Institutional context and VCT practitioner narratives: possibilities and limitations for HIV prevention in Rio de Janeiro, Brazil.

BACKGROUND: Voluntary Counseling and Testing (VCT) is an HIV prevention strategy that promotes the principles of confidentiality and informed consent. International research has highlighted VCT counselors' isolation from service planning and the contradictions they negotiate between local values and global testing recommendations. In Brazil, studies have identified many limitations, including counselors' difficulties to implement a vulnerability approach to HIV prevention as recommended in the country's national guidelines. These studies, however, have not considered the particularities of the institutional contexts where counselors work. This research addresses these gaps in the VCT literature by exploring how VCT services are organized and how counselors perceive and perform their practices in the state of Rio de Janeiro, Brazil. METHODS: This is a case study of VCT services in the state of Rio de Janeiro. The research design included individual structured interviews with seven VCT service coordinators and twenty individual semi-structured interviews with VCT counselors. Participants were sampled according to gender, undergraduate degree and work trajectory to capture a diverse range counselor narratives. RESULTS: The VCT services were relatively homogenous in terms of functioning and had a similar restricted roll of activities including individual counseling and occasional external prevention activities with groups vulnerable to HIV. All VCT services reported reductions in staff size. Some counselors used dialogical practices to build trust, guarantee confidentiality and adjust their practices in accordance with their clients' values and practices. Others emphasized imperative messages or focused on risk and individual responsibility. Connections between how counselors perceive their practices and the organization of their work environment were observed. CONCLUSIONS: Due to the importance of counseling as a prevention strategy we recommend rethinking the relationship between counselors' practices and the organization of VCT services. The challenges brought about by the expansion of "test and treat" programs globally and other social and symbolic aspects of the HIV epidemic, such as gender inequalities, must also be taken into account. Further reflection is also needed on the relationship between counseling guidelines and practices within the vulnerability approach to HIV prevention.

Late-Presenting Eosinophilic Granulomatosis with Polyangiitis as Cause of Pulmonary Fibrosis: A Case-Based Review.

Introduction: Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to sixth decade of life, and it is a very uncommon aetiology for pulmonary fibrosis. Clinical case: A Hispanic 72-year-old female patient presents with a history of lower extremities pain, paraesthesia, oedema, and occasional macroscopic haematuria. During her hospitalisation, the patient presents, and images showed findings compatible with pulmonary fibrosis and alveolar haemorrhage, which require a biopsy, establishing the diagnosis of an eGPA. Discussion: eGPA is a low-incidence autoimmune vasculitis, with a high number of phenotypes which explain the broad clinical spectrum, but recent advances has helped to understand the physiopathology and its link with other conditions like pulmonary fibrosis. Conclusion: Early diagnosis and management of this condition is mandatory because it is the only factor that change the outcome of the patients.

Caregiver Burden and Family Quality of Life in Early Intervention: The Role of Mothers and Family Confidence.

(1) Background: Because life events when there is a family member with a disability can affect the overall family wellbeing, contributing to enhance family quality of life (FQoL) in the field of early childhood intervention has become a priority. However, it is a distal outcome that needs other short-term outcomes to be addressed, some of them under the potential impact of support services. This study examines the relationships between caregiver burden, family confidence, and FQoL, as well as the influence of child and family variables. (2) Method: A total of 58 families with children in early intervention from four Spanish communities participated. Hierarchical regression was conducted to assess the relevance of each predictor. Also, a mediation was performed to investigate the mediating role of family confidence. (3) Results: The family income impacted FQoL scores, and when burden and confidence were added, it was no longer relevant. Mothers with higher levels of confidence predicted a higher FQoL. Finally, we found a complete mediation of family confidence in the relations between severity and caregiver burden on FQoL. (4) Conclusions: Caregiver burden and family confidence affect FQoL. Building families' confidence contributes to attenuating the impact of burden on FQoL.

"Learning to learn" in the Extended Inverted Classroom: An evaluation of the effects of interactive teaching on knowledge and cognitive regulation in medical students.

INTRODUCTION: The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course. METHODS: We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p < 0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI). RESULTS: A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p < 0.05) in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d = 0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d = 0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d = 0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d = 0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d = 0.31; 95%CI, 0.08-0.53). CONCLUSIONS: The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.

