Temporal trend of tuberculosis incidence and its spatial distribution in Macapá – Amapá

OBJETIVO: Avaliar a tendência temporal da incidência da tuberculose após a implementação do teste rápido molecular, identificar se a tuberculose apresenta variação sazonal e classificar o território de acordo com a densidade de casos e as áreas de risco em Macapá-AP. MÉTODOS: Estudo ecológico composto por casos de tuberculose registrados no SINAN entre 2001 e 2017. Foi utilizado o teste Prais-Winsten para classificar a tendência temporal da incidência e a Série Temporal Interrompida para identificar mudanças na tendência temporal antes e depois da implementação do teste rápido molecular, além de verificar a sazonalidade no município. Utilizou-se o estimador de Kernel para classificar a densidade de casos e estatística de varredura para identificar áreas de risco da tuberculose. RESULTADOS: Foram identificados 1730 casos, observando-se que a tendência temporal da incidência de tuberculose foi decrescente (-0,27% por mês, IC95% −0,13 a −0,41). Não houve mudança de nível na série temporal após a implantação do teste molecular GeneXpert® MTB/RIF, porém, o período pós teste foi classificado como crescente em termos da incidência (+2,09% por mês, IC95% 0,92 a 3,27). Quanto à variação sazonal, apresentou crescimento (+13,7%/mês, IC95% 4,71 a 23,87) nos meses de dezembro a junho, referente ao período de chuvas – chamado inverno amazônico – e decréscimo (-9,21% por mês, IC95% −1,37 a −16,63) nos demais períodos. Por meio de Kernel, foram classificadas áreas com alta densidade de casos nos distritos Central e Norte e, com a estatística de varredura, foram identificados três aglomerados de proteção, AE1 (RR = 0,07), AE2 (RR = 0,23) e AE3 (RR = 0,36), e um aglomerado de alto risco, AE4 (RR = 1,47). CONCLUSÃO: A tendência temporal da incidência de tuberculose se revelou decrescente na série temporal, todavia, um crescimento na detecção foi observado após introdução do TRM-TB, e ainda se evidenciou que há comportamento sazonal da tuberculose. A distribuição dos casos foi heterogênea, com tendência de concentração em territórios vulneráveis e de risco, evidenciando um padrão de desigualdade da doença no território.OBJECTIVE: To evaluate the temporal trend of tuberculosis incidence after the implementation of the rapid molecular test (RMT-TB), to identify whether tuberculosis presents seasonal variation and to classify the territory according to case density and risk areas in Macapá, Amapá. METHODS: Ecological study of tuberculosis cases registered in the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) between 2001 and 2017. We used the Prais-Winsten test to classify the temporal trend of incidence and the interrupted time series to identify changes in the temporal trend before and after the implementation of the rapid molecular test, and to verify seasonality in the municipality. The Kernel estimator was used to classify case density and scan statistics to identify areas of tuberculosis risk. RESULTS: A total of 1,730 cases were identified, with a decreasing temporal trend of tuberculosis incidence (−0.27% per month, 95%CI −0.13 to −0.41). The time series showed no change in level after the implementation of the GeneXpert®MTB/RIF molecular test; however, the incidence increased in the post-test period (+2.09% per month, 95%CI 0.92 to 3.27). Regarding the seasonal variation, it showed growth (+13.7%/month, 95%CI 4.71 to 23.87) from December to June, the rainy season – called amazon winter season –, and decrease (−9.21% per month, CI95% −1.37 to −16.63) in the other periods. We classified areas with high density of cases in the Central and Northern districts using Kernel and identified three protection clusters, SC1 (RR = 0.07), SC2 (RR = 0.23) and SC3 (RR = 0.36), and a high-risk cluster, SC4 (RR = 1.47), with the scan statistics. CONCLUSION: The temporal trend of tuberculosis incidence was decreasing in the time series; however, detection increased after the introduction of RMT-TB, and tuberculosis showed seasonal behavior. The case distribution was heterogeneous, with a tendency to concentrate in vulnerable and risk territories, evidencing a pattern of disease inequality in the territory

HIPERTENSÃO ARTERIAL: PREVALÊNCIA, TRATAMENTO E CONTROLE DA DOENÇA

In this article you will have the opportunity to understand that systemic arterial hypertension is a chronic non-communicable disease of multifactorial origin, and in addition, understand the diagnosis of hypertension, the associated risk factors and care management. This study is based on a bibliographical review, where bibliographical surveys were carried out based on the topic, understanding it to be a safe instrument for carrying out this research. Furthermore, in screening actions, health professionals must be sensitive to the signs and symptoms of hypertension to direct actions. People who experience headache, nausea, malaise, pain in the back of the neck, pain behind the eyes, chest pain, angina, fatigue and changes in blood pressure measurements without an apparent cause may have developed high blood pressure and should be screened and identified early for treatment. timely.Neste artigo você vai ter a oportunidade de compreender que a hipertensão arterial sistêmica é uma doença crônica não transmissível de origem multifatorial, e além disso, compreender o diagnóstico da HAS, os fatores de risco associados e o manejo do cuidado. Este estudo parte de uma revisão bibliográfica, onde foram realizados levantamentos bibliográficos a partir do tema, entendendo ser um instrumento seguro para a realização desta pesquisa. Além disso, nas ações de rastreamento os profissionais de saúde devem estar sensíveis aos sinais e sintomas da hipertensão para o direcionamento das ações. Pessoas que apresentam cefaleia, náusea, mal-estar, dor na nuca, dor atrás dos olhos, dor precordial, angina, fadiga e alteração na medida da pressão arterial sem causa aparente podem ter desenvolvido hipertensão arterial e devem ser rastreadas e identificadas precocemente para tratamento oportuno

EFEITO DA SEMAGLUTIDA NO TRATAMENTO DO DIABETES MELLITUS TIPO 2 E SUA APLICABILIDADE NO CONTEXTO DA ATENÇÃO PRIMÁRIA: UMA REVISÃO BIBLIOGRÁFICA.

Type 2 Diabetes Mellitus (DM2) is a disease characterized by a set of metabolic disorders that result in altered glycemic levels and, in the medium and long term, the appearance of lesions in target organs when not treated appropriately. This condition can be controlled by diet, physical exercise and drugs indicated for its treatment, and should always be monitored by a trained professional and, ideally, a multidisciplinary team. The purpose of this study was to address a generalized view of DM2 in relation to its pathophysiology, etiology and prognosis. Point out the possible medications for your treatment and their respective mechanisms of action, establishing a cost-effective relationship so that care occurs in the most favorable way possible. Furthermore, deepen knowledge about the use of Semaglutide in the treatment of people with DM2 related to its applicability in the context of primary care, evaluating its effectiveness, incidence of adverse reactions, economic viability and comparing it with other hypoglycemic agents available in the SUS. To construct this study, a bibliographical review of articles related to the topic was carried out, reaching the conclusion that shared therapy between doctor and patient combined with individualized treatment is necessary. The use of Semaglutide proved to be beneficial in terms of glycemic control and weight loss, however, attention should be paid to its adverse effects, mainly related to the gastrointestinal system.Diabetes Mellitus tipo 2 (DM2) é uma doença caracterizada por um conjunto de distúrbios metabólicos que resultam em níveis glicêmicos alterados e, a médio e longo prazo, pelo aparecimento de lesões em órgãos alvo quando não tratada adequadamente. Tal condição pode ser controlada por dieta, exercícios físicos e drogas indicadas para o seu tratamento, devendo sempre ser acompanhada por profissional capacitado e, idealmente, equipe multiprofissional. A proposta deste estudo foi abordar uma visão generalizada da DM2 com relação a sua fisiopatologia, etiologia e prognóstico. Apontar os medicamentos possíveis para seu tratamento e os seus respectivos mecanismos de ação, estabelecendo uma relação custo-efetiva para que o cuidado ocorra da maneira mais favorável possível. Além disso, aprofundar os conhecimentos sobre o uso da Semaglutida no tratamento de portadores de DM2 relacionado a sua aplicabilidade no contexto da atenção primária, avaliando sua eficácia, incidência de reações adversas, viabilidade econômica e comparando-a com os outros hipoglicemiantes disponíveis no SUS. Para a construção desse estudo foi realizada uma revisão bibliográfica de artigos relacionados à temática, chegando-se a conclusão de que se faz necessária uma terapêutica compartilhada entre médico e paciente aliado a um tratamento individualizado. O uso da Semaglutida se mostrou benéfico no que tange o controle glicêmico e a perda de peso, porém deve-se atentar aos seus efeitos adversos, principalmente, relacionados ao sistema gastrointestinal

Guided Endodontic Approach in Teeth with Pulp Canal Obliteration and Previous Iatrogenic Deviation: A Case Series

Pulp canal obliteration (PCO) is a challenging clinical scenario in which canals must be located in progressively narrowing roots. Recently, proof of concept papers have, in parallel, introduced the combination of cone-beam computed tomography and surface scans for the construction of guides to pilot the negotiation and preparation of partially or completely obliterated pulp chambers and canals in anterior and posterior teeth. Authors’ purpose is to describe the treatment approach for teeth with PCO and previous iatrogenic deviation using guided endodontic technique. The clinical cases reported here show that technological evolutions should make guided endodontic procedures more widespread because their execution is relatively fast and safe even in the cases of root canal deviation. Treatment of teeth with pulp canal obliteration with deviations or perforation may be more effective with designed 3D printed access guides that seems to be a safe and clinically feasible method to locate root canals

ATLANTIC POLLINATION: a data set of flowers and interaction with nectar-feeding vertebrates from the Atlantic Forest

Flowering plant species and their nectar-feeding vertebrates exemplify some of the most remarkable biotic interactions in the Neotropics. In the Brazilian Atlantic Forest, several species of birds (especially hummingbirds), bats, and non-flying mammals, as well as one lizard feed on nectar, often act as pollinators and contribute to seed output of flowering plants. We present a dataset containing information on flowering plants visited by nectar-feeding vertebrates and sampled at 166 localities in the Brazilian Atlantic Forest. This dataset provides information on 1902 unique interactions among 515 species of flowering plants and 129 species of potential vertebrate pollinators and the patterns of species diversity across latitudes. All plant-vertebrate interactions compiled were recorded through direct observations of visits, and no inferences of pollinators based on floral syndromes were included. We also provide information on the most common plant traits used to understand the interactions between flowers and nectar-feeding vertebrates: plant growth form, corolla length, rate of nectar production per hour in bagged flowers, nectar concentration, flower color and shape, time of anthesis, presence or absence of perceptible fragrance by human, and flowering phenology as well as the plant's threat status by International Union for Conservation of Nature (IUCN) classification. For the vertebrates, status of threat by IUCN classification, body mass, bill or rostrum size are provided. Information on the frequency of visits and pollen deposition on the vertebrate's body is provided from the original source when available. The highest number of unique interactions is recorded for birds (1771) followed by bats (110). For plants, Bromeliaceae contains the highest number of unique interactions (606), followed by Fabaceae (242) and Gesneriaceae (104). It is evident that there was geographical bias of the studies throughout the southeast of the Brazilian Atlantic Forest and that most effort was directed to flower-hummingbird interactions. However, it reflects a worldwide tendency of more plants interacting with birds compared with other vertebrate species. The lack of similar protocols among studies to collect basic data limits the comparisons among areas and generalizations. Nevertheless, this dataset represents a notable effort to organize and highlight the importance of vertebrate pollinators in this hotspot of biodiversity on Earth and represents the data currently available. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or scientific events

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Measurement of the impact-parameter dependent azimuthal anisotropy in coherent ρ0 photoproduction in Pb–Pb collisions at √sNN = 5.02 TeV

The first measurement of the impact-parameter dependent angular anisotropy in the decay of coherently photoproduced ρ0 mesons is presented. The ρ0 mesons are reconstructed through their decay into a pion pair. The measured anisotropy corresponds to the amplitude of the cos(2ϕ) modulation, where ϕ is the angle between the two vectors formed by the sum and the difference of the transverse momenta of the pions, respectively. The measurement was performed by the ALICE Collaboration at the LHC using data from ultraperipheral Pb−Pb collisions at a center-of-mass energy of sNN−−−√ = 5.02 TeV per nucleon pair. Different impact-parameter regions are selected by classifying the events in nuclear-breakup classes. The amplitude of the cos(2ϕ) modulation is found to increase by about one order of magnitude from large to small impact parameters. Theoretical calculations, which describe the measurement, explain the cos(2ϕ) anisotropy as the result of a quantum interference effect at the femtometer scale that arises from the ambiguity as to which of the nuclei is the source of the photon in the interaction