EDTA-mediated inhibition of DNases protects circulating cell-free DNA from ex vivo degradation in blood samples

AbstractObjetivesThe extracellular DNA occurring in plasma-EDTA and serum is a biomarker of growing interest, especially in prenatal diagnosis and oncology. The objectives of the present study were to compare the DNase activity in these specimens and to investigate its ex-vivo impact over the circulating cell-free DNA yield (ccfDNA), using the circulating cell-free fetal DNA (ccffDNA) as a tool.Design and methodsEDTA-plasma and serum from women bearing male fetus were submitted to an endogenous DNase activity assay based on qPCR hydrolysis probe degradation, they were treated with DNAse I to investigate the action of an exogenous nuclease and also submitted to different temperature conditions to investigate the temperature-dependent degradation of the ccffDNA. In all instances, all male ccffDNA were quantified by qPCR targeting the Y chromosome-specific sequence DYS-14. Moreover, a serial dilution of EDTA was added to nonanticoagulated plasma and serum before the endogenous DNAse activity assay, to investigate the EDTA-mediated inhibition of the blood's DNase.ResultsThe endogenous nuclease activity was 14.9-fold higher in serum compared to EDTA-plasma. The DNAse I treatment did not alter the ccffDNA yields in EDTA-plasma, but completely degraded it in serum. The addition of increasing doses of EDTA to nonanticoagulated plasma and serum resulted in a stepwise inhibition of their nucleases activity. Finally, we observed a much more pronounced temperature-mediated decrease on the ccffDNA amount in serum compared to EDTA-plasma.ConclusionThe exogenous and endogenous DNases are more active in serum, the anticoagulant EDTA indirectly inhibits blood DNases, and consequently ccfDNA is protected from the blood's DNase preanalytical impact in EDTA-plasma

Barreiras da reabilitação cardíaca em uma cidade do nordeste do Brasil

Identifying barriers by regions of Brazil can be a valuable strategy to improve the insertion and adherence of patients with cardiopathy to cardiovascular rehabilitation programs. Objective: To identify and describe the reasons that lead to the non-inclusion of individuals with cardiopathy in cardiovascular rehabilitation programs. Methods: Descriptive cross-sectional study with 79 individuals of both sexes, aged over 50 years, with cardiopathy from five private cardiology clinics. To identify the factors that interfered with the inclusion of patients in cardiovascular rehabilitation programs, the scale of barriers for cardiac rehabilitation was applied. This instrument is composed of 22 items, 21 of which are closed and objective questions. Individuals were instructed to tick "YES" or "NO" for each target item on the scale if they identified the item as a barrier to inclusion / adherence. Results: 64 (81%) of the sample did not know about the existence of cardiovascular rehabilitation and its benefits. For 50 (63%) the distance from the residence to the rehabilitation center was a barrier. In addition, the cost of urban mobility 37 (47%) and the lack of indication of the physician as unnecessary 32 (40%) were also pointed as barriers. Conclusion: The results of this study indicate that the main reasons for non-insertion in cardiovascular rehabilitation programs were the lack of knowledge about the benefits of this type of program, the distance of the patients' residence to the nearest center and the displacement cost.Averiguar as barreiras por regiões do Brasil, pode ser uma valiosa estratégia para melhorar a inserção e adesão dos pacientes cardiopatas a programas de reabilitação cardiovascular. Objetivo: Identificar e descrever os motivos que levam a não inclusão de indivíduos cardiopatas em programas de reabilitação cardiovascular. Métodos: Estudo descritivo de corte transversal com 79 indivíduos de ambos sexos, com idade superior a 50 anos, cardiopatas provenientes de cinco clínicas particulares de cardiologia. Para identificação dos fatores que interferiam na inclusão dos pacientes aos programas de reabilitação cardiovascular, foi aplicada a escala de barreiras para reabilitação cardíaca. Esse instrumento é composto de 22 itens, sendo que 21 são questões fechadas e objetivas. Os indivíduos foram instruídos a assinalar "SIM" ou "NÃO" para cada item objetivo da escala, caso identificassem o item como uma barreira ou não para a inclusão/adesão. Resultados: 64(81%) da amostra não sabia da existência da reabilitação cardiovascular e dos seus benefícios. Para 50(63%) a distância da residência até o centro de reabilitação foi uma barreira. Além disso, o custo com mobilidade urbana 37 (47%) e a não indicação do médico por achar desnecessário 32 (40%) também foram apontadas como barreiras. Conclusão: Os resultados deste estudo indicam que as principais bramireis para a não inserção em programas de reabilitação cardiovascular foram a falta de conhecimento sobre os benefícios desse tipo de programa, a distância da residência dos pacientes até o centro mais próximo e o custo com deslocamento

Promoção do uso racional de antidiabéticos: importância da habilidade de comunicação clínica: Promotion of rational use of antidiabetics: importance of clinical communication skills

O diabetes mellitus (DM) é uma doença de alta prevalência na população brasileira sendo responsável por parte significativa dos atendimentos médicos e multiprofissionais no âmbito do sistema único de saúde nacional. De caráter insidioso e progressivo, o DM leva a complicações crônicas e múltiplas comorbidades que impactam tanto a qualidade de vida do paciente, como gera grande demanda financeira. O arcabouço terapêutico disponível atualmente no serviço público, permite retardar o desenvolvimento destas complicações. Entretanto, ainda impera a falta de aderência ao tratamento bem como a falta de disseminação do conhecimento acerca da doença. Diante de tal problemática, este artigo discute as atuais estratégias do uso racional de medicamentos hipoglicemiantes e a importância da comunicação com o paciente visando a adequada aderência terapêutica

Estimating underreporting of leprosy in Brazil using a Bayesian approach.

BACKGROUND: Leprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions. METHODOLOGY/PRINCIPAL FINDINGS: Using data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States. CONCLUSIONS/SIGNIFICANCE: The magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission

Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017.

Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil

Physical disabilities caused by leprosy in 100 million cohort in Brazil.

BACKGROUND: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS: Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy

Conversão de glicerol em propilenoglicol

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Instituto de Química, 2017.O objetivo do trabalho consiste em avaliar se a produção de propilenoglicol por meio do reaproveitamento do glicerol é rentável, quais são os possíveis impactos ambientais associados ao processo e como isso ocorre

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil.

Importance: Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries. Objective: To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors. Design, Setting, and Participants: This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018. Exposures: Clinical characteristics of the primary case and sociodemographic factors of the household contact. Main Outcomes and Measures: Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects. Results: Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42). Conclusions and Relevance: The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed

Histórico clínico da Artrite Idiopática Juvenil (AIJ): uma revisão integrativa: Clinical history of Juvenile Idiopathic Arthritis (JIA): an integrative review

Introdução: A Artrite Idiopática Juvenil (AIJ), artropatia crônica mais prevalente nos primeiros anos de vida, caracteriza-se por artrite objetiva persistente em uma ou mais articulações por, no mínimo, seis semanas, com apresentações clínicas diversas. Objetivo: abordar os conceitos a respeito da história clínica da Artrite Idiopática Juvenil direcionando-os para a sua fisiopatologia, seu diagnóstico e tratamento. Metodologia: Trata-se de uma revisão integrativa de literatura, pautada na pergunta norteadora: “Artrite Idiopática Juvenil: como se dá a sua fisiopatologia, seu diagnóstico, e tratamento?”. O levantamento bibliográfico foi realizado nas seguintes bases de dados: Portal Regional BVS (LILACS), Scientific Eletronic Library Online (SciELO) e National Library of Medicine (PUBMED). Os Descritores Controlados de Ciências da Saúde (DeCS) utilizados na busca, em associação ao operador booleano “AND”, foram: “Artrite Juvenil Idiopática”; “Tratamento”; “Diagnóstico”. Foram selecionados 19 artigos, publicados entre 2014 e 2021, que estavam de acordo com o objetivo da pesquisa e se enquadravam nos seguintes critérios de inclusão: artigos publicados em português, inglês ou espanhol, cujos títulos e resumos mostraram-se em consonância com o propósito da revisão de literatura, indexados nos referidos bancos de dados. Artigos repetidos, dissertações e resumos de anais foram excluídos. Resultados: Desse modo, foram encontrados 87 artigos nas bases de dados supracitadas, o que reforça o caráter patológico obscuro da artrite idiopática juvenil, de maneira que os fatores etiológicos e fisiopatológicos ainda não bem esclarecidos, acreditando-se que estes relacionam-se a fatores genéticos, ambientais e associações com outras artrites crônicas. O diagnóstico é eminentemente clínico, porém alguns exames como, fator reumatoide, PCR e anti-CCP podem ser usados com fins prognósticos e acompanhamento do curso inflamatório, bem como para divisão em sete subtipos de Artrite idiopática Juvenil: sistêmica, oligarticular, poliarticular com fator reumatoide positivo, poliarticular com fator reumatoide negativo, artrite psoriásica, artrite relacionada à entesite (ARE) e forma indiferenciada. Nesse ínterim, o tratamento deve ser individualizado, centrado nas necessidades de cada paciente, visto a variedade de subtipos e manifestações clínicas dessa entidade clínica, de forma a possibilitar o controle da inflamação e restauração das articulações afetadas. Nessa análise, de forma geral, os tratamentos são conduzidos com anti-inflamatórios não esteroidais, glicorticoides, imunobiológicos e tratamento não farmacológico, caracterizado por atenção psicossocial, orientações dietéticas e exercícios físicos. Conclusão: Portanto, é possível inferir que se trata de uma patologia de importância clínica em que os fatores fisiopatológicos não são completamente conhecidos, o que reforça a necessidade de mais estudos dentro dessa abordagem. Para mais, ressalta-se a necessidade de uma equipe multiprofissional na abordagem e condução do paciente acometido, dado quadro clínico diverso, que requer um tratamento farmacológico e não farmacológico