Constituintes químicos de Vernonia scorpioides (Lam) Pers. (Asteraceae)

The chemical investigation of hexane and ethanol extracts from the aerial parts of Vernonia scorpioides resulted in the isolation and characterization of a new polyacetylene lactone, rel-4-dihydro-4β-hydroxy-5a-octa-2,4,6-triynyl-furan-2-(5H)-one, along with the new ethyl 3,4-dihydroxy-6,8,10-triynyl-dodecanoate, and seven known compounds: taraxasteryl acetate, lupeyl acetate, lupeol, lupenone, β-sitosterol, stigmasterol and luteolin. The structure of all compounds was determined by spectrometric techniques (HR-ESI-MS, ¹H and 13C NMR and IV) and comparison with published spectral data

Perspectivas Futuras em Terapias Imunomoduladoras para Psoríase uma análise abrangente

This scientific review provides a comprehensive and up-to-date analysis on Future Perspectives in Immunomodulatory Therapies for Psoriasis. Given the complexity and variability of this dermatological condition, it becomes crucial to thoroughly examine the available therapeutic approaches for a more effective understanding of this clinical challenge. Psoriasis, with its diverse clinical presentations, demands a holistic evaluation of available therapies, ranging from IL-23 inhibitors to lifestyle interventions, offering a complete overview of the current landscape. Not only does it highlight the diversity of available therapeutic approaches, but the review also emphasizes the crucial importance of personalization and early intervention. Recognizing the different manifestations of psoriasis and individual patient responses, the study underscores how therapeutic strategies tailored to the specific characteristics of each individual are essential to optimize outcomes. This personalization not only takes into account the uniqueness of each patient but also underscores the need for an integrative and multifaceted approach to psoriasis treatment. By exploring the latest findings and developments in this field, this study goes beyond consolidating existing information, aiming to foster a critical reflection on current therapeutic practices in psoriasis. In doing so, it provides valuable insights for healthcare professionals, researchers, and patients, fostering a deeper understanding of therapeutic strategies and contributing to the ongoing improvement of the quality of life for individuals with psoriasis.Esta revisão científica proporciona uma análise abrangente e atualizada sobre as Perspectivas Futuras em Terapias Imunomoduladoras para Psoríase. Diante da complexidade e variabilidade dessa condição dermatológica, torna-se crucial examinar detalhadamente as abordagens terapêuticas disponíveis para uma compreensão mais eficaz desse desafio clínico. A psoríase, com sua diversidade de apresentações clínicas, demanda uma avaliação holística das terapias disponíveis, desde os inibidores de IL-23 até intervenções no estilo de vida, oferecendo um panorama completo do cenário atual. Não apenas se destaca a diversidade de abordagens terapêuticas disponíveis, mas a revisão enfatiza a importância crucial da personalização e da intervenção precoce. Reconhecendo as diferentes manifestações da psoríase e as respostas individuais dos pacientes, o estudo ressalta como estratégias terapêuticas adaptadas às características específicas de cada indivíduo são essenciais para otimizar os resultados. Essa personalização não apenas leva em conta a singularidade de cada paciente, mas também sublinha a necessidade de uma abordagem integrativa e multifacetada para o tratamento da psoríase. Ao explorar as últimas descobertas e desenvolvimentos nessa área, este estudo vai além da consolidação de informações existentes, buscando promover uma reflexão crítica sobre as práticas terapêuticas atuais em psoríase. Ao fazê-lo, oferece insights valiosos para profissionais de saúde, pesquisadores e pacientes, fomentando uma compreensão mais profunda das estratégias terapêuticas e contribuindo para a contínua melhoria da qualidade de vida dos indivíduos com psoríase

The germline mutational landscape of BRCA1 and BRCA2 in Brazil

The detection of germline mutations in BRCA1 and BRCA2 is essential to the formulation of clinical management strategies, and in Brazil, there is limited access to these services, mainly due to the costs/availability of genetic testing. Aiming at the identification of recurrent mutations that could be included in a low-cost mutation panel, used as a first screening approach, we compiled the testing reports of 649 probands with pathogenic/likely pathogenic variants referred to 28 public and private health care centers distributed across 11 Brazilian States. Overall, 126 and 103 distinct mutations were identified in BRCA1 and BRCA2, respectively. Twenty-six novel variants were reported from both genes, and BRCA2 showed higher mutational heterogeneity. Some recurrent mutations were reported exclusively in certain geographic regions, suggesting a founder effect. Our findings confirm that there is significant molecular heterogeneity in these genes among Brazilian carriers, while also suggesting that this heterogeneity precludes the use of screening protocols that include recurrent mutation testing only. This is the first study to show that profiles of recurrent mutations may be unique to different Brazilian regions. These data should be explored in larger regional cohorts to determine if screening with a panel of recurrent mutations would be effective.This work was supported in part by grants from Barretos Cancer Hospital (FINEP - CT-INFRA, 02/2010), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, 2013/24633-2 and 2103/23277-8), Fundação de Apoio à Pesquisa do Rio Grande do Norte (FAPERN), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Ministério da Saúde, the Breast Cancer Research Foundation (Avon grant #02-2013-044) and National Institute of Health/National Cancer Institute (grant #RC4 CA153828-01) for the Clinical Cancer Genomics Community Research Network. Support in part was provided by grants from Fundo de Incentivo a Pesquisa e Eventos (FIPE) from Hospital de Clínicas de Porto Alegre, by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, BioComputacional 3381/2013, Rede de Pesquisa em Genômica Populacional Humana), Secretaria da Saúde do Estado da Bahia (SESAB), Laboratório de Imunologia e Biologia Molecular (UFBA), INCT pra Controle do Câncer and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). RMR and PAP are recipients of CNPq Productivity Grants, and Bárbara Alemar received a grant from the same agencyinfo:eu-repo/semantics/publishedVersio

