Libres de humo: efectividad de un programa de cesación tabáquica en un Centro de Salud Comunitario de la Ciudad Autónoma de Buenos Aires / Smoke-free: effectiveness of a smoking cessation program in a Community Health Center of the Autonomous City of Buenos Aires

Introducción. El consumo de tabaco representa un importante desafío para la salud pública debido a su alta incidencia y mortalidad, y es el principal factor de riesgo modificable para desarrollar enfermedades crónicas no transmisibles. La Residencia de Medicina General y Familiar del Hospital General de Agudos Dr. Teodoro Álvarez desarrolló un programa de cesación tabáquica en el Centro de Salud y Acción Comunitaria N◦34, que forma parte desde 2012 del Programa de Prevención y Control del Tabaquismo del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires, Argentina. Objetivo. Documentar los resultados de la eficacia de este programa y explorar las variables relacionadas con la probabilidad de éxito y recaída. Materiales y métodos. Estudio cuantitativo, de corte transversal analítico, con datos obtenidos de historias clínicas electrónicas entre 2017 y 2020. Fueron incluidos los pacientes que consultaron al menos en dos ocasiones al programa de cesación tabáquica y establecieron un día D al menos 30 días antes del abandono del consumo de tabaco. La eficacia terapéutica fue definida como haber permanecido al menos seis meses sin fumar, y la recaída, como el reinicio de consumo del tabaco luego de haber logrado 24 horas de abstinencia con fecha posterior al día D.Resultados.De 59 pacientes, 24 (40,7 %) lograron la eficacia terapéutica, de los cuales 5 (20,8 %) presentaron recaídas.De los 35 pacientes que no lograron alcanzar la etapa de mantenimiento, 30 (85,7 %) recayeron durante las primeras ocho semanas. El sexo masculino y el consumo de tabaco superior a 20 paquetes-año mostraron una mayor correlación con las recaídas. Conclusiones. El programa presentó una eficacia terapéutica del 40,7 % en el periodo evaluado. Se encontraron asociaciones entre una mayor eficacia terapéutica y ciertas características de los pacientes, pero se requieren más estudios para confirmar esta hipótesis. (AU)

Background. Tobacco consumption represents an important challenge for public health due to its high incidence and mortality and is the main modifiable risk factor for developing chronic non-communicable diseases. The General and Family Medicine Residence of the Hospital General de Agudos Dr. Teodoro Álvarez developed a smoking cessation program in Health and Community Action Centre N◦34. Since 2012 it has been part of the Program for the Prevention and Control of Smoking of the Ministry of Health of the Government of Buenos Aires, Argentina. Objective. To document the results of the effectiveness of the program and explore the variables related to the probability of success and relapse. Materials and methods. Quantitative, analytical cross-sectional study, with data obtained from electronic medical records between 2017 and 2020. Patients who consulted the smoking cessation program at least twice and established a D-day 30 days before quitting tobacco consumption were included. Therapeutic efficacy was defined as having remained at least six months without smoking, and relapse, as the resumption of tobacco consumption after having achieved 24 hours of abstinence with a date after day D. Results. Of 59 patients, 24 (40.7 %) achieved therapeutic efficacy, of which 5 (20.8 %) presented relapses. Among the35 patients who failed to reach the maintenance stage, 30 (85.7 %) relapsed during the first eight weeks. Male sex and tobacco consumption of more than 20 pack per year showed a greater correlation with relapses. Conclusions.The program presented a therapeutic efficacy of 40.7 % in the evaluated period. Associations were found between greater therapeutic efficacy and certain patient characteristics but more studies are required to confirm this hypothesis. (AU)

CYP450 y farmacogenética en Guatemala. Revisión narrativa / CYP450 and pharmacogenetics in Guatemala. Narrative review

El proyecto HapMap ha generado información y preguntas sobre la diversidad genética en las distintas poblaciones del mundo. En las últimas décadas, proyectos como la elucidación del genoma del mestizo mexicano han revelado las distancias genéticas entre mestizos y amerindios en México. Cerca de 20 genes son actualmente estudiados en paneles comerciales asociados al metabolismo de fármacos, uno de ellos el gen que expresa la enzima CY P2C19, la cual metaboliza cerca de 26 fármacos de importancia clínica. El objetivo fue revisar la literatura científica en Google Scholar, PubMed y ScienceDirect que reporta resultados sobre estudios farmacogenéticos en Guatemala, otros que presentan hallazgos sobre distancias genéticas en el guatemalteco y se compara con lo que se conoce de otras poblaciones del continente y el mundo, haciendo énfasis en CY P2C19. El mestizaje en Guatemala fue único, por ello es importante investigar sus variantes alélicas asociadas al metabolismo de fármacos, para permitir una terapéutica más efectiva y segura que mejore la calidad de vida del guatemalteco.

The HapMap project has generated information and queries about genetic diversity in the different populations around the world. In recent decades, research projects such as the elucidation of the genome of the Mexican Mestizo, have exposed the genetic distances between mestizos and Amerindians in Mexico. About 20 genes are currently studied in commercial panels associated with drug metabolism. One of them CY P2C19, that expresses the CY P2C19 enzyme, that metabolizes about 26 drugs of clinical importance. The objective was to review the scientific literature in Google Scholar, PubMed and ScienceDirect that reports results on pharmacogenetic studies in Guatemala, others that presented findings over genetic distances in Guatemala, as well as a comparison with the knowledge about other populations of the continent and world, with emphasis in CY P2C19 gen. Miscegenation in Guatemala was unique and is important to investigate the Guatemalan allelic variants associated with drug metabolism to allow a more effective and safe therapeutic and improve their quality of life.

