Pyoderma gangrenosum of the “sinus mammarum” in ulcerative colitis

The first part of this article deals with the report of a patient suffe - ring from pyoderma gangrenosum of the “sinus mammarum” associa - ted with asymptomatic ulcerative colitis. This is followed by a revision of the present epidemiological, etiological, pathogenetic and clinical knowledges about this systemic manifestation of chronic phlogosis of the colon. The Authors have analysed the treatment for this condition and emphasized the resistance of the cutaneous ulcer encountered to conven - tional medical therapy of the underlying colonic disease which proved to be efficacious only on the latter; this led to integrate traditional treatment with the use of perilesional injections of small doses of calcic heparin as an alternative to immunosuppressive drugs or surgery. Topical antithrombotic treatment, which can be justified by the histo - logical findings of phenomena of the vasculitis in the edge of pyoderma gangrenosum, demonstrated to be crucial and represents a peculiarity in the case here reported, which is unique in the literature as far as the Authors know, since it has not been experimented by anyone else

A temática ambiental na formação de pedagogos: perspectiva freireana nos documentos oficiais

O artigo apresenta resultados de uma pesquisa que buscou a presença da temática ambiental em documentos oficiais relacionados à formação de pedagogos. Adotou-se na investigação a abordagem de pesquisa qualitativa de cunho documental e foi observado que em parte dos documentos constam palavras, expressões e frases que enfatizam a temática ambiental, porém a articulação desta com a formação docente é ainda incipiente. Foram analisados: Constituição Federal; LDB; DCN Curso de Pedagogia; Plano Nacional de Educação; Plano Nacional de Educação em Direitos Humanos. Dos documentos pesquisados foram extraídos excertos referentes à temática ambiental e organizados em quadros que indicam aproximações com aspectos conservadores ou críticos da abordagem da temática ambiental. O presente estudo apresenta reflexões construídas a partir de elementos da teoria de Paulo Freire e pretende contribuir para o debate acerca da necessidade de inserção dessa temática nos cursos de formação de pedagogos

A sex-informed approach to improve the personalised decision making process in myelodysplastic syndromes: a multicentre, observational cohort study

Background Sex is a major source of diversity among patients and a sex-informed approach is becoming a new paradigm in precision medicine. We aimed to describe sex diversity in myelodysplastic syndromes in terms of disease genotype, phenotype, and clinical outcome. Moreover, we sought to incorporate sex information into the clinical decision-making process as a fundamental component of patient individuality. Methods In this multicentre, observational cohort study, we retrospectively analysed 13 284 patients aged 18 years or older with a diagnosis of myelodysplastic syndrome according to 2016 WHO criteria included in the EuroMDS network (n=2025), International Working Group for Prognosis in MDS (IWG-PM; n=2387), the Spanish Group of Myelodysplastic Syndromes registry (GESMD; n=7687), or the Dusseldorf MDS registry (n=1185). Recruitment periods for these cohorts were between 1990 and 2016. The correlation between sex and genomic features was analysed in the EuroMDS cohort and validated in the IWG-PM cohort. The effect of sex on clinical outcome, with overall survival as the main endpoint, was analysed in the EuroMDS population and validated in the other three cohorts. Finally, novel prognostic models incorporating sex and genomic information were built and validated, and compared to the widely used revised International Prognostic Scoring System (IPSS-R). This study is registered with ClinicalTrials.gov, NCT04889729. Findings The study included 7792 (58middot7%) men and 5492 (41middot3%) women. 10 906 (82middot1%) patients were White, and race was not reported for 2378 (17middot9%) patients. Sex biases were observed at the single-gene level with mutations in seven genes enriched in men (ASXL1, SRSF2, and ZRSR2 p<0middot0001 in both cohorts; DDX41 not available in the EuroMDS cohort vs p=0middot0062 in the IWG-PM cohort; IDH2 p<0middot0001 in EuroMDS vs p=0middot042 in IWG-PM; TET2 p=0middot031 vs p=0middot035; U2AF1 p=0middot033 vs p<0middot0001) and mutations in two genes were enriched in women (DNMT3A p<0middot0001 in EuroMDS vs p=0middot011 in IWG-PM; TP53 p=0middot030 vs p=0middot037). Additionally, sex biases were observed in co-mutational pathways of founding genomic lesions (splicing-related genes, predominantly in men, p<0middot0001 in both the EuroMDS and IWG-PM cohorts), in DNA methylation (predominantly in men, p=0middot046 in EuroMDS vs p<0middot0001 in IWG-PM), and TP53 mutational pathways (predominantly in women, p=0middot0073 in EuroMDS vs p<0middot0001 in IWG-PM). In the retrospective EuroMDS cohort, men had worse median overall survival (81middot3 months, 95% CI 70middot4-95middot0 in men vs 123middot5 months, 104middot5-127middot5 in women; hazard ratio [HR] 1middot40, 95% CI 1middot26-1middot52; p<0middot0001). This result was confirmed in the prospective validation cohorts (median overall survival was 54middot7 months, 95% CI 52middot4-59middot1 in men vs 74middot4 months, 69middot3-81middot2 in women; HR 1middot30, 95% CI 1middot23-1middot35; p<0middot0001 in the GEMSD MDS registry; 40middot0 months, 95% CI 33middot4-43middot7 in men vs 54middot2 months, 38middot6-63middot8 in women; HR 1middot23, 95% CI 1middot08-1middot36; p<0middot0001 in the Dusseldorf MDS registry). We developed new personalised prognostic tools that included sex information (the sex-informed prognostic scoring system and the sex-informed genomic scoring system). Sex maintained independent prognostic power in all prognostic systems; the highest performance was observed in the model that included both sex and genomic information. A five-to-five mapping between the IPSS-R and new score categories resulted in the re-stratification of 871 (43middot0%) of 2025 patients from the EuroMDS cohort and 1003 (42middot0%) of 2387 patients from the IWG-PM cohort by using the sex-informed prognostic scoring system, and of 1134 (56middot0%) patients from the EuroMDS cohort and 1265 (53middot0%) patients from the IWG-PM cohort by using the sex-informed genomic scoring system. We created a web portal that enables outcome predictions based on a sex-informed personalised approach. Interpretation Our results suggest that a sex-informed approach can improve the personalised decision making process in patients with myelodysplastic syndromes and should be considered in the design of clinical trials including low-risk patients. Copyright (c) 2022 Published by Elsevier Ltd. All rights reserved

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Maize cultivars comparison in nutritive solutions with aluminum levels

Com o objetivo de avaliar o comportamento de seis cultivares de milho (C125, C135, C425, C525, C701 e C805), quando submetidos à seis níveis de alumínio (0, 10, 20, 30, 40 e 50 mg.L-l) em solução nutritiva, com a finalidade de selecionar os cultivares mais tolerantes, foi conduzido um experimento em casa-de-vegetação, em Piracicaba, SP. Sete dias após a emergência em bandejas contendo areia lavada, as plantas foram transplantadas para caixas de polietileno leitoso com capacidade para 25 L de solução. As plantas foram sustentadas sobre a solução por placas de isopor contendo 12 furos. Em cada placa foram colocadas as quatro repetições de três dos seis cultivares. Durante o dia as plantas permaneciam nas soluções que continham alumínio e à noite eram transportadas para outras caixas contendo solução sem alumínio, sendo as soluções continuamente arejadas. Após cerca de 30 dias, as plantas foram colhidas, separadas em três partes: folhas, colmos e raízes, que foram secas, pesadas e analisadas para os teores de macronutrientes e alumínio. Nessas condições, foi possível chegar-se às seguintes conclusões: - Os cultivares C525, C125 e C805 são os mais tolerantes à presença do alumínio no meio de cultivo; - Os cultivares C701 e C425 são os mais sensíveis à presença do alumínio no meio de cultivo; - O cultivar C135 apresentou pequena tolerância ao alumínio, até o nível 10 mg.L-1 de alumínio; - O nível que melhor separou os cultivares tolerantes dos sensíveis foi 20 mg.L-1 de alumínio na solução; - O acúmulo do alumínio no sistema radicular das plantas de milho não foram devido somente ao acúmulo de fósforo nessa parte.A experiment was conducted in greenhouse conditions at Piracicaba, São Paulo, Brazil with the objective of avaluate six maize cultivars (C125, C135, C425, C525, C701 and C805) in six levels of aluminum solutions (0, 10, 20, 30, 40 and 50 mg.L-1) and to selecte more tolerant cultivars. The plants were transplanted to polietilen boxes that containing 25 L of solution, seven days after the emergency in trays with washed sand. The plants were sustained on the solutions with plates of polystyrene with twelve holes. In each plate there were taking four replications of three of the six cultivars. The plants stained in the solutions with aluminum during the morning and afternoon and they were transported to other boxes with nutritive solutions without aluminum at night. The solutions were continuously aired. When the plants had thirty days in the solutions, they were cuted and divided in three parts: leaves, stems and roots that were dried, weighed and analised to macronutrients and aluminum. In this conditions, was possible to take the following conclusions: - The cultivars C525, C125 and C805 were more tolerants to aluminum in the solutions; - The cultivars C701 and C425 were more sensitives to aluminum in the solutions; - The cultivar C135 had some tolerance to aluminum unti1 10 mg.L-1 level; - The better level to separate tolerant cultivars of sensitive ones was 20 mg.L-1 of aluminum in solution; - Aluminum accumulation in the root system is caused not only by phosphorus accumulation in this part

A temática ambiental nos documentos oficiais de formação de professores/pedagogos no brasil.

A presente pesquisa se fundamenta a partir da busca pela presença da Temática Ambiental em documentos oficiais que, além de explorarem dispositivos específicos de suas áreas, demandam também a respeito da referida temática em seu conteúdo. Adotamos a abordagem metodológica de pesquisa qualitativa, de cunho documental. Durante o processo de análise dos documentos, observamos que em parte deles aparecem palavras, expressões, frases, etc. que enfatizam a temática ambiental, porém a articulação desta com a formação docente é incipiente ainda. Em apenas dois desses documentos a temática ambiental ocupa espaço considerável no conteúdo tratado. Foram estudados os documentos, a saber: Constituição Federal de 1988; LDB – Lei de Diretrizes e Bases da Educação Nacional; PCN – Parâmetros Curriculares Nacionais Temas Transversais – Meio Ambiente e Saúde; Diretrizes Curriculares Nacionais para o Curso de Graduação em Pedagogia, Licenciatura; PNE – Plano Nacional de Educação; PNEDH – Plano Nacional de Educação em Direitos Humanos. De cada documento pesquisado, foram extraídos excertos referentes à temática ambiental, apresentando-se esta em cada um, de formas e perspectivas diferentes. O presente estudo pode contribuir para a reflexão acerca da temática ambiental que deve ser inserida nos cursos de formação de pedagogos a fim de fortalecer a educação como prática social

Maize cultivars comparison in nutritive solutions with aluminum levels

Com o objetivo de avaliar o comportamento de seis cultivares de milho (C125, C135, C425, C525, C701 e C805), quando submetidos à seis níveis de alumínio (0, 10, 20, 30, 40 e 50 mg.L-l) em solução nutritiva, com a finalidade de selecionar os cultivares mais tolerantes, foi conduzido um experimento em casa-de-vegetação, em Piracicaba, SP. Sete dias após a emergência em bandejas contendo areia lavada, as plantas foram transplantadas para caixas de polietileno leitoso com capacidade para 25 L de solução. As plantas foram sustentadas sobre a solução por placas de isopor contendo 12 furos. Em cada placa foram colocadas as quatro repetições de três dos seis cultivares. Durante o dia as plantas permaneciam nas soluções que continham alumínio e à noite eram transportadas para outras caixas contendo solução sem alumínio, sendo as soluções continuamente arejadas. Após cerca de 30 dias, as plantas foram colhidas, separadas em três partes: folhas, colmos e raízes, que foram secas, pesadas e analisadas para os teores de macronutrientes e alumínio. Nessas condições, foi possível chegar-se às seguintes conclusões: - Os cultivares C525, C125 e C805 são os mais tolerantes à presença do alumínio no meio de cultivo; - Os cultivares C701 e C425 são os mais sensíveis à presença do alumínio no meio de cultivo; - O cultivar C135 apresentou pequena tolerância ao alumínio, até o nível 10 mg.L-1 de alumínio; - O nível que melhor separou os cultivares tolerantes dos sensíveis foi 20 mg.L-1 de alumínio na solução; - O acúmulo do alumínio no sistema radicular das plantas de milho não foram devido somente ao acúmulo de fósforo nessa parte.A experiment was conducted in greenhouse conditions at Piracicaba, São Paulo, Brazil with the objective of avaluate six maize cultivars (C125, C135, C425, C525, C701 and C805) in six levels of aluminum solutions (0, 10, 20, 30, 40 and 50 mg.L-1) and to selecte more tolerant cultivars. The plants were transplanted to polietilen boxes that containing 25 L of solution, seven days after the emergency in trays with washed sand. The plants were sustained on the solutions with plates of polystyrene with twelve holes. In each plate there were taking four replications of three of the six cultivars. The plants stained in the solutions with aluminum during the morning and afternoon and they were transported to other boxes with nutritive solutions without aluminum at night. The solutions were continuously aired. When the plants had thirty days in the solutions, they were cuted and divided in three parts: leaves, stems and roots that were dried, weighed and analised to macronutrients and aluminum. In this conditions, was possible to take the following conclusions: - The cultivars C525, C125 and C805 were more tolerants to aluminum in the solutions; - The cultivars C701 and C425 were more sensitives to aluminum in the solutions; - The cultivar C135 had some tolerance to aluminum unti1 10 mg.L-1 level; - The better level to separate tolerant cultivars of sensitive ones was 20 mg.L-1 of aluminum in solution; - Aluminum accumulation in the root system is caused not only by phosphorus accumulation in this part

Renal resistive index in chronic kidney disease patients: Possible determinants and risk profile.

BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians.MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of pResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (pConclusionsThis analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function

Prevalência de sinais de sensibilidade ao látex em pacientes com mielomeningocele submetidos a múltiplos procedimentos cirúrgicos

JUSTIFICATIVA E OBJETIVOS: O número de pacientes alérgicos ao látex vem aumentando significativamente. É essencial reconhecê-los para preve nir e aplicar o tratamento adequado. O objetivo do estudo foi avaliar a prevalência de alergia ao látex em pacientes com mielomeningocele. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, os prontuários médicos de pacientes com diagnóstico de mielomeningocele no período de janeiro de 2002 a dezembro de 2007. Os pacientes foram agrupados em alérgicos e não alérgicos. A comparação dos grupos em relação ao gênero foi feita pelo teste do Qui-quadrado, pelo teste t de Student em relação à idade, e o teste de Mann-Whitney para comparação entre os grupos em relação as manifestações clínicas de alergia, número de procedimentos sob anestesia, de internações hospitalares e de cateterizações vesicais. RESULTADOS: O número médio de procedimentos sob anestesia foi de 7 no grupo com alergia e 4 no grupo sem alergia, sendo esta diferença estatisticamente significante (p = 0,028). O número médio de internações hospitalares foi de 4,5 no grupo com alergia e 3,4 no grupo sem alergia e a média de cateterização vesical foi 24,5 nos alérgicos e 21,7 nos não alérgicos. CONCLUSÕES: Os pacientes portadores de mielomeningocele submetidos a múltiplos procedimentos sob anestesia apresentam alto risco de desenvolvimento de sinais clínicos de alergia ao látex. Há necessidade de que pacientes com diagnóstico de mielomeningocele sejam submetidos exclusivamente a procedimentos latex-free, evitando o alto risco de sensibilização e suas complicações. Testes específicos para avaliação da sensibilização, marcadores genéticos e relação látex-fruta poderão contribuir para melhor entendimento dos fatores de risco relacionados à alergia ao látex e formas de prevençã