Spatio-temporal dynamics of visceral leishmaniasis in Brazil: A nonlinear regression analysis.

AIMS: This study describes the spatio-temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020. METHODS AND RESULTS: Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio-temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central-West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio-temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country. CONCLUSIONS: The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years.

Tegumentary leishmaniasis in Brazil: priority municipalities and spatiotemporal relative risks from 2001 to 2020.

Understanding the distribution of tegumentary leishmaniasis (TL) in different periods enables the adequate conduction of actions at the public health level. The present study analyzes the spatiotemporal evolution of TL incidence rates in the municipalities of Brazil and identifies priority areas from 2001 to 2020. Notifications of new cases were analyzed employing space-time scan statistics and Local Indicators of Spatial Association. As TL incidence rates presented a downward trend in most Brazilian municipalities, spatiotemporal clusters of high relative risks (RR) were more frequent in the first decade of the series. There was a concentration of those clusters in the North and Northeast regions, mainly in the Legal Amazon area. More recent high-RR areas were identified in municipalities of different regions. The number of priority municipalities showed a stable trend in Brazil. There was a great concentration of such municipalities in the states of Acre, Mato Grosso, Rondônia, Pará, and Amapá, as well as large areas in Roraima, Amazonas, Maranhão, and Tocantins, and smaller areas in the states of Goiás, Ceará, Bahia, Minas Gerais, São Paulo, and Paraná. The present study contributes to the understanding of the historical evolution of TL in Brazil and subsidizes actions to combat the disease.

Temporal patterns, spatial risks, and characteristics of tegumentary leishmaniasis in Brazil in the first twenty years of the 21st Century.

BACKGROUND: Tegumentary leishmaniasis (TL) is a significant public health issue in Brazil. The present ecological study describes the clinical and epidemiological characteristics of TL cases reported in the country, and analyzes the spatial and temporal patterns of the incidences and risks of occurrence across the five geopolitical regions and 27 federative units. METHODOLOGY/PRINCIPAL FINDINGS: Data regarding new cases of TL notified between 2001 and 2020 were obtained from the Information System for Notifiable Diseases of the Brazilian Ministry of Health. Joinpoint and spatial and temporal generalized additive models were used to establish trends in the evolution of TL during the target period. The incidence rate for the entire period was 226.41 cases/100,000 inhabitants. All regions of Brazil showed trends of decreasing incidence rates, albeit with fluctuations at specific times, with the exception of the Southeast where rates have increased since 2014, most particularly in Minas Gerais state. The disease was concentrated predominantly in the North region, with Acre state leading the incidence rank in the whole country, followed by Mato Grosso (Midwest), Maranhão and Bahia (Northeast) states. The spatial distribution of the risk of TL occurrence in relation to the annual averages was relatively stable throughout the period. The cutaneous form of TL was predominant and cases most frequently occurred in rural areas and among men of working age. The ages of individuals contracting TL tended to increase during the time series. Finally, the proportion of confirmations by laboratory tests was lower in the Northeast. CONCLUSION/SIGNIFICANCE: TL shows a declining trend in Brazil, but its widespread occurrence and the presence of areas with increasing incidence rates demonstrate the persistent relevance of this disease and the need for constant monitoring. Our findings reinforce the importance of temporal and spatial tools in epidemiologic surveillance routines and are valuable for targeting preventive and control actions.

Spatio-temporal relative risks and priority areas for visceral leishmaniasis control in Brazil, between 2001 and 2020.

Visceral leishmaniasis (VL) is a pressing public health problem in Brazil. The proper implementation of disease control programs in priority areas is a challenge for healthcare managers. The present study aimed to analyze the spatio-temporal distribution and identify high risk areas of VL occurrence in the Brazilian territory. We analyzed data regarding new cases with confirmed diagnosis of VL in Brazilian municipalities, from 2001 to 2020, extracted from the Brazilian Information System for Notifiable Diseases. The Local Index of Spatial Autocorrelation (LISA) was used to identify contiguous areas with high incidence rates in different periods of the temporal series. Clusters of high spatio-temporal relative risks were identified using the scan statistics. The accumulated incidence rate in the analyzed period was 33.53 cases per 100,000 inhabitants. The number of municipalities that reported cases showed an upward trend from 2001 onward, although there was a decrease in 2019 and 2020. According to LISA, the number of municipalities considered a priority increased in Brazil and in most states. Priority municipalities were predominantly concentrated in the states of Tocantins, Maranhão, Piauí, and Mato Grosso do Sul, in addition to more specific areas of Pará, Ceará, Piauí, Alagoas, Pernambuco, Bahia, São Paulo, Minas Gerais, and Roraima. The spatio-temporal clusters of high-risk areas varied throughout the time series and were relatively higher in the North and Northeast regions. Recent high-risk areas were found in Roraima and municipalities in northeastern states. VL expanded territorially in Brazil in the 21st century. However, there is still a considerable spatial concentration of cases. The areas identified in the present study should be prioritized for disease control actions.

