Clean and accurate soil quality monitoring in mining areas under environmental rehabilitation in the Eastern Brazilian Amazon.

Soil quality monitoring in mining rehabilitation areas is a crucial step to validate the effectiveness of the adopted recovery strategy, especially in critical areas for environmental conservation, such as the Brazilian Amazon. The use of portable X-ray fluorescence (pXRF) spectrometry allows a rapid quantification of several soil chemical elements, with low cost and without residue generation, being an alternative for clean and accurate environmental monitoring. Thus, this work aimed to assess soil quality in mining areas with different stages of environmental rehabilitation based on predictions of soil fertility properties through pXRF along with four machine learning algorithms (projection pursuit regression, PPR; support vector machine, SVM; cubist regression, CR; and random forest, RF) in the Eastern Brazilian Amazon. Sandstone and iron mines in different chronological stages of rehabilitation (initial, intermediate, and advanced) were evaluated, in addition to non-rehabilitated and native forest areas. A total of 81 soil samples (26 from sandstone mine and 55 from iron mine) were analyzed by both traditional wet-chemistry methods and pXRF. The available/exchangeable contents of K, Ca, B, Fe, and Al, in addition to H+Al, cation exchange capacity at pH = 7, Al saturation, soil organic matter, pH, sum of bases, base saturation, clay, and sand were accurately predicted (R2 > 0.70) using pXRF data, with emphasis on the prediction of Fe (R2 = 0.93), clay content (R2 = 0.81), H+Al (R2 = 0.81), and K+ (R2 = 0.85). The best predictive models were developed by RF and CR (86%) and when considering pXRF data + mining area + stage of rehabilitation (73%). The results highlight the potential of pXRF to accurately assess soil properties in environmental rehabilitation areas in the Amazon region (yet scarcely evaluated under this approach), promoting a more agile and cheaper preliminary diagnosis compared to traditional methods.

Could ultrasound and muscle elastography be associated with clinical assessment, laboratory and nailfold capillaroscopy in juvenile dermatomyositis patients?

BACKGROUND: Juvenile Dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Imaging exams are useful for muscle assessment, with ultrasonography (US) being a promising tool in detecting disease activity and tissue damage. There are few studies about muscle elastography. OBJECTIVES: Our aim was to associate clinical, laboratory, and nailfold capillaroscopy (NC) assessments with US in JDM patients; and to compare the findings of US and Strain Elastography (SE) from patients and healthy controls. METHODS: An analytic cross-sectional study was performed with JDM patients and healthy controls. Patients underwent clinical exam to access muscle strength and completed questionnaires about global assessment of the disease and functional capacity. Patients were submitted to NC and measurement of muscle enzymes. All subjects underwent US assessment, using gray scale, Power Doppler (PD), and SE. RESULTS: Twenty-two JDM patients and fourteen controls, aged between 5 and 21 years, matched for age and sex were assessed. In qualitative and semi-quantitative gray scale, we observed a higher frequency of alterations in patients (p < 0.001), while in PD, there was a higher frequency of positivity in patients' deltoids and anterior tibialis (p < 0.001). Active disease was associated with an important change in the semi-quantitative gray scale in deltoids (p = 0.007), biceps brachii (p = 0.001) and quadriceps femoris (p = 0.005). The SE demonstrated a high negative predictive value of 87.2. CONCLUSION: US was able, through gray scale, to differentiate JDM patients from controls, while PD achieved such differentiation only for deltoids and anterior tibialis. The semi-quantitative gray scale showed disease activity in proximal muscles. SE was not able to differentiate patients from controls.

Proximal sensing provides clean, fast, and accurate quality control of organic and mineral fertilizers.

Farms use large quantities of fertilizers from many sources, making quality control a challenging task, as the traditional wet-chemistry analyses are expensive, time consuming and not environmentally-friendly. As an alternative, this work proposes the use of portable X-ray fluorescence (pXRF) spectrometry and machine learning algorithms for rapid and low-cost estimation of macro and micronutrient contents in mineral and organic fertilizers. Four machine learning algorithms were tested. Whole (i.e., as delivered by the manufacturer) (CP) and ground (AQ) samples (429 in total) were analyzed to test the effect of fertilizer granulometry in prediction performance. Model validation indicated highly accurate predictions of macro (N: R2 = 0.92; P: 0.97; K: 0.99; Ca: 0.94, Mg: 0.98; S: 0.96) and micronutrients (B: 0.99; Cu: 0.99; Fe: 0.98; Mn: 0.91; Zn: 0.94) for both organic and mineral fertilizers. RPD values ranged from 2.31 to 9.23 for AQ samples, and Random Forest and Cubist Regression were the algorithms with the best performances. Even samples analyzed as they were received from the manufacturer (i.e., no grinding) provided accurate predictions, which accelerate the confirmation of nutrient contents contained in fertilizers. Results demonstrated the potential of pXRF data coupled with machine learning algorithms to assess nutrient composition in both mineral and organic fertilizers with high accuracy, allowing for clean, fast and accurate quality control. Sensor-driven quality assessment of fertilizers improves soil and plant health, crop management efficiency and food security with a reduced environmental footprint.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis.

OBJECTIVE: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. METHODS: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). RESULTS: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was -8.11% per year (95%CI -9.38; -6.82), while for Hepatitis B it was -4.13% (95%CI -6.03; -2.20), of Other viral hepatitis of -7.84% (95%CI -14.11; -1.11) and of Unspecified Hepatitis -5.67% per year (95%CI -6.22; -5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). CONCLUSION: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

Detailed characterization of iron-rich tailings after the Fundão dam failure, Brazil, with inclusion of proximal sensors data, as a secure basis for environmental and agricultural restoration.

Following the Fundão dam failure in Brazil, 60 million m3 of iron-rich tailings were released impacting an extensive area. After this catastrophe, a detailed characterization and monitoring of iron-rich tailings is required for agronomic and environmental purposes. This can be facilitated by using proximal sensors which have been an efficient, fast, and cost-effective tool for eco-friendly analysis of soils and sediments. This work hypothesized that portable X-ray fluorescence (pXRF) spectrometry combined with a pocket-sized (Nix™ Pro) color sensor and benchtop magnetic susceptibilimeter can produce substantial data for fast and clean characterization of iron-rich tailings. The objectives were to differentiate impacted and non-impacted areas (soils and sediments) based on proximal sensors data, and to predict attributes of agronomic and environmental importance. A total of 148 composite samples were collected on totally impacted, partially impacted, and non-impacted areas (natural soils). The samples were analyzed via pXRF to obtain the total elemental composition; via Nix™ Pro color sensor to obtain the red (R), green (G), and blue (B) parameters; and assessed for magnetic susceptibility (MS). The same samples used for analyses via the aforementioned sensors were wet-digested (USEPA 3051a method) followed by ICP-OES quantification of potentially toxic elements. Principal component analysis was performed to differentiate impacted and non-impacted areas. The pXRF data alone or combined with other sensors were used to predict soil agronomic properties and semi-total concentration of potentially toxic elements via random forest regression. For that, samples were randomly separated into modeling (70%) and validation (30%) datasets. The pXRF proved to be an efficient method for rapid and eco-friendly characterization of iron-rich tailings, allowing a clear differentiation of impacted and non-impacted areas. Also, important soil agronomic properties (clay, cation exchange capacity, soil organic carbon, pH and macronutrients availability) and semi-total concentrations of Ba, Pb, Cr, V, Cu, Co, Ni, Mn, Ti, and Li were accurately predicted (based upon the lowest RMSE and highest R2 and RPD values). Sensor data fusion (pXRF + Nix Pro + MS) slightly improved the accuracy of predictions. This work highlights iron-rich tailings from the Fundão dam failure can be in detail characterized via pXRF ex situ, providing a secure basis for complementary studies in situ aiming at identify contaminated hot spots, digital mapping of soil and properties variability, and embasing pedological, agricultural and environmental purposes.

A Proximal Sensor-Based Approach for Clean, Fast, and Accurate Assessment of the Eucalyptus spp. Nutritional Status and Differentiation of Clones.

Several materials have been characterized using proximal sensors, but still incipient efforts have been driven to plant tissues. Eucalyptus spp. cultivation in Brazil covers approximately 7.47 million hectares, requiring faster methods to assess plant nutritional status. This study applies portable X-ray fluorescence (pXRF) spectrometry to (i) distinguish Eucalyptus clones using pre-processed pXRF data; and (ii) predict the contents of eleven nutrients in the leaves of Eucalyptus (B, Ca, Cu, Fe, K, Mg, Mn, N, P, S, and Zn) aiming to accelerate the diagnosis of nutrient deficiency. Nine hundred and twenty samples of Eucalyptus leaves were collected, oven-dried, ground, and analyzed using acid-digestion (conventional method) and using pXRF. Six machine learning algorithms were trained with 70% of pXRF data to model conventional results and the remaining 30% were used to validate the models using root mean square error (RMSE) and coefficient of determination (R2). The principal component analysis clearly distinguished developmental stages based on pXRF data. Nine nutrients were accurately predicted, including N (not detected using pXRF spectrometry). Results for B and Mg were less satisfactory. This method can substantially accelerate decision-making and reduce costs for Eucalyptus foliar analysis, constituting an ecofriendly approach which should be tested for other crops.

Clean quality control of agricultural and non-agricultural lime by rapid and accurate assessment of calcium and magnesium contents via proximal sensors.

Ca and Mg are the most important chemical elements in lime. Properly measuring Ca and Mg contents is essential to assess the quality of lime products. Quality control guarantees the adequate use of lime in industrial processes, in soils, and helps avoiding adulteration. Proximal sensors can aid in this process by determining Ca and Mg contents easily, rapidly and without producing chemical waste. The objective of this study was to evaluate the use an environmentally-friendly method of analyzing the quality of lime. We studied 1) the use of portable X-ray fluorescence (pXRF) to predict concentrations of Ca and Mg in lime, 2) tested if NixPro™ sensor can improve prediction accuracy and 3) tested if sample preparation methods (grinding) affect analyses. 74 samples of lime were analyzed by two different laboratories (lab. 1 = 38, lab. 2 = 36). All samples submitted to pXRF and NixPro™ analyses. Sensor analyses were done in whole (CP) and ground (AQ) samples to test the effect of sample preparation in prediction performance. High correlation was found between Ca and Mg contents measured via pXRF and laboratory analyses. Mg-CP presented the highest correlation coefficient (r = 0.81); Mg-AQ, the lowest (0.57). Predictions presented good performance (R2 > 0.68); Mg had the best results (0.86). Separating models per laboratory showed that some datasets are harder to model, probably due to variability in the source material (limestone). The addition of NixPro™ data contributed to improve prediction accuracy, although slightly. Predictions using CP samples presented the best results, especially for Mg, indicating that grinding is not necessary. This pioneer study demonstrated that fused proximal sensors can be used to rapidly and easily determine contents of Ca and Mg in soil amendments without producing chemical waste.

Could ultrasound and muscle elastography be associated with clinical assessment, laboratory and nailfold capillaroscopy in juvenile dermatomyositis patients?

Abstract Background Juvenile Dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children. Imaging exams are useful for muscle assessment, with ultrasonography (US) being a promising tool in detecting disease activity and tissue damage. There are few studies about muscle elastography. Objectives Our aim was to associate clinical, laboratory, and nailfold capillaroscopy (NC) assessments with US in JDM patients; and to compare the findings of US and Strain Elastography (SE) from patients and healthy controls. Methods An analytic cross-sectional study was performed with JDM patients and healthy controls. Patients underwent clinical exam to access muscle strength and completed questionnaires about global assessment of the disease and functional capacity. Patients were submitted to NC and measurement of muscle enzymes. All subjects underwent US assessment, using gray scale, Power Doppler (PD), and SE. Results Twenty-two JDM patients and fourteen controls, aged between 5 and 21 years, matched for age and sex were assessed. In qualitative and semi-quantitative gray scale, we observed a higher frequency of alterations in patients (p < 0.001), while in PD, there was a higher frequency of positivity in patients' deltoids and anterior tibialis (p < 0.001). Active disease was associated with an important change in the semi-quantitative gray scale in deltoids (p = 0.007), biceps brachii (p = 0.001) and quadriceps femoris (p = 0.005). The SE demonstrated a high negative predictive value of 87.2. Conclusion US was able, through gray scale, to differentiate JDM patients from controls, while PD achieved such differentiation only for deltoids and anterior tibialis. The semi-quantitative gray scale showed disease activity in proximal muscles. SE was not able to differentiate patients from controls.

Caracterização e avaliação do paciente anticoagulado com varfarina em relação à complexidade da farmacoterapia / Characterization and evaluation of patients anticoagulated with warfarin in relation to the complexity of pharmacotherapy

A realização de diagnóstico e tratamento das arritmias sustentadas fazem parte da rotina clínica, sendo uma das arritmias mais frequentes a Fibrilação Atrial (FA). Para prevenção de eventos tromboembólicos em pacientes com FA, recomendase a anticoagulação oral, destacando-se a varfarina. Apesar da importância, esse medicamento possui estreita margem terapêutica, o que faz com que pequenas mudanças no tratamento gerem risco de eventos trombóticos ou hemorrágicos. Dentre essas mudanças, destaca-se a adesão aos demais medicamentos em uso, alteração do uso desses medicamentos por prescritores e automedicação. Várias são as interações entre varfarina e demais medicamentos de uso contínuo, acreditando-se que a complexidade da prescrição pode interferir nos desfechos clínicos da terapia anticoagulante. O objetivo do estudo foi caracterizar pacientes acompanhados em um ambulatório de anticoagulação em relação ao Índice de Complexidade da Farmacoterapia. Para identificação da complexidade da farmacoterapia, considerou-se as prescrições dos demais medicamentos em uso, prescritas por médicos da atenção primária em saúde. Utilizouse o instrumento Medication Regimen Complexity Index (MRCI). A complexidade, compreendida como a forma de administração, posologia e forma farmacêutica, fatores que interferem na adesão à terapia anticoagulante, foi subdividida em três níveis: baixa complexidade, moderada e alta, conforme indicado pela literatura. A análise da complexidade foi realizada por dois pesquisadores de forma independente, sendo considerados os critérios conforme orientação do MRCI. Trata-se de um estudo descritivo realizado em duas clínicas de anticoagulação, localizadas em Minas Gerais. Durante a pesquisa, pacientes foram acompanhados em dois ambulatórios de anticoagulação do Brasil, em uso de varfarina, foram convidados a participarem de um ensaio clínico entre dezembro de 2018 e fevereiro de 2019, sendo que posteriormente foi realizado um recorte para o presente estudo. Um total de 93 pacientes foram incluídos no estudo, sendo a média de idade de 63 anos e a maioria do sexo feminino (68,8%). A fibrilação atrial foi a indicação da ACO mais predominante (92,5%). A média do número de medicamentos utilizados foi de 7,0. A maioria dos pacientes com farmacoterapia classificada como alta (38, 6,5%) e média complexidade (24, 80,7%) apresentou TTR inadequado. O presente estudo permitiu identificar que há um predomínio de pacientes com alta complexidade da farmacoterapia, o que pode indicar necessidades de cuidados adicionais em relação ao tratamento anticoagulante. Para tanto, em casos de pacientes com controle inadequado da anticoagulação oral, recomenda-se que aspectos da complexidade da farmacoterapia sejam incorporados na abordagem educacional.

Diagnosis and treatment of sustained arrhythmias are part of the clinical routine, with one of the most frequent arrhythmias being Atrial Fibrillation (AF). To prevent thromboembolic events in patients with AF, oral anticoagulation is recommended, particularly warfarin. Despite its importance, this medication has a narrow therapeutic range, which means that small changes in treatment generate a risk of thrombotic or hemorrhagic events. Among these changes, adherence to other medications in use, changes in the use of these medications by prescribers and self-medication stand out. There are several interactions between warfarin and other medications for continuous use, with the belief that the complexity of the prescription may interfere with the clinical outcomes of anticoagulant therapy. The objective of the study was to characterize patients followed in an anticoagulation outpatient clinic in relation to the Pharmacotherapy Complexity Index. To identify the complexity of pharmacotherapy, prescriptions for other medications in use, prescribed by primary health care doctors, were considered. The Medication Regimen Complexity Index (MRCI) instrument was used. Complexity, understood as the form of administration, dosage and pharmaceutical form, factors that interfere with adherence to anticoagulant therapy, was subdivided into three complexity levels: low, moderate and high, as indicated in the literature. The complexity analysis was carried out by two researchers independently, considering the criteria as per MRCI guidance. This is a descriptive study carried out in two anticoagulation clinics, located in Minas Gerais. During the research, patients were monitored in two anticoagulation clinics in Brazil, using warfarin, and were invited to participate in a clinical trial between December 2018 and February 2019, and a selection was subsequently made for the present study. A total of 93 patients were included in the study, the average age was 63 years and the majority were female (68.8%). Atrial fibrillation was the most predominant OAC indication (92.5%). The average number of medications used was 7.0. The majority of patients with pharmacotherapy classified as high (38, 6.5%) and medium complexity (24, 80.7%) presented inadequate TTR. The present study identified that there is a predominance of patients with high complexity of pharmacotherapy, which may indicate the need for additional care in relation to anticoagulant treatment. Therefore, in cases of patients with inadequate control of oral anticoagulation, it is recommended that aspects of the complexity of pharmacotherapy be incorporated into the educational approach.

Avaliação do impacto da orientação farmacêutica aos pacientes sobre os medicamentos prescritos / Evaluation of the impact of pharmaceutical orientation given to patients on prescribed drugs

O uso racional de medicamentos é considerado um dos elementos-chave recomendados pela Organização Mundial de Saúde, cuja ausência pode acarretar consequências como reações adversas, diminuição da eficácia do medicamento, perdas de ordem econômica para o governo e/ou indivíduo, interações medicamentosas e agravo do quadro clínico do paciente. O serviço de orientação farmacêutica que envolve esse contexto foi discutido por poucos estudos, considerando-se interessante a utilização de um instrumento validado para demonstrar o impacto do fornecimento de orientação farmacêutica direcionada a pacientes em uso de medicamentos prescritos, o que constitui o objetivo desse trabalho. A metodologia utilizada foi estudo transversal conduzido em uma Unidade Básica de Saúde de Diamantina/ MG. Foi utilizado um questionário para medir o grau do conhecimento do paciente sobre seus medicamentos nos momentos pré e pós a realização de orientação farmacêutica. Após a orientação farmacêutica, observou-se diminuição do percentual de usuários que não conheciam seus medicamentos (73,2%; 93 para 33,9%; 43) e aumento do nível de conhecimento suficiente (14,2%; 18 para 18,9%; 24) e ótimo (11,0%; 14 para 47,2%; 60). Houve aumento do conhecimento dos usuários em todos os itens que compõem o questionário. A orientação farmacêutica apresentou impacto positivo sobre o conhecimento dos pacientes sobre seus medicamentos e constitui uma prática essencial para o Uso Racional dos Medicamentos.

The rational use of drugs is considered one of the key elements recommended by the World Health Organization, the absence of which can lead to consequences such as adverse reactions, decreased drug efficacy, economic losses for the government and/or individual, drug interactions, and worsening of the patient's clinical condition. The pharmaceutical orientation service that involves this context has been discussed by few studies, and the use of a validated instrument to demonstrate the impact of providing pharmaceutical guidance to patients on prescribed drugs is considered interesting and constitutes the objective of this work. The methodology used was a cross-sectional study conducted in a Primary Care Center in Diamantina, MG. A questionnaire was used to measure the patient's level of knowledge about their medications before and after receiving pharmaceutical guidance. After pharmaceutical orientation, there was a decrease in the percentage of users who did not know about their medications (73.2%; n=93 to 33.9%; n=43) and an increase in the level of sufficient knowledge (14.2%; n=18 to 18.9%; n=24) and excellent knowledge (11.0%; n=14 to 47.2%; n=60). There was an increase in users' knowledge of all the items that make up the questionnaire. Pharmaceutical orientation had a positive impact on patients' knowledge about their medications and constitutes an essential practice for the Rational Use of Medications.

Hepatitis mortality in Brazil and regions, 2001-2020: temporal trend and spatial analysis / Mortalidade por hepatites no Brasil e regiões, 2001-2020: tendência temporal e análise espacial

ABSTRACT Objective: To analyze the spatial distribution and the temporal trend of the hepatitis mortality rate in Brazil from 2001 to 2020. Methods: Ecological, temporal, and spatial study on mortality from hepatitis in Brazil with data from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM/DATASUS). Information was stratified by year of diagnosis, region of the country, municipalities (of residence). Standardized mortality rates (SMR) were calculated. The temporal trend was estimated by Prais-Winsten regression and the spatial distribution by the Global Moran Index (GMI). Results: The highest SMR means in Brazil were for Chronic viral hepatitis with 0.88 deaths per 100,000 inhabitants (SD=0.16), followed by Other viral hepatitis with 0.22/100,000 (SD=0.11). In Brazil, the temporal trend of mortality from Hepatitis A was −8.11% per year (95%CI −9.38; −6.82), while for Hepatitis B it was −4.13% (95%CI −6.03; −2.20), of Other viral hepatitis of −7.84% (95%CI −14.11; −1.11) and of Unspecified Hepatitis −5.67% per year (95%CI −6.22; −5.10). Mortality due to chronic viral hepatitis increased by 5.74% (95%CI 3.47; 8.06) in the North and 4.95% in the Northeast (95%CI 0.27; 9.85). The Moran Index (I) for Hepatitis A was 0.470 (p<0.001), for Hepatitis B 0.846 (p<0.001), Chronic viral hepatitis=0.666 (p<0.001), other viral hepatitis=0.713 (p<0.001), and Unspecified Hepatitis=0.712 (p<0.001). Conclusion: The temporal trend of hepatitis A, B, other viral, and unspecified hepatitis was decreasing in Brazil, while mortality from chronic hepatitis was increasing in the North and Northeast.

RESUMO Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de mortalidade por hepatites no Brasil no período de 2001 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre a mortalidade por hepatites no Brasil com dados do Sistema de Informações sobre Mortalidade (SIM/Datasus). As informações foram estratificadas por ano do diagnóstico, região do país, municípios (de residência). Foram calculadas as taxas padronizadas de mortalidade (TPM). A tendência temporal foi estimada pela regressão de Prais-Winsten e a distribuição espacial pelo Índice Global de Moran (IGM). Resultados: As maiores médias da TPM no Brasil foram para hepatite viral crônica, com 0,88 mortes para cada 100 mil habitantes (desvio padrão — DP=0,16), seguida de outras hepatites virais, com 0,22/100 mil (DP=0,11). No Brasil, a tendência temporal da mortalidade por hepatite A foi de −8,11% ao ano (intervalo de confiança de 95% — IC95% −9,38; −6,82), enquanto por hepatite B foi de −4,13% (IC95% −6,03; −2,20); de outras hepatites virais, foi de −7,84% (IC95% −14,11; −1,11) e de hepatite não especificada, de −5,67% ao ano (IC95% −6,22; −5,10). A mortalidade por hepatite viral crônica cresceu 5,74% (IC95%3,47; 8,06) no norte e 4,95% no nordeste (IC95% 0,27; 9,85). O Índice de Moran (I) para hepatite A foi de 0,470 (p<0,001), para hepatite B de 0,846 (p<0,001), hepatite viral crônica=0,666 (p<0,001), outras hepatites virais=0,713 (p<0,001) e hepatites não especificadas=0,712 (p<0,001). Conclusão: A tendência temporal das hepatites A, B, de outras hepatites virais e das não especificadas foi de diminuição no Brasil, enquanto a mortalidade por hepatites crônicas foi de crescimento nas Regiões Norte e Nordeste.

Implementação e viabilização do acesso à saúde bucal da população em situação de rua no município de Japaratuba/SE / Implementation and facilitation of access to oral health for the homeless population in the city of Japaratuba/SE

O estudo tem caráter qualitativo, descritivo, com referencial teórico no construcionismo social e na qualificação/interação dos profissionais da Equipe de Saúde da Família (ESF) na implementação deste projeto. Foram utilizadas como etapas de intervenção a capacitação dos profissionais envolvidos na execução do projeto, levantamento cadastral do quantitativo da População em Situação de Rua, ações de promoção e prevenção em saúde bucal fora da Unidade Básica de Saúde, com orientações sobre higiene bucal, confecção e distribuição de material educativo, divulgação das ações em carro de som pelo município, acesso ao tratamento odontológico com agendamento da primeira consulta odontológica programada e a longitudinalidade do cuidado. Portando, almejou-se com esse projeto o acesso ao atendimento clínico odontológico a PSR, estreitando vínculo entre a ESF e a PSR, quebrando paradigmas sociais, proporcionando um acolhimento multiprofissional mais humanizado. Fazendo-se necessário fortalecer as equipes de saúde bucal e da Família por meio de educação permanente, de tal modo que o acesso a ações em serviços de saúde bucal para a População em Situação de Rua seja priorizado

Toxicidad amoniacal afecta la absorción de cationes y el crecimiento de plantas de papaya inclusive con adición de silicio / Ammonia toxicity affects cations uptake and growth in papaya plants inclusive with silicon addition

ABSTRACT High ammonia (NH4 +) concentration can exert stress on many plants, which causes nutritional disorders and reduction on plant growth. However, depending on the intensity of the stress, it may be attenuated by silicon. In this work, the response of impact of cations and silicon accumulations and plant growth in cultivated papaya plants was investigated under different toxic ammonia concentrations regardless of the presence of silicon (Si). The experiment was conducted at the Universidade Estadual Paulista (UNESP) with papaya seedlings, variety 'Grupo Formosa' (Calimosa híbrida 01), grown in a glass greenhouse, in 1.7 dm3 pots filled with pine and coconut fiber-based substrate. The experimental design was a randomized block design, in a 5 x 2 factorial arrangement. There were five ammonium concentrations: 10, 20, 40, 80, and 100 mmol L-1 that were delivered via nutrient solution, in the absence and presence of Si (2 mmol L-1), with five replicates. After 31 days of growth, the cations and silicon accumulations in the shoot, plant height, stem diameter, root, and shoot dry matter were evaluated. Results revealed that increased ammonia concentration showed toxicity in papaya plants and stronger reductions in Ca, Mg, K and Si accumulations, plant heights, stem diameters, and root and shoot dry matter production, even when silicon was present and with greater effects on the shoot dry matter (87 %) than that of the roots (13 %).

RESUMEN Las altas concentraciones de amonio (NH4+) pueden ejercer estrés en las plantas cultivadas, lo que causa trastornos nutricionales y reducción del crecimiento. Sin embargo, dependiendo de la intensidad del estrés, este puede atenuarse mediante el silicio (Si). En este trabajo, se investigó la respuesta de la acumulación de cationes y silicio y el crecimiento de plantas de papaya cultivadas en diferentes concentraciones tóxicas de amonio independientemente de la presencia de silicio. El experimento se realizó en la Universidade Estadual Paulista (UNESP), con plántulas de papaya, variedad Grupo Formosa (Calimosa híbrida 01), cultivadas en invernadero, en macetas de 1,7 dm3, rellenas con sustrato a base de fibra de pino y coco. El diseño experimental fue en bloques al azar, en esquema factorial 5x2, con cinco concentraciones de amonio 10, 20, 40, 80 y 100 mmol L-1, en la ausencia y presencia de Si (2 mmol L-1), con cinco repeticiones. A los 31 días posteriores del inicio de los tratamientos, se evaluó la acumulación de calcio, magnesio, nitrógeno, potasio y silicio, altura de la planta, diámetro del tallo y la materia seca de la raíz y los brotes. Los resultados revelaron que el aumento de la concentración de amonio mostró toxicidad en plantas de papaya y una reducción en la acumulación de calcio, magnesio, potasio y silicio, la altura de la planta, diámetro del tallo y la producción de materia seca de raíces y brotes, aunque el silicio esté presente, con mayor afectación en la materia seca de los brotes (87 %) que en las raíces (13 %).

Gestante com Covid-19 submetida à cesariana por sofrimento fetal: primeiro relato de caso descrito no Brasil / Pregnant with Covid-19 submitted to cesarian for fetal suffering: first case report described in Brazil

A COVID-19 pode provocar um quadro respiratório agudo e sua sintomatologia varia de leve a crítica, culminando, às vezes, com à morte. Em relação às grávidas, existem poucas informações, relata-se, portanto o primeiro caso descrito no Brasil de uma gestante de 19 anos, que apresentava dispneia, hipóxia, tosse produtiva e febre, sendo diagnosticada com COVID-19. Após a evolução para a síndrome respiratória aguda grave foi submetida a cesárea de urgência devido a insuficiência respiratória materna e sofrimento fetal agudo. Após o parto, a parturiente foi encaminhada a unidade de terapia intensiva (UTI) e mantida sob ventilação pulmonar com parâmetros elevados. No décimo dia de internamento na UTI, houve progressão da insuficiência respiratória, coagulação vascular disseminada e hemorragia pulmonar que culminou com o óbito. Em função da gravidade, o recém-nascido (RN) foi entubado e encaminhado a unidade de terapia intensiva neonatal, onde apresentou melhora progressiva, sendo suspenso o oxigênio no vigésimo dia de vida. O RN recebeu alta hospitalar 29 dias após a internação, sem alteração no estado clínico geral. No presente estudo o parto cesariano mostrou-se seguro, ficando o RN isento de contaminação do SARS-CoV-2, ainda que, em sofrimento fetal os cuidados intensivos foram eficientes culminando com boa evolução e alta hospitalar.

COVID-19 can cause an acute respiratory condition and its symptoms vary from mild to critical, sometimes culminating in death. Regarding pregnant women, there is little information, therefore, the first case reported in Brazil of a 19-year-old pregnant woman, who had dyspnea, hypoxia, productive cough and fever, being diagnosed with COVID-19. After progressing to severe acute respiratory syndrome, she underwent an emergency cesarean section due to maternal respiratory failure and acute fetal distress. After delivery, the parturient was referred to the intensive care unit (ICU) and kept under pulmonary ventilation with high parameters. On the tenth day of admission to the ICU, there was a progression of respiratory failure, disseminated vascular coagulation and pulmonary hemorrhage that culminated in death. Depending on the severity, the newborn (NB) was intubated and sent to the neonatal intensive care unit, where he showed progressive improvement, with oxygen being suspended on the 20th day of life. The NB was discharged from the hospital 29 days after admission, with no changes in general clinical status. In the present study, cesarean delivery proved to be safe, leaving the newborn free from SARS-CoV-2 contamination, even though, in fetal distress, intensive care was efficient, culminating in a good evolution and hospital discharge.

A systematic review and meta-analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis.

On July 25, 2017, we conducted an extensive database tracking to identify all studies published from January 1990 to July 2017. Screening updates were performed until December 2017. RESULTS: There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. CONCLUSION: The mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.

Perfil Epidemiológico e Qualidade de Vida dos Estudantes de Medicina Portadores de Hiperidrose Primária / Epidemiological Profile and Quality of Life of Medicine Students with Primary Hyperhidrosis

RESUMO Hiperidrose é a produção excessiva de suor pelo corpo, podendo ser primária ou secundária e generalizada ou localizada. As regiões craniofacial, axilar, palmar, dorso, face interna das coxas, plantar são comumente afetadas. A hiperidrose primária (HP), embora seja uma doença benigna, apresenta um eminente impacto negativo na qualidade de vida do paciente. Essa doença é classificada quantitativamente de acordo com a Escala de Gravidade da Doença da Hiperidrose, com base em como ela pode afetar as atividades diárias, podendo ser de leve a grave intensidade. Os acadêmicos de medicina enfrentam situações desgastantes físicas e emocionais durante seus afazeres e, quando portadores de doenças crônicas como a HP, podem ser estigmatizados como inseguros na sua profissão. Objetivou-se definir a prevalência, os critérios diagnósticos, a gravidade e o impacto na qualidade de vida que a HP proporciona nos âmbitos profissional e extracurricular dos acadêmicos de medicina. Trata-se de um estudo transversal de abordagem quantitativa de caráter descritivo, que inclui 300 acadêmicos do curso de Medicina da Universidade Tiradentes, em Aracaju/SE, no período de agosto a novembro de 2017. Utilizaram-se frequências absolutas e relativas no caso de variáveis categóricas e medidas de tendência e variabilidade central no caso de variáveis numéricas. O valor de p < 0,05 foi considerado significativo. A prevalência de HP em estudantes de medicina foi de 18% sem diferença entre os sexos e com predomínios das cores branca e parda. A doença ocorreu principalmente em sítios combinados, como palmoplantar, sendo a região palmar a mais acometida. Os sintomas iniciaram-se, principalmente, durante a infância e adolescência, com prejuízo importante nas atividades diárias pessoais e laborativas, e exacerbação do suor com situações de estresse. A gravidade da HP mais encontrada foi a moderada, sendo o impacto negativo na qualidade de vida principalmente relatado nos graus mais avançados da doença, dificultando as atividades acadêmicas. É importante a inclusão do conhecimento da HP no currículo médico para uma maior divulgação da doença, de modo a permitir um diagnóstico precoce e relacionado à intensidade da sudorese na sua abordagem terapêutica.

ABSTRACT Hyperhidrosis is the excessive production of sweat by the body, which can be primary or secondary and generalized or localized. The craniofacial, axillary, palmar, dorsum, inner thigh, and plantar regions are commonly affected. Primary hyperhidrosis (HP), although a benign disease, has an imminent negative impact on the patient's quality of life. This disease is quantitatively classified according to the Hyperhidrosis Disease Severity Scale, based on how the disease affects daily activities, ranging from mild to severe intensity. Medical undergraduate students face physical and emotional stressful situations during their tasks, and when they have a chronic illness such as HP, they can be stigmatized as unsafe for their profession. The objective was to define HP prevalence, diagnostic criteria, severity and impact on the quality of life in the professional and extracurricular scenario of undergraduate medical students. This is a cross-sectional quantitative study of a descriptive nature, including 300 students from the Tiradentes University medical school, in Aracaju-SE, from August to November 2017. Absolute and relative frequencies were used in the case of categorical variables and measures of central tendency and variability were used for numerical variables; p value was considered significant when p <0.05. The prevalence of HP in medical students was 18%, with no difference between the genders and with the predominance of white and brown ethnicities. The disease occurred mainly in combined sites, such as palmar-plantar, with the palmar region being the most affected one. The symptoms began mainly during childhood and adolescence, with significant impairment in daily personal and work activities, with disease exacerbation under stress situations. The most common HP severity was moderate, with a negative impact on quality of life, mainly reported at the more advanced stages of the disease, hindering academic activities. It is important to include the knowledge of HP in the medical curriculum for a greater dissemination of information on the disease, allowing its early diagnosis and related to the intensity of sweating in its therapeutic approach.

Impact of primary hyperhidrosis on the life of physical education academics of a university in the Brazilian Northeast

Abstract Aim: To assess the prevalence, quality of life (QoL), and the damages caused by PH, in the professional and personal scope of Physical Education academics with Primary Hyperhidrosis (PH). Methods: A descriptive, exploratory, qualitative and quantitative cross-sectional study was carried out. Twenty-five students from the physical education course at Tiradentes University, Aracaju-SE, were interviewed from August to November 2017. Validated questionnaires were used on PH's influence in academic activities and QoL. absolute and relative frequencies in the case of categorical variables and measures of trend and central variability in the case of numerical variables. Results: The prevalence of PH in students of Physical Education was 11.11%, mainly in combined sites, such as palmoplantar, and with no difference between the sexes. The symptoms started mostly during childhood and adolescence. Most of the interviewees (92%) reported difficulties with activities such as sports, use of personal protective equipment, handling of work equipment and instruments, and exacerbation in stress situations. They reported significant harm to QoL in situations of greeting people with handshakes, writing, wearing socks and dancing socially. Conclusion: Although PH is a disease that negatively impacts the QoL, it is still little known in the academic world with little demand for medical help. Therefore, it is necessary greater dissemination of the disease for its early diagnosis, related to the intensity of the sweating for a better therapeutic approach.

Obesidade e dislipidemia na infância: uma revisão sobre a associação de marcadores laboratoriais / Obesity and dislipidemia in children: a review on the association of laboratory markers

A obesidade é uma patologia mundial e crescente que atinge mais de 300 milhões de pessoas. O Brasil acompanha essa tendência com índices também preocupantes em crianças, devido à mudança de hábitos alimentares e físicos. A correlação de obesidade e dislipidemia é percebida desde a infância e pode ser refletida na fase adulta com aumento de risco cardiovascular. Dessa forma, o presente estudo teve como objetivo, por meio de revisão literária sistemática, correlacionar os marcadores lipídicos com a obesidade em crianças através de artigos publicados entre 2000 e 2016 na base de dados PubMed. Para tanto, incluíram-se sete artigos para análise. Destes, cinco abordaram limitações de estudos do perfil lipídico e outros fatores de risco cardiovasculares. Crianças obesas obtiveram maiores alterações nos referidos marcadores quando comparadas a crianças normais. O mesmo resultado foi encontrado mais entre as meninas em comparação aos meninos. Após a análise dos artigos, conclui- se que é preciso definir com mais clareza a dislipidemia na infância, assim como se faz necessária a adoção de medidas atualizadas que visem reduzir o excesso de peso e a obesidade infantil.

Taquari, a new and a promising mango material: emergence, post-harvest and biometrics of fruit / Taquari: um novo e promissor material de mangueira

The fruit of 'Taquari' have attractive appearance, with intense yellow flesh, pleasant taste and absence of fibers, which makes it a potential material for, after a series of studies, being released as a variety. For biometrics, 50 mature fruit were used the results (average of three samples) were evaluated by descriptive statistics using central trend (average) and variability of data (standard error and coefficient of variation). For the germination test, the seeds were extracted from ripe fruit and dried; subsequently, they were germinated in sachets containing the mixture soil:sand:corral manure (3:1:1) as substrate, evaluating seedling emergence and polyembryony. The design was in randomized blocks and 5 treatments were studied, with 5 replicates each and 10 seeds per replicate. The percentage data were transformed into arc-sen, submitted to analysis of variance and the means, to Tukey test at 5% probability. For fruit quality characterization, 12 ripe fruits were used, separated into 3 lots with 4 fruit, using a completely randomized design. The fruit were characterized regarding firmness, peel and pulp color, soluble solids, titratable acidity, pH, ascorbic acid and respiratory rate. We conclude that the 'Taquari' has fruit with interesting characteristics for the Brazilian market and there is a better seedling emergence in the absence of seed coat, but with a greater occurrence of polyembryony. For quality characterization, the fruit present parameters such as soluble solids and titratable acidity similar to the main varieties of mangoes sold in the country, but with emphasis to the high ascorbic acid content detected.

Os frutos da mangueira 'Taquari' têm aparência atrativa, com polpa amarelo intenso, sabor agradável e ausência de fibras, o que a torna um material com grande potencial para futuramente ser lançado como variedade. Com o objetivo de avaliar caracteres fenotípicos relativos emergência, biometria e pós-colheita, do material 'Taquari' este trabalho foi desenvolvido. Para a biometria foram utilizados 50 frutos maduros, os resultados foram avaliados por estatística descritiva, utilizando-se de medida de tendência central (média) e de variabilidade de dados (desvio-padrão). Para o teste de germinação, as sementes foram extraídas de frutos maduros e colocadas para secar, em seguida, foram colocadas para germinar em saquinhos contendo como substrato mistura de solo:areia:esterco de curral curtido (3:1:1), avaliando-se a emergência das plântulas e a poliembrionia. O delineamento foi em blocos casualizados e foram estudados 5 tratamentos, com 5 repetições cada e 10 sementes por repetição. Os dados de porcentagem foram transformados em arc-sen, submetidos à análise de variância e as médias ao teste Tukey a 5% de probabilidade. Para a caracterização de qualidade dos frutos, utilizaram-se 12 frutos maduros, separadas em 3 lotes com 4 frutos, utilizando delineamento inteiramente casualizado. Os frutos foram caracterizados quanto a firmeza, coloração de casca e polpa, sólidos solúveis, acidez titulável, pH, ácido ascórbico e taxa respiratória. Conclui-se que a mangueira 'Taquari' apresenta frutos com características interessantes para o mercado brasileiro e há melhor emergência das plântulas na ausência do tegumento da semente, porém com maior ocorrência de poliembrionia. Para a caracterização de qualidade, os frutos apresentam parâmetros como de sólidos solúveis e acidez titulável similares às principais cultivares de mangas comercializadas no país, porém com destaque para os altos teores de ácido ascórbico encontrados.