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Waiting rooms provide an ideal location to disseminate health information. In this mixed-methods study, we evaluated waiting room-based health education talks at two clinics in the Dominican Republic and explored recommendations for implementing this intervention in similar settings. The talks addressed noncommunicable diseases, sexually transmitted infections, family planning and gender-based violence. We conducted pre- and posttests to assess attendees' change in knowledge and conducted semi-structured interviews with a subset of them. We conducted a semi-structured focus group with educators. Analyses included Wilcox Signed Rank Tests and McNemar tests for pre- and posttests, conventional content analysis for individual interviews and transcript coding for the focus group. Patient participants were 69.3% female aged 39.6 years (SD = 13.5) on average at one clinic (n = 127) and 100% female aged 17.4 (SD = 1.3) on average at the second clinic (n = 24). Focus group participants (n = 5) had 4.8 years (SD = 3.3) of health educator experience on average. Pre- and posttests showed significant improvement (P < 0.05) across all talks. Qualitative interviews emphasized engaging, clear and brief content delivery with visual aids. The focus group highlighted the importance of patient-centered design with culturally concordant delivery and identified implementation challenges. Findings demonstrate that waiting room-based education talks improve knowledge and provide suggestions for similar interventions.

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Oreochromis niloticus (Linnaeus) (Perciformes: Cichlidae), commonly named "tilapia", is the second most cultivated species in the world. Among the diseases that affect tilapia are parasitic diseases caused by parasites of the class Monogenoidea. The aim of the present study was to analyze parasitism rates among specimens of O. niloticus in farming systems, after dietary supplementation with ractopamine, a growth promoter that is used for fattening fish. The action of this substance on the quantitative parameters of infestation by Monogenoidea was evaluated. Samples of O. niloticus were obtained from a fish farm in Brasília, Federal District, Brazil. Their gills were removed and fixed. Four species of monogenoideans were collected: Cichlidogyrus halli, C. sclerosus, C. thurstonae and Scutogyrus longicornis. The results from this study indicate that the monogenoidean parasites of tilapias examined here presented different behaviors in relation to the ractopamine concentrations that were added to the food. The parasitological indexes did not present significant reductions through using ractopamine, thus leading to the conclusion that administration of ractopamine is not efficient as a method for controlling infestations of monogenoidean parasites.(AU)

Oreochromis niloticus (Linnaeus) (Perciformes: Cichlidae), tilápia, é a segunda espécie mais cultivada no mundo. Entre outras doenças que afetam a tilápia, estão as doenças provocadas por parasitos da classe Monogenoidea. O presente estudo teve como objetivo analisar os índices de parasitismo em espécies de O. niloticus provenientes de sistemas de cultivo, submetidos a uma dieta com suplementação de ractopamina, usada como promotor de crescimento no estágio de engorda dos peixes, para avaliar as ações dessa substância nos parâmetros quantitativos da infestação por Monogenoidea. Exemplares de O. niloticus obtidos na piscicultura "Agropecuária do Buriti Perdido", em Brasília, Distrito Federal, Brasil, foram examinados; as brânquias foram removidas e fixadas. Quatro espécies foram coletadas: Cichlidogyrus halli, C. sclerosus, C. thurstonae e Scutogyrus longicornis. Os resultados obtidos no presente estudo indicaram que as espécies de Monogenoidea parasitos de tilápia examinadas apresentam diferentes comportamentos relacionados à concentração de ractopamina adicionada ao alimento. Os índices parasitológicos não apresentaram redução significativa pelo uso da ractopamina, levando à conclusão de que a ractopamina não é eficiente como método de controle parasitário em infestações por Monogenoidea.(AU)

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The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

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Cryptorchidism (CPT), the most common male congenital abnormality, is variably associated with other male reproductive tract problems. We evaluated if cryptorchid rats develop enhanced testicular susceptibility to dibutyl phthalate (DBP) or acrylamide (AA) after extended exposure. Three studies with rats were performed: (1) in utero and postnatal exposure to DBP or AA; (2) establishment of CPT and orchiopexy; and (3) in utero and postnatal exposures to DBP or AA associated with CPT/orchiopexy. Seminiferous tubules were histologically scored according to the severity of lesions: (1) Rats exposed to DBP (score 1.5) or AA (score 1.1) presented mostly preserved spermatogenesis. Some seminiferous tubules showed vacuolated germinative epithelium, germ cell apoptosis, and a Sertoli cell-only (SCO) pattern. (2) CPT (score 3.3) resulted in decreased absolute testes weights, degenerated and SCO tubules, and spermatogenesis arrest that were reversed by orchiopexy (score 1.1). (3) Exposure to DBP or AA with CPT/orchiopexy led to atrophic testes, spermatogenesis arrest, germ cell exfoliation/multinucleation, and SCO tubules (both chemicals score 2.5). Exposure to chemicals such as DBP or AA prevented the recovery of cryptorchid testes by orchiopexy. The possible role of environmental contaminants should be considered when looking for factors that modulate human testicular disorders associated with CPT.

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INTRODUCTION: Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. OBJECTIVE: The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). METHODS: Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. RESULTS: Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. CONCLUSION: The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. KEY POINTS: • Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology.

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RESUMEN El dolor lumbopélvico es una condición muy frecuente, afectando un 50 a 70% de las mujeres durante el embarazo. En la mayoría de los casos ha habido una recuperación al mes o 3 meses postparto. Sin embargo, estudios reportan que la mejoría es incompleta, pudiendo persistir o aumentar años posterior al parto. Esta condición puede causar limitaciones en la vida diaria, provocando algún grado de discapacidad que muchas veces no es abordado con la importancia que se merece. Objetivo Determinar la prevalencia de dolor lumbopélvico y su relación con el grado de discapacidad durante el tercer trimestre de embarazo y 3 meses postparto. Material y método Estudio observacional y cohorte prospectivo; la muestra son 81 mujeres estudiadas en su tercer trimestre de embarazo y 3 meses postparto atendidas durante 2014-2015 en el Departamento de Obstetricia & Ginecología, Clínica Las Condes. Se aplicó un cuestionario y el Índice de discapacidad Oswestry en ambas etapas y autoadministrada. El análisis de datos se realizó con STATA10.0. Resultados El 81,48% de las embarazadas presentaron dolor lumbopélvico, siendo más prevalente y con una asociación significativa en el tercer trimestre (72,84%, p<0,001). El 25,93% de las mujeres lo mantiene después del parto. Existe una asociación significativa entre dolor lumbopélvico y grado de discapacidad (p<0,001), específicamente con actividades de la vida diaria, actividad sexual y actividades domésticas. Conclusiones Existe una alta prevalencia de dolor lumbopélvico en el embarazo, y un porcentaje no menor lo mantiene postparto, y en ambos casos está asociado a un grado de discapacidad.

ABSTRACT Lumbopelvic pain is a very frequent condition that affects between 50 to 70% of pregnant women. In many cases have been a recovery over the month or three months postpartum. However, some studies showed an incomplete improvement, so it could persist or increase through years after childbirth. This condition can cause daily life limitations, it is provoking some disability grade, that many times it didn't understand with the importance that deserve. Aim To identify the lumbopelvic pain prevalence and the relation with disability grade during the third trimester of pregnancy and three months postpartum. Material and Methods Observational and prospective cohort study; the sample was 81 women studied in her third trimester of pregnancy and three months postpartum during 2014-2015 in the "Departamento de Obstetricia & Ginecologia de Clínica Las Condes". It applied a questionnaire and the Oswestry Disability Index in both stages and self-administered. Data analysis was using STATA 10.0 software. Results 81, 48% of pregnant showed lumbopelvic pain, there were being more prevalent and significantly associated with third trimester (72, 84%, p<0,001). 25, 93% of women maintained this condition postpartum. There is a significant association between lumbopelvic pain and disability grade (p<0,001), specifically with daily life, sexual and domestic activities. Conclusions There is a high prevalence of lumbopelvic pain during pregnancy, and not less percentage maintained this condition postpartum, that associated with a high disability grade.

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This study investigated the occurrence, prevalence, mean abundance and mean intensity of monogenoidean parasites in Piaractus mesopotamicus farmed in cages in the reservoir of the Itaipu Hydroelectric Power Station, Paraná River, Brazil. The parasite distribution pattern and the correlation of prevalence and abundance with the total length of hosts were also investigated. Four monogenoidean species were collected: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni and M. viatorum. All the parasites collected in P. mesopotamicus showed the typical aggregated distribution pattern, and the abundance and the prevalence did not shown any correlation with the total length of hosts.(AU)

Neste estudo foi investigada a ocorrência, prevalência, abundância média e intensidade média de Monogenoidea parasitos de Piaractus mesopotamicus, cultivados em tanques-rede no reservatório da Usina Hidrelétrica de Itaipu, rio Paraná, Brasil. Foram investigados ainda o padrão de distribuição parasitária e a correlação entre a prevalência e abundância com o comprimento total dos hospedeiros. Quatro espécies de Monogenoidea foram coletadas: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni e M. viatorum. Todos os parasitos coletados em P. mesopotamicus apresentaram típico padrão de distribuição agregada e não foi observada correlação entre a abundância e a prevalência e o comprimento total dos hospedeiros.(AU)

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Abstract This study investigated the occurrence, prevalence, mean abundance and mean intensity of monogenoidean parasites in Piaractus mesopotamicus farmed in cages in the reservoir of the Itaipu Hydroelectric Power Station, Paraná River, Brazil. The parasite distribution pattern and the correlation of prevalence and abundance with the total length of hosts were also investigated. Four monogenoidean species were collected: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni and M. viatorum. All the parasites collected in P. mesopotamicus showed the typical aggregated distribution pattern, and the abundance and the prevalence did not shown any correlation with the total length of hosts.

Resumo Neste estudo foi investigada a ocorrência, prevalência, abundância média e intensidade média de Monogenoidea parasitos de Piaractus mesopotamicus, cultivados em tanques-rede no reservatório da Usina Hidrelétrica de Itaipu, rio Paraná, Brasil. Foram investigados ainda o padrão de distribuição parasitária e a correlação entre a prevalência e abundância com o comprimento total dos hospedeiros. Quatro espécies de Monogenoidea foram coletadas: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni e M. viatorum. Todos os parasitos coletados em P. mesopotamicus apresentaram típico padrão de distribuição agregada e não foi observada correlação entre a abundância e a prevalência e o comprimento total dos hospedeiros.

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This study investigated the occurrence, prevalence, mean abundance and mean intensity of monogenoidean parasites in Piaractus mesopotamicus farmed in cages in the reservoir of the Itaipu Hydroelectric Power Station, Paraná River, Brazil. The parasite distribution pattern and the correlation of prevalence and abundance with the total length of hosts were also investigated. Four monogenoidean species were collected: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni and M. viatorum. All the parasites collected in P. mesopotamicus showed the typical aggregated distribution pattern, and the abundance and the prevalence did not shown any correlation with the total length of hosts.

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In a recent study by our group on the prevalence of intestinal parasitic infections and on the knowledge, attitudes and practices of local residents of Campos dos Goytacazes, Rio de Janeiro, Brazil, we observed that about 50% of the inhabitants were parasitized and had some knowledge of intestinal parasitic infections but did not apply this knowledge in daily practice. We were thus motivated to implement strategies in health education to promote preventive measures in the locality. The goal of the present work was to evaluate the influence of health education on the prevalence of intestinal parasitic infections in the region in an effort to strengthen public policies for controlling these diseases in Brazil. The methodology adopted was based on action-research and a theoretical framework of health promotion. Our results demonstrate that the study population exhibited an enhanced awareness of the importance of disease from intestinal parasitic infections. Attitudes and practices related to prevention were significantly improved after the shared health education. In conclusion, this study allowed the shared construction of knowledge that reflected the true needs of the residents.

