Functional characterization and structural insights of three cutinases from the ascomycete Fusarium verticillioides.

Cutinases are serine esterases that belong to the α/ß hydrolases superfamily. The natural substrates for these enzymes are cutin and suberin, components of the plant cuticle, the first barrier in the defense system against pathogen invasion. It is well-reported that plant pathogens produce cutinases to facilitate infection. Fusarium verticillioides, one important corn pathogens, is an ascomycete upon which its cutinases are poorly explored. Consequently, the objective of this study was to perform the biochemical characterization of three precursor cutinases (FvCut1, FvCut2, and FvCut3) from F. verticillioides and to obtain structural insights about them. The cutinases were produced in Escherichia coli and purified. FvCut1, FvCut2, and FvCut3 presented optimal temperatures of 20, 40, and 35 °C, and optimal pH of 9, 7, and 8, respectively. Some chemicals stimulated the enzymatic activity. The kinetic parameters revealed that FvCut1 has higher catalytic efficiency (Kcat/Km) in the p-nitrophenyl-butyrate (p-NPB) substrate. Nevertheless, the enzymes were not able to hydrolyze polyethylene terephthalate (PET). Furthermore, the three-dimensional models of these enzymes showed structural differences among them, mainly FvCut1, which presented a narrower opening cleft to access the catalytic site. Therefore, our study contributes to exploring the diversity of fungal cutinases and their potential biotechnological applications.

Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study.

OBJECTIVES: To analyze the rate of gestational syphilis (GS) based on temporal trends over 11 years, as well as the spatial distribution of GS in Brazil, based on the identification of spatial clusters. METHODOLOGY: An ecological, using Brazil and its regions as an analysis unit, based on gestational syphilis data reported in the Notifiable Diseases Information System (SINAN), from 2011 to 2020. Thematic maps were built for spatial data analysis, and the Prais-Winsten autoregressive model was used to verify the trend. Spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of distribution of GS across Brazilian municipalities, using a 5% significance level. RESULTS: Gestational syphilis experienced a considerable increase in cases during the studied period, with a peak of 37,436 cases in 2018. The spatial distribution of the disease is heterogeneous in the country. A growing trend was observed in all states of Brazil, except for Espírito Santo, where it remained stationary, with a monthly variation of 10.32%. CONCLUSION: The spatial and temporal trend analysis point to syphilis as an important public health problem. The numbers are alarming and show the urgent need for measures to prevent and control syphilis during pregnancy.

Incorporation, adaptation and rejection of obstetric practices during the implementation of the "Adequate Childbirth Program" in Brazilian private hospitals: a qualitative study.

BACKGROUND: The "Adequate Childbirth Program" (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation. METHOD: This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software. RESULTS: The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals. CONCLUSIONS: After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it's harmful.

Brazil has high Cesarean Section (CS) rates, with rates far from the ideal recommended by the World Health Organization and a model of care that does not favor women's autonomy and empowerment. In 2015, a quality improvement project, called "Projeto Parto Adequado" (PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean section, in addition to encouraging the process of natural and safe childbirth. One of the components of this project was to reorganize the model of care in hospitals to prepare professionals for humanized and safe care. The data were collected in 8 hospitals with interviews with 49 professionals, approximately two years after the beginning of the project in the hospitals. There were changes in the hospital routine and in the care of women after the project. The professionals incorporated practices such as skin-to-skin contact and breastfeeding; diet during labor; non-invasive care technologies, especially to relieve pain during labor; birth plan; pregnancy courses with guided tours in hospitals (for pregnant women and family); and analgesia for vaginal labor. There was adaptation of existing practices in hospitals to reduce CS that had no clinical indication; better monitoring of labor, favoring vaginal delivery. And finally, the professionals rejected the practice that presses the uterine fundus, for not having shown efficacy in recent studies. We can conclude that the hospitals that participated in this study have made an effort to change their obstetric model. However, specific aspects of each hospital, the organization of the health system in Brazil, and the incentive of the local administration influenced the implementation of these changes by professionals in practice.

Effects of Mannosylerythritol-Lipids-B on Cutibacterium acnes ATCC 6919.

Mannosylerythritol-lipids-B (MEL-B) are microbial-produced glycolipids with skincare properties, notably moisturizing, antimelanogenic, antimicrobial, and antiaging. Thus, there is a potential use of MEL-B in a formulation for treating acne-prone skin. This study investigated the antimicrobial effect of MEL-B against the Gram-positive bacteria Cutibacterium acnes. The broth macro dilution method was used to evaluate the growth of C. acnes (3-4 CFU/mL), in the absence (positive control) or presence of MEL-B (128, 192, 256, and 512 µg/mL). Additionally, the leakage of genetic materials was used to determine the potential drug-induced membrane disruption of glycolipids. The amount of DNA and RNA release was quantified spectrophotometrically at 260 nm. Macro dilution technique and membrane integrity experiments showed that MEL-B does not have antimicrobial activity against C. acnes. Indeed, MEL-B assisted C. acnes growth. Ultimately, MEL-B has been reported as a remarkably active compound for skincare formulations; however, preliminarily, it should be avoided for acneic skin.

Developing non-opioid therapeutics to alleviate pain among persons with opioid use disorder: a review of the human evidence.

The opioid crisis remains a major public health concern, causing significant morbidity and mortality worldwide. Pain is frequently observed among individuals with opioid use disorder (OUD), and the current opioid agonist therapies (OAT) have limited efficacy in addressing the pain needs of this population. We reviewed the most promising non-opioid analgesic therapies for opioid-dependent individuals synthesising data from randomised controlled trials in the Medline database from December 2022 to March 2023. Ketamine, gabapentin, serotoninergic antidepressants, and GABAergic drugs were found to be the most extensively studied non-opioid analgesics with positive results. Additionally, we explored the potential of cannabinoids, glial activation inhibitors, psychedelics, cholecystokinin antagonists, alpha-2 adrenergic agonists, and cholinergic drugs. Methodological improvements are required to advance the development of novel analgesic strategies and establish their safety profile for opioid-dependent populations. We highlight the need for greater integration of experimental pain methods and abuse liability assessments, more granular assessments of prior opioid exposure, greater uniformity of pain types within study samples, and a particular focus on individuals with OUD receiving OAT. Finally, future research should investigate pharmacokinetic interactions between OAT and various non-opioid analgesics and perform reverse translation basic experiments, particularly with methadone and buprenorphine, which remain the standard OUD treatment.

Application of Goat and Lamb Lipases on the Development of New Immobilized Biocatalysts Aiming at Fish Oil Hydrolysis.

The use of lipases from animal sources for the synthesis of new biocatalysts is barely studied in the literature. The present work focused on the immobilization of lipases from kid goat's and lamb's epiglottis in different ionic supports. For this, anionic supports (monoaminoethyl-N-aminoethyl-agarose (MANAE) and diethylaminoethyl-agarose (DEAE)) and cationic supports (carboxymethyl-agarose and sulfopropyl-agarose) were used. The immobilization parameters were evaluated, as well as the thermal stability of the immobilized enzymes and their stability at different values of pH. Then, the performance of the biocatalysts was evaluated in hydrolysis reactions for obtaining omega-3 fatty acids from fish oil (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)). Values of 100% of recovered activity were obtained for lipase from goats, indicating that it was possible to maintain all the enzymatic activities of the immobilized enzymes on the supports. The immobilized enzymes were more stable in different pH conditions and at a temperature of 50 °C, reaching values of stabilization factor of 12.17 and t1/2 of 9.86 h-1, for lamb lipase immobilized in sulfopropyl agarose. In general, the anionic supports led to lower Km values and the cationic ones to a higher Vmax. Lamb lipase showed the highest selectivity values for EPA/DHA, reaching values of 6.43 using MANAE. Thus, the high potential for using such biocatalysts from animal sources in the food or pharmaceutical industries is observed.

The Potential of Crude and Partially Purified Black Rice Bran Extracts Obtained by Ultrasound-Assisted Extraction: Anti-Glycemic, Cytotoxicity, Cytoprotective, and Antitumoral Effects.

Recovering anthocyanins from black rice bran is a way of valuing this byproduct, by obtaining an extract with biological potential. The objective of this study was to recover anthocyanins using ultrasound-assisted extraction. Some of the extract was partially purified, and both (crude and partially purified) extracts were evaluated for their anthocyanin content, antioxidant activity, antidiabetic and antitumoral activities, cytotoxicity, and oxidative stress. An increase in the laboratory scale was also achieved, making possible to increase the extraction volume up to 20 times without significantly changing the content of anthocyanins (1.85 mg C3G/g DW). It was found that the purified sample presented a 4.2 times higher value of total anthocyanins compared to the crude sample. The best IC50 values for the purified sample were verified by DPPH and ABTS (0.76 and 0.33 mg/mL). The best results for antidiabetic activity were obtained for the partially purified sample: 0.82 µM C3G for α-glucosidase and 12.5 µM C3G for α-amylase. The extracts demonstrated protection (~70%) when subjected to the oxidative stress of L929 cells. An antitumoral effect of 25-30% for both extracts was found in A459 cells. The crude and partially purified extracts of black rice have antidiabetic and anticancer effects and more studies are needed to explore their potential.

Envenomation by a common green racer (Chlorosoma viridissimum) in the Brazilian Amazon: A report of three cases.

Envenomations by the common green racer (Chlorosoma viridissimum) are seldom reported in the literature. Herein, we report three cases caused by the same specimen of C. viridissimum in three different victims in the Brazilian Amazon. In all cases, the victims were either a biologist or biology students that were handling the animal and were bitten in their upper limbs. The victims showed only local symptoms, such as edema, tooth marks, pain, erythema, ecchymoses and bleeding. One of the patients presented extensive ecchymosis. Two patients sought medical care, but were only treated for local manifestations and evolved without complications. Chlorosoma viridissimum is capable of provoking mild to moderate signs and symptoms.

Alcohol Use Disorder and Chronic Pain: An Overlooked Epidemic.

Alcohol use disorder (AUD) and chronic pain disorders are pervasive, multifaceted medical conditions that often co-occur. However, their comorbidity is often overlooked, despite its prevalence and clinical relevance. Individuals with AUD are more likely to experience chronic pain than the general population. Conversely, individuals with chronic pain commonly alleviate their pain with alcohol, which may escalate into AUD. This narrative review discusses the intricate relationship between AUD and chronic pain. Based on the literature available, the authors present a theoretical model explaining the reciprocal relationship between AUD and chronic pain across alcohol intoxication and withdrawal. They propose that the use of alcohol for analgesia rapidly gives way to acute tolerance, triggering the need for higher levels of alcohol consumption. Attempts at abstinence lead to alcohol withdrawal syndrome and hyperalgesia, increasing the risk of relapse. Chronic neurobiological changes lead to preoccupation with pain and cravings for alcohol, further entrenching both conditions. To stimulate research in this area, the authors review methodologies to improve the assessment of pain in AUD studies, including self-report and psychophysical methods. Further, they discuss pharmacotherapies and psychotherapies that may target both conditions, potentially improving both AUD and chronic pain outcomes simultaneously. Finally, the authors emphasize the need to manage both conditions concurrently, and encourage both the scientific community and clinicians to ensure that these intertwined conditions are not overlooked given their clinical significance.

Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey. / Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

Itinerários de cuidado à saúde de mulheres em situações de abortamento: aspectos metodológicos do estudo qualitativo da pesquisa Nascer no Brasil II / Itinerarios para el cuidado de la salud de mujeres en situación de abortamiento: aspectos metodológicos del estudio cualitativo de la encuesta Nacer en Brasil II / Health care itineraries for women in situations of abortion: methodological aspects of a qualitative study for Birth in Brazil II survey

Nas últimas décadas, produziu-se um robusto corpus de pesquisas sobre aborto no Brasil, com diferentes desenhos, objetos e metodologias. Contudo, pela diversidade de situações em que as mulheres brasileiras vivenciam o abortamento, pela complexidade do tema e por suas modulações em contextos políticos e socioculturais distintos, o assunto não cessa de desafiar a academia, o campo da saúde e dos direitos reprodutivos. Neste artigo, apresentamos aspectos metodológicos de um estudo qualitativo sobre itinerários de cuidado à saúde de mulheres em situações de abortamento, componente da pesquisa Nascer no Brasil II, que objetiva discutir efeitos das desigualdades de gênero, de raça/etnia, de classe social, geracionais, regionais e territoriais nesses percursos. Discutimos o desenvolvimento do desenho do estudo; a construção do arcabouço teórico e recortes analíticos específicos; a elaboração do instrumento de entrevista; os critérios de seleção das mulheres; as estratégias de abordagem e condução das entrevistas; a gestão do fluxo do campo e dos materiais produzidos; os procedimentos analíticos; e os problemas éticos. Para incluir uma diversidade de mulheres e aprofundar resultados do componente quantitativo do Nascer no Brasil II, serão realizadas 120 entrevistas narrativas. O contexto de criminalização do aborto impacta a produção de conhecimento sobre o tema, impondo desafios como conseguir acesso às mulheres, assegurar o anonimato e sua privacidade, além do sigilo das informações, gerar condições objetivas e subjetivas para que possam narrar em profundidade as suas experiências. Com este artigo, procuramos contribuir para o debate sobre esses desafios das pesquisas sobre aborto no Brasil.

En las últimas décadas, se produjo un robusto corpus de investigaciones sobre el aborto en Brasil, con diferentes diseños, objetos y metodologías. Sin embargo, debido a la diversidad de situaciones en las que las mujeres brasileñas vivencian el abortamiento, la complejidad del tema y sus modulaciones en diferentes contextos políticos y socioculturales, el tema continúa desafiando a la academia, el campo de la salud y los derechos reproductivos. En este artículo, presentamos aspectos metodológicos de un estudio cualitativo sobre los itinerarios de cuidados de la salud de mujeres en situación de abortamiento, componente de la encuesta Nacer en Brasil II, que tiene como objetivo discutir los efectos de las desigualdades de género, raza/etnia, clase social, generacionales, regionales y territoriales en esos recorridos. Discutimos el desarrollo del diseño del estudio, la construcción del marco teórico y los recortes analíticos específicos, la elaboración del instrumento de entrevista, los criterios de selección de las mujeres, las estrategias de abordaje y realización de las entrevistas, el manejo del flujo del campo y de los materiales producidos, los procedimientos analíticos y los problemas éticos. Para abarcar una diversidad de mujeres y profundizar los resultados del componente cuantitativo de Nacer en Brasil II, se realizarán 120 entrevistas narrativas. El contexto de criminalización del aborto impacta la producción de conocimiento sobre el tema, imponiendo desafíos, tales como conseguir acceso a las mujeres, asegurar su anonimato y privacidad y la confidencialidad de la información, generar condiciones objetivas y subjetivas para que puedan narrar en profundidad sus experiencias. Con este artículo buscamos contribuir al debate sobre estos desafíos de las investigaciones sobre el aborto en Brasil.

In recent decades, several academic studies on abortion have been produced in Brazil, with different designs, objectives, and methodologies. However, due to the diversity of situations in which Brazilian women experience abortion, the complexity of this topic, and its modulations in different political and sociocultural contexts, it still challenges academicians and the fields of health and reproductive rights. In this article, we present methodological aspects of a qualitative study on health care itineraries of women in situations of abortion, a component of the Birth in Brazil II survey, whose objective is to discuss the effects of gender; race/ethnicity; social class; generational, regional, and territorial inequalities on care itineraries. We discuss the study design development, the construction of the theoretical framework and specific analytical axes, the development of interview instrument, definition of participant selection criteria, strategies to contact participants and conduct the interviews, management of field work and materials produced, analytical procedures, and ethical issues. In total, 120 narrative interviews were conducted in order to include a diversity of women and obtain detailed results from the quantitative analysis under Birth in Brazil II survey. The context of criminalization of abortion has an impact on the production of knowledge on this subject, creating challenges such as difficult access to women, women's anonymity, privacy and data confidentiality, creation of objective and subjective conditions so that they can narrate their experiences in depth. With this article, we seek to contribute to the debate about these challenges in abortion research in Brazil.

(In)sustentabilidade financeira municipal: a frágil metodologia proposta pela PEC do Pacto Federativo / (In)sostenibilidad financiera municipal: la metodología frágil propuesta por la PEC del Pacto Federativo / Municipal financial (in)sustainability: the fragile methodology proposed by the Federative Pact PEC

Resumo A partir da Constituição da República Federativa do Brasil de 1988, os municípios foram promovidos à condição de entes federativos brasileiros. Atualmente, o Brasil conta com 1.307 pequenos municípios, com população de no máximo 5 mil habitantes. Em 2019, entrou no cenário político e legislativo a Proposta de Emenda à Constituição n° 188 (PEC 188), tendo como uma de suas proposições a extinção/incorporação de pequenos municípios considerados insustentáveis. O presente estudo tem por objetivo evidenciar fragilidades/vulnerabilidades na metodologia proposta pela PEC 188/2019 para a mensuração da sustentabilidade financeira dos pequenos municípios brasileiros. Para o alcance do objetivo, tal modelo foi analisado e aplicado a todos os 5.570 municípios brasileiros, utilizando como base os períodos de 2015 a 2020. O estudo se fundamenta em pesquisa bibliográfica e documental, com abordagens descritiva e quantitativa. Para o tratamento e a análise dos dados, foram empregadas técnicas de estatísticas descritivas e medidas de tendência central. Os resultados evidenciam que, aplicada a metodologia da PEC 188, a média nacional de sustentabilidade dos municípios brasileiros é de 5%, reduzindo-se para menos de 3% quando analisados apenas os pequenos, com até 5 mil habitantes. Tem-se ainda que mais de 85% dos municípios brasileiros, em média, são classificados como "insustentáveis" com base na metodologia da PEC, elevando para 98% essa condição se analisados apenas os pequenos. A metodologia proposta pela PEC 188 carrega fragilidades que, se não sanadas previamente a uma possível promulgação, poderão ocasionar a extinção de aproximadamente 1.224 pequenos municípios.

Resumen A partir de la Constitución de la República Federativa del Brasil de 1988, los municipios fueron promovidos a la condición de entidades federativas brasileñas. Actualmente, Brasil tiene 1.307 pequeños municipios con una población máxima de 5.000 habitantes. En 2019, entró en el escenario político y legislativo la Propuesta de Reforma a la Constitución nº 188 (PEC 188) que, entre otras, propone la extinción/incorporación de pequeños municipios considerados insostenibles. Por lo tanto, el presente estudio tiene como objetivo resaltar las debilidades/vulnerabilidades existentes en la metodología propuesta por la PEC 188/2019 para medir la sostenibilidad financiera de los pequeños municipios brasileños. Para alcanzar el objetivo, la metodología propuesta por la PEC fue analizada y aplicada en los 5.570 municipios brasileños, tomando como base los períodos de 2015 a 2020. El estudio se basa en una investigación bibliográfica y documental, con enfoques descriptivos y cuantitativos. Para el tratamiento y análisis de los datos se utilizaron técnicas de estadística descriptiva y medidas de tendencia central. Los resultados muestran que, cuando se aplica la metodología PEC-188, el promedio nacional de sostenibilidad de los municipios brasileños es del 5%, reduciéndose a menos del 3% cuando se analizan solo municipios pequeños con hasta 5.000 habitantes. Asimismo, más del 85% de los municipios brasileños, en promedio, están clasificados como insostenibles con base en la metodología PEC, y dicha condición asciende al 98% al analizar solamente los municipios pequeños. La metodología propuesta por la PEC 188 tiene debilidades que, de no ser resueltas antes de una posible promulgación, podrían llevar a la extinción de aproximadamente 1.224 pequeños municipios brasileños.