Men's health care: construction and validation of a tool for nursing consultation.

OBJECTIVES: to elaborate and validate a data collection tool for nursing consultation with men in the context of Primary Health Care. METHOD: a methodological study developed in four stages. The first one consisted in tool elaboration, using databases and the Dorothea Orem's theoretical model. In the second and third stages, content validation and tool appearance by 23 nurse judges took place. The Concordance Index was used for assessment. In the fourth stage, a pilot test was carried out with 20 men using Primary Health Care. RESULTS: of the 145 indicators prepared, organized and submitted to validation process, items with the Concordance Index <0.80 were excluded. The final tool consisted of 156 items. An overall 0.88 Concordance Index calculation was obtained. CONCLUSIONS: the final tool presented content validity for data collection with men in Primary Health Care.

Aerobic exercise decreases chronic allergic lung inflammation and airway remodeling in mice.

RATIONALE: Aerobic conditioning improves exercise capacity and decreases symptoms in patients with asthma. However, its benefits in the context of allergic airway inflammation are poorly understood. OBJECTIVES: To evaluate the effects of two intensities of aerobic exercise on airway inflammation and remodeling in a model of chronic allergic lung inflammation. METHODS: Mice were subjected to chronic ovalbumin (OVA) sensitization and to 4 weeks of low (OVA+Low) or moderate (OVA+Mod) exercise training in a treadmill. Airway inflammation and remodeling and expression of helper T-cell type 1 and 2 cytokines were evaluated. MEASUREMENTS AND MAIN RESULTS: OVA-induced allergic airway inflammation and remodeling were characterized by an increase in collagen (288%), elastic fiber (56%), smooth muscle (380%), and epithelial (402%) contents (P < 0.001) when compared with the control group. OVA+Low and OVA+Mod groups presented a decrease in bronchoalveolar lavage fluid eosinophils (respectively, 84 and 75%; P < 0.01) and airway walls (respectively, 94 and 58%; P < 0.001) when compared with the OVA group. OVA+Low and OVA+Mod groups also presented a reduction in the number of peribronchial inflammatory cells expressing IL-4 (respectively, 85 and 75%; P < 0.01) and IL-5 (respectively, 88 and 89%; P < 0.01) when compared with the OVA group. Aerobic conditioning did not change the expression of either IFN-gamma or IL-2 by inflammatory cells or plasma levels of IgE or IgG1. OVA+Low and OVA+Mod groups presented an increase in the expression of IL-10 (P < 0.001). Low and moderate aerobic conditioning also reduced airway remodeling in OVA-sensitized mice when compared with the OVA group. CONCLUSIONS: We concluded that low and moderate aerobic exercise decreases airway inflammation and remodeling in a murine model of asthma.

Addison's disease, diffuse skin, and mucosal hyperpigmenation with subtle "flu-like" symptoms--a report of two cases.

Addison's disease, or chronic adrenocortical insufficiency, is the overproduction of adrenocorticotropic hormone by the pituitary gland as a compensatory mechanism for decreased cortisol production by the adrenal glands. Classically, patients affected with Addison's disease develop weakness, anorexia, electrolyte imbalances: decreased sodium and chloride with increased serum potassium resulting in hypotension, and hyperpigmentation of the skin and mucous membranes. Herein this case report, we focus on the subtle findings of diffuse hyperpigmentation and intermittent but repetitive "flu-like" symptoms in two patients to correctly identify the diagnosis of Addison's disease effectively and efficiently.

Creatine supplementation exacerbates allergic lung inflammation and airway remodeling in mice.

