Esôfago de Barret: Diagnóstico e Manejo

Gastroesophageal reflux disease (GERD) is a condition in which the acidic contents of the stomach flow back into the esophagus, causing symptoms such as heartburn, regurgitation, and chest pain. The diagnosis of GERD is based on clinical evaluation and may involve pH monitoring tests. The treatment of GERD is multifaceted and includes both medicinal and non-medicinal interventions. Proton pump inhibitors (PPIs) are often prescribed to reduce gastric acid production and alleviate symptoms. Additionally, dietary modification, weight loss, and lifestyle changes, such as elevating the head of the bed and avoiding meals before bedtime, play a crucial role in GERD management. Complications of GERD include the development of Barrett's esophagus, a condition in which the normal squamous epithelium of the esophagus is replaced by intestinal metaplasia. Barrett's esophagus is  associated with a higher risk of esophageal cancer, especially in cases of high-grade dysplasia. Therefore, early detection and regular surveillance through endoscopy are essential to prevent severe complications. Mortality is linked to the progression of the disease to esophageal cancer, particularly in advanced stages. Thus, early diagnosis and timely intervention are crucial to reduce GERD-related mortality. A multidisciplinary approach involving healthcare professionals such as gastroenterologists, surgeons, and other specialists is required to provide comprehensive and personalized care to GERD patients. Proper management of GERD aims to alleviate symptoms, prevent severe complications, and enhance the quality of life for individuals affected by this common gastrointestinal condition.O refluxo gastroesofágico (DRGE) é uma condição na qual o conteúdo ácido do estômago reflui para o esôfago, causando sintomas como azia, regurgitação e dor no peito. O diagnóstico do DRGE é baseado na avaliação clínica e pode envolver testes de monitoramento do pH esofágico. O tratamento do DRGE é multifacetado e inclui intervenções medicamentosas e não medicamentosas. Os inibidores da bomba de prótons (IBPs) são frequentemente prescritos para reduzir a produção de ácido gástrico e aliviar os sintomas. Além disso, a modificação da dieta, a perda de peso e mudanças no estilo de vida, como elevar a cabeceira da cama e evitar refeições antes de dormir, desempenham um papel crucial na gestão do DRGE. As complicações do DRGE incluem o desenvolvimento de esofagite de Barrett, uma condição na qual o epitélio escamoso normal do esôfago é substituído por metaplasia intestinal. O Esôfago de Barrett está associado a um maior risco de câncer de esôfago, especialmente em casos de displasia de alto grau. Portanto, a detecção precoce e a vigilância regular por meio de endoscopia são essenciais para prevenir complicações graves. A mortalidade está relacionada à progressão da doença para o câncer de esôfago, particularmente em estágios avançados. Portanto, o diagnóstico precoce e a intervenção oportuna são fundamentais para reduzir a mortalidade associada ao DRGE. Uma abordagem multidisciplinar, envolvendo profissionais de saúde como gastroenterologistas, cirurgiões e outros especialistas, é necessária para fornecer um cuidado abrangente e personalizado aos pacientes com DRGE. O tratamento adequado do DRGE visa aliviar os sintomas, prevenir complicações graves e melhorar a qualidade de vida dos pacientes afetados por essa condição gastrointestinal comum

O espírito das leis e as leis do espírito: a evolução do pensamento legislativo brasileiro em saúde mental He spirit of the law and the laws of the spirit: the evolution of Brazilian legal thought in the realm of mental health

Examina a evolução das leis e normas da República brasileira relativas ao padecimento mental, demarcando três períodos. No período inicial (1890-1910), caracterizado pela introdução do tema da patologia mental no campo das preocupações do Estado, o interesse fundamental foi o reconhecimento e a preservação dos direitos dos portadores dessas patologias; nesse período, a alteração mental é entendida em termos de neuropatologia. No período de ampliação da ação estatal (1911-1945) permanecem os interesses observados no período anterior; a interpretação de adoecimento mental não sofre alterações substanciais, a despeito do alargamento de sua abrangência. No período do desenvolvimentismo brasileiro (1946-1982), marcado por uma descontinuidade em relação aos períodos anteriores, prevalece um espírito econômico-desenvolvimentista, expresso na vigorosa ampliação do parque hospitalar e amparado por um pensamento humanista de tons conservadores; mantém-se o interesse na proteção dos portadores de doenças mentais.<br>The article explores the evolution of the Brazilian republic's laws and norms on mental illness during three periods. The first (1890-1910) saw the topic of mental pathology introduced into the State's realm of interest, with the main concern being to recognize and preserve the rights of those displaying such pathologies. During this period, mental alterations were understood in terms of neuropathology. The following period (1911-1945) saw expansion of government initiatives, with the same concerns as the previous period. The interpretation of mental illness did not undergo any major changes, although it broadened in scope. Marked by a discontinuity in relation to previous times, Brazil's developmentalist period (1946-1982) saw an economic developmentalist spirit hold sway, underpinned by humanist thought of conservative propensity. It brought a vigorous growth in the number of Brazilian hospitals, while interest in protecting the mentally ill continued

A detailed relevance analysis of enabling technologies for 6G architectures

Abstract As society evolves as a whole, new demands arise with increasingly demanding prerequisites, consequently requiring more significant effort to be met. Such demands cover emerging applications, such as remote surgeries in Smart Health use cases, whose latency and reliability network requirements cannot be met by current communication systems; or simply improving current applications with more challenging requirements to be achieved, such as increasing the transmission rate in a mobile network, offering Quality of Service (QoS), and consequently, better user experience. Therefore, enabling technologies must be chosen to design an appropriate 6G architecture to address such demands. However, the explosion of emerging applications focused on different scopes and requirements to be met makes choosing these enabling technologies extremely complex and unpredictable. Thus, this article aims to create a methodology for analyzing the relevance of enabling technologies and use it to design an optimal architecture capable of meeting the 6G demands. For this purpose, two methods named as Average (AVG) and Analytic Hierarchy Process (AHP) have been selected, whose objective is to determine the relevance of an enabler for the 6G architecture, taking into account different degrees of influencing variables for this analysis, such as adherence to a certain architectural model; popularity in the research area; degree of innovation; synergy with other enablers; and support for requirements. Each of these methods presents a particular result. In the case of the AVG method, the criteria and variables are evaluated independently, and the arithmetic mean is employed to combine the evaluations into a single measure of suitability. In contrast, the AHP method considers the relative importance of criteria and variables in order to classify an optimal set of enabling technologies capable of fulfilling the key roles to be performed by a 6G architecture, and consequently meeting the main 6G demands. Our evaluation provides a unique perspective on 6G enablers, identifying issues and fostering research for future mobile architectures. The results obtained also provide researchers with the necessary information to stay updated on emerging enabling technologies and their suitability for designing new optimized 6G architectures

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Núcleos de Ensino da Unesp: artigos 2007

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq