Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review

Objective: There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services. Methods: The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma. Results: Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers. Conclusions: Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.Univ Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Psiquiatria, Sao Paulo, SP, BrazilWeb of Scienc

Circular economy strategies and practices: A case study with multiple participants in the packaging sector in Brazil

This research analyses the leading strategies and practices for transforming Brazil's Circular Economy of packaging. In-depth semi-structured interviews (n=53) were conducted with stakeholders active in the Brazilian packaging sector and triangulated with document analysis. The main strategies identified were environmental education programs, MSW diversion practices, environmental crimes (regeneration) inspection, efficient use of products, and waste reduction (optimisation). As for sharing, the inequality resulting from regional differences in logistics infrastructure was highlighted. The paper has theoretical contributions, such as applying the ReSOLVE method and practices for generating social, environmental and economic benefits

Reduction Glossoplasty in a Calf with Bifid Tongue

Background: Fetal malformations are characterized by anatomical changes that compromise an organ or system. Tongue formation in bovines occurs with the fusion of three structures at the end of the fourth week of gestation, and any failure during this stage of embryonic development may lead to tongue malformation. Bifid tongue, also called glossoschisis, is a rare congenital abnormality in any species and is characterized by incomplete fusion of the lateral tongue buds, resulting in a deep groove in the midline of the tongue. The objective of this study was to describe a case of bifid tongue and the procedure of reduction glossoplasty in a calf of the Girolando breed in Tocantins State.Case: A male mixed-breed (Holstein-Friesian × Gir) calf, born from natural mating in the municipality of Araguaína, Tocantins, was clinically assessed in the Sector of Ruminant Clinical Medicine of the Federal University of Tocantins at 2 months of age. The owner reported that the animal exhibited difficulty in suckling after birth and that on inspection of the oral cavity, he observed changes in the tongue and mandible. Clinical examination of the oral cavity revealed the presence of a bifid tongue and abnormal fusion of the mandible in the region of the lower incisive teeth. It was decided to perform a surgical procedure with the aim of improving the animal’s quality of life because the owner wanted to keep it in the farm. An incision was made, followed by removal of the medial rims of the two tines of the tongue, and synthesis was performed, joining the ventral rims of the tongue, beginning at the root and ending at the apex.Discussion: The observed lesions are compatible with bifid tongue and mandibular fissure, both previously reported in other species. The literature has no reports of bifid tongue in bovines. The etiology of fetal malformations is still unclear, and the primary causes known in Brazil include ingestion of toxic plants by the mother, such as Mimosa tenuiflora and Poincianella pyramidalis; infections, with the main viral agents being bovine viral diarrhea virus and blue tongue virus; and teratogenic agents, namely certain medications administered during embryogenesis, e.g., ivermectin. Other potentially teratogenic agents that have not been identified as causes of malformation include radiation, cortisone, benzimidazoles, sulfonamides, folate antagonists, and organophosphates. The intense genetic improvement that the Holstein-Friesian breed has been subjected to, including inbreeding that results in consanguinity, may be a determining factor for the breed carrying mutant alleles. Because the calf in this report was crossbred from parents with Holstein-Friesian ancestry, it could carry mutant alleles that led to the malformation. Another etiology proposed in a study on embryological bases by Goodacre and Wallace (1990) is the persistence of buccopharyngeal membrane and amniotic constriction bands in the region of the branchial arches; this cause cannot be ruled out in the present case. Calves born with fetal malformations generate losses for cattle breeders because the calf dies either before or after birth, which may culminate with the death of the mother or, in cases in which the anomaly is compatible with life, damage to the animal’s development and well-being, as in the present report. Bifid tongue is a rare malformation in bovines, and reduction glossoplasty is essential for the description and improvement of techniques that aid bovine medicine; however, animals subjected to this procedure should not be used for reproduction. 

RRH: síndrome de envenenamento por 200 ferroadas de abelhas africanizadas

Envenoming syndrome from Africanized bee stings is a toxic syndrome caused by the inoculation of large amounts of venom from multiple bee stings, generally more than five hundred. The incidence of severe toxicity from Africanized bee stings is rare but deadly. This report reveals that because of the small volume of distribution, having fewer stings does not exempt a patient from experiencing an unfavorable outcome, particularly in children, elderly people or underweight people.A síndrome de envenenamento por ferroadas de abelhas africanizadas é causada pela inoculação de uma grande quantidade de peçonha por múltiplas ferroadas de abelhas, geralmente acima de quinhentas. A incidência de uma intoxicação severa por ferroadas de abelhas africanizadas é rara, porém letal. Este relato de caso aponta que, devido a um menor volume de distribuição do veneno, um número menor de ferroadas por abelhas africanizadas não exime o paciente de apresentar envenenamentos com desfecho desfavorável, principalmente em crianças, idosos e pessoas com baixo peso

ANÁLISE DA PREVALÊNCIA PARASITOLÓGICA EM AMOSTRAS FECAIS DE CRIANÇAS DE UMA ESCOLA DA REDE PÚBLICA DO ESTADO DE MINAS GERAIS

Introdução: as infecções parasitárias configuram um grave problema de saúde pública no Brasil, principalmente entre crianças, em decorrência de condições socioeconômicas e higiênico-sanitárias. Objetivo: analisar a prevalência parasitológica em amostras fecais de crianças de uma escola da rede pública do Estado de Minas Gerais. Método: trata-se de um estudo descritivo, exploratório, analítico, prospectivo, com abordagem quantitativa, realizada com 28 crianças com idade entre 6-10 anos de uma escola da rede pública. Foram analisadas amostras de fezes pelo método de Hoffman, Pons e Janer. Resultados: observou-se que 78,5% (n=22) das amostras apresentaram positividade parasitológica em ambos os sexos. Houve prevalência infecciosa de crianças do sexo feminino (n=18; 63,7%) as quais encontram-se com 6 anos de idade (n=14; 50,0%). As espécies de maior prevalência foram: Giardia lamblia (n=9; 31,8%), Entamoeba coli (n=6; 22,7%), Hymenolepis nana (n=6; 22,7%). Conclusão: as condições precárias ocasionadas pela deficiência de administrações públicas fazem com que famílias de renda baixa se aglomerem em regiões com pouco saneamento básico, tornando-se fácil a contaminação por parasitas.

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033

QUELOIDE GIGANTE EM ORELHA: UM RELATO DE CASO

A cicatrização é extremamente importante para a sobrevivência do ser humano, visto que configura um mecanismo de defesa refinado. A contínua restauração do tecido epitelial na pele, permite a regeneração celular e assegura sua integridade morfológica e funcional. O queloide é um fenômeno exclusivamente humano, e ocorre quando há falha na remodelação das cicatrizes provocadas pelo desequilíbrio entre a formação e a degradação de colágeno, assim como modificação na alteração em sua organização espacial, o que gera a cicatriz exuberante. A lesão é elevada, brilhante, pruriginosa e/ou dolorosa, se localiza na derme, com crescimento contínuo, além de ultrapassar os limites da ferida original. O relato aqui apresentado é de um paciente do sexo masculino, 56 anos, que procurou o ambulatório de Cirurgia Geral para exérese de estrutura hipertrófica no lóbulo auricular da orelha direita. O procedimento foi realizado sem nenhuma intercorrência e o paciente teve alta médica no mesmo dia com prescrição de analgésico