Creatine supplement is the most popular nutritional supplement, and has various metabolic functions and sports medicine applications. Creatine supplementation increases muscle mass and can decrease muscular inflammation. Some studies have also suggested a beneficial role of creatine supplementation on chronic pulmonary diseases such as chronic obstructive pulmonary disease and cystic fibrosis. Among athletes, the prevalence of asthma is high, and many of these individuals may be taking creatine. However, the effects of creatine supplementation on chronic pulmonary diseases of allergic origin have not been investigated. In the present study, we analyzed the effects of creatine supplementation on a model of chronic allergic lung inflammation. Thirty-one Balb/c mice were divided into four groups: control, creatine (Cr), ovalbumin (OVA), and OVA+Cr. OVA and OVA+Cr groups were sensitized with intraperitoneal injections of OVA on Days 0, 14, 28, and 42. OVA challenge (OVA 1%) and Cr treatment (0.5 g/kg/d) were initiated on Day 21 and lasted until Day 53. We determined the index of hyperresponsiveness, the serum levels of OVA-specific immunoglobulin (Ig)E and IgG(1), and the total and differential cell counts in bronchoalveolar lavage fluid. We also quantified airway inflammation, and the airway density of IL-4+, IL-5+, IL-2+, IFN-gamma+, and insulin-like growth factor (IGF)-1+ cells, collagen and elastic fibers, and airway smooth muscle thickness. Our results showed that creatine in OVA-sensitized mice increased hyperresponsiveness; eosinophilic inflammation; airway density of IL-4+, IL-5+, and IGF-1 inflammatory cells; airway collagen and elastin content; and smooth muscle thickness. The results show that creatine supplementation exacerbates the lung allergic response to OVA through a T helper cell type 2 pathway and increased IGF-1 expression.

Seleção de doador em serviço de hemoterapia: desafios da equipe de assistência ao paciente no processo de triagem clínica / Selección de donante en el servicio de hemoterapia: desafíos del equipo de asistencia al paciente en el proceso de cribado clínico / Donor selection in a hemotherapy service: challenges of the patient care team in the clinical screening process

RESUMO Objetivo: compreender os desafios vivenciados pela equipe multiprofissional envolvida no processo de triagem clínica nos critérios aptidão/inaptidão à doação de sangue. Método: estudo de abordagem qualitativa realizado em um serviço de hemoterapia de Minas Gerais com 12 profissionais da triagem clínica, médicos e enfermeiros, sendo os dados coletados por meio de entrevista semiestruturada e gravada, com interpretação conforme análise de conteúdo, segundo Laurence Bardin, contemplando: pré-análise; exploração do material e interpretação dos conteúdos; categorização dos achados. Resultados: exploradas quatro categorias temáticas: "percebendo as principais dificuldades da seleção de doadores de sangue"; "identificando dificuldades assistenciais em prol da aptidão/inaptidão no processo de triagem clínica para a doação sanguínea"; "a devolutiva/retorno àquele que se submete à triagem clínica para doação sanguínea"; "ambiguidade de sentimentos frente ao ato de promover aptidão/inaptidão para o processo de doação sanguínea". Conclusão: o estudo evidenciou que os principais desafios enfrentados pela equipe de assistência ao paciente no processo de triagem clínica foram a captação e seleção de doador; a devolutiva da inaptidão; e os sentimentos envolvidos no processo de triagem clínica.

RESUMEN Objetivo: comprender los desafíos experimentados por el equipo multiprofesional involucrado en el proceso de selección clínica en términos de aptitud/incapacidad para donar sangre. Método: estudio cualitativo realizado en un servicio de hemoterapia en Minas Gerais con 12 profesionales del cribado clínico, médicos y enfermeros, con datos recolectados a través de entrevistas semiestructuradas y grabadas, con interpretación según análisis de contenido, según Laurence Bardin, contemplando: preanálisis; exploración del material e interpretación de los contenidos; categorización de hallazgos. Resultados: se exploraron cuatro categorías temáticas: "darse cuenta de las principales dificultades en la selección de donantes de sangre"; "Identificación de dificultades de asistencia a favor de la aptitud / incapacidad en el proceso de cribado clínico para la donación de sangre"; "Devolución a quienes se someten a un examen clínico para la donación de sangre"; "Ambigüedad de sentimientos respecto al acto de promover la aptitud / incapacidad para el proceso de donación de sangre". Conclusión: el estudio mostró que los principales desafíos que enfrentó el equipo de atención al paciente en el proceso de cribado clínico fueron la captación y selección de donantes; la devolución de la inaptitud; y los sentimientos involucrados en el proceso de selección clínica.

