Cervical cancer control limiting factors and facilitators: a literature review. / Fatores limitadores e facilitadores para o controle do câncer de colo de útero: uma revisão de literatura.

This paper reviews the limiting factors and facilitators of access to Brazilian cervical cancer care public health services. This review employed bibliographic database Medline (interface with the Virtual Health Library/BVS and PubMed) and Lilacs / SciELO portals. We sought publications for the period 2011-2016 based on the use of specific terms from the sources consulted, regarding "cervical neoplasms" and "access to health services". We found 704 papers initially, which were shortlisted to 31 following adopted criteria, which were further reduced to 19 papers to make up the final selection. Access facilitating aspects such as wide coverage of the Pap smear test and coverage of biopsies equivalent to the number of altered prevention tests were mentioned. However, access limiting aspects such as inadequate Pap smear's periodicity, difficulties in scheduling appointments and exams, high rate of advanced staging and delays in diagnosis and treatment onset were also reported.

Este artigo revisa os fatores limitadores e facilitadores do acesso aos serviços públicos de saúde no Brasil na área da atenção ao câncer de colo de útero (CCU). Nesta revisão, foram utilizadas a base de dados bibliográficos Medline (interface com Biblioteca Virtual de Saúde/BVS e PubMed) e os portais Lilacs e SciELO. Buscou-se publicações referentes ao período 2011-2016, a partir do uso de termos específicos das fontes consultadas, relativos a 'neoplasias do colo do útero' e 'acesso aos serviços de saúde'. Foram inicialmente encontrados 704 artigos, mas, considerando os critérios adotados, foram selecionados 31 artigos, dos quais foram incluídos 19. Foram mencionados aspectos facilitadores do acesso como ampla cobertura do exame Papanicolaou e de biopsias equivalente ao número de preventivos alterados. Entretanto, aspectos limitadores de acesso como periodicidade inadequada do Papanicolau, dificuldades para agendamento de consultas e exames, alto índice de estadiamento avançado e atrasos no diagnóstico e no início de tratamento, também foram apresentados.

Fatores limitadores e facilitadores para o controle do câncer de colo de útero: uma revisão de literatura / Cervical cancer control limiting factors and facilitators: a literature review

Resumo Este artigo revisa os fatores limitadores e facilitadores do acesso aos serviços públicos de saúde no Brasil na área da atenção ao câncer de colo de útero (CCU). Nesta revisão, foram utilizadas a base de dados bibliográficos Medline (interface com Biblioteca Virtual de Saúde/BVS e PubMed) e os portais Lilacs e SciELO. Buscou-se publicações referentes ao período 2011-2016, a partir do uso de termos específicos das fontes consultadas, relativos a 'neoplasias do colo do útero' e 'acesso aos serviços de saúde'. Foram inicialmente encontrados 704 artigos, mas, considerando os critérios adotados, foram selecionados 31 artigos, dos quais foram incluídos 19. Foram mencionados aspectos facilitadores do acesso como ampla cobertura do exame Papanicolaou e de biopsias equivalente ao número de preventivos alterados. Entretanto, aspectos limitadores de acesso como periodicidade inadequada do Papanicolau, dificuldades para agendamento de consultas e exames, alto índice de estadiamento avançado e atrasos no diagnóstico e no início de tratamento, também foram apresentados.

Abstract This paper reviews the limiting factors and facilitators of access to Brazilian cervical cancer care public health services. This review employed bibliographic database Medline (interface with the Virtual Health Library/BVS and PubMed) and Lilacs / SciELO portals. We sought publications for the period 2011-2016 based on the use of specific terms from the sources consulted, regarding "cervical neoplasms" and "access to health services". We found 704 papers initially, which were shortlisted to 31 following adopted criteria, which were further reduced to 19 papers to make up the final selection. Access facilitating aspects such as wide coverage of the Pap smear test and coverage of biopsies equivalent to the number of altered prevention tests were mentioned. However, access limiting aspects such as inadequate Pap smear's periodicity, difficulties in scheduling appointments and exams, high rate of advanced staging and delays in diagnosis and treatment onset were also reported.

