Abstract Aging represents a critical life change followed by a loss of functional and neuropsychological abilities, as well as significant processes like coping with death. It is important to study the way older adults deal with the meaning of death and the anxiety it generates. Through a cross-sectional, correlational study the Folstein Mini Mental, Yesavage Scale, Templer's Fear of Death, Collet Lester's Death Anxiety and a supportive social network questionnaire were applied in a non-probabilistic sample of 63 older adults who attend institutional support groups. The results indicate cognitive impairment prevalence of 9.5%, with 17% of women reporting depression. There was an association between continuing to work and fear of death, as well as anxiety about death and having chronic-degenerative disease. Results also suggest a correlation between depression and end of life fear and the process and occurrence of the death of a relative, which is the highest indicators of anxiety. The results are discussed in relation to various aspects of gender, the situation of support from the family and social support network, as well as access to health and social security services.

Resumen El envejecimiento implica un cambio muy importante que va acompañado de pérdida de capacidades funcionales y neuropsicológicas, así como de procesos significativos como el manejo de la muerte. Es importante estudiar la manera en la que los adultos mayores enfrentan el significado de la muerte y la ansiedad generada. Mediante un estudio transversal y de alcance correlacional, se aplicó el mini mental de Folstein, la escala de Yesavage, la de miedo a la muerte de Templer y la de ansiedad a la muerte de Collet Lester, así como un cuestionario de redes sociales de apoyo en una muestra no probabilística de 63 adultos mayores que asisten a grupos de apoyo institucionales. Los resultados indican prevalencia de deterioro cognitivo de 9.5 %; 17 % de mujeres reporta depresión. Hay asociación entre continuar laborando y miedo a la muerte, así entre ansiedad a la muerte y tener enfermedad crónica-degenerativa, asimismo, existe correlación entre depresión y miedo al término de la vida, y al proceso y ocurrencia de la muerte de un familiar, que son los indicadores más altos de ansiedad. Los resultados se discuten con relación a diversos aspectos de género, situación del apoyo de red familiar y red social, así como acceso a los servicios de salud y de seguridad social.

Resumo Este trabalho teve como principal objetivo investigar como as relações estabelecidas na escola participam da constituição do self dos sujeitos autistas. Fizemos um estudo de caso múltiplo com três crianças autistas de 7 a 14 anos matriculadas em uma escola da rede pública. No total, tivemos onze participantes, duas professoras, uma coordenadora, uma monitora, cinco crianças autistas (três meninos e duas meninas), além de mais duas meninas não autistas. Durante o período de seis meses, foram feitas entrevistas com os adultos, observações naturalísticas das situações escolares (como sala de aula e recreio) e observação direta durante uma dinâmica com todas as crianças participantes. À luz das teorias de uma perspectiva dialógico-cultural, foi possível analisar nossas descobertas com base em uma estrutura de posições-I, posições do self, para cada sujeito participante. A partir da convergência de cada uma das posições possíveis de todos os sujeitos, chegamos a três eixos de relacionamento: brincar, ajudar e cuidar.

Abstract This study mainly aimed to investigate how the relationships established at school affect the constitution of the self of autistic subjects. We carried out a multiple case study with children aged from seven to 14 years old enrolled in a public school that featured diverse profiles, with a total of 11 participants, such as teachers, coordinator, special education assistant (all of them women), as well as five autistic children (three boys and two girls) and two non-autistic girls. During the 6-month period, we conducted interviews with the adults, natural observations of school situations, and collaborative dynamics with the participating children. In light of theories from a dialogical-cultural perspective, it was possible to analyze our findings based on an I-positions framework, self positions, for each participant subject. From the convergence of each of the possible positions of all the subjects, we arrived at three axes of relationship: Playing, Helping, and Caring.

Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Resumen El propósito del presente trabajo fue identificar las variables sociodemográficas y psicológicas relacionadas con el autocuidado y la calidad de vida en adultos mexicanos con diabetes mellitus tipo 2. Se utilizó un diseño transversal en una muestra de 60 personas (93 % mujeres) entre 36 y 66 años de edad (M = 54.3, DE = 4.71) adscritas al sistema de salud pública en San Luis Potosí, México. Se midieron las variables de autocuidado, autoeficacia, conocimientos en diabetes, ansiedad, depresión y calidad de vida con la aplicación de las escalas EECAC, EAG, DKQ-24, AMAS, BDI-II y SF-36. En el análisis de resultados se utilizó un análisis de regresión lineal para evaluar el impacto de las variables medidas sobre el autocuidado y la calidad de vida. En general, el modelo explicó 33.9 % de la variación del autocuidado a través de las variables depresión (β = -.27) y autoeficacia (β = .74). El 56 % de variación en calidad de vida relacionada con la salud física se explicó a partir de las variables se explicó a través de la ansiedad (β = -.26) y la depresión (β = -.40). Finalmente, la percepción positiva de autoeficacia y el estado de salud libre de ansiedad y depresión resultaron ser factores determinantes para el autocuidado y la calidad de vida relacionada con la salud.

Abstract The purpose of the present study was to identify sociodemographic and psychological variables related to self-care and quality of life in Mexican adults with type 2 Diabetes Mellitus. A cross-sectional design was used in a sample of 60 people (93% women) aged between 36 and 66 years ( M = 54.3, SD = 4.71) attached to the public health system in San Luis Potosí, Mexico. Self-care, self-efficacy, knowledge about diabetes, anxiety, depression and quality of life were measured using the EECAC, EAG, DKQ-24, AMAS, BDI-II and SF-36 scales. For data processing, a linear regression analysis was used to evaluate the impact of the measured variables on self-care and quality of life. In general, the model explained 33.9% of the variance of self-care through the variables depression (β = -.27) and self-efficacy (β = .74). The 56% variance in quality of life related to physical health was explained by the variables depression (ß = -34) and self-care ( β = .34). In their mental health component, 43.4% of variance in quality of life was explained through anxiety (β = -.26) and depression ( β = -.40). Finally, the positive perception of self-efficacy and health status free from anxiety and depression were determinant factors for self-care and health-related quality of life.

Resumo O propósito deste trabalho foi identificar as variáveis sociodemográficas e psicológicas relacionadas com o autocuidado e a qualidade de vida em adultos mexicanos com diabetes mellitus tipo 2. Utilizou-se um desenho transversal numa amostra de 60 pessoas (93 % mulheres) entre 36 e 66 anos (M = 54.3, DP = 4.71), vinculadas ao sistema de saúde pública em San Luis Potosí, México. Foram medidas as variáveis de autocuidado, autoeficácia, conhecimento em diabetes, ansiedade, depressão e qualidade de vida com a aplicação das escalas EECAC, EAG, DKQ-24, AMAS, BDI-II e SF-36. Na análise de resultados, utilizou-se a análise de regressão linear para avaliar o impacto das variáveis medidas sobre o autocuidado e a qualidade de vida. Em geral, o modelo explicou 33.9 % da variação do autocuidado por meio das variáveis depressão (β = -.27) e autoeficácia (β = .74). 56 % de variação em qualidade de vida relacionada com a saúde física foram explicadas a partir das variáveis depressão (β = -.34) e autocuidado (β = .34). Em seu componente de saúde mental, 43.4 % da variação em qualidade de vida foram explicadas por meio da ansiedade (β = -.26) e da depressão (β = -.40). Finalmente, a percepção positiva de autoeficácia e o estado de saúde livre de ansiedade e depressão foram fatores determinantes para o autocuidado e a qualidade de vida relacionada com a saúde.

Introduction During a diagnostic evaluation of canine visceral leishmaniasis (VL), two of seventeen dogs were found to be co-infected by Leishmania (Viannia) braziliensis and Leishmania (Leishmania) chagasi. Methods Specific polymerase chain reaction (PCR) and restriction fragment length polymorphism-PCR (RFLP-PCR) assays were performed. Results PCR assays for Leishmania subgenus identification followed by RFLP-PCR analysis in biopsies from cutaneous lesions and the spleen confirmed the presence of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) chagasi in those fragments. Conclusions This report reinforces the importance of using serological and molecular techniques in the epidemiological surveillance of canine populations in endemic areas in which both diseases are known to co-exist. In such cases, a reassessment of the control measures is required.

Abstract Breast cancer and pregnancy can be studied and suitably treated. It is a real challenge, and its approach must be the responsibility of a multidisciplinary team consisting of experts on the subject. Appropriate treatment will depend on the gestational age, and the morphological and biological characteristics of the disease. Surgery is possible throughout the pregnancy. Chemotherapy may be used from week 14 and during the second and third trimester of the pregnancy. Hormone and biological therapy are contraindicated during pregnancy. Radiotherapy treatment is not recommended during pregnancy, except in carefully selected individual cases. In Mexico, it is possible to treat a pregnant patient with breast using a multidisciplinary team consisting of specialists in gynecology-oncology surgical oncology, medical oncology, radiotherapy oncology, pathology, obstetrics-gynecology, and neonatology.

Resumen El cáncer de mama en el embarazo se puede estudiar y tratar adecuadamente. Representa un verdadero reto y su abordaje debe ser a cargo de un equipo multidisciplinario conocedor del tema. El tratamiento apropiado dependerá de la edad gestacional y de las características morfológicas y biológicas de la enfermedad. La cirugía es posible durante todo el embarazo. Se puede usar quimioterapia a partir de la semana 14 y durante el segundo y el tercer trimestre del embarazo. La terapia hormonal y la terapia biológica están contraindicadas durante el embarazo. La radioterapia no es tratamiento recomendado durante el embarazo, excepto casos cuidadosamente individualizados. En México, es posible evaluar y tratar cáncer de mama y embarazo con un equipo multidisciplinario integrado por ginecólogos-oncólogos y/o cirujanos oncólogos, oncólogo médico, oncólogo radioterapeuta, radiólogos, patólogos, ginecoobstetras y neonatólogos.

Amostras uropatogênicas de Escherichia coli isoladas de indivíduos moradores de localidades distintas na Cidade do Rio de Janeiro, foram caracterizadas quanto o sorotipo, propriedades hemolíticas e hemaglutinantes, susceptibilidade a antimicrobianos e perfil isoenzimático. O método molecular empregado associado com a investigação de marcadores de urovirulência, permitiu detectar uma grande diversidade entre os isolados. Entretanto, foi observada uma relação mais estreita entre amostras de Escherichia coli epidemiologicamente relacionadas.

Uropathogenic Escherichia coli strains isolated from individuals living in different areas of the city of Rio de Janeiro were characterized according to serotype, hemolytic properties, hemagglutination properties, antimicrobial susceptibility and isoenzymatic profile. The molecular approach used, together with investigation of urovirulence markers, enabled detection of great diversity among the isolates. However, closer relationships were observed between epidemiologically related Escherichia coli samples.

Triatoma rubrovaria has become the most frequently captured triatomine species since the control of T. infestans in the state of Rio Grande do Sul (RS), Brazil. The aim of this study was to evaluate aspects of the vectorial competence of T. rubrovaria using nymphs raised in laboratory under environmental conditions of temperature and humidity and fed on mice. The average developmental period of T. rubrovaria was 180.1 days. The percentage of defecation shortly after feeding was still higher than previous studies in which samples of T. rubrovaria subjected to a slight starvation period before the blood meal were used. The obtained results support former indication that T. rubrovaria presents bionomic characteristics propitious to be a good vector of Trypanosoma cruzi to man. Therefore its domiciliary invasion process must be continuously monitored.

No município de Paracambi, Estado do Rio de Janeiro, foi realizado um inquérito epidemiológico sobre a leishmaniose tegumentar americana na população canina residente em áreas endêmicas rural e semiurbana. Foram cadastrados 179 cães e 138 (77,1%) foram examinados, segundo seus aspectos clínicos e desenvolvimento de hipersensibilidade tardia ao antígeno Imunoleish® e respostas sorológicas à reação de imunofluorescência indireta e ao ensaio imunoenzimático. Dos 9 (6,5.%) animais portadores de lesões/cicatrizes suspeitas, 66,7% foram causadas por Leishmania sp; 44,4% produziram infecção em hamsters e apresentaram crescimento em meio de cultura, compatíveis com o comportamento de Leishmania do complexo braziliensis. A caracterização molecular (análises isoenzimáticas e do perfil de restrição do KDNA) identificou 2 amostras como similares à Leishmania (Viannia) braziliensis. A prevalência da infecção canina observada através do teste cutâneo, RIFI e ELISA foi, respectivamente, 10,1%, 16,7% e 27,8%. A presença das formas clínica/subclínica da LTA na população canina associada à infecção humana sugere que o cão pode atuar como possível fonte de infecção, assim como na disseminação da doença.

In the district of Paracambi, State of Rio de Janeiro an epidemiological survey for American tegumentary leishmaniasis in canine population was carried out in endemic localities. A total of 179 dogs was registered and 138 (77.1%) examined for their clinical aspects, development of delayed hypersensitivity (DHS) with Imunoleish® antigen and serological responses by indirect immunofluorescent reaction and enzyme-linked immunosorbent assay. In 9 (6.5%) dogs with active cutaneous lesions or suspect scars, 66.7% were caused by Leishmania sp; 44.4% produced infection in hamsters and showed growth in culture media, which was considered to be compatible with the species of Leishmania braziliensis complex. The molecular characterization (isoenzyme and KDNA restriction profiles) defined two strains with similar profiles for L. (Viannia) braziliensis. The prevalence of canine infection estimated by the cutaneous test, IFR and ELISA was 10.1%, 16.7% and 27.8%, respectively. The presence of clinical / sub-clinical form of ATL in canine population associated with human infections suggested that the dog can act as source of infection as well as for dissemination of the disease.

