Evasão no curso de Licenciatura em Matemática do IFRS Campus Caxias do Sul

Este artigo apresenta o resultado de uma pesquisa que teve como objetivo analisar o perfil socioeconômico dos alunos evadidos do curso de Licenciatura em Matemática do Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul – Campus Caxias do Sul. Para a obtenção de resultados acerca da evasão, foi realizada uma pesquisa com os dados socioeconômicos de todos os alunos e dos evadidos, para assim ter-se conhecimento dos indicadores das taxas de evasão do curso. Os seguintes fatores foram analisados: idade, naturalidade, motivo de ingresso, reserva de vagas, se o aluno é trabalhador, tipo de trabalho, escolaridade e modalidade de ensino. Os resultados apontam que a idade, o exercício de atividade remunerada, o ingresso por acesso universal e a proveniência de escolas públicas são as principais características dos alunos evadidos

COST-EFFECTIVENESS ANALYSIS OF TRASTUZUMAB EMTANSINE IN THE TREATMENT OF METASTATIC BREAST CANCER

Objective: To investigate the cost-effectiveness of second-line pharmacological treatments for metastatic breast cancer (MBC) by comparing trastuzumab emtansine (T-DM1) versus a combination of lapatinib and capecitabine (LAP+CAP) from the perspective of the Brazilian health system, the Unified Health System (Sistema Único de Saúde–SUS).Methods: The results of each treatment were simulated based on a three-state Markov decision model applied to a hypothetical cohort of 1,000 women, aged 50 y old or older, with MBC and HER2 (human epidermal growth factor receptor 2) overexpression. The data on the effectiveness of treatments were taken from reports in the literature. The period considered for simulation was three years subdivided into monthly cycles of transition between health states. A discount rate of 5% per year was applied to costs and outcomes. Possible uncertainty was assessed by means of a sensitivity analysis.Results: Chemotherapy for women with refractory MBC using T-DM1 monotherapy was ruled out by extended dominance. Treatment with LAP+CAP proved to be the most efficient strategy because the cost in relation to the overall survival (BRL 72,035.43/quality-adjusted life year–QALY) was the lowest and fell within the acceptability threshold, BRL 86,628.00.Conclusion: T-DM1 demonstrated pharmacological superiority over other agents used for the treatment of MBC in clinical studies. However, the price set for T-DM1 in Brazil is the determinant variable that contraindicates its inclusion in the SUS, in agreement with other international assessments

Evaluation of bedtime vs. morning levothyroxine intake to control hypothyroidism in older patients : a pragmatic crossover randomized clinical trial

Introduction: Drug scheduling in older adults can be a challenge, especially considering polypharmacy, physical dependency, and possible drug interactions. Properly testing alternative treatment regimens could therefore help to overcome treatment barriers. Hypothyroidism is a prevalent condition in older adults, however, studies evaluating Lthyroxine treatment effectiveness in this specific age group are still lacking. Most studies testing an evening administration of levothyroxine were mainly composed of younger adults. Therefore, this trial is aimed to assess if evening levothyroxine (LT4) administration can effectively control hypothyroidism in older patients. Materials and Methods: A randomized crossover clinical trial was conducted between June 2018 and March 2020 at the Hospital de Clínicas de Porto Alegre, a teaching hospital in Brazil, to compare the efficacy of morning and evening administration of LT4 for hypothyroidism control in older patients. The study protocol is published elsewhere. A total of 201 participants, ≥60 years old, with primary hypothyroidism treated with LT4 for at least 6 months and on stable doses for at least 3 months were included. Participants were randomly assigned to a starting group of morning LT4 intake (60min before breakfast) or bedtime LT4 intake (60min after the last meal). After ≥12 weeks of follow-up, a crossover between strategies was performed. The primary outcome was the change in serum thyrotropin (Thyroid-Stimulating Hormone; TSH) levels after 12 weeks of each LT4 administration regimen. Results: A total of 201 participants with mean age of 72.4 ± 7.2 years were included, out of which 84.1% were women; baseline characteristics and frequency of controlled hypothyroidism were similar between groups. Mean baseline TSH was 3.43 ± 0.25 mUI/L. In total, 118 participants attended three meetings, allowing 135 comparisons by crossover analytic strategy. Mean TSH levels after follow-up were 2.95 ± 2.86 in the morning group and 3.64 ± 2.86 in the bedtime group, p = 0.107. Discussion: Thyroid-Stimulating Hormone levels and frequency of controlled hypothyroidism were similar during the follow-up period regardless of the treatment regimen (morning or bedtime)

