Let's Talk About Lupus. Overview of an Innovative, High-Reach, Online Program to Fill the Education Gaps of Latin Americans Living With Lupus.

BACKGROUND/OBJECTIVE: The Latin American population living with lupus lacks reliable and culturally competent health education resources. We describe a Spanish and Portuguese online program to educate Latin American people about lupus. METHODS: An extensive network of Latin American stakeholders participated in the program design, implementation, dissemination, and evaluation. Patients and rheumatologists selected core topics. Rheumatologists prepared the content using evidence-based data. Adaptations were conducted to meet the audience's health literacy and cultural values. Social media was used to post audiovisual resources and facilitate users' interactions with peers and educators, and a Web site was created to offer in-depth knowledge. RESULTS: The most massive outreach was through Facebook, with more than 20 million people reached and 80,000 followers at 3 months, between the Spanish and Portuguese pages. Nearly 90% of followers were from Latin America. A high engagement and positive responses to a satisfaction survey indicate that Facebook users valued these resources. The Spanish and Portuguese Web sites accumulated more than 62,000 page views, and 71.7% of viewers were from Latin American. CONCLUSIONS: The engagement of patients and stakeholders is critical to provide and disseminate reliable lupus education. Social media can be used to educate and facilitate interactions between people affected by lupus and qualified health care professionals. Social media-based health education has extensive and scalable outreach but is more taxing for the professional team than the Web site. However, the Web site is less likely to be used as a primary education source by Latin American people because they value social interactions when seeking lupus information.

Monitoring of ammonia concentrations from coir-husk litter of Brazilian poultry house using diode laser photoacoustic spectroscopy.

Ammonia (NH[Formula: see text]) from manure is a concern in raising broiler due to possible damages to production and the environment. Brazil is the main exporter of chicken meat in the world and is also responsible for large waste of poultry litter. The country, likewise, figures as top 5 producers of green coconut, which results in considerable volumes of waste, since 80%-85% of the fruit is unusable. This work analyzes the ammonia concentration profile of two bedding substrates for raising broiler, to know, coir-husk fiber and a commonly used pine wood shavings in a Brazilian climate. A differential home-made photoacoustic cell combined with a diode laser was employed for sensing ammonia at trace levels. Such combination confers selectivity as well as lower limits of detection to the system. The chemical compositions pH, N, C, Ca, Mg, P[Formula: see text]O[Formula: see text] and K[Formula: see text]O were also determined, in addition to the moisture, dry matter and mineral content of substrates and litters. NH[Formula: see text] concentrations varied from (0.9 ± 0.3) ppmv to (19 ± 3) ppmv and from (2.1 ± 0.5) ppmv to (21 ± 3) ppmv for the coir-husk fiber and wood shavings substrates, respectively. Results showed the feasibility of using coconut fiber as poultry litter in regions where this material is a common waste. Moreover, as NH[Formula: see text] concentrations were lower for coconut fiber bedding compared to shavings, this coir-husk fiber is a potential residue to guarantee the environmental sustainability by Brazilian poultry farming. Coir-husk fibers presented significantly higher amounts of P and K in comparison to pine wood. NH[Formula: see text] profiles revealed that coir-husk fiber emitted lower quantities than wood shavings. Besides, a delay on the NH[Formula: see text] emission pattern was clearly seen when the coconut waste was the bedding material. Such a tendency was confirmed by the logistic model. Our findings, in turn, make the coir-husk an environmentally friendly alternative low-cost product for poultry litter as well as its potential use as natural fertilizer. The later deserves attention since there is a need to accurately assess the emissions of methane, nitrous oxide, and carbon dioxide during the composting process. In Brazil, the waste generated by the high production of green coconut is an environmental liability. The cost of poultry production has been high, reducing the profit of producers, who seek to make production cheaper. Measuring NH[Formula: see text] from poultry activity in Brazil, a tropical country, aims to control management and reduce production losses, since NH[Formula: see text] is a harmful gas to birds. The measurement of NH[Formula: see text] concentrations at trace levels from raising broilers by photoacoustic diode laser spectroscopy, to the best of our knowledge, has been reported for the very first time.

