O neoconstitucionalismo e a atuação do poder constituinte difuso: uma análise crítica da mutação constitucional em decisões judiciais para a aplicabilidade dos direitos fundamentais / Neoconstitutionalism and the action of diffuse constituent power: a critical analysis of constitutional mutation in judicial decisions for the enforceability of fundamental right

Trata-se de uma análise crítica sobre a forma que o exercício do Poder Constituinte Difuso, na manifestação do instituto da mutação constitucional em decisões judiciais, fortalece o movimento doutrinário pós-moderno, denominado de Neoconstitucionalismo. Assim, este movimento atual prega uma concepção de Constituição cujo valor não é apenas o hierárquico, mas sim o axiológico, de modo que exista um Estado Democrático Social que efetiva, na concretude, Direitos Fundamentais. Deste modo, esse artigo traz à tona a ideia de que quando a Constituição Federal de 1988 é interpretada pelo judiciário, de maneira informal, respeitando os limites hermenêuticos e os limites impostos pelo constituinte originário, ao passo que modifique o seu significado, mantendo-se a literalidade dessa norma suprema intacta, isso favorece, indubitavelmente, o cumprimento do que se busca nesse movimento constitucionalista atual. Além disso, este trabalho acadêmico também explica a maneira que a mutação constitucional se manifesta em algumas decisões judiciais, ao expor o risco quando um Estado, que é construído sob a ótica da democracia e dos fundamentos da fraternidade e da igualdade, não fortalece o movimento pós-positivista e, em razão disso, necessita-se de um controle mais rigoroso. Por fim, utilizou-se o método dedutivo com abordagem qualitativa, bem como o instrumento de coleta de dados descritos na bibliografia, ora pautados no referencial teórico adotado

Cardiopatias crônicas e o Covid-19: virulência, patogenia e interação medicamentosa / Chronic cardiopathies and Covid-19: virulence, pathogeny and drug interaction

Introdução: Dentre as manifestações extrapulmonares da COVID-19 destacam-se os efeitos cardiovasculares, devido às complicações cardíacas, recentemente relatadas em pacientes com cardiopatias crônicas, associadas à alta carga inflamatória por SARS-CoV-2. Objetivos: Analisar as repercussões clínicas do COVID-19 em pacientes cardiopatas; investigar o processo fisiopatológico do COVID em cardiopatas, em comparação com o processo em pacientes não cardiopatas; avaliar o risco cardiovascular gerado por medicamentos usados contra o COVID-19, bem como efeitos de fármacos anti-hipertensivos na fisiopatologia do coronavírus. Material e Métodos: A pesquisa foi realizada em 3 bases de dados, incluindo MEDLINE / PubMed, Scopus, Web of science e ScienceDirect. A estratégia de busca utilizou os descritores obtidos no Medical Subject Headings (MESH) da National Library of Medicine com a combinação das palavras-chave COVID-19, cardiovascular diseases e coronavírus por meio dos operadores booleanos AND e OR. Resultados: Dezoito artigos se adequaram aos temas propostos para esta revisão. Destes, sete abordaram as manifestações clínicas do COVID-19 em cardiopatas, cinco mostraram a fisiopatologia da doença e outros seis descreveram interações medicamentosas. Os resultados apontam que a hipertensão arterial sistêmica está presente em 57% dos pacientes hospitalizados por COVID-19 em Nova York. Cerca de 10% dos pacientes com cardiopatias prévias desenvolvem miocardite, podendo evoluir para bloqueio de condução, taquiarritmias e comprometimento da função ventricular esquerda. Pacientes com COVID-19 que apresentam hipertensão ou cardiopatias têm risco 3-4 vezes maior de desenvolver doença grave. Não há dados que sustentam que os IECA/BRA2 facilitam a entrada do coronavírus por aumentar a expressão da ECA2. Portanto, os pacientes devem continuar com o tratamento prescrito. Conclusão: Observa-se, portanto, que os riscos para o desenvolvimento de COVID-19 estão fortemente associados, entre outros fatores, à presença de cardiopatia crônica. Além disso, o vírus pode causar lesões cardíacas pela associação com o receptor de ECA-2, o que requer monitoração dos marcadores de lesões miocárdicas para pacientes internados por Sars-CoV-2, especialmente cardiopatas

Infecção bacteriana de pele: relato de caso de furunculose em paciente diabético / Bacterial skin infection: a case report of furunculosis in a diabetic patient

O Staphylococcus aureus é o agente etiológico de maior incidência nas infecções de pele, devido ao seu alto poder patogênico, fato este, intimamente relacionado às condições do hospedeiro e ao seu grau de virulência. A furunculose é uma dermatose que provém de uma infecção estafilocócica do folículo piloso e da glândula sebácea anexa. O processo inicial de formação se dá pela presença de um nódulo eritematoso, associado ao aumento da temperatura local e dor intensa. Os pacientes diabéticos são mais susceptíveis a processos infecciosos de pele, por ter suas propriedades biofísicas alteradas. O presente estudo visa o relato de um caso em que o paciente evoluiu com um quadro de Furunculose em nádega direita, há aproximadamente 1 (um) ano. O controle glicêmico e a introdução de antibióticos, fez com que o mesmo apresentasse boas respostas terapêuticas, com regressão total das lesões.

Leishmaniose cutânea e seus novos levantamentos sobre perfis epidemiológicos dos reservatórios e tratamentos tópicos: relato de caso / Leishmaniose cutânea and its new surveys on epidemiological profiles of reservoirs and topical treatments: case report

A leishmaniose tegumentar ou cutânea, é uma doença não contagiosa de caráter infeccioso, e o Brasil está entre os cinco países com maior número de casos. Novos padrões epidemiológicos vêm surgindo, sendo possível observar que o modelo de contágio não é somente aquele ligado a exposição das pessoas as matas ou ao vetor que vem diretamente as residências. O pressuposto de que o cão é o reservatório e causa para propagação da doença não tem se sustentando, sendo observado baixa transmissibilidade em algumas áreas, mesmo havendo cães infectados. De acordo com novas pesquisas, a participação de roedores silvestres somados a infecção de roedores sinantrópicos, são os principais fatores de ampliação da transmissão no peridomicílio. A linha de tratamento utilizada até hoje é sistêmica, como o antimonial pentavalente, seguidos de outros fármacos como anfotericina B lipossomal e isetionato de pentamidina. Doses altas das medicações sistêmicas são responsáveis por diversos efeitos tóxicos, casos de resistências e co-infecção. Sendo assim, estudos recentes, vem trazendo opções de tratamentos tópicos com formulações de cremes hidratantes, desenvolvidas para pesquisa contendo emulsão aquosa com 10% de isetionato de pentamidina (PI) e ácido úsnico (ACE5AU) e as emulsões anidras com ACP (10% de PI), emulsão anidra (ACPU) e ACU contendo ácido úsnico apresentaram bons resultados na regressão das lesões. O uso de extratos de Libidibia férrea em forma de hidrogel GelFrMeOH, devido suas características anti-inflamatórias, bactericidas, hipoglicêmicos e antioxidantes, apresentou boas chances de uso no futuro ao ser comparado com as infiltrações intralesionais de meglumina Glucantime® (IM), em pacientes mais velhos ou quando a via sistêmica não está sendo bem tolerada. Este relato de caso apresenta um paciente com leishmaniose tegumentar em tratamento por via sistêmica.

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Rhodolith Physiology Across the Atlantic: Towards a Better Mechanistic Understanding of Intra- and Interspecific Differences

International audienceCoralline algae are important components in a large variety of ecosystems. Among them, rhodoliths are a group of free-living coralline red algae that cover extensive coastal areas, from tropical to polar regions. In contrast to other ecosystem engineers, limited research efforts preclude our understanding of their physiology, underlying mechanisms, drivers and potential differences related to species under varying environments. In this study, we investigated the photosynthetic and calcification mechanisms of six Atlantic rhodolith species from different latitudes, as well as intra-specific differences in one species from four locations. Laboratory incubations under varying light levels provided simultaneous photosynthesis- and calcification-irradiance curves, allowing the assessment of inter- and intra-specific differences on the coupling between these two processes. Stable isotope analysis and specific inhibitor experiments were performed to characterize and compare carbon-concentrating mechanisms (CCMs), as well as the involvement of specific ion-transporters for calcification. Our findings showed significant differences in rhodolith physiological mechanisms that were partially driven by local environmental conditions (light, temperature). High variability was found in the coupling between photosynthesis and calcification, in CCM-strategies, and in the importance of specific ion transporters and enzymes involved in calcification. While calcification was strongly correlated with photosynthesis in all species, the strength of this link was species-specific. Calcification was also found to be reliant on photosynthesis- and light-independent processes. The latter showed a high plasticity in their expression among species, also influenced by the local environment. Overall, our findings demonstrate that (1) rhodolith calcification is a biologically-controlled process and (2) the mechanisms associated with photosynthesis and calcification display a large variability among species, suggesting potential differences not only in their individual, but also community responses to environmental changes, such as climate change

Effects of a remotely supervised resistance training program on muscle strength and body composition in adults with cystic fibrosis: Randomized controlled trial

Introduction Among the limited studies on physical exercise interventions in adults with cystic fibrosis (CF), few have specifically addressed the improvement of peripheral muscle strength and body fat-free mass. The aim of this study was to examine the impacts of a remotely supervised, individualized 8-week resistance training program of moderate to high intensity on strength and body composition in these subjects. Methods This was a randomized controlled trial performed in adults with CF. The exercise group (EX) performed three 1-h resistance training sessions per week over 8 weeks. The control group (CON) followed the physical activity recommendations of their physician. The main outcomes were muscle strength and body composition, with secondary measures including pulmonary function and quality of life. Two-way repeated measures analysis was used. Results In 23 participants (age 32.13 ± 7.72 years), the intervention showed a significant beneficial effect on leg press strength, with a large effect size, both in absolute (p = 0.011;  = 0.281) and relative (p = 0.007;  = 0.310) terms. Large intervention effects were observed on total fat mass (p < 0.001;  = 0.415), body adiposity index (p < 0.001;  = 0.436), and fat mass index (p < 0.001;  = 0.445), all showing reduction in the EX group. In addition, significant large size effects were detected on total fat-free mass (p = 0.046;  = 0.177), trunk fat-free mass (p = 0.039;  = 0.188), and fat-free mass index (p = 0.048;  = 0.174), all favoring exercise. No significant effects were observed on pulmonary function and quality of life. Conclusions An 8-week remotely supervised resistance training program, with moderate to high intensity, effectively improved lower limb muscle strength and body composition.Universidad Europea de Madrid (ref. 2021/UEM03)Familia Alonso Foundation4.1 Q1 JCR 20221.485 Q1 SJR 2022No data IDR 2022UE

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study).

Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment

Understanding the effect of the high hydrophobicity of the laser-prepared Ti/SnO₂-Sb-La₂O₃anode on its electrocatalytic properties

SnO2-Based materials have attracted much attention in the electrochemical oxidation field due to their high electrocatalytic activity. However, efforts are still required to improve their physical and electrochemical properties. Here we employed a CO2 laser thermal process, as a substitute to conventional furnace heating, for the synthesis of two SnO2-based anodes-Ti/SnO2-Sb2O5 and Ti/SnO2-Sb-La2O3. Compared with anodes made using conventional heating, the laser-prepared anodes show a more compact surface and a change from hydrophilic to super-hydrophobic wetting properties. Energy-dispersive X-ray spectroscopy and X-ray diffraction data reveal the uniform distribution of Sn, Sb, and La, as well as the formation of the desired oxides, respectively. The oxidation state and chemical composition were confirmed by X-ray photoelectron spectroscopy. Notably, the laser-prepared anodes exhibit a positive shift in the oxygen evolution overpotential, especially for the Ti/SnO2-Sb-La2O3 anode, and a 2-fold reduction in the charge transfer resistance. The electrochemical degradation of 4-nitrophenol (4-NP) was investigated in aqueous solutions by UV-Vis spectra employing all anodes produced. The results showed that laser-prepared Ti/SnO2-Sb-La2O3 displays the highest degradation efficiency at the lowest energy consumption. Also, a mechanism for the 4-NP oxidation at the SnO2-based anodes under the current working conditions is proposed. Finally, the notable reduction in processing time and energy spent using laser heating makes it a feasible alternative to produce SnO2-based anodes. Their improved properties enhance the potential of these anodes to be applied in the electrochemical treatment of polluted waters.Large Scale Energy Storag