Universidade Estadual do Ceará

Zika virus (ZIKV) has recently caused a pandemic disease, and many cases of ZIKV infection in pregnant women resulted in abortion, stillbirth, deaths and congenital defects including microcephaly, which now has been proposed as ZIKV congenital syndrome. This study aimed to investigate the in situ immune response profile and mechanisms of neuronal cell damage in fatal Zika microcephaly cases. Brain tissue samples were collected from 15 cases, including 10 microcephalic ZIKV-positive neonates with fatal outcome and five neonatal control flavivirus-negative neonates that died due to other causes, but with preserved central nervous system (CNS) architecture. In microcephaly cases, the histopathological features of the tissue samples were characterized in three CNS areas (meninges, perivascular space, and parenchyma). The changes found were mainly calcification, necrosis, neuronophagy, gliosis, microglial nodules, and inflammatory infiltration of mononuclear cells. The in situ immune response against ZIKV in the CNS of newborns is complex. Despite the predominant expression of Th2 cytokines, other cytokines such as Th1, Th17, Treg, Th9, and Th22 are involved to a lesser extent, but are still likely to participate in the immunopathogenic mechanisms of neural disease in fatal cases of microcephaly caused by ZIKV.

Heavy smoke from forest fires in the Amazon was observed to reduce cloud droplet size and so delay the onset of precipitation from 1.5 kilometers above cloud base in pristine clouds to more than 5 kilometers in polluted clouds and more than 7 kilometers in pyro-clouds. Suppression of low-level rainout and aerosol washout allows transport of water and smoke to upper levels, where the clouds appear "smoking" as they detrain much of the pollution. Elevating the onset of precipitation allows invigoration of the updrafts, causing intense thunderstorms, large hail, and greater likelihood for overshooting cloud tops into the stratosphere. There, detrained pollutants and water vapor would have profound radiative impacts on the climate system. The invigorated storms release the latent heat higher in the atmosphere. This should substantially affect the regional and global circulation systems. Together, these processes affect the water cycle, the pollution burden of the atmosphere, and the dynamics of atmospheric circulation.

Coronavirus (COVID-19) is a viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spread of COVID-19 seems to have a detrimental effect on the global economy and health. A positive chest X-ray of infected patients is a crucial step in the battle against COVID-19. Early results suggest that abnormalities exist in chest X-rays of patients suggestive of COVID-19. This has led to the introduction of a variety of deep learning systems and studies have shown that the accuracy of COVID-19 patient detection through the use of chest X-rays is strongly optimistic. Deep learning networks like convolutional neural networks (CNNs) need a substantial amount of training data. Because the outbreak is recent, it is difficult to gather a significant number of radiographic images in such a short time. Therefore, in this research, we present a method to generate synthetic chest X-ray (CXR) images by developing an Auxiliary Classifier Generative Adversarial Network (ACGAN) based model called CovidGAN. In addition, we demonstrate that the synthetic images produced from CovidGAN can be utilized to enhance the performance of CNN for COVID-19 detection. Classification using CNN alone yielded 85% accuracy. By adding synthetic images produced by CovidGAN,the accuracy increased to 95%. We hope this method will speed up COVID-19 detection and lead to more robust systems of radiology.

Summary Consumers are increasingly avoiding foods containing synthetic colourants, which lead food industries to replace them by natural pigments, such as carotenoids, betalains, anthocyanins and carminic acid. Betalains are water‐soluble nitrogen‐containing pigments, composed of two structural groups: the red‐violet betacyanins and the yellow‐orange betaxanthins. This review synthesises the published literature on basic chemistry of betalains, their sources and chemical stability. Moreover, several works are mentioned which have demonstrated the potent antioxidant activity of betalains, which has been associated with protection against degenerative diseases.

