As ações de Extensão Universitária na Escola de Governo da Fundação João Pinheiro: avanços e desafios

A Constituição Federal de 1988, em seu artigo 207, apresenta o princípio da indissociabilidade entre ensino, pesquisa e extensão ao dispor que: “as universidades gozam de autonomia didático- -científica, administrativa e de gestão financeira e patrimonial, e obedecerão ao princípio de indissociabilidade entre ensino, pesquisa e extensão”. Tal princípio pode ser compreendido como uma resposta a demandas sociais por uma Universidade socialmente responsável que dialogue mais ativamente com diversos setores da sociedade. Nos últimos anos, a extensão universitária tem se consolidado na Escola de Governo principalmente pela compreensão de seu crucial papel na proposta de uma formação de administradores com fundamentos teóricos sólidos, mas altamente sensíveis à realidade, a fim de que estes novos profissionais encontrem-se preparados para respeitar e valorizar as características individuais e sociocomunitárias

EXTENSÃO, ADMINISTRAÇÃO MUNICIPAL E CIDADANIA: O PROJETO DE EXTENSÃO 10ENVOLVER CAPACIDADES

Resumo: Com o intuito de proporcionar aos estudantes da graduação da Escola de Governo da Fundação João Pinheiro espaços de trocas de conhecimentos, de crescimento acadêmico e profissional que, em parceria com o Ministério Público de Minas Gerais, no ano de 2015 surgiu o projeto de extensão 10Envolver Capacidades. O referido projeto tem o seu foco principal direcionado para as administrações públicas dos dez municípios do estado de Minas Gerais com os menores Índice de Desenvolvimento Humano Municipal (IDHM) em 2010, em um trabalho com atividades voltadas para a gestão pública e o fortalecimento de espaços de participação social. Considerando isso, este estudo tem como objetivo geral analisar a percepção de estudantes que participaram do projeto 10Envolver Capacidades e os sentidos atribuídos sobre a experiência extensionista vivenciada. Para contribuir com o alcance deste objetivo foi feita uma sistematização das ações do projeto, com base em documentos produzidos durante as edições. Além disso,  quatro alunos e uma aluna que foram ao 10Envolver Capacidades participaram de uma dinâmica realizada no dia 3 de maio de 2019, apresentando uma carta na qual descreviam qual a mensagem para o projeto deixariam e como gostariam de vê-lo no futuro, com base nas experiências que vivenciaram. Esta "cápsula do tempo” foi aberta em 2021 e os depoimentos serão analisados. Palavras-chave: Extensão universitária. Administração Pública. Participação. Políticas Públicas

PENFIGÓIDE BOLHOSO INDUZIDO POR FÁRMACO: UM RELATO DE CASO

Farmacodermias são reações tegumentares e/ou sistêmicas produzidas pelo uso de medicamentos, sendo o penfigóide bolhoso uma patologia que pode ser desencadeado por diversas drogas. Paciente do sexo feminino, 85 anos, referiu bolhas difusas pelo corpo após internação prévia. Observou-se a presença de bolhas tensas íntegras e rotas, crostas e máculas hipocrômicas em pernas, antebraços e mãos, sem queixa de dor ou prurido. Constava em prontuário uso de diversos medicamentos. Paciente foi internada para investigação da etiologia. Foi solicitada dosagem de coproporfirina e uroporfirina que se apresentaram negativas, descartando a hipótese de porfiria cutânea tarda, e foi realizada biópsia cutânea de uma bolha, sugerindo diagnóstico de penfigóide bolhoso de etiologia farmacológica. Foi suspenso o uso de antibióticos e as medicações de uso contínuo para tratamento de hipertensão arterial e doença arterial obstrutiva periférica foram mantidas. Paciente evoluiu estável e sem intercorrências, com uso de prednisona oral e dexametasona tópica, obtendo melhora das lesões com evolução para ausência de bolhas, observando-se apenas lesões residuais. Pela análise das variáveis do caso pressupõe-se que as quinolonas foram as responsáveis pelo quadro. Ressalta-se a importância do reconhecimento das reações medicamentosas existentes e do questionamento do uso de medicamentos, garantindo assim diagnóstico precoce seguido da suspensão da medicação

Antioxidant and Antiproliferative Activities of Heterofucans from the Seaweed Sargassum filipendula

Fucan is a term used to denominate a type of polysaccharide which contains substantial percentages of l-fucose and sulfate ester groups. We obtained five heterofucans from Sargassum filipendula by proteolytic digestion followed by sequential acetone precipitation. These heterofucans are composed mainly of fucose, glucose, glucuronic acid, galactose and sulfate. These fucans did not show anticoagulant activity in PT and aPTT tests. Their antioxidant activity was evaluated using the follow tests; total antioxidant capacity, scavenging hydroxyl and superoxide radicals, reducing power and ferrous ion [Fe(II)] chelating. All heterofucans displayed considerable activity, especially SF-1.0v which showed the most significant antioxidant potential with 90.7 ascorbic acid equivalents in a total antioxidant capacity test and similar activity when compared with vitamin C in a reducing power assay. The fucan antiproliferative activity was performed with HeLa, PC3 and HepG2 cells using MTT test. In all tested conditions the heterofucans exhibited a dose-dependent effect. The strongest inhibition was observed in HeLa cells, where SF-1.0 and SF-1.5 exhibited considerable activity with an IC50 value of 15.69 and 13.83 μM, respectively. These results clearly indicate the beneficial effect of S. filipendula polysaccharides as antiproliferative and antioxidant. Further purification steps and additional studies on structural features as well as in vivo experiments are needed to test the viability of their use as therapeutic agents

Manejo da MIS-C: um protocolo prático

Em abril de 2020, os primeiros casos descrevendo um novo distúrbio hiperinflamatório associado ao COVID-19 afetando crianças e adolescentes foram relatados pela primeira vez no Reino Unido e na Itália. Esses pacientes apresentavam manifestações graves semelhantes à doença de Kawasaki, sendo essa caracterizada por uma vasculite sistêmica pediátrica que pode se manifestar com várias características clínicas, incluindo aneurismas da artéria coronária. Crianças diagnosticadas com MIS-C podem apresentar um amplo espectro de características clínicas e gravidade da doença. Até 80% dos pacientes foram admitidos na UTI, com 10% dos pacientes necessitando de ventilação mecânica. Dos 93 pacientes com ecocardiogramas, 52% apresentaram anormalidades (principalmente disfunção ventricular), 32% derrame pericárdico e 9% aneurismas de artéria coronária. Setenta por cento dos pacientes foram tratados com Imunoglobulina intravenosa (IVIG), 64% receberam glicocorticoides sistêmicos e 48% receberam IVIG e glicocorticoides sistêmicos. American College of Rheumatology publicou diretrizes clínicas para MIS-C. Eles incluíram um alto nível de consenso para a administração de altas doses de imunoglobulina intravenosa (IVIG) (2 g/kg com base no peso corporal ideal), glicocorticóides ou ambos como agentes de primeira linha

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research