Cardiac transplantation

A incidência da insuficiência cardíaca tem aumentado progressivamente nos últimos anos em função do aumento da longevidade da população, dos avanços no tratamento do infarto agudo com o uso de trombolíticos e de angioplastia, da ampliação das intervenções cardíacas e da melhora no diagnóstico da síndrome. Com as recentes modificações incorporadas no tratamento farmacológico houve sensível melhora na sobrevida dos pacientes. Todavia, a evolução da cardiomiopatia para formas terminais é inexorável pelas características da doença e, nessas situações, o transplante pode ser a única alternativa eficaz. O transplante cardíaco é a única forma eficaz de restaurar as funções hemodinâmicas do paciente, contudo apresenta limitações de diferentes ordens, não se aplicando a todos os candidatos. A carência de órgãos viáveis é um dos maiores fatores impeditivos no desenvolvimento dos transplantes. Este problema se torna mais evidente quando se trata de órgãos que são mais sensíveis às injúrias do choque e da isquemia. Em nosso meio, apesar dos grandes avanços conseguidos na legislação sobre transplantes de órgãos ainda existe carência de uma política de saúde efetiva voltada a fomentar a captação e a manutenção adequada dos doadores para que esta situação possa ser revertida. Os imunossupressores modernos oferecem bons resultados no controle dos episódios de rejeição a despeito da falta de maior especificidade. Os efeitos colaterais ainda são preocupantes e requerem controle rígido dos pacientes em longo prazo. A qualidade dos órgãos doados e o estado clínico grave dos candidatos que chegam aos centros de transplante são os principais fatores responsáveis pelos resultados insatisfatórios na fase imediata ao transplante de coração. O presente estudo visa apresentar uma revisão das principais etapas que envolvem o transplante cardíaco.The incidence of heart failure has increased in the recent years due to increased longevity of population, advances in treatment of acute myocardial infarction with the use of thrombolytics and angioplasty, the expansion of cardiac procedures and improvement in diagnosis of the syndrome. With recently incorporated changes in pharmacological treatment there was a significant improvement in patient survival. However, the development of cardiomyopathy to terminal forms is inexorable by the characteristics of the disease and in these situations the heart transplantation may be the only effective alternative. Heart transplantation is the only effective way to restore hemodynamic function of the patient, but has limitations of different orders and do not apply to all candidates. The shortage of viable organs is one of the biggest factors hindering the development of transplant, especially in those organs that are more susceptible to injuries from the shock and ischemia. In Brazil, despite the great progress made in the law of organ transplants, there is still a lack of an effective health policy aimed at promoting the capture and maintenance of appropriate donor organs. Only then this situation can be reversed. Modern immunosuppression works well in control of rejection episodes, but requires greater specificity. Side effects are still a concern and require the strict control of patients in long term. The quality of donor organs and the serious illness of the applicants who come to transplant centers are the main factors responsible for unsatisfactory results in the immediate postoperative period of heart transplantation. The present study aims to present a review of the principal stages that occur in the heart transplantation

Algebraic and Geometric Characterizations Related to the Quantization Problem of the C2,8C_{2,8} Channel

In this paper, we consider the steps to be followed in the analysis and interpretation of the quantization problem related to the $C_{2,8}$ channel, where the Fuchsian differential equations, the generators of the Fuchsian groups, and the tessellations associated with the cases $g=2$ and $g=3$, related to the hyperbolic case, are determined. In order to obtain these results, it is necessary to determine the genus $g$ of each surface on which this channel may be embedded. After that, the procedure is to determine the algebraic structure (Fuchsian group generators) associated with the fundamental region of each surface. To achieve this goal, an associated linear second-order Fuchsian differential equation whose linearly independent solutions provide the generators of this Fuchsian group is devised. In addition, the tessellations associated with each analyzed case are identified. These structures are identified in four situations, divided into two cases $(g=2$ and $g=3)$, obtaining, therefore, both algebraic and geometric characterizations associated with quantizing the $C_{2,8}$ channel.Comment: 31 pages, 9 figure

Projeto e construção de um picnômetro a ar para caracterização de insumos e produtos farmacêuticos

This paper describes a project, construction and test of a low cost air pycnometer, developed to be used preferentially in pharmaceutical research. A complete discussion of the construction, test and calibration of this equipment is presented and some measurements are made using pharmaceutical powders and dry granulations. The equipment performance has been estimated through its calibration curve, and the obtained value to its volume resolution is about 1%. This equipment is accomplished at the Applied Nuclear Physics Laboratory of University of Sorocaba (LAFINAU) in Sorocaba, SP, Brazil and it was denominated "Picnômetro a Ar Uniso - PICNAU"

‘Mutirão Agroflorestal’: herramienta de red de agroforestería del Vale do Paraíba, Brasil

Difundir los sistemas agroforestales (SAFs) en la cuenca del río Paraíba do Sul, Estado de São Paulo, Brasil, es el propósito de esfuerzo conjunto en Polo Regional/APTA, en Pindamonhangaba. Los SAFs se basan en consorcios de cultivos agrícolas, arbustos y árboles, aprovechando los mismos recursos (agua, luz y nutrientes). Entre los años 2010-2013, unas 330 personas de diversos orígenes participaron en esfuerzos conjuntos agroforestales. La metodología participativa incluye la planificación para la preparación y manejo de los SAFs, después de conciencia a través de conferencias y excursión. El método "mutirão agroforestal” promueve el intercambio de conocimiento, el rescate de los saberes populares y los recursos genéticos. El enfoque de SAFs en la restauración de las áreas ribereñas con producción diversificada amplificando la biodiversidad de la selva atlántica. La producción se basa en especies comestibles, entre ellos: Maranta arundinaceae, Colocasia esculenta, Pereskia sp., Talinum paniculatum, Xanthosoma sagittifolium, Manihot esculenta, plátano resistente - Musa sp.; de árboles nativo para madera (Calophyllum brasiliense e Centrolobium tomentosum), frutas (Euterpe edulis, Rolinia mucosa) y plantas fertilizantes (Cajanus cajan, Flemingia macrophylla, Tithonia diversifolia, Gliricidia sepium, Sesbania sp., Inga sp.). Se evalúan indicadores de sostenibilidad para balisar la gestión: resistencia a la penetración de una barra de hierro, tasa de cobertura del suelo por la proyección de la plantas de dosel, cantidad y calidad de vegetación espontánea, la presencia de organismos vivos en la capa superior del suelo, contenido de materia orgánica por la reacción del suelo con peróxido de hidrógeno, calidad de especies de anclaje y la cantidad de hojarasca del suelo. Como resultado, un grupo multidisciplinario ha sido articular la formación de Red de Agroforestería del Vale do Paraíba, de difundir los SAFs en la cuenca y los recursos genéticos de estas unidades pasan a los productores

Software Processes Improvement in light of Cognitive Biases: A Cross-Case Analysis

When making judgments, people rely on heuristics or shortcuts that can lead them to good solutions. In certain situations, however, these techniques can cause inconsistencies and promote cognitive biases. Referring to software processes improvement initiatives, it is important that the practices, techniques, methods and tools suggested for the processes provide mechanisms to support decision-making, thus minimizing the negative effects of such biases. This paper, based on a qualitative research applied in two IT companies in Brazil and Portugal, aims to examine eight biases: anchoring bias, exposure effect, hindsight bias, halo effect, planning fallacy, sunk-cost fallacy, availability-related bias, and Parkinson´s law effect. Through semi-structured interviews with project managers (PMs), roots causes were identified for each bias, as well as methods and tools used to minimize its negative effects, which were consolidated into a concepts map. Agile practices and knowledge management activities were cited as essential in software processes focusing on decision-making improvement

Técnicas de Extração de Informação para Avaliação da Qualidade de Páginas Web com o Uso de Ontologias

A qualidade dos conteúdos das páginas Web podem ser determinadas parcialmente através de indicadores como autoria do página, presença de referencias e de propriedade. Este artigo discute a aplicação de técnicas de extração de informação sobre a identificação de indicadores de qualidade, especificamente autoria. Ao contrário de outras técnicas de extração, as técnicas desenvolvidas neste trabalho não utilizam a estrutura da página como principal elemento de análise, voltando sua atenção para o conteúdo extraido. O objetivo final do trabalho é criar uma ferramenta que possibilita a avaliação da qualidade de sites de saúde. Com as entidades extraídas é populado uma ontologia onde estão definidos os critérios de qualidade para as páginas Web

Pesquisa de corpo inteiro com gálio-67 em uma paciente com paracoccidioidomicose: relato de caso

A 26 year-old female was admitted with abdominal pain, fever and weight loss. The clinical and laboratory investigations led to the diagnosis of paracoccidioidomycosis. Gallium-67 whole body images correlated well with the clinical course of the disease and with the patient's prognosis.Paciente do sexo feminino de 26 anos foi internada com dor abdominal, febre e emagrecimento. A investigação clínico-laboratorial estabeleceu o diagnóstico de paracoccidioidomicose. Os achados cintilográficos com citrato de gálio-67 correlacionaram-se com o curso clínico da paciente

Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

BACKGROUND: Aging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients. CONCLUSIONS/SIGNIFICANCE: Chagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies