Avaliação ambiental de manguezais adjacentes aos campos petrolíferos de Macau e Serra (RN), como subsídio às medidas mitigadoras ao processo erosivo

Among the various effects caused by the climate change and human intervention, the mangrove ecosystem changes through of the years has been worth mentioning, which hasn t known which are the pros and cons for the adjacent coastal and estuarine environments yet. It happens due to the present dynamism in these areas, besides of the difficult understanding of the processes associated with evolution. This study aimed to environmentally evaluate adjacent mangroves from the Macau and Serra oil fields, located on Rio Grande do Norte northern coast, to support the mitigating actions related to the containment of the erosive process, as well as, according to the principles of the Clean Development Mechanism (CDM), to assess the amount of atmospheric carbon sequestered by the studied ecosystem. An inventory was conducted through mangrouve mapping which has supplied this research, especially regarding to the structural characterization of mangrove areas. To understand the local mangrove behavior in a greater level detail, techniques of remote sensing, GIS and GPS were used to make an analogy between the current and past states of the mangrove studied, allowing to make anticipated projections for the future impacts or changes in that region. This study combined data from multispectral LANDSAT 5 TM, Landsat 7 ETM+ with radar microwave data from SAR RADARSAT-1, which increased the interpretation capacity of the data from optical sensor systems. The interpretations have been supported by the data field, representing a better and innovative methodology for the environmental and taxonomic characterization of mangrove forests considered. The results reveal that mangroves of the Ponta do Tubarão Sustainable Development Reserve are biologically representative areas and providing a variety of benefits, especially for local communities, constituting the priority sites for actions development aimed at conservation. They also have been showing the necessity to make mitigating measures in order to recover degraded areas through reforestation or creating new areas of mangrove, as currently 7.1% of the mangrove forests studied are dead or in an advanced state of decomposition. The amount of atmospheric carbon sequestered proved very significant when analyzed for the whole area, which is able to sequester atmospheric 4,294,458 Ton CO2 per yearDentre os diversos efeitos provocados pelas mudanças climáticas e pela intervenção humana, as alterações no ecossistema manguezal vêm merecendo destaque, cujas implicações para os ambientes estuarinos e costeiros adjacentes ainda estão distantes de serem conhecidas. Isto ocorre devido ao dinamismo presente nessas áreas, assim como a difícil compreensão dos processos associados à evolução das mesmas. O presente estudo teve como principal objetivo avaliar ambientalmente manguezais adjacentes aos campos petrolíferos de Macau e Serra, localizados no litoral setentrional do Rio Grande do Norte, como subsídio às medidas mitigadoras ao processo erosivo, além de, dentro dos princípios do chamado Mecanismo de Desenvolvimento Limpo (MDL), avaliar a quantidade de carbono atmosférico sequestrado para o ecossistema estudado. Através de mapeamento do manguezal, foi realizado um inventário, o que forneceu subsídios para o delineamento desta pesquisa, principalmente, no que diz respeito à caracterização estrutural da área de manguezal. Para entender o comportamento do manguezal em questão em um nível maior de detalhe, buscaram-se explicações em unidades espaciais maiores. Técnicas de Sensoriamento Remoto, SIG e GPS forneceram informações de comparação entre os estados atual e passado do manguezal, possibilitando projeções antecipadas para os futuros impactos ou alterações desta região. Este trabalho combinou dados multiespectrais do LANDSAT 5 TM, LANDSAT 7 ETM+ com dados de microondas de radar do tipo SAR do RADARSAT-1, ampliando a capacidade de interpretação dos dados de sistemas de sensores óticos. As interpretações foram apoiadas com dados de campo, objetivando uma melhor e inovadora metodologia para a caracterização ambiental e taxonômica das florestas de mangue em questão. Os resultados encontrados revelam que os manguezais da Reserva de Desenvolvimento Sustentável Estadual Ponta do Tubarão são áreas representativas biologicamente e que fornecem uma variedade de benefícios, principalmente para as comunidades locais, constituindo-se de sítios prioritários para o desenvolvimento de ações com vistas a sua conservação. Revelam também a necessidade de se tomar medidas mitigadoras no sentido de recuperar as áreas degradadas ou através do reflorestamento se criar novas áreas de manguezal, pois atualmente 7,1% das florestas de mangue estudadas encontram-se mortas ou em estado de decomposição bem avançado. A quantidade de carbono atmosférico sequestrado se mostrou bem significativa quando analisado para toda a área em questão, sendo esta, capaz de sequestrar 4.294.458 Ton CO2 atmosférico/an

Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis

Objective: To evaluate the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis. Design: Systematic review and meta-analysis of randomised trials. Data sources Searches were conducted of Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to 11 September 2021. Unpublished trials were identified from the grey literature and trial registries. Eligibility criteria for study selection: Randomised trials comparing viscosupplementation with placebo or no intervention for knee osteoarthritis treatment. Main outcome measures: The prespecified primary outcome was pain intensity. Secondary outcomes were function and serious adverse events. Pain and function were analysed as standardised mean differences (SMDs). The prespecified minimal clinically important between group difference was −0.37 SMD. Serious adverse events were analysed as relative risks. Methods: Two reviewers independently extracted relevant data and assessed the risk of bias of trials using the Cochrane risk of bias tool. The predefined main analysis was based only on large, placebo controlled trials with ≥100 participants per group. Summary results were obtained through a random effects meta-analysis model. Cumulative meta-analysis and trial sequential analysis under a random effects model were also performed. Results: 169 trials provided data on 21 163 randomised participants. Evidence of small study effects and publication biases was observed for pain and function (Egger’s tests with P<0.001 and asymmetric funnel plots). Twenty four large, placebo controlled trials (8997 randomised participants) included in the main analysis of pain indicated that viscosupplementation was associated with a small reduction in pain intensity compared with placebo (SMD −0.08, 95% confidence interval −0.15 to −0.02), with the lower bound of the 95% confidence interval excluding the minimal clinically important between group difference. This effect corresponds to a difference in pain scores of −2.0 mm (95% confidence interval −3.8 to −0.5 mm) on a 100 mm visual analogue scale. Trial sequential analysis for pain indicated that since 2009 there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Similar conclusions were obtained for function. Based on 15 large, placebo controlled trials on 6462 randomised participants, viscosupplementation was associated with a statistically significant higher risk of serious adverse events than placebo (relative risk 1.49, 95% confidence interval 1.12 to 1.98). Conclusion: Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference. Strong conclusive evidence indicates that viscosupplementation is also associated with an increased risk of serious adverse events compared with placebo. The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis

DESEMPENHO ECONÔMICO-FINANCEIRO DA PETROBRAS DE 2000 A 2014

RESUMOEste artigo tem como propósito compreender a trajetória de desempenho econômico-financeiro da Petrobras no período de 2000 a 2014. Como base metodológica adotou-se uma abordagem qualitativa e quantitativa, onde as junções dos principais indicadores e de um modelo complementaram a análise econômico-financeira da Petrobras, possibilitando uma classificação de pesquisa do tipo descritiva. Constatou-se que seu portfólio de ativos atribuiu baixa rentabilidade por conta do alto endividamento, sobretudo após o Pré-Sal. Concluiu-se que a Petrobras não representa, no atual momento, uma performance segura a um perfil conservador de investimentos de longo prazo diante de opções na aquisição de ações, cabendo um estudo futuro sobre como caracterizam-se os perfis atuais dos agentes acionistas da Petrobras.Palavras-chave: Petrobras. Análise das Demonstrações. Desempenho econômico-financeiro. ABSTRACTThis paper aims to understand the trajectory of economic and financial performance of Petrobras from 2000 to 2014. As methodological basis was adopted a qualitative and quantitative approach, where the joints of the main indicators and a model complemented the economic and financial analysis of Petrobras, allowing a search ranking of the descriptive type. It was found that its portfolio of assets assigned low profitability due to high debt, especially after the Pré-Sal. It’s concluded that Petrobras is not at present a safe performance to a conservative profile of long-term investments on options management buyout. Fitting, in turn, a future study on how to characterize the current profile of the shareholders of Petrobras agents.Keywords: Petrobras. Analysis of Financial Statements. Economic and financial performance

