Um esclarecimento sobre a real necessidade de realizar a reposição hormonal de testosterona no homem / A clarification on the real need for testosterone hormone replacement in men / Una aclaración sobre la necesidad real de sustituir la hormona testosterona en los hombres

O artigo é uma revisão sobre os aspectos relacionados ao envelhecimento masculino e necessidades de tratamentos, com ênfase no hipogonadismo tardio, baixa produção de testosterona e possível desenvolvimento do Distúrbio Androgênico do Envelhecimento Masculino (DAEM). O objetivo foi apresentar o DAEM e suas implicações sobre a qualidade de vida do paciente para promover e validar o tratamento, quando realmente for apropriado, para esse quadro clínico. Utilizou-se como a fonte de pesquisa Google Acadêmico, banco de dados Biblioteca Virtual em Saúde e do PubMed foram obtidos artigos com as aplicações dos seguintes filtros: 2010-2023 e descritores em saúde (andropausa, reposição hormonal, testosterona, DAEM, hipogonadismo e síndromes metabólicas). Os critérios de inclusão utilizados foram a disponibilidade integral dos artigos, ter os idiomas inglês e português, e abordar o tema da Doença Androgênica do Envelhecimento, todas as suas repercussões sobre a qualidade de vida do homem e, sobretudo, o seu tratamento. Para excluir artigos encontrados na busca, foram observadas obras que apenas tangenciam o tema e tinham enfoque em outros aspectos, como: estética e esporte. Após a aplicação do método, 14 trabalhos foram selecionados por estabelecerem grande relação com o tema. Esse distúrbio acarreta para o indivíduo um conjunto de sinais e sintomas capazes de comprometer sua qualidade de vida: disfunção erétil, baixa libido, obesidade, redução de massa magra ou sarcopenia, osteoporose e distúrbios do humor. O diagnóstico é feito clinicamente e através de exames laboratoriais de dosagem sérica de testosterona. Perante a confirmação diagnóstica e sem patologizar processos fisiológicos do envelhecimento, o tratamento indicado é a reposição de testosterona que tende a normalizar o quadro do idoso por amenizar ou finalizar os sinais e sintomas desse paciente, proporcionando-o uma terceira idade com qualidade de vida. Vale destacar que as disposições de formulações de testosterona são inúmeras: orais, transdérmicas, intramusculares ou injetáveis. A via de administração depende da situação individual de cada paciente e cada tipo de medicamento tem seus benefícios se comparado aos outros, seja por comparação entre efeitos colaterais, estabilidade de níveis séricos hormonais, custo e acesso. O DAEM precisa ser identificado e diagnosticado naqueles pacientes que necessitam de um tratamento por apresentar sinais e sintomas prejudiciais ao bem-estar. Para isso, a indústria farmacêutica disponibiliza uma gama de formas de administração de testosterona. Entretanto, é preciso ter clareza sobre a real necessidade de medicar um paciente.

The article is a review of aspects related to male aging and treatment needs, with an emphasis on late-onset hypogonadism, low testosterone production and the possible development of Androgenic Male Aging Disorder (AMAD). The aim was to present the AMAD and its implications for the patient's quality of life in order to promote and validate treatment, where appropriate, for this clinical condition. The search source used was Google Scholar, the Virtual Health Library database and PubMed, where articles were obtained using the following filters: 2010-2023 and health descriptors (andropause, hormone replacement, testosterone, AMAD, hypogonadism and metabolic syndromes). The inclusion criteria used were that the articles were available in full, that they were in English and Portuguese, and that they dealt with the subject of Androgenic Ageing Disorder, all its repercussions on men's quality of life and, above all, its treatment. To exclude articles found in the search, we looked at works that only touched on the subject and focused on other aspects, such as aesthetics and sport. After applying the method, 14 articles were selected because they were closely related to the topic. This disorder leads to a set of signs and symptoms that can compromise the individual's quality of life: erectile dysfunction, low libido, obesity, reduced lean mass or sarcopenia, osteoporosis and mood disorders. The diagnosis is made clinically and through laboratory tests of serum testosterone levels. Once the diagnosis has been confirmed and without pathologizing the physiological processes of ageing, the treatment indicated is testosterone replacement, which tends to normalize the condition of the elderly by easing or ending the signs and symptoms of the patient, providing them with a quality old age. It's worth noting that there are many different formulations of testosterone: oral, transdermal, intramuscular or injectable. The route of administration depends on the individual situation of each patient and each type of medication has its benefits compared to the others, whether it's a comparison of side effects, stability of serum hormone levels, cost and accessibility. AMAD needs to be identified and diagnosed in those patients who need treatment because they have signs and symptoms that are detrimental to their well-being. To this end, the pharmaceutical industry offers a range of forms of testosterone administration. However, it is necessary to be clear about the real need to medicate a patient.

El artículo es una revisión de los aspectos relacionados con el envejecimiento masculino y las necesidades de tratamiento, con énfasis en el hipogonadismo de inicio tardío, la baja producción de testosterona y el posible desarrollo del Trastorno Androgénico del Envejecimiento Masculino (TAME). El objetivo fue presentar el TAME y sus implicaciones en la calidad de vida del paciente, con el fin de promover y validar el tratamiento de esta condición clínica, cuando sea apropiado. La fuente de búsqueda utilizada fue Google Scholar, la base de datos de la Biblioteca Virtual de Salud y PubMed, donde se obtuvieron artículos utilizando los siguientes filtros: 2010-2023 y descriptores de salud (andropausia, reemplazo hormonal, testosterona, TAME, hipogonadismo y síndromes metabólicos). Los criterios de inclusión utilizados fueron que los artículos estuvieran disponibles en su totalidad, en inglés y portugués, y que abordaran el tema del Trastorno Androgénico del Envejecimiento, todas sus repercusiones en la calidad de vida de los hombres y, sobre todo, su tratamiento. Para excluir los artículos encontrados en la búsqueda, se consideraron los trabajos que sólo tocaban el tema y se centraban en otros aspectos, como la estética y el deporte. Tras aplicar el método, se seleccionaron 14 artículos por estar estrechamente relacionados con el tema. Este trastorno conlleva un conjunto de signos y síntomas que pueden comprometer la calidad de vida del individuo: disfunción eréctil, libido baja, obesidad, reducción de la masa magra o sarcopenia, osteoporosis y trastornos del estado de ánimo. El diagnóstico se realiza clínicamente y mediante pruebas de laboratorio de los niveles séricos de testosterona. Una vez confirmado el diagnóstico y sin patologizar los procesos fisiológicos del envejecimiento, el tratamiento indicado es el reemplazo de testosterona, que tiende a normalizar la condición del anciano, aliviando o terminando con sus signos y síntomas, proporcionándole una vejez con calidad de vida. Cabe destacar que existen diversas formulaciones de testosterona: oral, transdérmica, intramuscular o inyectable. La vía de administración depende de la situación individual de cada paciente y cada tipo de medicación tiene sus ventajas frente a las demás, ya sea en comparación con los efectos secundarios, la estabilidad de los niveles séricos de la hormona, el coste y la accesibilidad. Es necesario identificar y diagnosticar el TAME en aquellos pacientes que necesitan tratamiento porque presentan signos y síntomas perjudiciales para su bienestar. Para ello, la industria farmacéutica ofrece diversas formas de administración de testosterona. Sin embargo, es necesario tener clara la necesidad real de medicar a un paciente.

Representações sociais de gestantes sobre gravidez durante o pré-natal / Social representations of pregnant women about pregnancy during prenatal care

Objetivo:Apreender as representações sociais de gestantes sobre a gravidez durante o período pré-natal. Métodos:Estudo de abordagem qualitativa, norteado pelos pressupostos teóricos das Representações Sociais e metodológicos da Pesquisa Convergente Assistencial, realizado com 11 gestantes acompanhadas pela Estratégia Saúde da Família, após aprovação do Comitê de Ética. Para a coleta dos dados, foi realizada entrevista individual em profundidade com o método do grupo de convergência, entre setembro e novembro em 2016. Os dados obtidos foram submetidos à análise de conteúdo. Resultados:A análise dos dados resultou em duas categorias: Descoberta da gravidez e Gravidez como estado de mudanças. Evidenciou-se que as representações da gravidez estão ancoradas na realização do sonho e na crença religiosa que envolve a maternidade, bem como naconstituição familiar e no aumento do senso de responsabilidade. Considerações finais:Com o estudo, compreende-se que a gestação, mesmo ocasionando modificações físicas, psicológicase até mesmo sociais, é algo esperado pelas mulheres e que gera múltiplos sentimentos e provoca mudanças.

Objective:To understand the social representations of pregnant women about pregnancy during the prenatal period. Methods:Aqualitative study, guided by the theoretical assumptions of the Social and Methodological Representations of the Convergent Care Research, carried out with 11 pregnant women accompanied by the family health strategy, after approval by the Ethics Committee. For data collection, an in-depth individual interview and the convergence group method were carried out during September to November 2016. Thedata obtained was subjected to content analysis. Results:Data analysis resulted in two categories: discovery of pregnancy and; pregnancy as a state of change. It was evident that representations of pregnancy are anchored in the realization of the dream and in the religious belief that involves motherhood, as well as in the family constitution and increased sense of responsibility. Final considerations:It is understood from the study that pregnancy, even causing physical, psychological and social changes,is something expected by women and that generates multiple feelings and causes changes.

Avaliação da gravidade dos sinais e sintomas da COVID-19 em pacientes submetidos à cirurgia bariátrica / Assessment of the severity of signs and symptoms of COVID-19 in patients undergoing bariatric surgery / Evaluación de la gravedad de los signos y sintomas de COVID-19 em pacientes sometidos a cirurgía bariátrica

Objetivo: Avaliar a gravidade e a incidência dos sinais e sintomas da COVID-19 em pacientes bariátricos, relacionando-os ao índice de massa corporal (IMC) e a outros fatores considerados de risco para a doença.Método: trata-se de um estudo transversal. Os pacientes responderam a um questionário eletrônico e a avaliação da gravidade dos sinais e sintomas da infecção por SARS-CoV-2 foi realizada seguindo o manual "Orientações para manejo de pacientes com covid-19", do Ministério de Saúde do Brasil. Resultados: um total de 60 pacientes foram incluídos. Dos participantes, 60% apresentaram sintomas graves e a fadiga foi o sintoma mais frequente (90%). A análise mostrou uma associação significativa entre a presença de tosse e a condição de sobrepeso/obesidade (OR=3,720; IC=1,060­13,050; p=0,034). Além disso, apenas 6,7% foram hospitalizados, sem casos de intubação, todos com sobrepeso/obesidade (OR=1,333; IC=1,114­1,554). Conclusão:apesar de uma alta taxa de pacientes categorizados com sinais e sintomas graves, verificou-se uma baixa necessidade de internação hospitalar e ventilação mecânica não invasiva. Isso sugere que a perda de peso e a melhora das comorbidades pós-cirurgia podem contribuir para um risco reduzido de hospitalização em casos de infecção por COVID-19

