Stroke in Young Military Men With Heterozygous for MTHFR Gene Mutation or Factor V Leiden Gene Mutation Associated With Patent Foramen Ovale: Report of Two Cases and Therapeutic Strategy.

We report two cases of Brazilian patients (a 22-year-old male and a 48-year-old male) with ischemic stroke, whose arterial vascular study and echocardiographic investigation did not reveal any steno-occlusive arterial disease or typical cardioembolic finding, such as atrial fibrillation or myocardial dysfunction. A transcranial Doppler ultrasound and a transesophageal echocardiogram showed a patent foramen ovale (PFO), and the laboratory screening for coagulation abnormalities showed heterozygosity for MTHFR C677T and A1298C in one of the patients and heterozygosity for factor V Leiden gene mutations in the other patient. The significance of the association of PFO with Methylenetetrahydrofolate (MTHFR) C677T and A1298C variants or factor V Leiden mutation is discussed as a possible cause of ischemic stroke through paradoxical embolism from a venous source. There is a high prevalence of these two mentioned conditions in the general population, so we discuss two cases in which indication for anticoagulant therapy or percutaneous closure of PFO prevails.

Ocorrência de perigos físicos em alimentos / Occurrence of physical hazards in food

A ocorrência de matérias estranhas com potencial perigo físico em alimentos é um grande desafio para a indústria alimentícia, e a análise microscópica é provavelmente o instrumento mais útil para detectá-las e identificá-las. Considerando a escassez de dados sobre os perigos físicos em produtos alimentícios no Brasil, o objetivo deste estudo foi descrever essa ocorrência nos produtos analisados no Núcleo de Morfologia e Microscopia do Centro de Alimentos do Laboratório Central do Instituto Adolfo Lutz (IAL), em São Paulo, no período de 2008 a 2020. Os resultados revelaram que, das 7.221 amostras de alimentos analisadas, 89 (1,2%) estavam em desacordo com a legislação em vigor, por conterem perigos físicos. De acordo com a categoria de alimentos, a ocorrência foi maior para bebidas (43%), seguida de cereais, farinha e farelo (22%). Quanto ao tipo de matéria estranha, os plásticos (duros e flexíveis) foram os mais frequentes (48%), seguidos dos metais (15%) entre as partículas perigosas detectadas nas amostras. A detecção e identificação de perigos físicos, por meio de análises microscópicas, contribuem para a segurança e qualidade dos produtos alimentícios oferecidos à população (AU).

The occurrence of physical hazards in food is a great challenge for the food industry, and microscopic analysis is probably the most useful instrument to detect and identify them. Considering the scarcity of data on physical hazards in food products in Brazil, the aim of this study was to describe this occurrence in the products analyzed at the Nucleus of Morphology and Microscopy of the Food Center of the Adolf Lutz Institute's Central Laboratory (IAL) in São Paulo, from 2008 to 2020. Results revealed that of the 7,221 analyzed food samples, 89 (1.2%) did not comply with the legislation due to the presence of physical hazards. According to the food category, the occurrence was higher in beverages (43%), followed by cereals, yeasts, flour and bran (22%). Regarding the type of foreign matter, among the dangerous particles detected, the most frequently found were plastics (48%) (hard and flexible), followed by metals (15%). The detection and identification of physical hazards by microscopic analysis contributes to the safety and quality of food products offered to the public. (AU)

Efeito de intervenção educativa online na qualidade de vida de gestantes adolescentes / Efecto de intervención educativa online en la calidad de vida de embarazadas adolescentes / Effect of online educational intervention on pregnant adolescents' quality of life

Resumo Objetivo Avaliar o efeito de intervenção educativa online na qualidade de vida de gestantes adolescentes. Métodos Estudo quase experimental, do tipo grupo único pré e pós-teste, realizado nas Unidades Básicas de Saúde de Teresina, no período de outubro de 2017 a janeiro de 2018. Amostra de 35 gestantes adolescentes obtida por conveniência e a qualidade de vida avaliada por meio do Instrumento de Qualidade de Vida de Ferrans & Powers. Para escores de distribuição normal foi realizado o teste t e para os de distribuição não-paramétrica o teste Wilcoxon e o nível de significância adotado foi α=0,05. Resultados Após a intervenção educativa online houve melhora da qualidade de vida total (p<0,001) e nos domínios saúde/funcionamento (p<0,001), socioeconômico (p<0,001) e psicológico/espiritual (p<0,001), exceto no domínio família. Conclusão a intervenção educativa online teve efeito na qualidade de vida, permitindo que ela seja incorporada no processo de educação em saúde com gestantes adolescentes na atenção básica à saúde.

Resumen Objetivo Evaluar el efecto de una intervención educativa online en la calidad de vida de embarazadas adolescentes. Métodos Estudio cuasi experimental, tipo grupo único antes y después de la prueba, realizado en las Unidades Básicas de Salud de Teresina, en el período de octubre de 2017 a enero de 2018. Muestra de 35 mujeres embarazadas adolescentes, obtenida por conveniencia, y calidad de vida evaluada mediante el Instrumento de Calidad de Vida de Ferrans & Powers. Para la puntuación de distribución normal se realizó el test-T y para la de distribución no paramétrica, la Prueba de Wilcoxon. El nivel de significación adoptado fue α=0,05. Resultados Luego de la intervención educativa online, hubo una mejora de la calidad de vida total (p<0,001) y de los dominios salud/funcionamiento (p<0,001), socioeconómico (p<0,001) y psicológico/espiritual (p<0,001), excepto en el dominio familia. Conclusión La intervención educativa online tuvo efecto en la calidad de vida, lo que permitió que esta se incorpore en el proceso de educación para la salud para mujeres embarazadas adolescentes en la atención básica en salud.

Abstract Objective To assess the effect of online educational intervention on pregnant adolescents' quality of life. Methods This is a quasi-experimental study, of the pre- and post-test single group type, carried out in the Basic Health Units of Teresina, from October 2017 to January 2018. A sample of 35 pregnant adolescents was obtained by convenience. Quality of life was assessed using the Ferrans & Powers Quality of Life Instrument. For scores with normal distribution, Student's t-test was performed, and for those with non-parametric distribution, the Wilcoxon test was used and the significance level adopted was α=0.05. Results After the online educational intervention, there was an improvement in the total quality of life (p<0.001) and in health/functioning (p<0.001), socioeconomic (p<0.001) and psychological/spiritual (p<0.001) domains, except in the family domain. Conclusion The online educational intervention had an effect on quality of life, allowing it to be incorporated into the health education process with pregnant adolescents in Primary Health Care.

Detection of Ehrlichia sp. in Amblyomma sculptum parasitizing horses from Brazilian Pantanal wetland.

Bacteria of the genus Ehrlichia are transmitted by ticks and also are an important cause of infection in wild and domestic mammals. Infection with Ehrlichia spp. has been reported in horses, especially in the USA, Nicaragua and Brazil. In this study, we report the parasitism by Amblyomma sculptum, Rhipicephalus microplus and Dermacentor nitens ticks in horses from a ranch located in south Pantanal wetland. Molecular and serological analyzes to determine infection by Ehrlichia spp. in horses and their respective ticks were carried out. A total of 12 horses were submitted to blood collection to investigate antibodies by indirect immunofluorescence assay (IFA) using Ehrlichia canis crude antigens and to be tested by polymerase chain reaction (PCR) in order to amplify fragments of the 16S rRNA, dsb, groEL and sodB gene of Ehrlichia spp. A total of 164 tick specimens were removed from horses, stored in isopropanol and later identified as D. nitens, A. sculptum and R. microplus. DNA from ticks were extracted and subjected to the same PCR assays to detect Ehrlichia spp. Anti-Ehrlichia spp. antibodies were detected in five/12 (41.7 %) horses by IFA, with antibody titers ranging from 40 to 160. All horse DNA samples were negative for the 16S rRNA, dsb, groEL and sodB of Ehrlichia spp. One A. sculptum female was positive to all target genes of Ehrlichia. This tick was parasitizing an Ehrlichia-seropositive horse with antibody titer of 80. Nucleotide sequences of 16S rRNA, dsb, groEL and sodB genes showed close relationship with different strains of Ehrlichia detected in wild mammals, Amblyomma ticks and horses from Brazil and Argentina. Detection of anti-Ehrlichia sp. antibodies suggests that horses have been exposed to an ehrlichial agent in the Pantanal. Future studies on Ehrlichia infection should be carried out to better elucidate and to bring new information about equine ehrlichiosis, since these animals are important hosts of ticks in the Brazilian Pantanal wetlands.

Toxoplasmose ovina e equina: ocorrência de anticorpos em animais criados em centro de pesquisa na região do pantanal Sul Mato-Grossense, Brasil / Ovine and equine toxoplasmosis: occurrence of antibodies in animals raised in a research center in the pantanal region of Mato Grosso do Sul, Brazil / Toxoplasmosis ovina y equina: ocurrencia de anticuerpos en animales criados en un centro de investigación en la región del pantanal en el Mato Grosso del Sur, Brasil

A toxoplasmose é uma zoonose de distribuição mundial que acomete vertebrados homeotérmicos, incluindo o ser humano. Toxoplasma gondii, seu agente etiológico, é capaz de infectar seus hospedeiros por diversas vias de transmissão, dentre elas a ingestão de cistos teciduais, presente na carne crua ou malcozida, e a ingestão de oocistos, presentes na água e alimentos contaminados, sendo essas as principais rotas de infecção na cadeia epidemiológica da toxoplasmose. Neste sentido, a contaminação ambiental com oocistos esporulados apresenta-se como um importante fator de risco para a infecção toxoplásmica em animais herbívoros, como os equinos e ovinos. Enquanto os equinos mostram resistência à infecção e a manifestações de sinais clínicos da doença, em ovinos, a toxoplasmose pode ser responsável por importantes distúrbios reprodutivos como aborto e morte neonatal. Sendo assim, este estudo teve como objetivo pesquisar a presença de anticorpos específicos anti- T. gondii em equinos e ovinos criados na Fazenda Experimental Nhumirim, propriedade da Embrapa Pantanal, Mato Grosso do Sul, Brasil. Para tanto foram coletadas amostras de soro de 101 equinos e 99 ovinos entre março de 2011 e maio de 2015. As amostras de soro foram enviadas para o Laboratório de Toxoplasmose e outras Protozooses, do Instituto Oswaldo Cruz, na Fundação Oswaldo Cruz/RJ. Os soros foram submetidos à reação de imunofluorescência indireta, sendo consideradas positivas as amostras sororreagentes a partir da diluição de 1:64 para ambas as espécies. Anticorpos anti-T. gondii foram detectados em 15% (15/99) dos ovinos e 10% (10/101) dos equinos. A ocorrência de anticorpos específicos anti-T. gondii nas amostras de soro desses animais, aponta para uma contaminação ambiental da propriedade, onde possivelmente, felídeos silvestres estariam atuando como dispersores do parasito...(AU)

Toxoplasmosis is a worldwide zoonosis that affects homeothermic vertebrates, including humans. Toxoplasma gondii, its etiological agent, is capable of infecting its hosts through several transmission routes, including the ingestion of tissue cysts, present in raw or undercooked meat, and the ingestion of oocysts, present in contaminated water and food, being these are the main routes of infection in the epidemiological chain of toxoplasmosis. In this sense, environmental contamination with sporulated oocysts is an important risk factor for toxoplasmic infection in herbivorous animals, such as horses and sheep. While horses show resistance to infection and manifestations of clinical signs of the disease, in sheep, toxoplasmosis may be responsible for important reproductive disorders such as abortion and neonatal death. Therefore, this study aimed to investigate the presence of specific anti-T. gondii antibodies in horses and sheep raised on the Experimental Farm Nhumirim, property of Embrapa Pantanal, Mato Grosso do Sul, Brazil. For this purpose, serum samples were collected from 101 horses and 99 sheep between March 2011 and May 2015. The serum samples were sent to the Toxoplasmosis and other Protozoal Diseases Laboratory, at Oswaldo Cruz Institute, at Oswaldo Cruz Foundation/RJ. Sera were subjected to indirect immunofluorescence test, and seroreactive samples were considered positive from a 1:64 dilution for both species. Anti-T. gondii were detected in 15% (15/99) of sheep and 10% (10/101) of horses. The occurrence of specific anti-T. gondii in the serum samples of these animals, points to an environmental contamination of the property, where possibly wild felids would be acting as dispersers of the parasite...(AU)