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

The complete genome sequence of Chromobacterium violaceum reveals remarkable and exploitable bacterial adaptability

Chromobacterium violaceum is one of millions of species of free-living microorganisms that populate the soil and water in the extant areas of tropical biodiversity around the world. Its complete genome sequence reveals (i) extensive alternative pathways for energy generation, (ii) ≈500 ORFs for transport-related proteins, (iii) complex and extensive systems for stress adaptation and motility, and (iv) wide-spread utilization of quorum sensing for control of inducible systems, all of which underpin the versatility and adaptability of the organism. The genome also contains extensive but incomplete arrays of ORFs coding for proteins associated with mammalian pathogenicity, possibly involved in the occasional but often fatal cases of human C. violaceum infection. There is, in addition, a series of previously unknown but important enzymes and secondary metabolites including paraquat-inducible proteins, drug and heavy-metal-resistance proteins, multiple chitinases, and proteins for the detoxification of xenobiotics that may have biotechnological applications

Aquisição de leitura e escrita como resultado do ensino de habilidades de consciência fonológica Reading and writing acquisition as a result of teaching phonological awareness abilities

Quatro estudantes com dificuldades na aquisição de leitura e escrita foram submetidos a um programa de ensino para o desenvolvimento de habilidades de consciência fonológica, com tarefas de identificação de rima e aliteração e análise e síntese silábica e fonêmica, enquanto continuavam sendo expostos a um programa individualizado para ensino de leitura, no qual não haviam obtido sucesso previamente. Todos os participantes apresentaram baixos escores no pré-teste da Prova de Consciência Fonológica, mas concluíram o programa com sucesso e apresentaram elevados escores no pós-teste. A aquisição de leitura e de escrita mostrou uma clara aceleração após o desenvolvimento das habilidades de consciência fonológica e o efeito foi replicado entre os quatro alunos. Os resultados confirmam descobertas prévias sobre a relação entre consciência fonológica e aquisição de leitura e escrita. Tendo em vista o baixo repertório de entrada dos participantes, mesmo após exposição prolongada ao ensino de leitura, estes resultados, aliados aos de pesquisas recentes, sugerem fortemente a importância de estratégias para promover o desenvolvimento de habilidades de consciência fonológica antes ou simultaneamente ao ensino de leitura e escrita. Essas estratégias são especialmente importantes para estudantes em risco para o fracasso na aquisição desses repertórios e que constituem o maior contingente de alunos que requerem procedimentos especiais de ensino.<br>Four elementary school children who had previously failed in the acquisition of reading and spelling were included in a teaching program designed to establish phonological awareness. Tasks required the identification of rhymes and alliteration, and syllabic and phonemic analysis and synthesis. All participants scored low on the pre-tests for assessment of phonological awareness, but were successful in completing the program and scored high on the post-test assessment. Reading and spelling acquisition showed a clear acceleration after the development of phonological awareness; the effects were reliably replicated among the four students. These results confirm previous findings on the relation between phonological awareness and reading and writing acquisition. Considering the participants' repertoires, after the long and unsuccessful initial exposure to teaching procedures, the present results, along with the conclusions of recent intervention studies, strongly suggest the relevance of teaching strategies to promote phonological awareness, either before or simultaneously with teaching reading and writing. This is especially important for students at risk of reading failure, the largest contingent of students who need special teaching procedures

O Protagonismo Infantojuvenil nos Processos Educomunicativos

Neste volume “O protagonismo infantojuvenil nos processos educomunicativos”, reunimos 53 artigos que transitam sobre a temática do protagonismo infantojuvenil em diversas experiências e processos educomunicativos e para facilitar sua leitura e busca por temas de seu interesse, eles estão organizados em 8 capítulos que abordam a educomunicação a partir do fazer das crianças e da apropriação da produção midiática.&nbsp;Expressão artística, rádio, vídeo, jornalismo, cultura digital, redes sociais entre outros são os temas abordados pelos autores destes trabalhos. convidamos o leitor&nbsp;a mergulhar nesta jornada educomunicativa, vivendo e revivendo junto conosco essas experiências vividas por outros, refletindo em cada texto sobre como estamos, como evoluímos e como seguimos os passos daqueles que com sua ousadia, amor e luta elaboraram os fundamentos da educomunicação

Resumos concluídos - Saúde Coletiva

Resumos concluídos - Saúde Coletiv

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit