Interleukin 17F Gene Polymorphism as a Potential Protective Factor in the Immunopathology of Ocular Toxoplasmosis.

Ocular toxoplasmosis (OT) is characterised by intraocular inflammation due to Toxoplasma gondii infection. Studies have found that interleukin 17 (IL-17) plays a central role in the pathology of OT. However, nucleotide variability in IL17 and interleukin 17 receptor (IL17R) genes has not been characterised in OT. As cytokine gene polymorphisms may influence the expression of these molecules, the aim of this study was to verify whether IL17A (rs2275913), IL17F (rs763780), IL17RA (rs4819554) and IL17RC (rs708567) polymorphisms are associated with OT in a Brazilian population. This study enrolled 214 patients seropositive for T. gondii (110 with OT and 104 without) and 107 controls. Polymorphisms were identified by PCR-restriction fragment length polymorphism analysis, validated by DNA sequencing with chi-square and multivariate analyses being used to assess possible associations between polymorphisms and OT. Logistic regression under the dominant model revealed a protection factor against OT of the C mutant allele of the IL17F (rs763780) polymorphism. The T/C-C/C genotypes were significantly more common in patients without OT compared to those with OT (p value = 0.0066) and controls (p value = 0.014). Findings from this study suggest that the IL17F polymorphism may have an influence in the immunopathology of OT in Brazilian individuals.

Influence of interleukin 17 A and 17 F polymorphisms in keratoconus.

BACKGROUND: Until a few years ago, keratoconus was defined as a noninflammatory degenerative disease. However, recent studies have shown that the altered balance between inflammatory cytokines, proteases, and protease inhibitors, as well as free radicals and oxidants, have a crucial role in the pathogenesis of this disease. The aim of this study is to investigate whether interleukin 17 A G197A (rs2275913) and interleukin 17 F T7488C (rs763780) polymorphisms are associated with keratoconus in patients from a population of the northwestern region of the State of São Paulo, Brazil. METHODS AND RESULTS: 35 patients and 61 controls were enrolled. Genotyping of interleukin 17 A G197A and interleukin 17 F T7488C polymorphisms was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique. Statistical analyses were conducted using the chi-square test, and an odds ratio with a 95% confidence interval was also calculated to evaluate the association between polymorphisms and disease. Evaluating interleukin 17 F T7488C, we found that the TT genotype is associated as a risk factor for keratoconus (P = 0.04; OR = 3.01; CI 1.11-8.14). As for evaluating interleukin 17 A G197A, the allele and genotype frequencies between patients and controls were compared and no statistically significant differences were found. CONCLUSIONS: Our data showed that the interleukin 17 F T7488C polymorphisms may exert an influence in keratoconus.

Plasma concentrations of CCL3 and CCL4 in the cardiac and digestive clinical forms of chronic Chagas disease.

The aim of this study was to investigate the plasma levels of the CCL3 and CCL4 chemokines in patients with the cardiac and digestive clinical forms of chronic Chagas disease and in cardiac patients with and without left ventricular systolic dysfunction (LVSD). Plasma samples from 75 patients were evaluated by enzyme-linked immunosorbent assay (ELISA) to confirm infection by T. cruzi. Plasma levels of the CCL3 and CCL4 chemokines were measured using Milliplex® MAP assay (Millipore). There were no significant differences in the levels of CCL3 and CCL4 between patients with the digestive and cardiac clinical forms of Chagas disease. Moreover, no significant differences were found between patients without LVSD and those with LVSD. Higher CCL3 and CCL4 plasma levels were found in patients with LVSD compared to those with the digestive form of the disease. The CCL3 and CCL4 chemokines might not be involved in differential susceptibility to the digestive and cardiac clinical forms of chronic Chagas disease, and it seems they do not influence the development of LVSD.

Clinical and epidemiological profiles of individuals with drug-resistant tuberculosis.

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

Seroepidemiology of Toxoplasma gondii infection in blood donors in a population from the northwestern region of São Paulo state, Brazil.

BACKGROUND: Toxoplasmosis is one of the most common parasitic infections worldwide with varying prevalence between human populations. These variations are mainly associated with human exposure to risk factors. In this article, the seroprevalence of Toxoplasma gondii infection and the risk factors associated with infection in 1729 blood donors from São José do Rio Preto, São Paulo, Brazil were analysed. METHODS: The serological tests for detecting immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-T. gondii were used. The risk factors associated with the infection were identified through the application of an epidemiological questionnaire. RESULTS: The prevalence of T. gondii infection was 48.0%. The following factors were identified in the final model after multiple logistic regression analysis: drinking raw milk (p=0.003; odds ratio [OR] 1.364 [confidence interval {CI} 1.1 to 1.7]), residing in a rural area (p<0.0001; OR 2.764 [CI 1.7 to 4.6]) and receiving a blood transfusion (p=0.015; OR 1.856 [CI 1.1 to 3.0]). CONCLUSIONS: The data obtained in this study showed that the blood donor population is exposed to risk factors related to infection by T. gondii. These data allow the establishment of control programs to contribute to public health in northwestern São Paulo state.

miRNA 511_5p is a potential biomarker for ocular toxoplasmosis.

BACKGROUND: Ocular toxoplasmosis (OT) is a frequent clinical manifestation due to infection by Toxoplasma gondii. It is characterized by an inflammatory process involving macrophages activated by pro-inflammatory cytokines. The expression of microRNAs takes place during the inflammatory process and, among them, miRNA 511 regulates the activation of macrophages. This study evaluated the expression of miRNA 511_5p in patients with OT and healthy controls. METHODS: A total of 361 patients from the Hospital de Base of Fundação Faculdade de Medicina de São José do Rio Preto were enrolled and divided into four groups: G1-patients with active ocular lesions and reagent serology for T. gondii; G2-patients with scars and reagent serology for T. gondii; G3-patients without ocular lesions or scars and reagent serology for T. gondii; G4-patients without ocular lesions or scars and non-reagent serology for T. gondii. All patients underwent clinical and laboratory evaluation to confirm the diagnosis of OT. Serology tests, RNA extraction and cDNA synthesis were performed. RESULTS: The miRNA 511_5p levels were compared among the groups. The G1 group showed a high blood plasma concentration of miRNA 511_5p (mean 22.34) compared with the G2 (4.65), G3 (8.91) and G4 (3.52) groups (p<0.0001). CONCLUSION: These data suggest that miRNA 511_5p has significant potential as a biomarker for OT.

Epidemiological and molecular evaluation of BRAF, KRAS, NRAS genes and MSI in the development of colorectal cancer.

BACKGROUND AND OBJECTIVES: KRAS, NRAS, BRAF mutations and microsatellite instability (MSI) can be associated with Colorectal Cancer (CRC) development. MATERIAL AND METHODS: We evaluated 828 medical records of CRC patients from a school hospital from January/2016 to December/2020. Variables such as age, gender, ethnicity, literacy level, smoking, alcoholism, primary anatomical site, tumor staging, presence of BRAFV600E, KRAS, NRAS mutations and MSI , survival and metastasis were identified. The statistical analyses were performed (p < 0.05 was considered significant). RESULTS: There was a predominance of males (51.93%), whites (90.70%), low education (72.34%), smokers (73.79%), and non-alcoholics (79.10%). Rectum was the most affected site (42.14%), advanced tumor stage was most prevalent (62.07%), and metastasis occurred in (64.61%). Of the enrolled patients; 204 were investigated for BRAF mutation and detected in (2.94%); 216 for KRAS gene and detected in (26.08%); 210 for NRAS gene, and detected in (25.36%); 370 for MSI and detected in (44.68%). A significant association of CRC with NRAS mutation and alcohol habit (p = 0.043) was observed. The presence of MSI was associated with primary site proximal colon (p < 0.000), distal colon (p = 0.001) and rectum (p = 0.010). CONCLUSION: Patients with CRC are male, over 64 years old, white, with low education, smokers and non-alcoholics. The most affected primary site is rectum in advanced stage with metastasis. CRC is associated with NRAS mutation and alcohol habit, there is increased risk for primary site of proximal colon and MSI; decreased risk for distal colon and rectum in the presence of MSI.

Absence of significant genetic alterations in the VSX1, SOD1, TIMP3, and LOX genes in Brazilian patients with Keratoconus.

PURPOSE: To identify inherited or acquired mutations in the VSX1, SOD1, TIMP3 and LOX genes from the combined analysis of corneal and blood samples from patients with Keratoconus. METHODS: The casuistry was consisted of samples of peripheral blood and corneal epithelium from 35 unrelated patients with Keratoconus who were submitted to corneal crosslink treatment. Also, blood and corneal epithelium samples from 89 non-keratoconic patients were used to compose the control group. Ophthalmologic evaluations included a clinical examination, topography and tomography. DNA samples were extracted from peripheral blood and from corneal epithelium in both groups and all coding regions of the VSX1, SOD1, TIMP3 and LOX genes were amplified by polymerase chain reaction, denatured and subjected to polyacrylamide gel electrophoresis. Mutational screening was performed by single-strand conformation polymorphism and direct DNA sequencing. RESULTS: No pathogenic variant was found in all coding regions of VSX1, SOD1, TIMP3 and LOX genes, we detected only few SNPs (single-nucleotide polymorphisms). Among the polymorphisms stand out three of them, corresponding to the synonymous exchange of amino acids: exon 3 of VSX1 Ala182Ala and exon 3 of TIMP3 His83His and Ser87Ser; in patients with Keratoconus and also in control subjects. All the polymorphisms were found in samples of corneal epithelium and corresponding blood. CONCLUSION: There is absence of KC pathogenic related to mutations in the VSX1, SOD1, TIMP3 and LOX genes in the studied patients.

Identifying Priority Giant Anteater (Myrmecophaga tridactyla) Populations for Conservation in São Paulo State, Brazil.

Habitat loss is the main threat to biodiversity conservation worldwide. Some species may be particularly susceptible to the effects of fragmentation and the isolation of populations. The impacts of human activity on wild animal populations may be understood through relationships between individual genetic data and spatial landscape variables, particularly when considering local population dynamics influenced by fragmented habitats. Thus, the objective of this study was to analyze the population structure and genetic diversity of the giant anteater (Myrmecophaga tridactyla) using an individual sampling scheme (ISS) on a regional geographic scale. Data were collected from 41 specimens from twenty different locations in São Paulo State, Brazil, and six polymorphic microsatellite loci were genotyped. Our results indicate that barriers to gene flow exist and have segregated individuals of the farther away areas into two spatially structured clusters. The populations were also found to have high genetic diversity. The experimental sampling approach used herein enabled an analysis of the population dynamics of the giant anteater on a regional scale, as well as the identification of priority populations for genetic resource conservation for this species. The results reflect the need for adequate management plans. The efficacy of the sampling scheme may vary based on the study model used, but we argue that the use of an ISS combined with suitable molecular markers and statistical methods may serve as an important tool for initial analyses of threatened or vulnerable species, particularly in anthropized regions where populations are small or hard to characterize.

Absence of the c.169+50delTAAACAG mutation of SOD1 gene in a sample of keratoconus patients in Brazilian population.

OBJECTIVE: To determine the presence of the 7-bp deletion c.169+50delTAAACAG in intron 2 of Superoxide Dismutase-1 gene in keratoconic patients from the State of São Paulo, Brazil, which promotes splicing variations, resulting in non-functional Superoxide Dismutase-1 antioxidant proteins, which may damage the corneal structure. RESULTS: A group of 35 keratoconic patients, from whom 35 peripheral blood samples and 58 samples of corneal fragments were evaluated, and a control group of 89 individuals, from whom 41 blood samples and 149 samples of corneal fragments were collected. After the amplification of DNA fragments by polymerase chain reaction, mutational screening analysis was performed by enzymatic digestion, followed by direct sequencing. The absence of the 7-bp c.169+50delTAAACAG mutation in intron 2 of Superoxide Dismutase-1 gene was detected in the analyzed subjects of the 2 groups, both in the cornea and peripheral blood samples. Then, according to our results, there is no involvement of c.169+50delTAAACAG deletion in the pathogenesis of keratoconus in this population, once it was not detected. But we emphasize that studies involving this deletion must be continued in an attempt to elucidate this issue.

Medical, ethical, and legal aspects of hematopoietic stem cell transplantation for Crohn's disease in Brazil.

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.

First isolation and genotyping of Toxoplasma gondii in a free-living giant anteater (Myrmecophaga tridactyla) revealed a unique non-archetypal genotype.

The protozoan parasite Toxoplasma gondii can infect virtually all warm-blooded animals worldwide but little is known of its infection in the endangered giant anteaters (Myrmecophaga tridactyla). The present study found antibodies to T. gondii in 13 of 23 free-living M. tridactyla from the northwest region of São Paulo state, Brazil, by the Modified Agglutination Test (MAT, cut-off titer 1:25). Unfrozen tissues of seven M. tridactyla were bioassayed in mice and viable T. gondii (strain designated TgMytrBrSP1) isolated from one seropositive giant anteater. To our knowledge, this is a new host record for T. gondii. Genotyping using PCR-RFLP revealed the Brazilian clonal Type BrIII genotype, and a unique non-archetypal genotype was revealed by microsatellite analysis.

Confidence in palliative care issues by medical students and internal medicine residents.

BACKGROUND: Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. OBJECTIVE: To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. METHOD: A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. RESULTS: Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. CONCLUSION: Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.

Comparison of quality of life and functionality in type 2 diabetics with and without insulin.

INTRODUCTION: Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES: To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS: A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS: Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION: Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

Evaluation of Serological and Molecular Tests Used for the Identification of Toxoplasma gondii Infection in Patients Treated in an Ophthalmology Clinic of a Public Health Service in São Paulo State, Brazil.

Ocular toxoplasmosis is one of the most common complications caused by the infection with the parasite Toxoplasma gondii. The risk of developing eye lesions and impaired vision is considered higher in Brazil than other countries. The clinical diagnosis is difficult and the use of sensitive and specific laboratorial methods can aid to the correct diagnosis of this infection. We compared serological methods ELISA and ELFA, and molecular cPCR, Nested PCR and qPCR for the diagnosis of T. gondii infection in groups of patients clinically evaluated with ocular diseases non-toxoplasma related (G1 = 185) and with lesions caused by toxoplasmosis (G2 = 164) in an Ophthalmology clinic in Brazil. Results were compared by the Kappa index, and sensitivity (S), specificity (E), positive predictive value (PPV), and negative (NPV) were calculated. Serologic methods were in agreement with ELISA more sensitive and ELFA more specific to characterize the acute and chronic infections while molecular methods were discrepant where qPCR presented higher sensitivity, however, lower specificity when compared to cPCR and Nested PCR.

Guia de intervenção precoce como recurso terapêutico ocupacional para cuidadores de crianças hospitalizadas / Early intervention guide as occupational therapeutic resource for hospitalized child caregivers / Guía de intervención temprana como recurso terapéutico ocupacional para cuidadores de ninõs hospitalizados

Introdução: Os primeiros anos de vida de uma criança são essenciais para seu desenvolvimento neuropsicomotor. Quando a criança está hospitalizada, o acompanhamento de seu desenvolvimento se torna importante para a promoção de saúde, prevenção de agravos e a identificação de atraso motor, cognitivo, sensorial e social. Objetivo: Apresentar um guia de orientação aos cuidadores de crianças hospitalizadas sobre intervenção precoce, para avaliá-lo como recurso informativo sobre o desenvolvimento infantil. Método: Pesquisa de corte transversal, com delineamento descritivo, abordagem quantitativa com correlação entre variáveis, desenvolvida em um hospital-escola infantil de nível terciário. Participaram 21 cuidadores de crianças hospitalizadas com faixa etária de 0 a 24 meses, durante o período de maio a julho de 2020. Foram aplicados três questionários semiestruturados (um para caracterização da amostra e os outros dois para comprovar a eficácia do guia). Foi distribuído um guia impresso aos cuidadores. Os dados foram analisados estatisticamente, usando estatística descritiva e inferencial. Resultados: A maioria dos participantes (95,24%) era de mães das crianças, cuja média de idade foi de 6±5,74 meses. Os diagnósticos prevalentes foram as cardiopatias (57,14%) e tempo de internação em torno de 66±44,78 dias. Com a aplicação dos questionários, foi possível identificar o interesse dos cuidadores em receber informações sobre o desenvolvimento infantil e utilizar o guia como recurso para orientá-los sobre como propiciar estímulos saudáveis às crianças. Conclusão: O guia se mostrou um recurso informativo de grande valia, pois permite que os cuidadores se atentem à prevenção de atrasos no desenvolvimento e proporcionem maior qualidade de vida às crianças durante a internação e também no domicílio.(AU) Palavras-chave: Guia de estudo como assunto. Intervenção precoce. Terapia Ocupacional. Desenvolvimento Infantil. Cuidadores. Criança hospitalizada

Introduction: The first years of a child's life are essential for their neuropsychomotor development. When the child is hospitalized, monitoring their development becomes essential for health promotion, disease prevention, and identifying motor, cognitive, sensory, and social delays. Objective: Present an orientation guide for caregivers of hospitalized children on early intervention to evaluate it as an informative resource on child development. Method: We carried out a cross-sectional with a descriptive design, using a quantitative approach, developed in a tertiary-level children's teaching hospital. Participants were 21 caregivers of hospitalized children aged 0 to 24 months, from May to July 2020. Three semi-structured questionnaires were applied (one to characterize the sample and the other two to prove the guide's effectiveness). A printed guide was distributed to caregivers. Data were statistically analyzed using descriptive and inferential statistics. Results: Most participants (95.24%) were mothers of the children, whose mean age was 6±5.74 months. The principal diagnoses were heart disease (57.14%) and length of hospital stay around 66±44.78 days. With the application of the questionnaires, it was possible to identify the caregivers' interest in receiving information about child development and using the guide as a resource to guide them on how to provide healthy stimuli to children. Conclusion: The guide proved to be an informative resource of great value, as it allows caregivers to pay attention to the prevention of developmental delays and provide a better quality of life for children during hospitalization and at home.(AU) Keywords: Study guide as topic. Early intervention. Occupational therapy. Child development. Caregivers. Child Hospitalized

Introducción: Los primeros años de vida del niño son fundamentales para su desarrollo neuropsicomotor. Cuando el niño está hospitalizado, el seguimiento de su desarrollo se vuelve fundamental para la promoción de la salud, la prevención de enfermedades y la identificación de retrasos motores, cognitivos, sensoriales y sociales. Objetivo: Presentar una guía de orientación para cuidadores de niños hospitalizados sobre intervención temprana para evaluarla como recurso informativo sobre el desarrollo infantil. Método: Se realizó un estudio transversal con diseño descriptivo, con enfoque cuantitativo, desarrollado en un hospital de enseñanza infantil de tercer nivel. Participaron 21 cuidadores de niños hospitalizados de 0 a 24 meses, de mayo a julio de 2020. Se aplicaron tres cuestionarios semiestructurados (uno para caracterizar la muestra y los otros dos para comprobar la efectividad de la guía). Se distribuyó una guía impresa a los cuidadores. Los datos se analizaron estadísticamente mediante estadística descriptiva e inferencial. Resultados: La mayoría de las participantes (95,24%) eran madres de los niños, cuya media de edad fue de 6±5,74 meses. Los principales diagnósticos fueron cardiopatía (57,14%) y estancia hospitalaria en torno a 66±44,78 días. Con la aplicación de los cuestionarios se logró identificar el interés de los cuidadores en recibir información sobre el desarrollo infantil y utilizar la guía como recurso para orientarlos sobre cómo brindar estímulos saludables a los niños. Conclusión: La guía demostró ser un recurso informativo de gran valor, ya que permite a los cuidadores prestar atención a la prevención de retrasos en el desarrollo y brindar una mejor calidad de vida a los niños durante la hospitalización y en el hogar.(AU) Palabras clave: Guías de estudio como assunto. Intervención Temprana. Terapia ocupacional. Desarrollo infantil. Cuidadores. Niño hospitalizado

Risk factors for acute renal failure in nephrectomized patients treated in a university hospital.

BACKGROUND: New surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital. METHODS: Seventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed. RESULTS: Of the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001). CONCLUSIONS: An altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.

Impact of educational group strategy to improve clinical and glycemic parameters in individuals with diabetes and hypertension.

OBJECTIVE: To evaluate the impact of an educational group strategy to improve clinical and glycemic parameters in individuals with diabetes and hypertension. METHODS: This descriptive prospective study included 172 individuals living in São José do Rio Preto-SP, Brazil, who were enrolled in a well-integrated educational group called HIPERDIA (Record System for Follow-up of Hypertensive and Diabetic Individuals) coordinated by a qualified multidisciplinary team. We analyzed sociodemographic, anthropometric, clinical, and laboratory data. Data were collected in the first, fifth, and eighth meeting of the educational group. RESULTS: A total of 68.6% of patients were women, 85.4% were white, 64.0% had an incomplete basic education, 47.7% were retired, 79.7% had been diagnosed with diabetes for 6 or more years, 9.9% were smokers, and 9.9% used alcohol. Individuals' diastolic blood pressure decreased between the fifth and eighth meeting (p<0.05). Between the first and fifth meeting, both fasting glucose levels (p<0.05) and glycated hemoglobin decreased; the latter continue to drop at the fifth and eighth meetings (p<0.001). Anthropometric parameters remained unchanged. CONCLUSION: The results suggest that an educational group strategy is favorable for controlling diabetes mellitus and hypertension.

Pandemia do Coronavírus e Ensino Remoto Emergencial: Percepção do Impacto no Bem Estar de Universitários

Resumo: Jovens em ensino superior são mais vulneráveis ao aparecimento de sintomas psicológicos diante do contexto de COVID-19. Não só a pandemia, como a adaptação à realidade do ensino remoto e demais dificuldades podem afetar o bem estar dos universitários. Por isso, esse estudo buscou investigar a percepção de bem-estar e saúde mental de universitários que realizaram ensino remoto durante a quarentena. Trata-se de um estudo transversal, exploratório e descritivo. Utilizou-se o instrumento "Questionário sobre percepção do isolamento social por universitários durante quarentena da COVID-19". Por meio da técnica por amostragem de referência os universitários divulgaram o link de acesso ao questionário online a seus pares. Participaram 497 estudantes, a maioria mulheres (74,69%) com média de idade 21,71 (DP=2.85), matriculados em Instituição de Ensino Superior pública (IES) (72.89%). Encontrou-se correlação positiva e significante (p<0.0001) para prejuízo no desempenho acadêmico pela adesão ao Ensino Remoto Emergencial e a percepção negativa na saúde mental e no bem-estar. Nos dados qualitativos, foram identificados percepção de maior ansiedade (15.35%), estresse (7.3%) e alteração do sono (7.67%) nos participantes. Cerca de 91.96% dos participantes estão engajados em práticas de auto cuidado e gerenciamento emocional. Portanto, os resultados convergem com a literatura e implicam que o ensino remoto pode impactar negativamente sobre o bem-estar e gerar insegurança quanto à qualidade e solidez da formação acadêmica. Os dados desse estudo sugerem que as instituições implementem atividades preventivas em relação à saúde mental dos estudantes e adequem o ensino remoto a fim de reduzir o sofrimento identificado.

Abstract: Young people in higher education are more vulnerable to the appearance of psychological symptoms in the context of COVID-19. Also, the adaptation to remote education and other difficulties can affect the well-being of university students. Therefore, this study sought to investigate the perception of well-being and mental health of university students who underwent remote education during quarantine. This is a cross-sectional, exploratory, and descriptive study. The instrument used was "Questionnaire on the perception of social isolation by university students during quarantine of COVID-19". Using the reference sampling technique, university students released the link to access the online questionnaire to their peers. 497 students participated, most of them women (74.69%), with mean age of 21.71 (SD = 2.85), enrolled in a public higher education institution (HEI) (72.89%). A positive and significant correlation was found (p <0.0001) for academic performance impaired by the adhesion of Emergency Remote Education and the negative perception of mental health and well-being. In the qualitative part, participants noticed anxiety (15.35%), stress (7.3%) and altered sleep (7.67%). About 91.96% of the participants are engaged in self-care and emotional management practices. Therefore, the results converge with the literature and imply that online education can impact well-being and generate insecurity regarding the quality and solidity of academic training. Data from this study suggest that institutions should implement preventive activities regarding students' mental health and adapt remote learning in order to reduce student's distress.

