Clean and accurate soil quality monitoring in mining areas under environmental rehabilitation in the Eastern Brazilian Amazon.

Soil quality monitoring in mining rehabilitation areas is a crucial step to validate the effectiveness of the adopted recovery strategy, especially in critical areas for environmental conservation, such as the Brazilian Amazon. The use of portable X-ray fluorescence (pXRF) spectrometry allows a rapid quantification of several soil chemical elements, with low cost and without residue generation, being an alternative for clean and accurate environmental monitoring. Thus, this work aimed to assess soil quality in mining areas with different stages of environmental rehabilitation based on predictions of soil fertility properties through pXRF along with four machine learning algorithms (projection pursuit regression, PPR; support vector machine, SVM; cubist regression, CR; and random forest, RF) in the Eastern Brazilian Amazon. Sandstone and iron mines in different chronological stages of rehabilitation (initial, intermediate, and advanced) were evaluated, in addition to non-rehabilitated and native forest areas. A total of 81 soil samples (26 from sandstone mine and 55 from iron mine) were analyzed by both traditional wet-chemistry methods and pXRF. The available/exchangeable contents of K, Ca, B, Fe, and Al, in addition to H+Al, cation exchange capacity at pH = 7, Al saturation, soil organic matter, pH, sum of bases, base saturation, clay, and sand were accurately predicted (R2 > 0.70) using pXRF data, with emphasis on the prediction of Fe (R2 = 0.93), clay content (R2 = 0.81), H+Al (R2 = 0.81), and K+ (R2 = 0.85). The best predictive models were developed by RF and CR (86%) and when considering pXRF data + mining area + stage of rehabilitation (73%). The results highlight the potential of pXRF to accurately assess soil properties in environmental rehabilitation areas in the Amazon region (yet scarcely evaluated under this approach), promoting a more agile and cheaper preliminary diagnosis compared to traditional methods.

Clean quality control of agricultural and non-agricultural lime by rapid and accurate assessment of calcium and magnesium contents via proximal sensors.

Ca and Mg are the most important chemical elements in lime. Properly measuring Ca and Mg contents is essential to assess the quality of lime products. Quality control guarantees the adequate use of lime in industrial processes, in soils, and helps avoiding adulteration. Proximal sensors can aid in this process by determining Ca and Mg contents easily, rapidly and without producing chemical waste. The objective of this study was to evaluate the use an environmentally-friendly method of analyzing the quality of lime. We studied 1) the use of portable X-ray fluorescence (pXRF) to predict concentrations of Ca and Mg in lime, 2) tested if NixPro™ sensor can improve prediction accuracy and 3) tested if sample preparation methods (grinding) affect analyses. 74 samples of lime were analyzed by two different laboratories (lab. 1 = 38, lab. 2 = 36). All samples submitted to pXRF and NixPro™ analyses. Sensor analyses were done in whole (CP) and ground (AQ) samples to test the effect of sample preparation in prediction performance. High correlation was found between Ca and Mg contents measured via pXRF and laboratory analyses. Mg-CP presented the highest correlation coefficient (r = 0.81); Mg-AQ, the lowest (0.57). Predictions presented good performance (R2 > 0.68); Mg had the best results (0.86). Separating models per laboratory showed that some datasets are harder to model, probably due to variability in the source material (limestone). The addition of NixPro™ data contributed to improve prediction accuracy, although slightly. Predictions using CP samples presented the best results, especially for Mg, indicating that grinding is not necessary. This pioneer study demonstrated that fused proximal sensors can be used to rapidly and easily determine contents of Ca and Mg in soil amendments without producing chemical waste.

Proximal sensing provides clean, fast, and accurate quality control of organic and mineral fertilizers.

Farms use large quantities of fertilizers from many sources, making quality control a challenging task, as the traditional wet-chemistry analyses are expensive, time consuming and not environmentally-friendly. As an alternative, this work proposes the use of portable X-ray fluorescence (pXRF) spectrometry and machine learning algorithms for rapid and low-cost estimation of macro and micronutrient contents in mineral and organic fertilizers. Four machine learning algorithms were tested. Whole (i.e., as delivered by the manufacturer) (CP) and ground (AQ) samples (429 in total) were analyzed to test the effect of fertilizer granulometry in prediction performance. Model validation indicated highly accurate predictions of macro (N: R2 = 0.92; P: 0.97; K: 0.99; Ca: 0.94, Mg: 0.98; S: 0.96) and micronutrients (B: 0.99; Cu: 0.99; Fe: 0.98; Mn: 0.91; Zn: 0.94) for both organic and mineral fertilizers. RPD values ranged from 2.31 to 9.23 for AQ samples, and Random Forest and Cubist Regression were the algorithms with the best performances. Even samples analyzed as they were received from the manufacturer (i.e., no grinding) provided accurate predictions, which accelerate the confirmation of nutrient contents contained in fertilizers. Results demonstrated the potential of pXRF data coupled with machine learning algorithms to assess nutrient composition in both mineral and organic fertilizers with high accuracy, allowing for clean, fast and accurate quality control. Sensor-driven quality assessment of fertilizers improves soil and plant health, crop management efficiency and food security with a reduced environmental footprint.

Detailed characterization of iron-rich tailings after the Fundão dam failure, Brazil, with inclusion of proximal sensors data, as a secure basis for environmental and agricultural restoration.

Following the Fundão dam failure in Brazil, 60 million m3 of iron-rich tailings were released impacting an extensive area. After this catastrophe, a detailed characterization and monitoring of iron-rich tailings is required for agronomic and environmental purposes. This can be facilitated by using proximal sensors which have been an efficient, fast, and cost-effective tool for eco-friendly analysis of soils and sediments. This work hypothesized that portable X-ray fluorescence (pXRF) spectrometry combined with a pocket-sized (Nix™ Pro) color sensor and benchtop magnetic susceptibilimeter can produce substantial data for fast and clean characterization of iron-rich tailings. The objectives were to differentiate impacted and non-impacted areas (soils and sediments) based on proximal sensors data, and to predict attributes of agronomic and environmental importance. A total of 148 composite samples were collected on totally impacted, partially impacted, and non-impacted areas (natural soils). The samples were analyzed via pXRF to obtain the total elemental composition; via Nix™ Pro color sensor to obtain the red (R), green (G), and blue (B) parameters; and assessed for magnetic susceptibility (MS). The same samples used for analyses via the aforementioned sensors were wet-digested (USEPA 3051a method) followed by ICP-OES quantification of potentially toxic elements. Principal component analysis was performed to differentiate impacted and non-impacted areas. The pXRF data alone or combined with other sensors were used to predict soil agronomic properties and semi-total concentration of potentially toxic elements via random forest regression. For that, samples were randomly separated into modeling (70%) and validation (30%) datasets. The pXRF proved to be an efficient method for rapid and eco-friendly characterization of iron-rich tailings, allowing a clear differentiation of impacted and non-impacted areas. Also, important soil agronomic properties (clay, cation exchange capacity, soil organic carbon, pH and macronutrients availability) and semi-total concentrations of Ba, Pb, Cr, V, Cu, Co, Ni, Mn, Ti, and Li were accurately predicted (based upon the lowest RMSE and highest R2 and RPD values). Sensor data fusion (pXRF + Nix Pro + MS) slightly improved the accuracy of predictions. This work highlights iron-rich tailings from the Fundão dam failure can be in detail characterized via pXRF ex situ, providing a secure basis for complementary studies in situ aiming at identify contaminated hot spots, digital mapping of soil and properties variability, and embasing pedological, agricultural and environmental purposes.

Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis.

OBJECTIVE: The objective of this study was to assess the reduction in quality of life (QoL) caused by the persistence of primary plantar hyperhidrosis (PPH) symptoms and the level of satisfaction in PPH patients after retroperitoneoscopic lumbar sympathectomy (RLS). The efficacy, safety, and procedure of bilateral RLS in both sexes are also described in this study. METHODS: This is a longitudinal study of consecutive patients who sought specific treatment from a private practitioner for severe PPH as classified on the Hyperhidrosis Disease Severity Scale (HDSS) from October 2005 to October 2014. The patients were asked to report the symptoms of PPH experienced in the immediate preoperative period and to complete a standardized QoL questionnaire developed by de Campos at least 12 months after RLS. Disease outcomes, recurrence of symptoms, and any adverse effects of surgery were evaluated after 30 days and at least 12 months after RLS. RESULTS: Lumbar sympathectomy was performed 116 times in 58 patients; 30 days after surgery, PPH was resolved in all patients. Three patients (5.2%) reported transient thigh neuralgia, and 19 (32.7%) reported transient paresthesia in the lower limbs. There were no reports of retrograde ejaculation. At a minimum of 12 months after RLS, 49 of the 58 patients had fully and correctly answered the follow-up questionnaire and noted a mild (HDSS 2) to moderate (HDSS 3) increase in pre-existing compensatory sweating. One patient had a PPH relapse within 6 months. Improvement in QoL due to the resolution of PPH was reported in 98% of the 49 patients. None of the operations necessitated a change in the laparotomy approach, and none of the patients died. CONCLUSIONS: RLS is safe and effective for the treatment of severe PPH in both sexes. There were no reports of retrograde ejaculation after resection of L3 and L4 ganglia. There was a mild to moderate increase in compensatory sweating in about half of the patients, but without any regret or dissatisfaction for having undergone the surgery because of a significant improvement in QoL.

