Low eligibility for hepatitis B treatment in the Brazilian public health system.

BACKGROUND: Chronic hepatitis B (CHB) affects 257 million people worldwide. However, the proportion of patients eligible for treatment in the public health system has not been established. This study describes the clinical and laboratory profiles of untreated CHB patients and estimates the eligibility rate for antiviral therapy in accordance with the Brazilian Clinical Protocol and Therapeutic Guidelines. METHODS: Records of 670 CHB patients were collected from May 2012 to September 2013 in Minas Gerais. Data from each patient were analyzed by hepatitis B virus (HBV) management. RESULTS: 461 CHB patients were treatment-naive. Of these, 23 were HBeAg-positive, 352 were HBeAg-negative, and 14 were clinically diagnosed with cirrhosis. Periodic monitoring was performed in only three patients. However, 9.3% of untreated patients met the eligibility criteria for HBV treatment. CONCLUSIONS: Few CHB patients were active carriers and eligible candidates for antiviral therapy. This study revealed inadequate pre-treatment conduct in the Brazilian public health system, emphasizing the need for regular laboratory follow-up for patients initially not eligible for treatment. Such information may indirectly subsidize the planning and improvement of actions and services related to optimal HBV management in the public sphere.

Screening for Human T-Cell Lymphotropic Virus (HTLV) in Pregnant Women in the Peruvian Amazon and Systematic Review with Meta-Analysis of HTLV Infection in Peru.

Background. Human T-cell lymphotropic virus type 1 (HTLV-1) is responsible for tropical spastic paraparesis and HTLV-1-associated leukemia/lymphoma. The infection is endemic in some areas of Peru, but its prevalence in the Peruvian Amazon is not well established. We aimed to assess the seroprevalence of HTLV-1 infection in pregnant women in the Peruvian Amazon. Moreover, we performed a systematic literature review and meta-analysis of the seroprevalence of HTLV infection in Peru. (2) Methods. This is a prospective cross-sectional study involving pregnant women attending health centers in the city of Iquitos, Peru, in May and June 2019. The presence of antibodies against HTLV-1 was assessed using ELISA (HTLV I + II ELISA recombinant v.4.0, Wiener lab, Rosario, Argentina). Positive cases were confirmed by Western Blot and HTLV-1 proviral load. (3) Results. The study included 300 pregnant women with a mean age of 26 years (standard deviation [SD] 6.4). Five patients were diagnosed with HTLV-1 infection (prevalence 1.7%, 95% confidence interval (CI) 0.7% to 3.8%). Pregnant women with HTLV-1 infection were discretely younger (mean age 22.6 [SD 22.6] vs 26.8 [SD 6.3]; p = 0.128). None of the five women had been transfused, and all were asymptomatic. Two (40%) also had a positive serology for Strongyloides, but larvae were not detected in any of the parasitological stool studies. The systematic review component identified 40 studies, which showed that the prevalence of HTLV infection in the general population was 2.9% (95% CI 1.2% to 5.3%) and in women of childbearing age, 2.5% (95% CI 1.2% to 4.0%). (4) Conclusion. The prevalence of HTLV-1 in the Peruvian Amazon basin is about 1.7%, indicating an endemic presence. Screening for HTLV-1 in prenatal care is warranted.

Transcultural adaptation of the Injustice Experience Questionnaire into Brazilian Portuguese / Adaptação transcultural do Injustice Experience Questionnaire para o português do Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: It has been proposed that some individuals with musculoskeletal pain may perceive themselves as victims of injustice. Perception of injustice can have a significant impact on several pain-related outcomes, major depressive symptoms, disabilities, and absenteeism. The objective of this study consisted of a transcultural adaptation of the original instrument in English, Injustice Experience Questionnaire into a final version to be used in Brazil. METHODS: The whole translation process consisted of translation, back-translation and the review by a committee of experts. The pre-test was applied to 90 participants (41 participants with chronic musculoskeletal pain). For the psychometric analysis, the translated version was applied to 120 participants with chronic musculoskeletal pain. The internal consistency was verified by the Cronbach's alpha coefficient, and the construct validity was analyzed using factorial exploratory analysis. RESULTS: After the conclusion of the pre-test, there were no difficulties in understanding the translated questionnaire by more than 20% of the sample. The Cronbach alpha calculation for the 12 items of the Injustice Experience Questionnaire/Port-BR was 0.86 [CI (95%) = 0.83 to 0.90; p<0.001]. CONCLUSION: The questionnaire's Portuguese version proved to be easily understandable showing good semantic validation. Nevertheless, further studies should address other psychometric characteristics of this instrument.

RESUMO JUSTIFICATIVA E OBJETIVOS: Tem sido proposto que algumas pessoas com dor musculoesquelética podem desenvolver um sentimento de injustiça. A percepção da injustiça pode ter um impacto significativo em uma série de desfechos relacionados à dor, sintomas depressivos maiores, incapacidades e absenteísmo. O objetivo deste estudo consistiu em uma adaptação transcultural do instrumento original em inglês do Injustice Experience Questionnaire para uma versão final a ser utilizada no Brasil. MÉTODOS: Todo o processo consistiu em tradução, retrotradução e revisão pelo comitê de especialista. O pré-teste foi aplicado a 90 participantes (41 participantes com dor crônica musculoesquelética). Para a análise psicométrica, a versão traduzida foi aplicada a 120 participantes com dor crônica musculoesquelética. A consistência interna foi verificada pelo coeficiente alfa de Cronbach e a validade do construto foi analisada por meio de análise exploratória fatorial. RESULTADOS: Após a conclusão do pré-teste, não houve dificuldades em entender cada item do questionário traduzido por mais de 20% da amostra. O cálculo alfa de Cronbach para os 12 itens do Injustice Experience Questionnaire/Port-BR foi de 0,86 [IC (95%) = 0,83 a 0,90; p<0,001]. CONCLUSÃO: A versão em português do questionário mostrou-se facilmente compreensível com boa validação semântica. No entanto, estudos adicionais devem abordar outras características psicométricas desse instrumento.

Reduced Cancer Survival Among Adults With HIV and AIDS-Defining Illnesses Despite No Difference in Cancer Stage at Diagnosis.

BACKGROUND: It is not known whether immune dysfunction is associated with increased risk of death after cancer diagnosis in persons with HIV (PWH). AIDS-defining illness (ADI) can signal significant immunosuppression. Our objective was to determine differences in cancer stage and mortality rates in PWH with and without history of ADI. METHODS: PWH with anal, oropharynx, cervical, lung cancers, or Hodgkin lymphoma diagnoses from January 2000 to December 2009 in the North American AIDS Cohort Collaboration on Research and Design were included. RESULTS: Among 81,865 PWH, 814 had diagnoses included in the study; 341 (39%) had a history of ADI at time of cancer diagnosis. For each cancer type, stage at diagnosis did not differ by ADI (P > 0.05). Mortality and survival estimates for cervical cancer were limited by n = 5 diagnoses. Adjusted mortality rate ratios showed a 30%-70% increase in mortality among those with ADI for all cancer diagnoses, although only lung cancer was statistically significant. Survival after lung cancer diagnosis was poorer in PWH with ADI vs. without (P = 0.0001); the probability of survival was also poorer in those with ADI at, or before other cancers although not statistically significant. CONCLUSIONS: PWH with a history of ADI at lung cancer diagnosis had higher mortality and poorer survival after diagnosis compared to those without. Although not statistically significant, the findings of increased mortality and decreased survival among those with ADI (vs. without) were consistent for all other cancers, suggesting the need for further investigations into the role of HIV-related immune suppression and cancer outcomes.

Adult tonsillectomy: postoperative pain depends on indications / Tonsilectomia no adulto: a dor pós-operatória depende das indicações

ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.

Resumo Introdução: Dor intensa é uma das queixas mais importantes no pós-operatório de uma tonsilectomia. Com frequência, essa dor é descrita pelos pacientes, como comparável à dor que acompanha a tonsilite aguda. Apesar da tonsilite recorrente ser a indicação mais frequente para cirurgia, muitas tonsilectomias são realizadas por outras indicações, e esses pacientes podem não estar familiarizados com essa dor. Objetivo: Verificar se indivíduos com tonsilite recorrente apresentam diferenças na intensidade dolorosa pós-tonsilectomia vs. pacientes com outras indicações para cirurgia, sem histórico de episódios de tonsilite aguda. Método: Foram realizadas 61 tonsilectomias sob anestesia geral, com o uso de um laser potassium titanyl phosphate (KTP) (para que fosse eliminada uma possível influência de uma dissecção agressiva das tonsilas fibrosadas em pacientes com história de tonsilite recorrente), e hemostasia através de ligaduras de vasos sanguíneos nos leitos tonsilares. Os pacientes foram medicados com 37,5 mg de cloridrato de tramadol + 325 mg de paracetamol (comprimidos) durante 10 dias. As variáveis pós-operatórias foram tempo de internação hospitalar, hemorragia e percentual de readmissão. Os pacientes forneceram informações sobre a intensidade da dor em dias consecutivos, duração da dor, perda de peso corpóreo no dia 10 do pós-operatório, intensidade e duração da dificuldade de deglutição, e necessidade de doses adicionais de analgésicos. A velocidade de cicatrização também foi avaliada. Fibras nervosas capsulares foram examinadas histologicamente nas tonsilas resecadas com o uso de imunocorantes para marcadores de fibras nervosas gerais e de sensibilidade. Resultados: As indicações para a cirurgia foram: tonsilite aguda recorrente (34 pacientes), ausência de história de tonsilite recorrente - Tonsilite focal (20) e halitose (7). A intensidade da dor nos dias 3-4 do pós-operatório e a incidência de reinternações em decorrência de desidratação foram significativamente mais altas no grupo sem história de tonsilite recorrente. Não foram observadas diferenças significantes nas densidades relativas de fibras nervosas imunorreativas para protein gene product (PGP) 9.5 e calcitonin gene-related peptide (CGRP). Conclusão: Os pacientes com tonsilite recorrente e qualificados para tonsilectomia informaram menor intensidade da dor em relação aos pacientes sem histórico se tonsilite recorrente, e os escores para dor não apresentaram relação com a densidade das fibras nervosas.

