Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

ABSTRACT: Pornunça (Manihot sp.) is a potential forage to feed ruminants in drylands worldwide; however, evaluations of animal diets are necessary. This study assessed intake and digestibility of dry matter and nutrients, physiological responses, ingestive behavior, water intake, as well as hematological and biochemical responses of lambs fed diets containing increasing levels of Pornunça silage (PS) replacing Tifton-85 bermudagrass hay (Cynodon spp.). Treatments consisted of 0, 33, 66, and 100 % PS considering the roughage portion of the diet (% dry matter – DM). The experimental design was completely randomized with six replicates. Cyanide acid (HCN) levels in fresh Pornunça leaves were 207.7 mg kg−1 DM and 76.78 mg kg−1 DM in PS. Intake of DM and crude protein (CP), and neutral detergent fiber corrected for ash and protein (NDFap) increased linearly with increasing levels of PS in the diet. Digestibility of DM, NDF, and CP were higher with increasing levels of PS. Idle time decreased linearly, while water balance, water intake via food, and total water in feces increased with PS. Nitrogen balance, physiological, and hematological responses were not influenced by treatments, while the final alanine aminotransferase increased for lambs fed all diets evaluated. The PS up to 100 % of the roughage portion increased DM and nutrient intake and digestibility without altering physiological responses and the hematological and biochemical parameters, resulting in greater water intake via food.

ABSTRACT: Pullorum disease is described worldwide and is caused by Salmonella enterica subspecies enterica serovar Gallinarum biovar Pullorum (S. Pullorum). S. Pullorum infection is important in commercial poultry, provoking a systemic disease with high mortality rates. Its occurrence requires notification, and when it is diagnosed in commercial breeding flocks, its eradication is demanded. The aim of this study was to report a severe outbreak of Pullorum disease in young Guinea fowl (Numida meleagris), resulting in 100% mortality of keets (n=290) within the first two weeks of age. All examined keets had enlarged liver, kidneys and spleen (5/5), and the affected tissues were submitted to histological and bacteriological examination. On histopathology, random paratyphoid nodules characterized by areas of necrosis with fibrin and a moderate infiltrate of macrophages and heterophils were observed in the liver. In kidneys, discrete areas of necrosis associated with moderate multifocal infiltrates of lymphocytes, and plasma cells were observed. In the spleen, a moderate infiltrate of macrophages was noticed. Isolation of colonies suggestive of S. Pullorum from liver and spleen was performed in selective agars and, after biochemical tests, confirmed by specific duplex-PCR. The antimicrobial susceptibility test of the isolated strain revealed resistance to only sulfamethoxazole + trimethoprim among the tested antimicrobials. The S. Pullorum isolate recovered in the present study was highly pathogenic to N. meleagris and may represent a risk to other avian species, including industrial poultry.

RESUMO: A pulorose é descrita mundialmente e é causada por Salmonella enterica subespécie enterica sorovar Gallinarum biovar Pullorum (S. Pullorum). A infecção por S. Pullorum é importante em aves comerciais, provocando doença sistêmica com altas taxas de mortalidade. Sua ocorrência requer notificação e quando diagnosticada em aves de criação comercial resulta na erradicação do plantel. O objetivo deste estudo foi relatar um surto grave de pulorose em filhotes de galinhas-d’Angola (Numida meleagris), resultando em 100% de mortalidade das aves (n=290) nas primeiras duas semanas de idade. Os pintinhos recebidos tinham hepato, espleno e nefromegalia (5/5). Os tecidos dos cinco indivíduos recebidos foram submetidos a exame histológico e bacteriológico. Na histopatologia, foram observados nódulos paratifoides aleatórios caracterizados por áreas de necrose com fibrina e infiltrado moderado de macrófagos e heterófilos no fígado. Nos rins, foram observadas áreas discretas de necrose associadas a infiltrados multifocais moderados de linfócitos e plasmócitos. No baço, foi observado infiltrado moderado de macrófagos. O isolamento de colônias sugestivas de S. Pullorum de fígados e baços foi realizado em ágares seletivos e, após testes bioquímicos, confirmado por duplex-PCR específico. A susceptibilidade antimicrobiana da cepa isolada revelou resistência apenas ao sulfametoxazol + trimetoprim entre os antimicrobianos testados. O isolado de S. Pullorum recuperado no presente estudo foi altamente patogênico para N. meleagris e pode representar um risco para outras espécies de aves, incluindo aves industriais.

Abstract Fanconi anemia is a rare autosomal recessive disease. In this disease, cytokine pathways can induce the bone marrow failure that is observed in individuals with Fanconi anemia. Interleukin IL-17 exhibits a protective effect in organisms because it induces neutrophil recruitment and shows a pathological role in several models of autoimmune diseases, periodontal disease, cancer, allograft rejection, and graft versus host disease. Polymorphisms in the IL17A and IL17RA genes were evaluated from DNA in saliva, comparing individuals with or without Fanconi anemia, using models of genotypic transmission (additive, dominant, and recessive). Polymorphisms in the IL17A and IL17RA genes (rs2241044 [C allele], rs879577 [C allele], rs9606615 [T allele], and rs2241043 [C allele]) were risk factors for developing Fanconi anemia. We also performed an analysis of gene markers with clinical variables in the Fanconi group. Polymorphisms in the IL17A gene (rs3819025 [A allele] and rs2275913 [G allele], respectively) were associated with an age of less than 20 years (p = 0.026; RP 0.65) and the female sex (p = 0.043; RP 0.88). The IL17RA gene was also associated with age and the presence of leukoplakia (a potentially malignant oral disorder). An age of less than 20 years was associated with rs917864 (T allele; p = 0.036; RP 0.67). The presence of leukoplakia was associated with rs17606615 (T allele; p = 0.042; RP 0.47). To our knowledge, this is the first study that associates IL17A and IL17RA gene polymorphisms with Fanconi anemia and examines rs2241044 polymorphisms in scientific literature thus far.

Abstract Background Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy. Objective The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients. Methods The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population. Results Relevance, adequacy, clarity, and internal reliability of the instrument’s items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96. Conclusion EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.

Resumo Fundamento A varfarina é um anticoagulante oral útil para prevenção de tromboembolismo, embora seja considerado fármaco de alto risco de causar eventos adversos. Considerando os desafios práticos no controle da anticoagulação oral, os pacientes poderiam se beneficiar de estratégias educacionais que visem mudança de comportamento, participação ativa no autocuidado e adesão à farmacoterapia. Objetivo Construir e validar o protocolo EmpoderACO para mudança de comportamento em pacientes em uso de varfarina. Métodos As etapas metodológicas foram: definição de conceitos e domínios do autocuidado, identificação dos objetivos, construção e seleção dos itens, avaliação da validade de conteúdo e pré-teste na população alvo. Resultados Relevância, adequação, clareza e confiabilidade interna dos itens do instrumento foram avaliadas por comitê de juízes multiprofissional pela plataforma web E-surv, obtendo-se média de concordância ≥0,91. A compreensão do instrumento pela população-alvo teve clareza adequada com média de 0,96. Conclusão O EmpoderACO poderá contribuir para qualificar o processo de comunicação entre profissionais e pacientes, melhorar a adesão ao tratamento e os resultados clínicos, podendo ser replicado nos serviços de saúde.

ABSTRACT The appearance of ultra-processed foods (UPF) and their increase in sales has led to changes in food environments; these conditions are associated with negative repercussions on people's health. Therefore, this essay aimed to analyze the implications of the consumption of UPF, advances, and challenges in Latin America for public health in adults. The information was collected in different databases, which led to the review of documents that revealed data on consumption, implications, actions, and public policy challenges around UPF. Mexico and Chile were the countries with the highest per capita sales in Latin America. In the region, the prevalence of overweight, obesity, and type 2 diabetes mellitus was associated with high sales of UPF and an increase in fast-food establishments and supermarkets. Several countries in the region have issued advances in public and fiscal policies as improving the information that warns of the health risks of these products and an increase in taxes on products with inadequate nutritional profiles. Although these actions have begun to show positive effects by registering decreases in the consumption of UPF, it is essential to generate policies and actions that offer alternatives for the consumption of minimally processed foods, with adequate nutritional profiles that are affordable and allow the population to have consumption alternatives to UPF.

RESUMEN La aparición de los productos ultra-procesados y su incremento en las ventas, ha propiciado modificaciones en los entornos alimentarios, condiciones que se han asociado con repercusiones negativas en la salud de las personas. El objetivo de este ensayo fue analizar las implicancias del consumo de ultra-procesados, avances y retos en América Latina para la salud pública en adultos. Para ello, se buscó información en diferentes bases de datos lo que llevó a la revisión de documentos que presentaron datos sobre el consumo, implicancias, acciones y retos de políticas públicas en torno a los productos ultra-procesados. México y Chile registraron las ventas per cápita más altas de América Latina. Las altas ventas de estos productos, el incremento de establecimientos de comida rápida, así como de supermercados, se ha asociado con el aumento de la prevalencia de sobrepeso, obesidad y DM2 en la región; asimismo se detectaron avances en materia de políticas públicas y fiscales que han sido emitidas por los Estados para la mejora de la información la cual advierte de los riesgos a la salud de estos productos así como el incremento de impuestos a productos con perfiles nutrimentales inadecuados. Si bien, estas acciones han comenzado a evidenciar efectos positivos al registrarse decrementos en los consumos de productos ultra-procesados, es importante generar políticas y acciones que ofrezcan alternativas de consumo de alimentos mínimamente procesados, con perfiles nutrimentales adecuados y, económicamente asequibles que permitan a la población tener alternativas de consumo distintas a los ultra-procesados.

ABSTRACT In Peru, the COVID-19 pandemic demonstrated the usefulness of having a structured laboratory surveillance system that has been operational for 22 years, based on influenza surveillance; initially in the form of sentinel units, and later strengthened and innovated, with its own resources and with external support, to provide quality information. Biotechnological advances have been implemented for diagnostic confirmation and the capacity of the national laboratory network has been expanded, maintaining efficiency, considering the diverse and complex realities of each region, and overcoming difficulties regarding communication and articulation between institutions. It is necessary to consolidate this system, with collaborative and coordinated work between its components, boosting its effectiveness and timeliness and promoting genomic surveillance of new viruses and variants, as is currently the case with SARS-CoV-2.

RESUMEN En el Perú, la pandemia de la COVID-19 ha evidenciado la utilidad de tener un sistema de vigilancia laboratorial estructurado y en funcionamiento desde hace 22 años, basado en la vigilancia de influenza; inicialmente en modalidad de unidades centinela, y después fortaleciéndose e innovándose, con recursos propios y con apoyo externo, para generar información de calidad. Se han implementado avances biotecnológicos para la confirmación diagnóstica e incrementado las capacidades de la red nacional de laboratorios, manteniendo la eficiencia, considerando las diversas y complejas realidades de los niveles regionales, y superando dificultades de comunicación y articulación entre instituciones. Resulta necesario consolidar este sistema, con trabajo colaborativo y coordinado entre sus componentes, impulsando su eficacia y oportunidad y promoviendo la vigilancia genómica de nuevos virus y variantes, como actualmente ocurre con el SARS-CoV-2.

Abstract The action of substances with non-permeable cryoprotectant potential, besides glucose, has not yet been studied for the species Prochilodus brevis. The objective of this work was to evaluate the action of four non-permeable cryoprotectants on this species sperm cryopreservation. Five pools were cryopreserved in a solution of 5% glucose and 10% dimethyl sulfoxide (Me2SO) associated or not (control) with cryoprotectants egg yolk (5, 10 or 12%), soy lecithin (2.5, 7.5 or 10%), sucrose (5, 10 or 20%) and lactose (5, 8 or 15%). After thawing, samples were evaluated for sperm kinetics (total motility, motility duration, velocities, and wobble - WOB), morphology and membrane and DNA integrity. The treatments containing egg yolk improved significantly (P<0.05) results when compared the control for the membrane integrity parameter. When compared to other treatments, egg yolk, at any concentration, presented higher results (P<0.05) for membrane integrity, total motility, curvilinear velocity (VCL) and average path velocity (VAP) parameters. Egg yolk also showed the best results for WOB, but it did not differ from 5% and 8% lactose and 5% and 20% sucrose. Soy lecithin had the lowest percentages of morphologically normal sperm (P<0.05), while the other treatments did not differ from each other. There was no difference regarding DNA integrity data. Thus, 5% egg yolk is indicated as a non-permeable cryoprotectant for P. brevis, in association with 5% glucose and 10% Me2SO.

ABSTRACT In Peru, the COVID-19 pandemic demonstrated the usefulness of having a structured laboratory surveillance system that has been operational for 22 years, based on influenza surveillance; initially in the form of sentinel units, and later strengthened and innovated, with its own resources and with external support, to provide quality information. Biotechnological advances have been implemented for diagnostic confirmation and the capacity of the national laboratory network has been expanded, maintaining efficiency, considering the diverse and complex realities of each region, and overcoming difficulties regarding communication and articulation between institutions. It is necessary to consolidate this system, with collaborative and coordinated work between its components, boosting its effectiveness and timeliness and promoting genomic surveillance of new viruses and variants, as is currently the case with SARS-CoV-2.

RESUMEN En el Perú, la pandemia de la COVID-19 ha evidenciado la utilidad de tener un sistema de vigilancia laboratorial estructurado y en funcionamiento desde hace 22 años, basado en la vigilancia de influenza; inicialmente en modalidad de unidades centinela, y después fortaleciéndose e innovándose, con recursos propios y con apoyo externo, para generar información de calidad. Se han implementado avances biotecnológicos para la confirmación diagnóstica e incrementado las capacidades de la red nacional de laboratorios, manteniendo la eficiencia, considerando las diversas y complejas realidades de los niveles regionales, y superando dificultades de comunicación y articulación entre instituciones. Resulta necesario consolidar este sistema, con trabajo colaborativo y coordinado entre sus componentes, impulsando su eficacia y oportunidad y promoviendo la vigilancia genómica de nuevos virus y variantes, como actualmente ocurre con el SARS-CoV-2.

Abstract Studies around the world show an increase in global average temperatures, with a consequent increase in extreme events and changes in the distribution of precipitation, causing a decrease in agricultural production and changes in planting areas. This study analyzed the exposure to climate risk that the coffee crop in the region of Alta Mogiana/SP, Brazil has been presenting in the past thirty years (1991-2021). Time series of daily data of maximum and minimum temperature and precipitation were used. By the statistical tests we observed a trend of increase in maximum temperatures daily of approximately 1.4°C and minimum daily of 0.8°C in the municipalities of the region and a trend towards a decrease in precipitation of 0.9 mm daily, indicating greater exposure of the coffee crop in the region to climate risk and increased vulnerability for the coffee producer. In view of these analyses, a literature review was carried out, suggesting agroforestry systems and mechanical irrigation as the most promising strategies to manage climate risk in coffee plantations. In addition, drought-resistant cultivars, training courses for farmers, increased rural insurance, and nutritional control of the plants can also be considered efficient options for climate exposure in coffee plantations from Alta Mogiana.

ABSTRACT The present work validated and evaluated a duplex real-time RT-PCR using specific primers and probes for genes RdRp from SARS-CoV-2 and GAPDH from humans; the latter was used as an endogenous control in all reactions. We evaluated the specificity, the sensitivity, the robustness, the reproducibility, the repeatability, the comparability, and the limit of detection. The predictive positive and negative values (PPV and PNV, respectively) and all the parameters evaluated using our duplex real-time RT-PCR was 100%. The detection limit was 100 copies/µL according to the acceptance criteria established for the validation of this protocol. Our duplex real-time RT-PCR demonstrated to be a good alternative for the diagnosis of COVID-19; in addition, this PCR was used adequately in suspicion of COVID-19, allowing it to control the number of false-negatives.

RESUMEN Se validó y evaluó un método de RT-PCR en tiempo real usando cebadores y sondas específicas para los genes RdRP de SARS-CoV-2 y GAPDH de humanos; este último fue usado como control endógeno. Se evaluó la especificidad y sensibilidad; además, se evaluó otros parámetros como la robustez, la repetibilidad, reproducibilidad, comparabilidad y el límite de detección. La sensibilidad, especificidad, los valores predictivos positivo y negativo, la robustez, comparabilidad y la repetibilidad-reproducibilidad de la prueba de RT-PCR en tiempo real dúplex fue de 100%, con un límite de detección de 100 copias/µL, de acuerdo con los criterios de aceptación establecidos para validación del protocolo. Esta prueba estandarizada es una buena alternativa para el diagnóstico de COVID-19; además, la prueba fue aplicada de manera exitosa en personas sospechosas de la enfermedad permitiendo controlar el número de falsos negativos.

ABSTRACT The present work validated and evaluated a duplex real-time RT-PCR using specific primers and probes for genes RdRp from SARS-CoV-2 and GAPDH from humans; the latter was used as an endogenous control in all reactions. We evaluated the specificity, the sensitivity, the robustness, the reproducibility, the repeatability, the comparability, and the limit of detection. The predictive positive and negative values (PPV and PNV, respectively) and all the parameters evaluated using our duplex real-time RT-PCR was 100%. The detection limit was 100 copies/µL according to the acceptance criteria established for the validation of this protocol. Our duplex real-time RT-PCR demonstrated to be a good alternative for the diagnosis of COVID-19; in addition, this PCR was used adequately in suspicion of COVID-19, allowing it to control the number of false-negatives.

RESUMEN Se validó y evaluó un método de RT-PCR en tiempo real usando cebadores y sondas específicas para los genes RdRP de SARS-CoV-2 y GAPDH de humanos; este último fue usado como control endógeno. Se evaluó la especificidad y sensibilidad; además, se evaluó otros parámetros como la robustez, la repetibilidad, reproducibilidad, comparabilidad y el límite de detección. La sensibilidad, especificidad, los valores predictivos positivo y negativo, la robustez, comparabilidad y la repetibilidad-reproducibilidad de la prueba de RT-PCR en tiempo real dúplex fue de 100%, con un límite de detección de 100 copias/µL, de acuerdo con los criterios de aceptación establecidos para validación del protocolo. Esta prueba estandarizada es una buena alternativa para el diagnóstico de COVID-19; además, la prueba fue aplicada de manera exitosa en personas sospechosas de la enfermedad permitiendo controlar el número de falsos negativos.