Dichotomous analysis of gaseous emissions as influenced by the impacts of COVID-19 in Brazil: São Paulo and Legal Amazon.

Atmospheric contaminants severely impact air quality in large global urban centers. The emergence of COVID-19 in China in December 2019 and its expansion around the world reduced human activities on account of the implementation of a social isolation policy. In Brazil, COVID-19 arrived in February 2020, and a policy of social isolation was adopted in March by state governments; this work aimed to evaluate pollutant gas emissions in Brazil in the face of the pandemic. In the city of São Paulo, the concentrations of nitrogen dioxide (NO2) and carbon monoxide (CO) were analyzed at three automatic monitoring stations of the Environmental Company of the State of São Paulo (CETESB). In this way, reductions in concentrations of these gases were observed after the decree of social isolation on March 24, due to a noticeable drop in vehicle traffic in the city. A reduction in concentrations of NO2, between 53.6 and 73%, and a decrease in concentrations of CO, from 50 to 66.7%, were obtained at the monitoring stations. Another impact caused by COVID-19 was the increase in deforestation and fires was identified in the Brazilian Legal Amazon after social isolation, due to the decrease in the inspection of environmental agencies. The fires produce thermal degradation of the biomass, generating polluting gases and material particulate. These atmospheric contaminants are extremely harmful to the health of Amazonian populations. Summed to the expansion of COVID-19 in this region, all these factors combined cause the public health system to collapse. CO2eq emissions increase estimates, according to the Greenhouse Gas Emissions Estimation System technical report, ranged from 10 to 20% in 2020, compared to those from 2018. If Brazil maintains deforestation at this pace, it will be difficult to meet the emission reduction targets agreed at COP21.

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR).

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.

Characteristics of Patients With Early-Onset Arthritis in Latin America: Description of the REPANARC Cohort.

BACKGROUND: While many studies have tried to show that early intervention improves the clinical outcomes of early-onset arthritis, only a few were carried out in Latin America. OBJECTIVES: The aim of this study was to describe the Pan-American Registry of Early-Onset Arthritis (REPANARC) project and report the preliminary outcomes of a cohort of patients. METHODS: The REPANARC cohort consisted of a sample of patients from 6 Latin American countries. Patients with arthritis of 1 or more joints of 1-year duration or less were assessed by a rheumatologist during 6 consecutive clinical visits for a follow-up period of 2 years. The registry included clinical characteristics, medical history, physical examination, disease activity, analytical chemistries, imaging, current treatment, and a set of patient-reported outcome measures evaluating disability, psychological distress, and quality of life. RESULTS: A total of 173 patients were included with mean age of 41.9 ± 13.2 years; 83.8% were women. The predominant presentations at onset were insidious, polyarticular, additive, bilateral, and symmetrical. The initial diagnoses were rheumatoid arthritis (50.6%), undifferentiated arthritis (40.5%), and other arthritis (8.9%). With Disease Activity Score in 28 Joints, 76.9% had moderate to high disease activity, and 61.9% had moderate to severe disability (Health Assessment Questionnaire). Considering undifferentiated arthritis, 60.3% persisted undifferentiated, 29.4% evolved as rheumatoid arthritis, 4.4% remained self-limited, and 5.9% to other forms. The frequencies of depression and anxiety were high as measured with the Hospital Anxiety and Depression Scale, and approximately 20% had significant decrements in quality of life measured with the Medical Outcomes Study Short-Form 36 Health Survey Version 2. Mean time from the first symptoms to the first visit to a rheumatologist was 126 days. Shorter delays were confirmed to be associated with better outcomes. CONCLUSIONS: The REPANARC project is a useful tool to provide valuable information regarding patients with early-onset arthritis attending rheumatology centers in Latin-America.

Anticardiolipin Antibody Determination to Guide Q Fever Treatment.

Query (Q) fever is a worldwide infectious disease with acute and chronic manifestations caused by Coxiella burnetii. The clinical manifestations are so variable that the disease is often only diagnosed if systematically considered as a differential diagnosis. Here, we present a case of a 39-year-old man who lived in a countryside house, with cattle and sheep in his field, with acute Q fever hepatitis with the typical granulomatous arrangement in the liver biopsy. The diagnosis was confirmed by polymerase chain reaction (PCR) assay in a serum sample and the presence of phase II antibodies. Anticardiolipin antibody (aCL) determination at diagnosis of acute Q fever and during follow-up was made to persecute early identification and to guide the treatment and prophylaxis of possible complications, such as endocarditis.

