Renal ischemia/reperfusion induces prominent progressive kidney disease in diabetic mice.

Acute kidney injury (AKI) is a public health concern associated with high rates of mortality, even in milder cases. One of the reasons for the difficulty in managing AKI in patients is due to its association with pre-existing comorbidities, such as diabetes. In fact, diabetes increases the susceptibility to develop more severe AKI after renal ischemia. However, the long-term effects of this association are not known. Thus, an experimental model to evaluate the chronic effects of renal ischemia/reperfusion (IR) in STZ-treated mice was analyzed. We focused on the glomerular and tubulointerstitial damage, as well as kidney function and metabolic profile. It was found that pre-existing diabetes may potentiate progressive kidney disease after AKI, mainly by exacerbating pro-inflammatory and sustaining fibrotic responses and altering renal glucose metabolism. For our knowledge, this is the first report that highlights the long-term effects of renal IR on diabetes. The findings of this study can support the management of AKI in clinical practice.

Crystal structure of dihydroneopterin aldolase from Mycobacterium tuberculosis associated with 8-mercaptoguanine, and development of novel S8-functionalized analogues as inhibitors: Synthesis, enzyme inhibition, in vitro toxicity and antitubercular activity.

The crystallographic structure of the FolB enzyme from Mycobacterium tuberculosis (MtFolB), complexed with its inhibitor 8-mercaptoguanine (8-MG), was elucidated at a resolution of 1.95 Å. A novel series of S8-functionalized 8-MG derivatives were synthesised and evaluated as in vitro inhibitors of dihydroneopterin aldolase (DHNA, EC 4.1.2.25) activity of MtFolB. These compounds exhibited IC50 values in the submicromolar range. Evaluation of the activity for five compounds indicated their inhibition mode and inhibition constants. Molecular docking analyses were performed to determine the enzyme-inhibitor intermolecular interactions and ligand conformations upon complex formation. The inhibitory activities of all compounds against the M. tuberculosis H37Rv strain were evaluated. Compound 3e exhibited a minimum inhibitory concentration in the micromolar range. Finally, Compound 3e showed no apparent toxicity in both HepG2 and Vero cells. The findings presented herein will advance the quest for novel, specific inhibitors targeting MtFolB, an attractive molecular target for TB drug development.

Enhancing RECK Expression Through miR-21 Inhibition: A Promising Strategy for Bladder Carcinoma Control.

Bladder carcinoma (BC) is the tenth most frequent malignancy worldwide, with high morbidity and mortality rates. Despite recent treatment advances, high-grade BC and muscle-invasive BC present with significant progression and recurrence rates, urging the need for alternative treatments. The microRNA-21 (miR-21) has superexpression in many malignancies and is associated with cellular invasion and progression. One of its mechanisms of action is the regulation of RECK, a tumor suppressor gene responsible for inhibiting metalloproteinases, including MMP9. In a high-grade urothelial cancer cell line, we aimed to assess if miR-21 downregulation would promote RECK expression and decrease MMP9 expression. We also evaluated cellular migration and proliferation potential by inhibition of this pathway. In a T24 cell line, we inhibited miR-21 expression by transfection of a specific microRNA inhibitor (anti-miR-21). There were also control and scramble groups, the last with a negative microRNA transfected. After the procedure, we performed a genetic expression analysis of miR-21, RECK, and MMP9 through qPCR. Migration, proliferation, and protein expression were evaluated via wound healing assay, colony formation assay, flow cytometry, and immunofluorescence.After anti-miR-21 transfection, miR-21 expression decreased with RECK upregulation and MMP9 downregulation. The immunofluorescence assay showed a significant increase in RECK protein expression (p < 0.0001) and a decrease in MMP9 protein expression (p = 0.0101). The anti-miR-21 transfection significantly reduced cellular migration in the wound healing assay (p < 0.0001). Furthermore, in the colony formation assay, the anti-miR-21 group demonstrated reduced cellular proliferation (p = 0.0008), also revealed in the cell cycle analysis by flow cytometry (p = 0.0038). Our results corroborate the hypothesis that miR-21 is associated with BC cellular migration and proliferation, revealing its potential as a new effective treatment for this pathology.

Community-Based Action Research Intervention to Promote Occupational Health Nursing of Portuguese Quarry Workers.

The northern region of Portugal has the largest number of companies manufacturing granite and stone products, which has become the region's trademark. In the municipalities of Marco de Canaveses and Penafiel, the economic activity of this area is important. However, the lack of attractiveness of this activity, combined with the high prevalence of silicosis and tuberculosis in this population, has led to a growing shortage of labor. In order for this project to be the result of collaborative, integral work centered on the people who are the target of health promotion, we used the Participatory Health Research (PHR) approach, based on the PRECEDE-PROCEED model, to implement a mixed-methods study, including participant observation, interviews and document analysis. These data were used to co-create a study design. In 2021, a total of 102 interviews were carried out and self-completion surveys were distributed: the Fantastic Lifestyle Questionnaire (FLQ) and the EQ-5D-3L. Within the scope of occupational health nursing and in the field of action of public health nurses, with the interviews and self-completed surveys carried out, we identified potential focuses for occupational health nursing intervention to promote the health of stone industry workers: adherence to protective measures, energy balance deficit, tobacco and alcohol consumption and access to health services. Data analysis made it possible to assess the prevalence of risk behaviors by order and to involve managers and workers in the co-creation of a health promotion program. The accurate identification of the focuses for nursing intervention not only improves the effectiveness of occupational health services, allowing for targeted interventions adapted to workers' needs, but also contributes considerably to health promotion in the workplace, resulting in safer working environments, a reduction in occupational diseases and, consequently, a healthier and more productive workforce. This protocol of this study was not registered.

Hepatitis E Virus in Individuals Undergoing Heparin Therapy: An Observational Serological and Molecular Study.

INTRODUCTION: Heparin is derived from swine and has been suggested as a possible source of HEV. To study the potential risk of HEV infection associated with heparin treatment, two groups of individuals were compared. Sera from heparinized (N=93) and non-heparinized individuals (N=111) were tested for markers of acute HEV infection and anti-HEV IgG seroprevalence. METHODS: An acute HEV case was defined by the presence of anti-HEV IgM and/or HEV RNA. From the 93 heparinized individuals, one was positive for IgM and IgG anti-HEV and two were positive for HEV RNA (for both ORF3 and ORF2), and there were a total of two (2.2%) cases of current or recent HEV infection. From the 111 non-heparinized individuals, three were positive for IgM anti-HEV, one was positive for both IgM and IgG anti-HEV, and none was positive for HEV RNA, and there were a total of three (2.7%) cases of current or recent HEV infection. The difference between HEV cases in the heparinized individuals and the non-heparinized individuals was not statistically significant (2.2% vs. 2.7%; p = 0.799). RESULTS: Concerning IgG anti-HEV, it was detected in 32 individuals from the heparinized group and in 18 from the non-heparinized control group. A statistically significant difference was observed in the presence of anti-HEV IgG in heparinized individuals and controls (p = 0.003). CONCLUSION: This study has not found any association between heparin treatment and acute HEV infection, but has shown the use of therapeutic heparin as a risk factor for IgG anti-HEV seropositivity.

Exploring the BSA- and DNA-binding, cytotoxicity, and cell cycle evaluation of ternary copper(II)/diimine complexes with N,N-dibenzyl-N'-benzoylthiourea as promising metallodrug candidates.

Four new copper(II) complexes were synthesized and characterized with the general formula [Cu(N-N)(Th)(NO3)], where N-N corresponds to the N-heterocyclic ligands 1,10-phenanthroline (phen), 2,2'-bipyridine (bipy), 4,7-diphenyl-1,10-phenanthroline (dpp), and 4,4-dimethyl-2,2'-bipyridine (dmbp) and Th represents the N,N-dibenzyl-N'-benzoylthiourea. Cytotoxic activities of the complexes against HCT116 (human colon carcinoma), HepG2 (human hepatocellular carcinoma), and non-tumor MRC-5 (human lung fibroblast) cells were investigated. The copper(II) complexes 1-4 were characterized by spectroscopic techniques while complexes 1 and 2 were studied using single-crystal X-ray diffraction as well. The complexes possessed a five-coordinated structure with one nitrate ligand as a monodentate at the axial position and two bidentate ligands N-heterocyclic and N,N-dibenzyl-N'-benzoylthiourea. The complexes showed promising IC50 values, ranging from 0.3 to 9.0 µM. Furthermore, interaction studies with biomolecules such as calf thymus DNA (ct-DNA) and Bovine Serum Albumin (BSA), which can act as possible biological targets of the complexes, were carried out. The studies suggested that the compounds interact moderately with ct-DNA and BSA. Complexes 1, 2, and 4 did not lead to cell accumulation at any stage of the cell cycle but caused a significant increase in internucleosomal DNA fragmentation. Whereas, compound 3 caused cell cycle arrest in the S phase while doxorubicin caused cell cycle arrest in the G2/M phase. The effect of structural modifications on the metal compounds was correlated with their biological properties and it was concluded that an increase in biological activity occurred with increasing the extension of the diimine ligands. Thus, complex 3 was the most promising one.

5-Fluoroindole Reduces the Bacterial Burden in a Murine Model of Mycobacterium tuberculosis Infection.

Tuberculosis is a disease caused by a single pathogen that leads to a death toll estimated to be more than a million per year. Mycobacterium tuberculosis (Mtb), which affects mainly the lungs, spreads by airborne transmission when infectious respiratory particles from an infected human enter the respiratory tract of another person. Despite diagnosis and treatment being well established, the rise of cases of patients infected with Mtb strains with multidrug resistance to the antibiotics used in the regimen against the disease is alarming. Indole used as a core molecule has been described as a promising structure to treat several diseases. 5-Fluoroindole (5-FI) compound, evaluated in the free base and in the hydrochloride (5-FI.HCl) forms, inhibited the growth of pan-sensitive Mtb H37Rv strain in the same range (4.7-29.1 µM) of clinical isolates that have resistance to at least two first-line drugs. Although 5-FI showed no cytotoxicity in Vero and HepG2 cells, high permeability (2.4.10-6 cm/s) in the PAMPA assay, and high metabolic stability (Clint 9.0 mL/min/kg) in rat liver microsomes, limited solubility at plasmatic and intestinal pH values prompted formation and employment of its salt form (5-FI.HCl). Although the 5-FI.HCl compound showed increased solubility at pH values of 7.4 and 9.1 and increased stability in aqueous solutions, data for intrinsic clearance (Clint = 48 mL/min/kg) and a half-life (t 1/2 = 12 min) showed decreased metabolic stability. As 5-FI.HCl showed both good absorption and ability to reach the systemic circulation of animals without the need to use vehicles containing cosolvents or surfactants, it was chosen to evaluate its effectiveness in the model of tuberculosis in mice. The in vivo results showed the concentration of the compound in plasma increasing within 30 min in the systemic circulation and the capacity of reducing the Mtb burden in the lungs at the concentration of 200 µmol/kg after 21 days of infection, with no toxicity in mice.

Evaluation of glomerular sirtuin-1 and claudin-1 in the pathophysiology of nondiabetic focal segmental glomerulosclerosis.

Focal segmental glomerulosclerosis (FSGS) is the leading cause of nephrotic syndrome, which is characterized by podocyte injury. Given that the pathophysiology of nondiabetic glomerulosclerosis is poorly understood and targeted therapies to prevent glomerular disease are lacking, we decided to investigate the tight junction protein claudin-1 and the histone deacetylase sirtuin-1 (SIRT1), which are known to be involved in podocyte injury. For this purpose, we first examined SIRT1, claudin-1 and podocin expression in kidney biopsies from patients diagnosed with nondiabetic FSGS and found that upregulation of glomerular claudin-1 accompanies a significant reduction in glomerular SIRT1 and podocin levels. From this, we investigated whether a small molecule activator of SIRT1, SRT1720, could delay the onset of FSGS in an animal model of adriamycin (ADR)-induced nephropathy; 14 days of treatment with SRT1720 attenuated glomerulosclerosis progression and albuminuria, prevented transcription factor Wilms tumor 1 (WT1) downregulation and increased glomerular claudin-1 in the ADR + SRT1720 group. Thus, we evaluated the effect of ADR and/or SRT1720 in cultured mouse podocytes. The results showed that ADR [1 µM] triggered an increase in claudin-1 expression after 30 min, and this effect was attenuated by pretreatment of podocytes with SRT1720 [5 µM]. ADR [1 µM] also led to changes in the localization of SIRT1 and claudin-1 in these cells, which could be associated with podocyte injury. Although the use of specific agonists such as SRT1720 presents some benefits in glomerular function, their underlying mechanisms still need to be further explored for therapeutic use. Taken together, our data indicate that SIRT1 and claudin-1 are relevant for the pathophysiology of nondiabetic FSGS.

Detection of Cutibacterium acnes in Tissue Samples from Clean Primary Shoulder Surgeries - Part II / Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro - Parte II

Abstract Objective Research and identification of Cutibacterium acnes (C. acnes) and other microorganisms in deeptissue samples collected in clean shoulder surgeries of patients who did not undergo any previous invasive joint procedure and who had no clinical history of infection. Methods We analyzed the results of cultures of intraoperative deep tissue samples from 84 patients submitted to primary clean shoulder surgery. Tubes containing culture medium were used for storage and transport of anaerobic agents, prolonged incubation time, and mass spectrometer for diagnosis of bacterial agents. Results Bacteria growth was evidenced in 34 patients (40.4%) of the 84 included in the study. Of these, 23 had growth of C. acnes in at least one sample of deep tissue collected, corresponding to 27.3% of the total patients. The second most common agent was Staphylococcus epidermidis, present in 7.2% of the total individuals included. We showed a higher relationship between sample positivity and males, a lower mean age, absence of diabetes mellitus, ASA I score, and antibiotic prophylaxis in anesthetic induction with cefuroxime. Conclusions A high percentage of isolates of different bacteria was found in shoulder tissue samples of patients undergoing clean and primary surgeries, who had no history of previous infection. Identification of C. acnes was high (27.6%), and Staphylococcus epidermidis was the second most frequent agent (7.2%).

Resumo Objetivo Pesquisa e identificação de Cutibacterium acnes (C. acnes) e de outros microrganismos em amostras de tecidos profundos coletados em cirurgias limpas de ombro em pacientes que não foram submetidos a nenhum procedimento invasivo articular prévio e que não possuíam antecedentes clínicos de infecção. Métodos Foram analisados os resultados das culturas de amostras de tecidos profundos intraoperatórias de 84 pacientes submetidos à cirurgia limpa primária do ombro. Foram utilizados tubos contendo meio de cultivo para armazenamento e transporte de agentes anaeróbicos, tempo prolongado de incubação e espectrômetro de massa para diagnósticos de agentes bacterianos. Resultados Foi evidenciado o crescimento de bactérias em 34 pacientes (40,4%) dos 84 incluídos no estudo. Desses, 23 apresentavam crescimento de C. acnes em pelo menos uma amostra de tecido profundo coletada, correspondendo a 27,3% do total de pacientes. O segundo agente mais encontrado foi o Staphylococcus epidermidis, presente em 7,2% do total de indivíduos incluídos. Evidenciamos maior relação da positividade de amostras com o gênero masculino, uma média de idade inferior, a ausência de diabetes mellitus, o escore ASA I e a profilaxia antibiótica na indução anestésica com cefuroxima. Conclusões Verificou-se um elevado percentual de isolados de diferentes bactérias em amostras de tecidos de ombros de pacientes submetidos a cirurgias limpas e primárias e sem histórico de infecção anterior. A identificação de C. acnes foi elevada (27,6%) e o Staphylococcus epidermidis foi o segundo agente mais frequente (7,2%).

Detection of Cutibacterium acnes in Tissue Samples from Primary Clean Shoulder Surgeries - Part I / Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro - Parte I

Abstract Objective The present study aimed to identify bacterial agents in shoulder surgery specimens from patients with no history of previous shoulder infection or surgery. Methods Tendon, bursa, and bone specimens were collected during surgery, stored in sterile dry bottles, and sent to a hospital-associated laboratory for culture growth analysis in media for aerobic and anaerobic agents. Findings from 141 samples from 47 shoulders were analyzed. Results The cultures were negative in 46 cases (97.8%) and in 140 samples (99.2%). The culture was positive in a single patient, with growth of Staphylococcus hominis from one of three specimens collected. Conclusions The rates of bacterial growth were not consistent with the international literature, indicating the low effectiveness of laboratory methods used in Brazil.

Resumo Objetivo Identificar agentes bacterianos em amostras de cirurgias do ombro de pacientes sem histórico de infecção e de cirurgias prévias no ombro. Métodos Amostras de tendão, bursa e osso foram coletadas no intraoperatório, armazenadas em frascos estéreis a seco e enviadas para análise de crescimento de cultura em meios para agentes aeróbios e anaeróbios no laboratório credenciado ao hospital. Foram analisados os resultados de 141 amostras de 47 ombros. Resultados Obtivemos resultados de culturas negativas em 46 casos (97,8%) e em 140 amostras (99,2%). Apenas um paciente apresentou resultado positivo, com crescimento bacteriano do Staphylococcus hominis em uma das três amostras coletadas. Conclusões Não evidenciamos taxas de crescimento bacteriano condizentes com a literatura internacional, alertando para a baixa eficácia dos métodos laboratoriais utilizados no nosso país.

Evaluation of scapular dyskinesis in crossfit®- practicing athletes / Avaliação da discinese escapular em atletas praticantes de crossfit®

ABSTRACT Objective Evaluate the scapular movement of Crossfit® practitioners and identify whether they present an increased incidence of scapular dyskinesis (SD) compared to non-practitioners. Method A transversal study was evaluated quantitatively and dynamically, using retro-reflective spherical markers, the scapular movements of ten volunteers composing the control group, and 11 Crossfit® practitioners. The control group's results were used as a normality parameter and compared to those of the Crossfit® practitioner's group. Results It was identified that the superior scapular rotation in the ascending phase is inferior in the group of Crossfit® practitioners (p = 0.02). Conclusion The regular practice of Crossfit® causes scapular dyskinesis (SD), with alteration in the scapular superior rotation movement. Level of Evidence III: Retrospective comparative.

RESUMO Objetivo Avaliar o movimento escapular de praticantes de Crossfit® e identificar se apresentam incidência aumentada de discinese escapular (DE) quando comparados a não praticantes. Método Estudo transversal que avaliou de forma quantitativa e dinâmica, utilizando marcadores retro-refletivos esféricos, os movimentos escapulares de dez voluntários, compondo o grupo controle, e 11 praticantes de Crossfit®. Os resultados do grupo controle foram utilizados como parâmetro de normalidade e comparados aos do grupo de praticantes de Crossfit®. Resultados Identificou-se que a rotação superior escapular na fase ascendente é inferior no grupo de praticantes de Crossfit® (p = 0,02). Conclusão A prática regular de Crossfit® causa discinese escapular (DE), com alteração no movimento de rotação superior da escápula. Nível de Evidência III: Retrospectivo comparativo.

Os instintos nas neurociências afetivas e na psicologia analítica / Instincts in affective neuroscience and analytical psychology / Los instintos en las neurociencias afectivas y en la psicología analítica

Este artigo visa estabelecer relações entre a psicologia analítica de Carl Gustav Jung e as neurociências afetivas de Jaak Panksepp. Para isso, foi feita uma comparação entre os sistemas instintivos básicos propostos por ambas as teorias. Uma das principais características do pensamento de Jung, que o diferencia das outras teorias psicodinâmicas, é sua ênfase na base instintiva da psique, constituída de pré-disposições herdadas. Da mesma forma, as neurociências afetivas se concentram principalmente na base instintiva e herdada de certos comportamentos humanos, relacionados às emoções primárias, enraizadas principalmente em estruturas subcorticais. Através do estudo dessas estruturas, Panksepp demonstrou que existem diversos sistemas instintivos envolvidos na formação da personalidade humana, ponto que Jung também defendeu contra a primazia do instinto sexual na teoria de Sigmund Freud. Além disso, as neurociências afetivas e a psicologia analítica propõem intervenções psicoterapêuticas que levem em conta os aspectos instintivos da personalidade, considerando mudanças puramente cognitivas como insuficientes. Assim, apesar de seus pressupostos materialistas, as pesquisas Panksepp possuem pontos em comum com aspectos da teoria de Jung, com sistemas instintivos semelhantes, demonstrando a importância da história da espécie para a constituição psíquica do ser humano, contrariando a crescente onda do construcionismo social, que teve sua ascensão impulsionada pelos movimentos behavoristas dos anos 1950, e que ainda hoje permeia o imaginário popular.

The objective of this article is to establish connections between the analytical psychology of Carl Gustav Jung and the affective neuroscience of Jaak Panksepp. For this, the researcher made a comparison between the basic instinctive systems proposed by both theories. One of the main characteristics of Jung's thinking that sets it apart from other psychodynamic schools of thought is his emphasis on predispositions inherited from the psyche. Likewise, affective neuroscience focus mainly on the instinctual and inherited basis of human behavior, related to primary emotions rooted in subcortical structures. By studying these structures, Panksepp showed the influence of diverse instincts on human personality, a point that Jung also defended against the primacy of the sexual instinct in Sigmund Freud's theory. Furthermore, affective neuroscience and analytical psychology propose psychotherapeutic interventions that involve the instinctual aspects of personality, considering purely cognitive changes as insufficient. Thus, regardless of their materialist assumptions, Panksepp's researches have points in common with Jung's theory, outlining similar instinctual systems that demonstrate the importance of the history of species for the psychic constitution of human beings, countering the growing wave of social constructionism, which had its emergence driven by the behaviorist movements of the 50s, and which still permeates the popular imagination today.

Este artículo tiene como objetivo establecer relaciones entre la psicología analítica de Carl Gustav Jung y las neurociencias afectivas de Jaak Panksepp. Para ello, se realizó una comparación entre los sistemas instintivos básicos propuestos por ambas teorías. Una de las principales características del pensamiento de Jung, que lo diferencia de otras teorías psicodinámicas, es su énfasis en la base instintiva de la psique, formada por predisposiciones heredadas. Asimismo, las neurociencias afectivas se centran principalmente en la base instintiva y heredada de determinadas conductas humanas, relacionadas con las emociones primarias, enraizadas principalmente en estructuras subcorticales. A través del estudio de estas estructuras, Panksepp demostró que hay varios sistemas instintivos involucrados en la formación de la personalidad humana, un punto que Jung también defendió contra la primacía del instinto sexual en la teoría de Sigmund Freud. Además, las neurociencias afectivas y la psicología analítica proponen intervenciones psicoterapéuticas que tengan en cuenta los aspectos instintivos de la personalidad, considerando insuficientes los cambios puramente cognitivos. Así, a pesar de sus supuestos materialistas, las investigaciones de Panksepp tienen puntos en común con aspectos de la teoría de Jung, con sistemas instintivos similares, demostrando la importancia de la historia de las especies para la constitución psíquica del ser humano, contrarrestando la creciente ola de construccionismo social, que tuvo su auge impulsado por los movimientos behavioristas de los años 50, y que aún hoy permean el imaginario popular.

Using films to teach Public Health to portuguese medical students / Utilizar películas para enseñar Salud Pública a los estudiantes de medicina portugueses

Few published articles addressed the use of films to teach public health. This article describes our experience using films to teach public health to medical students from 2014 to 2017. Students were randomly allocated to groups and specific movies. Each group had three weeks to show and discuss the film in the classroom. Six films were used. After the exam, students were asked to complete a questionnaire. A Likert scale (1 to 5) was used in each question. The course unit was part of the 5th year of the Masters in Medicine curriculum taught at the Institute of Biomedical Sciences Abel Salazar. This study reports the answers given by 494 students (94.8%). More than 76% of the students graded the usefulness of the course unit with the highest values of the scale (4-5). That percentage was above 86% and 89% respectively for the items contents and methods. In general, students mentioned that they had learnt a lot on the subject, especially in the films And the Band Played On, Sicko and Super Size Me. Using films to teach public health to medical students appears to be an effective way of imparting the relevant public health knowledge. (AU)

Pocos artículos abordan el uso de películas para enseñar salud pública. Este artículo describe nuestra experiencia utilizando películas para enseñar salud pública a los estudiantes de medicina desde 2014 a 2017. Los estudiantes fueron asignados al azar en grupos y películas específicas. Cada grupo tuvo tres semanas para mostrar y discutir la película en la clase. Se utilizaron seis películas. Después del examen, se pidió a los estudiantes que completaran un cuestionario. Se utilizó una escala Likert (1-5) en cada pregunta. La asignatura formaba parte del 5º año del plan de estudios de la Maestría en Medicina que fue impartida en el Instituto de Ciencias Biomédicas Abel Salazar. Este estudio reporta las respuestas de 494 estudiantes (94,8%). Más del 76% de los estudiantes calificaron la utilidad de la asignatura con los valores más altos de la escala (4-5). Ese porcentaje fue superior al 86% y 89% respectivamente para los ítems contenidos y métodos. En general, los estudiantes mencionaron que habían aprendido mucho, especialmente en las películas En el filo de la duda, Sicko y Súper engórdame. El uso de películas para enseñar salud pública a estudiantes de medicina parece ser una forma efectiva de impartir los conocimientos pertinentes de salud pública. (AU)

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

A transição da fecundidade no Brasil ao longo do século XX - uma perspectiva regional / Fertility transition in Brazil across the 20th century - a regional perspective / La transición de la fecundidad en Brasil durante el siglo XX. Una perspectiva regional

A essência da transição da fecundidade consiste na mudança de um padrão de intensiva reprodução, quando muitas crianças nascem, mas muitas morrem, para uma reversão desse cenário, passando os nascimentos a serem planejados. Grande parte da literatura sobre a transição da fecundidade no Brasil indica que esse processo teria começado na segunda metade da década de 1960, caracterizando a transição brasileira como tardia e rápida. Apesar desse aparente consenso, o objetivo do presente estudo é indicar quando e onde começou a transição da fecundidade no Brasil, reestimando a transição da fecundidade regional do país. Aplica-se a técnica proposta por Frias e Oliveira, nos anos 1990, aos dados dos Censos Demográficos de 1940, 1950 e 1970 a 2010. Os resultados indicam que a transição da fecundidade já vinha em curso, em parte considerável do Brasil, desde o início da década de 1930, mais especificamente no Rio de Janeiro, em São Paulo e no extremo sul do país. Como consequência desse cenário heterogêneo, foram identificadas duas fases da transição da fecundidade. Na primeira, a transição foi lenta, similar ao modelo europeu, sendo precursores as regiões do Rio de Janeiro, São Paulo e o extremo sul. A segunda fase foi muito rápida, em consonância com a transição da fecundidade dos países retardatários no processo.

The essence of fertility transition is the shift from intensive reproduction, when many children are born but few survive, to a new pattern where births are fewer and planned. Some articles discussing fertility transition in Brazil indicate that this process began in the second half of the 1960s, characterizing the Brazilian transition as late and fast. Despite this consensus, the objective of this paper was to identify "when" and "where" fertility transition started in Brazil, reassessing regional fertility transition. We used the method proposed by Frias and Oliveira (1991) applied to Brazilian census data (1940, 1950 and 1970 to 2010) Results indicate that fertility transition had been underway since, at least the 1930s in some of Brazil's most important regions like Rio de Janeiro, São Paulo, and the far South. Because of this complex scenario, we argue that Brazil experienced two phases of fertility transition. The first one would have been long and slow, like the European fertility transition, pioneered by Rio de Janeiro, São Paulo, and the far South, whereas the second one was short and fast, in line with the fertility transition observed in countries where the process began later.

La esencia de la transición de la fecundidad es el cambio de un patrón de reproducción intensiva -cuando nacen muchos niños y pocos sobreviven- a otro en el cual la mayor parte de los nacimientos son planificados. Gran parte de la literatura sobre la transición de la fecundidad en Brasil indica que este proceso comenzó en la segunda mitad de la década del sesenta, lo que la caracateriza como tardía y rápida. A pesar de este aparente consenso, el objetivo de este trabajo es determinar cuándo y dónde comenzó esta transición, identificando este proceso desde el punto de vista regional. Se aplica el método de Frias y Oliveira, originalmente propuesto en 1991, a los datos de fecundidad reciente de los censos demográficos de Brasil de 1940, 1950 y 1970 a 2010. Los resultados indican que la transición de la fecundidad ya estaba en curso, en parte de Brasil, desde principios de la década del treinta en Río de Janeiro, en San Pablo y en el extremo sur del país. Como consecuencia de este escenario heterogéneo, habría dos fases de la transición: la primera, larga y lenta, similar al modelo europeo, cuyos precursores fueron Río de Janeiro, San Pablo y el extremo Sur; la segunda, corta y rápida, como la transición de los países rezagados en el proceso.

Métodos para estimação da subenumeração do grupo etário de 0 a 4 anos no Censo Demográfico brasileiro de 2000 / Methods for estimation of subenumeration of the 0-4 year old in the 2000 Brazilian Demographic Census / Métodos para la estimación de la subenumeración del grupo cero a cuatro años en el Censo Demográfico Brasileño del año 2000

O objetivo deste trabalho é discutir a aplicação de técnicas que contribuam para identificar e corrigir a subenumeração censitária para o grupo etário de 0 a 4 anos, utilizando, como população base, aquela enumerada no Censo Demográfico de 2000. Frequentemente, esse grupo possui baixa enumeração, se comparada àquela de faixas etárias da população adulta. Foram aplicadas cinco técnicas para a estimação do grupo de 0 a 4 anos e os resultados indicam que, não obstante o fato de técnicas já comumente usadas oferecerem resultados satisfatórios, formas alternativas têm grande potencial a ser explorado.

Our aim is to apply techniques which contribute to identify and correct the census underenumeration for people aged 0-4 years old, using population enumerated in the 2000 Brazilian census as reference for estimations. Usually, this group has lower enumeration than others, such as adult population. Five techniques were applied to the 0-4 year old group estimation and results indicate that, although usual techniques have offered satisfactory results, alternative forms have great potential to be explored.

El objetivo de este trabajo es la aplicación de técnicas que contribuyen en la identificación y corrección de la subenumeración censal del grupo etario de cero a cuatro años de edad, sobre la base de la población enumerada en el Censo Demográfico de 2000. Frecuentemente, este grupo posee baja enumeración, si se lo compara con la de otros grupos etarios de la población adulta. Para cumplir el objetivo, fueron aplicadas cinco técnicas para la estimación del grupo de cero a cuatro años, y los resultados señalan que, pese a que las técnicas comúnmente usadas ofrecen resultados satisfactorios, algunas formas alternativas también muestran gran potencial a ser explorado.

Application of P/F Brass ratio method in the context of fast-paced adolescent fertility decline / Aplicación de la técnica P/F de Brass en un contexto de rápida caída de la fecundidad adolescente / Aplicação da técnica P/F de Brass em um contexto de rápida queda da fecundidade adolescente

Abstract Adolescent fertility -fertility rates at ages 15-19- fell substantially (around 30 percent) between 2000 and 2010. It was the first time Brazil experienced such a decline in those ages since 1970, when the census included one question about children born in the past 12 months. This phenomenon has an important implication for the P/F Brass ratio technique: it underestimates the cumulated current fertility up to age group 20-24 (F2), considering this cohort's previous fertility experience. Therefore, the P2/F2 value, used as an adjustment factor for the reported fertility level, is significantly overestimated. This paper discusses this issue and proposes an alternative to correct the reference period error in the 2010 Demographic Census in Brazil. The results of applying the proposed alternative in this specific context were very similar to those obtained using different techniques, thus supporting the strength of our alternative.

Resumo O Brasil experimentou, entre 2000 e 2010, pela primeira vez desde 1970, quando se introduziu o quesito sobre filhos nascidos vivos nos 12 meses anteriores à data de referência do censo, queda significativa (em torno de 30%) das taxas específicas de fecundidade declarada das mulheres entre 15 e 19 anos (f*1). Esse fenômeno tem uma importante consequência para a aplicação da técnica P/F de Brass: gera um erro, por falta, na fecundidade corrente acumulada até o grupo etário de 20 a 24 anos (F2), se tomada como experiência pregressa dessa coorte, levando a um valor de P2/F2, usado para ajustar o nível da fecundidade declarada, significativamente sobrestimado. O presente trabalho discute detalhadamente este problema e, por fim, propõe uma alternativa para se corrigir o erro de período de referência da fecundidade corrente do Censo Demográfico de 2010 do Brasil. A alternativa proposta, neste contexto específico, gerou estimativas de taxa de fecundidade total muito próximas às produzidas por outras técnicas.

Resumen Por la primera vez desde 1970 —cuando se introdujo la pregunta sobre nacidos vivos en los 12 meses anteriores a la fecha de referencia del censo— Brasil experimentó, entre 2000 y 2010, una disminución significativa de aproximadamente 30% de las tasas específicas de fecundidad declarada de mujeres entre 15 y 19 años (f*1). Este fenómeno trae una consecuencia importante para la aplicación de la técnica P/F de Brass: genera un error por falta en la fecundidad actual acumulada para el grupo de edad de 20 a 24 años (F2), lo que concomitantemente provoca una significativa sobrestimación en el valor de P2/F2 —utilizado para corregir el nivel de la fecundidad declarada—. Este trabajo discute este problema y propone finalmente una adaptación de la técnica original de Brass para aplicarla a los datos del censo de 2010. La alternativa propuesta generó, en este contexto específico, estimaciones de la tasa global de fecundidad similares a las producidas por otras técnicas.

