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BACKGROUND: The use of antiretrovirals has increased the survival of People Living with HIV/AIDS (PLWHA), resulting in an aging population and a rise in the incidence of sarcopenia. The lack of uniformity among the prevalences found in studies may be associated with the use of different diagnostic criteria, highlighting the need for local studies to determine the prevalence of sarcopenia. METHODS: Cross-sectional study to estimate the prevalence and associated factors of sarcopenia using the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). This study included PLWHA of both sexes, aged 40 years or older, who were treated at the infectious disease outpatient clinic of a tertiary hospital from 2019 to 2021. Muscle mass was quantified through electrical bioimpedance, using resistance and reactance to calculate appendicular lean mass (ALM) in kg/m². Muscle strength, measured in kg, was assessed using a manual dynamometer, and muscle function was evaluated using the gait speed test (m/s). Numerical variables were analyzed using measures of central tendency and dispersion. The chi-square test was used to assess associations in categorical variables. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated to evaluate the strength of associations. RESULTS: Among the 218 PLWHA, the prevalence of sarcopenia was 8.7% (95% CI: 5.6 to 13.3). The mean age of the study population was 51.8 ± 8.3 years; 53.7% were male, 72.9% were brown/Black, 97.7% reported not using illicit drugs, and 24.8% were classified as obese. Multivariate analysis showed that the time since HIV diagnosis (P = 0.022) and the use of illicit drugs were associated with the diagnosis of sarcopenia. CONCLUSION: The prevalence of sarcopenia using the EWGSOP2 criteria was low. People with a longer duration of HIV infection and those using illicit drugs were more likely to develop sarcopenia.
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Infecções por HIV , Sarcopenia , Humanos , Sarcopenia/epidemiologia , Masculino , Feminino , Estudos Transversais , Prevalência , Pessoa de Meia-Idade , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/tratamento farmacológico , Adulto , Idoso , Fatores de Risco , Força MuscularRESUMO
PURPOSE: Craniofacial morphology is integral to Sleep Breathing Disorders (SBD), particularly Obstructive Sleep Apnea (OSA), informing treatment strategies. This review assesses the utility of two-dimensional (2D) photogrammetry in evaluating these metrics among OSA patients. METHODS: Following PRISMA guidelines, a systematic review was conducted. PubMed, Embase, and Lilacs databases were systematically searched for studies utilizing 2D photography in SBD. Findings were narratively synthesized. RESULTS: Thirteen studies involving 2,328 patients were included. Significant correlations were found between craniofacial measurements-specifically neck parameters and facial width-and OSA severity, even after BMI adjustment. Ethnic disparities in craniofacial morphology were observed, with photogrammetry effective in predicting OSA in Caucasians and Asians, though data for other ethnicities were limited. Pediatric studies suggest the potential of craniofacial measurements as predictors of childhood OSA, with certain caveats. CONCLUSION: 2D photogrammetry emerges as a practical and non-invasive tool correlating with OSA severity across diverse populations. However, further validation in various ethnic cohorts is essential to enhance the generalizability of these findings.
