Abstract This study aimed to estimate the cost of implementing a center for assisted human reproduction in a public reference hospital in Rio de Janeiro. The cost analysis was carried out from the perspective of the SUS provider of assistance. The eligible population was men and women diagnosed with the most frequent causes of infertility. The cost items included in primary care and medium complexity were consultations and examinations and in high complexity were equipment, human resources and supplies. Costs were identified and quantified through consultation with assisted reproduction clinics, specialists and literature. They have been valued through public databases. Data analysis was performed using an analytical decision model that included costs of assisted reproduction and effectiveness procedures. The cost per procedure in high complexity was R$ 18,829 for in vitro fertilization with intracytoplasmic sperm injection and R$ 5,649 for artificial insemination. The initial investment required to operate the high complexity center for 480 cycles was R$ 15,903,361 in the first year, which included structuring the physical environment. Estimating the investment required for the incorporation and maintenance of services in SUS is essential for the management of available financial resources.

Resumo O objetivo do estudo foi estimar o custo da implantação de um centro de reprodução humana em um hospital público de referência nacional localizado no Rio de Janeiro. A população elegível foi a de homens e mulheres que possuem diagnóstico das causas mais frequentes de infertilidade. Os itens de custos incluídos foram consultas, exames, equipamentos, recursos humanos e insumos. Os custos foram identificados e quantificados a partir de consulta a clínicas de reprodução assistida, especialistas e literatura. Foram valorados através de bases públicas. A análise dos dados foi realizada através de um modelo de decisão analítico. A perspectiva do estudo foi do SUS provedor. O custo por procedimento na alta complexidade foi de R$ 18.829 para a fertilização in vitro com injeção intracitoplasmática de espermatozoide e de R$ 5.649 para a inseminação artificial. O investimento inicial necessário para funcionamento do centro de alta complexidade para a realização de 480 ciclos foi de R$ 15.903.361 no primeiro ano, o qual incluiu a estruturação do ambiente físico. A estimativa do investimento necessário para a incorporação e manutenção dos serviços no SUS é indispensável para a gestão financeira.

Abstract This study aimed to estimate the cost of implementing a center for assisted human reproduction in a public reference hospital in Rio de Janeiro. The cost analysis was carried out from the perspective of the SUS provider of assistance. The eligible population was men and women diagnosed with the most frequent causes of infertility. The cost items included in primary care and medium complexity were consultations and examinations and in high complexity were equipment, human resources and supplies. Costs were identified and quantified through consultation with assisted reproduction clinics, specialists and literature. They have been valued through public databases. Data analysis was performed using an analytical decision model that included costs of assisted reproduction and effectiveness procedures. The cost per procedure in high complexity was R$ 18,829 for in vitro fertilization with intracytoplasmic sperm injection and R$ 5,649 for artificial insemination. The initial investment required to operate the high complexity center for 480 cycles was R$ 15,903,361 in the first year, which included structuring the physical environment. Estimating the investment required for the incorporation and maintenance of services in SUS is essential for the management of available financial resources.

Resumo O objetivo do estudo foi estimar o custo da implantação de um centro de reprodução humana em um hospital público de referência nacional localizado no Rio de Janeiro. A população elegível foi a de homens e mulheres que possuem diagnóstico das causas mais frequentes de infertilidade. Os itens de custos incluídos foram consultas, exames, equipamentos, recursos humanos e insumos. Os custos foram identificados e quantificados a partir de consulta a clínicas de reprodução assistida, especialistas e literatura. Foram valorados através de bases públicas. A análise dos dados foi realizada através de um modelo de decisão analítico. A perspectiva do estudo foi do SUS provedor. O custo por procedimento na alta complexidade foi de R$ 18.829 para a fertilização in vitro com injeção intracitoplasmática de espermatozoide e de R$ 5.649 para a inseminação artificial. O investimento inicial necessário para funcionamento do centro de alta complexidade para a realização de 480 ciclos foi de R$ 15.903.361 no primeiro ano, o qual incluiu a estruturação do ambiente físico. A estimativa do investimento necessário para a incorporação e manutenção dos serviços no SUS é indispensável para a gestão financeira.

