Multiomics Approach Reveals Serum Biomarker Candidates for Congenital Zika Syndrome.

The Zika virus (ZIKV) can be vertically transmitted, causing congenital Zika syndrome (CZS) in fetuses. ZIKV infection in early gestational trimesters increases the chances of developing CZS. This syndrome involves several pathologies with a complex diagnosis. In this work, we aim to identify biological processes and molecular pathways related to CZS and propose a series of putative protein and metabolite biomarkers for CZS prognosis in early pregnancy trimesters. We analyzed serum samples of healthy pregnant women and ZIKV-infected pregnant women bearing nonmicrocephalic and microcephalic fetuses. A total of 1090 proteins and 512 metabolites were identified by bottom-up proteomics and untargeted metabolomics, respectively. Univariate and multivariate statistical approaches were applied to find CZS differentially abundant proteins (DAP) and metabolites (DAM). Enrichment analysis (i.e., biological processes and molecular pathways) of the DAP and the DAM allowed us to identify the ECM organization and proteoglycans, amino acid metabolism, and arachidonic acid metabolism as CZS signatures. Five proteins and four metabolites were selected as CZS biomarker candidates. Serum multiomics analysis led us to propose nine putative biomarkers for CZS prognosis with high sensitivity and specificity.

Real-time PCR in the diagnosis of congenital toxoplasmosis.

The diagnosis of congenital toxoplasmosis presents limitations and therefore new options are necessary. The analysis of amniotic fluid by real-time PCR has already proved effective for confirmation of fetal infection. However, its performance in other biological samples is not clear yet. The aim of this study is to better understand the role of real-time PCR in the blood of the mother and newborn as well as in the amniotic fluid and placenta in the diagnosis of congenital toxoplasmosis. This is a descriptive cohort study of pregnant women with toxoplasmosis followed up in Rio de Janeiro, Brazil. Real-time PCR was performed in samples of maternal blood, amniotic fluid, placenta, and blood of newborns. In addition, histopathological examination of placentas was performed, and data collected from babies were collected. 116 pregnant women were followed up and 298 samples were analyzed. One (0.9%) pregnant woman presented positive PCR in the blood, 3 (3.5%) in the amniotic fluid, 1 (2.3%) in the placenta and no newborn had positive PCR in the blood. Histopathological study was suggestive of toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis, and only cases with positive PCR in the amniotic fluid had correlation of the PCR result with the diagnosis of congenital infection. Both maternal and blood samples of newborns and placenta did not prove to be promising in the diagnosis of congenital toxoplasmosis. Further studies are needed to evaluate the real role of molecular diagnosis in other biological materials rather than the amniotic fluid.

Coração em Criss-Cross: um relato de caso / Criss-Cross Heart: a case report

Coração em criss-cross (ou coração entrecruzado) foi descrito pela primeira vez em 1974. Trata-se de uma malformação cardíaca congênita, rara, ocorrendo 8 casos a cada 1.000.000 de crianças, e representando somente 0,1% das malformações congênitas. Os métodos diagnósticos de escolha são o ecocardiograma transtorácico, a ressonância magnética cardíaca (RMC), a angiotomografia (TC) e, eventualmente, o cateterismo cardíaco. Neste relato, descreve-se o caso de um recém-nascido com coração em criss-cross somado à dupla via de saída do ventrículo direito (VD), com vasos mal posicionados, além de comunicação interatrial (CIA), comunicação interventricular (CIV), displasia de valva tricúspide e veia cava superior esquerda persistente. Não se sabe a etiologia exata dessa malformação, mas parece ocorrer pela rotação dos ventrículos em seu eixo longitudinal, não acompanhada das rotações atrial e das valvas atrioventriculares (AV). Esse movimento produz uma alteração das vias de entrada dos ventrículos, determinando que o VD se posicione em plano superior e o esquerdo em plano inferior. Apesar de ainda não se saber a exata causa dessa anomalia, acredita-se que uma alteração genética possa estar levando a esses casos: a mutação do gene Cx43. O diagnóstico do caso em questão foi dado pela ecocardiografia transtorácica e da TC de aorta e artérias pulmonares, que mostraram, além do criss-cross, outras alterações, como dupla via de saída do VD, CIA e CIV amplas.(AU)