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Objetivos: Correlacionar el diagnóstico clínico de la incontinencia urinaria con los resultados de la cistometría, obtenidas por urodinamia monocanal y evaluar la tolerancia de las pacientes al examen. Método: Entre agosto y octubre de 2006, se realizaron 64 urodinamias monocanal con medición de presión de retro-resistencia uretral (URP), en pacientes que consultaron por diagnóstico clínico de incontinencia de orina (IO). Se correlacionó el diagnóstico clínico con los resultados de la urodinamia. Se aplicó una escala de tolerancia subjetiva del examen, donde O es la mayor tolerancia y 10 el máximo desagrado. Resultados: En 38 pacientes se indicó urodinamia con diagnóstico clínico de incontinencia de orina de esfuerzo (IOE), registrándose en la urodinamia: 9 tipo 0, 2 tipo I, 13 tipo II, 1 tipo III, 13 tipo ll+lll. De las 10 con IO mixta: 3 fueron normal, 1 tipo 0, 1 tipo II, 1 tipo III, 1 tipo ll+lll, 3 detrusor hiperactivo. De las 14 pacientes con urgeincontinencia: 1 normal, 1 tipo II, 6 tipo ll+lll y 6 con detrusor hiperactivo. En la tolerancia al examen todas registraron 2 a 3 puntos. Conclusiones: La urodinamia monocanal más la medición de la URP es un examen complementario de gran utilidad en el estudio de la incontinencia urinaria. Permite planificar la solución adecuada para cada caso y tiene un alto grado de tolerancia en las pacientes.

Objective: To compare the clinical diagnosis of the urinary incontinence with the results obtained by mono-channel urodynamic and to evaluate the patient's tolerance to this examination. Method: Between August and October 2006, 64 urodynamic were made in patients with clinical diagnosis of urinary incontinence. The clinical diagnosis was compared with the urodynamic results. A subjective tolerance scale was applied (0 was greater tolerance and 10 was maximum discomfort). Results: In 38 patients with clinical diagnosis of stress urinary incontinence, the urodynamic registered 9 (type 0), 2 (type I), 13 (type II), 1 (I type II), 13 (type ll+lll). In 10 with mixed urinary incontinence, the urodynamic showed 3 (normal), 1 (type 0), 1 (type II), 1 (type III), 1 type (ll+lll) and 3 hyperactive detrusor. In 14 patients with urgency incontinence, urodynamic showed 1 normal, 1 (type II), 6 (type ll+lll) and 6 hyperactive detrusor. All patients expressed 2 and 3 de-gree tolerance. Conclusions: The monochannel urodynamic is a complementan/ examination very useful in the study of the urinary incontinence. It allows planning the solution adapted for each case and with a high degree of tolerance.

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The ultrastructure of the body tegument of Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasite of Mugil liza from Brazil, was studied by transmission electron microscopy. The body tegument is composed of an external syncytial layer, musculature, and an inner layer containing tegumental cells. The syncytium consists of a matrix containing three types of body inclusions and mitochondria. The musculature is constituted of several layers of longitudinal and circular muscle fibers. The tegumental cells present a well-developed nucleus, cytoplasm filled with ribosomes, rough endoplasmatic reticulum and mitochondria, and characteristic organelles of tegumental cells.

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Foi realizado o estudo do tegumento do corpo de Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasito de Mugil liza (tainha) do Canal de Marapendi, Rio de Janeiro, Brasil, pela microscopia eletrônica de transmissão. O tegumento é formado por uma camada externa sincicial, uma camada muscular e uma camada interna contendo células tegumentares. O sincício consiste em matriz com três tipos de corpos de inclusão e mitocôndrias. A musculatura é formada por diversas camadas de fibras musculares longitudinais e circulares. As células tegumentares apresentam núcleo bem desenvolvido, citoplasma preenchido por ribossomas, retículo endoplasmático rugoso e mitocôndrias, organelas características das células tegumentares.

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The ultrastructure of the body tegument of Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasite of Mugil liza from Brazil, was studied by transmission electron microscopy. The body tegument is composed of an external syncytial layer, musculature, and an inner layer containing tegumental cells. The syncytium consists of a matrix containing three types of body inclusions and mitochondria. The musculature is constituted of several layers of longitudinal and circular muscle fibers. The tegumental cells present a well-developed nucleus, cytoplasm filled with ribosomes, rough endoplasmatic reticulum and mitochondria, and characteristic organelles of tegumental cells.

Foi realizado o estudo do tegumento do corpo de Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasito de Mugil liza (tainha) do Canal de Marapendi, Rio de Janeiro, Brasil, pela microscopia eletrônica de transmissão. O tegumento é formado por uma camada externa sincicial, uma camada muscular e uma camada interna contendo células tegumentares. O sincício consiste em matriz com três tipos de corpos de inclusão e mitocôndrias. A musculatura é formada por diversas camadas de fibras musculares longitudinais e circulares. As células tegumentares apresentam núcleo bem desenvolvido, citoplasma preenchido por ribossomas, retículo endoplasmático rugoso e mitocôndrias, organelas características das células tegumentares.

