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Background: HIV/AIDS remains a highly stigmatizing disease worldwide, preventing people with risk or infection from testing to learn their HIV status, accessing supportive services, or taking antiretroviral therapy. Despite many studies of HIV in blood donors, no studies have evaluated the factors that contribute to stigma surrounding this illness following notification process and counseling provided by blood centers. Methods: A cross-sectional questionnaire-based survey was conducted between 2016 and 2017. Persons with HIV were invited to return to the blood center for an audio computer-assisted interview after participation in an HIV risk factor assessment study conducted from 2007 to 2016. The questionnaire was based on HIV risk interviews developed by the US CDC, with modifications appropriate to the Brazilian setting which aimed to evaluate their follow-up activities, perceptions of HIV stigma and discrimination, and the quality of counseling and notification after the donation that tested positive for HIV. Response frequencies and adjusted odds ratios from multivariable logistic regression analyses are reported. Results: 268 HIV-positive blood donors agreed to participate in the study. Almost all participants, 262 (97 %), rated as very important or important the blood center counseling experience in their decision to seek health care. One-hundred-five (39 %) participants reported none to low levels of stigma, and 163 (61 %) participants moderate stigma. Individuals reporting heterosexual orientation (OR=2.13, 95 % CI [1.08‒4.22]) and healthcare-seeking behavior (OR=2.46, 95 % CI [1.10‒5.48]) had significantly increased odds of reporting moderate levels of stigma. Conclusions: Our study provides information about perceived stigma and discrimination in the Brazilian blood donor population and reinforces the importance of the counseling process in linkage to care and reducing HIV-related stigma.

BackgroundThe spreading adoption of value-based models of healthcare delivery has incentivized the use of patient-reported outcomes and experience measures (PROMs and PREMs) in clinical practice, with the potential to enrich the decision-making process with patient-reported data.MethodsThis perspective article explores PROs and the shared decision-making (SDM) process as components of value-based healthcare. We describe the potential of PROMs and PREMs within the decision-making process and present a digital framework for informing the shared decision-making process using aggregated data from a healthcare system PROMs and PREMs program, including early results from implementation in hospital network in Madrid, Spain.ResultsThe proposed digital framework incorporates aggregated data from a hospital network PROMs and PREMs program as part of a digital patient decision aid (PDA) for patients with lymphoma. After the first hematologist appointment, participating patients access the PDA to review relevant information about clinical and patient-reported outcomes for each of the possible options, assign a personal order of priority to different outcomes, and then select their preferred course of action. Patients’ answers are automatically uploaded to the EHR and discussed with hematologists at the next appointment. After beginning treatment, patients are invited to participate in the network PROMs program; participants’ PROMs data are fed back into the PDA, thus “closing the circle” between the decision-making process and patient-reported data collection.During the first 14 months after launching the decision aid in October 2022, of 25 patients diagnosed with follicular lymphoma at the four participating hospitals, 13 patients decided to participate. No significant differences in age or sex were observed between groups. Average SDM Q-9 score for patients filling in the questionnaire (n = 6) was 36.15 of 45 points.ConclusionVarious obstacles toward widespread implementation of SDM exist such as time constraints, lack of motivation, and resistance to change. Support and active engagement from policy makers and healthcare managers is key to overcome hurdles for capturing patient-reported data and carrying out shared decision-making at healthcare system level. Early results of a digital framework for PRO-enriched SDM seem to be beneficial to the decision-making process.

Summary: Background: The COVID-19 pandemic heightened risks for individuals with hematological malignancies due to compromised immune systems, leading to more severe outcomes and increased mortality. While interventions like vaccines, targeted antivirals, and monoclonal antibodies have been effective for the general population, their benefits for these patients may not be as pronounced. Methods: The EPICOVIDEHA registry (National Clinical Trials Identifier, NCT04733729) gathers COVID-19 data from hematological malignancy patients since the pandemic's start worldwide. It spans various global locations, allowing comprehensive analysis over the first three years (2020–2022). Findings: The EPICOVIDEHA registry collected data from January 2020 to December 2022, involving 8767 COVID-19 cases in hematological malignancy patients from 152 centers across 41 countries, with 42% being female. Over this period, there was a significant reduction in critical infections and an overall decrease in mortality from 29% to 4%. However, hospitalization, particularly in the ICU, remained associated with higher mortality rates. Factors contributing to increased mortality included age, multiple comorbidities, active malignancy at COVID-19 onset, pulmonary symptoms, and hospitalization. On the positive side, vaccination with one to two doses or three or more doses, as well as encountering COVID-19 in 2022, were associated with improved survival. Interpretation: Patients with hematological malignancies still face elevated risks, despite reductions in critical infections and overall mortality rates over time. Hospitalization, especially in ICUs, remains a significant concern. The study underscores the importance of vaccination and the timing of COVID-19 exposure in 2022 for enhanced survival in this patient group. Ongoing monitoring and targeted interventions are essential to support this vulnerable population, emphasizing the critical role of timely diagnosis and prompt treatment in preventing severe COVID-19 cases. Funding: Not applicable.

Objectives: Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail. Methods: We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy. Results: The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment. Conclusion: These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts.

Abstract Background and Objectives Because much of the work in academic medicine is done by committee, early career URiM faculty, are often asked to serve on multiple committees, including diversity work that may not be recognized as important. They may also be asked to serve on committees to satisfy a diversity “check box,” and may be asked more often than their non-URiM peers to serve in this capacity. We sought to describe the committee experiences of early career URiM faculty, hypothesizing that they may see committee service as a minority tax. Methods Participants in the Leadership through Scholarship Fellowship (LTSF) were asked to share their experiences with committee service in their careers after participating in a faculty development discussion. Their responses were analyzed and reported using qualitative, open, axial, and abductive reasoning methods. Results Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). Conclusions Early career URiM faculty reported an expectation of serving on committees and consequences for not serving related to their identity, but other areas of committee service they shared were not connected to their URiM identity. Because most of the experiences were not connected to the LTSF fellows’ URiM identity, this group has identified areas of committee service that may affect all early career faculty. More research is necessary to determine how committee service affects URiM and non-URiM faculty in academic family medicine.

Podophyllotoxin is a naturally occurring cyclolignan isolated from rhizomes of Podophyllum sp. In the clinic, it is used mainly as an antiviral; however, its antitumor activity is even more interesting. While podophyllotoxin possesses severe side effects that limit its development as an anticancer agent, nevertheless, it has become a good lead compound for the synthesis of derivatives with fewer side effects and better selectivity. Several examples, such as etoposide, highlight the potential of this natural product for chemomodulation in the search for new antitumor agents. This review focuses on the recent chemical modifications (2017–mid-2023) of the podophyllotoxin skeleton performed mainly at the C-ring (but also at the lactone D-ring and at the trimethoxyphenyl E-ring) together with their biological properties. Special emphasis is placed on hybrids or conjugates with other natural products (either primary or secondary metabolites) and other molecules (heterocycles, benzoheterocycles, synthetic drugs, and other moieties) that contribute to improved podophyllotoxin bioactivity. In fact, hybridization has been a good strategy to design podophyllotoxin derivatives with enhanced bioactivity. The way in which the two components are joined (directly or through spacers) was also considered for the organization of this review. This comprehensive perspective is presented with the aim of guiding the medicinal chemistry community in the design of new podophyllotoxin-based drugs with improved anticancer properties.

Com o advento dos transtornos mentais, o consumo de fármacos psicotrópicos pela população mundial torna-se acentuado, aumentando a preocupação quanto ao seu uso indiscriminado, principalmente por serem drogas que levam à dependência, entre outras Reações Adversas a Medicamentos. Dessa forma, há necessidade de conhecer o perfil de consumo para buscar estratégias para seu uso racional, além de servir como banco de dados, visto que o município de Macapá é carente de informações farmacoepidemiológicas, dificultando o direcionamento de ações de saúde, por parte dos órgãos reguladores sanitários. O objetivo deste estudo foi avaliar o consumo de medicamentos psicotrópicos no Município de Macapá-AP. Foram analisadas 200 amostras dos pacientes que procuravam as redes de drogarias para a compra de medicamentos psicotrópicos. O instrumento utilizado foi um questionário farmacoepidemiológio elaborado pelo pesquisador. A coleta dos dados ocorreu em 2 redes de drogarias, as quais foram chamadas de drogaria I e II. Os resultados obtidos foram analisados no programa Bioestat 5.0, com realização dos testes ANOVA e regressão logística múltipla. Apresentando média de idade de 41.5 (±18.9) anos drogaria I e 45.9 (±18.4) anos drogaria II. Sendo o gênero feminino o maior consumidor desses psicotrópicos, 61,7% (rede de drogaria I) e 62,2% (drogaria II). A média de valor gasto na drogaria I foi de R$ 54,30 com a moda R$ 65,00, na drogaria II R$ 10,20 sendo a moda R$ 65,00. A renda familiar de R$ 4.000,00 − R$4.999,00 foi a mesma nas duas redes, 10% drogarias I e 4,3% drogaria II. A maioria dos pacientes das drogarias I e II possui ensino superior completo, sendo 53,4% na drogaria I e 33,5% na drogaria II. No teste de regressão logística múltipla houve relação significativa entre o consumo de antiepilético em todas as faixas de renda familiar. Os medicamentos psicotrópicos das listas “A3, B1 e B2” mais dispensados pela drogaria I foram os anorexígenos, ansiolíticos, antiepiléticos, psicoestimulantes e hipnóticos e sedativos, respectivamente. E pela rede II, os ansiolíticos, antiepiléticos, os anorexígenos e os psicoestimulantes tiveram a mesma quantidade dispensada, os menos dispensados foram os hipnóticos sedativos. Todos os medicamentos dispensados foram classificados no sistema ATC/DDD. O consumo de medicamentos psicotrópicos ocorre de forma indiscriminada, neste contexto, existe a necessidade de implementação de serviços que assegurem o uso racional, com a participação dos profissionais médicos e farmacêuticos, ofertando todas as orientações farmacológicas.

