Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population.

BACKGROUND: The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. METHODS: This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. RESULTS: The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. CONCLUSION: Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.

Determination of fumonisin content in maize using near-infrared hyperspectral imaging (NIR-HSI) technology and chemometric methods.

Maize (Zea mays L.) is of socioeconomic importance as an essential food for human and animal nutrition. However, cereals are susceptible to attack by mycotoxin-producing fungi, which can damage health. The methods most commonly used to detect and quantify mycotoxins are expensive and time-consuming. Therefore, alternative non-destructive methods are required urgently. The present study aimed to use near-infrared spectroscopy with hyperspectral imaging (NIR-HSI) and multivariate image analysis to develop a rapid and accurate method for quantifying fumonisins in whole grains of six naturally contaminated maize cultivars. Fifty-eight samples, each containing 40 grains, were subjected to NIR-HSI. These were subsequently divided into calibration (38 samples) and prediction sets (20 samples) based on the multispectral data obtained. The averaged spectra were subjected to various pre-processing techniques (standard normal variate (SNV), first derivative, or second derivative). The most effective pre-treatment performed on the spectra was SNV. Partial least squares (PLS) models were developed to quantify the fumonisin content. The final model presented a correlation coefficient (R2) of 0.98 and root mean square error of calibration (RMSEC) of 508 µg.kg-1 for the calibration set, an R2 of 0.95 and root mean square error of prediction (RMSEP) of 508 µg.kg-1 for the test validation set and a ratio of performance to deviation of 4.7. It was concluded that NIR-HSI with partial least square regression is a rapid, effective, and non-destructive method to determine the fumonisin content in whole maize grains.

Arbuscular mycorrhizal fungi, phosphorus and organic residues in Peltophorum dubium (Spreng.) Taub. seedlings.

Studies have underscored a growingdemand for innovative practices in the cultivation of seedlings from forest species, with a notable emphasis on the utilization of organic waste, inoculation with arbuscular mycorrhizal fungi (AMF), and phosphate fertilization. This study aimed to evaluate the impact of organic residues, inoculation with AMF, and phosphorus on the growth and quality of Peltophorum dubium (Spreng.) Taub. seedlings. Two independent experiments were conducted. In Experiment I, treatments included inoculation with various AMF species: control (without inoculation), Clareoideoglomus etunicatum, Rhizophagus heterosporum, Rhizophagus clarum, and MIX (a combination of the three AMF species), all in conjunction with varying doses of phosphorus (0, 60, 120, 180, and 240 mg kg-1 soil). In Experiment II, treatments comprised a control group (without AMF) and inoculation with Glomus clarum, Gigaspora margarita, Gigaspora albida, Clareoideoglomus etunicatum, and MIX (a combination of the four AMF species), each associated with four substrates: S1) soil + coarse sand - SCS, S2) SCS + poultry manure, S3) SCS + cattle manure, and S4) SCS + sheep manure. Peltophorum dubium seedlings exhibited heightened growth with the inoculation of R. heterosporum, R. clarum, and MIX. Positive responses were observed in seedlings when exposed to organic residues, particularly sheep manure, resulting in increased biomass production and enhanced Dickson quality index. The AMF inoculation, specifically with R. heterosporum, R. clarum, and MIX, provided optimal growth conditions for P. dubium seedlings. Remarkably, the utilization of organic residues, notably substrates with chicken manure and cattle manure, exerted substantial positive effects on both growth and quality of P. dubium seedlings.

Olfactory Dysfunction in Adults from Rio Grande do Norte: A Cross-Sectional Study.

