O trabalho em equipe multiprofissional na Residência: a perspectiva dos residentes multiprofissionais / Multi-professional teamwork at the Residency: the perspective of multi- professional residents

Mudanças no contexto das políticas públicas desencadearam transformações nas práticas de atenção em saúde por meio da reorganização do sistema de saúde e formação de profissionais para atuação no setor. A Residência apresenta-se como uma das ferramentas para formação de profissionais de saúde, enfatizando cuidado integral e trabalho em equipe. O objetivo da pesquisa foi analisar a percepção de residentes multiprofissionais sobre trabalho em equipe na Atenção Primária à Saúde (APS) e apreender suas perspectivas acerca de sua inserção nas equipes de APS, na Residência. Utilizou-se análise de conteúdo dedutiva, uma ferramenta para análise de dados que visa interpretar um material de caráter qualitativo, descrevendo o conteúdo manifesto nas comunicações. Realizaram-se entrevistas semiestruturadas com 14 residentes que atuam em Unidades de Saúde da Família de Ribeirão Preto, São Paulo. Definiram-se três categorias temáticas para análise e discussão. Foram realizados apontamentos sobre formação na graduação e na Residência Multiprofissional para o trabalho em equipe na APS, reflexões sobre concepções e desafios do trabalho em equipe, e da inserção desses residentes nas equipes. Evidenciou-se que os residentes apresentam visão ampla sobre o trabalho em equipe, especialmente acerca do cuidado integral dos usuários, contemplando os profissionais, que se beneficiam da troca de experiência proporcionada por ações conjuntas. A Residência tem sido cenário importante de formação, considerando que o conceito e a prática do trabalho em equipe na APS vêm sendo vivenciados desde o início, e os residentes necessitam buscar suporte teórico e modelos para prática, a fim de sustentar seu trabalho.

Changes in the context of public policies brought changes in health care practices through reorganization of the health system and training of professionals to work in the sector. The Residency presents itself as one of the strategies for training health professionals, emphasizing integral care and teamwork. The objective of the research was to analyze the perception of multi-professional residents regarding teamwork in Primary Health Care (PHC); and to apprehend their perspectives about their insertion into PHC teams at the Residency. Deductive content analysis was used, which is a strategy for data analysis that aims to interpret a material of qualitative character, describing the manifest content in the communications. Semi- structured interviews were conducted with fourteen residents, who work in Family Health Units in Ribeirão Preto, São Paulo. Three thematic categories were defined for analysis and discussion. Discussions were held about graduation training and the Multi-professional Residency for teamwork in PHC; reflections on conceptions and challenges of teamwork, and the insertion of these residents into PHC teams. It was evident that the residents present a broad view on teamwork, especially on the integral care of the users, contemplating the professionals, who benefit from the exchange of experience provided by joint actions. Residency has been an important training scenario, given that the concept and practice of teamwork in PHC have been experienced since the beginning, and the residents need to seek theoretical support and models for the practice, in order to sustain their work.

Assistência à saúde de pessoas com doenças colorretais no sistema público a perspectiva do usuário / Health care for people with colorectal diseases in the public system: the user's perspective

Trata-se de um estudo de desenho misto, do tipo sequencial explanatório, sendo que na etapa quantitativa descritiva e transversal, objetivou-se analisar a demanda de atendimento de assistência de pessoas com queixas colorretais em Unidades de Saúde da Família no Sistema Único de Saúde (SUS); e na etapa qualitativa exploratória, interpretar o mapa de cuidado de pessoas com adoecimento colorretal crônico no SUS (Parecer No. 210/2018 CEP/EERP-USP). Na etapa quantitativa aplicou-se um instrumento de coleta de dados, elaborado pelas pesquisadoras, com base na revisão de literatura, para caracterização sociodemográfica, clínica, terapêutica e de referência de participantes usuários da Estratégia Saúde da Família com queixas colorretais, mediante critérios de inclusão e exclusão, no período de abril a setembro de 2019. A análise estatística descritiva dos dados indicou, que do total de 107 participantes, predominou 78 (72,9%) que tinham idade acima de 60 anos, 64 (59,8%) eram do sexo feminino, 61 (57%) tinham até oito anos de estudos, 68 (63,65) com companheiro, 56 (52,3%) eram aposentados, 45 (42,1%) apresentavam renda de até um salário mínimo e 95 (88,8%) não possuíam plano de saúde privado, sendo que o encaminhamento para o nível secundário foi devido ao protocolo de rastreamento para 62 (57,9%) e 45 (42,1%) por queixa colorretal, todos haviam realizado a Pesquisa de Sangue Oculto e destes, 78% tiveram resultado positivo; todos os entrevistados haviam recebido encaminhamento para realizar a colonoscopia. Além disso, 78 (72,9%) eram sedentários; e 66 (61,7%) consumiam carne vermelha e 45 (42,1%) embutidos. A análise univariada da associação das variáveis hábitos de vida, resultado de colonoscopia, presença de alterações displásicas ou doença colorretal não foi estatisticamente significante entre consumo de carne vermelha, consumo de embutidos ou ambos com o desfecho de colonoscopia normal, displasia intestinal com potencial neoplásico e doença diverticular ou orificial. Estes resultados dimensionaram o contexto de atendimento desta clientela na Atenção Primária à Saúde (APS), auxiliando o refinamento dos critérios de seleção dos possíveis participantes da etapa qualitativa. A etapa qualitativa foi realizada, no período de junho de 2020 a julho de 2020, mediante os critérios de seleção: pessoas acima de 18 anos, de ambos os sexos, com diagnóstico colorretal crônico: Doença inflamatória intestinal ou Neoplasia colorretal em internação especialidade de Coloproctologia de um hospital universitário público, de assistência terciária/quaternária. Nesta etapa, os dados foram coletados por meio de entrevistas individuais em profundidade com 14 participantes, cuja caracterização sociodemográfica, clínica e terapêutica revelou internação para tratamento cirúrgico, com maior gravidade clínica, sendo que 13 apresentavam diagnóstico de Neoplasia colorretal. Utilizou-se questões norteadoras, diário de campo, observação não participante e participante para a obtenção dos dados, que foram interpretados com Análise Temática, fundamentado pela Epidemiologia Social. O Mapa de Cuidado construído por estes, iniciou-se com queixas e sinais/sintomas gastrointestinais, envolvendo situações de maior gravidade clínica, com sofrimento físico e psicoemocional; diagnosticados como parasitose, hemorroidas e anemia na APS, cujos tratamentos não foram resolutivos. Para esta interpretação, articulou-se as ações destes participantes às suas queixas, à condição socioeconômica, cultural e psicoemocional, assim como à capacidade de enfrentamento do adoecimento oncológico e dos tratamentos, no qual ocorreu a focalização da vida destes e de suas famílias nos acontecimentos clínicos e terapêuticos do contexto de atendimento terciário/quaternário. O acesso aos serviços do SUS ocorreu de diferentes maneiras, com utilização de estratégias que agilizaram e asseguraram a resolução do seu problema de saúde, sendo que o agir leigo foi uma produção social, no cotidiano do SUS, mediado pelos acontecimentos, pelas ações dos profissionais e de suas próprias ações ou pelo sistema de apoio social, enfatizando-se o sofrimento desta clientela na busca pela assistência à saúde. Este mapa de cuidado mostrou que o agir leigo constituiu uma regulação assistencial no SUS, tão importante quanto as outras formas, composto pelos vínculos dos pacientes com profissionais dos serviços dos níveis primário, secundário, terciário/quaternário, de suas necessidades e possibilidades, além dos pontos de acesso ao sistema. Estes resultados poderão contribuir na implementação da gestão de cuidados de pessoas com adoecimento colorretal crônico no SUS, dando voz e protagonismo àquele que busca pela assistência à saúde

