Cochlear glial cells mediate glutamate uptake through a sodium-independent transporter.

Since glutamate is the primary excitatory neurotransmitter in the mammalian cochlea, the mechanisms for the removal of glutamate from the synaptic and extrasynaptic spaces are critical for maintaining normal function of this region. Glial cells of inner ear are crucial for regulation of synaptic transmission throughout since it closely interacts with neurons along the entire auditory pathway, however little is known about the activity and expression of glutamate transporters in the cochlea. In this study, using primary cochlear glial cells cultures obtained from newborn Balb/C mice, we determined the activity of a sodium-dependent and sodium-independent glutamate uptake mechanisms by means of High Performance Liquid Chromatography. The sodium-independent glutamate transport has a prominent contribution in cochlear glial cells which is similar to what has been demonstrated in other sensory organs, but it is not found in tissues less susceptible to continuous glutamate-mediated injuries. Our results showed that xCG- system is expressed in CGCs and is the main responsible for sodium-independent glutamate uptake. The identification and characterization of the xCG- transporter in the cochlea suggests a possible role of this transporter in the control of extracellular glutamate concentrations and regulation of redox state, that may aid in the preservation of auditory function.

Monitorização residencial da pressão arterial no controle da hipertensão arterial sistêmica: percepções de enfermeiras / Home blood pressure monitoring in the control of systemic arterial hypertension: nurses' perceptions / Monitoreo domiciliario de la presión arterial con miras a controlar la hipertensión arterial sistémica: percepciones de las enfermeras

Objetivo: analisar as percepções de enfermeiras sobre a Monitorização Residencial da Pressão Arterial no contexto da Atenção Primária à Saúde. Métodos: estudo descritivo, qualitativo, realizado em sete Unidades de Saúde da Família de Belém, Pará, com participação de 14 enfermeiras, que atuavam no Programa HiperDia. A coleta de dados ocorreu nos meses de janeiro a março de 2017, por meio de entrevistas semiestruturadas individuais, empregando roteiro elaborado pelos pesquisadores. As entrevistas foram gravadas, transcritas e submetidas à técnica de análise de conteúdo. Resultados: emergiram quatro categorias temáticas, abordando os conhecimentos sobre a Monitorização Residencial da Pressão Arterial, as práticas e estratégias no manejo da pessoa com hipertensão, a importância da monitorização, os recursos e métodos para o diagnóstico da doença e as dificuldades na execução dessa monitorização. Conclusão: as enfermeiras reconheceram a importância da Monitorização Residencial da Pressão Arterial nas ações empreendidas por suas equipes, destacando a aplicação desse método na prevenção de complicações da hipertensão. Todavia, ressaltaram que a efetividade perpassa pelo uso de aparelho adequado, não disponível nos serviços. (AU)

Objective: to analyze nurses' perceptions about Home Blood Pressure Monitoring in the context of Primary Health Care. Methods: a descriptive, qualitative study, carried out in seven Family Health Care Units in Belém, Pará, in which 14 nurses, who worked in the HiperDia Program participated. Data collection was conducted from January to March 2017, through individual semi-structured interviews, using a script prepared by the researchers. The interviews were recorded, transcribed, and submitted to content analysis technical procedures. Results: four thematic categories emerged, addressing knowledge about Home Blood Pressure Monitoring, the proceedings, and strategies in the management of people with hypertension, the importance of monitoring, the resources and methods for diagnosing the disease, and the difficulties in carrying out this monitoring. Conclusion: the nurses acknowledged the relevance of Home Blood Pressure Monitoring in the actions carried out by their teams, highlighting the use of this method in preventing complications of hypertension. However, they emphasized that effectiveness involves the use of an adequate device, which is not available in the services. (AU)

Objetivo: analizar las percepciones de las enfermeras sobre el Monitoreo Domiciliario de la Presión Arterial en el contexto de la Atención Primaria de Salud. Métodos: estudio descriptivo y cualitativo realizado en siete Unidades de Salud Familiar en Belém, Pará, con la participación de 14 enfermeras que trabajaron en el Programa HiperDia. La recopilación de datos tuvo lugar entre enero y marzo de 2017, mediante entrevistas individuales semiestructuradas, utilizando un guion preparado por los investigadores. Las entrevistas fueron grabadas, transcritas y sometidas a la técnica de análisis de contenido. Resultados: surgieron cuatro categorías temáticas, abordando el conocimiento sobre el control de la presión arterial en el domicilio, las prácticas y estrategias en el manejo de la persona con hipertensión, la importancia del monitoreo, los recursos y métodos para el diagnóstico de la enfermedad y las dificultades para realizar este monitoreo. Conclusión: las enfermeras reconocen la importancia del Monitoreo Domiciliario de la Presión Arterial en las acciones llevadas a cabo por sus equipos, subrayando la aplicación de este método en la prevención de las complicaciones de la hipertensión. No obstante, resaltaron que la eficacia requiere el uso de aparatos adecuados, que no están disponibles en los servicios. (AU)

Reference Equation of a New Incremental Step Test to Assess Exercise Capacity in the Portuguese Adult Population.

Step tests are important in community- and home-based rehabilitation programs to assess patients' exercise capacity. A new incremental step test was developed for this purpose, but its clinical interpretability is currently limited. This study aimed to establish a reference equation for this new incremental step test (IST) for the Portuguese adult population. A cross-sectional study was conducted on people without disabilities. Sociodemographic (age and sex), anthropometric (weight, height, and body mass index), smoking status, and physical activity (using the brief physical activity assessment tool) data were collected. Participants performed two repetitions of the IST and the best test was used to establish the reference equation with a forward stepwise multiple regression. An analysis comparing the results from the reference equation with the actual values was conducted with the Wilcoxon test. A total of 155 adult volunteers were recruited (60.6% female, 47.8 ± 19.7 years), and the reference equation was as follows: steps in IST = 475.52 - (4.68 × age years) + (30.5 × sex), where male = 1 and female = 0, and r2 = 60%. No significant differences were observed between the values performed and those obtained by the equation (p = 0.984). The established equation demonstrated that age and sex were the determinant variables for the variability of the results.

Expression of metalloproteinases 2 and 9 and plasma zinc concentrations in women with fibroadenoma.

OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman's test and Friedman's test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

Expression of metalloproteinases 2 and 9 and plasma zinc concentrations in women with fibroadenoma

SUMMARY OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman's test and Friedman's test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

Da invisibilidade à resistência: mulheres negras e a vida afrocentrada como potência de cuidado no território / From invisibility to resistance: black women and life afrocentric as a power of care in the territory

Esta dissertação aborda as dinâmicas do paradigma afrocentrado como potência de cuidado na vida de mulheres negras em territórios majoritariamente brancos, como Venâncio Aires, no interior do estado do Rio Grande do Sul. Por meio deste trabalho busco compreender como esses corpos de mulheres negras vivem em meio a diferenças culturais e olhares opressores na construção da sua identidade, etnicidade, corporeidade, bem como de que forma se compreendem enquanto pertencentes àquele território e como fazem para proteger suas subjetividades e produzir relações de cuidado de si, e consequentemente saúde. Para acessar as respostas a tais indagações, realizei entrevistas não-diretivas, baseada na abordagem metodológica da História de Vida Focal, com 3 mulheres negras, residentes e naturais do cenário em questão. Para esse percurso metodológico tive auxílio de ferramentas como observação participante, meu diário de campo e as fotografias resgatadas e geradas pelas mulheres que participaram deste estudo. Todos os materiais foram analisados de forma interpretativa e as imagens através da sociologia das imagens. Como resultado deste estudo pude perceber a expressão de formas de dominação racial, como as imagens de controle tem efeito direto e de forma consistente nas existências de mulheres negras, bem como tais processos são reiterados por barreiras raciais promovidas pelo território. Mas também me aproximei da magnitude que há na construção de algumas estratégias e possibilidades de proteção da vida e subjetividades neste cenário, como a composição de coletividades afrocentradas e potencializadoras do cuidado; as buscas pela ancestralidade como forma de reconhecimento e manutenção das torrentes de vida; e o autocuidado como um processo coletivo de preservação de si, dos seus e da sua própria cultura.

