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Conocimiento de cáncer de mama y factores sociodemográficos, acceso y atención en salud en mujeres consultantes en centros oncológicos, Cartagena – Colombia
No full textVerónica del Carmen Castro Bocanegra da Corporación Universitaria Rafael Núñe, do Programa de Instrumentación Quirúrgica teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Comunicação, Saúde e Crises Globais: parte 2 v. 15 n.1 (2021)Rafael de Jesús Tuesca Molina da Universidad del Norte, do Departamento de Salud Pública, do Programa de Maestría en Salud Pública teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Comunicação, Saúde e Crises Globais: parte 2 v. 15 n.1 (2021)Identificar fatores relacionados ao conhecimento do estado atual da doença em mulheres com câncer de mama e fatores sociodemográficos, diagnóstico, tratamento e cuidado do câncer de mama em instituições oncológicas, Cartagena-Colômbia. Estudo descritivo transversal; 211 mulheres com câncer de mama participaram através de uma pesquisa estruturada. Foi encontrada uma associação estatística entre a prática do auto-exame das mamas e o fato de ter uma educação superior e pertencer ao nível contributivo; além disso, uma mulher com menos de 50 anos de idade com diagnóstico confirmado de câncer e com um nível de educação superior entrou com uma ação de tutela. São identificadas as lacunas derivadas da estratificação social, segmentação geográfica e acesso a mecanismos de informação telefônica. Portanto, as condições de vulnerabilidade, baixo nível educacional e pobreza marcam diferenças e denotam a perda de oportunidades de detecção, cuidado e tratamento.To identify factors related to knowledge of the current state of the disease in women with breast cancer and sociodemographic factors, diagnosis, treatment and care of breast cancer in oncological institutions, Cartagena-Colombia. Cross-sectional descriptive study; 211 women with breast cancer participated through a structured survey. A statistical association was found between the practices of breast self-examination and having a higher education and belonging to the contributory level; in addition, a woman under 50 years old with a confirmed diagnosis of cancer and with a higher education level uses guardianship action by right. Gaps derived from social stratification, geographical, health system segmentation and access to telephone information mechanisms are identified. Therefore, the conditions of vulnerability, low educational level and poverty mark differences and denote lost opportunities for detection, care and treatment.Identificar los factores relacionados al conocimiento del estado actual de la enfermedad en mujeres con cáncer de mama y factores sociodemográficos, diagnóstico, tratamiento y atención del cáncer de mama en instituciones oncológicas, Cartagena-Colombia. Estudio descriptivo transversal; participaron 211 mujeres con cáncer de mama, mediante una encuesta estructurada. El Odd Ratio (OR) fueron calculados usando SPSS versión 23.0. Se encontró una asociación estadística entre la práctica del autoexamen de mama con el poseer estudios de educación superior y pertenecer al nivel contributivo; además, una mujer menor de 50 años con diagnostico confirmado de cáncer y que tenga un nivel educativo superior entró con una acción de tutela. Se identificaron lagunas derivadas de la estratificación social, segmentación geográfica y acceso a mecanismos de información telefónica. Por lo tanto, las condiciones de vulnerabilidad bajo nivel educativo y pobreza marcan diferencias y denotan oportunidades perdidas para la detección, atención y tratamiento
From Genome to Drugs: New Approaches in Antimicrobial Discovery
No full textCNPq (process no. 306894/
2019-0) and granted by CAPES (process no. 88887.368759/Decades of successful use of antibiotics is currently challenged by the emergence of
increasingly resistant bacterial strains. Novel drugs are urgently required but, in a scenario
where private investment in the development of new antimicrobials is declining, efforts to
combat drug-resistant infections become a worldwide public health problem. Reasons
behind unsuccessful new antimicrobial development projects range from inadequate
selection of the molecular targets to a lack of innovation. In this context, increasingly
available omics data for multiple pathogens has created new drug discovery and
development opportunities to fight infectious diseases. Identification of an appropriate
molecular target is currently accepted as a critical step of the drug discovery process.