La toxoplasmosis es una zoonosis de distribución mundial que afecta a los vertebrados homeotérmicos, incluidos los humanos. Toxoplasma gondii, su agente etiológico, es capaz de infectar a sus huéspedes a través de varias vías de transmisión, entre ellas la ingestión de quistes tisulares, presentes en carnes crudas o poco cocidas, y la ingestión de ooquistes, presentes en agua y alimentos contaminados, siendo estos las principales vías de infección en la cadena epidemiológica de la toxoplasmosis. En este sentido, la contaminación ambiental con ooquistes esporulados es un factor de riesgo importante para la infección por toxoplasma en animales herbívoros, como caballos y ovejas. Mientras que los caballos muestran resistencia a la infección y las manifestaciones de los signos clínicos de la enfermedad, en las ovejas, la toxoplasmosis puede ser responsable de importantes trastornos reproductivos como el aborto y la muerte neonatal. Por lo tanto, este estudio tuvo como objetivo investigar la presencia de anticuerpos específicos anti-T. gondii en caballos y ovejas criados en la Granja Experimental Nhumirim, propiedad de Embrapa Pantanal, Mato Grosso do Sul, Brasil. Para ello, se recolectaron muestras de suero de 101 caballos y 99 ovejas entre marzo de 2011 y mayo de 2015. Las muestras de suero se enviaron al Laboratorio de Toxoplasmosis y otros Protozoos, del Instituto Oswaldo Cruz, en la Fundação Oswaldo Cruz / RJ. Los sueros se sometieron a una reacción de inmunofluorescencia indirecta y las muestras serorreactivas se consideraron positivas a partir de una dilución 1:64 para ambas especies. Anti-T. gondii se detectaron en el 15% (15/99) de las ovejas y el 10% (10/101) de los caballos...(AU)

Toxoplasmose ovina e equina: ocorrência de anticorpos em animais criados em centro de pesquisa na região do pantanal Sul Mato-Grossense, Brasil / Ovine and equine toxoplasmosis: occurrence of antibodies in animals raised in a research center in the pantanal region of Mato Grosso do Sul, Brazil / Toxoplasmosis ovina y equina: ocurrencia de anticuerpos en animales criados en un centro de investigación en la región del pantanal en el Mato Grosso del Sur, Brasil

A toxoplasmose é uma zoonose de distribuição mundial que acomete vertebrados homeotérmicos, incluindo o ser humano. Toxoplasma gondii, seu agente etiológico, é capaz de infectar seus hospedeiros por diversas vias de transmissão, dentre elas a ingestão de cistos teciduais, presente na carne crua ou malcozida, e a ingestão de oocistos, presentes na água e alimentos contaminados, sendo essas as principais rotas de infecção na cadeia epidemiológica da toxoplasmose. Neste sentido, a contaminação ambiental com oocistos esporulados apresenta-se como um importante fator de risco para a infecção toxoplásmica em animais herbívoros, como os equinos e ovinos. Enquanto os equinos mostram resistência à infecção e a manifestações de sinais clínicos da doença, em ovinos, a toxoplasmose pode ser responsável por importantes distúrbios reprodutivos como aborto e morte neonatal. Sendo assim, este estudo teve como objetivo pesquisar a presença de anticorpos específicos anti- T. gondii em equinos e ovinos criados na Fazenda Experimental Nhumirim, propriedade da Embrapa Pantanal, Mato Grosso do Sul, Brasil. Para tanto foram coletadas amostras de soro de 101 equinos e 99 ovinos entre março de 2011 e maio de 2015. As amostras de soro foram enviadas para o Laboratório de Toxoplasmose e outras Protozooses, do Instituto Oswaldo Cruz, na Fundação Oswaldo Cruz/RJ. Os soros foram submetidos à reação de imunofluorescência indireta, sendo consideradas positivas as amostras sororreagentes a partir da diluição de 1:64 para ambas as espécies. Anticorpos anti-T. gondii foram detectados em 15% (15/99) dos ovinos e 10% (10/101) dos equinos. A ocorrência de anticorpos específicos anti-T. gondii nas amostras de soro desses animais, aponta para uma contaminação ambiental da propriedade, onde possivelmente, felídeos silvestres estariam atuando como dispersores do parasito...

Toxoplasmosis is a worldwide zoonosis that affects homeothermic vertebrates, including humans. Toxoplasma gondii, its etiological agent, is capable of infecting its hosts through several transmission routes, including the ingestion of tissue cysts, present in raw or undercooked meat, and the ingestion of oocysts, present in contaminated water and food, being these are the main routes of infection in the epidemiological chain of toxoplasmosis. In this sense, environmental contamination with sporulated oocysts is an important risk factor for toxoplasmic infection in herbivorous animals, such as horses and sheep. While horses show resistance to infection and manifestations of clinical signs of the disease, in sheep, toxoplasmosis may be responsible for important reproductive disorders such as abortion and neonatal death. Therefore, this study aimed to investigate the presence of specific anti-T. gondii antibodies in horses and sheep raised on the Experimental Farm Nhumirim, property of Embrapa Pantanal, Mato Grosso do Sul, Brazil. For this purpose, serum samples were collected from 101 horses and 99 sheep between March 2011 and May 2015. The serum samples were sent to the Toxoplasmosis and other Protozoal Diseases Laboratory, at Oswaldo Cruz Institute, at Oswaldo Cruz Foundation/RJ. Sera were subjected to indirect immunofluorescence test, and seroreactive samples were considered positive from a 1:64 dilution for both species. Anti-T. gondii were detected in 15% (15/99) of sheep and 10% (10/101) of horses. The occurrence of specific anti-T. gondii in the serum samples of these animals, points to an environmental contamination of the property, where possibly wild felids would be acting as dispersers of the parasite...

La toxoplasmosis es una zoonosis de distribución mundial que afecta a los vertebrados homeotérmicos, incluidos los humanos. Toxoplasma gondii, su agente etiológico, es capaz de infectar a sus huéspedes a través de varias vías de transmisión, entre ellas la ingestión de quistes tisulares, presentes en carnes crudas o poco cocidas, y la ingestión de ooquistes, presentes en agua y alimentos contaminados, siendo estos las principales vías de infección en la cadena epidemiológica de la toxoplasmosis. En este sentido, la contaminación ambiental con ooquistes esporulados es un factor de riesgo importante para la infección por toxoplasma en animales herbívoros, como caballos y ovejas. Mientras que los caballos muestran resistencia a la infección y las manifestaciones de los signos clínicos de la enfermedad, en las ovejas, la toxoplasmosis puede ser responsable de importantes trastornos reproductivos como el aborto y la muerte neonatal. Por lo tanto, este estudio tuvo como objetivo investigar la presencia de anticuerpos específicos anti-T. gondii en caballos y ovejas criados en la Granja Experimental Nhumirim, propiedad de Embrapa Pantanal, Mato Grosso do Sul, Brasil. Para ello, se recolectaron muestras de suero de 101 caballos y 99 ovejas entre marzo de 2011 y mayo de 2015. Las muestras de suero se enviaron al Laboratorio de Toxoplasmosis y otros Protozoos, del Instituto Oswaldo Cruz, en la Fundação Oswaldo Cruz / RJ. Los sueros se sometieron a una reacción de inmunofluorescencia indirecta y las muestras serorreactivas se consideraron positivas a partir de una dilución 1:64 para ambas especies. Anti-T. gondii se detectaron en el 15% (15/99) de las ovejas y el 10% (10/101) de los caballos...

Molusco contagioso como complicação de tatuagem: um relato de caso e revisão da literatura / Molluscum contagiosum as a tattoo complication: a case report and literature review

A tatuagem é uma prática antiga e muito popular atualmente. Os pigmentos utilizados mudaram com o tempo, mas continuam apresentando composições variadas e pouco regulamentadas. Há inúmeros casos descritos de efeitos adversos pós-tatuagem, em sua maioria infecciosos, e reações de hipersensibilidade. Relatamos o caso de uma mulher de 64 anos, hígida, com pápulas nas sobrancelhas um mês após realizar micropigmentação. A biópsia excisional fez o diagnóstico de molusco contagioso, e o tratamento foi realizado com curetagem das lesões. Na literatura, existem poucos relatos de disseminação de molusco contagioso causada por tatuagem.

Tattooing is an ancient practice and very popular nowadays. The pigments used have changed over time but still present varied and poorly regulated compositions. There are many described cases of adverse effects after tattooing, mainly infectious and hypersensitivity reactions. We report the case of a 64-yearold woman, healthy, with papules on her eyebrows one month after performing micropigmentation. The excisional biopsy diagnosed molluscum contagiosum, and the lesions were curetted. There are few reports in the literature of the spread of molluscum contagiosum caused by tattooing

Identification of large genetic variations in the equine infectious anemia virus tat-gag genomic region.

The aetiological agent of equine infectious anaemia (EIA) is the retrovirus equine infectious anemia virus (EIAV) that infects all members of the Equidae family. The EIA is widely disseminated in the Brazilian territory with a high seroprevalence in the Brazilian Pantanal and is mainly diagnosed using agar gel immunodiffusion (AGID). There are few complete EIAV genome sequences available in GenBank, which had an impact on molecular detection studies. In this study, we conducted molecular detection and sequencing of EIAV proviral DNA from Brazilian horses. We analysed the genomic region from exon 1 of tat to gag (tat-gag). Comparative serological tests, comprising AGID and two enzyme-linked immunosorbent assays (ELISAs), were also conducted. Of the 133 samples, 58 were positive in the tat-gag PCR, and 49 nucleotide sequences of 272 bp were obtained. Using this developed tat-gag PCR EIAV proviral DNA was detected in 7% of the AGID-negative samples and 26% of the AGID-negative samples were positive in at least one of the ELISA tests used. Using phylogenetic analysis, the Brazilian Pantanal EIAV sequences grouped in a different clade of EIAV sequences from other countries. Thus, the EIAV sequences can contribute to the knowledge of the tat-gag genomic region in the circulating viruses in the Brazilian Pantanal, in addition to providing new information about the genetic diversity. In addition, the serological results demonstrate the greater sensitivity of the ELISAs used in this study compared to AGID for EIA diagnosis.

A depressão e o risco de suicídio na enfermagem / Depression and suicide risk in nursing / Depresión y riesgo de suicidio en enfermería

Objetivo: analisar a depressão e o risco de suicídio entre os profissionais da Enfermagem segundo a literatura científica. Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados eletrônicas: Literatura Latino Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online e National Library of Medicine, via Pubmed, buscando artigos publicados entre 2010 a 2020. Resultados: Dentre os fatores desencadeantes para a depressão nos profissionais da enfermagem estão: conflitos no trabalho, de interesse e familiar, plantões noturnos, estresse, sobrecarga, relação interpessoal, baixa perspectiva profissional. Já os fatores desencadeantes para o suicídio estão: depressão, Burnout, baixa relação pessoa, uso de medicamentos e ansiedade. Conclusão: É um problema de saúde pública, em que afeta um grande número de profissionais da enfermagem, sendo mais comum nos técnicos de enfermagem. É preciso que haja criação de políticas públicas para que esse profissional seja atendido semanalmente por psicólogos e rodas de conversas. Desse modo, é de suma importância a detecção precoce de sintomas depressivos e ideação suicida.

