Cerebrospinal fluid: a target of some fungi and an overview

Meningitis is a potentially life-threatening infection characterised by the inflammation of the leptomeningeal membranes. The estimated annual prevalence of 8.7 million cases globally and the disease is caused by many different viral, bacterial, and fungal pathogens. Although several genera of fungi are capable of causing infections in the central nervous system (CNS), the most significant number of registered cases have, as causal agents, yeasts of the genus Cryptococcus. The relevance of cryptococcal meningitis has changed in the last decades, mainly due to the increase in the number of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and medications that impair the immune responses. In this context, coronavirus disease 19 (COVID-19) has also emerged as a risk factor for invasive fungal infections (IFI), including fungal meningitis (FM), due to severe COVID-19 disease is associated with increased pro-inflammatory cytokines, interleukin (IL)-1, IL-6, and tumour necrosis factor-alpha, reduced CD4-interferon-gamma expression, CD4 and CD8 T cells. The gold standard technique for fungal identification is isolating fungi in the culture of the biological material, including cerebrospinal fluid (CSF). However, this methodology has as its main disadvantage the slow or null growth of some fungal species in culture, which makes it difficult to finalise the diagnosis. In conclusions, this article, in the first place, point that it is necessary to accurately identify the etiological agent in order to assist in the choice of the therapeutic regimen for the patients, including the implementation of actions that promote the reduction of the incidence, lethality, and fungal morbidity, which includes what is healthy in the CNS.

Avaliação da qualidade de vida relacionada à saúde em um programa de reabilitação para pessoas com deficiência visual / Health-related quality of life assessment in a rehabilitation program for people with visual impairment

RESUMO Objetivo: Aplicar um protocolo para avaliar a qualidade de vida relacionada à saúde de participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência. Métodos: Foi realizado um estudo transversal com 60 adultos com deficiência visual participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência no Rio de Janeiro. O protocolo de pesquisa consistiu em um questionário com dados pessoais, sociais, demográficos e informações clínicas; no European Quality of Life 5 Dimensions 3 Level Version para medição genérica de qualidade de vida relacionada à saúde; no Patient Health Questionnaire-2 para rastrear a depressão e no Visual Function Questionnaire 25 para avaliar a qualidade de vida relacionada à saúde específica da função visual. A principal variável independente analisada foi o tempo de exposição ao programa. Modelos de regressão linear foram utilizados para investigar a relação entre o tempo no programa e a qualidade de vida relacionada à saúde do Visual Function Questionnaire 25 e do European Quality of Life 5 Dimensions 3 Level Version. Resultados: A maioria dos participantes (73%) possuía deficiência visual adquirida; 68% tinham menos de 60 anos e 53% perderam a visão há mais de 10 anos. A condição visual autorreferida mais comum foi cegueira em ambos os olhos (48%) e 42% frequentavam o programa há mais de 3 anos. A mediana do índice de utilidade do European Quality of Life 5 Dimensions 3 Level Version foi de 0,75. O instrumento específico para rastreamento de depressão, o Patient Health Questionnaire, identificou proporção de 27% de participantes positivos. O Visual Function Questionnaire 25 apresentou escores abaixo de 50 (escala de zero a cem) nos subdomínios visão geral, atividades de perto e atividades à distância. As medianas de dor ocular e aspectos sociais do Visual Function Questionnaire 25 foram significativamente menores entre aqueles que realizavam tratamento psiquiátrico. O tempo de reabilitação foi independentemente associado a melhores escores dos subdomínios saúde mental e atividades da vida diária. Conclusão: O protocolo demonstrou aplicabilidade para a avaliação de qualidade de vida relacionada à saúde em pessoas com deficiência visual, permitindo concluir que o maior tempo no programa de reabilitação foi associado a maiores escores de qualidade de vida.

ABSTRACT Purpose: This study aimed to implement a health-related quality of life (HRQoL) assessment protocol to measure the consequences of a rehabilitation program for visual impaired people at a leading reference institute in Brazil. Methods: A cross-sectional study was conducted with 60 visual impaired adults enrolled in a Rehabilitation Program of the Instituto Benjamin Constant. The research protocol consisted of a questionnaire with personal data, social, demographic, and clinical information; the EQ-5D-3L instrument for generic HRQoL measurement; the Patient Health Questionnaire-2 (PHQ- 2) to screen for depression, and the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) to assess specific HRQoL of visual function. The main independent variable analyzed was the exposure time to the rehabilitation. Linear regression models were used to investigate the relationship between rehabilitation time and HRQoL of the NEI VFQ-25 and EQ 5D-3L instruments. Results: Most participants (73%) have acquired visual impairment, 68% are under 60 years old, 53% lost their vision more than 10 years ago, the most common self-reported visual condition (48%) was blindness in both eyes and 42% are in the Rehabilitation Program for more than 3 years. The median HRQoL utility index for EQ 5D-3L was 0.75. The specific instrument for screening for depression, PHQ-2, identified 27% of participants above the cut-off point. The NEI VFQ-25 instrument showed scores below 50 (scale from 0 to 100) in subdomains: "general vision", "near activities" and "distance activities". The medians of "ocular pain" and "social aspects" of the VFQ-25 were significantly lower among those who have undergone psychiatric treatment. "Rehabilitation time" was independently associated with better scores of "mental health" and "role difficulties" subdomains. Conclusion: The protocol showed applicability for the assessment of HRQoL, allowing the conclusion that longer time in the rehabilitation program was associated with higher quality of life scores.

Accuracy of rapid point-of-care serological tests for leprosy diagnosis: a systematic review and meta-analysis

BACKGROUND Leprosy is a chronic infectious disease, still endemic in many countries that may lead to neurological, ophthalmic, and motor sequelae if not treated early. Access to timely diagnosis and multidrug therapy (MDT) remains a crucial element in the World Health Organization's strategy to eliminate the disease as a public health problem. OBJECTIVES This systematic review aims to evaluate the accuracy of rapid point-of-care (POC) tests for diagnosis of leprosy. METHODS Searches were carried out in electronic databases (PubMed, EMBASE, CRD, Cochrane Library and LILACS) in April 2021 for patients with suspicion or confirmatory diagnostic of leprosy, classified in multibacillary (MB) or paucibacillary (PB) cases, performing rapid POC serological tests compared to clinical evaluation, smear microscopy and immunohistochemistry analysis. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). A meta-analysis was undertaken to generate pooled estimates of diagnostic parameters, presenting sensitivity, specificity and diagnostic odds ratio (DOR) values. The review protocol was registered at PROSPERO, CRD # 42014009658. FINDINGS From 893 potentially relevant references, 12 articles were included reporting 16 diagnostic tests accuracy studies with 5395 individuals enrolled. Meta-analysis of NDO-LID and PGL-I tests data in MB patients showed sensitivity and specificity [95% confidence interval (CI)] of 0.83 (0.71-0.91), 0.91 (0.72-0.97); and 0.92 (0.86-0.96), 0.93 (0.78-0.98); respectively, with high heterogeneity among the studies. MAIN CONCLUSIONS Our results can inform policymakers regarding the possibility of implementing accurate, rapid POC tests for leprosy in public health services, especially within primary health care.

Hepatitis of unknown etiology in children in Brazil: A new challenge or the usual scenario ?

ABSTRACT Background: An outbreak of acute hepatitis of unknown etiology in children was recently reported worldwide. We aimed to describe the burden of hospitalizations due to hepatitis of unknown etiology in children/adolescents in Brazilian public hospitals. Methods: We retrieved a database of all hospitalizations in the Brazilian Unified Health System (SUS) from January/2019 to February/2022 using the "microdatasus" R package. Hepatitis of unknown etiology was defined by the following International Classification of Diseases [ICD-10] codes: B19, B19.0, B19.9, K72.0, K72.9, K75, K75.9, R94.5, or R93.2. The incidence rates (95% confidence interval, IC) per 1,000 all-cause hospitalizations in different age strata [< 6 years; 6-11 years and 12-17 years] were estimated. Results: A total of 94,198 hospitalizations due to hepatic or infectious diseases with potential liver injury were analyzed. Of them, 1,535 children/adolescents [48.2% male sex, 41.6% aged < 6 years] were hospitalized with hepatitis with unknown etiology. The top ICD-10 codes were B19.9 [unspecified viral hepatitis without hepatic coma; 39.9% (n = 612)], K72.9 [hepatic failure, unspecified; 29.8% (n = 457)], and K72.0 [hepatic failure, not elsewhere classified; 14.5% (n = 223)]. A total of 8.5% (n = 131) of individuals required liver transplantation and 7.0% (n = 107) died during the hospital-stay. In 2021, the incidence rates (95% CI) of hospitalizations for hepatitis with unknown etiology were 7.80 (7.63-7.98), 17.96 (17.46-18.48) and 13.28 (12.95-13.62) per 1,000 all-cause hospitalizations in subjects aged < 6 years, 6-11 years and 12-17 years-old, respectively. Similarly, the incidence rates of hospitalization due to hepatitis with unknown etiology per 1,000 all-cause hospitalizations (CI95%) in January-February/2022 were 7.52 (7.11-7.94), 16.82 (15.68-18.03), and 13.96 (13.10-14.85) for children/adolescents with age < 6 years, 6-11 years, and 12-17 years, respectively. Conclusions: A non-negligible number of hospitalizations due to hepatitis with unknown etiology in children/adolescents was observed in the last years in Brazil. Up to 15% of those cases needed liver transplantation or died.

Confiabilidad por el método test retest del Barómetro de la Familia versión peruana / Reliability by test retest method of the Peruvian version of Family Barometer

Resumen Objetivo: Determinar la confiabilidad del Barómetro de la Familia por medio del método test retest. Método: Estudio de tipo instrumental, se evaluó a 299 personas que vivían con sus parejas y/o hijos al momento de ser evaluados, el 83,6 % de la muestra fueron mujeres. El rango de edad fluctuó entre los 18 y 65 años (M=40,7 años). El Barómetro de la Familia (versión peruana) está compuesto por 98 ítems con diferentes opciones de respuesta (dicotómico, Likert, respuesta múltiple nominal y abierto de respuesta numérica) que evalúan la estructura y la dinámica familiar, además de la percepción que se tiene sobre temas relacionados a la familia como el aborto o el matrimonio. Se aplicaron los estadísticos kappa de Cohen (κ) y coeficiente de correlación intraclase (CCI). Resultados: La mayoría de reactivos que indagan sobre la estructura, dinámica familiar, violencia y conductas de riesgo son confiables (κ≥ 0,4 o CCI≥ 0,4). Por otro lado, preguntas sobre la separación, matrimonio, homosexualidad y aborto no son confiables (κ< 0,4 o CCI< 0,4). Conclusión: El cuestionario del Barómetro de la Familia demostró ser confiable en la medición de diversas características familiares en la población peruana.