[Ocular syphilis: alert for clinicians and ophthalmologists]. / Sífilis ocular: alerta para clínicos y oftalmólogos.

Syphilis is an infectious disease caused by the spirochete Treponema pallidum. It can cause ocular compromise at any stage, in immunocompetent or immunocompromised patients. Even though the ocular form is not frequent, due to the increase in the incidence of syphilis in recent years, it is mandatory to take it into consideration as a differential diagnosis in visual disorders. The most common clinical presentation is uveitis. Diagnosis is based on the presence of clinical signs and symptoms consistent with ophthalmologic involvement in a patient with syphilis. The CSF study should be performed on a clinical basis, to rule out concomitant neurological involvement. We present 5 cases of ocular syphilis, its clinical manifestations, treatment and evolution.

La sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum. Puede producir compromiso ocular en cualquier estadio, en pacientes inmunocompetentes o inmunocomprometidos. Si bien la frecuencia de presentación de la forma ocular no es alta, debido al aumento de la incidencia de sífilis en los últimos años, es necesario tenerla en cuenta como diagnóstico diferencial en los trastornos visuales. La presentación clínica más frecuente es la uveítis. Se objetiva ante la presencia de signos y síntomas clínicos consistentes con afectación oftalmológica en un paciente con sífilis. El estudio del LCR debe realizarse ante la sospecha clínica, para descartar compromiso neurológico concomitante. Comunicamos 5 casos de sífilis ocular, sus manifestaciones clínicas, tratamiento y evolución.

Effect of 3D-MOT training on the execution of manual dexterity skills in a population of older adults with mild cognitive impairment and mild dementia.

Computerized cognitive training tools are an alternative to preventive treatments related to cognitive impairment and aging. In this study, the transfer of 3D multiple object tracking (3D-MOT) training on manual dexterity concerning fine and gross motor skills in 38 elderly participants, half of them with mild cognitive impairment (MCI) and the other half with mild dementia (MD) was explored. A total of 36 sessions of the 3D-MOT training program were administered to the subjects. The Montreal Cognitive Assessment (MoCA) test was used to assess the baseline cognitive status of the participants. Two batteries of manual motor skills (GPT and MMDT) were applied before and after the 3D-MOT training program. The results showed an interaction effect of training and improvement in manual dexterity tests, from the first training session until the fifteenth session, and after this range of sessions, the interaction effect was lost. However, the training effect continued to the end of the thirty-six-session program. The experimental results show the effect of cognitive training on the improvement of motor skills in older adults. This type of intervention could have a broad impact on the aging population in terms of their attention, executive functions, and therefore, their quality of life.

Abscisic Acid Synthesis and Signaling during the Ripening of Raspberry (Rubus idaeus 'Heritage') Fruit.

The raspberry (Rubus idaeus L.) fruit is characterized by its richness in functional molecules and high nutritional value, but the high rate of fruit softening limits its quality during postharvest. Raspberry drupelets have a particular ripening regulation, depending partially on the effect of ethylene produced from the receptacle. However, the possible role of abscisic acid (ABA) in the modulation of quality parameters during the ripening of raspberry is unclear. This study characterized the fruit quality-associated parameters and hormonal contents during fruit development in two seasons. The quality parameters showed typical changes during ripening: a drastic loss of firmness, increase in soluble solids content, loss of acidity, and turning to a red color from the large green stage to fully ripe fruit in both seasons. A significant increase in the ABA content was observed during the ripening of drupelets and receptacles, with the higher content in the receptacle of ripe and overripe stages compared to the large green stage. Moreover, identification of ABA biosynthesis-(9-cis-epoxycarotenoid dioxygenase/NCED) and ABA receptor-related genes (PYRs-like receptors) showed three genes encoding RiNCEDs and nine genes for RiPYLs. The expression level of these genes increased from the large green stage to the full-ripe stage, specifically characterized by a higher expression of RiNCED1 in the receptacle tissue. This study reports a consistent concomitant increase in the ABA content and the expression of RiNCED1, RiPYL1, and RiPYL8 during the ripening of the raspberry fruit, thus supporting the role for ABA signaling in drupelets.

A Bibliometric Study on the Social Validity of Telepractice in Autism Spectrum Disorder.

The field of telepractice is generating increasing interest in recent years. In recent years, early childhood services have used resources such as support for interventions in families with children with autism spectrum disorder. Due to this situation, the social validity of such resources has emerged in this sector, receiving individual attention from academics and practitioners. However, a further deepening of such analyses is needed. Therefore, the main objective of this work is to analyze papers published in the Web of Science on social validity and telepractice in autism spectrum disorders. Bibliometric analysis allows us to discover the current state of a research field, to identify the main authors, articles, and topics, and to propose future lines of research to develop it further. Articles published between 2000 and 2021 were analyzed quantitatively, and by co-occurrence of words and authors. Subsequently, through bibliographic linking, the articles were grouped into different clusters. Five central themes were found, with social skills and the effectiveness of intervention programs being the most developed areas of research. Furthermore, studies focusing on evidence-based practices are necessary for the development of this research field. Thus, the analysis of social validity in the field of telepractice in children with autism spectrum disorders is a developing field within the early childhood sector.

Catalytic self-assembled monolayers on Au nanoparticles: the source of catalysis of a transphosphorylation reaction.

The catalytic activity of a series of Au monolayer protected colloids (Au MPCs) containing different ratios of the catalytic unit triazacyclononane⋅Zn(II) (TACN⋅Zn(II) ) and an inert triethyleneglycol (TEG) unit was measured. The catalytic self-assembled monolayers (SAMs) are highly efficient in the transphosphorylation of 2-hydroxy propyl 4-nitrophenyl phosphate (HPNPP), an RNA model substrate, exhibiting maximum values for the Michaelis-Menten parameters k(cat) and K(M) of 6.7×10(-3) s(-1) and 3.1×10(-4) M, respectively, normalized per catalytic unit. Despite the structural simplicity of the catalytic units, this renders these nanoparticles among the most active catalysts known for this substrate. Both k(cat) and K(M) parameters were determined as a function of the mole fraction of catalytic unit (x(1)) in the SAM. Within this nanoparticle (NP) series, k(cat) increases up till x(1) ≈0.4, after which it remains constant and K(M) decreases exponentially over the range studied. A theoretical analysis demonstrated that these trends are an intrinsic property of catalytic SAMs, in which catalysis originates from the cooperative effect between two neighboring catalytic units. The multivalency of the system causes an increase of the number of potential dimeric catalytic sites composed of two catalytic units as a function of the x(1) , which causes an apparent increase in binding affinity (decrease in K(M)). Simultaneously, the k(cat) value is determined by the number of substrate molecules bound at saturation. For values of x(1) >0.4, isolated catalytic units are no longer present and all catalytic units are involved in catalysis at saturation. Importantly, the observed trends are indicative of a random distribution of the thiols in the SAM. As indicated by the theoretical analysis, and confirmed by a control experiment, in case of clustering both k(cat) and K(M) values remain constant over the entire range of x(1) .

The effects of α-cellulose extraction and blue-stain fungus on retrospective studies of carbon and oxygen isotope variation in live and dead trees.

Tree-ring carbon and oxygen isotope ratios from live and recently dead trees may reveal important mechanisms of tree mortality. However, wood decay in dead trees may alter the δ(13)C and δ(18)O values of whole wood obscuring the isotopic signal associated with factors leading up to and including physiological death. We examined whole sapwood and α-cellulose from live and dead specimens of ponderosa pine (Pinus ponderosa), one-seed juniper (Juniperous monosperma), piñon pine (Pinus edulis) and white fir (Abies concolor), including those with fungal growth and beetle frass in the wood, to determine if α-cellulose extraction is necessary for the accurate interpretation of isotopic compositions in the dead trees. We found that the offset between the δ(13)C or δ(18)O values of α-cellulose and whole wood was the same for both live and dead trees across a large range of inter-annual and regional climate differences. The method of α-cellulose extraction, whether Leavitt-Danzer or Standard Brendel modified for small samples, imparts significant differences in the δ(13)C (up to 0.4‰) and δ(18) O (up to 1.2‰) of α-cellulose, as reported by other studies. There was no effect of beetle frass or blue-stain fungus (Ophiostoma) on the δ(13)C and δ(18)O of whole wood or α-cellulose. The relationships between whole wood and α-cellulose δ(13)C for ponderosa, piñon and juniper yielded slopes of ~1, while the relationship between δ(18)O of whole wood and α-cellulose was less clear. We conclude that there are few analytical or sampling obstacles to retrospective studies of isotopic patterns of tree mortality in forests of the western United States.

"Learning to Learn" in the Extended Inverted Classroom: An Evaluation of the Effects of Interactive teaching on Knowledge and Cognitive Regulation in Medical Students. / «Aprendiendo a aprender¼ en el Aula Invertida Extendida: una evaluación sobre los efectos de la enseñanza interactiva en el conocimiento y la regulación cognitiva de estudiantes de Medicina.

INTRODUCTION: The evidence regarding the effects of the Inverted Classroom on students' metacognitive skills is limited. This study evaluates these effects on student perceptions about knowledge and cognitive regulation during a surgical course. METHODS: We measured student perceptions before and after a conventional Inverted Classroom in surgery using the Metacognitive Awareness Inventory. We evaluated the mean differences between the scores of the two measurements using Student's t-test (p<0.05), and the size of the effect on knowledge and cognitive regulation using Cohen's d test (95%CI). RESULTS: A total of 158 students (pre-intervention) and 155 students (post-intervention) were included in the analysis. Significant differences were found (p<0.05)in, as well as positive effects on, the students' abilities to know their own learning (declarative knowledge) (d=0.24; 95%CI, 0.02-0.47), to use learning strategies (procedural knowledge) (d=0.19; 95%CI, -0.02 to 0.41) and to understand when and why to use these strategies (conditional knowledge) (d=0.20; 95%CI, -0.01 to 0.42), in addition to the abilities to plan (d=0.31; 95%CI, 0.09-0.53) and to evaluate their learning (d=0.31; 95%CI, 0.08-0.53). CONCLUSIONS: The Inverted Classroom has positive effects on metacognitive skills according to students' perceptions. Further studies are required that compare these effects with other methodologies for teaching in the classroom and the workplace.

Molecular and structural characterization of expansins modulated by fungal endophytes in the Antarctic Colobanthus quitensis (Kunth) Bartl. Exposed to drought stress.

Expansins are proteins involved in cell wall metabolism that play an important role in plant growth, development, fruit ripening and abiotic stress tolerance. In the present study, we analyzed putative expansins that respond to drought stress. Five expansin genes were identified in cDNA libraries isolated from Colobanthus quitensis gown either with or without endophytic fungi under hydric stress. A differential transcript abundance was observed by qPCR analysis upon drought stress. To compare these expansin genes, and to suggest a possible mechanism of action at the molecular level, the structural model of the deduced proteins was obtained by comparative modeling methodology. The structures showed two domains and an open groove on the surface of the proteins was observed in the five structural models. The proteins were evaluated in terms of their protein-ligand interactions using four different ligands. The results suggested differences in their mode of protein-ligand interaction, in particular concerning the residues involved in the protein-ligand interaction. The presented evidence supports the participation of some members of the expansin multiprotein family in the response to drought stress in C. quitensis and suggest that the response is modulated by endophytic fungi.

Vulnerability to STIs/HIV: sociability and the life trajectories of young women who have sex with women in Rio de Janeiro.

This study aims to better understand STI/HIV-related vulnerability among self-identified lesbians and bisexual young women aged 18-26 years in two neighbourhoods in Rio de Janeiro. Based on ethnographic observations and in-depth interviews, the paper analyses their life experiences and trajectories. Findings reveal that sexual identities and ties attributed to sexual interactions with women and men have an important role in influencing perceptions of vulnerability. The notion of STI and HIV risk is not well developed among women who have sex with women. It emerges largely in practices with bisexual female partners and those of the opposite sex, since in these the potential for HIV transmission (through contact with semen) is recognized. Sexually transmitted infection and HIV-related risk with male partners is seen as small by the women in the study, since such relationships are seen as 'occasional' and generally speaking occur with someone they know well. The value given to trust and the lack of alignment between sexual identities and sexual practices reinforces the need for approaches to STI and HIV prevention and care that prioritise the sexual history and practices of women and their sexual identities within specific contexts.

["In search of respect": life stories of black women seen at a Specialized Center for Women's Care in the Baixada Fluminense, Rio de Janeiro State, Brazil]. / "Respeito é bom e eu gosto": trajetórias de vida de mulheres negras assistidas por um Centro Especializado de Atendimento à Mulher em Situação de Violência na Baixada Fluminense, Rio de Janeiro, Brasil.

Based on a constructivist inter-sector approach and considering the possible agency and negotiations within violent relationships, the study aimed to understand how black women redefined gender violence according to their affective-sexual relationships. The procedures included participant observation in discussion groups and individual interviews with women seen at a Specialized Center for Women's Care in the Baixada Fluminense, Rio de Janeiro State, Brazil. According to the results, gender violence is present throughout the women's lives. The narratives reveal a feeling of affective-sexual loneliness caused by neglect by their partners or potential partners, as well as experiences with racist and sexist treatment in their own relationships at school and work. Violence, apparently limited to intimate partner relations, spills over into other family relations. Understanding violence as "lack of respect" produced a kind of "collective surveillance" among the women, evidencing the building of a solidarity network. By retelling their life stories, these women remember the past, present, and future with expectations by poor black working women of reinventing themselves. A joint on-going effort is needed by civil society, teaching institutions, and the political sphere to deconstruct culturally instituted models that persistently keep black women in a place of submission, inferiority, and marginalization.

Advances of native and non-native Antarctic species to in vitro conservation: improvement of disinfection protocols.

Plants that inhabit Antarctica have raised scientific interest due to their resilience to climate change, abiotic tolerance mechanisms and potential biological applications. In vitro propagation is useful for conservation, genetic material availability of these species and avoiding mass collection in their habitat. In vitro culture protocols for the native plants Colobanthus quitensis and Deschampsia antarctica and the non-native Juncus bufonius have been affected by endophytic microorganisms that proliferate when introduced to tissue cultures. This study evaluated the microbicidal and phytotoxic effect of calcium hypochlorite (Ca(ClO)2), silver nitrate (AgNO3) and silver nanoparticles (AgNPs), and their use at different concentrations for different time periods. The Ca(ClO)2 at 100 mg mL-1 showed the best microbial contamination control in D. antarctica (applied for 20 min) and for the three C. quitensis populations (applied for 15 min). In J. bufonius, AgNO3 at 10 mg mL-1 for 10 min reduced the microbial growth, but oxidative damage was generated. AgNPs did not prevent contamination or have adverse effects on tissues. Survival plantlets from each treatment, population or species were effectively introduced to the tissue culture and their propagation was successful. These results constitute a fundamental advance for the introduction, propagation and conservation of Antarctic species and their use in scientific research.

[Financial cost of early rheumatoid arthritis in the first year of medical attention: three clinical scenarios in a third-tier university hospital in Colombia]. / Costos directos de la artritis reumatoide temprana en el primer año de atención: simulación de tres situaciones clínicas en un hospital universitario de tercer nivel en Colombia.

INTRODUCTION: In Colombia, the cost burden of chronic diseases is not well known, either globally or in localized areas of the health system. Rheumatoid arthritis is one of most common chronic diseases, and represents a high cost for the health system. OBJECTIVE: The direct medical costs were estimated for rheumatoid arthritis patients in the in the first year of diagnosis at a level 3 university hospital in Colombia. MATERIALS AND METHODS: Three therapy settings for early rheumatoid arthritis patients were established in the first year of diagnosis according to national and international guidelines. Each setting included treatment with disease-modifying anti-rheumatic drugs or biologic therapy based on disease severity as measured by Disease Activity Score 28. All direct medical costs were included: specialized medical care, diagnostic tests and drugs. Cost information was obtained from the Central Military Hospital finance department in Bogotá and the national manual of drug prices based on the "Farmaprecios" 2007 guide, a reference in general use by health institutions. Results. The average of cost of medical care in patients with mild, moderate and severe disease was US $1689, $1805 and $23,441 respectively. The recommended retail prices of the medicines published in "Farmaprecios" was US $1418, $1821 and $31,931. When the charges levied by several major health institutions were compared, substantial increases were noted, US $4936, $7716 and $123,661, respectively. Drug costs represented 86% of total cost, laboratory costs were 10% and medical attention was only 4%. CONCLUSIONS: Drugs costs were the principal component of the total direct medical cost, and it increased 40 times when a biological therapy is used. Complete economic evaluation studies are necesary to estimate the viability and clinical relevance of biological therapy for early rheumatoid arthritis.

A review of HIV testing strategies among MSM (2005-2015): Changes and continuities due to the biomedicalization of responses to AIDS.

Global AIDS policy points to a new prevention rationale centred on the identification and treatment of people infected with HIV, particularly among the so-called key populations. This study analyses the continuities and changes in HIV testing strategies based on a meta-narrative review of academic output (2005-2015) focusing on men who have sex with men. We reviewed 65 articles based on their prevention approaches, testing strategies and the involvement of non-governmental organisations (NGOs) and community-based organisations. The analysis found continuities in HIV testing strategies in addition to changes. A new focus is reflected in the expansion and diversification of testing offered, the reduced importance of counselling, an emphasis on condom use associated with test results and on the absence of active participation of NGOs in implementing social responses to AIDS. Our findings indicate a systematic lack of problematising the potential ethical, political and cultural issues surrounding HIV testing as a strategy to control the epidemic. The findings of our study reinforce criticisms of the biomedicalization of current HIV-related policies, and reiterate the importance of combining progress achieved in increasing access to diagnosis and treatment with the historical achievements of social responses to AIDS.

Challenges facing HIV treatment as prevention in Brazil: an analysis drawing on literature on testing. / Desafios do tratamento como prevenção do HIV no Brasil: uma análise a partir da literatura sobre testagem.

According to current global AIDS guidelines, HIV testing is key to the success of the 'treatment as prevention' (TasP) strategy and the control of AIDS. In view of Brazil's commitment to these guidelines, this article characterizes the principles and justifications underpinning TasP and discusses implementation challenges. The analysis draws on a systematic review of the literature (2005 to 2015) on recruitment and testing strategies for men who have sex with men. This approach was adopted based on the assumption that current knowledge on HIV testing can offer valuable insights into the foundations of global AIDS policies and their uptake in local contexts. Based on the analysis of the 65 articles selected, we suggest that TasP represents a shift in the AIDS prevention paradigm. There is an overlap between prevention and care and the new approach places major emphasis on biomedical and psychological knowledge. The TasP approach fails to address the factors associated with HIV vulnerability and the stigma surrounding AIDS and undermines the participation of activists and PLWHA as autonomous producers of preventive of preventive practices. We argue that, to ensure the effective implementation of TasP in Brazil, it is necessary to discuss issues such as the protection of human rights and the structural problems facing Brazil's public health system.

Segundo as diretrizes globais atuais, a realização do teste anti-HIV é crucial para o sucesso da estratégia do 'tratamento como prevenção' (TcP) e controle da Aids. Dado o compromisso do Brasil com essa política, este artigo objetiva caracterizar os princípios e justificativas do TcP e discutir os desafios da sua implementação. A reflexão é orientada por uma revisão sistemática da literatura internacional de 2005 a 2015 sobre estratégias de captação e oferta do teste do HIV entre homens que fazem sexo com homens (HSHs). Tal escolha parte do pressuposto de que a produção acadêmica é uma fonte relevante para compreender os fundamentos e apropriações das políticas globais de Aids nos contextos locais. Segundo a análise dos 65 artigos selecionados, a TcP opera uma transformação no paradigma preventivo. Prevalece uma superposição entre prevenção e assistência, sugerindo maior peso aos conhecimentos e práticas biomédicos. Esse enfoque não contempla o enfrentamento de fatores estruturais associados à vulnerabilidade ao HIV e ao estigma da Aids e a participação de ativistas e PVHA como produtores autônomos de praticas preventivas. Argumentamos que a efetividades da TcP no Brasil requer uma discussão sobre a garantia dos direitos humanos e problemas estruturais e programáticos do sistema público de saúde.

In vivo anti-arthritic effect and repeated dose toxicity of standardized methanolic extracts of Buddleja cordata Kunth (Scrophulariaceae) wild plant leaves and cell culture.

ETHNOPHARMACOLOGICAL RELEVANCE: Buddleja cordata Humb. Bonpl. & Kunth, known by the population as Tepozán blanco, is a shrub plant used in traditional herbal medicine in Mexico for the treatment of tumors, cancer, sores, skin burns, rheumatic pains and diseases related to inflammatory processes such as arthritis; authors adjudicate this etno-medicinal effect to the presence of secondary metabolites in the plant such as verbascoside, however due to its low concentration in recent years biotechnological tools are applied as cell culture to biosynthesize these pharmacological active metabolites in greater quantities. AIM OF THE STUDY: Evaluate the possible toxic effect after a daily administration of MeOH extracts from wild plant leaves (Bc-Wp), and cell culture (Bc-Cc) of B. cordata for 28 days, and after their anti-edematous and antioxidant activities in vivo, as well their effect on the cytokines profile during experimental arthritis induced by complete Freund's adjuvant. MATERIALS AND METHODS: Both extracts were evaluated in CD1 male mice first in a toxicity test of repeated dose administrations (1 g/kg) for 28 days, after which pharmacological activity of both extracts was measure during experimental induced arthritis where three doses were tested, at the end of the study edema formation, body weight gain and antioxidant activity were measure in edema and ganglionic tissues. Finally, dose that exerted the best protective effect (250 mg/kg) was evaluated to quantify its effect over ganglionic tissue concentration of lymphocytes T CD4+, and cytokines (IL-1ß, TNF-α and IL-10), as well histological analysis in arthritic mice. RESULTS: Both extracts (Bc-Wp and Bc-Cc) did not exert lethality, however body weight gain and food in-take were lower than in healthy mice administered with vehicles, also extract-treated animals showed a decrease in serum lipid concentration and only Bc-Wp extract treated animals decrease serum alkaline phosphatase after 28 daily administration compared to healthy un-treated mice. During experimental arthritis best inhibition effect over edema development was observed in those animals administered with both extracts at dose of 250 mg/kg (Bc-Wp and Bc-Cc) on day 28, compared to CFA un-treated mice. Also both extracts reduce oxidative damage over lipids and proteins at the same dose, in both ganglionic and edema tissue, as well antioxidant enzymatic response was reduced in both tissues compared to arthritic un-treated group. In ganglionic tissue of arthritic mice, CD4+ lymphocytes concentration was reduced by Bc-Wp and Bc-Cc treatment (250 mg/kg) respectively, as well IL-1ß, and TNF-α levels. Only arthritic animals treated with Bc-Cc extract at 250 mg/kg generated a significant increase of IL-10 doubling the levels compared to CFA un-treated group. Histological analysis of popliteal ganglion showed that both extracts decrease the incidence of lytic lesions, lipid inclusions and leukocyte infiltration. CONCLUSION: Methanolic extracts of wild Buddleja cordata and its cell cultures did not generated lethality after a daily administration for 28 days at 1 g/kg, but it was observed that both showed a lipid-lowering effect. Also at dose of 250 mg/kg both extracts exerted anti-edematous, protection against the oxidation of lipid and proteins, regulation on antioxidant enzymatic response, down-regulation on lymphocytes CD4+ producers of IL-1ß and TNF-α, an increase in IL-10 levels, which caused a decrease in leukocyte infiltration in ganglionic tissue during experimental arthritis.

Sífilis ocular: alerta para clínicos y oftalmólogos / Ocular syphilis: alert for clinicians and ophthalmologists

Resumen La sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum. Puede producir com promiso ocular en cualquier estadio, en pacientes in munocompetentes o inmunocomprometidos. Si bien la frecuencia de presentación de la forma ocular no es alta, debido al aumento de la incidencia de sífilis en los últimos años, es necesario tenerla en cuenta como diagnóstico diferencial en los trastornos visuales. La presentación clínica más frecuente es la uveítis. Se objetiva ante la presencia de signos y síntomas clínicos consistentes con afectación oftalmológica en un pacien te con sífilis. El estudio del LCR debe realizarse ante la sospecha clínica, para descartar compromiso neurológi co concomitante. Comunicamos 5 casos de sífilis ocular, sus manifestaciones clínicas, tratamiento y evolución.

Abstract Syphilis is an infectious disease caused by the spi rochete Treponema pallidum. It can cause ocular compro mise at any stage, in immunocompetent or immunocom promised patients. Even though the ocular form is not frequent, due to the increase in the incidence of syphilis in recent years, it is mandatory to take it into consider ation as a differential diagnosis in visual disorders. The most common clinical presentation is uveitis. Diagnosis is based on the presence of clinical signs and symptoms consistent with ophthalmologic involvement in a patient with syphilis. The CSF study should be performed on a clinical basis, to rule out concomitant neurological involvement. We present 5 cases of ocular syphilis, its clinical manifestations, treatment and evolution.