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Introdução O Angioedema Hereditario (AEH) associado à deficiência do inibidor de C1 (C1-INH) é uma doença genética rara, debilitante e potencialmente fatal. As crises são imprevisíveis e podem ocorrer espontaneamente ou serem desencadeadas por estresse, trauma, procedimentos cirúrgicos, infecções e medicamentos. No Brasil, o Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde preconiza que o tratamento das crises é predominante hospitalar sem especificar nenhum tratamento medicamento. Todavia, atraso na resolutividade das crises ocasiona maior risco de óbito, aumento nos atendimentos de urgência e hospitalizações, cirurgias desnecessárias e impacto negativo na vida familiar. Neste contexto, afim de prevenir tais desfechos desfavoráveis, a Secretaria Estadual de Saúde do Espírito Santo estabeleceu um programa de assistência aos portadores de AEH e critérios de utilização do medicamento Icatibanto no tratamento das crises. Após 10 anos de implementação deste programa, este trabalho objetiva avaliar as características epidemiológicas dos pacientes atendidos no programa de assistência aos portadores de AEH no ES e a frequência de tratamento com Icatibanto nas crises de AEH. Métodos Estudo observacional retrospectivo, com levantamento de dados clínicos, epidemiológicos, laboratoriais e dos atendimentos em emergência de pacientes com diagnóstico de AEH cadastrados no programa de assistência aos pacientes com AEH da SESA/ES no período de 2012 à 2022. Resultados No período estudado foram diagnosticados 137 pacientes com AEH, sendo todos cadastrados no centro de referência ambulatorial. Desses, 117 (85,4%) com AEH por deficiência quantitativa do C1-INH, 8 (5,8%) com AEH por deficiência funcional de C1-INH e 12 (8,8%) com AEH com C1-INH normal, por variantes no gene F12. A idade variou de 7 a 97 anos (média: 40 anos) e 74 (54%) eram do sexo feminino. O tempo entre o início dos sintomas e o diagnóstico variou de 1 a 48 anos (média: 14,7 anos). Nos 10 anos de programa, 81 pacientes (59,1%) apresentaram 822 crises que necessitaram atendimento em emergência para aplicação de icatibanto. O tratamento das crises foi estabelecido em serviços de referência hospitalares a partir da geodistribuição dos casos diagnosticados afim agilizar o acesso. A localização de crise mais comum foi a abdominal (40%), seguida de face (27%), extremidades (26%) e laringe (13%). Quanto ao número de crises/ano/paciente, 48% apresentaram 1 crise/ano, 36% 2 a 5 crises/ano e 16% mais de 5 crises/ano. A maioria das crises (95%) necessitou de apenas uma dose do icatibanto para controle do edema. Nenhum paciente necessitou de intubação, hospitalização ou evoluiu para óbito. Faziam tratamento preventivo de crises com danazol ou ácido tranexâmico 67,9% desses pacientes. Discussão e conclusões A implantação de um centro de referência estadual para paciente com AEH realizando triagem dos familiares, mesmo em assintomáticos, contribuiu para o diagnóstico e recomendações de manejo da doença. O acesso otimizado ao tratamento das crises utilizando o medicamento icatibanto em referências hospitalares não registrou nenhum óbito por edema de laringe e cirurgias abdominais por suspeita de abdômen agudo. A frequência de crises dos pacientes diagnósticos neste programa estadual demonstra a necessidade de implementação de políticas de saúde voltadas para esta doença rara, especialmente no tratamento das crises.

Chronic kidney disease (CKD) has always been a complicated global challenge, ranking as the 12th leading cause of death worldwide. Hemodialysis, being one of the most opted renal replacement therapies (RRTs) for patients with end-stage renal disease (ESRD), still possesses some limitations in preventing complications, such as malnutrition and mineral bone disease (CKD-MBD). While efforts have focused on controlling CKD-MBD parameters like calcium and phosphate, less attention has been given to dietary interventions. Moreover, the adoption of low-phosphorus diets for hemodialysis patients is very complex due to potential conflicts with the guideline-recommended high-protein dietary approach. This study sought to investigate the relationship between dietary phosphorus intake and nutritional status in CKD patients undergoing regular hemodialysis.

