Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to thos...Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.展开更多
Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,incr...Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,increasing the incidence of structural congenital heart disease(CHD)and myocardial hypertrophy in newborns.Objective:This review aimed to examine the association between maternal diabetes mellitus and CHD.Methods:This systematic review used the STROBE and TRIPOD checklists registered in PROSPERO(CRD42024513858).It focused on diagnostic test accuracy using the Munn et al.protocol for systematic assessment,emphasizing the“PIRD”:Population,Index Test,Reference Test,Diagnosis of Interest.This review aimed the following PIRD model question:‘Does diabetic pregnant woman inffuence in fetal cardiac malformation?’using PRISMA 2020 statement.A systematic review was conducted on 19 October 2023 in the following databases:PubMed/MEDLINE,Embase(Elsevier),CINAHL(EBSCO),Scopus(Elsevier),Web of Science(Clarivate Analytics),LILACS,and SciELO.Only articles in English,Spanish,and Portuguese languages were selected.Results:Seven studies between 2018 and 2023 were selected.The studies differed in terms of the cardiac ultrasound parameters used to assess CHD and diagnose diabetes mellitus in pregnancy.They highlight the importance of fetal echocardiography in detecting CHD prenatally and assessing the impact of diabetes mellitus on fetal cardiac health,recommending proactive care planning and early intervention for better outcomes.Conclusions:The studies highlight the impact of maternal diabetes mellitus,particularly GDM,on fetal cardiac development and support early detection by fetal echocardiography.Standardization and collaboration are essential to reffne management and outcomes in high-risk pregnancies.展开更多
An investigation has been carried out into the effects of chromium and vanadium content on the oxidation rate and on the adhesion of oxide scales grown on three different chemical compositions of high speed steels und...An investigation has been carried out into the effects of chromium and vanadium content on the oxidation rate and on the adhesion of oxide scales grown on three different chemical compositions of high speed steels under dry and wet conditions.The oxidation tests were carried out in a thermobalance at 650℃for up to 14.4 ks.The mass gain of the specimens increased with increasing contents of water vapour. Alloy composition had no effect on the oxidation rate in dry conditions.The'adhesion'of the oxide scale was determined using indentation with a Rockwell C diamond and the pull adhesion test to determine the interfacial toughness and the tensile strength of the oxide metal bond,respectively.Generally,the results of the investigation indicated that oxide adhesion was lowest for the specimens exposed to dry conditions, and that with increasing water vapour content,the scale was more adherent.Indentation test results showed that an increase in the V concentration was deleterious to oxide adhesion in both the dry and wet environments,whereas an increase in the Cr-content had little effect on adhesion.展开更多
Obesity is a major worldwide health problem that is related to most chronic diseases,including male infertility.Owing to its wide impact on health,mechanisms underlying obesity-related infertility remain unknown.In th...Obesity is a major worldwide health problem that is related to most chronic diseases,including male infertility.Owing to its wide impact on health,mechanisms underlying obesity-related infertility remain unknown.In this study,we report that mice fed a high-fat diet(HFD)for over 2 months showed reduced fertility rates and increased germ cell apoptosis,seminiferous tubule degeneration,and decreased intratesticular estradiol(E2)and E2-to-testosterone ratio.Interestingly,we also detected a decrease in testicular fatty acid levels,behenic acid(C22:0),and docosahexaenoic acid(DHA,22:6n-3),which may be related to the production of dysfunctional spermatozoa.Overall,we did not detect any changes in the frequency of seminiferous tubule stages,sperm count,or rate of in vitro capacitation.However,there was an increase in spontaneous and progesterone-induced acrosomal exocytosis(acrosome reaction)in spermatozoa from HFD-fed mice.These data suggest that a decrease in E2 and fatty acid levels influences spermatogenesis and some steps of acrosome biogenesis that will have consequences for fertilization.Thus,our results add new evidence about the adverse effect of obesity in male reproduction and suggest that the acrosomal reaction can also be affected under this condition.展开更多
Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications ...Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.展开更多
Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P ...Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.展开更多
This study aimed to understand the use of low level laser in the regeneration of injured tissues. Also to design our own opinion on the subject, as chemists. Laser is nothing more than a light with very special charac...This study aimed to understand the use of low level laser in the regeneration of injured tissues. Also to design our own opinion on the subject, as chemists. Laser is nothing more than a light with very special characteristics that grant it therapeutic properties. We can observe the existence of three different types of laser, being one of them the therapeutic laser, which is used in substitution for medications or along with them. Another type of laser is the surgical one and, in addition to these, there is a diagnostic type. A great advantage is that, instead of taking the medicine, the patient’s own body can be activated by the laser to produce certain substances that can often replace the drugs. This is a literature review emphasizing the use of low level laser. Thus, the reflections from this study can contribute to the amplification of the production of knowledge that aims at the resignification of the use of laser in therapy. Greater attention was given to two types of laser radiation: He-Ne and As-Ga, both presenting a high therapeutic potential in superficial and deep injures. However, the He-Ne laser excels in superficial lesions, whereas the As-Ga laser does so in deep injures, such as articular, muscular, etc.展开更多
This study addresses challenges in fetal magnetic resonance imaging (MRI) related to motion artifacts, maternal respiration, and hardware limitations. To enhance MRI quality, we employ deep learning techniques, specif...This study addresses challenges in fetal magnetic resonance imaging (MRI) related to motion artifacts, maternal respiration, and hardware limitations. To enhance MRI quality, we employ deep learning techniques, specifically utilizing Cycle GAN. Synthetic pairs of images, simulating artifacts in fetal MRI, are generated to train the model. Our primary contribution is the use of Cycle GAN for fetal MRI restoration, augmented by artificially corrupted data. We compare three approaches (supervised Cycle GAN, Pix2Pix, and Mobile Unet) for artifact removal. Experimental results demonstrate that the proposed supervised Cycle GAN effectively removes artifacts while preserving image details, as validated through Structural Similarity Index Measure (SSIM) and normalized Mean Absolute Error (MAE). The method proves comparable to alternatives but avoids the generation of spurious regions, which is crucial for medical accuracy.展开更多
Congenital duodenal obstruction (CDO) is one of the most common anomalies presented in the neonatal period of intestinal obstruction, with an incidence of 1:10,000, and Preduodenal Portal Vein (PDPV) is a rare extrins...Congenital duodenal obstruction (CDO) is one of the most common anomalies presented in the neonatal period of intestinal obstruction, with an incidence of 1:10,000, and Preduodenal Portal Vein (PDPV) is a rare extrinsic cause of CDO. PDPV leads to CDO with a persistent vomiting, impairment of the oral feeding and weight loss, but other publications state an asymptomatic disease that may requires late surgical correction. Prenatal diagnosis of CDO, including PDPV, is evidenced by association of polyhydramnios with a dilated fluid-filled gastric and duodenum and a double-bobble image in the ultrasonography and permits a proper management of associated malformation, delivery, surgery and allows family counseling. PDPV is commonly associated to other intestinal obstruction such as extrinsic (annular pancreas, adhesive bands, malrotation, peritoneal bands, intestinal duplication), and intrinsic (atresia, web and stenosis), and also associated with cardiovascular anomalies, situs inversus, Down’s syndrome and polysplenia. This is full term 5 days old newborn, 2865 g girl, without prenatal diagnosis of CDO. It was not still established PDPV until surgery procedure such as Duodenoduodenostomy (Diamond-Shape) and can guide Paediatric Surgeons that face high intestinal obstruction in the neonate with or without prenatal diagnosis. In the ambulatory follow up after 4 months, baby has developed very well, in breast-feeding associated with formula-feeding with a normal weight gain (average of 550 g/month).展开更多
This paper uses a Value at Risk （VaR） approach to evaluate a country financial vulnerability, by analyzing the risk exposure of its Central Bank, as if their assets are subject to market risk. The Brazilian currency...This paper uses a Value at Risk （VaR） approach to evaluate a country financial vulnerability, by analyzing the risk exposure of its Central Bank, as if their assets are subject to market risk. The Brazilian currency exchange swaps contracts （USS/Brazilian Reais） are submitted to a delta-normal VaR method, in order to evaluate the market risk of each swaps series, by modeling the variance of the daily returns, from August 1999 to January 2003. All daily returns series exhibited heteroscedasticity in the conditional variance and sudden changes in the unconditional variance. The points of changes of the unconditional variance were determined through the Iterative Cumulative Sum of Squares （ICSS） algorithm, and the conditional variance was modeled with Markov-Switching-Generalized Autoregressive Conditional Heteroscedasticity （SWGARCH） in order to capture heteroscedasticity and regime change. The results lead to two main conclusions： First, a VaR model must incorporate heteroscedasticity and regime switching in order to describe the variance of the tested series, submitted to brisk changes of economic and political scenarios. Second, a volatility-based VaR do not necessarily generate forward-looking indicators, but rather coincident indicators of possible financial vulnerabilities. The future research will evolve towards evaluating the effects of the Basel III recommendations as if they could be applied to this crisis period.展开更多
<i>Cytomegalovirus</i> (CMV) and <i>Pneumocystis jirovecii</i> fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to pre...<i>Cytomegalovirus</i> (CMV) and <i>Pneumocystis jirovecii</i> fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus<sup>®</sup> and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or <i>Pneumocystis jirovecii</i>. Treatment with Ganciclovir<sup>®</sup> and Bactrim<sup>®</sup> was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and <i>Pneumocystis jirovecii</i>. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and <i>Pneumocystis jirovecii</i>. Adjusting the doses of immunosuppressants to individual needs can be an important measure for maintaining the proper immune system and consequently avoiding late opportunistic infections and death outcomes.展开更多
This text evaluates the convergence among the main targets of a Central Bank, like the Brazilian Central Bank, with that deals with objectives such as inflation targeting, bank regulation, and financial inclusion, whe...This text evaluates the convergence among the main targets of a Central Bank, like the Brazilian Central Bank, with that deals with objectives such as inflation targeting, bank regulation, and financial inclusion, when it operates subject to the Bank for International Settlements （BIS） recommendations gathered in the recent Basel III agreement. A Brazilian conjuncture analysis starts with the economic stabilization plan known as Piano Real （July, 1994） and takes account that, from 2007 onwards, the world economy is going through troubled times unchained by the international financial crisis that motivated the recent Basel Agreement （Basel III）. There are two lines of analysis： macroeconomic and marketing. From the macroeconomic approach, there are plenty models to predict money supply and monetary aggregates. From a marketing perspective, it can be inferred that technologies potentially innovatives may alter the current scenario. The financial time series chosen are： daily money supply, banking reserves, and annual inflation （monthly announced）. The first statistical and empirical evidences from the period （July, 1994 to December, 2011） show that the management of banking reserves does not interfere with the continuous growth of the monetary base plus demand deposits （M1） and cash in circulation, which possibly indicates an increasing financial inclusion. Moreover, there is no evidence that it creates inflationary pressures. The future works may require competencies pertinent to prospective finance and consumer behavior （marketing）.展开更多
The paper presents an analysis of computer programming languages based on the semiotics of Charles S. Peirce. The author describes how such languages could evolve in order to achieve some of the expressive characteris...The paper presents an analysis of computer programming languages based on the semiotics of Charles S. Peirce. The author describes how such languages could evolve in order to achieve some of the expressive characteristics of natural languages. This description evinces otherwise unnoticed differences between natural languages and programming languages, showing that Peircean semiotics is an efficient analysis tool. This suggests further research on the technical features needed to implement an easier way to program computers.展开更多
<span style="font-family:Verdana;">Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can pr...<span style="font-family:Verdana;">Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can progress to pain, distortion, and asymmetry of the breasts, requiring surgical revision. The present study is a case report. A 58-year-old woman with a medical diagnosis of capsular contracture of the right breast evidenced by ultrasound. She was referred to the physiotherapy clinic in October 2019 with an initial complaint of pain on palpation, swelling, and stiffness in her right breast. The patient was evaluated and the MAC</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method was used to treat capsular contracture. For this, 12 sessions of photodynamic therapy were carried out. The treatment included the use of LED by doping: red (300</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s), violet (60</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s) and blue (120</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s), with the use of 1% methylene blue in target areas, three times a week. The patient had the beginning of symptoms’ remission in the fourth visit and total remission in the 12th visit. It was concluded that the use of photodynamic therapy using the MAC</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method showed improvement in signs and symptoms</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">—</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">t</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">he sensation of prosthesis stiffness in the lower and medial region, local temperature, and pain in the right breast. The patient was followed up after treatment and currently, she has no complaints. There was also no need for surgical intervention. In the present case report, the MAC</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method proved to be effective. Further research is suggested with a cohort of patients with capsular contracture, with randomization and evaluation of a larger number of patients with the referred method.</span></span></span>展开更多
Silymarin, from the fruit of Silybum marianum, is known for its hepatoprotective action. The aim of this study was to review the mechanisms of action of the silymarin phytocomplex to expand the possibilities for its a...Silymarin, from the fruit of Silybum marianum, is known for its hepatoprotective action. The aim of this study was to review the mechanisms of action of the silymarin phytocomplex to expand the possibilities for its application in human health. The search for published articles was carried out on the CAPES Journals Portal platform, which covers worldwide scientific databases. Publications from 2010 to 2022 were included. Of the 311 articles retrieved, 21 were included. The articles discuss the diversity of silymarin’s applications and the possibility of optimizing its bioavailability using drug delivery systems. Silymarin shows promise in numerous diseases, such as liver, kidney, cardiovascular, respiratory and others. Its antiviral action has been demonstrated in studies and silymarin has the potential to be used as a complementary therapy in the treatment of many diseases, with the expectation that, in the future, it will be used in therapeutic protocols for exclusive use.展开更多
This paper presented the new sanitary and health protocols implemented by cruise companies in order to internationally resuming the industry. The perception of Brazilians regarding these new protocols was identified t...This paper presented the new sanitary and health protocols implemented by cruise companies in order to internationally resuming the industry. The perception of Brazilians regarding these new protocols was identified through a quantitative survey with a sample of 412 Brazilian respondents, carried out between May and June 2021. As main results, sanitary and health protocols that do not affect their experiences on board were identified, as well as those protocols that compromised the experience perceived by the future traveler. The respondents’ propensity to travel on cruise ships and their perceptions about the influence of the ship size, the number of ports of call, nationalities on board, the number of vips, among other aspects, were also analyzed. Finally, in the final section of this paper, we presented an estimation of the expected number of cruisers for the 21/22 cruising season in Brazil, based on a kind Bayesian argument, considering different scenarios for the forthcoming season.展开更多
文摘Introduction:Inadequate blood pressure(BP)control is a significant challenge.Therapeutic decisions based on home blood pressure monitoring(HBPM)have been shown to lead to better blood pressure control compared to those based on office blood pressure(OBP)measurements alone.Objectives:To compare,over a five-year period,the annual BP control rates in hypertensive patients who were treated and monitored by the same cardiologists and who periodically used HBPM.Methodology:This was a multicenter study conducted with five cross-sectional analyses at annual intervals,with the first in 2019 and the last in 2023.OBP and HBPM measurements were performed according to current guidelines.Two cutoff points were considered for the analysis of BP control by OBP:<140/90 mmHg and<130/80 mmHg.For HBPM,the cutoff was<130/80 mmHg.Comparisons of quantitative variables between years were established using the t-test or chi-square test.A p-value<0.05 was considered significant.Results:A total of 8,890 individuals with a mean age of 63.3(±14.9)years were included,of whom 65.8%were women.A reduction in mean OBP values was observed between 2019-2020 and 2021-2022.There was also a reduction in the average number of antihypertensive medications used in 2020,with a mean of 1.99 medications taken that year.Compared to 2020,2022 showed an improvement in control rates for OBP<130/80 mmHg(31.5%vs.35.7%;p=0.008)and OBP<140/90 mmHg(58.7%vs.65.7%;p<0.001).Conclusion:Continuous monitoring by the same physician and the use of home measurement tools can lead to better BP control in hypertensive patients.
文摘Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,increasing the incidence of structural congenital heart disease(CHD)and myocardial hypertrophy in newborns.Objective:This review aimed to examine the association between maternal diabetes mellitus and CHD.Methods:This systematic review used the STROBE and TRIPOD checklists registered in PROSPERO(CRD42024513858).It focused on diagnostic test accuracy using the Munn et al.protocol for systematic assessment,emphasizing the“PIRD”:Population,Index Test,Reference Test,Diagnosis of Interest.This review aimed the following PIRD model question:‘Does diabetic pregnant woman inffuence in fetal cardiac malformation?’using PRISMA 2020 statement.A systematic review was conducted on 19 October 2023 in the following databases:PubMed/MEDLINE,Embase(Elsevier),CINAHL(EBSCO),Scopus(Elsevier),Web of Science(Clarivate Analytics),LILACS,and SciELO.Only articles in English,Spanish,and Portuguese languages were selected.Results:Seven studies between 2018 and 2023 were selected.The studies differed in terms of the cardiac ultrasound parameters used to assess CHD and diagnose diabetes mellitus in pregnancy.They highlight the importance of fetal echocardiography in detecting CHD prenatally and assessing the impact of diabetes mellitus on fetal cardiac health,recommending proactive care planning and early intervention for better outcomes.Conclusions:The studies highlight the impact of maternal diabetes mellitus,particularly GDM,on fetal cardiac development and support early detection by fetal echocardiography.Standardization and collaboration are essential to reffne management and outcomes in high-risk pregnancies.
文摘An investigation has been carried out into the effects of chromium and vanadium content on the oxidation rate and on the adhesion of oxide scales grown on three different chemical compositions of high speed steels under dry and wet conditions.The oxidation tests were carried out in a thermobalance at 650℃for up to 14.4 ks.The mass gain of the specimens increased with increasing contents of water vapour. Alloy composition had no effect on the oxidation rate in dry conditions.The'adhesion'of the oxide scale was determined using indentation with a Rockwell C diamond and the pull adhesion test to determine the interfacial toughness and the tensile strength of the oxide metal bond,respectively.Generally,the results of the investigation indicated that oxide adhesion was lowest for the specimens exposed to dry conditions, and that with increasing water vapour content,the scale was more adherent.Indentation test results showed that an increase in the V concentration was deleterious to oxide adhesion in both the dry and wet environments,whereas an increase in the Cr-content had little effect on adhesion.
文摘Obesity is a major worldwide health problem that is related to most chronic diseases,including male infertility.Owing to its wide impact on health,mechanisms underlying obesity-related infertility remain unknown.In this study,we report that mice fed a high-fat diet(HFD)for over 2 months showed reduced fertility rates and increased germ cell apoptosis,seminiferous tubule degeneration,and decreased intratesticular estradiol(E2)and E2-to-testosterone ratio.Interestingly,we also detected a decrease in testicular fatty acid levels,behenic acid(C22:0),and docosahexaenoic acid(DHA,22:6n-3),which may be related to the production of dysfunctional spermatozoa.Overall,we did not detect any changes in the frequency of seminiferous tubule stages,sperm count,or rate of in vitro capacitation.However,there was an increase in spontaneous and progesterone-induced acrosomal exocytosis(acrosome reaction)in spermatozoa from HFD-fed mice.These data suggest that a decrease in E2 and fatty acid levels influences spermatogenesis and some steps of acrosome biogenesis that will have consequences for fertilization.Thus,our results add new evidence about the adverse effect of obesity in male reproduction and suggest that the acrosomal reaction can also be affected under this condition.
文摘Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt.</span><b> </b><span style="font-family:Verdana;">Male, elderly, and ex-alcoholic, diagnosed with liver cirrho</span><span style="font-family:Verdana;">sis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital</span> <span style="font-family:Verdana;">after 24 hours with agitation and mental confusion. He had a bowel move</span><span style="font-family:Verdana;">ment stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome.</span><b> </b><span style="font-family:Verdana;">Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.
基金funded in part by the Coordination of Improvement of Higher Level Personnel—Brazil(CAPES)—Finance Code 001 by the National Council of Scientific and Technological Development—Brazil(CNPq)—Doctorate GDby Research Foundation of the State of Rio Grande do Sul(FAPERGS).
文摘Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.
文摘This study aimed to understand the use of low level laser in the regeneration of injured tissues. Also to design our own opinion on the subject, as chemists. Laser is nothing more than a light with very special characteristics that grant it therapeutic properties. We can observe the existence of three different types of laser, being one of them the therapeutic laser, which is used in substitution for medications or along with them. Another type of laser is the surgical one and, in addition to these, there is a diagnostic type. A great advantage is that, instead of taking the medicine, the patient’s own body can be activated by the laser to produce certain substances that can often replace the drugs. This is a literature review emphasizing the use of low level laser. Thus, the reflections from this study can contribute to the amplification of the production of knowledge that aims at the resignification of the use of laser in therapy. Greater attention was given to two types of laser radiation: He-Ne and As-Ga, both presenting a high therapeutic potential in superficial and deep injures. However, the He-Ne laser excels in superficial lesions, whereas the As-Ga laser does so in deep injures, such as articular, muscular, etc.
文摘This study addresses challenges in fetal magnetic resonance imaging (MRI) related to motion artifacts, maternal respiration, and hardware limitations. To enhance MRI quality, we employ deep learning techniques, specifically utilizing Cycle GAN. Synthetic pairs of images, simulating artifacts in fetal MRI, are generated to train the model. Our primary contribution is the use of Cycle GAN for fetal MRI restoration, augmented by artificially corrupted data. We compare three approaches (supervised Cycle GAN, Pix2Pix, and Mobile Unet) for artifact removal. Experimental results demonstrate that the proposed supervised Cycle GAN effectively removes artifacts while preserving image details, as validated through Structural Similarity Index Measure (SSIM) and normalized Mean Absolute Error (MAE). The method proves comparable to alternatives but avoids the generation of spurious regions, which is crucial for medical accuracy.
文摘Congenital duodenal obstruction (CDO) is one of the most common anomalies presented in the neonatal period of intestinal obstruction, with an incidence of 1:10,000, and Preduodenal Portal Vein (PDPV) is a rare extrinsic cause of CDO. PDPV leads to CDO with a persistent vomiting, impairment of the oral feeding and weight loss, but other publications state an asymptomatic disease that may requires late surgical correction. Prenatal diagnosis of CDO, including PDPV, is evidenced by association of polyhydramnios with a dilated fluid-filled gastric and duodenum and a double-bobble image in the ultrasonography and permits a proper management of associated malformation, delivery, surgery and allows family counseling. PDPV is commonly associated to other intestinal obstruction such as extrinsic (annular pancreas, adhesive bands, malrotation, peritoneal bands, intestinal duplication), and intrinsic (atresia, web and stenosis), and also associated with cardiovascular anomalies, situs inversus, Down’s syndrome and polysplenia. This is full term 5 days old newborn, 2865 g girl, without prenatal diagnosis of CDO. It was not still established PDPV until surgery procedure such as Duodenoduodenostomy (Diamond-Shape) and can guide Paediatric Surgeons that face high intestinal obstruction in the neonate with or without prenatal diagnosis. In the ambulatory follow up after 4 months, baby has developed very well, in breast-feeding associated with formula-feeding with a normal weight gain (average of 550 g/month).
文摘This paper uses a Value at Risk （VaR） approach to evaluate a country financial vulnerability, by analyzing the risk exposure of its Central Bank, as if their assets are subject to market risk. The Brazilian currency exchange swaps contracts （USS/Brazilian Reais） are submitted to a delta-normal VaR method, in order to evaluate the market risk of each swaps series, by modeling the variance of the daily returns, from August 1999 to January 2003. All daily returns series exhibited heteroscedasticity in the conditional variance and sudden changes in the unconditional variance. The points of changes of the unconditional variance were determined through the Iterative Cumulative Sum of Squares （ICSS） algorithm, and the conditional variance was modeled with Markov-Switching-Generalized Autoregressive Conditional Heteroscedasticity （SWGARCH） in order to capture heteroscedasticity and regime change. The results lead to two main conclusions： First, a VaR model must incorporate heteroscedasticity and regime switching in order to describe the variance of the tested series, submitted to brisk changes of economic and political scenarios. Second, a volatility-based VaR do not necessarily generate forward-looking indicators, but rather coincident indicators of possible financial vulnerabilities. The future research will evolve towards evaluating the effects of the Basel III recommendations as if they could be applied to this crisis period.
文摘<i>Cytomegalovirus</i> (CMV) and <i>Pneumocystis jirovecii</i> fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus<sup>®</sup> and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or <i>Pneumocystis jirovecii</i>. Treatment with Ganciclovir<sup>®</sup> and Bactrim<sup>®</sup> was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and <i>Pneumocystis jirovecii</i>. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and <i>Pneumocystis jirovecii</i>. Adjusting the doses of immunosuppressants to individual needs can be an important measure for maintaining the proper immune system and consequently avoiding late opportunistic infections and death outcomes.
文摘This text evaluates the convergence among the main targets of a Central Bank, like the Brazilian Central Bank, with that deals with objectives such as inflation targeting, bank regulation, and financial inclusion, when it operates subject to the Bank for International Settlements （BIS） recommendations gathered in the recent Basel III agreement. A Brazilian conjuncture analysis starts with the economic stabilization plan known as Piano Real （July, 1994） and takes account that, from 2007 onwards, the world economy is going through troubled times unchained by the international financial crisis that motivated the recent Basel Agreement （Basel III）. There are two lines of analysis： macroeconomic and marketing. From the macroeconomic approach, there are plenty models to predict money supply and monetary aggregates. From a marketing perspective, it can be inferred that technologies potentially innovatives may alter the current scenario. The financial time series chosen are： daily money supply, banking reserves, and annual inflation （monthly announced）. The first statistical and empirical evidences from the period （July, 1994 to December, 2011） show that the management of banking reserves does not interfere with the continuous growth of the monetary base plus demand deposits （M1） and cash in circulation, which possibly indicates an increasing financial inclusion. Moreover, there is no evidence that it creates inflationary pressures. The future works may require competencies pertinent to prospective finance and consumer behavior （marketing）.
文摘The paper presents an analysis of computer programming languages based on the semiotics of Charles S. Peirce. The author describes how such languages could evolve in order to achieve some of the expressive characteristics of natural languages. This description evinces otherwise unnoticed differences between natural languages and programming languages, showing that Peircean semiotics is an efficient analysis tool. This suggests further research on the technical features needed to implement an easier way to program computers.
文摘<span style="font-family:Verdana;">Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can progress to pain, distortion, and asymmetry of the breasts, requiring surgical revision. The present study is a case report. A 58-year-old woman with a medical diagnosis of capsular contracture of the right breast evidenced by ultrasound. She was referred to the physiotherapy clinic in October 2019 with an initial complaint of pain on palpation, swelling, and stiffness in her right breast. The patient was evaluated and the MAC</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method was used to treat capsular contracture. For this, 12 sessions of photodynamic therapy were carried out. The treatment included the use of LED by doping: red (300</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s), violet (60</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s) and blue (120</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s), with the use of 1% methylene blue in target areas, three times a week. The patient had the beginning of symptoms’ remission in the fourth visit and total remission in the 12th visit. It was concluded that the use of photodynamic therapy using the MAC</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method showed improvement in signs and symptoms</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">—</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">t</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">he sensation of prosthesis stiffness in the lower and medial region, local temperature, and pain in the right breast. The patient was followed up after treatment and currently, she has no complaints. There was also no need for surgical intervention. In the present case report, the MAC</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><sup><span style="font-family:Verdana;"><span style="font-family:Verdana;">ò</span></span></sup></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> method proved to be effective. Further research is suggested with a cohort of patients with capsular contracture, with randomization and evaluation of a larger number of patients with the referred method.</span></span></span>
文摘Silymarin, from the fruit of Silybum marianum, is known for its hepatoprotective action. The aim of this study was to review the mechanisms of action of the silymarin phytocomplex to expand the possibilities for its application in human health. The search for published articles was carried out on the CAPES Journals Portal platform, which covers worldwide scientific databases. Publications from 2010 to 2022 were included. Of the 311 articles retrieved, 21 were included. The articles discuss the diversity of silymarin’s applications and the possibility of optimizing its bioavailability using drug delivery systems. Silymarin shows promise in numerous diseases, such as liver, kidney, cardiovascular, respiratory and others. Its antiviral action has been demonstrated in studies and silymarin has the potential to be used as a complementary therapy in the treatment of many diseases, with the expectation that, in the future, it will be used in therapeutic protocols for exclusive use.
文摘This paper presented the new sanitary and health protocols implemented by cruise companies in order to internationally resuming the industry. The perception of Brazilians regarding these new protocols was identified through a quantitative survey with a sample of 412 Brazilian respondents, carried out between May and June 2021. As main results, sanitary and health protocols that do not affect their experiences on board were identified, as well as those protocols that compromised the experience perceived by the future traveler. The respondents’ propensity to travel on cruise ships and their perceptions about the influence of the ship size, the number of ports of call, nationalities on board, the number of vips, among other aspects, were also analyzed. Finally, in the final section of this paper, we presented an estimation of the expected number of cruisers for the 21/22 cruising season in Brazil, based on a kind Bayesian argument, considering different scenarios for the forthcoming season.
