Combate à epidemia do VIH/SIDA na África Subsaariana : perspetiva histórica, panorama atual e impacto das resistências aos antirretrovirais

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021Em 2019 um total mundial de 38 milhões de pessoas vivia infetado pelo vírus da imunodeficiência humana (VIH), dos quais 25,6 milhões (67%) a residir na África Subsaariana. O controlo desta epidemia e o alcance dos alvos definidos pela Organização Mundial de Saúde (OMS) e a Organização das Nações Unidas no combate ao VIH/SIDA (UNAIDS) encontram-se afetados, não só por questões de acessibilidade e escassez de recursos, mas também pelo surgimento da resistência aos antirretrovirais. Estes países africanos devem, assim, constituir o principal foco de atenção neste contexto. Com este trabalho pretende-se rever a evidência mais relevante nesta área, de modo a compreender o real impacto da epidemia do VIH na África Subsaariana, perceber os fatores que tornam esta região o epicentro desta problemática e procurar soluções que visem combatê-la.By 2019, a global total of 38 million people were living with Human Immunodeficiency Virus (HIV), of which 25,6 million (67%) resided in sub- Saharan Africa. The control of this epidemic and the achievement of the targets defined by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) are being threatened, not only due to lack of accessibility and resources, but also by the emergence of the resistance to antiretrovirals. Therefore, these African countries should be the main focus of this interventions. The aim of this research is to review the latest and most relevant evidence in this area, in order to understand the real impact of the HIV epidemic in sub-Saharan Africa, the factors that put this region in the epicenter of this problem and seeking solutions in order to fight it

Osteotomy at low-speed drilling without irrigation versus high-speed drilling with irrigation: an experimental study

"Introduction: Excessively traumatic surgery can adversely affect the maturation of bone tissue and consequently diminish the predictability of osseointegration so the mechanical and thermal damage should be minimized during surgical procedure. The purpose of this study is to evaluate immediate histological alterations in rabbit tibias, produced by low speed drilling (50 rpm) without irrigation and conventional drilling (800 rpm) under profuse irrigation. Material and Methods: Thirty-six implant osteotomies were created in the tibias of 6 White female rabbits. Drilling began with a 1.5 mm round bur, followed by 2.0 mm, 2.5 mm and 3.5 mm helical drills. The posterior tibial cortex was evaluated as the positive control, and it was preserved during the surgical procedure. The receptor beds were collected for histological analysis. Results: All defects showed regular edges. Hematoxylin eosin (HE) sections showed that both techniques preserved the bone structure and the presence of living cells. No histological differences between the two surgical drilling techniques were found. Conclusions: Based on our results, we can conclude that the effects of implant site preparation on bone by low speed drilling (50 rpm) without irrigation and conventional drilling (800 rpm) under abundant irrigation are similar. Both surgical drilling techniques preserve bone-cell viability and the clinician can decide which drilling technique to use, based on other criteria. Keywords: Osteotomy; Osseointegration; Rabbits; Therapeutic Irrigation; Tibia; Wound Healing.

Explorando os diferenciais de disclosure de subvenção e assistência governamentais nas empresas brasileiras listadas na B3

