Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system.

Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics

ABSTRACT Background: Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. Methods: We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. Results: A total of 202 PLWH with CD4 > 200 cells/μL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. Conclusions: 17DD was safe and well-tolerated in PLWH with CD4 > 200 cells/μL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.

O Uso da Escala de Borg na Percepção do Esforço em Manobras de Reanimação Cardiopulmonar / The Use of the Borg Rating of Perceived Exertion Scale in Cardiopulmonary Resuscitation

Resumo Fundamento A parada cardiorrespiratória é um evento crítico cuja taxa de sobrevivência é relacionada à qualidade das manobras de reanimação, aliada à tecnologia. É importante compreender a percepção do cansaço durante esse procedimento visando a efetividade das compressões e o aumento das chances na sobrevida. Objetivo Aplicar a Escala de Borg para analisar o esforço percebido por enfermeiros durante as manobras de reanimação cardiopulmonar com dispositivo de feedback. Método Estudo experimental com distribuição randomizada de enfermeiros em hospital de ensino, simulando parada cardiorrespiratória, para avaliação da percepção do esforço utilizando a escala de Borg durante a reanimação cardiopulmonar com/sem dispositivo de feedback. Foi adotado nível de significância estatística 5%. Resultados Foram incluídos 69 enfermeiros atuantes em unidades críticas e não críticas de atendimento ao adulto. A percepção de esforço e a frequência cardíaca foi menor no grupo intervenção (p<0,001), influenciadas pelo dispositivo de feedback, sem diferença significativa quanto às unidades de atuação. Conclusão A escala de Borg mostrou-se adequada para os objetivos propostos. O dispositivo de feedback contribuiu no menor esforço e redução da frequência cardíaca durante as manobras de reanimação. O baixo custo e a facilidade de aplicação favorecem o uso em treinamentos e atendimentos em tempo real para avaliar o desempenho durante a reanimação, utilizando dispositivo de feedback por reduzir os esforços e a percepção do cansaço. Também permite a reflexão sobre os fatores intervenientes e recursos que podem influenciar na qualidade da assistência e nas chances de sobrevivência.

Abstract Background A cardiopulmonary arrest is a critical event whose survival rate is related to the quality of resuscitation maneuvers combined with the use of technology. It is important to understand the perception of fatigue during this procedure, aiming to improve the effectiveness of compressions to increase the chances of survival. Objectives To apply the Borg rating of perceived exertion scale (Borg scale) to analyze the exertion perceived by nurses during cardiopulmonary resuscitation maneuvers using a feedback device. Methods Experimental study with a randomized distribution of nurses in a teaching hospital. Perceived exertion during simulated cardiopulmonary resuscitation with/without a feedback device was assessed using the Borg scale. The statistical significance level of 5% was adopted. Results 69 nurses working in critical and non-critical adult care units were included. Perceived exertion and heart rate were lower in the intervention group (p<0.001), influenced by the feedback device, with no significant difference between critical and non-critical units. Conclusions The Borg scale proved to be adequate for the proposed objectives. The feedback device contributed to lower exertion and heart rate reduction during resuscitation maneuvers. The low cost and ease of application favor its use during training and real-time resuscitation attempts to assess performance using a feedback device to reduce exertion and perception of fatigue. It allows reflection on the intervening factors and resources that can influence the quality of resuscitation attempts and the chances of survival.

Travestis, transgender women and young MSM are at high risk for PrEP early loss to follow-up in Rio de Janeiro, Brazil

Abstract Introduction Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir (FTC/TDF) is highly effective in preventing HIV infection. This study aimed to identify factors associated with PrEP early loss to follow-up (ELFU) among gay, bisexual and other men who have sex with men (MSM), travestis and transgender women (TGW). Methodology This was a prospective cohort study evaluating TGW and MSM who initiated PrEP at the Evandro Chagas National Institute of Infectious Diseases (INI-Fiocruz) from 2014 to 2020. ELFU was defined as not returning for a PrEP visit within 180 days after first dispensation. Exposure variables included age, gender, race, education, transactional sex, condomless anal intercourse [CAI] (both in the past six months), binge drinking and substance use (both in past three months) and syphilis diagnosis at baseline. Multilevel logistic regression models with random intercepts and fixed slopes were used to identify factors associated with ELFU accounting for clustering of participants according to their PrEP initiation study/context (PrEP Brasil, PrEParadas, ImPrEP and PrEP SUS). Results Among 1,463 participants, the median age was 29 years (interquartile range 24-36), 83% self-identified as MSM, 17% as TGW, 24% were black, 37% mixed-black/pardo and 30% had < 12 years of education. Fifteen percent reported transactional sex, 59% reported CAI, 67% binge drinking, 33% substance use, and 15% had a syphilis diagnosis. Overall, 137 participants (9.7%) had ELFU. Younger age (18-24 years) (adjusted odds ratio [aOR] 1.9, 95%CI:1.2-3.2), TGW (aOR 2.8, 95%CI:1.6-4.8) and education < 12 years (aOR 1.9, 95%CI:1.2-2.9) were associated with greater odds of ELFU. Conclusion TGW, young individuals and those with lower education were at higher risk of PrEP ELFU. Our results suggest that the development of specific strategies targeting these populations should be a priority, through policies that aim to reduce the incidence of HIV infection.

Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil

ABSTRACT Background: Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. Methods: We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. Results: Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. Conclusion: We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.

The first case of acute HIV and monkeypox coinfection in Latin America

ABSTRACT Monkeypox (MPX) transmission outside non-endemic countries has been reported since May 2022, rapidly evolving into a multi-country outbreak. A potential role of sexual contact in transmission dynamics, as well as a predominance of anogenitallesions, are remarkable features of current cases. Screening for sexually transmitted infections (STIs) plays an important role in the evaluation of patients with suspected MPX infection. Herein we report the first case of a patient diagnosed with both MPX and acute HIV infection in Latin America. He had no major complications during his clinical course, and antiretroviral therapy was promptly initiated. Diagnosis of acute HIV requires a high level of suspicion and appropriate laboratory investigation. Health practitioners need to consider this diagnosis while evaluating patients with suspected MPX with a recent unprotected sexual contact.

Avaliação da tendência temporal e da prevalência de leishmaniose visceral canina e humana dentre os anos de 2010 a 2019 em municípios de Minas Gerais ­ Brasil / Evaluation of the temporal trend and prevalence of canine and human visceral leishmaniosis between 2010 and 2019 in municipalities of Minas Gerais - Brazil / Evaluación de la tendencia temporal y de la prevalencia de leishmaniosis visceral canina y humana entre los años 2010 a 2019 en los municipios de Minas Gerais ­ Brasil

Leishmanioses são causadas por protozoários do gênero Leishmania, parasitos que infectam grande número de mamíferos, incluindo o homem. A Leishmaniose Visceral (LV) é a forma mais severa da doença e invariavelmente leva ao óbito, se não diagnosticada e tratada precocemente. O objetivo deste estudo foi realizar uma análise de natureza documental, descritiva e analítica, de abordagem quantitativa das informações contidas no banco de dados Fundação Ezequiel Dias/Gerenciador de Ambientes Laboratoriais (FUNED/GAL), da Secretaria Estadual de Saúde de Minas Gerais. Os dados epidemiológicos que compõe este estudo são registros de casos positivos e negativos da cidade de Patos de Minas-MG e 18 municípios das mesorregiões do Triângulo Mineiro e Alto Paranaíba, Noroeste de Minas e Norte de Minas. No período compreendido entre janeiro de 2010 e junho de 2019 foram notificados um total de 1170 indivíduos suspeitos de Leishmaniose Visceral Canina e/ou Humana. 304 (25,98%) indivíduos receberam o resultado positivo, enquanto 866 foram negativos, e em alguns casos, inconclusivos. Os dados obtidos no estudo revelaram a tendência temporal crescente e alta prevalência da doença, mostrando que a doença está em expansão na região estudada onde o cão é o principal reservatório doméstico da doença, permanecendo como principal elo de ligação entre o protozoário e o hospedeiro humano.(AU)

Leishmaniasis are caused by protozoa of the genus Leishmania, parasites that infect a large number of mammals, including humans. Visceral Leishmaniasis (VL) is the most severe form of the disease and invariably leads to death if not diagnosed and treated early. The objective of this study was to carry out a documentary, descriptive and analytical analysis, with a quantitative approach to the information contained in the Fundação Ezequiel Dias/Manager of Laboratory Environments (FUNED/GAL) database from the Minas Gerais State Health Secretariat. The epidemiological data that make up this study are records of positive and negative cases in the city of Patos de Minas - MG and of 18 municipalities in the mesoregions of the Triângulo Mineiro and Alto Paranaíba, Northwest of Minas and North of Minas. In the period between January 2010 and June 2019, a total of 1170 individuals suspected of Canine and/or Human Visceral Leishmaniasis were notified. A total of 304 (25.98%) individuals received a positive result, while 866 were considered negative, and in some cases, inconclusive. The data obtained in the study revealed the growing temporal trend and high prevalence of the disease, showing that the disease is expanding in the studied region where the dog is presented as the main domestic reservoir of the disease, remaining as the main link between the protozoan and the human host.(AU)

Leishmaniosis son causadas por protozoos del género Leishmania, parásitos que infectan a un gran número de mamíferos, incluyendo el hombre. La Leishmaniosis Visceral (LV) es la forma más grave de la enfermedad e invariablemente conduce a la muerte, si no se la diagnostica y la trata a tiempo. El objetivo de ese estudio fue realizar un análisis de naturaleza documental, descriptivo y analítico, de enfoque cuantitativo de las informaciones contenidas en la base de datos Fundação Ezequiel Dias/Gerente de Ambientes de Laboratorio (FUNED /GAL), de la Secretaría de Salud del Estado de Minas Gerais. Los datos epidemiológicos que conforman este estudio son registros de casos positivos y negativos en la ciudad de Patos de Minas-MG y 18 municipios de las mesorregiones del Triângulo Mineiro y Alto Paranaíba, Noroeste de Minas y Norte de Minas. En el período comprendido entre enero de 2010 y junio de 2019, se notificó a un total de 1170 personas sospechosas de Leishmaniosis Visceral Canina y/o Humana. 304 (25,98%) individuos recibieron un resultado positivo, mientras que 866 fueron negativos y, en algunos casos, no concluyentes. Los datos obtenidos en el estudio revelaron la tendencia creciente temporal y la alta prevalencia de la enfermedad, mostrando que la enfermedad se está expandiendo en la región estudiada donde el perro es el principal reservorio doméstico de la enfermedad, permaneciendo como principal conexión entre el protozoo y el hospedero humano.(AU)

Empathic listening: welcoming strategy for nursing Professional in coping with with the coronavirus pandemic / Escucha empática: estrategia de bienvenida para los profesionales de enfermería para hacer frente a la pandemia de coronavirus / Escuta empática: estratégia de acolhimento aos profissionais de enfermagem no enfrentamento da pandemia por coronavírus

ABSTRACT Objective: to reflect on empathic listening use as a welcoming strategy for nursing professionals to cope with the challenges during the pandemic caused by the new coronavirus. Methods: this is a reflection study based on updated data surveys and theoretical-conceptual aspects of Non-Violent Communication and empathic listening. Results: in the performance during the COVID-19 pandemic, nursing professionals are exposed to violence of different natures related to occupational stress, work overload, anguishes and silenced suffering, with implications for the workers' health, who can be benefited and strengthened with empathetic listening. Final considerations: the health crisis has highlighted the weaknesses of the health system. Nursing acts as the largest contingent of the health workforce in coping with the pandemic. Empathetic listening is a powerful strategy in caring for and strengthening nursing professionals.

RESUMEN Objetivo: reflexionar sobre el uso de la escucha empática como estrategia de acogida de los profesionales de enfermería para afrontar los retos durante la pandemia provocada por el nuevo coronavirus. Métodos: estudio de reflexión, basado en datos actualizados y aspectos teóricos y conceptuales de la Comunicación No Violenta y la escucha empática. Resultados: en el desempeño durante la pandemia COVID-19, el profesional de enfermería se encuentra expuesto a violencias de diversa índole relacionadas con el estrés ocupacional, sobrecarga laboral, angustias y sufrimientos silenciados, con implicaciones para la salud del trabajador, que pueden ser beneficiadas y fortalecidas. con escucha empática. Consideraciones finales: la crisis sanitaria ha puesto de manifiesto las debilidades del sistema sanitario. La enfermería actúa como el mayor contingente del personal sanitario para hacer frente a la pandemia. La escucha empática es una poderosa estrategia en el cuidado y fortalecimiento de los profesionales de enfermería.

RESUMO Objetivo: refletir sobre a utilização da escuta empática como estratégia de acolhimento aos profissionais de enfermagem no enfrentamento dos desafios durante a pandemia pelo novo coronavírus. Métodos: estudo do tipo reflexão, realizado com base em levantamentos de dados atualizados e aspectos teórico-conceituais da Comunicação Não Violenta e escuta empática. Resultados: na atuação durante a pandemia de COVID-19, o profissional de enfermagem está exposto a violências de diferentes naturezas relacionadas ao estresse ocupacional, sobrecarga de trabalho, angústias e sofrimentos silenciados, com implicações na saúde do trabalhador, que pode ser beneficiado e fortalecido com a escuta empática. Considerações finais: a crise sanitária tem evidenciado as fragilidades do sistema de saúde. A enfermagem atua como o maior contingente da força de trabalho em saúde no enfrentamento da pandemia. A escuta empática é uma estratégia potente na atenção e fortalecimento dos profissionais de enfermagem.

SARS-CoV-2 testing disparities across geographical regions from a large metropolitan area in Brazil: Results from a web-based survey among individuals interested in clinical trials for COVID-19 vaccines

ABSTRACT After more than a year since the novel coronavirus (SARS-CoV-2) disease 2019 or COVID-19 has reached the status of a global pandemic, the number of COVID-19 cases continues to rise in Brazil. As no effective treatment been approved yet, only mass vaccination can stop the spread of SARS-CoV-2 and end the COVID-19 pandemic. Multiple COVID-19 vaccine candidates are under development and some are currently in use. This study aims to describe the characteristics of individuals who have registered in an online platform to participate in clinical trials for COVID-19 vaccines. Additionally, participants' characteristics according to age and presence of comorbidities associated with severe COVID-19 and differences of SARS-CoV-2 testing across different geographical areas/neighborhoods are provided. This was a cross-sectional web-based study conducted between September and December/2020, aiming to reach individuals aged ≥18 years who live in Rio de Janeiro metropolitan area, Brazil. Among 21,210 individuals who completed the survey, 20,587 (97.1%) were willing to participate in clinical trials for COVID-19 vaccines. Among those willing to participate, 57.8% individuals were aged 18-59 years and had no comorbidity, 33.7% were aged 18-59 years and had at least one comorbidity, and 8.6% were aged ≥ 60 years regardless the presence of any comorbidity. Almost half (42.6%) reported ever testing for COVID-19, and this proportion was lower among those aged ≥ 60 years (p < 0.001). Prevalence of positive PCR results was 16.0%, higher among those aged 18-59 years (p < 0.009). Prevalence of positive antibody result was 10.0%, with no difference across age and comorbidity groups. Participants from areas/neighborhoods with higher Human Development Index (HDI) reported ever testing for SARS-CoV-2 more frequently than those from lower HDI areas. Interest to participate in clinical trials for COVID-19 vaccines candidates in Rio de Janeiro was significantly high. The online registry successfully reached out a large number of individuals with diverse sociodemographic, economic and clinical backgrounds.

