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Sample translations submitted: 2
Portuguese to English: Paratireoidectomia na doença renal crônica: é hora de mudar? General field: Medical Detailed field: Medical (general)
Source text - Portuguese Paratireoidectomia na doença renal crônica: é hora de mudar?
Parathyroidectomy in chronic kidney disease patients: is it time for changes?
O hiperparatireoidismo secundário (HPTS) é um distúrbio comumente observado em pacientes com doença renal crônica. Pacientes diagnosticados com HPTS podem sofrer reduções em sua qualidade de vida, fraturas ósseas, doenças cardiovasculares e mortalidade.
Atualmente, os nefrologistas tratam a doença abordando direta ou indiretamente as glândulas paratireoides através de quelantes de fosfato (com ou sem cálcio), ativadores do receptor da vitamina D e calcimiméticos.1 Contudo, em vários pacientes urêmicos a doença evolui em tal grau que o tratamento clínico deixa de surtir efeito, tornando necessária a intervenção cirúrgica (paratireoidectomia).
No Brasil, as chances de um paciente necessitar de cirurgia são elevadas não apenas por conta da ausência de políticas preventivas adequadas para a doença renal crônica, mas também por causa do acesso limitado a medicamentos e da inviabilidade de se utilizar as novas tecnologias da saúde. Com efeito, uma pesquisa recentemente conduzida pelo Departamento de Doença Renal Crônica - Distúrbios do Metabolismo Mineral da Sociedade Brasileira de Nefrologia relatou que cerca de 11% dos pacientes em diálise crônica têm HPTS grave, com níveis de paratormônio superiores a 1000 pg/mL2 - todos, quase certamente, aguardando por uma paratireoidectomia.
Entendendo que a paratireoidectomia é uma solução atualmente inevitável em muitos desses casos, devemos considerar algumas questões importantes, a saber: qual o tipo preferencial de paratireoidectomia? Subtotal, total ou total com autotransplante de paratireoide? E conseguirá o autotransplante evitar o hipoparatireoidismo no pós operatório?
Em um estudo recentemente publicado no Jornal Brasileiro de Nefrologia, Vieira et al.3 investigaram essas questões em um grupo de pacientes com doença renal crônica (pacientes de transplante renal e em diálise peritoneal e hemodiálise) submetidos a paratireoidectomia com autotransplante. Os pacientes receberam uma infusão de bicarbonato para elevar o pH sérico, induzindo hipocalcemia leve; o efeito ocorreu apenas logo após a infusão e foi apenas temporário, e os níveis de paratormônio não se elevaram no grupo de pacientes. O grupo de controle, por outro lado, viu seus níveis de paratormônio se elevarem, sugerindo resposta atenuada do tecido de paratireoide implantado sobre a redução da calcemia. Uma explicação dada pelos autores foi a possível ausência de reinervação autônoma do enxerto por conta do período relativamente curto entre o estudo e a cirurgia (tempo mediano de 8, 9 meses). Embora o número de fragmentos implantados de tecido de paratireoide não pareça ser um determinante de peso na hipofunção do enxerto, o meio urêmico em si, independente do tipo de terapia renal substitutiva, pode possivelmente ter influenciado a função e a sobrevida do enxerto. Contrariamente aos achados desses autores, outro estudo que avaliou pacientes submetidos a paratireoidectomia total com autotransplante heterotópico de tecido paratireoídeo normal, relatou melhores resultados de função do enxerto.4 Contudo, são muitos os motivos ainda não completamente compreendidos para a hipofunção do enxerto em pacientes DOI: 10.5935/0101-2800.20160022 urêmicos.
Os autores sugerem que a opção pela paratireoidectomia subtotal em pacientes urêmicos seja revisada. Apesar dessa abordagem poder evitar o hipoparatireoidismo pós-operatório, ela também já foi associada a risco aumentado de hiperparatireoidismo persistente e recorrente que, no passado, exigia uma nova cirurgia. Aguardamos a realização de estudos prospectivos para determinar se tais complicações serão mais facilmente controladas pelas atuais estratégias clínicas.
Embora os debates sobre qual abordagem cirúrgica é a melhor para tratar o HPTS ainda persistam, foi demonstrado que a paratireoidectomia melhora a sobrevida dos pacientes em diálise.5 Portanto, recomendamos que os clínicos tenham em mente que (i) a paratireoidectomia deve continuar a ser oferecida sempre que for houver indicação e (ii) que operar mais tarde é melhor do que simplesmente não operar.
