Promoting safe and appropriate use of miltefosine to treat tegumentary leishmaniasis in Brazil: A best practice quality improvement project.

INTRODUCTION: Miltefosine is a new drug that was recently approved for the treatment of tegumentary leishmaniasis (TL) by the Brazilian health system. It has a teratogenic potential and requires follow-up of patients undergoing treatment. Improving compliance with best practices is essential to ensure the safe and appropriate use of this drug. OBJECTIVE: This project aimed to implement best practices for the safe and appropriate use of miltefosine in the treatment of TL in the state of Minas Gerais, Brazil. METHODS: This project was guided by the JBI Evidence Implementation Framework. Five best practice criteria were established based on the best available evidence. A baseline audit was conducted to measure current practice against best practice. Barriers to best practice were then identified and a follow-up audit was conducted to evaluate changes after the implementation of improvement strategies. Two sites were analyzed: a leishmaniasis reference service in Belo Horizonte, the capital of Minas Gerais, and the 28 regional offices. RESULTS: The baseline audit evaluated data from 197 miltefosine requests distributed across 13 regional sites. All requests from the reference service were compliant (100%). This is in contrast to the 60% compliance rate at the regional offices. The improvement strategies included intensifying direct communication with the regional health professionals, which increased the average compliance rate to 79.5%, 6 months after the interventions were introduced. CONCLUSION: This best practice implementation project effectively increased the compliance rate for the audited procedures. Communication from the reference site with the regional health professionals successfully increased compliance with best practices and promoted the safe and appropriate use of miltefosine. These strategies should analyzed and applied to improve other programs. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A184.

Implementation of health technologies in Brazil: analysis of federal guidelines for the public health system. / Implementação de tecnologias em saúde no Brasil: análise de orientações federais para o sistema público de saúde.

This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

O objetivo foi identificar o arcabouço regulatório e as orientações federais que sustentam o processo de implementação de tecnologias em saúde no Sistema Único de Saúde (SUS), por meio da análise de documentos e legislações relacionados à Política Nacional de Gestão de Tecnologias de Saúde, publicados entre 2009 e 2021. Foi realizada busca e seleção dos documentos e posterior extração de dados, agrupados por três categorias: normativas estruturantes, recomendações na avaliação de tecnologias e recomendações nas diretrizes clínicas. Em 38,8% das normativas, foram identificadas citações à implementação relacionadas principalmente às diretrizes clínicas do SUS, mas nenhum documento dedicado a orientar as ações de implementação. As recomendações relacionadas às implementações foram identificadas em 27,1% dos relatórios e em 66,1% das diretrizes, mas sem padronização e, de modo geral, pouco detalhadas, com foco em recursos e ações necessárias para a disponibilização da tecnologia, ao invés de métodos e intervenções para implementação. Os resultados confirmam a existência de uma lacuna de diretrizes formais para guiar o processo de implementação no Brasil, o que se constitui em oportunidade para o desenvolvimento de modelos alinhados à realidade do SUS.

Fatores associados a incapacidade funcional após acidente vascular cerebral isquêmico / Factores asociados a incapacidad funcional después de accidente cerebrovascular isquémico / Factors associated with functional disability after ischemic stroke

Resumo Objetivo Avaliar o nível de incapacidade funcional e identificar os fatores associados em pessoas após Acidente Vascular Cerebral Isquêmico. Métodos Coorte prospectiva, realizada em hospital de referência em neurologia, com 224 pessoas com acidente vascular cerebral isquêmico. A coleta de dados ocorreu entre março a outubro de 2019. Os participantes foram acompanhados durante a internação, quando as variáveis sociodemográficas e clínicas foram levantadas empregando-se instrumentos específicos e contatados após 90 dias, por ligação telefônica, para aplicação do Índice de Barthel modificado. Na análise, aplicou-se estatística descritiva e o teste Qui-quadrado de Pearson. Adotou-se significância estatística de 5%. Resultados A maioria apresentou algum grau de incapacidade funcional (58,5%), sendo que 29,5% apresentaram dependência moderada e 29,0% severa ou grave. As variáveis sexo feminino (p=0,011), tempo de chegada ao hospital de referência maior ou igual a 4,5h (p=0,017), Acidente vascular cerebral prévio (p=0,031), não ter realizado trombólise (p=0,023), ter hipertensão arterial (p=0,032) e maior gravidade estimada pela National Institute of Health Stroke Scale (p=0,000) foram associadas a maior nível de incapacidade. Conclusão Predominou a dependência de moderada a grave. A gravidade do evento, evento prévio, hipertensão, não submissão à trombólise, retardo à chegada ao hospital e sexo feminino foram associados a maior nível de incapacidade funcional.