Objective: to analyze depression and the risk of suicide among nursing professionals according to scientific literature. Method: This is an integrative literature review carried out in the electronic databases: Latin American and Caribbean Literature in Health Sciences, Scientific Electronic Library Online and National Library of Medicine, via Pubmed, looking for articles published between 2010 to 2020. Results: Among the triggering factors for depression in nursing professionals are: conflicts at work, of interest and family, night shifts, stress, overload, interpersonal relationship, low professional perspective. The triggering factors for suicide, on the other hand, are: depression, Burnout, low person-to-person ratio, medication use and anxiety. Conclusion: It is a public health problem, in which it affects a large number of nursing professionals, being more common among nursing technicians. It is necessary to create public policies so that this professional is assisted weekly by psychologists and conversations. Thus, it is extremely important for the early detection of depressive symptoms and suicidal ideation.

Objetivo: analizar la depresión y el riesgo de suicidio entre los profesionales de enfermería según la literatura científica. Método: Se trata de una revisión bibliográfica integradora realizada en las bases de datos electrónicas: Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Biblioteca Electrónica Científica en Línea y Biblioteca Nacional de Medicina, vía Pubmed, buscando artículos publicados entre 2010 a 2020. Resultados: Entre los factores desencadenantes de la depresión en los profesionales de enfermería se encuentran: conflictos laborales, de interés y familiares, turnos de noche, estrés, sobrecarga, relación interpersonal, baja perspectiva profesional. Los factores desencadenantes del suicidio, por otro lado, son: depresión, Burnout, baja relación persona a persona, uso de medicamentos y ansiedad. Conclusión: Es un problema de salud pública, en el que afecta a un gran número de profesionales de enfermería, siendo más común entre los técnicos de enfermería. Es necesario crear políticas públicas para que este profesional sea asistido semanalmente por psicólogos y conversaciones. Por tanto, es extremadamente importante para la detección precoz de síntomas depresivos e ideación suicida.

High Genomic Variability in Equine Infectious Anemia Virus Obtained from Naturally Infected Horses in Pantanal, Brazil: An Endemic Region Case.

Equine infectious anemia virus (EIAV) is a persistent lentivirus that causes equine infectious anemia (EIA). In Brazil, EIAV is endemic in the Pantanal region, and euthanasia is not mandatory in this area. All of the complete genomic sequences from field viruses are from North America, Asia, and Europe, and only proviral genomic sequences are available. Sequences from Brazilian EIAV are currently available only for gag and LTR regions. Thus, the present study aimed for the first time to sequence the entire EIAV genomic RNA in naturally infected horses from an endemic area in Brazil. RNA in plasma from naturally infected horses was used for next-generation sequencing (NGS), and gaps were filled using Sanger sequencing methodology. Complete viral genomes of EIAV from two horses were obtained and annotated (Access Number: MN560970 and MN560971). Putative genes were analyzed and compared with previously described genes, showing conservation in gag and pol genes and high variations in LTR and env sequences. Amino acid changes were identified in the p26 protein, one of the most common targets used for diagnosis, and p26 molecular modelling showed surface amino acid alterations in some epitopes. Brazilian genome sequences presented 88.6% nucleotide identity with one another and 75.8 to 77.3% with main field strains, such as EIAV Liaoning, Wyoming, Ireland, and Italy isolates. Furthermore, phylogenetic analysis suggested that this Brazilian strain comprises a separate monophyletic group. These results may help to better characterize EIAV and to overcome the challenges of diagnosing and controlling EIA in endemic regions.

Tumor glômico múltiplo em paciente com neurofibromatose tipo 1: relato de caso e revisão de literatura / Multiple glomus tumor in a patient with neurofibromatosis type 1: a case report and literature review

Neurofibromatose tipo I (NF1) é uma doença autossômica dominante, com incidência de 1/2.500-3.000 nascimentos e prevalência de aproximadamente 1/4.000-5.000 indivíduos; é causada por mutações genéticas no gene NF1, que afetam tecidos neurais e cutâneos. Tumor glômico é uma neoplasia benigna originada do glomo, uma estrutura neuromioatrial da pele presente nas pontas dos dedos e envolvida na termorregulação. São considerados historicamente tumores isolados esporádicos, porém existem estudos que comprovam sua relação com a neurofibromatose tipo I. Pacientes com neurofibromatose tipo 1 devem ser investigados. O relato de caso fornece suporte adicional à noção de que NF1 tem um risco associado a múltiplos tumores glômicos.

Neurofibromatosis type I (NF1) is an autosomal dominant disease, with an incidence of 1/2,500-3,000 births and a prevalence of approximately 1/4,000-5,000 individuals. Genetic mutations in the NF1 gene cause it, affecting neural and skin tissues. Glomus tumor is a benign neoplasm originating from the glomus, a neuromyoatrial structure of the skin present at the fingertips and involved in thermoregulation. The literature historically considered these tumors isolated and sporadic, but some studies have proved a relationship with neurofibromatosis type I. Thus, patients with neurofibromatosis type 1 should be investigated. The case report provides additional support for the notion that NF1 has a risk associated with multiple glomus tumors.

O Tema 793 do STF e o direcionamento do cumprimento das prestações na área de saúde conforme as regras de repartição de competências estabelecidas no SUS / The Item 793 of the Supreme Court and the compliance for health benefits according to the rules for the division of competences established for Brazilian SUS / Tema 793 de la Corte Suprema y la dirección del cumplimiento de los beneficios de salud de acuerdo con las reglas para la división de competencias establecidas en el SUS de Brasil

Objetivo: analisar o Tema 793 do STF, que trata da responsabilidade solidária dos entes federados pelo dever de prestar assistência à saúde, e que exigiu do magistrado que direcione o cumprimento da obrigação conforme as regras de repartição de competências. Metodologia: o trabalho utilizou o método dedutivo para compreender os diversos aspectos insertos no voto do relator Ministro Edson Fachin sobre o tema da repartição de competência no SUS, que culminou com a Tese 793 do STF. Resultados: o artigo apresenta as regras básicas de financiamento da assistência farmacêutica; fornece parâmetros para identificar o ente responsável pela prestação da saúde; indica formas de diminuir os custos da judicialização e aponta a União Federal como a maior responsável pelo financiamento da assistência farmacêutica. Conclusão: o Tema 793 não conseguiu ainda trazer uma unicidade das decisões judiciais, e não é claro sobre qual ente federado deva compor o polo passivo e ser condenado nas prestações da saúde. A identificação do devedor da prestação deve ser uma preocupação dos litigantes e dos operadores do direito, inclusive para assunção das eventuais penalidades por descumprimento

Objective: To overview the Item 793 of the Federal Supreme Court, which deals with the joint liability of federated entities for the duty to provide health care, and which required the magistrate to direct the fulfillment of the obligation according to the rules for the division of competences. Methodology: the the deductive method was applied to understand the various aspects inserted in the vote of the rapporteur Minister Edson Fachin on the subject of the division of competences in the Brazilian public health care system, SUS, which culminated in the Item 793 of the Federal Supreme Court. Results: this paper presents the basic rules for financing pharmaceutical assistance; providing parameters for identifying the provider of health care; it also indicates ways to reduce the costs of judicialization and points to the Federal Union as the main responsible for financing pharmaceutical assistance Conclusion: Item 793 has not yet been able to bring a single court decision, and it is not clear about which federated entity should male part of the factual matter and be condemned in health benefits. The identification of the debtor of the benefit should be a concern of the litigants and the legal operators, including the assumption of possible penalties for noncompliance

Objetivo: analizar el Tema 793 de la Corte Suprema, que se ocupa de la responsabilidad conjunta y solidaria de las entidades federadas por el deber de brindar atención médica, y que requiere que el magistrado dirija el cumplimiento de la obligación de acuerdo con las reglas para la división de competencias. Metodología: el trabajo utilizó el método deductivo para comprender los diversos aspectos insertados en la votación del relator Ministro Edson Fachin sobre el tema de la división de competencias en el SUS, que culminó con el Tema 793 del STF. Resultados: el artículo presenta las reglas básicas para financiar la asistencia farmacéutica; proporciona parámetros para identificar al proveedor de atención médica; Indica formas de reducir los costos de la judicialización y señala a la Unión Federal como el principal responsable de financiar la asistencia farmacéutica. Conclusión: el Tema 793 aún no ha sido capaz de presentar una decisión judicial única, y no está claro qué entidad federada debería conformar el polo pasivo y ser condenado en beneficios para la salud. La identificación del deudor del beneficio debe ser una preocupación de los litigantes y los operadores legales, incluida la asunción de posibles sanciones por incumplimiento.

Is Prolonged Slow Expiration a Reproducible Airway Clearance Technique?

BACKGROUND: Prolonged slow expiration (PSE) is a manual chest physical therapy technique routinely performed in clinical practice. However, the reliability and agreement of the technique have not been tested. OBJECTIVE: The objective of this study was to assess reliability and agreement between physical therapists during the application of PSE in infants with wheezing. DESIGN: This was a cross-sectional study. METHODS: Infants with a mean age of 59 weeks (SD = 26 weeks) were included in this study. Two physical therapists (physical therapist 1 and physical therapist 2) randomly performed 3 PSE sequences (A, B, and C). The expiratory reserve volume (ERV) was measured with a pneumotachograph connected to a face mask. ERV was used to evaluate the reproducibility of the technique between sequences and between physical therapist 1 and physical therapist 2. RESULTS: The mean ERV of the infants was 63 mL (SD = 21 mL). There was no statistically significant difference between the ERV values in the 3 sequences for physical therapist 1 (A: mean = 46.6 mL [SD = 17.8 mL]; B: mean = 45.7 mL [SD = 19.9 mL]; C: mean = 53.3 mL [SD = 26.3 mL]) and physical therapist 2 (A: mean = 43.5 mL [SD = 15.4 mL]; B: mean = 43.2 mL [SD = 18.3 mL]; C: mean = 44.8 mL [SD = 25.0 mL]). There was excellent reliability between the sequences for physical therapist 1 (ICC = 0.88 [95% CI = 0.63-0.95]) and physical therapist 2 (ICC = 0.82 [95% CI = 0.48-0.93]). Moderate agreement was observed between physical therapist 1 and physical therapist 2 (ICC = 0.67 [95% CI = 0.01-0.88]). According to Bland-Altman analysis, the mean difference between physical therapist 1 and physical therapist 2 was 4.1 mL (95% CI = -38.5 to 46.5 mL). LIMITATIONS: The data were collected in infants with wheezing who were not in crisis. This decreased lung mucus; however, it also reduced evaluation risks. CONCLUSIONS: PSE was a reproducible chest physical therapy technique between physical therapists.

Equine infectious anemia virus in naturally infected horses from the Brazilian Pantanal.

Equine infectious anemia (EIA) has a worldwide distribution, and is widespread in Brazil. The Brazilian Pantanal presents with high prevalence comprising equine performance and indirectly the livestock industry, since the horses are used for cattle management. Although EIA is routinely diagnosed by the agar gel immunodiffusion test (AGID), this serological assay has some limitations, so PCR-based detection methods have the potential to overcome these limitations and act as complementary tests to those currently used. Considering the limited number of equine infectious anemia virus (EIAV) sequences which are available in public databases and the great genome variability, studies of EIAV detection and characterization molecular remain important. In this study we detected EIAV proviral DNA from 23 peripheral blood mononuclear cell (PBMCs) samples of naturally infected horses from Brazilian Pantanal using a semi-nested-PCR (sn-PCR). The serological profile of the animals was also evaluated by AGID and ELISA for gp90 and p26. Furthermore, the EIAV PCR amplified DNA was sequenced and phylogenetically analyzed. Here we describe the first EIAV sequences of the 5' LTR of the tat gene in naturally infected horses from Brazil, which presented with 91% similarity to EIAV reference sequences. The Brazilian EIAV sequences also presented variable nucleotide similarities among themselves, ranging from 93,5% to 100%. Phylogenetic analysis showed that Brazilian EIAV sequences grouped in a separate clade relative to other reference sequences. Thus this molecular detection and characterization may provide information about EIAV circulation in Brazilian territories and improve phylogenetic inferences.

Factors affecting the performance of Pantaneiro horses

This study aimed to assess the physical performance of Pantaneiro horses with and without equine infectious anemia (EIA) under functional conditions of cattle management. The horses were subjected to a performance test and split into two groups according to a completely randomized design: animals were chosen from populations testing positive and negative for EIA. Performance was measured as a function of a data envelopment analysis (DEA) model considering four outputs and one unitary input. The output measures were the distance achieved in the performance test, hematocrit as a weighted average over the test duration, respiratory rate as weighted average over the test duration, and the level of lactic acid at the test termination. Weights for the hematocrit and the respiratory rate output variables were determined by means of factor analysis. The performance score was a weighted average of the output variables with the weights defined by the averages of the optimum individual multipliers in the DEA analysis. Contextual variables of interest were age, horse weight, room temperature, and corporal temperature. Only groups and room temperature were statistically significant effects, as indicated by a bootstrap analysis. The performance of group positive for EIA is significantly lower than that of the group negative for EIA and room temperature has a negative effect.(AU)

Equine infectious anaemia in equids of Southern Pantanal, Brazil: seroprevalence and evaluation of the adoption of a control programme / Anemia infecciosa equina em equídeos do Pantanal Sul, Brasil: soroprevalência e avaliação da adoção de um programa de controle

The working equid population in Corumbá, Southern Pantanal, is very large and has a crucial role in the main economic activity of the State of Mato Grosso do Sul, the beef cattle industry. The aim of the present study was to estimate the prevalence of equine infectious anaemia (EIA) in working equids of ranches in the municipality of Corumbá, by the official agar gel immunodiffusion (AGID) test, and evaluate the adoption of the Programme for the Prevention and Control of Equine Infectious Anaemia proposed by Embrapa Pantanal and official entities in the 1990s. From September to November 2009, forty ranches distributed through the area of the municipality were visited, and serum samples were obtained from 721 equines and 232 mules. According to previous publications and the present data, it was concluded that the prevalence of EIA in this population has increased from 18.17% to 38.60%, which represents at this time approximately 13,000 infected animals. There was no significant difference between the apparent prevalence of equines and mules. It was also verified that the control programme was not known by the greater part of the interviewed ranch owners, managers and foremen and, in their perception, EIA is not a primary threat to address. Among the studied variables, the serologic testing practice significantly reduced the risk for the presence of EIA seropositivity, as well as the separation of riding equipment and segregation of seropositives.(AU)

A população de equídeos de serviço em Corumbá, Pantanal Sul, é muito numerosa e tem um papel crucial na principal atividade econômica do estado de Mato Grosso do Sul, a pecuária de corte extensiva. O objetivo deste trabalho foi estimar a prevalência atual da anemia infecciosa equina (AIE) em equídeos de serviço em fazendas do município de Corumbá, pelo teste oficial de imunodifusão em gel de ágar (IDGA), e avaliar a adoção do Programa de Prevenção e Controle da Anemia Infecciosa Equina proposto pela Embrapa Pantanal e entidades oficiais nos anos 1990. De setembro a novembro de 2009, quarenta fazendas distribuídas na área do município foram visitadas, e amostras de soro obtidas de 721 equinos e 232 muares. De acordo com publicações anteriores e os dados obtidos neste trabalho, concluiu-se que a prevalência da AIE nesta população aumentou de 18.17% para 38,60%, o que representa atualmente cerca de 13.000 animais infectados. Não houve diferença significativa entre as prevalências aparentes de equinos e muares. Verificou-se, também, que o programa de controle era desconhecido pela maior parte dos produtores, gerentes e capatazes entrevistados e, na percepção dos mesmos, a AIE não é uma ameaça importante a ser enfrentada. Dentre as variáveis estudadas, a prática da realização de testes sorológicos reduziu significantemente o risco para a presença de soropositividade para AIE, assim como a separação dos equipamentos de montaria e a segregação dos soropositivos.(AU)

Equine infectious anaemia in equids of Southern Pantanal, Brazil: seroprevalence and evaluation of the adoption of a control programme / Anemia infecciosa equina em equídeos do Pantanal Sul, Brasil: soroprevalência e avaliação da adoção de um programa de controle

The working equid population in Corumbá, Southern Pantanal, is very large and has a crucial role in the main economic activity of the State of Mato Grosso do Sul, the beef cattle industry. The aim of the present study was to estimate the prevalence of equine infectious anaemia (EIA) in working equids of ranches in the municipality of Corumbá, by the official agar gel immunodiffusion (AGID) test, and evaluate the adoption of the Programme for the Prevention and Control of Equine Infectious Anaemia proposed by Embrapa Pantanal and official entities in the 1990s. From September to November 2009, forty ranches distributed through the area of the municipality were visited, and serum samples were obtained from 721 equines and 232 mules. According to previous publications and the present data, it was concluded that the prevalence of EIA in this population has increased from 18.17% to 38.60%, which represents at this time approximately 13,000 infected animals. There was no significant difference between the apparent prevalence of equines and mules. It was also verified that the control programme was not known by the greater part of the interviewed ranch owners, managers and foremen and, in their perception, EIA is not a primary threat to address. Among the studied variables, the serologic testing practice significantly reduced the risk for the presence of EIA seropositivity, as well as the separation of riding equipment and segregation of seropositives.(AU)

