Showing papers by "Universidade de Pernambuco published in 2016"

A century of trends in adult human height

Abstract: Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study

Abstract: Summary Background The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy. Methods We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities. Findings Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6–∞); OR 113·3 (95% CI 14·5–∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9–∞) for four cases without brain abnormalities. Interpretation Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size. Funding Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study

Abstract: Objective To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic. Design Retrospective study with a case series. Setting Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil. Participants 23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans. Results Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus—the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases. Conclusion Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.

2 nd Brazilian Consensus on Chagas Disease, 2015.

Abstract: Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

II Consenso Brasileiro em Doença de Chagas, 2015

Abstract: RESUMO A doenca de Chagas e uma condicao cronica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicologico, social e economico. Representa um importante problema de saude publica no Brasil, com diferentes cenarios regionais. Este documento traduz a sistematizacao das evidencias que compoe o Consenso Brasileiro de Doenca de Chagas. O objetivo foi sistematizar estrategias de diagnostico, tratamento, prevencao e controle da doenca de Chagas no pais, de modo a refletir as evidencias cientificas disponiveis. Sua construcao fundamentou-se na articulacao e contribuicao estrategica de especialistas brasileiros com conhecimento, experiencia e atualizacao sobre diferentes aspectos da doenca. Representa o resultado da estreita colaboracao entre a Sociedade Brasileira de Medicina Tropical e o Ministerio da Saude. Espera-se com este documento fortalecer o desenvolvimento de acoes integradas para enfrentamento da doenca no pais com foco em epidemiologia, gestao, atencao integral (incluindo familias e comunidades), comunicacao, informacao, educacao e pesquisas.

Congenital Zika syndrome with arthrogryposis: retrospective case series study.

Abstract: Objective To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Design Retrospective case series study. Setting Association for Assistance of Disabled Children, Pernambuco state, Brazil. Participants Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. Results The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Conclusions Congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis. The arthrogryposis was unrelated to the abnormalities of the joints themselves, but was possibly of neurogenic origin, with chronic involvement of central and peripheral motor neurones leading to deformities as a result of fixed postures in utero. Based on the neurophysiological observations, we suggest two possible mechanisms: tropism of neurones, with involvement of peripheral and central motor neurones, or a relation with vascular disorders.

Dengue Virus-Specific Antibodies Enhance Brazilian Zika Virus Infection.

Abstract: Anti-Flavivirus antibodies are highly cross-reactive and may facilitate Zika virus (ZIKV) infection through the antibody-dependent enhancement (ADE) mechanism. We demonstrate that dengue-specific antibodies enhance the infection of a primary Brazilian ZIKV isolate in a FcγRII-expressing K562 cell line. In addition, we demonstrate that serum samples from dengue-immune pregnant women enhanced ZIKV infection. These findings highlight the need for epidemiological studies and animal models to further confirm the role of ADE in the development of congenital and neurological complications associated with ZIKV infections.

More Common Than You Think: An In-depth Study of Casual Contributors

Abstract: Source code hosting websites (code forges) have recently changed to more social environments, and the contribution process evolved to the so-called pull-based development model. Due to the facilities brought by this evolution, Open Source Software (OSS) projects are now facing a high exposure, leading to an increasing number of contributors. However, not all these contributors want to have a long-term engagement with the project. In fact, popular projects are known to have a restricted set of core developers who drive the project, but now these projects count on a broad set of "not that involved" developers, which are responsible for a long tail of small contributions. In this paper, we shed the light on this important but overlooked set of developers: the casual contributors (also known as drive-by commits). First, we mined popular software repositories hosted on GitHub to investigate how common casual contributions are, and what are their characteristics. Second, we conducted two surveys with (1) the casual contributors and (2) the project maintainers aimed at understanding what motivates casual contributors and how they are perceived. Our results showed that although casual contributors are rather common (48.98% of the whole population of contributors in the projects analyzed), they are responsible for only 1.73% of the total number of commits. We also found that casual contributions are far from being trivial: even though a significant proportion of them are fixing typos and grammar issues (28.64%), we found several of them that have fixed bugs (30.20%), added new features (18.75%), and refactored code (8.85%). Still, we found that both casual contributors and project maintainers believe that casual contributions have more benefits than drawbacks. As a casual contributor said: "every bit helps".

[Brazilian Consensus on Chagas Disease, 2015].

