Translation, cross-cultural adaptation, and reproducibility of the Brazilian portuguese-language version of the Wisconsin Smoking Withdrawal Scale

OBJECTIVE: To cross-culturally adapt the Wisconsin Smoking Withdrawal Scale (WSWS) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. METHODS: The original English version of the WSWS was translated into Brazilian Portuguese. For cross-cultural adaptation, the Brazilian Portuguese-language version of the WSWS was administered to eight volunteers, all of whom were smokers. After adjustments had been made, the WSWS version was back-translated into English. The Brazilian Portuguese-language version was thereby found to be accurate. The final Brazilian Portuguese-language version of the WSWS was applied to 75 smokers at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. Intraclass correlation coefficients (ICCs) were used in order to test the concordance of the answers. The significance level was set at p < 0.05. RESULTS: Of the 75 volunteers, 43 (57.3%) were female. The overall mean age was 46.3 years. Interobserver and intraobserver reproducibility was determined for each of the WSWS seven domains, the ICCs for which ranged from 0.87 to 0.94 and from 0.76 to 0.92, respectively. The mean time to completion of the WSWS was 6 min and 44 s, and the response time per question ranged from 4.2 to 12.6 s. CONCLUSIONS: The Brazilian Portuguese-language version of the WSWS is reproducible, fast, and simple. It can therefore be used as a tool for assessing the severity of the symptoms of nicotine withdrawal syndrome.OBJETIVO: Adaptar culturalmente e avaliar a reprodutibilidade da Wisconsin Smoking Withdrawal Scale (WSWS) para o português do Brasil. MÉTODOS: Foi realizada a tradução da versão original em língua inglesa para o português. A versão traduzida foi aplicada em 8 voluntários fumantes para a adaptação cultural. Após ajustes, a versão da WSWS foi submetida à tradução retrógrada do português para o inglês. A versão em português do Brasil foi considerada adequada. Para a avaliação da reprodutibilidade, a escala foi aplicada em 75 fumantes em dois momentos, com intervalo de 30 minutos (reprodutibilidade interobservador) e, num terceiro momento, após 15 dias (reprodutibilidade intraobservador). Utilizou-se o coeficiente de correlação intraclasse (CCI) para testar a concordância entre as respostas. O nível de significância adotado foi p < 0,05. RESULTADOS: Dos 75 voluntários, 43 (57,3%) eram do gênero feminino. A média geral de idade foi 46,3 anos. A reprodutibilidade interobservador e intraobservador foi determinada para cada um dos sete domínios da WSWS, com CCI variando de, respectivamente, 0,87 a 0,94 e de 0,76 a 0,92. O tempo médio de resposta da WSWS foi 6 min e 44 s, e o tempo de resposta para cada questão variou de 4,2 a 12,6 s. CONCLUSÕES: A versão da WSWS para o português do Brasil é reprodutível, de aplicação rápida e simples, podendo ser utilizada como um instrumento de avaliação da gravidade dos sintomas da síndrome da abstinência à nicotina.Universidade Estadual de Ciências da Saúde de AlagoasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversity of Wisconsin Center for Tobacco Research and InterventionUNIFESP, EPMSciEL

Nasolacrimal Duct Neoplasm in a Bitch

Background: Nasolacrimal duct tumors are divided into primary and secondary, with primary tumors being rare in all species. Secondary involvement of the lacrimal sac and duct can occur from any skin lesion involving the eyelid and/or conjunctiva and from any neoplastic process involving the paranasal sinuses. Lacrimal sac metastatic lesions may originate from any distant site and include carcinomas or melanomas, with squamous cell carcinoma being the most common type. The objectives of the present report were to describe a case of squamous cell carcinoma in the nasolacrimal duct and to emphasize the importance of a good ophthalmic evaluation.   Case: A 16-year-old spayed bitch white poodle was presented to the veterinary clinic. The owner complained that the animal had epiphora and mucoid secretion in the right eye, eyelid hyperemia in both eyes, and sporadic sneezing with blood. On ophthalmic examination, the animal was initially diagnosed with nasolacrimal duct obstruction and right eye (OD) blepharitis and OU uveitis. Fourteen days after the first evaluation, the nasolacrimal duct region increased, with the presence of bloody secretion. Biomicroscopy showed nodules inside the lacrimal duct, in the punctum region. The animal was sedated to obtain a fragment of the nodule for histopathological analysis, and a subsequent oral cavity evaluation identified a nodule in the transition region between the 4th premolar and 1st molar, which was sent for cytology. Cytology of the medial corner region of the RE showed epithelial and mesenchymal cells with malignancy characteristics, and the biopsy was suggestive of malignant epithelial neoplasia (carcinoma). A surgical procedure for nodule resection was ruled out because bone involvement was extensive, and chemotherapy was selected. The patient died 2 months after the 1st consultation. The diagnosis was confirmed through necropsy via immunohistochemical tests, demonstrating squamous cell carcinoma (SCC) both in the mouth and the nasal and ocular sinuses. Discussion: The most common conditions affecting the nasolacrimal drainage system in dogs are those causing obstructions. These may be congenital, arising from a developmental defect of micropunctum or agenesis of the punctum, they may be acquired, arising from infection and inflammation. SCC is a malignant neoplasm originating in the stratified squamous epithelium. The predisposing factors in cats and dogs include lack of adnexal pigmentation and, possibly, chronic irritation of the ocular surface. A light coat is considered a relevant factor, especially in regions with little hair coverage. In addition to a mass lesion, other clinical signs of eyelid or ocular surface tumors may include epiphora, conjunctival vascular injection, mucopurulent ocular discharge, 3rd eyelid protrusion, conjunctival/corneal roughness or ulceration, and corneal neovascularization or pigmentation. Clinical presentations are nonspecific. Neoplasms, whether nasal and/or in the maxillary sinus, can invade the nasolacrimal duct and spread to the nasal cavity, and neoplasms in the nasal cavity can invade the nasolacrimal duct. Ophthalmic evaluation along with good inspection of the oral cavity is a useful tool in the diagnosis of eye neoplasms that may have effects on the oral cavity or vice versa due to the strong association between them. Early diagnosis is crucial for the clinical or surgical management of each case of ophthalmic neoplasia and for therapeutic success. Keywords: neoplasm, tumor, nasolacrimal duct, dog, eye. Título: Neoplasia de ducto nasolacrimal em uma cadela Descritores: neoplasia, tumor, canalículo lacrimal cão, olho.

Dez anos do “novo ENEM”: análise dos itens de matemática do ENEM referente à função polinomial do 2°grau / Ten years of the “new ENEM”: analysis of the ENEM mathematics items relating to the 2nd degree polynomial function

Abordamos nesta pesquisa, uma análise das questões envolvendo a função polinomial do 2° grau, analisando a distribuição e as características dos Itens da Prova de Matemática do “Novo ENEM” .  Nossa problemática foi averiguar se: As questões de função polinomial do 2° grau da prova de Matemática do “Novo ENEM” apresentadas estão distribuídas em conformidade com a Matriz de Referência contida nos aportes metodológicos do ENEM.    Em nossa análise, qualificamos as questões em cinco categorias de acordo com os eixos estruturadores do ENEM: (I) competências, (II) habilidades (III) contextualização (IV) interdisciplinaridade e (V) Conteúdos matemáticos.  Por meio desta análise, apresentamos reflexões e apontamentos para os professores de Matemática do Ensino Médio.

Statement of Second Brazilian Congress of Mechanical Ventilarion : part I

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Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.&nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. &nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.&nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.&nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.&nbsp; &nbsp;&nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.&nbsp;&nbsp;&nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp