Manipulation of unfolded protein response by zoonotic vaccinia virus strains Guarani P1 and Passatempo.

The replicative success of vaccinia virus (VACV) depends on its ability to subvert host functions. Poxviruses multiplication and maturation are closely associated with the endoplasmic reticulum (ER) and its membranes. This organelle responds to disturbances caused by the accumulation of misfolded proteins, leading to processing of these proteins or even programmed cell death through the unfolded protein response (UPR). Several studies show that different viruses can activate UPR pathway components and negatively modulate others. Here, we investigate the effects of infections by zoonotic VACV strains from Brazil, Guarani P1 virus (GP1V) and Passatempo virus (PSTV), in the activation of UPR pathway sensors. We observed translocation of ATF6 to the nucleus as well as transcriptional increase after GP1V, PSTV, and reference strain Western Reserve (WR) infection. XBP1 processing appears to be negatively modulated after VACV infection; however, inhibition of the inositol-requiring enzyme 1 (IRE1) kinase domain led to a reduction in plaque sizes for these viruses. The absence of PKR-like endoplasmic reticulum kinase (PERK) has an impact on the plaque phenotype of GP1V, PSTV viruses, as well as for the prototypical strain WR. These results indicate that the VACV manipulates the three arms of the UPR path differently to ensure replicative success.

Vaccinia virus induces endoplasmic reticulum stress and activates unfolded protein responses through the ATF6α transcription factor.

BACKGROUND: Cell responses to different stress inducers are efficient mechanisms that prevent and fight the accumulation of harmful macromolecules in the cells and also reinforce the defenses of the host against pathogens. Vaccinia virus (VACV) is an enveloped, DNA virus, belonging to the Poxviridae family. Members of this family have evolved numerous strategies to manipulate host responses to stress controlling cell survival and enhancing their replicative success. In this study, we investigated the activation of the response signaling to malformed proteins (UPR) by the VACV virulent strain-Western Reserve (WR)-or the non-virulent strain-Modified Vaccinia Ankara (MVA). METHODS: Through RT-PCR RFLP and qPCR assays, we detected negative regulation of XBP1 mRNA processing in VACV-infected cells. On the other hand, through assays of reporter genes for the ATF6 component, we observed its translocation to the nucleus of infected cells and a robust increase in its transcriptional activity, which seems to be important for virus replication. WR strain single-cycle viral multiplication curves in ATF6α-knockout MEFs showed reduced viral yield. RESULTS: We observed that VACV WR and MVA strains modulate the UPR pathway, triggering the expression of endoplasmic reticulum chaperones through ATF6α signaling while preventing IRE1α-XBP1 activation. CONCLUSIONS: The ATF6α sensor is robustly activated during infection while the IRE1α-XBP1 branch is down-regulated.

Quantification of SARS-CoV-2 in wastewater samples from hospitals treating COVID-19 patients during the first wave of the pandemic in Brazil.

The COVID-19 pandemic has caused a global health crisis, and wastewater-based epidemiology (WBE) has emerged as an important tool to assist public health decision-making. Recent studies have shown that the SARS-CoV-2 RNA concentration in wastewater samples is a reliable indicator of the severity of the pandemic for large populations. However, few studies have established a strong correlation between the number of infected people and the viral concentration in wastewater due to variations in viral shedding over time, viral decay, infiltration, and inflow. Herein we present the relationship between the number of COVID-19-positive patients and the viral concentration in wastewater samples from three different hospitals (A, B, and C) in the city of Belo Horizonte, Minas Gerais, Brazil. A positive and strong correlation between wastewater SARS-CoV-2 concentration and the number of confirmed cases was observed for Hospital B for both regions of the N gene (R = 0.89 and 0.77 for N1 and N2, respectively), while samples from Hospitals A and C showed low and moderate correlations, respectively. Even though the effects of viral decay and infiltration were minimized in our study, the variability of viral shedding throughout the infection period and feces dilution due to water usage for different activities in the hospitals could have affected the viral concentrations. These effects were prominent in Hospital A, which had the smallest sewershed population size, and where no correlation between the number of defecations from COVID-19 patients and viral concentration in wastewater was observed. Although we could not determine trends in the number of infected patients through SARS-CoV-2 concentrations in hospitals' wastewater samples, our results suggest that wastewater monitoring can be efficient for the detection of infected individuals at a local level, complementing clinical data.

