Seroepidemiology of Toxoplasma gondii infection in blood donors in a population from the northwestern region of São Paulo state, Brazil.

BACKGROUND: Toxoplasmosis is one of the most common parasitic infections worldwide with varying prevalence between human populations. These variations are mainly associated with human exposure to risk factors. In this article, the seroprevalence of Toxoplasma gondii infection and the risk factors associated with infection in 1729 blood donors from São José do Rio Preto, São Paulo, Brazil were analysed. METHODS: The serological tests for detecting immunoglobulin M (IgM) and immunoglobulin G (IgG) anti-T. gondii were used. The risk factors associated with the infection were identified through the application of an epidemiological questionnaire. RESULTS: The prevalence of T. gondii infection was 48.0%. The following factors were identified in the final model after multiple logistic regression analysis: drinking raw milk (p=0.003; odds ratio [OR] 1.364 [confidence interval {CI} 1.1 to 1.7]), residing in a rural area (p<0.0001; OR 2.764 [CI 1.7 to 4.6]) and receiving a blood transfusion (p=0.015; OR 1.856 [CI 1.1 to 3.0]). CONCLUSIONS: The data obtained in this study showed that the blood donor population is exposed to risk factors related to infection by T. gondii. These data allow the establishment of control programs to contribute to public health in northwestern São Paulo state.

miRNA 511_5p is a potential biomarker for ocular toxoplasmosis.

BACKGROUND: Ocular toxoplasmosis (OT) is a frequent clinical manifestation due to infection by Toxoplasma gondii. It is characterized by an inflammatory process involving macrophages activated by pro-inflammatory cytokines. The expression of microRNAs takes place during the inflammatory process and, among them, miRNA 511 regulates the activation of macrophages. This study evaluated the expression of miRNA 511_5p in patients with OT and healthy controls. METHODS: A total of 361 patients from the Hospital de Base of Fundação Faculdade de Medicina de São José do Rio Preto were enrolled and divided into four groups: G1-patients with active ocular lesions and reagent serology for T. gondii; G2-patients with scars and reagent serology for T. gondii; G3-patients without ocular lesions or scars and reagent serology for T. gondii; G4-patients without ocular lesions or scars and non-reagent serology for T. gondii. All patients underwent clinical and laboratory evaluation to confirm the diagnosis of OT. Serology tests, RNA extraction and cDNA synthesis were performed. RESULTS: The miRNA 511_5p levels were compared among the groups. The G1 group showed a high blood plasma concentration of miRNA 511_5p (mean 22.34) compared with the G2 (4.65), G3 (8.91) and G4 (3.52) groups (p<0.0001). CONCLUSION: These data suggest that miRNA 511_5p has significant potential as a biomarker for OT.

Epidemiological and molecular evaluation of BRAF, KRAS, NRAS genes and MSI in the development of colorectal cancer.

BACKGROUND AND OBJECTIVES: KRAS, NRAS, BRAF mutations and microsatellite instability (MSI) can be associated with Colorectal Cancer (CRC) development. MATERIAL AND METHODS: We evaluated 828 medical records of CRC patients from a school hospital from January/2016 to December/2020. Variables such as age, gender, ethnicity, literacy level, smoking, alcoholism, primary anatomical site, tumor staging, presence of BRAFV600E, KRAS, NRAS mutations and MSI , survival and metastasis were identified. The statistical analyses were performed (p < 0.05 was considered significant). RESULTS: There was a predominance of males (51.93%), whites (90.70%), low education (72.34%), smokers (73.79%), and non-alcoholics (79.10%). Rectum was the most affected site (42.14%), advanced tumor stage was most prevalent (62.07%), and metastasis occurred in (64.61%). Of the enrolled patients; 204 were investigated for BRAF mutation and detected in (2.94%); 216 for KRAS gene and detected in (26.08%); 210 for NRAS gene, and detected in (25.36%); 370 for MSI and detected in (44.68%). A significant association of CRC with NRAS mutation and alcohol habit (p = 0.043) was observed. The presence of MSI was associated with primary site proximal colon (p < 0.000), distal colon (p = 0.001) and rectum (p = 0.010). CONCLUSION: Patients with CRC are male, over 64 years old, white, with low education, smokers and non-alcoholics. The most affected primary site is rectum in advanced stage with metastasis. CRC is associated with NRAS mutation and alcohol habit, there is increased risk for primary site of proximal colon and MSI; decreased risk for distal colon and rectum in the presence of MSI.

Guia de intervenção precoce como recurso terapêutico ocupacional para cuidadores de crianças hospitalizadas / Early intervention guide as occupational therapeutic resource for hospitalized child caregivers / Guía de intervención temprana como recurso terapéutico ocupacional para cuidadores de ninõs hospitalizados

Introdução: Os primeiros anos de vida de uma criança são essenciais para seu desenvolvimento neuropsicomotor. Quando a criança está hospitalizada, o acompanhamento de seu desenvolvimento se torna importante para a promoção de saúde, prevenção de agravos e a identificação de atraso motor, cognitivo, sensorial e social. Objetivo: Apresentar um guia de orientação aos cuidadores de crianças hospitalizadas sobre intervenção precoce, para avaliá-lo como recurso informativo sobre o desenvolvimento infantil. Método: Pesquisa de corte transversal, com delineamento descritivo, abordagem quantitativa com correlação entre variáveis, desenvolvida em um hospital-escola infantil de nível terciário. Participaram 21 cuidadores de crianças hospitalizadas com faixa etária de 0 a 24 meses, durante o período de maio a julho de 2020. Foram aplicados três questionários semiestruturados (um para caracterização da amostra e os outros dois para comprovar a eficácia do guia). Foi distribuído um guia impresso aos cuidadores. Os dados foram analisados estatisticamente, usando estatística descritiva e inferencial. Resultados: A maioria dos participantes (95,24%) era de mães das crianças, cuja média de idade foi de 6±5,74 meses. Os diagnósticos prevalentes foram as cardiopatias (57,14%) e tempo de internação em torno de 66±44,78 dias. Com a aplicação dos questionários, foi possível identificar o interesse dos cuidadores em receber informações sobre o desenvolvimento infantil e utilizar o guia como recurso para orientá-los sobre como propiciar estímulos saudáveis às crianças. Conclusão: O guia se mostrou um recurso informativo de grande valia, pois permite que os cuidadores se atentem à prevenção de atrasos no desenvolvimento e proporcionem maior qualidade de vida às crianças durante a internação e também no domicílio.(AU) Palavras-chave: Guia de estudo como assunto. Intervenção precoce. Terapia Ocupacional. Desenvolvimento Infantil. Cuidadores. Criança hospitalizada

Introduction: The first years of a child's life are essential for their neuropsychomotor development. When the child is hospitalized, monitoring their development becomes essential for health promotion, disease prevention, and identifying motor, cognitive, sensory, and social delays. Objective: Present an orientation guide for caregivers of hospitalized children on early intervention to evaluate it as an informative resource on child development. Method: We carried out a cross-sectional with a descriptive design, using a quantitative approach, developed in a tertiary-level children's teaching hospital. Participants were 21 caregivers of hospitalized children aged 0 to 24 months, from May to July 2020. Three semi-structured questionnaires were applied (one to characterize the sample and the other two to prove the guide's effectiveness). A printed guide was distributed to caregivers. Data were statistically analyzed using descriptive and inferential statistics. Results: Most participants (95.24%) were mothers of the children, whose mean age was 6±5.74 months. The principal diagnoses were heart disease (57.14%) and length of hospital stay around 66±44.78 days. With the application of the questionnaires, it was possible to identify the caregivers' interest in receiving information about child development and using the guide as a resource to guide them on how to provide healthy stimuli to children. Conclusion: The guide proved to be an informative resource of great value, as it allows caregivers to pay attention to the prevention of developmental delays and provide a better quality of life for children during hospitalization and at home.(AU) Keywords: Study guide as topic. Early intervention. Occupational therapy. Child development. Caregivers. Child Hospitalized

Introducción: Los primeros años de vida del niño son fundamentales para su desarrollo neuropsicomotor. Cuando el niño está hospitalizado, el seguimiento de su desarrollo se vuelve fundamental para la promoción de la salud, la prevención de enfermedades y la identificación de retrasos motores, cognitivos, sensoriales y sociales. Objetivo: Presentar una guía de orientación para cuidadores de niños hospitalizados sobre intervención temprana para evaluarla como recurso informativo sobre el desarrollo infantil. Método: Se realizó un estudio transversal con diseño descriptivo, con enfoque cuantitativo, desarrollado en un hospital de enseñanza infantil de tercer nivel. Participaron 21 cuidadores de niños hospitalizados de 0 a 24 meses, de mayo a julio de 2020. Se aplicaron tres cuestionarios semiestructurados (uno para caracterizar la muestra y los otros dos para comprobar la efectividad de la guía). Se distribuyó una guía impresa a los cuidadores. Los datos se analizaron estadísticamente mediante estadística descriptiva e inferencial. Resultados: La mayoría de las participantes (95,24%) eran madres de los niños, cuya media de edad fue de 6±5,74 meses. Los principales diagnósticos fueron cardiopatía (57,14%) y estancia hospitalaria en torno a 66±44,78 días. Con la aplicación de los cuestionarios se logró identificar el interés de los cuidadores en recibir información sobre el desarrollo infantil y utilizar la guía como recurso para orientarlos sobre cómo brindar estímulos saludables a los niños. Conclusión: La guía demostró ser un recurso informativo de gran valor, ya que permite a los cuidadores prestar atención a la prevención de retrasos en el desarrollo y brindar una mejor calidad de vida a los niños durante la hospitalización y en el hogar.(AU) Palabras clave: Guías de estudio como assunto. Intervención Temprana. Terapia ocupacional. Desarrollo infantil. Cuidadores. Niño hospitalizado

Absence of significant genetic alterations in the VSX1, SOD1, TIMP3, and LOX genes in Brazilian patients with Keratoconus.

PURPOSE: To identify inherited or acquired mutations in the VSX1, SOD1, TIMP3 and LOX genes from the combined analysis of corneal and blood samples from patients with Keratoconus. METHODS: The casuistry was consisted of samples of peripheral blood and corneal epithelium from 35 unrelated patients with Keratoconus who were submitted to corneal crosslink treatment. Also, blood and corneal epithelium samples from 89 non-keratoconic patients were used to compose the control group. Ophthalmologic evaluations included a clinical examination, topography and tomography. DNA samples were extracted from peripheral blood and from corneal epithelium in both groups and all coding regions of the VSX1, SOD1, TIMP3 and LOX genes were amplified by polymerase chain reaction, denatured and subjected to polyacrylamide gel electrophoresis. Mutational screening was performed by single-strand conformation polymorphism and direct DNA sequencing. RESULTS: No pathogenic variant was found in all coding regions of VSX1, SOD1, TIMP3 and LOX genes, we detected only few SNPs (single-nucleotide polymorphisms). Among the polymorphisms stand out three of them, corresponding to the synonymous exchange of amino acids: exon 3 of VSX1 Ala182Ala and exon 3 of TIMP3 His83His and Ser87Ser; in patients with Keratoconus and also in control subjects. All the polymorphisms were found in samples of corneal epithelium and corresponding blood. CONCLUSION: There is absence of KC pathogenic related to mutations in the VSX1, SOD1, TIMP3 and LOX genes in the studied patients.

Influence of interleukin 17 A and 17 F polymorphisms in keratoconus.

BACKGROUND: Until a few years ago, keratoconus was defined as a noninflammatory degenerative disease. However, recent studies have shown that the altered balance between inflammatory cytokines, proteases, and protease inhibitors, as well as free radicals and oxidants, have a crucial role in the pathogenesis of this disease. The aim of this study is to investigate whether interleukin 17 A G197A (rs2275913) and interleukin 17 F T7488C (rs763780) polymorphisms are associated with keratoconus in patients from a population of the northwestern region of the State of São Paulo, Brazil. METHODS AND RESULTS: 35 patients and 61 controls were enrolled. Genotyping of interleukin 17 A G197A and interleukin 17 F T7488C polymorphisms was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique. Statistical analyses were conducted using the chi-square test, and an odds ratio with a 95% confidence interval was also calculated to evaluate the association between polymorphisms and disease. Evaluating interleukin 17 F T7488C, we found that the TT genotype is associated as a risk factor for keratoconus (P = 0.04; OR = 3.01; CI 1.11-8.14). As for evaluating interleukin 17 A G197A, the allele and genotype frequencies between patients and controls were compared and no statistically significant differences were found. CONCLUSIONS: Our data showed that the interleukin 17 F T7488C polymorphisms may exert an influence in keratoconus.

Identifying Priority Giant Anteater (Myrmecophaga tridactyla) Populations for Conservation in São Paulo State, Brazil.

Habitat loss is the main threat to biodiversity conservation worldwide. Some species may be particularly susceptible to the effects of fragmentation and the isolation of populations. The impacts of human activity on wild animal populations may be understood through relationships between individual genetic data and spatial landscape variables, particularly when considering local population dynamics influenced by fragmented habitats. Thus, the objective of this study was to analyze the population structure and genetic diversity of the giant anteater (Myrmecophaga tridactyla) using an individual sampling scheme (ISS) on a regional geographic scale. Data were collected from 41 specimens from twenty different locations in São Paulo State, Brazil, and six polymorphic microsatellite loci were genotyped. Our results indicate that barriers to gene flow exist and have segregated individuals of the farther away areas into two spatially structured clusters. The populations were also found to have high genetic diversity. The experimental sampling approach used herein enabled an analysis of the population dynamics of the giant anteater on a regional scale, as well as the identification of priority populations for genetic resource conservation for this species. The results reflect the need for adequate management plans. The efficacy of the sampling scheme may vary based on the study model used, but we argue that the use of an ISS combined with suitable molecular markers and statistical methods may serve as an important tool for initial analyses of threatened or vulnerable species, particularly in anthropized regions where populations are small or hard to characterize.

Detection of anti-Toxoplasma gondiiantibodies in wild free-living birds and mammals from the northwest region of São Paulo state, Brazil / Detecção de anticorpos anti-Toxoplasma gondiiem aves e mamíferos silvestres de vida livre da região noroeste do estado de São Paulo, Brasil

Toxoplasmosis is a protozoonosis caused by an obligate intracellular parasite named Toxoplasma gondii, which can infect humans and a large number of homeothermic animal species with worldwide distribution. The present study aimed to detect anti-T. gondii antibodies from serological samples of free-living wild animals from the northwest region of São Paulo state, Brazil. Thirty-two samples (eight from birds and 24 from mammals) were analyzed by the modified agglutination test (MAT) using 5 cut-off points for birds and 25 for mammals. Seropositivity was observed in 25% (2/8) of birds, including the species Rupornis magnirostris (roadside hawk) and Caracara plancus (southern caracara), and 29.2% (7/24) animals were seropositive among mammals, including one hoary fox (Lycalopex vetulus), two maned wolves (Chrysocyon brachyurus), one black howler monkey (Alouatta caraya), two crab-eating foxes (Cerdocyon thous) and one gray brocket deer (Mazama gouazoubira). The results obtained with the present study indicate the exposure to T. gondiiof free-living wild animals from the northwest region of São Paulo state and, therefore, that they probably play a role in the transmission and maintenance of T. gondii in the environment they inhabit. Thus, identification of the infection in several animal species in the region indicates the environmental contamination of the area. Studies of this nature may help to understand the importance of the prevention and control of this disease in Brazil.(AU)

A toxoplasmose é uma protozoonose causada por um parasita intracelular obrigatório denominado Toxoplasma gondii, que pode infectar os humanos e um vasto número de espécies animais homeotérmicas, apresentando distribuição mundial. O presente estudo objetivou a detecção de anticorpos anti-T. gondii a partir de amostras sorológicas de animais silvestres de vida livre da região noroeste do estado de São Paulo. Foram analisadas 32 amostras (oito de aves e 24 de mamíferos) por meio do teste de aglutinação modificado (MAT), utilizando ponto de corte 5 para as aves e 25 para os mamíferos. Soropositividade foi observada em 25% (2/8) das aves, incluindo as espécies Rupornis magnirostris (gavião-carijó) e Caracara plancus (carcará); entre os mamíferos, 29,2% (7/24) foram soropositivos incluindo uma raposa-do-campo (Lycalopex vetulus), dois lobos-guará (Chrysocyon brachyurus), um bugio-preto (Alouatta caraya), dois cachorros-do-mato (Cerdocyon thous) e um veado-catingueiro (Mazama gouazoubira). Os resultados obtidos com o presente estudo indicam a exposição dos animais selvagens de vida livre a T. gondii na região noroeste do estado de São Paulo e, portanto, que provavelmente apresentam papel na transmissão e manutenção de T. gondii no meio ambiente em que vivem. Assim, a identificação da infecção em várias espécies de animais na região indica a contaminação ambiental da área. Estudos dessa natureza podem ajudar no entendimento sobre a prevenção e o controle dessa importante doença no Brasil.(AU)

Pandemia do Coronavírus e Ensino Remoto Emergencial: Percepção do Impacto no Bem Estar de Universitários

Resumo: Jovens em ensino superior são mais vulneráveis ao aparecimento de sintomas psicológicos diante do contexto de COVID-19. Não só a pandemia, como a adaptação à realidade do ensino remoto e demais dificuldades podem afetar o bem estar dos universitários. Por isso, esse estudo buscou investigar a percepção de bem-estar e saúde mental de universitários que realizaram ensino remoto durante a quarentena. Trata-se de um estudo transversal, exploratório e descritivo. Utilizou-se o instrumento "Questionário sobre percepção do isolamento social por universitários durante quarentena da COVID-19". Por meio da técnica por amostragem de referência os universitários divulgaram o link de acesso ao questionário online a seus pares. Participaram 497 estudantes, a maioria mulheres (74,69%) com média de idade 21,71 (DP=2.85), matriculados em Instituição de Ensino Superior pública (IES) (72.89%). Encontrou-se correlação positiva e significante (p<0.0001) para prejuízo no desempenho acadêmico pela adesão ao Ensino Remoto Emergencial e a percepção negativa na saúde mental e no bem-estar. Nos dados qualitativos, foram identificados percepção de maior ansiedade (15.35%), estresse (7.3%) e alteração do sono (7.67%) nos participantes. Cerca de 91.96% dos participantes estão engajados em práticas de auto cuidado e gerenciamento emocional. Portanto, os resultados convergem com a literatura e implicam que o ensino remoto pode impactar negativamente sobre o bem-estar e gerar insegurança quanto à qualidade e solidez da formação acadêmica. Os dados desse estudo sugerem que as instituições implementem atividades preventivas em relação à saúde mental dos estudantes e adequem o ensino remoto a fim de reduzir o sofrimento identificado.

Abstract: Young people in higher education are more vulnerable to the appearance of psychological symptoms in the context of COVID-19. Also, the adaptation to remote education and other difficulties can affect the well-being of university students. Therefore, this study sought to investigate the perception of well-being and mental health of university students who underwent remote education during quarantine. This is a cross-sectional, exploratory, and descriptive study. The instrument used was "Questionnaire on the perception of social isolation by university students during quarantine of COVID-19". Using the reference sampling technique, university students released the link to access the online questionnaire to their peers. 497 students participated, most of them women (74.69%), with mean age of 21.71 (SD = 2.85), enrolled in a public higher education institution (HEI) (72.89%). A positive and significant correlation was found (p <0.0001) for academic performance impaired by the adhesion of Emergency Remote Education and the negative perception of mental health and well-being. In the qualitative part, participants noticed anxiety (15.35%), stress (7.3%) and altered sleep (7.67%). About 91.96% of the participants are engaged in self-care and emotional management practices. Therefore, the results converge with the literature and imply that online education can impact well-being and generate insecurity regarding the quality and solidity of academic training. Data from this study suggest that institutions should implement preventive activities regarding students' mental health and adapt remote learning in order to reduce student's distress.

Resumen: Los jóvenes en educación superior son más vulnerables a la aparición de síntomas psicológicos en el contexto de COVID-19. La pandemia, la adaptación a la educación a distancia y otras dificultades afectan el bienestar de los estudiantes universitarios. Este estudio buscó investigar la percepción de bienestar y salud mental de los que realizaron educación remota durante la cuarentena. Esto es un estudio transversal, exploratorio y descriptivo. El instrumento utilizado fue "Cuestionario sobre la percepción de aislamiento social de estudiantes universitarios durante la cuarentena de COVID-19". Utilizando la técnica de muestreo de referencia, los estudiantes lanzaron el enlace para acceder al cuestionario en línea a sus compañeros. Participaron 497 estudiantes, la mayoría mujeres (74,69%) con una media de edad de 21,71 (DE = 2,85) matriculados en una institución pública de educación superior (72,89%). Se encontró una correlación positiva y significativa (p<0,0001) para el rendimiento académico deteriorado por este modelo de enseñanza y la percepción negativa de salud y bienestar mental. En el resultado cualitativo se identificaron percepcíon de mayor ansiedad (15,35%), estrés (7,3%) y alteración del sueño (7,67%). Aproximadamente el 91,96% realiza prácticas de autocuidado y manejo emocional. Por tanto, los resultados convergen con la literatura e implican que la educación remota puede impactar el bienestar y generar inseguridad en cuanto a la calidad y solidez de la formación académica. Los datos de este estudio sugieren que las instituciones deben implementar actividades preventivas relacionadas con la salud mental de los estudiantes y adaptar el aprendizaje a distancia para reducir la angustia de los universitarios.

Levantamento clínico-epidemiológico de acidentes escorpiônicos na região de São José do Rio Preto, São Paulo, Brasil

Introdução: O escorpionismo configura importante e crescente problema de saúde pública no Brasil, sendo o principal causador de acidentes por animais peçonhentos. A espécie Tityus serrulatus (escorpião-amarelo) já foi largamente associada a maior gravidade dos casos em decorrência da toxicidade de seu veneno. No estado de São Paulo, em 2016, foram notificados 91.476 acidentes e 10 óbitos, sendo este o estado com a segunda maior quantidade de picadas. Objetivo: Realizar o levantamento clínico-epidemiológico dos acidentes escorpiônicos na região de São José do Rio Preto, São Paulo, Brasil, no período de 2010 a 2016. Métodos: Análise de prontuários dos pacientes atendidos pelo Centro de Assistência Toxicológica (CEATOX-21) do complexo Hospital de Base/Hospital da Criança e Maternidade (HB/HCM), de 2010 a 2016. Resultados: Observou-se um aumento de 111% no número de atendimentos por picadas de escorpião em 2016 com relação a 2010. A maioria das picadas ocorreu na própria residência do paciente (82%), em homens (54,9%), entre 24 e 60 anos de idade (24,9%). Em 29,11% dos casos, os pacientes eram menores de 12 anos ­ grupo associado a maior gravidade. As cidades com maior número de eventos foram São José do Rio Preto (36,8%); Mirassol (5,31%); e Nova Granada (4,31%). As solicitações de avaliação pelo CEATOX foram originadas principalmente pelo complexo HB/HCM (47,5%), seguido por 18,55% de hospitais particulares, 14,9% de serviços de urgência e emergência e 10,5% de hospitais filantrópicos/públicos/centros de saúde. O total de casos moderados e graves foi 20,7%, sendo a espécie T. serrulatus o responsável por ocasionar a imensa maioria dos acidentes por escorpiões peçonhentos na região. Conclusão: O escorpionismo apresenta crescimento importante durante o tempo analisado, em especial da espécie Tityus serrulatus. Em razão da manifestação clínica diversa e mutável, há a necessidade de avaliação constante dos pacientes picados para correta indicação de soroterapia.

Medical, ethical, and legal aspects of hematopoietic stem cell transplantation for Crohn's disease in Brazil.

Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.

Absence of the c.169+50delTAAACAG mutation of SOD1 gene in a sample of keratoconus patients in Brazilian population.

OBJECTIVE: To determine the presence of the 7-bp deletion c.169+50delTAAACAG in intron 2 of Superoxide Dismutase-1 gene in keratoconic patients from the State of São Paulo, Brazil, which promotes splicing variations, resulting in non-functional Superoxide Dismutase-1 antioxidant proteins, which may damage the corneal structure. RESULTS: A group of 35 keratoconic patients, from whom 35 peripheral blood samples and 58 samples of corneal fragments were evaluated, and a control group of 89 individuals, from whom 41 blood samples and 149 samples of corneal fragments were collected. After the amplification of DNA fragments by polymerase chain reaction, mutational screening analysis was performed by enzymatic digestion, followed by direct sequencing. The absence of the 7-bp c.169+50delTAAACAG mutation in intron 2 of Superoxide Dismutase-1 gene was detected in the analyzed subjects of the 2 groups, both in the cornea and peripheral blood samples. Then, according to our results, there is no involvement of c.169+50delTAAACAG deletion in the pathogenesis of keratoconus in this population, once it was not detected. But we emphasize that studies involving this deletion must be continued in an attempt to elucidate this issue.

First isolation and genotyping of Toxoplasma gondii in a free-living giant anteater (Myrmecophaga tridactyla) revealed a unique non-archetypal genotype.

The protozoan parasite Toxoplasma gondii can infect virtually all warm-blooded animals worldwide but little is known of its infection in the endangered giant anteaters (Myrmecophaga tridactyla). The present study found antibodies to T. gondii in 13 of 23 free-living M. tridactyla from the northwest region of São Paulo state, Brazil, by the Modified Agglutination Test (MAT, cut-off titer 1:25). Unfrozen tissues of seven M. tridactyla were bioassayed in mice and viable T. gondii (strain designated TgMytrBrSP1) isolated from one seropositive giant anteater. To our knowledge, this is a new host record for T. gondii. Genotyping using PCR-RFLP revealed the Brazilian clonal Type BrIII genotype, and a unique non-archetypal genotype was revealed by microsatellite analysis.

Speech-language-hearing follow-up of preterm children: feeding and neuropsychomotor performance / Acompanhamento fonoaudiológico de crianças nascidas pré-termo: desempenho alimentar e neuropsicomotor

ABSTRACT Purpose: to establish the breastfeeding rates at hospital discharge and post-discharge, analyze neuropsychomotor development, and indicate the rehabilitation referral rate of preterm children attended by speech-language-hearing therapists. Methods: a total of 39 preterm children participated in the study. They were born at a Children and Maternity Hospital between August 2016 and January 2017 and were followed up by the speech-language-hearing therapists during the hospital stay. The Spearman's statistical test was used. The p-value was set at 0.005; the correlation value was: r = 0.10 to 0.39, weak correlation; r = 0.40 to 0.69, moderate correlation; and r = 0.70 to 1, strong correlation. Results: of the 39 participants, 17 (43.6%) were discharged on exclusive breastfeeding; 4 (10.25%), on mixed milk feeding (breast and cup); 14 (35.9%), on mixed milk feeding (breast and baby bottle); and 4 (10.25%), on artificial milk feeding - baby bottle. After introducing solid food, 12.8% remained on breastfeeding, 38.4% on mixed milk feeding, and 48.7% in artificial milk feeding. Complementary feeding was introduced at 5 months (adjusted age). Auditory, motor and language development occurred as expected in 90% of the children, considering the milestone's adjusted age. Conclusion: at hospital discharge, most infants were on exclusive or mixed breastfeeding. After discharge, mixed breastfeeding lasted longer, and low neuropsychomotor development impairment rates and rehabilitation referral rates were observed.

RESUMO Objetivo: determinar os índices de aleitamento materno na alta e pós-alta hospitalar, analisar o desenvolvimento neuropsicomotor e indicar a taxa de encaminhamento para reabilitação de crianças nascidas pré-termo atendidas pelo serviço de fonoaudiologia. Métodos: participaram deste estudo 39 crianças nascidas pré-termo no Hospital da Criança e Maternidade, no período de agosto de 2016 a janeiro de 2017, acompanhados pela fonoaudiologia durante internação hospitalar. Foi utilizado o teste estatístico de Spearman, o valor de p foi 0,005; o valor de correlação foi r= 0,10 até 0,39 correlação fraca, r= 0,40 até 0,69 correlação moderada e r=0,70 até 1 correlação forte. Resultados: na alta hospitalar, dos 39 participantes, 17 (43,6%) estavam em aleitamento exclusivo, 4 (10,25%) em aleitamento misto (peito e copinho), 14 (35,9%) em aleitamento misto (peito e mamadeira) e 4 (10,25%) em aleitamento artificial (mamadeira). Após a introdução alimentar 12,8% permaneceram em aleitamento materno, 38,4% em aleitamento misto, e 48,7% em aleitamento artificial. A introdução de alimentação complementar ocorreu aos 5 meses de idade corrigida. O desenvolvimento auditivo, motor e de linguagem ocorreu conforme esperado para a idade corrigida do marco em 90% das crianças. Conclusão: na alta hospitalar a maioria dos lactentes estava em aleitamento materno de forma exclusiva ou mista, sendo que após a alta o aleitamento materno misto apresentou maior duração e foram observados baixos índices de prejuízos no desenvolvimento neuropsicomotor e de encaminhamento para reabilitação.

Comparison of quality of life and functionality in type 2 diabetics with and without insulin

SUMMARY INTRODUCTION Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

RESUMO INTRODUÇÃO Diabetes mellitus tipo 2 compromete física, psicológica, econômica e socialmente. OBJETIVOS Identificar e comparar qualidade de vida, depressão, desempenho funcional e exercício físico em pacientes com diabetes mellitus tipo 2 insulinizados ou não. MÉTODOS Estudo individuado, observacional, descritivo, transversal, comparativo envolvendo 100 pacientes (50 utilizam insulina e 50 não) em um hospital escola. Instrumentos utilizados: Ficha de Identificação e Perfil Socioeconômico; SF-36; Escala Hospitalar de Ansiedade e Depressão; Escala Visual Analógica de Dor; Medida Canadense de Desempenho Ocupacional e Questionário Internacional de Atividade Física. RESULTADOS Amostra composta, predominantemente, por indivíduos de meia-idade, sexo feminino, casados, ensino fundamental incompleto e aposentados. Há comprometimento de todos os domínios da qualidade de vida, sendo mais intenso nos insulinizados em capacidade funcional, limitação por aspectos físicos, dor, aspectos sociais, limitação por aspectos emocionais e saúde mental (P<0,05). Importante prevalência de sintomas ansiosos ou depressivos nos grupos, principalmente nos em uso de insulina, porém a ocorrência dos transtornos psiquiátricos correspondentes é improvável (P<0,05). Não houve diferença significativa da DNP entre os grupos (P=0,2296). O prejuízo da funcionalidade é semelhante em relação a atividades de autocuidado (P=0,4494) e produtividade (P=0,5759) nos dois grupos, havendo maior deterioração do lazer em usuários de insulina (P=0,0091). A maioria pratica atividade física, tendo a caminhada a maior adesão, sem diferença significativa ao comparar os grupos (P>0,05), repetindo-se nas demais modalidades. CONCLUSÃO Pacientes insulinizados apresentaram maior prejuízo da capacidade funcional e na socialização, assim como referem maiores dores neuropáticas e sintomas ansiosos e depressivos.

Comparison of quality of life and functionality in type 2 diabetics with and without insulin.

INTRODUCTION: Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES: To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS: A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS: Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION: Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

Evaluation of Serological and Molecular Tests Used for the Identification of Toxoplasma gondii Infection in Patients Treated in an Ophthalmology Clinic of a Public Health Service in São Paulo State, Brazil.

Ocular toxoplasmosis is one of the most common complications caused by the infection with the parasite Toxoplasma gondii. The risk of developing eye lesions and impaired vision is considered higher in Brazil than other countries. The clinical diagnosis is difficult and the use of sensitive and specific laboratorial methods can aid to the correct diagnosis of this infection. We compared serological methods ELISA and ELFA, and molecular cPCR, Nested PCR and qPCR for the diagnosis of T. gondii infection in groups of patients clinically evaluated with ocular diseases non-toxoplasma related (G1 = 185) and with lesions caused by toxoplasmosis (G2 = 164) in an Ophthalmology clinic in Brazil. Results were compared by the Kappa index, and sensitivity (S), specificity (E), positive predictive value (PPV), and negative (NPV) were calculated. Serologic methods were in agreement with ELISA more sensitive and ELFA more specific to characterize the acute and chronic infections while molecular methods were discrepant where qPCR presented higher sensitivity, however, lower specificity when compared to cPCR and Nested PCR.

Confidence in palliative care issues by medical students and internal medicine residents.

BACKGROUND: Palliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice. OBJECTIVE: To evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families. METHOD: A modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school. RESULTS: Students in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents. CONCLUSION: Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.

Comunicação alternativa ampliada na esclerose lateral amiotrófica: a tecnologia a favor da reabilitação / Augmentative and alternative communication in amyotrophic lateral sclerosis: technology for rehabilitation

Introdução:A Esclerose Lateral Amiotrófica (ELA), doença caracterizada por deterioração de neurônios motores causa paralisia progressiva de músculos esqueléticos, comprometendo a motricidade dos membros, da deglutição, da respiração e da fala. O comprometimento da fala tem papel fundamental na qualidade de vida do paciente bem como na de seu cuidador. A Comunicação Alternativa Ampliada (CAA) surge como uma oportunidade para amenizar as limitações de comunicação impostas pela doença. Objetivo: Avaliar a eficácia da Comunicação Alternativa Ampliada em pacientes com Esclerose Lateral Amiotrófica. Casuística e Métodos: Estudo quantitativo, descritivo e transversal com 13 pacientes, realizado em São José do Rio Preto ­ SP, Brasil, nos anos de 2015 e 2016. Instrumentos: questionários sócio-demográfico elaborado pelos pesquisadores; questionário de avaliação da ELA (Amyotrophic Lateral Sclerosis Assessment Questionnaire; ALSAQ-40); questionário de qualidade de vida em voz (QVV); e questionário de eficácia dos meios de comunicaçãoalternativa (Vox4All ou HeadMouse). O questionário sócio-demográfico, o ALSAQ-40e o questionário de qualidade de vida em voz foram aplicados antes da intervenção. A intervenção com a Comunicação Alternativa Ampliada foi aplicada durante seis atendimentos individuais com duração de 50 minutos cada, uma a duas vezes por semana com a ajuda do profissional da saúde. Apóso término das sessões, os pacientes responderam ao questionário sobre a eficácia dos meios de comunicação alternativa.A associação entre as variáveis foi medida utilizando o teste exato de Fisher. Resultados: A idade dos pacientes foi de 60,07±11,17 anos (média ± desvio padrão), e 76,92% apresentava cuidador familiar. Cem por cento dos pacientes apresentavam dificuldades na comunicação. Após a intervenção com a Comunicação Alternativa Ampliada os pacientes relataram melhora na comunicação (p<0,05) e consideraram esses métodos eficazes para o uso diário. Conclusão: A Comunicação Alternativa Ampliada pode ser considerada uma intervenção facilitadora na interação social e na qualidade de vida de pacientes com Esclerose Lateral Amiotrófica

Introduction:Amyotrophic Lateral Sclerosis (ALS), a disease characterized by deterioration of upper and lower motor neurons causes progressive paralysis in all skeletal muscles. It compromises limb motility, swallowing, breathing, and speech. Speech impairment plays a key role in both the patient and the caregiver's quality of life. Augmentative and Alternative Communication (AAC) emerges as an opportunity to alleviate the communication limitations imposed by the disease. Objective: Assess the effectiveness of Augmentative and Alternative Communication in patients with Amyotrophic Lateral Sclerosis. Patients and Methods:We carried out a descriptive, quantitative and cross-sectional study conducted with 13 patients in SP, Brazil from 2015 to 2016. We used a questionnaire designed by the researcher to assess sociodemographic characteristics; an Amyotrophic Lateral Sclerosis assessment questionnaire (ALSAQ-40); voice-related quality of life (V-RQOL); and a questionnaire to assess the effectiveness of alternative communication (Vox4All or HeadMouse). The sociodemographic questionnaire, the Amyotrophic Lateral Sclerosis assessment questionnaire and the voice-related quality of life survey were applied before the intervention. The intervention with Augmentative and Alternative Communication was applied during six individual visits lasting 50 minutes each, once or twice a week with the help of the health professional. After the end of the sessions, the patients answered the questionnaire on the effectiveness of the alternative means of communication. The association between variables was measured using the Fisher's exact test. Results: The mean age was 60.07 ± 11.17, and 76.92% of the patients had family caregivers. All the patients exhibited communication difficulties caused by voice-related quality of life. After Augmentative and Alternative Communication intervention, patients reported improved communication (p<0.05), and they considered these methods effective for daily use. Conclusion:Augmentative and Alternative Communication can be considered a facilitating intervention for social interaction and quality of life of patients with amyotrophic lateral sclerosis.