Fungal communities in pressmud composting harbour beneficial and detrimental fungi for human welfare.

Pressmud is a substrate derived from sugarcane juice filtrate, and around 26-40 kg of this residue are produced per ton of sugarcane. It is mainly used as fertilizer in crops, and its application in the field is often made without any prior treatment, but, in this research, it was studied for the risk this practice poses for human health. This research was stimulated by previous results indicating the presence of opportunistic pathogens in residues used in various composting systems and the extensive use of fresh pressmud in agriculture. Here, It was assessed the fungal diversity present in both fresh and composting pressmud using 454 pyrosequencing. In addition, heat-tolerant fungi were isolated and surveyed for their enzymatic repertoire of biomass-degrading enzymes (cellulase, xylanase, laccase and polygalacturonase). A wide range of opportunistic pathogens was found among the most abundant taxa in the fresh pressmud, such as Lomentospora prolificans (43.13 %), Trichosporon sp. (10.07 %), Candida tropicalis (7.91 %), and Hormographiella aspergillata (8.19 %). This indicates that fresh pressmud might be a putative source of human pathogenic fungi, presenting a potential threat to human health if applied as fertilizer without any treatment. With regard to the heat-tolerant fungi found in this substrate, all the 110 isolates screened were able to produce at least one of the tested enzymes. The pressmud composting process not only effectively reduces the load of pathogenic fungi, but also creates an interesting environment for fungi able to produce thermostable hydrolytic and oxidative enzymes with biotechnological applications.

Marine-derived fungi: diversity of enzymes and biotechnological applications.

The ocean is considered to be a great reservoir of biodiversity. Microbial communities in marine environments are ecologically relevant as intermediaries of energy, and play an important role in nutrient regeneration cycles as decomposers of dead and decaying organic matter. In this sense, marine-derived fungi can be considered as a source of enzymes of industrial and/or environmental interest. Fungal strains isolated from different substrates, such as invertebrates, decaying wood, seawater, sediments, and mangrove detritus, have been reported to be producers of hydrolytic and/or oxidative enzymes, with alginate lyase, amylase, cellulase, chitinase, glucosidase, inulinase, keratinase, ligninase, lipase, nuclease, phytase, protease, and xylanase being among the enzymes produced by fungi of marine origin. These enzymes present temperature and pH optima ranging from 35 to 70(∘)C, and 3.0 to 11.0, respectively. High-level production in bioreactors is mainly performed using submerged-state fermentation. Certain marine-derived fungal strains present enzymes with alkaline and cold-activity characteristics, and salinity is considered an important condition in screening and production processes. The adaptability of marine-derived fungi to oceanic conditions can be considered an attractive point in the field of fungal marine biotechnology. In this review, we focus on the advances in discovering enzymes from marine-derived fungi and their biotechnological relevance.

Excessive daytime sleepiness in patients with chronic kidney disease undergone hemodialysis / Sonolência excessiva diurna em pacientes com doença renal crônica submetidos a hemodiálise

Introduction Approximately 80% of patients with chronic kidney disease complain about sleep disorders, which is a much higher percentage than in the general population. Excessive daytime sleepiness is the third most frequent complaint in these patients, and it is significantly associated with a higher risk of sleep apnea. The aim of this study was to assess the presence of daytime sleepiness in patients with end stage renal disease (ESRD) who were undergoing diurnal hemodialysis. Materials and methods The Epworth Sleepiness Scale (ESS) was applied to patients with ESRD who underwent diurnal hemodialysis in the Centro de Nefrologia da Zona Norte in Sao Paulo, Brazil. Results A total of 168 patients were included in the study. According to the ESS, 31% presented with a mild propensity to sleep, 22% with a moderate propensity, and 17% with a severe propensity. Conclusion Our study concluded that 70% of the sample of patients with ESRD who were undergoing hemodialysis presented with a propensity to sleep in inappropriate circumstances on the ESS. When excessive daytime sleepiness is associated with sleep apnea and other comorbidities, it is essential to carefully assess patients’ complaints.

Introdução Aproximadamente 80% dos pacientes com doença renal crônica (DRC) referem alguma queixa sobre distúrbios do sono, sendo muito maior do que na população em geral. A sonolência excessiva diurna é a terceira queixa mais frequente e está significativamente associada com um maior rico de apneia do sono. O objetivo deste estudo foi avaliar a presença de sonolência excessiva diurna em pacientes com doença renal em estágio final (DREF) submetidos a hemodiálise diurna. Materiais e métodos A escala de sonolência de Epworth (ESE) foi aplicada em pacientes em DREF, que realizam hemodiálise diurna no Centro de Nefrologia da Zona Norte, na cidade de São Paulo. Resultados Cento e sessenta e oito pacientes foram incluídos no estudo. Trinta e um por cento da amostra apresentou uma leve propensão a dormir, de acordo com ESE, enquanto que vinte e dois por cento apresentaram uma moderada propensão e dezessete por cento apresentaram uma grave propensão. Conclusão Nosso estudo concluiu que 70% da amostra em DREF submetidos a hemodiálise apresentaram uma propensão de dormir em circunstâncias inapropriadas, de acordo com a escala de sonolência de Epworth. Uma vez que a sonolência excessiva diurna está associada com a apneia do sono e outras comorbidades é essencial estar atento às queixas desses pacientes.

Hanseníase e vulnerabilidade social: uma análise do perfil socioeconômico de usuários em tratamento irregular / Leprosy and social vulnerability: an analysis of the socioeconomic profile of users in irregular treatment

Este artigo analisa a determinação social da hanseníase, a partir do reconhecimento da vulnerabilidade social dos usuários em tratamento irregular, no Programa de Controle da Hanseníase do município de Campos dos Goytacazes (RJ). Para isso, apresenta uma pesquisa documental, com base nas Fichas de Cadastro Social dos usuários mencionados, destacando aspectos como trabalho, renda, formação familiar e acesso a políticas públicas. Seus resultados registram significativa presença de trabalho precarizado associado a baixos níveis de renda e de escolaridade, sendo a maioria considerada pobre ou indigente (51,5%) e não usuária de benefícios assistenciais (66,7%).

This article analyzes the social determination of leprosy, from the recognition of the social vulnerability of users in irregular treatment, in the Leprosy Control Program of the county of Campos dos Goytacazes – RJ. In order to do that, it presents a documental research, based on the social registration forms of the mentioned users, highlighting some aspects such as work, income, family background and access to public policies. Its results register significant presence of precarious work related to low schooling and income levels, being most of them considered poor or indigent (51,5%) and non-users of welfare benefits (66,7%).

Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial.

BACKGROUND: Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. METHODS/DESIGN: A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height(2); circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. DISCUSSION: CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).

Métodos de indução do trabalho de parto / Methods of induction of labour

Os métodos de indução do parto podem ser divididos em estímulos naturais, estímulos exógenos diretos ou mecânicos e estímulos exógenos indiretos ou farmacológicos, cada qual apresenta suas particularidades nas indicações e contraindicações. O objetivo deste artigo foi realizar uma revisão da literatura consultando Medline/Pubmed e a Biblioteca Cochrane para avaliar a eficácia e segurança na utilização dos principais métodos de indução do trabalho de parto. Apurou-se não haver método ideal de indução do trabalho de parto. Os estímulos naturais e os métodos alternativos carecem de maiores estudos para incentivo de seu uso rotineiro. As prostaglandinas, em destaque o misoprostol, está indicada no Índice de Bishop desfavorável e a ocitocina em condições cervicais favoráveis. Os avanços no campo da biologia molecular tem corroborado que o método ideal deve atuar em sincronismo com a contratilidade uterina e a maturação cervical.(AU)

Methods of labor induction can be classified as natural stimuli, direct exogenous stimuli or mechanical and indirect exogenous stimuli or pharmacological. Which one has its peculiarities in relation to indications and contraindications. The objective of this article was to assess the efficacy and safety of the main methods of induction of labor trough the analysis of the medical literature in Medline/Pubmed and the Cochrane Library to. No ideal method of inducing labor was found. Further studies are required to encourage natural stimuli and alternative methods more often. According to Bishop scores, prostaglandins, (especially misoprostol) are unfavorable and oxytocin in case of favorable cervical environment. Advances in the field of molecular biology have confirmed that the ideal method should work simultaneously with uterine contraction and cervical ripening.(AU)

Elementos da matriz extracelular da cérvice uterina e trabalho de parto prematuro / Elements of extracellular matrix from uterine cervix and premature labor

As taxas de prematuridade não atingem quedas significativas, mesmo em países desenvolvidos, alertando os pesquisadores a buscarem alternativas clínico-farmacológicas na prevenção desta enfermidade obstétrica. A matriz extracelular ocupa espaço relevante na maturação cervical, e seu entendimento é fundamental para possíveis ações preventivas. Destaca-se a provável correlação dos níveis locais de glicosaminoglicanos na prevenção do parto prematuro por inibir processos inflamatórios na cérvice uterina

The preterm delivery rates do not decrease significantly, even in developed countries, prompting researchers to seek pharmacological and clinical alternatives to prevent this obstetrics disorder. The extracellular matrix is important in cervical length, and its understanding is essential for possible preventive actions. We emphasize the probable correlation of the local levels of glycosaminoglycans to prevent premature labor by inhibiting inflammatory processes from uterine cervix

Babesia spp. infection in dogs from rural areas of São Paulo State, Brazil.

The status of Babesia spp. infection in dogs from rural areas of São Paulo State, Brazil was studied. For this, 150 animals were examined by blood smears and by PCR; the presence of tick infestation was also investigated. By the blood smear examination, 3 animals (2%) were detected positive and by PCR for Babesia spp. 12 (8%) were positive, with bands visualized in 450 bp. Rhipicephalus sanguineus or Amblyomma spp. were found on 36 (24%) of the 150 dogs. Amblyomma species found were A. cajennense (9/36-25%) and A. ovale (9/36-25%). It was not possible to correlate the presence of R. sanguineus and the infection with Babesia spp. The sequencing of four positive samples demonstrated close identity with B. canis vogeli already characterized in Brazil.

Babesia spp. infection in dogs from rural areas of São Paulo State, Brazil / Infecção por Babesia spp. em cães de áreas rurais do estado de São Paulo, Brasil

The status of Babesia spp. infection in dogs from rural areas of São Paulo State, Brazil was studied. For this, 150 animals were examined by blood smears and by PCR; the presence of tick infestation was also investigated. By the blood smear examination, 3 animals (2 percent) were detected positive and by PCR for Babesia spp. 12 (8 percent) were positive, with bands visualized in 450 bp. Rhipicephalus sanguineus or Amblyomma spp. were found on 36 (24 percent) of the 150 dogs. Amblyomma species found were A. cajennense (9/36-25 percent) and A. ovale (9/36-25 percent). It was not possible to correlate the presence of R. sanguineus and the infection with Babesia spp. The sequencing of four positive samples demonstrated close identity with B. canis vogeli already characterized in Brazil.

A presença de infecção por Babesia spp. em cães de áreas rurais do Estado de São Paulo, Brasil foi investigada. Para tanto, 150 cães foram examinados por técnicas parasitológicas de esfregaços sanguíneos e moleculares (PCR), e também, foi verificada a presença de carrapatos nestes animais. Pela análise de esfregaços sanguíneos, 3 (2 por cento) dos cães estavam infectados, enquanto pela PCR, 12 (8 por cento) dos animais foram positivos com bandas aproximadas de 450 pares de base (pb). Foram observados 36 (24 por cento) cães infestados com Rhipicephalus sanguineus ou com Amblyomma spp. As espécies de Amblyomma observadas foram A. cajennense (25 por cento) e A. ovale (25 por cento). Não foi possível correlacionar a presença de R. sanguineus com a infecção por Babesia spp. O seqüenciamento de quatro amostras positivas demonstrou alta identidade com B. canis vogeli, já caracterizada no Brasil.

Alterações histoquímicas das glicosaminoglicanas na cérvice uterina no final da prenhez da rata albina após ministração local de hialuronidase / Histochemical changes of the glycosaminoglycans in the uterine cervix of pregnant rats after local injection of hyaluronidase

OBJETIVO: estudar as alterações histoquímicas relacionadas às glicosaminoglicanas da cérvice uterina da rata albina, após ministração local de hialuronidase no final da prenhez. MÉTODOS: dez ratas com teste de prenhez positivo foram distribuídas aleatoriamente em dois grupos, numericamente iguais. O Grupo Controle (Gc) foi constituído pelas ratas que receberam 1 mL de água destilada, dose única, no 18° dia da prenhez, sob anestesia, ministrado na cérvice uterina. O Grupo Experimental (Gex) constou de ratas que receberam, sob as mesmas condições do Gc, 0,02 mL de hialuronidase, diluído em 0,98 mL de água destilada (total de 1 mL). No 20° dia de prenhez, as ratas foram novamente anestesiadas e submetidas à dissecção, preparando-se a cérvice uterina para estudo histoquímico com coloração de alcian blue e seus bloqueios (pH=0,5, pH=2,5, metilação e saponificação). RESULTADOS: verificou-se na lâmina própria no Gc, reação fortemente positiva (+3) e, no Gex, reação negativa, na coloração de alcian blue no pH=0,5. Em pH=2,5 a coloração também se apresentou fortemente positiva (+4) no Gc e fracamente positiva (+1) no Gex. Após metilação, tanto o Gc quanto o Gex mostraram reação negativa após coloração de alcian blue no pH=2,5. Com a reação de metilação seguida de saponificação e na digestão enzimática em lâmina, a coloração da lâmina própria se mostrou negativa em ambos os grupos. CONCLUSÕES: há uma nítida predominância de glicosaminoglicanas sulfatadas no Gc em relação ao Gex e uma tênue quantidade de glicosaminoglicanas carboxiladas identificadas no Gex. As modificações evidenciadas na matriz extracelular sugerem que a hialuronidase injetada localmente na cérvix uterina promoveu alterações bioquímicas compatíveis com maturação cervical.

PURPOSE: to study the histochemical changes related to the uterine cervix glycosaminoglycan of the albino female rat, after local ministration of hyaluronidases at the end of pregnancy. METHODS: ten female rats with positive pregnancy tests were randomly distributed in two numerically equal groups. The control group (Cg) was built up with rats that received a single dose of 1 mL of distilled water in the uterine cervix, under anesthesia, at the 18th pregnancy day. In the experimental group (Exg), the rats received 0.02 mL of hyaluronidase, diluted in 0.98 mL of distilled water (1 mL as a total), under the same conditions as the Cg. At the 20th pregnancy day, the rats were anesthetized once again and submitted to dissection, and the cervix prepared for histochemical study with alcian blue dye and its blockades (pH=0.5, pH=2.5, methylation and saponification). RESULTS: strongly positive reaction in the lamina propria (+3) has been seen in the Cg, and negative reaction in the Exg, with pH=0.5 alcian blue staining. With pH=2.5, staining has also been strongly positive (+4) in the Cg, and weakly positive (+1) in the Exg slide. After methylation, both groups have shown negative reaction, with pH=2.5 alcian blue staining. The lamina propria staining became negative after methylation in both groups, followed by saponification and enzymatic digestion on slide. CONCLUSIONS: there is clear predominance of sulphated glycosaminoglycans in the Cg as compared to the Exg and a small amount of identified carboxylated glycosaminoglycans in the Exg. The changes evidenced in the extracellular matrix have suggested that the hyaluronidase injected in the uterine cervix has promoted biochemical changes compatible with cervix maturation.

