Perfil dos casos de tuberculose com comorbidades em municípios paraenses de fronteira internacional nos anos de 2010 a 2019

Objetivos: Descrever e analisar o perfil socioepidemiológico e o desfecho dos casos de tuberculose associada com as comorbidades síndrome da imunodeficiência adquirida, alcoolismo, diabetes, doença mental e tabagismo no estado do Pará em populações residentes em três municípios situados na linha de fronteira internacional e em três municípios não fronteiriços, selecionados por suas populações equivalentes. Metodologia: trata-se de um estudo de natureza observacional, transversal, com abordagem descritiva e analítica. Os dados levantados foram obtidos do Sistema de informação de Agravos de Notificação (SINAN) para os casos de tuberculose nos municípios de Almeirim, Óbidos, Oriximiná, Juruti, Novo Repartimento e Tucumã no período de 2010 a 2019. Para a análise estatística aplicou-se o teste do Qui-quadrado. Resultados: Foram notificados 286 casos de tuberculose com comorbidades, sendo 177 casos (61,8%) ocorridos em municípios paraenses situados na fronteira com Guiana e Suriname. O alcoolismo (36,4%) e o tabagismo (28,9%) foram as comorbidades mais frequentes. O teste Qui-quadrado revelou significância estatística (p <0,05) para a localização do município (p= 0,0343), onde 53,5% dos pacientes que não obtiveram cura da tuberculose residiam em municípios na linha de fronteira internacional. Conclusão: O desfecho de cura para os casos de tuberculose com comorbidades são menores em pacientes residentes em municípios localizados na linha de fronteira internacional quando comparado ao desfecho dos casos em pacientes residentes em municípios não fronteiriços.

Real-Time Control of a Multi-Degree-of-Freedom Mirror Myoelectric Interface During Functional Task Training.

Motor learning mediated by motor training has in the past been explored for rehabilitation. Myoelectric interfaces together with exoskeletons allow patients to receive real-time feedback about their muscle activity. However, the number of degrees of freedom that can be simultaneously controlled is limited, which hinders the training of functional tasks and the effectiveness of the rehabilitation therapy. The objective of this study was to develop a myoelectric interface that would allow multi-degree-of-freedom control of an exoskeleton involving arm, wrist and hand joints, with an eye toward rehabilitation. We tested the effectiveness of a myoelectric decoder trained with data from one upper limb and mirrored to control a multi-degree-of-freedom exoskeleton with the opposite upper limb (i.e., mirror myoelectric interface) in 10 healthy participants. We demonstrated successful simultaneous control of multiple upper-limb joints by all participants. We showed evidence that subjects learned the mirror myoelectric model within the span of a five-session experiment, as reflected by a significant decrease in the time to execute trials and in the number of failed trials. These results are the necessary precursor to evaluating if a decoder trained with EMG from the healthy limb could foster learning of natural EMG patterns and lead to motor rehabilitation in stroke patients.

Men's feelings and emotions in the Covid-19 framing. / Sentimento e emoções de homens no enquadramento da doença Covid-19.

OBJECTIVE: to understand how men's feelings and emotions contribute to the Covid-19 framing in Brazil. METHOD: Asocial-historical, qualitative study, carried out with 200 men resident in Brazil, through online search on digital platform.The grasped data were analyzed by the Collective Subject Discourse method in the light of the reference of epidemic disease proposed by Charles Rosemberg. RESULTS: Negative feelings and anxiety prevailed due to the knowledge about the growing number of hospitalized patients and deaths from the pandemic conveyed in the news. For men, the optimism is necessary to encourage attitudes with responsibility and trust that the crisis will be overcome.Subsequently, men present a set of attitudes and behaviors for coping with the pandemic.Moreover,the acceptance signals the emergence of the fourth dramaturgical act of the Covid-19framing. CONCLUSION: Men's feelings and emotions, in this historic context, pervade three of the four acts of the Covid-19 framingin Brazil.

Motor skill acquisition during a balance task as a process of optimization of motor primitives.

It has been argued that the central nervous system relies on combining simple movement elements (i.e. motor primitives) to generate complex motor outputs. However, how movement elements are generated and combined during the acquisition of new motor skills is still a source of debate. Herein, we present results providing new insights into the role of movement elements in the acquisition of motor skills that we obtained by analysing kinematic data collected while healthy subjects learned a new motor task. The task consisted of playing an interactive game using a platform with embedded sensors whose aggregate output was used to control a virtual object in the game. Subjects learned the task over multiple blocks. The analysis of the kinematic data was carried out using a recently developed technique referred to as "movement element decomposition." The technique entails the decomposition of complex multi-dimensional movements in one-dimensional elements marked by a bell-shaped velocity profile. We computed the number of movement elements during each block and measured how closely they matched a theoretical velocity profile derived by minimizing a cost function accounting for the smoothness of movement and the cost of time. The results showed that, in the early stage of motor skill acquisition, two mechanisms underlie the improvement in motor performance: 1) a decrease in the number of movement elements composing the motor output and 2) a gradual change in the movement elements that resulted in a shape matching the velocity profile derived by using the above-mentioned theoretical model.

Brain oscillatory activity as a biomarker of motor recovery in chronic stroke.

In the present work, we investigated the relationship of oscillatory sensorimotor brain activity to motor recovery. The neurophysiological data of 30 chronic stroke patients with severe upper-limb paralysis are the basis of the observational study presented here. These patients underwent an intervention including movement training based on combined brain-machine interfaces and physiotherapy of several weeks recorded in a double-blinded randomized clinical trial. We analyzed the alpha oscillations over the motor cortex of 22 of these patients employing multilevel linear predictive modeling. We identified a significant correlation between the evolution of the alpha desynchronization during rehabilitative intervention and clinical improvement. Moreover, we observed that the initial alpha desynchronization conditions its modulation during intervention: Patients showing a strong alpha desynchronization at the beginning of the training improved if they increased their alpha desynchronization. Patients showing a small alpha desynchronization at initial training stages improved if they decreased it further on both hemispheres. In all patients, a progressive shift of desynchronization toward the ipsilesional hemisphere correlates significantly with clinical improvement regardless of lesion location. The results indicate that initial alpha desynchronization might be key for stratification of patients undergoing BMI interventions and that its interhemispheric balance plays an important role in motor recovery.

Sentimento e emoções de homens no enquadramento da doença Covid-19 / Mens feelings and emotions in the Covid-19 framing

Resumo O objetivo deste artigo é compreender como os sentimentos e as emoções de homens contribuem para o enquadramento da doença Covid-19 no Brasil. Estudo sócio-histórico, qualitativo, realizado com 200 homens residentes no Brasil, mediante pesquisa online em plataforma digital. Os dados apreendidos foram analisados pelo método do Discurso do Sujeito Coletivo à luz do referencial de doença epidêmica proposto por Charles Rosemberg. Prevaleceram sentimentos negativos e ansiedade como consequência do conhecimento acerca do crescente número de hospitalizados e mortos pela pandemia veiculada nos noticiários. Para os homens, o otimismo é necessário para encorajar atitudes com responsabilidade e confiar de que a crise será superada. Na sequência os homens apresentam um conjunto de atitudes e comportamentos para o enfrentamento da pandemia. E, a aceitação sinaliza a emergência do quarto ato dramatúrgico do enquadramento da Covid-19. Os sentimentos e as emoções de homens, no presente contexto histórico, atravessam três dos quatro atos de enquadramento da Covid-19 no Brasil.

Abstract Objective: to understand how men's feelings and emotions contribute to the Covid-19 framing in Brazil. Method: Asocial-historical, qualitative study, carried out with 200 men resident in Brazil, through online search on digital platform.The grasped data were analyzed by the Collective Subject Discourse method in the light of the reference of epidemic disease proposed by Charles Rosemberg. Results: Negative feelings and anxiety prevailed due to the knowledge about the growing number of hospitalized patients and deaths from the pandemic conveyed in the news. For men, the optimism is necessary to encourage attitudes with responsibility and trust that the crisis will be overcome.Subsequently, men present a set of attitudes and behaviors for coping with the pandemic.Moreover,the acceptance signals the emergence of the fourth dramaturgical act of the Covid-19framing. Conclusion: Men's feelings and emotions, in this historic context, pervade three of the four acts of the Covid-19 framingin Brazil.

Event-related desynchronization during movement attempt and execution in severely paralyzed stroke patients: An artifact removal relevance analysis.

The electroencephalogram (EEG) constitutes a relevant tool to study neural dynamics and to develop brain-machine interfaces (BMI) for rehabilitation of patients with paralysis due to stroke. However, the EEG is easily contaminated by artifacts of physiological origin, which can pollute the measured cortical activity and bias the interpretations of such data. This is especially relevant when recording EEG of stroke patients while they try to move their paretic limbs, since they generate more artifacts due to compensatory activity. In this paper, we study how physiological artifacts (i.e., eye movements, motion artifacts, muscle artifacts and compensatory movements with the other limb) can affect EEG activity of stroke patients. Data from 31 severely paralyzed stroke patients performing/attempting grasping movements with their healthy/paralyzed hand were analyzed offline. We estimated the cortical activation as the event-related desynchronization (ERD) of sensorimotor rhythms and used it to detect the movements with a pseudo-online simulated BMI. Automated state-of-the-art methods (linear regression to remove ocular contaminations and statistical thresholding to reject the other types of artifacts) were used to minimize the influence of artifacts. The effect of artifact reduction was quantified in terms of ERD and BMI performance. The results reveal a significant contamination affecting the EEG, being involuntary muscle activity the main source of artifacts. Artifact reduction helped extracting the oscillatory signatures of motor tasks, isolating relevant information from noise and revealing a more prominent ERD activity. Lower BMI performances were obtained when artifacts were eliminated from the training datasets. This suggests that artifacts produce an optimistic bias that improves theoretical accuracy but may result in a poor link between task-related oscillatory activity and BMI peripheral feedback. With a clinically relevant dataset of stroke patients, we evidence the need of appropriate methodologies to remove artifacts from EEG datasets to obtain accurate estimations of the motor brain activity.

Complex Upper-Limb Movements Are Generated by Combining Motor Primitives that Scale with the Movement Size.

The hand trajectory of motion during the performance of one-dimensional point-to-point movements has been shown to be marked by motor primitives with a bell-shaped velocity profile. Researchers have investigated if motor primitives with the same shape mark also complex upper-limb movements. They have done so by analyzing the magnitude of the hand trajectory velocity vector. This approach has failed to identify motor primitives with a bell-shaped velocity profile as the basic elements underlying the generation of complex upper-limb movements. In this study, we examined upper-limb movements by analyzing instead the movement components defined according to a Cartesian coordinate system with axes oriented in the medio-lateral, antero-posterior, and vertical directions. To our surprise, we found out that a broad set of complex upper-limb movements can be modeled as a combination of motor primitives with a bell-shaped velocity profile defined according to the axes of the above-defined coordinate system. Most notably, we discovered that these motor primitives scale with the size of movement according to a power law. These results provide a novel key to the interpretation of brain and muscle synergy studies suggesting that human subjects use a scale-invariant encoding of movement patterns when performing upper-limb movements.

Movement-related brain oscillations vary with lesion location in severely paralyzed chronic stroke patients.

In the past few years, innovative upper-limb rehabilitation methods have been proposed for chronic stroke patients. These methods aim at functional motor rehabilitation using Brain-machine interfaces to constitute an alternate pathway from the brain to the muscles. Even in patients with absence of residual finger movements, recovery could be achieved. The extent to which these interventions are affected by individual lesion topology is yet to be understood. In this study EEG was measured in 30 chronic stroke patients during movement attempts of the paretic arm. We show that the magnitude of the event-related desynchronization was smaller in patients presenting lesions with involvement of the motor cortex. This could have important implications on the design of new rehabilitation schemes for these patients, which might benefit from carefully tailored interventions.

Stroke lesion location influences the decoding of movement intention from EEG.

Recent studies have demonstrated the efficacy of brain-machine interfaces (BMI) for motor rehabilitation after stroke, especially for those patients with severe paralysis. However, a cerebro-vascular accident can affect the brain in many different manners, and lesions in diverse areas, even from significantly different volumes, can lead to similar or equal motor deficits. The location of the insult influences the way the brain activates when moving or attempting to move a paralyzed limb. Since the essence of a rehabilitative BMI is to precisely decode motor commands from the brain, it is crucial to characterize how lesion location affects the measured signals and if and how it influences BMI performance. This paper compares the performances of an electroencephalography (EEG)-based movement intention decoder in two groups of severely paralyzed chronic stroke patients: 14 with subcortical lesions and 14 with mixed (i.e., cortical and subcortical) lesions. We show that the lesion location influences the performance of the BMI when decoding the movement attempts of the paretic arm. The obtained results underline the need for further developments for a better individualization of BMI-based rehabilitative therapies for stroke patients.

Efeitos da clindamicina e gentamicina sobre amostras isoladas de infecções odontogênicas graves: estudo piloto / Effects of clindamycin and gentamicin on strains isolated from severe dental infections: a pilot study

As infecções odontogênicas graves constituem um desafio de tratamento por parte dos Cirurgiões Bucomaxilofaciais, geralmente necessitando de intervenções cirúrgicas e administração de antibióticos endovenosos. A associação entre a clindamicina e a gentamicina vem apresentando resultados clínicos satisfatórios ao longo dos anos. Este estudo analisou, in vitro, o tipo de efeito promovido pela gentamicina e pela clindamicina sobre amostras isoladas de infecções odontogênicas graves. Foram utilizadas 20 amostras bacterianas, sendo 13 de Streptococcus do grupo Viridans e 7 de anaeróbios obrigatórios. Estas amostras foram inoculadas em meios de cultura contendo clindamicina e gentamicina, isoladamente e em associação. Utilizou-se a clindamicina em diferentes concentrações e manteve-se a gentamicina a 3 µg/mL em todo o estudo. As amostras de Streptococcus do grupo Viridans mostraram resistência a ambas as drogas e à associação das mesmas, exceto por uma amostra, que se mostrou sensível à gentamicina. Os anaeróbios apresentaram resultados diversos, variando entre sensibilidade ou resistência extremas. Pode-se concluir que não existe um efeito de sinergismo por potenciação entre a gentamicina e a clindamicina e que, de acordo com o espectro de ação de cada droga, esta combinação pode favorecer o tratamento hospitalar das infecções odontogênicas graves. Novos estudos, entretanto, são necessários, para verificar se os efeitos variáveis observados na pesquisa podem interferir nos resultados clínicos

Severe dental infections are a challenge to treatment by oral and maxillofacial surgeons, usually requiring surgical intervention and administration of intravenous antibiotics. The combination of clindamycin and gentamicin, has shown satisfactory results over the years. This study analyzed in vitro the type of effect caused by gentamicin and clindamycin on the strains isolated from severe dental infections. Twenty bacterial samples were used, 13 Streptococcus from Viridans group and 7 obligate anaerobes. These samples were inoculated in culture media containing clindamycin and gentamicin, singly and in combination. Utilizing the clindamycin in different concentrations and kept gentamicin 3 µg/mL throughout the study. Streptococcus from Viridans group were kept for 24 hours in microaerophilic and anaerobic were kept in anaerobic jar for 48 hours both under a 37 ° C temperature. After the incubation period, the reading of the results was performed. Samples of Streptococcus Viridans group showed resistance to both drugs and combination there of, except for one, which was sensitive to gentamicin. Anaerobes showed mixed results, ranging from sensitivity or extreme resistance to variable effects and synergism by adding between drugs. It can be concluded that there is no synergistic effect of potentiation between gentamicin and clindamycin and, according to the spectrum of action of each drug, this combination can enhance hospital treatment of severe dental infections. New studies, however, are required to check whether the variable effects observed in this study may interfere with clinical outcomes

Mercury speciation in plankton from the Cabo Frio Bay, SE--Brazil.

Mercury (Hg) is considered a global pollutant, and the scientific community has shown great concern about its toxicity as it may affect the biota of entire systems, through bioaccumulation and bioamplification processes of its organic form, methylmercury (MeHg), along food web. However, few research studies deal with bioaccumulation of Hg from marine primary producers and the first-order consumers. So, this study aims to determine Hg distribution and concentration levels in phytoplankton and zooplankton in the Cabo Frio Bay, Brazil, a site influenced by coastal upwelling. The results from Hg speciation analyses show that inorganic mercury Hg(II) was the predominant specie in plankton from this bay. The annual Hg species distribution in plankton shown mean concentration of 2.00 ± 1.28 ng Hg(II) g(-1) and 0.15 ± 0.08 ng MeHg g(-1) wet weight (phytoplankton) and 2.5 ± 2.03 ng Hg(II) g(-1) and 0.25 ± 0.09 ng MeHg g(-1) wet weight (zooplankton). Therefore, upwelling zones should be considered in the Hg biogeochemical cycle models as a process that enhances Hg(II) bioaccumulation in plankton, raising its bioavailability and shelf deposition.

Mercury deposition during the previous century in an upwelling region; Cabo Frio, Brazil.

To investigate the upwelling influence on Hg biogeochemical cycles and the sedimentological changes during the previous ≈ 150 years, four sediment box-cores were sampled along an inshore offshore transect on the Southeastern Brazilian continental shelf. Mercury values were found to be relatively low, with means ranging between 8.08 and 30.4 ng g(-1). Mercury fluxes along the sediment cores are directly related to the well documented historical regional activity and global atmospheric deposition. The narrow relationship between mercury and organic carbon suggest that upwelling phenomenon and primary production may play an important role on Hg input and distribution along continental shelf depositional settings.

Características clínico-epidemiológicas de pacientes idosos com aids em hospital de referência, Teresina-PI,1996 a 2009 / Clinical and epidemiological characteristics of elderly patients with AIDS in a reference hospital, Teresina-PI, 1996 to 2009

Objetivo: investigar as características epidemiológicas de pacientes idosos com aids notificados em hospital de referência no município de Teresina, estado do Piauí, Brasil. Metodologia: foram revisadas as fichas de notificação de idosos com aids, no Sistema de Informação de Agravos de Notificação (Sinan) do Ministério da Saúde, de 1996 a 2009, em hospital de referência de Teresina-PI. Resultados: entre os casos notificados (n=69), a maioria era procedente do Piauí (68,1 por cento), com idade entre 60 e 69 anos (88,8 por cento), do sexo masculino (72,4 por cento) e com baixa escolaridade (86,9 por cento); a principal categoriade exposição foi a heterossexual (73,9 por cento) e quase metade dos casos (44,9 por cento) era de residentes em cidades com menos de 50 mil habitantes; as manifestações clínicas mais frequentes observadas foram caquexia, astenia, anemia, diarreia crônica, infecção por fungo e toxoplasmose cerebral; 27,5 por cento dos indivíduos investigados haviam falecido. Conclusão: os resultados apontam a aids entre idosos heterossexuais com baixa escolaridade.

Objective: to investigate the epidemiological characteristics of elderly patients reported with AIDS in a referral hospital, in the Municipality of Teresina, State of Piauí, Brazil. Methodology: review investigation of the compulsory AIDS notification forms of elderly people, in the Information System for Notifiable Diseases (Sinan) of the Brazilian Ministry of Health, from 1996 to 2009, in a referral hospital in Teresina-PI. Results: among the individuals investigated (n=69), 68.1 per cent were from the State of Piauí, 72.4 per cent were male, and 86.9 per cent had less than eight years of scholarship; 73.9 per cent were infected by heterosexual exposure, and 44.9 per cent were residents in cities with less than 50 thousand inhabitants; themost frequent clinical manifestations were cachexia, asthenia, anemia, chronic diarrhea, yeast infection and cerebral toxoplasmosis; 27.5 per cent of the individuals investigated had died. Conclusion: results suggest heterosexual AIDS among elderly with low education.