Sobrecarga no cuidado de paciente idoso com demência / Burden in elderly patient care with dementia / Sobrecarga en el cuidado del paciente mayor con demência

Com o envelhecimento populacional, as doenças crônico-degenerativas aumentaram. As demências destacam-se devido à perda cognitiva progressiva que compromete o desempenho nas atividades cotidianas, reduzindo a autonomia e a independência. A responsabilidade pelo cuidado modifica o cotidiano dos cuidadores, causando desgaste físico e emocional. Objetiva-se avaliar o nível de sobrecarga dos cuidadores dos pacientes com demência e seus fatores, caracterizar a amostra de pacientes e cuidadores e identificar as atividades cotidianas comprometidas pela demência. Como método, o estudo descritivo, exploratório, aprovado pelo Comitê de Ética em Pesquisa/FAMERP parecer n.o 358.178, realizado de setembro a dezembro de 2013, com 31 cuidadores de pacientes com demência, atendidos no ambulatório de um hospital de referência. Os cuidadores assinaram o Termo de Consentimento Livre e Pós-Esclarecimento, sendo submetidos à aplicação dos questionários: Escala de Sobrecarga do Cuidador de Zarit e entrevistas semi-estruturadas. Os resultados mostraram que, conforme o quadro de demência progride, há redução da autonomia e independência do idoso. O Teste de Qui-Quadrado de Fisher mostrou significância estatística na redução da realização de atividades de lazer, pelos idosos, antes e após o quadro de demência (p=0,0181). Dentre os cuidadores avaliados, prevaleceu o gênero feminino, com média de idade de 53±12,4 e redução da realização de atividades de lazer, pelos cuidadores, antes e após de assumirem o papel de cuidador informal (p=0,0402)...A análise estatística, utilizando a análise de correlação de Spearman, mostrou correlação entre o aumento de sobrecarga e redução da prática de atividade de lazer (p=0,0078). Como conclusões: a redução ou anulação da atividade de lazer na vida cotidiana implica na qualidade de vida desses cuidadores, o que pode ser evidenciado pela sobrecarga apresentada. Os dados indicam necessidade de atenção da equipe multiprofissional de saúde para esses cuidadores, dentre eles o terapeuta ocupacional, e possibilita uma reflexão sobre um tema relevante: o cuidado ao cuidador.

Due to the population ageing, the chronic- degenerative diseases have grown. The dementias have been highlighted because of the cognitive progressive loss that compromises the performance on the daily activities, reducing the autonomy and the independence matter. The responsibility for the care provided changes the caregivers' routine, causing physical and emotional distress. Objectives: evaluate the level of burden taken by the caregivers of patients with dementia and its factors, characterize the patients and caregivers' samples and identify the daily activities compromised by the dementia. Method: descriptive report, exploratory, approved by the Ethic Committee in Research/ FAMERP statement #358.178, held from September to December in 2013, with 31 caregivers of patients with dementia, assisted in a reference hospital ambulatory. The caregivers signed the Open Consent and Post Clarification Form, being submitted to questionnaires appliances: Caregiver from Zarit Overburden Scale and semi-structured interviews. Results: As the framework of dementia increases, there is an elderly autonomy and independence reduction. Fisher Exact Test showed a significant statistic in the reduction of leisure activities performance, by the elderly, before and after the state of dementia (p=0,0181). Among the evaluated caregivers, the feminine genre prevailed, with an average of 53±12,4 and the reduction of leisure activities performance, by the caregivers, before and after they undertook the position of informal caregiver (p=0,0078). Conclusion: the reduction or cancellation of the leisure activity on the daily life implies in these caregivers quality of life, which can be emphasized by the presented burden. The data points to a necessity of attention from the health multidisciplinary team to these caregivers, including the occupational therapist, and enables a reflection about a relevant subject: the care for the caregiver.

Con el envejecimiento poblacional, las enfermedades crónico-degenerativas aumentaron. Las demencias se destacan debido a la pérdida cognitiva progresiva que compromete el desempeño en las actividades cotidianas, reduciendo la autonomía y la independencia. La responsabilidad por el cuidado modifica el cotidiano de los cuidadores, causando desgaste físico y emocional. Se pretende evaluar el nivel de sobrecarga de los cuidadores de los pacientes con demencia y sus factores, caracterizar la muestra de pacientes y cuidadores e identificar las actividades cotidianas comprometidas por la demencia. Como método, el estudio descriptivo, exploratorio, aprobado por el Comité de Ética en Investigación / FAMERP, se consideró 358.178, realizado de septiembre a diciembre de 2013, con 31 cuidadores de pacientes con demencia, atendidos en el ambulatorio de un hospital de referencia. Los cuidadores firmaron el Término de Consentimiento Libre y Post-Aclaración, siendo sometidos a la aplicación de los cuestionarios: Escala de Sobrecarga del Cuidador de Zarit y entrevistas semiestructuradas. Los resultados mostraron que, conforme el cuadro de demencia progresa, hay reducción de la autonomía e independencia del anciano. La prueba de Qui-cuadrado de Fisher mostró significancia estadística en la reducción de la realización de actividades de ocio, por los ancianos, antes y después del cuadro de demencia (p = 0,0181). Entre los cuidadores evaluados, prevaleció el género femenino, con una media de edad de 53 ± 12,4 y reducción de la realización de actividades de ocio, por los cuidadores, antes y después de asumir el papel de cuidador informal (p =0,0402). El análisis estadístico, utilizando el análisis de correlación de Spearman, mostró correlación entre el aumento de sobrecarga y reducción de la práctica de actividad de ocio (p = 0,0078). Como conclusiones: la reducción o anulación de la actividad de ocio en la vidacotidiana implica la calidad de vida de esos cuidadores, lo que puede ser evidenciado por la sobrecarga presentada. Los datos indican necesidad de atención del equipo multiprofesional de salud para esos cuidadores, entre ellos el terapeuta ocupacional, y posibilita una reflexión sobre un tema relevante: el cuidado al cuidador.