ASP-2/Trans-sialidase chimeric protein induces robust protective immunity in experimental models of Chagas' disease.

Immunization with the Amastigote Surface Protein-2 (ASP-2) and Trans-sialidase (TS) antigens either in the form of recombinant protein, encoded in plasmids or human adenovirus 5 (hAd5) confers robust protection against various lineages of Trypanosoma cruzi. Herein we generated a chimeric protein containing the most immunogenic regions for T and B cells from TS and ASP-2 (TRASP) and evaluated its immunogenicity in comparison with our standard protocol of heterologous prime-boost using plasmids and hAd5. Mice immunized with TRASP protein associated to Poly-ICLC (Hiltonol) were highly resistant to challenge with T. cruzi, showing a large decrease in tissue parasitism, parasitemia and no lethality. This protection lasted for at least 3 months after the last boost of immunization, being equivalent to the protection induced by DNA/hAd5 protocol. TRASP induced high levels of T. cruzi-specific antibodies and IFNγ-producing T cells and protection was primarily mediated by CD8+ T cells and IFN-γ. We also evaluated the toxicity, immunogenicity, and efficacy of TRASP and DNA/hAd5 formulations in dogs. Mild collateral effects were detected at the site of vaccine inoculation. While the chimeric protein associated with Poly-ICLC induced high levels of antibodies and CD4+ T cell responses, the DNA/hAd5 induced no antibodies, but a strong CD8+ T cell response. Immunization with either vaccine protected dogs against challenge with T. cruzi. Despite the similar efficacy, we conclude that moving ahead with TRASP together with Hiltonol is advantageous over the DNA/hAd5 vaccine due to pre-existing immunity to the adenovirus vector, as well as the cost-benefit for development and large-scale production.

Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction.

INTRODUCTION: Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test. MATERIAL AND METHODS: In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient's death. The economic analysis was performed from the hospital costs' perspective. RESULTS: Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 - 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 - 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 - 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 - 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 - 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145. CONCLUSION: Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.

Lingual tonsil hypertrophy: about a case of unpredictable difficult airway / Hipertrofia de la amígdala lingual: a propósito de un caso de vía aérea difícil imprevisible

Abstract: Eleven years old children, proposed for resection of pylocitic astrocytoma of cerebellum, presented with lingual tonsil hypertrophy causing a unpredictable difficult airway approach. The presence of a lingual tonsil hypertrophied isn't diagnosed most of the times, with their occurrence being associated with previous tonsillectomy in more than half of the cases. Its occurrence, and non-identification, can originate scenarios of difficult airway approach, with a higher morbility association.

Resumen: Niño con 11 años, propuesto para exéresis de recidiva de astrocitoma pilocítico del cerebelo con hipertrofia de las amígdalas linguales a condicionar vía aérea difícil no previsible. La hipertrofia de las amígdalas linguales es subdiagnosticada y se suele asociar a amigdalectomía previa en más de la mitad de los casos. Su ocurrencia y no reconocimiento, puede originar situaciones de vía aérea difícil, con alta morbilidad asociada.

Validation of SmartVA using conventional autopsy: A study of adult deaths in Brazil.

Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods: This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings: The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for "Other NCDs" (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation: The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.

Prevalência de sobrepeso e de obesidade no primeiro ano de vida nas Estratégias Saúde da Família / Prevalence of overweight and obesity in the first year of life in the Family Health Strategies

Resumo Introdução O sobrepeso e a obesidade infantil representam alguns dos principais problemas de saúde pública no mundo, porém se observa escassez de registros de prevalência no Brasil no primeiro ano de vida. Objetivo Verificar a prevalência de sobrepeso e de obesidade no primeiro ano de vida das crianças cadastradas nas Estratégias Saúde da Família e identificar se existe diferença entre os índices peso por idade, estatura por idade, peso/estatura por idade e índice de massa corporal (IMC) por idade em relação ao sexo, à faixa etária e ao nível socioeconômico. Método Estudo transversal, com dados de peso e estatura coletados da Caderneta de Saúde da Criança. Resultados A prevalência de sobrepeso e de obesidade foi de 7,2% pelo índice peso/estatura e de 4,8% pelo IMC. Crianças com nível socioeconômico A-B apresentaram maior IMC por idade quando comparadas às crianças do nível C (p = 0,048). Crianças entre 6 e 12 meses de idade apresentaram valores superiores de peso por idade (p = 0,02) e estatura por idade (p = 0,01) quando comparadas às crianças menores de 6 meses. Conclusão A prevalência de sobrepeso e de obesidade das crianças no primeiro ano de vida depende do índice utilizado para classificação. O nível socioeconômico pode interferir nos valores do IMC por idade, enquanto a faixa etária pode interferir nos índices peso por idade e estatura por idade.

Abstract Background Childhood overweight and obesity represent one of the main public health problems in the world, but there is a scarcity of prevalence records in Brazil during the first year of life. Objective Verify the prevalence of overweight and obesity in the first year of life of infants enrolled in the Family Health Strategies, and to identify whether there is a difference in weight-per-age, height-per-age, weight/height-per-age and body mass index (BMI)-per-age in relation to sex, age group and socioeconomic level. Method A cross-sectional study was performed, in which weight and height data were collected from the Child Health Handbook. Results The prevalence of overweight and obesity was 7.2% according to the weight/height index, and 4.8% for the BMI index. Infants with an A-B socioeconomic status had higher BMI-per-age when compared to children at level C (p=0.048). Infants aged 6 to 12 months had higher weight-per-age (p=0.02) and height-per-age (p=0.01) than infants younger than six months. Conclusion The prevalence of overweight and obesity in the first year of life depends on the index used for classification. The socioeconomic status may interfere with BMI-per-age values, and the age group may interfere with weight-per-age and height-per-age indexes.

A strategy action from the Cievs/Pernambuco in response to the emergency on Congenital Syndrome associated to Zika virus infection: an integrative action / Estratégia de atuação do Cievs/Pernambuco na resposta à emergência da Síndrome Congênita associada à infecção pelo vírus Zika: uma ação integrativa

Abstract Objectives: to describe the strategy action from the Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) (Strategic Information on Health Surveillance Center) in response to the emergency on Congenital Syndrome associated to Zika virus infection (CSZ) in Pernambuco State between 2015 and 2016. Methods: description performed on the strategies and activities developed by Cievs/PE during the important international public health emergency related to CSZ. Results: participated in detecting suspected CSZ cases; participated in elaborating clinical epidemiological protocols; developed electronic forms to notify CSZ cases and pregnant women with exanthema rashes; prepared epidemiological reports; developed a website about the emergency on the Cievs/PE website; insert the occurrence in the Comitê de Avaliação e Monitoramento de Eventos (CAME) (Committee to Assess and Monitor Occurrence); resolution of demands during readiness; technical visits from National and International institutions. The actions developed by the Cievs/PE were fundamental in detecting and following-up on 2,073 CSZ cases. 390 cases were confirmed (18.1%) and 1,413 were discarded (65.6%), and 4,467 pregnant women had exanthema rash. Conclusions: the action from the Cievs/PE allowed to employ timely strategies on preparation and response in a qualified and cooperative way to face public health emergency on CSZ's

Resumo Objetivos: descrever a estratégia de atuação do Centro de Informações Estratégicas de Vigilância em Saúde (Cievs/PE) na resposta à emergência da Síndrome Congênita associada à infecção pelo vírus Zika (SCZ) no estado de Pernambuco, entre 2015 e 2016. Métodos: realizada descrição das estratégias e atividades desenvolvidas pelo Cievs/PE durante a emergência em saúde pública de importância internacional relacionada a SCZ. Resultados: participação na detecção dos casos suspeitos da SCZ; participação na elaboração dos protocolos clínico epidemiológicos; construção de formulários eletrônicos para notificação dos casos da SCZ e gestante com exantema; elaboração de informes epidemiológicos; construção de página eletrônica sobre a emergência no site do Cievs/PE; inserção do evento no Comitê de Avaliação e Monitoramento de Eventos (CAME); resolução de demandas durante a prontidão; visita técnica de instituições nacionais e internacionais. As ações desenvolvidas pelo Cievs/PE foram fundamentais para a detecção e acompanhamento de 2.073 casos da SCZ, com a confirmação 390 (18,1%) e descarte de 1.413 (65,6%) casos, e 4.467 gestantes com exantema. Conclusões: a atuação do Cievs/PE permitiu o emprego de estratégias de preparação e resposta em tempo oportuno, de forma qualificada e cooperativa no enfrentamento a emergência em saúde pública da SCZ.

Dissociation between dopaminergic response and motor behavior following intrastriatal, but not intravenous, transplant of bone marrow mononuclear stem cells in a mouse model of Parkinson's disease.

Parkinson's disease is characterized by the progressive loss of dopaminergic neurons from the substantia nigra, a process that leads to a dopamine deficiency in the striatum. This deficiency is responsible for the development of motor symptoms, including resting tremor, bradykinesia, rigidity and postural instability. Based on the observation of substantial neuronal death, alternatives to Parkinson's disease treatment have been studied, including cell-based therapies. The present study aimed to assess the therapeutic potential of intravenous and intrastriatal transplant of bone marrow mononuclear cells in a mouse model of Parkinson's disease. Animals underwent stereotaxic surgery and received an injection of 6-hydroxydopamine into their medial forebrain bundle. Three weeks later, mice were injected with bone marrow mononuclear cells or saline through the caudal vein or directly into their right striatum. Motor function was assessed using the rotarod and apomorphine-induced rotation tests. Our results showed that intrastriatal bone marrow mononuclear cells, but not intravenous, have a short-term therapeutic effect on dopaminergic response in this mice model of parkinsonism assessed by the apomorphine-induced rotation test. This phenomenon was not identified on the rotarod test, showing dissociation between dopaminergic response and motor behavior. Further experiments are needed to elucidate the precise mechanisms involved in these effects.

[Assessment of Service to verify the cause of death implementation in Pernambuco State, Brazil, 2012: multiple case study]. / Avaliação da implantação dos Serviços de Verificação de Óbito em Pernambuco, 2012: estudo de casos múltiplos.

OBJECTIVE: to evaluate the implementation of Death Verification Services in Pernambuco State, Brazil, in 2012. METHODS: this was an implementation analysis evaluation study; we constructed a logical framework and judgement matrix were prepared; primary data (direct observation and interviews) and secondary data were used; assessment of the level of Death Verification Services implementation was based on outcome-related structure and process indicators which were compared with the logical framework. RESULTS: the Recife and Caruaru Death Verification Services were considered to have achieved Advanced Partial Implementation, consistent with the outcome indicators measured, reaching 89.0% and 82.0% of the expected values, respectively; the Information Collection and Nosological/Aetiological Diagnosis components were considered to Fully Implemented at the Recife and Caruaru Death Verification Services; whilst the Education and Research component was only considered to be Fully Implemented at the Recife Death Verification Services. CONCLUSION: level of implementation was similar at both services; the higher level of the Education and Research component at the Recife Death Verification Services reveals the importance of technical and academic cooperation.

Avaliação da implantação dos Serviços de Verificação de Óbito em Pernambuco, 2012: estudo de casos múltiplos / Assessment of Service to verify the cause of death implementation in Pernambuco State, Brazil, 2012: multiple case study / Evaluación de la implantación de Servicios de Verificación de Muerte en Pernambuco, 2012: estudio de múltiples casos

OBJETIVO: avaliar a implantação dos Serviços de Verificação de Óbito (SVO) no estado de Pernambuco, Brasil, em 2012. MÉTODOS: pesquisa avaliativa de análise de implantação; elaborou-se modelo lógico e matriz de julgamento; utilizaram-se dados primários (observação direta e entrevistas) e secundários; a avaliação do grau de implantação foi baseada em indicadores de estrutura e processo, relacionados aos resultados e confrontados com o modelo lógico. RESULTADOS: os SVO de Recife e Caruaru alcançaram 89,0% e 82,0% dos valores esperados, respectivamente, e foram considerados como 'Parcialmente Implantado Avançado', de forma coerente com os indicadores de resultado aferidos; os componentes Coleta de Informação e Diagnóstico Nosológico/Etiológico obtiveram grau 'Implantado' nos SVO/Recife e SVO/Caruaru; o componente Ensino e Pesquisa obteve o grau 'Implantado' somente no SVO/Recife. CONCLUSÃO: houve semelhança no grau de implantação nos dois serviços; o maior grau de implantação do componente Ensino e Pesquisa no SVO/Recife revela a importância da cooperação técnico-acadêmica.

OBJECTIVE: to evaluate the implementation of Death Verification Services in Pernambuco State, Brazil, in 2012. METHODS: this was an implementation analysis evaluation study; we constructed a logical framework and judgement matrix were prepared; primary data (direct observation and interviews) and secondary data were used; assessment of the level of Death Verification Services implementation was based on outcome-related structure and process indicators which were compared with the logical framework. RESULTS: the Recife and Caruaru Death Verification Services were considered to have achieved Advanced Partial Implementation, consistent with the outcome indicators measured, reaching 89.0% and 82.0% of the expected values, respectively; the Information Collection and Nosological/Aetiological Diagnosis components were considered to Fully Implemented at the Recife and Caruaru Death Verification Services; whilst the Education and Research component was only considered to be Fully Implemented at the Recife Death Verification Services. CONCLUSION: level of implementation was similar at both services; the higher level of the Education and Research component at the Recife Death Verification Services reveals the importance of technical and academic cooperation.

OBJETIVO: evaluar la implantación de Servicios de Verificación de Muerte (SVM) en Pernambuco, Brasil, 2012. MÉTODOS: investigación evaluativa sobre análisis de implantación. Fue desarrollado el modelo lógico y matriz de juicio; se obtuvieron datos primarios (observación directa y entrevista) y secundarios; la evaluación del grado de implantación fue basado en los indicadores de estructura y proceso, relacionados con los resultados, comparándolos con el modelo lógico. RESULTADOS: los SVM Recife y Caruaru alcanzaron el 89,0% y 82,0% de los valores previstos, respectivamente, y se consideraron parcialmente implantados avanzados, coherentemente con los indicadores de resultados medidos; los componentes Recolección de Información, Diagnóstico Nosológico/Etiológico y Enseñanza e Investigación llegaron al grado implantado en SVM/Recife y en SVM/Caruaru solo losd os primeros, el componente Enseñanza e Investigación resultó no implantado. CONCLUSIÓN: hay una similitud en el grado de implantación de los dos servicios; el mayor grado de implantación del componente Enseñanza e Investigación en SVO/Recife revela la importancia de la cooperación técnica y académica.

[Competences acquired during medical training and the opinions and attitudes about abortion]. / Competências adquiridas durante a formação médica e as opiniões e atitudes sobre o aborto.

PURPOSE: To analyze and compare the knowledge, attitudes and opinions of medical students about abortion in Brazil during the progression of the course. METHODS: This was a cross-sectional study involving 174 medical students. A questionnaire was applied whose dependent variables were degree of information about abortion, including its legal aspects in Brazil, situations in which the students would agree with the expansion of permitted legal abortion, knowledge of someone undergoing abortion, and discomfort about performing the procedure legally. The independent variables were sociodemographic data, religion, and academic standing (first or second half of the course). For data analysis it was used χ2 and Fisher's exact tests, with the level of significance set at 5%. RESULTS: Among the interviewees, 59.8 % considered themselves well informed about the topic. Students demonstrated knowledge about the complications of abortion, with no differences with the progression of the course. Knowledge about the legal aspects of abortion in Brazil was shown by 48.9% of the sample, being significantly higher among students in the second half of the course (34.0 and 68.9%, respectively; p<0.001). Experiencing situations of clandestine abortion was significantly higher among students in the final half of the course (3.05 and 59.4%, respectively; p<0.001), the same being observed about knowing someone who underwent the procedure illegally (5.0 and 18.9%, respectively; p<0.001). The expansion of permissive legal abortion in Brazil was agreed about by 86.2% students, although 54.6% of the students reported that they felt uncomfortable about performing the procedure even legally, without statistical significance with the evolution of the course regarding the two situations. CONCLUSIONS: The experiences of abortion and the knowledge of legal aspects were significantly higher among students in the second half of the course, with no significant changes in attitudes or opinions about abortion being observed with the competences acquired during medical training.

Competencias adquiridas durante a formacao medica e as opinioes e atitudes sobre o aborto / Competences acquired during medical training and the opinions and attitudes about abortion

OBJETIVO: Avaliar e comparar o conhecimento, as atitudes e opiniões dos estudantes de Medicina quanto ao aborto no Brasil durante o evoluir do curso. MÉTODOS: Estudo transversal envolvendo 174 estudantes de Medicina. Foi aplicado um questionário cujas variáveis dependentes foram: o grau de informação sobre o aborto, incluindo seus aspectos jurídicos no Brasil, as situações em que concordaria com a ampliação do permissivo legal do aborto, o conhecimento de alguém submetido ao abortamento e o desconforto em realizar o procedimento de forma legal. As variáveis independentes estudadas foram: dados sociodemográficos, religião e situação acadêmica (primeira ou segunda metade do curso). Para análise dos dados foram utilizados os testes do χ2 e exato de Fischer, com nível de significância de 5%. RESULTADOS: Entre os entrevistados, 59,8% foram considerados bem informados acerca do tema. Os estudantes demonstraram conhecimento a respeito das complicações decorrentes do abortamento, sem diferenças com o evoluir do curso. O conhecimento dos aspectos legais do abortamento no Brasil foi demonstrado por 48,9% da amostra, sendo significativamente superior entre os alunos da segunda metade do curso (34,0 e 68,9% respectivamente; p<0,001). A vivência de situações do abortamento clandestino foi significativamente maior entre os alunos da metade final do curso (35,0 e 59,4% respectivamente p<0,001), o mesmo ocorrendo quanto ao conhecimento de alguém que tenha sido submetida ao procedimento de forma ilegal (5,0 e 18,9% respectivamente; p<0,001). A ampliação do permissivo legal do abortamento no Brasil foi concordado por 86,2% da amostra, porém 54,6% dos estudantes relataram que se sentem desconfortáveis em realizar o procedimento mesmo de forma legal, ambos sem significância ...

PURPOSE: To analyze and compare the knowledge, attitudes and opinions of medical students about abortion in Brazil during the progression of the course. METHODS: This was a cross-sectional study involving 174 medical students. A questionnaire was applied whose dependent variables were degree of information about abortion, including its legal aspects in Brazil, situations in which the students would agree with the expansion of permitted legal abortion, knowledge of someone undergoing abortion, and discomfort about performing the procedure legally. The independent variables were sociodemographic data, religion, and academic standing (first or second half of the course). For data analysis it was used χ2 and Fisher's exact tests, with the level of significance set at 5%. RESULTS: Among the interviewees, 59.8 % considered themselves well informed about the topic. Students demonstrated knowledge about the complications of abortion, with no differences with the progression of the course. Knowledge about the legal aspects of abortion in Brazil was shown by 48.9% of the sample, being significantly higher among students in the second half of the course (34.0 and 68.9%, respectively; p<0.001). Experiencing situations of clandestine abortion was significantly higher among students in the final half of the course (3.05 and 59.4%, respectively; p<0.001), the same being observed about knowing someone who underwent the procedure illegally (5.0 and 18.9%, respectively; p<0.001). The expansion of permissive legal abortion in Brazil was agreed about by 86.2% students, although 54.6% of the students reported that they felt uncomfortable about performing the procedure even legally, without statistical significance with the evolution of the course regarding the two situations. CONCLUSIONS: The experiences of abortion and the knowledge of legal aspects were significantly higher among students in the second half of the course, with ...

Ações de prevenção, diagnóstico e tratamento do transtorno depressivo maior em idosos, da Unidade Maria Madalena Ramos, município de Cachoeira-BA

O Transtorno Depressivo Maior (TDM) responde por uma síndrome clínica comum e de causa multifatorial. Pode apresentar, além de alterações do humor, alterações cognitivas, psicomotoras e vegetativas, sempre causando algum grau de prejuízo ao indivíduo. Além disso, estudos recentes apontam para um crescimento acentuado da população idosa brasileira e revelam um subdiagnóstico do TDM na atenção básica. Assim, objetiva-se capacitar os profissionais de saúde da atenção básica, promover ações de prevenção da doença, através de palestras e formações de grupos de apoio, além de atuar no diagnóstico precoce, acompanhar e disponibilizar tratamento aos idosos diagnosticados em parceria com a família dos pacientes e apoio multidisciplinar. Trata-se de uma abordagem do TDM e da necessidade de implementação de ações de prevenção, diagnóstico precoce, tratamento e acompanhamento de idosos portadores da desordem na Unidade Básica de Saúde Maria Madalena Ramos, em Cachoeira - BA.