The use of natural extracts with photoprotective activity: a 2015-2023 patent prospection.

Synthetic sunscreen offers protection against excessive exposure to ultraviolet (UV) radiation from the sun, and protects the skin from possible damage. However, they have low efficacy against the formation of reactive oxygen species (ROS), which are highly reactive molecules that can be generated in the skin when it is exposed to UV radiation, and are known to play a role in oxidative stress, which can contribute to skin aging and damage. Thus, there is an ongoing search for sunscreens that do not have these negative effects. One promising source for these is natural products. Therefore, the current patent review summarizes topical formulations made from natural compounds that have antioxidant properties and can be used as photoprotective or anti-aging agents, either using a single natural extract or a combination of extracts. The review reports basic patent information (applicant country, type of applicant, and year of filing) and gives details about the invention, including its chemical composition, and the in vitro and in vivo tests performed. These patents describe natural products that can be used to protect the skin and validate their efficacy, and safety, in addition to standardizing their formulations. The compositions described illustrate the consistent innovation in the use of natural products to protect against UV damage and photoaging disorders, a promising field which is receiving growing global recognition.

Access to health and social protection policies by homeless people during the COVID-19 pandemic: a mixed-methods case study on tailored inter-sector care during a health emergency.

Introduction: The article analyzed homeless people's (HP) access to health and social protection policies and tailored inter-sector care, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of Minas Gerais state, Brazil. It intended to provide data on HP and evaluate existing public policies focused on vulnerable populations during this health emergency. Methods: The study adopted a mixed-methods design with triangulation of quantitative and qualitative data. Results: Social cartography showed that in the early months of the pandemic, the health administration had difficulty reordering the health system, which experienced constant updates in the protocols but was nevertheless consolidated over the months. The evidence collected in the study showed that important emergency interventions in the municipality of BH involved activities that facilitated access by HP to the supply of services. Discussion: The existence of national guidelines for inter-sector care for HP cannot be ruled out as a positive influence, although the municipalities are responsible for their implementation. Significantly, a health emergency was necessary to intensify the relationship between health and social protection services. Roving services were among those with the greatest positive evidence, with the least need for infrastructure to be replicated at the local level. In addition, the temporary supply of various inter-sector services, simultaneously with the provision of day shelters by organized civil society, was considered a key factor for expanding and intensifying networks of care for HP during the emergency phase. A plan exists to continue and expand this model in the future. The study concluded that understanding the inter-sector variables that impact HP contributes to better targeting of investments in interventions that work at the root causes of these issues or that increase the effectiveness of health and social protection systems.

Giant Cell Arteritis Presenting as Multiple Ischaemic Strokes: A Successful case of Endovascular Treatment.

Giant cell arteritis (GCA) may manifest with aggressive intracranial stenosis resistant to medical therapy, and patients may develop refractory neurologic deficits and cerebral infarcts, making GCA a life-threatening condition. We report the case of a 68-year-old woman recently diagnosed with GCA, medicated with prednisolone 60 mg daily. Two weeks later, the patient was admitted to our Stroke Unit after a sudden episode of global aphasia. Magnetic resonance angiography showed two recent ischaemic lesions, besides an erythrocyte sedimentation rate of 17 mm/hour. A cerebral angiography revealed bilateral stenosis and dilation in the petrous, cavernous and supraclinoid segments of internal carotid arteries (ICA). The patient was started on intravenous methylprednisolone pulses (250 mg daily for five days). Computed tomography (CT) angiography and Doppler ultrasound showed severe vascular disease affecting multiple territories, without significant intracranial involvement. The hypothesis of GCA with extracranial vasculitic involvement was considered as the aetiology of ischaemic cerebral infarctions in multiple territories and, given the severity of the disease, it was decided to add tocilizumab. Despite this, the patient evolved with significant worsening neurological deficits and a CT scan confirmed the presence of new vascular events. Endovascular treatment (EVT) with balloon angioplasty was conducted on both ICAs, with improved calibre and downstream filling. After that, the patient presented sustained clinical improvement, without recurrence of any ischaemic events at the one-year follow-up. This clinical case stands out for the importance of EVT as an effective therapy in patients with medically refractory GCA with symptomatic intracranial stenosis, improving their prognosis. LEARNING POINTS: Giant cell arteritis may manifest with aggressive and symptomatic intracranial arterial stenoses.Endovascular treatment is an effective intervention to prevent ischaemic complications in intracranial giant cell arteritis.

Devices for osteoarthritis symptoms treatment: a patent review.

INTRODUCTION: Osteoarthritis is a musculoskeletal disease that can lead to the loss and inability of those affected to perform normal daily functions, which leads to a decrease in quality of life. The main symptoms of osteoarthritis are tenderness, joint pain, stiffness, crepitus, limited movement, and local inflammation. AREAS COVERED: The selected patents were deposited from 2010 to April 2022 involving 57 documents that were in line with the study objective in the final selection. The patents were classified in years, country, and applicants. Also, the therapeutic fields that presented the most documents were electrical stimulation, phototherapy, and ultrasound, followed by magnetic, electromagnetic, and thermotherapy. Therefore, the most current therapies used in the documents are already on the market. EXPERT OPINION: Although the OA is cureless, non-surgical treatments are classified as the primary management approach for this disease. The pharmacological and non-pharmacological therapies are employed to reduce its prevalence and ensure the effectiveness of treatments. A strategy for relieving OA symptoms is non-pharmacological treatment, which can be based on exercise and patient education, combined with other alternative therapies. These therapies are used as supplements to the main OA treatments, enhancing the effectiveness of treatment outcomes.

A Descriptive Review of Cannabis sativa Patents for Cancer Treatment.

BACKGROUND: Cannabis use for tumor treatment has been explored in several areas, and its potential for tumor remission is currently being studied after the discovery of the endogenous cannabinoid. OBJECTIVE: The study aimed to conduct a critical patent review to identify and explore the latest advances and therapeutic strategies using Cannabis to treat cancer. METHODS: The research was carried out in the free and online database Espacenet, using the descriptors "cancer" and "Cannabis or cannabidiol" in the title or abstract. A total of 95 patents were identified for preliminary evaluation in the database. Six duplicate patents were excluded, 12 referring to traditional Chinese medicine and 36 with a title in disagreement with the scope of this review. In addition the final selection involved 21 patents that were in line with the objective of the study. RESULTS: As observed in the reading of patents, the interest of pharmaceutical industries and researchers and the development of new products to fight cancer have increased in recent years. The main cannabinoids present in the patents are tetrahydrocannabinol, cannabidiol, and hemp. Moreover, the patents were classified and the main applicant countries were the United States followed by Japan, with a higher filing rate in 2019 and, mainly by the industry. CONCLUSION: In conclusion we can say that, the importance of parliamentary approval in the cultivation and investments that, in addition to bringing innovation to the industrial sector, enriches research in the area, contributing to the creation of new medicines.

A rare cause of severe esophagitis in an immunocompetent patient - double complication with an endoscopic resolution.

A 75-year-old male, without relevant medical history and negative HIV1/2 serology, presented at the emergency department with mixed shock (septic - from pleuroparenchymal origin - and hypovolemic due to upper gastrointestinal bleeding [UGIB]). Thoracoabdominal CT scan showed an esophagopleural fistula (EPF), with a large right pleural effusion (lately known to be compatible with exudate - Light's criteria) and right pneumothorax, without active bleeding. The upper gastrointestinal endoscopy (UGIE) showed a severe esophagitis and, in distal oesophagus, an ulcer with an orifice in the center. Biopsies of the edges of the ulcer were performed. Anatomopathological (AP) studies were negative for viral agents but tissue molecular studies (polymerase chain reaction [PCR]) identified cytomegalovirus (CMV) DNA. Despite no immunosuppression condition was identified, CMV severe esophagitis complicated by EPF with right-side empyema and UGIB was diagnosed. An oesophageal fully covered metal stent (FCMS), with anti-migration system, was left in place during 5-weeks and ganciclovir therapy (5mg/kg/day) was maintained for 21-days. Clinical-analytical, radiological and endoscopic improvement was noticed. No recurrence in the following year of follow-up.

COVID-19: A Possible Cause of Spontaneous Pneumoperitoneum.

Introduction: Pneumoperitoneum is the presence of air within the peritoneal cavity and is mostly caused by organ rupture. Spontaneous pneumoperitoneum accounts 5% to 15% of the cases and occurs in the absence of organ damage. The pulmonary origin of pneumoperitoneum is unusual, and probably associated with mechanical ventilation and alveolar leak. In patients with coronavirus disease 2019 (COVID-19) there are some reports of air leak, like pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema. Case presentation: We present the case of a 70-year-old man with COVID-19 pneumonia admitted to the Intensive Care Unit (ICU). Since admission he was on Non-Invasive Ventilation (NIV), without improvement, needing Invasive Mechanical Ventilation (IMV) due to severe respiratory failure. Five days after IMV despite protective lung ventilation, massive spontaneous subcutaneous emphysema, pneumomediastinum and pneumoperitoneum were diagnosed. Besides initial conservative management 12 hours later, the patient developed abdominal compartment syndrome requiring percutaneous needle decompression. Conclusions: Pneumoperitoneum can be considered a rare complication of COVID-19 pneumonia and its management, resulting not only from the viral pulmonary but also from secondary causes. Conservative management should be usually enough. However, in the presence of abdominal compartment syndrome prompt recognition and treatment are crucial and eventually lifesaving.

[The interface between public policies for the unhoused population: an integrative review]. / A interface entre as políticas públicas para a população em situação de rua: revisão integrativa.

The heterogeneous and vulnerable nature of the unhoused population reveal the complexity of living on the street and call for the State to play a fundamental role in the provision of health and social care policies. The scope of this study was to evaluate the intersectorality between health policies, social protection and organized civil society actions for the unhoused population in Brazil, based on an integrative literature review. To achieve this, a search was conducted in the SciELO, LILACS and PubMed databases, from which ten articles published between 2004-2021, all of a qualitative nature, were selected. From the analysis of the chosen articles, the evidence of intersectorality between the policies for the unhoused population was observed, mainly described as a point of intersection between the services offered. However, interventions are still poorly explored and systematized. It is recommended that quantitative studies aimed at the evaluation of intersectoral public policies be developed to allow the assessment of the impact of intersectorality between health services, social assistance and organized civil society on the quality of life of the unhoused population.

A heterogeneidade e vulnerabilidade da população em situação de rua revelam a complexidade de viver nessa condição e exige que o Estado tenha papel fundamental na oferta de políticas de saúde e assistência social. O objetivo do estudo, a partir de uma revisão integrativa da literatura, foi avaliar a intersetorialidade entre políticas de saúde, proteção social e ações da sociedade civil organizada para a população em situação de rua no Brasil. Foi realizada uma busca nas bases SciELO, Lilacs e PubMed, sendo selecionados dez artigos, publicados entre 2004-2021, todos de caráter qualitativo. Observou-se indícios da intersetorialidade entre as políticas para a população em situação de rua, descritas principalmente como uma ponte de acesso entre os serviços ofertados. Entretanto, as intervenções ainda são pouco exploradas e sistematizadas. Nesse sentido, recomenda-se que estudos de impacto voltados à avaliação de políticas públicas intersetoriais sejam desenvolvidos para que se permita a avaliação da efetividade da intersetorialidade entre os serviços de saúde, assistência social e sociedade civil organizada na qualidade de vida da população em situação de rua.

Predicting congenital syphilis cases: A performance evaluation of different machine learning models.

BACKGROUND: Communicable diseases represent a huge economic burden for healthcare systems and for society. Sexually transmitted infections (STIs) are a concerning issue, especially in developing and underdeveloped countries, in which environmental factors and other determinants of health play a role in contributing to its fast spread. In light of this situation, machine learning techniques have been explored to assess the incidence of syphilis and contribute to the epidemiological surveillance in this scenario. OBJECTIVE: The main goal of this work is to evaluate the performance of different machine learning models on predicting undesirable outcomes of congenital syphilis in order to assist resources allocation and optimize the healthcare actions, especially in a constrained health environment. METHOD: We use clinical and sociodemographic data from pregnant women that were assisted by a social program in Pernambuco, Brazil, named Mãe Coruja Pernambucana Program (PMCP). Based on a rigorous methodology, we propose six experiments using three feature selection techniques to select the most relevant attributes, pre-process and clean the data, apply hyperparameter optimization to tune the machine learning models, and train and test models to have a fair evaluation and discussion. RESULTS: The AdaBoost-BODS-Expert model, an Adaptive Boosting (AdaBoost) model that used attributes selected by health experts, presented the best results in terms of evaluation metrics and acceptance by health experts from PMCP. By using this model, the results are more reliable and allows adoption on a daily usage to classify possible outcomes of congenital syphilis using clinical and sociodemographic data.

Cytotoxic effect of crotoxin on cancer cells and its antitumoral effects correlated to tumor microenvironment: A review.

Cancer is the second leading cause of death worldwide, and despite the effort of standard treatments, the search for new tools against this disease is necessary. Importantly, it is known that the tumor microenvironment plays a crucial role in tumor initiation, progression, and response to therapies. Therefore, studies of potential drugs that act on these components are as critical as studies regarding antiproliferative substances. Through the years, studies of several natural products, including animal toxins, have been conducted to guide the development of medical compounds. In this review, we present the remarkable antitumor activities of crotoxin, a toxin from the rattlesnake Crotalus durissus terrificus, highlighting its effects on cancer cells and in the modulation of relevant elements in the tumor microenvironment as well as the clinical trials conducted with this compound. In summary, crotoxin acts through several mechanisms of action, such as activation of apoptosis, induction of cell cycle arrest, inhibition of metastasis, and decrease of tumor growth, in different tumor types. Crotoxin also modulates tumor-associated fibroblasts, endothelial cells, and immune cells, which contribute to its antitumoral effects. In addition, preliminary clinical studies confirm the promising results of crotoxin and support its potential future use as an anticancer drug.

Socioeconomic and sex inequalities in chronic pain: A population-based cross-sectional study.

OBJECTIVE: We investigated the impact of socioeconomic inequalities on chronic pain of older adults according to sex. MATERIALS AND METHODS: This population-based cross-sectional study used survey data from the 2015 cohort of the SABE Study (Saúde, Bem-estar e Envelhecimento), Brazil. Socioeconomic status was examined at individual level (educational attainment, financial independence, and race/skin color) and contextual level (Human Development Index). We analyzed the association between variables using the chi-square test and the Rao & Scott correction. Logistic regression models were adjusted for risk factors. RESULTS: The study comprised 1,207 older adults representing 1,365,514 residents 60≥ years of age in the city of São Paulo. Chronic pain was more frequent in females (27.2%) than in males (14.5%) (p<0.001). Females evidenced the worst self-perception of pain, especially those of the most vulnerable socioeconomic strata. Social inequalities impacted chronic pain in different ways between sexes. Among females, unfavorable living conditions (OR = 1.59; 95%CI 1.07; 2,37) and Blacks/Browns females were most likely to have chronic pain (OR = 1.32; 95%CI 1.01; 1.74). Among males, only the individual aspects were significant for the occurrence of chronic pain, such as low educational attainment (OR = 1.88; 95%CI 1.16; 3.04) and insufficient income (OR = 1.63; 95%CI 1.01; 2.62). DISCUSSION: The potential for inequality was greater for females than for males reflecting structural factors inherent in a highly unequal society. Conclusions: Equity-oriented health policies are critical to preventing pain in human aging.

Anti-tumor necrosis factor therapy is associated with attenuated humoral response to SARS-COV-2 vaccines in patients with inflammatory bowel disease.

