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RESUMO Introdução: O fenômeno da judicialização da saúde pública possui números expressivos, sobretudo quanto ao montante de gastos do erário ou ao volume processual. Entre suas causas, esta pesquisa se dedica à prescrição médica de fármacos em desconformidade com as diretrizes do Sistema Único de Saúde (SUS), com enfoque na percepção educacional do bacharelando em Medicina acerca da relação do médico com a judicialização da saúde pública. Objetivo: Este estudo teve como objetivo analisar a graduação médica acerca da prescrição de medicamentos não incorporados ao SUS, como fator gerador da judicialização da saúde. Método: Trata-se de um estudo descritivo, com abordagem qualitativa, desenvolvido com o corpo discente de uma Instituição de Ensino Superior do Estado do Espírito Santo/ES. A coleta de dados foi realizada por meio de questionários, seguindo um roteiro com perguntas norteadoras, registradas e examinadas de acordo com a análise de conteúdo proposta por Bardin. Conjuntamente, examinaram-se os planos de ensino de matérias que possuem maior aproximação com a temática. Resultado: Verificou-se uma lacuna entre a graduação médica e a judicialização em saúde no que diz respeito à prescrição de fármacos que não fazem parte da política pública sanitária do SUS, atraindo a necessidade de promoção de uma política pública educacional por parte das instituições de ensino de Medicina, voltada à efetiva abordagem do assunto, de maneira articulada e interdisciplinar.

Introduction: Reperfusion therapy is generally recommended in acute high-risk pulmonary embolism (HR-PE), but several population-based studies report that it is underused. Data on epidemiology, management and outcomes of HR-PE in Portugal are scarce. Objective: To determine the reperfusion rate in HR-PE patients, the reasons for non-reperfusion, and how it influences outcomes. Methods: In this retrospective cohort study of consecutive HR-PE patients admitted to a thromboembolic disease referral center between 2008 and 2018, independent predictors for non-reperfusion were assessed by multivariate logistic regression. PE-related mortality and long-term MACE (cardiovascular mortality, PE recurrence and chronic thromboembolic disease) were calculated according to the Kaplan–Meier method. Differences stratified by reperfusion were assessed using the log-rank test. Results: Of 1955 acute PE patients, 3.8% presented with hemodynamic instability. The overall reperfusion rate was 50%: 35 patients underwent systemic thrombolysis, one received first-line percutaneous embolectomy and one rescue endovascular treatment. Independent predictors of non-reperfusion were: age, with >75 years representing 12 times the risk of non-treatment (OR 11.9, 95% CI 2.7–52.3, p=0.001); absolute contraindication for thrombolysis (31.1%), with recent major surgery and central nervous system disease as the most common reasons (OR 16.7, 95% CI 3.2–87.0, p 75 anos associou-se a 12 vezes mais risco de NR (OR 11,9, 95%CI 2,7-52,3, p=0,001); contraindicações absolutas para trombólise (31,1%), sendo a cirurgia major recente e a doença do sistema nervoso central as causas mais comuns (OR 16,7, IC95% 3,2-87,0, p

Introduction: This study describes the experience of a reference center using continuous aspiration mechanical thrombectomy for acute high- and intermediate-high-risk pulmonary embolism (PE). Methods: Twenty-nine consecutive patients with acute central PE (48.3% high-risk PE; 82.8% in class >III from the original Pulmonary Embolism Severity Index score; median Charlson Comorbidity Index of 4) were treated with the Indigo® Mechanical Thrombectomy System between March 2018 and March 2020. Technical success was defined as successful placement of the device and initiation of aspiration thrombectomy. Clinical success was defined as any improvement in hemodynamic and/or oxygenation parameters, pulmonary hypertension or right heart strain at 48 hours, and survival to hospital discharge. Safety was defined as freedom from severe adverse events potentially related to the procedure. Three-month follow-up results were collected. Results: Technical success was 96.6%. Miller index and systolic pulmonary arterial pressure were significantly reduced after the procedure (-5.5±3.0, and -10.2±11.5 mmHg, respectively, both pIII do score PESI; mediana 4 do índice de comorbilidades de Charlson) com o sistema de trombectomia mecânica Indigo entre março/2018 e março/2020. Definiu-se sucesso técnico como colocação bem-sucedida do dispositivo e início da trombectomia. Definiu-se sucesso clínico como melhoria hemodinâmica, da oxigenação, hipertensão pulmonar e/ou da sobrecarga cardíaca direita às 48 horas; e sobrevivência hospitalar. Definiu-se segurança como ausência de eventos adversos graves relacionados com o procedimento. Registou-se seguimento clínico a três meses. Resultados: O sucesso técnico foi 96,6%. O índice de Miller e a pressão arterial pulmonar sistólica reduziram-se significativamente (-5,5±3,0 e -10,2±11,5 mmHg, respetivamente, p

Irreversible pulmonary arterial hypertension is considered a contraindication for surgical or percutaneous closure of atrial septal defects (ASD) due to risk of right heart failure. We present a case of 37 years-old woman who was referred to our center due to progressive worsening fatigue and high probability of pulmonary hypertension on a transthoracic echocardiogram. The diagnostic work-up revealed the presence of an ostium secundum atrial septal defect and severe pre-capillary pulmonary hypertension on right heart cathetherization (RHC). The patient was considered inoperable and started medical therapy with sildenafil and bosentan. After one year of treatment, she repeated RHC that showed a significant reduction in pulmonary vascular resistance making her eligible for closure. Surgical closure of ASD with a fenestra was performed with success. Our case emphasizes the importance of individual assessment even if cases where initial evaluation is unfavorable to closure in accordance with the guidelines.

Resumo: Introdução: A angioplastia pulmonar por balão (BPA) constitui uma alternativa terapêutica na hipertensão pulmonar tromboembólica crónica (HPTEC) inoperável ou hipertensão pulmonar (HP) residual/recorrente após cirurgia. O objetivo deste estudo foi avaliar a eficácia e segurança a curto prazo do programa de BPA. Métodos: Estudo prospetivo em centro único, que incluiu todas as sessões de BPA em doentes com HPTEC entre 2017 a 2019. Realizou‐se avaliação da classe funcional da OMS, biomarcadores plasmáticos, teste de marcha de 6 minutos (TM6 M) e cateterismo cardíaco direito no início e seis meses após a última sessão. Resultados: Foram realizadas 57 sessões de BPA em 11 doentes com HPTEC (64% doença inoperável, 82% sob terapêutica vasodilatadora pulmonar). O programa de BPA foi concluído com um seguimento mínimo de seis meses em nove doentes. Houve uma melhoria significativa na classe funcional OMS (p = 0,004), no TM6 M (aumento médio de 42 metros; p = 0,050) e uma tendência para melhoria hemodinâmica significativa: queda de 25% na pressão da artéria pulmonar média (PAPm; p = 0,082) e 42% na resistência vascular pulmonar (RVP; p = 0,056). No subgrupo de doentes que apresentavam critérios hemodinâmicos de gravidade (três doentes com PAPm > 40 mmHg), a redução foi significativa: 51% na PAPm (p = 0,013) e 67% na RVP (p = 0,050). Foram suspensos os análogos da prostaciclina e a oxigenoterapia de longa duração em todos os doentes. Foram registadas complicações minor em 25%. Não foram registadas complicações major ou mortes. Conclusões: Uma estratégia de BPA em doentes sob terapêutica vasodilatadora pulmonar melhora os sintomas, a capacidade de exercício e a hemodinâmica com uma relação risco‐benefício aceitável em doentes com HPTEC inoperável ou HP residual/recorrente após cirurgia. Abstract: Introduction: Balloon pulmonary angioplasty (BPA) is an alternative therapy in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or residual/recurrent pulmonary hypertension (PH) after surgery. The aim of this study was to assess the short‐term efficacy and safety of a BPA program. Methods: This prospective single‐center study included all BPA sessions performed in CTEPH patients between 2017 and 2019. Clinical assessment including WHO functional class, plasma biomarkers, 6‐min walk test (6MWT) and right heart catheterization was performed at baseline and six months after the last BPA session. Results: A total of 57 BPA sessions were performed in 11 CTEPH patients (64% with inoperable disease, 82% under pulmonary vasodilator therapy). Nine patients completed both the BPA program and a minimum six‐month follow‐up period. There were significant improvements in WHO functional class (p=0.004) and 6MWT (mean increase of 42 m; p=0.050) and a trend for significant hemodynamic improvement: 25% decrease in mean pulmonary artery pressure (mPAP) (p=0.082) and 42% decrease in pulmonary vascular resistance (PVR) (p=0.056). In the group of patients with severely impaired hemodynamics (three patients with mPAP >40 mmHg), the reduction was significant: 51% in mPAP (p=0.013) and 67% in PVR (p=0.050). Prostacyclin analogs and long‐term oxygen therapy were withdrawn in all patients. Minor complications were recorded in 25% of patients. There were no major complications or deaths. Conclusions: A BPA strategy on top of pulmonary vasodilator therapy further improves symptoms, exercise capacity and hemodynamics with an acceptable risk‐benefit ratio in patients with inoperable CTEPH or residual/recurrent PH after surgery.

Abstract To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3–15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01–1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06–1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26–2.69), asthma (OR: 1.52; 95% CI: 1.04–2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86–0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76–0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00–1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

Este artigo apresenta um grupo de indicadores voltados para avaliar o uso das Tecnologias da Informação e Comunicação na docência, que foram sugeridos por professores do Brasil e Portugal que atuaram em programas de uso de tecnologias digitais em seus países. A pesquisa constitui uma investigação qualitativa, com aplicação de questionários e realização de entrevistas e grupos focais, junto a professores da região da cidade de Aveiro, norte de Portugal, e dos municípios de Nossa Senhora da Glória, Tobias Barreto e Itabaiana, no estado de Sergipe, Brasil. As respostas desses professores ressaltam a necessidade do estabelecimento de indicadores avaliativos que considerem aspectos qualitativos da docência mediada por tecnologias digitais.

AimTo determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW).MethodsObservational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality.ResultsAs of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; pConclusionsHospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

Objetivou-se avaliar o potencial de produção de água potável através de dessalinizadores solar, e quais os benefícios advindos desta tecnologia para fomentar água potável para as populações que habitam regiões semiáridas. Para tanto, foram realizados estudos de campo e análises microbiológicas e de salinidade das águas. Assim, observou-se que os dessalinizadores são uma tecnologia de baixo custo, de fácil construção e que possibilita benefícios como: oferta de água segura, o que reduz riscos com a saúde; não detém custos com energia elétrica; e utiliza energia limpa e renovável, o que inibe impactos ambientais.

Pulmonary embolism due to primary antiphospholipid syndrome is rarely associated with chronic thromboembolic pulmonary hypertension, and therefore according to the latest guidelines on pulmonary hypertension, routine screening is not recommended. We describe a young patient with a late diagnosis of chronic thromboembolic pulmonary hypertension in the context of pulmonary embolism, primary antiphospholipid syndrome and suboptimal anticoagulation. Of note, mild cardiopulmonary symptoms were consistently misattributed to a depressive disorder because physical examination was normal, serial Doppler echocardiography failed to show pulmonary hypertension, and all other diagnostic tests were normal. Once symptoms became severe, positive screening tests led to the correct diagnosis and surgical referral, and bilateral pulmonary endarterectomy was successfully performed. This case demonstrates the need for extra awareness in patients with antiphospholipid syndrome and pulmonary embolism. Resumo: A embolia pulmonar devido à síndrome de anticorpo antifosfolípido raramente está associada a hipertensão pulmonar crónica tromboembólica, pelo que o seu rastreio não está recomendado pelas normas de orientação clínica atuais. Descreve-se o caso de uma doente jovem com o diagnóstico tardio de hipertensão pulmonar crónica tromboembólica no contexto de síndrome de anticorpo antifosfolípido primário e anticoagulação subterapêutica. A destacar que a sintomatologia cardiopulmonar de grau ligeiro foi incorretamente atribuída a humor depressivo devido à ausência de alterações no exame objetivo e nos meios complementares de diagnóstico, incluindo valores persistentemente normais de pressão sistólica da artéria pulmonar nos ecocardiogramas transtorácicos seriados. O agravamento sintomático progressivo conduziu à confirmação diagnóstica, após realização dos meios complementares de diagnóstico de rastreio, referenciação cirúrgica e realização de endarterectomia pulmonar bilateral com sucesso. Este caso demonstra a necessidade de uma vigilância mais apertada em doentes com síndrome de anticorpo antifosfolípido e embolia pulmonar. Keywords: Antiphospholipid syndrome, Pulmonary embolism, Chronic thromboembolic pulmonary hypertension, Pulmonary endarterectomy, Palavras-chave: Síndrome antifosfolípido, Embolia pulmonar, Hipertensão pulmonar tromboembólica crónica, Hipertensão pulmonar

Here, we present the case of a 78-year-old male patient with undifferentiated spindle cell sarcoma on the posteromedial surface of the right leg who experienced a long-lasting progression-free survival. Due to an underlying cardiac disease, the patient was not suitable for anthracyclines. In September 2015, he received first-line chemotherapy with trabectedin (Yondelis®) at the approved dosage and regimen – concomitant with external radiotherapy (RT). After the first 9 cycles of trabectedin plus RT given in the neoadjuvant setting, the patient underwent surgical resection. At that stage, we observed a very good pathological response with 80% of necrotic area. The patient resumed the therapy with trabectedin; however, approximately 5 months later, we observed a new nodular heterogeneous lesion with ill-defined margins in the right leg and suggestive of tumor relapse. Subsequently an above-the-knee amputation was performed, and the patient resumed his trabectedin therapy with the same dosage and regimen. In January 2018, almost 2 1/2 years after the start of trabectedin treatment and 30+ cycles of trabectedin, the patient is locoregionally and distant metastatically disease-free. Currently, the treatment with trabectedin is maintained without any significant serious toxicity. Future clinical trials are needed to gain additional insights into the role of trabectedin maintenance therapy until disease progression in the neoadjuvant setting and to identify predictive and prognostic criteria for response to trabectedin in patients with advanced sarcoma.

Introduction and Objectives: The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients. Methods: ED was assessed by the reactive hyperemia index (RHI), measured by PAT and defined as RHI

A 24-year-old woman who was 11 weeks pregnant and had a mechanical mitral valve presented at the emergency department with ischemic stroke. Although treatment with aspirin and unfractionated heparin was initially successful, subsequent management was almost impossible, as she eventually suffered a right hemispheric stroke, requiring percutaneous intervention and an emergency cesarian; prosthetic valve thrombosis with hemodynamic instability; and multiple bleeding complications. This case demonstrates how difficult it can be to select the appropriate treatment strategy for prosthetic valve thrombosis. Resumo: Uma mulher de 24 anos, grávida de 11 semanas, com uma prótese mecânica em posição mitral, foi admitida no serviço de urgência com um acidente vascular cerebral isquémico. Apesar de a terapêutica com aspirina e heparina não fracionada ter sido inicialmente bem-sucedida, a gestão subsequente da doente foi dificultada por várias intercorrências: acidente vascular cerebral hemisférico direito com necessidade de intervenção percutânea e realização de cesariana emergente; trombose obstrutiva de prótese com instabilidade hemodinâmica; múltiplas complicações hemorrágicas. Este caso permite ilustrar as dificuldades na seleção do tratamento da trombose de prótese. Keywords: Pregnancy and cardiovascular disease, Embolism and thrombosis, Heart valve prosthesis, Palavras-chave: Gravidez e doença cardiovascular, Trombose e embolia, Prótese valvular cardíaca

The authors report a rare clinical case of myocardial bridging of the three major coronary arteries, which manifested in an unusual way with severe biventricular dysfunction in the context of tachycardia. For the diagnosis, the authors relied on non-invasive multimodality cardiac imaging, including cardiac magnetic resonance, computed tomography angiography and myocardial perfusion scintigraphy. The implementation of targeted medical and neurohormonal therapy resulted in the recovery of ventricular function and clinical improvement. Resumo: Os autores descrevem um caso clínico raro de bridging miocárdico dos três territórios coronários, que se apresentou de forma invulgar com disfunção biventricular grave em contexto de taquicardia. Para o diagnóstico os autores basearam-se em exames de imagem cardíaca não invasivos, como a ressonância magnética cardíaca, a angiografia tomográfica computorizada e a cintigrafia de perfusão miocárdica. A instituição de terapêutica médica dirigida e neuro-hormonal permitiu a recuperação da função ventricular e a melhoria clínica. Keywords: Myocardial bridging, Myocardial stunning, Heart failure, Palavras-chave: Bridging miocárdico, Atordoamento miocárdico, Insuficiência cardíaca

Resumo: Nomeado em conjunto pela Sociedade Portuguesa de Cirurgia Cardio‐Torácica e Vascular (SPCCTV) e pela Sociedade Portuguesa de Cardiologia (SPC), o Grupo de Trabalho sobre Tempos de Espera para Cirurgia Cardíaca constituiu‐se com a missão de elaborar recomendações práticas acerca dos tempos de espera clinicamente aceitáveis para o largo espetro de patologias cardíacas do adulto que necessitam de cirurgia, ou de intervenção nas três fases críticas do seu tratamento: consulta de especialidade, ato de diagnóstico e terapêutica invasiva.A cirurgia cardíaca detém uma especificidade própria, não comparável às outras especialidades cirúrgicas e, como tal, assume‐se de especial importância a redução significativa dos seus tempos de espera máximos, assim como uma maior eficácia nos sistemas de monitorização e rastreabilidade do doente.A informação presente neste manuscrito baseou‐se, predominantemente, na informação clínica existente. A metodologia usada para estabelecer os critérios baseou‐se em estudos de história natural da doença, em estudos clínicos que compararam o tratamento médico com a intervenção, em análises retrospetivas ou prospetivas de doentes em lista de espera e na opinião de peritos ou de grupos de trabalho.Após esta primeira etapa, assinalada por esta publicação, a SPCCTV e a SPC devem ser consideradas como as interlocutoras naturais da tutela sobre esta matéria e comprometem‐se a colaborar de forma decisiva para a definição de estratégias de atuação, através da adequação da evidência clínica com a realidade e com os recursos disponíveis. Abstract: Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment.Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking.The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups.Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Palavras‐chave: Cirurgia cardíaca, Cardiologia, Diagnóstico, Listas de espera, Sistemas de saúde beveridgianos, Recomendações, Grupo de trabalho, Peritos, Consenso, Keywords: Cardiac surgery, Cardiology, Diagnosis, Waiting lists, Beveridge‐type health systems, Recommendations, Working group, Experts, Consensus

The purpose of this study was to identify the biopsychosocial and spiritual effects of crack use during pregnancy. This is a descriptive study with qualitative approach, it is a case report of a 33 year-old patient, multiparous, postpartum and used crack until the sixth month of pregnancy. After data collection and analysis, disorders were classified and placed in three thematic categories, which are: biological effects, psychological repercussions, and social and spiritual repercussions. The results of this study reinforce the need for holistic strategies of intervention for this specific segment of the population.

Introduction and Aim: Right ventricular function is a major determinant of prognosis in pulmonary hypertension. The aim of this study was to assess and compare right ventricular contractile reserve in healthy subjects (controls) and in subjects with pulmonary hypertension (cases). Methods: In this prospective study of seven cases and seven controls undergoing treadmill stress echocardiography, right ventricular S-wave velocity, tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and stroke volume index were assessed at rest and with exercise. The increase in each parameter between rest and exercise for cases and controls was analyzed and the magnitude of change in each parameter with exercise between cases and controls was compared. Results: A significant increase in S-wave velocity was observed in cases (rest: 9.4±3.1; exercise: 13.7±4.8 cm/s [p

The fortification of maize bread with legume flour was explored in order to increase the protein content of the traditional Portuguese bread ‘broa’, comprised of more than 50% maize flour. The optimization of legume incorporation (pea, chickpea, faba bean, lentil), considering the influence of different maize flours (traditional-white, traditional-yellow, hybrid-white, hybrid-yellow), on consumer liking and sensory profiling of ‘broa’ was studied. A panel of 60 naïve tasters evaluated twenty different breads, divided in four sets for each legume flour fortification, each set including four breads with varying maize flour and a control (no legume). Tasters evaluated overall liking and the sensory profile through a check-all-that-apply ballot. Crude protein and water content were also analyzed. There were no significant differences in overall liking between the different types of legumes and maize. The incorporation of chickpea flour yields a sensory profile that most closely resembles the control. The protein content increased, on average, 21% in ‘broa’, with legume flours having the highest value obtained with faba bean incorporation (29% increase). Thus, incorporation of legume flours appears to be an interesting strategy to increase bread protein content, with no significant impact on consumer liking and the ‘broa’ bread sensory profile.

A escassez de água advinda das condições climáticas do semiárido paraibano tem forçado inúmeras famílias rurais a consumirem água de má qualidade, o que tem contribuído para o aumento de casos de doenças transmitidas pela água. Tendo em vista esta problemática, objetivou-se analisar como o uso de destiladores solares pode proporcionar a obtenção de água potável, e avaliar os benefícios socioeconômicos e ambientais advindos do uso desta tecnologia. Após os estudos, observou-se que os destiladores solares são uma tecnologia de baixo custo econômico, de fácil disseminação social, utilizam energia solar (limpa e renovável), e são capazes de fornecer água potável para atender as demandas hídricas de famílias que convivem com a escassez hídrica em regiões semiáridas. Use of solar distillers to provide drinking water in semiarid Paraibano Abstract: The scarcity of water arising from climatic conditions of semi-arid Paraiba has forced many rural families to consume poor quality water, which has contributed to the increase in cases of waterborne diseases. In view of this problem, the objective was to examine how the use of solar distillers can provide the production of drinking water, and assess the socio-economic and environmental benefits from the use of this technology. After the studies, it was observed that solar distillers are a low economic cost technology, easy social diffusion, uses solar energy (clean, renewable), and are able to provide drinking water to meet the water demands of families living with the shortage of water in semi-arid regions

Resumo: A miocardiopatia de takotsubo (MCT), mais recentemente denominada acinesia/discinesia apical transitória do ventrículo esquerdo, miocardiopatia induzida por stress, síndrome do coração roto, caracteriza-se pela alteração reversível da contratilidade segmentar do ventrículo esquerdo (VE) na ausência de lesão coronária significativa.Foi descrita pela primeira vez em 1990, no Japão, assistindo-se posteriormente a um considerável reconhecimento mundial, através da publicação de várias séries de casos clínicos, calculando-se uma prevalência de 1,7 a 2,2% das situações em que existe suspeição clínica de síndrome coronária aguda (SCA). Apesar da progressiva caracterização, existem pontos a esclarecer, pelo que a MCT é ainda atualmente objeto de estudo.Neste artigo, descreve-se uma série de 10 casos de MCT que ocorreram num Serviço de Cardiologia, com o objetivo de correlacionar as características clínicas, laboratoriais, eletrocardiográficas, imagiológicas, complicações, terapêutica instituída e follow-up destes doentes, com as descritas nas revisões científicas atuais. Abstract: Takotsubo cardiomyopathy, also known as transient left ventricular apical ballooning syndrome, stress-induced cardiomyopathy and broken heart syndrome, is characterized by transient left ventricular dysfunction in the absence of obstructive coronary artery disease.It was first described in 1990 in Japan, and gained worldwide recognition following the publication of several series of case reports. Its prevalence is estimated to be 1.7-2.2% of suspected acute coronary syndromes. Although takotsubo cardiomyopathy has been progressively better characterized, certain aspects remain to be clarified, and it is still under study.In this article, we report a series of ten cases of takotsubo cardiomyopathy admitted to a cardiology department, and compare the clinical, laboratory, electrocardiographic and imaging characteristics, therapeutic regimens and follow-up of these patients with those described in the latest scientific reviews. Palavras-chave: Miocardiopatia de takotsubo, Acinesia/Discinesia transitória do ventrículo esquerdo, Miocardiopatia de stress, Keywords: Takotsubo cardiomyopathy, Transient left ventricular apical ballooning syndrome, Stress-induced cardiomyopathy

O objetivo deste trabalho foi estudar a viabilidade de utilização de águas de elevada salinidade na irrigação do coqueiro (Cocos nucifera L.) cv. Anão Verde, em fase inicial de produção, com 3,5 anos de cultivo. O experimento foi conduzido em blocos inteiramente casualizados, com quatro tratamentos, representados pelos níveis de salinidade da água de irrigação (condutividade elétrica - CEa = 0,1, 5,0, 10,0 e 15,0 dS m-1 a 25ºC) e cinco repetições. Constatou-se tendência de aumento do número de flores femininas por inflorescência, com o uso de águas salinas. A irrigação com águas de CEa>5,0 dS m-1 provocou redução no peso médio e no número de frutos colhidos, em relação ao controle (CEa = 0,1 dS m-1), a partir da 11ª e 14ª colheita, respectivamente. Condutividade elétrica da água de irrigação de 10 dS m-1 é o limite para se obter produção aceitável de frutos de coqueiro 'Anão Verde', nesse estádio fenológico.The objective of this work was to evaluate the viability of the use of saline water for irrigating coconut (Cocos nucifera L.) cv. Anão Verde in a 3.5 years-old plantation, at the initial phase of production. A completely randomized block design, consisting of four levels of water salinity (electrical conductivity - ECw = 0.1, 5.0, 10.0 and 15.0 dS m-1 at 25ºC), was adopted with five replications. Female flowers in inflorescence showed a tendency to enhance when salt was added to irrigation water. The use of saline waters with ECw>5.0 dS m-1 caused significant reductions in mean weight and number of fruits compared to control (ECw = 0.1 dS m-1) starting, respectively, at 11th and 14th harvest of fruits. Plants irrigated with saline waters of ECw up to 10.0 dS m-1 present acceptable mean yield for the studied crop stage.