CONTEXT: Several practice guidelines recommend that depression be evaluated and treated in patients with cardiovascular disease, but the potential benefits of this are unclear. OBJECTIVE: To evaluate the potential benefits of depression screening in patients with cardiovascular disease by assessing (1) the accuracy of depression screening instruments; (2) the effect of depression treatment on depression and cardiac outcomes; and (3) the effect of screening on depression and cardiac outcomes in patients in cardiovascular care settings. DATA SOURCES: MEDLINE, PsycINFO, CINAHL, EMBASE, ISI, SCOPUS, and Cochrane databases from inception to May 1, 2008; manual journal searches; reference list reviews; and citation tracking of included articles. STUDY SELECTION: We included articles in any language about patients in cardiovascular care settings that (1) compared a screening instrument to a valid major depressive disorder criterion standard; (2) compared depression treatment with placebo or usual care in a randomized controlled trial; or (3) assessed the effect of screening on depression identification and treatment rates, depression, or cardiac outcomes. DATA EXTRACTION: Methodological characteristics and outcomes were extracted by 2 investigators. RESULTS: We identified 11 studies about screening accuracy, 6 depression treatment trials, but no studies that evaluated the effects of screening on depression or cardiovascular outcomes. In studies that tested depression screening instruments using a priori-defined cutoff scores, sensitivity ranged from 39% to 100% (median, 84%) and specificity ranged from 58% to 94% (median, 79%). Depression treatment with medication or cognitive behavioral therapy resulted in modest reductions in depressive symptoms (effect size, 0.20-0.38; r(2), 1%-4%). There was no evidence that depression treatment improved cardiac outcomes. Among patients with depression and history of myocardial infarction in the ENRICHD trial, there was no difference in event-free survival between participants treated with cognitive behavioral therapy supplemented by an antidepressant vs usual care (75.5% vs 74.7%, respectively). CONCLUSIONS: Depression treatment with medication or cognitive behavioral therapy in patients with cardiovascular disease is associated with modest improvement in depressive symptoms but no improvement in cardiac outcomes. No clinical trials have assessed whether screening for depression improves depressive symptoms or cardiac outcomes in patients with cardiovascular disease.

Aedes aegypti L. is the major vector of dengue fever, an endemic disease in Brazil. In an effort to find effective and affordable ways to control this mosquito, the larvicidal activities of essential oils from nine plants widely found in the Northeast of Brazil were analyzed by measurement of their LC50. The essential oils were extracted by steam distillation and their chemical composition determined by GL-chromatography coupled to mass spectroscopy. The essential oils from Cymbopogon citratus and Lippia sidoides, reported in the literature to have larvicidal properties against A. aegypti, were used for activity comparison. The results show that Ocimum americanum and Ocimum gratissimum have LC50 of 67 ppm and 60 ppm respectively, compared to 63 ppm for L. sidoides and 69 ppm for C. citratus. These results suggest a potential utilization of the essential oil of these two Ocimum species for the control of A. aegypti.

OBJECTIVE: to construct and validate the Educational Content Validation Instrument in Health. METHOD: methodological study that includes the establishment of the conceptual structure; definition of objectives and population; construction of items and response scale; selection and arrangement of items; instrument structuring; opinion of experts; pre-test and content validation. RESULTS: an instrument with 15 items was constructed and, after expert evaluation, eighteen items were obtained, divided into three domains: objectives (four), structure/presentation (nine), and relevance (two). Six items were modified since they presented a percentage of agreement below 0.8. Items of the total instrument presented good internal consistency (0.877) regarding domains. CONCLUSION: an Educational Content Validation Instrument in Health was elaborated and validated, presenting good reliability, and may contribute to the practice of researchers and health professionals in the development of educational content.

Candida albicans is the most common human fungal pathogen, causing infections that range from mucous membranes to systemic infections. The present article provides an overview of C. albicans, with the production of biofilms produced by this fungus, as well as reporting the classes of antifungals used to fight such infections, together with the resistance mechanisms to these drugs. Candida albicans is highly adaptable, enabling the transition from commensal to pathogen due to a repertoire of virulence factors. Specifically, the ability to change morphology and form biofilms is central to the pathogenesis of C. albicans. Indeed, most infections by this pathogen are associated with the formation of biofilms on surfaces of hosts or medical devices, causing high morbidity and mortality. Significantly, biofilms formed by C. albicans are inherently tolerant to antimicrobial therapy, so the susceptibility of C. albicans biofilms to current therapeutic agents remains low. Therefore, it is difficult to predict which molecules will emerge as new clinical antifungals. The biofilm formation of C. albicans has been causing impacts on susceptibility to antifungals, leading to resistance, which demonstrates the importance of research aimed at the prevention and control of these clinical microbial communities.

Grape pomace (Vitis vinifera L.), Benitaka variety, grown in the semiarid region of Northeast Brazil was evaluated in relation to chemical composition, and content of minerals and functional properties. Its microbiological quality and toxic potential, using Artemia salina sp, were also investigated. The results showed that the flour obtained from these residues had below neutral pH (3.82), moisture (3.33g/100g), acidity of (0.64g of citric acid/100g), and ash (4.65 g/100g). The amount of total dietary fiber (46.17g/100g) stood out quantitatively compared to the content of carbohydrate (29.2g/100 g), protein (8.49g/100g), and lipids (8.16g/100g). The total energy was 224Kcal/100g. With regard to the compounds with functional properties, higher values of insoluble fiber 79% (36.4 g/100 g); vitamin C (26.25 mg of acid ascorbic/100g), and anthocyanins (131mg/100g) were found. The minerals iron, potassium, zinc, manganese, and calcium were present in higher concentrations. There were no significant copper values. The results showed that the grape residues are an important source of nutrients and compounds with functional properties suggesting that they can be incorporated as an ingredient in the diet and/or used as a dietary supplement aiming at health benefits. The residues did not show microbiological contamination and were considered nontoxic.

