Barriers to Access the Pap Smear Test for Cervical Cancer Screening in Rural Riverside Populations Covered by a Fluvial Primary Healthcare Team in the Amazon.

Cervical cancer is a major public health problem, especially in the north region of Brazil. The aim of the study was to identify the factors associated with not undergoing the cervical cancer screening test in rural riverside populations in the Amazon. A cross-sectional home-based survey was carried out in 38 locations covered by a fluvial primary healthcare team, and the administrative records of the screening tests from January 2016 to May 2019 were analyzed. After the descriptive analysis, logistic regression was performed considering the outcome of having undergone cervical cancer screening within the past three years. Of the 221 women assessed, 8.1% had never undergone the test, and 7.7% had undergone it more than three years ago. Multiparity (OR = 0.76 (95%CI = 0.64-0.90)), occupation in domestic activities (OR = 0.31 (95%CI = 0.11-0.89)), and lack of knowledge of the healthcare unit responsible for the service (OR = 0.18 (95%CI = 0.04-0.97)) were associated with not undergoing the cervical cancer screening test. The administrative records revealed that the screening test was performed outside the recommended age range (24%), performed needlessly (9.6%) with undue repetitions (3.2%), and a high percentage of the samples collected were unsatisfactory (23.5%). The findings revealed the existence of barriers for riverside women to access cervical cancer screening tests.

Guia prático de abordagem da criança e do adolescente com asma grave: Documento conjunto da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Practical guide to approaching children and adolescents with severe asthma: a joint document of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Asma grave é a asma que requer tratamento com altas doses de corticosteroide inalado associado a um segundo medicamento de controle (e/ou corticosteroide sistêmico) para impedir que se torne "descontrolada" ou permaneça "descontrolada" apesar do tratamento. Asma grave é considerada um subtipo de asma de difícil tratamento. A prevalência em crianças evidenciada pelo International Study of Asthma and Allergies in Childhood variou entre 3,8% e 6,9%. Existem diversos instrumentos para avaliação subjetiva, como diários de sintomas e questionários, bem como para avaliação objetiva com função pulmonar e avaliação da inflamação por escarro induzido, ou óxido nítrico exalado. A abordagem terapêutica varia desde doses altas de corticosteroide inalado e/ou oral, broncodilatadores de longa duração, antaganonistas de receptores muscarínicos, até os mais recentes imunobiológicos que bloqueiam a IgE ou IL-5.

Severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids in combination with a second control drug (and/or a systemic corticosteroid) to prevent it from becoming "uncontrolled" or remaining "uncontrolled" despite treatment. Severe asthma is considered a difficult-to-treat asthma subtype. The prevalence in children found by the International Study of Asthma and Allergies in Childhood ranged from 3.8% to 6.9%. There are several instruments for subjective assessment, such as symptom diaries and questionnaires, as well as for objective assessment, including pulmonary function testing and evaluation of inflammation by induced sputum or exhaled nitric oxide. The therapeutic approach includes high doses of inhaled and/or oral corticosteroids, long-acting bronchodilators, muscarinic receptor antagonists, and the latest biologics that block IgE or IL-5.

Perfil sociodemográfico e de adoecimento de idosos residentes em Instituição de Longa Permanência: estudo observacional / Sociodemographic profile and advice of elderly residents in a Long-Stay Institution: observational study / Perfil sociodemográfico y de enfermería de ancianos residentes en Institución de Larga Permanencia: estudio observacional

Foi objetivo identificar o perfil sociodemográfico e o de adoecimento de idosos residentes em uma Instituição de Longa Permanência. Estudo epidemiológico, descritivo e transversal. A maioria dos idosos era do gênero feminino, possuía baixo índice de escolaridade e renda familiar de um salário mínimo. Considerando-se o gênero, houve prevalência de doença renal crônica e osteoporose entre mulheres e hipertensão arterial sistêmica e acidente vascular cerebral entre os homens.

The objective was to identify the sociodemographic and illness profile of elderly residents in a long - term institution. Epidemiological, descriptive and crosssectional study. The majority of the elderly were of the female gender, had a low level of education and family income of a minimum wage. Considering the gender, there was prevalence of chronic kidney disease and osteoporosis among women and systemic arterial hypertension and stroke among men.

Fue objetivo identificar el perfil sociodemográfico y de enfermo de ancianos residentes en una Institución de Larga Permanencia. Estudio epidemiológico, descriptivo y transversal. La mayoría de los ancianos era del género femenino, poseía bajo índice de escolaridad y renta familiar de un salario mínimo. En vista del género, hubo prevalencia de enfermedad renal crónica y osteoporosis entre mujeres e hipertensión arterial sistémica y accidente cerebrovascular entre los hombres.

Post-embriononic development of Chrysomya putoria(Diptera: Calliphoridae) on a diet containing ampicillin in different concentrations.

Here we evaluate the effects of different concentrations of the antibiotic ampicillin on the growth and development of Chrysomya putoria. Third-generation, first instar larvae (L1) reared on 60 grams of homogenate+agar 65% were treated with ampicillin sodium. The experiment consisted of four replicates (40 larvae/replicate) of each antibiotic concentration tested (T1: 466µg/mL ; T2: 81.33 mg/mL and T3: 166.66mg/mL) and a T4: control. The body mass of the mature larvae, after they abandoned the diet, were recorded in batches of five. The variation between the mean body mass of larvae and the duration of larval and pupal stages, and overall duration of the development, viability and normal rates were analyzed by ANOVA. There were no significant differences between the four treatments in the following parameters: body mass of larvae that discontinued the diet as well as the duration of larval, pupal, and total development. The sex ratios found in the four treatments did not differ from those expected. Normality rates were 100% for all treatments. There were no significant differences between treatments for larval and overall viability, but pupal viability differed significantly between T1 and the control, T1 and T2, and between the control and T3. The antibiotic did not appear to significantly alter the development of C. putoria.

Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation.

OBJECTIVE: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance. DESIGN: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions. RESULTS: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818). CONCLUSIONS: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.

Effects of the antibiotics Gentamicin on the postembryonic development of Chrysomya putoria (Diptera: Calliphoridae).

We evaluate the effects the antibiotic Gentamicin on the development of Chrysomya putoria (Wiedemann, 1818). Third-generation, first-instar larvae were reared in a climatic chamber on 60 g of homogenate + agar 65% and were treated with three concentrations of Gentamicin: 4.44 mg/ml, 13.33 mg/ml, and 66.66 mg/ml. The control consisted of distilled water. The relationships between mean body mass of mature larvae (measured after diet abandonment, in batches of five individuals), duration of larval and pupal stages, and overall duration of development were analyzed. The actual sex ratio was compared against the expected using the chi square. None of the parameters measured differed significantly among the four treatments, with one exception: when Gentamicin concentration was 13.33 mg/ml, larval viability differed significantly from the control. All larvae from all treatments were considered normal. We conclude that the antibiotic did not significantly alter the development of C. putoria (Wiedemann) (Diptera: Calliphoridae).

Richieri-costa and Pereira syndrome: severe phenotype.

Richieri-Costa and Pereira syndrome, described in 1992, comprises short stature, Robin sequence, cleft mandible, limb malformations, and short larynx, deformed or lack of epiglottis, and abnormal aryepiglottic folds. There are 32 reported cases, only one described outside Brazil. We describe a 4-month-old boy with the most severe phenotype yet reported.

Timp1 interacts with beta-1 integrin and CD63 along melanoma genesis and confers anoikis resistance by activating PI3-K signaling pathway independently of Akt phosphorylation.

BACKGROUND: Anoikis resistance is one of the abilities acquired along tumor progression. This characteristic is associated with metastasis development, since tumorigenic cells must survive independently of cell-matrix interactions in this process. In our laboratory, it was developed a murine melanocyte malignant transformation model associated with a sustained stressful condition. After subjecting melan-a melanocytes to 1, 2, 3 and 4 cycles of anchorage impediment, anoikis resistant cells were established and named 1C, 2C, 3C and 4C, respectively. These cells showed altered morphology and PMA independent cell growth, but were not tumorigenic, corresponding to pre-malignant cells. After limiting dilution of 4C pre-malignant cells, melanoma cell lines with different characteristics were obtained. Previous data from our group showed that increased Timp1 expression correlated with anoikis-resistant phenotype. Timp1 was shown to confer anchorage-independent growth capability to melan-a melanocytes and render melanoma cells more aggressive when injected into mice. However, the mechanisms involved in anoikis regulation by Timp1 in tumorigenic cells are not clear yet. METHODS: The ß1-integrin and Timp1 expression were evaluated by Western blotting and CD63 protein expression by flow cytometry using specific antibodies. To analyze the interaction among Timp1, CD63 and ß1-integrin, immunoprecipitation assays were performed, anoikis resistance capability was evaluated in the presence or not of the PI3-K inhibitors, Wortmannin and LY294002. Relative expression of TIMP1 and CD63 in human metastatic melanoma cells was analyzed by real time PCR. RESULTS: Differential association among Timp1, CD63 and ß1-integrins was observed in melan-a melanocytes, 4C pre-malignant melanocytes and 4C11- and 4C11+ melanoma cells. Timp1 present in conditioned medium of melanoma cells rendered melan-a melanocytes anoikis-resistant through PI3-K signaling pathway independently of Akt activation. In human melanoma cell lines, in which TIMP1 and beta-1 integrin were also found to be interacting, TIMP1 and CD63 levels together was shown to correlate significantly with colony formation capacity. CONCLUSIONS: Our results show that Timp1 is assembled in a supramolecular complex containing CD63 and ß1-integrins along melanoma genesis and confers anoikis resistance by activating PI3-K signaling pathway, independently of Akt phosphorylation. In addition, our data point TIMP1, mainly together with CD63, as a potential biomarker of melanoma.

[Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study]. / Diferentes dispositivos inalatórios na crise aguda de asma: um estudo randomizado, duplo-cego e controlado com placebo.

OBJECTIVE: To verify the efficacy, side effects, and cost of treatment of acute asthma attacks, using different inhaler devices. METHODS: This is a randomized, double-blind, placebo-controlled study. Salbutamol was administered via a nebulizer, a metered-dose inhaler (attached to a commercially available spacer device), a homemade non-valved spacer device, or a dry powder inhaler. Assessments were made at zero, 20, 40 and 60 minutes, followed by the application of salbutamol and placebo with another device. Forty children (mean age of 11+/-3.5 years) with acute asthma attacks, were evaluated. Clinical score, forced expiratory volume in one second and side effects were analyzed. The costs for medication and spacer devices were calculated. RESULTS: There is no difference between groups regarding clinical score and variation of forced expiratory volume in one second. There was a major variation in the heart rate response to the nebulizer (35%) compared to the commercially available spacer and dry powder inhaler (15 and 17%) and between the homemade spacer and the commercially available spacer (28 and 15%) (p = 0.004). The nebulizer and homemade spacer caused more tremor (p = 0.02). The cost of treatment was higher for the nebulizer and commercially available spacer (p = 0.0001). CONCLUSIONS: The nebulizer was more expensive and used more medicine, showing the same efficiency. The homemade spacer was cheaper, but presented more side effects. The commercially available spacer was as expensive as the nebulizer, although safer. The dry powder inhaler was cheaper, but, just as the homemade spacer, it also caused tachycardia.

Diferentes dispositivos inalatórios na crise aguda de asma: um estudo randomizado, duplo-cego e controlado com placebo / Different inhaler devices in acute asthma attacks: a randomized, double-blind, placebo-controlled study

OBJETIVO: Verificar a eficácia, eventos adversos e custo do tratamento da crise aguda de asma, utilizando diferentes dispositivos inalatórios. MÉTODOS: Estudo randomizado, duplo-cego e controlado com placebo. Foi utilizado salbutamol em nebulizador, inalador dosimetrado com espaçadores industrial e artesanal e inalador em pó. As avaliações foram feitas em 0, 20, 40 e 60 minutos, seguidas da aplicação de salbutamol e placebo em outro dispositivo. Foram avaliadas 40 crianças em crise aguda de asma, com média de idade = 11±3,5 anos. Utilizou-se escore clínico e função pulmonar, e foram verificados eventos adversos. Foram calculados gastos com o medicamento e o dispositivo inalatório. RESULTADOS: O escore clínico e a variação no volume expiratório forçado no primeiro segundo foram semelhantes entre os grupos ao final do estudo. Foi encontrada uma variação maior na freqüência cardíaca com o uso de nebulizador (35 por cento) do que nos grupos que fizeram uso do espaçador industrial (15 por cento) e do inalador em pó (17 por cento), e também entre os espaçadores artesanal e industrial, 28 e 15 por cento, respectivamente (p = 0,004). O nebulizador e o espaçador artesanal provocaram mais tremores (p = 0,02). O custo do tratamento por paciente foi maior nos grupos nebulizador e espaçador industrial, R$ 22,31 e R$ 16,58, respectivamente (p = 0,0001). CONCLUSÕES: O nebulizador foi o mais caro e consumiu mais droga para apresentar a mesma eficácia. O espaçador artesanal foi o mais barato. No entanto, apresentou mais eventos adversos do que o espaçador industrial e o inalador em pó. O espaçador industrial foi tão caro quanto o nebulizador, porém mais seguro. O inalador em pó foi mais barato e apresentou menos tremores, mas taquicardia semelhante ao espaçador artesanal.

Sentinel lymph node biopsy in cutaneous melanoma: analysis of 240 consecutive cases.

BACKGROUND: The objective of this study was to evaluate practical rules for sentinel lymph node biopsy for melanoma and discuss the indications and outcomes of 240 patients. METHODS: A prospective, nonrandomized analysis was performed on 240 patients in a referral cancer center. The median patient age was 51 years, and the median Breslow thickness was 1.60 mm. Ulceration was found in 30.4 percent of the cases. The median follow-up was 27.81 months. The sentinel lymph node biopsy was performed in 240 patients with cutaneous melanoma thicker or equal to 1 mm. The operation was performed with preoperative lymphoscintigraphy and postoperative immunohistochemistry. A statistical analysis was performed comparing the need for a gamma probe in each location, the value of the experience, the need for immunohistochemistry, positivity compared with Breslow thickness, reasons for the success of the lymph node localization, and evolution. RESULTS: A total of 263 lymph node basins were identified (160 in the axilla, 86 in the inguinal region, and 17 in less common locations, including the popliteal, epitrochlear, and cervical regions). In every lymph node basin, the success of localization was directly related to use of the probe. The success rate for finding the sentinel lymph node increased year by year. Lymph node analysis disclosed positivity of 12.5 percent with hematoxylin and eosin staining and 17.5 percent with immunohistochemistry (excluding the sentinel lymph node not found disclosed 13.2 percent with hematoxylin and eosin and 18.5 percent with HMB45). Immunohistochemistry increased positivity by 40 percent. Positivity was directly related to Breslow thickness (p < 0.001). CONCLUSIONS: This study shows the importance of the gamma probe in all lymph node basins but mainly in the axilla and unusual basins, as well as the importance of experience and immunohistochemistry. As a new procedure, it was possible to recognize the pattern of recurrence in the follow-up.

Comparação da condutividade com a determinação de sódio na mesma amostra de suor / Comparison of conductivity with sodium determination in the same sweat sample

Objetivo: Avaliar os resultados da condutividade no suor pelo Wercor e compará-los à determinação quantitativa de sódio na mesma amostra. Métodos: foram analisadas 206 amostra de suor, das quais 31 de pacientes com diagnóstico de fibrose cística (FC). as amostras de suor foram obtidas por iontoforese pela pilocarpina e coletadas no sistema Macroduct durante um período máximo de 30 minutos. Foram realizadas pelas leituras imediatas da condutividade pelo Wescor e, em seguida, a determinação de sódio, a determinação de sódio por fotometria de chama. Resultados: Nos pacientes sem FC(n=175), os valores médios de condutividade e concentração de sódio foram 41 mmol/l (16-75mmol/l) e 36Eq/1 (12-75mEq/l) respectivamente. Nos pacientes com FC (n=31), a média da condutividade foi 119mmol/l (84-155mmol/l) e do sódio, de 113mEq/l (80-146Eq/l). Nenhum paciente com FC apresentou valores inferiores a 80mmol/l, tanto para a condutividade como para o sódio. Houve correlação entre a condutividade c e a dosagem de sódio (r=+0,99;p<0,0001). Conclusão: A avaliação da condutividade pelo Wescor simplifica o método e permite analisar amostras de menor volume com boa correlação com dosagem de sódio