Diagnóstico tardio da sarcoidose é comum no Brasil

OBJECTIVE:To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil.METHODS:We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment).RESULTS:We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively).CONCLUSIONS:The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.OBJETIVO:Avaliar a frequência do diagnóstico tardio de sarcoidose no Brasil e os fatores relacionados a esse atraso.MÉTODOS:Avaliamos pacientes com diagnóstico de sarcoidose confirmado por biópsia utilizando um questionário que abordava o tempo entre o início dos sintomas e a data da primeira consulta médica; e o número e especialidades dos médicos consultados. Sintomas sistêmicos e pulmonares, envolvimento extratorácico, dados espirométricos, estadiamento radiológico, escolaridade, renda individual e diagnóstico/tratamento de tuberculose foram comparados entre os pacientes com diagnóstico precoce (< 6 meses até o diagnóstico) e tardio (≥ 6 meses).RESULTADOS:Foram incluídos 100 pacientes. A mediana do número de médicos consultados foi 3 (variação: 1-14). O diagnóstico de sarcoidose foi feito na primeira consulta em 11 casos. Um clínico geral foi inicialmente consultado em 54 casos. O diagnóstico de sarcoidose foi precoce em 41 casos e tardio em 59. Não houve diferença entre os grupos no tocante ao gênero, raça, tipo de seguro saúde, escolaridade, renda, sintomas sistêmicos e respiratórios, envolvimento extratorácico e estadiamento radiológico. Os pacientes com diagnóstico tardio apresentavam menor CVF (80,3 ± 20,4% vs. 90,5 ± 17,1%; p = 0,010) e VEF1 (77,3 ± 19,9% vs. 86,4 ± 19,5%; p = 0,024), além de mais frequentemente receberem diagnóstico de tuberculose (24% vs. 7%; p = 0,032) e tratamento para tuberculose (≥ 3 meses; 20% vs. 0%; p = 0,002).CONCLUSÕES:O diagnóstico de sarcoidose é tardio em muitos casos, mesmo quando há achados de imagem sugestivos. O diagnóstico tardio está associado a menor função pulmonar na época do diagnóstico. Vários pacientes com sarcoidose recebem diagnóstico e tratamento de tuberculose.São Paulo Hospital for State Civil Servants Department of Respiratory DiseasesFederal University of São Paulo Department of PathologyFederal University of São PauloUNIFESP, Department of PathologyUNIFESPSciEL

A INTEGRAÇÃO DOS ESPORTES NA FORMAÇÃO INICIAL EM EDUCAÇÃO FÍSICA: UMA VIVÊNCIA COM O VÔLEIBOL AQUÁTICO (BIRIBOL)

A disciplina de vôlei ministrada pelo professor Wesley Lessa pinheiro, as sextas feiras das 18:30 as 21:30 ao quarto semestre, visando demostrar o voleibol no contexto histórico e evolutivo. Estudo da estrutura e funcionalidade do esporte voleibol como conteúdo programático da educação física escolar, com base no conhecimento e na experienciação de fundamentos técnico-táticos, da regulamentação oficial e de princípios didático-pedagógicos adequados para o processo ensino-aprendizagem

A INTEGRAÇÃO DOS ESPORTES NA FORMAÇÃO INICIAL EM EDUCAÇÃO FÍSICA: UMA VIVÊNCIA COM O BASQUETEBOL AQUÁTICO

O Basquetebol Aquático e uma modalidade coletiva, que pode ser utilizada em nível de lazer, terapia e treinamento. Uma prática esportiva que inclua elementos de outros esportes pode ser importante no processo de formação inicial para contribuir na formação de uma visão integrada do esporte na sociedade e no fazer pedagógico da Educação Física

Recomendações para oxigenoterapia domiciliar prolongada da Sociedade Brasileira de Pneumologia e Tisiologia (2022)

Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years later, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.Algumas doenças respiratórias crônicas podem evoluir com hipoxemia e, nessas situações, a oxigenoterapia domiciliar prolongada (ODP) está indicada como opção terapêutica com o objetivo principal de melhorar a qualidade e a expectativa de vida desses pacientes. O oxigênio domiciliar é usado há mais de 70 anos, e a ODP tem como base dois estudos da década de oitenta que demonstraram que o uso de oxigênio melhora a sobrevida de pacientes com DPOC. Existem evidências de que a ODP tem outros efeitos benéficos como melhora da função cognitiva e da capacidade de exercício e redução de hospitalizações. A ODP está indicada para outras doenças respiratórias que cursam com hipoxemia, segundo os mesmos critérios estabelecidos para a DPOC. Tem sido observado aumento no uso da ODP provavelmente pela maior expectativa de vida, maior prevalência de doenças respiratórias crônicas e maior disponibilidade de ODP no sistema de saúde. O primeiro consenso sobre ODP da Sociedade Brasileira de Pneumologia e Tisiologia foi publicado em 2000; após 22 anos, apresentamos esta versão atualizada. Este documento é uma revisão não sistemática da literatura, realizada por pneumologistas que avaliaram evidências científicas e diretrizes internacionais sobre ODP nas diversas doenças que cursam com hipoxemia e em situações específicas (exercício, sono e viagens aéreas). Estas recomendações, tendo em vista a prática clínica, oferecem diversos quadros com informações sobre indicações, fontes de oxigênio, acessórios e estratégias para melhor eficiência, efetividade e uso seguro da ODP, assim como um modelo para sua prescrição

Assessment of leaf anatomic and physiological characteristics and genetic divergence among Coffea arabica L. cultivars in the Brazilian Savanna

The knowledge on cultivars is essential for parental choosing on breeding programs. This research aimed to study the genetic divergence of Coffea arabica L. cultivars from a germoplasm bank of the Embrapa Cerrados, Brazil, for leaf anatomic and physiological characteristics. A total of 23 cultivars were evaluated: Acaiá Cerrado MG1474, Araponga MG1, Catiguá MG1, Catiguá MG2, Catiguá MG3, Catiguá MG3 P4, Catiguá MG3 P5, Catiguá MG3 P7, Catiguá MG3 P9, Catiguá MG3 P23, Catiguá MG3 P51, Catuaí Amarelo IAC 62, Catuaí Vermelho IAC 15, Catuaí Vermelho IAC 81, Catuaí Vermelho IAC 99, Caturra Vermelho MG0187, Guatenano Colis MG0207, Mundo Novo IAC 379-19, Paraíso MG1, Pau Brasil MG1, Sacramento MG1, San Ramon MG0198 and Topázio MG1190. In addition to the genetic divergence, the broad sense heritability and coefficient of genetic and environmental variation were also evaluated. All characteristics showed high coefficients of genetic variation and heritability values greater than 70 %, indicating a predominance of genetic over environmental factors, and that these are characteristics likely to obtain genetic gain. Catiguá MG1, Catiguá MG3 P51 and Topázio MG1190 stood out, with superior gas exchange characteristics. Attributes related to gas exchange were important for cultivar differentiation, demonstrating that they can be used in the early selection of Coffea arabica L. genotypes

Observation of the decay Λ _b ⁰ → ψ(2S)pπ⁻

International audienceThe Cabibbo-suppressed decay Λ$_{b}^{0}$  → ψ(2S)pπ$^{−}$ is observed for the first time using a data sample collected by the LHCb experiment in proton-proton collisions corresponding to 1.0, 2.0 and 1.9 fb$^{−1}$ of integrated luminosity at centre-of-mass energies of 7, 8 and 13 TeV, respectively. The ψ(2S) mesons are reconstructed in the μ$^{+}$μ$^{−}$ final state. The branching fraction with respect to that of the Λ$_{b}^{0}$  → ψ(2S)pK$^{−}$ decay mode is measured to b

Search for beautiful tetraquarks in the <i>ϒ</i>(1<i>S</i>)μ⁺μ⁻ invariant-mass spectrum

International audienceThe ϒ(1S)μ$^{+}$μ$^{−}$ invariant-mass distribution is investigated for a possible exotic meson state composed of two b quarks and two $\overline{b}$ quarks, ${X}_{b\overline{b}b\overline{b}}$ . The analysis is based on a data sample of pp collisions recorded with the LHCb detector at centre-of-mass energies $\sqrt{s}=7$ , 8 and 13 TeV, corresponding to an integrated luminosity of 6.3 fb$^{−1}$. No significant excess is found, and upper limits are set on the product of the production cross-section and the branching fraction as functions of the mass of the ${X}_{b\overline{b}b\overline{b}}$ state. The limits are set in the fiducial volume where all muons have pseudorapidity in the range [2.0, 5.0], and the ${X}_{b\overline{b}b\overline{b}}$ state has rapidity in the range [2.0, 4.5] and transverse momentum less than 15 GeV/c