Abstract: Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

Climate changes in mangrove forests and salt marshes

Abstract: Esta e uma sintese enquadrada na Rede de Monitoramento de Habitats Bentonicos Costeiros (ReBentos, GT4: Manguezais e Marismas), embasada em literatura cientifica que examina interacoes entre clima e biodiversidade, assim como fatores antropicos, incluindo aqueles responsaveis pela diminuicao da resiliencia sistemica. O objetivo deste trabalho e determinar as dificuldades quanto a deteccao de sinais precoces e alertas de mudancas climaticas com dados de monitoramento. No presente trabalho, tambem foram exploradas formas de contornar os diversos obstaculos identificados. A exposicao e a sensitividade de especies de mangue e de marisma, bem como dos ecossistemas dos quais fazem parte, os tornam extremamente vulneraveis e potenciais indicadores ambientais de mudancas de nivel do mar e outras respostas as variacoes do clima. Entretanto, a interpretacao de mudancas em manguezais e marismas e em seus atributos sistemicos deve ser meticulosa, considerando assinatura energetica, regime de disturbios e pressoes ambientais em cada local de estudo. Os potenciais de adaptacao e de sobrevivencia, em resposta a tais mudancas, dependem da fisiologia de cada especie e dos processos contextuais onde reside a resiliencia e a capacidade de persistir (em niveis local, de paisagem e regionais). A zona costeira deve ser alvo de medidas antecipatorias para reducao de riscos por quaisquer impactos, uma vez que nela ha intensa convergencia de processos sociais e ecologicos. Os ecossistemas dessa zona devem ser integrados em estrategias de adaptacao. O manejo costeiro deve ser embasado em mitigacao pro-ativa e colaborativa de longo-termo, sempre com base em estudos ecossistemicos e em programas de monitoramento que possam 1) prover sistema de alerta precoce; 2) preencher lacunas entre correlacoes simplistas que proveem inferencias fracas, e abordagens baseadas em processos que levem a atribuicoes mais confiaveis e a melhores niveis de antecipacao.

Prevalence of musculoskeletal pain in adolescents and association with computer and videogame use.

Abstract: Objective: This study investigated the presence of musculoskeletal symptoms in high school adolescents from public schools and its association with electronic device use. Methods: The sample consisted of 961 boys and girls aged 14 to 19 years who answered a questionnaire regarding the use of computers and electronic games, and questions about pain symptoms and physical activity. Furthermore, anthropometric assessments of all volunteers were performed. The chi-squared test and a multiple logistic regression model were used for the inferential analysis. Results: The presence of musculoskeletal pain symptoms was reported by 65.1% of the adolescents, being more prevalent in the thoracolumbar spine (46.9%), followed by pain in the upper limbs, representing 20% of complaints. The mean time of use for computers and electronic games was 1,720 and 583 minutes per week, respectively. The excessive use of electronic devices was demonstrated to be a risk factor for cervical and lumbar pain. Female gender was associated with the presence of pain in different body parts. Presence of a paid job was associated with cervical pain. Conclusion: A high prevalence of musculoskeletal pain in adolescents, as well as an increased amount of time using digital devices was observed. However, it was only possible to observe an association between the increased use of these devices and the presence of cervical and low back pain.

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

Abstract: Pneumonia plays an important role in children’s morbidity and mortality. In Brazil, epidemiological and social changes occurred concomitantly with the universal introduction of the 10-valent pneumococcal conjugate vaccine. This study identified risk factors for pneumonia following the implementation of a pneumococcal vaccination program. A hospital-based, case-control study involving incident cases of pneumonia in children aged 1–59 months was conducted between October 2010 and September 2013 at a tertiary hospital in northeastern Brazil. The diagnosis of pneumonia was based on the World Health Organization (WHO) criteria. The control group consisted of children admitted to the day-hospital ward for elective surgery. Children with comorbidities were excluded. The risk factors for pneumonia that were investigated were among those classified by the WHO as definite, likely and possible. A multivariate analysis was performed including variables that were significant at p ≤ 0.25 in the bivariate analysis. The study evaluated 407 children in the case group and 407 children in the control group. Household crowding (OR = 2.15; 95 % CI, 1,46–3,18) and not having been vaccinated against the influenza virus (OR = 3.59; 95 % CI, 2,62–4.91) were the only factors found to increase the likelihood of pneumonia. Male gender constituted a protective factor (OR = 0.53; 95 % CI, 0,39–0,72). Changes on risk factors for pneumonia were most likely associated with the expansion of the vaccination program and social improvements; however, these improvements were insufficient to overcome inequalities, given that household crowding remained a significant risk factor. The protection provided by the influenza vaccine must be evaluated new etiological studies. Furthermore, additional risk factors should be investigated.

Cardiac Regeneration using Growth Factors: Advances and Challenges.

Abstract: Myocardial infarction is the most significant manifestation of ischemic heart disease and is associated with high morbidity and mortality. Novel strategies targeting at regenerating the injured myocardium have been investigated, including gene therapy, cell therapy, and the use of growth factors. Growth factor therapy has aroused interest in cardiovascular medicine because of the regeneration mechanisms induced by these biomolecules, including angiogenesis, extracellular matrix remodeling, cardiomyocyte proliferation, stem-cell recruitment, and others. Together, these mechanisms promote myocardial repair and improvement of the cardiac function. This review aims to address the strategic role of growth factor therapy in cardiac regeneration, considering its innovative and multifactorial character in myocardial repair after ischemic injury. Different issues will be discussed, with emphasis on the regeneration mechanisms as a potential therapeutic resource mediated by growth factors, and the challenges to make these proteins therapeutically viable in the field of cardiology and regenerative medicine. Resumo O infarto do miocardio representa a manifestacao mais significativa da cardiopatia isquemica e esta associado a elevada morbimortalidade. Novas estrategias vem sendo investigadas com o intuito de regenerar o miocardio lesionado, incluindo a terapia genica, a terapia celular e a utilizacao de fatores de crescimento. A terapia com fatores de crescimento despertou interesse em medicina cardiovascular, devido aos mecanismos de regeneracao induzidos por essas biomoleculas, incluindo angiogenese, remodelamento da matriz extracelular, proliferacao de cardiomiocitos e recrutamento de celulas-tronco, dentre outros. Em conjunto, tais mecanismos promovem a reparacao do miocardio e a melhora da funcao cardiaca. Esta revisao pretende abordar o papel estrategico da terapia, com fatores de crescimento, para a regeneracao cardiaca, considerando seu carater inovador e multifatorial sobre o reparo do miocardio apos dano isquemico. Diferentes questoes serao discutidas, destacando-se os mecanismos de regeneracao como recurso terapeutico potencial mediado por fatores de crescimento e os desafios para tornar essas proteinas terapeuticamente viaveis no âmbito da cardiologia e da medicina regenerativa.

Short version of the Depression Anxiety Stress Scale-21: is it valid for Brazilian adolescents?

Abstract: Objetivo Avaliar a reprodutibilidade interdias, a concordância e a validade do construto da versao reduzida da Depression Anxiety Stress Scale-21 aplicada a adolescentes. Metodo A amostra foi composta por adolescentes de ambos os sexos, com idades entre 10 e 19 anos, recrutados de escolas e centros esportivos. A validade de construto foi realizada por analise fatorial exploratoria, e a confiabilidade foi calculada para cada construto, por meio de coeficiente de correlacao intraclasse, erro padrao de medida e mudanca minima detectavel. Resultados A analise fatorial combinando os itens correspondentes a ansiedade e estresse em um unico fator, e depressao em um segundo fator apresentou melhor adequacao de todos os 21 itens, com cargas fatoriais mais altas em seus respectivos construtos. Os valores de reprodutibilidade para a depressao foram coeficiente de correlacao intraclasse com 0,86, erros padrao de medida com 0,80 e mudanca minima detectavel com 2,22 e, para a ansiedade/estresse, foram coeficiente de correlacao intraclasse com 0,82, erro padrao de medida com 1,80 e mudanca minima detectavel com 4,99. Conclusao A versao reduzida da Depression Anxiety Stress Scale-21 apresentou excelentes valores de confiabilidade e tambem uma forte consistencia interna. O modelo de dois fatores com a condensacao dos construtos ansiedade e estresse em um unico fator foi o mais aceitavel para a populacao adolescente.

The role of physical exercise in obstructive sleep apnea.

Abstract: Obstructive sleep apnea (OSA) is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss. RESUMO A apneia obstrutiva do sono (AOS) e uma condicao clinica comum, possuindo prevalencia variavel e subestimada. Principal condicao associada a hipertensao arterial sistemica secundaria, associa-se ainda a fibrilacao atrial, acidente vascular encefalico e doenca arterial coronariana, aumentando a morbidade e mortalidade cardiovascular. O tratamento da AOS com pressao positiva continua em vias aereas nao e tolerado por todos os pacientes e, muitas vezes, nao e indicado para formas leves. Dai, metodos alternativos de tratamento da AOS e de suas consequencias cardiovasculares sao necessarios. A pratica usual de exercicios fisicos promove beneficios adicionais a reducao do peso em pacientes com AOS; contudo, os mecanismos ainda sao incertos. Entre as adaptacoes fisiologicas proporcionadas pelo exercicio fisico nessa populacao destacam-se o aumento do tonus da musculatura dilatadora das vias aereas superiores e do tempo do estagio do sono de ondas lentas e a reducao do acumulo cervical de liquido, da resposta inflamatoria sistemica e do peso corporeo. Os principais beneficios de programas de exercicio fisico para essa populacao incluem a reducao da gravidade da AOS e da sonolencia diurna e o aumento da eficiencia do sono e consumo maximo de oxigenio. Poucos estudos avaliaram o papel do exercicio fisico realizado de forma isolada no tratamento da AOS, alem de existirem muitas diferencas relacionadas aos protocolos de exercicio utilizados. Entretanto, o emprego de exercicios aerobios isolados ou combinados aos exercicios resistidos e um ponto comum entre os estudos. Nessa revisao, os principais estudos e mecanismos envolvidos no tratamento da AOS por meio da realizacao de exercicios fisicos sao apresentados. Alem dos beneficios clinicos sistemicos proporcionados pelo exercicio fisico, pacientes com AOS submetidos a um programa regular de exercicios predominantemente aerobicos, apresentam reducao da gravidade da doenca e da sonolencia diurna, aumento da eficiencia do sono e do pico de consumo de oxigenio, independentemente da perda de peso.

Haskell in Green Land: Analyzing the Energy Behavior of a Purely Functional Language

Abstract: Recent work has studied the effect that factors such as code obfuscation, refactorings and data types have on energy efficiency. In this paper, we attempt to shed light on the energy behavior of programs written in a lazy purely functional language, Haskell. We have conducted two empirical studies to analyze the energy efficiency of Haskell programs from two different perspectives: strictness and concurrency. Our experimental space exploration comprises more than 2000 configurations and 20000 executions. We found out that small changes can make a big difference in terms of energy consumption. For example, in one of our benchmarks, under a specific configuration, choosing one data sharing primitive (MVar) over another (TMVar) can yield 60% energy savings. In another benchmark, the latter primitive can yield up to 30% energy savings over the former. Thus, tools that support developers in quickly refactoring a program to switch between different primitives can be of great help if energy is a concern. In addition, the relationship between energy consumption and performance is not always clear. In sequential benchmarks, high performance is an accurate proxy for low energy consumption. However, for one of our concurrent benchmarks, the variants with the best performance also exhibited the worst energy consumption. To support developers in better understanding this complex relationship, we have extended two existing performance analysis tools to also collect and present data about energy consumption.

Pharmacologic management of pain in patients with Chikungunya: a guideline.

Abstract: From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.

Urban versus rural lifestyle in adolescents: associations between environment, physical activity levels and sedentary behavior.

Abstract: Objetivo Analisar os niveis de atividade fisica e o comportamento sedentario em adolescentes das areas urbanas e rurais. Metodos Estudo epidemiologico, transversal, com abordagem quantitativa e abrangencia estadual, cuja amostra foi constituida por 6.234 estudantes (14 a 19 anos), selecionados por meio de uma estrategia de amostragem aleatoria de conglomerados. As analises foram realizadas por meio do teste χ2 e da regressao logistica binaria. Resultados Na amostra, 74,5% dos adolescentes eram residentes em area urbana. Apos o ajuste, constatou-se que os adolescentes oriundos da area rural usavam menos televisao (odds ratio – OR: 0,45; intervalo de confianca de 95% – IC95%: 0,39-0,52), computador e/ou videogame (OR: 0,30; IC95%: 0,22-0,42), passavam menos tempo sentados (OR: 0,66; IC95%: 0,54-0,80), optaram menos pelo lazer passivo (OR: 0,83; IC95%: 0,72-0,95) e tinham menos chances de serem classificados como insuficientes ativos (OR: 0,88; IC95%: 0,78-0,99), quando comparados aqueles que residiam na area urbana, independentemente do sexo e da idade. Os adolescentes da area rural que nao trabalhavam apresentaram mais chances de serem classificados como insuficientemente ativos (OR: 2,59; IC95%: 2,07-3,24), mostrando que a ocupacao tinha um papel importante no nivel de atividade fisica deste grupo. Conclusao Os adolescentes residentes na area rural estiveram menos expostos aos comportamentos sedentarios, optaram mais por um lazer ativo e apresentaram um melhor nivel de atividade fisica, podendo a zona de domicilio e a ocupacao influenciar no estilo de vida deles.

