A novel tomato interspecific (Solanum lycopersicum var. cerasiforme and Solanum pimpinellifolium) MAGIC population facilitates trait association and candidate gene discovery in untapped exotic germplasm.

We developed a novel eight-way tomato multiparental advanced generation intercross (MAGIC) population to improve the accessibility of tomato relatives genetic resources to geneticists and breeders. The interspecific tomato MAGIC population (ToMAGIC) was obtained by intercrossing four accessions each of Solanum lycopersicum var. cerasiforme and Solanum pimpinellifolium, which are the weedy relative and the ancestor of cultivated tomato, respectively. The eight exotic ToMAGIC founders were selected based on a representation of the genetic diversity and geographical distribution of the two taxa. The resulting MAGIC population comprises 354 lines, which were genotyped using a new 12k tomato single primer enrichment technology panel and yielded 6488 high-quality single-nucleotide polymorphism (SNPs). The genotyping data revealed a high degree of homozygosity, an absence of genetic structure, and a balanced representation of the founder genomes. To evaluate the potential of the ToMAGIC population, a proof of concept was conducted by phenotyping it for fruit size, plant pigmentation, leaf morphology, and earliness. Genome-wide association studies identified strong associations for the studied traits, pinpointing both previously identified and novel candidate genes near or within the linkage disequilibrium blocks. Domesticated alleles for fruit size were recessive and were found, at low frequencies, in wild/ancestral populations. Our findings demonstrate that the newly developed ToMAGIC population is a valuable resource for genetic research in tomato, offering significant potential for identifying new genes that govern key traits in tomato. ToMAGIC lines displaying a pyramiding of traits of interest could have direct applicability for integration into breeding pipelines providing untapped variation for tomato breeding.

Peptaibiotics: Harnessing the potential of microbial secondary metabolites for mitigation of plant pathogens.

Agricultural systems are in need of low-cost, safe antibiotics to protect crops from pests and diseases. Peptaibiotics, a family of linear, membrane-active, amphipathic polypeptides, have been shown to exhibit antibacterial, antifungal, and antiviral activity, and to be inducers of plant resistance against a wide range of phytopathogens. Peptaibiotics belong to the new generation of alternatives to agrochemicals, aligned with the United Nations Sustainable Development Goals and the One Health approach toward ensuring global food security and safety. Despite that, these fungi-derived, non-ribosomal peptides remain surprisingly understudied, especially in agriculture, where only a small number has been tested against a reduced number of phytopathogens. This lack of adoption stems from peptaibiotics' poor water solubility and the difficulty to synthesize and purify them in vitro, which compromises their delivery and inclusion in formulations. In this review, we offer a comprehensive analysis of peptaibiotics' classification, biosynthesis, relevance to plant protection, and mode of action against phytopathogens, along with the techniques enabling researchers to extract, purify, and elucidate their structure, and the databases holding such valuable data. It is also discussed how chemical synthesis and ionic liquids could increase their solubility, how genetic engineering and epigenetics could boost in vitro production, and how omics can reduce screenings' workload through in silico selection of the best candidates. These strategies could turn peptaibiotics into effective, ultra-specific, biodegradable tools for phytopathogen control.

Genetics and breeding of phenolic content in tomato, eggplant and pepper fruits.

Phenolic acids and flavonoids are large groups of secondary metabolites ubiquitous in the plant kingdom. They are currently in the spotlight due to the numerous health benefits associated with their consumption, as well as for their vital roles in plant biological processes and in plant-environment interaction. Tomato, eggplant and pepper are in the top ten most consumed vegetables in the world, and their fruit accumulation profiles have been extensively characterized, showing substantial differences. A broad array of genetic and genomic tools has helped to identify QTLs and candidate genes associated with the fruit biosynthesis of phenolic acids and flavonoids. The aim of this review was to synthesize the available information making it easily available for researchers and breeders. The phenylpropanoid pathway is tightly regulated by structural genes, which are conserved across species, along with a complex network of regulatory elements like transcription factors, especially of MYB family, and cellular transporters. Moreover, phenolic compounds accumulate in tissue-specific and developmental-dependent ways, as different paths of the metabolic pathway are activated/deactivated along with fruit development. We retrieved 104 annotated putative orthologues encoding for key enzymes of the phenylpropanoid pathway in tomato (37), eggplant (29) and pepper (38) and compiled 267 QTLs (217 for tomato, 16 for eggplant and 34 for pepper) linked to fruit phenolic acids, flavonoids and total phenolics content. Combining molecular tools and genetic variability, through both conventional and genetic engineering strategies, is a feasible approach to improve phenolics content in tomato, eggplant and pepper. Finally, although the phenylpropanoid biosynthetic pathway has been well-studied in the Solanaceae, more research is needed on the identification of the candidate genes behind many QTLs, as well as their interactions with other QTLs and genes.

The Free Radical Scavenging Property of the Leaves, Branches, and Roots of Mansoa hirsuta DC: In Vitro Assessment, 3D Pharmacophore, and Molecular Docking Study.

In this work, a metabolic profile of Mansoa hirsuta was investigated, and in vitro assays and theoretical approaches were carried out to evaluate its antioxidant potential. The phytochemical screening detected saponins, organic acids, phenols, tannins, flavonoids, and alkaloids in extracts of leaves, branches, and roots. Through LC-MS analysis, the triterpenes oleanolic acid (m/z 455 [M-H]-) and ursolic acid (m/z 455 [M-H]-) were identified as the main bioactive components. The extracts of the leaves, branches, and roots revealed moderate antioxidant potential in the DPPH test and all extracts were more active in the ABTS test. The leaf extracts showed better antioxidant capacity, displaying IC50 values of 43.5 ± 0.14, 63.6 ± 0.54, and 56.1 ± 0.05 µg mL-1 for DPPH, ABTS, and kinetics assays, respectively. The leaf extract showed higher total flavonoid content (TFC) (5.12 ± 1.02 mg QR/g), followed by branches (3.16 ± 0.88 QR/g) and roots (2.04 ± 0.52 QR/g/g). The extract of the branches exhibited higher total phenolic content (TPC) (1.07 ± 0.77 GAE/g), followed by leaves (0.58 ± 0.30 GAE/g) and roots (0.19 ± 0.47 GAE/g). Pharmacophore and molecular docking analysis were performed in order to better understand the potential mechanism of the antioxidant activity of its major metabolites.

Transcutaneous Nerve Electrostimulation (TENS) in Pain Relief During Labor: A Scope Review.

OBJECTIVE: To map health evidence on the effectiveness of transcutaneous nerve electrostimulation (TENS) therapy in pain relief during delivery. METHODS: This is a scoping review in the PubMed, LILACS, Cochrane, VHL, PEDRO, and SciELO databases, through the descriptors electric stimulation, transcutaneous and labor, obstetric and their synonyms. RESULTS: A total of 263 studies were identified, of which 54 duplicates were excluded. After sorting by titles and abstracts, there were 24 articles for reading, remaining 6. The six studies evaluated the reduction of pain through the visual analogue scale (VAS). CONCLUSION: The findings indicate that the use of TENS as a nonpharmacological strategy for pain relief in labor has positive results.

OBJETIVO: Mapear evidências em saúde sobre a eficácia da terapia por estimulação elétrica nervosa transcutânea (TENS, na sigla em inglês) no alívio da dor durante o parto. MéTODOS: Trata-se de uma revisão de escopo nas bases de dados PubMed, LILACS, Cochrane, VHL, PEDRO e SciELO, através dos descritores estimulação eléctrica, transcutânea e trabalho, obstetrícia e os seus sinônimos. RESULTADOS: Foram identificados 263 estudos, dos quais 54 duplicados foram excluídos. Após a classificação por títulos e resumos, 24 artigos foram selecionados para leitura, restando 6. Os seis estudos avaliaram a redução da dor através da escala visual analógica (EVA). CONCLUSãO: Os resultados indicam que a utilização de TENS como estratégia não farmacológica para o alívio da dor no parto tem resultados positivos.

Genome wide association mapping for agronomic, fruit quality, and root architectural traits in tomato under organic farming conditions.

BACKGROUND: Opportunity and challenges of the agriculture scenario of the next decades will face increasing demand for secure food through approaches able to minimize the input to cultivations. Large panels of tomato varieties represent a valuable resource of traits of interest under sustainable cultivation systems and for genome-wide association studies (GWAS). For mapping loci controlling the variation of agronomic, fruit quality, and root architecture traits, we used a heterogeneous set of 244 traditional and improved tomato accessions grown under organic field trials. Here we report comprehensive phenotyping and GWAS using over 37,300 SNPs obtained through double digest restriction-site associated DNA (dd-RADseq). RESULTS: A wide range of phenotypic diversity was observed in the studied collection, with highly significant differences encountered for most traits. A variable level of heritability was observed with values up to 69% for morphological traits while, among agronomic ones, fruit weight showed values above 80%. Genotype by environment analysis highlighted the strongest genotypic effect for aboveground traits compared to root architecture, suggesting that the hypogeal part of tomato plants has been a minor objective for breeding activities. GWAS was performed by a compressed mixed linear model leading to 59 significantly associated loci, allowing the identification of novel genes related to flower and fruit characteristics. Most genomic associations fell into the region surrounding SUN, OVATE, and MYB gene families. Six flower and fruit traits were associated with a single member of the SUN family (SLSUN31) on chromosome 11, in a region involved in the increase of fruit weight, locules number, and fruit fasciation. Furthermore, additional candidate genes for soluble solids content, fruit colour and shape were found near previously reported chromosomal regions, indicating the presence of synergic and multiple linked genes underlying the variation of these traits. CONCLUSIONS: Results of this study give new hints on the genetic basis of traits in underexplored germplasm grown under organic conditions, providing a framework for the development of markers linked to candidate genes of interest to be used in genomics-assisted breeding in tomato, in particular under low-input and organic cultivation conditions.

Fruit composition profile of pepper, tomato and eggplant varieties grown under uniform conditions.

The study of the diversity within and between major Solanaceae crops (pepper, tomato, eggplant) is of interest for the selection and development of balanced diets. We have measured thirty-six major fruit composition traits, encompassing sugars, organic acids, antioxidants and minerals, in a set of 10 accessions per crop for pepper, tomato and eggplant, grown under the same cultivation conditions. The aim was to evaluate the diversity within species and to provide an accurate comparison of fruit composition among species by reducing to a minimum the environmental effect. Pepper, tomato and eggplant had a clearly distinct composition profile. Pepper showed the highest average content in total sugars and organic acids. Fructose and glucose were the major sugar compounds in the three species, although in pepper and tomato sucrose was present only in trace amounts. Citric acid was the major organic acid in pepper and tomato, while in eggplant it was malic acid. Pepper and eggplant had the highest total antioxidant activity. Vitamin C content was much higher in pepper than in tomato and eggplant, while eggplant accumulated high concentrations of chlorogenic acid. Furthermore, eggplant was the species with higher content in most minerals, particularly for K, Mg and Cu, while pepper was the richest in Fe. Due to their complementary nutritional profiles, a combined regular consumption of the three vegetables would supply more than 20% of the Dietary Reference Intake of several of the analysed phytochemicals. The large diversity within each species is of interest for selecting varieties with better nutritional and organoleptic profiles, as well as for breeding new cultivars.

Variation for Composition and Quality in a Collection of the Resilient Mediterranean 'de penjar' Long Shelf-Life Tomato Under High and Low N Fertilization Levels.

The 'de penjar' tomato (Solanum lycopersicum L.) is a group of local varieties from the Spanish Mediterranean region carrying the alc mutation, which provides long shelf-life. Their evolution under low-input management practices has led to the selection of resilient genotypes to adverse conditions. Here we present the first evaluation on nutritional fruit composition of a collection of 44 varieties of 'de penjar' tomato under two N fertilization levels, provided by doses of manure equivalent to 162 kg N ha-1 in the high N treatment and 49 kg N ha-1 in the low N treatment. Twenty-seven fruit composition and quality traits, as well as plant yield and SPAD value, were evaluated. A large variation was observed, with lycopene being the composition trait with the highest relative range of variation (over 4-fold) under both N treatments, and significant differences among varieties were detected for all traits. While yield and most quality traits were not affected by the reduction in N fertilization, fruits from the low N treatment had, on average, higher values for hue (5.9%) and lower for fructose (-11.5%), glucose (-15.8%), and total sweetness index (-12.9%). In addition, lycopene and ß-carotene presented a strongly significant genotype × N input interaction. Local varieties had higher values than commercial varieties for traits related to the ratio of sweetness to acidity and for vitamin C, which reinforces the appreciation for their organoleptic and nutritional quality. Highest-yielding varieties under both conditions displayed wide variation in the composition and quality profiles, which may allow the selection of specific ideotypes with high quality under low N conditions. These results revealed the potential of 'de penjar' varieties as a genetic resource in breeding for low N inputs and improving the organoleptic and nutritional tomato fruit quality.

Morphoagronomic characterization and whole-genome resequencing of eight highly diverse wild and weedy S. pimpinellifolium and S. lycopersicum var. cerasiforme accessions used for the first interspecific tomato MAGIC population.

The wild Solanum pimpinellifolium (SP) and the weedy S. lycopersicum var. cerasiforme (SLC) are largely unexploited genetic reservoirs easily accessible to breeders, as they are fully cross-compatible with cultivated tomato (S. lycopersicum var. lycopersicum). We performed a comprehensive morphological and genomic characterization of four wild SP and four weedy SLC accessions, selected to maximize the range of variation of both taxa. These eight accessions are the founders of the first tomato interspecific multi-parent advanced generation inter-cross (MAGIC) population. The morphoagronomic characterization was carried out with 39 descriptors to assess plant, inflorescence, fruit and agronomic traits, revealing the broad range of diversity captured. Part of the morphological variation observed in SP was likely associated to the adaptation of the accessions to different environments, while in the case of SLC to both human activity and adaptation to the environment. Whole-genome resequencing of the eight accessions revealed over 12 million variants, ranging from 1.2 to 1.9 million variants in SLC and from 3.1 to 4.8 million in SP, being 46.3% of them (4,897,803) private variants. The genetic principal component analysis also confirmed the high diversity of SP and the complex evolutionary history of SLC. This was also reflected in the analysis of the potential footprint of common ancestors or old introgressions identified within and between the two taxa. The functional characterization of the variants revealed a significative enrichment of GO terms related to changes in cell walls that would have been negatively selected during domestication and breeding. The comprehensive morphoagronomic and genetic characterization of these accessions will be of great relevance for the genetic analysis of the first interspecific MAGIC population of tomato and provides valuable knowledge and tools to the tomato community for genetic and genomic studies and for breeding purposes.

Genetic diversity, population structure, and relationships in a collection of pepper (Capsicum spp.) landraces from the Spanish centre of diversity revealed by genotyping-by-sequencing (GBS).

Pepper (Capsicum spp.) is one of the most important vegetable crops; however, pepper genomic studies lag behind those of other important Solanaceae. Here we present the results of a high-throughput genotyping-by-sequencing (GBS) study of a collection of 190 Capsicum spp. accessions, including 183 of five cultivated species (C. annuum, C. chinense, C. frutescens, C. baccatum, and C. pubescens) and seven of the wild form C. annuum var. glabriusculum. Sequencing generated 6,766,231 high-quality read tags, of which 40.7% were successfully aligned to the reference genome. SNP calling yielded 4083 highly informative segregating SNPs. Genetic diversity and relationships of a subset of 148 accessions, of which a complete passport information was available, was studied using principal components analysis (PCA), discriminant analysis of principal components (DAPC), and phylogeny approaches. C. annuum, C. baccatum, and C. chinense were successfully separated by all methods. Our population was divided into seven clusters by DAPC, where C. frutescens accessions were clustered together with C. chinense. C. annuum var. glabriusculum accessions were spread into two distinct genetic pools, while European accessions were admixed and closely related. Separation of accessions was mainly associated to differences in fruit characteristics and origin. Phylogeny studies showed a close relation between Spanish and Mexican accessions, supporting the hypothesis that the first arose from a main genetic flow from the latter. Tajima's D statistic values were consistent with positive selection in the C. annuum clusters, possibly related to domestication or selection towards traits of interest. This work provides comprehensive and relevant information on the origin and relationships of Spanish landraces and for future association mapping studies in pepper.

Comparative transcriptomics in Leishmania braziliensis: disclosing differential gene expression of coding and putative noncoding RNAs across developmental stages.

Leishmaniasis is a worldwide public health problem caused by protozoan parasites of the genus Leishmania. Leishmania braziliensis is the most important species responsible for tegumentary leishmaniases in Brazil. An understanding of the molecular mechanisms underlying the success of this parasite is urgently needed. An in-depth study on the modulation of gene expression across the life cycle stages of L. braziliensis covering coding and noncoding RNAs (ncRNAs) was missing and is presented herein. Analyses of differentially expressed (DE) genes revealed that most prominent differences were observed between the transcriptomes of insect and mammalian proliferative forms (6,576 genes). Gene ontology (GO) analysis indicated stage-specific enriched biological processes. A computational pipeline and 5 ncRNA predictors allowed the identification of 11,372 putative ncRNAs. Most of the DE ncRNAs were found between the transcriptomes of insect and mammalian proliferative stages (38%). Of the DE ncRNAs, 295 were DE in all three stages and displayed a wide range of lengths, chromosomal distributions and locations; many of them had a distinct expression profile compared to that of their protein-coding neighbors. Thirty-five putative ncRNAs were submitted to northern blotting analysis, and one or more hybridization-positive signals were observed in 22 of these ncRNAs. This work presents an overview of the L. braziliensis transcriptome and its adjustments throughout development. In addition to determining the general features of the transcriptome at each life stage and the profile of protein-coding transcripts, we identified and characterized a variety of noncoding transcripts. The novel putative ncRNAs uncovered in L. braziliensis might be regulatory elements to be further investigated.

Lesions of the Parotid Gland and Buccal Artery After Buccal Fat Pad Reduction.

The significant increase in esthetic surgery, especially buccal fat pad reduction, has led to a corresponding increase in lesions and postoperatory after-effects from this surgical procedure. The aim of this study is to discuss the immediate and mediate risks of removing the Bichat ball, as well as describing a clinical study in which this surgical procedure resulted in lesions of the parotid gland and buccal artery, which was confirmed via nuclear magnetic resonance. The facial lesions were remedied via exploratory surgery by opening a new orifice of the glandular duct in the buccal cavity followed by drainage and compressive surgical bandages.

O autocuidado do escolar hemofílico / Self-care of the hemophilic child

Objetivo: verificar como escolares com hemofilia A e B realizam o autocuidado. Método: trata-se de estudo bibliográfico, descritivo, tipo revisão integrativa da literatura. Buscou-se publicações entre 2013 à 2018 nas bases de dados BDENF, LILACS, MEDLINE e Biblioteca Virtual SciELO. Analisaram-se os dados de forma descritiva a partir do estabelecimento de categorias. Resultados: informam-se que cinco artigos respondem ao objetivo estudado. Realizou-se após a análise a categorização dos estudos e se observaram os benefícios de empoderar o paciente por meio do autogerenciamento desde a infância e a necessidade de compreender o processo de doença crônica, promovendo um autogerenciamento eficaz por meio de rotinas pré-estabelecidas. Conclusão: percebe-se que há escassez de artigos que abordem a realidade brasileira, dificultando a compreensão do cenário nacional. Identificouse a necessidade do escolar compreender a doença e gerar autonomia no gerenciamento do seu autocuidado.(AU)

Objective: to verify how children with hemophilia A and B perform self-care. Method: this is a bibliographic, descriptive, integrative literature review study. We searched publications from 2013 to 2018 in the databases BDENF, LILACS, MEDLINE and SciELO Virtual Library. Data were analyzed descriptively from the establishment of categories. Results: five articles respond to the objective studied. After the analysis, the studies were categorized and the benefits of empowering the patient through self-management from childhood and the need to understand the chronic disease process were promoted, promoting effective self-management through pre-established routines. Conclusion: it is clear that there is a shortage of articles that address the Brazilian reality, making it difficult to understand the national scenario. The need for children to understand the disease and generate autonomy in the management of their self-care was identified.(AU)

Objetivo: verificar cómo los niños con hemofilia A y B realizan el autocuidado. Método: este es un estudio de revisión bibliográfica, descriptivo, integrador de literatura. Se realizaron búsquedas en las publicaciones de 2013 a 2018 en las bases de datos BDENF, LILACS, MEDLINE y la Biblioteca Virtual SciELO. Los datos se analizaron descriptivamente a partir del establecimiento de categorías. Resultados: cinco artículos responden al objetivo estudiado. Después del análisis, se categorizaron los estudios y se promovieron los beneficios de empoderar al paciente a través del autocontrol desde la infancia y la necesidad de comprender el proceso de las enfermedades crónicas, promoviendo el autocontrol efectivo a través de rutinas preestablecidas. Conclusión: está claro que hay una escasez de artículos que aborden la realidad brasileña, lo que dificulta la comprensión del escenario nacional. Se identificó la necesidad de que los niños entiendan la enfermedad y generen autonomía en el manejo de su autocuidado.(AU)

Insights Into the Adaptation to Greenhouse Cultivation of the Traditional Mediterranean Long Shelf-Life Tomato Carrying the alc Mutation: A Multi-Trait Comparison of Landraces, Selections, and Hybrids in Open Field and Greenhouse.

Long shelf-life tomato (Solanum lycopersicum) landraces, characterized by carrying the alc allele in the NOR.NAC locus, have been traditionally cultivated in the Mediterranean region. These materials are adapted to open field conditions under low input conditions. However, cultivation under greenhouse is expanding fueled by increasing demand of these traditional tomatoes. We hypothesize that the large diversity in the long shelf-life landraces and derived materials can be exploited for adaptation to these new cultivation conditions. We have evaluated 12 varieties (seven landraces, three selections and two hybrids) carrying the alc mutation under open field (OF) and greenhouse (GH) cultivation, and evaluated them for 52 morphological, agronomic, chemical properties, and chemical composition descriptors. All descriptors, except six morphological ones, were variable. The variety effect was the greatest contributor to variation for most morphological traits, as well as for fruit weight, fruit shape, dry matter, and soluble solids content. However, significant environmental and genotype × environment interaction were found for 36 and 42 descriptors, respectively. Fruits from GH plants had lower weight and firmness and were less red than those from OF. On average, in GH yield was 35% lower and daily fruit weight loss in post-harvest 41% higher than in OF. However, fruits from GH had on average higher dry matter and soluble solids contents, antioxidant activity, glucose, fructose, and ascorbic acid concentrations, but lower contents in lycopene and ß-carotene than those from OF. A principal components analysis clearly separated varieties according to the cultivation environment. However, the distribution pattern of varieties within each of the two clusters (GH and OF) was similar, despite the strong G × E interaction for many descriptors. Landraces from the same origin plotted in the same area of each cluster, and selections and hybrids plotted together with the landraces. The results reveal a high impact of the cultivation environment on morphological, agronomic, chemical properties, and chemical composition of Mediterranean long shelf-life traditional tomato varieties. This suggests that breeding programs specifically focused to adaptation to greenhouse conditions should be developed.

SAPS 3 score as a predictive factor for postoperative referral to intensive care unit.

BACKGROUND: Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. However, some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this. METHODS: The study included patients undergoing intermediate-risk surgery with preoperative indication for ICU but who were taken to the ward postoperatively, because they appeared to be responding well. However, they required late ICU admission. ICU care and preoperative SAPS 3 score were evaluated. Palliative surgeries and patients readmitted to ICU were excluded. RESULTS: The study included 100 patients, 27 % of whom had late postoperative admission to the ICU. The preoperative SAPS 3 score was higher (45.4 ± 7.8 vs. 35.9 ± 7.4, P < 0.001) in patients who required delayed admission to the ICU postoperatively. Furthermore, they had undergone longer surgery (4.2 ± 1.9 vs. 2.7 ± 1.5 h, P < 0.001), and a greater proportion were gastrointestinal surgeries (14.8 vs. 5.5 %, P = 0.03) and intraoperative transfusion (18.5 vs. 5.5 % P = 0.04). In multivariate analysis, preoperative SAPS 3 and surgery duration independently predicted postoperative ICU admission, respectively (OR 1.25; 95 % CI 1.1-1.4 and OR 3.33; 95 % CI 1.7-6.3). CONCLUSION: The identification of high-risk surgical patients is essential for proper treatment; time of surgery and preoperative SAPS 3 seem to provide a useful indication of risk and may help better to characterize patients undergoing intermediate-risk surgery that demand ICU care.

Unidade de Tratamento de Queimaduras da Universidade Federal de São Paulo: estudo epidemiológico / Burn Care Unit of São Paulo Federal University: an epidemiological profile

INTRODUÇÃO: As queimaduras são traumas graves, que geram 100 mil atendimentos hospitalares por ano, no Brasil. As Unidades de Queimados são fundamentais para o tratamento desses pacientes e a produção de conhecimento sobre o tema. MÉTODO: O estudo estabeleceu o perfil de atendimento em cada ano de funcionamento da unidade no período de 2009 a 2012, e comparou, entre esses anos, a quantidade de pacientes internados, a procedência, os graus de queimadura, a idade, a superfície corporal queimada, os dias de internação, os tipos de procedimentos cirúrgicos, os agentes e a mortalidade. Para avaliação das possíveis associações, foi utilizado o teste do Qui-quadrado. RESULTADOS: Foram internados 321 pacientes. Em 2009, 70% dos pacientes apresentavam queimadura de II grau e, em 2012, 66% dos pacientes tinham queimadura de III grau. Em 2009, 37% vieram referenciados de outros serviços, e em 2012, 72%. A idade média dos pacientes foi de 29 anos em 2009 e 44 anos, em 2012. A superfície corporal queimada no início era de 13%, e em 2012, foi 8%. O tempo de internação subiu de 11 para 21 dias. Em 2009, realizaram-se 50 procedimentos cirúrgicos. Em 2012, foram 103. O agente causal mais encontrado foram os líquidos inflamáveis e a mortalidade global caiu de 7% para 4%, ao longo dos anos. CONCLUSÃO: Houve um aumento na quantidade de pacientes referenciados e complexos, com queimaduras de maior grau, exigindo mais procedimentos e maior hospitalização, ao longo dos anos. A taxa de mortalidade diminuiu, refletindo melhora técnica da Unidade, que se estabeleceu como referência regional no tratamento de queimados.

INTRODUCTION: Burns constitute severe trauma and account for 100,000 hospital visits per year in Brazil. Burns units are essential for the treatment of these patients and the generation of knowledge on this subject. METHOD: This study established the annual profile of burn unit attendance between 2009 and 2012. During these years of activity, we compared the number of hospitalized patients, patient origin, burn degree, age, burn body surface area, days of hospitalization, types of surgical procedures, agents, and mortality. Possible combinations were evaluated with the chi-square test. RESULTS: A total of 321 patients were hospitalized. In 2009, 70% of the patients presented secon-degree burns; in 2012, 66% of the patients presented third-degree burns. In 2009, 37% of the patients were referred to other services; in 2012, 72% were referred. The average patient age was 29 years old in 2009 and 44 years old in 2012. Burn body surface was 13% in 2009 and 8% in 2012. Hospitalization time increased from 11 to 21 days. A total of 50 surgical procedures were performed in 2009, while 103 were performed in 2012. Flammable liquids were the most commonly observed causal agents. The overall mortality rate decreased from 7% to 4% over the study period. CONCLUSION: There was an increase in the number of referred and complex patients with higher degree burns who required longer hospital stays and a greater number of procedures over the years. The decreased mortality rate reflected the technical improvement of the unit that was established as a regional reference for the treatment of burn victims.

Efeito do treinamento de força nas variáveis cardiovasculares em adolescentes com sobrepeso / Effect of strength training on cardiovascular variables in overweight adolescents / Efecto del entrenamiento de fuerza en las variables cardiovasculares en adolescentes con sobrepeso

OBJETIVO: O presente estudo teve por objetivo avaliar as respostas agudas cardiorrespiratórias e autonômicas induzidas por uma sessão de exercício físico resistido em adolescentes com sobrepeso. MÉTODOS: Foram avaliados 17 adolescentes do sexo masculino divididos em grupo controle (GC, n=9) e grupo sobrepeso (GSO, n=7). Todos foram submetidos a uma sessão exercícios resistidos para diferentes grupos musculares, realizados com sobrecarga de 60% da força máxima, com um intervalo de 45 segundos entre as séries e 90 segundos entre cada exercício. Antes, durante e após a sessão de exercícios os seguintes parâmetros foram avaliados: frequência cardíaca (FC), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD) e variabilidade da frequência cardíaca (VFC). RESULTADOS: Foi observado comportamento semelhante em ambos os grupos da PAS e PAD. A PAS aumentou durante o exercício e a PAD diminuiu. Ambas retornaram aos valores basais durante a recuperação. A FC aumentou durante a sessão de exercício nos dois grupos, porém, apenas no GSO houve retorno aos valores de repouso. Os índices da VFC no domínio do tempo (VAR RR e RMSSD) se comportaram de maneira semelhante frente ao exercício nos dois grupos, porém, no índice SDNN apenas o GSO retornou aos valores de repouso. A VFC no domínio da frequência apresentou comportamento semelhante em ambos os grupos. CONCLUSÕES: sugere-se que o aumento do nível de atividade física em indivíduos com sobrepeso pode prevenir as alterações autonômicas que estão associadas ao aumento do peso corporal e conferir efeito protetor ao sistema cardiovascular. .

OBJECTIVE: This study aimed to evaluate the acute cardiorespiratory and autonomic responses induced by a resistive exercise session in overweight adolescents. METHODS: We evaluated 17 male adolescents divided into control group (CG, n = 9) and overweight group (OWG, n = 7). All patients underwent one session of resistance exercises for different muscle groups, performed with overload of 60% of maximum strength, with an interval of 45 seconds between sets and 90 seconds between each exercise. Before, during and after the exercise session the following parameters were evaluated: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate variability (HRV). RESULTS: We observed similar behavior in both groups of SBP and DBP. The SBP increased during exercise while the DBP decreased. Both returned to baseline during recovery. HR increased during the workout in the two groups, but return to resting values only occurred in the OWG. The HRV indices in the time domain (VAR RR and RMSSD) behaved similarly to the exercise in both groups, but the SDNN index only returned to resting values in the OWG. HRV in the frequency domain exhibited similar behavior in both groups. CONCLUSIONS: It is suggested that the increased level of physical activity in overweight individuals can prevent autonomic changes that are associated with increased body weight and confer a protective effect on the cardiovascular system .

OBJETIVO: El presente estudio tuvo por objetivo evaluar las respuestas agudas cardiorrespiratorias y autonómicas inducidas por una sesión de ejercicio físico resistido en adolescentes con sobrepeso. MÉTODOS: Fueron evaluados 17 adolescentes del sexo masculino divididos en grupo control (GC, n=9) y grupo sobrepeso (GSO, n=7). Todos fueron sometidos a una sesión de ejercicios resistidos para diferentes grupos musculares, realizados con sobrecarga de 60% de la fuerza máxima, con un intervalo de 45 segundos entre las series y 90 segundos entre cada ejercicio. Antes, durante y después de la realización de la sesión de ejercicios los siguientes parámetros fueron evaluados: frecuencia cardíaca (FC), presión arterial sistólica (PAS), presión arterial diastólica (PAD) y variabilidad de la frecuencia cardíaca (VFC). RESULTADOS: Fue observado comportamiento semejante en ambos grupos de la PAS y PAD. La PAS aumentó durante el ejercicio y la PAD disminuyó. Ambas retornaron a los valores basales durante la recuperación. La FC aumentó durante la sesión de ejercicio en los dos grupos, no obstante, solamente en el GSO hubo retorno a los valores de reposo. Los índices de la VFC en el dominio del tiempo (VAR RR y RMSSD) se comportaron de manera semejante frente al ejercicio en los dos grupos, no obstante, en el índice SDNN sólo el GSO retornó a los valores de reposo. La VFC en el dominio de la frecuencia presentó comportamiento semejante en ambos grupos. CONCLUSIONES: Se sugiere que el aumento del nivel de actividad física en individuos con sobrepeso puede prevenir las alteraciones autonómicas que están asociadas al aumento del peso corporal y conferirle efecto protector al sistema cardiovascular. .

The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study.

INTRODUCTION: In some studies including small populations of patients undergoing specific surgery, an intraoperative liberal infusion of fluids was associated with increasing morbidity when compared to restrictive strategies. Therefore, to evaluate the role of excessive fluid infusion in a general population with high-risk surgery is very important. The aim of this study was to evaluate the impact of intraoperative fluid balance on the postoperative organ dysfunction, infection and mortality rate. METHODS: We conducted a prospective cohort study during one year in four ICUs from three tertiary hospitals, which included patients aged 18 years or more who required postoperative ICU after undergoing major surgery. Patients who underwent palliative surgery and whose fluid balance could change in outcome were excluded. The calculation of fluid balance was based on preoperative fasting, insensible losses from surgeries and urine output minus fluid replacement intraoperatively. RESULTS: The study included 479 patients. Mean age was 61.2 ± 17.0 years and 8.8% of patients died at the hospital during the study. The median duration of surgery was 4.0 (3.2 to 5.5) h and the value of the Simplified Acute Physiology Score (SAPS) 3 score was 41.8 ± 14.5. Comparing survivors and non-survivors, the intraoperative fluid balance from non-survivors was higher (1,950 (1,400 to 3,400) mL vs. 1,400 (1,000 to 1,600) mL, P <0.001). Patients with fluid balance above 2,000 mL intraoperatively had a longer ICU stay (4.0 (3.0 to 8.0) vs. 3.0 (2.0 to 6.0), P <0.001) and higher incidence of infectious (41.9% vs. 25.9%, P = 0.001), neurological (46.2% vs. 13.2%, P <0.001), cardiovascular (63.2% vs. 39.6%, P <0.001) and respiratory complications (34.3% vs. 11.6%, P <0.001). In multivariate analysis, the fluid balance was an independent factor for death (OR per 100 mL = 1.024; P = 0.006; 95% CI 1.007 to 1.041). CONCLUSIONS: Patients with excessive intraoperative fluid balance have more ICU complications and higher hospital mortality.

Gerenciando a segurança da clientela pediátrica nas incompatibilidades medicamentosas em uso do metotrexato endovenoso / Managing Safety in Pediatric Clients Incompatibilities in Drug Use Intravenous Methotrexate

A terapia com vários fármacos é a regra na quimioterapia antineoplásica e no tratamento de determinadas doenças infecciosas. Nesses casos os objetivos consistem na melhora da eficácia terapêutica e no retardo da emergência de células malignas ou de microrganismos resistentes aos efeitos dos fármacos disponíveis. Nas prescrições, das crianças internadas com patologias oncológicas, identificou-se como principal quimioterápico o Metotrexato (MTX), perfazendo um total de 3 a 4 doses por prescrição no tratamento de linfomas não Hodgkin e leucemias linfoides agudas. A interação farmacológica ocorre, quando um fármaco interfere com outros, alterando o efeito esperado, podendo ser prejudicial, á medida que causa aumento de riscos ao paciente. As interações farmacêuticas, também chamadas incompatibilidades medicamentosas, caracterizam-se por ocorrerem in vitro, isso é antes da administração no organismo, quando misturado dois ou mais fármacos em uma mesma seringa, equipo de soro ou outros recipientes. Objeto de estudo: As incompatibilidades físico-químicas dos medicamentos durante o ciclo de infusão do MTX endovenoso na clientela pediátrica com LLA e Linfoma não Hodgkin. Hipotese: O aprazamento de medicamentos concomitante a infusão do Metotrexato (MTX), realizado pelo enfermeiro, podem causar incompatibilidades que diminuem ou potencializam o efeito terapêutico deste quimioterápico. Objetivos: Traçar o perfil do tratamento farmacológico das crianças com LLA e LNH, durante o ciclo do MTX internadas na unidade pediátrica; verificar a prevalência das incompatibilidades físico-químicas entre os medicamentos administrados via endovenosa nas crianças com LLA e LNH, internadas na UP; estabelecer diretrizes para a Gerência do Cuidado de Enfermagem à crianças com LLA e LNH em uso de MTX endovenoso com a criação de um protocolo de aprazamento e administração. Foi um estudo observacional transversal, com abordagem quantitativa dos dados. A mostra foi composta por 13 pacientes com LLA e LNH, que atenderam os critérios de inclusão deste estudo, dos quais emergiram 86 prescrições. Os dados foram coletados no período de janeiro de 2008 à dezembro de 2011 e sofreram estatística descritiva e foi calculado a prevalência das incompatibilidades medicamentosas. O sexo masculino apresentou 61,5% da amostra, enquanto o feminino 38,5%; LLA com 85,6% e LNH com 15,2%; 100% de acessos centrais monolumen. Os eletrólitos apresentaram o maior numero de doses administradas, seguido do antiemético, e dos quimioterápicos. A interação medicamentosa do tipo farmacêutica, de maior prevalência foi a entre o cloridrato de ondansetrona e o bicarbonato de sódio a 8,4%, seguida da entre o cloridrato de midazolan e o bicarbonato de sódio. A pesquisa contribui para que o enfermeiro, se aproprie ainda mais dos conhecimentos relacionados a farmacocinética, farmacodinâmica e farmacêutica, assim como sobre as reações adversas medicamentosas, para que possam realizar a gerência do cuidado, no que tange toda a dinâmica da terapia medicamentosas, ou seja, uma assistência de enfermagem segura, livre de danos, sejam eles temporários ou permanentes, assegurando que os pacientes permaneçam o mínimo possível no ambiente hospitalar, assim como ter uma terapêutica medicamentosa com o resultado final que é a prevenção ou cura de doenças, e também eficácia nos tratamentos paliativo

Therapy with multiple drugs is the rule in cancer chemotherapy and in the treatment of certain infectious diseases. In such cases the objectives consist in improving the therapeutic efficacy and delay the emergence of malignant cells or microorganisms resistant to the effects of available drugs. In the prescriptions of children with oncological diseases, was identified as the main chemotherapeutic methotrexate (MTX), making a total of 3 to 4 doses per prescription in the treatment of non-Hodgkin lymphomas and acute lymphoid leukemias. The pharmacological interaction occurs, when a drug interferes with other, changing the desired effect and may be harmful, as will cause the patient to increased risks. The drug interactions, also called drug incompatibilities, characterized by occur in vitro that is prior to administration in the body, when two or more components mixed in one syringe, serum catheter or other containers. Object of study: The physicochemical incompatibilities of drugs during the course of intravenous infusion of MTX in pediatric clients with ALL and non-Hodgkin's lymphoma. Hypothesis: The scheduling of drugs concomitant infusion of methotrexate (MTX), performed by the nurse, can cause incompatibilities that reduce or enhance the therapeutic effect of chemotherapy. Objectives: To describe the pharmacological treatment of children with ALL and NHL, during the cycle of MTX admitted to the pediatric unit and verify the prevalence of physical and chemical incompatibilities between drugs administered intravenously in children with ALL and NHL, admitted in UP; establish guidelines for the Management of Nursing Care for children with ALL and NHL in MTX intravenously with the creation of a protocol for scheduling and administration. It was an observational cross-sectional quantitative data approach. The show was comprised of 13 patients with ALL and NHL, who met the study inclusion criteria, 86 of which emerged prescriptions. Data were collected from January 2008 to December 2011 and suffered descriptive statistics and calculated the prevalence of drug incompatibilities. The male group showed 61.5% of the sample, while females 38.5%, 85.6% with ALL and NHL with 15.2%, 100% hits central monolumen. Electrolytes showed the highest number of doses administered, followed by an anti-emetic, and chemotherapy. The type of pharmaceutical drug interaction, was the most prevalent of the ondansetron hydrochloride and sodium bicarbonate to 8.4%, followed by between midazolam hydrochloride and sodium bicarbonate. The research contributes to the nurse, to appropriate further knowledge related to pharmacokinetics, pharmacodynamics, and pharmaceutical, as well as on adverse drug reactions so that they can carry out care management, regarding the dynamics of drug therapy, or is a safe nursing care, free of damage, whether temporary or permanent, ensuring that patients remain as little as possible in the hospital environment, as well as having a drug therapy with the end result is the prevention or cure of diseases, and also effective in the palliative treatment

El tratamiento con múltiples fármacos es la regla en la quimioterapia del cáncer y en el tratamiento de ciertas enfermedades infecciosas. En tales casos, los objetivos consisten en la mejora de la eficacia terapéutica y retrasar la aparición de células malignas o microorganismos resistentes a los efectos de los fármacos disponibles. En las prescripciones de los niños con enfermedades oncológicas, fue identificado como el principal de la quimioterapia con metotrexato (MTX), haciendo un total de 3 a 4 dosis por receta en el tratamiento de los linfomas no Hodgkin y leucemias linfoides agudas. La interacción farmacológica ocurre cuando un medicamento interfiere con la otra, cambiando el efecto deseado y puede ser perjudicial, ya que hará que el paciente a un mayor riesgo. Las interacciones de medicamentos, también llamados incompatibilidades de drogas, caracterizado por producirse in vitro que es antes de la administración en el cuerpo, cuando dos o más componentes mezclados en una jeringa, catéter suero u otros recipientes. objeto de estudio: Las incompatibilidades físico-químicas de las drogas durante el curso de la infusión intravenosa de MTX en clientes pediátricos con LLA y no-Hodgkin. Hipótesis: La programación de las drogas de infusión concomitante de metotrexato (MTX), realizado por la enfermera, puede provocar incompatibilidades que reducen o aumentan el efecto terapéutico de la quimioterapia. Objetivos: Describir el tratamiento farmacológico de los niños con LLA y linfoma no Hodgkin, durante el ciclo de MTX ingresados en la unidad pediátrica y verificar la prevalencia de incompatibilidades físicas y químicas entre los fármacos administrados por vía intravenosa en niños con LLA y la NHL, admitió en la UP; establecer directrices para la Gestión de Cuidados de Enfermería para los niños con LLA y linfoma no Hodgkin en el MTX por vía intravenosa con la creación de un protocolo para la programación y administración. Fue un estudio observacional transversal enfoque cuantitativo de los datos. La muestra estaba compuesta por 13 pacientes con LLA y la NHL, que cumplieron con los criterios de inclusión del estudio, el 86 de los cuales surgieron las recetas. Los datos fueron recogidos entre enero de 2008 diciembre de 2011 y sufrió la estadística descriptiva y se calculó la prevalencia de las incompatibilidades de la droga. El grupo masculino mostró un 61,5% de la muestra, mientras que las mujeres 38,5%, 85,6% con todos y la NHL, con un 15,2%, 100% llega a monolumen centrales. Los electrolitos mostró el mayor número de dosis administradas, seguida de un antiemético, y la quimioterapia. El tipo de interacción fármaco, fue la más frecuente de la clorhidrato de ondansetrón y bicarbonato de sodio al 8,4%, seguido por entre el clorhidrato de midazolam y bicarbonato de sodio. La investigación contribuye a la enfermera, a un conocimiento adecuado adicional relacionada con la farmacocinética, la farmacodinamia y farmacéutica, así como sobre las reacciones adversas a los medicamentos para que puedan llevar a cabo la gestión de la atención, en cuanto a la dinámica de la terapia con medicamentos, o es un cuidado de enfermería seguro, libre de daño, ya sea temporal o permanente, asegurando que los pacientes permanecen tan poco como sea posible en el ambiente hospitalario, así como tener una terapia con medicamentos con el resultado final es la prevención o curación de enfermedades, y también eficaz en el tratamiento paliativo