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Diplomacia da saúde: respostas globais à pandemia
No full textEsta coletânea é produto do labor coletivo dos trabalhadores e colaboradores do Centro de Relações Internacionais em Saúde (CRIS) da Fundação Oswaldo Cruz. Os capítulos foram elaborados a partir do acompanhamento sistemático da saúde global e das respostas de atores-chaves do cenário global da diplomacia da saúde à pandemia/sindemia no transcorrer de todo o ano de 2021, realizado no âmbito do Observatório de Saúde Global e Diplomacia da Saúde do CRIS-Fiocruz
Strategic analysis of a medical genetics center at a national health research institute in Brazil: challenges for the country's public health system
No full textO objetivo deste artigo é discutir os desafios estratégicos em organizações complexas de saúde apoiado na análise da posição estratégica em um centro de genética médica em um instituto nacional de pesquisa em saúde brasileiro. Utilizou-se a démarche stratégique adaptada para institutos de pesquisa, incorporando a função formulação de políticas com apoio de bancos de dados institucionais, livros de registros, reuniões com atores-chave e oficinas de trabalho de dezembro de 2014 a junho de 2015. Foram definidos os segmentos diagnóstico clínico, doenças lisossômicas, osteogênese imperfeita, aconselhamento genético, citogenética, bioquímica e genômica. Estes mostraram-se adequados à missão institucional no que se refere à atenção de referência, necessitando investimentos em pontos estratégicos. Na produção científica destacaram-se os segmentos diagnóstico clínico, doenças lisossômicas e genômica. Os resultados mostraram que é preciso avançar na implementação de políticas e no planejamento para ampliar o acesso da população às novas tecnologias, investindo em formação e na articulação assistência/pesquisa/ensino. A incorporação da dimensão formulação de política foi fundamental para indicar o papel diferencial da genética médica no SUS.Objective: to discuss strategic challenges in complex health organizations sustained by an analysis in a Medical Genetics Center at a National Health Research Institute in Brazil. Method: Démarche Stratégique adapted for use with research institutes, including the policy formulation function. The study used institution's databases and workshops with key actors between Dec/2014 and Jun/2015. Results: Were defined the segments: clinical diagnosis, lysosomal diseases, osteogenesis imperfecta, genetic counseling, cytogenetics, biochemistry, and genomics. The findings reveal that the segments are aligned with the Institute's mission when it comes to referral care, although investment is required in strategic areas. The clinical diagnosis, lysosomal diseases, and genomics segments stood out in the scientific output portfolio. The findings show that progress needs to be made with policy implementation and planning to improve access to new technologies, together with investment in training and development, and the strengthening of coordination and collaboration between research institutes and referral services and between the wider healthcare network and research, care, and teaching. The inclusion of the policy formulation dimension was essential to highlight the unique role medical genetics plays in Brazil’s public health system and the importance of developing action plans in the field of public health
Biodiversity of Potential Vectors of Rickettsiae and Epidemiological Mosaic of Spotted Fever in the State of Paraná, Brazil
No full textSpotted Fever Rickettsioses (SFR) are diseases caused by bacteria of the genus
Rickettsia, and are transmitted mainly by ticks. Its eco-epidemiological scenarios
vary spatially, and may also vary over time due to environmental changes. It is the
main disease transmitted by ticks to humans in Brazil, with the state of Paraná
(PR) having the sixth highest number of notified incidences in the country. However,
information is lacking regarding the SFR disease cycles at likely infection sites within
PR. During case investigations or environmental surveillance in PR for SFR, 28,517
arthropods were collected, including species known or potentially involved in the
SFR cycles, such as Amblyomma sculptum, Amblyomma aureolatum, Amblyomma
ovale, Amblyomma dubitatum, Amblyomma parkeri, Ctenocephalides felis felis, and
Rhipicephalus sanguineus sensu lato. From these Rickettsia asembonensis, Rickettsia
bellii, Rickettsia felis, Rickettsia parkeri strain Atlantic Rainforest and Candidatus
Rickettsia paranaensis were detected. Ectoparasite abundance was found to be related
with specific hosts and collection environments. Rickettsiae circulation was observed
for 48 municipalities, encompassing 16 Health Regions (HR). As for socio-demographic
and assistance indicators, circulation occurred largely in the most urbanized HR, with
a higher per capita Gross Domestic Product, lower Family Health Strategy coverage,
and with a higher ratio of beds in the Unified Health System per thousand inhabitants.
For environmental variables, circulation occurred predominantly in HR with a climatic
classified as “subtropical with hot summers” (Cfa), and with forest type phytogeographic
formations. In terms of land use, circulation was commonest in areas with agriculture,
pasture and fields and forest cover. Rickettsiae were circulating in almost all hydrographic
basins of PR state. The results of this study provide the first descriptive recognition of SFR
in PR, as well as outlining its eco-epidemiological dynamics. These proved to be quite
heterogeneous, and analyzed scenarios showed characteristics strongly-associated
with the outbreaks, with cases presenting clinical variation in space, so illustrating the complexity of scenarios in PR state. Due to the diversity of the circumstances
surrounding SFR infections in PR, public health initiatives are necessary to foster a
better understanding of the dynamics and factors effecting vulnerability to SFR in this
Brazilian state
Geographical information system and spatial–temporal statistics for monitoring infectious agents in hospital: a model using Klebsiella pneumoniae complex
No full textBackground: The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial–temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. Methods: A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identifed by the use of Vitek-2 system (BioMérieux), were extracted from the hospital’s microbiology labora tory database. A basic scaled map of the hospital’s physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space–time permutation probability scan tests were used for cluster signals detection. Results: Of the total 759 studied isolates, a signifcant increase in the resistance profle of K. pneumoniae complex was detected during the studied years. We also identifed two space–time clusters afecting adult and paediatric patients harbouring CRKp complex on diferent foors, unnoticed by regular antimicrobial resistance surveillance. Conclusions: In-hospital GIS with space–time statistical analysis can be applied in hospitals. This spatial methodol ogy has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection
Chemical Constituents and Biological Activities of Croton heliotropiifolius Kunth
No full text1 Department of Biological Chemistry, Universidade Regional do Cariri—URCA, Av. Cel Antônio Luis, 1161,
Pimenta, Crato 63105-010, Brazil; [email protected] (P.A.d.S.F.);
[email protected] (D.L.S.); [email protected] (M.R.K.);
[email protected] (G.d.A.D.); [email protected] (G.J.T.S.);
[email protected] (F.L.A.B.)
2 Department of Biological Sciences, Universidade Regional do Cariri—URCA, Av. Cel Antônio Luis, 1161,
Pimenta, Crato 63105-010, Brazil; [email protected] (J.C.P.d.S.);
[email protected] (M.F.B.M.-B.)
3 Embrapa Agroindústria Tropical, Tropical R. Pernambuco, 2270–Pici, Fortaleza 60511-110, Brazil;
[email protected] (P.R.V.R.); [email protected] (E.S.d.B.)
4 Laboratório de Bioensaios, Universidade Federal do Cariri—UFCA, R. Olegário Emídio de Araújo, s/n,
Centro, Brejo Santo 63260-000, Brazil; [email protected]
5 Inhamuns Region Education, Science and Technology Center, Universidade Estadual do Ceará—UECE,
BR-020—Bezerra de Sousa, Tauá 63660-000, Brazil; [email protected]
6 Center for the Development of Scientific Research, Asuncion 1255, Paraguay;
[email protected] (M.C.V.G.); [email protected] (M.R.)
7 Laboratório de Investigação em Genética e Hematologia Translacional, Instituto Gonçalo Moniz, FIOCRUZ,
Salvador 40296-710, Brazil; [email protected] (C.C.); [email protected] (J.R.-F.)
8 Department of Botany, Universidade Federal de Pernambuco—UFPE, Av. Prof. Moraes Rego, 1235,
Recife 50670-901, Brazil; [email protected]
9 Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand 9717853577, Iran;
[email protected]
10 School of Allied Health Sciences, World Union for Herbal Drug Discovery (WUHeDD) and Research
Excellence Center for Innovation and Health Products (RECIHP), Walailak University,
Nakhon Si Thammarat 80160, Thailand; [email protected]
11 CICECO-Aveiro Institute of Materials and Department of Medical Sciences, University of Aveiro,
3810-193 Aveiro, PortugalFundação Cearense de Apoio ao Desenvolvimento Científico
e Tecnológico—FUNCAP through a Master’s scholarship.Croton heliotropiifolius Kunth (Euphorbiaceae), whose occurrence has already been registered
in the most varied Brazilian biomes, is commonly found in the Chapada do Araripe, Ceará. The
species is traditionally used to treat fungal, parasitic, and degenerative diseases. This study investigated
the chemical composition and pharmacological potential (antioxidant, antifungal, antiparasitic,
and cytotoxic) of an aqueous extract obtained from the roots of C. heliotropiifolius. Following a qualitative
phytochemical screening, the chemical constituents were identified by ultra-efficiency liquid
chromatography coupled witha quadrupole/time-of-flight system (UPLC-QTOF). The antioxidant
potential was verified by thin-layer chromatography (TLC). The direct and combined antifungal
activity of the extract against opportunistic Candida strains was investigated using the microdilution
method. The minimal fungicidal concentration (MFC) was determined by subculture, while the
modulation of the morphological transition (fungal virulence) was evaluated by light microscopy.
The in vitro antiparasitic activity was analyzed using epimastigotes of Trypanosoma cruzi and promastigotes
of Leishmania braziliensis and Leishmania infantum, while cytotoxicity was determined in
cultures of mouse fibroblasts. The phytochemical analysis identified the presence of acids, terpenes, flavonoids, lignans, and alkaloids. Among these constituents, the presence of polar and non-polar
phenolic compounds with known antioxidant action was highlighted. While the extract showed
clinically ineffective antifungal effects, it could enhance the effectiveness of fluconazole, in addition
to inhibiting the morphological transition associated with increased virulence in Candida strains.
Although the extract showed low cytotoxicity against fibroblasts, it also had weak antiparasitic
effects. In conclusion, Croton heliotropiifolius is a source of natural products with antifungal and
antioxidant potential
Análisis de la implementación de las estrategias de comunicación para las acciones de prueba y su vinculación al tratamiento del VIH/Sida en hombres que tienen sexo con otros hombres en Curitiba, Brasil
No full textAlan de Jesus da Universidade Federal do Rio de Janeiro, do Centro de Ciências da Saúde, do Instituto Nutes de Educação em Ciências e Saúde teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 2 v. 15 n.3 (2021)Há barreiras de acesso enfrentadas por homens gays e homens que fazem sexo com outros homens (HSH) à testagem e ao tratamento de HIV/aids devido a fatores estruturais e simbólicos. Daí, o objetivo do estudo que fundamenta este artigo é analisar a implementação das estratégias de comunicação para ampliar a testagem e vincular seu resultado ao tratamento de HIV/aids, em Curitiba (PR), pelo projeto A Hora é Agora (AHA), realizado de dezembro de 2014 a setembro de 2017, visando à maior aproximação dos que o executam com homens gays e HSH e ao desenvolvimento de meios mais efetivos de comunicação, identificando facilidades e dificuldades. Utilizou-se abordagem qualitativa por meio da análise documental do plano de comunicação e dos relatórios de atividades. As lições aprendidas foram a boa aceitação das campanhas 'corpo a corpo' feitas por educadores de pares nos espaços públicos, sobretudo em festas gays, e a necessidade de desenvolver estratégias específicas para HSH que não se identificam como gay.There are access barriers faced by gay men and men who have sex with men (MSM) to be tested for HIV/Aids and their treatment due to structural and symbolic factors. Hence, the objective of the study that underlies this article is to analyze the implementation of the communication strategies for expanding the testing and to link its result to treatment for HIV/Aids in Curitiba, Paraná, Brazil, by the project A Hora é Agora (AHA), implemented from December 2014 to September 2017, with the aim of coming closer to gay men and MSM and developing more effective means of communication, identifying facilities and difficul-ties. A qualitative approach by means of the documental analysis of the communication plan and activity reports was developed. The lessons learned were the good acceptance of the 'face to face' campaigns made by peer educators in public spaces, especially at gay parties, and the need to develop specific strategies for MSM who do not identify themselves as being gay.Los hombres homosexuales y los hombres que tienen sexo con hombres (HSH) enfrentan barreras de acceso a las pruebas y al tratamiento del VIH/Sida provocadas por factores estructurales y simbólicos. De ahí que el objetivo del estudio presentado en este artículo sea analizar la implementación de estrategias de comunicación para ampliar las pruebas y las vincular al tratamiento del VIH/Sida en Curitiba, Paraná, Brasil, practicada por el proyecto A Hora é Agora (AHA), realizado desde diciembre de 2014 hasta septiembre de 2017, con el objetivo de acercarse más a los hombres homosexuales y HSH y desarrollar medios de comunicación más efectivos, identificando facilidades y dificultades. Se utilizó un enfoque cualitativo por medio del análisis documental del plan de comunicación e informes de actividad. Las lecciones aprendidas fueron la buena aceptación de las campañas “mano a mano” realizadas por los educadores de pares en los espacios públicos, especialmente en las fiestas gay, y la necesidad de desarrollar estrategias específicas para los HSH que no se identifican como gay
Nutricionismo, publicaciones y celebridades: ¿qué nos dice el oráculo que comamos?
No full textNathalie Fonseca Gloria da Universidade do Estado do Rio de Janeiro, do Centro Biomédico, do Instituto de Nutrição, do Núcleo de Estudos sobre Cultura e Alimentação teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 2 v. 15 n.3 (2021)Maria Cláudia da Veiga Soares Carvalho da Universidade Federal do Rio de Janeiro, do Centro de Ciências da Saúde, do Instituto de Nutrição Josué de Castro, do Núcleo de Estudos e Ações de Educação Alimentar e Nutricional teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 2 v. 15 n.3 (2021)Cristiane Marques Seixas da Universidade do Estado do Rio de Janeiro, do Centro Biomédico, do Instituto de Nutrição, do Núcleo de Estudos sobre Cultura e Alimentação teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 2 v. 15 n.3 (2021)Daniela Menezes Neiva Barcellos da Universidade do Estado do Rio de Janeiro, do Centro Biomédico, do Instituto de Nutrição, do Núcleo de Estudos sobre Cultura e Alimentação teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Feminismos: perspectivas em comunicação e informação em saúde, parte 2 v. 15 n.3 (2021)As novas tecnologias da informação e comunicação, aliadas às novas mídias e redes de comunicação, transformaram privacidade em objeto de consumo. O cenário comunicacional medeia o acesso a produtos e serviços digitais com novos parâmetros de hábito alimentar e estilo de vida saudáveis. A visibilidade confere prestígio às postagens no ambiente on-line, legitimando-as. O objetivo deste estudo foi mapear a representatividade de postagens de celebridades e compreender seus significados no campo da Alimentação e Nutrição. O problema central é o efeito mágico de um comportamento saudável em orientações doutrinárias sobre o comer. Analisamos imagens e textos de seis perfis de nutricionistas que se tornaram celebridades no Brasil. As postagens guiam seguidores, reproduzindo modelos de respostas rápidas que prometem a felicidade na ilusão de uma disciplina e do controle de si. As páginas operam como 'oráculos' para uma vida saudável, seguindo uma lógica de comunicação fast thinking, pouco propensa à expressão do pensamento.New information and communication technologies combined with new media and communication networks have made privacy an object of consumption. The communication scenario mediates access to digital products and services with new parameters of healthy eating habits and lifestyle behaviors. Visibility gives prestige to posts that move through the online environment, legitimizing them. The aim of this study was to map the representativeness of celebrity posts and understand their meanings in the field of Food and Nutrition. The central problem is the magical effect of healthy behavior in doctrinal guidelines on eating. We analyzed images and texts of six profiles of nutritionists who became celebrities in Brazil. Posts guide followers, reproducing rapid response models that promise happiness of the illusion of self-discipline and self-control. The webpages operate as 'oracles' for healthy living, following the logic of a fast thinking communication, not prone to the expression of thought.Las nuevas tecnologías de la información y la comunicación, combinadas com los nuevos medios y redes de comunicación, han convertido privacidad en objeto de consumo. El escenario comunicacional media el acceso a productos y servicios digitales com nuevos parámetros de hábitos alimentarios y estilos de vida saludables. La visibilidad otorga prestigio a las publicaciones que se mueven por el entorno online, legitimándolas. El objetivo de este estúdio fue mapear la representatividad de las publicaciones de celebridades y comprender sus significados en el campo de la Alimentación y la Nutrición. El problema central es el efecto mágico del comportamiento saludable en las pautas doctrinales sobre la alimentación. Analizamos imágenes y textos de mayor receptividad de seis perfiles de nutricionistas que se convirtieron en celebridades en Brasil. Las publicaciones guían a los seguidores en la resolución de preguntas pragmáticas, reproduciendo modelos de respuestas rápidas que prometen felicidad en la ilusión de una disciplina y un autocontrol. Las páginas operan como 'oráculos' para una vida sana, siguiendo una lógica de comunicación fast thinking, no propensa a la expresión del pensamiento
Avaliação do papel da formação de rosetas por gametócitos de Plasmodium vivax na transmissão do paciente vetor
No full textPlasmodium vivax é o parasita da malária mais difundido geograficamente, causando malária principalmente fora da África subsaariana. Casos graves e mortes por malária vivax têm sido relatados nos últimos anos. A princípio acreditava-se que eventos como citoaderência e formação de rosetas eram restritos ao P. falciparum, como sendo seus principais fatores de virulência. No entanto, atualmente há evidências que apoiam a ideia de que P. vivax sofre o fenômeno de citoaderência e o processo de formação de rosetas foi descrito há mais de 20 anos em P. vivax. Entretanto poucos estudos foram feitos até hoje para investigar este fenômeno em P. vivax a fim de correlacionar o evento com a patogênese da doença. Assim o papel preciso das rosetas na patogênese da malária ainda permanece controverso. Por essa razão, o objetivo deste estudo é avaliar o papel do fenômeno de rosetas na transmissão do parasita ao vetor na malária vivax. Os ensaios foram realizados a partir do isolamento de gametócitos de P. vivax provenientes de amostras de sangue periférico de pacientes infectados, posteriormente foram feitos ensaios de roseteamento in vitro seguido de infecção experimental em Anopheles aquasalis para determinar a taxa de infectividade através da quantificação de oocistos do intestino médio do mosquito após 7 dias de infecção. Todas as amostras testadas foram capazes de formar rosetas com taxa de roseteamento variando entre 5,8 a 27%. Quanto a infectividade, observou-se que a taxa e intensidade de infecção é maior em isolados em formação de rosetas quando comparados com os que não formam rosetas. Além disso, foi realizado análise enzimática das enzimas digestivas do intestino do mosquito e correlacionà-la com o fenômeno de roseteamento. Por conseguinte, este estudo visa responder perguntas sobre o impacto do fenômeno de roseteamento de Plasmodium vivax na transmissão do parasita ao vetor e com isso portanto cooperar como uma ferramenta para estudos a posteriori que visem medidas alternativas de controle da transmissão da malária.Fundação de Amparo à Pesquisa do estado do Amazonas - FAPEAM,Plasmodium vivax is the most widespread malaria parasite geographically and the dominant human malaria parasite in most countries outside of sub- Saharan Africa. Despite being known to cause benign infection in humans, severe cases and deaths have been reported last years. For a long time Plasmodium vivax was a neglected parasite, due to its low parasitemia and inability to adapt to in vitro culture conditions, however, due to present severe clinical manifestations such as cerebral and placental malaria, similar to the most lethal parasite that is Plasmodium falciparum, thus suggesting that P. vivax has a certain pathogenic profile similar to P. falciparum, therefore the attention of the academic community turned to P. vivax. At first it was believed that events such as cytoadherence and rosette formation were restricted to P. falciparum as their main virulence factors. However, there is currently evidence supporting the idea that P. vivax undergoes the phenomenon of cytoadherence and the rosette formation process has been described for more than 20 years in P. vivax. However, few studies were made until today to investigate this phenomenon in P. vivax in order to correlate the event with the pathogenesis of disease. Thus the precise role of rosettes in the pathogenesis of malaria remains controversial. Therefore, the goal this study is to evaluate the role of rosettes phenomenon in vector transmission of the parasite in vivax malaria. The assays were performed from isolation of P. vivax gametocytes from peripheral blood samples from infected patients, later were made rosetting in vitro assays followed by experimental infection in Anopheles aquasalis to determine the infectivity rate by quantifying oocysts of the mosquito`s midgut after 7 days of infection. All samples tested were able to form rosettes with a rate of resetting ranging from 5,8 to 27%. As for infectivity, of infection is higher in isolates forming rosettes when compared to those that do not form rosettes. In addition, enzymatic analysis of digestive enzymes in the mosquito midgut was carried out and correlated with the phenomenon of resetting. Therefore, this study aims to answer questions about the impact of the Plasmodium vivax resetting phenomenon on the transmission of the parasite to the vector and therefore cooperate as a tool for later studies aimed at alternative measures to control malaria transmissio
Colorimetric RT‑LAMP SARS‑CoV‑2 diagnostic sensitivity relies on color interpretation and viral load
No full textThe use of RT-LAMP (reverse transcriptase—loop mediated isothermal amplifcation) has been considered as a promising point-of-care method to diagnose COVID-19. In this manuscript we show that the RT-LAMP reaction has a sensitivity of only 200 RNA virus copies, with a color change from pink to yellow occurring in 100% of the 62 clinical samples tested positive by RT-qPCR. We also demonstrated that this reaction is 100% specifc for SARS-CoV-2 after testing 57 clinical samples infected with dozens of diferent respiratory viruses and 74 individuals without any viral infection. Although the majority of manuscripts recently published using this technique describe only the presence of two-color states (pink =negative and yellow=positive), we verifed by naked-eye and absorbance measurements that there is an evident third color cluster (orange), in general related to positive samples with low viral loads, but which cannot be defned as positive or negative by the naked eye. Orange colors should be repeated or tested by RT-qPCR to avoid a false diagnostic. RT-LAMP is
therefore very reliable for samples with a RT-qPCR Ct < 30 being as sensitive and specifc as a RT-qPCR
test. All reactions were performed in 30 min at 65 °C. The use of reaction time longer than 30 min is also not recommended since nonspecifc amplifcations may cause false positives