RESUMO CONTEXTO: A constipação intestinal (CI) em pacientes com a forma digestiva da doença de Chagas é uma das principais razões para procura de atendimento médico. Os dados populacionais indicam que a prática de atividade física melhora a motilidade gastrointestinal. OBJETIVO: Este estudo avaliou a frequência intestinal e os sintomas de constipação e sua relação com o nível de atividade física em pacientes com e sem doença de Chagas. MÉTODOS: Pacientes (n=120) de ambos os gêneros, com idades entre 35 e 84 anos, nos quais 50% (n=60) eram do grupo Chagas e 50% (n=60) do grupo controle, foram avaliados quanto ao nível da CI utilizando a Escala de Avaliação da Constipação (CAS) e o nível de atividade física utilizando o Questionário Internacional de Atividade Física (IPAQ). RESULTADOS: Os pacientes do grupo Chagas classificados como ativos (IPAQ 2) apresentaram maior proporção (P=0,0235) de CI moderada com distensão abdominal grave (P=0,0159) e frequência de evacuação diminuída (P=0,0281) do que os pacientes do grupo controle, considerados muito ativos (IPAQ 1). O estilo de vida sedentário foi maior (P=0,0051) no grupo Chagas com duração, intensidade e frequência de atividade física menor que o grupo controle. A percepção de saúde no grupo Chagas foi regular para 46,7% (P=0,0035) e ruim para 8,3% (P=0,0244). CONCLUSÃO: Existe menor risco de desenvolver constipação intestinal em indivíduos mais ativos, evidenciando que o nível de atividade física interfere na frequência intestinal e nos sintomas de constipação em pacientes com e sem doença de Chagas. O nível de atividade física e percepção de saúde foram piores no grupo Chagas, reforçando o estigma da doença, que deve ser modificado pela capacitação dos profissionais de saúde que atendem rotineiramente esses pacientes.

ABSTRACT BACKGROUND: Intestinal constipation (IC) in patients with the digestive form of Chagas disease is one of the main reasons for seeking medical care. Population data indicate that the practice of physical activity improves gastrointestinal motility. OBJECTIVE: This study evaluated the bowel frequency and symptoms of constipation and their relationship with the level of physical activity in patients with and without Chagas disease. METHODS: Patients (n=120) of both genres, aged between 35 and 84 years, in which 50% (n=60) were in the Chagas group and 50% (n=60) were in the control group, were evaluated regarding the level of IC using the Constipation Assessment Scale (CAS) and regarding the level of physical activity using the International Physical Activity Questionnaire (IPAQ). RESULTS - Patients in the Chagas group classified as active (IPAQ 2) had higher proportion (P=0.0235) of moderate IC with severe abdominal distension (P=0.0159) and decreased evacuation frequency (P=0.0281) than the patients in the control group, considered to be very active (IPAQ 1). The sedentary lifestyle was greater (P=0.0051) in the Chagas group with duration, intensity and frequency of physical activity lower than the control group. The health perception in the Chagas group was regular for 46.7% (P=0.0035) and poor for 8.3% (P=0.0244). CONCLUSION: There is a lower risk of developing intestinal constipation in more active individuals, evidencing that the level of physical activity interferes with bowel frequency and symptoms of constipation in patients with and without Chagas disease. The level of physical activity and health perception were worse in the Chagas group, reinforcing the disease stigma, which should be modified by the training of health professionals who routinely attend these patients.

ABSTRACT: Objective Victims of external causes of trauma, caused either by traffic accidents or by violence in general, are mostly youngsters who evolve to brain death and potential donors. Considering that the time to determine brain death may interfere on the quality of the offered organs, the purpose of this study was to analyze the period of brain death diagnosis process. Material and Methods It is a retrospective, descriptive study on brain death diagnosis process and its duration in patients who are fatal victims due to external causes of trauma in a city in the Northwest of Paraná, Brazil, ranging from January to December 2012. Results The average of time for the period between the coma confirmation and the initial protocol for brain death determination in the four hospitals consisted of 18.90±13.62 hours; the average of protocol closure with Complementary Examination for the four studied hospitals consisted of 12±8 hours, and closure with clinical proof indicated 10±6 hours. Conclusion The data presented describe a failure in the entire brain death process, since coma detection until brain death diagnosis protocol closure, considerably increasing diagnosis time.

