Estudo da ativação e modulação da resposta imune contra a esporotricose experimental, a partir de vesículas extracelulares purificadas de células dendríticas / Study of the activation and modulation of the immune response against experimental sporotrichosis, using extracellular vesicles purified from dendritic cells

A esporotricose é uma zoonose micótica emergente e subcutânea, que afeta a pele, o sistema linfático e outros órgãos de humanos e animais. Assim como outras doenças infecciosas fúngicas, se torna ainda mais grave quando acomete pacientes imunossuprimidos. Essa infecção possui distribuição global e é endêmica em algumas regiões do Brasil e de outros países tropicais e subtropicais, sendo um problema de saúde pública importante em nosso país. A doença é causada por um complexo de pelo menos quatro espécies patogênicas, incluindo o Sporothrix brasiliensis (S. brasiliensis). A resposta imunológica contra estas espécies ainda não é completamente elucidada, mas estruturas como as vesículas extracelulares (VEs) poderiam transportar componentes importantes que podem contribuir na modulação e no controle desta importante infecção. Assim, o objetivo deste trabalho, é analisar a participação das VEs de células dendríticas (DCs) naive e VEs de DCs previamente primadas com leveduras de S. brasiliensis e primadas com VEs do fungo, na resposta imune contra a esporotricose experimental em modelos murinos. Para isso, as DCs obtidas da medula óssea de camundongos, foram cultivadas com leveduras de S. brasiliensis ou com VEs do fungo e posteriormente, VEs totais das DCs foram purificadas a partir de ultracentrifugação e analisadas quanto a sua participação na modulação da resposta imunológica. Essas VEs foram utilizadas em protocolo profilático em modelos murinos, previamente a infecção subcutânea experimental. Foi observado o diâmetro médio das lesões no decorrer de 35 dias de infecção e a carga fúngica da lesão na pele. Os resultados obtidos mostram que as VEs de DCs naive, e VEs de DCs previamente cultivadas com leveduras do fungo ou com VEs fúngicas, são capazes de modular a carga fúngica. Os grupos que receberam VEs de DCs de forma profilática, de modo geral apresentaram diminuição significativa da carga fúngica em relação ao grupo controle. Na análise comparativa apenas dos grupos que receberam a profilaxia, observa-se que o uso de VEs de DCs naive, resultam em uma carga fúngica maior que o uso de VEs de DCs previamente ativadas, e quando as DCs são ativadas com levedura, essa carga fúngica é a menor. Quando analisamos o perfil de citocinas na pele de camundongos tratados com as VEs previamente a infecção, observamos aumento de IFN-γ, TNF-α, IL-17 e IL-10 principalmente nos animais previamente tratados com VEs de DCs que foram ativadas com leveduras. Em relação às citocinas produzidas, podemos sugerir até o momento, uma resposta imunológica mista, mas que de alguma maneira, ainda não esclarecida, devem contribuir para melhor controle do processo infeccioso in vivo. Em relação a linfoproliferação, observa-se principalmente um aumento de linfócitos T CD4+ quando acrescentamos VEs de DCs que não foram previamente ativadas, mostrando uma ação de uma resposta mais inespecífica. Vale ressaltar que todos os protocolos profiláticos foram capazes de modular e minimizar o crescimento fúngico, quando comparados ao controle, ou seja, as VEs contribuíram com o controle da infecção e agiram a favor do hospedeiro, demonstrando um caráter protetivo

Sporotrichosis is an emerging subcutaneous mycotic zoonosis that affects the skin, lymphatic system, and other organs of humans and animals, and like other infectious fungal diseases, it becomes even more serious when it affects immunosuppressed patients. This infection has a global distribution and is endemic in some regions of Brazil and other tropicals and subtropicals countries, being an important public health problem in our country. The disease is caused by a complex of at least four pathogenic species, including Sporothrix brasiliensis (S. brasiliensis). The immunological response against these species has not yet been completely elucidated, but structures such as extracellular vesicles (EVs) could carry important components that can contribute to the modulation and control of this important infection. Thus, the objective of this work is to analyze the participation of EVs from naïve dendritic cells (DCs) and EVs from DCs previously primed with S. brasiliensis yeast and primed with EVs from the fungus, in the immune response against experimental sporotrichosis in murine models. For this, DCs obtained from the bone marrow of mice were cultivated with S. brasiliensis yeast or EVs from the fungus, and subsequently, total EVs from the DCs were purified through ultracentrifugation and analyzed for their participation in modulating the immune response. These EVs were used in a prophylactic protocol in murine models, before experimental subcutaneous infection. The average diameter of the lesions over 35 days of infection and the fungal load of the lesion on the skin were observed. The results obtained show that EVs from naïve DCs, and EVs from DCs previously cultured with yeast or fungal EVs, are capable of modulating the fungal load. The groups that received EVs from DCs prophylactically generally showed a significant decrease in fungal load compared to the control group. In the comparative analysis of only the groups that received prophylaxis, it was observed that the use of EVs from naïve DCs results in a higher fungal load than the use of EVs from previously activated DCs, and when the DCs are activated with yeast, this load fungal is smaller. When we analyzed the cytokine profile in the skin of mice treated with EVs before infection, we observed an increase in IFN-γ, TNF-α, IL-17, and IL-10, mainly in animals previously treated with EVs from DCs that were activated with yeast. About the cytokines produced, we can so far suggest a mixed immunological response, but in some way, not yet clear, they should contribute to better control of the infectious process in vivo. About lymphoproliferation, an increase in CD4+ T lymphocytes is mainly observed when we add EVs from DCs that were not previously activated, showing a more nonspecific response. It is worth highlighting that all prophylactic protocols were able to modulate and minimize fungal growth, when compared to the control, that is, EVs contributed to the control of the infection and acted in favor of the host, demonstrating a protective character

Estudo da ativação e modulação da resposta imune contra a esporotricose experimental, a partir de vesículas extracelulares purificadas de células dendríticas / Study of the activation and modulation of the immune response against experimental sporotrichosis, using extracellular vesicles purified from dendritic cells

