Sulfadiazine Plus Pyrimethamine Therapy Reversed Multiple Behavioral and Neurocognitive Changes in Long-Term Chronic Toxoplasmosis by Reducing Brain Cyst Load and Inflammation-Related Alterations.

Toxoplasma gondii infects one-third of the world population. For decades, it has been considered a silent lifelong infection. However, chronically T. gondii-infected persons may present psychiatric and neurocognitive changes as anxiety, depression, and memory loss. In a model of long-term chronic infection, behavioral alterations parallel neuroinflammation and systemic high cytokine levels, and may reflect brain cyst load. Recent findings support that in chronic infection an active parasite-host interplay involves an immune-mediated control of tissue cysts. Here, we tested the idea that etiological treatment in chronic phase may add advantage to intrinsic immune-mediated cyst control and impact behavioral changes. Thus, we combined sulfadiazine-plus-pyrimethamine (S+P), the first-choice therapy for toxoplasmosis, to study the association of brain cyst load and biological processes related to the immune response (neuroinflammation, blood-brain barrier -BBB- disruption and serum cytokine levels), with behavioral and neurocognitive changes of long-term chronic infection. Female C57BL/6 mice (H-2b) were infected (5 cysts, ME-49 strain) and treated with S+P from 30 to 60 days postinfection (dpi), compared with vehicle (Veh)-treated and noninfected controls. At endpoints (pre-therapy, 30 dpi; S+P therapy, 60 dpi; after ceased therapy, 90 dpi), independent groups were subjected to behavioral tests, and brain tissues and sera were collected. Multiple behavioral and neurocognitive changes were detected in the early (30 dpi) and long-term (60 and 90 dpi) chronic infection. S+P therapy resolved locomotor alterations, anxiety, and depressive-like behavior, partially or transiently ameliorated hyperactivity and habituation memory loss. Analysis after therapy cessation showed that S+P therapy reduced the number of stimuli required for aversive memory consolidation. S+P therapy resulted in reduced brain cyst load, neuroinflammation and BBB disruption, and lowered systemic Th1-cytokine levels. Correlation analysis revealed association between IFNγ, TNF and MCP-1/CCL2 serum levels, brain cyst load and behavioral and neurocognitive alterations. Moreover, principal-component analysis (PCA-2D and 3D projections) highlighted distinction between clusters (noninfected; Veh-treated and S+P-treated infected). Thus, our data suggest that S+P therapy added gain to intrinsic brain cyst control and, direct or indirectly, ameliorated inflammation-related alterations, traits associated with behavioral and neurocognitive alterations.

Ações de enfermeiros direcionadas a adolescentes obesos na atenção primária / Actions of nurses directed at obese teens in primary care

Objetivo: identificar a produção científica sobre ações do enfermeiro dirigidas a adolescentes obesos na Atenção Primária à Saúde. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, a partir da busca de publicações indexadas nas bases de dados entre 2010 e 2018: CINAHL, LILACS, MEDLINE, SCOPUS e Web of Science e Biblioteca Virtual SciELO. Recorreu-se ao método de leitura e avaliação por nível de evidência para realizar a análise descritiva dos dados, que se apresentaram em quadro sinóptico. Resultados: selecionaram-se 13 artigos. Evidenciou-se que as ações do enfermeiro direcionadas a adolescentes obesos na Atenção Primária à Saúde visaram ao estímulo à alimentação saudável, prática de atividade física e melhora da autoestima para a redução do peso, por meio de aconselhamento em saúde, uso de tecnologias, envolvimento da família e articulação intersetorial, incluindo a escola. Conclusão: aponta-se a necessidade de desenvolvimento de ações longitudinais, intersetoriais e amplas. Torna-se importante maior investimento no treinamento de enfermeiros com vistas à realização de intervenções, no âmbito da atenção primária, voltadas para adolescentes obesos, tendo por referência o cuidado integral.(AU)

Objective: to identify the scientific production on nurses' actions directed to obese adolescents in Primary Health Care. Method: this is a descriptive bibliographic study, integrative literature review, from the search for indexed publications in the databases between 2010 and 2018: CINAHL, LILACS, MEDLINE, SCOPUS and Web of Science and SciELO Virtual Library. The method of reading and evaluation by level of evidence was used to perform the descriptive analysis of the data, which were presented in a synoptic table. Results: 13 articles were selected. It was evidenced that the actions of nurses directed to obese adolescents in Primary Health Care aimed at stimulating healthy eating, physical activity practice and improving self-esteem for weight reduction through health counseling, use of technologies, involvement family and intersectoral articulation, including the school. Conclusion: there is a need for the development of longitudinal, intersectoral and broad actions. It is important to invest more in the training of nurses in order to perform interventions in the primary care, aimed at obese adolescents, with reference to comprehensive care.(AU)

Objetivo: identificar la producción científica sobre las acciones del enfermero dirigidas a adolescentes obesos en Atención Primaria de Salud. Método: estudio bibliográfico, descriptivo, tipo revisión bibliográfica integradora de la literatura, basado en la búsqueda de publicaciones indexadas en las bases de datos entre 2010 y 2018: CINAHL, LILACS, MEDLINE, SCOPUS y Web of Science y SciELO Virtual Library. El método de lectura y evaluación por nivel de evidencia se utilizó para realizar el análisis descriptivo de los datos, que se presentaron en una tabla sinóptica. Resultados: se seleccionaron 13 artículos. Se evidenció que las acciones de los enfermeros dirigidas a adolescentes obesos en Atención Primaria de Salud tenían como objetivo estimular la alimentación saludable, la práctica de actividad física y la mejora de la autoestima para la reducción de peso a través de asesoramiento en salud, el uso de tecnologías, participación de la familia y articulación intersectorial, incluida la escuela. Conclusión: existe la necesidad de desarrollar acciones longitudinales, intersectoriales y amplias. Es importante invertir más en la capacitación de enfermeros para realizar intervenciones en la atención primaria, dirigidas a adolescentes obesos, con referencia a la atención integral.(AU)