Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD).

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5-9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3-4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.

Comparison of antibody response to SARS-CoV-2 after two doses of inactivated virus and BNT162b2 mRNA vaccines in kidney transplant.

BACKGROUND: Antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after mRNA or adenoviral vector-based vaccines is weak in kidney transplant (KT) patients. However, few studies have focused on humoral response after inactivated virus-based vaccines in KT. Here, we compare antibody response following vaccination with inactivated virus (CoronaVac®) and BNT162b2 mRNA. METHODS: A national multicentre cross-sectional study was conducted. The study group was composed of patients from all KT centres in Uruguay, vaccinated between 1 and 31 May 2021 (CoronaVac®, n = 245 and BNT162b2, n = 39). The control group was constituted of 82 healthy individuals. Participants had no prior confirmed coronavirus disease 2019 (COVID-19) test. Blood samples were collected between 30 and 40 days after the second dose. Serum-specific immunoglobulin G (IgG) antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 Spike protein were determined using the COVID-19 IgG QUANT ELISA Kit. RESULTS: Only 29% of KT recipients showed seroconversion (36.5% BNT162b2, 27.8% inactivated virus, P = 0.248) in comparison with 100% in healthy control with either vaccine. Antibody levels against RBD were higher with BNT162b mRNA than with inactivated virus [median (interquartile range) 173 (73-554) and 29 (11-70) binding antibody units (BAU)/mL, P < 0.034] in KT and 10 times lower than healthy control [inactivated virus: 308 (209-335) and BNT162b2: 2638 (2608-3808) BAU/mL, P < 0.034]. In multivariate analysis, variables associated with negative humoral response were age, triple immunosuppression, estimated glomerular filtration rate and time post-KT. CONCLUSION: Seroconversion was low in KT patients after vaccination with both platforms. Antibody levels against SARS-CoV-2 were lower with inactivated virus than BNT162b mRNA. These findings support the need for strategies to improve immunogenicity in KT recipients after two doses of either vaccine.

A Leishmania-specific hypothetical protein expressed in both promastigote and amastigote stages of Leishmania infantum employed for the serodiagnosis of, and as a vaccine candidate against, visceral leishmaniasis.

BACKGROUND: LiHyV is an antigenic hypothetical protein present in both promastigote and amastigote stages of Leishmania infantum, which was recently identified by an immunoproteomic approach. A recombinant version of this protein (rLiHyV) was evaluated as a diagnostic marker for canine VL (CVL). In addition, the prophylactic efficacy of the rLiHyV protein, and two of its CD8(+) T cell epitopes, has been analyzed in a murine model of visceral leishmaniasis (VL). METHODS: Initially, the rLiHyV protein was evaluated by an ELISA technique for the serodiagnosis of CVL. Secondly, vaccines composed of the recombinant protein and both chemically synthesized peptides, combined with saponin as an adjuvant; were administered subcutaneously into BALB/c mice. The cellular and humoral responses generated by vaccination were evaluated. In addition, the parasite burden and immune response were studied 10 weeks after L. infantum infection. RESULTS: The rLiHyV protein was recognized by antibodies of VL dogs. No cross-reactivity was obtained with sera from dogs vaccinated with a Brazilian commercial vaccine, with sera from animals infected with Trypanosoma cruzi, Babesia canis and Ehrlichia canis, or those from non-infected animals living in an endemic area for leishmaniasis. After challenge with L. infantum, spleen cells of BALB/c mice vaccinated with rLiHyV/saponin stimulated with parasite antigens showed a higher production of IFN-γ, IL-12 and GM-CSF, than the same cells obtained from mice vaccinated with the individual peptides, or mice from control (inoculated with saline or saponin) groups. This Th1-type cellular response observed in rLiHyV/saponin vaccinated mice was accompanied by the induction of parasite-specific IgG2a isotype antibodies. Animals immunized with rLiHyV/saponin showed significant reductions in the parasite burden in the liver, spleen, bone marrow and in the lymph nodes draining the paws relative to control mice. CONCLUSIONS: The present study showed for the first time that the L. infantum LiHyV protein could be considered as a vaccine candidate against L. infantum infection, as well as a diagnostic marker for CVL.

New delivery systems for amphotericin B applied to the improvement of leishmaniasis treatment.

Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit ratio.

New delivery systems for amphotericin B applied to the improvement of leishmaniasis treatment

Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit ratio.

