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OBJECTIVES: To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. METHODS: Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. RESULTS: 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). CONCLUSIONS: Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.

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The search of novel strategies for anthelmintic control is a crucial need considering the widespread increase in resistant parasitic populations in livestock. Bioactive phytochemicals may contribute to improve parasite control by enhancing the effect of existing anthelmintic drugs. The aim of the current work was to evaluate the in vivo and in vitro pharmaco-chemical interaction and the in vivo efficacy of the combination of albendazole (ABZ) with thymol (TML) in lambs naturally infected with resistant gastrointestinal nematodes. Thirty (30) lambs were allocated into three experimental groups. Each group was treated orally with either ABZ (5 mg/kg), TML (150 mg/kg, twice every 24 h) or the co-administration of both compounds. Blood samples were collected between 0 and 51 h post-treatment and TML, ABZ and its metabolites were measured by HPLC. Individual faecal samples were collected at days -1 and 14 post-treatment to perform the faecal egg count reduction test. Additionally, the effect of TML on the sulphoreduction and sulphonation of ABZ sulphoxide was assessed in vitro using ruminal content and liver microsomes, respectively. The metabolism of TML in the ruminal content was very low and the monoterpene exhibited a low degree of association with the particulate phase of the ruminal content. No changes in the pharmacokinetic behavior of ABZ sulphoxide were observed in the presence of the natural product (TML). In contrast, the ABZ sulphone Cmax and AUC were lower (P 0.002 and 0.001 respectively) in the co-administered animals (0.16 ±â€¯0.07 µg/mL and 3.63 ±â€¯1.21 µg.h/mL) compared with those that received ABZ alone (0.45 ±â€¯0.15 µg/mL and 9.50 ±â€¯2.84 µg.h/mL). TML was detected in the bloodstream between 1 and 48 h post-treatment, which indicates the time of target nematodes being exposed to the bioactive monoterpene. However, the in vivo efficacy of TML was 0% and the presence of this terpene did not increase the efficacy of ABZ. The presence of TML significantly inhibited the ruminal sulphoreduction (P 0.001) and the hepatic sulphonation (P 0.001) of ABZ sulphoxide. These observations point out that in vivo pharmaco-parasitological studies are relevant to corroborate the adverse kinetic/metabolic interactions and the efficacy of bioactive natural products combined with synthetic anthelmintics.

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O Programa Nacional de Alimentação Escolar (PNAE) atende a 19,4% da população brasileira. Desde sua implantação, incorporou mudanças a partir da centralidade política dos problemas alimentares e nutricionais. Na contemporaneidade, figura-se como acesso à Segurança Alimentar e Nutricional (SAN), trazendo complexidade e desafios para a atuação do nutricionista. Objetivo: Compreender a aplicabilidade da resolução vigente, que dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica da rede pública, no contexto de uma Política de Segurança Alimentar e Nutricional e da prática do profissional nutricionista. Métodos: pesquisa descritiva-exploratória, abordagem quantiqualitativa acerca da execução do PNAE em Belo Horizonte - MG. Analisou-se a resolução nº 26/2013, em estrutura lógica e conceitos de SAN, bem como documentos operacionais. Foram apurados (dados secundários gerados da prática) e avaliados os indicadores de monitoramento e avaliação do PNAE acerca do desperdício/aceitabilidade (2013-2018) e de estado nutricional (2016). Realizou-se o levantamento das concepções dos profissionais nutricionistas acerca da aplicação das normas de execução do PNAE, por meio de entrevistas individuais. Utilizou-se dos resultados da análise de conteúdo da resolução nº26/2013, dos documentos orientadores das práticas e das falas de profissionais, bem como das análises estatísticas dos indicadores, para triangulação dos dados. Resultados: A resolução nº 26/2013 apresenta normas técnicas, administrativas, financeiras e éticas. Nesta, há referências ao direito ao acesso físico e econômico da alimentação, a universalidade do programa, a dimensão biológica e as práticas alimentares. A norma jurídica apresenta como indicadores de monitoramento e avaliação o estado nutricional e a aceitabilidade da alimentação escolar e os documentos operacionais incluem indicadores de desperdício de alimentos, estoque e adesão alimentar. Os dados de indicadores acerca do desperdício revelaram a prevalência de sobras alimentares excessivas (14,47%) e do resto-ingestão adequado (4,98%). As metodologias de análise de desperdício determinadas na legislação, e empregadas em nível municipal incluem somente medidas físicas de resíduos (sobras e restoingestão), que por meio do RI é avaliada a aceitabilidade da alimentação escolar. Quanto ao indicador estado nutricional, o excesso de peso foi o desvio nutricional mais recorrente, com prevalência de 25,4% entre os alunos avaliados e maioria eutrófica (71,1%). A triangulação possibilitou emergir duas categorias temáticas: (1) "Baixo valor de uso das métricas acerca da execução do PNAE" e (2) "O Saara da dimensão psicossocial e cultural nas normas de execução do PNAE". Tais categorias inserem-se "positivismo" e na "racionalidade científica", atreladas às normas e consequentemente à prática profissional. Conclusão: A partir da análise dos resultados e da discussão dos dados levantados foi possível apreender a baixa potência de aplicabilidade das normas de execução do PNAE enquanto política de SAN, emergindo as categorias que revelaram o baixo valor de uso das métricas exigidas na avaliação da execução do PNAE e o vazio das normas quanto à dimensão psicossocial e cultural da alimentação escolar.

