PANORAMA DOS QUILOMBOS SERGIPANOS: CONDIÇÕES DE VIDA E VULNERABILIDADES

Os quilombos são territórios de resistência cultural que conservam modos de vidas próprios ao tempo que reivindicam a ação estatal na efetivação dos seus direitos constitucionais. Para tanto, este estudo tem como objetivo realizar um diagnóstico sociocultural da situação dos quilombos sergipanos a partir das publicações encontradas no período de 2015 a 2019 na base de dados do Google Scholar. Foi desenvolvida uma pesquisa nesta plataforma, no período de agosto a novembro de 2019, aplicando separadamente os nomes de cada quilombo. Apareceram 6.180 artigos que abordavam em algum momento os termos do descritor, embora somente 68 tenham proporcionado efetivamente informações sobre cada quilombo e/ou tenham feito um diagnóstico sociocultural de algum dos territórios quilombolas dentro do recorte cultural estabelecido. Portanto, constata-se que existe um número muito pequeno de publicações acerca da temática, pois metade dos quilombos não foram abordados nas pesquisas científicas, o que demonstra a invisibilidade social desses territórios, na medida em que se tratam de experiências territoriais que denunciam a precária assistência do poder público

Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil

OBJECTIVE: To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC) and moderate risk, as determined by MELD score (15-20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival

Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil

OBJECTIVE: To analyze the impact of model for end‐stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION: Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS: A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post‐LT survival as end‐points. RESULTS: Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36‐months the difference between pre‐ vs. post‐MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long‐term post‐LT survival were observed in the post‐MELD period. Subgroups analysis showed special benefits to patients categorized as non‐hepatocellular carcinoma (non‐HCC) and moderate risk, as determined by MELD score (15‐20). DISCUSSION: This study ensured a more robust estimate of how the MELD policy affected post‐LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION: Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non‐HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objetivo: Descrever a epidemiologia de mortes por COVID-19 em um hospital na região da Amazônia em um período de 64 dias, que corresponde à curva de crescimento da primeira onda da pandemia de COVID-19 em 2020. Métodos: Os dados foram obtidos de 152 óbitos registrados em prontuários de adultos e idosos hospitalizados. Os dados foram também comparados com o número de óbitos em anos anteriores, no mesmo período estudado, de forma a avaliar o impacto da pandemia neste hospital. O estudo também avalia o impacto das transferências intra-hospitalares, contabilizando o número de vezes que os pacientes que faleceram realizaram transferências entre setores do hospital. Resultados: No período analisado, houve aumento de óbitos em relação aos anos anteriores. A maioria dos pacientes mortos era do sexo masculino, com idade entre 34 e 96 anos. Os óbitos foram associados a comorbidades como hipertensão arterial, diabetes mellitus e doença renal. A infecção por SARS-CoV-2 foi confirmada em 91 casos. Entre eles, 15 indivíduos foram internados sem condições relacionadas à infecção por SARS-CoV-2; eles tiveram um número três vezes maior de transferências hospitalares do que aqueles admitidos com sintomas de infecção por SARS-CoV-2. Dezesseis pacientes com infecção por SARS-CoV-2 desenvolveram sintomas respiratórios logo após a hospitalização. O exame diagnóstico para infecção por SARS-CoV-2 foi realizado em média 4 (± 6) dias após o início dos sintomas e 6 (± 6) dias após a admissão, e o tempo médio do início dos sintomas respiratórios até o óbito foi de 4 ( ± 6) dias. Conclusões: Esses dados sugerem alta presença de infecção hospitalar por SARS-CoV-2 na região amazônica brasileira, o que pode estar relacionado ao número de transferências setoriais, demora na confirmação do diagnóstico e falta de manejo. Relatamos um grave problema de saúde pública, pois demonstra a fragilidade das instituições de saúde no ambiente hospitalar.Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment

Conhecimentos, atitudes e prática do exame de Papanicolaou por mulheres, Nordeste do Brasil

