ABSTRACT
INTRODUCTION: Cancer has become a public health problem worldwide, affecting individuals of different age groups, including children, young adults and older patients. OBJECTIVE: To determine the clinical profile, staging and standard of oncological treatment of the 10 most frequent primary sites of cancer in young patients (< 60 years) vs older patients (≥ 60 years old) diagnosed between 2000 and 2019 in Brazil. MATERIALS AND METHODS: This cross-sectional study used data from the secondary database of the Hospital Cancer Registry, available on the web www.inca.org.br. Patients with cancer who were older than 18 years were included. Patients with non-melanoma skin cancer and with incomplete data on primary site and staging were excluded. RESULTS: The database had data from 1,891,912 eligible patients, of which 1,461,080 (77.2â¯%) corresponded to the ten leading cancer types which were to be evaluated in this study. Cancers of the breast, prostate, cervix, lung, colon, stomach, rectum, oesophagus, thyroid and larynx were the 10 most frequent cancer types identified. The mean of age of patients was 58.8 ±â¯14.2 years and most of them were female (59.8â¯%). Those in the older group were more commonly reported (50.8â¯%) and this group included more former or current smokers (48.4â¯% vs 40.8â¯%, pâ¯<â¯0.001). Young patients received more all-oncological treatment: surgery (53.2â¯% vs 41.1â¯%, pâ¯<â¯0.001), radiotherapy (47.3â¯% vs 46.3â¯%, pâ¯<â¯0.001) and chemotherapy (53.6â¯% vs 39.3â¯%, pâ¯<â¯0.001) than older patients. CONCLUSION: Evaluating cancer patients by age group may enhance cancer surveillance, redirecting control strategies and prioritising patients with more common primary site types.
Subject(s)
Neoplasm Staging , Neoplasms , Humans , Male , Brazil/epidemiology , Female , Neoplasms/epidemiology , Neoplasms/therapy , Neoplasms/pathology , Cross-Sectional Studies , Middle Aged , Aged , Adult , Age Factors , Registries , Young AdultABSTRACT
[ABSTRACT]. Objective. To describe the Brazilian experience of responding to public health emergencies in 2023, the organizational structure, and epidemiological characteristics. Methods. Three emergencies (case studies) that occurred during the study year were analyzed according to the actions implemented during the response and the impacts on the population. The public health emergencies were summarized and analyzed through research on official documents and websites of the Ministry of Health and local health authorities. Results. Case 1 – Emergency due to lack of assistance, considered by the Brazilian government to be a public health emergency of national importance, required an Emergency Operations Center (EOC) for the response due to the complexity of the actions. Case 2 – Emergency due to zoonoses (arboviruses and avian influenza) used the EOC response structure to develop activities aimed at stopping the emergence of arboviruses and preventing an avian influenza emergency in the country. Finally, case 3 – Emergencies due to disasters required local response structures and used the EOC to coordinate their actions with the federal government’s support. Conclusions. The Brazilian experience highlights the importance of intrasectoral and intersectoral coordination in managing response actions, constant monitoring and communication to improve response measures, national support for local response efforts, and adaptation of the EOC structure to the different contexts and complexities of the emergencies faced.
[RESUMEN]. Objetivo. Describir la experiencia de la respuesta a emergencias de salud pública en Brasil en el 2023, su estructura organizativa y sus características epidemiológicas. Métodos. Se analizaron tres emergencias (estudios de casos) ocurridas durante el año de estudio en lo que respecta a las medidas aplicadas durante la respuesta y su impacto en la población. Las emergencias de salud pública se resumieron y analizaron mediante la investigación de los documentos y sitios web oficiales del Ministerio de Salud y de las autoridades de salud locales. Resultados. En el caso 1, una emergencia por falta de asistencia que el gobierno brasileño consideró una emergencia de salud pública de importancia nacional, fue necesario un centro de operaciones de emergencia (COE) para la respuesta debido a la complejidad de las medidas. En el caso 2, una emergencia debida a varias zoonosis (infecciones por arbovirus y gripe aviar), se utilizó la estructura de respuesta del COE para llevar a cabo actividades destinadas a detener el surgimiento de los arbovirus y prevenir una emergencia de gripe aviar en el país. Por último, en el caso 3, las emergencias debidas a catástrofes requirieron estructuras de respuesta locales y utilizaron el COE para coordinar las medidas aplicadas, con el apoyo del gobierno federal. Conclusiones. La experiencia brasileña destaca la importancia de la coordinación intra e intersectorial en la gestión de las medidas de respuesta, el seguimiento y la comunicación constantes para mejorar esas medidas, el apoyo nacional a las actividades locales de respuesta y la adaptación de la estructura del COE a los diferentes contextos y complejidades de las emergencias afrontadas.
[RESUMO]. Objetivo. Descrever a experiência brasileira na resposta a emergências de saúde pública em 2023, bem como a estrutura organizacional e as características epidemiológicas. Métodos. Foram analisadas três emergências (estudos de casos) ocorridas durante o ano do estudo de acordo com as ações empreendidas durante a resposta e os impactos na população. As emergências de saúde pública foram resumidas e analisadas por meio de pesquisas em documentos e sites oficiais do Ministério da Saúde e de autoridades sanitárias municipais. Resultados. Caso 1 – Emergência devido à falta de assistência: considerada pelo governo brasileiro uma emergência de saúde pública de importância nacional, exigiu a mobilização de um Centro de Operações de Emergência em Saúde Pública (COE) para a resposta devido à complexidade das ações. Caso 2 – Emergência devido a zoonoses (arbovírus e influenza aviária): a estrutura de resposta do COE foi usada para desenvolver atividades para interromper o surgimento de arbovírus e evitar uma emergência de influenza aviária no país. Caso 3 – Emergências devido a desastres: exigiram estruturas de resposta municipais e uso do COE para coordenar ações com o apoio do governo federal. Conclusões. A experiência brasileira destaca a importância dos seguintes fatores: coordenação intra e intersetorial na gestão das ações de resposta; monitoramento e comunicação constantes para aprimorar as medidas de resposta; apoio nacional aos esforços municipais de resposta; e adaptação da estrutura do COE aos diferentes contextos e complexidades das emergências enfrentadas.
Subject(s)
Emergency Operations Center , Public Health , Disaster Planning , Disaster Preparedness , Disaster Response , Brazil , Emergency Operations Center , Public Health , Disaster Planning , Disaster Response , Brazil , Emergency Operations Center , Public Health , Disaster Planning , Disaster Preparedness , Disaster ResponseABSTRACT
[RESUMO]. Objetivo: Documentar as ações de farmacovigilância das vacinas contra a covid-19 que foram desenvolvidas pelo Programa Nacional de Imunizações do Brasil. Métodos: Pesquisa documental informativa no período de 2020 a 2023. Foram utilizadas fontes documentais do Ministério da Saúde durante a vacinação contra a covid-19 para análise e interpretação das ações realizadas. A análise foi subdividida nas etapas de preparação e operacionalização. As publicações foram organizadas de acordo com o título, data da publicação, descrição e link de acesso. Resultados: Foram encontrados e avaliados 86 documentos publicados durante a preparação e operacionalização da vacinação. Na fase de preparação, foi constituída a Câmara Técnica de Assessoramento em Imunizações e publicadas notas técnicas específicas para as vacinas contra covid-19 e introdução do novo sistema de informação. Na etapa de operacionalização, foi instituído o Comitê Interinstitucional de Farmacovigilância de Vacinas e outros Imunobiológicos e implementados sistemas de vigilância sentinela hospitalar para Eventos Adversos de Interesse Especial e a vigilância da segurança da vacinação contra a covid-19 em gestantes. Conclusão: A farmacovigilância foi fortalecida no contexto da vacinação contra a covid-19 no Brasil. Frente às lacunas do conhecimento e infodemia sobre as novas vacinas, fez-se necessária a adoção de estratégias complementares ao sistema de vigilância passiva para o monitoramento da segurança da vacinação. Colaborações interinstitucionais, disponibilidade de recursos adicionais, flexibilidade e oportunidade dos sistemas de informação contribuíram para que as ações de preparação e resposta da farmacovigilância de vacinas contra a covid-19 fossem efetivadas de forma abrangente no Brasil.
[ABSTRACT]. Objective: To document the actions taken by Brazil's National Immunization Program for the pharmacovigilance of COVID-19 vaccines. Methods: Documentary research on the period 2020 to 2023. Documentary sources from the national Ministry of Health during COVID-19 vaccination were used to analyze and interpret the actions taken. The analysis was split into two stages: preparation and operationalization. The publications were organized according to title, date of publication, description, and URL. Results: A total of 86 documents published during the preparation and operationalization of vaccination were found and evaluated. In the preparation phase, a technical advisory board on immunization was set up and specific technical notes were published for COVID-19 vaccines and the introduction of a new information system. In the operationalization stage, the Interinstitutional Committee for Pharmacovigilance of Vaccines and other Immunobiologicals was created. Also, hospital sentinel surveillance systems were established for adverse events of special interest, and surveillance of COVID-19 vaccination safety in pregnant women was implemented. Conclusion: Pharmacovigilance was strengthened in the context of COVID-19 vaccination in Brazil. Given the gaps in knowledge about the new vaccines, as well as the infodemic surrounding them, it was necessary to adopt strategies to complement the passive surveillance system for monitoring vaccination safety. Inter-institutional collaboration, the availability of additional resources, and flexible and timely information systems all contributed to a comprehensively effective preparation and response in the pharmacovigilance of COVID-19 vaccines in Brazil.
[RESUMEN]. Objetivo: Documentar las medidas de farmacovigilancia de las vacunas contra la COVID-19 adoptadas por el Programa Nacional de Inmunización de Brasil. Métodos: Investigación documental informativa durante el período 2020-2023. Se utilizaron fuentes documentales del Ministerio de Salud durante la vacunación contra la COVID-19 para analizar e interpretar las medidas adoptadas. El análisis se subdividió en las fases de preparación y ejecución. Las publicaciones se organizaron por título, fecha de publicación, descripción y enlace de acceso. Resultados: Se encontraron y evaluaron 86 documentos publicados durante las fases de preparación y ejecución. En la fase de preparación, se creó el Grupo Técnico Asesor sobre Inmunización y se publicaron notas técnicas específicas para las vacunas contra la COVID-19 y la introducción del nuevo sistema de información. En la fase de ejecución, se creó el Comité Interinstitucional de Farmacovigilancia de Vacunas y otros Productos Inmunobiológicos y se pusieron en marcha sistemas de vigilancia centinela hospitalaria para los eventos adversos de interés especial y de vigilancia de la seguridad de la vacunación contra la COVID-19 en las embarazadas. Conclusión En Brasil, se ha fortalecido la farmacovigilancia en el contexto de la vacunación contra la COVID-19. Dadas las lagunas en el conocimiento y la infodemia sobre las nuevas vacunas, fue necesario adoptar estrategias complementarias al sistema de vigilancia pasiva para el seguimiento de la seguridad de la vacunación. Las relaciones de colaboración interinstitucional, la disponibilidad de recursos adicionales y los sistemas de información flexibles y oportunos han contribuido a la ejecución integral de las medidas de preparación y respuesta en materia de farmacovigilancia de las vacunas contra la COVID-19 en Brasil.
Subject(s)
Pharmacovigilance , COVID-19 Vaccines , Immunization Programs , Sentinel Surveillance , Immunization , Pandemics , Brazil , Pharmacovigilance , COVID-19 Vaccines , Immunization Programs , Sentinel Surveillance , Immunization , Pandemics , Brazil , Pharmacovigilance , COVID-19 Vaccines , Immunization Programs , Sentinel Surveillance , ImmunizationABSTRACT
The knowledge of metals concentration in upwelling areas are a concern due the higher productivity of these areas In Cabo Frio Upwelling-Downwelling System (CFUS) is high primary productivity area and has been identified as an Hg hotspot to biota in SE Brazil that has been susceptible to Hg inputs, due to growing industrialization in the region. To investigate the concentration of Hg and Se metals, as well as the trophic transfer of these metals, the present study investigated Hg and Se concentrations in 64 samples collected in net mesh of >20, >64, >150 and >300 µm, in 2012, in the region's water masses. Higher mean Hg concentrations were found in zooplankton, 0.15 ± 0.09 µg g-1 (>300 µm) and 0.18 ± 0.1 µg g-1 (>150 µm), compared to phytoplankton, 0.11 ± 0.11 µg g-1 (>64 µm) and 0.06 ± 0.07 µg g-1 (>20 µm), and the calculation of the biomagnification factor (BMF) indicated that there was a process of magnification and trophic transfer. An opposite trend was found for Se in phytoplankton: higher average Se concentrations were observed in phytoplankton, 93.0 ± 65.2 µg g-1 (>64 µm), 93.8 ± 96.4 µg g-1 (>20 µm), compared to zooplankton, 91.1 ± 67.3 µg g-1 (>300 µm), 97.3 ± 71.3 µg g-1 (>150 µm). A positive linear relationship for the Hg:Al vs P:Al ratios was identified and indicated intracellular incorporation of Hg according to plankton size. Anthropogenic Hg sources were identified in the plankton samples by comparison with the sediment background values for the CFUS. Upwelling waters probably increased the availability of Hg and Se, these elements tend to bioaccumulate 10 to 100 times more than in areas with the influence of upwelling, due to fertilization and the increase in primary production.
Subject(s)
Environmental Monitoring , Mercury , Phytoplankton , Selenium , Water Pollutants, Chemical , Zooplankton , Brazil , Mercury/analysis , Selenium/analysis , Water Pollutants, Chemical/analysis , Atlantic Ocean , Animals , Food Chain , Seawater/chemistryABSTRACT
In this work, we evaluate the antimicrobial properties of three groups of plants selected by the ethnopharmacological method, reported ashaving antimicrobial and/or anti-inflammatory properties by a rural community in the Brazilian State of Pernambuco. The samples were divided into groups of seven plants reported as having antimicrobial properties (GI), another seven as having anti-inflammatory properties (GII) and eight plants reported to have both (GIII). The antimicrobial properties of these groups were compared using the disc-diffusion method for nine microorganisms: Gram-positive and Gram-negative bacteria, acid-alcohol resistant bacillus (BAAR) and yeast. Among the samples of GI, 28.6% demonstrated activity against the micro-organisms tested, compared with 57.1% for the GII plants and 100% of GIII. This study shows, then, that the selected species should be looked more carefully that greater care should be taken in selecting species recommended by ethnopharmacological reports for studies of antimicrobial properties, since plants reported to have anti-inflammatory properties may be more active than those reported as being antimicrobial.
Evaluar la actividad antimicrobiana de tres grupos de plantas seleccionadas por el método etnodirigido, citadas como antimicrobianas y/o antiinflamatorias por una comunidad rural del estado de Pernambuco, Brasil. Las muestras de las especies seleccionadas fueron divididas en grupos de siete plantas citadas como antimicrobianas (GI), siete plantas citadas como antiinflamatorias (GII) y otro grupo con ocho plantas citadas para ambas situaciones (GIII). Se realizó una comparación de las actividades antimicrobianas de estos grupos mediante el método de difusión en disco frente a nueve microorganismos: Gram-positivos, Gram-negativos, bacilos ácido-alcohol resistentes (BAAR) y levadura. De las plantas citadas como antimicrobianas (GI), el 28,6% mostró actividad frente a los microorganismos probados, mientras que de las plantas pertenecientes al GII, el 57,1% presentó actividad y todas las plantas citadas para ambas situaciones (GIII) fueron activas en un 100%. Se necesita tener cuidado en la selección de especies provenientes del enfoque etnodirigido para estudios que buscan actividad antimicrobiana, ya que las plantas citadas como antiinflamatorias fueron más activas que las citadas como antimicrobianas.
Subject(s)
Plants, Medicinal , Anti-Infective Agents/pharmacology , Anti-Inflammatory Agents/pharmacology , Brazil , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Understanding the local characteristics and statistics related to stillbirths may be the first step in a series of strategies associated with a reduction in stillbirth ratio. The aim of this study was to estimate the fetal mortality ratio and evaluate the investigation processes related to the causes of death, comparing the investigation according to the specific cause of death. METHODS: A cross-sectional study was retrospectively conducted in 10 tertiary obstetric care centers. Medical records of women with stillbirth managed between January 1, 2009 and December 31, 2018 were analyzed and classified, according to sociodemographic characteristics, and gestational and childbirth data, culminating in stillbirth. The stillbirth ratio and its causes were presented in proportions for the study period and individually for each health facility. RESULTS: Cases of 3390 stillbirths were analyzed. The stillbirth ratio varied from 10.74/1000 live births (LBs) in 2009 to 9.31/1000 in 2018. "Intrauterine hypoxia and asphyxia" (ICD-10 P20) and "unspecific causes of death" (ICD-10 P95) represented 40.8% of the causes of death. Investigation for TORCHS and diabetes occurred in 90.8% and 61.4% of deaths, respectively. Placental and necroscopic tests were performed in 36.6% of the cases. CONCLUSION: The adoption of a rational and standardized investigation of stillbirth remains an unmet need; the use of additional tests and examinations are lacking, especially when unspecific causes are attributed.
Subject(s)
Cause of Death , Hospitals, Maternity , Stillbirth , Humans , Stillbirth/epidemiology , Female , Cross-Sectional Studies , Brazil/epidemiology , Pregnancy , Retrospective Studies , Adult , Hospitals, Maternity/statistics & numerical data , Fetal Mortality , Young Adult , Infant, NewbornABSTRACT
Chagas disease (CD), a neglected tropical disease caused by Trypanosoma cruzi, is a significant public health issue particularly in Latin America, affecting millions worldwide. Diagnosis is a challenge owing to the genetic diversity of T. cruzi and the complexities involved in selecting antigens for the detection of anti-T. cruzi antibodies. This study evaluated four chimeric recombinant antigens (IBMP-8.1, IBMP-8.2, IBMP-8.3, and IBMP-8.4) designed to enhance diagnostic accuracy by addressing assay variability. We compared the diagnostic performance of these chimeric antigens using indirect ELISA as a diagnostic platform, with three commercial serological assays in Brazil, analyzing 100 serum samples from individuals with confirmed CD and 86 from non-infected controls. The results revealed that all assays and antigens demonstrated an area under the receiver operating characteristic curve of 100%, signifying their exceptional ability to distinguish between CD-positive and CD-negative samples. Notably, the chimeric antigens achieved 100% sensitivity, specificity, accuracy, and kappa index, equaling or surpassing the commercial assays. This research highlights the efficacy of IBMP chimeric antigens as reliable diagnostic tools for CD, suggesting their potential integration into commercial diagnostic platforms to enhance the accuracy and reliability of CD detection.
Subject(s)
Antigens, Protozoan , Chagas Disease , Enzyme-Linked Immunosorbent Assay , Sensitivity and Specificity , Trypanosoma cruzi , Chagas Disease/diagnosis , Chagas Disease/blood , Chagas Disease/immunology , Humans , Antigens, Protozoan/immunology , Antigens, Protozoan/blood , Antigens, Protozoan/genetics , Trypanosoma cruzi/immunology , Trypanosoma cruzi/genetics , Enzyme-Linked Immunosorbent Assay/methods , Serologic Tests/methods , Antibodies, Protozoan/blood , BrazilABSTRACT
BACKGROUND: This study aimed at describing the demographic and clinical characteristics, treatment patterns and overall survival of patients with MM in Brazil to identify gaps in the disease diagnosis and treatment. METHODS: MMyBRAve (NCT03506386) was a multicenter, observational study of patients diagnosed with MM in Brazil between January 2008 and December 2016, with data collection between August 2018 and September 2019 at 17 participating centers. RESULTS: Of 943 patients included, 914 had complete data for overall survival (OS) analysis. The most used frontline regimens were cyclophosphamide, thalidomide and dexamethasone; bortezomib, cyclophosphamide and dexamethasone; and thalidomide and dexamethasone. After a median follow-up of 63 months, the median OS from diagnosis was 70 months. These results indicate continuous improvements in comparison with previous observational studies from Brazil. The median OS in transplantation-ineligible (N = 491) and eligible (N = 452) patients were 49 and 93 months, respectively (hazard ratio [HR] = 0.52; 95% confidence interval [CI], 0.43 to 0.63; P < .001). The median OS also differed between patients with and without known prognostic factors. CONCLUSION: Despite the improvements, our results suggest that access to novel agents and transplantation continue to hinder further progress in patient outcomes in Brazil and countries with similar health-care constraints.
Subject(s)
Multiple Myeloma , Humans , Multiple Myeloma/mortality , Multiple Myeloma/therapy , Multiple Myeloma/diagnosis , Multiple Myeloma/drug therapy , Male , Female , Brazil , Aged , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Treatment Outcome , Aged, 80 and over , Adult , PrognosisABSTRACT
Given the cryptic and elusive nature of prey consumption, quantifying its contribution to the diet of free-ranging primates using behavioral methods is challenging. In this context, the use of carbon and nitrogen-stable isotopes represents a promising alternative approach. Here, we used stable isotope analysis to estimate the proportion of arthropods and fruits in the diet of black lion tamarins (Leontopithecus chrysopygus), an endangered primate endemic to the Brazilian Atlantic Forest. To do so, we ran stable isotope mixing models using isotopic data from hair samples of black lion tamarins living in six forest fragments showing different levels of habitat quality. Furthermore, we ran linear mixed models to assess the influence of habitat quality-fruit productivity (estimated by tree total basal area) and arthropod biomass - and individual characteristics (sex and body mass) on tamarins' δ15N values (a proxy for trophic position). Our results revealed that arthropods contributed more to black lion tamarins' diet than reported in previous behavioral studies, suggesting that behavioral observations may considerably underestimate the importance of arthropodivory in the diet of arboreal primates. The degree of arthropodivory and frugivory was similar within groups, in line with the strong group cohesion and synchronization of feeding behaviors of this species and supporting the role of site-specific habitat characteristics on dietary choice. Arthropod consumption was higher in areas with lower fruit productivity and did not increase when arthropod biomass increased, suggesting that fruits represent a limiting but preferred resource for this species. These results demonstrate the dietary plasticity of black lion tamarins in areas of lower forest quality, where they manage to compensate low fruit productivity by shifting to a diet richer in arthropods. Considering that this species occurs within a highly fragmented landscape, preserving and protecting small forest patches remains crucial for the conservation of this species.
Subject(s)
Arthropods , Carbon Isotopes , Diet , Forests , Fruit , Leontopithecus , Nitrogen Isotopes , Animals , Fruit/chemistry , Leontopithecus/physiology , Brazil , Diet/veterinary , Male , Nitrogen Isotopes/analysis , Female , Carbon Isotopes/analysis , Feeding BehaviorABSTRACT
The Amazon, an important biodiversity hotspot, remains poorly explored in terms of its microbial diversity and biotechnological potential. The present study characterized the metabolic potential of Gram-positive strains of the Actinomycetes and Bacilli classes isolated from soil samples of an Amazon Conservation Unit. The sequencing of the 16S rRNA gene classified the strains ACT015, ACT016, and FIR094 within the genera Streptomyces, Rhodococcus, and Brevibacillus, respectively. Genome mining identified 33, 17, and 14 biosynthetic gene clusters (BGCs) in these strains, including pathways for the biosynthesis of antibiotic and antitumor agents. Additionally, 40 BGCs (62,5% of the total BGCs) were related to unknown metabolites. The OSMAC approach and untargeted metabolomics analysis revealed a plethora of metabolites under laboratory conditions, underscoring the untapped chemical diversity and biotechnological potential of these isolates. Our findings illustrated the efficacy of the metabologenomics approach in elucidating secondary metabolism and selecting BGCs with chemical novelty.IMPORTANCEThe largest rainforest in the world is globally recognized for its biodiversity. However, until now, few studies have been conducted to prospect natural products from the Amazon microbiome. In this work, we isolated three free-living bacterial species from the microbiome of pristine soils and used two high-throughput technologies to reveal the vast unexplored repertoire of secondary metabolites produced by these microorganisms.
Subject(s)
Metabolomics , Multigene Family , RNA, Ribosomal, 16S , Secondary Metabolism , Soil Microbiology , Streptomyces , Metabolomics/methods , RNA, Ribosomal, 16S/genetics , Streptomyces/genetics , Streptomyces/metabolism , Streptomyces/classification , Streptomyces/isolation & purification , Phylogeny , Brevibacillus/metabolism , Brevibacillus/genetics , Brevibacillus/isolation & purification , Brevibacillus/classification , Bacteria/metabolism , Bacteria/genetics , Bacteria/classification , Bacteria/isolation & purification , Rainforest , Biodiversity , Biological Products/metabolism , Rhodococcus/metabolism , Rhodococcus/genetics , Rhodococcus/isolation & purification , Rhodococcus/classification , Biosynthetic Pathways/genetics , Anti-Bacterial Agents/biosynthesis , Anti-Bacterial Agents/metabolism , Anti-Bacterial Agents/pharmacology , Actinobacteria/metabolism , Actinobacteria/genetics , Actinobacteria/classification , Actinobacteria/isolation & purification , BrazilABSTRACT
The month of January 1925 marks the birth of the Annaes Brasileiros de Dermatologia e Syphilografia and currently, 100 years later, with great merit, we celebrate its evolution into Anais Brasileiros de Dermatologia (ABD). Indeed, those few brilliant pioneers never dreamed of the strength of the Brazilian Society of Dermatology nowadays. However, perhaps they envisioned a relevant role for ABD, with a natural space for dermatoses of infectious etiology, always prevalent in tropical and subtropical regions. And thus, it was established for decades. Currently, Brazilian Dermatology and ABD are plural and open to the different facets of Dermatology. However, both the specialty, Dermatology, and its official body, ABD, value and pay homage to history, and cannot forget or stray from it. Numerous challenges have been faced over the past 100 years. Many other challenges still remain, but it is up to us, as a gift to the 100th anniversary of the Anais Brasileiros de Dermatologia, to learn about them and reflect on them. The following text provides a summary of the history of ABD over the years. We invite national and international readers to celebrate with us.
Subject(s)
Dermatology , Periodicals as Topic , Brazil , Dermatology/history , History, 20th Century , Periodicals as Topic/history , History, 21st Century , Anniversaries and Special Events , Humans , Societies, Medical/historyABSTRACT
BACKGROUND: Acral melanomas (AM) are rare and approximately two-thirds of them occur on the soles of the feet beeing more prevalent in black and Asian individuals. Data on this subtype of melanoma are scarce in the Brazilian population. OBJECTIVES: To describe and correlate the epidemiological, clinical, dermoscopic, and histopathological features of AM a. METHODS: Single-center, retrospective and cross-sectional study, evaluating data from a 15-year period. RESULTS: A total of 48 cases were included. Mean age was 62.54 years, with a predominance of women (62.5%). The percentage of amelanotic melanomas was higher among lighter skin patients (20% × 7.7%). Polychromia was the most prevalent finding (94.4%). The parallel ridge pattern (PRP) had a prevalence of 78% and a serrated pattern was associated with lower Breslow thickness (p = 0.041). Ulceration present on histopathological (p = 0.013) or dermoscopic (p = 0.047) evaluation was associated with greater Breslow thickness. STUDY LIMITATIONS: Retrospective study with loss of data. CONCLUSION: Amelanotic tumors were more prevalent in ligther phototypes (20% × 7.7%). Polychromia was the most prevalent finding (94.4%) and ulceration observed on clinical or histopathological evaluation was associated with higher Breslow thickness (p = 0.013 and 0.047).
Subject(s)
Dermoscopy , Melanoma , Skin Neoplasms , Humans , Female , Brazil/epidemiology , Male , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Middle Aged , Retrospective Studies , Cross-Sectional Studies , Melanoma/epidemiology , Melanoma/pathology , Aged , Adult , Prevalence , Aged, 80 and over , Foot Diseases/pathology , Foot Diseases/epidemiology , Foot/pathologyABSTRACT
Mycobacteria infections are caused by species of the Mycobacterium tuberculosis complex (MTB) and other species called Non-Tuberculosis Mycobacteria (NTM). Identification of mycobacteria species is very important to define treatment and it can be achieved by direct culture. However, the lack of clear protocols regarding the use of culture or molecular tests on specimens diagnosed with granulomatous lesions causes delays in the diagnosis of the etiological agents and, consequently, the definition of the right treatment. This work aimed to characterize the incidence of mycobacteria species in pulmonary granulomatous lesions and the contribution of Polymerase Chain Reaction (PCR) in Formalin-Fixed Paraffin-Embedded Tissue (FFPE), direct culture, and Ziehl-Neelsen histological stain to the diagnosis. The authors performed an observational, centralized, and retrospective study in a cohort of 336 cases with pulmonary granulomatous lesions. Mycobacteria were detected by ZNS in 54/323 (16.72 %) and by direct culture in 40/198 (20.20 %). MTB DNA was detected by PCR in 10/57 (17.54 %). Mycobacterial culture results revealed MTB in 26/40 (65.00 %), whereas NTM was detected in 13/40 (32.50 %). NTM was represented by M. avium (n = 4), M. intracellulare (n = 3), M. kansasii (n = 3), M. colombiense (n = 1), M. paraffinicum (n = 1), and M. abscessus subsp. massiliense (n = 1). In conclusion, this study demonstrated that mycobacteria are detected in 16.72 % to 20.20 % of pulmonary granulomatous lesions. Moreover, MTB and NTM were detected in these lesions. The use of different methods for mycobacteria detection, in addition to culture, is complementary and contributes to fastening and increasing the detection of mycobacteria in these lesions.
Subject(s)
Polymerase Chain Reaction , Humans , Retrospective Studies , Female , Male , Adult , Middle Aged , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/epidemiology , Young Adult , Nontuberculous Mycobacteria/isolation & purification , Nontuberculous Mycobacteria/genetics , Incidence , Aged , Adolescent , Brazil/epidemiology , DNA, Bacterial/analysis , Granuloma/microbiology , Granuloma/pathology , Child , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/epidemiology , Mycobacterium/isolation & purification , Mycobacterium/geneticsABSTRACT
The study aimed to analyze the use of complementary and integrative health practices (CIHPs) during labor and birth in a freestanding birth center. A total of 28 different CIHPs were applied with or used by laboring women. The most adopted CIHPs were mind-body practices (99.9%) and natural products (35.5%), mostly used by primiparous women ( P <.05). Adopting CIHPs can increase care quality, increase positive experiences during childbirth, and promote evidence-based choices.
Subject(s)
Birthing Centers , Complementary Therapies , Integrative Medicine , Humans , Female , Cross-Sectional Studies , Birthing Centers/statistics & numerical data , Birthing Centers/standards , Birthing Centers/organization & administration , Adult , Brazil , Complementary Therapies/statistics & numerical data , Complementary Therapies/methods , Pregnancy , Integrative Medicine/statistics & numerical data , Integrative Medicine/methods , Integrative Medicine/standards , Integrative Medicine/trendsABSTRACT
PURPOSE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. FINDINGS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. CONCLUSION: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. IMPLICATIONS FOR NURSING PRACTICE: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.
OBJETIVO: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Tratase de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um "subconjunto de diagnósticos de enfermagem" utilizandose medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente. RESULTADOS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.
Subject(s)
Neoplasms , Nursing Diagnosis , Terminal Care , Humans , Neoplasms/nursing , Neoplasms/complications , Male , Cross-Sectional Studies , Female , Middle Aged , Aged , Brazil , Adult , Syndrome , Aged, 80 and overABSTRACT
PURPOSE: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women. METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.
OBJETIVO: Analisar evidências de validade de conteúdo do diagnóstico de enfermagem (DE) Risco de Pressão Arterial Instável em mulheres encarceradas. MÉTODO: Estudo metodológico de validade de conteúdo de um DE, realizado no Brasil, entre junho e setembro de 2022, tendo 49 enfermeiros como experts. Foram avaliados o título, a definição e a relevância dos 19 fatores de risco do DE Risco de Pressão Arterial Instável. Com base no modelo de diversidade preditiva, foram calculados o Índice de Validade de Conteúdo (IVC) e respectivos intervalos de confiança de 95% para cada fator de risco. IVC ≥ 0,8 foi considerado evidência adequada de validade de conteúdo. RESULTADOS: A relevância de 19 fatores etiológicos mostrou IVC ≥ 0,8. De acordo com a recomendação do painel de experts, um dos fatores etiológicos foi dividido em dois e dois rótulos de fatores etiológicos foram alterados. O título e a definição do diagnóstico foram reformulados. CONCLUSÃO: Foram considerados válidos um novo título (Risco de pressão arterial desequilibrada), nova definição e 20 fatores etiológicos (11 fatores de risco, cinco condições associadas e quatro populações de risco) do DE Risco de Pressão Arterial Instável em mulheres encarceradas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A NANDAI aceitou a proposta deste diagnóstico de enfermagem; portanto, este estudo contribuiu para a atualização da classificação baseada em evidências científicas. Essas evidências favorecerão o raciocínio diagnóstico e o reconhecimento do diagnóstico durante a avaliação clínica, além de subsidiar estudos que avaliem a validade clínica desses elementos em mulheres encarceradas.
Subject(s)
Nursing Diagnosis , Humans , Female , Risk Factors , Brazil , Adult , Middle Aged , Blood Pressure , Prisoners , Reproducibility of ResultsABSTRACT
BACKGROUND: Multicenter studies conducted in developed countries demonstrated that custom-made devices are safe, effective, and durable for treating complex abdominal aneurysms. However, the situation in developing countries, such as Brazil, is different. Funding and time to have the endoprosthesis delivered are the major concerns. In order to overcome these conditions, high-volume Brazilian university hospitals started gaining experience with a custom-made device produced in the country. OBJECTIVE: The present study aimed to describe the practice of 2 tertiary centers and report the early results of fenestrated and branched endovascular repair of complex aortic aneurysms with a custom-made national device available in the Brazilian public health system. METHODS: Retrospective analysis of all consecutive patients that underwent fenestrated and branched endovascular aneurysm repair (F/BEVAR) of complex aortic aneurysms using custom-made manufactured endoprosthesis in 2 tertiary centers from January 2020 to July 2022. RESULTS: Thirteen cases were included (10 male, mean age 69 ± 9 years). 70% were complex abdominal aneurysms, and 30% were type II, III, and IV thoracoabdominal aneurysms (mean aneurysm diameter 69.2 ± 8.12 mm). F/BEVAR included 33 visceral arteries. The Apolo® device was used in all cases. Technical success was achieved in 12 out of 13 patients (92.3%). Thirty-day major adverse events included one death (7.7%), 5 acute renal failure (38.4%), 2 spinal cord ischemia (15.4%). The 1-year survival rate was 92.3%. CONCLUSIONS: Fenestrated and branched endovascular repair of complex aortic aneurysms with the custom-made Apolo® device has proven safe and effective in high-volume tertiary centers in the Brazilian public health system. Considering the complexity of the cases, the early patency of vessels and low initial mortality support this device continuation and expansion to treat complex aortic aneurysms in a developing country.
Subject(s)
Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Endovascular Procedures , Prosthesis Design , Humans , Endovascular Procedures/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Male , Retrospective Studies , Aged , Female , Brazil , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Abdominal/diagnostic imaging , Treatment Outcome , Time Factors , Middle Aged , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Risk Factors , Postoperative Complications/etiology , Aged, 80 and over , Stents , Tertiary Care CentersABSTRACT
OBJECTIVE: To describe the reported cases of newborns subjected to tuberculosis preventive treatment (TPT) in the state of Paraná, Brazil, and to evaluate the safety and effectiveness in preventing the progression of TB disease in this population. METHOD: Observational, descriptive case series, with secondary data. The characteristics of the participants were analyzed from the information systems of preventive treatment of TB (of Paraná), between 2009 and 2016. To evaluate which children had developed tuberculosis later or died, we used the data from the information systems of TB (in Brazil), and mortality (in Paraná), covering the years 2009 to 2018. RESULTS: A total of 24 children underwent TPT with the age at treatment onset ranging from 0 to 87 days (median: 23 days). In 95.8 %, the exposure occurred at home, and in 33.3 % of cases, the mother was the source of the infection. A total of 20.8 % of the children tested positive for tuberculosis test at 3 months of age, 83.3 % completed treatment, and 2 experienced adverse events (gastrointestinal issues). No children developed TB or died during the minimum of a 2-year evaluation period through the official databases. CONCLUSIONS: In this case series, the adherence to the plan was high, with few adverse events and 100 % protection against infection.
Subject(s)
Antitubercular Agents , Infant, Newborn, Diseases , Tuberculosis , Female , Humans , Infant , Infant, Newborn , Male , Antitubercular Agents/therapeutic use , Brazil/epidemiology , Tuberculosis/prevention & control , Tuberculosis/therapy , Infant, Newborn, Diseases/prevention & control , Infant, Newborn, Diseases/therapyABSTRACT
OBJECTIVE: Translating and cross-culturally adapting the CFAbd-Score, Cystic Fibrosis (CF) Abdominal Score, to use in Brazilian spoken Portuguese. The CFAbd-Score is a questionnaire for assessing CF-related abdominal symptoms and their influence on the quality of life (QoL). It comprises 28 questions on five domains: abdominal pain, bowel movements, eating and appetite, gastroesophageal reflux symptoms, and the impact of gastrointestinal (GI) symptoms on QoL. METHOD: Cross-cultural adaptation included assessment of conceptual and item equivalence, semantic, operational, and measurement equivalence. Content validity was assessed. The validation and psychometric analysis phase included 97 people with CF (pwCF), median age:14.58y (IQR 9/19), and 105 healthy individuals, 15.10y (IQR 9/20). Exploratory factor analysis (FA) identified retained factors. Internal consistency of the extracted domains was evaluated using Cronbach's α, and the Kaiser-Meyer-Olkin test (KMO) was used to check the sample adequacy. Bartlett's test tested the null hypothesis that the correlation matrix is an identity matrix. RESULTS: All items were considered relevant to the construct and good semantic equivalence of the version was recognized. FA showed the appropriate weight of all items and good internal consistency, with Cronbach's alpha 0.89. Bartlett's test significance level (p < 0.001) and KMO coefficient of 0.72 indicated good adequacy for structure. Internal consistency coefficients (Cronbach's alpha) were good for abdominal pain: 0.84; abdominal bloating: 0.73; flatulence: 0.76; heartburn: 0.81, and low for reflux: 0.54. CONCLUSION: The CFAbd-Score was adapted to the Brazilian spoken Portuguese and demonstrated content and semantic equivalence. The final version showed appropriate validity, and internal consistency, preserving the psychometric properties of the original version.
Subject(s)
Cross-Cultural Comparison , Cystic Fibrosis , Gastrointestinal Diseases , Psychometrics , Quality of Life , Translations , Humans , Cystic Fibrosis/complications , Cystic Fibrosis/physiopathology , Female , Male , Adolescent , Brazil , Gastrointestinal Diseases/diagnosis , Surveys and Questionnaires/standards , Reproducibility of Results , Child , Young Adult , Case-Control StudiesABSTRACT
OBJECTIVE: To investigate how body mass index (BMI) and waist circumference (WC) may be associated with insulin resistance and type 2 diabetes (T2DM) in Brazilian adolescents. METHODS: Cross-sectional study using data from the Brazilian Study of Cardiovascular Risks in Adolescents (ERICA) including adolescents aged 12-17 years. The relationship between adiposity and T2DM was investigated using ordinal logistic regression models. To study the association between adiposity categories and the occurrence of insulin resistance, linear regression models were used. RESULTS: The prevalence of T2DM for the same BMI category did not increase with the presence of high WC. Regarding insulin resistance, for the same BMI categories, having a high WC resulted in a higher prevalence of insulin resistance (HOMA-IR). The only groups significantly associated with prediabetes and T2DM were those with obesity by BMI with elevated WC (POR 1.68, 95 % CI 1.45; 1.94) and obesity with normal WC (POR 1.58, 95 % CI 1.01; 2.46). Similar findings were observed concerning insulin resistance, where the increased WC had its greatest effect when associated with obesity by BMI (ß Coefficient 2.20, 95 % CI 1.89; 2.50). CONCLUSION: The combination of BMI and WC is better for assessing adolescents at risk of developing T2DM.