Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part I: pharmacological treatment

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

Tumor Rabdomioblástico Inflamatório Pulmonar: Relato de Caso / Pulmonary Inflammatory Rhabdomyoblastic Tumor: Case Report / Tumor Rabdomioblástico Inflamatorio Pulmonar: Informe de Caso

Introdução: Os sarcomas primários do pulmão são tumores malignos raros com incidência estimada em torno de 0,5% de todas as neoplasias pulmonares. De suas tipificações descritas na literatura, duas especialmente, os leiomiossarcomas e os rabdomiossarcomas, apresentam semelhanças em seu perfil genético, morfológico e imuno-histoquímico, o que os levou a receberem uma mesma classificação: tumor rabdomioblástico inflamatório. Esse tipo de tumor costuma acometer tecidos moles em extremidades e tronco, e predomina em meio a homens jovens e de meia-idade. Em razão do pequeno número de casos de tumores rabdomioblásticos relatados na literatura, tanto seu diagnóstico quanto seu tratamento são pouco descritos. Relato de caso: Paciente, sexo feminino, 19 anos, apresentou três episódios de infecção respiratória no lobo inferior do pulmão direito em um período de 18 meses. A tomografia computadorizada do tórax evidenciou obstrução do brônquio intermediário e áreas de bronquiectasias no lobo inferior direito. Diante disso, realizou-se bilobectomia inferior-média, conduzida por cirurgia robótica. A paciente recebeu alta hospitalar três dias depois do pós-operatório. A imuno-histoquímica revelou tumor rabdomioblástico inflamatório de baixo grau. Conclusão: Este relato apresentou um caso de tumor pulmonar raro, abordado por uma técnica cirúrgica ainda não relatada para esse tipo de patologia.

Introduction: Primary lung sarcomas are rare malignant tumors with an estimated incidence of around 0.5% of all lung neoplasms. Of their typifications described in the literature, two especially, leiomyosarcomas and rhabdomyosarcomas, have similarities in their genetic, morphological and immunohistochemical profile, which led them to be classified with the same name: inflammatory rhabdomyoblastic tumor. This type of tumor usually affects soft tissues in the extremities and trunk, and predominates among young and middle-aged men. Due to the small number of cases of rhabdomyoblastic tumors reported in the literature, both their diagnosis and treatment are poorly described. Case report: Female patient, 19 years old, who had three episodes of respiratory infection in the lower lobe of the right lung in a period of 18 months. Computed tomography of the chest showed obstruction of the intermediate bronchus and areas of bronchiectasis in the right lower lobe. In view of this, a lower middle bilobectomy was performed through robotic surgery. The patient was discharged from hospital three days after the operation. Immunohistochemistry revealed low-grade inflammatory rhabdomyoblastic tumor. Conclusion: This report described a case of a rare lung tumor, submitted to a surgical technique not yet reported for this type of pathology.

Introducción: Los sarcomas pulmonares primarios son tumores malignos raros con una incidencia estimada en torno al 0,5% de todas las neoplasias pulmonares. De sus tipificaciones descritas en la literatura, dos en especial, los leiomiosarcomas y los rabdomiosarcomas presentan similitudes en su perfil genético, morfológico e inmunohistoquímico, lo que los llevó a recibir la misma clasificación: tumor rabdomioblástico inflamatorio. Este tipo de tumor suele afectar a los tejidos blandos de las extremidades y el tronco, y predomina en hombres jóvenes y de mediana edad. Debido al escaso número de casos de tumores rabdomioblásticos reportados en la literatura, tanto su diagnóstico como su tratamiento están pobremente descritos. Informe del caso: Paciente de sexo femenino, 19 años que consultó por tres episodios de infección respiratoria en el lóbulo inferior del pulmón derecho en un período de 18 meses. La tomografía computarizada de tórax mostró obstrucción del bronquio intermedio y áreas de bronquiectasias en el lóbulo inferior derecho. Ante esto, se realizó una bilobectomía media baja mediante cirugía robótica. La paciente recibió el alta hospitalaria tres días después de la operación. Se realizó inmunohistoquímica y se definió el diagnóstico de tumor rabdomioblástico inflamatorio de bajo grado. Conclusión: Este informe presenta un caso de tumor pulmonar raro, tratado mediante una técnica quirúrgica aún no reportada para este tipo de patología.

