Measuring the value of solidarity: The abem financial assistance program for out-of-pocket payments on pharmacy medicines in Portugal.

OBJECTIVE: Out-of-pocket payments for prescribed medicines are still comparatively high in Portugal. The abem program was launched in Portugal in May 2016 to aid vulnerable groups by completely covering out-of-pocket costs of prescribed medicines in community pharmacies. This study assesses the impact of the program on poverty and catastrophic health expenditures. METHODS: A longitudinal study was carried out with the analysis of several program databases (from the beginning of the program in May 2016 to September 2018) covering the cohorts of beneficiaries, daily data on medicines dispensed, social referencing entities, and solidarity pharmacies. The study provides estimates of standard poverty measures (intensity and severity) as well as the incidence of catastrophic health expenditures. RESULTS: More than 6000 beneficiaries were supported (56.8% female, 34.7% aged 65 or over), encompassing 127,510 medicines (mainly nervous system and cardiovascular system) with an average 26.9% co-payment (payments totalling €1.5 million). The program achieved substantial reductions in poverty (3.4% in intensity, 5.6% in severity), and eliminated cases with catastrophic health expenditures in medicines that would have affected 7.5% of the beneficiaries. CONCLUSIONS: Findings confirm a continuous increase in the number of beneficiaries, enabling access to medicines especially for the vulnerable elderly, and a sizable impact on eliminating out-of-pocket payments for medicines in the target population.

[Oral Anticoagulation and the Incidence of Stroke Associated with Atrial Fibrillation in Mainland Portugal: A Modelling Study]. / Anticoagulação Oral e Incidência de Acidente Vascular Cerebral Associado a Fibrilhação Auricular em Portugal Continental: Um Estudo de Modelação.

INTRODUCTION: Atrial fibrillation is the most prevalent persistent dysrhythmia, contributing to a significant social and economic burden. The main objective of this study was to evaluate the association between oral anticoagulant use and the incidence of stroke associated with atrial fibrillation, in mainland Portugal. METHODS: The number of episodes of inpatient care with a main diagnosis of stroke and an additional diagnosis of atrial fibrillation, occurring monthly between January 2012 and December 2018, in individuals aged 18 years or over, was extracted from the hospital morbidity database. The number of patients with an atrial fibrillation code documented in this database was used as a proxy for the prevalence of known atrial fibrillation. The number of anticoagulated patients was estimated from total medicine sales of vitamin K antagonists and novel oral anticoagulants (apixaban, dabigatran, edoxaban and rivaroxaban) in mainland Portugal. Descriptive analyses were performed, and seasonal autoregressive integrated moving average (SARIMA) models were built using the R software. RESULTS: The mean number of episodes of stroke per month was 522 (± 57). The number of anticoagulated patients increased gradually from 68 943 to 180 389 per month. The decreasing trend in the number of episodes has been observed since 2016, along with the increased use of new oral anticoagulants compared to vitamin K antagonists. The final model indicated that the increase in oral anticoagulation use between 2012 and 2018, in mainland Portugal, was associated with a decrease in the number of episodes of stroke associated with atrial fibrillation. It was estimated that the shift in the type of anticoagulation used, between 2016 and 2018, was associated with a reduction of 833 episodes of stroke in patients with atrial fibrillation (4.2%). CONCLUSION: The use of oral anticoagulation was associated with a reduced incidence of stroke in patients with atrial fibrillation in mainland Portugal. This reduction was more relevant in the period between 2016 and 2018, and is probably related with the introduction of the novel oral anticoagulants.

Introdução: A fibrilhação auricular é a disritmia persistente mais prevalente, tendo um importante impacto social e económico. O objetivo principal deste estudo foi avaliar a associação entre a utilização de anticoagulantes orais e a incidência de acidente vascular cerebral associado a fibrilhação auricular, em Portugal continental. Métodos: A base de dados de morbilidade hospitalar foi utilizada para a contabilização dos episódios de internamento com um diagnóstico principal de acidente vascular cerebral e um diagnóstico adicional de fibrilhação auricular, ocorridos durante cada mês do período em análise (janeiro de 2012 a dezembro de 2018), em indivíduos com idade igual ou superior a 18 anos. O número de doentes com registo de fibrilhação auricular presentes nesta base de dados foi utilizado como um proxy da prevalência de fibrilhação auricular conhecida. O número de doentes anticoagulados foi estimado a partir das estatísticas das vendas de antagonistas da vitamina K e novos anticoagulantes orais (apixabano, dabigatrano, edoxabano e rivaroxabano) em Portugal continental. Foi realizada uma análise descritiva das variáveis, construindo-se depois modelos auto-regressivos integrados de médias móveis sazonais (seasonal autoregressive integrated moving average, SARIMA), com recurso ao software R. Resultados: Ocorreram, em média, 522 (± 57) episódios de acidente vascular cerebral por mês. Verificou-se um aumento gradual do número de doentes anticoagulados, passando de 68 943 para 180 389, por mês. A tendência decrescente no número de episódios verificou-se a partir de 2016, a par da maior utilização dos novos anticoagulantes orais, comparativamente aos antagonistas da vitamina K. O modelo final estimado indicou que o aumento do consumo de anticoagulação oral entre 2012 e 2018 em Portugal continental foi associado a um decréscimo do número de acidentes vasculares cerebrais associados a fibrilhação auricular. Estimou-se que, entre 2016 e 2018, a mudança no tipo de anticoagulação se associou a uma redução de 833 episódios de acidentes vascular cerebrais em doentes com fibrilhação auricular (4,2%). Conclusão: A anticoagulação oral associou-se à redução da incidência de acidente vascular cerebral em doentes com fibrilhação auricular, em Portugal continental. Esta redução foi mais relevante no período 2016 a 2018, em provável relação com a introdução dos novos anticoagulantes orais.

[The Antonio Gonçalves Peryassú mosquito collection at the Museu Nacional, in Rio de Janeiro: retrieving the memory of lost heritage]. / A coleção de mosquitos de Antonio Gonçalves Peryassú do Museu Nacional, Rio de Janeiro: registro de memória de um patrimônio desaparecido.

Collections formed and studies conducted in the early decades of the twentieth century in Rio de Janeiro, Brazil, were crucial for the study of the systematization and natural history of mosquitoes in Brazil. One key figure in this context was Antonio Gonçalves Peryassú. The history of a collection he organized at Museu Nacional [National Museum] in Rio de Janeiro between 1918 and 1922 is analyzed.

As coleções e pesquisas feitas nas primeiras décadas do século XX, no Rio de Janeiro, foram fundamentais para o estudo da sistemática e da história natural dos mosquitos no Brasil. Um personagem de destaque nesse cenário foi Antonio Gonçalves Peryassú. Analisamos o histórico de uma coleção por ele organizada no Museu Nacional do Rio de Janeiro, entre 1918 e 1922.

A coleção de mosquitos de Antonio Gonçalves Peryassú do Museu Nacional, Rio de Janeiro: registro de memória de um patrimônio desaparecido / The Antonio Gonçalves Peryassú mosquito collection at the Museu Nacional, in Rio de Janeiro: retrieving the memory of lost heritage

Resumo As coleções e pesquisas feitas nas primeiras décadas do século XX, no Rio de Janeiro, foram fundamentais para o estudo da sistemática e da história natural dos mosquitos no Brasil. Um personagem de destaque nesse cenário foi Antonio Gonçalves Peryassú. Analisamos o histórico de uma coleção por ele organizada no Museu Nacional do Rio de Janeiro, entre 1918 e 1922.

Abstract Collections formed and studies conducted in the early decades of the twentieth century in Rio de Janeiro, Brazil, were crucial for the study of the systematization and natural history of mosquitoes in Brazil. One key figure in this context was Antonio Gonçalves Peryassú. The history of a collection he organized at Museu Nacional [National Museum] in Rio de Janeiro between 1918 and 1922 is analyzed.

Atherosclerosis in the primary health care setting: A real-word data study.

INTRODUCTION AND OBJECTIVES: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. METHODS: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. RESULTS: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). CONCLUSIONS: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.

Through the Looking Glass: Unraveling the Stage-Shift of Acute Rejection in Renal Allografts.

Sub-optimal sensitivity and specificity in current allograft monitoring methodologies underscore the need for more accurate and reflexive immunosurveillance to uncover the flux in alloimmunity between allograft health and the onset and progression of rejection. QSant-a urine based multi-analyte diagnostic test-was developed to profile renal transplant health and prognosticate injury, risk of evolution, and resolution of acute rejection. Q-Score-the composite score, across measurements of DNA, protein and metabolic biomarkers in the QSant assay-enables this risk prognostication. The domain of immune quiescence-below a Q-Score threshold of 32-is well established, based on published AUC of 98% for QSant. However, the trajectory of rejection is variable, given that causality is multi-factorial. Injury and subtypes of rejection are captured by the progression of Q-Score. This publication explores the clinical utility of QSant across the alloimmunity gradient of 32-100 for the early diagnosis of allograft injury and rejection.

The impact of fake news on social media and its influence on health during the COVID-19 pandemic: a systematic review.

PURPOSE: As the new coronavirus disease propagated around the world, the rapid spread of news caused uncertainty in the population. False news has taken over social media, becoming part of life for many people. Thus, this study aimed to evaluate, through a systematic review, the impact of social media on the dissemination of infodemic knowing and its impacts on health. METHODS: A systematic search was performed in the MedLine, Virtual Health Library (VHL), and Scielo databases from January 1, 2020, to May 11, 2021. Studies that addressed the impact of fake news on patients and healthcare professionals around the world were included. It was possible to methodologically assess the quality of the selected studies using the Loney and Newcastle-Ottawa Scales. RESULTS: Fourteen studies were eligible for inclusion, consisting of six cross-sectional and eight descriptive observational studies. Through questionnaires, five studies included measures of anxiety or psychological distress caused by misinformation; another seven assessed feeling fear, uncertainty, and panic, in addition to attacks on health professionals and people of Asian origin. CONCLUSION: By analyzing the phenomenon of fake news in health, it was possible to observe that infodemic knowledge can cause psychological disorders and panic, fear, depression, and fatigue.

Atherosclerosis: The cost of illness in Portugal.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. METHODS: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. RESULTS: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). CONCLUSIONS: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

The burden of atherosclerosis in Portugal.

AIMS: This article sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. METHODS AND RESULTS: The burden of atherosclerosis was measured in disability-adjusted life years following the latest 2010 Global Burden of Disease (GBD) methodology. Disability-adjusted life years were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischaemic heart disease (IHD) (including acute myocardial infarction, stable angina, and ischaemic heart failure), ischaemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Years of life lost were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD, and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. Years lived with disability corresponded to the product of the number of prevalent cases by an average disability weight for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. Disability weights were sourced from the published literature. In 2016, 15 123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. Disability-adjusted life years totalled 260 943, 75% due to premature death (196 438 YLL) and 25% due to disability (64 505 YLD). CONCLUSION: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.

Covid-19: medidas de saúde pública para o enfrentamento da pandemia no Estado do Paraná / Covid-19: Public Health Measures for the management of the pandemic in the State of Paraná

Estudo descritivo com o objetivo de identificar as principais medidas de saúde pública divulgadas pelo governo do estado do Paraná para o combate à pandemia da Covid-19, entre 1 de janeiro a 27 de junho de 2020, e publicadas em veículos de comunicação oficiais. Entre as iniciativas governamentais estão medidas de prevenção da infecção, testagem da população, ampliação do número de leitos hospitalares e separação de áreas exclusivas Covid-19 nos hospitais. Até o momento do estudo, as estratégias governamentais adotadas foram capazes de manter o número de casos dentro da capacidade do sistema de saúde estadual. (AU)

This is a descriptive study that aims to elucidate the main public health measures reported by Paraná state government for the management of Covid-19 pandemic, from January 1st to June 27th, 2020, and published by official websites. Among the governmental initiatives are measures for infection control and prevention, population testing, hospital bed expansion and creation of Covid-19 exclusive areas in hospitals. Until the time of the study, the adopted government strategies maintained the number of cases within the state health system capacity. (AU)

Perfil epidemiológico da Covid-19 no Estado do Paraná / Epidemiological profile of Covid-19 in the State of Paraná

A pandemia de Covid-19 já causou mais de 990 mil óbitos pelo mundo. A doença, causada pelo coronavírus SARS-CoV-2, é um importante problema de saúde pública. Desde 12 de março até 28 de setembro de 2020, foram registrados 174.124 casos e 4.335 óbitos pela doença no Paraná. O estudo teve como objetivo traçar o perfil epidemiológico da Covid-19 no Paraná. Fez--se análise descritiva com dados do informe epidemiológico da Secretaria de Saúde do Estado. Até 28 de setembro de 2020, 1,5% da população paranaense havia sido contaminada e 72,6% dos pacientes já estavam recuperados. A média de idade dos casos e óbitos foram, respectivamente, de 39,8 e 68,6 anos. Dos confirmados, 91.676 (53%) eram do sexo feminino e dos óbitos, 2.599 (60%) do masculino. Dos 906 (0,5%) pacientes internados, 446 (49,2%) estavam em UTI. A taxa de letalidade era de 2,5%. É possível delinear o com-portamento da doença no Estado. (AU)

Covid-19 pandemic has already caused more than 990 thousand deaths worldwide. The coronavirus disease, due to SARS-CoV-2, is an important public health problem. From March 12 to September 28, 2020, Paraná has already registered 174.124 cases and 4.335 deaths. The aim of this study is to describe the epidemiological profile of Covid-19 in the state of Paraná. Data collection were informed by Health Secretary of Paraná. As of September 28, 1,5% of Paraná population had been infected and 72,6% had recovered. The mean age of confirmed cases and deaths were 39,8 and 68,6 years old, respectively. Among confirmed cases, 91.676 (53%) were female and among deaths, 2.599 (60%) were male. 906 (0,5%) were hospitalized, of which 446 (49,2%) were in ICU bed. Mortality rate was 2,5%. It is possible to determinate the disease's behavior in Paraná. (AU)

Perfil de óbitos por Covid-19 no Estado do Paraná no início da pandemia: estudo transversal / Profile of deaths by Covid-19 in the State of Paraná at the beginning of the pandemic: a cross-section study

O Novo Coronavírus representa uma emergência em saúde pública, trazendo desafios à vigilância epidemiológica. As estatísticas de mortalidade são primordiais nesse contexto e registros condizentes com a realidade de-pendem de um trabalho coordenado entre os serviços e técnicos que trabalham com os sistemas de informação em saúde. O objetivo foi descrever o papel da vigilância epidemiológica na identificação do perfil dos óbitos por Covid-19 no início da pandemia no Estado do Paraná. Trata-se de um estudo transversal a partir de dados do SIM ­ Sistema de Informação em Mortalidade, dados preliminares até a semana epidemiológica 22 (25 de maio de 2020). O perfil de óbitos por Covid-19 no Estado do Paraná com dados até maio de 2020 mostrou características semelhantes às de outras localidades, com maior acometimento do sexo masculino (68%), idosos (67%) e portadores de condições prévias (69%), sendo as principais delas hipertensão (23%), diabetes (21%) e cardiopatia (13%). A equipe de vigilância epidemiológica dos municípios e regionais de saúde tem papel fundamental na captação e qualificação dos dados de mortalidade e, no contexto pandêmico, se beneficia de orientações oportunas e comunicação eficiente por parte do nível estadual de gestão. (AU)

The New Coronavirus represents a public health emergency, bringing challenges to health surveillance such as the need to establish information flows in order to produce reliable statistics to support management actions. Statistics on mortality are essential in this process and records consistent with reality depend on coordinated work between services and information sys-tems. The objective has to describe the role of epidemiological surveillance in identifying the profile of deaths by Covid-19 at the beginning of the pandemic in the State of Paraná. Cross-sectional study using data from SIM ­ Mortality Information System, preliminary data until epidemiological week 22 (May 27, 2020). The mortality profile of deaths by Covid-19 in the state of Paraná with data up to May 2020 showed similar characteristics to the profiles of other locations, demonstrating to affect mostly males (68%), older population (67%) and people with previous conditions (69%), with the main comorbidities being hypertension (23%), diabetes (21%) and heart disease (13%). The epidemiological surveillance team of municipalities and regions of health has a fundamental role in identifying and qualifying mortality data and, in the pandemic context, benefits from timely guidance and efficient communication by the state level of management. (AU)

Centro de Operações de Emergência da Secretaria Estadual de Saúde do Paraná - Pandemia Covid-19 / Emergency operations center of Health Depart-ment of State of Paraná ­ Pandemic Covid-19

Este artigo apresenta o planejamento e ações de enfrentamento à pandemia por Covid-19 pelo Centro de Operações de Emergência em Saúde Pública da Secretaria Estadual de Saúde do Paraná. Trata-se de relato de experiência relativo ao processo de desenvolvimento e produtos decorrentes de ações de enfrentamento da pandemia relativos ao período de fevereiro a junho de 2020. As ações desenvolvidas resultaram na aprovação de 51 documentos direcionados à organização do enfrentamento da pandemia e apre-ciados em mais de 70 reuniões presenciais. Os produtos estão apresentados em assuntos: Medidas Administrativas de Enfrentamento; Controle Sanitário; Populações Vulneráveis e Serviços Especializados de Saúde; Processo de Tra-balho; Rastreamento Laboratorial, Tratamento e Promoção da Saúde; e Dados Epidemiológicos. As ações, experiência e aprendizagem alcançadas pelo Centro de Operações contribuíram para o enfrentamento da pandemia no Estado e contribuirão para enfrentamentos futuros. (AU)

This paper presents the planning and actions to combat the Co-vid-19 pandemic of the Center for Emergency Operations in Public Health of the State Health Department of Paraná. This is an experience report related to the development process and products resulting from actions to combat the pandemic concerning the period from February to June 2020. The actions developed resulted in the approval of 51 documents targeted to the organization of facing the pandemic and appreciated in more than 70 presential meetings. The products are presented in subjects: Administrative Measures of Coping; Sanitary Control; Vulnerable Populations and Specialized Health Ser-vices; Work Process; Laboratorial Tracking, Treatment and Health Promotion; and Epidemiological Data. The actions, experience, and learning achieved by the Operations Center contributed to facing the pandemic in the State and will contribute to future confrontations. (AU)

Takotsubo Multicenter Registry (REMUTA) - Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality. / Registro Multicêntrico de Takotsubo (REMUTA) ­ Aspectos Clínicos, Desfechos Intra-Hospitalares e Mortalidade a Longo Prazo.

BACKGROUND: Takotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil. OBJECTIVE: To describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up. METHODS: This is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted. RESULTS: The registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality. CONCLUSION: The results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216).

FUNDAMENTO: A síndrome de takotsubo (takotsubo) é uma forma de cardiomiopatia adquirida. Dados nacionais sobre essa condição são escassos. O Registro REMUTA é o primeiro a incluir dados multicêntricos dessa condição no nosso país. OBJETIVO: Descrever as características clínicas, prognóstico, tratamento intra-hospitalar e mortalidade hospitalar e em 1 ano de seguimento. MÉTODOS: Estudo observacional, retrospectivo, tipo registro. Incluídos pacientes internados com diagnóstico de takotsubo ou que desenvolveram esta condição durante internação por outra causa. Os desfechos avaliados incluíram fator desencadeador, análise dos exames, uso de medicações, complicações e óbito intra-hospitalar e em 1 ano de seguimento. O nível de significância adotado foi de 5%. RESULTADOS: Foram incluídos 169 pacientes, em 12 centros no Estado do Rio de Janeiro. A idade média foi de 70,9 ± 14,1 anos e 90,5% eram do sexo feminino; 63% dos casos foram de takotsubo primário e 37% secundário. Troponina I foi positiva em 92,5% dos pacientes e a mediana de BNP foi de 395 (176,5; 1725). Supradesnivelamento do segmento ST esteve presente em 28% dos pacientes. A fração de ejeção do ventrículo esquerdo teve mediana de 40 (35; 48)%. Observamos taxa de 25,7% de ventilação mecânica invasiva e 17,4% de choque. Suporte circulatório mecânico foi utilizado em 7,7%. A mortalidade intra-hospitalar foi de 10,6% e a mortalidade ao final de 1 ano foi de 16,5%. Takotsubo secundário e choque cardiogênico foram preditores independentes de mortalidade. CONCLUSÃO: Os resultados do REMUTA mostram que takotsubo não se trata de patologia benigna como se pensava, especialmente no grupo de takotsubo secundário que acarreta elevada taxa de complicações e de mortalidade. (Arq Bras Cardiol. 2020; 115(2):207-216).

Perfil epidemiológico dos portadores de sífilis entre 2010 e 2018 no Estado do Paraná, Brasil / Epidemiological profile of syphilis patients between 2010 and 2018 in Paraná State, Brazil

O objetivo desse trabalho foi analisar os casos de sífilis no Estado do Paraná, e descrever o perfil epidemiológico dos infectados, entre os anos de 2010 e 2018. O presente estudo é quantitativo, descritivo e observacional, foi desenvolvido com dados secundários do Sistema Nacional de Agravos de Notificação (SINAN), com a análise das taxas de detecção da sífilis adquirida. Entre 2010 e 2018 o Paraná registrou 39.900 casos de sífilis adquirida, sendo que 58,5% ocorreram em homens e 41,5% em mulheres. A faixa etária de maior incidência foi entre 20-29 anos (26,9%), seguida por 30-39 anos (21,4%). Quanto a escolaridade, a maioria dos infectados possuía ensino fundamental (18,5%) e médio (19%). A macrorregião leste do Estado apresentou a maior incidência de casos (59,28% dos casos em 2016). Devido ao aumento dos casos de sífilis adquirida no Paraná entre os anos de 2010 a 2018, conclui-se a necessidade do direcionamento de ações de prevenção e rastreio. (AU)

The study aimed to analyze the syphilis cases in Paraná State, and to describe the epidemiological profile of infected individuals, between 2010 and 2018. The present study is quantitative, descriptive and observational; it was developed with secondary data from the National System of Disorders notification, evaluating the detection rate of syphilis acquired. Between 2010 and 2018 Paraná registered 39,900 cases of Acquired Syphilis, being 58.5% in males and 41.5% in females. The age group with the highest incidence was between 20-29 years (26.9%), followed by 30-39 years (21.4%). As for schooling, most of the individuals in the identified cases had elementary (18.5%) and high school education (19%). The eastern macro- region of the state had the highest cases incidence (59.28% of cases in 2016). Due to the increase in syphilis cases acquired in Paraná between 2010 and 2018, it concludes the need to target prevention and screening actions. (AU)

Functional Consequences of PDK4 Deficiency in Doberman Pinscher Fibroblasts.

A splice site mutation in the canine pyruvate dehydrogenase kinase 4 (PDK4) gene has been shown to be associated with the development of dilated cardiomyopathy (DCM) in Doberman Pinchers (DPs). Subsequent studies have successfully demonstrated the use of dermal fibroblasts isolated from DPs as models for PDK4 deficiency and have shown activation of the intrinsic (mitochondrial mediated) apoptosis pathway in these cells under starvation conditions. For this study, we sought to further explore the functional consequences of PDK4 deficiency in DP fibroblasts representing PDK4wt/wt, PDK4wt/del, and PDK4del/del genotypes. Our results show that starvation conditions cause increased perinuclear localization of mitochondria and decreased cell proliferation, altered expression levels of pyruvate dehydrogenase phosphatase (PDP) and pyruvate dehydrogenase (PDH), dramatically increased PDH activity, and an impaired response to mitochondrial stress in affected cells. In sum, these results show the broad impact of PDK4 deficiency and reveal mechanistic pathways used by these cells in an attempt to compensate for the condition. Our data help to elucidate the mechanisms at play in this extremely prevalent DP disorder and provide further support demonstrating the general importance of metabolic flexibility in cell health.

Profile of gestational syphilis in the state of Paraná between 2010 and 2018 / Perfil da sífilis gestacional no estado do Paraná entre 2010 e 2018

Introduction: Gestational syphilis is responsible for increased fetal morbidity and mortality. It is related to intrauterine and neonatal complications, with vertical transmission being the most severe outcome. Screening and treatments are part of the prenatal routine. Objective: To describe the profile of gestational syphilis by state, regional incidence, time of diagnosis and treatment. Methods: Quantitative, descriptive, and observational study developed with secondary data from the National System of Notification of Disorders (Sistema de Informação de Agravos de Notificação ­ SINAN), to evaluate the variables: region, trimester of diagnosis and treatment of gestational syphilis. Results: Between 2010­2018, Paraná recorded 12,011 cases of gestational syphilis, corresponding to 8.5 per 1,000 live births. There was an increase in the number of cases across the state. Among infected pregnant women, most were between 20­29 years old (50.6%). Of the diagnoses, 43.6% were performed in the first trimester of pregnancy and 26.6% in the second. The most widely used treatment regimen was benzathine penicillin G 7,200,000 IU (63.7%). Conclusion: There was an increase in gestational syphilis in Paraná, however, there was greater effectiveness in diagnosis and treatment, with greater detection in the first trimester of pregnancy and prevalence of use of benzathine penicillin G. The study highlights the importance of correct clinical management and early detection, measures that prevent vertical transmission.

Introdução: A sífilis gestacional é responsável pelo aumento da morbimortalidade fetal. Está relacionada a complicações intrauterinas e neonatais, sendo a transmissão vertical o desfecho mais grave. Sua triagem e seu tratamento fazem parte da rotina do pré-natal. Objetivo: Descrever o perfil da sífilis gestacional no estado, a incidência em regionais, a época do diagnóstico e o tratamento. Métodos: Estudo quantitativo, descritivo e observacional desenvolvido com dados secundários do Sistema de Informação de Agravos de Notificação (SINAN), para avaliar as variáveis: região, trimestre do diagnóstico e tratamento da sífilis gestacional. Resultados: O Paraná registrou, entre 2010­2018, 12.011 casos de sífilis gestacional, o que corresponde a 8,5 a cada 1.000 nascidos vivos. Houve aumento no número de casos em todo o estado. Entre as gestantes infectadas, a maioria tinha entre 20­29 anos (50,6%). Dos diagnósticos, 43,6% foram realizados no primeiro trimestre de gestação e 26,6%, no segundo trimestre. O esquema terapêutico mais utilizado foi o de penicilina G benzatina 7.200.000 UI (63,7%). Conclusão: Houve aumento da sífilis gestacional no Paraná, porém, observou-se maior efetividade no diagnóstico e tratamento, com maior detecção no primeiro trimestre da gestação e prevalência do uso da penicilina G benzatina 7.200.000 UI. O estudo ressalta a importância do correto manejo clínico e da detecção precoce, medidas que evitam a transmissão vertical.

[Archival documents produced by scientific work: an analysis of laboratory notebooks from the Instituto Oswaldo Cruz]. / Documentos de arquivo produzidos pela atividade científica: uma análise dos cadernos de laboratório do Instituto Oswaldo Cruz.

Analisa o caderno de laboratório, espécie documental produzida a partir dos registros da atividade científica, e seus diferentes tipos, bem como seu uso e seus formatos na pesquisa biomédica. A reflexão se apoia na pesquisa em andamento sobre os documentos dos laboratórios do Instituto Oswaldo Cruz e na relação destes com os conceitos, métodos, técnicas e práticas da arquivologia. A metodologia compreendeu, além de pesquisa bibliográfica, a aplicação de questionário, entrevistas e diagnóstico dos arquivos, nos quais se buscou identificar a gênese documental, as espécies/tipologias presentes e as práticas de manutenção e uso dos registros provenientes de 15 laboratórios. Discute ainda o caderno aberto de laboratório, formato disseminado no âmbito do debate contemporâneo da ciência aberta.

An integrated, accurate, rapid, and economical handheld consumer gluten detector.

Celiac disease, characterized by autoimmune reactions to dietary gluten, affects up to 3 million in the US and approximately 0.5%-1% globally. A strict, lifelong gluten-free diet is the only treatment. An economic, simple, accurate, rapid and portable gluten testing device would enable gluten-sensitive individuals to safeguard their food safety. We developed a novel solution, Nima™, a gluten sensor that integrates food processing, gluten detection, result interpretation and data transmission in a portable device, detecting gluten proteins at or below the accepted 20 ppm threshold. We developed specific monoclonal antibodies, an optimized lateral flow immunoassay strip, and one-step aqueous extraction. Compared with reference R5, NimaTM antibodies (13F6 and 14G11) had 35- and 6.6-fold higher gliadin affinities, respectively. We demonstrated device performance using a comprehensive list of foods, assessing detection sensitivity, reproducibility, and cross-reactivity. Nima™ presented a 99.0% true positive rate, with a 95% confidence interval of 97.8%-100%.

PDK4 Deficiency Induces Intrinsic Apoptosis in Response to Starvation in Fibroblasts from Doberman Pinschers with Dilated Cardiomyopathy.

The Doberman pinscher (DP) canine breed displays a high incidence of idiopathic, nonischemic dilated cardiomyopathy (DCM) with increased mortality. A common mutation in DPs is a splice site deletion in the pyruvate dehydrogenase kinase 4 (PDK4) gene that shows a positive correlation with DCM development. PDK4, a vital mitochondrial protein, controls the switch between glycolysis and oxidative phosphorylation based upon nutrient availability. It is likely, although unproven, that DPs with the PDK4 mutation are unable to switch to oxidative phosphorylation during periods of low nutrient availability, and thus are highly susceptible to mitochondrial-mediated apoptosis. This study investigated cell viability, mitochondrial stress, and activation of the intrinsic (mitochondrial mediated) apoptotic pathway in dermal fibroblasts from DPs that were healthy (PDK4wt/wt), heterozygous (PDK4wt/del), and homozygous (PDK4del/del) for the PDK4 mutation under conditions of high (unstarved) and low (starved) nutrient availability in vitro. As hypothesized, PDK4wt/del and PDK4del/del cells showed evidence of mitochondrial stress and activation of the intrinsic apoptotic pathway following starvation, while the PDK4wt/wt cells remained healthy and viable under these conditions. Adeno-associated virus (AAV) PDK4-mediated gene replacement experiments confirmed cause-effect relationships between PDK4 deficiency and apoptosis activation. The restoration of function observed following administration of AAV-PDK4 provides strong support for the translation of this gene therapy approach into the clinical realm for PDK4-affected Dobermans.