Universidade Federal de São Paulo

Chronic kidney disease (CKD) represents one of today’s main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease – Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice. Keywords: Kidney Function Tests; Creatinine; Glomerular Filtration Rate; Diagnostic Tests; Cystatin C; Renal Insufficiency, Chronic; Race Factors

Chronic kidney disease (CKD) represents one of today’s main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease – Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice. Keywords: Kidney Function Tests; Creatinine; Glomerular Filtration Rate; Diagnostic Tests; Cystatin C; Renal Insufficiency, Chronic; Race Factors

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação.

Since the COVID-19 pandemic was first reported in 2019, it has rapidly spread around the world. Many countries implemented several measures to try to control the virus spreading. The healthcare system and consequently the general quality of life population in the cities have all been significantly impacted by the Coronavirus pandemic. The different waves of contagious were responsible for the increase in the number of cases that, unfortunately, many times lead to death. In this paper, we aim to characterize the dynamics of the six waves of cases and deaths caused by COVID-19 in Rio de Janeiro city using techniques such as the Poincaré plot, approximate entropy, second-order difference plot, and central tendency measures. Our results reveal that by examining the structure and patterns of the time series, using a set of non-linear techniques we can gain a better understanding of the role of multiple waves of COVID-19, also, we can identify underlying dynamics of disease spreading and extract meaningful information about the dynamical behavior of epidemiological time series. Such findings can help to closely approximate the dynamics of virus spread and obtain a correlation between the different stages of the disease, allowing us to identify and categorize the stages due to different virus variants that are reflected in the time series.

Mercury, a toxic heavy metal, has the potential to accumulate in humans, particularly in vulnerable groups such as pregnant women and children, posing significant health risks. Accurate assessment of mercury in food is crucial to ensure the absence of this contaminant or that intake is below the maximum permitted limits. Absorption Spectrometry (AAS) is an effective method for detecting trace levels of mercury in food, and it is recognized by international regulatory bodies. Despite advantages, common mercury analysis methods have limitations due to challenges associated with sample digestion. The technique based on direct mercury analysis by atomic absorption with thermal decomposition and amalgamation, without the need for prior sample preparation, offers significant benefits. Direct AAS plays a crucial role in food safety regulations by quantifying mercury content accurately, which is vital for consumer protection. In this chapter, we present a streamlined and rapid protocol for quantifying mercury levels in fish muscle through direct analysis using an atomic absorption spectrophotometer.

Recently, innovative approaches on total reflection X-ray fluorescence (TXRF) have been developed, such as benchtop models. These advancements offer simplified sample preparation, rapid system calibration, and time measurement. TXRF has been used in many different fields, particularly environmental chemistry and food analysis, where it is used to detect trace levels of toxic elements in various matrices such as sediments, water, plant, and animal tissues, with detection limit as low as picograms. For the determination of mercury, a prior sample preconcentration using EDTA is mandatory in TXRF analysis. Herein, we describe a protocol to determine the levels of Hg in seafood, using sample preparation with EDTA and further determination using TXRF.

Geosynthetic reinforcements have demonstrated their effectiveness in enhancing road pavement structures through mechanical stabilization. However, airport pavements possess distinctive characteristics, including higher pressure loads, thicker pavement layers, and the need for longer lasting and reliable surfaces due to restrictive operational requirements. Therefore, it is crucial to understand whether geosynthetics products can provide structural enhanced performance within airport pavements. To investigate this, finite element (FE) models were developed to assess the impact of geosynthetic reinforcements in flexible airport pavements subjected to cyclic aircraft loading. These models were calibrated using data from instrumented large-scale experimental prototypes conducted by Robinson and Norwood in 2019. A parametric study revealed that the inclusion of a geosynthetic at different positions could effectively reduce strains in the airport pavement. The optimal location for geosynthetic placement was identified at the subbase—subgrade interface. Furthermore, this study emphasizes the significant impact of multi-layer reinforcements, which was evident in the expanded region influenced by the stabilizing effect of the geosynthetic reinforcement. Permanent and dynamic displacements, as well as elongation deformations, showed significant advantages with the use of a multi-layer reinforcement system, demonstrating reduced permanent displacements by 24%, dynamic displacements by 16%, and elongation deformation by 18% compared to an unreinforced pavement.

The production of fully-heavy tetraquark states in proton–proton ( pp ) and proton–nucleus ( pA ) collisions at the center-of-mass energies of the Large Hadron Collider (LHC) and at the Future Circular Collider (FCC) is investigated considering that these states are produced through the double parton scattering mechanism. We estimate the cross sections for the $$T_{4c},$$ T 4 c , $$T_{4b}$$ T 4 b and $$T_{2b2c}$$ T 2 b 2 c states and present predictions for pp , pCa and pPb collisions considering the rapidity ranges covered by central and forward detectors. We demonstrate that the cross sections for pA collisions are enhanced in comparison to the pp predictions scaled by the atomic number. Moreover, our results indicate that a search of these exotic states is, in principle, feasible in the future runs of the LHC and FCC.

Background X-linked myotubular myopathy (XLMTM) is a rare, life-threatening congenital disease, which is not well-defined. To our knowledge, no studies characterizing the XLMTM disease burden have been conducted in Brazil. We identified and described patients with suspected XLMTM using administrative claims data from the Brazilian public healthcare system. Methods Data from 2015 to 2019 were extracted from the DATASUS database. As no XLMTM-specific ICD-10 code was available, a stepwise algorithm was applied to identify patients with suspected XLMTM by selecting male patients with a congenital myopathies code (G71.2), aged < 18 years at index date (first claim of G71.2), with an associated diagnostic procedure (muscle biopsy/genetic test) and without spinal muscular atrophy or Duchenne muscular dystrophy. We attempted to identify patients with suspected severe XLMTM based on use of both respiratory and feeding support, which are nearly universal in the care of XLMTM patients. Analyses were performed for the overall cohort and stratified by age at index date < 5 years old and ≥ 5 years old. Results Of 173 patients with suspected XLMTM identified, 39% were < 5 years old at index date. Nearly all ( N = 166) patients (96%) were diagnosed by muscle biopsy (91% of patients < 5 years old and 99% of patients ≥ 5 years old), six (3.5%) were diagnosed by clinical evaluation (8% of patients < 5 years old and 1% of patients ≥ 5 years old), and one was diagnosed by a genetic test. Most patients lived in Brasilia ( n = 55), São Paulo ( n = 33) and Minas Gerais ( n = 27). More than 85% of patients < 5 years old and approximately 75% of patients ≥ 5 years old had physiotherapy at the index date. In both age groups, nearly 50% of patients required hospitalization at some point and 25% required mobility support. Respiratory and feeding support were required for 3% and 12% of patients, respectively, suggesting that between 5 and 21 patients may have had severe XLMTM. Conclusion In this real-world study, genetic testing for XLMTM appears to be underutilized in Brazil and may contribute to underdiagnosis of the disease. Access to diagnosis and care is limited outside of specific regions with specialized clinics and hospitals. Substantial use of healthcare resources included hospitalization, physiotherapy, mobility support, and, to a lesser extent, feeding support and respiratory support.

Objective This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic–ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation. Study Design Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring. Results Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%, p = 0.23); however, a decrease in the rates of missing Sarnat examinations within 6 hours after birth was seen between the preintervention (n = 5, 7.6%) and postintervention (n = 2, 6.3%) periods (adjusted odds ratio [aOR]: 0.36 [0.25–0.52], p < 0.001). Centers with remote neuromonitoring support had significantly lower rates of seizures (27.6 vs. 57.5%; aOR: 0.26 [0.12–0.55], p < 0.001) and significant less seizure medication (27.6 vs. 68.7%; aOR: 0.17 [0.07–0.4], p < 0.001). Conclusion This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH. Key Points

This study aims to expand the discussion regarding the extent to which tourism can address socioeconomic expectations. Like other coastal regions, the state of Alagoas has prioritised tourism promotion, despite facing a rainy season that hinders its primary form of tourism, known as Sea, Sun and Sand tourism. We have based our assessment on climate and weather. Through various sources, we have identified narratives related to the rainy season. When crossing these narratives with the Alagoas Strategic Plan for Tourism Development 2013-2023, our findings revealed that the state's policy inadequately addresses the impact of the rainy season. Consequently, we have proposed some recommendations to better align with current local-regional constraints and demands. Beyond the scope of this work, our narrative approach has proven valuable in expanding the consideration of values and meanings within the framework of public policy development, potentially fostering a more holistic understanding of the environment-society relationship .

Esse estudo busca ampliar a discussão sobre a extensão na qual o turismo pode responder às expectativas socioeconômicas. Como em outras zonas costeiras, o estado de Alagoas tem priorizado a promoção turística, apesar da ocorrência de uma estação chuvosa que freia o desenvolvimento do seu principal tipo de turismo, de sol e praia. Neste contexto, o clima e o tempo são utilizados como pontos de referência para essa análise. Por intermédio de diversas fontes, foram identificadas nove narrativas relacionadas à estação chuvosa. As narrativas foram cruzadas com o Plano Estratégico para o Desenvolvimento Turístico de Alagoas 2013-2023, apontando que a estação chuvosa está mal refletida na política estadual. Para melhor abordar as limitações e demandas locais- regionais atuais, recomendações foram, assim, propostas. Além do escopo desse trabalho, a abordagem das narrativas provou ser útil para ampliar a consideração de valores e significados no desenvolvimento de políticas públicas, especialmente na relação ambiente-sociedade.

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain. PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

In his Theory of Needs, Maslow argues that in the self-actualization stage the individual would have more developed B-values, which would involve, among other characteristics, the tendency to be mostly dedicated to causes of collective interest to the detriment of individual interests. It would also be in the self-actualization stage that the environment would have an intrinsic value, an important aspect if we consider the need for developing solutions to socio-environmental problems. Would the Social Representation of the environment have a relationship with the different stages of needs proposed by Maslow in his theory? Could the self-actualization stage reveal an individual with a globalizing representation of the environment? To answer these questions , an study was conducted with 134 participants adapting and using the Environmental Motivation Profile Test instrument and the results showed a significant correlation between the stage of self-actualization and a globalizing representation of the Environment.

Resumo: Em sua Teoria das Necessidades, Maslow argumenta que no estágio de autorrealização o indivíduo teria valores B mais desenvolvidos, o que envolveria, entre outras características, a tendência a se dedicar principalmente a causas de interesse coletivo em detrimento de interesses individuais. Seria também na fase de autorrealização que o meio ambiente teria um valor intrínseco, aspecto importante se considerarmos a necessidade de desenvolver soluções para os problemas socioambientais. Nesse sentido, a Representação Social do meio ambiente teria relação com os diferentes estágios de necessidades propostos por Maslow em sua teoria? O estágio de autorrealização poderia revelar um indivíduo com uma representação globalizante do ambiente? Para res-ponder a essas questões, foi realizado um estudo com 134 participantes adaptando e utilizando o instrumento Teste de Perfil de Motivação Ambiental e os resultados mostraram uma correlação significativa entre o estágio de autorrealização e uma representação globalizante do Meio Ambiente.

During an epidemiological survey, a potential novel species within the basidiomycetous yeast genus Trichosporon was observed. The clinical strain was obtained from a urine sample taken from a Brazilian kidney transplant recipient. The strain was molecularly identified using the intergenic spacer (IGS1) ribosomal DNA locus and a subsequent phylogenetic analysis showed that multiple strains that were previously reported by other studies shared an identical IGS1-genotype most closely related to that of Trichosporon inkin. However, none of these studies provided an in-depth characterization of the involved strains to describe it as a new taxon. Here, we present the novel clinically relevant yeast for which we propose the name Trichosporon austroamericanum sp. nov. (holotype CBS H-24937). T. austroamericanum can be distinguished from other siblings in the genus Trichosporon using morphological, physiological, and phylogenetic characters.

To assess the feasibility of code-free deep learning (CFDL) platforms in the prediction of binary outcomes from fundus images in ophthalmology, evaluating two distinct online-based platforms (Google Vertex and Amazon Rekognition), and two distinct datasets. Two publicly available datasets, Messidor-2 and BRSET, were utilized for model development. The Messidor-2 consists of fundus photographs from diabetic patients and the BRSET is a multi-label dataset. The CFDL platforms were used to create deep learning models, with no preprocessing of the images, by a single ophthalmologist without coding expertise. The performance metrics employed to evaluate the models were F1 score, area under curve (AUC), precision and recall. The performance metrics for referable diabetic retinopathy and macular edema were above 0.9 for both tasks and CDFL. The Google Vertex models demonstrated superior performance compared to the Amazon models, with the BRSET dataset achieving the highest accuracy (AUC of 0.994). Multi-classification tasks using only BRSET achieved similar overall performance between platforms, achieving AUC of 0.994 for laterality, 0.942 for age grouping, 0.779 for genetic sex identification, 0.857 for optic, and 0.837 for normality with Google Vertex. The study demonstrates the feasibility of using automated machine learning platforms for predicting binary outcomes from fundus images in ophthalmology. It highlights the high accuracy achieved by the models in some tasks and the potential of CFDL as an entry-friendly platform for ophthalmologists to familiarize themselves with machine learning concepts.

Objective to determine the surgical indications for glenoid bone grafting associated with better postoperative ranges of motion. Methods This systematic review was conducted according to PRISMA. The included studies were subdivided according to the criteria used to indicate glenoid bone graft surgery: group for radiological indications only (Group R), group for radiological indications associated with clinical indications (Group R + C), and group for arthroscopic indications (Group A). The extracted and evaluated data were the range of motion of the shoulder. Results in the electronic search conducted in October 2022, 1567 articles were selected. After applying the inclusion criteria, 14 articles were selected for the systematic review. Regarding the ranges of motion, group A had the highest number of statistically positive results together with group R. Group A showed positive results in elevation parameters, loss of lateral rotation in adduction, and medial rotation in abduction. Group R showed positive results in lateral rotation in adduction and loss of lateral rotation in adduction. On the other hand, Group R + C was the one that presented the highest number of statistically negative results, in the following parameters: elevation, lateral rotation in abduction, loss of lateral rotation in adduction, and medial rotation in abduction. Conclusion the subgroups presented variable results in the evaluated parameters; however, the groups with arthroscopic and radiological indications showed the highest number of positive results, with the latter group showing the best results regarding lateral rotation. Level of Evidence II, Systematic Reviews. Keywords: Shoulder; Systematic Review; Orthopedic Surgery