Marco contextual: La hipertensión arterial es el factor de riesgo de enfermedad cardiovascular (HTA) con mayor prevalencia. El conocimiento básico de la salud es la primera dimensión de la alfabetización en la salud, la cual en Portugal presenta un nivel problemático y se la considera un problema de salud pública. Objetivo: Evaluar el nivel de conocimiento de los pacientes hipertensos sobre HTA e identificar variables que puedan estar relacionados. Metodología: Estudio descriptivo-exploratorio transversal. De los 3050 pacientes hipertensos, 307 constituyeron la muestra, no probabilística y por conveniencia. Se utilizó un cuestionario para evaluar conocimiento y actitudes. Resultados: Veintisiete por ciento tiene muy buen nivel de conocimiento. Se verificó una relación estadísticamente significativa entre nivel de conocimiento y grupo de edad (p = 0,002), escolaridad (p = 0,000) y actitud hacia el tratamiento (p = 0,004); y actitud hacia el tratamiento y control de la enfermedad (p = 0,050). Conclusión: Los enfermeros deben trabajando en la formación de los pacientes, con más empeño en la población de edad avanzada.

Enquadramento: A hipertensão arterial (HTA) é o fator de risco de doença cardiovascular com maior prevalência. O conhecimento básico em saúde é a primeira dimensão da literacia em saúde (LS), que, em Portugal, apresenta um nível problemático considerando-o um problema de saúde pública. Objetivo: Avaliar o nível de conhecimentos sobre HTA dos utentes hipertensos e identificar variáveis com as quais possam estar relacionados. Metodologia: Estudo descritivo-exploratório transversal. De 3050 utentes hipertensos inscritos numa unidade de saúde familiar (USF), 307 constituíram a amostra, determinada de forma não probabilística e por conveniência. Como instrumento de colheita de dados utilizou-se um questionário que avalia conhecimentos e atitudes destes utentes face à sua patologia. Resultados: Vinte e sete por cento apresentam conhecimentos de nível muito bom. Verificou-se relação estatisticamente significativa entre nível de conhecimentos e grupo etário (p = 0,002), escolaridade (p = 0,000) e atitude face ao tratamento (p = 0,004); e atitude face ao tratamento e controlo da doença (p = 0,050). Conclusão: Os enfermeiros devem trabalhar a capacitação dos utentes, intervindo de forma incisiva na população mais idosa.

Background: High blood pressure (HBP) is the dominant risk factor for cardiovascular diseases. Basic health knowledge is the first dimension of health literacy (LS), which in Portugal presents a disturbing level, thus becoming a public health problem. Objective: To assess the level of knowledge about HBP among individuals with this condition and identify potentially related variables. Methodology: Cross-sectional descriptive study conducted in a non-probabilistic sample of 307 individuals selected by convenience from 3050 hypertensive patients registered in a family health unit (USF). For data collection, a questionnaire was used to assess the knowledge and attitudes of individuals with HBP regarding their condition. Results: Twenty-seven percent possess a very good level of knowledge. A statistically significant relationship was found between level of knowledge and age group (p = 0.002), education level (p = 0.000), and attitude toward treatment (p = 0.004); and between attitude toward treatment and control of disease (p = 0.050). Conclusion: Nurses should persist in empowering patients and intervene more closely in the oldest population.

RESUMO Objetivo Investigar as alterações histológicas relacionadas à resposta inflamatória e à expressão de colágeno durante a cicatrização em ratos com desnutrição protéica. Métodos Vinte ratos Wistar machos foram submetidos à cirurgia cutânea e divididos em dois grupos experimentais: Desnutridos (dieta com caseína a 8%); Nutridos (17% de dieta com caseína). Animais foram eutanasiados após 5 e 10 dias, análises descritivas e quantitativas foram realizadas em cortes corados com hematoxilina-eosina e sirius vermelho, respectivamente. Análise estatística dos dados utilizando teste exato não paramétrico de Fisher com p<0,05 foi realizada. Resultados Aos cinco dias, observou-se aumento da proliferação fibroblástica (p<0,01) e expressão de colágeno (p<0,05) no grupo N5. Após 10 dias, animais N10 e MN10 apresentaram maior quantidade de tecido de granulação e edema/infiltrado inflamatório independente do estado nutricional (p>0,05), apenas grupo N10 apresentou proliferação fibroblástica (p<0,01) e aumento da expressão de colágeno (p<0,01). Conclusão A desnutrição protéica parece não influenciar na fase inflamatória da cicatrização, porém afeta negativamente a proliferação de fibroblastos e a síntese de colágeno.

ABSTRACT Objective Investigate histological changes related to inflammatory response and collagen expression during wound healing in rats with protein malnutrition. Methods Twenty male Wistar rats underwent cutaneous surgery and were divided into two experimental groups: Malnourished (8% casein diet); Nourished (17% casein diet). Animals were euthanized after 5th and 10th days, descriptive and quantitative analyses were performed on sections stained with hematoxylin-eosin and sirius red, respectively. Statistical analysis of data using nonparametric Fisher's exact test with p<0.05 was carried out. Results At five days, increased fibroblast proliferation (p<0.01) and collagen expression (p<0.05) was observed in N5 group. After ten days, N10 and MN10 animals showed higher amount of granulation tissue and edema/inflammatory infiltrate independent of nutritional status (p>0.05), only N10 group showed fibroblast proliferation (p<0.01) and increased collagen expression (p<0.01). Conclusion Protein malnutrition seems not to influence inflammatory phase of healing, whereas it negatively effects fibroblast proliferation and collagen synthesis.

Resumo Fundamentos: Os biomarcadores oxidativos exercem um importante papel na gênese dos processos relacionados ao risco cardiometabólico. Objetivo: Investigar a capacidade antioxidante total do plasma e sua associação com risco cardiometabólico em adultos jovens, não obesos e clinicamente saudáveis. Métodos: Estudantes universitários do estado de Sergipe, Brasil, com idade entre 18 e 25 anos, foram recrutados entre maio de 2013 e outubro de 2014. Parâmetros antropométricos, clínicos e bioquímicos foram medidos e analisados usando protocolos previamente padronizados e descritos na literatura. A medida da capacidade antioxidante total do plasma baseou-se na capacidade de todos os antioxidantes presentes na amostra (plasma) em inibir a oxidação do substrato oxidável ABTS (2,2-Azino-bis-(3-etilbenzotiazolina-6-sulfonato) a ABTS•+ pela metamioglobina. Resultados: Aproximadamente 25% da amostra apresentaram mais de um componente do risco cardiometabólico. Valores baixos de HDL foram o componente mais prevalente. Em comparação à ausência de componentes, os indivíduos com pelo menos um componente apresentou valores mais altos de peso corporal, circunferência da cintura, pressão sanguínea diastólica, glicemia de jejum e razão colesterol total/HDL-c, e valores mais baixos de HDL-c (p < 0,05). A glicemia de jejum foi o único parâmetro que se associou com a capacidade antioxidante total (R2 = 0,10; β = 0,17; p = 0,001). Conclusões: A capacidade antioxidante total não foi capaz de predizer os componentes do risco cardiometabólico possivelmente devido ao estabelecimento de mecanismos compensatórios que se tornam ativados em condições fisiológicas.

Abstract Background: The oxidative biomarkers play an important role in the genesis of cardiometabolic risk-related processes. Objective: To investigate the total antioxidant capacity of plasma and its association with cardiometabolic risk in non-obese and clinically healthy young adults. Methods: University students of the state of Sergipe, Brazil, aged between 18 and 25 years, were recruited for this study from May of 2013 and October of 2014. Anthropometric, clinical and biochemical parameters were measured and analyzed using protocols which were previously standardized and described in the literature. The measurement of plasma total antioxidant capacity was based on the ability that all the antioxidants present in the sample (plasma) have to inhibit the oxidation of the oxidizable substrate ABTS (2,2`- Azino-di-[3-ethylbenzthiazoline sulphonate]) to ABTS•+ by metmyoglobin. Results: Approximately 25% of the sample presented more than one component of cardiometabolic risk. Low HDL-cholesterol was the most prevalent component. Compared to absence of components, the subjects with at least one component presented greater body weight and waist circumference, higher levels of diastolic blood pressure and fasting glucose, greater total cholesterol/HDL-c ratio, and lower levels of HDL-c (p < 0.05). Fasting glycemia was the only parameter which was associated with total antioxidant capacity (R2 = 0.10; β = 0.17; p = 0.001). Conclusions: The plasma total antioxidant capacity was not able to predict the cardiometabolic risk components due possibly to the establishment of compensatory mechanisms that become activated in physiological conditions.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an intracellular bacillus of airborne transmission. The disease affects the skin and peripheral nerves and can cause neurological sequelae. The bacillus multiplies slowly in the host and the disease probably occurs due to malfunctioning in host immune response. This review addresses the role of some specific micronutrients in the immune response, such as Vitamins A, D, E, C, Zinc and Selenium, detailing their mechanisms of actions in infectious diseases, and in leprosy. The immune response to pathogens releases harmful substances, which lead to tissue damage. This review discusses how a decreased level of antioxidants may contribute to an increased oxidative stress and complications of infectious diseases and leprosy. As the nutrients have a regulatory effect in the innate and adaptative immune responses, a perfect balance in their concentrations is important to improve the immune response against the pathogens.