RESUMO As vítimas de causas externas por traumas, seja por acidentes de trânsito ou violência em geral, são em sua maioria jovens que evoluem para morte encefálica tornando-se potenciais doadores. Considerando que o tempo de determinação de morte encefálica pode interferir na qualidade dos órgãos ofertados, o objetivo deste estudo foi analisar o tempo do processo de determinação de morte encefálica. Trata-se de um estudo retrospectivo e descritivo sobre o processo de determinação de morte encefálica e sua duração, em pacientes vítimas fatais por causas externas ocasionadas por traumas, em um município do Noroeste do Paraná Brasil, no período de janeiro a dezembro de 2012. A média de tempo entre período compreendido entre a constatação do coma e início do protocolo de determinação de morte encefálica, nos quatro hospitais analisados foi de 18,90±13,62 horas e a média de encerramento do protocolo com Exame Complementar dos quatro hospitais estudados foi de 12±8 horas e do encerramento com prova clínica foi de 10±6 horas. Os dados apresentados descrevem uma falha em todo o processo de morte encefálica, desde a detecção do coma até a finalização do protocolo de determinação de morte encefálica, aumentando consideravelmente o período de tempo de seu diagnóstico.

RESUMEN: Objetivo Las víctimas de las causas externas de trauma, causadas ya sea por accidentes de tránsito o por la violencia en general, son en su mayoría jóvenes que evolucionan a muerte encefálica y posibles donantes. Teniendo en cuenta que el tiempo para determinar la muerte encefálica puede interferir en la calidad de los órganos ofrecidos, el propósito de este estudio fue analizar el período del proceso de diagnóstico de muerte encefálica. Material y métodos Es un estudio descriptivo retrospectivo sobre el proceso de diagnóstico de muerte encefálica y su duración en pacientes víctimas mortales por causas externas de traumatismo en una ciudad del noroeste de Paraná, Brasil, desde enero a diciembre de 2012. Resultados El promedio de tiempo para el período entre la confirmación del coma y el protocolo inicial para la determinación de la muerte encefálica en los cuatro hospitales fue de 18.90 ± 13.62 horas; el promedio de cierre del protocolo con Examen Complementario para los cuatro hospitales estudiados fue de 12 ± 8 horas, y el cierre con prueba clínica indicó 10 ± 6 horas. Conclusión Los datos presentados describen una falla en todo el proceso de muerte encefálica, desde la detección de coma hasta el cierre del protocolo de diagnóstico de muerte encefálica, lo que aumenta considerablemente el tiempo de diagnóstico.

Abstract INTRODUCTION: Trypanosoma cruzi, the etiologic agent of Chagas disease, is widely distributed in nature, circulating between triatomine bugs and sylvatic mammals, and has large genetic diversity. Both the vector species and the genetic lineages of T. cruzi present a varied geographical distribution. This study aimed to verify the influence of sympatry in the interaction of T. cruzi with triatomines. Methods: The behavior of the strains PR2256 (T. cruzi II) and AM14 (T. cruzi IV) was studied in Triatoma sordida (TS) and Rhodnius robustus (RR). Eleven fifth-stage nymphs were fed by artificial xenodiagnosis with 5.6 × 103 blood trypomastigotes/0.1mL of each T. cruzi strain. Every 20 days, their excreta were examined for up to 100 days, and every 30 days, the intestinal content was examined for up to 120 days, by parasitological (fresh examination and differential count with Giemsa-stained smears) and molecular (PCR) methods. Rates of infectivity, metacyclogenesis and mortality, and mean number of parasites per insect and of excreted parasites were determined. RESULTS: Sympatric groups RR+AM14 and TS+PR2256 showed higher values of the four parameters, except for mortality rate, which was higher (27.3%) in the TS+AM14 group. General infectivity was 72.7%, which was mainly proven by PCR, showing the following decreasing order: RR+AM14 (100%), TS+PR2256 (81.8%), RR+PR2256 (72.7%) and TS+AM14 (36.4%). CONCLUSIONS: Our working hypothesis was confirmed once higher infectivity and vector capacity (flagellate production and elimination of infective metacyclic forms) were recorded in the groups that contained sympatric T. cruzi lineages and triatomine species.

Abstract:INTRODUCTION:The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.METHODS:The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles.RESULTS:The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm.CONCLUSIONS:Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.

Este estudo objetivou identificar o conjunto de circunstâncias que contribuíram para o envolvimento de adultos em acidentes de trânsito. Estudo descritivo transversal, utilizando dados secundários. Os padrões são identificados por meio de análise de grupo, através de um método chamado de Classificação Hierárquica Ascendente. Cinco classes foram identificadas. Três envolvendo homens resultando em agravos leves, a partir de acidentes entre veículos ou veículo-objeto, período diurno e em condições de pista seca. Duas envolvendo mulheres, resultando em gravidade, destacando-se a direção noturna e menor utilização do cinto de segurança. Os achados deste estudo, principalmente no que se refere aos acidentes graves envolvendo motoristas mulheres, chama a atenção e aponta novos estudos envolvendo estas, cada vez mais presentes no trânsito.

This study aimed to identify the set of circumstances that contributed to the involvement of adults in traffic accidents. The study was of the cross-sectional type using secondary data. The patterns were identified through cluster analysis using a method called Hierarchical Ascendant Classification. Five classes were identified. Three classes involved males with minor injuries resulting from accidents between vehicles or vehicle-object, during the daytime and with dry road surface conditions. Two classes involved females, resulting in severe injuries, and were notable for occurring during the night and with a lower rate of use of seat belts. The findings of this study, especially in relation to the more serious accidents involving the female drivers, draw attention to this situation and point to a need for further studies involving these classes, which are increasingly common in traffic patterns.

Este estudo objetivou identificar o conjunto de circunstâncias que contribuíram para o envolvimento de adultos em acidentes de trânsito. Estudo descritivo transversal, utilizando dados secundários. Os padrões são identificados por meio de análise de grupo, através de um método chamado de Classificação Hierárquica Ascendente. Cinco classes foram identificadas. Três envolvendo homens resultando em agravos leves, a partir de acidentes entre veículos ou veículo-objeto, período diurno e em condições de pista seca. Duas envolvendo mulheres, resultando em gravidade, destacando-se a direção noturna e menor utilização do cinto de segurança. Os achados deste estudo, principalmente no que se refere aos acidentes graves envolvendo motoristas mulheres, chama a atenção e aponta novos estudos envolvendo estas, cada vez mais presentes no trânsito.

This study aimed to identify the set of circumstances that contributed to the involvement of adults in traffic accidents. The study was of the cross-sectional type using secondary data. The patterns were identified through cluster analysis using a method called Hierarchical Ascendant Classification. Five classes were identified. Three classes involved males with minor injuries resulting from accidents between vehicles or vehicle-object, during the daytime and with dry road surface conditions. Two classes involved females, resulting in severe injuries, and were notable for occurring during the night and with a lower rate of use of seat belts. The findings of this study, especially in relation to the more serious accidents involving the female drivers, draw attention to this situation and point to a need for further studies involving these classes, which are increasingly common in traffic patterns.

Introduction The aim of this study was to investigate the knowledge of toxoplasmosis among professionals and pregnant women in the public health services in Paraná, Brazil. Methods A cross-sectional observational and transversal study of 80 health professionals (44 nurses and 36 physicians) and 330 pregnant women [111 immunoglobulin M (IgM)- and IgG-non-reactive and 219 IgG-reactive] was conducted in 2010. An epidemiological data questionnaire was administered to the professionals and to the pregnant women, and a questionnaire about the clinical aspects and laboratory diagnosis of toxoplasmosis was administered to the professionals. Results The participants frequently provided correct responses about prophylactic measures. Regarding the clinical and laboratory aspects, the physicians provided more correct responses and discussed toxoplasmosis with the pregnant women. The professionals had difficulty interpreting the avidity test results, and the physicians stated that they referred pregnant women with high-risk pregnancies to a county reference center. Of the professionals, 53 (91.4%) reported that they instructed women during prenatal care, but only 54 (48.6%) at-risk pregnant women and 99 (45.2%) women who were not at risk reported receiving information about preventive measures. The physicians provided verbal instructions to 120 (78.4%) women, although instructional materials were available in the county. The pregnant women generally lacked knowledge about preventive measures for congenital toxoplasmosis, but the at-risk pregnant women tended to respond correctly. Conclusions This study provides data to direct public health policies regarding the importance of updating the knowledge of primary care professionals. Mechanisms should be developed to increase public knowledge because prophylactic strategies are important for preventing congenital toxoplasmosis.