Psychometric properties of the Brazilian-Portuguese Flow State Scale Short (FSS-BR-S).

"Flow experience" is a term used to describe the state of being fully immersed in what you are doing. The Flow State Scale (FSS-2) was developed to assess how people feel when they are in the flow state while participating in certain sports activities. The goal of this study was to obtain a short adapted version of the FSS-2 for the Brazilian-Portuguese language and for general activities (FSS-BR-S). To do this, we translated it both ways (forwards and backwards) and verified that the translation was accurate. Methods: After getting answers from 396 Brazilian participants, we performed (1) the construct validity of the FSS-BR-S and (2) the psychometric item quality analysis. The confirmatory factorial analysis shows that a FSS-BR-S factorial model is the best fit for the data (χ2 = 44.36, p = .023, df = 27, χ2/df = 1.64, CFI = 0.99, TLI = 0.98, and RMSEA = 0.04). Reliability tests done in this structure show that the FSS-BR-S (which only has nine items) has good internal consistency. The item quality analysis reveals that its difficulty and differentiating parameters are good for estimating the overall flow state. The test information curve for the short version demonstrates that it is very useful for estimating the flow states of each disposition. Discussion and Conclusions: Based on these findings, we can conclude that the FSS-BR-S has demonstrated sufficient validity to be used with Brazilians.

Use of cannabis and its derivates in chronic pain management: systematic review / Uso de cannabis e seus derivados no manejo da dor crônica: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain is a clinical condition that affects an important part of the Brazilian and world population, significantly affecting their lives. The medicinal properties of Cannabis have been explored for millennia, but recently its use for the relief of chronic pain symptoms has increased. CONTENTS: A systematic review was carried out with the objective of evaluating the use of cannabis and its derivatives in the management of chronic pain, analyzing its potential side effects and safety. For this, the following databases were used: Pubmed, Embase, Cochrane Library and BVS, searching for studies published in the last 5 years, in Portuguese, Spanish or English, using MeSH descriptors and relevant free terms. Randomized, double-blind clinical trials with at least 10 participants in each comparison arm and with at least 2 weeks of intervention were included. After screening the authors, a quantitative analysis of 4 clinical trials (586 patients) was performed, which were analyzed for the outcomes of: patients with 50% or 30% reduction in pain intensity compared to baseline, improvement in pain intensity average pain, discontinuation due to adverse effects, serious adverse effects, and any adverse effects. CONCLUSION: The analysis did not yield high-quality evidence pertaining to the evaluation of efficacy, safety, or adverse effects associated with the use of cannabis-derived treatments in the management of chronic pain. Consequently, the formulation of recommendations or restrictions in these regards is not feasible, leaving the utilization of these therapeutic modalities subject to individual assessment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica é uma condição clínica que atinge parte importante da população brasileira e mundial, afetando significativamente a vida dessas pessoas. As propriedades medicinais da Cannabis vêm sendo exploradas por milênios, mas recentemente seu uso para alívio dos sintomas da dor crônica tem aumentado. CONTEÚDO: Foi conduzida uma revisão sistemática com o objetivo de avaliar o uso de cannabis e seus derivados no manejo da dor crônica, analisando seus potenciais efeitos adversos e sua segurança. Para isso, foram utilizadas as seguintes bases de dados: PubMed, Embase, Cochrane Library e BVS, buscando estudos publicados nos últimos 5 anos, nos idiomas português, espanhol ou inglês, utilizando os descritores MeSH e termos livres relevantes. Foram incluídos ensaios clínicos randomizados, duplos-cegos, com pelo menos 10 participantes em cada braço de comparação e com no mínimo 2 semanas de intervenção. Após a triagem dos autores, foi procedida a análise quantitativa de 4 ensaios clínicos (586 pacientes), que foram analisados para os desfechos de: pacientes com redução da intensidade da dor 50% ou 30% em relação à linha de base, melhora na intensidade média da dor, descontinuidade devido a efeitos adversos, efeitos adversos graves e qualquer efeito adverso. CONCLUSÃO: Não foram encontradas evidências de alta qualidade quanto à avaliação dos desfechos de eficácia, segurança ou de efeitos adversos relacionados ao uso de tratamentos derivados da cannabis no manejo de dor crônica, não podendo ser produzidas recomendações ou restrições nesses aspectos, ficando o uso dessas modalidades terapêuticas sujeito a análise individual.

Anti-inflammatory effects of cannabinoids / Efeitos anti-inflamatórios dos canabinoides

ABSTRACT BACKGROUND AND OBJECTIVES: The use of cannabinoids for epileptic syndrome and control of side effects associated with chemotherapy is already widespread and supported by several well-controlled clinical trials. However, the use of these drugs in inflammatory pathologies is sometimes underestimated due to lack of scientific knowledge with a high degree of evidence, non-recognition of the endocannabinoid system as an active participant in these diseases, as well as fear of the stereotype surrounding the use of cannabis derivatives. The purpose of this study was to examine the anti-inflammatory and antioxidant effects of endogenous and exogenous cannabinoids on various physiological systems in which these ligands interact. CONTENTS: Studies cited in this review were obtained by searching Pubmed, Medline, Google Scholar, Scielo, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, and through the authors' familiarity with the published literature in this area of interest. Clinical, observational and intervention, experimental, qualitative studies and review articles were all included in the search. Articles were identified using the following descriptors: cannabis and tetrahydrocannabinol and cannabidiol and endocannabinoids and anti-inflammatory inflammation and oxidative stress. In addition, a manual revision of relevant references was also performed to capture articles that may not have been picked up through the initial search. The literature investigation was conducted from March 22 to May 2022. CONCLUSION: Cannabinoids show to be a promising therapeutic option in the context of inflammatory diseases, given the complete and complex relationship between the endocannabinoid system and the immune system. The setback to be overcome in the use of cannabinoids as anti-inflammatory drugs includes the synthesis of non-psychoactive cannabinoid receptor agonists while maintaining potent anti-inflammatory activity. Further studies are needed to increase our understanding of cannabinoids and their intricate effects on immune system disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso de canabinoides para síndrome epiléptica e controle de efeitos adversos associados à quimioterapia já é amplamente difundido e apoiado por vários ensaios clínicos bem controlados. Entretanto, o uso destes fármacos em doenças inflamatórias é, por vezes, subestimado pela falta de conhecimento científico com alto grau de evidência, pelo não reconhecimento do sistema endocanabinoide como participante ativo destas doenças, bem como por receio do estereótipo que envolve o uso dos derivados da cannabis. O objetivo deste estudo foi analisar os efeitos anti-inflamatórios e antioxidantes de canabinoides endógenos e exógenos em vários sistemas fisiológicos nos quais esses ligantes interagem. CONTEÚDO: Estudos citados nesta revisão foram obtidos por meio de buscas feitas nas bases de dados Pubmed, Medline, Google Acadêmico, Scielo, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, e através da familiaridade dos autores com a literatura publicada nesta área de interesse. Estudos clínicos, observacionais e de intervenção, experimentais, qualitativos e artigos de revisão foram todos incluídos na pesquisa. Os artigos foram identificados usando os seguintes descritores: cannabis , tetraidrocanabinol e canabidiol e endocanabinoides e inflamação anti-inflamatório e estresse oxidativo. Ademais, uma revisão manual nas referências relevantes também foi realizada para captura de artigos que podem não ter sido captados por meio da busca inicial. A investigação na literatura foi realizada no período de 22 de março a 17 de maio de 2022. CONCLUSÃO: Os canabinoides demonstram ser uma opção terapêutica promissora no contexto das doenças inflamatórias, haja vista a completa e complexa relação entre o sistema endocanabinoide e o sistema imune. O revés a ser vencido no uso de canabinoides como fármacos anti-inflamatórios inclui a síntese de agonistas de receptores canabinoides que não sejam psicoativos, mantendo a potente atividade anti-inflamatória. Novos estudos são necessários para aumentar a compreensão dos canabinoides e seus efeitos intrincados sobre distúrbios do sistema imunológico.

Decreased hippocampal serotonin 5HT1A expression in mesial temporal lobe of epilepsy patients.

INTRODUCTION: Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is a surgically remediable epilepsy with a relatively high prevalence and psychiatric comorbidities. Depressive disorders may occur in up to 25% of MTLE-HS patients suggesting a common molecular mechanism underlying both conditions. OBJECTIVE: To compare the gene expression comprising serotonin 5HT1A and 5HT2A, noradrenaline (NA) ADRA1A, and ADRA2A receptors in the hippocampus of MTLE-HS patients with and without major depression. METHODS: A cross-sectional study allocated 31 patients in three groups: MTLE-HS without psychiatric diagnosis (MTLE-HS group), MTLE-HS with major depression (MTLE-HS-D group) and a control group consisting of healthy volunteers without any neurological or psychiatric disorders. Demographic and clinical characteristics were compared among groups. Gene expression of receptors were analyzed using general linear mixed models (GLMM), with an unstructured matrix, normal link. RESULTS: The three groups showed a similar distribution regarding age, gender (p > 0.16), history of initial precipitating injury, family history of epilepsy, monthly frequency of seizures, side of hippocampal sclerosis, interictal spike distribution and anti-seizure medications did not differ between MTLE-HS and MTLE-HS-D groups (p > 0.05). We observed a greater expression of the 5HT1A receptor in the control group when compared to the MTLE-HS (P = .004) and MTLE-HS-D (P = .007). Nevertheless, we did not observe any difference when MTLE-HS and MTLE-HS-D groups were compared to the controls for the ADRA1A (P = .931; P = .931), ADRA2A (P = .120; P = .121) and 5HT2A (P = .638; P = .318, respectively) gene expression. CONCLUSION: Mesial temporal lobe epilepsy related to hippocampal sclerosis and MTLE-HS-D patients showed a lowered expression of the 5HT1A receptors when compared with the controls adjusted for age and schooling. Data suggest that temporal lobe epilepsy plasticity may affect serotonin receptors, which may lead to more frequent cases of major depression in this population. More studies comprising wider samples are necessary to confirm these results; they also should investigate serotonin reuptake drugs as an adjuvant therapeutic option for MTLE-HS disorder.

SUS: avaliação da eficiência do gasto público em saúde / SUS: evaluation of the efficiency of public health spending

Após a fase aguda da pandemia de covid-19, que originou uma crise sanitária mundial, matando aproximadamente 700 mil pessoas no Brasil, parece importante refletir sobre a necessidade de se aumentar os recursos destinados ao Sistema Único de Saúde (SUS). Criado na Constituição federal de 1988, o SUS sofreu desde seu nascedouro com o esvaziamento do orçamento da seguridade social e o subfinanciamento das ações e serviços públicos de saúde. A partir de 2016, após a queda da presidente Dilma Rousseff, essa situação se agravou, provocando, entre outros, um processo de desfinanciamento do SUS, no contexto do aumento da pobreza e da desigualdade. Neste cenário, a 'eficiência' aparece como panaceia administrativa, a qual, em nosso caso, acaba servindo para reforçar a ideia de que os problemas do SUS resultam da falsa dicotomia entre financiamento e gestão ­ quando é plausível admitir, que boa parte de seus problemas de gestão, tenham decorrido em razão de um quadro de restrição orçamentária.

Validation and psychometric properties of the Brazilian-Portuguese dispositional flow scale 2 (DFS-BR).

INTRODUCTION: Flow state is a psychological concept used to describe the optimal engagement in different activities. Therefore, the DFS-2 has been developed as an instrument to measure an individual's dispositional tendency to flow state as a personality trait. OBJECTIVE: Aiming to obtain an adapted version of the DFS-2 for the Brazilian-Portuguese language (DFS-BR) and for general activities, we performed its forward- and backward-translation, and we validated it. METHODS: After gathering answers from 681 Brazilian participants, we performed: (1) the construct validity of the DFS-BR; and (2) the psychometric item quality analysis. RESULTS: the Confirmatory Factorial Analysis (CFA) indicates the best fit for the gathered data is a nine multi-correlated factorial model (χ2/df = 4.23, CFI = 0.94, TLI = 0.93 and RMSEA = 0.069). Reliability tests performed in this structure indicates excellent internal consistency for the DFS-BR. The item quality analysis indicates that its difficulty and discriminating parameters have a good endorsement to estimate the dispositional flow state. Additionally, we proposed and validated a short version of the DFS-BR (composed of only nine items). The validation results indicates good fit (χ2/df = 2.94, CFI = 0.98, TLI = 0.97 and RMSEA = 0.053) and good internal consistency. The Test Information Curve of the short version indicates that it is very informative in the estimation of individual dispositional flow state. DISCUSSION AND CONCLUSIONS: In view of these results, we conclude that the DFS-BR showed good evidence of its validity to be used with Brazilian people. We also suggest the use of a short version when we need only measure the person's flow state based on the principle of Occam's razor. This principle is supported by the analysis presented in this article.

Analgesic effects of a 5% lidocaine patch after cesarean section: A randomized placebo-controlled double-blind clinical trial.

STUDY OBJECTIVE: This study aimed to evaluate the analgesic effects of a 5% lidocaine patch in acute postoperative pain after cesarean section. DESIGN: This is a prospective, randomized, double-blind study. SETTING: After surgery, active and placebo patches were applied in the operating room, and patients were evaluated during their stay at the postoperative recovery room and at the hospital ward. PATIENTS: Seventy-two women (18 years of age or older and American Society of Anesthesiologists status II) scheduled for cesarean section under spinal anesthesia were enrolled in the study. INTERVENTIONS: Patients were randomly assigned to an intervention or placebo group. According to the assigned group, a 5% lidocaine patch or a placebo patch was applied 1 cm above and below the Pfannenstiel incision after the surgery. MEASUREMENTS: The primary outcome was the pain score, evaluated using an 11-point numerical verbal scale in the first 36 h postoperatively. Secondary outcomes were the quality of recovery 24 h after surgery, consumption of rescue opioids, and the presence of adverse effects. MAIN RESULTS: Sixty-five women completed the study. The pain score was lower in the lidocaine group at 6 h (lidocaine group: 2.16 ± 1.71, placebo group: 3.21 ± 2.25; p = 0.031), 12 h (lidocaine: 1.58 ± 0.81, placebo: 2.24 ± 0.74; p = 0.001), 24 h (lidocaine: 0.74 ± 0.89, placebo: 1.94 ± 1.39; p < 0.0001), and 36 h (lidocaine: 0.48 ± 1.03, placebo: 1.68 ± 0.94; p = 0.001) after surgery. There were no differences in secondary outcomes during the follow-up period. CONCLUSION: The lidocaine patch reduced pain scores compared to placebo in the first 36 h after the surgery, despite no influence over opioid consumption, quality of recovery, or incidence of side effects.

Using data envelopment analysis and the bootstrap method to evaluate organ transplantation efficiency in Brazil.

Brazil has the most extensive public program for organ transplantation in the world, and the Brazilian National Health System (SUS) provides full coverage of all costs involved in organ donation, transplants, and post-transplant. Despite the relevance of the subject and the shortage of organs for transplants, transplantation process efficiency assessments are still uncommon in Brazil and abroad. This study aims to evaluate the efficiency of the Brazilian states and the Federal District in transforming potential organ donors into actual donations. We applied data envelopment analysis (DEA) in conjunction with the bootstrap technique, using organ transplantation data from 2018. The bootstrap methods applied (bootstrap technique, the bootstrap-biased scores of efficiency, and the bootstrap bias-corrected scores of efficiency) allow to obtain a confidence interval for DEA scores and provide greater robustness to studies based on DEA methodology. The bootstrap bias-corrected model indicates that there is significant room for improvement in terms of converting potential donors into actual donors. The mean corrected score is 0.55, signalizing that altogether the Brazilian states could maximize in 45% the number of transplanted organs without necessarily increasing the pool of potential donors. The study provides insights into the Brazilian processes of organ donation and transplantation, helping to identify locations in need of resource allocation improvements. Given the scarcity of studies with a joint application of DEA and bootstrap techniques in this crucial health activity, we also intend to methodologically contribute to this type of benchmark analysis, emphasizing the importance of considering measurement errors, randomness, and bias at DEA models.

