Clinical and echocardiographic predictors of left ventricular remodeling following anterior acute myocardial infarction

OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50–11.25] and remodeling group: 12.60 [10.74–14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI

Gestação e tabagismo: representações e experiências de pacientes de Unidades de Saúde da Família

OBJETIVO: Analisar e interpretar o que gestantes dependentes de tabaco/nicotina pensam e experimentam quanto à problemática relacionada a essas condições. MÉTODO: Pesquisa qualitativa utilizando narrativas de gestantes ou puérperas que fumaram ou interromperam o uso de tabaco na gestação. As narrativas de uma amostra intencional de 14 usuárias de Unidades de Saúde da Família de um município paulista foram analisadas quanto aos enunciados. RESULTADOS: Formularam-se quatro categorias: contraste entre desejo de interromper o uso e o papel não identificado dos profissionais e serviços; questões sobre a saúde da mãe e da criança; questões socioculturais e familiares e, por fim, uma "epidemiologia espontânea". As representações sociais constatadas mostram discrepâncias e homologias com os modos como as ciências da saúde lidam com o tabagismo no período gestacional. As participantes consideraram inexistir uma cultura terapêutica para tabagismo nos serviços de Atenção Primária à Saúde que frequentam, tendo se mostrado angustiadas com essa questão e com os conflitos socioculturais e familiares que enfrentam. Uma compreensão peculiar sobre os riscos para a saúde foi constatada. CONCLUSÃO: Embora os resultados não sejam generalizáveis, as tensões constatadas sugerem caminhos para uma maior adaptação da Atenção Primária à Saúde às necessidades das gestantes tabagistas

Iniciação científica com pesquisas qualitativas: relato da experiência de um grupo de professores e alunos de Medicina

This paper was aimed at reporting and discussing the experiences of a group of teachers and students of a medical undergraduate course about medical student research, achieved through research projects with qualitative methods, some of them having the Primary Health Care as a field of research. Contextualizing the report, it was emphasized the recent history of medical student research in Brazil and also the recent use of qualitative methods in health worldwide. The experience report was structured from a basic flowchart of the working process followed by the research projects internships. It is noteworthy that there was an autonomy in relation to data collection but, on the other hand, a greater reliance on their advisers when analyzing and interpreting the findings. Through these undergraduate stages, it is valued the network of meanings present in the health-illness-care process, particularly in Primary Health Care, considering that a progressive scientific understanding of this complex process helps to improve a medical practice effectively attentive to the full health needs of patients and communities.El objetivo fue presentar y discutir las experiencias de un grupo de profesores y estudiantes de Medicina en las etapas de iniciación científica realizadas por medio de proyectos de investigación utilizando métodos cualitativos, algunos de ellos con la Atención Primaria de Salud como campo de la investigación. Contextualizando el relato, el énfasis está en la historia relativamente reciente de la iniciación científica en Brasil, y lo también uso reciente y en gran escala de métodos cualitativos en la salud en todo el mundo. El relato de la experiencia se estructuró a partir del diagrama de flujo del proceso de trabajo seguido por las etapas de la iniciación científica. Es de destacar que hubo una relativa autonomía de los estudiantes respecto a la recopilación de datos, pero por otro lado, una mayor dependencia de sus orientadores en la revisión e interpretación de los resultados. A través de estas etapas, se considera que los valores de la red de significados presentes en la salud-enfermedad-cuidado son valorizados, en especial en la Atención Primaria de Salud, mientras que una progresiva comprensión científica de este complejo proceso ayuda a mejorar la práctica médica atenta a las completas necesidades de los pacientes y las comunidades.Objetivou-se relatar e discutir as experiências de um grupo de professores e alunos de graduação de Medicina sobre os estágios de iniciação científica, realizados por meio de projetos de pesquisa com métodos qualitativos, parte deles tendo a Atenção Primária à Saúde como campo de pesquisa. Contextualizando o relato, acentuou-se a história relativamente recente da iniciação científica no Brasil e, em nível mundial, a também recente utilização em mais ampla escala dos métodos qualitativos em saúde. O relato de experiência se estruturou a partir do fluxograma do processo de trabalho seguido pelos estágios de iniciação científica. Destacou-se ter havido uma relativa autonomia dos estudantes em relação à coleta de dados, mas, por outro lado, maior dependência em relação aos seus orientadores no momento de analisar e interpretar os achados. Por meio desses estágios, acredita-se que se valoriza a rede de significados presentes no processo saúde-doença-cuidado, em particular na Atenção Primária à Saúde, considerando que uma progressiva compreensão científica desse processo complexo ajuda a aperfeiçoar uma prática médica atenta às plenas necessidades de pacientes e comunidades

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora