Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

The authors report their experience with surgical treatment of 39 patients with biliary strictures of iatrogenic origin. Patients were grouped according to the level of obstruction as described by Bismuth, and the type of repair was based on this classification. A total of 45 operations were performed, including those for recurrent strictures: 22 hepaticojejunostomies, 10 Hepp and Couinad's operations, 6 choledochojejunostomies, 3 separate right and left hepaticojejunostomies, 1 hepaticojejunostomy with mucosal graft (Smith's technique), 1 intrahepatic cholangiojejunostomy (Longmire's technique), 1 choledochoduodenostomy and 1 choledochoplasty. Results were considered good if the patient was free of symptoms, jaundice or episodes of cholangitis, with serum alkaline phosphatase less than two-times the normal value. Minimum follow-up period of two years (obtained in 35 patients) was required to evaluate the results. Good results were obtained in 26 of those 30 patients (87%) who underwent only one biliary reconstruction, and in 3 of those 5 (60%) with more than one repair. Overall, 29 patients (83% of those 35) presented good results. The complexity of the surgical treatment of biliary strictures imposes the adoption of measures to prevent lesions to the bile duct. Factors related to the prognosis that must be emphasized are surgeonsa' individual experience and skills, location of the stricture and diameter of the anastomosis

Capacidade de uso de solo das propriedades rurais na microbacia do córrego Guará no Município de Marechal Cândido Rondon/PR

Soil is a finite resource, limited and non-renewable. The type of soil management is crucial to the sustainability of hydrological and productive potential of a watershed. This study aimed to diagnose the current state of the watershed of the Guará River, performing characterizations of the physical and environmental management tools such as use territorial environmental and land. The investigative unit was the soil in order to find the main agents of degradation, and finally recommend the best ways to watershed management, minimizing soil degradation.The land use is the most relevant for agriculture (65.9%) cultivated with soybeans, corn and wheat. The area used for pasture was (11.8%) used for dairy cattle feeding. The watershed has slopes 0-13 degrees, it reducing the risk of erosion. In the analyzed properties, the main obstacles were risk of erosion, stoniness, and flood risk. The watershed has a great capacity for agriculture, and areas not suitable for agriculture, appear suitable for grazing and forestry.O solo é um recurso finito, limitado e não renovável. O tipo de manejo do solo é determinante para a sustentabilidade do potencial hidrológico e produtivo de uma bacia hidrográfica. Este trabalho visou diagnosticar a situação atual da microbacia do córrego Guará, realizando caracterizações do meio físicoe ambiental, como ferramentas de gestão ambiental territorial e do uso do solo. Tendo como unidade investigativa o solo, a fim de encontrar os principais agentes de degradação, e por fim recomendar as melhores formas de manejo para a microbacia, minimizando a degradação do solo. O uso de solo de maior relevância é o destinado à agricultura (65,9%) cultivada com soja, milho e trigo. A área destinada à pastagem (11,8%) utilizada para alimentação do gado leiteiro. A microbacia apresenta declividade de 0 a 13 graus, com isso diminui os riscos de erosão hídrica. Nas propriedades analisadas, os principais empecilhos encontrados foram risco de erosão, pedregosidade e risco de inundação. A microbacia apresenta grande capacidade para agricultura, e nas áreas não aptas para agricultura, mostram-se aptas para pastagem e silvicultura

Espectrometria de absorção atômica: o caminho para determinações multi-elementares

This paper present an overview of way covered for the spectrometry of atomic absorption (AAS), tracing a line of the historical events in its development and its establishment as a multielement technique. Additionally, the efforts carried by through several researchers in the search for the instrumental evolution, the advances, advantages, limitations, and trends of this approach are related. Several works focusing its analytical applications are cited employing simultaneous multielement determination by flame (FAAS) and/or graphite furnace (GF AAS), and fast sequential multielement determination using FAAS are reported in the present review

Transfusion practices in brazilian Intensive Care Units (pelo FUNDO-AMIB)

BACKGROUND AND OBJECTIVES: Anemia of critical illness is a multifactorial condition caused by blood loss, frequent phlebotomies and inadequate production of red blood cells (RBC). Controversy surrounds the most appropriate hemoglobin concentration trigger for transfusion of RBC. We aimed to evaluate transfusion practices in Brazilian ICUs. METHODS: A prospective study throughout a 2-week period in 19 Brazilian ICUs. Hemoglobin (Hb) level, transfusion rate, organ dysfunction assessment and 28-day mortality were evaluated. Primary indication for transfusion and pretransfusion hemoglobin level were collected for each transfusion. RESULTS: Two hundred thirty-one patients with an ICU length of stay longer than 48h were included. An Hb level lower than 10 g/dL was found in 33% on admission in the ICU. A total of 348 RBC units were transfused in 86 patients (36.5%). The mean pretransfusion hemoglobin level was 7.7 ± 1.1 g/dL. Transfused-patients had significantly higher SOFA score (7.9 ± 4.6 vs 5.6 ± 3.8, p < 0.05, respectively), days on mechanical ventilation (10.7 ± 8.2 vs 7.2 ± 6.4, p < 0.05) and days on vasoactive drugs (6.7 ± 6.4 vs 4.2 ± 4.0, p < 0.05) than non-transfused patients despite similar APACHE II scores (15.2 ± 8.1 vs 14.2 ± 8.1, NS). Transfused patients had higher mortality rate (43.5%) than non-transfused patients (36.3%) (RR 0.60-1.15, NS). Only one patient (0.28%) had febrile non-hemolytic transfusion and urticarial reactions. CONCLUSIONS: Anemia is common in critically ill patients.It seems from the present study that transfusion practices in Brazil have had a more restrictive approach with a lower limit transfusion trigger.JUSTIFICATIVA E OBJETIVOS: A anemia é uma condição comum em pacientes graves. A transfusão de hemoderivados aumenta de forma significativa o risco de transmissão de agentes infecciosos e afeta o perfil imunológico. O objetivo deste estudo foi avaliar a incidência de anemia e a prática de transfusão de hemácias em UTI brasileiras. MÉTODO: Estudo prospectivo, multicêntrico, realizado em 19 UTI em um período de duas semanas. A presença de anemia, as indicações e a utilização de concentrados de hemácias, foram avaliadas diariamente. As complicações que ocorreram durante a internação na UTI e após a transfusão da primeira unidade de concentrado de hemácias foram registradas. RESULTADOS: Um total de 33% apresentava anemia na admissão na UTI e esta proporção aumentou para 55% no final de sete dias de internação. Um total de 348 unidades de concentrado de hemácias foi transfundido em 86 pacientes (36,5%). A média de suas unidades por paciente foi 4,1 ± 3,3 U. O nível de hemoglobina limiar para a transfusão de CH foi 7,7 ± 1,1 g/dL. Pacientes transfundidos tinham mais disfunções orgânicas avaliadas pelo escore SOFA (7,9 ± 4,6 versus 5,6 ± 3,8, transfundidos versus não transfundidos, p < 0,05). As taxas de mortalidade foram 43,5% e 36,3% em pacientes transfundidos e não transfundidos, respectivamente (RR 0,61-11,7, NS). Pacientes transfundidos tiveram número maior de complicações (1,58 ± 0,66 versus 1,33 ± 0,49, p = 0,0001). CONCLUSÕES: A anemia é comum em UTI brasileiras. O limiar transfusional de hemoglobina foi menor do que o observado em outros paises.Faculdade de Medicina de São José do Rio PretoUniversidade de São PauloUFRGS Departamento de Medicina Interna HC de Porto AlegreUniversidade Paris VIUFRJ CTI dos Hospitais Cardiotrauma Ipanema e São LucasAMIBUniversidade Estadual de LondrinaUFRGS FAMED HCPAFaculdade de Medicina de CatanduvaUNIFESP-EPMFundação Padre Albino UTI do Complexo HospitalarUniversidade Federal de São Paulo (UNIFESP) Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de TerapiaSanta Casa de Misericórdia de São PauloHospital Unimed de LimeiraUTI do Hospital Regional de AssisAMIB Departamento de MedicinaAmerican CollegeFundação Getúlio VargasHospital Pró CardíacoUNIRIOFGVHospital Santa Helena de GoiâniaHospital evangélico de Cachoeiro de Itapemirim Unidade coronarianaSBNHospital Evangélico Cachoeiro de Itapemirim UTI Adulto e CoronarianaUFRJUFRN Hospital Onofre Lopes UTIHospital Novo AtibaiaUNIFESP, EPMUNIFESP, Disciplina de Anestesiologia, Dor e Terapia Intensiva Setor de TerapiaSciEL

Effect of partial replacement with thermally processed sugar cane bagasse on the properties of mortars

Sugar cane bagasse is a residue of the sugar-alcohol industry, and its main destination is represented by burningboilers for power generation. The bagasse cogeneration of power produces a sugar cane bagasse ash(SCBA) residue that does not have a useful destination. Ashes are commonly studied as pozzolan in Portlandcement production. International Standards indicate the use of pozzolan with up to 50% substitution. In thepresent work, we investigate the use of SCBA as an addition in Portland cement. For this purpose, Portlandcement was prepared by substituting cement with 0, 10, 20, and 30% processed SCBA in volume. The asheswere processed by re-burning and grinding and were then characterized by scanning electron microscopy, Xraydiffraction, laser granulometry, X-ray fluorescence spectrometry, the Chapelle method, and pozollanicactivity. To evaluate the cement with substitution, we used the mortar recommended by NBR 7215. The mechanicalproperties of the cements with replacement were analysed through tests of the compressive strengthand flexural strength of mortars. The results appear interesting and support the possible use of SCBA in theproduction of cement from the aspect of mechanical properties evaluated

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis . Official document of the Brazilian Thoracic Association based on the GRADE methodology

A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF