Pontifical Catholic University of Rio Grande do Sul

Introduction Currently, high-resolution computed tomography (HRCT) is the imaging of choice for the differential diagnosis of various cystic lung lesions, including true cystic lung diseases (CLD) and lesions that may mimic them. However, the traditionally used inspiratory scan still presents a significant spectrum of overlapping radiological features. Recent studies have demonstrated variation in lesion size between inspiratory and expiratory phases, probably due to cyst-airway communication. In this study, we aimed to conduct a systematic review of paired inspiratory and expiratory HRCT in the assessment of cystic lesions as an additional tool to narrow the differential diagnosis. Methods A systematic search was performed in PubMed, Scopus, EMBASE, BVS, and Cochrane through August 2023. Full-text articles that performed paired inspiratory and expiratory CT scans in adult patients with cystic lung lesions were included, with the outcome measured as the reduction in lesion size according to the respiratory phase. Diagnoses were confirmed through histopathological or radiological features. Results Out of the 96 records, three studies met the criteria for inclusion and were analyzed, comprising a total of 149 participants and 513 cystic lesions. Pulmonary Langerhans Cell Histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM) honeycombing and cystic bronchiectasis became considerably smaller during expiratory CT scans, while the size of emphysema tended to remain constant during respiratory cycles. Conclusions This study has suggested that paired inspiratory and expiratory CT scans can be valuable for helping differentiate between emphysema and other diseases with a cystic pattern due to their ability to reveal dynamic properties of the lesions. However, the average reduction in cyst size as a single parameter is not sufficient for further refining diagnostics. Studies exploring advanced metrics to assess the reduction in lesion diameter emerge as potential opportunities to investigate the cyst-airway communication hypothesis and further enhance the diagnostic accuracy of paired methods.

Introduction: Chronic kidney disease (CKD) is related to high morbidity and mortality and loss of quality of life. Likewise, hyperparathyroidism is associated to progressive loss of renal function, with increased phosphate and decrease calcium levels, which induce the secretion of parathyroid hormone. Objectives: To translate into Portuguese (Brazil), culturally adapt and validate the questionnaire Parathyroid Symptoms Assessment (PAS), following reliability and validity criteria in patients with chronic kidney disease and hyperparathyroidism. Methods: Methodological and cross-sectional study, carried out at São Lucas Hospital/PUCRS, Porto Alegre, Brazil. The PAS questionnaire validation process followed protocols from previous studies. After translating into Portuguese, it was applied to 100 patients with secondary (SHPT) and tertiary or persistent (THPT) hyperparathyroidism. For PAS validation data, patients responded to the Short Form Health 36 (SF-36) questionnaire. Reliability criteria were evaluated using intraclass correlation coefficient (ICC) and Cronbach’s alpha (α-C). Validity was assessed by Spearman’s correlation coefficient between PAS and SF-36 values. Results: Participant’s mean age was 55.6 ± 15.6 years, 61% was male, and 68% was diagnosed with SHPT. Among 100 patients, 53% performed a PAS retest (ICC = 0.83). The internal reliability by α-C was 0.86. Negative correlations were observed between PAS questions and SF-36 physical and mental domains, which ranged from 0.3 to 0.7. Conclusion: The Brazilian version of the PAS questionnaire was found to be valid and reliable. The PAS questionnaire can be used to evaluate quality of life in Brazilian patients with hyperparathyroidism who speak Portuguese.

Resumo Introdução: A doença renal crônica (DRC) está relacionada à elevada morbimortalidade e perda de qualidade de vida. Igualmente, o hiperparatireoidismo está associado à perda progressiva da função renal, com níveis aumentados de fosfato e diminuição de cálcio, que induzem secreção do paratormônio. Objetivos: Traduzir para língua portuguesa (Brasil), adaptar culturalmente e validar o questionário Parathyroid Symptoms Assessment (PAS), seguindo critérios de confiabilidade e validade em pacientes com DRC e hiperparatireoidismo. Métodos: Estudo metodológico e transversal, realizado no Hospital São Lucas/PUCRS, Porto Alegre, Brasil. O processo de validação do questionário PAS seguiu protocolos de estudos anteriores. Após tradução para o português, aplicou-se a 100 pacientes com hiperparatireoidismo secundário (HPTS) e terciário ou persistente (HPTT). Para dados de validação do PAS, os pacientes responderam ao questionário Short Form Health 36 (SF-36). Critérios de confiabilidade foram avaliados usando coeficiente de correlação intraclasse (CCI) e alfa de Cronbach (α-C). A validade foi avaliada pelo coeficiente de correlação de Spearman entre valores de PAS e SF-36. Resultados: A idade média dos participantes foi 55,6 ± 15,6 anos, 61% eram homens e 68% foram diagnosticados com HPTS. Entre 100 pacientes, 53% realizaram reteste de PAS (CCI = 0,83). A confiabilidade interna por α-C foi 0,86. Observaram-se correlações negativas entre questões do PAS e os domínios físico e mental do SF-36, que variaram de 0,3 a 0,7. Conclusão A versão brasileira do questionário PAS mostrou-se válida e confiável. O questionário PAS pode ser usado para avaliar qualidade de vida em pacientes brasileiros com hiperparatireoidismo que falam português.

Background and Aims Endoscopic drainage of malignant biliary obstruction using metal stents is widely used to treat obstructive jaundice. However, the occurrence of stent occlusion or migration raises the hypothesis using stents with larger diameters may be associated with better outcomes. Methods PubMed, Embase, and Cochrane databases were systematically searched for studies comparing 10-mm vs. 12-mm covered metallic stents for recurrent unresectable biliary obstruction. The primary outcomes were recurrent biliary obstruction (RBO) and time to RBO (TRBO). Statistical analyses were performed using R software version 4.3.1. The risk ratio (RR) was used for binary outcomes, with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I2 statistics. Results We included five studies—one randomized clinical trial and four cohort studies—totaling 520 patients. Among these, 280 received 10-mm stents, while 240 were treated with 12-mm stents. The 12-mm stent is associated with a greater TRBO (HR 1.72; 95% CI 1.36 to 2.18), lower incidence of RBO (RR 0.59; 95% CI 0.44 to 0.78; I2=34%), and stent obstruction (RR 0.52; 95% CI 0.34 to 0.81; I2=33%). No significant differences were found for stent migration and adverse events rate between groups. Conclusion The 12-mm metallic stents significantly increase stent patency and reduce the incidence of RBO and stent obstruction in managing recurrent unresectable biliary obstruction, with no differences regarding stent migration and adverse events compared to 10-mm stents.

Resumo O artigo é decorrente de uma investigação etnográfica com bebês que, baseada nas contribuições do campo dos Estudos da Geografia da Infância e das discussões decorrentes da abordagem Pikler, teve como objetivo central discutir as vivências espaciais dos bebês a partir do movimento livre e da autonomia na creche. Metodologicamente, a pesquisa foi desenvolvida com oito bebês com idades entre 4 meses e 1 ano e 5 meses, durante um período de dez meses, em uma creche que fundamenta seu projeto educativo nos pressupostos teóricos da abordagem Pikler. Para a geração dos dados da pesquisa, foram utilizadas as seguintes estratégias metodológicas: observação, registro em diário de campo, registros fotográficos e fílmicos. Com base na leitura do diário de campo, assim como na decupagem das filmagens e na análise das fotografias, foram escritos episódios a respeito das vivências espaciais dos bebês ocorridas na investigação. A leitura do material gerado em campo possibilitou a identificação de recorrências presentes nas vivências espaciais dos bebês e a definição de três unidades analíticas: 1) os deslocamentos dos bebês pelos espaços da creche; 2) os bebês e as explorações das materialidades que constituem os espaços da creche; 3) as interações entre os bebês na ocupação dos espaços da creche. Com as análises, infere-se a importância de uma docência relacional pautada na promoção de espaços, tempos e materialidades, a qual possibilite que os bebês desfrutem do movimento livre e tenham a oportunidade de exercer a atividade autônoma por meio de suas vivências espaciais.

The article is the result of an ethnographic investigation with babies that, based on contributions from the field of Childhood Geography Studies and discussions from the Pikler approach, had as its central objective to discuss the spatial experiences of babies based on free movement and autonomy in daycare. Methodologically, the research was developed with eight babies aged between 4 months and 1 year and 5 months, over ten months, in a daycare center that bases its educational project on the theoretical assumptions of the Pikler approach. The following methodological strategies were used to generate the research data: observation, recording in a field diary, and photographic and film records. Based on reading the field diary, the footage breakdown, and analysis of the photographs, episodes were written about the spatial experiences of the babies that occurred during the investigation. Reading the material generated in the field made it possible to identify recurrences present in the spatial experiences of the babies and to define three analytical units: 1) the movements of the babies through the spaces of the daycare, 2) the babies and the explorations of the materialities that constitute the spaces of the daycare, 3) the interactions between the babies in the occupation of the spaces of the daycare. The analyses show the importance of relational teaching based on the promotion of spaces, times, and materialities, which allows babies to enjoy free movement and have the opportunity to exercise autonomous activity through their spatial experiences.

The rapid diagnosis of opportunistic infections (OIs) is critical for improving the health outcomes of people living with HIV/AIDS (PLWHA). This study aimed to describe the feasibility of implementing a package for the rapid diagnosis of tuberculosis, histoplasmosis, and cryptococcosis in patients with advanced HIV/AIDS disease in Porto Alegre, Brazil. The research involved two focus groups with health professionals, four in-depth interviews with healthcare managers, and twelve interviews with PLWHA. The corpus was analyzed using Descending Hierarchical Classification (DHC). The study found that the rapid test diagnosis intervention was generally well-received by patients and health professionals, improving diagnosis and treatment outcomes. However, it also identified several areas for improvement, including the need for expanded psychosocial support and enhanced coordination between health services. The findings have important implications for the development and implementation of policies and programs aimed at enhancing the diagnosis and treatment of OIs among PLWHA with advanced diseases. Further research should explore social determinants of HIV/AIDS mortality to offer valuable insights into improving prevention and treatment strategies. By prioritizing patient-centered care and improving coordination between health services, policymakers and health professionals can improve the health outcomes of PLWHA with advanced disease in Porto Alegre and other similar settings.

Purpose The influence of sexual activity on the spontaneous passage of ureteral stones has been tested by several randomized controlled trials (RCTs), but this relationship remains uncertain. This research has sought to investigate the link between sexual activity, including masturbation, and a higher rate of spontaneous expulsion of ureteral stones. Material and methods We searched PubMed, Embase, and Cochrane for RCTs, in January 2024, assessing the effectiveness of sexual activity or masturbation in the elimination of distal or intramural ureteral stones in patients who didn’t receive medical expulsive therapy. Heterogeneity was assessed with I ² . Values of p < 0.05 were considered statistically significant. Statistical analysis was performed using Review Manager 5.4.1 (Cochrane Center, The Cochrane Collaboration). Results We included 8 RCTs, totaling 755 patients, of which 383 (50.7%) engaged in sexual activity or masturbation 3–4 times per week for an average duration of 4 weeks. The expulsion rate at 2 weeks (OR: 3.48; [95% CI 2.37 to 5.11]; p < 0.00001) and at 4 weeks (OR: 3.28; [95% CI 2.23 to 4.83]; p < 0.00001) was higher in the sexual activity or masturbation group. The average time for stone expulsion (MD: -3.27; [95% CI −5.38 to −1.17]; p < 0.002) was shorter in the experimental group, as well as the average number of analgesic injections (MD: −0.6; [95% CI −0.91 to −0.29]; p < 0.0001). Conclusion Our findings suggest that sexual activity or masturbation appears to be effective as an expulsive medical therapy for patients with distal or intramural ureteral stones.

This paper shows results of an ethnographic study. Aimed to analyze literacy practices in a Bible study group that belongs to an evangelical pentecostal community in a rural area in Rio Grande do Sul (RS) state, Brazil. Data generated during insertions in the empirical field showed literacy that is intrinsic to religious practices, whose main literacy practice is reading the Bible, since it was usually included in tasks carried out by the children. The analysis was based on biblical storytelling which is used for evangelization in order to identify strategies that children use for interpreting writing, reading and orality in this context. Results show that literacy practices experienced by the children are strongly connected to the social context and certain particularities which involve interaction that characterizes the religious group’s culture. However, these literacy practices are permeated by the symbolic power which is perceived when ideas are instilled into children, while their behavior is shaped and they are led to accept dominant patterns which are then reproduced and considered legitimate and unquestionable. Keywords: Literacy Practices; Symbolic Power; Pentecostal Bible Study Group; Ethnographic Research

Cancer presents a significant global health burden. Traditional treatment modalities, especially radiotherapy and chemotherapy, have improved survival, but they have long-term consequences. Treatment-induced malignancies, a growing concern, pose risks to survivors. Often with limited treatment options, these tumors tend to have a worse survival rate. A thorough understanding of the main risk groups is critical for lifelong follow-up and personalized care strategies. This review provides an update on the knowledge of treatment-induced malignancies of the head and neck in cancer survivors; specifically, it discusses the risks, histological considerations, diagnosis and treatment strategies, follow-up recommendations, and future perspectives.

Objective: To provide an update on asthma mortality trends in Brazil and its regions between 2014 and 2021. Methods: This was a retrospective descriptive observational study based on asthma mortality data from the Brazilian National Ministry of Health Mortality Database for the 2014-2021 period. Results: In the study period, there were 18,584 asthma deaths in Brazil, with an annual increase of 2.5%, corresponding to 0.03 deaths/100,000 population (95% CI, 0.01-0.04; p = 0.01). The northeastern region of the country had the highest prevalence of asthma deaths (1.50 deaths/100,000 population), and the southern region showed the greatest variation in the study period (44%). We observed a higher proportion of deaths among females and elderly patients, and when analyzing asthma deaths by place of occurrence, we observed that 28% of all deaths occurred at home. Conclusions: Asthma mortality remains high and shows an increasing trend for the first time in the past decades. This constitutes an important public health concern, given the treatable nature of the disease. Keywords: Public health; Asthma; Mortality

This work studies the influence of incorporating core/shell nanoparticles of TiO 2 covered with SiO 2 (TiO 2 @SiO 2 nTS) in oil well cement class G, evaluating chemical changes in the cement composition due to CO 2 attack. The benefits of nTS, including its self-dispersion, pozzolanic properties, and filler effects, make this nanoparticle an attractive supplementary cementitious material for oil well applications. The cement slurry mixing followed the American Petroleum Institute procedures, and no dispersive method was applied for nTS. Hardened cement pastes with water/binder ratios of 0.44 and 0.35, the last being with 0.15 wt % of polycarboxylate ether additive (PCE), were cured in an autoclave (60°C and 40 bar) for 24 h and then submitted to degradation tests in CO 2-saturated water at high temperature and high pressure (HTHP) (90°C and 150 bar) during 7, 14, and 21 days. The characterization of the carbonated pastes was conducted using advanced techniques. X-ray microtomography and scanning electron microscopy showed that adding nTS and PCE significantly reduced the carbonation depth and the diffusion coefficient, with the latter decreasing by nearly an order of magnitude. Thermogravimetric and X-ray diffraction (Rietveld) analyses showed 1.32 and 1.90% higher CH amounts after carbonation in the mixtures with nTS, respectively. Moreover, in nTS's presence, a lower content of CaCO 3 was observed. The CaCO 3 and C−S−H were characterized using solid-state nuclear magnetic resonance (13 C and 29 Si). Results indicated that Aragonite is the main polymorph of CaCO 3 formed, while C−S−H exhibited a lower decalcification degree when nTS was added (about 4.10% lower). Compressive strength tests of the mixtures with nTS and PCE were approximately 31.6% higher when compared with REF−PCE (without nTS). Therefore, the combined effect of nTS and PCE showed interesting properties for HTHP applications.

Problematic Internet use is an emerging concern among adults and adolescents, and research on its impact on parents is still in its early stages. Despite limited literature on this topic, initial studies suggest that parents’ problematic Internet use can have adverse emotional, behavioral, and relational effects on their children. These studies highlight associations between problematic Internet use by mothers and lower quality in mother-child relationships, reduced quality time spent with children, and increased behavioral problems in children. Additionally, physical health concerns, such as being underweight in male infants and a higher potential for child abuse, have been linked to problematic Internet use by mothers. These effects extend into adolescence, with parents’ problematic Internet use predicting negative emotional outcomes in children and increased problematic Internet use in adolescents themselves. Given these findings, clinical approaches should include sessions with parents to understand the motivations behind their problematic Internet use, develop effective strategies for establishing healthier relationships with electronic devices, and promote more assertive parental practices. Therefore, incorporating parents into treatment interventions is essential for mitigating the negative consequences of problematic Internet use on both parents and children. Further research is needed to expand our understanding of this issue and develop more targeted interventions.

Recent research has shed light on the intricate relationship between mood disorders, such as major depressive disorder (MDD) and bipolar disorder (BD), and inflammation. This chapter explores the complex interplay involving immune and metabolic dysfunction in the pathophysiology of these disorders, emphasizing their association with autoimmunity/inflammatory conditions, chronic low-grade systemic inflammation, T cell overactivation, and immunosenescence. This perspective underscores the notion that MDD and BD are not solely brain disorders, highlighting their nature as multi-system conditions.

Background Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women. Methods PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software. Results From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89). Conclusions Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH.