Enterostomal therapy: a new specialty emerging for the Brazilian nursing

The authors relate the experience in the organization and development of the I Enterostomal Therapy Specialization Course, the pioneer in Brazil. They report the concepts and history about enterostomal therapy as a specialty; discuss the objectives, contents, teaching strategies, and evaluation process of the course.Os autores relatam sua experiência com a organização e implementação do I Curso de Especialização em Estomaterapia, realizado no Brasil, enfocando, inicialmente os aspectos conceituais e históricos acerca da especialidade, seguidos de informações sobre o curso, a saber: objetivos, conteúdo programático, estratégias de ensino e processo avaliativo

Preparo intestinal para colonoscopia: manitol vs fosfato de sódio. Resultados de estudo prospectivo e randomizado

MÉTODOS: Oitenta pacientes foram prospectivamente randomizados para receber 750 ml de manitol a 10% (M) ou 180 ml de solução à base de fosfato de sódio (FS), como preparo intestinal para colonoscopia eletiva. Todos os pacientes foram submetidos a avaliação laboratorial (hemoglobina, hematócrito, sódio, potássio, fósforo, cálcio e osmolaridade sérica) antes e depois do preparo. Completado o preparo intestinal, antes da realização do exame, os pacientes foram avaliados por questionário com a finalidade de identificar efeitos indesejáveis e tolerabilidade inerentes à solução empregada. A qualidade do preparo foi avaliada pelo colonoscopista, que desconhecia o tipo de solução empregada. RESULSTADOS: A análise bioquímica demonstrou elevação significativa dos níveis séricos de sódio e fósforo no grupo do FS, bem como uma queda mais acentuada do pótassio e cálcio séricos neste grupo, mas nenhuma destas alterações foi clinicamente sintomática. Não houve diferença significante na incidência de seis efeitos colaterais pesquisados. Seis de oito pacientes do grupo FS que em exame colonóscopico anterior haviam recebido manitol, manifestaram melhor tolerabilidade com a solução de FS. A qualidade do preparo foi considerada excelente ou boa em 85% dos casos preparados com FS e em 82,5% do grupo M (p=0.37). CONCLUSÃO: As duas soluções foram similares quanto à qualidade do preparo e incidência de efeitos colaterais. O menor volume necessário para o preparo com FS parece estar relacionado com uma melhor tolerabilidade desta solução. No entanto, a retenção dos íons sódio e fosfato com o uso da solução de FS torna desaconselhável seu emprego em pacientes com insuficiência renal, cirrose e insuficiência cardíaca.METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750 ml of 10% mannitol (Group M) or 180 ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure

EVALUATION OF FISH FAUNA STOCKS IN DAMS IN SOSSEGO MIME IN CANAÃ OF CARAJÁS (EASTERN AMAZON), CAPTURED WITH THE USE OF CAST NET BEFORE THE DEPOSIT OF TAILINGS

O presente estudo visa estimar a biomassa dos estoques de peixes na área da represa formada pela barragem de rejeitos da Mina Sossego em Canaã dos Carajás, capturados com uso de tarrafa para peixes. O trabalho de prospecção foi realizado durante o período de 29 de fevereiro a 06 de março de 2004, 6 meses após o fechamento da barragem e imediatamente antes do início do despejo dos rejeitos. Os valores médios estimados para a captura por unidade de área encoberta pela tarrafa (CPUA) e da biomassa foram 8,4 g m-² e 16.922,9 kg, respectivamente. Os grupos de peixes mais representativos foram: piabas, com 67,7% e acará, com 24,8% da biomassa total estimada. As espécies capturadas foram: Moenkhausia cf. sanctaefilomenae (piaba-olho-de-fogo), Tetragonopterus cf. argenteus (piaba-branca), Tetragonopterus chalceus (piaba-vermelha), Aequidens viridis (acará-cascudo), Crenicichla cincta (jacundá), Hoplerythrinus unitaeniatus (jejú), Curimata inornata (Branquinha) e Hoplias malabaricus (traíra).Palavras-chaves: prospecção pesqueira, captura por unidade de área, biomassa, barragem de rejeito.This study aims to estimate the biomass of fish stocks in the area of the dam formed by tailings of Sossego mine in Canaã dos Carajás, captured with the use of cast nets for fish. The prospecting work was carried out during the period from 29 February to 6 March 2004, 6 months after closing the dam and immediately before the disposal of waste. The average values estimated for the capture per unit area covered by cast nets (CPUA) and biomass were 8.4 g m-² and 16,922.7 kg, respectively. The most representative groups of fish were minnows, with 67.7% and discus with 24.8% of the total estimated biomass. The species caught were: Moenkhausia cf. sanctaefilomenae (redeye tetra fish), Tetragonopterus cf. argenteus (white tetra fish), Tetragonopterus chalceus (red tetra fish), Aequidens viridis (cichlasoma bimaculatum) Crenicichla cincta (jacunda) Hoplerythrinus unitaeniatus (jeju) Curimata inornata (branquinha) and Hoplias malabaricus (trahira).Keywords: fishing survey; yield per unit area; biomass; tailings dam

Organochlorine pesticides remediation techniques : technological perspective and opportunities

DATA AVAILABILITY : Data will be made available on request.Organochlorine pesticides have been widely used in agriculture to control agricultural pests. Although effective in controlling pests, organochlorine pesticides present numerous hazards to ecosystems and human health due to their persistence in the environment, bioaccumulation, and toxicity. Scientific studies have shown that organochlorines may be associated with endocrine and neurological problems. Several strategies have been developed to apply treatment techniques to remove pesticides from various ecosystems, both aquatic and terrestrial. Physicochemical and biological methods have revealed other potentialities for remediation of aqueous environments contaminated with organochlorine pesticides. In addition, combined processes using different approaches have been highlighted as efficient alternatives to mitigate the impacts of agrochemicals on the environment, e.g., physical technique followed by a biological process. However, there are still numerous gaps that need to be explored and elucidated. Therefore, this review addressed the impacts of organochlorine pesticides on ecosystems and some treatment techniques used to remove agrochemicals from water. Furthermore, new findings, technological perspectives, and opportunities on this subject were presented and discussed.The “Conselho Nacional de Desenvolvimento Científico e Tecnológico” (CNPq, Brazil) and “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior” (CAPES, Brazil), Finance Code 001.https://www.sciencedirect.com/journal/journal-of-hazardous-materials-lettershj2024Chemical EngineeringSDG-02:Zero Hunge

2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis

The objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission

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

The Genome of Anopheles darlingi, the main neotropical malaria vector

Anopheles darlingi is the principal neotropical malaria vector, responsible for more than a million cases of malaria per year on the American continent. Anopheles darlingi diverged from the African and Asian malaria vectors ∼100 million years ago (mya) and successfully adapted to the New World environment. Here we present an annotated reference A. darlingi genome, sequenced from a wild population of males and females collected in the Brazilian Amazon. A total of 10 481 predicted protein-coding genes were annotated, 72% of which have their closest counterpart in Anopheles gambiae and 21% have highest similarity with other mosquito species. In spite of a long period of divergent evolution, conserved gene synteny was observed between A. darlingi and A. gambiae. More than 10 million single nucleotide polymorphisms and short indels with potential use as genetic markers were identified. Transposable elements correspond to 2.3% of the A. darlingi genome. Genes associated with hematophagy, immunity and insecticide resistance, directly involved in vectorhuman and vectorparasite interactions, were identified and discussed. This study represents the first effort to sequence the genome of a neotropical malaria vector, and opens a new window through which we can contemplate the evolutionary history of anopheline mosquitoes. It also provides valuable information that may lead to novel strategies to reduce malaria transmission on the South American continent. The A. darlingi genome is accessible at www.labinfo.lncc.br/index.php/anopheles- darlingi. © 2013 The Author(s)

Processamento de placas de circuito impresso de equipamentos eletroeletrônicos de pequeno porte

A hydrometallurgical process applicable to printed circuit boards of small electrical and electronic devices was developed. This involved three leaching steps (60 ºC, 2 h): 6 mol L-1 NaOH, 6 mol L-1 HCl and aqua regia. NaOH removed the resin and flame retardant that covered the circuit boards. HCl dissolved the most electropositive metals and a small amount of copper (~0.3 wt%). Aqua regia dissolved the noble metals. Silver precipitated as AgCl. Gold and platinum were quantitatively extracted with pure methyl-isobutylketone and Alamine 336 (10 % vol. in kerosene), respectively. Slow evaporation of the raffinate crystallized CuCl2.4H2O (89% yield)