Monitoramento do esgoto como ferramenta de vigilância epidemiológica para controle da COVID-19: estudo de caso na cidade de Belo Horizonte / Sewage monitoring as a surveillance epidemiological tool for COVID-19 control: a case study in the city of Belo Horizonte

RESUMO A recente detecção de material genético (RNA) do novo coronavírus em amostras de fezes e no esgoto aponta para a possibilidade de se identificar a circulação do vírus e até mesmo estimar o número de pessoas infectadas em determinada região pelo monitoramento sistemático do esgoto, configurando-se em importante ferramenta epidemiológica de testagem massiva indireta, incluindo portadores sintomáticos e assintomáticos. Nesse sentido, concebeu-se um projeto para a detecção e a quantificação do novo coronavírus em amostras de esgoto coletadas em 15 sub-bacias de esgotamento sanitário dos ribeirões Arrudas e Onça, visando entender a dinâmica de circulação e a prevalência do vírus nas regiões investigadas. Tais sub-bacias esgotam os efluentes gerados por uma população da ordem de 1,5 milhão de pessoas no município de Belo Horizonte e parte de Contagem. O plano de amostragem contemplou 17 pontos (15 sub-bacias + afluente às 2 estações de tratamento de esgoto) de monitoramento semanal, com coletas compostas durante todo o período da manhã. A detecção e a quantificação do RNA viral efetuaram-se em laboratório por meio de ensaios de RT-qPCR. Os resultados obtidos em quatro semanas de monitoramento (semanas epidemiológicas 21 a 24) mostraram um incremento da ocorrência do vírus, atingindo 100% das regiões investigadas na semana epidemiológica 24. A estimativa da população infectada pelo novo coronavírus pelo monitoramento do esgoto em Belo Horizonte apresentou tendência de crescimento exponencial, sendo até 20 vezes maior do que o número de casos confirmados acumulados. Quanto à circulação do vírus, as concentrações do RNA viral têm se mostrado bastante variáveis nas regiões monitoradas, com maiores porcentagens de população infectada estimada ao norte e nordeste da capital mineira.

ABSTRACT The recent detection of SARS-CoV-2 RNA in stool and sewage samples highlights the possibility of mapping the circulation of the virus and even estimating the number of infected people through the systematic monitoring of sewage in a specific region. Therefore, this is an important epidemiological tool for large-scale indirect testing, including symptomatic and asymptomatic carriers. This project was conceived for the detection and quantification of the SARS-CoV-2 in sewage samples collected in 15 watersheds of the Arrudas and Onça streams, aiming to understand the dynamics of spread and the prevalence of the virus in these regions/watersheds. These sub-basins exhaust the effluents generated by a population of approximately 1.5 million people in the municipality of Belo Horizonte and part of Contagem. Weekly composite samples were collected during the morning periods in seventeen monitoring points (15 water sheds + influent to 2 sewage treatment plants). RNA detection and quantification were performed in the laboratory using RT-qPCR. The results obtained in four weeks of monitoring (epidemiological weeks 21 to 24) showed an increase in the occurrence of the virus, reaching 100% of the monitored regions investigated in epidemiological week 24. The infected population, estimated by sewage monitoring in Belo Horizonte, showed exponential growth, being up to 20 times higher than those of accumulated confirmed cases. As for the dynamics of virus spread, RNA concentrations have shown to be quite variable in the monitored regions with higher percentages of the estimated infected population in the northern and north-eastern portions of Belo Horizonte.

Assessing spatial distribution of COVID-19 prevalence in Brazil using decentralised sewage monitoring.

Brazil has become one of the epicentres of the COVID-19 pandemic, with cases heavily concentrated in large cities. Testing data is extremely limited and unreliable, which restricts health authorities' ability to deal with the pandemic. Given the stark demographic, social and economic heterogeneities within Brazilian cities, it is important to identify hotspots so that the limited resources available can have the greatest impact. This study shows that decentralised monitoring of SARS-CoV-2 RNA in sewage can be used to assess the distribution of COVID-19 prevalence in the city. The methodology developed in this study allowed the identification of hotspots by comprehensively monitoring sewers distributed through Belo Horizonte, Brazil's third largest city. Our results show that the most vulnerable neighbourhoods in the city were the hardest hit by the pandemic, indicating that, for many Brazilians, the situation is much worse than reported by official figures.

Judicialização e subpolítica médica / Judicialization and Medical Sub-Politics

Resumo O objetivo deste artigo é discutir o fenômeno da judicialização e a subpolítica médica na contemporaneidade. A judicialização é identificada como o envolvimento do Poder Judiciário na esfera política na tutela de interesses individuais, como uma interferência no planejamento das políticas públicas. As decisões judiciais acabariam definindo políticas, à margem do modelo democrático da modernidade industrial. Diversas pesquisas defendem que o Judiciário tende a atender estas demandas, evocadas sob o fundamento da garantia da saúde e vida, abalizadas pelas normas de direito constitucional à saúde e profissionais médicos. Mas a judicialização pode ser também caracterizada como eco de um processo reflexivo da modernidade, no qual direitos fundamentais estabelecidos potencializam uma nova cultura política. Os cidadãos utilizam meios não tradicionais de intervenção e controle público e judicial, buscando defender seus interesses e direitos. O próprio fundamento fático das demandas é construído reflexivamente pelo saber médico, impermeável a formas tradicionais de controle externo. Isto gera uma judicialização pautada pela medicina e favorece a expansão do campo de atuação médica, e do mercado e pesquisa para a indústria médico-hospitalar e farmacêutica. Tanto sociedade como Estado acabam sendo obrigados a recorrer a normas e conhecimentos medicinalmente constituídos e monopolizados, em uma estratégia reflexiva de mercado.