La lepra es una enfermedad infecciosa crónica causada por el Mycobacterium leprae, un bacilo intracelular de transmisión aérea. La enfermedad afecta la piel y los nervios periféricos y causa secuelas neurológicas. El bacilo se multiplica lentamente en el hospedador y posiblemente la enfermedad ocurre por el mal funcionamiento de la respuesta inmunitaria del hospedador. Esta revisión aborda el papel de algunos micronutrientes específicos en la respuesta inmunitaria, tales como las vitaminas A, D, E, C, el cinc y el selenio, detallando sus mecanismos de acción en las enfermedades infecciosas y en la lepra. La respuesta inmunitaria a los patógenos libera sustancias nocivas que producen lesión tisular. Esta revisión también aborda cómo una menor cantidad de antioxidantes puede contribuir a un aumento del estrés oxidativo y a complicaciones de las enfermedades infecciosas y la lepra. Puesto que los micronutrientes poseen un efecto regulador de la respuesta inmunitaria innata y adaptativa, es importante un equilibrio perfecto de sus concentraciones para mejorar la respuesta inmunitaria frente a los patógenos.

Introduction Leprosy is a chronic disease that affects skin and peripheral nerves. Disease complications include reactional episodes and physical impairment. One World Health Organization (WHO) goal of leprosy programs is to decrease the number of grade 2 impairment diagnoses by 2015. This study aims to evaluate clinical factors associated with the occurrence of leprosy reactions and physical impairment in leprosy patients. Methods We conducted a retrospective study of data from medical records of patients followed in two important centers for the treatment of leprosy in Aracaju, Sergipe, Brazil, from 2005 to 2011. We used the chi-square test to analyze associations between the following categorical variables: gender, age, operational classification, clinical forms, leprosy reactions, corticosteroid treatment, and physical impairment at the diagnosis and after cure. Clinical variables associated with multibacillary leprosy and/or reactional episodes and the presence of any grade of physical impairment after cure were evaluated using the logistic regression model. Results We found that men were more affected by multibacillary forms, reactional episodes, and grade 2 physical impairment at diagnosis. Leprosy reactions were detected in a total of 40% of patients and all were treated with corticosteroids. However, physical impairment was observed in 29.8% of the patients analyzed at the end of the treatment and our multivariate analysis associated a low dose and short period of corticosteroid treatment with persistence of physical impairments. Conclusions Physical impairment should receive an increased attention before and after treatment, and adequate treatment should be emphasized.

Introduction Schistosomiasis is endemic in 74 countries and is considered a serious public health problem in some locations. Methods A transverse study was performed of 13 landless settlements in southern Sergipe from February to December 2009. The study included 822 settlers, of whom 601 underwent stool testing. Results The prevalence of schistosomiasis in landless workers was 4.3%. The population has a low education level, and basic sanitation services are not available to all residents. Conclusions The prevalence of schistosomiasis was low in the population and among different settlements, possibly because of different forms of water use by the settlers.

OBJETIVO: Avaliar aspectos ultrassonográficos associados à morbidade em pacientes com formas clínicas crônicas de esquistossomose mansônica, utilizando-se protocolo proposto pela Organização Mundial da Saúde (OMS). MATERIAIS E MÉTODOS: Foram avaliadas duas populações distintas: a) área endêmica e b) institucional terciária, com histopatológico confirmando fibrose. Critérios de inclusão: diagnóstico confirmado por parasitológico de fezes para Schistosoma mansoni (método Kato-Katz). Critérios de exclusão: sorologia positiva para HIV, HTLV-1, VHB ou VHC. Foi utilizado protocolo ultrassonográfico de Niamey, proposto pela OMS. RESULTADOS: Avaliando-se isoladamente as medidas dos espaços periportais, estas se mostraram sem alterações em 21% dos indivíduos com doença avançada da instituição terciária. Utilizando-se todos os parâmetros do protocolo, 100% dos indivíduos da instituição terciária, com forma grave da doença, apresentaram fibrose periportal avançada. Em pacientes hepatoesplênicos da área endêmica não se identificou fibrose à ultrassonografia. CONCLUSÃO: O protocolo ultrassonográfico proposto pela OMS detecta fibrose periportal avançada nos pacientes com forma grave da doença, com maior sensibilidade do que a medida do espaço periportal isoladamente. A complexidade de identificação das fases iniciais da fibrose periportal, em áreas endêmicas, pela ultrassonografia, pode suscitar o campo da complementação diagnóstica e a continuidade do aprimoramento dos protocolos ultrassonográficos nestas áreas.

OBJECTIVE: To evaluate sonographic features associated with morbidity in patients with chronic clinical presentations of schistosomiasis mansoni, according to the protocol proposed by the World Health Organization (WHO). MATERIALS AND METHODS: Two distinctive populations were evaluated: a) patients from an endemic area, and b) patients from a tertiary institution, with histopathologically confirmed periportal fibrosis. Inclusion criteria: diagnosis confirmed by parasitological stool examination for Schistosoma mansoni (Kato-Katz method). Exclusion criteria: positive serology for HIV, HTLV-1, HBV or HCV. The Niamey protocol on ultrasonography proposed by the WHO was utilized. RESULTS: As the measures of periportal spaces were isolatedly evaluated, no alteration was observed in 21% of the tertiary institution patients with advanced disease. As all parameters of the Niamey protocol were considered, 100% of patients from the tertiary institution, with severe disease, presented advanced periportal fibrosis. In hepatosplenic patients from endemic areas, fibrosis was not identified at ultrasonography. CONCLUSION: The sonographic protocol proposed by the WHO can detect advanced periportal fibrosis in patients with severe form of disease with higher sensitivity than the isolated measurement of periportal space. The complexity involved in the sonographic identification of early stages of periportal fibrosis in endemic areas may give rise to the field of diagnostic supplementation and to a continued improvement of sonographic protocols in these areas.

INTRODUÇÃO: A esquistossomose é endêmica no Brasil, com elevada prevalência no Estado de Sergipe, apesar da existência do Programa de Controle da Esquistossomose (PCE). MÉTODOS: Foi realizado levantamento de dados do PCE-Sergipe de 2005 a 2008. A partir da matriz bruta formulou-se planilha de dados no software Access e analisou-se frequência e distribuição geográfica das infecções por Schistosoma mansoni e outros enteroparasitos. Estes dados foram exportados para o software Spring 5.0.5 para georreferenciamento e confecção de mapas temáticos de distribuição espacial e temporal por ano de avaliação. RESULTADOS: Foram positivos para S. mansoni 13,6% (14471/106287) de exames nos anos de 2005, 11,2% (16196/145069) em 2006, 11,8% (10220/86824) em 2007 e 10,6% (8329/78859) em 2008. A análise de mapas mostrou elevada prevalência da doença em Sergipe, em particular nos municípios Ilha das Flores, Santa Rosa de Lima, Santa Luzia do Itanhi e São Cristóvão. Além disso, avaliamos a associação entre as frequências dessas doenças parasitárias com indicadores sociais e de desenvolvimento dos diferentes municípios, de acordo com os dados do Instituto Brasileiro de Geografia e Estatística (IBGE) e da Superintendência de Recursos Hídricos (SRH). Observamos que os municípios com prevalência da esquistossomose maior do que 15% têm menor concentração de rede de esgotos (índice de higiene); p = 0,05. Adicionalmente, os municípios com prevalência de infecção por ancilostomídeos maior do que 10% apresentam um menor IDH educacional; p = 0,04. CONCLUSÕES: Ressalta-se a importância de maior controle dos fatores de risco ambientais e educacionais, na tentativa de reduzir prevalências dessas doenças parasitárias.

INTRODUCTION: Schistosomiasis is endemic in Brazil, with high prevalence in the State of Sergipe, despite the existence of the Schistosomiasis Control Program (PCE). METHODS: The data from Sergipe's PCE between 2005 and 2008 were surveyed. From the raw information, a database was created on a spreadsheet using the Access software. The frequency and geographic distribution of infections due to Schistosoma mansoni and other intestinal parasites were analyzed. These data were exported to the Spring 5.0.5 software for georeferencing and preparation of thematic maps of the spatial and temporal distribution according to year of evaluation. RESULTS: In 2005, 13.6% (14,471/106,287) of the tests were positive for S. mansoni, 11.2% (16,196/145,069) in 2006, 11.8% (10,220/86,824) in 2007 and 10.6% (8,329/78,859) in 2008. Analysis on the maps showed that there was high prevalence of the disease in Sergipe, and particularly in the municipalities of Ilha das Flores, Santa Rosa de Lima, Santa Luzia do Itanhi and São Cristóvão. Furthermore, we evaluated the association between the frequencies of these parasitic diseases and social and developmental indicators in the different municipalities, according to data from the Brazilian Institute for Geography and Statistics (IBGE) and the Department of Water Resources (SRH). We found that municipalities with schistosomiasis prevalence higher than 15% had lower coverage of sewage systems (hygiene index) (p = 0.05). Additionally, municipalities with hookworm prevalence higher than 10% had lower educational HDI (p = 0.04). CONCLUSIONS: The importance of greater control over environmental risk and educational factors needs to be emphasized in attempts to reduce the prevalence of these parasitic diseases.

Human T cell leukemia virus type-I (HTLV-I) infection is associated with spontaneous T cell activation and uncontrolled lymphocyte proliferation. An exacerbated type-1 immune response with production of pro-inflammatory cytokines (interferon-gamma and tumor necrosis factor-alpha) is significantly higher in patients with myelopathy associated to HTLV-I than in HTLV-I asymptomatic carriers. In contrast with HTLV-I, a chronic Schistosoma mansoni infection is associated with a type-2 immune response with high levels of interleukin (IL-4, IL-5, and IL-10) and low levels of IFN-gamma. In this study, clinical and immunological consequences of the HTLV-I and S. mansoni infection were evaluated. The immune response in patients with schistosomiasis co-infected with HTLV-I showed low levels of IL-5 (p < 0.05) in peripheral blood mononuclear cells cultures stimulated with S. mansoni antigen (SWAP) and decreased SWAP-specific IgE levels when compared with patients with only schistosomiasis (p < 0.05). Liver fibrosis was mild in all HTLV-I co-infected patients. Immunological response was also compared in individuals who had only HTLV-I infection with those who were co-infected with HTLV-I and helminths (S. mansoni and Strongyloides stercoralis). In patients HTLV-I positive co-infected with helminths the IFN-gamma levels were lower than in individuals who had only HTLV-I. Moreover, there were fewer cells expressing IFN-gamma and more cells expressing IL-10 in individuals co-infected with HTLV-I and helminths. These dates indicate that HTLV-I infection decrease type 2-response and IgE synthesis and are inversely associated with the development of liver fibrosis. Moreover, helminths may protect HTLV-I infected patients to produce large quantities of pro-inflammatory cytokines such as IFN-gamma.

This study objective was to evaluate the cytokines associated with early events of hepatic fibrosis in schistosomiasis mansoni. Hepatic fibrosis was classified by ultrasonography in 94 patients. Immunological evaluation was performed by measurement of secreted cytokines (interleukin IL-5, IL-10, IL-13, interferon-gamma, tumor necrosis factor-alpha and transforming growth factors-beta) in peripherl blood mononuclear cells stimulated by Schistosoma mansoni antigens. Significantly, higher levels of IL-5, IL-10 and IL-13 were found in supernatants of SEA-stimulated PBMC from subjects with degree III hepatic fibrosis as compared to patients with degree I or II fibrosis, Significant increases in IL-5 and IL-13 levels were also observed in some of the subjects who remained untreated for one year following initial assessment and developed more serious fibrosis during this period. The data suggests a role for type 2 cytokines in early stages of hepatic fibrosis in human schistosomiasis mansoni.