ABSTRACT Cutaneous leishmaniasis, caused by protozoa of the genus Leishmania, presents diverse clinical manifestations, and current therapeutic options have limitations, including long treatment periods, potential hospitalization, and excessive pain during treatment. Methyl gallate, a phenolic compound found in plants such as Libidibia ferrea, presents promising antileishmanial activity. Combining this compound with existing leishmaniasis medications could lead to reduced dosages and the minimization of side effects. This study aimed to assess the efficacy of a microemulsion containing methyl gallate, either on its own or in combination with Glucantime®, for the experimental treatment of cutaneous leishmaniasis in a 30-day in vivo assay using golden hamsters infected with Leishmania (Leishmania) amazonensis. The control groups included an untreated positive control and an uninfected, untreated negative control. After treatment, we evaluated clinical, parasitological, and biochemical parameters. While none of the treatments achieved clinical or parasitological cure, notable improvements were observed in the combined group, with significant reductions in snout skin lesions and parasite load when compared to the control. Biochemical parameters such as creatinine, CK-MB, GOT, and GPT remained unchanged, but urea and CPK levels significantly increased in all the experimental groups relative to the control. In conclusion, the integration of a topical methyl gallate microemulsion with intralesional Glucantime® showed potential as an effective treatment for cutaneous leishmaniasis. Further investigations into optimal dosages and therapeutic schemes are warranted in order to enhance treatment outcomes.

RESUMO A leishmaniose cutânea, causada por protozoários do gênero Leishmania, apresenta diversas manifestações clínicas e as opções terapêuticas atuais têm limitações, incluindo longos períodos de tratamento, possível hospitalização e dor excessiva durante o tratamento. O galato de metila, um composto fenólico encontrado em plantas como Libidibia ferrea, mostra atividade antileishmania promissora. A combinação deste composto com os medicamentos existentes para leishmaniose pode levar a dosagens reduzidas e à minimização dos efeitos colaterais. Este estudo teve como objetivo avaliar a eficácia de uma microemulsão contendo galato de metila, isoladamente ou em combinação com Glucantime®, no tratamento experimental da leishmaniose cutânea em um ensaio in vivo de 30 dias em hamsters sírios infectados com Leishmania (Leishmania) amazonensis. Os grupos de controle incluíram um controle positivo não tratado e um controle negativo não infectado e não tratado. Após o tratamento, avaliamos parâmetros clínicos, parasitológicos e bioquímicos. Embora nenhum dos tratamentos tenha alcançado cura clínica ou parasitológica, melhorias notáveis foram observadas no grupo combinado, com redução significativa nas lesões cutâneas do focinho e na carga parasitária em comparação com o controle. Parâmetros bioquímicos como creatinina, CK-MB, TGO e TGP permaneceram inalterados, os níveis de ureia e CPK aumentaram significativamente em todos os grupos experimentais em relação ao controle. Em conclusão, a integração da microemulsão tópica de galato de metila com Glucantime® intralesional mostrou potencial como um tratamento eficaz para a leishmaniose cutânea. Mais investigações sobre dosagens ideais e esquemas terapêuticos são necessárias para melhorar os resultados do tratamento.

Abstract Electricity distribution is a fundamental activity for society. However, mitigating actions on risks and dependencies of this activity still need to be discovered concerning Ecosystem Services (ES). This fact can negatively influence its prosperity, especially in the long term. Within this context, this paper aims to identify actions that mitigate the risks and dependencies on ES associated with a company in the electricity sector in Brazil that performs electricity distribution services. The identification was based on the collection, analysis, and interpretation of stakeholders’ perceptions of the activity through an adaptation of the Strategic Options Development and Analysis (SODA) problem structuring method. As a result, a structured vision of actions that mitigate ES risks and dependencies of electric power distribution, enabling management focused on the longevity of both the ES and the economic activity.

Resumen La distribución de electricidad es fundamental para la sociedad. Pero, se sabe poco sobre las acciones que mitigan los riesgos y la dependencia de esta actividad en relación con los servicios de los ecosistemas (ES). Tal hecho puede influir negativamente en su performance económica a largo plazo. Así pues, este trabajo tiene como objetivo identificar acciones que disminuyen los riesgos y dependencia de los SE, de una empresa del sector energético en Brasil que realiza el servicio de distribución. La identificación se basó en recopilación, análisis e interpretación de percepciones de actores involucrados en la actividad, mediante una adaptación del método Strategic Options Development and Analysis (SODA). Como resultado, se obtuvo una visión estructurada de las principales acciones que tienen potencial de disminuir los riesgos y dependencias de esta actividad en relación con los SE, permitiendo una gestión direccionada a la longevidad de los SE y a la actividad económica.

Resumo A distribuição de energia elétrica é uma atividade fundamental para a sociedade. No entanto, pouco se conhece sobre ações que mitiguem os riscos e dependências dessa atividade em relação aos Serviços Ecossistêmicos (SE). Tal fato pode influenciar negativamente sua prosperidade, especialmente, no longo prazo. Dentro desse contexto, o presente trabalho tem por objetivo identificar ações que mitigam os riscos e dependências em relação aos SE associados a uma empresa do setor elétrico no Brasil que realiza o serviço de distribuição de energia elétrica. A identificação se baseou na coleta, análise e interpretação de percepções de stakeholders envolvidos na atividade, por meio de uma adaptação do método de estruturação de problemas Strategic Options Development and Analysis (SODA). Como resultado, obteve-se uma visão estruturada de ações que mitigam os riscos e dependências da distribuição de energia elétrica em relação aos SE, possibilitando uma gestão focada na longevidade tanto dos SEs quanto da atividade econômica.

Abstract Background The long-term effects of mild COVID-19 on physical, cognitive, and mental health are not yet well understood. Objective The purpose of this paper is to describe the protocol for the ongoing “Post-COVID Brazil” study 2, which aims to evaluate the factors associated with health-related quality of life and long-term cardiovascular and non-cardiovascular outcomes one year after a mild episode of symptomatic COVID-19. Methods The “Post-COVID Brazil” study 2 is a prospective multicenter study that plans to enroll 1047 patients (NCT05197647). Centralized, structured telephone interviews are conducted at 1, 3, 6, 9, and 12 months after COVID-19 diagnosis. The primary outcome is the health-related quality-of-life utility score, assessed using the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints include the EQ-5D-3L at 3, 6, and 9 months, as well as all-cause mortality, major cardiovascular events, hospitalization, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value < 0.05 will be considered statistically significant for all analyses. Results The primary endpoint will be presented as the overall frequency of the EQ-5D-3L domains 12 months after SARS-CoV-2 infection. Main analysis will explore the association of independent variables with the study outcomes. Conclusion The “Post-COVID Brazil” study 2 aims to clarify the impact of long COVID on the quality of life and cardiovascular and non-cardiovascular outcomes of Brazilian patients who have had mild COVID-19.

Resumo Fundamento Os efeitos em longo prazo da COVID-19 leve sobre a saúde física, mental e cognitiva ainda não são bem conhecidos. Objetivo Este artigo visa descrever o protocolo para o estudo em andamento Pós-COVID Brasil 2, o qual tem como objetivo avaliar os fatores associados à qualidade de vida associada à saúde e desfechos cardiovasculares e não cardiovasculares de longo prazo um ano após um episódio de COVID-19 sintomática leve. Métodos O estudo “Pós-COVID Brasil 2” é um estudo multicêntrico prospectivo que pretende incluir 1047 pacientes (NCT05197647). Entrevistas estruturas, centralizadas são conduzidas em um mês, e aos três, seis, nove e 12 meses após o diagnóstico de COVID-19. O desfecho primário é o escore de utilidade da qualidade de vida relacionada à saúde, avaliado usando o questionário EuroQol-5D-3L (EQ-5D-3L) aos 12 meses. Desfechos secundários incluem o EQ-5D-3L aos três, seis e nove meses, mortalidade por todas as causas, eventos cardiovasculares maiores, hospitalização, retorno ao trabalho ou à escola, sintomas persistentes, novas incapacidades em atividades instrumentais diárias, déficit cognitivo, ansiedade, depressão, e sintomas de transtorno do estresse pós-traumático as três, seis, nove e doze meses após a infecção pelo SARS-CoV-2. Um valor de p<0,05 será considerado estatisticamente significativo para as análises. Resultados O desfecho primário será apresentado como frequência dos domínios do EQ-5D-3L doze meses após a infecção por SARS-CoV-2. A análise principal explorará a associação das variáveis independentes com os desfechos do estudo. Conclusão O estudo “Pós-COVID Brasil 2” tem como objetivo elucidar o impacto da COVID longa sobre a qualidade de vida e desfechos cardiovasculares e não cardiovasculares de brasileiros pacientes que apresentaram COVID-19 leve.

Abstract Background The long-term impact of hospitalization for COVID-19 on patients’ physical, mental, and cognitive health still needs further assessment. Objectives This study aims to evaluate factors associated with quality of life and cardiovascular and non-cardiovascular outcomes 12 months after hospitalization for COVID-19. Methods This prospective multicenter study intends to enroll 611 patients hospitalized due to COVID-19 (NCT05165979). Centralized telephone interviews are scheduled to occur at three, six, nine, and 12 months after hospital discharge. The primary endpoint is defined as the health-related quality-of-life utility score assessed by the EuroQol-5D-3L (EQ-5D-3L) questionnaire at 12 months. Secondary endpoints are defined as the EQ-5D-3L at three, six and nine months, return to work or education, persistent symptoms, new disabilities in instrumental activities of daily living, cognitive impairment, anxiety, depression, and post-traumatic stress symptoms, major cardiovascular events, rehospitalization, as well as all-cause mortality at 3, 6, 9, and 12 months after SARS-CoV-2 infection. A p-value <0.05 will be assumed as statistically significant for all analyses. Results The primary endpoint will be presented as the frequency of the EQ-5D-3L score 12 months after COVID-19 hospitalization. A sub-analysis to identify possible associations of independent variables with study outcomes will be presented. Conclusions This study will determine the impact of COVID-19 on the quality of life and cardiovascular and non-cardiovascular outcomes of hospitalized patients 12 months after discharge providing insights to the public health system in Brazil.

Resumo Fundamento O impacto em longo prazo da hospitalização por COVID-19 sobre a saúde física, mental e cognitiva dos pacientes requer mais investigação. Objetivos Este artigo visa avaliar os fatores associados com a qualidade de vida e desfechos cardiovasculares e não cardiovasculares 12 meses após a internação hospitalar por COVID-19. Métodos Este estudo multicêntrico prospectivo pretende incluir 611 pacientes internados por COVID-19 (NCT05165979). Entrevistas telefônicas centralizadas estão programadas para ocorrer em três, seis, nove e 12 meses após a alta hospitalar. O desfecho primário é definido como o escore de utilidade de qualidade de vida relacionada à saúde avaliada pelo questionário EuroQol-5D-3L (EQ-5D-3L) aos 12 meses. Desfechos secundários são definidos como o EQ-5D-3L aos três, seis e nove meses, retorno ao trabalho ou à escola, sintomas persistentes, novas incapacidades em atividades instrumentais diárias, déficit cognitivo, ansiedade, depressão, e sintomas de transtorno do estresse pós-traumático, eventos cardiovasculares maiores, reinternação, e mortalidade por todas as causas aos três, seis, nove e 12 meses após a infecção pelo SARS-CoV-2. Um valor de p<0,05 será considerado estatisticamente significativo para as análises. Resultados O desfecho primário será apresentado como frequência do escore EQ-5D-3L 12 meses após a internação por COVID-19. Uma subanálise para identificar possíveis associações das variáveis independentes com desfechos do estudo será apresentada. Conclusão Este estudo determinará o impacto da COVID-19 sobre a qualidade de vida e de desfechos cardiovasculares e não cardiovasculares de pacientes internados 12 meses após a alta, e fornecerá novas informações ao sistema público de saúde no Brasil.

ABSTRACT Purpose: to assess the influence of dentures on the electromyographic activity of masticatory muscles in individuals with Parkinson’s disease. Methods: an analytical, quantitative, cross-sectional study conducted at a public teaching hospital in 2017, assessing the stage of the disease, non-denture (ND) wearing, upper removable partial denture wearing (DW1), upper and lower removable partial denture wearing (DW2), and upper complete denture + lower removable partial denture wearing (DW3). The Student-Newman-Keuls test was used to compare the maximum voluntary muscle contraction between sides and between the denture wearing and non-denture wearing groups. Significance was set at α<0.05. Results: after applying the eligibility criteria, 41 patient records were included in the sample. The association between the stage of the disease and denture wearing showed predominance of DW2 in stage 1 (43%). A significant difference was found in the masseter muscle analysis between the non-denture wearing group and DW2 and DW3 (p=0.0018). As for the anterior temporalis muscle, there was a significant difference (p=0.0034) in three of the analysis groups (ND vs. DW2, ND vs. DW3, and DW1 vs. DW3). Conclusion: denture wearing has a negative impact on the electrical activity of masticatory muscles when compared with individuals who do not wear dentures and have natural teeth.

ABSTRACT BACKGROUND: Congenital vascular anomalies and hemangiomas (CVAH) such as infantile hemangiomas, port-wine stains and brain arteriovenous malformations (AVMs) impair patients’ lives and may require treatment if complications occur. However, a great variety of treatments for those conditions exist and the best interventions remain under discussion. OBJECTIVE: To summarize Cochrane systematic review (SR) evidence on treatments for CVAH. DESIGN AND SETTING: Review of SRs conducted in the Division of Vascular and Endovascular Surgery of Universidade Federal de São Paulo, Brazil. METHODS: A broad search was conducted on March 9, 2021, in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed treatments for CVAH. The key characteristics and results of all SRs included were summarized and discussed. RESULTS: A total of three SRs fulfilled the inclusion criteria and were presented as a qualitative synthesis. One SR reported a significant clinical reduction of skin redness by at least 20%, with more pain, among 103 participants with port-wine stains. One SR reported that propranolol improved the likelihood of clearance 13 to 16-fold among 312 children with hemangiomas. One SR reported that the relative risk of death or dependence was 2.53 times greater in the intervention arm than with conservative management, among 218 participants with brain AVMs. CONCLUSION: Cochrane reviews suggest that treatment of port-wine stains with pulsed-dye laser improves redness; propranolol remains the best option for infantile hemangiomas; and conservative management seems to be superior to surgical intervention for treating brain AVMs.

ABSTRACT: Identification and selection of nitrogen-fixing bacterial strains for inoculation into native leguminous tree species can assist in the recovery of degraded areas. Additionally, native strains from these areas are genetic resources adapted to these conditions and are thus suitable for selection. The aim of this study was to symbiotically and genetically characterize 18 bacterial strains from the Rhizobium and Bradyrhizobium genera isolated from Machaerium nyctitans, Platypodium elegans, and Ormosia arborea grown in a nursery in an iron mining area. Three experiments were conducted under axenic conditions in a greenhouse. The nodulation capacity of the strains was evaluated by the number (NN) and dry matter (NDM) of nodules. Symbiotic efficiency was evaluated based on the following parameters: SPAD index (SPAD), shoot dry matter (SDM), root dry matter (RDM), and total dry matter (TDM) of the plants, relative efficiency (RE), shoot nitrogen content (SNC), and total nitrogen content in the plant (TNC). The atpD and gyrB housekeeping genes and the nifH gene were sequenced for phylogenetic analysis, and the nodC and nodD symbiotic genes of the strains were amplified. Out of the 18 strains, 16 were authenticated by nodulation capacity in the species of origin. The SPAD variable allowed for the detection of differences between treatments before the SDM. Additionally, the SPAD index showed correlation with TNC, and the strain Bradyrhizobium sp., UFLA01-839, which may represent a new species, was outstanding in Machaerium nyctitans. The nifH, nodD, and nodC genes were detected in UFLA01-839.