[Myocardial infarction after taking zolmitriptan]. / Enfarte agudo do miocárdio após a toma de zolmitriptano.

Zolmitriptan is a drug used in the acute treatment of migraine, which should not be used in high cardiovascular risk individuals because of its potential to induce vasospasm. We report a rare case of myocardial infarction precipitated by taking zolmitriptan.

Diferença na qualidade de vida de tabagistas, ex-tabagistas e não tabagistas usuários das Unidades de Atenção Primária do município de Juiz de Fora, Minas Gerais / Difference in the quality of life of smokers, ex-smokers and non-smokers users of Primary Care Units in Juiz de Fora, Minas Gerais

O objetivo do presente estudo foi associar status tabágico (tabagistas, ex-tabagistas e não tabagistas) e a qualidade de vida entre usuários das Unidades de Atenção Primária à Saúde(APS). Realizou-se um estudo transversal com 500 usuários de 50 Unidades de APS do município de Juiz de Fora/MG.Foi utilizado questionário estruturado para coleta de dados sociodemográficos e de saúde e o questionário WHOQOL-BREF para avaliar a qualidade de vida. Para análise de dados foi empregada Regressão Logística. Os resultados das análises multivariadas evidenciaram que há maior chance de melhor qualidade de vida total para indivíduos ex-tabagistas (OR: 1,90; IC: 1,10-3,29) e não tabagistas (OR: 1,84; IC:1,14-2,95)em relação aos tabagistas. Da mesma forma, uma maior renda e a autodeclaração de cor da pele branca foram relacionados a melhor qualidade de vida total. Indivíduos não tabagistas também apresentaram melhor qualidade de vida no domínio físico comparado aos tabagistas(OR:2,24; IC:1,40-3,59). Conclui-se que, ex-tabagistas e não tabagistas tiveram maior chance de apresentarem melhor qualidade de vida global quando comparado aos tabagistas. Não tabagistas também apresentaram maior chance de melhor qualidade de vida no domínio físico em relação aos tabagistas.

The objective of the present study was to associate smoking status (smokers, ex-smokers and non-smokers) and quality of life among users of primary healthcare units. A cross-sectional study was conducted with 500 users of 50 Primary Health Care Units in the city of Juiz de Fora. A structured questionnaire was used to collect socio-demographic and health data and the WHOQOL-BREF questionnaire to assess the quality of life. For data analysis, LogisticRegression was used. The results of the multivariate analyzes showed that there is a greater chance of a better overall quality of life for ex-smokers (OR: 1.90; CI: 1.10-3.29) and non-smokers (OR: 1.84; CI: 1.14-2.95) in relation to smokers. Likewise, higher income and self-reported White skin color were related to a better overall quality of life. Non-smokers also presented better quality of life in the physical domain compared to smokers (OR:2.24; CI:1.40-3.59). It was concluded that ex-smokers and non-smokers were more likely to have a better overall quality of life when compared to smokers. Non-smokers also had a greater chance of better quality of life in the physical domain compared to smokers.

Análise do prolongamento do intervalo QT e fármacos em pacientes idosos em atendimento ambulatorial / Analysis of the QT interval prolongation and pharmaceuticals in elderly patients in ambulatory care

Objetivos: O objetivo deste estudo foi avaliar a frequência de síndrome do intervalo QT longo (SQTL) no traçado eletrocardiográfico de pessoas idosas e o uso concomitante de fármacos que possam agravá-la. Métodos: Trata-se de um estudo observacional, do tipo corte transversal, de pacientes idosos atendidos nos ambulatórios de especialidades do Hospital Santa Casa de Misericórdia de Vitória (ES), durante o período de seis meses.Resultados: Participaram do estudo 163 pacientes com 75 ± 8 (60­94) anos de idade, 60,7% (n = 99) dos quais eram do sexo feminino. Do total de pacientes, 33,1% (n = 54) faziam uso regular de pelo menos um fármaco de risco para prolongamento de intervalo QT corrigido (QTc). Trinta e quatro pacientes (20,9%) apresentaram QTc longo e 15 (9,2%), QTc de risco. Dos pacientes com QTc de risco, 4 (23,5%) faziam uso de pelo menos 1 fármaco de risco para prolongamento do intervalo QT (p = 0,07). Conclusão: Nesta amostra, observou-se alta frequência de SQTL, bem como o uso de fármacos potencialmente causadores de SQTL e arritmias.

Objectives: The objective of this study was to evaluate the frequency of long QT syndrome (LQTS) in the electrocardiographic tracing of elderly people and the concomitant use of drugs that can aggravate this condition. Methods: This is a crosssectional, observational study of elderly patients in outpatient services at Hospital Santa Casa de Misericórdia de Vitória, over a six-month period. Results: A total of 163 patients with 75 ± 8 (60­94) years of age, 60.7% (n = 99) of whom were female, participated in the study. Of the total number of patients, 33.1% (n = 54) were regularly taking at least one pharmaceutical that increased the risk of QTc prolongation; 34 patients (20.9%) had prolonged QTc and 15 (9,2%) had at-risk QTc. Of these patients with at-risk QTc, 4 (23.4%) were using at least 1 1 pharmaceutical that increases the risk of QT prolongation (p = 0.07). Conclusion: In this sample, a high frequency of LQTS was observed, as well as the use of pharmaceuticals that potentially cause LQTS and arrhythmias.

Prática educativa em uma escola de educação infantil: relato de experiência / Educational practice in a school of early childhood education: case studies

Objetivo: relatar o trabalho educativo realizado a partir de oficinas sobre o risco familiar detectado em uma comunidade. Método: estudo descritivo, tipo relato de experiência, fundamentado nos pressupostos da Ergologia, realizado em 2012 com 46 famílias de crianças do ensino fundamental. O projeto de pesquisa foi conduzido pelo Comitê de Ética em Pesquisa, conforme Parecer n. 245/2010. Resultados: o relacionamento grupal possibilitou o relato de situações conflituosas e estigmatizadoras, e a percepção da interferência dos transtornos do humor e do comportamento sobre a vida familiar. Houve sensibilização para aquisição de hábitos saudáveis, cuidado à criança e aproximação família-escola. Conclusão: emergiram reflexões sobre a práxis, contribuindo para a integração família e escola.(AU)

Objective: reporting the educational work conducted from workshops about family risk detected in a community. Method: a descriptive study of type experience report, based on the assumptions of Ergology, held in 2012 with 46 families of elementary school children. The research project was by the Research Ethics Committee, under Opinion n. 245/2010. Results: the group relationship enabled the account of conflict and stigmatizing situations and the perception of interference of mood disorders and behavior on family life. There was awareness of acquisition of healthy habits, child care and family-school approach. Conclusion: reflections on the practice emerged, helping to integrating family and school.(AU)

Objetivo: informe de la labor educativa de talleres acerca del riesgo familiar detectado en una comunidad. Método: un estudio descriptivo del tipo informe de experiencia, basado en los supuestos de la Ergología, celebrado en 2012 con 46 familias de niños de la escuela primaria. El proyecto de investigación fue aprobado por el Comité de Ética en la Investigación, bajo la Opinión n. 245/2010. Resultados: la relación de grupo habilitado la cuenta de las situaciones conflictivas y estigmatizadoras y la percepción de la interferencia de los trastornos del estado de ánimo y el comportamiento en la vida familiar. Hay una conciencia de la adquisición de hábitos saludables, el cuidado de niños y de aproximación familia-escuela. Conclusión: emergieron reflexiones sobre la práctica, ayudando a integrar la familia y la escuela.(AU)

Avaliação e classificação do risco familiar em uma escola de educação infantil / Evaluación y clasificación del riesgo familiar en una escuela de educación infantil / Assessment and classification of family risk in a school of early childhood education

Objective: To evaluate the familial risk for children of early childhood education to support educational practices and school-family integration. Method: This exploratory, descriptive quantitative. The data collection was performed in a school in a city in Minas Gerais, 2011. The subjects were 69 school families. We used a form with topics related to socioeconomic factors and clinical conditions of the members of the families concerned. The data was submitted to statistical analysis with variable frequency, enabling the establishment of priorities (risk level, sentries and factors influencing the risks). Results: The familial risk was between low and medium, the clinical criterion influence this classification. There is potential for development of chronic diseases such as hypertension, obesity, alcoholism, smoking, and psychosocial disorders. Conclusion: The classification provided to identify the need for health education in the pursuit of generating content and collective actions to raise awareness for the acquisition of healthy habits.

Objetivo: Avaliar o risco familiar de crianças da educação infantil para subsidiar práticas educativas e integração escola-família. Método: Pesquisa exploratória descritiva, quantitativa. Coleta de dados realizada em uma escola de um município de Minas Gerais, em 2011. Os sujeitos foram 69 famílias da escola. Utilizou-se um formulário com tópicos relacionados a fatores socioeconômicos e condições clínicas dos membros das famílias em questão. Submeteram-se os dados à análise estatística com frequência das variáveis, possibilitando o estabelecimento de prioridades (grau de risco, sentinelas e fatores que influenciam os riscos). Resultados: O risco familiar ficou entre baixo e médio, o critério clínico influenciou esta classificação. Observou-se potencial para desenvolvimento de doenças crônicas não transmissíveis, como: hipertensão arterial, obesidade, alcoolismo, tabagismo, além de transtornos psicossociais. Conclusão: A classificação propiciou identificar a necessidade de realizar práticas educativas em saúde, na busca de gerar conteúdos e ações coletivas voltadas para sensibilização para aquisição de hábitos saudáveis.

Objetivo: Evaluar el riesgo familiar para los niños de educación infantil para apoyar las prácticas educativas y la integración escuela-familia. Método: Exploratorio, descriptivo cuantitativo. La recolección de datos en una escuela en una ciudad en Minas Gerais en 2011. Los sujetos fueron 69 familias de la escuela. Se utilizó un formulario con los temas relacionados con los factores socioeconómicos y las condiciones clínicas de los miembros de las familias afectadas. Sometidos los datos a un análisis estadístico con una frecuencia variable, lo que permite el establecimiento de prioridades (nivel de riesgo, los centinelas y los factores que influyen en los riesgos). Resultados: El riesgo familiar fue entre baja y media, el criterio clínico influye esta clasificación. Existe un potencial para el desarrollo de enfermedades crónicas como la hipertensión, la obesidad, el alcoholismo, el tabaquismo y los trastornos psicosociales. Conclusión: La clasificación proporcionada a identificar la necesidad de educación para la salud en la búsqueda de la generación de contenidos y acciones colectivas para aumentar la conciencia para la adquisición de hábitos saludables.

Sífilis: ainda uma grande simuladora / Syphilis: still a big simulator

Sífilis é uma doença sistêmica e infecto-contagiosa, causada pelo Treponema pallidum. É dividida em duas formas: recente e tardia. A forma dita recente é subdividida em primária, secundária e latente. A forma tardia envolve comprometimento multissistêmico. A incidência e prevalência da sífilis decresceram em vários países após a introdução da penicilina em 1943. Após a década de 60, observou-se incremento de ambas, seguindo a trajetória de outras doenças sexualmente transmissíveis. A despeito dessa tendência, a sífilis é pouco considerada no diagnóstico diferencial de doenças sistêmicas, sobretudo em idosos. O objetivo deste trabalho foi relatar um caso de sífilis secundária com evolução "florida" em paciente idosa, enfatizando seus aspectos clínicos, evolutivos e terapêuticos, no intuito de ressaltar a importância de se considerar essa patologia no diagnóstico diferencial de doenças sistêmicas em idosos com histórico epidemiológico. É importante alertar os médicos que lidam com idosos acerca da necessidade DE se considerar essa patologia no diagnóstico diferencial de doenças sistêmicas nessa população, bem como orientar os pacientes com relação às medidas preventivas e, diante do diagnóstico, instituir terapêutica adequada de forma a impedir manifestações tardias da doença...