Visceral leishmaniasis in a Brazilian endemic area: an overview of occurrence, HIV coinfection and lethality

The Brazilian municipality of Rondonópolis, Mato Grosso State, represents an important visceral leishmaniasis (VL) endemic area. This study described epidemiological and clinical aspects of the occurrence, VL/HIV coinfection and lethality related to VL in Rondonópolis. Data from autochthonous cases reported between 2011 and 2016 were obtained from official information systems. During this period, 81 autochthonous cases were reported, with decreasing incidence through 2016. Contrastingly, the lethality rate was 8.6% overall, but varied widely, reaching a peak (20%) in 2016. Almost 10% of patients had VL/HIVcoinfection. The occurrence of VL prevailed among men (56.8%), brown-skinned (49.4%), urban residents (92.6%), aged 0-4 years (33.3%). Housewives or retired (29.6%) were the most affected occupational groups. Lower age was the main difference among the total VL cases and those who were coinfected or died. Clinically, fever, weakness and splenomegaly were more frequent among all VL cases and VL/HIV coinfected individuals. Bacterial infections (p=0.001) and bleeding (

Tratamento anti-chamas para madeiras utilizadas na construção civil

Nosso trabalho tem por objetivo oferecer as empresas contratantes dados referentes ao tratamento da madeira para torná-la anti chamas, a partir do principio que o homem não possui domínio pleno do fogo, utilizando ferramentas para adaptação do meio, o método utilizado é entendido como um instrumento passivo, porém com resultados significativos no que se trata de combate a incêndios aplicando se métodos simples que viabilizam uma melhora no sistema de segurança em relação aos incêndios. Tendo a madeira como alvo da origem do tratamento, uma vez que a mesma já é entendida no ramo da construção como um material resistente a altas temperaturas se comparada com aço, ferro, concreto entre outros matérias, visando essas informações tomamos como base a obtenção de dados atreves de revisões bibliográficas e entrevistas semi abertas, apurando informações tais como: qual a madeira apresenta melhor resultado com a aplicação, que tipo de tratamento deve ser aplicado, tempo de resistência ao fogo, espaço de tempo entre uma aplicação e outra, os benefícios referentes ao tempo para o combate ao principio de incêndios, entre outras informações que sirvam de base para calcular o custo benefício do projeto

Corneal Ulcer in a Sheep - Treatment with Third Eyelid Flap

Background: Corneal ulcers are frequently reported in the literature in several species, however, the treatment of traumatic lesions on the corneal surface of ruminants is still poorly described.  The use of the third eyelid flap is questioned when applied to deep ulcers, since the technique prevents the evolutionary follow-up of corneal healing and compromises care. However, several authors report its successful use for the treatment of superficial and deep corneal ulcers. This technique protects the ocular surface and prevents the occurrence of new lesions or their aggravation. The aim of this study was to report the treatment of corneal ulcers in sheep through the third eyelid flap associated with the use of topical antibiotics.Case: A 2-year-old Dorper sheep, with ocular discomfort, conjunctival hyperemia and mucopurulent secretion in the left eye, was assisted in a private rural property in the West region of Bahia, Brazil. The owner reported that before seeking veterinary help he used a spray based on oxytetracycline and hydrocortisone, which worsened the animal's condition. Upon inspection, it was observed eyelid asymmetry, slight lateralization of the head to the left, periorbital alopecia on the left face, intense blepharospasm in the left eye, with projection of the third eyelid occurring at times. The ophthalmic examination was performed after application of anesthetic eye drops based on proxymetacaine to reduce eye discomfort. A corneal stromal lesion, edema and fibrovascular tissue in the left eye were identified, but the cause of the lesion was not defined, with lagophthalmia, entropion, dystychiasis or ectopic cilia being ruled out. So, it was suggested that the lesion had occurred by a foreign body, such as dust or feed fiber.  The contralateral eye showed no changes, Schirmer 15 mm, no changes in sensory and sensory reflexes and negative fluorescein. No signal clinical disease. Due to the severity of the lesion, it was performed a third eyelid flap associated with drug treatment with ciprofloxacin eye drops, every 8 h for 21 days. The animal was placed in the right lateral decubitus position and palpebral akinesia was achieved with the application of 2 mL lidocaine without vasoconstrictor in the region of the auriculopalpebral nerve. This was followed by the routine performance of the third eyelid flap.Discussion: The delay in seeking veterinary care and the application of spray based on oxytetracycline and hydrocortisone aggravated the lesion, since the corticosteroid delays corneal healing and favors the aggravation of the lesion. After desensitization of the cornea, the animal allowed eye manipulation and it was possible to observe the lesion and choose the best treatment, with option for the third eyelid flap because it is a simple and fast technique, does not require special equipment or materials, ideal for performed in the field and is widely used in the treatment of injuries involving the cornea and, besides that, helps to contain corneal perforation and protect the ocular surface. Corneal debridement was also performed to remove necrotic debris and improve drug action, in addition to using broad-spectrum antibiotic eye drops until complete regeneration of the lesion. Twenty-one days after the surgical procedure, the patient had no ocular discomfort, the flap was removed and no changes in the corneal surface were observed. The treatment was considered satisfactory for the healing of the corneal ulcer, guaranteed the esthetics and visual function of the sheep.Keywords: keratitis, surgery, ciprofloxacin, ocular, ruminant

Bullous Keratopathy in a dog treated with Third Eyelid Flap and Autologous Serum Eye Drops

Background: Bullous Keratopathy (BK) is characterized by decompensation of the corneal stroma resulting in visual impairment by corneal opacity, discomfort, excessive tearing, blepharospasm and pain. The aim of this study was to report a case of BK in a dog and the complete recovery of the ocular structure and visual function, with a third eyelid flap associated with the use of autologous blood serum topically.Case: A 2-year-old Shih Tzu male dog, weighing 4.3 kg, with recurrent bilateral eye discomfort was brought to Ophthalmologist Veterinarian Assistance. The patient had already been seen by other veterinarians, but the signs returned in a short period of time after the prescription was suspended. During physical examination it was observed moderate blepharospasm in the right eye, epiphora in the left eye, and in both eyes was noted exophthalmos, medial corneal entropion, caruncle trichiasis and ectopic cilia in the upper and lower eyelids. Fluorescein test was positive in both eyes, and a large bullous, opaque and gelatinous lesion with irregular appearance was observed occupying a large part of the cornea of the right eye. Superficial corneal ulcer was diagnosed in left eye and BK in right eye, both probably in consequence of ectopic cilia presence. Surgical intervention was made, with the cauterization and excision of the ectopic cilia and third eyelid flap in the right eye. The cauterization of caruncle trichiasis was not authorized by the owner. Moxifloxacin eye drops in the dose of one drop four times a day in both eyes, lubricant based on hyaluronic acid in the dose of one drop four times a day in both eyes, and autogenous blood serum, obtained from the centrifugation of a blood sample of the dog itself, in the dose of one drop every hour in the right eye for 24 hours, and meloxicam in the dose of 0.1 mg/kg every 24 h for 3 days were prescribed. Elizabethan collar was recommended until removal of the third eye flap. During the surgery, a sample of eye secretion was collected and sent for culture and antibiogram and did not show growth of microorganisms. After seven days of the procedure, the animal did not show eye discomfort and corneal ulcer in the left eye was healed. The third eye flap remained stable until the return of 28 days and after removal of the capton, adhesions were identified, which were removed with Castroviejo scissors after application of topical anesthetic proxymetacaine hydrochloride eye drops. A fluorescein test was performed and the absence of corneal keratitis was confirmed. Discrete corneal scars (macula) were identified.Discussion: The patient in this report had several changes in ocular morphology that favored the formation of recurrent injuries which contributed to the formation of BK. The use of topical medications as unique treatment was not performed due to the severity of the lesion and the presence of alterations such as medial entropion, caruncle trichiasis and ectopic cilia that needed surgical corrections to resolve the causes of the lesions. In order to protect the cornea and provide compression of its epithelium, a third eyelid flap was performed, a low-invasive procedure that is quick and easy to perform. Ectopic cilia were cauterized to eliminate one of the causes of the corneal injuries, however, the other changes could not be corrected because they were not authorized by the owner. The adjuvant uses of ocular lubricant based on hyaluronic acid, a broad-spectrum topical antibiotic and mainly autogenous blood serum favored the epithelial reconstruction of the cornea by providing protection, vitamins, growth factors, immunoglobulins, anti-collagenolytic and bacteriostatic substances. The protocol used it enabled a rapid reduction in patient discomfort, reversal of injuries and recovery of visual function

Multicomponent systems with cyclodextrins and hydrophilic polymers for the delivery of Efavirenz

AbstractEfavirenz (EFZ) is one of the most used drugs in the treatment of AIDS and is the first antiretroviral choice. However, since it has low solubility, it does not exhibit suitable bioavailability, which interferes with its therapeutic action and is classified as a class II drug according Biopharmaceutical Classification System (low solubility and high permeability). Among several drug delivery systems, the multicomponent systems with cyclodextrins and hydrophilic polymers are a promising alternative for increasing the aqueous solubility of the drug. The present study aimed to develop and characterize in a ternary system of EFZ, MβCD and PVP K30. The results showed that the solid ternary system provided a large increase in the dissolution rate which was greater than 80% and was characterized by DSC, TG, XRD, FT-IR and SEM. The use of the ternary system (EFZ, MβCD and PVP K30 1%) proved to be a viable, effective and safe delivery of the drug. The addition of the hydrophilic polymer appeared to be suitable for the development of a solid oral pharmaceutical product, with possible industrial scale-up and with low concentration of CDs (cyclodextrins)

Cuidados de enfermagem durante o pré-natal para uma boa experiência no parto: uma revisão integrativa

Foi buscado na literatura científica os cuidados de enfermagem durante a assistência pré-natal para garantir uma experiência satisfatória durante o parto. É uma revisão integrativa, em que se utilizou a questão norteadora: Quais são os cuidados de enfermagem durante a assistência pré-natal para uma boa experiência no parto? Para a coleta de dados, usaram-se as bibliotecas virtuais: BVS e PUBMED, além das bases de dados Embase e Scopus. Os critérios para essa pesquisa foram artigos científicos disponíveis de forma gratuita, sem recorte temporal ou de linguagem. Os artigos editoriais, pesquisas de revisão, resenhas, teses, relatórios, cartas, artigos de opinião e estudos que não respondessem diretamente à questão central foram excluídos. Sendo assim, a amostra final da pesquisa foi de 10 artigos. A partir da análise dos artigos, foi compreendido que a enfermagem desempenha um papel essencial na assistência pré-natal, garantindo que as gestantes recebam atenção holística e personalizada, bem como foi evidenciado que os principais cuidados de enfermagem durante a assistência pré-natal, concentrando-se em como essas intervenções podem influenciar positivamente a experiência no parto. Sendo assim, os cuidados de enfermagem durante o pré-natal não apenas favorecem a saúde física, como também têm um papel fundamental na construção de uma experiência positiva no parto

Alterações comportamentais em crianças portadoras de enfermidades crônicas e suas repercussões na família: Hospital da Criança – Obras Sociais de Irmã Dulce, Salvador, BA

It is a pilot study, involving 15 children that were commited at the Hospital da Criança: Obras Sociais de Irmã Dulce, Salvador, Bahia. The objective of this study is the investigation of family’s perception about the pediatric patient with chronic illness. The responsible for the patient answered a questionnaire that approached subjects regarding the partner demographic profile, family  knowledge degree about the disease, behavior alterations in child and its family, besides the impression of prognostic and  the medical services that were offered to the researched population. The results evidenced that some kind of behavior alteration were presented by all evaluated population, being more frequent symptoms of: sadness; anxiety; isolation and sleepness. The parents referred that after the appearance of the disease, the more common manifestations were: increase of the familiar union, feeling of fear, anxiety and concern with physical sequels. Regarding the model of hospital care, it was revealed that they were satisfied with the quality and efficiency of the medical service. However, they consider insufficient the psychological support to the child and the family throughout the confrontation of the chronic disease. The next phase of this study should make possible a more consistent and inclusive analysis concerning the proposed theme.Trata-se de um estudo piloto que envolve 15 crianças internadas no Hospital da Criança: Obras Sociais de Irmã Dulce, Salvador, Bahia, realizado com o objetivo de investigar a percepção da família perante o paciente pediátrico, portador de enfermidade crônica. Para tanto, o responsável pelo paciente respondeu a um questionário que abordou questões referentes a perfil sociodemográfico, grau de conhecimento da família em relação à doença, percepção quanto a alterações comportamentais ocorridas na criança e na família, além da impressão quanto ao prognóstico e serviços médicos prestados à população pesquisada. Os resultados desta pesquisa evidenciaram que toda a população avaliada apresentou algum tipo de alteração comportamental, sendo mais freqüentes os sintomas: tristeza, ansiedade, isolamento e sonolência. Os pais referiram como manifestações mais comuns, após o surgimento da doença: maior união familiar, sentimento de medo, ansiedade e preocupação com seqüelas físicas. No que diz respeito ao padrão de assistência hospitalar, revelaram-se satisfeitos com a qualidade e eficiência do serviço médico prestado. Entretanto, consideram insuficiente o suporte psicológico à criança e à família no enfrentamento da doença crônica. A próxima fase deste estudo deverá possibilitar uma análise mais consistente e abrangente acerca do tema proposto

Eficácia da nebulização com solução salina hipertônica a 3% em crianças com bronquiolite viral aguda

Introdução: A bronquiolite é uma infecção viral aguda que afeta o trato respiratório inferior, predominantemente causada pelo vírus sincicial respiratório (VSR). O diagnóstico é baseado em sintomas clínicos, mas a diversidade nos critérios de diagnóstico dificulta a comparação entre estudos e diretrizes internacionais. A hospitalização por bronquiolite é comum em crianças menores de 2 anos, com tempo médio de internação de aproximadamente três dias. Embora o tratamento deva ser principalmente de suporte, muitos estudos indicam uma lacuna entre as práticas clínicas e as recomendações, com uso frequente de abordagens não baseadas em evidências. Este estudo busca avaliar a eficácia e segurança da nebulização com solução salina hipertônica a 3% no tratamento da bronquiolite. Objetivo: Investigar, interpretar e revisar os achados sobre o uso de nebulização com solução salina hipertônica a 3% em crianças com bronquiolite viral aguda, averiguando a eficácia e segurança do método nesses pacientes ao decorrer do tratamento. Metodologia: Utilizou-se a base Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), sob os descritores Bronchiolitis AND hypertonic saline, com seleção de artigos de revisão e artigos originais nos últimos 5 anos, seguindo os critérios de elegibilidade. Foram encontrados 94 artigos, dos quais foram selecionados 24 elegíveis. Resultados: Ao analisar os dados e evidências apresentados, infere-se que a nebulização com solução salina hipertônica a 3% parece proporcionar benefícios discretos no tratamento da bronquiolite viral aguda, incluindo redução da taxa de hospitalização e melhora dos sintomas clínicos. A falta de efeitos adversos relevantes sugere que é uma opção terapêutica segura. No entanto, são necessários estudos adicionais para confirmar esses resultados e determinar sua eficácia em longo prazo