Caminhos da subjetividade no acolhimento: atenção à saúde de soropositivos com base em histórias de vida / Paths of subjectivity in reception: healthcare attention to HIV-positive individuals trhough life stories

Ao longo da década de 1980, a epidemia do HIV atingiu um grupo populacional já marginalizado, o dos homossexuais masculinos, e instigou preconceito semelhante aos infectados com lepra, independente de classe social. A epidemia, no entanto, desencadeou o surgimento de novas ONGs, o fortalecimento de antigas, a aprovação da união civil entre pessoas do mesmo sexo, tendo mobilizado entidades de classe, pastorais da igreja, profissionais de saúde e órgãos do governo para medidas de resposta ao problema inicialmente ignorado pela sociedade (MONTEIRO; VILELLA, 2009; CECÍLIO, 2009). A empreitada pelos direitos ao tratamento e à prevenção do HIV logrou êxito principalmente com relação ao princípio da universalidade do Sistema único de Saúde (SUS). Os princípios da equidade e da integralidade, entretanto, com relação ao tratamento dos que vivem com HIV, ainda está em construção. Nosso estudo, conduzido na Casa da Aids, em São Paulo, teve por objetivos: saber que tipo de acolhimento os pacientes recebem, se eles realmente têm abertura para falar sobre seus anseios e sobre seus hábitos mais íntimos; pesquisar se o acolhimento realizado pelos profissionais da instituição consegue animá-los para a próxima ida. Queremos saber como isso pode ocorrer e também como poderia garantir vínculo e adesão ao tratamento. Como metodologia, realizamos a observação participante, tendo por base as contribuições de Bosi (1979) e Minayo (1992). Trata-se de uma técnica de coleta de informações largamente utilizada na pesquisa qualitativa, sobretudo as de cunho etnográfico. Implica no observador se colocar em relação ao campo e aos sujeitos numa atitude a um só tempo aberta e expectante, todavia com escassa ou nenhuma intervenção no processo. Foram entrevistados 11 sujeitos, 6 pacientes e 5 profissionais de saúde, todos na Casa da Aids. Utilizamos o conteúdo narrado para coletar as histórias de vida dos personagens, e fizemos as nossas narrativas sobre eles em forma de hestórias patográficas (NUNES, 2018; NUNES, 2019; SOUZA, 2003) e de historiobiografias (CRITELLI, 2013). As narrativas conferem, para qualquer usuário do sistema de saúde, uma absorção da própria vivência na doença, uma maior oportunidade daquele sujeito se apropriar do seu processo e, quiçá, transformá-lo, dentro do processo de saúde, em fonte de vida; permite ao profissional ter uma maior visão dos reais sentimentos que o sujeito que vive uma doença tem por seu tratamento; também faz com que tanto o profissional quanto o usuário tenham visão do mundo do sujeito que experencia aquele processo e com que enxerguem uma luz para melhorar a trajetória dele no sentido de controlar aquela doença. Finalmente, sugerimos algumas mudanças no fluxo do serviço de saúde, a fim de suprir a necessidade de estreitamento na relação instituição-usuário.

Throughout de 80s, the HIV epidemic reached an already marginalized population group, that of male homosexuals, and instigated similar prejudice to those infected with leprosy, regardless of social class. The epidemic, however, triggered the emergence of new NGOs, the strengthening of old ones, the approval of civil unions between the same-sex individuals, mobilizing professional associations, church, church pastoral groups, health professionals and government bodies to tackle a problem initially ignored by society (MONTEIRO; VILELLA, 2009; CECÍLIO, 2009). The advocacy for the rights to HIV treatment and prevention was particularly successful in relation to the principle of Universality of the SUS. However, the principles of Equity and Integrality concerning the treatment of those living with HIV, are still under development. Our study, conducted at Casa da AIDS, in São Paulo, had the following objectives: to find out what kind of sheltering the patients received, whether they felt comfortable to talk about their desires and their most intimate habits; research whether the support provided by the institution's professionals motivate them for subsequent visits. We sought to explore how this could happen, and also how it could ensure a connection and adherence to treatment. We proceeded with participant observation, based on the contributions of Bosi (1979) and Minayo (1992). Observation is a widely used information collection technique in qualitative research, especially in ethnographic research. It involves the observer adopting an open and expectant attitude towards the field and subjects, with minimal or no intervention in the process. Eleven subjects were interviewed, including 6 patients and 5 healthcare professionals, all at Casa da Aids. We used the narrated content collected the life stories of the characters, presenting our narratives about the characters in the form of patographic histories(NUNES, 2018; NUNES, 2019; SOUZA, 2003) and of historiobiographies (CRITELLI, 2013). Narratives provide any healthcare system user with an absorption of their own experience with the disease, offering a greater opportunity for the individual to take ownership of their process and, perhaps, transform it into a source of life within the health process. They allow professionals to gain a deeper understanding of the true feelings a person that lives with a disease has towards their treatment. Additionally, narratives enable both professionals and users to see the world from the perspective of an individual with that condition, shedding light on ways to improve their journey in controlling that illness. Finally, we suggest some changes in the healthcare services flow, in order to meet the need for a closer relationship between institution and user.

The Complex Role of the Microbiome in Non-Small Cell Lung Cancer Development and Progression.

In recent years, there has been a growing interest in the relationship between microorganisms in the surrounding environment and cancer cells. While the tumor microenvironment predominantly comprises cancer cells, stromal cells, and immune cells, emerging research highlights the significant contributions of microbial cells to tumor development and progression. Although the impact of the gut microbiome on treatment response in lung cancer is well established, recent investigations indicate complex roles of lung microbiota in lung cancer. This article focuses on recent findings on the human lung microbiome and its impacts in cancer development and progression. We delve into the characteristics of the lung microbiome and its influence on lung cancer development. Additionally, we explore the characteristics of the intratumoral microbiome, the metabolic interactions between lung tumor cells, and how microorganism-produced metabolites can contribute to cancer progression. Furthermore, we provide a comprehensive review of the current literature on the lung microbiome and its implications for the metastatic potential of tumor cells. Additionally, this review discusses the potential for therapeutic modulation of the microbiome to establish lung cancer prevention strategies and optimize lung cancer treatment.

Liquid Biopsy in Lung Cancer: Biomarkers for the Management of Recurrence and Metastasis.

Liquid biopsies have emerged as a promising tool for the detection of metastases as well as local and regional recurrence in lung cancer. Liquid biopsy tests involve analyzing a patient's blood, urine, or other body fluids for the detection of biomarkers, including circulating tumor cells or tumor-derived DNA/RNA that have been shed into the bloodstream. Studies have shown that liquid biopsies can detect lung cancer metastases with high accuracy and sensitivity, even before they are visible on imaging scans. Such tests are valuable for early intervention and personalized treatment, aiming to improve patient outcomes. Liquid biopsies are also minimally invasive compared to traditional tissue biopsies, which require the removal of a sample of the tumor for further analysis. This makes liquid biopsies a more convenient and less risky option for patients, particularly those who are not good candidates for invasive procedures due to other medical conditions. While liquid biopsies for lung cancer metastases and relapse are still being developed and validated, they hold great promise for improving the detection and treatment of this deadly disease. Herein, we summarize available and novel approaches to liquid biopsy tests for lung cancer metastases and recurrence detection and describe their applications in clinical practice.

Advances in the Molecular Landscape of Lung Cancer Brain Metastasis.

Lung cancer is one of the most frequent tumors that metastasize to the brain. Brain metastasis (BM) is common in advanced cases, being the major cause of patient morbidity and mortality. BMs are thought to arise via the seeding of circulating tumor cells into the brain microvasculature. In brain tissue, the interaction with immune cells promotes a microenvironment favorable to the growth of cancer cells. Despite multimodal treatments and advances in systemic therapies, lung cancer patients still have poor prognoses. Therefore, there is an urgent need to identify the molecular drivers of BM and clinically applicable biomarkers in order to improve disease outcomes and patient survival. The goal of this review is to summarize the current state of knowledge on the mechanisms of the metastatic spread of lung cancer to the brain and how the metastatic spread is influenced by the brain microenvironment, and to elucidate the molecular determinants of brain metastasis regarding the role of genomic and transcriptomic changes, including coding and non-coding RNAs. We also present an overview of the current therapeutics and novel treatment strategies for patients diagnosed with BM from NSCLC.

Pre-operative sarcopenia is predictive of recurrent gastrointestinal bleeding on left ventricular assist device support: A multicenter analysis.

INTRODUCTION: Whether pre left ventricular assist device (LVAD) sarcopenia is associated with higher incidence of gastrointestinal bleeding (GIB) on LVAD support remains unknown. METHODS: To study the association between preoperative sarcopenia and post LVAD GIB events, we performed a retrospective, multi-centered study including patients with chest CTs performed ≤ 3 months prior to LVAD implantation at the University of Minnesota (n = 143) and Houston Methodist Hospital (n = 133). To quantify sarcopenia, unilateral pectoralis muscle mass indexed to body surface area (PMI) and attenuation (approximated by mean Hounsfield units; PHUm) were measured on pre-operative chest CT scans. Negative binomial regression analyses were performed to determine the association between pectoralis muscle measures and number of GIB events to 2 years of LVAD support. RESULTS: The study cohort included 276 LVAD recipients with 43 % designated as bridge to transplant at the time of LVAD implantation. High pectoralis muscle mass and tissue attenuation were both protective against GIB events. Each 5 unit increase in PHUm was associated with an adjusted 19 % reduction in the incidence rate of GIB (95 % CI 7-29 %, p = 0.002). Each unit increase in PMI was associated with an adjusted 17 % reduction in the incidence of GIB (95 % CI 1- 29 %, p = 0.04). The models were adjusted for age, sex, INTERMACS profile, bridge to transplant status, creatinine, albumin and implanting center. CONCLUSION: Preoperative sarcopenia, as quantified by pectoralis muscle size and attenuation, was associated with the development of recurrent GI bleeding after LVAD implantation. These CT quantitative measures appear to predict not only early mortality but morbidity on LVAD as well.

The Shortage of Benzathine Penicillin and Its Impact on Congenital Syphilis Incidence: An Ecologic Study in the City of Rio de Janeiro.

BACKGROUND: The Pan American Health Organization indicates that increased incidence of congenital syphilis (CS) can be attributed to the lack of penicillin. This study aimed to analyze the relationship between the benzathine penicillin shortage and the significant increase in the incidence of congenital syphilis in the city of Rio de Janeiro from 2013 to 2017. METHODS: We used a mixed ecologic study design (temporal and multiple groups). Analysis units were the neighborhoods (spatial) and quarters (temporal) during those years. The study population consisted of CS patients who were living in the city of Rio de Janeiro. The benzathine penicillin supply measure for use in gestational syphilis considered the ratio between (1) the number of bottles dispensed to health facilities in each neighborhood and (2) the number of bottles necessary to treat pregnant women diagnosed with syphilis and their respective partners residing in each neighborhood. To evaluate the association between shortages and a significant increase in CS incidence, the negative-inflated zero-binomial regression model (longitudinal model) was used. RESULTS: During the study period, the incidence rate of CS in Rio de Janeiro neighborhoods was on average 19.6 per 1000 live births. In the simple analysis, shortage was associated with a 2.17-fold increase in the risk of a significant increase in CS incidence. After adjustment for the sufficient minimum set, the strength of association increased to 2.23 (95% confidence interval, 1.15-4.30). CONCLUSIONS: We conclude that the benzathine penicillin shortage had an impact on the increase in the incidence of CS in Rio de Janeiro.

Utilising a novel surveillance system to enhance field screening activities for the leishmaniases.

Over the last decade, an arbovirus surveillance system based on the preservation of nucleic acids (RNA/DNA) has been developed using Flinders Technology Associates (FTAⓇ) cards. Soaked in honey, FTAⓇ cards are applied in the field to detect arboviruses expectorated during mosquito sugar feeding. This technique has been shown to be inexpensive and efficient, and the implementation of this system for detecting parasites could be of international importance. As Leishmania parasites are highly prevalent in developing countries, FTAⓇ cards may offer an alternative inexpensive tool to enhance field surveillance activities for leishmaniasis. The simple approach of applying the cards in programs can substitute the necessary extensive training of personnel. In our hands, Leishmania macropodum DNA was shown to be stable on FTAⓇ cards during a 10-week time course, supporting their suitability for projects where direct access to laboratories is unobtainable and samples require storage prior to processing. This method may benefit programs in remote areas where accessibility to laboratory facilities are limited and samples need to be stored long-term.•This study found that FTA cards could be a valuable tool in the surveillance of leishmaniasis.•The method is based on the long-term preservation and detection of Leishmania DNA expectorated during insect sugar feeding.•The application of FTA cards can preclude the need to screen large samples and analysis of insect populations to provide evidence of disease transmission.

Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017?

OBJECTIVE: To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017. METHODS: This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis. RESULTS: BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis. CONCLUSIONS: Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.

Utilising a novel surveillance system to investigate species of Forcipomyia (Lasiohelea) (Diptera: Ceratopogonidae) as the suspected vectors of Leishmania macropodum (Kinetoplastida: Trypanosomatidae) in the Darwin region of Australia.

Up until recently, Australia was considered free of Leishmania due to the absence of phlebotomine sandfly species (Diptera: Phlebotominae) known to transmit Leishmania parasites in other parts of the world. The discovery of Leishmania (Mundinia) macropodum (Kinetoplastida: Trypanosomatidae) in Northern Australia sparked questions as to the existence of alternative vectors of Leishmania. This has added to the complexity of fully understanding the parasite's interaction with its vector, which is known to be very specific. Previous findings demonstrated L. macropodum infection beyond the blood meal stage in the day-biting midges Forcipomyia (Lasiohelea) Kieffer (Diptera: Ceratopogonidae) implicating them in the parasite's life cycle. Currently, there is no conclusive evidence demonstrating this suspected vector to transmit L. macropodum to a naïve host. Therefore, this research aimed to investigate the vector competency of day-biting midge F. (Lasiohelea) to transmit L. macropodum utilising a novel technology that preserves nucleic acids. Honey-soaked Flinders Technology Associates (FTA®) filter-paper cards were used to obtain saliva expectorated from biting midges while sugar-feeding. F. (Lasiohelea) were aspirated directly off macropods from a known Leishmania-transmission site and were kept in a waxed-paper container holding a honey-coated FTA® card for feeding. Insect identification and Taqman quantitative real-time PCR (qPCR) screening assays revealed L. macropodum DNA in F. (Lasiohelea) up to 7 days post field-collection, and in an unidentified biting midge, previously known as F. (Lasiohelea) sp.1. Moreover, 7/145 (4.83%) of FTA® cards were confirmed positive with L. macropodum DNA after exposure to field-collected F. (Lasiohelea). Additionally, FTA® cards were found to be a valuable surveillance tool, given the ease of use in the field and laboratory. Overall, our findings support previous reports on L. macropodum transmission by an alternative vector to phlebotomine sandflies. Further studies identifying and isolating infective L. macropodum promastigotes is necessary to resolve questions on the L. macropodum vector.

Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? / A quem afetou o desabastecimento de penicilina para sífilis no Rio de Janeiro, 2013-2017?

ABSTRACT OBJECTIVE To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017. METHODS This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis. RESULTS BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis. CONCLUSIONS Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.

RESUMO OBJETIVO Analisar o desabastecimento da penicilina benzatina (PB), caracterizando sua evolução temporal e distribuição espacial no município do Rio de Janeiro de 2013 a 2017. MÉTODOS Trata-se de estudo ecológico misto realizado com notificações de sífilis gestacional e congênita, registros de distribuição de PB e de dados sociodemográficos da população dos bairros do município do Rio de Janeiro. Para mensurar o desabastecimento foi calculado por trimestre um indicador de abastecimento de PB para cada bairro, entre 2013 e 2017. Mapas temáticos foram produzidos para identificar áreas e períodos com maior desabastecimento de PB, o qual foi descrito segundo condições sociodemográficas, rede de serviços de saúde e aspectos epidemiológicos da incidência de sífilis por bairro. RESULTADOS O desabastecimento de PB no município do Rio de Janeiro, no período de 2013 a 2017, não foi homogêneo no espaço ou no tempo. A evolução temporal e a distribuição espacial da escassez de PB revelam que o desabastecimento afetou de formas distintas os habitantes do município, sendo menor em 2013 e 2016 e mais intenso em 2014, 2015 e 2017, principalmente nos bairros das áreas programáticas AP3 e AP5, mais pobres e com maiores taxas de sífilis gestacional e congênita. CONCLUSÕES Analisar o desabastecimento de PB e sua evolução temporal e distribuição espacial no município do Rio de Janeiro permitiu reconhecer que os habitantes do município são afetados de diferentes modos. Compreender esse processo ajuda a planejar ações para enfrentar crises de desabastecimento, minimizando possíveis impactos no controle da sífilis, além de reduzir a desigualdade no acesso ao tratamento.

Crocodilepox Virus Evolutionary Genomics Supports Observed Poxvirus Infection Dynamics on Saltwater Crocodile (Crocodylus porosus).

Saltwater crocodilepox virus (SwCRV), belonging to the genus Crocodylidpoxvirus, are large DNA viruses posing an economic risk to Australian saltwater crocodile (Crocodylus porosus) farms by extending production times. Although poxvirus-like particles and sequences have been confirmed, their infection dynamics, inter-farm genetic variability and evolutionary relationships remain largely unknown. In this study, a poxvirus infection dynamics study was conducted on two C. porosus farms. One farm (Farm 2) showed twice the infection rate, and more concerningly, an increase in the number of early- to late-stage poxvirus lesions as crocodiles approached harvest size, reflecting the extended production periods observed on this farm. To determine if there was a genetic basis for this difference, 14 complete SwCRV genomes were isolated from lesions sourced from five Australian farms. They encompassed all the conserved genes when compared to the two previously reported SwCRV genomes and fell within three major clades. Farm 2's SwCRV sequences were distributed across all three clades, highlighting the likely mode of inter-farm transmission. Twenty-four recombination events were detected, with one recombination event resulting in consistent fragmentation of the P4c gene in the majority of the Farm 2 SwCRV isolates. Further investigation into the evolution of poxvirus infection in farmed crocodiles may offer valuable insights in evolution of this viral family and afford the opportunity to obtain crucial information into natural viral selection processes in an in vivo setting.

Defining Metabolic Rewiring in Lung Squamous Cell Carcinoma.

Metabolomics based on untargeted flow infusion electrospray ionization high-resolution mass spectrometry (FIE-HRMS) can provide a snap-shot of metabolism in living cells. Lung Squamous Cell Carcinoma (SCC) is one of the predominant subtypes of Non-Small Cell Lung Cancers (NSCLCs), which usually shows a poor prognosis. We analysed lung SCC samples and matched histologically normal lung tissues from eight patients. Metabolites were profiled by FIE-HRMS and assessed using t-test and principal component analysis (PCA). Differentially accumulating metabolites were mapped to pathways using the mummichog algorithm in R, and biologically meaningful patterns were indicated by Metabolite Set Enrichment Analysis (MSEA). We identified metabolic rewiring networks, including the suppression of the oxidative pentose pathway and found that the normal tricarboxylic acid (TCA) cycle were decoupled from increases in glycolysis and glutamine reductive carboxylation. Well-established associated effects on nucleotide, amino acid and thiol metabolism were also seen. Novel aspects in SCC tissue were increased in Vitamin B complex cofactors, serotonin and a reduction of γ-aminobutyric acid (GABA). Our results show the value of FIE-HRMS as a high throughput screening method that could be exploited in clinical contexts.

A crise do desabastecimento da penicilina benzatina e o impacto na sífilis congênita: um estudo ecológico no município do Rio de Janeiro / The crisis of the shortage of benzathine penicillin supply and its impact on congenital syphilis: an ecological study in the city of Rio de Janeiro

O objeto de estudo é a crise do desabastecimento da penicilina benzatina (PB) e o impacto na sífilis congênita (SC) por um estudo ecológico no Município do Rio de Janeiro. Os objetivos são (i) descrever a evolução temporal do desabastecimento da PB, da incidência de (SC) e do aumento significativo da sua incidência no município no período de 2013-2017; (ii) estudar a relação entre o desabastecimento da PB e o aumento significativo da incidência de SC. Trata-se de um estudo ecológico do tipo misto (múltiplos grupos e temporal) baseado em dados secundários de notificação de SC e sífilis gestacional (SG), de dispensação de PB e dados demográficos das populações residentes nos bairros do município do Rio de Janeiro. As unidades de estudo foram bairro (geográfica) e trimestre (temporal) dos anos estudados. A população de estudo foi constituída por todos os casos de SC notificados pelo Sistema de Informação de Agravos de Notificação (SINAN) do município do Rio de Janeiro, por local de residência (bairro) no município do Rio de Janeiro. O período de estudo considerou a necessidade de contemplar o expressivo desabastecimento de PB nas unidades de saúde. Sabe-se que em 2014, o desabastecimento se iniciou devido a problemas de ordem regulatório-sanitária, uma crise impedindo a plena atividade produtora de penicilina no mercado brasileiro. Somente em 2016 havia indícios que a situação havia sido regularizada. A exposição do estudo foi o nível de abastecimento de PB nas unidades básicas de saúde calculada pela razão entre o número de doses dispensadas e o número de doses necessárias de acordo com dados de notificação de sífilis gestacional do SINAN. O principal desfecho foi o aumento significativo da incidência de SC, mas também foi considerada a taxa de incidência da população de cada bairro. O modelo teórico contemplou a dimensão sociodemográfica (estrutura etária, sexo, mulheres chefes de família, escolaridade), a dimensão econômica (pobreza, desemprego, gini de renda), dimensão geográfica (aglomeração, homicídio) e assistência pré-natal (número de consultas, parceiros tratados e exames realizados). Para a análise de dados foi usado o modelo de regressão binomial negativo inflado de zero para variável desfecho incremento significativo da incidência de SC (> 200% em relação ao trimestre anterior) e o nível abastecimento de PB para unidades de saúde de cada bairro-trimestre/ano de 2013-2017. As variáveis consideradas no ajuste foram aquelas dimensões citadas. Os resultados indicam que (a) o desabastecimento de PB no período estudado teve distribuição heterogênea no espaço e tempo; (b) incremento da incidência de SC também distribuído heterogeneamente no tempo e espaço e (c) relação entre o desabastecimento de PB e incremento de incidência de SC, considerando a influencia dos fatores descritos no modelo teórico. Concluiu-se que o abastecimento influenciou no aumento da incidência dessa doença no Rio de Janeiro nos anos de estudo

The object of study is the crisis of the shortage of benzathine penicillin (BP) supply and the impact on congenital syphilis by an ecological study in the city of Rio de Janeiro. The goals are to (i) describe the temporal evolution of benzathine penicillin supply shortage, the incidence of congenital syphilis (CS) and the significant increase in its incidence in the municipality in the 2013-2017 period; (ii) to study the relation between the shortage of benzathine penicillin and the significant increase in the incidence of CS. This is a mixed-type (multiple groups and temporal) ecological study based on secondary data on CS and gestational syphilis (GS), benzathine penicillin dispensation, and demographic data of populations living in the neighborhoods of Rio de Janeiro. The units of study were neighborhood (geographical) and quarter (temporal) of the studied years. The study population consisted of all cases of SC reported by the Notification Aggravation Information System (SINAN) of the city of Rio de Janeiro, by place of residence (neighborhood) in the city of Rio de Janeiro. The study period considered the need to contemplate the expressive shortage of BP in the health units. It is known that in 2014, the shortage began due to regulatory-sanitary problems, a crisis that prevented the full production of penicillin in the Brazilian market. Only in 2016 were there indications that the situation had been regularized. The study's exposure was the level of BP supply in the basic health units calculated by the ratio between the number of doses dispensed and the number of doses required according to SINAN's gestational syphilis notification data. The main outcome was a significant increase in the incidence of CS, but the incidence rate of each neighborhood population was also considered. The theoretical model included the socio-demographic dimension (age structure, sex, female heads of household, schooling), economic dimension (poverty, unemployment, income gini index), geographic dimension (agglomeration, homicide) and prenatal care (amount of appointments, partners treated and examinations performed). For the data analysis it was used the negative binomial regression model inflated from zero to variable outcome significant increase of the incidence of SC (over 200% comparing the previous quarter) and the BP supply level per health units of each neighborhood-quarter each year between 2013-2017. The variables considered in the adjustment were those dimensions mentioned. The results indicate that (a) the shortage of BP in the studied period had heterogeneous distribution in space and time; (b) increase in the incidence of CS was also distributed heterogeneously in time and space, and (c) a relation between BP shortages and increased CS incidence, considering the influence of the factors described in the theoretical model. The conclusion was that the supply influenced the increase of the incidence of this disease in Rio de Janeiro in the years of study

Febre maculosa no Brasil: estudo da mortalidade para a vigilância epidemiológica / Spotted fever in Brazil: mortality study for epidemiological surveillance

Resumo Febre maculosa é uma doença infecciosa caracterizada por febre, com formas leves e atípicas até formas graves, e, quando não tratada adequadamente, pode apresentar taxa de letalidade de 85%. Causada pela Rickettsia rickettsii, é transmitida por meio da saliva de carrapato. No Brasil, o vetor mais importante é o Amblyomma cajennense. Discute-se o número de óbitos por Rickettsia no Brasil, projetando a necessidade de ampliação e disseminação do conhecimento sobre a possibilidade de ocorrência da febre maculosa brasileira (FMB), além de debater sintomas, diagnóstico diferencial e dados epidemiológicos. A metodologia consistiu na identificação dos óbitos por Rickettsia no Brasil entre 2005-2010, utilizando-se o Sistema de Informação sobre Mortalidade (SIM). Foram estudados 75 casos. Observou-se taxa de letalidade de 24,8% e uma concentração de óbitos nas regiões Sudeste e Sul do país. Os resultados obtidos contribuem para a sensibilização dos profissionais sobre a necessidade de união dos dados clínicos, epidemiológicos e laboratoriais, facilitando o reconhecimento da doença e o tratamento precoce.

Abstract Spotted Fever is an infectious disease, typically characterized by mild to severe fever, and may reach a 85% lethality rate if not properly treated. Spotted Fever is caused by Rickettsia rickettsii, and is transmitted through tick’s saliva. In Brazil, the most important vector is the Amblyomma cajennense. This study discusses the number of deaths due to rickettsial infection in Brazil, by projecting the needs for expansion and dissemination of knowledge on the possible occurrence of the Brazilian Spotted Fever; we also discuss the symptoms, differential diagnosis and epidemiological data. The methodology consisted in identifying the deaths by rickettsia in Brazil, from 2005 to 2010, using the Mortality Information System. Seventy five cases were studied. There was a concentration of deaths in the southeast and south of the country, and a lethality rate of 24.8%. The results will help in raising awareness among professionals, and will help to understand the importance of combining clinical, epidemiological and laboratory data to facilitate recognition of the disease and early treatment.

Febre maculosa no Brasil: estudo da mortalidade para a vigilância epidemiológica / Spotted fever in Brazil: mortality study for epidemiological surveillance

Resumo Febre maculosa é uma doença infecciosa caracterizada por febre, leves e típicas até graves, a qual, quando não tratada adequadamente, pode apresentar taxa de letalidade de 85%. Causada pela Rickettsia rickettsii, é transmitida através da saliva de carrapato. No Brasil, o vetor mais importante é o Amblyomma cajennense. Discute-se o número de óbitos por rickettsia no Brasil projetando a necessidade de ampliação e disseminação do conhecimento sobre a possibilidade da ocorrência da Febre Maculosa Brasileira, debatendo-se sintomas, diagnóstico diferencial e dados epidemiológicos. A metodologia consistiu na identificação dos óbitos por rickettsia, no Brasil, entre 2005 e 2010, utilizando-se o Sistema de Informação sobre Mortalidade. Foram estudados 75 casos. Observou-se a concentração de óbitos no Sudeste e Sul do país e uma taxa de letalidade de 24,8%. Os resultados obtidos contribuem para a sensibilização dos profissionais sobre a necessidade de união dos dados clínicos, epidemiológicos e laboratoriais, facilitando o reconhecimento da doença e o tratamento precoce.

Abstract Brazilian Spotted Fever is an infectious disease, typically characterized by mild to severe fever that if not properly treated, may reach a lethality rate of 85%. Brazilian Spotted Fever is caused by Rickettsia rickettsii that is transmitted through tick’s saliva. In Brazil, the most important vector is the Amblyomma cajennense. This study discusses the number of deaths due to infection by Rickettsia in Brazil, projecting the needs for knowledge expansion and dissemination on the possible occurrence of Brazilian Spotted Fever; and discusses the symptoms, differential diagnosis and epidemiological data. The methodology consisted in identifying the deaths by Rickettsia in Brazil, from 2005 to 2010, using the Mortality Information System. Seventy five cases were studied. There was a concentration of deaths in the southeast and south of the country, and a lethality rate of 24.8%. The results will help to raise awareness among professionals, and will help to understand the importance of combining clinical, epidemiological and laboratory data to facilitate recognition of the disease and early treatment.

Significados da saúde bucal na velhice / Meanings of oral health on old age

Este trabalho é resultado de um estudo guiado por um questionário semiestruturado,aplicado em situação de entrevista individual a oito idosos, de ambos os sexos, entre 67 e 85 anos. A partir do relato das histórias das suas próprias bocas, o objetivo foi identificar e analisar as respostas que evidenciam sua posição diante da questão da saúde bucal, como forma de aumentar os saberes odontológicos sobre a velhice, bem como de tentar qualificar ações e serviços voltados para as pessoas idosas. Os sujeitos, funcionalmente independentes, foram selecionados dentre os residentes de uma Instituição de Longa Permanência e dentre os participantes ativos de uma Universidade Aberta à Maturidade, justamente porque se acredita que personagens desses dois ambientes pensam de forma diferente sobre saúde e saúde bucal. Trata-se de pesquisa qualitativa, com abordagem interdisciplinar, buscando respostas a questões de um mesmo campo semântico, ainda que em relações diversas: saúde bucal, cuidados bucais, hábitos bucais, dentista, dente, dor de dente, saúde em geral do corpo, prótese e estética, estética e corpo, saúde pública, além de direitos dos idosos. Concluiu-se que os significados da saúde bucal na velhice, manifestos por esses sujeitos, mantêm relação com exemplos familiares valorizados por eles, com a vida social, a qualidade dos relacionamentos dentro e fora de suas casas, seu bem-estar, sexualidade, dentre aspectos outros correlatos, evidenciados durante a pesquisa.

This paper is the result of a research directed by a semi-structured questionnaire, applied to individual interview situation, when we asked eight old people, of both sexes, between 67 and 85 years, to describe the histories of their own mouths, the goal was to identify and analyze the responses that show your position on the issue of oral health. Furthermore, in order to increase dental knowledge in old age, as well as try to qualify actions and services for the elderly. The subject, functionally independent, were selected from among the residents of a Long Term Care Institutions and among the active participants of an Open University to Maturity, precisely because it is believed that characters of these two environments think differently about health and oral health. It is a qualitative research, with an interdisciplinary approach, seeking answers to questions of the same semantic field, albeit in different relationships: oral health, oral care, oral habits, dentist, tooth, toothache, general health of the body, prosthesis and aesthetics, aesthetics and body, public health, and old people`s rights. The results were analyzed based on all these histories of life and on each point of view. It was concluded that the meanings of oral health in old age, manifest by these subjects, maintain relationship with familiar examples valued by them, with social life, the quality of relationships inside and outside their homes, their well-being, sexuality, and other topics exposed during the research.

Significados da saúde bucal na velhice / Meanings of oral health on old age

Este trabalho é resultado de um estudo guiado por um questionário semiestruturado,aplicado em situação de entrevista individual a oito idosos, de ambos os sexos, entre 67 e 85 anos. A partir do relato das histórias das suas próprias bocas, o objetivo foi identificar e analisar as respostas que evidenciam sua posição diante da questão da saúde bucal, como forma de aumentar os saberes odontológicos sobre a velhice, bem como de tentar qualificar ações e serviços voltados para as pessoas idosas. Os sujeitos, funcionalmente independentes, foram selecionados dentre os residentes de uma Instituição de Longa Permanência e dentre os participantes ativos de uma Universidade Aberta à Maturidade, justamente porque se acredita que personagens desses dois ambientes pensam de forma diferente sobre saúde e saúde bucal. Trata-se de pesquisa qualitativa, com abordagem interdisciplinar, buscando respostas a questões de um mesmo campo semântico, ainda que em relações diversas: saúde bucal, cuidados bucais, hábitos bucais, dentista, dente, dor de dente, saúde em geral do corpo, prótese e estética, estética e corpo, saúde pública, além de direitos dos idosos. Concluiu-se que os significados da saúde bucal na velhice, manifestos por esses sujeitos, mantêm relação com exemplos familiares valorizados por eles, com a vida social, a qualidade dos relacionamentos dentro e fora de suas casas, seu bem-estar, sexualidade, dentre aspectos outros correlatos, evidenciados durante a pesquisa.(AU)

This paper is the result of a research directed by a semi-structured questionnaire, applied to individual interview situation, when we asked eight old people, of both sexes, between 67 and 85 years, to describe the histories of their own mouths, the goal was to identify and analyze the responses that show your position on the issue of oral health. Furthermore, in order to increase dental knowledge in old age, as well as try to qualify actions and services for the elderly. The subject, functionally independent, were selected from among the residents of a Long Term Care Institutions and among the active participants of an Open University to Maturity, precisely because it is believed that characters of these two environments think differently about health and oral health. It is a qualitative research, with an interdisciplinary approach, seeking answers to questions of the same semantic field, albeit in different relationships: oral health, oral care, oral habits, dentist, tooth, toothache, general health of the body, prosthesis and aesthetics, aesthetics and body, public health, and old people`s rights. The results were analyzed based on all these histories of life and on each point of view. It was concluded that the meanings of oral health in old age, manifest by these subjects, maintain relationship with familiar examples valued by them, with social life, the quality of relationships inside and outside their homes, their well-being, sexuality, and other topics exposed during the research.(AU)

Salivary shedding of HHV-8 in people infected or not by human immunodeficiency virus 1.

BACKGROUND: Human herpesvirus 8 (HHV-8), the main agent involved in the etiopathogenesis of Kaposi's sarcoma (KS) is primarily transmitted through sexual contact. The potential of saliva as a source of HHV-8 transmission remains unclear. The purpose of this work was to determine the frequency of HHV-8 detection in saliva of HIV-infected individuals and their family contacts. METHODS: The study group comprised 210 individuals. Group 1: 35 HIV-infected patients; group 2: 35 non-HIV individuals; group 3: two siblings for each patient from group 1; group 4: two siblings for each individual from group 2. Each participant had non-stimulated whole saliva collected and DNA was extracted. HHV-8-DNA amplification from ORF-26 was performed using a nested PCR protocol. RESULTS: HHV-8 DNA was detected in saliva from 14/35 (40%) HIV-infected individuals and 4/35 (11.4%) non-HIV-infected individuals (OR = 5.16, CI [1.49-17.88], P = 0.006). It was also possible to amplify HHV-8 DNA in 11/70 (15.7%) relatives of HIV-infected participants and 4/70 (5.71%) relatives of non-HIV-infected individuals(P = 0.041). Among the 14 group 1 patients with HHV-8 DNA detected in saliva, eight (57.1%) had a household member in whom HHV-8 DNA was also amplified (OR = 8, CI [1.58-40.29] P = 0.007). CONCLUSIONS: HHV-8 DNA is frequently found in saliva. HIV-infected individuals showed a higher frequency of detection of HHV-8 than healthy controls. HHV-8 DNA was significantly amplified in saliva of household members of HIV/HHV-8 co-infected individuals.

Teen peer educators and diabetes knowledge of low-income fifth grade students.

The current study was designed to evaluate a unique adolescent peer type 2 diabetes mellitus (Type 2 DM) prevention training program for fifth grade children. Peer educators were 22 high school students who participated in the Elementary Institute of Science's Commission on Science that Matters, a year-long program promoting active participation in the health and environmental sciences. Peer education was delivered in the form of a two hour health fair. A knowledge survey was given to fifth grade students in the classroom before the health fair began and then again in the classroom after the health fair. Fifth grade students were able to correctly identify Type 1 DM (23 vs. 40%; P < .01), Type 2 DM (21 vs. 52%; P < .001), and the signs of diabetes (10 vs. 39%; P < .001) after the health fair. This approach could be inexpensively integrated into any community-based health promotion with children and adolescents.

Efeito do tratamento com triptofano sobre parâmetros do comportamento alimentar em ratos adultos submetidos à desnutrição neonatal / Effects of tryptophan on the eating behavior of adult rats with neonatal malnutrition

OBJETIVO: Investigou-se os efeitos do tratamento com triptofano sobre o consumo alimentar em ratos adultos, submetidos ou não a desnutrição precoce. MÉTODOS: Sessenta e quatro ratos Wistar machos foram divididos em nutridos (n=32, caseína=17 por cento) e desnutridos (n=32, caseína=8 por cento), de acordo com a dieta materna empregada no período de lactação. Após o desmame, todos os ratos receberam dieta com 23 por cento de proteína. Pesos corporais foram avaliados no sétimo, vigésimo primeiro e septuagésimo dias de vida. Aos setenta dias de idade, cada grupo nutricional foi dividido em subgrupos: Nutrido-Salina (n=16) e Nutrido-Triptofano (n=16), Desnutrido-Salina (n=16) e Desnutrido-Triptofano (n=16). Os grupos receberam diariamente 1,0mL/100g de triptofano, na dose de 50mg/kgP ou salina (0,9 por centoNaCl), durante 14 dias. Neste período foram realizados os estudos dos parâmetros do comportamento alimentar. Posteriormente obteve-se a média do consumo alimentar relativo e a média do ganho de peso relativo. As análises estatísticas foram feitas utilizando os testes t Student e ANOVA seguido de Tukey, com p<0,05. RESULTADOS: As ninhadas de mães alimentadas com dieta hipoproteica mantiveram pesos inferiores comparados com as ninhadas nutridas (p<0,01) até os setenta dias de vida. Os ratos nutridos tratados com triptofano (M=6,88, DP=0,05) reduziram a ingestão alimentar comparados aos nutridos salina (M=7,27, DP=0,08) (p<0,01). Contudo, não houve efeito sobre o ganho de peso. Entre os desnutridos nenhuma diferença foi encontrada. CONCLUSÃO: Nesse estudo, a restrição proteica neonatal alterou a evolução ponderal em ratos. Além disso, a desnutrição precoce tornou os ratos adultos resistentes aos efeitos inibitórios do triptofano sobre a ingestão alimentar.

OBJECTIVE: This study investigated the effects of tryptophan on the eating behavior of adult rats submitted or not to early malnutrition. METHODS: Sixty-four male Wistar rats were divided into nourished (n=32, casein=17 percent) and malnourished (n=32, casein=8 percent) according to the diet given to the dam during lactation. After weaning, all rats were fed a diet with a protein content of 23 percent. The rats were weighed on day 7, day 21 and day 70 after birth. On day 70 after birth, each nutritional group was divided into 4 subgroups: nourished-saline (n=16), nourished-tryptophan (n=16), malnourished-saline (n=16) and malnourished-tryptophan (n=16). The tryptophan groups were given 1.0mL/100g of tryptophan for 14 days, at a dosage of 50mg/kgw of body weight and the saline groups were given 1.0mL/100g of 0.9 percent NaCl, also for 14 days. The eating behavior parameters were assessed during this period. The mean relative food intake and mean relative weight gain were then determined. The statistical analyses were done by the Student's t-test and ANOVA, followed by the Tukey test, with p<0.05. RESULTS: During the first 70 days of life, pups from protein-malnourished damns remained lighter than pups from well-nourished damns (p<0.01). Well-nourished rats treated with tryptophan (M=6.88, SD=0.05) ate less than those given saline (M=7.27, SD=0.08) (p<0.01) but weight was unaffected. No difference was found for the malnourished rats. CONCLUSION: In this study, neonatal protein restriction affected weight gain in rats. Furthermore, early malnutrition made adult rats resistant to the inhibitory effects of tryptophan on food intake.