Respiratory virus detection among healthcare professionals in Brazil: work-related contact and episode recurrence during the COVID-19 pandemic

OBJECTIVES

Since the beginning of the COVID-19 pandemic, changes in the circulation of respiratory viruses have been observed after measures to control the spread of SARS-CoV-2 were implemented. In this sense, we aimed to understand the circulation of the respiratory virus and its impact in a controlled healthy population of healthcare professional (HCP) volunteers in phase III of the clinical trial of the ChadOx nCoV1 conducted in São Paulo, Brazil.

STUDY DESIGN

This was a nested observational cohort study within a clinical trial.

METHODS

We performed RT-qPCR to detect SARS-CoV-2, influenza virus A and B (IVA and IVB), respiratory syncytial virus (RSV), human rhinovirus (HRV), human metapneumovirus (hMPV), human coronaviruses (hCoVs: HKU-1, NL63, OC43, and 229-E), parainfluenza virus (PiV) I-IV, and q-PCR for adenovirus in nasopharyngeal and oropharyngeal samples obtained from HCP enrolled in the clinical trial to assess respiratory viruses infection among vaccinated and non-vaccinated.

RESULTS

From July 2020 to January 2022, 876 samples were included from 737 volunteers (median age: 33 years, 62.9% female). New episodes were registered for 119 individuals. We observed an overall positivity of 37.7% for SARS-CoV-2 and 16.4% for other respiratory viruses; HRV was the second most detected virus (8%), followed by RSV (2.4%). Fully vaccinated individuals accounted for 53.3% of collected samples, and 52.9% presented at least one respiratory virus infection, with SARS-CoV-2 being the most predominant etiologic agent (62.3%). Influenza and hMPV were not detected among the tested samples. Among the subjects that presented more than one episode, SARS-CoV-2 and HRV infections were related to direct contact with patients (P < 0.002).

CONCLUSIONS

Data show high infection rates among HCPs even under mask policies and contact precautions, highlighting the need for improvement in infection control measures in this population regardless of the vaccination program.

Discovery of Putative Dual Inhibitor of Tubulin and EGFR by Phenotypic Approach on LASSBio-1586 Homologs

Combretastatin A-4 (CA-4, 1) is an antimicrotubule agent used as a prototype for the design of several synthetic analogues with anti-tubulin activity, such as LASSBio-1586 (2). A series of branched and unbranched homologs of the lead-compound 2, and vinyl, ethinyl and benzyl analogues, were designed and synthesized. A comparison between the cytotoxic effect of these homologs and 2 on different human tumor cell lines was performed from a cell viability study using MTT with 48 h and 72 h incubations. In general, the compounds were less potent than CA-4, showing CC50 values ranging from 0.030 μM to 7.53 μM (MTT at 72 h) and 0.096 μM to 8.768 μM (MTT at 48 h). The antimitotic effect of the target compounds was demonstrated by cell cycle analysis through flow cytometry, and the cellular mechanism of cytotoxicity was determined by immunofluorescence. While the benzyl homolog 10 (LASSBio-2070) was shown to be a microtubule stabilizer, the lead-compound 2 (LASSBio-1586) and the methylated homolog 3 (LASSBio-1735) had microtubule destabilizing behavior. Molecular docking studies were performed on tubulin protein to investigate their binding mode on colchicine and taxane domain. Surprisingly, the benzyl homolog 10 was able to modulate EGFR phosphorylate activity in a phenotypic model. These data suggest LASSBio-2070 (10) as a putative dual inhibitor of tubulin and EGFR. Its binding mode with EGFR was determined by molecular docking and may be useful in lead-optimization initiatives.

