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Contains fulltext : 291566.pdf (Publisher’s version ) (Open Access) BACKGROUND: The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS: This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS: We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.

Contains fulltext : 290798.pdf (Publisher’s version ) (Open Access) BACKGROUND: Several reports have demonstrated the impact of the COVID-19 pandemic on the management and outcome of patients with ST-segment elevation myocardial infarction (STEMI). The aim of the current analysis is to investigate the potential gender difference in the effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI patients within the ISACS-STEMI COVID-19 Registry. METHODS: This retrospective multicenter registry was performed in high-volume primary percutaneous coronary intervention (PPCI) centers on four continents and included STEMI patients undergoing PPCIs in March-June 2019 and 2020. Patients were divided according to gender. The main outcomes were the incidence and timing of the PPCI, (ischemia time ≥ 12 h and door-to-balloon ≥ 30 min) and in-hospital or 30-day mortality. RESULTS: We included 16683 STEMI patients undergoing PPCIs in 109 centers. In 2020 during the pandemic, there was a significant reduction in PPCIs compared to 2019 (IRR 0.843 (95% CI: 0.825-0.861, p < 0.0001). We did not find a significant gender difference in the effects of the COVID-19 pandemic on the numbers of STEMI patients, which were similarly reduced from 2019 to 2020 in both groups, or in the mortality rates. Compared to prepandemia, 30-day mortality was significantly higher during the pandemic period among female (12.1% vs. 8.7%; adjusted HR [95% CI] = 1.66 [1.31-2.11], p < 0.001) but not male patients (5.8% vs. 6.7%; adjusted HR [95% CI] = 1.14 [0.96-1.34], p = 0.12). CONCLUSIONS: The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures similarly observed in both genders. Furthermore, we observed significantly increased in-hospital and 30-day mortality rates during the pandemic only among females. Trial registration number: NCT 04412655.

SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older ( P = .002), less often active smokers ( P = .002), and hypercholesterolemic ( P = .006), they presented more often later than 12 h ( P = .037), more often to the hub and were more often in cardiogenic shock ( P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow ( P = .029) and more thrombectomy ( P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.

The so-called "smoking paradox", conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.

Virtualmente todas as doenças reumatológicas possuem os glicocorticoides dentro do arsenal terapêutico, seja como terapia inicial ou adjuvante. Corticoterapia está associada à rápida e precoce perda óssea, além de aumento no risco de fraturas. O aumento no risco de fraturas foi demonstrado mesmo em doses entre 2,5-7,5 mg/dia de prednisona ou equivalentes. Dose e duração da corticoterapia devem ser abreviadas para todos os pacientes. Adultos em programação de uso de prednisona ≥ 2,5 mg por ≥ 3 meses devem receber orientação de reposição de cálcio e vitamina D, assim como incentivo a exercícios de fortalecimento muscular, prevenção de quedas, dieta hipossódica, evitar ingestão de álcool e cessação do tabagismo. Avaliação inicial do risco de fraturas é recomendada em todos os pacientes, sendo indicada a realização de densitometria óssea e aplicação do escore FRAX em adultos maiores de 40 anos, história pessoal de fraturas por fragilidade ou presença de fatores de risco para perda óssea. Recomenda-se ajuste no FRAX naqueles em uso de prednisona ≥ 7,5 mg ou equivalentes. Bisfosfonatos orais (alendronato e risedronato) são terapia de primeira linha naqueles com indicação de tratamento farmacológico, com a possibilidade de uso de bisfosfonato endovenoso (ácido zoledrônico) nas contraindicações ao bisfosfonato oral. Avaliar individualmente o uso de teriparatida devido ao alto custo. Denosumabe não é tipicamente prescrito em razão do risco de perda óssea acelerada após sua suspensão. Especial atenção é necessária nas mulheres em idade fértil ou gestantes. A decisão terapêutica deve sempre ser compartilhada entre paciente e médico assistente. Unitermos: Osteoporose. Glicocorticoides. Corticosteroides. Fratura por fragilidade. Tratamento.

This was a retrospective observational study to determine the secular trends in osteoporosis hip fractures in Brazil from 2004 to 2013. The fracture rates were stable for both sexes, and there was not a secular trend. Fractures were predominant in the South and Southeast Regions. The hip fracture rate was lower in this study than in other studies. These regional differences may be considered in the FRAX Brazil calibration.Hip fractures are well-known osteoporotic fractures with high mortality and morbidity. Epidemiological studies in Brazil on hip fractures are scarce, and the great majority have been performed in small populations from a few cities. None of these studies has analyzed the long-term hip fracture secular trends, which are important data for the promotion of public health actions.This was a retrospective observational study with a secular trend analysis in patients over 50 years old who were admitted to the Brazilian Public Health System from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma hip fractures. The fracture rate was calculated when the patients were stratified by sex, age, and geographic region, and linear regression analysis was performed to evaluate the secular trends.The hip fracture rate per 100,000 inhabitants was 59.69; the rate was 74.72 in females and 42.95 in males. The fracture rates were higher in the South and Southeast Regions and steadily increased with age, and the average ratio of women-to-men was 1.74. No secular trend was detected in the overall population. Surprisingly, the secular trend only increased in the South region from 2004 to 2013, and the secular trends were stable in the other regions.Although the secular trend was similar to some worldwide studies, the hip fracture rate was lower than that previously observed in regional studies in Brazil. These regional differences may be considered in the FRAX Brazil calibration.

Introdução: O câncer de mama é o crescimento descontrolado de uma massa tumoral nas células do tecido epitelial da mama, prevalente em mulheres a partir dos 35 anos, tendo como tratamento a quimioterapia por vezes associada í radioterapia e í cirurgia mamaria, entretanto, a quimioterapia age de forma inespecí­fica gerando alterações como a neurotoxicidade, causada pelas substâncias administradas. Objetivo: Comparar a Variabilidade da Frequência Cardí­aca entre mulheres com câncer de mama e saudáveis. Material e métodos: Estudo transversal, não randomizado, comparativo e cego, de caráter quantitativo, com mulheres entre 25 e 75 anos, formando grupo câncer de mama (29) internadas no Hospital Ophir Loyola que tenham realizado quimioterapia, e grupo de mulheres saudáveis (24). Utilizou-se o Polar® modelo RS800cx para coleta que ocorreu na enfermaria do hospital, enquanto que as saudáveis no Ambulatório de Fisioterapia da Universidade da Amazônia, ambos em Belém/PA. Resultados: O desvio padrão da média de todos os intervalos cardí­acos normais, a largura da linha de base do histograma de intervalo cardí­aco, a dispersão dos pontos perpendiculares í linha de identidade e a dispersão dos pontos ao longo da linha de identidade demonstraram valores superiores no grupo saudável em relação ao grupo controle. O domí­nio de análise linear não apresentou variáveis com diferença estatí­stica. Conclusão: O presente estudo concluiu que a quimioterapia realizada em mulheres com câncer de mama altera a Variabilidade da Frequência Cardí­aca em comparação a mulheres saudáveis.Palavras-chave: neoplasias da mama, quimioterapia, frequência cardí­aca, sistema nervoso autônomo.Â

A partir da articulação entre a História das Ideias Linguísticas (HIL) e a Análise de Discurso, este trabalho toma como questão a formulação que determina o ensino da Língua Portuguesa como língua materna, conforme materializada na Matriz de Competências e Habilidades do Ensino Médio. Dada a relevância do documento ao nortear as práticas de ensino no Brasil, busca-se refletir sobre o modo como as políticas de línguas intervêm sobre e como produz sentidos para sujeito aluno. Com as noções de língua materna e língua nacional em Payer (2006; 2007; 2009; 2016) e em Guimarães (2005), o texto propõe um percurso de leitura em que problematizamos o conceito de língua materna em funcionamento no ensino e analisamos as consequências desta posição para o saber metalinguístico do aluno no ensino médio.

Neste trabalho, apresentamos os modelos de regressão spline de nós-livres como uma alternativa aos modelos não lineares utilizados em curvas de crescimento multifásico. Estudaremos o algoritmo de busca cega a través da seção dourada para escolher a melhor quantidade de nós e suas respectivas localidades. O pacote freeknotspline do software livre R foi utilizado para ajustar os modelos propostos. O critério de informação de Akaike foi usado para escolher o melhor modelo para diferentes graus do polinômio associados ao spline. Estudos de simulação foram realizados para entender melhor a posição dos nós, localidade e grau do polinômio relacionado aos modelos de regressão spline de nós-livres e como isto pode afetar a qualidade de ajuste do modelo. Com base no nosso estudo de simulação, propomos uma forma empírica de determinar o numero de nós, deixando que o algoritmo de busca escolha a posição dos nós. A metodologia é aplicada aos dados de crescimento multifásico de vacas da raça Hereford. In this work, we present the free-knot spline regression models as an alternative to the nonlinear models used in multiphase growth curves. We will study the blind search algorithm through the gold section to choose the best number of knot and their respective locations. The package freeknotspline of the free software R was used to fit the proposed models. The Akaike information criterion was used to choose the best model for different degrees of the polynomial associated with the spline. Simulation studies were performed to better understand the position of the knot, location and degree of the polynomial related to spline regression models of free-knots, and how this may affect the goodness of fit of the model. Based on our simulation study, we propose an empirical way of determining the number of knots, letting the search algorithm choose the position of the knots. The methodology is applied to the multiphase growth data of Hereford breed females.

Busca-se discutir neste trabalho o funcionamento da língua(gem) na mídia eletrônica para dar visibilidade ao jogo entre oralidade e escrita nos dizeres em circulação. Para tanto, apresentam-se, as relações entre imagem, som e o modo de inscrição do corpo, que de forma imbricada com o discurso da escrita e da oralidade constituem efeitos de sentidos para e por sujeitos. O material recortado para nossa análise é um vídeo intitulado “Óleo vaza na bacia”, publicado no YouTube em 2011, pelo canal “Keké isso na TV”. Propõe-se pensar, discursivamente, o modo como se desconstrói o ritual do discurso jornalístico construído a partir do discurso da escrita e o modo como o vídeo irrompe, desconstruindo esse lugar, ao esboçar o ritual discursivo estereotipado e naturalizado como discurso oral.Abstract: This work aims to discuss the functioning of the language in the electronic media to give visibility to the game between orality and writing in the sayings in circulation. For this, the relations between image, sound and the way of the body’s inscription are presented, which in an imbricated way with the writing discourse and orality discourse constitute effects of meanings for and by subjects. The chosen material for our analysis is a video titled "Óleo vaza na basca", published on YouTube in 2011, by the channel "Keké isso na TV". It is proposed to think in a discursive direction about the way how is deconstructed the ritual of journalistic discourse made from the writing discourse and the way in which video breaches, deconstructing this place, it outlined the naturalized and stereotyped discursive ritual as oral discourse.[1] O vídeo analisado “Óleo vaza da bacia” está disponível em: https://www.youtube.com/watch?v=4iZsDKhSp9I.

A tireotoxicose é uma rara síndrome clínica decorrente da exacerbação do hipertireoidismo, de etiologia e fatores desencadeantes diversos. A abordagem terapêutica pode ser realizada por meio de medicamentos para bloqueio da síntese, secreção e/ou inibição da ação periférica hormonal, além de terapia dirigida aos fatores desencadeantes. Entretanto, em casos refratários, a plasmaférese surge como importante opção de tratamento. Relatamos o caso de um paciente com doença de Graves, internado com quadro de hepatotoxicidade grave por propiltiouracil, que evoluiu com tireotoxicose, sendo indicada plasmaférese para rápida redução dos hormônios tireoidianos, em preparo para a tireoidectomia total.

A 59-year-old female farm worker developed a dark-centered cutaneous lesion in her right leg, associated with progressive swelling for the past 35 years. During the past 4 years, she also had dry cough and dyspnea, which became more intense for the past 6 months. She complained of asthenia and weight loss of 10 kg in the previous year. The patient had diabetes mellitus and hypertension. On physical examination, she had crackling rale at the base of the lungs, edema of the distal right lower limb, with several sinuses and ulcerated lesions of ≈1 cm with purulent discharge (Figure 1). Figure 1. Right lower foot with several ulcerated lesions with purulent discharge. Radiographic studies showed lytic foci of destruction in the medullary cavity with bone expansion, reactive sclerosis, and thickening of the cortex in right tibia and in bones of the right foot. Metatarsal bones also had cortical scalloping (Figure 2A and 2B). T1-weighted magnetic resonance image of the right foot with fat suppression after intravenous gadolinium demonstrate numerous round lesions containing small low-signal foci, also known as dot-in-circle sign, representing granulation tissue surrounded …