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Previamente, habíamos demostrado la actividad que poseen amoxicilina-sulbactam y sulbactam solo frente a Escherichia coli en la orina. Realizamos un estudio para determinar la etiología de las infecciones urinarias bajas no complicadas de la comunidad (IUBNCC) en Sudamérica. Participaron 10 laboratorios de 8 países sudamericanos. Cada laboratorio envió al centro coordinador (CEA, Bs. Aires) los resultados de susceptibilidad a amoxicilina y amoxicilina-sulbactam por el método de discos en 100 aislamientos consecutivos obtenidos de pacientes de 3 a 70 años con IUBNCC y además remitieron 20 cepas de E. coli consecutivas consideradas resistentes a amoxicilina por el método de disco. En el CEA se comprobó la CIM de amoxicilina, amoxicilina-sulbactam (2:1) y sulbactam solo; se determinó el título inhibitorio de la orina (TIO) en 12 voluntarios que recibieron una dosis oral de 500:500 mg de amoxicilina-sulbactam. Las orinas se recolectaron a las 0 a 2,2 a 4 y 4 a 6 h luego de la administración de amoxicilina-sulbactam y los TIO se verificaron sobre 5 cepas de E. coli resistentes (R) y 1 cepa sencible (S) a amoxicilina-sulbactam seleccionadas con diferentes CIM, entre las recibidas de cada centro participante; se determinaron las concentraciones de amoxicilina y sulbactam en la orina por un método microbiológico. Resultados: E. coli fue predominante 820/1.000 (82 por ciento); P, mirabilis y K. pneumoniae (4,3 por ciento ambas); S. saprophyticus (4,1 por ciento) y otros (5,3 por ciento). Susceptibilidad por discos en E. coli: 59,4 por ciento R a amoxicilina; 16,9 por ciento intermedias (I) y 23,7 por ciento S y para amoxicilina-sulbactam 28 por ciento R, 19,2 por ciento I y 52,8 por ciento S. Determinación de CIM: se estudiaron 102 E. coli R a amoxicilina-sulbactam, las CIM 90 (µg/ml fueron: amoxicilina > 2.048; amoxicilina-sulbactam: 256/128 y sulbactam solo, 128. TIO: Variaron desde > 1/32 a las 2 h; 1/16-1/4 a las 4 h y 1/4-1/2 a las 6 h para todas cepas estudiadas. Niveles de ATB en orina (µg/mI): amoxicilina y sulbactam respectivamente a las 2 h: 1.414 y 1.904: a las 4 h: 691 y 1.257 y a las 6 h: 462 y 641. Nuestros resultados confirman el predominio de E. coli en IUBNCC en Sudamérica y explican las discrepancias entre las resistencia supuesta por el método de discos y los éxitos clínicos logrados con amoxicilina-sulbactam en IUBNCC

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Two species of Digenea were recorded for the first time in South America and in new hosts: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) was reported from Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) and Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae) from Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). From the latter, Heliconema heliconema Travassos, 1919 (Nematoda, Physalopteridae), was also recovered representing also a new host for this nematode species

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Two species of Digenea were recorded for the first time in South America and in new hosts: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) was reported from Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) and Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae) from Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). From the latter, Heliconema heliconema Travassos, 1919 (Nematoda, Physalopteridae), was also recovered representing also a new host for this nematode species.

Duas espécies de Digenea foram registradas pela primeira vez na América do Sul e em novos hospedeiros: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) foi coletado de Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) e Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae), de Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). Deste último hospedeiro, uma espécie de Nematoda Heliconema heliconema Travassos, 1919 (Physalopteridae) foi coletada, representando também um novo hospedeiro para este nematóide.

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Two species of Digenea were recorded for the first time in South America and in new hosts: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) was reported from Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) and Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae) from Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). From the latter, Heliconema heliconema Travassos, 1919 (Nematoda, Physalopteridae), was also recovered representing also a new host for this nematode species.

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