Abstract The phenomenon of judicialization and the growing litigation in health demands have gained increasing importance - not only academic but also practical. In Brazil, this is usually seen by the academic criticism as the involvement of the Judiciary in the political sphere and its activity, as an interference in the planning of public policies. The judicial decisions would end up by defining policies, thus diverging from the democratic model of industrial modernity based upon the separation of Powers. Various research projects have argued that the Judiciary tends to attend to these demands, which invoke as their legal foundation the right to health, as defined by the constitutional norms, and based upon medical reports. This article discusses judicialization and medical sub-politics in the contemporary scene. In the light of contemporary social changes, judicialization can also be characterized as an echo of a reflexive process of modernity, in which established fundamental rights point to a new political culture. Citizens use non-traditional means of intervention and public and judicial control to defend their interests and rights. The very factual foundation of the demands is constructed reflectively by medical knowledge, impermeable to the traditional forms of external control. This generates a judicialization controlled by medicine and favors the expansion of the field of, activity, market and research for the medical, hospital and pharmaceutical industries. Thus, judicialization can attend to the more characteristically techno-scientific and economic interests than to democratic ones. Both society and the State end up by being obliged to have recourse to norms and knowledge medically constituted and monopolized, in a reflective market strategy. It is important to rethink judicialization in the light of the intensely political activity of medicine, thus opening up new prospects for the debate and critical understanding of this activity, its consequences, purposes and reflectively constructed risks.

Tupanvirus-infected amoebas are induced to aggregate with uninfected cells promoting viral dissemination.

The discovery of giant viruses in the last years has fascinated the scientific community due to virus particles size and genome complexity. Among such fantastic discoveries, we have recently described tupanviruses, which particles present a long tail, and has a genome that contains the most complete set of translation-related genes ever reported in the known virosphere. Here we describe a new kind of virus-host interaction involving tupanvirus. We observed that tupanvirus-infected amoebas were induced to aggregate with uninfected cells, promoting viral dissemination and forming giant host cell bunches. Even after mechanical breakdown of bunches, amoebas reaggregated within a few minutes. This remarkable interaction between infected and uninfected cells seems to be promoted by the expression of a mannose receptor gene. Our investigations demonstrate that the pre-treatment of amoebas with free mannose inhibits the formation of bunches, in a concentration-dependent manner, suggesting that amoebal-bunch formation correlates with mannose receptor gene expression. Finally, our data suggest that bunch-forming cells are able to interact with uninfected cells promoting the dissemination and increase of tupanvirus progeny.

Anti-inflammatory effect of two Lactobacillus strains during infection with Gardnerella vaginalis and Candida albicans in a HeLa cell culture model.

Lactobacilli are the dominant bacteria of the vaginal tract of healthy women and they play a major role in the maintenance of mucosal homeostasis, preventing genital infections, such as bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). It is now known that one mechanism of this protection is the influence that lactobacilli can exert on host immune responses. In this context, we evaluated two Lactobacillus strains (L. plantarum 59 and L. fermentum 137) for their immunomodulatory properties in response to Gardnerella vaginalis (BV) or Candida albicans (VVC) infections in a HeLa cell infection model. G. vaginalis and C. albicans triggered the secretion of pro-inflammatory cytokines (TNF-α, IL-1ß, IL-6 and IL-8) and the activation of NF-κB in HeLa cells, in contrast to L. plantarum 59 and L. fermentum 137. Treatments with the Lactobacillus strains or their cell-free supernatants before (pre-treatment) or after (post-treatment) the challenge with the pathogens resulted in decreased secretion of pro-inflammatory cytokines and decreased activation of NF-κB. The treatments with Lactobacillus strains not only decreased the secretion of IL-8, but also its expression, as confirmed by gene reporter luciferase assay, suggesting transcription-level control by lactobacilli. In conclusion, L. plantarum 59 and L. fermentum 137 were confirmed to have an anti-inflammatory effect against G. vaginalis and C. albicans and they were able to influence signalling in NF-κB pathway, making them interesting candidates as probiotics for the prevention or treatment of BV and VVC.

