Residents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

The clinical manifestations of chronic Chagas disease include the cardiac form of the disease and the digestive form. Not all the factors that act in the variable clinical course of this disease are known. This study investigated whether the CCR5Δ32 (rs333) and CCR5 59029 A/G (promoter region—rs1799987) polymorphisms of the CCR5 gene are associated with different clinical forms of chronic Chagas disease and with the severity of left ventricular systolic dysfunction in patients with chronic Chagas heart disease (CCHD). The antibodies anti-T. cruzi were identified by ELISA. PCR and PCR-RFLP were used to identify the CCR5Δ32 and CCR5 59029 A/G polymorphisms. The chi-square test was used to compare variables between groups. There was a higher frequency of the AA genotype in patients with CCHD compared with patients with the digestive form of the disease and the control group. The results also showed a high frequency of the AG genotype in patients with the digestive form of the disease compared to the other groups. The results of this study show that the CCR5Δ32 polymorphism does not seem to influence the different clinical manifestations of Chagas disease but there is involvement of the CCR5 59029 A/G polymorphism in susceptibility to the different forms of chronic Chagas disease. Besides, these polymorphisms do not influence left ventricular systolic dysfunction in patients with CCHD.

Haematobia irritans is a hematophagous parasite of cattle that causes significant economic losses in many parts of the world, including Brazil. In the present work, one American and four Brazilian populations of this species were studied by Random Amplified Polymorpht DNA (RAPD) to assess basically genetic variability within and between populations. Ten different decamer random primers were employed in the genomic DNA amplification, yielding 117 fragments in the five H. irritans populations. In Drosophila prosaltans, used as an outgroup, 81 fragments were produced. Forty-three of these fragments were shared by both species. Among the H. irritans samples, that from Rio Branco (Acre State, Brazil) produced the smallest numbers of fragments and polymorphic bands. This high genetic homogenity may be ascribed to its geographic origin (in the Northwest of Brazil), which causes high isolation and low gene flow, unlike the other Brazilian populations, from the South Central region, in which cattle trade is very intensive. Marker fragments (exclusive bands) detected in every sample enabled the population origin to be characterized, but they are also potentially useful for further approaches such as the putative origin of Brazilian populations from North America. Similarity indices [Nei& Li, 1979, Proc. Natl. Acad. Sci. USA 76: 5269-5273] and phylogenetic trees, rooted by using the outgroup and produced by the Phylogenetic Analysis using Parsimony (PAUP 4.0-Swofford, 2001) program showed the closest relationships between flies from Sao Jose do Rio Preto and Turúba (both from São Paulo State, Brazil) while flies from the geographically distant Rio Branco showed the greatest differentiation relative to the others.

Introdução: O escorpionismo configura importante e crescente problema de saúde pública no Brasil, sendo o principal causador de acidentes por animais peçonhentos. A espécie Tityus serrulatus (escorpião-amarelo) já foi largamente associada a maior gravidade dos casos em decorrência da toxicidade de seu veneno. No estado de São Paulo, em 2016, foram notificados 91.476 acidentes e 10 óbitos, sendo este o estado com a segunda maior quantidade de picadas. Objetivo: Realizar o levantamento clínico-epidemiológico dos acidentes escorpiônicos na região de São José do Rio Preto, São Paulo, Brasil, no período de 2010 a 2016. Métodos: Análise de prontuários dos pacientes atendidos pelo Centro de Assistência Toxicológica (CEATOX-21) do complexo Hospital de Base/Hospital da Criança e Maternidade (HB/HCM), de 2010 a 2016.  Resultados: Observou-se um aumento de 111% no número de atendimentos por picadas de escorpião em 2016 com relação a 2010. A maioria das picadas ocorreu na própria residência do paciente (82%), em homens (54,9%), entre 24 e 60 anos de idade (24,9%). Em 29,11% dos casos, os pacientes eram menores de 12 anos – grupo associado a maior gravidade. As cidades com maior número de eventos foram São José do Rio Preto (36,8%); Mirassol (5,31%); e Nova Granada (4,31%). As solicitações de avaliação pelo CEATOX foram originadas principalmente pelo complexo HB/HCM (47,5%), seguido por 18,55% de hospitais particulares, 14,9% de serviços de urgência e emergência e 10,5% de hospitais filantrópicos/públicos/centros de saúde. O total de casos moderados e graves foi 20,7%, sendo a espécie T. serrulatus o responsável por ocasionar a imensa maioria dos acidentes por escorpiões peçonhentos na região. Conclusão: O escorpionismo apresenta crescimento importante durante o tempo analisado, em especial da espécie Tityus serrulatus. Em razão da manifestação clínica diversa e mutável, há a necessidade de avaliação constante dos pacientes picados para correta indicação de soroterapia.

SUMMARY INTRODUCTION Type 2 diabetes mellitus compromises physical, psychological, economic, and social life. OBJECTIVES To identify and compare the quality of life, depression, functional performance, and physical activity in patients with type 2 diabetes mellitus who use insulin or not. METHODS A observational, descriptive, cross-sectional, comparative study involving 100 patients (50 use insulin and 50 do not) from a Teaching Hospital. Questionnaires used: Identification and Socioeconomic Profile; SF-36; Hospital Anxiety and Depression Scale; Visual Analogue Scale for Pain; Canadian Occupational Performance Measure, and International Physical Activity Questionnaire. RESULTS Sample composed predominantly by middle-aged, female, married, retired, and with incomplete elementary school individuals. There is impairment in all domains of quality of life, being more intense in functional capacity, physical limitations, pain, social aspects, limitation by emotional aspects, and mental health (P<0.05). There is a significant prevalence of anxiety or depressive symptoms in the groups, especially in those using insulin. However, the occurrence of the corresponding psychiatric disorders is unlikely (P<0.05). There was no significant difference in neuropathic pain between the groups (P=0.2296). Functional impairment is similar in both groups regarding self-care activities (P=0.4494) and productivity (P=0.5759), with a greater deterioration of leisure time in patients on insulin (P=0.0091). Most of them practice physical activity, predominantly walking, with no significant difference when comparing the groups (P>0.05), as well as in the other modalities. CONCLUSION Insulinized patients present greater impairment of functional capacity and socialization, as well as greater neuropathic pain, anxiety, and depressive symptoms.

ABSTRACT. The prawn genus Macrobrachium belongs to the family Palaemonidae. Its species are widely distributed in lakes, reservoirs, floodplains, and rivers in tropical and subtropical regions of South America. Globally, the genus Macrobrachium includes nearly 210 known species, many of which have economic and ecological importance. We analyzed three species of this genus (M. jelskii, M. amazonicum and M. brasiliense) using RAPD-PCR to assess their genetic variability, genetic structure and the phylogenetic relationship between them and to look for molecular markers that enable separation of M. jelskii and M. amazonicum, which are closely related syntopic species. Ten different random decamer primers were used for DNA amplification, yielding 182 fragments. Three of these fragments were monomorphic and exclusive to M. amazonicum or M. jelskii and can be used as specific molecular markers to identify and separate these two species. Similarity indices and a phylogenetic tree showed that M. amazonicum and M. jelskii are closest to each other, while M. brasiliense was the most differentiated species among them; this may be attributed to the different habitat conditions to which these species have been submitted. This information will be useful for further studies on these important crustacean species.

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