Abstract From the Constitution of the Federative Republic of Brazil of 1988, municipalities were promoted to the condition of Brazilian federative entities. Currently, Brazil has 1,307 small municipalities with a maximum population of 5,000 inhabitants. In 2019, the Proposal for Amendment to the Constitution nº 188 (PEC 188) entered the political and legislative scene, with one of its propositions being the extinction/incorporation of small municipalities considered unsustainable. Thus, this study aims to highlight existing weaknesses/vulnerabilities in the methodology proposed by PEC 188/2019 for measuring the Financial Sustainability of small Brazilian municipalities. The methodology proposed by the PEC was analyzed and applied to all 5,570 Brazilian municipalities, using the periods from 2015 to 2020 as a basis. The study is based on bibliographical and documentary research with descriptive and quantitative approaches. For data treatment and analysis, descriptive statistics and measures of central tendency techniques were used. The results show that, when the PEC-188 methodology is applied, Brazilian municipalities' national average of "sustainability" is 5%, reducing to less than 3% when only small municipalities with up to 5,000 inhabitants are analyzed. Furthermore, more than 85% of Brazilian municipalities, on average, are classified as "unsustainable" based on the PEC methodology, increasing this condition to 98% if only the stratum of small municipalities is analyzed. The methodology proposed by PEC 188 has weaknesses that, if not resolved prior to a possible enactment, could lead to the extinction of approximately 1,224 small Brazilian municipalities.

O impacto financeiro na saúde pública contra ist's em específico hiv no município de Ji-Paraná: análise de dados (2019 a 2022) / The financial impact on public health against ist's in specific hiv in the municipality of Ji-Paraná: data analysis (2019 to 2022) / Impacto financiero en la salud pública contra el vih en el municipio de Ji-Paraná: análisis de datos (2019 a 2022)

O investimento financeiro desempenha um papel fundamental no combate ao HIV, sendo essencial no financiamento de programas de prevenção, como campanhas de conscientização pública, distribuição de preservativos, testagem, tratamento e pesquisas. Sem investimento adequado, as taxas de infecção podem aumentar e as pessoas que vivem com HIV podem não ter acesso aos tratamentos e serviços de que precisam. Este estudo tem como objetivo analisar sobre o aumento de investimento na área da vigilância epidemiológica relativa ao combate a Infecções Sexualmente Transmissíveis (IST's) com um olhar para o vírus da imunodeficiência humana HIV, no município de Ji- Paraná no período de 2019 a 2022. Adotou-se como metodologia uma pesquisa elaborada de forma quantitativa, de caráter exploratório, por meio de uma análise de dados dos registros públicos epidemiológicos e também dos investimentos no fundo municipal de saúde publicados no portal de transparência do município de Ji-Paraná. O seguinte estudo possibilitou a análise dos investimentos realizados no fundo municipal de saúde para a realização de ações voltadas para o controle, diagnósticos e tratamento da Human Immuno Deficiency Virus (HIV) que teve influência direta na diminuição dos casos registrados pelo portal do Sistema de Informações de Agravos de Notificação (SINAN) no período de 2019 a 2020. Conclui-se que o investimento em saúde pública para o combate ao HIV/AIDS é fundamental e pode ser um grande desafio financeiro para os municípios, especialmente em tempos de crise econômica e escassez de recursos, a alocação de recursos adequados para programas de prevenção, tratamento, cuidados de saúde, serviços de apoio, pesquisa e monitoramento pode ajudar a reduzir a incidência de novos casos de HIV e garantir que as pessoas que vivem com HIV recebam o suporte necessário para gerenciar sua condição.

Financial investment plays a fundamental role in the fight against HIV, being essential in financing prevention programs, such as public awareness campaigns, condom distribution, testing, treatment, and research. Without adequate investment, infection rates can increase and people living with HIV may not have access to the trea- tments and services they need. This study aims to analyze the increase in investment in the area of epidemiological surveillance related to the fight against Sexually Transmitted Infections (STIs) with a focus on the Human Immunodeficiency Virus (HIV) in the mu- nicipality of Ji-Paraná from 2019 to 2022. A quantitative exploratory research methodo- logy was adopted, through an analysis of data from public epidemiological records and also investments in the municipal health fund published on the transparency portal of the municipality of Ji-Paraná. This study enabled the analysis of investments made in the municipal health fund for actions aimed at the control, diagnosis, and treatment of the Human Immuno Deficiency Virus (HIV), which had a direct influence on the decrease in cases recorded by the Notification of Aggravations Information System (SINAN) portal from 2019 to 2020. It is concluded that public health investment for the fight against HIV/AIDS is essential and can be a significant financial challenge for municipalities, especially in times of economic crisis and resource scarcity. Adequate allocation of re- sources for prevention programs, treatment, healthcare, support services, research, and monitoring can help reduce the incidence of new HIV cases and ensure that people living with HIV receive the necessary support to manage their condition. KEYWORDS: AIDS/HIV; Public Health; Financing.

La inversión financiera juega un papel fundamental en la lucha contra el VIH, siendo esencial para el financiamiento de programas de prevención, como campañas de concientización pública, distribución de preservativos, pruebas, tratamiento e investi- gaciones. Sin una inversión adecuada, las tasas de infección pueden aumentar y las per- sonas que viven con VIH pueden no tener acceso a los tratamientos y servicios que nece- sitan. Este estudio tiene como objetivo analizar el aumento de la inversión en el área de la vigilancia epidemiológica en relación a la lucha contra las Infecciones de Transmisión Sexual (ITS), con un enfoque en el virus de la inmunodeficiencia humana VIH, en el municipio de Ji-Paraná en el período de 2019 a 2022. Se adoptó como metodología una investigación elaborada de forma cuantitativa, de carácter exploratorio, a través de un análisis de datos de registros públicos epidemiológicos y también de las inversiones en el fondo municipal de salud publicadas en el portal de transparencia del municipio de Ji- Paraná. Este estudio permitió el análisis de las inversiones realizadas en el fondo munici- pal de salud para llevar a cabo acciones enfocadas en el control, diagnóstico y tratamiento del Virus de Inmunodeficiencia Humana (VIH), lo que tuvo una influencia directa en la disminución de los casos registrados por el portal del Sistema de Información de Agravios de Notificación (SINAN) en el período de 2019 a 2020. Se concluye que la inversión en salud pública para la lucha contra el VIH/SIDA es fundamental y puede ser un gran de- safío financiero para los municipios, especialmente en tiempos de crisis económica y es- casez de recursos, la asignación de recursos adecuados para programas de prevención, tratamiento, cuidado de la salud, servicios de apoyo, investigación y monitoreo puede ayudar a reducir la incidencia de nuevos casos de VIH y garantizar que las personas que viven con VIH reciban el apoyo necesario para manejar su condición.

