Reconfigured professional purpose in times of crisis: Experiences of frontline healthcare professionals during the COVID-19 pandemic.

How is professional purpose impacted in the context of a crisis? Building on discussions about professional purpose and identity, the paper explores how the understanding that professionals have about the framing, scope of functioning and aims of their profession is impacted during a time of crisis. The paper draws on interviews with 41 kinesiologists working at an accidents & emergencies (A&E) hospital in Chile during the COVID-19 pandemic. The paper shows professional purpose as a fluid, situated notion that gets re-shaped in light of contextual features. In the face of new and changing demands during times of crisis, professionals reconfigure their professional purpose to take advantage of the opportunities available. This reconfiguration takes place in response to the external context of the profession (its positioning in the public domain) and the internal relational context of the profession (its positioning with other professionals). The paper suggests a research agenda to develop a processual, situated approach to the interrogation of professional purpose to embed contextual features in scholarship in this area.

An in vitro method for the analysis of hemocyte-derived extracellular traps in shrimp.

The formation of extracellular traps (ETs) is a cell death mechanism relying on the release of nucleic acids in response to different stimuli. More recently, ETs have been recognized as an important cellular immune response since they are able to entrap and kill various microorganisms. The main goal was to describe a methodology to induce and visualize the in vitro formation of ETs by shrimp hemocytes. ETs formation was induced by the incubation of hemocyte monolayers from naïve shrimp (Penaeus vannamei) with a standard dose of Vibrio parahaemolyticus M0905. Following fixation, slides were stained with 4',6-diamidino-2-phenylindole (DAPI) and imaged by fluorescence microscopy. The methodology proposed in this study successfully induced the formation and release of hemocyte-derived ETs in penaeid shrimp. The procedure described here can be used as a novel immune marker to assess shrimp health status.

Marine Arthropods as a Source of Antimicrobial Peptides.

Peptide therapeutics play a key role in the development of new medical treatments. The traditional focus on endogenous peptides has shifted from first discovering other natural sources of these molecules, to later synthesizing those with unique bioactivities. This review provides concise information concerning antimicrobial peptides derived from marine crustaceans for the development of new therapeutics. Marine arthropods do not have an adaptive immune system, and therefore, they depend on the innate immune system to eliminate pathogens. In this context, antimicrobial peptides (AMPs) with unique characteristics are a pivotal part of the defense systems of these organisms. This review covers topics such as the diversity and distribution of peptides in marine arthropods (crustacea and chelicerata), with a focus on penaeid shrimps. The following aspects are covered: the defense system; classes of AMPs; molecular characteristics of AMPs; AMP synthesis; the role of penaeidins, anti-lipopolysaccharide factors, crustins, and stylicins against microorganisms; and the use of AMPs as therapeutic drugs. This review seeks to provide a useful compilation of the most recent information regarding AMPs from marine crustaceans, and describes the future potential applications of these molecules.

Changes in metabolic profiling of whiteleg shrimp (Penaeus vannamei) under hypoxic stress.

Hypoxia is a common concern in shrimp aquaculture, affecting growth and survival. Although recent studies have revealed important insights into hypoxia in shrimp and crustaceans, knowledge gaps remain regarding this stressor at the molecular level. In the present study, a gas chromatography-mass spectrometry (GC-MS)-based metabolomics approach was employed to characterize the metabolic signatures and pathways underlying responses of Pacific white shrimp (Penaeus vannamei) to hypoxia and to identify associated candidate biomarkers. We compared metabolite profiles of shrimp haemolymph before (0 h) and after exposure to hypoxia (1 & 2 h). Dissolved oxygen levels were maintained above 85 % saturation in the control and before hypoxia, and 15 % saturation in the hypoxic stress treatment. Results showed 44 metabolites in shrimp haemolymph that were significantly different between before and after hypoxia exposure. These metabolites were energy-related metabolites (e.g., intermediates of citric acid cycle, lactic acid, alanine), fatty acids and amino acids. Pathway analysis revealed 17 pathways that were significantly affected by hypoxia. The changes in metabolites and pathways indicate a shift from aerobic to anaerobic metabolism, disturbance in amino acid metabolism, osmoregulation, oxidative damage and Warburg effect-like response caused by hypoxic stress. Among the altered metabolites, lactic acid was most different between before and after hypoxia exposure and had the highest accurate value for biomarker identification. Future investigations may validate this molecule as a stress biomarker in aquaculture. This study contributes to a better understanding of hypoxia in shrimp and crustaceans at the metabolic level and provides a base for future metabolomics investigations on hypoxia.