Adult tonsillectomy: postoperative pain depends on indications.

INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5mg Tramadoli hydrochloridum+325mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed. CONCLUSION: Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.

Inter-regional cortical thickness correlations are associated with autistic symptoms: a machine-learning approach.

The investigation of neural substrates of autism spectrum disorder using neuroimaging has been the focus of recent literature. In addition, machine-learning approaches have also been used to extract relevant information from neuroimaging data. There are only few studies directly exploring the inter-regional structural relationships to identify and characterize neuropsychiatric disorders. In this study, we concentrate on addressing two issues: (i) a novel approach to extract individual subject features from inter-regional thickness correlations based on structural magnetic resonance imaging (MRI); (ii) using these features in a machine-learning framework to obtain individual subject prediction of a severity scores based on neurobiological criteria rather than behavioral information. In a sample of 82 autistic patients, we have shown that structural covariances among several brain regions are associated with the presence of the autistic symptoms. In addition, we also demonstrated that structural relationships from the left hemisphere are more relevant than the ones from the right. Finally, we identified several brain areas containing relevant information, such as frontal and temporal regions. This study provides evidence for the usefulness of this new tool to characterize neuropsychiatric disorders.

Nonlinear estimation of neural processing time from BOLD signal with application to decision-making.

The extraction of information about neural activity timing from BOLD signal is a challenging task as the shape of the BOLD curve does not directly reflect the temporal characteristics of electrical activity of neurons. In this work, we introduce the concept of neural processing time (NPT) as a parameter of the biophysical model of the hemodynamic response function (HRF). Through this new concept we aim to infer more accurately the duration of neuronal response from the highly nonlinear BOLD effect. The face validity and applicability of the concept of NPT are evaluated through simulations and analysis of experimental time series. The results of both simulation and application were compared with summary measures of HRF shape. The experiment that was analyzed consisted of a decision-making paradigm with simultaneous emotional distracters. We hypothesize that the NPT in primary sensory areas, like the fusiform gyrus, is approximately the stimulus presentation duration. On the other hand, in areas related to processing of an emotional distracter, the NPT should depend on the experimental condition. As predicted, the NPT in fusiform gyrus is close to the stimulus duration and the NPT in dorsal anterior cingulate gyrus depends on the presence of an emotional distracter. Interestingly, the NPT in right but not left dorsal lateral prefrontal cortex depends on the stimulus emotional content. The summary measures of HRF obtained by a standard approach did not detect the variations observed in the NPT.

Passiflora fissurosa, uma nova espécie de Passifloraceae para o Amazonas, Brasil / Passiflora fissurosa, a new species of Passifloraceae from Amazon, Brazil

Passiflora fissurosa M.A.D.Souza sp. nov., até o momento conhecida apenas da Reserva Florestal Adolpho Ducke, no Amazonas, Brasil, é descrita e ilustrada. Foi inserida no Subgênero Passiflora, Superseção Passiflora, Seção Laurifoliae e Série Laurifoliae, por apresentar folhas simples e inteiras, pecíolo biglandular, brácteas foliáceas, livres, maiores que 1 cm, pertencendo ao grupo de espécies com as duas séries externas da corona subiguais. Morfologicamente é semelhante a P. nitida, que difere pelo opérculo horizontal-encurvado com margem ereto-divergente, anel nectarífero presente, límen vertical e ovário glabro. A designação do epíteto deve-se à característica do ritidoma, suberoso e profundamente fissurado, característica somente encontrada em P. phellos, também pertencente à Série Laurifoliae, mas do grupo de espécies com a primeira série da corona menor que a segunda.

