87 research outputs found

    Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

    Get PDF
    This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidĂȘncias cientĂ­ficas que as suportam, quanto ao diagnĂłstico e tratamento da CDC, com especial ĂȘnfase na base de racionalidade que a embasou. A DC no sĂ©culo XXI mantĂ©m padrĂŁo epidemiolĂłgico de endemicidade em 21 paĂ­ses da AmĂ©rica Latina. Investigadores e gestores de paĂ­ses endĂȘmicos e nĂŁo endĂȘmicos indigitam a necessidade de se adotarem polĂ­ticas abrangentes, de saĂșde pĂșblica, para controle eficaz da transmissĂŁo inter-humanos da infecção pelo T. cruzi, e obter-se nĂ­vel otimizado de atendimento aos indivĂ­duos jĂĄ infectados, com foco em oportunização diagnĂłstica e terapĂȘutica. Mecanismos patogĂȘnicos e fisiopatolĂłgicos da CDC foram revisitados apĂłs atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistĂȘncia parasitĂĄria tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distĂșrbios autonĂŽmicos e microvasculares. Alguns deles recentemente constituĂ­ram alvos potenciais de terapĂȘuticas. A histĂłria natural das fases aguda e crĂŽnica foi revista, com realce para a transmissĂŁo oral, a forma indeterminada e as sĂ­ndromes crĂŽnicas. MetanĂĄlises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade apĂłs instalação da cardiomiopatia crĂŽnica. Condutas terapĂȘuticas aplicĂĄveis aos indivĂ­duos com a FIDC foram abordadas especificamente. Todos os mĂ©todos para detectar alteraçÔes estruturais e/ou funcionais com variadas tĂ©cnicas de imageamento cardĂ­aco tambĂ©m foram revisados, com recomendaçÔes de uso nos vĂĄrios cenĂĄrios clĂ­nicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por mĂ©todos que detectam fibrose miocĂĄrdica. A metodologia atual para diagnĂłstico etiolĂłgico e as consequentes implicaçÔes do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. TambĂ©m o tratamento de pacientes em risco ou com insuficiĂȘncia cardĂ­aca, arritmias e eventos tromboembĂłlicos, baseado em recursos farmacolĂłgicos e complementares, recebeu especial atenção. CapĂ­tulos suplementares subsidiaram as condutas aplicĂĄveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grĂĄvidas, na reativação da infecção apĂłs transplante cardĂ­acos, e outros.    Por fim, dois capĂ­tulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivĂ­duos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicaçÔes mĂ©dico-trabalhistas completaram esta diretriz.&nbsp

    stairs and fire

    Get PDF

    Busca de oportunidades: o caminho da competitividade The search of opportunities: the way to competitiveness

    No full text
    O aumento da dinĂąmica da competição a nĂ­vel mundial tem levado as empresas a se preocuparem mais com a busca de novas oportunidades. Essa tendĂȘncia deve crescer em importĂąncia, na medida em que os mercados internacionais tornem-se mais dependentes e as fronteiras ao livre comĂ©rcio diminuam. Este artigo discute alguns modelos e aspectos normativos da busca de oportunidade. Parte-se do pressuposto que o processo de busca de oportunidade pode e deve ser organizado de forma sistemĂĄtica.The growth of dinamic world competition has taken the organizations to have more interest in the search of new opportunities. This tendency must grow as international markets become more dependent and the boundaries of these free trades decrease gradually. This paper discusses some models and normative aspects in search of opportunities. This process could and must be organized in a sistematic way

    IMPACTOS DA INTELIGÊNCIA ARTIFICIAL NA EDUCAÇÃO SUPERIOR: UMA REVISÃO DA LITERATURA

    No full text
    Esse artigo investiga os principais impactos da IA na educação superior, abordando suas contribuiçÔes potenciais para a personalização do ensino, aprendizagem adaptativa, automatização de tarefas administrativas, tutoria e suporte ao estudante, pesquisa e anĂĄlise de dados, alĂ©m da geração automĂĄtica de feedback. O objetivo deste trabalho Ă© apresentar essas potencialidades, coletando e analisando sistematicamente os estudos disponĂ­veis na literatura com vistas a: (I) obter um entendimento abrangente sobre as interligaçÔes entre a IA e a educação superior; (II) fornecer uma visĂŁo geral do estado atual da pesquisa sobre este tĂłpico; e (III) identificar lacunas importantes nas abordagens existentes, bem como tendĂȘncia de pesquisa promissora. Para alcançar esses objetivos, a revisĂŁo sistemĂĄtica da literatura foi realizada cobrindo artigos publicados em periĂłdicos de trĂȘs bases de dados relevantes: Web of Science, Scielo.com e Scopus. Foram inicialmente selecionados 268 estudos primĂĄrios, os quais passaram por processo de seleção e revisĂŁo de pares, resultando 55 artigos finais, cujos modelos e soluçÔes de uso da IA na educação superior foram classificados e sumarizados. Os resultados da pesquisa apontam para a crescente utilização e impactos da IA na educação superior, estruturados a partir dos clusters de artificial intelligence in education, artificial intelligence, higher education e learning outcome, sendo os principais que apresentaram a maior concentração de artigos e os demais descritos no trabalho

    APAGANDO A NOTA QUE DIZ ESCRAVA: EFIGÊNIA DA SILVA, O BATISMO, O COMPADRIO, OS NOMES, AS CABEÇAS, AS CRIAS, O TRÁFICO, A ESCRAVIDÃO E A LIBERDADE (LUANDA, C. 1770-C. 1811)

    No full text

    Swine and Poultry Pathogens: the Complete Genome Sequences of Two Strains of Mycoplasma hyopneumoniae and a Strain of Mycoplasma synoviae

    Get PDF
    This work reports the results of analyses of three complete mycoplasma genomes, a pathogenic (7448) and a nonpathogenic (J) strain of the swine pathogen Mycoplasma hyopneumoniae and a strain of the avian pathogen Mycoplasma synoviae; the genome sizes of the three strains were 920,079 bp, 897,405 bp, and 799,476 bp, respectively. These genomes were compared with other sequenced mycoplasma genomes reported in the literature to examine several aspects of mycoplasma evolution. Strain-specific regions, including integrative and conjugal elements, and genome rearrangements and alterations in adhesin sequences were observed in the M. hyopneumoniae strains, and all of these were potentially related to pathogenicity. Genomic comparisons revealed that reduction in genome size implied loss of redundant metabolic pathways, with maintenance of alternative routes in different species. Horizontal gene transfer was consistently observed between M. synoviae and Mycoplasma gallisepticum. Our analyses indicated a likely transfer event of hemagglutinin-coding DNA sequences from M. gallisepticum to M. synoviae

    Search for narrow resonances using the dijet mass spectrum in pp collisions at s√=8  TeV

    Get PDF
    Results are presented of a search for the production of new particles decaying to pairs of partons (quarks, antiquarks, or gluons), in the dijet mass spectrum in proton-proton collisions at s√=8  TeV. The data sample corresponds to an integrated luminosity of 4.0  fb−1, collected with the CMS detector at the LHC in 2012. No significant evidence for narrow resonance production is observed. Upper limits are set at the 95% confidence level on the production cross section of hypothetical new particles decaying to quark-quark, quark-gluon, or gluon-gluon final states. These limits are then translated into lower limits on the masses of new resonances in specific scenarios of physics beyond the standard model. The limits reach up to 4.8 TeV, depending on the model, and extend previous exclusions from similar searches performed at lower collision energies. For the first time mass limits are set for the Randall–Sundrum graviton model in the dijet channel

    NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

    No full text
    Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data
    • 

    corecore