Here, we review how diverse layers of multi-omics data in conjunction with structural/
functional analysis and systems biology can be used to prioritize the best candidate
proteins. Once the target is selected, virtual screening can be used as a robust
methodology to explore molecular scaffolds that could act as inhibitors, guiding the
development of new drug lead compounds. This review focuses on how the advent of
omics and the development and application of bioinformatics strategies conduct a “bigdata
era” that improves target selection and lead compound identification in a costeffective
and shortened timeline
Congenital Zika syndrome: Growth, clinical, and motor development outcomes up to 36 months of age and differences according to microcephaly at birth
No full texta Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil
b Department of Medicine III, Federal University of Maranhão, São Luís, Maranhão, Brazil
c Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children/NINAR – Health Secretariat of the State of Maranhão, São Luís, Maranhão,
Brazil
d Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
e Sarah Network of Neurorehabilitation Hospitals, São Luís, Maranhão, Brazil
f Laboratory of Vector-Borne Infectious Diseases, Gonçalo Moniz Institute, Fiocruz-Bahia, and Department of Pathology and Legal Medicine, Faculty of
Medicine, Federal University of Bahia, Salvador, Bahia, BrazilDepartment of Science and
Technology of the Brazilian Ministry of Health, Maranhão State
Health Secretariat, National Council for Scientific and Technologi-
cal Development (CNPq is the Portuguese acronym, grant 440573/
2016-5), Coordination for the Improvement of Higher Education
Personnel (CAPES is the Portuguese acronym, grant 88881.130813/
2016-01), and the Foundation for the Support of Research and
Scientific and Technological Development of Maranhão (FAPEMA is
the Portuguese acronym, grant PPSUS-05963/16).Little is known regarding the developmental consequences of congenital Zika syndrome
(CZS) without microcephaly at birth. Most previously published clinical series were descriptive and they
had small sample sizes.
Study design: We conducted a cohort study to compare the growth, clinical, and motor development
outcomes for 110 children with CZS born with and without microcephaly up to their third birthday.
Ninety-three had their head circumference (HC) at birth abstracted and they did not have hypertensive
hydrocephalus at birth, where 61 were born with microcephaly and 32 without.
Results: The HC z-scores decreased steeply from birth to six months of age, i.e., from –3.77 to –6.39 among
those with microcephaly at birth and from –1.03 to –3.84 among those without. Thus, at 6 months of age,
the mean HC z-scores for children born without microcephaly were nearly the same as those for children
born with microcephaly. Children born without microcephaly were less likely to have brain damage,
ophthalmic abnormalities, and drug-resistant epilepsy, but the differences in many conditions were not
statistically significant.
Conclusions: Children born without microcephaly were only slightly less likely to present severe
neurologic impairment and to develop postnatal-onset microcephaly, and some of the original
differences between the groups tended to dissipate with age
Multidisciplinary approach detects speciation within the kissing bug Panstrongylus rufotuberculatus populations (Hemiptera, Heteroptera, Reduviidae)
No full textBACKGROUND Panstrongylus rufotuberculatus (Hemiptera-Reduviidae) is a triatomine species with a wide geographic
distribution and a broad phenotypic variability. In some countries, this species is found infesting and colonising domiciliary
ecotopes representing an epidemiological risk factor as a vector of Trypanosoma cruzi, etiological agent of Chagas disease. In
spite of this, little is known about P. rufotuberculatus genetic diversity.
METHODS Cytogenetic studies and DNA sequence analyses of one nuclear (ITS-2) and two mitochondrial DNA sequences (cyt
b and coI) were carried out in P. rufotuberculatus individuals collected in Bolivia, Colombia, Ecuador and Mexico. Moreover, a
geometric morphometrics study was applied to Bolivian, Colombian, Ecuadorian and French Guiana samples.
OBJECTIVES To explore the genetic and phenetic diversity of P. rufotuberculatus from different countries, combining chromosomal
studies, DNA sequence analyses and geometric morphometric comparisons.
FINDINGS We found two chromosomal groups differentiated by the number of X chromosomes and the chromosomal position of
the ribosomal DNA clusters. In concordance, two main morphometric profiles were detected, clearly separating the Bolivian sample
from the other ones. Phylogenetic DNA analyses showed that both chromosomal groups were closely related to each other and
clearly separated from the remaining Panstrongylus species. High nucleotide divergence of cyt b and coI fragments were observed
among P. rufotuberculatus samples from Bolivia, Colombia, Ecuador and Mexico (Kimura 2-parameter distances higher than 9%).
MAIN CONCLUSIONS Chromosomal and molecular analyses supported that the two chromosomal groups could represent
different closely related species. We propose that Bolivian individuals constitute a new Panstrongylus species, being necessary
a detailed morphological study for its formal description. The clear morphometric discrimination based on the wing venation
pattern suggests such morphological description might be conclusive
A Novel Hybrid of Chloroquine and Primaquine Linked by Gold(I): Multitarget and Multiphase Antiplasmodial Agent
No full text[a] C. de Souza Pereira, V. Schmitz, Prof. H. F. Dos Santos, Prof. M. Navarro
Departamento de Química
Universidade Federal de Juiz de Fora, Rua José Lourenço Kelmer, s/n –
Campus Universitário, Bairro Martelos CEP 36036-900, Juiz de Fora, Minas
Gerais (Brasil)
E-mail: [email protected]
[b] H. Costa Quadros, Dr. D. R. Magalhaes Moreira,
R. I. Santos De Deus Da Silva, Dr. M. Botelho Pereira Soares
Instituto Gonçalo Moniz
Fundação Oswaldo Cruz, Av. Waldemar Falcão, 121, Candeal, Salvador,
Bahia (Brasil)
[c] Dr. W. Castro
Centro de Química
Instituto Venezolano de Investigaciones Científicas (IVIC), Centro de
Química, Carretera Panamericana, Km 11, Altos de Pipe, San Antonio de los
Altos Miranda, 1020-A, Caracas (Venezuela)
[d] Dr. D. Fontinha, Dr. M. Prudêncio
Instituto de Medicina Molecular João Lobo Antunes
Faculdade de Medicina, Universidade de Lisboa
<Lisboa (Portugal)
[e] M. Gendrot, I. Fonta, J. Mosnier, Dr. B. Pradines
Unité Parasitologie et entomologie, Institut de recherche biomédicale des
armées, 19–21 Bd Jean Moulin, 13005 Marseille (France)
[f] M. Gendrot, I. Fonta, J. Mosnier, Dr. B. Pradines
Aix-Marseille Univ, IRD, SSA, AP-HM, VITROME, 19–21 Bd Jean Moulin,
13005 Marseille (France)
[g] M. Gendrot, I. Fonta, J. Mosnier, Dr. B. Pradines
IHU Méditerranée Infection, 19–21 Bd Jean Moulin, 13005 Marseille (France)
[h] I. Fonta, J. Mosnier, Dr. B. Pradines
Centre National de Référence du Paludisme, 19–21 Bd Jean Moulin, 13005
Marseille (France)CAPES
(grant no. 23038.006713/2013-88), CNPq (grant no. 305732/2019-
6), FAPES grant number APP0088/2016) and Fiocruz/Inova (grant
no.1642178247). MP was supported by grant PTDC-SAU-INF-
29550-2017 (FCT, Portugal). HFDS and VS also thankful to
FAPEMIG for the purchase of Nvidia graphics processing unit
(GPU) used to speed up the MD simulations. CSP thanks CAPES for
her Ph.D. scholarship.Plasmodium parasites kill 435 000 people around the world
every year due to unavailable vaccines, a limited arsenal of
antimalarial drugs, delayed treatment, and the reduced clinical
effectiveness of current practices caused by drug resistance.
Therefore, there is an urgent need to discover and develop new
antiplasmodial candidates. In this work, we present a novel
strategy to develop a multitarget metallic hybrid antimalarial
agent with possible dual efficacy in both sexual and asexual
erythrocytic stages. A hybrid of antimalarial drugs (chloroquine
and primaquine) linked by gold(I) was synthesized and
characterized by spectroscopic and analytical techniques. The
CQPQ-gold(I) hybrid molecule affects essential parasite targets,
it inhibits β-hematin formation and interacts moderately with
the DNA minor groove. Its interaction with PfTrxR was also
examined in computational modeling studies. The CQPQ-gold(I)
hybrid displayed an excellent in vitro antimalarial activity
against the blood-stage of Plasmodium falciparum and liverstage
of Plasmodium berghei and efficacy in vivo against P.
berghei, thereby demonstrating its multiple-stage antiplasmodial
activity. This metallic hybrid is a promising chemotherapeutic
agent that could act in the treatment, prevention, and
transmission of malari
Social inequalities and the pandemic of COVID-19: The case of Rio de Janeiro
No full textBackground: The novel coronavirus (SARS-CoV-2) is a global pandemic. The lack of protective vaccine or treatment led most of the countries to follow the flattening of the infection curve with social isolation measures. There is evidence that socioeconomic inequalities have been shaping the COVID-19 burden among low and middle-income countries. This study described what sociodemographic and socioeconomic factors were associated with the greatest risk of COVID-19 infection and mortality and how did the importance of key neighbourhood-level socioeconomic factors change over time during the early stages of the pandemic in the Rio de Janeiro municipality, Brazil.
Methods: We linked socioeconomic attributes to confirmed cases and deaths from COVID-19 and computed age-standardised incidence and mortality rates by domains such as age, gender, crowding, education, income and race/ethnicity.
Results: The evidence suggests that although age-standardised incidence rates were higher in wealthy neighbourhoods, age-standardised mortality rates were higher in deprived areas during the first 2 months of the pandemic. The age-standardised mortality rates were also higher in males, and in areas with a predominance of people of colour, which are disproportionately represented in more vulnerable groups. The population also presented COVID-19 'rejuvenation', that is, people became risk group younger than in developed countries.
Conclusion: We conclude that there is a strong health gradient for COVID-19 death risk during the early stages of the pandemic. COVID-19 cases continued to move towards the urban periphery and to more vulnerable communities, threatening the health system functioning and increasing the health gradient
COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health
No full textMachado, Daiane B. - Fundação Oswaldo Cruz. Instituto Gonçalo Muniz. Salvador, BA, Brasil.Islamabad, Pakistan (S Sikander PhD); Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK (S Sikander); Wellcome–DBT India Alliance, Sangath, New Delhi, India (M Balaji MSc, P Gonsalves MSc, V Patel); Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico (C Benjet PhD); The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China (E Y L Cheung PhD); The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China (E Y L Cheung); CBM Global and Centre for Global Mental Health, London, UK (J Eaton MBBS); School of Psychology, University of Sussex, Brighton, UK (P Gonsalves); Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA (M Hailemariam PhD); Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal (N P Luitel MPhil); Centre for Data and Knowledg Integration for Health, CIDACS–FIOCRUZ, Bahia, Brazil (D B Machado PhD); Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia (E Misganaw MA); Global Mental Health Peer Network, Pretoria, South Africa (E Misganaw); Pravara Institute of Medical Sciences, Loni, India (R Shidhaye PhD); Global Mental Health Peer Network, Johannesburg, South Africa (C Sunkel); Mentally Aware Nigeria Initiative, Lagos, Nigeria (V Ugo MBBS); United for Global Mental Health, London, UK (V Ugo); Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa (A J van Rensburg PhD); Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa (A J van Rensburg); Centre for Mental Health Law and Policy, Indian Law Society, Pune, India (S Pathare PhD); Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA (S Saxena MD).Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care
Cytomegalovirus and herpes simplex type 1 infections and immunological profile of community-dwelling older adults
No full textChronic infections, such as cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1), contribute to the inflammation process among older adults and are associated with the immunosenescence process. The aim was to identify the immunological profile associated with CMV and HSV-1 infections among older adults. This is a cross-sectional study, carried out with 1492 participants from the Bambuí Cohort Study of Aging - Minas Gerais, Brazil. For analysis purposes, we considered the presence of immunoglobulin G (IgG) for CMV and HSV-1 in the participants' serum, assessed by the enzyme-linked immunosorbent assay (ELISA); outcomes were defined by titration above the median (>160 UR/mL for HSV-1 and >399.5 U/mL for CMV). In order to assess the immunological profile, the following biomarkers were considered: IL-1beta, IL-10, IL-12, TNF, CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-6 and CRP; the first four being categorized as detectable levels or not, and the others using the Classification and Regression Tree (CART) method. The analysis was adjusted for sociodemographic variables, health behaviors and health conditions. The seroprevalence of anti CMV and anti HSV-1 antibodies was 99.4% and 97.0%, respectively. Higher concentrations of CXCL8 and CCL5 chemokines were associated with lower antibody titers for CMV, and higher concentrations of CXCL9, IL-6 and CRP were associated with higher levels of antibodies to CMV. Moreover, intermediate levels of CXCL10 were also associated with higher levels of antibodies to CMV. In HSV-1 infection, intermediate levels of CXCL9, CCL5 and IL-6 were less likely to have higher antibody titers for this infection. On the other hand, higher levels of CXCL10 and CRP were positively associated with higher antibody titers for HSV-1. The results describe important immunological changes and reinforce the potential effect of CMV and HSV-1 on the immunosenescence process
Factors associated with the use of biological drugs that modify the course of rheumatoid arthritis in the Specialized Pharmaceutical Care Component in Brazil
No full textA artrite reumatoide (AR) é uma doença crônica, sistêmica, imunomediada e de etiologia mal definida que atinge cerca de 0,2% a 1% da população brasileira. O tratamento da AR fornecido pelo Componente Especializado de Assistência Farmacêutica (CEAF) inclui os medicamentos modificadores do curso da doença biológicos (MMCDbio), de alto custo, utilizados para melhor controle da doença com atividade moderada a grave. Conhecer os fatores que podem estar associados ao uso dos MMCDbio pode contribuir para qualificar e racionalizar os recursos em saúde no Brasil, identificando os pontos prioritários para realizar uma intervenção. Objetivo: Analisar o acesso e os fatores associados ao uso dos medicamentos modificadores do curso da doença biológicos para artrite reumatoide no Brasil. Método: Foi realizado estudo longitudinal, com coleta de dados retrospectivos em base de dados secundários, individualizados e anonimizados de pacientes classificados com os CID-10 da AR, com 16 anos ou mais, que utilizaram medicamentos do CEAF, no período de janeiro a dezembro de 2019 no Brasil. A análise dos fatores associados ao uso de MMCDbio considerou os grupos de variáveis: características demográficas dos usuários; provisão de medicamentos para AR; oferta do cuidado em AR e caracterização dos municípios. Resultados: o estudo incluiu 155.679 indivíduos, dos quais 84,6% era do sexo feminino, com média de idade de 57 anos e média de IMC de 27,4 kg/m2. A adesão foi maior para os MMCDbio, expressa tanto pelo número de pacientes com pelo menos 80% do máximo de dispensações possíveis (64%) quanto pelo número médio de dispensações no ano. Os municípios de grande porte apresentaram maior na oferta de médicos reumatologistas, sendo observado gradiente linear com o porte populacional. O banco SIA/SUS APAC de medicamentos se mostrou extremamente limitado quanto a análise por porte populacional, devido a discrepância dos dados referentes aos municípios de dispensação registrados e os municípios que efetivamente realizaram a dispensação no período analisado. Conclusão: Os MMCDbio foram dispensados a cerca de um terço dos pacientes de AR que retiram medicamentos no CEAF no Brasil. Seu uso foi associado a presença de médico reumatologista.Rheumatoid arthritis (RA) is a chronic, systemic, immune-mediated and ill-defined etiology that affects about 0,2% to 1% of the Brazilian population. RA treatment provided by the Specialized Pharmaceutical Care Component (CEAF) includes biological Disease-Modifying Anti-Rheumatic Drugs (bDMARD) used to better control the disease with moderate to severe activity. Knowing the factors that may be associated with the use of bDMARD can contribute to qualify and rationalize health resources in Brazil, identifying the priority points to carry out an intervention. Objective: to describe the supply of medicines for RA at CEAF and to identify the factors associated with bDMARD access in 2019 in Brazil. Method retrospective study, from secondary databases, individualized and anonymized patients classified as RA ICD-10, aged 16 or over, attended in 2019, in Brazil. The analysis of factors associated with the use of bDMARD considered the groups of variables: demographic characteristics of users, provision of medicines for RA, offer of care in RA and characterization of the municipalities. Results: the study included 155,679 individuals of which 84.6% were female, with a mean age of 57 years and a mean body mass index (BMI) of 27.4 kg / m2. Adherence was higher for bDMARD, expressed both by the proportion of patients with nine or more dispensations per year (64%) and the average number of dispensations in the year. There was a greater offer of rheumatologists in large municipalities. The SIA / SUS APAC drug bank proved to be extremely limited in terms of population size analysis, due to the discrepancy in the data referring to the registered dispensing municipalities and the municipalities that actually carried out the dispensation in the analyzed period. Conclusion: bDMARD was dispensed to about one-third of RA patients who withdraw medication at CEAF in Brazil. Its use was associated with the presence of a rheumatologist
Cadernos CRIS - Fiocruz: Saúde Global e Diplomacia da Saúde - Informe 14 - Julho/Agosto - 2021
No full textInforme 14 produzido pelo CRIS-Fiocruz, sobre a semana de 27 de julho a 09 de agosto de 2021