INFLUÊNCIA DE SISTEMAS DE REFRIGERAÇÃO SOBRE A QUALIDADE DO SÊMEN OVINO CRIOPRESERVADO EM PALHETAS

Avaliaram-se diferentes sistemas de refrigeração do sêmen ovino, através da aferição e comparação das curvas obtidas e seus efeitos sobre a qualidade do sêmen criopreservado. Ao final da refrigeração, os parâmetros espermáticos motilidade, vigor, defeitos morfológicos, viabilidade e estado acrossomal foram analisados. Para a avaliação pós-descongelação mais dois testes foram acrescentados: avaliação da integridade de membrana plasmática (IMP) e teste de exaustão com quatro horas de incubação a +37ºC.  A refrigeração foi realizada em refrigerador doméstico e num balcão horizontal. Para controlar a queda de temperatura desses equipamentos, colocaram-se as palhetas entre bolsas plásticas contendo água aquecida a +32ºC, constituindo quatro sistemas: RS (refrigerador sem bolsa), RC (refrigerador com bolsa), BS (balcão sem bolsa) e BC (balcão com bolsa), os quais resultaram em quatro taxas de refrigeração: -1,4ºC/min, -0,4ºC/min, -2,9ºC/min e -0,45ºC/min, para RS, RC, BS e BC, respectivamente. Após a refrigeração, observou-se diferença na motilidade espermática (P<0,05), em que BS apresentou menor média. O sistema BS obteve a menor média de vivos íntegros e também a maior de mortos íntegros ao final da refrigeração, diferindo de RC e BC. Quanto aos defeitos morfológicos pós-refrigeração, BS apresentou maior média (P<0,05), ao passo que RC e BC apresentaram as menores médias. Não foram observadas diferenças significativas entre os tratamentos na descongelação e ao final do teste de exaustão. Concluiu-se que as diferentes taxas de refrigeração afetaram o sêmen no final da fase de refrigeração, mas não após a descongelação. PALAVRAS-CHAVES: Congelação, ovino, protocolos-refrigeração, sêmen

A mudança comportamental da população após a conscientização dos riscos do câncer do tipo melanoma

O câncer de pele é o crescimento descontrolado e autônomo de células presentes neste tecido. É causado pela exposição intensa e intermitente a radiação ultravioleta da luz solar ou camas de bronzeamento, o que desencadeia mutações, ou defeitos genéticos, que levam as células da pele a se multiplicarem rapidamente e formar tumores malignos. Sabendo-se do papel da exposição solar no desencadeamento de neoplasias de pele, este estudo tem como objetivo apresentar a mudança de conduta da população após a conscientização sobre riscos do câncer de pele do tipo melanoma. Trata-se de um mini revisão, a partir de 5 artigos selecionados nas bases de dados PubMed e Scielo, utilizando os descritores: prevention, melanoma, comportamento, sendo selecionados artigos publicados entre 2015 e 2018. Concluiu-se que após a intervenção por meio de medidas promotoras de conhecimento sobre os riscos de câncer de pele tipo melanoma os indivíduos mudaram a conduta em relação aos fatores que podem ocasionar o melanoma

Rabdomiólise em adolescente com infecção por influenza tipo A: um relato de caso

RESUMO: A gripe H1N1 mais conhecida como gripe suína, surgiu no México no ano de 2009 e se espalhou pelo mundo, sendo declarada pela Organização Mundial de Saúde (OMS) como uma pandemia. Geralmente a doença apresenta sintomas de uma síndrome gripal comum, podendo evoluir para complicações raras como a rabdomiólise. O objetivo do presente estudo é relatar o caso de um adolescente com sintomas detosse, dor de garganta e febre, que evoluiu com mialgia intensa e fraqueza muscular, sendo confirmada infecção por influenza A e rabdomiólise associada. Inicialmente o paciente foi diagnosticado com amigdalite bacteriana e tratado com antibiótico e antiinflamatório. Contudo, apresentou piora do quadro clínico com os sintomas de febre, mialgia, dificuldade para deambular, astenia, tosse seca e queda importante do estadogeral. Com isso, foi levantada a hipótese diagnóstica de infecção por H1N1, realizando os exames confirmatórios, iniciando o tratamento com Oseltamivir (Tamiflu®) e o tratamento para a correção da rabdomiólise. Portanto, conclui-se a necessidade de considerar a presença de miosite e rabdomiólise em qualquer indivíduo que apresenta sintomas gripais em que a mialgia severa e/ou fraqueza muscular estão associadas

Perfil sociodemográfico e saúde mental de pacientes em tratamento oncológico durante a pandemia da COVID-19 em uma unidade de combate ao câncer de Anápolis – GO

A doença por coronavírus 2019 (Covid-19) repercutiu em diversas dimensões, afetando aspectos como o socioeconômico, o educacional e o da saúde, corroborando para o aumento de distúrbios mentais na população em geral. Por conseguinte, os pacientes em tratamento oncológico são afetados psicologicamente por esse cenário, o que pode refletir diretamente em adesão terapêutica, prognóstico e qualidade de vida. Sendo assim, o presente estudo teve como objetivo descrever o perfil sociodemográfico e avaliar a influência do cenário pandêmico na saúde mental de pacientes em tratamento oncológico na cidade de Anápolis – Goiás. Trata-se de um estudo descritivo, transversal, de abordagem quantitativa, envolvendo pacientes entre 18 e 90 anos de idade em tratamento antineoplásico de março de 2020 à março de 2021, sendo usado para coleta de dados o Questionário de Saúde Geral (QSG-12). Participaram da pesquisa 133 pacientes, sendo 66,2% do sexo feminino; a idade variou de 20 a 87 anos, com prevalência entre 50 e 70 anos (54,13%); a situação conjugal predominante foi “casado” (52,6%); pertencentes à religião católica (61,7%); a maioria com baixa escolaridade (51,9%); e com uma renda de até um salário mínimo (58,6%). Em relação à saúde mental, percebeu-se que a sensação de agonia (42,1%), a incapacidade em concentrar-se no que faz (45,1%) e a a perda do sono pelas preocupações (45,1%) foram os aspectos negativos mais relatados. Também notou-se que não houve diminuição significativa das visitas ambulatoriais em razão da pandemia, sendo os aspectos mais considerados por aqueles que reduziram suas idas, o isolamento social e o receio de contrair a doença da Covid-19. Desse modo, deve-se haver um maior fomento a pesquisas sobre esse assunto, a fim de oferecer um melhor atendimento a esse perfil de pacientes.Coronavirus disease 2019 (Covid-19) has repercussed on several dimensions, affecting aspects such as socioeconomic, educational and health, corroborating the increase in mental disorders in the general population. Therefore, patients undergoing cancer treatment are affected psychologically by this scenario, which can directly reflect on therapeutic adherence, prognosis and quality of life. Thus, the present study aimed to describe the sociodemographic profile and evaluate the influence of the pandemic scenario on the mental health of patients undergoing cancer treatment in the city of Anápolis - Goiás. This is a descriptive, cross-sectional, quantitative study, involving patients between 18 and 90 years of age undergoing antineoplastic treatment from March 2020 to March 2021, and the General Health Questionnaire (GHQ-12) was used for data collection. The study included 133 patients, 66.2% female; age ranged from 20 to 87 years, with prevalence between 50 and 70 years (54.13%); predominant marital status was "married" (52.6%); belonging to the Catholic religion (61.7%); most with low education (51.9%); and with an income of up to one minimum wage (58.6%). Regarding mental health, it was noticed that the feeling of agony (42.1%), inability to concentrate on what they do (45.1%) and loss of sleep due to worries (45.1%) were the most reported negative aspects. It was also noted that there was no significant decrease in outpatient visits due to the pandemic, being the aspects most considered by those who reduced their trips, social isolation and fear of contracting Covid-19 disease. Accordingly, there should be greater encouragement to research on this subject in order to provide better care to this profile of patients

Diagnóstico pré-natal de doenças genéticas / Pré natal diagnostic of genetic disease

O diagnóstico pré-natal de doenças genéticas envolve exames invasivos, testes de rastreamento e métodos de triagem, para acompanhamento da viabilidade fetal durante o período gestacional. Neste artigo de revisão foram enfatizadas as principais indicações, contra-indicações, complicações, diferenças entre cada um dos procedimentos. Idade materna, período gestacional, presença de anomalia genética na família são os principais pré-requisitos para a escolha do método mais adequado a ser utilizado, sendo de caráter obrigatório o prévio conhecimento dos pais a respeito do risco-benefício do mesmo. O aconselhamento genético para este tipo de exame diagnóstico é de fundamental importância uma vez que o resultado pode mudar completamente as perspectivas de uma família. Esse tema é rodeado de questionamentos éticos visto que a vida de um concepto encontra-se em questão.

Resistência a antibióticos mediada por plasmídeos / Plasmide-mediated resistance to antibiotics

Resistência bacteriana à agentes antimicrobianos é um problema mundial sério, e entendendo a base molecular de como os genes responsáveis  pela resistência são adquiridos  e transmitidos, pode-se  contribuir com a criação de novas estratégias antimicrobianas. Um mecanismo eficiente para a aquisição e disseminação de determinantes de resistência é a transmissão por elementos genéticos móveis (plasmídeos). Verificou-se que plasmídeos, transposons através de conjugação, são responsáveis pela expansão horizontal de genes de resistência ao longo das gerações de bactérias. Recentemente, elementos de expressão gênica foram denominados “integrons” que são veículos para aquisição de genes de resistência levada por plasmídeos. Os integrons também estão envolvidos na recombinação genética de determinantes de resistência e foram observados em patógenos bacterianos múltiplo-antibiótico-resistentes

Multidisciplinary approach in breast cancer.

Breast cancer is the most common neoplasm among women. Worldwide, there will be about 2.1 million newly diagnosed female breast cancer cases in 2018, accounting for almost 1 in 4 cancer cases among women. The disease is the most frequently diagnosed cancer in the vast majority of the countries. The purpose of this article is to report the positive experience of a multidisciplinary team in the care of women with breast cancer and their family members. Our approach that is part of the Cancer Patient Support Center (CPSC) at the public health (IPSEMG) in Brazil has been developed taking into account a broader concept of health care. We value not only individual dimensions in patient care, but also common ones, we recognize the importance of dealing with non-biological aspects of the disease, such as socioeconomic, political and cultural facets and our service is focused on health promotion rather than merely on curative treatment. Among the advantages of our approach, we highlight the facilitated accessibility to health services, the patient-centered communication and shared decision making, and the strong bonds between health professionals, patients, and family members. As part of CPSC`s activities, we emphasize the services provided by ?Aconchego? (?Warmth?), that is our breast cancer support group at public health in Brazil

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations