RESUMO Objetivos: identificar os fatores associados à qualidade de vida relacionada à saúde específica de sobreviventes de acidente vascular encefálico. Métodos: estudo transversal, realizado com 160 sobreviventes de acidente vascular encefálico. Os dados foram coletados por meio do Índice de Barthel, Escala de Qualidade de Vida Específica para Acidente Vascular Encefálico e instrumento semiestruturado para os dados sociodemográficos e clínicos, analisados por estatística descritiva e inferencial. Resultados: a qualidade de vida relacionada à saúde associou-se à atividade laboral (p=0,027), atividade física (p=0,007), capacidade funcional (p=0,001), presença de cuidador (<0,001), alteração motora (p = 0,001) e reabilitação (p=0,003). As pessoas funcionalmente dependentes demonstraram 14,61 vezes mais chance de apresentar baixa qualidade de vida relacionada à saúde; e aquelas com alteração motora demonstraram 3,07 vezes mais chance. Conclusões: evidenciou-se que a dependência funcional e a alteração motora elevam a chance de uma baixa qualidade de vida relacionada à saúde em sobreviventes de acidente vascular encefálico.

ABSTRACT Objectives: to identify factors associated with specific health-related quality of life in cerebrovascular accident, or stroke, survivors. Methods: cross-sectional study, carried out with 160 cerebrovascular accident survivors. Data were collected using the Barthel Index, Cerebrovascular Accident Specific Quality of Life Scale, and semi-structured instruments for sociodemographic and clinical data, analyzed by descriptive and inferential statistics. Results: health-related quality of life was associated with work activity (p=0.027), physical activity (p=0.007), functional capacity (p=0.001), presence of caregiver (<0.001), motor alteration (p = 0.001) and rehabilitation (p=0.003). The functionally dependent people were 14.61 times more likely to present low health-related quality of life, and those with motor impairment were 3.07 times more likely. Conclusions: it was evidenced that functional dependence and motor impairment increase the chance of low health-related quality of life in cerebrovascular accident survivors.

RESUMEN Objetivos: identificar factores relacionados a calidad de vida relacionada a salud específica de supervivientes de accidente cerebrovascular. Métodos: estudio transversal, realizado con 160 supervivientes de accidente cerebrovascular. Los datos fueron recolectados mediante el Índice de Barthel, Escala de Calidad de Vida Específica para Accidente Cerebrovascular e instrumento semiestructurado para los datos sociodemográficos y clínicos, analizados por estadística descriptiva e inferencial. Resultados: la calidad de vida relacionada a salud se relacionó a la actividad laboral (p=0,027), actividad física (p=0,007), capacidad funcional (p=0,001), presencia de cuidador (<0,001), alteración motora (p = 0,001) y rehabilitación (p=0,003). Las personas funcionalmente dependientes demostraron 14,61 veces más chance de presentar baja calidad de vida relacionada a salud; y aquellas con alteración motora demostraron 3,07 veces más chance. Conclusiones: se evidenció que la dependencia funcional y la alteración motora elevan la chance de una baja calidad de vida relacionada a la salud en supervivientes de accidente cerebrovascular.

Abstract Objectives: To determine the incidence and risk of adverse obstetric and neonatal outcomes according to SARS-CoV-2 infection severity in pregnant women. Method: Open prospective study of pregnant women tested for SARS-CoV-2 by serological and molecular assays during pregnancy or delivery in two hospitals in Sao Paulo, Brazil from April 12, 2020, to February 28, 2021. Five groups were considered for analysis: C0, negative COVID-19 results and no COVID-19 symptoms; C1, positive COVID-19 results, and no symptoms; C2, positive COVID-19 results with mild symptoms; C3, positive COVID-19 results with moderate symptoms; and C4, positive COVID-19 results with severe symptoms. The association between obstetric and neonatal outcomes and COVID-19 severity was determined using multivariate analysis. Results: 734 eligible pregnant women were enrolled as follows: C0 (n = 357), C1 (n = 127), C2 (n = 174), C3 (n = 37), and C4 (n = 39). The following pregnancy and neonatal outcomes were associated with severe COVID-19: oligohydramnios (adjusted Odds Ratio [aOR] = 6.18; 95% CI 1.87‒20.39), fetal distress (aOR = 4.01; 95% Confidence Interval [CI] 1.84‒8.75), preterm birth (aOR = 5.51; 95% CI 1.47‒20.61), longer hospital stay (aOR = 1.66; 95% CI 1.36‒2.02), and admission to the neonatal intensive care unit (aOR = 19.36; 95% CI, 5.86‒63.99). All maternal (n = 6, 15.4%, p < 0.001) and neonatal (n = 5, 12.5%, p < 0.001) deaths and most fetal deaths (n = 4, 9.8%, p < 0.001) occurred in C4 group. Moderate COVID-19 was associated with oligohydramnios (aOR = 6.23; 95% CI 1.93‒20.13) and preterm birth (aOR = 3.60; 95% CI 1.45‒9.27). Mild COVID-19 was associated with oligohydramnios (aOR=3.77; 95% CI 1.56‒9.07). Conclusion: Adverse pregnancy and neonatal outcomes were associated with maternal symptomatic COVID-19 status, and risk increased with disease severity. HIGHLIGHTS COVID-19 increases the rates of adverse pregnancy and neonatal outcomes. Serious cases are associated with oligohydramnios, fetal distress, prematurity, neonatal ICU admission, maternal and neonatal deaths. The maternal clinical status dictates obstetric and neonatal outcomes.

Resumo Objetivo Correlacionar a capacidade funcional e o estresse percebido com a qualidade de vida relacionada à saúde de sobreviventes de acidente vascular encefálico. Métodos Estudo analítico transversal, realizado com 160 sobreviventes de acidente vascular encefálico cadastrados em Unidades de Saúde da Família. Os dados foram coletados mediante a utilização de um instrumento semiestruturado para obtenção dos dados sociodemográficos e de saúde, o Índice de Barthel, a Escala de Estresse Percebido e a Escala de Qualidade de Vida Específica para acidente vascular encefálico. As correlações entre os escores dos instrumentos foram verificadas pelo Teste de Correlação de Spearman. Resultados Os participantes apresentaram dependência funcional e estresse percebido moderados. Evidenciou-se baixa qualidade de vida relacionada à saúde, com maior comprometimento nos domínios papéis sociais e papéis familiares. Verificou-se correlação estatística significativa entre a qualidade de vida relacionada à saúde com a capacidade funcional (r=705; p<0,001) e o estresse percebido (r=-436; p<0,001). Conclusão A capacidade funcional e o estresse percebido relacionaram-se de forma significativa à qualidade de vida relacionada à saúde de pessoas acometidas por acidente vascular encefálico, demonstrando que a qualidade de vida relacionada à saúde se eleva à medida que a funcionalidade aumenta e o estresse diminui.

Abstract Objective To correlate functional capacity and perceived stress with the health-related quality of life of stroke survivors. Methods This is a cross-sectional analytical study, conducted with 160 stroke survivors registered in Family Health Units. Data were collected using a semi-structured instrument to obtain sociodemographic and health data, the Barthel Index, the Perceived Stress Scale and the Stroke Specific Quality of Life Scale. Correlations between instrument scores were verified by Spearman’s correlation test. Results Participants showed moderate functional dependence and perceived stress. Low health-related quality of life was evidenced, with greater impairment in the social roles and family roles domains. There was a statistically significant correlation between health-related quality of life and functional capacity (r=705; p<0.001) and perceived stress (r=-436; p<0.001). Conclusion Functional capacity and perceived stress were significantly related to the health-related quality of life of people affected by stroke, demonstrating that health-related quality of life increases as functionality increases and stress decreases.