This is a study of mixed design, of an explanatory sequential type, and in the quantitative descriptive and transversal stage, the objective was to analyze the demand for assistance from people with colorectal symptoms in Family Health Units in the Unified System Health (SUS); and in the qualitative exploratory stage, interpret the care map for people with chronic colorectal illness in SUS (Note Nº. 210/2018 CEP / EERP-USP). In the quantitative stage, a data collection instrument was developed by the researchers, based on the literature review, for sociodemographic, clinical, therapeutic, and reference characterization of participating users of the Family Health Strategy with colorectal symptoms, considering inclusion and exclusion criteria, from April to September 2019. The descriptive statistical analysis of the data indicated that, out of a total of 107 participants, 78 (72.9%) predominated who were over 60 years old, 64 (59.8%) were female, 61 (57%) had up to eight years of study, 68 (63.65) with a partner, 56 (52.3%) were retired, 45 (42.1%) had an income of up to one minimum wage and 95 (88.8%) did not have a private health plan, and the referral to the secondary level was due to the screening protocol for 62 (57.9%) and 45 (42.1%) due to colorectal complaints, all had carried out the Occult Blood Survey and of these, 78% had a positive result; all respondents had been referred for colonoscopy. In addition, 78 (72.9%) were sedentary; and 66 (61.7%) consumed red meat and 45 (42.1%) sausages. The univariate analysis of the association of the variables life habits, the result of colonoscopy, presence of dysplastic changes or colorectal disease was not statistically significant between consumption of red meat, consumption of sausages or both with the outcome of normal colonoscopy, intestinal dysplasia with neoplastic potential and diverticular or artificial disease. These results have dimensioned the context of care for this clientele in Primary Health Care (PHC), helping to refine the selection criteria of possible participants in the qualitative stage. The qualitative stage was carried out, from June 2020 to July 2020, using the selection criteria: people over 18 years of age, of both sexes, with chronic colorectal diagnosis: Inflammatory bowel disease or Colorectal neoplasia in Coloproctology specialty hospitalization of a public university hospital, of tertiary/quaternary assistance. In this stage, data were collected through in-depth individual interviews with 14 participants, whose sociodemographic, clinical, and therapeutic characterization revealed hospitalization for surgical treatment, with greater clinical severity, with 13 presenting a diagnosis of colorectal neoplasia. Guiding questions, field diary, non-participant and participant observation were used to obtain the data, which were interpreted with Thematic Analysis, based on Social Epidemiology. The Care Map built by them started with gastrointestinal complaints and signs/symptoms, involving situations of greater clinical severity, with physical and psycho-emotional suffering; diagnosed as parasitosis, hemorrhoids, and anemia in PHC, whose treatments were not effective. For this interpretation, the actions of these participants were linked to their complaints, to their socioeconomic, cultural, and psycho-emotional condition, as well as to their ability to cope with oncological illness and treatments, in which the lives of these and their families were focused on the events and therapeutic aspects of the tertiary/quaternary care context. Access to SUS services occurred in different ways, using strategies that streamlined and ensured the resolution of their health problem, and the lay agency as social production, in the daily routine of SUS, mediated by events, by the actions of professionals and their actions or the social support system, emphasizing the suffering of this clientele in the search for health care. This care map showed that the lay act constituted an assistance regulation in SUS, as important as the other forms, composed by the bonds of patients with professionals from the services of the primary, secondary, tertiary/quaternary levels, of their needs and possibilities, in addition to the access points to the system. These results may contribute to the implementation of the care management of people with chronic colorectal illness in SUS, giving voice and leadership to those seeking health care.

First isolation of West Nile virus in Brazil

BACKGROUND Serological evidence of West Nile virus (WNV) infection has been reported in different regions of Brazil from equine and human hosts but the virus had never been isolated in the country. OBJECTIVES We sought to identify the viral etiology of equine encephalitis in Espírito Santo state. METHODS We performed viral culture in C6/36 cells, molecular detection of WNV genome, histopathology and immunohistochemistry from horse cerebral tissue. We also carried out sequencing, phylogenetic analysis and molecular clock. FINDINGS Histopathologic analysis from horse cerebral tissue showed injury related to encephalitis and WNV infection was confirmed by immunohistochemistry. The virus was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) from brain tissue and subsequently isolated in C6/36 cells. WNV full-length genome was sequenced showing the isolated strain belongs to lineage 1a. The molecular clock indicated that Brazilian WNV strain share the same common ancestor that were circulating in US during 2002-2005. MAIN CONCLUSIONS Here we report the first isolation of WNV in Brazil from a horse with neurologic disease, which was clustered into lineage 1a with others US WNV strains isolated in beginning of 2000's decade.

Encephalitis associated with Zika virus infection and reactivation of the varicella-zoster virus in a Brazilian child

Abstract We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.

Potential role of dengue virus, chikungunya virus and Zika virus in neurological diseases

This study showed that laboratory markers of recent infection by dengue, Zika or chikungunya arboviruses were detected in the biological samples of approximately one-third of patients with encephalitis, myelitis, encephalomyelitis or Guillain-Barré syndrome, in a surveillance programme in Piauí state, Brazil, between 2015-2016. Fever and myalgia had been associated with these cases. Since in non-tropical countries most infections or parainfectious diseases associated with the nervous system are attributed to herpesviruses, enteroviruses, and Campylobacter jejuni, the present findings indicate that in tropical countries, arboviruses may now play a more important role and reinforce the need for their surveillance and systematic investigation in the tropics.

Clinical and serological tests for arboviruses in free-living domestic pigeons (Columba livia)