Abstract Objective: It is to determine the reliability of the Family Barometer using the test retest method. Method: An instrumental study, 299 people living with their partners and / or children were evaluated at the time of evaluation, 83,6 % of the sample were women. The age range fluctuated between 18 and 65 years (M = 40,7 years). The Family Barometer (Peruvian version) is made up of 98 items with different response options (dichotomous, Likert, multiple nominal response and open numerical response) that evaluate the family structure and dynamics, in addition to the perception that one has about family related issues like abortion or marriage. Cohen's kappa statistics (κ) and intraclass correlation coefficient (ICC) were applied. Results: Most of the items that inquire about the structure, family dynamics, violence and risk behaviors are reliable (κ≥ 0,4 or CCI≥ 0,4). On the other hand, questions about separation, marriage, homosexuality and abortion are not reliable (κ <0,4 or ICC <0,4). Conclusion: The Family Barometer questionnaire proved to be reliable in measuring various family characteristics in the Peruvian population.

COVID-19: a meta-analysis of diagnostic test accuracy of commercial assays registered in Brazil

ABSTRACT The accuracy of commercially available tests for COVID-19 in Brazil remains unclear. We aimed to perform a meta-analysis to describe the accuracy of available tests to detect COVID-19 in Brazil. We searched at the Brazilian Health Regulatory Agency (ANVISA) online platform to describe the pooled sensitivity (Se), specificity (Sp), diagnostic odds ratio (DOR) and summary receiver operating characteristic curves (SROC) for detection of IgM/IgG antibodies and for tests using naso/oropharyngeal swabs in the random-effects models. We identified 16 tests registered, mostly rapid-tests. Pooled diagnostic accuracy measures [95%CI] were: (i) for IgM antibodies Se = 82% [76-87]; Sp = 97% [96-98]; DOR = 168 [92-305] and SROC = 0.98 [0.96-0.99]; (ii) for IgG antibodies Se = 97% [90-99]; Sp = 98% [97-99]; DOR = 1994 [385-10334] and SROC = 0.99 [0.98-1.00]; and (iii) for detection of SARS-CoV-2 by antigen or molecular assays in naso/oropharyngeal swabs Se = 97% [85-99]; Sp = 99% [77-100]; DOR = 2649 [30-233056] and SROC = 0.99 [0.98-1.00]. These tests can be helpful for emergency testing during the COVID-19 pandemic in Brazil. However, it is important to highlight the high rate of false negative results from tests which detect SARS-CoV-2 IgM antibodies in the initial course of the disease and the scarce evidence-based validation results published in Brazil. Future studies addressing the diagnostic performance of tests for COVID-19 in the Brazilian population are urgently needed.

Reinsertion of Distal Brachial Biceps Tendon Rupture through Single Incision Using Anchors / Reinserção da ruptura distal do bíceps braquial mediante incisão única com uso de âncoras

Abstract Objective To evaluate 15 patients with ruptured distal biceps tendon submitted to reinsertion via a single, anterior and transverse approach using two anchors. They were submitted to a rehabilitation protocol and, within six months, to an evaluation of the range of motion and strength intensity during flexion and supination of the operated elbow. Methods The data were collected prospectively, and were analyzed through the Mann-Whitney test and the mixed-model test to evaluate the force between the operated and non-operated elbows. Results A total of 80% of the patients were men, 60% were injured on the dominant side, 46% were manual workers, and 73% led sedentary lifestyles. The use of anabolic steroids was reported by two patients. After the treatment, the patients recovered supination strength by 98% and flexion by 94%. According to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 73% of the patients presented the score expected of a normal population. Conclusion The single, anterior and transverse approach associated with tendon repair using anchors was esthetically satisfactory, with good strength recovery during flexion and supination, and no occurrence of heterotopic ossification.

Resumo Objetivo Avaliar 15 pacientes com ruptura do tendão distal do bíceps submetidos a reinserção por meio de via única, anterior e transversa no antebraço com o uso de duas âncoras. Os pacientes foram submetidos a um protocolo de reabilitação e, ao término de seis meses, efetuou-se avaliação do arco de movimento do cotovelo operado e da intensidade de força durante a flexão e a supinação. Métodos Os dados foram coletados de maneira prospectiva, e foram analisados pelo teste de Mann-Whitney e pelo teste de modelos mistos para avaliar a força entre os cotovelos operado e não operado. Resultados Um total de 80% dos pacientes eram homens, 60% sofreram lesão do lado dominante, 46% eram trabalhadores braçais, e 73% não praticavam atividades físicas regularmente. O uso de anabolizante foi relatado por dois pacientes. Após o tratamento, os pacientes recuperaram 98% da força de supinação, e 94% da de flexão. De acordo com questionário de Disfunções do Braço, Ombro e Mão (Disabilities of the Arm, Shoulder and Hand, DASH), 73% dos pacientes encontram-se dentro do esperado para uma população normal. Conclusão A via única, anterior e transversa associada ao reparo do tendão com o uso de âncoras apresentou-se esteticamente satisfatória, com boa recuperação da força durante a flexão e a supinação, não ocorrendo casos de ossificação heterotópica ou complicações graves.

Primer reporte de bacterias y dinoflagelados marinos luminiscentes del Parque Nacional Isla del Coco, Costa Rica

Introducción: La bioluminiscencia es la capacidad de ciertos organismos para transformar la energía química en energía lumínica mediante varios procesos bioquímicos. Objetivo: El aislamiento e identificación por primera vez de bacterias luminiscentes en agua marina superficial y la identificación de dinoflagelados luminiscentes marinos del Parque Nacional Isla del Coco, Costa Rica. Metodología: Se colectaron muestras de agua marina obtenida por buceo a 20 m y a nivel superficial de 13 sitios en la Isla del Coco, Costa Rica. Por otra parte, se analizaron muestras de fitoplancton colectadas desde la superficie hasta los 30 m de profundudad en los alrededores de 8 sitios de la Isla del Coco, y se determinaron varias especies luminiscentes pertenecientes a los géneros Ornithocercus y Ceratocorys. Resultados: Se logró obtener 7 aislados bacterianos luminiscentes, se identificaron y caracterizaron bioquímicamente mediante una plataforma automatizada (Vitek) con altos niveles de confianza, se ubicaron taxonómicamente dentro del género Vibrio,2 especies: V. alginolyticus y V. parahaemolyticus, además, algunos aislados presentaron resistencia al antibiótico ampicilina y 100% capacidad hemolítica. Esta investigación muestra evidencia de la presencia de especies microscópicas marinas en Isla del Coco, Costa Rica, capaces de presentar el fenómeno de la luminiscencia, por lo que profundizar en su estudio sería relevante en cuanto a la importancia de estos microorganismos en la producción de metabolitos secundarios y como indicadores de floraciones algales nocivas, por lo que se hace necesario realizar más investigación científica para determinar su potencial biotecnológico. Conclusiones: De la misma forma, los resultados obtenidos en esta investigación sugieren expandir las localidades de colecta y aislamientos de microorganismos luminiscentes, acompañado de una caracterización bioquímica y molecular, con el fin de explorar la diversidad microbiana asociada a eventos de luminiscencia y determinar los ambientes en el que estas especies se desarrollan.

Introduction: Bioluminescence is the ability of certain organisms to transform chemical energy into light energy through various biochemical processes. Objective: Isolation and identification for the first time of luminescent bacteria of superficial marine water, and the identification of marine luminescent dinoflagellates of Isla del Coco National Park, Costa Rica. Methods: Samples of seawater obtained by diving at 20 m and at a surface level of 13 sites were collected. On the other hand, phytoplankton samples collected from the surface up to 30 m deep were analyzed in the surroundings of 8 sites of Cocos Island, and several luminescent species belonging to the genera Ornithocercus and Ceratocorys were determined. Results: Seven luminescent bacterial isolates were obtained, they were identified and characterized biochemically by means of an automated platform (Vitek) with high levels of confidence, they were taxonomically located within the genus Vibrio, 2 species: V. alginolyticus and V. parahaemolyticus, in addition, some isolates presented resistance to the antibiotic ampicillin and 100% hemolytic capacity. This research shows evidence of the presence of marine microscopic species in Cocos Island, Costa Rica, capable of presenting the phenomenon of luminescence, so that further study would be relevant in terms of the importance of these microorganisms in the production of metabolites secondary and as indicators of harmful algal blooms, so it is necessary to conduct more scientific research to determine their biotechnological potential. Conclusions: In the same way, the results obtained in this investigation suggest expanding the collection and isolation of luminescent microorganisms, accompanied by a biochemical and molecular characterization, in order to explore the microbial diversity associated with luminescence events and determine the environments in which that these species develop.

Caracterización fenotípica y molecular, e influencia de medios de cultivo, en el crecimiento y emisión de luz de bacterias del litoral de La Habana, Cuba

Introducción: El complejo enzimático emisor de luz de las bacterias luminiscentes es una poderosa herramienta bioquímica, con una amplia variedad de aplicaciones, incluyendo el control de la calidad ambiental. Objetivos: Identificar taxonómicamente dos bacterias luminiscentes de las aguas de la plataforma cubana, así como seleccionar los medios de cultivo que favorezcan su crecimiento y luminiscencia. Métodos: La identificación taxonómica de las bacterias luminiscentes se llevó a cabo utilizando métodos tradicionales y moleculares. Cuatro medios de cultivo (LM, Boss, Chalk, ZoBell) fueron evaluados en función de la tasa de crecimiento específico (μ) y la luminiscencia utilizando un espectrofotómetro Genesys 10UV y un espectro fluorómetro Shimadzu RF-5301pc, respectivamente. Resultados: La caracterización bioquímica y fisiológica de los aislamientos de CBM-976 y CBM-992 mostró similitudes con las especies de Vibrio harveyi. El análisis del posicionamiento taxonómico confirmó una alta correspondencia con las cepas de V. harveyi aisladas de entornos acuáticos, utilizando secuencias parciales de los genes 16S rRNA, gyrB y pyrH. Se seleccionaron los medios de cultivo LM y ZoBell por tener una alta tasa de crecimiento específico de las cepas CBM-976 y CBM-992; así como por mostrar altos valores de luminiscencia. Los resultados permitirán profundizar en la caracterización fisiológica y son el punto de partida para el desarrollo de métodos de detección de contaminantes. Conclusiones: La combinación de las características fisiológicas y bioquímicas, así como las técnicas de biología molecular contribuyeron a determinar la posición taxonómica de las cepas CBM-976 y CBM-992 aisladas de las aguas marinas cubanas como Vibrio harveyi. Además, se seleccionaron los medios de cultivo LM y ZoBell como los más adecuados para el crecimiento y la emisión de luminiscencia de ambas cepas.