A Proximal Sensor-Based Approach for Clean, Fast, and Accurate Assessment of the Eucalyptus spp. Nutritional Status and Differentiation of Clones.

Several materials have been characterized using proximal sensors, but still incipient efforts have been driven to plant tissues. Eucalyptus spp. cultivation in Brazil covers approximately 7.47 million hectares, requiring faster methods to assess plant nutritional status. This study applies portable X-ray fluorescence (pXRF) spectrometry to (i) distinguish Eucalyptus clones using pre-processed pXRF data; and (ii) predict the contents of eleven nutrients in the leaves of Eucalyptus (B, Ca, Cu, Fe, K, Mg, Mn, N, P, S, and Zn) aiming to accelerate the diagnosis of nutrient deficiency. Nine hundred and twenty samples of Eucalyptus leaves were collected, oven-dried, ground, and analyzed using acid-digestion (conventional method) and using pXRF. Six machine learning algorithms were trained with 70% of pXRF data to model conventional results and the remaining 30% were used to validate the models using root mean square error (RMSE) and coefficient of determination (R2). The principal component analysis clearly distinguished developmental stages based on pXRF data. Nine nutrients were accurately predicted, including N (not detected using pXRF spectrometry). Results for B and Mg were less satisfactory. This method can substantially accelerate decision-making and reduce costs for Eucalyptus foliar analysis, constituting an ecofriendly approach which should be tested for other crops.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis.

OBJECTIVE: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. METHODS: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). RESULTS: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was -8.11% per year (95%CI -9.38; -6.82), while for Hepatitis B it was -4.13% (95%CI -6.03; -2.20), of Other viral hepatitis of -7.84% (95%CI -14.11; -1.11) and of Unspecified Hepatitis -5.67% per year (95%CI -6.22; -5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). CONCLUSION: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

Could ultrasound and muscle elastography be associated with clinical assessment, laboratory and nailfold capillaroscopy in juvenile dermatomyositis patients?

BACKGROUND: Juvenile Dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Imaging exams are useful for muscle assessment, with ultrasonography (US) being a promising tool in detecting disease activity and tissue damage. There are few studies about muscle elastography. OBJECTIVES: Our aim was to associate clinical, laboratory, and nailfold capillaroscopy (NC) assessments with US in JDM patients; and to compare the findings of US and Strain Elastography (SE) from patients and healthy controls. METHODS: An analytic cross-sectional study was performed with JDM patients and healthy controls. Patients underwent clinical exam to access muscle strength and completed questionnaires about global assessment of the disease and functional capacity. Patients were submitted to NC and measurement of muscle enzymes. All subjects underwent US assessment, using gray scale, Power Doppler (PD), and SE. RESULTS: Twenty-two JDM patients and fourteen controls, aged between 5 and 21 years, matched for age and sex were assessed. In qualitative and semi-quantitative gray scale, we observed a higher frequency of alterations in patients (p < 0.001), while in PD, there was a higher frequency of positivity in patients' deltoids and anterior tibialis (p < 0.001). Active disease was associated with an important change in the semi-quantitative gray scale in deltoids (p = 0.007), biceps brachii (p = 0.001) and quadriceps femoris (p = 0.005). The SE demonstrated a high negative predictive value of 87.2. CONCLUSION: US was able, through gray scale, to differentiate JDM patients from controls, while PD achieved such differentiation only for deltoids and anterior tibialis. The semi-quantitative gray scale showed disease activity in proximal muscles. SE was not able to differentiate patients from controls.

Advances in flow cytometric serology for canine visceral leishmaniasis: diagnostic applications when distinct clinical forms, vaccination and other canine pathogens become a challenge.

We have previously reported the applicability of flow cytometry anti-fixed Leishmania infantum chagasi promastigotes IgG (FC-AFPA-IgG) as a novel serological device for laboratorial diagnosis of CVL. Herein, we validate throughout a blind study applied into a broader range of coded sera samples that FC-AFPA-IgG at serum dilution 1:8192 have an outstanding performance to discriminate the serological reactivity of canine visceral leishmaniasis (CVL, n=64) and Leishmune vaccines (VAC, n=62) and non-infected controls (NI, n=25). Moreover, we have evaluated the performance of indirect immunofluorescence antibody test (IFAT) and the crude-antigen enzyme-linked immunosorbent assay (ELISA) in parallel with FC-AFPA-IgG, to discriminate the seroreactivity of NI, CVL and VAC. Our data demonstrated that both ELISA and FC-AFPA-IgG showed similar performance to detect the seronegativity in 100% of NI, whereas FC-AFPA-IgG displayed better performance to exclude seropositivity in 100% of VAC. The high kappa agreement indexes observed suggested similar performance between these two serological testes when distinct clinical forms of CVL become a challenge. Furthermore, the FC-AFPA-IgG applied at sera dilution 1:8192 showed a remarkable performance to discriminate CVL from other co-endemic canine infections with high co-negativity in dogs infected with Trypanosoma cruzi and Leishmania braziliensis (86% and 84%, respectively). In conclusion, the data presented here re-emphasize the applicability of FC-AFPA-IgG as an innovative methodology able to discriminate post-infection imunomediated seroreactivity from that triggered by prophylactic immunization with minor cross-reactivity with other relevant canine pathogens, which may contribute as a supplementary assay for the CVL immunodiagnosis.

Idiopathic uveitis presents different characteristics and outcome from juvenile idiopathic arthritis- related uveitis / Uveíte idiopática apresenta características e desfecho diferentes da uveíte associada à Artrite Idiopática Juvenil

ABSTRACT Objective: To describe the clinical features and outcomes of patients with uveitis associated with juvenile idiopathic arthritis (JIA) and idiopathic uveitis. Methods: This was an observational, retrospective study, conducted in a tertiary center. Patients under 18 years old who experienced at least one episode of uveitis and followed between 2000 and 2019 were included. Results: A total of 82 patients were included, of whom 43 had idiopathic uveitis and 39 had uveitis associated with JIA. Anterior uveitis was the primary site of ocular inflammation (76.8%) and occurred in 24 and 39 patients with idiopathic uveitis and uveitis associated with JIA arthritis, respectively (p=0.02). The complete response to corticotherapy was more frequent in uveitis associated with JIA (p=0.001). Total and partial responses to biological disease modifying antirheumatic drugs were more frequent in uveitis associated with JIA (p=0.025) and idiopathic uveitis (p=0.045), respectively. There were 203 complications: cataracts were more frequently present in idiopathic uveitis (p=0.05), while synechiae was more frequent in uveitis associated with JIA (p=0.02). Conclusion: Idiopathic uveitis and uveitis associated JIA frequently follow a chronic course and an increased risk of visual loss in childhood. The uveitis associated with JIA showed better response to systemic corticotherapy and total response to biologic disease modifying antirheumatic drugs more frequently.

RESUMO Objetivos: Descrever as características clínicas e desfechos dos pacientes com uveíte associada à Artrite Idiopática Juvenil (AIJ) e da Uveíte Idiopática. Métodos: Este foi um estudo retrospectivo observacional conduzido em um centro terciário. Foram incluídos pacientes abaixo dos 18 anos de idade que apresentaram pelo menos um episódio de uveíte e que estiveram em acompanhamento médico entre os anos de 2000 e 2019. Resultados: Foram incluídos 82 pacientes, sendo 43 com uveíte idiopática e 39 com uveíte associada à AIJ. A uveíte anterior foi o sítio primário de acometimento (76,8%) em 24 e 39 pacientes com uveíte idiopática e uveíte associada à AIJ, respectivamente (p=0.02). Resposta total à corticoterapia foi mais frequente na uveíte associada à AIJ (p=0.001). Respostas total e parcial às drogas antirreumáticas modificadoras de doença biológicas foram mais frequentes na uveíte associada à AIJ (p=0.025) e na uveíte idiopática (p=0.045), respectivamente. Foram encontradas 203 complicações: a catarata foi mais frequente na uveíte idiopática (p=0.05), enquanto a sinéquia foi mais frequente na uveíte associada à AIJ (p=0.02). Conclusão: A uveíte idiopática e a uveíte associada à AIJ frequentemente apresentam um curso crônico e um risco elevado de perda visual na infância. A uveíte associada à AIJ apresentou melhor resposta à corticoterapia sistêmica e resposta total às drogas modificadoras de doença reumática biológicas mais frequentemente.

A systematic review and meta-analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis.

On July 25, 2017, we conducted an extensive database tracking to identify all studies published from January 1990 to July 2017. Screening updates were performed until December 2017. RESULTS: There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. CONCLUSION: The mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.

Could ultrasound and muscle elastography be associated with clinical assessment, laboratory and nailfold capillaroscopy in juvenile dermatomyositis patients?

Abstract Background Juvenile Dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Imaging exams are useful for muscle assessment, with ultrasonography (US) being a promising tool in detecting disease activity and tissue damage. There are few studies about muscle elastography. Objectives Our aim was to associate clinical, laboratory, and nailfold capillaroscopy (NC) assessments with US in JDM patients; and to compare the findings of US and Strain Elastography (SE) from patients and healthy controls. Methods An analytic cross-sectional study was performed with JDM patients and healthy controls. Patients underwent clinical exam to access muscle strength and completed questionnaires about global assessment of the disease and functional capacity. Patients were submitted to NC and measurement of muscle enzymes. All subjects underwent US assessment, using gray scale, Power Doppler (PD), and SE. Results Twenty-two JDM patients and fourteen controls, aged between 5 and 21 years, matched for age and sex were assessed. In qualitative and semi-quantitative gray scale, we observed a higher frequency of alterations in patients (p < 0.001), while in PD, there was a higher frequency of positivity in patients' deltoids and anterior tibialis (p < 0.001). Active disease was associated with an important change in the semi-quantitative gray scale in deltoids (p = 0.007), biceps brachii (p = 0.001) and quadriceps femoris (p = 0.005). The SE demonstrated a high negative predictive value of 87.2. Conclusion US was able, through gray scale, to differentiate JDM patients from controls, while PD achieved such differentiation only for deltoids and anterior tibialis. The semi-quantitative gray scale showed disease activity in proximal muscles. SE was not able to differentiate patients from controls.

Caracterização e avaliação do paciente anticoagulado com varfarina em relação à complexidade da farmacoterapia / Characterization and evaluation of patients anticoagulated with warfarin in relation to the complexity of pharmacotherapy

A realização de diagnóstico e tratamento das arritmias sustentadas fazem parte da rotina clínica, sendo uma das arritmias mais frequentes a Fibrilação Atrial (FA). Para prevenção de eventos tromboembólicos em pacientes com FA, recomendase a anticoagulação oral, destacando-se a varfarina. Apesar da importância, esse medicamento possui estreita margem terapêutica, o que faz com que pequenas mudanças no tratamento gerem risco de eventos trombóticos ou hemorrágicos. Dentre essas mudanças, destaca-se a adesão aos demais medicamentos em uso, alteração do uso desses medicamentos por prescritores e automedicação. Várias são as interações entre varfarina e demais medicamentos de uso contínuo, acreditando-se que a complexidade da prescrição pode interferir nos desfechos clínicos da terapia anticoagulante. O objetivo do estudo foi caracterizar pacientes acompanhados em um ambulatório de anticoagulação em relação ao Índice de Complexidade da Farmacoterapia. Para identificação da complexidade da farmacoterapia, considerou-se as prescrições dos demais medicamentos em uso, prescritas por médicos da atenção primária em saúde. Utilizouse o instrumento Medication Regimen Complexity Index (MRCI). A complexidade, compreendida como a forma de administração, posologia e forma farmacêutica, fatores que interferem na adesão à terapia anticoagulante, foi subdividida em três níveis: baixa complexidade, moderada e alta, conforme indicado pela literatura. A análise da complexidade foi realizada por dois pesquisadores de forma independente, sendo considerados os critérios conforme orientação do MRCI. Trata-se de um estudo descritivo realizado em duas clínicas de anticoagulação, localizadas em Minas Gerais. Durante a pesquisa, pacientes foram acompanhados em dois ambulatórios de anticoagulação do Brasil, em uso de varfarina, foram convidados a participarem de um ensaio clínico entre dezembro de 2018 e fevereiro de 2019, sendo que posteriormente foi realizado um recorte para o presente estudo. Um total de 93 pacientes foram incluídos no estudo, sendo a média de idade de 63 anos e a maioria do sexo feminino (68,8%). A fibrilação atrial foi a indicação da ACO mais predominante (92,5%). A média do número de medicamentos utilizados foi de 7,0. A maioria dos pacientes com farmacoterapia classificada como alta (38, 6,5%) e média complexidade (24, 80,7%) apresentou TTR inadequado. O presente estudo permitiu identificar que há um predomínio de pacientes com alta complexidade da farmacoterapia, o que pode indicar necessidades de cuidados adicionais em relação ao tratamento anticoagulante. Para tanto, em casos de pacientes com controle inadequado da anticoagulação oral, recomenda-se que aspectos da complexidade da farmacoterapia sejam incorporados na abordagem educacional.

Diagnosis and treatment of sustained arrhythmias are part of the clinical routine, with one of the most frequent arrhythmias being Atrial Fibrillation (AF). To prevent thromboembolic events in patients with AF, oral anticoagulation is recommended, particularly warfarin. Despite its importance, this medication has a narrow therapeutic range, which means that small changes in treatment generate a risk of thrombotic or hemorrhagic events. Among these changes, adherence to other medications in use, changes in the use of these medications by prescribers and self-medication stand out. There are several interactions between warfarin and other medications for continuous use, with the belief that the complexity of the prescription may interfere with the clinical outcomes of anticoagulant therapy. The objective of the study was to characterize patients followed in an anticoagulation outpatient clinic in relation to the Pharmacotherapy Complexity Index. To identify the complexity of pharmacotherapy, prescriptions for other medications in use, prescribed by primary health care doctors, were considered. The Medication Regimen Complexity Index (MRCI) instrument was used. Complexity, understood as the form of administration, dosage and pharmaceutical form, factors that interfere with adherence to anticoagulant therapy, was subdivided into three complexity levels: low, moderate and high, as indicated in the literature. The complexity analysis was carried out by two researchers independently, considering the criteria as per MRCI guidance. This is a descriptive study carried out in two anticoagulation clinics, located in Minas Gerais. During the research, patients were monitored in two anticoagulation clinics in Brazil, using warfarin, and were invited to participate in a clinical trial between December 2018 and February 2019, and a selection was subsequently made for the present study. A total of 93 patients were included in the study, the average age was 63 years and the majority were female (68.8%). Atrial fibrillation was the most predominant OAC indication (92.5%). The average number of medications used was 7.0. The majority of patients with pharmacotherapy classified as high (38, 6.5%) and medium complexity (24, 80.7%) presented inadequate TTR. The present study identified that there is a predominance of patients with high complexity of pharmacotherapy, which may indicate the need for additional care in relation to anticoagulant treatment. Therefore, in cases of patients with inadequate control of oral anticoagulation, it is recommended that aspects of the complexity of pharmacotherapy be incorporated into the educational approach.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis / Mortalidade por hepatites no Brasil e regiões, 2001-2020: tendência temporal e análise espacial

ABSTRACT Objective: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. Methods: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). Results: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was −8.11% per year (95%CI −9.38; −6.82), while for Hepatitis B it was −4.13% (95%CI −6.03; −2.20), of Other viral hepatitis of −7.84% (95%CI −14.11; −1.11) and of Unspecified Hepatitis −5.67% per year (95%CI −6.22; −5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). Conclusion: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

RESUMO Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de mortalidade por hepatites no Brasil no período de 2001 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre a mortalidade por hepatites no Brasil com dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). As informações foram estratificadas por ano do diagnóstico, região do país, municípios (de residência). Foram calculadas as taxas padronizadas de mortalidade (TPM). A tendência temporal foi estimada pela regressão de Prais-Winsten e a distribuição espacial pelo Índice Global de Moran (IGM). Resultados: As maiores médias da TPM no Brasil foram para hepatite viral crônica, com 0,88 mortes para cada 100 mil habitantes (desvio padrão — DP=0,16), seguida de outras hepatites virais, com 0,22/100 mil (DP=0,11). No Brasil, a tendência temporal da mortalidade por hepatite A foi de −8,11% ao ano (intervalo de confiança de 95% — IC95% −9,38; −6,82), enquanto por hepatite B foi de −4,13% (IC95% −6,03; −2,20); de outras hepatites virais, foi de −7,84% (IC95% −14,11; −1,11) e de hepatite não especificada, de −5,67% ao ano (IC95% −6,22; −5,10). A mortalidade por hepatite viral crônica cresceu 5,74% (IC95%3,47; 8,06) no norte e 4,95% no nordeste (IC95% 0,27; 9,85). O Índice de Moran (I) para hepatite A foi de 0,470 (p<0,001), para hepatite B de 0,846 (p<0,001), hepatite viral crônica=0,666 (p<0,001), outras hepatites virais=0,713 (p<0,001) e hepatites não especificadas=0,712 (p<0,001). Conclusão: A tendência temporal das hepatites A, B, de outras hepatites virais e das não especificadas foi de diminuição no Brasil, enquanto a mortalidade por hepatites crônicas foi de crescimento nas Regiões Norte e Nordeste.

Avaliação do impacto da orientação farmacêutica aos pacientes sobre os medicamentos prescritos / Evaluation of the impact of pharmaceutical orientation given to patients on prescribed drugs

O uso racional de medicamentos é considerado um dos elementos-chave recomendados pela Organização Mundial de Saúde, cuja ausência pode acarretar consequências como reações adversas, diminuição da eficácia do medicamento, perdas de ordem econômica para o governo e/ou indivíduo, interações medicamentosas e agravo do quadro clínico do paciente. O serviço de orientação farmacêutica que envolve esse contexto foi discutido por poucos estudos, considerando-se interessante a utilização de um instrumento validado para demonstrar o impacto do fornecimento de orientação farmacêutica direcionada a pacientes em uso de medicamentos prescritos, o que constitui o objetivo desse trabalho. A metodologia utilizada foi estudo transversal conduzido em uma Unidade Básica de Saúde de Diamantina/ MG. Foi utilizado um questionário para medir o grau do conhecimento do paciente sobre seus medicamentos nos momentos pré e pós a realização de orientação farmacêutica. Após a orientação farmacêutica, observou-se diminuição do percentual de usuários que não conheciam seus medicamentos (73,2%; 93 para 33,9%; 43) e aumento do nível de conhecimento suficiente (14,2%; 18 para 18,9%; 24) e ótimo (11,0%; 14 para 47,2%; 60). Houve aumento do conhecimento dos usuários em todos os itens que compõem o questionário. A orientação farmacêutica apresentou impacto positivo sobre o conhecimento dos pacientes sobre seus medicamentos e constitui uma prática essencial para o Uso Racional dos Medicamentos.

The rational use of drugs is considered one of the key elements recommended by the World Health Organization, the absence of which can lead to consequences such as adverse reactions, decreased drug efficacy, economic losses for the government and/or individual, drug interactions, and worsening of the patient's clinical condition. The pharmaceutical orientation service that involves this context has been discussed by few studies, and the use of a validated instrument to demonstrate the impact of providing pharmaceutical guidance to patients on prescribed drugs is considered interesting and constitutes the objective of this work. The methodology used was a cross-sectional study conducted in a Primary Care Center in Diamantina, MG. A questionnaire was used to measure the patient's level of knowledge about their medications before and after receiving pharmaceutical guidance. After pharmaceutical orientation, there was a decrease in the percentage of users who did not know about their medications (73.2%; n=93 to 33.9%; n=43) and an increase in the level of sufficient knowledge (14.2%; n=18 to 18.9%; n=24) and excellent knowledge (11.0%; n=14 to 47.2%; n=60). There was an increase in users' knowledge of all the items that make up the questionnaire. Pharmaceutical orientation had a positive impact on patients' knowledge about their medications and constitutes an essential practice for the Rational Use of Medications.

Clinical value of anti-Leishmania (Leishmania) chagasi IgG titers detected by flow cytometry to distinguish infected from vaccinated dogs.

Leishmune vaccination covers a broader number of endemic areas of canine visceral leishmaniasis (CVL) and therefore the development of new serological devices able to discriminate CVL from Leishmune vaccinees becomes an urgent need considering the post-vaccine seroconversion detected throughout conventional methodologies. Herein, we have described the establishment of a flow cytometry based methodology to detect anti-fixed L. (L.) chagasi promastigotes antibodies (FC-AFPA-IgG, FC-AFPA-IgG1 and FC-AFPA-IgG2) in sera samples from Leishmania (Leishmania) chagasi infected dogs and Leishmune vaccinees. The results of FC-AFPA were reported along the sera titration curve (1:128-1:524,288), as percentage-of-positive-fluorescent-parasite (PPFP). The use of PPFP=20% as a cut-off edge to segregate negative and positive results at sera dilution 1:2048 revealed outstanding performance indexes that elect FC-AFPA-IgG and IgG2 (both detected by polyclonal FITC-labeled second step reagent) applicable to the serological diagnosis of CVL, with 100% of specificity for both IgG and IgG2 and 97 and 93% of sensitivity, respectively. Moreover, FC-AFPA-IgG, applied at sera dilution 1:2048, also appeared as a useful tool to discriminate L. chagasi infected dogs from Leishmune vaccinees, with 76% of specificity. Outstanding likelihood indexes further support the performance of FC-AFPA-IgG for exclusion diagnosis of CVL in Leishmune vaccinees. Analysis of FC-AFPA-IgG at sera dilution 1:8192 revealed the most outstanding indexes, demonstrating that besides the ability of PPFP

Implementação e viabilização do acesso à saúde bucal da população em situação de rua no município de Japaratuba/SE / Implementation and facilitation of access to oral health for the homeless population in the city of Japaratuba/SE

O estudo tem caráter qualitativo, descritivo, com referencial teórico no construcionismo social e na qualificação/interação dos profissionais da Equipe de Saúde da Família (ESF) na implementação deste projeto. Foram utilizadas como etapas de intervenção a capacitação dos profissionais envolvidos na execução do projeto, levantamento cadastral do quantitativo da População em Situação de Rua, ações de promoção e prevenção em saúde bucal fora da Unidade Básica de Saúde, com orientações sobre higiene bucal, confecção e distribuição de material educativo, divulgação das ações em carro de som pelo município, acesso ao tratamento odontológico com agendamento da primeira consulta odontológica programada e a longitudinalidade do cuidado. Portando, almejou-se com esse projeto o acesso ao atendimento clínico odontológico a PSR, estreitando vínculo entre a ESF e a PSR, quebrando paradigmas sociais, proporcionando um acolhimento multiprofissional mais humanizado. Fazendo-se necessário fortalecer as equipes de saúde bucal e da Família por meio de educação permanente, de tal modo que o acesso a ações em serviços de saúde bucal para a População em Situação de Rua seja priorizado

Effect of aqueous extract of the leaves of Baccharis trimera on the proliferation of hepatocytes after partial hepatectomy in rats.

PURPOSE:: To evaluate the effect of aqueous extract of Baccharis trimera leaves on the proliferative capacity of the liver after partial hepatectomy (PH) in rats. METHODS:: Twenty Wistar rats weighing between 300 and 450g were divided into two groups: control (HP) and test (HP100-rats that received the aqueous extract of Baccharis trimera for four days at a dose of 100 mg / kg / day). On the fifth day, animals from both groups underwent resection of 70% of the liver. Twenty-four hours later, they were sacrificed and the remnant liver was removed and prepared for studied through PCNA immunohistochemistry. Data analysis for comparison between the two groups was made through the non-parametric statistical test Mann-Whitney test. RESULTS:: In all the animals studied was found most abundant nuclear immunostaining positive hepatocytes interlobular located in regions of the liver. Quantitative analysis of PCNA-positive cells revealed positivity rate significantly higher mean (p = 0.02) in HP100 group (77.1 ± 13.6) compared to the HP group (45.8 ± 12.9). CONCLUSION:: DAdministration of aqueous extract of the leaves of Baccharis trimera 100 mg/kg of animal has a significant positive effect on liver regeneration in rats, 24 hours after hepatectomy (70%).

Isotype patterns of immunoglobulins: hallmarks for clinical status and tissue parasite density in Brazilian dogs naturally infected by Leishmania (Leishmania) chagasi.

The role of anti-leishmanial immune response underlying the susceptibility/resistance during canine visceral leishmaniasis (CVL) has been recognized throughout ex vivo and in vitro investigations. Recently, we demonstrated that immunoglobulin levels (Igs), as well as the parasite load are relevant hallmarks of distinct clinical status of CVL. To further characterize and upgrade the background on this issue, herein, we have evaluated, in Leishmania (Leishmania) chagasi naturally infected dogs, the relationship between tissue parasitism (skin, bone marrow, spleen, liver and lymph node), the CVL clinical status (asymptomatic (AD), with no suggestive signs of the disease; oligosymptomatic (OD), with maximum three clinical signs-opaque bristles; localized alopecia and moderate loss of weight; symptomatic (SD), serologically positive with severe clinical signs of visceral leishmaniasis), and the humoral immunological profile of anti-Leishmania immunoglobulins (IgG, IgG1, IgG2, IgM, IgA and IgE). Our major statistically significant findings revealed distinct patterns of tissue parasite density within L. chagasi-infected dogs despite their clinical status, pointing out the spleen and skin as the most relevant sites of high parasitism during ongoing CVL. Parasite density of bone marrow and spleen were the most reliable parasitological markers to decode the clinical status of CVL. Moreover, the parasite density of bone marrow better correlates with most anti-Leishmania Igs reactivity. Additionally, a prognostic hallmark for canine visceral leishmaniasis was found, highlighting strong correlation between IgG1 and asymptomatic disease, but with IgA, IgE and IgG2 displaying better association with symptomatic disease. The new aspects of this study highlighted pioneer findings that correlated the degree of tissue parasite density (low (LP), medium (MP) and high (HP) parasitism) with distinct patterns of anti-Leishmania Igs reactivity. In this scope, our data re-enforce the anti-Leishmania IgG but with IgA reactivity as the better marker for overall tissue parasitism. The association between clinical status, Ig profile and the tissue parasitism support a novel investigation on the impact of humoral immune response and susceptibility/resistance mechanism during ongoing CVL.

Clinical and epidemiological profile of multiple sclerosis in a reference center in the State of Bahia, Brazil.

Multiple sclerosis (MS) is an autoimmune, demyelinating and degenerative disease that affects the central nervous system. Its prevalence and clinical aspects vary according to the continent considered, being more frequent in Caucasians and young individuals aged 20 to 40 years. Epidemiological data from Brazil show that prevalence is variable, being more frequent in the Southern and Southeastern areas of the country, rather than in the Northern and Northeastern areas. The purpose of this paper is to describe MS clinical and epidemiological features in the State of Bahia, in the Brazilian Northeastern region. Thus, we held a cross-sectional study over the period from February to May, 2005, in the Multiple Sclerosis Patient Support Center ("Núcleo de Apoio aos Pacientes com Esclerose Múltipla") of Bahia, which included all patients with a diagnosis of MS seen over this period of time. A total of 121 patients were investigated, being 80.2% females (female:male ratio=4:1), with higher frequency in mulatto individuals (64%), and the relapsing-remitting type (91.3%). Most patients (68.7%) had mild MS, and blacks were prone to worse prognosis compared to other patients.