Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of DYSGLYCEMIA that may occur during pregnancies in Brazil, considering that many cases of DYSGLYCEMIA in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of Dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of Dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Sociedade civil, entre o político-estatal e o universo gerencial

Cet article est fondé sur le concept de société civile développé par le marxiste Antonio Gramsci et propose un dialogue critique avec les autres idées de la société civile qui, de nos jours, cherchent à s'affirmer dans le panorama politique et culturel. Nous nous fondons sur le fait d'être passé, au cours des dernières décennies, d'une idée de société civile prioritairement politique-publique, scène de luttes démocratiques et de nouvelles hégémonies, vers une image qui transforme la société civile soit en ressource de gestion ­ un arrangement de la société destiné à rendre possible différents genres spécifiques de politiques publiques ­ soit en un facteur de reconstruction étique et dialogique de la vie sociale. L'incorporation de l'idée de participation au langage de planification a déplacé la société civile de son champs principal (celui de l'organisation de nouvelles hégémonies) vers un espace de coopération et de gestion de la crise. Par ailleurs, l'expansion de l'activisme social, dans un cadre de crise politique de l'État et de la démocratie représentative a poussé vers la recherche d'une autre «place» à partir de laquelle il serait possible d'établir et de répandre de nouvelles postulations éthiques et de nouvelles procédures collectives. D'une phase où le marxisme était prépondérant et laissait sa marque, nous sommes entrés dans une phase dans laquelle la perspective libérale, affirmée de façon orthodoxe ou nuancée, prévaut et opère comme principale référence.

Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.

Consensus for the diagnosis, prognosis and treatment of canine mammary tumors

The purpose of this paper is to establish criteria that could guide the diagnosis, prognosis and treatment of canine mammary neoplasias. It was elaborated during the Mammary Pathology Meeting: Diagnosis, Prognosis and Treatment of the Canine Mammary Neoplasm, held on November 6 th and 7 th, 2010 in Belo Horizonte - MG, Brazil, sponsored by the Laboratory of Comparative Pathology - UFMG, with the support of the Brazilian Association of Veterinary Pathology (ABPV) and Brazilian Association of Veterinary Oncology (ABROVET). Academics from several regions of Brazil were present and contributed to this work.

Daily biofilm control and oral health: Consensus on the epidemiological challenge-Latin American Advisory Panel

Our understanding of dental plaque biofilm has evolved since the nonspecific plaque hypothesis that considered plaque as a nonspecific mass of native microorganisms that, because of lack of oral hygiene, builds up in proportions great enough to overcome the host resistance threshold and affect the tooth structure and tooth supporting tissues. A great diversity of microorganisms-over 700 species-was detected in the oral cavity, and evidence shows that the investigation of specific microorganisms or associations of microorganisms as etiological agents for periodontal diseases and caries is not a simplistic approach. Although clinical evidence shows that oral mechanical hygiene is fundamental to prevent and control caries and periodontal disease, it is important to highlight that optimal control is not achieved by most individuals. Thus the complementary use of chemotherapeutic agents has been investigated as a way to overcome the deficiencies of mechanical oral hygiene habits, insofar as they reduce both plaque formation and gingival inflammation, and represent a valid strategy to change the biofilm and maintain dental and periodontal health. The role of the dental professional is to monitor patients and offer them the best recommendations to preserve oral health throughout their life. With this in mind, chemical control should be indicated as part of daily oral hygiene, together with mechanical procedures, for all individuals who present supragingival and/or subgingival biofilm, taking into account age, physical and/or psychological limitations, allergies, and other factors.

Influenza among the elderly in the Americas: A consensus statement

Influenza exacts a heavy burden on the elderly, a segment of the population that is estimated to experience rapid growth in the near future. In the past decade most developed and several developing countries have recommended influenza vaccination for those > 65 years of age. The World Health Organization (WHO) set a goal of 75% influenza vaccination coverage among the elderly by 2010, but it was not achieved. In 2011, the Technical Advisory Group at the Pan American Health Organization, Regional Office of WHO for the Americas, reiterated the influenza vaccine recommendation for older adults. Relatively little information has been compiled on the immunological aspect of aging or on reducing its impact, information particularly relevant for clinicians and gerontologist with firsthand experience confronting its effects. To fill this data gap, in 2012 the Americas Health Foundation (Washington, D.C., United States) and the nonprofit, Fighting Infectious Diseases in Emerging Countries (Miami, Florida, United States), convened a panel of Latin American clinicians and gerontologists with expertise in influenza to discuss key issues and develop a consensus statement. The major recommendations were to improve influenza surveillance throughout Latin America so that its impact can be quantified; and to conduct laboratory confirmation of influenza for all patients who have flu-like symptoms and are frail, immunosuppressed, have comorbidities, are respiratory compromised, or have been admitted to a hospital. The panel also noted that: since evidence for antivirals in the elderly is unclear, their use should be handled on a case-by-case basis; despite decreased immunological response, influenza vaccination in older adults is still crucial; indirect immunization strategies should be encouraged; and traditional infection control measures are essential in long-term care facilities.

Mobilização social pela educação e a legitimação das políticas educacionais no PDE

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Democracia e Mercosul: um binômio verdadeiro?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology

A esclerose múltipla (EM) é uma doença inflamatória, autoimune, desmielinizante e degenerativa do sistema nervoso central. Estudos epidemiológicos têm identificado associações de hipovitaminose D com doenças autoimunes. O principal objetivo desta revisão é responder se há evidências que indiquem o uso terapêutico de vitamina D em monoterapia para pacientes com EM. Por meio dos sites PUBMED, EMBASE, LILACS e Scielo foram realizadas buscas usando os descritores “vitamin D”, e “multiple sclerosis” até 12/09/2013. Estudos clínicos randomizados, controlados e duplo-cegos foram selecionados para avaliar a resposta terapêutica da vitamina D na EM. Não foram encontradas evidências científicas que justifiquem o uso da vitamina D em monoterapia no tratamento da EM, na prática clínica.

Epidemiological Report on the Treatment of Patients with Gestational Trophoblastic Disease in 10 Brazilian Referral Centers Results After 12 Years Since International FIGO 2000 Consensus

OBJECTIVE: To evaluate treatment of Brazilian patients with gestational trophoblastic disease (GTD).STUDY DESIGN: A retrospective cohort study with analysis of medical reports performed in 10 Brazilian referral centers from January 2000 to December 2011.RESULTS: Of 5,250 patients 3 died (0.06%) at the time of uterine evacuation. Spontaneous remission of GTD (group G1) was observed in 4,103 cases, and 1,144 (21.8%) progressed to gestational trophoblastic neoplasia (GTN) (G2). In G1 2,716 (66.2%) had complete hydatidiform mole (HM) and 1,210, partial HM (29.5%); 3,772 patients (92.7%) recovered as noted in December 2012. In G2, of 1,118 patients treated, initial histopathological results of previous gestation were complete HM (77.5% [n = 886]), partial HM (8.8% [n = 100]), and choriocarcinoma (8.0% [n = 92]); 930 (81.3%) were low-risk, 200 (17.5%) were high-risk GTN, and 14 had placental site trophoblastic tumor (PSTT) (1.2%); cure was achieved in 1,078 cases (96.4%), but 26 patients (2.3%) died (4 low-risk [0.4%], 19 high-risk [9.5%], and 3 PSTT [21.4%]).CONCLUSION: The highest death rates were due to high-risk GTN and PSTT. Patients with molar pregnancy should be referred to a referral center for an early diagnosis and prompt treatment of GTN in order to reduce the morbidity and mortality found in advanced stages.

Formação de professores: as diretrizes nacionais e o poder local

Coming as a result from a comprehensive research based on Lima’s studies (2008), this article is intended for investigating the process of reorganization of the Pedagogy course offered by a state public university since 2006, when the new National Curricular Guides were instituted. The subject matter brings up as one of its purposes to identify the main difficulties and the possible answers given in order to cause the changes to happen, taking in consideration both the external and internal interests of the institution. To further these aims, actual instruments were applied to the research: documents related to the Pedagogy course that were kept in the Council of the university and interviews with the members who took part in the process of readjustment. Because it is a public university, at first there was a mistaken presumption of the primacy of an administration founded upon democratic principles, in which the divergent opinions do not turn out to be taken as mere pretexts, but as an opportunity of dialogue and to establish collective projects. However, the results of the analysis shook that basic assumption and proved the opposite: the process was led to a rational/bureaucratic pattern of administration, the goals of which intended to adjust the institution to the external precepts and to establish the consensus — understood here as an absolute lack of conflicts. Nevertheless, it was chosen to conciliate the Pedagogy course to the national guides, without causing any harm to the departmental interests. These are reasons that justify satisfactorily the fact of this article being supposed to raise and quicken new and revitalized debate whenever there is an engagement of those who are most concerned for the duty of student teachers’ instruction, but mainly that of being expected to participate in the effective discussion/decision — making process of creating ends which to strive and work for.

O provimento do cargo do gestor escolar e a qualidade de ensino nas escolas públicas: análise a partir das publicações nacionais (1990-2005)

The research that originated this article was aimed at analyzing how the Brazilian publications from 1990 through 2005 set out the relationship between the appointment of school principals and democratic management and quality education. To that end, 38 books were selected and divided into three periods: 1990-1995; 1996-2000; 2001-2005. The findings indicate that from the second period on there is increasing consensus among scholars about the election of school principals as a form of appointment directly related to the democratization of management and quality improvement, defined as a collective and participatory construction of educational goals and practices.

Os momentos maquiavelianos no Brasil e as camadas do poder: do pacto político popular-democrático ao rentista financista

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)