Comparação entre dois PCMSOs de uma empresa de transporte rodoviário em Curitiba

Orientador : Raffaello Popa Di BernardiMonografia (especialização) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Curso de Especialização em Medicina do TrabalhoInclui referênciasResumo :O cuidado com a saúde do trabalhador é previsto na legislação brasileira em aspectos gerais, e atualmente detalhado pela norma regulamentadora n.7 (NR7), do Ministério do Trabalho e Emprego, que estabelece a obrigatoriedade de elaboração e implementação de Programa de Controle Médico de Saúde Ocupacional - PCMSO a empregadores e instituições que admitam trabalhadores como empregados. O objetivo deste artigo é comparar dois PCMSO de dois fornecedores distintos, contratados por uma empresa de transporte rodoviário de Curitiba - PR. Para tanto, os dois programas serão confrontados com a legislação em vigor, que estabelece os parâmetros e diretrizes mínimos a serem observados, bem como com as notas técnicas emitidas pela Secretaria de Segurança e Saúde no Trabalho, que esclarecem e aprofundam o alcance da NR7; ou seja, os PCMSOs deverão contemplar o cumprimento das exigências das leis, a promoção da saúde do trabalhador, a prevenção de acidentes de trabalho, a redução do absenteísmo e a redução de gastos com cuidados de saúde do trabalho. Espera-se que da comparação surjam diferenças tanto entre os PCMSOs e a NR7 quanto entre os PCMSOs dos dois fornecedores, evidenciando o grau de adequação às normas e a efetividade e a eficiência no atendimento às expectativas das empresas contratantes. Assim, será possível estabelecer um parâmetro qualitativo para empresas que necessitem de tal serviço para garantir aos seus empregados cuidados garantidos em lei. Palavras-Chave: PCMSO, norma regulamentadora, parâmetro qualitativo, saúde do trabalhador, medicina do trabalh

Excretory-Secretory Products from Hookworm L3 and Adult Worms Suppress Proinflammatory Cytokines in Infected Individuals

We compared the effects of larval and adult worm excretory-secretory (ES) products from hookworm on the proliferative responses and cytokine secretion in peripheral blood mononuclear cells (PBMCs) from hookwormpatients and egg-negative, nonendemic controls. When compared with negative controls, mitogen-stimulated PBMC from hookworm-infected individuals showed a significantly reduced proliferative response when adult worm ES antigen was added to the cultures. Furthermore, in hookworm-infected individuals a significant downmodulation of inflammatory interleukin (IL)-6 and tumor necrosis factor (TNF)-α secretion resulted when PBMCs were stimulated with mitogen in combination with larval or adult worm ES. Both, interferon (IFN)-γ and IL-10 secretion were significantly lower in stimulated PBMC from infected individuals; however the IFN-γ/IL-10 ratio was much lower in hookworm-infected patients. Comparable effects, although at lower concentrations, were achieved when PBMCs from both groups were incubated with living hookworm third-stage larvae. We suggest that hookworm ES products downmodulate proliferative responses and inflammation during the chronic phase of the disease and facilitate early larval survival or adult worm persistence in the gut

Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil.

BACKGROUND: The use of liquid medium (MGIT960) for tuberculosis (TB) diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes. METHODS AND FINDINGS: A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ) method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ). Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39). Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001). No other important differences were observed. CONCLUSIONS: This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN79888843

Zoonotic tuberculosis in human beings caused by Mycobacterium bovis—a call for action

Mycobacterium tuberculosis is recognised as the primary cause of human tuberculosis worldwide. However, substantial evidence suggests that the burden of Mycobacterium bovis, the cause of bovine tuberculosis, might be underestimated in human beings as the cause of zoonotic tuberculosis. In 2013, results from a systematic review and meta-analysis of global zoonotic tuberculosis showed that the same challenges and concerns expressed 15 years ago remain valid. These challenges faced by people with zoonotic tuberculosis might not be proportional to the scientific attention and resources allocated in recent years to other diseases. The burden of zoonotic tuberculosis in people needs important reassessment, especially in areas where bovine tuberculosis is endemic and where people live in conditions that favour direct contact with infected animals or animal products. As countries move towards detecting the 3 million tuberculosis cases estimated to be missed annually, and in view of WHO's end TB strategy endorsed by the health authorities of WHO Member States in 2014 to achieve a world free of tuberculosis by 2035, we call on all tuberculosis stakeholders to act to accurately diagnose and treat tuberculosis caused by M bovis in human beings

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome: ABESO 2022

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.info:eu-repo/semantics/publishedVersio

Leishmaniose Visceral Canina: um problema de saúde pública em expansão

As leishmanioses são doenças negligenciadas de grande importância em saúde pública. Esta doença, causada por parasitos do gênero Leishmania e transmitidos por insetos vetores pode se manifestar sob as formas visceral, cutânea e muco-cutânea. A leishmaniose visceral ganhou importante destaque na abordagem da “Saúde Única” em função da interface humana, veterinária e ambiental. Neste contexto, a detecção de novas áreas com ocorrência de casos autóctones de LV canina é o marco para iniciar a investigação, vigilância e monitoramento epidemiológico. O município de Lavras era considerado área silenciosa e não vulnerável para leishmaniose visceral canina até o ano de 2013. Diante da necessidade de confirmação da infecção canina, o objetivo do presente trabalho foi confirmar a ocorrência de casos autóctones de LV canina no município de Lavras – MG, com técnicas parasitológicas, sorológicas e moleculares. A partir da Reação em Cadeia da Polimerase em tempo real – qPCR, foi analisada a carga parasitária de amostras de baço e medula óssea de nove cães naturalmente infectados, sabidamente positivos para LVC nos testes DPP® e EIE LVC Bio-Manguinhos®. Foram observadas quatro amostras positivas para Leishmania infantum em medula óssea, e cinco amostras positivas de baço. Não houve diferença significativa para os valores de carga parasitária entre os dois tipos de tecido analisados. A confirmação da infecção por L. infantum em cães realizada neste estudo é a primeira na macrorregião de Lavras - sul do estado de Minas Gerais, e serve de alerta para implementação das ações de vigilância e controle, no sentido de evitar a dispersão da doença e a ocorrência de casos humanos

Stoma-free survival after anastomotic leak following rectal cancer resection : worldwide cohort of 2470 patients

Funding Information: The TENTACLE-Rectum study was funded by Medtronic External Research Program. The authors declare no other conflict of interest.Peer reviewedPublisher PD

Clinical Impact of the Line Probe Assay and Xpert® MTB/RIF Assay in the Presumptive Diagnosis of Drug-Resistant Tuberculosis in Brazil: A Pragmatic Clinical Trial

Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month