Staphylococcus capitis Bloodstream Isolates: Investigation of Clonal Relationship, Resistance Profile, Virulence and Biofilm Formation.

Staphylococcus capitis has been recognized as a relevant opportunistic pathogen, particularly its persistence in neonatal ICUs around the world. Therefore, the aim of this study was to describe the epidemiological profile of clinical isolates of S. capitis and to characterize the factors involved in the persistence and pathogenesis of these strains isolated from blood cultures collected in a hospital in the interior of the state of São Paulo, Brazil. A total of 141 S. capitis strains were submitted to detection of the mecA gene and SCCmec typing by multiplex PCR. Genes involved in biofilm production and genes encoding enterotoxins and hemolysins were detected by conventional PCR. Biofilm formation was evaluated by the polystyrene plate adherence test and phenotypic resistance was investigated by the disk diffusion method. Finally, pulsed-field gel electrophoresis (PFGE) was used to analyze the clonal relationship between isolates. The mecA gene was detected in 99 (70.2%) isolates, with this percentage reaching 100% in the neonatal ICU. SCCmec type III was the most prevalent type, detected in 31 (31.3%) isolates and co-occurrence of SCCmec was also observed. In vitro biofilm formation was detected in 46 (32.6%) isolates but was not correlated with the presence of the ica operon genes. Furthermore, biofilm production in ICU isolates was favored by hyperosmotic conditions, which are common in ICUs because of the frequent parenteral nutrition. Analysis of the clonal relationship between the isolates investigated in the present study confirms a homogeneous profile of S. capitis and the persistence of clones that are prevalent in the neonatal ICU and disseminated across the hospital. This study highlights the adaptation of isolates to specific hospital environments and their high clonality.

Epidemiological surveillance of Human Papillomavirus (HPV) genotypes in oral and genital tracts and the impact of HPV vaccination on male university students from Rio de Janeiro state, Brazil / Vigilância Epidemiológica dos genótipos de papilomavírus humano (HPV) nos tratos oral e genital e o impacto da vacinação em estudantes universitários do sexo masculino do estado do Rio de Janeiro, Brasil

Introduction: Human Papillomavirus (HPV) infections are of significant concern in men, given its potential impact on their health and the risk of transmission to partners. Understanding and addressing this infection in men is crucial to evaluate the effectiveness of vaccination in reducing HPV-related diseases. Objective: To assess the impact of HPV vaccination, potential genotype shifts, and adverse effects, through a prospective study conducted with male university students. Methods:The study involved 286 volunteers who were examined at Sexually Transmitted Disease Clinics at the Universidade Federal Fluminense in Niterói, Rio de Janeiro, Brazil. The HPV prevalence was evaluated using generic PCR, genotyped by DNA microarray and monitored adverse effects. Results: The findings of this study revealed the absence of moderate or severe adverse effects. Genetic shifts were observed, including the disappearance of oncogenic HPV types 16 and 18. Surprisingly, even after completing the full vaccine regimen, students still harbored HPV11 in the oral tract. Furthermore, persistent HPV 6 and 11 infections were identified in three students, who had pre-existing infections prior to vaccination, at the follow-up visit. Multivariate analysis uncovered independent associations, notably an increased risk of HPV infection in the oral tract among men who have sex with men. HPV prevalence rates remained low both before and after the vaccination scheme (T0: 14.7%, T1: 8.7%). Even after the full vaccination scheme, the prevalence remained similar at T2 (14.6%), with no statistically significant differences recorded. HPV11 emerged as the most prevalent type throughout the study, followed by HPV6. Vaccine genotypes were detected in a significant proportion of samples at T0 (85.4%), T1 (89.5%), and T2 (100%). Conclusion: Overall, this study suggests that vaccination may represent a promising approach to reducing HPV-related health risks. These findings shed light on the potential benefits and challenges of HPV vaccination, emphasizing the need for continued monitoring and vaccination efforts

Introdução: As infecções por papilomavírus humano (HPV) são de grande preocupação em homens, dada sua possível influência na saúde deles e no risco de transmissão para parceiros. Compreender e abordar essa infecção em homens é fundamental para avaliar a eficácia da vacinação na redução de doenças relacionadas ao HPV. Objetivo: Avaliar o impacto da vacinação contra o HPV, possíveis alterações genotípicas e efeitos adversos, por meio de um estudo prospectivo realizado em estudantes universitários do sexo masculino. Métodos: O estudo envolveu 286 voluntários examinados em Clínicas de Doenças Sexualmente Transmissíveis na Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. A prevalência do HPV foi avaliada por polymerase chain reaction (PCR) genérico e genotipada por microarranjo de DNA, e foram monitorados os efeitos adversos. Resultados: Os resultados deste estudo revelaram a ausência de efeitos adversos moderados ou graves. Observaram-se mudanças genéticas, incluindo o desaparecimento dos tipos oncogênicos do HPV 16 e 18. Surpreendentemente, mesmo após a conclusão do esquema completo de vacinação, os estudantes ainda abrigavam o HPV 11 na cavidade oral. Além disso, foram identificadas infecções persistentes pelo HPV 6 e 11 em três estudantes que já tinham infecções preexistentes antes da vacinação e na visita de acompanhamento. A análise multivariada revelou associações independentes, especialmente um aumento no risco de infecção pelo HPV na cavidade oral em homens que têm relações sexuais com homens. As taxas de prevalência do HPV permaneceram baixas tanto antes quanto depois do esquema de vacinação (T0: 14,7%, T1: 8,7%). Mesmo após a conclusão do esquema de vacinação, a prevalência permaneceu semelhante em T2 (14,6%), sem diferenças estatisticamente significativas registradas. O HPV 11 emergiu como o tipo mais prevalente ao longo do estudo, seguido pelo HPV 6. Genótipos da vacina foram detectados em uma proporção significativa de amostras em T0 (85,4%), T1 (89,5%) e T2 (100%). Conclusão: No geral, este estudo sugere que a vacinação pode representar uma abordagem promissora para a redução dos riscos à saúde relacionados ao HPV. Esses achados lançam luz sobre os benefícios e desafios potenciais da vacinação contra o HPV, enfatizando a necessidade de monitoramento contínuo e esforços de vacinação

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use.

OBJECTIVE: To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems. DESIGN: An ecological study and a cohort study. SETTING: Two medical surgical intensive care units (ICUs) in inner Brazil. PARTICIPANTS: Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed. METHODS: In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the "carbapenem pressure," described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models. RESULTS: The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02-0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001-1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam). CONCLUSIONS: Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population ("herd effect"-like) impact of antimicrobial use in the ICUs.

Apoio matricial de enfermagem como inovação no cuidado à pessoa com ferida / Matrix support for nursing as an innovation in the care of people with wounds / Apoyo matricial de enfermería como innovación en el cuidado de personas con heridas

Objetivo: relatar a vivência profissional de enfermeiros na implantação do apoio matricial de enfermagem no cuidado à pessoa com ferida na Atenção Primária à Saúde. Método: relato de experiência acerca da implantação do Apoio Matricial como modelo de atendimento à pessoa com ferida no município de Florianópolis ­ entre junho de 2019 a junho de 2020. Resultados: a implantação trouxe como resultado a ampliação do acesso ao serviço de saúde e o fortalecimento do vínculo entre a equipe da Estratégia Saúde da Família e a pessoa com ferida e seus familiares. Além disso, propiciou a adequada avaliação das lesões, o cuidado compartilhado, o registro clínico das consultas, o monitoramento dos dados, e o devido faturamento dos curativos efetuados. Considerações finais: esse modelo de atendimento trouxe maior resolutividade da Atenção Primária à Saúde a partir da qualificação do atendimento, e melhor gerenciamento das informações em saúde. Este relato busca contribuir para evolução da ciência e estimular a replicabilidade do modelo em outras realidades. (AU)

Objective: To report the professional experience of nurses in the implementation of matrix support in nursing care for people with wounds in Primary Health Care. Methods: Experience report on the implementation of Matrix Support as a model of care for people with wounds in the city of Florianópolis ­ between June 2019 to June 2020. Results: The implementation brought as a result, in addition to the expansion of access to health services and strengthening of the bond between the ESF and the person with the wound and their families, it provided adequate assessment and shared care, the clinical record of consultations, data monitoring and due billing of dressings performed. Conclusión: this service model brought greater resoluteness in Primary Health Care from the qualification of the service, and better management of health information. This report seeks to contribute to the evolution of science and encourage the model's replicability in other realities. (AU)

Objetivo: Reportar la experiencia profesional del enfermero en la implementación del soporte matricial en la atención de enfermería a personas con heridas en Atención Primaria de Salud. Métodos: Relato de experiencia en la implementación del Soporte Matriz como modelo de atención a personas con heridas en la ciudad de Florianópolis - entre junio de 2019 y junio de 2020. Resultados: La implementación trajo como resultado, además de la ampliación del acceso a los servicios de salud y el fortalecimiento del vínculo entre la ESF y la persona con la herida y sus familiares, brindó una adecuada valoración. y la atención compartida, la historia clínica de las consultas, el seguimiento de los datos y la debida facturación de los apósitos realizados. Conclusión: Este modelo de servicio trajo mayor resolución en la Atención Primaria de Salud a partir de la calificación del servicio y una mejor gestión de la información en salud. Este informe busca contribuir a la evolución de la ciencia y fomentar la replicabilidad del modelo en otras realidades. (AU)

N-acylhydrazone Derivative-Loaded Cellulose Acetate Films: Thermoanalytical, Spectroscopic, Mechanical and Morphological Characterization.

Cellulose acetate (ACT) is one of the most important cellulose derivatives due to its biodegradability and low toxicity, presenting itself as one of the main substitutes for synthetic materials in the development of wound dressing films. The incorporation of a N-acylhydrazonic derivative (JR19), with its promising anti-inflammatory activity, may represent an alternative for the treatment of skin wounds. This work aims to develop and to physicochemically and mechanically characterize ACT films containing JR19. The films were prepared using the 'casting' method and further characterized by thermoanalytical and spectroscopic techniques. In addition, mechanical tests and morphological analysis were performed. Thermogravimetry (TG) and differential scanning calorimetry (DSC) analyses showed that the thermal events attributed to excipients and films were similar, indicating the absence of physical incompatibilities between ACT and JR19. Infrared spectroscopy showed that JR19 was incorporated into ACT films. The characteristic band attributed to C≡N (2279 to 2264 cm-1) was observed in the spectra of JR19, in that of the physical mixture of JR19/ACT, and, to a lesser extent, in the spectra of JR19 incorporated into the ACT film, suggesting some interaction between JR19 and ACT. X-ray diffraction (XRD) evidenced the suppression of the crystallinity of JR19 (diffraction peaks at 8.54°, 12.80°, 14.09°, 16.08°, 18.19°, 22.65°, 23.59°, 24.53°, 25.70°, 28.16° and 30.27°2θ) after incorporation into ACT films. The mechanical tests indicated the adequate integrity of the films and their resistance to bending. The morphological characterization showed JR19 crystals along with a homogeneously distributed porous structure throughout the surface of the films with an average diameter of 21.34 µm and 22.65 µm of the films alone and of those incorporating JR19F, respectively. This study was able to characterize the ACT films incorporating JR19, showing their potential to be further developed as wound healing dressings.

[Mental Health Global Action Programme (mhGAP) in Chile: Lessons Learned and Challenges for Latin America and the CaribbeanPrograma de ação mundial para reduzir as lacunas em saúde mental (mhGAP) no Chile: aprendizados e desafios para América Latina e Caribe]. / Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe.

OBJECTIVES: Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results. METHODS: Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. RESULTS: The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (x¯ = 4.77) and mental and behavioral disorders in children and adolescents (x¯ = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. CONCLUSIONS: The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean.

OBJETIVOS: Apresentar a metodologia de avaliação completa da implementação do Programa de ação mundial para reduzir as lacunas em saúde mental (Mental Health GAP, mhGAP) no Chile e descrever seus resultados. MÉTODOS: Estudo avaliativo transversal baseado em levantamento realizado com profissionais de referência do programa, distribuídos em 29 serviços de saúde da rede pública do país, e entrevistas individuais e grupos focais com as principais partes interessadas e especialistas. O enfoque da avaliação foi a relevância e o impacto do mhGAP na prestação de serviços de saúde mental e a implementação do programa. RESULTADOS: Os participantes do estudo avaliaram positivamente a implementação progressiva do mhGAP no Chile. Em particular, 1) eles afirmaram possuir recursos melhores para detecção, diagnóstico e tratamento de transtornos frequentes e estratégias de encaminhamento eficientes; 2) classificaram todos os módulos como importantes, com destaque a autoagressão/suicídio (x¯ = 4,77) e transtornos mentais e de comportamento em crianças e adolescentes (x¯ = 4,58); 3) avaliaram de forma favorável a realização das Jornadas Nacionais de Saúde Mental e suas iterações em nível local contribuindo ao sucesso da implementação do mhGAP e 4) concordaram com a necessidade de atrair mais interessados, reforçar alguns aspectos e ampliar a divulgação do programa. CONCLUSÕES: A implementação do mhGAP no Chile é um caso emblemático de aprendizado apoiado no avanço da saúde mental comunitária e saúde da família, entre outros fatores. Esta conquista cria uma oportunidade única para continuar a expandir a implementação do programa no país e disseminar esta experiência a outros contextos na América Latina e Caribe.

Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe

[RESUMEN]. Objetivos. Presentar la metodología de evaluación integral de la implementación del Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile y exponer sus resultados. Métodos. Estudio evaluativo de corte transversal basado en una encuesta a referentes clave del programa, desplegados en los 29 servicios públicos de salud del país, y entrevistas individuales y grupos focales con actores clave y expertos. El foco de la evaluación estuvo en la relevancia e impacto del mhGAP en la prestación de servicios de salud mental y en la implementación del programa. Resultados. Los participantes evaluaron positivamente la implementación progresiva del mhGAP en Chile, en particular: 1) manifestaron contar con mejores herramientas de detección, diagnóstico y tratamiento de trastornos frecuentes, y estrategias eficientes de derivación; 2) calificaron todos los módulos como importantes; los más relevantes fueron autolesión/suicidio (x¯ = 4,77) y trastornos mentales y conductuales del niño y el adolescente (x¯ = 4,58); 3) evaluaron favorablemente las Jornadas Nacionales y sus réplicas y su contribución al éxito de la implementación del mhGAP; 4) coincidieron en la necesidad de incorporar nuevos actores, fortalecer algunos aspectos y ampliar la información sobre el programa. Conclusiones. La implementación del mhGAP en Chile constituye un caso emblemático de aprendizaje, apoyado por el desarrollo de la salud mental comunitaria y la salud familiar, entre otros factores. Lo logrado abre una oportunidad única para continuar avanzando en la implementación de este programa en el país y transmitir esta experiencia a otros contextos de América Latina y el Caribe.

[ABSTRACT]. Objectives. Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program’s results. Methods. Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. Results. The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (x¯ = 4.77) and mental and behavioral disorders in children and adolescents (x¯ = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. Conclusions. The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean.

[RESUMO]. Objetivos. Apresentar a metodologia de avaliação completa da implementação do Programa de ação mundial para reduzir as lacunas em saúde mental (Mental Health GAP, mhGAP) no Chile e descrever seus resultados. Métodos. Estudo avaliativo transversal baseado em levantamento realizado com profissionais de referência do programa, distribuídos em 29 serviços de saúde da rede pública do país, e entrevistas individuais e grupos focais com as principais partes interessadas e especialistas. O enfoque da avaliação foi a relevância e o impacto do mhGAP na prestação de serviços de saúde mental e a implementação do programa. Resultados. Os participantes do estudo avaliaram positivamente a implementação progressiva do mhGAP no Chile. Em particular, 1) eles afirmaram possuir recursos melhores para detecção, diagnóstico e tratamento de transtornos frequentes e estratégias de encaminhamento eficientes; 2) classificaram todos os módulos como importantes, com destaque a autoagressão/suicídio (x¯ = 4,77) e transtornos mentais e de comportamento em crianças e adolescentes (x¯ = 4,58); 3) avaliaram de forma favorável a realização das Jornadas Nacionais de Saúde Mental e suas iterações em nível local contribuindo ao sucesso da implementação do mhGAP e 4) concordaram com a necessidade de atrair mais interessados, reforçar alguns aspectos e ampliar a divulgação do programa. Conclusões. A implementação do mhGAP no Chile é um caso emblemático de aprendizado apoiado no avanço da saúde mental comunitária e saúde da família, entre outros fatores. Esta conquista cria uma oportunidade única para continuar a expandir a implementação do programa no país e disseminar esta experiência a outros contextos na América Latina e Caribe.

Nebivolol for the Treatment of Essential Systemic Arterial Hypertension: A Systematic Review and Meta-Analysis.

INTRODUCTION: Cardiovascular diseases are the main cause of mortality worldwide, and systemic arterial hypertension is associated with a large number of these cases. The objective of health professionals and health policies should be searching for the best therapeutics to control this disease. A recent consensus indicated that ß-blockers have recently lost their place in initial indications for the treatment of systemic arterial hypertension and are now more indicated for the treatment of hypertension in association with other clinical situations such as angina, heart failure and arrhythmia; however, it is known that this approach was based on studies that evaluated older ß-blockers such as atenolol. OBJECTIVE: The main objective of this study was to perform a systematic review with subsequent meta-analysis on the use of nebivolol for hypertensive disease treatment, comparing it with drugs of the main antihypertensive classes. METHODS: This systematic review was based on a search of the MEDLINE (via Pubmed), Scopus, Cochrane, International Pharmaceuticals Abstracts (IPA), and Lilacs databases for randomized and double-blind clinical trials. In addition, we also searched for gray literature studies, to 31 July 2015. Next, a cumulative meta-analysis was performed, with studies being added in a sequential manner, evaluating their impact on the combined effect. For this project, we only meta-analyzed direct comparisons of random effect. RESULTS: Overall, 981 clinical trials were included in this systematic review. After careful analysis, 34 randomized and double-blind clinical trials were included to investigate the efficacy of nebivolol on systolic (SBP) and diastolic blood pressure (DBP) control and adverse effects. The study population comprised 12,465 patients with systemic arterial hypertension (SAH) aged between 18 and 85 years; 17% of subjects were of Black ethnicity, approximately 55% were men, and almost 10% had diabetes. In SBP management, nebivolol was superior to other ß-blockers and diuretics and showed no difference in efficacy when compared with angiotensin receptor blockers or calcium channel blockers. There were insufficient studies on angiotensin-converting enzyme inhibitors for adequate comparison of both SBP and DBP control. For DBP control, nebivolol was more efficient than other ß-blockers, angiotensin receptor blockers, diuretics, and calcium channel blockers. DISCUSSION: Nebivolol is a third-generation ß-blocker with additional capabilities to improve blood pressure levels in patients with arterial hypertension, because it acts by additional mechanisms such as endothelium-dependent vasodilation associated with L-arginine and oxide nitric acid, nitric oxide activity on smooth muscle cells, decreasing platelet aggregation, and leukocyte adhesion in the endothelium, decreasing oxidative stress. Although nebivolol has shown good results in controlling hypertension in this study (with few adverse events when compared with placebo treatment) and has an unquestionable benefit in individuals with heart failure (mainly with reduced ejection fraction), there is a lack of studies proving the benefit of this drug for controlling hypertension and reducing clinical outcomes such as cardiovascular (or general) mortality, acute myocardial infarction, or stroke. CONCLUSIONS: Nebivolol demonstrated at least similar control of blood pressure levels in hypertensive individuals when compared with drugs of the most used classes. In addition, in relation to the control of arterial hypertension, studies with clinical outcomes should be performed to ensure the use of this drug in detriment to others with these well-established results.

Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe / Mental Health Global Action Programme (mhGAP) in Chile: Lessons Learned and Challenges for Latin America and the Caribbean / Programa de ação mundial para reduzir as lacunas em saúde mental (mhGAP) no Chile: aprendizados e desafios para América Latina e Caribe

RESUMEN Objetivos. Presentar la metodología de evaluación integral de la implementación del Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile y exponer sus resultados. Métodos. Estudio evaluativo de corte transversal basado en una encuesta a referentes clave del programa, desplegados en los 29 servicios públicos de salud del país, y entrevistas individuales y grupos focales con actores clave y expertos. El foco de la evaluación estuvo en la relevancia e impacto del mhGAP en la prestación de servicios de salud mental y en la implementación del programa. Resultados. Los participantes evaluaron positivamente la implementación progresiva del mhGAP en Chile, en particular: 1) manifestaron contar con mejores herramientas de detección, diagnóstico y tratamiento de trastornos frecuentes, y estrategias eficientes de derivación; 2) calificaron todos los módulos como importantes; los más relevantes fueron autolesión/suicidio (x¯ = 4,77) y trastornos mentales y conductuales del niño y el adolescente (x¯ = 4,58); 3) evaluaron favorablemente las Jornadas Nacionales y sus réplicas y su contribución al éxito de la implementación del mhGAP; 4) coincidieron en la necesidad de incorporar nuevos actores, fortalecer algunos aspectos y ampliar la información sobre el programa. Conclusiones. La implementación del mhGAP en Chile constituye un caso emblemático de aprendizaje, apoyado por el desarrollo de la salud mental comunitaria y la salud familiar, entre otros factores. Lo logrado abre una oportunidad única para continuar avanzando en la implementación de este programa en el país y transmitir esta experiencia a otros contextos de América Latina y el Caribe.

ABSTRACT Objectives. Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results. Methods. Cross-sectional evaluative study based on a survey of key program informants deployed in 29 public health services in the country, as well as individual interviews and focus groups with key actors and experts. The evaluation was focused on the relevance and impact of mhGAP on the provision of mental health services and on the implementation of the program. Results. The participants gave a positive evaluation of the progressive implementation of mhGAP in Chile. In particular: 1) They reported having better tools for detecting, diagnosing, and treating common disorders, and efficient referral strategies; (2) They rated all modules as important, the most relevant being self-harm/suicide (x¯ = 4.77) and mental and behavioral disorders in children and adolescents (x¯ = 4.58); (3) They favorably assessed the National Mental Health Day training courses and the subsequent courses repeated at the local level, indicating that these courses contributed to successful implementation of mhGAP; (4) They agreed on the need to incorporate new actors, strengthen certain aspects, and expand information on the program. Conclusions. The implementation of mhGAP in Chile is an emblematic example of learning supported by the development of community mental health and family health, among other factors. These accomplishments offer a unique opportunity to continue advancing the implementation of this program in the country and to implement this experience in other contexts in Latin America and the Caribbean.

RESUMO Objetivos. Apresentar a metodologia de avaliação completa da implementação do Programa de ação mundial para reduzir as lacunas em saúde mental (Mental Health GAP, mhGAP) no Chile e descrever seus resultados. Métodos. Estudo avaliativo transversal baseado em levantamento realizado com profissionais de referência do programa, distribuídos em 29 serviços de saúde da rede pública do país, e entrevistas individuais e grupos focais com as principais partes interessadas e especialistas. O enfoque da avaliação foi a relevância e o impacto do mhGAP na prestação de serviços de saúde mental e a implementação do programa. Resultados. Os participantes do estudo avaliaram positivamente a implementação progressiva do mhGAP no Chile. Em particular, 1) eles afirmaram possuir recursos melhores para detecção, diagnóstico e tratamento de transtornos frequentes e estratégias de encaminhamento eficientes; 2) classificaram todos os módulos como importantes, com destaque a autoagressão/suicídio (x¯ = 4,77) e transtornos mentais e de comportamento em crianças e adolescentes (x¯ = 4,58); 3) avaliaram de forma favorável a realização das Jornadas Nacionais de Saúde Mental e suas iterações em nível local contribuindo ao sucesso da implementação do mhGAP e 4) concordaram com a necessidade de atrair mais interessados, reforçar alguns aspectos e ampliar a divulgação do programa. Conclusões. A implementação do mhGAP no Chile é um caso emblemático de aprendizado apoiado no avanço da saúde mental comunitária e saúde da família, entre outros fatores. Esta conquista cria uma oportunidade única para continuar a expandir a implementação do programa no país e disseminar esta experiência a outros contextos na América Latina e Caribe.