La acelerada búsqueda de candidatos terapéuticos contra SARS-CoV-2, métodos in silico: Revisión / The accelerated search for drug candidates against SARS-CoV-2, in silico methods: Review

El reposicionamiento de fármacos como la derivatización química, que se han aplicado en los estudios de descubrimiento y diseño de fármacos contra el SARS-CoV-2, dependen del ciclo de vida del virus, las dianas moleculares identificadas y un diseño basado en su estructura e interacciones moleculares. Se realizó una revisión extensa en las bases de datos públicas e institucionales RSCB-Protein Data Bank, ZINC, NCBI (PubMed, PMC), PubChem, Science Direct e instituciones como CDC, NIH y revistas científicas especializadas sobre los avances en la búsqueda de nuevas moléculas contra el nuevo coronavirus basadas en estudios in silico, detectándose más de 40,000 publicaciones sobre SARS-CoV-2 y cerca de 200 relacionadas a dichos estudios, las consideradas más relevantes fueron analizadas e incluidas en este artículo. Su análisis evidencia el avance acelerado de las herramientas computacionales y fortaleza del diseño de fármacos asistido por computadora (in silico approach) para la generación de nuevas moléculas con posibilidad de ser activas contra COVID-19 y presenta las principales dianas moleculares sobre la que actúan estos agentes con potencial antiviral.

The search of new applications for approved drugs by the regulatory authorities around the world, as well as their chemical derivatization in the search for new and effective drugs against SARS-CoV-2 depends of the viral life cycle, action of the drug and a receptor-based design. We performed a deep bibliographic research in peer reviewed scientific journals, data bases RSCB-Protein Data Bank, ZINC, NCBI (PubMed, PMC), PubChem, Science Direct and institutions (CDC, NIH) in the search of new molecules tested in silico against the novel coronavirus. As a result, we found more than 40,000 research papers related to SARS-CoV-2 and nearby 200 look on in silico studies, taking into consideration for this work all the more relevant for us, evidenced the accelerated advance and strength of the drug design assisted by computer (in silico approach) to develop new molecules that can be effective against COVID-19 and, at the same time, it exposes the main molecular targets.

Vasos subclavios: ¿Qué tan cerca se encuentran de la clavícula? / Subclavian vessels: how close are they to the clavicle?

INTRODUCCIÓN: la lesión de los vasos subclavios durante la cirugía de clavícula es una situación rara, de suceder podría resultar incluso mortal; conocer su ubicación es indispensable para minimizar ese riesgo.OBJETIVO: determinar la ubicación y la distancia de la AS y VS respecto a la clavícula. Secundariamente, identificar las características particulares que influencien la ubicación y la distancia. MATERIALES Y MÉTODO: estudio retrospectivo, AngioTAC de tórax y cuello entre 2012 y 2017; se midió la longitud de la clavícula, distancia y dirección de los vasos subclavios en cada tercio de la clavícula, como también la angulación entre una horizontal y el centro de los vasos subclavios. Resultados: 39 AngioTC, 78 hombros. Distancia AS/clavícula tercio proximal, medio y distal 32,8mm (20,3-46,3), 15,4mm (6,8-28,0) y 62,7mm (37,0-115,4) respectivamente. La distancia VS/clavícula tercio proximal, medio y distal fue: 7,4mm (1,0-19,2), 16,2mm (6,7-34,7) y 67,1mm (29,7-117,0) respectivamente. La ubicación de AS y VS con respecto a la clavícula es posterosuperior en el tercio proximal, posteroinferior en el tercio medio e inferior en el tercio distal. CONCLUSIÓN: En el tercio proximal la vena puede estar solo a 1mm de la clavícula y la arteria a 6mm en dirección antero-posterior, resultando esa zona la más peligrosa. En el tercio medio la distancia es mayor, pudiendo estar arteria y vena a solo 6mm, la dirección de brocado más peligrosa es antero-inferior con una inclinación promedio de 45° caudal. El tercio distal es el más seguro, los vasos están al menos a 30mm de distancia hacia caudal. Nivel de evidencia III.

BACKGROUND: injury to the subclavian vessels during clavicle surgery is a rare situation, if it happens it could even be fatal; knowing their location is essential to minimize that risk. OBJECTIVE: determine location and distance of the AS and VS with respect to the clavicle. Secondarily identify particular characteristics that influence location and distance. MATERIAL AND METHODS: retrospective study, AngioTAC of thorax and neck between 2012 and 2017; it was measured the length of the clavicle, distance and direction of the subclavian vessels in each third of the clavicle and angulation between a horizontal and the center of the subclavian vessels were measured. Results: 39 AngioTC, 78 shoulders. AS / clavicle third proximal, middle and distal distance 32.8mm (20.3-46.3), 15.4mm (6.8-28.0) and 62.7mm (37.0-115.4) respectively. Distance VS / clavicle third proximal, middle and distal was: 7.4mm (1.0-19.2), 16.2mm (6.7-34.7) and 67.1mm (29.7-117.0) respectively. The location of AS and VS with respect to the clavicle is posterosuperior in the proximal third, posteroinferior in the middle third and inferior in the distal third. CONCLUSION: In the proximal third the vein can be only 1mm from the clavicle and the artery to 6mm in the anterior-posterior direction, this zone is the most dangerous. In the middle third the distance is greater, artery and vein can be only to 6mm, the most dangerous drilling direction is antero-inferior with an average inclination of 45° caudal. The distal third is the safest, the vessels are at least 30mm away from the vessels. Level of evidence III.

