Predictive factors of the contracture test for diagnosing malignant hyperthermia in a Brazilian population sample: a retrospective observational study

Abstract Introduction Malignant Hyperthermia (MH) is a pharmacogenetic, hereditary and autosomal dominant syndrome triggered by halogenates/succinylcholine. The In Vitro Contracture Test (IVCT) is the gold standard diagnostic test for MH, and it evaluates abnormal skeletal muscle reactions of susceptible individuals (earlier/greater contracture) when exposed to caffeine/halothane. MH susceptibility episodes and IVCT seem to be related to individual features. Objective To assess variables that correlate with IVCT in Brazilian patients referred for MH investigation due to a history of personal/family MH. Methods We examined IVCTs of 80 patients investigated for MH between 2004‒2019. We recorded clinical data (age, sex, presence of muscle weakness or myopathy with muscle biopsy showing cores, genetic evaluation, IVCT result) and IVCT features (initial and final maximum contraction, caffeine/halothane concentration triggering contracture of 0.2g, contracture at caffeine concentration of 2 and 32 mmoL and at 2% halothane, and contraction after 100 Hz stimulation). Results Mean age of the sample was 35±13.3 years, and most of the subjects were female (n=43 or 54%) and MH susceptible (60%). Of the 20 subjects undergoing genetic investigation, 65% showed variants in RYR1/CACNA1S genes. We found no difference between the positive and negative IVCT groups regarding age, sex, number of probands, presence of muscle weakness or myopathy with muscle biopsy showing cores. Regression analysis revealed that the best predictors of positive IVCT were male sex (+12%), absence of muscle weakness (+20%), and personal MH background (+17%). Conclusions Positive IVCT results have been correlated to male probands, in accordance with early publications. Furthermore, normal muscle strength has been confirmed as a significant predictor of positive IVCT while investigating suspected MH cases.

Fatigue, depression, and physical activity in patients with malignant hyperthermia: a cross-sectional observational study

Abstract Background Malignant Hyperthermia (MH) is a pharmacogenetic disorder triggered by halogenated anesthesia agents/succinylcholine and characterized by hypermetabolism crisis during anesthesia, but also by day-to-day symptoms, such as exercise intolerance, that may alert the health professional. Objective The study aimed to analyze the incidence of fatigue in MH susceptible patients and the variables that can impact perception of fatigue, such as the level of routine physical activity and depression. Methods A cross-sectional observational study was carried out with three groups - 22 patients susceptible to MH (positive in vitro muscle contracture test), 13 non-susceptible to MH (negative in vitro muscle contracture test) and 22 controls (no history of MH). Groups were assessed by a demographic/clinical questionnaire, a fatigue severity scale (intensity, specific situations, psychological consequences, rest/sleep response), and the Beck depression scale. Subgroups were re-assessed with the Baecke habitual physical exercise questionnaire (occupational physical activity, leisure physical exercise, leisure/locomotion physical activity). Results There were no significant differences among the three groups regarding fatigue intensity, fatigue related to specific situations, psychological consequences of fatigue, fatigue response to resting/sleeping, depression, number of active/sedentary participants, and the mean time and characteristics of habitual physical activity. Nevertheless, unlike the control sub-group, the physically active MH-susceptible subgroup had a higher fatigue response to resting/sleeping than the sedentary MH susceptible subgroup (respectively, 5.9 ± 1.9 vs. 3.9 ± 2, t-test unpaired, p< 0.05). Conclusion We did not detect subjective fatigue in MH susceptible patients, although we reported protracted recovery after physical activity, which may alert us to further investigation requirements.

Patient suspected susceptibility to malignant hyperthermia: impact of the disease

Abstract Introduction Malignant Hyperthermia (MH) is an inherited hypermetabolic syndrome triggered by exposure to halogenated anesthetics/succinylcholine. The lack of knowledge regarding this condition might be associated with the rare occurrence of MH reaction and symptoms. Methods This observational study evaluated 68 patients from 48 families with confirmed or suspected MH susceptibility due to medical history of MH reaction or idiopathic increase of creatine kinase or MH-related myopathies. Participants were assessed by a standardized questionnaire and submitted to physical/neurological examination to assess the characteristics of patients with MH, their knowledge about the disease, and the impact suspected MH had on their daily lives. Results Suspected MH impacted the daily life of 50% of patients, creating difficulties in performing surgical/clinical/dental treatment and problems related to their family life/working/practicing sports. The questionnaire on MH revealed a correct answer score of 62.1 ± 20.8 (mean ± standard deviation) on a scale 0 to 100. Abnormal physical/neurological examination findings were detected in 92.6% of susceptible patients. Conclusions Suspected MH had impacted the daily lives of most patients, with patients reporting problems even before MH investigation with IVCT. Patients showed a moderate level of knowledge about MH, suggesting the need to implement continuing education programs. MH susceptible patients require regular follow-up by a health team to detect abnormalities during physical and neurological examination.

"Nem tão doentes, nem tão livres de doença": narrativas de mulheres com câncer de mama sobre a investigação da herança genética em um instituto oncológico de pesquisa / "Ni tan enfermas, ni tan libres de la enfermidad": relatos de mujeres con cáncer de mama sobre la investigación de la herencia genética en un instituto de investigación oncológica / "Not so sick, not so disease-free": narratives of women with breast cancer about the investigation of genetic inheritance in an oncological research institute

A tese versa sobre a susceptibilidade hereditária para o câncer de mama sob um olhar socioantropológico. O tema apresenta relevância em função da atual valorização da genética na área da oncologia e dos impactos que esse campo da medicina produz na vida das pessoas e famílias envolvidas. A partir de uma produção etnográfica, buscou-se compreender como a prática do aconselhamento genético interfere em diversos planos da vida de mulheres com câncer de mama hereditário, como o psicoafetivo, social e familiar, atendidas por um instituto oncológico de pesquisa, pertencente ao setor privado de saúde. Para investigação metodológica, utilizou-se um conjunto de dados empíricos: entrevistas semiestruturadas com mulheres com (suspeita de) câncer de mama hereditário, observação de consultas com o serviço de genética e documentos online relativos à hereditariedade da doença na mama. Como resultados, constatou-se de que modos às percepções biomédicas acerca da noção de risco atravessaram a produção de subjetividades, identidades e coletividades das interlocutoras. Outros pontos explorados nas narrativas foram: as repercussões, individuais e coletivas, ocasionadas pela experiência do aconselhamento genético e o entrelaçamento da doença e da hereditariedade a outras vivências de cunho individual. O estudo visou contribuir a dar visibilidade às experiências e as demandas das mulheres investigadas e somar aos estudos risco, biotecnologias e subjetividades.AU

This thesis is about hereditary susceptibility to breast cancer from a socio-anthropological perspective. The theme is relevant due to the current appreciation of the genetics field in the oncological area and the impact on the lives of people and families involved. From an ethnographical starting point, how genetic counselling interferes with the life planning of women with hereditary breast cancer breast in areas such as psycho-affective, social and familiar. The search was conducted in an oncological research institute that belongs to the private healthcare system. For the methodological research, it was used a set of empirical data: semi-structured interviews with (suspected) hereditary breast cancer; participant observation of genetic consultations and online documents related to the heredity of the disease in the breast. As result, it has been noticed how the biomedical perceptions about the notion of risk cross through to the interlocutors' subjective productions, identities and sense of collective. Another aspect of the narratives is the relationship of genetics with oncological illness. It also stands out the individual and collective repercussions caused by the experience of genetic counselling and the intertwining of the disease and heredity with other individual experiences. The study aimed to contribute to giving visibility to the experiences and demands of the women investigated and also to add studies of the risk, biotechnologies and subjectivities.AU

La tesis aborda la susceptibilidad hereditaria al cáncer de mama desde una perspectiva socio-antropológica. El tema es relevante debido a la actual valorización de la genética en el área de la oncología y a los impactos que ese campo de la medicina tiene en la vida de las personas y familias. Con base en una producción etnográfica, buscamos comprender cómo la práctica del asesoramiento genético interfiere en diferentes áreas de la vida de mujeres con cáncer de mama hereditario, como el psicoafectivo, social y familiar, asistidas por un instituto de investigación oncológica, perteneciente al sector privado del cuidado de la salud. La investigación se fundamenta en un conjunto de datos empíricos: entrevistas semiestructuradas con mujeres con (sospecha de) cáncer de mama hereditario, observación de consultas en el servicio de genética y documentos en línea relacionados con la herencia familiar de la enfermedad. Como resultado, se constató como las percepciones sobre la biomedicina sobre la noción de riesgo atraviesan la producción de subjetividades, identidades y colectividades de las interlocutoras. Otros puntos explorados en las narrativas fueron: las repercusiones individuales y colectivas provocadas por la experiencia de la consejería genética y el entrelazamiento de la enfermedad y la herencia con otras experiencias de carácter individual. El estudio pretendió dar visibilidad a las experiencias y demandas de las mujeres investigadas y contribuir a los estudios sobre riesgo, biotecnologías y subjetividades. AU

Actividad antimicrobiana in vitro del extracto de hojas de Bixa orellana L. contra bacterias anaerobias asociadas a la vaginosis bacteriana y Lactobacillus spp / In vitro antimicrobial activity of Bixa orellana L. leaves extract against anaerobic bacteria associated to bacterial vaginosis and Lactobacillus spp.

Objetivos . Describir la actividad antimicrobiana in vitro del extracto metanólico de las hojas de Bixa orellana L. contra las bacterias anaerobias asociadas a la vaginosis bacteriana y Lactobacillus spp. Materiales y métodos . Se incluyeron en el estudio ocho cepas de referencia ATCC; Gardnerella vaginalis, Prevotella bivia, Peptococcus niger, Peptostreptococcus anaerobius, Mobiluncus curtisii, Atopobium vaginae, Veillonella parvula y Lactobacillus crispatus, y 22 aislamientos clínicos; once aislados de Gardnerella vaginalis y once aislados de Lactobacillus. La susceptibilidad antimicrobiana se determinó mediante el método de difusión en agar. La concentración mínima inhibitoria (CMI) y la concentración bactericida mínima (CBM) fueron determinadas utilizando el método de dilución en agar y un método de dilución modificado, respectivamente. Resultados . Todas las cepas de referencia ATCC tuvieron un alto nivel de susceptibilidad al extracto, con excepción de P. vibia, V. parvula y L. crispatus. Interesantemente, los aislamientos clínicos de G. vaginalis y la cepa ATCC de G. vaginalis fueron los más susceptibles al extracto dados los bajos valores de CMI (1,0 - 2,0 mg/mL) y CBM (1,0 - 4,0 mg/mL), mientras que, los aislamientos clínicos de Lactobacillus spp. y la cepa ATCC de L. crispatus fueron los menos susceptibles debido a los altos valores de CMI (32,0 mg/mL) y CBM (≥ 32,0 mg/mL). Conclusiones . Los experimentos in vitro sugieren que el extracto posee propiedades antibacterianas selectivas dada su alta actividad contra bacterias anaerobias asociadas a vaginosis bacteriana y baja actividad contra especies de Lactobacillus.

Objective. To describe the in vitro antimicrobial activity of the methanolic extract of Bixa orellana L. leaves against anaerobic bacteria associated to bacterial vaginosis and Lactobacillus spp. Materials and methods. Eight ATCC reference strains; Gardnerella vaginalis, Prevotella bivia, Peptococcus niger, Peptostreptococcus anaerobius, Mobiluncus curtisii, Atopobium vaginae, Veillonella parvula, and Lactobacillus crispatus, and twenty-two clinical isolates; eleven Gardnerella vaginalis and eleven Lactobacillus strains, were included in the study. The antimicrobial susceptibility was determined by the agar diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined by using agar dilution and a modified dilution plating method, respectively. Results. All ATCC reference strains showed high levels of susceptibility to the extract, except P. vibia, V. parvula and L. crispatus. Interestingly, all G. vaginalis clinical isolates and the G. vaginalis ATTC strain were the most susceptible to the extract, given their low MIC (1.0 - 2.0 mg/mL) and MBC (1.0 - 4.0 mg/mL) values, whereas, the Lactobacillus spp. clinical isolates and the L. crispatus ATCC strain were the least susceptible bacteria given their high MIC (32.0 mg/mL) and MBC (≥ 32.0 mg/mL) values. Conclusions. In vitro experiments suggest that the extract possesses selective antimicrobial properties given its high activity against bacterial vaginosis-associated anaerobic bacteria and low activity against Lactobacillus species.

ABO blood group association and COVID-19. COVID-19 susceptibility and severity: a review

Abstract Introduction The SARS-CoV-2 pandemic has been affecting the health and economic, as well as social, life of the entire globe since the end of 2019. The virus causes COVID-19, with a wide range of symptoms among the infected individuals, from asymptomatic infection to mortality. This, along with a high infection rate, prompted efforts to investigate the potential mechanisms of the different clinical manifestations caused by SARS-CoV-2 among the infected populations. Hypothesis One of the possible mechanisms that has been reported is the ABO blood system polymorphism. Indeed, one of the major proposed mechanisms is the presence of naturally occurring anti-A antibodies in individuals of groups O and B, which could be partially protective against SARS-CoV-2 virions. Objective and Method This article aimed to review the published data on the potential effect of the ABO blood group system on the susceptibility to COVID-19 and the disease progression and outcomes. Results The reviewed data suggest that individuals of blood group A are at a higher risk of infection with SARS-CoV-2 and may develop severe COVID-19 outcomes, whereas blood group O is considered protective against the infection, to some extent. However, some of the available studies seem to have been influenced by unaccounted confounders and biases. Conclusion Therefore, further appropriately controlled studies are warranted to fully investigate the possible association between the ABO blood groups and COVID-19 susceptibility and severity.

Susceptibilidad antimicrobiana de bacterias aisladas en sepsis del acceso vascular. Instituto de Nefrología, 2019 / Antimicrobial susceptibility of bacteria isolated from vascular access sepsis. Institute of Nephrology, 2019

Introducción: El acceso vascular en hemodiálisis es esencial para el enfermo renal por su repercusión en la calidad de vida. La fístula arteriovenosa, los catéteres para hemodiálisis o las prótesis vasculares, aunque han evolucionado gradualmente hacia el perfeccionamiento, son proclives a las infecciones debidas fundamentalmente a bacterias de la microbiota de la piel y mucosas. Objetivo: Caracterizar la susceptibilidad antimicrobiana de las bacterias aisladas de pacientes con sepsis del acceso vascular en el servicio de hemodiálisis del Instituto de Nefrología. Material y Métodos: Estudio de corte transversal, en el período comprendido entre enero a diciembre de 2019. El universo estuvo constituido por 112 aislamientos obtenidos a partir de muestras de hemocultivos, secreciones y puntas de catéter de los pacientes con bacteriemias, sepsis o secreción en el sitio de inserción del catéter o acceso vascular. Resultados: El 72,3 por ciento de las muestras estudiadas fueron hemocultivos. Se obtuvo 38,3 % de aislamientos de Staphylococcus aureus, sensibles en su totalidad a la vancomicina. El 68,1 % de las cepas de Escherichia coli fueron productoras de betalactamasas de espectro extendido (BLEE) con sensibilidad superior a 60 % a aminoglucósidos y carbapenémicos; similar patrón de sensibilidad mostraron las cepas de Pseudomonas, no obstante, el 100% fue resistente a las cefalosporinas. Conclusiones: No se reportó resistencia a la vancomicina en el estudio. Los aislamientos de los gérmenes gramnegativos mostraron elevada resistencia a las cefalosporinas y una buena sensibilidad a aminoglucósidos y carbapenémicos(AU)

Introduction: The vascular access in hemodialysis is essential for the renal patient both for its associated morbidity and mortality as well as for its impact on quality of life. Although arteriovenous fistula, hemodialysis catheters or vascular prostheses have gradually evolved toward improvement, they are prone to infections primarily due to bacteria on the skin and mucosal microbiota. Objective: To characterize the antimicrobial susceptibility of bacteria isolated from patients with vascular access sepsis in the hemodialysis service of the Institute of Nephrology. Material and Methods: A cross-sectional study was conducted in the period January-December 2019. The universe consisted of all 112 isolates obtained from blood culture samples, secretions and catheter tips from patients with bacteremia, sepsis or discharge at the site of catheter insertion or vascular access. Results: The results show that 72.3% of the samples studied were blood cultures. Also, 38.3 percent of Staphylococcus aureus isolates, which were totally sensitive to vancomycin, were obtained. On the other hand, 68.1% of Escherichia coli strains were extended spectrum beta-lactamases (ESBL) producers with sensitivity to aminoglycosides and carbapenems greater than 60%. Pseudomonas strains exhibited a similar pattern of sensitivity, however, 100% were resistant to cephalosporins. Conclusions: No resistance to vancomycin was reported in this study. Gram-negative isolates showed high resistance to cephalosporins and good sensitivity to aminoglycosides and carbapenems(AU)

Detección de ß-lactamasas de espectro extendido en Escherichia coli aisladas de ecosistemas dulceacuícolas de La Habana / Detection of extended-spectrum ß;-lactamases in Escherichia coli isolated from freshwater ecosystems in Havana

Introducción: Las cepas de Escherichia coli productoras de β-lactamasas de espectro extendido son patógenos multirresistentes y una de las bacterias que más contribuyen con la resistencia antibiótica bacteriana en la clínica. Sin embargo, se aíslan cada vez con más frecuencia de ambientes naturales, tales como los ecosistemas acuáticos en los cuales se emplea como un indicador de contaminación fecal. Objetivo: Evaluar la susceptibilidad a los antibióticos y la producción de enzimas ß-lactamasas de espectro extendido de aislados de Escherichia coli procedentes de ecosistemas dulceacuícolas de La Habana. Métodos: Se analizaron 43 aislados de E. coli provenientes de los ríos Almendares, Quibú y Luyanó de La Habana. Se determinó la susceptibilidad a 18 antibióticos y la producción fenotípica de ß-lactamasas de espectro extendido según las normas del Instituto de Estándares para el Laboratorio Clínico. La detección molecular de las enzimas se realizó mediante reacción en cadena de la polimerasa. Se calculó el índice de multirresistencia a los antibióticos y los patrones de resistencia de cada aislado de E. coli- ß-lactamasas de espectro extendido. Resultados: El 65 por ciento de los aislados de E. coli fueron resistentes al menos a un antibiótico y el 35 por ciento fueron sensibles a todos los antibióticos. El fenotipo ß-lactamasas de espectro extendido fue detectado en siete aislados; de estos, cuatro fueron portadores del gen bla CTX-M-1 y tres presentaron bla TEM. El 37 por ciento de los aislados de E. coli mostraron valores de índices de multirresistencia a los antibióticos menores que 0,22; el 16 por ciento de 0,22; el 9,3 por ciento mayor que 0,5; y el 5 por ciento mayor que 0,7. Los aislados de E. coli-BLEE mostraron corresistencia a las familias de las tetraciclinas, quinolonas, aminoglucósidos y macrólidos. Conclusiones: La presencia de aislados ambientales multirresistentes de E. coli productores de ß-lactamasas de espectro extendido en ecosistemas dulceacuícolas de La Habana destaca la necesidad de implementar estrategias de control para prevenir la diseminación de estos aislados en los ambientes naturales(AU)

Introduction: Extended-spectrum β-lactamase-producing Escherichia coli strains are multiresistant pathogens and one of the bacteria contributing most greatly to bacterial antibiotic resistance in clinical practice. However, they are increasingly isolated from natural environments, such as aquatic ecosystems, where they are used as fecal pollution indicators. Objective: Evaluate antibiotic susceptibility and extended-spectrum ß-lactamase enzyme production in Escherichia coli isolates from freshwater ecosystems in Havana. Methods: An analysis was conducted of 43 E. coli isolates from the rivers Almendares, Quibú and Luyanó in Havana. Determination was made of susceptibility to 18 antibiotics and phenotypic production of extended-spectrum ß-lactamases according to standards from the Clinical and Laboratory Standards Institute. Molecular detection of the enzymes was performed by polymerase chain reaction. Estimation was carried out of the antibiotic multiresistance index and the resistance patterns of each extended-spectrum E. coli ß-lactamase isolate. Results: Of the E. coli isolates studied, 65 percent were resistant to at least one antibiotic, whereas 35 percent were sensitive to all antibiotics. The extended-spectrum ß-lactamase phenotype was detected in seven isolates, of which four were carriers of the gene bla CTX-M-1 and three contained bla TEM. 37 percent of the E. coli isolates displayed antibiotic multiresistance index values below 0.22, 16 percent of 0.22, 9.3 percent above 0.5 and 5 percent above 0.7. ESBL E. coli isolates displayed co-resistance to the families tetracyclines, quinolones, aminoglycosides and macrolides. Conclusions: The presence of multiresistant extended-spectrum ß-lactamase-producing environmental E. coli isolates in Havana freshwater ecosystems highlights the need to implement control strategies aimed at preventing the spread of these isolates in natural environments(AU)

Susceptibilidad a la ciprofloxacina en Salmonella enterica serotipo Typhi, no multidrogorresistente, 2017 a 2020 / Susceptibility to ciprofloxacin in Salmonella enterica serotype Typhi, no multidrug resistant, 2017 to 2020

Introducción. Los patrones de susceptibilidad antimicrobiana de Salmonella enterica serotipo Typhi se han modificado globalmente durante las últimas tres décadas. Objetivo. Describir los patrones de susceptibilidad antimicrobiana de las cepas de Salmonella enterica Typhi, aisladas en El Salvador de enero 2017 a junio 2020. Metodología. Evaluación secundaria de las bases de datos del Laboratorio Nacional de Salud Pública, de los aislamientos de Salmonella enterica Typhi con sus respectivos antibiogramas, de muestras de pacientes que adolecieron de fiebre tifoidea en El Salvador, de enero 2017 a junio 2020. Resultados. 1406 aislamientos de Salmonella enterica Typhi fueron reportados. El 100 % de los aislamientos analizados presentó susceptibilidad a la ceftriaxona y a la azitromicina. El 99,9 % de los aislamientos analizados presentó susceptibilidad a la ampicilina, al cloranfenicol, a la tetraciclina y al trimetoprim-sulfametoxazol. Para ciprofloxacina, se detectó susceptibilidad en el 8,5% de las cepas analizadas, susceptibilidad intermedia en el 91,5% y resistencia en el 0,08 %. Conclusión. Los hallazgos son compatibles con lo reportado a nivel mundial: el desarrollo rápido de susceptibilidad intermedia o resistencia a la ciprofloxacina, una vez esta es adoptada como el tratamiento de elección para la fiebre tifoidea. En El Salvador, los antibióticos antes considerados como de primera línea contra Salmonella enterica Typhi, deben ser reciclados

Introduction. The antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi have been modified globally for the past three decades. Target. Describe the antimicrobial susceptibility patterns of Salmonella enterica Typhi strains, isolated in El Salvador from January 2017 to June 2020. Methodology. Secondary assessment from the databases of the National Public Health Laboratory, of the isolates of Salmonella enterica Typhi with their respective antibiograms, of samples of patients who suffered from typhoid fever in El Salvador, from January 2017 to June 2020. Results. 1406 isolates of Salmonella enterica Typhi were reported. 100% of the isolations analyzed showed susceptibility to ceftriaxone and azithromycin. 99.9% of the isolates analyzed presented susceptibility to ampicillin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole. For ciprofloxacin, detected susceptibility in 8.5% of the strains analyzed, intermediate susceptibility in 91.5% and resistance in the 0.08%. Conclution. The findings are consistent with what has been reported worldwide: the rapid development of susceptibility intermediate or resistance to ciprofloxacin, once it is adopted as the treatment of choice for typhoid fever. In El Salvador, antibiotics previously considered first-line against Salmonella enterica Typhi, must be recycled

Caenorhabditis elegans como modelo de infección para el estudio de antimicrobianos / Caenorhabditis elegans as an infection model for the study of antimicrobials

Resumen A pesar de algunas limitaciones éticas, los animales juegan un papel importante como anfitriones sustitutos para investigar los mecanismos fisiopatológicos de enfermedades con el fin de indagar en ellos medicamentos contra diferentes patologías. Uno de los grandes problemas en salud pública a nivel mundial en el contexto farmacológico es la producción de antibióticos y la ocurrencia de resistencia microbiana, además, cada vez resulta más complejo el uso de modelos animales por las restricciones bioéticas actuales, no obstante, es necesario usar modelos simples en los estudios preliminares que permitan evaluar las interacciones huésped-patógeno-antimicrobiano. Al validar que Caenorhabditis elegans es susceptible a varias bacterias y además tiene la capacidad de responder a estímulos ambientales con cambios observables en el comportamiento tras ser alimentado con diversas bacterias, resulta muy útil usarlo en este tipo de investigaciones ya que tiene una vida promedio corta y no cuenta con restricciones éticas para su uso. Por lo anterior, en este artículo se revisa la susceptibilidad que tiene C.elegans de infectarse con diferentes bacterias, además, ya que aún no se ha validado completamente como modelo para poner a prueba antimicrobianos se propone que este nematodo es útil como modelo In vivo para evaluar infecciones y tratamientos antibacterianos.

Abstract Despite some ethical limitations, animals play an important role as surrogate hosts in investigating the pathophysiological mechanisms of disease in order to test drugs against different pathologies. One of the great problems in public health worldwide in the pharmacological context is the production of antibiotics and the occurrence of microbial resistance, the use of animal models is becoming increasingly complex due to current bioethical restrictions, however, it is necessary to use models simple in preliminary studies that allow evaluating host-pathogen-antimicrobial interactions. Validating that Caenorhabditis elegans is susceptible to various bacteria and also has the ability to respond to environmental stimuli with observable changes in behavior after being fed with various bacteria, it is very useful to use it in this type of research since it has a short average life and does not have ethical restrictions for its use. Therefore, this article reviews the susceptibility of C. elegance to become infected with different bacteria, in addition, since it has not yet been fully validated as a model to test antimicrobials, it is proposed that this nematode is useful as an in vivo model. to evaluate infections and antibacterial treatments.

Evolución del índice de actividad en pacientes con esclerosis sistémica tratados con ciclofosfamida y prednisona / Evolution of the index of activity in patients with systemic sclerosis treated with cyclophosphamide and prednisone

Introducción: La esclerosis sistémica es una enfermedad autoinmune del tejido conectivo donde ocurre inicialmente la vasculopatía y persiste durante toda la enfermedad. El índice de actividad revela un periodo crítico de la enfermedad. Objetivo: Evaluar la evolución clínica del índice de actividad de pacientes con esclerosis sistémica para determinar si el esquema terapéutico aplicado disminuye los síntomas de actividad sistémica. Métodos: Estudio cuasi experimental terapéutico de 31 pacientes atendidos en el Hospital Lucía Íñiguez Landín de Holguín que se dividieron en dos grupos según las etapas clínicas obtenidas del índice de desarrollo integral desde marzo del 2013 hasta marzo del 2016: el grupo A (etapas clínicas I y II) con 16 pacientes y el grupo B (etapas clínicas III y IV) con 15 pacientes. La evolución se evaluó según variables del instrumento al inicio, a los 6 y 12 meses de aplicado el esquema terapéutico. Se utilizó la prueba T o la prueba exacta de Fisher cuando los valores eran igual a 3 o menores. El cálculo de la media, análisis porcentual y la prueba de Wilcoxon se usaron para conocer la relación de variables en el tiempo. Resultados: El esquema terapéutico aplicado, previa validación, mejoró el índice de actividad de los pacientes de ambos grupos A y B (en etapas clínicas tempranas y tardías). Al evaluar el índice de actividad, en esta serie predominó la actividad moderada, tanto a los 6 como a los 12 meses durante el tratamiento médico. En ambos grupos la mejoría del índice de actividad fue significativa, tanto para la actividad moderada como para la intensa, más notable a partir de los 12 meses con p≤0,05 para el grupo A. Hubo baja susceptibilidad para la mejoría de los sistemas gastrointestinal y respiratorio, en el trascurso de la evaluación de este índice. Conclusiones: Se alcanzó mejoría en el índice de actividad de pacientes con esclerosis sistémica, con el esquema terapéutico aplicado, con estabilidad clínica y humoral desde las etapas iniciales de la enfermedad(AU)

Introduction: The systemic sclerosis is an autoimmune disease of the connective tissue where the vasculopathy happens initially and persist during all the disease. The immune component starts since the inflammatory process triggers off but he diminishes until you dwell on the evolutionary course and it is substituted for fibrosis, this ends pathogenic acquires great significance in the process. The index of activity reveals a critical period of the disease. Objective: Evaluating patients' clinical evolution of the index of activity with systemic sclerosis with the applied therapeutics. Methods: The study was quasi-experiences (or secondary prevention). In order to determine if the therapeutic applied scheme decreases symptomatology of its systemic activity. You started in March of the 2013 to March of the 2016, with duration of 24 months. They were 31 patients that split into two groups according to the clinical stages obtained of Comprehensive Development Index. In the group to (clinical stages I and II) 16 patients and in the group B (clinical stages III and IV) 15 patients. The evolution evaluated according to variables of the instrument of evaluation the start, to the six and 12 months itself of once the therapeutic scheme was applied. The T utilized the proof itself, or exact Fisher's proof when moral values were all the same or minor to three, the statistical significance determined in p≥ 0.05 itself. The calculation of the stocking, percentage analysis, and Wilcoxon's proof to know the relation of variables through the time. Results: The therapeutic applied scheme, previous validation, you improved the index of activity of the patients of both groups A and B that is in clinical premature and overdue stages. In the activity moderated for the group A statistical significance for system microvascular (0.023) and respiratory (0.025) to the six months, and to the 12 months' skin (0.023) and microvascular (0.006). For the intense activity significant improvement to the six months for muscleskelettic (0.005) and rheumatoid positive factor (0.008), to the 12 months' significant improvement for muscleskelettic (0.004); and examine of laboratory like erythrocyte sedimentation rate (0.008) circulating immune complexes (0.005), and rheumatoid factor (0.003). For the group B in the moderate activity significant improvement for respiratory system existed (0.014), and cardiovascular (0.020) that kept to the 12 months, added up its digestive system (0.008). Evident level improvement of skin (0.004), circulating immune complexes (0.008) and rheumatoid factor were caught up within the intense activity to the 12 months (0.014). Conclusions: Improvement in the index of activity of patients with systemic sclerosis, with the therapeutic scheme applied, with clinical stability and humoral from initial stages of the disease was caught up with(AU)

Susceptibilidad antimicrobiana y serovariedades de Salmonella aisladas en carnes y productos cárnicos / Antimicrobial susceptibility and serovarieties of Salmonella isolated from meat and meat products

Introducción: La carne de ave y otros tipos de carnes provenientes de animales infectados son importantes vehículos de salmonelosis. Objetivo: Determinar la susceptibilidad a los antimicrobianos y las serovariedades de Salmonella aisladas en carnes y productos cárnicos. Material y Métodos: Se analizaron 172 aislados en el período enero de 2012 a marzo de 2020 en el laboratorio de Microbiología del Instituto Nacional de Higiene Epidemiología y Microbiología de Cuba. El serotipaje se determinó según la norma ISO/TR 6579-3:2014. La susceptibilidad antimicrobiana se realizó mediante el método de difusión con discos (Bauer-Kirby) de acuerdo con la metodología descrita en la normativa del Instituto de Normas Clínicas y de Laboratorio. Resultados: Las serovariedades identificadas con mayor frecuencia fueron: S. Enteritidis, S. Agona, S. Derby, S. Infantis y S. London, 18 (43,9 %) serovariedades identificadas en las carnes frescas también se encontraron en las procesadas. Los porcentajes más altos de resistencia antimicrobiana se hallaron frente al ácido nalidíxico, la tetraciclina y la ampicilina.S. Enteritidis y S. Typhimurium expresaron resistencia a un mayor número de antibióticos. Conclusiones: Los resultados sugieren que las carnes frescas constituyen una fuente de diseminación de Salmonella, incluso aquellas portadoras de resistencia a los antimicrobianos(AU)

Poultry and other types of meat from infected animals are important vehicles of salmonellosis. Objective: To determine the susceptibility to antimicrobial agents and serovarieties of Salmonella isolated from meat and meat products. Material and Methods: A total of 159 isolates were analyzed at the Cuban National Institute of Hygiene, Epidemiology and Microbiology during the period between January 2012 and March 2020. Serotypes were determined according to ISO/TR 6579-3: 2014. Antimicrobial susceptibility was determined by the Bauer-Kirby technique, according to the methodology described in the regulations of the Clinical and Laboratory Standards Institute. Results: The most frequent serovarieties identified were S. Enteritidis, S. Agona, S. Derby, S. Infantis and S. London. Also, 18 (43, 9 %) of serovarieties identified in fresh meat were found in processed meat. The highest percentages were related to antimicrobial resistance to nalidixic acid, tetracycline and ampicillin. S. Enteritidis and S. Typhimurium serotypes showed resistance to a greater number of antibiotics. Conclusions: The results suggest that fresh meats are an important source of Salmonella contamination, including those that are carriers of antimicrobial-resistant pathogens(AU)

Antígenos del sistema sanguíneo ABO como factor de riesgo para la gravedad de la infección por SARS-CoV-2 / Blood system ABO antigens as risk factor for severity of SARS-CoV-2 infection

Resumen Introducción: Se desconoce si existe una influencia del sistema sanguíneo ABO en susceptibilidad y gravedad de la enfermedad. Objetivo: Analizar si existe una asociación entre los antígenos del sistema ABO y la susceptibilidad y gravedad de la infección por SARS-CoV-2. Material y métodos: Se compararon las frecuencias de los antígenos del sistema ABO en 73 casos confirmados de infección por SARS-CoV-2 y 52 donadores clínicamente sanos. La gravedad de la infección se evaluó comparando la frecuencia de los antígenos por gravedad de la enfermedad y la mortalidad. Resultados: El riesgo de padecer infección por SARS-CoV-2 se incrementa en sujetos con antígeno A vs los no-A (OR=1.45; IC95 %:1.061-1.921). El fenotipo sanguíneo O disminuye el riesgo de padecer infección por SARS-CoV-2 (OR=0.686; IC95 %: 0.522-0.903). No se encontraron diferencias entre la gravedad de la enfermedad. En los pacientes graves, el riesgo de mortalidad se incrementó en sujetos con antígeno A vs los no-A (OR= 3.34; IC95 %: 1.417-8.159). Conclusión: El grupo sanguíneo A es un factor de riesgo para padecer infección por SARS-CoV-2, no así en la gravedad de la enfermedad, pero en los pacientes graves fue un factor de riesgo para la mortalidad.

Abstract Introduction: Whether there is an influence of the ABO blood system on susceptibility to the disease and its severity is unknown. Objective: To analyze if there is an association between the ABO blood system phenotypes and susceptibility to SARS-CoV-2 infection and its severity. Material and methods: The frequency of ABO antigens was compared in 73 confirmed cases of SARS-CoV-2 infection and 52 clinically healthy donors. The severity of the infection was evaluated by comparing the frequency of antigens by severity of the disease and mortality. Results: The risk of SARS-CoV-2 infection is increased in subjects with antigen A vs non-A subjects (OR=1.45; 95 %: 1.061-1.921). Blood phenotype O decreases the risk of SARS-CoV-2 infection (OR= 0.686; 95 % CI: 0.522-0.903). No differences were found regarding disease severity. The mortality risk is increased in subjects antigen A vs non-A (OR= 3.34; 95% IC: 1.417-8.159). Conclusion: Blood group A is a risk factor for SARS-CoV-2 infection, but not for disease severity, although in critically ill patients it is a risk factor for mortality.

Susceptibilidad de las mucosas oculares al SARS COV-2: bioseguridad sanitaria / Susceptibility of eye mucosa to SARS CoV-2: sanitary biosecurity

RESUMEN: El SARS CoV-2, agente causal de la enfermedad llamada Covid-19, infecta las mucosas digestivas y respiratorias, afectando las células epiteliales. El virus ingresa a través del receptor de membrana ACE2 provocando la disrupción de la homeostasis celular. Frecuentes reportes indican la presencia de conjuntivitis ocular en pacientes diagnosticadas con Covid-19, lo cual ha alertado a los científicos sobre el potencial foco de infección viral de las secresiones lagrimales.Los epitelios de la conjuntiva ocular sub-palpebral y corneal, se caracterizan por presentar el receptor de la enzima convertidora de angiotensina 2 (ACE2) y proteasa transmembrana asociada serina 2 (TMPRSS2), cuya interacción activa los mecanismos de liberación de citoquinas, capaces de instalar un proceso de conjuntivitis infecciosa por SARS CoV-2, pero no necesariamente hacer extensiva la infección hacia los sistemas digestivo y respiratorio.Aunque este proceso inflamatorio es más frecuente como una expresión de la infección general y más grave. Sin embargo, cualquiera sea la vía de infección o ingreso del virus SARS CoV-2 es importante considerar el riesgo de infectividad de las lágrimas y las secresiones conjuntivales en los pacientes. Este estudio pretende llamar la atención sobre las medidas de cuidados y control sanitario, incorporando mejores normas de protección personal y bioseguridad, especialmente en el áreas de oftalmología, asumiendo que la mucosa ocular puede ser una vía de entrada del virus y a la vez una fuente de contagio.También considerar la potenciación de la infección viral con las enfermedades de base asociadas, como glaucoma y diabetes.Se sugiere además incorporar estudios histológicos de la mucosa ocular para diferenciar epitelios sanos e infectados.

SUMMARY: SARS CoV-2, the causal agent of the Covid- 19 disease, infects the digestive and respiratory mucosa, affecting epithelial cells. The virus enters through the ACE2 membrane receptor causing the disruption of cell homeostasis. Frequent reports indicate the presence of ocular conjunctivitis in patients diagnosed with Covid-19, which has alerted scientists to the potential source of viral infection from lacrimal secretions. The epithelia of the sub-palpebral and corneal ocular conjunctiva are characterized by presenting the receptor for angiotensin-converting enzyme 2 (ACE2) and associated transmembrane protease serine 2 (TMPRSS2), whose interaction activates cytokine release mechanisms, with the ability to start the infectious conjunctivitis process by SARS CoV-2, but not necessarily extend the infection to the digestive and respiratory systems. Although this inflammatory process is more frequent as an expression of the general and more serious infection. However, whatever the route of infection or entry of the SARS CoV-2 virus, it is important to consider the risk of infection of tears and conjunctival secretions in patients. This study aims to draw attention to health care and control measures, incorporating better standards of personal protection and biosafety, especially in the areas of ophthalmology, assuming that the ocular mucosa can be a route of entry for the virus, and at the same time a source of contagion. A further consideration is the potential of viral infection with associated underlying diseases, such as glaucoma and diabetes. It is also suggested to incorporate histological studies of the ocular mucosa to differentiate healthy and infected epithelia.

Evaluation of susceptibility and response in the surface of agents of surface mycoses (Trichophyton mentagrophytes; T. tonsurans) to antifungal drugs of interest in a medical clinic / Avaliação da susceptibilidade e resposta in vitro de agentes de micoses superficiais (Trichophyton mentagrophytes; T. tonsurans) à drogas antifúngicas de interesse em clínica médica

INTRODUCTION: The resistance of fungal species to drugs usually used in clinics is of great interest in the medical field. OBJECTIVE: To evaluate susceptibility and in vitro response of species of Trichophyton spp. to antifungal drugs of interest in clinical medicine. METHODS: 12 samples of clinical isolates from humans were used, nine of T. mentagrophytes and three of T. tonsurans. Susceptibility tests were performed according to the agar diffusion (AD) and broth microdilution (BM) methods. RESULTS: In the AD method, the species T. tonsurans presented a percentage of sensitivity of 33% in relation to amphotericin B and 66% to itraconazole, with 100% resistance to ketoconazole and fluconazole. T. mentagrophytes also showed 100% resistance to ketoconazole in this technique, with 11% sensitivity to ketoconazole, 22% to itraconazole and 22% of samples classified as sensitive dose dependent. In the MC method, the species T. tonsurans presented a sensitivity percentage of 66%, 55% and 33% in relation to ketoconazole, fluconazole and itraconazole, respectively. The T. mentagrophytes species presented sensitivity percentages of 11%, 11%, 33% and 55% for amphotericin B, itraconazole, ketoconazole and fluconazole, respectively. CONCLUSION: There was resistance in vitro of the species of T. mentagrophytes and T. tonsurans against the antifungal fluconazole and relative resistance against ketoconazole in the AD method. In BM, however, important percentages of sensitivity were observed for the two species analyzed in relation to the antifungals fluconazole and ketoconazole when compared to itraconazole and amphotericin B.

INTRODUÇÃO: A resistência de espécies fúngicas às drogas usualmente empregadas no meio clínico é motivo de grande interesse na área médica. OBJETIVO: Avaliar susceptibilidade e resposta in vitro de espécies de Trichophyton spp. a drogas antifúngicas de interesse em clínica médica. MÉTODOS: Foram utilizadas 12 amostras de isolados clínicos de humanos, sendo nove de T. mentagrophytes e três de T. tonsurans. Foram realizados testes de susceptibilidade segundo os métodos de difusão em ágar (DA) e microdiluição em caldo (MC). RESULTADOS: No método de DA, a espécie T. tonsurans apresentou percentual de sensibilidade de 33% em relação à anfotericina B e de 66% ao itraconazol, com 100% de resistência frente ao cetoconazol e ao fluconazol. A espécie T. mentagrophytes também apresentou 100% de resistência frente ao cetoconazol nesta técnica, com 11% de sensibilidade ao cetoconazol, 22% ao itraconazol e 22% das amostras classificadas como sensível dose dependente. No método de MC, a espécie T. tonsurans apresentou percentual de sensibilidade de 66%, 55% e 33% em relação ao cetoconazol, fluconazol e itraconazol, respectivamente. A espécie T. mentagrophytes apresentou percentuais de sensibilidade de 11%, 11%, 33% e 55% para anfotericina B, itraconazol, cetoconazol e fluconazol, respectivamente. CONCLUSÃO: Houve resistência in vitro das espécies do T. mentagrophytes e T. tonsurans frente ao antifúngico fluconazol e resistência relativa frente ao cetoconazol no método de DA. Na MC, no entanto, foram observados importantes percentuais de sensibilidade das duas espécies analisadas frente aos antifúngicos fluconazol e cetoconazol quando comparadas ao itraconazol e à anfotericina B.

Susceptibility of field populations of Haematobia irritans to fipronil in Uruguay / Suscetibilidade de populações de campo de Haematobia irritans ao fipronil no Uruguai

Fipronil was registered in Uruguay in 1997, and, since then, it has been used for the control of Haematobia irritans irritans and Rhipicephalus microplus. The susceptibility of H. irritants to this drug has not been evaluated. Therefore, the goal of the present study was to evaluate the resistance of H. irritans to fipronil. Additionally, a survey was carried out with the farmers to evaluate the use of fipronil for H. irritans control in the ranches where the flies came from. For the bioassays, 31 field populations of H. irritans were exposed to 10 concentrations of fipronil (3.2-16.0μg.cm2), and their LC50 values were calculated using probit analysis. A bioassay was performed with horn flies from the susceptible colony maintained at the USDA-ARS Knipling-Bushland U.S. Livestock Insects Research Laboratory for comparison and calculation of resistance ratios (RRs). All 31 field populations surveyed in the study were susceptible to fipronil, with resistance ratios ranging from <0.5 to 2.2. Four populations with RRs >1 did not differ significantly from the susceptible strain. A single population showed an RR >2.2. Overall, the survey shows that fipronil was mostly used for R. microplus control, and in only three ranches, which were free of R. microplus, was fipronil used for horn fly control. Seventeen farmers did not use fipronil at all in the last three years. It is concluded that, in Uruguay, field populations of horn flies remain susceptible to fipronil.(AU)

O fipronil foi registrado no Uruguai em 1997 e, desde então, tem sido utilizado no controle de Haematobia irritans irritans e Rhipicephalus microplus. O objetivo do presente estudo foi avaliar a susceptibilidade de populações de campo de H. irritans ao fipronil. Além disso, foi realizada uma pesquisa para avaliar a utilização de fipronil e as práticas de controle de H. irritans nas fazendas de onde provinham as moscas. Para os bioensaios, 31 populações de campo de H. irritans foram expostas a 10 concentrações de fipronil (3,2-16,0μg.cm2), e seus valores de CL50 foram calculados usando análise probit. Um bioensaio foi realizado com H. irritans da colônia suscetível mantida no USDA-ARS Knipling-Bushland U.S. Livestock Insects Research Laboratory para comparação e cálculo das razões de resistência (RRs). Todas as 31 populações de campo pesquisadas no estudo eram suscetíveis ao fipronil, com taxas de resistência variando de <0,5 à 2,2. Quatro populações com Rrs >1 não diferiram significativamente da cepa suscetível. Uma única população apresentou RR >2,2. No geral, o fipronil tinha sido usado principalmente para o controle de R. microplus, e em apenas três fazendas, que estavam livres de R. microplus, o fipronil era utilizado para o controle da H. irritans. Em 17 fazendas não tinha sido utilizado fipronil nos últimos três anos. Conclui-se que no Uruguai as populações de H. irritans no campo permanecem suscetíveis ao fipronil.(AU)

Standardization of resazurin use in susceptibility testing of natural products against yeasts in planktonic cells and in biofilms formation

Natural products, such as the ethanolic propolis extract (PE), have been shown to be a safe and effective therapeutic alternative for the treatment of fungal skin and nail diseases. However, the presence of the resin and the physicochemical characteristics of the extract sometimes difficult the reading and determination of breakpoints of the in vitrotests, evidencing the need for alternatives that facilitate the reading. The present study aimed to standardize the use of resazurin in tests of susceptibility of PE with planktonic yeast cells and biofilm forms. The antifungal activity of PE was determined by minimum inhibitory concentration (MIC) and we observed that, for all Candida spp. tested, the most reproducible MIC results were obtained when resazurin was placed after 24 hours of incubation and remained more 24 hourswith yeasts plus PE. For encapsulated yeasts, there was no dye reduction and color transition. Resazurin was also used for the evaluation of minimal biofilm inhibitory concentration and minimal biofilm eradication concentration and it was metabolized and reproducedthe action of PE on Candida biofilms. In addition, microdilution checkerboard plates were made with the dye, which assisted reading the result of the interaction between PE and nystatin. We observed that the resin, the color and the turbidity of the PE slightly changed the color of the resazurin in high concentrations of the extract and did not impair the reading. Therefore, the resazurin standardization tests were proven to be efficient and grounds that it should be used as an auxiliary methodology for reading and interpretation of the susceptibility tests for non-encapsulated yeasts with natural products, which form turbidity or precipitation, such as propolis.

Creencias frente al embarazo y enfermedades bucodentales percibidas por gestantes en Montería, Colombia / Beliefs against pregnancy and oral diseases perceived by pregnant women in Montería, Colombia / Crenças contra gravidez e doenças bucodentais percebidas por gestantes em Monteria, Colômbia

Objetivo: Interpretar las creencias de susceptibilidad percibida en-tre la condición de embarazo y las enfermedades bucodentales por mujeres gestantes de la ciudad de Montería, en el Departamento de Córdoba, Colombia. Materiales y métodos: Estudio cualitativo con enfoque microetnográfico, cuyos resultados se obtuvieron mediante la observación y las entrevistas a profundidad que fueron aplicadas a 19 gestantes adscritas a un hogar comunitario de la comuna cuatro de la ciudad de Montería, Córdoba, en 2019, quienes fueron selec-cionadas por conveniencia. La información se recolectó durante el I semestre del 2019 y se organizó a partir de la dimensión del Mo-delo de creencias en salud: susceptibilidad percibida. El análisis se realizó bajo los parámetros de la técnica de análisis de contenido. Resultados: La creencia de susceptibilidad que predominó entre las gestantes fue que en el periodo de embarazo las enfermedades bu-cales son normales y que su origen obedecía a la succión del calcio a la madre por parte del bebé para su crecimiento. Conclusión: Las creencias que poseen las gestantes actúan como barreras frente a la adopción de comportamientos saludables y de su permanencia en programas de promoción de la salud oral y prevención de las enfer-medades bucodentales.

Objective: To interpret the beliefs of perceived susceptibility between the condition of pregnancy and oral diseases by pregnant women in Monteria, Córdoba, Colombia. Material and method:Qualitative study with a micro-ethnographic approach. The results were gotten through obser-vation and in-depth interviews that were applied to 19 pregnant women of the commune four in Monteria, Córdoba in 2019, selected by convenience. The information was collected during the first semester of 2019, and it was organized based on the dimension of the Health Belief Model: perceived susceptibility; the analysis was performed under the parameters of the content analysis technique. Results:the prevailing belief among pregnant women was that oral diseases were cau-sed because the baby got all the calcium during pregnancy. Conclusion: The threats suffered by pregnant women act as barriers against the adoption of healthy behaviors, and their permanence in programs to promote oral health and prevent oral diseases.

Objetivo: Interpretar as crenças de susceptibilidade percebida durante a gravidez das doenças bucais e dentais por gestantes na cidade de Monteria, no estado de Córdoba, Colômbia Materiais e métodos: Estudo qualitativo com foco micro etnográfico, os resultados obtiveram-se mediante observação e as entrevistas a profundidade aplicadas em 19 mulheres grávidas de um lar comu-nitário da comuna quatro da cidade de Monteria, Córdoba em 2019. Organizou-se a partir da dimensão do modelo de crenças em saúde: susceptibilidade percebida. A análise realizou-se se-guindo os parâmetros da técnica de análise de conteúdo. Resultados: A crença de susceptibilidade que se observou durante a gravidez perante as doenças dentais e bucais são normais e que a sua origem obedeceu à sucção do cálcio da mãe para o neném em formação. Conclusão: As crenças que possuem as grávidas atuam como empecilhos frente a adoção de comportamentos saudáveis e de permanência em programas de promoção da saúde oral e das doenças bucais e dentais.

Prevalência e fatores associados à toxoplasmose em gestantes de um município do interior do estado de São Paulo / Prevalence and factors associated with toxoplasmosis in pregnant women in a municipality in the state of São Paulo

Introdução: A Toxoplasmose afeta entre 7% a 80% da população mundial, variando de um país para outro em função dos grupos étnicos que se caracterizam pelos hábitos alimentares e condições de higiene. Estima-se que na América do Norte, Grã-Bretanha, Escandinávia e Sul da Ásia a população infectada seja de 30%, com um aumento consideravelmente superior a 60% na África e América Latina. A infecção é, em sua maioria, assintomática ou associada com sintomas autolimitados em adultos saudáveis. Entretanto, a toxoplasmose é uma infecção de grande relevância clínica em dois grupos bem definidos: indivíduos imunossuprimidos e gestantes, em virtude de sua gravidade e morbidades associada. Objetivos: Estimar a prevalência e fatores associados para Toxoplasmose em gestantes com referência aos grupos diagnósticos na gestação, do Ministério da Saúde, que realizavam acompanhamento de pré-natal nas unidades básicas de saúde do município de Ribeirão Preto-SP. Método: Estudo epidemiológico, analítico transversal, com coleta de informações por meio de resultados de exames sorológicos para Toxoplasmose, bem como da aplicação de um questionário, validado em conteúdo por especialistas na área de saúde da mulher. No sentido de enaltecer os resultados obtidos, este estudo salientou as evidências científicas mediante revisão integrativa de literatura, desenvolvida segundo método PRISMA, PICO e a questão norteadora "Quais são as possíveis evidências acessíveis sobre a prevalência e suscetibilidade da Toxoplasmose durante a gestação e as principais variáveis associadas?". Para composição do modelo logístico foram realizadas análises bivariadas. A seleção das variáveis independentes foi feita por meio dos testes Exato de Fisher ou Qui-quadrado, com correção de Yates e teste t de Student. Para o modelo logístico final ajustado, além dos parâmetros, também foram calculadas as respectivas razões de chance (OR) ajustadas, com Intervalos de 95% de Confiança (IC). Em todas as análises o nível de significância adotado foi de 5% (α= 0.05). O programa utilizado para as análises estatísticas foi o R Core Team, 2018, versão 3.6.1. Resultados: Na Revisão de Literatura foram identificados 31 artigos, com ênfase em fatores ambientais, comportamentais, padrões alimentares e de higiene encontrados nas diversas culturas e localizações geográficas a nível continental. As dificuldades impostas pelas características geográficas também foram apontadas como uma limitação de acesso aos serviços de saúde, favorecendo o desconhecimento das formas de contágio do protozoário, também associados às maiores prevalências da doença na gestação. O rastreamento sorológico e a vigilância da Toxoplasmose Congênita foram contemplados como ações para a redução da soroprevalência e suscetibilidade na população de gestantes para Toxoplasmose. Na análise quantitativa, foram incluídas 165 gestantes com idade entre 14 e 44 anos. Em relação à soroprevalência total, 57 (34,5%), IC [95%]: [27,3; 41,8], foram reagentes para IgG, sendo soroprevalentes 54 (32,7%) e 3 (1,8%) sororeativas. Dentre as gestantes, 108 (65,5%) apresentaram suscetibilidade para ausência dos anticorpos antitoxoplasma IgG e IgM. Nenhum dos exames foi inconclusivo, ou seja, positivo para IgM exclusivamente. A análise de regressão logística multivariada mostrou que a chance de ser reagente ao anticorpo antitoxoplasma IgG é 1,09 vezes maior ODDS =1,09; IC [1,03 ; 1,16] (p = 0,004); ensino fundamental incompleto, aumenta a chance em 19,68 vezes da gestante ser classificada com IgG reagente em relação às participantes com ensino técnico ou superior ODDS = 19,68; IC [1,47 ; 262,82] (p = 0,024), sendo 12,34 para as participantes com ensino fundamental completo I ODDS = 12,34; IC [1,19 ; 128,19] (p = 0,035) e 12,13 vezes maior para aquelas com escolaridade do ensino fundamental completo II ODDS = 12,13; IC [1,17 ; 125,38] (p = 0,036). O contato direto com a terra apresentou 4,41 vezes mais chance de classificar as gestantes com IgG reagente do que em relação as que não tinham contato direto ODDS = 4,41; IC [1,24; 15,73] (p = 0,022). Conclusões: O conhecimento sobre a prevalência e variáveis associadas para Toxoplasmose na gestação, no município de Ribeirão Preto, pode contribuir para reflexão e análise da efetividade das ações de saúde direcionadas a qualidade de assistência no pré-natal para redução dessa infecção na população de gestantes, como também para prevenção da Toxoplasmose Congênita.

Introduction: Toxoplasmosis affects between 7% and 80% of the world population, varying from one country to another depending on the ethnic groups that are characterized by eating habits and hygiene conditions. It is estimated that in North America, Great Britain, Scandinavia and South Asia the infected population is 30%, with a considerable increase of more than 60% in Africa and Latin America. Infection, is mostly asymptomatic or associated with self-limited symptoms in healthy adults. However, toxoplasmosis is an infection of great clinical relevance in two well-defined groups: immunosuppressed individuals and pregnant women, due to its severity and associated morbidities. Objectives: To estimate the prevalence and associated factors for Toxoplasmosis in pregnant women with reference to the diagnostic groups during pregnancy, of the Ministry of Health, who performed prenatal care in the basic health units of the city of Ribeirão Preto-SP. Method: This is an epidemiological, cross-sectional analytical study, with information collection through the results of serological tests for Toxoplasmosis, as well as the application of a questionnaire, validated in content by specialists in the area of women's health. In order to enhance the results obtained, this study highlighted the scientific evidence through an integrative literature review, developed according to prisma, PICO and the fundamental question about What are the possible accessible evidences on the prevalence and susceptibility of Toxoplasmosis during pregnancy and the main associated variables?". For the composition of the logistic model, bivariate analyses were performed. The selection of independent variables was made by fisher's exact or chi-square tests, with Yates correction and Student's t-test. For the adjusted final logistic model, in addition to the parameters, the respective adjusted chance ratios (OR) were also calculated, with 95% Confidence Intervals (CI). In all analyses the level of significance 5% (α = 0.05). The program used for statistical analysis was the R Core Team, 2018, version 3.6.1. Results: In the Literature Review, 31 articles were identified, with emphasis on environmental, behavioral, dietary and hygiene patterns found in the various cultures and geographical locations at the continental level. The difficulties imposed by geographic characteristics were also pointed out as a limitation of access to health services, favoring the ignorance of the forms of protozoan contagion, also associated with the higher prevalence of the disease during pregnancy. Serological screening and surveillance of Congenital Toxoplasmosis were included as actions to reduce seroprevalence and susceptibility in the population of pregnant women for Toxoplasmosis. In the quantitative analysis, 165 pregnant women aged between 14 and 44 years were included. Regarding total seroprevalence, 57 (34.5%), CI [95%]: [27.3; 41.8], were reagents for IgG, being seroprevalent 54 (32.7%) and 3 (1.8%) seroreactive. Among the pregnant women, 108 (65.5%) susceptibility to the absence of IgG and IgM antitoxoplasma antibodies. None of the tests were inconclusive, i.e., positive for IgM exclusively. Multivariate logistic regression analysis showed that the chance of being reagent to antitoxoplasma IgG antibody is 1.09 times higher ODDS =1.09; CI [1.03; 1.16] (p = 0.004); incomplete elementary school increases the chance of the pregnant woman being classified as being classified as reagent IgG in relation to participants with technical or higher education ODDS = 19.68; CI [1.47 ; 262.82] (p = 0.024), 12.34 for participants with complete elementary school I ODDS = 12.34; CI [1.19 ; 128.19] (p = 0.035) and 12.13 times higher for those with complete elementary school II ODDS = 12.13; CI [1.17 ; 125.38] (p = 0.036). Direct contact with the land presented 4.41 times more likely to classify pregnant women with reagent IgG than in those who had no direct contact ODDS = 4.41; CI [1.24; 15.73] (p = 0.022). Conclusions: Knowledge about the prevalence and associated variables for Toxoplasmosis during pregnancy, in the city of Ribeirão Preto, may contribute to reflection and analysis of the effectiveness of health actions directed to the quality of prenatal care to reduce this infection in the population of pregnant women, as well as to prevent Congênita Toxoplasmosis.