Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review.

BACKGROUND: The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. METHODS: To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. CONCLUSIONS: The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.

Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review

ABSTRACT Background: The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. Methods: To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. Conclusions: The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.

Irgafos 168 and Irganox 1076 as new cocaine cutting agents: A COVID-19 pandemic impact on cocaine profiling and trafficking in Brazil.

BACKGROUNDS: Restrictions in movement and closure of borders imposed by the Sars-Cov- 2 worldwide pandemic have affected the global illicit drug market, including cocaine trafficking. In this scenario, comparing cutting agents added to the cocaine and the drug purity are valuable strategies to understand how the drug trade has been impacted by the pandemic. METHODS: In this work, 204 cocaine salt materials seized in the Brazilian Federal District, before (2019) and during COVID-19 pandemics (2020) were analyzed by two analytical techniques: gas chromatography-mass spectrometry (GC-MS) and Fourier-transform infrared spectroscopy (FTIR). Statistical analyses, including Principal Component Analysis (PCA), were applied to evaluate the COVID-19 pandemic impact in the local market. Bibliometric analysis was performed as a forensic intelligence tool. RESULTS: From 2019-2020, cocaine average purity decreased 26 % while the frequency of cutting agents, as caffeine and anesthetics (lidocaine, tetracaine) increased. The high percentage of unknown were increased. Different cocaine profiling seized in 2020 showed new cutting agents, such as Irganox 1076, and Irgafos 168, indicating a trend on new adulterants/diluents introduced in the local market to mitigate the local drug shortage. Also in 2020, there was an increase in the local cocaine seizures, despite of the cocaine drug purity decreased by 26 % compared to 2019. CONCLUSIONS: Taken together, these data showed that the covid-19 pandemics has impacted cocaine trafficking in the Brazilian Federal District, an increase in cocaine seizures, which may indicate greater demand for the drug and, specially, changes in the cocaine purity and cutting agents profiling showing how traffickers tried to minimize difficulties in crossing the Brazilian border during COVID-19 restrictions. The information is relevant since Brazil is one of the major departure points for traded cocaine to the world. Bibliometric analysis showed that Irgafos 168 and Irganox 1076 were consistently identified as cocaine cutting agents for the first time.

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner. Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities. Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists. Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.

Epidural Anesthesia for Cesarean Section in a Pregnant Woman With Acute Pulmonary Edema: A Case Report.

Although rare, acute pulmonary edema is the most common cause of death in pregnant women with severe hypertension. The authors report a case involving a pregnant woman at 36 weeks of gestation with preeclampsia, who exhibited pulmonary edema and required immediate cesarean delivery. The patient had type 1 respiratory failure and needed supplemental oxygenation with a Venturi mask. The cesarean section was performed successfully under epidural anesthesia. Women with severe preeclampsia and acute pulmonary edema remain a challenge when presented for cesarean delivery, and the best anesthetic option remains controversial.

High VEGFA Expression Is Associated with Improved Progression-Free Survival after Bevacizumab Treatment in Recurrent Glioblastoma.

Glioblastoma (GB) is one of the deadliest human cancers. Many GB patients do not respond to treatment, and inevitably die within a median of 15-18 months post-diagnosis, highlighting the need for reliable biomarkers to aid clinical management and treatment evaluation. The GB microenvironment holds tremendous potential as a source of biomarkers; several proteins such as MMP-2, MMP-9, YKL40, and VEGFA have been identified as being differentially expressed in GB patient samples. Still to date, none of these proteins have been translated into relevant clinical biomarkers. This study evaluated the expression of MMP-2, MMP-9, YKL40, and VEGFA in a series of GBs and their impact on patient outcome. High levels of VEGFA expression were significantly associated with improved progression-free survival after bevacizumab treatment, thus having potential as a tissue biomarker for predicting patients' response to bevacizumab. Noteworthily, VEGFA expression was not associated with patient outcome after temozolomide treatment. To a lesser extent, YKL40 also provided significant information regarding the extent of bevacizumab treatment. This study highlights the importance of studying secretome-associated proteins as GB biomarkers and identifies VEGFA as a promising marker for predicting response to bevacizumab.

Congenital syphilis: associated factors in a follow-up outpatient clinic.

OBJECTIVE: This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. METHODS: This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). RESULTS: A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. The mothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). CONCLUSIONS: Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Assessing the Antitumor Potential of Variants of the Extracellular Carbohydrate Polymer from Synechocystis ΔsigF Mutant.

Cancer is a leading cause of death worldwide with a huge societal and economic impact. Clinically effective and less expensive anticancer agents derived from natural sources can help to overcome limitations and negative side effects of chemotherapy and radiotherapy. Previously, we showed that the extracellular carbohydrate polymer of a Synechocystis ΔsigF overproducing mutant displayed a strong antitumor activity towards several human tumor cell lines, by inducing high levels of apoptosis through p53 and caspase-3 activation. Here, the ΔsigF polymer was manipulated to obtain variants that were tested in a human melanoma (Mewo) cell line. Our results demonstrated that high molecular mass fractions were important for the polymer bioactivity, and that the reduction of the peptide content generated a variant with enhanced in vitro antitumor activity. This variant, and the original ΔsigF polymer, were further tested in vivo using the chick chorioallantoic membrane (CAM) assay. Both polymers significantly decreased xenografted CAM tumor growth and affected tumor morphology, by promoting less compact tumors, validating their antitumor potential in vivo. This work contributes with strategies for the design and testing tailored cyanobacterial extracellular polymers and further strengths the relevance of evaluating this type of polymers for biotechnological/biomedical applications.

Protocol for pragmatic randomized clinical trial to evaluate the completion of treatment of latent Mycobacterium tuberculosis infection with Isoniazid in the 300 mg formulation.

INTRODUCTION: It is essential to strengthen the treatment of latent tuberculosis infection (LTBI) to break the chain of transmission. The drug used worldwide for the treatment of LTBI is Isoniazid. A clinical trial conducted in Brazil has demonstrated the bioequivalence of Isoniazid in the 300 mg formulation with 3 tablets in the 100 mg formulation. Further studies are needed to evaluate the completion of treatment with Isoniazid 300 mg single tablet. OBJECTIVE: Describing a protocol for a clinical trial to evaluate the completion of treatment of LTBI with the drug Isoniazid in 300 mg tablet formulation compared to the use of Isoniazid in 100 mg tablet formulation. METHODS: This is a pragmatic, multicenter, randomized, open-label clinical trial registered on the Rebec RBR-2wsdt6 platform. Individuals 18 years of age or older with an indication for treatment of LTBI will be included, with only 1 individual per family nucleus. Individuals whose index case of active TB is categorized as retreatment, multidrug-resistant and extremely resistant, individuals transferred from the original center two or more weeks after the onset of treatment, and persons deprived of liberty will be excluded. The study intervention will be the treatment of LTBI with 1 tablet of Isoniazid 300 mg. The control group will receive the treatment of LTBI with 3 tablets of Isoniazid 100 mg. Follow-up will be performed at month 1, month 2 and at the end of treatment. The primary outcome will be completion of treatment. CONCLUSION: It is expected that with the treatment with the 300 mg formulation, more patients will complete the treatment based on the complexity index of pharmacotherapy. Our study intends to substantiate theoretical and operational strategies that respond to the demand for incorporation of a new formulation of the drug for the treatment of LTBI in the Unified Health System network.

Profile of pregnant women and children accompanied due to T. gondii exposure at a referred healthcare center: What has changed in 10 years? / Perfil de gestantes e crianças acompanhadas por exposição ao Toxoplasma gondii num centro de referência: O que mudou 10 anos depois?

Abstract Objectives: to characterize the profile of pregnant women and newborns accompanied at a reference center for infectious-parasitic diseases, after the exposure of T. gondii, establishing comparisons with a previous study, in the same location, ten years ago. Methods: this is a retrospective cohort study, with a follow-up of four years (2016 to 2019), using the previous study carried out from 2002 to 2010 as a comparative for the variables assessed. Mothers who presented tests suggestive of seroconversion for the disease during prenatal care and their respective concepts, followed up over a year, were included. The chi-square test was used, assuming a significance level of 5% for the comparison of the groups in the two periods. Results: during the period from 2016 to 2019, 79 binomials were studied, whereas 58 binomials were accompanied in the previous period. Comparing both periods, the findings showed lower proportions of adolescents (p<0.001), with low schooling (p<0.001), with low serological testing (p<0.001) and with late or postnatal diagnosis (p<0.001). As to the children, the findings showed fewer changes in fundoscopy (p<0.001), strabismus (p=0.002), hepatomegaly (p=0.026) and any sequelae (p<0.001). Conclusion: a positive advance was observed regarding the care provided for the mother-child binomial affected by T. gondii, with a reduction in negative outcomes for the child. However, there are still challenges concerning the diagnosis and proper management of the disease.

Resumo Objetivos: caracterizar o perfil de gestantes e neonatos acompanhadas em um centro de referência em doenças infecto-parasitárias, após exposição ao Toxoplasma gondii, estabelecendo comparações em relação a estudo prévio, no mesmo local, há dez anos. Métodos: trata-se de estudo de coorte retrospectivo, com seguimento de quatro anos (2016 a 2019), servindo o estudo prévio realizado de 2002 a 2010 como comparativo para as variáveis estudadas. Foram incluídas mães que apresentaram durante o pré-natal exames sugestivos soroconversão para a doença e seus respectivos conceptos, acompanhados ao longo de um ano. Utilizou-se o teste qui-quadrado, assumindo-se nível de significância de 5% para a comparação dos grupos nos dois períodos. Resultados: durante o período de 2016 a 2019, foram estudados 79 binômios, enquanto no período anterior foram acompanhados 58 binômios. Comparando-se os dois períodos, em relação às mães, registraram-se menores proporções de adolescentes (p<0,001), de baixa escolaridade (p<0,001), baixa realização de testes sorológicos (p<0,001) e com diagnóstico tardio ou pós-natal (p<0,001). Em relação às crianças, verificaram-se menores proporções de alterações de fundoscopia (p<0,001), estrabismo (p=0,002), hepatomegalia (p=0,026) e qualquer sequela (p<0,001). Conclusão: observou-se um avanço em relação aos cuidados para o binômio mãe-filho acometido pelo T. gondii, com redução de desfechos negativos sobre a criança. Todavia, ainda existem desafios para o diagnóstico e adequado manejo da doença.

A incidência de lesão por pressão em UTI no Brasil: uma revisão integrativa / The incidence of pressure injury in THE ICU in Brazil: an integrative review / La incidencia de la lesión por presión en la UCI en Brasil: una revisión integradora

Objetivo: conhecer a incidência de lesão por pressão em UTI no Brasil, identificar os motivos que levam a essa incidência e propor medidas que possam reduzir o aparecimento de lesões por pressão em UTI no Brasil. Método: trata-se de uma revisão integrativa, a seleção da amostragem foi realizada nas bases de dados LILACS, MEDLINE e BDENF, no período de fevereiro a março de 2022, sendo selecionados 9 artigos. Resultados: a taxa de incidência de lesão teve uma grande variação entre os estados analisados. Em Recife foi observado uma taxa de incidência de 5,6% enquanto no Rio de Janeiro chegou a 65,3%. Os estudos foram concentrados na região sudeste e nordeste, o que não nos aponta uma média nacional. As regiões mais acometidas foram a sacra, calcâneo e trocanter e em relação aos estágios foram o 2 em sua maioria. A adoção de medidas preventivas e a atuação da equipe multidisciplinar continuam sendo a melhor prática de prevenção de lesão por pressão. Considerações Finais: a incidência de lesão por pressão nas UTI do Brasil ainda é desconhecida, porém o fato de não conhecermos essa incidência nacional não é motivo para que não façamos o que já conhecemos de práticas baseadas em evidências quanto o assunto é prevenção de lesão por pressão

Objective: to know the incidence of pressure injuries in ICUs in Brazil, identify the reasons that lead to this incidence and propose measures that can reduce the occurrence of pressure injuries in ICUs in Brazil. Method: this is an integrative review, the selection of the sample was carried out in the LILACS, MEDLINE and BDENF databases, from February to March 2022, with 9 articles selected. Results: The injury incidence rate varied widely among the states analyzed. In Recife, an incidence rate of 5.6% was observed, while in Rio de Janeiro it reached 65.3%. The studies were concentrated in the Southeast and Northeast regions, which does not indicate a national average. The most affected regions were the sacral, calcaneus and trochanter and in relation to the stages they were mostly 2. The adoption of preventive measures and the performance of the multidisciplinary team continue to be the best practice for the prevention of pressure injuries. Final Considerations: The incidence of pressure injuries in ICUs in Brazil is still unknown, but the fact that we do not know this national incidence is no reason for us not to do what we already know of evidence-based practices when it comes to preventing pressure ulcers. pressure

Objetivo: Objetivo: conocer la incidencia de lesiones por presión en la UTI en Brasil, identificar las razones que conducen a esa incidencia y proponer medidas que puedan reducir la aparición de lesiones por presión en la UTI en Brasil. Método: se trata de una revisión integradora, la selección del muestreo se realizó en bases de datos lilacs, MEDLINE y BDENF, de febrero a marzo de 2022, y se seleccionaron 9 artículos. Resultados: la tasa de incidencia de lesión tuvo una gran variación entre los estados analizados. En Recife, se observó una tasa de incidencia del 5,6%, mientras que en Río de Janeiro alcanzó el 65,3%. Los estudios se concentraron en las regiones sudeste y noreste, lo que no indica un promedio nacional. Las regiones más afectadas fueron la sacra, calcánea y trocánter y en relación a las etapas fueron las 2 en la mayoría. La adopción de medidas preventivas y la actuación del equipo multidisciplinar siguen siendo la mejor práctica de prevención de lesiones por presión. Consideraciones finales: la incidencia de lesiones por presión en la UTI brasileña aún se desconoce, pero el hecho de que no conozcamos esta incidencia nacional no es una razón por la cual no hagamos lo que ya sabemos de las prácticas basadas en la evidencia con respecto al tema es la prevención de lesiones por presión

Fatores associados ao autocuidado das pessoas com diabetes mellitus na pandemia de COVID-19 / Associated factors with the self-care of people with diabetes mellitus in the COVID-19 pandemic

RESUMO Objetivo analisar os fatores associados ao autocuidado em pessoas com diabetes durante a pandemia de COVID-19. Métodos estudo transversal analítico e exploratório online com 70 participantes, utilizando o Questionário de Atividades de Autocuidado com o Diabetes. O perfil clínico e sociodemográfico foi retratado com uma análise descritiva. Já para a associação entre as variáveis, aplicaram-se o teste exato de Fisher, o teste Qui-quadrado e regressão de Poisson com variância robusta. Resultados após a regressão, os itens Atividade física, Uso de medicação e Alimentação geral do Questionário de Atividades de Autocuidado com o Diabetes apresentaram, respectivamente, associação significativa com as variáveis exercício físico (p<0,001), ocupação (p=0,005) e idade (p=0,01). Conclusão os itens de exercício físico, uso de medicação e alimentação geral do questionário de autocuidado se relacionaram com as variáveis de idade, ocupação e prática de exercício físico, respectivamente. Contribuições para a prática os serviços de saúde devem intensificar a investigação dos fatores associados às dificuldades das pessoas com diabetes, para oferecer uma melhor qualidade de vida e uma promoção de saúde adequada para essa população.

ABSTRACT Objective to analyze the factors associated with self-care in people with diabetes during the COVID-19 pandemic. Methods cross-sectional analytical and exploratory online study with 70 participants, using the Summary Diabetes Self-Care Activities Questionnaire. The clinical and sociodemographic profile was portrayed with a descriptive analysis. Fisher's exact test, the Chi-square test and Poisson regression with robust variance were used to determine the association between the variables. Results after regression, the items Physical Activity, Use of Medication and General Diet from the Summary Diabetes Self-Care Activities Questionnaire showed, respectively, a significant association with the variables Physical Exercise (p<0.001), Occupation (p=0.005) and Age (p=0.01). Conclusion the physical exercise, medication use and general diet items on the self-care questionnaire were related to the variables of age, occupation, and physical exercise, respectively. Contributions to practice health services should intensify the investigation of factors associated with the difficulties of people with diabetes, to offer a better quality of life and adequate health promotion for this population.

Closing the Gap: A Case Report on a Blood Patch Solution for Cerebrospinal Fluid Leak.

Spontaneous intracranial hypotension is a condition resulting from cerebrospinal fluid leaks at the spinal level that disrupt the regulation of intracranial pressure. This disorder is an uncommon cause of debilitating headaches but can have variable clinical manifestations, which contributes to delayed diagnosis and potentially severe consequences. The standard treatment consists of conservative measures such as bed rest, hydration, and a pharmacological approach with paracetamol, caffeine, ergotamine, and dexamethasone. When conservative measures fail, an epidural blood patch is the gold standard treatment, where a small amount of blood is injected into the epidural space to form a clot to seal any existing leak. Recent studies showed a success rate of 64% without the need for further intervention. The authors report a case of a 55-year-old woman with a three-month history of daily severe headaches. Imaging exams showed subdural collections, suggesting the hypothesis of cerebrospinal fluid hypotension. After the failure of conservative measures, an epidural blood patch was performed with progressive clinical improvement.  This case demonstrates the potential effectiveness of an epidural blood patch in the management of spontaneous intracranial hypotension and its complications, offering an encouraging option for those unresponsive to conservative measures. It also highlights the importance of a multidisciplinary approach involving neurologists and anesthesiologists.