A população de equídeos de serviço em Corumbá, Pantanal Sul, é muito numerosa e tem um papel crucial na principal atividade econômica do estado de Mato Grosso do Sul, a pecuária de corte extensiva. O objetivo deste trabalho foi estimar a prevalência atual da anemia infecciosa equina (AIE) em equídeos de serviço em fazendas do município de Corumbá, pelo teste oficial de imunodifusão em gel de ágar (IDGA), e avaliar a adoção do Programa de Prevenção e Controle da Anemia Infecciosa Equina proposto pela Embrapa Pantanal e entidades oficiais nos anos 1990. De setembro a novembro de 2009, quarenta fazendas distribuídas na área do município foram visitadas, e amostras de soro obtidas de 721 equinos e 232 muares. De acordo com publicações anteriores e os dados obtidos neste trabalho, concluiu-se que a prevalência da AIE nesta população aumentou de 18.17% para 38,60%, o que representa atualmente cerca de 13.000 animais infectados. Não houve diferença significativa entre as prevalências aparentes de equinos e muares. Verificou-se, também, que o programa de controle era desconhecido pela maior parte dos produtores, gerentes e capatazes entrevistados e, na percepção dos mesmos, a AIE não é uma ameaça importante a ser enfrentada. Dentre as variáveis estudadas, a prática da realização de testes sorológicos reduziu significantemente o risco para a presença de soropositividade para AIE, assim como a separação dos equipamentos de montaria e a segregação dos soropositivos.(AU)

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests / Eficácia e segurança do hidrato de cloral na sedação de lactentes para testes de função pulmonar

Abstract Objective: To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. Methods: All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. Results: The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14-182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. Conclusions: The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

Resumo Objetivo: Descrever a eficácia e a segurança do hidrato de cloral na sedação de lactentes para testes de função pulmonar. Métodos: Foram avaliadas retrospectivamente todas as tentativas de sedação para exames de função pulmonar em lactentes feitas entre junho 2007 e agosto 2014. Apneia obstrutiva do sono e cardiopatia foram contraindicações para os exames. Dados antropométricos, indicação do exame, dose empregada, desfechos da sedação e intercorrências clínicas foram registrados e descritos. Resultados: Avaliaram-se as tentativas de sedação de 277 lactentes (165 meninos) com mediana de 51,5 semanas de vida (14-182). A principal indicação para os testes foi sibilância recorrente (56%) e a dose de hidrato de cloral usada variou entre 50-80mg/kg (via oral). Dezoito (6,5%) lactentes apresentaram algum tipo de intercorrência clínica e foram as mais frequentes: tosse e/ou secreção na via aérea (1,8%); desconforto respiratório alto (1,4%) e vômitos (1,1%). Um lactente prematuro apresentou bradicardia por cerca de 15 minutos, responsiva a estimulação tátil. Todos os efeitos adversos observados foram transitórios e não houve necessidade de manobras de reanimação e uso de medicações injetáveis. Conclusões: Os dados demonstraram que o hidrato de cloral, nas doses empregadas, é um medicamento seguro e eficaz para a sedação de lactentes em procedimentos de curta duração, como os testes de função pulmonar. Devido à possibilidade de eventos adversos graves, as recomendações referentes à dosagem e contraindicações devem ser seguidas de forma rígida e os lactentes devem ser monitorados por equipe treinada.

Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. / Eficácia e segurança do hidrato de cloral na sedação de lactentes para testes de função pulmonar.

OBJECTIVE: To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. METHODS: All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. RESULTS: The sedation attempts in 277 infants (165 boys) with a median age of 51.5 weeks of life (14 to 182 weeks) were evaluated. The main indication for the tests was recurrent wheezing (56%) and the chloral hydrate dose ranged from 50 to 80mg/kg (orally). Eighteen (6.5%) infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%); respiratory distress (1.4%) and vomiting (1.1%). A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. CONCLUSIONS: The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

Estudo da identidade histológica de subprodutos de soja (Glycine max L. ) / Study on the histological identity of soy products (Glycine max L. )

A partir do grão de soja são obtidos diversos subprodutos, tais como farinha, farelo, proteína texturizada e óleo, constantemente utilizados em formulações de alimentos como biscoitos, pães, chocolates, entre outros. Durante o processamento, a estrutura da soja pode ser alterada, de forma a impossibilitar a identificação histológica deste vegetal nos produtos alimentícios. Este trabalho teve como objetivo identificar as características histológicas de diferentes subprodutos de soja. Amostras de proteína texturizada de soja, proteína de soja desengordurada, proteína isolada de soja e proteína de soja concentrada foram cedidas por uma indústria processadora de soja. Estas amostras foram submetidas à análise histológica, seguindo-se os Métodos Oficiais do Instituto Adolfo Lutz, para verificação da presença dos elementos histológicos característicos. Dentre os quatro subprodutos analisados, somente a proteína isolada de soja não apresentou elementos histológicos característicos. A proteína de soja concentrada apresentou menor quantidade de elementos histológicos em relação à proteína texturizada de soja e à proteína de soja desengordurada. Estes achados contribuirão para a análise de produtos à base de soja no que se refere à sua composição, a fim de identificar possíveis fraudes ou contaminações.

From the soya beans are obtained various by-products such as flour, meal, textured protein and oil, which are regularly used in food formulations such as cookies, breads, chocolates, among others. During the food processing, the soya structure might be changed, and turning into hard to perform the histological identification of this vegetable in the food products. This study aimed at identifying the histological characteristics of different soy sub-products. Textured soy protein, defatted soy protein, soy-isolated protein and concentrated soy protein samples were provided by a soybean processor industry. These samples were investigated by means of histological analysis, according to the Official Methods of the Instituto Adolfo Lutz for detecting the presence of the characteristic histological elements. Among the four analyzed sub-products, the isolated soy protein only showed no characteristic histological elements. The concentrated soy protein showed the lowest amounts of histological elements in relation to the textured soy protein and the defatted soy protein. These findings will contribute to the soya-based products analyses concerning their composition, in order to identify the potential fraud or contamination.