Introduction Smell is one of the senses of the human body, and it can be affected by several factors, such as viral infections, traumatic brain injury, iatrogenesis, smoking, and neurodegenerative and systemic diseases. Objectives The main goal of the present study is to describe the epidemiology of olfactory disorders in Rio Grande do Norte (RN). More specifically, to determine the prevalence of olfactory dysfunction and to identify the main risk factors related to these dysfunctions in the state's population. Methods A total of 180 volunteers living in the RN underwent the Connecticut Clinical Research Center (CCCRC) smell test and a clinical and demographic questionnaire. Results A total of 58.89% of the patients presented normosmia and 87.78% were classified as having between normal and mild hyposmia. A statistically significant relationship was found between worse performance in the test and nasal surgery ( p = 0.041) and the subjective feeling of not having an accurate sense of smell ( p = 0.006 on the right nostril). There was no statistical relationship between the olfactory status and the report of coronavirus disease 2019 (COVID-19) infection ( p = 0.254). Conclusion The occurrence of altered sense of smell in our study was different from that reported in other studies that used the same test. The relationship with COVID-19 was not clear.

Overview of the New Bioactive Heterocycles as Targeting Topoisomerase Inhibitors Useful Against Colon Cancer.

Colorectal cancer (CRC) is the third most common worldwide cancer with high mortality. Factors such as more effective screening programs and improvements in treatment modalities have favored a decrease in the incidence and mortality rate of colorectal cancer in the last three decades. Metastatic CRC is incurable in most cases, and therapy using multiple drugs can increase patients' life expectancy by 2 to 3 years. Chemotherapy is the primary treatment, and fluoropyrimidines correspond to the first treatment line. They can be used in monotherapy or therapeutic schemes of oxaliplatin, FOLFOX (intravenous fluorouracil, leucovorin, and oxaliplatin), and CAPOX (oral capecitabine and oxaliplatin) or regimens based on Irinotecan, such FOLFIRI (fluorouracil, leucovorin, and Irinotecan) and CAPIRI (capecitabine and Irinotecan). Like Camptothecin, irinotecan and other analogs have a mechanism of action based on forming a ternary complex with Topoisomerase I and DNA by reversibly binding, providing DNA damage and consequent cell death. This way, topoisomerases are vital enzymes for DNA maintenance and cell viability. Thus, here we will review the main works demonstrating the correlation between the inhibition of different isoforms of topoisomerases and the in vitro cytotoxic activity in colon cancer. The findings revealed that natural compounds, semi-synthetic and synthetic analogs showed potential cytotoxicity against several colon cancer cell lines in vitro and that this activity was often accompanied by the ability to inhibit type I and II topoisomerases, demonstrating that these enzymes can be promising drug targets for the development of new chemotherapeutics against colon cancer.

Selectivity of herbicides used in corn on Crotalaria ochroleuca G. Don.

In the cropping systems that integrate the corn crop, the insertion of Crotalaria ochroleuca G. Don is predominantly intercropped. In this context, there is a need to observe herbicides that present selectivity for this sunn hemp species. The objective of this study was to evaluate the selectivity of pre and post-emergent herbicides on C. ochroleuca. Two field experiments were conducted in randomized blocks with four replications, involving the pre-emergence and post-emergence application of different herbicide treatments. For the pre-emergent ones, amicarbazone, atrazine and flumioxazin provided phytotoxicity higher than 90% and, consequently, low plant biomass. On the other hand, acetochlor and s-metolachlor did not cause phytotoxicity and did not affect the dry mass of crotalaria. In post-emergence, atrazine + mesotrione showed phytotoxicity >95%, followed by nicosulfuron and 2.4-D with phytotoxicity between 50-60%, whereas tembotrione did not cause injury to the plants. Thus, it was found that among the pre-emergent, acetochlor and s-metolachlor were selective, and for the emerging powders, only tembotrione was the most selective for all parameters analyzed.

The Power of Molecular Dynamics Simulations and Their Applications to Discover Cysteine Protease Inhibitors.

