A Europa do século XXI : que realidade monetária e fiscal

Mestrado em Economia Internacional - área de especialização em Estudos Europeusinfo:eu-repo/semantics/publishedVersio

Complicação pós cateterização venosa central: relato de caso / Complication after central venous catheterization: case report

A cateterização intravascular venosa - em especial, cateteres venosos centrais - é um procedimento extremamente frequente em pacientes cirúrgicos. Há diversas complicações a depender do sítio de inserção. Alocação anômala da ponta do cateter na punção de veia subclávia é um exemplo disso. Uma manobra simples que pode ser realizada a fim de minimizar esta complicação é a manobra de Ambesh, sobretudo, para garantir desfecho favorável estes pacientes

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Molecular Profile of Variants in <i>CDH1</i>, <i>TP53</i>, <i>PSCA</i>, <i>PRKAA1</i>, and <i>TTN</i> Genes Related to Gastric Cancer Susceptibility in Amazonian Indigenous Populations

Gastric Cancer is a disease associated with environmental and genetic changes, becoming one of the most prevalent cancers around the world and with a high incidence in Brazil. However, despite being a highly studied neoplastic type, few efforts are aimed at populations with a unique background and genetic profile, such as the indigenous peoples of the Brazilian Amazon. Our study characterized the molecular profile of five genes associated with the risk of developing gastric cancer by sequencing the complete exome of 64 indigenous individuals belonging to 12 different indigenous populations in the Amazon. The analysis of the five genes found a total of 207 variants, of which 15 are new in our indigenous population, and among these are two with predicted high impact, present in the TTN and CDH1 genes. In addition, at least 20 variants showed a significant difference in the indigenous population in comparison with other world populations, and three are already associatively related to some type of cancer. Our study reaffirms the unique genetic profile of the indigenous population of the Brazilian Amazon and allows us to contribute to the conception of early diagnosis of complex diseases such as cancer, improving the quality of life of individuals potentially suffering from the disease

Relationship between clinical and postmortem evaluation in repeat breeder beef cows Relação entre características clínicas e post-mortem em vacas de corte repetidoras de serviço

The objective of this study was to investigate the causes of the repeat breeder syndrome comparing clinical signs and postmortem findings in beef cows. The identification of factors affecting the reproductive tract can support decisions as to whether treatment of repeat breeder cows is justifiable than culling. Since all animals were submitted to clinical examination before being slaughtered, this study has a differential approach when compared with others, where genital tracts from abattoir were examined. In this study, 130 crossbred cows and heifers that have failed to conceive after three or more services were identified, submitted to a clinical examination and blood collection for karyotyping and sent to an abattoir. postmortem examinations included macroscopic evaluation of the genital tracts, bacteriology and histopathology of the uterus. Uterine alterations were predominant followed by oviduct and ovarian pathologies. Histopathological examination was more sensitive as a diagnostic tool than clinical examination. Repeat breeder cows had a predominance of uterine abnormalities (95%), such as inflammatory (42.9%) and degenerative (59.7%) conditions. Oviduct abnormalities were found in 29.8 % of animals. Furthermore, 1 out 10 karyotyped cows showed aneuploidy. Thus, this study stressed the importance of laboratory exams in the diagnosis of the causes of infertility of repeat breeder cows.<br>O objetivo deste estudo foi avaliar as causas de infertilidade em vacas de corte repetidoras de serviço, relacionando sinais clínicos com características laboratoriais post-mortem. A identificação dos fatores que afetam o desempenho reprodutivo pode fornecer uma fundamentação científica para auxiliar na decisão quanto ao destino de vacas repetidoras de serviço; tratamento ou descarte. Este estudo tem abordagem diferencial dos trabalhos que contemplam somente a ocorrência de alterações post-mortem do trato genital. A correlação das alterações post-mortem com o histórico clínico dos animais pode auxiliar na determinação da causa de repetição de serviço de animais sem alteração clínica. Foram utilizadas 130 vacas e novilhas cruzas que não conceberam depois de, no mínimo, três serviços. Todos os animais foram identificados e submetidos à exame clínico e coleta de sangue para cariotipagem. Foram incluídos no estudo apenas animais com histórico de falha reprodutiva. Os animais foram encaminhados para um abatedouro e foram realizados exames post-mortem como inspeção macroscópica do trato genital, cultura bacteriológica e estudo histopatológico do útero. Alterações uterinas foram predominantes seguidas de alterações de oviduto e ovário. Foi observada uma maior freqüência de alterações histopatológicas de útero que alterações clínicas. Os animais utilizados no estudo apresentaram alta freqüência de patologia uterina (95%), tanto inflamatórias (42,9%) quanto degenerativas (59,7%). Patologias diagnosticadas somente por exames post-mortem e laboratoriais como oclusão tubária (29,8%) e trissomia do par sexual também foram observadas (1/10 vacas). Portanto, este estudo evidencia a importância do exame laboratorial no diagnóstico das causas de infertilidade de vacas com histórico de repetição de serviço

Teses sobre hepatites na Faculdade de Medicina da Universidade Federal do Rio de Janeiro, 1837-2000 Theses on hepatitis at the Faculdade de Medicina of the Universidade Federal do Rio de Janeiro, 1837-2000

Apresenta inventário das teses sobre hepatites da Faculdade de Medicina da Universidade Federal do Rio de Janeiro entre 1837 e 2000. A análise indica potencialidades e limites para discussão do quadro evolutivo do conhecimento científico no Brasil sobre esses agravos. As teses também são discutidas à luz de seus referenciais científicos e das mudanças tecnológicas e sociais que as influenciaram. Identificam-se e categorizam-se os marcos do ensino médico e do conhecimento sobre as hepatites, considerando que as teses revelam, no mínimo, o estado da arte de seu objeto. O estudo permitiu explorar as bases em que os saberes científicos sobre as hepatites foram construídos e indicar possibilidades de pesquisas na reconstrução do conhecimento científico de outros agravos.<br>An inventory of the theses on hepatitis of the Faculdade de Medicina of the Universidade Federal do Rio de Janeiro between 1837 and 2000 is presented. The analysis indicates the potential and limits for discussion of the evolutionary framework of scientific knowledge on these health problems in Brazil. The theories are also discussed in light of their scientific reference points and the technological and social changes that influenced them. The landmarks in medical education and knowledge about hepatitis are identified and categorized, considering that the theses reveal at the very least the state of the art on the subject. The study makes it possible to explore the foundations upon which the scientific knowledge on hepatitis were built and indicate possibilities for research in the reconstruction of scientific knowledge of other health problems

Unraveling the genetic background of individuals with a clinical familial hypercholesterolemia phenotype

Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism caused by pathogenic/likely pathogenic variants in LDLR, APOB, and PCSK9 genes. Variants in FH-phenocopy genes (LDLRAP1, APOE, LIPA, ABCG5, and ABCG8), polygenic hypercholesterolemia, and hyperlipoprotein (a) [Lp(a)] can also mimic a clinical FH phenotype. We aim to present a new diagnostic tool to unravel the genetic background of clinical FH phenotype. Biochemical and genetic study was performed in 1,005 individuals with clinical diagnosis of FH, referred to the Portuguese FH Study. A next-generation sequencing panel, covering eight genes and eight SNPs to determine LDL-C polygenic risk score and LPA genetic score, was validated, and used in this study. FH was genetically confirmed in 417 index cases: 408 heterozygotes and 9 homozygotes. Cascade screening increased the identification to 1,000 FH individuals, including 11 homozygotes. FH-negative individuals (phenotype positive and genotype negative) have Lp(a) >50 mg/dl (30%), high polygenic risk score (16%), other monogenic lipid metabolism disorders (1%), and heterozygous pathogenic variants in FH-phenocopy genes (2%). Heterozygous variants of uncertain significance were identified in primary genes (12%) and phenocopy genes (7%). Overall, 42% of our cohort was genetically confirmed with FH. In the remaining individuals, other causes for high LDL-C were identified in 68%. Hyper-Lp(a) or polygenic hypercholesterolemia may be the cause of the clinical FH phenotype in almost half of FH-negative individuals. A small part has pathogenic variants in ABCG5/ABCG8 in heterozygosity that can cause hypercholesterolemia and should be further investigated. This extended next-generation sequencing panel identifies individuals with FH and FH-phenocopies, allowing to personalize each person’s treatment according to the affected pathway