ABSTRACT Objective: to understand the challenges experienced by the multi-professional team involved in the clinical screening process in terms of aptitude/inability to donate blood. Method: a qualitative study conducted in a hemotherapy service in Minas Gerais with 12 professionals from clinical screening, doctors and nurses, with data collected through semi-structured and recorded interviews, with interpretation according to content analysis, according to Laurence Bardin, contemplating: pre-analysis; exploration of the material and interpretation of the contents; categorization of the findings. Results: four thematic categories were explored: "realizing the main difficulties in the selection of blood donors"; "Identifying assistance difficulties in favor of aptitude/inaptitude in the clinical screening process for blood donation"; "The answer to those who undergo clinical screening for blood donation"; "Ambiguity of feelings regarding the act of promoting aptitude/inaptitude for the blood donation process". Conclusion: the study showed that the main challenges faced by the patient care team in the clinical screening process were the capture and selection of donors; the answer of inaptitude; and the feelings involved in the clinical screening process.

Men's health care: construction and validation of a tool for nursing consultation / Atención de salud del hombre: construcción y validación de instrumento para consulta de enfermería / Atenção à saúde do homem: construção e validação de instrumento para consulta de enfermagem

ABSTRACT Objectives: to elaborate and validate a data collection tool for nursing consultation with men in the context of Primary Health Care. Method: a methodological study developed in four stages. The first one consisted in tool elaboration, using databases and the Dorothea Orem's theoretical model. In the second and third stages, content validation and tool appearance by 23 nurse judges took place. The Concordance Index was used for assessment. In the fourth stage, a pilot test was carried out with 20 men using Primary Health Care. Results: of the 145 indicators prepared, organized and submitted to validation process, items with the Concordance Index <0.80 were excluded. The final tool consisted of 156 items. An overall 0.88 Concordance Index calculation was obtained. Conclusions: the final tool presented content validity for data collection with men in Primary Health Care.

RESUMEN Objetivos: elaborar y validar un instrumento de recolección de datos para consultas de enfermería con hombres en el contexto de la Atención Primaria de Salud. Métodos: estudio metodológico desarrollado en cuatro etapas. El primero consistió en la elaboración del instrumento, utilizando las bases de datos y el modelo teórico de Dorothea Orem. En la segunda y tercera etapas, se llevó a cabo la validación del contenido y la apariencia del instrumento por 23 enfermeras jueces. El índice de concordancia se utilizó para la evaluación. En la cuarta etapa, se llevó a cabo una prueba piloto con 20 hombres utilizando la Atención Primaria de Salud. Resultados: de los 145 indicadores preparados, organizados y presentados al proceso de validación, se excluyeron los ítems con índice de concordancia <0,80. El instrumento final consistió en 156 ítems. Se obtuvo un cálculo global de índice de concordancia de 0,88. Conclusiones: el instrumento final presentó la validez de contenido para la recopilación de datos con hombres en el contexto de la Atención Primaria de Salud.

RESUMO Objetivos: elaborar e validar um instrumento de coleta de dados para consulta de enfermagem junto ao homem no contexto da Atenção Primária à Saúde. Métodos: estudo metodológico, desenvolvido em quatro etapas. A primeira consistiu na elaboração do instrumento, utilizando-se bases de dados e o modelo teórico de Dorothea Orem. Na segunda e terceira etapas, ocorreu a validação de conteúdo e aparência do instrumento por 23 juízes enfermeiros. Para avaliação, foi utilizado o Índice de Concordância. Na quarta etapa, foi realizado o teste piloto com 20 homens usuários da Atenção Primária à Saúde. Resultados: dos 145 indicadores elaborados, organizados e submetidos ao processo de validação, foram excluídos os itens com Índice de Concordância menor que 0,80. O instrumento final foi composto por 156 itens. Obteve-se o cálculo de Índice de Concordância global de 0,88. Conclusões: o instrumento final apresentou validade de conteúdo para a coleta de dados junto a homens no contexto da Atenção Primária à Saúde.

Fatores associados ao desempenho de serviços da atenção primária à saúde / Factors associated with the performance of primary health care services / Factores asociados con el rendimiento de los servicios de la atención primaria de salud

Objetivo: Avaliar o desempenho de equipes de Saúde da Família (eSF) e equipes de Atenção Básica (eAB) sobre a presença e extensão de atributos da Atenção Primária à Saúde (APS) através da visão dos usuários. Métodos: Trata-se de um estudo observacional transversal realizado em um município da região centro-oeste de Minas Gerais (MG) entre janeiro e junho de 2016 com amostra representativa de 384 usuários assistidos por eSF e eAB. Os dados foram obtidos por meio da aplicação do instrumento Primary Care Assessment Tool (PCATool-Brasil) - usuários adultos. Inicialmente, calculou-se o escore de cada atributo/componente e os escores essencial e geral. Utilizou-se a modelagem de análise multivariada para identificar variáveis associadas à avaliação satisfatória (escore ≥ 6,6) da APS. Resultados: Os resultados apontam que a maioria dos atributos/componentes da APS não está devidamente implantado no cenário em questão. Identificou-se, ainda, na análise multivariada, que a avaliação de usuários da eSF (Odds Ratio: 2,09) e de pessoas com até oito anos de estudo (Odds Ratio: 1,94) está associada à avaliação satisfatória da APS. Conclusão: Na visão dos usuários, a eSF tem maior potencial para a presença e extensão dos atributos/componentes da APS, reforçando, assim, o papel de destaque dessa estratégia como principal arranjo organizacional de APS no cenário nacional. (AU)

Avaliação da atenção primária: o ponto de vista de usuários / Evaluation of primary care: the point of view of users

RESUMO O objetivo deste artigo foi avaliar atributos da Atenção Primária à Saúde (APS), sob a percepção de usuários. Trata-se de estudo transversal que teve como participantes 384 usuários adultos vinculados a equipes de APS. Aplicou-se o instrumento Primary Care Assessment Tool - usuários adultos, versão reduzida. O Grau de Afiliação e dois atributos atingiram escores médios superiores a 6,6, sendo assim, bem avaliados. Os demais obtiveram escores inferiores a 6,6, não atingindo a média estabelecida como desejável. Conclui-se que os atributos da APS analisados receberam avaliação heterogênea e que a maioria necessita de um olhar mais atento e de investimento por parte dos gestores e profissionais.

ABSTRACT The aim of this paper was to evaluate attributes of the Primary Health Care (PHC), under the perception of users. It is a cross-sectional study that had as participants 384 adult users linked to PHC teams. The Primary Care Assessment Tool - adult users, reduced version - was applied. The Degree of Affiliation and two attributes reached average scores higher than 6.6 and were thus well evaluated. The other attributes had scores lower than 6.6, not reaching the average score established as desirable. It is concluded that the analyzed APS attributes received a heterogeneous evaluation and that most of them need a closer look and investment by the managers and professionals.

Funções administrativas na gestão local da Atenção Básica em Saúde / Administrative functions in the local management of Basic Health Care

Objetivo: analisar a realização das funções administrativas na gestão local da Atenção Básica em Saúde.Método: estudo qualitativo, tipo descritivo, com 21 gestores, sendo seis gerentes de distritos sanitários e 15gerentes de Unidades Básicas de Saúde. Para a coleta de dados, utilizou-se roteiro semiestruturado. Os dadosforam analisados a partir da técnica de Análise de Conteúdo, na modalidade Análise Temático-Categorial.Resultados: emergiram duas categorias analíticas: a) Atribuições dos gestores locais de saúde: indefinição ecoexistência de atividades assistenciais e gerenciais e b) Realização das funções administrativas. Conclusão:os resultados mostram uma prática gerencial frágil, sendo as funções administrativas realizadas de formaincipiente e assistemática. Há, ainda, certa indefinição das atribuições do cargo de gestor, levando os mesmosa exercerem dupla função (gerenciar e assistir). Este estudo leva a uma reflexão sobre o trabalho de gerenteslocais de saúde na Atenção Básica e suas práticas gerenciais, em busca de efetivação e melhorias nasintervenções em saúde.

Resultados preliminares do efeito da água da represa Billings na tireóide das tilápias / Effect of water from the billings reservoir on tilapia thyroid glandspreliminary results

The presence of endocrine disruptors in reservoirs and water sources has been related to environmental impact and public health issues. In this context, the objective of this study is to show morphological changes in the thyroid gland of the Nile Tilapia (Oreochromisniloticus) exposed to the water from Billings Reservoir. Tilapia individuals were kept in two tanks, ten fishes in water from the Billings Reservoir and 10 fishes in mineral water (control). All specimens were sacrificed by medullary section after 5 months treatment period for thyroid collection. Histological analysis of Hematoxylin/Eosin stained glass slides and morphometric study of photomicrograph scans (1000X and 400X) of thyroid follicles (area, perimeter, circumference factor, major and minor diameter) were performed using Image J software. Preliminary study of six fishes (n = 6) from the Billings Reservoir and analysis of8 follicles per individual showed the presence of lymphocytic infiltrate and larger area and perimeter of follicles (26,969,881 ± 13,507,948, 4m2 X 10,957,141 ± 7,286,471,01m2 and 615,793 ± 387,122 ± 182.485,39m X 136.426,80m to p = 0.05). These results indicate that the Tilapia thyroid can be a biomarker for assessment of water contamination.(AU)

A presença de disruptores endócrinos em represas e mananciais e os conseqüentes problemas ambientais e de saúde pública têm sido relatados, nesse contexto o presente trabalho teve como objetivo evidenciar as alterações morfológicas na tireoide de Tilápias do Nilo (Oreochromis niloticus) expostas às águas da Represa Billings. Para alcançar esse objetivo 20 tilápias foram armazenadas por 5 meses em dois aquários, sendo 10 peixes em um com a água proveniente da represa Billings e 10 peixes em um aquário com água mineral (controle). Após esse período os peixes foram sacrificados por secção medular para extração da tireóide. Foram realizadas análises histológicas das mesmas em lâminas coradas com hematoxilina/eosina e análises morfométricas de foto digitalizações (1000X e 400X), utilizando-se o programa Image J, dos folículos tireoideanos (área, perímetro, fator de circunferência, maior e menor diâmetro). Nas análises preliminares de seis peixes (n=6) expostos a água da represa Billings, observou-se em 8 folículos de cada exemplar, a presença de infiltrado linfocitário e também maior área e perímetro dos folículos (26.969.881 ± 13.507.948,4µm2 X 10.957.141 ± 7.286.471,01µm2 e 615.793 ± 182.485,39µm X 387.122 ± 136.426,80µm para p = 0,05). Esses resultados indicam que a tireóide de tilápias do Nilo pode ser um biomarcador para avaliação de águas contaminadas.(AU)

Resultados preliminares do efeito da água da represa Billings na tireóide das tilápias / Effect of water from the billings reservoir on tilapia thyroid glandspreliminary results

The presence of endocrine disruptors in reservoirs and water sources has been related to environmental impact and public health issues. In this context, the objective of this study is to show morphological changes in the thyroid gland of the Nile Tilapia (Oreochromisniloticus) exposed to the water from Billings Reservoir. Tilapia individuals were kept in two tanks, ten fishes in water from the Billings Reservoir and 10 fishes in mineral water (control). All specimens were sacrificed by medullary section after 5 months treatment period for thyroid collection. Histological analysis of Hematoxylin/Eosin stained glass slides and morphometric study of photomicrograph scans (1000X and 400X) of thyroid follicles (area, perimeter, circumference factor, major and minor diameter) were performed using Image J software. Preliminary study of six fishes (n = 6) from the Billings Reservoir and analysis of8 follicles per individual showed the presence of lymphocytic infiltrate and larger area and perimeter of follicles (26,969,881 ± 13,507,948, 4m2 X 10,957,141 ± 7,286,471,01m2 and 615,793 ± 387,122 ± 182.485,39m X 136.426,80m to p = 0.05). These results indicate that the Tilapia thyroid can be a biomarker for assessment of water contamination.