Extrarenal Pelvis in a Cat - Diagnosis by Scintigraphy

Background: In people, extrarenal pelvis is a normal anatomical variant, characterized by the protusion of the pelvis out of the renal hilum, which can be associated with other anomalies, or predispose to stasis or infection. While other diagnostic imaging methods provide anatomical and morphological information about the kidney, scintigraphy allows to determine the renal function and has greater sensitivity in the detection of functional alterations. The aim of this work is to report the case of an asymptomatic cat diagnosed with extrarenal pelvis detected by scintigraphy, which presented alterations in laboratory and renal imaging tests, and absence of associated obstructive process. Case: A 7-year-old mixed-breed female cat was evaluated for a routine health assessment at the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS). When performing the imaging and laboratory tests, renal alterations compatible with chronic kidney disease were found in the abdominal ultrasonography examination and in serum creatinine levels. Therefore, it was decided to perform scintigraphy evaluation to better assess renal function. Dynamic renal scintigraphy with 99mTcDTPA revealed an evident concentration of the radiotracer in the left kidney with effective elimination only after the diuretic stimulus. The right kidney exhibited less concentration of the radiotracer but showed effective elimination before the diuretic stimulus. Image analysis suggested the presence of an extrarenal pelvis on the left side. The relative renal uptake was 68% for the left kidney and 32% for the right kidney. The glomerular filtration rate was 1.65 mL/min/kg. Static renal scintigraphy with 99mTcDMSA revealed irregularity in the distribution of the radiotracer in both kidneys, showing less activity in the caudal pole of the left kidney. The right kidney was apparently reduced and with less activity, especially in the medial portion. The relative renal uptake was 65% for the left kidney and 35% for right kidney, while the absolute renal uptake of the left kidney was 33% and that of the right kidney was 17%. The alteration described in the left kidney, in correlation with dynamic renal scintigraphy, suggested an aspect of lower activity in the caudal pole due to the presence of activity in the extrarenal pelvis. The left kidney was classified as presenting normal renal function and there was moderate to severe deficit of renal function on the right side. Discussion: Chronic kidney disease may be present before clinical signs and biochemical abnormalities are identified. In this report, the animal was referred for a routine evaluation and showed no clinical signs nor alterations on physical examination. However, as renal morphological alterations were seen on ultrasonography and the cat presented mild azotemia, it was decided to perform two renal scintigraphy exams. Despite the radiotracer elimination from the left kidney was seen only after the diuretic stimulus, dynamic renal scintigraphy did not show any obstructive process. This delay on elimination was probably a result of the anatomical variant called extrarenal pelvis. In the static renal scintigraphy, it was possible to evaluate morphological changes in the kidneys and suggest less activity in the caudal pole of the left kidney, due to the presence of activity in the extrarenal pelvis, apparently causing the mentioned defect. The correct diagnosis of morphological changes is essential and for this purpose the best combination of imaging tests is necessary. Renal scintigraphy was fundamental, in this case, for the diagnosis of extrarenal pelvis in one of the kidneys, an abnormality not reported in the feline species within the literature researched by the authors. In addition, renal scintigraphy helped to guide the clinical management of the patient described in this report. Keywords: renal scintigraphy, chronic kidney disease, ultrasonography, nuclear medicine. Título: Pelve extrarrenal em uma gata - diagnóstico por cintilografia. Descritores: cintilografia renal, doença renal crônica, ultrassonografia, medicina nuclear

METHODS AIMED AT REDUCING THE RESIDUAL RISK OF PATHOGEN TRANSMISSION DURING PLATELET TRANSFUSION: A LITERATURE REVIEW

Objective: In the Brazilian public health system, sterile filtration is often used to prevent infections associated with platelet transfusion. The literature addressing this issue indicates that pathogen inactivation could be incorporated as an alternative to the development of individual tests and blood donor selection. The objective was to assess whether the use of platelets submitted to pathogen inactivation by photochemical methods could decrease the incidence of post-transfusion infections by viruses, bacteria or other pathogens compared to the use of platelet concentrate or platelets extracted by apheresis without photochemical treatment.Methods: A literature review from 1998 to 2015 was conducted. The scientific literature was surveyed using six electronic databases, two Internet search tools and a manual search of references, using specific search strategies for each database. The selected studies were assessed for quality according to a specific methodology. Data analysis was performed by observations made from the efficacy of the methods.Results: From a detailed analysis of 426 articles retrieved, 10 articles were selected for this review. Among the selected studies, seven studies were clinical trials, and three studies were systematic reviews in combination with meta-analysis. The outcomes analyzed included the reduction of the residual risk in pathogen transmission, mortality, occurrence of hemorrhagic events, corrected count increment (CCI) after 1 h, CCI after 24 h, and transfusion reactions.Conclusion: Differences were found in the quality of the included studies. Systematic reviews conducted on this topic, in alliance with political, social and administrative factors, will aid decision makers regarding its incorporation into the Brazilian Health System.Keywords: Blood Platelets, Platelet Transfusion, Platelet Transfusion/methods*, Riboflavin, Ultraviolet Rays, Photosensitizing Agents, Platelet Transfusion/adverse effect

A influência da suplementação de coenzima Q10 sobre o esquema de tratamento medicamentoso de Hipertensão Arterial Sistêmica

Objetivo: Avaliar, através de revisão de literatura, qual o efeito do uso de CoQ10 sobre a dose dos medicamentos hipotensores, quando usados em conjunto. Método: Trata-se de um estudo de revisão da literatura. A busca de artigos foi realizada na base de dados Medline entre os meses de janeiro a março de 2023. Foram utilizados na pesquisa os descritores “hypertension” e “coenzyme Q10”. Resultados: Foram encontrados 17 estudos, mas atenderam aos critérios da pesquisa apenas 2 estudos; em uma publicação os autores descreveram o resultado da administração de CoQ10 a pacientes hipertensos e em outra compilou várias intervenções feitas com o uso de CoQ10 em diferentes cardiopatias. Conclusão: Os estudos que avaliaram a influência da CoQ10 na dose de anti-hipertensivos quando associada ao tratamento padrão mostraram necessidade de menor dose ou de menos medicamentos para controle pressórico