RESUMO
Resumo Num cenário epidêmico ainda preocupante, a prevenção da Transmissão Vertical (TV) do HIV impõe problemas complexos, devido as vulnerabilidades individual, social e moral das mulheres vivendo com o vírus, somadas às fragilidades da rede de saúde. A partir de um caso emblemático, este estudo buscou compreender os desafios bioéticos do cuidado para a prevenção da TV do HIV no âmbito do Comitê de Porto Alegre/RS. Os eixos analíticos desenvolvidos refletem sobre como a produção do cuidado se articula, por um lado, com discursos e práticas relacionais pautadas no gênero e interseccionadas por raça e classe social e, por outro, com vulnerabilidades programáticas das políticas de saúde. Vislumbrou-se um processo de extrema estigmatização, em que as poucas ofertas para as mulheres cisgênero se dirigiam à regulação reprodutiva e perpetuavam dinâmicas de violência estrutural. Discute-se caminhos para a construção de um cuidado que incorpore a perspectiva decolonial e busque produzir equidade e justiça social ao reconhecer as trajetórias das mulheres.
Abstract In a still worrying epidemic scenario, the prevention of Vertical Transmission (VT) of HIV poses complex problems, due to the individual, social, and moral vulnerabilities of women living with the virus, in addition to the weaknesses of the health network. Based on an emblematic case, this study sought to understand the bioethical challenges of HIV VT prevention in the scope of the Porto Alegre/RS Committee. The analytical categories developed reflect on how the production of care is articulated, on the one hand, with relational discourses and practices based on gender and intersected by race and social class and, on the other, with programmatic vulnerabilities of health policies. A process of extreme stigmatization was revealed, in which the few offers for cisgender women were aimed toward reproductive regulation and perpetuated dynamics of structural violence. We discuss ways of building care that incorporates a decolonial perspective and seeks to produce equity and social justice by recognizing women's trajectories.
Assuntos
Humanos , Masculino , Feminino , Mulheres , Bioética , HIV , Transmissão Vertical de Doenças Infecciosas , Enquadramento Interseccional , BrasilRESUMO
BACKGROUND AND AIM: Gonorrhea is a bacterial infection in the urogenital tract, transmitted by sexual or perinatal contact, caused by Neisseria gonorrhoeae, a gram-negative diplococcus. The present study evaluates the frequency of N. gonorrhoeae in women treated at Hospital Wladimir Arruda in poor area of São Paulo and also verifies the presence of genetic resistance against three antimicrobials of different classes: Tetracycline, Azithromycin and Ciprofloxacin. METHODS: This is an observational and descriptive study with a quantitative approach. Samples were collected at Hospital Escola Wladimir Arruda. The volunteers are women from 16 to 65 years of age. Sociodemographic, gynecological, sexual and health data are collected through a questionnaire, their symptoms/clinical manifestation were requested by the medical records, and then the participant is referred for collection of samples of cervical vaginal smear. The samples were screened for N. gonorrhoeae (dcmH gene) and tested for resistance genes to Tetracycline, Azithromycin and Ciprofloxacin through PCR. RESULTS: In the total of 127 samples analyzed by Real-Time PCR, 23 were positive and correspond to a general prevalence of a gonococcal infection in the studied population of 17% (CI:95%), and the participants were married (43.4%), had active sexual life (56.5%) and did not use any type of condom during sexual intercourse (52.1%). The resistance to the tetM ribosomal gene was found in 14 samples, prevalence of 60% (CI= 95%). CONCLUSIONS: We have described a concerning frequency of N. gonorrhoeae infection in females attended in an outcare patient. Also, most of the strains detected presented resistance to one or more antimicrobials.
Assuntos
Anti-Infecciosos , Gonorreia , Humanos , Feminino , Gonorreia/epidemiologia , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Azitromicina/uso terapêutico , Brasil/epidemiologia , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Neisseria gonorrhoeae/genética , Ciprofloxacina/uso terapêutico , Tetraciclina , Anti-Infecciosos/uso terapêuticoRESUMO
Resumo Este estudo visa evidenciar os esforços empreendidos pelos Tribunais de Contas (TCs) brasileiros no período de pandemia do coronavírus a fim de colaborar com seus jurisdicionados, seus servidores e a sociedade para o enfrentamento de seus efeitos. Realizou-se pesquisa descritiva, com abordagem qualitativa, por meio de análise das legislações emitidas pelos TCs, para avaliação das ações tomadas por eles. Entre os achados, destacam-se as ações de âmbito interno e pedagógicas empreendidas na forma de medidas destinadas ao público externo (como a limitação no atendimento presencial), à suspensão de eventos coletivos, de reuniões presenciais e viagens, à adoção de teletrabalho, ao contingenciamento de despesas, cursos à distância etc. Entre as ações processuais, destacam-se as suspensões de Sessões Plenárias ou das Câmaras, dos prazos processuais e da remessa das prestações de contas. Por fim, no tocante às ações orientativas e de monitoramento empreendidas pelos TCs, constatou-se que foi elaborada uma série de diretrizes e recomendações em relação às práticas adotadas pelos órgãos de controle externo de modo colaborativo aos demais poderes, de modo orientar os gastos públicos, a aquisição e a contratação de serviços com dispensa de licitação, entre outros riscos. Conclui-se que o conjunto de medidas implementadas pelos TCs demonstra mudança no status tradicional de controle posterior das contas públicas, que enseja uma atuação punitiva para um controle prévio e concomitante, por meio de recomendações, fiscalizações e monitoramento, quando o gestor ainda dispõe de instrumentos para corrigir eventuais erros e evitar o desperdício e a má aplicação do recurso público.
Resumen Este estudio tiene como objetivo evidenciar los esfuerzos realizados por los Tribunales de Cuentas (TC) brasileños en el período de la pandemia de coronavirus para colaborar con sus jurisdiccionales, funcionarios y la sociedad para enfrentar sus efectos. Se realizó una investigación descriptiva con enfoque cualitativo mediante el análisis de la legislación emitida por los TC para evaluar las acciones tomadas por los estos. Entre los resultados, se destacan las acciones administrativas y pedagógicas emprendidas en forma de medidas dirigidas al público externo, como la limitación en el servicio presencial, la suspensión de eventos colectivos, de reuniones presenciales y viajes; la adopción del teletrabajo, la restricción de gastos, y cursos de aprendizaje a distancia. Entre las acciones procesales están las suspensiones de sesiones plenarias o cámaras, de plazos procesales y de envío de las prestaciones de cuentas. Finalmente, con respecto a las acciones de orientación y supervisión emprendidas por los TC, se constató la elaboración de una serie de directrices y recomendaciones con relación a las prácticas adoptadas por los organismos de control externo de manera colaborativa con los otros poderes, a los efectos de orientar el gasto público, la adquisición y contratación de servicios sin licitación, entre otros riesgos. Se concluye que el conjunto de medidas implementadas por los TC muestra un cambio en el estatus tradicional: del control posterior de las cuentas públicas ‒ que da lugar a acciones punitivas ‒ hacia el control previo y concomitante, a través de recomendaciones, inspecciones y monitoreo, cuando el administrador tiene los instrumentos para corregir eventuales errores y evitar el desperdicio y la mala utilización de los recursos públicos.
Abstract This study aims to highlight the efforts made by the Brazilian Courts of Accounts (CAs) during the COVID-19 pandemic to collaborate with its jurisdictional authorities, civil servants, and society to face its effects. Descriptive and qualitative research was carried out, analyzing the legislation issued by the CAs to evaluate their actions. Among the findings, it was observed that the CAs took administrative and pedagogical measures to protect the public, such as the suspension or restriction of face-to-face service. Also, the courts suspended collective events, face-to-face meetings, and travel, adopted telework, limited expenditures and distance learning courses. Among the procedural measures, Plenary Sessions or Chambers, procedural deadlines, and remittance of accounts were suspended. Finally, the activities of guidance and monitoring were conducted under a series of guidelines and recommendations created collaboratively with other agencies and branches of government, guiding public spending, the acquisition and contracting of services with no bidding requirements, among other procedures. It is concluded that the set of measures implemented by the CAs shows a change in the traditional status of subsequent control of public accounts - which gives rise to punitive action - for prior and concurrent control, with recommendations, inspections, and monitoring, when the manager still has instruments to amend errors and avoid waste and misapplication of public resources.
Assuntos
Infecções por Coronavirus , Gestão em Saúde , Normas Jurídicas , Poder Legislativo , Pesquisa Qualitativa , Pandemias/prevenção & controle , Gastos Públicos com SaúdeRESUMO
A phytochemical study of Pavonia multiflora A. St-Hil. (Malvaceae) led to the isolation through chromatographic techniques of 10 secondary metabolites: vanillic acid (1), ferulic acid (2), p-hydroxybenzoic acid (3), p-coumaric acid (4), loliolide (5), vomifoliol (6), 4,5-dihydroblumenol A (7), 3-oxo-α-ionol (9), blumenol C (10), and taraxerol 4-methoxybenzoate (8), the latter being a novel metabolite. Their structures were identified by (1) H- and (13) C-NMR, using one- and two-dimensional techniques, and X-ray crystallography. In this work, we report the effect of compounds 5 and 8 on several photosynthetic activities in an attempt to search for new compounds as potential herbicide agents that affect photosynthesis. Both compounds inhibited the electron flow from H2 O to methyl viologen; therefore, they act as Hill reaction inhibitors. Using polarographic techniques and studies of the fluorescence of chlorophyll a, the interaction sites of these compounds were located at photosystem II.
Assuntos
Malvaceae/química , Ácido Oleanólico/análogos & derivados , Fotossíntese/efeitos dos fármacos , Complexo de Proteínas do Centro de Reação Fotossintética/antagonistas & inibidores , Técnicas In Vitro , Ácido Oleanólico/química , Ácido Oleanólico/isolamento & purificação , Ácido Oleanólico/farmacologia , Complexo de Proteínas do Centro de Reação Fotossintética/metabolismoRESUMO
BACKGROUND: Familial forms of hyperparathyroidism are responsible for approximately 10% of the cases of primary hyperparathyroidism, and their management is different from the sporadic forms. Our objective was to study the gene sequence and expression of HRPT2 and clinical outcome regarding recurrence or persistence rates in three Brazilian kindreds with familial hyperparathyroidism after up to 30 years of follow-up. METHODS: Clinical and biochemical data, direct sequencing of germline DNA of the HRPT2 gene, and analysis of parafibromin expression (HRPT2 gene product) using RT-PCR and immunohistochemistry of resected parathyroid neoplasms were performed. RESULTS: Affected members of kindred A were found to carry a novel, germline, nonsense mutation in exon 1 (c.96G>A; W32X) of HRPT2. Six of seven patients who have undergone less than total parathyroidectomy recurred after up to 30 years of follow-up. An unrelated affected patient from kindred B had a germline mutation in exon 7 (c.686delGAGT), and the disease recurred with several pulmonary metastases after 5 years follow-up. The affected member of kindred C also had a previously described mutation in exon 7 (c.679delAG) and the disease recurred after 10 years of follow-up. All parathyroid neoplasms from these families had diffuse loss of expression by immunohistochemistry. CONCLUSIONS: An unacceptable recurrence/persistence rate (80%) associated with increasingly difficult re-operations and risk of parathyroid carcinoma in the setting of germline mutations of HRPT2 gene with familial hyperparathyroidism suggest that a more aggressive operative approach should be undertaken in these patients. Parafibromin immunohistochemistry may serve as a cost-effective screen for HRPT2-related aggressive parathyroid disease.
Assuntos
Hiperparatireoidismo/genética , Proteínas Supressoras de Tumor/genética , Adolescente , Adulto , Idoso , Análise Mutacional de DNA , Feminino , Expressão Gênica , Humanos , Hiperparatireoidismo/cirurgia , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
Ossifying fibroma (OF) is a benign neoplasm related to bone characterized by a progressive enlargement of the affected jaw. Recently, the candidate tumor suppressor gene HRPT2 was identified and alterations in this gene were related with the Hyperparathyroidism-jaw tumor syndrome that is characterized by parathyroid adenoma or carcinoma, fibro-osseous lesions (mainly OF) of the jaws, and renal lesions. The purpose of the present study was to evaluate the HRPT2 gene in OF. Tumour and blood samples were obtained from 3 patients with OF and one with juvenile ossifying fibroma (JOF). The results demonstrated three novel mutations in two out of three genotyped OF's. Interestingly, one of these patients showed a germ-line mutation after blood analysis. RT-PCR amplification was performed to analyze HRPT2 mRNA expression and only wild-type HRPT2 transcript was found in all tumours. Investigation of the parafibromin protein by immunohistochemistry showed a similar pattern of immunolocalization with strong nuclear and cytoplasmic staining in all cases. In conclusion, the present study shows for the first time mutations of HRPT2 gene in OF and suggests that OF may arise due to haploinsufficiency of the HRPT2 gene.