RESUMEN Introducción: Las enfermedades infecciosas intestinales (diarrea) son una causa importante de morbilidad y mortalidad a nivel mundial. En 2015, constituyeron la novena causa principal de muerte para todas las edades. Objetivo: describir las características epidemiológicas de la mortalidad por enfermedades infecciosas intestinales (diarreas) en Paraguay durante los años 2015 al 2019. Metodología: Estudio descriptivo, ecológico, transversal, retrospectivo, muestreo no probabilístico de casos consecutivos. Se consideraron los óbitos del CIE - 10, que incluyen al cólera (A01), fiebres tifoidea y paratifoidea (A01), shigelosis (A03), otras infecciones intestinales bacterianas (A04), otras intoxicaciones alimentarias bacterianas (A05), amebiasis (A06), otras enfermedades intestinales debidas a protozoarios (A07), infecciones intestinales debidas a virus (A08) y diarrea y gastroenteritis de presunto origen infeccioso (A09). Se utilizaron datos de acceso abierto de la página WEB de la Dirección General de Información Estratégica en Salud del MSP y BS de todos los Departamentos del país. Se calcularon tasas crudas y ajustadas (por 100.000 habitantes). Se utilizaron Excel y EPI INFO 7.0. Resultados: Se registraron 495 muertes, la mayor prevalencia fue en 2019 (tasa ajustada de 1,83) y menor en 2017 (1,36). Los meses con mayor mortalidad fueron enero y julio (9,9%). El 51,72% fueron mujeres (256), 30,91% mayores de 80 años y 28,28% (140) menores de 5 años, edad promedio 50,8, solteros 56,77% (281) y sin ningún tipo de educación 41,82% (207). El 80,61% (399) residía en área urbana. Las mayores tasas se registraron en Boquerón (33,3) y Amambay (15,2). El 95,56% (473) fueron diarreas y gastroenteritis de origen infeccioso. Discusión: Se registra alto porcentaje de mortalidad de diarreas de origen infeccioso. Los extremos de la vida constituyen la población más vulnerable.

ABSTRACT Introduction: Infectious intestinal diseases (diarrhea) are a major cause of morbidity and mortality worldwide. In 2015, it constituted the ninth leading cause of death for all ages. Objective: To describe the epidemiological characteristics of mortality due to infectious intestinal diseases (diarrhea) in Paraguay from 2015 to 2019. Methods: Descriptive, ecological, cross-sectional, retrospective, and non-probabilistic sampling of consecutive cases was performed. ICD-10 deaths included cholera (A01), typhoid and paratyphoid fever (A01), shigellosis (A03), other bacterial intestinal infections (A04), other bacterial food poisoning (A05), amebiasis (A06), other intestinal diseases due to protozoa (A07), intestinal infections due to viruses (A08), and diarrhea and gastroenteritis of presumed infectious origin (A09). Open access data were obtained from the WEB page of the General Directorate of Strategic Information in Health of the MSP and BS of all the Departments of the country. Crude and adjusted rates (per 100,000 inhabitants) were calculated. Excel and EPI INFO 7.0 were used. Results: 495 deaths were registered; the highest prevalence was in 2019 (adjusted rate of 1.83) and the lowest in 2017 (1.36). The months with the highest mortality rates were January and July (9.9%). 51.72% were women (256), 30.91% were over 80 years old and 28.28% (140) were under 5 years old, average age 50.8, single 56.77% (281) and without any type of education 41.82% (207). A total of 80.61% (399) of the respondents resided in urban areas. The highest rates were registered in Boquerón (33.3) and Amambay (15.2). Diarrhea and gastroenteritis of infectious origin accounted for 95.56% of the cases (473). Discussion: There was a high percentage of mortality from infectious diarrhea. Extremes of life were the most vulnerable populations.

ABSTRACT The oral involvement in the Hematopoietic Stem Cell Transplantation is well described in the literature. The goal of the dental treatment and management of the oral lesions related to the HSCT is to reduce the harm caused by preexisting oral infection or even the worsening of oral acute/chronic GVHD and late effects. The aim of this guideline was to discuss the dental management of patients subjected to HSCT, considering three phases of the HSCT: pre-HSCT, acute phase, and late phase. The literature published from 2010 to 2020 was reviewed in order to identify dental interventions in this patient population. The selected papers were divided into three groups: pre-HSCT, acute and late, and were reviewed by the SBTMO Dental Committee's members. When necessary, an expertise opinion was considered for better translating the guideline recommendations to our population dental characteristics. This manuscript focused on the pre-HSCT dental management. The objective of the pre-HSCT dental management is to identify possible dental situations that On behalf of the Dental Committee of the Brazilian Society of Gene Therapy and Bone Marrow Transplantation (SBTMO) can worsening during the acute phase after the HSCT. Each guideline recommendations were made considering the Dentistry Specialties. The clinical consensus on dental management prior to HSCT provides professional health caregivers with clinical setting-specific information to help with the management of dental problems in patients to be subjected to HSCT.

RESUMO Objetivo: Comparar o desempenho de indicadores antropométricos para identificar o excesso de gordura corporal (GC) em adolescentes. Métodos: Estudo metodológico com amostragem probabilística por conglomerados, por sorteio das escolas e turmas. A coleta de dados incluiu características sociodemográficas e medidas antropométricas. O índice de massa corporal (IMC), a relação cintura-estatura (RCE), o índice de conicidade (IC) e a circunferência da cintura (CC) foram calculados. O percentual de gordura corporal (%GC) foi calculado com base na espessura das dobras cutâneas e utilizado como padrão-ouro. Para analisar os dados, foram utilizadas estatísticas descritivas, teste t de Student, curva Receiver Operating Characteristic (ROC) e índice de Youden. Foi calculado o coeficiente de correlação entre os indicadores e o %GC. Resultados: Participaram do estudo 997 adolescentes de escolas municipais. Identificou-se, pelo IMC, que 10,6% dos adolescentes apresentavam sobrepeso e 4,7%, obesidade. O IMC, a CC e a RCE apresentaram a maior acurácia para predizer a gordura corporal. Todos os indicadores antropométricos apresentaram especificidade superior à sensibilidade para diagnosticar excesso de GC no sexo masculino. A CC apresentou a maior sensibilidade em ambos os sexos. O IC apresentou a menor área sob a curva ROC e a menor sensibilidade em ambos os sexos, mas especificidade equivalente aos demais indicadores. Conclusões: IMC, RCE e CC apresentaram a melhor capacidade de predizer excesso de GC em adolescentes e os melhores coeficientes de correlação. Essas ferramentas podem ser consideradas formas de rastreamento na identificação do excesso de GC em adolescentes.

Abstract Objective: To compare the performance of anthropometric indicators that identify excess body fat (BF) in adolescents. Methods: This is a methodological study that used probability cluster sampling through school and class draws. Data collection included sociodemographic characteristics and anthropometric measures. Body mass index (BMI), waist-to-height ratio (WtHR), conicity index (C index), and waist circumference (WC) were calculated. Body fat percentage (BF%) was calculated from skinfold thickness and used as the gold standard. To analyze the data, descriptive statistics, Student’s t-test, Receiver Operating Characteristic (ROC) curve, and Youden’s index were used, in addition to correlation coefficient calculation between the indicators and BF%. Results: A total of 997 adolescents enrolled in municipal secondary schools participated in the study. By calculating the BMI, we found that 10.6% of adolescents were overweight, and 4.7% were obese. BMI, WC, and WtHR had the highest accuracy to predict body fatness. All the anthropometric indicators had higher specificity than sensitivity to diagnose excess BF in males. WC had the highest sensitivity in both genders. C index had the smallest area under the ROC curve and the lowest sensitivity in both genders, but its specificity was equivalent to that of the other indicators. Conclusions: BMI, WtHR, and WC were the best anthropometric indicators to predict excess BF in adolescents and had the best correlation coefficients. These tools can be considered in the screening to detect excess BF in adolescents.

ABSTRACT Enrolling in Higher Education includes various stressors for the student and the literature points to the need for interventions to facilitate adaptation to university. The academic experiences workshop, a brief psychological intervention (8 sessions) based on behavioral analysis, sought to develop repertoires for coping with the stressors present in higher education. Nine nursing students participated after signing consent terms. They provide answers before and after participating in the workshop: 1) the Self-Reporting Questionnaire, Brazilian version, an instrument for screening symptoms related to common mental disorders (CMD); and 2) the Psychological Well-Being Scale (PBS). Initially, 88.9% of participants had symptoms of CMD, and the mean EBEP was 24.97 (SD=1.22). After the intervention, only 22.2% of the students continued to present symptoms of CMD, and the mean EBEP increased to 29.34 (SD=1.17). The implications of this intervention are discussed in view of the challenges faced by School and Educational Psychology in Higher Education.

RESUMEN La entrada en la enseñanza universitaria incluye estresores variados para el estudiante y la literatura apunta la necesidad de intervenciones para facilitar la adaptación a la universidad. El taller de vivencias académicas, una intervención psicológica corta (8 sesiones) de base analítico-comportamental, buscó desarrollar repertorios para el enfrentamiento de los estresores presentes en la enseñanza universitaria. Participaron 9 académicas de enfermería que, tras consentimiento, respondieron antes y después la participación en el taller: 1) el Self-Reporting Questionnaire, versión brasileña, un instrumento de selección de síntomas relacionados a trastornos mentales comunes (TMC); y 2) la Escala de Buen-estar Psicológico (EBEP). Inicialmente, el 88,9% de las participantes presentaban síntomas de TMC, y el promedio de la EBEP fue 24,97 (DP=1,22). Tras la intervención, solamente el 22,2% de las estudiantes continuaron presentando síntomas de TMC, y el promedio de la EBEP aumentó para 29,34 (DP=1,17). Las implicaciones de esta intervención son discutidas teniendo en vista los desafíos enfrentados por la Psicología Escolar y Educacional en la enseñanza universitaria.

RESUMO O ingresso no Ensino Superior inclui estressores variados para o estudante e a literatura aponta a necessidade de intervenções para facilitar a adaptação à universidade. A oficina de vivências acadêmicas, uma intervenção psicológica breve (8 sessões) de base analítico-comportamental, buscou desenvolver repertórios para o enfrentamento dos estressores presentes no Ensino Superior. Participaram 9 acadêmicas de enfermagem, que após consentimento, responderam antes e após a participação na oficina: 1) o Self-Reporting Questionnaire, versão brasileira, um instrumento de triagem de sintomas relacionados a transtornos mentais comuns (TMC); e 2) a Escala de Bem-estar Psicológico (EBEP). Inicialmente, 88,9% das participantes apresentavam sintomas de TMC, e a média da EBEP foi 24,97 (DP=1,22). Após a intervenção, somente 22,2% das estudantes continuaram apresentando sintomas de TMC, e a média da EBEP aumentou para 29,34 (DP=1,17). As implicações dessa intervenção são discutidas tendo em vista os desafios enfrentados pela Psicologia Escolar e Educacional no Ensino Superior.

Abstract Objective: To describe the health-related quality of life (QOL) in children with cerebral palsy (CP) associated with congenital Zika infection. Methods: Cross-sectional study of a consecutive series of children, followed in a referral multicentric rehabilitation network in Brazil. We invited the caregivers to respond to the Brazilian version of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM) questionnaire. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) 26.0™. We used absolute and relative frequencies for categorical variables and mean and standard deviation for continuous variables. Results: The sample consisted of 193 children, at mean age of 50.3±7.6 months. We observed a predominance of children with cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level V (93.7%). Epilepsy (88.4%) was the most common comorbidity. CPCHILDTM mean scores were activities of daily living (ADL)/personal care 43.2±12.6; positioning, transferring and mobility 33.7±16.5; comfort and emotions 84.4±15.2; communication and social interaction (CoSI) 48.2±24.3; health 70.9±17.1; and overall quality of life (OQOL) 72.1±17.1. Total score was 54.8±11.3. Conclusions: Among children with cerebral palsy (CP) related to congenital Zika syndrome, the quality of life (QOL) scores were very similar to other populations with cerebral palsy (CP). The activities of positioning, transferring and mobility had the greatest impact on health-related quality of life (QOL). Rehabilitation strategies and public policies should prioritize aspects related to mobility for this population.

RESUMO Objetivo: Descrever a qualidade de vida relacionada à saúde em crianças com paralisia cerebral associada à infecção congênita pelo zika. Métodos: Estudo transversal de série consecutiva de casos de crianças acompanhadas em uma rede multicêntrica de reabilitação no Brasil. Convidamos o(s) cuidador(es) a responder à versão brasileira do Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM). A análise estatística foi realizada com o pacote estatístico Statistical Package for the Social Sciences (SPSS) 26.0™. Para variáveis categóricas, foram utilizadas frequências absolutas e relativas e, para variáveis contínuas, média e desvio padrão. Resultados: Cento e noventa e três crianças, com idade média de 50,3±7,6 meses, foram incluídas. Observou-se predomínio de crianças com paralisia cerebral Gross Motor Function Classification System (GMFCS) nível V (93,7%). Epilepsia (88,4%) foi a comorbidade mais comum. As pontuações médias do CPCHILDTM foram: atividades de vida diária/cuidados pessoais 43,2±12,6; posicionamento, transferência e mobilidade 33,7±16,5; conforto e emoções 84,4±15,2; comunicação e interação social 48,2±24,3; saúde 70,9±17,1; e qualidade de vida geral 72,1±17,1. A pontuação total foi 54,8±11,3. Conclusões: Entre as crianças com paralisia cerebral relacionada à síndrome do zika congênita, as atividades de posicionamento, transferência e mobilidade tiveram maior impacto na qualidade de vida relacionada à saúde, semelhantemente a outras etiologias de paralisia cerebral. As estratégias de reabilitação e as políticas públicas devem priorizar os aspectos relacionados à mobilidade dessa população.

Abstract Objective: Congenital Zika virus Syndrome is characterized by a series of neurological changes bearing consequences for child development. In view of the large number of children born with microcephaly and other neurological disorders, this qualitative study sought to understand and review the coping strategies used by 10 mothers of children affected by the syndrome. Methods: A semi-structured interview was applied, which identified four main maternal stressors: diagnosis; childcare routine; child treatment; and development and access to health services. Results: The most used coping strategies with regard to these stressors were: information-seeking, problem-solving, and delegation. Conclusion: The implications of such results for the care of this population are discussed within the perspective of expanding the adaptive coping to these stressors and ensuring the necessary support for those families in the long and difficult process of taking care of a child with this syndrome.