BACKGROUND In this study, we evaluated the role of free-living domestic pigeons (Columba livia) as a reservoir of arboviruses in the city of Belém, state of Pará, Brazil. We investigated the presence of antibodies against the most prevalent arboviruses. OBJECTIVES This study was aimed at evaluating some clinical and physical parameters of domestic pigeons, including the presence of antibodies to Amazon-endemic arboviruses. METHODS Eighty-five healthy pigeons were captured in Mangal das Garças Park, in Belém, and were bled. Upon capture, the birds were subjected to a clinical examination in search of alterations that could indicate the presence of arboviruses. Blood samples were converted to serum and tested using the haemagglutination inhibition (HI) technique with a panel of 19 antigens of arboviruses circulating in the Amazon. The confirmation assay for the positive reactions to the viral species tested by HI was a neutralisation test in new-born Swiss albino mice (Mus musculus) [mouse neutralisation test (MNT)]. FINDINGS A total of 10 (11.8%) serum samples tested positive for antiflavivirus antibodies by HI. All the samples positive for the HI test were subjected to MNT for detection of viruses and yielded negative results (logarithmic neutralisation index < 1.7). MAIN CONCLUSION The results represent the first serological detection of antiarbovirus antibodies in domestic pigeons as potential hosts of arboviruses in Brazil. The detection of haemagglutination-inhibiting antibodies against genus Flavivirus indicated that there was recent contact between the analysed domestic pigeons and these arboviruses. Further studies are needed to evaluate the role of free-living pigeons in the maintenance cycle and spread of arboviruses in the Amazon.

Prevalence of antibodies to equine alphaviruses in the State of Pará, Brazil / Prevalência de anticorpos para alphavirus em equinos do estado do Pará, Brasil

The State of Pará comprises 26% of Brazilian Amazon region, where a large diversity of arboviruses has been described. This study sought to assess the prevalence and distribution of hemagglutination inhibition (HI) antibodies against antigens of four alphaviruses (Togaviridae: Alphavirus ) from the species: Eastern equine encephalitis (EEEV), Western equine encephalitis (WEEV), Mayaro virus (MAYV), and Mucambo virus (MUCV) in 753 serum samples of horses in Pará State, Brazil. All investigated arboviruses were detected and indicate that horses are susceptible to these alphaviruses, and show evidences of their active circulation in farm animals in the Brazilian Amazon.(AU)

O estado do Pará corresponde a 26% da Amazônia brasileira, onde uma grande diversidade de arbovírus foi descrita. Este estudo procurou avaliar a prevalência e a distribuição de anticorpos inibidores da hemaglutinação (IH) contra antígenos de quatro alfavirus (Togaviridae: Alphavirus ), das espécies: Vírus da encefalite equina do leste (EEEV), Vírus da encefalite equina do oeste (WEEV), Vírus mayaro (MAYV) e Vírus mucambo (MUCV), de 753 amostras de soro de equinos no estado do Pará, Brasil. Todos os arbovirus pesquisados foram detectados, indicando que os equinos são suscetíveis a esses Alphavirus e mostrando evidências de sua circulação ativa em animais de fazenda na Amazônia brasileira.(AU)

Waterborne toxoplasmosis investigated and analysed under hydrogeological assessment: new data and perspectives for further research

We present a set of data on human and chicken Toxoplasma gondiiseroprevalence that was investigated and analysed in light of groundwater vulnerability information in an area endemic for waterborne toxoplasmosis in Brazil. Hydrogeological assessment was undertaken to select sites for water collection from wells for T. gondiioocyst testing and for collecting blood from free-range chickens and humans for anti-T. gondiiserologic testing. Serologic testing of human specimens was done using conventional commercial tests and a sporozoite-specific embryogenesis-related protein (TgERP), which is able to differentiate whether infection resulted from tissue cysts or oocysts. Water specimens were negative for the presence of viable T. gondiioocysts. However, seroprevalence in free-range chickens was significantly associated with vulnerability of groundwater to surface contamination (p < 0.0001; odds ratio: 4.73, 95% confidence interval: 2.18-10.2). Surprisingly, a high prevalence of antibodies against TgERP was detected in human specimens, suggesting the possibility of a continuous contamination of drinking water with T. gondiioocysts in this endemic setting. These findings and the new proposed approach to investigate and analyse endemic toxoplasmosis in light of groundwater vulnerability information associated with prevalence in humans estimated by oocyst antigens recognition have implications for the potential role of hydrogeological assessment in researching waterborne toxoplasmosis at a global scale.

Flavonóides: constituição química, ações medicinais e potencial tóxico / Flavonoids: Chemical composition, medical actions and toxicity

