Barriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers, and cardiac patients

Background: Despite clinical practice guideline recommendations that cardiovascular disease patients participate, cardiac rehabilitation (CR) programs are highly unavailable and underutilized. This is particularly true in low-resource settings, where the epidemic is at its’ worst. The reasons are complex, and include health system, program and patient-level barriers. This is the first study to assess barriers at all these levels concurrently, and to do so in a lowresource setting. Methods: In this cross-sectional study, data from three cohorts (healthcare administrators, CR coordinators and patients) were triangulated. Healthcare administrators from all institutions offering cardiac services, and providers from all CR programs in public and private institutions of Minas Gerais state, Brazil were invited to complete a questionnaire. Patients from a random subsample of 12 outpatient cardiac clinics and 11 CR programs in these institutions completed the CR Barriers Scale. Results: Thirty-two (35.2%) healthcare administrators, 16 (28.6%) CR providers and 805 cardiac patients (305 [37.9%] attending CR) consented to participate. Administrators recognized the importance of CR, but also the lack of resources to deliver it; CR providers noted referral is lacking. Patients who were not enrolled in CR reported significantly greater barriers related to comorbidities/functional status, perceived need, personal/family issues and access than enrollees, and enrollees reported travel/work conflicts as greater barriers than non-enrollees (all p < 0.01). Conclusions: The inter-relationship among barriers at each level is evident; without resources to offer more programs, there are no programs to which physicians can refer (and hence inform and encourage patients to attend), and patients will continue to have barriers related to distance, cost and transport. Advocacy for services is needed. Keywords: Health care services, Cardiac rehabilitation, Cardiac care facilities, Attitude of health personnelYork University Librarie

Biometrics, physiology, production, and quality of Cantaloupe melons grown with saline waters under semi-arid conditions

Brazilian Northeast region emerges as both producer and exporter relevant of cantaloupe melon to several countries; however, this region is vulnerable to salinization problems due to it is inserted in a semi-arid area. This study aimed to evaluate the biometrics, physiological, production and quality of new cantaloupe melon hybrids cultivated with different saline waters under semi-arid conditions. The experiment was conducted using a drip irrigation system in a split-plot randomized design. The plot was different irrigation water electrical conductivity (ECw) levels: 0.5, 2.0, 3.5, and 5.0 dS m-1, while the subplot was two new cantaloupe melon hybrids: Zielo and SV1044. Plant biometrics (stems and leaves analysis), plant physiology (solutes accumulation and gas exchange in leaves), fruit production (number, weight, and yield), and fruit quality (physical and chemical analysis) were investigated. Stem length, leaf numbers, leaf area, and shoot dry mass decreased when ECw increased from 0.5 to 5.0 dS m-1. Also, there was an increase of Na and Cl concentration and reduction of K concentration in leaves due to ECw increase. Gas exchange reduction, losses in fruit numbers, weight, yield, and in quality were observed with the ECw increase. It is possible to conclude that the ECw increase salinizes the soil and increases Na and Cl concentration in plants causing reduction in gas exchange, in growth, and in fruit production and quality. However, the response of cultivated hybrids regarding salinity may be different, as in our study that the Zielo hybrid was less affected by the increase in ECw.Brazilian Northeast region emerges as both producer and exporter relevant of cantaloupe melon to several countries; however, this region is vulnerable to salinization problems due to it is inserted in a semi-arid area. This study aimed to evaluate the biometrics, physiological, production and quality of new cantaloupe melon hybrids cultivated with different saline waters under semi-arid conditions. The experiment was conducted using a drip irrigation system in a split-plot randomized design. The plot was different irrigation water electrical conductivity (ECw) levels: 0.5, 2.0, 3.5, and 5.0 dS m-1, while the subplot was two new cantaloupe melon hybrids: Zielo and SV1044. Plant biometrics (stems and leaves analysis), plant physiology (solutes accumulation and gas exchange in leaves), fruit production (number, weight, and yield), and fruit quality (physical and chemical analysis) were investigated. Stem length, leaf numbers, leaf area, and shoot dry mass decreased when ECw increased from 0.5 to 5.0 dS m-1. Also, there was an increase of Na and Cl concentration and reduction of K concentration in leaves due to ECw increase. Gas exchange reduction, losses in fruit numbers, weight, yield, and in quality were observed with the ECw increase. It is possible to conclude that the ECw increase salinizes the soil and increases Na and Cl concentration in plants causing reduction in gas exchange, in growth, and in fruit production and quality. However, the response of cultivated hybrids regarding salinity may be different, as in our study that the Zielo hybrid was less affected by the increase in ECw

Antifungal activity of schinol and a new biphenyl compound isolated from Schinus terebinthifolius against the pathogenic fungus Paracoccidioides brasiliensis

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to isolate and identify the antifungal compounds from the extracts of <it>Schinus terebinthifolius </it>(Anacardiaceae) against clinical isolates of the pathogenic fungus <it>Paracoccidioides brasiliensis</it>.</p> <p>Methods</p> <p>The hexane and dichlomethane fractions from leaves and stems of <it>S. terebinthifolius </it>were fractionated using several chromatography techniques to afford four compounds.</p> <p>Results</p> <p>The compounds isolated from <it>S. terebinthifolius </it>were identified as schinol (<b>1</b>), a new biphenyl compound, namely, 4'-ethyl-4-methyl-2,2',6,6'-tetrahydroxy[1,1'-biphenyl]-4,4'-dicarboxylate (<b>2</b>), quercetin (<b>3</b>), and kaempferol (<b>4</b>). Compounds <b>1 </b>and <b>2 </b>were active against different strains of <it>P. brasiliensis</it>, showing a minimal inhibitory concentration value against the isolate Pb B339 of 15.6 μg/ml. The isolate Pb 1578 was more sensitive to compound <b>1 </b>with a MIC value of 7.5 μg/ml. Schinol presented synergistic effect only when combined with itraconazole. The compounds isolated from S. <it>terebinthifolius </it>were not able to inhibit cell wall synthesis or assembly using the sorbitol assay.</p> <p>Conclusion</p> <p>This work reveals for the first time the occurrence of compound <b>2 </b>and discloses activity of compounds <b>1 </b>and <b>2 </b>against several clinical isolates of <it>P. brasiliensi</it>s. These results justify further studies to clarify the mechanisms of action of these compounds.</p

Tissue distribution of DNA-Hsp65/TDM-loaded PLGA microspheres and uptake by phagocytic cells

This study aimed to demonstrate that microspheres, used as delivery vehicle of DNA-Hsp65/TDM [plasmid DNA encoding heat shock protein 65 (Hsp65) coencapsulated with trehalose dimycolate (TDM) into PLGA microspheres], are widely spread among several organs after intramuscular administration in BALB/c mice. In general, we showed that these particles were phagocytosed by antigen presenting cells, such as macrophages and dendritic cells. Besides, it was demonstrated herein that draining lymph node cells presented a significant increase in the number of cells expressing costimulatory molecules (CD80 and CD86) and MHC class II, and also that the administration of the DNA-Hsp65/TDM and vector/TDM formulations resulted in the up-regulation of CD80, CD86 and MHC class II expression when compared to control formulations (vector/TDM and empty). Regarding the intracellular trafficking we observed that following phagocytosis, the microspheres were not found in the late endosomes and/or lysosomes, until 15 days after internalization, and we suggest that these constructions were hydrolysed in early compartments. Overall, these data expand our knowledge on PLGA [poly (lactic-co- glycolic acid)] microspheres as gene carriers in vaccination strategies, as well as open perspectives for their potential use in clinical practice

Avaliação das percepções dos discentes EJA em relação aos docentes e a vivência no âmbito escolar/ Evaluation of the perceptions of the EJA discents in relation to teachers and experience school scope

As relações interpessoais entre discentes e docentes, na modalidade EJA, são necessárias e fundamentais para que a aprendizagem aconteça. De modo geral, esta pesquisa tem como objetivo: avaliar as percepções dos discentes EJA em relação aos docentes quanto às contribuições da aprendizagem e à vivência no âmbito escolar. E como objetivos específicos: analisar a vivência dos discentes EJA com todos que compõem a escola; e, delinear as considerações expostas pelos discentes EJA em analogia a (in)disciplina e a vivência familiar. Este estudo pauta-se na problemática: como os discentes EJA avaliam o trabalho docente em sua vivência escolar? Hipoteticamente, verifica-se que os docentes fomentam uma vivência escolar agradável e colaborativa com os discentes, de modo que estes entendam que a educação é uma porta de acesso a melhorias, principalmente na vida profissional e emocional. Este artigo fundamenta-se na LDB nº 9.394/96 e nos pressupostos teóricos de Zampin (2017), Silva (2014), Silva e Moura (2013), Martins e Silva (2011) e Cury (2004). Em termos estruturais, iniciou-se por meio do levantamento bibliográfico, tendo como metodologia exploratória descritiva e abordagem quantitativa e qualitativa, mediante pesquisa de campo e levantamento de dados por questionário semiestruturado que será respondido por 23 discentes que estudam em uma escola pública municipal localizada no interior do Estado de Pernambuco. Diante do que foi apurado, percebe-se que os discentes EJA sentem-se acolhidos pelos docentes, e estes sempre procuram trabalhar de forma que a aprendizagem significativa aconteça.

MicroRNA Hsa-miR-134 is a circulating biomarker for mesial temporal lobe epilepsy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Epilepsy is misdiagnosed in up to 25% of patients, leading to serious and long-lasting consequences. Recently, circulating microRNAs have emerged as potential biomarkers in a number of clinical scenarios. The purpose of this study was to identify and to validate circulating microRNAs that could be used as biomarkers in the diagnosis of epilepsy. Quantitative real-time PCR was used to measure plasma levels of three candidate microRNAs in two phases of study: an initial discovery phase with 14 patients with mesial temporal lobe epilepsy (MTLE), 13 with focal cortical dysplasia (FCD) and 16 controls; and a validation cohort constituted of an independent cohort of 65 patients with MTLE and 83 controls. We found hsa-miR-134 downregulated in patients with MTLE (p = 0.018) but not in patients with FCD, when compared to controls. Furthermore, hsa-miR-134 expression could be used to discriminate MTLE patients with an area under the curve (AUC) of 0.75. To further assess the robustness of hsa-miR-134 as a biomarker for MTLE, we studied an independent cohort of 65 patients with MTLE, 27 of whom MTLE patients were responsive to pharmacotherapy, and 38 patients were pharmacoresistant and 83 controls. We confirmed that hsa-miR-134 was significantly downregulated in the plasma of patients with MTLE when compared with controls (p < 0.001). In addition, hsa-miR-134 identified patients with MTLE regardless of their response to pharmacotherapy or the presence of MRI signs of hippocampal sclerosis. We revealed that decreased expression of hsa-miR-134 could be a potential non-invasive biomarker to support the diagnosis of patients with MTLE.Epilepsy is misdiagnosed in up to 25% of patients, leading to serious and long-lasting consequences. Recently, circulating microRNAs have emerged as potential biomarkers in a number of clinical scenarios. The purpose of this study was to identify and to v124FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIORCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)2013/07559-3; 2013/00099-7sem informaçãosem informaçã

Bats, Trypanosomes, and Triatomines in Ecuador: New Insights into the Diversity, Transmission, and Origins of Trypanosoma cruzi and Chagas Disease

The generalist parasite Trypanosoma cruzi has two phylogenetic lineages associated almost exclusively with bats—Trypanosoma cruzi Tcbat and the subspecies T. c. marinkellei. We present new information on the genetic variation, geographic distribution, host associations, and potential vectors of these lineages. We conducted field surveys of bats and triatomines in southern Ecuador, a country endemic for Chagas disease, and screened for trypanosomes by microscopy and PCR. We identified parasites at species and genotype levels through phylogenetic approaches based on 18S ribosomal RNA (18S rRNA) and cytochrome b (cytb) genes and conducted a comparison of nucleotide diversity of the cytb gene. We document for the first time T. cruzi Tcbat and T. c. marinkellei in Ecuador, expanding their distribution in South America to the western side of the Andes. In addition, we found the triatomines Cavernicola pilosa and Triatoma dispar sharing shelters with bats. The comparisons of nucleotide diversity revealed a higher diversity for T. c. marinkellei than any of the T. c. cruzi genotypes associated with Chagas disease. Findings from this study increased both the number of host species and known geographical ranges of both parasites and suggest potential vectors for these two trypanosomes associated with bats in rural areas of southern Ecuador. The higher nucleotide diversity of T. c. marinkellei supports a long evolutionary relationship between T. cruzi and bats, implying that bats are the original hosts of this important parasite

Vascular retinal findings after COVID-19 vaccination in 11 cases: a coincidence or consequence?