Unilateral Renal Agenesis in Chilean-Flamingo (Phoenicopterus chilensis)

Background: Phoenicopterus chilensis is a South American wild bird classified a species near threatened in the National List of Endangered Species of the International Union for Conservation of Nature. With the increase of the contact between human population and wild animals, this species’ habitat is becoming increasingly vulnerable, with a declining population. Due to the importance of its conservation, the knowledge of abnormalities that affect this species becomes essential. This report aims to describe the first diagnosed case of unilateral renal agenesis in chilean-flamingo.Case: A captive male chilean-flamingo (Phoenicopterus chilensis) was found dead in its enclosure and then was referred at necropsy. The cause of death was the presence of tracheal fungal granuloma, caused by Aspergillus sp. Macroscopically, during the examination of the cellomatic cavity, the absence of the right kidney was noted, also evidencing the absence of the caudal renal vein. Emerging from the caudal division of the kidney was noted a blind-end renal vessel (Figure 1). For the histopathological examination, the remaining kidney was fixed in 10% formalin, processed by paraffin embedding technique and stained with Hematoxylin and Eosin (HE). When analyzing the left kidney parenchyma, preserved histological architecture was noted, without any changes in the tissue structures of the organ. Thus, no hypertrophy by compensatory mechanisms of the remaining kidney was observed (Figure 2).Discussion: Unilateral renal agenesis is a very rare congenital defect in dogs, cats and also in birds. It occurs in the complete absence of one of the kidneys, a situation with which the animal can live satisfactorily if there is a normal kidney to assume the functions. In association, ipsilateral ureteral agenesis and compensatory hypertrophy of the remaining kidney may occur. At the time of necropsy, due to the remaining kidney has normal size and within topographic limits, dorsally in contact with the pelvis and sinsacrum, the absence of compensatory hypertrophy was suspected, which was confirmed by histopathological examination. Clinical signs of unilateral renal agenesis, when present, are related to renal failure. The signs develop when the remaining kidney fails to fully absorb the other's functions and fails to maintain the organism's homeostasis. In the case of this report, the specimen showed no clinical signs related to renal agenesis, probably because was no functional compensation for the single kidney. This condition was only noticed after flamingo necropsy, who death because tracheal fungal granuloma, caused by Aspergillus sp. Other reported ways of diagnosing this malformation in animals while alive were imaging and abdominal cavity surgery. The etiopathogenesis of unilateral renal agenesis in animals is uncertain, however, the hereditary cause is commonly described in rats and small animals. It cannot be concluded that the same happened with the animal of this study due to the fact of lack of data regarding the parents and history of animal. It is concluded that in unilateral renal agenesis, the compensatory hypertrophy of the remaining kidney and any clinical symptoms may not be present. Necroscopic and complementary exams are essential to obtain the diagnosis of unilateral renal agenesis. Knowing that the chilean-flamingo is considered as a species near threatened of extinction, it is important to know the abnormalities that affect this species, because this information may be essential for conservation programs

Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis.

OBJECTIVE To assess the effectiveness and safety of different preparations and doses of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and paracetamol for knee and hip osteoarthritis pain and physical function to enable effective and safe use of these drugs at their lowest possible dose. DESIGN Systematic review and network meta-analysis of randomised trials. DATA SOURCES Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, regulatory agency websites, and ClinicalTrials.gov from inception to 28 June 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised trials published in English with ≥100 patients per group that evaluated NSAIDs, opioids, or paracetamol (acetaminophen) to treat osteoarthritis. OUTCOMES AND MEASURES The prespecified primary outcome was pain. Physical function and safety outcomes were also assessed. REVIEW METHODS Two reviewers independently extracted outcomes data and evaluated the risk of bias of included trials. Bayesian random effects models were used for network meta-analysis of all analyses. Effect estimates are comparisons between active treatments and oral placebo. RESULTS 192 trials comprising 102 829 participants examined 90 different active preparations or doses (68 for NSAIDs, 19 for opioids, and three for paracetamol). Five oral preparations (diclofenac 150 mg/day, etoricoxib 60 and 90 mg/day, and rofecoxib 25 and 50 mg/day) had ≥99% probability of more pronounced treatment effects than the minimal clinically relevant reduction in pain. Topical diclofenac (70-81 and 140-160 mg/day) had ≥92.3% probability, and all opioids had ≤53% probability of more pronounced treatment effects than the minimal clinically relevant reduction in pain. 18.5%, 0%, and 83.3% of the oral NSAIDs, topical NSAIDs, and opioids, respectively, had an increased risk of dropouts due to adverse events. 29.8%, 0%, and 89.5% of oral NSAIDs, topical NSAIDs, and opioids, respectively, had an increased risk of any adverse event. Oxymorphone 80 mg/day had the highest risk of dropouts due to adverse events (51%) and any adverse event (88%). CONCLUSIONS Etoricoxib 60 mg/day and diclofenac 150 mg/day seem to be the most effective oral NSAIDs for pain and function in patients with osteoarthritis. However, these treatments are probably not appropriate for patients with comorbidities or for long term use because of the slight increase in the risk of adverse events. Additionally, an increased risk of dropping out due to adverse events was found for diclofenac 150 mg/day. Topical diclofenac 70-81 mg/day seems to be effective and generally safer because of reduced systemic exposure and lower dose, and should be considered as first line pharmacological treatment for knee osteoarthritis. The clinical benefit of opioid treatment, regardless of preparation or dose, does not outweigh the harm it might cause in patients with osteoarthritis. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42020213656

Dupla tarefa na doença de Parkinson: uma revisão de literatura / Dual tasks in Parkinson’s disease: a literature review

A Doença de Parkinson (DP) consiste em um transtorno neurodegenerativo crônico, causado pela degeneração de neurônios que sintetizam o neurotransmissor dopamina na região do cérebro denominada de núcleos da base, na área mais conhecida como substância negra, resultando na redução da quantidade de dopamina na região do corpo estriado, outra área cerebral.  O objetivo do presente trabalho consistiu em observar, através de uma revisão de literatura, os efeitos e os benefícios da dupla tarefa na doença de Parkinson. O formato escolhido foi o bases de dados SciELO (Scientific Electronic Library Online), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e PEDro (Bade de Dados em Evidências em Fisioterapia)., de uma revisão da literatura, com artigos dos últimos cinco anos provenientes das nos idiomas português, espanhol e inglês com ênfase nos seguintes descritores: Dupla Tarefa; Parkinson; Reabilitação; Fisioterapia. Os resultados destacaram melhorias em torno dos sintomas cognitivos e motores, favorecendo o equilíbrio, a marcha, desenvolvimento de habilidades de automatização, transferência de aprendizado, tempo de caminhada, diminuição do fenômeno de congelamento e atenuando significativamente o risco de quedas, de maneira que o paciente da DP tenha melhorias significativas acerca de sua qualidade de vida. Com o advento da fisioterapia no enfrentamento da Doença de Parkinson, as abordagens terapêuticas com ênfase na dupla tarefa contribuem de forma ímpar na reabilitação desses indivíduos

ESTRATÉGIAS UTILIZADAS NO CUIDADO A PESSOAS HIPERTENSAS NO DOMICILIO: REFLEXÕES ACERCA DO PAPEL DA EQUIPE MULTIPROFISSIONAL DE SAÚDE