Evaluation of immune stimulatory products for whiteleg shrimp (Penaeus vannamei) by a metabolomics approach.

The use of probiotics, prebiotics and dietary fiber has become a common practice in shrimp aquaculture as alternatives to antibiotic treatment. However, not much is known about the metabolic mechanisms underlying the effects of probiotics and immunostimulant used in shrimp aquaculture. In this study, a gas chromatography-mass spectrometry (GC-MS) based metabolomics approach was used to characterize metabolite profiles of haemolymph and gills of whiteleg shrimp (Penaeus vannamei) exposed to four treatments (cellulose fiber, probiotics with Vibrio alginolyticus, a combination of cellulose fiber and V. alginolyticus and a control treatment). The cellulose fiber was administrated as a feed additive (100 mg⋅Kg-1 feed), while the probiotics was applied in the water (105 UFC⋅mL-1 culture water). The results showed significant differences in haemolymph metabolite profiles of immune stimulated treatments compared to the control and among treatments. The combination of cellulose fiber and probiotics resulted in greater differences in metabolic profiles, suggesting a better immune stimulation with this approach. The changes in haemolymph metabolome of treated shrimp reflected several biochemical pathway modifications, including changes in amino acid and fatty acid metabolism, disturbances in energy metabolism and antimicrobial activity and stress responses. For gill tissues, significant differences were only found in lactic acid between the probiotic group and the control. Among the altered metabolites, the increases of itaconic acid in haemolymph, and lactic acid in both haemolymph and gill tissues of immune-stimulated suggest the potential use of these metabolites as biomarkers for health assessment in aquaculture.

Microbial community characterization of shrimp survivors to AHPND challenge test treated with an effective shrimp probiotic (Vibrio diabolicus).

BACKGROUND: Acute hepatopancreatic necrosis disease (AHPND) is an important shrimp bacterial disease caused by some Vibrio species. The severity of the impact of this disease on aquaculture worldwide has made it necessary to develop alternatives to prophylactic antibiotics use, such as the application of probiotics. To assess the potential to use probiotics in order to limit the detrimental effects of AHNPD, we evaluated the effect of the ILI strain, a Vibrio sp. bacterium and efficient shrimp probiotic, using metabarcoding (16S rRNA gene) on the gastrointestinal microbiota of shrimp after being challenged with AHPND-causing V. parahaemolyticus. RESULTS: We showed how the gastrointestinal microbiome of shrimp varied between healthy and infected organisms. Nevertheless, a challenge of working with AHPND-causing Vibrio pathogens and Vibrio-related bacteria as probiotics is the potential risk of the probiotic strain becoming pathogenic. Consequently, we evaluated whether ILI strain can acquire the plasmid pV-AHPND via horizontal transfer and further cause the disease in shrimp. Conjugation assays were performed resulting in a high frequency (70%) of colonies harboring the pv-AHPND. However, no shrimp mortality was observed when transconjugant colonies of the ILI strain were used in a challenge test using healthy shrimp. We sequenced the genome of the ILI strain and performed comparative genomics analyses using AHPND and non-AHPND Vibrio isolates. Using available phylogenetic and phylogenomics analyses, we reclassified the ILI strain as Vibrio diabolicus. In summary, this work represents an effort to study the role that probiotics play in the normal gastrointestinal shrimp microbiome and in AHPND-infected shrimp, showing that the ILI probiotic was able to control pathogenic bacterial populations in the host's gastrointestinal tract and stimulate the shrimp's survival. The identification of probiotic bacterial species that are effective in the host's colonization is important to promote animal health and prevent disease. CONCLUSIONS: This study describes probiotic bacteria capable of controlling pathogenic populations of bacteria in the shrimp gastrointestinal tract. Our work provides new insights into the complex dynamics between shrimp and the changes in the microbiota. It also addresses the practical application of probiotics to solve problems with pathogens that cause high mortality-rate in shrimp farming around the world. Video Abstract.

New records of Demospongiae (Porifera) from Reserva Marina El Pelado (Santa Elena, Ecuador), with description of Tedania (Tedania) ecuadoriensis sp. nov.

The first taxonomic descriptions of the sponge diversity at El Pelado Marine Protected Area in the province of Santa Elena, Ecuador is reported. Tedania (Tedania) ecuadoriensis Jaramillo & Hajdu, sp. nov. is described from its shallow waters. In addition, Callyspongia (Callyspongia) aff. californica (sensuCruz-Barraza and Carballo 2008; non sensuDickinson 1945) and Cliona aff. euryphylle are reported for the first time. The former species is likely distributed over 4,000 km along the Tropical Eastern Pacific, whereas the latter might be an example of a trans-isthmian lineage. An amended diagnosis for Callyspongia (Callyspongia) and an updated identification key for the subgenera of Callyspongia are provided.

Surgeon and patient perceptions of cure in advanced gastrointestinal malignancies: Are we on the same page?

BACKGROUND AND OBJECTIVES: Effective communication is essential to complex shared decision making and is associated with improved recovery and pain control. However, patients and surgeons often have disparate expectations of treatment efficacy and perceptions of cure for advanced malignancies. This study measures correlation of patient and surgeon expectations with perceptions of cure. METHODS: Our prospective study surveying surgeon-patient dyads before and after surgical consultation was performed for advanced abdominal malignancy between July and November 2017 at a single NCI designated cancer center using electronic questionnaires. RESULTS: Patients and surgeons' own opinions regarding surgical candidacy (Q1), chance at cure (Q2), and life expectancy (Q3) did not measurably change from pre- to postvisit survey as evidenced by unchanged response concordance (patients Q1 P = .82; Q2 P = .81; and Q3 P = .53; surgeon responses Q1: P = .17; Q2: P = .32; and Q3: P = .50). Patient and surgeon perception of likelihood of cure and of estimated life expectancy remained discordant in pre- and postvisit surveys (Q2: P = .006 and Q3: P = .03). CONCLUSIONS: These data highlight the stark differences between patient and surgeon perceptions of cure and prognosis of gastrointestinal cancers. These results prove that a larger scale study using this electronic questionnaire is feasible and important to better understand these differences and enhance shared decision making.

Expression of CD20 after viral reactivation renders HIV-reservoir cells susceptible to Rituximab.

The identification of exclusive markers to target HIV-reservoir cells will represent a significant advance in the search for therapies to cure HIV. Here, we identify the B lymphocyte antigen CD20 as a marker for HIV-infected cells in vitro and in vivo. The CD20 molecule is dimly expressed in a subpopulation of CD4-positive (CD4+) T lymphocytes from blood, with high levels of cell activation and heterogeneous memory phenotypes. In lymph node samples from infected patients, CD20 is present in productively HIV-infected cells, and ex vivo viral infection selectively upregulates the expression of CD20 during early infection. In samples from patients on antiretroviral therapy (ART) this subpopulation is significantly enriched in HIV transcripts, and the anti-CD20 monoclonal antibody Rituximab induces cell killing, which reduces the pool of HIV-expressing cells when combined with latency reversal agents. We provide a tool for targeting this active HIV-reservoir after viral reactivation in patients while on ART.

Halogenated Tyrosine Derivatives from the Tropical Eastern Pacific Zoantharians Antipathozoanthus hickmani and Parazoanthus darwini.

In the search for bioactive marine natural products from zoantharians of the Tropical Eastern Pacific, four new tyrosine dipeptides, named valdiviamides A-D (1-4), were isolated from Antipathozoanthus hickmani, and two new tyramine derivatives, 5 and 6, from Parazoanthus darwini. The phenols of all six tyrosine derivatives are substituted by bromine and/or iodine atoms at the ortho positions of the hydroxyl. The planar structures of these aromatic alkaloids were elucidated from 1D and 2D NMR experiments in combination with HRESIMS data, and the absolute configurations of 1-4 were deduced from comparison between experimental and calculated electronic circular dichroism spectra. As halogenated tyrosine derivatives could represent chemotaxonomic markers of these genera, we decided to undertake the first chemical investigation of another species, Terrazoanthus cf. patagonichus. As expected, no halogenated metabolite was evidenced in the species, but we report herein the identification of two new zoanthoxanthin derivatives, named zoamides E (7) and F (8), from this species. Antimicrobial and cytotoxicity bioassays revealed that valdiviamide B (2) displayed moderate cytotoxicity against the HepG2 cell line with an IC50 value of 7.8 µM.

EGFR exon 20 insertion in lung adenocarcinomas among Hispanics (geno1.2-CLICaP).

OBJECTIVES: Contrasting other EGFR mutations (EGFRm) in lung adenocarcinomas, insertions in exon 20 (exon20ins) are generally associated with resistance to targeted therapy, limiting therapeutic options and impoverishing the prognosis compared to other EGFRm. We sought to extensively characterize exon20ins from a large cohort of lung adenocarcinomas in Hispanic patients. MATERIALS AND METHODS: This was a region-wide, observational longitudinal cohort study to evaluate characteristics and outcomes of patients with exon20ins in lung adenocarcinoma, based on a secondary analysis of electronic records from the Geno1.2-CLICaP Platform and extended genotype testing. Patients from six Latin-American countries were included (Argentina, Colombia, Costa Rica, Ecuador, Panama, and Mexico). Data obtained included the molecular spectrum (extended genotyping for mutations in BRAF, NRAS, PIK3CA, Her2 and MEK1, as well as for EGFR amplification, ALK and PD-L1 protein expression), clinic-pathologic characteristics, prevalence and outcomes to therapeutic approach. RESULTS AND CONCLUSIONS: 4.005 patients diagnosed with stage III/IV lung adenocarcinoma from 2011 to 2016 were initially screened. Among these, 88 patients had a confirmed exon20 in. and were included; median age was 66-years, 62.5% were females, 64% were never smokers and 39% presented with brain metastases. The H773insH variant was the most frequent, making up 21.6% of cases. A common EGFRm was concomitantly found in 36.4% (del19/L858R), and 8% (G719X/L861Q/S768I) of cases. Five cases had additional mutations in PI3K, KRAS and MEK1, 26% had EGFR amplification and 81.7% had PD-L1 expression 1-50%. Overall response rate to first-line therapy was 28% and overall survival was 16.4 months. Prognosis was positively influenced by the concomitant presence of common EGFRm and response to first-line. Our results suggest that patients with EGFR exon20ins have similar clinical characteristics to those with common EGFRm but a poorer prognosis. Last, the mean PD-L1 expression in this population seems higher than for patients with common EGFRm.

Callyspongidic Acids: Amphiphilic Diacids from the Tropical Eastern Pacific Sponge Callyspongia cf. californica.

The first chemical study of the marine sponge Callyspongia cf. californica widely distributed along the coasts of the Tropical Eastern Pacific led to the identification of a new family of amphiphilic derivatives called callyspongidic acids. The four isolated metabolites 1-4 feature a hydrophilic diacid end opposed to both an aromatic moiety and a long alkyl chain. They were evaluated against a panel of pathogenic microbes and seven tumoral cell lines, displaying moderate inhibitory properties against the A2058 melanoma cell line with an IC50 of 3.2 µM for callyspongidic acid C13:0 (2).

Evaluación de la calidad de la atención estomatológica de dos servicios de Estomatología General Integral. Sancti Spíritus. 2018 / Evaluation of the quality of dental care of two General Comprehensive Stomatology services. Sancti Spíritus. 2018

RESUMEN Fundamento: La calidad de la atención estomatológica está caracterizada en el proceso y factores que intervienen en la prestación de los servicios, dirigidos a alcanzar buenos resultados en lo que a salud bucal se refiere. Objetivo: Evaluar la calidad de la atención estomatológica de dos servicios de Estomatología General Integral de la provincia Sancti Spíritus. Metodología: Se Realizó una investigación en sistema y servicio de salud en la provincia Sancti Spíritus de enero a noviembre del 2016. De las 21 unidades asistenciales que prestan el servicio de Estomatología General Integral, se eligieron dos, una de la zona urbana y otra de la zona rural. El muestreo aleatorio simple fue el proceder que se empleó para efectuar esta elección en cada zona. El Policlínico Tipo II del municipio Cabaiguán fue la unidad seleccionada en la zona urbana y la Clínica Estomatológica Banao del municipio Sancti Spíritus en la zona rural. La muestra fueron 388 pacientes y 24 estomatólogos. Las variables: calidad del servicio, estructura, proceso y resultado, se utilizaron métodos del nivel teórico, empírico (encuesta) y de la estadística descriptiva. Resultados: En el servicio rural los pacientes estuvieron satisfechos en un 57.8 % y en el urbano en un 51.9 %; los profesionales se mostraron medianamente satisfechos en ambos servicios con 50.0 % y 71.4 % respectivamente. Conclusiones: La calidad de la atención estomatológica en la zona urbana fue evaluada de bien y en la rural de regular. Algunos indicadores de las variables estructura y resultado se identificaron con dificultad.

ABSTRACT Background: The quality of dental care is characterized in the process and factors that interfere in the provision of services, aimed at achieving good results in terms of oral health. Objective: To evaluate the quality of dental care of two General Comprehensive Stomatology services in Sancti Spíritus province. Methodology: An investigation was carried out on the system and health service in Sancti Spíritus province from January to November 2016. From 21 health care units that provide General Comprehensive Stomatology service, two were chosen, one from the urban area and the other from the rural one. The procedure used to make this choice in each zone was the Simple random sample. The Type II Polyclinic in Cabaiguán was the selected unit from the urban area and the Dental Clinic Banao in Sancti Spíritus, from the rural one. The sample consisted of 388 patients and 24 dentists. The variables: quality of service, structure, process and result, methods of theoretical, empirical (survey) and descriptive statistics were used. Results: From the rural service the patient's satisfaction represents 57.8 % and from the urban one 51.9 %; the professional's satisfaction was moderately in both services which represent 50.0 % and 71.4 % respectively. Conclusions: The quality of dental care from the urban area was evaluated as good and from the rural area as regular. Some indicators of the structure and outcome variables were identified with difficulty.

Zoanthamine Alkaloids from the Zoantharian Zoanthus cf. pulchellus and Their Effects in Neuroinflammation.

Two new zoanthamine alkaloids, namely 3-acetoxynorzoanthamine (1) and 3-acetoxyzoanthamine (2), have been isolated from the zoantharian Zoanthus cf. pulchellus collected off the coast of the Santa Elena Peninsula, Ecuador, together with three known derivatives: zoanthamine, norzoanthamine, and 3-hydroxynorzoanthamine. The chemical structures of 1 and 2 were determined by interpretation of their 1D and 2D NMR data and comparison with literature data. This is the first report of zoanthamine-type alkaloids from Zoanthus cf. pulchellus collected in the Tropical Eastern Pacific. The neuroinflammatory activity of all the isolated compounds was evaluated in microglia BV-2 cells and high inhibitory effects were observed in reactive oxygen species (ROS) and nitric oxide (NO) generation.

Assessing the Zoantharian Diversity of the Tropical Eastern Pacific through an Integrative Approach.

Zoantharians represent a group of marine invertebrates widely distributed from shallow waters to the deep sea. Despite a high diversity and abundance in the rocky reefs of the Pacific Ocean, very few studies have been reported on the diversity of this group in the Tropical Eastern Pacific coasts. While molecular techniques recently clarified some taxonomic relationships within the order, the taxonomy of zoantharians is still highly challenging due to a lack of clear morphological characters and confusing use of different data in previous studies. Our first insight into the zoantharian diversity at El Pelado Marine Protected Area - Ecuador led to the identification of six species: Terrazoanthus patagonichus; Terrazoanthus sp.; Antipathozoanthus hickmani; Parazoanthus darwini; Zoanthus cf. pulchellus; and Zoanthus cf. sociatus. A metabolomic approach using UHPLC-HRMS was proven to be very efficient as a complementary tool in the systematics of these species and specialized metabolites of the ecdysteroid and alkaloid families were identified as key biomarkers for interspecific discrimination. These results show good promise for an application of this integrative approach to other zoantharians.

Ecdysonelactones, Ecdysteroids from the Tropical Eastern Pacific Zoantharian Antipathozoanthus hickmani.

Despite a large occurrence, especially over the Pacific Ocean, the chemical diversity of marine invertebrates belonging to the order Zoantharia is largely underexplored. For the two species of the genus Antipathozoanthus no chemical study has been reported so far. The first chemical investigation of Antipathozoanthus hickmani collected at the Marine Protected Area "El Pelado", Santa Elena, Ecuador, led to the isolation of four new ecdysteroid derivatives named ecdysonelactones. The structures of ecdysonelactones A-D (1-4) were determined based on their spectroscopy data, including 1D and 2D NMR and HRMS. The four compounds of this family of ecdysteroids feature an unprecedented γ-lactone fused at the C-2/C-3 position of ring A. These derivatives exhibited neither antimicrobial nor cytotoxic activities.

A simple in vitro method to evaluate the toxicity of functional additives used in shrimp aquaculture.