Purpose: The primary purpose of this study was to assess vascular retinal findings temporally related to COVID-19 vaccination. With greater information regarding all possible future adverse events, we hope to understand the real dimension and relevance of what was presented. Methods: Eleven patients with visual complaints after COVID-19 vaccination were enrolled. Data on the following were included: age, sex, vaccine, time of symptom onset, systemic findings, medical history, best-corrected visual acuity, and ocular findings by slit-lamp biomicroscopy as well as multimodal retinal imaging (color fundus, red-free photography, spectral-domain optical coherence tomography, optical coherence tomography angiography, and fluorescein-angiography). Inclusion criteria were the presence of ophthalmologic signs within 30 days after the first or second dose of any COVID-19 vaccine. Results: Of 11 patients, five had arterial occlusion (45.4%), four had venous occlusion (36.4%), and two (18.2%) had nonspecific vascular alterations suggestive of retinal ischemia such as cotton-wool spots. The mean age was 57 (SD = 16; range: 27-84) years. The mean time of symptoms onset was 10 (SD = 5.4; range: 3-16) days. Nine patients were female (81.8%). Systemic risk factors were observed in 36.4% of patients. Two patients had both neurological and visual symptoms, with arterial occlusion. Overall, 36.4% patients had COVID-19 in the previous year. Seven patients (63.6%) received ChAdOx1 nCoV- 19 (AZD1222) vaccine. Conclusions: Our data suggest that retinal events temporally related to COVID-19 vaccination are possible but are very rare. The relationship of these events with post-COVID-19 vaccination warrants further attention to derive a meaningful conclusion.RESUMO Objetivos: o principal objetivo deste estudo foi descrever pacientes com achados vasculares retinianos temporalmente relacionados à vacinação contra COVID-19. Com maior notificação de possíveis eventos adversos similares, esperamos compreender a real dimensão e relevância do que foi apresentado. Métodos: Onze pacientes com queixas visuais após vacinação contra COVID-19 foram estudados. Os dados analisados foram: idade, gênero, tipo de vacinação, tempo de aparecimento de sintomas, achados sistêmicos, antecedentes pessoais, acuidade visual com melhor correção, biomicroscopia e imagem retiniana multimodal (retinografia colorida, red-free, SD-OCT, OCTA e angiofluoresceinografia). Os critérios de inclusão foram a presença de alterações oftalmológicas ocorridas dentro de 30 dias após a primeira ou segunda dose de qualquer vacina contra COVID-19. Resultados: Onze pacientes foram incluídos: 5 com oclusão arterial (45,4%), 4 com oclusão venosa (36,4%) e 2 (18,2%) com alterações não específicas vasculares sugestivas de isquemia retiniana como exsudatos algodonosos. A idade média dos pacientes foi de 57 anos (DP=16; com intervalo de 27 a 84 anos). A média de tempo de aparecimento de sintomas após a vacinação foi de 10 dias (DP=5,4; com intervalo de 3 a 16 dias). Nove dos onze pacientes eram do sexo feminino (81,8%). Fatores de risco sistêmicos foram observados em 36,4% dos pacientes. Dois pacientes tiveram sintomas neurológicos e visuais, com oclusão arterial. 36,4% dos pacientes tiveram infecção prévia por COVID-19 no último ano. Sete pacientes (63,6%) receberam a vacina ChAdOx1 nCoV-19 (AZD1222). Conclusões: nossos dados sugerem que eventos retinianos temporalmente relacionados à vacinação contra COVID-19 são possíveis, porém raros. A relação entre estes eventos pós-vacinais exigem futura atenção antes de maiores conclusões

Neoplasmas oculares e de anexos em cães e gatos no Rio Grande do Sul: 265 casos (2009-2014)

Neoplasias oculares causam desconforto, problemas de visão e podem refletir doenças sistêmicas. Um estudo retrospectivo foi realizado para identificar e analisar neoplasmas oculares e de anexos obtidos por biópsias enviadas ao Setor de Patologia Veterinária (SPV) da Universidade Federal do Rio Grande do Sul (UFRGS). Durante o período de janeiro de 2009 a dezembro de 2014 realizou-se 265 diagnósticos de neoplasmas oculares e de anexos, destes 87,5% na espécie canina e em 12,5% na espécie felina. As neoplasias ocorreram mais em animais com idade superior a 12 meses e idosos, e os cães (52/232) e gatos (21/33) sem raça definida foram os mais acometidos. A pálpebra foi o local mais acometido na espécie canina (164/232) e felina (20/33), seguida pela terceira pálpebra em cães (20/232) e órbita nos felinos (5/33). O tumor mais diagnosticado nos cães foi o adenoma meibomiano (82/232) e nos gatos o carcinoma de células escamosas (10/33), ambos em pálpebras. Foram identificados nos cães 24 tipos tumorais e nos gatos 16. Em caninos as neoplasias benignas representaram o maior número de diagnósticos (56%) sendo que em felinos o maior número de casos foi de neoplasias malignas (75,8%).Ocular neoplasms cause discomfort, loss of vision or may also reflect systemic diseases. A retrospective study has been performed to identify and analyze ocular and annexes neoplasms obtained by biopsies sent to the Sector of Veterinary Pathology at the Federal University of Rio Grande do Sul (SPV/ UFRGS). 265 diagnoses of ocular and annexes neoplasms, 87.5% in canine species and 12.5% in feline species, were made from January 2009 to December 2014. Neoplasms occurred more in animals over the age of 12 months and animals of old age, dogs (52/232) and cats (21/33) mixed breed were the most affected. The eyelid was most commonly affected in dogs (164/232) and feline (20/33), followed by the third eyelid in dogs (20/232) and eye orbit in cats (5/33). The most common tumor diagnosed was meibomian adenoma in dogs (82/232) and squamous cell carcinoma in cats (10/33) both in the eyelids. Twenty four tumor types have been identified in dogs and 16 in cats. Benign neoplasms in dogs represented the largest number of diagnosis (56%) whereas in cats, there were more cases of malignant neoplasms (75.8%)