ABSTRACT The objective of this study was to determine the effects that breeder age has on digestive and immune system development; the transfer of immunoglobulins to egg yolk, yolk sac, and neonate chicks; and the immune response of chicks up to 35 days old. Three ages (32, 42, and 52 weeks) of Hubbard breeders were studied with ages as treatments. A total of 425 eggs were weighed for each of the three treatments and incubated. After hatching, a total of 300 1-day-old chicks were used in each treatment. We studied the development of the gastrointestinal tract and immune system of progeny and IgY transfer from breeder to progeny. Chicks from 52-week-old breeders had greater gastrointestinal tract growth up to seven days of life and greater body weight at 14 days. Older breeders (52 weeks) had higher amounts of IgY in serum and egg yolk. Chicks from the youngest breeders (32-weeks-old) had a better immune response at two weeks post-vaccination. It can be concluded that the older breeders have a greater capacity to immunize progeny up to 14 days. Strategies can be developed to increase IgY in the serum of young breeders and, consequently, increase the innate immunity of the newly-hatched chicks.

Resumo Introdução as tecnologias educacionais proporcionam conhecimento de forma mais interativa e promoção da saúde à comunidade, contribuindo para a construção do saber dos seus usuários. Contudo, ainda são pouco utilizadas para as pessoas com diabetes mellitus. Objetivo elaborar e validar o conteúdo e aparência de um álbum seriado sobre prevenção do pé diabético para utilização por profissionais da Atenção Primária à Saúde. Materiais e Métodos estudo metodológico. Os dados foram coletados de agosto a setembro de 2018 e ocorreu por meio do envio de instrumentos de avaliação de validação, via e-mail, para especialistas selecionados na Plataforma Lattes. Para análise dos dados, foi utilizado o Índice de Validade de Conteúdo (IVC) com valor mínimo estabelecido de 0,78. Resultados participaram sete especialistas com experiência em educação em saúde, tecnologias educacionais e/ou diabetes mellitus. Em relação aos objetivos, estrutura, apresentação e relevância, todos os itens apresentaram IVC global de 0,96. Conclusão o álbum seriado foi considerado válido pelos especialistas e uma tecnologia capaz de auxiliar o profissional de saúde no rastreio do pé em risco da pessoa com diabetes mellitus.

RESUMEN Introducción A través de las tecnologías educativas, se proporcionan conocimientos de una manera más interactiva para promover la salud en la comunidad, lo que contribuye a la construcción de conocimiento entre sus usuarios. Sin embargo, estas tecnologías no se han orientado a las personas con diabetes mellitus. Objetivo Desarrollar y validar el contenido y el diseño de una guía didáctica sobre la prevención del pie diabético para su uso por parte de los profesionales de la Atención Primaria de Salud. Materiales y métodos Se llevó a cabo un estudio metodológico a través de la recolección de datos entre agosto y septiembre de 2018 mediante el envío de instrumentos de evaluación y validación por correo electrónico a especialistas seleccionados en la plataforma Lattes. Para el análisis de los datos se utilizó el Índice de Validez del Contenido (IVC) con un valor mínimo establecido de 0.78. Resultados Se contó con la participación de siete especialistas con experiencia en educación sanitaria, tecnologías educativas y/o diabetes mellitus. En cuanto a los objetivos, la estructura, la presentación y la pertinencia, todos los temas presentaron un IVC global de 0.96. Conclusiones Los expertos consideraron que la guía didáctica era válida, además de ser una herramienta que ayudaría al profesional de la salud durante el examen de pie en personas con diabetes mellitus.

ABSTRACT Introduction Educational technology provides knowledge in a more interactive way to promote health in the community, which contributes to the construction of knowledge among users. However, these technologies have not been targeted to people with diabetes mellitus. Objective To develop and validate the content and design of an educational guide on the prevention of diabetic foot complications to be used by Primary Healthcare professionals. Materials and Methods A methodological study was conducted through data collection between August and September 2018 by sending assessment and validation instruments by email to selected specialists in the Lattes platform. The Content Validity Index (CVI) with a minimum value of 0.78 was used for data analysis. Results Seven specialists with experience in health education, educational technology and/or diabetes mellitus were involved. In terms of objectives, structure, presentation and relevance, all topics had an overall CVI of 0.96. Conclusions The experts validated the educational guide as a tool that would help health professionals during foot exams in people with diabetes mellitus.

ABSTRACT The diversity of endophytic fungi in healthy coconut palm leaves (Cocos nucifera) was assessed by analyzing fungal isolates from three coconut cultivars (yellow dwarf, green dwarf, and a hybrid cultivar PB121) used agriculturally in Brazil. The influence of season (rainy or dry) on the endophytic fungal community was also analyzed. Overall, 318 fungal isolates were obtained from 972 coconut leaf fragments. The rDNA ITS region was sequenced from representative species of the isolated endophytic fungi and the most common species identified were Nigrospora oryzae, Pestalotiopsis sp., and Zasmidium musae. The alpha diversity of the endophytic fungi was also calculated. Nonmetric multidimensional scaling (NMDS) ordination and permutational analysis of variance (PERMANOVA) revealed significant seasonal effects on the composition of the endophyte community. However, practically no influence was observed on the fungal communities for the different cultivars of coconut.

RESUMO A videira ‘BRS Magna’ tem como vantagens a adaptação a diferentes regiões brasileiras e a elaboração de suco de qualidade. Entretanto, requer a definição de componentes do sistema de cultivo, como porta-enxerto, para cada região. O objetivo deste estudo foi caracterizar a composição química e o potencial antioxidante de sucos de uvas colhidas de videiras ‘BRS Magna’ cultivadas sobre diferentes porta-enxertos, nas condições tropicais do Submédio do Vale do São Francisco. As uvas foram colhidas no Campo Experimental de Bebedouro/Embrapa Semiárido, em Petrolina-PE, Brasil. Os tratamentos corresponderam aos porta-enxertos ‘IAC 766’, ‘IAC 572’, ‘IAC 313’, ‘Freedom’, ‘Paulsen 1103’, ‘Harmony’ e ‘SO4’. Foram elaborados os sucos de uvas de duas safras, para avaliação após o armazenamento. Para cada safra, adotou-se o delineamento experimental em blocos ao acaso, com quatro repetições. A qualidade dos sucos variou com os tratamentos, em cada duração do armazenamento. Aos nove meses, os sucos da primeira safra apresentaram perda de pigmentos e de compostos fenólicos, sendo que aquele elaborado com uvas de plantas enxertadas sobre ‘Harmony’ distinguiu-se pelos teores de sólidos solúveis (SS), intensidade de cor (IC), antocianinas, índice de polifenois totais (IPT) e capacidade antioxidante. Os sucos da segunda safra, aos quatro meses, caracterizaram-se por maiores teores de alguns compostos, destacando-se o tratamento ‘SO4’ pelos SS, IC, polifenóis extraíveis totais, IPT e capacidade antioxidante. Os porta-enxertos menos vigorosos conferiram melhor qualidade ao suco, desde que se considere o potencial de armazenamento e o processo de elaboração.