OBJECTIVES: The aim of the study was to analyze the impact of ischemic stroke on health-related quality of life (QoL) and associate this event with individuals' clinical and sociodemographic characteristics. METHODS: We investigated the clinical and demographic aspects of stroke patients. The Modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS) and the Stroke Specific Quality of Life Scale (SS-QoL) were used for correlation analysis. RESULTS: Among 131 patients with ischemic stroke, 53.4% of patients presented with moderate to severe disability on the Rankin Scale. According to the SS-QoL, several QoL domains were compromised. QoL was significantly negatively correlated with the values of the Rankin and NIHSS scales, indicating lower QoL among people with worse functional status and greater clinical severity of stroke (p<0.001). The use of orthosis and total anterior circulation infarct subtype of stroke led to a more marked reduction in QoL. CONCLUSION: The present study described an inversely proportional relationship between the severity of stroke, disability and QoL. The use of orthosis also had a negative impact on QoL. Early identification of these factors could promote better interventions for individuals with ischemic stroke, minimizing disabilities and improving QoL.

Collagen and elastin are thought to dominate the elasticity of the connective tissue including lung parenchyma. The glycosaminoglycans on the proteoglycans may also play a role because osmolarity of interstitial fluid can alter the repulsive forces on the negatively charged glycosaminoglycans, allowing them to collapse or inflate, which can affect the stretching and folding pattern of the fibers. Hence, we hypothesized that the elasticity of lung tissue arises primarily from 1) the topology of the collagen-elastin network and 2) the mechanical interaction between proteoglycans and fibers. We measured the quasi-static, uniaxial stress-strain curves of lung tissue sheets in hypotonic, normal, and hypertonic solutions. We found that the stress-strain curve was sensitive to osmolarity, but this sensitivity decreased after proteoglycan digestion. Images of immunofluorescently labeled collagen networks showed that the fibers follow the alveolar walls that form a hexagonal-like structure. Despite the large heterogeneity, the aspect ratio of the hexagons at 30% uniaxial strain increased linearly with osmolarity. We developed a two-dimensional hexagonal network model of the alveolar structure incorporating the mechanical properties of the collagen-elastin fibers and their interaction with proteoglycans. The model accounted for the stress-strain curves observed under all experimental conditions. The model also predicted how aspect ratio changed with osmolarity and strain, which allowed us to estimate the Young's modulus of a single alveolar wall and a collagen fiber. We therefore identify a novel and important role for the proteoglycans: they stabilize the collagen-elastin network of connective tissues and contribute to lung elasticity and alveolar stability at low to medium lung volumes.

A obra Erguer a voz: pensar como feminista, pensar como negra, de bell hooks, foi publicada originalmente em 1989 nos Estados Unidos com o titulo Talking Back: Thinking Feminist, Thinking Black . No Brasil, a publicacao ocorreu em 2019, pela editora elefante, contando com o prefacio de Marilea de Almeida e traduzida por Catia Bocaiuva Maringolo.  O livro Erguer a voz: pensar como feminista, pensar como negra e resultante da narrativa da trajetoria pessoal da autora refletida com um vies teorico. A edicao e composta por introducao, vinte e tres ensaios e uma entrevista, atraves dos quais transmite seu pensamento de modo didatico sem fazer uso de uma escrita de dificil entendimento. Com foco nas questoes feministas e raciais, a autora aborda os padroes racistas, machistas e sexistas que envolvem o cotidiano de mulheres negras no campo pessoal e academico, com isso, realiza um esforco politico, erguendo sua voz ao falar/estudar sobre sua propria realidade e das demais mulheres negras, denunciando o contexto de opressao e dominacao que envolve o cotidiano destas. Na obra argumenta que pessoas negras sao criadas acreditando que existem muitas coisas que nao podem ser faladas nos espacos publicos e nem mesmo nos privados, e, a partir dessa percepcao, bell hooks tem o proposito de conectar esses dois polos, instigando o leitor a pensar criticamente sobre a divisao existente entre publico e privado.