Power is not enough to make us strong ETQ FAL The heart must also sing the human song. --Syl Lowhar (1965) First allied by the British in 1889, the islands [...]

The performance of an Iranian Ta'ziyeh play in the US testifies to the vitality of traditional Persian drama in exile. The exiled director Mohammad Ghaffari staged 'Moses and the Wandering Dervish' in 1988, transforming it to fit a mixed audience which included Iranians. The play is from the 13th century, written by the poet Rumi as a religious drama. Modern scenes were interjected into the play, such as from the Vietnam War.

The COVID-19 pandemic impacts on eating habits among adolescents may be more relevant in pediatric patients with immunocompromised chronic diseases. This case-control study conducted between June and October 2020 aimed to: (i) describe dietary patterns of adolescents with chronic conditions compared to healthy controls and (ii) determine associations between food consumption, health-related quality of life (HRQL) and sleep quality during the COVID-19 pandemic. Participants (184 immunocompromised and 58 healthy adolescents, aged 14.3 [SD 2.5]) responded to HRQL and sleep validated instruments (PedsQL and PSQI) and three 24 h food recalls via online software. Adjusted linear and logistic regressions were used to assess differences in dietary patterns and associations between food consumption (according to Nova classification) and HRQL and sleep quality. Adolescents with gastrohepatic, rheumatic, and kidney diseases had an improved dietary pattern vs. their healthy peers, showing greater consumption of unprocessed and minimally processed foods (unstandardized coefficient (b) = 7.35%[95%CI 1.59; 13.1]; b = 15.10%[95%CI 7.00; 23.1]; and b = 11.2%[95%CI 5.68; 16.8]), and lower consumption of ultraprocessed foods (b = −7.53%[95%CI-12.90; −2.18]; b = −11.4%[95%CI-18.90; −3.94]; b = −10.8%[95%CI-16.00; −5.68]). Consumption of culinary ingredients was associated with reduced psychological HRQL in controls (standardized coefficient (β) = −0.26[95%CI-0.52; −0.004]), and processed food consumption was associated with improved sleep latency in immunocompromised participants (β = 0.16[95%CI 0.01; 0.31]). These findings suggest diet quality may play a role in HRQL and sleep quality in this population, and may be relevant for clinical practitioners and policy makers when considering the importance of dietary quality in immunocompromised youths.

Neste comentário é realizada a análise da decisão monocrática proferida no âmbito da ação direta de inconstitucionalidade por omissão com pedido de medida cautelar nº 60 (ADO nº 60) do Supremo Tribunal Federal (STF). A importância deste estudo se justifica pelos argumentos fornecidos na decisão como resposta aos requerentes, que postulam o reconhecimento da inconstitucionalidade da conduta da União na condução do Fundo Clima, bem como na adoção de medidas de proteção ambiental pertinentes à mitigação de mudanças climáticas. Isso porque, a despeito da importância do meio ambiente como pressuposto para o desfrute de outros direitos que integram o mínimo existencial, abre-se espaço para que seja discuto, no âmbito do dever estatal de proteção, a necessidade de observância ao direito ao meio ambiente ecologicamente equilibrado de forma autônoma e não apenas para assegurar o gozo de outros direitos fundamentais e humanos. Diante disso, considerando o atual contexto, em que o direito ao meio ambiente saudável é protegido com vistas a garantir a efetivação de direitos essenciais para os seres humanos, torna´-se fundamental compreender de que forma a inovadora teoria recepcionada pela jurisprudência brasileira por meio da ADO nº 60 - o direito ao meio ambiente como direito autônomo, com interesse jurídico em si mesmo- pode contribuir para o cenário de proteção ambiental brasileiro.

Introduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers.Methods: This observational study was conducted in São Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic.Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls.Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.

