The expression of VDACs and Bcl2 family genes in pituitary adenomas: clinical correlations and postsurgical outcomes.

Introduction: Pituitary adenomas (PAs) are benign tumors with high prevalence and, occasionally, aggressive course. The tumorigenesis of these lesions is not completely understood at the molecular level. BAK1 and BAX proteins play fundamental roles in apoptosis and seem to interact with VDAC proteins, whose expressions have been markedly altered in cancer, impacting their prognosis. Objective: to evaluate the gene expression of VDAC1, VDAC2, BAK1 and BAX and their association with clinical and imaging characteristics in PA. Methods: Clinical-epidemiological data were collected from 117 tumor samples from patients affected by PA. Invasiveness was assessed by the Knosp scale. Gene expression was examined by real-time PCR. Relative expression analysis was performed by 2^(-DDCt) method. Results: The sample was mainly composed of women (69/117 - 57.2%). Tumor subtypes observed were Non-Functioning (NF) (73/117 - 62.4%), Acromegaly (24/117 - 20.5%) and Cushing's Disease (CD) (20/117 - 17.1%). Compared to normal tissue, there was a significant reduction in VDAC1 expression in the Acromegaly (p=0.029) and NF (p=0.002) groups. BAX expression was lower in all groups (p <0.001; p=0.007; P =0.005). No difference was found in VDAC2 and BAK1 expression, compared to normal pituitary. Overexpression of VDAC2 occurred in PAs with post-surgical regrowth (p=0.042). A strongly negative correlation was observed in BAX and BAK1 expression in CD. Conclusion: The results indicated that downregulations of VDAC1 and BAX may be related to resistance to apoptosis. In contrast, overexpression of VDAC2 in regrowing PAs suggests an antiapoptotic role for this gene. In summary, the genes evaluated might be involved in the biopathology of PAs.

Maternal hyperglycemia affects cell proliferation signalling and stromal organization in the prostate of neonatal and juvenile rat offspring.

Gestational diabetes mellitus is a common medical complication during pregnancy. It creates a hyperglycemic environment and impacts offspring development, increasing the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease. The impact of gestational diabetes on the prostates of adult offspring has already been described; however, it is not known whether these effects are due only to the maternal condition or whether the offspring develop them throughout life. This investigation evaluated the prostates of neonatal and juvenile offspring of hyperglycemic rats due to diabetes. Diabetes was induced with streptozotocin (50 mg/kg, ip) in pregnant Wistar rats and the prostates of 7- or 30-day-old pups from healthy (PC7, PC30) or diabetic (PD7, PD30) mothers were evaluated. We found reduced body weight in pups of PD7 and PD30 and prostate weight in PD30. Prostate branching was not affected, but a reduction in apoptotic levels was associated with impaired acinar bud canalization in neonates. Additionally, PD7 presented reduced ERK1/2 phosphorylation, cell proliferation and collagen, but fibroblasts were increased. In PD30, there was a reduction in the area of the secretory epithelium and stroma, but the luminal area was increased. Moreover, fibroblasts, smooth muscle cells, collagen and metalloproteinase 2 were decreased in these juvenile pups. These data indicate that maternal hyperglycemia inactivates an important cell proliferation signaling pathway in the prostate in the first postnatal days (which is restored in the juvenile period), but it was not sufficient to avoid epithelial and stromal atrophy. This effect on postnatal gland development may impact the reproductive capacity of the prostate in adult life.

Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil

INTRODUCTION: This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. METHODS: A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. RESULTS: We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p<0.001), were younger (61.4±13.7 vs. 63.8±13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves. CONCLUSIONS: In the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.

Interaction between poly(A)-binding protein PABPC4 and nuclear receptor corepressor NCoR1 modulates a metabolic stress response.

Mitochondria are organelles known primarily for generating ATP via the oxidative phosphorylation process. Environmental signals are sensed by whole organisms or cells and markedly affect this process, leading to alterations in gene transcription and, consequently, changes in mitochondrial function and biogenesis. The expression of mitochondrial genes is finely regulated by nuclear transcription factors, including nuclear receptors and their coregulators. Among the best-known coregulators is the nuclear receptor corepressor 1 (NCoR1). Muscle-specific knockout of NCoR1 in mice induces an oxidative phenotype, improving glucose and fatty acid metabolism. However, the mechanism by which NCoR1 is regulated remains elusive. In this work, we identified the poly(A)-binding protein 4 (PABPC4) as a new NCoR1 interactor. Unexpectedly, we found that silencing of PABPC4 induced an oxidative phenotype in both C2C12 and MEF cells, as indicated by increased oxygen consumption, mitochondria content, and reduced lactate production. Mechanistically, we demonstrated that PABPC4 silencing increased the ubiquitination and consequent degradation of NCoR1, leading to the derepression of PPAR-regulated genes. As a consequence, cells with PABPC4 silencing had a greater capacity to metabolize lipids, reduced intracellular lipid droplets, and reduced cell death. Interestingly, in conditions known to induce mitochondrial function and biogenesis, both mRNA expression and PABPC4 protein content were markedly reduced. Our study, therefore, suggests that the lowering of PABPC4 expression may represent an adaptive event required to induce mitochondrial activity in response to metabolic stress in skeletal muscle cells. As such, the NCoR1-PABPC4 interface might be a new road to the treatment of metabolic diseases.

Causal validation of the risk for corneal injury in critically ill adults.

BACKGROUND: The validity of a nursing diagnosis depends on a continuous investigation process in different populations to provide clinical evidence. The risk for corneal injury nursing diagnosis was approved in 2013 and only reviewed in 2017, demonstrating the need to perform a clinical validation to improve it. AIM: To perform a causal validation of the risk for corneal injury nursing diagnosis in critically ill adults. STUDY DESIGN: A prospective cohort study was performed in two intensive critical care units in Northern Brazil with adults aged over 18 years without corneal injury at admission. The patients were evaluated for 10 days, using a data collection tool composed of risk factors for the risk for corneal injury nursing diagnosis. The independent variables were described through absolute and relative frequency. The accuracy measures and risk factors were identified through Cox regression, considering a 95% confidence interval. RESULTS: The nurses assessed 209 critically ill adults and identified that 76.0% of them presented the risk for corneal injury nursing diagnosis, with 16.3% developing a corneal injury, all having previously presented the risk for corneal injury nursing diagnosis. The risk factors identified were eyeball exposure (hazard ratio: 1.78; 95% CI: 1.27-2.51), Glasgow score < 6 (hazard ratio: 1.73; 95% CI: 1.15-2.60) and periorbital oedema (hazard ratio: 1.43; 95% CI: 1.03-1.99), with these factors showing high specificity, and the mechanical ventilation variable, showing high sensitivity, with ROC curve of .86. CONCLUSION: Eyeball exposure, Glasgow score < 6 and periorbital oedema are the risk factors of the risk for corneal injury nursing diagnosis, in critically ill adults. These risk factors guide nursing interventions. This causal validation can improve the risk for corneal injury nursing diagnosis levels of evidence in the NANDA International Taxonomy. RELEVANCE TO CLINICAL PRACTICE: It is necessary to guide nursing interventions for critically ill adults with lowered level of consciousness and corneal exposure for the prevention of corneal injury.

Os direitos fundamentais e a convivência familiar e comunitária de adolescentes em cumprimento de medida socioeducativa em meio aberto em teses e dissertações recentes no Brasil / Fundamental rights and the family and community coexistence of adolescents in compliance with socio-educational measure in open environment in recent theses and dissertations in Brazil / Derechos fundamentales y convivencia familiar y comunitaria de adolescentes en cumplimiento de medida socioeducativa en medio abierto en tesis y disertaciones recientes en Brasil

O presente artigo aborda a temática do direito à convivência familiar e comunitária de adolescentes em cumprimento de medida socioeducativa em meio aberto, enquanto um direito fundamental. Possui como objetivo verificar se as produções selecionadas abordam e/ou como abordam os direitos fundamentais e sua relação com o direito à convivência familiar e comunitária para os adolescentes em cumprimento de medidas socioeducativas em meio aberto. Realizou-se uma busca na Biblioteca Digital de Teses e Dissertações (BDTD) com as seguintes palavras-chave: ato infracional e direitos fundamentais. Foram selecionadas cinco dissertações que apresentavam em seu título referência às medidas socioeducativas em meio aberto e/ou aos direitos fundamentais. A coleta de dados pautou-se no corpo dos referidos textos, a partir dos quais se fez um levantamento quantitativo e análise qualitativa. Os resultados apontaram que todas as dissertações fizeram referência aos direitos fundamentais de crianças e adolescentes. Especificamente sobre o direito à convivência familiar e comunitária, apenas um não abordou a temática. Verificou-se nas produções as normas legais para a garantia dos direitos fundamentais e a responsabilidade compartilhada entre Estado, sociedade e família na proteção social desses sujeitos. Confirma-se a premissa que as medidas socioeducativas em meio aberto são mais efetivas ao não privarem o adolescente do seu convívio social e familiar. Além disso, o exercício da cidadania pelos adolescentes só acontece a partir da sua inserção no território e convívio. Portanto, é imprescindível a adoção de políticas públicas condizentes com a realidade social que assegurem condições para o rompimento com a trajetória infracional do adolescente.(AU)

This article addresses the issue of the right to family and community coexistence of adolescents in compliance with socio-educational measures in an open environment, as a fundamental right. Its objective is to verify whether the selected productions address and/or how they address fundamental rights and their relationship with the right to family and community life for adolescents in compliance with socio-educational measures in an open environment. A search was carried out in the Digital Library of Theses and Dissertations (BDTD) with the following keywords: infraction act and fundamental rights. Five dissertations were selected that had in their title reference to socio-educational measures in an open environment and/or to fundamental rights. Data collection was based on the body of these texts, from which a quantitative survey and qualitative analysis were carried out. The results showed that all dissertations made reference to the fundamental rights of children and adolescents. Specifically on the right to family and community life, only one did not address the issue. It was verified in the productions the legal norms for the guarantee of the fundamental rights and the shared responsibility between State, society and family in the social protection of these subjects. It confirms the premise that socio-educational measures in an open environment are more effective when they do not deprive adolescents of their social and family life. In addition, the exercise of citizenship by adolescents only happens from their insertion in the territory and coexistence. Therefore, it is essential to adopt public policies consistent with the social reality that ensure conditions for breaking with the adolescent's infraction trajectory.(AU)

Este artículo aborda el tema del derecho a la vida familiar y comunitaria de los adolescentes que se encuentran cumpliendo una medida socioeducativa en un ambiente abierto, como derecho fundamental. Tiene como objetivo verificar si las producciones seleccionadas abordan y/o cómo abordan los derechos fundamentales y su relación con el derecho a la vida familiar y comunitaria de los adolescentes en cumplimiento de las medidas socioeducativas en un ambiente abierto. Se realizó una búsqueda en la Biblioteca Digital de Tesis y Disertaciones (BDTD) con las siguientes palabras clave: infracción y derechos fundamentales. Se seleccionaron cinco disertaciones que tuvieran en su título referencias a medidas socioeducativas en un ambiente abierto y/oa derechos fundamentales. La recolección de datos se basó en el cuerpo de estos textos, a partir de los cuales se realizó un levantamiento cuantitativo y un análisis cualitativo. Los resultados mostraron que todas las disertaciones hicieron referencia a los derechos fundamentales de los niños y adolescentes. Específicamente sobre el derecho a la vida familiar y comunitaria, solo uno no abordó el tema. Se verificó en las producciones las normas jurídicas para la garantía de los derechos fundamentales y la corresponsabilidad entre Estado, sociedad y familia en la protección social de estos sujetos. Se confirma la premisa de que las medidas socioeducativas en un ambiente abierto son más efectivas en la medida en que no privan a los adolescentes de su vida social y familiar. Además, el ejercicio de la ciudadanía por parte de los adolescentes sólo ocurre a partir de su inserción en el territorio y la convivencia. Por lo tanto, es fundamental adoptar políticas públicas acordes con la realidad social que aseguren condiciones para romper con la trayectoria delictiva del adolescente.(AU)

Distribution and spatial density of viral hepatitis cases in Brazil due to occupational accidents.

Introduction: Viral hepatitis, an infectious disease endemic to Brazil, can be transmitted by occupational accident. Objectives: To analyze the distribution and spatial density of viral hepatitis due to occupational accidents in Brazil from 2007 to 2014. Methods: This ecological study of multiple groups used data from the Brazilian Sistema de Informação de Agravos de Notificação (Disease Information Notification System). Spatial analysis of cluster detection and point density was performed using kernel techniques and estimates. Results: The recorded cases were concentrated in the southeastern (40.6%) and southern regions (28.1%), and a small increase occurred between 2011 and 2014 (53.9%). The etiological classification was predominantly hepatitis C virus (45.3%) and B virus (45.1%). Conclusions: Reports of viral hepatitis due to occupational accidents have increased in Brazil in recent years, with a higher density in the southeastern and southern regions, especially viruses B and C. Thus, occupational health surveillance must be intensified, including vaccination cards for worker admission to the public or private companies.

Vacinação completa autorreferida e fatores associados entre trabalhadores de saúde na Bahia / Self-reported complete vaccination and associated factors among health workers in Bahia / Vacunación completa autorreferida y factores asociados en trabajadores de la salud de Bahía

A vacinação completa é a principal estratégia para o controle de doenças imunopreveníveis e o seu monitoramento é fundamental para vigilância e proteção da saúde dos trabalhadores que atuam nesse setor. Neste trabalho, objetivou-se estimar a prevalência da vacinação completa autorreferida e analisar os fatores associados à vacinação entre trabalhadores da Atenção Primária à Saúde e média complexidade. Trata-se de um estudo transversal, com amostra aleatória de 453 trabalhadores de Santo Antônio de Jesus (BA), no período de junho a dezembro de 2019. Foram coletados dados sociodemográficos, características do trabalho e vacinação. A análise da vacinação completa autorreferida se baseou no calendário vacinal do adulto, preconizado pelo Programa Nacional de Imunizações (PNI). Prevaleceram indivíduos do sexo feminino (82,8%), com 40 anos ou mais (55,2%), com filhos (73,9%) e que se autodeclararam pretos/pardos/indígenas (86,4%). A prevalência de vacinação completa foi estimada em 20,3% (IC 95% 16,8-24,3%). Associaram-se à vacinação completa autorreferida: ser profissional de assistência direta ao usuário e condições de ambiente de trabalho, como oferta de treinamentos e trabalho envolvendo administração de medicamentos. Fazem-se necessárias estratégias que estimulem a ampliação da cobertura vacinal e o fortalecimento da vigilância em saúde dos trabalhadores deste setor. A situação vacinal foi baseada em autorrelato, podendo sofrer influência de vieses de memória e de falsa resposta. Aspectos relacionados à não aceitação da vacinação por trabalhadores da saúde devem ser melhor investigados.

Complete vaccination is the main strategy for the control of vaccine-preventable diseases, and its monitoring is essential for surveillance and health protection of workers from this field. In this work, we aimed to estimate the prevalence of self-reported complete vaccination and to analyze the factors associated with vaccination among healthcare workers in the primary health care, of medium complexity services. This is a cross-sectional study, with a random sample of 453 healthcare workers from the municipality of Santo Antônio de Jesus (BA), from June to December 2019. Sociodemographic data, work conditions and vaccination status were collected. The analysis of self-reported complete vaccination was based on the adult vaccination schedule, recommended by the Brazilian National Immunization Program (PNI). Females (82.8%), aged 40 years or older (55.2%), with children (73.9%), and self-declared black/brown/indigenous (86.4%) prevailed. The prevalence of complete vaccination was estimated at 20.3% (95% CI 16.8-24.3%). The characteristics associated with self-reported complete vaccination were: being a professional of direct assistance to the user, and working environment conditions such as the provision of training and work involving medication administration. Strategies that encourage the expansion of vaccination coverage and the strengthening of health surveillance of workers in this sector are necessary. Vaccination status was self-reported and may be influenced by memory and false response biases. Aspects related to non-acceptance of vaccination by health workers should be further investigated.

La vacunación completa es la principal estrategia para el control de las enfermedades inmunoprevenibles, y su seguimiento es fundamental para la vigilancia y protección de la salud de los trabajadores que laboran en este sector. Este trabajo pretendió estimar la prevalencia de vacunación completa autorreportada y analizar los factores asociados a la vacunación entre trabajadores de atención primaria de salud, de mediana complejidad. Se trata de un estudio transversal, realizado con una muestra aleatoria de 453 trabajadores de Santo Antônio de Jesus, en Bahía (Brasil), en el periodo de junio a diciembre de 2019. Se recogieron datos sociodemográficos, características del trabajo y vacunación. El análisis de vacunación completa autorreportada se basó en el esquema de vacunación de adultos recomendado por el Programa Nacional de Inmunizaciones (PNI). Predominó el sexo femenino (82,8%), con 40 años o más (55,2%), con hijos (73,9%) y autodeclarado negro/pardo/indígena (86,4%). La prevalencia de vacunación completa se estimó en un 20,3% (IC 95% 16,8-24,3%). Ser un profesional de asistencia directa al usuario y las condiciones del ambiente de trabajo, como la provisión de capacitación y el trabajo que involucra la administración de medicamentos, se asociaron con la vacunación completa autorreportada. Son necesarias estrategias que incentiven la ampliación de las coberturas de vacunación y el fortalecimiento de la vigilancia de la salud de los trabajadores de este sector. El estado de vacunación fue autoinformado y puede estar influenciado por sesgos de memoria y de respuesta falsa. Los aspectos relacionados con la no aceptación de la vacunación por parte de los trabajadores de la salud deben investigarse más a fondo.

Macroscopic, morphometric, and tomographic features of the mandible of the collared peccary (Pecari tajacu) applied to clinical morpho-physiology and imaging.

Veterinary dentistry is one of the specialties with the greatest potential to contribute to animal welfare; however, it requires a deep anatomical knowledge of the region to be treated. Therefore, the aim was to describe the macroscopic, morphometric, and tomographic anatomy of the mandible of the collared peccary in order to provide support for a better understanding of local morpho-physiology and to improve clinical procedures and interpretation of imaging exams in live adult specimens. Four mandibles from wild adult Pecari tajacu were used. The mandibles were submitted to CT scanning, and comparative analyses were performed using multiplanar views. Afterward, mandibular morphometry was conducted following the literature. Each hemimandible is composed of body, angle, and ramus. The main bony landmarks are the mandibular foramen, three main lateral mental foramina, two medial mental foramina, condylar and coronoid processes, and mandibular and angular notches. The teeth are bunodont, and the dental formula is I3/C1/PM3/M3. All bony structures were observed both in the prepared mandible and in the tomographic images and their 3D reconstruction. No obvious differences were observed in the morphometric data between males and females, or between right and left hemimandibles. It can be concluded that the mandible of the collared peccary may be anatomically structured to favor its omnivorous feeding habit. CT scan proved to be an excellent tool for evaluating the teeth and mandible, and it also provides reliable 3D bone reconstructions that can be helpful in the structural identification and the planning of oral care in live adult animals.

Viral hepatitis caused by occupational accidents: distribution of cases in Brazil, 2007-2014 / Hepatites virais por acidentes de trabalho: distribuição dos casos no Brasil, 2007-2014 / Hepatitis viral por accidentes de trabajo: distribución de casos en Brasil, 2007-2014

Background and Objectives: to analyze the distribution of cases of viral hepatitis due to occupational accidents in Brazil from 2007 to 2014. Methods: this is an ecological study of a descriptive nature of notifications of viral hepatitis registered in the Information System for Notifiable Diseases. Results: they point out that the mean incidence of viral hepatitis due to occupational accidents in Brazil was 2 cases/1,000,000 of the economically active and employed population. There was an increasing trend in the Midwest region (p=0.02), among women (p=0.01) and those aged 38 to 49 years and 50 and older (p=0.01). The decreasing time trend was observed among those up to 37 years old and for non-black race/skin color (p=0.04). Conclusion: the temporal distribution was stationary in most regions and states in Brazil, increasing among female workers over 38 years old and decreasing among non-black women and under 37 years old.(AU)

Justificativa e Objetivos: analisar a distribuição dos casos de hepatites virais por acidentes de trabalho no Brasil de 2007 a 2014. Métodos: trata-se de um estudo ecológico de natureza descritiva das notificações de hepatites virais registradas no Sistema de Informação de Agravos de Notificação. Resultados: apontam que a incidência média de hepatites virais por acidentes de trabalho no Brasil foi de 2 casos/1.000.000 da população economicamente ativa e ocupada. Houve tendência de aumento na região Centro-Oeste (p=0,02), entre as mulheres (p=0,01) e entre 38 a 49 anos e 50 anos ou mais (p=0,01). A tendência temporal decrescente foi observada entre aqueles com até 37 anos e para raça/cor da pele não preta (p=0,04). Conclusão: a distribuição temporal foi estacionária na maioria das regiões e estados do Brasil, aumentando entre as trabalhadoras acima de 38 anos e diminuindo entre as mulheres não negras e com menos de 37 anos.(AU)

Justificación y Objetivos: analizar la distribución de los casos de hepatitis viral por accidentes de trabajo en Brasil de 2007 a 2014. Métodos: se trata de un estudio ecológico de carácter descriptivo de las notificaciones de hepatitis viral registradas en el Sistema de Información de Enfermedades de Declaración Obligatoria. Resultados: señalan que la incidencia media de hepatitis viral por accidente de trabajo en Brasil fue de 2 casos/1.000.000 de población económicamente activa y ocupada. Hubo una tendencia creciente en la región del Medio Oeste (p=0,02), entre las mujeres (p=0,01) y las de 38 a 49 años y 50 y más (p=0,01). La tendencia temporal decreciente se observó entre los de hasta 37 años y para raza/color de piel no negra (p=0,04). Conclusión: la distribución temporal fue estacionaria en la mayoría de las regiones y estados de Brasil, aumentando entre las trabajadoras mayores de 38 años y disminuyendo entre las mujeres no negras y menores de 37 años.(AU)

Comparative study of the digastric and the stylohyoid muscles between wild boars (Sus scrofa scrofa) and domestic swine (Sus scrofa domesticus): revisiting the gross anatomy.

Considering Suidae Familie as a perfect and viable experimental biomedical model for research applied to human medicine, it has been sought to describe the comparative anatomy of the digastric and the stylohyoid muscles between boars and domestic swine. Heads of Sus scrofa scrofa and Sus scrofa domesticus were dissected. The digastric muscle presented only one muscle belly as anatomical component of a tendinous origin in the jugular process of the occipital bone, and muscle insertion in the midventral edge of the caudal two thirds of the body of the mandible. Thus, its function is fundamentally associated with the lowering and the retracting of the mandible which, by the way, can deliver greater muscle power at lesser energy expense. For the stylohyoid muscle, the tendinous origin was in the laterocaudal edge of the dorsal third of the stylohyoid bone. The muscle insertion - primarily, was in the lateral and caudal edges from the mid third portion up to the ventral extremity of the thyrohyoid bone, and secondarily as a laterolateral aponeurotic blade which would unite, in a bilateral manner, an insertion that was common to the sternohyoid, the geniohyoid, and the mylohyoid muscles in a median ventral region. This morphology were similar to the two specimens studied expanding the information available, which were completely unknown for the suidae until the moment.

A atuação do assistente social na alta hospitalar do Hospital Universitário Regional dos Campos Gerais no contexto da humanização e integralidade em saúde / The role of the social worker at the discharge of the Hospital Universitário Regional dos Campos Gerais in the context of humanization and integrality in health / La actuación del asistente social en el alta hospitalaria del Hospital Universitario Regional dos Campos Gerais en el contexto de la humanización e integralidad en salud

O objetivo da pesquisa é compreender a atuação do Assistente Social na alta hospitalar do Hospital Universitário Regional dos Campos Gerais (HURCG). O estudo é exploratório e de natureza qualitativa, sendo utilizados o formulário de dados e o grupo focal como procedimentos metodológicos de coleta de dados e, para interpretar os dados adquiridos no grupo focal, a análise de conteúdo temática. Constatou-se que a atuação do Assistente Social no HURCG perpassa os casos emergenciais e os complexos, sendo o vínculo de confiança e a resolutividade dos problemas os fatores determinantes na relação dos Assistentes Sociais com outros profissionais e com os pacientes na alta hospitalar no HURCG. O Assistente Social é considerado um dos profissionais essenciais no planejamento da alta hospitalar. Além disso, a articulação com a rede de atendimento e os princípios de humanização e integralidade no atendimento mostraram-se imprescindíveis nesse processo.

The research aims to understand the role of the Social Worker at the hospital discharge of the Hospital Universitário Regional dos Campos Gerais (HURCG). The study has an exploratory and qualitative nature. The data form and the focus group were used as methodological procedures for data collection. To interpret the data acquired in the focus group, thematic content analysis was used. It was verified that the role of the Social Worker in the HURCG pervades the emergency and complex cases and problem solving are the determining factors in the relationship between Social Workers and other professionals and patients on discharge from HURCG. It was noted that the Social Worker is considered as one of the essential professionals in planning hospital discharge. In addition, the articulation with the service network and the principles of humanization and integrality in care were essential in this process.

La investigación tiene como objetivo comprender la actuación del Asistente Social en el alta hospitalaria del Hospital Universitario Regional dos Campos Gerais (HURCG). El estudio posee un marco exploratorio y una naturaleza cualitativa. Como procedimientos metodológicos de recolección de datos se utilizaron el formulario de datos y el grupo focal. Para interpretar los datos adquiridos en el grupo focal se utilizó el análisis de contenido temático. Se constató que la actuación del Asistente Social en el HURCG atravesaba los casos de emergencia y los complejos, siendo el vínculo de confianza y la resolución de los problemas los factores determinantes en la relación de los asistentes sociales con otros profesionales y con los pacientes en el alta hospitalaria en el HURCG. Se notó que el Asistente Social es considerado como uno de los profesionales esenciales en la planificación del alta hospitalaria. Además, la articulación con la red de atención y los principios de humanización e integralidad en la atención se mostraron imprescindibles en ese proceso.

Risk for corneal injury in intensive care unit patients: A cohort study.

AIM: To identify the incidence and risk factors for corneal injury amongst critically ill patients. METHOD: A prospective cohort study with adult patients from one intensive care unit in Northern Brazil. Logistic regression was performed to predict the risk factors associated with corneal injury. RESULTS: Data from 149 patients revealed 18.8% (28/149) corneal injuries. Factors independently associated with corneal injury were patients with eyeball exposure (OR: 27.31; 95% CI: 3.50-212.78); lagophthalmos (OR: 17.15; 95% CI: 5.78-50.85); chemosis (OR: 7.39; 95% CI: 2.28-23.97), periorbital oedema (OR: 7.99; 95% CI: 2.19-29.13) and hospitalisation >7-days (OR: 11.96; 95% CI: 3.27-43.66) had a significantly higher risk of developing corneal injury in this ICU. CONCLUSION: Corneal injury was a common complication amongst critically ill patients and was associated with altered physiological function of the eyes such as exposure, lagophthalmos, chemosis and periorbital oedema. This study suggests introduction of a corneal injury prevention protocol for nursing and adding lagophthalmos and chemosis to the NANDA-I Taxonomy, thus contributing to the assessment and monitoring for the risk for corneal injury in critically ill patients.

A laboratory study of the accuracy of three electronic apex locators: influence of embedding media and radiographic assessment of the electronic apical limit.

AIM: To evaluate several factors that might interfere with the use of electronic root canal length measurement devices (ERCLMDs) in a laboratory setting, including two different embedding media (alginate and electroconductive gel), three different types of devices and the radiographic view on the assessment of the electronic readings. METHODOLOGY: Thirty single-rooted extracted human mandibular premolars were selected. After access and canal pre-flaring, a size 10 K-file was inserted in the canal up to the major apical foramen under magnification (×10), and this length was recorded as the actual length (AL) of the canal. Teeth were mounted on a specific endodontic training kit platform (ProTrain). Two different embedding media (electroconductive gel and alginate) and three different ERCLMDs: Apex ID (SybronEndo, Glendora, CA, USA), CanalPro Apex Locator (Coltene-Endo, Cuyahoga Falls, OH, USA) and the Root ZX II (J. Morita, Tokyo, Japan), were tested. Following the measurement at the 0.5 mark of each ERCLMD using alginate, two periapical radiographs (bucco-lingual and proximal views) were taken. The difference between the electronic readings and the AL, as well as the distance from the file tip to the apex of the roots on the radiographs, was calculated. Data were analysed statistically (two-way anova, Tukey's and chi-squared tests) at 5% significance level. RESULTS: The incidence of over-extended readings was significantly greater (P < 0.05) when using the ProTrain electroconductive gel, except for Root ZX II at the 0.5 mark. Root ZX, CanalPro and Apex ID had similar accuracy when the 0.0/APEX mark was used to locate the foramen. For the radiographic method, no difference was found between the devices or radiographic views. CONCLUSION: Compared with alginate, the conductive gel of the ProTrain kit negatively affected most of the electronic readings. The three evaluated ERCLMDs had similar accuracy in locating the apical foramen when using the mark 0.0/APEX and alginate as the embedding media. Although the ProTrain platform allows radiographs to be exposed in both bucco-lingual and proximal views, no difference was found between the views when evaluating the apical limit provided by the 0.5 mark in mandibular premolars embedded in alginate.

Association of ionophores, yeast, and bacterial probiotics alters the abundance of ruminal microbial species of pasture intensively finished beef cattle.

The effect of the association of non-protein nitrogen, yeast, and bacterial probiotics on the ruminal microbiome of beef cattle intensively finished on pasture was evaluated. The experiment was carried out in a completely randomized design with five treatments and four replications. The treatments consisted of a group of animals kept on pasture that received low consumption supplementation (LS) and four groups that received for 98 days, 17.5 g concentrate kg-1 body weight. The supplements were composed of the association of additives: urea (U), slow-release non-protein nitrogen (U+SRN), yeast (Saccharomyces cerevisiae; U+SRN+Y), and bacterial probiotics (live strains of bacteria; U+SRN+Y+BP). All supplements also contained salinomycin and virginiamycin. After slaughtering the animals, samples of ruminal content were collected to quantify groups of fibrolytic bacteria (Ruminococcus albus and Fibrobacter succinogenes), non-fibrolytic (Prevotella ruminicola, Selenomonas ruminantium, and Streptococcus bovis), Archaea, and ciliate protozoa, using the qPCR technique. The abundance of F. succinogenes was the same for the LS animals and those that received the supplement U+SRN+Y (1.42×108 copies mL-1) but higher than the other treatments. Supplementation reduced by 90% the abundance of S. bovis compared to the LS. The inclusion of yeast increased the abundance of fibrolytic bacteria by 2.2-fold. For animals that received the supplement U+SRN+Y+BP and the LS, there was no difference for non-fibrolytic bacteria (3.07×109 copies mL-1). The use of yeasts and sources of non-protein nitrogen in high-concentrate diets for beef cattle stimulates the growth of fibrolytic bacteria, which can contribute to the reduction of digestive disorders and metabolic diseases in animals that receive diets with high concentrate in pasture intensive termination systems.

MRI findings of the cervical spine in patients with mucopolysaccharidosis type VI: relationship with neurological physical examination.

AIM: To describe the magnetic resonance imaging (MRI) findings of the cervical spine of patients with mucopolysaccharidosis type VI (MPS VI) and correlate them with clinical manifestations. MATERIALS AND METHODS: This is a cross-sectional study involving 12 patients with MPS VI. A limited neurological examination was undertaken in each patient including Tinel's test, assessment of muscle tone, and the evaluation of deep tendon reflexes. Additionally, each patient underwent cervical spine MRI to evaluate platybasia, odontoid dysplasia, periodontoid soft-tissue thickening, spinal canal stenosis, myelopathy, basilar invagination, platyspondyly, and reduction of nasopharyngeal airway. RESULTS: Nine patients were male (75%). The average age was 12.5 (±3.5 years). Tinel's test was negative in all patients. No muscle tone abnormalities were observed. Approximately 48% of the tested reflexes were considered abnormal, 10 of which (8.3%) were pathological occurring in five different patients (41.6%). At MRI, all patients showed periodontoid soft-tissue thickening and cervical spinal stenosis; six showed spinal cord compression and two showed myelopathy. Odontoid hypoplasia and basilar invagination were observed in nine patients. All patients with cervical stenosis on MRI had abnormal reflexes; however, only two of the six patients with evidence of cord compression on MRI had abnormal reflexes on clinical examination. CONCLUSIONS: The present study of 12 patients with MPS VI demonstrated that a normal neurological examination cannot confidently exclude potential cord compression in patients with this condition. MRI may aid in the timely identification of cervical spine abnormalities, and potentially play a role in lessening morbidity and mortality in patients with MPS.

Evaluation of fluoride and sodium hypochlorite solutions during the electrochemical dissolution of conventional NiTi instruments and Gold thermomechanically treated NiTi instruments.

AIM: To compare the dissolution time of two solutions, a fluoride solution and a sodium hypochlorite solution, both saturated with sodium chloride, during the electrochemical dissolution of instruments consisting of conventional nickel-titanium alloy and Gold thermomechanically treated nickel-titanium alloy. METHODOLOGY: Two solutions, an NaF solution consisting of 12 g L-1 NaF with 180 g L-1 NaCl and an NaOCl solution consisting of 2.5% NaOCl with 180 g L-1 NaCl, were evaluated in a polarization test of a sample of 48 ProTaper Universal F1 (PTU F1) and WaveOne Gold Small (WOGS) instruments. The electric potentials were 0.5 V and 5 V for the NaF and NaOCl solutions, respectively. The electrochemical cell consisted of three electrodes for the polarization test of the PTU F1 and WOGS instruments, which had 6 mm of the tip immersed in the test solutions. The electric current was recorded for 540 s. If complete dissolution of the immersed tip occurred in less than the expected time, the experiment was considered complete. The time variations (in seconds) of the instruments in the solutions were measured. Data were subjected to statistical analysis using the Mann-Whitney, Kruskal-Wallis and Dunn tests. The corrosion patterns of the instruments were evaluated by scanning electron microscopy (SEM). RESULTS: The NaF and NaOCl solutions were associated with significantly different (P = 0.000) dissolution times of the instrument, with mean values of 12.96 s and 83.63 s, respectively. There was no significant difference (P = 0.649) in dissolution time between the PTU F1 and WOGS instruments. CONCLUSIONS: NaF and NaOCl solutions were able to electrochemically dissolve PTU F1 and WOGS instruments. However, the NaF solution achieved dissolution in significantly less time.

Morphometry of the mandibular foramen applied to the local anesthetic block to inferior alveolar nerve in boars (Sus scrofa scrofa Linnaeus, 1758) / Morfometria do forame mandibular aplicada ao bloqueio anestésico local do nervo alveolar inferior de javalis (Sus scrofa scrofa Linnaeus, 1758)

Boars kept on commercial farms use their canine teeth as a mechanism of defense and attack in order to express their natural instincts, which could result in fractures of the teeth and jaws. Thus, utilizing local desensitization of the inferior alveolar nerve is crucial for executing therapeutic procedures in the oral cavities of those animals. Then, the goal is to carry out the morphometry of the mandibular foramen of that species, correlating it with the mandibular structures, while doing so in the safest manner for the animals. For that purpose, six hemimandibles of young-aged Sus scrofa scrofa were used, from which the proposed measurements were taken. On average, the lateral margin of the condylar process stood 142.43 mm away from the root of the lower medial incisive tooth. The longitudinal axis of the body of the mandible measured 22.3 mm at the level of the diastema that exists between the fourth lower premolar tooth and the first lower molar tooth. The mandibular foramen, from the caudal limit of the ventral margin, would be positioned at 26.6 mm from the ventral margin of the angle of the mandible in that level, 34.92 mm away from the medial margin of the condylar process, and 38.63 mm away from the dorsal limit from the caudal margin of the coronoid process. The lack of statistically significant differences, and observing that the osseous accident under scrutiny had been positioned in the ramus of the mandible, indicated that the proposed procedure should be performed from the introduction of the needle in an oblique and rostrodorsal direction for 2.0 cm, and angulated at 60º with the anatomic reference created by the medial demarcation obtained via the support of the thumb on the lateral margin of the ramus of the mandible, ventrally to the zygomatic arch, all while preserving neighboring structures and establishing an unheard-of anesthetic methodology for boars.(AU)

Javalis mantidos em criatórios comerciais utilizam os dentes caninos como mecanismo de defesa e ataque a fim de expressar seus instintos naturais, o que pode resultar em fraturas dentárias e da mandíbula propriamente dita. Desta forma, propiciar a dessensibilização local do nervo alveolar inferior é essencial para a execução de procedimentos terapêuticos na cavidade oral destes animais. Logo, objetivou-se realizar a morfometria do forame mandibular desta espécie a fim de correlacioná-lo com as estruturas mandibulares, inferindo, também, sobre a forma mais segura de realização da referida técnica nos espécimes. Para tanto, foram utilizadas seis hemimandíbulas de Sus scrofa scrofa jovens, a partir das quais foram realizadas as mensurações propostas. Em média, a margem lateral do processo condilar distanciou-se 142,43 mm da raiz do dente incisivo medial inferior; o eixo longitudinal do corpo da mandíbula mediu 22,3 mm ao nível do diastema existente entre o quarto dente pré-molar e o primeiro dente molar inferiores; e o forame mandibular, a partir do extremo caudal de sua margem ventral, posicionou-se a 26,6 mm da margem ventral do ângulo da mandíbula neste nível, 34,92 mm da margem medial do processo condilar, e 38,63 mm do extremo dorsal da margem caudal do processo coronóide. Na falta de diferenças estatisticamente significantes, e observando que o acidente ósseo estudado posicionou-se no ramo da mandíbula, indica que o procedimento proposto deva ser realizado a partir da introdução da agulha em sentido oblíquo rostroventral por 2,0 cm e angulada a 60º com o referencial anatômico criado pela delimitação medial obtida pelo apoio do dedo polegar na margem lateral do ramo da mandíbula, ventralmente ao arco zigomático, preservando as estruturas próximas e definindo-se uma metodologia anestésica inédita para os Javalis.(AU)

Morphometry of mental foramina applied to local anesthesia in hoary fox (Lycalopex vetulus Lund, 1842) / Morfometría de forámenes mentales aplicada a la anestesia local en zorro de campo común (Lycalopex vetulus Lund, 1842)

In order to perform local anaesthetic blockade of the mental nerves, it is fundamentally to determine anatomical references, including the precise identification of the mental foramina; however, the literature does not present specific data on such structures in the Hoary Fox. Therefore, the objective was describing the morphometry of the mental foramina of this specie, in order to correlate its topographies with the mandibular anatomical reference points, supporting the effective technique for mental desensitization. For this purpose, four mandibles of adult bodies of Lycalopex vetulus were used. Bilaterally, three mental foramina were observed located on the rostral third of the lateral margin of the mandibular body. One of them is more caudal, positioned ventrally to the lower third premolar tooth; a medium one, is located ventrally to the lower first premolar tooth; and a rostral one, placed ventrally to the lower intermediate incisor tooth. There were no statistically significant differences between the antimeres. Therefore, it is indicated that the local anaesthetic block of the mental nerves in this species should be performed by inserting the needle approximately 4.4 mm in a ventrodorsal direction. It is necessary positioning it perpendicularly to the ventral margin of the mandibular body and juxtaposed to its lateral face, using as anatomical reference the interalveolar space located between the first two lower premolar teeth. Thus, that the point established for anaesthetic injection (caudal limit of the ventral margin of the middle mental foramen), provides greater safety for its realization since, for small animals, the recommendation for blockade is represented by needle penetration on the direction of emergence of the mental nerve and artery from this foramen, which makes these structures more exposed to iatrogenic lesions resulting from the technique.

Para realizar el bloqueo anestésico local de los nervios mentales, es fundamental determinar referencias anatómicas, incluida la identificación precisa de los forámenes mentales; sin embargo, la literatura no presenta datos específicos referente a estas estructuras en el zorro de campo común. Por lo tanto, el objetivo fue describir la morfometría de los forámenes mentales de esta especie, para correlacionar sus topografías con los puntos de referencia anatómicos mandibulares, apoyando la técnica efectiva para la desensibilización mental. Para este propósito, se utilizaron cuatro mandíbulas de Lycalopex vetulus adultos. Bilateralmente, se observaron tres resistencias mentales ubicadas en el tercio rostral del margen lateral del cuerpo mandibular. Uno de ellos es más caudal, posicionado ventralmente hacia el tercer diente premolar inferior; uno mediano, localizado ventralmente hacia el primer diente premolar inferior; y uno rostral, colocado ventralmente al diente incisivo intermedio inferior. No se observaron diferencias estadísticamente significativas entre los antímeros. Por lo tanto, el bloqueo anestésico local de los nervios mentales en esta especie debe realizarse insertando la aguja aproximadamente 4,4 mm en dirección ventrodorsal. Es necesario colocar ésta perpendicularmente al margen ventral del cuerpo mandibular y yuxtapuesto a su cara lateral, utilizando como referencia anatómica, el espacio interalveolar ubicado entre los dos primeros dientes premolares inferiores. De este modo, el punto establecido para la inyección de anestesia (límite caudal del margen ventral del foramen mental medio), proporciona una mayor seguridad para su realización ya que, para los animales pequeños, la recomendación de bloqueo está representada por la penetración de la aguja en la dirección de emergencia del nervio mental y la arteria de este foramen, lo que hace que estas estructuras estén más expuestas a las lesiones iatrogénicas resultantes de la técnica.