Introduction: The light-emitting enzyme complex of luminescent bacteria is a powerful biochemical tool, with a wide variety of applications including environmental quality monitoring. Objectives: To identify taxonomically two luminescent bacteria from Cuban shelf waters, as well as select the culture media that favor their growth and luminescence. Methods: The taxonomic location of the luminescent bacteria was carried out using traditional and molecular methods. Four culture media (LM, Boss, Chalk, ZoBell) were evaluated as a function of specific growth rate (μ) and luminescence, using a Genesys 10UV spectrophotometer and a Shimadzu RF-5301pc spectrofluorometer, respectively. Results: Biochemical and physiological characterization of CBM-976 and CBM-992 isolates showed similarities with Vibrio harveyi species. Phylogenetic positioning analysis confirmed a high correspondence with V. harveyi strains isolated from aquatic environments, using partial sequences of 16S rRNA, gyrB and pyrH genes. LM and ZoBell culture media were selected for having a high specific growth rate of CBM-976 and CBM-992 strains, as well as for showing high luminescence values. The results will allow deepening the physiological characterization and are the starting point for the development of contaminant detection methods. Conclusions: The rational combination of physiological and biochemical characteristics, as well as the molecular approach, contributed to determine the taxonomic position of CBM-976 and CBM-992 strains isolated from Cuban marine waters as Vibrio harveyi. Furthermore, LM and ZoBell culture media were selected as the most suitable for growth and luminescence emission for both strains.

Clinical inertia in insulin prescription for patients with type 2 diabetes mellitus at a primary health care institution of Cartagena, Colombia / Inercia clínica en la prescripción de insulina en pacientes con diabetes mellitus tipo 2 de una institución de baja complejidad en Cartagena de Indias, Colombia

Abstract Introduction: Evidence has demonstrated clinical or prescriptive inertia along with an increased prescription of insulin, causing a delay in the change of prescription. Objective: To determine the prescription pattern and clinical inertia of insulin use in the treatment of patients with type 2 diabetes mellitus (DM2) enrolled in a diabetes program at a primary health care institution of Cartagena, Colombia. Materials and methods: Pharmacoepidemiology study that addresses drug utilization based on data collected through a review of medical records of 331 patients with DM2, aged 18 and older, who had at least 6 months of control. Results: 64.4% of patients were treated with long-acting insulin analogues and 18.4% used insulin; 52.7% of the patients in which insuline use was required did not have a prescription of this drug. Conclusions: There is clinical inertia related to insulin prescription. Strategies should be implemented to overcome prescriptive inertia for people with DM2 in order to achieve therapeutic goals earlier and effectively prevent the development and progression of chronic complications.

Resumen Introducción. Paralelo al aumento de la prescripción de la insulina se ha demostrado la inercia clínica o prescriptiva, de tal manera que la demora en cambiar la prescripción es prolongada. Objetivo. Determinar el patrón de prescripción y la inercia clínica en la utilización de insulina al momento de estar indicada en el tratamiento de los pacientes con diabetes mellitus tipo 2 (DM2) que acuden a un programa de diabetes en una institución de baja complejidad de Cartagena, Colombia. Materiales y métodos. Estudio de farmacoepidemiología dirigido al campo de los estudios de utilización de medicamentos que se basó en datos recogidos mediante la revisión de historias clínicas de 331 pacientes con DM2, mayores de 18 años y que tuvieran mínimo 6 meses de control. Resultados. El 18.4% de los pacientes utilizaron insulina. 64.4% fueron tratados con análogos de insulinas de acción prolongada. 52.7% de los pacientes con indicación de insulina no tenían prescrito el fármaco. Conclusiones. Existe inercia clínica para la prescripción de insulina. Se deben implementar estrategias que superen la inercia prescriptiva para que las personas con DM2 alcancen tempranamente las metas terapéuticas y prevengan de manera efectiva el desarrollo y la progresión de complicaciones crónicas.

IDENTIFICACIÓN MOLECULAR Y DISTRIBUCIÓN POTENCIAL DEL ANFÍPODO TERRESTRE Talitroides topitotum (Crustacea: Amphipoda: Talitridae) EN COSTA RICA / Molecular Identification and Potential Distribution of Terrestrial Amphipod Talitroides topitotum (Crustacea: Amphipoda: Talitridae) in Costa Rica

RESUMEN El anfípodo terrestre, Talitroides topitotum, es un talítrido distribuido mundialmente en regiones subtropicales y templadas, con un amplio rango de distribución altitudinal, temperatura y humedad. Se colectaron y procesaron especímenes desde el año 2012 al 2016, mediante remoción-filtración de sustratos húmedos. Se identificaron taxonómicamente por características fenotípicas diagnósticas, se determinó su estado de desarrollo y se separaron por sexo. Se extrajo ADN de anfípodos completos, seguido de una PCR de los genes citocromo oxidasa subunidad 1 y del ARN ribosomal de la subunidad 16S. Se obtuvo un árbol filogenético por máxima verosimilitud con un modelo GTR-GAMMA. El análisis de la distribución potencial de T. topitotum se estimó utilizando 19 variables bioclimáticas. En este estudio, se amplía la distribución previamente reportada y en altitudes entre los 1900 a 595 m s.n.m. Se analizaron 39 localidades, en las cuales: 1) Hay presencia de T. topitotum, 2) no hubo presencia de anfípodos terrestres, 3) no hubo presencia de Talitroides sp., pero sí de un anfípodo nativo. La abundancia proporcional de T. topitotum se inclina hacia las hembras adultas, una proporción alta de juveniles y no se detectaron individuos machos. El análisis bioinformático determinó el posicionamiento taxonómico de la especie T. topitotum dentro del agrupamiento de anfípodos terrestres, además, la especie exógena diverge de Cerrorchestia hyloraina demostrando una separación filogenética entre especies, las cuales pueden estar compartiendo hábitats. T. topitotum, según el modelo de máxima entropía, posee una alta capacidad de dispersión y estaría siendo favorecida, en cuanto a su asentamiento y propagación, por elementos climáticos como temperatura, precipitación y humedad, y factores como la altitud. Nuestros hallazgos son relevantes para la toma de decisiones de manejo y monitoreo del desplazamiento de especies nativas de anfípodos terrestres en la región.

ABSTRACT The land-hopper, Talitroides topitotum, is a talitrid amphipod distributed worldwide in subtropical and template regions, with a wide range of altitudinal distribution, temperature and humidity. Specimens were collected and processed since 2012 until 2016, by collection-filtration of wet substrates. Specimens were taxonomically identified using diagnostic phenotypic characteristics, and the developmental stage and sex were recorded. DNA was extracted from whole amphipods, followed by PCR of cytochrome oxidase subunit 1 and ribosomal RNA subunit 16S genes. Partial genetic sequences were obtained and a maximum-likelihood phylogenetic tree was calculated based on a GTR-GAMMA model. The analysis of potential distribution of T. topitotum was estimated using 19 bioclimatic variables. This study extends the previously reported distribution and elevations between 1900 and 595 m a.s.l. Thirty-nine localities were analyzed, where the following categories were registered: 1) T. topitotum is present, 2) terrestrial amphipods are not present, 3) T. topitotum is not present, but the native amphipod is present. The relative abundance of T. topitotum corresponds to adult females, a high proportion ofjuveniles and no males were collected. The bioinformatic analysis established the taxonomic position of T. topitotum within a group of terrestrial amphipods; moreover, the invasive species diverges of Cerrorchestia hyloraina, demonstrating the phylogenetic separation between these species that could be sharing habitats. Based on the model of maximum entropy, T. topitotum shows a high dispersion capacity and its establishment and propagation are been improved by climatic elements such as temperature, precipitation, humidity, and elevation. Our findings are relevant for management policies and monitoring the distribution of native species of terrestrial amphipods in the region.

Evaluación de la prescripción de glibenclamida en diabéticos tipo 2 / Evaluation of glibenclamide prescription in type 2 diabetic patients

RESUMEN Introducción: Las sulfonilureas permanecen junto con la metformina como el tratamiento farmacológico más usado para los pacientes diabéticos tipo 2, y continúan siendo los antidiabéticos más prescritos en algunas regiones del mundo. Objetivo: Evaluar la prescripción de glibenclamida en aspectos relacionados a contraindicaciones, dosificación, y prevención de efectos adversos, en el tratamiento de los pacientes diabéticos tipo 2 que acuden a una institución de salud de baja complejidad en Cartagena de Indias, Colombia. Metodología: Estudio descriptivo con enfoque desde la fármaco-epidemiología dirigido específicamente al campo de los estudios de utilización de medicamentos, basado en los datos recogidos mediante revisión de historias clínicas de 331 pacientes diabéticos tipo 2, mayores de 18 años en un centro de atención primaria en salud de la ciudad de Cartagena de Indias entre los años 2013 y 2014. Se estudiaron variables demográficas, clínicas y paraclínicas, el esquema terapéutico y la calidad de la prescripción. La información se analizó usando estadística descriptiva. Resultados: 57 % (189) de los pacientes utilizaron glibenclamida siendo un 59.3 % (153) prescrito de manera inadecuada, 45.5% (86) tenían alguna contraindicación para el empleo del medicamento. En 1 % de los pacientes de la muestra se prescribió sobrepasando el rango de dosis terapéutica Conclusiones: La calidad de la prescripción de la glibenclamida fue inadecuada en una proporción importante de pacientes, se hace necesario implementar estrategias educacionales que capaciten al personal médico para una correcta utilización de los fármacos antidiabéticos. La glibenclamida comparada con otras sulfonilureas de segunda generación nos brinda más desventajas que ventajas.

ABSTRACT Introduction: Sulfonylureas remain with metformin as the most used drug treatment for type 2 diabetic patients and remain the most prescribed anti-diabetic in some regions of the world. Target: Evaluate prescribing glyburide in aspects related to contraindications, dosage, and prevention of adverse effects, in the treatment of type 2 diabetic patients attending a health institution low complexity in Cartagena de Indias, Colombia. Methodology: Descriptive study with approach from the pharmaco-epidemiology specifically directed to the field of studies of drug use, based on the data collected through review of medical records of 331 type 2 diabetic patients over 18 years in a primary health care in the city of Cartagena de Indias between 2013 and 2014. demographic, clinical and paraclinical variables, the therapeutic plan and prescription quality were studied. Data was analyzed using descriptive statistics. Results: 57 % (189) patients using glyburide. In 59.3% (153) inappropriately prescribed glibenclamide. 45.5% (86) of the patients had a contraindication to the use of the drug. In 1% of patients were prescribed the sample exceeding the therapeutic dose range Conclusions: The quality of prescribing glyburide was inadequate in a substantial proportion of patients, it is necessary to implement educational strategies that enable medical personnel to ensure proper use of antidiabetic drugs. Glyburide compared with other second-generation sulfonylureas gives us more disadvantages than advantages.

Commercial enzyme-linked immunosorbent assay versuspolymerase chain reaction for the diagnosis of chronic Chagas disease: a systematic review and meta-analysis

Chronic Chagas disease diagnosis relies on laboratory tests due to its clinical characteristics. The aim of this research was to review commercial enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) diagnostic test performance. Performance of commercial ELISA or PCR for the diagnosis of chronic Chagas disease were systematically searched in PubMed, Scopus, Embase, ISI Web, and LILACS through the bibliography from 1980-2014 and by contact with the manufacturers. The risk of bias was assessed with QUADAS-2. Heterogeneity was estimated with the I2 statistic. Accuracies provided by the manufacturers usually overestimate the accuracy provided by academia. The risk of bias is high in most tests and in most QUADAS dimensions. Heterogeneity is high in either sensitivity, specificity, or both. The evidence regarding commercial ELISA and ELISA-rec sensitivity and specificity indicates that there is overestimation. The current recommendation to use two simultaneous serological tests can be supported by the risk of bias analysis and the amount of heterogeneity but not by the observed accuracies. The usefulness of PCR tests are debatable and health care providers should not order them on a routine basis. PCR may be used in selected cases due to its potential to detect seronegative subjects.

Cárie oculta: diagnóstico e alternativa para tratamento - relato de casos clínicos / Hidden caries: diagnosis and an alternative for treatment – case report

O termo cárie oculta vem sendo utilizado para descrever lesões de cárie em dentina sob superfícies de esmalte aparentemente hígidas ou minimamente desmineralizadas. Considerando a dificuldade de diagnóstico e como essas lesões possuem progressão silenciosa, muitas vezes não são detectadas no exame clínico de rotina. O objetivo deste trabalho é relatar, baseado na literatura, dois casos clínicos de cárie oculta, ressaltando a importância da radiografia interproximal para o seu diagnóstico, bem como descrever o tratamento restaurador através da técnica da matriz oclusal individual de acrílico...

The term hidden caries is used to describe carious lesions in dentine under apparently sound enamel surface or minimum desmineralized one. Considering the difficult in its diagnosis and as these injuries have slow progression, many times they are not detected in the clinical examination of routine. The objective of this work is to discuss two clinical cases of hidden caries, standing out the importance of the interproximal radiography for the diagnosis, as well as to describe the restoring treatment carried through the use of individual occlusal acrylic matrix technique...

Caries experience in young children with congenital heart disease in a developing country

Oral care is frequently suboptimal in children from developing countries, especially those suffering from severe systemic diseases. The aim of the present study was to analyze the oral epidemiological profile of 3-to-5-year-old children with congenital heart disease. Dental and medical records of children evaluated at the Dental Service of the National Institute of Cardiology, Rio de Janeiro, Brazil, were reviewed. Caries experience was reported using the dmft index. Negative behavior towards dental management was recorded. The sample consisted of 144 children aged 4.41 ± 0.95 years. The mean dmft value was 5.4 ± 4.9, and 80.5% had at least one caries lesion. Dmft index was greater in the presence of cyanotic cardiac disease and in children with negative behavior. An increase in the “missing” component of the dmft index was also found in children using medicine on a daily basis. A higher caries experience was associated with children whose fathers had only an elementary education. In conclusion, children with congenital heart disease had high levels of caries experience at a young age. Cyanosis, negative behavior, daily use of medicine, one-parent family and the educational level of fathers seem to influence caries experience in children with congenital cardiac disease.

Desastres naturais: sistemas de informação e vigilância: uma revisão da literatura / Natural disasters: information systems and surveillance system: a review of literature

Objetivo: realizar revisão bibliográfica sobre a construção e implementação de sistemas de informação e vigilância sobre desastres naturais. Metodologia: o presente artigo apresenta uma revisão de literatura de artigos científicos realizada nas bases de dados Pubmed e Scielo. Resultados: demonstraram que os sistemas de informação e/ou vigilância utilizados tinham como objetivos principais a análise da extensão dos danos, identificação das áreas e populações vulneráveis e avaliação das necessidades em saúde de grupos populacionais mais expostos à ocorrência dos desastres. Conclusões: há a necessidade de sistemas de informação e vigilância integrados entre áreas como Saúde Pública, Defesa Civil e Ambiental para a análise dos efeitos dos desastres sobre a saúde das populações.

Objective: literature review on the construction and implementation of information systems and surveillance of natural disasters. Methodology: this article presents a literature review of papers held in the databases Pubmed and Scielo. Results: showed that information systems and/or surveillance were used as main objectives the analysis of the extent of the damage, identifying areas and vulnerable populations and assessment of health needs of population groups most exposed to the occurrence of disasters. Conclusions: there is need for information systems and integrated monitoring within areas such as Public Health, Civil and Environmental Defense to analyze the effects of disasters on the health of populations.

Dentinogênese Imperfeita tipo III e tipo II em crianças: relato de casos / Dentinogenesis Imperfecta type III and type II in children: cases report

O objetivo deste artigo é relatar dois casos de dentinogênese imperfeita, tipo III e tipo II, respectivamente, em crianças, enfatizando a importância do diagnóstico e do tratamento reabilitador. Clinicamente, em ambos os casos, constataram-se destruição dos molares decíduos, perda de dimensão vertical e coloração cinza-acastanhada dos elementos dentários. Vale ressaltar que em relação à criança com dentinogênese imperfeita tipo III, o diagnóstico foi fechado após exame histopatológico. No entanto, devido as constantes faltas às consultas para realização do tratamento, o mesmo encontra-se em andamento. Já, quanto ao caso da dentinogênese imperfeita tipo II, o tratamento reabilitador baseou-se na reconstrução dos molares decíduos com coroas de aço pré-fabricadas e restaurações estéticas nos caninos decíduos e incisivos inferiores permanentes, restabelecendo a estética e função.

This paper aimed to report two cases of type III and type II dentinogenesis imperfecta, in children, emphasizing the diagnosis and the rehabilitation treatment importance. Intraoral examination, in both cases, revealed destruction of the deciduous molars, dimension vertical loss and gray coloring of the teeth. Besides, in relation to the child with type III dentinogenesis imperfecta, a histopathologic exam was done to conclude the diagnosis. On the other hand, the all treatment of this child cannot be realized, because his constant faults. In relation to the other case, the rehabilitation treatment aimed to reconstruct the deciduous molars with steel crowns and aesthetic restorations on the deciduous canines and permanent lower incisives, reestablishing the aesthetic and function.

Qualidade de vida e saúde bucal em escolares do Rio de Janeiro / Quality of life and oral health in school children of Rio de Janeiro

O objetivo deste estudo foi validar o índice de Impactos Odontológicos no Desempenho de Atividades Diárias da Criança (Child-OIDP) e aplicá-lo para avaliar o impacto da saúde bucal no desempenho das atividades diárias de escolares da rede pública do Riode Janeiro. Na adaptação transcultural do Child-OIDP para crianças brasileiras, três tradutores, tendo como língua materna o português, realizaram versões do instrumento. Estas foram avaliadas em um comitê multiprofissional de revisão que produziu uma única versão preliminar. Esta versão foi utilizada em discussão em um grupo focal com dez escolares de 11-14 anos e aplicada em uma amostra que envolveu 13 outros escolares da mesma faixa etária em uma escola pública em Nova Iguaçu, Rio de Janeiro.Uma nova revisão realizou as modificações de acordo com o que se verificou no estudo piloto. A versão foi re-traduzida para a língua inglesa por dois tradutores nativos em inglês e revisadas novamente pelo comitê de revisão e pelos autores do Child-OIDPoriginal. A versão brasileira do Child-OIDP foi aplicada em estudo com 342 crianças do Rio de Janeiro e Belo Horizonte. Em termos de reprodutibilidade, o kappa ponderadofoi 0,76 e o ICC 0,79. O alfa de Cronbach foi de 0,63. O índice teve associação estatisticamente significante com medidas de autopercepção em saúde (saúde bucal autopercebida, satisfação com saúde bucal, necessidades odontológicas percebidas,saúde geral autopercebida; Kruskal-Wallis). Após a validação, o índice Child-OIDP foi aplicado a uma amostra probabilística de 571 crianças de 11-12 anos matriculadas em escolas públicas do Rio de Janeiro, que também passaram por um exame bucal. Nototal, 88,7 por cento dos escolares apresentaram pelo menos um impacto odontológico nos últimos três meses. As atividades diárias mais afetadas foram comer e limpar a boca. Um modelo de regressão logística foi utilizado para identificar associação entre o índice e variáveis sócio-demográficas, clínicas e relativas à autopercepção em saúde bucal entre as crianças. Foi encontrada associação estatisticamente significante entre a presença de impacto e o índice de cárie (...). Crianças com presença de cárie ou suas conseqüências tiveram 2,20 mais chances de ter impacto do que criançaslivres de cáries. Pode ser concluído que a versão brasileira do índice Child-OIDP,validada na presente pesquisa tem aplicabilidade para avaliação de necessidades em saúde bucal e mostrou-se associada à presença de cárie ou suas conseqüências e às variáveis de autopercepção em saúde bucal.

Adaptação transcultural de índices de qualidade de vida relacionada à saúde bucal / Cross-cultural adaptation of quality of life indices for oral health

O objetivo do presente trabalho foi avaliar criticamente o processo de adaptação transcultural dos principais instrumentos de qualidade de vida relacionados à saúde bucal. Foram realizadas buscas nas bases de dados bibliográficos LILACS e MEDLINE, com o intuito de encontrar estudos que se propuseram a adaptar instrumentos para mensuração de qualidade de vida relacionada à saúde bucal para culturas diferentes daquela em que o instrumento original foi desenvolvido. Vinte e nove artigos foram avaliados. Foi verificada grande disparidade nos métodos empregados para adaptar instrumentos de mensuração de qualidade de vida relacionada à saúde bucal, o que limita a futura utilização dos indicadores não adaptados corretamente, uma vez que eles podem não representar uma medida correta da saúde dessa população.

The aim of this study was to evaluate the cross-cultural adaptation of the main quality of life instruments related to oral health. Studies on cross-cultural adaptation of oral health-related quality of life measures were searched for in LILACS and MEDLINE. Twenty-nine articles were analyzed, identifying distinct methods for cross-cultural adaptation of oral health-related quality of life measures. Such differences could jeopardize the future use of these instruments, since the instruments may not adequately represent the health status of the respective target populations.

Reabilitação de dentes decíduos com pinos pré-fabricados e coroas de celulóide: relato de caso / Rehabilitation of deciduos teeth with prefabricated posts and celluloid crows: case report

O presente estudo aborda técnicas operatórias para reconstrução de dentes decíduos anteriores com grande destruição coronária. Os autores apresentam um caso clínico realizado na Clínica de Odontologia da Universidade Veiga de Almeida (UVA), no qual pinos pré-fabricados foram utilizados juntamente com coroas de celulóide na reabilitação estética e funcional de um paciente infantil.