Introdução: Os componentes da Assistência Farmacêutica (AF) foram criados para dividir os custos de aquisição de medicamentos entre as três esferas do governo a fim de garantir o abastecimento nos diferentes níveis de gestão da saúde no Sistema Único de Saúde (SUS). O Componente Estratégico da Assistência Farmacêutica (CEAF) é uma estratégia de acesso a medicamentos de média e alta complexidade no SUS com linhas de cuidado definidas em Protocolos Clínicos e Diretrizes Terapêuticas (PCDT), publicadas pelo Ministério da Saúde. Diante do exposto, o objetivo do trabalho foi avaliar o processo de dispensação dos medicamentos do CEAF no Estado do Amapá, e a satisfação do usuário com os serviços prestados. Métodos: O estudo foi realizado na Farmácia de Medicamentos Excepcionais (FARMEX) no Município de Macapá-AP, única farmácia de dispensação dos medicamentos do CEAF do estado. Foram avaliados 112 processos de dispensação e aplicados 179 questionários no período de junho a julho de 2015. Resultados: O elenco de medicamentos no CEAF dispensados aos pacientes envolvidos no estudo foi de 36. Os mais frequentes foram Olanzapina (18,93%) e Adalimumabe (11,36%). O farmacêutico foi o responsável por 60,71% dos atendimentos. Todos os pacientes foram informados do agendamento da retirada e da necessidade de renovação dos exames e documentos. A dupla checagem e a verificação da vigência do tratamento foram observadas em 98,21% e 91,7% dos atendimentos, respectivamente. No entanto, não foi observado nos atendimentos o repasse de informações a respeito das condições de armazenamento e possíveis interações medicamentosas. A advertência sobre possíveis reações adversas foi observada em 3,57% dos atendimentos e Informações sobre o esquema de administração do medicamento em apenas 8,03% dos atendimentos. De um modo geral o serviço da FARMEX foi considerado Bom pelos usuários destacando-se o horário de funcionamento e o atendimento oferecido. A maioria dos pacientes classificou o tempo de deferimento do processo (em média 7 dias úteis) como Bom. Discussão: Uma das características mais evidenciadas do CEAF é o fato do acesso ao medicamento acontecer mediante cumprimento de exigências definidas nos PCDTs, dependendo, portanto, das ofertas de serviços e de especialistas os quais podem ser fatores limitantes de acesso. Os aspectos burocráticos envolvidos na dispensação são necessários para prestação de contas com o governo, garantia do abastecimento e acesso aos medicamentos. Não devem ser desconsideradas, porém, informações sobre uso correto do medicamento, uma vez que estas irão consolidar as atividades que compõem a AF. A média de tempo levada da entrega da documentação até o recebimento do medicamento representa um ponto positivo em relação a outros estados. Conclusões: Durante o processo de dispensação todas as exigências burocráticas do CEAF foram observadas, porém, as informações referentes à farmacoterapia requerem maior atenção. Ainda assim, a satisfação do usuário em relação ao serviço foi, em sua maioria, positiva.

Introdução: O Componente Especializado da Assistência Farmacêutica (CEAF) é uma estratégia de acesso a medicamentos voltado a atenção de média e alta complexidade no SUS. De acordo com a resolução Nº 308 de 1997 do Conselho Federal de Farmácia, no ato da dispensação cabe ao farmacêutico informar de forma clara e objetiva sobre o modo de administração e alertar para possíveis reações adversas e interações com alimentos e medicamentos, colaborando assim para a adesão a terapia. As principais causas para não adesão à terapia incluem a dificuldade de acesso ao medicamento, o aparecimento de reações adversas e a não compreensão do esquema terapêutico ou da importância do tratamento. Diante disso, o objetivo deste estudo foi avaliar a adesão à terapia do usuário do CEAF no estado do Amapá. Métodos: O estudo foi realizado na Farmácia de Medicamentos Excepcionais (FARMEX) no município de Macapá-AP, única farmácia do CEAF do estado do Amapá. Após assinatura do Termo de Consentimento Livre e Esclarecido, os pacientes responderam ao questionário de Morisky-Green, composto de quatro perguntas que visam determinar se o insucesso do tratamento se deveu a: esquecimento, desleixo, ocorrência de melhora do estado geral ou por reações adversas. Este trabalho foi submetido e aprovado pelo Comitê de Ética da Universidade Federal do Amapá, sob o registro CAAE nº 43339015.2.0000.0003. Resultados: Foram entrevistados 132 pacientes entre junho e julho de 2015, sendo 63,7% do sexo feminino. A maioria possuía entre 41-60 anos (40,8%) e Ensino Médio Incompleto (26,6%). 57% dos pacientes foram classificados como alta adesão, 37% como média adesão e 6% como baixa adesão. Discussão: A maioria dos medicamentos do componente especializado são aqueles que apresentam efeitos adversos e interações medicamentosas importantes, o que pode implicar na adesão à terapia. A farmácia do CEAF no Amapá possui um espaço relativamente pequeno e o atendimento é realizado por um vidro que separa o farmacêutico/atendente do paciente, dificultando o entendimento das perguntas e inclusão de informações. Ainda assim, observou-se grau de adesão à terapia satisfatório o que pode estar relacionado ao fato dos pacientes do CEAF apresentarem dependência do medicamento, por se tratarem de portadores de doenças crônicas, em que os benefícios são maiores que os malefícios na terapia. É importante ressaltar que, mesmo sem o atendimento adequado, dentro da FARMEX os pacientes entendem a necessidade da continuidade no seu tratamento. Conclusões: Embora a FARMEX não apresente condições ideais, o percentual de boa adesão é maior do que o relatado na literatura. Acredita-se que em melhores condições de infraestrutura que permitam o atendimento personalizado e individual, bem como o desenvolvimento de atividades de seguimento farmacoterapêutico, seja possível garantir a segurança do paciente, melhorar a adesão à terapia, o uso racional do medicamento e consequentemente melhorar a qualidade de vida do usuário.

Abstract Background Patients with hematological malignancies (HM) are at high risk of mortality from SARS-CoV-2 disease 2019 (COVID-19). A better understanding of risk factors for adverse outcomes may improve clinical management in these patients. We therefore studied baseline characteristics of HM patients developing COVID-19 and analyzed predictors of mortality. Methods The survey was supported by the Scientific Working Group Infection in Hematology of the European Hematology Association (EHA). Eligible for the analysis were adult patients with HM and laboratory-confirmed COVID-19 observed between March and December 2020. Results The study sample includes 3801 cases, represented by lymphoproliferative (mainly non-Hodgkin lymphoma n = 1084, myeloma n = 684 and chronic lymphoid leukemia n = 474) and myeloproliferative malignancies (mainly acute myeloid leukemia n = 497 and myelodysplastic syndromes n = 279). Severe/critical COVID-19 was observed in 63.8% of patients (n = 2425). Overall, 2778 (73.1%) of the patients were hospitalized, 689 (18.1%) of whom were admitted to intensive care units (ICUs). Overall, 1185 patients (31.2%) died. The primary cause of death was COVID-19 in 688 patients (58.1%), HM in 173 patients (14.6%), and a combination of both COVID-19 and progressing HM in 155 patients (13.1%). Highest mortality was observed in acute myeloid leukemia (199/497, 40%) and myelodysplastic syndromes (118/279, 42.3%). The mortality rate significantly decreased between the first COVID-19 wave (March–May 2020) and the second wave (October–December 2020) (581/1427, 40.7% vs. 439/1773, 24.8%, p value

Antibiotic-resistant bacteria are a growing concern for human and animal health. The objective of this study was to determine the antimicrobial resistance and extended-spectrum beta-lactamase genes in Enterobacterales, Pseudomonas spp. and Acinetobacter spp. isolates from the uterus of healthy mares. For this purpose, 21 mares were swabbed for samples, which were later seeded on blood agar and MacConkey agar. The isolates were identified using MALDI-TOF and the antimicrobial susceptibility test was performed using the Kirby–Bauer technique. To characterize the resistance genes, a polymerase chain reaction (PCR) scheme was performed. Of the isolates identified as Gram-negative, 68.8% were Enterobacterales, represented by E. coli, Enterobacter cloacae, Citrobacter spp., and Klebsiella pneumoniae; 28.1% belonged to the genus Acinetobacter spp.; and 3.1% to Pseudomonas aeruginosa. A 9.3% of the isolates were multidrug-resistant (MDR), presenting resistance to antibiotics from three different classes, while 18.8% presented resistance to two or more classes of different antibiotics. The diversity of three genes that code for ESBL (blaTEM, blaCTX-M and blaSHV) was detected in 12.5% of the strains. The most frequent was blaSHV, while blaTEM and blaCTX-M were present in Citrobacter spp. and Klebsiella pneumoniae. These results are an alarm call for veterinarians and their environment and suggest taking measures to prevent the spread of these microorganisms.

RESUMO A mácula dome-shaped consiste na elevação convexa da região macular, encontrada principalmente em pacientes com alta miopia. O significado clínico e a correlação com outras patologias oculares ainda são incertos. Este artigo tem como objetivo descrever dois casos de mácula dome-shaped com acúmulo de fluido sub-retiniano em olhos alto míopes. Trata-se de pacientes com baixa acuidade visual, fundus miopicos e nítida elevação em forma de cúpula na área macular vista na tomografia de coerência óptica. A mácula dome-shaped pode cursar com descolamento seroso da retina neurossensorial envolvendo a fóvea, levando à baixa acuidade visual. Sua patogênese ainda não é bem estabelecida. De acordo com a tomografia de coerência óptica, a mácula dome-shaped pode ser classificada em três tipos morfológicos, sendo, nesses dois casos, demonstrada a disposição oval horizontalizada. Interessante ressaltar que o diagnóstico de mácula dome-shaped deve ser considerado em pacientes alto míopes, especialmente quando há queixa de baixa acuidade visual, que pode estar relacionada à presença de fluido sub-retiniano. Como o exame clínico não permite o diagnóstico adequado da mácula em cúpula, a realização da tomografia de coerência óptica com cortes verticais e horizontais é fundamental na suspeita de mácula dome-shaped.

Abstract The technique RT-qPCR for viral RNA detection is the current worldwide strategy used for early detection of the novel coronavirus SARS-CoV-2. RNA extraction is a key pre-analytical step in RT-qPCR, often achieved using commercial kits. However, the magnitude of the COVID-19 pandemic is causing disruptions to the global supply chains used by many diagnostic laboratories to procure the commercial kits required for RNA extraction. Shortage in these essential reagents is even more acute in developing countries with no means to produce kits locally. We sought to find an alternative procedure to replace commercial kits using common reagents found in molecular biology laboratories. Here we report a method for RNA extraction that takes about 40 min to complete ten samples, and is not more laborious than current commercial RNA extraction kits. We demonstrate that this method can be used to process nasopharyngeal swab samples and yields RT-qPCR results comparable to those obtained with commercial kits. Most importantly, this procedure can be easily implemented in any molecular diagnostic laboratory. Frequent testing is crucial for individual patient management as well as for public health decision making in this pandemic. Implementation of this method could maintain crucial testing going despite commercial kit shortages.

Abstract Introduction The use of herbal medicine is on the rise worldwide, and safety issues associated with herbal medicines may have an exacerbated impact in elderly because this population has an increased susceptibility and sensitivity to health complications due to the aging process. Methods This cross-sectional study was carried out at a primary health care unit in the city of Macapa, Brazil. The herbal medicines used and the sociodemographic characteristics of 123 voluntarily consenting participants were collected using a structured questionnaire. A total of 132 herbal medicines with oral or topical administration were donated by the elderly for microbial analysis before consumption, and 18 water samples used in the preparation of homemade herbal medicines were collected. Bacterial and fungal counts and identification of bacterial pathogens (Escherichia coli, Salmonella spp., Pseudomonas aeruginosa and Staphylococcus aureus) were performed according to the regulations of the Brazilian Pharmacopoeia and World Health Organization. Water analysis for the detection of coliforms and E. coli was carried out using Colilert® according to the manufacturer’s instructions and the techniques established by Standard Methods. Results Of the study participants, 78.8% were women. Bacterial growth was observed in samples from 51.5% of study and 35.6% had fungal growth. A total of 31.8% of the herbal medicine samples exceeded the safety limits (CFU/g ≤ 105), including 16.7% of the homemade herbal medicines and 15.1% of the commercial herbal medicines. It was also found that 31.0% of the samples exceeded the safety limit for fungal growth. The microorganisms most commonly isolated from the herbal medicines were S. aureus (49.2%), followed by Salmonella spp. (34.8%), E. coli (25.8%), and P. aeruginosa (14.4%). Of water samples analyzed, 77.8% were positive for total coliforms (1 ml) and in 66.7% water samples E. coli was detected (1 ml), making them unfit for consumption. Conclusions The use of homemade and commercial herbal medicines is a major risk to the health of elderly who use these therapies due to the lack of microbial quality standards. We observed levels of viable bacteria and fungi that were above safety limits; in addition, we were able to isolate pathogenic bacteria from these herbal medicines.

It is unknown whether HTLV-1/2 prevalence has been stable or changing with time in Brazil. We present a 10-year (2007–2016) analysis of HTLV-1/2 infection in first-time blood donors from four blood banks in Brazil. The Brazilian blood centers participating in this multicenter Recipient Epidemiology and Donor Evaluation Study (REDS) are located in Recife in the Northeast and in São Paulo, Rio de Janeiro and Belo Horizonte located in the Southeast of the country. A previous REDS study using the same database from 2007 to 2009 showed that the prevalence per 100,000 donors was 222 in Recife, 83 in Belo Horizonte and 101 in São Paulo. From 2007 to 2016, HTLV-1/2 prevalence was calculated by year, blood center and birth cohort. Covariates included age, gender, schooling, self-reported skin color and type of donation. From 1,092,174 first-blood donations, in the general analysis, HTLV-1/2 infection predominated in females, donors over 50 years of age, black skin color and less educated. The average prevalence was 228 per 100,000 donors in Recife, 222 in Rio de Janeiro, 104 in Belo Horizonte and 103 in São Paulo. In the 10-year analysis, HTLV-1/2 prevalence was stable, but a trend was observed toward an increase in HTLV-1/2 infection among younger people (p < 0.001), males (p = 0.049), those with white skin color (p < 0.001), and higher education (p = 0.014). Therefore, this 10-year surveillance of the infection showed stable HTLV-1/2 prevalence overall but a trend toward increased prevalence among the younger and more educated donors despite Brazilian policies to control sexually transmitted infections being in place for more than 10 years.

Objective: The purpose of this study was to analyze the primary and secondary labels of plantbased medicines. Method: This research has a cross-sectional and descriptive. The procedure consisted of analyzing 100 labels of medicinal plant-based products used by elderly people from (in) Macapá-AP, in 2017. A script was prepared to verify their adequacy to health standards based on the Brazilian legislation (commercial name, botanical nomenclature, active ingredients, concentration, route of administration, age-restricted use, quantity and pharmaceutical form, preservation care, company name, CNPJ - Brazils's companies registration number, composition, SAC, expiration date, manufacture and batch), descriptive analysis of the data was performed (protocol number 38400314.9.0000.0003). Results: Only 4% of the products completely met the analyzed criteria. One of the main problems observed was the absence of a uniform standard of presentation of information on the packaging. About 7% of these products did not present any information besides the popular name of the medicinal plant used, 37% of the packages (or labels) contain statements and images that induce self-medication, errors in use, or references to "natural medicine", besides, transmitting the idea that the product has superior properties to drugs on the market. Conclusions: The results obtained suggest that the packaging of medicinal plant-based products induces the irrational use of medicines due to the lack of adequate information, as well as the presence of inadequate makenting strategies, in accordance with current national legislation.

Introdução: A Profilaxia Pré-Exposição (PrEP) de risco é uma estratégia de saúde pública que possui como objetivo a redução da probabilidade de infecção pelo vírus do HIV por meio da utilização de medicamentos antirretrovirais antes da exposição sexual. Métodos: Foi realizado um estudo epidemiológico, do tipo ecológico com dados obtidos do painel de monitoramento da PrEP do Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis do Ministério da Saúde. A população estudada composta por usuários em PrEP e também por descontinuidade do uso da PrEP em todas as unidades da federação do Brasil entre janeiro de 2018 e junho de 2021. Os mapas cloropléticos foram elaborados considerando a proporção de usuários e de descontinuidades a cada 100.000 habitantes e em cada mapa foi plotado o número de dispensadores para referência utilizando o software QGis 3.16.9. Uma matriz de correlação foi elaborada utilizando o teste de Spearman para cálculo do coeficiente de correlação e considerando significativo p < 0,05, realizado pelo software R 4.1. Resultados: Foram identificadas no âmbito nacional 270 serviços dispensadores e as unidades da federação com maior proporção de usuários a cada 100.000 habitantes foram: São Paulo (23,34), Santa Catarina (22,69), Mato Grosso do Sul (15,74), Roraima (15,32) e Goiás (15,12). As unidades da federação com maior proporção de descontinuidade por 100.000 habitantes foram: Espírito Santo (26,14), São Paulo (17,43), Roraima (12,62), Mato Grosso do Sul (12,45) e Santa Catarina (10,09). Houve correlação estatisticamente significativa entre a quantidade de dispensadores e a proporção de usuários por 100.000 habitantes (rho = 0,55) e também com a proporção de descontinuidades por 100.000 habitantes (rho = 0,44). Conclusão: As unidades da federação com maior proporção de usuários PrEP se concentraram na região Sul e Sudeste, suavemente diferente das unidades da federação com maior proporção de descontinuidades da PrEP que contou com maior representação da região Centro-Oeste. O aumento do número de serviços dispensadores apresentou maior correlação com o número de usuários do que com o número de descontinuidades.

Background: Test-seeking is associated with HIV in Brazilian blood donors. This study sought to investigate the frequency with which three different donor groups: deferred donors, accepted donors who tested HIV positive [HIV (+)], and accepted donors who tested infectious disease markers negative [IDM (−)], came to the blood bank at the suggestion of a health care professional. Study design and methods: Donors deferred for reporting high-risk behaviors and participants in an HIV risk factor case-control study completed a confidential audio computer-assisted self-interview (ACASI) that included two questions related to health care professionals and test-seeking. Results: Of 4013 enrolled deferred donors, 468 (11.8%) reported a health care professional suggested donation as a way to be tested for infection. Of 341 HIV (+) and 791 IDM (−) participants, 43 (12.6%) and 11 (1.4%), respectively, reported a health care professional suggested donation as a way to be tested for infection. Physicians were the most frequently reported source of referral: [(61.5% of deferred, 69.1% of HIV (+), and 9.1% of IDM (−) donors)]. Conclusion: HIV (+) donors and deferred donors were 10 times more likely to report test-seeking behavior by suggestion of health care professional than IDM (−) donors. If true, efforts should be made to educate health care professionals and blood donors on how to safeguard the blood supply, emphasizing that HIV testing should be done at volunteer testing centers rather than at the blood centers. Keywords: Blood donation, Healthcare professionals, Test-seeking

RESUMO Resenha bibliográfica do livro Economia Institucional: fundamentos teóricos e históricos, da autoria de , Huáscar Fialho Pessali e Ramón Garcia Fernández, publicado pela Editora UNESP, de São Paulo, em 2017.

Based on ethnopharmacological studies, a lot of plants, as well as its compounds, have been investigated for the potential use as wound healing agents. In Brazil, Curatella americana is traditionally used by local people to treat wounds, ulcers and inflammations. However, to the best of our knowledge, its traditional use in the treatment of wounds has not been validated by a scientific study. Here, some compounds, many of them flavonoids, were identified in the hydroethanolic extract from the leaves of C. americana (HECA) by LC-HRMS and LC-MS/MS. Besides that, solutions containing different concentrations of HECA and a gel produced with this extract were evaluated for its antimicrobial, coagulant and wound healing activities on an excision mouse wound model as well as its acute dermal safety. A total of thirteen compounds were identified in HECA, mainly quercetin, kaempferol and glucoside derivatives of both, besides catechin and epicatechin known as wound healing agents. The group treated with 1% of HECA exhibited highest wound healing activity and best rate of wound contraction confirmed by histopathology results. The present study provides scientific evidence of, this extract (HECA) possess remarkable wound healing activity, thereby, supporting the traditional use.

Panicum virgatum (swich-grass) is cultivated in some countries to obtain biomass used in the production of heat, fiber, electricity and second generation ethanol. Currently, in Argentina, this species is used for forage and as an ornamental. The aim of this work was to design an agroclimatic zoning model for swich-grass in Argentina, both for upland and lowland ecotypes, based on its bioclimatic requirements and employing a Geography Information System. The variables taken into consideration were: average temperature during growing period and reproductive period, frost free days and rainfall during growing season. This work demonstrated that an ample region of the country is agro-climatically suitable for the implantation of switch-grass in rainfed conditions or with complementary irrigation. The agroclimatic zoning for the upland ecotype shows that suitability reaches latitudes of up to 46ºS, while the lowland ecotype can be grown up to 40ºS. Thornthwaite's Moisture Index equal to zero was overlapped to the Argentinean agroclimatic zoning for upland and lowland types, to obtain the potential growing areas under dry-subhumid, semiarid to arid climates. The areas where switch-grass should be effectively tested are those categorized as optimal, very suitable, suitable, and very suitable/suitable with irrigation, located to the West of TMI equal to zero, which include dry-subhumid (0

The environment, guaranteed in the brazilian Constitution of 1988 as a fundamental right, has a broad definition, that, beyond the mere reference to nature, contemplating life in all its forms and expressions. In this broad understanding, ecologically balanced environment and essential to a healthy quality of life shall be guaranteed not only for present generations and also for those who has to come. This guarantee for future generations is an expression of the principle of intergenerational equity that inspires but an environmental state, at least a greening democratic state.

Cultural background can influence cognition, including executive functions (EFs), abilities that encompass skills responsible for self-regulation of thoughts and behavior. The seminal unity and diversity model of EFs proposes the existence, in adulthood, of at least three correlated but separable EF latent (shared variance in more than one task/indicator) domains: inhibition, updating and shifting. However, evidence of the cross-cultural generality of this framework is lacking, especially in adolescence, an age during which these domains become more clearly separable. We tested whether this EF fractionation could be observed in early adolescents (9- to 15-year-olds) from metropolitan areas in Brazil (São Paulo) and Iran (Tehran) (total sample: 739; 407 Iranians; 358 girls). Participants carried out two open-access tasks that are representative of each EF domain and that were adapted to each cultural context. Seven latent model configurations were tested. The three-correlated latent factor structure had adequate fit, and multiple-group confirmatory factor analysis invariance testing showed invariance for country at the level of the latent factor structure (configural), factor loadings (metric), and partial invariance at the intercept (scalar) level. Iranians had higher scores in all domains. Multiple indicators multiple causes invariance testing showed model invariance across age (except for one task) and parental education. Performance in all domains improved with age and only minimally with parental schooling. We conclude that EF fractionation into three domains is present in the first half of adolescence in two samples from underrepresented populations in the literature, suggesting a potential generality of EF latent unity/diversity development at this age.

Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is a new and revolutionary identification method for microorganisms and has recently been introduced into clinical microbiology in many industrialized countries in Europe and North America.Our study aimed to compare the performance and practicality of two commercial MALDI-TOF MS platforms in a head-to head manner at a routine laboratory in Chile.During a five-month period in 2012-13, the diagnostic efficiency (correct identification rate) and agreement between Microflex LT (Bruker Daltonics) and Vitek MS (bioMérieux) was compared in a parallel manner to conventional identification including genotypic analysis for difficult-to-identify strains. The study included 804 microbial isolates: 252 Enterobacteriaceae, 126 non-fermenters, 36 other gram-negative rods, 279 gram-positive cocci, 32 gram-positive rods, 32 anaerobes, and 47 yeasts. Other relevant factors of the two devices such as user friendliness and connectivity were also evaluated and compared.Both systems correctly identified the vast majority (98%) of the isolates to the genus level. Vitek MS reached higher rates of identification to species and species complex level than Microflex LT (81% vs. 85% and 87% vs. 93%, respectively), which was mainly based on the higher performance among coagulase negative staphylococci and Candida isolates. The evaluation of user friendliness and other technical aspects showed only marginal differences, which slightly favored Vitek MS, mainly due to its ready-to-use supplies, easier connectivity and workflow integration, and availability of local technical support.Both MALDI-TOF MS systems permitted fast and accurate identification of most microbial strains and showed a high level of user-friendliness. The observed differences were marginal and slightly favored Vitek MS, mainly due to practicality and connectivity issues within our setting.

Esse artigo tem por objetivo discutir os diferentes sentidos conferidos ao termo "instituição". Apesar das definições de instituição terem encontrado certo consenso em torno da ideia de regras de comportamento, muito amiúde não é claro o objeto ao qual se referem os autores quando falam em instituições. Nesse sentido, destacamos três dimensões institucionais, ou sentidos conferidos ao termo instituição, que são encontrados na literatura especializada. São elas: (i) instituições como regras do jogo; (ii) instituições como modelos mentais; e (iii) instituições como organizações. Deste modo, uma distinção entre a velha e a nova economia institucional está cada vez mais difícil de ser realizada, justamente por conta da confusão dessas dimensões institucionais num único termo. Por fim, veremos que institucionalistas contemporâneos como Hodgson e Chang transitam de modo bastante fluido entre essas dimensões institucionais.

Nesse artigo, procuro ilustrar alguns conceitos importantes de filosofia da ciênciaatravés da exposição de dois modelos macroeconômicos bastante simples, o clássico e o keynesiano, apresentados em cursos introdutórios de macroeconomia. Conceitos trabalhados em filosofia da ciência como o modelo hipotético-dedutivo, a tese da simetria, a ideia de paradigma kuhniano, o programa de pesquisa científico lakatosiano, bem como os propostos por Lawson no campo do realismo crítico, são buscados e identificados nesses modelos macroeconômicos como forma de mostrar que o estudo da metodologia é fundamental para a boa compreensão das teorias científicas — as matérias-primas da ciência social.

El presente trabajo se plantea como un acercamiento a las cartas privadas de una mujer chilena de comienzos del siglo XX: Wanda Morla Lynch. Esta aproximación considera al género epistolar como un género discursivo complejo y contradictorio, pero propicio para dar cuenta de una intimidad, de unos sentimientos y de una subjetividad femenina dada la relación de complicidad que se establece entre las cartas y el estado de vida del sujeto femenino, marcado históricamente por una posición de subordinación y “deber ser” impuesto por la sociedad patriarcal. De esta forma, este corpus epistolar nos permitirá analizarlo a la luz de una previa caracterización de las cartas privadas como un género discursivo en sí mismo y que posee una determinada singularidad formal en relación a los otros géneros que conforman el corpus de la escritura autobiográfica; pero también explorar y rescatar el valor de estas cartas como fuente documental, ya que ponen al descubierto la voz de una mujer chilena que fue testigo privilegiada de los cambios que se produjeron en el París de los años ’20, epicentro de la vanguardia modernista de ese tiempo.

O presente trabalho teve como objetivo detectar a variação nos teores de fenois totais e flavonoides e na atividade antioxidante em amostras de B. trimera. Amostras secas e pulverizadas foram submetidas à extração por maceração estática para obtenção dos extratos hexânico, em acetato de etila e etanólico. Prospecção fitoquímica e avaliação dos teores de constituintes fenólicos e da atividade antioxidante foram realizadas. Os dados foram demonstrados como média ± desvio padrão e análise de variância seguida de teste de Tukey foi utilizada para medir o grau de significância (p < 0,05). Flavonoides, taninos, cumarinas, terpenoides e esteroides, alcaloides e antraquinonas foram detectados nas amostras. Os teores de flavonoides totais variaram entre 1,99 ± 0,29 a 5,20 ± 0,31 g/100g, enquanto os fenóis totais foram de 1,56 ± 0,01 a 11,09 ± 0,13 g/100g. Os extratos produziram CE50 entre 35,65 ± 0,74 e 242,74 ± 6,49 µg/mL. Os resultados indicam que o uso de solventes de diferentes polaridades no processo de extração é uma importante estratégia para detectar variação nos teores de fenois totais e falvonoides e na atividade antioxidante em amostras de B. trimera.

RESUMEN Esta investigación intenta ser una aproximación a un tipo de escritura autobiográfica en particular, tal como lo es el diario íntimo, el cual se nos presenta como un subgénero literario complejo y contradictorio, que se resiste a definiciones precisas. Desde esta perspectiva, postulamos que el diario íntimo es una forma específica de autorreferencialidad, un diálogo permanente del autor consigo mismo, con los otros y con la sociedad que lo rodea en un tiempo y espacio determinado y que surge de la necesidad del yo y de sus múltiples máscaras por expresarse libre de censuras, ya sea propias o ajenas. En segundo lugar, es importante precisar que esta investigación está centrada en los Diarios de la escritora chilena Teresa Wilms Montt, los cuales no sólo nos van a permitir establecer una caracterización del diario íntimo en sí, en tanto posee una determinada singularidad; forma lo discursiva en relación a los otros subgenéros literarios que conforman el corpus de la escritura autobiográfica; sino que también nos va a permitir realizar una caracterización de la autora como personaje y de la ideología que subyace tras su elección del diario íntimo como medio para dar cuenta de su concepción de la vida.

Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.