Molecular and parasitological survey of Hepatozoon canis (Apicomplexa: Hepatozoidae) in dogs from rural area of Sao Paulo state, Brazil.

Hepatozoon canis is a protozoan that infects dogs and is transmitted by the ingestion of the brown dog tick, Rhipicephalus sanguineus. Two distinct species of Hepatozoon genus can infect dogs, H. canis and H. americanum. Routine tests to detect the disease are based on direct examination of gametocytes on Giemsa-stained blood smears. The objectives of this study were the investigation of infection prevalence in rural area dogs, the comparison of diagnostics by blood smear examination and polymerase chain reaction (PCR), and the association of infection with tick infestation. Blood smears, collected by puncture of the cephalic vein and ear margin capillary bed from 150 dogs, were examined. This technique detected 17 positive animals (11.3%), with 14 (9.3%) in peripheral blood and seven (4.7%) in cephalic vein blood. PCR tests detected 80 (53.3%) positive animals. R. sanguineus and Amblyomma spp. were found in 36 of the dogs (24%), in equal proportions. The identified species for Amblyomma genus were A. cajennense and A. ovale. Data analysis showed that PCR was much more sensitive when compared to blood smear examination. Hepatozoon species was previously identified as closely related to H. canis.

Alteração da matriz extracelular da cérvice uterina durante a gestação / Changes in the extracellular matrix of the uterine cervix during pregnancy

A matriz extracelular do colo uterino sofre importantes mudanças em sua composição no decorrer da gestação e principalmente no período peripartal. Tais mudanças são necessárias para transformar o colo uterino imaturo, uma estrutrura fibrosa, em um órgão complacente o bastante para a passagem do feto no trabalho de parto. Conhecer melhor todo o processo de amadurecimento cervical é de fundamental importância para obterem-se melhores resultados na indução do parto.

[Histochemical changes of the glycosaminoglycans in the uterine cervix of pregnant rats after local injection of hyaluronidase]. / Alterações histoquímicas das glicosaminoglicanas na cérvice uterina no final da prenhez da rata albina após ministração local de hialuronidase.

PURPOSE: to study the histochemical changes related to the uterine cervix glycosaminoglycan of the albino female rat, after local administration of hyaluronidases at the end of pregnancy. METHODS: ten female rats with positive pregnancy tests were randomly distributed in two numerically equal groups. The control group (Cg) was built up with rats that received a single dose of 1 mL of distilled water in the uterine cervix, under anesthesia, at the 18th pregnancy day. In the experimental group (Exg), the rats received 0.02 mL of hyaluronidase, diluted in 0.98 mL of distilled water (1 mL as a total), under the same conditions as the Cg. At the 20th pregnancy day, the rats were anesthetized once again and submitted to dissection, and the cervix prepared for histochemical study with alcian blue dye and its blockades (pH=0.5, pH=2.5, methylation and saponification). RESULTS: strongly positive reaction in the lamina propria (+3) has been seen in the Cg, and negative reaction in the Exg, with pH=0.5 alcian blue staining. With pH=2.5, staining has also been strongly positive (+4) in the Cg, and weakly positive (+1) in the Exg slide. After methylation, both groups have shown negative reaction, with pH=2.5 alcian blue staining. The lamina propria staining became negative after methylation in both groups, followed by saponification and enzymatic digestion on slide. CONCLUSIONS: there is clear predominance of sulphated glycosaminoglycans in the Cg as compared to the Exg and a small amount of identified carboxylated glycosaminoglycans in the Exg. The changes evidenced in the extracellular matrix have suggested that the hyaluronidase injected in the uterine cervix has promoted biochemical changes compatible with cervix maturation.