Objective: To assess the severity and incidence of COVID-19 signs and symptoms in bariatric patients, relating them to body mass index (BMI) and other risk factors for the disease. Method:This is a cross-sectional study. Patients completed an electronic questionnaire, and the severity of SARS-CoV-2 infection signs and symptoms was assessed following the "Guidelines for the management of COVID-19 patients" by the Brazilian Ministry of Health. Results:A total of 60 patients were included. Among the participants, 60% presented with severe symptoms, with fatigue being the most frequent symptom (90%). The analysis showed a significant association between the presence of cough and the condition of overweight/obesity (OR=3.720; CI=1.060­13.050; p=0.034). Moreover, only 6.7% were hospitalized, with no cases requiring intubation, all within the overweight/obesity subgroup (OR=1.333; CI=1.114­1.554).Conclusion: Despite a high rate of patients categorized with severe signs and symptoms, there was a low need for hospital admission and non-invasive mechanical ventilation. This suggests that weight loss and improvement of comorbidities post-surgery may contribute to a reduced risk of hospitalization in COVID-19 infection case.

Objetivo: Evaluar la gravedad y la incidencia de los signos y síntomas de COVID-19 en pacientes bariátricos, relacionándolos con el índice de masa corporal (IMC) y otros factores de riesgo para la enfermedad. Metodo:Se trata de un estudio transversal. Los pacientescompletaron un cuestionario electrónico, y la gravedad de los signos y síntomas de la infección por SARS-CoV-2 se evaluó siguiendo las "Guías para el manejo de pacientes con COVID-19" del Ministerio de Salud de Brasil. Resultados:Se incluyó un total de 60 pacientes. Entre los participantes, el 60% presentó síntomas severos, siendo la fatiga el síntoma más frecuente (90%). El análisis mostró una asociación significativa entre la presencia de tos y la condición de sobrepeso/obesidad (OR=3.720; IC=1.060­13.050; p=0.034). Además, solo el 6.7% fueron hospitalizados, sin casos que requirieran intubación, todos dentro del subgrupo de sobrepeso/obesidad (OR=1.333; IC=1.114­1.554). Conclusión:A pesar de una alta tasa de pacientes clasificados con signos y síntomasseveros, hubo una baja necesidad de admisión hospitalaria y ventilación mecánica no invasiva. Esto sugiere que la pérdida de peso y la mejora de las comorbilidades postoperatorias pueden contribuir a un riesgo reducido de hospitalización en casos de infección por COVID-19

Trombectomía más fleboextracción: una técnica alternativa en el manejo de la enfermedad hemorroidal externa trombosada / Thrombectomy combined with vein stripping: An alternative technique to treat thrombosed external hemorrhoid disease

Resumen Objetivo: Evaluar los resultados de la trombectomía más fleboextracción como alternativa en el manejo de la enfermedad hemorroidal externa trombosada. Materiales: Estudio observacional, cuantitativo, retrospectivo, transversal y descriptivo de los pacientes que consultaron y se sometieron a la trombectomía más fleboextracción como técnica alternativa en el manejo de la enfermedad hemorroidal externa trombosada en el servicio de coloproctología del Hospital Militar Central desde el primero de enero de 2014 hasta el 31 de diciembre de 2016. Resultados: Se encontró que 197 pacientes consultaron por hemorroides externas trombosadas, el 71 % eran hombres y el promedio de edad para el grupo de manejo conservador fue de 48,5 años, frente al promedio del grupo de manejo quirúrgico, que fue de 43,2 años. El seguimiento promedio posterior al inicio del tratamiento médico o quirúrgico fue de 16 meses. En el grupo de manejo quirúrgico, la tasa de recurrencia fue del 7,2 % y el intervalo de recurrencia fue 29,2 meses. Conclusiones: Los pacientes a quienes se les practicó la técnica de trombectomía más fleboextracción presentaron una menor tasa de retrombosis hemorroidal, menor tasa de dolor y sangrado posoperatorio. La trombectomía hemorroidal con fleboextracción es una técnica bien tolerada en el consultorio, que se puede realizar sin anestesia, a diferencia del estándar de manejo actual con hemorroidectomía externa en elipse, que requiere anestesia local, regional o general, y una sala de procedimientos quirúrgicos que deja un defecto mayor en la piel por el tejido resecado, un mayor tiempo de cicatrización y de dolor posoperatorio.

Abstract Objective: To evaluate the results of thrombectomy combined with vein stripping as an alternative to treat external thrombosed hemorrhoid disease. Materials and methods: This is an observational, quantitative, retrospective, cross-sectional and descriptive study of the patients who underwent thrombectomy combined with vein stripping as an alternative technique to treat thrombosed external hemorrhoid disease at the Coloproctology Service of the Hospital Militar Central from January 1, 2014, to December 31, 2016. Results: It was found that 197 patients consulted due to thrombosed external hemorrhoids. 71% were men. The average age for the conservative treatment group vs. the surgical treatment group was 48.5 vs. 43.2 years, respectively. The average follow-up time after initiation of medical or surgical treatment was 16 months. In the surgical treatment group, the recurrence rate was 7.2% and the recurrence interval was 29.2 months. Conclusions: Patients who underwent thrombectomy combined with vein stripping had a lower recurrence rate of thrombosed hemorrhoids, a lower pain score, and less postoperative bleeding. Hemorrhoid thrombectomy combined with vein stripping is a well-tolerated technique that can be performed at the doctor's office without anesthesia, unlike the current management standard with external elliptical hemorrhoidectomy, which that requires local, regional, or general anesthesia, and a surgical room, leaving a larger skin defect following the resection of the tissue, with longer healing time and greater postoperative pain.

Glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in type 1 diabetes based on genomic ancestry.

BACKGROUND: Black individuals have a great risk of developing chronic kidney disease (CKD) that is associated with high morbimortality, so it is important to classify them into the correct renal function group. Some equations used to estimate glomerular filtration rate (eGFR) divide patients only into two categories: African Americans and non-African Americans. The CKD-EPI equation was tested only in African Americans, and not Black patients from other regions, and takes into consideration self-reported color-race instead of genomic ancestry (GA) to determine the use of the ethnic correction factor. So far, this equation has not been evaluated in admixed populations, such as the Brazilian, using the percentage of GA to decide to apply the correction factor. The purpose of our study was to compare, in patients with type 1 diabetes (T1D), the eGFR calculated without the use of the correction factor, with the values obtained using the correction factor in patients presenting 50% or more of African GA. METHODS: This cross-sectional, multicenter study enrolled 1279 patients from all geographic regions of Brazil. The CKD-EPI equation was used and CKD was defined as eGFR < 60 ml/min. GA were inferred using a panel of 46 AIM-INDEL, afterwards patients presenting an African GA ≥ 50% were selected. RESULTS: Initially, all patients with African GA ≥ 50% (n = 85) were considered as non-African Americans when calculating the eGFR and afterwards the ethnic correction factor was applied to recalculate the eGFR. CKD was present in 23 patients and 56.5% of them were redefined as having normal renal function after using the correction factor, mainly women [11 of the 13 patients (84.6%)], with GFR between 52-59.3 ml/min. CONCLUSIONS: More than half of the patients in the study were reclassified to a normal renal function group, showing that GA may be an important tool to decide between the use of the ethnic correction factor in the CKD-EPI equation in a highly admixed population of patients with T1D. A large-scale study involving GA and eGFR in comparison to reference methods should be conducted to better establish whether or not the ethnic correction factor should be used in highly admixed populations.

Prevalence and risk factors of toxoplasmosis among adults in a small Brazilian city

Abstract INTRODUCTION: The prevalence of Toxoplasma gondii infection varies markedly among different populations, especially depending on factors related to socioeconomic development and eating habits. Cássia dos Coqueiros is a small city in Brazil with rural characteristics and increased risk factors traditionally associated with T. gondii infection. METHODS: We carried out a cross-sectional study involving 970 inhabitants aged 18 years or more, selected from patients of the local health unit and home visits in urban and rural areas. Each participant completed a survey with questions regarding demographic, socioeconomic, and risk factors for toxoplasmosis. Blood samples from participants were tested for presence of IgG and IgM antibodies against T. gondii using a chemiluminescent microparticle immunoassay. RESULTS: The prevalence of IgG and IgM antibodies was 62.3% and 2.5%, respectively. Variables that proved to be independent predictors of infection were age, low levels of education, and previous diagnosis of toxoplasmosis. CONCLUSIONS: The high prevalence of toxoplasmosis serological markers in this adult population highlights the need to promote preventive practices, especially those directed toward women of childbearing age, in this part of Brazil.

Representações de puérperas sobre o cuidado recebido no trabalho de parto e parto / The representations puerperal women have about the care they received during labor

Resumo Objetivo: descrever as representações sociais de puérperas sobre o cuidado recebido durante o trabalho de parto e parto. Metodologia: trata-se de um estudo descritivo baseado na Teoria do Núcleo Central, desenvolvido com 119 puérperas em uma maternidade pública localizada no Brasil, na cidade de Fortaleza, Ceará. Os dados foram coletados por meio do Teste de Associação Livre de Palavras, que continha como estímulos indutores: trabalho de parto, parto, cuidado no trabalho de parto e parto, sendo transcritos e analisados pelo software Evoc. Resultados: a partir da análise estrutural, os vocábulos dor, felicidade e orientação apresentaram maior frequência como elemento central dos respectivos termos indutores. Conclusão: por meio dos resultados obtidos, é possível afirmar que o momento do trabalho de parto e do parto é crucial para que o enfermeiro planeje e execute uma adequada assistência durante o processo de parturição a fim de reduzir o impacto das representações negativas em relação a esse processo.

Resumen Objetivo: describir las representaciones sociales de puérperas sobre el cuidado recibido durante el trabajo de parto y parto. Metodología: se trata de un estudio descriptivo basado en la Teoría del Núcleo Central, desarrollado con 119 madres, en un hospital público de Fortaleza, Ceará, Brasil. Los datos fueron recolectados por medio del Test de Asociación de Palabras, que contenía como estímulos inductores: cuidado, trabajo de parto, parto, cuidado en el trabajo de parto y en el parto, siendo transcritos y analizados por el software Evoc. Resultados: a partir del análisis estructural, los vocablos dolor, felicidad y orientación presentaron mayor frecuencia como elemento central de los respectivos términos inductores. Conclusión: por medio de los resultados obtenidos, es posible afirmar que el momento del trabajo de parto y el parto es crucial para que el enfermero planee y ejecute una adecuada asistencia durante el proceso de parto con el fin de reducir el impacto de las representaciones negativas en relación con ese proceso.

Abstract Objective: to describe the social representations puerperal women have about the care they received during labor and delivery. Methodology: this is a descriptive study, based on the Theory of the Central Nucleus, which was undertaken with 119 women in the postpar-tum period in a public maternity hospital, located in the city of Fortaleza, Ceará, Brazil. The data were collected through the Free Word Association Test, which included as inductive stimuli: care, labor, delivery and care in labor and delivery. The data were transcribed and analyzed with Evoc software. Results: the structural analysis showed that the words "pain", "happiness" and "guidance" ocurred more frequency as a central feature of the respective inducing terms. Conclusion: the results confirm that the moment of labor and delivery is crucial for nurses in the planning and implementation of adequate care during parturition insofar, as such measures lessen the impact of negative representations of childbirth.

