinaRESUMO
Nuclear factor Y (NF-Y) is a ubiquitous transcription factor found in eukaryotes. It is composed of three distinct subunits called NF-YA, NF-YB and NF-YC. NF-Ys have been identified as key regulators of multiple pathways in the control of development and tolerance to biotic and abiotic factors. The present study aimed to identify and characterize the complete repertoire of genes coding for NF-Y in citrus, as well as to perform the functional characterization of one of its members, namely CsNFYA5, in transgenic tobacco plants. A total of 22 genes coding for NF-Y were identified in the genomes of sweet orange (Citrus sinensis) and Clementine mandarin (C. clementina), including six CsNF-YAs, 11 CsNF-YBs and five CsNF-YCs. Phylogenetic analyses showed that there is a NF-Y orthologous in the Clementine genome for each sweet orange NF-Y gene; this was not observed when compared to Arabidopsis thaliana. CsNF-Y proteins shared the same conserved domains with their orthologous proteins in other organisms, including mouse. Analysis of gene expression by RNA-seq and EST data demonstrated that CsNF-Ys have a tissue-specific and stress inducible expression profile. qRT-PCR analysis revealed that CsNF-YA5 exhibits differential expression in response to water deficit in leaves and roots of citrus plants. Overexpression of CsNF-YA5 in transgenic tobacco plants contributed to the reduction of H2O2 production under dehydration conditions and increased plant growth and photosynthetic rate under normal conditions and drought stress. These biochemical and physiological responses to drought stress promoted by CsNF-YA5 may confer a productivity advantage in environments with frequent short-term soil water deficit.
Assuntos
Fator de Ligação a CCAAT/genética , Citrus/genética , Secas , Proteínas de Plantas/genética , Estresse Fisiológico , Arabidopsis/genética , Fator de Ligação a CCAAT/metabolismo , Citrus/metabolismo , Genes de Plantas/genética , Filogenia , Proteínas de Plantas/metabolismo , Plantas Geneticamente Modificadas/genética , Alinhamento de Sequência , Nicotiana/genéticaRESUMO
MAIN CONCLUSION: Overexpression of the citrus CsTIP2;1 improves plant growth and tolerance to salt and drought stresses by enhancing cell expansion, H 2 O 2 detoxification and stomatal conductance. Tonoplast intrinsic proteins (TIPs) are a subfamily of aquaporins, belonging to the major intrinsic protein family. In a previous study, we have shown that a citrus TIP isoform, CsTIP2;1, is highly expressed in leaves and also transcriptionally regulated in leaves and roots by salt and drought stresses and infection by 'Candidatus Liberibacter asiaticus', the causal agent of the Huanglongbing disease, suggesting its involvement in the regulation of the flow of water and nutrients required during both normal growth and stress conditions. Here, we show that the overexpression of CsTIP2;1 in transgenic tobacco increases plant growth under optimal and water- and salt-stress conditions and also significantly improves the leaf water and oxidative status, photosynthetic capacity, transpiration rate and water use efficiency of plants subjected to a progressive soil drying. These results correlated with the enhanced mesophyll cell expansion, midrib aquiferous parenchyma abundance, H2O2 detoxification and stomatal conductance observed in the transgenic plants. Taken together, our results indicate that CsTIP2;1 plays an active role in regulating the water and oxidative status required for plant growth and adaptation to stressful environmental conditions and may be potentially useful for engineering stress tolerance in citrus and other crop plants.