A esporotricose é uma zoonose micótica emergente e subcutânea, que afeta a pele, o sistema linfático e outros órgãos de humanos e animais. Assim como outras doenças infecciosas fúngicas, se torna ainda mais grave quando acomete pacientes imunossuprimidos. Essa infecção possui distribuição global e é endêmica em algumas regiões do Brasil e de outros países tropicais e subtropicais, sendo um problema de saúde pública importante em nosso país. A doença é causada por um complexo de pelo menos quatro espécies patogênicas, incluindo o Sporothrix brasiliensis (S. brasiliensis). A resposta imunológica contra estas espécies ainda não é completamente elucidada, mas estruturas como as vesículas extracelulares (VEs) poderiam transportar componentes importantes que podem contribuir na modulação e no controle desta importante infecção. Assim, o objetivo deste trabalho, é analisar a participação das VEs de células dendríticas (DCs) naive e VEs de DCs previamente primadas com leveduras de S. brasiliensis e primadas com VEs do fungo, na resposta imune contra a esporotricose experimental em modelos murinos. Para isso, as DCs obtidas da medula óssea de camundongos, foram cultivadas com leveduras de S. brasiliensis ou com VEs do fungo e posteriormente, VEs totais das DCs foram purificadas a partir de ultracentrifugação e analisadas quanto a sua participação na modulação da resposta imunológica. Essas VEs foram utilizadas em protocolo profilático em modelos murinos, previamente a infecção subcutânea experimental. Foi observado o diâmetro médio das lesões no decorrer de 35 dias de infecção e a carga fúngica da lesão na pele. Os resultados obtidos mostram que as VEs de DCs naive, e VEs de DCs previamente cultivadas com leveduras do fungo ou com VEs fúngicas, são capazes de modular a carga fúngica. Os grupos que receberam VEs de DCs de forma profilática, de modo geral apresentaram diminuição significativa da carga fúngica em relação ao grupo controle. Na análise comparativa apenas dos grupos que receberam a profilaxia, observa-se que o uso de VEs de DCs naive, resultam em uma carga fúngica maior que o uso de VEs de DCs previamente ativadas, e quando as DCs são ativadas com levedura, essa carga fúngica é a menor. Quando analisamos o perfil de citocinas na pele de camundongos tratados com as VEs previamente a infecção, observamos aumento de IFN-γ, TNF-α, IL-17 e IL-10 principalmente nos animais previamente tratados com VEs de DCs que foram ativadas com leveduras. Em relação às citocinas produzidas, podemos sugerir até o momento, uma resposta imunológica mista, mas que de alguma maneira, ainda não esclarecida, devem contribuir para melhor controle do processo infeccioso in vivo. Em relação a linfoproliferação, observa-se principalmente um aumento de linfócitos T CD4+ quando acrescentamos VEs de DCs que não foram previamente ativadas, mostrando uma ação de uma resposta mais inespecífica. Vale ressaltar que todos os protocolos profiláticos foram capazes de modular e minimizar o crescimento fúngico, quando comparados ao controle, ou seja, as VEs contribuíram com o controle da infecção e agiram a favor do hospedeiro, demonstrando um caráter protetivo

Sporotrichosis is an emerging subcutaneous mycotic zoonosis that affects the skin, lymphatic system, and other organs of humans and animals, and like other infectious fungal diseases, it becomes even more serious when it affects immunosuppressed patients. This infection has a global distribution and is endemic in some regions of Brazil and other tropicals and subtropicals countries, being an important public health problem in our country. The disease is caused by a complex of at least four pathogenic species, including Sporothrix brasiliensis (S. brasiliensis). The immunological response against these species has not yet been completely elucidated, but structures such as extracellular vesicles (EVs) could carry important components that can contribute to the modulation and control of this important infection. Thus, the objective of this work is to analyze the participation of EVs from naïve dendritic cells (DCs) and EVs from DCs previously primed with S. brasiliensis yeast and primed with EVs from the fungus, in the immune response against experimental sporotrichosis in murine models. For this, DCs obtained from the bone marrow of mice were cultivated with S. brasiliensis yeast or EVs from the fungus, and subsequently, total EVs from the DCs were purified through ultracentrifugation and analyzed for their participation in modulating the immune response. These EVs were used in a prophylactic protocol in murine models, before experimental subcutaneous infection. The average diameter of the lesions over 35 days of infection and the fungal load of the lesion on the skin were observed. The results obtained show that EVs from naïve DCs, and EVs from DCs previously cultured with yeast or fungal EVs, are capable of modulating the fungal load. The groups that received EVs from DCs prophylactically generally showed a significant decrease in fungal load compared to the control group. In the comparative analysis of only the groups that received prophylaxis, it was observed that the use of EVs from naïve DCs results in a higher fungal load than the use of EVs from previously activated DCs, and when the DCs are activated with yeast, this load fungal is smaller. When we analyzed the cytokine profile in the skin of mice treated with EVs before infection, we observed an increase in IFN-γ, TNF-α, IL-17, and IL-10, mainly in animals previously treated with EVs from DCs that were activated with yeast. About the cytokines produced, we can so far suggest a mixed immunological response, but in some way, not yet clear, they should contribute to better control of the infectious process in vivo. About lymphoproliferation, an increase in CD4+ T lymphocytes is mainly observed when we add EVs from DCs that were not previously activated, showing a more nonspecific response. It is worth highlighting that all prophylactic protocols were able to modulate and minimize fungal growth, when compared to the control, that is, EVs contributed to the control of the infection and acted in favor of the host, demonstrating a protective character

Frequency, Markers and Costs of Secondary Bacterial Infection in Pediatric Dengue.

BACKGROUND: Secondary bacterial infection (SBI) occurs in a proportion of individuals with dengue and results in longer hospitalization, higher mortality, and increased health-related costs. However, the frequency, risk factors and predictive biomarkers of this comorbidity in pediatric dengue is partially known. METHODS: We conducted a retrospective multicenter study in a dengue hyperendemic region of Colombia, analyzing 1597 children from two pediatric cohorts. We included children with confirmed dengue (mild to severe disease) and evaluated the rate of SBI, their clinical characteristics, diagnostic predictors and attention costs. We also assessed the diagnostic performance of plasma interleukin (IL)-6 for detecting SBI in pediatric dengue. RESULTS: The frequency of SBI in children with dengue with warning signs in cohorts 1 and 2 was 2.4% and 7.3%, respectively, and this rate reached 30.7% and 38.2% in children with severe disease. Staphylococcus aureus and Escherichia coli were the more frequent infectious agents. Increased total leukocytes and C-reactive protein levels, as well as high IL-6 at hospital admission, in children <48 months of age were early indications of SBI in dengue. Higher rates of organ dysfunction, the requirement of a longer hospitalization and a 2.3-fold increase in attention costs were observed in SBI. CONCLUSIONS: An important proportion of children with dengue course with SBI and exhibit higher morbidity. Elevated leukocytes, C-reactive protein and IL-6 in young children are early markers of SBI. Physicians should identify children with dengue and risk factors for SBI, microbiologically confirm the bacterial infection, and rationally and timely provide antimicrobial therapy.

Cargas de trabalho, precarização e Saúde do Trabalhador no agronegócio no semiárido do Nordeste brasileiro / Workloads, precariousness and worker health in agribusiness in the semi-arid region of Northeast Brazil

RESUMO A expansão do agronegócio no semiárido do nordeste do Brasil tem transformado agricultores camponeses em empregados de empresas de fruticultura, trazendo mudanças para seus modos de vida e trabalho. O estudo objetivou analisar condições, processos e cargas de trabalho no agronegócio de fruticultura. Realizou-se pesquisa qualitativa em que foram entrevistados empregados do agronegócio. As evidências foram produzidas e analisadas a partir de referenciais do campo Saúde do Trabalhador, fundamentando-se na teoria da determinação social do processo saúde-doença e adotando 'processos de trabalho' e 'cargas de trabalho' como categorias compreensivas das relações entre trabalho e saúde-doença. Observou-se que a produção agrícola se baseia na monocultura, no uso intensivo de mecanização e de agrotóxicos, e segue os moldes organizacionais da acumulação flexível e do taylorismo e fordismo. O mundo do trabalho vivido pelos empregados é marcado por alienação dos trabalhadores, precarização e intensificação do trabalho, que se concretizam em cargas de trabalho físicas, psíquicas, fisiológicas e, sobretudo, químicas. Estas advêm do uso intenso de agrotóxicos, presentes em todos os ambientes e processos de trabalho investigados. A proteção da saúde desses trabalhadores tensiona o Sistema Único de Saúde (SUS) a intensificar a vigilância em Saúde do Trabalhador, e a saúde coletiva, a incluir a problemática da saúde no debate público sobre os modelos agrícolas nacionais.

ABSTRACT The expansion of agribusiness in the semi-arid region of northeastern Brazil has transformed self-employed farmers into employees of fruit growing companies, bringing changes to their ways of life and work. The study aimed to analyze conditions, processes and workloads in the fruit growing agribusiness. A qualitative research was carried out in which agribusiness employees were interviewed. Evidence was produced and analyzed based on references from the Occupational Health field, based on the theory of social determination of the health-disease process and adopting 'work processes' and 'workloads' as comprehensive categories of the relationship between work and health-disease. It was observed that agricultural production is based on monoculture, on the intensive use of mechanization and pesticides, and follows the organizational molds of flexible accumulation and Taylorism/Fordism. The world of work experienced by employees is marked by alienation of workers, precariousness and intensification of work, which materialize in physical, psychic, physiological and, above all, chemical workloads. These come from the intense use of pesticides, present in all environments and work processes investigated. Protecting the health of these workers pushes the Unified Health System (SUS) to intensify worker's health surveillance, and collective health to include the issue of health in the public debate on national agricultural models.

Bats (Mammalia, Chiroptera) and bat flies (Diptera, Streblidae) from the Cazumbá-Iracema and Chico Mendes Reserve, Western Brazilian Amazon.

Bats belong to the order Chiroptera and are composed of 18 families, 202 genera, and 1420 species. Cosmopolitans, they have a high diversity of trophic and behavioral guilds, several ecosystem services, and intraspecific associations with ectoparasites. In Brazil, 68 species of Streblidae have already been recorded, although knowledge about the bat fauna and their ectoparasites is still low. Thus, the objective was to present a list of bat species, and to relate parasites with hosts, for two extractive reserves in the state of Acre, western Brazilian Amazon. The collections took place in ten nights, five in each RESEX, both carried out in August 2019. At each point, 10 mist nets (9 m × 2.5 m) were used, remaining open for 6 h. The captured bats were stored in cotton bags and had their data collected. Subsequently, the search for ectoparasites was carried out throughout the individual's body and extracted with brushes moistened with 96% ethyl alcohol and fine-tipped tweezers. Species of flies were identified to the lowest taxonomic level through specific bibliography. Thirty-three bats from six trophic guilds and 46 ectoparasitic dipterans were sampled, all from the Streblidae family. The most abundant bat family was Phyllostomidae, a recurring result in several studies carried out in the neotropical region. This is related to the selectivity of the mist net in bat sampling, in addition to a close correlation between Phyllostomidae bats and ectoparasitic flies of the Streblidae family.

Perfil epidemiológico dos pacientes hospitalizados com covid-19 no município de Mossoró - RN / Epidemiological profile of COVID-19 hospitalized patients in the municipality of Mossoró-RN / Perfil Epidemiológico de pacientes con COVID-19 en el municipio de Mossoró-RN

Introdução: Assim como observado no cenário nacional, o município de Mossoró apresentou altas taxas de letalidade nos primeiros meses de pandemia. Todavia, o conhecimento epidemiológico em torno da COVID-19 no município tem ocorrido, sobretudo, através de documentos institucionais das Secretarias de Saúde. Desse modo, a finalidade deste estudo é fornecer evidências que permitam ampliar a compreensão da ocorrência da doença em nível local, ofertar dados e informações que venham a subsidiar as políticas públicas de saúde municipais e gerar hipóteses sobre a morbimortalidade da doença para futuras investigações científicas. Objetivo: Analisar o perfil epidemiológico dos casos internados e confirmados de COVID-19 no município de Mossoró no estado do Rio Grande do Norte/Brasil. Metodologia: Estudo observacional transversal, baseado em dados secundários de casos internados de COVID-19 registrados no Sistema Único de Saúde entre março e outubro de 2020.Resultados:Foram incluídos na amostra 664 pacientes, dos quais 46,5% evoluíram para óbito. Entre as internações, 63,1% resultaram em internações em unidades de terapia intensiva. Observamos diferenças estatísticas significativas entre 'admissão na unidade de terapia intensiva e evolução para óbito' e 'faixa etária e evolução para óbito' e, maior risco entre idosos acima de 60 anos, com comorbidades, dispneia e saturação de O2 <95%. A necessidade de suporte ventilatório invasivo foi considerada fator predisponente para óbito. O risco de internação na unidade de terapia intensiva foi maior entre as idosas. Conclusões: A hospitalização e o óbito de pacientes com COVID-19foram maiores em pacientes idosos com comorbidades (AU).