Loucura, psiquiatria e sociedade: o campo da saúde mental coletiva e o processo de individualização no Brasil / Madness, psychiatry and society the field of collective mental health and the individualization process in Brazil

Esta Tese tem por objetivo discutir o Campo da Saúde Mental Coletiva e as novas formas sociais contemporâneas, no contexto da modernização reflexiva e do processo de Individualização. Parte da hipótese de que o quadro social em que o Campo se alicerça não corresponde às formas sociais contemporâneas. As novas formas sociais contemporâneas produzem novas formas de subjetividade, novas formas de regulação institucional e de atuação da Psiquiatria, mas o descompasso entre o Campo e a sociedade está na base de sua incapacidade para lidar com estas novas formas de sofrimento, regulação e medicalização-psiquiatrização. Reflexivamente, o Campo acaba reproduzindo e ampliando a medicalização, e contribui para a produção e radicalização das novas formas e riscos que lhes escapam, por sua inépcia para atuar na Contemporaneidade. O processo de modernização reflexiva levou a profundas mudanças socioestruturais na sociedade contemporânea, transformando também o objeto do Campo da Saúde Mental que, contudo, não as reconhece por estar assentado em marcos teóricos moderno-industriais. Para caracterizar o Campo, realizou-se uma análise crítica sistemática de 201 publicações sobre o Campo da Saúde Mental Coletiva, em 02 periódicos científicos nacionais: 105 da revista Saúde em Debate entre 1976 e 2011 e 96 da revista Ciência & Saúde Coletiva entre 1996 e 2011. A partir desta análise, identificamos e discutimos o perfil de autoria das publicações, os referenciais teóricos e principais experiências que influenciaram o Campo, as concepções sobre Psiquiatria e as possibilidades de transformação das relações com a loucura e a sociedade, no contexto da Reforma Psiquiátrica, e as principais categorias conceituais identificadas. Alicerçada nesta discussão, a Tese busca refletir, no marco dos processos de modernização reflexiva e individualização sobre a subjetividade, as dimensões familiar e laboral, e a Psiquiatria. Considerando as importantes contribuições do Campo, indicamos a necessidade de ampliar o seu marco epistemológico e olhar sobre o fenômeno do adoecimento, para incorporar à sua reflexão as novas formas e relações sociais da Contemporaneidade, e a necessidade de ampla e radical politização do Campo

This thesis aims to discuss the Collective Mental Health Field and the new contemporary social forms, in the context of Reflexive Modernization and the Individualization Process. Part of the hypothesis is that the social context in which the Field is based does not correspond to contemporary social forms. The new contemporary social forms produce new forms of subjectivity, new forms of institutional regulation and Psychiatric action, but the mismatch between the Field and Society is the basis of their inability to deal with these new forms of suffering, regulation and medicalization or 'psychiatry-action'. Reflexively, the Field ends up reproducing and expanding the medicalization, and contributes to the production and radicalization of the new forms and risks that escape it, by its ineptitude to act in the Contemporaneity. The Reflexive Modernization process has led to profound socio-structural changes in contemporary society, transforming also the object of the Field of Mental Health, which, however, does not recognize them because it is based on modern-industrial theoretical frameworks. In order to characterize the field, a systematic critical analysis of 201 publications on the field of Collective Mental Health was carried out in 02 national scientific journals: 105 of the journal Saúde em Debate between 1976 and 2011 and 96 of the journal Ciência e Saúde Coletiva between 1996 and 2011. Based on this analysis, we identified and discussed the authorship profile of the publications, the theoretical references and main experiences that influenced the field, the conceptions about Psychiatry and the possibilities of transforming relations with madness and society in the context of the Psychiatric Reformation movements and policies, and the main conceptual categories identified. Based on this discussion, the thesis seeks to reflect, within the framework of the processes of Reflexive Modernization and individualization on subjectivity, the family and work dimensions, and Psychiatry. Considering the important contributions of the Field, we indicate the need to broaden its epistemological framework and look at the phenomenon of mental illness, to incorporate into its reflection the new forms and social relations of Contemporaneity, and the need for a broad and radical politicization of the Field

Amputation risk after the revascularization procedures in sarcoma resections.

OBJECTIVE: The objective of this study is to evaluate the efficacy of vascular reconstructive surgery after resection of bone and soft tissue tumors in extremities and the risk of progression to amputation. METHODS: This is a retrospective, observational data collection from medical records of patients who underwent resection of bone and soft tissue tumors in the period of 2002-2015. Thirteen patients met the inclusion criteria, which evaluated the correlations between certain factors (gender, tumor type, location, reconstruction, revascularization and patency, infection) with amputation in the postoperative period. RESULTS: In this study, of the 13 patients undergoing reconstruction, five (38.46%) evolved to amputation. All patients who progressed to amputation had the following in common: presence of bone sarcoma (p = 0.005), having undergone reconstruction with an orthopedic prosthesis (p = 0.005), lack of vascular patency in the revascularization site in the postoperative period (p = 0.032), and surgical site infection (p = 0.001). None of the patients with soft tissue sarcoma underwent amputation, and the only patient with bone sarcoma who did not undergo amputation had no infection and maintained vascular patency of the graft. CONCLUSION: The occurrence of infection appears to be one of the main risk factors for failure of revascularization, especially in cases of bone sarcoma in which vascular reconstruction is performed with placement of a non-conventional joint prosthesis.

OBJETIVO: O objetivo deste estudo é avaliar a eficácia da cirurgia de reconstrução vascular após ressecção de tumores ósseos e tecidos moles em extremidades e o risco de evolução para amputação. MÉTODOS: Estudo retrospectivo, observacional, de coleta de dados em prontuário médico de pacientes submetidos a ressecção de tumores ósseos e de tecidos moles de 2002 a 2015; 13 pacientes preencheram o critério de inclusão, foram avaliadas as correlações de determinados fatores (gênero, tipo de tumor, localização, reconstrução, revascularização e patência, infecção) com amputação no pós-operatório. RESULTADOS: No presente estudo, dos 13 pacientes submetidos à reconstrução, cinco (38,46%) evoluíram com amputação. Todos os pacientes que evoluíram com amputação tinham em comum o fato de ser portadores de sarcoma ósseo (p = 0,005), ter sido submetidos a reconstrução com prótese ortopédica (p = 0,005) e não apresentar patência vascular no local da revascularização no período pós-operatório (p = 0,032), além de apresentar infecção no local da cirurgia (p = 0,001). Nenhum dos pacientes portadores de sarcoma de partes moles foi submetido à amputação e o único paciente do grupo com sarcoma ósseo que não sofreu amputação não apresentava infecção e mantinha patência vascular no enxerto. CONCLUSÃO: A ocorrência de infecção parece ser um dos principais fatores de risco para a falência da revascularização, especialmente nos casos de sarcoma ósseo em que a reconstrução vascular é feita juntamente com colocação de próteses articulares não convencionais.

Amputation risk after the revascularization procedures in sarcoma resections / Risco de amputação após procedimento de revascularização nas ressecções de sarcoma

ABSTRACT OBJECTIVE: The objective of this study is to evaluate the efficacy of vascular reconstructive surgery after resection of bone and soft tissue tumors in extremities and the risk of progression to amputation. METHODS: This is a retrospective, observational data collection from medical records of patients who underwent resection of bone and soft tissue tumors in the period of 2002-2015. Thirteen patients met the inclusion criteria, which evaluated the correlations between certain factors (gender, tumor type, location, reconstruction, revascularization and patency, infection) with amputation in the postoperative period. RESULTS: In this study, of the 13 patients undergoing reconstruction, five (38.46%) evolved to amputation. All patients who progressed to amputation had the following in common: presence of bone sarcoma (p = 0.005), having undergone reconstruction with an orthopedic prosthesis (p = 0.005), lack of vascular patency in the revascularization site in the postoperative period (p = 0.032), and surgical site infection (p = 0.001). None of the patients with soft tissue sarcoma underwent amputation, and the only patient with bone sarcoma who did not undergo amputation had no infection and maintained vascular patency of the graft. CONCLUSION: The occurrence of infection appears to be one of the main risk factors for failure of revascularization, especially in cases of bone sarcoma in which vascular reconstruction is performed with placement of a non-conventional joint prosthesis.

RESUMO OBJETIVO: O objetivo deste estudo é avaliar a eficácia da cirurgia de reconstrução vascular após ressecção de tumores ósseos e tecidos moles em extremidades e o risco de evolução para amputação. MÉTODOS: Estudo retrospectivo, observacional, de coleta de dados em prontuário médico de pacientes submetidos a ressecção de tumores ósseos e de tecidos moles de 2002 a 2015; 13 pacientes preencheram o critério de inclusão, foram avaliadas as correlações de determinados fatores (gênero, tipo de tumor, localização, reconstrução, revascularização e patência, infecção) com amputação no pós-operatório. RESULTADOS: No presente estudo, dos 13 pacientes submetidos à reconstrução, cinco (38,46%) evoluíram com amputação. Todos os pacientes que evoluíram com amputação tinham em comum o fato de ser portadores de sarcoma ósseo (p = 0,005), ter sido submetidos a reconstrução com prótese ortopédica (p = 0,005) e não apresentar patência vascular no local da revascularização no período pós-operatório (p = 0,032), além de apresentar infecção no local da cirurgia (p = 0,001). Nenhum dos pacientes portadores de sarcoma de partes moles foi submetido à amputação e o único paciente do grupo com sarcoma ósseo que não sofreu amputação não apresentava infecção e mantinha patência vascular no enxerto. CONCLUSÃO: A ocorrência de infecção parece ser um dos principais fatores de risco para a falência da revascularização, especialmente nos casos de sarcoma ósseo em que a reconstrução vascular é feita juntamente com colocação de próteses articulares não convencionais.

HDR brachytherapy decreases proliferation rate and cellular progression of a radioresistant human squamous cell carcinoma in vitro.

PURPOSE: To investigate the effects of high dose rate (HDR) brachytherapy on cellular progression of a radioresistant human squamous cell carcinoma in vitro, based on clinical parameters. MATERIALS AND METHODS: An acrylic platform was designed to attach tissue culture flasks and assure source positioning during irradiation. At exponential phase, A431cells, a human squamous cell carcinoma, were irradiated twice up to 1100 cGy. Cellular proliferation was assessed by Trypan blue exclusion assay and survival fraction was calculated by clonogenic assay. DNA content analysis and cell cycle phases were assessed by flow cytometry and gel electrophoresis, respectively. Cellular death patterns were measured by HOPI double-staining method. RESULTS: Significant decreasing cellular proliferation rate (p < 0.05) as well as reduced survival fraction (p < 0.001) in irradiated cells were observed. Moreover, increased percentage of cells arrested in the G2/M phase (32.3 ± 1.5%) in the irradiated group as compared with untreated cells (8.22 ± 1.2%) was detected. Also, a significant (p < 0.0001) nuclei shrinking in irradiated cells without evidence of necrosis or apoptosis was found. CONCLUSION: HDR brachytherapy led to a decreased proliferation rate and cell survival and also hampered cellular progression to mitosis suggesting that tumor cell death mainly occurred due to mitotic death and G2/M cell cycle arrest.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients.

OBJECTIVES: To evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. METHODS: Twenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. RESULTS: The results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). CONCLUSION: Surgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

OBJETIVO: Avaliar os resultados do tratamento cirúrgico de pacientes com lesão de dedo em martelo com o uso de placa-gancho e parafuso. MÉTODOS: Foram analisados 25 pacientes entre 20 e 35 anos, 19 do sexo masculino e seis do feminino, de maio de 2008 a dezembro de 2012. Os pacientes foram submetidos à avaliação de acordo com os critérios de Crawford e o acompanhamento médio foi de 18 meses. RESULTADOS: Os resultados obtidos foram excelentes em 10 pacientes (40%) e bons em 15 (60%); 21 pacientes (84%) não referiram dor no 18° mês de pós-operatório. Foi verificada ausência de limitação da amplitude de movimento em 14 casos (56%), limitação da extensão em sete (28%) e limitação da flexão em quatro (16%). CONCLUSÃO: O tratamento cirúrgico com redução aberta e fixação interna com placa-gancho e parafuso demonstrou ser uma ótima opção de tratamento nas fraturas em martelo e é considerado um método seguro e eficaz.

Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients / Osteossíntese do dedo em martelo com placa e parafuso: avaliação de 25 pacientes

To evaluate the results from surgical treatment of patients with mallet finger injury using a hook plate and screw. METHODS: Twenty-five patients (19 males and six females) between the ages of 20 and 35 years were analyzed between May 2008 and December 2012. They were evaluated in accordance with Crawford's criteria and the mean follow-up was 18 months. RESULTS: The results from 10 patients (40%) were excellent and from 15 (60%), good. Twenty-one patients (84%) reported no pain, 18 months after the operation. There was no limitation to range of motion in 14 cases (56%), limitation of extension in seven (28%) and limitation of flexion in four (16%). CONCLUSION: Surgical treatment by means of open reduction and internal fixation using a hook plate and screw proved to be an excellent option for treating mallet finger fractures and was considered to be a safe and effective method.

Avaliar os resultados do tratamento cirúrgico de pacientes com lesão de dedo em martelo com o uso de placa-gancho e parafuso. MÉTODOS: Foram analisados 25 pacientes entre 20 e 35 anos, 19 do sexo masculino e seis do feminino, de maio de 2008 a dezembro de 2012. Os pacientes foram submetidos à avaliação de acordo com os critérios de Crawford e o acompanhamento médio foi de 18 meses. RESULTADOS: Os resultados obtidos foram excelentes em 10 pacientes (40%) e bons em 15 (60%); 21 pacientes (84%) não referiram dor no 18° mês de pós-operatório. Foi verificada ausência de limitação da amplitude de movimento em 14 casos (56%), limitação da extensão em sete (28%) e limitação da flexão em quatro (16%). CONCLUSÃO: O tratamento cirúrgico com redução aberta e fixação interna com placa-gancho e parafuso demonstrou ser uma ótima opção de tratamento nas fraturas em martelo e é considerado um método seguro e eficaz.

Selection of Lactobacillus strains as potential probiotics for vaginitis treatment.

Lactobacilli are the dominant bacteria of the vaginal tract of healthy women, and imbalance of the local microbiota can predispose women to acquire infections, such as bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC). Although antimicrobial therapy is generally effective, there is still a high incidence of recurrence and increase of microbial resistance due to the repetitive use of antimicrobials. Thus, it has been suggested that administration of probiotics incorporating selected Lactobacillus strains may be an effective strategy for preventing vaginal infections. Accordingly, the in vitro probiotic potential of 23 lactobacilli isolated from the vaginal ecosystem of healthy women from Cuba was evaluated for use in BV and VVC treatments. Eight strains were selected based on their antagonist potential against Gardnerella vaginalis, Candida albicansor both. In vitro assays revealed that all these strains reduced the pathogen counts in co-incubation, showed excellent adhesive properties (biofilm formation and auto-aggregation), were able to co-aggregate with G. vaginalis and C. albicans, yielded high amounts of hydrogen peroxide and lactic acid and demonstrated high adhesion rates to epithelial HeLa cells. Interference tests within HeLa cells showed that all strains were able to reduce the adherence of pathogens by exclusion or displacement. Lactobacilli were able to inhibit HeLa cell apoptosis caused by pathogens when the cells were incubated with the probiotics prior to challenge. These results suggest that these strains have a promising probiotic potential and can be used for prevention or treatment of BV and VVC.

O poder normativo das comissões intergestores bipartite e a efetividade de suas normas / The normative power of Bipartite Inter-Commissions and the effectiveness of their rules

O objetivo deste artigo é discutir o poder normativo da Comissão Intergestores Bipartite (CIB) e a efetividade de suas normas, no bojo do Direito Sanitário brasileiro. Metodologicamente, adotou-se a análise bibliográfica e legislativa, articulada à teoria discursiva do direito e democracia de Habermas. A CIB foi instituída pela Norma Operacional Básica 01/1993 e responde pelos aspectos operacionais do Sistema Único de Saúde (SUS). É um espaço de negociação e pactuação entre gestores municipais e estaduais, promovendo a integração dos diferentes sistemas municipais de saúde sob coordenação do governo estadual. As normas expedidas pela CIB, na forma de resoluções, têm natureza jurídica de direitos-meio, isto é, estabelecem os procedimentos específicos para realização do direito à saúde, permitindo que todos os potenciais destinatários dessas normas possam conhecer, aderir, criticar ou mesmo judicializá-las. O poder normativo da CIB decorre da previsão legislativa expressa para regular os aspectos operacionais do SUS e da legitimidade democrática, exercida diretamente pelo cidadão ou através dos Conselhos Estaduais de Saúde (CES). Caracterizado como fórum de negociação e operacionalização das políticas de saúde, com potencial para abrir e aprofundar canais de participação e controle social, é um espaço de gênese democrática de direitos, e suas normas devem ser, portanto, respeitadas por integrarem o ordenamento jurídico e cumprirem sua função de instrumentalização normativa do SUS...

The objective of this paper is to discuss the normative power of the Inter-managers Bipartite Commission (CIB – in Portuguese) and the effectiveness of its norms, in the context of the Brazilian Health Law. Methodologically, it was adopted a bibliographic and legislative analysis, articulated with Habermas’ discursive theory of law and democracy. The CIB was instituted by the Basic Operational Norm 01/1993 and responds for the operational aspects of the Brazilian National Public Health System (SUS – in Portuguese). It is a forum for negotiation and operationalization between municipal and state managers, promoting the integration of the various municipal health systems coordinated by the state government. The norms issued by the CIB in the form of resolutions, have the nature of procedural rights, in other words, they establish specific procedures for fulfilling the right to health, allowing all potential receivers of these norms to acknowledge, to support, to criticize or even to challenge them in court. The normative power of the CIB results from express legal prevision to regulate the opera-tional aspects of the SUS, and its democratic legitimacy is the result of the control directly exercised by citizens or through the State Council of Health. Characterized as a forum for the negotiation and operationalization of health policies, with the potential for opening and deepening channels of participation and social control, it is a space for democratic genesis of rights and its rules, therefore, must be respected, once they integrate the Legal System, and articulate the norms of the SUS...

Proteção legal à amamentação, na perspectiva da responsabilidade da família e do estado no Brasil / Right to breastfeeding, right to health and family: the legal protection network in Brazil

O objetivo deste estudo é analisar a proteção legal à amamentação, na perspectiva da responsabilidade da família e do Estado, no Brasil. Adotou-se uma abordagem qualitativa com identificação e análise das normas de proteção ao direito à amamentação, com destaque para a inovação constitucional do direito fundamental à amamentação. Caracterizou-se, assim, a fundamentalidade do direito à amamentação como Direito Humano autônomo e, também, como desdobramento do direito à saúde. Identificou-se o arcabouço legal de proteção e promoção àbamamentação, notadamente, os direitos da mãe trabalhadora, o direito à alimentação e à saúde da criança e a regulação do comércio de fórmulas que fomentam a interrupção precoce da amamentação. O estudo identificou que o Brasil possui uma proteção legal abrangente à amamentação e uma política consistente nesse sentido. Deve-se dar continuidade a essas ações, buscando educar a família, a sociedade, profissionais de saúde e gestores sobre a importância da amamentação e seu relevo na promoção da saúde materno-infantil.

