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Resumo Objetivo Compreender o papel das redes de apoio no cuidado de crianças acometidas pela Síndrome Congênita pelo Vírus Zika. Métodos Estudo qualitativo, realizado em Centro de Referência Estadual em Neurodesenvolvimento, no nordeste brasileiro, entre abril de 2017 e fevereiro de 2018. Participaram pais de crianças com microcefalia atendidos no local. Foram realizadas 18 entrevistas semiestruturadas, sendo três com pai e mãe e 15 somente com mães, totalizando 21 participantes. A amostra foi definida pelo critério de saturação e foi utilizada análise de conteúdo na modalidade temática. Resultados Os resultados são apresentados a partir das categorias de análise “rede informal” e “rede formal”. A rede de apoio informal, especialmente os avós, exerceu importante suporte emocional e financeiro aos pais. As redes sociais virtuais se destacaram como espaço de compartilhamento de informações e experiências. Quanto à rede de apoio formal, as famílias estabeleceram vínculos mais fortes com profissionais da atenção especializada que ofertaram suporte técnico e acolhimento aos pais e às crianças. Já a atenção primária desempenhou mais o papel de encaminhamento para a atenção especializada. Foram relatados diferentes graus de resolutividade por parte dos municípios, em termos de programas, de atuação de gestores e de profissionais. Conclusão As redes informais e formais atuaram de modo complementar no tratamento e apoio às crianças com Síndrome Congênita pelo Vírus Zika. A inserção em diferentes redes informais possibilitou apoio social para enfrentar o impacto provocado pela doença. Apesar do investimento do Ministério da Saúde na atenção primária foi identificada fragilidade neste nível de atenção. Resumen Objetivo Comprender el papel de las redes de apoyo en el cuidado de niños afectados por el síndrome congénito por el virus del zika. Métodos Estudio cualitativo, realizado en un Centro de Referencia Regional en Neurodesarrollo, en el nordeste brasileño, entre abril de 2017 y febrero de 2018. Participaron padres de niños con microcefalia atendidos en el lugar. Se realizaron 18 entrevistas semiestructuradas, de las cuales tres fueron con el padre y la madre y 15 solo con madres, un total de 21 participantes. La muestra fue definida por el criterio de saturación y se utilizó análisis de contenido en la modalidad temática. Resultados Los resultados se presentan a partir de las categorías de análisis “red informal” y “red formal”. La red de apoyo informal, especialmente los abuelos, ejerció un importante soporte emocional y financiero para los padres. Las redes sociales virtuales se destacaron como un espacio para compartir información y experiencias. Respecto a la red de apoyo formal, las familias establecieron vínculos más fuertes con profesionales de la atención especializada, que ofrecieron soporte técnico y acogida a los padres y a los niños. Por otro lado, la atención primaria cumplió más el papel de derivar a la atención especializada. Se relataron diferentes niveles de resolución de problemas por parte de los municipios, en términos de programas, de actuación de gestores y de profesionales. Conclusión Las redes informales y formales actuaron de modo complementario en el tratamiento y apoyo a niños con síndrome congénito por el virus del zika. La inserción en diferentes redes informales permitió un apoyo social para enfrentar el impacto provocado por la enfermedad. A pesar de las inversiones en atención primaria del Ministerio de Salud, se identificó fragilidad en este nivel de atención. Abstract Objective To understand the role of support networks in the care of children affected by Congenital Zika Syndrome. Methods This is a qualitative study, conducted at a State Reference Center on Neurodevelopment, in northeastern Brazil, between April 2017 and February 2018. Parents of children with microcephaly treated at the site participated. 18 semi-structured interviews were conducted, three with father and mother and 15 only with mothers, totaling 21 participants. The sample was defined by the saturation criterion and content analysis was used in the thematic modality. Results The results are presented from the categories of analysis “informal network” and “formal network”. The informal support network, especially grandparents, exercised important emotional and financial support to parents. Virtual social networks stood out as a space for sharing information and experiences. Regarding the formal support network, the families established stronger bonds with specialized care professionals who offered technical support and care to parents and children. Primary care, on the other, played the role of referral to specialized care. Different degrees of resolution were reported by the municipalities, in terms of programs, the performance of managers and professionals. Conclusion Formal and formal networks acted in a complementary way in the treatment and support of children with Congenital Zika Syndrome. The insertion in different indirect networks allowed social support to face the impact caused by the disease. Despite the ministry of health’s investment in primary care, fragility was identified in this level of care.

Background: Euterpe oleracea Mart (açaí) is traditionally used as antidiarrheal, kidney and liver infections and as antimalarial. Methods: A review on Euterpe oleracea Mart was carried out in different databases, such as PubMed, Medline, Scielo, Herbal Medicine, as well as dissertations, theses, and books. Results: The literature shows the anticancer potential of açaí in different e cancer models. Regarding phytochemical composition, the literature shows greater amount of polyphenols, especially anthocyanins. Conclusions: The different uses of Euterpe oleracea Mart have been demonstrated by pharmacological and phytochemical studies, with the great amount of polyphenols, found in açaí, being pointed out as the main responsible for its anticancer activity.

Background: Species of mycotoxin-producing fungi are potentially dangerous to humans and animals. The liver is the best-known organ of action of these substances. The aim of this study was to isolate microscopic fungi from honey and investigate the cytotoxic effect of the extract of Penicillium sp. in an experimental model. Methods: Honey samples were cultured in Sabouraud agar. After isolated and identified microscopically, the colonies of the genus Penicillium sp. were transplanted to the Sabouraud dextrose agar culture medium. After its development, they were processed to obtain an extract. Eighteen Wistar mice were randomly assigned to experimental (GI) and control (GII) groups. The GI was subjected to an oral inoculation of the extract, while GII received a placebo. Procedures were performed every day for thirty days, after which the liver of each animal was removed for analysis. Results: Aspergillus sp. (86.2%), Geotrichum sp. (6.89%) and Penicillium sp. (6.89%) were isolated. The most frequent species was Aspergillus niger (46%). In relation to the cytotoxic effects of the extract of Penicillium sp., the gross findings in the liver of GI suggested mainly congestion. Light microscopy showed that the little hepatic lobules were preserved and there was vascular congestion of sinusoids. Light microscopy of specimens from the experimental group showed that 68.2% were abnormal, whereas 87.5% of the control group were within normal limits. Conclusions: The results suggest that there was contamination in honey samples. There was a predominance of macroscopic and microscopic changes in the liver of experimental rats, suggesting liver damage by Penicillium sp. Antecedentes: Las especies de hongos productores de micotoxinas son potencialmente peligrosas para humanos y animales. El hígado es el órgano de acción más conocido de estas sustancias. El objetivo de este estudio fue aislar hongos microscópicos de la miel e investigar el efecto citotóxico del extracto de Penicillium sp. en un modelo experimental. Métodos: Las muestras de miel se cultivaron en agar Sabouraud. Luego de aisladas e identificadas microscópicamente, las colonias del género Penicillium sp. fueron trasplantados al medio de cultivo agar dextrosa Sabouraud. Luego de su desarrollo, fueron procesados para obtener un extracto. Se asignaron aleatoriamente dieciocho ratones Wistar a grupos experimentales (GI) y de control (GII). El GI se sometió a una inoculación oral del extracto, mientras que el GII recibió un placebo. Los procedimientos se realizaron todos los días durante treinta días, después de lo cual se extrajo el hígado de cada animal para su análisis. Resultados: Aspergillus sp. (86,2%), Geotrichum sp. (6,89%) y Penicillium sp. (6,89%) fueron aislados. La especie más frecuente fue Aspergillus niger (46%). En relación con los efectos citotóxicos del extracto de Penicillium sp., los hallazgos macroscópicos en el hígado de GI sugirieron principalmente congestión. La microscopía óptica mostró que los pequeños lóbulos hepáticos estaban conservados y había congestión vascular de los sinusoides. La microscopía óptica de las muestras del grupo experimental mostró que el 68,2 % eran anormales, mientras que el 87,5 % del grupo de control estaba dentro de los límites normales. Conclusiones: Los resultados sugieren que hubo contaminación en las muestras de miel. Hubo un predominio de cambios macroscópicos y microscópicos en el hígado de ratas experimentales, lo que sugiere daño hepático por Penicillium sp. Introdução: Espécies de fungos produtores de micotoxinas são potencialmente perigosas para humanos e animais. O fígado é o órgão de ação mais conhecido dessas substâncias. O objetivo deste estudo foi isolar fungos microscópicos do mel e investigar o efeito citotóxico do extrato de Penicillium sp. em um modelo experimental. Métodos: Amostras de mel foram cultivadas em ágar Sabouraud. Depois de isoladas e identificadas microscopicamente, as colônias do gênero Penicillium sp. foram transplantados para o meio de cultura Sabouraud dextrose agar. Após o seu desenvolvimento, foram processados para obtenção de um extrato. Dezoito camundongos Wistar foram distribuídos aleatoriamente nos grupos experimental (GI) e controle (GII). O GI foi submetido à inoculação oral do extrato, enquanto o GII recebeu placebo. Os procedimentos foram realizados diariamente durante trinta dias, após os quais o fígado de cada animal foi retirado para análise. Resultados: Aspergillus sp. (86,2%), Geotrichum sp. (6,89%) e Penicillium sp. (6,89%) foram isolados. A espécie mais frequente foi Aspergillus niger (46%). Em relação aos efeitos citotóxicos do extrato de Penicillium sp., os achados macroscópicos no fígado do GI sugeriram principalmente congestão. A microscopia de luz mostrou que os pequenos lóbulos hepáticos estavam preservados e havia congestão vascular dos sinusóides. A microscopia de luz dos espécimes do grupo experimental mostrou que 68,2% estavam anormais, enquanto 87,5% do grupo controle estavam dentro dos limites normais. Conclusões: Os resultados sugerem que houve contaminação nas amostras de mel. Houve predomínio de alterações macroscópicas e microscópicas no fígado de ratos experimentais, sugerindo lesão hepática por Penicillium sp.

Açaí berry is a fruit from the tree commonly known as açaízeiro (Euterpe oleracea Mart.) originated from the Amazonian region and widely consumed in Brazil. There are several reports of the anti-inflammatory activity of its pulp and few data about the seed’s potential in inflammation control. This work aimed to evaluate the effect of catechin-rich açaí extract on lipopolysaccharide (LPS)-stimulated RAW 264.7 cells and carrageenan-induced paw edema. The treatment with E. oleracea ethyl acetate extract (EO-ACET) was used in an in vitro model performed with macrophages stimulated by LPS, in which pro-inflammatory markers were evaluated, and in an in vivo model of acute inflammation, in which edema inhibition was evaluated. EO-ACET showed an absence of endotoxins, and did not display cytotoxic effects in RAW 264.7 cells. LPS-stimulated cells treated with EO-ACET displayed low levels of nitrite and interleukins (IL’s), IL-1β, IL-6 and IL-12, when compared to untreated cells. EO-ACET treatment was able to inhibit carrageenan-induced paw edema at 500 and 1000 mg/kg, in which no acute inflammatory reaction or low mast cell counts were observed by histology at the site of inoculation of λ-carrageenan. These findings provide more evidence to support further studies with E. oleracea seeds for the treatment of inflammation.

Background: This study addresses the antitumoral properties of Penicillium purpurogenum isolated from a polluted lagoon in Northeastern Brazil. Methods: Ethyl Acetate Extracellular Extract (EAE) was used. The metabolites were studied using direct infusion mass spectrometry. The solid Ehrlich tumor model was used for antitumor activity. Female Swiss mice were divided into groups (n = 10/group) as follows: The negative control (CTL&minus, ), treated with a phosphate buffered solution, the positive control (CTL+), treated with cyclophosphamide (25 mg/kg), extract treatments at doses of 4, 20, and 100 mg/kg, animals without tumors or treatments (Sham), and animals without tumors treated with an intermediate dose (EAE20). All treatments were performed intraperitoneally, daily, for 15 days. Subsequently, the animals were euthanized, and the tumor, lymphoid organs, and serum were used for immunological, histological, and biochemical parameter evaluations. Results: The extract was rich in meroterpenoids. All doses significantly reduced tumor size, and the 20 and 100 mg/kg doses reduced tumor-associated inflammation and tumor necrosis. The extract also reduced the cellular infiltration of lymphoid organs and circulating TNF-&alpha, levels. The extract did not induce weight loss or renal and hepatic toxic changes. Conclusions: These results indicate that P. purpurogenum exhibits immunomodulatory and antitumor properties in vivo. Thus, fungal fermentation is a valid biotechnological approach to the production of antitumor agents.

Background. Cardiovascular disease (CVD) is the leading cause of death in Western civilizations. The type of fatty acid which makes up the diet is related to the cardiovascular morbimortality and the formation of atheromas. Populations with high consumption of oils and fats have a higher number of deaths from CVD. Purpose. In the present study, the objective was to comparatively analyze the microcirculatory effects of unrefined babassu oil with olive oil in microcirculation and liver of male hamsters of the species Mesocricetus auratus, checking the permeability to macromolecules after ischemia-reperfusion (I/R) without and with topical application of histamine 5 × 10−6 M. This is an experimental study, using as model the hamster’s cheek pouch, which was prepared for intravital microscopy. The hamsters were divided into seven groups and orally treated for 14 days, twice a day (at 8 AM and 4 PM), orally received treatments in the following doses: unrefined babassu oil (BO) 0.02 mL/dose (group BO-2), 0.06 mL/dose (group BO-6), and 0.18 mL/dose (BO-18 group); extra virgin olive oil (OI) 0.02 mL/dose (group OI-2), 0.06 mL/dose (group OI-6), and 0.18 mL/dose (OI-18 group); and mineral oil (MO) 0.18 mL/dose (MO-18 group). The observations were made on the 15th day on the hamsters’ cheek pouch; the increase of vascular permeability induced by I/R with and without histamine application was evaluated, and in the liver the biological material was collected aseptically then fixed in 10% buffered formalin. Results. Microcirculatory analyses showed a significant reduction in the number of leaks after I/R with and without the topical use of histamine in animals treated with unrefined BO 0.06 mL/dose (BO-6) and 0.18 mL/dose (BO-18) compared to animals treated with OI. The BO group (p<0.001) presented a dose-response relationship for decreasing leaks after I/R with and without topical use of histamine. Histological liver analyses showed no fat deposition changes in any of the treatment groups. Phytochemical analyses evidenced a chemical compound (C31H60NO8) in unrefined BO but not in OI. Conclusions. This experiment demonstrates the protective effect of unrefined BO on the microcirculatory system and its greater dose effect than that of OI. Finding a chemical compound (C31H60NO8) that is present in BO but not in OI opens the possibility of investigating whether this chemical compound was responsible for the protective effect on membrane permeability.

Background: Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer.The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the Northeast of Maranhão. Methods: The study was composed of 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus. Results: HPV was present in 88 women (73.3%), and HPV 16 was the most prevalent (48/54%), followed by HPV 18 (12/13.6%). Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. HPV 18 B variant (2/29%) was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05). Conclusions: Women with cervical cancer are associated with a higher frequency of HPV 16 and 18 in the Northeast region of Brazil, with a high prevalence of the lineage A among women with HPV 18.

