Cirurgia endoscópica intrarrenal combinada (ECIRS) em posição galdakao-valdívia modificada: um relato de caso / Endoscopic combined intrarenal surgery (ECIRS) in galdakao modified supine valdivia position: a case report

Introdução: A nefrolitíase é uma patologia de alta prevalência. Possui importante morbidade por complicações agudas, relacionadas a obstrução de vias urinárias e quadros de insuficiência renal, bem como quadros infecciosos que podem evoluir à sepsis. Classicamente seu tratamento é cirúrgico e tem-se a nefrolitotomia percutânea (NPC) como padrão ouro para cálculos renais maiores que 2 cm.  Relato de caso: Paciente masculino, 48 anos, com repetidos quadros de infecção urinária. A investigação foi realizada com exames laboratoriais e de imagem. Possui sobrepeso, hipertensão leve, sem outras comorbidades. Apresentando cálculo coraliforme, complexo à esquerda, foi submetido a abordagem endoscópica combinada, ureteroscópica e percutânea em posição supina modificada, com completa extirpação de cálculos, com alta no segundo dia de pós-operatório, retornando em 45 dias para retirada de duplo jota, com boa evolução

Measurement properties of the falls efficacy scale in patients on hemodialysis

From Springer Nature via Jisc Publications RouterHistory: received 2023-12-08, accepted 2024-03-06, registration 2024-03-07, epub 2024-03-18, online 2024-03-18, collection 2024-12Acknowledgements: The authors thank the nursing and medical staff at the Nephrology Unit for their friendly support.Publication status: PublishedFunder: Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG; Grant(s): APQ 02229, 2018Funder: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES; Grant(s): 001, 2020Funder: National Council for Scientific and Technological Development - CNPqPelagia Koufaki - ORCID: 0000-0002-1406-3729 https://orcid.org/0000-0002-1406-3729Background: The measurement properties of the falls efficacy scale have not been evaluated in patients on hemodialysis. This study determined the inter- and intrarater reliability, standard error of measurement, minimal detectable change, and limits of agreements of the falls efficacy scale in patients on hemodialysis. Methods: A cross-sectional study was conducted with 65 patients (57.5 ± 13.9 years, 63.1% male) on hemodialysis. The fear of falling was assessed by two previously trained raters using the falls efficacy scale. The intraclass correlation coefficient, standard error of measurement, minimal detectable change, and Bland–Altman plot were calculated to assess the inter- and intrarater reliability of the falls efficacy scale. Results: The interrater intraclass correlation coefficient was 0.91, and the intrarater intraclass correlation coefficient was 0.78, representing excellent interrater and good intrarater reliability. The standard error of measurement for inter- and intrarater assessments were 2.99 and 4.46, and the minimal detectable change for inter- and intrarater assessments were 9.26 and 12.33, respectively. The interrater mean difference score was 0.26 (95% limits of agreement: − 8.01 to 8.53), and the intrarater mean difference score was − 1.06 (95% limits of agreement: − 13.39 to 11.27). Conclusion: In patients on hemodialysis, the falls efficacy scale showed excellent and good inter- and intrarater reliability, respectively. Additionally, standard error of measurement, minimal detectable change, and limits of agreements of the falls efficacy scale score were satisfactory.pubpu

Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil.

The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available

Currents issues in cardiorespiratory care of patients with post-polio syndrome

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI)

Characterization Of Reactive Stroma In Prostate Cancer: Involvement Of Growth Factors, Metalloproteinase Matrix, Sexual Hormones Receptors And Prostatic Stem Cells

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Introduction and Objectives: Reactive Stroma (RStr) is observed in many human cancers and is related to carcinogenesis. The objectives of the present study were to stablish a relationship of the RStr microenvironment with prostate cancer (Pca) through a morphological and molecular characterization, and to identify a possible relationship between RStr with worse prognosis factors and occurrence of malignant prostatic stem cells. Materials and Methods: Forty prostatic samples were selected from men with Pca diagnosis submitted to radical prostatectomy; they were divided in two groups: Group-1 (n = 20): samples without reactive stroma; Group-2 (n = 20): samples of PCa with intense stroma reaction. Prostatic samples were evaluated for RStr intensity by Masson Trichromic stain and posteriorly submitted to histopathological and immunohistochemistry analysis for antigens: alpha-actin, vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA, AR, Er alpha and ER beta. Results: Reactive stroma with intense desmoplastic reactivity was significantly more frequent in intermediate (Gleason 7, 3+4) and high grade tumors (Gleason 7, 4+3). The group with intense stromal reactivity showed significant higher levels of Vimentin, IGF-1, MMP-2, FGF-2, C-Myc, PSCA and ER alpha. Conclusions: It can be concluded that RStr may be a predictive marker of Pca progression, since it was associated with increase of growth factors, imbalance of androgen and estrogen receptors and presence of malign prostatic stem cells.415849858Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2009/50397-9

Apoio familiar aos adolescentes egressos do sistema sócio-educativo da região de Ponta Grossa – PR

The article presents the experience, developed by the Project of Academic Extension, “Family Support to the egressed adolescents, that came from a social and educational system, in the region of Ponta Grossa, PR, which participates of the University Without Frontiers, of the State Office of Science, Technology and College Teaching (SETI). It aims mainly to promote social inclusion of the adolescents, by moving the managers of public politics and society, to bring them conditions for maintaining these Young coexistence in the family and in the community. Its also aims to help them to rescue and to strength family ties, by intersectorial and interdisciplinary works, focusing network attendance, through a methodology that, besides to direct care for adolescents of their families, develops and information system that identifies city social politics and the risk factors to the adolescents violation of conduct.Este artigo apresenta a experiência desenvolvida pelo Projeto de Extensão Universitária: Apoio familiar aos adolescentes egressos do sistema sócio-educativo da região de Ponta Grossa – PR, que integra o Programa Universidade Sem Fronteiras da Secretaria de Estado da Ciência, Tecnologia e Ensino Superior/SETI. Tem, por objetivos principais, promover a inclusão social dos adolescentes egressos, através da mobilização dos gestores das políticas públicas e da sociedade, a fim de propiciar condições para serem acolhidos e mantidos estes jovens no convívio familiar e no comunitário. Também visa resgatar e fortalecer os vínculos familiares, a partir de trabalho interdisciplinar e intersetorial que prima pelo atendimento em rede, por uma metodologia que, além do atendimento direto a adolescentes e a suas famílias, desenvolve um sistema de informação que identifica as políticas sociais municipais e os fatores de risco às condutas infracionais de adolescentes