A structured 2-week follow-up visit in the cascade of care for TB increases case detection.

Delayed detection in TB due to structural and diagnostic shortcomings is pivotal for disease transmission, morbidity and mortality. We investigated whether an inclusive screening, followed by a structured clinical follow-up (FU) could improve case-finding.Patients were recruited from health centres in Bissau, Guinea-Bissau, and Gondar, Ethiopia. A routine FU was done at Week 2. If persisting symptoms were found, patients were investigated using chest X-ray (CXR) and Xpert® MTB/RIF, followed by a medical consultation. The main outcome were additional TB patients diagnosed by applying the FU strategy.Of 3,571 adults, 3,285 (95%) were examined at Week 2 FU, where 2,491 (72%) were asymptomatic. Screening patients presenting with cough >2 weeks alone contributed to the diagnosis of 93 patients (45% of all patients diagnosed here), whereas a TBscore >3 increased this by 18 (9%); adding a Week 2 FU yielded an additional 94 (46%) patients. Among the 794 (24%) with persisting symptoms, 25 were diagnosed using Xpert and 69 at clinical FU, which constituted 46% (94/205) of the total TB patients diagnosed.A Week 2 FU visit, which can be nested into routine healthcare, increased the diagnosis of TB patients by two-fold and avoids diagnostic gaps in the cascade-of-care..

A self-rated health score predicts severe disease and high mortality in patients with pulmonary TB.

BACKGROUND: Health-related quality of life (HRQoL) in patients with pulmonary TB may be predictive of disease outcome; however, HRQoL instruments are often complicated and unsuitable for use in low-resource settings. A single-item self-rated health (SRH) score may represent a simpler alternative which could be used in clinical decision-making.AIMS: To evaluate internal and external validity of SRH and its correlation with TBscore/TBscoreII in a low-resource setting.METHODS: We used data from our ongoing prospective TB cohort study in Guinea-Bissau. Cohen´s d was used to assess internal validity, and receiver-operating characteristics and mortality statistics to assess external validity. Correlation between SRH and TBscore/TBscoreII was estimated using linear regression.RESULTS: SRH showed satisfactory internal validity and ability to discriminate between fatal cases at high and low scores, although not at middling scores. SRH and TBscore/TBscoreII correlated well at each examination but changes in scores did not, which may be due to ceiling/floor effects and a lag between disease severity and HRQoL.CONCLUSION: SRH shows potential as a quick and simple method to identify patients in need of intensified follow-up during treatment provision. More research is needed to assess its generalisability beyond our setting and to develop models for clinical use of SRH.

Undernutrition risk and nutritional screening implementation in hospitals: Barriers and time trends (2019-2020).

BACKGROUND & AIMS: Undernutrition screening is the starting point for high-quality nutrition care. In Portugal, the systematic nutritional risk assessment became mandatory for every inpatient in hospitals of the National Health System in 2019. The aims of this study were to describe the country's nutritional risk prevalence of hospitalized patients, and the experience of implementing a systematic undernutrition screening method, including time trends, barriers, and facilitators. METHODS: This research was carried out in Portuguese Public Hospitals (n = 49) and included both the analysis of data from health information systems between January 2019 and December 2020 and from an online survey. The performance indicators are described for 38 hospitals that use the SClinico electronic health records software provided by the Ministry of Health. The Nutritional Risk Screening 2002 (NRS 2002) was applied to adult patients and the STRONGkids to paediatric patients. In order to assess barriers and facilitators the online survey was applied to all public hospitals (n = 49), including Hospital Centres and Local Health Units. RESULTS: In 2020, 25.5% of the screened patients were nutritionally at risk. There was a significant increase in the proportion of patients screened from the pre- (10.6 ± 1.9%) to the post-adaptation period of the electronic health record (23.3 ± 4.8%, July-December 2019, and 25.4 ± 2.2%, January-June 2020) (p < 0.001). Data from 41 Hospital Centres and Local Health Units (84%) were obtained from the online survey. The major barriers identified were the lack of human resources (89.7%) and equipment (41.0%), as well as insufficient knowledge about the role of undernutrition screening (35.9%). The most-reported facilitators were the integration of undernutrition screening to electronic health records (22.2%) and good multidisciplinary articulation (36.1%). CONCLUSION: The high prevalence of nutritional risk justifies the mandatory nutritional screening, which leads to the improvement of the quality of hospital care. However, local and national efforts are warranted to adapt nutritional screening policies to local conditions and to increase and improve its implementation.

Knowledge, attitudes, practices about HIV and implications in risk and stigma prevention among French Guianese and Brazilian border inhabitants : Beliefs about HIV among border inhabitants.

BACKGROUND: The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area. METHODS: A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l'Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12. RESULTS: Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents. CONCLUSIONS: These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.

Molecular detection of Wolbachia pipientis in natural populations of mosquito vectors of Dirofilaria immitis from continental Portugal: first detection in Culex theileri.

Wolbachia pipientis (Rickettsiales: Rickettsiaceae) protects mosquitoes from infections with arboviruses and parasites. However, the effect of its co-infection on vector competence for Dirofilaria immitis (Spirurida: Onchocercidae) in the wild has not been investigated. This study aimed to screen vectors of D. immitis for wPip, to characterize these, and to investigate a possible association between the occurrence of W. pipientis and that of the nematode. The presence of W. pipientis was assessed in the five mosquito potential vectors of D. immitis in Portugal. Polymerase chain reaction (PCR) products were sequenced, and wPip haplotypes were determined by PCR-restricted fragment length polymorphism (RFLP). Results showed that wPip was detected in 61.5% of Culex pipiens (Diptera: Culicidae) pools and 6.3% of Culex theileri pools. wPip 16s rRNA sequences found in Cx. theileri exactly match those from Cx. pipiens, confirming a mosquito origin, rather than a nematode origin, as some specimens were infected with D. immitis. Only wPip haplotype I was found. No association was found between the presence of wPip and D. immitis in mosquitoes and hence a role for this endosymbiont in influencing vectorial competence is yet to be identified. This study contributes to understanding of wPip distribution in mosquito populations and, to the best of the authors' knowledge, is the first report of natural infections by wPip in Cx. theileri.

Modeling the Growth Kinetics of Anodic TiO2 Nanotubes.

The fundamental understanding of the barrier layer (δ(b)) growth in TiO2 nanotubes (NTs) is here established and compared with the classical metal oxidation theory from Mott and Cabrera. The role of δ(b) in the anodization of TiO2 NTs under different applied potentials and times was analyzed using scanning transmission electron microscopy (STEM). Contrary to the well-known case of anodic aluminum oxide, we found that δ(b) of TiO2 NTs progressively grows over time due to the nonsteady anodization regime. We then establish a relation between the phenomenological growth of the barrier layer with time and applied voltage, δ(b)(V,t) using the high-field Mott and Cabrera conduction theory. The developed model was found to be in excellent agreement with the experimental data from both STEM and anodization curves. On the basis of these results, the relationship between δ(b) and the anodization time and potential can now be quantitatively understood.

Tailoring the Ti surface via electropolishing nanopatterning as a route to obtain highly ordered TiO2 nanotubes.

Highly ordered TiO2 nanotubes (NTs) were synthesized by the electrochemical anodization of Ti foils subjected to electropolishing (EP) pre-treatment. We found that the Ti surface roughness plays an important role in the onset of pore nucleation in enhancing the local focusing effect of the electrical field. Additionally, EP induces the formation of dimple structures on the metal surface, which can work as a pre-pattern prior to anodization. These shallow ripples lead to a preferentially ordered pore nucleation, offering an organizational improvement of the anodic oxide NTs. We found that, depending on the EP applied potential, the roughness and the spatial period of the ripple-like structures varies from 8-2 nm and from 122-30 nm, respectively. Such tuning allowed us to focus on the influence of the initial Ti pre-surface topography features on the NTs' length, organization, and hexagonal arrangement quality, as well as diameter and density. Our results show that an EP under 10 V is the most suitable to obtain a small Ti surface roughness, the largest NT length (40% enhancement), and the effective improvement of the ordered hexagonal NTs' arrays over larger areas. Furthermore, the NTs' dimensions (pore diameters and density) were also found to depend on the initial Ti surface topography. The use of optimized EP allows us to obtain highly hexagonal self-ordered samples at a reduced time and cost.

Swallowing dysfunction in Wilson's disease: a scintigraphic study.

Although dysphagia is a common complaint of patients with Wilson's disease (WD) and pneumonia is an important cause of death in these patients, swallowing function remains an underinvestigated field in this condition. The aim of this study was to characterize swallowing dynamics in WD patients. Eight WD patients and 15 age-matched controls underwent scintigraphic evaluation of oral and pharyngeal deglutition. Patients had significantly slower oral transit (P = 0.008) and a greater percentage of oral residue (P = 0.006) when compared to controls. Two of eight patients were free of neurological symptoms at time of examination. Impaired oropharyngeal function was found in patients without dysphagia and without neurological symptoms. Our findings indicate that WD may present with objective swallowing dysfunction, even in the absence of neurological manifestations. Further studies are necessary to investigate the impact of this dysfunction on morbidity and mortality in WD.

Validation of a melasma quality of life questionnaire for Brazilian Portuguese language: the MelasQoL-BP study and improvement of QoL of melasma patients after triple combination therapy.

