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1.
Arch Microbiol ; 206(3): 123, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38407586

RESUMO

In this comprehensive study, we delved into the capabilities of five fungal strains: Aspergillus flavus, Aspergillus niger, Penicillium chrysogenum, Penicillium glabrum, and Penicillium rubens (the latter isolated from heavy crude oil [HCO]) in metabolizing HCO as a carbon source. Employing a meticulously designed experimental approach, conducted at room temperature (25 °C), we systematically explored various culture media and incubation periods. The results unveiled the exceptional resilience of all these fungi to HCO, with A. flavus standing out as the top performer. Notably, A. flavus exhibited robust growth, achieving a remarkable 59.1% expansion across the medium's surface, accompanied by distinctive macroscopic traits, including a cottony appearance and vibrant coloration. In an effort to further scrutinize its biotransformation prowess, we conducted experiments in a liquid medium, quantifying CO2 production through gas chromatography, which reached its zenith at day 30, signifying substantial bioconversion with a 38% increase in CO2 production. Additionally, we monitored changes in surface tension using the Du Noüy ring method, revealing a reduction in aqueous phase tension from 72.3 to 47 mN/m. This compelling evidence confirms that A. flavus adeptly metabolizes HCO to fuel its growth, while concurrently generating valuable biosurfactants. These findings underscore the immense biotechnological potential of A. flavus in addressing challenges related to HCO, thereby offering promising prospects for bioremediation and crude oil bioupgrading endeavors.


Assuntos
Aspergillus flavus , Dióxido de Carbono , Biodegradação Ambiental , Aspergillus niger , Biotecnologia
2.
Ecotoxicol Environ Saf ; 280: 116523, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-38850707

RESUMO

In recent years micro- and nanoplastics and metal-oxide nanomaterials have been found in several environmental compartments. The Antarctic soft clam Laternula elliptica is an endemic Antarctic species having a wide distribution in the Southern Ocean. Being a filter-feeder, it could act as suitable bioindicator of pollution from nanoparticles also considering its sensitivity to various sources of stress. The present study aims to assess the impact of polystyrene nanoparticles (PS-NP) and the nanometal titanium-dioxide (n-TiO2) on genome-wide transcript expression of L. elliptica either alone and in combination and at two toxicological relevant concentrations (5 and 50 µg/L) during 96 h exposure. Transcript-target qRT-PCR was performed with the aim to identify suitable biomarkers of exposure and effects. As expected, at the highest concentration tested, the clustering was clearer between control and exposed clams. A total of 221 genes resulted differentially expressed in exposed clams and control ones, and 21 of them had functional annotation such as ribosomal proteins, antioxidant, ion transport (osmoregulation), acid-base balance, immunity, lipid metabolism, cell adhesion, cytoskeleton, apoptosis, chromatin condensation and cell signaling. At functional level, relevant transcripts were shared among some treatments and could be considered as general stress due to nanoparticle exposure. After applying transcript-target approach duplicating the number of clam samples, four ecologically relevant transcripts were revealed as biomarkers for PS-NP, n-TiO2 and their combination at 50 µg/L, that could be used for monitoring clams' health status in different Antarctic localities.


Assuntos
Bivalves , Nanopartículas , Titânio , Transcriptoma , Poluentes Químicos da Água , Animais , Bivalves/efeitos dos fármacos , Bivalves/genética , Titânio/toxicidade , Regiões Antárticas , Nanopartículas/toxicidade , Transcriptoma/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Biomarcadores/metabolismo , Poliestirenos/toxicidade , Monitoramento Ambiental/métodos
3.
Int J Mol Sci ; 25(10)2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38791425

RESUMO

Wound healing is a complex process involving a number of mechanisms [...].


Assuntos
Cicatrização , Humanos , Ferimentos e Lesões/terapia , Animais
4.
Int J Mol Sci ; 24(6)2023 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-36983030

RESUMO

Wounds are a serious global health problem [...].


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Cicatrização
5.
Int J Mol Sci ; 24(13)2023 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-37446220

RESUMO

Essential oils are composed of terpenes, some of which have properties related to healing. Bursera schlechtendalii essential oil (BSEO) is used to heal superficial wounds. However, there have been no studies verifying this property. The objectives of this study were to evaluate the healing activity of BSEO in a murine model and to propose the roles of its chemical components in this process. Healing activity was evaluated by an incision model, histological analysis was performed, and tensile strength and antibacterial activity were measured. The chemical composition of BSEO was determined by gas chromatography coupled with mass spectrometry (GC-MS), and the mechanisms of action of each chemical component during the phases of the healing process were proposed. In addition, acute dermal toxicity was evaluated. BSEO showed better wound closure at the macroscopic, histological, and tensile strength levels compared to controls and had an antibacterial effect. The major compound in BSEO was α-phellandrene. However, most of the monoterpenes identified in BSEO were in agreement with information found in the literature, so the possibility of synergy between the chemical components and their different targets in the healing process was schematically proposed. BSEO was shown to be safe in the dermal toxicity evaluation.


Assuntos
Bursera , Óleos Voláteis , Camundongos , Animais , Óleos Voláteis/farmacologia , Óleos Voláteis/química , Bursera/química , Terpenos/farmacologia , Cicatrização , Monoterpenos/farmacologia , Monoterpenos/química , Antibacterianos/farmacologia
6.
Plant Foods Hum Nutr ; 78(1): 139-145, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36370292

RESUMO

This study aimed to evaluate the solar dryers' cover material effects on the colorimetric and physicochemical properties of pumpkin flowers (Cucurbita maxima). A direct cabinet solar dryer was designed using three cover types: polycarbonate, polyethylene, and aluminum with selective surface (titanium oxide coating). A unifactorial experimental design with three levels was adopted. Pumpkin flower stability was assured by reducing the initial moisture content (95.22%) and water activity (0.989) to 3.15% and 0.276 in the polycarbonate dryer, to 3.03% and 0.279 in the selective surface dryer, and 5.19% and 0.364 in the polyethylene dryer. The drying kinetics showed that the drying time needed to achieve the moisture equilibrium was 480, 540, and 720 min in the respective dryers, depending on the ambient conditions. The initial pumpkin flower hue angle was 76.52°; however, this value decreased to 74.81, 69.52, and 70.23° in the dryers with polycarbonate, polyethylene, and the selective surface respectively; this behavior indicates a pumpkin flower tendency to orange color. The dryer with the selective surface obtained the best properties in pumpkin flowers. The pumpkin flower showed an initial total soluble solid of 1.5°Brix increased to 30°Brix in the polycarbonate and polyethylene dryers and 39°Brix in the selective dryer. The titanium oxide dryer observed an increment in ascorbic acid content from 3.5 to 8.806 mg/100 g, whereas 6.45 and 5.87 mg/100 g in the polycarbonate and polyethylene dryer, respectively.


Assuntos
Cucurbita , Cucurbita/química , Colorimetria , Flores , Polietileno
7.
Rev Gastroenterol Peru ; 43(3): 228-235, 2023.
Artigo em Espanhol | MEDLINE | ID: mdl-37890847

RESUMO

Our objective was to develop a diagnostic test to predict the etiology of Variceal Upper Gastrointestinal Bleeding (VUGIB). We conducted a retrospective cohort study. Medical records of patients over 18 years of age with Upper Gastrointestinal Bleeding (UGIB) who attended the emergency service of Hospital Cayetano Heredia (HCH) in Lima-Peru between 2019 and 2022 were reviewed; demographic, laboratory and clinical data were collected. Subsequently, predictive variables of variceal upper gastrointestinal bleeding (VUGIB) were identified using multiple logistic regression. Each variable with predictive capacity was assigned a score with a cut-off point and served to build a predictive scale for VUGIB. 197 medical records of patients with UGIB were included, of which 127 (64%) had non-variceal bleeding, and 70 (36%), variceal. Four independent predictors were identified: hematemesis (red vomit) (OR: 4,192, 95% CI: 1.586-11.082), platelet count (OR: 3.786, 95% CI: 1.324-10.826), history of UGIB (OR: 2.634, 95% CI: 1.017-6.820), signs of chronic liver disease (OR: 11.244, 95% CI: 3.067-35.047), with which a predictive scale was constructed, with a cut-off point >7 and ≤7; which showed a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative of 58.6%, 90.6%, 77.4%, 79.9%, 6.20, and 0.46 respectively. In conclusion, the predictive scale with a cut-off point >7 is useful for predicting the presence of VUGIB in patients who attend the emergency room for UGIB.