Assuntos
Adaptação Fisiológica , Antioxidantes/metabolismo , Aquaporinas/metabolismo , Citrus/genética , Proteínas de Membrana/metabolismo , Proteínas de Plantas/metabolismo , Aquaporinas/genética , Citrus/citologia , Citrus/crescimento & desenvolvimento , Citrus/fisiologia , Secas , Expressão Gênica , Peróxido de Hidrogênio/metabolismo , Proteínas de Membrana/genética , Fotossíntese , Folhas de Planta/citologia , Folhas de Planta/genética , Folhas de Planta/crescimento & desenvolvimento , Folhas de Planta/fisiologia , Proteínas de Plantas/genética , Raízes de Plantas/citologia , Raízes de Plantas/genética , Raízes de Plantas/crescimento & desenvolvimento , Raízes de Plantas/fisiologia , Estômatos de Plantas/citologia , Estômatos de Plantas/genética , Estômatos de Plantas/crescimento & desenvolvimento , Estômatos de Plantas/fisiologia , Transpiração Vegetal , Isoformas de Proteínas , Cloreto de Sódio/metabolismo , Estresse Fisiológico , Nicotiana/citologia , Nicotiana/genética , Nicotiana/crescimento & desenvolvimento , Nicotiana/fisiologia , Água/fisiologiaRESUMO
Late Embryogenesis Abundant (LEA) proteins are an ubiquitous group of polypeptides that were first described to accumulate during plant seed dehydration, at the later stages of embryogenesis. Since then they have also been recorded in vegetative plant tissues experiencing water limitation and in anhydrobiotic bacteria and invertebrates and, thereby, correlated with the acquisition of desiccation tolerance. This study provides the first comprehensive study about the LEA gene family in sweet orange (Citrus sinensis L. Osb.), the most important and widely grown fruit crop around the world. A surprisingly high number (72) of genes encoding C. sinensis LEAs (CsLEAs) were identified and classified into seven groups (LEA_1, LEA_2, LEA_3 and LEA_4, LEA_5, DEHYDRIN and SMP) based on their predicted amino acid sequences and also on their phylogenetic relationships with the complete set of Arabidopsis thaliana LEA proteins (AtLEAs). Approximately 60% of the CsLEAs identified in this study belongs to the unusual LEA_2 group of more hydrophobic LEA proteins, while the other LEA groups contained a relatively small number of members typically hydrophilic. A correlation between gene structure and motif composition was observed within each LEA group. Investigation of their chromosomal localizations revealed that the CsLEAs were non-randomly distributed across all nine chromosomes and that 33% of all CsLEAs are segmentally or tandemly duplicated genes. Analysis of the upstream sequences required for transcription revealed the presence of various stress-responsive cis-acting regulatory elements in the promoter regions of CsLEAs, including ABRE, DRE/CRT, MYBS and LTRE. Expression analysis using both RNA-seq data and quantitative real-time RT-PCR (qPCR) revealed that the CsLEA genes are widely expressed in various tissues, and that many genes containing the ABRE promoter sequence are induced by drought, salt and PEG. These results provide a useful reference for further exploration of the CsLEAs functions and applications on crop improvement.
Assuntos
Citrus sinensis/crescimento & desenvolvimento , Citrus sinensis/genética , Regulação da Expressão Gênica de Plantas , Proteínas de Plantas/genética , Estresse Fisiológico , Cromossomos de Plantas , Citrus sinensis/embriologia , Genoma de Planta , FilogeniaRESUMO
Background: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. Objectives: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. Methods: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. Results: The patients’ mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). Conclusion: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access. .
Fundamento: Menos complicações hemorrágicas e deambulação precoce fazem do acesso radial uma via privilegiada para cateterismo cardíaco. Entretanto, a abordagem transradial (TR) nem sempre é bem-sucedida, sendo necessária a sua conversão em acesso femoral. Objetivo: Avaliar a taxa de conversão do acesso radial em femoral no cateterismo cardíaco e identificar seus fatores preditivos. Métodos: Registro prospectivo de dois centros, incluindo 7.632 pacientes consecutivos submetidos a cateterização via acesso radial entre janeiro de 2009 e outubro de 2012. Avaliou-se a incidência de conversão em acesso femoral e seus fatores preditivos através de análise de regressão logística. Resultados: A idade média dos pacientes foi de 66 ± 11 anos, sendo 32% deles mulheres. Houve 2.969 (38.4%) intervenções coronarianas percutâneas (ICP),sendo a artéria radial direita a primeira escolha mais usada (97,6%). A taxa de insucesso do acesso radial foi de 5,8%. Fatores preditivos independentes da conversão do acesso radial em femoral foram o uso de bainhas introdutoras curtas (OR 3,047; IC: 2,380-3,902; p < 0,001), ICP (OR 1,729; IC: 1,375-2,173; p < 0,001), sexo feminino (OR 1,569;IC: 1,234-1,996; p < 0,001), doença multiarterial (OR 1,457; IC: 1,167-1,819; p = 0,001), área de superfície corporal(ASC) ≤ 1,938 (OR 1,448; IC: 1,120-1,871; p = 0,005) e idade > 66 anos (OR 1,354; IC: 1,088-1,684; p = 0,007). Conclusão: A abordagem transradial para cateterismo cardíaco tem alta taxa de sucesso e a necessidade de sua conversão em acesso femoral nesta coorte foi baixa. Os fatores preditivos independentes de sua conversão em acesso femoral foram: sexo feminino; idade mais avançada; menor ASC; uso de bainhas introdutoras curtas; doença multiarterial; e ICP. .
Assuntos
Humanos , Toxinas Bacterianas , Staphylococcus aureus , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologiaRESUMO
BACKGROUND: Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access. OBJECTIVES: To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors. METHODS: Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis. RESULTS: The patients' mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007). CONCLUSION: Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.
Assuntos
Cateterismo Cardíaco/métodos , Artéria Femoral , Artéria Radial , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Feminino , Artéria Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Artéria Radial/cirurgia , Fatores de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
A avaliação do declínio cognitivo implica a mensuração de uma discrepância entre o nível de funcionamento anterior a uma lesão ou situação de declínio (pré-mórbido) e o estado atual do indivíduo. No entanto, dados relativos ao funcionamento pré-mórbido (ou Inteligência Pré-Mórbida: IPM) raramente se encontram disponíveis, sendo necessário recorrer a métodos indiretos de estimação. O presente estudo apresenta uma abordagem histórica do desenvolvimento das várias metodologias de estimação da IPM, sistematizando e analisando a validade desses métodos, desde as primeiras abordagens qualitativas, às recentes estratégias mais quantitativas. Concluise que a metodologia mais válida, fiável e promissora para a estimação da IPM combina, em fórmulas de regressão, a informação relativa à capacidade atual do sujeito e dados referentes a variáveis demográficas. O constante desenvolvimento de metodologias de estimação da IPM progressivamente mais fiáveis evidencia a importância desta variável na avaliação e investigação psicológica.(AU)
Cognitive decline assessment implies measuring discrepancies between the subject's previous (premorbid) and the current levels of functioning. However, this information is rarely available and clinicians have to infer it by using indirect methods. This article provides an historical overview of the different methods that have been developed for premorbid intelligence estimation, from the first qualitative methods to the most recent quantitative approaches. The discussion sustains that the most valid methods for premorbid intelligence estimation are those that combine current level of the subject's performance and demographic variables in regression formulas. The constant development of premorbid estimation methods with increasing validity is suggestive of the importance that this measure has for psychological assessment.(AU)
La evaluación del deterioro cognitivo supone la medición y definición de la presencia de una discrepancia entre el nivel del funcionamiento anterior a una lesión o situación de deterioro (premórbido) y el estado actual del indivíduo. Sin embargo, los datos referidos relativos al funcionamiento premórbido (o inteligencia premórbida: IPM) raramente se encuentran disponibles, siendo necesario recurrir a métodos indirectos de estimación. El presente estudio presenta un método de acercamiento histórico del desarrollo de diferentes metodologías de estimación de la IPM, sistematizando y analizando brevemente la validez de estos métodos desde los primeros acercamientos cualitativos a recientes estrategias más cuantitativas. Se concluye sobre la metodología más válida, fiable y prometedora para la estimación del IPM que combina, en fórmulas de regresión, la información relativa a la capacidad actual del sujeto y datos referentes a las variables demográficas. El constante desarrollo de metodologías de estimación de la IPM, cada vez más fiables, demuestra la importancia que esta variable ocupa en la evaluación e investigación científica.(AU)
Assuntos
Inteligência , Testes NeuropsicológicosRESUMO
A avaliação do declínio cognitivo implica a mensuração de uma discrepância entre o nível de funcionamento anterior a uma lesão ou situação de declínio (pré-mórbido) e o estado atual do indivíduo. No entanto, dados relativos ao funcionamento pré-mórbido (ou Inteligência Pré-Mórbida: IPM) raramente se encontram disponíveis, sendo necessário recorrer a métodos indiretos de estimação. O presente estudo apresenta uma abordagem histórica do desenvolvimento das várias metodologias de estimação da IPM, sistematizando e analisando a validade desses métodos, desde as primeiras abordagens qualitativas, às recentes estratégias mais quantitativas. Concluise que a metodologia mais válida, fiável e promissora para a estimação da IPM combina, em fórmulas de regressão, a informação relativa à capacidade atual do sujeito e dados referentes a variáveis demográficas. O constante desenvolvimento de metodologias de estimação da IPM progressivamente mais fiáveis evidencia a importância desta variável na avaliação e investigação psicológica...
Cognitive decline assessment implies measuring discrepancies between the subject's previous (premorbid) and the current levels of functioning. However, this information is rarely available and clinicians have to infer it by using indirect methods. This article provides an historical overview of the different methods that have been developed for premorbid intelligence estimation, from the first qualitative methods to the most recent quantitative approaches. The discussion sustains that the most valid methods for premorbid intelligence estimation are those that combine current level of the subject's performance and demographic variables in regression formulas. The constant development of premorbid estimation methods with increasing validity is suggestive of the importance that this measure has for psychological assessment...
La evaluación del deterioro cognitivo supone la medición y definición de la presencia de una discrepancia entre el nivel del funcionamiento anterior a una lesión o situación de deterioro (premórbido) y el estado actual del indivíduo. Sin embargo, los datos referidos relativos al funcionamiento premórbido (o inteligencia premórbida: IPM) raramente se encuentran disponibles, siendo necesario recurrir a métodos indirectos de estimación. El presente estudio presenta un método de acercamiento histórico del desarrollo de diferentes metodologías de estimación de la IPM, sistematizando y analizando brevemente la validez de estos métodos desde los primeros acercamientos cualitativos a recientes estrategias más cuantitativas. Se concluye sobre la metodología más válida, fiable y prometedora para la estimación del IPM que combina, en fórmulas de regresión, la información relativa a la capacidad actual del sujeto y datos referentes a las variables demográficas. El constante desarrollo de metodologías de estimación de la IPM, cada vez más fiables, demuestra la importancia que esta variable ocupa en la evaluación e investigación científica...
Assuntos
Inteligência , Testes NeuropsicológicosRESUMO
BACKGROUND: Bariatric surgery is an important method for treatment of morbid obesity. It is known that significant nutritional deficiencies might occur after surgery, such as, calorie-protein malnutrition, iron deficiency anemia, and lack of vitamin B12, thiamine, and folic acid. OBJECTIVE: The objective of our study was to validate a computerized intelligent decision support system that suggests nutritional diagnoses of patients submitted to bariatric surgery. METHODS: There were fifteen clinical cases that were developed and sent to three dietitians in order to evaluate and define a nutritional diagnosis. After this step, the cases were sent to four bariatric surgery expert dietitians who were aiming to collaborate on a gold standard. The nutritional diagnosis was to be defined individually, and any disagreements were solved through a consensus. The final result was used as the gold standard. Bayesian networks were used to implement the system, and database training was done with Shell Netica. For the system validation, a similar answer rate was calculated, as well as the specificity and sensibility. Receiver operating characteristic (ROC) curves were projected to each nutritional diagnosis. RESULTS: Among the four experts, the rate of similar answers found was 80% (48/60) to 93% (56/60), depending on the nutritional diagnosis. The rate of similar answers of the system, compared to the gold standard, was 100% (60/60). The system sensibility and specificity were 95.0%. The ROC curves projection showed that the system was able to represent the expert knowledge (gold standard), and to help them in their daily tasks. CONCLUSIONS: The system that was developed was validated to be used by health care professionals for decision-making support in their nutritional diagnosis of patients submitted to bariatric surgery.
RESUMO
The role played by human activity in coastline changes indicates a general tendency of retreating coasts, especially deltaic environments, as a result of the recent trend of sea level rise as well as the blockage of the transfer of sediments towards the coast, especially due to the construction of dams. This is particularly important in deltaic environments which have been suffering a dramatic loss of area in the last decades. In contrast, in this paper, we report the origin and evolution of an anthropogenic delta, the Valo Grande delta, on the south-eastern Brazilian coast, whose origin is related to the opening of an artificial channel and the diversion of the main flow of the Ribeira de Iguape River. The methodology included the analysis of coastline changes, bathymetry and coring, which were used to determine the sedimentation rates and grain-size changes over time. The results allowed us to recognize the different facies of the anthropogenic delta and establish its lateral and vertical depositional trends. Despite not being very frequent, anthropogenic deltas represent a favorable environment for the record of natural and anthropogenic changes in historical times and, thus, deserve more attention from researchers of different subjects.
RESUMO
Este estudo retrata uma experiência de estágio básico do curso de Psicologia da Universidade Federal do Triângulo Mineiro em um Centro de Atenção Psicossocial (CAPS) da cidade de Uberaba (MG), para a disciplina Vivência Profissional V. Objetivou-se apreender a vivência concreta de quem assume o papel de cuidador do sujeito em sofrimento psíquico. Para tanto, foram realizados três encontros com uma cuidadora de uma usuária psicótica, utilizando-se de uma entrevista aberta. A construção do presente relato envolveu a articulação entre os dados obtidos e trabalhos presentes na literatura acerca da temática. A partir das falas da entrevistada foram selecionadas categorias que representam sua vivência enquanto cuidadora. Dentre os diversos aspectos identificados nesta experiência, destaca-se a sobrecarga produzida por tal cuidado.(AU)
This study depicts an experience of basic internship of the Psychology graduate course at Universidade Federal do Triângulo Mineiro at the Centro de Atenção Psicossocial (CAPs) in Uberaba, Brazil. It aimed at apprehending lived aspects of a caregiver of a subject in psychic suffering. Three meetings were held with a caregiver of a psychotic subject and an open interview was used. This report involves data obtained in the interviews and published work in scientific literature about the theme. From content present in the interviews, some categories were selected to represent her living experience as a caregiver. Along with many aspects identified in the interview, its burdensome nature is highlighted.(AU)
El presente trabajo es resultado de la experiencia de tres estudiantes de Psicología de la Universidad Federal do Triangulo Mineiro, en el Centro de Atencion Psicossocial (CAPS) de Uberaba, durante la materia Vivencia Profesional. El objetivo fue aprender la vivencia concreta de quien asume el rol de cuidador del sujeto psicótico. Por lo tanto fueron realizadas tres reuniones con una cuidadora de una psicótica, en que se utilizó una entrevista abierta. La construcción del presente relato envuelve la articulación entre los datos obtenidos y trabajos presentes en la literatura acerca del tema. A partir de las conversaciones de la entrevistada fueron seleccionadas categorías que representan su vivencia como cuidadora. Dentro de los diversos aspectos identificados en esta experiencia se destacan la sobre carga producida por tal cuidado.(AU)