The recent increase in babies born with brain and eye malformations in Brazil is associated with Zika virus (ZIKV) infection in utero. ZIKV alters host DNA methylation in vitro. Using genome-wide DNA methylation profiling we compared 18 babies born with congenital ZIKV microcephaly with 20 controls. We found ZIKV-associated alteration of host methylation patterns, notably at RABGAP1L which is important in brain development, at viral host immunity genes MX1 and ISG15, and in an epigenetic module containing the causal microcephaly gene MCPH1. Our data support the hypothesis that clinical signs of congenital ZIKV are associated with changes in DNA methylation.

Background: Cervical cancer is the fourth most common type of cancer affecting women globally. In Brazil, it is the third most frequent type of cancer in women and HPV is present in approximately 90% of cases. Evidence suggests that variants of HPV 16 can interfere biologically and etiologically during the development of cervical cancer. Methods: Cervix tumor fragments were collected, their DNA was extracted, and nested PCR was used to detect HPV. Positive samples were sequenced to determine the viral genotype. To characterize the HPV 16 strains, positive samples PCR was used to amplify the LCR and E6 regions of the HPV 16 virus. Results: Data from 120 patients with cervical cancer were analyzed. Most women were between 41 and 54 years of age, had schooling until primary school, a family income between 1 and 2 times the minimum wage and were married/in a consensual union. There was no statistically significant association between HPV or socio-demographic variables and risk factors for cervical cancer (P < 0.05). HPV was present in 88 women (73%). The most prevalent types were HPV 16 (47/54%), HPV 18 (12/13.8%), HPV 35 (6/6.9%) and HPV 45 (5/5.7%). Of the 47 HPV 16 positive cases, variant A (49%) was present in 23 samples, followed by variant D in 20 cases (43%), and variants B and C in 2 cases each (4%).The most prevalent histological type of HPV 16 tumors was epidermoid carcinoma, followed by adenocarcinoma. There was a statistically significant association between HPV 16 variants and the tumors’ histological types (P < 0.001).Conclusions: Knowledge of HPV 16 variants will provide data on their influence on the pathological and oncogenic aspects of cervical lesions.

Introduction. In recent decades, there has been an intensification of environmental problems, which are becoming increasingly critical and frequent due to population growth. Microorganisms, including soilborne fungi, play an essential role in maintaining and balancing the environment. One of the most impacted ecosystems in São Luís, Maranhão, Brazil, is the Jansen Lagoon State Park, an important tourist spot, which has suffered anthropogenic actions such as the dumping of household waste (sewage) in its body of water. As a consequence, these pollutants can accumulate in the adjacent soil, since the body of water is near this substrate. The objectives were to isolate and identify filamentous fungi from the soil of the Jansen Lagoon State Park. Methods. Monthly soil samples were collected and later processed using the modified suspension technique according to Clark (1965). Results. The isolated genera were Aspergillus, Penicillium, Trichoderma, Absidia, and Fusarium. Aspergillus is the fungal genus of greater dominance in the soil of the Jansen Lagoon State Park. Aspergillus niger was the dominant species (37%), followed by A. tamarii (21.6%). Conclusion. The main isolated fungi from the Jansen Lagoon State Park were Aspergillus niger and Aspergillus tamrii. These fungi can be used as biological markers of pollution and as biodegraders and/or bioremediators to improve the area studied.

Objective: To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. Method: A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables. Results: The aspects of breastfeeding that showed higher percentages of the category “poor” were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p

This study aimed at the investigation of physicochemical characteristics of oils and the morphometric characteristics of fruits and seeds (almonds) of babassu (Orbignya phalerata Martius), by ecological region of the state of Maranhão. For this, samples of babassu were obtained from the following regions: Litoral, Cocais, Baixada, Cerrado and Pre-Amazonia of the state of Maranhão, and analyzed the following physicochemical parameters: acidity index, saponification index, refraction index and humidity using Analytical Standards of the Adolfo Lutz Institute. Fruits were collected from the same regions to analyze the morphometric characteristics by measuring the fruits and almonds of the studied species. The results indicate that the acidity indexes are within the maximum limit established by the ANVISA National Standard and the saponification indexes indicate the presence of medium to high molecular weight lipids. The refractometric results are in line with current standards and the moisture content was less than 1%. The lots of Orbignya phalerata Martius babassu presented a significant variability in size and weight for fruits and almonds by region.

Objetivo: Analisar a distribuição de variedades intratipo de Papillomavirus humano em mulheres de grupos minoritários. Metodologia: foram incluídos 5 estudos primários, publicados entre 2016 a 2019, no idioma inglês. Resultados: A prevalência de infecção pelo HPV em mulheres de grupos minoritários foi de 31.72%. Foram pesquisados 54 grupos étnicos em cinco países, Brasil, Índia, Nigéria e Holanda sendo dois estudos realizados no Brasil, sendo um no estado do Maranhão e outro no estado Pará. A prevalência entre 21.16% e 38.89%. Os genótipos de HPV mais frequentes foram o HPV18, HPV16, HPV31, HPV35, HPV39, HPV45, HPV51, HPV52 e, o HPV58. Apenas um estudo revolução variedades intratipo. Conclusão: A prevalência de HPV de alto risco situou-se entre 2% e 8%. Os estudos não revelaram análises de linhagens e sublinhagens do HPV 16 e HPV 18. Foram escassas publicações utilizando a métodos de biologia molecular em grupos quilombolas, indígenas e ciganas em países da américa do sul considerando a relevância destes povos na formação cultural nos países latinos.

Background Zika virus (ZIKV) is a flavivirus associated with microcephaly and other fetal anormalities. However, evidence of asymptomatic ZIKV infection in pregnant women is still scarce. This study investigated the prevalence of Zika infection in asymptomatic pregnant women attending two public maternities in Maranhão state, Northeast Brazil. Methods A total of 196 women were recruited at the time of delivery by convenience sampling from two maternity clinics in São Luís, Maranhão, Brazil, between April 2017 and June 2018. Venous blood, umbilical cord blood and placental fragments from maternal and fetal sides were collected from each subject. ZIKV infection was determined by reverse transcription polymerase chain reaction (RT-qPCR) for ZIKV and by serology (IgM and IgG). Nonspecific laboratory profiles (TORCH screen) were obtained from medical records. Results The participants were mostly from São Luís and were of 19–35 years of age. They had 10–15 years of schooling and they were of mixed race, married, and Catholic. ZIKV was identified in three umbilical cord samples and in nine placental fragments. Mothers with positive ZIKV RT-qPCR were in the age group older than 19 years. Of the 196 women tested by ZIKV rapid test, 6 and 117 women were positive for anti-ZIKV IgM and anti-ZIKV IgG antibodies, respectively. Placental Immunohistochemistry study detected ZIKV in all samples positive by RT-PCR. The newborns did not show any morphological and/or psychomotor abnormalities at birth. Conclusions Asymptomatic ZIKV infection is frequent, but it was not associated to morphological and/or psychomotor abnormalities in the newborns up to 6 months post-birth. Although pathological abnormalities were not observed at birth, we cannot rule out the long term impact of apparent asymptomatic congenital ZIKV infection., Author summary Zika virus (ZIKV) belongs to family Flaviviridae, genus Flavivirus and it is transmitted by the bite of female Aedes mosquitoes. In October 2015 an unexpected increase in the number of newborns with microcephaly in Brazil. After investigation, Zika virus was strongly related to microcephaly. Considering the epidemiological importance of ZIKV infection during pregnancy and its repercussions on the mother-fetus pair, the aim of the present study was to investigate ZIKV infection in the placenta and umbilical cord blood of women served by the Brazilian Health System in São Luís, state of Maranhão, Northeast, Brazil, after the first ZIKV epidemic. This study investigated the prevalence of Zika infection in asymptomatic pregnant women attending two public maternities in Maranhão state, Northeast Brazil. We believe that these findings will contribute to the need of continuous awareness of the risk of ZIKV infection in pregnancy and the need to improving the health care and strategic planning of public policies regarding obstetric and neonatal care.

Euterpe oleracea Mart. (açai) is a native palm from the Amazon region. There are various chemical constituents of açai with bioactive properties. This study aimed to evaluate the chemical composition and cytotoxic effects of açai seed extract on breast cancer cell line (MCF-7). Global Natural Products Social Molecular Networking (GNPS) was applied to identify chemical compounds present in açai seed extract. LC-MS/MS and molecular networking were employed to detect the phenolic compounds of açai. The antioxidant activity of açai seed extract was measured by DPPH assay. MCF-7 breast cancer cell line viability was evaluated by MTT assay. Cell death was evaluated by flow cytometry and time-lapse microscopy. Autophagy was evaluated by orange acridin immunofluorescence assay. Reactive oxygen species (ROS) production was evaluated by DAF assay. From the molecular networking, fifteen compounds were identified, mainly phenolic compounds. The açai seed extract showed cytotoxic effects against MCF-7, induced morphologic changes in the cell line by autophagy and increased the ROS production pathway. The present study suggests that açai seed extract has a high cytotoxic capacity and may induce autophagy by increasing ROS production in breast cancer. Apart from its antioxidant activity, flavonoids with high radical scavenging activity present in açai also generated NO (nitric oxide), contributing to its cytotoxic effect and autophagy induction.

Objective: To evaluate the plasma cytokine levels during T cell-mediated inflammatory responses and compare the metabolic markers between overweight and obese perimenopausal women without systemic diseases. Methods: Sixty perimenopausal women were divided into two groups (overweight and obese). Participants in both groups had their waist-to-height ratio (WHtR) measured and blood samples collected for the evaluation of estradiol, fasting glucose, leptin, high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-10, IL-17A levels, and lipid profile. Results: In univariate analysis, women with obesity showed increased WHtR, fasting glucose, leptin, and IL-6 (p < 0.05) levels; however, significant differences were not observed in IL-10 or IL-17A (p > 0.05) levels. In the receiver operating characteristic curve, the highest areas under the curve were shown for leptin (0.856) and IL-6 (0.706). IL-6 levels correlated with both hs-CRP (r = 0.302, p = 0.020) and leptin (r = 0.294, p = 0.022). However, in multivariate analysis, IL-6 was not associated with a greater likelihood of obesity (OR = 1.61; 95% CI: 0.82-3.15; p = 0.16), when potential confounders were considered. Conclusion: IL-6 levels varied between overweight and obese perimenopausal women, and this association was weaker when adjusted for other clinical variables.

Background The current literature does not provide accurate information about the association between use of artificial nipples and sucking patterns in infants. Aims We aimed to investigate whether pacifier use and/or bottle-feeding were associated with nutritive sucking (NS) and non-nutritive sucking (NNS) patterns. Study design Cross-sectional study. Subjects 429 full-term infants/mothers. Outcome measures Data were collected through a questionnaire and observations of NS during breastfeeding and NNS (finger sucking). Multivariate logistic regression was used to analyze the adjusted associations between artificial nipple use and between NS and NNS changes. Results There were higher frequencies of changes in the NNS and NS patterns in the group that used artificial nipples. Regarding the type of artificial nipple, pacifier use had a greater influence on changes in the NNS pattern whereas the use of a baby bottle presented a greater number of associations with changes in the NS pattern. Conclusion The findings suggest that the use of artificial nipples may be associated with changes in the sucking patterns of infants, demonstrating the possible existence of nipple confusion and its effect on breastfeeding.

Background. Cardiovascular diseases are leading causes of death worldwide. Recent studies suggest that infection by some viruses, including the human papillomavirus (HPV), may increase the risk of developing atheromatous lesions on coronary arteries. However, there is a lack of data regarding the possible association between HPV infection and coronary artery disease (CAD) in women. Objective. To investigate whether HPV infection is associated with the occurrence of CAD among climacteric women. Methods. The presence of CAD and cervical HPV DNA was investigated in 52 climacteric women. Social and demographic variables and metabolic profiles were also investigated. Results. Among 27 women with CAD, 16 were positive for HPV, whereas 11 were negative. The presence of cervical HPV was strongly associated with CAD, after adjusting for demographic variables, health and sexual behaviors, comorbidities, and known cardiovascular risk factors. HPV-positive women showed a greater likelihood of having CAD (odds ratio [OR] = 3.74; 95% confidence interval [CI]: 1.16 to 11.96) as compared with HPV-negative women, particularly those infected with high-risk HPV types (OR = 4.90; 95% CI: 1.26 to 19.08). Conclusion. These results support the hypothesis that HPV infection might be associated with CAD among climacteric women, though further studies are needed to investigate the mechanisms involved.

Introduction: Climacteric women are susceptible to a number of changes, among them osteoporosis. Osteoporosis is a disease characterized by low bone mass and susceptibility to fracture. Currently, this disease is a public health issue, being necessary to recognize its risk factors. Objectives: Identify risk factors related to osteoporosis in women attending Propis/Proex/UFMA, tracing a socio-demographic characterization and considering community lifestyles. Material and methods: This is a transversal retrospective clinical with a quantitative approach study conducted between March and June 2013 in São Luís (MA) with 107 women treated at the Programa de Práticas de Integralidade em Saúde (Propis - Integrality Health Practice Program). The study was approved by the University Hospital Ethics Committee of UFMA under opinion no. 362/07. Data were tabulated and analyzed in the epidemiological Epi-Info® software, version 3.4.1. Results: The brown color was predominant, consensual relationships proved to be a protective factor and low education was a risk factor. The average age of the group with menopause was 54.1 years and without menopause was 31.3 years (p < 0.0001). The average age of menopause was 43.7 years. The irregular menstrual cycle was a protective factor. The average number of pregnancies was 4.56 for the group with menopause and 2.45 for the group without menopause, with most births occurring normally (p < 0.0001). Smoking, physical inactivity and caffeine intake were risk factors, while the absence of alcoholism and of soda intake were protective factors for the disease. Conclusion: The patients followed the socioeconomic and demographic profile of Maranhão. Most had menarche and menopause in appropriate periods, showed no positive family history of osteoporosis, did not usually drink alcohol, were sedentary and the caffeine intake was high. RESUMO Introdução: As mulheres no climatério estão suscetíveis a uma série de mudanças, entre elas a osteoporose. A osteoporose é uma doença caracterizada por uma baixa massa óssea e susceptibilidade à fratura. Atualmente, essa doença é um problema de saúde pública e é necessário reconhecer seus fatores de risco. Objetivos: Identificar os fatores de risco relacionados com a osteoporose em mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis)/Proex/UFMA, traçar uma caracterização sociodemográfica e considerar o estilo de vida da comunidade. Material e métodos: Trata-se de um estudo transversal retrospectivo clínico com uma abordagem quantitativa, feito entre março e junho de 2013, em São Luís (MA), com 107 mulheres atendidas pelo Programa de Práticas de Integralidade em Saúde (Propis). O estudo foi aprovado pelo Comitê de Ética do Hospital Universitário da UFMA, sob parecer nº 362/07. Os dados foram tabulados e analisados com o software epidemiológico Epi-Info®, versão 3.4.1. Resultados: A etnia parda foi predominante, a união estável mostrou ser um fator protetor e a baixa escolaridade foi um fator de risco. A idade média do grupo com menopausa foi de 54,1 anos e a do sem menopausa de 31,3 anos (p < 0,0001). A idade média da menopausa foi de 43,7 anos. O ciclo menstrual irregular foi um fator protetor. O número médio de gestações foi de 4,56 para o grupo com menopausa e 2,45 para o grupo sem menopausa, com a maior parte dos partos normal (p < 0,0001). O tabagismo, a inatividade física e o consumo de cafeína foram fatores de risco, enquanto a ausência de alcoolismo e de ingestão de refrigerante foram fatores de proteção para a doença. Conclusão: Os pacientes seguiram o perfil socioeconômico e demográfico do Maranhão. A maior parte teve a menarca e a menopausa em períodos apropriados, não apresentava antecedentes familiares de osteoporose, não costumava ingerir bebida alcoólica, era sedentária e consumia uma elevada quantidade de cafeína.

Urinary incontinence (UI) has been associated with chronic respiratory symptoms, and it affects quality of life. This study evaluated the quality of life of asthmatic patients from the Assistance Program for Asthmatic Patients (PAPA) with and without UI.This is an analytical descriptive cross-sectional study using a sample of 358 women with asthma. Data were collected via the International Consultation Incontinence Questionnaire-Simplified Form (ICIQ-SF), Quality of Life in Asthma Questionnaire (QLAQ-ASTHMA) and Short Form 36 Health Survey (SF-36).We found a general prevalence of UI of 55.3%. Overall quality of life scores in the SF-36 and QLAQ-ASTHMA were not related to the presence of UI. However, the amount of urine lost was significantly correlated with the subdomains physical aspects, general health, social functioning and mental health of the SF-36 and with socioeconomic and psychosocial domains of the QLAQ-ASTHMA.Urinary incontinence may affect a large proportion of older women with asthma. This study demonstrates the importance of routinely evaluating the occurrence of UI in order to improve the quality of life of asthmatic patients.

It is clear the concern of governments to discipline the actions related to health. It is likely to disability retirement the server stricken with ankylosing spondylitis and other musculoskeletal diseases. Objective: Describe the morbidity profile for musculoskeletal pathologies of public in Sao Luis retired due to disability. Materials and Methods: This was an observational, descriptive and retrospective, study of 60 employee records containing information recorded by the Commission of Forensic Medicine between January 2009 and December 2011. The sums of years lost due to retirement were calculated as an indicator of the impact of disability retirement in musculoskeletal diseases. The conduct of the study received approval from the Commission of Forensic Medicine Division of IPAM and staff through the Commitment Term Use of Medical Records and Statement of Consent. Results: The analysis of disability retirement due to musculoskeletal disorders diagnosis shows that occurred primarily in men (90%) aged 61 – 65 years, and the professionals most affected were teachers and administrative agent. The musculoskeletal disorders occurred in 10% of the study sample, and the most retired for disability integral type and/or proportional were administrative agent and assistant general services. Conclusion: The study shows the need for health promotion and surveillance in relation to workers’ health, providing better working conditions and reducing illness among servers, reducing the number of disability pension for musculoskeletal pathologies

Due to the lack of effective pharmacotherapy options to treats Alzheimer’s disease, new strategies have been approached in the search for multi-target molecules as therapeutic options. In this work, four indole alkaloids, geissoschizoline, geissoschizone, geissospermine, and 3′,4′,5′,6′-tetradehydrogeissospermine were isolated from Geissospermum vellosii (Pao pereira) and evaluated for their anticholinesterase activities. While geissospermine inhibited only butyrylcholinesterase (BChE), the other alkaloids behaved as non-selective inhibitors of acetylcholinesterase (AChE) and BChE. In cell viability tests, only geissoschizoline was not cytotoxic. Therefore, geissoschizoline actions were also evaluated in human cholinesterases, where it was twice as potent inhibitor of hBChE (IC50 = 10.21 ± 0.01 µM) than hAChE (IC50 = 20.40 ± 0.93 µM). On enzyme kinetic studies, geissoschizoline presented a mixed-type inhibition mechanism for both enzymes. Molecular docking studies pointed interactions of geissoschizoline with active site and peripheral anionic site of hAChE and hBChE, indicating a dual site inhibitor profile. Moreover, geissoschizoline also played a promising anti-inflammatory role, reducing microglial release of NO and TNF-α at a concentration (1 μM) ten and twenty times lower than the IC50 values of hBChE and hAChE inhibition, respectively. These actions give geissoschizoline a strong neuroprotective character. In addition, the ability to inhibit hAChE and hBChE, with approximate inhibitory potencies, accredits this alkaloid for therapeutic use in the moderate to severe phase of AD. Thus, geissoschizoline emerges as a possible multi-target prototype that can be very useful in preventing neurodegeneration and restore neurotransmission.

This article aims to evaluate the total phenolics and antioxidant activity of the prepared extract of the fungus Penicillium purpurogenum, obtained from a polluted marine environment of Sao Luis-MA. The research was carried out at Laguna da Jansen located in the Municipality of Sao Luis, Maranhao, Brazil. Four sediment collections were performed from May to September 2017, in the morning period. The samples were obtained from a depth of up to 73.5 cm with the aid of a metal dredger. The identification of the fungus followed methodologies of isolation and subsequent preparation of the extracts with evaluation of total phenolics by the Folin-Ciocalteu method and antioxidant activity by the DPPH radical sequestration method. Identification confirmed the presence of Penicillium purpurogenum . The extracts of P. purpurogenum varied in the quantification of total phenolics of 791.00 mg EAT g -1 for FR1 extract and 650.82 mg EAT g -1 for FR2. In antioxidant activity, wecould verify that the EC 50 found in the FR1 extract was 22.59 μg mL -1 and FR2 39.80 μg mL -1 . Concluding that the EXTRACT FR2 showed strong antioxidant activity while FR1 was very strong by the DPPH radical method.

Objetivo: Avaliar o perfil alimentar, estado nutricional, hábitos de vida e consumo de frequência alimentar de derivados de babaçu em comunidades quilombolas em uma cidade do estado do Maranhão, Brasil. Métodos: Foi realizado um estudo descritivo por meio de questionários de recordação de 24 horas, pesquisa de frequência alimentar de derivados de babaçu e dados antropométricos. O estudo foi realizado em comunidades quilombolas no nordeste do Brasil. Resultados: A amostra foi composta por 87 indivíduos com mais de 21 anos. A amostra apresentou 57,47% de participantes do sexo feminino e 42,53% do masculino, com faixa etária predominante entre 40 e 59 anos. De acordo com o estado nutricional, 47,13% foram classificados como eutróficos, 35,63% como obesos e 3,45% como baixo peso. Entre os indivíduos obesos e com sobrepeso, 69,76% eram do sexo feminino. As proteínas tiveram o maior percentual de adequação, 83,91%. Os carboidratos foram consumidos acima dos níveis recomendados, 27,59%. Conclusão: Os derivados de babaçu mais frequentemente ingeridos foram óleo e nozes. O estudo demonstrou alta prevalência de sobrepeso e obesidade. A proteína foi o macronutriente com a maior porcentagem de adequação da dieta. A ingestão de vitaminas A, C, E e B2 foi inadequada.

Introduction: Candida parapsilosis is one of the main species that is able to adhere to forming biofilms on inert materials. Adhesion is the first step towards the colonization and invasion of host cells during the infectious process. Among the infections, vulvovaginal candidiasis is increasingly common. The objective was to evaluate the profile of adherence and biofilm formation of eight isolates of C. parapsilosis on the metal used in intrauterine devices (IUDs). Methods: Eight strains of C. parapsilosis presenting strong adhesion and biofilm formation properties were isolated from vaginal secretions in a previous study. To assay the adhesion and biofilm formation, copper fragments were made and cultivated in tubes containing 3 mL of phosphate-buffered saline and incubated for 6 and 24 h at 37 °C to evaluate biofilm formation. After incubation, the intensity of adherence and of biofilm formation on copper fragments were determined by performing a colony count. Results: All isolates were able to form biofilms and the isolate Cp62 showed many cells joined in a planktonic mode forming biofilms. The use of an IUD is one of the main factors that favors vulvovaginal candidiasis, and the presence of copper in this device increases the chance of recurrent vulvovaginal candidiasis (CVVR) due to the ease with which species of the genus Candida can adhere to inert surfaces. Conclusion: This research showed that the clinical isolates studied adhered to IUD copper fragments and formed biofilms, further increasing their virulence.

INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P

Background Anal cancer malignancies comprise about 1.5 to 3% of cancers from the gastrointestinal in which high-risk types of human papillomavirus (HR-HPV) is responsible for >80% of cases. The aim of this work was to detect and perform human papillomavirus (HPV) genotyping in squamous cell carcinoma specimens from the anal canal and to investigate the association between viral infection and histopathological and clinical aspects. Methods The presence of genotype-specific HPV DNA in formalin-fixed paraffin embedded tissue from 27 anal SCC samples from a reference cancer hospital of São Luís, State of Maranhão, Brazil was performed by Linear Array HPV Genotyping Test and the INNO-LiPA HPV Genotyping Assay. Fisher’s Exact test and Chi-square test were performed in order to evaluate the association between HPV type and clinical and morphological variables. P values less than 0.05 were considered statistically significant. Results Average age of patients at the time of diagnosis was 54.96 years ± 15.81; 74.07% of patients were female. Vegetative ulcers represented the most common type of lesion (22.22%). The lesions ranged in size from 2.1 cm to 5.0 cm and mostly were well-differentiated (70.38%). Lymph node involvement was observed in 26% of the patients. Molecular evaluation revealed that HPV infection was detected in 81.48% of the lesions, and the most common type found was the oncogenic HPV 16. Statistical analysis indicated that the clinical and histopathological variables were not associated with HPV infection. Conclusions Our results indicate that anal SCC rarely occurs in the absence of HPV and emphasize the predominant role of HPV16. The evaluation about genotype-specific prevalence of HPV in anal SCC is important to assess the potential benefit of HPV vaccination.

Introduction: There are more than 300,000 extractors using the babaçu coconut as a source of income in the States of Maranhão, Pará, Tocantins and Piauí, and this activity is associated with fungal infections. The objective of this study was to examine the occurrence of emergent fungi in the conjunctiva, nails and surface and subcutaneous injuries of female coconut breakers in Esperantinópolis, Maranhão. Additionally, soil samples and palm structures were collected. Methods: The obtained samples were cultured in Petri dishes containing potato-dextrose-agar and chloramphenicol. The etiological agent was confirmed by a direct mycological exam and growth in culture. Results: In total, 150 domiciles were visited, and samples were collected from 80 patients. From the ground, the most frequently isolated fungus was Aspergillus niger (53. 8%). the most frequently detected fungus in babaçu coconut was Aspergillus niger (66.7%). Conjunctival fungal growth occurred in 76.3% of the women. The ocular fungal microbiota consisted of filamentous fungi (80.6%), and yeasts were present in 19.4% of cases. Onychomycosis was diagnosed in 44% (11/25) of the women. Conclusions: The identification of the genera Neosartorya, Rhizopus and Curvularia in onychomycoses shows that emergent filamentous fungi can be isolated. Aspergillus sp., Penicillium sp. and Scedosporium sp. were the predominant genera found in the babaçu coconut. From ocular conjunctiva, Candida spp. were the most prevalent species isolated, and Fusarium sp. was present only in one woman. The nearly permanent exposure of coconut breakers to the external environment and to the soil is most likely the reason for the existence of a mycotic flora and fungal infections, varying according to the individual's practices and occupation.

The fatty acid composition of six Orbignya phalerata samples of different cities from Maranhao State (Brazil) was studied. The oils were extracted by two methods using Soxhlet extractor and the fatty acid composition was evaluated by gas chromatography-mass spectrometry (GC-MS) analysis. The lipid fraction content showed that the solvent used influences lipid extraction, the highest percent was obtained with hexane. Lipid content ranged from 62.46-67.45%, with predominance of saturated fatty acids (80.32-87.80%), mainly lauric acid (C12:0) with 44.86 to 52.15%. Multivariate analysis showed the distribution of O. phalerata samples into three distinct regions and suggests that the oil chemical composition may be associated with their geographic location. These data show knowledge of the biodiversity of O. phalerata fatty acids among the different regions of the Maranhao State (Brazil).

Background Human papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women. Methods This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups. Results HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection. Conclusions It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.

Summary Objectives To determine the frequency of human papillomavirus (HPV) types and behavioral characteristics related to cytological abnormalities in women descendants of slaves, who live in isolated communities known as quilombos in the state of Maranhao, Brazil. Methods Cervicovaginal specimens of 353 women were analyzed by conventional cytology and genotyping. HPV detection and genotyping was performed using a linear array HPV genotyping test kit. Behavioral factors and their association with cytological abnormalities were analyzed, as well as the association between cytological abnormalities and HPV infection. Results The frequency of HPV infection was 13%, and infection with high-risk HPV types was more frequent than with low-risk types (10.2% vs. 2.8%). The most prevalent genotypes were HPV 68 (3.1%) and HPV 58 (2.6%). HPV-positive women were 6.5 times more likely than HPV-negative women to be diagnosed with cytological abnormalities. There was a significant association between HPV infection and the presence of cytological abnormalities in women 31–40 years of age and in women 51–60 years of age. Conclusions A distinct profile of high-risk HPV genotypes was detected, with predominance of types 68 and 58. It is possible that the results of the present study are due to specific characteristics of the population, which is geographically isolated and maintains conservative sexual habits.

Background Mycobacterium tuberculosis multidrug resistance, especially against rifampicin and isoniazid, places pulmonary tuberculosis in the list of emerging diseases. The misuse of therapeutic regimens is one of its main predisposing factors. Case presentation Four clinical cases (three were brown and one black) with multidrug-resistant tuberculosis, treated in a reference hospital in the state of Maranhão, Brazil, were reported to evaluate the importance of radiological framework on disease evolution. Conclusion The clinical framework showed a bad evolution and drug resistance, while radiology showed lung lesions, ranging from exudative infiltrates to lung parenchyma disintegration.

Background Familial cancer includes some types of cancer aggregation without a well-defined inheritance pattern. Cancer genetics is an essential component of clinical practice in oncology. In Brazil, breast cancer is the leading cause of death in women. In Maranhão, studies on genetic predisposition are necessary to investigate the incidence and mortality rates. The aim of this study was to investigate familial cancer among relatives of women who died of breast cancer in São Luís, Brazil, constructing a pedigree to identify families with a hereditary predisposition, an important step in the early diagnosis of malignant tumors. Methods The city of São Luís is located on the Island of Maranhão, northeastern Brazil, with a population of 997,098 inhabitants mainly comprising blacks and mulattoes, including descendants of runaway slaves from the Amazon region itself. Data for pedigree construction were obtained from the records of 54 patients seen at the Aldenora Bello Institute of Oncology, São Luís, between 2000 and 2007, as well as by interview with relatives of the patients. Results The mean patient age at diagnosis was 39.5 years. Most women were mulattoes (36/54, 66.6 %). A history of cancer was observed in 18 families, with 16 families possessing cases of cancer among first-degree relatives and five among second-degree relatives. Conclusion A concentration of cancer cases was found in families of patients diagnosed until the age of 40, a finding demonstrating the importance of a family history prior to genetic counseling.

The pattern of epidemic meningococcal disease in the African meningitis belt may be influenced by the background level of population immunity but this has been measured infrequently. A standardised enzyme-linked immunosorbent assay (ELISA) for measuring meningococcal serogroup A IgG antibodies was established at five centres within the meningitis belt. Antibody concentrations were then measured in 3930 individuals stratified by age and residence from six countries. Seroprevalence by age was used in a catalytic model to determine the force of infection. Meningococcal serogroup A IgG antibody concentrations were high in each country but showed heterogeneity across the meningitis belt. The geometric mean concentration (GMC) was highest in Ghana (9.09 μg/mL [95% CI 8.29, 9.97]) and lowest in Ethiopia (1.43 μg/mL [95% CI 1.31, 1.57]) on the margins of the belt. The force of infection was lowest in Ethiopia (λ = 0.028). Variables associated with a concentration above the putative protective level of 2 μg/mL were age, urban residence and a history of recent vaccination with a meningococcal vaccine. Prior to vaccination with the serogroup A meningococcal conjugate vaccine, meningococcal serogroup A IgG antibody concentrations were high across the African meningitis belt and yet the region remained susceptible to epidemics.

INTRODUCTION: One of the important current problems in HIV/AIDS infection is the establishment of epidemiological and laboratorial prognostic parameters during patient follow-up. This study aimed at analyzing the evolution of laboratory tests: CD4 lymphocyte count, viral load, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the epidemiological variables sex and age as prognostic factors for survival in progression to death among AIDS patients. METHODS: A retrospective study was conducted using analysis of medical records, and prospective 24-month follow-up of patients with HIV/ AIDS attended at the President Vargas Hospital Outpatient Clinic, a reference center in HIV/ AIDS attendance in the State of Maranhão, Brazil. The study analyzed patients aged 10 to 60 years old, who manifested AIDS and who were not using antiretroviral therapy or had used it for less than 5 years. The Chi-square test was used for statistical analysis. RESULTS: The sample included 100 patients - 57 were current outpatients, and 43 had died. The variables viral load (p=0.726), ALT (p=0.314), sex (p=0.687), and age (p=0.742) were analyzed, and no evidence of association between them and worst prognosis was observed. CONCLUSIONS: A significant relation was verified between low Hb levels (p=0.000) and CD4 (p=0.000) and shorter survival. INTRODUÇÃO: Uma das importantes dificuldades atuais na infecção HIV/AIDS é estabelecer parâmetros epidemiológicos e laboratoriais prognósticos no seguimento dos pacientes. Esse trabalho objetivou analisar a evolução dos exames laboratoriais: contagem de linfócitos CD4, carga viral, dosagem de hemoglobina (Hb), de aspartato aminotransferase (AST), de alanino aminotransferase (ALT) e as variáveis epidemiológicas: sexo e idade, como fatores prognósticos de sobrevida na evolução para o óbito em pacientes com AIDS. MÉTODOS: Foi realizado um estudo retrospectivo a partir da análise de prontuários e um prospectivo por seguimento de pacientes portadores de HIV/AIDS, no Serviço Ambulatorial da referência assistencial em HIV/AIDS, no Estado do Maranhão, durante 24 meses. Os pacientes analisados tinham faixa etária compreendida entre 10 e 60 anos, apresentavam quadro clínico manifesto e não faziam uso de antirretroviral ou ainda o faziam há menos de 5 anos. Para análise estatística, foi adotado o teste qui-quadrado. RESULTADOS: A amostra compreendeu 100 pacientes, dos quais 57 se encontravam em tratamento ambulatorial e 43 já tinham ido a óbito. Variáveis como carga viral (p= 0,726), ALT (p=0,314), sexo (p=0,687) e faixa etária (p=0,742) foram analisadas e nenhuma evidência de associação entre elas com o pior prognóstico foi verificada. CONCLUSÕES: Constatou-se uma significante relação entre baixos níveis de Hb (p=0,000) e de CD4 (p=0,000) com menor sobrevida.

Visceral leishmaniasis (VL), also known as kala-azar, is an important public health problem. If not treated, virtually all clinically symptomatic patients die within months. The diagnosis is based on the Montenegro skin test (MST) and anti-Leishmania titers. Nevertheless, the time required for cured individuals living in a leishmaniasis-endemic area to present a positive skin test and negative anti-Leishmania serology is known. To determine the cellular and humoral immune response profile in relation to different times post-VL cure, a cross-sectional study was conducted on subjects from a kala-azar endemic area in Paço do Lumiar, MA, Brazil, on the basis of 1995-2005 notifications reported by the National Health Foundation/Regional Coordination of Maranhão. We visited cured individuals with a history of VL within the last 10 years. Seventy-four subjects (30 females) ranging in age from 1 to 44 years were included, all of them symptom free at the time of the study. A cellular immune response was observed in 73 (98.6%) subjects, whereas no significant antibody titers were detected by indirect immunofluorescence (IIF) in the sera of 69 (93.2%) cases. Ten years post-cure, 39 (52%) subjects had a positive MST and negative IIF reaction, while in one subject the skin and anti-Leishmania serology tests were negative. Two other subjects were positive in both tests 1 year after cure. These data suggest that a cellular immune response may still be present in subjects cured of VL regardless of post-cure time, and that the parasite persists in the host after clinical cure of the disease. This would explain the persistence of significant Leishmania sp antibody titers in some subjects after treatment.

Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.

Objective: to evaluate the prevalence of cardiovascular risk factors associated with dyslipidemia in Quilombola communities in Maranhão, Brazil. Methods: a cross-sectional study was performed from February 2010 to November 2011. A total of 202 individuals belonging to the Quilombola communities in Codó, Maranhão were assessed. Risk factors associated with dyslipidemia and metabolic syndrome (MS) were evaluated. Results: the results showed a high prevalence of dyslipidemia (72.28%) and hypertension (43.07%). Isolated hypertriglyceridemia (38.61%) with normal levels of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol was present in most individuals. Furthermore, the prevalence of MS and the estimated cardiovascular risks were low in this population. Conclusion: dyslipidemia, at the expense of triglycerides, and hypertension was highly prevalent. However, the frequency of other risk factors for cardiovascular events was low. A low prevalence of MS and cardiovascular risk according to the Framingham score for cardiovascular diseases was also identified. Objetivos: evaluar los factores de riesgo cardiovascular asociados con dislipidemia en comunidades quilombolas de Maranhão, Brasil. Métodos: un estudio transversal se realizó entre febrero del 2010 hasta el noviembre del 2011 en 202 individuos pertenecientes a comunidades quilombolas de Codó-MA. Se evaluaron los factores de riesgo asociados con la dislipidemia y el síndrome metabólico (SM). Resultados: el estudio mostró una alta prevalencia de la dislipidemia (72,28%) y de la hipertensión (43,07%). Hipertrigliceridemia aislada (38,61%) con valores de lipoproteínas de alta densidad y lipoproteínas de baja densidad normales estuvieron presentes en la mayoría. La prevalencia del síndrome metabólico y riesgo cardiovascular estimado fue bajo en esta población. Conclusión: hubo una alta prevalencia de dislipidemia, a expensas de los triglicéridos e hipertensión, no obstante, la frecuencia de otros factores de riesgo de eventos cardiovasculares fue baja. Una baja prevalencia de SM y el riesgo cardiovascular según la puntuación de riesgo de Framingham para la enfermedad cardiovascular también se ha identificado. Objetivos: avaliar os fatores de risco cardiovascular associados à dislipidemia em comunidades quilombolas do Maranhão, Brasil. Métodos: um estudo transversal foi realizado no período de fevereiro de 2010 a novembro de 2011 em 202 indivíduos pertencentes às comunidades quilombolas de Codó-MA. Avaliaram-se os fatores de risco associados à dislipidemia e síndrome metabólica (SM). Resultados: o estudo mostrou alta prevalência de dislipidemia (72,28%) e de hipertensão arterial (43,07%). Houve predomínio de hipertrigliceridemia isolada (38,61%) com valores de lipoproteína de alta densidade e lipoproteína de baixa densidade normais na maioria dos indivíduos. A prevalência de síndrome metabólica e o risco cardiovascular estimado foram baixos nesta população. Conclusão: houve grande prevalência de dislipidemia, à custa de triglicerídeos, e hipertensão; entretanto, a frequência de outros fatores de risco para eventos cardiovasculares foi baixa. Uma baixa prevalência de SM e de risco cardiovascular, segundo o escore de Framingham para doenças cardiovasculares, também foi identificada.

Estudo comparativo de anticorpos IgG e IgE antileishmania como marcadores de infecção e doença em área endêmica de leishmaniose visceral na ilha de São Luis, MA no período de maio de 1999 a maio de 2000. A casuística foi composta de 1.016 menores de 16 anos. Destes, foram randomizados 85 para dosagem de IgE antileishmania pelo ELISA. A prevalência de soropositividade por IgG foi de 17,1% (174 menores) e 0,4% da população evoluiu para leishmaniose visceral doença. A positividade para IgE antileishmania, foi de 43,5% dos 85 indivíduos estudados. Dos 7 casos de calazar no passado analisados, observou-se que todos apresentavam positividade para IgG e 4 (57,14%) permaneciam positivos para IgE, mesmo 7 anos após a cura. Os 3 menores com leishmaniose visceral doença, apresentaram positividade para IgG e IgE antileishmania. A detecção de IgE antileishmania demonstrou ser marcador de infecção para Leishmania chagasi em área endêmica, não sendo entretanto, marcador de doença. Comparative study regarding IgG and IgE anti-leishmania as markers of infection and illness among residents of a visceral leishmaniasis visceral leishmaniasis endemic area, São Luis, MA in the period from May 1999 to May 2000. All the 1,016 individuals younger than 16 years old were tested for the presence of IgG by ELISA. A total of 174 (17,1%) children revealed a positive IgG test and 4 children showed symptoms of classical visceral leishmaniasis during the time of the survey: 85 IgE anti-leishmania ELISA tests with positivity of 43,5% were realized. In this sample, all 7 children with past-visceral leishmaniasis in the sample were IgG positive and 4 (57,1%) were IgE positive, even after a 7 year post treatment period. Three children with current visceral leishmaniasis were evaluated, and all of them were positive for both tests. The detection of antileishman IgE antibodies presented as a good marker for infection by Leishmania chagasi in endemic areas but not as a disease marker.

The specificity of human antileishmanial IgG and IgE antibodies to glycosylated antigens of Leishmania chagasi was evaluated. An ELISA was performed with soluble leishmanial antigen (SLA) and a panel of 95 sera including samples from patients with subclinical infection (SC) and visceral leishmaniasis (VL), subjects cured of visceral leishmaniasis (CVL), and from healthy individuals from endemic areas (HIEA). Antileishmanial IgG were verified for 18 (40%) of 45 SC subjects (mean absorbance of 0.49 +/- 0.17). All nine sera from VL patients had such antibody (0.99 +/- 0.21), while 11 (65%) of 17 CVL individuals were seropositive (0.46 +/- 0.05). Only three (12%) of 24 HIEA controls reacted in IgG-ELISA. Antileishmanial IgE was detected in 26 (58%) of 45 SC patients (0.35 +/- 0.14), and in all VL patients (0.65 +/- 0.29). These antibodies were also detected in 13(76%) of 17 CVL subjects (0.42 +/- 0.14) while all HIEA controls were seronegative. There was no correlation between antileishmanial IgG and IgE antibody absorbances. Mild periodate oxidation at acid pH of SLA carbohydrates drastically diminished its antigenicity in both IgG and IgE-ELISA, affecting mainly the antigens of 125, 102, 94, and 63 kDa as demonstrated by western immunoblotting.

Objetivo: Verificar, na mais recente literatura, o efeito dos bicos artificiais, como mamadeiras e chupetas, sobre a prática do aleitamento materno. Métodos: Foi realizada uma revisão da literatura nas bases de dados LILACS, SciELO e PubMed, considerando estudos originais publicados entre os anos de 2010 e 2015, em português e inglês, utilizando-se os descritores “chupetas”, “amamentação”, “mamadeiras”, “desmame” e “alimentação artificial”, combinados ou isolados, com seus respectivos correspondentes na língua inglesa. Resultados: foram incluídos 25 artigos conforme os critérios de inclusão e exclusão. Estudos apontaram uma relação entre o desmame e o uso de chupetas, e o desmame e uso de chupetas e outros bicos artificiais. Além disso, os estudos evidenciaram que a redução no uso de chupeta gera um aumento na duração do aleitamento. Outras variáveis comuns relacionadas ao desmame relatadas na literatura foram: ausência materna, trabalhar fora ou falta de proteção legal, baixa escolaridade materna, idade materna e problemas relacionados às mamas e nascimento em unidade não “Hospital Amigo da Criança”. Conclusões: O uso de bicos artificiais está sendo relacionado ao desmame precoce ou à diminuição da duração do aleitamento materno. Necessita-se ainda que outros estudos sejam realizados a fim de compreender melhor como os bicos artificiais agem sobre as habilidades orais da criança.

Background: The human papillomavirus (HPV) prevalence in males has been reported to be between 3.6% and 84%, depending specially on the socioeconomic status. HPV infection has been related as a risk factor for penile cancer. This is a rare tumor, and other risk factors include lack of personal hygiene and men who have not undergone circumcision. Penile cancer is less than 1% of cancers in men in the United States, however, is much more common in some parts of Asia, Africa, and South America, where it accounts for up to 10% of cancers in men. This study aimed to determine the prevalence of HPV-DNA in penile cancers in Sao Luis, Brazil and to correlate the virus presence to histopathological factors. Methods: Tumor paraffin samples of 76 patients with penile carcinoma were tested in order to establish the prevalence and distribution of genotypic HPV using PCR/Nested and automated sequencing. To evaluate the association between HPV types and other clinical and morphological variables, a nonparametric ANOVA was performed using a Kruskal Wallis test, and statistical significance was determined to a value of p < 0.05. Results: The average age of patients at the time of diagnosis was 66 years ± 17.10. Regarding location, 65.79% of the tumors were located in the glans, and the most common types were vegetative (34.21%) and squamous (98.68%). Most of the lesions ranged in size from 2.1 to 5.0 cm, presenting Jackson I stage and Broders II degree. It was observed that 32 patients had at least one invaded and/or infiltrated structure. Lymph node involvement was observed in 19.76% of the patients, and 21.05% showed an inflammatory process. In the molecular evaluation, HPV infection was observed in 63.15% of the lesions, and the most common type was HPV 16. Conclusions: From the statistical analysis, it can be verified that the variables were not associated with infection by the HPV virus. Although penile cancer can result from various risk factors that act in synergy, an HPV virus infection is important for the development of such neoplasm.

Background Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system. Case presentation The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm3 and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya–Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole. Conclusion This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20-30% of the world's population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis.In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007-2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE.Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p = 0.01) and Penicillium (p = 0.005) and between cough and seropositivity for Aspergillus (p = 0.007).Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.