Medical practice involves constant decision-making processes. For these actions to be more assertive, the conscious use of literature is fundamental. However, the exponential growth of published scientific articles exceeds human capacity for interpretation, requiring innovative approaches. With this in mind, the aim of this study was to explore the use of artificial intelligence (AI) in the analysis of medical literature and to develop and evaluate a system for semi-automated use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to classifying systematic reviews by level of evidence. Firstly, a scoping review was conducted to identify the state of the art of using AI to analyze medical literature. Subsequently, a functional AI-based system was developed to identify the domains of imprecision, risk of bias, inconsistency and methodological quality of the review and then classify it by level of evidence in real scenarios. The evaluation of the application of the system was carried out on a sample of Cochrane systematic reviews. The results were one published scoping review, a second article in the publication phase and a registered digital product. The system obtained an overall accuracy of 63.2% and a kappa of 0.44 (moderate) for GRADE classification. These results were higher than those found in the literature, demonstrating that the system can be used to semiautomate the GRADE approach, as an auxiliary tool for human evaluators, seeking greater speed and a reduction in inconsistencies. Further work should be carried out to expand its use in different scenarios and adapt the dimensions and criteria for the GRADE approach based on the results. The latest AI technologies will be indispensable in these new directions.

Sickle cell disease (SCD) is one of the most prevalent hemoglobinopathies and results from the replacement of normal hemoglobin (Hb A) by hemoglobin S (HbS), in a homozygous or heterozygous state with other abnormal hemoglobins. The Hb S variant results from the substitution of glutamic acid for valine at position 6 of the β polypeptide chain. This alteration causes profound changes in the stability and solubility of the Hb molecule, favoring the sickling phenomenon and causing serious clinical consequences. The pathophysiology of the disease involves several complications, such as intense hemolytic anemia, and any tissue or organ can be affected. The Sickle cell disease (SCD) is one of the most prevalent hemoglobinopathies and results from the replacement of normal hemoglobin (Hb A) with hemoglobin S (HbS), in a homozygous or heterozygous state with other abnormal hemoglobins. Variant Hb S results from the substitution of glutamic acid for valine at position 6 of the β-polypeptide chain. This alteration causes profound changes in the stability and solubility of the Hb molecule favoring the phenomenon of sickling, causing severe clinical consequences. The pathophysiology of the disease involves several complications, such as intense hemolytic anemia, and any tissue or organ can be affected. The same pathological effects of DF on the connective tissues of different parts of the body - kidneys, liver, spleen, lungs and heart - have occurred in dental tissues and the oral cavity in general. In this context, the aim of this systematic review was to identify and analyze the prevalence of oral manifestations found in patients with DF. The electronic databases consulted were MEDLINE (via Pubmed), EMBASE, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS). After analysis of a total of 16 included studies (n=3852), the presence of caries, malocclusion, and gingival bleeding were the most commonly reported oral changes. The prevalence of combined caries was 0.72 (95% CI: 0.54- 0.91), malocclusion 0.86 (95% CI: 0.43-1.28), and gingival bleeding 0.62 (95 % CI: 0.40-0.84). Knowledge about this may help to fill an existing gap in the scientific literature and above all guide dental surgeons in the approach and care of patients with FD, reducing iatrogenesis and improving care to this group.

Introduction: chronic kidney disease (CKD) is defined as the presence of structural changes and/or kidney functions for a period longer than three months. It is an insidious disease whose guarantee of early diagnosis and longitudinal follow-up enable a better prognosis and mitigate complications arising from the onset and progression of CKD. In this sense, it is important to recognize the adequacy of access for people with CKD to the health care network (RAS) at all levels of health care. Objective: to analyze the adequacy of access for people with chronic kidney disease to the Health Care Network. Methods: to respond to this objective, three articles were prepared, with specific methodologies, according to the designs used in each of them, being a systematic review of literature and the other two cross-sectional studies. Results: the first article ever published in Research, Society and Development, was entitled “Assistance to patients with CKD in primary health care: a systematic literature review”, aimed to analyze assistance to patients with CKD in primary health care. Conclusion article 1: The results of this review demonstrated weakened care for chronic kidney disease patients in basic health care. The second article was developed together with a scientific initiation student/scholar/FAPEMIG, already submitted to the Brazilian Journal of Scientific Initiation whose title and objective were respectively: “Approach to kidney health according to the stage of kidney disease and level of care to health” and identify whether or not patients with chronic kidney disease had an approach to kidney health according to the stage of the disease and level of health care. Conclusion article 2: it was identified that the majority of patients evaluated had an approach to kidney health according to the stage of CKD, however, people ≥ 60 years old were more likely to not have been approached about kidney health. And the third article was titled: “Factors associated with inadequate access for people with chronic kidney disease to the health care network” and its objective is the general objective of the thesis, that is, to analyze the adequacy of access for people with chronic kidney disease to the Health Care Network. Conclusion article 3: People who had a private health plan were three times more likely to have inadequate access to RAS, compared to those who did not have one. And those under 60 were 1.71 times more likely to have inadequate access to the RAS when compared to the elderly. Final considerations: The study findings highlight the importance of increasing the efficiency and effectiveness of the referral and counter-referral process in the RAS so that there is no overload at any level of health care. Furthermore, the existing fragility in Basic Health Care in creating and maintaining links with the population to implement actions to prevent diseases and injuries, as well as health promotion in terms of the approach to kidney health, also becomes noticeable. Based planning and actions are necessary so that public health policies are implemented through the empowerment of health professionals in the single health system, with qualifications and training that enable them to assist with excellence both people at risk of developing CKD or even those with a confirmed diagnosis.

Beta-carbolinic alkaloids are pharmacologically active compounds, widely distributed in the environment. According to the literature, they have already been shown to be effective in the treatment of several diseases, including cancer. Therefore, in the search for new antitumor agents, the present study aimed to evaluate the cytotoxicity of twelve different synthetic βcarbolinic alkaloids and, also, to evaluate the in vitro genotoxic and mutagenic potentials of two of the most promising of these alkaloids, called NQBio-006 and NQBio- 021, using the tumor cell lines TOV-21G (ovary) and MDA-MB-231 (breast). The two compounds were chosen after their cytotoxic potential screening using the MTT assay, since they displayed lower IC50 values and demonstrated promising selectivity index values in relation to the nontumor strain WI-26VA4, after 24-hour treatments. Genotoxic and Mutagenic potential were evaluated by performing the alkaline comet assay and the cytokinesis-block micronucleus assay, respectively, after 3-hour treatments, with and without metabolic activation. Cyclophosphamide and methyl methanesulfonate were used as positive control in the treatments with and without metabolic activation (S9 fraction), respectively. For the alkaloid NQBio-006, genotoxicity and mutagenicity tests were performed at concentrations of 0.6; 1.2; 1.9 and 2.5 in the TOV-21G line, while for the compound NQBio-021 concentrations of 0.4; 0.9; 1.7; 3.5; 5.2 and 6.9 were performed in the MDA-MB-231 strain. In addition, to verify selectivity, studies were conducted using WI-26VA4 at the same concentrations. The results showed that NQBio-006 did not induce primary DNA damage, with and without metabolic activation. However, the compound was shown to be mutagenic with and without S9 fraction, indicating that the compound acts by failure in chromosomal segregation. The compound NQBio-021 was genotoxic and mutagenic with and without S9, which indicates that this compound is capable of causing breaks in the DNA. However, none of them were genotoxic or mutagenic in WI-26VA4. In addition, to assess whether the compounds are good drug candidates, a prediction of in silico ADME (absorption, distribution, metabolism and excretion) parameters was performed. The results obtained showed that both alcaloids have antitumor potential, since they were cytotoxic and selective against the human tumor strains used and caused chromosomal changes that are related to the induction of cell death by apoptosis, according to the literature. However, additional studies must be carried out in vitro and in vivo to assess the efficacy and safety of these compounds in antitumor treatments

In the last decades, changes in the health/disease pattern have evidenced the rise of non-communicable chronic diseases. Type 2 diabetes mellitus (DM2) is an important public health problem and, due to its multifactorial etiology, requires a comprehensive and comprehensive approach to the patient. Due to its capacity for longitudinal care, primary health care plays an effective role in the prevention and treatment of this disease. This study aims to analyze factors associated with glycemic control in patients with DM2 treated in primary care in Carmo do Cajuru/MG. This is a population-based cross-sectional study using secondary data from medical records of primary health care patients. Sociodemographic, clinical and behavioral information were collected from patients with type 2 diabetes mellitus. From this information it was possible to draw a profile of the patients and relate it to glycemic control. A hierarchical cluster analysis was developed, using the Jaccard similarity method. Glycated hemoglobin was the variable used to classify the control or not of the disease and, in the absence of this data, we used fasting glucose. The results showed that most patients were female (59.67%), over 60 years old (65.45%) and overweight (70.92%). Few patients had a nutritional consultation (22.3%) or participated in health groups (19.92%). Only a minority had records of evaluations considered important by most current guides and guidelines: eye fundus (1.59%) and feet (2.39%) as well as referral to hyperdia strategies (10.36%). Almost half of the patients did not have adequate glycemic control. These results show us the need for a broader view of the patient with DM2 beyond the blood glucose tests.

Introduction: The new coronavirus (SARS-CoV-2), which causes the
“Coronavirus Disease 2019” (COVID-19), was responsible for the emergence of
a pandemic started in the first months of 2020. During social distancing, a group
that drew attention was that of the delivery men, who during the pandemic
expanded their activities. Its role in maintaining the economy was essential.
Deprived of social guarantees related to the employment relationship, delivery
men add the risks inherent to their mobility to the risks inherent to contamination
by SARS-CoV-2. (AQUINO; PILATE; FELIX, 2020), making them possible
vectors of the disease (ORTIZ-PRADO et al., 2021). Justification: The
motivation of this dissertation was justified by the growing number of positive
cases of COVID-19, the need to monitor the contamination rate among delivery
man and investigate the association of factors that collaborated with the infection
of delivery man by SARS-Cov-2. Objectives: To assess the prevalence of SARS￾CoV-2 infection in delivery man in a medium-sized city, at two different times of
the pandemic, and to associate it with social and occupational risk factors that
make the delivery man more susceptible to SARS-CoV- 2. Methodology: Clinical
samples were collected in two stages to search for anti-SARS-CoV-2 antibodies
and SARS-CoV-2 viral RNA in the same group of delivery man. Questionnaire
about the social, occupational and preventive profile of COVID-19 was applied
among the delivery man. The variables were measured using the Chi-Square and
Mann-Whitney methods with a significance of 5%. Multiple logistic regression
sought an association of measured factors with the positivity found. Results:
There was an important increase in the total positivity of the second stage of
collections (P=0.06), with a significant increase in the rapid test (p=0.03), when
compared to the results of the first stage of collections. The amount of the
positivity of the two stages resulted in a final prevalence of 15.4% (95% CI
0.0938-0.2322). Among the social characteristics, the level of education showed
the greatest difference, although without significance (p=0.11) and a high number
of delivery man had low education (36% had not completed high school). The
delivery man knowledge about risk groups and symptoms was “High”, but
regarding the forms of contagion during the work routine, it was only “Good”.
Regarding preventive behavior, the group that said they “did not wash their
hands” after going to the bathroom was significant (0.03). In the multiple logistic
regression analysis, the variable “wash your hands after going to the bathroom”
was the only variable that maintained a significant association with the outcome,
so the chance of the delivery person being contaminated by SARS-CoV-2 was
significantly higher among those who said not having the habit of “washing hands
after going to the bathroom”. Conclusion: This work proved to be of high
importance for the class of delivery men, as it went beyond the presentation of
prevalence, involving socioeconomic, behavioral and working conditions
characteristics, agreeing that there is a need for a labor legislation that benefits
the entire class. We concluded that the prevalence among delivery men was high
and that they were potentially exposed to the risk of contamination, contributing
to the dissipation of SARS-CoV-2. Our findings are in agreement with other
prevalences found in studies with delivery people (ORTIZ-PRADO et al., 2021)
and in other studies that evaluated the prevalence of groups that worked in
person during the pandemic.

Health Care-Related Infections (HAI) represent a public health problem, especially in relation to those caused by antimicrobial-resistant bacteria in intensive care units (ICU). HAIs are responsible for high rates of morbidity, longer hospital stay and mortality. The main bacteria causing HAI are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aerugionosa, Enterobacter spp., and Escherichia coli belonging to the acronym ESKAPEE. In this context, the objective of this study was to estimate the prevalence of HAIs caused by bacteria of the ESKAPEE group in an adult ICU of a referral hospital in infectology in Minas Gerais. This is a cross-sectional study developed with 77 patients admitted to the ICU with a diagnosis of HAI caused by bacteria from the ESKAPEE group with microbiological evidence from January 1, 2017 to December 31, 2019. Data were collected from a search in the Hospital Management Integrated System (SIGH) and by active search in printed sheets in the Hospital Infection Control Service and in the Microbiology Laboratory. The comparison between groups (ESKAPEE and patients who had HAI) was made using the mean and standard deviation for the variable “age” and the difference in the mean between the groups was investigated using the Student's t test. Categorical variables were compared between groups using Pearson's chi-square test. The significance level adopted was 5%. A total of 1081 patients hospitalized during the study period were obtained. Of these, 112 patients had HAIs with microbiological evidence, and the overall prevalence of HAIs diagnosed by the SCIH was 10.36%. Of the total of 77 patients diagnosed with HAI by ESKAPEE, 50 (64.94%) were multidrug-resistant. No statistically significant associations were found between all variables analyzed. The mean age of patients who had HAI caused by bacteria from the ESKAPEE group was 47.97 years. All patients in the research used at least one invasive procedure, with the blood stream being the most affected site of infection in the ESKAPEE group. The microorganisms isolated from HAI caused by bacteria of the ESKAPEE group belong, for the most part, to the group of Gram-negative bacteria (87.60%). The most prevalent bacterial species of the ESKAPEE group were: Acinetobacter baumannii 26 (26.80%), then Klebsiella pneumoniae 23 (23.70%), Pseudomonas aeruginosa 23 (23.70%). The most prescribed classes of antimicrobials were glycopeptides followed by polymyxins. There vii was an expressive prevalence of HAI caused by Gram-negative bacteria and the most affected site was bloodstream infection. This result suggests a reassessment of the protocols and continuing education of health professionals.

The new coronavirus (COVID-19) pandemic has changed the social life in our planet, from January 2020 until now. It has changed ways of social and religious gathering, traveling and transports. All come and go system has been modified to prevent the virus (SARS-CoV-2) spread, the social isolation and people´s illness has brought panic, uprising and chaos in health care systems.

The exhaustion of hospital beds, disappearance of protective equipment and medical supplies from the commerce and shortage of human resources have brought the need for alternative and innovative forms of health care. Internationally, the primary care practice has had to change in response to the COVID-19 pandemic. Consequently, it has been seen an unprecedented increase in the telehealth tool use. It also emerges the need to provide quality, ethic, and satisfaction to the system users. The telemedicine is an important innovation, although little is known about patient satisfaction and how this alternative will modify the traditional clinical practice. This work is about the telehealth service evaluation with the proposal the users remotely access information and teleconsultations related to COVID-19, the service has been implemented in two municipalities in Minas Gerais (Divinópolis and Teófilo Otoni), because of the partnership between The Telehealth Network of Minas Gerais, Municipal Health Departments, and the Federal University of São João del-Rei. For data collection, the Satis-COVID scale has been applied through an interview with patients cared by the TeleCOVID system from 05/17/2020 to 02/28/2021, that has been adapted from a validated instrument, consisting of 10 items distributed in one dimension: “Diagnostic capacity and disease management”, “Satisfaction with access, with the assistance and the TeleCOVID System use”. The interview to evaluate the satisfaction with the received care has been performed by telephone contact. Initially, a descriptive analysis from the data obtained from eligible users that answered the scale had been performed and, subsequently, the correlation, construct, validity and internal consistency analysis of the global item and each dimension of the Satis-COVID scale were accomplished. In addition to presentation of the global and stratified satisfaction of users regarding the service received by TeleCOVID.

A isquemia cerebral é uma das doenças com maior taxa de mortalidade atualmente. Entre as vítimas que não morrem, a maioria terá alguma incapacidade funcional como sequela. Portanto, quando se trata de isquemia, o problema não está relacionado apenas à mortalidade, mas também à incapacidade que acomete o indivíduo, como dificuldades de comunicação, alimentação e mobilidade, além de problemas de interação pessoal. Atualmente, o ativador do plasminogênio tecidual (rt-PA) é o único tratamento farmacológico para isquemia e não existem tratamentos com efeitos neuroprotetores para esta doença. Recentemente, os esteróides cardiotônicos (CTS) demonstraram promover neuroproteção contra a isquemia. No entanto, os CTS são drogas que possuem índice terapêutico estreito e sua utilização na clínica é restrita. O BD-15 é um novo derivado não tóxico da digoxina benzilidina que demonstrou aumentar diretamente a atividade da alfa3-Na,K-ATPase e prevenir a isquemia química em modelo de células N2a, mas nunca foi testado em um modelo de isquemia em animal. Relatamos aqui os resultados do uso de BD-15 contra danos cognitivos e ações neurotóxicas causadas durante a isquemia cerebral. Ratos Wistar foram divididos em 4 grupos (6 animais por grupo): Controle, Controle + BD 100 µg/kg tratamento, Isquemia e Isquemia + BD-15 100 µg/kg tratamento. A isquemia cerebral transitória foi induzida com oclusão bilateral de ambas as carótidas comuns artérias por 30 minutos, e após isso o animal foi acompanhado por três dias de reperfusão, com ou sem tratamento com BD-15 (uma dose por dia IP, 100 µg/kg) e o hipocampo foi coletado para realizar análises bioquímicas como: perfil lipídico e peroxidação e atividades enzimáticas de membrana (PMCA, SERCA e acetilcolinesterase); A análise histológica e os parâmetros comportamentais avaliados pelo teste de comportamento de campo aberto (os parâmetros avaliados foram o número de vezes que o animal mudou de quadrante, levantou o corpo e apresentou comportamento de autolimpeza e o número de visitas aos quadrantes centrais). Na análise histológica, a isquemia provocou um dano no tecido cerebral após 3 dias de reperfusão, e o tratamento com BD-15 foi capaz de diminuir esse dano. A isquemia provocou uma diminuição na atividade total da Na,K-ATPase e um aumento nos níveis de expressão da bomba e BD-15 impedem que as alterações causadas pela isquemia. O mesmo perfil foi encontrado para a atividade total de PMCA e os níveis de expressão de PMCA4. O BD-15 também foi capaz de prevenir a diminuição da atividade de SERCA, Mg-ATPase e acetilcolinesterase causada pela isquemia. A peroxidação lipídica da membrana (substância reativa ao ácido tiobarbitúrico), foi aumentada no grupo isquêmico, e novamente o BD-15 foi capaz de prevenir esse efeito. Em relação ao perfil lipídico, observamos aumento do conteúdo de fosfolipídios e colesterol no grupo isquêmico e diminuição nos grupos tratados com BD-15. Os parâmetros comportamentais demonstraram que o BD-15 previne o dano motor causado pela isquemia. Em conclusão, o BD-15 é um STC não tóxico que demonstra a prevenção de danos cerebrais provocados por isquemia, e parece promover neuroproteção em animais expostos à isquemia global.

Motor development (DM) can be defined as the continuous changes in motor behavior throughout life, it is multicausal and inseparable from genetic and environmental factors. It can be divided into phases, among them, the fundamental movement phase in which the fundamental motor skills (HMFs) of stability, locomotion and manipulation are developed. The HMFs are the basis of the motor repertoire that leads in sequences to specialized movements and that, therefore, will be used to participate efficiently in organized and unorganized physical activities throughout life, and therefore, increases the chances of those who develop them. proficiently, to have a physically active lifestyle preventing the emergence of chronic non-communicable diseases. The objective of this research was to investigate the impact of the period of social isolation due to the Covid-19 pandemic on the development of HMFs of schoolchildren aged 7 to 10 years. This is a longitudinal study that observed the performance of students in HMFs. The study procedures were carried out in two stages, the first being before the beginning of social isolation due to the pandemic, in March 2020 (T1) and the second after the easing of social isolation and the return to face-toface classes in the educational system of Minas Gerais, in August 2021 (T2). The students were weighed and measured, the parents/guardians responded to an adapted anamnesis to identify the socioeconomic class of the family and inform the daily routine of the participants in T1 and T2, considering the social restrictions of isolation. To test the motor performance, the Test of Gross Motor Development – 3 (TGMD-3) was used. This test assesses 13 fundamental motor skills divided into the locomotion and ball skills subtests. The first study, which evaluated the DM and HMFs of schoolchildren in general and compared by sex, showed DM below what was expected for their age, especially in ball skills. Emphasis on the girls who were even worse than the boys, more specifically on the skills of bouncing and kicking the ball. It was concluded that the stimuli received by children throughout their lives, especially regarding manipulation skills, including in physical education classes, were not enough to develop the children's fundamental motor skills. Stratifying the participants, only those who were 10 years old were evaluated in terms of TGMD – 3 and routine in T1, as it is expected that at this age they would be proficient in DM as well as in HMFs. The results showed DM below the expected for the age. Most played at home (84.2%), had more than two hours a day to do whatever they wanted (73.7%) and did not participate in guided activity outside the context of physical education classes (68.4%) . They then showed better performance on the locomotion subtest (47.4% on average) than on the ball skills subtest (5.3% on average) (Chi-square X2 = 10.5; p = 0.04) . Therefore, it is possible to assume that the opportunities to perform tasks throughout life were more focused on the performance of locomotion activities than ball skills. However, due to low global motor performance, it is possible to infer that physical education classes alone are not enough for good performance in fundamental motor skills, both for boys and girls. The second study evaluated the impact of the period of social isolation on the development of schoolchildren's HMFs. According to the theory of human development, considering the maturational aspects, no type of worsening in performance from T1 to T2 was expected. And more than 60% of the students remained stable or got worse in the locomotion subtest, and 71.4 presented the same results in the ball skills subtest. Most participants increased the time spent with technological devices such as cell phones, computers and tablets, considered sedentary activities, also increased the time they slept and began to play more at home, which was statistically significant and has a negative association with the performance of children. fundamental motor skills. The proportion of participants who started to perform housework increased significantly, and this had a positive association with improved performance of locomotion skills. However, motor development is multicausal and inseparable from environmental factors, so an isolated fact does not explain the phenomenon as a whole. Therefore, it is concluded that the factors 10 associated with changes in the school's routine, together, influenced the development of HMFs, since this development is multicausal and is inextricably modified by genetic and environmental factors. And the findings reinforce this theory, that of dynamical systems.

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Introduction: Extended spectrum antimicrobial dosing strategies to reach the
therapeutic target, especially for bacterial infections in critically ill patients, remains
a challenge. Objective: To evaluate the pharmacokinetics (PK) and
pharmacodynamics (PD) of piperacillin in critically ill patients in an Intensive Care
Unit (ICU) in a medium-sized hospital in the Midwest of Minas Gerais. Method: This
is a cross-sectional study, where the outcome of reaching the therapeutic target was
evaluated in critically ill patients allocated in an ICU, using piperacillin. Individuals
with indication of piperacillin use were recruited during a 12-month period. 03 blood
samples were collected on the fifth day of treatment with piperacillin with two-hour
intervals between each sample, and the antimicrobial in blood plasma was
quantified by high performance liquid chromatography (HPLC). Reaching the
therapeutic target was measured using the effectiveness parameter set at 50% and
100% of the time free concentrations were above the minimum inhibitory
concentration (%fT>MIC) for a MIC of 8 mg/L. Clinical severity outcomes of patients
included at 5, 7, 14, 28 and 30 days of ICU treatment with piperacillin were also
evaluated. Data were expressed as medians, interquartile (IQ25%-75%), minimum
and maximum values. Results: We included 30 patients, adults, aged 71 years
(median: 61-78/IQ25%-75%), with a predominance of females 53% (n=16). Using
12g of piperacillin per day, infusion time of approximately 30 minutes, with intervals
between doses of 8/8h, it was observed that 50% (n=15) of patients reached
50%fT>MIC, and 33% (n=15) =10) 100%fT>MIC. P.aeruginosa was the most
prevalent bacterium, present in 20% (n=6) of the isolates from biological samples
from the patients included. Conclusion: Reaching the therapeutic target in critically
ill patients using empiric piperacillin is still quite controversial, and we believe that
further studies are needed in this area.

Introduction: COVID-19 is a recent illness that has caused awareness in the
scientific community due to its high transmissibility, the variety of the symptoms, and
the unknown consequences in long term. Despite that, a worse prognosis between
the illness and conditions related to body composition, such as obesity and
sarcopenia, has been observed and, therefore, deserves attention, as well as the
methods used to measure the body composition. Objectives: To study the quality of
life, aspects of the disease, and the body composition of post-covid patients,
comparing different methods such as anthropometry, bioimpedance (BIA), and
ultrasound (US) with Dual-Energy X-Ray Absorptiometry (DEXA), evaluating The
correlation and agreement of these methods. Methods: A observational study was
developed, evaluating patients from the post-Covid outpatient in Divinópolis, Minas
Gerais, with the collection of data relating to the quality of life, through the SF-36
questionnaire and the body composition, by BIA, anthropometry, ultrasound, And
Dexa. Results: Concerning body composition, 44% of patients were classified as
obese according to body fat mass index and 8% had an appendicular lean mass
index compatible with low muscle mass measured by DEXA. 64% presented
substantially increased abdominal circumference. About Covid-19, 47.6% needed
hospitalization during the acute phase of the disease, 23.8% required mechanical
ventilation, and 90% were already vaccinated. The quality-of-life data revealed that
the worst-performance aspect was the limitation by emotional aspects (0.00) and the
the physical limitation (25.00) and the best score was mental health (51.05). There
was good reproducibility of the measurements of the adipose and muscular tissue by
US with ICC greater than 0.90 in all anatomical regions. There was a moderate
correlation between the DEXA A / G rate and the circumference of the waist and
between the A / G rate with intra-abdominal fat measured by US (ICC = 0.567 and
0.563), respectively. As for lean mass, there was a positive moderate correlation
between appendicular muscle mass measured by the US and the appendicular lean
mass measured by DEXA, with a Spearman correlation of 0.620. About the
percentage of body fat, only BIA presented an agreement with Dexa by the analysis
of Bland Altman. Conclusion: Changes to the body composition were frequent, with
the quality-of-life data revealing limitations of emotional and physical aspect in
patients. Between body composition tests, BIA presented the best performance in the
evaluation of adipose tissue compared to the gold standard. More widespread
research is needed for the most in-depth knowledge of the characteristics of the postCovid symptomatic population and the validity of methods, such as US to evaluate
body adipose tissue. Development and validation of specific equations for our
population should be stimulated, positively influencing agreement with Dexa.

Objective: The present study aimed to assess which is the best dose of benznidazole in the chronic phase of Chagas Disease, with better efficacy and less toxic effects, through a systematic review and a population pharmacokinetic model. Justification: Divergent results in research with the standard dose of 5mg / kg / day for 60 days in the chronic phase of the disease have been observed. Materials and Methods: The systematic review was conducted followed by meta-analysis and searches were performed in four databases, including studies published until May 2019. The descriptors used were: “Chagas disease”, “benznidazole”, “therapy medication ”,“ pharmacokinetics ”,“ dose-response relationship, medication ”and“ chronic disease ”. The meta-analysis compared studies using the standard dose of 5 mg / kg / day for 30 or 60 days. For the construction of the population kinetics model, a prospective cohort was carried out, in which patients with chronic Chagas' disease who are followed up at the Instituto de Infectologia Emílio Ribas were approached. Benznidazole was prescribed at a dose of 5mg / kg / day for 8/8 hours for 60 days. Two weeks after the start of treatment, blood samples were obtained to determine the concentration of the drug. Adverse events were assessed using a standardized questionnaire. Partial Results: In the systematic review, 23 articles were included and, of these, nine were selected for the meta-analysis. The selected studies were published between 1996 and 2018, with benznidazole dose regimens ranging from 2.5 mg / kg / day to 10mg / kg / day, lasting 30 to 80 days of treatment. Researches that used the standard dose for 30 days showed better results for the observed parameters (CRP, cardiac changes and negative serology) compared to those that used for 60 days. The prospective cohort included ten patients, with an average age of 50.3 years (SD = 5.62), the majority of whom were brown (90.0%) and female (60.0%). Adverse events have been reported after starting treatment, namely: diarrhea, pruritus, hypogeusia, liver dysfunction, oro-labial herpes, paresthesia, peripheral neuropathy, epigastric pain, dyspepsia / constipation and arthromyalgia. Conclusions: The results of the systematic review pointed to a great diversity of dosing schedules, indicating that there is still no consensus on the ideal dose schedule for benznidazole in the chronic phase of Chagas disease.

Identify and minimize risks, prevent incidents and improve SP, has been highlighted
worldwide in high-risk clinical procedures, such as teletherapy, so the objective of this
study was to build and validate a graphic protocol and checklist for the evaluation of
safe patient care in oncological treatment by teletherapy. For this, a methodological
study was made, with a mixed approach, subdivided into four stages: i) identification
and synthesis of scientific evidence on patient safety in oncological treatment by
teletherapy (scoping review), from the mnemonic combination: participants, Concept
and context (PCC): P - oncological patient, C - patient safety and C - teletherapy
treatment; ii) construction of a graphic protocol and checklist for the evaluation of safe
patient care in oncological treatment by teletherapy, based on national and
international guidelines and data scoping review (step 1), in addition to the components
structure, process and result; iii) content and appearance validation of the graphic
protocol and checklist, in two rounds by the Delphi technique; iv) application of a pilot
study in a radiotherapy unit of Minas Gerais. The results were analyzed by descriptive
statistics and the classification of care by applying the pilot study, from the score listed
in the graphic protocol. In the scoping review, 67 studies were found that
recommended the following measures to prevent and reduce the occurrence of
incidents in teletherapy treatment: implementation of risk and process management
programs; promotion of safe workflow; use of systems of voluntary notification of
incidents and learning with them and promotion of SP culture. The graphic protocol
and the checklist were built based on national and international guidelines and
scientific evidence retrieved by the scoping review, being organized according to the
Donabediana triad (structure, process and result). After the two rounds of Delphi, the
graphic protocol and checklist were considered valid in content (CVC>90%) and
appearance (CVC>90%). During the application of the pilot study, the graphic protocol
and the checklist were suitable for use, that is, objective, easy to read and interpret,
and no adjustments were necessary at the time of application. Thus, it was possible to
construct and validate in content and appearance a graphic protocol and checklist for
the evaluation of safe care to the patient in oncological treatment by teletherapy and
aims to if this tool can contribute to improving management in teletherapy services and
patient safety.

Immunobiologicals are thermolabile substances, which means that they need to be
kept at an ideal temperature in order to preserve their characteristics and properties.
In Brazil, the Ministry of Health, through the National Immunization Program, has a
logistical structure that involves storage, conservation, manipulation, transport and
distribution, to guarantee the conservation of these substances from the producing
laboratory to the user, called Cold Chain . Like every service provided by any
organization, maintaining the quality of the Cold Chain has a financial cost that needs
to be measured and evaluated in order to achieve an efficient allocation of resources.
This study aimed to analyze the costs of the Cold Chain for conservation of
immunobiologicals at the municipal level. This is an economic evaluation research
focused on cost analysis, carried out between the years 2020 and 2022. The study
was divided into two stages: In the first stage, a checklist of activities was developed
and validated using the Delphi technique. cost generators of the Cold Chain municipal
instance, in order to have a more accurate description of the resources consumed in
the process of conservation of immunobiologicals. After the validation process, the
checklist consisted of 27 activities, 7 of them in the Transport and Receiving
component, 18 in the Storage and Handling component and 2 in the Supervision and
Permanent Education component. Considering all components, the checklist's total
content validation index was 92.3%. Total internal consistency obtained a Cronbach's
Alpha coefficient value of 0.9534. In the second stage, a study was carried out on the
costing of the Cold Chain. The unit of analysis was the Municipal Instance. The
perspective of the Unified Health System as a funder was considered, and the year
2021 as the time frame. A period of one year was considered as the time horizon of
the analysis. Direct medical, non-medical, and indirect costs were included. Activity￾Based Costing was used as a method to determine the cost and a sensitivity analysis
was performed to identify the influence of the main categories on the final cost. In the
period studied, the total cost of the Cold Chain was R$ 1,003,729.48, with non-medical
direct costs being the most representative (61.24%). Human resources were the most
influential items, both in direct medical and non-medical costs, representing 76.43% of
the total cost. The study allowed the construction of a checklist of activities that
generate reliable costs and valid content, becoming an important tool for assessing
costs in the cold chain. It also allowed the determination of the total cost of the
municipal Cold Chain as well as the main categories that influence this cost. Thus, the
results are useful for planning the allocation of financial resources, as they provide
valuable information for decision making, as well as for controlling variables that can
influence final costs.

Introdução: a aplicação prática do autocuidado vem sendo adotada como medida preventiva adicional para preservação das funções renais. E o Letramento em Saúde (LS) pode ser utilizado como ferramenta que viabiliza esse autocuidado. Objetivo: Avaliar a associação entre Letramento em Saúde e a capacidade de autocuidado de pacientes renais crônicos nos estágios não dialíticos. Método: trata-se de um estudo transversal analítico desenvolvido no ambulatório de nefrologia de um município do centro oeste Mineiro/Brasil. Foram Incluídos adultos e idosos de ambos os sexos, com diagnóstico de Doença Renal Crônica em tratamento conservador, e excluídos pacientes que não tiveram cognição adequada testada pelo teste Mini Mental. Para avaliar o Letramento em Saúde foi aplicado o instrumento SAHLPA-18 e o autocuidado a escala ASAS-R. Resultados: entre os 47 pacientes analisados 57,4% eram do sexo masculino; 69,6% casados; 70,2% se consideravam brancos e 80,9% eram católicos. A média de idade foi de 63,9 anos; a maior parte (78,7%) não trabalhava; 63,9% não completaram o ensino fundamental e 85,1% possuíam renda abaixo de dois salários mínimos. Os estágios predominantes da doença renal (63,8%) foram o 3B e o 4. Além disso, 19,1% tinham o hábito de ler e 38,3% costumavam usar a internet. Na avaliação do Letramento em Saúde 59,6% tinham letramento inadequado (< 14 pontos) e a mediana de 13 pontos, variando entre 0 a 18. O autocuidado, avaliado pelo ASAS-R e quantificado pela escala de Likert com nota máxima 75, obteve média geral de 54,4 pontos (DP=9,4). Com relação ao conhecimento sobre doença renal, somente 8,5% conheciam muito sobre essa doença. No que diz respeito a associação entre o Letramento em Saúde adequado e o Autocuidado, essa foi significativa com p<0,001. Houve ainda, correlação positiva e direta indicando que o aumento dos valores da pontuação do Letramento em Saúde também aumentou a capacidade do autocuidaddo. No modelo final, a regressão linear múltipla identificou que a cada aumento de um ponto no Letramento em Saúde, ocorreu um aumento de 0,54 na capacidade do autocuidado. O R2 foi 40%, ou seja, o Letramento e a variável relacionada ao trabalho explicam 40% da variabilidade dos dados de Autocuidado. Conclusão: houve associação significativa entre o Letramento em Saúde e a capacidade de Autocuidado dos pacientes renais crônicos não dialíticos. Com estes resultados acredita-se que a concretização do Letramento em Saúde como ferramenta adicional para se efetivar o autocuidado na abordagem preventiva aos pacientes com DRC viabilizaria a redução das situações de vulnerabilidade, permitindo uma melhor qualidade de vida, autonomia e tomada de decisões conscientes relativas ao estado de saúde. 

Em breve

Visceral leishmaniasis (VL) is a neglected tropical disease that has major impacts on public health. Brazil has the majority of cases of human visceral leishmaniasis (LVH) in the American continent, whose form of transmission is of the zoonotic type, having the role of a prominent dog in the urban cycle of the disease. To improve the control and prevention of VL, it is essential to understand the factors associated with the occurrence of canine visceral leishmaniasis (CVL), but many of these are still controversial or poorly understood. In addition, few studies contemplate the theme of responsible animal custody and its relationship with an LVC. The present study analyzes factors associated with CVL in dogs domiciled in the municipality of Divinópolis (MG). This is an analytical sectional epidemiological study, conducted in partnership with the Municipal Health Secretariat of the municipality. In visits initiated by the city, DPP ® and ELISA tests for the diagnosis of CVL were earlier. Subsequently, in new visits to the same households, a questionnaire was needed to the dog's guardians about several variables possibly associated with CVL already studied in the literature and which also included new variables, related to responsible animal custody. The data were identified by means of bivariate analyzes and by simple and geographically weighted logistic regression models (GWLR). Of the 704 forced dogs, 47 (6.7%) tested positive for LVC. All variables related to the adoption of responsible guarding principles were associated with lower chances of infection. In multivariate models, it was identified that dogs bred exclusively in the peridomicium; with free access to the street; who was under tutelage of lack of education or higher education; and those acquired as adults were more likely to be positive. These associations have a consistent pattern throughout the studied territory. The results showed a high and stable prevalence of CVL in the municipality of Divinópolis (MG) and the existence of relevant variables for directing disease control actions, especially with regard to aspects related to responsible animal custody.

Objective: Evaluate the profile of patients and requests for direct oral anticoagulants (DOACs) assisted through the courts. Methods: Descriptive documental study divided into two articles: (1) Data collection was carried out in Divinópolis of all cases judged with a favorable opinion by the court regarding the request of the DOACs. Data collection was carried out from three secondary sources: court proceedings, patient records and the Health Information System (HIS); (2) The sociodemographic, diagnostic and treatment characteristics of the patients were evaluated, as well as information on the evidence of the technology's efficacy and safety and the conclusion of all Technical Notes (TN) referring to the request for DOACs obtained from the e-NatJus platform. Results: Article 1: A total of 74 processes referring to the request of DOACs in the city of Divinópolis-MG were included in the study. It was observed that 74.3% of the individuals were female, the average age was 70 years. The most common diagnosis was atrial fibrillation (36.5%). About 52.7% of physicians reported that there was a therapeutic attempt with warfarin before the introduction of DOACs and convenience (24.3%) was the most used justification by prescribers for choosing DOACs, followed by difficulty in controlling INR (20, 3%). Another finding was that 25.7% of the patients never obtained the medication requested through the courts at the SUS pharmacy. Article 2: 181 TN were included in the study: rivaroxaban (67%), apixaban (16%), dabigatran (12%) and edoxaban (5%). Approximately 86 TN had similar content in the scientific evidence item. It was observed that 57.5% had an unfavorable conclusion to make the requested medication available. Among the 77 TN that had a favorable conclusion, 57.1% did not evaluate the recommendations of the National Commission for the Incorporation of Technologies. Conclusion: It was observed in most of the analyzed processes and TNs that the medical prescriptions of DOACs were not based on protocols and clinical guidelines established by the SUS to treat the respective clinical conditions, in both studies we found the lack of important information as an obstacle, leaving gaps regarding the real need for the judicialization of these drugs.

Introduction: Work stress is one of the main focuses of occupational health. Illness at work favors the medicalization of manifestations of suffering. The association between job stress and medication use is still scarce, especially in Brazil. Objective: To investigate whether job stress is associated with the use of antidepressants and benzodiazepines in a sample of active Brazilian workers. Methods: This is a cross-sectional study developed with a sample of 12,015 active workers participating in the baseline (2008-2010) of the Longitudinal Study of Adult Health (ELSA-Brasil). Work stress was assessed using the Brazilian version of the Demand-ControlSupport Questionnaire, consisting of 17 items. Drug use was considered based on self-report of use of at least one drug from the classes of interest in the last two weeks. The association between job stress and medication use was assessed using logistic regression. Results: Of the 12,015 study participants, 52.3% were female, 47.7% were between 45 and 54 years old, and 52.7% had at least higher education. The prevalence of use of antidepressants and benzodiazepines was 7.6% and 3.1%, respectively. Individuals using antidepressants often had a high demand job (41.5%), medium control (38.0%) and low social support (39.7%). Participants using benzodiazepines were mostly in high demand (43.6%), medium control (38.4%) and medium social support (36.3%). After adjusting for confounding variables, having high control and high social support at work was associated with lower odds of using antidepressants. High control at work was also associated with lower use of benzodiazepines. Workers exposed to active, high-strain work were more likely to use benzodiazepines. Final considerations: the results of this study reinforce the hypothesis that stress at work is associated with the use of benzodiazepine antidepressants, demonstrating its importance for contributing to interventions in the workplace, as well as to the rational use of medications in the population of workers

Introduction: Brazilian studies show that among the drugs most used by judicial litigation in Brazil, are those used for the treatment of Diabetes Mellitus (DM). In view of this, it is essential to seek strategies that enable the improvement of patient care management, in an efficient and resolutive manner. Objectives: To evaluate the use of public health services, compliance with clinical protocols and therapeutic guidelines (PCDT), glycemic control and the effectiveness of pharmacotherapeutic follow-up in patients with type 1 Diabetes Mellitus (T1DM) who receive at least one drug through judicial litigation. Methods: The study population corresponded to patients with T1DM who receive at least one drug through judicial litigation in the municipality of Divinópolis-MG. Studies with secondary data were carried out to verify if the patients were monitored by the Unified Health System (SUS) and if they had previously used human insulins (compliance with the PCDT). Through a crosssectional study, the glycemic control of patients was verified by means of tests of fasting glycemia and glycated hemoglobin and a single arm intervention study was carried out by means of pharmacotherapeutic follow-up in these patients. Results: 55.1% of patients are not monitored by SUS, 53.9% did not use human insulin prior to the use of analogs, 90% did not have glycemic control and pharmacotherapeutic follow-up promoted improvements in blood glucose, blood pressure levels, knowledge about the insulin application techniques, quality of life and health, eating habits and resolution of Pharmacotherapeutic Problems. Conclusion: Most patients with T1DM who receive drugs by judicial means in the analyzed municipality are not monitored by SUS, did not present compliance with the PCDT and did not have glycemic control. However, pharmacotherapeutic follow-up has provided clinical, therapeutic, laboratory and behavioral benefits, with an improvement in the quality of life and health of these patients

Introduction: The diagnosis and surgical treatments for head and neck cancer (CCP) are accompanied by suffering, which affects the patient and their family, which can change the quality of life (QOL) and lead to depression. Resilience can influence QOL and depression scores in cancer patients. Objectives: To evaluate the resilience, QOL and depression scores in patients with CCP at different times of treatment and correlate these variables. Patients and methods: This is a study developed with 28 patients diagnosed with CCP undergoing surgery, from August 2017 to November 2019, followed up in three moments. The Mini Mental State Examination, University of Washington Quality of Life Questionnaire, Beck Depression Inventory and Resilience Scale were applied. Results: Regarding QOL, there was a difference in the physical function domain, when comparing periods T1 and T2. At T2, patients who underwent only surgery had higher scores in all domains and in total QOL (QWL). At T3, physical function and QWL were higher in surgical-only patients. Patients with CCP in early stages had higher scores in all domains of QOL and QWL at T2. At T3, surgical patients had better physical function than those who required adjuvant treatments. Regarding depression, it was noted that surgical patients had lower scores than those who underwent surgery followed by some adjuvant therapy in T2. In the same period of time, there was a difference between patients with CCECP in early and advanced stages, with higher scores in the latter. As for resilience, at T2, only surgical patients had higher self-confidence scores and the ability to adapt to situations, when compared to those who underwent surgery followed by adjuvant treatments. There was a positive correlation between resilience and QOL and negative correlations between depression and resilience and between depression and QOL. Conclusion: In this sample, the type of treatment interfered with QOL, depression and resilience, as well as tumor staging impacted QOL and depression. A positive correlation was observed between resilience and QOL, as well as a negative one between depression, resilience and QOL.

This study aimed to evaluate the nosological profile of the State of Amazonas, municipality of Humaitá and riverside population of the municipality in light of the phenomenon of epidemiological transition. A study was carried out on the health situation in Brazil, Amazonas and Humaitá in the context of demographic and epidemiological transition. To characterize this scenario, secondary data from the main health information systems were used. Concomitantly, a prevalence study was carried out on Chronic Non-Communicable Diseases (NCDs) and Infectious and Parasitic Diseases (IPD) that affect the riverside population along the Madeira River, in Humaitá – AM. The traditional riverside population has been showing changes in their lifestyles, caused by socio-environmental impacts that interfere with the morbidity and mortality profile, since the Amazon region is endemic and several infectious diseases continue to grow. The field study site was 16 riverside communities located along the Madeira River, in the municipality of Humaitá, State of Amazonas, in Western Amazonia. An observational method of prevalence study was used, with a sample size of 183 adult individuals, who were screened and verified: weight, height, waist circumference, blood pressure, clinical and epidemiological history, and physical and laboratory examinations were performed. Prevalence analyzes and prevalence ratios were calculated with confidence intervals with statistical significance of 95% and p<0.05. The prevalence of systemic arterial hypertension (SAH) was 44.7%, of which 52.6% were female. Of the hypertensive individuals, 77.5% did not use medication. About 51.5% of hypertensive patients have Grade I SAH. The prevalence of type 2 diabetes mellitus was 16.4%, where no patient used medication and about 40.4% of the studied population fits into the glucose intolerance range . Metabolic syndrome had a prevalence of 24.0%, higher frequency in females (33.8%) (p=0.007). Regarding renal dysfunction, there was a prevalence of 12.1% in both genders. The risk factors found were alcoholism, smoking and obesity, and more than 45% had at least two risk factors. There was a prevalence of 8.7% of PID (Leprosy 5.5%). We found that this riverside population has high prevalence of CNCDs and risk factors, low frequency of medication use, revealing inefficiency of the local health system. We observed that the state of Amazonas and the municipality of Humaitá are less advanced in relation to the demographic and epidemiological transition process in relation to the average in Brazil, as they present coexistence of morbidity and mortality rates from CNCDs and the presence of ILD with morbidity and mortality still high. We found that the access of these populations to health services is limited, economic conditions are unfavorable, and health problems are often solved in the community itself, and that even in remote areas of the northern region, we have already encountered the process of epidemiological transition (or population) in progress, with delineations of problems related to the double burden of diseases (DIP and CNCD), in poor areas, with difficult access and with an unstructured family health strategy.

Cancer is a leading cause of death worldwide and its treatment is hampered by the lack of specificity and side effects of current drugs. Thus, the search for new antitumor agents and targets becomes important to find a tumor cell selective drug. In this context, cardiotonic steroids (CTS), such as digitoxin, are compounds that interact with Na, K-ATPase to induce antineoplastic effects, however these digitalis have a narrow therapeutic index. Thus, the synthesis of analogs with modifications in digitoxin glycosidic moiety has been shown to be an interesting approach for more selective and more effective analogs as antitumor agents. In addition, CTS may induce apoptosis in tumor cells by interfering with mitochondrial function, inducing oxidative stress and cell death. Therefore, the aim of this study was to evaluate the antitumor mechanism of the α-L-amicetosis digitoxigenin and α-L-rhamnose digitoxigenin compounds with respect to oxidative parameters in HeLa cells and to evaluate the involvement of PMCA4 in the antitumor mechanism of these analogs. For this, the levels of hydrogen peroxide (H2O2), reduced glutathione (GSH) catalase activity (CAT) and superoxide dismutase (SOD) were measured and the analogues induced a state of oxidative stress increasing the levels of H2O2 and reducing the levels of GSH and SOD activity. Involvement of PMCA4, an important enzyme for the control of intracellular Ca2+ levels, was evaluated using HT-29 cells treated with the analogs for 24 and 48 hours. Briefly, HT-29 cells before reaching confluence do not express PMCA4 and the analogs were very cytotoxic under this condition. In addition, α-L-rhamnose digitoxigenin increased NCS-1 and AIF levels which may be a reason for its higher cytotoxicity. However, after 5 days of confluence where cells express PMCA4 on the plasma membrane the analogs were not cytotoxic. This suggests that the analogs induce increased intracellular Ca2+ levels because the presence or absence of PMCA4 in the plasma membrane is important for this cytotoxicity. Therefore our results promoted a better understanding of the mechanism of action of these analogs and highlighted PMCA4 as an important target for the development of antitumor agents.

INTRODUCTION: Falls represent a major public health problem worldwide as it is the second leading cause of accidental death on the planet, accounting for 646 thousand deaths per year. The frequency of its occurrence increases with age and the degree of fragility, adding to the presence of other risk factors. Medicines have been presented as potential factors associated with the fall, however the results in the literature are still divergent in relation to the pharmacological classes that are associated with this events. OBJECTIVE: To analyze the association between falls and the use of medications in frail non-institutionalized elderly users of Primary Care of the Unified Health System (SUS).METHOD: This is a case-control study that was conducted with users of Primary Care of the Unified Health System (SUS) in Divinópolis city in the state of Minas Gerais, Brazil. The elderly who are accompanied by primary health care professionals, who have Systemic Arterial Hypertension (SAH) and / or Diabetes Mellitus (DM), classified as fragile, registered in the Integrated Health System (SIS) at period from January 2011 to July 2015 were eligible for inclusion in the study. For the collection of all variables, a secondary source of information, the municipality's SIS, was used. The cases were frail elderly people with self-reported falls in the last year, and controls were frail elderly people with no reports of falls, matched by sex, age and health unit. The outcome variable was a fall in the last year. The exposure variables were the use of medicines by pharmacological class, the use of combined medicines therapy, inclusion and exclusion of medicines  and dose adjustment in the last 12 months. Clinical and sociodemographic characteristics were considered to be covariates. The magnitude of the associations was estimated by odds ratio (OR) paired using univariate and multivariate conditional logistic regression, with a 95% confidence interval. RESULTS: The population consisted of 1028 elderly people (514 in each group). The median age of the study participants was 71 years (interquartile range 66 - 76.5 years), with a predominance of females (74.1%). Of the 1028 study participants, 982 were diagnosed with SAH and 514 DM. The medicines that act on the renin-angiotensin system were the most used among the participants (60.7% in the control group and 65% in the case group). In the univariate analysis, the use of antianemics, classified as B03 by Anatomical Therapeutic Chemical (ATC), the use of anti-inflammatories (M01) and antiepileptics (N03) were associated with the fall. In this stage, the exclusion and inclusion of medications in the last 12 months also showed an association. After adjusting for the other exposure variables and covariates, there was a significant association between falls and the use of antianemic drugs (B03). CONCLUSION: The fall in frail non-institutionalized elderly people is associated with the use of antianemic agents, an association that has not been described in other studies. On the other hand, the outcome was not associated with the other pharmacological classes tested, with combined drug therapy, inclusion and exclusion of medicines and dose adjustment in the last 12 months.

Invasive plants are the cause of great concern for agriculture in Brazil and worldwide. The frequent and excessive use of herbicides, over the years, has caused a situation of resistance that is aggravated when it is related to damage to the environment and living beings, whether in the short or long term, due to direct or indirect exposure to these agents. The growing emphasis on organic agriculture and environmental protection has given great attention to allelopathic research through the use of plant extracts with biological activity to replace synthetic herbicides, making them safer and less aggressive alternatives. Thus, in the present work, potentially herbicidal substances (phenolic, acid and benzoxazinones) were tested, coming from natural products and belonging to the most studied classes over the past few years. The compounds obtained by hemisynthesis of a natural constituent, (3,4,5-trimethoxybenzoic acid and 2,4,6 trimethoxyphenol), in addition to its novel product, obtained by synthesis via SN2 reaction (3,4,5- trimethoxybenzoate of 2 -ethoxy-2-oxoethyl) showed phytotoxic activity in tests with seeds of cultivars of economic interest. Benzoxazinone and its analog (3-hydroxy-2- nitropyridine), showed excellent results, inhibiting practically 100% germination in lettuce, onion and tomato seeds, pointing out these compounds as promising prototypes for potential herbicides from natural sources.

Objective: To assess quality of life (QOL) and health literacy (HL) and their association with sociodemographic, clinical, behavioral and health care aspects in patients with Chagas disease (CD). Method: This present doctoral thesis was developed in the SaMi-Trop cohort which was constituted in 2011-2012, composed of 1959 patients with positive CD serology, in a region with a high prevalence of chronic CD in Minas Gerais state. Baseline data collection was carried out in 2013-2014 and the first follow-up in 2015-2016. QOL was measured at both times using the WHOQOL-Bref scale. Health literacy (HL) was assessed only in the first follow-up, using the SAHLPA-18 scale. This thesis was divided into two parts, each part corresponding to a scientific article with independent objectives and analyzes: i) sectional study to assess the QOL profile among patients with CD and its association with sociodemographic, behavioral, and clinical characteristics; multivariate analysis using beta regression was used; and ii) cross-sectional study to assess the prevalence of HL and its association with sociodemographic and clinical characteristics, health care, and QOL in patients with CD. Patients who knew how to read were included for HL evaluation. Those who could not read were considered illiterate. Literate people responded to the SAHLPA-18 scale. The literacy variable was composed of three categories: 1) illiterate; 2) inadequate HL and; 3) adequate HL. Binary multinomial logistic regression and beta regression were used. Results: A lower QOL was identified in the Environment Domain followed by the Physical Domain, and a higher QOL was observed in the Social Relations Domain. The subjective perception of QOL was not associated with the severity of the disease using the presence of Chagas cardiomyopathy as a marker. There was a high prevalence of illiteracy and inadequate health literacy. Being illiterate is associated with worse QOL. Both are associated with worse clinical outcomes such as the use of more medication and the presence of Chagas cardiomyopathy with left ventricular dysfunction (LVD). Conclusion: The findings of this thesis reinforce the importance of quality of life and health literacy indicators for care planning, health communication, and clinical management of patients with CD living in remote regions, with low access to specialized health services.

Introduction: Leishmaniasis is a disease that presents itself from small skin lesions to visceral disorders that can evolve to death. Its diagnosis is still a difficult task. Objectives: To evaluate the association of histopathological criteria with the results of polymerase chain reaction (PCR) of clinically suspected cases of cutaneous leishmaniasis (CL). Methods: An observational, cross-sectional, and retrospective study that evaluated, by PCR and histological examination, skin samples received during 9 years of clinically suspected cases of CL. Results: The results demonstrate that the evaluated histological variables did not show statistical significance with the result of the PCR when considered individually: ulceration (P = 0.231), epidermal hyperplasia (P = 0.595), hyperkeratosis (P = 0.103), presence of granuloma (P = 0.280), neutrophils (P = 0.475), histiocytes (P = 0.241), lymphocytes (0.543), plasmocytes (0.291), and necrosis (0.746). Limitations: Cases from a single institution with a small number of negative ones in PCR were analyzed. Conclusions: The data from the present study highlight the high specificity of microscopy analysis with 100% agreement with the PCR result for clinically suspected cases in an endemic Brazilian region. However, a histopathological finding in isolation cannot predict PCR positive results.

DESENHO RACIONAL DE UMA PROTEÍNA MULTIEPITOPO USADA COMO ALVO VACINAL CONTRA STREPTOCOCCUS PNEUMONIAE

Introduction: Dengue is a neglected disease, although it has a major impact on public health worldwide. Thus, studies of cell receptors involved in its pathogenesis have been strengthened. The CD-209 gene, which goes through the alternative splicing process, codes for DC-SIGN glycoprotein (Dendritic Cell-Specific ICAM-3 Grabbing Non-integrin) in thirteen distinct isoforms: soluble and membrane. Membrane isoforms exist mainly on the surface of human immature dendritic cells (iDCs), allowing early adhesion of Dengue virus (DENV). The complete isoform has four major regions: cytoplasmic domain (N-terminal), transmembrane region (TM), extracellular neck region, and carbohydrate recognition domain (CRD) that is responsible for the interaction with DENV glycoprotein E. Soluble isoforms lose the transmembrane portion and their role in the process of DENV infection is not well understood. Objectives: This work proposed to evaluate changes in the process of infection of iDCs by DENV in the presence of three DC-SIGN recombinant soluble isoforms: 8, 10 and 12 at varying concentrations, able (8 and 10) or unfit (12) to interact with. DENV due to intact or altered CRD. Methods: The heterologous expression of isoform 10 (complete soluble) in Escherichia coli BL21 DE3 Rosetta strain was confirmed by SDS-PAGE and Western Blotting. The recombinant protein was purified by cobalt column affinity chromatography, analyzed by SDS-PAGE and quantified by Bradford. The two other soluble isoforms, 8 and 12, were produced in previous works. Recombinant proteins were validated on a mannose affinity chromatography column. DENV-2 was multiplied in Aedes albopictus C6/36 cell line and quantified by TCID₅₀ in BHK-21 cells. Profile cells close to iDCs were produced from the THP-1 strain stimulated with IL-4 and GM-CSF factors at 50 ng/ mL, each one, for 144 hours. Phenotyping of iDC profile cells was performed by flow cytometry by analysis of CD11c, CD86, CD209 and CD14 receptors. Infection assays were performed in the presence of around 10⁶ iDCs/ well, DENV-2 with MOI  1 and isoforms 8, 10 and 12 separately at concentrations of 100, 50 and 25 ng/ mL. The viral load after the infection assay was estimated by qPCR and statistical analysis was performed by Kruskal-Wallis and ANOVA tests. Results: The purified isoform 10 was obtained for a total of 0.813 mg. After functional testing of the isoforms, two of them with intact CRD (8 and 10) maintained their ability to bind to mannose residues and the one with altered CRD (12) was unable to bind to these residues as predicted. Obtaining iDC profile cells was confirmed by increasing expression of CD11c, CD86 and CD209 surface markers and maintaining CD14 expression as predicted for cells differentiated from THP-1. Infection assays demonstrated a 23-fold increase in DENV viral load in the presence of isoforms 8 and 10 at 100 ng / mL compared to viral control (p <0.05). At lower concentrations of 50 and 25 ng / mL, the same isoforms maintained viral less than viral control (p <0.05). Isoform 12 did not alter viral load at any of the concentrations tested. Conclusions: It was possible to conclude that at higher concentrations (range 100 ng / mL), isoforms able to interact with DENV increase viral infection acting as opsonins. At lower concentrations these isoforms appear to inhibit DENV infection. Future trials with MOI different concentrations of different isoforms and even with other viruses are promising.

AVALIAÇÃO DE ATIVIDADES BIOLÓGICAS DO EXTRATO ETANÓLICO E FRAÇÕES DAS PARTES AÉREAS DE LIPPIA ALA (VERBENACEAE)