Introduction:As observed in the national scenario, the city of Mossoró showed high lethality rates in the first months of the pandemic. However, the epidemiological knowledge around COVID-19 in the municipality has occurred mostly through institutional documents from the Health Secretariats. Thus, the purpose of this study is to provide evidence to broaden the understanding of the occurrence of the disease at the local level, provide data and information that will support municipal health public policies and generate hypotheses about the morbidity and mortality of the disease for future scientific investigations. Objective: To analyze the epidemiological profile of hospitalized and confirmed cases of COVID-19 in the municipality of Mossoró in the state of Rio Grande do Norte/Brazil. Methodology:This is a cross-sectional and observational study, based on secondary data from the hospitalized COVID-19 cases recorded in the Unified Health System (Sistema Unificado de Saúde, SUS) between March and October 2020. Results:664 patients were included in the sample, of which 46.5% evolved to death. Among hospitalizations, 63.1% resulted in intensive care units admissions. We observed significant differences between intensive care unit admission and evolution to death' and 'age group and evolution to death' and, higher risk among elderly individuals over 60 years, with comorbidities, dyspnea and O2 saturation<95%. Need for invasive ventilatory support was considered a predisposing factor for death. The risk of intensive care unit admission was higher among eldery women.Conclusions:Hospitalization and death of patients with COVID-19 were higher in elderly patients with comorbidities (AU).

Introducción: Como se observó en el escenario nacional, el municipio de Mossoró presentó altas tasas de letalidad en los primeros meses de la pandemia. Sin embargo, el conocimiento epidemiológico en torno al COVID-19 en el municipio se ha dado principalmente a través dedocumentos institucionales de las Secretarías de Salud. Por lo tanto, el objetivo de este estudio es proporcionar evidencias para ampliar el conocimiento de la ocurrencia de la enfermedad en el ámbito local, proporcionar datos e informaciones que apoyen las políticas públicas municipales de salud y generar hipótesis sobre la morbilidad y mortalidad de la enfermedad para futuras investigaciones científicas. Objetivo: Analizar el perfil epidemiológico de los casos hospitalizados y confirmados de COVID-19 en el municipio de Mossoró en el estado de Rio Grande do Norte/Brasil.Metodología: Se trata de un estudio transversal y observacional, basado en datos secundarios de los casos hospitalizados de COVID-19 registrados en el Sistema Unificado de Salud (SUS) entre marzo y octubre de 2020. Resultados: La muestra incluyó 664 pacientes, de los cuales el 46,5% falleció. Entre los ingresos, el 63,1% resultaron en ingresos en la unidad de cuidados intensivos. Se observaron diferencias estadísticas significativas entre el "ingreso en la unidad de cuidados intensivos y la evolución hasta la muerte" y el "grupo de edad y la evolución hasta la muerte", y un mayor riesgo entre los pacientes mayores de 60 años, con comorbilidades, disnea y saturación de O2 <95%. La necesidad de soporte ventilatorio invasivo se consideró un factor predisponente para la muerte. El riesgo de ingreso en la unidad de cuidados intensivos fue mayor entre las mujeres de edad avanzada. Conclusiones: La hospitalización y la muerte de los pacientes con COVID-19 fueron mayores en los pacientes de edad avanzada con comorbilidades (AU).

Educação em Saúde com gestantes na estratégia saúde da família: desafios e possibilidades / Health education for pregnant women in the family health strategy: challenges and possibilities

Introdução: a Educação em Saúde com gestantes deve incorporar novas ações no âmbito da Atenção Primária à Saúde, com possibilidades de promover saúde e prevenir doenças, bem como garantir o exercício de práticas e saberes alternativos ao modelo biomédico, evocando reflexões críticas e o compartilhamento de experiências por meio das gestantes. Objetivo: buscou-se analisar as atividades de Educação em Saúde direcionadas para as gestantes nas equipes da Estratégia Saúde da Família. Metodologia: trata-se de um estudo qualitativo, desenvolvido em Unidades Básicas de Saúde do município de Mossoró/RN, que reuniu narrativas de 15 usuárias por meio de entrevistas semiestruturadas. Resultados: após utilização da Análise Temática de Conteúdo, os resultados foram separados em duas categorias principais e cinco subcategorias. A primeira categoria avaliou as ações de Educação em Saúde, caracterizadas por serem esporádicas (ou inexistentes em alguns serviços) e pela alternância entre metodologias de ensino vertical e horizontal. Por outro lado, a segunda categoria evocou o significado dos encontros entre as gestantes e os profissionais de saúde, marcado por fragilidades na escuta qualificada, no diálogo e na realização das ações educativas durante o pré-natal. Conclusão: de acordo com os discursos das gestantes, percebemos que as estratégias de ensino, quando pautadas nos preceitos de Paulo Freire, estão intimamente ligadas à promoção da saúde. Isso porque garante às gestantes uma consciência crítica sobre o seu autocuidado; o que se constitui como primeira iniciativa para que ocorram mudanças nos seus hábitos de vida e na maneira como enfrentam as circunstâncias inerentes à gestação.

Introduction: health education for pregnant women proposes the incorporation of new actions within the scope of Primary Health Care, with possibilities of promoting health and preventing diseases, as well as ensuring the exercise of practices and knowledge alternative to the biomedical model, evoking critical reflections and the sharing of experiences by pregnant women. Objective: this study aimed to analyze the Health Education activities directed to pregnant women in the Family Health Strategy teams. Methodology: this is a qualitative study, developed in Basic Health Units of the municipality of Mossoró/RN, which gathered narratives of 15 users through semi-structured interviews. Results: after using Thematic Content Analysis, the results were separated into two main categories and five subcategories. The first category evaluated the Health Education actions, characterized by being sporadic (or nonexistent in some services) and by the alternation between vertical and horizontal teaching methodologies. On the other hand, the second category evoked the meaning of the meetings between pregnant women and health professionals, marked by weaknesses in qualified listening, dialogue and the realization of educational actions during prenatal care. Conclusion: according to the pregnant women's speeches, we realize that teaching strategies, when based on Paulo Freire's precepts, are closely related to health promotion. This is because it guarantees to pregnant women a critical consciousness about their self-care, which is the first initiative for changes to occur in their life habits and in the way they face the circumstances inherent to pregnancy.

Accuracy and Sensitivity of Clinical Parameters in Predicting Successful Extubation in Patients with Acute Brain Injury.

BACKGROUND: Brain injuries are frequent causes of intubation and mechanical ventilation. The aim of this study was to investigate the accuracy and sensitivity of clinical parameters in predicting successful extubation in patients with acute brain injury. METHODS: Six hundred and forty-four patients assisted at a high-complexity hospital were recruited. Patients were divided as for successful or failed extubation. The VISAGE score, maximum inspiratory and expiratory pressures, peak cough flow, and airway occlusion pressure at 0.1 s were used as predictors. Logistic regression analyses using ROC-curve identified values of accuracy and sensitivity. The Hosmer-Lemeshow test and the stepwise method calibrated the statistical model. RESULTS: VISAGE score (odds ratio of 1.975), maximum inspiratory pressure (odds ratio of 1.024), and peak cough flow (odds ratio of 0.981) are factors consistent in distinguishing success from failure extubation. The ROC curve presented an accuracy of 79.7% and a sensitivity of 95.8%. CONCLUSIONS: VISAGE score, maximum inspiratory pressure and peak cough flow showed good accuracy and sensitivity in predicting successful extubation in patients with acute brain injury. The greater impact of VISAGE score indicates that patients' neurological profile should be considered in association with ventilatory parameters in the decision of extubation.

Vulnerabilidade da pessoa idosa institucionalizada e o apoio social na perspectiva da pandemia de covid-19 / Vulnerability of institutionalized older people and social support in the perspective of the COVID-19 pandemic

Resumo Objetivo Discutir as medidas de prevenção da covid-19 no contexto da vulnerabilidade das pessoas idosas institucionalizadas e analisar o apoio social ofertado às Instituições de Longa Permanência para Idosos durante a pandemia. Método Pesquisa qualitativa realizada com trabalhadores de 24 instituições filantrópicas do Rio Grande do Norte. Os conceitos de vulnerabilidade em saúde e apoio social embasaram a organização e discussão dos dados submetidos à análise temática. Resultados As instituições adotaram, parcialmente, as medidas de prevenção recomendadas pela Agencia Nacional de Vigilância Sanitária, em evidência: cancelamento de visitas, uso de Equipamentos de Proteção Individual e limpeza dos ambientes. Em sua maioria, as instituições priorizaram o controle da transmissão viral, secundarizando a redução dos impactos sociopsicológicos referentes ao distanciamento e isolamento social. Foram observadas medidas não recomendadas e sem evidência científica, como o uso de ivermectina. Ainda, a atuação das redes de assistência social e de saúde se efetivou de forma mais integrada, melhorando o apoio social oferecido às instituições na perspectiva da pandemia. O Sistema Único de Saúde se destacou pelas recomendações sanitárias, oferta de insumos e atenção da Estratégia Saúde da Família, enquanto o Sistema Único de Assistência Social atuou de maneira menos expressiva. Conclusão Em geral, as medidas adotadas foram insuficientes para a prevenção da covid-19 diante das suscetibilidades dos idosos institucionalizados. Embora a pandemia tenha ampliado a rede de apoio social e a visibilidade das Instituições de Longa Permanência para Idosos, tornam-se necessários maiores investimentos do poder público para efetivar a redução de vulnerabilidade dessas pessoas idosas.

Abstract Objective Discuss covid-19 prevention measures in the context of the vulnerability of institutionalized elderly people and analyze the social support offered to Long Stay Institutions for the Elderly during the pandemic. Method Qualitative research carried out with workers from 24 philanthropic institutions in Rio Grande do Norte. The concepts of vulnerability in health and social support supported the organization and discussion of data submitted to thematic analysis. Results The institutions partially adopted the prevention measures recommended by the National Health Surveillance Agency, in evidence: cancellation of visits, use of Personal Protective Equipment and cleaning of environments. For the most part, institutions prioritized the control of viral transmission, putting the reduction of socio-psychological impacts related to social distancing and isolation in the background. Measures not recommended and without scientific evidence were observed, such as the use of ivermectin. Also, the performance of social assistance and health networks was carried out in a more integrated way, improving the social support offered to institutions in the perspective of the pandemic. The Unified Health System stood out for its sanitary recommendations, supply of supplies and attention from the Family Health Strategy, while the Unified Social Assistance System acted in a less expressive way. Conclusion In general, the measures adopted were insufficient to prevent covid-19 in view of the susceptibilities of institutionalized elderly people. Although the pandemic has expanded the social support network and the visibility of Long-Stay Institutions for the Elderly, greater investments by the government are necessary to effectively reduce the vulnerability of these elderly people.

NASF-AB no campo e nas águas: o cuidado em torno do trabalho, ambiente e saúde de famílias agricultoras e pescadoras / NASF-AB in the field and in the waters: the care around work, environment and health of farming and fishing families / NASF-AB en el campo y en las aguas: el cuidado acerca del trabajo, el medio ambiente y la salud de las familias campesinas y pesqueras

Resumo O Núcleo Ampliado de Saúde da Família e Atenção Básica foi criado no Brasil para apoiar e ampliar a atenção e a gestão na Saúde da Família. Analisa-se a sua atuação quanto à saúde do trabalhador e saúde e ambiente em territórios do campo e das águas com as famílias que vivem da pesca artesanal e da agricultura camponesa. Pesquisa qualitativa que se ancorou em referenciais da Sociologia das Ausências e da Saúde Coletiva, na abordagem particular que esta faz das relações entre saúde, ambiente e trabalho. A pesquisa valeu-se do emprego de grupos focais na produção de narrativas de profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica em municípios do semiárido e do litoral do Nordeste. Evidenciaram-se singularidades socioeconômicas e culturais das populações do campo e das águas; invisibilidades e potencialidades sobre seus modos de vida e trabalho; cargas e doenças relacionadas ao trabalho; e aspectos da atuação do Núcleo Ampliado de Saúde da Família e Atenção Básica mediante interações com o trabalho e o ambiente nesses territórios. Os cuidados oferecidos a estas populações consideram parcialmente suas especificidades socioculturais, produtivas, ambientais e de saúde, sendo preciso ampliar o reconhecimento de seus modos de vida e trabalho visando intervenções mais exitosas sobre os problemas e necessidades de saúde - o que aponta desafios à formação em saúde para o Sistema Único de Saúde.

Abstract The Extended Family Health and Primary Care Center (Núcleo Ampliado de Saúde da Família e Atenção Básica - NASF-AB) was created in Brazil to support and expand Family Health care and management. Its performance regarding workers' health and health and environment in rural and water territories is analyzed with families that live from artisanal fishing and peasant agriculture. This is a qualitative research that was anchored in references from the Sociology of Absences and Collective Health, in the latter's particular approach to the relations between health, environment, and work. The research used focus groups to produce narratives of professionals from the Extended Center for Family Health and Primary Care in municipalities in the semiarid and coastal regions of the Northeast. The socioeconomic and cultural singularities of the rural and water populations were evidenced; invisibilities and potentialities about their ways of life and work; work-related burdens and diseases; and aspects of the performance of the Extended Family Health Center and Primary Care through interactions with work and the environment in these territories. The care offered to these populations partially considers their sociocultural, productive, environmental, and health specificities, and it is necessary to expand the recognition of their ways of life and work, aiming at more successful interventions on health problems and needs; which poses challenges to health education for the Unified Health System.

Resumen El Núcleo Ampliado de Salud de la Familia y Atención Básica fue creado en Brasil para apoyar y ampliar la atención y gestión en Salud de la Familia. Se analiza su desempeño en materia de salud de los trabajadores y salud y medio ambiente en territorios del campo y de las aguas con las familias que viven de la pesca artesanal y de la agricultura campesina. Investigación cualitativa que se basó en referentes de la Sociología de las Ausencias y de la Salud Colectiva, en el particular abordaje que esta hace de la relación entre salud, medio ambiente y trabajo. La investigación se basó en la utilización de grupos focales en la producción de narrativas por parte de profesionales del Núcleo Ampliado de Salud de la Familia y Atención Básica en municipios de la región semiárida y del litoral del Nordeste. Se evidenciaron singularidades socioeconómicas y culturales de las poblaciones del campo y de las aguas; invisibilidades y potencialidades sobre sus formas de vida y trabajo; cargas y enfermedades relacionadas con el trabajo; y aspectos de la actuación del Núcleo Ampliado de Salud de la Familia y Atención Primaria a través de interacciones con el trabajo y el medio ambiente en estos territorios. La atención ofrecida a estas poblaciones considera parcialmente sus especificidades socioculturales, productivas, ambientales y de salud, siendo necesario ampliar el reconocimiento de sus modos de vida y de trabajo, visando intervenciones más exitosas sobre los problemas y necesidades de salud; lo que apunta desafíos a la formación en salud para el Sistema Único de Salud.

Proximity to freshwater blue space and type 2 diabetes onset: the importance of historical and economic context.

Salutogenic effects of living near aquatic areas (blue space) remain underexplored, particularly in non-coastal and non-urban areas. We evaluated associations of residential proximity to inland freshwater blue space with new onset type 2 diabetes (T2D) in central and northeast Pennsylvania, USA, using medical records to conduct a nested case-control study. T2D cases (n=15,888) were identified from diabetes diagnoses, medication orders, and laboratory test results and frequency-matched on age, sex, and encounter year to diabetes-free controls (n=79,435). We calculated distance from individual residences to the nearest lake, river, tributary, or large stream, and residence within the 100-year floodplain. Logistic regression models adjusted for community socioeconomic deprivation and other confounding variables and stratified by community type (townships [rural/suburban], boroughs [small towns], city census tracts). Compared to individuals living ≥1.25 miles from blue space, those within 0.25 miles had 8% and 17% higher odds of T2D onset in townships and boroughs, respectively. Among city residents, T2D odds were 38-39% higher for those living 0.25 to <0.75 miles from blue space. Residing within the floodplain was associated with 16% and 14% higher T2D odds in townships and boroughs. A post-hoc analysis demonstrated patterns of lower residential property values with nearer distance to the region's predominant waterbody, suggesting unmeasured confounding by socioeconomic disadvantage. This may explain our unexpected findings of higher T2D odds with closer proximity to blue space. Our findings highlight the importance of historic and economic context and interrelated factors such as flood risk and lack of waterfront development in blue space research.

COVID-19 in Brazil-Preliminary Analysis of Response Supported by Artificial Intelligence in Municipalities.

The novel coronavirus disease (COVID-19) forced rapid adaptations in the way healthcare is delivered and coordinated by health systems. Brazil has a universal public health system (Sistema Unico de Saúde-SUS), being the main source of care for 75% of the population. Therefore, a saturation of the system was foreseen with the continuous increase of cases. The use of Artificial Intelligence (AI) to empower telehealth could help to tackle this by increasing a coordinated patient access to the health system. In the present study we describe a descriptive case report analyzing the use of Laura Digital Emergency Room-an AI-powered telehealth platform-in three different cities. It was computed around 130,000 interactions made by the chatbot and 24,162 patients completed the digital triage. Almost half (44.8%) of the patients were classified as having mild symptoms, 33.6% were classified as moderate and only 14.2% were classified as severe. The implementation of an AI-powered telehealth to increase accessibility while maintaining safety and leveraging value amid the unprecedent impact of the COVID-19 pandemic was feasible in Brazil and may reduce healthcare overload. New efforts to yield sustainability of affordable and scalable solutions are needed to truly leverage value in health care systems, particularly in the context of middle-low-income countries.

Fishway in hydropower dams: a scientometric analysis.

Building dams for hydroelectric use causes several negative effects on the aquatic fauna with special attention to fish communities. In fact, among other impacts, dams act as a barrier for migratory fish, causing discontinuities in rivers and not allowing fish to move to the headwaters to breed and back to the lower portions of rivers, to grow. For more than 300 years, fishways have been used to minimize the impact of dams. Here, we assess the worldwide knowledge about fishways, identifying the temporal and spatial pattern and the situation of Brazil in this global pattern. For this, we conducted scientometric research on the Web of Science repository with the following words: weir, fish, facilities, ladder, pass, dam, fish ladder, fish pass, fishway, hydropower, Petromyzon, and salmon between 1985 and 2019. Initially, we obtained 1282 articles. After a selection, 324 articles aimed to describe fishway efficiency and the relationship with the fish fauna remained. Most of the articles on dams, fishways, and fish are from North America and Europe. Among the articles in South America, most are from Brazil. Nonetheless, information on the topic is incipient in Brazil, since the country has one of the biggest hydropower in the world and 42 scientific articles about fishways published in the international scientific database. Ecology is the area of knowledge with most articles, with continuous growth in the last 10 years. Studies in the field of ecology are strategical, as this field can integrate different areas of knowledge to test the efficiency of fishways in fish conservation and may be able to answer the question: "Are fishways an ecological trap?" Research focusing on this question is important to understand the efficiency of fishways to better evaluate solutions to minimize the negative effects of dams on fish and increase the effectiveness of fishways.

Coronavirus infection and nursing care for children and adolescents with cancer.

OBJECTIVE: Reflect on the implications of COVID-19 for the nursing care of pediatric oncology patients. METHODS: Theoretical and reflective essay, based on recent scientific publications and expert recommendations on the care of pediatric patients under cancer treatment in the context of the current pandemic. RESULTS: Reflected on the involvement of the pediatric population in general by COVID-19, the vulnerability of pediatric oncology patients to the complications of the disease and the likely challenges for their care. The pandemic demanded a rapid adaptation of health services in terms of patient care flow, care protocols, infection prevention measures, and redefinition of cancer therapy, with repercussions for professionals, patients, and their families. FINAL CONSIDERATIONS: It is not yet known how often or how severely children with cancer have been affected by COVID-19, but therapeutic and care adaptations for the maintenance of these patients' treatment in the pandemic context are noted.

Coronavirus infection and nursing care for children and adolescents with cancer / Infecciones por coronavirus y los cuidados de enfermería dirigidos a niños y adolescentes con cancer / Infecções por coronavírus e os cuidados de enfermagem direcionados a crianças e adolescentes com cancer

ABSTRACT Objective: Reflect on the implications of COVID-19 for the nursing care of pediatric oncology patients. Methods: Theoretical and reflective essay, based on recent scientific publications and expert recommendations on the care of pediatric patients under cancer treatment in the context of the current pandemic. Results: Reflected on the involvement of the pediatric population in general by COVID-19, the vulnerability of pediatric oncology patients to the complications of the disease and the likely challenges for their care. The pandemic demanded a rapid adaptation of health services in terms of patient care flow, care protocols, infection prevention measures, and redefinition of cancer therapy, with repercussions for professionals, patients, and their families. Final considerations: It is not yet known how often or how severely children with cancer have been affected by COVID-19, but therapeutic and care adaptations for the maintenance of these patients' treatment in the pandemic context are noted.

RESUMEN Objetivo: Reflejar acerca de implicaciones de COVID-19 a los cuidados de enfermería con pacientes oncológicos pediátricos. Métodos: Ensayo teórico-reflexivo, basado en publicaciones científicas recientes y recomendaciones de especialistas acerca del cuidado con pacientes pediátricos en tratamiento oncológico del contexto de la actual pandemia. Resultados: Reflejó acerca del acometimiento de la población pediátrica en general por COVID-19, la vulnerabilidad de pacientes pediátricos oncológicos a las complicaciones de la enfermedad y probables desafíos para su cuidado. La pandemia exigió una rápida adecuación de los servicios de salud cuanto al flujo de atención de pacientes, protocolos asistenciales, medidas de prevención de infección y redefinición de la terapéutica oncológica, con repercusiones a los profesionales, pacientes y sus familias. Consideraciones finales: Aún no se sabe con que frecuencia o gravedad niños con cáncer son afectados por COVID-19, pero perciben adaptaciones terapéuticas y asistenciales a la manutención del tratamiento de esos pacientes del contexto de pandemia.

RESUMO Objetivo: refletir sobre as implicações da COVID-19 para os cuidados de enfermagem com pacientes oncológicos pediátricos. Métodos: ensaio teórico-reflexivo, a partir de publicações científicas recentes e recomendações de especialistas sobre o cuidado com pacientes pediátricos em tratamento oncológico no contexto da atual pandemia. Resultados: refletiu-se sobre o acometimento da população pediátrica em geral pela COVID-19, a vulnerabilidade dos pacientes pediátricos oncológicos às complicações da doença e os prováveis desafios para seu cuidado. A pandemia exigiu uma rápida adequação dos serviços de saúde quanto a fluxo de atendimento de pacientes, protocolos assistenciais, medidas de prevenção de infecção e redefinição da terapêutica oncológica, com repercussões para os profissionais, pacientes e suas famílias. Considerações finais: Ainda não se sabe com que frequência ou gravidade crianças com câncer têm sido afetadas pela COVID-19, porém notam-se adaptações terapêuticas e assistenciais para a manutenção do tratamento desses pacientes no contexto de pandemia.

Coronavirus infection and nursing care for children and adolescents with cancer / Infecciones por coronavirus y los cuidados de enfermería dirigidos a niños y adolescentes con cancer / Infecções por coronavírus e os cuidados de enfermagem direcionados a crianças e adolescentes com cancer

ABSTRACT Objective: Reflect on the implications of COVID-19 for the nursing care of pediatric oncology patients. Methods: Theoretical and reflective essay, based on recent scientific publications and expert recommendations on the care of pediatric patients under cancer treatment in the context of the current pandemic. Results: Reflected on the involvement of the pediatric population in general by COVID-19, the vulnerability of pediatric oncology patients to the complications of the disease and the likely challenges for their care. The pandemic demanded a rapid adaptation of health services in terms of patient care flow, care protocols, infection prevention measures, and redefinition of cancer therapy, with repercussions for professionals, patients, and their families. Final considerations: It is not yet known how often or how severely children with cancer have been affected by COVID-19, but therapeutic and care adaptations for the maintenance of these patients' treatment in the pandemic context are noted.

