ANÁLISE LINGUÍSTICA EM PERSPECTIVA DIALÓGICA: A FÁBULA EM PROPOSTA DE PRÁTICA NO 6° ANO DO ENSINO FUNDAMENTAL

Este estudo apresenta o desenvolvimento de uma proposta de prática de análise linguística de perspectiva dialógica a partir do trabalho com o gênero fábula, para implementação no 6° ano do Ensino Fundamental. Os resultados apontam que: a) as escolhas vocabulares, sintagmáticas e sintáticas materializadas nos textos do gênero fábula podem ser abordadas pelo viés valorativo, o que facilita a compreensão do discurso mobilizado no gênero; b) os encaminhamentos teórico-metodológicos dialógicos constituem uma sequência de análise linguística completa, a envolver atividades epilinguísticas e metalinguísticas em perspectiva dialógica, que ajudam a compreender as valorações mobilizadas no enunciado.Palavras-chave: Dialogismo. Análise linguística. Gênero fábula. DOI: https://doi.org/10.47295/mgren.v10i1.294

Lesão de plexo braquial secundária a pseudoaneurisma de artéria axilar após luxação glenoumeral: relato de caso

ResumoAs lesões de artéria axilar e consequente compressão de plexo braquial são extremamente raras em pacientes com luxação de glenoumeral e podem ter manifestações clínicas bastante variadas. Essa articulação é uma das mais acometidas por luxação do corpo humano, representando cerca de 45% dos casos. Menos de 1% dos pacientes com luxação de ombro apresentam complicações vasculares; no entanto, quando há lesão da artéria axilar, a incidência de lesão de plexo braquial associada é de 27% a 44%. Relatamos um caso de compressão do plexo braquial por um pseudoaneurisma de artéria axilar após uma luxação glenoumeral. O objetivo é lembrar a existência dessa associação, a fim de diagnosticá‐la precocemente e evitar complicações graves, como a lesão neurológica.AbstractLesions of the axillary artery and consequent compression of the brachial plexus are extremely rare in patients with glenohumeral dislocation and may have greatly varying clinical manifestations. This joint is one of the most affected by dislocation in the human body, accounting for approximately 45% of cases. Less than 1% of patients with shoulder dislocation have vascular complications; however, when there is damage in the axillary artery, the incidence of associated brachial plexus injury is 27% to 44%. The authors report on a case of brachial plexus compression by an axillary artery pseudoaneurysm after a glenohumeral dislocation, aiming to highlight the existence of this association, in order to make an early diagnosis and avoid serious complications, such as neurologic injury

Cannabidiol Exerts a Neuroprotective and Glia-Balancing Effect in the Subacute Phase of Stroke

Pharmacological agents limiting secondary tissue loss and improving functional outcomes after stroke are still limited. Cannabidiol (CBD), the major non-psychoactive component of Cannabis sativa, has been proposed as a neuroprotective agent against experimental cerebral ischemia. The effects of CBD mostly relate to the modulation of neuroinflammation, including glial activation. To investigate the effects of CBD on glial cells after focal ischemia in vivo, we performed time-lapse imaging of microglia and astroglial Ca2+ signaling in the somatosensory cortex in the subacute phase of stroke by in vivo two-photon laser-scanning microscopy using transgenic mice with microglial EGFP expression and astrocyte-specific expression of the genetically encoded Ca2+ sensor GCaMP3. CBD (10 mg/kg, intraperitoneally) prevented ischemia-induced neurological impairment, reducing the neurological deficit score from 2.0 ± 1.2 to 0.8 ± 0.8, and protected against neurodegeneration, as shown by the reduction (more than 70%) in Fluoro-Jade C staining (18.8 ± 7.5 to 5.3 ± 0.3). CBD reduced ischemia-induced microglial activation assessed by changes in soma area and total branch length, and exerted a balancing effect on astroglial Ca2+ signals. Our findings indicate that the neuroprotective effects of CBD may occur in the subacute phase of ischemia, and reinforce its strong anti-inflammatory property. Nevertheless, its mechanism of action on glial cells still requires further studies

Perfil epidemiológico de Morbidade Hospitalar por Insuficiência Cardíaca, entre 2019 e 2023: Estudo Ecológico

INTRODUCTION: Heart failure (HF) is a clinical condition in which the heart cannot pump blood effectively, resulting in symptoms such as shortness of breath and fatigue. In Brazil, this pathology represents one of the main causes of hospitalization. This study analyzes hospitalizations, costs and demographic characteristics of patients with HF in Brazil, with the aim of informing health policies to reduce their impact. OBJECTIVE: This study aims to analyze hospital admissions for HF in Brazil from January 2019 to December 2023, with emphasis on distribution by age group, patient sex, types of care and hospital costs. METHODOLOGY: This is a quantitative retrospective study using data from the SUS Hospital Information System (SIH/SUS), accessed via the TABNET/DATASUS secondary database. Hospitalizations, age group, patient sex, types of care and hospital costs due to HF in Brazil between January 2019 and December 2023 were analyzed. The analysis used descriptive statistics and tabulation in a Microsoft Excel 2016 spreadsheet, with results presented in tables in Microsoft Word 10. RESULTS: Between January 2019 and December 2023, there were 941,669 hospitalizations for heart failure in Brazil, with a higher prevalence in the Southeast region (50.78%). Hospital costs totaled R$1,735,613,591.98. Hospitalizations were predominantly among elderly people over 60 years of age, and the majority of visits were urgent (94.43$ 1.735.613.591,98. As internações foram predominantes em idosos acima de 60 anos, e a maioria dos atendimentos foi de urgência (94,43%). Homens representaram 51,40% das internações. Esses dados destacam a importância de estratégias de prevenção e tratamento eficazes. CONCLUSÃO: Os dados sobre insuficiência cardíaca no Brasil indicam uma alta concentração de casos na Região Sudeste, com predominância de internações em idosos e atendimentos de urgência. A maior prevalência entre homens ressalta diferenças de risco. É crucial implementar estratégias de prevenção e manejo precoce, especialmente em regiões menos desenvolvidas, para reduzir a dependência de cuidados emergenciais e melhorar os resultados de saúde, focando na população idosa

Análise dos Indicadores de Neoplasia Maligna do Cólon no Brasil em 2024: Estudo Ecológico

INTRODUCTION: Malignant neoplasm of the colon, or colorectal cancer, is a serious condition that arises in the colon or rectum, with high prevalence and global mortality. In Brazil, the combination of genetic, environmental and lifestyle factors contributes to its increase. This study analyzes the rates of hospitalizations, deaths and mortality due to colonic malignancy between January and May 2024, highlighting regional inequalities and the need for more effective health strategies. OBJECTIVE: This study aims to quantify and analyze the rates of hospitalizations, deaths and mortality rates due to malignant neoplasia of the colon in Brazil. METHODOLOGY: The retrospective study with a quantitative approach used data from the SUS Hospital Information System (SIH/SUS), provided by the SUS Information Technology Department (TABNET/DATASUS). The analysis covered hospitalizations, deaths and mortality rates due to malignant colon neoplasia in Brazil from January to May 2024, using descriptive statistics and tabulation in Microsoft Excel 2016 and Microsoft Word 10 spreadsheets. RESULTS: Between January and May 2024, the Southeast Region led with 44.98% of hospitalizations and 58.28% of deaths due to malignant neoplasia of the colon, reflecting a high mortality rate of 10 .78. The North Region had the highest mortality rate (14.37) and only 1.78% of hospitalizations. The South and Northeast regions showed significant numbers, highlighting regional disparities in the management and treatment of colorectal cancer in Brazil. CONCLUSION: Therefore, the analysis of data on hospitalizations, deaths and mortality rates due to malignant colon neoplasia in Brazil between January and May 2024 reveals notable regional disparities, highlighting inequality in access and quality of care. The Southeast Region has better rates due to a more advanced health infrastructure, while the North and Central-West face significant challenges. It is imperative to adopt more equitable healthcare policies and invest in infrastructure to reduce these inequities and improve outcomes for all patients.INTRODUÇÃO: Neoplasia maligna do cólon, ou câncer colorretal, é uma condição grave que surge no cólon ou reto, com alta prevalência e mortalidade global. No Brasil, a combinação de fatores genéticos, ambientais e de estilo de vida contribui para seu aumento. Este estudo analisa as taxas de internações, óbitos e mortalidade por neoplasia maligna do cólon entre janeiro e maio de 2024, destacando desigualdades regionais e a necessidade de estratégias de saúde mais eficazes. OBJETIVO: Este estudo visa quantificar e analisar as taxas de internações, óbitos e taxa de mortalidade por neoplasia maligna de cólon no Brasil. METODOLOGIA: O estudo retrospectivo com abordagem quantitativa utilizou dados do Sistema de Informações Hospitalares do SUS (SIH/SUS), fornecidos pelo Departamento de Informática do SUS (TABNET/DATASUS). A análise abrangeu internações, óbitos e taxa de mortalidade por neoplasia maligna de cólon no Brasil de janeiro a maio de 2024, empregando estatística descritiva e tabulação em planilhas do Microsoft Excel 2016 e Microsoft Word 10. RESULTADOS: Entre janeiro e maio de 2024, a Região Sudeste liderou com 44,98% das internações e 58,28% dos óbitos por neoplasia maligna de cólon, refletindo uma alta taxa de mortalidade de 10,78. A Região Norte apresentou a maior taxa de mortalidade (14,37) e apenas 1,78% das internações. As regiões Sul e Nordeste mostraram números significativos, destacando disparidades regionais na gestão e tratamento do câncer colorretal no Brasil. CONCLUSÃO: Portanto, a análise dos dados de internações, óbitos e taxas de mortalidade por neoplasia maligna de cólon no Brasil entre janeiro e maio de 2024 revela notáveis disparidades regionais, destacando a desigualdade no acesso e na qualidade dos cuidados. A Região Sudeste apresenta melhores índices devido a uma infraestrutura de saúde mais avançada, enquanto Norte e Centro-Oeste enfrentam desafios significativos. É imperativo adotar políticas de saúde mais equitativas e investir em infraestrutura para reduzir essas desigualdades e melhorar os resultados para todos os pacientes

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier