Popular health surveillance practices in Brazil: scoping review. / Práticas de vigilância popular em saúde no Brasil: revisão de escopo.

This study aims to identify the Popular Health Surveillance practices in Brazil, described in the scientific literature. A scoping review was carried out in the LILACS, MEDLINE, MEDCARIB, PAHO-IRIS, WHOLIS, and Scopus databases from the CAPES Periodical Portal in May 2022. Studies that clearly addressed community/population protagonism in a health surveillance experience were included in the review, with a total of 6 studies. Three categories resulted from the analysis: 1. Cues for Popular Surveillance in Health; 2. Fundamental principles of Popular Surveillance; and, 3. Pandemic and Popular Protagonism. The studies address experiences of Popular Surveillance with different actions of population groups for the production of health that experience the different risks and impacts of the productive processes in the environment, in health and in their ways of life. It highlights the importance of strengthening the Popular Surveillance representation based on the articulation of knowledge of the actors involved with data production, health promotion and health care in the territories.

Este estudo tem como objetivo identificar as práticas de Vigilância Popular em Saúde no Brasil, descritas na literatura científica. Realizou-se uma revisão de escopo nas bases LILACS, MEDLINE, MEDCARIB, PAHO-IRIS, WHOLIS, Scopus a partir do Portal de Periódicos da CAPES em maio de 2022. Incluíram-se estudos que explicitassem o protagonismo comunitário/popular em uma experiência de vigilância em saúde. A revisão abrangeu 6 estudos. Da análise resultaram três categorias: 1. Pistas para uma Vigilância Popular em Saúde; 2. Princípios fundamentais da Vigilância Popular; e, 3. Pandemia e Protagonismo Popular. Os estudos abordam experiências de Vigilância Popular com diferentes atuações de grupos populacionais para a produção da saúde que vivenciam os diversos riscos e impactos dos processos produtivos no ambiente, na saúde e em seus modos de vida. Destaca-se a importância em fortalecer a representação de Vigilância Popular a partir da articulação de saberes de atores envolvidos com a produção de dados, a promoção e o cuidado em saúde nos territórios.

Práticas de vigilância popular em saúde no Brasil: revisão de escopo / Popular health surveillance practices in Brazil: scoping review

Resumo Este estudo tem como objetivo identificar as práticas de Vigilância Popular em Saúde no Brasil, descritas na literatura científica. Realizou-se uma revisão de escopo nas bases LILACS, MEDLINE, MEDCARIB, PAHO-IRIS, WHOLIS, Scopus a partir do Portal de Periódicos da CAPES em maio de 2022. Incluíram-se estudos que explicitassem o protagonismo comunitário/popular em uma experiência de vigilância em saúde. A revisão abrangeu 6 estudos. Da análise resultaram três categorias: 1. Pistas para uma Vigilância Popular em Saúde; 2. Princípios fundamentais da Vigilância Popular; e, 3. Pandemia e Protagonismo Popular. Os estudos abordam experiências de Vigilância Popular com diferentes atuações de grupos populacionais para a produção da saúde que vivenciam os diversos riscos e impactos dos processos produtivos no ambiente, na saúde e em seus modos de vida. Destaca-se a importância em fortalecer a representação de Vigilância Popular a partir da articulação de saberes de atores envolvidos com a produção de dados, a promoção e o cuidado em saúde nos territórios.

Abstract This study aims to identify the Popular Health Surveillance practices in Brazil, described in the scientific literature. A scoping review was carried out in the LILACS, MEDLINE, MEDCARIB, PAHO-IRIS, WHOLIS, and Scopus databases from the CAPES Periodical Portal in May 2022. Studies that clearly addressed community/population protagonism in a health surveillance experience were included in the review, with a total of 6 studies. Three categories resulted from the analysis: 1. Cues for Popular Surveillance in Health; 2. Fundamental principles of Popular Surveillance; and, 3. Pandemic and Popular Protagonism. The studies address experiences of Popular Surveillance with different actions of population groups for the production of health that experience the different risks and impacts of the productive processes in the environment, in health and in their ways of life. It highlights the importance of strengthening the Popular Surveillance representation based on the articulation of knowledge of the actors involved with data production, health promotion and health care in the territories.

Cutaneous manifestations of COVID-19 patients in a Hospital in São Paulo, Brazil, and global literature review

Abstract Background: Since the beginning of the COVID-19 pandemic, a myriad of cutaneous manifestations have been described in association with this viral infection. However, in Latin America, this kind of data is still scarce. Objective: In this sense, the goal of this study was to describe the dermatological findings observed during SARS-CoV-2 infection, in a Brazilian Hospital. Methods: This is a cross-sectional, retrospective and descriptive study of 50 cases of new-onset dermatologic symptoms in patients with COVID-19, treated at Hospital Sírio-Libanês, from February to June 2020. Results: The patients (n = 50) were classified into 6 groups, according to the elementary lesions and the statistical analysis was performed. The most common cutaneous lesions were maculopapular eruptions (44%), necrosis, purpura, and livedo (32%), urticarial lesions (12%), pseudochilblains (4%) and papular-vesicular eruption (4%). In 46% of the patients the cutaneous lesions occurred in association with other symptoms, such as pruritus (38%), pain and burning sensation (8%). Lower limbs were affected in 44% of the cases, followed by the trunk (38%), upper limbs (24%) and face (14%). Cutaneous lesions were mostly found after other COVID-19 systemic symptoms, with a mean period between the viral syndrome and cutaneous signs of 5 days (SD = 6.1 days). Study limitations: It is a small sample, in a single-center study, with patients exclusively from a private Hospitals. Conclusions: Patients in Brazil have the same proportion of lesions as revealed in other studies in Europa. The compiled data is essential for a better understanding of cutaneous manifestations deemed secondary to COVID.

HPLC-TBARS-EVSC (high-performance liquid chromatography-thiobarbituric acid reactive substances-ex vivo stratum corneum) protocol: Selection of the subjects and approach to present the results.

OBJECTIVE: Nowadays, it is recognized the need for improved safety and efficacy protocols to evaluate the human stratum corneum (SC) and its interaction with topical and cosmetic formulations by minimally or non-invasive methodologies. The aim of our research work was to streamline the HPLC-TBARS-EVSC (high-performance liquid chromatography-thiobarbituric acid reactive substances-ex vivo stratum corneum) methodology, by exploring the results of a group of 18 subjects. METHODS: The study included nine women and nine men aged between 19 and 57 years old with phototypes from II to V. Sites in the forearm of each volunteer were randomly delimited, and the SC was collected by tape stripping. HPLC was used to quantify the MDA-TBA2 (malondialdehyde-thiobarbituric acid) adduct from the tape-stripped SC, irradiated and not by an ultraviolet (UV) simulator chamber. RESULTS: Observing the findings of our present investigation, and the statistical approach applied, the use of the ratio between the treatment site and control would be an adequate strategy to better discriminate and evaluate the results. Additionally, an optimal selection of the volunteers to respond specifically to the purpose of the ex vivo assay also can be considered advantageous. CONCLUSIONS: It seemed that in future studies focusing on the impact of SC UV-induced lipid peroxidation, determined by the HPLC-TBARS-EVSC, the most suitable subjects are females aged less than 35 years old, with phototype II.

OBJECTIF: Aujourd'hui, il est nécessaire d'améliorer les protocoles de sécurité d'emploi et d'efficacité pour évaluer le stratum corneum (SC) humain et son interaction avec les formulations topiques et cosmétiques par des méthodologies peu ou pas invasives. L'objectif de notre travail de recherche était de rationaliser la méthodologie HPLC-TBARS-SCEV, à savoir chromatographie en phase liquide à haute performance (High Performance Liquid Chromatography), substances réactives à l'acide thiobarbiturique (Thiobarbituric Acid Reactive Substances), stratum corneum ex vivo (SCEV), en explorant les résultats d'un groupe de 18 sujets. MÉTHODES: L'étude incluait 9 femmes et 9 hommes âgés de 19 à 57 ans présentant des phototypes II à V. Des sites de l'avant-bras de chaque volontaire ont été délimités de manière aléatoire, et le SC a été recueilli par « tape stripping ¼. La chromatographie en phase liquide à haute performance a été utilisée pour quantifier l'adduit MDA-TBA2 (malondialdéhyde - acide thiobarbiturique) à partir du SC recueilli par « tape stripping ¼, irradié et non irradié par une chambre de simulation à ultraviolets (UV). RÉSULTATS: En observant les résultats de notre recherche actuelle et l'approche statistique appliquée, l'utilisation du rapport entre le site traité et le site contrôle serait une stratégie adéquate pour mieux discriminer et évaluer les résultats. En outre, une sélection optimale des volontaires pour répondre spécifiquement à l'objectif du test ex vivo peut également être considérée comme bénéfique. CONCLUSIONS: Il semble que dans les études futures axées sur l'impact de la peroxydation lipidique induite par UV du SC, déterminé par la méthodologie HPLC-TBARS-SCEV, les sujets les plus appropriés sont les femmes âgées de moins de 35 ans présentant un phototype II.

Emergency department use and Artificial Intelligence in Pelotas: design and baseline results.

OBJETIVO: To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. METHODS: The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. RESULTS: In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. CONCLUSION: The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.

Cutaneous manifestations of COVID-19 patients in a Hospital in São Paulo, Brazil, and global literature review.

BACKGROUND: Since the beginning of the COVID-19 pandemic, a myriad of cutaneous manifestations have been described in association with this viral infection. However, in Latin America, this kind of data is still scarce. OBJECTIVE: In this sense, the goal of this study was to describe the dermatological findings observed during SARS-CoV-2 infection, in a Brazilian Hospital. METHODS: This is a cross-sectional, retrospective and descriptive study of 50 cases of new-onset dermatologic symptoms in patients with COVID-19, treated at Hospital Sírio-Libanês, from February to June 2020. RESULTS: The patients (n = 50) were classified into 6 groups, according to the elementary lesions and the statistical analysis was performed. The most common cutaneous lesions were maculopapular eruptions (44%), necrosis, purpura, and livedo (32%), urticarial lesions (12%), pseudochilblains (4%) and papular-vesicular eruption (4%). In 46% of the patients the cutaneous lesions occurred in association with other symptoms, such as pruritus (38%), pain and burning sensation (8%). Lower limbs were affected in 44% of the cases, followed by the trunk (38%), upper limbs (24%) and face (14%). Cutaneous lesions were mostly found after other COVID-19 systemic symptoms, with a mean period between the viral syndrome and cutaneous signs of 5 days (SD = 6.1 days). STUDY LIMITATIONS: It is a small sample, in a single-center study, with patients exclusively from a private Hospital. CONCLUSIONS: Patients in Brazil have the same proportion of lesions as revealed in other studies in Europa. The compiled data is essential for a better understanding of cutaneous manifestations deemed secondary to COVID.

Treatments used by chronic obstructive pulmonary disease patients in Brazil: National Survey of Health, 2013.

OBJECTIVE: To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS: A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS: A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION: The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.

Emergency department use and Artificial Intelligence in Pelotas: design and baseline results / Uso serviços de serviços de urgência e emergência e Inteligência Artificial em Pelotas: protocolo e resultados iniciais

RESUMO Objetivo: To describe the initial baseline results of a population-based study, as well as a protocol in order to evaluate the performance of different machine learning algorithms with the objective of predicting the demand for urgent and emergency services in a representative sample of adults from the urban area of Pelotas, Southern Brazil. Methods: The study is entitled "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Between September and December 2021, a baseline was carried out with participants. A follow-up was planned to be conducted after 12 months in order to assess the use of urgent and emergency services in the last year. Afterwards, machine learning algorithms will be tested to predict the use of urgent and emergency services over one year. Results: In total, 5,722 participants answered the survey, mostly females (66.8%), with an average age of 50.3 years. The mean number of household people was 2.6. Most of the sample has white skin color and incomplete elementary school or less. Around 30% of the sample has obesity, 14% diabetes, and 39% hypertension. Conclusion: The present paper presented a protocol describing the steps that were and will be taken to produce a model capable of predicting the demand for urgent and emergency services in one year among residents of Pelotas, in Rio Grande do Sul state.

RESUMO Objetivo: Descrever os resultados iniciais da linha de base de um estudo de base populacional, bem como um protocolo para avaliar o desempenho de diferentes algoritmos de aprendizado de máquina, com o objetivo de predizer a demanda de serviços de urgência e emergência em uma amostra representativa de adultos da zona urbana de Pelotas, no Sul do Brasil. Métodos: O estudo intitula-se "Emergency department use and Artificial Intelligence in PELOTAS (RS) (EAI PELOTAS)" (https://wp.ufpel.edu.br/eaipelotas/). Entre setembro e dezembro de 2021, foi realizada uma linha de base com os participantes. Está previsto um acompanhamento após 12 meses para avaliar a utilização de serviços de urgência e emergência no último ano. Em seguida, serão testados algoritmos de machine learning para predizer a utilização de serviços de urgência e emergência no período de um ano. Resultados: No total, 5.722 participantes responderam à pesquisa, a maioria do sexo feminino (66,8%), com idade média de 50,3 anos. O número médio de pessoas no domicílio foi de 2,6. A maioria da amostra tem cor da pele branca e ensino fundamental incompleto ou menos. Cerca de 30% da amostra estava com obesidade, 14% com diabetes e 39% eram hipertensos. Conclusão: O presente trabalho apresentou um protocolo descrevendo as etapas que foram e serão tomadas para a produção de um modelo capaz de prever a demanda por serviços de urgência e emergência em um ano entre moradores de Pelotas, no estado do Rio Grande do Sul.

Linking eutrophication to carbon dioxide and methane emissions from exposed mangrove soils along an urban gradient.

Mangroves are one of the most important but threatened blue carbon ecosystems globally. Rapid urban growth has resulted in nutrient inputs and subsequent coastal eutrophication, associated with an enrichment in organic matter (OM) from algal and sewage sources and substantial changes in greenhouse gas (GHG) emissions. However, the effects of nitrogen (N) and phosphorus (P) enrichment on mangrove soil OM composition and GHG emissions, such as methane (CH4) and carbon dioxide (CO2), are still poorly understood. Here, we aim to evaluate the relationships between CO2 and CH4 efflux with OM composition in exposed soils from three mangrove areas along watersheds with different urbanization levels (Rio de Janeiro State, Brazil). To assess spatial (lower vs. upper intertidal zones) and seasonal (summer vs. winter) variability, we measured soil-air CO2 and CH4 fluxes at low spring tide, analyzing elementary (C, N, and P), isotopic (δ13C and δ15N), and the molecular (n-alkanes and sterols) composition of surface soil OM. A general trend of OM composition was found with increasing urban influence, with higher δ15N (proxy of anthropogenic N enrichment), less negative δ13C, more short-chain n-alkanes, lower C:N ratio (proxies of algal biomass), and higher epicoprostanol content (proxies of sewage-derived OM). The CO2 efflux from exposed soils increased greatly in median (25/75 % interquartile range) from 4.6 (2.9/8.3) to 24.0 (21.5/32.7) mmol m-2 h-1 from more pristine to more urbanized watersheds, independent of intertidal zone and seasonality. The CO2 fluxes at the most eutrophicated site were among the highest reported worldwide for mangrove soils. Conversely, CH4 emissions were relatively low (three orders of magnitude lower than CO2 fluxes), with high peaks in the lower intertidal zone during the rainy summer. Thus, our findings demonstrate the influence of coastal eutrophication on global warming potentials related to enhanced heterotrophic remineralization of blue carbon within mangrove soils.

The nitric oxide pathway is involved in the anti-inflammatory effect of the rutheniumcomplex [Ru(bpy)2(2-MIM)(NO)](PF6)3.

Metal coordination complexes are chemotherapeutic and anti-inflammatory agents. The ruthenium complex FOR811A ([Ru(bpy)2(2-MIM)Cl](PF6)3) FOR811A was evaluated in mice models of acute inflammation and behavioral tests. Animals received FOR811A (3, 10 or 30 mg/kg; i.p.), indomethacin (20 mg/kg; i.p.), L-NAME (20 mg/kg; i.v.) aminoguanidine (50 mg/kg; i.p.) or dexamethasone (0.5 mg/kg; s.c.) 30 min before inflammatory stimulation. Paw edema was induced by carrageenan (400 µg/paw), TNF-α or L-arginine (15 nmol/paw) (5 ng/paw) and evaluated by hydropletismometry 4 h later. Peritonitis was induced by carrageenan (500 µg; i.p.) and evaluated 4 h later for hypernociception and quantification of total/differential leukocytes, total protein reduced glutathione (GSH) and myeloperoxidase (MPO). FOR811A inhibited the paw edema induced by carrageenan at 3 (64%; p < 0.0001), 10 (73%; p < 0.0001) and 30 mg/kg (66%; p < 0.0001), and at 10 mg/kg that induced with L-arginine by 75% or TNF-α by 55% (p = 0.0012). Paw tissues histological analysis showed reduction in mast cells (46%; p = 0.0027), leukocyte infiltrate (66%; p < 0.0001), edema and hemorrhagic areas. Immunohistochemical evaluation revealed inhibition of iNOS (62%; p < 0.0001) and TNF-α (35%; p < 0.0001). In the peritonitis model FOR811A increased (2.8X; p < 0.0001) hypernociceptive threshold, reduced total leukocytes (29%; p < 0.0001), neutrophils (47%; p = 0.0003) and total proteins (36%; p = 0.0082). FOR811A also inhibited MPO (47%; p = 0.0296) and increased GSH (1.8X; p < 0.0001). In the behavioral tests, FOR811A reduced (30.6%) the number of crossings in the open field, and increased (16%) the number of falls in the Rota rod. Concluding, FOR811A presents anti-inflammatory and antioxidant effects, via nitric oxide pathway.

[Delay in quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age: Brazilian National Health Survey, 2013]. / Atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade: Pesquisa Nacional de Saúde, 2013.

The study aimed to estimate the prevalence of delay in the three doses of quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, based on data from the Brazilian National Health Survey (PNS) of 2013 and to analyze the delay in each of the doses according to sociodemographic variables and use of health services and public health interventions. The data are from the PNS a cross-sectional study performed in 2013. The outcome was delay in at least one of the three doses of the quadrivalent vaccine. Delay was defined as a dose received at least 30 days after the recommended date according to information on the child's vaccination card. Prevalence of delay was analyzed according to sociodemographic variables and use of health services. A descriptive analysis was performed to obtain absolute and relative frequencies and their respective 95% confidence intervals. Of the 2,016 children with information collected, 1,843 were analyzed. The prevalence of delay in at least one dose of the vaccine was 44%. There was a delay of 14.8% in the first dose, 28.8% in the second, and 45.4% in the third, and 10% of the children had delays in all three doses. Higher prevalence of delay was associated with male gender, brown skin color, the poorest income quintile, and residence in rural areas and the North of Brazil. The study revealed high prevalence of delay with the quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, with the highest delay in the third dose.

O objetivo foi estimar a prevalência do atraso nas três doses da vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade, no Brasil, por meio dos dados da Pesquisa Nacional de Saúde (PNS) de 2013 e descrever o atraso em cada uma das doses segundo variáveis sociodemográficas, utilização de serviços e intervenções públicas de saúde. Foram utilizados dados da PNS, estudo transversal realizado em 2013. O desfecho foi o atraso pelo menos em uma das três doses da vacina tetravalente. Considerou-se como atraso a dose recebida pelo menos 30 dias após a data preconizada, segundo informação da caderneta de vacinação. A prevalência do atraso foi descrita segundo variáveis sociodemográficas e utilização de serviços de saúde. Realizou-se análise descritiva obtendo-se frequências absolutas e relativas e seus respectivos intervalos de 95% de confiança. Das 2.016 crianças com informações coletadas, 1.843 foram analisadas. A prevalência de atraso de pelo menos uma dose da vacina foi de 44%. Observou-se atraso de 14,8% na primeira, 28,8% na segunda e 45,4% na terceira dose, sendo que 10% das crianças tiveram atraso nas três doses. Maiores prevalências de atraso foram encontradas em crianças do sexo masculino, de cor da pele parda, pertencentes ao quintil mais pobre de riqueza, moradores da zona rural e da Região Norte do Brasil. Evidenciou-se alta prevalência de atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses do Brasil, sendo maior na terceira dose.

El objetivo fue estimar la prevalencia del atraso en las tres dosis de la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad, en Brasil, mediante los datos de la Encuesta Nacional de Salud (PNS) de 2013 y describir el retraso en cada una de las dosis, según variables sociodemográficas, utilización de servicios e intervenciones públicas de salud. Se trata de un estudio transversal, realizado en 2013, con datos de la PNS. El resultado fue el retraso por lo menos en una de las tres dosis de la vacuna tetravalente. Se consideró como un atraso la dosis recibida por lo menos 30 días tras la fecha prefijada, según la información de la cartilla de vacunación. La prevalencia del atraso fue descrita según variables sociodemográficas y utilización de servicios de salud. Se realizó un análisis descriptivo, obteniéndose frecuencias absolutas y relativas, así como sus respectivos intervalos de 95% de confianza. De los 2016 niños con información recogida, se analizaron 1843. La prevalencia de atraso de por lo menos una dosis de la vacuna fue de un 44%. Se observó un retraso de 14,8% en la primera, un 28,8% en la segunda y un 45,4% en la tercera dosis, siendo que un 10% de los niños sufrieron atraso en las tres dosis. Las mayores prevalencias de atraso se encontraron en niños de sexo masculino, mestizos, pertenecientes al quintil más pobre de riqueza, habitantes de la zona rural y de la Región Norte de Brasil. Se evidenció una alta prevalencia de atraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de Brasil, siendo mayor en la tercera dosis.

Treatments used by chronic obstructive pulmonary disease patients in Brazil: National Survey of Health, 2013 / Tratamentos utilizados por portadores de DPOC no Brasil: Pesquisa Nacional de Saúde, 2013

ABSTRACT OBJECTIVE To estimate the prevalence of treatments used for the management of chronic obstructive pulmonary disease (COPD) in the Brazilian adult population. METHODS A population-based cross-sectional study with data from the 2013 Brazilian National Survey of Health, including individuals aged 40 years or older, with a self-reported medical diagnosis of COPD, chronic bronchitis and/or emphysema, who were asked about treatments used for disease management. RESULTS A total of 60,202 adults were interviewed, of which 636 were 40 years of age or older and had reported a medical diagnosis of COPD, emphysema, or chronic bronchitis. Less than half (49.4%) of the diagnosed population reported using some type of treatment, with differences regarding the macro-region of the country (South 53.8% - Northeast 41.2%, p = 0.007). Pharmacological treatment was the most reported, and emphysema patients had the highest proportion of those undergoing more than one type of treatment. Among the individuals who reported having only chronic bronchitis, 55.1% (95%CI: 48.7-61.4) used medication, 4.7% (95%CI: 2.6-8.3) underwent physical therapy, and 6.0% (95%CI: 3.6-9.9) oxygen therapy. On the other hand, among the emphysema patients, 44.1% (95%CI: 36.8-51.7) underwent drug treatment, 8.8% (95%CI: 5.4-14.2) physical therapy, and 10.0% (95%CI: 6.3-15.6) oxygen therapy. CONCLUSION The prevalence of treatments for COPD management was below ideal in 2013. The pharmacological treatment was the main type of treatment, followed by oxygen therapy and physical therapy.

RESUMO OBJETIVO Estimar a prevalência dos tratamentos utilizados para o manejo da doença pulmonar obstrutiva crônica (DPOC) na população adulta brasileira. MÉTODOS Estudo transversal de base populacional com dados oriundos da Pesquisa Nacional de Saúde de 2013, incluindo indivíduos com 40 anos ou mais, com diagnóstico médico autorreferido de DPOC, bronquite crônica e/ou enfisema, os quais foram questionados sobre tratamentos utilizados para o manejo da doença. RESULTADOS Foram entrevistados 60.202 adultos, dos quais 636 tinham 40 ou mais anos de idade e haviam referido diagnóstico médico de DPOC, enfisema ou bronquite crônica. Menos da metade (49,4%) da população diagnosticada relatou utilizar algum tipo de tratamento, havendo diferenças quanto à macrorregião do país (Sul 53,8% - Nordeste 41,2%, p = 0,007). O tratamento medicamentoso foi o mais referido e portadores de enfisema apresentaram a maior proporção de mais de um tipo de tratamento utilizado. Entre os indivíduos que declararam ter apenas bronquite crônica, 55,1% (IC95% 48,7-61,4) usavam medicamento, 4,7% (IC95% 2,6-8,3) realizavam fisioterapia e 6,0% (IC95% 3,6-9,9) oxigenoterapia. Por outro lado, entre os enfisematosos, 44,1% (IC95% 36,8-51,7) realizavam tratamento medicamentoso, 8,8% (IC95% 5,4-14,2) fisioterapia e 10,0% (IC95% 6,3-15,6) oxigenoterapia. CONCLUSÕES As prevalências de tratamentos para o manejo da DPOC estavam aquém do ideal em 2013. O medicamentoso foi o principal tipo de tratamento, seguido de oxigenoterapia e fisioterapia.

Atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade: Pesquisa Nacional de Saúde, 2013 / Delay in quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age: Brazilian National Health Survey, 2013 / Retraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad: Encuesta Nacional de Salud, 2013

Resumo: O objetivo foi estimar a prevalência do atraso nas três doses da vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses de idade, no Brasil, por meio dos dados da Pesquisa Nacional de Saúde (PNS) de 2013 e descrever o atraso em cada uma das doses segundo variáveis sociodemográficas, utilização de serviços e intervenções públicas de saúde. Foram utilizados dados da PNS, estudo transversal realizado em 2013. O desfecho foi o atraso pelo menos em uma das três doses da vacina tetravalente. Considerou-se como atraso a dose recebida pelo menos 30 dias após a data preconizada, segundo informação da caderneta de vacinação. A prevalência do atraso foi descrita segundo variáveis sociodemográficas e utilização de serviços de saúde. Realizou-se análise descritiva obtendo-se frequências absolutas e relativas e seus respectivos intervalos de 95% de confiança. Das 2.016 crianças com informações coletadas, 1.843 foram analisadas. A prevalência de atraso de pelo menos uma dose da vacina foi de 44%. Observou-se atraso de 14,8% na primeira, 28,8% na segunda e 45,4% na terceira dose, sendo que 10% das crianças tiveram atraso nas três doses. Maiores prevalências de atraso foram encontradas em crianças do sexo masculino, de cor da pele parda, pertencentes ao quintil mais pobre de riqueza, moradores da zona rural e da Região Norte do Brasil. Evidenciou-se alta prevalência de atraso na vacina tetravalente (DTP+Hib) em crianças de 12 a 23 meses do Brasil, sendo maior na terceira dose.

Abstract: The study aimed to estimate the prevalence of delay in the three doses of quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, based on data from the Brazilian National Health Survey (PNS) of 2013 and to analyze the delay in each of the doses according to sociodemographic variables and use of health services and public health interventions. The data are from the PNS a cross-sectional study performed in 2013. The outcome was delay in at least one of the three doses of the quadrivalent vaccine. Delay was defined as a dose received at least 30 days after the recommended date according to information on the child's vaccination card. Prevalence of delay was analyzed according to sociodemographic variables and use of health services. A descriptive analysis was performed to obtain absolute and relative frequencies and their respective 95% confidence intervals. Of the 2,016 children with information collected, 1,843 were analyzed. The prevalence of delay in at least one dose of the vaccine was 44%. There was a delay of 14.8% in the first dose, 28.8% in the second, and 45.4% in the third, and 10% of the children had delays in all three doses. Higher prevalence of delay was associated with male gender, brown skin color, the poorest income quintile, and residence in rural areas and the North of Brazil. The study revealed high prevalence of delay with the quadrivalent vaccine (DTP+Hib) in children 12 to 23 months of age in Brazil, with the highest delay in the third dose.

Resumen: El objetivo fue estimar la prevalencia del atraso en las tres dosis de la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de edad, en Brasil, mediante los datos de la Encuesta Nacional de Salud (PNS) de 2013 y describir el retraso en cada una de las dosis, según variables sociodemográficas, utilización de servicios e intervenciones públicas de salud. Se trata de un estudio transversal, realizado en 2013, con datos de la PNS. El resultado fue el retraso por lo menos en una de las tres dosis de la vacuna tetravalente. Se consideró como un atraso la dosis recibida por lo menos 30 días tras la fecha prefijada, según la información de la cartilla de vacunación. La prevalencia del atraso fue descrita según variables sociodemográficas y utilización de servicios de salud. Se realizó un análisis descriptivo, obteniéndose frecuencias absolutas y relativas, así como sus respectivos intervalos de 95% de confianza. De los 2016 niños con información recogida, se analizaron 1843. La prevalencia de atraso de por lo menos una dosis de la vacuna fue de un 44%. Se observó un retraso de 14,8% en la primera, un 28,8% en la segunda y un 45,4% en la tercera dosis, siendo que un 10% de los niños sufrieron atraso en las tres dosis. Las mayores prevalencias de atraso se encontraron en niños de sexo masculino, mestizos, pertenecientes al quintil más pobre de riqueza, habitantes de la zona rural y de la Región Norte de Brasil. Se evidenció una alta prevalencia de atraso en la vacuna tetravalente (DTP+Hib) en niños de 12 a 23 meses de Brasil, siendo mayor en la tercera dosis.

Potential interactions between psychotropic drugs and alcohol and tobacco dependence

Abstract The aim of this study was to identify and analyze the potential interactions between psychotropic drugs and alcohol and tobacco addiction. A cross-sectional study was carried out on secondary data collection in a Center for Psychosocial Care in Alcohol and Other Drugs. Subjects aged 18 years old and over, with alcohol and tobacco dependence, who were taking psychotherapies were included. Medical records with the most recent prescriptions were reviewed. Potential interactions between psychotropic drugs and alcohol and tobacco were analyzed using the Micromedex database and stratified according to clinical risks and mechanisms of action. The Pearson's Chi-square test was used to find significant associations between the variables of interest. The significance level was set at 5%. Between the 2010-2018 period, 2,322 subjects were treated at the care center. Of these, 1,020 fulfilled the inclusion criteria, out of whom 515 (50.5%) were dependent on alcohol and 310 (30.4%) were dependent on tobacco. We found 1,099 potential interactions between psychotropic drugs and alcohol and 160 potential interactions between psychotropic drugs and tobacco. In relation to alcohol dependence, psychotropic drugs interacted largely with moderate clinical risk, and pharmacokinetic mechanisms of action. In relation to tobacco dependence, high clinical risk interactions and pharmacodynamic mechanisms of action predominated.