To mitigate the economic losses provoked by disease outbreaks, shrimp producers employ therapeutic additives. However, important issues such as the toxicity of these products on shrimp are not always considered. In vivo toxicity assays require a lot of time and large economic and physical resources. Here, we describe an in vitro procedure to evaluate the toxicity of functional additives, used in the production of shrimp Penaeus vannamei. This method adapted the cell viability assay based on the reduction of tetrazolium salts (MTT) to primary cell cultures of shrimp hemocytes. •A simple and reliable tool that requires few physical and economic resources to evaluate in short time (6 h) the cytotoxic effect of therapeutic products and additives to be included in shrimp culture•This inexpensive method requires only a modified Hank's balanced salt solution (HBSS) containing Ca2+ and Mg2+ to keep hemocytes metabolically active to successfully carry out the cytotoxicity assay•This toxicity in vitro assay does not require exposure of the shrimp to compounds at toxic concentrations.

Terrazoanthines, 2-Aminoimidazole Alkaloids from the Tropical Eastern Pacific Zoantharian Terrazoanthus onoi.

The first chemical study of the common species Terrazoanthus onoi, present off the coast of Ecuador, led to the identification of a new family of 2-aminoimidazole alkaloids named terrazoanthines A-C (1-3). Homologues 1 and 2 feature an unprecedented 6-(imidazol-5-yl)benzo[d]imidazole. Acyl substitution pattern and complete configurational assignments were deduced from comparison between experimental and theoretical 13C NMR and ECD data, respectively. These compounds may represent key derivatives in the biosynthesis of zoanthoxanthins.

Mejores prácticas para el lavado y manipulación de la bolsa de alimentación enteral Kangaroo / Best practices for washing and handling of the bag Kangaroo enteral feeding / Melhores práticas para a lavagem e manuseio do saco alimentação enteral Kangaroo

ResumenIntroducción: La nutrición enteral es una valiosa herramienta en la terapia de los pacientes hospitalizados, especialmente en las unidades de cuidado intensivo y en pacientes que, por sus patologías, pierden su habilidad de ingerir alimentos.Metodología: se aplicó la metodología que señala la práctica clínica basada en evidencia (PCBE) que trata de localizar hallazgos que respondan a la pregunta clínica planteada mediante el estudio y análisis de investigaciones primarias y originales de alta calidad científica.Resultados: Ningún estudio respondió directamente a la pregunta, sin embargo, varias investigaciones aluden que el lavado de manos y el uso de guantes limpios funcionan como estrategia para la manipulación y lavado de este dispositivo. La calidad de los estudios encontrados es baja ya que provienen de investigaciones basadas en la opinión de expertos y revisión de literatura de poca calidad.Conclusiones:No se encuentra evidencia significativa que respalde el uso de técnica aséptica médica y quirúrgica para el manejo y lavado de la bolsa Kangaroo de alimentación enteral.

AbstractIntroduction. Enteral nutrition is a valuable tool in the therapy of hospitalized, especially in intensive care units, and patients for their diseases lose their ability to ingest food patients.Method. The methodology pointing evidence-based clinical practice (PCBE) dealing with the study and analysis of primary and original research of high scientific quality, locating findings that respond to the clinical question posed was applied.Results. No study directly answer the question, however, several investigations allude to the fact that washing hands and using clean gloves as a strategy for handling and washing of this device. The quality of the studies found is low because they come from research based on expert opinion and literature review of low quality.Conclusion. No significant evidence to support the use of medical and surgical aseptic technique for handling and washing Kangaroo Enteral feed bag was found.

ResumoIntrodução.Enteral nutrition é uma ferramenta valiosa na terapia de hospitalizadas, especialmente em unidades de cuidados intensivos, e os pacientes para suas doenças perdem a sua capacidade de ingerir alimentos pacientes.Método. A metodologia apontando prática clínica baseada em evidências (PCBE) lidar com o estudo e análise de pesquisa primária e original de elevada qualidade científica, localização de resultados que respondam à questão clínica proposta foi aplicada.Resultado. Nenhum estudo responder diretamente a questão, no entanto, várias investigações fazem alusão ao fato de que lavar as mãos e usar luvas limpas como uma estratégia para a manipulação e lavagem deste dispositivo. A qualidade dos estudos encontrados é baixa, porque eles vêm de uma pesquisa com base em opinião de especialistas e revisão da literatura de baixo qualidade.Conclusão.Nenhuma evidência significativa para apoiar o uso da técnica médica e cirúrgica asséptica para manusear e lavar o saco de alimentação Canguru Enteral foi encontrado.