Resumo Este artigo busca analisar diferenças nas condições de vida e saúde das professoras principais provedoras do domicílio em comparação às coprovedoras, durante a pandemia de Covid-19. Trata-se de estudo transversal realizado em 2020, por meio de formulário on-line enviado aos professores da rede estadual de Minas Gerais. A variável dependente foi ser ou não a principal provedora da família (principal provedora vs. coprovedora) e as independentes foram agrupadas em sociodemográficas, ocupacionais, situação de saúde e comportamentos. Analisaram-se dados somente das mulheres e estimou-se a regressão logística. Entre as 12.817 professoras participantes, 47,2% declararam-se principais provedoras. Dentre elas, observou-se predomínio de mulheres mais velhas, que viviam sem companheiro(a), com filhos(as) e, no geral, apresentavam características que retrataram pior condição socioeconômica, maior acúmulo de trabalho e comportamentos menos saudáveis. Os resultados permitiram identificar desvantagens nas condições de vida e saúde das professoras principais provedoras financeiras de suas famílias em comparação às coprovedoras.

Abstract The objective was to analyze differences in living and health conditions of teachers who are the main providers for their household compared to co-providers during the COVID-19 pandemic. The cross-sectional study was carried out in 2020, through an online form sent to teachers of public schools in the state of Minas Gerais, Brazil. The dependent variable was whether or not they were their family’s main provider (main provider vs. co-provider) and independent variables were grouped into sociodemographic, occupational, health status and behaviors. Only women’s data were analyzed and logistic regression was estimated. Among the 12,817 participating female schoolteachers, 47.2% declared to be the main providers. In this subgroup, there was a predominance of older women, who lived without a partner, with children and, in general, these teachers presented worse socioeconomic conditions, greater accumulation of work and less healthy behaviors. The results of the present study allow to identify disadvantages in living and health conditions of female schoolteachers who are the main financial providers of their families compared to co-providers.

Resumen El objetivo fue analizar las diferencias en las condiciones de vida y salud entre las profesoras que son las principales proveedoras del hogar y las coproveedoras, durante la pandemia de COVID-19. Estudio transversal realizado en 2020, a través de un formulario en línea enviado a profesoras de escuelas públicas del estado de Minas Gerais, Brasil. La variable dependiente fue ser o no la proveedora principal de la familia (proveedora principal versus coproveedora) y las variables independientes se agruparon en sociodemográficas, ocupacionales, sanitarias y conductuales. Solo se analizaron los datos de las mujeres y se estimó una regresión logística. Entre las 12.817 maestras participantes, el 47,2 % se declaró proveedora principal. En este subgrupo predominaron las mujeres mayores, que vivían sin pareja, con hijos y, en general, estas profesoras tenían características que retrataban una peor condición socioeconómica, mayor acumulación de trabajo y conductas menos saludables. Los resultados del presente estudio permiten identificar desventajas en las condiciones de vida y salud de las profesoras de escuela que son las principales proveedoras económicas de sus familias en comparación con las coproveedoras.

RESUMO Objetivo: analisar os preditores de disfunção temporomandibular em pessoas com doença de Parkinson (DP) verificando suas associações com aspectos sociodemográficos e estágios da doença. Métodos: estudo que utilizou fonte de dados secundários de uma pesquisa realizada em 2017, com 110 pessoas com DP que foram avaliadas pelo questionário para Pesquisa em Disfunção Temporomandibular (RDC/TMD) e pela escala de estadiamento da DP. As variáveis preditoras de DTM estudadas foram: dor, crepitação, estalido, apertamento/rangido noturno e diurno, mordida desconfortável/não habitual, rigidez matinal e zumbido. Os aspectos sociodemográficos avaliados foram: idade, sexo, escolaridade, estado civil, renda e estágios da doença de 1 a 3. Utilizou-se o Odds ratio do Qui-quadrado com intervalo de confiança de 95% e nível de significância de p<0,05. Resultados: verificou-se associação entre os preditores: apertamento/rangido noturno e renda (p=0,006); zumbido e grupos de renda ½ a 3 (p=0,003) e de 4 a 10 salários mínimos (p=0,004). Além da associação do zumbido e estágio 1 (p=0,02). Conclusão: nesse estudo verificou-se que os preditores associados com a DTM em pessoas com DP foram: dor, estalido, crepitação, mordida desconfortável/não habitual e rigidez matinal. E destes verificou-se associação entre renda e estágio 1 da doença com apertamento/rangido noturno e zumbido.

ABSTRACT Purpose: to analyze the predictors of temporomandibular disorder in people with Parkinson’s disease, verifying their associations with sociodemographic aspects and stages of the disease. Methods: a study based on secondary data from research conducted in 2017 with 110 people with Parkinson’s disease. They were assessed with the Research Diagnostic Criteria for Temporomandibular Disorders and the Parkinson’s disease staging scale. The studied predictive variables for temporomandibular disorder were pain, crepitation, clicking, nighttime and daytime clenching/gnashing, uncomfortable/non-habitual bite, morning rigidity, and tinnitus. The sociodemographic aspects assessed were age, sex, schooling level, marital status, income, and stages 1 to 3 of the disease. The chi-squared odds ratio was used with a 95% confidence interval and significance level at p < 0.05. Results: an association was verified between nighttime clenching/gnashing and income (p = 0.006); tinnitus and income range from ½ to 3 (p = 0.003) and from 4 to 10 minimum wages (p = 0.004); and between tinnitus and stage 1 (p = 0.02). Conclusion: this study verified that the predictors associated with temporomandibular disorder in people with Parkinson’s disease were pain, clicking, crepitation, uncomfortable/non-habitual bite, and morning rigidity. It was verified that income and stage 1 of the disease had an association with nighttime clenching/gnashing and tinnitus.

RESUMO Objetivo: avaliar a força de mordida em pessoas com doença de Parkinson e correlacionar com: idade, sexo, estágio e tempo da doença, uso de prótese dentária, presença de disfunção temporomandibular, lado de início dos sintomas e preferência mastigatória. Métodos: foi aplicado o questionário Critério de Diagnóstico para Pesquisa em Disfunção Temporomandibular, a escala Hoehn & Yahr para estágio da doença de Parkinson e realizou-se o exame clínico da cavidade oral. Seguido do registro da força de mordida, utilizando um dinamômetro analógico, com haste adaptada para a preensão bucal. Os resultados obtidos da força de mordida e correlação com as variáveis foram analisadas por meio do teste T independente (p<0,05). Resultados: a amostra foi composta por 42 parkinsonianos com média de idade de 64 anos, desses 67% eram do sexo masculino. Observou-se não haver diferença na correlação com: idade, disfunção temporomandibular, estágio e tempo de diagnóstico da doença de Parkinson, bem como entre os lados, início dos sintomas e preferência mastigatória, no entanto, houve associação significante entre os sexos: masculino e feminino para ambos os lados (direito - p=0,002; esquerdo - p=0,04) e na utilização de prótese dentária para a força de mordida do lado direito (p=0,03). Conclusão: constatou-se que ser do sexo feminino e fazer uso de prótese dentária são fatores associados à redução da força de mordida em pessoas com doença de Parkinson.

ABSTRACT Purpose: to assess the bite force in people with Parkinson’s disease and correlate it with age, sex, stage and time of the disease, dentures use, presence of temporomandibular disorder, side of symptom onset, and masticatory preference. Methods: the Research Diagnostic Criteria for Temporomandibular Disorders and the Hoehn & Yahr Parkinson’s disease scale were used, and the participants’ oral cavity was clinically examined. Then, the bite force was measured with an analog dynamometer, whose bar was adapted for mouth grip. The bite force results and their correlation with the variables were analyzed with the independent t-test (p<0.05). Results: the sample comprised 42 parkinsonians at a mean age of 64 years, 67% of whom were males. No difference was observed in the correlation with age, temporomandibular disorder, stage and time of Parkinson's disease; or between the sides, symptom onset and masticatory preference. However, there was a significant association between the sexes (males and females) for both sides (right - p=0.002; left - p=0.04) and denture use for bite force on the right side (p=0.03). Conclusion: being a female and using dentures are factors associated with decreased bite force in people with Parkinson’s disease.

ABSTRACT This article aims to evaluate the general (expansionist or contractionist) orientation of the discretionary component of Brazilian fiscal policy in the period 1995-2017, as well as to verify its position in relation to the economic cycle (procyclical or anticyclical). To this end, it proposes and applies a new methodology to separate the discretionary fiscal impulse from the part of the fiscal result arising from the operation of automatic fiscal stabilizers. It concludes that fiscal policy: 1) generated a mostly procyclical (destabilizing) position of its discretionary component, leading it to amplify rather than dampen economic cycles; 2) failed to prevent the public debt GDP ratio from entering the unsustainable path at the end of the period. Suggestions are made to improve its performance.

RESUMEN Este artículo tiene como objetivo evaluar la orientación general (expansionista o contraccionista) del componente discrecional de la política fiscal brasileña en el periodo 1995-2017, así como verificar su posición respecto al ciclo económico (procíclica o anticíclica). Con este fin, proponemos y aplicamos una nueva metodología para separar el impulso fiscal discrecional de la parte del resultado fiscal que se obtiene de la activación de los estabilizadores fiscales automáticos. Concluimos que la política fiscal: 1) generó una posición mayormente procíclica (desestabilizadora) de su componente discrecional, lo que la llevó a amplificar en lugar de amortiguar los ciclos económicos; 2) no pudo evitar que la relación deuda pública/PIB entrase en una trayectoria insostenible al final del periodo. Se hacen algunas sugerencias para mejorar su rendimiento.

Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country’s territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

RESUMO JUSTIFICATIVA E OBJETIVOS: A doença de Parkinson leva a movimentos mandibulares que afetam o ciclo mastigatório e induzem a dor orofacial, uma das principais alterações clínicas encontradas na disfunção temporomandibular. Sendo assim, o presente estudo objetivou analisar os possíveis fatores associados à disfunção temporomandibular e verificar a frequência da disfunção nessa população. MÉTODOS: Trata-se de um estudo de corte transversal, no qual os participantes foram avaliados com o Critério de Diagnóstico para pesquisa em disfunção temporomandibular, utilizado para classificar a disfunção temporomandibular e obter, através do exame físico e autorrelato, as variáveis estudadas. RESULTADOS: Foram avaliadas 139 pessoas com doença de Parkinson. Dessas, 77 encontraram-se dentro dos critérios de elegibilidade, sendo que 70% da amostra era do sexo masculino, com média de idade de 62±9 anos, tempo de diagnóstico da doença de Parkinson de 6±4 anos e com 71% da amostra no estágio moderado. Não foram encontradas associações significativas entre a idade, sexo, tempo e estágio da doença com a disfunção temporomandibular. Das variáveis analisadas, os resultados significativos mostraram que a presença de dor (OR=10,92; IC95%=2,25-59,93; p<0,001) representa uma maior chance de desenvolver a disfunção temporomandibular, a crepitação (Kappa=0,34; p<0,004) reflete uma precisão moderada na classificação do transtorno da articulação temporomandibular e o estalido (valor preditivo negativo=77%; p<0,032) aumenta a probabilidade de ter a disfunção temporomandibular. CONCLUSÃO: Neste estudo, a frequência de disfunção temporomandibular foi de 30% e verificou-se que os fatores associados à disfunção em pessoas com doença de Parkinson foram dor, estalido e crepitação.

ABSTRACT BACKGROUND AND OBJECTIVES: Parkinson’s disease leads to mandibular movements that affect the masticatory cycle and induce orofacial pain, one of the main clinical alterations found in temporomandibular dysfunction. Thus, the present study aimed to analyze the possible factors associated with temporomandibular dysfunction and to verify the frequency of the dysfunction in this population. METHODS: This was a cross-sectional study in which the participants were evaluated using the Diagnostic Criteria for Temporomandibular Dysfunction research, used to classify the temporomandibular dysfunction and to obtain by physical examination and self-report the variables studied. RESULTS: A total of 139 people with Parkinson’s disease were evaluated. Of these, 77 met the eligibility criteria, with 70% of the sample being male, with an average age of 62±9 years; Parkinson’s disease diagnosis time of 6±4 years and with 71% of the sample in the moderate stage of Parkinson’s disease. No significant associations were found between age, gender, time and stage of the disease with temporomandibular dysfunction. Of the variables analyzed, the significant results showed that the presence of pain (OR=10.92, 95% CI=2.25-59.93, p<0.001) has a greater chance of developing temporomandibular dysfunction, crepitation (Kappa=0.34, p<0.004) reflects moderate accuracy in the classification of temporomandibular joint disorder and the click (negative predictive value=77%, p<0.032) increases the probability of having temporomandibular dysfunction. CONCLUSION: Therefore, in this study, the frequency of the temporomandibular dysfunction was 30%, and it was observed that the factors associated with the dysfunction in people with Parkinson’s disease were: pain, click, and crackle.

Abstract Introduction: Although it is an essential component of the treatment of acute lymphoid leukemia in children, asparaginase causes adverse reactions that sometimes make it impossible to use it fully. Hypersensitivity reactions are the most frequent and may lead to early discontinuation of treatment. The present study aimed to investigate suspicions of adverse reactions during the infusion of asparaginase in a pediatric cohort. Methods: A retrospective observational study was carried out at a university pediatric institute in the state of Rio de Janeiro. Information regarding clinical features and characteristics of adverse reactions was collected from hospital medical records. Suspicions of adverse reactions were classified regarding causality and severity. Results: Seventy-three suspicions of adverse reactions were recorded during asparaginase infusion in 72 children in the study period. Allergic hypersensitivity reactions were suspected in 60.5% of the cases. Of these, 25% of the reactions occurred during induction and 61.1% in concomitant use with vincristine, findings that diverge from other studies. High-risk classification and younger age were considered risk factors for these reactions. A total of 72.4% of the reactions were classified as grade 1 or 2, which suggest that not all are related to antibody formation; this highlights the importance of differential diagnosis with other reactions, such as non-allergic hypersensitivity and hyperammonemia. Conclusion: The implementation of the differential diagnosis of reactions related to infusion of asparaginase with ammonia dosage and classification of the grade of reactions is crucial to facilitate the identification and proper management of each type of reaction.

Resumo Fundamento: A pré-eclâmpsia tem sido associada a vários fatores de risco e eventos. No entanto, esta doença é merecedora de mais investigações, tendo em vista a multiplicidade de fatores relacionados que acometem diferentes populações. Objetivo: Avaliar os fatores maternos e os resultados perinatais adversos em uma coorte de gestantes com pré-eclâmpsia da rede pública de saúde de Maceió. Métodos: Estudo de coorte prospectivo realizado em 2014 na rede pública de saúde do município com uma amostra de gestantes calculada com base na prevalência de pré-eclâmpsia de 17%, nível de confiança de 90%, poder de 80% e razão de 1:1. Foi aplicado um questionário para coleta de dados socioeconômicos, pessoais e antropométricos, e obtidas variáveis perinatais de prontuário e da declaração de nascido vivo. Análise realizada com regressão de Poisson e teste do qui-quadrado, considerando p < 0,05 como significativo. Resultados: Foram estudadas 90 gestantes com pré-eclâmpsia (GCP) e 90 gestantes sem pré-eclâmpsia (GSP). História prévia de pré-eclâmpsia (razão de prevalência [RP] = 1,57, intervalo de confiança de 95% [IC 95%] 1,47-1,67, p = 0,000) e cor da pele negra (RP = 1,15, IC 95% 1,00-1,33, p = 0,040) estiveram associadas à ocorrência de pré-eclâmpsia. Entre os recém-nascidos das GCP e GSP, 12,5% e 13,1%, respectivamente, eram pequenos para a idade gestacional (p = 0,907) e 25,0% e 23,2%, respectivamente, eram grandes para a idade gestacional (p = 0,994). Houve predomínio da via de parto cesariana. Conclusão: História pessoal de pré-eclâmpsia e cor da pele negra estiveram associadas à ocorrência de pré-eclâmpsia. Houve elevadas frequências de desvios de peso ao nascer e da via de parto cesariana.

Abstract Background: Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. Objective: To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. Methods: Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. Results: We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. Conclusion: Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries.