Calidad de vida y sarcopenia en pacientes adultos con insuficiencia renal crónica / Quality of life and sarcopenia in adult patients with chronic renal failure

RESUMEN Introducción: la calidad de vida puede alterarse en los pacientes con insuficiencia renal crónica, sobre todo si sufren concomitantemente de sarcopenia. Objetivo: determinar la relación entre sarcopenia y calidad de vida en pacientes adultos con insuficiencia renal crónica del Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Metodología: se utilizó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica. Se midieron variables antropométricas, clínicas y laboratoriales. La calidad de vida se evaluó con el cuestionario EQ-5D y la sarcopenia con la fuerza de prensión palmar y el índice de masa muscular. Los datos se sometieron a estadística descriptiva y analítica con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: ingresaron al estudio 62 varones con edad media 56 ± 15 años y 57 mujeres con edad media 51 ± 16 años. La más frecuente de la insuficiencia renal fue la hipertensión arterial asociada a la diabetes mellitus (45,4 %). La sarcopenia se confirmó en 38,6 % de los pacientes. La calidad de vida fue buena en 30,25 %, regular en 39,5 % y mala en 30,25 %. Conclusión: en pacientes adultos con insuficiencia renal crónica, la sarcopenia predominó en los sujetos con regular y mala calidad de vida.

ABSTRACT Introduction: the quality of life can be altered in patients with chronic renal failure, especially if they suffer concomitantly from sarcopenia. Objective: to determine the relationship between sarcopenia and quality of life in adult patients with chronic renal failure at the Hospital Nacional (Itauguá) and the Hospital Militar (Asunción) between April and November 2021. Methodology: an observational, descriptive, cross-sectional design was used. Adult subjects of both sexes, carriers of chronic renal failure were included. Anthropometric, clinical and laboratory variables were measured. Quality of life was evaluated with the EQ-5D questionnaire and sarcopenia with palm grip strength and muscle mass index. The data was submitted to descriptive and analytical statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 62 men with a mean age of 56 ± 15 years and 57 women with a mean age of 51 ± 16 years entered the study. The most frequent renal failure was arterial hypertension associated with diabetes mellitus (45.4 %). Sarcopenia was confirmed in 38.6 % of the patients. The quality of life was good in 30.25 %, regular in 39.5 % and bad in 30.25 %. Conclusion: in adult patients with chronic renal failure, sarcopenia prevailed in subjects with fair and poor quality of life.

Metaciclogénesis de Trypanosoma cruzi en Belminus ferroae (Reduviidae: Triatominae) y capacidad infectiva de las heces en condiciones de laboratorio / Metacyclogenesis of Trypanosoma cruzi in B. ferroae (Reduviidae: Triatominae) and feces infectivity under laboratory conditions

Resumen | Introducción. Belminus ferroae es un triatomino de comportamiento entomófago, sin embargo, puede alimentarse de vertebrados ocasionalmente. No se ha demostrado infección natural por Trypanosoma cruzi en esta especie, como tampoco la metaciclogénesis del parásito. Objetivo. Examinar la metaciclogénesis de T. cruzi en B. ferroae y la capacidad infectiva de las heces o sus contenidos intestinales en roedores. Materiales y métodos. Se analizaron las heces y la orina expulsadas espontáneamente por los insectos o mediante compresión abdominal o extracción del contenido intestinal a los 10, 20, 30, 40, 50 y 60 días. Se cuantificó la carga parasitaria de T. cruzi y sus formas evolutivas se identificaron con tinción de Giemsa. Asimismo, se evaluó en ratones albinos la capacidad infectiva de los tripomastigotes metacíclicos de T. cruzi obtenidos de las heces o contenidos intestinales de los especímenes infectados. Resultados. El análisis parasitológico reveló tres (15 %) insectos infectados con T.cruzi a los 30 (n=1), 40 (n=1) y 50 (n=1) días después de la infección con cargas parasitarias de hasta 1,62 x 105 tripanosomas/mm3 y porcentajes de metaciclogénesis entre el 3,5 y el 6,78 %. Conclusiones. Se demuestra por primera vez, en una especie del género Belminus, la metaciclogenésis de T. cruzi en condiciones de laboratorio y la capacidad infectiva de las heces para un huésped vertebrado.

Abstract | Introduction: Belminus ferroae is a triatominae with entomophagous behavior. However, it may occasionally feed on vertebrates. Currently, there is no evidence of natural infection with Trypanosoma cruzi or the occurrence of metacyclogenesis in this species. Objective: To test T. cruzi metacyclogenesis in B. ferroae and the infectivity of their feces or intestinal contents in rodents under laboratory conditions. Materials and methods: Twenty nymphs of B. ferroae were infected with an autochthonous strain of T. cruzi (M/HOM/VE/09/P6). Fecal and urine samples were collected from spontaneous droppings or by compressing the bugs' abdomens and, eventually, by removing their gut contents, and then examined at 10, 20, 30, 40, 50, and 60 days. We quantified T. cruzi parasitic load, as well as the evolutionary forms in feces, urine, and intestinal contents by Giemsa staining. Similarly, we evaluated the infectivity of T. cruzi metacyclic trypomastigotes in albino mice. Results: The parasitological analysis showed three insects (15%) infected with T. cruzi at 30 (n=1), 40 (n=1), and 50 (n=1) days post-infection. We observed parasitic loads of up to 1.62 x 105 trypanosomes/mm3 and metacyclogenesis percentages between 3.5% and 6.78%. Conclusions: This is the first time that T. cruzi metacyclogenesis is reported in a species of the genus Belminus under laboratory conditions and the infectivity of Belminus' feces is demonstrated on a vertebrate host.