Trabalhadores com deficiência: vivências de prazer e sofrimento / Trabajadores con discapacidad: experiencias de placer y sufrimiento / Workers with impairment: experiences of pleasure and suffering

Pessoas com deficiência foram historicamente segregadas e consideradas incapazes para o trabalho, mas atualmente preconiza-se sua inclusão em uma perspectiva biopsicossocial. Consequentemente, o número de trabalhadores com deficiência aumentou, embora a forma como vivenciam o trabalho ainda seja pouco conhecida. O objetivo deste estudo foi apreender como os trabalhadores com deficiência vivenciam e dão sentido à experiência de trabalho. Foram realizadas 30 entrevistas semiestruturadas. O trabalho apresentou-se como organizador da vida, estruturador da identidade e gerador de prazer e sofrimento, resultando em atitudes resilientes. O prazer mostrou-se relacionado a recompensas pessoais e sociais. O sofrimento associou-se às imposições e apropriações das exigências organizacionais, individualismo, desvalorização e falta de reconhecimento. Trabalhar com uma deficiência revelou-se uma experiência complexa, que envolve a interação entre um corpo com lesões, a subjetividade do trabalhador, a organização do trabalho e a sociedade como um todo.

Las personas con discapacidad han sido históricamente segregadas y consideradas incapaces de trabajar, pero en la actualidad se recomienda su inclusión en una perspectiva biopsicosocial. En consecuencia, el número de trabajadores con discapacidad ha aumentado, a pesar que la forma como vivencian el trabajo aún es poco conocida. Este estudio trata de comprender cómo estos trabajadores experimentan y dan sentido a la experiencia laboral. Se realizaron 30 entrevistas semi-estructuradas. El trabajo se presenta como organizador de la vida, estructura de la identidad y generador de placer y sufrimiento, lo que resulta en actitudes resilientes. El placer se relaciona con recompensas personales y sociales. El sufrimiento a las exigencias e imposiciones de las organizaciones, individualismo, desvalorización y falta de reconocimiento. Trabajar con una discapacidad ha demostrado ser una experiencia compleja que implica la interacción entre un cuerpo con lesiones, la subjetividad, la organización del trabajo y la sociedad en su conjunto.

People with impairments were historically segregated and perceived as unable to work, but their social inclusion has been lately advocated in a biopsychosocial approach. Therefore, the number of workers with impairments has increased, but there is still little knowledge about the way they experience work. The aim of this study was to apprehend how workers with impairments experience and give meaning to their work. Thirty semi-structured interviews were carried out. The meaning of work was related to life organization, identity structuring and pleasure and suffering development, which resulted in resilient attitudes. Pleasure was related to personal and social rewards. Suffering was associated with the imposition and the appropriation of organizational demands, individualism, devaluation and lack of recognition. Working with an impairment proved to be a complex experience that involved the interaction between a body with impairments, the subjectivity of the worker, the work organization and the society as a whole.

Trabalhadores com deficiência: vivências de prazer e sofrimento / Trabajadores con discapacidad: experiencias de placer y sufrimiento / Workers with impairment: experiences of pleasure and suffering

Pessoas com deficiência foram historicamente segregadas e consideradas incapazes para o trabalho, mas atualmente preconiza-se sua inclusão em uma perspectiva biopsicossocial. Consequentemente, o número de trabalhadores com deficiência aumentou, embora a forma como vivenciam o trabalho ainda seja pouco conhecida. O objetivo deste estudo foi apreender como os trabalhadores com deficiência vivenciam e dão sentido à experiência de trabalho. Foram realizadas 30 entrevistas semiestruturadas. O trabalho apresentou-se como organizador da vida, estruturador da identidade e gerador de prazer e sofrimento, resultando em atitudes resilientes. O prazer mostrou-se relacionado a recompensas pessoais e sociais. O sofrimento associou-se às imposições e apropriações das exigências organizacionais, individualismo, desvalorização e falta de reconhecimento. Trabalhar com uma deficiência revelou-se uma experiência complexa, que envolve a interação entre um corpo com lesões, a subjetividade do trabalhador, a organização do trabalho e a sociedade como um todo.

Las personas con discapacidad han sido históricamente segregadas y consideradas incapaces de trabajar, pero en la actualidad se recomienda su inclusión en una perspectiva biopsicosocial. En consecuencia, el número de trabajadores con discapacidad ha aumentado, a pesar que la forma como vivencian el trabajo aún es poco conocida. Este estudio trata de comprender cómo estos trabajadores experimentan y dan sentido a la experiencia laboral. Se realizaron 30 entrevistas semi-estructuradas. El trabajo se presenta como organizador de la vida, estructura de la identidad y generador de placer y sufrimiento, lo que resulta en actitudes resilientes. El placer se relaciona con recompensas personales y sociales. El sufrimiento a las exigencias e imposiciones de las organizaciones, individualismo, desvalorización y falta de reconocimiento. Trabajar con una discapacidad ha demostrado ser una experiencia compleja que implica la interacción entre un cuerpo con lesiones, la subjetividad, la organización del trabajo y la sociedad en su conjunto.

People with impairments were historically segregated and perceived as unable to work, but their social inclusion has been lately advocated in a biopsychosocial approach. Therefore, the number of workers with impairments has increased, but there is still little knowledge about the way they experience work. The aim of this study was to apprehend how workers with impairments experience and give meaning to their work. Thirty semi-structured interviews were carried out. The meaning of work was related to life organization, identity structuring and pleasure and suffering development, which resulted in resilient attitudes. Pleasure was related to personal and social rewards. Suffering was associated with the imposition and the appropriation of organizational demands, individualism, devaluation and lack of recognition. Working with an impairment proved to be a complex experience that involved the interaction between a body with impairments, the subjectivity of the worker, the work organization and the society as a whole.

Work reality perceived by individuals with impairments: a biopsychosocial experience.

BACKGROUND: Individuals with different impairments are working in the formal and/or informal market despite physical and attitudinal barriers. To date, few studies have addressed this situation from the perspective of the individuals. OBJECTIVE: Apprehend factors that restrict work performance in the perspective of workers with impairments and identify the strategies employed and the difficulties faced. PARTICIPANTS: Individuals with impairment who exercised paid activities. METHODS: Thirty semi-structured interviews and eleven observations of individuals in work activities. RESULTS: Limitations stemming from participants' disability and health status had an influence over their execution of tasks, but did not compromise work performance. Environmental factors that impacted as facilitators or barriers were: lack of preparation of colleagues, employers, education and rehabilitation systems; attitudes and coexistence; accessibility, implementation of land use policies, urban structures and transportation; products and technology; and distributive policies. Personal factors (upbringing, self-esteem, good mood, outgoingness, communicability, willpower, age and how the disability was acquired) also influenced participation at work. Important strategies included recognizing and sharing capabilities and needs, which minimized or eliminated difficulties at work. CONCLUSIONS: Workers with impairments developed effective strategies for dealing with adverse situations, which remained in the individual realm. Working with impairments is a complex experience that demands overcoming old paradigms.

Work ability and stress in a bus transportation company in Belo Horizonte, Brazil / Avaliação da capacidade para o trabalho e estresse em uma empresa de transporte coletivo de Belo Horizonte, Brasil

Demographic, occupational and psychosocial characteristics affect the health and occupational performance of workers. The objective of the present study was to elaborate a profile of the work ability and factors that affect it in a bus transportation company in Belo Horizonte, Brazil. The instruments used included a socio-demographic and occupational questionnaire, the Work Ability Index and the Job Stress Scale. Demographic information revealed that 85.7 percent of the 126 employees of the company were active workers, 98 percent were males, with an average of 39 years of age (SD= 10) and 79 months working in the company (SD= 68); more than half reported having a low schooling level. In terms of personal habits, 88 percent were exposed to one or more risk factors, especially a sedentary lifestyle. The average strain value (as a consequence of stress) was 0.78 (SD= 0.2) and 75.3 percent reported episodes of violence at the workplace. The work ability was good to excellent among 89 percent of the workers. Results from the logistic regression analysis showed that strain was the only significant variable in relation to the Work Ability Index, (estimated odds ratio of 0.02). The results suggest that psychosocial factors presented the greatest association with work ability, and preventive and/or corrective measures should be implemented.

Características demográficas, ocupacionais e psicossociais afetam a saúde e o desempenho dos trabalhadores. O objetivo deste estudo foi elaborar um perfil da capacidade para o trabalho e fatores que a afetam em uma empresa de transporte coletivo de Belo Horizonte, Brasil. Os instrumentos utilizados foram o Índice de Capacidade para o Trabalho, a Job Stress Scale e um questionário sociodemográfico e ocupacional. Dos 126 trabalhadores, 14,3 por cento estavam aposentados ou afastados, todos por doença. Entre os ativos, a maioria era do sexo masculino (98 por cento), com idade média de 39 anos (DP=10), baixa escolaridade (acima de 50 por cento) e tempo médio na empresa de 79 meses (DP=68). Quanto aos hábitos pessoais, 88 por cento estavam expostos a um ou mais fatores de risco, em especial o sedentarismo. O valor médio de desgaste (conseqüência do estresse) foi 0,78 (DP=0.2) e 75,3 por cento relataram episódios de violência no trabalho. A capacidade para o trabalho foi boa ou ótima em 89 por cento dos casos. No modelo de regressão logística com variável resposta ICT, a única variável significativa foi o desgaste (razão de chance estimada de 0,02). Os resultados sugerem que fatores psicossociais apresentaram maior associação com a capacidade para o trabalho e medidas preventivas e/ou corretivas devem ser implementadas.

Work ability and stress in a bus transportation company in Belo Horizonte, Brazil.

Demographic, occupational and psychosocial characteristics affect the health and occupational performance of workers. The objective of the present study was to elaborate a profile of the work ability and factors that affect it in a bus transportation company in Belo Horizonte, Brazil. The instruments used included a socio-demographic and occupational questionnaire, the Work Ability Index and the Job Stress Scale. Demographic information revealed that 85.7% of the 126 employees of the company were active workers, 98% were males, with an average of 39 years of age (SD= 10) and 79 months working in the company (SD= 68); more than half reported having a low schooling level. In terms of personal habits, 88% were exposed to one or more risk factors, especially a sedentary lifestyle. The average strain value (as a consequence of stress) was 0.78 (SD= 0.2) and 75.3% reported episodes of violence at the workplace. The work ability was good to excellent among 89% of the workers. Results from the logistic regression analysis showed that strain was the only significant variable in relation to the Work Ability Index, (estimated odds ratio of 0.02). The results suggest that psychosocial factors presented the greatest association with work ability, and preventive and/or corrective measures should be implemented.

Utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde na avaliação fisioterapêutica de indivíduos com problemas musculoesqueléticos nos membros inferiores e região lombar / The use of the International Classification of Functioning, Disability and Health in the physical therapy assessment of individuals with musculoskeletal disorders of the lower limbs and lumbar region

Introdução: A estrutura e o conteúdo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) podem contribuir para a orientação e sistematização da prática clínica do fisioterapeuta. Apesar de promissor, seu uso ainda é limitado, principalmente devido à complexidade de sua aplicação. O objetivo deste estudo foi analisar as dificuldades encontradas no uso da CIF para codificar atividades/participação de pacientes com problemas musculoesqueléticos nos membros inferiores e na região lombar avaliados por um fisioterapeuta. Métodos: Foram utilizados os relatos dos pacientes quanto às atividades/participação alteradas em decorrência de problemas musculoesqueléticos. Os dados foram coletados dos prontuários e agrupados em categorias para codificação posterior. Resultados: Cinco domínios da CIF foram utilizados para descrever as atividades/participação alteradas nesses indivíduos (mobilidade, cuidados pessoais, vida doméstica, áreas principais da vida e vida comunitária, social e cívica) e foram identificadas quatro questões relacionadas à codificação: (1) códigos múltiplos para algumas atividades/participação; (2) código impreciso para detalhar uma atividade/participação (distância corrida); (3) código ?não especificado? para classificar o ?entrar no carro?; (4) códigos genéricos para atividades/participação que se referem a esportes. Discussão: A possibilidade de seleção de vários códigos para uma mesma condição, decorrente da superposição e inter-relação de atividades/participação, pode tornar a classificação inconsistente em algumas situações. A ausência de detalhamento para algumas atividades/participação pode limitar a precisão na categorização e documentação das informações. Conclusão: A CIF possibilitou a caracterização do estado de saúde dos indivíduos, mas apresenta algumas questões que devem ser consideradas para seu aperfeiçoamento.

Adesão de indivíduos portadores de hemiplegia a um programa domiciliar de exercícios / Adherence of individuals with stroke to a home-based exercice program

Estudos ressaltam a importância e eficácia de programa de fortalecimento e condicionamento físico em pacientes pós-AVC e defendem a continuidade do tratamento para manutenção dos ganhos obtidos. Entretanto, a adesão de indivíduos a programas de atividade física sem supervisão e de longa duração é baixa. Apesar dessas evidências, o fisioterapeuta recomenda rotineiramente a realização de exercícios domiciliares, sem incorporar estratégias de adesão. Os objetivos deste trabalho foram avaliar a adesão de indivíduos com hemiplegia a um programa de exercícios domiciliares combinado a estratégia de adesão e identificar os fatores relacionados à adesão. Foram utilizados os instrumentos: questionário sociodemográfico e clínico, questionário de atividade física, COVS, PAH, TC6min e SF-36. As estratégias de adesão foram palestras, termo de compromisso, cartilhas, calendários de exercícios e brindes. A adesão foi interpretada de acordo com a realização total ou parcial dos exercícios propostos. Foi feita análise descritiva das variáveis e, para compração entre os grupos adesão e não adesão, foram usados o teste qui-quadrado, t-Student e poder estatístico (alfa=0,05). A média de idade dos 14 participantes foi de 57 anos (DP=6) e apresentaram boa mobilidade e condicionamento físico previamnete ao programa. Dos 11 indivíduos que aderiram, 10 apresentaram alta adesão após 0s 6 meses. Apenas os domínios aspectos emocionais e saúde mental do SF-36 apresentaram diferença significativa entre grupos: o domínio capacidade funcional apresentou poder estatístico>80 por cento. Os resultados sugerem que fatores psicológicos, combinados a estratégias de adesão parecem contribuir para a prática regular de atividade física domiciliar em indivíduos com hemiplegia crônica