Introduction: primary health care is the first contact of users with public health, and is responsible for offering promotional, preventive and curative actions to the population, with home care having grown as a result of geographic, epidemiological, social and cultural practices that have been spreading around the world, seeking a care proposal that promotes greater comfort and well-being for families, including the public with chronic diseases, such as Systemic Arterial Hypertension. Objective: to reflect on the strategies used by the multiprofessional health team in the care of hypertensive patients at home, and to transcend a reflection related to the prevalent difficulties for these patients. Method: this is a narrative review. The search took place in the following databases: Lilacs, Bdenf and the SciELO portal, with the inclusion criteria, articles published in full that addressed the theme, theses, dissertations, books and documents in Portuguese, English and Spanish. Duplicate studies, in languages ​​other than those selected and studies available for a fee, were excluded. Results and discussion: In this context, the commonly used strategies were educational actions through conversation circles using personalized badges and debates about thematic references, health promotion, disease prevention, didactic guidelines about healthy eating habits, and emphasizing the importance of health care. Conclusion: The strategies implemented by the FHS are fundamental, as they help in the treatment of SAH and provide an improvement in the quality of life of patients.Introducción: la atención primaria de salud es el primer contacto de los usuarios con la salud pública, y el encargado de ofrecer acciones promocionales, preventivas y curativas a la población, con la atención domiciliaria creciendo debido a los cambios geográficos, epidemiológicos, sociales y culturales que se han ido extendiendo por todo el escenario mundial, buscando una propuesta de atención que promueva una mayor comodidad y bienestar para las familias, incluyendo al público con enfermedades crónicas, como la Hipertensión Arterial Sistémica. Objetivo: reflexionar sobre las estrategias utilizadas por el equipo multidisciplinario de salud en la atención de pacientes hipertensos en el hogar, y trascender una reflexión relacionada con las dificultades prevalentes para estos pacientes. Método: se trata de una revisión narrativa. La búsqueda se realizó en las bases de datos: Lilacs, Bdenf y en el portal SciELO, con los criterios de inclusión, artículos publicados en el integra que abordaron el tema, tesis, disertaciones, libros y documentos en portugués, inglés y español. Los estudios duplicados se excluyeron en idiomas distintos de los seleccionados y los estudios disponibles de manera remunerada. Resultados y discusión: En este contexto, las estrategias comúnmente utilizadas fueron las acciones educativas a través de ruedas de conversación utilizando insignias personalizadas y debates sobre temas temáticos, promoción de la salud, prevención de enfermedades, orientación didáctica sobre hábitos alimenticios saludables y enfatizando la importancia del cuidado de la salud. Conclusión: Las estrategias implementadas por la ESF son fundamentales, ya que ayudan en el tratamiento de la HSA.Introdução: a tenção primária a saúde constitui-se como primeiro contato dos usuários com a saúde pública, e o responsável pela oferta de ações promocionais, preventivas e curativas a população, tendo o atendimento domiciliar crescido em decorrência das mudanças geográficas, epidemiológicas, sociais e culturais que vem se alastrando pelo cenário mundial, buscando uma proposta de cuidados que promova maior conforto e bem-estar as famílias, incluindo o público portador de doenças crônicas, como a Hipertensão Arterial Sistêmica. Objetivo: refletir acerca das estratégias utilizadas pela equipe multiprofissional de saúde no cuidado a hipertensos no âmbito domiciliar, e transcender uma reflexão relacionada as dificuldades prevalentes para esses pacientes. Método: trata-se de uma revisão narrativa. A busca ocorreu nas bases de dados: Lilacs, Bdenf e no portal da SciELO, com os critérios de inclusão, artigos publicados na integra que abordassem a temática, teses, dissertações, livros e documentos nos idiomas português, inglês e espanhol. Excluíram-se estudos duplicados, em idiomas diferentes dos selecionados e estudos disponíveis de forma paga. Resultados e discussão: Nesse contexto as estratégias comumente utilizadas foram as ações educativas através de rodas de conversas utilizando crachás personalizados e debates acerca dos referentes temáticos, promoção de saúde, prevenção de agravos, orientações de forma didática acerca de hábitos alimentares saudáveis, e enfatizando a importância do acolhimento em saúde. Conclusão: As estratégias implementadas pelas ESF são fundamentais, pois auxiliam no tratamento da HAS e proporciona uma melhora na qualidade de vida dos pacientes

ESTRATÉGIAS UTILIZADAS NO CUIDADO A PESSOAS HIPERTENSAS NO DOMICILIO: REFLEXÕES ACERCA DO PAPEL DA EQUIPE MULTIPROFISSIONAL DE SAÚDE

Introduction: primary health care is the first contact of users with public health, and is responsible for offering promotional, preventive and curative actions to the population, with home care having grown as a result of geographic, epidemiological, social and cultural practices that have been spreading around the world, seeking a care proposal that promotes greater comfort and well-being for families, including the public with chronic diseases, such as Systemic Arterial Hypertension. Objective: to reflect on the strategies used by the multiprofessional health team in the care of hypertensive patients at home, and to transcend a reflection related to the prevalent difficulties for these patients. Method: this is a narrative review. The search took place in the following databases: Lilacs, Bdenf and the SciELO portal, with the inclusion criteria, articles published in full that addressed the theme, theses, dissertations, books and documents in Portuguese, English and Spanish. Duplicate studies, in languages ​​other than those selected and studies available for a fee, were excluded. Results and discussion: In this context, the commonly used strategies were educational actions through conversation circles using personalized badges and debates about thematic references, health promotion, disease prevention, didactic guidelines about healthy eating habits, and emphasizing the importance of health care. Conclusion: The strategies implemented by the FHS are fundamental, as they help in the treatment of SAH and provide an improvement in the quality of life of patients.Introducción: la atención primaria de salud es el primer contacto de los usuarios con la salud pública, y el encargado de ofrecer acciones promocionales, preventivas y curativas a la población, con la atención domiciliaria creciendo debido a los cambios geográficos, epidemiológicos, sociales y culturales que se han ido extendiendo por todo el escenario mundial, buscando una propuesta de atención que promueva una mayor comodidad y bienestar para las familias, incluyendo al público con enfermedades crónicas, como la Hipertensión Arterial Sistémica. Objetivo: reflexionar sobre las estrategias utilizadas por el equipo multidisciplinario de salud en la atención de pacientes hipertensos en el hogar, y trascender una reflexión relacionada con las dificultades prevalentes para estos pacientes. Método: se trata de una revisión narrativa. La búsqueda se realizó en las bases de datos: Lilacs, Bdenf y en el portal SciELO, con los criterios de inclusión, artículos publicados en el integra que abordaron el tema, tesis, disertaciones, libros y documentos en portugués, inglés y español. Los estudios duplicados se excluyeron en idiomas distintos de los seleccionados y los estudios disponibles de manera remunerada. Resultados y discusión: En este contexto, las estrategias comúnmente utilizadas fueron las acciones educativas a través de ruedas de conversación utilizando insignias personalizadas y debates sobre temas temáticos, promoción de la salud, prevención de enfermedades, orientación didáctica sobre hábitos alimenticios saludables y enfatizando la importancia del cuidado de la salud. Conclusión: Las estrategias implementadas por la ESF son fundamentales, ya que ayudan en el tratamiento de la HSA.Introdução: a tenção primária a saúde constitui-se como primeiro contato dos usuários com a saúde pública, e o responsável pela oferta de ações promocionais, preventivas e curativas a população, tendo o atendimento domiciliar crescido em decorrência das mudanças geográficas, epidemiológicas, sociais e culturais que vem se alastrando pelo cenário mundial, buscando uma proposta de cuidados que promova maior conforto e bem-estar as famílias, incluindo o público portador de doenças crônicas, como a Hipertensão Arterial Sistêmica. Objetivo: refletir acerca das estratégias utilizadas pela equipe multiprofissional de saúde no cuidado a hipertensos no âmbito domiciliar, e transcender uma reflexão relacionada as dificuldades prevalentes para esses pacientes. Método: trata-se de uma revisão narrativa. A busca ocorreu nas bases de dados: Lilacs, Bdenf e no portal da SciELO, com os critérios de inclusão, artigos publicados na integra que abordassem a temática, teses, dissertações, livros e documentos nos idiomas português, inglês e espanhol. Excluíram-se estudos duplicados, em idiomas diferentes dos selecionados e estudos disponíveis de forma paga. Resultados e discussão: Nesse contexto as estratégias comumente utilizadas foram as ações educativas através de rodas de conversas utilizando crachás personalizados e debates acerca dos referentes temáticos, promoção de saúde, prevenção de agravos, orientações de forma didática acerca de hábitos alimentares saudáveis, e enfatizando a importância do acolhimento em saúde. Conclusão: As estratégias implementadas pelas ESF são fundamentais, pois auxiliam no tratamento da HAS e proporciona uma melhora na qualidade de vida dos pacientes

Guidelines for the management of neuroendocrine tumours by the Brazilian gastrointestinal tumour group

Neuroendocrine tumours are a heterogeneous group of diseases with a significant variety of diagnostic tests and treatment modalities. Guidelines were developed by North American and European groups to recommend their best management. However, local particularities and relativisms found worldwide led us to create Brazilian guidelines. Our consensus considered the best feasible strategies in an environment involving more limited resources. We believe that our recommendations may be extended to other countries with similar economic standards.Univ Sao Paulo, Inst Canc Estado Sao Paulo, BR-01246000 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Dept Radiol & Oncol, BR-01246903 Sao Paulo, BrazilHosp Sirio Libanes, BR-01308050 Sao Paulo, BrazilHosp Moinhos de Vento Porto Alegre, BR-90035000 Porto Alegre, RS, BrazilOncoctr, BR-30360680 Belo Horizonte, MG, BrazilUniv Fed Rio Grande do Sul, Dept Cirurgia, BR-90040060 Porto Alegre, RS, BrazilHosp Clin Porto Alegre, BR-90035903 Porto Alegre, RS, BrazilUniv Fed Ceara, Fac Med, Dept Fisiol & Farmacol, BR-60020180 Fortaleza, Ceara, BrazilHosp Univ Walter Cantidio, BR-60430370 Fortaleza, Ceara, BrazilInst Nacl Canc, BR-20230240 Rio De Janeiro, BrazilUniv Sao Paulo, Fac Med, Disciplina Endocrinol & Metabol, BR-01246903 Sao Paulo, BrazilAC Camargo Canc Ctr, Dept Surg, BR-01509010 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Dept Gastroenterol, Sao Paulo, BrazilUniv Fed Ciencias Saude Porto Alegre, BR-90050170 Porto Alegre, RS, BrazilHosp Albert Einstein, BR-05652900 Sao Paulo, BrazilHosp Base, Fac Med Sao Jose do Rio Preto, BR-15090000 Sao Paulo, BrazilSanta Casa Sao Jose do Rio Preto, BR-15025500 Sao Jose Do Rio Preto, BrazilPontificia Univ Catolica Parana, Hosp Erasto Gaertner, BR-81520060 Curitiba, Parana, BrazilUniv Fed Rio Grande do Norte, BR-59300000 Natal, RN, BrazilUniv Sao Paulo, Inst Coracao, BR-05403900 Sao Paulo, BrazilAC Camargo Canc Ctr, Med Oncol, BR-01509010 Sao Paulo, BrazilUniv Fed Sao Paulo, Disciplina Gastroenterol, BR-04021001 Sao Paulo, BrazilHosp Sao Rafael, BR-41253190 Salvador, BA, BrazilHosp Canc Barretos, Dept Cirurgia Aparelho Digest Alto & Hepatobiliop, BR-14784400 Sao Paulo, BrazilUniv Sao Paulo, Fac Med, Dept Patol, BR-01246903 Sao Paulo, BrazilClin AMO, BR-1950640 Salvador, BA, BrazilHosp Sao Jose, BR-01323001 Sao Paulo, BrazilUniv Nove de Julho, BR-02111030 Sao Paulo, BrazilUniv Fed Sao Paulo, Disciplina Gastroenterol, BR-04021001 Sao Paulo, BrazilWeb of Scienc