Measurement of angular and CP asymmetries in D0→π+π-μ+μ- and D0→K+K-μ+μ- decays

The first measurements of the forward-backward asymmetry of the dimuon pair (A_{FB}), the triple-product asymmetry (A_{2ϕ}), and the charge-parity-conjugation asymmetry (A_{CP}), in D0→π+π-μ+μ- and D0→K+K-μ+μ- decays are reported. They are performed using data from proton-proton collisions collected with the LHCb experiment from 2011 to 2016, corresponding to a total integrated luminosity of 5  fb^{-1}. The asymmetries are measured to be A_{FB}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(3.3±3.7±0.6)%, A_{2ϕ}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(-0.6±3.7±0.6)%, A_{CP}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(4.9±3.8±0.7)%, A_{FB}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, A_{2ϕ}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(9±11±1)%, A_{CP}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, where the first uncertainty is statistical and the second systematic. The asymmetries are also measured as a function of the dimuon invariant mass. The results are consistent with the standard model predictions

Evidence for an nc(1S)ff- resonance in B0 yc(1S)K+ decays

A Dalitz plot analysis of B0→ηc(1S)K+π- decays is performed using data samples of pp collisions collected with the LHCb detector at centre-of-mass energies of s=7,8 and 13TeV , corresponding to a total integrated luminosity of 4.7fb-1 . A satisfactory description of the data is obtained when including a contribution representing an exotic ηc(1S)π- resonant state. The significance of this exotic resonance is more than three standard deviations, while its mass and width are 4096±20-22+18MeV and 152±58-35+60MeV , respectively. The spin-parity assignments JP=0+ and JP=1- are both consistent with the data. In addition, the first measurement of the B0→ηc(1S)K+π- branching fraction is performed and gives B(B0→ηc(1S)K+π-)=(5.73±0.24±0.13±0.66)×10-4, where the first uncertainty is statistical, the second systematic, and the third is due to limited knowledge of external branching fractions

Measurement of the CKM angle γ using<i> B</i>^± → <i>DK</i>^± with D → K _S ⁰ π⁺π⁻, K _S ⁰ K⁺K⁻ decays

A binned Dalitz plot analysis of $B^\pm \to D K^\pm$ decays, with $D\to K_\text{S}^0\pi^+\pi^-$ and $D\to K_\text{S}^0K^+K^-$, is used to perform a measurement of the CP-violating observables $x_{\pm}$ and $y_{\pm}$, which are sensitive to the Cabibbo-Kobayashi-Maskawa angle $\gamma$. The analysis is performed without assuming any $D$ decay model, through the use of information on the strong-phase variation over the Dalitz plot from the CLEO collaboration. Using a sample of proton-proton collision data collected with the LHCb experiment in 2015 and 2016, and corresponding to an integrated luminosity of 2.0$\,\text{fb}^{-1}$, the values of the CP violation parameters are found to be $x_- = ( 9.0 \pm 1.7 \pm 0.7 \pm 0.4) \times 10^{-2}$, $y_- = ( 2.1 \pm 2.2 \pm 0.5 \pm 1.1) \times 10^{-2}$, $x_+ = (- 7.7 \pm 1.9 \pm 0.7 \pm 0.4) \times 10^{-2}$, and $y_+ = (- 1.0 \pm 1.9 \pm 0.4 \pm 0.9) \times 10^{-2}$. The first uncertainty is statistical, the second is systematic, and the third is due to the uncertainty on the strong-phase measurements. These values are used to obtain \gamma = \left(87\,^{+11}_{-12}\right)^\circ, $r_B = 0.086^{+ 0.013}_{-0.014}$, and $\delta_B = (101 \pm 11)^\circ$, where $r_B$ is the ratio between the suppressed and favoured $B$-decay amplitudes and $\delta_B$ is the corresponding strong-interaction phase difference. This measurement is combined with the result obtained using 2011 and 2012 data collected with the \lhcb experiment, to give \gamma = \left(80\,^{+10}_{\,-9}\right)^\circ, $r_B = 0.080 \pm 0.011$, and $\delta_B = (110 \pm 10)^\circ$.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://lhcbproject.web.cern.ch/lhcbproject/Publications/LHCbProjectPublic/LHCb-PAPER-2018-017.html. Version 2 includes minor changes made during journal revie