CRIANÇAS E ADOLESCENTES ÓRFÃOS: UM ESTUDO SOBRE A INFLUÊNCIA DA ORFANDADE NO PROCESSO DE FORMAÇÃO PSICOSSOCIAL E DESENVOLVIMENTO DA PERSONALIDADE

O presente estudo tem por objetivo investigar as influências conflituosas no desenvolvimento psicossocial de sujeitos órfãos de pai. Segundo diversos trabalhos que discutem a orfandade paterna, a ausência do genitor pode gerar situações aversivas de caráter psicossocial, de acordo com cada fase do desenvolvimento que o indivíduo se encontra. Participaram da pesquisa três adolescentes órfãos de pai, sendo que os mesmos foram entrevistados de forma individual com a finalidade de investigar por meio de pesquisa qualitativa descritiva, a orfandade e os fenômenos decorrentes da ausência da figura paterna em quatro diferentes temáticas: Aspectos do desenvolvimento infantil; Participação dos genitores no desenvolvimento; Relacionamento filho-pai; Avaliação do relacionamento com a família. Os conteúdos manifestos foram examinados pela técnica de análise de discurso. O estudo revelou que a ausência paterna afeta o desenvolvimento emocional de tal forma que os participantes da pesquisa expressam emoções regressivas na busca de reorganização psíquica, assim como pode vir acontecer durante a transição para fases posteriores ao longo da vida

Dexmedetomidine-Tiletamine-Zolazepam Followed by Inhalant Anesthesia in Spectacled Bears (Tremarctos ornatus)

Background: The spectacled bear (Tremarctos ornatus) is the only bear species inhabiting South America and is classified as vulnerable according to the International Union for Conservation of Nature (IUCN) Red List. Among the few publications on the use of general anesthesia and advanced monitoring of ursids in veterinary hospital settings, little is described regarding chemical restraint, general anesthesia and monitoring of spectacled bears. This case series describes the use of a dexmedetomidine-tiletamine-zolazepam chemical restraint combination and its effects on cardiorespiratory variables and arterial blood gases observed in two spectacled bears submitted to isoflurane anesthesia for imaging and/or surgical procedures.Cases: Two female, one adult and one senile, all-term captive spectacled bears were referred to the Veterinary Medical Teaching Hospital at the Universidade Estadual Paulista - Unesp, Botucatu campus, both with a presumable history of recent trauma. After immobilization with an intramuscular (IM) administration of tiletamine-zolazepam (3.8 - 4.3 mg/kg) and dexmedetomidine (6.4 - 7.6 µg/kg), anesthesia induction was achieved by means of intravenous (IV) propofol (1 - 2 mg/kg). The patients then underwent isoflurane inhalant anesthesia and were submitted to intermittent positive-pressure ventilation through the remainder of the procedures. Initial settings of inspiratory flow rate were adjusted to obtain Ppeak of 10 cmH2O and tidal volumes (Vt) of 10 mL/kg, as well as respiratory rates (ƒR)and inspiration-to-expiration (I:E) ratio of 10 breaths/min and 1:2, respectively, and were then adjusted throughout anesthesia to maintain normocapnia (end-tidal carbon dioxide concentrations between35 and 45 mmHg). One of the individuals was chemically restrained (6.4 mg/kg of tiletamine-zolazepam and 7.7 µg/kg of dexmedetomidine) on a second anesthetic event for imaging procedures. Arterial blood gas analysis were performed with the subjects breathing room air and oxygen-enriched air. Both animals exhibited severe hypoxemia (partial pressure of oxygen [PaO2] < 60 mmHg) while breathing room air (inspired oxygen fraction [FiO2] ≅ 0.21). An impaired blood oxygenation (PaO2/FiO2 < 400) was still observed despite mechanical ventilation and the provision of 1.0 FiO2. Alveolar recruitment maneuvers (3 sequential mechanical sights with peak airway pressure at 20 - 30 cmH2O during 15 - 30 s each) were then performed, which resulted in improved PaO2/FiO2 ratios. All other blood gas, electrolytes and acid-base variables did not appear to be importantly altered by chemical restraint and general anesthesia.Discussion: Dexmedetomidine-tiletamine-zolazepam resulted in reliable chemical restraints and is a feasible option for immobilizing spectacled bears, though severe hypoxemia may proceed. Hypoxemia is the most commonly described complication in bear anesthesia, and was also evidenced in the current report. However, low PaO2/FiO2 ratios tend to be accompanied by hypercapnia and therefore counteracted by oxygen supplementation in bears, which was not observed in the present report. In fact, blood oxygenation only reached regular values after alveolar recruitment maneuvers, which is compatible to an atelectasis-related hypoxemia. Therefore, either inhalant anesthesia or field chemical restraint should be accompanied by advanced monitoring (cardiorespiratory variables and blood gas analysis) in until further studies address the management of hypoxemia in spectacled bear. since Advanced monitoring was of major importance for a safe outcome and an uneventful recovery in this species.Keywords: balanced anesthesia, dexmedetomidine, general anesthesia, spectacled bear, Tremarctos ornatus, wildlife

Hidrolisado proteico de carne mecanicamente separada de tilápia-do-nilo

The objective of this work was to enzymatically obtain hydrolysate tilapia protein powder by two drying methods, and to perform a physicochemical characterization of the final products, as well as to evaluate their thermal stability. Proximal composition, aminogram, fatty acid profile, pH, color, water activity, and microbiological analyses were performed. Crude protein was the prominent component, with 87% in the spray-dried powder and 89% in the lyophilized powder, showing no statistical difference. The samples showed no bacterial growth, which may be associated with the low water activity in the products. Dry samples had b* positive, and the freeze-dried ones were more yellowish than the spray-dried ones. Both drying methods promoted similar luminosity near the white color. In the thermal analysis, samples showed 26% mass loss at 200°C, and degradation started at 290°C. Enzymatic hydrolysis is efficient, and the hydrolysate tilapia protein powder contains all essential amino acids. The hydrolysate shows similar protein content for both spray-dried and freeze-dried samples, and the final products are stable at high temperatures.O objetivo deste trabalho foi obter, por via enzimática, um hidrolisado proteico de tilápia em pó, por dois métodos de secagem, e realizar uma caracterização físico-química dos produtos finais, bem como avaliar sua estabilidade térmica. Foram realizadas análises de composição proximal, aminograma, perfil de ácidos graxos, pH, cor, atividade da água e análises microbiológicas. A proteína bruta foi o componente proeminente, com 87% no pó obtido por secagem por aspersão e 89% no pó liofilizado, e não apresentou diferença estatística. As amostras não apresentaram crescimento bacteriano, o que pode estar associado à baixa atividade de água dos produtos. As amostras secas tiveram b* positivo, e as amostras secas por liofilização mostraram-se mais amareladas do que as obtidas por aspersão. A secagem em ambos os métodos promoveu luminosidades semelhantes, próximas à cor branca. Na análise térmica, as amostras apresentaram perda de massa de 26% a 200°C, e a degradação foi observada a temperaturas a partir de 290°C. A hidrólise enzimática é eficiente, e os hidrolisados proteicos de tilápia em pó contém todos os aminoácidos essenciais. O hidrolisado apresenta teor de proteína semelhante em amostras secas por aspersão e liofilizadas, e os produtos finais são estáveis em altas temperaturas

Are we teaching patient safety to our academics? : The experience of a course in the countryside of São Paulo

Nowadays, one of the biggest concerns in the health care field is centered on patient safety with a primary focus on the errors of the medical team. In 2009, WHO created a guide for universities aimed at patient safety in which it suggests new ways of approaching patients, thus improving the quality of trained professionals and dramatically reducing adverse events. There is a consensus that there is a restructuring of a system that currently presents serious failures that result in permanent harm to the objective of the medical team, which is the well-being of the patient, as well as an efficient inspection of the Decree Number 529/13 in Brazilian universities. It is in this context that the present work proposes to highlight the gap currently existing in Brazilian universities, based on the sampling of one of them, located in the countryside of São Paulo. Prospective intervention study using a quantitative and qualitative methodology, carried out in two stages: analysis of teaching plans and application of the quantitative and qualitative perception instrument to professors. Was not found in the teaching plans of the modules of the medical course at Universidade Brasil the concept of patient safety. Semi-structured questionnaire was answered by 47 teachers, 11 (23.4%) of the basic cycle and 36 (76.6%) of the clinical cycle and internship. Professors at Universidade Brasil consider that the themes are extensivily addressed in their classes, although they are not described in most of the modules\u27 teaching plans. Medical education in Brazil needs a qualitative leap, and that leap is certainly in the area of patient safety.  In the context of implementation, the multiprofessional edition of the World Health Organization (WHO) patient safety curriculum guide can be used as guidance and a current and very promising development in relation to the acquisition and examination of the skills necessary for safe care for the patient is the establishment of interprofessional training wards. Considering that medical students are the future driving force of change in health care, it is necessary to encourage quality improvement and patient safety education to offer the patient-centered. The graduation, at any time and since day one, is the moment of formation, therefore favorable to the teaching of this topic for students in the health care field, and all teachers should be involved with these contents.