Interaction of Carthamus oil, chromium picolinate and glyburide in blood glucose and its impact on liver enzymes and lipid profile in diabetes-induced rats

SUMMARY Introduction: Carthamus oil is a compound that has the potential to be used in numerous applications due to its anti-inflammatory, antioxidant, immunomodulatory and neuroprotective effects. Chromium picolinate has been indicated for the control of insulin resistance. Aim: To evaluate the effect of Carthamus oil (30 mg/kg) and chromium picolinate (5 µg/kg) interaction with oral glyburide in chemically diabetes-induced Wistar rats and its influence on drug therapy. Method: Diabetes mellitus was induced with streptozotocin, and the animals were randomized into experimental groups (n= 6/group), who received gastric gavage treatments for ten days, G1: control, G2: diabetic and received glyburide, G3: diabetic and received the interaction of Carthamus oil and chromium picolinate, G4: diabetic and received the interaction ofglyburide, Carthamus oil and chromium picolinate. After the treatment period, fasting blood glucose, post-sucrose blood glucose, total cholesterol and triglyceride levels, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in blood serum were compared, in addition to urine analysis. Results: In this study, the only altered parameters were the post-sucrose blood glucose measurement with the lowest result for G4 (P <0.05) and the ALT measurement, with lower values for G4 (P <0.05) compared to G1. Conclusion: It can be concluded that the unprecedented interaction of Carthamus oil, chromium picolinate and glyburide contributed to the reduction of blood glucose and serum levels of ALT in diabetic rats and is promising for future studies in humans.

Introdução: o óleo de cártamo (Carthamus oil) tem sido utilizado em diversas aplicações devido suas ações antiinflamatória, antioxidante, imunomoduladora e neuro protetora. O picolinato de cromo tem sido indicado para o controle da resistência à insulina. Objetivo: avaliar o efeito da interação de óleo de cártamo (30 mg/kg) e picolinato de cromo (5 µg/kg) com glibenclamida em ratos com diabetes induzida. Metodologia: a indução de diabetes mellitus foi realizada com injeção intra-peritoneal de estreptozotocina e os animais foram aleatoriamente distribuidos em grupos experimentais (n= 6/grupo), que receberam os tratamentos por gavagem gástrica durante dez dias, G1: controle, G2: grupo diabético que recebeu gliben-clamida, G3: grupo diabético que recebeu óleo de cártamo e picolinato de cromo, G4: grupo diabético que recebeu glibenclamida, óleo de cártamo e picolinato de cromo. Após os dias de tratamento via oral, determinou-se o peso corpóreo, glicemia de jejum, colesterol total, triglicerideos, glicemia após uma hora de gavagem gástrica com sacarose, transaminases hepáticas e a avaliação da urina. Resultados: a análise estatistica dos dados indicou que os únicos parâmetros alterados foram a glicemia após a ingestão de sacarose, os menores valores obtidos foram em G4 (P <0.05) e a redução dos niveis séricos de ALT em G4 (P <0.05) quando comparados com G1. Conclusão: a interação inédita do óleo de cártamo, picolinato de cromo e glibencla-mida contribuiu para a redução da glicose sanguinea e dos niveis séricos de ALT em ratos diabéticos, é promissora para estudos futuros em humanos.

Introducción: el aceite de cártamo (Carthamus oil) se ha utilizado en diversas aplicaciones debido a sus propiedades antiinflamatorias, antioxidantes, inmunomodu-ladoras y neuroprotectoras. El picolinato de cromo ha sido indicado para el control de la resistencia a la insulina. Objetivo: evaluar el efecto de la interacción de aceite de cártamo (30 mg/kg) y picolinato de cromo (5 µg/kg) con glibenclamida en ratas con diabetes inducida. Metodología: la inducción de diabetes mellitus se realizó con inyección intraperitoneal de estreptozotocina y los animales se distribuyeron aleatoriamente en grupos experimentales (n= 6/grupo), los cuales recibieron tratamientos por sonda gástrica durante diez dias, G1: control, G2: grupo diabético que recibieron glibenclamida, G3: grupo diabético que recibió aceite de cártamo y picolinato de cromo, G4: grupo diabético que recibió glibenclamida, aceite de cártamo y picolinato de cromo. Después de los dias de tratamiento oral, se determinó peso corporal, glucosa en ayunas, colesterol total, triglicéridos, glucosa después de una hora de sonda gástrica con sacarosa, transaminasas hepáticas y evaluación de orina. Resultados: el análisis estadistico de los datos indicó que los únicos parámetros alterados fueron la glucosa en sangre después de la ingesta de sacarosa, los valores más bajos obtenidos fueron en G4 (P <0,05) y la reducción de los niveles séricos de ALT en G4 (P <0,05) cuando en comparación con G1. Conclusión: la interacción sin precedentes del aceite de cártamo, el picolinato de cromo y la glibenclamida contribuyó a la reducción de los niveles de glucosa en sangre y ALT sérica en ratas diabéticas, es prometedora para futuros estudios en humanos.

