Embolização das arterias uterinas como tratamento de miomas sintomaticos

Orientadores: Gustavo Antonio de Souza, Cecilia Maria Roteli MartinsTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasDoutorad

Educomunicação e diversidade: múltiplas abordagens

Esta coletânea de capítulos intitulada “Educomunicação e Diversidade: múltiplas abordagens” reúne estudos apresentados no VI Encontro Brasileiro de Educomunicação e III EducomSul, realizado em Porto Alegre em 2015. Nessa obra, percebe-se que as dimensões interculturais, transversais e cidadãs suscitadas pela educomunicação vêm contribuindo para o aumento de intervenções comunicacionais diversas, em termos de linguagens e de conteúdos, em práticas educativas formais e não formais. Denotando a diversidade como uma área em expansão na educomunicação

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Contribuição ao estudo do doppler colorido associado a ultra-sonografia na avaliação da resposta a quimioterapia neo-adjuvante no carcinoma de mama localmente avançado

Orientadores: Gustavo Antonio de Souza, Sophie F.M. DerchainDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: o objetivo deste trabalho foi comparar os tamanhos dos tumores mamários localmente avançados através dos métodos clínicos, mamográficos e ultra-sonográficos e descrever os parâmetros do doppler associado à ultra sonografia, avaliados antes e depois da quimioterapia primária. Os sujeitos deste estudo foram 18 mulheres com o diagnóstico de carcinoma da mama acompanhadas no Hospital e Maternidade Leonor Mendes de Barros, com tumor primário clínico maior ou igual a 50mm. As mulheres foram submetidas à palpação, mamografia, ultra-sonografia e doppler associado à ultra-sonografia no momento do diagnóstico. A seguir, foram submetidas a três ciclos de quimioterapia com 5-fluoracil, adriamicina e ciclofosfamida e realizaram novamente os exames citados. O exame clínico foi o que mostrou-se como o melhor método para avaliar o tamanho dos tumores. A mamografia permitiu avaliar menos da metade dos casos e a ultra-sonografia não acrescentou maiores informações do que a palpação. Após a identificação de casos com resposta (redução do tamanho clínico ~50% e tamanho ultra-sonográfico :2:25%) e sem resposta (redução do tamanho ~línico <50% e ou <25% do tamanho . ultra-sonográfico), observou-se que o índice de resistência, pulsatilidade, coeficiente AIS apresentaram uma variação significativamente diferente na pré e pós-quimioterapia no grupo sem resposta e, ainda, quando comparadas as suas diferenças, observou-se que a velocidade média apresentou-se significativamente diferente, nestes grupos. Observou-se um padrão diferente das médias na pré-quimioterapia, principalmente das velocidades máxima e média que talvez possam predizer a resposta à quimioterapia. Utilizando os valores das médias do grupo com resposta como corte para estes dois parâmetros, pôde-se estabelecer uma sensibilidade de 67% e uma especificidade de 89% para predição da resposta. A finalidade deste estudo foi contribuir para obter-se um método seguro para a avaliação da resposta na pré e pós-quimioterapia e tentar mostrar novos caminhos capazes de predizerem a respostaAbstract: The objective of this study was to compare the sizes of locally advanced breast tumors through clinical, mammographic and ultrasonographic methods and describe the parameters of color doppler ultrasound evaluated before and afier of the primary chemotherapy. A total of 18 women with the diagnosis of breast carcinoma were carried out at the Hospital e Maternidade Leonor Mendes de Barros, with clinical primary tumors equal or bigger than 50mm. These women were submitted to palpation, mammography, ultrasound and color doppler ultrasound at the moment of diagnosis. Following up, they were submitted to three cycles of chemotherapy with F AC and afier completing the primary antiblastic therapy, a second round of the same exams was performed. The clinical exam turned up to be the most efficient method to evaluate the size of tumors. The mammography helped to evaluate less than half the number of cases and the ultrasonography was of no use in increasing the accuracy already obtained with palpation. Afier the identification of cases with response (reduction of clinical size ~50% and ultrasonographical size ;;:Q5%) , and with no response (reductio~ of clinical size <50% and either <25% . of ultrasonographical), it was observed that the resistance index, pulsatibility and AIS coefficient presented a significant variation that differed from pre and pos-chemotherapy in the group with no response. When the pos and pre differences were compared, it was observed that the average speed presented itself different in the groups. A different pattern of the pre-chemotherapy average was observed, specially in the maximum and average speeds that may predict the response to the chemotherapy. Using the values of the average from the group with response for both parameters, one can establish a sensitivity of 67% and a specificity of 89% to predict the response. The aim of this study was to contribute in obtaining a safe method to evaluate pre and pos chemotherapy response and try to show new ways to predict it using color doppler ultrasoundMestradoTocoginecologiaMestre em Medicin

Design, Synthesis, Experimental and Theoretical Characterization of a New Multitarget 2-Thienyl-<i>N</i>-Acylhydrazone Derivative

Pulmonary arterial hypertension (PAH) is a chronic cardiovascular disease that displays inflammatory components, which contributes to the difficulty of adequate treatment with the available therapeutic arsenal. In this context, the N-acylhydrazone derivative LASSBio-1359 was previously described as a multitarget drug candidate able to revert the events associated with the progression of PAH in animal models. However, in spite of having a dual profile as PDE4 inhibitor and adenosine A2A receptor agonist, LASSBio-1359 does not present balanced potencies in the modulation of these two targets, which difficult its therapeutic use. In this paper, we describe the design concept of LASSBio-1835, a novel structural analogue of LASSBio-1359, planned by exploiting ring bioisosterism. Using X-ray powder diffraction, calorimetric techniques, and molecular modeling, we clearly indicate the presence of a preferred synperiplanar conformation at the amide function, which is fixed by an intramolecular 1,5-N∙∙∙S &#963;-hole intramolecular interaction. Moreover, the evaluation of LASSBio-1835 (4) as a PDE4 inhibitor and as an A2A agonist confirms it presents a more balanced dual profile, being considered a promising prototype for the treatment of PAH