Resumo Objetivo: A síndrome congênita do vírus Zika é caracterizada por uma série de alterações neurológicas com consequências para o desenvolvimento da criança. Diante do elevado número de crianças afetadas pela síndrome, nascidas com microcefalia e outros distúrbios neurológico, este estudo qualitativo buscou compreender e analisar as estratégias de coping utilizadas por 10 mães de crianças afetadas nessa situação. Método: Foi utilizada uma entrevista semiestruturada, que identificou quatro principais estressores maternos: o diagnóstico; a rotina e os cuidados com a criança; o tratamento e desenvolvimento da criança e a dificuldade de acesso aos serviços de saúde. Resultados: As estratégias de enfrentamento mais utilizadas para lidar com esses estressores foram: busca de informações, resolução de problemas e delegação. Conclusão: Discutem-se as implicações desses resultados para o cuidado das mães na perspectiva de ampliar o enfrentamento adaptativo aos estressores e garantir o suporte necessário às famílias no longo e difícil processo de cuidar de uma criança com a Síndrome Congênita do Vírus Zika.

Abstract Background Chagas’ disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas’ disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown. Objectives To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival. Methods Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (“Change” group). A p-value < 0.05 was considered statistically significant. Results Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates. Conclusions This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.

Resumo Fundamento A Doença de Chagas (DC) é uma causa importante de transplante cardíaco (TC). O principal obstáculo é a reativação da DC (RDC), normalmente associada a altas doses de imunossupressores. Estudos anteriores sugeriram uma associação do micofenolato de mofetila com aumento na RDC. No entanto, preditores de mortalidade são desconhecidos. Objetivos Identificar os fatores de risco de mortalidade em pacientes com DC após o TC e o impacto do regime antiproliferativo sobre a sobrevida. Métodos Estudo retrospectivo com pacientes chagásicos submetidos ao TC entre janeiro de 2004 e setembro de 2020, em protocolo de imunossupressão que priorizava o uso de azatioprina e sua mudança para micofenolato de mofetila em caso de rejeição. Realizamos regressão univariada para identificar preditores de mortalidade e comparamos sobrevida, rejeição, e evidência RDC entre os pacientes que usavam azatioprina, micofenolato de mofetila, e aqueles que mudaram de azatioprina para micofenolato (grupo “Mudança”) após a alta. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados Foram incluídos 85 pacientes, 54,1% homens, idade mediana 49 (39-57) anos, e 91,8% com prioridade na lista de espera. Dezenove (22,4%) usavam azatioprina, 37 (43,5%) micofenolato de mofetila, e 29 (34,1%) trocaram a terapia; a sobrevida não foi diferente entre os grupos, 2,9 (1,6-5,0) x 2,9 (1,8-4,8) x 4,2 (2,0-5,0) anos, respectivamente; p=0,4. Não houve diferença na taxa de rejeição (42%, 73% e 59% respectivamente; p=0,08) ou de RDC (T. cruzi positiva na biópsia endomiocárdica 5% x 11% x 7%; p=0,7; uso benzonidazol 58% x 65% x 69%; p=0,8; PCR positiva para T. cruzi 20% x 68% x 42% respectivamente; p=0,1). Conclusões Este estudo retrospectivo com pacientes com DC e TC não mostrou diferença na sobrevida entre os diferentes regimes antiproliferativos. O uso de micofenolato de mofetila não foi associado com taxas significativamente mais altas de RDC ou rejeição do enxerto nesta coorte. Novos ensaios randomizados são necessários para abordar essa questão.

ABSTRACT Introduction. Meningitis is a disease that requires immediate diagnosis and treatment. The epidemiology changed over the years due to the advances in conjugate vaccines, however, the mortality rate, as well as the disease burden, are still very high. Objective. To describe the epidemiological characteristics of meningitis mortality in Paraguay in the 2015-2019 period. Materials and methods. Descriptive and ecological study in which data was obtained from the open and official website of the General Department of Strategic Information of the Ministry of Public Health and Social Welfare. Crude and adjusted rates (per 100,000 inhabitants) were calculated using Excel and EPI INFO 7.0. Results. In the study period, 125 deaths were registered with the highest prevalence in 2018 (adjusted rate of 0.55 per 100,000 inhabitants) and the lowest in 2017 (adjusted rate of 0.27 per 100,000 inhabitants). The months with the highest mortality were August and December with 15.2% and 11.2%, respectively. Males were the predominant gender with 58.40% (73 people), 21.60% (27) were under 4 years of age, mostly women, and 12% (11) were seniors (60-70 years), mostly men. Average age was 37.76 years, 67.20% single (84) and 26.40% (33) had no formal education and 80.80% (101) lived in urban areas. The highest rates were registered in Paraguarí (6.8 per 100,000 inhabitants) and Caazapa (3.3 per 100,000 inhabitants). There were no cases in Alto Paraguay. Conclusion: The extremes of life remain a vulnerable population for meningitis.

RESUMEN Introducción. La meningitis es una emergencia que requiere diagnóstico y tratamiento inmediato. La epidemiología cambió con las vacunas conjugadas, pero la carga de la enfermedad y las muertes siguen altas. Objetivo. Describir las características epidemiológicas de la mortalidad por meningitis en Paraguay en el periodo 2015-2019. Materiales y métodos. Estudio ecológico y descriptivo en el que se obtuvieron datos de acceso abierto disponibles en la página WEB de la Dirección General de Información Estratégica en Salud del Ministerio de Salud Pública y Bienestar Social de todas las regiones sanitarias del país. Se calcularon las tasas crudas y ajustadas (por 100.000 habitantes) por Excel y EPI INFO 7.0. Resultados. Se registraron 125 muertes, la mayor prevalencia fue en el 2018, con una tasa ajustada de 0,55 por 100.000 habitantes y la menor en 2017, con 0,27 por 100.000 habitantes. Los meses con mayor mortalidad fueron agosto (15,2%) y diciembre (11,2%). El 58,40% de los fallecidos fueron varones (73), 21,60% (27) menores de 4 años, en su mayoría mujeres y 12% (11) adultos mayores (60-70 años), mayoría varones. La edad promedio fue 37,76 años, solteros el 67,20% (84) y no escolarizados el 26,40% (33). El 80,80% (101) residía en el área urbana. Las mayores tasas se registraron en Paraguarí (6,8 por 100.000 habitantes) y Caazapá (3,3 por 100.000 habitantes), no se registraron casos en Alto Paraguay. Conclusión. Los extremos de la vida siguen siendo una población vulnerable para la meningitis.

Abstract Diabetes mellitus and arterial hypertension are among the five risk factors that increase mortality in the world. Both are chronic, non-communicable diseases (NCDs), that have a pathophysiological association. Advanced glycation end products (AGEs), produced by the lack of glycemic control in diabetic patients, interact with their AGE receptors (AGER) resulting in increased arterial stiffness, inflammation and endothelial changes - which increases the risk of developing hypertension and other complications. We ran a systematic review in Pubmed, SciELO, Cochrane Library and Web of Science databases using keywords and Boolean operators to optimize the search, with the objective of assessing the mechanism of non-enzymatic glycation of proteins present in patients with diabetes and its correlation with the onset of hypertension, exposing all the endothelial and cellular damage caused by AGEs. We found 719 papers, of which 99 were read in full, and 26 met the eligibility criteria and were included in the present review. AGEs should be considered one of the main cardiometabolic risk factors. Reducing the AGE-AGER interaction will result in cardiovascular protection and increased life expectancy.

Resumo Diabetes mellitus e hipertensão arterial estão entre os cinco fatores de risco que elevam a mortalidade no mundo. Ambas são doenças crônicas não transmissíveis (DCNT) que têm associação fisiopatológica. Os produtos finais de glicação avançada (AGEs), produzidos pela falta de controle glicêmico nos pacientes diabéticos, interagem com seus receptores para AGEs (RAGE) resultando no aumento da rigidez arterial e da inflamação e em alterações endoteliais, fatores que intensificam o risco do desenvolvimento da hipertensão e de demais complicações. Realizou-se uma revisão sistemática nas bases de dados Pubmed, SciELO, Cochrane Library e Web of Science utilizando descritores e operadores booleanos para otimizar a busca, com o objetivo de fornecer o mecanismo da glicação não enzimática de proteínas presente em pacientes com diabetes e sua correlação com o aparecimento da hipertensão, expondo todo o dano endotelial e celular ocasionado pelos AGEs. Foram encontrados 719 artigos, dos quais 99 foram lidos na íntegra, e 26 atenderam aos critérios de elegibilidade e foram incluídos na presente revisão. Os AGEs devem ser considerados um dos principais fatores de risco cardiometabólico. A redução da interação AGE-RAGE resultará na proteção cardiovascular e no aumento da expectativa de vida.

Abstract Background Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. Objective To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. Methods We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the “off” and “on” phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients “off” medication versus controls) and paired (PD patients “off” medication versus PD patients “on” medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2ρ). Significance was set at 5%. Results The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group – confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2ρ = 0.197 for spirometry and η2ρ = 0.043 for impulse oscillometry). Conclusion Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease.

Resumo Antecedentes A doença de Parkinson (DP) causa uma série de distúrbios do movimento, muitos deles se desenvolvendo na fase inicial. Objetivo Analisar função pulmonar de pessoas com DP em estágio leve e investigar o efeito da levodopa nesse processo. Métodos Vinte e um participantes com DP idiopática e vinte controles saudáveis foram incluídos na pesquisa. Todos os sujeitos foram submetidos a avaliações de espirometria e oscilometria de impulso. Participantes com DP foram avaliados nas fases ‘on’ e 'off' de medicação anti-parkinsoniana. A medicação dos pacientes foi convertida em dose diária de levodopa. A análise estatística foi realizada com testes transversais (Parkinson na fase ‘off’ da medicação vs controles) e pareados (Parkinson nas fases ‘off’ vs ‘on’ da medicação). O efeito da levodopa foi calculado pelo eta ao quadrado parcial (η2ρ). Significância foi estipulada em 5%. Resultados Pacientes com DP apresentaram valores normais na oscilometria de impulso. Na espirometria, os resultados indicaram uma desordem ventilatória obstrutiva incipiente no grupo DP – confirmada pelas curvas fluxo-volume dos pacientes. Pacientes com DP receberam uma dose diária de 354,7 ± 148,2 miligramas de levodopa. Análises pareadas mostraram baixo impacto da medicação anti-parkinsoniana nos parâmetros pulmonares (η2ρ = 0,197 na espirometria e η2ρ = 0,043 na oscilometria de impulso). Conclusão Pacientes com DP na fase leve apresentam complacência e resistência pulmonares compatíveis com parâmetros normais. Diferenças espirométricas indicam distúrbio ventilatório obstrutivo incipiente em pacientes com DP. A administração de levodopa apresentou baixo efeito na função pulmonar na fase leve da doença.

Abstract The goal of this study was to establish the behavior of cefotaxime (CTX)-resistant E. coli and/or colistin-resistant E. coli, isolated from fecal samples of pigs in Argentina to other antimicrobials classified by the WHO as critically important for public health. In 2018, 56 samples from 11 farms located in Buenos Aires, Córdoba, Santa Fe, and San Luis provinces were processed. Thirty-one cefotaxime-resistant E. coli, 21 colistin-resistant E. coli, and 23 cefotaxime-colistin-resistant E. coli were obtained. Sixty-nine percent of the E. coli isolated were resistant to nalidixic acid and 37.3 % to ciprofloxacin, antimicrobials classified as the highest priority. No carbapenem-resistant E. coli were isolated. Seventy-three isolates were classified as multiresistant, of which 50 % showed resistance against 6 or 7 antimicrobial groups. Third-generation cephalosporin resistance was mainly associated with the blaCTX-M gene, particularly blaCTX-M-8/25, while colistin resistance was associated with the mcr-1 gene. The study evidence that Argentinian pigs harbor multidrug-resistant E. coli isolates, including resistance to antimicrobials of critical importance for human and veterinary medicine. Complementary analyses will be necessary to determine extended-spectrum β-lactamase-producing E. coli clones circulating in pig farms and their implications for public health.

Resumen El objetivo del trabajo fue establecer el comportamiento de aislamientos de E. coli resistentes a cefotaxima (CTX) y/o colistina, obtenidos de materia fecal de cerdos de la República Argentina, frente a antimicrobianos de importancia crítica para la salud pública. En 2018, se procesaron 56 muestras de 11 granjas localizadas en las provincias de Buenos Aires, Córdoba, Santa Fe y San Luis. Se obtuvieron 31 aislamientos resistentes a cefotaxima, 21 a colistina y 23 a ambos antimicrobianos. El 69 % de los aislamientos fue resistente a ácido nalidíxico y el 37,3 % a ciprofloxacina, antimicrobianos de máxima prioridad. No se aislaron E. coli resistentes a carbapenemes. Setenta y tres aislamientos se comportaron como multirresistentes, de los cuales el 50 % mostró resistencia frente a seis o siete grupos de antimicrobianos. La resistencia a cefalosporinas de tercera generación se relacionó principalmente con el gen blaCTX-M, particularmente, blaCTX-M-8/25, mientras que la resistencia a colistina se asoció con el gen mcr-1. De los resultados se desprende que existen cerdos en la República Argentina que portan E. coli con resistencia a múltiples antimicrobianos, incluyendo los de importancia crítica para medicina humana y veterinaria. Otros estudios complementarios permitirán determinar los clones de E. coli productores de ß-lactamasas de espectro extendido circulantes en granjas porcinas y su implicancia sobre la salud pública.

Resumo Adenium obesum (Forssk.) Roem. & Schult, conhecida popularmente como rosa-do-deserto, tem se tornado uma opção valiosa para o setor de plantas ornamentais. Na floricultura, a produção de híbridos é priorizada, para isso, o conhecimento da biologia floral e da reprodução sexuada da espécie é fundamental. Objetivou-se com o presente estudo: (1) testar concentrações de sacarose e temperaturas na germinação in vitro de grãos de pólen de Adenium obesum; (2) identificar o efeito da temperatura na viabilidade de grãos de pólen de Adenium obesum e; (3) avaliar a viabilidade dos grãos de pólen e receptividade estigmática pré-antese, abertura floral e 72 horas pós-abertura floral em três acessos de Adenium obesum. Interação significativa entre temperaturas e concentrações de sacarose foi observada no teste de germinação in vitro. A maior porcentagem de germinação in vitro dos grãos de pólen, 39,81% foi observada na temperatura estimada de 26,05 °C. Os acessos de rosa-do-deserto mantidos em B.O.D. sob temperatura de 30 °C e fotoperíodo de 16 horas de luz apresentaram florescimento mais rápido e as temperaturas ≥ 25 °C indicaram porcentagens de viabilidade dos grãos de pólen acima de 69%. A temperatura é um dos fatores abióticos mais importantes, influencia a germinação dos grãos de pólen, crescimento do tubo polínico e pode afetar a fertilização. O acesso ICA-bd destacou-se e pode ser considerado como doador de pólen em polinizações artificiais. O estigma das flores encontrou-se receptivo desde um dia antes da abertura das flores até três dias após a flor abrir. Os dois parâmetros apresentados acima, receptividade estigmática e viabilidade polínica, permitem fazer inferências importantes sobre os momentos mais apropriados para a polinização e subsequente fertilização na rosa-do-deserto.

Abstract Adenium obesum (Forssk.) Roem. & Schult., popularly known as desert rose, has become a valuable ornamental plant. In floriculture, the production of hybrids is prioritized. Hence, knowledge on floral biology and sexual reproduction of the target species is fundamental. The objectives of this study were: (1) to test sucrose concentrations and temperatures for in vitro germination of A. obesum pollen grains; (2) to identify the effect of temperature on the viability of A. obesum pollen grains; and (3) to evaluate the viability of pollen grains and stigma receptivity in pre-anthesis, at flower opening, and 72 h post-flower opening in three accessions of A. obesum. A significant relationship between temperatures and sucrose concentrations was observed in the in vitro germination test. The highest percentage of in vitro germination of pollen grains, 39.81%, was observed at an estimated temperature of 26.05 °C. Desert rose accessions maintained in biochemical oxygen demand (BOD) chambers at 30 °C during a 16-h light photoperiod showed faster flowering, and temperatures ≥ 25 °C induced pollen grain viability percentages above 69%. Temperature is one of the most important abiotic factors, influencing mainly in pollen germination, pollen tube growing and in efficiency fertilization. The ICA-wd accession stood out and can be considered a pollen donor in artificial pollination. The stigmas of flowers were receptive from a day before flower opening until three days after. The two parameters presented above, stigma receptivity and pollen viability, allow inferences about the appropriate time for successful pollination and subsequent fertilization in desert roses.

Abstract Recent literature emphasizes how the specific stressors of the COVID-19 outbreak affect the general population and frontline professionals, including those conducting support or backup activities in health units, which can lead to vicarious traumatization. Vicarious traumatization has been used to describe negative emotional reactions in mental health professionals who assist or treat victims of traumatic events. Thus, the aim of this article is to report the actions used in the face of the psychological demands of professionals in a hospital, who were not on the frontline of COVID-19. We collected their sociodemographic information and checked the psychological impact using the depression, anxiety, and stress scale (DASS-21), which was followed by a psychoeducational program (topics related to COVID-19 control and prevention), and individual psychological care for the most severe cases. A total of 118 professionals participated in this study; they were between 20 and 67 years old. Mild to moderate anxiety was observed in 36.5% of the medical teams, 83.3% of the administrative staff, and 65.7% of general service workers, while stress symptoms were observed in 80.2%, 83.3%, and 59.9%, respectively. Depressive symptoms (35.3%) were more frequent in general service workers. The medical teams reported the benefits of primary psychological care, while the other professionals demanded more institutional support services related to the prevention and use of personal protective equipment. This study highlights relevant psychological demands that have repercussions on the daily lives of professionals. The psychoeducational program was considered positive regarding clarification actions. However, it was not perceived as effective in reducing fear, which may result from vicarious traumatization and requires other intervention modalities.

ABSTRACT Objective To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group. Methods A retrospective cross-sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded. Results The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups. Conclusion Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.

Resumen Objetivo: Adaptar y validar la Escala de Intensidad de Arrepentimiento-10 (RIS-10) para profesionales de la salud brasileños. Métodos: Este estudio de validación se realizó en dos fases: la primera fue la traducción de los instrumentos y la segunda, la validación de campo evaluando las propiedades psicométricas de validez y confiabilidad de la escala con 341 profesionales (médicos, enfermeras y fisioterapeutas) vinculados a hospitales. La validez se evaluó mediante la validez de contenido (evaluación de seis jueces), criterios (correlación con la Escala de Satisfacción de Vida - SWLS y Self-Reporting Questionnaire 20 -SRQ-20) y constructo (análisis exploratorio mediante el método de rotación Promax, basado en el gráfico de pendiente (Criterio de Kaiser y confirmatorio por el modelo de ecuación estructural) luego de aplicar el cuestionario a los profesionales. La confiabilidad se midió mediante el coeficiente α de Cronbach y la prueba de reprueba en un período máximo de 30 días. La reproducibilidad se calculó por correlación intraclase. Resultados: Participaron 341 profesionales, con una edad media de 38.6 ± 9.2 años. El índice de validez de contenido (IVC) fue de 1.00 para todos los ítems de la escala en proporción de acuerdo con los jueces. El análisis factorial exploratorio mostró una correlación satisfactoria (Kaiser-Meyer-Olkin = 0.88), sugiriendo un modelo de dos factores, que comprende los componentes principales de la emoción de arrepentimiento (Factor I - emociones, Factor II - sentimientos), correspondiente al 64% de la variación total del primer factor. Tras la confirmación, el índice cuadrático medio residual estandarizado = 0.063 estuvo cerca de ser aceptable y los otros valores estaban por debajo. La escala se correlacionó positivamente con SRQ-20 (p<0.001) y negativamente con SLWS (p = 0.003). La confiabilidad mostró un α de Cronbach = 0.863 y la confiabilidad test-retest mostró valores más bajos de lo esperado. El gráfico de Bland-Altman mostró un sesgo medio de -1.5 con límites inferior y superior de 15.8 a 12.8, respectivamente. Conclusión: El RIS-10 adaptado a la población mostró un desempeño adecuado en las propiedades psicométricas utilizadas para evaluar la intensidad del arrepentimiento relacionado con la prestación de atención a la salud.

Abstract Objective: The aim of the study was to adapt and validate the Regret Intensity Scale-10 (RIS-10) for Brazilian health professionals. Methods: The validation study took place in two phases, in which the first was the translation of the instruments and the second, the field validation using psychometric properties validity and reliability of the scale with 341 professionals (doctors, nurses and physiotherapists) linked to hospitals. Validity was assessed using content validities (six judges evaluation), criteria (correlation with the Life Satisfaction Scale - SWLS and Self-Reporting Questionnaire 20 -SRQ-20) and construct (exploratory analysis using the rotation method Promax, based on the slope graph and the Kaiser criterion and confirmatory using the structural equation model) after applying the questionnaire to professionals.Reliability was measured by Cronbach's α coefficient and retest test over a maximum period of 30 days. Reproducibility was calculated by intraclass correlation. Results: A total of 341 professionals participated, with an average age of 38.6 ± 9.2 years. The content validity index (CVI) was 1.00, for all items of the scale in the proportion of agreement of the judges. Exploratory factor analysis showed a satisfactory correlation (Kaiser-Meyer-Olkin = 0.88), suggesting a two-factor model, which comprises the main components of the emotion of regret (Factor I - emoticons, Factor II - feelings), accounting for 64% of the total variation of the first factor. In the confirmation, the index standardized root mean squared residual = 0.063 was close to the acceptable and other values were below. The scale correlated positively with SRQ-20 (p < 0.001) and negatively with SLWS (p = 0.003). Reliability showed (Cronbach’s α = 0.863) and test-retest reliability showed lower values than expected. The Bland-Altman graph showed a mean bias of -1.5 with lower and upper limits of 15.8 to 12.8 respectively. Conclusion: The RIS-10 adapted for the population performed adequately in the psychometric properties evaluated for the assessment of the intensity of regret related to the provision of health care.

Resumo Objetivo: O objetivo do estudo foi adaptar e validar a Regret Intensity Scale-10 (RIS-10) para profissionais de saúde brasileiros. Métodos: O estudo de validação ocorreu em duas fases, sendo a primeira a tradução dos instrumentos e a segunda, a validação de campo utilizando as propriedades psicométricas validade e confiabilidade da escala com 341 profissionais (médicos, enfermeiros e fisioterapeutas) vinculados a hospitais. A validade foi avaliada por meio de validades de conteúdo (avaliação de seis juízes), critérios (correlação com a Escala de Satisfação de Vida - SWLS e Self-Reporting Questionnaire 20 -SRQ-20) e construto (análise exploratória usando o método de rotação Promax, com base no gráfico de inclinação e critério de Kaiser e confirmatório pelo modelo de equações estruturais) após aplicação do questionário aos profissionais. A confiabilidade foi medida pelo coeficiente α de Cronbach e teste de reteste em um período máximo de 30 dias. A reprodutibilidade foi calculada por correlação intraclasse. Resultados: Participaram 341 profissionais, com média de idade de 38.6 ± 9.2 anos. O índice de validade de conteúdo (IVC) foi de 1,00, para todos os itens da escala na proporção de concordância dos juízes. A análise fatorial exploratória mostrou correlação satisfatória (Kaiser-Meyer-Olkin = 0.88), sugerindo um modelo de dois fatores, que compreende os principais componentes da emoção de arrependimento (Fator I - emoções, Fator II - sentimentos), correspondendo a 64% da variação total do primeiro fator. Na confirmação, o índice raiz quadrada média residual padronizada = 0.063 ficou próximo do aceitável e os demais valores ficaram abaixo. A escala correlacionou-se positivamente com SRQ-20 (p <0.001) e negativamente com SLWS (p = 0.003). A confiabilidade apresentou (α de Cronbach = 0.863) e a confiabilidade teste-reteste apresentou valores menores do que o esperado. O gráfico de Bland-Altman mostrou um viés médio de -1.5 com limites inferior e superior de 15.8 a 12.8, respectivamente. Conclusão: O RIS-10 adaptado para a população apresentou desempenho adequado nas propriedades psicométricas avaliadas para avaliação da intensidade do arrependimento relacionado à prestação de cuidados de saúde.