This thesis talks about the dynamics of the afro-centered paradigm as a power of care in the lives of black women in territories of mostly white people, such as Venâncio Aires, in the countryr of the state of Rio Grande do Sul. Through this research I seek to understand how black women can live in a place of cultural differences and oppressive views in the construction of their identity, ethnicity, corporeality, as well as how they understand themselves as belonging to that territory and how they manage to protect their subjectivities and produce relationships of self- care, and consequently health. To access the answers to such questions, I conducted non-directive interviews, based on the methodological approach of the Focal Life Story, with 3 black women, residents and natives of the scenario in question. For this methodological path I had was helped by the tools such as participant observation, my diary of field and the photographs rescued and made by the women who participated in this study. All materials were analyzed by interpretative method and the images through the sociology of images. As a result of this study, I could see the expression of forms of racial domination, how the control images have a direct and consistent effect on the existence of black women, as well as how such processes are reiterated by racial barriers promoted by the territory. Thus, I got closer to the magnitude of the construction of some strategies and possibilities for protection of life and subjectivities in this scenario, such as the composition of afro-centered collectivities that enhance care; the search for ancestry as a way of recognizing and maintaining the streams of life; and self-care as a collective process of self-preservation, their beloved ones and their own culture.

Association between matrix metalloproteinase-9 gene polymorphism and breast cancer in Brazilian women.

OBJECTIVE: This study aimed to determine the relationship between rs17576 (MMP-9) polymorphism and increased cancer risk in a Brazilian breast cancer cohort. METHODS: This study included 141 women (71 breast cancer patients and 70 controls without breast cancer) who donated 3 mL of their peripheral blood for genomic DNA extraction. This DNA was then genotyped using a real-time polymerase chain reaction. RESULTS: The AG (rs17576) genotype was identified in 26 (18.43%) participants in the case group and in 22 (15.60%) participants in the control group (p=0.274), while the GG genotype was identified in ten (7.09%) participants in the case group and in one (0.70%) participant in the control group (p<0.003 - OR (95% CI) 13.13 (1.73, 593.08). No significant difference in the incidence rates was observed for AG or GG rs17576 genotypes in premenopausal women, p=0.813 and p=0.556, respectively. However, in postmenopausal women, the AG genotype was shown to occur in 14 (22.5%) participants in the case group and in 4 (6.45%) participants in the control (p<0.043), while GG genotype occurred in eight (12.90%) of the individuals in the case group and in none of the individuals in the control group (p<0.006). CONCLUSION: In this study, the MMP-9 rs17576 GG polymorphic variant was shown to be significantly associated with breast cancer risk in premenopausal women, while the AG and GG genotypes were associated with increased cancer risk in postmenopausal women.

Perfil de pessoas com hipertensão atendidas na estratégia saúde da família em um município do nordeste brasileiro / Profile of persons with hypertension seen at family health strategy of a municipality in northeastern Brazil / Perfil de personas con hipertensión atendidas en la estrategia de salud familiar en un municipio del noreste de Brasil

Objetivo: Avaliar o perfil de vida de pacientes com hipertensão arterial, levando em considerações as condições socioeconômicas e estruturas físicas e psicobiológicas. Método: Estudo descritivo-exploratório, de abordagem quantitativa, com 40 pessoas portadoras de hipertensão arterial, cadastrados numa unidade da Estratégia de Saúde da Família do município de Balsas, Maranhão. Os dados foram obtidos por meio da aplicação do questionário "Estilo de vida fantástico" e questionário sociodemográfico. Foi realizada análise descritiva. Resultados: Verificou-se que: 62,5% eram do sexo feminino e 37,5% do sexo masculino, que se encontram na faixa etária de 21 a 40 anos com 10%, 41 a 60 anos com 42,5%, 61 a 80 anos com 35% e 81 a 100 anos com 12,5%. Os domínios que mais necessitam de mudança são Afeto, Nutrição e Pressa. Conclusão: O perfil dos pacientes demonstrou que os mesmos influenciam na autoestima, na formação da personalidade, nas relações familiares e sociais de cada pessoa.

Objective: To evaluate the life profile of patients with arterial hypertension, taking into account socioeconomic conditions and physical and psychobiological structures. Method: Descriptive-exploratory study, with a quantitative approach, with 40 people with arterial hypertension, registered in a unit of the Family Health Strategy in the municipality of Balsas, Maranhão. Data were obtained through the application of the "Fantastic lifestyle" questionnaire and sociodemographic questionnaire. Descriptive analysis was performed. Results: It was found that: 62.5% were female and 37.5% male, who are in the age group of 21 to 40 years old with 10%, 41 to 60 years old with 42.5%, 61 80 years old with 35% and 81 to 100 years old with 12.5%. The domains that most need change are Affection, Nutrition and Hurry. Conclusion: The profile of the patients demonstrated that they influence self-esteem, personality formation, family and social relationships of each person.

Objetivo: Objetivo: evaluar el perfil de vida de los pacientes con hipertensión arterial, teniendo en cuenta las condiciones socioeconómicas y las estructuras físicas y psicobiológicas. Método: Estudio descriptivo-exploratorio, con enfoque cuantitativo, con 40 personas con hipertensión arterial, inscrito en una unidad de la Estrategia de Salud Familiar en el municipio de Balsas, Maranhão. Los datos se obtuvieron mediante la aplicación del cuestionario "Fantastic lifestyle" y el cuestionario sociodemográfico. Se realizó un análisis descriptivo. Resultados: Se encontró que: 62.5% eran mujeres y 37.5% hombres, que están en el grupo de edad de 21 a 40 años con 10%, 41 a 60 años con 42.5%, 61 80 años con 35% y 81 a 100 años con 12.5%. Los dominios que más necesitan cambios son afecto, nutrición y prisa. Conclusión: el perfil de los pacientes demostró que influyen en la autoestima, la formación de la personalidad, las relaciones familiares y sociales de cada persona.

Association between matrix metalloproteinase-9 gene polymorphism and breast cancer in Brazilian women

OBJECTIVE: This study aimed to determine the relationship between rs17576 (MMP-9) polymorphism and increased cancer risk in a Brazilian breast cancer cohort. METHODS: This study included 141 women (71 breast cancer patients and 70 controls without breast cancer) who donated 3 mL of their peripheral blood for genomic DNA extraction. This DNA was then genotyped using a real-time polymerase chain reaction. RESULTS: The AG (rs17576) genotype was identified in 26 (18.43%) participants in the case group and in 22 (15.60%) participants in the control group (p=0.274), while the GG genotype was identified in ten (7.09%) participants in the case group and in one (0.70%) participant in the control group (p<0.003 - OR (95% CI) 13.13 (1.73, 593.08). No significant difference in the incidence rates was observed for AG or GG rs17576 genotypes in premenopausal women, p=0.813 and p=0.556, respectively. However, in postmenopausal women, the AG genotype was shown to occur in 14 (22.5%) participants in the case group and in 4 (6.45%) participants in the control (p<0.043), while GG genotype occurred in eight (12.90%) of the individuals in the case group and in none of the individuals in the control group (p<0.006). CONCLUSION: In this study, the MMP-9 rs17576 GG polymorphic variant was shown to be significantly associated with breast cancer risk in premenopausal women, while the AG and GG genotypes were associated with increased cancer risk in postmenopausal women.

Expression of matrix metalloproteinase 2 and 9 in breast cancer and breast fibroadenoma: a randomized, double-blind study.

BACKGROUND: Matrix metalloproteinases (MMPs) 2 and 9 may play an important role in cell proliferation and dissemination of cancer. However, few studies have compared the expression of these proteins between breast cancer and fibroadenoma. MATERIAL AND METHODS: A randomized, double-blind study was carried out in 66 premenopausal women, aged 20-49 years, who had been diagnosed with fibroadenoma or breast cancer. The patients were divided into two groups: Group A, control (fibroadenoma, n=36) and Group B, study (cancer, n=30). Immunohistochemical analysis was performed using tissue samples of fibroadenoma and breast cancer to assess MMP-2 and MMP-9 antigen expression. Cells were considered positive if exhibiting brown cytoplasmic staining. Fisher's exact test was used to compare the percentage of cases with cells expressing MMP-2 and MMP-9 in control and study groups (p < 0.05). RESULTS: Light microscopy showed a higher concentration of cells with positive cytoplasmic staining for MMP-2 and MMP-9 expression in breast cancer than in fibroadenoma. The percentage of cases with cells expressing MMP-2 in the control and study groups was 41.67% and 86.11%, respectively (p < 0.0009), whereas the percentage of cases with cells expressing MMP-9 in groups A and B was 66.67% and 93.33%, respectively (p<0.0138). MMP-2 and MMP-9 positive expression was significantly higher in moderately differentiated tumors compared to well and poorly differentiated tumors, p <0.005 and p<0.001, respectively. CONCLUSIONS: The current study shows that MMP-2 and MMP-9 protein expression was significantly higher in the breast cancer than in the fibroadenoma and also in moderately differentiated breast cancer.

A case-control study of Metallothionein-1 expression in breast cancer and breast fibroadenoma.

The overexpression of Metallothionein-1 (MT-1) may play an important role in breast cancer; however, few studies have compared MT-1 expression between breast cancer and fibroadenoma. A cross-sectional controlled study was performed in 66 premenopausal women, aged 20-49 years, who had been histologically diagnosed with breast fibroadenoma or breast cancer. The patients were divided into two groups: group A, control (fibroadenoma, n = 36) and group B, study (breast cancer, n = 30). Immunohistochemistry was performed on tissue samples of fibroadenoma and breast cancer patients to evaluate the expression of metallothionein using an anti-MT-1 polyclonal antibody (rabbit polyclonal anti-metallothionein-Catalog Number biorbyt-orb11042) at a dilution of 1:100. The data were analyzed using NOVA (p < 0.05). Microscopic analysis showed a higher concentration of anti-MT-1-stained nuclei in breast cancer tissues than in fibroadenoma tissues. The mean proportion of cells with anti-MT-1-stained nuclei was 26.93% and 9.10%, respectively, in the study and control groups (p < 0.001). Histological grade 3 tumors showed a significantly higher MT-1 expression than hitological grade 1 (p < 0.05), while breast tumors negative for estrogen-, progesterone- and HER2- receptors had a significantly higher MT-1 expression than positive breast tumors positive for these parameters (p < 0.05). MT-1 protein in women of reproductive age was significantly higher in breast cancer than in fibroadenoma in this study. Furthermore, there was higher MT-1 immunoreactivity in more aggressive tumors.

Light-harvesting, 3rd generation RuII/CoII MOF with a large, tubular channel aperture.

A photoactive, hetero-metallic CoII/RuII-based metal-organic framework (MOF) with a large channel aperture, ca. 21 Å, is reported. The photophysical properties of the MOF are derived from the RuII nodes giving rise to emission centred at ca. 620 nm and relatively long triplet 3MLCT lifetimes. In addition to the optical attributes, the 1H-imidazo [4,5-f][1,10]-phenanthroline ligand imparts structural functionality to the MOF which is composed of alternating CoII- and RuII-based nodes of Δ and Λ helicity. The framework maintains its integrity upon activation and shows gas sorption behaviour that is characteristic of mesoporous materials promoting high CO2 sorption capacities and selectivities over N2.

Itinerário terapêutico de pessoas com diabetes mellitus tipo 2 que sofreram amputação de membro inferior: experiência do adoecimento / Therapeutic itinerary of people with type 2 diabetes mellitus who suffered lower limb amputation: experience of the disease

Introdução: O Diabetes Mellitus é uma doença ocasionada pela falha na secreção de insulina pelo pâncreas ou da ação da mesma no organismo. O Diabetes Mellitus tipo 2 é responsável por cerca de 90 a 95% dos casos de diabetes, essa é causa de diversas complicações na vida das pessoas, as abordadas aqui são o pé diabético e a amputação de membro inferior. Para entender o trajeto da doença e usuário utilizamos o itinerário terapêutico. Objetivo: Conhecer o itinerário terapêutico com foco nas experiências de adoecimento de usuários da Atenção Primária à Saúde que sofreram amputação do membro inferior decorrente de complicações do diabetes mellitus tipo 2. Metodologia: Foi realizada pesquisa qualitativa do tipo estudo de caso com seis participantes diabéticos com amputação de membro inferior e em acompanhamento em Unidades Básicas de Saúde. As informações foram coletadas através de entrevistas semi-estruturadas, categorizados e analisados utilizando a análise temática. Resultados/discussão: Os resultados demonstraram experiências singulares que perpassam a cronicidade e gravidade da DM2, a dificuldade em mudar hábitos enraizados e os desafios das mudanças corporais e cotidianas ligadas a amputação do membro, bem como as dinâmicas do adoecimento. Considerações finais: A realização de um cuidado completo e atento a todas as possibilidades da DM2 é primordial. Para mais, abordagens motivacionais, promoção de autocuidado e de prevenção de agravos são de extrema relevância, porém são perpassados por diversas questões pessoais, que são anteriores ao processo de tratamento e que se referem a como os sujeitos experienciam e vivenciam o adoecimento. (AU)

Itinerário terapêutico de pessoas com diabetes mellitus tipo 2 que sofreram amputação de membro inferior: experiência do adoecimento / Therapeutic itinerary of people with type 2 diabetes mellitus who suffered lower limb amputation: experience of the disease

Introdução: O Diabetes Mellitus é uma doença ocasionada pela falha na secreção de insulina pelo pâncreas ou da ação da mesma no organismo. O Diabetes Mellitus tipo 2 é responsável por cerca de 90 a 95% dos casos de diabetes, essa é causa de diversas complicações na vida das pessoas, as abordadas aqui são o pé diabético e a amputação de membro inferior. Para entender o trajeto da doença e usuário utilizamos o itinerário terapêutico. Objetivo: Conhecer o itinerário terapêutico com foco nas experiências de adoecimento de usuários da Atenção Primária à Saúde que sofreram amputação do membro inferior decorrente de complicações do diabetes mellitus tipo 2. Metodologia: Foi realizada pesquisa qualitativa do tipo estudo de caso com seis participantes diabéticos com amputação de membro inferior e em acompanhamento em Unidades Básicas de Saúde. As informações foram coletadas através de entrevistas semi-estruturadas, categorizados e analisados utilizando a análise temática. Resultados/discussão: Os resultados demonstraram experiências singulares que perpassam a cronicidade e gravidade da DM2, a dificuldade em mudar hábitos enraizados e os desafios das mudanças corporais e cotidianas ligadas a amputação do membro, bem como as dinâmicas do adoecimento. Considerações finais: A realização de um cuidado completo e atento a todas as possibilidades da DM2 é primordial. Para mais, abordagens motivacionais, promoção de autocuidado e de prevenção de agravos são de extrema relevância, porém são perpassados por diversas questões pessoais, que são anteriores ao processo de tratamento e que se referem a como os sujeitos experienciam e vivenciam o adoecimento. (AU)

Review of Polymorphism of the Calcium-Sensing Receptor Gene and Breast Cancer Risk.

Polymorphism of the calcium-sensing receptor gene (CaSR or CaR) has been associated with an increased risk for breast cancer. This receptor plays an important role in calcium homeostasis, and has also been detected in several tissues that are unrelated to calcium metabolism, such as the skin, brain, and breast. The calcium-sensing receptor on cellular level, it regulates cell differentiation, proliferation, cell death, and gene expression. In breast cancer cells, CaSR seems to stimulate secretion of the parathyroid hormone-related protein (PTHrP), which stimulates cellular proliferation. Likewise, some studies have supported not only an association between calcium receptor gene polymorphism and breast cancer risk, but also a higher aggressiveness and unfavorable outcomes in breast cancer, which led us to make a survey in Pubmed on the subject in the last 10 years. Thus, in the literature there is a paucity of studies on the subject and the aim of this review was to show the role of calcium-sensing receptor and its association with breast cancer risk.

Retention, engagement, and adherence to pre-exposure prophylaxis for men who have sex with men and transgender women in PrEP Brasil: 48 week results of a demonstration study.

BACKGROUND: PrEP Brasil was a demonstration study to assess feasibility of daily oral tenofovir diphosphate disoproxil fumarate plus emtricitabine provided at no cost to men who have sex with men (MSM) and transgender women at high risk for HIV within the Brazilian public health system. We report week 48 pre-exposure prophylaxis (PrEP) retention, engagement, and adherence, trends in sexual behaviour, and incidence of HIV and sexually transmitted infections in this study cohort. METHODS: PrEP Brasil was a 48 week, open-label, demonstration study that assessed PrEP delivery at three referral centres for HIV prevention and care in Rio de Janeiro, Brazil (Fundação Oswaldo Cruz), and São Paulo, Brazil (Universidade de São Paulo and Centro de Referência e Treinamento em DST e AIDS). Eligible participants were MSM and transgender women who were HIV negative, aged at least 18 years, resident in Rio de Janeiro or São Paulo, and reported one or more sexual risk criteria in the previous 12 months (eg, condomless anal sex with two or more partners, two or more episodes of anal sex with an HIV-infected partner, or history of sexually transmitted infection [STI] diagnosis). Participants were seen at weeks 4, 12, 24, 36, and 48 for PrEP provision, clinical and laboratory evaluation, and HIV testing. Computer-assisted self-interviews were also done at study visits 12, 24, 36, and 48, and assessed sexual behaviour and drug use. PrEP retention was defined by attendance at the week 48 visit, PrEP engagement was an ordinal five-level variable combining presence at the study visit and drug concentrations, and PrEP adherence was evaluated by measuring tenofovir diphosphate concentrations in dried blood spots. Logistic regression models were used to quantify the association of variables with high adherence (≥4 doses per week). The study is registered with ClinicalTrials.gov, number NCT01989611. FINDINGS: Between April 1, 2014, and July 8, 2016, 450 participants initiated PrEP, 375 (83%) of whom were retained until week 48. At week 48, 277 (74%) of 375 participants had protective drug concentrations consistent with at least four doses per week: 183 (82%) of 222 participants from São Paulo compared with 94 (63%) of 150 participants from Rio de Janeiro (adjusted odds ratio 1·88, 95% CI 1·06-3·34); 119 (80%) of 148 participants who reported sex with HIV-infected partners compared with 158 (70%) of 227 participants who did not (1·78, 1·03-3·08); 67 (87%) of 77 participants who used stimulants compared with 210 (71%) of 298 participants who did not (2·23, 1·02-4·92); and 232 (80%) of 289 participants who had protective concentrations of tenofovir disphosphate at week 4 compared with 42 (54%) of 78 participants who did not (3·28, 1·85-5·80). Overall, receptive anal sex with the last three partners increased from 45% at enrolment to 49% at week 48 (p=0·17), and the mean number of sexual partners in the previous 3 months decreased from 11·4 (SD 28·94) at enrolment to 8·3 (19·55) at week 48 (p<0·0013). Two individuals seroconverted during follow-up (HIV incidence 0·51 per 100 person-years, 95% CI 0·13-2·06); both of these patients had undetectable tenofovir concentrations at seroconversion. INTERPRETATION: Our results support the effectiveness and feasibility of PrEP in a real-world setting. Offering PrEP at public health-care clinics in a middle-income setting can retain high numbers of participants and achieve high levels of adherence without risk compensation in the investigated populations. FUNDING: Brazilian Ministry of Health, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Secretaria de Vigilancia em Saúde, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, and Fundação de Amparo à Pesquisa do Estado de São Paulo.

Uso de solução lipídica em intoxicação por beta-bloqueador: relato de caso / Use of lipid solution in beta-blocking severe intoxication: case report

Intoxicações por medicações de uso habitual ou drogas ilícitas tornaram-se um grave problema de saúde pública, com um impacto não apenas na mortalidade, mas com sequelas psicossociais relevantes. As manifestações clínicas dependem das propriedades farmacológicas da droga. Uso de solução lipídica no tratamento de intoxicações graves tem se tornado uma realidade cada vez mais consistente. O objetivo deste trabalho é relatar o caso de uma paciente atendida no HPS João XXIII a partir de coleta de dados em prontuário. C.R.F ,39 anos sexo feminino, encaminhada da Unidade de pronto-atendimento de Ribeirão das Neves devido a ingestão proposital de três cartelas de atenolol, fluoxetina e losartana, onde foi realizado lavagem gástrica, administração de carvão ativado, e reposição volêmica, sem resposta. À admissão, evoluiu com parada cardiorrespiratória durante 10 minutos, sendo iniciadas medidas de ressuscitação, seguida de administração de solução lipídica. Foi encaminhada para unidade de terapia intensiva onde permaneceu por seis dias, seguido de alta para enfermaria e após dez dias de internação alta hospitalar sem qualquer sequela. Os beta-bloqueadores são substâncias bem absorvidas pelo trato gastrointestinal. Os primeiros efeitos tóxicos aparecem 20 a 30 minutos após a ingestão e o efeito máximo ocorre após 4 a 6 horas, podendo chegar a 10 horas em alguns compostos. De 2014 a 2016 foram realizados 92 atendimentos devido a intoxicação por beta-bloqueador (19 presenciais e 73 por telefone) no Serviço de Toxicologia do Hospital João XXIII, sendo metade destes por tentativa de auto-extermínio. Nenhum óbito foi registrado nesse período. (AU)

Intoxications from commonly used medications or illicit drugs have become a serious public health problem, with an impact not only on mortality, but also on psychosocial and morbidity sequelae. The clinical manifestations depend on the pharmacological properties of the drug. Use of lipid solution in the treatment of severe poisoning has become an increasingly consistent reality. The purpose of this paper is to report the case of a patient attended in the HPS John XXIII from data collection in medical records. C.R.F, a 39-year-old female, referred from the Ribeirão das Neves emergency room due to the intentional ingestion of three tablets of atenolol, fluoxetine and losartan, where gastric lavage, activated carbon administration and volumetric replacement were performed without response. Upon admission, he evolved with cardiorespiratory arrest for 10 minutes, and resuscitation measures were initiated, followed by administration of lipid solution. She was referred to an intensive care unit where she remained for six days, followed by discharge to the ward and ten days after hospital discharge without any sequelae. Beta-blockers are well-absorbed substances in the gastrointestinal tract. The first toxic effects appear 20 to 30 minutes after ingestion and the maximum effect occurs after 4 to 6 hours, and can reach 10 hours in some compounds. From 2014 to 2016, 92 consultations were performed due to beta-blocker poisoning (19 presential and 73 by telephone) at the Toxicology Service of the Hospital João XXIII, half of which were for self-extermination. No deaths were recorded during this period. (AU)

Bcl-2 antigen expression in luminal A and triple-negative breast cancer.

Biomarkers for the prognosis of breast cancer have been routinely used in clinical practice, including the expression of hormone receptors, Ki-67 and HER-2. More recently, Bcl-2 has been recognized as an important prognostic factor in breast cancer, although controversies persist with respect to the significance of its expression. The aim of the present study was to evaluate Bcl-2 antigen expression in luminal A and triple-negative breast cancer. Sixty women with invasive ductal carcinoma were included in the study and divided into two groups: Group A (luminal A) and Group B (triple-negative), with 30 cases in each group. Immunohistochemistry was performed on tissue sections to evaluate Bcl-2 antigen expression. Fisher's exact test was used to compare the proportions of cases with cells expressing Bcl-2 between the two subtype cancer groups, with statistical significance being established at p < 0.05. The number of cases with cells expressing Bcl-2 in Groups A and B was 26 (86.7%) and 12 (40.0%), respectively (p < 0.0003). In the present study, the expression of the anti-apoptotic protein Bcl-2 was greater in luminal A breast cancer tissue samples compared to triple-negative breast cancer.

Diagnosis of Oral Hairy Leukoplakia: The Importance of EBV In Situ Hybridization.

Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV), which has been related to HIV infection. In situ hybridization (ISH) is the gold-standard diagnosis of OHL, but some authors believe in the possibility of performing the diagnosis based on clinical basis. The aim of this study is diagnose incipient lesions of OHL by EBV ISH of HIV-infected patients and the possible correlations with clinical characteristics of the patients. Ninety-four patients were examined and those presenting with clinical lesions compatible to OHL were submitted to biopsy prior to EBV ISH. Twenty-eight patients had lesions clinically compatible to the diagnosis of OHL, but only 20 lesions were confirmed by EBV ISH. The patients with OHL had a mean age of 41.9 years and were HIV-infected for 11.2 years, on average, including CD4 count of 504.7 cells/mm3 and log10 viral load = 1.1. Among the quantitative variables, there was a statistically significant correlation with age only (P = 0.030). In conclusion, the presence of OHL in patients with HIV/AIDS results in changes in the epidemiological characteristics of the disease, and this fact allied with subtle clinical-morphological features makes clinical diagnosis very difficult. Therefore, EBV ISH is important for a definitive diagnosis of OHL.

Insulin-like growth factor 1 gene polymorphism in women with breast cancer.

Breast cancer is a disease of unknown etiology; however, the major risk factors are genetic alterations. Studies have demonstrated an association between insulin-like growth factor 1 (IGF-1) gene polymorphism and cell proliferation and reduced apoptosis, in addition to its role in breast cancer growth and aggressiveness. Two polymorphic variants of the IGF-1 gene are highlighted in association with breast cancer, rs6220 and rs7136446, although controversy exists as to this relationship. The current study included 137 women (68 breast cancer cases and 69 controls without breast cancer) who had 3 ml of peripheral blood drawn for the study of genomic DNA extracted from leukocytes using the genotyping technique by real-time polymerase chain reaction. The CC genotype (rs7136446) was present in 4 women (5.9%) from the case group and in 2 (3.0%) women from the control group (p = 0.67), while the GG genotype (rs6220) occurred in 8 (11.5%) women from the case group and in 5 (7.2%) women from the control group (p = 0.75). No statistically significant difference was observed between the CC genotype of variant rs7136446 in premenopausal case and control women (p = 0.31), thus as there was also no significant difference between case and control postmenopausal women (p = 1.00). Concerning the GG genotype of rs6220, it occurred in 6 (14.2%) premenopausal case and 4 (8%) control women (p = 0.71) and no difference was found in postmenopausal women (p = 1.00). In the current study, IGF-1 gene polymorphism of SNP variants rs6220 and rs7136446 had no statistically significant association with breast cancer, both in premenopausal and postmenopausal women.