ABSTRACT The ‘BRS Magna’ grapevine has the advantage of adapting to different regions of Brazil and producing juice of good quality. However, it is necessary to define the components of the cropping system, such as the rootstock, for each region. The aim of this study was to characterise the chemical composition and antioxidant capacity of grape juice collected from ‘BRS Magna’ grapevines grown on different rootstock under the tropical conditions of the Sub-middle São Francisco Valley. The grapes were harvested in the Experimental Area of Bebedouro/Embrapa Semiárido, in Petrolina, Pernambuco, Brazil. The treatments corresponded to the ‘IAC 766’, ‘IAC 572’, ‘IAC 313’, ‘Freedom’, ‘Paulsen 1103’, ‘Harmony’ and ‘SO4’ rootstock. The grape juice was prepared from two harvests for evaluation after storage. For each harvest, a randomised block design was used, with four replications. The quality of the juice varied with the treatment in each storage period. At nine months, the juice from the first harvest showed a loss of pigment and phenolic compounds, while the juice made with grapes from plants grafted onto ‘Harmony’ stood out for soluble solids content (SS), colour intensity (CI), anthocyanins, total polyphenol index (TPI) and antioxidant capacity. Juice from the second harvest was characterised at four months by higher levels of various compounds, especially the ‘SO4’ treatment for SS, CI, total extractable polyphenols, TPI and antioxidant capacity. Considering storage potential and the preparation process, the less-vigorous rootstock resulted in better quality juice.

RESUMO A fibrose pulmonar idiopática (FPI) é uma forma de pneumopatia intersticial crônica fibrosante de causa desconhecida, que acomete preferencialmente homens idosos, com história atual ou pregressa de tabagismo. Mesmo sendo uma doença incomum, ela assume grande importância devido a sua gravidade e prognóstico reservado. Nas últimas décadas, diversas modalidades terapêuticas farmacológicas foram investigadas para o tratamento dessa doença, de tal modo que conceitos clássicos vêm sendo revisados. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento da FPI. Procurou-se fornecer orientações a questões de ordem prática, enfrentadas pelos clínicos no seu cotidiano. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de corticosteroides, N-acetilcisteína, tratamento medicamentoso do refluxo gastroesofágico, inibidores dos receptores da endotelina, inibidores da fosfodiesterase-5, pirfenidona e nintedanibe. Para a formulação das perguntas PICO, um grupo de especialistas brasileiros atuantes na área foi reunido, sendo realizada uma extensa revisão bibliográfica sobre o tema. As revisões sistemáticas com meta-análises previamente publicadas foram analisadas quanto à força das evidências compiladas e, a partir daí, foram concebidas recomendações seguindo a metodologia Grading of Recommendations Assessment, Development and Evaluation. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FPI, objetivando principalmente favorecer seu manejo, e pode se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FPI.

ABSTRACT Idiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

Abstract The correct identification of pigmented nodular lesions of the scalp is often challenging. Despite the importance of clinical patterns and dermoscopy, important adjuvant tools that are usually helpful, their interpretation sometimes is not clear-cut. Here, the authors discuss a case of sebaceoma mimicking a malignant pigmented neoplasia, with conclusive histopathology.

Resumo Foi avaliado um composto comercial de ácidos orgânicos, adicionado à ração, no controle da Salmonella de frangos de corte desafiados com Salmonella Enteritidis e Salmonella Enteritidis associadas à Eimeria tenella. Foram utilizados 504 pintos de um dia, fêmeas, da linhagem Hubbard®, sendo o delineamento inteiramente casualizado em esquema fatorial 2x3, totalizando seis tratamentos com seis repetições e 14 aves a unidade experimental. Foi analisado o pH intestinal, o escore de lesão dos cecos, contagem de oocistos fecais e a presença de salmonela no baço e tonsilas cecais das aves. Aves desafiadas com S. Enteritidis que receberam ácidos apresentaram menor frequência de isolamento da bactéria nos órgãos linfoides analisados. Assim como apresentaram redução no número de oocistos de E. tenella nas excretas coletadas diretamente na bandeja e redução dos escores de lesão intestinal provocadas pela infecção por Eimeria tenella. Os ácidos orgânicos promoveram benefício à saúde intestinal dos frangos de corte com reflexos positivos no controle da Salmonella Enteritidis juntamente com a Eimeria tenella.

Abstract A commercial organic acids compound was assessed, added to feed, to control Salmonella Enteritidis. Broilers were challenged with Salmonella Enteritidis and Salmonella Enteritidis associated with Eimeria tenella. Five hundred and four day-old Hubbard® females chicks were used in a completely randomized design in a 2x3 factorial, a total of six treatments with six replications and being 14 birds the experimental unit. Intestinal pH, cecum lesion score, oocyst faecal counts and the presence of Salmonella in the cecal tonsils and spleen of broilers were investigated. Broilers that were challenged only with S. Enteritidis that received the compound in test showed lower frequency of bacteria isolation in lymphoid organs. Besides, decreased number of oocysts of E. tenella was observed and the intestinal lesion scores caused by infection was lower. Organic acids promoted a benefit on broilers intestinal health with positive effects on the control of Salmonella Enteritidis with Eimeria tenella.

Abstract: Background: Dermatological diseases are among the primary causes of the demand for basic health care. Studies on the frequency of dermatoses are important for the proper management of health planning. Objectives: To evaluate the nosological and behavioral profiles of dermatological consultations in Brazil. Methods: The Brazilian Society of Dermatology invited all of its members to complete an online form on patients who sought consultations from March 21-26, 2018. The form contained questions about patient demographics, consultation type according to the patient's funding, the municipality of the consultation, diagnosis, treatments and procedures. Diagnostic and therapeutic decisions were compared between subgroups. Results: Data from 9629 visits were recorded. The most frequent causes for consultation were acne (8.0%), photoaging (7.7%), nonmelanoma skin cancer (5.4%), and actinic keratosis (4.7%). The identified diseases had distinct patterns with regard to gender, skin color, geographic region, type of funding for the consultation, and age group. Concerning the medical conducts, photoprotection was indicated in 44% of consultations, surgical diagnostic procedures were performed in 7.3%, surgical therapeutic procedures were conducted in 19.2%, and cosmetic procedures were performed in 7.1%. Study limitations: Nonrandomized survey, with a sample period of one week. Conclusion: This research allowed us to identify the epidemiological profiles of the demands of outpatients for dermatologists in various contexts. The results also highlight the importance of aesthetic demands in privately funded consultations and the significance of diseases such as acne, nonmelanoma skin cancer, leprosy, and psoriasis to public health.

Abstract: The medical-dermatological demographics favors health planning and guides expansion of the specialty. We conducted an ecological study of dermatologists members of the Brazilian Society of Dermatology (SBD). We evaluated: gender, age, address; which were compared with population and human development index indicators of municipalities. We evaluated 8384 members, distributed in 527 (9.5%) municipalities throughout Brazil. The female sex represented 78.4% of the members and the median age was 43 (36-54) years. The median density of dermatologists was 0.35 (0.21-0.37) per 10,000 inhabitants. The correlation (Spearman's rho) between density of dermatologists and human development index was 0.39 (p <0.01). The Brazilian dermatologist is characterized as: female, age <50 years and presenting an heterogeneous distribution throught the country.

Resumo: O presente trabalho tem como objetivo descrever a prevalência e fatores associados a eventos adversos a medicamentos (EAM) referidos por usuários de medicamentos no Brasil. Trata-se de um estudo transversal de base populacional, realizado no período de setembro de 2013 a fevereiro de 2014, com dados coletados na Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM). Foram consideradas todas as pessoas que referiram o uso de medicamentos; entre elas, foram identificadas as que referiram pelo menos um problema com o uso do medicamento. Realizou-se uma análise descritiva para estimar a prevalência e os intervalos de 95% de confiança (IC95%) de EAM entre as variáveis estudadas, e foram calculadas as razões de prevalência bruta e ajustada, pela regressão de Poisson, na investigação dos fatores associados aos EAM. A prevalência de EAM no Brasil foi de 6,6% (IC95%: 5,89-7,41), sendo maior e estatisticamente significante após a realização da análise multivariada, entre pessoas do sexo feminino; residentes nas regiões Centro-oeste e Nordeste; que consumiam maior número de medicamentos; que percebiam seu estado de saúde como “ruim”; e que se automedicavam. Os EAM foram mais relatados para os medicamentos fluoxetina, diclofenaco e amitriptilina. Os EAM mais referidos pelos entrevistados foram sonolência, dor epigástrica e náuseas. Os EAM mais referidos pelos entrevistados foram de natureza leve, considerados evitáveis e estiveram associados a medicamentos de uso frequente pela população. Em razão desse estudo, foi possível conhecer a dimensão do problema ocasionado pelo uso de medicamentos no Brasil.

Abstract: The aim of this study was to describe the prevalence of adverse drug events (ADEs) and associated factors reported by users of medicines in Brazil. This was a cross-sectional population-based study conducted from September 2013 to February 2014 with data from the Brazilian National Survey on Access, Use, and Promotion of Rational Use of Medicines (PNAUM). The study included all individuals that reported the use of medicines and identified, among them, all those reporting at least one problem with the medicine’s use. A descriptive analysis was performed to estimate ADE prevalence and 95% confidence intervals (95%CI) among the target variables. Crude and adjusted prevalence ratios were calculated using Poisson regression to investigate factors associated with ADEs. Overall ADE prevalence in Brazil was 6.6% (95%CI: 5.89-7.41), and after multivariate analysis, higher prevalence was associated with female gender, residence in the Central and Northeast regions, consumption of more medicines, “bad” self-rated health, and self-medication. The drugs most frequently reported with ADEs were fluoxetine, diclofenac, and amitriptyline. The most frequent ADEs were somnolence, epigastric pain, and nausea. Most reported ADEs were mild, avoidable, and associated with medicines used frequently by the population. The study provided knowledge on the size of the problem with use of medicines in Brazil.

Resumen: El presente trabajo tiene como objetivo describir la prevalencia y factores asociados a eventos adversos con medicamentos (EAM), informados por usuarios de medicamentos en Brasil. Se trata de un estudio transversal de base poblacional, realizado durante el período de septiembre de 2013 a febrero de 2014, con datos recogidos en la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM). Se consideraron a todas las personas que informaron del uso de medicamentos; entre ellas, se identificaron a las que informaron de por lo menos un problema con el uso del medicamento. Se realizó un análisis descriptivo para estimar la prevalencia y los intervalos de confianza a 95% (IC95%) de EAM entre las variables estudiadas, y se calcularon las razones de prevalencia bruta y ajustada, por la regresión de Poisson, en la investigación de los factores asociados a los EAM. La prevalencia de EAM en Brasil fue de un 6,6% (IC95%: 5,89-7,41), siendo mayor y estadísticamente significante tras la realización del análisis multivariado, entre personas del sexo femenino; residentes en las regiones Centro-Oeste y Nordeste; que consumían un mayor número de medicamentos; que percibían su estado de salud como “malo”; y que se automedicaban. Se informaron de más EAM en medicamentos como: fluoxetina, diclofenaco y amitriptilina. Los EAM más referidos por los entrevistados fueron somnolencia, dolor epigástrico y náuseas. Los EAM más referidos por los entrevistados fueron de naturaleza leve, considerados evitables y estuvieron asociados a medicamentos de uso frecuente por la población. Con motivo de este estudio, fue posible conocer la dimensión del problema ocasionado por el uso de medicamentos en Brasil.

Resumo: O presente trabalho tem como objetivo descrever a prevalência e fatores associados a eventos adversos a medicamentos (EAM) referidos por usuários de medicamentos no Brasil. Trata-se de um estudo transversal de base populacional, realizado no período de setembro de 2013 a fevereiro de 2014, com dados coletados na Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM). Foram consideradas todas as pessoas que referiram o uso de medicamentos; entre elas, foram identificadas as que referiram pelo menos um problema com o uso do medicamento. Realizou-se uma análise descritiva para estimar a prevalência e os intervalos de 95% de confiança (IC95%) de EAM entre as variáveis estudadas, e foram calculadas as razões de prevalência bruta e ajustada, pela regressão de Poisson, na investigação dos fatores associados aos EAM. A prevalência de EAM no Brasil foi de 6,6% (IC95%: 5,89-7,41), sendo maior e estatisticamente significante após a realização da análise multivariada, entre pessoas do sexo feminino; residentes nas regiões Centro-oeste e Nordeste; que consumiam maior número de medicamentos; que percebiam seu estado de saúde como “ruim”; e que se automedicavam. Os EAM foram mais relatados para os medicamentos fluoxetina, diclofenaco e amitriptilina. Os EAM mais referidos pelos entrevistados foram sonolência, dor epigástrica e náuseas. Os EAM mais referidos pelos entrevistados foram de natureza leve, considerados evitáveis e estiveram associados a medicamentos de uso frequente pela população. Em razão desse estudo, foi possível conhecer a dimensão do problema ocasionado pelo uso de medicamentos no Brasil.

Abstract: The aim of this study was to describe the prevalence of adverse drug events (ADEs) and associated factors reported by users of medicines in Brazil. This was a cross-sectional population-based study conducted from September 2013 to February 2014 with data from the Brazilian National Survey on Access, Use, and Promotion of Rational Use of Medicines (PNAUM). The study included all individuals that reported the use of medicines and identified, among them, all those reporting at least one problem with the medicine’s use. A descriptive analysis was performed to estimate ADE prevalence and 95% confidence intervals (95%CI) among the target variables. Crude and adjusted prevalence ratios were calculated using Poisson regression to investigate factors associated with ADEs. Overall ADE prevalence in Brazil was 6.6% (95%CI: 5.89-7.41), and after multivariate analysis, higher prevalence was associated with female gender, residence in the Central and Northeast regions, consumption of more medicines, “bad” self-rated health, and self-medication. The drugs most frequently reported with ADEs were fluoxetine, diclofenac, and amitriptyline. The most frequent ADEs were somnolence, epigastric pain, and nausea. Most reported ADEs were mild, avoidable, and associated with medicines used frequently by the population. The study provided knowledge on the size of the problem with use of medicines in Brazil.

Resumen: El presente trabajo tiene como objetivo describir la prevalencia y factores asociados a eventos adversos con medicamentos (EAM), informados por usuarios de medicamentos en Brasil. Se trata de un estudio transversal de base poblacional, realizado durante el período de septiembre de 2013 a febrero de 2014, con datos recogidos en la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional de Medicamentos en Brasil (PNAUM). Se consideraron a todas las personas que informaron del uso de medicamentos; entre ellas, se identificaron a las que informaron de por lo menos un problema con el uso del medicamento. Se realizó un análisis descriptivo para estimar la prevalencia y los intervalos de confianza a 95% (IC95%) de EAM entre las variables estudiadas, y se calcularon las razones de prevalencia bruta y ajustada, por la regresión de Poisson, en la investigación de los factores asociados a los EAM. La prevalencia de EAM en Brasil fue de un 6,6% (IC95%: 5,89-7,41), siendo mayor y estadísticamente significante tras la realización del análisis multivariado, entre personas del sexo femenino; residentes en las regiones Centro-Oeste y Nordeste; que consumían un mayor número de medicamentos; que percibían su estado de salud como “malo”; y que se automedicaban. Se informaron de más EAM en medicamentos como: fluoxetina, diclofenaco y amitriptilina. Los EAM más referidos por los entrevistados fueron somnolencia, dolor epigástrico y náuseas. Los EAM más referidos por los entrevistados fueron de naturaleza leve, considerados evitables y estuvieron asociados a medicamentos de uso frecuente por la población. Con motivo de este estudio, fue posible conocer la dimensión del problema ocasionado por el uso de medicamentos en Brasil.

ABSTRACT INTRODUCTION: Trypanosoma cruzi is the etiologic agent of Chagas disease in humans, mainly in Latin America. Trypanosome stocks were isolated by hemoculture from patients followed at Evandro Chagas National Institute of Infectious Diseases (FIOCRUZ) and studied using different approaches. METHODS: For species and genotype identification, the stocks were analyzed by parasitological techniques, polymerase chain reaction assays targeted to specific DNA sequences, isoenzyme patterns, besides sequencing of a polymorphic locus of TcSC5D gene (one stock). RESULTS: The isolates presented typical T. cruzi morphology and usually grew well in routine culture media. Metacyclic trypomastigotes were found in cultures or experimentally infected Triatoma infestans. All isolates were pure T. cruzi cultures, presenting typical 330-bp products from kinetoplast DNA minicircles, and 250 or 200-bp amplicons from the mini-exon non-transcribed spacer. Their genetic type assignment was resolved by their isoenzyme profiles. The finding of TcI in one asymptomatic patient from Paraíba was confirmed by the sequencing assay. TcVI was found in two asymptomatic individuals from Bahia and Rio Grande do Sul. TcII was identified in six patients from Pernambuco, Bahia and Minas Gerais, who presented different clinical forms: cardiac (2), digestive with megaesophagus (1), and indeterminate (3). CONCLUSIONS: The main T. cruzi genotypes found in Brazilian chronic patients were identified in this work, including TcI, which is less frequent and usually causes asymptomatic disease, unlike that in other American countries. This study emphasizes the importance of T. cruzi genotyping for possible correlations between the parasite and patient’ responses to therapeutic treatment or disease clinical manifestations.

RESUMO O presente estudo foi projetado para investigar as atividades antioxidante, antinociceptiva e anti-inflamatória do extrato etanólico dos galhos de Ageratum fastigiatum. Perfil fitoquímico e teores de fenois totais e flavonoids foram determinados. A atividade antioxidante foi avaliada por 2,2-difenil-1-picril-hidrazila (DPPH) e pelo método de poder de redução do ferro. O efeito antinociceptivo foi avaliado usando os ensaios de contorções abdominais induzidas por ácido acético, formalina, placa quente e imersão da cauda; enquanto os testes do edema de pata e pleurisia induzidos por carragenina foram realizados para examinar a atividade anti-inflamatória contra inflamação aguda. O extrato revelou a presença de flavonoides, taninos, cumarinas, terpenos, esteroides e saponina. Teores expressivos de fenóis totais e flavonoides e um promissor efeito antioxidante foram quantificados. Nas doses de 50, 100 e 200 mg/kg, o extrato inibiu as contorções, reduziu ambas as fases do tempo da lambida da pata e aumentou o tempo de reação sobre a placa quente. No teste de imersão da cauda, o extrato (50, 100 e 200 mg/kg) causou uma inibição significativa da dor. Nessas doses, o edema de pata, o volume do exsudato e a migração leucocitária foram significativamente reduzidos. Esses resultados sugerem que A. fastigiatum pode ser uma fonte de substâncias ativas com atividades antioxidante, antinociceptiva e anti-inflamatória, adicionando uma base científica para o uso na medicina popular brasileira.

ABSTRACT The present study was designed to investigate the antioxidant, antinociceptive and anti-inflammatory activities of the ethanol extract from Ageratum fastigiatum branches. Phytochemical screening and total phenol and flavonoid contents were determined. The antioxidant activity was assessed by 2,2-diphenyl-1-pycrilhydrazin (DPPH) and iron reducing power methods. The antinociceptive effect was evaluated using the acetic acid-induced writhing, formalin, hot plate and tail immersion assays; while the carrageenan-induced paw edema and pleurisy tests were performed to examine the anti-inflammatory activity against acute inflammation. The extract revealed the presence of flavonoids, tannins, coumarins, terpenes, sterols and saponins. Expressive levels of total phenols and flavonoids and a promising antioxidant effect were quantified. At the doses of 50, 100 and 200 mg/kg, the extract inhibited the writhing, reduced both phases of paw licking time and increased the reaction time on the hot plate. In the tail immersion test, the extract (50, 100 and 200 mg/kg) caused a significant inhibition of pain. In these doses, the paw edema, exudate volume and leucocyte mobilization were significantly reduced. These results suggest that A. fastigiatum can be an active source of substances with antioxidant, antinociceptive and anti-inflammatory activities, adding scientific support to the appropriate use in the Brazilian folk medicine.