PrevTev: construção e validação de aplicativo móvel para orientações sobre tromboembolismo venoso / PrevTev: construction and validation of a mobile application for guidelines on venous thromboembolism

Resumo: Introdução: Como o tromboembolismo venoso (TEV) é uma das principais causas de mortes evitáveis em pacientes hospitalizados, é importante a criação de medidas para sua prevenção e seu tratamento. Porém, para a profilaxia de qualidade, a educação e o envolvimento dos pacientes são necessários, e uma das ferramentas para facilitar as atividades educativas em saúde são as tecnologias educacionais. Objetivo: Este estudo teve como objetivos construir e validar um aplicativo móvel sobre orientações para prevenção de TEV em pacientes hospitalizados durante a internação e após a alta hospitalar. Método: Trata-se de um estudo metodológico composto por duas fases (construção e validação), divididas em nove etapas. A fase de validação foi realizada com 11 juízes especialistas e 30 representantes do público-alvo. Utilizaram-se quatro instrumentos de coletas de dados: Suitability Assessment of Materials (SAM), Instrumento de Validação de Conteúdo Educativo em Saúde (IVCES), Instrumento de Avaliação para o Público-alvo e System Usability Scale (SUS), todos interpretados mediante avaliação específica. Resultado: Entre os juízes especialistas, a média da pontuação do SAM foi 89,4%, e a do IVCES, 93,8%. Em relação à opinião do público-alvo, a média de concordância no primeiro instrumento de coleta de dados foi 95%, e a do SUS, 79,5 pontos. Conclusão: O aplicativo móvel foi considerado válido mediante a metodologia aplicada por juízes especialistas e público-alvo.

Abstract: Introduction: Venous thromboembolism (TEV) is one of the main causes of preventable deaths in hospitalized patients. Therefore, it is important to create methods for its prevention and treatment. However, for quality prophylaxis, it is necessary to educate and involve patients, and one of the tools to facilitate educational activities in health is educational technologies. Objective: To build and validate a mobile application on guidelines for preventing TEV in hospitalized patients during hospitalization and after discharge from hospital. Methods: Methodological study consisting of two phases (construction and validation), divided into nine steps. The validation phase was carried out with 11 expert judges and 30 representatives of the target audience. Four data collection instruments were used: Suitability Assessment of Materials (SAM), Health Educational Content Validation Instrument (IVCES), Target Audience Assessment Instrument and System Usability Scale (SUS), all interpreted by specific evaluation. Results: Among the expert judges, the average score for the SAM was 89.4% and for the IVCES, 93.8%. In relation to the opinion of the target audience, the average agreement score in the first data collection instrument was 95% and for the SUS, 79.5 points. Conclusion: The mobile application was considered valid according to the methodology applied by the expert judges and target audience.

Erratum to: Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil

ABSTRACT OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception ("Very Bad" with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs). DESCRIPTORS: COVID-19 Vaccines. Vaccination Refusal. Socioeconomic Factors. Political Activism. Health Knowledge, Attitudes, Practice.

Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil

ABSTRACT OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception ("Very Bad" with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs).

Suspensão oral de rutina interfere na hiperplasia hepática em ratos / Oral rutin suspension intervene in hepatic hyperplasia in rats

ABSTRACT BACKGROUND: Rutin is a flavonol glycoside that can be found in a wide variety of vegetables and has activity, anti-cancer, anti-inflammatory and anti-diabetic properties. OBJECTIVE: This study investigated the effect of rutin oral administration on Wistar rats submitted to hepatic hyperplasia after partial hepatectomy (PH). METHODS: To achieve this, we considered the analysis of hepatic hyperplastic and plasma biochemical activity of Wistar rats, subjected to treatment with rutin 40 mg/kg/day for 10 days in group 1 (G1) or saline in group 2 (G2), followed by partial hepatectomy. RESULTS: The results indicated an increase in the number of mitoses after 24 hours and 48 hours (P=0.0022 and P=0.0152, respectively) of PH in the group that received rutin, as well as an increase in AST serum levels after 24 hours (P=0.0159) and 48 hours (P=0.0158) and alkaline phosphatase after 24 hours (P=0.015) in the same group, in relation to the respective controls. The group that received rutin showed a more evident variation than the control group when comparing the 24 hour and 48 hour results regarding AST, number of mitoses and number of apoptosis (P<0.005). CONCLUSION: It was concluded that rutin intervened in hepatic hyperplasia after 24 hours and 48 hours of PH, favoring hepatic hyperplasia.

RESUMO CONTEXTO: A rutina é um flavonoide que pode ser encontrado em grande variedade de vegetais e apresenta atividades anticâncer, anti-inflamatória e antidiabética. OBJETIVO: O objetivo deste estudo foi investigar o efeito da administração oral de rutina sobre a hiperplasia hepática em ratos Wistar submetidos à hepatectomia parcial. MÉTODOS: Foi realizada a análise da hiperplasia hepática e da bioquímica plasmática dos ratos Wistar tratados com rutina 40 mg/kg por 10 dias no grupo 1 (G1) ou salina no grupo 2 (G2), seguido da hepatectomia parcial. RESULTADOS: Os resultados indicaram aumento do número de mitoses após 24 e 48 horas (P=0,0022 e P=0,0152, respectivamente) da hepatectomia parcial no grupo que recebeu rutina, além de um aumento nos níveis séricos de AST após 24 horas (P=0,0159) e 48 horas (P=0,0158) e de fosfatase alcalina após 24 horas (P=0,015) no mesmo grupo, em relação aos respectivos controles. O grupo que recebeu rutina mostrou variação mais evidente do que o grupo controle quando se comparou os resultados de 24 horas e 48 horas em relação a AST, número de mitoses e número de apoptoses (P<0,005). CONCLUSÃO: Foi possível concluir que a rutina interferiu na hiperplasia hepática após 24 e 48 horas após a hepatectomia parcial, favorecendo a hiperplasia hepática.

Influence of silymarin and chromium picolinate on the pharmacotherapy of rats with induced diabetes / Influência da silimarina e picolinato de cromo na farmacoterapia de ratos com diabetes induzida

SUMMARY Food supplements are easily acquired and used in various countries. Silymarin has been indicated for diseases of the liver and Chromium picolinate has been indicated for body weight loss and for the improvement of glycemic index. The objective of the present study was to assess the effects of short-term treatment with a combination of silymarin (50 mg/kg) and chromium picolinate (5 µg/kg) on the standard glibenclamide treatment (10 mg/kg) of rats with induced diabetes. DM2 was induced with streptozotocin. Experimental groups of rats: healthy control group, glibenclamide diabetic group, silymarin diabetic group, and silymarin, chromium picolinate and glibenclamide group. After 10 days of oral treatment, we determined body weight, fasting glycemia, glycemia 1 h after gastric gavage with sucrose, and AST and ALT transaminases. Statistical analysis of the data indicated that there was no change in body weight or fasting glycemia, but that glycemia increased after gavage with sucrose in the group submitted to combined therapy. Thus, we concluded that the combination of silymarin and chromium picolinate reduced the efficacy of glibenclamide in the short term, although the two substances had a protective effect on the liver as observed by the reduction of blood transaminase levels.

RESUMO Suplementos alimentares são de fácil aquisição e uso em diversos países. A silimarina tem sido indicada para desordens hepáticas e o picolinato de cromo tem sido utilizado para perda de peso corporal e melhoria do índice glicêmico. O objetivo deste trabalho foi avaliar os efeitos do tratamento utilizando uma combinação de silimarina (50 mg/kg) e picolinato de cromo (5 µg/kg) sobre o tratamento com glibencla-mida (10 mg/kg) em ratos com diabetes induzida com estreptozotocina. Os grupos experimentais foram: grupo controle sadio, grupo diabético glibenclamida, grupo diabético silimarina e grupo diabético silimarina, picolinato de cromo e glibencla-mida. Após 10 dias de tratamento via oral, determinou-se o peso corpóreo, glicemia de jejum, glicemia após uma hora de gavagem gástrica com sacarose e transaminases hepáticas. A análise estatística dos dados indicou que não ocorreu alteração significativa no peso corpóreo e na glicemia de jejum, mas ocorreu aumento significativo dos níveis glicêmicos no grupo diabético silimarina, picolinato de cromo e glibenclamida após a gavagem com sacarose no grupo com a terapia combinada. Portanto, conclui-se que a combinação utilizada reduziu a eicácia da glibenclamida em curto prazo, embora ambas substancias tenham exibido efeito hepatoprotetor, observado pela redução dos níveis plasmáticos de transaminases.

Social inequality and pneumonia hospitalization in children under five years of age in Maranhão, Brazil / Desigualdade social e hospitalizações por pneumonia em crianças menores de cinco anos no Estado do Maranhão, Brasil

Abstract Objectives: to describe the characteristics of pneumonia hospitalizations in children under five years of age across the State of Maranhão, Brazil, and explore patterns of spatial distribution of admissions. Methods: ecological study using data on occurrences (age, gender, skin color/race, month of occurrence, and municipality of residence) between 2012 and 2017 taken from the Unified Health System's Hospital Information System and municipal level socioeconomic indicators for 2010. Each respiratory disease, including pneumonia, was presented as a percentage of overall admissions for respiratory tract diseases, together with the monthly distribution of admissions as a percentage of total annual cases, and annual rate of admissions by gender. The General G* statistic was calculated to identify significant clustering of municipalities with similar proportions of hospital admissions for pneumonia relative to overall hospital admissions. Results: pneumonia was the leading cause of admissions for respiratory disease, accounting for 57% of all cases and occurring with greater frequency in the rainy season (February to June) and in cities with lower socioeconomic indicator values. The rate of admissions decreased over the study period. Significant clusters (p<0.05) of municipalities with high proportions of hospital admissions for pneumonia relative to overall hospital admissions occurred predominantly in the south of the state, while clusters with low propor-tions were located mainly in and around the metropolitan region of the state capital São Luís. Conclusions: pneumonia was shown to be a key cause of hospitalization in children and its distribution was associated with contextual socioeconomic factors, reflecting the quality of life and health status of children in Maranhão.

Resumo Objetivos: descrever as características das hospitalizações por pneumonia entre crianças menores de cinco anos de idade no estado do Maranhão e verificar seu padrão de distribuição geoespacial. Métodos: estudo ecológico, com dados ocorridos entre 2012 e 2017, coletados do Sistema de Informações Hospitalares segundo idade, sexo, cor/raça, mês de ocorrência e município de residência. Utilizaram-se também medidas socioeconômicas contextuais dos municípios em 2010. Apresentaram-se as características percentuais das causas de hospitalização do aparelho respiratório e por pneumonia, sua variação temporal ao longo dos meses e as taxas nos anos de estudo. Aplicou-se a estatística G* para verificar a formação de significativos clusters de municípios com similares níveis de hospitalizações. Resultados: a pneumonia foi a principal causa da hospitalização (57%), ocorrendo, frequentemente, nos meses de intensas chuvas (fevereiro a junho) e em cidades com piores indicadores socioeconômicos. As taxas de internação decresceram no período. Significativos agrupamentos (p<0,05) de municípios com maiores proporções de pneumonia ocorreram no sul do estado e com menores na região metropolitana da capital São Luís. Conclusões: a pneumonia foi importante causa de hospitalização de crianças e sua distribuição está associada a características socioeconômicas contextuais, refletido o nível de qualidade de vida e saúde no Maranhão.

Effects of storage on vis-NIR-SWIR reflectance spectra of Mombasa grass leaf samples / Efeitos do armazenamento no espectro de reflectância vis-NIR-SWIR de amostras foliares de capim Mombaça

ABSTRACT: Vis-NIR-SWIR reflectance spectra of leaf samples, collected in the laboratory, allow the calibration of predictive models to quantify their physicochemical attributes in a practical manner and without producing chemical residues. This technique should enable the development of management strategies for intensification of pasture use. However, spectral analysis performed in the laboratory may be affected by the deterioration of plant material during transport from the field to the lab, so storage methods are necessary. This research aimed to evaluate the effects of different storage methods on the spectral response of Mombasa grass leaves. Three methods were evaluated: (i) artificially refrigerated environment, (ii) humid environment, and (iii) without microenvironment control. These methods were tested in five different storage times: 2 hours, 4 hours, 8 hours, 24 hours and 48 hours. The spectral behavior of the leaves still inserted in the plant was used as a quality reference. Results showed notable changes at the earliest storage time for the treatment without microenvironment control. Both methods with microenvironment control stabilized the occurrence of spectral changes over 48 hours of the samples storage, thus both were suggested for this species.

RESUMO: Espectros de reflectância vis-NIR-SWIR de amostras foliares, coletados em laboratório, permitem a calibração de modelos preditivos para quantificação de seus atributos físico-químicos de maneira prática e sem produção de resíduos químicos. Esta técnica permite o desenvolvimento de estratégias de manejo para a intensificação do uso de pastagens. Contudo, análises espectrais realizadas em laboratório podem ser afetadas pela deterioração do material vegetal durante o transporte do campo ao laboratório, fazendo-se necessário a utilização de métodos de armazenamento. O presente trabalho objetivou avaliar o efeito de diferentes métodos de armazenamento na resposta espectral de folhas de capim Mombaça. Avaliou-se três métodos: (i) ambiente refrigerado artificialmente; (ii) ambiente úmido; e (iii) ao ar livre, sem controle do microambiente; assim como, cinco diferentes tempos de armazenamento: 2 horas, 4 horas, 8 horas, 24 horas e 48 horas. O comportamento espectral das folhas ainda inseridas na planta foi utilizado como referência de qualidade. Os resultados mostraram alterações pronunciadas para o armazenamento ao ar livre já nos primeiros intervalos de tempo. Ambos métodos com controle de microambiente permitiram estabilizar a ocorrência de alterações espectrais ao longo das 48h de armazenamento das amostras, sendo ambos sugeridos para esta espécie.

Cost modifications during the early years of the use of the national cardiovascular data registry for quality improvement

OBJECTIVES: Quality improvement (QI) initiatives based on data from international registries have been reported previously; however, there is a lack of information on the impact on the costs of medical care associated with the use of these tools. METHODS: Patients admitted due to myocardial infarction (MI), included in the ACTION Registry® and CathPCI Registry®, in a private Brazilian hospital (i.e., the reference hospital) were analyzed. The costs of care of these patients were compared to the costs of MI admissions in nine similar hospitals not included in the same QI program. Regression models were used to analyze the cost change over time between the two groups of hospitals. Readmission rates were compared using logistic regression, adjusting for the same variables as in the cost model. RESULTS: Overall, the annual medical cost inflation in Brazil was higher than the annual cost trend in the reference hospital during the period of analysis. Moreover, the annual in-hospital costs indicate that the reference hospital has a statistically significant 6% lower cost trend for patients with acute MI, compared to patients with the same diagnostic code in the comparison hospitals group, in an adjusted analysis (p-value=0.041). Using multivariable analysis, the readmission rates were also found to be significantly lower in the reference hospital than in the comparison hospitals, with an odds ratio of 0.68 (p-value=0.042). CONCLUSION: The use of the NCDR® as a benchmark to guide QI programs outside the United States was associated with the positive impact of bending the cost curve to below that of national medical inflation and the comparison hospitals' costs, with a lower incidence of hospital readmission.

Soil biomass and microbial activity in soybean crop area under different cover crops and different soil correction systems / Biomassa e atividade microbiana do solo em área de cultivo de soja sob diferentes plantas de cobertura e diferentes sistemas de correção de solo

This study aimed to evaluate soil biomass and microbial activity and soybean yield under different limestone and gypsum doses and different cover crops. The experiment was carried out in the experimental area of the Fundação de Apoio a Pesquisa Agropecuária de Chapadão, on a Dystrophic Red Latosol, using cultivar Desafio. The experiment consisted of a randomized blocks design, in a split-plot factorial scheme (3x4x3), with three replications. Plots consisted of three gypsum doses: control (without gypsum), recommended dose (2.3 Mg ha-1), and double dose (4.6 Mg ha-1). Subplots consisted of four limestone doses (2, 4, and 6 Mg ha-1) and the control (without limestone). Each block had three different cover crops: Brachiaria, Millet, and allow. The values obtained with the test revealed that brachiaria had better basal respiration in the absence of gypsum. Conversely, millet had better basal respiration in with the gypsum dose. Basal respiration, using brachiaria as cover crop, was higher at the dose of 2700 kg ha-1 of limestone. However, for the fallow and the millet, basal respiration was higher when using the highest limestone dose of 6000 kg ha-1. The variable microbial biomass showed differences between cover crops only in the absence of gypsum. Brachiaria and fallow presented the highest mean for microbial biomass. The use of millet as a cover crop together with gypsum doses increased the microbial biomass. The variables mass of 100 grains and grain yield had higher mean at the limestone dose of 6000 kg ha-1 .

O objetivo do trabalho foi avaliar a biomassa e atividade microbiana do solo, e produtividade da soja sob efeito das diferentes doses de calcário e gesso e diferentes coberturas de solo. O experimento foi conduzido na área experimental da Fundação de Apoio a Pesquisa Agropecuária de Chapadão, sob Latossolo Vermelho Distrófico, com a cultivar Desafio. O delineamento experimental utilizado foi em blocos casualizados, em esquema fatorial (3x4x3) de parcelas subdividas, com 3 repetições. As parcelas foram constituídas por 3 quantidades de gesso agrícola, sendo: controle (sem gesso), recomendado (2,3 Mg ha-1) e o dobro (4,6 Mg ha-1), as subparcelas por 4 doses de calcário (2, 4 e 6 Mg ha-1), além do controle (sem calcário), onde cada bloco apresentou 3 coberturas diferentes: Braquiaria, Milheto e Pousio. Os resultados foram submetidos ao teste de Tukey 5%. Com os valores obtidos pudemos observar que a respiração basal foi melhor para braquiária na ausência de gesso, e na presença o milheto se saiu melhor. A respiração basal, utilizando a braquiária como cobertura, foi maior na dose de 2700 kg ha-1 de calcário. Já utilizando o pousio e o milheto foi na maior dose 6000 kg ha-1. A variável biomassa microbiana apresentou diferença entre as coberturas apenas na ausência de gesso, onde a braquiária e o pousio apresentaram as maiores médias para esta variável. A utilização do milheto como cobertura em conjunto com as doses de gesso acarretou aumento da biomassa microbiana. A massa de 100 grãos e a produtividade de grãos apresentaram maior média na dose de 6000 kg ha-1 de calcário.

Reforma curricular e intenção profissional de especialização médica / Curricular reform and the professional intention of medical specialization / Reforma curricular e intención de especialización médica

Resumo A reforma determinada pelas Diretrizes Curriculares Nacionais do curso de graduação em medicina estabeleceu como eixo do modelo didático-assistencial a atenção primária à saúde. Contudo, a escolha pela especialização pode ser influenciada por fatores individuais, culturais e socioeconômicos. O objetivo deste estudo foi avaliar os aspectos que motivam estudantes na escolha da carreira e o impacto da reforma curricular nesta decisão. Trata-se de pesquisa transversal, descritiva e quantitativa, com aplicação de questionários pela internet a 1.006 alunos de medicina das cinco regiões do Brasil. Concluiu-se que houve pouco interesse por medicina de família e comunidade (1,5%; n=15), ginecologia e obstetrícia (3,1%; n=31) e pediatria (4,7%; n=47). A afinidade pela área foi o principal fator nessa escolha, sendo considerada "muito importante" por 91,1% (n=916) dos discentes, seguida pelo estilo de vida pretendido (56,8% n=571).

Abstract The reform determined by the National Curricular Guidelines of the Medical Graduation Course established primary health care as the axis of the teaching-care model. However, the option of specialization may be influenced by individual, cultural and socioeconomic factors. The objective of this study was to evaluate the factors that motivate students in their career choice, and the impact of the curricular reform on this decision. This was a cross-sectional, descriptive and quantitative research. It consisted of questionnaires applied through the internet to 1,006 medical students from the five regions of Brazil. It was concluded that there was little interest in family and community medicine (1.5%; n=15), gynecology and obstetrics (3.1%; n=31) and pediatrics (4.7%; n=47). Affinity for the field was the main factor in this choice, being considered "very important" by 91.1% (n=916) of the students, followed by the intended lifestyle (56.8% n=571).

Resumen La reforma determinada por las Directrices Curriculares Nacionales de la carrera de grado en Medicina, estableció como eje del modelo didáctico-asistencial la Atención Primaria de la Salud. No obstante, la elección de la especialización puede verse influenciada por factores individuales, culturales y socioeconómicos. El objetivo de este estudio fue evaluar los aspectos que motivan a los estudiantes en la elección de la carrera y el impacto de la reforma curricular en esta decisión. Se trata de una investigación transversal, descriptiva y cuantitativa, con la aplicación de cuestionarios, a través de internet, a 1.006 estudiantes de medicina de todas las regiones de Brasil. Se concluyó que hubo poco interés por la medicina de la familia y la comunidad (1,5%; n=15), ginecología y obstetricia (3,1%; n=31) y pediatría (4,7%; n=47). La afinidad por el área fue el principal factor en esa elección, siendo considerada "muy importante" por el 91,1% (n=916) de los estudiantes, seguida por el estilo de vida deseado (56,8% n=571).

The essential oil of Curcuma longa rhizomes as an antimicrobial and its composition by Gas Chromatography/Mass Spectrometry / Óleo essencial de Curcuma longa L. como um antimicrobiano e composição por Cromatografi a Gasosa/Espectrometria de massas

Objective This study aimed to extract the essential oil of Curcuma longa rhizomes collected in Brazil, determine its composition by gas chromatography and mass spectrometry, and evaluate its hemolytic action and antimicrobial activity. Methods The oil extraction was performed by hydrodistillation; its composition was determined by GC-MS; the Minimum Inhibitory Concentration was evaluated through microdilution, and the hemolytic activity was analyzed in sheep red blood cells. Results The essential oil's major components are zingiberene (11%), sesquiphellandrene (10%), ß-turmerone (10%), and α-curcumene (5%). It proved efficient at inhibiting Staphylococcus aureus with Minimum Inhibitory Concentrations of 38.8µl/mL, Staphylococcus epidermidis (Minimum Inhibitory Concentrations of 50.0µl/mL), Escherichia coli (Minimum Inhibitory Concentrations of 44.4µl/mL), and Pseudomonas aeruginosa (Minimum Inhibitory Concentrations of 27.7µl/mL). Conclusion Despite provoking hemolysis in sheep red blood cells, the essential oil suggests promising results for a variety of purposes due to its antibacterial properties. Supplementary research is necessary to determine in vivo activity and the potential use of the C. longa essential oil as an antimicrobial agent in diverse situations.

Objetivo Este trabalho teve como objetivo determinar a composição e avaliar as atividades antimicrobiana e hemolítica do óleo essencial de rizomas da Curcuma longa L. Métodos A extração do óleo essencial foi realizada por hidrodestilação e sua composição determinada por cromatografia gasosa com espectrometria de massas. A Concentração Mínima Inibitória foi avaliada por microdiluição e a atividade hemolítica foi analisada em hemácias de carneiro. Resultados Os componentes majoritários encontrados foram zingibereno (11%), sesquipelenadieno (10%), ß-turmerona (10%) e α-curcumeno (5%). O óleo essencial provocou hemólise e inibiu Staphylococcus aureus (Concentração Mínima Inibitória=38,8µl/mL), Staphylococcus epidermidis (Concentração Mínima Inibitória=50,0µl/mL), Escherichia coli (Concentração Mínima Inibitória=44,4µl µl/mL) e Pseudomonas aeruginosa (Concentração Mínima Inibitória=27,7µl/mL). Conclusão Apesar de provocar hemólise, o óleo essencial analisado tem potencial para diversas finalidades, devido às suas propriedades antibacterianas. Estudos complementares são necessários para determinar a atividade in vivo e o potencial uso de óleo essencial de C. longa como agente antimicrobiano em diversas situações.

Produção e qualidade físico-química do mel produzido em Salinas-MG / Honey production in Salinas-MG and its physical and chemical quality

A apicultura tem se mostrado uma alternativa de renda para os produtores, o mel obtido pode sofrer modificações, gerando a necessidade de produzi-lo dentro de níveis elevados de qualidade. O objetivo deste trabalho foi diagnosticar e caracterizar as condições de produção e a qualidade físico-química do mel em Salinas-MG. Identificou-se o perfil socioeconômico dos apicultores e os processos utilizados para obtenção e comercialização do produto através de questionário qualitativo e visitas in loco. Foram coletadas amostras do mel produzido e realizadas análises físico-químicas no Laboratório de Análise de Alimentos do IFNMG – Campus Salinas. Os resultados demonstraram somente duas amostras com valores acima do permitido para acidez e hidroximetilfurfural (HMF), indicando possíveis falhas na produção ou estocagem. Ações de educação continuada e capacitação aos apicultores podem ser benéficas para a melhoria das condições de produção e comercialização do produto final.

Pretreatment of hepatetctomized rats with Coleus forskohlii did not interfere with the course of hepatic hyperplasia

Abstract Purpose Coleus forskohlii Briq., a medicinal plant originally from India, has been indicated against heart disease, expiratory disorders, convulsions, and hepatic changes, among others. In view of the broad pharmacological potential of the plant and the scarce information about its effects, the objective of the present study was to investigate the effect of its use for pretreatment of partially hepatectomized rats. Methods The animals were divided into two experimental groups: Control (CG) receiving physiological saline for 10 days before partial hepatetctomy, and Treated (TG) receiving 40 mg Coleus forskohlii/kg/day for 10 days before partial hepatectomy. The treatments were performed by gastric gavage. After the surgical procedure, treatment was continued according to the following groups: CG 24 h, CG 48 h, TG 24 h, and TG 48 hs, and liver tissue and intracardiac blood samples were obtained for histological and biochemical analysis, respectively. Results No significant differences were observed in mitotic or apoptotic index or in the concentrations of the enzymes AST, ALT and alkaline phosphatase, and no areas of fibrosis were detected. Conclusion Treatment with Coleus forskohlii did not interfere with the course of hepatic hyperplasia.

Clinical and laboratorial features of oral candidiasis in HIV-positive patients

Abstract INTRODUCTION We describe the clinical and laboratorial features of oral candidiasis in 66 HIV-positive patients. METHODS: Polymerase chain reaction-based techniques were performed for differentiation of Candida spp. isolated from patients at a public teaching hospital in Midwest Brazil. RESULTS: Oral lesions, mainly pseudomembranous, were significantly related to higher levels of immunosuppression. Of 45 Candida isolates, 66.7% were C. albicans. Most of the isolates were susceptible to the antifungal drugs tested. CONCLUSIONS: Oral lesions were associated with higher immunosuppression levels. Lower susceptibility to antifungals by non-albicans isolates supports the importance of surveillance studies using susceptibility tests to aid in the treatment.

Capsiate treatment in liver surgeries may compromise its recovery

Abstract Purpose: To investigate the effects of capsiate treatment on hepatic hyperplasia in partially hepatectomized rats. Methods: The animals were divided into a Capsiate group (CPH), a Capsiate Post-Partial Hepatectomy group (CPPH) and a Partial Hepatectomy Control group (PH). CPH and CPPH animals received 60 mg/kg/day Capsiate for 30 days. Next, the rats underwent partial hepatectomy. CPPH animals continued to receive treatment for 48 h after partial hepatectomy. Liver tissue and intracardiac blood samples were obtained 24 or 48 h after PH. Results: Capsiate treatment interfered with hepatic parameters, reducing the number of mitoses and apoptosis and increasing blood ALT and alkaline phosphatase concentrations. Conclusion: Capsiate treatment preceding hepatic surgery may compromise the initial period of postoperative recovery.