A proposta de adoção de fila única nas unidades de terapia intensiva e nas demais internações hospitalares, durante a pandemia de Covid-19 no Brasil: considerações teóricas do campo da economia da saúde sobre as alternativas disponíveis / Nota Técnica n. 65 (Diset): A proposta de adoção de fila única nas unidades de terapia intensiva e nas demais internações hospitalares, durante a pandemia de Covid-19 no Brasil: considerações teóricas do campo da economia da saúde sobre as alternativas disponíveis / Português

Esta nota técnica tem o objetivo de analisar, de modo exploratório, algumas vantagens e desvantagens da eventual adoção de uma fila única, conforme vem sendo proposto, para organizar as internações, inclusive em unidades de terapia intesiva (UTIs), em todos os hospitais públicos e privados brasileiros, no contexto da atual pandemia do novo coronavírus (Sars-COV-2), causador da Covid-19. A análise utiliza elementos teóricos, e de resultados práticos, observados em economia da saúde e, de modo complementar, em teoria das filas (Queueing Theory). Essa análise se justifica em função da gravidade da situação atual e da possibilidade de que a fila única seja adotada na presente pandemia, ou que venha a ser novamente objeto de debate, em eventuais futuras pandemias, ou em epidemias que ocorram no país.

A nova metodologia de reajuste dos planos de saúde medirá os custos, os preços e a eficiência das operadoras?

Nosso objetivo é compreender os pressupostos teóricos dessa metodologia, tendo em mente o exame da sua capacidade de medir a evolução dos custos e preços desse segmento, bem como de mensurar a eficiência das operadoras em funcionamento no mercado de planos de saúde brasileiro. Cabe assinalar, a agência reguladora não fez aparentemente qualquer avaliação de impacto dessa nova regra ­ por exemplo ­ a partir dos dados de desempenho das operadoras observados no passado, o que nos deixou reticentes para construir cenários empíricos, a partir da utilização dos microdados da ANS. De fato, como os microdados das operadoras não estão disponíveis para nós, nenhum exercício empírico foi realizado nesta nota técnica (NT). Nessa linha, dividimos este trabalho em quatro seções, além desta introdução. Na seção 2, faremos umabreve retrospectiva das alternativas regulatórias avaliadas pela ANS. Na seção 3, questionamos algumas dimensões técnicas assumidas pela nova metodologia, em especial seu modelo de regulação por desempenho e o fator de ganhos de eficiência (FGE) ­ equivalente ao chamado fator X dos modelos de regulação por teto de preços (price cap).3 Na seção 4, além de apontar lacunas presentes no debate, sugerimos uma abordagem mais ousada para se regular o setor de saúde suplementar, que requereria uma quebra de paradigma e uma conciliação dessa regulação com a do próprio Sistema Único de Saúde (SUS). Na seção 5, resumiremos as principais conclusões deste trabalho.

High expression of XIAP and Bcl-2 may inhibit programmed cell death in glioblastomas.

Glioblastoma (GBM) is the most malignant glioma and represents 29% of all brain tumors. Tumorigenesis is intimately connected with characteristics acquired in the physiologic pathway of cellular death. OBJECTIVE: In the present study, the expression of anti-apoptotic (XIAP and Bcl-2) and apoptotic (cytochrome C, caspase 9, APAF-1), caspase 3 and the Smac/DIABLO genes related to the apoptosis pathway were evaluated in 30 samples of glioblastoma. METHODS: The gene expression was evaluated in 30 glioblastomas (WHO grade IV) and compared to 10 white matter control samples with real-time PCR. RESULTS AND CONCLUSION: There were higher expressions of XIAP (p = 0.0032) and Bcl-2 (p = 0.0351) in the glioblastoma samples compared to the control samples of normal brain. These results raise the question of whether Bcl-2 and XIAP genes can be responsible for the inhibition of programmed cell death in glioblastomas. Moreover, they provide additional information capable of allowing the development of new target therapy strategies.

High expression of XIAP and Bcl-2 may inhibit programmed cell death in glioblastomas / Alta expressão de XIAP e Bcl-2 pode inibir morte celular programada em glioblastomas

ABSTRACT Glioblastoma (GBM) is the most malignant glioma and represents 29% of all brain tumors. Tumorigenesis is intimately connected with characteristics acquired in the physiologic pathway of cellular death. Objective: In the present study, the expression of anti-apoptotic (XIAP and Bcl-2) and apoptotic (cytochrome C, caspase 9, APAF-1), caspase 3 and the Smac/DIABLO genes related to the apoptosis pathway were evaluated in 30 samples of glioblastoma. Methods: The gene expression was evaluated in 30 glioblastomas (WHO grade IV) and compared to 10 white matter control samples with real-time PCR. Results and Conclusion: There were higher expressions of XIAP (p = 0.0032) and Bcl-2 (p = 0.0351) in the glioblastoma samples compared to the control samples of normal brain. These results raise the question of whether Bcl-2 and XIAP genes can be responsible for the inhibition of programmed cell death in glioblastomas. Moreover, they provide additional information capable of allowing the development of new target therapy strategies.

RESUMO O glioblastoma (GBM) é o glioma mais maligno e representa 29% de todos os tumores cerebrais. A tumorigênese está intimamente ligada à características adquiridas na via fisiológica de morte celular. Objetivo: Avaliar a expressão de genes anti-apoptóticos (XIAP e Bcl-2) e apoptóticos (citocromo C, a caspase 9, APAF-1), caspase 3 e SMAC/DIABLO, relacionados à apoptose, em 30 amostras de tecido de pacientes com glioblastoma. Métodos: A expressão gênica foi avaliada em trinta glioblastomas e comparada a dez amostras controles de substância branca por PCR em tempo real. Resultados e Conclusão: Houve maior nível de expressão de XIAP (p = 0,0032) e Bcl-2 (p = 0,0351) em comparação com as amostras controle, de cérebro normal. Estes resultados levantam a questão de que os genes Bcl-2 e XIAP podem ser responsáveis pela inibição da morte celular programada em glioblastomas, além disso, proporcionam informação adicional capaz de permitir o desenvolvimento de novas estratégias de terapia alvo.

High expression of anti-apoptotic genes in grade I and II meningiomas.

Objective: To evaluate the expression of c-FLIP, XIAP, Bcl-2, caspase 3, 8 and 9, cytochrome c, APAF 1 and Smac/DIABLO genes related to apoptosis pathways. Methods: The gene expression was evaluated in 30 meningiomas (WHO grades I and II) and in 10 normal samples (from arachnoid tissue) through PCR-RT. Results: The results showed higher expression of anti-apoptotic genes in meningiomas when compared to the control group, which had a low expression of pro-apoptotic genes. Conclusion: There is a possible block in the activation of caspases through the intrinsic apoptosis pathway in meningiomas. c-FLIP modulates caspase 8 and, by inhibiting its activation due to the lack of connection with the receiver, there is a block to the FAS activation of apoptosis by its extrinsic pathway.

High expression of anti-apoptotic genes in grade I and II meningiomas / Alta expressão de genes anti-apoptóticos em meningiomas graus I e II

ABSTRACT One of the different genetic mechanisms involved in the carcinogenesis of meningiomas is influenced by interactions between proteins that induce and inhibit apoptosis. Objective To evaluate the expression of c-FLIP, XIAP, Bcl-2, caspase 3, 8 and 9, cytochrome c, APAF 1 and Smac/DIABLO genes related to apoptosis pathways. Methods The gene expression was evaluated in 30 meningiomas (WHO grades I and II) and in 10 normal samples (from arachnoid tissue) through PCR-RT. Results The results showed higher expression of anti-apoptotic genes in meningiomas when compared to the control group, which had a low expression of pro-apoptotic genes. Conclusion There is a possible block in the activation of caspases through the intrinsic apoptosis pathway in meningiomas. c-FLIP modulates caspase 8 and, by inhibiting its activation due to the lack of connection with the receiver, there is a block to the FAS activation of apoptosis by its extrinsic pathway.

RESUMO Um dos diferentes mecanismos genéticos envolvidos na carcinogênese de meningiomas é influenciado por interações entre proteínas que induzem e inibem a apoptose. Objetivos Avaliar a expressão de c-FLIP, XIAP, Bcl-2, caspase 3, 8 e 9, citocromo C, APAF 1 e Smac/DIABLO, genes relacionados com as vias da apoptose. Métodos A expressão gênica foi avaliada em trinta amostras de meningiomas (OMS grau I e II) e em dez amostras normais (de aracnóide) por PCR em tempo real. Resultados Os resultados mostraram maior expressão de genes antiapoptóticos em meningiomas quando comparados com controle, em contraste com a menor expressão de genes próapoptóticos. Conclusão Há um possível bloqueio na ativação de caspases através da via intrínseca da apoptose em meningiomas. O c-FLIP modula a caspase 8 e, desse modo, inibindo a sua ativação pela ausência de ligação com o receptor, há um bloqueio na ativação de FAS pela via extrínseca da apoptose.

A Crise do mercado de planos de saúde: devemos apostar nos planos populares ou no SUS? / The Crisis of the health insurance market : should we bet on the popular health plans or the SUS? / La Crisis del mercado de planes de salud : ¿debemos apostar en los planes populares o en el SUS?

O presente texto avalia, sob um enfoque primordialmente econômico, as potenciais consequências da eventual implementação, no Brasil, dos chamados "planos de saúde acessíveis". Como tais planos ainda não existem, as possibilidades empíricas de nossa análise ficam, no momento, limitadas às eventuais lições presentes na literatura. O que pudemos verificar é uma grande incerteza sobre os potenciais impactos desses planos na saúde da população. Existiriam riscos de degradação da saúde dos mais pobres e de piora nas condições financeiras do Sistema Único de Saúde (SUS).

This text assesses, from an economic standpoint, the potential consequences of the implementation in Brazil of the so-called "Affordable Health Plans". Since such plans do not yet exist, an eventual empirical analysis is presently limited to the possible lessons we found in the literature. What we have seen is a great deal of uncertainty about the potential impacts of these plans on population health. There would be risks of degradation of the health of the poorest and of worsening in the financial conditions of the Brazilian Unified Health System (SUS).

Este texto evalúa, desde un punto de vista económico, las probables consecuencias de la implementación, en Brasil, de los llamados "Planes de Salud Accesibles". Como estos planes todavía aún no existen, las posibilidades empíricas de nuestro análisis quedan, en el momento, limitada a las eventuales lecciones presentes en la literatura. Lo que hemos podido comprobar es una gran incertidumbre sobre los posibles impactos de estos planes en la salud de la población. Los riesgos de degradación de la salud de los más pobres y de agravamiento en las condiciones financieras del Sistema Único de Salud brasileño.

Risk factors for Charcot foot.

OBJECTIVE: Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus. MATERIALS AND METHODS: A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS: In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 - 9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 - 9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 - 22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 - 14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 - 0.52) of 6.25 (1.92 - 20.0) was a protective factor. DISCUSSION: The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor.

Risk factors for Charcot foot

Objective Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus.Materials and methods A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).Results In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 – 9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 – 9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 – 22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 – 14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 – 0.52) of 6.25 (1.92 – 20.0) was a protective factor.Discussion The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor. Arch Endocrinol Metab. 2015;59(3):226-30.

Prevalence of Entamoeba histolytica/Entamoeba dispar in the city of Campina Grande, in northeastern Brazil.

There is a clear need to perform epidemiological studies to find the true prevalence of Entamoeba histolytica around the world. The evaluation of this prevalence has been hindered by the existence of two different species which are morphologically identical, but genetically different, namely E. histolytica, which causes amebiasis, and E. dispar, which is non-pathogenic. In Brazil, the E. dispar has been detected in communities in the Southeastern (SE) and Northeastern (NE) regions with poor sanitation. However, individuals infected with E. histolytica have been identified in other regions. There is an absence of reports on the prevalence of these parasites in the state of Paraíba, which also has areas with poor sanitary conditions where a high prevalence of the E. histolytica/E. dispar complex has been detected in children from urban slums. The present study evaluated the prevalence of E. histolytica and E. dispar in 1,195 asymptomatic children between two and 10 years of age, living in a sprawling urban slum in Campina Grande, in the state of Paraíba, in Northeastern Brazil. These children were examined and their feces samples were analyzed microscopically. A total of 553 children tested positive for the E. histolytica/E. dispar complex, and 456 of the positive samples were tested with the E. histolytica II® ELISA kit. All 456 samples were negative for the presence of the adhesin E. histolytica specific antigen. The evidence suggests that in this community E. histolytica is absent and E. dispar is the dominant species.

PREVALENCE OF Entamoeba histolytica/Entamoeba dispar IN THE CITY OF CAMPINA GRANDE, IN NORTHEASTERN BRAZIL / Prevalência de Entamoeba histolytica/Entamoeba dispar na cidade de Campina Grande, Nordeste do Brasil

There is a clear need to perform epidemiological studies to find the true prevalence of Entamoeba histolytica around the world. The evaluation of this prevalence has been hindered by the existence of two different species which are morphologically identical, but genetically different, namely E. histolytica, which causes amebiasis, and E. dispar, which is non-pathogenic. In Brazil, the E. dispar has been detected in communities in the Southeastern (SE) and Northeastern (NE) regions with poor sanitation. However, individuals infected with E. histolytica have been identified in other regions. There is an absence of reports on the prevalence of these parasites in the state of Paraíba, which also has areas with poor sanitary conditions where a high prevalence of the E. histolytica/E. dispar complex has been detected in children from urban slums. The present study evaluated the prevalence of E. histolytica and E. dispar in 1,195 asymptomatic children between two and 10 years of age, living in a sprawling urban slum in Campina Grande, in the state of Paraíba, in Northeastern Brazil. These children were examined and their feces samples were analyzed microscopically. A total of 553 children tested positive for the E. histolytica/E. dispar complex, and 456 of the positive samples were tested with the E. histolytica II® ELISA kit. All 456 samples were negative for the presence of the adhesin E. histolytica specific antigen. The evidence suggests that in this community E. histolytica is absent and E. dispar is the dominant species.

A prevalência mundial de Entamoeba histolytica não está bem estabelecida. Este fato deve-se à complicação derivada da existência de duas espécies morfologicamente idênticas, mas geneticamente diferentes: a E. histolytica que causa amebíases e a E. dispar descrita como não patogênica. No Brasil, em comunidades com precárias condições sanitárias e endêmicas para várias parasitoses, localizadas nas regiões Sudeste (SE) e Nordeste (NE), somente E. dispar tem sido encontrada, porém outras regiões, apresentam indivíduos infectados por E. histolytica. Na região agreste do Estado da Paraíba (NE) que apresenta as mesmas precárias condições sanitárias, não tem sido reportada prevalência específica destes parasitos, embora fosse encontrada alta prevalência do complexo E. dispar/E. histolytica em crianças em favela urbana. O presente estudo foi realizado em favela da cidade de Campina Grande, Estado da Paraíba, onde 1.195 crianças de dois a 10 anos sem sintomatologia foram examinadas. Amostras de fezes destas crianças foram analisadas microscopicamente, encontrando-se 553 positivas para o complexo E. dispar/E. histolytica. Do total de amostras positivas, 456 foram submetidas à pesquisa do antígeno especifico para E. histolytica pelo teste ELISA E. histolytica II®,obtendose resultado negativo para a presença do antígeno adesina específico de E. histolytica, em todas as amostras testadas. Os resultados sugerem que nesta comunidade não há infecção por E. histolytica, e que E. dispar é a espécie dominante na região.

Desigualdades por sexo e por raça e o direito aos transplantes de órgãos no Brasil / Inequalities by gender and race and the right to organ transplantantion in Brazil

O presente texto trata do perfil dos transplantados e do problema das desigualdades no acesso aos transplantes de órgãos no Sistema Nacional de Transplantes (SNT) do Sistema Único de Saúde (SUS). A equidade mos procedimentos relacionados com transplantes de órgãos no Brasil recebe garantias constitucionais. Um recorte por gênero indica que o Brasil tem população com maioria de mulheres. Sob o ponto de vista étnico, pretos e pardos são a maioria da população. As necessidades de transplantes não diferem muito entre esses diferentes grupos populacionais. A despeito disso, constata-se que a maioria dos transplantes de órgãos, no Brasil, são feitos em homens e em brancos. Existem inúmeras causas para essas desigualdades.