OBJECTIVE: To assess the knowledge, attitudes and practices of women related to the Pap test and the association between these behaviors and sociodemographic characteristics. METHODS: A household survey with quantitative approach was conducted. A total of 267 women aged 15 to 69 years, randomly selected in a stratified manner, living in the city of São José de Mipibu, Northeastern Brazil, were interviewed in 2007. A questionnaire consisting of pre-coded open questions was administered and answers were described and analyzed, as for adequacy of knowledge, attitudes, and practices of women regarding the Pap test. Tests of association were carried out between sociodemographic characteristics and behaviors studied at a 5% significance level. RESULTS: Although 46.1% of the women interviewed showed adequate knowledge about the Pap test, a significantly higher proportion of adequacy was seen regarding attitudes and practices, 63.3% and 64.4%, respectively. Higher schooling was associated with adequacy of knowledge, attitudes, and practices. The main barriers to the Pap test were negligence, non-requesting by their physicians, and shame. CONCLUSIONS: The physician is the main source of information about the Pap test. However, women who more often attend medical visits, despite their good practice, show low adequacy of knowledge and attitudes related to the Pap test, which indicates that they are not receiving appropriate information on the test's purpose, advantages and benefits to women's health.OBJETIVO: Analisar conhecimentos, atitudes e práticas das mulheres em relação ao exame citológico de Papanicolaou e a associação entre esses comportamentos e características sociodemográficas MÉTODOS: Inquérito domiciliar com abordagem quantitativa. Foram entrevistadas 267 mulheres com idade de 15 a 69 anos, selecionadas de forma estratificada aleatória, residentes no município de São José do Mipibu, RN, em 2007. Utilizou-se questionário com perguntas pré-codificadas e abertas, cujas respostas foram descritas e analisadas quanto à adequação dos conhecimentos, atitudes e prática das mulheres em relação ao exame preventivo de Papanicolaou. Foram realizados testes de associação entre as características sociodemográficas e os comportamentos estudados, com nível de significância de 5%. RESULTADOS: Apesar de 46,1% das mulheres entrevistadas terem mostrado conhecimento adequado, proporções de adequação significativamente maiores foram observadas em relação às atitudes e prática quanto ao exame: 63,3% e 64,4%, respectivamente. O maior grau de escolaridade apresentou associação com adequação dos conhecimentos, atitudes e prática, enquanto as principais barreiras para a realização do exame relatadas foram descuido, falta de solicitação do exame pelo médico e vergonha. CONCLUSÕES: O médico é a principal fonte de informação sobre o exame de Papanicolau. Entretanto, mulheres que vão a consultas com maior freqüência, embora apresentem prática mais adequada do exame, possuem baixa adequação de conhecimento e atitude frente ao procedimento, sugerindo que não estejam recebendo as informações adequadas sobre o objetivo do exame, suas vantagens e benefícios para sua saúde.OBJETIVO: Analizar conocimientos, actitudes y prácticas de las mujeres con relación al examen citológico de Papanicolaou y su asociación entre comportamientos y características sociodemográficas. MÉTODOS: Pesquisa domiciliar con abordaje cuantitativo. Fueron entrevistadas 267 mujeres con edad de 15 a 69 años, seleccionadas de forma estratificada aleatoria, residentes en el municipio de São José do Mipibu, Noreste de Brasil, en 2007. Se utilizó cuestionario con preguntas pre-codificadas y abiertas, cuyas respuestas fueron descritas y analizadas con relación a la adecuación de los conocimientos, actitudes y práctica de las mujeres con relación al examen preventivo de Papanicolaou. Fueron realizadas exámenes de asociación entre las características sociodemográficas y los comportamientos estudiados, con nivel de significancia de 5%. RESULTADOS: A pesar de 46,1% de las mujeres entrevistadas haber mostrado conocimiento adecuado, proporciones de adecuación significativamente mayores fueron observadas con relación a las actitudes y práctica con respecto al examen: 63,3% y 64,4%, respectivamente. El mayor grado de escolaridad presentó asociación con adecuación de los conocimientos, actitudes y práctica, con relación a las principales barreras para la realización del examen relatadas fueron descuido, falta de solicitud del examen por el médico y vergüenza. CONCLUSIONES: El médico es la principal fuente de información sobre el examen de Papanicolaou. Mientras tanto, mujeres que van a consultas con mayor frecuencia, a pesar de presentar práctica más adecuada del examen, poseen baja adecuación del conocimiento y actitud frente al procedimiento, sugiriendo que no están recibiendo las informaciones adecuadas sobre el objetivo del examen, sus ventajas y beneficios para su salud

ATLANTIC-PRIMATES: a dataset of communities and occurrences of primates in the Atlantic Forests of South America

