Hydrogel Cross-Linking via Thiol-Reactive Pyridazinediones.

Thiol-reactive Michael acceptors are commonly used for the formation of chemically cross-linked hydrogels. In this paper, we address the drawbacks of many Michael acceptors by introducing pyridazinediones as new cross-linking agents. Through the use of pyridazinediones and their mono- or dibrominated analogues, we show that the mechanical strength, swelling ratio, and rate of gelation can all be controlled in a pH-sensitive manner. Moreover, we demonstrate that the degradation of pyridazinedione-gels can be induced by the addition of thiols, thus providing a route to responsive or dynamic gels, and that monobromo-pyridazinedione gels are able to support the proliferation of human cells. We anticipate that our results will provide a valuable and complementary addition to the existing toolkit of cross-linking agents, allowing researchers to tune and rationally design the properties of biomedical hydrogels.

Presença do alérgeno de soja Gly m 1 no ar em Maringá - PR / Levels of airborne soy allergen Gly m 1 in Maringá, PR, Brazil

Introdução: O conhecimento da aerobiologia local é fundamental para o alergista. Os aeroalérgenos são capazes de sensibilizar e levar ao desenvolvimento de doenças respiratórias alérgicas, portanto devem ser monitorados rotineiramente, tendo em vista possíveis mudanças locais conforme alterações climáticas, poluição e atividades agroindustriais. Objetivo: Verificar a presença e concentração do alérgeno principal da poeira da casca da soja (Gly m 1) na atmosfera da cidade de Maringá-PR e possíveis associações aos fatores climáticos. A escolha da soja deve-se a alta prevalência desta cultura no Brasil e nesta região do país. Até o presente momento, há apenas um estudo piloto feito por este mesmo grupo avaliando a presença deste alérgeno no Brasil. Métodos: Foram realizadas coletas de material atmosférico, durante o período de março de 2017 a março de 2018, durante 24 ou 48 horas distribuídas no decorrer do período, totalizando 70 amostras, das quais 10 foram excluídas por problemas técnicos de coleta. As amostras foram avaliadas pelo método ELISA (Enzyme linked immunosorbent assay ) para Gly m 1, sendo que todas as amostras apresentaram níveis detectáveis do alérgeno. Resultados: A mediana de concentração de Gly m 1 foi de 4,89 ng/m3. Os valores encontrados variaram de 0,66 ng/ m3 a 1826,1 ng/m3. Das 60 amostras analisadas, 23% delas apresentaram valores superiores a 90 ng/m3, sendo os meses de junho/2017 e março/2018 com concentrações mais elevadas. Houve correlação positiva das concentrações de Gly m 1 com as temperaturas máxima, média e mínima, umidade relativa, vento e insolação. Conclusão: Os dados evidenciam exposições constantes da população ao alérgeno do Gly m 1, por vezes em níveis elevados possivelmente capazes de gerar sensibilização e sintomas.

Introduction: Knowledge of local aerobiology is essential for allergists. Because airborne allergens can sensitize the population and lead to allergic respiratory diseases, they must be routinely monitored for the effects of climate change, pollution, and agroindustry. Objective: To verify the airborne presence and concentration of the main soy hull dust allergen (Gly m 1) in Maringá, PR, Brazil and possible associations with climatic factors. Soybeans were selected due to the high prevalence of this crop in this region. To date, only 1 pilot study (conducted by our group) has evaluated this allergen's presence in Brazil. Methods: Atmospheric material was collected between March 2017 and March 2018 in 24- or 48-hour intervals, totaling 70 samples, of which 10 were excluded due to technical problems. The samples were tested for Gly m 1 using enzyme-linked immunosorbent assay, and all samples showed detectable levels of the allergen. Results: The median concentration of Gly m 1 was 4.89 ng/m3, with values ranging from 0.66 ng/m3 to 1826.1 ng/m3. Of the 60 samples, 23% showed values > 90 ng/m3, with June 2017 and March 2018 having the highest concentrations. There was a positive correlation between Gly m 1 concentration and maximum, mean, and minimum temperatures, relative humidity, wind, and insolation. Conclusion: The data show that the population is constantly exposed to the Gly m 1 allergen, sometimes at high levels, which may lead to sensitization and symptoms.

Desempenho do Escore Pediátrico de Alerta (EPA) de deterioração clínica / Desempeño del Sistema de Alerta Precoz Infantil (SAPI) de deterioración clínica / Pediatric Alert Score (EPA) performance in clinical deterioration

Resumo Objetivo Avaliar a acurácia, utilidade, reprodutibilidade e aplicabilidade do Escore Pediátrico de Alerta (EPA) na identificação da deterioração clínica em crianças e adolescentes hospitalizados. Métodos Estudo de teste diagnóstico, prospectivo, realizado entre outubro/2018 a outubro/2019, para medir a acurácia diagnóstica do EPA em uma amostra de 240 crianças, e sua reprodutibilidade e aplicabilidade em uma amostra de 60 crianças. Os dados foram processados e analisados no MedCalc e VassarStats.net. Resultados No ponto de corte ≥ 3, o escore apresentou sensibilidade de 73,6%, especificidade de 95,7%, valor preditivo positivo de 83%, valor preditivo negativo de 92,7, área sob a curva ROC de 93,6%, prevalência estimada pelo teste de 19,6%, razão de probabilidade positiva 17,1, probabilidade pós-teste positivo de 77,8%, kappa simples de 0,946. Conclusão O estudo fornece evidências sobre a elevada acurácia, utilidade e reprodutibilidade do EPA na identificação da deterioração clínica em um cenário hospitalar pediátrico brasileiro, e considerou o instrumento aplicável no contexto da pesquisa.

Resumen Objetivo Evaluar la precisión, utilidad, reproducibilidad y aplicabilidad del Sistema de Alerta Precoz Infantil (SAPI) en la identificación del deterioro clínico en niños y adolescentes hospitalizados. Métodos Estudio de prueba diagnóstica, prospectiva, realizada entre octubre de 2018 y octubre de 2019, para medir la precisión diagnóstica del SAPI en una muestra de 240 niños y su reproducibilidad y aplicabilidad en una muestra de 60 niños. Los datos fueron procesados y analizados en MedCalc y VassarStats.net. Resultados En el punto de corte ≥ 3, el puntaje presentó una sensibilidad del 73,6 %, especificidad del 95,7 %, valor predictivo positivo del 83 %, valor predictivo negativo de 92,7, área bajo la curva ROC del 93,6 %, prevalencia estimada por la prueba del 19,6 %, razón de probabilidad positiva 17,1, probabilidad posprueba positiva del 77,8 %, kappa simple de 0,946. Conclusión El estudio presenta evidencias sobre la elevada precisión, utilidad y reproducibilidad del SAPI en la identificación del deterioro clínico en un escenario hospitalario pediátrico brasileño, por lo que el instrumento se consideró aplicable en el contexto de la investigación.

Abstract Objective To assess the Pediatric Alert Score (EPA) accuracy, usefulness, reproducibility and applicability in identifying clinical deterioration in hospitalized children and adolescents. Methods This is a prospective diagnostic test study, carried out between October/2018 and October/2019, to measure EPA diagnostic accuracy in a sample of 240 children, and its reproducibility and applicability in a sample of 60 children. Data were processed and analyzed on MedCalc and VassarStats.net. Results At cut-off point ≥ 3, the score had a sensitivity of 73.6%, specificity of 95.7%, positive predictive value of 83%, negative predictive value of 92.7, area under the ROC curve of 93.6%, estimated prevalence of 19.6%, positive probability ratio of 17.1, positive post-test probability of 77.8%, simple Kappa of 0.946. Conclusion The study provides evidence on EPA high accuracy, usefulness and reproducibility in identifying clinical deterioration in a Brazilian pediatric hospital setting, and considered the instrument applicable in the context of the research.

Conhecimento de enfemeiras sobre a criança com doença falciforme / Conocimiento de enfemeiras sobre el niño con enfermedad falciforme / Knowledge of nurses about children with sickle cell disease

Objetivo: conhecer a percepção das enfermeiras sobre a criança com doença falciforme. Método: pesquisa qualitativa Convergente-Assistencial, ocorrida em hospital público pediátrico, da qual participaram 12 enfermeiras da emergência no período de julho de 2020 a abril de 2021, após submissão ao Comitê de Ética. As técnicas de coleta de dados foram: sondagem do conhecimento por entrevista semiestruturada, grupos de convergência e observação participante. Os dados foram analisados conforme referencial da Pesquisa Convergente-Assistencial e suas fases, sendo elas concepção, instrumentalização, teorização, transferência e análise. Resultados: as enfermeiras reconheceram a doença pela principal manifestação clínica, a crise álgica, a qual foi citada como característica marcante da criança com doença falciforme. Considerações finais: as enfermeiras atuantes na emergência pediátrica conhecem alguns aspectos da doença falciforme e revelaram conhecimento incipiente sobre a fisiopatologia da doença.

Objetivo: conocer la percepción de las enfermeras sobre el niño con enfermedad falciforme. Método: Investigación cualitativa Convergente-Asistencial, ocurrida en hospital público pediátrico, de la cual participaron 12 enfermeras de la emergencia en el período de julio de 2020 a abril de 2021, tras sumisión al Comité de Ética. Las técnicas de recolección de datos fueron: sondeo del conocimiento por entrevista semiestructurada, grupos de convergencia y observación participante. Los datos fueron analizados conforme referencial de la Investigación Convergente-Asistencial y sus fases, siendo ellas concepción, instrumentalización, teorización, transferencia y análisis. Resultados: las enfermeras reconocieron la enfermedad por la principal manifestación clínica, la crisis álgica, la cual fue citada como característica distintiva del niño con enfermedad falciforme. Consideraciones finales: las enfermeras que actúan en la emergencia pediátrica conocen algunos aspectos de la enfermedad falciforme y revelaron conocimiento incipiente sobre la fisiopatología de la enfermedad.

Objective: to know the perception of nurses about the child with sickle cell disease. Method: qualitative Convergent-Care research, occurred in a public pediatric hospital, in which 12 emergency nurses participated from July 2020 to April 2021, after submission to the Ethics Committee. The data collection techniques were: survey of knowledge by semi-structured interview, convergence groups and participant observation. The data were analyzed according to the referential of the Convergent-Care Research and its phases, being them conception, instrumentalization, theorization, transfer and analysis. Results: the nurses recognized the disease by the main clinical manifestation, the pain crisis, which was cited as a striking characteristic of the child with sickle cell disease. Final considerations: the nurses working in the pediatric emergency know some aspects of sickle cell disease and revealed incipient knowledge about the pathophysiology of the disease.

Differential plasticity and fate of brain-resident and recruited macrophages during the onset and resolution of neuroinflammation.

Microglia and border-associated macrophages (BAMs) are brain-resident self-renewing cells. Here, we examined the fate of microglia, BAMs, and recruited macrophages upon neuroinflammation and through resolution. Upon infection, Trypanosoma brucei parasites invaded the brain via its border regions, triggering brain barrier disruption and monocyte infiltration. Fate mapping combined with single-cell sequencing revealed microglia accumulation around the ventricles and expansion of epiplexus cells. Depletion experiments using genetic targeting revealed that resident macrophages promoted initial parasite defense and subsequently facilitated monocyte infiltration across brain barriers. These recruited monocyte-derived macrophages outnumbered resident macrophages and exhibited more transcriptional plasticity, adopting antimicrobial gene expression profiles. Recruited macrophages were rapidly removed upon disease resolution, leaving no engrafted monocyte-derived cells in the parenchyma, while resident macrophages progressively reverted toward a homeostatic state. Long-term transcriptional alterations were limited for microglia but more pronounced in BAMs. Thus, brain-resident and recruited macrophages exhibit diverging responses and dynamics during infection and resolution.

Nursing protocol for children with sickle cell disease in emergency room: a convergent-care approach.

OBJECTIVE: to describe the methodological process of developing a nursing care protocol for children with sickle cell disease in the emergency room. METHOD: convergent care research, carried out in a public pediatric hospital in the state of Bahia, with 12 emergency nurses specialist. Data production took place between July 2020 and April 2021, with semi-structured interviews, observation in a field diary and convergence groups, according to the research phases: conception, instrumentation, scrutiny and analysis. RESULTS: The final result was the construction of a nursing care protocol for children with sickle cell disease in the emergency room for use in the study field. FINAL CONSIDERATIONS: the Convergent Care Research proved to be an excellent methodological procedure for intervention in the health service, whose nursing care protocol was based on the reflections of professionals on evidence-based practices, whose consensus can enable safe and quality care.

Percepções dos profissionais de linha de frente da saúde sobre HIV e juventudes / Frontline health professionals' perceptions about HIV and youth

RESUMO A temática do HIV ainda é permeada de estigmas e culpabilização de indivíduos por seus comportamentos. Políticas públicas, incluindo a de HIV/Aids, são baseadas em categorias políticas que geram efeitos simbólicos, reproduzindo ou enfrentando estigmas. A literatura afirma que Trabalhadores da Linha de Frente (TLF) mobilizam valores pessoais e profissionais nas interações com os usuários, que podem incluir categorias sociais ou políticas. Este artigo objetivou compreender como TLF operam tais categorias em contextos institucionais de ambiguidade, bem como analisar se suas percepções com relação às categorias de comportamento de risco e juventude estão em consonância com as políticas públicas. Foram analisadas 8 normativas e entrevistados 42 trabalhadores de 6 serviços de saúde. Os materiais foram codificados, as categorias oficiais foram comparadas, e as práticas, identificadas. As conclusões sugerem que as categorias sociais e políticas têm influência mútua. As categorias políticas ainda são legitimadas por meio de percepções sociais de normalidade e risco, especialmente ao lidar com populações prioritárias. As categorias sociais, operadas na implementação reforçam estigmas e julgamentos morais sobre alguns jovens, como os negros e pobres, as mães solteiras e a comunidade LGBTQIA+. Os serviços especializados utilizam mais as categorias políticas do que os serviços de atenção primária.

ABSTRACT Discussions about HIV are still permeated with stigmas and placing blame on individuals for their behavior. Public policies, including those related to HIV/AIDS, are based on political categories that can generate symbolic effects, either by reproducing or confronting stigmas. The literature points out that frontline health workers (TLF) apply personal and professional values in their interactions with service users, and that these values may be influenced by social or political categories. This article aims to understand how TLF operate such categories in institutional contexts that might be ambiguous, as well to analyze whether TLF's perceptions of categories related to risk behavior and youth are in line with public policies. We analyzed 8 policy documents and interviewed 42 workers from 6 health services. The materials were coded, the official categories were compared and the practices were identified. The findings suggest that social and political categories have mutual influences. Political categories are still legitimized through social perceptions of normalcy and risk, especially as it relates to priority populations. Social categories, which operate in policy implementation, reinforce stigmas and moral judgments about certain young people, such as blacks and the poor, single mothers and those who belong to the LGBTQIA+ community. Specialized services utilize political categories more than primary care services.

Nursing protocol for children with sickle cell disease in emergency room: a convergent-care approach / Protocolo de enfermería del niño con enfermedad falciforme en la emergencia: un enfoque convergente-asistencial / Protocolo de enfermagem à criança com doença falciforme na emergência: uma abordagem convergente-assistencial

ABSTRACT Objective: to describe the methodological process of developing a nursing care protocol for children with sickle cell disease in the emergency room. Method: convergent care research, carried out in a public pediatric hospital in the state of Bahia, with 12 emergency nurses specialist. Data production took place between July 2020 and April 2021, with semi-structured interviews, observation in a field diary and convergence groups, according to the research phases: conception, instrumentation, scrutiny and analysis. Results: The final result was the construction of a nursing care protocol for children with sickle cell disease in the emergency room for use in the study field. Final considerations: the Convergent Care Research proved to be an excellent methodological procedure for intervention in the health service, whose nursing care protocol was based on the reflections of professionals on evidence-based practices, whose consensus can enable safe and quality care.

RESUMEN Objetivo: describir el proceso metodológico de elaboración de un protocolo asistencial de enfermería para niños con enfermedad falciforme en la emergencia. Método: se trata de una investigación convergente y asistencial, realizada en un hospital público pediátrico del estado de Bahía, entre 12 enfermeras de urgencias. La producción de datos se realizó entre julio de 2020 y abril de 2021, mediante entrevistas semiestructuradas, observación en diario de campo y grupos de convergencia, según las fases de la investigación: concepción, instrumentación, escrutinio y análisis. Resultados: El resultado final fue la construcción de un protocolo de cuidados de enfermería para niños con anemia falciforme en el servicio de urgencias, para su uso en el campo de estudio. Consideraciones finales: la Investigación Convergente Asistencial demostró ser un excelente procedimiento metodológico de intervención en el servicio de salud, cuyo protocolo de cuidados de enfermería surgió de las reflexiones de los profesionales sobre las prácticas basadas en evidencias, en las que el consenso puede permitir una atención segura y de calidad.

RESUMO Objetivo: descrever o processo metodológico de elaboração de um protocolo assistencial de enfermagem para crianças com doença falciforme na emergência. Método: pesquisa convergente assistencial, realizada em um hospital público pediátrico do estado da Bahia, com 12 enfermeiras da emergência. A produção dos dados ocorreu entre julho de 2020 e abril de 2021, com entrevista semiestruturada, observação em diário de campo e grupos de convergência, conforme fases da pesquisa: concepção, instrumentalização, perscrutação e análise. Resultados: O resultado final foi a construção do protocolo assistencial de enfermagem para criança com doença falciforme na emergência, para uso no campo de estudo. Considerações finais: a Pesquisa Convergente Assistencial mostrou-se como excelente procedimento metodológico para intervenção no serviço de saúde, cujo protocolo assistencial de enfermagem partiu das reflexões dos profissionais sobre as práticas baseadas em evidências, em que consensos podem possibilitar uma assistência segura e de qualidade.

Future Perspectives in Detecting EGFR and ALK Gene Alterations in Liquid Biopsies of Patients with NSCLC.

Non-small-cell lung cancer (NSCLC) is a major cause of death worldwide. Alterations in such genes as EGFR and ALK are considered important biomarkers in NSCLC due to the existence of targeted therapies with specific tyrosine kinase inhibitors (TKIs). However, specific resistance-related mutations can occur during TKI treatment, which often result in therapy inefficacy. Liquid biopsies arise as a reliable tool for the early detection of these types of alterations, allowing a non-invasive follow-up of the patients. Furthermore, they can be essential for cancer screening, initial diagnosis and to check surgery success. Despite the great advantages of liquid biopsies in NSCLC and the high input that next-generation sequencing (NGS) approaches can provide in this field, its use in oncology is still limited. With improvement of assay sensitivity and the establishment of clinical guidelines for liquid biopsy analysis, it is expected that they will be used in routine procedures. This review focuses on the usefulness of liquid biopsies of NSCLC patients as a means to detect alterations in EGFR and ALK genes and in disease management, highlighting the impact of NGS methods.

Hyperbaric oxygen therapy decreases mortality due to Fournier's gangrene: a retrospective comparative study.

There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier's gangrene. The aim of this study was to compare the evolution of patients with Fournier's gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier's gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier's gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.

Compensated hypogonadism in men with sickle cell disease.

OBJECTIVE: To evaluate the prevalence of hypogonadism in a population of men with SCD and characterize its aetiology. Sickle cell disease (SCD) is associated with the development of hypogonadism, but there is still controversy regarding its aetiology and clinical implications. METHODS: We performed a cross-sectional study of 34 men with SCD aged > 18 years. Sociodemographic and clinical data, including anthropometric measurements (weight, height and BMI), were obtained. Early morning, blood samples were collected and total testosterone (TT), free testosterone (FT), luteinizing hormone (LH), follicle stimulating hormone (FSH), a complete blood count and haemoglobin electrophoresis were measured. Eugonadism was defined as T ≥300 ng/dL and LH ≤9.4 mUI/mL; primary hypogonadism as T < 300 ng/dL and LH > 9.4 mUI/mL; secondary hypogonadism as T < 300 ng/dL and LH ≤ 9.4 mUI/mL; and compensated hypogonadism as T ≥ 300 ng/dL and LH > 9.4 mUI/mL. RESULTS: Median age was 33 (26-41) years, and SS genotype was the most frequent (73.5%). The prevalence of eugonadism, compensated hypogonadism and secondary hypogonadism was 67.5%, 26.4% and 5.88%, respectively. No men with primary hypogonadism were identified in our sample. Those with compensated hypogonadism had also higher FSH levels (>7.8 mUI/mL, P < .0001). CONCLUSION: In our study population of men with SCD, a high prevalence of compensated hypogonadism was identified, which is a controversial and distinct clinical entity that warrants monitoring and further research.

Trypanin Disruption Affects the Motility and Infectivity of the Protozoan Trypanosoma cruzi.

The flagellum of Trypanosomatids is an organelle that contributes to multiple functions, including motility, cell division, and host-pathogen interaction. Trypanin was first described in Trypanosoma brucei and is part of the dynein regulatory complex. TbTrypanin knockdown parasites showed motility defects in procyclic forms; however, silencing in bloodstream forms was lethal. Since TbTrypanin mutants show drastic phenotypic changes in mammalian stages, we decided to evaluate if the Trypanosoma cruzi ortholog plays a similar role by using the CRISPR-Cas9 system to generate null mutants. A ribonucleoprotein complex of SaCas9 and sgRNA plus donor oligonucleotide were used to edit both alleles of TcTrypanin without any selectable marker. TcTrypanin -/- epimastigotes showed a lower growth rate, partially detached flagella, normal numbers of nuclei and kinetoplasts, and motility defects such as reduced displacement and speed and increased tumbling propensity. The epimastigote mutant also showed decreased efficiency of in-vitro metacyclogenesis. Mutant parasites were able to complete the entire life cycle in vitro; however, they showed a reduction in their infection capacity compared with WT and addback cultures. Our data show that T. cruzi life cycle stages have differing sensitivities to TcTrypanin deletion. In conclusion, additional work is needed to dissect the motility components of T. cruzi and to identify essential molecules for mammalian stages.

Factors associated with the clinical deterioration recognized by an early warning pediatric score / Factores asociados al deterioro clínico reconocido por una puntuación pediátrica de alerta temprana / Fatores associados à deterioração clínica reconhecida por um escore pediátrico de alerta precoce

ABSTRACT Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.

RESUMEN Objetivo: identificar los factores asociados al deterioro clínico reconocido por una Puntuación Pediátrica de Alerta Temprana. Método: estudio de corte transversal realizado en un hospital público pediátrico terciario con 271 niños de cero a diez años de edad, hospitalizados entre mayo y octubre de 2015. Para identificar a los niños con y sin signos de deterioro clínico, se aplicó la versión traducida, adaptada y validad del Brighton Pediatric Early Warning Score para el contexto brasileño. Se utilizaron el análisis de regresión logística y la relación de prevalencia (RP) para medir la asociación entre las variables estudiadas. Se adoptaron el Intervalo de Confianza (IC) del 95% y el Valor de p como medida de significancia estadística para identificar los potenciales factores asociados. Resultados: los factores asociados al deterioro clínico de los niños estudiados fueron los siguientes: edad ≤ 2 años (p=0,000), internación en la unidad de emergencia (p=0,000), comorbilidad (p=0,020) y diagnóstico clínico de enfermedad respiratoria (p=0,000). Conclusión: los niños con una edad máxima de 2 años, con alguna comorbidad, con diagnóstico de enfermedad respiratoria e internadas en la unidad de emergencia presentaron una mayor probabilidad de deterioro clínico. Identificar factores asociados al deterioro clínico puede servir como alerta y orientar al equipo de salud hacia los niños más susceptibles a este fenómeno.

RESUMO Objetivo: identificar os fatores associados à deterioração clínica reconhecida por um Escore Pediátrico de Alerta Precoce. Método: estudo de corte transversal, realizado num hospital público pediátrico terciário, com 271 crianças de zero a dez anos, hospitalizadas entre maio e outubro de 2015. Para a identificação das crianças com e sem sinais de deterioração clínica, foi aplicada a versão traduzida, adaptada e validada do Brighton Pediatric Early Warning Score para o contexto brasileiro. Foram utilizadas a análise de regressão logística e a razão de prevalência (RP) para medir a associação entre as variáveis estudadas. O Intervalo de Confiança (IC) de 95% e Valor de p foram adotados como medida de significância estatística para a identificação dos potenciais fatores associados. Resultados: os fatores associados à deterioração clínica das crianças estudadas foram idade ≤ 2 anos (p=0,000), internamento na unidade de emergência (p=0,000), comorbidade (p=0,020) e diagnóstico clínico de doença respiratória (p=0,000). Conclusão: crianças ≤ 2 anos, portadoras de comorbidade, com diagnóstico de doença respiratória e internadas na unidade de emergência apresentaram aumento da probabilidade de deterioração clínica. A identificação de fatores associados à deterioração clínica pode alertar e direcionar a equipe de saúde para crianças mais suscetíveis a esse fenômeno.

Detection of anti-Leptospira spp. agglutinins in captive South American river turtles, Podocnemis expansa

Leptospirosis is a zoonosis transmitted by contact with infected urine or water contaminated with the agent. Searches for Leptospira spp. in reptiles are scarce although most species have contact with aquatic environments. We evaluated the presence of anti-Leptospira spp. antibodies in Podocnemis expansa housed at the Amazonian Zoobotanical Garden, in Belém, Pará state, Brazil. We analyzed 74 serum samples through the microscopic agglutination test using 31 live antigens from different Leptospira spp. serogroups. Thirty samples (40.5%) were positive against Leptospira spp., with titrations between 100 and 3,200 for one or more serogroups. The Hebdomadis serogroup was the most prevalent, with 26 (87%) out of the 30 positive samples, followed by Djasiman, with two (7%) and Celledoni and Bataviae with one (3%) sample each. The detection of anti-Leptospira spp. agglutinins in P. expansa suggests that the aquatic environment is a transmission route for this pathogen among chelonians. (AU)

Conhecer para prevenir: complementação do conhecimento dos alunos do ensino fundamental sobre microbiologia e parasitologia em três escolas de Uberlândia-MG / Know to prevent: complementation of the knowledge of the students of fundamental education on microbiology and parasitology in three schools of Uberlândia-MG

O conhecimento sobre microbiologia e parasitologia é considerado abstrato, pois muitos agentes causadores de doenças não são vistos a olho nu, o que distancia os alunos da realidade. Assim, nossos objetivos foram promover ações educativas por meio de ferramentas didáticas lúdicas que possibilitassem a complementação do aprendizado dos alunos frente aos diferentes grupos de microorganismos e parasitos e das ações de profilaxia relacionadas aos mesmos, e avaliar se ao final eles tinham condições de discriminar os grupos e relacionar com as doenças e as formas de profilaxia. Para tanto, foram feitas entrevistas junto aos professores para levantamento das possíveis atividades a serem desenvolvidas. A ação foi definida e então dividida em três momentos (aula expositiva, jogo didático e mostra científica) realizados entre agosto e novembro de 2018, atingindo aproximadamente 350 alunos, de oitavos e nonos anos, de três escolas públicas da zona urbana e rural da cidade de Uberlândia-MG. Para avaliar o impacto da ação foi feita uma análise comparativa de questionários aplicados antes (pré-intervenção) e após a ação (pós-intervenção). O percentual das respostas corretas nos questionários pós-intervenção aumentou em duas escolas (p>0,005). Quanto à análise por questões, as menores porcentagens de acertos foram observadas em perguntas relacionadas à distinção entre doenças bacterianas e virais, o reconhecimento dos sintomas e a associação das formas de transmissão com a profilaxia. Assim, este estudo reforça a importância da educação em saúde para que os alunos se mobilizem frente ao combate das doenças.(AU)

The knowledge about microbiology and parasitology is considered abstract since causative agents of diseases cannot be seen with the naked eye, leading to students' detachment from reality. Therefore, this work aimed to promote educational actions through playful tools that could complement students' learning regarding the different groups of microorganisms and parasites and the prophylactic measures related to them. Furthermore, at the end of the actions it was evaluated if the students were able to discriminate the groups of microorganisms and relate them to the diseases they cause and the different forms of prophylaxis. To this end, interviews were conducted with teachers to survey the possible activities that could be used. The action was defined and then divided into three moments (expository class, didactic game and scientific show) held between August and November 2018, reaching approximately 350 students, from the eighth and ninth years, from three public schools in the urban and rural area of the city oftUberlândia-MG. To assess the impact of the action, a comparative analysis of questionnaires was applied before (pre-intervention) and after the action (post-intervention). The percentage of correct answers in the questionnaires post-intervention increased in two schools (p>0,005). Regarding the analysis by questions, the lowest percentages of correct answers were observed in questions related to the distinction between bacterial and viral diseases, the recognition of the symptoms and the association of transmission ways with prophylaxis. Thus, this study reinforces the importance of health education for students to mobilize in the fight against diseases.(AU)

Targeting epimastigotes of Trypanosoma cruzi with a peptide isolated from a phage display random library.

Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi, which is transmitted by insects of the family Reduviidae. Since conventional treatments with nitroheterocyclic drugs show serious adverse reactions and have questionable efficiency, different research groups have investigated polypeptide-based approaches to interfere with the parasite cell cycle in other Trypanosomatids. These strategies are supported by the fact that surface players are candidates to develop surface ligands that impair function since they may act as virulence factors. In this study, we used a phage display approach to identify peptides from one library-LX8CX8 (17 aa) (where X corresponds to any amino acid). After testing different biopanning conditions using live or fixed epimastigotes, 10 clones were sequenced that encoded the same peptide, named here as EPI18. The bacteriophage expressing EPI18 binds to epimastigotes from distinct strains of T. cruzi. To confirm these results, this peptide was synthetized, biotinylated, and assayed using flow cytometry and confocal microscopy analyses. These assays confirmed the specificity of the binding capacity of EPI18 toward epimastigote surfaces. Our findings suggest that EPI18 may have potential biotechnological applications that include peptide-based strategies to control parasite transmission.

The modulatory effect of triclosan on the reversion of the activated phenotype of LX-2 hepatic stellate cells.

Hepatic diseases leading to fibrosis affect millions of individuals worldwide and are a major public health challenge. Although, there have been many advances in understanding hepatic fibrogenesis, an effective therapy remains elusive. Studies focus primarily on activation of the hepatic stellate cells (HSCs), the principal fibrogenic cells in the liver; however, fewer numbers of studies have examined molecular mechanisms that deactivate HSC, controlling the profibrogenic phenotype. In the present study, we evaluated cellular and molecular actions of the chemical triclosan (TCS) in reverting activated HSCs to a quiesced phenotype. We demonstrated that the inhibition of the enzyme fatty acid synthase by TCS in activated HSCs promotes survival of the cells and triggers cellular and molecular changes that promote cellular phenotypic reversion, offering potentially new therapeutic directions.

Práticas de aleitamento materno em unidade de terapia intensiva neonatal / Prácticas de lactancia materna en la unidad de cuidados intensivos neonatales / Breastfeeding practices in the neonatal intensive care unit

Objetivo analisar as formas de aleitamento materno realizadas na Unidade de Terapia Intensiva Neonatal e identificar suas facilidades e dificuldades. Método estudo qualitativo e descritivo, numa Unidade de Terapia Intensiva Neonatal de maternidade pública. Os dados foram coletados por meio de entrevista semiestruturada e observação direta entre fevereiro e março de 2017. Foram entrevistados cinco profissionais de saúde e sete mães. Resultados emergiram três categorias: Compreensão das mães e profissionais sobre o conceito e a importância do aleitamento materno; Formas de aleitamento materno na voz de mães e profissionais de saúde; e Interferências para a realização do aleitamento materno. Conclusão na prática do aleitamento materno no contexto da Unidade de Terapia Intensiva Neonatal existem algumas dificuldades que são atenuadas pela presença de fonoaudiólogo, parceria do banco de leite e atuação dos profissionais de saúde. As pessoas têm dificuldade em definir o aleitamento materno e o relacionam exclusivamente com a amamentação.

Objetivo analizar las formas de lactancia materna realizadas en la Unidad de Cuidados Intensivos Neonatales e identificar sus facilidades y dificultades. Método estudio cualitativo y descriptivo, en una Unidad de Cuidados Intensivos Neonatales en una maternidad pública. Los datos fueron recopilados mediante entrevistas semiestructuradas y observación directa entre febrero y marzo de 2017. Fueron entrevistados cinco profesionales de la salud y siete madres. Resultados surgieron tres categorías: Comprensión de madres y profesionales sobre el concepto y la importancia de la lactancia materna; Formas de lactancia materna en la voz de madres y profesionales de salud; e Interferencias para la lactancia materna. Conclusión en la práctica de la lactancia materna en el contexto de la Unidad de Cuidados Intensivos Neonatales, existen algunas dificultades mitigadas por la presencia de un logopeda, la asociación con el banco de leche y el desempeño de los profesionales de salud. Las personas tienen dificultad para definir la lactancia materna y la relacionan exclusivamente con amamantamiento.

Objective to analyze the forms of breastfeeding performed in the Neonatal Intensive Care Unit and to identify its facilities and difficulties. Method qualitative and descriptive study, in a Neonatal Intensive Care Unit in a government maternity. Data were collected through semi-structured interviews and direct observation between February and March 2017. Five health professionals and seven mothers were interviewed. Results three categories emerged: Understanding of mothers and professionals about the concept and importance of breastfeeding; Forms of breastfeeding in the voice of mothers and health professionals; and Interferences for breastfeeding. Conclusion in the breastfeeding practice in the context of the Neonatal Intensive Care Unit, there are some difficulties mitigated by the presence of a speech therapist, partnership with the milk bank and the performance of health professionals. People have difficulty to define breastfeeding and relate it to exclusive breastfeeding.

Engineering a single-chain antibody against Trypanosoma cruzi metacyclic trypomastigotes to block cell invasion.

Trypanosoma cruzi is a flagellate protozoan pathogen that causes Chagas disease. Currently there is no preventive treatment and the efficiency of the two drugs available is limited to the acute phase. Therefore, there is an unmet need for innovative tools to block transmission in endemic areas. In this study, we engineered a novel recombinant molecule able to adhere to the T. cruzi surface, termed scFv-10D8, that consists of a single-chain variable fragment (scFv) derived from mAb-10D8 that targets gp35/50. The synthetic gene encoding scFv-10D8 was cloned and fused to a 6×His tag and expressed in a prokaryotic expression system. Total periplasmic or 6xHis tag affinity-purified fractions of scFv-10D8 retained the capacity to bind to gp35/50, as shown by Western blot analyses. Pre-incubation of metacyclic trypomastigotes with scFv-10D8 showed a remarkable reduction in cell invasion capacity. Our results suggest that scFv-10D8 can be used in a paratransgenic approach to target parasites in insect vectors, avoiding dissemination of infective forms. Such advances in the development of this functional molecule will surely prompt the improvement of alternative strategies to control Chagas disease by targeting mammalian host stages.