O Programa de Aquisição de Alimentos (PAA) em Cuiabá-MT na Ótica da Nova Economia Institucional

O Programa de Aquisição de Alimentos (PAA), em Cuiabá-MT, foi analisado na ótica da nova economia institucional quanto à operacionalização e metas; resultados produtivos; e eventuais dificuldades ou imperfeições na gestão. Fez-se análise estatística das variáveis tecnológicas assim como produção e área, comparando-se grupos dos participantes e dos não participantes do PAA. Os resultados indicaram que o programa estava sendo executado com algumas dificuldades ou imperfeições devido à sua estrutura de governança. As metas do programa foram avaliadas tanto no âmbito do “MDS-Prefeitura” como de “MDSCONAB”. Houve diferença favorável ao grupo do PAA quanto à participação em organizações. Não existiu diferença na produção média entre os grupos participantes e não participantes; e foram detectados filtros institucionais em ambos os níveis de análise

Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy. Is schistosomiasis hypertension an important confounding factor?

INTRODUCTION: Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years. Pulmonary thromboendarterectomy for select patients is a potentially curative procedure when correctly applied. In Brazil, the clinical and hemodynamic profiles of chronic thromboembolic pulmonary hypertension patients have yet to be described. OBJECTIVES: To evaluate the clinical and hemodynamic characteristics of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment in Brazil. METHODS: From December 2006 to November 2009, patients were evaluated and scheduled for pulmonary thromboendarterectomy. The subjects were classified according to gender, age and functional class and were tested for thrombofilia and brain natriuretic peptide levels. RESULTS: Thirty-five consecutive chronic thromboembolic pulmonary hypertension patients were evaluated. Two patients tested positive for schistosomiasis, and 31 were enrolled in the study (19 female, 12 male). The majority of patients were categorized in functional classes III and IV. Hemodynamic data showed a mean pulmonary vascular resistance (PVR) of 970.8 ± 494.36 dynas·s·cm-5 and a low cardiac output of 3.378 ± 1.13 L/min. Linear regression revealed a direct relation between cardiac output and pulmonary vascular resistance. Paradoxical septal movement was strongly correlated with pulmonary vascular resistance and cardiac output (p=0.001). Brain natriuretic peptide serum levels were elevated in 19 of 27 patients. CONCLUSIONS: In a referral center for pulmonary hypertension in Brazil, chronic thromboembolic pulmonary hypertension patients evaluated for pulmonary thromboendarterectomy had a hemodynamically severe status and had elevated brain natriuretic peptide serum levels. There was a predominance of females in our cohort, and the prevalence of hematological disorders and schistosomiasis was low (less than 10%)

Conocimiento nutricional y hábitos alimenticios de la Selección Brasileña de Fútbol Sala

Introduction: Futsal is a sport that requires nutritional support to support the high-energy expenditure and significant loss of fluids and electrolytes during training and matches. It is important that high-level athletes follow appropriate, evidence-based nutrition. To our knowledge, there is a lack of data on the eating habits and nutrition knowledge of Futsal players. Therefore, this study aims to describe the nutritional knowledge and eating habits of players of the national Brazilian Futsal Team. A secondary aim was to translate the Abridged Nutrition for Sport Questionnaire into Portuguese for use in Portuguese-speaking athletes. Material and methods: This is a cross-sectional and descriptive study. The evaluations were carried out during the preparation period of the Brazilian Futsal Team for the FIFA Futsal World Cup 2020 qualifiers.  We evaluated anthropometry (weight, height, body mass index) nutritional knowledge (assessed using a translated version of the Abridged Nutrition for Sport Knowledge Questionnaire) and eating habits (assessed using a validated Brazilian FFQ), as well as supplement use. The translation of the ANSKQ was undertaken using previous validated forward-backward translation procedures. Results: The mean total correct score on the ANSKQ was 12 out of a possible 35 (34.45%). The mean total correct score on the ANSKQ was 12 out of a possible 35 (34.45%). Players had a statistically significantly higher score for “General Nutrition” knowledge than Sports Nutrition Knowledge (47.27% vs 28.53%, p<0.005). Futsal players had infrequent consumption of the food group "Milk and dairy products", and frequent consumption of "Snacks" as well as fruits. Regarding dietary supplements, 46% of athletes said they consume, or previously consumed, with Whey Protein being the most common supplement. Conclusions: There is room from improvement in athletes nutrition knowledge, especially sports specific knowledge. Futsal players may also require education on appropriate supplement use and dietary intake.Introducción: El fútbol sala es un deporte que requiere un apoyo nutricional para soportar el alto gasto energético y pérdida significativa de líquidos y electrolitos durante los entrenamientos y partidos. Por tanto, este estudio tiene como objetivo describir el conocimiento nutricional y los hábitos alimenticios de los jugadores de la Selección Brasileña de Fútbol Sala. Un objetivo secundario fue traducir el Cuestionario abreviado de conocimiento sobre Nutrición para el deporte (ANSKQ) para su uso en atletas que hablan portugués. Material y métodos: Se trata de un estudio descriptivo y transversal. Las evaluaciones ocurrieron durante el período de preparación de la Selección Brasileña de Fútbol Sala para las eliminatorias del Mundial de Fútbol Sala FIFA 2020. Evaluamos la antropometría (peso, altura, índice de masa corporal), el conocimiento nutricional (versión traducida del ANSKQ) y los hábitos alimentarios (FFQ brasileño validado), así como el uso de suplementos. La traducción del ANSKQ se llevó a cabo utilizando procedimientos de traducción previamente validados. Resultados: La puntuación media de aciertos en el ANSKQ fue de 12 (de 35) (34.45%). Los jugadores obtuvieron una puntuación estadísticamente significativa más alta en el conocimiento de “Nutrición general” que en el Conocimiento de nutrición deportiva (47,27% frente a 28,53%, p <0,005). Los jugadores de fútbol sala tenían un consumo poco frecuente del grupo "Leche y productos lácteos", y un consumo frecuente de "Snacks" y frutas. A respecto de los suplementos alimenticios, el 46% de los deportistas afirmaron consumir, o haber consumido, siendo la proteína de suero el suplemento más habitual. Conclusiones: Hay margen de mejora en el conocimiento nutricional de los atletas, especialmente en los conocimientos específicos de nutrición deportiva. Los jugadores de fútbol sala también pueden requerir orientación sobre el uso apropiado de suplementos y la ingesta dietética

Performance of the Titanium-Nitride-Oxide Coated Stent in Patients with Multivessel Coronary Artery Disease

ABSTRACTBackgroundTo date, there are no studies evaluating the use of the titanium-nitride-oxide coated stent in patients with multivessel coronary artery disease. We have compared the performance of the Titan-2® stent to that of the second generation drug-eluting stents in this scenario.MethodsFrom 2011 to 2012, 284 patients were treated with the Titan-2® stent, of which 100 (35.2%) had multivessel coronary artery disease. This group was compared to 100 patients, of a group of 304 (38.9%) patients with multivessel coronary artery disease treated with second generation drug-eluting stents with durable or biodegradable polymers. The primary endpoint was the occurrence of major adverse cardiovascular events at 1 year.ResultsClinical, angiographic and procedure-related characteristics of the patients did not show differences between groups. Most patients in the Titan-2® group were male (70%), mean age was 68.4 ± 12.9 years and 25% were diabetic. Stable symptomatic patients were prevalent (68%), 51% had three-vessel disease and ventricular function was preserved (55.6 ± 12.7%). The incidence of major adverse cardiovascular events at 1 year in the Titan-2® group was 21% (vs. 17%; p = 0.59), death was observed in 3% (vs. 2%; p > 0.99) of the patients, acute myocardial infarction in 5% (vs. 4%; p > 0.99) and a new revascularization procedure in 13% (vs. 11%; p = 0.83). Definitive stent thrombosis was not observed in either group.ConclusionsThe Titan-2® stent showed similar results to those of the second-generation drug-eluting stents, which makes it attractive for use in the complex scenario of patients with multivessel coronary artery disease.RESUMODesempenho do Stent Recoberto por Titânio-Óxido Nítrico em Pacientes com Doença Coronária MultiarterialIntrodçãoAté o momento, nenhum estudo avaliou o stent recoberto por titânio-óxido nítrico em pacientes com doença arterial coronariana multiarterial. Comparamos o desempenho do stent Titan-2® ao stents farmacológicos de segunda geragao nesse cenário.MétodosNo período de 2011 a 2012, 284 pacientes foram tratados com o stent Titan-2®, dos quais 100 (35,2%) eram portadores de doença arterial coronariana multiarterial. Esse grupo foi comparado a 100 pacientes, de um grupo de 304 (38,9%), com doença arterial coronariana multiarterial, tratados com o stent farmacológico de segunda geração com polímeros duráveis ou biodegradáveis. O desfecho primário foi a ocorrência de eventos cardíacos adversos maiores em 1 ano.ResultadosCaracterísticas clínicas, angiográficas e do procedimento não apresentaram diferenças entre os grupos. A maioria dos pacientes do grupo Titan-2® era do sexo masculino (70%), com idade de 68,4 ± 12,9 anos e 25% eram diabéticos. Predominaram os quadros clínicos estáveis (68%), 51% tinham acometimento triarterial e a função ventricular estava preservada. A incidência de eventos cardiovasculares adversos maiores em 1 ano no grupo Titan-2® foi de 21% (vs. 17%; p = 0,59), óbito ocorreu em 3% (vs. 2%; p > 0,99) dos pacientes, infarto do miocárdio em 5% (vs. 4%; p > 0,99) e nova revascularização miocárdica em 13% (vs. 11%; p = 0,83). Não foram constatadas tromboses de stent definitivas em nenhum grupo.ConclusõesO uso do Titan-2® apresentou resultados similares aos do stent farmacológico de segunda geração, o que o torna atrativo para ser utilizado no complexo cenário de pacientes portadores de doença arterial coronariana multiarterial

Influence of dental erosion on shear bond strength of ceramic brackets bonded with two different adhesive systems: an in vitro study

This study aimed to analyze the shear bond strength (SBS) of ceramic orthodontic brackets bonded with two different adhesive systems to intact and eroded teeth. Ceramic brackets were bonded to 72 bovine central incisors divided into four groups, defined by two study factors: enamel condition (control group, kept in artificial saliva; and experimental group, eroded by using immersion cycles in Coke™ for 90 seconds, every six hours for five days), and adhesive system type (Transbond™ XT or Transbond™ Plus Color Change). Polycrystalline ceramic brackets were adhesively fixed on all specimens using the same light curing protocol. SBS was tested using 0.5 mm/min and the failure mode was classified. SBS data was analyzed using two-way ANOVA followed by Tukey test. The adhesive remnant index (ARI) scores were analyzed using Kruskal-Wallis test with Dunn's post-hoc pairwise comparison (α=0.05). Percentages of ARI scores between the groups were compared by Fisher’s exact test. Spearman's correlation coefficient was applied to investigate the correlation between ARI scores and SBS values. Only the adhesive system factor had significant effect on SBS (p=0.014), Transbond™ Plus Color Change showing higher values. No significance was found for enamel condition (p=0.665) or the interaction between adhesive system and enamel condition (p=0.055). ARI scores frequencies differed between groups (p<0.001). The median ARI scores were statistically different for most comparisons among the groups. However, no significant correlation was found between ARI scores and SBS. In conclusion, the type of adhesive system affected the SBS of ceramic brackets to dental enamel, but the enamel condition, intact or eroded, had no significant effect. There was no correlation between ARI scores and SBS values, although eroded enamel tended to retain more adhesive after bracket removal

Prevention of hypertension in patients with pre-hypertension: protocol for the PREVER-prevention trial

<p>Abstract</p> <p>Background</p> <p>Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a population-based intervention to prevent the incidence of hypertension and the development of target-organ damage.</p> <p>Methods</p> <p>This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.</p> <p>Discussion</p> <p>The early use of blood pressure-lowering drugs, particularly diuretics, which act on the main mechanism of blood pressure rising with age, may prevent cardiovascular events and the incidence of hypertension in individuals with hypertension. If this intervention shows to be effective and safe in a population-based perspective, it could be the basis for an innovative public health program to prevent hypertension in Brazil.</p> <p>Trial Registration</p> <p>Clinical Trials <a href="http://www.clinicaltrials.gov/ct2/show/NCT00970931">NCT00970931</a>.</p

Macro-scale (biomes) differences in neotropical stream processes and community structure

The definition of conservation strategies and ecological assessment schemes requires understanding ecosystem patterns over multiple spatial scales. This study aimed to determine if macro-scale structural and functional (processes) patterns associated with stream ecosystems differed among three neotropical biomes (Cerrado, Amazon, Atlantic Forest). We compared the aquatic communities (benthic invertebrates and hyphomycetes) and processes (decomposition rates, primary production and biofilms growth and aquatic hyphomycetes reproduction rates-sporulation) of Cerrado stream sites (neotropical savannah) against those of stream sites in the connecting biomes of the Atlantic Forest and Amazon (rainforests). We expected that, contrary to the biome dependency hypothesis the community structure and processes rates of streams at the biome-scale would not differ significantly, because those ecosystems are strongly influenced by their dense riparian forests, which have a transitional character among the three biomes. Fifty-three stream sites were selected covering a wide range of geographic locations (Table 1), from near the Equator (2° S) in the Amazon, to intermediate latitudes in the Cerrado (12-19° S), and latitudes closer to the tropic of Capricorn in the Atlantic Forest (19º-25° S). We found that: 1) at the abiotic level, the aquatic ecosystems of the three biomes differed, which was mostly explained by large-scale factors such as temperature, precipitation and altitude; 2) functional and structural variables did not behave similarly among biomes: decomposition and sporulation rates showed larger differences among biomes than invertebrate and aquatic hyphomycete assemblages structure; 3) invertebrate assemblages structure differed between the rainforests and Cerrado but not between rainforests (Amazon and Atlantic Forest) whereas aquatic hyphomycetes were similar among all biomes; 4) biofilm growth and algae concentration in biofilms of artificial substrates were highly variable within biomes and not significantly different between biomes. Overall, aquatic ecosystem processes and community structure differed across biomes, being influenced by climatic variables, but the variation is not as pronounced as that described for terrestrial systems. Considering the potential use of these functional and structural indicators in national-wide ecological assessments, our results indicate the need to define different reference values for different biomes, depending on the variable used. The approach followed in this study allowed an integrative analysis and comparison of the stream ecosystems across three tropical biomes, being the first study of this kind. Future studies should try to confirm the patterns evidenced here with more sites from other areas of the three biomes, and especially from the Amazon, which was the least represented biome in our investigation. © 201

Evaluation of urinary biomarkers in the follow-up of ureteropelvic junction obstruction in children

Introdução: Postula-se que o aumento do metabolismo das proteínas da matriz extracelular está associado à fibrose tecidual no contexto de estenose de junção ureteropélvica (EJUP). O manejo ideal da EJUP permanece discutível. Este estudo casocontrole prospectivo teve como objetivo investigar se os níveis urinários de proteínas da matriz extracelular são úteis para discernir os pacientes com hidronefrose obstrutiva daqueles com hidronefrose não obstrutiva em crianças com hidronefrose unilateral secundária à obstrução ao nível da junção pieloureteral. Métodos: Setenta e quatro pacientes foram incluídos no estudo. Concentrações urinárias de metaloproteinases de matriz extracelular (MMP) -1, -2, -9 e -10 e os inibidores de metaloproteinases (TIMP) -1 e -2, valores absolutos e normalizados pela creatinina (Cr) urinária, bem como as características clínicas (grau de hidronefrose, função renal diferencial e t1 / 2) foram registradas nos seguintes grupos de pacientes de mesma idade: 26 crianças com hidronefrose obstrutiva no diagnóstico inicial e durante o pós-operatório da correção cirúrgica (grupo hidronefrose obstrutiva); 22 crianças com hidronefrose não obstrutiva no momento do diagnóstico e após seis meses de observação (grupo hidronefrose não obstrutiva); e 26 crianças sem qualquer condição do trato urinário (grupo controle). Os resultados foram avaliados estatisticamente usando para grupos homogêneos, uma análise de variância unilateral (ANOVA) e para grupos não paramétricos, teste de Mann-Whitney ou teste de Kruskal-Wallis. Resultados: Comparando as amostras iniciais, MMP-1, MMP-2, MMP-10 TIMP-1 e TIMP-2 apresentaram maior concentração no grupo hidronefrose obstrutiva e menor concentração no grupo controle. Os níveis de MMP-9 foram menores no grupo controle, mas maiores no hidronefrose não obstrutiva. A análise das curvas ROC mostrou um perfil diagnóstico melhor para a detecção de hidronefrose obstrutiva para MMP-2/Cr (área sob a curva ASC - de 0,655), TIMP-1/Cr (ASC - de 0,692) e TIMP-2/Cr (ASC de 0,678). A avaliação dos parâmetros no grupo hidronefrose obstrutiva, no pré e pós-operatório apresentou queda na concentração urinária de TIMP-1 e TIMP-2 e aumento na concentração urinária de MMP-1, MMP- 2, MMP-9 e MMP-10. Todas as proteínas analisadas permaneceram estáveis no grupo hidronefrose não obstrutiva no momento do diagnóstico e após seis meses de observação. Conclusão: Demonstramos que os pacientes pediátricos com hidronefrose obstrutiva apresentam concentrações significativamente maiores de MMP-2, TIMP-1 e TIMP-2. Particularmente, os níveis de TIMP-2 foram correlacionados à gravidade da obstrução e, portanto, pode ser um biomarcador urinário útil para alocar corretamente as crianças com EJUP entre o tratamento cirúrgico e o seguimento conservador. Após a pieloplastia, TIMP-1 e TIMP-2 apresentaram diminuição progressiva no pós-operatório, o que também é altamente desejável para marcadores urinários.Introduction: Extracellular matrix proteins have been found to be associated with tissue fibrosis in the setting of ureteropelvic junction obstruction (UPJO). The ideal management of UPJO remains debatable. This prospective case-control study aimed to investigate whether urinary levels of extracellular matrix proteins (associated to tissue fibrosis) are useful to discriminate the severity of urinary obstruction in children with unilateral ureteropelvic junction obstruction (UPJO). Methods: Seventy-four patients were enrolled in the study. Urinary matrix metalloproteinases (MMP) -1, -2, -9, -10 and metalloproteinase inhibitors (TIMP) -1 and -2 as well as clinical characteristics (hydronephrosis grade, differential renal function and t1/2) were measured in the following age-matched groups: 26 children with obstructive hydronephroses HN at initial diagnosis and during six months after dismembered pyeloplasty; 22 children with non-obstructive HN at diagnosis and after six months of observation; and 26 children without any urinary tract condition, as the control group. Results were assessed statistically using for homogenous groups, a one-way analysis of variances (ANOVA) and for nonparametric groups, MannWhitney test or Kruskal Wallis test was performed. Results: Comparing the initial samples, uMMP-1/Cr, uMMP-2/Cr, uMMP-10/Cr uTIMP-1/Cr and u-TIMP-2/Cr had higher concentration in obstructive HN group and lower concentration in control group. The uMMP-9/Cr levels were lower in control group, but higher in non-obstructive HN group. The ROC curves analysis showed a promising diagnostic profile for the detection of obstructive HN for uMMP-2/Cr (area under the curve AUC of 0.655), uTIMP-1/Cr (AUC of 0.692) and uTIMP-2/Cr (AUC of 0.678). The follow-up evaluation in the obstructive HN group, pre- and postoperatively depicted fall in urinary concentration of uTIMP-1/Cr and uTIMP-2/Cr and increase in urinary concentration of uMMP-1/Cr, uMMP-2/Cr, uMMP-9/Cr and uMMP-10/Cr. All analyzed proteins were stable in non-obstructive HN at diagnosis and after six months of observation. Conclusion: We demonstrated that pediatric patients with obstructive HN have significantly higher uMMP-2, uTIMP-1 and uTIMP-2 concentrations. Particularly, uTIMP-2 levels were correlated to severity of the obstruction and therefore, it might be a useful urinary biomarker to correctly allocate children with HN between surgical management vs follow-up. After pyeloplasty, uTIMP-1 and uTIMP-2 presented a progressive decrease postoperatively, which is also highly desirable for urinary markers