Anatomia óssea e muscular do antebraço e mão de Chrysocyon brachyurus (Carnivora, Canidae) / Bone and muscular anatomy of the antibone and handof Chrysocyon brachyurus (Carnivora, Canidae)

O lobo-guará Chrysocyon brachyurus Illiger, 1815, é o maior canídeo da América do Sul, pesa cerca de 25 kg quando adulto e está ameaçado de extinção. Descrições anatômicas contribuem para a complementação das informações sobre espécies silvestres e para implicações conservacionistas, clínicas e cirúrgicas. Objetivou-se descrever os ossos e os músculos do antebraço e mão do lobo-guará. A preparação das peças foi feita a partir dos métodos usuais de dissecação, em animais preservados em solução de formol a 10%. Os espécimes pertencem ao acervo didático do Laboratório de Ensino e Pesquisa em Animais Silvestres da UFU e são provenientes de indivíduos atropelados. Os ossos descritos foram: rádio, ulna, ossos cárpico acessório, cárpico ulnar e cárpico intermédio; ossos cárpicos I, II, III e IV; ossos metacárpicos I, II, III, IV, V; falanges proximais, falanges médias e falanges distais do primeiro ao quinto dedo. Os músculos observados foram: extensor radial do carpo; pronador redondo; braquiorradial; extensor comum dos dedos; extensor ulnar do carpo; extensor lateral dos dedos; supinador; abdutor longo do dedo I; flexor radial do carpo; flexor profundo dos dedos; flexor superficial dos dedos; flexor ulnar do carpo; pronador quadrado; interflexor; lumbricais; abdutor curto dos dedos I e II e flexor curto do dedo I.

The maned wolf Chrysocyon brachyurus (Illiger, 1815) is the largest canid in South America, weighs about 25 kg as an adult and is threatened of extinction. Anatomical descriptions contribute to the complementation of information on wild species and for conservation, clinical and surgical implications. The purpose of this study was to describe the bones and muscles of the forearm and hand of the maned wolf. The methodology was through the usual dissecting methods in animals preserved in 10% formalin solution. The animals belong to the didactic collection of the Laboratory of Teaching and Research in Wild Animals of the UFU and come from run over. The bones evaluated were: radius, ulna, carpal accessory, carpi ulnar and carpi intermedium; carpal bones I, II, III and IV; metacarpal bones I, II, III, IV, V; proximal phalanges, middle phalanges and distal phalanges from first to fifth finger. The muscles observed were: radial extensor carpal; pronator round; brachioradial; common extensor of fingers; ulnar carpal extensor; lateral extensor of the fingers; supinator; abductor long finger I; flexor carpi radialis; flexor deep fingers; superficial flexor of the fingers; ulnar flexor of the carpus; square pronator; interflexor; lumbrils; short abductor of fingers I and II and short flexor of finger I.

Anatomia óssea e muscular do antebraço e mão de Chrysocyon brachyurus (carnivora, canidae) / Bone and muscular anatomy of the antibone and hand of Chrysocyon brachyurus (carnivora, canidae)

O lobo-guará Chrysocyon brachyurus Illiger, 1815, é o maior canídeo da América do Sul, pesa cerca de 25 kg quando adulto e está ameaçado de extinção. Descrições anatômicas contribuem para a complementação das informações sobre espécies silvestres e para implicações conservacionistas, clínicas e cirúrgicas. Objetivou-se descrever os ossos e os músculos do antebraço e mão do lobo-guará. A preparação das peças foi feita a partir dos métodos usuais de dissecação, em animais preservados em solução de formol a 10%. Os espécimes pertencem ao acervo didático do Laboratório de Ensino e Pesquisa em Animais Silvestres da UFU e são provenientes de indivíduos atropelados. Os ossos descritos foram: rádio, ulna, ossos cárpico acessório, cárpico ulnar e cárpico intermédio; ossos cárpicos I, II, III e IV; ossos metacárpicos I, II, III, IV, V; falanges proximais, falanges médias e falanges distais do primeiro ao quinto dedo. Os músculos observados foram: extensor radial do carpo; pronador redondo; braquiorradial; extensor comum dos dedos; extensor ulnar do carpo; extensor lateral dos dedos;supinador; abdutor longo do dedo I; flexor radial do carpo; flexor profundo dos dedos; flexor superficial dos dedos; flexor ulnar do carpo; pronador quadrado; interflexor; lumbricais; abdutor curto dos dedos I e II e flexor curto do dedo I.

The maned wolf Chrysocyon brachyurus (Illiger, 1815) is the largest canid in South America, weighs about 25 kg as an adult and is threatened of extinction. Anatomical descriptions contribute to the complementation of information on wild species and for conservation, clinical and surgical implications. The purpose of this study was to describe the bones and muscles of the forearm and hand of the maned wolf. The methodology was through the usual dissecting methods in animals preserved in 10% formalin solution. The animals belong to the didactic collection of the Laboratory of Teaching and Research in Wild Animals of the UFU and come from run over. The bones evaluated were: radius, ulna, carpal accessory, carpi ulnar and carpi intermedium; carpal bones I, II, III and IV; metacarpal bones I, II, III, IV, V; proximal phalanges, middle phalanges and distal phalanges from first to fifth finger. The muscles observed were: radial extensor carpal; pronator round; brachioradial; common extensor of fingers; ulnar carpal extensor; lateral extensor of the fingers; supinator; abductor long finger I; flexor carpi radialis; flexor deep fingers; superficial flexor of the fingers; ulnar flexor of the carpus; square pronator; interflexor; lumbrils; short abductor of fingers I and II and short flexor of finger I.

