Thiazolidine derivatives: In vitro toxicity assessment against promastigote and amastigote forms of Leishmania infantum and ultrastructural study.

Neglected diseases, such as Leishmaniasis, constitute a group of communicable diseases that occur mainly in tropical countries. Considered a public health problem with limited treatment. Therefore, there is a need for new therapies. In this sense, our proposal was to evaluate in vitro two series of thiazolidine compounds (7a-7e and 8a-8e) against Leishmania infantum. We performed in vitro evaluations through macrophage cytotoxicity assays (J774) and nitric oxide production, activity against promastigotes and amastigotes, as well as ultrastructural analyzes in promastigotes. In the evaluation of cytotoxicity, the thiazolidine compounds presented CC50 values between 8.52 and 126.83 µM. Regarding the evaluation against the promastigote forms, the IC50 values ranged between 0.42 and 142.43 µM. Compound 7a was the most promising, as it had the lowest IC50. The parasites treated with compound 7a showed several changes, such as cell body shrinkage, shortening and loss of the flagellum, intense mitochondrial edema and cytoplasmic vacuolization, leading the parasite to cell inviability. In assays against the amastigote forms, the compound showed a low IC50 (0.65 µM). These results indicate that compound 7a was efficient for both evolutionary forms of the parasite. In silico studies suggest that the compound has good oral bioavailability. These results show that compound 7a is a potential drug candidate for the treatment of Leishmaniasis.

Trajetórias educacionais como evidência da qualidade da educação básica brasileira / Educational trajectories as evidence of the quality of Brazilian basic education / Trayectorias educativas como evidencia de la calidad de la educación básica brasileña

Segundo a Constituição Federal brasileira, o direito à educação significa a garantia do acesso à escola, onde a população deve permanecer durante o tempo legalmente determinado, a fim de adquirir os conhecimentos e habilidades necessários para a vida adulta plena. Este artigo tem como foco a análise da permanência dos estudantes na escola, condição essencial para a aprendizagem e representada por suas trajetórias educacionais. Dados longitudinais do Censo Escolar, de 2007 a 2015, foram utilizados para analisar as trajetórias educacionais classificadas em três tipos: regular; com poucas irregularidades; e com muitas irregularidades. Os resultados mostram que alguns grupos sociais são muito mais propensos a ter uma trajetória regular e outros a ter repetência ou a ficar fora da escola em alguns anos. Uma proporção alta de meninos de cor/raça preta tem trajetórias com muitas irregularidades. O artigo mostra que o Índice de Desenvolvimento da Educação Básica (Ideb) - o indicador oficial para medir a qualidade da educação nos municípios - pode atingir um valor alto, mesmo que muitos estudantes tenham trajetórias irregulares. Isso evidenciou o efeito da seletividade embutido nesse indicador. Em conclusão, este trabalho sugere a incorporação das trajetórias educacionais no monitoramento da qualidade da educação nos municípios.

According to the Federal Brazilian Constitution, the right to education means that all children had access to a school, and remained there for the legally determined time and, acquired the knowledge and skills necessary for full adult life. This paper focuses on the analysis of students' permanence in school, an essential condition for learning represented here by their educational trajectories. The School Census longitudinal data, from 2007 to 2015 were used to analyze the student's educational trajectories classified into three types: regular; with few irregularities; and with many irregularities. The results show that some social groups are much more prone to having a regular trajectory, and others to having grade repetition or being out of school after few years. A large proportion of black boys have trajectories with many irregularities. In addition, this paper shows that the Basic Education Development Index (IDEB, acronym in Portuguese) - the official index for measuring the quality of education in the municipalities - can reach a high value even if many students have irregular trajectories. This evidenced the selectivity effect embedded in this indicator. This paper suggests the incorporation of educational trajectories into the indicator to monitor the quality of education in Brazilian municipalities.

De acuerdo con la Constitución Federal brasileña, el derecho a la educación significa la garantía de acceso a la escuela, donde los estudiantes deben permanecer por el tiempo legalmente determinado para adquirir los conocimientos y habilidades necesarios para la vida adulta plena. Este artículo se centra en el análisis de la permanencia de los estudiantes en la escuela, condición esencial para el aprendizaje, y representada por sus trayectorias educativas. Datos longitudinales de los censos escolares desde 2007 hasta 2015 se utilizaron para estudiar las trayectorias educativas del alumno, que se clasificaron en tres tipos: regular, con pocas irregularidades, con muchas irregularidades. Los resultados muestran que algunos grupos sociales son mucho más propensos a tener una trayectoria regular y otros a repetir el grado o quedar fuera de la escuela por algunos años. Una gran proporción de estudiantes negros tiene trayectorias con muchas irregularidades. Además, este trabajo muestra que el Índice de Desarrollo de la Educación Básica (IDEB) —índice oficial para medir la calidad de la educación en los municipios— puede alcanzar un valor alto a pesar de que muchos estudiantes tienen trayectorias irregulares. Esto evidenció el efecto de selectividad incorporado en este indicador. Este trabajo sugiere la incorporación de las trayectorias educativas en el indicador de seguimiento de la calidad de la educación en los municipios brasileños.

Assessment of marine macroalgae potential for gadolinium removal from contaminated aquatic systems.

Gadolinium (Gd) is a rare earth associated with hospital and urban wastewaters due to its application as a contrast agent for magnetic resonance imaging. In this work, the uptake of Gd from contaminated seawater by three living marine macroalgae, Ulva lactuca (Chlorophyta), Fucus spiralis (Phaeophyta) and Gracilaria sp. (Rhodophyta) was studied along 72 h. Surface analysis (FTIR), water content, kinetic modelling, and Gd quantification in seawater and biomass were performed. All species were able to accumulate Gd from seawater with 10, 157, and 500 µg Gd L-1, although green and red macroalgae performed better, following the order: green > red > brown. Removal efficiencies reached 85%, corresponding to a bioconcentration factor of 1700. In more complex solutions that intended to mimic real contaminated environments, namely mixtures with other rare earth elements (Y, La, Ce, Pr, Nd, Eu, Tb, Dy), and with potentially toxic elements commonly found in wastewaters (Cr, Ni, Cu, Cd, Hg, Pb), at two salinities (10 and 30), the macroalgae kept its efficiency: 84% and 88% of removal by green and red macroalgae, respectively. Overall, findings evidence that living macroalgae could be a countermeasure to the increasing anthropogenic enrichment of Gd observed in the aquatic environment.

A avaliação da sensibilidade à feniltiocarbamida em docentes de uma faculdade privada / The assessment of sensitivity to phenylthiocarbamide in teachers of a private college / La evaluación de la sensibilidad a la feniltiocarbamida en profesores de un colegio privado

Avaliar a sensibilidade gustativa a proteína PTC nos docentes de uma faculdade privada de Goiás, associando esta sensibilidade gustativa à ingestão de alimentos que contém essa substância, hábitos socioculturais e alimentares. Método: A avaliação da sensibilidade ao composto PTC (Feniltiocarbamida) ocorreu junto a 40 docentes de uma faculdade privada do estado de Goiás após administração oral de uma gota da solução de concentração 0,01% do composto, seguida pela aplicação do questionário para avaliar à substância testada. Os dados foram analisados no programa EpiInfo versão 7.2.3.0. Para se verificar a associação entre a sensibilidade gustativa ao PTC e as variáveis dependentes. utilizou-se os testes do qui-quadrado ou o teste exato de Fisher. Resultados: Observou-se que 65% dos docentes recrutados apresentam sensibilidade ao PTC. De 40 participantes, 47,5% eram do sexo feminino e 52,5% do sexo masculino. A população era da faixa etária entre 24 e 62 anos. Após a administração da solução do composto PTC (0,01%), a sensibilidade ao sabor amargo foi a mais relatada. Não houve associação entre a sensibilidade gustativa ao PTC e as variáveis estudadas. Conclusão: A inclusão na dieta de alimentos considerados saudáveis, associados ao sabor amargo, pode também ser influenciada pelo grau de sensibilidade e tolerância à esses alimentos.

To evaluate the taste sensitivity to PTC protein in the teachers of a private college in Goiás, associating this taste sensitivity to the ingestion of foods that contain this substance, sociocultural and eating habits. Method: The sensitivity assessment to the compound PTC (Phenylthiocarbamide) occurred with 40 teachers from a private college in the state of Goiás after oral administration of a drop of the 0.01% concentration solution of the compound, followed by the application of the questionnaire to evaluate the tested substance. The data were fulfilled using the EpiInfo program version 7.2.3.0. To verify an association between taste sensitivity to PTC and as dependent dependents. chi-square tests or Fisher's exact test are used. Results: It was observed that 65% of the recruited professors are sensitive to PTC. Of the 40 participants, 47.5% were female and 52.5% male. The population was between 24 and 62 years old. After administration of the PTC compound solution (0.01%), sensitivity to bitter taste was the most reported. There was no association between taste sensitivity to PTC and the variables studied. Conclusion: The inclusion in the diet of foods considered considered, associated with the bitter taste, can also be influenced by the degree of sensitivity and tolerance to these foods.

Evaluar la sensibilidad gustativa a la proteína PTC en los profesores de un colegio privado de Goiás, asociando esta sensibilidad gustativa a la ingestión de alimentos que contienen esta sustancia, hábitos socioculturales y alimentarios. Método: La evaluación de sensibilidad al compuesto PTC (Feniltiocarbamida) se realizó con 40 profesores de un colegio privado en el estado de Goiás luego de la administración oral de una gota de la solución de concentración al 0.01% del compuesto, seguida de la aplicación del cuestionario para evaluar la sustancia probada. Los datos se cumplieron utilizando el programa EpiInfo versión 7.2.3.0. Verificar una asociación entre la sensibilidad gustativa a PTC y como dependientes dependientes. Se utilizan pruebas de chicuadrado o la prueba exacta de Fisher. Resultados: Se observó que el 65% de los profesores reclutados son sensibles al PTC. De los 40 participantes, el 47,5% eran mujeres y el 52,5% hombres. La población tenía entre 24 y 62 años. Después de la administración de la solución del compuesto PTC (0,01%), la sensibilidad al sabor amargo fue la más notificada. No hubo asociación entre la sensibilidad gustativa al PTC y las variables estudiadas. Conclusión: La inclusión en la dieta de los alimentos considerados considerados, asociados al sabor amargo, también puede estar influenciada por el grado de sensibilidad y tolerancia a estos alimentos.

O lazer e o tempo do não trabalho no capitalismo: as ilusões do consumo / Leisure and the time of not working in capitalism: the illusions of consumption

A sociedade organizou-se social e economicamente tendo a categoria trabalho como seu alicerce. Em sua centralidade, o trabalho nos humanizou e nos desumanizou, nos liberou dos limites impostos pela natureza, mas ao mesmo tempo nos aprisionou na era do valor e do consumo, no capitalismo. Em uma sociedade de produção maciça, o tempo de não trabalhar é em grande medida um tempo de consumo. O direito ao tempo livre foi uma das reivindicações da classe trabalhadora brasileira a partir da promulgação da Consolidação das Leis do Trabalho (CLT) em 1943. Nos tempos atuais, o lazer é visto como um tempo de fruição e do prazer individual, alicerçado no mito do bem-estar. Diante do cenário apresentado, o objetivo deste artigo é colocar em questão a sociedade fundamentada no consumo e no trabalho, tendo em vista que o lazer também se enquadra como uma forma de apropriação do tempo de não trabalho por parte do capital.

Society organized itself socially and economically with the category of work as its foundation. In its centrality, labor has humanized us and dehumanized us, liberated us from the limits imposed by nature, but at the same time imprisoned us in the era of value and consumption, in capitalism. In a mass production society, the time of not working is largely a time of consumption. The right to free time was one of the demands of the Brazilian working class since the enactment of the Consolidation of Labor Laws (CLT) in 1943. Nowadays, leisure is seen as a time of enjoyment and individual pleasure, grounded in myth Of well-being. In view of the presented scenario, the objective of this article is to question the society based on consumption and work, considering that leisure also fits as a way of appropriating the time of not working on the part of the capital.

Assessment of quality of life in patients with advanced oral cancer who underwent mandibulectomy with or without bone reconstruction

INTRODUCTION Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. Objective To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. Material and methods 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. Results Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. Conclusion There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).