Data from the Chagas Disease Control Program indicate a growing domiciliary and peridomiciliary invasion of Triatoma rubrovaria in the State of Rio Grande do Sul, where it has become the most frequent triatomine species captured there since the control of T. infestans. Bionomic characteristics that could influence the vectorial capacity of T. rubrovaria as vector of Trypanosoma cruzi were evaluated: patterns of (i) feeding, (ii) defecation, and (iii) resistance to starvation, using insects fed on mice. Fifty three percent of the females showed a defecation pattern conducive to chagasic transmission, defecating either on or near the bite site. The averages of the resistance to starvation varied from 48.1 to 179 days, for the first and fifth nymphal stages, respectively. Our study shows that with respect to the patterns of feeding, defecation and resistance to fasting, T. rubrovaria presented similar rates to the ones observed for other effective vector species, such as T. infestans. Thus, based on our studies we conclude that T. rubrovaria has biological characteristics that can positively influence its capacity to become infected and transmit T. cruzi, and also to keep residual populations after chemical control interventions.

Thermal shocks induce changes in the nuclear phenotypes that correspond to survival (heterochromatin decondensation, nuclear fusion) or death (apoptosis, necrosis) responses in the Malpighian tubules of Panstrongylus megistus. Since thermal tolerance increased survival and molting rate in this species following sequential shocks, we investigated whether changes in nuclear phenotypes accompanied the insect survival response to sequential thermal shocks. Fifth instar nymphs were subjected to a single heat (35 or 40°C, 1 h) or cold (5 or 0°C, 1 h) shock and then subjected to a second shock for 12 h at 40 or 0°C, respectively, after 8, 18, 24 and 72 h at 28°C (control temperature). As with specimen survival, sequential heat and cold shocks induced changes in frequency of the mentioned nuclear phenotypes although their patterns differed. The heat shock tolerance involved decrease in apoptosis simultaneous to increase in cell survival responses. Sequential cold shocks did not involve cell/nuclear fusion and even elicited increase in necrosis with advancing time after shocks. The temperatures of 40 and 0ºC were more effective than the temperatures of 35 and 5ºC in eliciting the heat and cold shock tolerances, respectively, as shown by cytological analysis of the nuclear phenotypes. It is concluded that different sequential thermal shocks can trigger different mechanisms of cellular protection against stress in P. megistus, favoring the insect to adapt to various ecotopes.

Triatoma rubrovaria has become the most frequently captured triatomine species after the control of T. infestans in the State of Rio Grande do Sul (RS), Brazil. Isoenzymatic and chromatic studies indicate the existence of, at least, two distinct phenotypic patterns of T. rubrovaria in RS. The geographic variation noted through molecular tools may also result in distinct profiles of vectorial potentiality. In order to enhance our understanding of the bionomic knowledge of T. rubrovaria separate batches of the species were collected from different municipalities of RS distant from 72 to 332 km: Santana do Livramento (natural ecotope), Santana do Livramento (artificial ecotope), Santiago (natural ecotope), Canguçu (peridomicile) and Encruzilhada do Sul (natural ecotope). A total of 285 specimens were collected, 85 specimens kept sufficient fecal material in their guts for the precipitin analysis. The results indicated the food eclecticism for this species and the anti-rodent serum showed the highest positivity in most localities. From the total of analyzed samples, only 1.3% of unique positivity for human blood was registered, all of them for Santiago population. This reactivity to human blood may be associated to pastures activities in the field.

Triatoma rubrovaria has become the most frequently captured triatomine species since the control of T. infestans in the State of Rio Grande do Sul (RS), Brazil. In order to evaluate the genetic variability of this species, field collections were performed in four municipalities where it has been reported and distant from 75 to 322 km. Specimens were analyzed by color pattern and isoenzymes. Nine enzymatic loci were interpreted from nine enzymatic systems. The Santiago population was isolated from the others with chromatic monomorphism and diagnostic alleles at Idh and Pgm loci. The study shows the existence of, at least, two distinct populations of T. rubrovaria in RS with different phenotypic and genetic pattern.

Although cases of leishmaniasis co-infection have been described in acquired immunodeficiency syndrome patients as well as those who have undergone organ transplants, to our knowledge, the present report is the first documented case of simultaneous cutaneous, visceral and ocular leishmaniasis due to Leishmania (Viannia) braziliensis in a transplant patient. The patient had been using immunosuppressive drugs since receiving a transplanted kidney. The first clinical signs of leishmaniasis included fever, thoracic pain, hepatosplenomegaly, leucopenia and anemia. The cutaneous disease was revealed by the presence of amastigotes in the skin biopsy. After three months, the patient presented fever with conjunctive hyperemia, intense ocular pain and low visual acuity. Parasites isolated from iliac crest, aqueous humor and vitreous body were examined using a range of molecular techniques. The same strain of L. (V.) braziliensis was responsible for the different clinical manifestations. The immunosuppressive drugs probably contributed to the dissemination of Leishmania.