Pre-clinical evaluation of LASSBio-1491: From in vitro pharmacokinetic study to in vivo leishmanicidal activity

Leishmaniasis is a public health issue. It is among the top five parasitic illnesses worldwide and is one of the most neglected diseases. The current treatment disease includes limitations of toxicity, variable efficacy, high costs and inconvenient doses and treatment schedules. LASSBio-1736 was described as antileishmanial drug-candidate to cutaneous leishmaniasis, displaying plasma stability and with no preliminary signals of hepatic or renal toxicity. In this paper, we described the in vitro pharmacokinetic study of LASSBio-1491 (a less lipophilic isostere of LASSBio-1736) and it is in vitro and in vivo leishmanicidal activities. Our results demonstrated that LASSBio-1491 has high permeability, satisfactory aqueous solubility, long plasma and microsomal half-lives and low in vitro systemic clearance, suggesting a pharmacokinetic profile suitable for its use in a single daily dose. The antileishmanial effect of LASSBio-1491 was confirmed in vitro and in vivo. It exhibited no cytotoxic effect to mammalian cells and displayed good in –vivo effect against BALB/c mice infected with Leishmania major LV39 substrain, being 3 times more efficient than glucantime.

Design, synthesis, and biological evaluation of new thalidomide-donepezil hybrids as neuroprotective agents targeting cholinesterases and neuroinflammation

A new series of eight multifunctional thalidomide-donepezil hybrids were synthesized based on the multi-target-directed ligand strategy and evaluated as potential neuroprotective, cholinesterase inhibitors and anti-neuroinflammatory agents against neurodegenerative diseases. A molecular hybridization approach was used for structural design by combining the N-benzylpiperidine pharmacophore of donepezil and the isoindoline-1,3-dione fragment from the thalidomide structure. The most promising compound, PQM-189 (3g), showed good AChE inhibitory activity with an IC₅₀ value of 3.15 μM, which was predicted by docking studies as interacting with the enzyme in the same orientation observed in the AChE-donepezil complex and a similar profile of interaction. Additionally, compound 3g significantly decreased iNOS and IL-1β levels by 43% and 39%, respectively, after 24 h of incubation with lipopolysaccharide. In vivo data confirmed the ability of 3g to prevent locomotor impairment and changes in feeding behavior elicited by lipopolysaccharide. Moreover, the PAMPA assay evidenced adequate blood-brain barrier and gastrointestinal tract permeabilities with an Fa value of 69.8%. Altogether, these biological data suggest that compound 3g can treat the inflammatory process and oxidative stress resulting from the overexpression of iNOS and therefore the increase in reactive nitrogen species, and regulate the release of pro-inflammatory cytokines such as IL-1β. In this regard, compound PQM-189 (3g) was revealed to be a promising neuroprotective and anti-neuroinflammatory agent with an innovative thalidomide-donepezil-based hybrid molecular architecture.

The terpenic diamine GIB24 inhibits the growth of Trypanosoma cruzi epimastigotes and intracellular amastigotes, with proteomic analysis of drug-resistant epimastigotes

The effect of N-geranyl-ethane-1,2-diamine dihydochloride (GIB24), a synthetic diamine, was assayed against different developmental forms of the parasitic protozoan Trypanosoma cruzi (strain Dm28c). The compound was effective against culture epimastigote forms (IC₅₀/24h = 5.64 μM; SI = 16.4) and intracellular amastigotes (IC₅₀/24h = 12.89 μM; SI = 7.18), as detected by the MTT methodology and by cell counting, respectively. Incubation of epimastigotes for 6h with 6 μM GIB24 (IC₅₀/24h value) resulted in significant dissipation of the mitochondrial membrane potential, prior to permeabilization of the plasma membrane. Rounded epimastigotes with cell size reduction were observed by scanning electron microscopy. These morpho-physiological changes induced by GIB24 suggest an incidental death process. Treatment of infected Vero cells did not prevent the intracellular amastigotes from completing the intracellular cycle. However, there was a decrease in the number of released parasites, increasing the ratio amastigotes/trypomastigotes. Proteomic analysis of 15 μM GIB24 resistant epimastigotes indicated that the compound acts mainly on mitochondrial components involved in the Krebs cycle and in maintaining the oxidative homeostasis of the parasites. Our data suggest that GIB24 is active against the main morphological forms of T. cruzi.

