Tecer outro Cesto de Conhecimentos? Pesquisa colaborativa e remota na pandemia de covid-19 / Weave another Basket of Knowledge? A remote collaborative research on the covid-19 pandemic

Resumo A partir da experiência do projeto Respostas Indígenas à COVID-19 no Brasil: arranjos sociais e saúde global (PARI-c), na região do Alto Rio Negro (AM), buscamos refletir neste artigo sobre as possibilidades e implicações da produção colaborativa de conhecimento com pesquisadoras indígenas, levando em consideração a emergência sanitária, as imobilidades territoriais, as desigualdades sociais e as diferenças epistemológicas e de políticas ontológicas. A partir da ideia de Cestos de conhecimento, pensamos as formas e possibilidades dessa colaboração, à luz de discussões contemporâneas sobre processos de "descolonização" da saúde pública (global, planetária) e do conhecimento em saúde. A base empírica para este artigo é uma descrição da experiência metodológica, de produção de conhecimento, focada em duas faces: o campo e a escrita. Esse material nos permite tecer algumas considerações em torno da relevância e do sentido de formas de geração de "saberes híbridos", para lidar com contextos de crises globais ou sindemias. Estas formas, como veremos, atravessam o realinhamento das alianças e têm na escrita de mulheres um lugar especial de atenção.

Abstract From the experience of the project Indigenous Responses to COVID-19 in Brazil: social arrangements and global health (PARI-c), in the region of Alto Rio Negro (AM), we seek to reflect in this article on the possibilities and implications of collaborative knowledge production with indigenous researchers, taking into account the health emergency, territorial immobilities, social inequalities, and epistemological and ontological policy differences. From the idea of Baskets of knowledge, we think about the forms and possibilities of this collaboration, in the light of contemporary discussions on processes of "decolonization" of public health (global, planetary) and health knowledge. The empirical basis for this article is a description of the methodological experience of knowledge production, focused on two aspects: the field and writing. This material allows us to make some considerations around the relevance and meaning of ways of generating "hybrid knowledge", to deal with contexts of global crises or syndemics. These ways, as we shall see, cross the realignment of alliances and find a special focal point on women's writing.

Transcatheter aortic valve replacement: the experience of one brazilian health care center

Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática / Surgical treatment of atrial fibrillation using bipolar radiofrequency ablation in rheumatic mitral disease

OBJETIVO: Avaliar a eficácia do tratamento cirúrgico da fibrilação atrial (FA) utilizando ablação com radiofrequência bipolar durante cirurgia cardíaca de procedimentos mitrais de etiologia reumática. MÉTODOS: Foram avaliados, retrospectivamente, os prontuários e exames de 53 pacientes submetidos à cirurgia valvar mitral, com ou sem cirurgia tricúspide ou aórtica associada, em que foi realizada ablação de FA utilizando radiofrequência bipolar. Trinta e quatro (64 por cento) pacientes eram mulheres e a idade variou de 27 a 72 anos (média: 49,3 anos ± 10,7 anos). O tempo médio de FA relatado foi de 41 meses (variou de 3 a 192 meses). O tipo de FA apresentado foi: paroxística em oito pacientes, persistente em três, permanente em 42. O átrio esquerdo apresentava tamanho médio de 52,9 ± 8,5 mm. As cirurgias realizadas foram: 47 trocas de valva mitral e seis plastias mitrais. O seguimento eletrocardiográfico foi completo em 83 por cento dos pacientes, ao final de 14 meses. Informações adicionais oriundas de Holter 24h foram exploradas. RESULTADOS: Ocorreram sete (13 por cento) óbitos per-operatórios e a sobrevida após 14 meses foi de 87 por cento. Os ritmos cardíacos encontrados após um ano de cirurgia foram: sinusal em 25 (66 por cento) pacientes, FA em sete (18 por cento), Flutter em cinco (13 por cento), Juncional em um (3 por cento). CONCLUSÃO: O uso de radiofrequência bipolar para tratamento de FA em pacientes submetidos à cirurgia valvar mitral de origem reumática é efetivo no controle da arritmia em 68 por cento dos pacientes, após 14 meses.

OBJECTIVE: To analyze the effectiveness of surgical treatment of atrial fibrillation (AF) using bipolar radiofrequency ablation during mitral valve procedures of rheumatic etiology in heart surgery. METHODS: We retrospectively reviewed medical registries of 53 patients submitted to atrial ablation with bipolar radiofrequency energy during mitral valve surgery. Thirty four (64 percent) patients were women and the age varied from 27 to 72 years old (average: 49.3 ± 10.7 years). Aortic and/or tricuspid procedures were also present in 36 (68 percent) patients. Average time of reported atrial fibrillation was 41 months (from 3 to 192 months). Type of AF was classified as: paroxysmal in 8 patients, persistent in 3, permanent in 42. Left atrium had an average size of 52.9 ± 8.5 mm. The surgeries in these series were: 47 mitral valve replacements and 6 mitral valve repairs. Eletrocardiografic follow up was 83 percent complete in 14 months. Data from 24h Holter were explored. RESULTS: Seven (13 percent) perioperative deaths were observed and survival after 14 months was 87 percent. Observed heart rhythm after 1 year of surgery was sinus rhythm in 25 (66 percent) patients, AF in 7 (18 percent), flutter in 7 (13 percent), junctional in 1 (3 percent). CONCLUSION: Bipolar radiofrequency ablation in patients submitted to mitral valve surgery of rheumatic etiology is effective in converting to sinus rhythm in 68 percent of patients after 14 months.