A tireotoxicose é uma rara síndrome clínica decorrente da exacerbação do hipertireoidismo, de etiologia e fatores desencadeantes diversos. A abordagem terapêutica pode ser realizada por meio de medicamentos para bloqueio da síntese, secreção e/ou inibição da ação periférica hormonal, além de terapia dirigida aos fatores desencadeantes. Entretanto, em casos refratários, a plasmaférese surge como importante opção de tratamento. Relatamos o caso de um paciente com doença de Graves, internado com quadro de hepatotoxicidade grave por propiltiouracil, que evoluiu com tireotoxicose, sendo indicada plasmaférese para rápida redução dos hormônios tireoidianos, em preparo para a tireoidectomia total. Thyrotoxicosis is a rare clinical syndrome resulting from an exacerbation of hyperthyroidism, with various etiology and triggering factors. Its approach may be accomplished by blocking the synthesis of hormones, their secretion and/or inhibition of their peripheral action, besides treating the triggering factors. However, in refractory cases, plasmapheresis appears as an important option for treatment. We report a patient with Graves' disease who was admitted with thyrotoxicosis and signs of severe hepatotoxicity induced by propylthiouracil. Plasmapheresis was indicated, with the aim of rapidly reducing thyroid hormones in the preparation for total thyroidectomy.

A tireotoxicose é uma rara síndrome clínica decorrente da exacerbação do hipertireoidismo, de etiologia e fatores desencadeantes diversos. A abordagem terapêutica pode ser realizada por meio de medicamentos para bloqueio da síntese, secreção e/ou inibição da ação periférica hormonal, além de terapia dirigida aos fatores desencadeantes. Entretanto, em casos refratários, a plasmaférese surge como importante opção de tratamento. Relatamos o caso de um paciente com doença de Graves, internado com quadro de hepatotoxicidade grave por propiltiouracil, que evoluiu com tireotoxicose, sendo indicada plasmaférese para rápida redução dos hormônios tireoidianos, em preparo para a tireoidectomia total.

Thyrotoxicosis is a rare clinical syndrome resulting from an exacerbation of hyperthyroidism, with various etiology and triggering factors. Its approach may be accomplished by blocking the synthesis of hormones, their secretion and/or inhibition of their peripheral action, besides treating the triggering factors. However, in refractory cases, plasmapheresis appears as an important option for treatment. We report a patient with Graves' disease who was admitted with thyrotoxicosis and signs of severe hepatotoxicity induced by propylthiouracil. Plasmapheresis was indicated, with the aim of rapidly reducing thyroid hormones in the preparation for total thyroidectomy.

Este texto busca analisar um conjunto de nomes do centro da cidade de Pontes e Lacerda – MT, cidade de faixa de fronteira Brasil/Bolívia e procura compreender como estes nomes significam uma história de urbanização. A partir de Guimarães (2005), os nomes e seu funcionamento semântico-enunciativo são pensados pela relação de enunciações. Nessa conjuntura, o conjunto de nomes tomado para análise passa a ser compreendido pelas relações enunciativas que circunscreve o processo sócio-histórico de ocupação e urbanização da cidade. Pela história de enunciações e pelo modo em que se dá a nomeação enquanto acontecimento de linguagem percebe-se a constituição de um pertencimento à territorialidade e à nacionalidade brasileira significado como memorável nos nomes de ruas e avenidas da cidade do extremo oeste do Brasil.

A 44-year-old male patient presented with right chest pain for 6 years, along with progressive swelling in the same region. He did not report fever, weight loss, trauma or previous surgery. On physical examination, a 5 cm focal bulge was observed in the right hemithorax just below and medial to the nipple (figure 1). Chest x-ray showed opacification of the anterior lower third of the right hemithorax (figure 2), which on CT scan corresponded to a heterogeneous mass, compressing the right lung parenchyma and the mediastinum, partially protruding through the chest …

A piezoelectric micromachined microphone with in-plane directivity has been recently introduced [Appl. Phys. Lett. 102, 054109 (2013)]. The work is inspired by a design introduced by Miles et al. [J. Acoust. Soc. Am. 125(4), 2009], which was, in-turn, inspired by the hearing mechanism of a particular type of parasitoid fly. A rocking structure pivots about a rotational hinge in response to in-plane pressure gradients, and the rocking motion is read by springs attached to the end of the rocking ‘teeter-totter’ structure, with the springs themselves employing thin piezoelectric films, which operate in a 3-1 mode. Prototypes have been fabricated that employ rocking structures 1 mm x 2 mm in size and functionality has been verified via directivity measurements performed in an anechoic chamber. This presentation will focus on exploring the design space of this sensor, which is accomplished with a hybrid model based on FEA and network models. Designs which maximize SNR are presented, and anticipated microfabrication challenges of these designs are highlighted.