Cooperação Internacional no Âmbito da Educação Profissional: O programa de capacitação docente do Centro Paula Souza e do Servicio Nacional de Adiestramiento en Trabajo Industrial

O CONGRESSO DE INTERNACIONALIZAÇÃO DA EDUCAÇÃO SUPERIOR – CIES 2019 é um evento in- ternacional, que reúne professores, pesquisadores e estudantes de graduação e pós-graduação para divulgar a produção científica no campo da Internacionalização do Ensino Superior e fortalecer a cooperação internacional entre diferentes instituições de ensino e grupos de pesquisa no âmbito do MERCOSUL. A iniciativa é fruto de uma parceria entre pesquisadores da Universidade Federal da Integra- ção Latino-Americana (UNILA - Brasil), a Universidad Nacional del Litoral (UNL - Argentina), a Uni- versidad Nacional de Asunción (UNA - Paraguay) e a Universidad de la República (UDeLaR - Uru- guay), que atuam em projetos vinculados ao Setor Educacional do MERCOSUL, no Núcleo de Estudos e Investigações em Educação Superior. O evento será realizado nos dias 4, 5 e 6 de Setembro de 2019 no campus PTI da UNILA, dentro do Parque Tecnológico da Usina Hidrelétrica de Itaipu, na cidade de Foz do Iguaçu, Paraná, Brasil. A UNILA, sede do evento, é uma universidade temática criada em 2010 pelo governo federal do Brasil com a missão institucional de formar recursos humanos aptos a contribuir com a integra- ção latino-americana, com o desenvolvimento regional e com o intercâmbio cultural, científico e educacional da América Latina, especialmente no MERCOSUL. Sua finalidade, portanto, é conver- ter-se em um espaço de encontros, de trocas e de aprendizagem mútua, que reforçam o compro- misso em prol da pertinência, da excelência e da construção sustentável de um mundo melhor.O presente estudo refere-se à análise crítica de um dos programas resultantes da parceria entre duas instituições dedicadas à promoção da educação profissional e tecnológica (EPT): o Centro Paula Souza (CPS), autarquia do governo do estado de São Paulo, Brasil e o Servicio Nacional de Adiestramiento en Trabajo Industrial (SENATI), com sede em Lima, no Peru. O acordo entre as instituições congêneres data de 2011 e viabiliza a troca de conhecimentos técnicos e científicos por meio da participação dos alunos do SENATI nas Feiras Tecnológicas do CPS e na capacitação dos instrutores da instituição peruana, ministrada por docentes brasileiros. O trabalho a ser apresentado é um estudo de caso referente a esta última prática, no que tange a análise da cooperação sul-sul entre duas instituições dedicadas à EPT à luz do conceito de cooperação horizontal1 e pretende refletir os desafios e as oportunidades encontrados no âmbito da interação cultural e linguística.Núcleo de Estudios e Investigaciones en Educación Superior del Mercosur - NUCLEO Grupo Interdisciplinar de Pesquisa em Educação na América Latina – EducAL/UNILA Instituto Mercosul de Estudos Avançados – IMEA/UNILA Pró-Reitoria de Relações Institucionais e Internacionais – PROINT/UNIL

Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing

Introduction: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). Objectives: To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. Methods: Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. Results: All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. Conclusions: IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival

BAG3 Genetic Cardiomyopathy May Overlap Fulminant Myocarditis Clinical Findings.

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The management of heart failure cardiogenic shock:an international RAND appropriateness panel

Background: Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. Methods: A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate). Results: Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. Conclusion: This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines

Venoarterial Extracorporeal Membrane Oxygenation with or without Simultaneous Intra-Aortic Balloon Pump Support as a Direct Bridge to Heart Transplantation: Results from a Nationwide Spanish Registry

[Abstract] OBJECTIVES To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). RESULTS There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02–4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56–1.58). CONCLUSIONS In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality

Preoperative toxoplasma gondii serostatus does not affect long-term survival of cardiac transplant recipients: analysis of the Spanish Heart Transplantation Registry

[Abstract] Background. It's unclear whether pre-transplant T. gondii seropositivity is associated with impaired survival in heart transplant recipients. Objectives. To test the above-mentioned hypothesis in the Spanish Heart Transplantation Registry. Methods. Post-transplant outcomes of 4048 patients aged > 16 years who underwent first, single-organ heart transplantation in 17 Spanish institutions from 1984 to 2014 were studied. Long-term post-transplant survival and survival free of cardiac death or retransplantation of 2434 (60%) T. gondii seropositive recipients and 1614 (40%) T. gondii seronegative recipients were compared. Results. T. gondii seropositive recipients were older, had higher body mass index, and presented higher prevalence of hypertension, hypercholesterolemia, COPD and Cytomegalovirus seropositivity than T. gondii seronegative recipients. In univariable analysis, pre-transplant T. gondii seropositivity was associated with increased post-transplant all-cause mortality (non-adjusted HR 1.15; 95% CI 1.04–1.26). However, this effect was no longer statistically significant after multivariable adjustment by recipient's age and sex (adjusted HR 1.01, 95% CI 0.92–1.11). Extended multivariable adjustment by other potential confounders showed similar results (adjusted HR 0.99, 95% CI 0.89–1.11). T. gondii seropositivity had no significant effect on the composite outcome cardiac death or retransplantation (non-adjusted HR 1.08, 95% CI 0.95–1.24, p = 0.235). The distribution of the causes of death was comparable in T. gondii seropositive and T. gondii seronegative recipients. No statistically significant impact of donor's T. gondii serostatus or donor-recipient T. gondii serostatus matching on post-transplant survival was observed. Conclusions. Our analysis did not show a significant independent effect of preoperative T. gondii serostatus on long-term outcomes after heart transplantation

Literature:a potentially open place to the misconception and to the alterity in ELE classes for the Brazilians

Diante do processo de instrumentalização de que vem sendo objeto a língua espanhola nas práticas de ensino aprendizado, nas quais fica reduzida a uma língua veicular a serviço de resolver as urgências do sujeito contemporâneo, entendido como um sujeito pragmático, propomos trabalhar o texto literário como um suporte ligado a experiências de leitura nessas práticas. Pensamos que dessa forma poderíamos oferecer uma certa resistência à referida redução da língua, pois, nossa hipótese é que a materialidade do texto literário torna possível o confronto entre um sujeito e duas dimensões que consideramos que não devem ser escamoteadas, tal como, a nosso ver, acontece no processo de instrumentalização de que falamos. Este, de fato, não apenas evita a dimensão do equívoco mas também contorna a exposição à alteridade. De nossa perspectiva, determinados textos literários apresentam de forma potencializada a não estabilização semântica dos sentidos e exploram a relação com o estranho. Nesse sentido, realizamos uma experiência piloto com aprendizes brasileiros de língua espanhola que nos permitiu constituir um corpus no qual a partir do lugar teórico da Análise do Discurso de linha francesa analisamos as imagens detectadas nas respostas dos aprendizes aos questionários aplicados ao longo do processo, bem como as produções escritas por eles realizadas durante mesmo. Nessa análise, detectamos deslocamentos tanto no nível do registro imaginário quanto no da elaboração simbólica.In teaching learning practices, the Spanish language has been suffering from the instrumentalization process in which it is transformed in a vector language so as to solve the contemporary subject urgencies, being this subject understood as a pragmatic subject. We propose here to deal with the literary text as a support linked to reading experiences in these practices and in this way we thought be possible to offer a certain resistance to the language usage as mentioned above. Our hypothesis is that the literary text materiality makes it possible the confrontation between one subject and two dimensions which, in our view, shouldnt be disguised such as it happens in the instrumentalization process . In fact, this not only would avoid the misconception dimension but also would minimize the exposition to the alterity. From our perspective, certain literary texts present the non-stabilization semantics of the senses in a potentialized form and explore the relation with the strange. In this sense, on the grounds of the Discourse Analysis in the French line of thought , we have done a pilot experience with Brazilian learners of the Spanish language , allowing us to constitute a corpus, in which the detected images in the learners answers to the questionnaires throughout the process are analyzed as well as the written productions. In this analysis, we have detected misplacement both in the imaginary register level and in the symbolic elaboration

Central extracorporeal membrane oxygenation as a bridge to decision in a patient with a ventricular septal rupture complicating a myocardial infarction

In the era of primary percutaneous coronary intervention, mechanical complications after acute myocardial infarction are extremely rare, with an incidence of less than 0.5%. Rupture of the ventricular septum is the least frequent occurrence. Despite early surgical repair, mortality still remains high. Patients who are at high risk of perioperative death include those with cardiogenic shock and multiorgan dysfunction. In this group, a mechanical circulatory support such as an Extracorporeal Membrane Oxygenation circuit could be used as bridge to surgical repair is feasible or heart transplantation, as it provides hemodynamic stability and the potential to correct multiorgan dysfunction. We reported a case pf ECMO device implantation as a bridge to heart transplantation in a patient with post infarction ventricular septal rupture. Unfortunately, while on the waiting list for heart transplantation with maximum priority the patient had massive diffuse alveolar hemorrhage secondary to the anticoagulation required by the equipment and died. Resumen: En la era de la intervención coronaria percutánea primaria, las complicaciones mecánicas tras un infarto de miocardio agudo son extremadamente infrecuentes, con una incidencia de menos del 0,5%. La ruptura del septum ventricular es el caso menos frecuente. A pesar de la reparación quirúrgica, la mortalidad sigue siendo elevada. Los pacientes con alto riesgo de muerte perioperativa incluyen a aquellos con shock cardiógeno y síndrome de disfunción multiorgánica. En este grupo, podría utilizarse soporte circulatorio mecánico, tal como el circuito de oxigenación por membrana extracorpórea, como puente hacia la reparación quirúrgica o trasplante cardiaco, ya que aporta estabilidad dinámica y la posibilidad de corregir el síndrome de disfunción multiorgánica. Se reporta un caso de implantación de dispositivo de membrana extracorpórea, como puente al trasplante cardiaco, en un paciente con ruptura del septum ventricular tras infarto. Lamentablemente, a pesar de estar en lista de espera con prioridad máxima, sufrió una hemorragia alveolar difusa masiva, secundaria a la anticoagulación requerida por el equipo, y falleció. Keywords: Ventricular septal rupture, Extracorporeal membrane oxygenation circuit, Acute myocardial infarction, Palabras clave: Ruptura del septum ventricular, Circuito de oxigenación por membrana extracorpórea, Infarto de miocardio agud