Adenocarcinoma cervical e abandono terapêutico: a ótica dos enfermeiros em uma cidade do extremo norte brasileiro / Cervical adenocarcinoma and therapeutic dropouts: the perspective of nurses in a city in the extreme north of brazil / Adenocarcinoma cervical y abandono terapéutico: la perspectiva de los enfermeros de una ciudad del extremo norte de brasil

RESUMO Objetivo: descrever, na perspectiva do enfermeiro, as causas de abandono das usuárias em tratamento do adenocarcinoma cervical e analisar as propostas para diminuir esse abandono. Método: o estudo é descritivo, qualitativo, do tipo investigação narrativa. Participaram sete enfermeiros assistencialistas, atuantes em uma unidade de alta complexidade oncológica, na cidade de Macapá, capital do estado do Amapá, Brasil. O estudo foi realizado no período de três a 20 de dezembro de 2019. Os dados foram submetidos à análise temática categorial. Resultados: emergiram duas categorias: principais causas de abandono das usuárias em tratamento do adenocarcinoma cervical e estratégias do enfermeiro para a diminuição do abandono do tratamento pelas usuárias. Conclusão: para favorecer o resgate das usuárias, os enfermeiros participantes propõem consulta de Enfermagem e um plano de ação multiprofissional, respeitando as singularidades de cada mulher.

ABSTRACT Objective: to describe, from the perspective of nurses, the causes of dropout of users in treatment for cervical adenocarcinoma and analyze the proposals to reduce this dropout. Method: the study is descriptive, qualitative, of narrative research type. Seven care nurses, working in a high complexity oncology unit in the city of Macapá, capital of the state of Amapá, Brazil, participated. The study was conducted in the period from December three to 20, 2019. Data were submitted to categorical thematic analysis. Results: two categories emerged: main causes of dropout of users in treatment for cervical adenocarcinoma and nurse strategies for the reduction of treatment dropout by users. Conclusion: to promote the rescue of the users, the participating nurses propose a Nursing consultation and a multi-professional action plan, respecting the singularities of each woman.

RESUMEN Objetivo: describir, desde el punto de vista del enfermero, las causas de abandono de las usuarias en el tratamiento del adenocarcinoma de cuello uterino y analizar las propuestas para disminuir dicho abandono. Método: El estudio es una investigación descriptiva, cualitativa y narrativa. Participaron siete enfermeros asistenciales, que trabajan en una unidad de oncología de alta complejidad en la ciudad de Macapá, capital del estado de Amapá, Brasil. El estudio se realizó en el periodo comprendido entre el 3 y el 20 de diciembre de 2019. Los datos se sometieron a un análisis categórico temático. Resultados: surgieron dos categorías: principales causas de abandono de las usuarias en el tratamiento del adenocarcinoma cervical y estrategias de los enfermeros para reducir el abandono del tratamiento por parte de las usuarias. Conclusión: para favorecer el resguardo de las usuarias, los enfermeros participantes proponen una consulta de Enfermería y un plan de acción multiprofesional, resaltando las singularidades de cada mujer.

Multi-locus phylogenetic analysis groups the New World bacterium Rickettsia sp. strain ApPR with the Old World species R. africae; proposal of "Candidatus Rickettsia paranaensis".

Rickettsia parkeri sensu stricto (s.s.) is an emerging human pathogen in the Americas. Comprehension of the etiology of R. parkeri infections in South America is complicated by the existence of genetic variants (Atlantic rainforest, NOD and Parvitarsum) of this species that are associated with specific groups of Amblyomma ticks. The rickettsial bacterium strain ApPR was first reported in Amblyomma parkeri ticks in Southern Brazil in 2012 and was considered, based on sequencing of fragments of the gltA, htrA, ompA and ompB genes, to represent yet another genetic variant of R. parkeri. In the current work, a multi-locus phylogenetic analysis employing additional genes and intragenic regions was performed using DNA extracted from (a) larvae of A. parkeri and Amblyomma species haplotype Nazaré ticks collected from wild birds, (b) a nymph of Amblyomma sp. haplotype Nazaré recovered from a monkey (Callicebus nigrifons), representing the first report of that tick parasitizing a non-human primate and (c) from a cultured isolate of ApPR, isolated from colony-reared adults of Amblyomma geayi. Phylogenetic inference performed using Maximum-likelihood (ML), Maximum Parsimony (MP) and Bayesian (B) methods, consistently placed strain ApPR outside the New World R. parkeri complex and instead grouped it in proximity to the Old World species Rickettsia africae and Rickettsia sibirica. Estimates of evolutionary divergence provided additional support for the inferred phylogenetic relationship. Given the clear evolutionary distance between strain ApPR and R. parkeri we propose the recognition of "Candidatus Rickettsia paranaensis".