Low-intensity resistance training promotes a reduction of mechanical hyperalgesia and increase of muscle strength in rats submitted to the diffused chronic muscle pain model / Treinamento resistido de baixa intensidade promove redução da hiperalgesia mecânica e aumento da força muscular em ratos submetidos ao modelo de dor crônica muscular difusa

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia syndrome (FMS) is characterized by different factors, such as chronic diffuse muscle pain (CDMP), fatigue and psycho-emotional changes. Among the animal models that mimic FMS, the acid saline model is consolidated in the development and maintenance of CDMP. Resistance training (RT) has been an effective method for reducing pain in FMS. Thus, the aim of the present study was to evaluate the effects of resistance training on nociceptive and motor responses in an animal model of chronic diffuse muscular pain. METHODS: Twenty-four male Wistar rats were allocated into four groups: resistance training, RT control, amitriptyline (AMITRIP) and AMITRIP control; all treatment protocols lasted 4 weeks. CDMP was induced in all mice. Then, the animals were treated with low-intensity RT (40% 1 maximum repetition) and AMITRIP (10 mg/kg/day). The mechanical paw withdrawal threshold, locomotor activity and muscle strength were evaluated. RESULTS: Animals treated with both RT and AMITRIP showed an increase in the mechanical paw withdrawal threshold (p<0.05) compared to their controls, suggesting a reduction in mechanical hyperalgesia. There was no improvement in locomotor activity in all groups (p>0.05). Animals with CDMP that underwent RT showed an increase in hindlimb muscle strength (p<0.0001) compared to the RT control group. CONCLUSION: Low-intensity resistance training resulted in antihyperalgesic effects and improved muscle strength in animals submitted to the CDMP model.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome da fibromialgia (SFM) é caracterizada por diferentes fatores, como dor crônica muscular difusa (DCMD), fadiga e alterações psicoemocionais. Dentre os modelos animais que mimetizam a SFM, o modelo de salina ácida é consolidado no desenvolvimento e na manutenção da DCMD. O treinamento resistido (TR) tem sido um método eficaz para redução da dor na SFM. Assim, o objetivo do presente estudo foi avaliar os efeitos do TR na resposta nociceptiva e motora em modelo animal de dor crônica muscular difusa. MÉTODOS: Vinte e quatro ratos machos Wistar foram alocados em quatro grupos: treinamento resistido (TR), controle do TR, amitriptilina (AMITRIP) e controle da AMITRIP, todos os protocolos de tratamento tiveram duração de 4 semanas. A DCMD foi induzida em todos os ratos. Em seguida, os animais foram tratados com TR de baixa intensidade (40% 1 repetição máxima) e AMITRIP (10 mg/kg/dia). Foram avaliados o limiar mecânico de retirada de pata, a atividade locomotora e a força muscular. RESULTADOS: Animais tratados tanto com TR quanto com AMITRIP apresentaram aumento do limiar mecânico de retirada de pata (p<0,05) em relação aos seus controles, sugerindo redução da hiperalgesia mecânica. Não foi observada melhora da atividade locomotora em todos os grupos (p>0,05). Animais com DCMD que realizaram TR obtiveram aumento da força muscular dos membros posteriores (p<0,0001) em comparação ao grupo controle do TR. CONCLUSÃO: Treinamento resistido de baixa intensidade resultou em efeitos anti-hiperalgésicos e melhora da força muscular em animais submetidos ao modelo de DCMD.

The Pancreas in Coronavirus Disease 2019 Infection.

An association between acute pancreatitis (AP) and coronavirus disease 2019 (COVID-19) has been proposed but the mechanisms of pancreatic injury of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the implicative role on the development of AP are not yet fully understood. COVID-19 also imposed major challenges on pancreatic cancer management. We conducted an analysis on the mechanisms of pancreatic injury by SARS-CoV-2 and reviewed published case reports of AP attributed to COVID-19. We also examined the pandemic effect on pancreatic cancer diagnosis and management, including pancreatic surgery.

Ancient vocation, new reality: experiences of teachers during the COVID-19 pandemic / Antiga vocação, nova realidade: vivências de professoras de ensino fundamental durante a pandemia da COVID-19

The COVID-19 pandemic led to social isolation and school closures as measures to contain its spread. Based on phenomenology, the present study aimed to know and understand the senses and meanings that 10 Elementary School teachers attributed to their work in the midst of the COVID-19 pandemic. Method Dialogical meetings were held with each participant generating Comprehensive Narratives. Results The results were organized into five significant elements: (a) fulfillment of a childhood dream arising from the influence of significant people; (b) teaching as an act of love and social transformation; (c) continuous search for space and social recognition, (d) pandemic as an imbalance of life and profession and (e) digital teachers as a new reality. Conclusion The reiteration of the teachers' commitment and motivation in the face of the imposed challenges, the need for adaptation and resilience and a change in perspective in the self-image and perception of social appreciation in relation to teaching work stand out.

A pandemia da COVID-19 acarretou isolamento social e fechamento das escolas como medidas para conter sua propagação. Fundamentado na fenomenologia, o presente estudo objetivou conhecer e compreender os sentidos e significados que 10 professoras, de Ensino Fundamental, atribuíram ao seu trabalho em meio à pandemia da COVID-19. Método Encontros dialógicos foram realizados com cada participante, gerando Narrativas Compreensivas. Resultados Os resultados foram organizados em cinco elementos significativos: (a) realização de um sonho de infância decorrente da influência de pessoas significativas; (b) docência como um ato de amor e de transformação social; (c) busca contínua por espaço e reconhecimento social, (d) pandemia como desequilíbrio de vida e profissão e (e) professores digitais como uma nova realidade. Conclusão Destaca-se a reiteração do compromisso, e a motivação das professoras, frente aos desafios impostos e as necessidades de adaptação e resiliência, assim como uma mudança de perspectiva na autoimagem e percepção da valorização social em relação ao trabalho docente.

Operadores linguísticos das relações de poder no cuidado às pessoas com deficiência / Linguistic operators of power relations in the care of persons with disabilities / Operadores de lenguaje de las relaciones de poder en la atención a personas con discapacidad

Esse artigo analisa as construções discursivas das pessoas que operam o cuidado nos serviços ambulatoriais no Sistema Único de Saúde brasileiro e seus efeitos nos corpos de pessoas com deficiência. Trata-se de um estudo qualitativo e analítico, de abordagem cartográfica, com a participação de trabalhadoras, gestoras, usuárias-cidadãs e seus familiares, em um Centro Especializado em Reabilitação na Paraíba que oferta cuidado ambulatorial multiprofissional para quatro áreas da deficiência (física, intelectual, visual e auditiva) e para o transtorno do espectro do autismo. Identificamos diversos dispositivos disciplinares, dentre eles a operacionalização de diferentes códigos linguísticos que estruturam relações assimétricas de poder no controle dos corpos. Reconhecemos que as complexas relações de poder são imanentes ao campo da assistência à saúde, não exclusivamente da Rede de Cuidado à Pessoa com Deficiência. Identificar e dar visibilidade aos efeitos dessas relações na produção do cuidado em saúde permite balizarmos nossas atuações como seres políticos no mundo do cuidado.

This article analyzes the discursive constructions of people who provide care in outpatient services in the Brazilian Unified Health System and their effects on the bodies of people with disabilities. This is a qualitative and analytical study, with a cartographic approach, with the participation of workers, managers, user-citizens and their families, in a Specialized Rehabilitation Center in Paraíba that offers multidisciplinary outpatient care for four areas of disability (physical, intellectual, visual and auditory) and autism spectrum disorder. We identified several disciplinary devices, among them the operationalization of different linguistic codes that structure asymmetrical power relations in the control of bodies. We recognize that complex power relations are immanent in the field of health care, not exclusively in the Care Network for Persons with Disabilities. Identifying and giving visibility to the effects of these relationships in the production of health care allows us to define our actions as political beings in the world of care.

Este artículo analiza las construcciones discursivas de las personas que brindan atención en los servicios de consulta externa del Sistema Único de Salud de Brasil y sus efectos en los cuerpos de las personas con discapacidad. Se trata de un estudio cualitativo y analítico, de abordaje cartográfico, con participación de trabajadores, gestores, ciudadanos-usuarios y sus familias, en un Centro Especializado de Rehabilitación en Paraíba que ofrece atención para cuatro áreas de discapacidad (física, intelectual, visual y auditiva) y para el trastorno del espectro autista. Identificamos varios dispositivos disciplinarios, entre ellos la operacionalización de códigos lingüísticos, que estructuran relaciones asimétricas de poder en el control de los cuerpos. Reconocemos que las complejas relaciones de poder son inmanentes en el campo de la atención ala salud, no exclusivamente en la Red de Atención a s Personas con Discapacidad. Identificar y visibilizar los efectos de estas relaciones en la producción del cuidado en salud nos permite definir nuestras acciones como entes políticos en el mundo del cuidado.

Scale of Creative Potential at Work: validity based on external criteria and reliability evaluation / Escala de Potencial Criativo no Trabalho: investigação de evidências de validade baseadas em critério externo e precisão / Escala de Potencial Creativo en el Trabajo: investigación de evidencias de validez basadas en criterios externos y precisión

O presente estudo visou adicionar evidências de validade à Escala de Potencial Criativo no Trabalho, por meio da investigação da influência de variáveis relacionadas ao sujeito (gênero, idade e nível de escolaridade) e ao ambiente organizacional (tempo de empresa) nos resultados do teste e investigar a precisão do instrumento por meio do método de teste e reteste. A amostra foi composta por 371 participantes, com idade média de 33,1 anos, funcionários de empresas de pequeno a grande porte. Nenhuma das variáveis se mostrou significativa nos dois fatores do instrumento (bloqueios e barreiras à criatividade; atributos e características que favorecem a criatividade). Somente três interações se mostraram significativas (sexo x idade no Fator 1; escolaridade x idade no Fator 1; idade x tempo no Fator 2). A precisão se mostrou adequada (r = 0,650 no Fator 1 e r = 0,729 no Fator 2). Estudos voltados à investigação de outras qualidades psicométricas do instrumento são recomendados (AU).

The goal of this study was to add evidence of validity for the Creative Potential at Work Scale, by investigating the influences of variables related to the subject (sex, age, level of education) and the organizational environment (length of time in the company) on test results. The reliability of the instrument was also examined using the test and retest method. Participants in the study were 371 employees employed in small to large companies with a mean age of 33.1 years. There was no significant relationship between any of the variables and the two factors of the instrument (blocks and barriers to creativity; attributes and characteristics that promote creativity). There were only three significant interactions in the study (sex x age for Factor 1; education x age for Factor 1; age x time for Factor 2). In this study, reliability was found to be adequate (r=.650 for Factor 1 and r=.729 for Factor 2). The instrument should be investigated further to determine its other psychometric properties (AU).

El presente estudio tuvo como objetivo agregar evidencias de validez a la Escala de Potencial Creativo en el Trabajo, investigando la influencia de las variables relacionadas con el tema (género, edad y nivel de educación) y el entorno organizacional (tiempo en la empresa) en los resultados a través del método de test-retest. La muestra consistió en 371 participantes, con una edad media de 33.1 años, empleados de pequeñas y grandes empresas. Ninguna de las variables resultó significativa en los dos factores del instrumento (bloqueos y barreras a la creatividad; atributos y características que favorecen la creatividad). Solo tres interacciones fueron significativas (sexo x edad en el Factor 1; educación x edad en el Factor 1; edad x tiempo en el Factor 2). La precisión demostró ser adecuada (r = 0.650 en el Factor 1 y r = 0.729 en el Factor 2). Se recomienda la realización de estudios para investigar otras cualidades psicométricas del instrumento (AU).

Biomarcadores salivares do carcinoma de células escamosas / Salivary biomarkers of squamous cell carcinoma

O carcinoma de células escamosas (OSCC) é uma neoplasia maligna que atinge a cavidade oral, lábios e orofaringe com uma das maiores taxa de mortalidade em todo o mundo, quando em comparação com outros carcinomas, o que o torna um problema de saúde pública (MORO, 2018). Devido à sua grande prevalência, os pesquisadores buscam por mecanismos para aprimorar o diagnóstico da doença em sua fase inicial, no intuito de possibilitar melhor qualidade de vida e sobrevida a esses pacientes (CHENG et al., 2014). Tem-se desenvolvido estudos através da expressão de proteínas, envolvendo o mecanismo biomolecular da carcinogênese oral na busca de identificação de biomarcadores que tenham potencial preditivo e um bom prognóstico para OSCC (CARVALHO; OLIVEIRA, 2015; LOUSADA-FERNANDEZ et at., 2018). Em uma revisão sobre o genoma salivar do câncer oral, este destacou-se justamente pelo fato de suas proteínas estarem localmente expressas (SHAH et at., 2011), tornando seus biomarcadores salivares de fácil e rápida coleta, já que a proliferação desordenada de células malignas deixa derivados de DNA, RNA, vesiculas (exossomos) e marcadores proteicos nos fluidos creviculares, podendo demostrar de forma preventiva o câncer. Com isso, esses biomarcadores podem ser identificados na fase inicial da doença, ao contrário do exame clínico, já que as manifestações clínicas são tardias, o que gera um prognóstico ruim (LOUSADA-FERNANDEZ et al., 2018). Diante desse quadro, o objetivo deste trabalho foi fazer uma revisão de literatura acerca do papel dos biomarcadores tumorais e discutir sobre a atual situação do câncer bucal, justificando o uso de biomarcadores salivares e entendendo seu papel no diagnóstico precoce. Para isso foi feita uma busca detalhada nas bases de dados Pubmed-Medline, Biblioteca Virtual em Saúde, Lilacs e Scielo, para identificar os mais recentes biomarcadores citados nas literaturas ultilizando as palavras-chaves: carcinoma, biomarcadores, saliva. Também foram incluídos dados coletados da Organização Mundial da Saúde e do Instituto Nacional do Câncer.