Implante coclear e qualidade de vida: estudo com pais e familiares de crianças surdas / Cochlear implant and quality of life: a study with parents and families of deaf children / Implante coclear y calidad de vida: un estudio con padres y familias de niños sordos

Introdução: O implante coclear é uma solução auditiva concretizada no cenário brasileiro, constituindo-se uma estratégia viável de reabilitação auditiva para perdas auditivas severas e profundas. Porém, apesar dos grandes avanços tecnológicos e dos excelentes resultados obtidos e descritos na literatura, ter um filho implantado pode comprometer a qualidade de vida dos familiares envolvidos no processo. Objetivo: Comparar a qualidade de vida de um grupo de pais e familiares que possuem filhos usuários de implante coclear, antes e depois da implantação. Método: Trata-se de um estudo clínico descritivo transversal. Participaram 30 indivíduos que foram submetidos ao questionário WHOQOLBref antes da cirurgia e depois de seis meses de ativação do implante. O escore geral e os dados relativos aos quatro domínios abrangidos (físico, psicológico, meio ambiente e relações sociais) foram analisados e descritos. Resultados: Houve mudança positiva significativa para os escores dos domínios de meio ambiente e relações sociais do instrumento. Não houve diferença significativa no escore geral e nos domínios físico e psicológico. Conclusão: Foi possível comparar a qualidade de vida de um grupo de pais de crianças usuárias de IC, antes e depois do processo cirúrgico e ativação do dispositivo. A implantação gerou melhora significativa nos domínios: meio ambiente e relações sociais, evidenciando que houve melhora da qualidade de vida dos pais entrevistados.

Introduction: The cochlear implant is a hearing solution implemented in the Brazilian scenario, becoming a viable strategy for auditory rehabilitation for severe and profound hearing loss. However, despite the great technological advancements and the excellent results obtained and described in the literature, having an implanted child can compromise the quality of life of the families involved in the process. Objective: Compare the quality of life of a group of parents and families who have children users of cochlear implants, before and after implantation. Method: This is a cross-sectional clinical study. The participants were 30 individuals that were submitted to the WHOQOL- Bref questionnaire before surgery and after six months of implant activation. The overall score and the data for the four areas covered (physical, psychological, environmental and social relations) were analyzed and described. Results: There was a significant positive change to the scores of environmental and social relationships domains of the instrument. There was no significant difference in the overall score or on the physical and psychological domains. Conclusion: It was possible to compare the quality of life of a group of parents of children using CI before and after the surgical process and device activation. The implantation has generated significant improvement in the environment and social relationships areas, showing an improvement in the quality of life of the interviewed parents.

Introducción: El implante coclear es una solución auditiva concretizada en la escena brasileña, que se constituye como estrategia de rehabilitación auditiva viable para la pérdida de audición severa y profunda. Sin embargo, a pesar de los grandes avances tecnológicos y los excelentes resultados obtenidos y descritos en la literatura, tener un niño implantado puede comprometer la calidad de vida de las familias involucradas en el proceso. Objetivo: Comparar la calidad de vida de un grupo de padres y familias que tienen niños usuarios de implantes cocleares, antes y después de la implantación. Método: Se trata de un estudio clínico descriptivo transversal. Se incluyeron 30 individuos que se sometieron al cuestionario WHOQOL Bref antes de la cirugía y después de seis meses de la activación del implante. La puntuación global y los datos para los cuatro dominios cubiertos (físico, psicológico, medioambientales y relaciones sociales) fueron analizados y descritos. Resultados: Hubo un cambio positivo significativo de las puntuaciones en los dominios de las relaciones sociales y medioambientales del instrumento. No hubo diferencia significativa en la puntuación total y en los dominios físico y psicológico. Conclusión: Fue posible comparar la calidad de vida de un grupo de padres de niños que utilizan IC, antes y después del proceso quirúrgico y activación del dispositivo. La implantación ha generado una mejora significativa en los dominios medioambientales y relaciones sociales, demostrando una mejora en la calidad de vida de los padres entrevistados.

Transmitted drug resistance in patients with acute/recent HIV infection in Brazil

Abstract Introduction: The widespread use of antiretroviral therapy increased the transmission of antiretroviral resistant HIV strains. Antiretroviral therapy initiation during acute/recent HIV infection limits HIV reservoirs and improves immune response in HIV infected individuals. Transmitted drug resistance may jeopardize the early goals of early antiretroviral treatment among acute/recent HIV infected patients. Methods: Patients with acute/recent HIV infection who underwent resistance test before antiretroviral treatment initiation were included in this analysis. HIV-1 sequences were obtained using an in house protease/reverse transcriptase genotyping assay. Transmitted drug resistance was identified according to the Stanford HIV Database for Transmitted Drug Resistance Mutations, based on WHO 2009 surveillance list, and HIV-1 subtyping according to Rega HIV-1 subtyping tool. Comparison between patients with and without transmitted drug resistance was made using Kruskal-Wallis and Chi-square tests. Results: Forty-three patients were included, 13 with acute HIV infection and 30 with recent HIV infection. The overall transmitted drug resistance prevalence was 16.3% (95% confidence interval [CI]: 8.1-30.0%). The highest prevalence of resistance (11.6%, 95% CI: 8.1-24.5) was against non-nucleoside reverse transcriptase inhibitors, and K103N was the most frequently identified mutation. Conclusions: The high prevalence of nonnucleoside reverse transcriptase inhibitors resistance indicates that efavirenz-based regimen without prior resistance testing is not ideal for acutely/recently HIV-infected individuals in our setting. In this context, the recent proposal of including integrase inhibitors as a first line regimen in Brazil could be an advantage for the treatment of newly HIV infected individuals. However, it also poses a new challenge, since integrase resistance test is not routinely performed for antiretroviral naive individuals. Further studies on transmitted drug resistance among acutely/recently HIV-infected are needed to inform the predictors of transmitted resistance and the antiretroviral therapy outcomes among these population.

Age-Standardized Mortality Rates Related to Cirrhosis in Brazil from 2000 to 2012: A Nationwide Analysis

ABSTRACT Background. Cirrhosis remains the most frequent liver-related cause of death worldwide and we aimed to evaluate its burden in Brazil from 2000 to 2012. Material and methods. The Brazilian National Death Registry was analyzed from 2000 to 2012. Death by cirrhosis was defined by the presence of I85, K73 and/or K74 ICD 10 codes in contributing or underlying causes of death on the death certificate (DC). Crude mortality rates were calculated as the ratio of the absolute number of deaths and the estimated population. Mortality rates were age-adjusted by the direct standardization method using the WHO standard population. Results. A total of 265,180 deaths where cirrhosis was mentioned on the DC [77% male, aged 56 years] occurred from 2000 to 2012. Cirrhosis codes were present in 46% of liver-related deaths and 2% of all deaths in this period. Despite an increase in the absolute number of deaths (n = 18,245 to 22,340), the age-standardized mortality rates (95%CI) decreased from 13.32 (13.16-13.48) to 11.71 (11.59-11.83) per 100,000 inhabitants from 2000 to 2012 (p < 0.001). This trend was not uniform across the country, with decreases in death rates in the South [14.46 (14.07-14.87) to 10.89 (10.59-11.19)] and Southeast [15.85 (15.6-16.09) to 12.52 (12.34-12.70)] and increases in the North [8.84 (8.24-9.43) to 11.53 (11.08-11.99)] and Northeast [9.41 (9.13-9.69) to 10.93 (10.68-11.17)] (p < 0.001 for all). Conclusion. Cirrhosis remains a major public health issue, despite the reduction in mortality rates in the last decade.

Dificuldades percebidas por trabalhadores com deficiência no cotidiano do trabalho / Difficulties perceived by workers with disabilities in the routine of their work / Dificultades percebidas por los trabajadores con discapacidades en la rutina de su trabajo

Este estudo teve como objetivo investigar, junto a trabalhadores com deficiência, as principais dificuldades enfrentadas os primeiros meses de trabalho. Trata-se de pesquisa qualitativa com 16 trabalhadores com deficiência, numa empresa privada de ensino superior e médio no noroeste do estado do Rio Grande do Sul. A coleta dos dados se deu mediante entrevista estruturada e análise de conteúdo em agosto 2014. Foi possível elencar duas categorias: a primeira inerente às dificuldades enfrentadas pelos trabalhadores com deficiência, e a segunda, às (in)satisfações e contribuições do trabalhador para a melhoria do processo de trabalho. Identificou-se que a maioria dos entrevistados não enfrentou dificuldades, contudo em alguns relatos, foi possível apreender alguma discriminação e dificuldades de adaptação. Algumas ações da empresa foram facilitadoras do processo de inserção do trabalhador com deficiência. Considera-se que a inclusão do enfermeiro, dentro das empresas, possa contribuir para uma melhor integração destes trabalhadores (AU).

This study aimed to investigate, with disabled workers, the main difficulties faced by these in their first months at work. It is qualitative research with 16 disabled workers, in a private company providing teaching services at a high school and higher education level, in the northwest of the Brazilian state of Rio Grande do Sul. Data collection took place through a structured interview and content analysis, in August 2014. It was possible to list two categories: the first, inherent to the difficulties faced by the disabled workers, and the second, to the worker's (dis-)satisfactions and contributions to improving the work process. It was identified that the majority of the interviewees did not face difficulties ­ however, in some reports, it was possible to learn some instances of discrimination, and difficulties in adapting. Some of the company's actions facilitated the process of the disabled worker's insertion. It is considered that the inclusion of the nurse, within companies, may contribute to the better integration of these workers (AU).

El objetivo de este estudio fue investigar, con trabajadores discapacitados, las principales dificultades a las que se enfrentan en sus primeros meses de trabajo. Se trata de una investigación cualitativa con 16 trabajadores discapacitados, en una empresa privada que presta servicios de enseñanza en una escuela secundaria y superior, en el noroeste del estado brasileño de Rio Grande do Sul. La recolección de datos se realizó mediante una entrevista estructurada y un análisis de contenido, en agosto de 2014. Se pudo enumerar dos categorías: la primera, inherente a las dificultades de los trabajadores discapacitados, y la segunda a las (des) satisfacciones y Contribuciones para mejorar el proceso de trabajo. Se identificó que la mayoría de los entrevistados no se enfrentaban a dificultades; sin embargo, en algunos informes se pudo conocer algunos casos de discriminación y dificultades de adaptación. Algunas de las acciones de la empresa facilitaron el proceso de inserción del trabajador discapacitado. Se considera que la inclusión de la enfermera, dentro de las empresas, puede contribuir a la mejor integración de estos trabajadores (AU).

Newborn physiological responses to noise in the neonatal unit, / Respostas fisiológicas de neonatos frente a ruídos em unidade neonatal

ABSTRACT INTRODUCTION: The incorporation of technologies in the care of infants has contributed to increased survival; however, this has turned neonatal unit into a noisy environment. OBJECTIVE: To evaluate the physiological and functional effects resulting from the exposure to noise on low-weight newborns in incubators in a neonatal unit. METHODS: Prospective, observational, quantitative, exploratory, descriptive study. The adopted statistical method included tables of frequency, descriptive statistics, and Student's t-test, with a 0.05 level of significance. As data collection tools, the environmental noise and the noise inside of the incubator were evaluated, and the Assessment of Preterm Infant Behavior scale was used to assess premature newborn behavior and projected specifically to document the neurobehavioral functioning of preterm infants. The data collection occurred from September of 2012 to April of 2013; 61 low-weight newborns admitted in the neonatal unit and in incubators were observed. RESULTS: Significant differences in the variables heart rate and oxygen saturation were noted when newborns were exposed to noise. CONCLUSION: Low-weight neonates in incubators present physiological alterations when facing discomfort caused by environmental noise in neonatal units.

Resumo INTRODUÇÃO: A incorporação de tecnologias no cuidado dos recém-nascidos contribui para o aumento da sobrevivência, porém, transformou as unidades neonatais em locais muito ruidosos. OBJETIVO: Avaliar os efeitos fisiológicos e funcionais decorrentes de exposição a ruídos em uma unidade neonatal em recém-nascidos de baixo peso em incubadora. MÉTODO: Estudo prospectivo, de caráter observacional, de abordagem quantitativa e natureza descritiva exploratória. O método estatístico utilizado foi o de tabelas de frequência, estatística descritiva e o teste t de student pareado, ao nível de significância de 0,05. Como instrumento de coleta dos dados foi avaliado o ruído ambiental e no interior das incubadoras e utilizada a escala assessment of preterm infant behavior para avaliação do comportamento dos bebês prematuros e projetada especificamente para documentar o funcionamento neurocomporta-mental dos bebês pré-termo. A coleta dos dados aconteceu no período de setembro de 2012 a abril de 2013 e foram observados 61 recém-nascidos de baixo peso em incubadora internados na unidade neonatal. RESULTADOS: Verifica-se a existência de diferenças significativas na variável frequência cardíaca e saturação de oxigênio frente à exposição a ruídos. CONCLUSÃO: Recém-nascidos de baixo peso em incubadora apresentam alterações fisiológicas quando se encontram em desconforto causado pelo ruído ambiente de unidades neonatais.

A percepção dos técnicos de enfermagem em relação aos riscos ocupacionais em salas de vacinas / Nursing technicians' perceptions regarding the occupational risks in vaccination rooms / Percepción de los técnicos de enfermería acerca de los riesgos ocupacionales en salas de vacunas

Estudo descritivo, de abordagem qualitativa, cujo objetivo foi identificar os riscos ocupacionais em salas de vacinas. Participaram da pesquisa 10 técnicos de enfermagem que atuam em cinco salas de vacina de um município no noroeste do Rio Grande do Sul. Os dados foram coletados por meio de uma entrevista semiestruturada e observação simples, e analisados por meio da análise temática no período de março a maio de 2012. Observou-se que as salas de vacinas apresentam inúmeros riscos ocupacionais e que muitos trabalhadores não os percebem, pois havia balcão com pia para lavar as mãos, mas estas tinham altura muito baixa nas cinco salas observadas, além da iluminação deficiente em todas salas. As vacinadoras entendem que os riscos ocupacionais estão relacionados somente aos acidentes de trabalho. A atenção do serviço municipal de promoção à saúde do trabalhador pode conferir valor à qualidade no trabalho destes profissionais.

This descriptive study with a qualitative approach aimed to identify the occupational risks in vaccinations. A total of 10 nursing technicians participated in the research; these worked in five vaccination rooms in a municipality in the North-west of the state of Rio Grande do Sul. The data were collected through semi-structured interviews and simple observation, and were analyzed using thematic analysis in the period March - May 2012. It was observed that the vaccination rooms present innumerable occupational risks - and that many workers do not perceive these. There was a work surface with a basin for handwashing, but these were at a very low height in the five rooms observed, in addition to there being inadequate lighting in all rooms. The vaccinators understand occupational risks as relating only to work accidents. The attention of the municipal service for the promotion of worker's health could add value to the quality in these subjects' work.

Estudio descriptivo, de abordaje cualitativo, cuyo propósito fue identificar los riegos ocupacionales en salas de vacunas. Participaron de la investigación 10 técnicos de enfermería que actúan en cinco salas de vacuna de un municipio del noroeste de Rio Grande do Sul. Los datos fueron obtenidos por medio de una entrevista semiestructurada y de observación simple, y analizados por medio del análisis temático en el periodo de marzo a mayo de 2012. Se observó que las salas de vacunas presentan muchos riegos ocupacionales y que muchos trabajadores no los perciben, pues había local para lavar las manos, pero este presentaba una altura muy baja en las cinco salas observadas, además de la iluminación deficiente en todas las salas. Las personas que aplican las vacunas entienden que los riegos ocupacionales están relacionados solamente a los accidentes de trabajo. La atención del servicio municipal de promoción de la salud del trabajador puede agregar valor a la cualidad en el trabajo de estes sujetos.

Incidence rate of modifying or discontinuing first combined antiretroviral therapy regimen due to toxicity during the first year of treatment stratified by age

Toxicity is the most frequently reported reason for modifying or discontinuing the first combined antiretroviral therapy regimens, and it can cause significant morbidity, poor quality of life and also can be an important barrier to adherence, ultimately resulting in treatment failure and viral resistance. Elderly patients with HIV/AIDS (≥50 years) may have a different profile in terms of treatment modification due to higher incidence of comorbidities and polypharmacy. The aim of this study was to describe the incidence of modifying or discontinuing first combined antiretroviral therapy regimen due to toxicity (TOX-MOD) during the first year of treatment at the IPEC – FIOCRUZ HIV/AIDS cohort, Rio de Janeiro, Brazil, stratified by age. Demographic, clinical and treatment characteristics from antiretroviral-naïve patients who first received combined antiretroviral therapy between Jan/1996 and Dec/2010 were collected. Incidence rate and confidence interval of each event were estimated using quasipoisson model. To estimate hazard ratio (HR) of TOX-MOD during the first year of combined antiretroviral therapy Cox's proportional hazards regression was applied. Overall, 1558 patients were included; 957 (61.4%), 420 (27.0%) and 181 (11.6%) were aged <40, 40–49, and ≥50 years, respectively. 239 (15.3%) events that led to any modifying or discontinuing within the first year of treatment were observed; 228 (95.4%) of these were TOX-MOD, corresponding to an incidence rate of 16.6/100 PY (95% CI: 14.6–18.9). The most frequent TOX-MOD during first combined antiretroviral therapy regimen were hematologic (59; 26.3%), central nervous system (47; 20.9%), rash (42; 19.1%) and gastrointestinal (GI) (38; 16.7%). In multivariate analysis, incidence ratio of TOX-MOD during the first year of combined antiretroviral therapy progressively increases with age, albeit not reaching statistical significance. This profile was maintained after adjusting the model for sex, combined antiretroviral therapy regimen and year of combined antiretroviral therapy initiation. These results are important because not only patients are living longer and aging with HIV, but also new diagnoses are being made among the elderly. Prospective studies are needed to evaluate the safety profile of first line combined antiretroviral therapy on elderly individuals, especially in resource-limited countries, where initial regimens are mostly NNRTI-based.

Efetividade dos esquemas antirretrovirais de primeira e segunda linha utilizados no tratamento de Pacientes com HIV/AIDS numa coorte urbana no Rio de Janeiro / Effectiveness of first- and second-line antirretroviral therapy in a HIV/AIDS urban cohort in Rio de Janeiro, Brazil

Introdução: O Brasil foi o primeiro país em desenvolvimento a implantar um programa de acesso universal ao tratamento antirretroviral (TAR) em larga escala, acarretando aumento da sobrevida da população vivendo com HIV/Aids, diminuição da incidência de infecções oportunistas e diminuição das hospitalizações. [...] Objetivo: Estimar as taxas de efetividade dos esquemas antirretrovirais e fatores associados à resposta ao tratamento e sua durabilidade para TAR de primeira e segunda linhas na coorte de pacientes com HIV/Aids do IPEC-Fiocruz. Primeiro Artigo: Foi estimada a efetividade de TAR de primeira linha no IPEC-Fiocruz e os fatores sóciodemográficos, comportamentais, clínicos e estruturais associados à supressão viral foram avaliados. [...] Entre janeiro de 2000 e junho de 2010, 1.311 pacientes iniciaram TAR de primeira linha, dos quais 987 (75 por cento) utilizaram esquemas baseados em ITRNN. A efetividade foi de 77 por cento, 76 por cento e 68 por cento aos seis, 12 e 24 meses, respectivamente. Fatores associados com supressão viral, definida como ter uma medida de carga viral menor ou igual 400 cópias/mL sem modificação/interrupção de classe, na análise multivariada em 12 meses foram maior escolaridade, início da TAR no calendário mais recente (2005- 2010) e participação em estudo clínico; aos 24 meses nossos resultados sugerem que ser mais velho e usar esquemas baseados em ITRNN são fatores independentemente associados a melhor resposta. Segundo Artigo: Foram descritos os desfechos relacionados a TAR de segunda linha no IPEC Fiocruz, assim como o tempo até a falha e os fatores associados...

Introduction: Brazil was the first developing country to introduce a free access to antiretroviral therapy (cART) for all in need, leading to an increase in HIV/AIDS population survival and a decrease on the incidence of opportunistics infections and hospitalizations. [...] Objective: Evaluate first- and second-line cART effectiveness and factors correlated with response to treatment and its durability in HIV/AIDS IPEC-FIOCRUZ cohort.First Article: First-line cART effectiveness in IPEC-Fiocruz cohort was estimated and sociodemographic,behavioral, clinical and structural factors associated with virologic suppression were evaluated. Virologic suppression was accessed at 6, 12, and 24 months from cARTinitiation. Quasi-Poisson regression was used to quantify the association of factors with virologic suppression at 12 and 24 months. From January 2000 through June 2010, 1,311patients started first-line cART; 987 (75 percent) patients used NNRTI-based regimens. [...] In multivariate analysis, factors associated with virologic suppression, defined ashaving a viral load measurement less than or equal to 400 copies/mL without drug class modification and/or discontinuation, at 12 months were higher formal education, starting cART more recently(2005-2010) and clinical trial participation; for the 24-month endpoint, older age and anNNRTI-based regimen were also independently associated with virologic suppression. Second Article: Second-line cART outcomes in IPEC-Fiocruz cohort were described, including time to failure as well as factors associated with treatment failure...