Intergenerational transmission between quilombola mothers and daughters: reproductive autonomy and intervening factors / Transmisión intergeracional entre madres e hijas quilombolas: autonomía reproductiva y factores intervinientes / Transmissão intergeracional entre mães e filhas quilombolas: autonomia reprodutiva e fatores intervenientes

ABSTRACT Objective: to analyze reproductive autonomy in quilombola women and the intervening factors of intergenerational transmission between mothers and daughters. Method: a cross-sectional and analytical study developed with 160 women, mothers and daughters from quilombola communities in the municipality of Vitória da Conquista, Bahia. The National Health Survey questionnaire was used to verify sociodemographic characteristics and intervening factors; and the Reproductive Autonomy Scale was also employed. The Chi-square, Mann-Whitney and Wilcoxon tests were applied. The data were analyzed by means of simple and multiple linear regression. Results: the group of mothers presented higher frequency of women that are married or live with a partner (66.2%), who worked (51.2%) and who had higher incomes (358.00 ± 663.00). The daughters presented more years of study (10.50 ± 5.00). Reproductive autonomy and intergenerational transmission between mothers and daughters mainly occur in the Absence of coercion (ICC=0.70; p=0368) and Communication (ICC=0.69; p=0694) domains. The mother's age (ß-adjusted=-0.027; p=0.039) and the daughter's skin color/race (ß-adjusted=0.423; p=0.049) were intervening factors in intergenerational transmission related to Decision-making, associated with the mother's age and with the daughter's self-recognition as black-skinned. Conclusion: the daughters do not follow the same choice as their mothers, which can be understood due to greater accessibility to reproductive planning services and increased schooling levels. Intergenerational transmission among quilombolas presents important specificities for reproductive decisions and enables a better understanding of the information and qualification of the health professionals' assistance in the care provided to these women.

RESUMEN Objetivo: analizar la autonomía reproductiva en mujeres quilombolas y los factores intergeneracionales de transmisión entre madres e hijas. Método: estudio transversal y analítico desarrollado con 160 mujeres, madres e hijas de comunidades quilombolas de la ciudad de Vitória da Conquista, Bahía. Se utilizó el cuestionario de la Pesquisa Nacional de Saúde para verificar las características sociodemográficas y los factores intervinientes; y la Escala de Autonomía Reproductiva. Se aplicaron las pruebas de Chi-cuadrado, Mann-Whitney y Wilcoxon. Los datos se analizaron mediante regresión lineal simple y múltiple. Resultados: el grupo de madres presentó mayor frecuencia de mujeres casadas o con pareja (66,2%), que trabajaban (51,2%) y tenían mayores ingresos (358,00 ± 663,00). Las hijas presentaron más años de escolaridad (10,50 ± 5,00). La autonomía reproductiva y la transmisión intergeneracional entre madres e hijas ocurren especialmente en los dominios Ausencia de Coerción (CCI=0,70; p=0368) y Comunicación (CCI=0,69; p=0694). La edad de la madre (ß-ajustada=-0.027; p=0.039) y la etnia / raza de la hija (ß-ajustada=0.423; p=0.049) fueron factores que intervinieron en la transmisión intergeneracional relacionada con la Toma de Decisiones, asociada a una menor edad de la madre y al autorreconocimiento de la hija como negra. Conclusión: las hijas no siguen la misma opción que sus madres, lo que puede explicarse debido a la mayor accesibilidad a los servicios de planificación reproductiva y mayores niveles de educación. La transmisión intergeneracional entre quilombolas presenta importantes especificidades para las decisiones reproductivas y permite una mejor comprensión de la información y la calificación de la asistencia de los profesionales de la salud en el cuidado de estas mujeres.

RESUMO Objetivo: analisar a autonomia reprodutiva em mulheres quilombolas e os fatores intervenientes da transmissão intergeracional entre mães e filhas. Método: estudo transversal e analítico desenvolvido com 160 mulheres, mães e filhas de comunidades quilombolas do município de Vitória da Conquista, Bahia. Utilizou-se o questionário da Pesquisa Nacional de Saúde para verificar características sociodemográficas e fatores intervenientes; e a Escala de Autonomia Reprodutiva. Foram aplicados testes qui-quadrado, Mann-Whitney e Wilcoxon. Os dados foram analisados através de regressão linear simples e múltipla. Resultados: o grupo das mães apresentou maior frequência de mulheres casadas ou com companheiro (66,2%), que trabalhavam (51,2%) e maior renda (358,00 ± 663,00). As filhas apresentaram mais anos de estudo (10,50 ± 5,00). A autonomia reprodutiva e a transmissão intergeracional entre mães e filhas ocorrem, sobretudo, nos domínios Ausência de Coerção (CCI=0,70; p=0368) e Comunicação (CCI=0,69; p=0694). A idade da mãe (ß-ajustado=-0,027; p=0,039) e cor/raça da filha (ß-ajustado=0,423; p=0,049) foram fatores intervenientes na transmissão intergeracional relacionada a Tomada de Decisão, associados a menor idade da mãe e ao autorreconhecimento da filha como negra. Conclusão: as filhas não acompanham a mesma escolha das mães, o que pode ser entendido por uma maior acessibilidade aos serviços de planejamento reprodutivo e aumento nos níveis de escolaridade. A transmissão intergeracional entre quilombolas apresenta especificidades importantes para decisões reprodutivas e possibilita melhor entendimento das informações e qualificação da assistência dos profissionais de saúde no cuidado com essas mulheres.

Vatairea guianensis lectin stimulates changes in gene expression and release of TNF-α from rat peritoneal macrophages via glycoconjugate binding.

Using a rat model of peritonitis, we herein report the inflammatory effect induced by the lectin isolated from Vatairea guianensis (VGL) seeds in the context of interactions between VGL and both toll-like receptor 4 (TLR4) and tumor necrosis factor receptor 1 (TNFR1). Peritoneal macrophages were stimulated with VGL for dose-dependent gene expression and release of TNF-α. In vivo results showed that VGL (1 mg/kg; intraperitoneal) induced peritonitis in female Wistar rats. Leukocyte migration, macrophage activation, and protein leakage were measured 3 and 6 hours after induction. In vitro, peritoneal macrophages were stimulated with VGL for gene expression and TNF-α dosage (mean ± SEM (n = 6), analysis of variance, and Bonferroni's test (P < .05)). In silico, VGL structure was applied in molecular docking with representative glycans. It was found that (a) VGL increases vascular permeability and stimulates leukocyte migration, both rolling and adhesion; (b) lectin-induced neutrophil migration occurs via macrophage stimulation, both in vitro and in vivo; (c) lectin interacts with TLR4 and TNFR1; and (d) stimulates TNF-α gene expression (RT-PCR) and release from peritoneal macrophages. Thus, upon lectin-glycan binding on the cell surface, our results suggest that VGL induces an acute inflammatory response, in turn activating the release of peritoneal macrophages via TNF-α and TLR and/or TNFR receptor pathways.

Trichosporon asahii superinfections in critically ill COVID-19 patients overexposed to antimicrobials and corticosteroids.

OBJECTIVES: To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID-19 patients. METHODS: From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID-19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. RESULTS: Five critically ill COVID-19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad-spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30-day mortality was 80%. The five T asahii strains from the COVID-19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross-transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. CONCLUSIONS: Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID-19 patients to prevent infections by hard-to-treat fungi like T asahii.

Livedoid vasculopathy in 75 Brazilian patients in a single-center institution: Clinical, histopathological and therapy evaluation.

This study presents a single center experience with livedoid vasculopathy (LV). A rare disease that can lead to severe quality of life impairment. Characterize clinical data of LV patients at the Dermatology Division at the University of São Paulo. A retrospective and transversal study was conducted, from 1 January 2005 to 31 December 2019. About 75 patients diagnosed as LV and confirmed by skin biopsy were included. Epidemiology, clinical appearance, histopathology data, and treatment history were observed. There were 78.66% Caucasian women, with a mean age of 39.9 years. Frequent cutaneous manifestations were ulcers, atrophic blanche-like scars, hyperpigmentation, purpuras, telangiectasias, and livedo racemosa. Pain, pruritus, and hypoesthesia were the main symptoms. After treatment, almost 40% of cases relapsed during spring and summer months. About 66% of cases had thrombophilia factors associated, such as high levels of lipoprotein(a). Frequent treatments included acetylsalicylic acid, pentoxifylline, and diosmin with hesperidin. Not being a prospective study. This research provides useful data on Latin American LV patients, indicating multifactorial conditions involved in LV pathogenesis. An extensive work-up including autoimmune laboratory tests, thrombophilia factors, and other conditions associated with venous stasis should be part of LV investigation and controlled to improve treatment response.

Livedo Racemosa: Clinical, Laboratory, and Histopathological Findings in 33 Patients.

Livedo racemosa is a cutaneous finding characterized by a persistent, erythematous, or violaceous discoloration of the skin, in a broken, branched, discontinuous, and irregular pattern. A retrospective review of 33 cases with clinical diagnosis of livedo racemosa over the past 6 years was evaluated in the dermatology department of a tertiary care hospital. We found predominance in Caucasian women (78.8%); age ranged from 8 to 81 years, with a mean age of 36 years. Livedo racemosa was described as generalized in 12 patients (36.4%), although the main localization was on lower limbs (42%). After laboratory testing and histopathological examinations, 12 patients (36.4%) were classified with idiopathic livedo racemosa; secondary diseases were diagnosis in 21 patients (63.6%), including Sneddon's syndrome, cutaneous polyarteritis nodosa, systemic lupus erythematosus, and others. Medical history of thrombotic events was described in 8 (24.2%) patients, and also 8 (24.2%) patients had abnormal results for 2 or more thrombophilia laboratory tests. Skin biopsy showed no histological abnormalities in 11 cases (33.3%), thrombosis of dermal blood vessels in 10 (30.3%), intimal/subintimal thickening in 7 (21.2%), and vasculitis in 5 (15.2%). In conclusion, livedo racemosa is a clinical feature that might be correlated to vascular disorders, such as thrombotic and/or hypercoagulable states, autoimmune diseases, and neoplastic diseases, or it can be secondary to specific medications. It is essential to establish a correct approach in cases of livedo racemosa, which includes anamnesis, physical examination, laboratory test, histological examination, and complementary examination according to clinical findings, in order to diagnosis underlying causes.