Prevalência de perda auditiva e vulnerabilidade a saúde em crianças de 25 a 36 meses: uma análise da distribuição espacial / Prevalence of hearing loss and health vulnerability in children aged 25 to 36 months: an analysis of spatial distribution

RESUMO Objetivo Analisar a associação entre perda auditiva e a vulnerabilidade à saúde em crianças na faixa etária de 25 a 36 meses. Método Estudo observacional analítico do tipo transversal realizado por meio da triagem auditiva infantil em nove creches. A triagem constou de anamnese, meatoscopia, timpanometria, emissões otoacústicas transientes e audiometria tonal limiar. Para cada exame realizado foi estabelecido o critério de "passa" e "falha". Os endereços residenciais das crianças foram georreferenciados e foi construído mapa coroplético da distribuição espacial, considerando o Índice de Vulnerabilidade à Saúde (IVS). Foi realizada análise de associação entre o IVS com as variáveis sexo, exames audiológicos e regional de domicílio por meio dos testes Qui-quadrado de Pearson, e Exato de Fisher. Resultados Foram avaliadas 95 crianças de ambos os sexos, destas, 44,7% apresentaram alteração em pelo menos um dos exames realizados, sendo encaminhadas para avaliação otorrinolaringológica e auditiva. Das alterações observadas 36,9% ocorreram na timpanometria e 7,8% nas emissões otoacústicas transientes. Dentre crianças encaminhadas para avaliação, 9,7% apresentaram diagnóstico de perda auditiva do tipo condutiva, 13,6% resultados dentro da normalidade e 21,4% não compareceram para reavaliação. Das crianças que apresentaram o diagnóstico final de perda auditiva do tipo condutiva (9,7%), 1,9% foi classificado como IVS de risco baixo e 6,8% como IVS de risco médio. Houve significância estatística entre IVS e o local de residência da criança. Conclusão Não houve associação com significância estatística entre alteração auditiva e IVS, entretanto foi possível observar que 77,7% das crianças com diagnóstico de perda auditiva residiam em setores censitários de risco médio do IVS.

ABSTRACT Purpose To analyze the association between hearing loss and health vulnerability in children aged 25 to 36 months. Methods Analytical observational cross-sectional study conducted through child hearing screening in nine day-care centers. The screening consisted of anamnesis, otoscopy, tympanometry, transient otoacoustic emissions, and pure tone audiometry. For each exam performed, the 'pass' and 'fail' criteria were established. The children's residential addresses were georeferenced and a choropleth map of the spatial distribution was built, considering the Health Vulnerability Index (HVI). The analysis of the association between the HVI and the variables sex, auditory assessment, and region area of the household was performed using Pearson's Chi-square and Fisher's Exact tests. Results Ninety-five children of both sexes were evaluated, of which 44.7% presented alterations in at least one of the exams performed, being referred for otorhinolaryngological evaluation and subsequent auditory assessment. Of the observed changes, 36.9% occurred in the tympanometry and 7.8% in the transient otoacoustic emissions. Among children referred for reassessment, 9.7% were diagnosed with conductive hearing loss, 13.6% results within normal limits and 21.4% did not attend for assessment. Of the children who presented the final diagnosis of conductive hearing loss (9.7%), 1.9% were classified as low-risk HVI and 6.8% as medium-risk HVI. There was statistical significance between HVI and the child's place of residence. Conclusion The association between hearing loss and HIV was not statistically significant; however, it was possible to observe that 77.7% of the children with hearing loss resided in sectors with medium- risk HIV

C-reactive protein as a marker of postoperative complication of emergency colorectal surgery

Introduction: The literature converges regarding the use of C-reactive protein (CRP) tests between postoperative days (PODs) 3 and 5 of elective procedures. In this period, they have great sensitivity and negative predictive value (NPV) for severe and anastomotic complications about two days before the first clinical sign. The few studies on colorectal urgency suggest that, despite the different initial values according to the surgical indication, following POD 3, the level of CRP is similar to that of elective procedures. However, given the heterogeneity of the studies, there is no consensus on the cutoff values for this use. Objective: To validate the use and propose a PO CRP cut-off value in urgent colorectal procedures as an exclusion criterion for complications of anastomosis or the abdominal cavity. Method: Retrospective analysis of the medical records of 308 patients who underwent urgent colorectal surgical procedures between January 2017 and December 2019. The following data were considered: age, gender, surgical indication, type of procedure performed, complications, CRP levels preoperatively and from POD 1 to 4, and the severity of the complications. We compared the CRP levels and the percentage variations between the preoperative period and PODs 1 to 4 as markers of severe complications using the receiver operating characteristic (ROC) curve. Results: The levels of CRP on POD4, and their percentage drops between PODs 2 to 4 and PODs 3 to 4, were better to predict severe complications. A cutoff of 7.45mg/dL on POD 4 had 91.7% of sensitivity and NPV. A 50% drop between PODs 3 and 4 had 100% of sensitivity and NPV. Conclusion: Determining the level of CRP is useful to exclude severe complications, and it could be a criterion for hospital discharge in POD 4 of emergency colorectal surgery. (AU)

Vulnerabilidade a infecções sexualmente transmissíveis em idosos usuários de um centro de testagem e aconselhamento / Vulnerability to sexually transmissible infections in elderly users of a trial and counseling center

O processo de envelhecimento populacional e o aumento do número de casos de Infecções Sexualmente Transmissíveis (IST) em idosos evidenciam a necessidade de ações voltadas para a terceira idade. Trata-se um estudo analítico observacional transversal, exploratório, com o objetivo de investigar situações de vulnerabilidade relacionadas à IST em idosos usuários de um Centro de Testagem e Aconselhamento para DTS/Aids de um município de médio porte do estado da Bahia, Brasil, no período de 2006 a 2012. Foram utilizados dados secundários de 233 usuários, com 60 anos ou mais, coletados dos Formulários de Entrada do Sistema de Informação do Centro de Testagem e Aconselhamento, prontuários clínicos e folha de descrição do atendimento. Houve predomínio de usuários do sexo masculino (60,94%), faixa etária de 60 a 70 anos (75,97%), cor parda (26,61%), casados (61,80%), aposentados (57,08%) e com escolaridade de 4 a 7 anos de estudo (35,19%). A maioria relatou a relação sexual como tipo de exposição (76,39%), preferência heterossexual (92,27%) e parceria fixa (72,96%). A frequência de uso do preservativo foi baixa com o parceiro não fixo (32,73%) e com o parceiro fixo (5,58%). A prevalência de IST foi 25,32%, com maior percentual entre os homens. A IST mais prevalente foi a hepatite C (10,73%), seguida da hepatite B (8,58%), sífilis (7,73%) e HIV (3,43). A faixa etária menor que 70 anos mostrou associação estatisticamente significativa com a presença de IST. Os resultados evidenciaram práticas sexuais inseguras e elevada vulnerabilidade dos idosos às IST, havendo necessidade de ações preventivas direcionadas a esse grupo populacional, considerando suas necessidades e especificidades.

The population aging process and the increase in the number of cases of Sexually Transmitted Infections (STI) in the elderly shows the need of actions aimed at that population. This is an exploratory, observational, cross-sectional study to investigate vulnerability situations related to Sexually Transmitted Infections in elderly users of an STD/AIDS Counseling Center of a medium-sized city in the state of Bahia, Brazil, from 2006 to 2012. The study used secondary data from 233 users aged 60 or older, collected from the Counseling Center Information System Admission Forms, clinical records and service description sheet. There was a predominance of male users (60.94%), 60 to 70 years old (75.97%), brown (26.61%), married (61.80%), retired (57,8%) and with 4 to 7 years of schooling (35,19%). Most reported sexual intercourse as the exposure type (76.39%), heterosexual preference (92.27%) and stable partnership (72.96%). The frequency of condom use was low with non-stable partners (32.73%) and with stable partners (5.58%). The prevalence of STI was 25.32%, with greater percentage among men. The most prevalent STI was hepatitis C (10.73%), followed by hepatitis B (8.58%), syphilis (7.73%) and HIV (3.43). The age group younger than 70 years showed a statistically significant association with the presence of STI. The results evidenced unsafe sexual practices and high vulnerability of the elderly to STIs, requiring preventive actions aimed at that population group, considering their needs and specificities.

Cecum perforation associated with a calcium polystyrene sulfonate bezoar - a rare entity / Perfuração do ceco associada a bezoar de poliestirenossulfonato de cálcio - uma entidade rara

Abstract Hyperkalemia is one of the most common electrolyte disorders, responsible for a high number of adverse outcomes, including life-threatening arrhythmias. Potassium binders are largely prescribed drugs used for hyperkalemia treatment but unfortunately, there are many adverse events associated with its use, mostly gastrointestinal. Identification of patients at highest risk for the serious complications associated with the current potassium binders, such as colon necrosis and perforation, could prevent fatal outcomes. The authors present a case of a 56-year-old man with secondary diabetes and chronic renal disease that was treated for hyperkalemia with Calcium Polystyrene Sulfonate (CPS). He later presented with acute abdomen due to cecum perforation and underwent ileocecal resection but ultimately died from septic shock a week later. During surgery, a solid white mass was isolated in the lumen of the colon. The mass was identified as a CPS bezoar, a rare drug-mass formed in the gastrointestinal tract that contributed to the perforation. A previous history of partial gastrectomy and vagothomy was identified as a probable risk factor for the CPS bezoar development. Hopefully, the two new potassium binders patiromer and (ZS-9) Sodium Zirconium Cyclosilicate will help treat such high-risk patients, in the near future.

Resumo A hipercalemia é um dos distúrbios eletrolíticos mais comuns, responsável por um grande número de desfechos adversos, incluindo arritmias potencialmente fatais. Quelantes de potássio são amplamente prescritos para o tratamento da hipercalemia, mas infelizmente são muitos os eventos adversos associados ao seu uso, em particular os gastrointestinais. A identificação de pacientes com risco mais elevado para complicações graves associadas aos quelantes de potássio atualmente em uso, como necrose e perfuração do cólon, pode evitar desfechos fatais. O presente artigo descreve o caso de um homem de 56 anos com diabetes secundário e doença renal crônica em tratamento por hipercalemia com poliestirenossulfonato de cálcio (PSC). Posteriormente o paciente apresentou abdômen agudo devido a perfuração do ceco e foi submetido a uma ressecção ileocecal, mas acabou indo a óbito por choque séptico uma semana mais tarde. Durante a cirurgia, uma massa branca sólida foi isolada no lúmen do cólon. A massa foi identificada como um bezoar de PSC, uma massa de fármaco de rara ocorrência formada no trato gastrointestinal que contribuiu para a perfuração. História pregressa de gastrectomia parcial e vagotomia foi identificada como provável fator de risco para o desenvolvimento do bezoar de PSC. Espera-se que os dois novos quelantes de potássio - patiromer e ciclossilicato de zircônio sódico - ajudem a tratar pacientes de alto risco em um futuro próximo.

Vulnerability of adolescents to sexually transmitted infections / Vulnerabilidade a infecções sexualmente transmissíveis em adolescentes

Introduction: Adolescents are especially susceptible to sexually transmitted infections, with approximately 1/7 of all new cases of human immunodeficiency virus infection in this group. Objective: To investigate the vulnerability to sexually transmitted infections among adolescents of the Centers for Testing and Counseling for Sexually Transmitted Diseases / Aids, CTAs, in the city of Juazeiro, state of Bahia, Brazil, from 2006 to 2012. Methods: This was an exploratory cross-sectional study that used secondary data from 1,173 adolescents. Data analysis was processed in Stata 9.0 software by descriptive statistics and Pearson's χ2 test. Results: There was predominance of female adolescents (56.86%), brown (22.85%), single (80.22%), with 8­11 years of education (44.76%) and stable partner (56.78%). The prevalence of sexually transmitted infections was of 5.88%, and there was statistically significant association with sex (more prevalent among girls; p=0.014), education (more common among the less educated; p=0.031) and marital status (more frequent among married/common-law; p=0.036). Conclusion: Safer sex practices and later start of sexual activity combined with empowering actions, especially girls', are important steps to reduce sexually transmitted diseases among adolescents

Introduction: Adolescents are especially susceptible to sexually transmitted infections, with approximately 1/7 of all new cases of human immunodeficiency virus infection in this group. Objective: To investigate the vulnerability to sexually transmitted infections among adolescents of the Centers for Testing and Counseling for Sexually Transmitted Diseases / Aids, CTAs, in the city of Juazeiro, state of Bahia, Brazil, from 2006 to 2012. Methods: This was an exploratory cross-sectional study that used secondary data from 1,173 adolescents. Data analysis was processed in Stata 9.0 software by descriptive statistics and Pearson's χ2 test. Results: There was predominance of female adolescents (56.86%), brown (22.85%), single (80.22%), with 8­11 years of education (44.76%) and stable partner (56.78%). The prevalence of sexually transmitted infections was of 5.88%, and there was statistically significant association with sex (more prevalent among girls; p=0.014), education (more common among the less educated; p=0.031) and marital status (more frequent among married/common-law; p=0.036). Conclusion: Safer sex practices and later start of sexual activity combined with empowering actions, especially girls', are important steps to reduce sexually transmitted diseases among adolescents

Genome of Leptospira borgpetersenii strain 4E, a highly virulent isolate obtained from Mus musculus in southern Brazil

A previous study by our group reported the isolation and characterisation of Leptospira borgpetersenii serogroup Ballum strain 4E. This strain is of particular interest because it is highly virulent in the hamster model. In this study, we performed whole-genome shotgun genome sequencing of the strain using the SOLiD sequencing platform. By assembling and analysing the new genome, we were able to identify novel features that have been previously overlooked in genome annotations of other strains belonging to the same species.

A influência de polimorfismos de base única na metilação de DNA em genes de receptores olfatórios / Single nucleotide polymorphisms lead to differential DNA methylation in odorant receptor genes

Os genes de receptores olfatórios (OR) pertencem a uma família de proteínas de membrana formada por cerca de 1000 genes no genoma de camundongo. Os genes OR são expressos de forma monogênica e monoalélica nos neurônios olfatórios (OSNs). No entanto, ainda não está claro o mecanismo que permite essa forma de expressão peculiar, sobretudo, qual o papel da metilação de DNA nesse processo. Nosso estudo determinou o padrão de metilação de DNA da região promotora e codificadora do gene Olfr17. Em células de epitélio olfatório (MOE) de camundongos adultos, observamos na região codificadora (CDS) do gene uma frequência de metilação em dinucleotídeos CpG 58%, enquanto que na sua região promotora ela foi bem mais baixa. Os níveis de metilação do Olfr17 em MOE de embrião (E15.5) e fígado foram similares aos observados em MOE de animais adultos. Em seguida, analisamos se a metilação de DNA pode regular a expressão gênica do Olfr17. Utilizando animais transgênicos onde os neurônios olfatórios que expressam Olfr17 também expressam GFP, pudemos selecionar neurônios olfatórios GFP+ e analisar a metilação do gene Olfr17, que está ativo nestas células. Verificamos que o padrão geral de metilação do Olfr17, tanto na região CDS como na região promotora, não se altera quando este gene está ativo. Este resultado indica que alterações na metilação do gene Olfr17 não são necessárias para que este receptor seja expresso. Finalmente, verificamos que a região promotora do gene Olfr17, de duas linhagens de camundongos diferentes, a C57BL/6 e a 129, possuem dois polimorfismos de base única (SNPs) que alteram o conteúdo CpG. Devido a estes SNPs, a linhagem 129 apresenta dois sítios CpG adicionais, inexistentes na linhagem C57BL/6. Nossas análises mostraram que estes CpGs são frequentemente metilados, o que torna o promotor do Olfr17 de 129 significativamente mais metilado que o promotor de C57BL/6. Em seguida, nós analisamos o nível de expressão no MOE dos dois alelos de Olfr17, o 129 e o C57BL/6, utilizando ensaios de RT-qPCR. Estes experimentos demonstraram que o nível de expressão do alelo 129, que possui 3 CpGs metiladas em seu promotor, é menor que o do alelo C57BL/6, que apresenta apenas uma CpG que é pouco metilada em seu promotor. Nossos resultados sugerem que as alterações na região promotora influenciam a probabilidade com que o gene OR é escolhido para ser expresso no MOE

Olfactory receptor (OR) genes belong to a large family of membrane proteins composed of 1000 genes in the mouse genome. The OR genes are expressed in the olfactory sensory neurons (OSNs) in a monogenic and monoallelic fashion. However, the mechanisms that govern OR gene expression are unclear. Here we asked whether DNA methylation plays a role in the regulation of OR gene expression. We first determined the DNA methylation pattern in the coding (CDS) and promoter regions of the odorant receptor gene Olfr17. In olfactory epithelium (MOE) cells, the CpG methylation level in the CDS is 58% but is much lower in the promoter region of the gene. In embryonic MOE (E15.5) and liver, the levels of Olfr17 DNA methylation are similar to the ones shown in adult MOE. We next analyzed whether DNA methylation is involved in Olfr17 regulation. We isolated GFP+ neurons from transgenic mice that coexpress GFP with Olfr17, and analyzed the DNA methylation pattern of the Olfr17, which is active in these cells. We found that the general methylation pattern, both, in the coding and promoter regions is not altered in the active gene. These results indicate that changes in DNA methylation are not required for the activation of Olfr17. Finally, we found that the Olfr17 promoter region from two different mouse strains, C57BL/6 and 129, has two single-nucleotide polymorphisms (SNPs) that alter the CpG content. The SNPs lead to the existence of two additional CpGs in the 129 allele, which are absent in the C57BL/6 allele. These CpGs are frequently methylated, making the 129 Olfr17 promoter significantly more methylated than the Olfr17 promoter from C57BL/6. We next performed RT-qPCR experiments to analyze the expression levels of the 129 and C57BL/6 Olfr17 alleles in the MOE. These experiments showed that the expression level of the 129 Olfr17 allele, which contains three methylated CpGs in its promoter region, is lower than the one from C57BL/6, which contains only one, undermethylated CpG, in its promoter. Our results suggest that these promoter modifications regulate the probability of the OR gene choice

Dynamics and diversity of the bacterial community during the spontaneous decay of açai (Euterpe oleracea) fruits

Abstract The biodiversity and evolution of the microbial community in açai fruits (AF) between three geographical origins and two spontaneous decay conditions were examined by applying culture-independent methods. Culture-independent methods based on 16S rRNA from fifteen samples revealed that Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Acidobacteria were the most abundant phyla. At the genus level, Massilia (taxon with more than 50% of the sequences remaining constant during the 30 h of decay), Pantoea, Naxibacter, Enterobacter, Raoultella and Klebsiella were identified, forming the carposphere bacterial microbiota of AF. AF is fibre-rich and Massilia bacteria could find a large quantity of substrate for its growth through cellulase production. Beta diversity showed that the quality parameters of AF (pH, soluble solids, titratable acidity and lipids) and elemental analysis (C, N, H and C/N ratio) were unable to drive microbial patterns in AF. This research offers new insight into the indigenous bacterial community composition on AF as a function of spontaneous postharvest decay.

Dynamics and diversity of the bacterial community during the spontaneous decay of açai (Euterpe oleracea) fruits

Abstract The biodiversity and evolution of the microbial community in açai fruits (AF) between three geographical origins and two spontaneous decay conditions were examined by applying culture-independent methods. Culture-independent methods based on 16S rRNA from fifteen samples revealed that Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Acidobacteria were the most abundant phyla. At the genus level, Massilia (taxon with more than 50% of the sequences remaining constant during the 30 h of decay), Pantoea, Naxibacter, Enterobacter, Raoultella and Klebsiella were identified, forming the carposphere bacterial microbiota of AF. AF is fibre-rich and Massilia bacteria could find a large quantity of substrate for its growth through cellulase production. Beta diversity showed that the quality parameters of AF (pH, soluble solids, titratable acidity and lipids) and elemental analysis (C, N, H and C/N ratio) were unable to drive microbial patterns in AF. This research offers new insight into the indigenous bacterial community composition on AF as a function of spontaneous postharvest decay.

PERFIL EPIDEMIOLÓGICO DOS USUÁRIOS DE UM CENTRO DE TESTAGEM E ACONSELHAMENTO DA BAHIA / EPIDEMIOLOGICAL PROFILE OF THE USERS OF A TESTING AND COUNSELING CENTER OF BAHIA / PERFIL EPIDEMIOLÓGICO DE LOS USUARIOS DE UN CENTRO DE PRUEBAS Y ASESORAMIENTO DE BAHIA

Os Centros de Testagem e Aconselhamento realizam diagnóstico e ações preventivas para doenças sexualmente transmissíveis, oferecendo testagem sorológica para HIV, sífilis e hepatites virais B e C. O objetivo da pesquisa foi traçar o perfil epidemiológico dos usuários de um Centro de Testagem e Aconselhamento da Bahia no período de 2006 a 2012, em relação a características sociodemográficas, situações de vulnerabilidade individual e prevalência de infecções sexualmente transmissíveis. Para tanto, foi realizado um estudo descritivo do tipo levantamento epidemiológico, utilizando dados secundários de serviços de saúde de 7.048 usuários, coletados dos formulários de entrada do sistema de informação dos Centros de Testagem e Aconselhamento, folha de descrição do atendimento e prontuários clínicos. A análise dos dados foi realizada por estatística descritiva, no Stata 9.0. Os resultados mostraram predomínio de mulheres (52,87%), faixa etária entre 20 a 30 anos (40,32%), casados/união estável (48,69%) e escolaridade de 8 a 11 anos (38,14%). A prevalência de infecções sexualmente transmissíveis foi 12,25%, mais frequente entre os homens, e o agravo mais prevalente foi sífilis (4,52%), seguido de infecção por HIV (3,33%), hepatites B (2,62%) e hepatite C (1,78%). O uso consistente do preservativo com parceiro fixo (17,19%) e parceiro não fixo (34,37%) foi baixo, com maior exposição do sexo feminino. Concluiu-se que a elevada prevalência de infecções sexualmente transmissíveis evidencia a situação de exposição e vulnerabilidade desta população, necessitando ações que contribuam para o empoderamento individual e coletivo na adoção de comportamentos sexuais mais seguros.

The Testing and Counseling Centers perform diagnostic and preventive actions for Sexually Transmitted Diseases, offering testing for HIV, syphilis and hepatitis B and C. The objective of the research was to trace the epidemiological profile of the users of a Testing and Counseling Center of Bahia from 2006 to 2012, in relation to sociodemographic characteristics, situations of individual vulnerability and prevalence of sexually transmitted infections. For that purpose, it was realized a descriptive study of epidemiological survey, using secondary data of health services of 7048 users, collected from input forms from the information system of Testing and Counseling Centers, service description sheet and clinical chart. The analysis was performed using descriptive statistics in Stata 9.0. There was a predominance of women (52.87%), aged 20-30 years (40.32%), married /stable union (48.69%), education between 8 to 11 years (38.14%). The Sexually Transmitted Infections prevalence was 12.25%, more frequent among men, and the most problem was syphilis (4.52%), followed by HIV (3.33%) and hepatitis B (2.62%) and hepatitis C (1.78%). Consistent condom uses with a fixed partner (17, 19%) and non-fixed partner (34.37%) was low, females were more exposed. In conclusion, the high prevalence of sexually transmitted infections shows the situation of exposure and vulnerability of this population, requiring actions that contribute to individual and collective empowerment in the adoption of safer sexual behaviors.

Los Centros de Asesoramiento y Pruebas realizan diagnóstico y prevención de enfermedades de transmisión sexual y ofrecen prueba de VIH, sífilis y hepatitis B y C. La investigación tuvo por objetivo trazar el perfil epidemiológico de los usuarios de un Centro de Asesoramiento y Pruebas de la Bahía no período de 2006 a 2012, en relación a características sociodemográficas, situaciones de vulnerabilidad individual y prevalencia de infecciones sexualmente transmisibles. Para ello fue utilizado un estudio descriptivo de tipo de levantamiento epidemiológico, utilizando datos secundarios de 7048 usuarios, recogidos de formularios de entrada del Sistema de Información del Centro de Asesoramiento y Pruebas, hoja de descripción de la atención y registros médicos. El análisis se realizó mediante estadística descriptiva en el Stata 9.0. Hubo predominio de mujeres (52,87%), edad 20-30 años (40,32%), casadas/unión estable (48.69%), educación entre 8-11 años (38,14%). La prevalencia de infecciones de transmisión sexual fue 12,25%, más frecuente entre los hombres, y la infección más prevalente fue sífilis (4,52%), seguida por VIH (3,33%) y hepatitis B (2,62%) y hepatitis C (1,78%). El uso consistente de preservativos con pareja fija (17,19%) y no fija (34,37%) fue bajo, con mayor exposición femenina. Se ha concluido que la elevada prevalencia de infecciones sexualmente transmisibles evidencia una situación de exposición y vulnerabilidad de la población, que exige acciones que contribuyan para el empoderamiento individual y colectivo en la adopción de comportamientos sexuales más seguros.

Factors Associated With Condom Use in Women of a Testing and Advice Center for STD/AIDS of Bahia, Brazil / Fatores Associados ao Uso de Preservativo em Mulheres Usuárias de um Centro de Testagem e Aconselhamento para DST/AIDS da Bahia, Brasi

The feminization process of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection in Brazil is evidenced by the expressive increase in the number of infected women and by mortality rates, which is increasing in females, contrary to what occurs among men. Despite the diffusion of condoms, consistent use is still considered low, even in relations with non-regular partners. Objective: To investigate factors associated with the use of condoms with non-regular partners, in women users of a Testing and Counseling Center for sexually transmitted disease (STD)/AIDS of Bahia, from 2006 to 2012. Methods: This is a transversal observational analytical study. Secondary data of 790 women users of a Testing and Counseling Center, obtained from forms and clinical records, were used. Statistical analysis, crude and adjusted, used the prevalence ratio as the measure of association and a 95% confidence interval. Results: The consistent use of condom in relations with non-regular partners was low (27.97%). The main reasons appointed to justify the absence of use were not liking it (35.71%) and difficulty in negotiating with the partner (21.22%). The outcome was associated statistically to the absence of use of condom in the last relation with a regular partner and to the age of first sexual relation lower than 16 years. Conclusion: The findings contribute to the understanding of the behavior of women in relationships with non-regular partners and provide a base in planning coping actions against the diseases resulting from unprotected sex, both in specialized care and in the primary health care network.

O processo de feminização da infecção por HIV/AIDS, no Brasil, é evidenciado pela elevação expressiva no número de mulheres infectadas e também pelas taxas de mortalidade, que vem aumentando no sexo feminino, ao contrário do que ocorre entre os homens. Apesar da difusão do preservativo, o uso consistente ainda é considerado baixo, mesmo em relações com parceiros não fixos. Objetivo: Investigar fatores associados ao uso de preservativo com parceiros não fixos, em mulheres usuárias de um Centro de Testagem e Aconselhamento (CTA) para DST/AIDS da Bahia, de 2006 a 2012. Métodos: Trata-se de um estudo analítico observacional transversal. Foram utilizados dados secundários de 790 mulheres usuárias de um CTA, obtidos de formulários e prontuário clínicos. A análise estatística, bruta e ajustada, adotou a medida de associação razão de prevalência com intervalo de confiança de 95%. Resultados: O uso consistente de preservativo nas relações com parceiro não fixo foi baixo (27,97%). Os principais motivos apontados para justificar a ausência de uso foram não gostar (35,71%) e dificuldade de negociação com o parceiro (21,22%). O desfecho associou-se estatisticamente com ausência de uso de preservativo na última relação com parceiro fixo e idade da primeira relação sexual menor que 16 anos. Conclusão: Os achados contribuem para a compreensão do comportamento de mulheres em relações eventuais e trazem subsídios para o planejamento de ações de enfrentamento dos agravos decorrentes de relações sexuais desprotegidas, tanto na atenção especializada quanto na Atenção Primária à Saúde.