BACKGROUND: Immunosuppressive therapy used in the treatment of inflammatory bowel disease (IBD) is known to reduce vaccine immunogenicity. AIMS: This study aimed to 1) predict the humoral response elicited by SARS-CoV-2 vaccination in IBD patients based on their ongoing treatment and other relevant patient and vaccine characteristics and 2) assess the humoral response to a booster dose of mRNA vaccine. METHODS: We conducted a prospective study in adult IBD patients. Anti-spike (S) IgG antibodies were measured after initial vaccination and again after one booster dose. A multiple linear regression model was created to predict anti-S antibody titer following initial complete vaccination in different therapeutic groups (no immunosuppression, anti-TNF, immunomodulators and combination therapy). A two-tailed Wilcoxon test for two dependent groups was performed to compare anti-S values before and after the booster dose. RESULTS: Our study included 198 IBD patients. The multiple linear regression identified anti-TNF and combination therapy (versus no immunosuppression), current smoking, viral vector (versus mRNA) vaccine and interval between vaccination and anti-S measurement as statistically significant predictors of the log anti-S antibody levels (p < 0.001). No statistically significant differences were found between no immunosuppression and immunomodulators (p = 0.349) and between anti-TNF and combination therapy (p = 0.997). Statistically significant differences for anti-S antibody titer before and after the booster dose of mRNA SARS-CoV-2 vaccine were found, both for non-anti-TNF and anti-TNF groups. CONCLUSIONS: Anti-TNF treatment (either alone or in combination therapy) is associated with lower anti-S antibody levels. Booster mRNA doses seem to increase anti-S both in non-anti-TNF and anti-TNF treated patients. Special attention should be paid to this group of patients when planning vaccination schemes.

Monitoring SARS-CoV-2 seroprevalence over time among pregnant women admitted to delivery units: Suitability for surveillance.

OBJECTIVES: To determine SARS-CoV-2 seroprevalence over time and risk factors among pregnant women at delivery in São Paulo, Brazil; and to evaluate the suitability of pregnant women as a sentinel population for SARS-CoV-2 serosurveillance. METHODS: Unselected consecutive pregnant women presenting at the labor ward of a single large hospital between July 20th 2020 to February 21st 2021 were enrolled and tested for SARS-CoV-2 serology using two assays: the rapid chromatic Wondfo One Step (for total IgA and IgG detection) and Roche Elecsys assay (detecting anti-nucleoprotein [N] IgG). SARS-CoV-2 seroprevalence was computed as smooth spline function over time with 95% confidence intervals (CI). Risk factors were evaluated for positivity by each assay. We compared timepoint seroprevalence by the two assays with four concomitant community household surveys (HHS), in which the Roche assay was used, to determine the sensitivity and relevance of the pregnant women population as sentinel population. RESULTS: Overall SARS-CoV-2 seroprevalence was 28.9% (221/763) by Roche and 17.9% (137/763) by Wondfo. Reported symptoms experienced during pregnancy were all significantly correlated with being SARS-CoV-2 seropositive at delivery with any assay (with odds-ratios ranging from 3.0 [95% CI: 2.1-4.3] for coryza to 22.8 [95% CI: 12.3-46.6] for ageusia). Seropositivity by either assay was high in women at delivery in the early period of the pandemic (June 2020), compared with seropositivity in women from the concomitant HHS: 44.1% (95% CI: 21.8-66.4) for Roche, 54.1% (30.9-78.5) for Wondfo, versus 11.4% (95% CI: 9.2-13.6) for HHS. For later periods (October 2020 and January 2021), the seropositivity in women at delivery measured by Roche corresponded well with the prevalence found among women in the HHS using the same assay, whilst prevalence measured by Wondfo dropped. CONCLUSIONS: Women at delivery represent a highly exposed and readily accessible population for sentinel surveillance of emerging infections such as SARS-CoV-2.