The National School Food Program (NSFP) serves 19.4% of the Brazilian population. Since its implementation, it has incorporated changes based on the political centrality of food and nutritional problems. Nowadays, it appears as access to Food and Nutritional Security (FNS), bringing complexity and challenges to the performance of the nutritionist. Objective: To understand the applicability of the current resolution, this provides for the provision of school meals to students of basic education in public schools, in the context of a Food and Nutrition Security Policy and the practice of a nutritionist. Methods: descriptive-exploratory research, quantitative and qualitative approach about the execution of PNAE in Belo Horizonte-MG. Resolution nº 26/2013 was analyzed, in logical structure and SAN concepts, as well as operational documents. The NSFP monitoring and evaluation indicators about waste / acceptability (2013-2018) and nutritional status (2016) were assessed (secondary data generated from the practice). There was a survey of the conceptions of nutritionist professionals about the application of the rules of execution of the NSFP, through individual interviews. The results of the content analysis of resolution nº 26/2013 were used, as well as the documents guiding practices and the speeches of professionals, as well as the statistical analysis of the indicators, for data triangulation. Results: Resolution nº 26/2013 was divided into technical, administrative, financial and ethical standards. There are contexts of the right to physical and economic access, the universality of the program, the biological dimension and dietary practices. The legal standard presents nutritional status and acceptability as indicators, and operational documents include indicators of food waste, stock, and food adherence. Indicator data show the prevalence of food leftovers (14.47%) and adequate rest-intake (4.98%), which are known to the participants. In view of values determined by the municipality, 30% of the sample presented inadequate values, with a bad IR (11.8%) or unacceptable (18.2%) index. The waste analysis methodologies determined in the legislation, and employed at the municipal level include only physical measures of waste (leftovers and restingestion), and through RI it is possible to assess the acceptability of food. Excess weight becomes the most prevalent nutritional deviation, with a prevalence of 25.4% among the students evaluated, and most of them enter eutrophy (71.1%). The triangulation made it possible to emerge two thematic categories: "Low use value of the metrics about the execution of the NSFP" and "The Sahara of the psychosocial and cultural dimension in the rules of execution of the NSFP". Such categories fall under "positivism" and "scientific rationality, linked to norms and, consequently, to professional practice. Conclusion: From the analysis of the results and discussion of the data collected, it was possible to apprehend the low applicability power of the NSFP execution rules as a FNS policy, emerging the categories that revealed the low use value of the metrics required in the evaluation of the execution of the NSFP and the lack of norms regarding the psychosocial and cultural dimension of school feeding.

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Essential oil from the leaves of Artemisia vulgaris L. (Compositae) cultivated in Brazil was investigated for its chemical composition and biological activities including antibacterial, antifungal, and anthelmintic. The constituents of essential oils isolated by hydro-distillation were examined by GC-MS and a total of 18 components were identified. The essential oil was dominated by oxygenated sesquiterpenes (44.4%), sesquiterpene hydrocarbons (33.3%), and oxygenated monoterpenes (16.6%). Caryophyllene (37.45%), germacrene D (16.17%), and humulene (13.66%) were the major components. The essential oils from A. vulgaris showed bactericidal and fungicidal properties against Staphylococcus aureus and Candida albicans, respectively. Anthelmintic activity against Haemonchus contortus was absent in this essential oil. Altogether above results indicate that essential oils from A. vulgaris can be used for various medicinal purposes.

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Abstract Haemonchus contortus is a gastrointestinal nematode that is responsible for high mortality rates in ruminant herds. The resistance of nematodes to synthetic anthelmintics is widespread and requires a continuous search for new bioactive molecules, such as proteins. The objective of this study was to evaluate the anthelmintic potential of a protease purified from the latex of Ficus benjamina against H. contortus . Fresh latex was collected from plants via small incisions in the green stems, the rubber was removed by centrifugation, and the latex protein extract (LPE) was obtained. After LPE fractionation with ammonium sulfate and chromatography of the fraction containing the highest proteolytic activity on CM-cellulose, a cysteine protease (FbP) was purified. FbP has a molecular mass of approximately 23.97 kDa, and its proteolytic activity was stable between pH 6.0 and pH 10 and over a broad temperature range, with optimum activity at 60 °C. FbP inhibited both the development and exsheathment of H. contortus larvae, with 50% effective concentrations of 0.26 and 0.79 mg/mL, respectively. We conclude that this cysteine protease from F. benjamina latex with anthelmintic activity against H. contortus could be a promising alternative for the development of products for use in parasite control programmes.

Resumo Haemonchus contortus é um nematoide gastrintestinal, responsável por altas taxas de mortalidade em rebanhos de pequenos ruminantes. A resistência dos nematoides aos anti-helmínticos sintéticos está generalizada e requer uma busca contínua por novos compostos bioativos, como as proteínas. O objetivo deste trabalho foi avaliar o potencial anti-helmíntico da protease purificada do látex de Ficus benjamina contra H. contortus . O látex fresco foi coletado das plantas por pequenas incisões nas hastes verdes e o extrato proteico de látex (EPL) foi obtido. Após o fracionamento do EPL com sulfato de amônio e cromatografia da fração contendo a maior atividade proteolítica da CM-Celulose, uma protease cisteínica (FbP) foi purificada. A FbP tem massa molecular de cerca de 23,97 kDa, a atividade proteolítica foi estável entre pH 6,0 e pH 10 e ao longo de uma ampla faixa de temperatura, com atividade ótima a 60 °C. A FbP inibiu tanto o desenvolvimento quanto o desembainhamento das larvas de H. contortus, com 50% de inibição nas concentrações de 0,26 e 0,79 mg/mL, respectivamente. Concluímos que esta protease cisteínica do látex de F. benjamina, com ação anti-helmíntica contra H. contortus, pode ser uma alternativa promissora para o desenvolvimento de produtos a serem utilizados em programas de controle de parasitos.

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Haemonchus contortus is a gastrointestinal nematode that is responsible for high mortality rates in ruminant herds. The resistance of nematodes to synthetic anthelmintics is widespread and requires a continuous search for new bioactive molecules, such as proteins. The objective of this study was to evaluate the anthelmintic potential of a protease purified from the latex of Ficus benjamina against H. contortus . Fresh latex was collected from plants via small incisions in the green stems, the rubber was removed by centrifugation, and the latex protein extract (LPE) was obtained. After LPE fractionation with ammonium sulfate and chromatography of the fraction containing the highest proteolytic activity on CM-cellulose, a cysteine protease (FbP) was purified. FbP has a molecular mass of approximately 23.97 kDa, and its proteolytic activity was stable between pH 6.0 and pH 10 and over a broad temperature range, with optimum activity at 60 °C. FbP inhibited both the development and exsheathment of H. contortus larvae, with 50% effective concentrations of 0.26 and 0.79 mg/mL, respectively. We conclude that this cysteine protease from F. benjamina latex with anthelmintic activity against H. contortus could be a promising alternative for the development of products for use in parasite control programmes.(AU)

Haemonchus contortus é um nematoide gastrintestinal, responsável por altas taxas de mortalidade em rebanhos de pequenos ruminantes. A resistência dos nematoides aos anti-helmínticos sintéticos está generalizada e requer uma busca contínua por novos compostos bioativos, como as proteínas. O objetivo deste trabalho foi avaliar o potencial anti-helmíntico da protease purificada do látex de Ficus benjamina contra H. contortus . O látex fresco foi coletado das plantas por pequenas incisões nas hastes verdes e o extrato proteico de látex (EPL) foi obtido. Após o fracionamento do EPL com sulfato de amônio e cromatografia da fração contendo a maior atividade proteolítica da CM-Celulose, uma protease cisteínica (FbP) foi purificada. A FbP tem massa molecular de cerca de 23,97 kDa, a atividade proteolítica foi estável entre pH 6,0 e pH 10 e ao longo de uma ampla faixa de temperatura, com atividade ótima a 60 °C. A FbP inibiu tanto o desenvolvimento quanto o desembainhamento das larvas de H. contortus, com 50% de inibição nas concentrações de 0,26 e 0,79 mg/mL, respectivamente. Concluímos que esta protease cisteínica do látex de F. benjamina, com ação anti-helmíntica contra H. contortus, pode ser uma alternativa promissora para o desenvolvimento de produtos a serem utilizados em programas de controle de parasitos.(AU)

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Haemonchus contortus is a gastrointestinal nematode that is responsible for high mortality rates in ruminant herds. The resistance of nematodes to synthetic anthelmintics is widespread and requires a continuous search for new bioactive molecules, such as proteins. The objective of this study was to evaluate the anthelmintic potential of a protease purified from the latex of Ficus benjamina against H. contortus . Fresh latex was collected from plants via small incisions in the green stems, the rubber was removed by centrifugation, and the latex protein extract (LPE) was obtained. After LPE fractionation with ammonium sulfate and chromatography of the fraction containing the highest proteolytic activity on CM-cellulose, a cysteine protease (FbP) was purified. FbP has a molecular mass of approximately 23.97 kDa, and its proteolytic activity was stable between pH 6.0 and pH 10 and over a broad temperature range, with optimum activity at 60 °C. FbP inhibited both the development and exsheathment of H. contortus larvae, with 50% effective concentrations of 0.26 and 0.79 mg/mL, respectively. We conclude that this cysteine protease from F. benjamina latex with anthelmintic activity against H. contortus could be a promising alternative for the development of products for use in parasite control programmes.

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Gastrointestinal nematodes are a significant concern for animal health and well-being, and anthelmintic treatment is mainly performed through the use of chemical products. However, bioactive compounds produced by plants have shown promise for development as novel anthelmintics. The aim of this study is to assess the anthelmintic activity of protein fractions from Spigelia anthelmia on the gastrointestinal nematode Haemonchus contortus. Plant parts were separated into leaves, stems and roots, washed with distilled water, freeze-dried and ground into a fine powder. Protein extraction was performed with sodium phosphate buffer (75 mM, pH 7.0). The extract was fractionated using ammonium sulfate (0-90%) and extensively dialyzed. The resulting fractions were named LPF (leaf protein fraction), SPF (stem protein fraction) and RPF (root protein fraction), and the protein contents and activities of the fractions were analyzed. H. contortus egg hatching (EHA), larval exsheathment inhibition (LEIA) and larval migration inhibition (LMIA) assays were performed. Proteomic analysis was conducted, and high-performance liquid chromatography (HPLC) chromatographic profiles of the fractions were established to identify proteins and possible secondary metabolites. S. anthelmia fractions inhibited H. contortus egg hatching, with LPF having the most potent effects (EC50 0.17 mg mL-1). During LEIA, SPF presented greater efficiency than the other fractions (EC50 0.25 mg mL-1). According to LMIA, the fractions from roots, stems and leaves also reduced the number of larvae, with EC50 values of 0.11, 0.14 and 0.21 mg mL-1, respectively. Protein analysis indicated the presence of plant defense proteins in the S. anthelmia fractions, including protease, protease inhibitor, chitinase and others. Conversely, secondary metabolites were absent in the S. anthemia fractions. These results suggest that S. anthelmia proteins are promising for the control of the gastrointestinal nematode H. contortus.

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Objetivo: Determinar a prevalência de disfunção sexual em mulheres com diagnóstico de artrite reumatoide (AR) inicial (menos de um ano de sintomas ao diagnóstico), bem como avaliar a possível associação entre disfunção sexual com atividade da AR e incapacidade funcional. Métodos: Estudo transversal, que avaliou mulheres com diagnóstico de AR inicial, acompanhadas de forma protocolar na coorte Brasília, no Hospital Universitário de Brasília. Dados demográficos, índice de atividade da doença (Disease Activity Score 28 – DAS 28) e dados do questionário de incapacidade funcional (Health Assessment Questionnaire – HAQ) foram obtidos por entrevistas diretas. Usou-se o índice de função sexual feminina (Female Sexual Function Index – FSFI), questionário que contém 19 itens que avaliam seis domínios: desejo sexual, excitação sexual, lubrificação vaginal, orgasmo, satisfação sexual e dor. Resultados: Foram estudadas 68 pacientes, das quais 54 (79,4%) relataram atividade sexual nas últimas quatro semanas. A média de idade foi de 49,7 ± 13,7 anos e a maioria era casada (61,4%). O DAS-28 médio foi de 3,6 ± 1,5 e a média do HAQ foi de 0,7. A prevalência de disfunção sexual (FSFI ≤26) foi de 79,6%. Não houve associação de atividade de doença nem de incapacidade funcional com a ocorrência de disfunção sexual nas pacientes avaliadas. Conclusão: A prevalência de disfunção sexual encontrada neste estudo foi superior à relatado na literatura em mulheres saudáveis. Há necessidade de conhecimento da extensão do problema para oferecer possibilidades terapêuticas adequadas aos pacientes. .

Objective: To determine the prevalence of sexual dysfunction in women diagnosed with early rheumatoid arthritis (RA) (less than one year of symptoms at the time of diagnosis), as well as to evaluate the possible association between sexual dysfunction with AR activity and functional disability. Methods: Cross-sectional study assessing women diagnosed with early RA, accompanied per protocol in the Brasilia Cohort, Hospital Universitário de Brasília. Demographics, disease activity index (Disease Activity Score 28 – DAS 28) and functional disability questionnaire (Health Assessment Questionnaire – HAQ), were obtained by direct interviews. The Female Sexual Function Index (FSFI) was used questionnaire which contains 19 items that assess six domains: sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. Results: 68 patients studied, of whom 54 (79.4%) reported sexual activity in the last four weeks. The participants were 49.7 ± 13.7 (mean ± SD) years old and the majority were married (61.4%). The mean DAS 28 was 3.6 ± 1.5 and the mean HAQ was 0.7. The prevalence of sexual dysfunction (FSFI ≤26) was 79.6%. There was no association of disease activity or of functional disability with the occurrence of sexual dysfunction in the female patients evaluated. Conclusion: The prevalence of sexual dysfunction found in this study was higher than that reported in the literature in healthy women. A knowledge of the extent of the problem is needed to provide adequate therapeutic options for these patients. .

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OBJECTIVE: To determine the prevalence of sexual dysfunction in women diagnosed with early rheumatoid arthritis (RA) (less than one year of symptoms at the time of diagnosis), as well as to evaluate the possible association between sexual dysfunction with AR activity and functional disability. METHODS: Cross-sectional study assessing women diagnosed with early RA, accompanied per protocol in the Brasilia Cohort, Hospital Universitário de Brasília. Demographics, disease activity index (Disease Activity Score 28 - DAS 28) and functional disability questionnaire (Health Assessment Questionnaire - HAQ), were obtained by direct interviews. The Female Sexual Function Index (FSFI) was used, questionnaire which contains 19 items that assess six domains: sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction and pain. RESULTS: 68 patients studied, of whom 54 (79.4%) reported sexual activity in the last four weeks. The participants were 49.7±13.7 (mean±SD) years old and the majority were married (61.4%). The mean DAS 28 was 3.6±1.5 and the mean HAQ was 0.7. The prevalence of sexual dysfunction (FSFI ≤26) was 79.6%. There was no association of disease activity or of functional disability with the occurrence of sexual dysfunction in the female patients evaluated. CONCLUSION: The prevalence of sexual dysfunction found in this study was higher than that reported in the literature in healthy women. A knowledge of the extent of the problem is needed to provide adequate therapeutic options for these patients.

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