Criss-cross heart was first described in 1974. It is a rare congenital heart malformation that occurs in 8 cases per 1,000,000 children, and represents only 0.1% of congenital malformations. The diagnostic methods of choice are transthoracic echocardiography, cardiac magnetic resonance (CMR), computed tomography angiography (CT) and, sometimes, cardiac catheterization. This report describes the case of a newborn with a criss-cross heart in addition to double-outlet right ventricle (RV), with poorly positioned vessels, in addition to atrial septal defect (ASD), interventricular septal defect, tricuspid valve dysplasia and persistent left superior vena cava. The exact etiology of this malformation is not known, but it seems to occur due to rotation of the ventricles in their longitudinal axis, not accompanied by rotation of the atrial and atrioventricular (AV) valves. This movement produces abnormal ventricular inlets, determining that the RV be positioned on a superior plane and the left ventricle on an inferior plane. Although the exact cause of this anomaly is still unknown, it is believed that a genetic abnormality may be leading to these cases: mutation of the Cx43 gene. Diagnosis of the case concerned was given by transthoracic echocardiography and computed CT of the aorta and pulmonary arteries, which showed, in addition to the criss-cross heart, other abnormalities, such as double-outlet RV, large ASD and ventricular septal defect (VSD).(AU)

Real-time PCR in the diagnosis of congenital toxoplasmosis

ABSTRACT The diagnosis of congenital toxoplasmosis presents limitations and therefore new options are necessary. The analysis of amniotic fluid by real-time PCR has already proved effective for confirmation of fetal infection. However, its performance in other biological samples is not clear yet. The aim of this study is to better understand the role of real-time PCR in the blood of the mother and newborn as well as in the amniotic fluid and placenta in the diagnosis of congenital toxoplasmosis. This is a descriptive cohort study of pregnant women with toxoplasmosis followed up in Rio de Janeiro, Brazil. Real-time PCR was performed in samples of maternal blood, amniotic fluid, placenta, and blood of newborns. In addition, histopathological examination of placentas was performed, and data collected from babies were collected. 116 pregnant women were followed up and 298 samples were analyzed. One (0.9%) pregnant woman presented positive PCR in the blood, 3 (3.5%) in the amniotic fluid, 1 (2.3%) in the placenta and no newborn had positive PCR in the blood. Histopathological study was suggestive of toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis, and only cases with positive PCR in the amniotic fluid had correlation of the PCR result with the diagnosis of congenital infection. Both maternal and blood samples of new-borns and placenta did not prove to be promising in the diagnosis of congenital toxoplasmosis. Further studies are needed to evaluate the real role of molecular diagnosis in other biological materials rather than the amniotic fluid.

Effect of low-level light therapy before radiotherapy in oral squamous cell carcinoma: An in vitro study.

Radiation therapy for head and neck squamous cell carcinoma (HNSCC) is associated with several complications. Although photobiomodulation (PBM) has radioprotective effects in normal tissue, it could also enhance the growth of neoplastic cells. Thus, the present study aimed to investigate the cellular response of oral squamous cell carcinoma with pre-exposure to low-level phototherapy before radiotherapy. SCC9, Cal-27, A431, and HaCaT cell lines were subjected to low-level light therapy and radiotherapy. The cells were treated with a single energy density (300 J/cm2) of a light-emitting diode (660 nm) prior to ionizing radiation at different doses (0, 2, 4, and 6 Gy). After 24 h, wound scratch, proliferation, clonogenic cell survival, cell death, and reactive oxygen species (ROS) analyses were performed to evaluate cell response. The cell lines pre-exposed to PBM at the analyzed dosage were radiosensitive. The treatment significantly reduced cell proliferation and clonogenic cell survival. Migration and cell death assays also revealed positive results, with the treatment group showing lower rate of migration and higher cell death than did the control group. Moreover, PBM effectively increased the intracellular levels of ROS. PBM at 300 J/cm2 is a promising radiosensitizing modality to reduce the radiation dose and avoid the intolerable side effects of radiotherapy for HNSCC, thus increasing the probability of successful treatment. However, further studies are needed to support and confirm the results.

PCR-based diagnosis is not always useful in the acute acquired toxoplasmosis in immunocompetent individuals.

Toxoplasmosis is the most prevalent zoonosis in the world and is associated with a large spectrum of diseases. Acute acquired toxoplasmosis (AAT) is considered a benign and self-limiting disease but severe postnatal infections have been reported, particularly in South America. Laboratory diagnosis is based on the detection of anti-Toxoplasma gondii IgM, IgG, and presence of low IgG avidity. However, these assays present limitations, and therefore, PCR has been suggested as an alternative diagnostic tool. In this study, we performed real-time and nested PCR in DNA blood samples from 59 individuals with AAT lasting less than 80 days. None of the patients had parasitic DNA detected by PCR, even in the more severe cases or when blood was collected early after disease onset. These negative results indicate that the parasitemia kinetics needs investigation to determine the best time for blood sampling, especially in immunocompetent individuals. Thus, we emphasize that a negative PCR result does not exclude recent T. gondii infection, and serological criteria are still decisive for the laboratory diagnosis of AAT.

Responsabilidade Técnica em Enfermagem / Technical responsibility in nursing

Objetivo: O presente estudo teve como objetivo analisar o que vem sendo publicado sobre Responsabilidade Técnica em Enfermagem. Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados: Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Public Medline (PubMed), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (Scielo), no período de janeiro a março de 2020 utilizando os descritores "Responsabilidade Técnica" e "Enfermagem" e seus correspondentes em inglês, na qual foram selecionados 11 artigos, todos em português, sem recorte temporal. Resultados: o registro da Anotação de Responsabilidade Técnica em Enfermagem, assim como em outras profissões, constitui um importante atributo para qualidade no exercício profissional, necessita ter seus conceitos e atribuições difundidos e ser mais estudada no contexto cientifico. Conclusão: para a realização desta pesquisa sobre a Responsabilidade Técnica em Enfermagem foi encontrado um número restrito de publicações, com baixos níveis de evidência científica, em sua maioria, faziam referência à responsabilidade sem vínculo ao Conselho de Enfermagem, o que demostra a necessidade da ampliação de estudos sobre o tema para que os conceitos e implicações do exercício da Responsabilidade Técnica em Enfermagem, nos serviços de saúde, sejam melhor esclarecidos. (AU)

Objective: The present study had analyze what has been published about Technical Responsibility in Nursing. Methods: This is an integrative review carried out in the databases: Periodical Portal of the Coordination for the Improvement of Higher Level Personnel (CAPES), Public Medline (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientific Electronic Library Online (Scielo), from January to March 2020 using the descriptors "Technical Responsibility" and "Nursing" and their correspondents in English, in which 11 articles were selected, all in Portuguese, without temporal cut-off. Results: the register of the Technical Responsibility in Nursing, as well as in other professions, constitutes an important attribute for quality in the professional exercise, needs to have its concepts and attributions diffused and to be more studied in the scientific context. Conclusion: in order to carry out this research on Technical Responsibility in Nursing, a limited number of publications were found, eith low levels of scientific evidence, mostly referring to responsibility without a link to the Nursing Council, which demonstrates the need to expand studies. On the subject so that the concepts and implications of the exercise of Technocal Responsibility in Nursing in health services are better clarified. (AU)

Objetivo: El presente estudio tuvo como objetivo analizar lo publicado sobre Responsabilidad Técnica en Enfermería. Método: Se trata de una revisión integradora realizada en las bases de datos: Portal de Periódicos de la Coordinación para el Perfeccionamiento del Personal de Nivel Superior (CAPES), Public Medline (PubMed), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online (Scielo), de enero a marzo de 2020 utilizando los descriptores "Technical Responsibility" y "Nursing" y sus corresponsales en inglés, en los que se seleccionaron 11 artículos, todos en portugués, sin reducción de tiempo. Resultados: el registro de la Responsabilidad Técnica en Enfermería, así como en otras profesiones, constituye un atributo importante para la calidad en la práctica profesional, necesita que sus conceptos y atribuciones sean difundidos y profundizados em el contexto científico. Conclusión: para realizar esta investigación sobre Responsabilidad Técnica em Enfermería se encontró um número limitado de publicaciones, com bajos niveles de evidencia científica, mayoritariamente referidas a responsabilidade sin vinculación al Consejo de Enfermería, lo que demuestra la necesidad de ampliar los estúdios sobre el tema para que se aclaren mejor los conceptos e implicaciones del ejercicio de la Responsabilidad Técnica em Enfermería em los servicios de salud. (AU)

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil

ABSTRACT Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. Results: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). Conclusion: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

Toxoplasmosis in pregnancy: a clinical, diagnostic, and epidemiological study in a referral hospital in Rio de Janeiro, Brazil.

Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. RESULTS: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). CONCLUSION: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases.

High prevalence of Chlamydia trachomatis in pregnant women attended at Primary Health Care services in Amazon, Brazil.

Chlamydia trachomatis (CT) infection is often silent and can lead to long-term reproductive complications in women. In this study, we determined the prevalence of CT infection and possible associations between the presence of the infection and clinical-epidemiological variables in pregnant women attended at the Basic Health Units of the Coari city, Amazonas, Brazil. From July 2016 to March 2017, 164 pregnant women undergoing prenatal care were recruited. One hundred of these women were tested for CT infection using two types of samples: cervico-vaginal and urine. The diagnosis was confirmed by PCR with primers specific for the omp1 gene of CT chromosomal DNA. Of the 100 pregnant women, 18 (18%) had CT infection, 8 (8%) of which were positive in both samples, 7 (7%) only in the urine sample and 3 (3%) only in cervical-vaginal sample. There was moderate agreement (Kappa=0.55) and no statistically significant difference between sample types (p = 0.400). The mean age of infected women was 21.1 years (SD = 4.6). Of the clinical-epidemiological variables analyzed, "more than 2 partners in the last 12 months" (p = 0.022) and gynecological complaint of "pain after intercourse" (p = 0.020) were associated with CT infection. This study showed a high prevalence (18%) of CT infection among pregnant women in Coari / Amazonas. Urine sampales were as good as cervical-vaginal ones for the screening of CT infection during the prenatal period.

Chlamydia trachomatis infection in women living in remote areas in Amazonas, Brazil-a self-collection screening experience.

Chlamydia trachomatis infection is the most common sexually transmitted bacterial infection among women. In Brazil, there is no organized screening program for C. trachomatis, and the actual prevalence of infection is unknown. This study aimed to determine the prevalence of C. trachomatis infection in women living in riverside communities in the Amazon, using self-collection employing the Evalyn® Brush and polymerase chain reaction. A total of 299 riverine women aged 18-81 years, mean age 35.7 (±12.8) years, predominantly agricultural workers, with low schooling and living with a partner, participated in this study. The prevalence of C. trachomatis infection was found to be 3.7% (95% CI 1.8-6.5), most of them being symptomatic. The mean age of the first sexual intercourse reported by women was 15.2 (±2.3) years, and the majority reported having had none or only one partner in the last 12 months, with very low adherence to consistent condom use (15.4%). Most women (98.3%) reported having approved using the vaginal self-collecting brush, and only 4.7% reported having difficulty in handling the brush. We consider that a vaginal self-collecting device is adequate for diagnosing C. trachomatis infection in women living in remote, hard-to-reach areas.

T. vaginalis in riverside women in Amazonia, Brazil: an experience using the EVALYN® BRUSH vaginal self-collection device.

INTRODUCTION: The challenges related to the diagnosis of sexually transmitted infections present more complex factors in remote and hard-to-reach areas. The use of self-collection devices that facilitate the obtaining of a biological sample with high quality for sensitive molecular tests have been examined. This study aimed to evaluate the performance and acceptance of the Evalyn® Brush (Rovers® Medical Devices) for detection of T. vaginalis among women living in the riverside communities of Amazonas, Brazil. METHODOLOGY: The study included 300 riverside women. They received instructions for self-collection, carried out the task, and then answered a questionnaire on the use of the device. T. vaginalis was detected by Polymerase Chain Reaction, using primers TVK3/TVK7. RESULTS: The mean age of the women was 35.8 years, and most of them presented low schooling, low income, agricultural activity and lived in a marital union. All samples were positive for human genomic DNA (100%) and the prevalence of T. vaginalis infection was 5.6% (n = 17). Of the 300 women, 293 (97.7%) indicated that they liked the use of the device, 287 (95.7%) reported having had no difficulty in handling it, 265 (88.3%) did not feel any type of discomfort and 228 (76%) said they preferred the self-collection to the collection made by the professional, mainly due to privacy and comfort. CONCLUSIONS: The Evalyn® Brush proved reliable as a device for the collection of biological samples for molecular analysis and was well-accepted by women. Its use can be indicated in remote and hard to reach places.

Levantamento Sistemático dos Focos de Estresse Parental em Cuidadores de Crianças com Síndrome de Down / Systematic Review of Parental Stress Outbreaks in Caregivers of Children with Down Syndrome

RESUMO: A chegada de uma criança com Síndrome de Down (SD) requer uma readaptação familiar, demandando esforços em relação aos cuidados diários ou às rotinas terapêuticas e escolares. Os objetivos deste estudo foram compreender quais são os principais focos de estresse parental em cuidadores de crianças com SD e identificar quem são os cuidadores principais dessas crianças. Trata-se de uma revisão de literatura de abordagem qualitativa, que utilizou como referencial teórico pesquisas empíricas publicadas a partir de 2010, encontradas nos portais Google Acadêmico, Scielo e Psicologia.PT, e nos periódicos: Interação em Psicologia, CEPE UEG e Ata CIAIQ 2016. Inicialmente, foram identificadas 23 pesquisas, utilizando-se os descritores Síndrome de Down, estresse e cuidadores. Após filtragem, cinco passaram para revisão final. O resultado evidencia que o estresse parental está relacionado a três fatores - à deficiência, ao desenvolvimento da criança e ao papel do cuidador. Os principais focos de estresse foram o impacto do diagnóstico; medo da discriminação e preconceito; falta de autonomia da criança; sobrecarga emocional do cuidador; preocupação com a sexualidade; baixa escolaridade paterna; mães que não podem trabalhar; e crianças mais velhas. As mães apresentaram os níveis mais elevados de estresse. A divisão familiar equilibrada em relação aos cuidados com a criança com SD, além de um acompanhamento psicológico familiar, são alternativas para reduzir os níveis de estresse e garantir saúde física e mental aos cuidadores. Conclui-se que os focos de estresse parental são diversos e causam abalo emocional, dificuldades de aceitação e adaptação familiar.

ABSTRACT: The arrival of a child with Down Syndrome (DS) requires a family readaptation, demanding efforts in relation to daily care or therapeutic and school routines. The aims of this study were to understand what the main sources of parental stress in caregivers of children with DS are and identify who the main caregivers of these children are. This is a literature review of a qualitative approach that used a theoretical framework of empirical researches published as of 2010, found in the Google Scholar, Scielo and Psychology.PT portals, and in the journals: Interação em Psicologia, CEPE UEG e Ata CIAIQ 2016. Initially, 23 researches were identified, through the use of the descriptors Down syndrome, stress and caregivers. After filtering, five works were selected for a final review. The result shows that parental stress is related to three factors - disability, development of the child and the role of the caregiver. The main stress outbreaks were the impact of the following diagnosis; fear of discrimination and prejudice; lack of autonomy of the child; emotional overload of the caregiver; concern about sexuality; low paternal schooling; mothers who cannot work; and older children. Mothers had the highest levels of stress. A balanced family division in relation to childcare with DS, as well as family psychological counseling, are alternatives to reducing stress levels and guarantee physical and mental health to caregivers. It is concluded that parental stress outbreaks are diverse and cause emotional distress, difficulties of acceptance and family adaptation.

Self-sampling coupled to the detection of HPV 16 and 18 E6 protein: A promising option for detection of cervical malignancies in remote areas.

OBJECTIVE: To evaluate both the performance and acceptability of a method coupling self-sampling with detection of cervical malignancy via elevated HPV 16 and 18 E6 oncoproteins (OncoE6™ Cervical Test) in remote areas in Brazil. METHODS: Women living in rural villages in proximity to Coari city, Amazonas, Brazil were invited to participate in a cervical cancer screening study. 412 subjects were enrolled; there were no refusals. In addition to E6 protein detection, DNA was extracted from the brushes and evaluated for HPV genotypes by PCR (PGMY09/11), followed by typing by the Papillocheck™ if positive. Subjects who were found to be positive for OncoE6 or HPV-DNA were referred for colposcopy. RESULTS: For 110 subjects (27%) this was the first cervical cancer exam. Overall the HPV-DNA prevalence was 19.1% (n = 79); 1.4% (n = 6) were positive by the OncoE6 Test. Fifty-six women attended the invitation for colposcopy where nine had an abnormal cervix and were subsequently biopsied. Histopathological analysis revealed 2 CIN3, 2 carcinomas and 5 CIN1. OncoE6 called two out of the three HPV 16 or 18 associated CIN3+ lesions. CONCLUSIONS: The findings suggest that self-administered sample collection in combination with OncoE6 Test is feasible in this population. This could enable expanded screening coverage while ensuring a high specificity which is imperative given the remote geographic location, since women bearing abnormal test results would necessitate travel and logistical burden to access colposcopy and treatment.