Resumen Objetivo Evaluar el nivel de incapacidad funcional e identificar los factores asociados en las personas después de un accidente cerebrovascular isquémico. Métodos Cohorte prospectiva, realizada en un hospital de referencia en neurología, con 224 personas con accidente cerebrovascular isquémico. La recopilación de datos se llevó a cabo entre marzo y octubre de 2019. Se acompañó a los participantes durante la internación, momento en que se recopilaron las variables sociodemográficas y clínicas mediante la utilización de instrumentos específicos, y se los contactó 90 días después, por teléfono, para aplicar el Índice de Barthel modificado. En el análisis se aplicó estadística descriptiva y la prueba χ2 de Pearson. Se adoptó significación estadística de 5 %. Resultados La mayoría presentó algún nivel de incapacidad funcional (58,5 %), de los cuales el 29,5 % presentó dependencia moderada y el 29,0 % dependencia severa o grave. Las siguientes variables fueron asociadas a un mayor nivel de incapacidad: sexo femenino (p=0,011), tiempo de llegada al hospital de referencia mayor o igual a 4,5 h (p=0,017), accidente cerebrovascular previo (p=0,031), no haber realizado trombólisis (p=0,023), tener hipertensión arterial (p=0,032) y mayor gravedad estimada por la National Institute of Health Stroke Scale (p=0,000). Conclusión Predominó la dependencia de moderada a grave. La gravedad del evento, evento previo, hipertensión, no realización de trombólisis, retraso de la llegada al hospital y sexo femenino fueron las variables asociadas a un mayor nivel de incapacidad funcional.

Abstract Objective To assess the functional disability level and identify associated factors in people after Ischemic Cerebral Vascular Accident. Methods A prospective cohort, carried out in a reference hospital in neurology with 224 people with ischemic stroke. Data collection took place between March and October 2019. Participants were followed up during hospitalization, when sociodemographic and clinical variables were collected using specific instruments and contacted after 90 days, by telephone call, to apply the Modified Barthel Index. In the analysis, descriptive statistics and Pearson's chi-square test were applied. Statistical significance of 5% was adopted. Results Most had some degree of functional disability (58.5%), with 29.5% having moderate dependence and 29.0% having severe dependence. The variables being female (p=0.011), time of arrival at the reference hospital greater than or equal to 4.5 hours (p=0.017), previous stroke (p=0.031), not having undergone thrombolysis (p=0.023), having high blood pressure (p=0.032) and greater severity estimated by the National Institute of Health Stroke Scale (p=0.000) were associated with a higher disability level. Conclusion Moderate to severe dependence predominated. The severity of the event, previous event, hypertension, non-submission to thrombolysis, delay in arriving at the hospital and female gender were associated with a higher functional disability level.

Implementação de tecnologias em saúde no Brasil: análise de orientações federais para o sistema público de saúde / Implementation of health technologies in Brazil: analysis of federal guidelines for the public health system

Resumo O objetivo foi identificar o arcabouço regulatório e as orientações federais que sustentam o processo de implementação de tecnologias em saúde no Sistema Único de Saúde (SUS), por meio da análise de documentos e legislações relacionados à Política Nacional de Gestão de Tecnologias de Saúde, publicados entre 2009 e 2021. Foi realizada busca e seleção dos documentos e posterior extração de dados, agrupados por três categorias: normativas estruturantes, recomendações na avaliação de tecnologias e recomendações nas diretrizes clínicas. Em 38,8% das normativas, foram identificadas citações à implementação relacionadas principalmente às diretrizes clínicas do SUS, mas nenhum documento dedicado a orientar as ações de implementação. As recomendações relacionadas às implementações foram identificadas em 27,1% dos relatórios e em 66,1% das diretrizes, mas sem padronização e, de modo geral, pouco detalhadas, com foco em recursos e ações necessárias para a disponibilização da tecnologia, ao invés de métodos e intervenções para implementação. Os resultados confirmam a existência de uma lacuna de diretrizes formais para guiar o processo de implementação no Brasil, o que se constitui em oportunidade para o desenvolvimento de modelos alinhados à realidade do SUS.

Abstract This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.

Factors associated with decision time to seek care in the face of ischemic stroke.

OBJECTIVE: To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. METHOD: Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. RESULTS: The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. CONCLUSION: The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.

Protective effects of Theracurmin treatment during experimental infection of the Colombian strain of Trypanosoma cruzi at the testicular site.

Introduction: Chagas' disease is a tropical neglected illness caused by Trypanosoma cruzi and remains one of the most significant causes of morbidity and mortality in South and Central Americas. The disease is caused by a moderate to intense and persistent inflammatory response characterized by local upregulated expression and production of inflammatory mediators that favors the activation and recruitment of distinct cells of the immune system into different tissues to eliminate the parasites. Theracurmin is a curcumin's derived formulation of nanoparticles. Its anti-inflammatory properties make this bioactive compound a mitigating factor in pathological cases after an overwhelming inflammatory response. Methods: Our research focused on the testicular investigation in 28 mice infected by 103 trypomastigote forms of Colombian strain of T. cruzi and preventively treated with Theracurmin. The mice were treated with 30 mg/Kg of Theracurmin during the period of 30 days. At the 30th day post infection animals were euthanized, and its testicles were collected to morphological and immunological assays. Results: The animals infected and treated with Theracurmin presented a reduction in the testicular levels of IL-15 and IL-6. The volume density (%) of the tunica propria was also higher in all infected animals, but Theracurmin decreased this parameter in the treated animals. In the intertubular area, the percentage of some intertubular components was decreased in the infected animals such as the percentage and volume of Leydig cells, connective tissue, and macrophages. Discussion: Furthermore, our data pointed to the daily use of Theracurmin in the diet as a protective element of the testicular function.

Host Preferences Shown by Drosophilids (Diptera) in a Commercial Fruit and Vegetable Distribution Center Follow the Wild Neotropical Pattern.

Although drosophilids have been extensively studied in laboratories worldwide, their ecology is still relatively poorly understood. This is unfortunate because some species are currently expanding their geographic distribution and infesting fruit crops. Here, we investigated the relationship between drosophilids and potential plant hosts in a commercial fruit and vegetable distribution center in the Neotropical region. We collected discarded fruits and vegetables from this commercial center during two time periods (2007-2008 and 2017-2018). Resources were weighted and individually monitored in the laboratory. The drosophilids that emerged were identified, and the relationship between them and their resources was explored. From the 99,478 kg of potential hosts collected, we identified 48 plant taxa, from which 48,894 drosophilids of 16 species emerged. On both collecting occasions, drosophilid assemblages were strongly dominated by basically the same exotic species, which explore a broader range of resources, especially those of exotic origin, when compared to neotropical drosophilids. These results are concerning because the studied site, Along with other urban markets around the world, might be acting as sources of generalist widespread species that disperse to surrounding natural vegetation and contribute to biotic homogenization.

Capacitação profissional em hanseníase na Atenção Primária à Saúde: protocolo de revisão de escopo / Professional training in leprosy in Primary Health Care: a scoping review protocol

OBJETIVO: Descrever a sistematização do desenvolvimento de uma revisão de escopo para mapear evidências científicas relativas à capacitação profissional da equipe de assistência ao paciente em hanseníase na Atenção Primária à Saúde. MÉTODO: Fundamentar-se-á nas recomendações do Preferred Reporting Items for Systematic and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR), atendendo às orientações do Instituto Joanna Briggs. Espera-se que as evidências encontradas na literatura nacional e internacional possam direcionar profissionais e gestores na implementação de ações de controle e eliminação da hanseníase como problema de saúde pública, por meio da educação.

OBJECTIVE: To describe the systematization of a scoping review to map scientific evidence related to the professional training of the members of the leprosy primary health care team. METHOD: The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) will be met, as well as the Joanna Briggs Institute's guidelines. It is expected that the evidence found in the national and international literature can guide professionals and managers in implementing actions to control and eliminate leprosy, a public health problem, through education.

Factors associated with decision time to seek care in the face of ischemic stroke / Factores asociados con el tiempo de decisión para buscar atención médica por accidente cerebrovascular isquémico / Fatores associados ao tempo de decisão para procurar atendimento em face ao acidente vascular cerebral isquêmico

ABSTRACT Objective: To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. Method: Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. Results: The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. Conclusion: The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.

RESUMEN Objetivo: Verificar la asociación entre factores sociodemográficos, clínicos, ambientales, cognitivos, y emocionales y el tiempo de decisión de las personas con accidente cerebrovascular isquémico para buscar un servicio de salud luego del inicio de los síntomas o Wake up stroke Método: Estudio transversal realizado de marzo a octubre de 2019, con 304 pacientes, en un hospital público, referencia en neurología. Datos obtenidos por entrevista y de la historia clínica. El tiempo de decisión se analizó como una media geométrica. En los análisis bivariados y multivariados se utilizó la regresión lineal y el Criterio de Información de Akaike para seleccionar el mejor modelo. Se adoptó una significancia estadística del 5% Resultados: La media geométrica del tiempo de decisión fue de 0,30h (IC 95% 0,23-0,39). El modelo final explicó este tiempo en un 41%, mostrando un aumento de 0,5 min para las personas con hipertensión arterial, 10,8 min para las que esperaron a que los síntomas mejoraran, 1,4 min para las que estaban solas al inicio de los síntomas, 3, 9 min para las que estaban en casa, 3,2 min para los que estaban en el trabajo y 2,1 en la calle/vía pública Conclusión: El tiempo promedio de decisión para buscar un servicio de salud fue alto e influenciado por variables clínicas, ambientales, cognitivas y emocionales. Los resultados orientan a los enfermeros hacia la educación en salud.

RESUMO Objetivo: Verificar a associação entre fatores sociodemográficos, clínicos, ambientais, cognitivos e emocionais e o tempo de decisão de pessoas com acidente vascular cerebral isquêmico para procurar um serviço de saúde após o início dos sintomas ou Wake up stroke Método: Estudo transversal realizado de março a outubro de 2019, com 304 pacientes, em hospital público, referência em neurologia. Dados obtidos por entrevista e no prontuário. O tempo de decisão foi analisado em média geométrica. Nas análises bivariadas e multivariada foi usada a regressão linear e o Critério de Informação de Akaike foi usado na seleção do melhor modelo. Adotou- se significância estatística de 5% Resultados: A média geométrica do tempo de decisão foi de 0,30h (IC 95% 0,23-0,39). O modelo final explicou em 41% esse tempo, mostrando aumento de 0,5 min para pessoas com hipertensão arterial; 10,8 min para quem esperou os sintomas melhorarem; 1,4 min para quem estava sozinho no início dos sintomas; 3,9 min para quem estava em casa; 3,2 min no trabalho e 2,1 na rua/via pública Conclusão: A média do tempo de decisão para procura de serviço de saúde foi alta e influenciada por variáveis clínicas, ambientais, cognitivas e emocionais. Os resultados orientam enfermeiros para a educação em saúde.

Insights into CX3CL1/Fractalkine during experimental Trypanosoma cruzi infection.

Trypanosoma cruzi triggers a progressive myocarditis in mammalians through activation and recruitment of leukocytes and release of inflammatory mediators. The chemokine CX3CL1 has been highlighted for its potential role in the parasite controlling in end-pathological status of infected hosts. This study investigated the systemic and cardiac release of CX3CL1 in experimental T. cruzi infection and how this chemokine correlates with endothelin-1 and TNF. Male Fisher rats (n = 20) were infected, or not, by the Y strain of T. cruzi and parasitemia was daily evaluated and immunoassays performed in the cardiac tissue macerated supernatant and in serum to evaluate CX3CL1, endothelin, and TNF production on days 5 and 15 of infection. T. cruzi infection induced a higher serum and cardiac production of these mediators on days 5 and 15 of infection. In both periods of infection, respectively, CX3CL1 showed a positive correlation with TNF (r = 0.833, p < 0.001 and r = 0.723, p < 0.001) and endothelin-1 (r = 0.801, p < 0.05 and r = 0.857, p < 0.001), which reinforce its participation in the T. cruzi-induced myocarditis development.

Associação entre fatores sociodemográficos e consumo de álcool, tabaco e hipnóticos em mulheres rurais / Asociación entre factores sociodemográficos y consumo de alcohol, tabaco e hipnóticos en mujeres rurales / Association between sociodemographic factors and consumption of alcohol, tobacco and hypnotics in rural women

Objetivo: investigar a associação entre fatores sociodemográficos e consumo de álcool, tabaco e hipnóticos em mulheres rurais. Método: estudo transversal realizado com 259 mulheres rurais. Para a coleta dos dados, utilizou-se formulário estruturado e o Alcohol, Smoking and Substance Involvement Screening Test. Para a análise empregou-se o Teste qui-quadrado e/ou Exato de Fisher com intervalo de confiança de 95%. Resultados: observou-se associação entre o uso do tabaco e a cor (p=0,041), a crença religiosa (p=0,001) e benefício governamental (p=0,006). Houve associação entre o consumo de álcool e a crença religiosa (p≤0,001). Quanto a necessidade de intervenção, observou-se associação entre tabaco e cor (p=0,009), renda (p=0,001) e benefício governamental (p=0,006), assim como álcool e idade (p=0,035), crença religiosa (p=0,006) e renda (p=0,002). Conclusão: fatores como religião, cor, renda, idade e benefício governamental estão associados ao uso de álcool e tabaco em mulheres rurais.

Objetivo: investigar la asociación entre factores sociodemográficos y consumo de alcohol, tabaco e hipnótico en mujeres rurales. Método: estudio transversal realizado con 259 mujeres rurales. Para la recolección de datos, se utilizó un formulario estructurado y se utilizó la Prueba de Detección de Alcohol, Smoking and Substance Involvement Screening Test. Para el análisis se utilizó el Chi-Cuadrado y/o la Prueba Exacta de Fisher con un intervalo de confianza del 95%. Resultados: hubo asociación entre el consumo de tabaco y el color (p=0,041), la creencia religiosa (p=0,001) y el beneficio gubernamental (p=0,006). Hubo una asociación entre el consumo de alcohol y las creencias religiosas (p≤0,001). En cuanto a la necesidad de intervención, hubo una asociación entre el tabaco y el color (p=0,009), los ingresos (p=0,001) y el beneficio del gobierno (p=0,006), así como el alcohol y la edad (p=0,035), las creencias religiosas (p=0,006) y los ingresos (p=0,002). Conclusión: factores como la religión, el color, los ingresos, la edad y el beneficio del gobierno están asociados con el consumo de alcohol y tabaco en las mujeres rurales.

Objective: to investigate the association between sociodemographic factors and alcohol, tobacco and hypnotic consumption in rural women. Method: cross-sectional study conducted with 259 rural women. For data collection, a structured form was used and the Alcohol, Smoking and Substance Involvement Screening Test was used. For the analysis, the Chi-Square and/or Fisher's Exact Test with a 95% confidence interval was used. Results: there was an association between tobacco use and color (p=0.041), religious belief (p=0.001) and governmental benefit (p=0.006). There was an association between alcohol consumption and religious belief (p≤0.001). Regarding the need for intervention, there was an association between tobacco and color (p=0.009), income (p=0.001) and government benefit (p=0.006), as well as alcohol and age (p=0.035), religious belief (p=0.006) and income (p=0.002). Conclusion: factors such as religion, color, income, age and government benefit are associated with alcohol and tobacco use in rural women.

THE EFFECT OF PRIMARY CARE POLICY CHANGES ON HOSPITALIZATION FOR AMBULATORY CARE SENSITIVE CONDITIONS: NOTES FROM BRAZIL

Objective: to assess the effect of changes on Primary Care policies on the trend in hospitalization rates for Ambulatory Conditions Sensitive to Primary Care in the city of Rio de Janeiro, Brazil. Study design: It´s an ecological study with data from Brazilian National Health Information System.  Methods: We performed interrupted time series analysis, comparing 3 different periods due to primary care policies in Brazil: 2008-2009; 2010-2017, and 2018-2019. Dataset included total ACSC and rates for 19 groups of conditions. Results: There was a non-significant increasing trend in baseline admissions. The reform impacted (policy #1) the change in trend, causing it to reduce in the period significantly. However, the change in the PNAB (policy #2) did not change the trend but reduced the rate of decline. Trends and differences among periods vary due to the ACSC group. Conclusion: Primary care is sensitive to changes in public health policies. The hospitalization rate for ambulatory care-sensitive conditions is an indicator that reflects the changes and the adaptability of the organization of the health service network to guarantee universal coverage and to attend to the population's demand.

Efeito do extrato das folhas da Passiflora edulis na cicatrização da pele em ratos / Efecto del extracto de hoja de Passiflora edulis en la cicatrización de la piel en ratas / Effect of Passiflora edulis leaf extract on skin healing in rats

Objetivo: avaliar o efeito do extrato das folhas da Passiflora edulis na cicatrização da pele em ratos, especificamente na área da lesão e na proliferação de fibroblastos. Materiais e método: estudo experimental realizado com 54 ratos da linhagem Wistar, machos, adultos, divididos igualmente em três grupos. A indução das lesões em formato circular na região dorso-cervical foi realizada com o auxílio de um punch trepano de 8 mm. As lesões do grupo de controle foram higienizadas diariamente com água filtrada e sabonete vegetal glicerinado de pH neutro. Os outros dois grupos, além da higienização diária, receberam tratamento com creme contendo extrato a 20 % das folhas da Passiflora edulis, e creme base sem extrato a 20 % das folhas da Passiflora edulis, respectivamente. No 1o, 4o, 7o e 14o dia de tratamento foram obtidas imagens para cálculo da área de lesão. No 4o, 7o e 14o dia de tratamento foram coletados espécimes para análises histológicas. Resultados: não foram encontradas diferenças estatisticamente significativas entre os grupos experimentais com relação à comparação de médias da área de lesão e de proliferação de fibroblastos. Conclusões: o uso tópico do extrato a 20 % das folhas da Passiflora edulis não apresentou efeito na área de lesão e na proliferação de fibroblastos na cicatrização da pele em ratos.

Objetivo: evaluar el efecto del extracto de hoja de Passiflora edulis en la curación de la piel en ratas, específicamente el área de la lesión y de la proliferación de fibroblastos. Materiales y método: estudio experimental con 54 ratas Wistar macho adultas, divididas por igual en tres grupos. La inducción de lesiones de forma circular en la región dorsocervical se realizó con la ayuda de un punzón de 8 mm. Las lesiones del grupo de control se limpiaron diariamente con agua filtrada y jabón vegetal glicerinado con pH neutro. Los otros dos grupos, además de la limpieza diaria, recibieron tratamiento con crema que contenía extracto al 20 % de las hojas de Passiflora edulis, y crema base sin extracto al 20 % de las hojas de Passiflora edulis, respectivamente. Los días 1, 4, 7 y 14 de tratamiento, se obtuvieron imágenes para calcular el área de la lesión. Los días 4, 7 y 14 de tratamiento, se recolectaron muestras para análisis histológicos. Resultados: no se encontraron diferencias estadísticamente significativas entre los grupos experimentales con respecto a la comparación de las medias del área de la lesión y la proliferación de fibroblastos. Conclusiones: el uso tópico del extracto al 20 % de las hojas de Passiflora edulis no tuvo efecto en el área de la lesión y de la proliferación de fibroblastos en la curación de la piel en ratas.

Objective: To evaluate the effect of Passiflora edulis leaf extract on skin healing in rats, specially the lesion area and on fibroblast proliferation. Materials and method: Experimental study with 54 male adult Wistar rats equally divided into three groups. The induction of circular-shaped lesions in the dorso cervical region was performed with the aid of an 8 mm climbing punch. Control group lesions were daily cleaned with filtered water and neutral pH glycerinated vegetable soap. The other two groups, in addition to daily cleansing, received treatment with cream containing 20 % extract of Passiflora edulis leaves and base cream without this extract, respectively. On day 1, 4, 7 and 14 of treatment, images were obtained to calculate the lesion area. On day 4, 7 and 14 of treatment, specimens were collected for histological analysis. Results: No statistically significant differences were found between the experimental groups regarding the comparison of means of lesion area and fibroblast proliferation. Conclusion: Topical use of the 20 % extract of Passiflora edulis leaves had no effect on the affected area and the proliferation of fibroblasts on skin healing in rats.

Chlorapatite Derived From Fish Scales.

The present work demonstrates the production of chlorapatite (ClAp) through thermal decomposition of chemically treated fish scales, originating from an Amazon fish species (Arapaima gigas). The scales were treated with hydrochloric acid (HCl) solution for deproteinization. Afterwards, the solution was neutralized by sodium hydroxide (NaOH) treatment to obtain an apatite-rich slurry. The heat treatment was carried out at different temperatures including 600 °C, 800 °C, and 1000 °C. The powders obtained were characterized through X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), energy-dispersive X-ray spectroscopy (EDS), and scanning electron microscopy (SEM). The XRD analysis and FTIR spectra confirmed the incorporation of chlorine into the apatite structure. The FTIR results showed absorption bands relative to the OH-, PO43- functional groups which are a characteristic of chlorapatite; moreover, the intensity of the OH-Cl elongation could be observed. Chlorapatite Ca5(PO4)3Cl, NaCl, and NaCaPO4 phases were identified, achieving up to 87.4 wt% for ClAp. From the SEM observations, the ClAp obtained consisted of slightly larger grains and more crystalline with increasing temperature with observed grains ranging in sizes between 1 and 5 µm and 84.27% crystallinity for the ClAp1000 sample. The ClAp and NaCaPO4 can be used in electronics as a phosphor material due to the fact of its luminescence and biomedical applications.

Estratégias de enfrentamento das doenças por idosas hospitalizadas / Coping strategies of disease by elderly hospitalized women / Estrategias de enfrentamiento de las enfermedades por ancianas hospitalizadas

Objetiva-se analisar as estratégias de enfrentamento de doenças por idosas hospitalizadas. Participaram desta pesquisa dez idosas internas na clínica médica de um hospital. As idades variaram entre 60 a 73 anos, sendo a amostra intencional e por conveniência. Para coleta de dados, utilizou-se questionário sociodemográfico e entrevista semiestruturada. A análise de dados foi realizada pelo software Iramuteq, por meio da Classificação Hierárquica Descendente. Os resultados identificaram que as participantes utilizam mecanismos adaptativos de enfrentamentos focalizados no problema, representado pela descrição da rotina médica e do cuidado com o corpo; e focalizados na emoção, caracterizado por estratégias de religiosidade, resiliência e suporte socioafetivo. A rejeição ou negação da morte emergiu enquanto mecanismo para lidar com a ideia de finitude. Conhecer as estratégias de enfrentamento da doença e seus desdobramentos pode auxiliar na assistência à saúde, visando implementar ações que resultem na melhoria da qualidade de vida dos idosos. (AU)

The objective of the present study was to analyze the strategies for coping with disease by elderly hospitalized women. Participants included 10 elderly women hospitalized in the medical clinic of a hospital, aged 60 to 73, and sample selection was intentional or convenience-based. For data collection we used a social demographic questionnaire and a semi-structured interview. Data analysis was performed by the software Iramuteq and the Hierarchic Descendent Classification. The results revealed that participants used adaptation mechanisms of confrontation focused on the problem, represented by the description of the medical routine and care with the body; and focused on the emotion, characterized by strategies of religiosity, resilience and by the social affective support. Rejection or denial of death emerged as a mechanism to deal with the idea of finitude. Knowing the strategies of confrontation of the disease and their repercussions can help in health assistance, aiming to implement actions that lead to the improvement of the quality of life for the elderly. (AU)

El objetivo de este estudio fue analizar las estrategias para enfrentar las enfermedades por ancianas hospitalizadas. Participaron de esta investigación, diez ancianas internadas en una clínica médica de un hospital, con edades que variaban de 60 a 73 años, siendo la muestra, intencional y por conveniencia. Para recolectar los datos, fue utilizado un cuestionario socio demográfico y una entrevista semiestructurada. El análisis de datos fue realizado por el software Iramuteq, por medio de Clasificación Jerárquica Descendiente. Los resultados revelaron que los participantes utilizan mecanismos adaptativos de enfrentamiento, enfocados en el problema, representado por la descripción de rutina médica y cuidado con el cuerpo; y con foco en la emoción, caracterizado por estrategias de religión, resiliencia y apoyo socio afectivo. El rechazo o negación de muerte surgió como mecanismo para hacer frente a la idea de finitud. Conocer las estrategias de enfrentamiento de la enfermedad y sus desdoblamientos puede auxiliar en la asistencia a la salud, con la intención de implementar acciones que resulten en la mejoría de la calidad de vida de los ancianos. (AU)

Perfil do consumidor de carne bovina das feiras livres de Aracaju ­ SE / Consumer profile of Aracaju - SE

As feiras livres foram criadas para permitir que o produtor rural pudesse oferecer diretamente ao consumidor produtos de sua atividade, sem intermediários. O presente trabalho teve como objetivo avaliar o comportamento do consumidor de carne bovina das feiras livres de Aracaju, SE e saber quais os motivos reais que os levam a essa prática traçando assim seu perfil, considerando as preferências de compra e consumo com relação ao corte da carne e quais as condições social e econômica desses consumidores. A pesquisa teve um caráter qualitativo e quantitativo, com aplicação de checklist in loco, com 530 pessoas de 9 feiras do município que foram selecionadas por critério de quantidade de bancas de carne existentes em cada feira. Os resultados obtidos mostram que o perfil do consumidor é constituído por mulheres com idade média de 50 anos, com o 1º grau e dispondo de uma renda familiar de até 1salário mínimo; que moram em casa com 4 pessoas onde consomem carne de 1 a 2 vezes por semana tendo a alcatra como corte de preferência e que não são clientes exclusivas da feira livre (compram carne em outro estabelecimento); apesar de não conhecerem a procedência da carne e os riscos de consumi-la, confiam na carne que compram justificando tal fato por manterem uma relação de confiança com o vendedor.(AU)

Dynamic evaluation method of lower limbs joint alignment (MADAAMI) for dancers during the plié / Método de avaliação dinâmica do alinhamento articular dos membros inferiores (MADAAMI) de bailarinos durante o plié / Método de evaluación dinámica del alineamiento articular de las extremidades inferiores (MADAAMI) de bailarines durante el plié

Abstract In classical ballet, the joint misalignments during the plié can generate various injuries. To evaluate potential misalignments during the plié the aim of this study was to present a method for dynamic evaluation of lower limb alignment articulation (called MADAAMI). MADAAMI was validated by 12 experts, and for the evaluation of its reproducibility and for agreement with 3D kinematics, 20 dancers were assessed using a video recording of their plié. For statistical analysis we used the Kappa coefficient (k) (p < 0.05) and percentage agreement (C). We conclude that MADAAMI had satisfactory reproducibility and intra-rater agreement with 3D kinematics (k > 0.40 and C > 80%), and it is a suitable and valid method for use by the same examiner.