Female Mortality­ Profile of deaths in reproductive age not related to maternity / Mortalidade Feminina ­ Perfil de Óbitos na Idade Fértil Não Associados à Maternidade / Mortalidad Femenina - Profile de Deaths en la Edad Fértil No Asociados a la Maternidad

Background and Objectives: The mortality profile is an important health indicator and its analysis allows researchers to identify inequalities and trends that require specific actions and studies. This study sought to identify the mortality profile in women of childbearing age in the municipality of Santa Cruz do Sul, in the period between 2013 and 2017. Methods: This is an epidemiological study, with a quantitative approach, following an exploratory descriptive and documentary research method. The data were obtained from the analysis of the Death Declaration records in the Mortality Information System of the municipality. Results: The mortality profile in women of childbearing age was white skin color, age between 40 and 49 years, with 8 to 11 years of schooling, who worked and lived in urban areas. Neoplasms were the main cause of death, especially in bronchi and lungs. Conclusion: The data show the importance of investing in women's health and cancer prevention, especially in the bronchi and lungs.(AU)

Justificativa e Objetivos: A avaliação do perfil de mortalidade é um importante indicador de saúde, sua análise permite identificar situações de desigualdade e tendências que demandam ações e estudos específicos. Sendo assim, esse estudo tem objetivo identificar o perfil de mortalidade em mulheres na idade fértil (MIF) no município de Santa Cruz do Sul, no período entre 2013 a 2017. Métodos: Estudo epidemiológico, abordagem quantitativa de caráter descritivo exploratório do tipo documental. Os dados foram produzidos por meio da análise de Declarações de Óbito no Sistema de Informações sobre Mortalidade do município. Resultados: O perfil da mortalidade das MIF é de mulheres de raça branca, com idade entre 40 e 49 anos, tendo de 8 a 11 anos de estudo, que desempenhavam algum tipo de atividade laboral e residiam em área urbana. A principal causa de mortalidade foi a neoplasia, com destaque para a de brônquios de pulmões. Conclusão: Os dados mostram a importância de investir na promoção da saúde das mulheres e na prevenção do câncer, principalmente o de brônquios e pulmões.(AU)

Justificación y Objetivos: Identificar el perfil de mortalidad en mujeres en edad fértil (MEF) en el municipio de Santa Cruz do Sul (Brasil), en el periodo entre 2013 y 2017. Métodos: Estudio epidemiológico, cuantitativo, de carácter descriptivo-exploratorio y documental. Se obtuvieron los datos por medio del análisis de los Certificados de Fallecimientos en el Sistema de Informaciones sobre Mortalidad de la municipalidad. Resultados: El perfil de la mortalidad de las MEF es de mujeres blancas, con edad entre 40 y 49 años, con el nivel de estudios entre 8 y 11 años, que desempeñaban algún tipo de actividad laboral y residían en barrios de la zona urbana. La principal causa de mortalidad fue la neoplasm, destacándose la de bronquios pulmonares. Conclusión: Los datos muestran la importancia de invertir en la promoción de la salud de las mujeres y la prevención del cáncer, principalmente el de bronquios y pulmones.(AU)

[Cochineals in the Portuguese-Brazilian world: the eighteenth-century manuscript edited by Manuel Joaquim Henriques de Paiva]. / A cochonilha no mundo luso-brasileiro: o manuscrito setecentista editado por Manuel Joaquim Henriques de Paiva.

A previously unpublished, modernized transcript of the manuscript História do descobrimento da cochonilha no Brasil (History of the discovery of the cochineal in Brazil), edited by the physician and chemist Manuel Joaquim Henriques de Paiva between 1774 and 1801, is presented. By bringing out this reviewed, annotated version of the pioneering study by his brother, the physician José Henriques Ferreira, Paiva wanted to encourage the culture and trade of the cochineal, an insect that produced a red dye that was in great demand in Europe. História... thus provides indications of the key role of so-called scientific knowledge in the development and growth of the Portuguese kingdom and their primary colony.

O documento que o leitor encontrará a seguir é a transcrição inédita e modernizada do manuscrito História do descobrimento da cochonilha no Brasil, editado pelo médico e químico Manuel Joaquim Henriques de Paiva entre os anos de 1774 e 1801. O propósito de Paiva, com essa versão revista e anotada do estudo pioneiro de seu irmão, o médico José Henriques Ferreira, era estimular a cultura e o comércio da cochonilha, um inseto produtor de corante avermelhado muito requisitado na Europa. A História..., portanto, fornece indícios do papel capital dos saberes ditos científicos para o fomento e engrandecimento do Reino português e de sua principal colônia.

A cochonilha no mundo luso-brasileiro: o manuscrito setecentista editado por Manuel Joaquim Henriques de Paiva / Cochineals in the Portuguese-Brazilian world: the eighteenth-century manuscript edited by Manuel Joaquim Henriques de Paiva

Resumo O documento que o leitor encontrará a seguir é a transcrição inédita e modernizada do manuscrito História do descobrimento da cochonilha no Brasil, editado pelo médico e químico Manuel Joaquim Henriques de Paiva entre os anos de 1774 e 1801. O propósito de Paiva, com essa versão revista e anotada do estudo pioneiro de seu irmão, o médico José Henriques Ferreira, era estimular a cultura e o comércio da cochonilha, um inseto produtor de corante avermelhado muito requisitado na Europa. A História..., portanto, fornece indícios do papel capital dos saberes ditos científicos para o fomento e engrandecimento do Reino português e de sua principal colônia.

Abstract A previously unpublished, modernized transcript of the manuscript História do descobrimento da cochonilha no Brasil (History of the discovery of the cochineal in Brazil), edited by the physician and chemist Manuel Joaquim Henriques de Paiva between 1774 and 1801, is presented. By bringing out this reviewed, annotated version of the pioneering study by his brother, the physician José Henriques Ferreira, Paiva wanted to encourage the culture and trade of the cochineal, an insect that produced a red dye that was in great demand in Europe. História... thus provides indications of the key role of so-called scientific knowledge in the development and growth of the Portuguese kingdom and their primary colony.

Photobiomodulation and photodynamic therapy for the treatment of oral mucositis in patients with cancer.

BACKGROUND: Photobiomodulation therapy (PBM-T) can penetrate soft tissues and exert analgesic and healing effects, and is thus a promising alternative for prevention and treatment of oral mucositis (OM). The aim of this study was to evaluate the efficacy of PBM-T, alone or combined with photodynamic therapy (PDT), for treatment of OM in cancer patients. METHODS: Fifty-six patients were recruited from the Oncology Department of a teaching hospital. Patients underwent grading of OM and were divided into two groups (n = 28 each): PBM-T and PBM-T + PDT. In the PBM-T group, low-level laser was applied to 61 points in the oral cavity, once weekly for 4 weeks (wavelength 660 nm, power 100 mW, energy density 142 J/cm², spot energy 4 J, irradiation time 40 s). In the PBM-T + PDT group, in addition to PBM-T as described above, patients rinsed with 20 ml of photosensitizing mouthwash (curcumin 1.5 g/L) and the oral cavity was irradiated with a blue (468 nm) LED for 5 min. RESULTS: Significant reductions in OM grade were observed after application of PBM-T or PBM-T + PDT (p < 0.0001). PBM-T + PDT resulted in a shorter time to resolution of lesions compared to PBM-T alone (p = 0.0005). CONCLUSIONS: PBM-T, alone or combined with PDT, can be used for the treatment of OM. PDT + PBM-T in particular accelerated the OM healing process, reducing time to lesion remission from 15 to 11 days.

Formação em saúde e efeitos no trabalho: avaliando processos e caminhos de processos educativos / Training in health and effects at work: evaluating processes and trajectories of educational processes / Formación en salud y efectos en el trabajo: evaluando procesos y caminos de procesos educativos

Este estudo de caso analisou a experiência de avaliação de um curso de especialização em saúde pública no estado da Bahia usando o referencial teórico metodológico da área de avaliação Treinamento, Desenvolvimento e Educação. As complexidades e transversalidades da saúde no cotidiano do trabalho indicam a necessidade de reordenamento das práticas e de transformações dos processos de trabalho e formação dos profissionais atuantes neste campo, além de tomar-se o trabalho como princípio educativo, adotando metodologias que favoreçam o diálogo e a capacidade crítico-reflexiva. Considera-se a avaliação como prática inerente e indutora de melhorias em qualquer processo educativo. Assim, este estudo justifica-se pela importância do desenvolvimento de práticas de avaliações em processos educativos e por incentivar a utilização de modelos baseados na avaliação integrada e em profundidade de processos educativos no campo da saúde. Os dados foram coletados com a aplicação de instrumentos de avaliação do curso, em diferentes momentos, identificando a reação e a aprendizagem dos discentes. O referencial utilizado tem consistência e aplicabilidade no campo da educação na saúde e, por meio dele, evidenciou-se coerência entre os níveis de avaliação de reação e aprendizagem. Para os discentes, o curso teve aplicabilidade e contribuiu para aprendizagem de conhecimentos e habilidades acerca da atuação do profissional sanitarista. Insumos, procedimentos e proacessos do curso foram avaliados positivamente. No entanto, alguns aspectos da estrutura e da didática foram avaliados abaixo da expectativa. Portanto, espera-se que este trabalho contribua para o conhecimento na área de avaliação de processos educativos, inspirando a adoção de perspectivas metodológicas de avaliação contínua e em profundidade no campo da educação na saúde.

This case study analyzed the assessment experience of a Specialization Course in Public Health in the state of Bahia using the methodological theoretical framework of the TD & E Evaluation area. The complexity and cross-sectional nature of health in daily life indicate a need for reorganizing practices, changes in work processes, and in the training of professionals working in this field, in addition to taking work as an educational principle and methodologies that favor dialogue and critical reflexive capacity. Assessments are considered an inherent practice that leads to improvements in any educational process. This study is justified by the importance of developing evaluation practices in educational processes and favoring the use of models based on the integrated and in-depth evaluation of educational processes in the Health field. Data were collected through the application of the evaluation instruments course at different moments, identifying the reaction and learning of students. The reference framework used is consistent and applicable in the field of health education, in addition to showing consistency between the levels of evaluation for Reaction and Learning. For students, the course had applicability and contributed to the learning of knowledge and skills about the work of sanitarist professionals. Inputs, procedures and course processes were evaluated positively. Some aspects of the structure and didactics were evaluated below expectations. We hope that this study contributes to the knowledge in the field of evaluation of educational processes, inspiring the adoption of methodological perspectives of continuous and in depth evaluation in the field of health education.

Este estudio de caso analizó la experiencia de evaluación de un curso de especialización en salud pública en el estado de Bahía, usando el referencial teórico metodológico del área de evaluación TD&E. Las complejidades y transversalidades de la salud en el cotidiano del trabajo indican la necesidad de reordenamiento de las prácticas y transformaciones de los procesos de trabajo y de la formación de los profesionales actuantes en este campo, además de considerar el trabajo como principio educativo, adoptando metodologías que favorezcan el diálogo y la capacidad crítica-reflexiva. Se considera la evaluación como práctica inherente e inductora de mejoras en cualquier proceso educativo. Este estudio se justifica por la importancia del desarrollo de prácticas de evaluación en procesos educativos y por favorecer la utilización de modelos basados en la evaluación integrada y en profundidad de procesos educativos en el campo de la salud. Los datos se recopilaron aplicando instrumentos de evaluación del curso en diferentes momentos, identificando la reacción y el aprendizaje de los alumnos. El referencial utilizado tiene consistencia y aplicabilidad en el campo de la educación en la salud, por lo cual se evidenció coherencia entre los niveles de evaluación de reacción y aprendizaje. Para los discentes, el curso tuvo aplicabilidad y contribuyó al aprendizaje de conocimientos y habilidades acerca de la actuación del profesional sanitarista. Los insumos, procedimientos y procesos del curso se evaluaron positivamente. Algunos aspectos de la estructura y didáctica se evaluaron por debajo de la expectativa. Se espera que este trabajo contribuya al conocimiento en el área de evaluación de procesos educativos, inspirando la adopción de perspectivas metodológicas de evaluación continua y en profundidad en el campo de la educación en la salud.

Ruptura gástrica. Informe de un caso / Gastric rupture. Case report

Resumen La expresión abdomen agudo en pediatría implica el concepto de una emergencia médica de origen abdominal. En los primeros días de la vida, las anomalías digestivas congénitas (presentes en aproximadamente 1 de cada 5000 recién nacidos) constituyen la causa más importante de abdomen agudo. La ruptura gástrica es un cuadro que puede describirse como causa de catástrofe intraabdominal, pudiendo ocasionar shock y muerte del paciente. Este trabajo describe un caso de ruptura gástrica espontánea en un niño de tres años de edad, con cuadro clínico de más o menos 12 horas de evolución, consistente en dolor abdominal asociado a náuseas, distensión abdominal. La madre refirió que no ha había deposiciones ni flatos. Ecografía abdominal reportó abundante líquido en cavidad abdominal. El niño fue llevado a quirófano y falleció.

Abstract The expression acute abdomen in pediatrics, implies the concept of a medical emergency of abdominal origin. In the first days of life, congenital digestive abnormalities (those present in about 1 in 5000 infants) are the most important cause of acute abdomen. Gastric rupture is a condition that can be described as the cause of intra-abdominal cataracts, which can cause shock and death of the patient. This paper describes a case of spontaneous gastric rupture in a 3-year-old boy with a clinical picture of about 12 hours of evolution consisting of abdominal pain associated with nausea, abdominal distension, the mother who has not had bowel movements Abdominal ultrasound reports abundant fluid in the abdominal cavity, which is taken to the operating room and dies.

Posttranscriptional Interaction Between miR-450a-5p and miR-28-5p and STAT1 mRNA Triggers Osteoblastic Differentiation of Human Mesenchymal Stem Cells.

We demonstrate that the interaction between miR-450a-5p and miR-28-5p and signal transducer and activator of transcription 1 (STAT1) mRNA correlates with the osteoblastic differentiation of mesenchymal stem cells from human exfoliated deciduous teeth (shed cells). STAT1 negatively regulates runx-related transcription factor 2 (RUNX2), which is an essential transcription factor in this process. However, the elements that trigger osteoblastic differentiation and therefore pause the inhibitory effect of STAT1 need investigation. Usually, STAT1 can be posttranscriptionally regulated by miRNAs. To test this, we used an in vitro model system in which shed cells were chemically induced toward osteoblastic differentiation and temporally analyzed, comparing undifferentiated cells with their counterparts in the early (2 days) or late (7 or 21 days) periods of induction. The definition of the entire functional genome expression signature demonstrated that the transcriptional activity of a large set of mRNAs and miRNAs changes during this process. Interestingly, STAT1 and RUNX2 mRNAs feature contrasting expression levels during the course of differentiation. While undifferentiated or early differentiating cells express high levels of STAT1 mRNA, which was gradually downregulated, RUNX2 mRNA was upregulated toward differentiation. The reconstruction of miRNA-mRNA interaction networks allowed the identification of six miRNAs (miR-17-3p, miR-28-5p, miR-29b, miR-29c-5p, miR-145-3p, and miR-450a-5p), and we predicted their respective targets, from which we focused on miR-450a-5p and miR-28-5p STAT1 mRNA interactions, whose intracellular occurrence was validated through the luciferase assay. Transfections of undifferentiated shed cells with miR-450a-5p or miR-28-5p mimics or with miR-450a-5p or miR-28-5p antagonists demonstrated that these miRNAs might play a role as posttranscriptional controllers of STAT1 mRNA during osteoblastic differentiation. J. Cell. Biochem. 118: 4045-4062, 2017. © 2017 Wiley Periodicals, Inc.

Satisfação dos pacientes atendidos no estágio curricular de fisioterapia na comunidade / Satisfaction of patients attended in physical therapy in the community curriculum training / Satisfacción de los pacientes atendidos en la pasantía de fisioterapia en la comunidad

A inserção do fisioterapeuta na atenção básica é uma realidade que necessita de avaliação, no que se refere à satisfação dos usuários nos serviços de saúde. Os questionários tornam-se instrumentos auxiliadores e contribuem para o conhecimento sobre a relevância do serviço de Fisioterapia, no contexto da saúde pública, para o planejamento e a avaliação dos serviços prestados à população. O objetivo deste trabalho foi mensurar a satisfação dos pacientes atendidos no estágio curricular de Fisioterapia na Comunidade, em um dos 50 bairros do município de Maceió (AL). Para isso, foi realizado um estudo descritivo, transversal e quantitativo, com uma amostra de 15 pacientes, onde foi utilizada - como instrumento de coleta - uma adaptação do questionário "Instrumento para aferir a satisfação do paciente com a assistência fisioterapêutica na rede pública de saúde". Para análise estatística, foi realizado o teste de normalidade de Shapiro-Wilk, complementado pelo teste não paramétrico de Friedman - na comparação das dimensões - e, em seguida, o teste não paramétrico de Wilcoxon, para verificar entre quais dimensões as diferenças foram significativas. As informações obtidas nesta pesquisa demonstraram um alto nível de satisfação geral e foi observada a diferença significativa entre os domínios relação terapeuta/paciente e satisfação; higiene e satisfação; acesso e satisfação (p<0,05). Por meio da análise realizada, foi possível constatar que os pacientes, em sua maior parte, mostraram-se satisfeitos com o serviço oferecido...

The insertion of the physical therapist in primary care is a reality that needs assessment with regard to user satisfaction in health services. Questionnaires become auxiliary instruments and contribute to the knowledge concerning the importance of physical therapy services in the context of public health, in order to plan and to evaluate the services provided for the population. The aim of this study was to measure the satisfaction of patients assisted at the Physical Therapy curricular internship in the community, in one of the 50 neighborhoods in the city of Maceió, Alagoas. For this purpose, we performed a descriptive, cross-sectional and quantitative study with a sample of 15 patients. An adaptation of the questionnaire "I nstrumento para aferir a satisfação do paciente com a assistência fi sioterapêutica na rede pública de saúde " (Instrument to assess patient satisfaction regarding physical therapy care in public health) was used as a data collection instrument. The statistical analysis was performed with the Shapiro-Wilk test for normality, complemented with nonparametric Friedman - for a comparison of dimensions - and then the nonparametric Wilcoxon test, to check the significant differences between dimensions. The information obtained in this study demonstrated a high level of overall satisfaction, and a significant difference was observed between therapist/patient relationship and satisfaction, hygiene and satisfaction, access and satisfaction (p<0.05). Through this analysis, it was determined that most patients were satisfied with the provided service...

La inserción del fisioterapeuta en la atención básica es una realidad que necesita evaluación, en lo que se refiere a la satisfacción de los usuarios en los servicios de salud. Los cuestionarios se vuelven instrumentos auxiliadores y contribuyen al conocimiento de la relevancia del servicio de Fisioterapia, en el contexto de la salud pública, para el planeamiento y la evaluación de los servicios prestados a la población. El objetivo de este trabajo fue medir la satisfacción de los pacientes atendidos en la pasantía de Fisioterapia en la Comunidad, en uno de los 50 barrios del municipio de Maceió (AL). Para eso, fue realizado un estudio descriptivo, transversal y cuantitativo, con una muestra de 15 pacientes, donde fue utilizada - como instrumento de recolección - una adaptación del cuestionario "Instrumento para medir la satisfacción del paciente con la asistencia fisioterapéutica en la red pública de salud". Para análisis estadístico, fue realizado el test de normalidad de Shapiro-Wilk, complementado por el test no paramétrico de Friedman - en la comparación de las dimensiones - y, enseguida, el test no paramétrico de Wilcoxon, para verificar entre cuales dimensiones las diferencias fueron significativas. Las informaciones obtenidas en esta investigación demostraron un alto nivel de satisfacción general y fue observada la diferencia significativa entre los dominios relación terapeuta/paciente y satisfacción; higiene y satisfacción; acceso y satisfacción (p<0,05). Por medio del análisis realizado, fue posible constatar que los pacientes, en su mayor parte, se mostraron satisfechos con el servicio ofrecido...

Chronic periodontitis and C-reactive protein levels.

BACKGROUND: This study aims to analyze the relationship between chronic periodontitis and C-reactive protein (CRP) by considering associated variables in individuals with or without cardiovascular disease. METHODS: A sample of 359 individuals of both sexes (aged ≥40 years) was assessed. Among these individuals, 144 subjects were admitted to the hospital because of a first occurrence of acute myocardial infarction; 80 subjects were in the hospital for reasons other than acute myocardial infarction; and 135 subjects were living in the community. A questionnaire was applied to obtain demographic and lifestyle characteristics. Complete clinical periodontal examinations and anthropometric assessments were performed. CRP levels, plasma glucose levels, lipid profiles, and blood tests were performed to investigate any conditions that might have suggested infection and/or inflammation. CRP evaluations were performed using nephelometry. Individuals were considered to have periodontal disease if they simultaneously presented at least four teeth with one or more sites with probing depth ≥4 mm, clinical attachment loss ≥3 mm, and bleeding on probing. Procedures for descriptive analyses and logistic regression were used. RESULTS: In the chronic periodontitis group, mean CRP levels were higher than those in the group without chronic periodontitis (2.6 ± 2.6 mg/L versus 1.78 ± 2.7 mg/L, respectively). The final model showed that individuals with chronic periodontitis were more likely to have high CRP levels (adjusted odds ratio: 2.26; 95% confidence interval: 1.30 to 3.93) considering the effects of age, schooling level, sex, smoking, high-density lipoprotein cholesterol, and diabetes. CONCLUSION: In this study, chronic periodontitis is associated with elevated plasma CRP levels, even after controlling for several potential confounders.

Production of diarrhoetic phycotoxin okadaic acid associated with the microalgae Dinophysis acuminata (Ehremberg 1834) in Sepetiba bay, RJ, and your implication in public health / Produção da ficotoxina diarreica ácido ocadaico associada à microalga Dinophysis acuminata (Ehremberg 1839) na baía de Sepetiba, RJ e sua implicação para a saúde pública

Microalgas constituem o principal alimento para moluscos bivalvos. Porém no fitoplâncton podem ser encontradas microalgasnocivas como Dinophysis, implicadas na produção da toxina ácido okadaico (AO). A baía de Sepetiba, RJ, apresenta áreasadequadas à malacocultura, principalmente na região da ilha Guaíba. Nessa região localiza-se um dos maiores bancosnaturais do mexilhão Perna perna neste estado, que fornece sementes para cultivos nas baías de Sepetiba e Ilha Grande.O AO, principal causador do Envenenamento Diarréico por Moluscos, apresenta como efeito agudo sintomatologiagastrintestinal. Como efeito crônico relata-se a promoção de tumores (estômago e intestinos). Este estudo objetivou detectaro AO e identificar Dinophysis spp. na região estudada. Coletaram-se mexilhões em bancos naturais (ilhas Guaíba e Madeira),para a detecção do AO e amostras de fitoplâncton para a identificação das microalgas durante a primavera/verão 2003/2004.A análise por Cromatografia Líquida de Alta Eficiência detectou o AO, em baixas concentrações, em todas as amostras.Identificaram-se cinco espécies de Dinophysis, das quais D. acuminata apresentou a maior abundância relativa para ogênero no período analisado. Os resultados sugerem um perfil toxígeno de baixo potencial, porém constante. Nessacircunstância, consumidores regulares de moluscos poderiam estar expostos ao perigo representado pelos efeitos crônicosdesta ficotoxina.

The major source of food for bivalve molluscs is microalgae. In the phytoplancton can be found potentially toxic microalgae as Dinophysis spp., often involved in the production of the toxin okadaic acid (OA). Sepetiba Bay, RJ, presents appropriated sites to malacoculture, mainly in the region of the Guaiba Island. In this region is located one of the largest natural bed of mussel Perna perna in the state, going to seed crops in the Sepetiba and Ilha Grande bays. OA, which is the most implicated toxin of Diarrhoetic Shellfish Poisoning, presents gastrointestinal symptoms as acute effect. Chronic effects related are promotions of tumors in stomach and intestines. The present study aimed to detect OA and identify Dinophysis present in studied sites. Mussels were collected from natural beds (Guaiba and Madeira islands) for the detection of OA and phytoplankton samples collects were carried out for the identification of harmful microalgae, during spring and summer 2003/2004. Chemical analysis using High Performance Liquid Chromatography detected the presence of OA in all samples in low concentrations. Five species of potentially toxic Dinophysis were identified, from which D. acuminata showed higher relative abundance to genera in the period. The results suggest a constant low profile of the toxigenic potential. Thus regular consumers of shellfish could be exposed to the chronic effects of this phycotoxin.