RESUMO INTRODUÇÃO As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. OBJETIVO Analisar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral, submetidos a operações radicais com intenção curativa. MATERIAL E MÉTODOS 47 pacientes portadores de carcinoma espinocelular de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Os pacientes foram submetidos ao teste de qualidade de vida após o tempo mínimo de seis meses do tratamento cirúrgico. RESULTADOS Dos 183 pacientes, com apenas 47 (25,7%) foi possível a realização da entrevista, compondo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos. A maioria dos pacientes apresentava estadiamento clínico IV (83%), sendo submetidos à radioterapia adjuvante (95,4%). A média do escore obtido após a avaliação dos questionários foi de 64,6. Os piores escores foram encontrados nos quesitos deglutição e mastigação. CONCLUSÃO Não houve diferenças estatisticamente significativas nos domínios de qualidade de vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea). Pacientes entrevistados dois anos ou mais após o tratamento apresentaram escores superiores (p=0,02).

Empathy by default: Correlates in the brain at rest.

BACKGROUND: Empathy, defined as the ability to access and respond to the inner world of another person, is a multidimensional construct involving cognitive, emotional and self-regulatory mechanisms. Neuroimaging studies report that empathy recruits brain regions which are part of the social cognition network. Among the different resting state networks, the Default Mode Network (DMN) may be of particular interest for the study of empathy since it has been implicated in social cognition tasks. METHOD: The current study compared the cognitive and emotional empathy scores, as measured by the Interpersonal Reactivity Index, with the patterns of activation within the DMN, through the neuroimaging methodology of resting-state functional magnetic resonance. RESULTS: Results suggest a significant positive correlation between cognitive empathy and activation of the bilateral superior medial frontal cortex nodes of the DMN. Contrastingly, a negative correlation was found between emotional empathy and the same brain region. CONCLUSIONS: Overall, this data highlights a critical role of the medial cortical regions of the DMN, specifically its anterior node, for both cognitive and emotional domains of the empathic process.

Assessment of quality of life in patients with advanced oral cancer who underwent mandibulectomy with or without bone reconstruction.

INTRODUCTION: Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. OBJECTIVE: To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. MATERIAL AND METHODS: 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. RESULTS: Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. CONCLUSION: There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).

Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block.

OBJECTIVES: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. OBJECTIVE: We sought to investigate rubidium-82 (82Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. METHODS: Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82Rb-positron emission tomography studies and without left bundle branch block (GII). RESULTS: Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p<0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). CONCLUSION: The data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with left bundle branch block.

Low-carbohydrate diet versus euglycemic hyperinsulinemic clamp for the assessment of myocardial viability with 18F-fluorodeoxyglucose-PET: a pilot study.

Positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) is considered the gold standard for myocardial viability. A pilot study was undertaken to compare FDG-PET using euglycemic hyperinsulinemic clamp before (18)F-fluorodeoxyglucose ((18)F-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before (18)F-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest (99m)Tc-sestamibi-SPECT and two (18)F-FDG studies (PET-CLAMP and PET-DIET). Myocardial tracer uptake was visually scored using a 5-point scale in a 17-segment model. Hibernating myocardium was defined as normal or mildly reduced metabolism ((18)F-FDG uptake) in areas with reduced perfusion ((99m)Tc-sestamibi uptake) since (18)F-FDG uptake was higher than the degree of hypoperfusion-perfusion/metabolism mismatch indicating a larger flow defect. PET-DIET identified 79 segments and PET-CLAMP 71 as hibernating myocardium. Both methods agreed in 61 segments (agreement = 94.5 %, κ = 0.78). PET-DIET identified 230 segments and PET-CLAMP 238 as nonviable. None of the patients had hypoglycemia after DIET, while 20 % had it during CLAMP. PET-DIET compared with PET-CLAMP had a good correlation for the assessment of hibernating myocardium. To our knowledge, these data provide the first evidence of the possibility of myocardial viability assessment with this technique.

Avaliação citogenética de frentistas expostos ao benzeno em postos de gasolina de Campo Maior, PI / Cytogenetic assessment of attendants exposed to benzene in gas stations in Campo Maior, PI

O biomonitoramento do risco ocupacional em trabalhadores expostos ao benzeno e derivados é realizado como diagnóstico e prevenção de danos a curto e longo prazo ao material genético. Testes de curta duração que determinam o perigo genético são categorizados pelos indicadores biológicos que avaliam mutação gênica, dano cromossômico ou lesão no DNA. A associação íntima desses indicadores fortalece a importância dos testes de genotoxicidade. O estudo objetiva avaliar o risco de mutagenicidade e anormalidades nucleares em indivíduos expostos ao benzeno. Avaliaram-se células da mucosa oral (teste de micronúcleos), sangue periférico (hemograma automatizado) de vinte frentistas da cidade de Campo Maior, PI, e o do grupo controle, além da aplicação do questionário de estudo epidemiológico. Relacionaram-se os resultados ao estilo de vida desses profissionais. A frequência de micronúcleos no grupo exposto foi significativa (***P,0,0001/Student's test), assim como a frequência de anormalidades nucleares para cariólise (**P<0,001) e para binucleação (*P<0,05). A frequência de cariólise e etilismo (r= 0,464) também apresentou uma correlação positiva(P*<0,05). Evidenciou-se que essa exposição ao petróleo e derivados induz mutagenicidade, citotoxicidade e apoptose, sendo necessário, por isso, conscientizar empregadores e trabalhadores dos postos de gasolina sobre o uso de EPI e intensificar o monitoramento ocupacional.

Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: impact of structured learning and experience on the accuracy of the Amsterdam classification system.

OBJECTIVE: Several classification systems have been launched to characterize Barrett's esophagus (BE) mucosa using magnification endoscopy with narrow band imaging (ME-NBI). The good accuracy and interobserver agreement described in the early reports were not reproduced subsequently. Recently, we reported somewhat higher accuracy of the classification developed by the Amsterdam group. The critical question then formulated was whether a structured learning program and the level of experience would affect the clinical usefulness of this classification. MATERIAL & METHODS: Two hundred and nine videos were prospectively captured from patients with BE using ME-NBI. From these, 70 were randomly selected and evaluated by six endoscopists with different levels of expertise, using a dedicated software application. First, an educational set was studied. Thereafter, the 70 test videos were evaluated. After classification of each video, the respective histological feedback was automatically given. RESULTS: Within the learning process, there was a decrease in the time needed for evaluation and an increase in the certainty of prediction. The accuracy did not increase with the learning process. The sensitivity for detection of intestinal metaplasia ranged between 39% and 57%, and for neoplasia between 62% and 90%, irrespective of assessor's expertise. The kappa coefficient for the interobserver agreement ranged from 0.25 to 0.30 for intestinal metaplasia, and from 0.39 to 0.48 for neoplasia. CONCLUSION: Using a dedicated learning program, the ME-NBI Amsterdam classification system is suboptimal in terms of accuracy and inter- and intraobserver agreements. These results reiterate the questionable utility of corresponding classification system in clinical routine practice.

Consistency of FDG-PET accuracy and cost-effectiveness in initial staging of patients with Hodgkin lymphoma across jurisdictions.

INTRODUCTION: Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. METHODS: All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. RESULTS: In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. CONCLUSION: FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.

Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow-band imaging: accuracy and interobserver agreement of different classification systems (with videos).

BACKGROUND: Three different classification systems for the evaluation of Barrett's esophagus (BE) using magnification endoscopy (ME) and narrow-band imaging (NBI) have been proposed. Until now, no comparative and external evaluation of these systems in a clinical-like situation has been performed. OBJECTIVE: To compare and validate these 3 classification systems. DESIGN: Prospective validation study. SETTING: Tertiary-care referral center. Nine endoscopists with different levels of expertise from Europe and Japan participated as assessors. PATIENTS: Thirty-two patients with long-segment BE. INTERVENTIONS: From a group of 209 standardized prospective recordings collected on BE by using ME combined with NBI, 84 high-quality videos were randomly selected for evaluation. Histologically, 28 were classified as gastric type mucosa, 29 as specialized intestinal metaplasia (SIM), and 27 as SIM with dysplasia/cancer. Assessors were blinded to underlying histology and scored each video according to the respective classification system. Before evaluation, an educational set concerning each classification system was carefully studied. At each assessment, the same 84 videos were displayed, but in different and random order. MAIN OUTCOME MEASUREMENTS: Accuracy for detection of nondysplastic and dysplastic SIM. Interobserver agreement related to each classification. RESULTS: The median time for video evaluation was 25 seconds (interquartile range 20-39 seconds) and was longer with the Amsterdam classification (P < .001). In 65% to 69% of the videos, assessors described certainty about the histology prediction. The global accuracy was 46% and 47% using the Nottingham and Kansas classifications, respectively, and 51% with the Amsterdam classification. The accuracy for nondysplastic SIM identification ranged between 57% (Kansas and Nottingham) and 63% (Amsterdam). Accuracy for dysplastic tissue was 75%, irrespective of the classification system and assessor expertise level. Interobserver agreement ranged from fair (Nottingham, κ = 0.34) to moderate (Amsterdam and Kansas, κ = 0.47 and 0.44, respectively). LIMITATION: No per-patient analysis. CONCLUSIONS: All of the available classification systems could be used in a clinical-like environment, but with inadequate interobserver agreement. All classification systems based on combined ME and NBI, revealed substantial limitations in predicting nondysplastic and dysplastic BE when assessed externally. This technique cannot, as yet, replace random biopsies for histopathological analysis.

Cost effectiveness of positron emission tomography in patients with Hodgkin's lymphoma in unconfirmed complete remission or partial remission after first-line therapy.

PURPOSE: To assess the cost effectiveness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with Hodgkin's lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment. PATIENTS AND METHODS: One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management. RESULTS: After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is -$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving. CONCLUSION: FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil.

Agente comunitário de saúde: percepções na estratégia da saúde da família / Community health agent: family health strategy perceptions / Agente comunitario de salud: percepciones en la estrategia de salud de la familia

O estudo teve como objetivo compreender o significado de ser um Agente Comunitário de Saúde-ACS em umPrograma Saúde da Família. Pesquisa descritiva, qualitativa, com inspiração fenomenológica que buscou a essência dodiscurso do ACS do município de Sete Lagoas-MG. As entrevistas foram gravadas com sete ACS a partir da questãonorteadora: Qual a sua percepção como Agente Comunitário de Saúde na Estratégia Saúde da Família? A análise compreensivadas falas possibilitou a construção de cinco categorias: ACS, elo entre a equipe multiprofissional e a comunidade;valorização profissional; papel do ACS na equipe multiprofissional e sua contribuição para a mudança do modelo deatenção básica; formação profissional; condições de trabalho insalubres. Evidenciou-se que os Agentes de Saúde daFamília têm conhecimento e consciência do seu papel dentro da equipe multiprofissional, sentem-se despreparados paraexercer todas as suas atribuições, desvalorizados em relação à comunidade e a outros membros da equipe. Percebem osriscos ocupacionais da profissão e a falta de ações para minimização destes, além da baixa remuneração.

This study's objective was to understand the meaning of being a Community Health Agent (ACS) in aFamily Health Program (PSF). Descriptive, qualitative, with phenomenological inspiration research that sought the essenceof the ACS? speech, and all them work in the city of Sete Lagoas-MG. The interviews were recorded with 7 ACS, guided bythe question ?what is your perception about family health strategy, as a Community Health Agent?? The comprehensiveanalysis of speech allowed the construction of five categories: ACS, link between the team and the community; professionalevaluation; the ACS role in the team and their contribution to the change of basic care model; training; unhealthy workconditions. It showed that the Agents of Family Health are aware and conscious of their role within the team, feelunprepared to exercise all their tasks, devalued in relation to community and other team members. Also, they perceive theoccupational hazards of the profession and lack of actions to minimize them, beyond the low payment.

El estudio tuvo como objetivo comprender el significado de ser un agente comunitario de salud - ACS en unPrograma de Salud de la Familia (PSF). Investigación descriptiva, cualitativa, con inspiración fenomenológica que buscó laesencia del discurso del ACS en la ciudad de Sete Lagoas-MG. Las entrevistas fueron grabadas con siete ACS a partir decuestión norteadora: ¿cuál es su percepción como un Agente Comunitario de Salud en la Estrategia de Salud de la familia? Elanálisis comprensivo de los discursos posibilitó la construcción de cinco categorías: ACS, enlace entre el equipo multiprofesionaly la comunidad; valorización profesional; el papel del ACS en el equipo multiprofesional y su contribución para la mudanzadel modelo de atención básica; formación profesional; condiciones de trabajo insalubres. Se demostró que el Agente de Saludde la Familia tiene conocimiento y conciencia de su papel dentro del equipo multiprofesional, se sienten despreparados paraejercer todas sus atribuciones, desvalorizados en relación a la comunidad y a otros miembros del equipo. Percibieron losriesgos ocupacionales de la profesión y la falta de acciones para minimización de estos, además de baja remuneración.

Role of 18F-fluorodeoxyglucose positron emission tomography in preoperative assessment of cytologically indeterminate thyroid nodules.

OBJECTIVE: The objective of the study was to determine the diagnostic accuracy of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) in the preoperative diagnosis of thyroid nodules with indeterminate fine-needle aspiration biopsy results. METHODS: Forty-two consecutive patients with thyroid nodules with indeterminate cytological results participated in this study. Abnormal (18)F-FDG PET uptake was assessed visually and by measuring the maximum standardized uptake value (SUVmax) in thyroid topography. All these results were compared with the final pathological results. RESULTS: The presence of focal uptake correlated with a greater risk of malignancy (P = 0.018). All 11 malignant nodules had focal uptake (sensitivity of 100%). Of the 31 patients with benign nodules, there were 19 with positive uptake (specificity of 38.7%). The pre-PET probability of cancer was 26.2% (11 of 42), and this probability increased to 36.7% after PET for those patients whose exam showed focal uptake (11 of 30). The preoperative use of (18)F-FDG PET would result in a significant reduction (39%, 12 of 31) in the number of thyroidectomies performed in patients with benign lesions. SUVmax could not improve this degree of accuracy. There was no correlation between thyroid nodule size and SUVmax value (P = 0.96). Patients with carcinomas were younger than patients with benign lesions (P = 0.048). There was no other clinical, laboratory, or ultrasonographic variable related to malignancy. CONCLUSIONS: (18)F-FDG PET provides high sensitivity to malignant lesions and may be a potentially useful tool in the evaluation of thyroid nodules with indeterminate cytological findings. For these nodules the number of unnecessary thyroidectomies in a hypothetical algorithm using (18)F-FDG PET would be reduced by 39%.

Recursos familiares e o desempenho cognitivo dos alunos do ensino básico brasileiro / Family resources and cognitive performance by primary school students in Brazil

This article discusses the processes by which family structure affects students' cognitive performance in Brazilian schools. The article's basic premise is that family influence is not a uni-dimensional construct, and the study thus uses four dimensions to capture such influence. The effects of these factors on students' performance are measured through a school attainment analysis model. The data are compatible with a model in which the parents' involvement acts as a mediating factor for the action of cultural resources, which in turn depend on economic resources, which have only indirect effects on students' cognitive performance in primary school.

Dans cet article, on examine les processus à travers lesquels la structure familiale peut gêner les performances cognitives des élèves au Brésil. On part du pressupposé que l'influence de la famille ne repose pas sur un principe unidimensionnel mais que, pour la saisir, il faut se servir de quatre dimensions. Les effets de ces facteurs sur les résultats scolaires des élèves sont examinés par le moyen d'un modèle d'analyse des trajectoires. Les données sont compatibles avec un modèle où l'engagement des parents agit comme un facteur de médiation dans l'intervention des ressources culturelles qui, à leur tour, dépendent des ressources économiques; celles-ci n'ont que des effets indirects sur les performances cognitives des élèves de l'enseignement primaire et secondaire.

Josué de Castro e o Brasil / Josué de Castro and the Brasil

A fome não se resume aos determinantes previstos numa espécie de ocorrência natural dos fatos. A fome não é do mundo, ela está estranhada aqui por questões que fogem ao campo da fatalidade. Fome não se dissocia de conjuntura socioeconômica, de decisão política, de debate ideológico. Assim provou Josué de Castro. Assim acreditam os organizadores do seminário e de seu desdobramento, registrado neste livro.