Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission.

The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.

Relationship between aerobic capacity and pelvic floor muscles function: a cross-sectional study.

The objective of this study was to evaluate the relationship between aerobic capacity and pelvic floor muscles (PFM) function in adult women. Women aged 18 or over and without urinary dysfunction or other chronic diseases were eligible to participate. They completed the habitual physical activity (HPA) questionnaire, underwent a PFM functional evaluation by palpation and perineometry, and performed a submaximal (between 75 and 85% of maximum heart rate) cardiopulmonary exercise (CPX) test to determine the ventilatory anaerobic threshold (VAT). Forty-one women were included (35±16 years, 75% physically active, 17% very active, and 8% sedentary and 17% presented grade 1 PFM contraction, 31.8% grade 2, 26.8% grade 3, and 24.4% grade 4, according to the modified Oxford Scale). The average PFM contraction pressure obtained by perineometer was 53±26 cmH2O and the average oxygen consumption at VAT (VO2VAT) obtained from CPX was 14±2 mL·kg-1·min-1. Significant correlations were found between PFM contraction pressure and VO2VAT (r=0.55; P<0.001); between PFM contraction pressure and HPA score (r=0.38; P=0.02); between age and VO2VAT (r=-0.25; P=0.049); and between VO2VAT and HPA score (r=0.36; P=0.02). An age-adjusted multiple linear regression equation (R2=0.32) was derived to estimate VO2VAT from the contraction value obtained by perineometer, so that the PFM contraction pressure was able to predict VO2VAT. The equation was validated using data from another group of 20 healthy women (33±12 years; PFM contraction: 49±23 cmH2O) and no significant difference was found between actual VO2VAT and predicted VO2VAT (13.1±1.9 vs 13.8±2.0 mL·kg-1·min-1). In conclusion, PFM function is associated with aerobic capacity in healthy women and PFM contraction pressure may be used to estimate VO2VAT in this population.

Antiproliferative effects of ß-blockers on human colorectal cancer cells.

Colon cancer is the fourth and third most common cancer, respectively in men and women worldwide and its incidence is on the increase. Stress response has been associated with the incidence and development of cancer. The catecholamines (CA), adrenaline (AD) and noradrenaline (NA), are crucial mediators of stress response, exerting their effects through interaction with α- and ß-adrenergic receptors (AR). Colon cancer cells express ß-AR, and their activation has been implicated in carcinogenesis and tumor progression. Interest concerning the efficacy of ß-AR blockers as possible additions to cancer treatment has increased. The aim of this study was to investigate the effect of several AR agonists and ß-blockers following cell proliferation of HT-29 cells, a human colon adenocarcinoma cell line. For this purpose, HT-29 cells were incubated in the absence (control) or in the presence of the AR-agonists, AD, NA and isoprenaline (ISO) (0.1-100 µM) for 12 or 24 h. The tested AR agonists revealed proliferative effects on HT-29 cells. In order to study the effect of several ß-blockers following proliferation induced by AR activation, the cells were treated with propranolol (PRO; 50 µM), carvedilol (CAR; 5 µM), atenolol (ATE; 50 µM), or ICI 118,551 (ICI; 5 µM) for 45 min prior, and simultaneously, to incubation with each of the AR agonists, AD and ISO, both at 1 and 10 µM. The results suggested that adrenergic activation plays an important role in colon cancer cell proliferation, most probably through ß-AR. The ß-blockers under study were able to reverse the proliferation induced by AD and ISO, and some of these blockers significantly decreased the proliferation of HT-29 cells. The elucidation of the intracellular pathways involved in CA-induced proliferation of colon cancer cells, and in the reversion of this effect by ß-blockers, may contribute to identifying promising strategies in cancer treatment.

[Effects of surface electrical stimulation in older women with stress urinary incontinence: a randomized controlled pilot study]. / Efectos de la electroestimulación superficial en las mujeres mayores con incontinencia urinaria de esfuerzo: estudio piloto aleatorio controlado.

OBJECTIVE: The objective of this study was to evaluate the effects of surface electrical stimulation in elderly women with stress urinary incontinence (SUI) as compared to no treatment. MATERIALS AND METHODS: This randomized controlled pilot study included women over the age of 60 years, with at least one episode of stress urinary leakage during the previous month. Fourteen women were allocated according to a computer generated randomization list in two groups: surface electrical stimulation (SES), and control group (CG). The women in the SES group were treated with surface electrical stimulation using four electrodes, during six weeks with two weekly sessions of 20 minutes each. They were evaluated before and after treatment primary outcome, urinary leakage, and secondary outcomes, King's Health Questionnaire, pressure perineometry, and subjective satisfaction. RESULTS: For the urinary leakage, there was a significant decrease in SES group after treatment (P=.017). Significant differences were observed between the SES group and CG in the evaluation after treatment (P<.01; effect size: -1,38; 95% confidence interval from 1,18 to 14,14). No significant differences were observed in both groups for the outcome pelvic floor muscle pressure. In the evaluation of quality of life, a significant reduction of score in the gravity domain was observed for the SES group after treatment (P=.017). CONCLUSION: The results of this study showed that surface electrical stimulation in elderly women with SUI can be an effective method for the improvement of urinary leakage.

Efectos del fortalecimiento del suelo pélvico en la calidad de vida de un grupo de mujeres con incontinencia urinaria: estudio aleatorizado controlado / Effects of Pelvic Floor Muscle Training on Quality of Life of a Group of Women With Urinary Incontinence: Randomized Controlled Trial

Objetivos: Evaluar los efectos de la kinesioterapia en un grupo de mujeres con incontinencia urinaria (IU) sobre la calidad de vida (CV), el nivel de presión y función de los músculos del suelo pélvico en mujeres con IU. Material y métodos: Estudio piloto aleatorizado controlado de 30 mujeres (edad: 60,87±05,09 años) que fueron evaluadas al inicio y después de 12 semanas de tratamiento. Se realizaron las siguientes evaluaciones: prueba de absorbente de una hora, presión y función de los músculos del suelo pélvico y el cuestionario King’s Health Questionnaire (KHQ). Las voluntarias fueron distribuidas aleatoriamente en dos grupos: kinesioterapia en grupo y grupo de control. El protocolo del grupo de kinesioterapia en grupo consistió en 12 sesiones, con una duración de una hora. Los datos fueron analizados usando las pruebas de Wilcoxon y Mann-Whitney. El nivel de significación fue del 5%.ResultadosEl tratamiento en grupo mostró una mejoría significativa en: la prueba de absorción de una hora (p=0,053); la función (p<0,006) y el nivel de la presión (p=0,0014) de contracción de los músculos del suelo pélvico y en algunos ámbitos del KHQ: el impacto de la incontinencia urinaria (p=0,034), las limitaciones en el desempeño de las tareas diarias (p=0,025), el sueño y la disposición (p=0,018), así como la gravedad (p=0,004). En el grupo de control no hubo diferencias significativas. Conclusiones: El protocolo para fortalecer los músculos del suelo pélvico en grupo fue eficaz para mejorar la IU, CV, función y presión de la contracción de los músculos del suelo pélvico (AU)

Objective: To evaluate the effects of Kinesiotherapy on function and level of pressure of pelvic floor muscle and quality of life (QOL) of a group of women with urinary incontinence (UI). Materials and methods: This is a randomized controlled pilot trial. Thirty women (age 60.87±9.05 years) were evaluated, before and after 12 weeks of treatment, for urinary loss, pelvic floor muscle function and pressure; and quality of life (QOL). Volunteers were randomly allocated into two groups: Kinesiotherapy Group and Control Group. The Kinesiotherapy Group protocol consisted of 12 1-hour sessions with exercises to strengthen pelvic floor muscle and information for UI. The Control Group did not receive any treatment during the corresponding time. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney test. The significance level was 5%.ResultsThe Kinesiotherapy Group presented a significant improvement in urinary loss (p=0.053), pelvic floor muscle function (p<0.006) and pressure (p=0.0014) and in some domains of King’s Health Questionnaire for QOL assessment: incontinence impact (p=0.034), limitations of daily activities (p=0.025), sleep and disposition (p=0.018) and also gravity domains (p=0.004). No differences were found in the control group for any variables. Conclusion: The protocol to strengthen the pelvic floor muscle used by the Kinesiotherapy Group was effective to improve the UI, QOL, function and pressure of pelvic floor muscle contraction (AU)

[Effects of pelvic floor muscle training on quality of life of a group of women with urinary incontinence: randomized controlled trial]. / Efectos del fortalecimiento del suelo pélvico en la calidad de vida de un grupo de mujeres con incontinencia urinaria: estudio aleatorizado controlado.

OBJECTIVE: To evaluate the effects of Kinesiotherapy on function and level of pressure of pelvic floor muscle and quality of life (QOL) of a group of women with urinary incontinence (UI). MATERIALS AND METHODS: This is a randomized controlled pilot trial. Thirty women (age 60.87±9.05 years) were evaluated, before and after 12 weeks of treatment, for urinary loss, pelvic floor muscle function and pressure; and quality of life (QOL). Volunteers were randomly allocated into two groups: Kinesiotherapy Group and Control Group. The Kinesiotherapy Group protocol consisted of 12 1-hour sessions with exercises to strengthen pelvic floor muscle and information for UI. The Control Group did not receive any treatment during the corresponding time. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney test. The significance level was 5%. RESULTS: The Kinesiotherapy Group presented a significant improvement in urinary loss (p=0.053), pelvic floor muscle function (p<0.006) and pressure (p=0.0014) and in some domains of Kinǵs Health Questionnaire for QOL assessment: incontinence impact (p=0.034), limitations of daily activities (p=0.025), sleep and disposition (p=0.018) and also gravity domains (p=0.004). No differences were found in the control group for any variables. CONCLUSION: The protocol to strengthen the pelvic floor muscle used by the Kinesiotherapy Group was effective to improve the UI, QOL, function and pressure of pelvic floor muscle contraction.

Vaginal cone for postmenopausal women with stress urinary incontinence: randomized, controlled trial.

OBJECTIVE: To investigate the effect of vaginal cones and pelvic floor muscle training (PFTM) in postmenopausal women with stress urinary incontinence. METHODS: This randomized, controlled study included postmenopausal women, who complained of stress urinary incontinence. Forty-five women were allocated to three groups: a group given therapy with vaginal cones (n = 15), a group receiving therapy with PFTM (n = 15), and the control group (n = 15). Subjects in the intervention groups were treated for 6 weeks with twice-weekly sessions of 40 min. Women in the vaginal cone group carried out the pelvic floor muscle strengthening with vaginal cones. The control group did not receive any treatment during the corresponding time. They were evaluated before, at the end of treatment and 6 weeks after treatment completion for primary outcomes (1-h pad test for urinary loss and pelvic floor muscle pressure) and secondary outcomes (quality of life with King's Health Questionnaire, satisfaction with treatment, and continuity of training). RESULTS: For urinary leakage, there were statistical differences between the treated groups and the control group at the end of treatment and 6 weeks after treatment (all p < 0.01; effect size: vaginal cone group 20.97; PFMT group 20.96). The same behavior was shown for treatment with pelvic floor muscle pressure (all p < 0.01; effect size: vaginal cone group 22.58; PFMT group 21.68). There were no differences between the vaginal cone and PFMT groups in any of the evaluations. In outcomes for quality of life, significant differences were observed for incontinence impact and gravity domains when both treated groups were compared with the control group after treatment. Both groups reported similar satisfaction levels and the vaginal cone group demonstrated lower training continuity. CONCLUSION: Based on this study, there were similar positive results for treatment with the vaginal cone and pelvic floor muscle training for urinary leakage, pelvic floor muscle pressure and quality of life for postmenopausal women with stress urinary incontinence after 6 weeks.

Prevalence of human papillomavirus (HPV) type 16 variants and rare HPV types in the central Amazon region.

Infection by human papillomavirus (HPV) is one of the primary causes of mortality by cancer in northern Brazil. Sexually active women from Manaus, Amazonas, without cytological alterations and women with pre-malignant and malignant cytological alterations were examined for HPV virus, identified via PCR and sequencing. The target region for this study was part of the L1 capsid gene of HPV. Twenty-three samples that were PCR-positive were sequenced. Analysis of 336 bp demonstrated a high incidence of high-risk HPV types in the population of Manaus, identified as HPVs 16, 33, 58, 66, 68. HPV type 16 was the most prevalent, presenting two variants similar to the Asian-American (AA) and East-Asian type (As) variants. A rare HPV type 13 related to "Heck's disease" was also detected. This preliminary provides important information about the HPV circulating in Amazonas State.

Acesso a medicamentos essenciais em farmácias e drogarias do Município de Araraquara / Access to essential drugs in pharmacies and drugstores in the City of Araraquara

O presente estudo apresentou como objetivo avaliar a disponibilidade de 20 medicamentos essenciais para doenças mais prevalentes na atenção básica à saúde. Portanto, se faz necessário que estes medicamentos estejam disponíveis e seus preços sejam acessíveis nas farmácias e drogarias do setor privado. O estudo foi realizado, no município de Araraquara/SP, utilizando-se dois formulários preconizados pela OMS, sendo um para registro de disponibilidade e outro para registro de preços. Os medicamentos mais disponíveis nas farmácias e drogarias foram o propranolol (90,5%), captopril (96%) e ranitidina (96%), e os menos disponíveis foram sulfato ferroso (27%), beclometasona (33,8%) e ibuprofeno (41,9%). Os medicamentos que apresentaram maior variação entre os preços praticados foram propranolol (97,1%), hidroclorotiazida 96,4% e glibenclamida (95,0%), e os de menor variação foram salbutamol (30,8%) e sulfametoxazol + trimetoprima (30,2%). Os medicamentos genéricos foram os que apresentaram menor preço, representando metade dos medicamentos avaliados (10). Os indicadores de acesso por capacidade de aquisição para o tratamento das principais doenças no nível de atenção básica demonstraram que nenhum estabelecimento continha todos os medicamentos avaliados e, além disso, apresentou grandes variações de preços, comprometendo o seu acesso aos usuários. Dados obtidos nesta pesquisa demonstram a importância da farmácia popular para melhorar o acesso dos consumidores aos medicamentos, diminuindo o custo e aumentando a disponibilidade dos itens selecionados pela Relação Nacional de Medicamentos.

A survey to determine the availability of 20 essential medicines for the diseases with highest prevalence in primary health care was conducted in the city of Araraquara. The presence and the price of these medicines in private sector pharmacies and drugstores of the city were recorded. Two forms, recommended by the WHO, were used in the survey, one for availability and the other for prices. The drugs most commonly available in pharmacies and drugstores were: propranolol (90.5%), captopril (96%) and ranitidine (96%), while the least available were ferrous sulfate (27%), beclomethasone (33.8%) and ibuprofen (41.9%). The drugs that showed the greatest variation among the prices charged were: propranolol (97.1%), hydrochlorothiazide (96.4%) and glibenclamide (95.0%), while the least variable were salbutamol (30.8%) and trimethoprim-sulfamethoxazole (30.2%). Generic drugs, which were half (10) of those assessed, had the lowest prices. The indicators of access, referring to the ability of patients to acquire drugs for the treatment of major diseases at the primary health care level, showed that no establishment stocked all 20 essential drugs and that wide variations existed in their prices, undermining their availability to drug users, whose only sources are pharmacies and drugstores. These data demonstrate the importance of the popular pharmacy to improve the access to medicines, by lowering the cost and increasing the availability of the items selected for the National List of Essential Drugs (RENAME).

[Chronic hypoparathyroidism: review of 5 clinical cases]. / Hipoparatiroidismo crónico: revisão de 5 casos clínicos.

In 5 patients with a long clinical evolution of tetany and/or convulsions and with documented hypocalcaemia and hyperphosphatemia, low or inappropriate values of parathormone were detected. Only two of the patients had a history of subtotal thyroidectomy and all presented with basal ganglia calcification, bilateral subcapsular cataracts and prolonged QTc interval in the ECG. After one month of oral therapy with calcium and calcitriol, the values of calcaemia and phosphatemia were in a near-normal range with the exception of a patient in which that normalization was much slower and only occurred after correction of magnesaemia. In this last patient statistical correlation between QTc interval in the ECG and the calcaemia was statistically significant (P less than 0.001). We conclude that the QTc interval can be a useful and accessible index in acute situations of symptomatic hypocalcaemia.