Death and Resistance: Professionals on the Front Line Against COVID-19 / Morte e Resistência: Profissionais na Linha de Frente Contra a Covid-19 / Muerte y Resistencia: Profesionales de Primera Línea Contra el Covid-19

Abstract The COVID-19 pandemic has intensely affected the quality of life and labor conditions of healthcare workers (HCWs). This study sought to understand the experiences of 16 professionals in medicine, nursing and physical therapy who work on the "frontline" of the new Coronavirus. A phenomenological design was used. Results were organized into four axes: (a) the impact of the arrival of the pandemic; (b) participants' progressive exhaustion; (c) fear and coping; and (d) rethinking life and death. Experiences of anguish, anxiety, depression, and physical and psychological health problems stand out. It was possible to observe that the lack of national coordination, in addition to unscientific political positions, were felt as an aggravating factor for work demands, and that impotence in the face of the disease implicated in rethinking the meaning of life and death. According to the JD-R model, the need to expand resources and emotional support so HCWs can properly manage psychosocial risk factors at work is evident.

Resumo A pandemia vem afetando intensamente a qualidade de vida e condições laborais dos trabalhadores da saúde (TS). Este estudo teve por objetivo compreender as vivências de 16 profissionais da medicina, enfermagem e fisioterapia que atuam na "linha de frente" do novo coronavírus. Empregou-se desenho fenomenológico. Os resultados foram organizados em quatro eixos: (a) o impacto da chegada; (b) desgaste progressivo; (c) medo e enfrentamento e (d) repensando a morte e a vida. Destacam-se vivências de angústia, ansiedade, depressão, agravos à saúde física e psicológica. Foi possível observar que a falta de coordenação nacional somada a posicionamentos políticos anticientíficos foi sentida como agravante das demandas laborais e que a impotência diante da doença implicou repensar o sentido da vida e da morte. Com base no modelo JD-R, fica evidente a necessidade de ampliar recursos e suporte emocional aos TS a fim de administrar adequadamente os Fatores Psicossociais de Risco no Trabalho.

Resumen La pandemia ha afectado intensamente la calidad de vida y condiciones laborales de los trabajadores de la salud (TS). Este estudio buscó conocer experiencias de 16 profesionales de medicina, enfermería y fisioterapia que trabajan en la "primera línea" del nuevo coronavirus. Se utilizó diseño fenomenológico. Los resultados se organizaron en: (a) el impacto de la llegada; (b) desgaste progresivo; (c) miedo y confrontación; y (d) repensar la muerte y la vida. Se destacan experiencias de angustia, ansiedad, depresión, problemas de salud física y psicológica. Se observó que la falta de coordinación nacional, sumada a posiciones políticas acientíficas, fue un agravante de demandas laborales y que la impotencia frente a la enfermedad implicaba repensar el sentido de la vida y la muerte. Desde el modelo JD-R, es evidente la necesidad de ampliar recursos y apoyo emocional a los TS para gestionar adecuadamente los Factores de Riesgo Psicosocial en el Trabajo.

Acute pancreatitis and COVID-19: A literature review.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19), and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARS-CoV-2, but the mechanisms of pancreatic injury are still a subject of debate. There is also controversy on whether SARS-CoV-2 can cause AP or if it is an epiphenomenon. AIM: To review and to explore the relationship between SARS-CoV-2 infection and AP, and to provide an overview of the existing literature on possible mechanisms of SARS-CoV-2-induced pancreatic lesion. METHODS: A systematic review was conducted in accordance with PRISMA guidelines for papers on SARS-CoV-2 infection and AP. A narrative review on possible mechanisms of SARS-CoV-2-induced pancreatic lesion was also performed. RESULTS: A literature review revealed a growing body of evidence on SARS-CoV-2-induced pancreatic lesions including the mechanisms of direct virus-mediated injury, systemic inflammatory response and circulating pro-inflammatory interleukins, virus-induced lipotoxicity, and drug-induced injury. A systematic review of the literature revealed 22 cases of AP in COVID-19 patients. However, limitations of the reported cases make it difficult to establish a causal relationship between SARS-CoV-2 infection and AP. All of the studies agreed on special monitoring and surveillance of this subset of patients due to the still unknown clinical progression, therapeutic implications, and prognosis. CONCLUSION: AP should be considered in COVID-19 patients, especially in those exhibiting abdominal pain and systematic, and complete reporting of these cases should be general practice. However, there is still insufficient evidence showing that COVID-19 can cause AP or negatively impact prognosis. Additional studies are needed to clarify the relationship between these two entities and their theragnostic significance.

Fibrolipoma em cavidade oral: relato de caso / Fibrolipoma of the oral cavity: case report

Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma.

O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas

Tratamento de hemangioma em mucosa labial por escleroterapia: relato de caso clínico / Treatment of hemangioma in labial mucosa by sclerotherapy: clinical case report

O hemangioma é uma lesão vascular, podendo represen-tar-se como uma neoplasia benigna dos vasos sanguíneos, relativamente rara na cavidade oral, podendo causar prejuízo estético e funcional a depender da sua região. Sua localiza-ção mais frequente é o lábio superior, mas pode ocorrer em outras regiões, como língua, mucosa jugal e palato. O seu tratamento depende, principalmente, do correto diagnóstico da lesão, bem como da localização anatômica da mesma e pode ser realizado com esclerose química, crioterapia, la-serterapia, excisão cirúrgica convencional, embolia arterial ou eletrocautério. O objetivo desse trabalho é apresentar um caso clínico, de um paciente do gênero masculino, 63 anos de idade, apresentando hemangioma desde os 16 anos de idade, com recidiva há dez anos em lábio superior. Ao exame físico intrabucal observou-se uma lesão tumoral, de coloração arroxeada, base séssil, assintomática, com limites bem definidos, medindo aproximadamente 4 cm em seu maior diâmetro, localizada na mucosa labial superior. Foi realizada manobra de vitropressão que apresentou um esmaecimento da coloração arroxeada, permitindo diag-nóstico clínico de hemangioma. O tratamento proposto foi a esclerose terapêutica com cinco aplicações de oleato de monoetanolamina 5%, considerando as características clínicas e os métodos de diagnóstico desta lesão. Por meio de um diagnóstico preciso e uma conduta terapêutica ade-quada, o caso apresenta-se com um acompanhamento de dois meses com significativa redução até o momento, e com um resultado estético funcional satisfatório. Conclui-se que a eficácia da escleroterapia realizada com o uso do oleato de monoetanolamina 5% é uma alternativa terapêutica segura.

Hemangioma is a vascular lesion, and may represent a benign neoplasm of blood vessels, relatively rare in the oral cavity, and may cause aesthetic and functional impairment depending on its region. Its most frequent location is the upper lip, but may occur in other regions, such as tongue, jugal mucosa and palate. Its treatment depends mainly on the correct diagnosis of the lesion, as well as its anatomical location and can be performed with chemical sclerosis, cryotherapy, laser therapy, conventional surgical excision, arterial embolism or electrocautery. The aim of this paper is to present a case report of a 63-year-old male patient with hemangioma since he was 16 years old, with a recurrence of the upper lip for 10 years. Physical examination revealed an asymptomatic purplish-colored, lesion-shaped tumor with well-defined limits, measuring approximately 4 cm in its largest diameter, located in the upper lip mucosa. A vitropression maneuver was performed that showed a faint purplish coloration, allowing a clinical diagnosis of hemangioma. The proposed treatment was therapeutic sclerosis with five applications of 5% mono-ethanolamine oleate, considering the clinical characteristics and diagnostic methods of this lesion. Through an accurate diagnosis and an appropriate therapeutic approach, the case presents a two-month follow-up with significant reduction so far, and a satisfactory functional aesthetic result. It is concluded that the effectiveness of sclerotherapy perfor-med with the use of 5% monoethanolamine oleate is a safe therapeutic alternative.

Gastroenteric Viruses Detection in a Drinking Water Distribution-to-Consumption System in a Low-Income Community in Rio de Janeiro.

The availability of drinking water is one of the main determinants of quality of life, disease prevention and the promotion of health. Viruses are important agents of waterborne diseases and have been described as important markers of human faecal contamination. This study aimed to investigate viruses' presence as an indicator of drinking water quality in low-income communities in the Manguinhos area, Rio de Janeiro, Brazil. Three hundred and four drinking water samples (2L/each) were collected along the drinking water distribution-to-consumption pathway in households, as well as healthcare and school units. Water samples were collected both directly from the water supply prior to distribution and after storage in tanks and filtration units. Using qPCR, viruses were detected 50 times in 45 water samples (15%), 19 of these being human adenovirus, 17 rotavirus A and 14 norovirus GII. Viral loads recovered ranged from 5E+10 to 8.7E+106 genome copies/Liter. Co-detection was observed in five household water samples and there was no difference regarding virus detection across sampling sites. Precarious and inadequate environmental conditions characterized by the lack of local infrastructure regarding basic sanitation and waste collection in the territory, as well as negligent hygiene habits, could explain viral detection in drinking water in regions with a water supply system.

Stuttering Impact: A Shared Perception for Parents and Children?

BACKGROUND/AIMS: Previous research has provided information about how school-aged children perceive their own stuttering; however, less is known about how stuttering is perceived by their parents. The ways that parents view their children's stuttering could influence how the children themselves react to it. This study proceeds to assess how parents' perceptions of the impact of stuttering relate to the perceptions of children. METHOD: Participants were 50 children who stutter aged 7-12 years (mean = 9.10; SD = 1.7) and their parents, recruited from different cities in Portugal. The European Portuguese version of the Overall Assessment of the Speaker's Experience of Stuttering was administered to the children, and an adapted version of the tool was administered to their parents. RESULTS: Both parents and children showed generally similar overall impact ratings, typically falling in the mild and moderate ranges. Differences were observed in families with a history of stuttering: for those families, a comparison of parents' and children's scores revealed, in some domains, that parents perceived the impact of stuttering to be greater than the children did, especially related with children's reactions to stuttering and their quality of life. CONCLUSION: Knowledge about how parents perceive the impact of stuttering on their children is important because families can play a key role in helping children cope with stuttering. These findings highlight the benefits of using an individualized treatment approach for each child that focuses on their perceptions, as well as on those of the parents, in order to address negative attitudes toward children's stuttering.

Detection of salivirus in raw sewage samples in Rio de Janeiro, Brazil

Gastroenteric viruses are important pathogens related to cases of acute gastroenteritis, affecting millions of people worldwide with a major impact on children under five in developing countries. The introduction of metagenomic approach techniques in the 2000s has allowed the description of new viruses, among them Salivirus, which has been associated worldwide with cases of diarrhea. This study aimed to detect salivirus in raw sewage samples from a wastewater treatment plant (WWTP) collected between June 2013 and May 2014 in Rio de Janeiro, Brazil. Fifty-two samples collected weekly were tested by using a real-time quantitative PCR (qPCR). Salivirus genome was detected in 71.1% (37/52) of the samples, with viral concentration ranging from 7.56 x 104 to 7.20 x 106 genomic copies per liter. Higher viral loads were detected in the summer and fall of 2014, although these data were not sufficient to infer seasonality for this virus. The high prevalence of salivirus in sewage samples highlights the importance of viral research in wastewater to generate data on salivirus circulation, increasing understanding regarding its dissemination in the population.

Temperament, Executive Functioning, and Anxiety in School-Age Children Who Stutter.

The purpose of this study was to examine temperament dimensions, executive functioning ability, and anxiety levels in school-age children who stutter and their non-stuttering peers. Participants were 100 Portuguese children aged 7 to 12 years (M = 9.13; SD = 1.70), including 50 children who stutter and 50 children who do not stutter. Analyses, which were performed separately for younger and older participants, sought to identify correlations between key variables. Temperament was evaluated through a parent questionnaire, executive functioning was evaluated through children's responses on a performance test, and anxiety level was assessed through a self-perception scale. On the temperament measure, comparisons between children who stutter and their non-stuttering peers revealed that older children who stutter exhibited significantly higher scores on the Anger/Frustration, Impulsivity, and Sadness subscales, and lower averages on the Attention/Focusing, Perceptual sensitivity, and Soothability/Falling Reactivity subscales. On the executive functioning task, comparisons revealed that the group of younger children who stutter exhibited significantly higher average execution times than their non-stuttering peers. There were no statistically significant differences in anxiety between children who stutter and children who do not stutter, and there were no statistically significant correlations between temperament factors and measures of executive functioning. Children who stutter experienced lower ability to orient attention and greater emotional reactivity compared with their non-stuttering peers. Significant correlations were found between executive functioning and age and among the temperament factors themselves. These results, which support the need for a multidimensional view of stuttering, were interpreted in the context of the Dual Diathesis - Stressor model. Findings indicate that temperament and executive functioning abilities may contribute to the development of stuttering.

Instructional therapeutic toy in the culture care of the child with diabetes type 1.

OBJECTIVE: To analyze the experience of the child with diabetes type 1 in the care related to the techniques of glycemic monitoring and insulin application by use of instructional therapeutic toy, in accordance with the culture care. METHOD: Qualitative study with premise of the ethnonursing carried out in secondary public service of reference in the treatment of diabetes, in the city Fortaleza, Ceará State, between January and November of 2014, among 26 school-age children. Based on the Observation, Participation, Reflection Enabler, were developed educational activities using instructional therapeutic toy. RESULTS: The children expressed doubts regarding the insulin therapy and the glycaemia checking. They also were interested in the orientations mediated by means of the therapeutic toy in the culture care. They asked about the rotation, location and administration of the insulin. Some children asked for the syringes to play and learn how to inject it in the dolls. CONCLUSION: To bring in this activity promoted approximation and effective communication with the child in the educational approach, increasing its ability in the self care.

Surveillance of Noroviruses in Rio De Janeiro, Brazil: Occurrence of New GIV Genotype in Clinical and Wastewater Samples.

Genogroup (G) IV norovirus (NoV) has been described in the literature as infectious agents in humans, although there are few reports regarding the frequency and spread of this virus, resulting in insufficient epidemiological data. The aim of this study was to investigate the occurrence of GIV norovirus in the State of Rio de Janeiro, Brazil in order to evaluate frequency, concentration, and genetic diversity using clinical and environmental approaches. For this purpose, 316 stool samples were collected from acute gastroenteritis cases reported over a period of three years. Wastewater samples were also obtained from the main wastewater treatment plant (WWTP) located in Rio de Janeiro throughout one year, totalizing 156 samples. All samples were submitted to quantitative analysis by TaqMan™ real-time PCR for GIV norovirus. Three out of 316 clinical samples were positive (0.9%) for GIV, with viral load ranging from 104 to 106 genome copies (CG) per gram. Regarding wastewater samples, GIV were detected in 52% of raw sewage, with viral load ranging from 104 to 106 CG per liter. Phylogenetic analysis revealed the circulation of a new GIV genotype in both clinical and environmental samples. To our knowledge, this is the first description of GIV norovirus in clinical samples in Brazil. These results demonstrate the importance of performing laboratory surveillance of clinical and environmental samples, assisting the comprehension of the epidemiology pattern of viruses with neglected diagnosis and indefinite impact in the population.

Instructional therapeutic toy in the culture care of the child with diabetes type 1 / Juguete terapéutico instructivo en el cuidado cultural del niño con diabetes tipo 1 / Brinquedo terapêutico instrucional no cuidado cultural da criança com diabetes tipo 1

ABSTRACT Objective: To analyze the experience of the child with diabetes type 1 in the care related to the techniques of glycemic monitoring and insulin application by use of instructional therapeutic toy, in accordance with the culture care. Method: Qualitative study with premise of the ethnonursing carried out in secondary public service of reference in the treatment of diabetes, in the city Fortaleza, Ceará State, between January and November of 2014, among 26 school-age children. Based on the Observation, Participation, Reflection Enabler, were developed educational activities using instructional therapeutic toy. Results: The children expressed doubts regarding the insulin therapy and the glycaemia checking. They also were interested in the orientations mediated by means of the therapeutic toy in the culture care. They asked about the rotation, location and administration of the insulin. Some children asked for the syringes to play and learn how to inject it in the dolls. Conclusion: To bring in this activity promoted approximation and effective communication with the child in the educational approach, increasing its ability in the self care.

RESUMEN Objetivo: analizar la experiencia del niño con diabetes tipo 1 en los cuidados relacionados con las técnicas de monitoreo glucémico y aplicación de insulina por medio del uso de juguete terapéutico instructivo, a la luz del cuidado cultural. Método: el estudio cualitativo con supuestos de la etnoenfermería realizado en servicio público de referencia en el tratamiento de diabetes, en la ciudad de Fortaleza, Ceará, de enero a noviembre de 2014, con 26 niños en edad escolar. Con base en el modelo observación-participación-reflexión, se desarrollaron actividades educativas con utilización de juguete terapéutico instructivo. Resultados: los niños expresaron sus dudas relacionadas con la insulinoterapia y la verificación de la glucemia y demostraron interés en las orientaciones mediadas por el juguete terapéutico en el cuidado cultural. Se preguntó sobre la rotación, los lugares y la forma de aplicación de la insulina. Otros solicitaron las jeringas para jugar y aprender a aplicar en los muñecos. Conclusión: la inserción de esa actividad favoreció la aproximación y la comunicación efectiva con el niño en el enfoque educativo, ampliando sus habilidades en su propio cuidado.

RESUMO Objetivo: analisar a experiência da criança com diabetes tipo 1 nos cuidados relacionados às técnicas de monitoração glicêmica e aplicação de insulina mediada pelo brinquedo terapêutico instrucional, à luz do cuidado cultural. Método: estudo qualitativo com pressupostos da Etnoenfermagem, realizado em serviço público de referência no tratamento de diabetes, em Fortaleza, Ceará, de janeiro a novembro de 2014, com 26 crianças em idade escolar. Com base no modelo observação-participação-reflexão, desenvolveram-se atividades educativas com utilização de brinquedo terapêutico instrucional. Resultados: as crianças expressaram suas dúvidas relacionadas à insulinoterapia e à verificação da glicemia e demonstraram interesse nas orientações mediadas pelo brinquedo terapêutico no cuidado cultural. Questionaram sobre rodízio, locais e forma de aplicação da insulina. Outras solicitaram as seringas para brincar e aprender a aplicar nos bonecos. Conclusão: essa atividade favoreceu a aproximação e a comunicação efetiva com a criança na abordagem educativa, ampliando suas habilidades no cuidado de si.

Folic Acid Impairs the Uptake of 5-Methyltetrahydrofolate in Human Umbilical Vascular Endothelial Cells.

BACKGROUND: Adequate folate status supports endothelial structure and function. Folic acid (FA), an oxidized synthetic folate, which is present in the plasma of patients consuming fortified food or FA supplements, may impair cellular uptake of physiological, reduced folates. We studied the effect of FA on uptake of the dominant circulatory folate, 5-methyltetrahydrofolate (5MTHF) in endothelial cells. METHODS AND RESULTS: For short-term effects of FA, primary human umbilical vein endothelial cells (HUVECs) were maintained in growth medium containing 200 nM 5MTHF and preincubated with 20 nM FA 10 minutes before the 5MTHF uptake assessment. For long-term effects, HUVECs were cultured for 3 passages in growth medium containing either 200 nM 5MTHF, or a combination of 100 nM 5MTHF and 100 nM FA. 5MTHF uptake was assessed after exposing cells to 200 nM [C5]-5MTHF, after which intracellular [C5]-5MTHF was quantified using liquid chromatography/tandem mass spectrometry. Acute FA exposure caused a 57% reduction in 5MTHF uptake compared with control conditions (51 ± 12 vs. 22 ± 7 fmol·min·mg protein; P = 0.01). Long-term exposure to FA reduced 5MTHF uptake by 41% (51 ± 12 vs. 30 ± 11 fmol·min·mg protein; P = 0.05) and reduced total cellular 5MTHF levels by 47 ± 21% in HUVEC (P = 0.02). CONCLUSION: Unmetabolized FA, which appears in the plasma after consumption of fortified food or FA supplements, may impair uptake of 5MTHF, the dominant bioactive form of folate, in HUVEC.

Acute Pancreatitis Etiology Investigation: A Workup Algorithm Proposal.

BACKGROUND: Acute pancreatitis represents a significant number of hospital admissions. Most of the patients are admitted in an acute setting. Early identification of its etiology is an essential step toward the rational approach, both for its implications in the immediate therapy and the prevention of recurrence. Although often obvious, the etiological workup of acute pancreatitis can be challenging. CONCLUSION: There are several studies emphasizing the multiple etiologies underlying acute pancreatitis but lacking structured diagnostic workups to allow a rational and organized study. The main goal of this work is to develop an algorithm proposal, which aims to serve as a guide for the investigation of the etiology of acute pancreatitis based on a review of already published literature, adjusted to the reality of our hospital and the available resources.

Enteric viruses in HIV-1 seropositive and HIV-1 seronegative children with diarrheal diseases in Brazil.

Diarrheal diseases (DD) have distinct etiological profiles in immune-deficient and immune-competent patients. This study compares detection rates, genotype distribution and viral loads of different enteric viral agents in HIV-1 seropositive (n = 200) and HIV-1 seronegative (n = 125) children hospitalized with DD in Rio de Janeiro, Brazil. Except for group A rotavirus (RVA), which were detected through enzyme immunoassay, the other enteric viruses (norovirus [NoV], astrovirus [HAstV], adenovirus [HAdV] and bocavirus [HBoV]) were detected through PCR or RT-PCR. A quantitative PCR was performed for RVA, NoV, HAstV, HAdV and HBoV. Infections with NoV (19% vs. 9.6%; p<0.001), HBoV (14% vs. 7.2%; p = 0.042) and HAdV (30.5% vs. 14.4%; p<0.001) were significantly more frequent among HIV-1 seropositive children. RVA was significantly less frequent among HIV-1 seropositive patients (6.5% vs. 20%; p<0.001). Similarly, frequency of infection with HAstV was lower among HIV-1 seropositive children (5.5% vs. 12.8%; p = 0.018). Among HIV-1 seropositive children 33 (16.5%) had co-infections, including three enteric viruses, such as NoV, HBoV and HAdV (n = 2) and NoV, HAstV and HAdV (n = 2). The frequency of infection with more than one virus was 17 (13.6%) in the HIV-1 negative group, triple infection (NoV + HAstV + HBoV) being observed in only one patient. The median viral load of HAstV in feces was significantly higher among HIV-1 positive children compared to HIV-1 negative children. Concerning children infected with RVA, NoV, HBoV and HAdV, no statistically significant differences were observed in the medians of viral loads in feces, comparing HIV-1 seropositive and HIV-1 seronegative children. Similar detection rates were observed for RVA, HAstV and HAdV, whilst NoV and HBoV were significantly more prevalent among children with CD4+ T lymphocyte count below 200 cells/mm3. Enteric viruses should be considered an important cause of DD in HIV-1 seropositive children, along with pathogens more classically associated with intestinal infections in immunocompromised hosts.