Resumen El pie diabético (PD) representa una de las complicaciones crónicas de la enfermedad diabética, que se debe a alteraciones estructurales y funcionales del pie, lo que provoca, entre otros efectos, las úlceras del pie diabético (UPD). Las tasas de mortalidad asociadas con el desarrollo de una UPD se estiman en un 5 % en el primer año y en un 42 % a los cinco años. A menudo puede identificarse un evento iniciador potencialmente prevenible, como un traumatismo menor que causa una lesión cutánea. La presentación clásica de la UPD es la de un pie infectado grave a través de una herida previa, con necrosis rápidamente progresiva. Se observa un tejido necrótico y colecciones purulentas. Las amputaciones del pie, muchas de las cuales pueden prevenirse con un reconocimiento y un tratamiento tempranos, pueden ser necesarias en hasta el 20 % de las úlceras del pie diabético. Los exámenes de detección sistemáticos para la afectación neuropática y vascular de las extremidades inferiores y la inspección cuidadosa de los pies pueden reducir sustancialmente la morbilidad de los problemas de los pies. El tratamiento efectivo de las UPD es complejo y requiere un gasto considerable de recursos y un costo significativo para el sistema de atención médica. En la presente revisión se hace una descripción de la fisiopatología, epidemiología, presentación clínica, diagnóstico y tratamiento de la UPD.

Abstract The diabetic foot (PD) represents one of the chronic complications of diabetic disease, which occurs due to structural and functional alterations of the foot, causing, among others, diabetic foot ulcers (DFU). Mortality rates associated with the development of a DFU are estimated at 5 % in the first year, and 42 % at five years. A potentially preventable initiating event can often be identified, such as minor trauma causing a skin lesion. The classic presentation of DFU is that of a severely infected foot through a previous wound, with rapidly progressive necrosis, necrotic tissue and purulent collections are observed. Foot amputations, many of which can be prevented with early recognition and treatment, may be required in up to 20 % of diabetic foot ulcers. Routine screening for neuropathic and vascular involvement of the lower extremities and careful inspection of the feet can substantially reduce the morbidity of foot problems. Effective treatment of DFUs is complex and requires considerable expenditure of resources and significant cost to the health care system. This review provides a description of the pathophysiology, epidemiology, clinical presentation, diagnosis, and treatment of DFU.

Abstract This study investigated the prevalence of possible bruxism and its association with social capital among undergraduates during the coronavirus disease (COVID-19) pandemic. This cross-sectional study was conducted at a private university in Southern Brazil. Data were collected through a self-administered electronic questionnaire (Google Forms). Possible bruxism was measured using the following question: “Do you grind your teeth or clench your jaws?”. Social capital was evaluated using individual social networks. Data on self-perceived oral health, anxiety, sociodemographics, and information related to university graduates were also collected. Adjusted logistic regression models with a hierarchical approach were used to evaluate associations. The results are presented as odds ratios (ORs) and 95% confidence intervals (95%CIs). Altogether, 345 undergraduates participated in the study, with a mean age of 21.8 years (standard deviation = 5.21). The prevalence of bruxism in the sample was 57.1%. Undergraduates with low social capital had 2.06 times greater odds of bruxism than their counterparts (OR 2.06; 95%CI 1.11–3.83). Female undergraduates (OR 2.40, 95%CI 1.39–4.12), those who were in the final year of university (OR 1.13, 95%CI 1.04–1.21), and those who perceived they needed dental treatment (OR 1.91; CI: 1.21–3.02) also had greater odds of possible bruxism. In conclusion, the prevalence of possible bruxism was high among undergraduate students during the COVID-19 pandemic and associated with lower social capital levels. Knowledge of these factors is important to identify risk groups and plan strategies to control bruxism in this population.

ABSTRACT Objective To evaluate the food practices and nutritional status of students who use the University Restaurant at a public university. Methods This is a cross-sectional study carried out with 958 university students. Data related to regular eating practices (≥5 times/week), routine food consumption and nutritional status were collected. The association between University Restaurant attendance and dietary practices and body mass index was reviewed by bivariate logistic regression model and multiple regression. Results Students who attended the University Restaurant three or more times a week were more likely to regularly consume beans (OR: 1.35, p=0.041) and fresh salad (OR: 1.77, p<0.001) and less likely to have afternoon snack (OR: 0.68; p=0.008). In addition, an association between soda consumption and overweight was observed. Conclusion Thus, the importance of strategies that seek to promote incentives for healthy eating and lifestyle practices in the university population become evident.

RESUMO Objetivo O objetivo do estudo foi avaliar as práticas alimentares e o estado nutricional de estudantes usuários do restaurante-escola em uma universidade pública. Métodos Trata-se de um estudo transversal realizado com 958 estudantes universitários. Foram coletados dados relacionados às práticas alimentares regulares (≥5 vezes/semana), à rotina alimentar e ao estado nutricional. A associação entre a frequência de ida ao restaurante-escola, práticas alimentares e índice de massa corporal foi analisada por modelo de regressão logística bivariada e regressão múltipla. Resultados Os estudantes que frequentaram o restaurante-escola 3 ou mais vezes por semana apresentaram maiores chances de consumir regularmente feijão (OR: 1,35, p=0,041) e salada crua (OR: 1,77, p<0,001) e menos chances de realizar o lanche da tarde (OR: 0,68; p=0,008). Além disso, foi observada associação entre o consumo de refrigerante e o excesso de peso. Conclusão Dessa forma, evidencia-se a importância de estratégias que busquem promover incentivos a práticas alimentares e de vida saudáveis na população universitária.

BACKGROUND Distinct N-acetyltransferase 2 (NAT2) slow acetylators genotypes have been associated with a higher risk to develop anti-tuberculosis drug-induced hepatotoxicity (DIH). However, studies have not pointed the relevance of different acetylation phenotypes presented by homozygotes and compound heterozygotes slow acetylators on a clinical basis. OBJECTIVES This study aimed to investigate the association between NAT2 genotypes and the risk of developing DIH in Brazilian patients undergoing tuberculosis treatment, focusing on the discrimination of homozygotes and compound heterozygotes slow acetylators. METHODS/FINDINGS The frequency of NAT2 genotypes was analysed by DNA sequencing in 162 patients undergoing tuberculosis therapy. The mutation analyses revealed 15 variants, plus two new NAT2 mutations, that computational simulations predicted to cause structural perturbations in the protein. The multivariate statistical analysis revealed that carriers of NAT2*5/*5 slow acetylator genotype presented a higher risk of developing anti-tuberculosis DIH, on a clinical basis, when compared to the compound heterozygotes presenting NAT2*5 and any other slow acetylator haplotype [aOR 4.97, 95% confidence interval (CI) 1.47-16.82, p = 0.01]. CONCLUSION These findings suggest that patients with TB diagnosis who present the NAT2*5B/*5B genotype should be properly identified and more carefully monitored until treatment outcome in order to prevent the occurrence of anti-tuberculosis DIH.

RESUMO A partir de referenciais do feminismo negro, da perspectiva interseccional e dos estudos étnicoraciais no Brasil, problematizam-se o racismo e o sexismo na academia brasileira com base na caracterização e análise da presença/ausência de professoras negras em programas de pós-graduação em ciências da saúde de duas universidades federais fluminenses, UFRJ e UFF. Utilizando informações de sites de 31 Programas de Pós-Graduação (PPG), reconstruíram-se quantitativamente os perfis de gênero e étnico-raciais por universidade e área de avaliação. Identificaram-se 23 professoras negras que ocupam 26 vagas docentes nos PPG analisados. Com base em informações da Plataforma Lattes, também se abordou longitudinalmente a dimensão de estudo. Os resultados assinalam que a presença de professoras negras é de 2% na UFRJ e de 6% na UFF; que ela é maior em áreas relativas aos cuidados e ínfima em áreas de maior prestígio científico e socioeconômico, como medicina. Constata-se o racismo como principal sistema de poder, operando no contexto institucional e disciplinar. Neste último, associado ao sexismo que determina as hierarquias de gênero nas áreas de saúde. Observa-se, também, que as desigualdades de raça se sobrepõem às de gênero no contexto desta pesquisa, confirmando as teses que apontam o epistemicídio dos saberes negros.

ABSTRACT Based on black feminism, intersectional perspective and Brazilian ethnic-racial studies, the paper problematized racism and sexism in the Brazilian academy. It characterizes and analyses the presence/ absence of black women professors in PhD programs in health sciences of two federal universities, UFRJ and UFF. Using information from the websites of 31 PhD programs, we reconstructed, quantitatively, the gender and ethnic-racial profiles of the PhD programs by university and evaluation area. Twentythree black women professors were identified in 26 teaching positions. Based on information from the Plataforma Lattes, we also addressed the study dimension longitudinally. The results indicate that the presence of black women professors is 2% at UFRJ and 6% at UFF. It is greater in areas related to care, and non-existent in areas of greater scientific and socio-economic prestige, such as Medicine. Racism is seen as the main power system, operating in the institutional and disciplinary context. In the latter, it is associated with sexism that determines gender hierarchies in health fields. It is also observed that race inequalities overlap with gender inequalities in the context of this research, confirming the theses that point to the epistemicide of black knowledge.

RESUMO A partir de referenciais do feminismo negro, da perspectiva interseccional e dos estudos étnicoraciais no Brasil, problematizam-se o racismo e o sexismo na academia brasileira com base na caracterização e análise da presença/ausência de professoras negras em programas de pós-graduação em ciências da saúde de duas universidades federais fluminenses, UFRJ e UFF. Utilizando informações de sites de 31 Programas de Pós-Graduação (PPG), reconstruíram-se quantitativamente os perfis de gênero e étnico-raciais por universidade e área de avaliação. Identificaram-se 23 professoras negras que ocupam 26 vagas docentes nos PPG analisados. Com base em informações da Plataforma Lattes, também se abordou longitudinalmente a dimensão de estudo. Os resultados assinalam que a presença de professoras negras é de 2% na UFRJ e de 6% na UFF; que ela é maior em áreas relativas aos cuidados e ínfima em áreas de maior prestígio científico e socioeconômico, como medicina. Constata-se o racismo como principal sistema de poder, operando no contexto institucional e disciplinar. Neste último, associado ao sexismo que determina as hierarquias de gênero nas áreas de saúde. Observa-se, também, que as desigualdades de raça se sobrepõem às de gênero no contexto desta pesquisa, confirmando as teses que apontam o epistemicídio dos saberes negros.

ABSTRACT Based on black feminism, intersectional perspective and Brazilian ethnic-racial studies, the paper problematized racism and sexism in the Brazilian academy. It characterizes and analyses the presence/ absence of black women professors in PhD programs in health sciences of two federal universities, UFRJ and UFF. Using information from the websites of 31 PhD programs, we reconstructed, quantitatively, the gender and ethnic-racial profiles of the PhD programs by university and evaluation area. Twentythree black women professors were identified in 26 teaching positions. Based on information from the Plataforma Lattes, we also addressed the study dimension longitudinally. The results indicate that the presence of black women professors is 2% at UFRJ and 6% at UFF. It is greater in areas related to care, and non-existent in areas of greater scientific and socio-economic prestige, such as Medicine. Racism is seen as the main power system, operating in the institutional and disciplinary context. In the latter, it is associated with sexism that determines gender hierarchies in health fields. It is also observed that race inequalities overlap with gender inequalities in the context of this research, confirming the theses that point to the epistemicide of black knowledge.

Abstract Background Skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis (NUCL) caused by L. (L.) infantum chagasi are characterized by lymphohistiocytic inflammatory infiltrate associated with epithelioid granuloma and scarce parasitism. However, the in situ cellular immune response of these patients is unclear. Therefore, the aim of the present study was to characterize the cellular immune response in the skin lesions of patients affected by NUCL. Methods Twenty biopsies were processed by immunohistochemistry using primary antibodies to T lymphocytes (CD4, CD8), NK cells, B lymphocytes, macrophages, nitric oxide synthase and interferon-gamma. Results Immunohistochemistry revealed higher expression of all cellular types and molecules (IFN-γ, iNOS) in the dermis of diseased skin compared to the skin of healthy individuals (p < 0.05). Morphometric analysis performed in the skin lesions sections showed the predominance of CD8+ T lymphocytes in the mononuclear infiltrate, followed by macrophages, mostly iNOS+, a response that could be mediated by IFN-γ. Conclusion Our study improves knowledge of the cellular immune response in non-ulcerated or atypical cutaneous leishmaniasis caused by L. (L.) infantum chagasi in Central America and pointed to the pivotal participation of CD8+ T lymphocytes in the host defense mechanisms against the parasite in patients with NUCL.

Although Leishmania infantum is well-known as the aethiological agent of visceral leishmaniasis (VL), in some Central American countries it may cause atypical non-ulcerated cutaneous leishmaniasis (NUCL). However, the mechanisms favoring its establishment in the skin are still unknown. Lipophosphoglycan (LPG) is the major Leishmania multivirulence factor involved in parasite-host interaction. In the case of viscerotropic L. infantum, it causes an immunosuppression during the interaction with macrophages. Here, we investigated the biochemical and functional roles of LPGs from four dermotropic L. infantum strains from Honduras during in vitro interaction with murine macrophages. LPGs were extracted, purified and their repeat units analysed. They did not have side chains consisting of Gal(β1,4)Man(α1)-PO4 common to all LPGs. Peritoneal macrophages from BALB/c and C57BL/6 were exposed to LPG for nitric oxide (NO) and cytokine (TNF-α and, IL-6) production. LPGs from dermotropic strains from Honduras triggered higher NO and cytokine levels compared to those from viscerotropic strains. In conclusion, LPGs from dermotropic strains are devoid of side-chains and exhibit high pro-inflammatory activity.

ABSTRACT Background: Influenza burden in Brazil is considerable with 4.2–6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach. Objective: To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE). Methods: Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model. Results: Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2. Discussion: FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness). Conclusion: All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus trivalent influenza vaccine in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil (Appendix A).

Abstract: Dermatofibroma is a frequent benign tumor of easy clinical diagnosis in most cases, but that can mimic other dermatoses. Dermoscopy may help to define the diagnosis and its classical pattern is a central white area, similar to a scar, surrounded by a discrete pigment network. However, dermoscopic findings are not always typical. We describe here a case of dermatofibroma exhibiting ridges, furrows and pseudocomedos, a pattern which is typical of seborrheic keratosis, in dermoscopy.