Brazil is facing its first outbreak of Zika virus, particularly in the northeast region. Most cases of Zika virus infection are self-limited and without sequelae, but there have been clusters of cases of microcephaly in some areas of known Zika virus transmission. Although strongly suspected, the causal relation between in-utero exposure to Zika and microcephaly is yet to be established. The increased number of microcephaly cases in Brazil has led to a high level of concern among pregnant women throughout the country. On Feb 1, 2016, WHO's International Health Regulations Emergency Committee advised that the clusters of microcephaly and other neurological disorders and their possible association with Zika virus constitutes a Public Health Emergency of International Concern.1WHOWHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations.http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/Date: Feb 1, 2016Google Scholar Measurement of newborn head circumference is useful as a screening tool for detecting microcephaly, independently of its cause. Before 2015, the annual numbers of reported cases of microcephaly in Brazil were consistently below 200.2Brasil Ministério da SaúdeDATASUS. Tabulação de anomalia ou defeito congênito em nascidos vivos (in Portuguese).http://www2.aids.gov.br/cgi/tabcgi.exe?caumul/anoma.defGoogle Scholar Between mid-2015 and Jan 30, 2016, 4783 suspected cases of microcephaly were reported, including newborn and fetal losses.3Brasil Ministério da SaúdeCentro de Operações de Emergências em Saúde Pública sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe epidemiológico 11—semana epidemiológica 04/2016 (24 a 30/01/2016). Ministério da Saúde, Brasília2016Google Scholar Of these, 1103 cases have completed clinical, laboratory, and imaging examinations, and 404 (36·2%) were classified as confirmed cases of microcephaly. Among the confirmed cases, brain abnormalities were detected by imaging in 387 babies and Zika virus was detected in 17 babies, including in two fetal losses.3Brasil Ministério da SaúdeCentro de Operações de Emergências em Saúde Pública sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe epidemiológico 11—semana epidemiológica 04/2016 (24 a 30/01/2016). Ministério da Saúde, Brasília2016Google Scholar The remaining 709 cases were discarded and 3670 suspected cases of microcephaly remain under investigation.3Brasil Ministério da SaúdeCentro de Operações de Emergências em Saúde Pública sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe epidemiológico 11—semana epidemiológica 04/2016 (24 a 30/01/2016). Ministério da Saúde, Brasília2016Google Scholar Although 36·2% seems to be a high rate of true positives, it has to be interpreted with caution because in the present situation newborn babies with visible cranial deformities are likely to be fast-tracked for in-depth examination. This temporal increase in suspected cases of microcephaly could also be distorted given both raised awareness, with more children than usual being measured and reported, and changing definitions of microcephaly over time. The possibility of over-reporting and misdiagnosis was recently raised by the Latin American Network of Congenital Malformations,4Latin American Network of Congenital MalformationsMicrocefalias en el ECLAMC y en Brasil (in Portuguese).http://www.eclamc.org/microcefaliaarchivos.phpDate: Dec 5, 2015Google Scholar and their report led to speculation in the international scientific press on the magnitude of the increase in microcephaly cases.5Butler D Brazil's surge in small-headed babies questioned by report.Nature. 2016; 530: 13-14Crossref PubMed Scopus (47) Google Scholar To help interpret these numbers, it is instructive to assess how head circumference criteria for defining suspected cases of microcephaly have evolved (table). Before Dec 8, 2015, Brazil's Ministry of Health6Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância Note Informativa 01/2015. COES Microcefalias. Ministério da Saúde, Brasília2015Google Scholar recommended a cutoff for head circumference of less than or equal to 33 cm for term newborn babies (both sexes and all gestational ages); for preterm babies, the cutoff was the 3rd centile of the Fenton7Fenton TR Kim JH A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013; 13: 59Crossref PubMed Scopus (1399) Google Scholar curves of head circumference by gestational age and sex. On Dec 8, 2015, the Ministry of Health in Brazil revised the case definition for suspected microcephaly in newborn babies and reduced the head circumference criterion in term newborn babies to less than or equal to 32 cm.8Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta àocorrência de microcefalia relacionada à infecção pelo vírus Zika. Ministério da Saúde, Brasília2015Google Scholar On Jan 21, 2016, the Pan American Health Organization (PAHO)9Pan American Health OrganizationLineamientos preliminares de vigilancia de microcefalia en recién nacidos en entornos con riesgo de circulación de virus Zika. Jan 22, 2016. Pan American Health Organization, Washington, DC2016Google Scholar proposed the use of fixed cutoffs of 32·0 cm and 31·6 cm for term boys and girls, on the basis of the 3rd percentile for term newborn babies of any gestational age according to the WHO Growth Standards.10WHOThe WHO child growth standards.www.who.int/childgrowth/en/Google Scholar For preterm babies, PAHO9Pan American Health OrganizationLineamientos preliminares de vigilancia de microcefalia en recién nacidos en entornos con riesgo de circulación de virus Zika. Jan 22, 2016. Pan American Health Organization, Washington, DC2016Google Scholar recommended use of the 3rd centile of either the Fenton7Fenton TR Kim JH A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013; 13: 59Crossref PubMed Scopus (1399) Google Scholar or InterGrowth11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar curves. Use of fixed cutoff head circumference measurements for all term infants is inappropriate since it does not account for the fact that 68·1% of term newborn babies in Brazil are below 40 weeks' gestational age, partly owing to the fact the country has the highest caesarean section rate in the world.12Gibbons L Belizan JM Lauer JA Betran AP Merialdi M Althabe F Inequities in the use of cesarean section deliveries in the world.Am J Obstet Gynecol. 