Higiene oral: estrtégia para redução de infecção na unidade de terapia intensiva cardiológica / Oral hygiene: a strategy to reduce infection in a cardiac intensive care unit

OBJETIVO: Verificar a efetividade da higiene bucal como forma de redução da microbiota patogênica causadora da pneumonia associada à ventilação mecânica (PAVM) em pacientes internados na Unidade de Terapia Intensiva (UTI) cardíaca. MÉTODO: Comparação da microbiota oral obtida através do exame de swab, antes e após a realização da higiene oral com clorexidina a 0,12%. Cada paciente foi avaliado (exame de swab) em dois períodos: em até 24 horas a partir da sua chegada na UTI e após 48 horas ou após 72 horas. Se houve alta após 48 horas da admissão, o exame foi realizado 48 horas depois; se houve alta após 72 horas da admissão, o exame foi realizado 72 horas depois. Além disso, foi verificada a presença de saburra lingual através de exame visual. A amostra foi coletada em 16 pacientes, de ambos os sexos, com média de idade de 61,8 anos. RESULTADOS: A saburra lingual foi considerada espessa em 68,75% dos pacientes, o que caracterizava uma higienização deficiente. Após as sessões de higiene oral, 81,25% dos indivíduos apresentaram redução da quantidade de cocos e bacilos Gram negativos, os quais representam a potencial flora patogênica bucal. Quando a segunda avaliação da microbiota oral foi realizada após 72 horas, 100% dos indivíduos apresentaram alteração positiva (redução da quantidade de cocos e bacilos Gram negativos); já quando a microbiota foi reavaliada após 48 horas, 75% dos participantes apresentaram alteração positiva em relação à patogenicidade das bactérias. CONCLUSÃO: É possível reduzir a microbiota patogênica potencialmente causadora de PAVM através da higiene oral, no presente trabalho realizada com a associação de métodos químico e mecânico. (AU)

OBJECTIVE: To verify the effectiveness of oral hygiene as a means of reducing the pathogenic microbiota that causes ventilator-associated pneumonia (VAP) in patients admitted to a cardiac Intensive Care Unit (ICU). METHODS: Comparison between oral microbiota obtained by swab, before and after oral hygiene with 0.12% chlorhexidine. Each patient was assessed (swab test) at two time points: within 24 hours after ICU admission and after 48 hours or 72 hours. If hospital discharge occurred more than 48 hours after admission, the test was conducted 48 hours later if discharge occurred more than 72 hours after admission, the test was conducted 72 hours later. In addition, the presence of tongue plaque was determined by visual examination. The sample was collected from 16 patients of both sexes, with a mean age of 61.8 years. RESULTS: Tongue plaque was considered thick in 68.75% of patients, characterizing poor hygiene. After the oral hygiene sessions, 81.25% of subjects presented with a reduction in the number of Gram-negative cocci and bacilli, which represent the potential pathogenic oral flora. When the second evaluation of the oral microbiota was performed after 72 hours, 100% of subjects presented with positive change (reduction in the amount of Gram-negative cocci and bacilli), whereas when the microbiota was revaluated after 48 hours, 75% of the subjects presented with positive change in terms of bacterial pathogenicity. CONCLUSION: It is possible to reduce the pathogenic microbiota with the potential to cause VAP by means of oral hygiene, carried out in this study with a combination of chemical and mechanical methods. (AU)

Detection and genotyping of HPV in women with indeterminate cytology and low-grade squamous intraepithelial lesions / Detecção e genotipagem do HPV em mulheres com citologia indeterminada e lesão intraepitelial escamosa de baixo grau

ABSTRACT Introduction: The human papillomavirus (HPV) is the main risk factor related to cervical cancer, the third most frequent type of cancer in Brazilian women. Early identification of high-risk HPV types in the normal cervix, or cervix with premalignant lesions may help prevent the progression of these lesions to cancer. Objective: This study aimed to detect and genotype HPV in women with low-grade intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASC-US). Methods: Patients were selected from files of the cytology laboratory of Fundação Alfredo da Mata (FUAM), between January 2009 and July 2011, for cytological reassessment and HPV molecular detection with genotyping. Results: Out of the100 eligible patients, 70% (70/100) participated in the study; initially, 34 of them had ASC-US and 36 had LSIL. After cytological reassessment, eight (11.4%) patients showed normal cytology; 33 (47.2%), inflammatory lesions; 22 (31.4%), ASCUS; six (8.6%), LSIL; and one (1.4%), high-grade squamous intraepithelial lesions (HSIL). HPV was detected in 28.6% (20/70) of the samples. Out of the 20 HPV-positive patients, one had normal cytology, six showed inflammatory cytology, 10 showed ASCUS, two had LSIL and one, HSIL. After genotyping, the HPV types identified were: 6, 16, 58, 61, 70, 83, 84 and 85. The most prevalent HPV type was the 58. Conclusion: The presence of high-risk HPV in women with old cervical lesions, whether they have evolved or not, indicates the need to improve patient monitoring and surveillance. .

RESUMO Introdução: O papilomavírus humano (HPV) é o principal fator de risco relacionado com câncer cervical. A identificação precoce de tipos de HPV de alto risco em cérvice normal ou com lesões precursoras pode auxiliar a prevenir que essas lesões progridam para neoplasias malignas. Objetivos: Este estudo teve como objetivo detectar e genotipar o HPV em mulheres com resultado citológico de lesão intraepitelial escamosa de baixo grau (LSIL) e células escamosas atípicas de significado indeterminado (ASC-US). Métodos: Mulheres diagnosticadas com LSIL e ASC-US foram selecionadas a partir do arquivo de exames do Laboratório de Citologia da Fundação Alfredo da Matta (FUAM), em Manaus (AM), no período de janeiro de 2009 a julho de 2011, para reavaliação citológica, detecção molecular e genotipagem do HPV. A detecção molecular foi realizada pela técnica de nested reação em cadeia da polimerase (PCR); a genotipagem, por sequenciamento automático do ácido desoxirribonucleico (DNA). Resultados: Das 100 pacientes selecionadas, 70% (70/100) participaram do estudo, sendo que inicialmente 34 delas tinham resultado citológico de ASC-US e 36 de LSIL. Após reavaliação citológica, oito (11,4%) apresentaram citologia normal; 33 (47,2%), citologia inflamatória; 22 (31,4%), ASC-US; seis (8,6%), LSIL e uma (1,4%), lesão intraepitelial de alto grau (HSIL). O HPV foi detectado em 28,6% (20/70) das amostras examinadas. Das 20 pacientes HPV positivas, uma apresentou citologia normal; seis apresentaram citologia inflamatória; 10 exibiram ASC-US; duas, LSIL e uma, HSIL. Foram identificados os tipos de HPV 6, 16, 58, 61, 70, 83, 84 e 85, sendo o HPV 58 o mais prevalente. Conclusão: A presença de HPV de alto risco em mulheres com lesões cervicais antigas, tendo elas evoluído ou não, mostra a necessidade de maior acompanhamento e vigilância dessas pacientes. .

Remodelamento cardíaco após oclusão percutânea da comunicação interatrial tipo ostium secundum em adultos: um estudo ecocardiográfico com novas técnicas / Cardiac remodeling after percutaneous closure of atrial septal defect in adults: an echocardiographic study with new techniques

Introdução: A comunicação interatrial tipo ostium secundum(CIA) é uma cardiopatia congênita frequente, sendo a mais comumente encontrada na população adulta. Seu tratamento está indicado quando há repercussão hemodinâmica caracterizada pelo aumento das dimensões das câmaras direitas à ecocardiografia, independente da presença de sintomas. Nas últimas 2 décadas o fechamento percutâneo da CIA emergiu como a modalidade terapêutica preferencial devido sua alta eficácia e menor morbidade que a correção cirúrgica.Tanto o tratamento cirúrgico como o percutâneo da CIA resultam em remodelamento cardíaco com redução progressiva do tamanho das câmaras direitas e aumento das esquerdas. Recentemente, novas técnicas ecocardiográficas vem sendo empregadas para avaliação das dimensões, geometria e função das câmaras cardíacas incluindo o ecocardiograma tridimensional e o rastreamento de marcadores acústicos. Hipótese e objetivos: Partiu-se da hipótese que o fechamento percutâneo da CIA, por ser um método não invasivo, levaria a rápido remodelamento cardíaco mesmo em adultos com sobrecarga volumétrica crônica das câmaras direitas. Tivemos como objetivo avaliar o comportamento temporal do remodelamento cardíaco e analisar possíveis diferenças existentes entre pacientes de diferentes faixas etárias e com tamanhos diversos de CIA. Material e métodos: Estudo observacional, prospectivo, não randomizado de um braço único de uma coorte de adultos submetidos ao fechamento percutâneo da CIA com a prótese Cera (Lifetech, Shenzheng, China) e acompanhados por um ano...

Epidemiologia da cárie dentária em crianças da primeira infância no município de Belém, PA / Caries epidemiology of children in the primary infancy in the City of Belém, PA

Objetivo: O objetivo deste estudo foi avaliar o perfil epidemiológico da cárie dentária em crianças de 6 a 36 meses de idade no município de Belém-PA. Métodos: A amostra consistiu de 340 crianças. Nove examinadores calibrados participaram deste estudo. Índices ceo-d e ceo-s foram utilizados para o exame clínico. As crianças foram divididas de acordo com a idade em: 6-12, 13-24 e 25-36 meses. Os dados foram estatisticamente avaliados através do teste de qui- -quadrado, adotando-se um nível de significância de 5%. Resultados: A prevalência de cárie foi de 32,9% no total da amostra examinada. Índices ceo-d e ceo-s médios foram de 1,12 (dp=2,31) e 1,64 (dp=4,00), respectivamente. Observou-se um aumento significativo quanto à presença da cárie de acordo com a idade (P=0,0020). Do total de 6340 dentes decíduos examinados, houve maior proporção para o componente “cariado” com 362 dentes. Foi observada relação significativa de tratamentos curativos e a faixa etária de 25 a 36 meses (P=0,0057). Conclusão: Estes dados reforçam a importância da atenção odontológica precoce em crianças que se encontram na primeira infância neste município.

Objective: The objective of this study was to evaluate the epidemiological profile of children aged 6-36-months-old living in the city of Belém, Pará, Brazil. Methods: The final sample was 340 children. Nine calibrated examiners participated in this study. The DMFT and DMFS indexes were used for clinical examination. The children were divided by age in: 6-12, 13-24 and 25-36-months-old. Data was statistically analyzed using the Qui-square test, with a significance level of 5%. Results: The prevalence of dental caries was 32,9% in the total of the sample. Indexes dmft and dmfs were 1.12 (sd=2.31) and 1.64 (sd=4,00), respectively. There has been a highly significant increase in caries experience proportionally with increasing age (P=0.0020). From the 6340 examined teeth, it was observed a higher proportion for decayed component with 362 teeth. There was a statistically significance relationship between curatives treatments and the age of 25 to 36-months-old (P=0.0057). Conclusions: The results of the current study emphasize the importance of an early odontological assistance for primary infants living at this city.

"Hidden" sexually transmitted infections among women in primary care health services, Amazonas, Brazil.

This study describes the prevalence of infection by Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in a female population in Amazonas, Brazil. We collected cervical samples from 361 women examined at 10 primary care health services in the city of Coari, Amazonas, Brazil. The women were interviewed about socio-economic data, clinical history and sexual behaviour. Pelvic examinations were performed and cervical specimens were collected for detection of pathogens by PCR. The prevalence of infection was: 12.7% for Trichomonas vaginalis, 6.4% for Chlamydia trachomatis and 1.4% for Neisseria gonorrhoeae. There were no statistically significant associations between infections by any of the pathogens nor by any pathogen alone with any clinical variable, socio-demographic data or sexual behaviour. This study draws attention to the need for surveillance and possible need for screening for Chlamydia trachomatis, which often progresses asymptomatically. For the significant prevalence found, attention should also be given to asymptomatic infection by Trichomonas vaginalis, since this pathogen has recently been implicated as a risk factor for HIV infection.

High prevalence and genotypic diversity of the human papillomavirus in Amazonian women, Brazil.

The aim of this study was to determine the prevalence of human papillomavirus (HPV) in a women population living within the state of Amazonas, Brazil, and to determine the viral genotypes found. The study included 361 sexually active women over 18 years of age. We performed the Pap test and the molecular diagnosis for HPV DNA using polymerase chain reaction (PCR). The amplicons obtained were sequenced in automatic sequencer for genotyping. The presence of HPV DNA was found in 29.1% (105) of the women. Only 321 women presented satisfactory slides for cytological diagnosis, 97.9% (314) had normal cytology (negative for cancer), and 2.1% (7) had abnormal cytology (4 ASCUS, 1 LSIL, and 2 HSIL). The types more frequently found were HPV 16 (58.1%) and HPV 58 (20.0%). Additionally, we found more 13 types of HPV. Compared with previous studies in Brazil, our data confirmed a high prevalence and genotypic diversity of HPV in Brazilian women.