Os flavonóides são um grupo de substâncias naturais com estrutura fenólica variável, e portanto, de considerável interesse científico e terapêutico. Assim, teve-se por objetivo realizar uma revisão bibliográfica, de forma extensa porém objetiva, sobre as principais ações terapêuticas e a toxicidade das principais classes de flavonóides. A partir desta revisão da literatura, verificou-se, em ensaios pré-clínicos, que estes compostos tem o potencial de modificar a biossíntese de eicosanoides (resposta anti-prostanoide e antiinflamatoria); de proteger o colesterol-LDL da oxidacão (inibindo formação de placa aterosclerotica); de prevenir a agregacão plaquetária tendo efeitos anti-trombóticos; de promover o efeito anti-hipertensivo e anti-isquêmico; de regenerar antioxidantes primários, como a vitamina C, no organismo; de ter efeito antipromocionais na carcinogênese de alguns tipos de câncer; de amenizar os sintomas da menopausa; de aumentar a lipólise; de desacelerar o processo degenerativo em bainhas de mielina; de aumentar a secreção de insulina; de aumentar a expressão de genes responsáveis pela produção de proteínas sinápticas; de estimular os linfócitos B a produzirem anticorpos e de possuir atividade leishmanicida. Quanto a toxicidade dos flavonóides, estudos demostram que em altas doses e em utilização crônica, estes compostos desencadeiam reações alérgicas em humanos; modificam as membranas de hepatócitos causando necrose e morte celular em ratos; causam mutagenicidade e clastogenicidade em medula óssea de camundongos; interferem de forma significativa no funcionamento da tireóide e inibe a ação de citocromos P450 causando alterações drásticas no funcionamento do fígado de roedores. Dessa forma, pode-se verificar que os flavonóides tem uma grande capacidade terapêutica quando bem utilizado, devendo-se sempre levar em consideração doses e tempo de exposição aos organismos aos quais são administrados. Essas considerações são importantes por servirão de base para o estabelecimento de doses seguras e eficazes de utilização dos flavonóides para a população.

Flavonoids are a group of natural substances with variable phenolic structure and therefore, considerable scientific interest and therapeutic. Thus, the objective was to conduct a literature review of but objective extensively on major therapeutic actions and on the toxicity of flavonoids class. In this literature review, it was found that, in preclinical studies, these compounds have the potential to modify the biosynthesis of eicosanoids; protect LDL cholesterol from oxidation; prevent platelet aggregation with antithrombotic effects; promote the antihypertensive and anti-ischemic effect; regenerate primary antioxidants like vitamin C in the body; not to promote some carcinogenic effects on certain types of cancer; alleviate menopausal symptoms; increase lipolysis; slow down degenerative process in myelin sheaths; increase insulin secretion; increase the expression of genes responsible for the production of synaptic proteins; stimulate lymphocytes B to produces antibodies and have leishmanicydal activity. About the toxicity of flavonoids, studies show that, at high doses and in chronic use, these compounds trigger allergic reactions in humans; modify the membranes of hepatocytes, causing necrosis and cell death, in rats; cause mutagenicity and clastogenicity in mouse bone marrow, interfere significantly on thyroid function and inhibit the action of cytochrome P450, causing drastic changes in the function of the liver in rodents. Thus, it can be seen that the flavonoids have a wide therapeutic capacity when properly used, taking into account doses and exposure times to whom they are administered. These considerations are important because they set the bases for the establishment of safe and effective doses of flavonoids on the population.

Serological evidence for Saint Louis encephalitis virus in free-ranging New World monkeys and horses within the upper Paraná River basin region, Southern Brazil

Introduction Saint Louis encephalitis virus (SLEV) primarily occurs in the Americas and produces disease predominantly in humans. This study investigated the serological presence of SLEV in nonhuman primates and horses from southern Brazil. Methods From June 2004 to December 2005, sera from 133 monkeys (Alouatta caraya, n=43; Sapajus nigritus, n=64; Sapajus cay, n=26) trap-captured at the Paraná River basin region and 23 blood samples from farm horses were obtained and used for the serological detection of a panel of 19 arboviruses. All samples were analyzed in a hemagglutination inhibition (HI) assay; positive monkey samples were confirmed in a mouse neutralization test (MNT). Additionally, all blood samples were inoculated into C6/36 cell culture for viral isolation. Results Positive seroreactivity was only observed for SLEV. A prevalence of SLEV antibodies in sera was detected in Alouatta caraya (11.6%; 5/43), Sapajus nigritus (12.5%; 8/64), and S. cay (30.8%; 8/26) monkeys with the HI assay. Of the monkeys, 2.3% (1/42) of A. caraya, 6.3% 94/64) of S. nigritus, and 15.4% (4/26) of S. cay were positive for SLEV in the MNT. Additionally, SLEV antibodies were detected by HI in 39.1% (9/23) of the horses evaluated in this study. Arboviruses were not isolated from any blood sample. Conclusions These results confirmed the presence of SLEV in nonhuman primates and horses from southern Brazil. These findings most likely represent the first detection of this virus in nonhuman primates beyond the Amazon region. The detection of SLEV in animals within a geographical region distant from the Amazon basin suggests that there may be widespread and undiagnosed dissemination of this disease in Brazil. .

Seroprevalence of flaviviruses antibodies in water buffaloes (Bubalus bubalis) in Brazilian Amazon

The state of Pará encompasses 26% of Brazilian Amazon where an enormous diversity of arboviruses has been found. This study aimed to assess the prevalence and distribution of hemagglutination-inhibition antibodies against antigens of six Flavivirus (yellow fever virus, Ilheus virus, Saint Louis encephalitis virus, Cacipacore virus, Bussuquara virus and Rocio virus) in water buffaloes in Pará state, Brazil. The prevalence of antibodies in these farm animals is important to determine the circulating arboviruses.

Seroprevalence of flaviviruses antibodies in water buffaloes (Bubalus bubalis) in Brazilian Amazon

The state of Pará encompasses 26% of Brazilian Amazon where an enormous diversity of arboviruses has been found. This study aimed to assess the prevalence and distribution of hemagglutination-inhibition antibodies against antigens of six Flavivirus (yellow fever virus, Ilheus virus, Saint Louis encephalitis virus, Cacipacore virus, Bussuquara virus and Rocio virus) in water buffaloes in Pará state, Brazil. The prevalence of antibodies in these farm animals is important to determine the circulating arboviruses.

Lupus erythematosus: considerations about clinical, cutaneous and therapeutic aspects

Systemic Lupus Erythematosus is a chronic inflammatory disease with multifactorial etiology. Although clinical manifestations are varied, the skin is an important target-organ, which contributes to the inclusion of skin lesions in 4 out of the 17 new criteria for the diagnosis of the disease, according to the Systemic Lupus International Collaborating Clinics. The cutaneous manifestations of lupus are pleomorphic. Depending on their clinical characteristics, they can be classified into Acute Cutaneous Lupus Erythematosus, Subacute Cutaneous Lupus Erythematosus, Chronic Cutaneous Lupus Erythematosus and Intermittent Cutaneous Lupus Erythematosus. Treatment is based on preventive measures, reversal of inflammation, prevention of damage to target organs and relief of adverse events due to pharmacological therapy. The most commonly used treatment options are topical, systemic and surgical treatment, as well as phototherapy. The correct handling of the cases depends on a careful evaluation of the morphology of the lesions and the patient's general status, always taking into consideration not only the benefits but also the side effects of each therapeutic proposal.

Fístula faringocutânea em paciente oncológico: implicações para a Enfermagem / Pharyngocutaneous Fistula in Cancer Patients: Implications for Nursing

Introdução: O câncer de laringe é um dos mais comuns a atingir região da cabeça e pescoço, representando 25% dos tumores malignos que acometem essa área. Quando diagnosticada precocemente, essa neoplasia tem cura; mas, na maioria dos casos, os pacientes são submetidos à faringolaringectomia e laringectomia total, nos quais a complicação mais grave é a fístula faringocutânea. O presente estudo trata das principais implicações da fístula faringocutânea e os cuidados de enfermagem em pacientes submetidos à laringectomia total. Objetivo: Descrever as principais implicações da complicação fístula faringocutânea para subsidiar a assistência de enfermagem. Método: Estudo de revisão integrativa da literatura, com coleta de dados nas bases Lilacs, Medline, Pubmed e Google acadêmico, dos quais foram selecionadosquatro artigos que se adequavam aos critérios de seleção do estudo. Resultados: Como resultados, todos os autores enfatizam que a fístula faringocutânea é a maior, e mais frequente complicação em pacientes submetidos à laringectomiatotal, com uma diversidade de fatores elencados na literatura que resultam na formação dessa fístula; a identificaçãodesses fatores de risco é imprescindível para o planejamento da assistência de enfermagem perioperatória. Conclusão:Há escassez de estudos sobre os fatores de risco para a formação da fístula faringocutânea e os cuidados de enfermagem. O enfermeiro deve atuar no ensino para prevenção dessa complicação, assegurar recuperação fisiológica e reabilitação do paciente, além de favorecer a cicatrização, diminuindo riscos de infecção, tempo de internação, gastos hospitalarese promover melhora da qualidade de vida desses pacientes.

Persistence of experimental Rocio virus infection in the golden hamster (Mesocricetus auratus)

Rocio virus (ROCV) is an encephalitic flavivirus endemic to Brazil. Experimental flavivirus infections have previously demonstrated a persistent infection and, in this study, we investigated the persistence of ROCV infection in golden hamsters (Mesocricetus auratus). The hamsters were infected intraperitoneally with 9.8 LD50/0.02 mL of ROCV and later anaesthetised and sacrificed at various time points over a 120-day period to collect of blood, urine and organ samples. The viral titres were quantified by real-time-polymerase chain reaction (qRT-PCR). The specimens were used to infect Vero cells and ROCV antigens in the cells were detected by immunefluorescence assay. The levels of antibodies were determined by the haemagglutination inhibition technique. A histopathological examination was performed on the tissues by staining with haematoxylin-eosin and detecting viral antigens by immunohistochemistry (IHC). ROCV induced a strong immune response and was pathogenic in hamsters through neuroinvasion. ROCV was recovered from Vero cells exposed to samples from the viscera, brain, blood, serum and urine and was detected by qRT-PCR in the brain, liver and blood for three months after infection. ROCV induced histopathological changes and the expression of viral antigens, which were detected by IHC in the liver, kidney, lung and brain up to four months after infection. These findings show that ROCV is pathogenic to golden hamsters and has the capacity to cause persistent infection in animals after intraperitoneal infection.

Soroprevalência de anticorpos anti-alfavírus em equídeos em um surto de encefalite equina, Paraíba, 2009

Os objetivos deste estudo foram determinar a prevalência de anticorpos inibidores da hemaglutinação para alfavírus em equinos investigados durante um surto ocorrido na Paraíba, em 2009, bem como comparar os resultados obtidos para o vírus da Encefalite Equina do Leste (EEE) mediante uso das técnicas de inibição de hemaglutinação e de soroneutralização em microplacas. Foi realizada coleta de sangue em 182 equídeos, distribuídos em 15 municípios da região oeste da Paraíba, onde existia relato da doença e/ou morte de equinos. Observou-se uma prevalência pré-teste para Encefalite Equina do Leste de 12,8%, prevalência real de 63,7% e prevalência aparente de 54,3%. Quando comparados os resultados obtidos no teste de inibição de hemaglutinação com o de soroneutralização, observou-se uma sensibilidade de 77,6% e especificidade de 86,4% no primeiro teste. Os valores preditivos positivos e negativos foram de 90,9% e 68,7%, respectivamente. O estudo revelou um grande número de animais infectados e sem manifestação clínica aparente.  Os resultados do teste de inibição de hemaglutinação associados as informações clínicas, epidemiológicas e ao diagnóstico virológico (detecção de genoma viral) foram capazes de confirmar a epizootia na área e demonstram que esta técnica pode ser recomendada como de triagem em inquéritos sorológicos desta natureza pela elevada sensibilidade e especificidade do

Queratose liquenoide crônica: relato de caso / Keratosis lichenoides chronica: case report

A queratose liquenoide crônica ou doença de Nekam é uma dermatose mucocutânea rara da queratinização, com curso crônico e progressivo, que acomete geralmente indivíduos entre 20 e 40 anos. Existem, aproximadamente, 70 casos descritos na literatura. Devido à raridade desta dermatose e à ausência de tratamento efetivo, é uma doença de difícil manejo. No caso em questão, apresentamos um paciente de 42 anos com pápulas violáceas, hiperqueratósicas, algumas confluentes, com aspecto linear, rendilhado e em placas, localizadas no tronco e membros há cinco anos. Lesões aftoides na cavidade oral e úlceras rasas na genitália também faziam parte do quadro. O anatomopatológico foi bastante sugestivo de queratose liquenoide crônica. Introduziu-se tratamento com acitretina e dapsona, havendo melhora parcial do quadro.

Keratosis lichenoides chronica or Nekam's disease is a rare mucocutaneous dermatosis characterized by keratinization. It is chronic and progressive usually affecting individuals aged 20-40 years. Around 70 cases have been reported in the literature. Due to the rarity of this condition and the lack of effective treatment, it is a difficult disease to manage. In the case described below we present a 42-yearold patient with violaceous and hyperkeratotic papules in linear, reticular or plaque form, located on the trunk and limbs for five years. Aphthous lesions in the oral cavity and shallow ulcers on the genitalia also formed part of the clinical manifestation. Pathologic examination was suggestive of keratosis lichenoides chronica. Acitretin and dapsone was introduced and the lesions partially improved.

Epidemiology of Saint Louis encephalitis virus in the Brazilian Amazon region and in the State of Mato Grosso do Sul, Brazil: elevated prevalence of antibodies in horses / Epidemiologia do vírus da encefalite Saint Louis na Amazônia brasileira e no Estado do Mato Grosso do Sul, Brasil: elevada prevalência de anticorpos em equinos

The immunity of horses (n = 1401) against Saint Louis encephalitis virus (SLEV) was investigated in the Brazilian Amazon region (Bragança/Pará, Salvaterra/Pará, Macapá/Amapá and Rio Branco/Acre) and Maracaju, State of Mato Grosso do Sul, by the hemagglutination inhibition (HI) and plaque reduction neutralization (PRNT) tests. HI and neutralizing antibodies specific (monotypic reactivity, MR) for SLEV and other flaviviruses included in the tests were detected, as was cross-reactivity (CR) against flaviviruses. In the HI test, MR was observed in 248 (17.7 percent) serum samples, 137 of which were (55.2 percent) againstSLEV; CR was detected in 380 (27.1 percent). The frequency of MR against SLEV was significantly higher in Macapá and CR was significantly higher in Salvaterra. In the PRNT, neutralization of SLEV was observed in 713 (50.9 percent) samples, and the prevalence of neutralizing antibodies was significantly higher in Macapá than in Salvaterra (p = 0.0083). This study adds new data regarding the immunity of horses against SLEV in Brazil, and it confirms the wide distribution of SLEV and the diversity of flaviviruses in the country, as well as the apparent absence of disease in SLEV-infected horses.

A imunidade de equinos (n = 1401) contra o vírus da encefalite Saint Louis (SLEV) foi investigada na Amazônia brasileira (Bragança/PA, Salvaterra/PA, Macapá/AP e Rio Branco/AC) e Maracaju, no Estado do Mato Grosso do Sul, por meio detestes de inibição da hemaglutinação (IH) e neutralização por redução de placas (PRNT). Foram detectados anticorpos IH e neutralizantes específicos (reações monotípicas – RM) para SLEV e outros flavivírus incluídos nos testes, assim como reações cruzadas para flavivírus. Pelo teste de IH, RM foram observadas em 248 (17,7 por cento) amostras de soro, 137 (55,2 por cento) para SLEV, e RC para flavivírus foram detectadas em 380 (27,1 por cento). A frequência de RM para SLEV e de RC foi significativamente maior em Macapá e Salvaterra, respectivamente. Pelo PRNT, foi observada a neutralização do SLEV em 713 (50,9 por cento) amostras, e a prevalência de anticorpos neutralizantes foi significativamente maior em Macapá, em comparação com Salvaterra (p = 0,0083). Este estudo traz novos dados a respeito da imunidade de equinos contra SLEV no Brasil, e confirma a ampla distribuição de SLEV e a diversidade de flavivírus no País, bem como a aparente ausência de doenças em equinos infectados por SLEV.

Estudo experimental sobre a patogenicidade do Vírus Ilhéus em hamsters dourados (Mesocricetus auratus) / Pathogenesis of the Ilheus virus in golden hamsters (Mesocricetus auratus)

Visando investigar a patogenicidade do Flavivirus Ilhéus (VILH) foi inoculada, via intraperitoneal, 9,8 DL de suspensão 50 viral em hamsters dourados jovens (Mesocricetus auratus) e, diariamente, soros e vísceras (cérebro, fígado, coração, baço, rins e pulmões) de animais infectados e de controles não-infectados foram obtidos sob anestesia. Durante o experimento foi determinado o título viral do VILH em soros e vísceras infectados, em camundongos recém-nascidos. Ademais, a detecção de antígeno e os níveis de anticorpos por testes de fixação do complemento e inibição da hemaglutinação foram realizados nos soros. Exame histopatológico por HE e a detecção de antígenos virais por Imunohistoquímica (IHQ) foram realizados nos tecidos dos animais. A dose inoculada ocasionou a morte dos animais por encefalite no sétimo dia pós inoculação. Todos os órgãos estudados apresentaram alterações teciduais detectáveis por histopatologia. Volumosa presença de antígeno viral foi detectada por IHQ no cérebro, e, em menor quantidade, no fígado, baço e rins; porém, nestes órgãos, a presença de antígeno viral foi transitória e de leve intensidade, o que corroborou com os títulos virais obtidos nesses órgãos. Não foram encontrados antígenos virais em coração e pulmões, sugerindo que os títulos (DL ) 50 observados nesses órgãos, durante a titulação em camundongos, decorreram da presença do VILH na corrente sanguínea (viremia). Os achados deste estudo reforçam o importante e conhecido neurotropismo do VILH.

The pathogenesis of the Ilheus flavivirus (Flaviviridae) was investigated in golden hamsters (Mesocricetus auratus) using an inoculum of 9.8 LD50 via intraperitoneal (IP). For ten days, two infected and one control animals were anesthetized, and blood and viscera fragments (brain, liver, heart, lung, spleen and kidneys) were collected on a daily basis for determination of viral titers in newborn mice and antigens/antibody by complement fixation and hemagglutination inhibition tests. Additionally, the pathology of animal tissues was studied by the the hematoxylin and eosin method, viral antigens were detected by immunochemistry, and all collected viscera showed histopathological changes. Large amounts of ILHV antigens were detected by immunohistochemistry in the brain, and in lower quantities in the liver, spleen and kidneys, corroborating with newborn viral titers in them. This inoculum resulted in a fatal outcome of all infected animals seven days after experimentation. Viral antigens were not found in the heart and lungs, suggesting that the viral titers obtained were caused by viremia and not by viral damage. The information in this study confirms the neurotropism and neuropathogenicity of ILHV.