2012; 206: e1-19Summary Full Text Full Text PDF PubMed Scopus (203) Google ScholarTablePreliminary estimates of the specificity, sensitivity, and number of suspected cases of microcephaly in Brazil according to different screening criteriaCutoffsSpecificity*Based on applying the InterGrowth standards to the distribution of livebirths by gestational age in Brazil.Sensitivity†Preliminary results based on a case series of 31 newborn babies with radiological evidence of brain abnormalities.Estimated annual number of suspected cases (thousands)‡Calculated on the basis of sensitivity and the gestational age distribution of Brazilian newborn babies.Northeast BrazilBrazilBrazil's Ministry of Health6Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância Note Informativa 01/2015. COES Microcefalias. Ministério da Saúde, Brasília2015Google Scholar (up to Dec 8, 2015)≤33 cm for term newborn babies of both sexes; <−2 SD of Fenton reference7Fenton TR Kim JH A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013; 13: 59Crossref PubMed Scopus (1399) Google Scholar by gestational age and sex for preterm babies79·3%92%158602Brazil's Ministry of Health8Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta àocorrência de microcefalia relacionada à infecção pelo vírus Zika. Ministério da Saúde, Brasília2015Google Scholar (after Dec 8, 2015)≤32 cm for term newborn babies of both sexes; <−2 SD of Fenton reference by gestational age and sex for preterm babies93·8%86%46178Pan American Health Organization9Pan American Health OrganizationLineamientos preliminares de vigilancia de microcefalia en recién nacidos en entornos con riesgo de circulación de virus Zika. Jan 22, 2016. Pan American Health Organization, Washington, DC2016Google Scholar<3rd percentile (WHO child growth standards10WHOThe WHO child growth standards.www.who.int/childgrowth/en/Google Scholar) for term newborn babies (<31·6 cm for girls and 32·0 cm for boys) and of the Fenton or InterGrowth reference for preterm babies96·1%80%29114Below −2 SD, InterGrowth standards11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar<−2 SD (InterGrowth standards) for gestational age and sex, all newborns97·8%85%1863Below −3 SD, InterGrowth standards11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar<−3 SD (InterGrowth standards) for gestational age and sex, all newborns99·9%57%0·83* Based on applying the InterGrowth standards to the distribution of livebirths by gestational age in Brazil.† Preliminary results based on a case series of 31 newborn babies with radiological evidence of brain abnormalities.‡ Calculated on the basis of sensitivity and the gestational age distribution of Brazilian newborn babies. Open table in a new tab The reasons for choosing the Fenton7Fenton TR Kim JH A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.BMC Pediatr. 2013; 13: 59Crossref PubMed Scopus (1399) Google Scholar reference are unclear. The Fenton chart is based on a meta-analysis of six pre-existing studies from high-income countries with non-standardised methods, as is the case for most neonatal anthropometric charts.13Giuliani F Ohuma E Spada E et al.Systematic review of the methodological quality of studies designed to create neonatal anthropometric charts.Acta Paediatr. 2015; 104: 987-996Crossref PubMed Scopus (22) Google Scholar Instead, we applied the sex-specific and gestational-age specific InterGrowth standards11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar to the gestational age distribution of Brazilian infants in 201214Brasil Ministerio da SaudeDATASUS. Sistema Nacional de Nascidos Vivos (in Portuguese).http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.defDate: 2016Google Scholar to estimate the specificity of evolving definitions of suspected cases of microcephaly (table). InterGrowth11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar is a prescriptive standard for fetal and newborn growth based on healthy gestations from eight countries. In this prospective, multicentre study, women had a reliable ultrasound estimate of gestational age using crown–rump length before 14 weeks of gestation or biparietal diameter if antenatal care started between 14 weeks and 24 weeks or less of gestation.11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar Newborn anthropometric measures were obtained by identically trained anthropometric teams using the same equipment at all sites, which included Brazil. The InterGrowth study was designed to be fully consistent with the WHO Growth Standards,15Villar J Papageorghiou AT Pang R et al.Monitoring human growth and development: a continuum from the womb to the classroom.Am J Obstet Gynecol. 2015; 213: 494-499Summary Full Text Full Text PDF PubMed Scopus (36) Google Scholar which are used throughout the world, thus providing a comparable standard for fetal growth and newborn size. Both standards are perfectly matched for term newborn babies. Because microcephaly cases were excluded from the InterGrowth samples, the distribution of head circumferences in the standard is appropriate for estimating specificity of a given cutoff. The use of a cutoff of −3 SD below the mean value for newborn head circumference was proposed by a 2013 systematic review of microcephaly, on the basis of the finding that most newborn babies with head circumferences between −2 SD and −3 SD below the mean range do not have any evidence of malformation.16Woods CG Parker A Investigating microcephaly.Arch Dis Child. 2013; 98: 707-713Crossref PubMed Scopus (100) Google Scholar The −3 SD cutoff has been used traditionally by the Latin American Collaborative Study of Congenital Malformations.4Latin American Network of Congenital MalformationsMicrocefalias en el ECLAMC y en Brasil (in Portuguese).http://www.eclamc.org/microcefaliaarchivos.phpDate: Dec 5, 2015Google Scholar A WHO manual on surveillance of birth defects defines microcephaly as a head circumference below −2 SD of sex-specific and gestational-age specific curves, but only if accompanied by structural abnormalities of the brain.17WHOBirth defects surveillance: a manual for programme managers. World Health Organization, Geneva2014Google Scholar The WHO manual explicitly states that absence of such abnormalities rules out a diagnosis; it does not recommend diagnostic workouts for all children with small heads.17WHOBirth defects surveillance: a manual for programme managers. World Health Organization, Geneva2014Google Scholar We derived preliminary estimates of sensitivity from 31 cases of confirmed microcephaly from ten states in Brazil, including eight northeastern states.18Schuler-Faccini L Ribeiro EM Feitosa IM et al.Brazilian Medical Genetics Society–Zika Embryopathy Task ForcePossible association between Zika virus infection and microcephaly—Brazil, 2015.MMWR Morb Mortal Wkly Rep. 2016; 65: 59-62Crossref PubMed Scopus (787) Google Scholar The newborn babies had head circumferences below the Ministry of Health cutoff at the time of birth and had brain abnormalities confirmed by imaging that were compatible with congenital infection (mainly brain calcifications, lissencephaly, and ventriculomegaly). These are the first consecutive confirmed cases available to our coauthors who are involved in surveillance in the ten states. In these 31 babies with microcephaly there was no evidence of intrauterine exposure to other infectious diseases, such as syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpesvirus. The average head circumference was 28·4 cm (SD 2·3), with a mean InterGrowth Z score of −3·5 (SD 1·4). Only three newborn babies had head circumferences greater than or equal to 32 cm, all with mild radiological signs of brain abnormalities. The table shows the sensitivity of the different diagnostic criteria for suspected microcephaly based on our case series. These preliminary results must be interpreted with caution given the small number of cases, the fact that most measurements were rounded to full cm instead of mm, and the possibility of notification bias. Although the specificity of the cutoffs used so far seem high, in a country with almost 2·9 million annual births there would still be many newborn babies classified as suspected cases who would require in-depth investigation. The table shows that the number of cases of suspected microcephaly range from more than 600 000 with the initial criterion from the Ministry of Health6Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância Note Informativa 01/2015. COES Microcefalias. Ministério da Saúde, Brasília2015Google Scholar to just over 3000 if −3 SD is used as the cutoff. The fact that 3670 of the 4783 suspected cases of microcephaly identified in the past months are still under investigation is not surprising given delays in obtaining access to advanced diagnostic facilities in Brazil's national health system.19Solla J Chioro A Atenção ambulatorial especializada.in: Giovanella L Escorel S Lobato LVC Noronha JC Carvalho AI Políticas e sistema de saúde no Brasil. Editora Fiocruz, Rio de Janeiro2008: 627-663Google Scholar This backlog of cases under investigation may become worse as increasing numbers of suspected cases are reported and babies' head circumferences are measured more often than in the past. Another consideration is the emotional stress for parents whose healthy babies with small heads are incorrectly screened as positive. There is a trade-off between specificity and sensitivity. Since there is no effective treatment for congenital microcephaly, there is a strong argument to prioritise specificity over sensitivity. Increasing specificity would reduce the iatrogenic potential of radiation during brain tomography, which is 100 times higher than that for a chest x-ray,20Davies HE Wathen CG Gleeson FV Risks of exposure to radiological imaging and how to minimize them.BMJ. 2011; 342: 589-593Crossref Scopus (90) Google Scholar and would help alleviate the emotional effects on parents of healthy children who are given a false-positive result in the screening assessment. This approach would also reduce the burden and costs to an already overstretched health system. Although true cases of microcephaly that are missed by a less sensitive cutoff could benefit from early intellectual stimulation, there would still be opportunities to detect their condition later during infancy. Arguments for prioritising sensitivity include the fact that we are in the early stages of a new epidemic about which little is known. It is also conceivable that babies with microcephaly who would profit most from early intellectual stimulation could be exactly those whose head circumference is closer to the normal range. On the basis of our results (table), we recommend use of a consistent set of diagnostic criteria for suspected microcephaly that take into account gestational age for term and preterm newborn babies; such criteria are provided by the InterGrowth standards.11Villar J Cheikh Ismail L Victora CG et al.for the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st)International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.Lancet. 2014; 384: 857-868Summary Full Text Full Text PDF PubMed Google Scholar These are preliminary recommendations that can be revised once a larger case series is accrued. The sensitivity of a cutoff for head circumference of −3 SD seems to be too low, particularly during what seems to be a new epidemic of microcephaly, when one does not want to miss many cases. We favour a cutoff of −2 SD, which has similar sensitivity to the current Ministry of Health8Brasil Ministério da SaúdeSecretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância e resposta àocorrência de microcefalia relacionada à infecção pelo vírus Zika. Ministério da Saúde, Brasília2015Google Scholar and PAHO9Pan American Health OrganizationLineamientos preliminares de vigilancia de microcefalia en recién nacidos en entornos con riesgo de circulación de virus Zika. Jan 22, 2016. Pan American Health Organization, Washington, DC2016Google Scholar recommendations, with the advantage of greatly reducing the number of newborn babies who will need investigation. Although −2 SD and the 3rd percentile seem to be close, the latter cutoff would classify an additional 0·7% of the population as suspected cases, or about 20 000 Brazilian newborn babies per year. The recent availability of a computer and mobile-phone based application for the estimation of head circumference Z scores by gestational age and sex will contribute to the field implementation of the InterGrowth standards;21InterGrowth21st. Oxford University, Oxford2016http://intergrowth21.ndog.ox.ac.uk/en/ManualEntryGoogle Scholar Portuguese and Spanish versions have also been made available. Although there is evidence of an increased number of cases of microcephaly in Brazil, we show that the number of suspected cases relied on a screening test that had very low specificity and therefore overestimated the actual number of cases by including mostly normal children with small heads. We recommend that national and international agencies should refrain from reporting suspected cases and speed up investigation to report on confirmed cases with laboratory or radiological evidence. It is also important that health workers measure head circumference in all newborn babies using standardised anthropometric techniques, and report results in mm. The present situation in Brazil is certainly a severe public health challenge. Better measurement and use of the appropriate growth standards are essential for the continued surveillance of microcephaly cases that are potentially associated with the Zika virus infection. CGV and FCB were part of the team of researchers that created the InterGrowth standards; the standards are in public domain and the researchers involved in their creation do not receive any financial benefits from their use.

Tungiasis is caused by the flea Tunga penetrans. Growing urbanization, improved housing and use of appropriate footwear presumably have led to an overall reduction of the occurrence of this ectoparasitosis within the last decades. However, it is still highly prevalent where people live in extreme poverty, occurring in many Latin American and African countries. Although the infection has long been known, data on the ectoparasite's biology and the epidemiology of the disease are scant. Methods for treatment, prevention and control have never been evaluated in a scientific manner. Tungiasis remains an important public health problem for the very poor, a problem neglected by those who are affected, by the medical profession and by the scientific community.

Este trabalho é resultado de uma pesquisa que teve como objetivo analisar as visões de professores sobre a aprendizagem significativa no ensino superior e sua mobilização para este propósito. Buscou-se também, identificar a visão dos professores sobre aprendizagem significativa; verificar as estratégias utilizadas pelos docentes para mobilizar a aprendizagem significativa; e diagnosticar as dificuldades e deliberações dos docentes nesse processo. A investigação consistiu em uma abordagem qualitativa, tendo, como procedimentos metodológicos, estudo bibliográfico e realização de entrevistas semiestruturadas com professores da educação superior. O contexto do estudo foi um Centro Universitário situado no Sertão Central do Ceará, com professores do curso de psicologia. A análise se desenvolveu por meio da percepção docente acerca do uso das metodologias ativas na educação superior, bem como apontando as dificuldades e desafios ao trabalhar estratégias que valorizam e estimulam a relação entre teoria e prática. Os resultados da investigação indicaram que a visão dos docentes sobre a aprendizagem significativa, refere-se ao conceito atribuída por Ausubel (1982) em relação à compreensão sobre a aprendizagem significativa, em que reconhecem a importância da interação dos conhecimentos prévios com os conhecimentos reelaborados no cotidiano da sala de aula. O aprendizado é considerado significativo quando expressa uma prática refletida, capaz de modificar a percepção do estudante em relação aos saberes sistematizados e reconstruídos.

A relação médico-paciente é uma temática que hoje encontra um renovado interesse na produção cientifica, na formação e prática clínica com a aplicação de técnicas comunicacionais que podem proporcionar uma melhor qualidade na relação. O presente artigo, por meio de uma revisão da literatura e da apresentação dos resultados de uma pesquisa que realizamos sobre a relação entre médicos e pacientes no Programa de Saúde da Família no Estado do Ceará, se propõe a refletir sobre quais os fatores que estão na raiz desta problemática. Uma melhor relação médico-paciente não tem somente efeitos positivos na satisfação dos usuários e na qualidade dos serviços de saúde, mas exerce também uma influência direta sobre o estado de saúde dos pacientes. Esta demanda exige a implementação de mudanças visando à aquisição de competências na formação dos médicos.

This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.

Moringa oleifera Lam (Moringaceae) is a plant with high nutritional and medicinal value. Native to India, it is now widely distributed throughout tropical and subtropical regions of the world. Its different parts are sources of proteins, vitamins and minerals and present different pharmacological and biotechnological potential. Moreover, M. oleifera seeds are widely used in water and effluent treatment, for their coagulation, flocculation and sedimentation properties, their ability of improving water quality, by reducing organic matter and microbial load, with special applicability in intensive animal production systems, such as aquaculture. In addition, due to its high nutritional value and several medicinal properties, this tree may act as a nutritional and medical alternative for socially neglected populations. In this context, this review gathers information on M. oleifera, emphasizing its chemical constituents, nutritional, pharmacological and antimicrobial properties, applications in the treatment of water effluents, and ecological and social aspects.

Basquin's law of fatigue states that the lifetime of the system has a power-law dependence on the external load amplitude, tf approximately sigma 0- alpha, where the exponent alpha has a strong material dependence. We show that in spite of the broad scatter of the exponent alpha, the fatigue fracture of heterogeneous materials exhibits universal features. We propose a generic scaling form for the macroscopic deformation and show that at the fatigue limit the system undergoes a continuous phase transition. On the microlevel, the fatigue fracture proceeds in bursts characterized by universal power-law distributions. We demonstrate that the system dependent details are contained in Basquin's exponent for time to failure, and once this is taken into account, remaining features of failure are universal.

OBJECTIVES: The aims of this study were to test the essential oil from Lippia sidoides Cham. for antifungal activity, in vitro, against Candida spp. and Microsporum canis, to evaluate its acute and subchronic toxicological effects, in vivo, and to determine its chemical constituents. METHODS: The antifungal activity, in vitro, was initially evaluated by the agar-well diffusion technique, and the MIC and minimum fungicidal concentration (MFC) were determined by the broth microdilution method. The acute and subchronic toxicological effects were determined in mice and rats, respectively. The chemical composition of the essential oil was determined by gas chromatography coupled to mass spectroscopy. RESULTS: The essential oil obtained from L. sidoides was effective against all tested strains by the agar-well diffusion method. The MICs of L. sidoides essential oil for strains of M. canis ranged from 4 to 70 mg/L and the MFCs ranged from 9 to 150 mg/L. The MICs for strains of Candida spp. ranged from 620 to 2500 mg/L and the MFCs ranged from 1250 to 5000 mg/L. The main constituents of L. sidoides essential oil were thymol (59.65%), E-caryophyllene (10.60%) and p-cymene (9.08%). The acute administration of the essential oil up to 3 g/kg by the oral route to mice was devoid of overt toxicity. The 30 day oral administration of L. sidoides oil (117.95 mg/kg/day) to rats did not induce any significant histopathological, haematological or serum biochemical alterations. CONCLUSIONS: The essential oil from L. sidoides may be a promising source in the search for new antifungal drugs due to its efficacy and low toxicity.