Discovery of sulfonyl hydrazone derivative as a new selective PDE4A and PDE4D inhibitor by lead-optimization approach on the prototype LASSBio-448: In vitro and in vivo preclinical studies

Phosphodiesterase 4 (PDE4) inhibitors have emerged as a new strategy to treat asthma and other lung inflammatory diseases. Searching for new PDE4 inhibitors, we previously reported the discover of LASSBio-448, a sulfonamide with potential to prevent and reverse pivotal pathological features of asthma. In this paper, two novel series of sulfonamide (6a-6m) and sulfonyl hydrazone (7a-7j) analogues of LASSBio-448 have been synthetized and evaluated for selective inhibitory activity toward cAMP-specific PDE4 isoforms. From these studies, we have identified 7j (LASSBio-1632) as a new anti-asthmatic lead-candidate associated with selective inhibition of PDE4A and PDE4D isoenzymes and blockade of airway hyper-reactivity (AHR) and TNF-α production in the lung tissue. In addition, it was able to relax guinea pig trachea on non-sensitized and sensitized animals and showed great TGI permeability.

215 Invitro evaluation of reprogramming at 20% or 5% oxygen tension in adult equine fibroblasts

The reprogramming process suffers from effects of external and internal factors, one of which is oxygen concentration, because it plays important roles in several processes of the cell. The objective of this study was to evaluate the effect of oxygen during reprogramming of equine adult fibroblasts. Fibroblasts were isolated from the skin of one male and immediately cultured under high (20%, HO group) or low (5%, LO group) oxygen tension. Generation of induced pluripotent stem cells (iPSCs) was performed by transduction with human sequences of OCT4, SOX2, KLF4, and c-MYC cDNAs. Morphology evaluation and RNA samples collection were performed at the day of transduction (Day 0), and then every 3 days (Days 3, 6, 9, 12, 15, and 18). Six days after transduction, cells were passed to mouse embryonic fibroblast (MEFs). A third group, in which the cells were cultured in high oxygen and passed to low oxygen, was formed (high to low group, HLO) and analysed. The equine (e)iPS colonies were evaluated in terms of reprogramming efficiency, morphology, detection of alkaline phosphatase, and qRT-PCR for markers of pluripotency (OCT4, REX1, NANOG, and SOX2 genes), glycolysis (PFKM and GAPDH), mitochondrial fission and fusion (DNM1L and MFN1), hypoxia (HIF1α, HIF2α, and VEGFA), and presence of the exogenous vector (HS). The values of the target genes were normalized by the average values of the housekeeping genes (HPRT1 and PPIA) and the fold changes were calculated using the 2(−ΔCT) equation. After 10, 11 and 14 days of transduction, the first colonies appeared in the LO, HO, and HLO groups. Their reprogramming efficiency was 1.67%, 0.08%, and 0.025%, respectively. The cells were primarily identified by their morphology: colonies with well-defined edges and cells with a high nuclear/cytoplasm ratio. Our results indicated that genes related to pluripotency increased at first, and then some decreased at Day 18, probably due to the time of picking the first colonies. The LO group showed more elevated levels of these genes than HO group, in accordance with the higher reprogramming efficiency found in LO. Lentiviral vector expression peaked at Day 3 and then decreased at Day 3 in LO and at Day 12 in HO. Glycolysis genes were less expressed in LO, which may suggest a successful metabolism change. The mitochondrial gene MF1 was higher in HO than in LO, and expression of DNM1L increased at Day 12 in the LO group. Expression of VEGFA, a direct target of HIF1α, behaved similarly. Expression of HIF1α and HIF2α differed from expected, being higher in LO than in HO. The expression of HIF1α and HIF2α increased when the shift from high to low oxygen occurred, suggesting that these genes were not expressed before, likely because cells were adapted to the low oxygen tension. When the shift occurs, the cells reacted with an increase of HIF1α and HIF2α. The study of these effects during reprogramming invitro is critical, and biological repetitions to reinforce this data are underway. Herein, we show that the invitro reprogramming process may be modulated by environmental oxygen changes.

216 Oxygen levels and pluripotency maintenance supplements affect cellular reprogramming of bovine fibroblasts

Different supplements are used during invitro cellular reprogramming, usually acting on pluripotency maintenance and/or differentiation inhibition, such as basic fibroblast growth factor (bFGF), leukemia inhibitory factor (LIF), and 2i (MEK inhibitor: PD0325901 + GSK3 inhibitor: CHIR99021). Another important factor affecting the reprogramming process is the oxygen (O2) tension because O2 levels can modify cellular metabolism and epigenetic markers, which are known to modulate pluripotency. Our objective was to evaluate the efficiency of reprogramming bovine fibroblasts in combination with different oxygen tensions (high O2, hO2×low O2, lO2) in different cell differentiation inhibitors: bFGF and bFGF + LIF + 2i (FL2i). Bovine fibroblasts were transduced with lentivirus harbouring mouse OSKM transcription factors (OCT4, SOX2, KLF4, and cMYC). Three clonal lineages were analysed for each experimental group. Pluripotency was characterised by morphology, detection of alkaline phosphatase, formation of embryoid bodies, and analysis of gene expression. As an initial pluripotency test, all colonies were positive for alkaline phosphatase (AP) activity in passages 5 to 6. Colonies were cultured for at least 15 passages (±140 days) with the exception of bFL2i colonies cultured in lO2, which did not grow beyond 7 to 8 passages. For gene expression analysis, samples of each colony in passages 5, 10, and 15 were used. When gene expression was analysed, both endogenous NANOG and OCT4 were increased in the bFGF group when cultured in hO2, and bFGF cultured in lO2 was higher than in the FL2i group (P&lt;0.05). Also, NANOG was increased in early passages compared with late passages (P&lt;0.05); SOX2 and FGF5 were increased in lO2 groups (P&lt;0.05). The bFGF treatment increased STELLA expression compared with bFL2i (P&lt;0.05) at both oxygen tensions. Interestingly, exogenous vector expression increased in the bFGF group compared with bFL2i (P&lt;0.05) but was not affected by oxygen tension (P&gt;0.05). All colonies tested were able to form embryoid bodies. In conclusion, it was not possible to maintain bovine induced pluripotent stem cells (biPS) in bFL2i treatment cultured in lO2 because these colonies were not able to remain viable after 8 passages. Moreover, small molecule supplementation strongly affected pluripotency gene expression. Further analysis on epigenetic changes, metabolism, and self-renewal is necessary to understand the pluripotent state in biPS under our experimental conditions. We acknowledge FAPESP for funding (grant 2015/26816-5 and fellowship 2018/24520-7).

214 Different pluripotency maintenance supplements affect the reprogramming process and pluripotency state of bovine-induced pluripotent stem cells

After the emergence of induced cell reprogramming, achieved through the addition of Yamanaka transcription factors (Oct4, Sox2, Klf4, and cMyc; OSKM) to somatic cells, the number of studies regarding induction and maintenance of pluripotency has increased greatly. The success of bovine iPSCs (biPSCs) was first described by Summer et al. (2011 J. Anim. Sci. 89, 2708-2716; https://doi.org/10.2527/jas.2010-3666); however, investigations on the pluripotent state of biPSCs are still needed because different protocols and characterisation profiles have since been used. The aim of this study was to produce biPSC lines supplemented with different pluripotency maintenance agents to improve self-renewal and pluripotency maintenance. For that, bovine fetal (50 days) fibroblasts (3×104) were transduced with lentivirus harbouring mouse OSKM transcription factors. The cells were further cultured in reprogramming medium (Dulbecco's modified Eagle's medium/F12 KO and 20% KSR (knockout serum replacement)) supplemented with basic fibroblast growth factor (bFGF), leukemia inhibitory factor (LIF), bFGF+2i or LIF+2i (where 2i inhibitors are PD0325901 and CHIR99021). The capacity for cell reprogramming was analysed by colony formation and maintenance after manually and enzymatic passaging and alkaline phosphatase (AP) activity detection; additionally, pluripotency state was assessed by reverse transcription (RT)-PCR (pluripotency biomarkers: OCT4, NANOG, and SOX2; naïve state: STELLA, LIFr, and ESRRb; primed state: OTX2 and FGF5; and mouse (m)OSKM and invitro differentiation assay (embryoid body formation). Statistical analysis was performed using the JMP software (SAS Institute Inc.). All treatments were successful at generating colonies after 28 days of mOSKM transduction, with 32 colonies in bFGF (0.53% efficiency), 21 colonies in bFGF+2i (0.35% efficiency), 5 colonies in LIF (0.08% efficiency), and 3 colonies in LIF+2i (0.05% efficiency) treatments/groups. As an initial pluripotency test, all colonies were positive for AP activity at passage 3. The colonies were cultured for at least 25 passages (±200 days) except for those from the LIF+2i treatment, which were not able to remain viable after 15 passages. Gene expression analysis of the pluripotency (naïve and primed) biomarkers in biPSCs by RT-PCR revealed that colonies from the bFGF treatment were upregulated in NANOG, OCT4, (pluripotency biomarkers), and STELLA (naïve biomarker) (P&lt;0.05) compared with bFGF+2i and LIF groups. There were no differences in expression of SOX2 (pluripotency biomarker gene) and naïve/primed biomarkers (OXT2, LIFr, and ESRRb) (P&gt;0.05). Additionally, the relative abundance of mOSKM was not different between groups (P&gt;0.05). For further pluripotency analysis, biPS colonies were tested for the invitro differentiation assay, and all colonies tested were able to form embryoid bodies. In conclusion, bovine fetal fibroblasts were successfully reprogrammed when using OSKM in all medium tested; however, LIF+2i treatment did not grow beyond 25 passages. Further tests should be performed to determine the pluripotency status of these biPSCs. We acknowledge FAPESP for funding (grant nos. 2012/50533-2, 2015/26816-5, and 2016/16841-2).

Synthesis of new lophine-carbohydrate hybrids as cholinesterase inhibitors: cytotoxicity evaluation and molecular modeling

In this study, we synthesized nine novel hybrids derived from d-xylose, d-ribose, and d-galactose sugars connected by a methylene chain with lophine. The compounds were synthesized by a four-component reaction to afford the substituted imidazole moiety, followed by the displacement reaction between sugar derivatives with an appropriate N-alkylamino-lophine. All the compounds were found to be the potent and selective inhibitors of BuChE activity in mouse serum, with compound 9a (a d-galactose derivative) being the most potent inhibitor (IC50 = 0.17 μM). According to the molecular modeling results, all the compounds indicated that the lophine moiety existed at the bottom of the BuChE cavity and formed a T-stacking interaction with Trp231, a residue accessible exclusively in the BuChE cavity. Noteworthily, only one compound exhibited activity against AChE (8b; IC50 = 2.75 μM). Moreover, the in silico ADME predictions indicated that all the hybrids formulated in this study were drug-likely, orally available, and able to reach the CNS. Further, in vitro studies demonstrated that the two most potent compounds against BuChE (8b and 9a) had no cytotoxic effects in the Vero (kidney), HepG2 (hepatic), and C6 (astroglial) cell lines.

The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil

The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.

Shoulder injuries in soccer goalkeepers: review and development of a FIFA 11+ shoulder injury prevention program

In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA) 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity.

Análise do SICK Scapula em jogadores de handebol com e sem dor no ombro durante o arremesso

INTRODUÇÃO: A discinesia escapular é definida como uma alteração da posição escapular, tanto dinâmica quanto estática, resultante de desequilíbrios da musculatura periescapular secundários à fadiga, trauma ou lesão neurológica. O SICK Scapula avalia e caracteriza as alterações escapulares estaticamente, variando de 0 a 20 pontos (0 = melhor possível). No exame, a escápula é avaliada em três aspectos: dor objetiva, dor subjetiva e mau posicionamento escapular.OBJETIVO: Comparar o SICK Scapula entre jogadores de handebol sintomáticos e assintomáticos.MÉTODOS: A amostra foi composta por 57 atletas de handebol divididos em dois grupos, de acordo com a presença de dor no ombro: grupo assintomático (GA) (N = 27) e grupo sintomático (GS) (N = 30). O SICK Scapulafoi avaliado entre os atletas, tanto em relação à sua pontuação final como às subescalas. O GS apresentou maior pontuação no SICK Scapula em relação ao GA (8 ± 2,3 vs 2,7 ± 1,8; p<0,001).RESULTADOS: Nas subescalas, os GA e GS também apresentaram diferenças significantes quanto à dor subjetiva (0 vs. 1,73 ± 0,83; p < 0,001), dor objetiva (0,41 ± 0,64 vs. 2,5 ±0,86; p < 0,001) e mau posicionamento escapular (2,3 ± 1,9 vs. 3,7 ± 1,5; p = 0,002).CONCLUSÃO: Os atletas de handebol com dor relacionada ao arremesso apresentam maior pontuação com relação à dor e às alterações de posicionamento escapular, segundo avaliação pelo SICK Scapula, em comparação com os que não apresentam sintomatologia.

Glenohumeral range of motion in handball players with and without throwing-related shoulder pain

BACKGROUND

Overhead athletes are subject to adaptations in the shoulder including glenohumeral internal rotation deficit (GIRD). It has been documented that this alteration is more evident in overhead athletes with pain. Our objective was to compare glenohumeral rotation motion between symptomatic and asymptomatic handball players.

MATERIALS AND METHODS

Glenohumeral rotation range of motion, GIRD, external rotation gain (ERG), and total rotation motion were determined with a standard goniometer in 30 handball players with pain and 27 without pain. Differences between the throwing and non-throwing shoulder were determined in each group.

RESULTS

Handball players with pain had significantly greater GIRD (P = .002), ERG (P = .027), and external rotation in the throwing arm (P = .042) and lesser internal rotation in the throwing arm (P = .029) in comparison to the athletes without pain. Comparisons between limbs exhibited a significant difference in the 2 groups regarding internal and external rotation (P < .02), but differences within the group with pain were greater. Differences were not found in the total rotation motion between the 2 groups.

CONCLUSION

Handball players showed specific adaptations in the throwing shoulder; in particular, handball players with pain have greater GIRD, ERG, and external rotation and lesser internal rotation of the throwing shoulder.

Tradução e adaptação cultural para o português do Brasil do western ontario shoulder instability index (WOSI)

INTRODUÇÃO: A instabilidade no ombro é um problema comum que afeta pacientes, mais frequentemente, na segunda e terceira décadas de vida e atletas que participam de esportes de arremesso ou de contato. Entre suas consequências estão dor, decréscimo no nível de atividade e um decréscimo geral na qualidade de vida. Muitos tratamentos têm sido propostos para os diversos tipos de instabilidade; entretanto, existem poucos instrumentos de avaliação que comprovem sua eficácia. Para utilização de medidas de avaliação em saúde desenvolvidas e utilizadas em outro idioma é necessário realizar a equivalência transcultural, sendo desnecessário criar e validar outro instrumento que avalie a condição de interesse. O objetivo deste estudo foi realizar a tradução e a adaptação cultural do questionário WOSI (The Western Ontario Shoulder Instability Index) para a língua portuguesa do Brasil. MATERIAIS E MÉTODOS: O protocolo aplicado consistiu em: 1) preparação, 2) tradução, 3) tradução de volta à língua original (retrotradução), 4) interrogatório cognitivo, e 5) relato de informações. Ao serem concluídas as etapas de tradução e retrotradução, as versões foram enviadas para os autores do WOSI original, que aprovaram para continuação do estudo. A versão em português foi aplicada em 35 pacientes com instabilidade no ombro para verificar o nível de compreensão do instrumento. A versão brasileira final do WOSI foi definida após conseguir menos que 15% de "não compreensão" em cada item. Para análise das variáveis, foi utilizada estatística descritiva. RESULTADOS: Para obter a equivalência cultural foram realizadas modificações e alterações de termos sugeridas pelos pacientes para os itens "não compreendidos". CONCLUSÃO: Após a tradução e adaptação cultural do questionário, a versão em português do WOSI foi concluída.

Effect of In-Ga-Al-P diode laser irradiation on angiogenesis in partial ruptures of Achilles tendon in rats

OBJECTIVE

This study was conducted to analyze the effect of different irradiances of low-level laser therapy (LLLT) on angiogenesis after partial rupture of Achilles tendon of rats.

BACKGROUND DATA

METHODS

Ninety-six animals were divided into three groups subject to treatment during 3, 5, and 7 days post-lesion. Thirty-two animals were used in each group. The groups were further divided into four subgroups with eight animals in each, receiving In-Ga-Al-P laser (660 nm) treatment at (1) mean output of 10 mW, (2) 40 mW during 10 sec, (3) a sham subgroup, and (4) a non-treatment subgroup. Each animal was subjected to a lesion of the Achilles tendon by dropping a 186-g weight from a 20-cm height over the tendon. Treatment was initiated 6 h post-injury for all the groups. Blood vessels were colored with India ink injection and were examined in a video microscope.

RESULTS

Laser exposure promoted an increase in blood vessel count when compared to controls. The 40-mW group showed early neovascularization, with the greatest number of microvessels after three laser applications. The 10-mW subgroup showed angiogenesis activity around the same time as the sham laser group did, but the net number of vessels was significantly higher in the former than in the controls. After seven irradiations, the subgroup receiving 40 mW experienced a drop in microvessel number, but it was still higher than in the control groups.

CONCLUSIONS

LLLT of different intensities seems to promote neovascularization in damaged Achilles tendons of rats after partial rupture compared to controls.

Nothing is going to stop me now: obstacles perceived by low-income women as they become self-sufficient

As low-income women struggle to become self-sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low-income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self-esteem, especially relating to school; "bad" relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.

Factor and latent class analysis of DSM-IVADHD symptoms in a school sample of Brazilian adolescents

OBJECTIVE

To evaluate the validity of the multidimensional construct proposed by DSM-IV for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents.

METHOD

An instrument including all 18 DSM-IVADHD symptoms was administered to 1,013 students aged 12 to 14 years at 64 state schools by trained research assistants. Each symptom was rated on a Likert scale with five levels of severity (never, almost never, sometimes, frequently, and always).

RESULTS

Using an exploratory factor analytic approach (principal components analysis), two factors were extracted. Factor I (hyperactivity-impulsivity) comprised eight DSM-IV hyperactive-impulsive symptoms with loadings > or =0.40. Factor II (inattention) included also eight DSM-IV symptoms of inattention. The two factors explained 34% of the total variance and had an interfactor correlation of 0.45. Latent class analysis demonstrated similar classes in males and females, but class structures were markedly different from previous analyses of parent report data.

CONCLUSION

The findings support the appropriateness of the multidimensional construct introduced by DSM-IV in the diagnosis of ADHD in a different culture but emphasize the possible impact of different reporters on the results of structural model-testing.