Prevalence of chronic rhinosinusitis without/with nasal polyps according to severity in Spain.

BACKGROUND: The worldwide prevalence range of chronic rhinosinusitis (CRS) is 5-12%; from this, 20 % have nasal polyps. Due to the little epidemiological data about CRS in the Spanish population, this study analyses the prevalence and severity of CRS with (CRSwNP) or without (CRSsNP) nasal polyps, and their connection with other coexisting type 2 inflammatory diseases in Spain. METHODOLOGY: This is a retrospective, large-scale, nationwide, epidemiological study based on the electronic medical records from the BIG-PAC® database. Patients diagnosed of CRSsNP and CRSwNP were identified using specific disease codes. The severe form of the disease was defined as patients who received at least a long course of antibiotics in CRSsNP or ≥2 short courses of systemic corticosteroids in CRSwNP in ≤12 months during the last 2 years, and/or had previous sinus surgery. Physician-diagnosed prevalence, sociodemographic and clinical characteristics, and disease severity were assessed. RESULTS: Out of a cohort of 1,012,257 patients (≥18 years old), 42,863 and 7,550 patients with diagnosed CRSsNP and CRSwNP, respectively, were analysed. The overall prevalence of diagnosed CRS was 5.1%, being 4.3% and 0.8% for CRSsNP and CRSwNP, respectively. Patients with CRSwNP and severe forms of the disease were older and had higher levels of type 2 inflammatory biomarkers than CRSsNP patients and non-severe disease. CONCLUSIONS: Although CRSsNP was more prevalent than CRSwNP, the severe forms of CRS were more frequent in patients with CRSwNP. In addition, CRSwNP patients had a higher incidence of coexisting type 2 inflammatory diseases.

Post hoc analysis of the SuperB and Zilverpass trials for treatment of long and complex superficial femoral artery lesions.

OBJECTIVE: In two randomized controlled trials, the outcomes of endovascular treatment of complex femoropopliteal arterial lesions were compared with bypass surgery and considered a valid alternative treatment. The aim of this study was to compare both endovascular treatment options with the hypothesis that implantation of heparin-bonded self-expanding covered stents (Viabahn [SECS]) or drug-eluting stents (ZilverPTX [DES]) are related to similar clinical outcomes at 1-year follow-up. METHODS: In a post-hoc analysis, the SuperB trial and Zilverpass databases were merged. Patients in the endovascular treatment arms were included, and data was analyzed in an intention-to-treat (ITT) and a per-protocol (PP) fashion. Data included baseline and lesion characteristics, procedural details, and follow-up data. The primary endpoint of this study was primary patency at 1-year follow-up. The secondary endpoints were secondary patency, target lesion revascularization (TLR), limb loss, and all-cause mortality. RESULTS: A total of 176 patients were included; 63 in the SECS arm and 113 in the DES arm. Through 1-year follow-up, there were no significant differences in primary patency (ITT: 63.4% vs 71.1%: P = .183 and PP: 60.8% vs 71.1%; P = .100). Secondary patency rates were not significantly different in the ITT analysis (86.5% vs 95.1%; P = .054), but in the PP analysis, there was a significant difference in favor of the DES group (SECS, 85.6% vs DES, 95.1%; P = .038). There was no significant difference in freedom from TLR between groups (79.6% vs 77.0%; P = .481). No major amputations were performed in the SECS group, and two were performed in the DES group (1.8%). Survival rate was 98.2% in the SECS group, and 91.3% in the DES group after 1-year follow-up (P = .106). Based on diagnosis (intermittent claudication vs chronic limb-threatening ischemia) no differences between patients with intermittent claudication and chronic limb-threatening ischemia were observed in primary patency, secondary patency and freedom from TLR. CONCLUSIONS: Treatment of complex femoropopliteal arterial disease with the heparin-bonded Viabahn endoprosthesis and the Zilver PTX drug-eluting stent are related to similar primary and secondary patency, and TLR rates at 1 year, except for secondary patency in the PP analysis. This study further supports the endovascular treatment of long complex lesions in the femoropopliteal artery.

Stakeholder Analysis as a strategic tool in framing collaborative governance arenas for marine litter monitoring.

Monitoring and assessment of marine litter requires multi-stakeholder involvement at national and subnational levels. Collaborative governance approaches are important, but often fail without adequate effort towards identifying and engaging stakeholders with appropriate profiles for the issue at stake. Stakeholder Analysis (SA) is increasingly used to ensure efficient governance arrangements. Our hypothesis is that SA contributes to collaborative governance processes for marine litter policies. We explored a pioneer participatory process in Brazil, where SA was applied to identify, categorize, and prioritize stakeholders, and analyze their power and interest, for the Strategic Plan for Monitoring and Assessing Marine Litter in the state of São Paulo. A top-down/bottom-up approach revealed that snowball sampling complemented the stakeholder assemblage identified by the consultation of experts. Prioritization of data-related stakeholders streamlined the participatory process. The interest-power matrix evaluated stakeholders' influences, guiding specific engagement strategies. We highlight the significance of SA in collaborative governance and mobilizing key stakeholders for effective marine litter monitoring initiatives, contributing to the global agenda to combat marine pollution.

Incidence of healthcare-associated Clostridioides difficile infection in a quaternary referral university hospital in Brazil.

Clostridioides difficile infection (CDI) is an important cause of diarrhea in hospitals worldwide. The incidence of CDI in Latin America has not yet been standardized. To fill this gap, the present study performed a daily active surveillance, for three months, between April to July of 2021, at a quaternary referral university hospital in Brazil. The incidence density was 9.2 cases per 10,000 patient-days. Cases were associated mostly with ribotypes 014 and 106 (44% and 22%, respectively). Ribotype 027 was not identified. The findings strongly reinforce the need for broad epidemiological studies on the incidence of CDI in Brazilian hospitals to increase the understanding, prevention, and treatment of this infection.

Nutrition risk prevalence and screening tools' validity in pediatric patients: A systematic review.

Nutrition screening (NS) allows health professionals to identify patients at nutritional risk (NR), enabling early nutrition intervention. This study aimed to systematically review the criterion validity of NS tools for hospitalized non-critical care pediatric patients and to estimate the prevalence of NR in this population. This research was performed using PubMed, Embase, and Scopus databases until June 2021. The reviewers extracted the studies' general information, the population characteristics, the NR prevalence, and the NS tools' concurrent and predictive validity data. Quality evaluation was performed using the Newcastle-Ottawa Scale, adapted Newcastle-Ottawa Scale, and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The primary studies were qualitatively analyzed, and descriptive statistics were calculated to describe the NR prevalence. Of the total 3944 studies found, 49 met the inclusion criteria. Ten different pediatric NS tools were identified; the most frequently used were Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Pediatric Yorkhill Malnutrition Score (PYMS). The mean NR prevalence was 59.85% (range, 14.6%-96.9%). Among all NS tools analyzed, STRONGkids and PYMS showed the best diagnostic performance. STRONGkids had the most studies of predictive validity showing that the NR predicted a higher hospital length of stay (odds ratio [OR], 1.96-8.02), health complications during hospitalization (OR, 3.4), and the necessity for nutrition intervention (OR, 18.93). Considering the diagnostic accuracy, robust and replicated findings of predictive validity, and studies' quality, STRONGkids performed best in identifying NR in the pediatric population among the tools identified.

Fast and efficient electrochemical thinning of ultra-large supported and free-standing MoS2 layers on gold surfaces.

Molybdenum disulfide (MoS2) is a very promising layered material for electrical, optical, and electrochemical applications because of its unique and outstanding properties. To unlock its full potential, among different preparation routes, electrochemistry has gain interest due to its simple, fast, scalable and simple instrumentation. However, obtaining large-area monolayer MoS2 that will enable the fabrication of novel electronic and electrochemical devices is still challenging. In this work, we reported a simple and fast electrochemical thinning process that results in ultra-large MoS2 down to monolayer on Au surfaces. The high affinity of MoS2 by Au surfaces enables the removal of bulk layers while preserving the first layer attached to the electrode. With a proper choice of the applied potential, more than 90% of the bulk regions can be removed from large-area MoS2 crystals, as confirmed by atomic force microscopy, photoluminescence, and Raman spectroscopy. We further address a set of contributions that are helpful to elucidate the features of MoS2, namely, the hyphenation of electrochemistry and optical microscopy for real-time observation of the thinning process that was revealed to occur from the edges to the center of the flake, an image treatment to estimate the thinning area and thinning rate, and the preparation of free-standing MoS2 layers by electrochemically thinning bulk flakes on microhole-structured Ni/Au meshes.

Biocompatible Wearable Electrodes on Leaves toward the On-Site Monitoring of Water Loss from Plants.

Impedimetric wearable sensors are a promising strategy for determining the loss of water content (LWC) from leaves because they can afford on-site and nondestructive quantification of cellular water from a single measurement. Because the water content is a key marker of leaf health, monitoring of the LWC can lend key insights into daily practice in precision agriculture, toxicity studies, and the development of agricultural inputs. Ongoing challenges with this monitoring are the on-leaf adhesion, compatibility, scalability, and reproducibility of the electrodes, especially when subjected to long-term measurements. This paper introduces a set of sensing material, technological, and data processing solutions that overwhelm such obstacles. Mass-production-suitable electrodes consisting of stand-alone Ni films obtained by well-established microfabrication methods or ecofriendly pyrolyzed paper enabled reproducible determination of the LWC from soy leaves with optimized sensibilities of 27.0 (Ni) and 17.5 kΩ %-1 (paper). The freestanding design of the Ni electrodes was further key to delivering high on-leaf adhesion and long-term compatibility. Their impedances remained unchanged under the action of wind at velocities of up to 2.00 m s-1, whereas X-ray nanoprobe fluorescence assays allowed us to confirm the Ni sensor compatibility by the monitoring of the soy leaf health in an electrode-exposed area. Both electrodes operated through direct transfer of the conductive materials on hairy soy leaves using an ordinary adhesive tape. We used a hand-held and low-power potentiostat with wireless connection to a smartphone to determine the LWC over 24 h. Impressively, a machine-learning model was able to convert the sensing responses into a simple mathematical equation that gauged the impairments on the water content at two temperatures (30 and 20 °C) with reduced root-mean-square errors (0.1% up to 0.3%). These data suggest broad applicability of the platform by enabling direct determination of the LWC from leaves even at variable temperatures. Overall, our findings may help to pave the way for translating "sense-act" technologies into practice toward the on-site and remote investigation of plant drought stress. These platforms can provide key information for aiding efficient data-driven management and guiding decision-making steps.

Metazoan parasites of white mullet Mugil curema Valenciennes, 1836 (Mugiliformes: Mugilidae) and new records of occurrence in the western Atlantic, Brazil.

Mugil curema is a pelagic fish species and it is considered the most common species of the Mugilidae family on the Brazilian coast. The objective of this study was to compile the existing information on the metazoan parasites of this host, as well as including new records from specimens captured in the Cabedelo city, state of Paraíba, Brazil. In the present study, we listed 81 taxa belonging to ten groups previously recorded for the host M. curema, and included 16 species recorded in the Cabedelo region. Eight out of 16 parasite taxa found in the Cabedelo region are first host records for M. curema: Ligophorus brasiliensis, Ligophorus sp.1, Ligophorus sp.2 (Monogenea), Fellodistomidae gen. sp., Bucephalidae gen. sp. (Digenea), Pharyngodonidae gen. sp. (Nematoda), Piscicolidae gen. sp. (Hirudinea) and Lernaeopodidae gen. sp. (Copepoda). Monogenea was the most abundant taxonomic group, followed by Copepoda. Despite the number of existing parasitological studies on this host species, new records of occurrence were made for the Cabedelo region and for the host, indicating that the knowledge about the parasites associated with this fish species is still under construction, especially because of its wide geographic distribution.

Application of chemometric tools in the development and sensory evaluation of gluten-free cracknel biscuits with the addition of chia seeds and turmeric powder.

Gluten-free biscuits were developed with the addition of chia seeds (Salvia hispanica L.) and turmeric powder. An experimental design 22 were employed in the formulation optimization that promotes better sensory acceptance through acceptance test with a hedonic scale of 9 points. For characterization purposes, the centesimal composition from chia seeds and the turmeric powder were determined. The biscuits were produced from an optimized formulation with and without chia seeds and turmeric powder with microbiological results safe for consumption by evaluation Salmonella sp., positive coagulase Staphylococcus, and Coliforms to 45 °C. The Principal Components Analysis (PCA) was used in the investigation of sensory results (color, flavor, texture, smell, appearance, overall impression). It was also considered the habits of consuming food with/without gluten, purchase intentions, including age and gender. The results show that there is no distinction between the biscuits with the addition of chia seeds and turmeric powder. A statistical test using the confidence ellipse confirms that there no significant difference, at a 95% confidence level, among the sensory results for the biscuits with and without chia seeds and turmeric powder.

Milk lymphocyte profile and macrophage functions: new insights into the immunity of the mammary gland in quarters infected with Corynebacterium bovis.

BACKGROUNDS: The present study explored the viability of bovine milk macrophages, their intracellular production of reactive oxygen and nitrogen species (RONS), and their phagocytosis of Staphylococcus aureus, as well as the profile of lymphocytes, from healthy udder quarters and udder quarters infected by Corynebacterium bovis. The study included 28 healthy udder quarters from 12 dairy cows and 20 udder quarters infected by C. bovis from 10 dairy cows. The percentages of macrophages and lymphocytes were identified by flow cytometry using monoclonal antibodies. Macrophage viability, RONS production, and S. aureus phagocytosis were evaluated by flow cytometry. RESULTS: Milk samples from quarters infected with C. bovis showed a lower percentage of macrophages but an increased number of milk macrophages per mL and a higher percentage of macrophages that produced intracellular RONS and phagocytosed S. aureus. No effect of C. bovis infection on macrophage viability was found. Udder quarters infected by C. bovis showed a higher percentage of T cells and CD4+ T lymphocytes, but no effect was found on the percentage of CD8+ CD4- T, CD8- CD4- T, or B lymphocytes. CONCLUSIONS: Thus, our results corroborate, at least in part, the finding that intramammary infections by C. bovis may offer protection against intramammary infections by major pathogens.

Bifunctional Metal Meshes Acting as a Semipermeable Membrane and Electrode for Sensitive Electrochemical Determination of Volatile Compounds.

The monitoring of toxic inorganic gases and volatile organic compounds has brought the development of field-deployable, sensitive, and scalable sensors into focus. Here, we attempted to meet these requirements by using concurrently microhole-structured meshes as (i) a membrane for the gas diffusion extraction of an analyte from a donor sample and (ii) an electrode for the sensitive electrochemical determination of this target with the receptor electrolyte at rest. We used two types of meshes with complementary benefits, i.e., Ni mesh fabricated by robust, scalable, and well-established methods for manufacturing specific designs and stainless steel wire mesh (SSWM), which is commercially available at a low cost. The diffusion of gas (from a donor) was conducted in headspace mode, thus minimizing issues related to mesh fouling. When compared with the conventional polytetrafluoroethylene (PTFE) membrane, both the meshes (40 µm hole diameter) led to a higher amount of vapor collected into the electrolyte for subsequent detection. This inedited fashion produced a kind of reverse diffusion of the analyte dissolved into the electrolyte (receptor), i.e., from the electrode to bulk, which further enabled highly sensitive analyses. Using Ni mesh coated with Ni(OH)2 nanoparticles, the limit of detection reached for ethanol was 24-fold lower than the data attained by a platform with a PTFE membrane and placement of the electrode into electrolyte bulk. This system was applied in the determination of ethanol in complex samples related to the production of ethanol biofuel. It is noteworthy that a simple equation fitted by machine learning was able to provide accurate assays (accuracies from 97 to 102%) by overcoming matrix effect-related interferences on detection performance. Furthermore, preliminary measurements demonstrated the successful coating of the meshes with gold films as an alternative raw electrode material and the monitoring of HCl utilizing Au-coated SSWMs. These strategies extend the applicability of the platform that may help to develop valuable volatile sensing solutions.

Development and evaluation of naproxen-loaded sericin/alginate beads for delayed and extended drug release using different covalent crosslinking agents.

Different polymer matrix compositions based on sericin and alginate blend (using or not the covalent crosslinking agents dibasic sodium phosphate, polyvinyl alcohol and polyethylene glycol) were evaluated to entrap naproxen. Sericin has been shown to be essential for improving incorporation efficiency. Comparing the formulations with and without crosslinking agent, the best results were obtained for that composed only of sericin and alginate, with satisfactory values of entrapment efficiency (>80%) and drug loading capacity (>20%). In this case, delayed release (<10% in acid medium) and prolonged release (~360 min) were achieved, with a complex release mechanism involving swelling and polymer chain relaxation. The incorporation of the drug could be confirmed by the techniques of characterization of X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR), as well as drug compatibility with the polymer matrix. In addition, particles of suitable size for multiparticulate systems were obtained and with higher thermal stability when compared to the pure drug.

The Use of Bone Marrow-Derived Stem Cells in the Treatment of a Comminuted Tibiotarsal Fracture in a Juvenile Red-legged Seriema (Cariama cristata).

An adult red-legged seriema (Cariama cristata) presented with a comminuted fracture of the tibiotarsus and fibula. Surgery was performed, and a type II external fixator, with 2 distal and 2 proximal pins, was used to stabilize the fracture. After a 10-day stabilization period, the bird developed a second fracture on the same bone, proximal to the first fracture site. Another surgery was performed on the seriema similar to the first one. However, in this second surgical procedure a single pin, instead of 2 perpendicular pins, was placed proximally to the fracture site. After the second surgical procedure, bone marrow stem cells (BMSCs) from the seriema's left ulna were collected. Twenty-seven days after the second surgery, the BMSCs were transplanted, into the fracture sites. Twenty-four days after the stem cells were injected into the fractures (51 days after the second surgical procedure), radiographic images revealed healing bone calluses at the fracture sites. The fracture healing was relatively long for this case (a total of 75 days). The addition of bone marrow stem cell therapy to the use of external fixation may have contributed to the healing observed radiographically 24 days after administration; therefore, bone marrow stem cell therapy, in addition to traditional surgical fracture reduction and stabilization, may be a promising therapeutic approach for avian cases with similar injuries and bone anatomy. However, as this is a single case, this therapeutic modality deserves further application and study. Moreover, we suggest modifications in the bone marrow stem cell collection and therapy, which may be useful for future studies and application involving birds.

Occurrence of tayras (Eira barbara Linnaeus, 1758) with anomalous coloration in Cerrado remnants in the state of São Paulo, Brazil / Ocorrência de iraras (Eira barbara Linnaeus, 1758) com coloração anômala em remanescentes de Cerrado no estado de São Paulo, Brasil

Abstract: Coloration anomalies are mainly genetically-based disorders in which body pigmentation is either reduced (hypopigmentation) or produced in excess (melanism), in parts or the totality of the body. Cases of hypopigmentation have been documented in many neotropical mammals, including the tayra (Eira barbara Linnaeus, 1758). We expand the account of anomalous coloration occurrence presenting new registers of hypopigmented tayras in Brazil. Data was collected during a mammal survey carried out in three agricultural landscapes within the Cerrado domain in the northeast of the state of São Paulo. We obtained two kinds of records of hypopigmented tayras, one from direct sighting and the other from a camera-trap. We discuss the likely implications of this conspicuous coloration to tayras and highlight some possibilities of study.

Resumo: Colorações anômalas são desordens geralmente de origem genética, em que a pigmentação do corpo é reduzida (hipopigmentação) ou excessiva (melanismo), em partes ou totalmente. Casos de hipopigmentação já foram documentados em muitos mamíferos neotropicais, incluindo a irara (Eira barbara Linnaeus, 1758). Nós expandimos os relatos de ocorrência de colorações anômalas apresentando novos registros de iraras hipopigmentadas no Brasil. Dados foram coletados durante um levantamento de mamíferos em três paisagens agrícolas no domínio do Cerrado no nordeste do estado de São Paulo. Obtivemos dois tipos de registros de iraras hipopigmentadas, sendo um por avistamento e outro por armadilhas fotográficas. Nós discutimos possíveis implicações ecológicas dessa coloração em iraras e sugerimos novas possibilidades de estudos.

Diversity and genetic stability in banana genotypes in a breeding program using inter simple sequence repeats (ISSR) markers.

Banana (Musa spp) is a fruit species frequently cultivated and consumed worldwide. Molecular markers are important for estimating genetic diversity in germplasm and between genotypes in breeding programs. The objective of this study was to analyze the genetic diversity of 21 banana genotypes (FHIA 23, PA42-44, Maçã, Pacovan Ken, Bucaneiro, YB42-47, Grand Naine, Tropical, FHIA 18, PA94-01, YB42-17, Enxerto, Japira, Pacovã, Prata-Anã, Maravilha, PV79-34, Caipira, Princesa, Garantida, and Thap Maeo), by using inter-simple sequence repeat (ISSR) markers. Material was generated from the banana breeding program of Embrapa Cassava & Fruits and evaluated at Embrapa Coastal Tablelands. The 12 primers used in this study generated 97.5% polymorphism. Four clusters were identified among the different genotypes studied, and the sum of the first two principal components was 48.91%. From the Unweighted Pair Group Method using Arithmetic averages (UPGMA) dendrogram, it was possible to identify two main clusters and subclusters. Two genotypes (Garantida and Thap Maeo) remained isolated from the others, both in the UPGMA clustering and in the principal cordinate analysis (PCoA). Using ISSR markers, we could analyze the genetic diversity of the studied material and state that these markers were efficient at detecting sufficient polymorphism to estimate the genetic variability in banana genotypes.

Genetic diversity in natural populations of mangaba in Sergipe, the largest producer State in Brazil.

Mangaba (Hancornia speciosa Gomes) is found in areas of coastal tablelands in the Brazilian Northeast and Cerrado regions. This species has been subjected to habitat fragmentation that is mainly due to human activity, and requires conservation strategies. The aim of this study was to analyze the structure and inter- and intrapopulation genetic diversity of natural populations of H. speciosa Gomes using inter-simple sequence repeat (ISSR) molecular markers. A total of 155 individuals were sampled in 10 natural populations (ITA, PAC, IND, EST, BC, PIR, JAP, BG, NEO, and SANT) in the State of Sergipe, Brazil. Fifteen primers were used to generate 162 fragments with 100% polymorphism. Genetic analysis showed that the variability between populations (77%) was higher than within populations (23%). It was possible to identify five different groups by the unweighted pair group method with arithmetic mean and principal coordinate analysis, and only one individual (E10) remained isolated. Using ISSR markers it was possible to obtain a molecular profile of the populations evaluated, showing that these markers were effective and exhibited sufficient polymorphism to estimate the genetic variability of natural populations of H. speciosa Gomes.

Persistent infectious and tropical diseases in immigrant correctional populations.

A number of infectious diseases amongst travelers and the immigrant populations are a major public health concern. Some have a long incubation period or remain asymptomatic or paucisymptomatic for many years before leading to significant clinical manifestations and/or complications. HIV, hepatitis B and C, tuberculosis or latent syphilis are among the most significant persistent diseases in migrants. Schistosomiasis and strongyloidiasis, for instance, are persistent helminthic infections that may cause significant morbidity, particularly in patients co-infected with HIV, hepatitis B and C. Chagas disease, which was initially confined to Latin America, must also now be considered in immigrants from endemic countries. Visceral leishmaniasis and malaria are other examples of parasitic diseases that must be taken into account by physicians treating incarcerated migrants. The focus of this review article is on the risk of neglected tropical diseases in particularly vulnerable correctional populations and on the risk of infectious diseases that commonly affect migrants but which are often underestimated.

Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: Data from the PROVAR study.

BACKGROUND: Accurate estimates of Rheumatic Heart Disease (RHD) burden are needed to justify improved integration of RHD prevention and screening into the public health systems, but data from Latin America are still sparse. OBJECTIVE: To determine the prevalence of RHD among socioeconomically disadvantaged youth (5-18years) in Brazil and examine risk factors for the disease. METHODS: The PROVAR program utilizes non-expert screeners, telemedicine, and handheld and standard portable echocardiography to conduct echocardiographic screening in socioeconomically disadvantaged schools in Minas Gerais, Brazil. Cardiologists in the US and Brazil provide expert interpretation according to the 2012 World Heart Federation Guidelines. Here we report prevalence data from the first 14months of screening, and examine risk factors for RHD. RESULTS: 5996 students were screened across 21 schools. Median age was 11.9 [9.0/15.0] years, 59% females. RHD prevalence was 42/1000 (n=251): 37/1000 borderline (n=221) and 5/1000 definite (n=30). Pathologic mitral regurgitation was observed in 203 (80.9%), pathologic aortic regurgitation in 38 (15.1%), and mixed mitral/aortic valve disease in 10 (4.0%) children. Older children had higher prevalence (50/1000 vs. 28/1000, p<0.001), but no difference was observed between northern (lower resourced) and central areas (34/1000 vs. 44/1000, p=0.31). Females had higher prevalence (48/1000 vs. 35/1000, p=0.016). Age (OR=1.15, 95% CI:1.10-1.21, p<0.001) was the only variable independently associated with RHD findings. CONCLUSIONS: RHD continues to be an important and under recognized condition among socioeconomically disadvantaged Brazilian schoolchildren. Our data adds to the compelling case for renewed investment in RHD prevention and early detection in Latin America.

Patients with psychoactive substance use disorders treated in a psychiatric emergency unit / Pacientes com transtornos relacionados ao uso de substâncias psicoativas atendidos em uma unidade de emergência psiquiátrica

To describe the socio demographic and clinical profile of patients with mental and behavioral disorders due to psychoactive substance (PAS) use, evaluated by the Psychiatric team of the Referenced Emergency Unit (REU) at the State University Clinical Hospital of Campinas (UNICAMP-HC). Methods and casuistic: This is a descriptive and quantitative study, which analyzed patients with mental and behavioral disorders due to PAS use, evaluated by the Psychiatricteam of the REU-HC-UNICAMP during a period of 12 months, starting on May 2010. Results: There were evaluated 350 patients with PAS related disorders, representing 23.8% of those who sought psychiatric care. Most were males and younger than other patients of the emergency unit. The main reason for seeking help was psychiatric complaint other than PAS related disorders (23.1%), followed by desire to be treated oneself/being admitted to inpatient psychiatric treatment (20.8%) and intoxication (12.5%); 38.5% had a diagnosis of multiple PAS dependence and 34.8% were diagnosed with isolated alcohol dependence; 36% had psychiatric comorbidities and, when compared to other patients, they received more medications during attendance and were less directed to primary care units. Conclusion: There is a high rate of consultations of patients with PAS related problems in the psychiatric emergency unit. Data on the profile of the evaluated these patients can contribute to the improvement of care to this population...

Descrever o perfil sócio demográfico e clínico de pacientes com transtornos relacionados ao uso de substâncias psicoativas (SPA) atendidos pela Psiquiatria da Unidade de Emergência Referenciada (UER) do Hospital de Clínicas (HC) da UNICAMP. Métodos e casuística: Estudo descritivo e quantitativo, que avaliou os pacientes com transtornos relacionados ao uso de SPA atendidos pela Psiquiatria da UER do HC-UNICAMP no período de 12 meses a partir de maio de 2010. Resultados: Foram avaliados 350 pacientes com transtornos por uso de SPA, representando 23.8% do total dos que procuraram atendimento psiquiátrico. Maioria do sexo masculino e mais jovens do que os demais pacientes. O principal motivo de atendimento foi queixa psiquiátrica outra que não o uso de SPA (23,1%), seguido do desejo de se tratar/internar (20,8%) e intoxicação (12,5%).38,5% tinham diagnóstico de dependência de múltiplas SPA e 34,8% dependência exclusiva de álcool;36% apresentavam comorbidade psiquiátrica. Quando comparados com os demais pacientes avaliados pela Psiquiatria, receberam mais medicações no atendimento e foram menos encaminhados à atenção primária. Conclusão: Há elevada taxa de atendimento de pessoas com problemas relacionados ao uso de SPA na emergência psiquiátrica. Dados sobre o perfil dos atendidos podem contribuir para a melhoria da assistência a esta população...

Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions.

Rheumatic heart disease (RHD) affects at least 32.9 million people worldwide and ranks as a leading cause of death and disability in low-income and middle-income countries (LMICs). Echocardiographic screening has been demonstrated to be a powerful tool for early RHD detection, and holds potential for global RHD control. However, national screening programmes have not emerged. Major barriers to implementation include the lack of human and financial resources in LMICs. Here, we focus on recent research advances that could make echocardiographic screening more practical and affordable, including handheld echocardiography devices, simplified screening protocols and task shifting of echocardiographic screening to non-experts. Additionally, we highlight some important remaining questions before echocardiographic screening can be widely recommended, including demonstration of cost-effectiveness, assessment of the impact of screening on children and communities, and determining the importance of latent RHD. While a single strategy for echocardiographic screening in all high-prevalence areas is unlikely, we believe recent advancements are bringing the public health community closer to developing sustainable programmes for echocardiographic screening.