The purpose of this study was to analyze the legal protection of breastfeeding from the perspective of the family and the State’s responsibility, in Brazil. The study was conducted with a qualitative approach to identify and analyze the norms that protects the right to breastfeed, especially the constitutional innovation of the fundamental right to breastfeeding. It was characterized the fundamentality of this right as an autonomous human right and also as a dimension of the right to health. It was identified the legal framework that protects and promotes breastfeeding, especially the rights of working mothers, the children’s right to nutrition and health and the regulation of formulas that promote premature stop ofbreastfeeding. The study concludes that Brazil has a comprehensive legal protection for breastfeeding and a consistent policy in this area. It should continue these actions, seekingto educate the family, society, health professionals and managers about the benefits of breastfeeding and its importance in promoting maternal and child health.

O poder normativo das comissões intergestores bipartite e a efetividade de suas normas à luz da teoria do discurso do direito / The normative power of bipartite intergovernmental commissions and effectiveness of its standards: a study from the CIB-Bahia

A Comissão Intergestores Bipartite (CIB) foi instituída pela Norma Operacional Básica 01/93 e responde pelos aspectos operacionais do Sistema Único de Saúde (SUS). É um espaço de negociação e pactuação entre gestores municipais e estaduais, promovendo a integração dos diferentes sistemas municipais de saúde sob coordenação do governo estadual. As normas expedidas pela CIB, na forma de resoluções, têm natureza jurídica de direitos-meio, isto é, estabelecem os procedimentos específicos para realização do direito à saúde, permitindo que todos os potenciais destinatários destas normas possam conhecer, aderir, criticar ou mesmo judicializá-las. O poder normativo da CIB decorre da previsão legislativa expressa para regular os aspectos operacionais do SUS e da legitimidade democrática, exercida diretamente pelo cidadão, ou através dos Conselho Estadual de Saúde (CES). As normas que emanam deste fórum deliberativo devem ser respeitas por integrarem o ordenamento jurídico e cumprirem sua função de instrumentalização normativa do SUS. Nesse sentido, o objetivo desta pesquisa foi discutir o poder normativos da CIB e a efetividade de suas normas, a partir do paradigma do discurso do direito. Realizamos uma análise documental, a partir das resoluções e das atas da CIB, para compreender sua dinâmica discurso-deliberativa e caracterizá-la, ou não, como um espaço de gênese democrática de direitos. Identificamos e classificamos as propostas aprovadas quanto à correspondência com as resoluções do CES, quanto ao conteúdo, à forma de aprovação à dinâmica da discussão das propostas aprovadas que resultaram em resoluções. Foi possível perceber que há um grande potencial democrático na CIB, um potencial que precisa ser explorado. Mas há também fragilidades e contradições na dinâmica das discussões no interior da Intergestores. Há indício de uma institucionalização que mina o potencial democrático-discursivo e se fecha à participação e controle social...

The Intermanager Bipartite Commission (IBC) was instituted by the Basic Operational Norm 01/93 and responds for the operational aspects of the Unified Health System (UHS). It is a forum for negotiation and pactuation between municipal and state managers, promoting the integration of the various municipal health systems coordinated by the state government. The norms issued by the IBC in the form of resolutions , have the nature of procedural rights, in other words, establish specific procedures for fulfill the right to health , allowing all potential receivers of these norms to acknowledge, support, criticize or even challenge them in court. The normative power of the ICB results from express legal prevision to regulate the operational aspects of the UHS, and its democratic legitimacy is the result of the control exercised directly by citizens or through the State Council of Health (SCH). The norms that emanate from the ICB should recognize as a part of the legal order and fulfill its operational goal inside the legal health system. Accordingly, the objective of this research was to discuss the normative power of the IBC and the effectiveness of its resolutions, under the paradigm of the discourse theory of law. The methodology was fulfilled through the documentary analysis of the resolutions and discussions of IBC, to understand its deliberative and discursive dynamics to characterize it, or not, as a forum for democratic genesis of rights. We identify and rank the proposals approved as its correspondence with the resolutions of the SCH, as its the content, its approval procedures, and the dynamics of the discussion to approve proposals that resulted in resolutions. We observed that there is a great democratic potential in IBC, a potential that needs to be explored. But there are also weaknesses and contradictions in the dynamics of the discussions within the Intermanager...

Complete genome sequence of type strain Campylobacter fetus subsp. venerealis NCTC 10354T.

Campylobacter fetus subsp. venerealis is the etiologic agent of bovine genital campylobacteriosis, a sexually transmitted disease of cattle that is of worldwide importance. The complete sequencing and annotation of the genome of the type strain C. fetus subsp. venerealis NCTC 10354(T) are reported.