Resumen: Los jóvenes en educación superior son más vulnerables a la aparición de síntomas psicológicos en el contexto de COVID-19. La pandemia, la adaptación a la educación a distancia y otras dificultades afectan el bienestar de los estudiantes universitarios. Este estudio buscó investigar la percepción de bienestar y salud mental de los que realizaron educación remota durante la cuarentena. Esto es un estudio transversal, exploratorio y descriptivo. El instrumento utilizado fue "Cuestionario sobre la percepción de aislamiento social de estudiantes universitarios durante la cuarentena de COVID-19". Utilizando la técnica de muestreo de referencia, los estudiantes lanzaron el enlace para acceder al cuestionario en línea a sus compañeros. Participaron 497 estudiantes, la mayoría mujeres (74,69%) con una media de edad de 21,71 (DE = 2,85) matriculados en una institución pública de educación superior (72,89%). Se encontró una correlación positiva y significativa (p<0,0001) para el rendimiento académico deteriorado por este modelo de enseñanza y la percepción negativa de salud y bienestar mental. En el resultado cualitativo se identificaron percepcíon de mayor ansiedad (15,35%), estrés (7,3%) y alteración del sueño (7,67%). Aproximadamente el 91,96% realiza prácticas de autocuidado y manejo emocional. Por tanto, los resultados convergen con la literatura e implican que la educación remota puede impactar el bienestar y generar inseguridad en cuanto a la calidad y solidez de la formación académica. Los datos de este estudio sugieren que las instituciones deben implementar actividades preventivas relacionadas con la salud mental de los estudiantes y adaptar el aprendizaje a distancia para reducir la angustia de los universitarios.

Detection of anti-Toxoplasma gondiiantibodies in wild free-living birds and mammals from the northwest region of São Paulo state, Brazil / Detecção de anticorpos anti-Toxoplasma gondiiem aves e mamíferos silvestres de vida livre da região noroeste do estado de São Paulo, Brasil

Toxoplasmosis is a protozoonosis caused by an obligate intracellular parasite named Toxoplasma gondii, which can infect humans and a large number of homeothermic animal species with worldwide distribution. The present study aimed to detect anti-T. gondii antibodies from serological samples of free-living wild animals from the northwest region of São Paulo state, Brazil. Thirty-two samples (eight from birds and 24 from mammals) were analyzed by the modified agglutination test (MAT) using 5 cut-off points for birds and 25 for mammals. Seropositivity was observed in 25% (2/8) of birds, including the species Rupornis magnirostris (roadside hawk) and Caracara plancus (southern caracara), and 29.2% (7/24) animals were seropositive among mammals, including one hoary fox (Lycalopex vetulus), two maned wolves (Chrysocyon brachyurus), one black howler monkey (Alouatta caraya), two crab-eating foxes (Cerdocyon thous) and one gray brocket deer (Mazama gouazoubira). The results obtained with the present study indicate the exposure to T. gondiiof free-living wild animals from the northwest region of São Paulo state and, therefore, that they probably play a role in the transmission and maintenance of T. gondii in the environment they inhabit. Thus, identification of the infection in several animal species in the region indicates the environmental contamination of the area. Studies of this nature may help to understand the importance of the prevention and control of this disease in Brazil.(AU)

A toxoplasmose é uma protozoonose causada por um parasita intracelular obrigatório denominado Toxoplasma gondii, que pode infectar os humanos e um vasto número de espécies animais homeotérmicas, apresentando distribuição mundial. O presente estudo objetivou a detecção de anticorpos anti-T. gondii a partir de amostras sorológicas de animais silvestres de vida livre da região noroeste do estado de São Paulo. Foram analisadas 32 amostras (oito de aves e 24 de mamíferos) por meio do teste de aglutinação modificado (MAT), utilizando ponto de corte 5 para as aves e 25 para os mamíferos. Soropositividade foi observada em 25% (2/8) das aves, incluindo as espécies Rupornis magnirostris (gavião-carijó) e Caracara plancus (carcará); entre os mamíferos, 29,2% (7/24) foram soropositivos incluindo uma raposa-do-campo (Lycalopex vetulus), dois lobos-guará (Chrysocyon brachyurus), um bugio-preto (Alouatta caraya), dois cachorros-do-mato (Cerdocyon thous) e um veado-catingueiro (Mazama gouazoubira). Os resultados obtidos com o presente estudo indicam a exposição dos animais selvagens de vida livre a T. gondii na região noroeste do estado de São Paulo e, portanto, que provavelmente apresentam papel na transmissão e manutenção de T. gondii no meio ambiente em que vivem. Assim, a identificação da infecção em várias espécies de animais na região indica a contaminação ambiental da área. Estudos dessa natureza podem ajudar no entendimento sobre a prevenção e o controle dessa importante doença no Brasil.(AU)