The study aims to explore the differences in the disclosure of Government Grants and Assistance (SAG) in publicly traded Brazilian companies. The sample consists of 353 publicly traded companies listed on Brasil, Bolsa and Balcão (B3) between 2017 and 2019. The data were obtained by analyzing the content of the explanatory notes referring to the Standardized Financial Statements (DFP) available on the company's website. B3 S/A, verifying the information related to SAG, as stated in the Accounting Pronouncements Committees (CPC), CPC 07 (2008) and CPC 07 R1 (2010). To achieve the objectives of the study, an independent t-mean comparison test and analysis of variance were performed. The results showed that the SAG are mostly of State (39.8%) and Federal (38.6%) origin and the most representative SAG is granted to companies through tax incentives (54.1%). The results of the statistical tests show that the level of SAG disclosure does not differ according to corporate governance and the period. On the other hand, the results show that unregulated companies present higher levels of SAG disclosure and that the oil, gas and biofuels and health sectors presented, respectively, the highest and lowest levels of SAG disclosure. The study seeks to contribute to the literature by evidencing the existence of differences, or not, in the level of disclosure of SAG based on company characteristics, such as the level of corporate governance, regulation, the sample period and the sector of activity.O estudo tem como objetivo explorar as diferenças do disclosure de Subvenção e Assistência Governamentais (SAG) nas empresas brasileiras de capital aberto. A amostra é composta por 353 empresas de capital aberto listadas na Brasil, Bolsa e Balcão (B3) entre 2017 e 2019. Os dados foram obtidos por meio da análise do conteúdo das notas explicativas referentes às Demonstrações Financeiras Padronizadas (DFP) disponíveis no site da B3 S/A, verificando as informações relativas às SAG, conforme enunciado nos Comitês de Pronunciamentos Contábeis (CPC), CPC 07 (2008) e CPC 07 R1 (2010). Para a realização dos objetivos do estudo, procedeu-se ao teste de comparação de médias t independente e análise de variância. Os resultados evidenciaram que as SAG têm, em sua maioria, origem Estadual (39,8%) e Federal (38,6%) e a SAG mais representativa é concedida para as empresas através de incentivos fiscais (54,1%). Os resultados dos testes estatísticos mostram que o nível de disclosure de SAG não difere a partir da governança corporativa e do período. Por outro lado, os resultados mostram que as empresas não reguladas apresentam maiores níveis de disclosure de SAG e que os setores de petróleo, gás e biocombustíveis e de saúde apresentaram, respectivamente, o maior e o menor nível de disclosure de SAG. O estudo busca contribuir para a literatura por evidenciar a existência de diferenças, ou não, do nível de disclosure de SAG a partir de características das empresas, como o nível de governança corporativa, a regulação, o período amostral e o setor de atuação

Perfil glicêmico de indivíduos assistidos em uma instituição de idosos de Feira de Santana – Bahia, de agosto a outubro de 2006

The health of older patients is very important because advanced age results in a reduction of metabolic rates and contributes to the fragility and poor general health of the elderly people. Plasma glucose levels increase by approximately 2 mg/dL/ per decade after 40 years of age, and it is caused by: a decrease in the synthesis and/ or secretion of insulin, a decrease in peripheral sensitivity, alteration of corporal composition, and a decrease in physical activity. Additionally, as old age evolves, there is a gradual decrease in glomerular filtration flux. The present study evaluated the glycemia profiles of people assisted by the Lar do Irmão Velho (LIV) in Feira de Santana, Bahia, during the period between August and October, 2006, by measuring glycemia levels. Blood was collected from 51 elderly people, with each individual participating only in the trials. Blood samples were analyzed at the Laboratory of Clinical Analyses of State University of Feira de Santana where glycemia was measured using enzymatic colorimetric analysis. The age, sex and previous diagnosis of diabetes in the patients were taken into consideration. It was noted that 11,8% of the patients had hypoglycemia. 15,7% of the patients were diabetic and, 50% of those did not have controlled serum glucose levels. It was not possible to diagnose new cases of diabetes as only a single blood sample was taken from each participant.A saúde do paciente idoso merece um importante destaque, pois o avançar da idade provoca uma redução do metabolismo desses pacientes, tornando evidente a fragilidade, bem como a debilidade, refletida em suas condições de saúde. O nível plasmático de glicose de jejum aumenta aproximadamente 2mg/dL por década após os 40 anos. As causas para essa alteração são: a diminuição da síntese e/ou secreção de insulina; diminuição da sensibilidade periférica; alteração da composição corpórea; diminuição da atividade física. Além disso, a medida que a velhice vai evoluindo, há uma diminuição gradativa do fluxo de filtração glomerular. O objetivo desse estudo foi avaliar o perfil glicêmico dos internos assistidos pela Instituição Lar do Irmão Velho (LIV) em Feira de Santana - Bahia, no período de agosto a outubro de 2006, através da dosagem da glicose plasmática. Realizou-se uma pesquisa de campo com a coleta sanguínea em 51 pessoas, sendo que cada indivíduo participou uma única vez da coleta de dados. Estas amostras foram enviadas ao Laboratório de Análises Clínicas da Universidade Estadual de Feira de Santana, onde a glicemia foi mensurada utilizando o método enzimático colorimétrico. Levou-se em consideração a idade, o sexo e se havia diagnóstico prévio de diabetes nos participantes. Constatou-se que 11,8% dos internos encontravam-se com hiperglicemia e não houve casos de hipoglicemia. Dos 15,7% dos diabéticos, 50% não tinham os níveis de glicemia controlados. Não foi possível diagnosticar novos casos de diabetes, pois foi obtida apenas uma amostra sangüínea de cada participante

A cooperação entre a Universidade Federal de Santa Maria e as Forças Armadas: repercussão no desenvolvimento das políticas públicas

This research has the objective of analyzing the repercussion of cooperation between the Federal University of Santa Maria and the Armed Forces for public policies. It is a qualitative research case study. The data of the agreements made available by the Coordination of Projects and Agreements and also by the Project Portal of the UFSM were analyzed. To carry out the search in the Project Portal, a reference framework with keywords referring to the themes: Army, Air Force and Navy was elaborated, based on the National Defense Strategy (2012). The theme proposed for this study is justified by the fact that cooperation fosters mutual benefits for the city that seeks to consolidate itself as a reference in products for the military sector, for the two institutions that, through the combination of efforts, can develop researches with greater optimization in the use of resources, both human and infrastructure.Esta pesquisa tem o objetivo de analisar a repercussão da cooperação entre a Universidade Federal de Santa Maria e as Forças Armadas para as políticas públicas. Trata-se de uma pesquisa de cunho qualitativo do tipo estudo de caso. Foram analisados os dados dos convênios disponibilizados pela Coordenadoria de Projetos e Convênios e também pelo Portal de Projetos da UFSM. Para realizar a busca no Portal de Projetos foi elaborado, a partir da Estratégia de Defesa Nacional (2012), um quadro referencial com palavras-chaves que remetem para os temas: Exército, Força Aérea e Marinha. A temática proposta para este estudo justifica-se pelo fato da cooperação promover mútuos benefícios para a cidade que busca se consolidar como referência em produtos para o setor militar, para as duas instituições que, por meio da conjugação de esforços, podem desenvolver pesquisas com maior otimização no uso de recursos, tanto humanos quanto de infraestrutura

Gastroesophageal Foreign Bodies in Dogs - Endoscopy and Surgical Removal

Background: Gastroesophageal foreign bodies (GFD) are commonly diagnosed in dogs and are considered an endoscopic emergency that, although not resulting in serious clinical sequelae or mortality, can compromise the health and well-being of the patient. The use of the digestive endoscopy for the diagnosis and treatment of GFD can be a valuable and viable alternative. There are cases of GFD in dogs for which the indicated treatment is surgery, which can be performed using minimally invasive or conventional techniques, associated or not with flexible endoscopy. The objective of this work is to describe 16 cases of GFD removal in dogs demonstrating the efficiency of upper digestive endoscopy. Cases: Of the 16 GFD cases, 63% (10/16) were male and 37% (6/16) female. Most aged under 1 year (63%), puppies (5/16) and juveniles (5/16). The patient with the lowest body weight was a miniature pinscher weighing 0.8 kg (Case 14) and the heaviest was an American Pit Bull Terrier weighing 28 kg (Case 11), the mean body weight of patients diagnosed with GFD was 10.2 ± 6.7 kg. Small and medium breeds were more affected, 44.7% (7/16) and 44.7% (7/16), respectively, and large breeds (Golden Retrievier and Bull Terrier), from cases 1 and 4, the least affected, 12.6% (2/16) of the cases. The 16 patients underwent a 12 h food fast and a 4 h water fast, as gastrointestinal emptying in these cases of GFD can be influenced by these foreign bodies. All underwent general inhalation anesthesia with monitoring of physiological parameters (temperature, heart rate, respiratory rate, oxygen saturation and blood pressure) before, during and after EGD, being positioned in left lateral decubitus. The 16 canine patients with suspected GFD underwent EGD for diagnostic confirmation and removal of foreign bodies. Five esophageal FB were diagnosed, 31% (5/16), and 11 gastric FB, 69% (11/16). The most frequently diagnosed foreign bodies were bone and tissue, 37.5% (6/16) and 31% (5/16). Other foreign bodies were materials such as plastics, metals, rubber, foam and stone. Of the 16 cases of GFD, EGD efficiently treated 88% (14/16) without the need for hospitalization, with only supportive treatment for the remission of complications caused by the presence of foreign bodies in the gastroesophageal tract. The main complications related to the presence of GFD were esophagitis in 25% (4/16) of cases, gastritis in 38% (6/16) and both alterations in 13% (2/16). Discussion: In this work, we can observe that more than a third of the clinical cases of treated dogs were diagnosed with GFD, demonstrating that these cases are common in the veterinary clinic. Most of these animals were males less than 1 year old. The improvement of learning in this category can lead these animals to exacerbated oral exploration of new objects. Most FBs were found in the stomach because they were of adequate size, consistency and shape for their passage through the esophagus, whereas esophageal FBs were all bone fragments of rigid consistency with diameters and sizes larger than the esophageal lumen. The interval between the ingestion of the object and the veterinary care can be decisive for the removal of the FB in the esophagus or stomach. Most gastric FBs removed were fabrics and plastics, flexible objects that can pass through the esophageal lumen more easily. Removal of GFD by endoscopy was performed with a high success rate, with only 2 cases being resolved by esophagostomy and gastrotomy. Flexible endoscopy proved to be an efficient technique for removing treated GFD, which can help remove FB during esophagotomy and be associated with rigid endoscopy. Patients recovered quickly and without complications, but it is important to emphasize that inadequate maneuvers and conducts can determine other outcomes. The use of endoscopy for GFD removal needs to be more popularized, as it can ensure better results for dogs treated with GFD. Keywords: digestive tract, endoscopic extraction, flexible endoscopy, ingested object, rigid endoscopy

As mídias sociais no contexto da educação superior

A pesquisa aqui relatada analisou ferramentas para suporte educacional com potencial para promover práticas colaborativas e interativas e traçou um panorama quantitativo sobre as principais mídias sociais utilizadas por professores e estudantes de nível superior da macrorregião de Bauru. Este trabalho também objetivou compreender o valor e a apropriação de tais mídias no contexto educacional dos envolvidos. Para tanto, foi aplicado um Survey entre professores e estudantes do ensino superior que permitisse conhecer as preferências em relação às mídias sociais utilizadas por este público. Os resultados apontaram que a maioria dos participantes acredita que as mídias poderiam ser utilizadas como recurso didático-pedagógico (59,3%) e que são excelentes ferramentas para troca de informações entre os envolvidos no processo educacional (61,1%)

Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital

OBJECTIVE: Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil. METHOD: We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation. RESULTS: In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p = 0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage. CONCLUSIONS: In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis

Early detection of weed in sugarcane using convolutional neural network

Weed infestation is an essential factor in sugarcane productivity loss. The use of remote sensing data in conjunction with Artificial Intelligence (AI) techniques, can lead the cultivation of sugarcane to a new level in terms of weed control. For this purpose, an algorithm based on Convolutional Neural Networks (CNN) was developed to detect, quantify, and map weeds in sugarcane areas located in the state of Alagoas, Brazil. Images of the PlanetScope satellite were subdivided, separated, trained in different scenarios, classified and georeferenced, producing a map with weed information included. Scenario one of the CNN training and test presented overall accuracy (0,983), and it was used to produce the final mapping of forest areas, sugarcane, and weed infestation. The quantitative analysis of the area (ha) infested by weed indicated a high probability of a negative impact on sugarcane productivity. It is recommended that the adequacy of CNN’s algorithm for Remotely Piloted Aircraft (RPA) images be carried out, aiming at the differentiation between weed species, as well as its application in the detection in areas with different culture crop

Uso da acupuntura no tratamento da dor na odontologia: uma revisão de literatura / Use of acupuncture in the treatment of pain in dentistry: a literature review

Introdução: A acupuntura possui a finalidade de restaurar, promover e equilibrar as funções energéticas dos tecidos e órgãos, melhorando a circulação sanguínea, aumentando a imunidade, e trazendo bem-estar físico e mental (RIZZI et al.; 2010). Em Odontologia, a acupuntura vem sendo utilizada com sucesso para indução da anestesia em diversos procedimentos, controle de complicações pós-cirúrgicas, desordens temporomandibulares, bruxismo e até mesmo para xerostomia e hipofluxo salivar. Metodologia: O trabalho refere-se de uma pesquisa de revisão integrativa de literatura, para relacionar o uso da acupuntura no tratamento de dor na área da odontologia, a partir de coleta de dados realizados em fontes secundárias, por meio de levantamento bibliográfico, tendo características, descritivas, retrospectiva, com abordagem qualitativa. Conclusão: O foco deste trabalho é demonstrar a importância da acupuntura no tratamento da dor na área odontológica. Portanto, o uso da acupuntura como método de manejo da dor é importante para o bem-estar do indivíduo, melhorando assim a qualidade de vida