Superfície de resposta e adubação orgânica e fosfatada para a cultura do pinhão-manso

O pinhão-manso é uma planta perene e concentra apreciáveis quantidades de óleo em suas sementes. Objetivou-se avaliar o crescimento da cultura de pinhão-manso em resposta a diferentes recomendações de adubação quanto à matéria orgânica e fósforo em condições irrigadas. Conduziu-se experimento em vasos, com delineamento de blocos casualizados, com tratamentos de combinação fatorial 4 x 4, sendo 4 recomendações de adubação orgânica: ausência de adubação (0 t ha-1), dose recomendada (4 t ha-1), uma vez e meia a dose recomendada (6 t ha-1) e duas vezes a dose recomendada (8 t ha-1), e 4 recomendações de adubação fosfatada (ausência de fosfatado (0 kg ha-1); dose recomendada (90 kg ha-1); uma vez e meia a dose recomendada (135 kg ha-1) e duas vezes a dose recomendada (180 kg ha-1), em quatro repetições, uma planta por parcela. Avaliou-se o crescimento aos 60, 90, 120, 150, 180 e 210 dias após o transplantio, através da mensuração da Altura da Planta, Diâmetro Caulinar, Número de Folhas, Área Foliar e o Número de Ramos. A recomendação de adubação orgânica e fosfatada sugerida pelo laboratório foi insuficiente para o crescimento das plantas do pinhão-manso. O uso isolado de matéria orgânica na cultura do pinhão-manso promove efeitos positivos sobre todas as variáveis de crescimento estudadas

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy

Hexapoda Yearbook (Arthropoda: Mandibulata: Pancrustacea) Brazil 2020: the first annual production survey of new Brazilian species

This paper provided a list of all new Brazilian Hexapoda species described in 2020. Furthermore, based on the information extracted by this list, we tackled additional questions regarding the taxa, the specialists involved in the species descriptions as well as the journals in which those papers have been published. We recorded a total of 680 new Brazilian species of Hexapoda described in 2020, classified in 245 genera, 112 families and 18 orders. These 680 species were published in a total of 219 articles comprising 423 different authors residing in 27 countries. Only 30% of these authors are women, which demonstrates an inequality regarding sexes. In relation to the number of authors by species, the majority of the new species had two authors and the maximum of authors by species was five. We also found inequalities in the production of described species regarding the regions of Brazil, with Southeast and South leading. The top 10 institutions regarding productions of new species have four in the Southeast, two at South and with one ate North Region being the outlier of this pattern. Out of the total 219 published articles, Zootaxa dominated with 322 described species in 95 articles. The average impact factor was of 1.4 with only seven articles being published in Impact Factors above 3, indicating a hardship on publishing taxonomic articles in high-impact journals.The highlight of this paper is that it is unprecedent, as no annual record of Hexapoda species described was ever made in previous years to Brazil.Fil: Silva Neto, Alberto Moreira. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Lopes Falaschi, Rafaela. Universidade Estadual do Ponta Grossa; BrasilFil: Zacca, Thamara. Universidade Federal Do Rio de Janeiro. Museu Nacional; BrasilFil: Hipólito, Juliana. Universidade Federal da Bahia; BrasilFil: Costa Lima Pequeno, Pedro Aurélio. Universidade Federal de Roraima; BrasilFil: Alves Oliveira, João Rafael. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Oliveira Dos Santos, Roberto. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Heleodoro, Raphael Aquino. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Jacobina, Adaiane Catarina Marcondes. Universidade Federal do Paraná; BrasilFil: Somavilla, Alexandre. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Camargo, Alexssandro. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: de Oliveira Lira, Aline. Universidad Federal Rural Pernambuco; BrasilFil: Sampaio, Aline Amanda. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: da Silva Ferreira, André. Universidad Federal Rural Pernambuco; BrasilFil: Martins, André Luis. Universidade Federal do Paraná; BrasilFil: Figueiredo de Oliveira, Andressa. Universidade Federal do Mato Grosso do Sul; BrasilFil: Gonçalves da Silva Wengrat , Ana Paula. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; BrasilFil: Batista Rosa, Augusto Henrique. Universidade Estadual de Campinas; BrasilFil: Dias Corrêa, Caio Cezar. Universidade Federal Do Rio de Janeiro. Museu Nacional; BrasilFil: Costa De-Souza, Caroline. Museu Paraense Emilio Goeldi; BrasilFil: Anjos Dos Santos, Danielle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Centro de Investigación Esquel de Montaña y Estepa Patagónica. Universidad Nacional de la Patagonia "San Juan Bosco". Centro de Investigación Esquel de Montaña y Estepa Patagónica; ArgentinaFil: Pacheco Cordeiro, Danilo. Instituto Nacional Da Mata Atlantica; BrasilFil: Silva Nogueira, David. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Almeida Marques, Dayse Willkenia. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Nunes Barbosa, Diego. Universidade Federal do Paraná; BrasilFil: Mello Mendes, Diego Matheus. Instituto de Desenvolvimento Sustentável Mamirauá; BrasilFil: Galvão de Pádua, Diego. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Silva Vilela, Diogo. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Gomes Viegas, Eduarda Fernanda. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; BrasilFil: Carneiro dos Santos, Eduardo. Universidade Federal do Paraná; BrasilFil: Rodrigues Fernandes, Daniell Rodrigo. Ministério da Ciência, Tecnologia, Inovações. Instituto Nacional de Pesquisas da Amazônia; Brasi

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp