81 research outputs found
Descrição de uma Nova EspĂ©cie de Cyrtoneuropsis Malloch, 1925 (Diptera, Muscidae) e Primeiro Registro do GĂȘnero no Estado do MaranhĂŁo, Brasil
Cyrtoneuropsis maranhensis sp.nov. from the State of MaranhaÌo, Brazil, is described with illustrations of male and female terminalia. The genus is recorded for the first time from the State of MaranhaÌo, Brazil.Cyrtoneuropsis maranhensis sp.nov. do Estado do MaranhaÌo, Brasil, eÌ descrita com ilustraçoÌes da terminaÌlia do macho e da feÌmea. O geÌnero eÌ assinalado pela primeira vez no Estado do MaranhaÌo, Brasil
ACALASIA NA DOENĂA DE CHAGAS Ă DIFERENTE DE ACALASIA IDIOPĂTICA? EXPERIĂNCIA DO HOSPITAL DE CLĂNICAS DE PORTO ALEGRE
Objetive: The objective of this study is to evaluate the differences between achalasia in Chagasâ disease and idiopathic achalasia in patients admitted to the Hospital de ClĂnicas de Porto Alegre, by analyzing epidemiologic, clinic, radiologic and manometric findings.Methods: Patients referred to the Hospital de Clinicas de Porto Alegre between November 1996 and December 2001 with suspicion of achalasia, later confirmed by esophageal manometry, were included in the study. In addition to manometric and radiologic findings, patients were assessed for age, sex, symptomsand symptomatic period.Results: Among 51 patients, nine (18%) presented positive serology for Chagasâ disease and 42 (82%) presented negative serology. The latter were considered carriers of idiopathic achalasia. The mean age of patients with achalasia in Chagasâ disease was 62 ± 15 years, while the mean age in the idiopathic group was 43 ± 18 years (P < 0.02). The symptomatic period for patients with achalasia in Chagasâ disease was 74 ± 47 months, and in the idiopathic group, 49 ± 35 months (P < 0.05). Dysphagia, regurgitation, thoracic pain and weight loss, values at the lower esophageal sphincter (basal pressure, post-deglutitive relaxation pressure/duration and total length) and at the esophageal body (amplitude and duration of the post-deglutitive waves) were similar in both groups.Conclusions: The only statistically significant differences found between the two groups were age and length of the symptomatic period, significantly greater in patients with achalasia in Chagasâ disease. These data suggest a greater resistance to the symptoms in older patients.Objetivo: O presente trabalho tem como objetivo avaliar as diferenças entre a acalasia chagĂĄsica e a idiopĂĄtica em pacientes do Hospital de ClĂnicas de Porto Alegre, atravĂ©s da anĂĄlise de achados epidemiolĂłgicos, clĂnicos, radiolĂłgicos e manomĂ©tricos.MĂ©todos: Foram estudados pacientes encaminhados ao Hospital de ClĂnicas de Porto Alegre, entre novembro de 1996 e dezembro de 2001, com suspeita de acalasia, posteriormente, confirmada por manometria esofĂĄgica. AlĂ©m das caracterĂsticas manomĂ©tricas e radiolĂłgicas, os pacientes foram avaliados quanto a idade, sexo, sintomas e tempo de evolução.Resultados: Entre 51 pacientes, nove (18%) tiveram sorologia positiva para doença de Chagas e 42 (82%) sorologia negativa. IndivĂduos com sorologia negativa foram considerados portadores de acalasia idiopĂĄtica. Pacientes com acalasia chagĂĄsica tinham mĂ©dia de idade de 62 ± 15 anos e os com idiopĂĄtica 43 ± 18 anos (P < 0,02). O perĂodo de evolução dos sintomas em pacientes com acalasia chagĂĄsica foi de 74 ± 47 meses e nos idiopĂĄticos 49 ± 35 meses (P < 0,05). Disfagia, regurgitação, dor torĂĄcica e emagrecimento, valores do esfĂncter esofĂĄgico inferior (pressĂŁo basal, pressĂŁo e duração de relaxamento pĂłs-deglutição e comprimento total) e do corpo esofĂĄgico (amplitude e duração das ondas pĂłs-deglutição) foram similares em ambos os grupos.ConclusĂ”es: As Ășnicas diferenças estatisticamente significativas encontradas entre os dois grupos foram a mĂ©dia de idade e o perĂodo de evolução dos sintomas, maiores nos pacientes chagĂĄsicos. Esses dados permitem especular sobre uma maior tolerĂąncia aos sintomas nos pacientes com idade mais avançada
CurrĂculo e RelaçÔes Ătnico-Raciais: o Estado da Arte
Este artigo apresenta a sistematização e a anĂĄlise dos 38 artigos, 13 teses e 50 dissertaçÔes da Categoria CurrĂculo. Inicialmente, demonstraremos os resultados do exame das teses e das dissertaçÔes. Em seguida, refletiremos acerca dos artigos. Para a leitura e anĂĄlise dos artigos e da produção discente, utilizamos como subsĂdio os referenciais da anĂĄlise de conteĂșdo, por meio da anĂĄlise categorial (BARDIN, 2008). Ao final, apresentaremos os caminhos abertos para pesquisas futuras e as recomendaçÔes da produção investigada para a implementação da Lei nÂș 10.639/2003
Pervasive gaps in Amazonian ecological research
Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4
While the increasing availability of global databases on ecological communities has advanced our knowledge
of biodiversity sensitivity to environmental changes,5â7 vast areas of the tropics remain understudied.8â11 In
the American tropics, Amazonia stands out as the worldâs most diverse rainforest and the primary source of
Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13â15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazonâs biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus
crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced
environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian
Amazonia, while identifying the regionâs vulnerability to environmental change. 15%â18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by
2050. This means that unless we take immediate action, we will not be able to establish their current status,
much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio
Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes
BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events
Peso de nascimento como preditor para a gravidade da lesĂŁo da substĂąncia branca cerebral neonatal
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20 [1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030
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