Hibiscus increases functional capacity and the anti-obesity effect in trained obese rats / El hibiscus aumenta la capacidad funcional y el efecto antiobesidad en ratas obesas entrenadas / O hibiscus aumenta a capacidade funcional e o efeito antiobesidade em ratos obesos treinados

ABSTRACT Introduction Hibiscus sabdariffa (Hs) has been widely used for weight loss and in the fight against obesity-associated comorbidities. Objective To evaluate the effects of Hs and physical training on the functional capacity of normal-weight and obese rats. Methods Wistar rats were distributed into eight experimental groups: control (C, n = 8) , Hibiscus Sabdariffa (Hs, n = 8), high-intensity interval training (IT, n = 8), high-intensity interval training + Hibiscus Sabdariffa (ITHs, n = 8), obese (O, n = 8), obese + continuous aerobic training (OAT, n = 8), obese + Hibiscus Sabdariffa (OHs, n = 8), , and obese + continuous aerobic training + Hibiscus Sabdariffa (OATHs, n = 8). Hibiscus Sabdariffa extract was administered for 60 days in a dose of 150 mg/kg of body weight. The maximum progressive effort test (MPET) was performed on a treadmill at the beginning and end of the study. The variables analyzed were maximum speed Vmáx time, and distance covered. Lactate was measured immediately after the MPET. Functional capacity was evaluated by the distance/adiposity index. The ANOVA with Bonferroni post hoc and Pearson's correlation tests were used at a 5% significance level. Results After both types of training, moderate-intensity continuous and high-intensity interval performed on the treadmill, final body weight, weight gain, and the adiposity index decreased, and Vmax, time, and distance covered in the MPET increased, in addition to an improvement in functional capacity. Hs supplementation reduced the adiposity index in normal-weight and obese rats. Hs associated with aerobic training reduced final body weight and increased functional capacity. Conclusion Hs supplementation promoted a reduction in the adiposity index in normal-weight and obese rats and an increase in the functional capacity of trained obese rats. Level of Evidence III; Therapeutic Studies - Outcome Investigation. Case study - control.

RESUMEN Introducción El Hibiscus Sabdariffa (Hs) ha sido ampliamente utilizado para promover la pérdida de peso y tratar las comorbilidades asociadas a la obesidad. Objetivos Evaluar los efectos del Hs y el entrenamiento físico sobre la capacidad funcional de ratas eutróficas y obesas. Métodos Se distribuyeron ratas Wistar en ocho grupos experimentales: Control (C, n=8), Hibiscus Sabdariffa (Hs, n=8), , entrenamiento de intervalos de alta intensidad (EI, n=8)), entrenamiento de intervalos de alta intensidad + Hibiscus Sabdariffa (EIHs, n=8), obeso (O, n=8)), obeso + entrenamiento continuo aeróbico (OEA, n=8), obeso + Hibiscus Sabdariffa (OHs, n=8), obeso + entrenamiento continuo aeróbico + Hibiscus Sabdariffa (OEAHs, n=8). Se administró extracto de Hibiscus Sabdariffa durante 60 días a una dosis de 150 mg / kg de peso corporal. Se realizó una prueba de esfuerzo progresivo máximo (PEPM) en una cinta rodante al principio y al final del estudio. Las variables analizadas fueron: velocidad máxima Vmáx, tiempo y distancia recorrida. El nivel de lactato se midió inmediatamente después de la PEPM. La capacidad funcional se evaluó mediante el índice de distancia / adiposidad. Se empleó el método ANOVA con post hoc de Bonferroni y las pruebas de correlación de Pearson, a un nivel de significancia del 5%. Resultados Después de ambos tipos de entrenamiento, el entrenamiento continuo a intensidad moderada y el entrenamiento de intervalos de alta intensidad realizados en cinta rodante, las ratas presentaron disminución del peso corporal final, aumento de peso e índice de adiposidad, así como aumentaron la Vmax, el tiempo y la distancia recorrida en la PEPM, y mejoraron la capacidad funcional. La suplementación con Hs disminuyó el índice de adiposidad en ratas eutróficas y obesas. El Hibiscus asociado al entrenamiento aeróbico redujo el peso corporal final y aumentó la capacidad funcional. Conclusión La suplementación con Hs redujo el índice de adiposidad en ratas eutróficas y obesas y aumentó la capacidad funcional de ratas obesas entrenadas. Nivel de Evidencia III; Estudios Terapéuticos - Investigación de Resultados. Estudio de caso - control.

RESUMO Introdução O Hibiscus Sabdariffa (Hs) tem sido amplamente utilizado para emagrecimento e no combate às comorbidades associadas à obesidade. Objetivos Avaliar os efeitos do Hs e do treinamento físico sobre a capacidade funcional de ratos eutróficos e obesos. Métodos Ratos Wistar foram distribuídos em oito grupos experimentais: Controle (C, n = 8), Hibiscus Sabdariffa (Hs, n = 8), treinamento intervalado de alta intensidade (TI, n = 8), treinamento intervalado de alta intensidade + Hibiscus Sabdariffa (TIHs, n = 8), obeso (O, n = 8), obeso + treinamento contínuo aeróbico (OTA, n = 8), obeso+ Hibiscus Sabdariffa (OHs, n = 8), obeso + treinamento contínuo aeróbico + Hibiscus Sabdariffa (OTAHs, n = 8). O extrato de Hibiscus Sabdariffa foi administrado por 60 dias na dose de 150 mg/kg de peso corporal. Foi realizado teste de esforço progressivo máximo (TEPM) em esteira no início e no final do estudo. As variáveis analisadas foram: velocidade máxima (Vmáx), tempo e distância percorrida. O lactato foi mensurado imediatamente depois do TEMP. A capacidade funcional foi avaliada pela distância/índice de adiposidade. Empregou-se ANOVA com post hoc de Bonferroni e correlação de Pearson, adotando-se o nível de significância de 5%. Resultados Depois de ambos os tipos de treinamento, o contínuo em moderada intensidade e o intervalado de alta intensidade realizados em esteira, reduziram o peso corporal final, o ganho de peso e o índice de adiposidade, bem como aumentaram a Vmáx, tempo e distância percorrida no TEPM, além de melhora da capacidade funcional. A suplementação de Hs diminuiu o índice de adiposidade nos ratos eutróficos e obesos. O Hs associado ao treinamento aeróbico reduziu o peso corporal final e aumentou a capacidade funcional. Conclusão A suplementação de Hs promoveu redução no índice de adiposidade em ratos eutróficos e obesos e aumentou a capacidade funcional de ratos obesos treinados. Nível de evidência III; Estudos Terapêuticos - Investigação de Resultados. Estudo caso controle .

"Louco sim, drogado não": o imaginário de profissionais da saúde mental / "Crazies over junkies": The collective imagination of mental health professionals

Considerando que as práticas clínicas se baseiam tanto em conhecimentos científicos como em crenças e valores nem sempre conscientes, este estudo objetiva investigar o imaginário coletivo de profissionais de saúde mental sobre o paciente psiquiátrico, na perspectiva da psicologia psicanalítica concreta. Justifica-se, portanto, desde o interesse em aperfeiçoar a qualidade do atendimento, tendo em vista tanto o benefício dos pacientes, como a melhoria das condições de exercício profissional. A partir de uma entrevista psicológica coletiva, articulada ao redor do uso do Procedimento de Desenhos-Estórias com Tema, abordamos sete profissionais de nível superior que trabalham em equipamento de saúde mental. A consideração do material permitiu a produção interpretativa de dois campos de sentido afetivo-emocional: "Sofredores psicóticos" e "Impostores dependentes". O quadro geral apresenta a coexistência de visões solidárias e éticas diante do psicótico com visões preconceituosas e hostis em relação ao dependente químico. Esse contraste se baseia sobretudo na dificuldade em perceber que a base motivacional do uso da droga seria o sofrimento emocional. Como um todo, esse cenário permite pensar que a reforma psiquiátrica gerou transformações que promovem acolhimento, mas que ainda permanecem estigmas a serem superados.

