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Neurological commitment is a neglected manifestation of Chagas disease (CD). Meningoencephalitis mainly affects children and immunosuppressed patients, while stroke can occur with or without cardiac compromise. One of the possible causes of stroke development is microvascular commitment. Our group previously described that experimental Trypanossoma cruzi acute infection leads to cerebral microvasculopathy. This condition is characterized by decreased capillary density, increased leukocyte rolling and adhesion, and endothelial dysfunction. CD was discovered 114 years ago, and until today, only two drugs have been available for clinical treatment: benznidazole and nifurtimox. Both present a high cure rate for the acute phase (80%) and small cure rate for the chronic phase (20%). In addition, the high occurrence of side-effects, without proper medical follow-up, can result in treatment abandonment. Therefore, the search for new therapeutic schemes is necessary. Statins are drugs already used in the clinic that have several pleiotropic effects including endothelial function improvement, anti-inflammatory action, as well as trypanocidal effects, making them a potential alternative treatment for brain microvasculopathy in CD. Here, we investigate the effect of lovastatin (LOV) on brain microvasculopathy and inflammatory parameters. Swiss Webster mice were intraperitoneally inoculated with the Y strain of T. cruzi. Treatment with lovastatin (20 mg/kg/day) was initiated 24 h after the infection and continued for 14 consecutive days. We observed that LOV treatment did not affect parasitemia, brain microcirculation alterations, or the reduction in cerebral blood flow caused by T. cruzi infection. Also, LOV did not prevent the increased number of CD3+ cells and eNOS levels in the T. cruzi-infected brain. No alterations were observed on VCAM-1 and MCP-1 expressions, neither caused by infection nor LOV treatment. However, LOV prevented the increase in F4/80+ cells and ICAM-1 levels in the brain caused by acute infection with T. cruzi. These results suggest an anti-inflammatory activity of LOV, but more studies are needed to elucidate the role of LOV in CD acute infection.
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ABSTRACT Objective: To identify how patient-centered care has been addressed in tuberculosis studies with adolescents. Data source: We searched for articles published in Portuguese, Spanish and English in the Virtual Health Library (LILACS), PubMed (MedLine), and Scopus (Elsevier) databases, from 2000 to 2020, using descriptors (DeCS, MeSH) in Portuguese and English. Data synthesis: 1,322 studies were identified, of which 18 were selected. The main themes found were related to adherence to tuberculosis treatment, knowledge, attitudes and practices, health education, and public policies. Conclusions: We observed that both the number of researchers dedicated to the topic and the presence of a truly person-centered view are still scarce elements in tuberculosis among adolescents research.
RESUMO Objetivo: Identificar, por meio de uma revisão integrativa, como o cuidado centrado no paciente tem sido abordado nos estudos de tuberculose com adolescentes. Fontes de dados: Buscamos artigos publicados em português, espanhol e inglês nas bases de dados da Biblioteca Virtual em Saúde - BVS (LILACS), PubMed (MedLine) e Scopus (Elsevier), de 2000 a 2020, utilizando descritores (DeCS, MeSH) em português e inglês. Síntese dos dados: Foram identificados 1.322 estudos, dos quais 18 foram selecionados. Os principais temas encontrados foram relacionados à adesão ao tratamento da tuberculose, conhecimentos, atitudes e práticas, educação em saúde e políticas públicas. Conclusões: Observamos que tanto o número de pesquisadores dedicados ao tema quanto a presença de uma visão verdadeiramente centrada na pessoa ainda são elementos escassos na pesquisa da tuberculose entre adolescentes.
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A doença de Chagas crônica afeta seis milhões de pessoas em regiões endêmicas, com 30 mil novos casos anuais logo, espaços de divulgação científica são muito importantes para ofertar informações de qualidade à população. As iniciativas envolvendo o controle da doença de Chagas não podem se limitar às pesquisas com enfoque biológico. Este estudo objetiva apresentar um panorama sobre o processo de construção do canal Falamos de Chagas, no YouTube, sua importância para a comunicação, a informação, a educação em saúde e a mobilização social, bem como refletir sobre a qualidade de uma subamostra de vídeos do canal. Trata-se de um estudo qualitativo, dividido em duas fases: criação do canal e análise qualitativa dos vídeos sobre a doença disponíveis no YouTube. Observamos que existe potencial nas redes sociais, enquanto recurso de comunicação, contudo é preciso cautela, uma vez que se faz necessária a certificação da qualidade do material
Chronic Chagas disease affects six million people in endemic regions, with 30,000 new infected cases an-nually thus, initiatives involving science diffusion are relevant to offer qualified information to the people. Chagas disease control initiatives cannot be limited to the level of biological focused research. This study aims to present an overview of the construction process of the YouTube channel Falando de Chagas, its importance for communication, information, health education and social mobilization, as well as to reflect on the quality of a subsample of videos present in the channel. Qualitative in nature, the study was divided into two stages: construction of the channel and qualitative analysis of videos about the disease available on YouTube. We observed that there is potential for social networks as communication resources, but caution is needed in their use, since the quality of the material needs certification
La enfermedad de Chagas crónica afecta seis millones de personas en regiones endémicas, con 30.000 nuevos casos anuales los espacios de divulgación científica son muy importantes para ofrecer información a la población. Las iniciativas de control de la enfermedad de Chagas no pueden limitarse al nivel de investigación con enfoque biológico. El estudio tiene como objetivo presentar un panorama del proceso de construcción del canal Falando de Chagas, en YouTube, su importancia para la comunicación, información, educación en salud y movilización social, así como reflexionar sobre la calidad de una submuestra de videos presentes en la canal. De naturaleza cualitativa, el estudio se dividió en dos fases: construcción del canal y análisis cualitativo de videos sobre la enfermedad disponibles en YouTube. Observamos que existe potencial para las redes sociales como recurso de comunicación, sin embargo, se requiere cautela en su uso, ya que se requiere certificar la calidad del material
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Humanos , Trypanosoma cruzi , Educação em Saúde , Doença de Chagas , Mortalidade , Pesquisa Qualitativa , Doenças Negligenciadas , Comunicação em Saúde , Rede SocialRESUMO
Central nervous system alterations was described in Chagas disease in both human and experimental models, leading to meningoencephalitis, stroke and cognitive impairment. Recently, our group demonstrated that acute infection by Trypanossoma cruzi leads to cerebral microvasculophaty in mice with endothelial dysfunction, capillary rarefaction, increased rolling and leukocyte adhesion. Only benznidazole and nifurtimox are available for clinical treatment, they have an efficiency of 80% in the acute phase and less than 20% in chronic phase. However, the effect of these drugs on brain microcirculation has not yet been evaluated. We hypothesized that early treatment with benznidazole could protect brain microcirculation during acute experimental Chagas disease. Swiss Webster mice were inoculated with 104 trypomastigotes forms of T. cruzi, and after 24 h they were treated with 50 or 100 mg/kg/day of benznidazole for 14 consecutive days. In untreated infected mice, we observed cerebral microvascular rarefaction, increase in leukocyte rolling and adhesion, reduced cerebral blood flow, and increased CD3+ and F4-80+ cells in brain tissue. Early treatment with benznidazole at 100 mg/kg/day and 50 mg/kg/day prevented the occurrence of the alterations mentioned. Here, we show that BZ is able to protect the microcirculation and reduced brain inflammation in acute experimental Chagas disease.
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Doença de Chagas , Animais , Humanos , Camundongos , Doença de Chagas/tratamento farmacológicoRESUMO
The scope of this article is to analyze the life histories of Chagas disease (CD) patients, searching for elements in their narratives that might present possibilities for coping with this problem. Caused by the protozoan Trypanosoma cruzi, Chagas disease combines conditions of infection and/or progression to disease, in accordance with biological and social determinants and affects around 6 to 7 million people infected with T. cruzi. More than 6,000 people die each year due to complications in the chronic CD phase. This is a qualitative study using the life history technique that was used in open interviews. We collected a wealth of material with which we can work on the context of the disease in multiple dimensions. We associate sensitive listening with the needs of people living with the CD to give strength to their voice, valuing their own life story, transforming them into masters of their history and knowledge. Visibility emerged and prevailed, exposing the disease itself as a central theme and two general sub-themes: their perceptions about the disease and their own life, in the context of the disease. We identified the need to (re)think the problem of Chagas disease as something visible and present.
O artigo tem por objetivo analisar as histórias de vida de portadores de doença de Chagas (DC), para evidenciar em suas narrativas elementos e possibilidades de enfrentamento dessa problemática. Causada pelo protozoário Trypanosoma cruzi, a DC combina condições de infecção assintomática e/ou de progressão para doença de acordo com determinantes biológicos e sociais e afeta 6 a 7 milhões de pessoas infectadas. No mundo anualmente 6 mil pessoas em consequência das complicações na fase crônica da DC. Realizamos um estudo qualitativo com uso da técnica de história de vida coletadas em entrevistas abertas, coletando um material riquíssimo para trabalhar o contexto da doença em múltiplas dimensões. Associamos uma escuta sensível com a necessidade das pessoas vivendo com a DC darem força à sua voz, valorizando sua própria história de vida, transformando-as em detendoras de sua história e de seu conhecimento. A visibilidade emergiu e prevaleceu, expondo a própria doença como tema central e dois subtemas gerais: suas percepções sobre a doença e a sua própria vida, no contexto da doença. Identificamos a necessidade de (re)pensar a problemática da doença de Chagas como algo visível e presente.
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Doença de Chagas , Trypanosoma cruzi , Doença Crônica , HumanosRESUMO
Resumo O artigo tem por objetivo analisar as histórias de vida de portadores de doença de Chagas (DC), para evidenciar em suas narrativas elementos e possibilidades de enfrentamento dessa problemática. Causada pelo protozoário Trypanosoma cruzi, a DC combina condições de infecção assintomática e/ou de progressão para doença de acordo com determinantes biológicos e sociais e afeta 6 a 7 milhões de pessoas infectadas. No mundo anualmente 6 mil pessoas em consequência das complicações na fase crônica da DC. Realizamos um estudo qualitativo com uso da técnica de história de vida coletadas em entrevistas abertas, coletando um material riquíssimo para trabalhar o contexto da doença em múltiplas dimensões. Associamos uma escuta sensível com a necessidade das pessoas vivendo com a DC darem força à sua voz, valorizando sua própria história de vida, transformando-as em detendoras de sua história e de seu conhecimento. A visibilidade emergiu e prevaleceu, expondo a própria doença como tema central e dois subtemas gerais: suas percepções sobre a doença e a sua própria vida, no contexto da doença. Identificamos a necessidade de (re)pensar a problemática da doença de Chagas como algo visível e presente.
Abstract The scope of this article is to analyze the life histories of Chagas disease (CD) patients, searching for elements in their narratives that might present possibilities for coping with this problem. Caused by the protozoan Trypanosoma cruzi, Chagas disease combines conditions of infection and/or progression to disease, in accordance with biological and social determinants and affects around 6 to 7 million people infected with T. cruzi. More than 6,000 people die each year due to complications in the chronic CD phase. This is a qualitative study using the life history technique that was used in open interviews. We collected a wealth of material with which we can work on the context of the disease in multiple dimensions. We associate sensitive listening with the needs of people living with the CD to give strength to their voice, valuing their own life story, transforming them into masters of their history and knowledge. Visibility emerged and prevailed, exposing the disease itself as a central theme and two general sub-themes: their perceptions about the disease and their own life, in the context of the disease. We identified the need to (re)think the problem of Chagas disease as something visible and present.
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Google algorithms record trends in interest on topics relevant to public health. WEB searches were analyzed (2014-2019) to identify patterns linked to prostate cancer. Relative Search Volumes (RSV) were analyzed by Google Trends on "prostate cancer" (PC), "prostate examination" (PE) and "PSA"; 260-week time series; Brazil region; Health category; Trend lines (degree 2 polynomials) to identify patterns; Averages compared by ANOVA; Sudden increase in November searches; Searches on PC greatly surpass PE and PSA; Stable annual PC averages; Discreet reduction in PE; Marked increase in PSA. In campaign months: Discreet increase in PC; stability in PE; Marked increase in PSA. "Blue November" campaigns encourage early identification of prostate cancer, although interest is seen to be focused on the disease per se with a lack of interest in diagnosis throughout the year. Differences in relation to "Pink October" are discussed - tenuous relation to educational level on prevention habits and the influence of celebrities. The conclusion drawn is that RSV analysis might be useful in tracking trends in prostate cancer screening to provide input for campaign developers.
