Role of diagnostic imaging technologists during the COVID-19 pandemic: the importance of organization and planning in the first line. / Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea.

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception. In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.

What Cancer Patients Want to Know? Questions from Oncologic Patients in a Brazilian Private Cancer Center.

To establish the more relevant questions oncologic patients may have during cancer treatment. Cross-sectional observational study with all patients undergoing chemotherapy or radiotherapy for cancer in a Brazilian health institution. A questionnaire with open and close questions about cancer diagnosis, treatment, and prognosis was applied. A total of 198 patients were evaluated of whom 122 (62%) were female and 80% of the patients were between 50 and 89 years old. Sixty-one percent of women and 62% of men had questions about cancer diagnosis and treatment. Although questions about nutrition were the most frequent for all patients (72% of men and 48% of women), treatment short- and long-term consequences were a concern for 31% of men and treatment effects on esthetics for 21% of women. After having been informed by the oncology team about their diagnosis and treatment, 49% of the patients also searched for other sources of information. Thirty-eight patients (20%) searched for alternative treatments for cancer. About half of the patients searched for other sources of information after having been informed by the oncology team about their cancer diagnosis and treatment. The present study reinforces the importance for the oncologic health team to spend sufficient time with patients in order to clarify doubts about cancer diagnosis and treatment.

Membrane transporters in the bioproduction of organic acids: state of the art and future perspectives for industrial applications.

Organic acids such as monocarboxylic acids, dicarboxylic acids or even more complex molecules such as sugar acids, have displayed great applicability in the industry as these compounds are used as platform chemicals for polymer, food, agricultural and pharmaceutical sectors. Chemical synthesis of these compounds from petroleum derivatives is currently their major source of production. However, increasing environmental concerns have prompted the production of organic acids by microorganisms. The current trend is the exploitation of industrial biowastes to sustain microbial cell growth and valorize biomass conversion into organic acids. One of the major bottlenecks for the efficient and cost-effective bioproduction is the export of organic acids through the microbial plasma membrane. Membrane transporter proteins are crucial elements for the optimization of substrate import and final product export. Several transporters have been expressed in organic acid-producing species, resulting in increased final product titers in the extracellular medium and higher productivity levels. In this review, the state of the art of plasma membrane transport of organic acids is presented, along with the implications for industrial biotechnology.

Cellular immunotherapy: a clinical state-of-the-art of a new paradigm for cancer treatment.

Cancer immunotherapy has opened a new chapter in Medical Oncology. Many novel therapies are under clinical testing and some have already been approved and implemented in cancer treatment protocols. In particular, cellular immunotherapies take advantage of the antitumor capabilities of the immune system. From dendritic cell-based vaccines to treatments centered on genetically engineered T cells, this form of personalized cancer therapy has taken the field by storm. They commonly share the ex vivo genetic modification of the patient's immune cells to generate or induce tumor antigen-specific immune responses. The latest clinical trials and translational research have shed light on its clinical effectiveness as well as on the mechanisms behind targeting specific antigens or unique tumor alterations. This review gives an overview of the clinical developments in immune cell-based technologies predominantly for solid tumors and on how the latest discoveries are being incorporated within the standard of care.

Ketoprofen-loaded rose hip oil nanocapsules attenuate chronic inflammatory response in a pre-clinical trial in mice.

This study aimed to develop nanocapsules containing ketoprofen using rose hip oil (Keto-NC) as oil core, and to evaluate their anti-inflammatory activity in acute and chronic ear edema models in mice. Physicochemical characterization, drug release, photostability and cytotoxicity assays were performed for the developed Keto-NC formulations and compared to ketoprofen-loaded nanocapsules using medium chain triglycerides as oil core (Keto-MCT-NC). Anti-inflammatory activity of orally delivered KP (Ketoprofen-free; 10 mg.kg-1) or Keto-NC (2.5; 5; 10 mg.kg-1) was assessed in mouse acute and chronic ear edema induced by croton oil (CO). Edema histological characteristics were determined by H&E stain, and redox parameters were analyzed in blood plasma and erythrocytes. Keto-MCT-NC and Keto-NC did not exhibit differences regarding physicochemical parameters, including size diameters, polydispersity index, pH, Ketoprofen content, and encapsulation efficiency. However, Keto-NC, which contains rose hip oil as lipid core, decreased drug photodegradation under UVC radiation when compared to Keto-MCT-NC. KP or Keto-NC were not cytotoxic to keratinocyte cultures and produced equal edema inhibition in the acute protocol. Conversely, in the chronic protocol, Keto-NC was more effective in reducing edema (~60-70% on 7-9th days of treatment) when compared to KP (~40% on 8-9th days of treatment). This result was confirmed by histological analysis, which indicated reduction of edema and inflammatory infiltrate. A sub-therapeutic dose of Keto-NC (5 mg.kg-1) significantly reduced edema when compared to control. Finally, KP and Keto-NC exhibited similar effects on redox parameters, suggesting that the advantages associated with Ketoprofen nanoencapsulation did not involve oxidative stress pathways. The results showed that Keto-NC was more efficient than KP in reducing chronic inflammation. These data may be important for the development of strategies aiming treatment of chronic inflammatory diseases with fewer adverse effects.

Subsurface nitrate reduction under wetlands takes place in narrow superficial zones.

This study aims to investigate the depth distribution of the Nitrate Reduction Potential (NRP) on a natural and a re-established wetland. The obtained NRP provides a valuable data of the driving factors affecting denitrification, the Dissimilatory Nitrate Reduction to Ammonium (DNRA) process and the performance of a re-established wetland. Intact soil cores were collected and divided in slices for the determination of Organic Matter (OM) through Loss of Ignition (LOI) as well as Dissolved Organic Carbon (DOC) and NRP spiking nitrate in batch tests. The Nitrate Reduction (NR) was fitted as a pseudo-first order rate constant (k) from where NRPs were obtained. NR took place in a narrow superficial zone showing a dropping natural logarithmic trend along depth. The main driving factor of denitrification, besides depth, was OM. Although, DOC and LOI could not express by themselves and absolute correlation with NRP, high amounts of DOC ensured enough quantity and quality of labile OM for NR. Besides, high concentration of LOI but a scarce abundance of DOC failed to drive NR. DNRA was only important in superficial samples with high contents of OM. Lastly, the high NRP of the re-established wetland confirms that wetlands can be restored satisfactorily.

Dendritic cells phenotype fitting under hypoxia or lipopolysaccharide; adenosine 5'-triphosphate-binding cassette transporters far beyond an efflux pump.

This study examines adenosine 5'-triphosphate-binding cassette (ABC) transporters as a potential therapeutic target in dendritic cell (DC) modulation under hypoxia and lipopolysaccharide (LPS). Functional capacity of dendritic cells (DCs) (mixed lymphocyte reaction: MLR) and maturation of iDCs were evaluated in the presence or absence of specific ABC-transporter inhibitors. Monocyte-derived DCs were cultured in the presence of interleukin (IL)-4/granulocyte-macrophage colony-stimulating factor (GM-CSF). Their maturation under hypoxia or LPS conditions was evaluated by assessing the expression of maturation phenotypes using flow cytometry. The effect of ABC transporters on DC maturation was determined using specific inhibitors for multi-drug resistance (MDR1) and multi-drug resistance proteins (MRPs). Depending on their maturation status to elicit T cell alloresponses, the functional capacity of DCs was studied by MLR. Mature DCs showed higher P-glycoprotein (Pgp) expression with confocal microscopy. Up-regulation of maturation markers was observed in hypoxia and LPS-DC, defining two different DC subpopulation profiles, plasmacytoid versus conventional-like, respectively, and different cytokine release T helper type 2 (Th2) versus Th1, depending on the stimuli. Furthermore, hypoxia-DCs induced more B lymphocyte proliferation than control-iDC (56% versus 9%), while LPS-DCs induced more CD8-lymphocyte proliferation (67% versus 16%). ABC transporter-inhibitors strongly abrogated DC maturation [half maximal inhibitory concentration (IC50 ): P-glycoprotein inhibition using valspodar (PSC833) 5 µM, CAS 115104-28-4 (MK571) 50 µM and probenecid 2·5 µM], induced significantly less lymphocyte proliferation and reduced cytokine release compared with stimulated-DCs without inhibitors. We conclude that diverse stimuli, hypoxia or LPS induce different profiles in the maturation and functionality of DC. Pgp appears to play a role in these DC events. Thus, ABC-transporters emerge as potential targets in immunosuppressive therapies interfering with DCs maturation, thereby abrogating innate immune response when it is activated after ischaemia.

[Child health and nutrition in a Teréna indigenous community, Mato Grosso do Sul, Brazil]. / Nutrição e saúde infantil em uma comunidade indígena Teréna, Mato Grosso do Sul, Brasil.

This paper describes the health and nutritional situation of South American Indian children from a Teréna community, characterizing their nutritional status, food consumption, and socioeconomic and environmental conditions. The sample included 100 children, ranging from 0 to 59 months of age and living in Aldeia Córrego do Meio, Mato Grosso do Sul. Prevailing nutritional deficits were: 8.0% for the weight-for-age index, 16.0% for height-for-age, and 5.0% for weight-for-height. The growth deficit rate was higher than that of the Brazilian population as a whole, probably reflecting the precarious socioeconomic, environmental, and health conditions in this Teréna community. Analysis of the average nutrient sufficiency in the infant diet showed that nutritional recommendations for the different groups were not complied with. New studies, characterized as transdisciplinary and longitudinal, are necessary to better understand this process.

[Health and nutritional status of infants in a population of the Center-Western region of Brazil]. / Saúde e estado nutricional infantil de uma população da região Centro-Oeste do Brasil.

OBJECTIVE: To evaluate the nutritional status of infants who reside in the city of Campo Grande, State of Mato Grosso do Sul, Brazil. METHODS: The method used was that of a cross sectional household study by means of an anthropometric social survey, sampling 652 children from 0 to 59 months of age. RESULTS: A low prevalence of nutritional deficit, excepting that of height-for-age, starting in the first year of life, was found. The nutritional status proved to be influenced by the socioeconomic conditions, especially concerning per capita family income. Nearly all children started breast-feeding but were weaned during the first month. Exclusive breast-feeding is of short duration and soon replaced by infant formula. The survey of mother-child assistance demonstrated an excellent coverage of prenatal care, but inadequacy in the follow-up of the child's health at all income levels. CONCLUSIONS: The need to carry out changes in the approach to preventive actions and in the monitoring of the nutritional situation of the children, concerning the problems identified in this study in order to allow for the development of differential actions in the nutritional field has been identified.

[CAPS of Florianapolis: a group experience with psychotic clients outside the mental hospital, for 10 year]. / CAPS--florianópolis: uma experiência de grupo com clientes psicóticos fora dos muros do manicômio, durante dez anos.

It is an experience report done with chronic psychotic clients, in a process of institution disconstruction, that have been followed by a nurse in a CAPS*/NAPS from Florianópolis, during ten years, it is from 1989 to 1999. By the end of this period, it can be visualized that chronic psychotic clients, when they are in a systematic outpatient attendance with a link in a therapeutic group, can keep a reasonable health life, reaching their goals, overcoming their crises and keeping themselves out of the mental hospital.

Autism as the defusion of drives.

The author's metapsychological view of the dismantling and adhesive identification typical of infantile autism is that these phenomena result from the fate of the death drive and the libido in a situation of thoroughgoing defusion of the drives. He notes that Freud's original idea of the defused death drive was taken up by Ferenczi and then by Klein, who applied it to the situation at the very beginning of life. A clinical illustration is given and the author observes that this view has therapeutic consequences that are also relevant to the work of an institution and to the therapists' countertransference, in terms of the value of sadism and masochism in helping to fuse the drives. Fusion of the drives is presented as an important element of Bion's alpha or container function. This conception also tends to modify the therapist's attitude to the parents of autistic children. In the author's view, the fate of the libidinal component in autism has tended to be disregarded, but accounts for the phenomena of adhesiveness and auto-sensuality; the latter should in his opinion rather be called dismantled erotism, to emphasise the absence of the unifying function of forms of auto-erotism in integration of the self. The author stresses the lack of projection in autistic pathology and discusses its possible reasons.

Misoprostol intracervical vs. vaginal: características clínicas en la inducción del parto / Misoprostol intracervical or vaginal. Clinics characteristics in delivery induction

Misoprostol (Cytotec, Searle de México, S. A.), una prostaglandina sintética (PG) análoga de la E, fue administrada a 100 mujeres embarazadas durante el tercer trimestre (edad gestacional media de 39,4 semanas), en dosis de 100 mcg para la inducción del parto. La vía de administración fue vaginal (n=68) o intracervical (n=32), con una distribución aleatoria. Después de unas pocas horas, tras una aplicación única del medicamento, 95 pacientes iniciaron una labor activa de parto, otras 4 pacientes la iniciaron posterior a una segunda aplicación, 24 horas después. No se encontró alguna diferencia estadísticamente significativa con respecto al resultado del embarazo o la madurez cervical, clasificada según el puntaje de Bishop, al comparar las dos vías de administración. La edad y paridez tampoco mostraron diferencias estadísticamente significativas como factores que modularan la respuesta al medicamento. Ochenta y tres pacientes tuvieron un parto vaginal dentro de las primeras 18 horas posterior a una única aplicación del medicamento. De las 4 pacientes que recibieron una segunda dosis vaginal (n=2) o intracervical (n=2), tres tuvieron partos vaginales. La tasa global de cesáreas fue del 12 por ciento . En 4 pacientes se observaron efectos colaterales sistématicos maternos mínimos, relacionados con el medicamento. Hubo taquisistolia en 11 casos, en uno de los cuales se detectó sufrimiento agudo que se resolvió con tratamiento tocolítico. La administración local de misoprostol logró la maduración cervical y la labor de parto activa

Artificially induced menstrual cycle with natural estradiol and progesterone.

In order to study the feasibility and efficacy of using natural 17 beta-estradiol (E2) and progesterone (P) to induce endometrial changes, a group of patients with history of premature ovarian failure and bilateral oophorectomy, also interested in the embryo transfer program with donor ovum, were given transdermal E2 (Estraderm, Ciba Pharmaceutical Co., Summit, NJ), and vaginal progesterone suppositories. Serial serum E2, P, follicle-stimulating hormone, and luteinizing hormone were determined by radioimmunoassays. The dosages of E2 and P were adjusted according to the levels of E2 and P so that their changes could follow the same pattern as that of a normal spontaneous menstrual cycle. Serial ultrasonic evaluation of the endometrium and endometrial biopsy during the late luteal phase also was performed. Preliminary data indicated that transdermal E2 patches and vaginal P suppositories, while being as effective in inducing endometrial development for the embryo transfer procedure with donor ovum as synthetic steroids, can also provide a more physiologic approach that may conveniently and safely be extended into the second trimester of pregnancy.

[Place of psychoanalysis in a day hospital for psychotic little children]. / Place de la psychanalyse dans un hôpital de jour pour petits enfants psychotiques.

The authors try to draw conclusions from Winnicot's articles on the discontinous nature of emotional development. They try to understand how autism may originate in disruptions of self-non-self" attachments. However, they admit that the child's personality may develop even within such disruptions. In an experiment of intensive care in a day-hospital for autistic or psychotic children they have tried to restore these attachments in the hospital itself, through continuous care by each member of the staff, regardless of qualification or training. This continuity provides a basis for relationships which may be voiced and interpreted during the children's therapy as they share this reference experience. Its continuity makes life in the institution therapeutic in itself, even without psychoanalytic interpretations. The lack of spoken language gives rise to communication difficulties and use of an educated self is a current project. Two clinical observations exemplify the parallel work of parents and children and their reciprocal interactions. As the origin and future of these psychoses are still open questions, the possible responsibility of predisposing or initial fragilizing factors which facilitate this lasting personality organization is to be considered.