DNA damage and primordial follicle activation after in vitro culture of sheep ovarian cortex in Morus nigra leaf extract / Dano ao DNA e ativação do folículo primordial após a cultivo in vitro do córtex ovariano de ovelha em extrato de folha de Morus nigra

This study evaluated the effect of Morus nigra leaf extract, with or without supplementation, on morphology, activation and DNA damage of preantral follicles cultured within sheep ovarian tissue. Ovaries were collected and divided into fragments, being one fixed for histological and Terminal deoxynucleotidyl transferase (TdT) mediated dUTP nick-end labeling (TUNEL) analysis (fresh control). The remaining fragments were cultured for 7 days in alpha minimum essential media (α-MEM) supplemented with bovine serum albumin (BSA), insulin, transferrin, selenium, glutamine, hypoxanthine and ascorbic acid (α-MEM+; control medium) or into medium composed of M. nigra extract without supplements (0.1; 0.2 or 0.4mg/mL) or supplemented with the same substances described above for α-MEM+ (MN 0.1+; 0.2+ or 0.4+mg/mL). Then, tissues were destined to histological and TUNEL analysis. The α-MEM+ treatment had more morphologically normal follicles than all M. nigra extract treatments. However, α-MEM+ treatment also showed signs of atresia because the percentage of TUNEL positive cells was similar in α-MEM+ and in 0.1mg/mL M. nigra without and with supplements. Moreover, a reduction in the primordial follicles and an increase in the growing ones were observed in all treatments, except 0.2mg/mL M. nigra. In conclusion, the follicles cultured at 0.1mg/mL M. nigra extract were in good condition and able to continue their development, as demonstrated by the same rates of DNA damage and follicular activation as the control medium.(AU)

Este estudo avaliou o efeito do extrato das folhas de Morus nigra, com ou sem suplementos, sobre a morfologia, a ativação e o dano ao DNA de folículos pré-antrais cultivados inclusos em tecido ovariano. Os ovários foram coletados e divididos em fragmentos, sendo um fixado para análise histológica e ensaio de marcação de terminações dUTP mediada por desoxinucleotidil transferase terminal (TUNEL) (controle fresco). Os fragmentos restantes foram cultivados durante 7 dias em meio essencial mínimo alfa (α-MEM) suplementado com albumina sérica bovina (BSA), insulina, transferrina, selênio, glutamina, hipoxantina e ácido ascorbico (α-MEM+; meio controle) ou em meio composto de extrato de M. nigra sem suplementos (0,1; 0,2 or 0,4mg/mL) ou suplementado com as mesmas substâncias descritas para α-MEM+ (MN 0,1+; 0,2+ or 0,4+mg/mL). Então, os tecidos foram destinados à análise histológica e TUNEL. O tratamento do α-MEM+ apresentou mais folículos morfologicamente normais que todos os tratamentos do extrato de M. nigra. No entanto, o tratamento com α-MEM+ também mostrou sinais de atresia, pois a porcentagem de células TUNEL positivas foi semelhante em α-MEM+ e em 0,1mg/mL M. nigra sem e com suplementos. Além disso, observou-se uma redução nos folículos primordiais e um aumento nos folículos em crescimento em todos os tratamentos, exceto 0,2mg/mL M. nigra. Em conclusão, os folículos cultivados com 0,1mg/mL de extrato de M. nigra estavam em boas condições e aptos a continuar seu desenvolvimento, como demonstrado pelas taxas de dano ao DNA e de ativação folicular semelhantes ao meio controle.(AU)

Ophthalmologic profile among Hansen’s disease patients in a tertiary hospital

Background@#Ophthalmologic evaluation is often neglected in routine screening of Hansen’s disease patients. In line with the global aim of reducing grade 2 disability, eye examination should be an essential part of routine examination of Hansen’s disease patients.@*Objective@#To describe the ophthalmologic profile of patients with Hansen’s disease seen in a tertiary hospital.@*Methods@#A point-prevalence survey was conducted. Sixty-six Hansen’s disease patients, aged 18 and above, underwent complete ophthalmologic examination including visual acuity, refraction, external eye examination, intraocular pressure determination, dilated pupil examination, palpebral aperture measurement, corneal sensation testing, and tear breakup time determination. Statistical analysis was done.@*Results@#All patients had ocular findings with lepromatous leprosy (62%) being the highest. Fifty-three percent had Type 2 lepra reaction. Most were males, disease duration in majority was < 5 years and bacillary morphologic index was 4.0 – 4.99. Patients with Grade 1 and Grade 2 disability of the eyes were 62% and 17% respectively. The most common ocular complications were: abnormal tear breakup time (79%), cataracts (53%),blepharitis (47%), madarosis (39%) and corneal opacities (24%).@*Conclusion@#There is a significant number of ocular findings among leprosy patients in this study. The highest number of ocular complications is among patients in the lepromatous pole. There is a preference of M. leprae for cooler areas; hence, the anterior chamber was greatly affected.

Fractura de clavícula distal con cortical superior indemne: cirugía mínimamente invasiva / Distal clavicle fracture with intact upper cortex: minimally invasive surgery

INTRODUCCIÓN Las fracturas de clavícula distal desplazadas son manejadas generalmente de manera quirúrgica dada la alta probabilidad de no-unión con el tratamiento ortopédico. El propósito de este trabajo es evaluar el uso del sistema de fijación con doble botón cortical para la reducción y estabilización de la fractura de clavícula distal que presenten indemnidad de la cortical superior. MÉTODOS: Estudio retrospectivo observacional clínico-imagenológico de pacientes con fractura desplazada de clavícula distal operados con técnica mínimamente invasiva mediante reducción con sistema de fijación con doble botón cortical. Se describe como criterio radiológico de "Cortical Superior Indemne (CSI)" la presencia del rasgo de fractura a 1cm o más, hacia distal desde el tubérculo conoide, identificándose ese criterio como característica necesaria para la indicación del tratamiento propuesto. Se describen las complicaciones post-operatorias, progresión radiológica y resultados funcionales. RESULTADOS: 21 pacientes fueron tratados con esa técnica con un seguimiento promedio de 23,4 meses. No hubo casos de no unión, infección o herida dehiscente y ningún paciente requirió el retiro del dispositivo. Se encontró un Simple Shoulder Test (SST) promedio de 79,4 (66 - 91,7) y QuickDASH de 11 (6,8 - 15,9). El 87,5% de las fracturas desplazadas de clavícula distal tenían indemnidad de la cortical superior. CONCLUSIÓN: La técnica mínimamente invasiva para la reducción y fijación de la fractura de clavícula distal desplazada con botones corticales es una alternativa simple, reproducible, con pocas complicaciones y excelentes resultados funcionales.

BACKGROUND: Displaced distal clavicle fractures are commonly managed through surgery due to a high probability of nonunion with conservative treatments. The purpose of this study is to evaluate the use of Flip-buttons as a minimally invasive method for fixing and stabilizing displaced distal clavicle fractures when the upper cortical it́s intact. METHODS: A retrospective observational study of radiological and clinical results of patients with displaced distal clavicle fracture that were treated with the Flip-button technique. The indication for using this surgical method was based on the radiological criteria of "Intact Upper Cortical (IUC)" described by the authors as the presence of the fracture 1cm or more, distally to de conoid tubercle. Post-operative complications, radiologic and functional progress were recorded. RESULTS: 21 patients were treated with this technique, all with complete bony union. No patients presented infection or wound dehiscence and implant removal was not necessary in any case. The mean follow-up was of 23,4 months. The mean score in Simple Shoulder Test (SST) was 79,4 (66 - 91,7) and a mean QuickDASH of 11 (6,8 - 15,9). 87,5% of all the displaced distal clavicle fractures had IUC. CONCLUSION: The minimally invasive technique for the reduction and fixation of the displaced distal clavicle fracture with cortical buttons is a simple and reproducible alternative, with few complications and excellent functional results.

Afectos y conductas sexuales en adolescentes: diferencias y semejanzas en dos culturas, España y Colombia / Sexual feelings and behaviors in adolescents: differences and similarities in two cultures, Spain and Colombia

Resumen Este trabajo pretende identificar las posibles diferencias de género en afectos y conductas sexuales de España y Colombia. La muestra total fue de 508 participantes de centros de educación secundaria, 270 en España y 238 en Colombia, de edades entre los 15 y 18 años y con una media de edad de 16.4 años. Los resultados obtenidos muestran un doble patrón en varones y mujeres, tanto en España como en Colombia, especialmente en relación a los afectos sexuales y no tanto en las conductas sexuales.

Abstract This work aims to identify gender differences in sexual behaviors and feelings between adolescents living in Spain and Colombia. A total of 508 participants from secondary schools, 270 from Spain and 238 from Colombia, took part in this study. The age of the participants ranged from 15 and 18 years. The results showed a double standard for men and women, both in Spain and Colombia, especially in relation to sexual feelings rather than on sexual behavior.

La hipertensión arterial en Venezuela y sus factores determinantes / Arterial hypertension and determinants in Venezuela

RESUMEN Objetivo Determinar la prevalência y los factores determinantes fundamentales de la hipertensión arterial, en la población venezolana. Métodos Se realizó una revisión sistemática de la literatura en las bases de datos PubMed y LILACS. Los criterios de inclusión fueron: HTA, Venezuela y riesgos. Se escogieron artículos publicados en cualquier idioma, sin límite de tiempo. Resultados Se encontraron 90 artículos de los cuales 20 cumplieron con los criterios. La mayoría de la data proviene de estudios realizados en la región central del país. La prevalencia del HTA encontrada en la zona rural es de 33 %; en la zona urbana oscila entre 24 y 31 %; en niños 2,5 %. Los trabajos evidenciaron que los factores determinantes modificables son la obesidad y las dislipidemias. En cuanto a los no modificables se encuentran los antecedentes familiares, la raza y la edad. Conclusiones No hay datos suficientes para establecer la prevalencia de la enfermedad en Venezuela, ni conocer cuáles son sus factores determinantes de manera global. Se recomienda incentivar estudios multicéntricos de prevalencia que comprendan la totalidad del país. Los estudios deben ser regulares en el tiempo (estudios longitudinales) para describir el aumento o no de la prevalencia.(AU)

ABSTRACT Objective To determine the prevalence and determinants of arterial hypertension in the Venezuelan population. Methods A systematic review of the literature was performed in the PubMed and LILACS databases. The inclusion criteria were hypertension, Venezuela and risks. Articles published in any language were chosen, with no time limit. Results Out of 90 articles found during the search, only 20 met the inclusion criteria. Most of the data come from studies conducted in the central region of the country. The prevalence of hypertension found in the rural area is 33 %, while it oscillates between 24 and 31 % in the urban area, and 2.5 % in children. The studies showed that modifiable determining factors include obesity and dyslipidemias. In turn, non-modifiable factors include family history, race and age. Conclusions Data are insufficient to establish the prevalence of the disease in Venezuela and its determinants. It is recommended to encourage multicenter prevalence studies that cover the entire country. Studies should be regularly done over time (longitudinal studies) to describe the increase or not in prevalence.(AU)

Selection, isolation, and identification of fungi for bioherbicide production

Abstract Production of a bioherbicide for biological control of weeds requires a series of steps, from selection of a suitable microbial strain to final formulation. Thus, this study aimed to select fungi for production of secondary metabolites with herbicidal activity using biological resources of the Brazilian Pampa biome. Phytopathogenic fungi were isolated from infected tissues of weeds in the Pampa biome. A liquid synthetic culture medium was used for production of metabolites. The phytotoxicity of fungal metabolites was assessed via biological tests using the plant Cucumis sativus L., and the most promising strain was identified by molecular analysis. Thirty-nine fungi were isolated, and 28 presented some phytotoxic symptoms against the target plant. Fungus VP51 belonging to the genus Diaporthe showed the most pronounced herbicidal activity. The Brazilian Pampa biome is a potential resource for the development of new and sustainable chemical compounds for modern agriculture.