Resumo No ballet clássico, os desalinhamentos articulares durante o passo plié podem gerar várias lesões. Para avaliar esses possíveis desalinhamentos durante a sua execução, o objetivo deste estudo foi apresentar um Método de Avaliação Dinâmica do Alinhamento Articular dos Membros Inferiores (chamado MADAAMI). O MADAAMI foi validado por 12 especialistas e, para a avaliação da sua reprodutibilidade e da sua concordância com a análise cinemática 3D, 20 dançarinos foram avaliados através de uma gravação de vídeo em que executavam o plié. Para a análise estatística foi usado o coeficiente Kappa (k) (p<0,05) e o percentual de concordância (C). Concluímos que o MADAAMI teve reprodutibilidade intra-avaliador e concordância com a análise cinemática 3D satisfatórias (k>0,40 e C>80%) e se caracterizou como um método adequado e válido para uso por um único examinador.

Resumen En ballet clásico, los desajustes articulares durante el plié pueden generar diversas lesiones. Para evaluar esos posibles desajustes durante el plié, el objetivo de este trabajo fue presentar un método para la evaluación dinámica de la alineación de las extremidades inferiores (conocido como MADAAMI). MADAAMI fue validado por 12 expertos y para la evaluación de su reproducibilidad y de su concordancia con la cinemática en 3D se evaluó a 20 bailarines mediante grabaciones de vídeo durante el plié. Para el análisis estadístico se utilizó el coeficiente de kappa (k) (p <0,05) y el acuerdo de porcentaje (C). Se concluyó que MADAAMI cuenta con reproducibilidad intraevaluador, que la concordancia con la cinemática en 3D fue satisfactoria (k > 0,40 y C > 80%), y que es un método adecuado y válido para su uso por el mismo examinador.

Static and Functional Balance in Individuals With COPD: Comparison With Healthy Controls and Differences According to Sex and Disease Severity.

BACKGROUND: Studies have shown that individuals with COPD have impaired body balance, probably caused by the disease's multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity. METHODS: Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores. RESULTS: In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm2 vs 11.6 ± 4.0 cm2, respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P < .001). In the COPD group, men performed better in the Timed Up and Go test than women (9.8 ± 1.2 s vs 10.9 ± 2.2 s, respectively, P = .03), whereas women presented a better static balance in comparison with men for all parameters related to center of pressure (P < .005 for all). Disease severity did not affect any balance results. CONCLUSIONS: Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity.

Kinematic evaluation of the classical ballet step "plié".

Lack of alignment between the lowerlimb structures, such as the hips, knees, and longitudinal arches of the feet, has been described as an important predisposing factor in musculoskeletal injury among classical ballet dancers. However, no studies were found that analyzed basic ballet movements with quantification of objective criteria of the movements. The purposes of this study were: 1. to establish a methodology to quantify, using kinematic evaluation, the technical criteria that guide the correct execution of all phases of the plié (simultaneous flexion of the hips, knees, and ankle joints); and 2. to explore whether experienced ballet dancers respect those criteria when performing the plié. The technical criteria considered were the following: 1. midfoot stability; 2. pelvic positioning in a neutral alignment; 3. pelvic stability, represented by pelvic angle variation; and 4. vertical alignment of the knee joint with the second toe of the ipsilateral foot. Twenty dancers from Porto Alegre, Brazil, with 18 years of uninterrupted ballet training, were filmed while performing plié using four synchronized cameras. The descriptive statistical analysis involved calculating the median, minimum, and maximum of each of the technical criteria. Results showed that for criterion 1, the 20 dancers showed great stabilization of the midfoot; for criteria 2 and 3, 18 dancers displayed pelvic instability tending toward retroversion throughout execution of the plié; and for criterion 4, 13 dancers presented with medial misalignment of the knees at all phases of the plié. Using these criteria, it was possible to characterize the plié from a kinematic point of view.