RESUMEN Objetivo: Reflejar acerca de implicaciones de COVID-19 a los cuidados de enfermería con pacientes oncológicos pediátricos. Métodos: Ensayo teórico-reflexivo, basado en publicaciones científicas recientes y recomendaciones de especialistas acerca del cuidado con pacientes pediátricos en tratamiento oncológico del contexto de la actual pandemia. Resultados: Reflejó acerca del acometimiento de la población pediátrica en general por COVID-19, la vulnerabilidad de pacientes pediátricos oncológicos a las complicaciones de la enfermedad y probables desafíos para su cuidado. La pandemia exigió una rápida adecuación de los servicios de salud cuanto al flujo de atención de pacientes, protocolos asistenciales, medidas de prevención de infección y redefinición de la terapéutica oncológica, con repercusiones a los profesionales, pacientes y sus familias. Consideraciones finales: Aún no se sabe con que frecuencia o gravedad niños con cáncer son afectados por COVID-19, pero perciben adaptaciones terapéuticas y asistenciales a la manutención del tratamiento de esos pacientes del contexto de pandemia.

RESUMO Objetivo: refletir sobre as implicações da COVID-19 para os cuidados de enfermagem com pacientes oncológicos pediátricos. Métodos: ensaio teórico-reflexivo, a partir de publicações científicas recentes e recomendações de especialistas sobre o cuidado com pacientes pediátricos em tratamento oncológico no contexto da atual pandemia. Resultados: refletiu-se sobre o acometimento da população pediátrica em geral pela COVID-19, a vulnerabilidade dos pacientes pediátricos oncológicos às complicações da doença e os prováveis desafios para seu cuidado. A pandemia exigiu uma rápida adequação dos serviços de saúde quanto a fluxo de atendimento de pacientes, protocolos assistenciais, medidas de prevenção de infecção e redefinição da terapêutica oncológica, com repercussões para os profissionais, pacientes e suas famílias. Considerações finais: Ainda não se sabe com que frequência ou gravidade crianças com câncer têm sido afetadas pela COVID-19, porém notam-se adaptações terapêuticas e assistenciais para a manutenção do tratamento desses pacientes no contexto de pandemia.

Atitudes de enfermeiros na administração de quimioterápicos em oncologia pediátrica / Nurses' attitudes in the administration of chemotherapy in pediatric oncology / Actitudes de enfermeros en la administración de quimioterápicos en oncología pediátrica

Objetivo: analisar as atitudes de enfermeiros acerca da administração de antineoplásicos em oncologia pediátrica. Método: estudo descritivo, com análise estatística dos dados. Participaram 20 enfermeiros de um hospital de ensino, localizado na capital paulista, que administravam quimioterapia (QT) a crianças e adolescentes. Em 2016, mediante questionário autoaplicável, foram coletados dados de caracterização dos participantes e sobre suas atividades profissionais na administração de QT, que incluíam principais receios e preocupações, além dos potenciais eventos adversos associados à quimioterapia. Resultados: poucos participantes eram especialistas na área de oncologia ou pediatria; a maioria dos profissionais buscou conhecimento e capacitação por iniciativa própria; os enfermeiros classificaram a atividade como complexa e específica para quem possui interesse na área. Conclusão: todos os enfermeiros consideraram a QT o principal tratamento para o câncer infanto-juvenil. O risco de extravasamento e a falta de dispositivos adequados para administração das drogas foram os fatores que mais preocuparam os participantes.

Objective: to examine nurses' attitudes to the administration of antineoplastics in pediatric oncology. Method: this descriptive study used statistical data analysis. The participants were twenty nurses, who administered chemotherapy to children and adolescents at a teaching hospital in São Paulo City. In 2016, data were collected using a self-report questionnaire on the participants' characteristics and their experience with chemotherapy administration, which included the main chemotherapyrelated fears, concerns and potential adverse events. Results: few participants were specialists in the field of oncology or pediatrics; most sought knowledge and capacity-building on their own initiative; and the nurses classified the activity as complex and specific to those with an interest in the field. Conclusion: all the nurses considered chemotherapy the main treatment for childhood cancer. The factors that most concerned the participants were the risk of extravasation and the lack of appropriate devices for drug administration.

Objetivo: analizar las actitudes de enfermeros acerca de la administración de antineoplásicos en oncología pediátrica. Método: estudio descriptivo, con análisis estadística de los datos. Participaron 20 enfermeros de un hospital de enseñanza, ubicado en la capital de São Paulo, que administraban quimioterapia (QT) a niños y adolescentes. En 2016, a través de cuestionario autoaplicable, se recopilaron datos sobre la caracterización de los participantes y sobre sus actividades profesionales en la administración de quimioterapia que incluían los principales temores, preocupaciones y potenciales eventos adversos asociados a la quimioterapia. Resultados: pocos participantes eran especialistas en el área de oncología o pediatría; la mayoría de los profesionales buscó conocimiento y capacitación por iniciativa propia; los enfermeros clasificaron la actividad como compleja y específica para quien tiene interés en el área. Conclusión: todos los enfermeros consideraron la quimioterapia como el tratamiento principal para el cáncer infantil. El riesgo de extravasación y la falta de dispositivos adecuados para la administración de las drogas fueron los factores que más preocuparon a los participantes.

Effectiveness of annual single doses of diethylcarbamazine citrate among bancroftian filariasis infected individuals in an endemic area under mass drug administration in Brazil.

The Global Program to Eliminate Lymphatic Filariasis has achieved extraordinary success in reducing transmission and preventing morbidity through mass drug administration (MDA) to the population at-risk. Brazil is the only currently using diethylcarbamazine citrate (DEC) alone for MDA, so an assessment of its effectiveness is needed. We report the trends of filarial markers in a cohort of 175 individuals infected with Wuchereria bancrofti in areas that underwent MDA in the city of Olinda, Northeastern Brazil. The prospective study was conducted between 2007 and 2012 (corresponding to five annual MDA rounds). The quantification of microfilaraemia (QMFF) was assessed by filtration. Circulating filarial antigen (CFA) was detected through immunochromatographic point-of-care test (POCT-ICT) and Og4C3-ELISA whereas antifilarial antibody titres (IgG4) were assessed through Bm14 assay. The CFA and IgG4 titres were measured by Optical Density (OD). The main characteristics at baseline, MDA coverage and the trend of filarial infection markers during follow up were described. The trend of filarial markers in relation to time (years of MDA), sex and age were analysed through Generalized Estimating Equations (GEE) models. The models demonstrated a significant decrease in all markers during MDA. The probability of remaining positive by QMFF and POCT-ICT diminished 70% and 46%, respectively, after each MDA round. There was a significant annual drop in CFA (-0.290 OD) and IgG4 antibodies titres (-0.303 OD). This study provides evidence that MDA with DEC alone can be effective in the elimination of LF in Brazil.