Avaliação de custo-efetividade da vacina pneumocócica conjugada 13-valente comparada à vacina pneumocócica polissacarídica e não vacinação no Sistema de Saúde Suplementar Brasileiro / Cost-effectiveness evaluation of pneumococcal conjugate vaccine 13-valent compared to the polysaccharide pneumococcal vaccine and non-vaccination in the Brazilian Supplementary Health System

RESUMO Objetivo: As doenças causadas pela bactéria Streptococcus pneumoniae (pneumococo) são importantes causas de morbimortalidade no mundo, principalmente em indivíduos nos extremos de idade. O objetivo deste estudo foi avaliar os benefícios e custos incrementais associados à vacina pneumocócica conjugada 13-valente PCV13 (Prevenar® 13), comparada à não utilização de vacina e à utilização de vacina pneumocócica polissacarídica PPSV23 no Sistema de Saúde Suplementar, por meio de uma análise de custo-efetividade. Métodos: Foi realizado um estudo de custo-efetividade utilizando um modelo de Markov que englobou os estados de saúde saudável, doença pneumocócica e morte. Neste estudo foram incluídos dados clínicos de pacientes com doença pneumocócica (bacteremia, meningite, internações por pneumonia e pneumonias ambulatoriais), custos médicos diretos e indiretos, considerando um horizonte de tempo de três anos, com ciclos anuais e uma coorte hipotética de pacientes com 50 anos ou mais. Análises de sensibilidade univariada e probabilística também foram realizadas. Resultados: A utilização da vacina PCV13 se mostrou dominante em relação às demais estratégias nos pacientes com risco baixo, moderado e alto. A análise de sensibilidade probabilística indica que a chance de PCV13 ser a estratégia mais custo-efetiva é de 90%, quando um limiar de R$ 12.000 para cada ano de vida ganho é definido. Conclusões: Foi possível observar que a utilização da vacina PCV13 para a prevenção de doenças pneumocócicas em adultos com 50 anos ou mais, considerando o desfecho clínico "anos de vida salvos", pode ser a estratégia mais eficiente quando comparada à não vacinação ou à utilização da vacina PPSV23.

Diseases caused by the bacteria Streptococcus pneumoniae are important sources of morbidity and mortality around the world, specially in regard to elderly people. We sought to assess costs and benefits inherent to 13-valent pneumococcal conjugate vaccine (PCV13, Prevenar® 13) compared to pneumococcal polysaccharide vacine (PPSV23) and the policy of does providing vaccine in the perspective of Brazilian Private Health System. Methods: A cost-effectiveness analysis model was performed by means of a Markov modelling which comprised the health states healthy, pneumococcal disease and death. In this study were included clinical data of patients with pneumococcal disease (bacteremia, meningitis, hospitalization due to pneumonia and community acquired pneumonia) and direct and indirect medical costs. A three year time horizon and an annual cycle were set. The hypothetic cohort corresponds to patients aging 50 years or more. One-way and probabilistic sensitivity analyses were performed. Results: PCV13 is dominant over PPSV23 and non- -vaccination policy in low- moderate- and high-risk patients. Probabilistic analysis shows that PCV13 has a probability of being 90% more cost-effective when a threshold of BRL 12.000 is defined for each incremental life-year gained. Conclusions: Considering the outcome life-years gained PCV13 is the strategy that most promote value for money in patients aging 50 years or more, in the Brazilian Private Health System.

Epidemiología del estado de salud periodontal en la VII Región del Maule, Chile / Epidemiology of periodontal status in the Maule Region, Chile

Antecedentes Pese a que la enfermedad periodontal es una patología altamente prevalente, en Chile la información regional es escasa y limitada, especialmente en lo referente a la realidad de la población rural. Objetivo Dada la falta de datos locales y el alto índice de ruralidad de la Región del Maule, el objetivo de este estudio fue determinar el estado periodontal de la población de 6, 12, 15, 35 a 44 y 65 a 74 años que vive en la Región del Maule. Metodología Se llevó a cabo un estudio transversal (EpiMaule) con 2.414 personas, agrupadas según las edades de vigilancia epidemiológica señaladas por la Organización Mundial de la Salud (OMS) para estudios poblacionales, sexo y zona de procedencia. Se midió el índice de placa bacteriana de Silness y Löe (IP), el índice gingival de Löe y Silness (IG) y el índice periodontal comunitario (IPC). Se analizaron los datos mediante estadística descriptiva y analítica con un nivel de significancia del 5%. Resultados La gran mayoría de la población presentó niveles moderados de placa bacteriana y de inflamación gingival, tanto los niños como los adultos y los adultos mayores. Los adolescentes de 15 años mostraron la mayor prevalencia de sangramiento al sondaje en todas las edades examinadas. Los adultos mayores mostraron los valores más altos de IP (1,75) e IG (1,62) entre todos los grupos estudiados, afectando mayormente a los mayores que viven en zonas rurales. Los hombres y la población rural presentan los valores más altos para el IP como para el IG (p < 0,05). Con un 77,2% de la población de 35 a 44 años, el código 2 del IPC fue el más frecuentemente detectado. Por su parte, el 28,8% de los participantes de 65-74 años tenían profundidades al sondaje ≥ 4 mm, representando el grupo etario con mayor prevalencia de este nivel de IPC (p < 0,05). Conclusiones La población de la Región del Maule presenta importantes diferencias en el estado periodontal según edad, sexo y ruralidad, siendo los más afectados los adultos mayores. Estos datos sugieren la necesidad de implementar políticas de salud bucal que aborden diferencialmente las distintas necesidades de las personas.

Background Despite periodontal disease being highly prevalent in Chile, information from the regions is scarce and limited, particular as regards the situation in the rural population. Objective Given the lack of local data and the high rurality index of the Maule Region, the aim of this study was to determine the periodontal status of the 6, 12, 15, 35 to 44, and 65 to 74 year-old population that lives in the Region. Methodology A cross-sectional study (EpiMaule) was conducted on 2,414 individuals, grouped according to the epidemiological surveillance ages indicated by the World Health Organisation (WHO) for population studies, sex and area of study. The measurements made include the Silness-Löe bacterial plaque index (IP), Silness-Löe gingival index (IG), and the community periodontal index (IPC). The data were analysed using descriptive and analytical statistics with a significance level of 5%. Results The large majority of the population, including children, adults and the elderly, had moderate levels of bacterial plaque and gingival inflammation. Adolescents of 15 years showed the highest prevalence of bleeding on probing in all the ages examined. The older adults had the highest IP (1.75) and IG values among all the groups studied, mainly affecting the older ones that lived in rural areas. Males and the rural population had the highest values for IP as well as for IG (P < .05). A CPI level of 2 was most frequently detected in 77.2% of the 35 to 44 years population. On the other hand, more than one-quarter (28.8%) of the 65-74 year-old participant had probe depths ≥ 4 mm, being the age group with a high prevalence at this CPI level (P < .05). Conclusions The population of the Maule Region show significant differences in periodontal status, according to age, sex, and rurality, with the elderly being the most affected. These data suggest the need to implement oral health policies that differentially approach the individual needs of the population.

Evaluation of anti-inflammatory, immunomodulatory, chemopreventive and wound healing potentials from Schinus terebinthifolius methanolic extract

Inflammatory and genetic alterations are related to the development of chronic diseases such as cancer. Schinus terebinthifolius Raddi, Anacardiaceae, is used in folk medicine to treat inflammation, wounds and tumors. This study evaluated the anti-inflammatory, immunomodulatory, chemopreventive, and wound healing potentials of the methanolic extract from the leaves of Schinus terebinthifolius. The chemical composition of the extract was characterized using preliminary analytical LC methods. The results showed that the anti-inflammatory activity of the methanolic extract was similar to that of dexamethasone for edema reduction. Also, it inhibited the leukocyte migration into the air pouch and decreased plasma extravasation. In addition, the methanolic extract showed a healing action similar to that observed with collagenase. The methanolic extract is not genotoxic nor mutagenic, and in contrast it has chemopreventive activity, which elicits a high percentage of damage reduction by comet and micronucleus assay, preferably by bioantimutagenic action. The methanolic extract induced apoptosis and enhanced splenic phagocytosis in animals treated with cyclophosphamide. The methanolic extract contents, resolved by LC, include phenolic acid and flavonoids. Our results suggest a therapeutic potential for the methanolic extract.

Socio-demographic profile of child and adolescent users of oral health services in Victoria, Australia / Perfil sociodemográfico de crianças e adolescentes usuários de serviços públicos de cuidado de saúde bucodental em Victoria, Austrália / Perfil sociodemográfico de niños y adolescentes usuarios de servicios públicos de atención en salud bucodental en Victoria, Australia

The aim of this study was to investigate the socio-demographic characteristics of the eligible population of users of public oral health care services in the Australian state of Victoria, aged 17 years or younger. The study was conducted as a secondary analysis of data collected from July 2008 to June 2009 for 45,728 young clients of public oral health care. The sample mean age was 8.9 (SD: 3.5) years. The majority (82.7%) was between 6 and 17 years of age, and 50.3% were males. The majority (76.6%) was Australian-born and spoke English at home (89.1%). The overall mean DMFT was 1.0 (SD: 2.1) teeth, with a mean dmft of 3.16 (SD: 5.79) teeth. Data indicate that, among six year olds in the Significant Caries Index (SiC) category, the mean dmft was 6.82 teeth. Findings corroborate social inequalities in oral health outcome and provide suggestions for oral health services to develop strategies and priorities to reduce inequalities in health and well-being, and better coordinate and target services to local needs.

O objetivo deste estudo foi investigar as características sociodemográficas de usuários do serviço público de saúde bucal no Estado de Vitória, Austrália, com até 17 anos de idade. O presente estudo é uma análise de dados secundários de 45.728 sujeitos que recorreram ao serviço público de saúde bucal entre julho de 2008 a junho de 2009. A idade média da amostra foi 8,9 (DP: 3,5) anos. A maioria dos sujeitos (82,7%) apresentava entre 6 e 17 anos de idade e 50,3% eram do gênero masculino. A maioria (76,6%) havia nascido na Austrália e falava inglês em casa (89,1%). O índice CPOD médio foi 1,0 (DP: 2,1) e o ceod 3,16 (DP: 5,79). Os dados indicam que entre as crianças de 6 anos categorizadas no Significant Caries Index (SiC), o índice ceod médio foi 6,82. Os achados demonstram desigualdade social nos desfechos de saúde bucal e fornecem sugestões para que os serviços de saúde bucal desenvolvam estratégias e prioridades para reduzir tais desigualdades na saúde e bem-estar, de forma a adequar os serviços às necessidades locais.