Fatores de risco materno-fetais para o nascimento pré-termo em hospital de referência de Minas Gerais / Maternal and fetal risk factors for preterm birth in a reference hospital in Minas Gerais

Introdução. São considerados prematuros, os bebês nascidos antes de completar 37 semanas de gestação e, no Brasil, sua prevalência chega a aproximadamente 10%. A prematuridade pode comprometer a saúde do recém-nascido (RN) e levar a repercussões socioeconômicas. Portanto, é fundamental rastrear gestantes sob risco através de pré-natal adequado, a fim de afastá-las dessas condições ou minimizar suas implicações. Objetivos. Avaliar os principais fatores de risco maternos e fetais associados ao parto pré- termo em um hospital de referência em Barbacena. Métodos. Estudo transversal, retrospectivo, analítico, realizado no Hospital Santa Casa de Misericórdia de Barbacena. Avaliou-se prontuários materno-fetais impressos, disponibilizados de todos os nascimentos pelo Sistema Único de Saúde (SUS), em 2017. Foram analisados dados como: idade, profissão e patologias maternas; exames realizados durante gestação e informações do RN. Resultados. Dentre os 1278 prontuários, foram encontrados 177 prematuros. Verificou-se que diabetes mellitus (DM) ou diabetes mellitus gestacional (DMG), infecções do trato urinário (ITU), síndromes hipertensivas na gravidez, sífilis materna, gemelaridade e parto cesáreo foram estatisticamente relevantes como fatores de risco para prematuridade; e as gestantes trabalhadoras rurais tiveram menos partos prematuros de forma estatisticamente significativa quando comparadas às outras ocupações. Primiparidade e extremos de idade reprodutiva não foram significativos. Quanto aos RN, malformações e peso pequeno para a idade gestacional (PIG) também foram fatores de risco. Conclusões. Os principais fatores de risco maternos e fetais associados ao parto pré-termo na amostra foram DM, ITU, síndromes hipertensivas na gravidez, sífilis materna, gemelaridade, parto cesáreo, malformações fetais e PIG. (AU)

Introduction. Babies born before 37 weeks of gestation are considered premature and, in Brazil, their prevalence reaches approximately 10%. Prematurity can compromise the newborn's health and lead to socioeconomic repercussions. Therefore, it is essential to track pregnant women at risk through an adequate prenatal care, in order to remove them from these conditions or minimize their implications. Objective. To evaluate the main maternal and fetal risk factors associated with preterm birth in a reference hospital in Barbacena. Methods. A retrospective cross-sectional study, non-experimental made in Santa Casa de Misericórdia de Barbacena hospital. This study evaluated print medical records available of all births in Sistema Único de Saúde (SUS) in 2017. Some data were analyzed, such as: age, profession and maternal pathologies; examinations performed during pregnancy and information about the newborn. Results. The sample consisted of 1278 records of births, and there were 177 preterm births. It was checked that previous diabetes or gestational diabetes, urinary tract infections (UTI), pregnancy-induced hypertension, maternal syphilis, twinning and caesarean delivery were statistic relevant factors for prematurity; pregnant women who had a rural occupation had fewer premature deliveries in a statistically significant way than other occupations. First time pregnant women and those at extreme fertile age were not significant. About newborn data, malformations and small for gestational age (SGA) were risk factors for preterm birth. Conclusions. The main maternal and fetal risk factors associated with preterm birth on this study were diabetes, UTI, hypertension syndrome during pregnancy, maternal syphilis, twinning, caesarean delivery, malformations and SGA. (AU)

Atraso vacinal no município de Barbacena (MG): contextualizando o problema / Vaccine delay in the municipality of Barbacena (MG): contextualizing the problem

Introdução: O Programa Nacional de Imunizações (PNI) visa controlar ou erradicar doenças infectocontagiosas através de coberturas vacinais. Entretanto, há fatores que dificultam a vacinação. Este estudo procurou avaliar quais vacinas apresentaram maior atraso entre crianças de 0-5 anos incompletos e os principais motivos desses atrasos, bem como os dados socioeconômicos das respectivas mães nos três principais postos de saúde de Barbacena nos dias "D" das campanhas nacionais. Materiais e métodos: Estudo de corte transversal referente às crianças com atraso vacinal durante os dias "D" das campanhas nacionais contra poliomielite realizadas em 2014 e 2015. Os critérios de exclusão foram a não aceitação em participar da pesquisa, crianças com idade fora da faixa etária do estudo e aquelas que não apresentaram cartão. Resultados: Foram encontradas 112 crianças com atraso. Quando avaliadas as vacinas, notou-se que a prevalência de atraso foi da DTP-48 meses e da triviral-15 meses. Quanto aos motivos, destacaram-se presença de sintomas, desconhecimento e esquecimento. Orientação profissional e falta de vacina no posto também tiveram relevância. Conclusão: Foram encontrados atrasos na maioria das vacinas. Motivos que merecem destaque são a orientação profissional e falta de vacina. Provavelmente, o problema foi a falta de informação adequada. Entretanto, é necessário expandir o estudo.