Magnitude da qualidade de vida relacionada ao trabalho entre profissionais atuantes em unidades de urgência e emergência / Magnitude of work-related quality of life among professionals working in urgency and emergency units / Magnitud de la calidad de vida relacionada con el trabajo entre profesionales que trabajan en unidades de urgencia y emergencia

O objetivo deste estudo foi investigar a qualidade de vida dos profissionais de saúde nas emergências no município de Vitoria de Santo Antão ­ PE. Trata-se de um estudo transversal, descritivo com abordagem quantitativa do tipo survey. Foi realizado com 70 profissionais de saúde (médicos, enfermeiros e técnicos de enfermagem), aplicando os questionários: epidemiológico direcionado ao trabalho, QAFH (questionário de atividade física habitual) e QWLQ-bref (Quality of Working Life Questionnaire ­ Bref). Na análise foram empregadas técnicas estatísticas descritivas e multivariadas. A prevalência de 21,4% (IC95%: 13,4 ­ 32,4) de profissionais não satisfeitos com a qualidade de vida no trabalho. As medianas nos domínios pessoal, profissional e QVT total do QWLQ-bref foram mais elevadas entre os médicos (p < 0,05). O alto índice de funcionários não satisfeitos no emprego impõe a adoção de estratégias visando à melhoria na qualidade de vida e no trabalho.

The objective of this study was to investigate the quality of life of health professionals in emergencies in the city of Vitoria de Santo Antão - PE. This is a cross- sectional, descriptive study with a quantitative approach of the survey type. It was carried out with 70 health professionals (doctors, nurses and nursing technicians), applying the questionnaires: epidemiological work-oriented, QAFH (habitual physical activity questionnaire) and QWLQ-bref (Quality of Working Life Questionnaire ­ Bref). In the analysis, descriptive and multivariate statistical techniques were used. The prevalence of 21.4% (95%CI: 13.4 ­ 32.4) of professionals not satisfied with the quality of life at work. The medians in the personal, professional and total QWL domains of the QWLQ-bref were higher among physicians (p < 0.05). The high rate of dissatisfied employees at work requires the adoption of strategies aimed at improving quality of life and work.

El objetivo de este estudio fue investigar la calidad de vida de los profesionales de la salud en emergencias en la ciudad de Vitoria de Santo Antão - PE. Se trata de un estudio descriptivo transversal con enfoque cuantitativo del tipo survey. Se realizó con 70 profesionales de la salud (médicos, enfermeros y técnicos de enfermería), aplicándose los cuestionarios: epidemiológico orientado al trabajo, QAFH (cuestionario de actividad física habitual) y QWLQ-bref (Cuestionario de Calidad de Vida Laboral ­ Bref). En el análisis se utilizaron técnicas estadísticas descriptivas y multivariadas. Prevalencia del 21,4% (IC95%: 13,4 ­ 32,4) de profesionales insatisfechos con la calidad de vida en el trabajo. Las medianas en los dominios de CVL personal, profesional y total del QWLQ-bref fueron mayores entre los médicos (p < 0,05). El alto índice de empleados insatisfechos en el trabajo exige la adopción de estrategias encaminadas a mejorar la calidad de vida y de trabajo.

A interface entre as políticas públicas para a população em situação de rua: revisão integrativa / The interface between public policies for the unhoused population: an integrative review

Resumo A heterogeneidade e vulnerabilidade da população em situação de rua revelam a complexidade de viver nessa condição e exige que o Estado tenha papel fundamental na oferta de políticas de saúde e assistência social. O objetivo do estudo, a partir de uma revisão integrativa da literatura, foi avaliar a intersetorialidade entre políticas de saúde, proteção social e ações da sociedade civil organizada para a população em situação de rua no Brasil. Foi realizada uma busca nas bases SciELO, Lilacs e PubMed, sendo selecionados dez artigos, publicados entre 2004-2021, todos de caráter qualitativo. Observou-se indícios da intersetorialidade entre as políticas para a população em situação de rua, descritas principalmente como uma ponte de acesso entre os serviços ofertados. Entretanto, as intervenções ainda são pouco exploradas e sistematizadas. Nesse sentido, recomenda-se que estudos de impacto voltados à avaliação de políticas públicas intersetoriais sejam desenvolvidos para que se permita a avaliação da efetividade da intersetorialidade entre os serviços de saúde, assistência social e sociedade civil organizada na qualidade de vida da população em situação de rua.

Abstract The heterogeneous and vulnerable nature of the unhoused population reveal the complexity of living on the street and call for the State to play a fundamental role in the provision of health and social care policies. The scope of this study was to evaluate the intersectorality between health policies, social protection and organized civil society actions for the unhoused population in Brazil, based on an integrative literature review. To achieve this, a search was conducted in the SciELO, LILACS and PubMed databases, from which ten articles published between 2004-2021, all of a qualitative nature, were selected. From the analysis of the chosen articles, the evidence of intersectorality between the policies for the unhoused population was observed, mainly described as a point of intersection between the services offered. However, interventions are still poorly explored and systematized. It is recommended that quantitative studies aimed at the evaluation of intersectoral public policies be developed to allow the assessment of the impact of intersectorality between health services, social assistance and organized civil society on the quality of life of the unhoused population.

Cytotoxic effect of crotoxin on cancer cells and its antitumoral effects correlated to tumor microenvironment: A review

Cancer is the second leading cause of death worldwide, and despite the effort of standard treatments, the search for new tools against this disease is necessary. Importantly, it is known that the tumor microenvironment plays a crucial role in tumor initiation, progression, and response to therapies. Therefore, studies of potential drugs that act on these components are as critical as studies regarding antiproliferative substances. Through the years, studies of several natural products, including animal toxins, have been conducted to guide the development of medical compounds. In this review, we present the remarkable antitumor activities of crotoxin, a toxin from the rattlesnake Crotalus durissus terrificus, highlighting its effects on cancer cells and in the modulation of relevant elements in the tumor microenvironment as well as the clinical trials conducted with this compound. In summary, crotoxin acts through several mechanisms of action, such as activation of apoptosis, induction of cell cycle arrest, inhibition of metastasis, and decrease of tumor growth, in different tumor types. Crotoxin also modulates tumor-associated fibroblasts, endothelial cells, and immune cells, which contribute to its antitumoral effects. In addition, preliminary clinical studies confirm the promising results of crotoxin and support its potential future use as an anticancer drug.

Post-Viral Fatigue Following SARS-CoV-2 Infection during Pregnancy: A Longitudinal Comparative Study.

Studies reported post-COVID-19 fatigue in the general population, but not among pregnant women. Our objectives were to determine prevalence, duration, and risk factors of post-viral fatigue among pregnant women with SARS-CoV-2. This study involved 588 pregnant women with SARS-CoV-2 during pregnancy or delivery in Brazil. Three groups were investigated: G1 (n = 259, symptomatic infection during pregnancy); G2 (n = 131, positive serology at delivery); G3 (n = 198, negative serology at delivery). We applied questionnaires investigating fatigue at determined timepoints after infection for G1, and after delivery for all groups; fatigue prevalence was then determined. Cox regression was used to estimate hazard ratio (HR) and 95% CI of the risk of remaining with fatigue in G1. Overall fatigue prevalence in G1 at six weeks, three months and six months were 40.6%, 33.6%, and 27.8%, respectively. Cumulative risk of remaining with fatigue increased over time, with HR of 1.69 (95% CI: 0.89-3.20) and 2.43 (95% CI: 1.49-3.95) for women with moderate and severe symptoms, respectively. Multivariate analysis showed cough and myalgia as independent risk factors in G1. Fatigue prevalence was significantly higher in G1 compared to G2 and G3. Post-viral fatigue prevalence is higher in women infected during pregnancy; fatigue's risk and duration increased with the severity of infection.

A importância da Vigilância Sanitária na avaliação de projetos arquitetônicos dos estabelecimentos sujeitos ao controle sanitário / The importance of Sanitary Surveillance in the evaluation of architectural projects of establishments subject to sanitary control

Introdução: A avaliação da estrutura física de estabelecimentos de saúde e de interesse à saúde é complexa e requer análise técnica específica quanto a seus espaços e equipamentos, cabendo ao profissional capacitado avaliar se todas essas questões atendem ao mínimo necessário para a garantia do cuidado à saúde. Objetivo: Demonstrar a importância da Vigilância Sanitária na avaliação da estrutura física dos estabelecimentos sujeitos ao controle sanitário mediante a análise de projetos arquitetônicos. Método: Trata-se de um estudo exploratório, retrospectivo, com utilização de abordagem quali-quantitativa. A pesquisa utilizou dados secundários, sendo autorizada pela Diretoria de Vigilância em Estrutura Física (DVEF) da Superintendência de Vigilância Sanitária do Estado de Minas Gerais. O estudo considerou os projetos apresentados à DVEF no período de janeiro de 2019 a dezembro de 2020. Buscou-se identificar as principais normas utilizadas e os principais aspectos considerados no processo de licenciamento sanitário. Resultados: Falta de acessibilidade, cruzamento de fluxos, desorganização espacial dos ambientes, falta de ventilação ou ventilação inadequada, pouca ou nenhuma iluminação natural, área insuficiente ou até mesmo o superdimensionamento de ambientes, materiais de acabamento inadequados e implantação em local inapropriado (próximo a leitos de rios, indústrias poluentes) foram alguns dos problemas encontrados nos projetos arquitetônicos avaliados. Conclusões: A avaliação prévia de projetos arquitetônicos de estabelecimentos de saúde e de interesse à saúde é mais um aliado na obtenção de serviços que congreguem segurança, eficiência e efetividade em suas atividades, visando eliminar, diminuir ou prevenir riscos à saúde inerentes às atividades desenvolvidas em todo tipo de estabelecimento de atendimento à saúde humana.

Introduction: The assessment of the physical structure of health facilities and those of interest to health is complex and requires specific technical analysis regarding their spaces and equipment, and it is up to the trained   professional to assess whether all these issues meet the minimum necessary to guarantee health care. Objective: To demonstrate the importance of sanitary surveillance in the evaluation of the physical structure of establishments subject to sanitary control through the analysis of architectural projects. Method: This is an exploratory, retrospective study, using a quali-quantitative approach. The research used secondary data, being authorized by the Board of Surveillance in Physical Structure (DVEF) of the Superintendence of Sanitary Surveillance of the State of Minas Gerais. The study considered the projects submitted to DVEF from January 2019 to December 2020. We sought to identify the main standards used and the main aspects considered in the health licensing process. Results: Lack of accessibility, crossing of flows, spatial disorganization of the environments, lack of ventilation or inadequate ventilation, little or no natural lighting,  insufficient area or even the oversizing of environments, inadequate finishing materials, implantation in an inappropriate location (close to river beds, polluting industries), were some of the problems found in the evaluated architectural projects. Conclusions: The prior assessment of architectural projects of health facilities and of interest to health is another ally in obtaining services that bring together safety, efficiency, and effectiveness in their activities, aiming to eliminate, reduce or prevent health risks inherent to the activities carried out in all types of human health care establishments.

Multimorbidity and health care of community health workers in Vitória, Espírito Santo, Brazil, 2019: a cross-sectional study. / Multimorbidade e cuidado com a saúde de agentes comunitários de saúde em Vitória, Espírito Santo, 2019: um estudo transversal.

OBJECTIVE: To assess health conditions, health care and lifestyle habits of community health workers (CHW) in Vitória, Espírito Santo, Brazil. METHODS: This was a cross-sectional study using baseline data from an intervention study. Biochemical, anthropometric and hemodynamic examinations and interviews were carried out between October 2018 and March 2019 in Vitória. Appropriate statistical tests, in accordance with the sample design, were performed using SPSS software version 21.0, adopting p<0.05. RESULTS: We assessed 262 CHWs with a mean age of 46.1±9.3 years. High prevalence of prediabetes (22.9%), diabetes mellitus (17.2%), hypertension (37.0%), obesity (39.8%), hypercholesterolemia (57.3%), hypertriglyceridemia (27.1%), multimorbidity (40.8%), physical inactivity (60.9%) and use of anxiolytics/antidepressants (22.5%) was found. Some 40% of the CHWs had three or more morbidities. CONCLUSION: High percentages of chronic diseases, multimorbidity, sedentary lifestyle and use of anxiolytics/antidepressants were found in CHWs in Vitória.