Acesso vascular permanente em pacientes renais crônicos terminais no Brasil

OBJECTIVE: To assess factors associated with the establishment of permanent vascular access for patients with end-stage renal disease. METHODS: Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276). Data were from the TRS Project - "Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS: About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure < 1 year; shorter dialysis therapy; having no private health insurance; living in the central-western, northeastern and southeastern regions of Brazil; and living in the northern region plus having no private health insurance. In the final model there was found a positive association between the outcome and pre-dialysis care and no were association with socioeconomic and comorbidity variables. CONCLUSIONS: The study results showed that the focus should on pre-dialysis care to increase the establishment of an arteriovenous vascular access before starting hemodialysis in Brazil.OBJETIVO: Analizar factores asociados a la provisión de acceso vascular arteriovenoso en Brasil. MÉTODOS: Estudio transversal, nacionalmente representativo, con pacientes con enfermedad renal crónica terminal acompañados en servicios de diálisis o en centros transplantadores en el año de 2007. La muestra incluyó pacientes que tuvieron la hemodiálisis como primera modalidad de tratamiento y que sabían con que tipo de acceso vascular habían iniciado el tratamiento (N=2.276). Los datos son oriundos del Proyecto TRS - "Evaluación económica-epidemiológica de las modalidades de Terapia renal Sustitutiva en Brasil". Fue utilizada la regresión logística múltiple. RESULTADOS: Aproximadamente 30% de los pacientes tenían acceso vascular arteriovenoso. Los factores asociados a la baja probabilidad de tener acceso vascular arteriovenoso como primer tipo de acceso fueron: tiempo de diagnóstico de enfermedad renal crónica anterior a la entrada en hemodiálisis < 1 año, menor tiempo de tratamiento dialítico, no poseer cobertura de seguro de salud, residir en la región Centro-Oeste, Noreste y Sureste, y residir en la región Norte y al mismo tiempo no poseer cobertura de seguro de salud. En el modelo final no fue observada asociación del resultado con variables socioeconómicas y co-morbilidades, pero si con cuidados pre-diálisis. CONCLUSIONES: Los resultados muestran que para aumentar la provisión de acceso vascular arteriovenoso antes del inicio de la hemodiálisis en Brasil, los esfuerzos deben ser enfocados en el cuidado pre-diálisis.OBJETIVO: Analisar fatores associados à provisão de acesso vascular arteriovenoso no Brasil. MÉTODOS: Estudo transversal, nacionalmente representativo, com pacientes com doença renal crônica terminal acompanhados em serviços de diálise ou em centros transplantadores no ano de 2007. A amostra incluiu apenas pacientes que tiveram a hemodiálise como primeira modalidade de tratamento e que sabiam com que tipo de acesso vascular haviam iniciado o tratamento (N = 2.276). Os dados são oriundos do Projeto TRS - "Avaliação econômico-epidemiológica das modalidades de Terapia Renal Substitutiva no Brasil". Regressão logística múltipla foi utilizada. RESULTADOS: Aproximadamente 30% dos pacientes tinham acesso vascular arteriovenoso. Os fatores associados à baixa probabilidade de ter acesso vascular arteriovenoso como primeiro tipo de acesso foram: tempo de diagnóstico de doença renal crônica anterior à entrada em hemodiálise < 1 ano, menor tempo de tratamento dialítico, não possuir cobertura de plano de saúde, residir na região Centro-Oeste, Nordeste e Sudeste, e residir na região Norte e ao mesmo tempo não possuir cobertura de plano de saúde. No modelo final não foi observada associação do desfecho com variáveis socioeconômicas e comorbidades, mas sim com cuidados pré-diálise. CONCLUSÕES: Os resultados mostram que, para aumentar a provisão de acesso vascular arteriovenoso antes do início da hemodiálise no Brasil, os esforços devem ser focados no cuidado pré-diálise

Neoplasias benignas e malignas em 261 necropsias de pacientes HIV positivos no período de 1989 a 2008

Considering that there are some studies with autopsies from AIDS describing only malignant neoplasias and that changes can occur after the introduction of Highly Active Antiretroviral Therapy (HAART), our objectives were to analyze the frequency of benign and malignant neoplasms in AIDS patients in the periods of both pre- and post-HAART. This is a retrospective study with 261 autopsies of HIV-positive patients between 1989 and 2008 in Uberaba, Brazil. Sixty-six neoplasms were found (39 benign, 21 malignant and six premalignant) in 58 patients. The most frequent malignant neoplasms were lymphoid, in 2.7% (four Non-Hodgkin lymphoma, one Hodgkin, one multiple myeloma and one plasmablastic plasmacytoma), and Kaposi's Sarcoma, in 2.3% (six cases). The most frequent benign neoplasms were hepatic hemangiomas in 11 (4.2%) of 261 cases and uterine leiomyoma in 11 (15.7%) of 70 woman. In the pre-HAART period eight (9.8%) benign neoplasias and four (4.9%) malignant occurred in 82 patients; in the post-HAART period, 29 (16.2%) benign and 17 (9.5%) malignant were present; however, the differences were not significant. We conclude that the introduction of HAART in our region doesn't look to have modified the frequency of neoplasms occurring in patients with HIV.Tendo em vista que trabalhos sobre necropsias de AIDS analisam apenas neoplasias malignas e que ocorreram alterações após a terapia antiretroviral altamente eficaz (HAART), este estudo foi feito com objetivo de avaliar a frequência de neoplasias benignas e malignas nos períodos pré e pós-HAART. Estudo retrospectivo de 261 necropsias de HIV positivos entre 1989 e 2008 em Uberaba - Brasil. Foram encontradas 66 neoplasias (39 benignas, 21 malignas e seis lesões pré-invasivas) em 58 pacientes. As neoplasias malignas mais frequentes foram linfóides, em 2,7% (quatro linfomas não Hodgkin, um Hodgkin, um mieloma múltiplo e um plasmocitoma plasmoblástico) e, sarcoma de Kaposi, em 2,3% (seis casos). As benignas mais frequentes foram hemangiomas hepáticos em 11 (4,2%) dos 261 casos e leiomiomas uterinos em 11 (15,7%) das 70 mulheres. No período pré-HAART ocorreram oito (9,8%) neoplasias benignas e quatro (4,9%) malignas em 82 pacientes; no pós-HAART, 29 (16,2%) benignas e 17 (9,5%) malignas; entretanto, essas diferenças não foram estatisticamente significantes. Concluímos que a introdução da HAART em nossa região não parece ainda ter alterado a frequência de neoplasias em pacientes HIV

AVALIAÇÃO DO NÍVEL DE MATURIDADE DA INDÚSTRIA 4.0 EM UMA INSTITUIÇÃO DE ENSINO SUPERIOR DA ZONA OESTE DO RIO DE JANEIRO

Due to the increase in global competitiveness and the need to improve the efficiency and flexibility of industrial operations. This work aims to evaluate the degree of maturity of Industry 4.0 in a higher education institution located in the Western Zone of Rio de Janeiro, identifying the main trends, challenges and opportunities for it. To do this, secondary sources such as books, scientific articles, market research, reports, and case studies will be conducted. The analysis of the collected data allows for the identification of the main areas of application of Industry 4.0, such as automation, artificial intelligence, the Internet of Things, cyber-security, logistics, and advanced manufacturing. The main barriers to the implementation of Industry 4.0 in the country, such as a lack of specialized labor, lack of investment, and inadequate infrastructure, are also evaluated. As a result of this work, according to the CMMI and ACATECH evaluation models of degree of maturity, the higher education institution located in the Western Zone of the State of Rio de Janeiro had its degree measured at level 1, being the most basic of the presented levels of the five levels of maturity degrees. In addition to presenting an overview of the degree of maturity of Industry 4.0 in the institution, recommendations are provided to improve decision-making based on data and the automation of routine tasks, increasing efficiency and the ability to respond to changes.Este artigo, decorrente de um estudo de caso com abordagem qualitativa, teve por objetivo avaliar o grau de maturidade da Indústria 4.0 em uma instituição de ensino superior localizada na Zona Oeste do Rio de Janeiro, identificando as principais tendências, desafios e oportunidades para ela. Para isso, serão realizadas pesquisas em fontes secundarias como livros, artigos científicos, pesquisas de mercado, relatórios e estudos de caso. A análise dos dados coletados permite identificar as principais áreas de aplicação da Indústria 4.0, como automação, inteligência artificial, internet das coisas, ciber-segurança, logística e manufatura avançada. Também são avaliadas as principais barreiras para a implementação da Indústria 4.0 no país, como falta de mão de obra especializada, falta de investimentos e infraestrutura inadequada. Como resultado deste trabalho é apresentado de acordo com os modelos CMMI e ACATECH de avaliação de grau de maturidade que a instituição de ensino superior localizada na zona oeste do Estado do Rio de janeiro teve seu grau mensurado no nível 1, sendo o mais básico dos níveis apresentados dos cinco níveis de graus de maturidade. Além de apresentado uma visão geral do grau de maturidade da Indústria 4.0 na instituição, é fornecido recomendações para melhorarem as suas tomadas de decisão baseadas em dados e a automação de tarefas rotineiras, aumentando a eficiência e a capacidade de resposta às mudanças

Análise das Mudanças da Cobertura do Solo de uma Área de Cerrado (Savana Tropical) no Centro-Oeste do Brasil

The objective of the present work was to carry out an analysis of the land cover of an area in the centre-west of Brazil, at two different times, in 1966 and 2001, using a satellite image and a topographic map, in the Geographic Information System (GIS) environment. The 1966 land cover map was obtained by vectorizing the SE-22-Y-A-V topographic map (IBGE), while the 2001 land cover map was obtained from supervised automatic classification of the Landsat image ETM+ satellite orbit/point 224/073 of August 2001. The analysis showed alterations from natural cover to anthropogenic. In 1966, natural cover was 90% or more (principally true cerrado and forest), while in 2001, natural cover had decreased to 24%, being replaced by arable land and primarily grassland.O objetivo do presente trabalho foi produzir uma análise multitemporal da cobertura do solo em uma área no centro-oeste do Brasil, em duas diferentes épocas, em 1966 e 2001, utilizando uma imagem de satélite e uma carta topográfica em ambiente SIG (Sistema de Informações Geográficas). A carta de cobertura do solo de 1966 foi obtida pela vetorialização da carta topográfica SE-22-Y-A-V (IBGE), enquanto que a carta de cobertura do solo de 2001 foi obtida através de uma classificação automática supervisionada da imagem do satélite Landsat 7 ETM+ órbita/ponto 224/073 de agosto de 2001. A análise mostrou as alterações da cobertura natural para antrópica. Em 1966, a cobertura natural representava 90% ou mais da área estudada (principalmente por cerrado sentido restrito e formações florestais), enquanto que em 2001, a cobertura natural havia diminuído para 24%, sendo substituída principalmente por áreas de agricultura e pasto

Mobility and dual task in healthy and neurological impaired older adults: cross-sectional study / Mobilidade e dupla tarefa em idosos saudáveis e com comprometimento neurológico: estudo transversal

Purpose: compare the association between performance during the execution of dual tasks with cognitive function, mobility and clinical aspects and to present a proposal for a dual task evaluation on postural control in elderly participants. Materials and methods: Study cross-sectional. The participants were allocated into groups: healthy elderly group, individuals in the mild cognitive impairment group and individuals with Parkinson's disease. Motor evaluation was performed through the Foot Eight Walking and Timed Up and Go tests. Results: The Mild Cognitive Impairment Group presented a greater increase in time during the cognitive and motor tasks in Foot Eight Walking. For the cognitive Timed Up and Go, the Mild Cognitive Impairment Group presented longer times than the other groups, whereas the motor and simple Timed Up and Go required a longer time by the Parkinson's Disease Group. Conclusions: The nonrectilinear lane mobility test was useful as an evaluation method for the elderly participants and the strong correlation with already established mobility instruments is also highlighted

Effectiveness of the Brazilian Visceral Leishmaniasis Surveillance and Control Programme in reducing the prevalence and incidence of Leishmania infantum infection.

Background Control strategies adopted by the Brazilian Visceral Leishmaniasis Surveillance and Control Programme (VLSCP) include identifying and culling seropositive infected dogs, early diagnosis and treatment of human cases, chemical control of the vector and population awareness. This study evaluated the effectiveness of the VLSCP on the prevalence and incidence rates of Leishmania infantum in children residing in areas under different VLSCP intervention times. Methods A quasi-experimental epidemiological study with a panel (two cross-sectional) and a concurrent cohort was performed in three areas of Belo Horizonte, southeast Brazil. The first cross-sectional study (I) was carried out with 1875 children, 478 of which were enrolled in the cohort study. In the second cross-sectional study (II), 413 additional children were included, totalizing 891 children. Laboratory diagnosis was performed by ELISA-rK39. Analyses included multilevel logistic and Poisson regression models. Results The incidence rates of L. infantum infection were: 14.4% in the area where VLSCP intervention was initiated in 2006 (AI2006); 21.1% in the area where intervention was initiated in 2008 (AI2008); and 11.6% in the area where intervention was initiated in 2010 (AI2010 - control area). A follow-up period of 24 months showed that the persons-time incidence rates in AI2006, AI2008, and AI2010 were: 6.2/100, 10/100, and 5.6/100 persons/24 months, respectively. The final prevalence rates of infection (cross-sectional II - in 2012), compared to the initial rates (cross-sectional I - in 2010), increased 83.7% in AI2006, 74.1% in AI2008, and decreased 5% in AI2010. Analysis of the effectiveness revealed that children residing in AI2008 are more likely to be infected (OR = 1.84; 95% CI: 1.06-3.23) and present a higher risk of infection (IRR = 1.76; 95% CI: 1.05-2.95) compared to those in AI2010. No statistically significant differences were observed in asymptomatic infection (OR and IRR) in AI2006 compared to AI2010. Conclusions The VLSCP was not effective at controlling L. infantum infection in areas where interventions had respectively been carried out for six and four years. However, it is unclear what the consequences in terms of human infection and diseases would be in the absence of the VLSCP. Efforts to improve the effectiveness of control measures remain a necessary priority

Traumatismo orofacial e a qualidade de vida relacionada à saúde bucal: uma revisão sistemática

A região orofacial é uma das regiões corporais que mais são acometidas com danos traumáticos, em especial na dentição e nos tecidos moles adjacentes. A análise dos diferentes aspectos da saúde bucal relatadas pelo paciente faz parte da pesquisa sobre qualidade de vida relacionada à saúde bucal (QVRSB), que ajuda a melhorar a prestação de tratamento odontológico. Esta revisão sistemática objetiva analisar os impactos do trauma orofacial sobre a qualidade de vida relacionada à saúde bucal (QVRSB). Foi realizada busca nos bancos de dados PubMed, ScienceDirect, Scopus, Google Scholar e Scielo e com base na ferramenta PRISMA e na aplicação dos critérios de inclusão e exclusão foram selecionados 5 artigos para análise e discussão. Infere-se que a QVRSB dos pacientes é impactada pelas lesões traumáticas orofaciais, tendo relação diretamente proporcional, maior impacto imediatamente após o diagnóstico e de acordo com a gravidade do trauma. A maioria dos estudos limita-se a crianças e adolescentes, contudo, o traumatismo orofacial ocorre em qualquer idade. O questionário “condensed oral health impact profile – 14 (OHIP-14)” e suas adaptações são ferramentas importantes para os estudos sobre a QVRSB. Por fim, os estudos que relacionam a QVRSB e o trauma orofacial são importantes para retirar ensinamentos para a prática clínica dos atendimentos odontológicos

Permanent vascular access in patients with end-stage renal disease, Brazil

OBJECTIVE: To assess factors associated with the establishment of permanent vascular access for patients with end-stage renal disease. METHODS: Cross-sectional study conducted in a nationally representative sample of Brazilian end-stage renal disease patients in dialysis and transplant centers during 2007. The sample comprised only patients who received hemodialysis as a primary therapy modality and reported the type of vascular access for their primary hemodialysis treatment (N=2,276). Data were from the TRS Project - "Economic and Epidemiologic Evaluation of Modalities of Renal Replacement Therapy in Brazil". Multiple logistic regression analysis was used to assess factors associated with the establishment of permanent vascular access in these patients. RESULTS: About 30% of the patients studied had an arteriovenous vascular access. The following factors were associated with a lower likelihood of having an arteriovenous vascular access as a primary type of access: time of hemodialysis start since the diagnosis of chronic renal failure < 1 year; shorter dialysis therapy; having no private health insurance; living in the central-western, northeastern and southeastern regions of Brazil; and living in the northern region plus having no private health insurance. In the final model there was found a positive association between the outcome and pre-dialysis care and no were association with socioeconomic and comorbidity variables. CONCLUSIONS: The study results showed that the focus should on pre-dialysis care to increase the establishment of an arteriovenous vascular access before starting hemodialysis in Brazil

Transcriptional profiles of the human pathogenic fungus paracoccidioides brasiliensis in mycelium and yeast cells

This work was supported by MCT, CNPq, CAPES, FUB, UFG, and FUNDECT-MS. PbGenome Network: Alda Maria T. Ferreira, Alessandra Dantas, Alessandra J. Baptista, Alexandre M. Bailão, Ana Lídia Bonato, André C. Amaral, Bruno S. Daher, Camila M. Silva, Christiane S. Costa, Clayton L. Borges, Cléber O. Soares, Cristina M. Junta, Daniel A. S. Anjos, Edans F. O. Sandes, Eduardo A. Donadi, Elza T. Sakamoto-Hojo, Flábio R. Araújo, Flávia C. Albuquerque, Gina C. Oliveira, João Ricardo M. Almeida, Juliana C. Oliveira, Kláudia G. Jorge, Larissa Fernandes, Lorena S. Derengowski, Luís Artur M. Bataus, Marcus A. M. Araújo, Marcus K. Inoue, Marlene T. De-Souza, Mauro F. Almeida, Nádia S. Parachin, Nadya S. Castro, Odair P. Martins, Patrícia L. N. Costa, Paula Sandrin-Garcia, Renata B. A. Soares, Stephano S. Mello, and Viviane C. B. ReisParacoccidioides brasiliensis is the causative agent of paracoccidioidomycosis, a disease that affects 10 million individuals in Latin America. This report depicts the results of the analysis of 6,022 assembled groups from mycelium and yeast phase expressed sequence tags, covering about 80% of the estimated genome of this dimorphic, thermo-regulated fungus. The data provide a comprehensive view of the fungal metabolism, including overexpressed transcripts, stage-specific genes, and also those that are up- or down-regulated as assessed by in silico electronic subtraction and cDNA microarrays. Also, a significant differential expression pattern in mycelium and yeast cells was detected, which was confirmed by Northern blot analysis, providing insights into differential metabolic adaptations. The overall transcriptome analysis provided information about sequences related to the cell cycle, stress response, drug resistance, and signal transduction pathways of the pathogen. Novel P. brasiliensis genes have been identified, probably corresponding to proteins that should be addressed as virulence factor candidates and potential new drug targets