Effect of Melanin Biosynthesis Inhibition on the Antifungal Susceptibility of Chromoblastomycosis Agents.

Chromoblastomycosis (CBM) is a chronic subcutaneous infection caused by genera of melanized fungi: Fonsecaea, Cladophialophora, Phialophora, Exophiala, and Rhinocladiella. Melanin is a virulence factor known to influence antifungal susceptibility. A specific inhibitor of melanin biosynthesis is tricyclazole. The aim of this study was to evaluate the effect of melanin inhibition on antifungal susceptibility of chromoblastomycosis agents and describe the susceptibility profiles of some unusual CBM agents. Seventy-six clinical isolates, representing 13 species of the five main genera of CBM agents, were studied. The antifungal susceptibility testing was performed according to the M38-A2 protocol of CLSI (Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi, 3rd ed., CLSI Standard M38, 2017). In the melanin inhibition test, 16 mg/liter of tricyclazole was added to the medium used in the inoculum preparation and the susceptibility assay. CBM agents were less susceptible to amphotericin B than azoles and terbinafine. The unusual species showed similar susceptibility profiles to those of other species of the same genera. With tricyclazole exposure, MICs of terbinafine, posaconazole, and itraconazole for Fonsecaea spp. significantly decreased (P < 0.05). For Phialophora spp., this reduction was significant for posaconazole and itraconazole. For the other genera, there was a reduction in MICs of terbinafine and itraconazole; however, the statistical tests were not significant. Melanin inhibition can increase the antifungal susceptibility of most CBM agents to itraconazole and terbinafine, the main drugs used in the disease treatment. This increased susceptibility may open up new possibilities for therapy in refractory cases of CBM and/or cases caused by resistant fungal strains. Further studies are needed to confirm the same results in vivo.

Preoperative clinical pathway of breast cancer patients: determinants of compliance with EUSOMA quality indicators.

BACKGROUND: The European Society of Breast Cancer Specialists (EUSOMA) has defined quality indicators for breast cancer (BC). The aim of this study was to describe the preoperative clinical pathway of breast cancer patients and evaluate the determinants of compliance with EUSOMA quality indicators in the Optisoins01 cohort. METHODS: Optisoins01 is a prospective, multicentric study. Data from operable BC patients were collected, including results from before surgery to 1 year follow-up. Seven preoperative EUSOMA quality indicators were compared with the clinical pathways Optisoins01. RESULTS: Six hundred and four patients were included. European Society of Breast Cancer Specialists targets were reached for indicator 1 (completeness of clinical and imaging diagnostic work-up), 3 (preoperative definitive diagnosis) and 5 (waiting time). For indicator 8 (multidisciplinary discussion), the minimum standard of 90% of the patients was reached only in general hospitals and comprehensive cancer centres. Having more than 1 medical examination within the centre was associated with an increased waiting time for surgery, whereas it was reduced by having an outpatient breast biopsy. The comprehensive cancer centre type was the only parameter associated with the other quality indicators. CONCLUSIONS: European Society of Breast Cancer Specialists quality indicators are a useful tool to evaluate care organisations. This study highlights the need for a standardised and coordinated preoperative clinical pathway.

Susceptibility to antifungal agents and enzymatic activity of Candida haemulonii and Cutaneotrichosporon dermatis isolated from soft corals on the Brazilian reefs.

Candida is a common fungus with the capacity to cause infections in humans. However, most studies have concentrated on clinical isolates and little is known about the identity, ecology and drug resistance of free living species/strains. Here, we isolate eight strains of Candida haemulonii and four strains of Cutaneotrichosporon dermatis from three marine cnidarian zoanthids species (Palythoa caribaeorum, Palythoa variabilis and Zoanthus sociatus) collected from Brazilian coral reefs. Strains were identified by sequencing of the D1/D2 domain LSU rDNA and ITS region. We tested these environmental isolates for their capacity to grow in media with increasing concentration of NaCl, capacity to grow in different temperatures, enzymatic activity and antifungal susceptibility. For C. haemulonii, all strains strongly produced gelatinase, esterase and albuminase and were either able to express lipase, phospholipase and keratinase, but not express urease and DNase. The strains were able to grow at 37 °C, but not at 39 °C, and except for LMS 40, all of them could grow in a 10 % NaCl medium. All isolates were resistant to all antifungals tested, with exception for ketoconazole and tioconazole (MIC = 2 µg/mL). For C. dermatis, all strains could grow at 39 °C and could not express phospholipase, keratinase or gelatinase. However, all were capable of expressing urease, lipase and esterase. Three out of four strains could grow in a 10 % NaCl medium, but none grew in a 30 % NaCl medium. The strains showed high values of minimal inhibitory concentration. LMPV 90 was resistant to tioconazole, terbinafine, fluconazole and posaconazole, and LMS 38 was resistant to all antifungal agents tested. We discuss the characterization of C. haemulonii and C. dermatis as a possible emerging pathogen due to its animal-related enzymatic arsenal and antifungal resistance.

The patient-breast cancer care pathway: how could it be optimized?

BACKGROUND: A care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient's home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope. METHODS/DESIGN: An observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. We will include and follow during 1 year 1,000 patients. The study consists of 3 work-packages: - Cost of pathway The aim of this WP is to calculate the overall costs of the early BC pathway at 1 year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production). - Patient satisfaction and work reintegration Three questionnaires will assess the patients' satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 ('breast cancer' module, SCNS-BR8); and the OUTPASSAT-35 questionnaire. - Quality, coordination and access to innovation Quality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care. The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient's access to innovation. DISCUSSION: The assessment of care pathways encourages the implementation of new payment models. Our approach could help health care professionals and policymakers to establish other cost-of-illness studies and plan the allocation of resources on a patient basis rather than a visit basis.

In vitro susceptibility of chromoblastomycosis agents to five antifungal drugs and to the combination of terbinafine and amphotericin B.

Chromoblastomycosis is a chronic mycosis that affects the skin and subcutaneous tissues caused by several genera of dematiaceous fungi. There is not a treatment of choice. Thus, tools that help guide clinical practice are fundamental. In this sense, antifungal activity tests in vitro could be useful. However, trials with chromoblastomycosis agents are scarce. The aim of this study was to evaluate both the in vitro susceptibility of 60 chromoblastomycosis agents to five antifungals and the combination of amphotericin B (AMB) and terbinafine (TRB). TRB, itraconazole (ITZ) and ketoconazole (KTZ) were, in this order, the drugs which showed better activity against the chromoblastomycosis agents. The less active drugs were voriconazole (VRZ) and AMB. The more differentiated group was Exophiala spinifera. Cladophialophora carrionii and Fonsecaea spp. are significantly more susceptible to KTZ than Phialophora verrucosa, whereas C. carrionii is significantly more sensitive to VRZ than P. verrucosa and E. spinifera. Assays in this direction allow the knowledge of the susceptibility of the causative agents which may help the management of patients with this disease. This study includes the largest number of these agents and of genera found in the literature.

Dichotomy in Neutralizing Antibody Induction to Peptide-Conjugated Vaccine in Squalene Emulsion Contrast With Aluminum Hydroxide Formulation.

W614A-3S peptide is a modified 3S motif of the HIV-gp41 (mutation W614A). We previously detected the presence of natural neutralizing antibodies directed against W614A-3S peptide (NAbs) in long-term non-progressor HIV+ patients. Here, we compared the efficacy of W614A-3S peptide formulated in either squalene emulsion (SQE) or in aluminum hydroxide (Alum) in inducing broadly-NAbs (bNAbs). Rabbit and mouse models were used to screen the induction of bNAbs following 4 immunizations. SQE was more efficient than Alum formulation in inducing W614A-3S-specific bNAbs with up to 67%-93% of HIV strains neutralized. We then analyzed the quality of peptide-specific murine B cells by single-cell gene expression by quantitative reverse transcription-PCR and single-cell V(D)J sequencing. We found more frequent germinal center B cells in SQE than in Alum, albeit with a different gene expression profile. The V(D)J sequencing of W614A-3S-specific BCR showed significant differences in BCR sequences and validates the dichotomy between adjuvant formulations. All sixteen BCR sequences which were cloned were specific of peptide. Adjuvant formulations of W614A-3S-peptide-conjugated immunogen impact the quantity and quality of B cell immune responses at both the gene expression level and BCR sequence.

Existential transformations in the process of facing amyotrophic lateral sclerosis by the family caregiver.

OBJECTIVE: To understand the existential transformations of the family caregiver of a person living with Amyotrophic Lateral Sclerosis. METHOD: Qualitative study based on assumptions of Martin Heidegger Existential Phenomenology, with 12 family caregivers of the person with Amyotrophic Lateral Sclerosis, in Alagoas. The testimonies were obtained from June 2019 to March 2020 and analyzed, categorized, and discussed based on the theoretical-philosophical framework adopted and thematic literature. RESULTS: Phenomenological sense of the existential transformations of the family caregiver of a person living with Amyotrophic Lateral Sclerosis, unveiled with the categories: Being the caregiver of the person living with ALS; Being responsible for decision making; Resignifying the existence in view of the possibility of loss; Spirituality influencing the transformation process. CONCLUSIONS: The family caregiver has an appropriate life due to the inherent vicissitudes of the disease, which provides moving moments that lead him to rethink his existence and to value life.

Direct medical and non-medical costs of a one-year care pathway for early operable breast cancer: Results of a French multicenter prospective study.

INTRODUCTION: The organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis. METHODS: OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method. RESULTS: Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified. CONCLUSION: Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.

Mentoring experience in medical residency: challenges and experiences / Experiência de mentoria na residência médica: desafios e vivências

Abstract: Introduction: Medical residency represents a challenging moment, with a high level of demand and the need to develop several personal and professional skills. Therefore, in April 2019, the unprecedented mentoring program for thirty internal medicine residents was implemented, seeking to offer personal support and encourage professional development. Experience Report: A mentoring program was structured in April 2019, lasting 11 months, consisting of 30 internal medicine residents and 6 mentors with experience in clinical preceptorship, covering topics that are not usually discussed in the training of these specialists, such as professionalism, empathy, burnout and quality of life, time management, conflict management and role-model. The meetings took place monthly, in a location defined by the group. After the end of the activity, an opinion poll was conducted using a standardized questionnaire with answers arranged on a Likert scale to assess the relevance of the discussed topics and the impact on the medical residents' practice. A 90% response rate was obtained, highlighting the relevance of the topic Burnout and quality of life and empathy. A total of 96.3% of residents stated that the program changed their mind about their professional behavior. They declared that mentoring "opened their mind about the diversity of opinions, allowing personal and professional growth" and that "to manage time, conflicts, burnout are present in our daily lives and are also part of the medicine we practice". However, there were complaints about some difficulties among the group members to define the time and day when the meetings should be held. In summary, the activity had a positive evaluation from the mentees. Discussion: There is a positive impact of the mentoring program on the training of a resident doctor, improving self-confidence and having a positive impact on the professional career despite the faced difficulties. Mentoring also serves as a psychosocial support, creating free access between the resident and the preceptor, culminating, based on our evaluation, in an excellent relationship between mentors and mentees. Conclusion: In Ceará, the mentoring program for internal medicine residents was unprecedented. There is a positive effect, in which important topics were discussed in more depth, with greater personal and professional growth. We suggest that mentoring be maintained and included as an essential activity in the curriculum of Medical Residency Programs.

Resumo: Introdução: A residência médica representa um momento desafiador, com elevado nível de exigência e necessidade de desenvolvimento de inúmeras competências pessoais e profissionais. Com base nisso, implantou-se, em abril de 2019, um programa de mentoria inédito para 30 residentes de clínica médica, buscando oferecer suporte pessoal e estimular desenvolvimento profissional. Relato de experiência: O programa de mentoria foi estruturado em abril de 2019, com 30 residentes de clínica médica e seis mentores com experiência em preceptoria clínica. Com duração de 11 meses, o programa abordou temas não usualmente discutidos na formação desses especialistas, como profissionalismo, empatia, burnout e qualidade de vida, gestão de tempo, gestão de conflitos e role-model. Os encontros ocorriam mensalmente, com local definido pelo grupo. Após o fim da atividade, foi realizada pesquisa de opinião utilizando questionário padronizado com respostas em escala Likert para avaliação de relevância dos temas discutidos e impacto na prática dos médicos residentes. Obtiveram-se 90% de respostas, nas quais se destacou a relevância dos temas burnout e qualidade de vida e empatia. Dos residentes, 96,3% afirmaram que as discussões mudaram a forma deles de pensar e agir profissionalmente. Destacaram que o mentoring "abria a mente acerca de diversidade de opiniões, permitindo crescimento pessoal e profissional" e que "Gerir o tempo, conflitos, burnout estão presentes no nosso dia a dia e também fazem parte da medicina que praticamos", pontuando dificuldade de consenso entre os membros do grupo para definição do horário e dia a ser realizada a reunião. A atividade demonstrou avaliação positiva dos mentorados. Discussão: Na formação de um médico residente, o programa de mentoria melhora a autoconfiança e promove um impacto positivo na carreira profissional apesar das dificuldades enfrentadas. A mentoria funciona ainda como suporte psicossocial, pois cria-se um livre acesso entre residente e preceptor, o que culmina, na nossa avaliação, em uma excelente relação entre mentores e mentorados. Conclusão: No Ceará, o programa de mentoring para os residentes de clínica médica foi inédito. Houve efeito positivo, em que temas importantes foram discutidos com mais profundidade, com maior crescimento pessoal e profissional. Os autores sugerem que o mentoring seja mantido e incluído como atividade essencial no currículo dos programas de residência médica.

Childhood obesity in the perception of children, families and health and education professionals / La obesidad infantil desde la óptica de los niños, familiares y profesionales de la salud y la educación / Obesidade infantil na percepção de crianças, familiares e profissionais de saúde e de educação

ABSTRACT Objective: to understand the perspective of children, families and health and education professionals about childhood obesity. Method: a qualitative research study with the participation of 13 children, 12 family members, seven health professionals in primary care and seven education professionals, all linked to the Health at School Program. Data was collected through semi-structured interviews, using recreational resources and applying a scale of silhouettes with children, during the period from April 2017 to March 2018. The analysis was based on the assumptions of thematic content analysis. Results: three categories were identified: Multifactoriality of childhood obesity; Body image by the child, by family members and bullying at school; Perspectives and actions associated with childhood obesity. For the study participants, childhood obesity is conditioned by overeating, with a low nutritional value, in addition to insufficient physical activity. They also understand that the actions to combat obesity proved to be incipient or insufficient. For children, obesity implies dissatisfaction with body image and bullying at school. Conclusion: according to the perspective of the participants, there is a need for integrated actions between health and education professionals, including children and family members, to prevent and combat childhood obesity; in addition to governmental actions to strengthen public policies that consider health promotion and prevention of harms to the child population.

RESUMEN Objetivo: comprender la perspectiva de los niños, familiares y profesionales de la salud y la educación sobre la obesidad infantil. Método: investigación cualitativa con la participación de 13 niños, 12 familiares, siete profesionales de la salud de atención primaria y siete profesionales de la educación, todos vinculados al Programa Salud en la Escuela. La recolección de datos se realizó mediante entrevistas semiestructuradas, mediante la utilización de recursos lúdicos y la aplicación de una escala de siluetas con niños, de abril de 2017 a marzo de 2018. El análisis se basó en los supuestos del análisis de contenido temático. Resultados: se identificaron tres categorías: Multifactorialidad de la obesidad infantil; Imagen corporal desde la óptica del niño, los familiares y el bullying infantil; Perspectivas y acciones asociadas a la obesidad infantil. Para los participantes del estudio, la obesidad infantil está condicionada por la sobrealimentación, con bajo valor nutricional, además de una actividad física insuficiente. También entienden que las acciones para combatir la obesidad resultaron ser incipientes o insuficientes. Para los niños, la obesidad implica insatisfacción con la imagen corporal y bullying escolar. Conclusión: desde la perspectiva de los participantes, existe la necesidad de implementar acciones integradas entre los profesionales de la salud y la educación, los niños y los familiares, para prevenir y combatir la obesidad infantil; además de acciones gubernamentales para fortalecer políticas públicas que consideren la promoción de la salud y la prevención de lesiones en la población infantil.

RESUMO Objetivo: compreender a perspectiva de crianças, familiares e profissionais da saúde e da educação acerca da obesidade infantil. Método pesquisa qualitativa com participação de 13 crianças, 12 familiares, sete profissionais da saúde da atenção básica e sete profissionais da educação, todos vinculados ao Programa Saúde na Escola. A coleta de dados foi por entrevista semiestruturada, utilização de recursos lúdicos e aplicação de escala de silhuetas com crianças, no período de abril de 2017 a março de 2018. A análise foi fundamentada nos pressupostos da análise temática de conteúdo. Resultados: foram identificadas três categorias: multifatorialidade da obesidade na infância; Imagem corporal pela criança, por familiares e o bullying na escola; Perspectivas e ações associadas à obesidade infantil. Para os participantes do estudo a obesidade infantil é condicionada por alimentação excessiva, com baixo valor nutricional, além da prática insuficiente de atividade física. Entendem, ainda, que as ações para combater a obesidade se mostraram incipientes ou insuficientes. Para as crianças a obesidade implica na insatisfação com a imagem corporal e no bullying escolar. Conclusão: conforme a perspectiva dos participantes, aponta-se para a necessidade de ações integradas entre profissionais da saúde e da educação, que incluam crianças e familiares, para prevenção e combate da obesidade infantil; além de ações governamentais para o fortalecimento das políticas públicas que consideram a promoção da saúde e prevenção de agravos à população infantil.

Existential transformations in the process of facing amyotrophic lateral sclerosis by the family caregiver / Transformaciones existenciales en el proceso de enfrentamiento de la esclerosis lateral amiotrofica por parte del cuidador familiar / Transformações existenciais no processo de enfrentamento da esclerose lateral amiotrófica pelo cuidador familiar

ABSTRACT Objective To understand the existential transformations of the family caregiver of a person living with Amyotrophic Lateral Sclerosis. Method Qualitative study based on assumptions of Martin Heidegger Existential Phenomenology, with 12 family caregivers of the person with Amyotrophic Lateral Sclerosis, in Alagoas. The testimonies were obtained from June 2019 to March 2020 and analyzed, categorized, and discussed based on the theoretical-philosophical framework adopted and thematic literature. Results Phenomenological sense of the existential transformations of the family caregiver of a person living with Amyotrophic Lateral Sclerosis, unveiled with the categories: Being the caregiver of the person living with ALS; Being responsible for decision making; Resignifying the existence in view of the possibility of loss; Spirituality influencing the transformation process. Conclusions The family caregiver has an appropriate life due to the inherent vicissitudes of the disease, which provides moving moments that lead him to rethink his existence and to value life.

RESUMEN Objetivo Comprender las transformaciones existenciales del cuidador familiar de una persona que vive con Esclerosis Lateral Amiotrófica. Método Martin Heidegger, con 12 cuidadores familiares de la persona con Esclerosis Lateral Amiotrófico, en Alagoas. Los testimonios se obtuvieron de junio de 2019 a marzo de 2020 y analizados, categorizados y discutidos con base en el marco teórico-filosófico adoptado y literatura temática. Resultados Sentido fenomenológico de las transformaciones existenciales del cuidador familiar de una persona viviendo con Esclerosis Lateral Amiotrófica, develado con las categorías: Ser el cuidador de la persona que vive con ELA; Ser responsable de la toma de decisiones; Redefinir la existencia ante la posibilidad de pérdida; La espiritualidad influye em el proceso de transformación. Conclusiones El cuidador familiar tiene una vida adecuada debido a las vicisitudes inherentes a la enfermedad, lo que le brinda momentos conmovedores que lo llevan a repensar su existencia y valorar la vida.

RESUMO Objetivo Compreender as transformações existenciais do cuidador familiar de uma pessoa que vive com Esclerose Lateral Amiotrófica. Método Estudo qualitativo fundamentado em pressupostos da Fenomenologia Existencial de Martin Heidegger, com 12 familiares cuidadores da pessoa com Esclerose Lateral Amiotrófica, em Alagoas. Os depoimentos foram obtidos de junho de 2019 a março de 2020 e analisados, categorizados e discutidos a partir do referencial teórico-filosófico adotado e literatura temática. Resultados Sentido fenomenológico das transformações existenciais do cuidador familiar de uma pessoa que vive com Esclerose Lateral Amiotrófica, desvelado com as categorias: Sendo cuidador da pessoa que vive com a ELA; sendo responsável pela tomada de decisão; Ressignificando a existência diante da possibilidade da perda; A espiritualidade influenciando o processo da transformação. Conclusões O familiar cuidador tem sua vida apropriada pelas vicissitudes inerentes à doença, que proporciona momentos comoventes que o leva a repensar sua existência e valorizar a vida.

Association of the mammalian proto-oncoprotein Int-6 with the three protein complexes eIF3, COP9 signalosome and 26S proteasome.

The mammalian Int-6 protein has been characterized as a subunit of the eIF3 translation initiation factor and also as a transforming protein when its C-terminal part is deleted. It includes a protein domain, which also exists in various subunits of eIF3, of the 26S proteasome and of the COP9 signalosome (CSN). By performing a two-hybrid screen with Int-6 as bait, we have isolated subunits belonging to all three complexes, namely eIF3-p110, Rpt4, CSN3 and CSN6. The results of transient expression experiments in COS7 cells confirmed the interaction of Int-6 with Rpt4, CSN3 and CSN6, but also showed that Int-6 is able to bind another subunit of the CSN: CSN7a. Immunoprecipitation experiments performed with the endogenous proteins showed that Int-6 binds the entire CSN, but in low amount, and also that Int-6 is associated with the 26S proteasome. Taken together these results show that the Int-6 protein can bind the three complexes with various efficiencies, possibly exerting a regulatory activity in both protein translation and degradation.

The experience of parents of children with cancer in treatment failure conditions / La experiencia de los padres de niños con cáncer en la condición de fracaso terapéutico / A vivência dos pais da criança com câncer na condição de impossibilidade terapêutica

ABSTRATC Study based on Heidegger's existential phenomenology. The objective was to understand the experience of parents of children with cancer in treatment failure conditions. Participants were eight parents of eight patients seen at an oncology center from January to May 2014. Interviews were conducted guided by the question: Tell me about your experience of being a family member of a child with cancer in treatment failure conditions? Three ontological themes emerged: the phenomenon unveiled in the discovery of the child's cancer; experiencing the process involving the child's cancer; unveiling the possibility of the child's death. It was evidenced that the experience of these parents was permeated by intense and devastating feelings towards the early loss, annihilating dreams of a desired future. It is essential for nursing to look more attentively at the family of terminal patients.

RESUMEN Estudio basado en la fenomenología existencial de Heidegger. Tuvo como objetivo comprender la experiencia de los padres de niños con cáncer en la condición de fracaso terapéutico. Los participantes fueron ocho padres de ocho pacientes atendidos en un centro de oncología de enero a mayo del 2014. Se realizaron entrevistas guiadas por la pregunta: ¿Dime cómo es su experiencia de ser miembro de la familia de un niño con cáncer en la condición de fracaso terapéutico? Emergieron tres temas ontológicos: el fenómeno presentado en el descubrimiento del cáncer en el niño; experimentar el proceso que implica la enfermedad oncológica en el niño; la revelación de la posibilidad de la muerte del niño. Era evidente que la experiencia de estos padres fue permeado por sentimientos intensos y devastadores antes de la pérdida temprana, aniquilando sueños de un futuro deseado. Es fundamental que la Enfermería considera con más atención la familia del paciente terminal.

RESUMO Estudo fundamentado na fenomenologia existencial heideggeriana, cujo objetivo foi compreender a vivência dos pais da criança com câncer na condição de impossibilidade terapêutica. Participaram da pesquisa oito pais de oito pacientes, atendidos em um centro de oncologia, de janeiro a maio de 2014. As entrevistas foram norteadas pela seguinte questão: conte para mim como é para você a experiência de ser familiar de uma criança oncológica na condição de impossibilidade terapêutica? Três temáticas ontológicas emergiram: o fenômeno desvelado na descoberta do câncer no filho; vivenciando o processo que envolve a doença oncológica no filho; o desvelar da possibilidade da morte do filho. Evidenciou-se que a vivência destes pais foi permeada por sentimentos intensos e devastadores diante da perda precoce, aniquilando sonhos de um futuro desejado. Torna-se imprescindível a enfermagem direcionar um olhar mais atento à família de pacientes terminais.

Vivência da mulher jovem com câncer de mama e mastectomizada / Experience of young women with breast cancer and mastectomized / La experiencia de la mujer joven con cáncer de mama y mastectomizada

Objetivo:O objetivo deste estudo foi compreender a vivência da mulher jovem diagnosticada com câncer de mama e mastectomizada.Métodos:Trata-se de uma pesquisa qualitativa com abordagem fenomenológica, fundamentada no referencial heideggeriano. Após a aprovação do projeto pelo Comitê de Ética, foram realizadas entrevistas livres, guiadas pela seguinte pergunta norteadora: Como foi pra você ter câncer de mama e ser submetida à mastectomia? Participaram da pesquisa sete mulheres com idade entre 18 e 35 anos.Resultados:Foram obtidas três categorias temáticas: Vivência da descoberta do câncer; Vivência do tratamento em busca da cura do câncer; Vivência da superação do câncer.Conclusão:O fenômeno revela-se permeado de angústia e perplexidade diante do estar-no-mundo com câncer de mama, por desconhecer que um diagnóstico tão sombrio pode pertencer ao mundo do jovem.

Objective: The aim of this study was to understand the experience of young women diagnosed with breast cancer andmastectomized. Methods: This is a qualitative study with a phenomenological approach, grounded in Heideggerian framework.After being approved by a Research Ethics Committee, open interviews were conducted, guided by the following question: Whatwas it like for you to have breast cancer and undergo mastectomy? A total of seven women aged between 18 and 35 yearsparticipated in this study. Results: Three thematic categories were obtained: The experience of being diagnosed with cancer;The experience of undergoing treatment in search of a cure for cancer; The experience of overcoming cancer. Conclusion: Thisphenomenon appears to be fraught with anguish and bewilderment of being-in-the-world with breast cancer, ignoring the factthat such a grim diagnosis may belong to the world of the young.

Objetivo: Comprender la experiencia de la mujer joven con diagnóstico de cáncer de mama y mastectomizada. Métodos: Estudiocualitativo con enfoque fenomenológico, fundamentado en el referencial de Heidegger. Después de la aprobación del proyecto porel Comité de Ética, fueron realizadas entrevistas abiertas, guiadas por la pregunta orientadora: ¿Cómo fue para ti la descubiertadel cáncer de mama y la realización de la mastectomía? Participaron de la encuesta siete mujeres con edades entre 18 y 35años. Resultados: Emergieron tres categorías temáticas: Experiencia del descubrimiento de la enfermedad; Experiencia deltratamiento en busca de una cura para el cáncer; Experiencia de superación del cáncer. Conclusión: El fenómeno revelaselleno de angustia y perplejidad frente al estar-en-el-mundo con cáncer de mama, por ignorar que tal diagnóstico sombrío puedapertenecer también al mundo de los jóvenes.

Abdominal pain and preeclampsia: sonographic findings in the maternal liver.

OBJECTIVE: To describe sonographic findings in livers of pregnant women with severe preeclampsia and abdominal pain. METHODS: Over a 12-month period, we performed serial sonographic examinations on 32 pregnant women with severe preeclampsia and acute right upper quadrant and epigastric pain. On each sonogram we observed the liver size and texture, "periportal halo" sign, gallbladder wall, Glisson capsule thickness, painful compression of the liver and gallbladder, and ascites. The pancreas, spleen, kidneys, and uterus were also studied. Sonography was repeated after delivery. RESULTS: Initial sonograms showed liver abnormalities in 28 patients. Abnormalities consisted of liver hypertrophy (n = 24), hyperechoic thickening of the periportal area (periportal halo sign; n = 23), striated thickening of the gallbladder wall (n = 27), hyperechoic thickening of the Glisson capsule (n = 11), liver areas of increased echogenicity (n = 11), subcapsular hematoma (n = 1), and subcapsular calcification (n = 1). Probe compression of the liver enhanced abdominal pain (n = 13), whereas the gallbladder was painless in all cases. No gallbladder stones were detected. Ascites (n = 16) and pleural effusion (n = 11) were also present. In no case did we detect abnormalities of the pancreas, kidneys, or spleen. All patients eventually had hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome according to the American College of Obstetricians and Gynecologists classification. In 7 cases, HELLP syndrome developed postpartum. Three patients also had eclampsia. Follow-up sonograms highlighted quick regression of abnormalities after delivery. CONCLUSIONS: The livers of women with severe preeclampsia who had HELLP syndrome showed sonographic abnormalities before biological abnormalities. Serial sonographic examinations could therefore contribute to the obstetric care of these women. Preeclampsia and HELLP syndrome should be routinely checked for in all pregnant women with acute abdominal pain.