A large family of enzymes with the function of hydrolyzing peptide bonds, called peptidases or cysteine proteases (CPs), are divided into three categories according to the peptide chain involved. CPs catalyze the hydrolysis of amide, ester, thiol ester, and thioester peptide bonds. They can be divided into several groups, such as papain-like (CA), viral chymotrypsin-like CPs (CB), papain-like endopeptidases of RNA viruses (CC), legumain-type caspases (CD), and showing active residues of His, Glu/Asp, Gln, Cys (CE). The catalytic mechanism of CPs is the essential cysteine residue present in the active site. These mechanisms are often studied through computational methods that provide new information about the catalytic mechanism and identify inhibitors. The role of computational methods during drug design and development stages is increasing. Methods in Computer-Aided Drug Design (CADD) accelerate the discovery process, increase the chances of selecting more promising molecules for experimental studies, and can identify critical mechanisms involved in the pathophysiology and molecular pathways of action. Molecular dynamics (MD) simulations are essential in any drug discovery program due to their high capacity for simulating a physiological environment capable of unveiling significant inhibition mechanisms of new compounds against target proteins, especially CPs. Here, a brief approach will be shown on MD simulations and how the studies were applied to identify inhibitors or critical information against cysteine protease from several microorganisms, such as Trypanosoma cruzi (cruzain), Trypanosoma brucei (rhodesain), Plasmodium spp. (falcipain), and SARS-CoV-2 (Mpro). We hope the readers will gain new insights and use our study as a guide for potential compound identifications using MD simulations.

Thrombolysis in cervical artery dissection--data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database.

OBJECTIVE: To examine whether thrombolysis for stroke attributable to cervical artery dissection (CeAD(Stroke) ) affects outcome and major haemorrhage rates. METHODS: We used a multicentre CeAD(Stroke) database to compare CeAD(Stroke) patients treated with and without thrombolysis. Main outcome measures were favourable 3-month outcome (modified Rankin Scale 0-2) and 'major haemorrhage' [any intracranial haemorrhage (ICH) and major extracranial haemorrhage]. Adjusted odds ratios [OR (95% confidence intervals)] were calculated on the whole database and on propensity-matched groups. RESULTS: Among 616 CeAD(Stroke) patients, 68 (11.0%) received thrombolysis; which was used in 55 (81%) intravenously. Thrombolyzed patients had more severe strokes (median NIHSS score 16 vs. 3; P < 0.001) and more often occlusion of the dissected artery (66.2% vs. 39.4%; P < 0.001). After adjustment for stroke severity and vessel occlusion, the likelihood for favourable outcome did not differ between the treatment groups [OR(adjusted) 0.95 (95% CI 0.45-2.00)]. The propensity matching score model showed that the odds to recover favourably were virtually identical for 64 thrombolyzed and 64 non-thrombolyzed-matched CeAD(Stroke) patients [OR 1.00 (0.49-2.00)]. Haemorrhages occurred in 4 (5.9%) thrombolyzed patients, all being asymptomatic ICHs. In the non-thrombolysis group, 3 (0.6%) patients had major haemorrhages [asymptomatic ICH (n = 2) and major extracranial haemorrhage (n = 1)]. CONCLUSION: As thrombolysis was neither independently associated with unfavourable outcome nor with an excess of symptomatic bleedings, our findings suggest thrombolysis should not be withheld in CeAD(Stroke) patients. However, the lack of any trend towards a benefit of thrombolysis may indicate the legitimacy to search for more efficient treatment options including mechanical revascularization strategies.

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

[Toxocara canis cerebral vasculitis revealed by iterative strokes]. / Vascularite cérébrale àToxocara canis révélée par des AVC itératifs.

INTRODUCTION: Cerebral vasculitis is a rare and severe condition, posing problems for diagnosis and treatment. Toxocara canis cerebral vasculitis is exceptionally rare, with only 4 cases having been reported. We report an additional case revealed by iterative strokes. OBSERVATION: A 49-years-old Laotian man presented with right ACA infarction associated with contrast enhancement of cerebrospinal fluid, and multiple segmental stenoses in small and medium caliber encephalic arteries, in a context of hypereosinophilia and chronic headaches. Laboratory tests showed lymphocytic meningitis and T. canis antibody IgE in the blood and CSF. The diagnosis of T. canis cerebral vasculitis was retained. During follow-up, the patient presented again with left pontine hemorrhagic stroke. Conventional cerebral angiography confirmed progression of vasculitis despite treatment. CONCLUSION: This case-report illustrates the diagnostic and therapeutic difficulties associated with vasculitis.

Genetic diversity of Peltophorum dubium (Spreng.) Taub. progenies from the states of Minas Gerais and Mato Grosso do Sul, Brazil.

There is little information regarding the genetic diversity of native species aimed at identifying the best viable progenies for in situ and ex situ conservation. Furthermore, there is a lack of future forest improvement programs. We aimed to know the genetic diversity of 64 Peltophorum dubium (Spreng.) Taub. (Fabaceae) progenies. We determined this species' dendrometric characteristics, and when using multivariate techniques and cluster analysis, we verified the differences between the progenies and groups with less heterogeneity. The progeny and provenance test was installed in Dourados (Mato Grosso do Sul - MS), with seeds collected in three MS regions (Vale do Ivinhema, Serra de Maracaju, and Serra da Bodoquena) and in the micro-region of Lavras (Minas Gerais - MG). The experiment was conducted in an alpha lattice 8 x 8 with four repetitions. We found genetic variability among and within P. dubium populations for all height, diameter, circumference at breast height, volume, and basal area characters. We suggest that P. dubium populations have high genetic variability, which indicates possible genetic improvement through best progeny selection. The UPGMA and Tocher methods grouped the progenies into three and nine groups, respectively, in which the most divergent individuals come from MG and the Bonito region in MS. Based on morphological characters, P. dubium progenies identified as 45, 47, 49, 50, 55, and 59 from MG are the most promising, while progenies 6 and 9 were the least promising.

Topoisomerase Enzyme Inhibitors as Potential Drugs Against Cancer: What Makes Them Selective or Dual? - A Review.

Topoisomerase inhibitors are extensively used in cancer chemotherapy. In the process of identifying novel anticancer compounds, biological evaluations are crucial and include, among others, the use of in silico and in vitro approaches. This work aimed to present recent research involving the obtainment and in silico and in vitro evaluation of topoisomerase I, II, and double inhibitors, of synthetic and natural origin, as potential compounds against tumor cells, in addition to proposing the construction of a desirable enzyme catalytic site. Therefore, it was observed that most Topoisomerase I inhibitors presented medium to large structures, with a rigid portion and a flexible region. In contrast, Topoisomerase IIα inhibitors showed medium and large structural characteristics, in addition to the planarity of the aromatic rings, which are mitigated due to flexible rings but may also present elements that restrict conformation. Most compounds that exhibit dual inhibitory activity had relatively long chains, in addition to a flat and rigid portion suggestive of affinity for Topo I and a flexible region characteristic of selective drugs for Topo II. Besides, it is noticed that most compounds that exhibit dual inhibitory showed similarities in the types of interactions and amino acids when compared to the selective compounds of Topo I and II. For instance, selective Topoisomerase I inhibitors interact with Arginine364 residues, and selective Topoisomerase II inhibitors interact with Arginine487 residues, as both residues are targets for dual compounds.

Application of Heterocycles as an Alternative for the Discovery of New Anti-ulcer Compounds: A Mini-Review.

A peptic ulcer is a lesion located in the esophagus, stomach, and upper intestine, caused by an imbalance between acid secretion and the release of protective mucus. This pathology is prevalent in approximately 14% of the world population and is commonly treated with proton pump inhibitors and type 2 histaminergic receptor antagonists, however, these drugs present concerning side effects that may lead to gastric cancer. In this sense, this research aimed to present the main heterocyclics studied in recent years. The screening method for the choice of articles was based on the selection of publications between 2000 and 2021 present in the Science Direct, Web of Science, Capes, and Scielo databases, by using the descriptors ''new derivatives'', "heterocyclics" "antiulcerogenic", "gastroprotective" and "antisecretor". This research showed that the most used rings in the development of anti-ulcer drugs were benzimidazole, quinazoline, thiazole, and thiadiazole. The results also portray several types of modern in silico, in vitro and in vivo assays, as well as the investigation of different mechanisms of action, with emphasis on proton pump inhibition, type 2 histaminergic receptor blockers, potassium competitive acid blockers, type E prostaglandin agonism, anti-secretory activity and anti-oxidant action. Additionally, the review evidenced the presence of the nitrogen atom in the heterocyclic ring as a determinant of the potential of the compound. This research suggests new alternatives for the treatment of gastric lesions, which may be more potent and cause fewer side effects than the currently used, and tend to evolve into more advanced studies in the coming years.

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC).

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69,248 admissions followed for 283,069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2·03 days (95% CI 1·52-2·54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity.

Alpha-decay half-life of Hafnium isotopes reinvestigated by a semi-empirical approach.

- New estimates of partial α-decay half-life, T1/2, for 156-162,174,176Hf isotopes by a semi-empirical, one-parameter model are given. The used model is based on the quantum mechanical tunneling mechanism through a potential barrier, where the Coulomb, centrifugal and overlapping components to the barrier have been considered within the spherical nucleus approximation. This approach enables to reproduce, within a factor 2, the measured T1/2 of ground-state to ground-state (gs-gs) α-transitions for the artificially produced 156-162Hf isotopes. Half-life predictions for α-transitions from the ground-state of 159,161Hf isotopes to the first gamma-excited level of 155,157Yb isotopes are reported for the first time. The model also provides T1/2-values of (2.43±0.28)×1016 a and (1.47±0.19)×1020 a for the naturally occurring 174Hf and 176Hf isotopes, respectively, in quite good agreement with a number of estimates by other authors. In addition, the present methodology indicates that 174,176Hf isotopes exhibit α-transition to the first gamma-excited level of their daughter Ytterbium isotopes which half-lives are found (0.9±0.1)×1018 a and (0.72±0.08)×1022 a, respectively, with a chance of being measured by improved α-detection and α-spectrometry methods available nowadays.

Radiation-induced angiosarcoma: case report.

Angiosarcoma of the breast accounts for less than 1% of breast tumors. This tumor may be primary or secondary to previous radiation therapy and it is also named "radiogenic angiosarcoma of the breast", which is still a rare entity with a poor prognosis. So far, there are only 307 cases reported about these tumors in the literature. We present a case of a 73-year-old woman with a prior history of breast-conserving treatment of right breast cancer, exhibiting mild pinkish skin changes in the ipsilateral breast. Her mammography was consistent with benign alterations (BI-RADS 2). On incisional biopsy specimens, hematoxylin-eosin showed atypical vascular lesion and suggested immunohistochemisty for diagnostic elucidation. Resection of the lesions was performed and histology showed radiogenic angiosarcoma. The patient underwent simple mastectomy. Immunohistochemistry was positive for antigens related to CD31 and CD34, and C-MYC oncogene amplification, confirming the diagnosis of angiosarcoma induced by breast irradiation. A delayed diagnosis is an important concern. Initial skin changes in radiogenic angiosarcoma are subtle, therefore, these alterations may be confused with other benign skin conditions such as telangiectasia. We highlight this case clinical aspects with the intention of alerting to the possibility of angiosarcoma of the breast in patients with a previous history of adjuvant radiation therapy for breast cancer treatment. Sixteen months after the surgery the patient remains asymptomatic.

Electrically conductive nanocomposites made from cellulose nanofibrils and polyaniline.

Electrically conductive nanocomposites from cellulose nanofibrils (CNF) were successfully produced by in situ polymerization of aniline onto CNF, and studied by open circuit potential (Voc), four probe direct current (dc) electrical conductivity, ultraviolet-visible (UV-Vis) spectroscopy and scanning electron microscopy (SEM). The oxidative polymerization of aniline using ammonium peroxydisulfate in hydrochloric acid aqueous solutions was realized by the addition of nanofibrils leading to an aqueous suspension of CNF coated with polyaniline (PANI). This procedure lead to stable, green suspensions of CNF coated with PANI in the emeraldine oxidation state as demonstrated by Voc and UV-Vis analyses. Electrically conductive films of this cellulose nanocomposite could be cast from aqueous solutions with conductivity close to the conducting polymer, yet with the potential for more useful flexible films.

Desafios da atenção primária em João Pessoa contra o coronavírus na perspectiva do usuário / User perspective on the challenges of primary care against the coronavirus in joão pessoa / Desafíos de la atención primaria en João Pessoa frente al coronavirus desde la perspectiva del usuario

No cenário pandêmico, o Sistema Único de Saúde precisou reinventar seus processos de trabalho, estabelecer novos fluxos de atendimento e fortalecer suas redes de atenção para prevenir e reduzir o contágio do vírus. Este estudo visa avaliar, do ponto de vista dos usuários, os desafios da Atenção Primária à Saúde em João Pessoa, Paraíba, no controle do coronavírus. Trata-se de uma pesquisa transversal descritiva, com abordagem qualiquantitativa, que utilizou questionários elaborados no aplicativo Google Forms® e analisou os resultados por meio da estatística descritiva simples. Diante disso, foram selecionados quarenta usuários da Unidade Básica de Saúde, escolhidos durante as visitas dos pesquisadores à unidade localizada no bairro Cristo Redentor, em João Pessoa, entre março de 2020 e março de 2022. Ao serem questionados acerca da qualidade do preparo assistencial da unidade em relação ao atendimento dos casos não suspeitos, alguns usuários, ainda que uma parcela minoritária, fizeram uma avaliação negativa, uma vez que sentiram falta do cuidado assistencial. Além disso, conforme os relatos dos usuários, foram escassas as ações das equipes na busca ativa de sintomas respiratórios em grupos de risco. No tocante à comunicação da unidade com a comunidade durante a pandemia, foram relatadas dificuldades em contatar o posto, o que traz à tona a importância do agente comunitário de saúde e abre uma discussão sobre telessaúde, além de destacar a inviabilização da longitudinalidade e integralidade do cuidado durante esse período. Diante da crise sanitária global, nota-se que o confronto à pandemia pressupôs uma reestruturação da rede assistencial, na qual o verdadeiro desafio da Atenção Primária foi aprofundar seus atributos.

In the pandemic scenario, the Unified Health System had to reinvent its work processes, establishing new service flows and strengthening its care networks to prevent and reduce the virus spread. This study evaluates, from the user perspective, the challenges faced by Primary Health Care in João Pessoa, Paraíba, in controlling the coronavirus. A descriptive, qualitative-quantitative cross-sectional research was conducted by applying questionnaires prepared using Google Forms®. Results were analyzed using simple descriptive statistics. A total of 40 Basic Health Unit users were selected during researchers' visits to the Cristo Redentor neighborhood unit between March 2020 and March 2022. When asked about the unit's care quality regarding non-suspect cases, some users made a negative evaluation, since the attention dispended felt lacking. Moreover, according to the participants, the teams seldomly actively searched for respiratory symptoms in risk groups. Regarding the unit's communication with the community during the pandemic, users reported difficulties in contacting the unit, which brings up the importance of community health agents and opens the discussion about telemedicine, as well as emphasizes the unfeasibility of care longitudinality and comprehensiveness during this period. Faced with a global health crisis, combating the pandemic required restructuring the care network, in which the real challenge of Primary Care was to further its attributes.

En el escenario de la pandemia, el Sistema Único de Salud necesitó reinventar sus procesos de trabajo, establecer nuevos flujos de servicios y fortalecer sus redes de atención para prevenir y mitigar la propagación del virus. Este estudio tiene como objetivo evaluar, desde el punto de vista de los usuarios, los desafíos de la atención primaria de salud en João Pessoa, Paraíba (Brasil), en el control del coronavirus. Se trata de una investigación descriptiva de corte transversal, con enfoque cualicuantitativo, que utilizó cuestionarios elaborados en la aplicación Google Forms y analizó los resultados mediante estadística descriptiva simple. Así, fueron seleccionados cuarenta usuarios de la Unidad Básica de Salud, elegidos durante las visitas de los investigadores a la unidad ubicada en el barrio Cristo Redentor, en João Pessoa, entre marzo de 2020 y marzo de 2022. Se evidenció una evaluación negativa, aunque minoritaria, al interrogatorio acerca de la calidad de la preparación asistencial de la unidad con relación a la atención de casos no sospechosos, ya que sintieron falta de atención. Además, según los reportes de los usuarios, hubo pocos informes de equipos que buscaran activamente síntomas respiratorios en grupos de riesgo. Respecto a la comunicación de la unidad con la comunidad durante la pandemia, se informaron dificultades para contactar a la unidad, lo que resalta la importancia del agente comunitario de salud y abre la discusión sobre la telesalud, además de poner de relieve la inviabilidad de la longitudinalidad e integralidad de la atención durante este período. Frente a la crisis sanitaria global, se constata que enfrentar la pandemia requirió una reestructuración de la red de atención, en la que el verdadero desafío de la atención primaria era profundizar sus atributos.

Olfactory Dysfunction in Adults from Rio Grande do Norte: A Cross-Sectional Study

Abstract Introduction Smell is one of the senses of the human body, and it can be affected by several factors, such as viral infections, traumatic brain injury, iatrogenesis, smoking, and neurodegenerative and systemic diseases. Objectives The main goal of the present study is to describe the epidemiology of olfactory disorders in Rio Grande do Norte (RN). More specifically, to determine the prevalence of olfactory dysfunction and to identify the main risk factors related to these dysfunctions in the state's population. Methods A total of 180 volunteers living in the RN underwent the Connecticut Clinical Research Center (CCCRC) smell test and a clinical and demographic questionnaire. Results A total of 58.89% of the patients presented normosmia and 87.78% were classified as having between normal and mild hyposmia. A statistically significant relationship was found between worse performance in the test and nasal surgery (p = 0.041) and the subjective feeling of not having an accurate sense of smell (p = 0.006 on the right nostril). There was no statistical relationship between the olfactory status and the report of coronavirus disease 2019 (COVID-19) infection (p = 0.254). Conclusion The occurrence of altered sense of smell in our study was different from that reported in other studies that used the same test. The relationship with COVID-19 was not clear.

[Contribution of the Dijon Stroke Registry after 20 years of data collection]. / Les apports du registre dijonnais des accidents vasculaires cérébraux en 20 ans d'activité

INTRODUCTION: The Dijon Stroke Registry is the only population-based registry in France which has collected neurological data without interruption for more than 20 years. This registry has produced reliable epidemiological data from a large non-selected population. PATIENTS AND METHODS: During the 20-year study period, 3142 ischemic strokes, 341 primary cerebral hemorrhages and 74 subarachnoid hemorrhages were recorded. Age at first stroke rose by five years in men and eight years in women. RESULTS: Comparing the descriptive epidemiology data between 1985 to 1989 and the 2000-2004 periods, the following results were noted: age- and sex-standardized incidences of first-ever stroke were stable except for lacunar stroke where the incidence increased significantly (p=0.05), and for cardioembolic stroke where incidence decreased significantly (p=0.01); 28-day case-fatality rates decreased significantly mainly for lacunar stroke (p=0.05) and for primary cerebral hemorrhage (p=0.03). The proportion of subjects with hypercholesterolemia and diabetes increased significantly (p<0.01). Analysis of cohort data issuing from the registry yielded the following findings: hyperglycemia during the acute stage of cerebral infarct was linked with poor prognosis; lower levels of E. apolipoprotein linked to HDL-cholesterol were associated with atherothrombotic infarcts; activation of coagulation factors was linked with atherothrombotic infarct; decreased N-acetyl-aspartate, a marker of the number of neurons, and increased serum lactate, a marker of anaerobic metabolism measured by proton magnetic resonance spectroscopy were noted in the cohort of cerebral infarct victims; release of platelet V-glycoprotein was noted in cerebral infarct; the incidence of cerebral infarct rose during autumn and during periods with high levels of atmospheric ozone and was higher in male smokers aged more than 40 years with hypertension. The population-based registry contributed to the assessment of medicoeconomic expenditures and professional practices. CONCLUSION: In Dijon, age- and sex-standardized stroke incidence has remained stable over the past 20 years. Increasing age at first-ever stroke, decreasing case-fatality rate, increasing use of antiplatelet treatments and a reduction in certain prestroke risk factors were noted.