Tratamento medicamentoso para depressão e prevenção quaternária / Drug treatment for depression and quaternary prevention / Tratamiento farmacológico para la depresión y la prevención cuaternaria

O uso generalizado de antidepressivos tem aumentado progressivamente nos últimos anos. No entanto, as evidências para o tratamento medicamentoso da depressão são pouco consistentes, sendo restritas as formas mais graves do transtorno e com modesta melhora clínica. Além disso, os efeitos adversos e os riscos relacionados ao uso crônico dessas medicações estão bem estabelecidos na literatura científica. Assim, é importante que os médicos de família tenham uma abordagem crítica deste problema e se questionem qual a melhor forma de ajudar seus pacientes. Os autores deste artigo levantam algumas hipóteses para explicar a prescrição excessiva de antidepressivos e, principalmente, trazem orientações para médicos de família e comunidade no cuidado das pessoas com depressão, com sugestões práticas de orientar o cuidado pela prevenção quaternária, utilizando ferramentas como o compartilhamento de decisão, o cuidado colaborativo e a busca dos suportes sociais durante a consulta.

The widespread use of antidepressants has increased steadily in recent years. However, the evidence for drug treatment of depression is not very consistent, with the most severe forms of the disorder being restricted and with modest clinical improvement. In addition, the adverse effects and risks related to the chronic use of these medications are well established in the scientific literature. Thus, it is important that family doctors take a critical approach to this problem and ask themselves how best to help their patients. The authors raise some hypotheses to explain the excessive prescription of antidepressants and, mainly, bring guidelines for family and community doctors in the care of people with depression, with practical suggestions to guide care for quaternary prevention, using tools such as sharing of decision, collaborative care, and the search for social supports during the consultation.

El uso generalizado de antidepresivos ha aumentado de manera constante en los últimos años. Sin embargo, la evidencia para el tratamiento farmacológico de la depresión no es muy consistente, ya que las formas más graves del trastorno están restringidas y con una modesta mejoría clínica. Además, los efectos adversos y los riesgos relacionados con el uso crónico de estos medicamentos están bien establecidos en la literatura científica. Por lo tanto, es importante que los médicos de familia adopten un enfoque crítico de este problema y se pregunten cuál es la mejor manera de ayudar a sus pacientes. Los autores plantean algunas hipótesis para explicar la prescripción excesiva de antidepresivos y, principalmente, traen pautas para los médicos de familia y comunitarios en la atención de personas con depresión, con sugerencias prácticas para orientar la atención para la prevención cuaternaria, utilizando herramientas como el intercambio de decisiones, colaborativo atención y búsqueda de apoyos sociales durante la consulta.

A molecular survey using a validated real-time PCR assay finds no evidence of bovine alphaherpesvirus 2 in samples from animals with suspected vesicular disease in Brazil between 2014 and 2017.

Bovine alphaherpesvirus 2 (BoHV-2) is the etiologic agent of bovine mammillitis (BM) and pseudo-lumpy skin disease. BM is also important because its clinical presentation can be confused with foot-and-mouth disease (FMD), making it necessary to establish differential diagnoses and perform additional laboratory tests. The objective of this work was to use a validated real-time PCR assay to test for the presence of BoHV-2 in samples from cattle and buffalo with suspected vesicular disease in Brazil. The method could detect the virus at a concentration of 0.5 fg/µL and had 99.4% amplification efficiency, a repeatability error of only 4.1%, and good reproducibility with other reagents. No evidence of BoHV-2 causing vesicular disease in cattle and buffalo was found in this work. This study was able to validate a new methodology for detection of BoHV-2 and evaluate its usefulness for investigating outbreaks of vesicular disease Brazil. The importance of BoHV-2 in cases involving other clinical signs should still be studied using the qPCR developed in this work.

Validation of a real-time PCR assay for detection of swinepox virus.

Swine are the only known hosts of swinepox virus (SWPV), the sole member of the genus Suipoxvirus, family Poxviridae. Rapid diagnosis is recommended for appropriate interventions because of the high morbidity associated with this virus. This study describes a real-time quantitative PCR (qPCR) assay for rapid detection and quantification of SWPV. The detection limit, repeatability, reproducibility, and specificity of this assay were determined. The efficiency was 96%, and the R2 value was 0.996. The detection limit was 1 fg or 10-0.5 TCID50/50 µL. Tests showed that the greatest source of error in the SWPV qPCR assay was variation between analysts rather than different qPCR kits or equipment. All nucleic acids from other viruses or samples collected from swine were negative in the specificity test. qPCR for SWPV is a new method with tested variables that allows main sources of error in laboratory diagnosis and viral quantification to be identified.