Serum uric acid and renal function in patients with type 1 diabetes: a nationwide study in Brazil.

BACKGROUND: Diabetes nephropathy is a microvascular complication associated with high morbidity and mortality in patients with type 1 diabetes, and its pathogenesis is not fully understood. Our aim was to evaluate the association between levels of serum uric acid and renal function assessed by glomerular filtration rate (GFR) and albuminuria in patients with type 1 diabetes. METHODS: This is a multicenter, cross-sectional, observational study with 1686 patients, conducted between August 2011 and August 2014 in 14 public clinics from ten Brazilian cities. Renal function was estimated by CKD-EPI (adults) and by Schwartz (adolescents). RESULTS: We analyzed 1686 patients, aged 30.1 ± 12.0, with 15.4 ± 9.3 years of duration of diabetes; 55.8% were female and 54.0% were Caucasians. Serum uric acid was related to renal function, with a mean of 4.8 ± 1.4 (in the normal renal function group) vs 5.2 ± 2.0 (GFR ≥ 60 ml/min and albuminuria) vs 6.5 ± 2.6 mg/dl (GFR < 60 ml/min). In the pooled group, multivariate analysis showed an inverse correlation between serum uric acid and GFR (r = - 0.316, p < 0.001) with a decrease of 4.11 ml/min in the GFR for every increase of 1 mg/dl in serum uric acid. Considering only patients with normal renal function (n = 1170), a decrease of 2.04 ml/min in the GFR for every increase of 1 mg/dl in Serum uric acid was noted using multivariate analysis. CONCLUSIONS: Patients with higher levels of serum uric acid have worse renal function, independently of HbA1c or duration of diabetes, which persisted even in patients with normal renal function. Further prospective studies are necessary to establish if patients with higher serum uric acid may have an elevated risk for developing chronic kidney disease.

Prevalência de enteroparasitos em crianças de uma unidade de educação infantil municipal de Rondonópolis ­ MT / Prevalence of enteroparasites in children of a municipal infant education unit of Rondonópolis - MT

Objetivos: Este estudo teve como um de seus objetivos avaliar a presença de enteroparasitos em crianças que frequentavam um Centro de Educação Municipal Infantil (CMEI) de Rondonópolis - MT. Métodos: Foram realizadas as coletas das amostras fecais no período de março a maio de 2016 e, posteriormente, analisadas pelo método de Hoffman, Pons e Janer (HPJ) no laboratório de Ciências Básicas da Universidade Federal de Mato Grosso, Campus Universitário de Rondonópolis, finalizando com um questionário sócio demográfico de fatores de risco para a infecção. Resultados: Entre as 57 crianças pesquisadas, detectou-se positividade para enteroparasitoses em 10 (17,54%) delas, o parasita mais prevalente foi a Giardia lamblia (70%). Em relação ao sexo, a maior positividade das amostras se deu entre crianças do sexo masculino. Conclusão: Os achados dessa pesquisa demonstram que, embora o Ministério da Saúde venha aplicando medidas de controle dos enteroparasitos como o Programa Saúde na Escola, mais medidas deverão ser tomadas, principalmente pelos profissionais de saúde da Atenção Primária. Uma medida simples e eficaz é a educação em saúde executada de forma específica para a conscientização dessas crianças e de seus responsáveis sobre cuidados e higienização para uma melhor qualidade de vida. (AU)

Objectives: This study had as one of its objectives the evaluation of the presence of enteroparasites in children attending a Municipal Infant Education Center (CMEI) in Rondonópolis - MT. Methods: Feces samples were collected from March to May of 2016 and later analyzed by the method of Hoffman, Pons and Janer (HPJ) in the laboratory of Basic Sciences of the Federal University of Mato Grosso, Campus Universitário de Rondonópolis, ending with a Sociodemographic questionnaire and risk factors for infection. Results: Among the 57 children surveyed, 10 (17.54%) of them were positive for enteroparasitoses, the most prevalent parasite was Giardia lamblia (70%). In relation to sex, the greatest positivity occurred among male children. Conclusion: The findings of this research demonstrate that although the Ministry of Health has been implementing measures to control enteroparasites, such as the School Health Program. More actions should be taken, mainly by primary health care professionals. A simple and effective measure is health education to raise awareness of these children and their caregivers about care and hygiene for a better quality of life. (AU)

Práticas de profissionais de saúde na assistência ao parto e nascimento / Practices of health professionals in delivery and birth care

Compreender as práticas adotadas por profissionais de saúde no atendimento à parturiente. Métodos:estudo qualitativo, realizado em uma maternidade pública com 13 profissionais de saúde, a partir de entrevista semiestruturada. Dados narrativos organizados de acordo com o método de análise de conteúdo, tendo como referencial as evidências científicas para boas práticas de atenção ao parto e nascimento, fundamentada nas recomendações da Organização Mundial da Saúde. Resultados: revelaram-se dois contextos assistências:utilização de práticas respaldadas em evidências científicas e práticas rotineiras, cujas evidências não são favoráveis ao uso, o que denota a adoção de práticas oriundas de crenças e saberes de plantonistas. Conclusão:os profissionais apoiavam suas práticas em evidências científicas, porém permaneciam utilizando estratégias cuja eficácia não está garantida, apontando ainda um longo caminho para humanizar a assistência durante a parturição.

Objective: to understand the practices adopted by health professionals in the care of parturient women.Methods: qualitative study conducted in a public hospital with 13 health professionals through semi-structuredinterviews. Narrative data were organized according to content analysis. Scientific evidence for best practices indelivery and birth care according to recommendations of the World Health Organization, were used as reference.Results: two care contexts were raised: the use of practices backed by scientific evidence and routine practiceswhose evidence is not favorable to use, denoting the adoption of practices derived from beliefs and knowledgeof physicians on duty. Conclusion: professionals had their practices backed by scientific evidence, but theystill use strategies whose effectiveness is not guaranteed. There is, therefore, a long way to humanize the careprovided during childbirth.

Pesticides drive risk of micropollutants in wastewater-impacted streams during low flow conditions.

Micropollutants enter surface waters through various pathways, of which wastewater treatment plants (WWTPs) are a major source. The large diversity of micropollutants and their many modes of toxic action pose a challenge for assessing environmental risks. In this study, we investigated the potential impact of WWTPs on receiving ecosystems by describing concentration patterns of micropollutants, predicting acute risks for aquatic organisms and validating these results with macroinvertebrate biomonitoring data. Grab samples were taken upstream, downstream and at the effluent of 24 Swiss WWTPs during low flow conditions across independent catchments with different land uses. Using liquid chromatography high resolution tandem mass spectrometry, a comprehensive target screening of almost 400 organic substances, focusing mainly on pesticides and pharmaceuticals, was conducted at two time points, and complemented with the analysis of a priority mixture of 57 substances over eight time points. Acute toxic pressure was predicted using the risk assessment approach of the multi-substance potentially affected fraction, first applying concentration addition for substances with the same toxic mode of action and subsequently response addition for the calculation of the risk of the total mixture. This toxic pressure was compared to macroinvertebrate sensitivity to pesticides (SPEAR index) upstream and downstream of the WWTPs. The concentrations were, as expected, especially for pharmaceuticals and other household chemicals higher downstream than upstream, with the detection frequency of plant protection products upstream correlating with the fraction of arable land in the catchments. While the concentration sums downstream were clearly dominated by pharmaceuticals or other household chemicals, the acute toxic pressure was mainly driven by pesticides, often caused by the episodic occurrence of these compounds even during low flow conditions. In general, five single substances explained much of the total risk, with diclofenac, diazinon and clothianidin as the main drivers. Despite the low predicted acute risk of 0%-2.1% for affected species, a significant positive correlation with macroinvertebrate sensitivity to pesticides was observed. However, more effect data for pharmaceuticals and a better quantification of episodic pesticide pollution events are needed for a more comprehensive risk assessment.

Epidemiological study of hepatitis B and C in a municipality with rural characteristics: Cássia dos Coqueiros, State of São Paulo, Brazil

Abstract: INTRODUCTION: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.

Sentimentos advindos da maternidade: revelações de um grupo de gestantes / Feelings arising out of motherhood: revelations of a group of pregnant women / Sentimientos derivados de la maternidad: revelaciones de un grupo de mujeres embarazadas

Este estudo objetivou identificar os sentimentos revelados por um grupo de gestantes em dois momentos - ao descobrir a gravidez e no instante atual da gestação -, bem como identificar dificuldades ao longo deste processo. Participaram nove gestantes com idade entre 20 e 40 anos, as quais em sua maior parte eram primíparas e conviviam com o companheiro. Depois de formado, o grupo foi levado a participar de três encontros: no primeiro se apresentou a proposta da pesquisa e as gestantes falaram dos sentimentos que as envolviam na atual gestação; o segundo encontro foi conduzido com base nos aspectos negativos relacionados à gestação identificados no primeiro encontro, encorajando as gestantes a falarem deste aspecto; e o terceiro encontro foi de encerramento do grupo e se sua avaliação pelas gestantes. Os resultados revelaram que o sentimento inicial era o de que as mulheres não desejavam a gravidez, por diversas razões, desencadeando sentimentos de tristeza, medo, culpa e ansiedade; mas estes sentimentos negativos se transformaram em sentimentos de alegria e satisfação, principalmente pelo resultado do exame de ultrassonografia e pela aceitação da gravidez pelo companheiro. Conclui-se que a formação do grupo das gestantes ofereceu acolhimento, interação das participantes e expressão significativa de suas emoções e foi uma oportunidade para revelar sentimentos e limitações/dificuldades, tanto individuais quanto coletivas.

The goal of this study was to identify feelings revealed by a group of pregnant women in two moments: at the time of discovering and in the present moment of pregnancy, as well as identifying difficulties throughout this process. Participated nine pregnant women by the age between 20 and 40 years, most of primiparous and living with spouse. After the group was formed, it was conducted in three different times: at the first meeting, the proposal of the research was showed and the pregnant women talked about the feelings that involved the current pregnancy; the second meeting was conducted based on the negative aspects related to pregnancy, identified at first, and mothers were encouraged to verbalize about this point; at the third time, the group was closed and it was evaluated by the pregnant women. The results revealed that the initial feeling of pregnant women was non-acceptance of pregnancy for several reasons, causing feelings of sadness, fear, guilt and anxiety. However, there was a transition to these negative feelings to joy and satisfaction, mainly due to ultrasound and acceptance of pregnancy by their partners. We conclude that the group of pregnant women offered reception and interaction between participants and stimulated significant expression of their emotions, being an opportunity to reveal feelings and limitations/difficulties, both individual and collective.

Este estudio buscó identificar los sentimientos revelados por un grupo de mujeres embarazadas en dos momentos: al descubrir el embarazo y en el momento actual de la gestación, así como identificar dificultades a lo largo de este proceso. Participaron nueve mujeres embarazadas de edades comprendidas entre 20 y 40 años, la mayoría primíparas y conviviendo con su cónyuge. Después de formado, el grupo fue conducido en tres momentos diferentes: en la primera reunión, se presentó la propuesta de la investigación y las mujeres embarazadas verbalizaron sobre los sentimientos que implicaban el actual embarazo; la segunda reunión fue conducida con base en los aspectos negativos relacionados con el embarazo identificados en el primer momento, convenciendo a las madres que verbalizaran acerca de estos aspectos; el tercer momento fue el cierre del grupo y su evaluación por las mujeres embarazadas. Los resultados revelaron que el sentimiento inicial fue que las mujeres no deseaban el embarazo por varias razones, desencadenando sentimientos de tristeza, miedo, culpa y ansiedad. Hubo, sin embargo, una transición de estos sentimientos negativos para los de alegría y satisfacción, debido principalmente al examen de ecografía y a la aceptación del embarazo por su cónyuge. Se concluye que la formación del grupo de mujeres embarazadas ofreció acogimiento, interacción de las participantes y expresión significativa de sus emociones, constituyendo una oportunidad para revelar sentimientos y limitaciones/dificultades, tanto individuales como colectivas.

Care for both mother and child immediately after childbirth: a descriptive study

Aim: To understand the perceptions of users about the care provided to them and their newborns immediately after childbirth. Method: This is a descriptive study in which a qualitative approach was used, involving 20 postpartum women admitted to a secondary level Public Hospital of Fortaleza. Semi-structured interviews were carried out and were analyzed by means of Bardin's content analysis technique. Results: Three categories were highlighted: Care provided to newborns; care (or lack of care) provided to postpartum women; and structural failures of the maternity hospital. Discussion: Postpartum care was primarily focused on guidance on breastfeeding, without considering other demands of women, such as: the need for greater attention by the health team; more humane behavior of some health professionals; and guidance on self-care. Conclusion: Postpartum care is still limited and it requires greater attention and commitment from health professionals, as well as adjustments in the structural and organizational conditions of the maternity hospital so that it may provide decent and humane care...

Representações sociais de puérperas sobre o atendimento pré-natal na atenção primária de saúde / Social representations of postpartum women on prenatal care in primary health care

Objetivou-se apreender as representações sociais de puérperas sobre o atendimento pré-natal na atenção primária de saúde. Estudo descritivo, qualitativo, norteado pela Teoria das Representações Sociais, desenvolvido em nove Centros de Saúde da Família, em Fortaleza, Ceará, Brasil, de maio a julho de 2012. Participaram 31 puérperas, por meio de entrevista semiestruturada. Estas foram gravadas, transcritas na íntegra e processadas através do software ALCESTE - versão 2010. Os resultados observados na análise lexical das entrevistas revelaram a distribuição dos conteúdos em quatro classes. Exploraram-se neste estudo as classes 4 e 1, que tratam do atendimento no pré-natal. As representações sociais das usuárias sobre o pré-natal estão ancoradas na dimensão protocolar e na dimensão socioeducativa. Faz-se necessária a implantação e a manutenção de atividades para o compartilhamento de saberes e de interação entre as usuária.

Evidências qualitativas sobre o acompanhamento por doulas no trabalho de parto e no parto / Qualitative evidence of monitoring by doulas during labor and childbirth

Objetivou-se elaborar uma metassíntese com as evidências sobre o trabalho das doulas no acompanhamento às mulheres em trabalho de parto e de parto. Realizou-se um levantamento nas bases de dados Medline, PubMed, SciELO, Lilacs, usando os descritores doulas, gestação, trabalho de parto, parto e terapia alternativa, no período de 2000 a 2009. Foram selecionados sete artigos e destes emergiram quatro categorias: suporte proporcionado por doulas; experiências das parturientes; relacionamento profissional; e opiniões e experiências dos profissionais. Os principais suportes estavam relacionados aos aspectos físico, emocional, espiritual e social. As experiências evidenciaram que as doulas estimulam a relação mãe e filho, orientam para uma amamentação bem-sucedida e contribuem para prevenir a depressão pós-parto. Observou-se controvérsia entre os profissionais quanto à aceitação deste novo membro na equipe obstétrica, e destacou-se o cuidado como inovador, que acalma, encoraja e supre as necessidades da gestante. Concluiu-se que os estudos qualitativos sobre este tema são recentes, incipientes, mas reveladores de uma importante possibilidade para a humanização do trabalho de parte e parto.

The objective of this study was to conduct a metasynthesis of evidence of the work of doulas assisting women in labor and during childbirth. Articles between 2000 and 2009 were located in the Medline, PubMed, SciELO, and Lilacs databases using the key search words: doulas, gestation, labor, and alternative therapy. Seven articles were selected for the study and four categories were created: the support provided by doulas; the birth mother's experiences; professional relationship: and opinions and experiences of professionals. The doulas offered physical, emotional, spiritual and social support. Experiments showed that the professionals stimulated the mother/child relationship, oriented towards successful breastfeeding, and contributed to the prevention of post-partum depression. Controversy was observed among professionals regarding acceptance of the role of the doula as a member of the obstetrics team. The doula's care was considered innovative, calming, encouraging, and attended all the needs of the pregnant woman. The conclusion is that qualitative studies on the work of doulas are recent, incipient, but revealing as to the important possibility of humanizing labor and childbirth.

Chronic graft versus host disease: a scleroderma-like case report

INTRODUCTION: Chronic graft versus host disease (cGVHD) is the most common consequence of allogeneic bone marrow transplantation, and it is associated with morbidity and mortality. Oral manifestations are diagnosed in approximately 80 percent of patients with chronic GVHD. OBJECTIVE: To present a case of chronic GVHD with scleroderma-like lesions in skin and oral cavity CASE REPORT: A 27-year-old female was admitted, in a Hematology Center, in 1997, with previous diagnosis of chronic myeloid leukemia since 1994. Over past four months after allogeneic BTM she developed cGVHD in eyes, mouth, liver, lungs and skin. The patient presented sclerotic skin changes, hyperkeratosis of hands and xerophthalmia. CONCLUSION: Clinical manifestations of chronic GVHD are similar to autoimmune collagen vascular disease and the two main types of cutaneous chronic GVHD are lichenoid and sclerodermatous.

Levantamento etnobotânico de plantas utilizadas como anti-hiperlipidêmicas e anorexígenas pela população de Nova Xavantina-MT, Brasil / Ethnobotanical survey of plants used as anti-hyperlipidemic and anorexigenic by the population of Nova Xavantina-MT, Brazil

O presente trabalho verificou a utilização de plantas medicinais encontradas no Cerrado mato-grossense para o tratamento de hiperlipidemias e obesidade. Entrevistas com 180 pessoas acima de 50 anos foram realizadas em Nova Xavantina-MT. O questionário abordou nome popular, parte utilizada, forma de preparo e uso das espécies citadas, além de informações gerais sobre o uso de plantas. As dez plantas mais citadas foram coletadas, identificadas e estudadas por meio de uma revisão bibliográfica. A maioria dos entrevistados (95,6 por cento) declarou utilizar plantas medicinais regularmente, sendo que 71,5 por cento deles herdaram o conhecimento sobre plantas dos pais e avós e 94,20 por cento relataram aconselhar o uso aos mais jovens. Além disso, 93,6 por cento atestaram que as plantas são mais eficazes que os medicamentos de farmácia e 57 por cento consideraram forte o efeito das mesmas, ou seja, sempre resolvem o problema de saúde. Quanto aos efeitos adversos, 95,9 por cento disseram nunca ter sentido após o uso de plantas. Dos entrevistados, 56,7 por cento conheciam ou já haviam utilizado plantas medicinais no tratamento de hiperlipidemias e obesidade, sendo citadas 54 espécies medicinais diferentes pertencentes a 53 gêneros e 38 famílias, com destaque para Fabaceae (13 por cento). As dez plantas mais citadas foram: guatambu (Aspidosperma tomentosum Mart.), quina-do-cerrado (Strychnos pseudoquina St. Hil.), ipê-roxo [Tabebuia impetiginosa (Mart. Ex DC.) Standl], embaúba (Cecropia pachystachya Trec.), calunga (Simaba sp.), pata-de-vaca [Bauhinia rufa (Bong.) Steud.], mangaba (Hancornia speciosa Gomez), batata-de-tiú [Jatropha elliptica (Pohl.) Muell. Arg.], folha-de-carne (Casearia sylvestris Sw.) e manacá (Spiranthera odoratissima A. St.-Hil.). A folha foi a parte mais utilizada (46 por cento) e o preparo das plantas ocorre principalmente por meio de infusão citado por 36,5 por cento dos entrevistados. Apesar do uso popular destas plantas no combate as hiperlipidemias e obesidade, há necessidade de estudos fitoquímicos e farmacológicos que comprovem estas atividades, com vistas ao desenvolvimento de um fitoterápico.

This study checked the use of medicinal plants found in the Cerrado mato-grossense for the treatment of hyperlipidemia and obesity. Interviews with 180 people over 50 years were held in Nova Xavantina-MT. The questionnaire addressed popular name, part used, type of preparation and use of the species mentioned, beyond general information about the use of plants. The ten plants most cited were collected, identified and studied through a literature review. Most respondents (95.6 percent) said using medicinal plants regularly, while 71.5 percent of them inherited the knowledge of plants of parents and grandparents and 94.20 percent reported the use to advise youngsters. Furthermore, 93.6 percent attested that the plants are more effective than the drugs from pharmacy and 57 percent considered the strong effect of the same, i.e., they always solved health problems. Regarding adverse effects, 95.9 percent said they have never felt them after the use of plants. Of the respondents, 56.7 percent knew or had used medicinal plants in the treatment of hyperlipidemias and obesity, being cited 54 medicinal species belonging to 53 different genera and 38 families, with emphasis on Fabaceae (13 percent). The ten most cited were: guatambu (Aspidosperma tomentosum Mart.), quina-do-cerrado (Strychnos pseudoquina St. Hil.), ipê-roxo [Tabebuia impetiginosa (Mart. Ex DC.) Standl], embaúba (Cecropia pachystachya Trec.), calunga (Simaba sp.), pata-de-vaca [Bauhinia rufa (Bong.) Steud.], mangaba (Hancornia speciosa Gomez), batata-de-tiú [Jatropha elliptica (Pohl.) Muell. Arg.], folha-de-carne (Casearia sylvestris Sw.) and manacá (Spiranthera odoratissima A. St.-Hil.). The leaf was the most used (46 percent) and the preparation of the plants occurs mainly through the infusion cited by 36,5 percent of respondents. Despite the popular use of these plants for treatment of obesity and hyperlipidemia, further chemical and pharmacological studies are required to demonstrate these activities, in order to develop a phytotherapic product.