RESUMEN Introducción: Las infecciones agudas de vías respiratorias inferiores, de etiología viral, constituyen la principal causa de hospitalización y mortalidad infantil. El objetivo del presente estudio es conocer la frecuencia de las infecciones respiratorias agudas grave (IRAG) y los virus prevalentes en pacientes ≤15 años. Materiales y Métodos: Estudio observacional, descriptivo, producto de la vigilancia de IRAG, periodo enero/2019-mayo/2023. Se incluyeron todos los pacientes ≤15 años hospitalizados con diagnóstico de IRAG. Se analizaron datos demográficos, características clínicas y evolutivas. Resultados: Fueron hospitalizados 256 pacientes ≤15 años con diagnóstico de IRAG, 54,3%(139/256) de sexo masculino. El 69,1% correspondían a <2años, 15,6% de 2 a 4 años y 15,2% de 5 a 19 años. El 17,5% presentaban factores de riesgo. El 3,5% (9/256) tenía vacuna anti-influenza. El mayor número de casos se objetivó en 2019. En 2020 y 2021 se registró el menor número de casos, relacionado a la política de encierro durante la pandemia de COVID-19. El virus prevalente fue el Virus Sincitial Respiratorio (VSR). En el 2019, el VSR fue el virus más frecuente (p<0.0001.RR=1,56.IC95%= 1,18 - 2,06); el SARS - CoV2 fue el más frecuente en 2020. Según grupo etario el VSR fue más frecuente en <2 años (p<0.0001.RR=1,70.IC95%=1,18-2,06) y el SARS - CoV2 en los ≥2 años (p<0.0001.RR=2,50.IC95%=2,53-3,53). El VSR no fue asociado a factores de riesgo. El 39,4%(101/256) requirió ingreso a la UCIP, situación más frecuente en pacientes con factores de riesgo (21,7%vs14,8%,NS). El ingreso a UCI fue más frecuente en los <2 años (44,1% vs 29,1%;p<0,02.RR=1,51.IC95%=1,03-2,22). No hubo diferencias significativas del requerimiento de UCI y los virus aislados. La letalidad fue del 7,8%(20/256), más frecuente en el sexo femenino (p<0.02.RR=0,36.IC95%=0,1-0,9), no asociado a la edad ni etiología. Conclusion: La IRAG por VSR constituye una causa importante de hospitalización en <2 años, más frecuente en el sexo masculino. El ingreso a UCIP fue más frecuente en los <2años. La letalidad fue más frecuente en el sexo femenino.

ABSTRACT Introduction: Acute lower respiratory tract infections, of viral etiology, are the main cause of hospitalization and infant mortality. The objective of the present study is to know the frequency of severe acute respiratory infections (SARI) and prevalent viruses in patients ≤15 years of age. Materials and Methods: Observational, descriptive study, product of SARI surveillance, period January/2019-May/2023. All patients ≤15 years of age hospitalized with a diagnosis of SARI were included. Demographic data, clinical and evolutionary characteristics were analyzed. Results: 256 patients ≤15 years old with a diagnosis of SARI were hospitalized, 54.3% (139/256) male. 69.1% corresponded to <2 years, 15.6% from 2 to 4 years and 15.2% from 5 to 19 years. 17.5% had risk factors. 3.5% (9/256) had an anti-influenza vaccine. The highest number of cases was observed in 2019. In 2020 and 2021, the lowest number of cases was recorded, related to the confinement policy during the COVID-19 pandemic. The prevalent virus was Respiratory Syncytial Virus (RSV). In 2019, RSV was the most common virus (p<0.0001.RR=1.56.95%CI= 1.18 - 2.06); SARS - CoV2 was the most frequent in 2020. According to age group, RSV was more frequent in <2 years (p<0.0001.RR=1.70.CI95%=1.18-2.06) and SARS - CoV2 in those ≥2 years (p<0.0001.RR=2.50.95%CI=2.53-3.53). RSV was not associated with risk factors. 39.4% (101/256) required admission to the PICU, a more frequent situation in patients with risk factors (21.7% vs 14.8%,NS). Admission to the ICU was more frequent in those <2 years (44.1% vs 29.1%; p<0.02.RR=1.51.95%CI=1.03-2.22). There were no significant differences in the ICU requirement and the isolated viruses. The fatality rate was 7.8% (20/256), more frequent in females (p<0.02.RR=0.36.95%CI=0.1-0.9), not associated with age or etiology. Conclusion: SARI due to RSV is an important cause of hospitalization in <2 years, more frequent in males. Admission to the PICU was more frequent in those <2 years old. Fatality was more frequent in females.

Resumen Antecedentes: Se evalúa la influencia de la heterogeneidad ambiental en la comunidad de palmas a escala del paisaje en el límite norte de la distribución de la selva tropical húmeda en América. Preguntas: ¿Cómo la heterogeneidad a nivel de paisaje (edáfica, topográfica, así como la densidad, diversidad y biomasa arbórea) influye en la distribución de las especies de palma en una reserva forestal afectada por la defaunación? Sitio y años de estudio: El estudio se realizó en la Estación de Biológica Tropical Los Tuxtlas, Veracruz, México, en 2020. Métodos: Se delinearon unidades de paisaje (UP) basadas en suelo y geomorfología, se obtuvieron datos de la riqueza y abundancia de los árboles para caracterizar la heterogeneidad ambiental. Se analizó como influye la heterogeneidad ambiental en la composición, riqueza y abundancia de las especies de palma. Resultados: La abundancia y composición de las especies de palmas difirió entre las UP, en ambos casos fueron influenciadas por la presencia de fragmentos gruesos del suelo, altitud, inclinación de la pendiente y precipitación anual. La riqueza y densidad de árboles afectaron significativamente a la comunidad de palmas, pero sólo cuando se analizaron en combinación con variables edáficas y topográficas. Conclusiones: Los resultados revelan que existe una marcada heterogeneidad edáfica y topográfica que influye en la distribución de las especies de palmas a escala de paisaje, por lo que el enfoque de la heterogeneidad ambiental permite asociar la variación abiótica con los patrones de distribución de las especies y su coexistencia en comunidades tropicales altamente diversas.

Abstract Background: Our study presents the first assessment of the relationships between environmental heterogeneity and the palm community at the landscape scale at the northern boundary of tropical rainforest distribution in America. Question: How does landscape-level heterogeneity (edaphic, topographic as well as the density, diversity, and tree biomass) shapes the palm community in a protected reserve affected by defaunation? Study site and date: The study was carried out in Los Tuxtlas Tropical Biology Station, Veracruz, Mexico (2020). Methods: We delineated landscape units (LUs) based on soil and geomorphology to characterize the biophysical mosaic. We built rank-abundance curves to compare the palm richness and their abundance among LUs. Permutational multivariate analysis of variance (PERMANOVA) and nonmetric multidimensional scaling (NMDS) were applied to detect shifts in the palm community across LUs. Results: Integrating abiotic and biotic components by delimiting LUs allowed us to evaluate the multifactorial effect of environmental heterogeneity on the palm community. The density and composition of the palms changed significantly among the LUs, influenced by soil coarse fragments, elevation, slope inclination, and annual precipitation. Tree richness and density had a significant effect on the palm community only when analyzed in combination with the soil-topography variables. Conclusions: The results reveal that there is high edaphic and topographic heterogeneity that influences palm species distribution at the landscape scale. The environmental heterogeneity approach allows capturing novel abiotic variation to explain the distribution patterns of palm species and their coexistence in highly diverse tropical communities.

Abstract This study aims to analyze the development of critical thinking on gender issues in the context of higher education training, taking as a case study the work proposal "Gender(s)" which aimed to carry out a transdisciplinary project articulated between the Curricular Units of Workshop of Arts, Technologies and Multimedia IV (OATM IV) - Sculpture and Multimedia Art modules - and Art Theory, of the 2nd semester of the academic year 2019/2020, promoting reflection on the issue of Gender and critical thinking of undergraduate students in Visual Arts and Technologies of the School of Education of the Polytechnic of Lisbon. The aim of this project is to promote reflection on the gender issue and critical thinking among undergraduate Visual Arts and Technologies students at the School of Education of the Polytechnic of Lisbon.During the process, teachers assumed the role of facilitators, creating a space free of censorship, finding that students mobilized and developed critical thinking, in processes of investigation and artistic creation around gender stereotypes. The imagination of different gender possibilities led to a reflection about values as cultural constructions and to the awareness of each one's agency to reinvent them and contribute to social change. In this way, we consider that artistic production and/or interpretation of art works stimulate autonomous thinking, capable of dealing with new situations, through the projection of several alternative hypotheses. We conclude, therefore, that art education is a privileged space to stimulate the development of critical thinking, without resorting to preconceived ideas, being, therefore, potentially able to combat class, culture or gender stereotypes and, in this way, contribute to the creation of values that guide a socially fair action.

Resumo Este artigo pretende analisar o desenvolvimento do pensamento crítico sobre questões de género no contexto da formação no ensino superior, tomando como caso de estudo a proposta "Género(s)", que visou a realização de um projeto transdisciplinar articulado entre as Unidades Curriculares de Oficina de Artes, Tecnologias e Multimédia IV (OATM IV) - módulos de Escultura e Arte Multimédia - e de Teoria da Arte, do 2º semestre do ano letivo de 2019/2020, promovendo a reflexão sobre a questão de género e o pensamento crítico dos estudantes de Licenciatura em Artes Visuais e Tecnologias da Escola Superior de Educação do Politécnico de Lisboa. No decorrer do processo, os professores assumiram um papel de facilitadores, criando um espaço livre de censura e constatando que os estudantes mobilizaram e desenvolveram o pensamento crítico em processos de investigação e criação artística em torno de estereótipos sobre questões de género. A imaginação de diferentes possibilidades de géneros levou a uma reflexão sobre os valores enquanto construções culturais e à consciência do agenciamento de cada um para os reinventar e contribuir para a mudança social. Deste modo, consideramos que a produção artística e/ou a interpretação de obras de arte estimulam o pensamento autónomo, capaz de lidar com situações novas, através da projeção de várias hipóteses alternativas. Concluímos, assim, que a educação artística é um espaço privilegiado para estimular o desenvolvimento do pensamento crítico, sem recorrer a ideias pré-concebidas, sendo por isso potencialmente apto a combater os estereótipos de classe, cultura ou género e, deste modo, contribuir para a criação de valores orientadores de uma ação socialmente justa.

ABSTRACT Background Reduced or null expression of E-cadherin protein is a frequent cause of diffuse gastric cancer (DGC). More than 50% of patients with DGC present somatic variants in CDH1 gene. Objectives The objectives of this study were to study E-cadherin expression and identify variants in the CDH1 gene in gastric tumors of patients with DGC. Methods We studied 18 Mexican DGC patients who attended a hospital of the Mexican Social Security Institute; E-cadherin expression was determined by immunohistochemistry, and variants were identified by Sanger sequencing in promoter and coding regions. Predictive analysis was performed using PolyPhen-2 and HOPE software. Results We found that 56% of DGC patients showed reduced expression of E-cadherin. All patients carried CDH1 variants; overall, 12 different CDH1 variants were identified. Predictive analysis revealed that the rs114265540 variant was probably damaging, with a value of 0.985, indicating a functional impact on the E-cadherin protein. Variants rs34939176 and rs33964119 were identified as risk factors for DGC (odds' ratios [OR] = 31.3, 95% CI 6.3-154.0, p < 0.001; OR = 6.1, 95% CI 2.0-19.0, p < 0.001, respectively) given their elevated frequency and by comparing it with those reported for MXL population in the 1000 Genomes Project database. Conclusions In this Mexican population, the percentage of diffuse gastric tumors with reduced expression of E-cadherin was similar to that reported in other populations. All gastric tumors of DGC patients studied had somatic CDH1 gene variants; however, the rs114265540, rs34939176, and rs33964119 variants were importantly related to DGC.

Resumo: A Rede de Cuidados à Pessoa com Deficiência (RCPCD) foi implantada em 2012 como desdobramento das ações do Plano Viver sem Limite, sendo objeto de pesquisas recentes, entretanto, não foram encontrados estudos de avaliação do grau de implantação dessa rede. O objetivo deste artigo foi avaliar o grau de implantação da RCPCD em oito estados nas cinco regiões geográficas brasileiras. Realizou-se estudo de casos múltiplos mediante pesquisa avaliativa do grau de implantação da RCPCD nos estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul e São Paulo. Para tanto, desenvolveu-se um modelo lógico da política e uma matriz de medidas. O grau de implantação de sete estados foi classificado como moderado, somente o Amazonas obteve grau de implantação incipiente. Foram identificadas diferenças importantes na avaliação de cada fase desse processo, as fases de diagnóstico regional e adesão à rede obtiveram grau de implantação de moderado a avançado na maioria dos estados. Na fase da contratualização dos serviços, nenhum estado alcançou o grau avançado de implantação e a fase de acompanhamento e monitoramento da RCPCD basicamente não ocorreu em todos os estados. A matriz de medidas permite avaliar o grau de implantação da RCPCD. Ainda, o reconhecimento dos resultados do grau de implantação pelos grupos condutores e áreas técnicas estaduais referendou o uso desse instrumento. Salienta-se a necessidade de ações para o aprimoramento dessa implantação, tais como: fortalecer a regionalização, instituir grupos condutores regionais, garantir mecanismos de contratualização e definir critérios para certificação dos pontos de atenção.

Resumen: La Red de Atención a Personas con Discapacidad (RCPCD) se implementó en 2012 en el Sistema Único de Salud como resultado de las acciones del Plan Vivir sin Límite, y es objeto de una investigación reciente; sin embargo, no hay estudios de evaluación del grado de implementación de esta red. El objetivo de este estudio fue evaluar el grado de implementación de la RCPCD en ocho estados de las cinco regiones geográficas brasileñas. Se realizó un estudio de caso múltiple mediante una investigación evaluativa sobre el grado de implementación de la RCPCD en los estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul y São Paulo. Para ello, se elaboraron un modelo lógico de la política y una matriz de medidas. El grado de implementación de siete estados se clasificó como moderado, solamente Amazonas obtuvo un grado de implementación incipiente. Se identificaron diferencias importantes en la evaluación de cada fase de este proceso, las fases de diagnóstico regional y adhesión a la red lograron un grado de implementación de moderado a avanzado en la mayoría de los estados. En la fase de contratación de los servicios, ningún estado alcanzó el nivel avanzado de implementación, y la fase de seguimiento y monitoreo de la RCPCD básicamente no se realizó en todos los estados. La matriz de medidas permite evaluar el grado de implementación de la RCPCD, y el reconocimiento de los resultados del grado de implementación por parte de los grupos de dirección y el área técnica de los estados avaló su uso. Son necesarias más acciones para mejorar esta implementación, tales como: fortalecer la regionalización, establecer grupos de dirección regional, garantizar mecanismos de contratación y definir criterios para la certificación de puntos de atención.

Abstract: The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.

ABSTRACT Introduction: Immunogenicity has emerged as a challenge in the development of vaccines against coronavirus disease of 2019 (COVID-19). Immunogenicity is a determinant of the efficacy and safety of vaccines. This systematic review and associated meta-analysis summarized and characterized the immunogenicity of COVID-19 vaccines in randomized controlled trials (RCTs). Methods: Relevant RCTs were systematically sourced from different medical databases in August 2021. The risk ratios and mean differences with 95% confidence intervals were calculated. Results: Of 2,310 papers, 16 RCTs were eligible for review. These RCTs involved a total of 26,698 participants (15,292 males and 11,231 females). The pooled results showed a significant difference in the geometric mean titer between the vaccinated and control groups in favor of the vaccine group after 1 and 2 months of follow-up, for the young age group (18 - < 55y), and with different doses (P < 0.001). The difference in the older age group (>55y) was insignificant (P = 0.24). The seroconversion rate of spike neutralizing antibodies favored the vaccine groups 1 or 2 months after vaccination (P < 0.001). The seroconversion rate of the vaccine group was significantly different (P < 0.001) from that of the control group. Conclusions: Vaccination elicits immunogenicity in the follow-up period for all age groups and at low and large doses. Therefore, people should be encouraged to receive vaccines currently being offered. A boost dose has been asserted for the elderly.

Abstract The Yarinacocha lake is an emblematic ecosystem of the Peruvian Amazon, representing the main point of fish landing and a tourist attraction in the city of Pucallpa. The wide fauna diversity in this area has made it the target of various studies, although for fish species most of them were focused on commercial species. In this work, we carried out the first ichthyofauna species inventory of the Yarinacocha lake, sampling throughout the entire lake during the rainy and dry seasons and considering also all previously recorded species deposited in the Ichthyological Collection of the MUSM with the same locality. A total of 164 fish species were recorded, representing 10 orders (plus Eupercaria), 34 families and 116 genera. Characiformes was the order with more species (68 spp., 41.5%) followed by Siluriformes (59 spp., 36%), Cichliformes (17 spp., 10.5%), and Gymnotiformes (8 spp., 4.9%). The most highly represented families, including almost 55.5% of the total diversity obtained, were Characidae (23 spp., 14%), followed by Cichlidae (17 spp., 10.4%), Loricariidae (14 spp., 8.5%), Pimelodidae (13 spp., 7.9%), Doradidae (13 spp., 7.4%) and Anostomidae (12 spp., 7.3%). From the total fish species recorded in this study, only 22 are considered protected species following the IUCN criteria and 109 species have commercial importance, including 90 ornamental species (54.8%). Our results contribute to the knowledge of the ichthyofauna of the Yarinacocha lake and can be used as a starting point for its conservation and sustainable management over time.

Resumo O lago Yarinacocha é um ecossistema emblemático da Amazônia peruana, representando o principal ponto de desembarque de peixes e também uma atração turística da cidade de Pucallpa. A grande diversidade faunística nesta área a tornou alvo de vários estudos, embora para as espécies de peixes a maioria deles tenha sido focada em espécies comerciais. Neste trabalho, realizamos o primeiro inventário da ictiofauna do lago Yarinacocha, amostrando todo o lago durante as estações chuvosa e seca, e também considerando todas as espécies depositadas na Coleção Ictiológica do MUSM dessa localidade. Um total de 164 espécies de peixes foram registradas, representando 10 ordens (mais Eupercaria), 34 famílias e 116 gêneros. Characiformes foi a ordem com mais espécies (68 espécies, 41,5%), seguida por Siluriformes (59 espécies, 36%), Cichliformes (17 espécies, 10,5%) e Gymnotiformes (8 espécies, 4,9%). As famílias mais representadas, incluindo quase 55,5% da diversidade total obtida, foram Characidae (23 spp., 14%), seguido por Cichlidae (17 spp., 10,4%), Loricariidae (14 spp., 8,5%), Pimelodidae (13 spp., 7,9%), Doradidae (13 spp., 7,4%) e Anostomidae (12 spp., 7,3%). Do total de espécies de peixes registradas neste estudo, apenas 22 são consideradas espécies protegidas seguindo os critérios da IUCN e 109 espécies têm importância comercial, incluindo 90 espécies ornamentais (54,8%). Nossos resultados contribuem para o conhecimento da ictiofauna do lago Yarinacocha e podem ser utilizados como ponto de partida para sua conservação e manejo sustentável ao longo do tempo.

Abstract This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

Abstract: The Care Network for People with Disabilities (RCPCD) was implemented in 2012 as a consequence of the actions of the Viver sem Limite (Living without Limits) plan and has been the research object of recent studies. However, no published studies address the degree of implementation of this network. This study aimed to evaluate the degree of implementation of the RCPCD in eight states in the five regions of Brazil. This multiple case study performed evaluative research of the degree of implementation of the RCPCD in the states of Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul, and São Paulo. A logical model of the policy and a measurement matrix were developed. The degree of implementation of seven states was moderate, but Amazonas had an incipient degree of implementation. The evaluation of each stage of the process showed important differences, as the regional diagnosis and network adhesion stages presented moderate to advanced degrees of implementation in most states. In the service contracting stage, no state had an advanced degree of implementation, and the stage of follow-up and monitoring of the RCPCD was not even reached. The measurement matrix helps evaluate the degree of implementation of the RCPCD, and, by recognizing its results, the state steering groups and technical area recommend its use. Actions to improve this implementation, such as strengthening regionalization, establishing regional steering groups, ensuring contracting mechanisms, and defining criteria for certification of the care points, are necessary.

Resumen: La Red de Atención a Personas con Discapacidad (RCPCD) se implementó en 2012 en el Sistema Único de Salud como resultado de las acciones del Plan Vivir sin Límite, y es objeto de una investigación reciente; sin embargo, no hay estudios de evaluación del grado de implementación de esta red. El objetivo de este estudio fue evaluar el grado de implementación de la RCPCD en ocho estados de las cinco regiones geográficas brasileñas. Se realizó un estudio de caso múltiple mediante una investigación evaluativa sobre el grado de implementación de la RCPCD en los estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul y São Paulo. Para ello, se elaboraron un modelo lógico de la política y una matriz de medidas. El grado de implementación de siete estados se clasificó como moderado, solamente Amazonas obtuvo un grado de implementación incipiente. Se identificaron diferencias importantes en la evaluación de cada fase de este proceso, las fases de diagnóstico regional y adhesión a la red lograron un grado de implementación de moderado a avanzado en la mayoría de los estados. En la fase de contratación de los servicios, ningún estado alcanzó el nivel avanzado de implementación, y la fase de seguimiento y monitoreo de la RCPCD básicamente no se realizó en todos los estados. La matriz de medidas permite evaluar el grado de implementación de la RCPCD, y el reconocimiento de los resultados del grado de implementación por parte de los grupos de dirección y el área técnica de los estados avaló su uso. Son necesarias más acciones para mejorar esta implementación, tales como: fortalecer la regionalización, establecer grupos de dirección regional, garantizar mecanismos de contratación y definir criterios para la certificación de puntos de atención.

Resumo: A Rede de Cuidados à Pessoa com Deficiência (RCPCD) foi implantada em 2012 como desdobramento das ações do Plano Viver sem Limite, sendo objeto de pesquisas recentes, entretanto, não foram encontrados estudos de avaliação do grau de implantação dessa rede. O objetivo deste artigo foi avaliar o grau de implantação da RCPCD em oito estados nas cinco regiões geográficas brasileiras. Realizou-se estudo de casos múltiplos mediante pesquisa avaliativa do grau de implantação da RCPCD nos estados/casos: Amazonas, Bahia, Espírito Santo, Mato Grosso do Sul, Minas Gerais, Paraíba, Rio Grande do Sul e São Paulo. Para tanto, desenvolveu-se um modelo lógico da política e uma matriz de medidas. O grau de implantação de sete estados foi classificado como moderado, somente o Amazonas obteve grau de implantação incipiente. Foram identificadas diferenças importantes na avaliação de cada fase desse processo, as fases de diagnóstico regional e adesão à rede obtiveram grau de implantação de moderado a avançado na maioria dos estados. Na fase da contratualização dos serviços, nenhum estado alcançou o grau avançado de implantação e a fase de acompanhamento e monitoramento da RCPCD basicamente não ocorreu em todos os estados. A matriz de medidas permite avaliar o grau de implantação da RCPCD. Ainda, o reconhecimento dos resultados do grau de implantação pelos grupos condutores e áreas técnicas estaduais referendou o uso desse instrumento. Salienta-se a necessidade de ações para o aprimoramento dessa implantação, tais como: fortalecer a regionalização, instituir grupos condutores regionais, garantir mecanismos de contratualização e definir critérios para certificação dos pontos de atenção.

Abstract Introduction: Members of the Herpesviridae family have been described in patients with systemic lupus erythematous (SLE), but the clinical impact on renal function is not well known. Methods: HSV1, HSV2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8 were evaluated by molecular biology on admission in blood samples from 40 consecutive SLE patients hospitalized for lupus activity. Results: Patients were 90.0% female, 77.5% non-white, with average age of 32.7 ± 13.6 years. We found positivity for EBV (65.0%), CMV (30.0%), HSV-1 (30.0%), HHV-6 (12.5%), and HHV-7 (7.5%). For all viruses, age, SLEDAI, hematological tests, ferritin, LDH, C-reactive protein, and erythrocyte sedimentation rate (ESR) were not significant. However, EBV positivity was a significant factor for higher serum creatinine (3.0 ± 2.8 vs. 0.9 ± 0.8; P = 0.001) and urea (86 ± 51 vs. 50 ± 46; P = 0.03). Moreover, positive cases for EBV only or with combined co-infections (66.7%-CMV; 58.3%-HSV-1) or negative for EBV only were evaluated by Kruskal-Wallis test again showed statistical significance for serum creatinine and urea (both P ≤ 0.01), with posttest also showing statistical differences for renal dysfunction and EBV presence (alone or in combined co-infections). The presence of EBV viral load was also significant for nephrotic-range proteinuria, renal flare, and the need for hemodialysis. Conclusion: Members of the Herpeviridae family (mainly EBV, HSV-1 and CMV) are common on hospital admission of SLE patients, reaching 65% for EBV, which seems to be associated with renal dysfunction and could reflect a previous association or overlapping disease, which is not well understood.

Resumo Introdução: Membros da família Herpesviridae tem sido descritos em pacientes com lúpus eritematoso sistêmico (LES), mas o impacto clínico na função renal não é bem conhecido. Métodos: Avaliou-se HSV1, HSV2, VZV, EBV, CMV, HHV-6, HHV-7, HHV-8 por biologia molecular na admissão em amostras sanguíneas de 40 pacientes com LES consecutivos hospitalizados por atividade lúpica. Resultados: Pacientes 90,0% mulheres, 77,5% não brancos, idade média 32,7 ± 13,6 anos. Encontramos positividade para EBV (65,0%), CMV (30,0%), HSV-1 (30,0%), HHV-6 (12,5%), HHV-7 (7,5%). Para todos os vírus, idade, SLEDAI, exames hematológicos, ferritina, LDH, proteína C reativa, velocidade de hemossedimentação não foram significativos. Entretanto, positividade para EBV foi estatisticamente significativo para creatinina (3,0 ± 2,8 vs. 0,9 ± 0,8; P = 0,001) e ureia (86 ± 51 vs. 50 ± 46; P = 0,03) séricas mais elevadas. Ademais, casos positivos para EBV isolado ou com coinfecções combinadas (66,7%-CMV; 58,3%-HSV-1) ou negativos apenas para EBV foram avaliados pelo teste Kruskal-Wallis e novamente mostraram significância estatística para creatinina e ureia séricas (ambas P ≤ 0,01), com pós-teste mostrando também diferenças estatísticas para disfunção renal e presença de EBV (sozinho ou em coinfecções combinadas). A presença de carga viral do EBV também foi significativa para proteinúria de faixa nefrótica, inflamação aguda, necessidade de hemodiálise. Conclusão: Membros da família Herpeviridae (principalmente EBV, HSV-1, CMV) são comuns na admissão de pacientes com LES, chegando a 65% para EBV, que parece associar-se à disfunção renal podendo refletir associação prévia ou doença sobreposta, o que não é bem compreendido.

RESUMEN Introducción: El cáncer de mama es una enfermedad que va aumentando su incidencia anualmente; es así que en búsqueda de alternativas complementarias para el tratamiento, se han estudiado algunas plantas medicinales que contienen grandes cantidades de polifenoles, los cuales tienen efectos anticancerígenos como es el caso del Cenchrus echinatus L. Objetivo: Determinar la seguridad y el efecto protector del extracto etanólico de Cenchrus echinatus L. (cadillo) sobre el cáncer de mama inducido por 7,12-Dimetilbenzo[a]antraceno DMBA en Rattus rattus. Métodos: Estudio preclínico, experimental en ratones machos Balb/C53 y ratas Holtzman de ambos sexos. Se calculó la toxicidad aguda (DL50) y la toxicidad a 45 días mediante métodos de los probits y OECD respectivamente; para evaluar el efecto protector se utilizó el método de Barros 2004, también se registró microscópicamente la proliferación de células tumorales, utilizando el análisis estadístico descriptivo e inferencial, considerando p<0.05. Resultados: Los estudios de seguridad demuestran que el extracto no induce cambios significativos a nivel hematológico, bioquímico y anatomopatológico. Se logró un 76.92 % del efecto protector del extracto frente al cáncer de mama inducido por DMBA en ratas. Conclusiones: Se ha demostrado que el extracto de Cenchrus echinatus L. presenta efecto protector sobre el cáncer de mama inducido por 7,12-Dimetilbenzo[a]antraceno en Rattus rattus; y no es tóxico en ratones y ratas.

ABSTRACT Introduction: Breast cancer is a disease that is increasing its incidence yearly; it is thus in search of complementary alternatives for treatment, some medicinal plants containing large amounts of polyphenols have been studied, which have anti-cancer effects as is the case of Cenchrus echinatus L. Objective: determine the safety and protective effect of the extract ethanolic of Cenchrus echinatus L. (cadillo) on 7,12-Dimethylbenzo[a]anthracene DMBA-induced breast cancer in Rattus rattus. Methods: Preclinical, experimental study in male Balb/C53 mice and Holtzman rats of both sexes. Acute toxicity (DL50) and toxicity at 45 days were calculated by methods of the probits and OECD respectively; to evaluate the protective effect the method of Barros 2004 was used, also the proliferation of tumor cells was recorded microscopically, using descriptive and inferential statistical analysis, considering p<0.05. Results: The safety studies demonstrate that the extract does not induce significant changes at the hematological, biochemical, and anatomopathological levels. A 76.92 % of the protective effect of the extract against DMBA-induced breast cancer in rats was achieved. Conclusions: It has been shown that the extract of Cenchrus echinatus L. presents a protective effect on 7,12-Dimethylbenzo[a]anthracene-induced breast cancer in Rattus rattus, and is not toxic to mice and rats.

Resumo Objetivo Determinar a prevalência de citologia com laudo de células glandulares atípicas (AGCs, na sigla em inglês) e analisar a significância clínica nas diferentes faixas etárias Métodos Estudo observacional retrospectivo, usando os dados arquivados no sistema do Instituto Nacional de Câncer no Brasil, que incluiu mulheres rastreadas entre janeiro de 2002 a dezembro de 2008. As mulheres incluídas tinham citologia com resultado de AGCs, que foram acompanhadas com colposcopia e nova citologia Resultados Um total de132,147 exames citopatológicos foram incluídos durante o período de estudo. Quinhentas e trinta e três mulheres com citologia de AGC foram identificadas e destas, 69.41% (370) foram encaminhadas para colposcopia e nova citologia. A prevalência de citologia de AGC na população estudada foi 0.4%. A maioria das mulheres (79.22%) com resultado citológico de AGC tinham idade entre 25 e 54 anos. A segunda citologia demonstrou 67.56% (250/370) de normalidade, 24.5% (91/370) de atipias escamosas, e 6.2% (23/370) de AGC. Na biopsia das mulheres com a 2ª citologia de AGC, 43.4% (10/23) tinham histologia normal, 43.4% (10/23) tinha lesões escamosas, 8.7% (2/23) tinha adenocarcinoma invasor e 1.2% (1/23) tinha laudo inconclusivo. Todas as mulheres com lesões intraepiteliais escamosas de alto grau (HSIL, na sigla em inglês) ou adenocarcinoma invasor (respectivamente 5 e 2pacientes), após a 2ª citologia com AGC, tinham 25 anos de idade ou mais. Conclusão A prevalência de citologia com AGC foi baixa na população estudada. Muitos casos de citologia com AGC apareceram em mulheres adultas, entre 25 e 54 anos de idade. Embora a maioria das pacientes tiveram histologia normal após seguimento, várias apresentaram lesões intraepiteliais escamosas ou glandulares invasoras.

Abstract Objective To determine the prevalence of the atypical glandular cells (AGCs) cytology and to analyze its clinical significance in different age ranges. Methods Retrospective observational study using computerized data from the Brazilian National Cancer Institute, including women screened between January 2002 and December 2008. The women included were those with an AGC result who were properly followed-up with colposcopy and a second cytology. Results A total of 132,147 cytopathological exams were performed during the study period. Five-hundred and thirty-three (0.4%) women with AGC cytology were identified and, of these, 69.41% (370/533) were properly referred for colposcopy and a new cytology. Most of the women (79.2%) with a 1st or 2nd AGC cytology were between the ages of 25 and 54 years. The 2nd cytology demonstrated 67.6% (250/370) of normality, 24.5% (91/370) of squamous atypia, and 6.2% (23/370) of AGC, 0.8% (3/370) adenocarcinoma in situ and 0.8% (3/370) adenocarcinoma invasor. On biopsy of the women with a second AGC cytology, 43.4% (10/23) had normal histology, 43.4% (10/23) had squamous lesions, 8.7% (2/23) had invasive adenocarcinoma, and 1.2% (1/23) had an inconclusive report. All of the women with high-grade squamous intraepithelial lesion (HSIL) or invasive adenocarcinoma (respectively 5 and 2 patients), after a 2nd AGC cytology were 25 years old or older. Conclusion The prevalence of the AGC cytology was low in the studied population. Most of the AGC cytology cases occurred in adult women between the ages of 25 and 54. Although most of the patients had normal histology after follow-up, several of them presented with squamous intraepithelial lesions or invasive adenocarcinoma.

ABSTRACT: The permanent maxillary canine (PMC) is the second most frequently impacted tooth due to its long intraosseous descent and eruption chronology. The objective of this study was to evaluate the degree of dental development and position of the PMC between the ages of 8 and 11 years 11 months in order to suggest an optimal chronological age for their early evaluation in panoramic radiography. A retrospective study was carried out, where 239 panoramic radiographs of children aged 8 to 11 years were analyzed. They were grouped according to age, gender and apical area; Then, the degree of dental development and position of the left PMC apex were analyzed. The results show that there are no significant differences in the position of the PMC with respect to chronological age. Furthermore, between eight years six months and nine years six months, 61% of the canines had more than half of the root formed. In conclusion, the early evaluation with panoramic radiography of the PMC is suggested from eight years six months to nine years six months, to alert the clinician in cases where the eruptive path is deviated.

RESUMEN: El canino maxilar permanente (CMP) es el segundo diente con mayor frecuencia de impactación debido a su largo descenso intraóseo y cronología de erupción. El objetivo de este estudio fue evaluar el grado de desarrollo dentario y posición del CMP entre los 8 años y los 11 años 11 meses con el fin de sugerir una edad cronológica óptima para su evaluación temprana en radiografía panorámica. Se realizó un estudio retrospectivo, en donde se analizaron 239 radiografías panorámicas de niños de 8 a 11 años. Éstas se agruparon según edad, género y área apical; luego se analizó el grado de desarrollo dentario y posición del vértice CMP izquierdo. En los resultados se observó que no existen diferencias significativas de la posición del CMP respecto a la edad cronológica. Además, entre los ocho años seis meses y nueve años seis meses un 61% de los caninos tuvieron más de la mitad de formación radicular. En conclusión, la evaluación temprana con radiografía panorámica del CMP se sugiere desde los ocho años seis meses a los nueve años seis meses, para alertar al clínico en casos donde el trayecto eruptivo se encuentre desviado.

RESUMO Objetivo Investigar se há associação entre padrões alimentares e conteúdo mineral ósseo em adultos brasileiros. Métodos Este é um estudo transversal de base populacional. A saúde óssea de indivíduos adultos (20-59 anos) de ambos os sexos, residentes na cidade de Viçosa, MG, Brasil, (n=572) foi avaliada por meio da absorciometria de raios-X de dupla energia. O padrão alimentar foi obtido através de um questionário de frequência alimentar; a análise fatorial exploratória foi aplicada para obter os padrões alimentares e a regressão linear foi usada para a análise multivariada. Resultados Foram identificados dois padrões alimentares distintos: um padrão “carne e bebidas alcóolicas”, composto por condimentos, bebidas alcoólicas, alimentos à base de massa e salgadinhos, e um padrão “local tradicional”, composto de ovos, feijões, feijão tropeiro, margarina, manteiga, azeite, café e chá, cereais e tubérculos (cargas fatoriais ≥0,20). Verificadas as associações considerando os fatores de confusão, identificou-se que o conteúdo mineral ósseo para o sexo masculino se associou positivamente ao padrão alimentar “local tradicional” (β=0,058; 95% CI: 0,003–0,112; p=0,036), e para o sexo feminino foi encontrada associação inversa com o padrão “carne e bebidas alcóolicas” (β=-0,057; 95% CI: -0,110 -0,003; p=0,037). Conclusão Uma associação positiva entre o padrão alimentar “local tradicional” e a saúde óssea foi identificada.

ABSTRACT Objective The aim of the study was to investigate if there is an association between dietary patterns and bone mineral content among Brazilian adults. Methods This is a cross-sectional, population-based study. Bone health was assessed using dual-energy x-ray absorptiometry. The dietary pattern was obtained using a food frequency questionnaire. An exploratory factor analysis obtained the dietary patterns. Linear regression was used for the multivariate analysis. The research was conducted with adult individuals (20-59 years old) of both sexes residing in the city of Viçosa, MG, Brazil (n=572). Results Two distinct dietary patterns were identified: a “meats and alcoholic drinks” pattern, composed of condiments, alcoholic drinks, dough-based foods, and savory snacks; and a “local traditional” pattern, composed of eggs, beans, trooper’s beans, margarine, butter, olive oil, coffee and tea, cereals, and tubers (factor loadings ≥0.20). Having verified the associations considering the confounding factors, we identified that the bone mineral content for males was positively associated with the “local traditional” dietary pattern (β=0.058; 95% CI: 0.003–0.112; p=0.036), and for females an inverse association with the “meats and alcoholic drinks” pattern was found (β=-0.057; 95% CI: -0.110 -0.003; p=0.037). Conclusion We identified a positive association between the local traditional dietary pattern and bone health.

ABSTRACT Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. Methods: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. Results: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. Conclusions: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.