Considering that clinical practices are based both on scientific knowledge and on beliefs and values that are not always conscious, this study aims to investigate the collective imagination of mental health professionals about the psychiatric patient, from the perspective of psychoanalytic concrete psychology. The importance of this study lies on the interest in improving the quality of care, considering both the benefit of patients and the improvement of professional practice conditions. Based on a collective psychological interview, articulated around the use of the Thematic Story-Drawing Procedure, we approached seven higher education professionals who work in mental health service. Consideration of the material allowed the interpretative production of two affective-emotional fields of meaning: "Psychotic sufferers" and "Dependent impostors". The overall picture shows the coexistence of sympathetic and ethical views toward the mentally psychotic with prejudiced and hostile views toward the drug-dependent. This contrast is mainly based on the difficulty in realizing that the motivational basis for drug use would be emotional suffering. As a whole, this scenario allows us to conclude that the psychiatric reform has brought about transformations that promote acceptance, but that stigmas to be overcome still remain.

Saúde, reprodução e sexualidade nos tempos da COVID-19: memórias incorporadas das mulheres no Brasil / Health, reproduction and sexuality in times of COVID-19: embodied memories of women in Brazil / Salud, reproducción y sexualidad en los tiempos de COVID-19: memorias encarnadas de las mujeres en Brasil

Objetivo: compreender como a pandemia de COVID-19 afetou a vida e a saúde das mulheres, com ênfase nos aspectos da saúde sexual e reprodutiva, e refletir sobre os direitos sexuais e reprodutivos e a justiça reprodutiva no contexto da crise sanitária. Metodologia: utilizou-se questionário online com 113 perguntas objetivas e uma questão aberta para comentários. De 8.313 mulheres que responderam ao questionário, 1.838 relataram suas vivências durante a pandemia na questão aberta. Esse material passou por técnicas de análise narrativa e temática e de construção de memória. Resultados: evidenciou-se a ampliação das dificuldades de acesso a serviços de saúde, em especial de saúde sexual e reprodutiva; o aprofundamento das iniquidades na divisão sexual do trabalho, com sobrecarga de trabalho doméstico e profissional; a insegurança econômica; o tensionamentos das relações afetivo-sexuais e maior exposição à violência; e importantes repercussões na saúde psicoemocional. Todos esses aspectos afetaram as experiências de saúde e adoecimento; a vida sexual; e os planos e experiências reprodutivas nos primeiros anos de pandemia. Conclusão: no Brasil, na sobreposição da emergência sanitária com a crise democrática de direitos, fatos sociais e fatos fisiológicos se misturam e se totalizam na experiência histórica e material do corpo sexual e reprodutivo das mulheres, seguindo as linhas de força das precariedades e injustiças de gênero, de raça e de classe. Os relatos das mulheres contribuem para a construção de uma memória coletiva ­não necessariamente unívoca e linear ­da pandemia. Memórias que podem não apenas ilustrar o momento presente, como contribuir para o entendimento e enfrentamento de crises semelhantes futuras.

Objective: this study seeks to comprehend the impact of the COVID-19 pandemic on women's lives and health, with a particular focus on sexual and reproductive health, andto reflect on sexual and reproductive rights and reproductive justice within the context of the health crisis.Methods:employing an online questionnaire featuring 113 objective questions and one open-ended question for free comments, the study gathered responses from 8,313 women. Out of these, 1,838 utilized the open question to articulate their experiences during the pandemic. The collected material underwent analysis using narrative and thematic approaches, along with memory construction techniques.Results:the findings indicate heightened challenges in accessing health services, particularly for sexual and reproductive health. The pandemic deepened inequities in the sexual division of labor, leading to increased domestic and professional workloads, economic insecurity, elevated tensions in affective-sexual relationships, greater exposure to violence, and notable repercussions on psycho-emotional health. These factors collectively influenced women's health/illness experiences, sexual lives, and reproductive plans during the initial years of the pandemic. Conclusion: the intersection of the health crisis with a democratic crisis in rights has intertwined social and physiological factors into the historical and material experiences of women's sexual and reproductive bodies. These experiences follow the trajectories of gender, race, and class-based precariousness and injustices. Women's accounts contribute to the construction of a collective memory of the pandemic that is not necessarily uniform or linear. Beyond illustrating the present moment, these memories aid in understanding and addressing similar crises in the future.

Objetivo: comprender cómo la pandemia de COVID-19 afectó la vida y la salud de las mujeres, con énfasis en aspectos de salud sexual y reproductiva y reflexionar sobre los derechos sexuales y reproductivos y la justicia reproductiva, en el contexto de la crisis sanitaria. Metodología:se utilizó un cuestionario online con 113 preguntas objetivas y una pregunta abierta para comentarios libres al final. De 8.313 mujeres que respondieron el cuestionario, 1.838 relataron sus experiencias durante la pandemia, en este espacio abierto. Este material fue analizado mediante técnicas análisis de narrativa y temática y de construcción de memoria. Resultados: hubo aumento de las dificultades para acceder a los servicios de salud, especialmente de salud sexual y reproductiva, profundización de las inequidades en la división sexual del trabajo, con sobrecarga de trabajo doméstico y profesional, inseguridad económica, tensiones en las relaciones afectivo-sexuales y mayor exposición. a la violencia, e importantes repercusiones en la salud psicoemocional. Todos estos aspectos afectaron las experiencias de salud/enfermedad, la vida sexual, los planes y experiencias reproductivas, en los primeros años de la pandemia. Conclusión: en Brasil, en el solapamiento de la crisis sanitaria con la crisis democrática y de derechos, hechos sociales y hechos fisiológicos se mezclan y totalizan en la experiencia histórica y material de los cuerpos sexuales y reproductivos de las mujeres, siguiendo las líneas de fuerza de la precariedad y las injusticias. de género, raza y clase. Las narrativas de las mujeres contribuyen a la construcción de una memoria colectiva ­no necesariamente unívoca y lineal ­ de la pandemia. Memorias que no sólo pueden ilustrar el momento presente, sino que también contribuyen a comprender y afrontar crisis futuras similares.

Infertilidade, justiça reprodutiva e pandemia de COVID-19: reflexões sobre acesso e barreiras / Infertility, reproductive justice and the COVID-19 pandemic: reflections on access and barriers / Infertilidad, justicia reproductiva y la pandemia de COVID-19: reflexiones sobre acceso y barreras

Objetivo: refletir sobre o acesso a serviços de saúde para infertilidade e reprodução humana assistida durante o período da pandemia de COVID-19, na perspectiva da justiça reprodutiva. Metodologia: utilizou-se dados do inquérito online da pesquisa Pandemia de COVID-19e práticas reprodutivas de mulheres no Brasil, que obteve 8.313 respostas de mulheres residentes em todas as regiões do país, de 18 anos ou mais. O questionário autoaplicável circulou entre julho e outubro de 2021, contendo questões fechadas e abertas. A análise descritiva das respostas objetivas de 242 mulheres que referiram buscar atendimento para infertilidade contou com o cálculo de frequências simples das variáveis. Já os textos escritos nos espaços abertos do questionário foram submetidos à análise temática. Resultados: o estudo verificou a existência de barreiras institucionais e não institucionais para os cuidados da infertilidade, ambas incrementadas pela pandemia. Conclusão: recomenda-se a efetivação de política pública que garanta acesso pleno a todas as pessoas, haja vista que o tratamento para infertilidade e reprodução assistida tende a se restringir a mulheres cisgênero, de camadas médias e altas, mais escolarizadas e majoritariamente brancas.

Objective: to critically examine access to health services for infertility and assisted human reproduction during the COVID-19 pandemic, emphasizing the perspective of reproductive justice. Methods: data for analysis were derived from the online survey titled COVID-19 Pandemic and Women's Reproductive Practices in Brazil, garnering 8,313 responses from women aged 18 years or older residing in all regions of the country. The self-administered questionnaire circulated from July to October 2021 and comprised both closed and open-ended questions. Descriptive analysis of the objective responses obtained from 242 women actively seeking infertility care involved the calculation of simple frequencies for relevant variables. Responses provided in the open-ended sections of the questionnaire underwent thematic analysis. Results: revealed the presence of both institutional and non-institutional barriers to infertility care, with a notable exacerbation during the pandemic. Conclusion: given that infertility and assisted reproduction treatment predominantly cater to cisgender women from middle and upper socio-economic strata, characterized by higher education levels and mostly white, there is a compelling need for the implementation of public policies that ensure equitable access for all individuals.

Objetivo: reflexionar sobre el acceso a los servicios de salud para la infertilidad y la reproducción humana asistida durante el período de la pandemia de COVID-19, desde la perspectiva de la justicia reproductiva. Metodología: se utilizaron datos de la encuesta en línea de la Pandemia de COVID-19y prácticas reproductivas de las mujeres en Brasil, que obtuvo 8.313 respuestas de mujeres residentes en todas las regiones del país, con edad igual o superior a 18 años. El cuestionario autoaplicado circuló entre julio y octubre de 2021, conteniendo preguntas cerradas y abiertas. El análisis descriptivo de las respuestas objetivas de 242 mujeres que relataron buscar atención por infertilidad implicó el cálculo de frecuencias simples de las variables. Los textos escritos en los espacios abiertos del cuestionario fueron sometidos a análisis temático. Resultados:el estudio verificó la existencia de barreras institucionales y no institucionales para la atención de la infertilidad, ambas aumentadas por la pandemia. Conclusión: se recomiendala implementación de una política pública que garantice el pleno acceso a todas las personas, dado que el tratamiento de la infertilidad y reproducción asistida tiende a estar restringido a mujeres cisgénero de clase media y alta, con mayor educación y en su mayoría blancas.

Segurança do paciente na administração de medicações parenterais: conhecimento de acadêmicos de Enfermagem / Seguridad del paciente en la administración de medicamentos parenterales: conocimiento de los estudiantes de enfermería / Patient safety in the administration of parenteral medications: knowledge of nursin students

Objetivo: avaliar o conhecimento de acadêmicos de enfermagem sobre a administração de medicações parenterais. Método: estudo descritivo de abordagem quantitativa. Desenvolvido em duas instituições de ensino superior, no curso de enfermagem. A pesquisa foi feita através de uma entrevista com questionário estruturado, contendo questões divididas por via de administração parenteral. Resultados: na via intradérmica, 48,1% erraram sobre a indicação e 57,4% erraram sobre o ângulo de introdução da agulha. Na via intramuscular, 66,7% erraram sobre os locais de aplicação e 57,4% acertaram sobre o ângulo de punção em 90° graus. Na via subcutânea, 55,6% erraram sobre a dose indicada e 85,2% erraram sobre os locais de aplicação. Na via endovenosa, 87,0% acertaram sobre a definição da via e 90,7% acertaram sobre a finalidade da via. Conclusão: os acadêmicos de enfermagem possuem conhecimento insuficiente sobre as medicações parenterais, denotando a necessidade de englobar mais conhecimento e evitando eventos adversos.(AU)

Objective: to verify the knowledge of nursing students about the administration of parenteral medications. Method: descriptive study of quantitative approach. Developed in two higher education institutions, in the nursing course, through an interview with a structured questionnaire, containing questions divided by parenteral administration. Results: in the intradermal route, 48.1% were wrong about the route indication and 57.4% were wrong about the needle introduction angle. In the intramuscular route, 66.7% were wrong about the application sites and 57.4% were right about the puncture angle at 90 degrees. In the subcutaneous route, 55.6% were wrong about the indicated dose and 85.2% were wrong about the application sites. In the intravenous route, 87.0% were right about the definition of the route and 90.7% were right about the purpose of the route. Conclusion: nursing students have insufficient knowledge about parenteral medications, denoting the need to encompass more knowledge and avoid adverse events.(AU)

Objetivo: verificar el conocimiento de los estudiantes de enfermería sobre la administración de medicamentos parenterales. Método: estudio cuantitativo desarrollado en curso de enfermería de dos instituciones de educación superior, con cuestionario estructurado con preguntas por tipo de administración parenteral. Resultados: en la vía intradérmica el 48,1% se equivocó en la indicación y el 57,4% en el ángulo de introducción de la aguja. En la vía intramuscular el 66,7% se equivocó en los sitios de aplicación y el 57,4% acertó en el ángulo de punción. En la vía subcutánea, el 55,6% se equivocó en la dosis indicada y el 85,2% en los sitios de aplicación. En la vía intravenosa, el 87,0% acertó en la definición y el 90,7% acertó en la finalidad. Conclusión: los estudiantes de enfermería tienen conocimientos insuficientes sobre medicamentos parenterales, denotando la necesidad de abarcar más conocimientos y evitar eventos adversos.(AU)

Prueba Xpert® MTB/RIF para el diagnóstico de Tuberculosis en el Instituto Médico La Floresta

La necesidad de un diagnóstico rápido, sensible y específico para tuberculosis es apremiante; se estiman 4 000 muertes cada día y aproximadamente 28 000 personas se contagian de esta enfermedad. La prueba Xpert®MTB/RIF consiste en un ensayo de diagnóstico in vitro de reacción en cadena de la polimerasa (PCR) en tiempo real automatizada, semicuantitativa, que en tan solo dos horas, permite detectar el ácido desoxirribonucleico (ADN) del complejo Mycobacterium tuberculosis (MTB) y mutaciones asociadas a la resistencia a rifampicina. Objetivo: Describir la experiencia del ensayo Xpert®MTB/ RIF y su valor diagnóstico en Dpto. de Microbiología del Instituto Médico La Floresta, desde abril 2012 hasta abril 2021. Métodos: Estudio descriptivo de muestras respiratorias y de otras procedencias, de pacientes con sospecha de tuberculosis, ensayadas por PCR a través del Xpert®MTB/RIF. Adicionalmente se realizó Ziehl-Neelsen y cultivo por el método de Ogawa Kudoh modificado, dependiendo del volumen de muestra recibida. Resultados: De 618 PCR realizadas, 58 muestras fueron positivas (9,4 %), 56 correspondieron a adultos y 2 a niños, 81 % se clasificaron como tuberculosis pulmonar y 19 % como extrapulmonar. A 37 se les realizó cultivo, de las cuales 10 no desarrollaron crecimiento, y a 33 adicionalmente Ziehl-Neelsen, de las cuales 12 presentaron baciloscopias negativas. En cinco de las muestras se detectó resistencia a rifampicina. Conclusiones: A través de la prueba Xpert®MTB/RIF fue posible detectar MTB en aquellas con baciloscopias negativas, en las que no desarrollaron crecimiento en el cultivo y permitió la rápida instauración de tratamiento en la tuberculosis multirresistente.

The rapid, sensitive, and specific diagnosis for tuberculosis is urgent; 4 000 deaths are estimated every day and approximately 28 000 people are infected with this disease. The Xpert®MTB/RIF test consists of an automated, semi-quantitative real-time polymerase chain reaction (PCR) in vitro diagnostic assay that, in just two hours, allows the detection of Mycobacterium tuberculosis complex (MTB) DNA and mutations associated with resistance to rifampicin. Objective: To describe the experience of the Xpert®MTB/RIF assay and its diagnostic value in the Department of Microbiology of the La Floresta Medical Institute, from April 2012 to April 2021. Methods: Descriptive study of respiratory samples and other sources, from patients with suspected of tuberculosis, assayed by PCR through Xpert®MTB/RIF. Additionally, Ziehl-Neelsen and culture were performed by the modified Ogawa Kudoh method, depending on the volume of sample received. Results: Of 618 PCR performed, 58 samples were positive (9.4 %), 56 corresponded to adults and 2 to children, 81 % were classified as pulmonary tuberculosis and 19 % as extrapulmonary. Culture was performed on 37, of which 10 did not develop growth, and on 33 additionally Ziehl-Neelsen, of which 12 presented negative bacilloscopy. Rifampicin resistance was detected in five of the samples. Conclusions: Through the Xpert®MTB/RIF test, it was possible to detect MTB in those with negative bacilloscopy, in which they did not develop growth in the culture and allowed the rapid establishment of treatment in multidrug-resistant tuberculosis.

Considerações sobre a comunicação do diagnóstico de câncer infantil: posição da criança, lugar dos pais, efeitos do discurso médico e possibilidades de intervenção do discurso do psicanalista / Considerations on communicating the diagnosis of childhood cancer: the child's position, the parent's place, effects of the medical discourse, and the intervention possibilities of the discourse of the psychoanalyst / Considérations à propos de la communication de la diagnose de cancer de l'enfant: la position de l'enfant, la place des parents, les effets du discours médical et le possibilités d'intervention du discours de l'analyste / Consideraciones sobre la comunicación del diagnóstico de cáncer infantil: posición del niño, el lugar de los padres, los efectos del discurso médico y las posibilidades de intervención del discurso del analista

O presente trabalho tem como objetivo investigar o processo de comunicação do diagnóstico de câncer infantil, levando em consideração a posição da criança, o lugar dos pais, os efeitos do discurso médico e as possibilidades de intervenção do discurso do analista. A partir da discussão de três casos clínicos, percebeu-se que a escuta analítica pôde auxiliar a equipe diante do conflito bioético cada vez mais presente na oncopediatria: deve a criança saber a verdade ou deve ser ela protegida da verdade? O discurso do psicanalista, estando advertido da impossibilidade de tudo dizer a respeito da verdade, consegue de antemão se desvencilhar desses imperativos e operar proporcionando um giro discursivo que produz como efeito a entrada em cena do saber singular do sujeito- -criança em detrimento de um saber universitário de ordem protocolar.

This paper investigates the process of communicating the diagnosis of childhood cancer considering the child's position, the parents' place, the effects of the medical discourse, and the intervention possibilities of the discourse of the psychoanalyst. Based on three clinical cases, the discussion points out how the analytic listening helped the team faced with a bioethical conflict increasingly present in pediatric oncology: should the child know the truth, or should they be protected from it? Being aware of the impossibility of telling the whole truth, the analyst can disentangle themself in advance from these imperatives and provide a discursive turn which highlights the child subject's singular knowledge in detriment of the formal academic knowledge.

La présente recherche vise à enquêter sur le processus de communication du diagnostic de cancer de l'enfant, tenant compte de la position de l'enfant, de la place des parents, des effets du discours médical et des possibilités d'intervention du discours de l'analyste. À partir de la discussion de trois cas cliniques, il a été possible de percevoir que l'écoute analytique a pu aider l'équipe face au conflit bioéthique de plus en plus présent en oncologie pédiatrique: l'enfant doit-il savoir la vérité ou doit-il être protégé de la vérité? Le discours du psychanalyste, prévenu de l'impossibilité de tout dire la vérité, parvient d'avance à se débarrasser de ces impératifs et à opérer en pourvoyant une tournure discursive qui produit l'effet de mise en scène du savoir singulier du sujet enfant au détriment du savoir de l'université de l'ordre protocolaire.

Este trabajo tiene como objetivo investigar el proceso de comunicación del diagnóstico de cáncer infantil, teniendo en cuenta la posición del niño, el lugar de los padres, los efectos del discurso médico y las posibilidades de intervención del discurso del analista. A partir de la discusión de tres casos clínicos, se constató que la escucha analítica ha podido ayudar al equipo ante el conflicto bioético cada vez más presente en la oncología pediátrica: ¿El niño debe conocer la verdad o debe estar protegido de la verdad? El discurso del analista, advertido de la imposibilidad de decir toda la verdad, logra de antemano deshacerse de estos imperativos y proporcionar un giro discursivo que produce el efecto de la entrada en escena del saber singular del sujeto infantil en detrimento del saber de la universidad de orden protocolario.