Assuntos
Varizes Esofágicas e Gástricas , Hepatopatias , Humanos , Adolescente , Adulto , Estudos Retrospectivos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico , Análise Multivariada , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Medição de Risco
8.
J Trop Pediatr ; 68(6)2022 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-36375036

RESUMO

BACKGROUND: Atherosclerosis is a cardiovascular disease, highly predictable, and associated with different atherogenic indices (AI) in adults. However, such indexes in the pediatric population are far less explored. The objective of this study was to evaluate the AI and the cardiovascular factors in the pediatric population in the South-Southeast of México. METHODS: A total of 481 children between 2 and 17 years old were recruited. Anthropometric evaluation, blood pressure (BP), lipid profile, apolipoprotein A-I (ApoA-I) and apolipoprotein B (ApoB) were measured, and AI were calculated. The population was grouped by age, binary logistic regression analysis was performed to analysis for associations of AI and cardiovascular risk factors. Sensibility and specificity of AI to detect metabolic alteration were evaluated for curve ROC. RESULTS: The atherogenic risk presented a high prevalence in the pediatric population, such as LDL-c/ApoB (86.9%), AIP (78%) and AC (36.6%). Preschoolers showed a higher risk of ApoB/ApoA-I and ApoB/LDL-c, while adolescents have a high risk of AIP. CRI-I and AC were associated with elements of lipid profile and body mass index (BMI). ROC curves analysis shows that AIP is the best index evaluating metabolic syndrome (MS) (0.87) and dyslipidemia (0.91). CONCLUSION: Such pediatric population showed a high risk of AI, mainly by LDL-c/ApoB and AIP. The BMI was the cardiovascular risk factors most frequently related to AI, AIP is the best index for detecting cases of MS and dyslipidemia. This is the first study carried out in the pediatric population from the South-Southeast of Mexico that evaluated the AI.


Assuntos
Aterosclerose , Dislipidemias , Adolescente , Criança , Pré-Escolar , Humanos , Apolipoproteína A-I , Apolipoproteínas B , Aterosclerose/epidemiologia , LDL-Colesterol , Dislipidemias/epidemiologia , México/epidemiologia , Fatores de Risco
9.
Entropy (Basel) ; 24(7)2022 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-35885176

RESUMO

This paper explains the mathematical foundations of a method for modelling semi-rigid unions. The unions are modelled using rotational rather than linear springs. A nonlinear second-order analysis is required, which includes both the effects of the flexibility of the connections as well as the geometrical nonlinearity of the elements. The first task in the implementation of a 2D Beam element with semi-rigid unions in a nonlinear finite element method (FEM) is to define the vector of internal forces and the tangent stiffness matrix. After defining the formula for this vector and matrix in the context of a semi-rigid steel frame, an iterative adjustment of the springs is proposed. This setting allows a moment-rotation relationship for some given load parameters, dimensions, and unions. Modelling semi-rigid connections is performed using Frye and Morris' polynomial model. The polynomial model has been used for type-4 semi-rigid joints (end plates without column stiffeners), which are typically semi-rigid with moderate structural complexity and intermediate stiffness characteristics. For each step in a non-linear analysis required to adjust the matrix of tangent stiffness, an additional adjustment of the springs with their own iterative process subsumed in the overall process is required. Loops are used in the proposed computational technique. Other types of connections, dimensions, and other parameters can be used with this method. Several examples are shown in a correlated analysis to demonstrate the efficacy of the design process for semi-rigid joints, and this is the work's application content. It is demonstrated that using the mathematical method presented in this paper, semi-rigid connections may be implemented in the designs while the stiffness of the connection is verified.

12.
Int J Syst Evol Microbiol ; 67(7): 2236-2241, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28671523

RESUMO

Two slow-growing strains, AMBPC1010T and AMBPC1011, were isolated from nodules of Cajanus cajan in the Dominican Republic. 16S rRNA gene analysis placed these strains within the genus Bradyrhizobium, being phylogenetically equidistant to several species of this genus. Analysis of the recA and atpD genes showed that the strains isolated belong to a cluster containing the strains Bradyrhizobium ottawaense OO99T, 'Bradyrhizobium americanum' CMVU44 and Bradyrhizobium daqingense CCBAU 15774T, and presented similarity values lower than 96 % for both genes with respect to the strains nodulating C. cajan. DNA-DNA hybridization analysis showed averages of 36, 40 and 39 % relatedness with respect to the representative strains of Bradyrhizobium ottawaense, 'Bradyrhizobium americanum' and Bradyrhizobium daqingense, respectively. Phenotypic characteristics also differed from those of the most closely related species of the genus Bradyrhizobium. Therefore, based on the data obtained in this study, we propose to classify the strains AMBPC1010T (=LMG 29967T=CECT 9227T) and AMBPC1011 into a novel species named Bradyrhizobium cajani sp. nov.


Assuntos
Bradyrhizobium/classificação , Cajanus/microbiologia , Filogenia , Nódulos Radiculares de Plantas/microbiologia , Técnicas de Tipagem Bacteriana , Composição de Bases , Bradyrhizobium/genética , Bradyrhizobium/isolamento & purificação , DNA Bacteriano/genética , República Dominicana , Genes Bacterianos , Hibridização de Ácido Nucleico , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Simbiose
15.
Front Immunol ; 15: 1352556, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38655251

RESUMO

Background: Post-operative infections are a common cause of morbidity following major surgery. Little is understood about how major surgery perturbs immune function leading to heightened risk of subsequent infection. Through analysis of paired blood samples obtained immediately before and 24 h following surgery, we evaluated changes in circulating immune cell phenotype and function across the first 24 h, to identify early immune changes associated with subsequent infection. Methods: We conducted a prospective observational study of adult patients undergoing major elective gastrointestinal, gynecological, or maxillofacial surgery requiring planned admission to the post-anesthetic care unit. Patients were followed up to hospital discharge or death. Outcome data collected included mortality, length of stay, unplanned intensive care unit admission, and post-operative infections (using the standardized endpoints in perioperative medicine-core outcome measures for perioperative and anesthetic care criteria). Peripheral blood mononuclear cells were isolated prior to and 24 h following surgery from which cellular immune traits including activation and functional status were assessed by multi-parameter flow cytometry and serum immune analytes compared by enzyme-linked immunosorbent assay (ELISA). Results: Forty-eight patients were recruited, 26 (54%) of whom developed a post-operative infection. We observed reduced baseline pre- and post-operative monocyte CXCR4 and CD80 expression (chemokine receptors and co-stimulation markers, respectively) in patients who subsequently developed an infection as well as a profound and selective post-operative increase in CD4+ lymphocyte IL-7 receptor expression in the infection group only. Higher post-operative monocyte count was significantly associated with the development of post-operative infection (false discovery rate < 1%; adjusted p-value = 0.001) with an area under the receiver operating characteristic curve of 0.84 (p < 0.0001). Conclusion: Lower monocyte chemotaxis markers, higher post-operative circulating monocyte counts, and reduced co-stimulatory signals are associated with subsequent post-operative infections. Identifying the underlying mechanisms and therapeutics to reverse defects in immune cell function requires further exploration.


Assuntos
Monócitos , Humanos , Feminino , Masculino , Monócitos/imunologia , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Adulto , Biomarcadores/sangue
16.
Animals (Basel) ; 14(18)2024 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-39335253

RESUMO

Probiotics in aquaculture hold promise for enhancing fish health and growth. Due to their increased specificity and affinity for their host, indigenous probiotics may offer isolated and potentially amplified benefits. This study investigated the effects of Lactococcus lactis PH3-05, previously isolated from adults of tropical gar (Atractosteus tropicus), on the growth, survival, digestive enzyme activity, intestinal morphology, expression of barrier and immune genes, and intestinal microbiota composition in the larvae of tropical gar. Larvae were fed with live L. lactis PH3-05 concentrations of 104, 106, and 108 CFU/g for 15 days alongside a control diet without probiotics. Higher concentrations of L. lactis PH3-05 (106 and 108 CFU/g) positively influenced larval growth, increasing hepatocyte area and enterocyte height. The 106 CFU/g dose significantly enhanced survival (46%) and digestive enzyme activity. Notably, the 108 CFU/g dose stimulated increased expression of muc-2 and il-10 genes, suggesting enhanced mucosal barrier function and anti-inflammatory response. Although L. lactis PH3-05 did not significantly change the diversity, structure, or Phylum level composition of intestinal microbiota, which was constituted by Proteobacteria, Bacteroidota, Chloroflexi, and Firmicutes, an increase in Lactobacillus abundance was observed in fish fed with 106 CFU/g, suggesting enhanced probiotic colonization. These results demonstrate that administering L. lactis PH3-05 at 106 CFU/g promotes growth, survival, and digestive health in A. tropicus larvae, establishing it as a promising indigenous probiotic candidate for aquaculture applications.

17.
Nutrients ; 16(10)2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38794721

RESUMO

Cardiovascular disease risk throughout the life course is increased by abnormal blood lipid levels in youth. The dietary glycemic index (GI) and glycemic load (GL) during adolescence might be related to abnormal blood lipids. This study aimed to analyze the association between dietary GI, GL and dyslipidemia in adolescents from two marginalized regions of Chiapas, Mexico. A cross-sectional study was conducted with 213 adolescents. Food intake was assessed using 24 h recalls. The association between dyslipidemia and dietary GI or GL was tested by using logistic regression models. Low HDL-c was the most prevalent risk factor (47.4%), followed by hypertriglyceridemia (25.4%). In this population, overall dietary GI was not associated with dyslipidemia. A high dietary GL was associated with 2.39 higher odds of low HDL-c (95% CI: 1.21-4.74) when compared to low GL. Female adolescents with high dietary GL had 3.20 higher odds of hypertriglyceridemia (95% CI: 1.03-9.88), whereas no association was found for males. No associations were observed between overall dietary GL and total cholesterol or LDL-c. In adolescents from urban and rural communities in Chiapas, a high dietary GL was associated with a detrimental effect on HDL-c. In female adolescents, high GL was associated with hypertriglyceridemia.


Assuntos
Dislipidemias , Índice Glicêmico , Carga Glicêmica , Humanos , Adolescente , Feminino , Masculino , México/epidemiologia , Dislipidemias/epidemiologia , Dislipidemias/sangue , Estudos Transversais , HDL-Colesterol/sangue , Dieta/efeitos adversos , Fatores de Risco , Hipertrigliceridemia/sangue , Hipertrigliceridemia/epidemiologia , Prevalência , Modelos Logísticos
18.
Environ Pollut ; 348: 123816, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38508369

RESUMO

The increase of plastic production together with the incipient reuse/recycling system has resulted in massive discards into the environment. This has facilitated the formation of micro- and nanoplastics (MNPs) which poses major risk for environmental health. Although some studies have investigated the effects of pristine MNPs on reproductive health, the effects of weathered MNPs have been poorly investigated. Here we show in Caenorhabditis elegans that exposure to photoaged polystyrene nanoplastics (PSNP-UV) results in worse reproductive performance than pristine PSNP (i.e., embryonic/larval lethality plus a decrease in the brood size, accompanied by a high number of unfertilized eggs), besides it affects size and locomotion behavior. Those effects were potentially generated by reactive products formed during UV-irradiation, since we found higher levels of reactive oxygen species and increased expression of GST-4 in worms exposed to PSNP-UV. Those results are supported by physical-chemical characterization analyses which indicate significant formation of oxidative degradation products from PSNP under UV-C irradiation. Our study also demonstrates that PSNP accumulate predominantly in the gastrointestinal tract of C. elegans (with no accumulation in the gonads), being completely eliminated at 96 h post-exposure. We complemented the toxicological analysis of PSNP/PSNP-UV by showing that the activation of the stress response via DAF-16 is dependent of the nanoplastics accumulation. Our data suggest that exposure to the wild PSNP, i.e., polystyrene nanoplastics more similar to those actually found in the environment, results in more important reprotoxic effects. This is associated with the presence of degradation products formed during UV-C irradiation and their interaction with biological targets.


Assuntos
Proteínas de Caenorhabditis elegans , Caenorhabditis elegans , Animais , Poliestirenos/metabolismo , Microplásticos/toxicidade , Microplásticos/metabolismo , Estresse Oxidativo , Proteínas de Caenorhabditis elegans/metabolismo
19.
Exp Parasitol ; 134(3): 368-73, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23567250

RESUMO

Effects of maternal malnutrition during lactation on the kidneys in mice infected with Schistosoma mansoni. Kidneys from programmed infected mice and their respective controls fed a normal diet (23% protein), a protein-restricted group (PR) (8% protein) and a caloric-restricted group (CR) (according to the PR group intake) evaluated by biometry, morphometry and histopathology. Both PR and CR groups showed a reduction in the number of glomeruli when compared with the control group (CR: -29% vs C; PR: -41% vs C; p<0.05) as well as infected mice (ICR: -32% vs IC; IPR: -47% vs IC; p<0.05). Among infected mice, ICR group showed higher kidney weights (+18% vs IC and +12% vs IPR; p<0.01). The ICR and IPR groups showed largest perimeter and area when compared to the corresponding uninfected group (ICR vs CR: +26%; IPR vs PR: +21%, p<0.05) and area (ICR vs CR: +95%; IPR vs PR: +50%, p<0.05). The ICR group showed an increase of within Bowman (CR vs ICR: +56%, p<0.05), whereas Bowman's space was reduced (PR vs IPR, -61%; p<0.05). Conclude that malnutrition during lactation programmed the metabolic state of the host, resulting in the evolution of the histology of the renal parenchyma.


Assuntos
Rim/patologia , Lactação/fisiologia , Desnutrição/complicações , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Esquistossomose mansoni/patologia , Animais , Animais Lactentes , Restrição Calórica , Dieta com Restrição de Proteínas , Modelos Animais de Doenças , Feminino , Rim/crescimento & desenvolvimento , Camundongos
20.
F1000Res ; 12: 1215, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38666264

RESUMO

Background: Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods: We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results: Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion: Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.

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