A presença de disruptores endócrinos em represas e mananciais e os conseqüentes problemas ambientais e de saúde pública têm sido relatados, nesse contexto o presente trabalho teve como objetivo evidenciar as alterações morfológicas na tireoide de Tilápias do Nilo (Oreochromis niloticus) expostas às águas da Represa Billings. Para alcançar esse objetivo 20 tilápias foram armazenadas por 5 meses em dois aquários, sendo 10 peixes em um com a água proveniente da represa Billings e 10 peixes em um aquário com água mineral (controle). Após esse período os peixes foram sacrificados por secção medular para extração da tireóide. Foram realizadas análises histológicas das mesmas em lâminas coradas com hematoxilina/eosina e análises morfométricas de foto digitalizações (1000X e 400X), utilizando-se o programa Image J, dos folículos tireoideanos (área, perímetro, fator de circunferência, maior e menor diâmetro). Nas análises preliminares de seis peixes (n=6) expostos a água da represa Billings, observou-se em 8 folículos de cada exemplar, a presença de infiltrado linfocitário e também maior área e perímetro dos folículos (26.969.881 ± 13.507.948,4µm2 X 10.957.141 ± 7.286.471,01µm2 e 615.793 ± 182.485,39µm X 387.122 ± 136.426,80µm para p = 0,05). Esses resultados indicam que a tireóide de tilápias do Nilo pode ser um biomarcador para avaliação de águas contaminadas.

Aerobic conditioning and allergic pulmonary inflammation in mice. II. Effects on lung vascular and parenchymal inflammation and remodeling.

Recent evidence suggests that asthma leads to inflammation and remodeling not only in the airways but also in pulmonary vessels and parenchyma. In addition, some studies demonstrated that aerobic training decreases chronic allergic inflammation in the airways; however, its effects on the pulmonary vessels and parenchyma have not been previously evaluated. Our objective was to test the hypothesis that aerobic conditioning reduces inflammation and remodeling in pulmonary vessels and parenchyma in a model of chronic allergic lung inflammation. Balb/c mice were sensitized at days 0, 14, 28, and 42 and challenged with ovalbumin (OVA) from day 21 to day 50. Aerobic training started on day 21 and continued until day 50. Pulmonary vessel and parenchyma inflammation and remodeling were evaluated by quantitative analysis of eosinophils and mononuclear cells and by collagen and elastin contents and smooth muscle thickness. Immunohistochemistry was performed to quantify the density of positive cells to interleukin (IL)-2, IL-4, IL-5, interferon-gamma, IL-10, monocyte chemotatic protein (MCP)-1, nuclear factor (NF)-kappaB p65, and insulin-like growth factor (IGF)-I. OVA exposure induced pulmonary blood vessels and parenchyma inflammation as well as increased expression of IL-4, IL-5, MCP-1, NF-kappaB p65, and IGF-I by inflammatory cells were reduced by aerobic conditioning. OVA exposure also induced an increase in smooth muscle thickness and elastic and collagen contents in pulmonary vessels, which were reduced by aerobic conditioning. Aerobic conditioning increased the expression of IL-10 in sensitized mice. We conclude that aerobic conditioning decreases pulmonary vascular and parenchymal inflammation and remodeling in this experimental model of chronic allergic lung inflammation in mice.

Abordagem dos fatores de risco para lactentes sibilantes: subsídios para a assistência de enfermagem na atenção primária à saúde / Addressing risk factors for sibilants infants: grants for nursing care in primary health care

Introdução: A maioria das crianças apresentam sibilância nos primeiros anos de vida, caracterizada por broncoespasmos, achado extremamente importante, por relacionar-se com causas de morbidade em todo o mundo, tanto em países desenvolvidos como em desenvolvimento. A literatura revela que episódios de sibilância recorrente e precoce estão relacionados com diversos fatores, que podem ser desencadeantes e/ou facilitadores para sibilância e estão posteriormente associados à asma em idade escolar. Objetivo: Relatar a experiência de acadêmicas de enfermagem no cuidado ao lactente sibilante, enfatizando os fatores de risco para sibilância. Resultados: Foram encontrados fatores desencadeantes e/ou facilitadores que contribuem para as crises recorrentes de sibilo, como sexo masculino, infecções respiratórias, antecedente pessoal de dermatite atópica, pai tabagista, ter irmãos, apresentar eosinofilia, presença de poeira e mofo no ambiente domiciliar. Conclusão: O conhecimento da prevalência, da gravidade e de fatores de risco para sibilância em lactentes é de grande importância para os profissionais da saúde, uma vez que podem adotar medidas preventivas, visando a redução da morbidade em relação à sibilância nesta faixa etária.