Passiflora fissurosa M.A.D. Souza sp. nov., presently known only from the Adolpho Ducke Forest Reserve in Amazonian Brazil, is described and illustrated. P. fissurosa belongs in the subgenus Passiflora, Supersection Passiflora, Section Laurifoliae and Series Laurifoliae, with simple, entire leaves, a biglandular petiole, free foliaceous stipules larger than 1 cm, in the group of species with the outer two series of the corona sub-equal. Morphologically it resembles P. nitida, which differs by the horizontal curved with erect-divergent margin operculum, the presence of a nectariferous ring, vertical limen and glabrous ovary. The epithet is derived from the characteristic of the bark, which is corky and profoundly fissured, which is showed only by P. phellos of the Laurifoliae group which has the first series of the corona smaller than the second.

An fMRI normative database for connectivity networks using one-class support vector machines.

The application of functional magnetic resonance imaging (fMRI) in neuroscience studies has increased enormously in the last decade. Although primarily used to map brain regions activated by specific stimuli, many studies have shown that fMRI can also be useful in identifying interactions between brain regions (functional and effective connectivity). Despite the widespread use of fMRI as a research tool, clinical applications of brain connectivity as studied by fMRI are not well established. One possible explanation is the lack of normal patterns and intersubject variability-two variables that are still largely uncharacterized in most patient populations of interest. In the current study, we combine the identification of functional connectivity networks extracted by using Spearman partial correlation with the use of a one-class support vector machine in order construct a normative database. An application of this approach is illustrated using an fMRI dataset of 43 healthy subjects performing a visual working memory task. In addition, the relationships between the results obtained and behavioral data are explored.

The impact of functional connectivity changes on support vector machines mapping of fMRI data.

Functional magnetic resonance imaging (fMRI) is currently one of the most widely used methods for studying human brain function in vivo. Although many different approaches to fMRI analysis are available, the most widely used methods employ so called "mass-univariate" modeling of responses in a voxel-by-voxel fashion to construct activation maps. However, it is well known that many brain processes involve networks of interacting regions and for this reason multivariate analyses might seem to be attractive alternatives to univariate approaches. The current paper focuses on one multivariate application of statistical learning theory: the statistical discrimination maps (SDM) based on support vector machine, and seeks to establish some possible interpretations when the results differ from univariate approaches. In fact, when there are changes not only on the activation level of two conditions but also on functional connectivity, SDM seems more informative. We addressed this question using both simulations and applications to real data. We have shown that the combined use of univariate approaches and SDM yields significant new insights into brain activations not available using univariate methods alone. In the application to a visual working memory fMRI data, we demonstrated that the interaction among brain regions play a role in SDM's power to detect discriminative voxels.

A method to produce evolving functional connectivity maps during the course of an fMRI experiment using wavelet-based time-varying Granger causality.

Functional magnetic resonance imaging (fMRI) is widely used to identify neural correlates of cognitive tasks. However, the analysis of functional connectivity is crucial to understanding neural dynamics. Although many studies of cerebral circuitry have revealed adaptative behavior, which can change during the course of the experiment, most of contemporary connectivity studies are based on correlational analysis or structural equations analysis, assuming a time-invariant connectivity structure. In this paper, a novel method of continuous time-varying connectivity analysis is proposed, based on the wavelet expansion of functions and vector autoregressive model (wavelet dynamic vector autoregressive-DVAR). The model also allows identification of the direction of information flow between brain areas, extending the Granger causality concept to locally stationary processes. Simulation results show a good performance of this approach even using short time intervals. The application of this new approach is illustrated with fMRI data from a simple AB motor task experiment.

Contribuição ao conhecimento morfológico das espécies de leguminosae comercializadas no estado do Pará, como "angelim" / Contribution to the morphologic knowledge of the species of leguminosae in the state of Pará, traded as \"angelim\"

Sete espécies de Leguminosae comercializadas como "angelim", no estado do Pará, foram analisadas quanto aos aspectos morfológicos dos órgãos vegetativos e reprodutivos. Este estudo visou determinar diferenças básicas entre as espécies comercializadas com esta denominação vernacular, a fim de auxiliar no processo de identificação taxonômica das mesmas. Foi elaborada uma chave dicotômica para separar as espécies estudadas (Andira surinamensis, Dinizia excelsa, Hymenolobium excelsum, H. modestum, H. pulcherrimum, H. petraeum e Vatairea paraensis). As principais características utilizadas no campo, para separação das espécies estudadas, foram folha, folíolo, casca e tronco, porém, espécies de Andira, Hymenolobium e Vatairea, por apresentarem-se desprovidas de folhas no período fértil, necessitam de dados dos órgãos reprodutivos.