Association between COPD and hearing loss with impaired speech recognition: a cross-sectional study.

INTRODUCTION: Studies have identified a greater risk of sensory neural hearing loss in individuals with COPD compared to healthy individuals, but it is unclear whether they are at increased risk of hearing loss with impaired speech recognition. The aim of this study was to assess whether COPD is associated with hearing loss that affects speech recognition. METHODS: This is a case-control study. We screened individuals from health facilities in the municipality of Jundiai. We enrolled a test group of individuals with COPD and an age-matched control group composed of individuals with asthma. The selected individuals attended an appointment with a chest physician, responded questionnaires and underwent tonal and speech audiometry. Adjusted binary logistic regression analysis evaluated whether COPD was associated with reduced speech recognition. RESULTS: We enrolled 36 individuals with COPD and 72 with asthma. Individuals with COPD were more likely to have a reduced speech recognition compared to asthmatic individuals [Reduced recognition of three-syllable words: adjusted OR 3.72, 95 CI (1.38 - 10.02)] [Reduced recognition of monosyllable words: adjusted OR 4.74, 95 CI (1.52 - 14.76)]. CONCLUSION: We conclude that individuals with COPD from primary and secondary healthcare facilities have at least 38% greater risk of hearing loss with reduced speech recognition compared to an age-matched control group of individuals with asthma recruited from the same facilities. We recommend that longitudinal studies evaluate whether regular screening could contribute to the prevention or early treatment of hearing loss in individuals with moderate-severe COPD.

Dwarf and tall elephant grass silages: intake, nutrient digestibility, nitrogen balance, ruminal fermentation, and ingestive behavior in sheep.

The objective of this study was to evaluate the exclusive supply of dwarf or tall elephant grass silages, harvested at 60 days of growth, without wilting or the use of additives, on intake, apparent digestibility, nitrogen balance, rumen parameters, and ingestive behavior of sheep. Eight castrated male crossbred sheep (57.6 ± 5.25 kg body weight), fistulated in the rumen, were distributed in two 4 × 4 Latin squares with four treatments and eight animals per treatment and four periods. The treatments consisted of four elephant grass genotype silages (Mott, Taiwan A-146 2.37, IRI-381, or Elephant B). There was no effect of silages (P > 0.05) on dry matter, neutral detergent fiber, and total digestible nutrient intake. The dwarf-sized elephant grass silages provided higher crude protein intake (P = 0.047) and N intake (P = 0.047), while the IRI-381 genotype silage provided higher non-fibrous carbohydrate intake compared to Mott (P = 0.042), without differing from Taiwan A-146 2.37 and Elephant B silages. There were no differences (P > 0.05) among the digestibility coefficients of the evaluated silages. It was observed that silages produced with Mott and IRI-381 genotypes caused a slight decrease in ruminal pH (P = 0.013), and the propionic acid concentration was higher in the rumen fluid of the animals fed with Mott silage (P = 0.021). Therefore, dwarf or tall elephant grass silages, produced with cut genotypes at 60 days of growth and without the use of additives or wilting process, can be used in sheep feeding.

Assessment of water quality and concentration of heavy metals in fishes in the estuary of the Perizes River, Gulf of Maranhão, Brazil.

The present study evaluated physicochemical and microbiological variables of the water in the estuary of the Perizes River in the state of Maranhão, Brazil, heavy metal levels in the muscle tissue of fish species (Genyatremus luteus, Macrodon ancylodon, Sciades herzbergii and Mugil curema). Data were collected bimonthly between Nov 2017 and May 2018. Physicochemical variables of the water (pH, salinity, conductivity, dissolved oxygen and turbidity). The microbiological analysis of the water was performed using the multiple-tube method. Atomic absorption spectrophotometry was used for the determination of heavy metals in muscle tissue of the fishes. The results revealed minor fluctuations in the environmental variables, with the exception of turbidity. The microbiological quality of the water was associated with acceptable bacterial levels. Regarding heavy metals, acceptable concentrations were found of Al, Cu, Fe, Mn, Zn, Ni and Hg, whereas Cr and Pb were found at concentrations higher than the maximum.

Additive effects of resveratrol and doxorubicin on bladder cancer cells.

The treatment of bladder cancer remains a challenge in clinical practice. Different chemotherapeutic protocols can be used; however, it is common to observe tumor recurrence and secondary effects that result in toxicity. Doxorubicin (DOX), one of the most effective anticancer agents used to treat bladder cancer, can cause chronic cardiotoxicity, limiting its use in clinical practice. Resveratrol (RES), a natural product with potential antitumor activity against bladder cancer, is associated with rapid metabolism and low bioavailability and needs to be combined with chemotherapeutic drugs to improve its use. Our study aimed to assess the therapeutic effect of a low concentration of DOX (2 µM) in combination with RES (150, 200 and 250 µM) on two bladder cancer cell lines. We investigated the mechanism of interaction between the drugs by performing cytotoxicity, clonogenic, oxidative stress, cell migration, cell morphology and nuclear division index (NDI) assays. Cytotoxicity evaluation revealed an additive interaction between RES and DOX for both cell lines. Additionally, the results of cell colony formation, oxidative stress, cell migration, cell morphology and NDI assays showed that a combination of DOX and RES was more effective than RES or DOX alone. In conclusion, a low concentration of DOX combined with RES could potentiate the antitumor effects of the drugs on bladder cancer cells, thus overcoming the secondary effects caused by DOX and the low bioavailability of resveratrol.

Investigation of the parasitoid Ixodiphagus hookeri (Hymenoptera: Encyrtidae) in Amblyomma sculptum (Acari: Ixodidae) ticks in the municipality of Salto, São Paulo, Brazil

The presence of capybaras (Hydrochoerus hydrochaeris) in urban and periurban areas has caused increased numbers of cases of Brazilian spotted fever. With the aim of investigating the presence of the parasitoid Ixodiphagus hookeri in Amblyomma sculptum ticks in the municipality of Salto, state of São Paulo, samples were collected monthly from 14 sites. Thirty samples were placed in containers for observation of the emergence of microhymenopterans and 88 samples were subjected to molecular testing to identify the presence of I. hookeri DNA. Neither dissections nor observation of emergence indicated any presence of I. hookeri larvae in ticks. Samples subjected to polymerase chain reaction (PCR) amplification of the mCOX I region of I. hookeri did not reveal its presence, although fragments corresponding to mRNA 16S of Amblyomma sculptum ticks were amplified in all samples tested.

Presença da mutação do gene BRCA1 em cadelas com tumores mamários malignos / Presence of BRCA1 gene mutation in bitches with malignant mammary tumors

Mammary tumors (MTs) in bitches are similar to breast cancers in women. Thus, they can be used as a model for human breast cancer and findings can be extrapolated for use in human medicine. BRCA1 is a tumor suppressor gene. When the gene has a mutation, it cannot repair damaged DNA, which causes genetic instability and tumorigenesis. Therefore, we aimed to study the frequency of single nucleotide polymorphisms (SNPs) in the BRCA1 gene that are associated with distinct histological types of malignant MT in bitches. The study population consisted of 91 bitches, including a control group of 6 animals with healthy mammary glands and 85 animals with MTs. All animals underwent a presurgery evaluation consisting of a questionnaire administered to the person responsible for the animal, a physical examination, collection of peripheral blood for hematological and serum biochemistry evaluations, an electrocardiogram, and a preanesthesia evaluation. In addition, distant metastasis was studied via chest radiography and abdominal ultrasound. After evaluations were complete, the animals that could undergo surgery were administered general anesthesia and underwent a mastectomy or mammary gland sample collection. Histopathological examination and molecular analysis were performed to identify mutations in the BRCA1 gene. Histopathological examinations found 10 different types of malignant tumors in 36 sick animals. Tumor samples plus samples from the 6 control animals were subjected to DNA extraction, polymerase chain reaction (PCR) analysis, and genetic sequencing. The tumor with the highest incidence (33.33%) was a complex carcinoma, followed by carcinoma in mixed tumor (13.88), tubular carcinoma (13.88) and carcinosarcoma (13.88). Molecular analysis revealed 3 different SNP points in 5 samples (4006G>A, 3619A>G, and 3761C>T). The allelic variant 4006G>A (1/36) resulted in the alteration of the amino acid valine by isoleucine (V1336 I). The mutation 3619A>G (2/36) inserted the amino acid alanine instead of threonine (T1207 A). The mutation 3761C>T (2/36) led to the alteration of the amino acid serine by phenylalanine (S1254 F), a mutation for which there are no published reports. The histological types that showed BRCA1 mutations were complex carcinoma (1/5), carcinoma in mixed tumor (1/5), papillary carcinoma (1/5) and tubular carcinoma (2/5). Software analysis identified the new SNP (nucleotide 3761) in BRCA1 and 2 point mutations in nucleotides 4006 and 3619 and responsible for genetic instability. The development of breast cancer is caused by many endogenous and exogenous factors. The results of our study show that these factors have a greater presence in female, mixed breed, uncastrated, and older dogs, confirming the data in the veterinary literature. In the present study, we found different histological types of malignant breast tumors with mutations in the BRCA1 gene, as other authors have reported. However, we also found the mutation 3761C>T, which, to the best of our knowledge, has not been reported in the literature. This shows the need for studies in veterinary medicine that assess mutations in the BRCA1 gene and the most common histological types. In conclusion, SNPs in the BRCA1 gene cause genetic instability, resulting in additional mutations that lead to the development of breast tumors. They are point mutations that affect transcription, resulting in truncated proteins. These proteins may have a loss of function, leading to carcinogenesis.(AU)

STUDY OF PALM OIL AND GLUTAMINE AS FUNCTIONAL FOODS ON PEPTIDE TYROSINE TYROSINE AND GLUCAGON-LIKE PEPTIDE 1 IN OBESE PATIENTS FOLLOWING UP ON THE AMBULATORY HEALTH SERVICES OF A PUBLIC HOSPITAL

Incretin-based therapies are an alternative for the treatment of type 2 diabetes and weight reduction. In this respect, functional foods such as palm oil and glutamine are dietary strategies for the stimulation of intestinal peptides. Objective: The aim of this study was to evaluate whether the palm oil capsules of ileal release (LI) and of glutamine (LI) result in increased secretion of glucagon-like peptide-1 (GLP-1) and Peptide tyrosine tyrosine (PYY). Method: Nineteen obese patients follow-up of the Ambulatory Health Services, received nutritional guidance and supplementation with ileal release capsules containing palm oil and glutamine. Result: Prospective analysis showed an increase in median GLP-1 levels between T0 (before treatment) and T2 (after 2 months of treatment) from 21.9 pmol/liter (2-93) to 25.7 pmol/liter (3-92.5) (p= 0.564). The baseline of peptide YY increased between T0 68.5 pg / mL (46.5 to 150) to 71 pg / mL (46-181) in T2 (p= 0.909). The significant level established for all analyses was 5% (p <0.05). Conclusion: The daily intake of palm oil capsules (LI) and of glutamine (LI) by a period of 2 months did not influence the secretion of GLP-1 and PYY in obese patients. However, weight maintenance was observed during the evaluated period. Further studies are needed for inferences in this population, to determine if functional foods such as palm oil and glutamine are associated with other specific health benefits.

Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis.

OBJECTIVE: To analyze the influence of multimorbidity on the treatment outcome of new cases of pulmonary tuberculosis. METHOD: A population-based analytical study, using secondary data, collected from the database of the Notification Disease Information System, of new cases of pulmonary tuberculosis in the state of Rio Grande do Sul between 2013 and 2016. The relationship between multimorbidity and the outcome was analyzed with Multinomial Logistic Regression. RESULTS: Multimorbidity was present in 37.0% of the cases. Of these, the Relative Risk (RR) was 1.7 for treatment abandonment and 2.9 for death. HIV had an RR of 2.1 for dropout and of 3.9 for death. The higher the number of comorbidities, the higher the RR for unfavorable outcomes. CONCLUSION: Multimorbidity influences on unfavorable outcomes of the treatment for tuberculosis.

Plantão Psicológico Gestáltico - A Escrita de uma Experiência / Gestaltic Psychological Duty - The Writing of an Experience / Deber Psicológico Gestáltico - La Escritura de una Experiencia

Apresento a escrita de minha experiência de criação do campo de estágio em Plantão Psicológico fundamentado na Abordagem Gestáltica num curso de graduação em Psicologia numa Instituição particular de Ensino Superior no Rio de Janeiro. Sendo escassa a literatura gestáltica neste tema, recorri a autores baseados em Carl Rogers, em cuja abordagem há farta oferta de publicações, o que me permitiu criar boas conexões com autores da Gestalt-terapia. Chamei para compor esse diálogo autores da Psicologia Social e, assim, proponho o único atendimento no Plantão Psicológico Gestáltico como uma prática de clínica ampliada que pró-move deslocamentos nos fazeres acadêmicos na graduação em Psicologia por expandir as práticas clínicos na clínica-escola para além da psicoterapia bipessoal e por propor a sensibilidade como condição de encorpamento ético nos fazeres psicológicos. Finalizo, indicando o Plantão Psicológico Gestáltico como uma prática política e inclusiva, portanto, democrática, contemplando contemporaneamente a demanda por atenção psicológica pontual, em diferentes espaços e contextos - fomentando atenção especialmente à nossa formação universitária. (AU)

I present the writing of my experience of creating the field of internship on Psychological Duty based on the Gestaltic Approach in a graduation course in Psychology in a private Institution of Higher Education in Rio de Janeiro. Being the gestalt literature scarce on this subject, I have resorted to authors based on Carl Rogers, in whose approach there is a large supply of publications, which allowed me to create good connections with Gestalt-therapy authors. I called authors of Social Psychology to compose this dialogue and so, I propose the only service in the Gestaltic Psychological Duty as an expanded clinic practice, which promotes displacements in the academic studies in Psychology by expanding clinical practices in the clinic-school beyond bipersonal psychotherapy and for proposing sensitivity as a condition of ethical embodiment in psychological studies. I conclude by indicating the Gestaltic Psychological Duty as a political and inclusive practice, therefore, democratic, contemporaneously contemplating the demand for punctual psychological attention, in different spaces and contexts - fostering attention especially to our university education. (AU)

Presento mi experiencia en la creación de la pasantía sobre el Deber Psicológico basada en el Enfoque Gestáltico en un curso de graduación en Psicología en una Institución de Educación Superior privada en Rio de Janeiro. Como hay poca literatura gestáltica sobre este tema, he recurrido a autores basados en Carl Rogers, en cuyo enfoque hay una gran oferta de publicaciones, lo que me permitió crear buenas conexiones con los autores de la terapia Gestalt. Llamé a los autores de la Psicología Social para componer este diálogo y así, propongo el único servicio en el Deber Psicológico Gestáltico como una práctica clínica expandida, que promueva desplazamientos en los estudios académicos de la Psicología para expandir las prácticas clínicas en la clínica-escuela más allá de la psicoterapia bipersonal y para proponer la sensibilidad como condición de incorporación ético en los estudios psicológicos. Concluyo señalando el Deber Psicológico Gestáltico como una práctica política e inclusiva, así que democrática, que contempla la demanda de atención psicológica puntual, en diferentes espacios y contextos - fomentando la atención especialmente a nuestra educación universitaria. (AU)

Importância do raciocínio etiológico e topográfico de lesões: relato de neuropatia óptica traumática conduzida como acidente vascular cerebral / Importance of etiological and topographic injury reactions: report of a traumatic optic neuropathy conducted as a cerebrovascular accident

Introdução: O trauma ocular ou periocular pode afetar o nervo óptico e causar baixa acuidade visual ou alteração de campo visual. Essa lesão, denominada neuropatia óptica, quando de etiologia traumática, pode ser classificada como direta, através da compressão, perfuração ou laceração do nervo óptico por ação de corpos estranhos, fraturas do assoalho da órbita ou hemorragias, e indireta, quando a partir de um trauma externo ao globo ocular há lesão por transmissão da onda de choque ou desaceleração, levando à lesão do nervo óptico pelo estiramento de suas fibras ou edema comprometendo sua vascularização, comum nos acidentes automobilísticos e nas quedas. Descrição do Caso: O presente estudo objetiva relatar um caso de neuropatia óptica traumática conduzida erroneamente como acidente vascular cerebral em uma paciente do sexo feminino de 29 anos, com história de queda da própria altura. Discussão: A investigação feita pela história clínica, evolução do quadro e novos achados fundoscópicos permitiu o diagnóstico correto e melhor orientação da paciente. Conclusão: O conhecimento da neuropatia óptica traumática e da anatomia da via óptica têm extrema importância no raciocínio topográfico e etiológico das lesões traumáticas que cursam com comprometimento visual, poupando o paciente de possíveis intervenções invasivas e desnecessárias (AU)

Introduction: Eye or periocular trauma can affect the optic nerve and cause low visual acuity or visual field alteration. This lesion, called optic neuropathy, when of traumatic etiology, can be classified as direct, through compression, perforation or laceration of the optic nerve by action of foreign bodies, fractures of the orbit floor or hemorrhages, and indirect, when from an external trauma to the eyeball there is injury by transmission of the shock wave or deceleration, leading to optic nerve injury by stretching its fibers or edema compromising its vascularization, common in automobile accidents and falls. Case Report: The present study aims to describe a case of traumatic optic neuropathy mistakenly conducted as a stroke in a 29-yearold female patient with a history of falling from his own height. Discussion: The investigation was possible because of the clinical history, evolution of the condition and new fundoscopic findings that allowed the correct diagnosis and better orientation of the patient. Conclusion: Knowledge of traumatic optic neuropathy and anatomy of the optical pathway have extreme importance in the topographic and etiological reasoning of traumatic lesions that present with visual impairment, saving the patient from possible interventions invasive and unnecessary. (AU)

Os estigmas do adolescer com doença renal: significados das experiências de adoecimento crônico / The stigmas of growing up with kidney disease: meanings of the experiences of chronic illness

O presente estudo procurou compreender os significados dos estigmas relacionados à experiência do adoecimento crônico no adolescer com doença renal crônica. Para tanto, foram entrevistados 9 adolescentes com doença renal crônica tendo como ponto de partida para contato com esses adolescentes a Fundação do Rim do Rio de Janeiro.Os adolescentes foram entrevistados, com perguntas que buscaram entender as repercussões da doença renal no processo de adolescer, compreender em que medida o tratamento interfere nas interações sociais e explorar as marcas do tratamento em seu processo de adolescer relacionado ao corpo e relacionamentos. As entrevistas foram transcritas e analisadas a partir de uma perspectiva qualitativa.Conseguimos observar diversos pontos relacionados à experiência do adoecimento crônico sejam eles os estigmas da doença renal crônica, a influência do capacitismo, a predominância do adultocentrismos, além de questões ligadas a ruptura biográfica, fragilidade social, os conceitos de cura e transplante renal e permanecer com doença renal crônica, todas levando a interferências no processo de adolescer.Esperamos com isso trazer uma maior compreensão da experiência do adoecimento crônico a fim de agirmos como sociedade em seus mais variados setores de forma a amenizar o sofrimento dos adolescentes que vivem com doença renal crônica.

The present study sought to understand the meanings of the stigmas related to the experience of chronic illness in adolescence with chronic kidney disease. For this purpose, 9 adolescents with chronic kidney disease were interviewed, having as their starting point for contact with these adolescents the Rio de Janeiro Kidney Foundation. The adolescents were interviewed, with questions that sought to understand the repercussions of kidney disease in the adolescent process, to understand to what extent the treatment interferes in social interactions and to explore the treatment marks in their adolescent process related to the body and relationships. The interviews weretranscribed and analyzed from a qualitative perspective.We were able to observe several points related to the experience of chronic illness, be they the stigmas of chronic kidney disease, the influence of capacitism, the predominance of adult-centeredness, in addition to issues related to biographical rupture, social fragility, the concepts of cure and kidney transplantation and staying with chronic kidney disease, all leading to interference in the adolescent process.With this we hope to bring a greater understanding of the experience of chronic illness in order to act as a society in its most varied sectors in order to alleviate the suffering of adolescents who live with chronic kidney disease.

Relationship between multimorbidity and the outcome of the treatment for pulmonary tuberculosis / Relación entre la multimorbilidad y el resultado del tratamiento de la tuberculosis pulmonar / Relação entre multimorbidade e o desfecho do tratamento da tuberculose pulmonar

ABSTRACT Objective: To analyze the influence of multimorbidity on the treatment outcome of new cases of pulmonary tuberculosis. Method: A population-based analytical study, using secondary data, collected from the database of the Notification Disease Information System, of new cases of pulmonary tuberculosis in the state of Rio Grande do Sul between 2013 and 2016. The relationship between multimorbidity and the outcome was analyzed with Multinomial Logistic Regression. Results: Multimorbidity was present in 37.0% of the cases. Of these, the Relative Risk (RR) was 1.7 for treatment abandonment and 2.9 for death. HIV had an RR of 2.1 for dropout and of 3.9 for death. The higher the number of comorbidities, the higher the RR for unfavorable outcomes. Conclusion: Multimorbidity influences on unfavorable outcomes of the treatment for tuberculosis.

RESUMEN Objetivo: Analizar la influencia de la multimorbilidad en el resultado del tratamiento de nuevos casos de tuberculosis pulmonar. Método: Estudio analítico de base poblacional, en el que utilizan datos secundarios, recopilados de la base de datos del Sistema de Información de Enfermedades de Notificación, de nuevos casos de tuberculosis pulmonar en el estado de Rio Grande do Sul entre 2013 y 2016. La relación entre la multimorbilidad y el resultado se analizó con regresión logística multinominal. Resultados: Se registró multimorbilidad en el 37,0% de los casos. De estos, el riesgo relativo (RR) fue de 1,7 para el abandono del tratamiento y de 2,9 para la muerte. El VIH tuvo un RR de 2.1 para el abandono y de 3.9 para la muerte. A mayor cantidad de comorbilidades, mayor será el RR correspondiente a resultados desfavorables. Conclusión: La multimorbilidad influye en los resultados desfavorables del tratamiento de la tuberculosis.

RESUMO Objetivo: Analisar a influência da multimorbidade no desfecho do tratamento de casos novos de tuberculose pulmonar. Métodos: Estudo analítico de base populacional, utilizando dados secundários, coletados no banco do Sistema de informação de Agravos de Notificação, de casos novos de tuberculose pulmonar ocorridos no estado do Rio Grande do Sul entre os anos de 2013 e 2016. A relação entre a multimorbidade e o desfecho foi analisada com Regressão Logística Multinominal. Resultados: A multimorbidade esteve presente em 37,0% dos casos. Destes, o risco relativo (RR) foi de 1,7 para abandono do tratamento e 2,9 para o óbito. O HIV apresentou o RR de 2,1 para o abandono e de 3,9 para óbito. Quanto maior o número de comorbidades eleva-se o RR para os desfechos desfavoráveis. Conclusões: A multimorbidade influencia nos desfechos desfavoráveis do tratamento da tuberculose.

Serviços Residenciais Terapêuticos na cidade do Rio de Janeiro: uma análise da estrutura e do processo de cuidado / Therapeutic Residential Services in the city of Rio de Janeiro: an analysis of the structure and process of care

RESUMO O objetivo do artigo foi analisar a estrutura e o processo de cuidado nos Serviços Residenciais Terapêuticos existentes no município do Rio de Janeiro. Trata-se de um estudo transversal que se concentrou na coleta de informações primárias por meio de instrumento estruturado. A pesquisa foi realizada em todos os dispositivos em funcionamento no mês de dezembro de 2016. No Rio de Janeiro, as Residências Terapêuticas recebem essencialmente pacientes egressos de internações psiquiátricas de longa permanência (94,3%), com grande oferta de vagas em dispositivos com presença de equipe nas 24 horas do dia (63,8%). Foi constatado que parte significativa dos moradores apresentava baixa frequência nas atividades assistenciais dos Centros de Atenção Psicossocial (48,7%). O cuidado interno nos dispositivos residenciais aponta para uma modelagem com forte entrelaçamento entre a moradia e as ações de reabilitação psicossocial. A baixa rotatividade de usuários mostra uma tendência para constituição de serviços com cuidado de longo prazo, o que deve ser levado em conta na manutenção e na expansão do programa no intuito de planejar serviços efetivos. Os resultados apontam que as bolsas de apoio à desinstitucionalização e, principalmente, a renda contínua aferida mediante o Benefício de Prestação Continuada são vitais para a sustentabilidade do programa.

ABSTRACT This paper aims to analyze the structure and the process of care in the existing Therapeutic Residential Services for people with mental health problems in the city of Rio de Janeiro. This is a cross-sectional study focused on the collection of primary information through a structured instrument. The research was conducted in all facilities operating in December 2016. In Rio de Janeiro, Therapeutic Residences receive mainly long-stay patients from mental hospitals (94.3%), with a large number of vacancies in devices with a 24-hours daily presence of staff (63.8%). A significant part of dwellers had a low frequency in the care activities of the Psychosocial Care Centers (48.7%). The internal care in the residential facilities points to a model with strong interweaving between housing and the psychosocial rehabilitation actions. The low turnover of users shows a trend towards the establishment of services with long-term care, which should be taken into account in the maintenance and expansion of the program to plan effective services. The results show that grants to support deinstitutionalization, and mainly the income received from the Continuous Cash Benefit program are vital to the program's sustainability.

Serviço de saúde procurado pelas pessoas com sintomas da tuberculose / Health service searched by people with tuberculosis symptoms / Servicio de salud utilizado por las personas con síntomas de la tuberculosis

Objetivo: identificar o perfil das pessoas com tuberculose em relação ao comportamento de busca por atendimento diante dos primeiros sintomas da doença. Método: estudo quantitativo desenvolvido em quatro municípios do Rio Grande do Sul entre 2013 e 2014, com aplicação de questionário estruturado às pessoas com tuberculose pulmonar que iniciaram o tratamento no período. Análise dos dados realizada no software Statistica 12, utilizando-se estatística descritiva. Resultados: o serviço de saúde mais procurado foi o pronto atendimento (35,7%). Quanto ao perfil, houve predomínio do sexo masculino (58,7%), cor da pele branca (59,8%), viviam sem companheiro (67,4%), escolaridade inferior a 8 anos (75,0%), emprego formal (41,3%), renda de 1 a 2 salários mínimos (43,5%). Conclusão: houve diferenças no perfil de acordo com o comportamento de busca por atendimento, e destaca-se que conhecê-lo é essencial para o planejamento de ações de diagnóstico precoce.

Aim: to identify the profile of people with tuberculosis in relation to the behavior of search for care against the first symptoms of the disease. Method: quantitative study developed in four cities of Rio Grande do Sul, between 2013 and 2014, with the application of a structured questionnaire to people with pulmonary tuberculosis who began treatment within the period. Data analysis was performed in Statistica 12 software, using descriptive statistics. Results: the most sought after health service was prompt care (35.7%). Regarding the profile, there was a predominance of males (58.7%), white skin color (59.8%), who lived without a partner (67.4%), education less than 8 years (75.0%), formal employment (41.3%), income from 1 to 2 minimum wages (43.5%). Conclusion: there were differences in the profile according to the behavior of search for care, and it is noted that knowing it is essential for the planning of early diagnosis actions.

Objetivo: identificar el perfil de las personas con tuberculosis con relación al comportamiento de búsqueda por atención a partir de los primeros síntomas de la enfermedad. Método: estudio cuantitativo, desarrollado en cuatro municipios del Rio Grande do Sul, entre 2013 y 2014, por medio de la aplicación de cuestionario estructurado a las personas con tuberculosis pulmonar, que iniciaron el tratamiento en el período. Análisis de los datos realizada por el software Statistica 12, utilizando estadística descriptiva. Resultados: el servicio de salud más buscado fue el de pronta atención (35,7%). Cuanto al perfil hubo predominio del sexo masculino (58,7%), color de piel blanca (59,8%), vivían sin compañero (67,4%), escolaridad inferior a 8 años (75,0%), empleo formal (41,3%), renta de 1 a 2 salarios mínimos (43,5%). Conclusión: hubo diferencias en el perfil de acuerdo con el comportamiento de búsqueda por atención, y se destaca que conocerlo es esencial para la planificación de acciones de diagnóstico precoz.

Influence of Core-Veneer Thickness Ratio on the Fracture Load and Failure Mode of Zirconia Crowns.

PURPOSE: To evaluate the influence of different core-veneer thickness (CVT) ratios on fracture loads and failure modes of zirconia crowns with or without thermomechanical cycling (TC). MATERIALS AND METHODS: Forty yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) cores were veneered with a pressable ceramic and divided into four groups (n = 10): group 1 - 1:3 CVT ratio (0.5-mm core, 1.5-mm veneer); group 2 - 1:1 CVT ratio (1.0-mm core, 1.0-mm veneer); groups 3 and 4 - identical to groups 1 and 2, respectively, except that they underwent TC (1,000,000 cycles with an 84-N load applied at a 4-Hz frequency, temperature cycling at 4°C, 37°C, and 55°C - 30 seconds each). Loads were applied axially to the central fossa of the crowns with a 1 mm/min crosshead speed at 200 N until failure. RESULTS: Two-way ANOVA showed that the crowns with a 1:3 CVT ratio had a lower mean fracture load than crowns with a 1:1 CVT ratio (group 1 = 1666.4 ± 466.4 N; group 2 = 2156.6 ± 472.3 N). TC had no effect on the fracture load for crowns with the same CVT ratio. The failures observed for the crowns in groups 1, 3, and 4 were fractures within the veneering ceramic, which exposed the core. The failure severity of fractures for group 2 was less extensive, characterized by chipping within the ceramic veneer. CONCLUSION: Crowns with a 1:1 CVT ratio had higher fracture load values and more conservative failures. TC had no effect on the fracture load of the ceramic crowns.

Feline subcutaneous pythiosis / Pitiose subcutânea em um felino

ABSTRACT: Pythiosis in felines is a rare disease associated with the oomycete Pythium insidiosum. The aim of this report was to describe the macroscopic, histopathological, and molecular characteristics of P. insidiosum infection in a 2-year-old cat, with a localized invasive subcutaneous mass. The feline had an increase of volume near the anal region since it was younger. The cat died just after surgery. The necropsy was performed, and samples were collected for histopathological examination. Microscopically, the skin lesion was characterized by necro-eosinophilic dermatitis, panniculitis, and myositis surrounding negatively stained hyphal structures. In the sections stained with GMS, dark brown hyphae were clearly seen inside the affected tissue. They were rarely septate and their walls were almost parallel. Immunohistochemistry using a polyclonal anti-P. insidiosum antibody showed a strongly immunostained hyphae into the lesions. The analysis based on PCR had a positive result for P. insidiosum. Pythiosis should be considered in the differential diagnosis of subcutaneous tissue disorders in felines.

RESUMO: Pitiose em felinos é uma doença de ocorrência rara associada ao oomiceto Pythium insidiosum. O objetivo deste relato é descrever as características macroscópicas, histopatológicas e moleculares da infecção por P. insidiosum em um gato de dois anos de idade, com uma massa invasiva localizada no subcutâneo. O gato morreu logo após a cirurgia, sendo realizada a necropsia e coleta de amostras para exame histopatológico. Microscopicamente, a lesão cutânea foi caracterizada por dermatite necroeosinofílica, paniculite e miosite envolvendo imagens de hifas negativamente coradas. Nas seções coradas com GMS, hifas marrom-escuras foram claramente vistas dentro do tecido afetado. As hifas raramente eram septadas e suas paredes eram quase paralelas. A imuno-histoquímica, utilizando um anticorpo policlonal anti-P. insidiosum, mostrou hifas fortemente imunomarcadas nas lesões. A análise baseada em PCR teve resultado positivo para P. insidiosum. A pitiose deve ser considerada no diagnóstico diferencial de desordens teciduais subcutâneas em felinos.

Respostas cardiorrespiratórias e percepção subjetiva do esforço de hemiparéticos submetidos à prática de exergames / Cardiorrespiratory responses and subjective perception of the effort in hemiparetics after exergames practice / Respuestas cardiorrespiratorias y percepción subjetiva del esfuerzo de hemipareticos después de la práctica de exergames

Objetivo: avaliar as respostas cardiorrespiratórias e percepção subjetiva do esforço de pacientes hemiparéticos submetidos à prática dos jogos de vídeo do XBOX Kinect. Método: estudo de casos múltiplos com abordagem quantitativa, com avaliação da frequência cardíaca, frequência respiratória, saturação de oxigênio, pressão arterial e percepção do esforço durante prática do jogo Your Shape Fitness Evolved 2012® cinco e dez minutos após o término da atividade, sendo considerados também os valores de frequência cardíaca máxima e de treino para fornecer mais segurança a pesquisa. Resultados: a amostra foi composta por dois sujeitos que apresentaram respostas adequadas a prática dos jogos ativos de vídeo game. Para o sujeito 1 a atividade foi considerada como leve e para o sujeito 2 uma atividade moderada. Conclusão: evidenciou-se a necessidade de mais estudos científicos para esclarecer os efeitos desses jogos sobre os diversos sistemas e a necessidade de profissionais habilitados a utilização desses jogos para fins terapêuticos.(AU)

Objective: to evaluate the cardiorespiratory responses and subjective perception of the effort of hemiparetic patients submitted to XBOX Kinect video games. Method: multiple case study with quantitative approach, with evaluation of heart rate, respiratory rate, oxygen saturation, blood pressure and perception of effort during practice of the game Your Shape Fitness Evolved 2012® five and ten minutes after the end of the activity, being also considered the values of maximum heart rate and training to provide more safety to the research. Results: the sample consisted of two subjects who presented adequate responses to the practice of active video game games. For subject 1 the activity was considered as mild and for subject 2 a moderate activity. Conclusion: the need for more scientific studies to clarify the effects of these games on the different systems and the need for professionals qualified to use these games for therapeutic purposes was evidenced.(AU)

Objetivo: evaluar las respuestas cardiorrespiratorias y percepción subjetiva del esfuerzo de pacientes hemiparéticos despúes de la práctica de los juegos de vídeo del XBOX Kinect. Método: Estudio de casos múltiples con abordaje cuantitativo, con evaluación de la frecuencia cardíaca, respiratoria, saturación de oxígeno, presión arterial y percepción del esfuerzo durante la práctica del juego Your Shape Fitness Evolved 2012® después de cinco y diez minutos del término de la actividad. Se consideran también los valores de frecuencia cardiaca máxima y de entrenamiento para proporcionar más seguridad a la investigación. Resultados: la muestra fue compuesta por dos sujetos, éstos presentaron respuestas adecuadas a la práctica de los juegos activos de video. Para el sujeto 1 la actividad fue considerada como leve y para el sujeto 2 una actividad moderada. Conclusión: se evidenció la necesidad de más estudios científicos para aclarar los efectos de estos juegos sobre los diversos sistemas y la necesidad de profesionales habilitados para la utilización de esos juegos para fines terapéuticos.(AU)

Conceitos, manifestações clínicas e cuidados imediatos na disreflexia autonômica / Concepts, clinical manifestations, and immediate care in autonomical disreflexia / Conceptos, manifestaciones clínicas y cuidados inmediatos en la disreflexia autonómica

Objetivo: revisar a literatura a respeito da disreflexia autonômica e apresentar conceitos, manifestações clínicas e cuidados imediatos diante dessa síndrome. Método: revisão integrativa da literatura realizada no período de maio a junho de 2018. Para a busca de dados foram utilizadas as bases de dados SciELO, PubMed e Medline. Resultados: foram selecionados quinze artigos publicados no período de 2013-2018, em português, espanhol e inglês, que contemplaram em seus títulos e/ou resumos/conteúdo o termo disreflexia autonômica e/ou reabilitação e/ou traumatismo da medula espinal e/ou seus respectivos unitermos, disponibilizados na íntegra. Quanto ao ano de publicação, observou-se que 33,33% dos artigos selecionados foram publicados em 2017; em relação ao idioma de publicação, a língua inglesa predomina em 73,33% deles; no que tange ao canal de publicação, a revista The Journal of Spinal Cord Medicine apresenta 20% dos artigos escolhidos. Quanto às abordagens dos estudos, verificou-se a determinação de conceitos, manifestações clínicas e cuidados imediatos como temáticas mais apresentadas. Conclusão: foi possível observar que a disreflexia autonômica é uma síndrome de grandes limitações, fatores etiológicos e necessidades de cuidados especializados. Vale mencionar que há uma grande escassez de estudos sobre o tema.(AU)

Objective: to review the literature on autonomic dysreflexia and to present concepts, clinical manifestations and immediate care before this syndrome. Method: it is an integrative literature review, performed in the period from may to june 2018. Data search was performed using the SciELO, PubMed and Medline databases. Results: fifteen articles published in the period of 2013-2018 in Portuguese, Spanish and English were selected, which included in their titles and/or abstracts/contents the term autonomic dysreflexia and/or rehabilitation and/or spinal cord injuries and/ or their respective uniterms, available in full. As for the year of publication, it was observed that 33.33% of the articles selected were published in 2017; in relation to the language of publication, the English language predominates in 73.33% of them; with regard to the publication channel, The Journal of Spinal Cord Medicine presents 20% of the articles chosen. Regarding the approaches of the studies, the determination of concepts, clinical manifestations and immediate care were the most presented themes verified. Conclusion: it was possible to observe that autonomic dysreflexia is a syndrome of major limitations, etiological factors and specialized care needs. It is worth mentioning that there is a great shortage of studies on the subject.(AU)

Objetivo: Revisar la literatura acerca de la disreflexia autonómica y presentar conceptos, manifestaciones clínicas y cuidados inmediatos ante este síndrome. Método: es una revisión integrativa de la literatura, realizada en el período de mayo a junio de 2018. Para la búsqueda de datos se utilizaron las bases de datos SciELO, PubMed y Medline. Resultados: fueron seleccionados quince artículos publicados en el periodo 2013-2018, en portugués, español e inglés, cuyos títulos y/o resúmenes/contenido presentaba el término disreflexia autonómica y/o rehabilitación y/o traumatismo de la médula espinal y/o sus respectivos unitermos, disponibles en su totalidad. Se verificó que con respecto al año de publicación hubo un contingente mayor de publicaciones en el año 2017 (33,33%), en lengua inglesa (73,33%), mientras que la revista donde la temática fue más abordada fue The Journal of Spinal Cord Medicine (20%). En cuanto a los enfoques de los estudios, se verificó la determinación de conceptos, manifestaciones clínicas y cuidados inmediatos como temáticas más presentadas. Conclusión: fue posible observar que la disreflexia autonómica es un síndrome de grandes limitaciones, factores etiológicos y necesidades de cuidados especializados. Vale mencionar que hay una gran escasez de estudios sobre el tema.(AU)

Preservation of the vagus nerves in subtotal esophagectomy without thoracotomy.

PURPOSE: To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. METHODS: Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. RESULTS: Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. CONCLUSION: The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.