BACKGROUND: Pigmentation disorders, such as melasma, greatly influence the quality of life (QoL) of affected individuals who usually consider the disorder to be more severe than the objective clinical scores. Several instruments have been successfully developed to evaluate QoL. However, they must be adapted to the target population in terms of language and cultural diversity. The first, specific QoL questionnaire for melasma (MelasQoL) was developed for English speaking patients. OBJECTIVES: To validate the Brazilian Portuguese version of the MelasQoL evaluation questionnaire for patients with melasma (MelasQoL-BP) and to assess the impact of treatment with a triple combination cream (hydroquinone, fluocinolone acetonide and tretinoin) on the QoL of patients with moderate-to-severe melasma. METHODS AND RESULTS: Three hundred individuals from the five Brazilian geographic regions took part in this multicentre study. Their mean age was 42 years and skin phototype distribution was: type II 7.0% of patients, III 23.7%, IV 42.7% and V 22.7%. Melasma Area and Severity Index (MASI), MelasQoL-BP and the short version of the QoL assessment instrument from the World Health Organization (WHOQOL-BREF) were used to assess melasma severity and QoL at baseline. MelasQoL-BP was previously translated and culturally adapted from the English version, with participation of the authors and according to the standards of the World Health Organization (WHO). From the original sample, we randomized150 volunteers to treat melasma and repeated the evaluation after 8 weeks. The analysis of the MelasQoL-BP baseline answers demonstrated an important impact of the disease on skin appearance (65% of patients were bothered all the time or most of the time), frustration (55%), embarrassment (57%) and influence of the disease on interpersonal relationships (42%). Forty-three per cent of patients felt not attractive or even dirty due to their skin condition. MelasQoL-BP results showed significant internal consistency (Cronbach's alpha coefficient 0.919; P < 0.001) and good correlation with MASI scores. After treatment, the global assessment showed good or excellent results in 91.4% of the patients. The clinical outcome was not associated with the initial MASI score (P = 0.814; chi-square), skin colour (P = 0.449; probability ratio) or skin pigmentation (P = 0.814; chi-square). There was also a significant reduction on MelasQoL-BP scores (Wilcoxon test; P < 0.001) after treatment, with the mean +/- SD results shifting from 44.4 +/- 14.9 at baseline to 24.3 +/- 15.5 after treatment. The analysis of the MelasQoL-BP before and after treatment showed an important effect of the impact of treatment on a number of QoL measures. Of note, skin appearance (69.8 vs. 10.1% of patients were bothered all the time or most of the time, respectively), frustration (59.7% vs. 12.2%, respectively), embarrassment (56% vs. 9.3%, respectively) and influence of the disease on interpersonal relationships (35.3% vs. 5.8%, respectively) were greatly improved. CONCLUSIONS: This study demonstrates that MelasQoL-BP is a valid instrument and can be used to evaluate the quality of life and response to melasma treatment in Brazilian patients. The triple combination treatment produced significant results, regarding both clinical severity and quality of life.

[Nurses dealing with emergency patients: a psychodynamic approach]. / A prática do enfermeiro com pacientes da UTI: uma abordagem psicodinâmica.

The purpose of this research is to investigate the existence of defensive strategies employed by intensive care unit nurses at a public hospital in Brasilia-DF, manage the suffering generated in the nurse-patient relationship, which arises a constant confrontation with life-death contents. This effort involved four collective interviews with eight professionals. The interviews theme were the difficulties, limitations and fulfillment with the patient care. The defensive behavior were analysed through the professionals' speeches. Four strategies were identified: impersonalness, emotional distance, avoidance of communication and high evaluation of technical procedures. The employment of these strategies facilitates a psychological balance to minimize the contact with suffering, although, these defensive strategies can affect quality of work or the nurse's life extra work.

Effects of cortisol and progesterone on insulin binding and lipogenesis in adipocytes from normal and diabetic rats.

Cortisol implants in normal and diabetic rats reduced body weight, adiposity, insulin receptor concentration and both basal and insulin-stimulated rates of lipogenesis in isolated adipocytes, whilst insulin sensitivity was unchanged. In normal but not diabetic rats these changes were accompanied by increased serum glucose and insulin concentrations. In contrast, progesterone implants in normal and diabetic rats increased body weight gain, adiposity, insulin receptor concentration and both basal and insulin-stimulated rates of lipogenesis in adipose tissue, again without affecting insulin sensitivity. Progesterone did not affect serum insulin concentrations in normal or diabetic rats but accelerated the decline in serum glucose concentrations which occurred during an overnight fast in diabetic rats. The results suggest that cortisol inhibits lipogenesis in adipose tissue without affecting insulin sensitivity, cortisol reduces insulin binding in adipose tissue without a requirement for hyperinsulinaemia, which might itself indirectly lead to down-regulation of the insulin receptor, and in diabetic rats progesterone stimulates lipogenesis in adipose tissue without any increase in food intake or serum insulin concentrations suggesting that progesterone may have a direct anabolic role in adipose tissue.

Silicose em cavadores de pocos. / Silicosis in well diggers

Sao apresentados 24 casos de silicose em cavadores de pocos cuja idade media era de 44 anos (29 a 58). Todos eram sintomaticos sendo os sintomas mais comuns a dispneia e a tosse. Todos apresentaram lesoes radiologicas, predominando a fibrose pulmonar nos lobos superiores. O eletrocardiograma mostrou sobrecarga de camara direita em tres casos, bloqueio de ramo direito em dois, sendo normal em 19 casos.A espirometria revelou um disturbio funcional misto em 12 casos, restricao pura em cinco, obstrucao pura em tres e foi normal em quatro casos