Delayed gametocyte clearance in Plasmodium vivax malaria is associated with polymorphisms in the cytochrome P450 reductase (CPR).

Primaquine (PQ) is the main drug used to eliminate dormant liver stages and prevent relapses in Plasmodium vivax malaria. It also has an effect on the gametocytes of Plasmodium falciparum; however, it is unclear to what extent PQ affects P. vivax gametocytes. PQ metabolism involves multiple enzymes, including the highly polymorphic CYP2D6 and the cytochrome P450 reductase (CPR). Since genetic variability can impact drug metabolism, we conducted an evaluation of the effect of CYP2D6 and CPR variants on PQ gametocytocidal activity in 100 subjects with P. vivax malaria. To determine gametocyte density, we measured the levels of pvs25 transcripts in samples taken before treatment (D0) and 72 hours after treatment (D3). Generalized estimating equations (GEEs) were used to examine the effects of enzyme variants on gametocyte densities, adjusting for potential confounding factors. Linear regression models were adjusted to explore the predictors of PQ blood levels measured on D3. Individuals with the CPR mutation showed a smaller decrease in gametocyte transcript levels on D3 compared to those without the mutation (P = 0.02, by GEE). Consistent with this, higher PQ blood levels on D3 were associated with a lower reduction in pvs25 transcripts. Based on our findings, the CPR variant plays a role in the persistence of gametocyte density in P. vivax malaria. Conceptually, our work points to pharmacogenetics as a non-negligible factor to define potential host reservoirs with the propensity to contribute to transmission in the first days of CQ-PQ treatment, particularly in settings and seasons of high Anopheles human-biting rates.

Effect of primaquine dose on the risk of recurrence in patients with uncomplicated Plasmodium vivax: a systematic review and individual patient data meta-analysis.

BACKGROUND: Primaquine is used to eliminate Plasmodium vivax hypnozoites, but its optimal dosing regimen remains unclear. We undertook a systematic review and individual patient data meta-analysis to investigate the efficacy and tolerability of different primaquine dosing regimens to prevent P vivax recurrence. METHODS: For this systematic review and individual patient data meta-analysis, we searched MEDLINE, Web of Science, Embase, and Cochrane Central for prospective clinical studies of uncomplicated P vivax from endemic countries published between Jan 1, 2000, and June 8, 2023. We included studies if they had active follow-up of at least 28 days, and if they included a treatment group with daily primaquine given over multiple days, where primaquine was commenced within 7 days of schizontocidal treatment and was given alone or coadministered with chloroquine or one of four artemisinin-based combination therapies (ie, artemether-lumefantrine, artesunate-mefloquine, artesunate-amodiaquine, or dihydroartemisinin-piperaquine). We excluded studies if they were on prevention, prophylaxis, or patients with severe malaria, or if data were extracted retrospectively from medical records outside of a planned trial. For the meta-analysis, we contacted the investigators of eligible trials to request individual patient data and we then pooled data that were made available by Aug 23, 2021. We assessed the effects of total dose and duration of primaquine regimens on the rate of first P vivax recurrence between day 7 and day 180 by Cox's proportional hazards regression (efficacy analysis). The effect of primaquine daily dose on gastrointestinal symptoms on days 5-7 was assessed by modified Poisson regression (tolerability analysis). The study was registered with PROSPERO, CRD42019154470. FINDINGS: Of 226 identified studies, 23 studies with patient-level data from 6879 patients from 16 countries were included in the efficacy analysis. At day 180, the risk of recurrence was 51·0% (95% CI 48·2-53·9) in 1470 patients treated without primaquine, 19·3% (16·9-21·9) in 2569 patients treated with a low total dose of primaquine (approximately 3·5 mg/kg), and 8·1% (7·0-9·4) in 2811 patients treated with a high total dose of primaquine (approximately 7 mg/kg), regardless of primaquine treatment duration. Compared with treatment without primaquine, the rate of P vivax recurrence was lower after treatment with low-dose primaquine (adjusted hazard ratio 0·21, 95% CI 0·17-0·27; p<0·0001) and high-dose primaquine (0·10, 0·08-0·12; p<0·0001). High-dose primaquine had greater efficacy than low-dose primaquine in regions with high and low relapse periodicity (ie, the time from initial infection to vivax relapse). 16 studies with patient-level data from 5609 patients from ten countries were included in the tolerability analysis. Gastrointestinal symptoms on days 5-7 were reported by 4·0% (95% CI 0·0-8·7) of 893 patients treated without primaquine, 6·2% (0·5-12·0) of 737 patients treated with a low daily dose of primaquine (approximately 0·25 mg/kg per day), 5·9% (1·8-10·1) of 1123 patients treated with an intermediate daily dose (approximately 0·5 mg/kg per day) and 10·9% (5·7-16·1) of 1178 patients treated with a high daily dose (approximately 1 mg/kg per day). 20 of 23 studies included in the efficacy analysis and 15 of 16 in the tolerability analysis had a low or unclear risk of bias. INTERPRETATION: Increasing the total dose of primaquine from 3·5 mg/kg to 7 mg/kg can reduce P vivax recurrences by more than 50% in most endemic regions, with a small associated increase in gastrointestinal symptoms. FUNDING: Australian National Health and Medical Research Council, Bill & Melinda Gates Foundation, and Medicines for Malaria Venture.

Spatial analysis of a case of reverse logistics of medicines in community pharmacies in Brazil - a preliminary study

Background: The reverse logistics of medicines consists of the logistical procedure of collection, transport, storage, treatment and final disposal of post-consumer or expired waste. Medicines can be toxic to the environment and affect the health of citizens of the territory. Community pharmacies, as a health facility, play a key role in this process. Objectives: Define the spatial analysis and cases of reverse logistics of medicines in community pharmacies in Brazil. Methods: This is a cross-sectional study, and the research covered the medicines collected by 400 community pharmacies in the period from 2020 to 2022. To obtain the data, the medicines were collected, weighed, segregated and the weight released on a dedicated waste management platform. All regions of Brazil subject to georeferencing were processed using the free software Geographic Information System (QGIS). Data were expressed as median and range or as frequency of occurrence. Chi-square t-test and Fisher's exact test were used to compare variables. The accepted significance level was 5%. Results: Of the five existing regions in Brazil, only three had records of reverse medication logistics. 4,519.74 Kg of products were collected, and the North region of Brazil was responsible for 69.1% of the collection. In the spatial analysis, it was possible to perceive a difference between the areas of concentration of the RDL, that is, locations where collections were carried out in the period from 2020 to 2022. Conclusion: The present study preliminarily analyzed the reverse logistics of medicines in Brazil. The data obtained can contribute to the knowledge of this area and to the strengthening of the process. Thus, these places must exercise a task force for the educational process of the population about the risks of incorrect disposal of medicines and that this could harm the environment, economic aspects of society, food and the entire context that involves health and well-being. of citizens (AU)

Influence of sex on the exposure to isoniazid in patients with pulmonary tuberculosis.

Isoniazid is a key component of tuberculosis treatment. Adequate exposure is a determinant for therapeutic success; however, considerable inter- and intraindividual variations in drug plasma levels can lead to unfavorable outcomes. While some predictors of isoniazid levels are well-known, others, such as sex, yield controversial results, requiring further investigation to optimize exposure. This study investigates whether the sex of patients influences the dose administered and the concentrations of isoniazid in plasma. Levels of isoniazid were associated with the N-acetyltransferase 2 phenotypes. A total of 76 male and 58 female patients were included. Isoniazid was measured by high-performance liquid chromatography, and N-acetyltransferase 2 phenotypes were assessed using molecular techniques. The results show that the dose administered, expressed in mg/kg, was higher in females, but the plasma levels were similar between both sexes. Among patients, 46.2%, 38.8%, and 15% were slow, intermediate, and fast acetylators, respectively. As expected, isoniazid levels were associated with the acetylation phenotypes, with higher concentrations in the slow acetylators. Thus, sex-related difference in isoniazid levels is due to the body weight of patients, and the optimized dose regimen based on patient weight and acetylator phenotypes can improve the treatment outcomes.

Effect of adherence to primaquine on the risk of Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis.

BACKGROUND: Imperfect adherence is a major barrier to effective primaquine radical cure of Plasmodium vivax. This study investigated the effect of reduced adherence on the risk of P. vivax recurrence. METHODS: Efficacy studies of patients with uncomplicated P. vivax malaria, including a treatment arm with daily primaquine, published between January 1999 and March 2020 were identified. Individual patient data from eligible studies were pooled using standardized methodology. Adherence to primaquine was inferred from i) the percentage of supervised doses and ii) the total mg/kg dose received compared to the target total mg/kg dose per protocol. The effect of adherence to primaquine on the incidence of P. vivax recurrence between days 7 and 90 was investigated by Cox regression analysis. RESULTS: Of 82 eligible studies, 32 were available including 6917 patients from 18 countries. For adherence assessed by percentage of supervised primaquine, 2790 patients (40.3%) had poor adherence (≤ 50%) and 4127 (59.7%) had complete adherence. The risk of recurrence by day 90 was 14.0% [95% confidence interval: 12.1-16.1] in patients with poor adherence compared to 5.8% [5.0-6.7] following full adherence; p = 0.014. After controlling for age, sex, baseline parasitaemia, and total primaquine dose per protocol, the rate of the first recurrence was higher following poor adherence compared to patients with full adherence (adjusted hazard ratio (AHR) = 2.3 [1.8-2.9]). When adherence was quantified by total mg/kg dose received among 3706 patients, 347 (9.4%) had poor adherence, 88 (2.4%) had moderate adherence, and 3271 (88.2%) had complete adherence to treatment. The risks of recurrence by day 90 were 8.2% [4.3-15.2] in patients with poor adherence and 4.9% [4.1-5.8] in patients with full adherence; p < 0.001. CONCLUSION: Reduced adherence, including less supervision, increases the risk of vivax recurrence.

Performing rapid metabolite tests (IgG-IgM) for SARS-CoV-2 infection in community pharmacies: A cross sectional-study from Brazil

Background: Immunochromatographic rapid tests in pharmacies allow the discovery of specific antibodies against SARS-CoV-2 or viral antigens and provide a broader and more effective screening of the virus. However, in many countries, this process is still not well defined. In this sense, the perception of pharmacists about these screening practices presents an overview of how the service is being carried out in the country. Objective: This study was to evaluate the performance of rapid immunochromatographic tests and their clinical results in community pharmacies in northern Brazil. Method: A retrospective study was carried out between May 2020 and December 2021 in community pharmacies in the northern region of Brazil. Participants were 18 years of age or older, of both sexes, who spontaneously sought the SARS-CoV-2 rapid testing service at pharmacies located in the municipality of Belem and who had had close contact with the virus or symptoms infection-related. Data were expressed as median and range or as frequency of occurrence. Chi-square t-test and Fisher’s exact test were used to compare variables. The accepted significance level was 5%. This study was approved by the Research Ethics Committee (number: 4,865,206). Results: A total of 78,849 patients were recruited into the study. Most patients, 37,847 (48%), were tested antibody positive for SARS-CoV-2. There were no severe signs and symptoms of the disease. The results showed the great demand for carrying out the rapid test in pharmacies and these places could contribute to the understanding of this health establishment, to curb the speed of SARS-CoV-2 dissemination. (AU)

Influence of sex on the exposure to isoniazid in patients with pulmonary tuberculosis

ABSTRACT Isoniazid is a key component of tuberculosis treatment. Adequate exposure is a determinant for therapeutic success; however, considerable inter- and intraindividual variations in drug plasma levels can lead to unfavorable outcomes. While some predictors of isoniazid levels are well-known, others, such as sex, yield controversial results, requiring further investigation to optimize exposure. This study investigates whether the sex of patients influences the dose administered and the concentrations of isoniazid in plasma. Levels of isoniazid were associated with the N-acetyltransferase 2 phenotypes. A total of 76 male and 58 female patients were included. Isoniazid was measured by high-performance liquid chromatography, and N-acetyltransferase 2 phenotypes were assessed using molecular techniques. The results show that the dose administered, expressed in mg/kg, was higher in females, but the plasma levels were similar between both sexes. Among patients, 46.2%, 38.8%, and 15% were slow, intermediate, and fast acetylators, respectively. As expected, isoniazid levels were associated with the acetylation phenotypes, with higher concentrations in the slow acetylators. Thus, sex-related difference in isoniazid levels is due to the body weight of patients, and the optimized dose regimen based on patient weight and acetylator phenotypes can improve the treatment outcomes.

Resilience, self-efficacy and motivation as positive psychological characteristics of student and professional dancers / Resiliência, autoeficácia e motivação como características psicológicas positivas de bailarinos alunos e profissionais

ABSTRACT This study aimed at assessing the following psychological variables: resilience, self-efficacy and motivation. A total of 135 dancers participated in the study, that is, 112 students from the Brazilian dance school known as Escola de Dança do Teatro Guaíra, 15 professional dancers from the school referred to as Balé Teatro Guaíra, and 08 professional dancers from the school named G2 Cia de Dança. The evaluation of the psychological variables was carried out by using four questionnaires: Resilience Scale (RS), General Self-Efficacy Scale (GSE), Self-Efficacy Scale for Dancers (SESD), and Sport Motivation Scale-II (SMS-II). The Hierarchical Cluster Analysis with the Ward's method and Mann-Whitney test were used for assessing the data. The results showed that students and professionals have similar levels of motivation, but divergent ones regarding friendship, personal fulfilment, satisfaction, meaning of life and self-confidence, ability to adapt to situations of resilience, and psychological self-efficacy. The Cluster Analysis enabled the researchers to organize the group of student dancers with similar characteristics into three clusters, that is, 'predominant', 'intermediate' and 'minority', whereas the group of professional dancers was divided into two groups, 'minor and 'major''. It was concluded that both student dancers and professional ones showed high values of resilience, self-efficacy and motivation. These results highlight that dance has an important role in the construction of a positive psychological profile.

RESUMO Esta pesquisa analisou as seguintes variáveis psicológicas: resiliência, autoeficácia e motivação. Um total de 135 bailarinos participou do estudo, isto é, 112 alunos da Escola de Dança do Teatro Guaíra, 15 bailarinos profissionais do Balé Teatro Guaíra e 08 bailarinos profissionais do G2 Cia de Dança. A avaliação das variáveis psicológicas foi realizada por meio de quatro questionários: Escala de Resiliência (ES), Escala de Autoeficácia Geral Percebida (EAGP), Escala de Autoeficácia para Bailarinos (AEBAI) e Escala de Motivação para o Esporte II (SMS-II). Para análise de dados utilizou-se a Análise de Clusters hierárquica com o Método de Ward e o Teste de Mann-Whitney. Os resultados mostraram que alunos e profissionais possuem níveis semelhantes para a motivação, todavia distintos com relação às categorias de amizade, realização pessoal, satisfação, significado de vida e autoconfiança, capacidade de adaptação a situações da resiliência e autoeficácia psicológica. A Análise de Clusters possibilitou organizar o grupo de bailarinos alunos com características semelhantes em três clusters, isto é, "predominante", "intermediário" e "minoritário", enquanto que o grupo de bailarinos profissionais foi dividido em dois grupos, isto é, "menor" e "maior". Concluiu-se que tanto bailarinos alunos e profissionais da dança apresentaram altos índices de resiliência, autoeficácia e motivação. Estes resultados permitem afirmar que a dança têm um papel importante na construção de um perfil psicológico positivo.

Relação entre o perfil sociodemográfico e a competência motora de crianças / Relationship between the sociodemographic profile and motor competence of children

Resumo Objetivo Verificar as relações estabelecidas entre os fatores individuais e ambientais na competência motora de crianças de 06 a 10 anos de idade. Método Trata-se de um estudo de caráter quantitativo, sustentado na estatística descritiva e inferencial. Os seguintes instrumentos de coleta foram utilizados: Teste de Proficiência Motora de Bruininks-Oseretsky e Home Observation for Measurement of the Environment - Middle Childhood. Resultados As análises indicaram a influência dos constructos ambientais no desenvolvimento e manutenção da competência motora das crianças, elucidando o fato de que o ambiente domiciliar adequado é um fator de proteção para o desenvolvimento dessa competência. Crianças residentes em casas adequadas apresentaram em média 66% mais chances de terem competência motora. Outro fato evidenciado deu-se em razão da disparidade no nível de competência motora entre os sexos, com destaque para o fato de que meninas com idade entre 9 e 10 anos que residem em domicílios classificados como não adequados localizados na região central da cidade e que estudam em escolas públicas apresentaram valores de competência motora abaixo do esperado para sua idade. Conclusão O perfil sociodemográfico de crianças que apresentaram as melhores chances para uma proficiência motora mais alta foi de meninos com idade entre 6 e 7 anos que residem em domicílios classificados como adequados localizados em bairros e que estudam em escolas privadas.

Abstract Objective To verify the relationships established between individual and environmental factors in the motor competence of children aged 06 to 10 years. Method This is a quantitative study supported by descriptive and inferential statistics. The following collection instruments were used: Bruininks-Oseretsky Motor Proficiency Test and Home Observation for Measurement of the Environment - Middle Childhood. Results The analyses indicated the influence of environmental constructs on the development and maintenance of children's motor competence, elucidating the fact that the appropriate home environment is a protective factor for the development of this competence. Children residing in adequate homes were 66% more likely to have motor competence on average. Another fact highlighted was due to the disparity in the level of motor competence between the sexes, with emphasis on the fact that girls aged 9-10 years who live in households classified as unsuitable, located in the central region of the city, studying in public schools presented motor competence values below the expected for their age. Conclusion The sociodemographic profile of children who presented the best chances for higher motor proficiency included boys aged 6-7 years old, living in households classified as adequate, located in neighborhoods outside the central region, and studying in private schools.

Pharmacokinetics of chloroquine in patients with malaria by P. vivax from the Western Brazilian Amazon basin.

The western Amazon basin is an important endemic area for malaria by P. vivax. In recent years, several reports showed the treatment failure with chloroquine, which can be related to resistance. The assessment of chloroquine resistance requires the evaluation of drug exposure, and when possible, the estimation of the pharmacokinetic parameters. However, there is no data on the pharmacokinetics of chloroquine in this endemic area. Moreover, the influence of the early reappearance of parasites in blood on the exposure to the drug was low exploited in the literature. The present study described the pharmacokinetic parameters of chloroquine in whole blood of adult patients with P. vivax malaria from the western Brazilian Amazon basin and compared the area under the curve (AUC) with the parasitological outcome at day 28. A total of 19 patients with parasite recurrence within 28 days and 20 patients with no recurrence were included in the study. Chloroquine was measured by high-performance liquid chromatography (HPLC). The pharmacokinetic parameters were estimated by non-compartmental modeling. The maximum concentration ranged from 1285 to 2030 ng/mL. The terminal half-life varied from 5.3 to 12.8 days. The volume of distribution from 1090 to 2340 L/kg, and the area under the curve to the last measurable concentration from 247 to 432 ng/mL.h. The pharmacokinetic parameters were similar in both groups, which suggests the lack of influence of early reappearance of parasites on chloroquine pharmacokinetics.

Psychometric properties of the Movement Assessment Battery for Children (MABC-2): an analysis based on the Item Response Theory / A falta capacidade discriminatória em tarefas motoras do Movement Assessment Battery for Children ­ 2: O que a Teoria de Resposta ao Item revela?

Introduction: the American Psychiatric Association reveals that 6% of school-age children have developmental coordination disorder. Objective: this study aimed at assessing the suitability of the tasks proposed by the MABC-2 motor assessment instrument based on the psychometric properties of such an instrument and the analysis of the Item Response Theory. Methods: 582 children ranging in age from 3 to 5 years old of both sexes participated in the study. The motor tasks suitability for children was verified by using the Gradual Response Model, and applying the Maximum Likelihood Estimation method. Results: the motor task 'bicycle trail' showed a lower discriminatory power and was removed from the analysis. Considering the 'Aiming & Catching' dimension, 'Threading Beads' was the motor task with the highest degree of difficulty. Regarding balance, the 'One Leg Balance' task was classified as having a high degree of difficulty; on the other hand, the motor tasks 'Jumping on mats' and 'Catching Beanbag' required below average motor performance levels, that is, they are tasks with low discrimination capacity. The results showed that the low discriminative capacity of some MABC-2 items regarding this study sample makes it difficult to correctly classify the child's general motor performance level.Conclusion: the findings show that there is a need to review the suitability of the MABC-2 motor tasks in order to equate the difficulty and discriminatory capacity of the tasks so that standardization more appropriate to the reality of children from different populations is established.Keywords: psychometric properties, motor tasks, motor performance.

Introdução: a American Psychiatric Association revela que 6% das crianças em idade escolar apresentavam desordem coordenativa desenvolvimental. Objetivo: analisar a adequabilidade das tarefas propostas no instrumento de avaliação motora MABC-2 a partir da análise da teoria de resposta ao item.Método: participaram do estudo 582 crianças de 3 a 5 anos de idade, de ambos os sexos. A adequabilidade das tarefas motoras às crianças foi verificada por meio do modelo de resposta gradual, com método de estimação de máxima verossimilhança. Resultados: os resultados evidenciaram a existência de apenas dois fatores, sendo que as tarefas relativas ao "Equilíbrio" e "Lançar e "Receber", das dimensões propostas no modelo original foi agrupado em uma dimensão. Além disso, a tarefa motora "Caminho da bicicleta" não apresentou bom ajuste ao modelo, sendo eliminada das análises. Com isto, o modelo final apresentou bons índices de ajuste, e os parâmetros relacionados à tarefa indicaram a falta de equivalência de dificuldade e capacidade discriminatória entre as tarefas motoras do instrumento.Conclusão: os achados indicam que existe a necessidade de rever a adequabilidade das tarefas motoras do MABC-2 no sentido de equiparar a dificuldade e a capacidade discriminatória das tarefas a fim de criar uma padronização mais adequada a realidade de crianças de diferentes populações.

Parâmetros de dificuldade e discriminação das tarefas motoras do instrumento KTK: uma análise a partir da teoria de resposta ao item / Difficulty and discrimination parameters of the KTK instrument motor tasks: an analysis from item response theory

RESUMO Nas últimas décadas o uso da Teoria de Resposta ao Item (TRI) tem sido implementada devido à complexidade dos cálculos estatísticos que permite analisar com profundidade testes educacionais, questionários e listas de itens aplicados em diferentes áreas como a psicometria, ranking esportivo e pedagogia. A partir dessa premissa este estudo teve como objetivo verificar a adequabilidade das tarefas motoras do KTK analisando o grau de dificuldade e parâmetro de discriminação de cada tarefa motora. Participaram do estudo 385 crianças de 5 a 14 anos. O instrumento avaliado foi o KTK (Körperkoordinationstest für Kinder), composto por quatro tarefas motoras: trave de equilíbrio, saltos monopedais, saltos laterais e transposição de plataformas. As análises foram conduzidas a partir dos dados brutos adquiridos em cada tarefa motora. A fim de verificar a estrutura fatorial da matriz teórica subjacente ao teste, foi realizada uma análise fatorial exploratória seguida da análise fatorial confirmatória. Os parâmetros de dificuldade e discriminação de cada tarefa motora foram analisados a partir do modelo de resposta gradual, fundamentado na teoria de resposta ao item (TRI). Os resultados corroboram com a estrutura fatorial sugerida na versão original do KTK, apresentando apenas um fator, chamado de coordenação motora. Os indicadores da Análise Fatorial Confirmatória (AFC) foram aceitáveis, indicando boa qualidade do modelo ajustado para a amostra. Conclui-se que a análise de TRI evidenciou diferenças nos parâmetros de dificuldade e de discriminação entre as tarefas motoras do KTK, demonstrando a importância de considerar uma ponderação na criação de tabelas normativas de avaliações motoras.

ABSTRACT In the last decades, the use of Item Response Theory (IRT) has been implemented due to the complexity of statistical calculations that allows for in-depth analysis of educational tests, questionnaires and lists of items applied in different areas such as psychometry, sports ranking and pedagogy. Based on this premise, this study aimed to verify the suitability of the KTK motor tasks analyzing the degree of difficulty and discrimination parameters of each motor task. A total of 385 children aged 5 to 14 years participated in the study. The instrument evaluated was the KTK (Körperkoordinationstest für Kinder), consisting of four motor tasks: balance beam, single-pedal jumps, side jumps and platform transposition. Analyzes were conducted from the raw data acquired in each motor task. In order to verify the factor structure of the theoretical matrix underlying the test, an exploratory factor analysis was performed, followed by a confirmatory factor analysis. The difficulty and discrimination parameters of each motor task were analyzed using the gradual response model, based on the Item Response Theory (IRT). The results corroborate the factor structure suggested in the original version of the KTK, presenting only one factor, called motor coordination. The AFC indicators were acceptable, indicating good quality of the model adjusted for the sample. It is concluded that the IRT analysis evidenced differences in the parameters of difficulty and discrimination between the KTK motor tasks, demonstrating the importance of considering a weighting in the creation of normative tables of motor assessments.

Movement assessment battery for children-second edition: theoretical adequacy of a motor assessment instrument / Movement assessment battery for children-second edition: adequação teórica do modelo do instrumento de avaliação motora

ABSTRACT Objective: To investigate the adequacy of the theoretical model of the Movement Assessment Battery for Children-Second Edition (MABC-2) instrument. Methods: 582 children, of both sexes, aged between 3 and 5 years and residents in the city of Maringá (state of Paraná, Southern Brazil) participated in the study. Data were collected from May/2014 to June/2015 and analyzed using descriptive and inferential statistics. Results: The evidence obtained from exploratory factor analysis indicated the presence of two factors, which was the option that best fitted the explanatory model. Hence, it was necessary to regroup the motor tasks of the dimensions "Aiming & catching" and "Balance" into only one dimension. It is noteworthy that the "Bicycle trail" motor task did not fit the model, as it presented a low and negative factor load in the analyzed dimensions. In the confirmatory factor analysis, adequate adjustment indices were observed for the tested model, which confirmed the non-classification of the "Bicycle trail" motor task in the original dimension. Conclusions: After removing the "Bicycle trail" motor task, the adjusted two-factor model seems to be the most appropriate to assess the motor performance of children participating in the study.

RESUMO Objetivo: Investigar a adequabilidade do modelo teórico do instrumento de avaliação motora Movement Assessment Battery for Children-Second Edition. Métodos: Participaram do estudo 582 crianças, de ambos os sexos com idade entre 3 e 5 anos da cidade de Maringá, Paraná, no período de maio/2014 a junho/2015. Para analisar os dados, utilizou-se a estatística descritiva e inferencial. Resultados: As evidências obtidas por meio da análise fatorial exploratória indicaram a presença de dois fatores. Essa opção foi a que melhor se ajustou ao modelo explicativo. Com isso, foi necessário reagrupar as tarefas motoras das dimensões "lançar e receber" e "equilíbrio" em apenas uma dimensão. Destaca-se que a tarefa motora "caminho da bicicleta" não se adequou ao modelo, pois apresentou carga fatorial baixa e negativa nas dimensões analisadas. Na análise fatorial confirmatória, observaram-se índices de ajustamento adequados para o modelo testado, a qual confirmou o não enquadramento da tarefa motora "caminho da bicicleta" na dimensão original. Conclusões: Após a retirada da tarefa motora "caminho da bicicleta", o modelo ajustado de dois fatores parece ser o mais adequado para avaliar o desempenho motor das crianças participantes do estudo.

Tratamento de efluentes: remoção de detergente utilizando processo Fenton com ultrassom e prego reutilizado / Effluent treatment: detergent removal using Fenton ultrasound process and reused nail

RESUMO Diferentes metodologias são descritas na literatura para tratamento de efluentes industriais. Entretanto, a maioria dos processos não são totalmente eficientes quando o efluente apresenta baixo conteúdo de partícula coloidal suspensa e alta concentração de matéria orgânica e detergentes. Entre os métodos que são estudados para eliminar detergente e matéria orgânica de efluentes industriais, o processo Fenton é uma estratégia atraente. No presente estudo, foi aplicada uma metodologia para remoção de detergente de efluentes líquidos utilizando processo Fenton com ultrassom e prego reutilizado. A otimização de parâmetros para tratamento do efluente foi realizada por meio das análises de pH, detergente, cor, turbidez, demanda química de oxigênio, demanda bioquímica de oxigênio, óleos e graxas, e sólidos suspensos. Os melhores resultados foram obtidos em pH 3,5, com 90 mg L−1 de peróxido de hidrogênio e um prego de ferro (2,7g) tanto para o processo Fenton como para o Fenton com ultrassom. Nessas condições, os valores de remoção de detergente foram de 99,4%. Em pH 2,5, 4,5 e 5,5, os valores obtidos para remoção de detergente foram menores, 75,2, 89,5, 68,4%, respectivamente. Resultados semelhantes foram obtidos para cor, turbidez, demanda química de oxigênio e demanda bioquímica de oxigênio. A reutilização dos pregos mostrou que a eficiência média na remoção de detergente até o quarto ciclo foi acima de 90%, e, a partir do quinto ciclo, observou-se uma diminuição gradativa, sendo a diferença entre o primeiro e o sexto ciclo em torno de 10%.

ABSTRACT Different methodologies are described in the literature for the industrial effluents treatment. However, most processes are not fully efficient when the effluent has low suspended colloidal particle content and high concentration of organic matter and detergents. Among the methods that are studied to eliminate detergent and organic matter from industrial effluents, the Fenton process is an attractive strategy. In the present study, a more sustainable methodology was applied to remove detergent and organic matter from liquid effluents using Fenton process with ultrasound and recycled nail. The optimization of parameters for effluent treatment was carried out through the analysis of pH, detergents, color, turbidity, chemical oxygen demand, biochemical oxygen demand, oils and greases, and suspended solids. The best results were obtained at pH 3.5, with 90 mg L−1 of hydrogen peroxide and an iron nail (2.7 g) both for the Fenton process and Fenton with ultrasound. Under these conditions, detergent removal values were 99.4%. At pH 2.5, 4.5, and 5.5, the values obtained for detergent removal were lower, 75.2, 89.5, and 68.4%, respectively. Similar results were obtained for color, turbidity, chemical oxygen demand, and biochemical oxygen demand. The reuse of the nails showed that the average detergent removal efficiency up to the fourth cycle was above 90%, and, from the fifth cycle, a gradual decrease was observed, with the difference between the first and sixth cycles being around 10%.

A preliminary study on the association of tamoxifen, endoxifen, and 4-hydroxytamoxifen with blood lipids in patients with breast cancer.

The long-term treatment with tamoxifen can alter the lipid profile of patients with breast cancer. Only a few studies associated the plasma concentrations of tamoxifen, endoxifen, and 4-hydroxytamoxifen with blood lipids, which is relevant as the distribution of these compounds for the tissues can be changed, negatively affecting the treatment. The variations in lipids also can account for the high interindividual variation in plasma concentrations of these compounds. The aim of this preliminary study was to associate the plasma levels of tamoxifen and the active metabolites with the lipid levels. An observational study of cases was conducted in patients with breast cancer using tamoxifen in a daily dose of 20 mg. The lipids were measured by spectrophotometric methods and the plasma concentrations of tamoxifen, endoxifen, and 4-hydroxytamoxifen by high-performance liquid chromatography. A total of 20 patients were included in the study. The median plasma concentrations of tamoxifen, 4-hydroxytamoxifen and endoxifen were 62 ng/mL, 1.04 ng/mL and 8.79 ng/mL. Triglycerides levels ranged from 59 to 352 mg/dL, total cholesterol from 157 to 321 mg/dL, LDL-c from 72 mg/dL to 176 mg/dL and HDL-C from 25.1 mg/dL to 62.8 mg/dL. There were no significant associations between the plasma concentrations of tamoxifen, 4-hydroxytamoxifen, and endoxifen with the levels of triglycerides and total cholesterol. The multivariate analysis revealed a weak association between plasma concentrations of tamoxifen and the active metabolites with HDL-c, LDL-c and VLDL-c. This finding provides preliminary evidence of the low impact of lipoproteins levels in the exposure to tamoxifen, 4-hydroxytamoxifen and endoxifen.

MOVEMENT ASSESSMENT BATTERY FOR CHILDREN-SECOND EDITION: THEORETICAL ADEQUACY OF A MOTOR ASSESSMENT INSTRUMENT.

OBJECTIVE: To investigate the adequacy of the theoretical model of the Movement Assessment Battery for Children-Second Edition (MABC-2) instrument. METHODS: 582 children, of both sexes, aged between 3 and 5 years and residents in the city of Maringá (state of Paraná, Southern Brazil) participated in the study. Data were collected from May/2014 to June/2015 and analyzed using descriptive and inferential statistics. RESULTS: The evidence obtained from exploratory factor analysis indicated the presence of two factors, which was the option that best fitted the explanatory model. Hence, it was necessary to regroup the motor tasks of the dimensions "Aiming & catching" and "Balance" into only one dimension. It is noteworthy that the "Bicycle trail" motor task did not fit the model, as it presented a low and negative factor load in the analyzed dimensions. In the confirmatory factor analysis, adequate adjustment indices were observed for the tested model, which confirmed the non-classification of the "Bicycle trail" motor task in the original dimension. CONCLUSIONS: After removing the "Bicycle trail" motor task, the adjusted two-factor model seems to be the most appropriate to assess the motor performance of children participating in the study.

Nutritional determinants as potential contributors to anemia in children and adolescents with malaria by P. vivax / Determinantes nutricionais como potenciais contribuintes para anemia em crianças e adolescentes com malária por P. vivax / Determinantes nutricionales como posibles contribuyentes para la anemia en niños y adolescentes con malaria por P. Vivax

Background and Objectives: Nutrition, in addition to its physiological function, plays an important role in the recovery of individuals with malaria, a disease that still represents a serious public health problem in the world. The objective of this study was to assess nutritional determinants in the frequency of food intake and the occurrence of anemia in children and adolescents with P. vivax malaria. Methods: A cross-sectional analytical study was carried out between 2014 and 2015 in the Marajo Island. The hemoglobin level was measured by the colorimetric enzymatic reaction and a questionnaire of food intake frequency was used to assess the consumption of different types of food. Results: A total of 67 patients met the inclusion criteria, from which 62.7% were children and 37.3% were adolescents. There was a high consumption of ultra-processed foods in both age groups. Anemia occurred in 52.2% of patients, and in most of them it was moderate. There was no significant association between anemia and sex, age group or parasitemia at admission. However a significant association was found between anemia and the ingestion of ultra-processed foods. Conclusion: The ingestion of ultra-processed foods contributes to anemia in children and adolescent with malaria by P. vivax.(AU)

Justificativa e Objetivos: A nutrição, além de sua função fisiológica, desempenha um papel importante na recuperação de indivíduos com malária, uma doença que ainda representa um grave problema de saúde pública no mundo. O objetivo deste estudo é avaliar os determinantes nutricionais na frequência da ingestão alimentar e a ocorrência de anemia em crianças e adolescentes com malária por P. vivax. Métodos: Estudo transversal analítico, realizado entre 2014 e 2015 na ilha do Marajó. O nível de hemoglobina foi medido pela reação enzimática colorimétrica e um questionário de frequência de ingestão alimentar foi utilizado para avaliar o consumo de alimentos. Resultados: Um total de 67 pacientes atendeu aos critérios de inclusão do estudo, dos quais 62,7% eram crianças e 37,3% adolescentes. Houve alto consumo de alimentos ultraprocessados em ambas as faixas etárias. A anemia foi detectada em 52,2% dos pacientes e, na maioria deles, foi moderada. Não houve associação significativa entre anemia e sexo, faixa etária ou parasitemia na admissão. No entanto, encontramos uma associação significativa entre presença de anemia e ingestão de alimentos ultraprocessados. Conclusão: A ingestão de alimentos ultraprocessados contribui para a anemia em crianças e adolescentes com malária por P. vivax.(AU)

Justificación y objetivos: La nutrición, además de su función fisiológica, juega un papel importante en la recuperación de las personas con malaria, una enfermedad que todavía representa un importante problema de salud pública en el mundo. El objetivo de este estudio es evaluar los determinantes nutricionales en la frecuencia del consumo de alimentos y la ocurrencia de anemia en niños y adolescentes con malaria por P. vivax. Métodos: se realizó un estudio analítico transversal entre 2014 y 2015, en la Isla de Marajó. El nivel de hemoglobina fue evaluado por ensayos enzimáticos colorimétricos y se utilizó un cuestionario de frecuencia de consumo de alimentos para evaluar el consumo. Resultados: Un total de 67 pacientes cumplió los criterios de inclusión en el estudio, de los cuales el 62,7% eran niños y el 37,3% adolescentes. Se registró un alto consumo de alimentos ultraprocesados en niños y adolescentes. La anemia se detectó en el 52,2% de los pacientes, de carácter moderada principalmente. No se encontró una asociación significativa entre anemia y sexo, grupo de edad o parasitemia al ingreso. Sin embargo, se encontró una asociación significativa entre la anemia y la ingestión de alimentos ultraprocesados. Conclusión: La ingesta de alimentos ultraprocesados se asocia con la presencia de anemia en niños y adolescentes con malaria por P. vivax.(AU)

Football society players over the age of 55: how stressful can a match be?

This study aimed atassessingthe physical activitylevel, heart rate and the salivary cortisol level of football society players.The sample consisted of 19 male mastersfootballplayerswith an average age of 56.7±3.9 years. The long form of the International Physical Activity Questionnaire (IPAQ)andPolar®heart rate monitors were usedas instruments, in additionto Salivette® tubes to measure salivary cortisol. Data analysis was performed by using the repeated measuresAnalysis of Variance (ANOVA) with Bonferroni post hoctest,and Spearman's Rank Correlation Coefficient. The results showed that the salivary cortisol concentration indicated an index of 1.97 ng/ml at the beginning of the match;40 minutes after that thesevalues increased to 8.00 ng/ml,and 60 minutesafter the match had started they reached 8.40 ng/ml. Considering the post-match moment, a moderate and positive correlation between the salivary cortisol concentration and heart rate (averageand maximum) wasseen. In conclusion,the physical effort expended during football Society practice needs to be monitored due to the high heart rate and high increase in the salivary cortisol concentrationofthis age group.

Exposure to chloroquine in male adults and children aged 9-11 years with malaria due to Plasmodium vivax.

BACKGROUND: Chloroquine is effective against the asexual blood stage of Plasmodium vivax. A high proportion of children are underdosed with the drug, but there are no studies comparing chloroquine exposure in adults and children aged 8-11 years old. The present study intends to compare these populations using the area under the curve (AUC) derived from the plasma concentration-time profile in patients with P. vivax. METHODS: A prospective study of cases was performed on male children (aged 9-11 years) and adults with vivax malaria. Blood samples were collected after several days of treatment. Chloroquine was measured by high-performance liquid chromatography. A non-compartmental pharmacokinetic model was used to calculate the pharmacokinetic parameters of the drug. RESULTS: A total of 20 children and 25 adults were included in the study. Plasma concentrations of chloroquine in older children ranged from 67 to 1112 ng/ml, and in adults the value ranged from 74 to 1147 ng/ml. The AUC to the last measurable concentration and to infinite was significantly lower in children than in adults, indicating a lower exposure to the drug. CONCLUSION: These data demonstrate lower exposure to chloroquine in children, which corroborates the importance of optimising the doses of chloroquine in the study age band to ensure adequate exposure to the drug.