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INTRODUÇÃO O hiperparatireoidismo é considerado uma causa endócrina de hipertensão arterial (HA) secundária. Contudo, a natureza dessa associação é ainda controversa na literatura. RELATO DE CASO Paciente de sexo masculino, 53 anos de idade, com antecedente de HA desde os 30 anos, em estágio III ao diagnóstico, evoluiu com HA refratária apesar do uso de 7 classes de anti-hipertensivos: Olmesartana (40mg/dia), Anlodipino (10mg/dia), Clortalidona (25mg/dia), Espironolactona (25mg/dia), Atenolol (50mg/dia) e Hidralazina (150mg/dia), mantendo PA total de 135/95 na MAPA de 24h e apresentando retinopatia hipertensiva grau II e microalbuminúria. Ao longo do acompanhamento foi identificado hiperparatireoidismo normocalcêmico: paratormônio (PTH)= 117 pg/mL (VR: 18-88); cálcio sérico total= 8,9 mg/dL; 25-OH- vitamina D= 17,8 ng/mL, com evidência de captação tênue de formação nodular filiforme adjacente ao polo superior do lobo tireoidiano esquerdo (1,4cmx0,2cm) em cintilografia de paratireoide. Dada a ausência de sintomas e por se tratar de alteração discreta, optou-se por tratamento conservador com reposição de colecalciferol e carbonato de cálcio. No entanto, apesar da reposição ao longo de um ano, o PTH permaneceu elevado (118 pg/mL) e a HA continuou refratária. DISCUSSÃO Numerosos estudos observacionais reportam uma correlação positiva entre PTH e níveis de PA, tanto no hiperparatireoidismo primario como no secundário, independente da presença de hipercalcemia. Alem disso, evidência experimental aponta efeitos vasoativos diretamente atribuíveis ao PTH, assim como aumento da secreção de renina, promoção de rigidez arterial e hipertrofia ventricular. Apesar disso, uma relação causal ainda não foi definitivamente estabelecida e alguns autores sugerem inclusive causalidade reversa. No caso aqui exposto a hipótese de associação causal é sugerida pela refratariedade do quadro hipertensivo que acompanha a elevação sustentada dos níveis de PTH. A comprovação dessa causalidade se daria pelo controle da HA mediante a paratireoidectomia. No entanto, em casos limítrofes como o presente, o procedimento não é rotineiramente indicado, não sendo portanto possível assinar um veredito de cumplicidade.
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Humanos , Masculino , Pessoa de Meia-Idade , HipertensãoRESUMO
This review summarizes the state of knowledge on athecate dinoflagellates occurring within the South Atlantic Ocean and Atlantic sector of the Southern Ocean. We compiled data from 105 articles and selected 33 addressing any aspect of athecate dinoflagellate studies. Our aim is to discuss the patterns in athecate dinoflagellate distribution by building a thorough species list and an occurrence map based on species recorded in coastal and oceanic waters. We found 69 species totaling 141 occurrences in the entire South Atlantic Ocean basin. Contradicting global trends, most species distributed throughout this region are subtropical. We linked this trend to a higher local effort in dinoflagellate research instead of higher biodiversity, especially when compared to usual hotspots in biodiversity attributed to tropical oceans. The Subantarctic and Antarctic regions had a low number of occurrences, with 12 and 5, respectively. Except for the occurrence of Gyrodinium lachryma in the Antarctic Zone, all records are unique, poorly described and never recorded again for species such as Gymnodinium baccatum and Gymnodinium antarcticum. This demonstrates that the state of knowledge regarding athecate dinoflagellates in the South Atlantic and especially in the Antarctic region is still limited due to a lack of directed investigation.
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Biodiversidade , Dinoflagellida , Dinoflagellida/classificação , Oceano Atlântico , Regiões AntárticasRESUMO
Objective Based on the relationship between sleep and sports performance, the present study aimed to evaluate sleep quality and excessive daytime sleepiness among adult CrossFit (CrossFit, LLC, Santa Cruz, CA, USA) practitioners and to verify possible associations with intestinal health. Methods This cross-sectional study involved males and females aged ≥ 18 years who had been regularly practicing CrossFit for at least 3 months. This survey used an online questionnaire addressing demographic and socioeconomic data, disease history, dietary characteristics, and questions regarding CrossFit. To assess intestinal health, the ROME IV Consensus Criteria and Bristol Scale were used. The Pittsburgh International Sleep Quality Index (PSQI-BR) and Epworth Sleepiness Scale were used to assess sleep quality. Results A total of 1,090 people (73.3% females) with a mean age of 31.2 ± 7.5 years were included. Considering the diagnosis of constipation, 36.9% of the patients were classified as constipated, especially females when compared with males ( p < 0.001). On the sleepiness scale, 22.4% of the volunteers showed excessive daytime sleepiness, which was also observed more frequently among females ( p = 0.013). In the PSQI-BR, 47.4% of participants were classified as having poor sleep quality (poor sleepers). The overall PSQI-BR score was 5.81 ± 2.85, with no difference between males and females ( p = 0.360). There was a positive correlation between the PSQI-BR global score and a diagnosis of constipation and excessive daytime sleepiness. There was a negative correlation between the stool type on the Bristol scale and the PSQI-BR global score. Conclusion The present study demonstrated that sleep quality was poor among CrossFit users, especially females, which can compromise their training performance.
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A role of IL-10 is down-regulating T-cell responses to schistosome antigens. Since SmATPDases can be correlated to modulation of the immune response, we evaluated the expression of enzymes in S. mansoni eggs. Faecal samples were collected from 40 infected individuals to detect coding regions of the SmATPDases. The cytokines were measured in supernatants of PBMC. The analysis was performed by the global median determination and set up high producers (HP) of cytokines. Six individuals expressed SmATPDase1, six expressed SmATPDase2 and six expressed both enzymes. The group who expressed only SmATPDase1 showed a high frequency of IFN-γ, TNF IL-4 HP; individuals who expressed only SmATPDase2 showed a high frequency of IFN-γ, IL-6 and IL-4 HP; and individuals who expressed both enzymes showed a high frequency of IL-10 HP. The comparison of the IFN-γ/IL-10 ratio presented higher indices in the group who had SmATPDase 2 expression than those who had the expression of both enzymes. The positive correlation between infection intensity and IL-10 levels remained only in the positive SmATPDase group. The IL-10 is the only cytokine induced by the expression of both enzymes. Our data suggest that the expression of both enzymes seems to be a factor that modulates the host immune response by inducing high IL-10 production.
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Schistosoma mansoni , Esquistossomose mansoni , Animais , Humanos , Interleucina-10/metabolismo , Interleucina-4/metabolismo , Leucócitos Mononucleares , Citocinas/metabolismoRESUMO
Secondary immunodeficiency can result from neoplasms, infections, or immunosuppressive therapy. Rituximab (RTX) is an anti-CD20 antibody that depletes B lymphocytes and can induce symptomatic hypogammaglobulinemia. We report 3 cases of symptomatic hypogammaglobulinemia associated with the use of RTX. In patient 1 with rheumatoid arthritis, RTX induced low levels of immunoglobulins and recurrent airway infections. RTX discontinuation led to a normalization of the humoral immune response. Patients 2 and 3, treated with RTX for non-Hodgkin lymphoma and systemic lupus erythematosus, respectively, developed persistent secondary hypogammaglobulinemia requiring immunoglobulin replacement therapy for years. After RTX discontinuation, patients may experience rapid recovery of humoral function or remain with low serum immunoglobulin levels for extended periods. With the increasing use of therapies targeting components of the immune system, a high degree of clinical suspicion for the development of secondary immunodeficiency may minimize the morbidity and mortality associated with these therapies.
As imunodeficiências secundárias podem ser uma consequência de neoplasias, infecções ou tratamentos imunossupressores. O rituximabe (RTX) é um anticorpo anti-CD20 que depleta os linfócitos B e pode induzir uma hipogamaglobulinemia sintomática. Aqui, relatamos três casos de hipogamaglobulinemia sintomática associada ao uso de RTX. Na primeira paciente com artrite reumatoide, o RTX induziu a baixos níveis de imunoglobulinas associadas a infecções de vias aéreas de repetição. Após a suspensão do RTX, houve normalização da resposta imune humoral. Os outros dois casos, com o uso de RTX para tratamento de linfoma não-Hodgkin e lúpus eritematoso sistêmico, respectivamente, as pacientes evoluíram com hipogamaglobulinemia secundária persistente, com necessidade de reposição de imunoglobulina por vários anos. Pacientes tratados com RTX podem apresentar, após a sua suspensão, uma recuperação rápida da função humoral ou permanecerem com baixos níveis séricos de imunoglobulinas por longos períodos. Com o crescente uso dos tratamentos direcionados para componentes do sistema imunológico, um alto grau de suspeição clínica para o aparecimento de imunodeficiências secundárias pode minimizar a morbimortalidade associada a estes tratamentos.
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Humanos , Feminino , Adulto , Pessoa de Meia-IdadeRESUMO
Introdução: a pneumonia é uma infecção nos pulmões, provocada pela penetração de microrganismos. Outras infeções respiratórias, incluindo a SARS-COV-2, podem agravar a clínica do paciente. Por sua vez, esta é uma doença sistêmica, com foco pulmonar que pode gerar complicações respiratórias, dentre elas a pneumonia. Neste seguimento, estudos evidenciam que 15% dos pacientes com COVID-19 podem apresentar pneumonia leve e 5% evoluir para pneumonia grave. Objetivo: comparar a ocorrência de morbimortalidade por pneumonia no Estado da Bahia, no período pré e durante a pandemia de COVID-19. Metodologia: trata-se de um estudo ecológico, quantitativo, com dados públicos, disponíveis no Sistema Informações em Saúde da plataforma DataSUS/ TABNet, referentes ao Estado da Bahia, no período de jan./2018 a dez./2021. Foram selecionados os dados: internamentos, média de internamento, óbitos e taxa de mortalidade. Os dados foram analisados através da estatística descritiva, frequência relativa, e estatística analítica com o teste de frequências relativas U de Mann-Whitney. Resultados: o Estado da Bahia, registrou um total de 48 mil internações por pneumonia, com média de taxa de permanência de internamento de 6,4 dias e um total de 8 mil óbitos, com média de taxa de mortalidade de 16,91% ao ano. Observa-se que ocorreu redução nas internações e óbitos, e aumento na taxa de mortalidade por pneumonia, no período estudado (P<0,001). Conclusão: contudo, verificou-se que no Estado da Bahia durante o período da pandemia de COVID-19, ocorreram redução no número de internados e óbitos, e aumento na taxa de mortalidade por pneumonia, comparando-se ao mesmo período pré pandemia.
Introduction: pneumonia is an infection in the lungs, caused by exposure to microorganisms. Other respiratory infections, including SARS-COV-2, may aggravate the patient's health condition. In turn, this is a systemic disease, with a pulmonary focus that can lead to respiratory complications, including pneumonia. In this area, studies show that 15% of patients with COVID-19 may have mild pneumonia and 5% progress to severe pneumonia. Objective: to compare the occurrence of morbidity and mortality from pneumonia in the State of Bahia, in the period before and during the COVID-19 pandemic. Methodology: this is an ecological, quantitative study, with public data, available in the Health Information System of the DataSUS/TABNet platform, referring to the State of Bahia, from Jan./2018 to Dec./2021. Selected data: hospitalizations, average hospitalization, deaths and mortality rate. Data were analysed using descriptive statistics, relative frequency, and analytical statistics with the Mann-Whitney U relative frequency test. Results: the State of Bahia recorded a total of 48,000 hospitalizations for pneumonia, with an average hospitalization stay rate of 6.4 days and a total of 8,000 deaths, with an average mortality rate of 16.91% per year. It is observed that there was a reduction in hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, in the studied period (P<0.001). Conclusion: however, it was found that in the State of Bahia during the period of the COVID-19 pandemic, there was a reduction in the number of hospitalizations and deaths, and an increase in the mortality rate due to pneumonia, compared to the same pre-pandemic period.
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Humanos , Masculino , Feminino , Pneumonia , Infecções Respiratórias , Sistema Único de Saúde , Indicadores de Morbimortalidade , COVID-19 , Broncopneumonia , Estudos Ecológicos , Estudos de Avaliação como AssuntoRESUMO
Introduction: The aim of the present study was to investigate the association between the single nucleotide polymorphism (SNP) rs1927914 A/G in TLR4 gene and the immunological profile of household contacts (HHC) of leprosy patients. Leprosy classification is usually complex and requires the assessment of several clinical and laboratorial features. Methods: Herein, we have applied distinct models of descriptive analysis to explore qualitative/quantitative changes in chemokine and cytokine production in HHC further categorized according to operational classification [HHC(PB) and HHC(MB)] and according to TLR4SNP. Results and discussion: Our results showed that M. leprae stimuli induced an outstanding production of chemokines (CXCL8;CCL2; CXCL9; CXCL10) by HHC(PB), while increase levels of pro-inflammatory cytokines (IL-6; TNF; IFN-γ; IL-17) were observed for HHC(MB). Moreover, the analysis of chemokine and cytokine signatures demonstrated that A allele was associated with a prominent soluble mediator secretion (CXCL8; CXCL9; IL-6; TNF; IFN-γ). Data analysis according to TLR4 SNP genotypes further demonstrated that AA and AG were associated with a more prominent secretion of soluble mediators as compared to GG, supporting the clustering of AA and AG genotypes into dominant genetic model. CXCL8, IL-6, TNF and IL-17 displayed distinct profiles in HHC(PB) vs HHC(MB) or AA+AG vs GG genotype. In general, chemokine/cytokine networks analysis showed an overall profile of AA+GA-selective (CXCL9-CXCL10) and GG-selective (CXCL10-IL-6) axis regardless of the operational classification. However, mirrored inverted CCL2-IL-10 axis and a (IFN-γ-IL-2)-selective axis were identified in HHC(MB). CXCL8 presented outstanding performance to classify AA+AG from GG genotypes and HHC(PB) from HHC(MB). TNF and IL-17 presented elevated accuracy to classify AA+AG from GG genotypes and HHC(PB) (low levels) from HHC(MB) (high levels), respectively. Our results highlighted that both factors: i) differential exposure to M. leprae and ii) TLR4 rs1927914 genetic background impact the immune response of HHC. Our main results reinforce the relevance of integrated studies of immunological and genetic biomarkers that may have implications to improve the classification and monitoring of HHC in future studies.
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Hanseníase , Mycobacterium leprae , Humanos , Interleucina-17 , Receptor 4 Toll-Like/genética , Interleucina-6 , Citocinas , Hanseníase/genética , Imunidade , QuimiocinasRESUMO
PURPOSE: Most individuals experience significant deterioration in their oral health-related quality of life (OHRQoL) in the first few days after tooth extraction. This study aimed to evaluate the impact of antimicrobial photodynamic therapy (aPDT) and low-level laser therapy (LLLT) protocols on OHRQoL after extraction of lower molars. METHODS: The investigators designed a double-blind, randomized controlled clinical trial study. Patients with indications for lower molar extraction were included in the study and randomized into four groups: control group, antimicrobial photodynamic therapy group, LLLT group (LLLT.G), and aPDT and LLLT group (aPDT + LLLT.G).The Oral Health Impact Profile (OHIP-14) questionnaire was used through an interview with the participants before the extraction (T0 - baseline) and on the 7th (T1) and 30th (T2) days after extraction. Other variables were age, sex, ethnicity, decayed-missing-filled teeth (DMFT) and tooth types. Appropriate univariate and bivariate statistics were computed, and statistical significance was set at a value P < .05. RESULTS: The sample was composed of 40 patients with a mean age of 41.25 ± 13.97 and 25 (62.5%) were women. The mean OHIP-14 scores were significantly different in the intervals at T0 versus T1 and T0 versus T2 for all domains (P < .001), demonstrating a positive impact on the OHRQoL. The total scores indicated a significant improvement in the OHRQoL in the aPDT (7.10, standard deviation 4.18, P = .043), LLLT (6.40, SD 5.87, P = .025), and aPDT + LLLT (5.30, SD 3.59, P = .012) groups compared to that in the control group (12.90, SD 6.64) at T1. Patients undergoing extraction of lower mandibular molars with aPDT + LLLT had the lowest mean OHIP-14 total score at T1 (5.30) and T2 (0.70). CONCLUSION: The aPDT and LLLT protocols had a positive impact on the participants' OHRQoL. These procedures can be applied in everyday surgical practice.
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Anti-Infecciosos , Terapia com Luz de Baixa Intensidade , Fotoquimioterapia , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Masculino , Terapia com Luz de Baixa Intensidade/métodos , Qualidade de Vida , Dente Molar/cirurgiaRESUMO
O objetivo deste estudo foi analisar a relação do ato de comer com o controle da doença e a qualidade de vida em adultos com diabetes tipo 1 (DM1). Trata-se de estudo transversal, realizado através de um questionário on-line com a versão brasileira do Diabetes Quality of Life Measure (DQOL-Brasil) e de perguntas sobre controle alimentar. Foram incluídos 103 voluntários (85,4% mulheres). Nas relações com a comida, 68,9% disseram sentir vontade de comer quando estão ansiosos, preocupados ou tensos. O escore global foi de 2,36 ± 0,75 no DQOL-Brasil, e os domínios "satisfação" e "preocupações relacionadas ao diabetes" apresentaram valores mais altos. A variável idade teve correlação negativa com o escore global do DQOL-Brasil e com os domínios "impacto", "preocupações sociais/vocacionais" e "preocupações com diabetes". Esta pesquisa demonstrou associação entre o ato de comer com o controle do DM1, o que pode prejudicar a qualidade de vida desses indivíduos.
This study aimed to analyze the relationship between eating behavior, disease control, and quality of life in adults with type 1 diabetes mellitus (DM1). This cross-sectional study was conducted using an online questionnaire based on the Brazilian version of the Diabetes Quality of Life Measure (DQOL-Brazil), comprising questions on dietary control. A total of 103 volunteers (85.4% women) were included in this study. In relation to food, 68.9% said that they felt like eating when they were anxious, worried, or tensed. The overall score was 2.36 ± 0.75 on the DQOL-Brazil, with higher scores for the domains "satisfaction" and "diabetes-related concerns." The age variable had a negative correlation with the global DQOL-Brazil score and with the domains "impact," "social/vocational concerns," and "diabetes-related concerns." This study demonstrated an association between the act of eating and DM1 control, affecting the quality of life in these individuals.
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The objective of this study was to analyze the association between sociodemographic and occupational variables with the lifestyle of health professionals in pediatric units during the COVID-19 pandemic. A cross-sectional study was conducted with 407 health professionals working in four pediatric health units in the State of Bahia, northeast Brazil. The Fantastic Lifestyle Questionnaire and a questionnaire with sociodemographic and employment variables self-applied via Google Forms were used. The final binary logistic regression models revealed significant associations between those who received 3 to 5 minimum wages, without a marital relationship and with more than one employment relationship. Data suggest that these sociodemographic and occupational profiles are more exposed to risky lifestyle behaviors. The findings of this study demonstrated the need for greater attention to the health of health professionals in the pediatric field, as well as the promotion of initiatives that seek to value the work of these professionals and reduce the damage caused to their lifestyle, especially in a pandemic scenario.
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COVID-19 , Humanos , Criança , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Estilo de Vida , Atenção à SaúdeRESUMO
OBJETIVO: Analisar a experiência da enfermidade da mulher com câncer de mama e os caminhos percorridos em busca da saúde. MÉTODO: A abordagem qualitativa e exploratória foi utilizada com a escolha do Estudo de Caso. As informações apreendidas foram analisadas, ordenadas e classificadas em categorias empíricas e articuladas aos referenciais teóricos. RESULTADOS: Observou-se que os caminhos em busca da saúde podem ser antagônicos a uma rede de atenção hierarquizada e sistematizada. Barreiras funcionais se mostraram presentes, ao desnudar as dificuldades encontradas pela usuária na resolutividade. Evidenciou-se que o cuidado interprofissional e o uso das tecnologias leves podem ser ferramentas potentes para o cuidado integral. CONCLUSÃO: O estudo aponta que o caminho em busca do cuidado integral pode ser arraigado por teias, que envolvem os sujeitos e suas escolhas dentro ou fora do sistema e das redes de atenção à saúde.
OBJECTIVE: To analyze the illness experience of a woman with breast cancer and the paths taken in search of health. METHOD: A qualitative and exploratory approach was used with the choice of the Case Study. The information gathered was analyzed, sorted, and classified into empirical categories, which were later linked to theoretical frameworks. RESULTS: It was observed that the paths in search of health could be antagonistic to a hierarchical and systematized care network. There were functional barriers, as the difficulties encountered by the user were exposed. It was shown that interprofessional care and the use of light technologies could be powerful tools for integral care. CONCLUSION: The study points out that the path in search of comprehensive care can be rooted in webs, which involve the subjects and their choices within or outside the health care system and networks.
OBJETIVO: Analizar la experiencia de enfermedad de una mujer con cáncer de mama y los caminos recorridos en la búsqueda de la salud. MÉTODO: Se utilizó un enfoque cualitativo y exploratorio con la elección del Estudio de Caso. La información recopilada fue analizada, ordenada y clasificada en categorías empíricas, que luego fueron vinculadas a marcos teóricos. RESULTADOS: Los caminos en busca de la salud pueden ser antagónicos a una red de atención jerarquizada y sistematizada. Existían barreras funcionales, pues se exponían las dificultades encontradas por el usuario. Se demostró que el cuidado interprofesional y el uso de tecnologías livianas pueden ser herramientas poderosas para el cuidado integral. CONCLUSIÓN: La busca de la integralidad de la atención puede radicar en redes, que involucran a los sujetos y sus elecciones dentro o fuera del sistema y de las redes de salud.
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Neoplasias da Mama , Assistência Centrada no Paciente , Itinerário TerapêuticoRESUMO
Brain-derived neurotrophic factor (BDNF) is the most abundant brain neurotrophin and plays a critical role in neuronal growth, survival and plasticity, implicated in the pathophysiology of Bipolar Disorders (BD). The single-nucleotide polymorphism in the BDNF gene (BDNF rs6265) has been associated with decreased hippocampal BDNF secretion and volume in met carriers in different populations, although the val allele has been reported to be more frequent in BD patients. The anterior cingulate cortex (ACC) is a key center integrating cognitive and affective neuronal connections, where consistent alterations in brain metabolites such as Glx (Glutamate + Glutamine) and N-acetylaspartate (NAA) have been consistently reported in BD. However, little is known about the influence of BDNF rs6265 on neurochemical profile in the ACC of Healthy Controls (HC) and BD subjects. The aim of this study was to assess the influence of BDNF rs6265 on ACC neurometabolites (Glx, NAA and total creatine- Cr) in 124 euthymic BD type I patients and 76 HC, who were genotyped for BDNF rs6265 and underwent a 3-Tesla proton magnetic resonance imaging and spectroscopy scan (1 H-MRS) using a PRESS ACC single-voxel (8cm3) sequence. BDNF rs6265 polymorphism showed a significant two-way interaction (diagnosis × genotype) in relation to NAA/Cr and total Cr. While met carriers presented increased NAA/Cr in HC, BD-I subjects with the val allele revealed higher total Cr, denoting an enhanced ACC metabolism likely associated with increased glutamatergic metabolites observed in BD-I val carriers. However, these results were replicated only in men. Therefore, our results support evidences that the BDNF rs6265 polymorphism exerts a complex pleiotropic effect on ACC metabolites influenced by the diagnosis and sex.
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Transtorno Bipolar , Masculino , Humanos , Transtorno Bipolar/diagnóstico por imagem , Transtorno Bipolar/genética , Giro do Cíngulo/metabolismo , Fator Neurotrófico Derivado do Encéfalo/genética , Imageamento por Ressonância Magnética , Polimorfismo de Nucleotídeo Único/genéticaRESUMO
Objetivou-se analisar o perfil demográfico e clínico dos casos de hanseníase e associar os fatores relacionadas às incapacidades físicas com a Atenção Primária à Saúde(APS)na perspectiva de Redes de Atenção à Saúde em Sinop, Mato Grosso. Trata-se de um estudo transversal, que percorreu três etapas analíticas: conhecimento do perfil epidemiológico; classificação da capacidade da Atenção Primária em coordenar as Redes de Atenção à Saúde; correlação dessa classificação com o número de casos novos, desfecho e o Grau de Incapacidade Física e correlação do número de casos novos e a média de cobertura da Atenção Primária por meio do coeficiente de correlação de Pearson. Foram considerados os casos novos de hanseníase notificados no período de 2014 a 2018. Dos 1.649 casos novos, 63% foram mulheres, entre 15 e 59 anos (83%),com até nove anos de estudo (47%),e negros (61%). Cura respondeu por 86% dos registros. Predomínio de Grau de incapacidade física0no diagnóstico (58%) e ausência de avaliação no desfecho (17,1%). Todas as Atenção Primária à Saúde foram classificadas como 'condição boa' na coordenação das Redes de Atenção. O abandono apresentou 'correlação moderada' com a capacidade da Atenção Primária em coordenar as Redes de Atenção e a média de cobertura da Atenção Primária com o número de casos indicou correlação 'muito alta'. A Atenção Primária, na perspectiva da Rede de Atenção, se mostrou efetiva no controle e na condução da hanseníase no território municipal.
The objective was to analyze the clinical epidemiological profile of leprosy cases and associate this profile with primary health care from the perspective of health care networks. This is a cross-sectional study that covered three analytical stages: knowledge of the epidemiological profile; classification of the capacity of the APS to coordinate the RAS; correlation of this classification withthe numberof new cases, outcome and the Degree of Physical Disability (GIF),and correlation of the number of new cases and the average coverage of PHC, using the Pearson correlation coefficient. New cases of leprosy reported in the period from 2014 to 2018 were considered. Of the 1,649 new cases, 63% were women, between 15 and 59years (83%), with up to nine years of education (47%) and black (61% ). Healing accounted for 86% of the records. The predominance of GIF 0 in the diagnosis (58%) and absence ofevaluation in the outcome (16%). All UBS were classified as 'good condition' in the RAS coordination. Dropout showed a 'moderate correlation' with the PHC's ability to coordinate the RAS and the mean PHC coverage with the number of cases indicated a 'veryhigh' correlation. APS, from the perspective of RAS, proved to be effective in controlling and managing leprosy in the municipal territory.
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Atenção Primária à Saúde , Doenças Endêmicas , HanseníaseRESUMO
We surveyed macronutrients and dissolved iron (DFe) concentrations and speciation in a transect over the shelf of the South Brazil Bight (SBB) at Santa Marta Grande Cape (SE Brazil) during a coastal downwelling episode. Driven by dominant NE winds, coastal downwelling is a common feature during the austral summer and force after water convergence, with contribution of internal wave breaking at the shelf edge, upwelling of macronutrients into the nutrient-depleted waters of the southbound Brazil Current at ~100 km from the coastline. As a result, we found a plume of high turbidity that reached the euphotic layer, a deepening of the silicate, nitrate, and phosphate isolines over the shelf and a bulging of the nitrate and phosphate isolines over the shelf edge and the slope. Our first measurements of DFe concentration and speciation in the area revealed that against prior findings in other coastal areas, macronutrients, DFe, and iron ligand cycles were disentangled. Higher DFe concentrations were often found at the surface indicating aerial deposition. Secondary DFe maxima over the sediment-water interface and in the upwelled plume indicated DFe fluxes from the sediment and from resuspended instable colloids. Iron ligand concentrations were higher than DFe concentrations in most stations with a clear land-to-ocean gradient. Subtraction of HS iron ligands revealed that except in upwelled water, the bulk of surface ligands was the result of local biological processes. The analysis of the concentrations of Fe-HS complexes showed that the contribution of HS to DFe was dominant in upwelled waters, significant in waters close to the coast, but nearly negligible in the rest of the studied area. We hypothesize that the injection of iron-humic complexes into the euphotic layer during summer upwelling episodes is the key to understanding the persistent high chlorophyll meanders found over the shelf edge of the SBB coast.
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The COVID-19 pandemic has highlighted the inequalities in health care access in Brazil, exarcerbating vulnerabilities and social determinants of health. Inequality is part of the context of rural populations, especially rural workers and family and subsistence farmers due to both the direct consequences of work activity and the unfavorable socioeconomic context, especially regarding service provision, the guaranteeing of rights, and the coordination of care networks. This article reviews challenges to the health of these workers and outlines proposals for disease prevention in the context of the COVID-19 pandemic.
Apandemia de covid-19 no mundo trouxe à tona as desigualdades vivenciadas no acesso à saúde no Brasil, escancarando as vulnerabilidades e os determinantes sociais de saúde. É nesse ínterim de iniquidades que as populações rurais se inserem, em especial trabalhadores e trabalhadoras rurais e membros da agricultura familiar e de subsistência, tanto pelas consequências diretas da atividade laboral quanto pelo contexto socioeconômico desfavorável, especialmente no que diz respeito a oferta de serviços, garantia de direitos e articulação das redes de assistência. Frente a isso, o presente trabalho discute os desafios relacionados à saúde desses trabalhadores e traça propostas para a prevenção de agravos da referida população no contexto da pandemia de covid-19.
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Introdução: Muitas mulheres sofrem com sintomas associados à menopausa, que podem apresentar diferentes graus de intensidade e afetar sua qualidade de vida. Objetivo: Identificar a prevalência e severidade dos principais sintomas nas diferentes fases do climatério. Métodos: Foram selecionadas mulheres com idades entre 40 e 65 anos, que responderam a um questionário on-line com dados sociodemográficos, de saúde, alimentação e características menstruais e de menopausa. Para avaliar os sintomas da menopausa e sua intensidade, foi aplicado o questionário internacional validado Menopause Rating Scale (MRS). Resultados: Foram incluídas 283 mulheres (36,8% na pré-menopausa, 24% na perimenopausa e 39,2% na pós-menopausa). Excesso de peso foi mais prevalente na perimenopausa do que na pré-menopausa (P=0,012). Sintomas como diminuição da libido, secura vaginal, incontinência urinária, dores musculares e articulares, alterações lipídicas e ondas de calor, calorões, foram mais prevalentes em valores absolutos nas mulheres pós-menopausa. As mulheres no período de perimenopausa apresentaram maior prevalência, em valores absolutos, de estresse, irritabilidade, dor de cabeça, problemas na pele, falta de concentração/memória, distúrbios do sono e fadiga. De acordo com o MRS, não houve diferença no domínio psicossocial (P=0,265) e os sintomas somato-vegetativos e urogenitais são mais intensos nas mulheres na perimenopausa e pós-menopausa, quando comparadas com as mulheres na pré-menopausa (P<0,001). O escore global do questionário também demonstra essa intensidade menor no grupo pré-menopausa (P=0,001). Conclusões: Este estudo demonstrou uma prevalência e severidade maior de sintomas em mulheres na perimenopausa e pós-menopausa, o que pode prejudicar a qualidade de vida dessas mulheres nessa fase da vida
Introduction: Many women experience symptoms associated with menopause that present with different degrees of intensity and affect their quality of life. Objective: To identify the prevalence and severity of the main symptoms during different climacteric phases. Methods: Women aged 4065 years answered an online questionnaire on sociodemographic data, health, diet, menstrual, and menopausal characteristics. The internationally validated Menopause Rating Scale (MRS) questionnaire was used to assess menopausal symptoms and their intensities. Results: 283 women were included (36.8% pre-menopausal, 24% peri-menopausal, and 39.2% post-menopausal). Excess weight was more prevalent in the peri-menopausal group than in the pre-menopausal group (P=0.012). Symptoms such as decreased libido, vaginal dryness, urinary incontinence, muscle and joint pain, lipid alterations, and hot flashes were more prevalent in the absolute values of post-menopausal women. Women in the peri-menopausal period had a higher prevalence, in absolute values, of stress, irritability, headache, skin problems, lack of concentration/memory, sleep disorders, and fatigue. According to the MRS, there was no difference in the psychosocial domain (P=0.265) but somato-vegetative and urogenital symptoms are more intense in peri-menopausal and post-menopausal women when compared to pre-menopausal women (P<0.001). The global score on the questionnaire also demonstrated a lower intensity in the pre-menopausal group's symptoms (P=0.001). Conclusions: This study demonstrated a higher prevalence and severity of symptoms in peri-menopausal and post-menopausal women, which may impair the quality of life of these women at this stage of life.
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Humanos , Feminino , Qualidade de Vida , Climatério , Menopausa , Prevalência , Estudos Transversais , Saúde da Mulher , Pré-Menopausa , Pós-Menopausa , Perimenopausa , DietaRESUMO
This work compared biofloc technology and aquamimicry technologies in Litopenaeus vannamei lined ponds, using a density of 60 shrimp·m-2. The experiment lasted 120 days, with two treatments, bioflocs (TBio) and aquamimicry (TMi), and three replications for each. In both treatments, the average values of the water quality parameters were as follows: temperature was 24.0 ± 0.32 °C, dissolved oxygen was 8.00 ± 0.45 mg·L-1, pH was 8.40 ± 0.20, and alkalinity was 240.01 ± 37.15 mg·L-1. The control of water quality was effectively maintained in both treatments, indicating the aquamimicry system's capability to efficiently recycle the nutrients found in the lined ponds' water. Furthermore, both treatments demonstrated efficiency in shrimp production, and the shrimp from the TMi treatment reached an average final weight of 11.73 ± 2.21 g, average survival of 53.3 ± 15.2%, and productivity of 3.56 ± 0.15-ton·ha-1. The TBio shrimp reached a final weight of 11.48 ± 1.25 g, survival of 63.3 ± 8.16%, and productivity of 4.08 ± 1.10-ton·ha-1. The present study demonstrated that TMi treatment ponds presented zootechnical performances close to those of TBio treatment ponds. The results achieved can contribute to the improvement of this cultivation system to use it in higher stocking densities.(AU)
Este trabalho comparou as tecnologias sistema de bioflocos e aquamimicry em viveiros revestidos de Litopenaeus vannamei,usando densidade de 60 camarões·m-2. O experimento teve duração de 120 dias e envolveu dois tratamentos, bioflocos (TBio) e aquamimicry (TMi), e três repetições para cada um. Em ambos os tratamentos, os valores médios dos parâmetros de qualidade da água foram os seguintes: temperatura = 24,0 ± 0,32 °C, oxigênio dissolvido = 8,00 ± 0,45 mg·L-1, pH = 8,40 ± 0,20, e alcalinidade = 240,01 ± 37,15 mg·L- 1. O controle da qualidade da água foi efetivamente mantido em ambos os tratamentos, indicando a capacidade do sistema aquamimicry de reciclar eficientemente os nutrientes encontrados na água dos tanques revestidos. Além disso, ambos os tratamentos demonstraram eficiência na produção de camarões. Os camarões procedentes do tratamento TMi atingiram peso final médio de 11,73 ± 2,21 g, sobrevivência média de 53,3 ± 15,2% e produtividade de 3,56 ± 0,15 ton·ha-1. Os camarões do TBio alcançaram peso final de 11,48 ± 1,25 g, sobrevivência de 63,3 ± 8,16% e produtividade de 4,08 ± 1,10 ton·ha-1. O presente estudo demonstrou que viveiros do tratamento TMi apresentaram desempenhos zootécnicos próximos aos dos viveiros do tratamento TBio. Os resultados alcançados podem contribuir para o aprimoramento desse sistema de cultivo com o objetivo de utilizá-lo em densidades de estocagens mais elevadas.(AU)
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Animais , Aquicultura , Penaeidae/crescimento & desenvolvimento , Simbióticos/análise , Ração Animal/análise , Brasil , PesqueirosRESUMO
Objective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended. Level of Evidence V, Expert Opinion.
Objetivo: O Consenso Brasileiro de Viscossuplementação do Quadril visa gerar uma fonte referencial a partir do conhecimento teórico e da experiência clínica de especialistas da área. Métodos: Um painel multidisciplinar foi formado com quinze especialistas (médicos do esporte, ortopedistas, fisiatras e reumatologistas), com base na experiência clínica e acadêmica no uso da viscossuplementação do quadril. Foram elaboradas, discutidas e votadas doze afirmativas. Cada membro do painel deu um valor entre 0 e 10 numa escala tipo Likert, especificando seu nível de concordância com a afirmação. Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação do quadril, destacando-se: a melhor indicação é para tratar artrose de quadril leve a moderada; pode ser indicada para casos graves; os resultados podem variar de acordo com o viscossuplemento utilizado; não deve ser realizada como procedimento isolado, mas em conjunto com outras medidas reabilitadoras e farmacológicas; a melhor técnica para infiltração no quadril deve se basear nas referências anatômicas combinadas com guiagem por imagem; a viscossuplementação do quadril é um procedimento custo-efetivo. Conclusão: A viscossuplementação é uma alternativa terapêutica segura e eficaz na osteoartrite do quadril, mesmo em casos graves. Recomenda-se o uso de métodos guiados. Nível de Evidência V, Opinião do Especialista.
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Objetivo: mapear o acesso ao diagnóstico e os impactos no cuidado em mulheres com câncer de mama em um serviço de referência estadual no nordeste do Brasil. Métodos: Abordagem qualitativa exploratória, com dados coletados por meio de entrevista a partir de um roteiro semiestruturado. O local escolhido para a coleta dos dados foi um Centro Estadual de Oncologia. A amostra foi composta por 11 participantes, embasando-se na saturação das respostas para a sua composição. A interpretação de dados foi realizada pelo método de análise de conteúdo. Resultados: As entrevistas revelam que a produção do diagnóstico em câncer de mama se inicia por diversos caminhos, um deles é por meio dos mutirões de mamografia, ou seja, através de campanhas focalizadas. Nesse percurso, as mulheres acessam diferentes pontos da rede de atenção, enfrentando as lacunas deixadas pelos serviços de saúde, como o déficit de comunicação e a fragmentação do cuidado. Portanto, é necessário que haja uma interlocução efetiva entre os serviços, visando minimizar os atrasos no diagnóstico e no início da terapêutica, possibilitando, assim, a continuidade da atenção. Conclusões: O diagnóstico do câncer por muitas vezes ainda é realizado por campanhas de detecção, mas, para tanto, há ainda itinerários produzidos por estas mulheres com muitas barreiras que dificultam o acesso aos resultados. Uma dessas barreiras é a comunicação, a qual se estabelece um obstáculo importante para continuidade do cuidado e consequentemente a resolutividade precoce desta condição de saúde.
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OBJECTIVE: To assess the burden and consequences of migraine in Brazil in terms of health-related quality of life (HRQoL), work productivity and daily activities, and healthcare resource utilization (HRU). BACKGROUND: Despite existing data on how migraine affects populations worldwide, there are limited data on the burden of migraine in Latin America. METHODS: This cross-sectional study used patient-reported data from the 2018 Brazil National Health and Wellness Survey. HRQoL scores (EuroQol 5-dimension 5-level [EQ-5D-5L]; 36-item Short Form Health Survey, version 2 [SF-36v2]; and Short Form 6-dimension [SF-6D]), impairments to work productivity and daily activities (Work Productivity and Activity Impairment questionnaire), and all-cause HRU were compared between migraine respondents and matched non-migraine controls. RESULTS: Of the 12,000 total respondents in the survey database, 1643 self-reported a physician diagnosis of migraine and were propensity score matched 1:1 with controls without migraine. HRQoL was lower in patients with migraine versus non-migraine controls, with significantly lower SF-36v2 physical (mean [± SD] 50.3 [7.5] vs. 52.0 [7.6]) and mental component (mean [± SD] 42.9 [10.2] vs. 46.0 [9.9]) summary scores and SF-6D (mean [± SD] 0.7 [0.1] vs. 0.7 [0.1]) and EQ-5D-5L (mean [± SD] 0.7 [0.2] vs. 0.8 [0.2]) utility scores (all p < 0.001). Patients with migraine reported higher levels of work productivity loss (mean [± SD], 40.6% [31.4%] vs. 28.6% [30.9%], including absenteeism 12.8% [19.1%] vs. 8.4% [17.1%] and presenteeism 35.0% [28.7%] vs. 24.8% [28.0%]; all p < 0.001); activity impairment (mean [± SD] 36.0% [28.8%] vs. 25.5% [28.1%]; p < 0.001); and significantly higher HRU in the past 6 months (healthcare provider and emergency department visits [mean [± SD] 7.2 [9.5] vs. 4.5 [6.3] and 1.7 [3.8] vs. 0.9 [2.2]; both p < 0.001] and hospitalizations [mean [± SD] 0.4 [2.7] vs. 0.2 [1.1]; p = 0.002]) than controls. CONCLUSION: Migraine is associated with poorer HRQoL, higher all-cause HRU, and greater activity impairment and work productivity loss versus non-migraine controls in Brazil.