Primates play an important role in ecosystem functioning and offer critical insights into human evolution, biology, behavior, and emerging infectious diseases. There are 26 primate species in the Atlantic Forests of South America, 19 of them endemic. We compiled a dataset of 5,472 georeferenced locations of 26 native and 1 introduced primate species, as hybrids in the genera Callithrix and Alouatta. The dataset includes 700 primate communities, 8,121 single species occurrences and 714 estimates of primate population sizes, covering most natural forest types of the tropical and subtropical Atlantic Forest of Brazil, Paraguay and Argentina and some other biomes. On average, primate communities of the Atlantic Forest harbor 2 ± 1 species (range = 1–6). However, about 40% of primate communities contain only one species. Alouatta guariba (N = 2,188 records) and Sapajus nigritus (N = 1,127) were the species with the most records. Callicebus barbarabrownae (N = 35), Leontopithecus caissara (N = 38), and Sapajus libidinosus (N = 41) were the species with the least records. Recorded primate densities varied from 0.004 individuals/km 2 (Alouatta guariba at Fragmento do Bugre, Paraná, Brazil) to 400 individuals/km 2 (Alouatta caraya in Santiago, Rio Grande do Sul, Brazil). Our dataset reflects disparity between the numerous primate census conducted in the Atlantic Forest, in contrast to the scarcity of estimates of population sizes and densities. With these data, researchers can develop different macroecological and regional level studies, focusing on communities, populations, species co-occurrence and distribution patterns. Moreover, the data can also be used to assess the consequences of fragmentation, defaunation, and disease outbreaks on different ecological processes, such as trophic cascades, species invasion or extinction, and community dynamics. There are no copyright restrictions. Please cite this Data Paper when the data are used in publications. We also request that researchers and teachers inform us of how they are using the data. © 2018 by the The Authors. Ecology © 2018 The Ecological Society of Americ

Coma hiperosmolar associado ao transplante de fígado Hyperosmolar coma associated with liver transplantation

INTRODUÇÃO: O diagnóstico diferencial dos pacientes inconscientes sempre inclui o coma hiperosmolar hiperglicêmico não-cetótico. RELATO DE CASO: Paciente do sexo feminino, 22 anos, tipo sangüíneo O+, branca, natural e procedente do Recife - PE com queixa de icterícia e astenia há um mês. Ao exame físico, havia icterícia 3+/4+, desnutrição leve (IMC 17,5) e asterixis. Os exames laboratoriais sugeriram hepatite fulminante. Após 12 horas da inclusão na lista de espera pelo transplante, recebeu enxerto de fígado de doador cadáver, mediante o uso de técnica de piggback sem intercorrências. No 10º dia pós-operatório evoluiu com trombose de artéria hepática (TAH), diagnosticada por ultra-som com doppler de artéria hepática. Após 48 horas foi retransplantada sem intercorrências. A partir do 13º dia de pós-operatório, evoluiu com hiperglicemia grave (> 600 mg/dl) e alteração do nível de consciência (9 pontos na escala de coma de Glasgow). Osmolaridade sérica nesse momento igual a 309 mOsm/kgH2O. O nível sérico de tacrolimus nesse dia foi de 11 ng/dl. Coma hiperosmolar hiperglicêmico não-cetótico foi tratado clinicamente por 48 horas. Recebeu alta no 30º dia de pós-operatório do retransplante, sem diabete mellitus. CONCLUSÃO: O coma hiperosmolar é um evento raro no pós-operatório de transplante de fígado e pode modificar a evolução do paciente.BACKGROUND: The literature described an increased incidence of gastrointestinal stromal tumors (GISTs) in patients with neurofibromatosis type 1. These tumors typically occur in the small intestine, and frequently are multiple. Often the behavior of the tumor in this association is more favorable than in sporadic cases. CASE REPORT: Incidental diagnosis of GIST was done in a patient with neurofibromatosis type 1 during treatment for acute abdomen. Trans-operatively was identified a retrocecal perforated appendicitis and a neoplastic mass in the proximal jejunum. The lesion occupied approximately 70% of the circumference of the organ and had no invasion of adjacent structures. Moreover, there were dozens of small nodules scattered throughout the length of the jejunum and ileum. The pathology revealed malignancy consistent with GIST, with moderate degree of atypia, low mitotic index (<5 / 50) and absence of necrosis. In immunohistochemical analysis, the neoplastic cells were positive for CD-34 and CD-117 (c-KIT), and negative for desmin. After surgery, the use of Imatinib chemotherapy was indicated. After a follow-up period of 12 months, the patient showed no signs of recurrence. CONCLUSION: GISTs should be considered in the presence of abdominal mass and neurofibromatosis type 1, affecting mainly small bowel. Sometimes Imatinib can be administered with good results in the control of the disease