Lack of evidence for human infection with Xenotropic murine leukemia virus-related virus in the Brazilian Amazon basin

Introduction This study confirmed the absence of natural infection with Xenotropic murine leukemia virus-related virus (XMRV) or XMRV-related disease in human populations of the Brazilian Amazon basin. We demonstrated that 803 individuals of both sexes, who were residents of Belem in the Brazilian State of Pará, were not infected with XMRV. Methods Individuals were divided into 4 subgroups: healthy individuals, individuals infected with human immunodeficiency virus, type 1 (HIV-1), individuals infected with human T-lymphotrophic virus, types 1 or 2 (HTLV-1/2), and individuals with prostate cancer. XMRV infection was investigated by nested PCR to detect the viral gag gene and by quantitative PCR to detect pol. Results There was no amplification of either gag or pol segments from XRMV in any of the samples examined. Conclusions This study supports the conclusions of the studies that eventually led to the retraction of the original study reporting the association between XMRV and human diseases. .

Produtivismo na saúde: desafios do SUS na invenção da gestão democrática / Health in productivism: challenges of SUS in the invention of democratic management

A Associação Brasileira de Editoras Universitárias lançou o livro Produtivismo na Saúde – Desafios do SUS na invenção da Gestão democrática. Fruto de uma pesquisa desenvolvida conjuntamente por quatro grupos de pesquisas acadêmicas (três da Universidade Federal de Pernambuco e um do Centro de Pesquisas Aggeu Magalhães/Fiocruz Pernambuco), a obra busca aprofundar criticamente o tema do produtivismo na saúde a partir de diferentes abordagens: sociais, jurídicas, da saúde coletiva e de saberes e práticas de saúde. Com 231 páginas, o livro é dividido em quatro capítulos que abordam os temas: Gestão em saúde e produtivismo; Humanização, parto e nascimento; Sofrimento, subjetividade e medicalização; e por fim, Práticas antiutilitaristas e integrativas em saúde. Para Islândia Sousa, pesquisadora da Fiocruz PE e uma das coordenadoras da publicação, a obra possui ineditismo por discutir de modo interdisciplinar os efeitos negativos do modelo econômico no campo da saúde, o que favoreceu um olhar ampliado acerca do tema, e também apresenta experiências que visam minimizar os estes efeitos...

Diversity and three-dimensional structures of the alpha Mcr of the methanogenic Archaea from the anoxic region of Tucuruí Lake, in Eastern Brazilian Amazonia

Methanogenic archaeans are organisms of considerable ecological and biotechnological interest that produce methane through a restricted metabolic pathway, which culminates in the reaction catalyzed by the Methyl-coenzyme M reductase (Mcr) enzyme, and results in the release of methane. Using a metagenomic approach, the gene of the a subunit of mcr (mcrα) was isolated from sediment sample from an anoxic zone, rich in decomposing organic material, obtained from the Tucuruí hydroelectric dam reservoir in eastern Brazilian Amazonia. The partial nucleotide sequences obtained were 83 to 95 percent similar to those available in databases, indicating a low diversity of archaeans in the reservoir. Two orders were identified -the Methanomicrobiales, and a unique Operational Taxonomic Unit (OTU) forming a clade with the Methanosarcinales according to low bootstrap values. Homology modeling was used to determine the three-dimensional (3D) structures, for this the partial nucleotide sequence of the mcrα were isolated and translated on their partial amino acid sequences. The 3D structures of the archaean mcrα observed in the present study varied little, and presented approximately 70 percent identity in comparison with the mcrα of Methanopyrus klanderi. The results demonstrated that the community of methanogenic archaeans of the anoxic C1 region of the Tucurui reservoir is relatively homogeneous.

Characterization of 23S rRNA domain V mutations in gastric biopsy patients from the eastern Amazon

Resistance of Helicobacter pylori to clarithromycin is characterised by simple point mutations in the 23S ribosomal RNA (rRNA) gene and is responsible for the majority of cases of failure to eradicate this bacterium. In this paper, we characterised the variability of the 23S rRNA gene in biopsies of patients with gastric pathologies in the eastern Amazon (Northern Region of Brazil) using PCR and sequencing. A total of 49 sequences of H. pylori strains were analysed and of those, 75.6 percent presented nucleotide substitutions: A2142G (3.3 percent), T2182C (12.9 percent), G2224A (6.45 percent), T2215C (61.3 percent), A2192G (3.3 percent), G2204C (6.4 percent) and T2221C (6.4 percent). Of the mutations identified, four are known mutations related to cases of resistance and 16.1 percent are not yet described, revealing a high prevalence of mutations in the H. pylori 23S rRNA gene among the strains circulating in the in the eastern Amazon. The high prevalence in individuals with gastric pathologies in the Northern Region of Brazil demonstrates the need for characterising the profile of these strains to provide correct therapy for patients, considering that mutations in this gene are normally associated with resistance to the primary medication used in controlling H. pylori infection.

Avaliação da experiência de cárie e necessidade de tratamento de pré-escolares de 5 e 6 anos das redes pública e privada do município de Porto Velho, Rondônia / Evaluation of caries experience and treatment needs of children of 5 and 6 age of public and private schools in the city of porto velho, rondônia

O objetivo do estudo foi o de comparar a prevalência de cárie de pré-escolares do município de Porto Velho.Foram examinadas 227 crianças, de 5 e 6 anos, sendo 85 (37,4%) de uma escola privada (A), 79 (34,8%) deuma escola municipal localizada no centro da cidade (B), e 63 (27,8%) de uma escola municipal da periferia(C). Os resultados foram submetidos à análise de variância e ao teste t, com diferença estatisticamente significante(p <= 0,05), quando comparados os índices das três escolas (A<=B<=C). A quantidade de participanteslivres de cárie na Escola A (77,65%) foi maior do que nas escolas B e C (20% e 2,35%, respectivamente).Restauração de uma superfície foi a necessidade de tratamento mais encontrada nas Escolas A e C (45,45%e 40,66%). Entretanto, na Escola B, a restauração de duas superfícies foi a mais observada (50,99%). Comrelação aos componentes do índice ceo-d, tanto nas escolas públicas (B=76,4% e C=92,83%) quanto naprivada (61,79%), o componente c (cariado) foi o de maior prevalência. Os resultados sugerem que o nívelsocioeconômico das crianças pesquisadas, a partir da escola em que estudavam e da localização desta teminfluência nos índices de cárie, indicando a importância de se planejarem estratégias adequadas para cada grupo da população.

The aim of this study was to compare the level of tooth decay of chldren from the city Porto Velho, 227 children on age 5 and 6 were evaluated, been 85 (37,4%) of private school (A), 79 (34,8%) of a public school that is located in the center of Porto Velho (B) ande also 63 (27,8%) of a public school that is located in periphery of the city (C). The results were submitted to a variance analysis and to t test, with significant statically difference (p<=0,05) when compared to the index of the three schools (A<=B<=C). The amount of tooth decay free patients in school A (77,65%) was bigger than school B and C (20% and 2,35%), respectively). Restorations of one face of the teeth were the treatment needed most found in school A and C (45,5% and 40,66%), however in school B restorations of the teeth's faces of the teeth were the most seen (50,59%). In relation to the compound of ceo-d index, as in public school (B=76,4% and C=92,83%), as in the private school (61,79%), the compound C (tooth decay) was the most prevalent. The results suggest that socioeconomic level of the children investigated, from the school that they study and its location, has an influence in the tooth decav index. Indicating the importance to plan appropriate strategies for each population group.

Genetic structure of red-handed howler monkey populations in the fragmented landscape of Eastern Brazilian Amazonia

We genotyped 15 microsatellite loci in order to evaluate the effects of habitat fragmentation, caused by flooding of the Tucuruí reservoir, on the genetic structure of Alouatta belzebul in eastern Amazonia. The analysis included two populations sampled in 1984, representing both margins of the Tocantins river, and three populations sampled 18 years later. Minimal differences in the diversity levels between present-day (Ho = 0.62-0.69 and A R = 6.07-7.21) and pre-flooding (Ho = 0.60-0.62 and A R = 6.27-6.77) populations indicated there was no significant loss of genetic variability, possibly because of successful management strategies applied during the flooding. The changes observed were limited to shifts in the composition of alleles, which presumably reflect the admixture of subpopulations during flooding. Given this, there were significant differences in the Rst values (p = 0.05) in all but one between-site comparison. Both present-day and original populations showed a deficit of heterozygotes, which suggests that this may be typical of the species, at least at a local level, perhaps because of specific ecological characteristics. The relatively large number of private alleles recorded in all populations may be a consequence of the Wahlund effect resulting from population admixture or a process of expansion rather than the loss of rare alleles through genetic drift. Additionally, the levels of genetic variability observed in this study were higher than those reported for other species of Neotropical primates, suggesting good fitness levels in these A. belzebul populations. Regular genetic monitoring of remnant populations, especially on islands, should nevertheless be an integral component of long-term management strategies.

Perfil sexual e frequência de infecções genitais em adolescentes atendidos em uma clínica universitária / Sexual profile and frequency of genital infections in teenagers treated in the university clinic

Introdução: atualmente os adolescentes se encontram em situação de vulnerabilidade para infecções genitais, devido às altas taxas de atividade sexual com diferentes parceiros e falhas no uso do preservativo. Objetivo: descrever o perfi l sexual e a frequência das infecções genitais diagnosticadas em adolescentes atendidos no Setor de DST da Universidade Federal Fluminense (UFF) nos anos de 2005 e 2006. Métodos: foi realizado um estudo seccional, descritivo,observacional e quantitativo através da análise dos prontuários de adolescentes entre 12 e 19 anos de idade atendidos no Setor de DST/UFF no período de janeiro de 2005 a dezembro de 2006. Os dados foram tratados através de análise descritiva por meio de porcentagem. Resultados: a parcela de adolescentes que frequentou o serviço foi igual para ambos os sexos, porém a maioria acima dos 16 anos de idade, com parceiro(a) sexual fixo(a) exclusivo(a) em 57,2% dos casos no ano de 2005 e 57,63% para o ano de 2006, onde a maioria não utilizava preservativo e não apresentava história de prévia de DST em ambos os anos do estudo. Destes, 46,9% (2005) e 38,98% (2006) possuíam o ensino fundamental incompleto, e 50,3% (2005) e 55,93% (2006) eram estudantes. A iniciação sexual ocorreu em torno dos 13 anos de idade e o diagnóstico mais comum foi de infecção pelo vírus do papiloma humano (HPV) com a frequência de 46,8% em 2005 e 54,84% em 2006. Conclusão: os adolescentes constituem um grupo vulnerável em relação à sexualidade, assim, porvezes, não percebem o risco em adquirir infecções genitais, tais como as DST, portanto, não se protegem por meio do uso do preservativo. Esses resultados demonstraram elevada frequência de DST, principalmente no que diz respeito à infecção pelo HPV, indicando a necessidade de medidas de prevenção, programas de educativos que busquem a redução deste risco, além de um atendimento especializado realizado por profissionais habilitados a fi m de realizarum correto diagnóstico e, consequentemente, um tratamento das infecções genitais no acompanhamento do grupo em questão.

Introduction: now adays, young people are in vulnerable situation for genital infections, due to high rates of sexual activity with different partners andfailures in the use of condoms. Objectives: describe the sexual profile and frequency of genital infections diagnosed in adolescents seen in a DST Clinicof Federal Fluminense University (UFF) in the years 2005 and 2006. Methods: a cross-sectional study was conducted, descriptive, observational and quantitative through records analysis of adolescents between 12 and 19 years of age attended in DST/UFF Sector from January to December of the years 2005 and 2006. The data was processed through descriptive analysis by percentage. Results: the share of teenagers who attended the service was equalfor both sexes, but the majority over 16 years of age, with fi xed sexual partner only in 57.2% of cases in 2005 and 57.63% for the year 2006, in which the majority did not use condoms and had no history of the DST in both years of study. Of these 46.9% (2005) and 38.98% (2006) had incomplete primary school and 50.3% (2005) and 55.93% (2006) were students. The sexual initiation occurred around 13 years of age and genital infection by the human papilloma virus (HPV) was described as the most frequent in this group. Conclusion: teenagers are a vulnerable group in relation to sexuality, thus, theyare not aware of the risks of acquiring genital infections such as STDs, therefore they do not protect themselves through preservatives. These results showhighly frequent STD's, mostly the ones related to HPV, indicating the need for prevention measures, educational programs that aim at the reduction of thisrisk along with a specialized care by qualifi ed professionals in order to make a correct diagnosis and, as a result, a treatment for the genital infections inthe following up of the group.

Utilização de medicamentos durante a gravidez na cidade de Natal, Rio Grande do Norte, Brasil / Drug use during pregnancy in Natal, Brazil

OBJETIVO: estudar o uso de medicamentos por gestantes atendidas durante o pré-natal em unidades básicas do Sistema Único de Saúde (SUS) na cidade de Natal, rio Grande do Norte, Brasil. MÉTODOS: foram entrevistadas 610 grávidas, entre o primeiro e o terceiro trimestre de gestação, que compareceram para consulta pré-natal em unidades de saúde localizadas nos quatro distritos sanitários de Natal, entre maio e julho de 2006. Os dados foram coletados com entrevistas estruturadas, baseando-se em perguntas uso-orientadas e medicamento-orientadas. Os fármacos foram classificados de acordo com o Anatomical Therapeutic Chemical Classification System (ATC) e segundo critérios de risco para a gestação da Food and Drug Administration (FDA). Utilizou-se teste do chi2 para análise dos dados. RESULTADOS: eram utilizados 1.505 medicamentos, obtendo-se uma média de 2,4 drogas por mulher. O uso de pelo menos um fármaco na gravidez foi relatado por 86,6 por cento das gestantes. As classes mais utilizadas foram os antianêmicos (35,6 por cento dos medicamentos), analgésicos (24,9 por cento), drogas para distúrbios gastrintestinais (9,1 por cento) e vitaminas (7 por cento). De acordo com a classificação do FDA, dos medicamentos empregados 42,7 por cento pertencem a categoria A de risco; 27,1 por cento à categoria B, 29,3 por cento à categoria C; 0,3 à categoria D e nenhum à categoria X. Foram usados, no primeiro trimestre da gestação, 43,6 por cento dos fármacos. Observou-se maior uso de medicamentos quanto maior a escolaridade e a renda familiar da mulher. A automedicação ocorreu em 12,2 por cento dos medicamentos; esse índice foi maior no primeiro trimestre de gravidez e em gestantes de baixa escolaridade e multigestas. CONCLUSÕES: as gestantes de Natal estão sendo expostas a uma variedade de medicamentos, cuja segurança na gravidez ainda é incerta, o que exige prescrição criteriosa para evitar possíveis danos ao feto.

PURPOSE: to study the use of medicines by pregnant women during prenatal care in clinics of the national public health system in the city of Natal, Brazil. METHODS: a total of 610 pregnant women between the first and the third trimesters of pregnancy were interviewed in the public clinics of the four sanitary districts of Natal, from May to July 2006. The data were collected by a structured questionnaire, based in use-oriented and medicine-oriented questions. The drugs were classified according to the Anatomical Therapeutic Chemical Classification System (ATC), in agreement with the gestation risk criteria from the Food and Drugs Administration (FDA). The statistical analysis was made by the chi2 test. RESULTS: a total of 1,505 drugs were used, with an average of 2.4 medications per woman. The use of at least one drug was found in 86.6 percent of the women. The most frequently used drugs were anti-anemics (35.6 percent), analgesics (24.9 percent), drugs for gastrointestinal disorders (9.1 percent) and vitamins (7 percent). According to the FDA classification, 42.7 percent belonged to category A risk, 27.1 percent to category B, 29.3 percent to category C, 0.3 percent to category D and none to category X. The use of medicines during the first trimester of pregnancy amounted to 43.6 percent. The rate of drug use increased with higher schooling level and family income. Self-medication was found in 12.2 percent of the drug intake and this rate was higher in the first trimester of gestation and with women with low education level and previous gestations. CONCLUSIONS: pregnant women from Natal are being exposed to a variety of medicines with uncertain safety in pregnancy. Therefore, more careful prescription is needed, to avoid possible fetal damage.

Genetic variability and efficiency of DNA microsatellite markers for paternity testing in horse breeds from the Brazilian Marajó archipelago

In this study, 15 microsatellite DNA loci used in comparative tests by the International Society for Animal Genetics were applied to the evaluation of genetic diversity and management, and the efficiency of paternity testing in Marajoara horses and Puruca ponies from the Marajó Archipelago. Based on the genotyping of 93 animals, mean allelic diversity was estimated as 9.14 and 7.00 for the Marajoara and Puruca breeds, respectively. While these values are similar to those recorded in most European breeds, mean levels of heterozygosity were much lower (Marajoara 49 percent, Puruca 40 percent), probably as a result of high levels of inbreeding in the Marajó populations. The mean informative polymorphic content of this 15-marker system was over 50 percent in both breeds, and was slightly higher in the Marajoara horses. The discriminative power and exclusion probabilities derived from this system were over 99 percent for both populations, emphasizing the efficacy of these markers for paternity testing and genetic management in the two breeds.