Trajectory Patterns of Weight and Length in Children: From Birth Until 2-Years of Age.

OBJECTIVE: The aim was to identify trajectory patterns of weight and length in children from birth until two years of life and establish associations with maternal and child characteristics. METHODS: A mixed-cohort study was conducted in public health services in Colombo-PR, Brazil, between 2018 and 2022. Pregnancy information was gathered through anthropometric data collection and questionnaires. Birth data were extracted from birth record forms, while weight and length data in the first two years of life were obtained from physical and electronic health service records. Weight and length trajectory patterns were identified using a group-based trajectory model. The definition of the number of trajectory patterns to be selected considered the model fit to the type of variable, its practical utility, as well as the probabilities of group membership. RESULTS: Two trajectory patterns of weight and length were identified among the children. The majority exhibited a pattern of weight (67.8%, n = 382) and length (90.9%, n = 472) considered high and stable, with a tendency to decelerate from one and a half years of age. The probability of belonging to the lower weight gain group was associated with female sex (41.5%, p < 0.001), smoking during pregnancy (48.7%, p = 0.008), prematurity (65.0%, p = 0.001), cesarean delivery (36.4%, p = 0.009), small for gestational age (69.0%, p < 0.001), and twinning (69.2%, p = 0.002). Similarly, the probability of belonging to the lower length gain group was associated with female sex (11.7%, p < 0.001), smoking during pregnancy (20.6%, p = 0.003), cesarean delivery (10.1%, p = 0.048), born small for gestational age (46.4%, p < 0.001), and twinning (46.1%, p < 0.001). CONCLUSION: Conditions during pregnancy and childbirth can impact growth patterns in the first two years of life.

Losartan Attenuates Radiation-Induced Damage on Testes and Accelerates Tubular Regeneration.

Male germ cells are particularly susceptible to radiation; infertility being a common consequence after radiotherapy as it impairs spermatogenesis. This study aimed to test whether treatment with losartan (LOS), a selective antagonist of angiotensin II receptor subtype 1 (AT1R), can prevent or attenuate the acute and long-term radiation-induced damage to testes. Wistar rats were randomly distributed into six groups, three of which were studied on day 2 after irradiation: control (CTRL 2), irradiated non-treated (IR 2), and irradiated and treated with LOS (IRLOS 2); and three other groups that were studied on day 60 after irradiation: control (CTRL 60), irradiated non-treated (IR 60), and irradiated and treated with LOS (IRLOS 60). Seven consecutive days before and on the day of irradiation with 2.5 Gy directly administered in the scrotum, the animals were treated with LOS (34 mg/kg/two times/day). This treatment was continued 2 or 60 days after irradiation. The sperm quality was assessed from epididymis cauda. In addition, the testes were submitted to histopathological and morphometric-stereological analysis as well as the proliferating cell nuclear antigen (PCNA) quantification. Serum FSH and LH and plasma testosterone levels were also determined. The data obtained 2 days after the irradiation showed germ cell apoptosis, formation of vacuoles in the seminiferous epithelium, sloughing of germ cells into the lumen, and retention and phagocytosis of step-19 spermatids in Sertoli basal cytoplasm. The treatment with LOS in this period did not prevent or attenuate a radio-induced damage to the testes, illustrating that this drug does not protect against apoptosis derived from direct effects of radiation. On the other hand, 60 days after exposure, the data evidenced the deleterious effects of ionizing radiation on the testes as decreasing of testicular, epididymal, and seminal vesicle masses; tubular atrophy; reduction of cellular proliferation; and loss of germ cells. LOS was able to prevent some of those deleterious effects, promoting improvements in seminal vesicle mass, sperm vitality, plasma testosterone levels, vacuole number, and cell proliferation. In conclusion, inhibition of the AngII/AT1R axis by LOS is effective in protecting the indirect/delayed radiation damage resulting from oxidative stress established in the tissue.

Factors Involved in the Apoptotic Cell Death Mechanism in Yellow Fever Hepatitis.

Yellow fever (YF), a non-contagious infectious disease, is endemic or enzootic to the tropical regions of the Americas and Africa. Periodic outbreaks or epidemics have a significant impact on public health. Programmed cell death, or apoptosis, is generally characterised by distinct morphological changes and energy-dependent biochemical pathways. In this study, we performed immunohistochemistry analysis to identify and quantify proteases and protein targets involved in the cascade that triggers apoptosis in YF virus (YFV)-infected human hepatocytes. Liver tissue samples were collected from 26 individuals, among whom 21 were diagnosed as YF-positive, and five were flavivirus-negative and died due to other causes. The histopathological alterations in YFV-positive cases were characterised by the presence of apoptotic bodies, steatosis, cellular swelling, and extensive necrosis and haemorrhage in the hepatic lobules. Additionally, we observed an abundance of inflammatory infiltrates in the portal tract. The expression of various apoptotic markers in the hepatic parenchyma, including CASPASE 3, CASPASE 8, BAX, FAS, FASL, GRANZYME B, and SURVIVIN, differed between YFV-positive cases and controls. Collectively, this study confirmed the complexity of YFV infection-induced apoptosis in situ. However, our data suggest that apoptosis in liver parenchyma lesions may significantly contribute to the pathogenesis of fatal YF in humans.

Th22 cytokines and yellow fever: Possible implications for the immunopathogenesis of human liver infection.

Yellow fever (YF) is an infectious disease considered a public health problem in tropical and subtropical areas. YF has many pathophysiological events that are correlated with the host immune response. In this study, the in situ Th22 cytokine profile was evaluated. Liver tissue samples were collected from 21 YFV-positive patients who died of the disease and five flavivirus-negative controls who died of other causes and whose hepatic parenchyma architecture was preserved. Immunohistochemical (IHC) analysis of tissues in the hepatic parenchyma of YF cases showed significantly higher expression of interleukin (IL)-22, IL-13, tumour necrosis factor-alpha, and FGF basic (FGF b) in YFV-positive cases than that in flavivirus-negative controls. These results indicate that the response of Th22 cytokines emerges as an alternative for a better understanding of adaptive immunity in the hepatic parenchyma, highlighting the role of cytokines in the repair and suppressive responses in the immunopathogenesis of YFV infection.

Health Hazard Assessment Due to Slimming Medicinal Plant Intake.

According to the World Health Organization (WHO), about 80% of people rely on medicinal plants for their primary health needs. Traditional medicine's principal benefits are their vast population knowledge, low severe adverse effects rate, low cost, and the lack of a medical prescription to use them. While obesity has become a global health issue, an increase in finding cheap and fast ways to lose weight escalates medicinal herbs' use for this purpose, both in dietary supplements or in teas. At the same time that Brazil aims to expand traditional medicine, reports regarding toxicology and poisoning put natural products' safety in check. Plants can accumulate heavy metals and metalloids leading to health risks; however, there is a lack of information on that matter, possibly due to a lack of international standardization regarding elemental contamination - this study aimed to determine metal and metalloid concentrations in slimming medicinal plants and their respective teas and evaluate their safety consumption. Metal and metalloid content were determined by inductively coupled plasma optical emission spectrometry (ICP OES). All plants and teas were within the set limits for tolerable upper intake level (UL), provisional tolerable daily maximum intake (PTDMI), and provisional tolerable weekly intake (PTWI). The hazard quotient index (HQ) was above 1 for almost all plants, and the Hibiscus sabdariffa tea regarding aluminum content. The arsenic level was above the Brazilian Pharmacopeia limit in natura plants demonstrating risk in their consumption. Some herbs also presented detection for elements with no safety limits set, such as lead, cadmium, and arsenic, which could mark as a red flag for consumption once their security intake is not precise yet.

The effect of primary care policy changes on hospitalisation for ambulatory care sensitive conditions: notes from Brazil.

OBJECTIVES: The aim of this study was to assess the effect of the Primary Health Care Reform and the impact of recent national policy changes on the trend in hospitalisation rates for Ambulatory Conditions Sensitive to Primary Care (ACSC) in the city of Rio de Janeiro, Brazil. STUDY DESIGN: Ecological study with data from the Brazilian National Health Information System. METHODS: This study performed an interrupted time-series analysis, comparing three different time periods related to important changes in primary care policies in Brazil: Baseline (2008-2009); Primary Health Care Reform (RCAPS) (2010-2017); and National Primary Health Care Policy (PNAB) (2018-2019). Data included total monthly admissions for ACSC and rates for 19 groups of causes for hospitalisation. RESULTS: There was a non-significant increasing trend in ACSC hospital admissions between January 2008 and December 2009 (ß = 4.01, 95% confidence interval [CI] -12.14 to 20.15). The Primary Health Care Reform (RCAPS), which commenced in January 2010, resulted in a significant reduction in ACSC hospital admission trends during this time period (ß = -7.97, 95% CI -9.78 to -6.16). Change in the PNAB did not change the declining ACSC hospital admission trend but it did reduce the rate of decline. In addition, the coefficient was no longer significant (ß = -1.93, 95% CI -2.46 to 0.59), suggesting that monitoring of the historical series for a long time may show a reversal of the downward trend in some months. The most consistent change in ACSC hospital admission trend occurred between baseline and the RCAPS (ß slope = -0.143, P < 0.001) and the level between the RCAPS period and the new PNAB (ß step = 7.00, P = 0.008). Trends and differences in the time periods vary in the different ACSC hospitalisation-cause groups. CONCLUSION: Changes in public health policies impact ACSC hospitalisation rates, which can thus be used as an indicator for monitoring primary health care. We also recommend analysing admission rates by the individual ACSC hospitalisation-cause groups.

Critical perspective of social participation in health surveillance / Vigilância civil em saúde, estudos de população e participação popular

Many barriers impede the defense of health equity, especially those that hinder social participation in health. In the mid-1990s, Victor Valla proposed incorporating the population's participation into health surveillance through Paulo Freire's popular education. This counterpoint to traditional surveillance practices, then called civil health surveillance, is added to the expanded concept of health, and has a strong connection with the critical perspective of epidemiology to understand the dialectical relationship between social classes and their lived spaces. The practice of civil surveillance aims to overcome essential gaps left by traditional methods of public health investigation. It includes a lack of attention to socio-cultural contexts, the construction of risk located only in the individual, and the representation of public health agendas that privilege and pathologize certain behaviors. In this sense, this paper discusses concept of civil health surveillance, the locus of discussion of population studies in the reification of the role of the contextual effect in explaining the social production of health and the incorporation of popular participation in health surveillance as an element of social transformation. The deepening of this discussion allows a participatory construction of new health models focused on the effective reduction of health inequities and, consequently, the effective universalization of the right to health.

Muitas barreiras impedem a defesa da equidade na saúde, especialmente aquelas que dificultam a participação popular. Em meados dos anos 90, Victor Valla propõe a incorporação da participação da população à prática da vigilância em saúde, por meio da educação popular de Paulo Freire. Este contraponto às práticas tradicionais da vigilância, nomeadas vigilância civil da saúde, se somam à concepção ampliada de saúde, e possuem forte ligação com a perspectiva crítica da epidemiologia enquanto meio de compreender a relação dialética entre classes sociais e seus espaços vividos. A prática da vigilância civil pretende superar lacunas importantes deixadas pelos métodos tradicionais de investigação em saúde pública, como falta de atenção aos contextos socioculturais, a construção do risco localizada somente no indivíduo e a representação de agendas de saúde pública que privilegiam e patologizam certos comportamentos.  Neste sentido, o presente trabalho debate o conceito de vigilância civil da saúde, o locus de discussão dos estudos de população na reificação do papel do efeito contextual para a explicação da produção social da saúde e a incorporação da participação popular à vigilância em saúde como elemento de transformação social. O aprofundamento desta discussão, no limite, permite uma construção participativa de novos modelos de saúde focados na redução efetiva das iniquidades em saúde e, consequentemente, universalização efetiva do direito à saúde.

Proposition of a novel animal model of systemic sclerosis induced by type V collagen in C57BL/6 mice that reproduces fibrosis, vasculopathy and autoimmunity.

BACKGROUND: Type V collagen (Col V) has the potential to become an autoantigen and has been associated with the pathogenesis of systemic sclerosis (SSc). We characterized serological, functional, and histopathological features of the skin and lung in a novel SSc murine model induced by Col V immunization. METHODS: Female C57BL/6 mice (n = 19, IMU-COLV) were subcutaneously immunized with two doses of Col V (125 µg) emulsified in complete Freund adjuvant, followed by two intramuscular boosters. The control group (n = 19) did not receive Col V. After 120 days, we examined the respiratory mechanics, serum autoantibodies, and vascular manifestations of the mice. The skin and lung inflammatory processes and the collagen gene/protein expressions were analyzed. RESULTS: Vascular manifestations were characterized by endothelial cell activity and apoptosis, as shown by the increased expression of VEGF, endothelin-1, and caspase-3 in endothelial cells. The IMU-COLV mice presented with increased tissue elastance and a nonspecific interstitial pneumonia (NSIP) histologic pattern in the lung, combined with the thickening of the small and medium intrapulmonary arteries, increased Col V fibers, and increased COL1A1, COL1A2, COL3A1, COL5A1, and COL5A2 gene expression. The skin of the IMU-COLV mice showed thickness, epidermal rectification, decreased papillary dermis, atrophied appendages, and increased collagen, COL5A1, and COL5A2 gene expression. Anti-collagen III and IV and ANA antibodies were detected in the sera of the IMU-COLV mice. CONCLUSION: We demonstrated that cutaneous, vascular, and pulmonary remodeling are mimicked in the Col V-induced SSc mouse model, which thus represents a suitable preclinical model to study the mechanisms and therapeutic approaches for SSc.

Analytical validation of an in-house method for adenosine deaminase determination.

BACKGROUND: The adenosine deaminase (ADA) enzyme is a marker of inflammatory processes whose activity can be measured through a colorimetric method developed as an in-house assay. This validation can reduce costs and expand the alternatives for laboratory diagnosis. METHODS: The ADA analysis was achieved through a modified form of Giusti and Galanti's (1984) method. The following parameters were characterized: calibration curve, linearity, analytical sensitivity, limit of detection, limit of quantification, method working range, precision (within-assay and between-assay), bias, total analytical error, and sample stability. The results were statistically evaluated and compared with quality specifications based on biological variations and the performance of commercial tests. RESULTS: The analytical sensitivity and limit of detection (0.013 and 3.0 U/L, respectively) were lower than those of commercial tests. The method's working range was 3.2-100.0 U/L. According to the quality specification, the method showed optimum performance with a bias <3.5%. However, repeatability (2.2% and 1.7% for normal- and high-activity samples, respectively) and reproducibility achieved worse results when compared to commercial tests. The method demonstrated an inappropriate between-assay precision for low enzymatic activity (10.4%) and the minimum and desirable performance for medium (8.8%) and high (5.0%) activities, respectively. It also presented at least a minimum performance (<25%) for the total analytical error of the three analyzed samples. The pleural fluid samples were found to be stable at -20°C for six days. CONCLUSION: The findings show that the in-house method displays an acceptable performance and is capable of generating results comparable to existing commercial tests.

Advanced Stage Breast Sarcoma Treatment in a Third World Country Public Hospital.

The case reports a 49-year-old patient, drug-addicted, undernourished, and homeless, who was referred to our service presenting a diagnostic of breast sarcoma and ulcerating tumor which extended from the right breast to the right flank. She underwent hygienic mastectomy and, as it developed, she presented a range of complications, culminating in the recurrence of the tumor and pulmonary metastasis few months after her initial treatment. There is relevance in our study not only because it reports the development of the breast sarcoma, rare neoplasm, and its aggressiveness with fast recurrence, but also because it exposes the impact of biopsychosocial behavior of this patient in her clinical outcome.

PD-L1 May Mediate T-Cell Exhaustion in a Case of Early Diffuse Leishmaniasis Caused by Leishmania (L.) amazonensis.

Introduction: Diffuse cutaneous leishmaniasis (DCL) is a rare disease form associated with Leishmania (L.) amazonensis in South America. It represents the "anergic" pole of American Tegumentary Leishmaniasis, and the explanation for its resistance to treatment remains elusive. We aimed to study some possible immunological mechanisms involved in the poor DCL treatment response by evaluating some cell surface molecules obtained from a patient with DCL by flow cytometry. Case presentation: A 65-year-old DCL patient who initially failed to respond to the standard treatment for the disease showed vacuolated macrophages filled with amastigotes in lesion biopsy, and L. (L.) amazonensis was identified through ITS1PCR amplification. The Leishmania skin test and indirect immunofluorescence analysis revealed negative results. Peripheral blood from the patient was collected after a few months of treatment, when the patient presented with no lesion. Peripheral blood mononuclear cells were analyzed ex vivo and in vitro after 48 h of stimulation with soluble L. (L.) amazonensis antigen (SLA). Cell death, surface molecules, and intracellular molecules, such as IFN-γ and granzyme B, were analyzed in the cells using flow cytometry. Analysis of the surface markers showed an increased expression of the inhibitory molecule programmed death ligand 1 (PD-L1) in the monocytes restimulated with SLA (approximately 65%), whereas the negative controls were 35% positive for PD-L1. Conversely, compared with the negative controls, we observed a decrease in CD4+IFN-γ+ T cells (8.32 versus 1.7%) and CD8+IFN-γ+ T cells (14% versus 1%). We also observed a relevant decrease in the granzyme B levels in the CD8+ T cells, from 31% in the negative controls to 5% after SLA restimulation. Conclusion: The dysfunctional activation of PD-L1 inhibitory pathway after Leishmania antigen stimulation and reduced levels of IFN-gamma and granzyme B-producing cells could be closely related to unresponssiveness to standard drug treatment of DCL patient.

Seroepidemiological survey on Leptospira spp. infection in wild and domestic mammals in two distinct areas of the semi-arid region of northeastern Brazil.

Leptospirosis is a bacterial zoonotic disease that causes severe reproductive problems in livestock and generates economic losses for farmers. This study aimed to determine the seroprevalence of anti-Leptospira antibodies in small mammals, both wild and domestic, in two distinct areas of the semi-arid region of northeastern Brazil: the National Park of Serra das Confusões (NPSC), state of Piauí, a preserved area; and rural areas in the municipalities of Petrolina and Lagoa Grande, state of Pernambuco, non-preserved areas. Serum samples were evaluated using the microscopic agglutination test (MAT). Approximately 4% (6/152) of the wild animals were positive, all of them in the non-preserved area. Overall, the seroprevalence rates among goats and sheep were 13.4 (77/576) and 4.6% (24/518), respectively, confirmed in both areas. The seroprevalence rates in dogs and cats were 5.6 (10/180) and 4.7% (2/43) and were determined only in the non-preserved area. The risk factors associated with Leptospira spp. infection were as follows: ages of 1-3 and > 3 years for goats and sheep, region (preserved area) for goats, intensive management system for sheep, and region (non-preserved area) for dogs and wildlife. The present study confirmed the presence of circulation of Leptospira spp. in both of these areas of the Caatinga biome, as well as a variety of serotypes in these areas.

Acogimiento en las Unidades de Salud de la Familia según el punto de vista de los profesionales / Welcome at the family health units according to the health professionals' criteria

Introducción: el Acogimiento no es una cuestión resuelta para profesionales que presentan dificultades en procesos de trabajo, en lo que se refiere a la perspectiva interdisciplinar y a la integración con los demás niveles de atención para viabilizar el sistema de referencia y contra referencia de los usuarios Objetivo : discutir la vivencia del Acogimiento por profesionales de los equipos de salud de la familia. Métodos: investigación descriptiva de abordaje cualitativa, en tres unidades de la Estrategia Salud de la Familia del Municipio Río de Janeiro, de junio a agosto de 2011. Universo conformado por 23 profesionales de salud que fueron entrevistados bajo un guion semiestructurado. El análisis de los testimonios evidenció la presencia de dos categorías: concepción de acogimiento, vivencia del Acogimiento por los profesionales. Resultados: los profesionales poseen una concepción de Acogimiento consonante con la Política Nacional de Humanización, donde el usuario debe tener la primacía de ser atendido luego que llega al servicio, ser bien tratado por todos los profesionales y tener su necesidad respondida. A pesar de esta concepción, quedó evidente que se necesita avanzar en la concepción del Acogimiento como ordenador de los procesos de trabajo, pues persiste la fragmentación en la asistencia prestada, lo que transforma la práctica profesional distante de la integración de las acciones entre los miembros de los equipos y de la interdisciplinariedad como principio de la dirección del trabajo de la Estrategia de la Salud de la Familia. Conclusiones: el acogimiento a los usuarios se mostró incipiente como modelo de respuestas a las demandas, este modelo puede ser mejor cualificado si todos los que de él participan están involucrados con el cambio del atendimiento curativo y burocratizado(AU)

It is a case of a descriptive investigation with quality approach, which had as goal to discuss the experience of the Welcoming by professionals from the family health teams. The data were collected from three units of the Family Health Strategy of Rio de Janeiro City, from June to August, 2011. The sample was done with 23 health professionals who were interviewed by using a semi-structured script. The analysis of the testimonials showed the existence of two categories: welcoming conception, and experiencing of the Welcoming by professionals. The results obtained in this investigation allowed apprehending that the professionals have a conception of Welcoming consistent with National Humanization Politics, where the user must have the precedence to be attended as soon as his arrival to the service, be well treated by all the professionals and has his need answered. However, despite of this conception, it became clear that on the day by day of the units, the professionals need to improve the conception of the Welcoming as organizer of the working process of the teams as persists the fragmentation on the given assistance, which makes the practical professional far from the integration of the actions between the team members and the interdisciplinarity as a guiding principle of the work of the Family Health Strategy(AU)