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Face , Fotogrametria , Apneia Obstrutiva do Sono , Humanos , Face/anatomia & histologia , Fotogrametria/métodos , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnósticoRESUMO
APRESENTAÇÃO DO CASO: Caso 1- G.H.A, 14 anos, deu entrada no serviço, com histórico de palpitações, além de diagnóstico de comunicação interatrial (CIA) e interventricular (CIV), em acompanhamento ambulatorial. Realizou ecocardiograma transtorácico (ECOTT) que evidenciou CIV perimembranosa, parcialmente ocluída por tecido acessório das valvas tricúspide e aórtica, com tecido da valva coronária direita protuindo para o átrio direito, formando um aneurisma do seio coronário direito roto, com fluxo aorta-átrio direito. Após realização de exame encaminhado para internação de urgência, durante a qual foi submetido a ventriculosseptoplastia (VSP) e plastia da válvula coronária direita da valva aórtica. Caso 2- H.C.S, 6 anos, assintomático, em seguimento ambulatorial devido CIV. Foi submetido a ECOTT de controle, no qual evidenciou-se uma CIV duplamente relacionada, parcialmente ocluída por tecido acessório das valvas tricúspide e aórtica, com prolapso da válvula coronariana direita e aneurisma do seio de valsalva. Após realização do diagnóstico encaminhado eletivamente para correção cirúrgica, sendo realizado VSP. DISCUSSÃO: O aneurisma do seio de valsalva é uma patologia rara associada a cardiopatias congênitas como CIV, valva aórtica bicúspide e coartação de aorta. O aneurisma mais comum é relacionado ao seio coronário direito. Geralmente, os pacientes desenvolvem sintomas apenas após sua ruptura palpitações, sinais de baixo débito, síncopes. O método de escolha para diagnóstico é o ecocardiograma, sendo um exame de baixo custo, amplamente disponível e não invasivo. Em alguns casos outros métodos complementários são necessários para auxiliar o diagnóstico, tais como angiotomografia computadorizada e ressonância nuclear magnética. COMENTÁRIOS FINAIS: Trata-se da comparação de dois casos clínicos demonstrando a associação de CIV parcialmente ocluída por tecido acessório da valva aórtica e aneurisma de seio de valsalva. Dessa forma, ressalta-se a importância do acompanhamento clínico e ecocardiográfico deste grupo de pacientes, que, por muitas vezes, apresentam-se assintomáticos, possibilitando a intervenção cirúrgica precoce e evitando desfechos desfavoráveis e graves, como a própria rotura do aneurisma do seio de valsava.
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Humanos , Adolescente , Comunicação Atrioventricular , Seio Aórtico , Ecocardiografia , AneurismaRESUMO
BACKGROUND: The success of tungiasis treatment is highly dependent on adequate environmental control. METHODS: This is a real-world observational cohort study designed to monitor the effectiveness of topical dimethicone together with a One Health approach for the control of tungiasis in the Sanumás communities, Amazon rainforest, Brazil. We followed up on 562 indigenous people and 81 domestic dogs for 1.5 years in a 3-month interval. A new molecular method for large-scale soil evaluation was also tested. The control of tungiasis was independently conducted by the Brazilian Ministry of Health and comprised topical dimethicone application (NYDA®) for humans, single-dose oral afoxolaner for dogs, and in-house soil fumigation with fipronil. The main outcome was the occurrence of tungiasis after the use of topical dimethicone together with the One Health approach. RESULTS: A total of 49 of the 562 indigenous people had active tungiasis at enrollment (8.72%). Only three cases of tungiasis resulted in active lesions after the use of topical dimethicone together with the One Health approach, with two cases of recurrence. From the 6-month follow-up and after, soil infestation was not detected. CONCLUSIONS: We conclude that the use of NYDA® together with animal and environmental interventions are effective measures for the control of tungiasis.
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BACKGROUND: Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. METHODS: We conducted an observational study to detect clinical and epidemiological factors associated with tungiasis using a cross-sectional strategy and multivariate logistic regression. Soil analysis was performed by visual and microscopic methods. RESULTS: We examined 555 persons, 45 of whom had active tungiasis; 18 cases were classified as mild, 16 as moderate and 11 as severe. The disease was significantly more prevalent in children than in adults (odds ratio (OR) 15.77; 95% confidence interval (CI) = 5.34-67.91; p < 0.001). Soil infestation was significantly related to the occurrence of human tungiasis (OR = 12.29; 95% CI = 3.75-45.88). The sex and GPS location of the houses were not related to the occurrence of tungiasis. CONCLUSIONS: We conclude that tungiasis is an important problem in the Sanumás community, especially for children. We suggest that interruption of the off-host transmission cycle, together with regular treatment [human and animal interventions], must be prioritized to achieve control of tungiasis in indigenous populations.
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Introdução: O leite materno e uma importante fonte de nutrição o mesmo possui as substâncias adequadas para suprir todas as necessidades do bebê. Além de nutritivo, o leite materno protege contra infecções, evita a desnutrição, reduz a morbidade por diarreia, infecções respiratórias, previne episódios de otite média, asma dentre outros. O aleitamento materno exclusivo deve ser preconizado até os 6 meses de vida, sendo recomenda a continuação da amamentação pelo menos até o segundo aniversário da criança. Neste contexto, a assistência do enfermeiro é de fundamental importância pois o mesmo possui as habilidades necessárias para dar suporte nessa fase tão importante. Objetivos: os objetivos deste estudo foram demonstrar as principais características do Leite Materno, os benefícios da amamentação e demonstrar o papel do enfermeiro neste contexto. Método: Esta pesquisa foi desenvolvida a partir de uma revisão integrativa da literatura. Resultados; os dados obtidos a partir desta revisão demonstraram que a assistência do enfermeiro no contexto do aleitamento materno se dá principalmente através da consulta de enfermagem, onde o mesmo presta os cuidados necessários para minimizar os possíveis prejuízos para o binômio mãe e filho, por meio de orientações e desenvolvimento de ações que visam promover e incentivar o aleitamento. Conclusão: conclui-se que o enfermeiro é um profissional impar dentro da atenção prestada, sua atua extremamente indispensável em todas as etapas envolvidas no aleitamento materno.
Introduction: Breast milk is an important source of nutrition and has the appropriate substances to meet all the baby's needs. In addition to being nutritious, breast milk protects against infections, prevents malnutrition, reduces morbidity due to diarrhea, respiratory infections, and prevents episodes of otitis media and asthma, among others. Exclusive breastfeeding should be recommended until the child is six months old, and continued breastfeeding is recommended until at least the child's second birthday. In this context, the nurse's assistance is of fundamental importance, since he/she has the necessary skills to provide support in this very important phase. Objectives: The objectives of this study were to demonstrate the main characteristics of breast milk, the benefits of breastfeeding, and to show the nurse's role in this context. Method: This research was developed from an integrative literature review. Results: The data obtained from this review showed that the nurse's assistance in the context of breastfeeding occurs mainly through the nursing consultation, where the nurse provides the necessary care to minimize possible damage to the mother and child, through guidance and development of actions aimed at promoting and encouraging breastfeeding. Conclusion: it is concluded that the nurse is a unique professional in the care provided, and his/her actions are extremely indispensable in all the stages involved in breastfeeding.
Introducción: La leche materna es una importante fuente de nutrición y posee las sustancias adecuadas para satisfacer todas las necesidades del bebé. Además de ser nutritiva, la leche materna protege frente a infecciones, previene la desnutrición, reduce la morbilidad por diarrea, infecciones respiratorias, previene episodios de otitis media y asma entre otros. La lactancia materna exclusiva debe recomendarse hasta los seis meses de edad, y la lactancia materna continuada al menos hasta que el niño cumpla dos años. En este contexto, la asistencia de la enfermera es de fundamental importancia, ya que tiene las habilidades necesarias para proporcionar apoyo en esta fase tan importante. Objetivos: Los objetivos de este estudio fueron demostrar las principales características de la leche materna, los beneficios de la lactancia materna y mostrar el papel de las enfermeras en este contexto. Método: Esta investigación se desarrolló a partir de una revisión bibliográfica integradora. Resultados: los datos obtenidos a partir de esta revisión demuestran que la asistencia del enfermero en el contexto de la lactancia materna se hace principalmente a través de la consulta de enfermería, donde presta los cuidados necesarios para minimizar los posibles perjuicios para el binomio madre e hijo, mediante orientaciones y desarrollo de acciones que buscan promover e incentivar la lactancia. Conclusión: se concluye que la enfermera es una profesional imparcial en los cuidados prestados, y su actuación es sumamente imprescindible en todas las etapas que conlleva la lactancia materna.
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O Câncer de mama é uma doença que afeta as células mamarias, e é uma das principais causas da mortalidade em muitas mulheres, principalmente se detectado tardiamente. Objetivo: Demonstrar a importância do enfermeiro na prevenção do câncer de mama, sensibilização e conscientização das mulheres. Metodologia: Trata-se de uma revisão integrativa da literatura. Resultados e discussão: Foram selecionados 15 artigos para a amostra desta revisão, o período de publicação analisada foi de 2013 a 2023, sendo o buscador principal as bases de dados Literatura Latino-Americana em Ciências em Saúde (LILACS) e Scientific Eletronic Library Online (SCIELO). Os resultados encontrados na pesquisa mostram a importância da prática profissional do enfermeiro relacionado a orientação, educação e diagnóstico precoce da neoplasia. Conclusão: Foi possível concluir que o enfermeiro é profissional qualificado e comprometido com atributos para orientar, prevenir e promover ações de educação em saúde, visando melhorar a qualidade de vida.
Breast Cancer is a disease that affects breast cells, and is one of the main causes of mortality in many women, especially if detected late. Objective: To demonstrate the importance of nurses in the prevention of breast cancer, awareness and awareness of women. Methodology: This is an integrative literature review. Results and discussion: 15 articles were selected for the sample of this review, the publication period analyzed was from 2013 to 2023, the main search engine being the Latin American Literature in Health Sciences (LILACS) and Scientific Electronic Library Online databases ( SCIELO). The results found in the research show the importance of professional nursing practice related to guidance, education and early diagnosis of cancer. Conclusion: It was possible to conclude that the nurse is a qualified and committed professional with attributes to guide, prevent and promote health education actions, aiming to improve the quality of life.
El Cáncer de Mama es una enfermedad que afecta a las células mamarias, y es una de las principales causas de mortalidad en muchas mujeres, especialmente si se detecta tarde. Objetivo: Demostrar la importancia de las enfermeras en la prevención del cáncer de mama, concienciación y sensibilización de las mujeres. Metodología: Se trata de una revisión bibliográfica integradora. Resultados y discusión: 15 artículos fueron seleccionados para la muestra de esta revisión, el período de publicación analizado fue de 2013 a 2023, siendo el principal motor de búsqueda las bases de datos Literatura Latinoamericana en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online ( SCIELO). Los resultados encontrados en la investigación muestran la importancia de la práctica profesional de enfermería relacionada con la orientación, educación y diagnóstico precoz del cáncer. Conclusiones: Fue posible concluir que la enfermera es una profesional cualificada y comprometida con atributos para orientar, prevenir y promover acciones de educación para la salud, con el objetivo de mejorar la calidad de vida.
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INTRODUÇÃO E/OU FUNDAMENTOS: O transplante cardíaco (TX) pediátrico iniciou sua história há pouco mais de meio século. Desde então, grandes avanços aconteceram, principalmente na década de 80, com o desenvolvimento das terapias imunossupressoras, o progresso das técnicas cirúrgicas e dos cuidados de terapia intensiva (UTI). Atualmente poucos são os serviços que realizam TX pediátrico no Brasil, muitos deles pela falta de experiência profissional, pela dificuldade no manejo da insuficiência cardíaca avançada e, principalmente, pela falta de doadores. MÉTODOS: Análise retrospectiva de diagnósticos, indicações, complicações e resultados dos pacientes menores de 14 anos submetidos à TX no período de Dezembro de 2017 à Janeiro de 2022. RESULTADOS: Foram 5 pacientes menores de 14 anos submetidos ao TX no período citado, com idade entre 5 e 13 anos, peso entre 16 e 32 kg, 4 do sexo masculino, 4 brasileiros e 1 estrangeiro, 3 pacientes tinham o diagnóstico de Miocardiopatia dilatada e 2 com Cardiopatia Congênita que evoluíram para falência ventricular. Três pacientes precisaram de assistência mecânica com ECMO antes de receber o coração, com tempo médio de 19 dias. O tempo de internação na UTI pediátrica pós TX variou entre 6 e 45 dias. Todos os pacientes receberam indução com Thimoglobulina e esquema tríplice de imunossupressão: Inibidor de Calcineurina, Antiproliferativo e esteróide. O tempo de internação na enfermaria pediátrica variou entre 27 e 76 dias. Um paciente evoluiu com laceração subglótica e necessidade de traqueostomia, e um foi a óbito dois anos e meio após o TX, relacionado à Covid-19. As complicações mais frequentes foram hipertensão arterial e risco de infecção por citomegalovírus (CMV). As reinternações ocorreram por pneumonia, suspeita de rejeição e viremia aumentada para CMV. Todos realizaram biópsia endomiocárdica; dois pacientes apresentaram rejeição grau I. Quatro pacientes seguem em acompanhamento ambulatorial, assintomáticos e com níveis séricos de imunossupressão adequados. CONCLUSÃO: O TX cardíaco pediátrico ainda é padrão ouro para os casos de falência cardíaca na faixa etária pediátrica. Apesar dos desafios, os resultados satisfatórios foram determinantes e impactaram no prognóstico desses pacientes. Vencer as resistências parece ser o caminho para o sucesso de casos tão desafiadores.
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , AdolescenteRESUMO
INTRODUÇÃO E/OU FUNDAMENTOS: Os tumores cardíacos (TC) são raros em todas as idades. A grande maioria dos TC primários na faixa etária pediátrica são benignos, entre eles, rabdomiomas, fibromas e mixomas são os mais prevalentes. A seguir, descreveremos uma série de casos de TIC em crianças, destacando suas características clínicas e ecocardiográficas. RELATO DO CASO: CASO 1 Criança, feminino, 5 meses, encaminhada para investigação devido histórico familiar esclerose tuberosa. Sem intercorrências no período neonatal, assintomática, sem arritmias visualizadas em eletrocardiograma (ECG). Em investigação ecocardiográfica evidenciado, massa hiperrefringente, homogênea, no ventrículo direito (VD) medindo 15x10mm, e outras 2 imagens arredondas no interior do ventrículo esquerdo (VE) de 4.5x3.4mm e 7x3mm, sem gerar obstruções, sugestivas de rabdomioma. CASO 2 Criança, feminino, 1 ano, encaminhada devido histórico de sopro cardíaco ao nascimento, sem sinais de cianose ou baixo débito, realizado ecocardiograma (ECO) na maternidade que evidenciou TC único. Apresenta dispneia ao choro intenso e desvio extremo do eixo do QRS. Em investigação ecocardiográfica atual, evidenciado massa única de 48x54mm, aderida ao septo interventricular com centro calcificado e sem vascularização gerando obstrução dinâmica a via de saída de VD; sugestivo de fibroelastoma obstrutivo. CASO 3 Criança, masculino, 5 anos, em seguimento desde o 1 mês, devido imagem sugestiva de rabdomioma em ECO fetal. Assintomático, apresentando distúrbio de condução de ramo direito. Em evolução ecocardiográfica foram evidenciadas 3 imagens ecogênicas: no anel da vala tricúspide, séssil, medindo cerca de 7x6mm, no ápice do VE de 12x10 mm e no ápice de VD de 5x3mm, não obstrutivas, sugestivas de rabdomioma; com regressão posterior. CASO 4 Criança, masculino,12 anos, em seguimento devido TC. Realizou biopsia com 1 ano, confirmando diagnóstico de neurofibroma. Assintomático, com extrassístoles ventriculares no ECG e arritmia extrassistólica ventricular polimórfica frequente no holter. Evidenciado no ECO, massa intramural no VE com áreas de calcificação, sem causar obstrução, com aumento progressivo, atualmente medindo 68x36mm. Conclusões: O ECO é o exame mais utilizado no diagnóstico inicial dos TC, visto que possui grande acessibilidade, baixo custo e não é invasivo. Características como o número de TC, tamanho, localização, presença de vascularização ou calcificações são de extrema importância na diferenciação dos tipos de tumores, contribuindo para o diagnóstico e tratamento precoces.
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Humanos , Feminino , LactenteRESUMO
INTRODUCTION: Ebstein's anomaly occurs due to failure in the delamination of the septal and posterior leaflets with apical displacement of the functional annulus, dilatation of the atrialized portion of the right ventricle, thinning of the free wall, dilatation of the true annulus and redundant anterior leaflet with multiple fenestrations. The "Cone" reconstruction of the tricuspid valve, described by Silva et al, results in complete coaptation of the valves with excellent results in the medium and long term. OBJECTIVES: In this study, clinical and echocardiographic data of patients undergoing surgical repair using this technique was reviewed. METHODS: Pre and post-operative (PO) records and echocardiograms of 8 patients operated on from 2018 to 2022 were reviewed. RESULTS: The median age of the group was 22.5 (2 to 42 years). In the pre-operative 3 patients had Wolf-Parkinson-White ventricular pre-excitation and 6 had atrial septal defect associated, 6 had moderate to severe dyspenia, with only one being cyanotic. All had severe tricuspid regurgitation (TI) and 6 had moderate to severe right ventricular dilatation. In the immediate PO, moderate TI was detected in 2 and mild in 6. In 1 patient, Glenn anastomosis was added to the Cone procedure due to hemodynamic instability and hypoxemia immediately after bypass. In the post-operative follow-up time, median of 11.5 months, all patients were asymptomatic and TI increased from mild to moderate in only one case. One patient required pacemaker implantation due to complete atrioventricular block. CONCLUSION: In this small cohort, the Cone procedure resulted in significant improvement of the tricuspid regurgitation, no mortality and low morbidity with significant improvement of the clinical status.
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Insuficiência da Valva Tricúspide , Anomalia de Ebstein , Bloqueio Atrioventricular , Valva TricúspideRESUMO
CASO CLÍNICO: Paciente do sexo feminino, oito meses de idade, portadora de Síndrome de Down, internada em nosso serviço devido insuficiência cardíaca descompensada e cianose. Realizado ecocardiograma transesofágico, que evidenciou defeito do septo atrioventricular (DSAV) desbalanceado, com componente valvar direito tipo "Ebstein-like", com acolamento de suas cúspides e inserção de cordas próximo a via de saída, atrialização do ventrículo direito (VD), que exibia dimensões reduzidas, insuficiência importante da valva atrioventricular (VAV) e artérias pulmonares pequenas. Realizado cateterismo cardíaco, evidenciando hipofluxo pulmonar (Qp/Qs de 0,4) gerado pela obstrução da via de saída do VD pelas cordas da VAV e dimensões reduzidas das artérias pulmonares. Foi submetida à plastia da VAV esquerda e confecção de shunt central aortopulmonar, porém ainda mantendo insuficiência importante da VAV. Evoluiu com síndrome de baixo débito cardíaco e óbito ainda no pós operatório. DISCUSSÃO: A Anomalia de Ebstein é caracterizada pelo deslocamento apical da inserção das cúspides septal e posterior ao miocárdio. É uma patologia rara, presente em 1 a cada 200000 nascidos. Os DSAV, por outro lado, são encontrados em maior frequência na população. A associação destas duas patologias é extremamente rara, sendo descrita inicialmente em um relato de 12 casos por Knott-Craig e colaboradores. Desde então poucos são os casos encontrados em literatura, sendo a maioria diagnósticos realizados por autópsia e relatos do desafio da correção cirúrgica por diversas técnicas, sendo a mais recente pela cirurgia do cone. O diagnóstico do DSAV com anomalia de Ebstein pode ser realizado pelo ecocardiograma, onde se observa a presença de comunicação interatrial ostium primum, comunicação interventricular de via de entrada, deslocamento apical da cúspide septal, com falha de delaminação e da VAV direita. O quadro clínico é variável, sendo relacionado com a presença de obstrução na via de saída do VD e refluxo das VAVs. CONCLUSÃO: Relatamos uma combinação rara de cardiopatias, em que o diagnóstico ecocardiográfico é de extrema importância para o manejo clínico e cirúrgico. Neste caso, a realização do ecocardiograma transesofágico associada ao cateterismo cardíaco, possibilitou a avaliação detalhada das valvas e ventrículos para a programação cirúrgica mais adequada para esta patologia desafiadora. Infelizmente, devido a gravidade da anomalia, o paciente não resistiu à operação.
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Feminino , Lactente , Síndrome de Down , Cardiopatias Congênitas , Insuficiência CardíacaRESUMO
The phyllophorids Phyllophorella robusta, Selenkiella siamense and Cladolella virgo, as well as the sclerodactylid Clarkiella discoveryi, are the type species of their respective genera, all described by Heding Panning (1954) and each known only from a single specimen, were revisited in order to reassess their morphology by means of optical and electron microscopy, and micro-computed tomography. Additionally, a new species of phyllophorid is described, the fourth of the genus Thorsonia.
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Pepinos-do-Mar , Animais , Pepinos-do-Mar/anatomia & histologia , Microtomografia por Raio-XRESUMO
Background: A paramount factor in the control of neglected tropical diseases from both medical and social aspects is education. New strategies must be constantly pursued to test and provide educational information related to diseases affecting vulnerable populations. We applied the Q method as a model to measure educational neglect based on the burden of disseminated tungiasis. Methods: Using a saturation method for sample size calculation, we recruited students and healthcare professionals to evaluate and classify 27 statements related to the prevention, control and treatment of tungiasis. After quantitative analysis, the Q method was applied based on the paired use of the centroid method and Varimax rotation, and 4 factors were extracted representing the main sets of viewpoints among the participants. Results: We included 119 healthcare professionals with different academic degrees. Statements classified by specialists with a + agreement were also classified as a + agreement by most of the participants. However, we detected 5 important disagreements related to the topical treatment of tungiasis and control of the disease in the environment and animals. The Q method showed that almost no consensus was detected for four statements. The classification of each statement was not related to the participants' academic degree. Conclusions: There is significant educational neglect related to tungiasis prevention and treatment in healthcare sciences in Brazil. We conclude that the Q method may be an interesting strategy alone or associated with quantitative strategies for detecting educational limitations related to neglected diseases. In countries where neglected diseases are endemic, a detailed study evaluating the quality of education related to these diseases must be prioritized.
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A new species of Dendrochirotida sea cucumber, Parathyone itapuaensis, is described and illustrated herein based on specimens collected from rocky intertidal regions of the northeastern coast of Brazil. The new species is characterized by a suite of morphological characters revealed by light stereomicroscope, SEM and microCT studies of the calcareous ring, dermal ossicles, Polian vesicles and madreporite. Parathyone itapuaensis sp. nov. is characterized by having 10 tentacles, two Polian vesicles and single madreporite; length of anterior process (radial plate) larger than length of the base of the radial plate; body wall with buttons with triangular knobs and knobbed multiperforated plates in the anal region; and tentacles with arched rods, knobbed in the margins and shallow cups knobbed in the outer and inner surfaces. A key to the recognition of Parathyone species is given.
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Pepinos-do-Mar/anatomia & histologia , Pepinos-do-Mar/classificação , Animais , BrasilRESUMO
Describing ontogenetic morphological change is an important part of integrative taxonomy; still, most taxonomic studies are based only on adult characters. Here, we provide illustrations and a morphological description of the sea stars from Bahia, including ontogenetic and intraspecific variation, and identify taxonomic issues. A total of 293 specimens from different localities along the Bahia State coastline and comparative material from other localities were examined. Eighteen species (11 genera, eight families) of Asteroidea were identified; Astropectinidae was the most representative family. All species identified also occur in subtropical Brazilian waters and most species are from shallow water habitats with soft bottoms. Most observed ontogenetic variation was quantitative in nature, such as the increase in the number of spines in the furrow and of spinelets in the paxillae with specimen growth. Genera that require further taxonomic studies are Astropecten and Othilia, whose specimens are commonly misidentified in local studies. One third of the species from Bahia are currently classified as "Vulnerable" in the Brazilian Red List, but baseline data on the population biology of these species are scarce. An illustrated identification key to the 65 Brazilian sea star species is also provided. This taxonomic study will facilitate the identification of specimens occurring along the Brazilian coast and help scientists and policy makers to establish the conservation status of the Brazilian species.
Assuntos
Equinodermos , Animais , Biologia , Brasil , Equinodermos/classificação , Ecossistema , Estrelas-do-MarRESUMO
Despite descending from heavily calcified ancestors, the holothuroid skeleton is fully internal and composed of microscopic ossicles and a ring of plates bound by connective tissue, the calcareous ring. The calcareous ring exhibits a complex and poorly understood morphology; as a result, establishing unambiguous homology statements about its macrostructure has been challenging and phylogenetic studies have had to simplify this important structure. Here, we provide the first broad comparative study of Dendrochirotida calcareous rings using micro-computed tomography (µCT). A detailed description of the three-dimensional macrostructure of the calcareous ring of 10 sea cucumber species, including rare and type specimens, is presented. The structures observed were highly variable at the subfamily level, especially at the point of tissue attachment. The relationship between the calcareous ring and its associated organs, and their functional morphology are discussed. To aid future phylogenetic studies, we listed 22 characters and performed a preliminary cladistic analysis. The topology obtained supports the idea that the simple, cucumariid ring is ancestral to the mosaic-like phyllophorid ring; however, it did not support the monophyly of the cucumariids. It also did not support the family Sclerodactylidae, which was described based on the ring morphology. Differently from the dermal ossicles, which are highly homoplastic, the general homoplasy index of the calcareous ring characters was relatively low. This result highlights the importance of this structure for phylogenetic inference. Unfortunately, time since collection, rough collection methods and fixation can damage the skeleton, and the calcareous ring is often overlooked in taxonomic descriptions. The data presented here will improve our understanding of holothuroid relationships and facilitate studies on holothuroid functional morphology and biomechanics.
Assuntos
Pepinos-do-Mar/anatomia & histologia , Esqueleto/diagnóstico por imagem , Animais , Filogenia , Esqueleto/anatomia & histologia , Microtomografia por Raio-XRESUMO
BACKGROUND: Aedes aegypti and Culex quinquefasciatus are the main urban vectors of arthropod-borne viruses causing human disease, including dengue, Zika, or West Nile. Although key to disease prevention, urban-mosquito control has met only limited success. Alternative vector-control tactics are therefore being developed and tested, often using entomological endpoints to measure impact. Here, we test one promising alternative and assess how three such endpoints perform at measuring its effects. METHODS: We conducted a 16-month, two-arm, cluster-randomized controlled trial (CRCT) of mosquito-disseminated pyriproxyfen (MD-PPF) in central-western Brazil. We used three entomological endpoints: adult-mosquito density as directly measured by active aspiration of adult mosquitoes, and egg-trap-based indices of female Aedes presence (proportion of positive egg-traps) and possibly abundance (number of eggs per egg-trap). Using generalized linear mixed models, we estimated MD-PPF effects on these endpoints while accounting for the non-independence of repeated observations and for intervention-unrelated sources of spatial-temporal variation. RESULTS: On average, MD-PPF reduced adult-mosquito density by 66.3% (95% confidence interval, 95% CI: 47.3-78.4%); Cx. quinquefasciatus density fell by 55.5% (95% CI: 21.1-74.8%), and Ae. aegypti density by 60.0% (95% CI: 28.7-77.5%). In contrast, MD-PPF had no measurable effect on either Aedes egg counts or egg-trap positivity, both of which decreased somewhat in the intervention cluster but also in the control cluster. Egg-trap data, therefore, failed to reflect the 60.0% mean reduction of adult Aedes density associated with MD-PPF deployment. CONCLUSIONS: Our results suggest that the widely used egg-trap-based monitoring may poorly measure the impact of Aedes control; even if more costly, direct monitoring of the adult mosquito population is likely to provide a much more realistic and informative picture of intervention effects. In our CRCT, MD-PPF reduced adult-mosquito density by 66.3% in a medium-sized, spatially non-isolated, tropical urban neighborhood. Broader-scale trials will be necessary to measure MD-PPF impact on arboviral-disease transmission.
Assuntos
Controle de Mosquitos/métodos , Mosquitos Vetores/efeitos dos fármacos , Piridinas/farmacologia , Aedes/efeitos dos fármacos , Animais , Brasil , Culex/efeitos dos fármacos , Humanos , Inseticidas/farmacologiaRESUMO
OBJECTIVE: To evaluate if the topical application of 10% potassium nitrate applied before in-office bleaching is effective to reduce the risk and intensity of tooth sensitivity (TS), as well as to evaluate if its application can jeopardize color change. MATERIALS AND METHODS: A randomized, split-mouth triple-blind clinical trial was conducted on 43 young patients with incisors A2 or darker. Half of the patient's upper arch received either the application of a 10% potassium nitrate or placebo gel for 10 min in a university setting. In-office bleaching was performed in three 15-min applications in two clinical sessions (1-week interval) using 35% hydrogen peroxide. Risk and intensity of TS was recorded with a 0-4 Numeric Rating Scale and a 0-10 Visual Analogue Scale during bleaching, 1 hour, 24 hours, and 48 hours after bleaching. Color was evaluated before and 1 month after bleaching with shade guides (Vita Classical and Vita Bleachedguide) and a spectrophotometer. The risk of TS (McNemar's test) and intensity of TS (Wilcoxon signed-rank for Numeric Rating Scale and paired t-test for Visual Analogue Scale) were statistically evaluated. Color change was compared using paired t-test. Significant level was set at 5%. RESULTS: No significant difference was observed in the absolute risks of TS between groups (RR = 1.11; 95% CI 0.97 to 1.27; P = .12), which exceeded 87% for both groups. Similarly, no difference in TS intensities was detected (P > .05). Significant whitening was observed with all color measurement instruments with no difference between groups (P > .05). CONCLUSION: The topical application of 10% potassium nitrate, before in-office bleaching, did not reduce the risk and intensity of TS and did not jeopardize color change.