Congenital syphilis: associated factors in a follow-up outpatient clinic / Sífilis congênita: fatores associados em um ambulatório de seguimento

Abstract Objective: This study aimed to describe the characteristics of mothers and children assisted in a follow-up clinic for congenital syphilis and identify the factors associated with the confirmation of the diagnosis. Methods: This is a prospective study conducted from 2016 to 2019 in Montes Claros, Northern Minas Gerais, Brazil. Specific forms addressing maternal sociodemographic, behavioral, and lifestyle habit characteristics, as well as characteristics related to access to healthcare, were used. Hierarchical Poisson regression analysis was performed to define the factors associated with diagnostic confirmation, including the calculation of the prevalence ratios (PR) and respective 95% confidence intervals (95%CI). Results: A total of 200 binomials (mother-child) who attended at least one appointment as part of the follow-up after discharge from the maternity hospital were eligible for the study. The mothers were mostly young (79.0%), with a low educational level (43.0%), and black (89.5%). Nearly half of the mothers reported not having a steady sexual partner (42.5%). About a quarter attended less than six prenatal appointments (27.5%). Nearly half did not treat the disease adequately during pregnancy (24.5%). The diagnosis of congenital syphilis was confirmed for 116 children. The following factors were associated with the diagnostic confirmation after multiple analyses: low maternal educational level (PR 1.30; 95%CI 1.05-1.60), maternal risky sexual behavior (PR 1.34; 95%CI 1.07-1.66), inadequate treatment of the mother (PR 3.16; 95%CI 2.42-4.47), and lack of treatment of the partner (PR 1.44; 95%CI 1,18-1.81). Conclusions: Syphilis remains a major challenge. The results highlight the social inequities associated with congenital syphilis and the lack of proper management of pregnant women and their partners.

Resumo Objetivo: Descrever as características de mães e crianças atendidas em um ambulatório de acompanhamento de sífilis congênita e identificar os fatores associados à confirmação do diagnóstico. Métodos: Trata-se de um estudo prospectivo realizado de 2016 a 2019, em Montes Claros, norte de Minas Gerais. Foram utilizados formulários específicos que abordavam características sociodemográficas, comportamentais e de hábitos de vida das mães, bem como características relacionadas ao acesso aos cuidados de saúde. Foi realizada análise de regressão de Poisson hierárquica para s definição dos fatores associados à confirmação diagnóstica, com cálculo das razões de prevalência (RP) e respectivos intervalos de confiança de 95% (IC95%). Resultados: Duzentos binômios (mãe-filho) que compareceram a pelo menos uma consulta como parte do acompanhamento após a alta da maternidade foram elegíveis para o estudo. As mães eram, em sua maioria, jovens (79,0%), com baixa escolaridade (43,0%) e negras (89,5%). Quase metade das mães relatou não ter parceiro sexual fixo (42,5%). Cerca de um quarto compareceu a menos de seis consultas de pré-natal (27,5%). Quase metade não tratou a doença adequadamente durante a gravidez (24,5%). O diagnóstico de sífilis congênita foi confirmado em 116 crianças. Os seguintes fatores foram associados à confirmação diagnóstica após análise múltipla: baixa escolaridade materna (RP 1,30; IC95% 1,05-1,60), comportamento de risco materno (RP 1,34; IC95% 1,07-1,66), tratamento inadequado da mãe (RP 3,16; IC95% 2,42-4,47) e falta de tratamento do companheiro (RP 1,44; IC95% 1,18-1,81). Conclusões: A sífilis continua sendo um grande desafio. Os resultados revelam as iniquidades sociais associadas à sífilis congênita e a falta de manejo adequado das gestantes e seus parceiros.

Elaboration and analysis of psychometric properties of a questionnaire to assess pregnant women's knowledge about toxoplasmosis / Elaboração e análise de propriedades psicométricas de um questionário para avaliar o conhecimento de gestantes sobre toxoplasmose

Abstract Objectives: to elaborate and analyze the psychometric properties of a questionnaire to assess among pregnant women's knowledge about toxoplasmosis. Methods: methodological study elaborating an instrument conducted in the north of Minas Gerais in 2019. The steps followed were: 1. Elaboration of the questionnaire items based on medical literature available in indexed databases. 2. Content validation. 3. Apparent validation. 4. Construct validation with hypothesis testing after the application of the questionnaire and comparison of the mean scores using the Mann-Whitney U test. 5. Reliability analysis with internal consistency analysis and test-retest. Results: the final instrument consisted of 26 items. Content validation reached 90% agreement among experts. The hypothesis test found a significant diference among the scores of the groups evaluated (p<0.001). Cronbach's alpha found a value of 0.84 and the test-retest showed an intra-class correlation index of 0.78 (p<0.001). Conclusions: the instrument elaborated proved to be valid and reliable and could be used to assess among pregnant women's knowledge about toxoplasmosis and, therefore, guiding to the educational and preventive measures.

Resumo Objetivos: elaborar e analisar as propriedades psicométricasde um questionáriopara avaliação do conhecimento sobre toxoplasmose entre gestantes. Métodos: estudo metodológico de elaboração de instrumento, realizado no norte de Minas Gerais, em 2019. O estudo seguiu os seguintes passos: 1. Elaboração dos itens a do questionário, com base na literatura médica disponível em bases indexadas. 2. Validação de conteúdo. 3. Validação aparente. 4. Validação de constructo, com teste de hipóteses, após aplicação do questionário e comparação de médias dos escores por meio do teste U de Mann-Whitney. 5. Análise de confabilidade, com análise da consistência interna e teste-reteste. Resultados: o instrumento final foi composto por 26 itens. Na validação de conteúdo alcançou 90% de concordância entre os experts. O teste de hipótese registrou diferença significativa entre os escores dos grupos avaliados (p<0,001). O alfa de Cronbach apresentou valor de 0,84 e o teste-reteste apresentou índice de correlação intra-classe de 0,78 (p<0,001). Conclusão: o instrumento elaborado apresentou-se válido e confável e poderá ser utilizado para avaliação de conhecimento sobre toxoplasmose entre gestantes, norteando medidas educativas e preventivas.

Development of Thermo- and pH-Sensitive Liposomal Magnetic Carriers for New Potential Antitumor Thienopyridine Derivatives.

The development of stimuli-sensitive drug delivery systems is a very attractive area of current research in cancer therapy. The deep knowledge on the microenvironment of tumors has supported the progress of nanosystems' ability for controlled and local fusion as well as drug release. Temperature and pH are two of the most promising triggers in the development of sensitive formulations to improve the efficacy of anticancer agents. Herein, magnetic liposomes with fusogenic sensitivity to pH and temperature were developed aiming at dual cancer therapy (by chemotherapy and magnetic hyperthermia). Magnetic nanoparticles of mixed calcium/manganese ferrite were synthesized by co-precipitation with citrate and by sol-gel method, and characterized by X-ray diffraction (XRD), scanning electron microscopy in transmission mode (STEM), and superconducting quantum interference device (SQUID). The citrate-stabilized nanoparticles showed a small-sized population (around 8 nm, determined by XRD) and suitable magnetic properties, with a low coercivity and high saturation magnetization (~54 emu/g). The nanoparticles were incorporated into liposomes of dipalmitoylphosphatidylcholine/cholesteryl hemisuccinate (DPPC:CHEMS) and of the same components with a PEGylated lipid (DPPC:CHEMS:DSPE-PEG), resulting in magnetoliposomes with sizes around 100 nm. Dynamic light scattering (DLS) and electrophoretic light scattering (ELS) measurements were performed to investigate the pH-sensitivity of the magnetoliposomes' fusogenic ability. Two new antitumor thienopyridine derivatives were efficiently encapsulated in the magnetic liposomes and the drug delivery capability of the loaded nanosystems was evaluated, under different pH and temperature conditions.

Policy and strategies addressing prevention and control of antimicrobial resistance in Brazil: A scoping review protocol.

INTRODUCTION: Antimicrobial resistance (AMR) is considered one of the biggest health challenges of the 21st century. It has both social and economic consequences; therefore, timely review of public health policies that have been designed to manage AMR is essential. Brazil too has developed and implemented various polices for the prevention and control of AMR. However, till date, no study provides insights regarding the various public health policies or other programs implemented by Brazilian institutes. OBJECTIVE: The objective is to define a scoping review protocol of policies that were developed to address prevention and control of antimicrobial resistance in Brazil, from a human health perspective. METHOD: This protocol has been registered in the Open Science Framework (DOI 10.17605/OSF.IO/EC9ZJ). Indexed literature in English, Spanish and Portuguese published till December 2020 in Lilacs, PubMed, Embase, and official websites of the Brazilian government will be reviewed. This review considers all studies identified through a comprehensive search of peer-reviewed and grey literature databases that have a reference for policies made for managing AMR in Brazil. The criteria for the scoping review will be set by two evaluators. A third evaluator will be consulted, if there is any disagreement between the two primary evaluators. A standardized form will be used for data extraction from the selected studies. The results will be presented in a tabular form with narrative abstracts related to the topics identified through the scoping review protocol. The PRISMA extension for Scoping Reviews tool will be used.

Influence of drug-related problems on length of hospital stay of women with a history of preeclampsia: A multicenter study.

BACKGROUND: Approximately 5-7 % of pregnant women have hypertension during pregnancy, requiring antihypertensive drug treatment. There have been a lack of studies evaluating how drug-related problems (DRPs) affect morbidity or mortality in the postpartum period among women with a history of preeclampsia. OBJECTIVE: To determine the influence of drug-related problems on length of hospital stay of postpartum women with a history of preeclampsia. METHODS: This cross-sectional study included postpartum women diagnosed with preeclampsia, from June to November 2016, in two teaching maternity hospitals in Brazil. The outcomes assessed were, length of hospital stay of postpartum women. The DRPs were classified through the Pharmaceutical Care Network Europe Foundation (PCNE) v 8.01. RESULTS: 600 women were included, and 354 (59%) were exposed to at least one DRP. The most frequent DRPs were no administration of the prescribed medication, lack of prescription of a medication, although the indication was clear, and ineffectiveness (unknown reason). In patients exposed to DRP, the average length of hospital stay after labour was 5.4 (S.D. 3.6) days versus 4.4 (S.D. 3.3) days in patients non-exposed to DRP (p = 0.0001). The period (in days) to achieve blood pressure control after labour was 4.5 (S.D. 3.5) 3.5 (S.D. 3.2), respectively (p = 0.0001). There were no deaths during the study. CONCLUSION AND RELEVANCE: Drug-related problems significantly increased the length of hospital stay in postpartum women with a history of preeclampsia.

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II's method.

OBJECTIVE: To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations. BACKGROUND: Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured. METHODS: A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method. RESULTS: Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines. CONCLUSIONS: The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.

Validation of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with COPD.

PURPOSE: COPD fits the profile of disabling health conditions. This study aims to validate the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with COPD. MATERIAL AND METHODS: 100 participants with COPD responded to the Brazilian 36-item version of the WHODAS 2.0, as well as the Saint George's Respiratory Questionnaire (SGRQ), and the COPD Assessment Test (CAT). Spirometric data was extracted from medical records. RESULTS: The internal consistency analysis showed coefficients for all WHODAS 2.0 domains with a strong correlation (0.70-0.85) except for Life activities, which had a moderate correlation (coefficient = 0.60). In the construct analysis, the coefficients for the WHODAS and SGRQ domains presented a consistent correlation among them, varying from 0.40 to 0.69. No correlation was evidenced among the WHODAS domains and the spirometric data, highlighting that linear measures fail when associated with the functioning of an individual with COPD. Discriminative analysis revealed a capacity for the WHODAS 2.0 to distinguish among COPD different levels of clinical impact obtained from CAT excluding the Getting along domain. CONCLUSION: The WHODAS 2.0 shows as a valid instrument that can sensibly assess functioning differences related to the clinical impact classification level in subjects with COPD.IMPLICATIONS FOR REHABILITATIONWHODAS 2.0 is a valid tool to assess functioning in subjects with COPD.WHODAS 2.0 is sensitive to functioning differences related to classification level and to clinical impact in individuals with COPD.As a Patient-Reported Outcome Measure (PROM), WHODAS 2.0 offers the opportunity to develop clinical patient-centered interventions, improving the health care.As a low-cost, easy-to-use tool, WHODAS can be a useful resource in the process of clinical assessment of patient functioning.