Algoritmos do Google registram tendências no interesse sobre temas relevantes à saúde coletiva. Analisamos buscas na web (2014-2019) para identificar padrões ligados ao câncer de próstata. Analisamos volumes de pesquisa relativos (VPR) pelo Google Trends sobre "câncer de próstata" (CAP), "exame de próstata"(EP) e "PSA"; séries temporais de 260 semanas; região Brasil; categoria "saúde" e linhas de tendência (polinomiais ordem 2) para identificar padrões; médias comparadas por ANOVA. Identificamos crescimentos súbitos nas buscas nos meses de novembro; buscas sobre CAP superam largamente EP e PSA; médias anuais CAP estáveis; EP com discreta queda; PSA com marcada ascensão. Nos meses de campanhas: elevação discreta de CAP; estabilidade em EP; marcada elevação de PSA. O "Novembro Azul" incentiva a identificação precoce do câncer de próstata, embora observe-se interesse focado na doença e desinteresse sobre o diagnóstico ao longo do ano. Diferenças em relação ao "Outubro Rosa" são discutidas - fraca interferência do nível de escolaridade sobre os hábitos de prevenção e influência de celebridades. Concluiu-se que análises de VPR podem ser úteis ao acompanhamento de tendências sobre o rastreio do câncer de próstata para fornecer subsídios aos desenvolvedores das campanhas.
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Detecção Precoce de Câncer , Neoplasias da Próstata , Humanos , Masculino , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/prevenção & controle , Saúde Pública , Ferramenta de BuscaRESUMO
BACKGROUND: The importance of health professionals has been recognized in COVID-19 pandemic-affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers' perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. OBJECTIVE: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. METHODS: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. RESULTS: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. CONCLUSIONS: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination-conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future.
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Violence and aggression represent severe social problems, with profound impacts on public health. Despite the development of experimental models to study aggressive behavior is highly appreciated, the underlying mechanisms remain poorly understood. Given the key contribution of mitochondria to central nervous system bioenergetics, we hypothesized that mitochondrial function in brain would be altered by social stress. Using a model of spontaneous aggression, we investigated here the effects of social stress on brain mitochondrial function in prefrontal cortex of Swiss mice. Animals were categorized as highly aggressive, subordinate and non-aggressive (harmonic) after stress induced by regrouping and compared them with non-regrouped animals. Despite social stress did not affect brain cortex oxygen consumption rates and NADH:cytochrome c oxidoreductase activity, cytochrome c oxidase expression and activity were significantly lower in highly aggressive animals compared to non-regrouped ones. These changes were not observed in ATP synthase and adenine nucleotide translocator content suggesting a selective effect of social stress on cytochrome c oxidase. Therefore, aggressive behavior generated upon social stress associates to selective reduction in cytochrome c oxidase activity, with potential detrimental effects on brain bioenergetics and function.
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Agressão/fisiologia , Respiração Celular/fisiologia , Córtex Cerebral/enzimologia , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Comportamento Social , Estresse Psicológico/enzimologia , Agressão/psicologia , Animais , Ativação Enzimática/fisiologia , Masculino , Camundongos , Estresse Psicológico/psicologiaRESUMO
Several studies evaluating clinical forms of chronic Chagas disease show that about one-third of patients present cardiac involvement. Heart failure, sudden death and cardioembolic stroke are the main mechanisms of death in Chagas heart disease. The impact of specific etiologic treatment on the prognosis of patients with chronic Chagas heart disease is very limited regardless of the presence or absence of heart failure. Patients with symptomatic Chagas heart disease present serum selenium (Se) levels lower than patients without Chagas heart disease. Moreover, Se supplementation in animal models showed promising results. The aim of this trial is to estimate the effect of Se treatment on prevention of heart disease progression in patients with Chagas cardiomyopathy. However, we had to introduce some protocol modifications in order to keep trial feasibility, as follows: the primary outcome was restricted to left ventricular ejection fraction as a continuous variable, excluding disease progression; the follow-up period was decreased from 5 years to 1 year, an adjustment that might increase the participation rate of our study; the superior age limit was increased from 65 to 75 years; and diabetes mellitus was no longer considered an exclusion criterion. All of these protocol modifications were extensively debated by the research team enrolled in the design, recruitment and conduction of the clinical trial to guarantee a high scientific quality. TRIAL REGISTRATION: Clinical Trials.gov, NCT00875173 . Registered on 20 October 2008.