Introduction: The National Immunization Program (NIP) aims to control or eradicate infectious diseases through vaccination coverage. However, there are factors that influence vaccination. Objectives: To assess which vaccines presented higher delay among children between 0-5 years of age and the main reasons for these delays, as well as to evaluate the socioeconomic data of their mothers at the three main health posts of the city of Barbacena on the "D" days of the national immunization campaigns. Materials and methods: Cross-sectional study of children with delayed immunization on the "D" days of the national immunization campaigns against polio conducted in 2014 and 2015. The exclusion criteria were: refusal in taking part in the research, children whose age was not in the age range of the study, and those who did not have their vaccination cards. Results: 112 children had at least one vaccination delay. Regarding the vaccines, it was noted that the prevalence delay was in the DTP at 48 months and in the MMR at 15 months. The reasons given for this delay were the presence of symptoms, unawareness, and oblivion. Professional guidance and shortage of vaccine at the post also had relevance. Conclusion: Delays were found in most vaccines. The reasons worth mentioning are professional guidance and shortage of vaccine. The problem was likely due to the lack of adequate information. However, it is necessary to expand the study.

Community-acquired urinary tract bacterial infections and drug resistance among patients followed at a reference center in Fortaleza, Ceará, Brazil

Background: The aim of this study was to assess the antimicrobial resistance pattern of the most frequent pathogens responsible for community-acquired urinary tract infection (UTI). Methods: This is a retrospective, descriptive epidemiological survey involving all urine samples submitted for culture and antimicrobial susceptibility testing from patients with clinical diagnosis of UTI followed at the outpatient clinic of the Núcleo de Atenção Médica Integrada, University of Fortaleza, Brazil. The study period was from September 2012 to July 2013. Urine cultures were processed with clean-catch midstream urine samples in the local laboratory employing standard methods. A questionnaire was used to collect patient demographic data and the results of the bacterial identification and susceptibility testing. The data were analyzed by SPSS software. Results: A total of 514 urine samples were analyzed. Most patients were females (78.6%). Patients' mean age was 39 years old. Bacterial growth was observed in 16.5% of the samples. This rate was lower in women (13.6%) than in men (27.3%). The most prevalent pathogen was Escherichia coli (57.6%), followed by Klebsiella sp. (35.3%) and Proteus sp. (4.7%). E. coli showed a high frequency of resistance to ampicillin (88.2%) and sulfamethoxazole/trimethoprim (77.1%), as well as significant resistance to ciprofloxacin (38.9%) and norfloxacin (39.4%). Isolates from elderly patients (>60 years) had higher resistance to all tested antibiotics. Conclusions: There is a trend toward increasing bacterial resistance among the main UTI pathogens. Resistance to sulfamethoxazole/trimethoprim follows a worldwide increase rate tendency and it should be avoided as a first-line empirical treatment for UTIs. A significant resistance to quinolones was also observed.

Leprosy nephroptthy: a review of clinical and histopathological features / Nefropatia da hanseníase: revisão dos aspectos clínicos e histopatológicos

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

A hanseníase é doença crônica causada pelo Mycobacterium leprae, altamente incapacitante e com envolvimento sistêmico em alguns casos. O envolvimento renal tem sido relatado em todas as formas da doença, sendo mais frequente nas formas multibacilares. A apresentação clínica é variável e determinada pela reação do sistema imunológico do hospedeiro ao bacilo. Durante o curso da doença podem ocorrer os chamados estados reacionais, nos quais o sistema imune reage contra o bacilo, exacerbando as manifestações clínicas. Diferentes lesões renais tem sido descritas na hanseníase, incluindo glomerulonefrites, nefrite intersticial, amiloidose secundária e pielonefrite. O mecanismo exato que leva à glomerulonefrite na hanseníase ainda não está completamente esclarecido. O tratamento da hanseníase inclui o uso de rifampicina, dapsona e clofazimina. Prednisona e antiinflamatórios não-hormonais podem ser usados no controle dos episódios imunológicos agudos.

Investigation of urinary abnormalities and risk factors for kidney disease in the World Kidney Day campaigns in Northeast Brazil / Investigação de alterações urinárias e fatores de risco para doença renal nas campanhas do Dia Mundial do Rim no Nordeste do Brasil

Objective: chronic kidney disease (CKD) is an increasing common problem in the world due to the exponential growth of diabetes mellitus, hypertension and other risk factors. The aim of this study is to investigate urinary abnormalities and risk factors for kidney disease in the general population. Methods: this study was performed from data collected during the annual World Kidney Day (WKD) campaigns, in Fortaleza, Ceará, Brazil, between 2009 and 2012. The population sought assistance spontaneously in stands placed in high people-traffic areas. Results: among 2,637 individuals interviewed, the mean age was 50.7±15.7 years and 53% were male. The main risk factors found were sedentarism (60.7%), obesity (22.7%) and smoking (19.8%). Blood pressure (BP) > 140x90 mmHg was found in 877 (33%). Increased BP was found for the first time in 527 cases (19.9%). Cardiovascular diseases were reported in 228 (8.6%). Diabetes was related by 343 (13%). Capillary blood glucose > 200 mg/dL was found in 127 (4.8%) and it was > 200 mg/dL for the first time in 30 (1.13%). Urinalysis was performed in 1,151 people and found proteinuria in 269 (23.3%). Proteinuria was most frequent in hypertension people (77.3% vs. 55.8%, p=0.0001), diabetes mellitus (22.7% vs. 15.2%, p=0.005) and elderly (42.1% vs. 30.7%, p=0.0007). Conclusion: risk factors for CKD are frequent in the general population. Many individuals had hypertension and diabetes and did not know this. It is important to regularly perform actions like WKD in order to early detect potential candidates for CKD. .

Objetivo: a doença renal crônica (DRC) é um problema crescente no mundo em razão do crescimento exponencial do diabetes mellitus, da hipertensão e de outros fatores de risco. O objetivo deste estudo é investigar alterações urinárias e fatores de risco para doença renal na população geral. Métodos: este estudo foi realizado a partir de dados coletados durante as campanhas anuais do Dia Mundial do Rim, em Fortaleza, Ceará, Brasil, entre 2009 e 2012. A população buscou atendimento espontaneamente nos stands montados em locais de alto tráfego de pessoas. Resultados: entre 2.637 indivíduos entrevistados, a média de idade foi de 50,7±15,7 anos, sendo 53% do gênero masculino. Os principais fatores de risco encontrados foram sedentarismo (60,7%), obesidade (22,7%) e tabagismo (19,8%). Pressão arterial (PA) > 140x90 mmHg foi encontrada em 877 casos (33%). Aumento da PA foi encontrado pela primeira vez em 527 casos (19,9%). Doenças cardiovasculares foram relatadas por 228 indivíduos (8,6%). Diabetes foi relatado por 343 indivíduos (13%). Glicemia capilar > 200 mg/dL foi encontrada em 127 casos (4,8%) e > 200 mg/dL pela primeira vez em 30 (1,13%). O exame de urina foi realizado por 1.151 pessoas, sendo encontrada proteinúria em 269 casos (23,3%). Proteinúria foi mais frequente em pessoas com hipertensão (77,3% vs. 55,8%, p = 0,0001), diabetes mellitus (22,7% vs. 15,2%, p = 0,005) e em idosos (42,1% vs. 30,7%, p = 0,0007). Conclusão: fatores de risco para DRC são frequentes na população geral. Muitos indivíduos tinham hipertensão e diabetes e não sabiam disso. É importante a realização de ações como o Dia Mundial do Rim com o objetivo de detectar precocemente potenciais candidatos à DRC. .

Proliferación de trypanosoma cruzi en la membrana peritoneal y líquido ascítico de ratones con infección aguda / Proliferation of trypanosoma cruzi in the peritoneal membrane and ascitic liquid of mice with acute infection

En este estudio fue analizada la parasitemia y el parasitismo en el líquido ascítico (LA), membrana peritoneal (MP) y en otros tejidos de 40 ratones machos NMRI durante la infección aguda. Los ratones (20 ratones por grupo) fueron inoculados por vía intradérmica con tripomastigotos metacíclicos linaje T.cr I de las cepas P6 y P11 obtenidos de Rhodnius prolixus. Formas delgadas y gruesas de tripomastigotos fueron encontradas en la sangre de todos los ratones. En los ratones infectados con la cepa P6 los tripomastigotos aparecieron primero en él LA a los 13 días pi y en la sangre a los 18 días pi, en los ratones infectados con la cepa P11 los parásitos se observaron primero en la sangre a los 15 días pi y en él LA a los 22 días pi. Los ratones desarrollaron emaciación, disnea, hirsutismo, pérdida de la actividad motora de las patas posteriores y hepatoesplenomegalia. Los ratones fueron sacrificados a los 39 días pi. El estudio histológico mostró que T. cruzi prolifera formando nidos de amastigotos y tripomastigotos en la MP. Los parásitos también fueron encontrados en el músculo esquelético y en el corazón de los ratones infectados con la cepa P6. La inmunotinción con PAP reveló antígeno de T. cruzi en las secciones de esófago, estómago, intestino delgado y grueso, bazo, riñón, hígado, próstata y pene de los ratones. Estos resultados confirmaron que las cepas P6 y P11 desarrollaron anormalidades histopatológicas en el tracto gastrointestinal, renal y órgano reproductivo. La localización intra-peritoneal de los parásitos y la acumulación de fluido peritoneal, reveló ascitis y peritonitis causada por el incremento de líquido en la cavidad peritoneal y destrucción del tejido peritoneal de los ratones. El presente estudio reporta por primera vez la proliferación de tripomastigotos en la cavidad peritoneal cinco días antes de encontrarse en la sangre periférica para la cepa P6 causando daño intraperitoneal y muerte del modelo murino utilizado.

In this study we analyzed the parasitemia and parasitism in the ascitic fluid (AF), peritoneal membrane (PM) and in other tissues of 40 NMRI male mice during acute infection. Mice (20 mice per group) were inoculated by intradermal route with metacyclic trypomastigotes T.cI lineage of P6 or P11 strains obtained from Rhodnius prolixus. Slender and stout forms were observed in the blood of all mice. In infected mice with P6 strain the trypomastigotes were observed first in the AF at day 13 pi and in blood at day 18 pi. Meanwhile in infected mice with P11 strain trypomastigotes were observed first in the blood at day 15 pi and in the AF at day 22 pi. Infected mice showed emaciation, dyspnea, bristled hair, loss of motor activities in the rear limbs and hepatosplenomegaly. Mice were sacrificed at day 39 pi. Histological finding indicated that T. cruzi proliferates forming amastigotes and trypomastigotes nests in the PM. Parasites were also observed in skeletal muscle of the mice and in the heart of infected mice with P6 strain. Imunostaining with PAP revealed T. cruzi antigen in esophagus, stomach, thin and thick intestine, spleen, and kidney, liver, prostate and penis. The results show that P6 and P11 colonized and produced abnormalities in the gastrointestinal tract, renal and reproductive organs. Intra-peritoneal localization of parasites and accumulation of peritoneal fluid, revealed ascites and peritonitis caused by increase of fluid in the peritoneal cavity and destruction of the membrane peritoneal of the mice. This study reports for the first time the proliferation of trypomastigotes in the peritoneal cavity five days earlier than in peripheral blood for the P6 strain causing intra-peritoneal damage and death in the murine model used.

Hyponatremia, acute kidney injury, and mortality in HIV-related toxoplasmic encephalitis

BACKGROUND: There are no reports on hyponatremia and acute kidney injury (AKI) involved in the course of HIV-related toxoplasmic encephalitis (TE). The main objective of this study was to describe the occurrence of hyponatremia and its relationship with AKI and mortality in HIV-related toxoplasmic encephalitis (TE). METHODS: This was a retrospective cohort study on patients with HIV-related TE. AKI was considered only when the RIFLE (risk, injury, failure, loss, end-stage) criterion was met, after the patient was admitted. RESULTS: A total of 92 patients were included, with a mean age of 36 ± 9 years. Hyponatremia at admission was observed in 43 patients (46.7%), with AKI developing in 25 (27.1%) patients during their hospitalization. Sulfadiazine was the treatment of choice in 81% of the cases. Death occurred in 13 cases (14.1%). Low serum sodium level correlated directly with AKI and mortality. Male gender (OR 7.89, 95% CI 1.22-50.90, p = 0.03) and hyponatremia at admission (OR 4.73, 95% CI 1.22-18.30, p = 0.02) were predictors for AKI. Independent risk factors for death were AKI (OR 8.3, 95% CI 1.4-48.2, p < 0.0001) and hyponatremia (or 9.9, 95% ci 1.2-96.3, p < 0.0001). CONCLUSION: AKI and hyponatremia are frequent in TE. Hyponatremia on admission is highly associated with AKI and mortality.

Efecto de la infección congénita por Trypanosoma cruzi sobre el desarrollo intrauterino y la respuesta inmune fetal-neonatal / Effect of congenital infection by Trypanosoma cruzi on intrauterine development and the fetal-neonatal immune response

En la infección congénita por Trypanosoma cruzi la morbilidad y mortalidad varían desde casos asintomáticos hasta severos cuadros clínicos de la enfermedad. En recién nacidos infectados por T. cruzi se ha encontrado que no existe un perfil clínico determinado, puesto que durante el desarrollo intrauterino se producen diversas alteraciones, presentándose cambios en el perfil serológico y parasitológico. Algunos factores intrínsecos del hospedador, tales como: la barrera placentaria y la capacidad tanto de la madre como del feto de desarrollar una respuesta inmune específica capaz de controlar la multiplicación parasitaria podrían estar involucrados en tales diferencias. Otra posibilidad incluye el polimorfismo genético de T. cruzi, pues se considera que las cepas de mayor virulencia pueden atravesar con mayor facilidad la placenta y son más patógenas para el feto y/o neonato.

In congenital infection by Trypanosoma cruzi, morbidity and mortality vary from asymptomatic cases to severe clinical forms of the disease. It has been found that there is no specific clinical profile in newborns infected by T. cruzi, since during intrauterine development diverse pathological changes take place, causing alterations in the serological and parasitological profiles. Some intrinsic factors of the host, such as: the placental barrier and the ability of both, mother and fetus, to develop a specific immune response to control parasite multiplication, could be involved in such differences. Another possibility includes the genetic polymorphism of T. cruzi, since it is considered that strains of greater virulence can cross the placenta more easily and are more pathogenic to the fetus and/or the neonate.

Programa preparar da CRSSUL: as emoções pautadas na continuidade digna da vida dos trabalhadores municipais no período da aposentadoria / Preparing the program CRSSUL: emotions guided by the continuity of life worthy of the municipal workers during retirement

Trata-se de uma Pesquisa Qualitativa Descritiva que disserta sobre um fenômeno coletivo desencadeado pelo Curso do Programa PRE PARAR para os trabalhadores municipais da CRS SUL, no período da aposentadoria, através da análise de suas avaliações escritas em questionário aplicado no sexto e último encontro, assim como no seu comportamento e participação em todos os encontros do referido Curso.

Programa Preparar da CRSSUL: As emoções pautadas na continuidade digna da vida dos trabalhadores municipais no período da aposentadoria

Trata-se de uma Pesquisa Qualitativa Descritiva que disserta sobre um fenômeno coletivo desencadeado pelo Curso do Programa PRE PARAR para os trabalhadores municipais da CRS SUL, no período da aposentadoria, através da análise de suas avaliações escritas em questionário aplicado no sexto e último encontro, assim como no seu comportamento e participação em todos os encontros do referido Curso

Presencia de epimastigotes de Trypanosoma cruzi en el plasma seminal de ratones con infección aguda / Trypanosoma cruzi epimastigotes in seminal plasma in acute infected mice

Se reporta la presencia de formas evolutivas de Trypanosoma cruzi en el plasma seminal (PS) de ratones NMRI, inoculados por vía subcutánea con 2x104 tripomastigotes metacíclicos cepa P6 obtenidos de Rhodnius prolixus. Al separar las muestras de sangre a los 15 días pos-infección, un ratón eyaculó espontáneamente y el examen directo del PS reveló la presencia de formas epimastigotes de T. cruzi en activo movimiento mezclados con los espermatozoides. Las preparaciones del PS coloreadas con Giemsa, mostraron formas epimastigotes libres y en división, tripomastigotes y amastigotes extracelulares y dentro de células fagocíticas. Los resultados de este estudio revelaron los diferentes estadios de T. cruzi en el PS de ratón, con morfogénesis similar a como ocurre en el insecto vector. El parasitismo encontrado en el PS del ratón con infección aguda, aporta importante información epidemiológica sobre la vía de transmisión sexual de T. cruzi, principalmente entre la población de reservorios silvestres que se encuentran en áreas endémicas y no endémicas para la enfermedad de Chagas.

We report the presence of evolving forms of Trypanosoma cruzi in the seminal plasma (SP) of NMRI mice subcutaneously inoculated with 2x104 metacyclic trypomastigotes obtained from P6 strain Rhodnius prolixus. When taking blood samples at 15 days post-infection, the mouse spontaneously ejaculated and the direct SP exam revealed the presence of active epimastigotes of T. cruzi mixed with spermatozoids. SP preparations stained with Giemsa showed free and dividing epimastigotes, extracellular trypomastigotes and amastigotes, as well as, within phagocytic cells. The results showed the presence of T. cruzi at the different stages of its life cycle in the mouse PS, observing similar morphogenesis in the PS to the one known in the insect vector. The parasitism found in the SP of this mouse with acute infection, provides important epidemiological information about the T. cruzi pathway of sexual transmission, mainly among the population of wild reservoirs found in endemic and non-endemic areas for Chagas`disease.

Neck circumference, a bedside clinical feature related to mortality of acute ischemic stroke / Perímetro cervical, uma medida à beira do leito relacionada com a mortalidade no acidente vascular cerebral isquêmico

OBJECTIVE: The aim of this study was to evaluate clinical/demographic factors, sleep alterations and one year mortality in acute ischemic stroke. METHODS: This was a prospective study of 89 consecutive patients (mean age 64.39 ± 8.51 years) with acute ischemic stroke. High risk of obstructive sleep apnea (OSA) was evaluated by the Berlin questionnaire, daytime somnolence by the Epworth Sleepiness Scale (> 10) and subjective sleep quality by the Pittsburgh Sleep Quality Index (> 5). Clinical and anthropometric data including body mass index, hip-waist ratio, neck circumference (NC) were obtained. Increased NC was defined if > 43 cm in men and > 38 cm in women. Stroke severity was estimated by the Barthel Index and the modified Rankin Scale. The end-point was death after 12 months follow-up. RESULT: One-year mortality was 8.9 percent. Non-survivors were older (p = 0.006) and had larger NC (p = 0.02). Among all cases, large NC was related to high risk of OSA, diabetes and hypertension (Fisher's exact test). Compared to men, women showed relatively larger NC. Overall, family history of stroke (74.2 percent), diabetes (33.7 percent) and hypertension (78.6 percent) were frequent; obesity (11.2 percent) was uncommon. Daytime sleepiness (34.8 percent), poor sleep quality (65.2 percent) and risk of OSA (58.42 percent) were frequently found. CONCLUSION: Poor sleep quality, excessive daytime sleepiness and high risk of OSA are frequent in this sample with acute ischemic stroke. One-year mortality was related to older age and large NC. As obesity is uncommon in acute stroke patients, a large NC should be taken as a significant clinical sign related to mortality.

