Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals.

BACKGROUND: Although the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals. METHODS: We investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8-14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution. RESULTS: A total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19. CONCLUSIONS: This report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.

Isomeric effects tuning the electron transport in carotenoid derivatives: from ohmic to rectifier behavior.

Single-molecules have been widely investigated in the last decades due to their promises as devices in molecular electronics. One of the advantages in the use of natural compounds in molecular electronics is the economy of material and molecular synthesis, which makes the process both cheaper and self-sustaining. Although many studies have considered electronic transport in single molecules, there are few studies associated with isomeric effects in biologically appealing systems. In the present work, we have studied ballistic electron transport in two isomeric forms of a retinol molecule: 11-cis and all-trans-retinol. The molecules were connected between two Au(111) electrodes and calculations were performed with the NEGF-DFT methodology. Current-voltage, differential conductance, and rectification curves were obtained and compared for two structures. While 11-cis-retinol shows a more symmetrical current-voltage curve, all-trans-retinol acts as molecular diode for low applied voltages. Our results suggest that a simple isomeric effect modulates the molecular device from nanowires to diodes with potential applications as field-effect transistors.

O extrato bruto hidroalcoólico das folhas de Piper caldense C. DC. na redução do consumo de álcool em ratos / The hydroalcoholic extract of leaves of Piper caldense C. DC. decreases alcohol consumption in rats

A investigação de plantas medicinais como recurso terapêutico para combater o alcoolismo ainda é muito insipiente com poucas espécies investigadas. No presente trabalho avaliamos o efeito do extrato hidroalcoólico das folhas da planta Piper caldense C. DC. com relação ao consumo de álcool e também a sua potencialidade ansiolítica. Foram utilizados ratos Wistar machos, os quais foram divididos em grupos controle (solução fisiológica) e tratado (extrato da planta nas doses de 25, 50 e 150 mg/kg, e diazepam 2 mg/kg). Os animais foram tratados através da via intraperitoneal 1 h antes dos experimentos. Os modelos animais utilizados foram: Labirinto em Cruz Elevado (LCE) e auto-administração de álcool (AA). No LCE o extrato não apresentou efeito ansiolítico do tipo benzodiazepínico. Por outro lado, no comportamento relacionado a auto-administração de solução de álcool, o extrato apresentou efeito significativo reduzindo o consumo de álcool em relação ao grupo controle. Apesar do extrato não ter apresentado efeito ansiolítico, o mesmo parece apresentar potencialidades para combater o abuso e a dependência de álcool.

The investigation of medicinal plants as therapeutic resources in the combat of alcoholism is still very incipient with few species being investigated. The purpose of the present study was to examine the effects of the hydroalcoholic extract of leaves of Piper caldense C. DC. in relation to alcohol consumption and also its anxiolytic potentiality. Male Wistar rats, which had been separated into control group (saline) and treated group (Plant extract doses of 25, 50 and 150 mg/kg and 2 mg/kg of diazepam), were used. Animals were injected intraperitoneally 1 h before the tests. The following models were used: Elevated plus maze (EPM) and alcohol self-administration (ASA). In the EPM, the extract did not show benzodiazepine anxiolytic effect. On the other hand, in the behavior related to alcohol self-administration, the extract showed a significant effect, reducing alcohol consumption compared to the control group. Although the extract has not shown any anxiolytic effect, the results suggest that the plant has potential to combat alcohol abuse and addiction.

Ação de extratos de plantas medicinais sobre a motilidade do trato gastrointestinal / Action of medicinal plant extracts on the gastrointestinal tract motility

Muitas plantas são utilizadas pela população para o tratamento e a cura de doenças. Entre elas encontram-se a Persea major Kopp, Piper mollicomum Kunth. e Serjania erecta Radlk. as quais são utilizadas para diversas enfermidades, inclusive para tratar distúrbios do trato gastrointestinal. O objetivo deste trabalho foi estudar os efeitos dos extratos dessas três plantas sobre a motilidade gastrointestinal. Camundongos Swiss foram tratados com os extratos pela via oral 1 hora antes da administração de uma solução semisólida de carboximetilcelulose 1,5% e vermelho de fenol 0,05% e, após 15 minutos, o esvaziamento gástrico e o trânsito intestinal avaliados. O extrato hidroalcoólico da P. major (100 a 1000 mg Kg-1, p.o.) e o extrato hidroalcoólico da P. mollicomum (100 e 300 mg Kg-1, p.o.) aumentaram o trânsito intestinal. No entanto, somente o extrato da P. major (100 e 300 mg Kg-1) também aumentou o esvaziamento gástrico. O extrato etanólico da S. erecta (100 a 1000 mg Kg-1, p.o.) não alterou a motilidade gastrointestinal. Estes resultados sugerem que a Persea major e a Piper mollicomum mereçam estudos mais aprofundados em busca de princípios ativos ou matéria vegetal efetiva para o tratamento de distúrbios do trato gastrointestinal como a constipação.

Many plants are popularly used for the treatment and healing of diseases. The Persea major Kopp, Piper mollicomum Kunth. and Serjania erecta Radlk. are used in several illnesses, including the treatment of disorders of the gastrointestinal tract. The aim of this study was to evaluate the effects of the extracts of these plants on the gastrointestinal motility. Swiss mice were orally treated with extracts one hour before the administration of a semisolid solution of 1.5% carboxymethylcellulose and 0.05% phenol red. After 15 minutes, the gastric emptying and intestinal transit were determined. The hydroalcoholic extract of P. major (100 to 1000 mg Kg-1, p.o.) and the hydroalcoholic extract of P. mollicomum (100 and 300 mg Kg-1, p.o.) increased the intestinal transit. However, only the P. major extract (100 and 300 mg Kg-1) increased the gastric emptying. The ethanolic extract of S. erecta (100 to 1000 mg Kg-1, p.o.) did not alter the gastrointestinal motility. These results suggest that Persea major and Piper mollicomum can be of interest for further studies in the search of active principles or effective plant material for the treatment of disorders of the gastrointestinal tract, such as constipation.

Aproveitamento de soro lácteo na formulação de bebidas com frutas e hortaliças / The use of whey in the formulation of beverages with fruits and vegetables

O uso do soro lácteo como complemento na formulação de alimentos visando ao seu aproveitamento é uma alternativa para a obtenção de novos produtos. Neste trabalho, desenvolveram-se bebidas à base de soro oriundo de queijo coalho tipo A com frutas e hortaliças. Na formulação das bebidas, utilizaram-se diferentes proporções entre soro lácteo, frutas e hortaliças, com adição de 10% de açúcar. Seis bebidas foram formuladas e submetidas a um teste de preferência, e as três primeiras colocadas foram submetidas a um teste de aceitação sensorial. As três preferidas foram as bebidas sabor graviola, morango e goiaba. A bebida sabor graviola obteve aceitação com as melhores notas nos atributos sensoriais cor, sabor, aparência e qualidade global, seguida pela formulação de sabor morango, mas sem diferença significativa (P>0,05). A bebida sabor goiaba teve o diferencial no atributo odor e superou as bebidas sabor graviola e morango (P<0,05). Conclui-se que é viável a elaboração de bebidas à base de soro de queijo coalho com frutas.

The use of whey as complement in food formulation aiming it's an alternative for the attainment of new products. The aim of this work was developed a type A curd cheese whey derived drink with fruits and vegetables. On drink's formulation was used different ratios of whey, fruits and vegetables, with 10% of sugar. Six drinks were formulated and submited to a preference test. The three best drinks were submitted to a acceptance test. The three best drinks were graviola, strawberry and guava flavours. The graviola one had the greater acceptability with best grades in color's sensory attributes, flavor, appearance and overall quality, following the strawberry flavor, but without significant difference (P<0,05). The guava dink had it's differential on scent character, overcoming the graviola and strawberry drinks (P<0,05). In conclusion we can say that whey-based drink with fruits is viable.

Aproveitamento de soro lácteo na formulação de bebidas com frutas e hortaliças / The use of whey in the formulation of beverages with fruits and vegetables

O uso do soro lácteo como complemento na formulação de alimentos visando ao seu aproveitamento é uma alternativa para a obtenção de novos produtos. Neste trabalho, desenvolveram-se bebidas à base de soro oriundo de queijo coalho tipo A com frutas e hortaliças. Na formulação das bebidas, utilizaram-se diferentes proporções entre soro lácteo, frutas e hortaliças, com adição de 10% de açúcar. Seis bebidas foram formuladas e submetidas a um teste de preferência, e as três primeiras colocadas foram submetidas a um teste de aceitação sensorial. As três preferidas foram as bebidas sabor graviola, morango e goiaba. A bebida sabor graviola obteve aceitação com as melhores notas nos atributos sensoriais cor, sabor, aparência e qualidade global, seguida pela formulação de sabor morango, mas sem diferença significativa (P>0,05). A bebida sabor goiaba teve o diferencial no atributo odor e superou as bebidas sabor graviola e morango (P<0,05). Conclui-se que é viável a elaboração de bebidas à base de soro de queijo coalho com frutas.(AU)

The use of whey as complement in food formulation aiming it's an alternative for the attainment of new products. The aim of this work was developed a type A curd cheese whey derived drink with fruits and vegetables. On drink's formulation was used different ratios of whey, fruits and vegetables, with 10% of sugar. Six drinks were formulated and submited to a preference test. The three best drinks were submitted to a acceptance test. The three best drinks were graviola, strawberry and guava flavours. The graviola one had the greater acceptability with best grades in color's sensory attributes, flavor, appearance and overall quality, following the strawberry flavor, but without significant difference (P<0,05). The guava dink had it's differential on scent character, overcoming the graviola and strawberry drinks (P<0,05). In conclusion we can say that whey-based drink with fruits is viable.(AU)

Determinants of self-monitoring of blood glucose in patients with Type 1 diabetes: a multi-centre study in Brazil.

AIM: The aim of this study was to determine the relationship between the daily frequency of self-monitoring of blood glucose and glycaemic control, demographic and socio-economic status in patients with Type 1 diabetes under routine clinical care in Brazil. METHODS: This was a cross-sectional, multi-centre study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data were obtained from 3176 patients, aged 22 ± 11.8 years, of whom 56.3% were female and 57.4% were Caucasian. The mean time since diabetes diagnosis was 11.7 ± 8.1 years. RESULTS: The prevalence of self-monitoring of blood glucose was 88.5%. There was a significant increase in self-monitoring frequency associated with female gender, lower ages, more intensive diabetes management and higher socio-economic status. A correlation between HbA(1c) levels and the daily frequency of self-monitoring was observed (r(s) = -0.13; P = 0.001). The mean HbA1c levels were related to the daily frequency of self-monitoring (P < 0.001) without additional benefit to patients who performed self-monitoring more than four times daily (9.2, 11.2, 10.2,15.2 and 15% for one, two, three, four, five or more self-monitoring tests daily, respectively; P < 0.0001). CONCLUSIONS: The majority of our patients (88.5%) performed three or more self-monitoring tests daily, with more frequent testing reported by females, younger patients, those on intensive insulin regimens and of higher socio-economic status. No additional benefit was found in patients who performed self-monitoring more than four times daily. The diabetes care team must improve patients' education regarding self-monitoring of blood glucose and its benefits.

Evaluation of renal function in sickle cell disease patients in Brazil.

The objective of this study was to investigate renal function in a cohort of 98 patients with sickle cell disease (SCD) followed up at a tertiary hospital in Brazil. Clinical and laboratory characteristics at the time of the most recent medical examination were analyzed. Renal function was evaluated by the estimation of glomerular filtration rate (GFR) by the criteria of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). We compared patients with normal GFR to patients with decreased GFR (<60 mL·min(-1)·(1.73 m(2))(-1)) and hyperfiltration (>120 mL·min(-1)·(1.73 m(2))(-1)). Comparison between patients according to the use of hydroxyurea and comparison of clinical and laboratory parameters according to GFR were also carried out. Average patient age was 33.8 ± 13.3 years (range 19-67 years), and 57 (58.1%) patients were females. The comparison of patients according to GFR showed that patients with decreased GFR (<60 mL·min(-1)·(1.73 m(2))(-1)) were older, had lower levels of hematocrit, hemoglobin and platelets and higher levels of urea and creatinine. Independent risk factors for decreased GFR were advanced age (OR = 21.6, P < 0.0001) and anemia (OR = 39.6, P < 0.0001). Patients with glomerular hyperfiltration tended to be younger, had higher levels of hematocrit, hemoglobin and platelets and lower levels of urea and creatinine, with less frequent urinary abnormalities. Hydroxyurea, at the dosage of 500-1000 mg/day, was being administered to 28.5% of the patients, and there was no significant difference regarding renal function between the two groups. Further studies are required to establish the best therapeutic approach to renal abnormalities in SCD.

PP156. High prevalence of pre-pregnancy overweight and obesity associated with maternal and perinatal complications.

INTRODUCTION: High prevalence of pre-pregnancy weight excess, as well as evidence of increased risk of maternal and perinatal complications associated with nutritional states have been observed lately. Considering the possible ethnic and environmental influences few studies have assessed this risk in pregnant Brazilian women. OBJECTIVES: This study aimed at determining the prevalence of pre-pregnancy weight excess (overweight and obesity) and its association with maternal and perinatal complications in a Brazilian women population. METHODS: We conducted a prospective cross-sectional study with 3,300 women who had birth care at the Asa Sul Regional Hospital of Brasília - Federal District (FD), from October 2009 to May 2010. Nutritional status was determined by body mass index (BMI), according to WHO criteria (2000): Low weight (BMI<18.5kg/m(2)), Normal weight (BMI between 18.5 and 24.9kg/m(2)), Weight excess (BMI⩾25kg/m(2)), Overweight (BMI between 25 and 29.9kg/m(2)) and obesity (BMI⩾30kg/m(2)). The outcome variables were: pre-clinical complications such as chronic hypertension and diabetes, manifestation of gestational hypertension/preeclampsia, pregnancy duration and resolution as well as perinatal outcomes. The association among these variables was assessed using chi-square (Pearson) and Fisher's exact test. Results were considered significant when p<0.05. RESULTS: In this population, weight excess before pregnancy had a prevalence of 27.2%, being 19.7% and 7.5% of pregnant women presenting, respectively, overweight and obesity. The prevalence of normal weight was 64.6% and low weight was 8.3%. Comparing the weight excess (BMI⩾25kg/m(2)) group with the normal weight group it was observed predominant hypertension (23% vs. 10%) and diabetes (10.1% vs. 3.6%), prolonged pregnancy (14.4% vs. 10.7%) and cesarean section rate (58.1% vs. 47.2%) in the weight excess group. Newborn weight equal to or greater than 4,000 g (9.5% vs. 4.5%) as well as fetal macrosomia (14.6% vs. 7.4%) also predominated in weight excess group. The comparison among the groups normal weight, overweight and obesity showed predominance of hypertension, diabetes cesarean section rate, newborns weight and fetal macrosomia in the obesity group. CONCLUSION: In the population analyzed, the prevalence of pre-pregnancy weight excess, particularly obesity, was high and associated with maternal and perinatal complications. Weight excess pre-pregnancy should be considered a risk to the pregnancy, demanding different obstetric care. Efforts should be made so that, in the pre-pregnancy period, women's weight can be as close to the normal weight as possible.

In vitro evaluation of surface roughness and microhardness of restorative materials submitted to erosive challenges.

The aim of this study was to evaluate the effect of different acidic solutions on the microhardness and surface roughness of restorative materials. The 120 specimens of restorative materials (Fuji II LC, Vitremer, Supreme XT, and Supreme XT + Biscover LV) were randomly divided into three groups according to the immersion media: hydrochloric acid, soft drink, or distilled water. Over a period of five weeks, the groups were immersed in the solutions, which were changed weekly. Data were tested using analysis of variance and the Fisher protected least significant difference test (p<0.05). The results showed that the glass ionomer materials showed the highest surface roughness values (Fuji II LC: 0.111 ± 0.014 µm before and 0.139 ± 0.016 µm after immersion; Vitremer: 0.177 ± 0.012 µm before and 0.084 ± 0.012 µm after immersion), whereas the lowest values were found for the resin sealed with Biscover LV before (0.047 ± 0.011 µm) and after exposure in distilled water (0.043 ± 0.007 µm), soft drink (0.040 ± 0.005 µm), and hydrochloric acid (0.045 ± 0.005 µm). The Supreme XT showed the highest microhardness values before (44.96 ± 2.51 KHN) and after the aging process (41.26 ± 1.22 KHN in water, 35.96 ± 0.81 KHN in soft drink, and 34.74 ± 0.97 KHN in HCl), with significant differences from the other materials (p<0.0001). The lowest microhardness values were found for glass ionomer materials. The solutions used in this study decreased the microhardness of all studied materials, whereas the sealed surface suffered minor changes in microhardness and surface roughness after exposure to acidic solutions.

PTPN22 polymorphism is related to autoimmune disease risk in patients with Turner syndrome.

Individuals with Turner syndrome (TS) clearly have an increased risk for autoimmune diseases. Recently, an allelic variation (C1858T) of the PTPN22 gene was revealed to be associated with the development of autoimmunity. Thus, the aim of this study was to determine the frequency of the PTPN22 C1858T polymorphism in women with Turner syndrome (TS) compared to controls. Case-control study comprises 142 women with TS (cases) and 180 healthy and fertile women without a history of autoimmune disease (controls). Detection of the PTPN22 C1858T polymorphism (rs2476601) was performed by TaqMan real-time PCR. The chi-square test was used to compare allele and genotype frequencies between groups and to estimate the Hardy-Weinberg equilibrium. All P-values were two-tailed, and 95% confidence intervals (CIs) were calculated. A P-value <0.05 was considered statistically significant. Genotypes CC, CT and TT of the PTPN22 C1858T polymorphism presented frequencies of, respectively, 67.6%, 28.2% and 4.2% in the TS, and 82.8%, 16.1% and 1.1% in the control group (P = 0.0043). Alleles C and T were present in, respectively, 81.7% and 18.3% of the patients with TS (P = 0.001, OR = 2.22, 95% CI = 1.39-3.54) and in 90.8% and 9.2%, respectively, of the controls. The data suggest that in Brazilian patients with TS, the PTPN22 C1858T polymorphism may be an important genetic factor predisposing to autoimmune disease risk.

Muscular force is reduced in neurofibromatosis type 1.

OBJECTIVES: To measure muscular force in neurofibromatosis type 1 (NF1) patients. METHODS: The maximal voluntary muscular force (F(max)) was measured in the first 21 volunteer patients without acute health problems at the routine annual examination in the Neurofibromatosis Outpatient Reference Center during October-November (2007). The NF1 individuals were 9 males and 12 females, aged from 7 to 60 years and physically sedentary. The healthy control group was 21 healthy subjects matched to NF1 group by age, sex and physical activity. A handgrip test instrument was used to measure maximal force. To allow comparisons between physically different patients, forearm circumference (cm) was measured with a tape and forearm cross sectional area was derived to express the force per unit of forearm area. Data were compared using a t Student test (P<0.05). RESULTS: The mean F(max) of NF1 male (260-/+136 N) and NF1 female (217-/+76 N) were lower than expected for their sex and age. Healthy men showed greater F(area) (9.8-/+3.2 N x cm(-2)) than NF1 men (5.7-/+2.6 N x cm(-2)) and healthy women (6.7-/+1.6 N x cm(-2)) showed greater F(area) than NF1 females (5.7-/+1.9 N x cm(-2)). CONCLUSION: Maximal voluntary muscle force was reduced in NF1 patients.

p16(INK4a) Expression does not predict the outcome of cervical intraepithelial neoplasia grade 2.

Spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN2) lesions has been recognized since 1955, but predictors of this are poorly understood. Among the predictive markers studied, p16(INK4a) has been suggested to be of some value in monitoring the diagnosis of CIN2. In this clinical trial, 90 Brazilian women, diagnosed to CIN2 and high-risk human papillomavirus infection, were randomized into two groups of equal size: 45 women whose lesions were excised and 45 women subjected to prospective follow-up at 3-month intervals at least for 1 year (mean 6.8 months). p16(INK4a) expression was analyzed in paraffin-embedded sections using immunohistochemical staining. Among the 45 women in the follow-up group, 42% experienced spontaneous regression, 11% showed persistence, 22% progressed to CIN3, and 20% had partial regression to CIN1 or ASCUS (atypical squamous cell undetermined signifiance). p16(INK4a) expression was detected in 68.9% of the patients. In univariate survival (Cox) analysis, no significant difference in regression was obtained between p16(INK4a)-negative and -positive CIN2 lesions (adjusted HR = 1.1; 95% CI 0.6-2.0). In conclusion, p16(INK4a) expression could be useful in the diagnosis of CIN2. However, it failed to predict the outcome of CIN2. Because of its high spontaneous regression rate, follow-up could be considered as a management option of CIN2 in young and compliant women.

Influence of narrow-band UVB phototherapy on cutaneous microbiota of children with atopic dermatitis.

OBJECTIVE: In the present work, the effect of narrow-band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo). METHODS: Count, isolation and identification of cutaneous microbiota from anticubital fossa were performed in 10 controls and 10 AD patients, both submitted to similar levels (P > 0.05) of UVB phototherapy (4.3 +/- 0.9 and 4.3 +/- 0.8 accumulated joules, respectively). Additionally, Staphylococcus aureus isolates were screened for the production of exotoxins. RESULTS: The total and staphylococcal cutaneous microbial population levels were higher (P < 0.05) in AD patients than in the controls. All these population levels decreased (P < 0.05) for both AD and control patients after UVB phototherapy, which also decreased the SCORAD for AD patients. All patients with AD and 50% of controls were carriers of S. aureus, and harboured the bacteria simultaneously on skin and anterior nares. All of the S. aureus strains recovered from AD patient skin produced toxin and the B type was the most frequently detected (70%), followed by C (20%) and A (10%) toxins. Only 40% of the S. aureus isolates from control patients produced toxin. After UVB treatment, microbial population levels of AD patients were similar (P > 0.05) to the ones found in control patients before phototherapy, and toxin production ability of S. aureus isolates decreased drastically. CONCLUSION: The results of the present study show the beneficial effect of UVB phototherapy on AD and suggest that this may be attributable not only to reduction of skin surface bacteria but also to the suppression of superantigen production from S. aureus.

Single-blind and comparative clinical study of the efficacy and safety of benzoyl peroxide 4% gel (BID) and adapalene 0.1% Gel (QD) in the treatment of acne vulgaris for 11 weeks.

objectives: To compare the efficacy and tolerability of a gel containing benzoyl peroxide 4%, used twice daily, with a gel containing adapalene 0.1% used once daily, in the treatment of acne vulgaris for 11 weeks. methods: 178 patients bearing acne vulgaris, aged between 13 and 30 years, were studied in a comparative and single-blind clinical study. The 178 patients were divided into two groups: 89 patients treated with benzoyl peroxide 4% and 89 patients treated with adapalene 0.1%. The treatment duration was 11 weeks. The efficacy assessment was conducted through an accounting of both the inflammatory and non-inflammatory lesions in all visits. The safety assessment was conducted through reports regarding adverse reactions and local tolerance in all visits and an overall tolerance at the end of the study. conclusions: The results showed that both treatments were efficient in the reduction of acne lesions after 11 weeks treatment and were well tolerated, without any serious adverse event report. The benzoyl peroxide 4% was superior in the reduction of the number of inflammatory and non-inflammatory lesions at weeks 2 and 5, when compared to adapalene 0.1%.

Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region.

Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence.

Osteomyelitis caused by Paracoccidioides brasiliensis in a child from the metropolitan area of Rio de Janeiro.

The authors describe a case of paracoccidioidomycosis in a 7-year-old girl from the city of Rio de Janeiro who initially presented to her physician with a lesion in her calcaneous which was misdiagnosed and treated as bacterial osteomyelitis. Later, cutaneous manifestations, lymph node enlargement, and hepatosplenomegaly developed and biopsy of the skin and cervical lymph nodes showed the fungus which was also present in the sputum. It is emphasized that Paracoccidioides brasiliensis can be the cause of bone lesions in endemic areas of Latin America and that response to treatment with amphotercin B is good.

HTLV-I associated infective dermatitis may be an indolent HTLV-I associated lymphoma.

When present for a first time blood donation, a 28-year-old Brazilian white female reported a pruritic eczema of the scalp and retroauricular areas since childhood that had been frequently infected. Her mother had been diagnosed as having HTLV-I-associated myelopathy (HAM), and the patient was found to be a human T-lymphotropic virus type-I (HTLV-I) carrier. The patient had been breast-fed for 6 months. The patient had a complete examination, and a biopsy was taken from eczema in the retroauricular area. The biopsy indicated chronic lymphohistiocytic dermatitis with no abnormal lymphocytes. Eleven months later, the patient had an infiltration in the skin of the retroauricular area and a new biopsy revealed atypical lymphocytes. Nested polymerase chain reaction (PCR) was positive for HTLV-I and immunohistochemistry of the tissue at this time confirmed adult T-cell leukemia/lymphoma (ATLL). Retrospective immunohistochemistry showed that the first fragment submitted from the biopsy 11 months before was also compatible with the diagnosis of ATLL. This case fulfilled all major criteria for diagnosis of HTLV-I-associated infective dermatitis (HTLV-I-ID). We postulate that the patient had indolent ATLL associated with HTLV-I infective dermatitis since childhood. We recommend that tissue immunohistochemistry analysis be done in any patient with HTLV-associated infective dermatitis.

Abortion in Brazil: legislation, reality and options.

Abortion is illegal in Brazil except when performed to save the woman's life or in cases of rape. This paper gives a brief history of parliamentary and extra-parliamentary efforts to change abortion-related legislation in Brazil in the past 60 years, the contents of some of the 53 bills that have been tabled in that time, the non-governmental stakeholders involved and the debate itself in recent decades. The authorities in Brazil have never assumed full public responsibility for reproductive health care or family planning, let alone legal abortion; the ambivalence of the medical profession is an important obstacle. Most politicians avoid getting involved in the abortion debate, but the majority of bills in the 1990s have favoured less restrictive legislation. Incremental legislative and health service changes could help to improve the situation for women. Advocacy is probably the most important action, to promote an environment conducive to change. Clandestine abortion is a serious public health problem in Brazil, and the inadequacy of family planning services is one of the causes of this problem. The solutions should be made a priority for the Brazilian public health system.

Antinociception caused by the extract of Hedyosmum brasiliense and its active principle, the sesquiterpene lactone 13-hydroxy-8,9-dehydroshizukanolide.

The hydroalcoholic extract (HE) obtained from stems and leaves of Hedyosmum brasiliense, given i.p., produced significant inhibition of acetic acid-induced abdominal constriction in mice, with a mean ID50 of 12.7 mg/kg. This effect installed rapidly (0.5 h) and lasted for up to 2 h. Given orally up to 1000 mg/kg, the HE was ineffective. When assessed in the formalin response the HE, given i.p., inhibited the first and second phase, with ID50s of 31.1 and 21.7 mg/kg for the first and the second phases, respectively. The HE also inhibited capsaicin-induced neurogenic pain with ID50 of 69.0 mg/kg, but, in contrast to morphine, failed to cause analgesia in either the tail-flick or hot-plate models of pain. In addition, its antinociception was not reversed by naloxone. The sesquiterpene lactone 13-hydroxy-8,9-dehydroshizukanolide, isolated from H. brasiliense and already reported in other plant species (given by i.p., i.t., or i.c.v. routes) exhibited graded antinociception against acetic-acid writhing and capsaicin-induced licking. Additionally, we have corrected some physico-chemical data already reported for this compound. It is concluded that both the extract and the sesquiterpene lactone isolated from H. brasiliense produced marked antinociception in different models of chemical pain. The site of action involved in the antinociception of the 13-hydroxy-8,9-dehydroshizukanolide remains unclear, but the opioid pathway seems unlikely to be involved in its action.