Os municípios brasileiros e os gastos próprios com saúde: algumas associações / Brazilian municipalities and their own expenditures on health: some associations

Resumo Em um contexto que combina descentralização e subfinanciamento da política pública de saúde, os municípios brasileiros ampliam de modo expressivo seus gastos no setor, alocando proporção das receitas próprias (tributação direta somada às transferências intergovernamentais obrigatórias da União e dos estados) em níveis superiores aos determinados constitucionalmente. Porém, ainda são incipientes os estudos que investigam a composição das despesas com saúde nessas unidades federativas, de modo a descrever suas principais características e explicações. A fim de contribuir para a supressão desta lacuna, o presente artigo explora algumas associações entre atributos dos municípios (porte populacional, região do país, proporção de idosos, mortalidade infantil, contratação de serviços privados e transferência SUS) e despesas em saúde executadas com receitas próprias. O estudo realizou estatísticas descritivas e regressões lineares múltiplas para investigar tais associações com dados referentes ao ano de 2010. Os resultados sinalizam para iniquidades fiscais no setor ao se comparar municípios de diferentes faixas populacionais e condições socioeconômicas, entre os quais, são percebidas importantes diferenças em termos dos gastos per capita com os elementos de despesa analisados.

Abstract In a context that combines decentralization and underfunding of public health policy, Brazilian municipalities expressively extend their spending in this sector, allocating a proportion of their own revenues (direct taxation added to the mandatory intergovernmental transfers from the Union and the states) at levels above the ones that are constitutionally determined. However, there have been incipient studies investigating the expenditure composition on health in these federative units, in order to describe its main characteristics and explanations. In order to contribute to eliminating this gap, this article explores some associations between attributes of the municipalities (population size, region of the country, the proportion of older adults, child mortality, hiring private services and SUS transfer) and health expenditure implemented with the municipalities' own recipes. The study used descriptive statistics and multiple linear regressions in order to investigate such associations with data for 2010. The results point to tax inequities in the sector when comparing municipalities of different population groups and socioeconomic conditions, including the perception of important differences in terms of per capita spending on the analyzed expenditure items.

Physiologic parameters in female red-billed curassows (Crax blumenbachii) in rehabilitation / Parâmetros fisiológicos em fêmeas de mutum do Sudeste (Crax blumenbachii) em reabilitação

The present paper reports blood gas analysis, hematologic and micro bacteriologic information on four female Red-billed curassows, rescued from illegal wild animal trading, that were undergoing habilitation for reintroduction into the wild through Projeto Centrofauna/Botucatu-SP. There is a lack of physiological data on this species, endemic to the region of Atlantic Forest (Mata Atlântica), now under threat of extinction. This lack of information makes the clinical evaluation of these birds very difficult and has a direct and adverse effect on any of these birds received for medical treatment in hospitals, veterinary clinics and centers for research and conservation, as well as in reintroduction centers.

O presente artigo reporta dados inéditos de análise hemogasométrica, hematológica e bacteriológica de quatro fêmeas de Mutum do Sudeste, resgatadas do tráfico ilegal de animais silvestres e em processo de habilitação e reintrodução para vida-livre pelo Projeto Centrofauna, Botucatu/SP. Na literatura há uma falta de dados fisiológicos sobre esta espécie, endêmica da região da Mata Atlântica e ameaçada de extinção. Esta falta de informação faz com que avaliações clínicas nesta espécie aviária sejam muito difíceis de interpretar, causando um efeito direto e negativo nestas aves para a realização de tratamento médico em hospitais, clínicas veterinárias, centros de pesquisa e/ou conservação, bem como centros de reintrodução.

Caracterização dos níveis de fecundidade no Brasil, 1970–2010 / Characterization of fertility levels in Brazil, 1970–2010

Analisamos os Censos Demográficos do Brasil de 1970, 1980, 1991, 2000 e 2010, com o objetivo de investigar os fatores associados com a mulher ter tido filho nascido vivo no ano anterior ao censo. Estimamos modelos de regressão logística para mulheres entre 10 e 49 anos. Como variáveis independentes, selecionamos região de residência, localidade rural/urbana, presença de eletricidade, cor/raça, religião, estado conjugal, participação no mercado de trabalho, tempo de residência no município, informação se a mulher teve um filho nascido morto, idade, educação e parturição. Os resultados confirmam que a probabilidade da mulher ter tido filho no último ano é maior nas regiões Norte e Nordeste, assim como em domicílios sem eletricidade. Mulheres que tiveram maior chance de ter tido um filho são pretas/pardas, católicas, casadas, não participantes no mercado de trabalho, migrantes no curto prazo, tiveram filho nascido morto, estão entre 20 e 29 anos de idade, possuem baixa escolaridade e possuem mais filhos. Os padrões têm mudado ao longo do tempo, levantando importantes questões para análises futuras.

We analyze the 1970, 1980, 1991, 2000, and 2010 Brazilian Demographic Censuses, in order to investigate the associated factors with a woman having had a live birth during the year prior toeach census. We estimated logistic regression models for women aged 10–49 years. As independent variables, we selected region of residence, rural/urban location, presence of electricity, color/race, religion, marital status, labor market participation, time of residence in the municipality, information about whether they had a stillbirth, age, education, and parity. Our findings confirm that the probability a woman had a child is higher in the North and Northeast regions, as well as in households without electricity. Women that have a greater chance of having had a child are black/brown, Catholic, married, non-labor market participants, short-term migrants, experienced a stillbirth, between 20–29 years of age, have less education, and have higher parity. Patterns have been changing throughout time, thus posing questions for further analyses.