Changes in emotional state due to the COVID-19 pandemic may potentially modify eating habits, which may differ as a function of body mass index (BMI). Using a self-reported, questionnaire-based survey we evaluated Brazilian women during the pandemic for: (i) the influence of BMI on changes in eating habits, food choice determinants, and psychological symptoms; (ii) associations between eating habits, food choice determinants and psychological symptoms. General characteristics, anthropometric data, eating habits before and during the pandemic, food choice determinants and psychological symptoms during the pandemic were collected between June and September, 2020. Participants (n = 1,183) were normal weight (60.4%), overweight (26.2%) and obese (13.4%). A higher frequency of “cooking” (72.3–77.6%, p = 0.004) and “use of delivery service” (29.8–48.8%, p < 0.001) was reported during, in comparison to before the pandemic. Additionally, a higher prevalence of “snacking” (57.1–63.8%, p = 0.005) and “eating at table” (78.5–82.7%, p < 0.001) was reported during the pandemic, while the number of participants reporting “dieting” decreased (28.7–20.4%, p < 0.001). “Health”, “natural concerns” and “need and hunger” were less important determinants for participants with overweight/obesity compared to normal weight. Regression analysis indicated that (i) “health”, “natural concerns” and “affect regulation”; (ii) “health”, “pleasure”, “convenience”, and “natural concerns”; and (iii) “visual appeal” and “pleasure” were the food choice determinants more associated with eating habits among women with normal weight, overweight, and obesity, respectively. In conclusion, eating habits were modified during the pandemic despite BMI, whereas food choice determinants differed between overweight/obesity and normal weight women.

Micromachining allows the production of parts and components on a micro scale with high precision and has become a key process to meet the growing demand for micro parts and micro components. To meet the quality requirements of the generated surfaces and reduce the cutting forces, strategies have been analysed, such as the use of the cutting fluid. Therefore, this research aimed to verify the effect of the frequency of the use of cutting fluid during the micro-milling of the Inconel 718 alloy. For this purpose, an ultra-refined cemented carbide micro end mill coated with (Al, Ti) N and 400 µm in diameter was used. A spindle speed of 20,000 rpm, a cutting speed of 13.8 m/min, a feed per tooth of 5 µm/tooth and an axial depth of cut of 40 µm were used as cutting parameters. Two frequencies of application of the cutting fluid were evaluated, corresponding to the flow rate of 40.7 and 270.0 ml/ h, in addition to the dry test. To measure the cutting forces, a Kistler dynamometer with operating range of -5 kN to +10 kN was used. In addition, the process simulation was performed using the AdvantEdge software by ThirdWave Systems. The results showed that the higher flow of the cutting fluid provided lower cutting forces and that, in dry machining, the cutting force increased significantly during the machining of a slot.

Background: The aim of this study was to investigate possible associations between food consumption and eating habits and food choice determinants in women during COVID-19 pandemic.Methods: This is a cross-sectional survey conducted in Brazil between June and September, 2020, during which time social distancing measures were in place.Results: Participants (n = 629) were aged 34.0 years and mostly within normal weight according to BMI (60.4%). “Snacking” and “liking” associated with increased energy (β = 164.27 and β = 110.24) and carbohydrate intake (β = 1.97 and β = 1.80), and with reduced protein intake (β = −1.54 and β = −1.18). In contrast, “dieting” and “weight control” associated with reduced energy (β = −162.57 and β = −111.49) and carbohydrate intake (β = −2.78 and β = −2.07), and with increased protein intake (β = 3.78 and β = 1.65). “Dieting” (β = 7.27), “need and hunger” (β = 3.34), and “health” (β = 4.94) associated with an increased consumption of unprocessed and minimally processed foods, whereas “replacing main meals with snacks” (β = −8.98), “snacking” (β = −6.92) and binge eating symptoms (β = −0.34) associated with reduced consumption of foods within this processing level. In contrast, “use of delivery services” (β = 3.39), “replacing main meals with snacks” (β = 5.49), “visual appeal” (β = 2.17), “social norms” (β = 2.19) and “affect regulation” (β = 2.01) associated with increased ultraprocessed food consumption. Overall, associations were more frequent and pronounced when analyzing food consumption by processing level rather than by macronutrient intake.Conclusion: Some eating habits and food choice determinants (“snacking,” “replacing meals with snacks,” “use of delivery services”) observed during the COVID-19 pandemic were associated with an unhealthy diet (high energy and carbohydrate consumption, increased ultraprocessed food consumption and reduced unprocessed/minimally processed foods consumption) in Brazilian women.