OBJETIVO: O objetivo do estudo é avaliar em pacientes com acidente vascular cerebral (AVC) isquêmico, os fatores clínico/demográficos, alterações do sono e a mortalidade após um ano. MÉTODOS: Trata-se de estudo prospectivo envolvendo 89 pacientes consecutivos (64,39 ± 8,51 anos) com AVC isquêmico agudo. Foram avaliados o risco elevado de apneia obstrutiva do sono (AOS) (questionário de Berlin), a sonolência diurna (Escala de Sonolência Epworth > 10) e a qualidade subjetiva do sono (Índice de Qualidade de Sono Pittsburgh > 5). O índice de massa corpórea, a relação cintura-quadril e o perímetro cervical (PC) foram estudados: PC aumentado foi definido se > 43 cm (homens) e > 38 cm (mulheres). Estimou-se a gravidade da doença pelo Índice de Barthel e pela Escala de Rankin modificada. O desfecho final foi o óbito após 12 meses. RESULTADOS: A mortalidade após um ano foi de 8,9 por cento. Os pacientes que foram a óbito eram mais idosos (p = 0,006) e apresentavam PC aumentado (p = 0,02). O PC aumentado relacionou-se com a presença de diabetes, hipertensão arterial e risco elevado de AOS (teste exato de Fisher). As mulheres apresentavam, relativamente, maior PC. Entre todos, história familiar de doença cerebrovascular (74,2 por cento), diabetes (33,7 por cento) e hipertensão (78,6 por cento) foram frequentes; obesidade (11,2 por cento) foi incomum. Sonolência diurna (34,8 por cento), má qualidade do sono (65,2 por cento) e risco de AOS (58,42 por cento) foram frequentes. CONCLUSÃO: Alterações do sono são frequentes no AVC isquêmico agudo. Mortalidade foi mais comum em pacientes mais idosos e com maior PC. No AVC isquêmico, o PC aumentado relaciona-se com a mortalidade e provavelmente constitui-se uma medida clínica importante a ser considerada.

La infección por Trypanosoma cruzi en ratones gestantes induce una respuesta inmune celular con producción de citocinas en sus fetos / Trypanosoma cruzi infection in pregnant mice induces a cellular immune response with citokines production in their fetuses

El objetivo del presente estudio fue detectar las citocinas IFN-g, IL-4 e IL-10 expresadas por células T CD4+ en tejidos de fetos de ratones con infección chagásica aguda. Para ello, se examinaron fetos de ratones NMRI cuyas madres fueron infectadas con 22×10³ tripomastigotes metacíclicos de la cepa M/HOM/BRA/53/Y de T. cruzi y preñadas durante la fase aguda de la infección. Para la detección y localización de infiltrados inflamatorios, nidos de parásitos, antígenos de T. cruzi y citocinas se emplearon las técnicas de hematoxilina-eosina, peroxidasa-anti-peroxidasa e inmunofluorescencia indirecta. Se detectaron infiltrados inflamatorios y antígenos con nidos de amastigotes en el músculo esquelético fetal. Células T CD4+ productoras de IFN-g así como depósitos de IFN-g e IL-10 fueron detectados en las secciones de placenta, corazón y músculo esquelético de fetos de ratones infectadas, mientras que células CD4+/IL-10+ se encontraron sólo en músculo esquelético, adicionalmente se detectaron depósitos de IL-4 sólo en placentas de ratones sanas. Estos resultados indican que el feto es capaz de generar una respuesta inmune propia frente a antígenos transmitidos por su madre, lo cual induce la secreción de citocinas que actuando en sinergia con los anticuerpos maternos le confieren un estado de protección contra la infección, y que la transmisión del parásito depende de factores específicos de cada madre, la cual puede modificar su capacidad de controlar tal transmisión ya sea a nivel placentario o sistémico.

The objective of this study was to detect the cytokines IFN-g, IL-4 and IL-10 expressed by CD4+ T cells in tissues of fetal mice with acute chagasic infection. For this, we examined the fetuses of NMRI mice whose mothers were infected with 22×10³ metacyclic trypomastigotes of the M/HOM/BRA/53/Y strain of T. cruzi and made pregnant during the acute phase of infection. For the detection and localization of inflammatory infiltrates, nest parasites, antigens of T. cruzi and cytokines we used hematoxylin-eosin techniques, peroxidase-anti-peroxidase and immunofluorescence. The immunohistochemical study revealed the presence of inflammatory infiltrates and antigens with amastigote nests in fetal skeletal muscle. CD4 + T cells producing IFN-g, as well as deposits of IFN-g and IL-10, were detected in sections of placenta, heart and skeletal muscle of fetuses of mice infected, while CD4+/IL-10+ was found only in skeletal muscle; in addition, deposits of IL-4 were detected only in placentas of healthy mice. These results indicate that fetuses are capable of generating their own immune response to antigens transmitted by their mother, which induces the secretion of cytokines and that, acting in synergy with the maternal antibodies, confer them a state of protection against infection; and that the transmission of the parasite depends on factors specific to each mother, which may modify its ability to control such transmission at the placental or systemic levels.

Doenças emergentes e condições de trabalho de enfermagem: um estudo de caso durante a pandemia de H1N1 no Rio de Janeiro / Emerging diseases and conditions of work of nursing: a case study during the H1N1 pandemic in Rio de Janeiro

As doenças infecto-parasitárias, ainda hoje, em pleno século XXI são responsáveis por uma quantidade generosa de morbidade e mortalidade no Brasil e no mundo. Muitas delas são amplamente influenciadas pelas mudanças climáticas que estão ocorrendo em todo o planeta fazendo com que sua incidência e distribuição geográfica aumentem. A dengue é considerada a principal doença reemergente nos países tropicais e subtropicais. A malária tem forte incidência nos países ao sul do deserto do Saara na África, ocorrendo também em vários países da América do Sul que possuem parte da região Amazônica em seu território. Várias doenças voltam a assolar a população de vários locais como as leishmanioses, a Doença de Lyme, erlichioses entre outras. Em março de 2009 começam a ocorrer os primeiros casos de uma nova doença inicialmente denominada Influenza suína, a qual, levou alguns indivíduos a óbito em Oaxaca, uma cidade mexicana localizada a 400 quilômetros da capital. Rapidamente, a doença se espalhou pelo país e posteriormente, no começo do mês de abril de 2009 já, existiam relatos de casos em vários países. O objetivo geral desta pesquisa é verificar em que medida o cuidado de enfermagem realizado expressou um maior ou menor grau de controle do enfermeiro sobre seu trabalho, apontando para os potenciais riscos (biológicos) de adoecimento e impactos negativos na saúde deste trabalhador. O presente estudo foi desenvolvido por meio de uma abordagem quantitativa com desenho longitudinal e observacional, delineamento de pesquisa não experimental e caráter descritivo. Foi feita a análise observacional nas tendas quanto a sua infraestrutura e posteriormente foi passado um questionário aos enfermeiros pautado em questões sobre o risco biológico que estes estavam sendo submetidos...

Infectious-parasitic diseases, up to the present, in XXI century are responsible for a high morbidity and mortality rate in Brazil as well as overseas. Many of them are widely influenced by climatic modifications that have been occuring all over the planet leading to an increase in their incidence and geographical distribution. Dengue is considered the main reemerging disease in tropical and subtropical countries. Malaria has strong incidence in countries that are in the south of Sahara desert in Africa, also occuring in many countries of South America that have part of their territory in Amazon region. A great deal of diseases have been frightening the population once again in many places, as leishmanioses, Lyme Disease, erlichioses, for instance. In March, 2009 the first cases of a new disease initially termed Influenza swine started to appear, leading some subjects to death in Oaxaca, a mexican city localized 400 kilometers far from the capital. Rapidly ,the disease had spread all over the country and later, in the beginning of April , 2009 there were some related cases in several countries. The overall aim of this study is to verify to what extent the nursing care that is carried out has expressed a higher or lower degree of control from the part of the nurse about his/her job, pointing at potential risks (biological) of illnesses and negative impacts into the worker health status. This study was developed by means of quantitative approach with longitudinal and observational design, a non experimental research and descriptive features. An observational analysis was carried out at the tents for their infra-structure and after this, a questionnaire was applied to the nurses based on matters as the biological risk they were being exposed...

Uma fotografia, múltiplas imagens: a educação rural no norte do Brasil / One photograph, myriad images: rural education in Northern Brazil

Aborda os processos de constituição e institucionalização de escolas nas fazendas de criação extensiva localizadas na ilha de Marajó, interior de Soure, Brasil, e demonstra que eles ocorreram associados à grande propriedade e a relações políticas estabelecidas entre fazendeiros, vaqueiros e poder público. Refexões teóricas, dados sociais e acontecimentos somam-se a imagens fotográficas que revelam a fragilidade da educação pública oferecida às crianças das zonas rurais do extremo norte do país.

The article addresses the processes by which schools have been established and institutionalized on extensive-grazing ranches in rural Soure, Marajó Island, Brazil. Emergence of these schools has been tied to large landholdings and to the political relations between ranchers, vaqueiros, and government. Theoretical reflections, social data, and events are placed side-by-side with photographs that depict the fragile state of public education available to children living in the rural areas of far northern Brazil.