Em conclusão, como nefrologistas, as melhores estratégias daqui para a frente são elevar o nosso conhecimento sobre a progressão da doença o mais brevement possível e oferecer seguimento contínuo para os pacientes. Assim, conseguiremos ter melhor controle sobre o distúrbio do metabolismo mineral ao longo dos diferentes estágios da doença renal crônica. Afinal de contas, nosso objetivo deve ser não apenas discutir com nossos pacientes qual a melhor abordagem cirúrgica, mas sim, em última análise, tentar evitar a necessidade de uma paratireoidectomia.
Referências
1. Barreto FC, de Oliveira RA, Oliveira RB, Jorgetti V. Pharmacotherapy of chronic kidney disease and mineral bone disorder. Expert Opin Pharmacother 2011;12:2627-40. DOI: http:// dx.doi.org/10.1517/14656566.2011.626768
2. Oliveira RB, Silva EN, Charpinel DM, Gueiros JE, Neves CL, Sampaio Ede A, et al. Secondary hyperparathyroidism status in Brazil: Brazilian census of parathyroidectomy. J Bras Nefrol 2011;33:457-62. DOI: http://dx.doi.org/10.1590/S0101- 28002011000400011
3. Vieira PD, Ohe MN, Santos LM, Kunii IS, Santos RO, Carvalho AB, et al. Parathyroid responsiveness during hypocalcemia after total parathyroidectomy and autotransplantation in patients with renal hyperparathyroidism. J Bras Nefrol 2016;38:184-91.
4. Lo CY, Tam SC. Parathyroid autotransplantation during thyroidectomy: documentation of graft function. Arch Surg 2001;136:1381-5. PMID: 11735864 DOI: http://dx.doi. org/10.1001/archsurg.136.12.1381
5. Goldenstein PT, Elias RM, Pires de Freitas do Carmo L, Coelho FO, Magalhães LP, Antunes GL, et al. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One 2013;8:e68870 DOI: http:// dx.doi.org/10.1371/journal.pone.0068870
Translation - English Fellype Carvalho Barreto 1,2
Affiliations:
1. Universidade Federal do Paraná, Department of Internal Medicine, Nephrology, Curitiba - PR.
2. Pontifícia Universidade Católica do Paraná.
Secondary hyperparathyroidism (SHPT) is a disorder commonly seen in patients with chronic kidney disease (CKD). Patients diagnosed with SHPT can experience a decreased quality of life, bone fractures, cardiovascular disease and mortality.
At present, nephrologists are treating the disease by targeting the parathyroid glands either directly or indirectly using phosphate binders (with or without calcium), vitamin D receptor activators and calcimimetics (1). However, in a number of uremic patients, the disease evolves to the extent that it becomes unresponsive to these treatments and therefore surgical intervention (parathyroidectomy) is necessary.
In Brazil, the chances of a patient undergoing surgery is increased not only because of an inadequate preventative health policy aimed at chronic kidney disease but also because of a limited access to appropriate medications and inaccessible new health technologies. Indeed, a recent survey conducted by the Department of Chronic Kidney Disease – Mineral Metabolism Disorder of the Brazilian Society of Nephrology reported that around 11% of chronic dialysis patients have severe SHPT, showing parathormone levels above 1000 pg/mL (2) – all, most certainly, waiting for parathyroidectomy.
Seeing that parathyroidectomy is currently an unavoidable solution in many of these cases, we must consider some important questions, namely, what is the preferred type of parathyroidectomy? Subtotal, total or total with parathyroid tissue autotransplantation? And, is autotransplantation effective in avoiding post-surgical hypoparathyroidism?
In a recent study published in the Brazilian Journal of Nephrology (3), Vieira and colleagues investigated these questions in a group of CKD patients (renal transplant, peritoneal and hemodialysis patients) who had undergone parathyroidectomies with auto-transplantation. They gave a bicarbonate infusion to raise the serum pH, inducing mild hypocalcemia; though the effect was only temporary immediately after the infusion with parathyroid hormone levels failing to rise in the patient group. The control group, on the other hand did rise, suggesting a blunted response of the implanted parathyroid tissue to decrease calcemia. One explanation given by the authors was the possible absence of autonomic reinnervation of the graft due to the relatively short period between the study and the surgery (median time of 8 to 9 months). Though the number of implanted fragments of parathyroid tissue did not seem to be a major determinant of graft’s hypofunction, the uremic milieu per se, regardless of the type of renal replacement therapy, was hypothesized as possibly influencing the graft function and survival. Contrary to the authors’ findings, another study, which evaluated patients who underwent total thyroidectomies with heterotopic autotransplantation of normal parathyroid tissue, reported better results for graft function (4). Though, there are multiple reasons why graft hypofunctioning may occur in uremic patients which are not yet fully understood.
The authors suggest that subtotal parathyroidectomy should be revised in uremic patients. Although this approach may avoid post-surgical hypoparathyroidism, it has also been associated with increased risk of both persistent and recurrent hyperparathyroidism, which, in the past required a new surgery. Whether these complications will be more easily controlled by current clinical strategies remains to be seen by prospective studies.
While the debate continues to discover which surgical approach is best to treat severe SHPT, it has been demonstrated that parathyroidectomy improves survival in dialysis patients (5). Therefore, clinicians are recommended to bear in mind that (i) parathyroidectomy should continue to be performed whenever indicated and, (ii) that operating later is better than not operating at all.
In conclusion, as nephrologists, the best strategy forward is to increase our knowledge of the disease progression at the earlier stages with patient follow up analysis. As such, we can achieve better control of the mineral metabolism disorder along the different stages of chronic kidney disease. After all, our aim should not only be to discuss with our patients the best surgical approach, but ultimately to try and prevent parathyroidectomy.
References:
1. Barreto FC, Oliveira RA, Oliveira RB, Jorgetti V. Pharmacotherapy of chronic kidney disease and mineral bone disorder. Expert Opinion on Pharmacotherapy 2011; 12(17): 2627-40.
2. Secondary hyperparathyroidism status in Brazil: Brazilian census of parathyroidectomy. Rodrigo Bueno de Oliveira; Eduardo Neves da SilvaII; Douglas Moraes Freire Charpinel; José Edevanilson Barros Gueiros; Carolina Lara Neves; Elisa de Albuquerque Sampaio; Fellype de Carvalho Barreto; Cristina KarohlI; Melani Custódio Ribeiro; Rosa Maria Affonso MoysésI; Vanda Jorgetti; Aluizio Barbosa de Carvalho. J Bras Nefrol 2011; 33(4):457-62.
3. Vieira
4. Lo CY, Tam SC. Parathyroid autotransplantation during thyroidectomy: documentation of graft function. Arch Surg. 2001; 136(12):1381-1385
5. Goldenstein PT, Elias RM, Pires de Freitas do Carmo L, Coelho FO, Magalhães LP, Antunes GL, Custódio MR, Montenegro FL, Titan SM, Jorgetti V, Moysés RM. Parathyroidectomy improves survival in patients with severe hyperparathyroidism: a comparative study. PLoS One. 2013 Aug 5;8(8):e68870.
Portuguese to English: AÇÃO DE EXIBIÇÃO DE DOCUMENTOS General field: Law/Patents Detailed field: Law (general)
Source text - Portuguese Em face de XXXXX, pessoa jurídica de direito privado, inscrita no CNPJ sob o nº XXXXX, com endereço na XXXXX - Centro, Rio de Janeiro - RJ, XXXXX com fulcro nos artigos, XXXXX e seguintes e XXXXX e seguintes do CPC, consoante as razões de fato e de Direito que passa a expor:
DOS FATOS
A Empresa-Autora realizou, via atendimento telefônico, a contratação de serviço de telefonia da Empresa-Ré, o qual consistia no fornecimento de 6 (seis) linhas telefônicas para uso empresarial.
No momento da contratação, o preposto da XXXXX informou que o prazo de fidelidade seria de 2 (dois) anos, razão pela qual eventual rescisão sem ônus somente poderia ser solicitada quando exaurido tal período.
Findo o prazo de fidelidade de dois anos, estando todas as faturas quitadas e sem que houvesse interesse em continuar com os serviços da Ré, a Autora entrou em contato com a central de atendimento da primeira para solicitar o cancelamento do serviço contratado.
No entanto, para sua surpresa, a Autora, na ligação com número de protocolo XXXXX, foi informada que o cancelamento somente poderia ser realizado mediante o pagamento de uma multa contratual!
Isto porque, conforme afirmado pela Ré, a ruptura do contrato foi solicitada pela Autora antes do término prazo de fidelidade de 2 (dois) anos, motivo pelo qual tal a penalidade era devida e seria acrescentada na próxima fatura.
A Autora foi categórica em afirmar que o prazo de fidelidade já havia expirado, deixando claro que a cobrança era irregular.
Não obstante os argumentos da demandante a demandada recusou-se a realizar o cancelamento do plano sem a cobrança de citada multa.
A Autora, inconformada com a cobrança, solicitou à Ré uma cópia do contrato firmado, de forma a comprovar que tal prazo já teria se esgotado.
Além disso, solicitou também que lhe fosse enviado um documento oficial da empresa discriminando o valor da multa em caso de rescisão do contrato antes do prazo de dois anos de finalidade, de forma que pudesse verificar qual seria o valor proporcional e efetivamente devido, caso o prazo de fidelidade ainda não tivesse acabado.
No entanto, mesmo tendo a Autora requerido o referido contrato por diversas vezes, a Ré quedou-se na mais completa inércia.
A Autora EM XXXXX /201x, ao receber sua fatura, deparou-se com o valor exorbitante de R$ XXXXX (XXXXX), estando discriminados apenas os seguintes serviços: a) Serviços Contratados, no valor de R$ XXXXX (XXXXX); e b) Utilização Acima do Contratado, no valor de R$ XXXXX (XXXXX), que, somados, perfazem a monta de R$ XXXXX (XXXXX).
Não havia na referida fatura (DOC. ANEXO) qualquer informação quanto aos R$ XXXXX (XXXXX) restantes, valor este que foi arbitrariamente imposto pela Ré.
Translation - English To the Chief Justice of the Civil Court of Rio de Janeiro
GRERJ ELECTRONIC Nº: XXXXX
XXXXX (hereinafter “Plaintiff”), a legal entity under private law, registered CNPJ no. XXXXX, situated on XXXXX, Centre, Rio de Janeiro, RJ, herein represented by its partners XXXXX, Brazilian, married, XXXXX, identity card # XXXXX issued by the SPP / ES, registered CPF No. XXXXX, resident at XXXXX - Rio de Janeiro, RJ, CEP: XXXXX and XXXXX, Brazilian, married, XXXXX, identity card no. XXXXX issued by the IFP / RJ, registered CPF No. XXXXX, resident at XXXXX - Rio de Janeiro, RJ, CEP: XXXXX, represented by their lawyers and power of attorney, duly constituted, using the email addresses: XXXXX and XXXXX and located at XXXXX - Centre - Rio de Janeiro, propose:
ACTION TO SHOW DOCUMENTS
Against XXXXX (hereinafter “Defendant”), a legal entity under private law, registered CNPJ No. XXXXX, situated at XXXXX - Centre, Rio de Janeiro - RJ, CEP: XXXXX focusing on articles XXX and thereafter and XXX and thereafter of the CPC, subject to fact and of law for the following reasons:
THE FACTS
The Plaintiff contracted a telephone service, via a telephone service line, from the Defendant which supplied six (6) telephone lines for business use.
During this telephone conversation, the XXXXX representative stated that the contract would last for 2 (two) years, and that provided the contract was maintained for this time period, no cancellation costs would be incurred should the client wish to cancel the contract after this date.
At the end of the two year period, and all invoices having been paid, the Plaintiff decided that they had no interest in carrying on with the services of the Defendant and initially contacted the customer services line to cancel the contract.
However, to the Plaintiff’s surprise, they were told during this telephone conversation (Protocol number XXXXX) that they could only cancel the contract upon payment of a contractual fine!
The reason for this, according to the Defendant, was that the Plaintiff asked to terminate the contract before the two year contract ended and was therefore in breach of contract and liable to pay a fine which would be added to their next bill.
The Plaintiff was categorical in stating that the contract had already expired and that charging them a fine was completely wrong.
Nonetheless, and regardless of the Plaintiff’s arguments, the Defendant refused to cancel the plan without charging a fine.
The Plaintiff, who adamantly disagreed with the charge, requested a copy of the signed contract from the Defendant, in order to prove that the contract had indeed expired.
In addition, the Plaintiff also requested from the Defendant an official document itemizing the costs of the fine should a contract be terminated before the two year contract end date, and so that they could check the proportional and actual debt, just in case the contract had not yet expired.
However, even though the Plaintiff requested this document on several occasions, the Defendant was inertia.
In XXXXX 201X, the Plaintiff was aghast when they received a bill from the Defendant for the exorbitant amount of R$ XXXXX (XXXXX), with only the following services being listed: a) Contracted Services, to the value of R$ XXXXX (XXXXX); and b) Extra usage over and above contract limits, to the value of R$ XXXXX (XXXXX), which together amounted to R$ XXXXX (XXXXX).
There was no information in the above mentioned bill (DOC. ATTACHED) regarding the remaining R$ XXXXX (XXXXX), which was arbitrarily imposed by the Defendant.
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Bachelor's degree - Napier University, Edinburgh
Experience
Years of experience: 8. Registered at ProZ.com: Jul 2018.
Experience translator, proofreader and copywriter specializing in medicine, law, marketing, business and tourism.
I am from the UK and have a BA (Hons) Business Degree. Before becoming a full-time translator and writer, I lived and worked for 17 years in Brazil. In Brazil, I
ran a successful, small hotel in Rio de Janeiro and there, I used
much of my writing skills in English and Portuguese for business purposes. Since returning to the UK, I have had a variety of writing jobs ranging from copywriting for large multinationals to translations for medical journals and legal contracts.
I am fluent
in English and Portuguese and I have a general knowledge of Spanish.
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