Resumen Objetivo Correlacionar la capacidad funcional y el estrés verificado con la calidad de vida relacionada a la salud de sobrevivientes de accidente vascular encefálico. Métodos Estudio analítico transversal, realizado con 160 sobrevivientes de accidente vascular encefálico registrados en Unidades de Salud de la Familia. Los datos fueron recopilados por medio de la utilización de un instrumento semiestructurado para la obtención de los datos sociodemográficos y de salud, el Índice de Barthel, la Escala de Estrés Percibido y la Escala de Calidad de Vida Específica para accidente vascular encefálico. Las correlaciones entre las puntuaciones de los instrumentos fueron verificadas por medio de la Prueba de Correlación de Spearman. Resultados Los participantes presentaron una dependencia funcional y estrés percibidos moderados. Se evidenció una baja calidad de vida relacionada con la salud, con un mayor comprometimiento en los dominios roles sociales y roles familiares. Se observó una correlación estadística significativa entre la calidad de vida relacionada con la salud, con la capacidad funcional (r=705; p<0,001) y el estrés percibido (r=-436; p<0,001). Conclusión La capacidad funcional y el estrés percibido se relacionaron de forma significativa con la calidad de vida relacionada con la salud de personas acometidas por accidente vascular encefálico, demostrando que la calidad de vida relacionada con la salud se eleva a medida que la funcionalidad aumenta y el estrés disminuye.

Resumo Objetivos: Descrever os aspectos da epidemia de microcefalia no Estado do Piauí. Métodos: Foram incluídos todos os casos de microcefalia congênita confirmados no estado entre 2015-2016 (n = 100). Os formulários de investigação do Centro Regional de Referência em Microcefalia foram analisados. Os casos descartados (n = 63) foram usados como grupo de comparação. Resultados: Em outubro, novembro e dezembro de 2015, as taxas de incidência atingiram 4,46, 6,33 e 3,86/1.000 nascidos vivos, respectivamente; 44 casos foram relatados na capital do estado. Entre as mães de casos confirmados e descartados, a frequência de erupção cutânea durante a gravidez foi 50/97 (51,5%) e 8/51 (15,7%), respectivamente (p < 0,001); 33 casos confirmados (35,9%) apresentaram um escore z de perímetro cefálico entre -2 e -3, 23 (25%) entre -3 e -4 e 8 (8,7%) apresentaram escore z inferior a -4. As tomografias computadorizadas cerebrais revelaram calcificações em 78/95 (82,1%) dos casos. Lisencefalia, hidrocefalia e agenesia do corpo caloso também foram observadas com mais frequência. Os achados oftalmológicos incluíram rarefação e atrofia do epitélio pigmentar da retina. Foram observadas ausência de emissões otoacústicas em 21/70 casos. Um recém-nascido também apresentou atrofia muscular dos membros inferiores. Não houve diferenças significativas nas taxas de vacinação para gripe, vacina difteria tétano e coqueluche acelular e hepatite B em qualquer grupo. Conclusões: O Estado do Piauí, como outros na região Nordeste, enfrentou, entre 2015 e 2016, uma epidemia de microcefalia congênita, supostamente relacionada à infecção congênita pelo vírus Zika, mais intensa na capital. Os desafios atuais incluem melhora do controle de vetores, pesquisa básica, ampliação de ferramentas de diagnóstico para exame pré-natal do vírus Zika, vacinas e cuidados de saúde para crianças afetadas.

Abstract Objectives: To describe aspects of the microcephaly epidemic in the state of Piauí. Methods: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group. Results: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between −2 and −3, 23 (25%) between −3 and −4, and 8 (8.7%) had a z-score of less than −4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. Conclusions: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Abstract In the present study a banana, strawberry and juçara smoothie was developed using an experimental mixture design. The juçara proportion was kept constant while the banana:strawberry ratio varied and the main responses were the sensory acceptability and the antioxidant capacity. From five formulations, only the one with the highest percentage of strawberry was rejected, most likely due to its lower sugar content and higher acidity. In general, panelists chose the sweeter formulations, which were those with a higher percentage of banana. Relating to the consistency, the best formulation was the one containing the same proportion of strawberry and banana pulp, which provided a better flow to the product. Additionally, this sample showed intermediate values of phenolic compounds and antioxidant capacity, as well as desirable physicochemical characteristics. In spite of being possible to obtain four formulations with good sensory acceptance, the one with equal amounts of banana and strawberry pulp is highlighted due to its antioxidant capacity and sensory characteristics, statistically corroborated by the desirability function.

CONTEXTO E OBJETIVO: Mycobaterium avium subsp. paratuberculosis (MAP) tem atraído o interesse de pesquisadores devido às semelhanças entre a paratuberculose e a doença de Crohn (CD). Este estudo objetivou avaliar a frequência de MAP por meio de cultura, histologia e reação da polimerase em cadeia (PCR), em biópsias intestinais de pacientes brasileiros com CD. PCR quantitativa em tempo real (qRT-PCR) foi realizada nas amostras positivas. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico com grupo controle realizado em duas universidades federais. MÉTODOS: Amostras frescas foram coletadas de 25 pacientes; cinco com CD, oito com colite ulcerativa (UC) e 12 controles sem doença inflamatória intestinal (nIBD). Também foram coletadas 149 amostras fixadas em parafina (FFPE): 44 CD, 49 UC e 56 nIBD. RESULTADOS: Nenhuma das amostras frescas foi positiva para MAP. Cinco amostras FFPE (uma CD, duas UC e duas nIBD) e três amostras frescas (uma de cada grupo) foram positivas por IS900-PCR. qRT-PCR foi realizada nessas oito amostras. Nas amostras FFPE, havia 192,12 cópias/μl no grupo CD, 72,28 cópias/μl no UC e 81,43 cópias/μl no nIBD. Nas amostras frescas, havia 432,99 cópias/μl, 167,92 cópias/μl e 249,73 cópias/μl nos grupos CD, UC e nIBD, respectivamente. A maior carga bacteriana foi encontrada no grupo CD. CONCLUSÃO: Este estudo não fornece evidências do papel de MAP na etiologia da CD, embora DNA de MAP tenha sido detectado em pacientes dos três grupos. Este é o primeiro relato da presença de MAP em biópsias intestinais humanas no Brasil.

CONTEXT AND OBJECTIVE: Mycobacterium avium subsp. paratuberculosis (MAP) has attracted the interest of researchers because of similarities between paratuberculosis and Crohn's disease (CD). The aim of this study was to evaluate the frequency of MAP through cultures, histology and polymerase chain reaction (PCR) on intestinal biopsies from Brazilian CD patients. Quantitative real time PCR (qRT-PCR) was performed on positive samples. DESIGN AND SETTING: Analytical cross-sectional study with control group at two federal universities. METHODS: Fresh samples were collected from 25 patients; five with CD, eight with ulcerative colitis (UC) and 12 controls with non-inflammatory bowel disease (nIBD). Formalin-fixed paraffin-embedded (FFPE) samples from 143 patients were also collected: 44 CD, 49 UC and 56 nIBD. RESULTS: None of the fresh samples was positive for MAP. Five FFPE samples (one CD, two UC and two nIBD) and three fresh samples (one in each group) were positive through IS900-PCR. qRT-PCR was performed on these eight samples. Among the FFPE samples, there were 192.12 copies/μl in the CD group, 72.28 copies/μl in UC and 81.43 copies/μl in nIBD. Among the fresh samples, there were 432.99 copies/μl, 167.92 copies/μl and 249.73 copies/μl in the CD, UC and nIBD groups, respectively. The highest bacterial load was in the CD group. CONCLUSION: This study does not provide evidence for a role of MAP in the etiology of CD, although MAP DNA was detected in all three patient groups. This is the first report of MAP presence in human intestinal biopsies in Brazil.