Oxidative stress evaluation in patients with chronic Chagas disease.

INTRODUCTION: Chagas disease (CD), caused by protozoan Trypanosoma cruzi (T. cruzi), is a neglected disease that affects millions of people worldwide. The parasite clearance by the immune cells is accomplished by the activation of inflammation and production of reactive oxygen species, including nitric oxide (NO) that can lead to tissue injury and DNA damage. On the other hand, to balance the oxidative environment and decrease free radicals, there is an antioxidant system composed of enzymes and vitamins. The aim was to evaluate oxidative stress parameters in symptomatic and asymptomatic patients with Chagas disease. METHODS: Participants were divided into three groups: indeterminate CD (asymptomatic, n = 8), CD with cardiac/digestive involvement (symptomatic, n = 14), and Control healthy individuals (n = 20). The following parameters were analyzed: DNA damage, NO serum levels, hydrophilic antioxidant capacity (HAC) and vitamin E. RESULTS: Symptomatic patients showed increased DNA damage and NO levels and lower HAC and vitamin E levels compared to asymptomatic patients and control subjects. CONCLUSIONS: It is possible to conclude that CD patients with clinical symptoms have higher oxidative stress, characterized by increased DNA damage and NO levels, and reduced antioxidant capacity and vitamin E levels.

Perception of health, quality of life and functional capacity in adults and elderly after hospitalization due to complications of COVID-19 - a longitudinal study with 6-month follow-up / Percepción de salud, calidad de vida y capacidad funcional en adultos y ancianos poshospitalización por complicaciones del COVID-19 - estudio longitudinal con seguimiento de seis meses / Percepção de saúde, qualidade de vida e capacidade funcional em adultos e idosos pós-internação hospitalar em função de complicações da COVID-19 - estudo longitudinal com follow-up de seis meses

ABSTRACT The study aims to evaluate the perception of health, quality of life and functional capacity during six months after COVID-19-related hospitalization. This is a prospective longitudinal study carried out at Universidade São Judas Tadeu (USJT) in partnership with the Instituto Ânima Brasil. Thirteen adult participants, including young and older adults, were evaluated, had a confirmed diagnosis of COVID-19 and were hospitalized. A characterization and interdisciplinary questionnaire built by the researchers was used to assess health perception, quality of life, and functional capacity of participants. In this study, participants were followed for a 6-month period and the main results obtained were: the identification of a significant increase in walking time after three months (p=0.002) as well as an improvement in the perception of quality of life (p=0.002). In addition, the levels of tiredness and physical activity were evaluated; the mean responses were "little tired" and "irregularly active," respectively, and remained unchanged over six months. Considering that patients who were hospitalized due to COVID-19 showed a reduction in the perception of quality of life and walking time soon after the hospital period, it was identified that over time they tend to improve these perceptions.

RESUMEN El objetivo de este estudio fue evaluar la percepción de salud, calidad de vida y capacidad funcional durante seis meses posteriores a la hospitalización por COVID-19. Se trata de un estudio prospectivo longitudinal, realizado en la Universidade São Judas Tadeu (USJT) y el Instituto Ânima Brasil. Se evaluaron a trece participantes, entre adultos jóvenes y adultos mayores, que tenían diagnóstico confirmado del COVID-19 y se encontraban hospitalizados por complicaciones de esa enfermedad. Se utilizó un cuestionario de caracterización e interdisciplinario elaborado por los investigadores para evaluar la percepción de salud, la calidad de vida y la capacidad funcional de los participantes. En este estudio se realizó seguimiento de los participantes durante un período de seis meses, y los principales resultados fueron: un significativo aumento en el tiempo de caminata después de tres meses (p=0,002), así como una mejora en la percepción de la calidad de vida (p=0,002). Además, se evaluaron los niveles de cansancio y de actividad física, y las respuestas medias fueron "poco cansado" e "irregularmente activo", las cuales se mantuvieron sin cambios durante seis meses. Considerando que los pacientes que fueron hospitalizados por COVID-19 presentaron una reducción en la percepción de calidad de vida y en el tiempo de marcha tras el período en el hospital, se identificó que con el tiempo tienden a mejorar estas percepciones.

RESUMO O objetivo do estudo foi avaliar a percepção de saúde, a qualidade de vida e a capacidade funcional dos pacientes durante seis meses após a internação por COVID-19. Trata-se de um estudo de delineamento prospectivo longitudinal realizado na Universidade São Judas Tadeu (USJT) em parceria com o Instituto Ânima Brasil. Foram avaliados 13 participantes adultos, entre jovens e idosos, que apresentaram diagnóstico confirmado de COVID-19 e foram internados. Foi utilizado um questionário de caracterização e interdisciplinar construído especificamente para inquirir a percepção de saúde, a qualidade de vida e a capacidade funcional dos participantes. Neste estudo, eles foram acompanhados no período de seis meses, e os principais resultados obtidos foram: a identificação do aumento significativo no tempo de caminhada após três meses (p=0,002), bem como a melhora na percepção de qualidade de vida (p=0,002). Além disso, foram avaliados os níveis de cansaço e de prática de atividade física, e as respostas médias foram, respectivamente, "pouco cansaço" e "irregularmente ativo", as quais se mantiveram inalteradas ao longo de seis meses. Tendo em vista que os pacientes que foram submetidos à internação hospitalar devido à COVID-19 apresentaram redução da percepção de qualidade de vida e do tempo de caminhada logo após o período hospitalar, foi identificado que, com o decorrer do tempo, eles demonstraram tendência de melhora dessas percepções.

Recent Advances in Herbal-Derived Products with Skin Anti-Aging Properties and Cosmetic Applications.

Although aesthetic benefits are a desirable effect of the treatment of skin aging, it is also important in controlling several skin diseases, mainly in aged people. The development of new dermocosmetics has rapidly increased due to consumers' demand for non-invasive products with lower adverse effects than those currently available on the market. Natural compounds of plant origin and herbal-derived formulations have been popularized due to their various safe active products, which act through different mechanisms of action on several signaling pathways for skin aging. Based on this, the aim of the review was to identify the recent advances in herbal-derived product research, including herbal formulations and isolated compounds with skin anti-aging properties. The studies evaluated the biological effects of herbal-derived products in in vitro, ex vivo, and in vivo studies, highlighting the effects that were reported in clinical trials with available pharmacodynamics data that support their protective effects to treat, prevent, or control human skin aging. Thus, it was possible to identify that gallic and ferulic acids and herbal formulations containing Thymus vulgaris, Panax ginseng, Triticum aestivum, or Andrographis paniculata are the most promising natural products for the development of new dermocosmetics with skin anti-aging properties.

Increase in the Antioxidant and Anti-Inflammatory Activity of Euterpe oleracea Martius Oil Complexed in ß-Cyclodextrin and Hydroxypropyl-ß-Cyclodextrin.

Reactive oxygen species (ROS) are aerobic products generated during cellular respiration, but in the case of oxidative stress, they become key factors in the development of inflammatory processes and chronic diseases such as diabetes and rheumatoid arthritis. In this work, Euterpe oleracea oil (EOO), as well as the complexes produced by slurry (S) and kneading (K), were analyzed for antioxidant capacity in vitro, while only the ß-cyclodextrin complex obtained by kneading (EOO-ßCD-K), which showed better complexation, was selected for anti-inflammatory assays in vivo. In the scavenging activity of OH·, the hydroxypropyl-ß-cyclodextrin complex obtained by kneading (EOO-HPßCD-K) exhibited an activity 437% higher than the pure oil. In the paw edema assay, EOO-ßCD-K reduced edema by 200% and myeloperoxidase (MPO) activity by 112%. In an air pouch model, this treatment showed a reduction in leukocyte, MPO, and Interleukin-1ß (IL-1ß) levels; meanwhile those of glutathione and IL-10 were increased, demonstrating its ability to potentiate the anti-inflammatory effect of EOO.

Revision of Gypogyna Simon, 1900 (Araneae: Salticidae).

Gypogyna Simon, 1900 is revised. Three species are recognized and diagnosed. The type species, Gypogyna forceps Simon, 1900, is redescribed and recorded from several localities in South America. Gypogyna amazonica Ruiz sp. nov. is described based on a male from Manaus, Brazil. Gypogyna mexicana Ruiz Bustamante sp. nov. is described based on specimens of both sexes from the state of Jalisco, Mexico. In addition, some comments on cheliceral dentiton and genital morphology are discussed.

Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease.

American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.

Perfil de diagnósticos de enfermagem CIPE® para pré-natal, por trimestre gestacional / Perfil de diagnósticos de enfermería CIPE® para atención prenatal, por trimestre gestacional / ICNP® nursing diagnoses profile for prenatal by gestational trimester

Resumo Objetivo Identificar diagnósticos de enfermagem pela Classificação Internacional para a Prática de Enfermagem (CIPE®) à consulta de enfermagem pré-natal na atenção primária, segundo trimestre gestacional. Métodos Estudo transversal, conduzido em uma Unidade de Saúde da Família do município de Botucatu/SP. Participaram 48 gestantes, atendidas nos meses de agosto a novembro de 2015, nas 95 consultas de enfermagem de pré-natal realizadas. Adotou-se como referencial a Teoria das Necessidades Humanas Básicas. Resultados Foram identificados 452 diagnósticos, agrupados em diagnósticos de promoção à saúde, de risco e com foco no problema. A maior parte deles voltaram-se às necessidades psicobiológicas envolvendo necessidades de nutrição, hidratação, eliminações e exercícios e atividades físicas. Evidenciaram-se semelhanças quando considerados os três trimestres de gravidez, o que pode decorrer do fato de terem sido incluídas no estudo apenas gestantes de risco habitual, de forma que frequentemente os diagnósticos propostos guardavam relação com alterações fisiológicas decorrentes da gravidez normal. Foi pequena a proporção de diagnósticos voltados às necessidades psicossociais, com destaque às necessidades de segurança, gregária e aceitação. Nenhum diagnóstico foi proposto relacionado às necessidades psicoespirituais. Conclusão A maior parte do conjunto de diagnósticos propostos está no contexto do desenvolvimento de hábitos de vida saudáveis. Porém, nesse processo, há que se considerar a necessidade de ampliar a abordagem da gestante, de forma a contemplar diagnósticos psicossociais e psicoespirituais.

Resumen Objetivo Identificar diagnósticos de enfermería a través de la Clasificación Internacional de la Práctica de Enfermería (CIPE®) para consultas de enfermería prenatal en la atención primaria, según el trimestre gestacional. Métodos Estudio transversal, conducido en una Unidad de Salud de la Familia en el municipio de Botucatu, estado de São Paulo. Participaron 48 mujeres embarazadas, atendidas entre los meses de agosto y noviembre de 2015, en 95 consultas de enfermería prenatal. Se adoptó la teoría de las necesidades humanas básicas como marco referencial. Resultados Se identificaron 452 diagnósticos, agrupados en diagnósticos de promoción de la salud, de riesgo y con foco en el problema. La mayor parte se relacionó con las necesidades psicobiológicas, que incluye necesidades de nutrición, hidratación, eliminación y ejercicio y actividad física. Se observaron semejanzas cuando se consideraron los tres trimestres del embarazo, lo que puede provenir del hecho de haber incluido solo gestantes de riesgo normal en el estudio. De esta forma, los diagnósticos propuestos estaban con frecuencia asociados con alteraciones fisiológicas resultantes de un embarazo normal. La proporción de diagnósticos relacionados con las necesidades psicosociales fue pequeña, con énfasis en la necesidad de seguridad, gregaria y de aprobación. No se propuso ningún diagnóstico relacionado con las necesidades psicoespirituales. Conclusión La mayor parte del conjunto de diagnósticos propuestos está dentro del contexto del desarrollo de hábitos de vida más saludables. Sin embargo, en este proceso hay que considerar la necesidad de ampliar el enfoque hacia la mujer embarazada, a fin de contemplar diagnósticos psicosociales y psicoespirituales.

Abstract Objective To identify nursing diagnoses by the International Classification for Nursing Practice (ICNP®) to prenatal nursing consultation in primary care according to gestational trimester. Methods This is a cross-sectional study conducted at a Family Health Unit in the city of Botucatu/SP. Forty-eight pregnant women, assisted from August to November 2015, participated in the 95 prenatal nursing consultations held. The Theory of Basic Human Needs was adopted as a framework. Results We identified 452 diagnoses, grouped into health promotion, risk diagnoses and focused on the problem. Most of them turned to psychobiological needs involving needs for nutrition, hydration, eliminations, and exercises and physical activities. Similarities were evident when considering the three trimesters of pregnancy, which may be due to the fact that only pregnant women of habitual risk were included in the study so that the proposed diagnoses were often related to physiological changes resulting from normal pregnancy. There was a small proportion of diagnoses aimed at psychosocial needs, with emphasis on the needs of security, gregariousness, and acceptance. No diagnosis has been proposed related to psychospiritual needs. Conclusion Most of the set of diagnoses proposed is in the context of developing healthy lifestyle habits. However, in this process, it is necessary to consider the need to expand the approach of pregnant women, in order to include psychosocial and psychospiritual diagnoses.

Perfil de pacientes vítimas de fraturas internados em um hospital universitário: estudo transversal / Profile of fracture victim patients interned in a university hospital: a cross-sectional study

Descrever o perfil clínico epidemiológico dos pacientes vítimas de fraturas internados em um hospital universitário do Maranhão. MÉTODOS: Trata-se de um estudo descritivo transversal, retrospectivo e de abordagem quantitativa, realizado a partir da análise de prontuários destes pacientes no Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA) no setor de traumato-ortopedia. RESULTADOS: Foram analisados 251 prontuários, no qual houve predomínio do sexo masculino (52,59%), cor parda (64,1%), residentes em São Luís (57%), solteiros (51%), baixa escolaridade, apresentando maior índice de ensino fundamental incompleto (35,3%) e a média de idade foi de 45,4 anos. O tipo de trauma que mais causou fraturas foram as quedas, com 127 vítimas (50,6%), seguido dos acidentes de trânsito com 27,8% de acidentes motociclísticos, 3,98% de acidentes automobilísticos, 3,98% de atropelamentos. Quanto às regiões corpóreas mais acometidas, observou-se com maior frequência as lesões nos membros inferiores (MMII), sendo 33,47% fraturas de fêmur, 23,11% de tíbia e 11,95% de tornozelo. O tipo de cirurgia mais realizado foi a osteossíntese, para a estabilização do seguimento, com 82,87% de prevalência. Desses pacientes 98,8% obtiveram alta hospitalar após procedimento cirúrgico com mediana de 3 dias de internação e 1,2% evoluíram para óbito. CONCLUSÃO: Houve maior prevalência de fraturas entre os indivíduos do sexo masculino, solteiros, compreendidos na faixa etária de 13 a 38 anos, o mecanismo de trauma com maiores números de casos foram quedas e acidentes de trânsito, com maior acometimento dos membros inferiores.

To describe the clinical epidemiological profile of patients who suffered fractures hospitalized at a university hospital in Maranhão. METHODS: This is a cross-sectional, retrospective and quantitative study based on the analysis of the medical records of these patients at the Federal University Hospital of Maranhão (HU-UFMA) in the orthopedic-trauma sector. RESULTS: A total of 251 medical records were analyzed, with a predominance of males (52.59%), brown (64.1%), residents in São Luís (57%), unmarried individuals (51%), low education, incomplete elementary school index (35.3%) and the mean age was 45,49 years. The type of trauma that caused the most fractures were falls, with 127 victims (50.6%), followed by traffic accidents with motorcycle accidents 3.98%, 3.88% motor vehicle crashes, 3.98% of run over. As for the most affected body regions, lesions in the lower limbs (LL) were observed, 33.47% with fractures of the femur, 23.11% of the tibia and 11.95% of the ankle. The most frequent type of surgery was osteosynthesis, for stabilization of follow-up, with 82.87%. Of these patients, 98.8% were discharged after a surgical procedure with a median of 3 days of hospitalization and 1.2% died. CONCLUSION: There was a higher prevalence among males, single, comprised between 13 and 38 years old, the mechanism of trauma with the highest numbers of cases were falls and traffic accidents, with a higher prevalence of LL involvement.

Epidemiologia da cárie dentária em crianças pré-escolares de um município do Nordeste Brasileiro / Epidemiology of dental caries in pre-school children of a municipality in the brazilian northeast

Objetivo: Verificar a prevalência de cáries em pré-escolares, por meio do índice ceo-d. Método: Estudo transversal, desenvolvido entre fevereiro e outubro de 2016, com 189 crianças pré-escolares, com idade de cinco anos. Os dados foram coletados por meio de exame clínico, sistematizados no Microsoft Excel® e analisados com estatística descritiva segundo diretrizes do manual da Pesquisa SB-Brasil 2010. Resultados: Obteve-se índice ceo-d 4,48, com predominância de 90,4% do componente cariado, 3,4% extração indicada, 6,1% obturado. Apenas 20,1% da amostra obteve ceo-d = 0 (não apresentou lesões de cárie) e 68,7% nunca visitou o dentista até o momento da realização da pesquisa. Conclusão: A análise dos resultados dos componentes "c", "e" e "d" do índice ceo-d infere que a alta prevalência da doença cárie está relacionada a fatores diversos, como higiene oral precária, medo/ansiedade, dificuldade de acesso aos serviços de saúde bucal ou escassez destes para a faixa etária. (AU)

Objective: To verify the prevalence of caries disease in preschoolers using the ceo-d index. Method: Cross-sectional study, developed between February and October 2016, with 189 preschoolers with age of five years. The data were collected through clinical examination, systematized in Microsoft Excel® and analyzed with descriptive statistics according to guidelines of SB-Brazil 2010 Research Manual. Results: The ceo-d index was 4.48, with a predominance of 90.4% of the carious component, 3.4% indicated extraction, and 6.1% obturated. Only 20.1% of the sample obtained ceo-d = 0 (did not present caries lesions) and 68.7% never visited the dentist until the moment of the research. Conclusion: The analysis of the results of the components "c", "e" and "d" of the ceo-d index infers that the high prevalence of caries disease is related to diverse factors such as poor oral hygiene, fear/anxiety, difficulty accessing health services or shortage of these for the age group. (AU)

Objetivo: Verificar la prevalencia de caries en los niños en edad pré-escolar, por medio del índice ceo-d. Método: Estudio transversal, desarrollado entre febrero y octubre de 2016, con 189 niños de cinco años. Los datos fueron recolectados por medio de examen clínico, sistematizados en Microsoft Excel® y analizados con estadísticas descriptivas de acuerdo con las directrices del Manual de Investigación SB-Brasil 2010. Resultados: Se obtuvo un índice ceo-d 4,48, con predominancia de 90,4% del componente cariado, 3,4% extracción indicada, 6,1% obturado. Solamente 20,1% de la muestra obtuvo ceo-d = 0 (no presentó lesiones de caries) y 68,7% nunca visitó al dentista hasta el momento de la realización de la investigación. Conclusión: El análisis de los resultados de los componentes "c", "e" y "d" del índice ceo-d, indica que la alta prevalencia de la caries está relacionada a factores diversos como higiene oral precaria, miedo/ansiedad, dificultad de acceso a los servicios de salud bucal o escasez de estos para esta franja de edad. (AU)

Nonconformities in clinical laboratories in Macapá, Amapá, Brazil, based on the RDC no. 302/2005/Anvisa / Não conformidades em laboratórios clínicos de Macapá, Amapá, Brasil, com base na RDC nº 302/2005/Anvisa

ABSTRACT Introduction: Clinical analysis laboratories are health care facilities that provide resources for outpatient and/or emergency diagnoses; they are regulated in Brazil by the Resolution of the Collegiate Board of Directors (RDC) no. 302, of October 13, 2005, of the Brazilian National Agency of Sanitary Surveillance (Anvisa). Objective: The aim of this study was to perform a normative evaluation in clinical analysis laboratories, based on RDC no. 302, of October 13, 2005. Material and method: This is a cross-sectional and descriptive study. Twelve clinical laboratories participated in the study. The data were obtained through a structured questionnaire and answered by the technical leaders of the participating laboratories, in the municipality of Macapá, Amapá, Brazil. Results: The average nonconformity found among the participants was 9.64%, which allowed an overall evaluation among them as satisfactory, in relation to the minimum requirements demanded by the standardization recommended by Anvisa. When the participants were analyzed individually, there was a variation from 4.82% to 21.69% of the nonconformities index. Other studies agree with the results, however there is disagreement in a research carried out in Porto Alegre, Rio Grande do Sul, Brazil, possibly due to the fact that the laboratories present in this study do not have a quality management system in their processes. Conclusion: Laboratories 2, 3, 4, 6, 9, 11, and 12 were rated as satisfactory. Laboratories 1, 5, 7, 8 and 10 were rated as partially satisfactory. No laboratories were rated as unsatisfactory.

RESUMEN Introducción: Los laboratorios clínicos son establecimientos de salud que ofrecen recursos para diagnósticos ambulatorios y/o de emergencia; son regulados en Brasil por la resolución del Directorio Colegiado (RDC) nº 302, de 13 de octubre de 2005, de la Agencia Nacional de Vigilancia Sanitaria (Anvisa). Objetivo: Este trabajo tuvo como objetivo efectuar una evaluación normativa en laboratorios clínicos, teniendo como base la RDC nº 302, de 13 de octubre de 2005. Material y método: Estudio transversal y descriptivo, con la participación de 12 laboratorios clínicos. Los datos se obtuvieron mediante cuestionario estructurado contestado por los responsables técnicos de los laboratorios participantes, en el municipio de Macapá, Amapá, Brasil. Resultados: La media de no conformidades entre los participantes fue de 9,64%, lo que permitió una evaluación general entre ellos como satisfactorios, con respecto a los requisitos mínimos exigidos por la Anvisa. Cuando los participantes fueron evaluados individualmente, hubo variación de 4,82% hasta 21,69% en el índice de no conformidades. Otros estudios presentaron resultados concordantes; sin embargo, hay desacuerdo en una investigación realizada en Porto Alegre, Rio Grande do Sul, Brasil, posiblemente porque los laboratorios participantes en ese estudio no tienen un sistema de gestión de calidad en sus procesos. Conclusión: Los laboratorios 2, 3, 4, 6, 9, 11 y 12 fueron evaluados como satisfactorios; los laboratorios 1, 5, 7, 8 y 10, como parcialmente satisfactorios. Ningún laboratorio fue evaluado como insatisfactorio.

RESUMO Introdução: Os laboratórios de análises clínicas são estabelecimentos de saúde que oferecem recursos aos diagnósticos ambulatoriais e/ou emergenciais; são regulamentados no Brasil pela Resolução da Diretoria Colegiada (RDC) nº 302, de 13 de outubro de 2005, da Agência Nacional de Vigilância Sanitária (Anvisa). Objetivo: Este trabalho teve como objetivo realizar uma avaliação normativa em laboratórios de análises clínicas, tendo como base a RDC nº 302, de 13 de outubro de 2005. Material e método: Estudo transversal e descritivo, com a participação de 12 laboratórios clínicos. Os dados foram obtidos por meio de questionário estruturado respondido pelos responsáveis técnicos dos laboratórios participantes, no município de Macapá, Amapá, Brasil. Resultados: A média de não conformidade encontrada entre os participantes foi de 9,64%, o que permitiu uma avaliação geral entre eles como satisfatórios, em relação aos requisitos mínimos exigidos pela normatização preconizada pela Anvisa. Quando os participantes foram avaliados individualmente, houve variação de 4,82% a 21,69% no índice de não conformidades. Outros estudos apresentam resultados concordantes; contudo, há discordância em uma pesquisa realizada em Porto Alegre, Rio Grande do Sul, Brasil, possivelmente pelo fato de os laboratórios presentes neste estudo não terem um sistema de gestão de qualidade nos seus processos. Conclusão: Os laboratórios 2, 3, 4, 6, 9, 11 e 12 foram avaliados como satisfatórios; os laboratórios 1, 5, 7, 8 e 10, como parcialmente satisfatórios. Nenhum laboratório foi avaliado como insatisfatório.

Investigation of Chagas disease within the same family: case study / Investigação da doença de Chagas em um mesmo núcleo familiar: estudo de caso

ABSTRACT Chagas disease (CD) is a neglected endemic disease. Its classic form of transmission occurs through hematophagous triatomine insects. Its classic form of transmission occurs through hematophagous triatomine insects. There are cases of the disease in non-endemic regions that occur through alternative transmissions, as this possibility also exists. The aim of this study was to report a case among members of a same family (born and resident in Taquarituba, São Paulo, Brazil) diagnosed with CD. The family matriarch lived in a mud house in the countryside and reported contact with the triatomine during childhood. Two grown-up children are also seroreactive; both reported not having contact with the insect as children. Medical record analyzes and new laboratory tests were performed. Clinical history and recent tests have confirmed positivity for CD in the matriarch and her grown-up children. Parasitological techniques have shown negative results, evidencing that they are in the chronic form of the disease. Congenital transmission may have occurred between them, as well as the possibility of vector transmission by secondary species cannot be ruled out, since the patients come from a municipality considered endemic for CD in the past.

RESUMEN La enfermedadde Chagas (EC) es una infección endémica que ha sido descuidada. Su forma clásica de transmisión ocurre mediante insectos triatominos hematófagos. Hay casos de la enfermedad en regiones no endémicas que ocurrieron por vías alternativas de transmisión, puesto que también hay esa posibilidad. El objetivo de este estudio fue reportar un caso de miembros de una misma familia diagnosticados con EC. La matriarca de la familia vivía en una casa hecha de barro en la zona ruraly reportó contacto con el triatomino en su infancia. Dos hijosson también sero-reactivos, pero no reportaron contacto con el insecto cuando eran ninos. Se hicieron análisis de historial médico y nuevaspruebas de laboratorio. El histórico clínico y laspruebas recientes confirmaran la positividad para EC, tanto en la madre como en los hijos. Las técnicasparasitológicas demostraron resultados negativos, comprobando la forma crónica de la enfermedad. Transmisión congénitapuede haber ocurrido entre ellos, así como no se puede descartar la posibilidad de ocurrencia de transmisión vectorial por especies secundarias, ya que los pacientes proceden de un municipio que fue considerado endémico para EC en el pasado.

RESUMO A doença de Chagas (DC) é uma enfermidade endêmica negligenciada. Sua forma clássica de transmissão ocorre por meio de insetos triatomíneos hematófagos. Há casos da doença em regiões não endêmicas ocorridos por transmissões alternativas, uma vez que também existe essa possibilidade. O objetivo deste estudo foi relatar um caso de membros da mesma família (natural e residente em Taquarituba, São Paulo, Brasil) diagnosticados com DC. A matriarca da família morava em uma casa de barro na zona rural e relatou contato com o triatomíneo na infância. Dois filhos também são sororreagentes; ambos relataram não terem tido contato com o inseto quando crianças. Análises de prontuário e novos testes laboratoriais foram feitos. O histórico clínico e os recentes exames confirmaram a positividade para DC, tanto na mãe quanto nos filhos. As técnicas parasitológicas demonstraram resultados negativos, constatando forma crônica da doença. Transmissão congênita pode ter ocorrido entre eles, assim como também não se pode descartar a possibilidade de ocorrência de transmissão vetorial por espécies secundárias, visto que os pacientes são oriundos de um município considerado endêmico para DC no passado.

Association of vitamin D3, VDR gene polymorphisms, and LL-37 with a clinical form of Chagas Disease.

INTRODUCTION: Chagas disease (CD) is an important public health problem in Brazil and worldwide. Aging and obesity are important matters in patients with CD, as is hypovitaminosis D3, which can decrease the quality of life of these patients. Immunomodulation mediated by vitamin D3, especially the production of antimicrobial peptides such as cathelicidin LL-37, might be related to the severity and symptoms of CD. This study aimed to determine the serum levels of vitamin D and LL-37 and VDR gene polymorphisms in patients with chronic CD. METHODS: This study included male patients with cardiac and indeterminate clinical forms of CD. Clinical, anthropometric, and blood parameters were obtained. Serum levels of 25(OH)D3 and LL-37 were determined by chemiluminescence and enzyme-linked immunosorbent assay respectively. Fok (rs731236), Bsm (rs1544410), Apa (rs7975232), and Taq (rs731236) polymorphisms of the VDR gene were investigated by PCR-RFLP. RESULTS: Sixty-four patients were included in the study: 18 of the cardiac form and 46 of the indeterminate form. No differences in age, ethnicity, BMI, arterial hypertension, diabetes mellitus, or dyslipidemias were observed between groups. However, the serum levels of 25(OH)D3, but not of LL-37, were lower in the cardiac form group. The association among polymorphisms, vitamin D, and clinical form was not significant. CONCLUSIONS: Decreased levels of vitamin D suggest an association with the cardiac form of CD. Studies investigating the roles of vitamin D and LL-37 in the immune response and their associations with VDR polymorphisms and disease susceptibility are necessary.

eNose analysis of volatile chemicals from dogs naturally infected with Leishmania infantum in Brazil.

BACKGROUND: Visceral leishmaniasis (VL) in Brazil is a neglected, vector-borne, tropical parasitic disease that is responsible for several thousand human deaths every year. The transmission route involves sand flies becoming infected after feeding on infected reservoir host, mainly dogs, and then transmitting the Leishmania infantum parasites while feeding on humans. A major component of the VL control effort is the identification and euthanasia of infected dogs to remove them as a source of infection. A rapid, non-invasive, point-of-care device able to differentiate between the odours of infected and uninfected dogs may contribute towards the accurate diagnosis of canine VL. METHODOLOGY/PRINCIPAL FINDINGS: We analysed the headspace volatile chemicals from the hair of two groups of dogs collected in 2017 and 2018 using a bench-top eNose volatile organic chemical analyser. The dogs were categorised as infected or uninfected by PCR analysis of blood samples taken by venepuncture and the number of parasites per ml of blood was calculated for each dog by qPCR analysis. We demonstrated using a robust clustering analysis that the eNose data could be discriminated into infected and uninfected categories with specificity >94% and sensitivity >97%. The eNose device and data analysis were sufficiently sensitive to be able to identify infected dogs even when the Leishmania population in the circulating blood was very low. CONCLUSIONS/SIGNIFICANCE: The study illustrates the potential of the eNose to rapidly and accurately identify dogs infected with Le. infantum. Future improvements to eNose analyser sensor sensitivity, sampling methodology and portability suggest that this approach could significantly improve the diagnosis of VL infected dogs in Brazil with additional potential for effective diagnosis of VL in humans as well as for the diagnosis of other parasitic diseases.

Association of vitamin D3, VDR gene polymorphisms, and LL-37 with a clinical form of Chagas Disease

Abstract INTRODUCTION: Chagas disease (CD) is an important public health problem in Brazil and worldwide. Aging and obesity are important matters in patients with CD, as is hypovitaminosis D3, which can decrease the quality of life of these patients. Immunomodulation mediated by vitamin D3, especially the production of antimicrobial peptides such as cathelicidin LL-37, might be related to the severity and symptoms of CD. This study aimed to determine the serum levels of vitamin D and LL-37 and VDR gene polymorphisms in patients with chronic CD. METHODS: This study included male patients with cardiac and indeterminate clinical forms of CD. Clinical, anthropometric, and blood parameters were obtained. Serum levels of 25(OH)D3 and LL-37 were determined by chemiluminescence and enzyme-linked immunosorbent assay respectively. Fok (rs731236), Bsm (rs1544410), Apa (rs7975232), and Taq (rs731236) polymorphisms of the VDR gene were investigated by PCR-RFLP. RESULTS: Sixty-four patients were included in the study: 18 of the cardiac form and 46 of the indeterminate form. No differences in age, ethnicity, BMI, arterial hypertension, diabetes mellitus, or dyslipidemias were observed between groups. However, the serum levels of 25(OH)D3, but not of LL-37, were lower in the cardiac form group. The association among polymorphisms, vitamin D, and clinical form was not significant. CONCLUSIONS: Decreased levels of vitamin D suggest an association with the cardiac form of CD. Studies investigating the roles of vitamin D and LL-37 in the immune response and their associations with VDR polymorphisms and disease susceptibility are necessary.

Isoniazid-resistant tuberculous spondylodiscitis associated with scrofuloderma

The extrapulmonary forms of tuberculosis are responsible for about 20% of cases. Scrofuloderma is the cutaneous manifestation secondary to infection in some subcutaneous foci. A 33-year-old patient was admitted to the Clinical Hospital with exudative skin lesions on the back and thorax, initiated 10 months previously, associated with daily fever, and constipation. Spine resonance showed a paravertebral pseudotumoral lesion with T4 and T9 invasion, including vertebral canal and sub-ligament extension. The lesions presented fistulas for paravertebral muscles, lung and skin. Polimerase chain reaction (PCR) proved positive for Mycobacterium tubeculosis in the thorax wound secretion, caracterizing tuberculous spondilodiscitis with scrofuloderma. Treatment was initiated with rifampicin, isoniazid, pyrazinamide and ethambutol with important clinical improvement after the first week. The febrile peaks came to an end and there was improvement in the pattern of the cutaneous lesions. The susceptibility test showed resistance to isoniazid

Intervenções fisioterapêuticas na função pulmonar em pacientes submetidos a cirurgia bariátrica / Physiotherapeutic interventions in pulmonary function of patients submitted to bariatric surgery

O objetivo desta pesquisa foi buscar na literatura evidências sobre intervenções utilizadas pela fisioterapia em pacientes submetidos a cirurgia bariátrica. Métodos: As buscas foram realizadas nos meses de janeiro e fevereiro de 2018, através do acesso online em bases de dados: Pubmed/Medline, PEDro, Scielo e Lilacs. Utilizou estratégia PICo, onde foram definidos: População (P): Obesidade Mórbida; Interesse (I): Prática baseada em evidências; Contexto (Co): estudos de intervenções. Resultados: Através das estratégias de busca foram encontrados 951 artigos. Após leitura dos resumos, observados critérios de inclusão e exclusão, foram excluí­dos um total de 901, restando 50 artigos que foram lidos na í­ntegra e, em seguida, elegeram-se 10 estudos. As evidências das intervenções do treinamento muscular respiratório podem ser observadas nos ensaios clí­nicos contendo bom rigor metodológico. O treinamento muscular respiratório pode ser considerado como uma intervenção, juntamente com outras terapêuticas (dois ní­veis de pressão ­ Bilevel) que compõem o tratamento de pacientes submetidos í cirurgia bariátrica, auxiliando na obtenção de resultados satisfatórios. Conclusão: O ní­vel de evidência atualmente disponí­veis do impacto das intervenções fisioterapêuticas, como o treinamento muscular respiratório, na função pulmonar de pacientes submetidos í cirurgia bariátrica se mostrou alto. A análise metodológica realizada neste estudo mostrou poucos números de estudos de ensaios clí­nicos, retratando a real necessidade de novos estudos que possam integrar a pratica clí­nica. (AU)

The objective of this study was to search in the literature for evidence on interventions used by physical therapy in patients undergoing bariatric surgery. Methods: The study was performed in January and February 2018, through online access in databases: Pubmed/Medline, PEDro, Scielo and Lilacs. It was used the PICo strategy, and it was defined: Population (P): Morbid Obesity; Interest (I): Evidence-based practice; Context (Co): intervention studies. Results: We found 951 articles. After reading the abstracts and observing inclusion and exclusion criteria, a total of 901 were excluded, remaining 50 articles that were read in full, and then 10 studies were chosen. Evidence from respiratory muscle training interventions can be observed in clinical trials with good methodological rigor. Respiratory muscular training can be considered as an intervention, along with other therapeutics (two levels of pressure - Bilevel) that make up the treatment of patients undergoing bariatric surgery, helping to obtain satisfactory results. Conclusion: The level of evidence currently available on the impact of physiotherapeutic interventions, like respiratory muscular training, on lung function in patients undergoing bariatric surgery was high. The methodological analysis performed in this study showed few clinical trial studies, showing the real need for new studies that could integrate clinical practice. (AU)

Saúde Mental na Atenção Primária: tecendo ferramentas de abordagem familiar / Salud Mental en Atención Primaria: taller de herramientas de enfoque familiar / Mental Health in Primary Care: weaving family approach tools

Este estudo de caso objetiva realizar análise das relações dos sujeitos com transtorno mental, a partir de ferramentas de abordagem familiar, no município de Tianguá - Ceará, Brasil, no período de abril a junho de 2015. As informações foram coletadas por meio de uma entrevista e diário de campo, durante visita ao lar, também mapeadas e analisadas a partir das seguintes ferramentas de avaliação familiar: tipologia, genograma, ecomapa e P.R.A.C.T.I.C.E. O núcleo familiar é composto por quatro membros, sendo Rosa uma deficiente auditiva (mãe e provedora da família) e três filhos com transtorno mental: o Cravo (esquizofrenia), o Girassol (transtorno mental severo) e a Margarida (deficiente mental), que vivem em situação de extrema vulnerabilidade social, segundo a Escala de Risco Familiar Coelho-Savassi (ERF-CS). Os resultados evidenciaram um arranjo monoparental feminino, escore 32 da ERF-CS, com interação social frágil e relações familiares conflituosas e distantes, acentuadas pela descompensação mental e falta de apoio multiprofissional especializado. O estudo mostra a importância do uso de ferramentas de abordagem familiar para potencializar práticas e fortalecer o papel ordenador da ESF/APS. Contudo, diante de casos complexos, sozinha, a ESF/APS não consegue efetivar a integralidade, requerendo, portanto, apoio matricial da rede especializada, proporcionando mais autonomia aos sujeitos

Este estudio de caso tiene como objetivo realizar análisis de las relaciones de los sujetos con trastorno mental, a partir de herramientas de abordaje familiar, en el municipio de Tianguá - Ceará, Brasil, en el período de abril a junio de 2015. Las informaciones fueron recolectadas por medio de una entrevista y diario de campo, durante visita al hogar, también mapeadas y analizadas a partir de las siguientes herramientas de evaluación familiar: tipología, genograma, ecomapa y P.R.A.C.T.I.C.E. El núcleo familiar está compuesto por cuatro miembros, siendo Rosa una deficiente auditiva (madre y proveedora de la familia) y tres hijos con trastorno mental: Clavel (esquizofrenia), Girasol (trastorno mental severo) y Margarita (deficiente mental), que viven en situación de extrema vulnerabilidad social, según la Escala de Riesgo Familiar Coelho-Savassi (ERF-CS). Los resultados evidenciaron un núcleo monoparental femenino, escore 32 de la ERF-CS, con interacción social frágil y relaciones familiares conflictivas y distantes, acentuadas por la descompensación mental y falta de apoyo multiprofesional especializado. El estudio muestra la importancia del uso de herramientas de abordaje familiar para potenciar prácticas y fortalecer el papel ordenador de la ESF/APS. Sin embargo, delante de casos complejos, solamente, la ESF/APS no consigue hacer efectiva la integralidad, requiriendo, por lo tanto, apoyo matricial de la red especializada, proporcionando más autonomía a los sujetos

The objective of this case study is to conduct analysis of the relations of individuals with mental disorders, with the use of family approach tools in the municipality of Tianguá - Ceará, Brazil, from April to June 2015. The information was collected through interviews and field diary, during home visits; followed by mapping and analysis of family assessment tools: typology, genogram, ecomap and P.R.A.C.T.I.C.E. The family composition consists of four members, Rosa had hearing impaired (mother and provider of the family) and three children had mental disorders: Carnation (Schizophrenia), Sunflower (severe mental disorder) and Margaret (mentally handicapped). This family lives in extreme social vulnerability according to the Coelho-Savassi Family Risk Scale (ERF-CS). The results showed a female single parent arrangement, scoring 32 at ERF-CS with frail social interaction and distant family relations, marked by mental decompensation and lack of specialized multidisciplinary support. The study shows the importance of using family approach tools to enhance practices and strengthen the role of the FHS/PHC. However, in view of complex cases alone, the FHS/PHC cannot be effective, requiring, therefore, matrix support of specialized network which provides more autonomy to the subjects

Interações medicamentosas e consequentes intervenções farmacêuticas na Unidade de Terapia Intensiva de um hospital privado em Macapá, Amapá / Interactions medicative and consequents interventions pharmaceutics in the unity of intensive therapy in a private hospital in Macapa, Amapa

Introdução: Pacientes internados em Unidades de Terapia Intensiva (UTI) são submetidos a tratamentos com múltiplos fármacos, visto a gravidade dos problemas que são tratados. A interação medicamentosa é definida como um evento causado pela modificação do efeito ou aproveitamento de um fármaco no organismo em virtude de outro. A avaliação das potenciais interações medicamentosas pode auxiliar a equipe multiprofissional a promover um tratamento de qualidade, evitando que estas interações sejam danosas ao paciente, diminuindo o tempo de internação e consequentemente auxiliando na redução de custos. Objetivo: Avaliar as principais interações medicamentosas observadas nas UTI de um hospital privado na cidade de Macapá (Amapá, AP) através da análise das prescrições e das consequentes intervenções adotadas a fim de minimizar seus riscos. Método: Foram avaliadas prescrições de pacientes internados em UTI quanto à presença de potenciais interações medicamentosas e sua respectiva classificação, segundo seu risco e mecanismo. As principais interações foram destacadas a fim de destacar seu mecanismo e medidas adotadas pela equipe multidisciplinar. Resultados: Observou-se que a maioria das interações, tanto na UTI adulto quanto na UTI neonatal, foram consideradas de risco moderado. As interações farmacocinéticas foram mais comuns na UTI adulto, enquanto as farmacodinâmicas predominaram na UTI neonatal. O manejo no horário de administração dos medicamentos foi a intervenção mais adequada para a maioria dos casos das interações medicamentosas. Conclusões: o monitoramento das potenciais interações em pacientes críticos procura garantir a segurança do paciente, buscando diminuir os riscos potenciais aos quais estes estão expostos.

Introduction: Patients admitted to Intensive Care Units (ICU) are submitted to multiple drug treatments, considering the severity of their problems. Drug interaction is defined as an event caused by the modification of the effect or use of a drug in the body. The evaluation of potential drug interactions can help the multiprofessional team to promote a quality treatment, avoiding harmful interactions, reducing the length of hospitalization and consequently reducing costs. Objective: To evaluate the main drug interactions observed in the ICUs of a private hospital in the city of Macapá, Brazil, through the analysis of the prescriptions and the consequent interventions adopted in order to minimize their risks. Method: Prescriptions of patients admitted to the ICU were evaluated for the presence of potential drug interactions and their respective classification according to their risk and mechanism. A brief bibliographic study about the main interactions was carried out in order to highlight its mechanism and the measures adopted by the multidisciplinary team. Results: We observed that the majority of the interactions, both in the adult ICU and in the neonata ICU, were considered of moderate risk. Pharmacokinetic interactions were more common in the adult ICU, while pharmacodynamics predominated in the neonatal intensive care unit. Management during the administration of medications was the most appropriate intervention for most cases of drug interactions. Conclusions: Monitoring of potential interactions in critically ill patients seeks to ensure patient safety in order to reduce the potential risks to which they are exposed.

On four new species of the jumping spider genus Mago O. Pickard-Cambridge, 1882 from South America (Araneae: Salticidae).

Four new species of Mago O. Pickard-Cambridge, 1882 are described. Mago furcatus sp. nov. and Mago mimicus sp. nov. are described from Ecuador (Orellana and Napo provinces, respectively), both based only on the male holotypes. Both sexes of Mago pardo sp. nov. and the male of Mago apophysis sp. nov. are also described from the state of Pará, Brazil. A map with records of these species is given.