El objetivo de este estudio fue describir las características sociodemográficas de la población de usuarios de los servicios públicos de atención odontológica, de 17 o menos años de edad, en el estado australiano de Victoria. El estudio realiza un análisis secundario de los datos de 45.728 pacientes que asistieron a los servicios de atención odontológica públicos entre julio 2008 y junio 2009. El promedio de edad de la muestra fue 8,9 (s.d. 3,5) años. La mayoría (82,7 %) tenía entre 6 y 17 años de edad, y el 50,3 % fue de sexo masculino. La mayoría (76,6%) nació en Australia y hablaba inglés en casa (89,1%). El COPD promedio fue 1.0 (s.d. 2.1) dientes, con un ceod promedio de 3,16 (s.d. 5,79) dientes. A los 6 años de edad en la categoría de Índice de Caries Significativo, el dmft promedio fue de 6.82 dientes. Los resultados confirman desigualdades sociales en salud bucodental y proporcionan sugerencias para los servicios de salud bucodental, con el fin de desarrollar estrategias y prioridades tendientes a la reducción de desigualdades en salud y bienestar.

Sexuality in old age: key issues,gender differences and future proposals / Sexualidade na velhice: questões-chave, as diferenças de gênero e propostas futuras

This work presents a brief overview of some of the most important issues related to sexuality during old age. First, it presents the state of the current situation, in order to later explore some of the elements that have been considered key factors in experiencing sexuality, specifically in this stage of life, while exploring certain needs and difficulties. Similarly, some of the differences between men and women, within this context, are presented. Finally, future proposals aimed at better understanding this topic in old age are presented, with suggestions on how to improve wellbeing and care in regard to sexuality among the aging population.

Este trabalho apresenta uma breve descrição de algumas das questões mais importantes relacionadas com a sexualidade durante a velhice. Primeiro, apresenta-se o estado da situação atual, para depois explorar alguns dos elementos que foram considerados fatores-chave na vivência da sexualidade, especificamente nesta fase da vida, ao explorar certas necessidades e dificuldades. Do mesmo modo, algumas das diferenças entre homens e mulheres, neste contexto, são apresentadas. Finalmente, as propostas futuras que visam a uma melhor compreensão deste tema na terceira idade são expostas, com sugestões sobre como melhorar o bem-estar e cuidados em relação à sexualidade da população idosa.

Transexualidad y vejez: una realidad por conocer / Transsexuality and aging: an important reality to investigate

El presente trabajo hace un breve recorrido por algunas de las cuestiones de mayor relevancia para las personas transexuales durante la vejez. En primer lugar, expone el estado de la cuestión actual sobre la transexualidad durante la vejez y las líneas de trabajo que han abordado de manera específica la vejez de las personas transexuales, exponiendo cuáles son sus necesidades específicas y las dificultades encontradas. Finalmente refleja diversas propuestas de futuro destinadas a mejorar el bienestar de las personas transexuales mayores...

This paper makes a brief tour of some most important issues for transsexual people in old age. Firstly, it exposes the current needs and difficulties on transsexualism aging and focuses upon studies of age on transsexuals. Finally, this review propose several proposals to improve wellbeing of older transsexual people...

Avaliação de aterosclerose coronária por imagem cardíaca: valor complementar do escore de cálcio à perfusão miocárdica / Coronary atherosclerosis evaluation through cardiac imaging: complementary role of calcium score to myocardial perfusion

Nas últimas décadas, observaram-se avanços na investigação e manejo da doença cardiovascular e uma redução significativa como causa da mortalidade. Entretanto, a doença cardiovascular permanece como a principal causa de morte, em vários países, inclusive no Brasil. Identificar o indivíduo de maior risco para eventos cardiovasculares é de grande importância para que seja possível intensificar e enfatizar medidas de prevenção. As ferramentas diagnósticas não invasivas evoluíram e conseguiu-se, hoje, com boa margem de segurança, identificar os pacientes que mais se beneficiarão dos procedimentos de revascularização do miocárdio, em relação ao tratamento medicamentoso, principalmente, pelo uso da cintilografia do miocárdio. Dúvidas ainda persistem no sentido de como manejar um paciente com fatores de risco para doença cardiovascular, com teste de esforço positivo e cintilografia do miocárdio negativa. O que demonstra a literatura com relação ao valor do escore de cálcio, em pacientes assintomáticos nessas situações? Neste artigo, será feita uma reflexão sobre esses pacientes, os quais são bastante frequentes na prática cardiológica do dia a dia.

Tradução, adaptação e confiabilidade interexaminadores do manual de administração da escala de Fugl-Meyer / Translation, adaptation and inter-rater reliability of the administration manual for the Fugl-Meyer assessment

CONTEXTUALIZAÇÃO: Recentemente a confiabilidade da versão brasileira da Escala de Fugl-Meyer (EFM) foi avaliada pela pontuação dada pela observação de um único examinador que aplicou a escala. Quando diferentes examinadores aplicam a escala, a confiabilidade pode depender da interpretação dada à ficha de avaliação. Nesse caso, um manual de administração claro é fundamental para garantir homogeneidade na aplicação. OBJETIVOS: Traduzir e adaptar para o português-Brasil a versão do Manual de Administração em francês-canadense da EFM e avaliar a confiabilidade interexaminadores quando diferentes examinadores aplicam a EFM com base nas informações contidas no manual. MÉTODOS: Participaram do estudo 18 adultos (59±10 anos) com hemiparesia crônica (38±35 meses pós-Acidente Vascular Encefálico). Oito sujeitos participaram da primeira parte do estudo e dez, da segunda parte. Baseada na análise dos resultados da parte 1, desenvolveu-se uma versão adaptada à qual foram adicionadas informações e fotos para ilustrar a posição do paciente e do examinador. A confiabilidade interexaminadores foi avaliada com o Coeficiente de Correlação Intraclasse (CCI). RESULTADOS: A confiabilidade da EFM baseada na versão adaptada do manual foi excelente para o escore motor total do membro superior (MS, CCI=0,98) e membro inferior (MI, CCI=0,90), sentido de movimento (CCI=0,98), amplitude de movimento (ADM) passiva do MS (CCI=0,84) e do MI (CCI=0,90) e moderada para a sensibilidade tátil (0,75). A avaliação da dor articular apresentou baixa confiabilidade. CONCLUSÃO: Os resultados mostram que, com exceção da avaliação da dor, a aplicação da EFM com base na versão adaptada do manual de aplicação em português-Brasil apresenta adequada confiabilidade interexaminadores.

BACKGROUND: Recently, the reliability of the Brazilian version of the Fugl-Meyer Assessment (FMA) was assessed through the scoring given according to observations made by a single evaluator who applied the test. When different raters apply the scale, the reliability may depend on the interpretation given to the assessment sheet. In such cases, a clear administration manual is essential for ensuring homogeneity of application. OBJECTIVES: To translate and adapt the French Canadian version of the FMA administration manual into Brazilian Portuguese and to evaluate the inter-rater reliability when different evaluators apply the FMA on the basis of the information contained in the manual. METHODS: Eighteen adults (59±10 years) with chronic hemiparesis (38±35 months after a stroke) took part in this study. Eight patients participated in the first part of the study and 10 in the second part. Based on analyzing the results from part 1, an adapted version was developed, in which information and photos were added to illustrate the positions of the patient and evaluator. The inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: The reliability of the FMA based on the adapted version of the manual was excellent for the total motor scores for the upper limbs (ICC=0.98) and lower limbs (ICC=0.90), as well as for movement sense (ICC=0.98) and upper and lower-limb passive range of motion (ICC=0.84 and 0.90, respectively). The reliability was moderate for tactile sensitivity (0.75). The joint pain assessment presented low reliability. CONCLUSIONS: The results showed that, except for pain assessment, application of the FMA based on the adapted version of the application manual for Brazilian Portuguese presented adequate inter-rater reliability.

Resposta fisiológica à infestação experimental com ichthyophthirius multifiliis (Fouquet, 1876) em alevinos de jundiá (Rhamdia quelen quoy e gaimard, 1824) previamente alimentados com diferentes fontes lipídicas / Physiological response of experimental challenge of Ichthyophthirius multifiliis (Fouquet, 1876) in jundiá (Rhamdia quelen quoy and gaimard, 1824) fingerlings rather fed with different lipid sources

Um fator limitante nas primeiras fases do cultivo do jundiá (Rhamdia quelen Quoy e Gaimard, 1824) é a presença da ictioftiríase. Os ácidos graxos poliinsaturados (PUFAs) presentes na dieta possuem uma potente atividade imuno-moduladora, e esta atividade depende da espécie analisada e da quantidade/qualidade dos PUFAs da dieta. O objetivo do presente estudo foi avaliar a resposta fisiológica de alevinos de jundiá, alimentados com diferentes fontes de ácidos graxos, quando parasitados pelo protozoário Ichthyophthirius multifiliis (Fouquet, 1876). Alevinos de jundiá (7,6±0,8g) alimentados durante sete semanas com cinco dietas contendo diferentes fontes lipídicas: óleos de peixe, linhaça e milho foram expostos ao protozoário. No quinto dia a presença da doença foi detectada. Amostras de sangue foram coletadas e sobrevivência e graus de infestação foram estimados. As diferentes dietas afetaram a sobrevivência dos alevinos, sendo que alevinos que consumiram dietas com óleo de peixe apresentaram uma maior sobrevivência. O hematócrito e o grau de infestação não apresentaram diferença estatística significativa entre os tratamentos, entretanto a contagem diferencial dos leucócitos registrou diferença. Os resultados mostraram pela primeira vez no jundiá que, diferentes fontes lipídicas produzem respostas fisiológicas diversas, podendo representar uma alternativa ao tratamento da doença. Novos estudos deverão ser realizados no sentido de aprofundar o conhecimento aqui gerado.

A limiting factor in the early stage of the jundiá (Rhamdia quelen Quoy; Gaimard, 1824) culture is the presence of diseases such as ichthyophthiriasis or "Ich". Dietary polyunsaturated fatty acids (PUFAs) have a potent immunomodulatory activity; and this activity depend of the fish species, quantity/quality of the dietary PUFAS. The aim of this study was evaluate the physiologic response ofjundiá, rather fed diets with different sources of fatty acids when challenge to Ich disease. Fingerlings ofjundiá (7.6±0.8g) were fed during seven weeks with five diets with a different lipid source: fish, linseed and corn oils. Then, the fish were challenged with the Ichthyophthirius multifiliis (Fouquet, 1876). On the 5th day, the presence of the disease was detected. Survival rate, blood samples and infection grade were recorded. Diets affect the survival rate of fingerlings, thus fish fed with diet with fish oil showed a higher survival. Hematocrit and infestation grade no recorder differences among treatment. The differential analysis of white blood cells shows difference. The results point out, at first time injundiá, that dietary lipids caused diversity physiologic response, this may be represent an opportunity for the disease treatment. New studies must be carrying out to deep knowledge found.