Strains of the Propionibacterium acnes type III lineage are associated with the skin condition progressive macular hypomelanosis

Abstract: Progressive macular hypomelanosis (PMH) is a common skin disorder that causes hypopigmentation in a variety of skin types. Although the underlying aetiology of this condition is unclear, there is circumstantial evidence that links the skin bacterium Propionibacterium acnes to the condition. We now describe the first detailed population genetic analysis of P. acnes isolates recovered from paired lesional and non-lesional skin of PMH patients. Our results demonstrate a strong statistical association between strains from the type III phylogenetic lineage and PMH lesions (P = 0.0019), but not those representing other phylogroups, including those associated with acne (type IA1). We also demonstrate, based on in silico 16S rDNA analysis, that PMH isolates previously recovered from patients in Europe are also consistent with the type III lineage. Using comparative genome analysis, we identified multiple genomic regions that are specific for, or absent from, type III strains compared to other phylogroups. In the former case, these include open reading frames with putative functions in metabolism, transport and transcriptional regulation, as well as predicted proteins of unknown function. Further study of these genomic elements, along with transcriptional and functional analyses, may help to explain why type III strains are associated with PMH.

Genetic variation in PTX3 and plasma levels associated with hepatocellular carcinoma in patients with HCV.

Abstract: Hepatitis C virus (HCV) is the main cause of chronic liver disease, cirrhosis and hepatocellular carcinoma (HCC) worldwide. The risk to develop HCC increases with the severity of liver inflammation and fibrosis. Long pentraxin 3 (PTX3) is a soluble pattern-recognition receptor produced by phagocytes and nonimmune cells at sites of inflammation or injury. The aim of the present study was to determine the association of PTX3 polymorphisms and its plasma levels with HCC occurrence among patients with HCV. Samples from 524 patients with chronic hepatitis C were evaluated in this study. Two polymorphisms (rs1840680 and rs2305619) in the PTX3 gene were determined by real-time PCR. PTX3 plasma levels were measured by Enzyme-linked Immunosorbent Assay (ELISA). Our data show a significant association between PTX3 polymorphisms and HCC occurrence in univariate and multivariate analysis (P = 0.024). Patients with HCC had higher PTX3 plasma levels compared to individuals with mild or severe fibrosis (P < 0.0001 and P = 0.002, respectively). In addition, PTX3 rs2305619 polymorphism and plasma levels were correlated with Child-Pugh scores B and C in HCC individuals. PTX3 seems to be a risk factor for HCC occurrence in chronic hepatitis C. This is the first study that evaluates PTX3 in the context of hepatitis C.

Intra-individuals and inter- and intra-observer reliability of short-term heart rate variability in adolescents

Abstract: Summary Background To examine the reliability of heart rate variability (HRV) parameters in adolescents and to analyse the inter- and intra-observer reliability of data analysis. Methods The sample included 27 adolescents aged 14–19 years old. RR intervals were obtained for 10 min in the supine position on two different days (Day 1 and Day 8) with an interval of 7 days to analyse intra-individual reliability. The signals obtained on Day 1 were used to analyse the inter- and intra-observer reliability of HRV parameters. The RR intervals, standard deviation of all RR intervals (SDNN), root mean square of the squared differences between adjacent normal RR intervals (RMSSD), the percentage of adjacent intervals over 50 ms (PNN50), and low (LF) and high (HF) frequencies were obtained. Frequency-domain variables were analysed using the autoregressive (AR) and fast Fourier transform (FFT) methods. Results There were no intra-individuals difference in RR intervals between Day 1 and Day 8 (P>0·05). The intraclass correlation coefficient (ICC) ranged from 0·647 to 0·913, whereas the coefficient of variation (CV) was lower than 20% for all parameters, except PNN50 and LF/HF. The inter- and intra-observer reliability ranged from 0·915 to 0·996 and 0·990 to 0·993, respectively. In addition, the CV was lower than 20% (inter-observer) and 7% (intra-observer) to all HRV parameters. Conclusion Indicators of reproducibility obtained in this study suggest that HRV can be used in adolescents; however, the analysis of HRV parameters should be performed by the same person.