TRABALHO SOCIAL-REPRODUTIVO, DIREITO À SAÚDE E COVID-19: UMA REFLEXÃO À LUZ DA TEORIA DA INTERSECCIONALIDADE DE FRASER

Thispaper has as its object of study the theme of the right to health of  black and poor women in the context of the Covid-19 epidemic. Thispaper analyzes the relation between Fraser’s theory of interseccionality and the impact of the Covid-19 on the health of black and poor women who take on care functions and activities considered essential that could not be interrupted in the pandemic. The main research question consists in questioning: what was the relatationship between Fraser’s theory of interseccionality, established from a neo-marxist rereading, and the diproportionate impact of the Covid-19 on the lives and health of black and poor women who take on the care jobs and activities considered essential in the Brazilian pandemic context? It is argued, in the light of the Fraser’s theory of interseccionality, that the possibility of social isolation for women who took on social reproductive work and who were overrepresented in thefrontline activities in the Brazilian pandemic  context was permeated by criteria of race, gender and class, and such positions of subjection are produced by capitalist society, conceived as an institutionalized social order. As a result, although black and poor women are primarily responsible for reproductive social work in elite families and many of them have taken on activities considered essential,  they remain deprived of acess to qualified care services and the right to life during the pandemic context as a result of a broad commodification of care services promoted by neoliberal capitalism.  The research technique used is the indirect documentation through bibliographic investigation of the theoretical frameworks of Fraser and Marx and documentary research resulting from the survey of primary statistical sources. The work uses the historical-analytical method by Fraser. O presente trabalho tem como objeto de estudo a temática do direito à saúde de mulheres pobres e pretas no contexto da epidemia de Covid-19. O trabalho analisa a relação entre a teoria da interseccionalidade de Fraser e o impacto da pandemia da Covid-19 na saúde de mulheres pretas e pobres que assumiram funções de cuidado e atividades consideradas essenciais que não podiam ser interrompidas na pandemia.  O principal problema de pesquisa consiste no questionamento: qual a relação entre a teoria da interseccionalidade de Fraser, estabelecida a partir de uma releitura neomarxista, e o impacto desproporcional da pandemia da Covid-19 na vida e na saúde de mulheres negras e pobres que assumiram o trabalho social-reprodutivo e as consideradas atividades essenciais no contexto pandêmico brasileiro? Sustenta-se, à luz da teoria da interseccionalidade de Fraser, que a possibilidade de isolamento social de mulheres que assumiram o trabalho social-reprodutivo e que estavam sobrerrepresentadas em atividades da linha de frente no contexto pandêmico brasileiro foi perpassada por marcadores de raça, de gênero e de classe, sendo tais posições de sujeição produzidas pela sociedade capitalista, concebida como uma ordem social institucionalizada.  Como resultado, tem-se que, ainda que mulheres negras e pobres sejam principais responsáveis pelo trabalho-social reprodutivo nas famílias de classe média e de elite e de muitas delas terem assumido atividades consideradas essenciais, elas permaneceram privadas do acesso aos serviços de cuidado qualificados e do direito de preservar a vida durante o contexto pandêmico como resultado da mercantilização abrangente dos serviços de cuidado promovida pelo capitalismo neoliberal.  A técnica de pesquisa utilizada é a documentação indireta por meio de investigação bibliográfica aos marcos teóricos de Fraser e de Marx e de pesquisa documental decorrente do levantamento de fontes estatísticas primárias. Utiliza-se o método histórico-analítico de Fraser. &nbsp

Determination of biomarkers of cannabis consumption in hair samples: preliminary results

Poster apresentado no 20º Congresso Nacional de Medicina Legal e Ciências Forenses, 5ª Reunião da rede de Serviços médico-legais e forenses de Língua Portuguesa, Coimbra, 2022Over 96 million European adults are estimated to have consumed illicit drugs at some point in their lives, and cannabis is still the most consumed drug. The Portuguese data is obtained using surveys, but this type of study has several disadvantages, such as under or overestimation of consumption rates, which may lead to biased conclusions.Consequently, it is desirable that these studies are accompanied by drug monitoring in biological samples to circumvent the associated drawbacks.N/

Documenting human exposure to cannabinoids using oral fluid

Comunicação apresentada no 13º Encontro Nacional de Cromatografia, Lisboa, 17-19 dezembro 2023.The importance of studying non-conventional biological matrices such as oral fluid (OF) is increasingly being recognized. This sample presents several advantages, mainly related to its collection procedure: it is non-invasive, easy to perform by non-medical personnel, can be performed under supervision to prevent adulteration, and provides low biohazard risk. OF samples are more likely to contain parent drugs, reflecting recent drug use – a major advantage of this matrix1. A fast and robust analytical methodology was developed in OF samples for the determination of tetrahydrocannabinol (THC), 11-hydroxy-tetrahydrocannabinol (THC-OH), 11-carboxytetrahydrocannabinol (THC-COOH), cannabinol (CBN) and cannabidiol (CBD) by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), aiming at documenting cannabis consumption. Briefly, 200-μL aliquots of OF were subjected to protein precipitation with a refrigerated methanol/acetonitrile mixture (80:20, v/v). After centrifugation, the extracts were evaporated to dryness, reconstituted in methanol, and 5-μL aliquots were injected into the UPLC-QTRAP-MS 6500+ (SCIEX®) system (in a 14-minute run). The analysis was carried out in MRM mode with two transitions for each compound and one transition for each internal standard. The method was validated according to the guidelines of ANSI/ASB 0362. Parameters such as ion suppression/enhancement, interferents, linearity, precision and accuracy, limits of detection and quantification, dilution integrity and stability were studied and showcased satisfactory results. The 2 ng/mL cut-off for THC3 was achieved, and the method was successfully applied to real samples (57.95- 898.28 ng/mL for THC; 0.17-4.09 ng/mL for THC-COOH; 1.26-44.57 ng/mL for CBN; 0.42-1007.86 ng/mL).N/

Desenvolvimento e validação de um método analítico para a determinação de canabinóides em amostras de fluido oral por LC-MS/MS

Comunicação apresentada no 21º Congresso de Medicina Legal e Ciências ForensesA canábis é a droga de abuso mais consumida na Europa, pelo que várias metodologias analíticas têm sido desenvolvidas para a quantificação dos seus componentes em matrizes biológicas, especialmente sangue e urina. No entanto, cada vez mais se está a reconhecer a importância do estudo de matrizes biológicas não-convencionais, nomeadamente cabelo e fluido oral (ou saliva) – os seus procedimentos de recolha não são invasivos e estas amostras fornecem informações complementares sobre o uso de drogas, permitindo o controlo da exposição recente (saliva) e de médio a longo prazo (cabelo). Desta forma, foi desenvolvida uma metodologia analítica para a determinação e quantificação de tetrahidrocanabinol (THC), 11-hidroxi-tetrahidrocanabinol (THC-OH), 11-carboxitetrahidrocanabinol (THC-COOH), canabinol (CBN) e canabidiol (CBD) em amostras de saliva por cromatografia líquida acoplada à espectrometria de massa em tandem (LC-MS/MS). Segundo as Mandatory Guidelines for Federal Workplace Drug Testing Programs, o cut-off de THC em amostras de saliva é 2 ng/mL, exigindo um procedimento de extração otimizado e a utilização de uma técnica cromatográfica sensível. Resumidamente, a 200 μL de saliva foi adicionado o padrão interno, e as amostras foram submetidas a precipitação proteica com uma mistura de metanol/acetonitrilo (80:20, v/v) refrigerada. Depois de centrifugados, os extratos foram evaporados até à secura, reconstituídos em metanol, e 5 μL foram injetados no equipamento UPLC-QTRAP-MS 6500+ (SCIEX®), numa corrida de 14 minutos. A análise foi efetuada em modo MRM com duas transições para cada composto e uma transição para cada padrão interno. Os métodos foram validados de acordo com as diretrizes da norma ANSI/ASB 036, tendo sido estudados os parâmetros supressão iónica, interferentes, linearidade, precisão e exatidão, carryover, limites de deteção e quantificação, efeito de diluição e estabilidade das amostras extraídas. Todos os estudos destes parâmetros apresentaram resultados satisfatórios, e o método foi aplicado com sucesso a amostras reais. O método desenvolvido mostrou-se fácil, rápido, eficaz e robusto, estando apto para ser utilizado na rotina do laboratório, e sendo uma ferramenta complementar útil para o estudo do consumo recente de canabinóides.N/

Photodynamic Therapy as Novel Treatment for Halitosis in Adolescents: A Case Series Study

Introduction: Halitosis is a common problem that affects a large portion of the population worldwide. The origin of this condition is oral in 90% of cases and systemic in 10% of cases. The foul odor is caused mainly by volatile sulfur compounds produced by Gram-negative bacteria. However, it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide (H2S) in the presence of amino acids, such as cysteine. Light with and without the combination of chemical agents has been used to induce therapeutic and antimicrobial effects. In photodynamic therapy, the antimicrobial effect is confined to areas covered by the photosensitizing dye. The aim of the present case series study was to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using a sulfide meter (Halimeter®).Methods: Five adolescents aged 14 to 16 years were evaluated using a sulfide meter before and one hour after photodynamic therapy, which involved the use of methylene blue 0.005% on the middle third and posterior thirds of the dorsum of the tongue and nine points of laser irradiation in the red band (660 nm) with an energy dose of 9 J, power output of 100 mW and 90-seconds exposure time.Results: A 31.8% reduction in the concentration of volatile sulfur compounds was found in the comparison of the initial and final readings. The statistically significant reduction (p = 0.0091) led to an absence of halitosis following treatment (mean: 58.2 ppb).Conclusion: Photodynamic therapy seems to be effective on reduction the concentration of volatile sulfur compounds.Considering the positive effects of photodynamic therapy in this case series, further studies involving microbiological analyses should be conducted to allow comparisons of the results

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Cognitive Vocal Program applied to individuals with signals presbylarynx: preliminary results

PURPOSE: To propose and verify the feasibility of a vocal program intervention in patients with presbylarynx signs with or without vocal complaints. METHOD: Among 20 elder participants of the current research, 3 female patients with median age of 67 years were chosen for the pilot study. Laryngological examination, vocal recording with CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) protocol, and Screening Protocol of Risk of Dysphonia (SPRD) were conducted before and after the program intervention. They joined the Cognitive Vocal Program for presbyphonia based on the genetic epistemology by Jean Piaget associated with vocal techniques based on scientific literature. This program is structured with six sessions and each one of them is focused in different aspects of vocal production. RESULTS: After the program intervention, some aspects such as loudness, coordination between breathing and speaking, accuracy in articulatory movements, jitter, and harmonics-to-noise ratio improved with parameters within the expected range for the age group. Three female participants were observed for better vocal quality, higher fundamental frequency, and better maximum phonation time. In two cases, tension related to loudness elevation and better scores on SPRD was observed. Using by high-speed laryngeal image, we also observed reduction of presbylarynx signs, and remarkable improvement in glottis closure competence and mucosal wave movement of the patients with and without vocal complaints. CONCLUSION: The preliminary results suggest encouraging prospects for the proposal with improvement in the aspects analyzed. This program was well designed and did not require any further adjustments