Phytochemical analysis, toxicity and evaluation of antioxidant and antimicrobial activities of leaves of Dipteryx alata Vogel.

In this study, our objective was to conduct a comprehensive phytochemical analysis, determine toxicity levels, and assess the antioxidant and antimicrobial properties of extracts derived from the leaves of Dipteryx alata Vogel, a native species of the Brazilian cerrado flora. Three distinct extracts were prepared utilizing assisted ultrasound and the Soxhlet apparatus, namely, Ultrasound Crude Extract (UCE), Soxhlet Crude Extract (SCE), and the Soxhlet Ethanol Extract (SEE). The phytochemical analysis revealed the presence of flavonoids, tannins, phytosterols, and saponins in all extracts. Additionally, alkaloids were specifically identified in the SCE and SEE extracts. In the analysis using LC-DAD, the compounds gallic acid, rutin, quercetin, luteolin and kampefrol were determined in higher concentrations in the SCE, followed by the SEE and UCE, respectively. The GC-MS analysis revealed the presence of campesterol, stigmasterol and ß-sitosterol in all extracts, with UCE and SCE showing a higher concentration of ß-sitosterol. SCE showed the highest concentration of all identified compounds. In the analysis of antioxidant activity by DPPH• and ABTS•+, SEE showed greater efficiency (IC50 = 2.98 ± 2.92 and 6.57 ± 0.89 µg/mL, respectively). In the toxicity test with Allium cepa, all extracts stimulated root growth at 50 g/mL; UCE and SEE stimulated root growth at 250 g/mL; and SEE inhibited root growth at 750 g/mL. In the Artemia salina toxicity, all extracts were non-toxic. Antibacterial activity was identified in the microorganisms S. aureus and S. mutans; however, the extracts did not show antifungal action against the strain of C. albicans. The extracts of D. alata have therapeutic potential for applicability in dentistry.

North Central Asia isotopic database for archaeological samples.

The North Central Asia Isotopic Database (NCAID) is an open-access dataset of stable isotope measurements from archaeological remains, spanning from the Early Neolithic until present-day in North Central Asia. With 3,143 individual entries corresponding to data accumulated over more than 20 years of research, this comprehensive dataset encompasses measurements of stable carbon and nitrogen isotopes in organic fractions from archaeological humans, animals, and plants. NCAID incorporates diverse supporting information, providing geographical information, archaeological context descriptions, and chronology. This resource facilitates research into past human lifeways, paleo-environments/climates, and animal management practices throughout North Central Asia and will be continually updated as more novel data is released.

Transoral versus transfacial surgical approach to maxillary tumors: evaluation of outcomes and perspectives.

Neoplasms of the maxilla have multiple different origins and histology, and often extend towards the infratemporal fossa, orbit, or skull base. Extensive resection may be required, often leading to poor esthetic and functional results. Usually, these lesions are removed via a transfacial approach. The aim of this study was to compare the outcomes of the transoral versus transfacial approach for maxillary tumors. A single-institution retrospective study was conducted on patients with maxillary-midface tumors, treated between January 2009 and December 2019. The patients were divided into two groups according to the surgical approach, transfacial or transoral, and the following outcomes were assessed: extent of the resection based on Brown's classification; postoperative pathology margin assessment; reconstruction technique; esthetic/functional results. A total of 178 patients were included. A satisfactory resection was obtained in both groups, with the transoral cohort achieving a higher rate of clear oncological margins (positive margins: transoral group 3.7% versus transfacial group 6.8%, P = 0.389) and a significantly higher University of Washington Quality of Life score (mean 72.2 versus 67.8, P < 0.001). Even large and invasive tumors can be treated successfully with the transoral approach, avoiding unesthetic facial scars while still providing complete resection of the tumor.

Volumetric changes in post hemiglossectomy reconstruction with anterolateral thigh free flap versus radial forearm free flap.

The volume of the reconstructed tongue is considered a critical factor for tongue function. Studies investigating the difference in volume loss between the anterolateral thigh free flap (ALTF) and radial forearm free flap (RFFF) used in reconstruction of the tongue after hemiglossectomy are lacking. The aim of this study was to determine whether there is a significant difference in shrinkage between these two flaps. This was a retrospective study of all patients treated for tongue cancer by hemiglossectomy who underwent either ALTF or RFFF reconstruction at the University of Florida College of Medicine between January 2018 and April 2022. Computed tomography scans were used to measure the volumetric changes in the ALTF and RFFF at two time points over a 6-month period. Of the 85 patients assessed, 10 fulfilled the inclusion criteria: five were reconstructed with an ALTF and five with a RFFF. All underwent adjuvant radiotherapy. The mean ALTF percentage shrinkage was 39.6% ± 3.9%, while for the RFFF it was 51.1% ± 6.2% (P = 0.008). Therefore, it is recommended that the difference in volume loss between the two flaps is taken into consideration. It is suggested that in hemiglossectomy cases, the ALTF is made 1.4 times larger than the defect, while the RFFF is made 1.5 times larger.

Parkia from Cerrado: phytochemical bioprospection, toxicity and in vitro bioactivities of bark and flower extracts.

Parkia platycephala is the only species of the genus Parkia that is endemic to the brazilian Cerrado and the tree symbol of the state of Tocantins, but there are still few studies regarding its bioprospecting. In this study, we aimed to investigate the phytochemical composition, toxicity and bioactivities of the bark and flower of Parkia platycephala. Hot sequential extractions (Soxhlet) were performed using methanol and hydroethanolic solution (70%), after degreasing the sample (hexane). The presence of flavonoids, tannins, steroids and alkaloids was detected in the preliminary screening. Trilinolein, (Z)-9-octadecenamide, 3-O-methyl-d-glucose were detected by Gas Chromatography coupled to Mass Spectrometry (GC-MS). In the Liquid Chromatography with Diode Array Detector (LC-PDA) analysis, it was detected exclusively ferulic acid (bark) and ellagic acid (flower). The ethanolic extract of the bark (IC50=10.69 ± 0.35 µgmL-1) has an antioxidant potential (DPPH• radical) higher than that of the rutin standard (IC50=15.85 ± 0.08 µgmL-1). All extracts showed excellent anticholinesterase potential (Ellman), with emphasis on the ethanol extract of the flower (IC50 =5.34 ± 0.12 µgmL-1). Regarding toxicity (Artemia salina), the methanolic extract of the bark and the ethanolic extract of the flower presented high and moderate levels, respectively. Such results limit the concentrations of biological activities in this study, however, the antioxidant and anticholinesterase indices fall short of toxicity. The results demonstrated promising antioxidant and anticholinesterase activities of both the bark and the flower of Parkia platycephala.

Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression.

Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient's clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.

Inhibition, Attentional Control and Binding Abilities in Relation to Dissociative Symptoms Among PTSD Patients.

INTRODUCTION: The relationship between dissociation and cognitive abilities remains controversial. Empirical studies have reported positive, negative and non-existent associations between dissociation and cognition. These inconsistent results may be due to the fact that the studies focused mainly on trait dissociation, while dissociation is not stable but transient. After validating the French version of the Clinician Administered Dissociative States Scale (CADSS), the aim of the present study was to evaluate the relationship between state dissociation and cognitive abilities. METHOD: We recruited 83 patients suffering from post-traumatic stress disorder (PTSD) and assessed them twice. At T1, they performed a neutral Stroop task and a neutral binding task. At T2 (one to three weeks later), after a script-driven dissociative induction, they performed an emotional Stroop task and an emotional binding task. Between the two sessions, they completed questionnaires at home evaluating PTSD severity, trait dissociation and cognitive difficulties. State dissociation was assessed at T1 and T2 using the Clinician-Administered Dissociative States Scale (CADSS). RESULTS: We found good psychometric properties of the French version of the CADSS. After inducing dissociation, significantly lower attentional performance was found among patients with than without dissociative reactions. We found a significant positive correlation between state dissociation and increased attention and memory difficulties after induction. CONCLUSION: The French version of the CADSS is a reliable and valid tool to assess state dissociation, which is correlated with attentional difficulties. Attentional training is recommended to help patients control dissociative symptoms.

The monodominance of Acuri in Pantanal formations: allelochemical effects of its leaves and the presence of Acurizais.

The presence of monodominant vegetative formations almost exclusively composed of Acuri palm trees (Attalea phalerata) stands out in some regions of the Pantanal Sul-Mato-Grossense. These formations are generally associated with anthropic, edaphic and/or hydrological factors. However, little is known about the effect of allelopathy on the formation and maintenance of these areas. Herein, we investigated the chemical composition of A. phalerata aqueous leaf extract and the potential allelopathic effects on germination and growth of target L. sativa, L. esculentum and S. obtusifolia species. Thus, extracts at concentrations of 0, 2.5, 5, 10, 15, and 20% were used for germination and growth bioassays with a completely randomised design in a germination chamber and greenhouse. The results showed that the A. phalerata extracts negatively affected the germination speed index and mean germination time of the target species and positively affected seedling length under controlled conditions and were also stimulated in the greenhouse. Thus, the formation of Acurizals can be related to the presence of secondary metabolites in the leaves, in addition to other environmental factors.

Tunable unconventional kagome superconductivity in charge ordered RbV3Sb5 and KV3Sb5.

Unconventional superconductors often feature competing orders, small superfluid density, and nodal electronic pairing. While unusual superconductivity has been proposed in the kagome metals AV3Sb5, key spectroscopic evidence has remained elusive. Here we utilize pressure-tuned and ultra-low temperature muon spin spectroscopy to uncover the unconventional nature of superconductivity in RbV3Sb5 and KV3Sb5. At ambient pressure, we observed time-reversal symmetry breaking charge order below [Formula: see text] 110 K in RbV3Sb5 with an additional transition at [Formula: see text] 50 K. Remarkably, the superconducting state displays a nodal energy gap and a reduced superfluid density, which can be attributed to the competition with the charge order. Upon applying pressure, the charge-order transitions are suppressed, the superfluid density increases, and the superconducting state progressively evolves from nodal to nodeless. Once optimal superconductivity is achieved, we find a superconducting pairing state that is not only fully gapped, but also spontaneously breaks time-reversal symmetry. Our results point to unprecedented tunable nodal kagome superconductivity competing with time-reversal symmetry-breaking charge order and offer unique insights into the nature of the pairing state.

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

Self-inflicted craniomaxillofacial gunshot wounds: management, reconstruction, and outcomes.

Suicide by firearm remains one of the leading causes of violence-related injury death in the United States each year. The mortality rate from these injuries is high, resulting in a paucity of outcome data in the literature regarding injuries to the maxillofacial region. This has largely been attributed to a lack of funding for research in this area compared to other leading causes of mortality in the United States. The aim of this study was to detail the authors' experience and approach to complex maxillofacial reconstruction using both local reconstructive methods and microvascular free tissue transfer. A retrospective cohort study was designed, including patients who sustained self-inflicted gunshot wounds to the maxillofacial region between January 1, 2012 and May 1, 2020. Forty-one patients met the inclusion criteria. The majority of the patients were male (87.8%). Mean patient age was 44.2 ± 16.6 years. Alcohol or drugs, and a psychiatric history were present in a majority of the cases. The most involved anatomical region was the midface (75.6% of cases). Seven patients required free tissue transfer for reconstruction, with many needing multiple flaps. Self-inflicted gunshot wounds represent challenging reconstruction scenarios, often in the setting of severe psychological trauma, and require a multidisciplinary team to ensure the optimal outcome.

A proteção dos dados médicos e o acesso à informação de saúde em Portugal à luz do Regulamento (UE) 2016/679 / The protection of medical data access to health information in Portugal under (EU) Regulation 2016/679 / La protección de datos médicos y el acceso a la información sanitaria en Portugal según el Reglamento (UE) 2016/679

Objetivo: analisar a legislação e as principais questões pertinentes ao armazenamento das informações relativas à saúde do paciente em bancos de dados, bem como as exceções ao dever de sigilo, à luz do Regulamento (UE) 2016/679 (novo Regulamento Geral de Proteção de Dados) e da Lei n.º 58/2019. Metodologia: por meio de uma revisão legislativa e doutrinária, confrontamos os dispositivos que abordam o direito à privacidade do paciente, a proteção do sigilo médico e o acesso de dados, analisando as exceções ao dever de sigilo que decorrem da lei e dos estatutos das ordens profissionais que tutelam o exercício das profissões. Resultados: a dispersão das normas que tratam a proteção de dados pode criar obstáculos à efetivação do direito e dúvidas acerca da interpretação do novo Regulamento Geral de Proteção de Dados. Conclusão: o novo Regulamento e a Lei n.º 58/2019 têm o escopo de sistematizar a matéria concernente à proteção dos dados, mas deverão ser confrontadas com a legislação interna portuguesa que aborde outras questões transversais, a exemplo das tratadas na Lei de Bases da Saúde em Portugal, no Regime Geral dos Arquivos e do Património Arquivístico, dentre outros, o que implica uma dificuldade acrescida ao utilizador do direito.

Objective: to analyze legislation and key issues related to the storage of patient data in databases and exceptions to confidentiality under Regulation (EU) 2016/679 (new General Data Protection Regulation) and Law No. 58/2019.Methods: through a review of legislation and doctrine, we contrast the provisions that address the patient's right to privacy, the protection of medical secrecy, and access to data, and analyze the exceptions to confidentiality arising from the law and the statutes of the professional codes that protect the practice of the professions. Results: the scattering of norms dealing with data protection may lead to obstacles in the realization of the right to data protection and to doubts in the interpretation of the new Regulation. Conclusion: the new Regulation and Law No. 58/2019 are suitable to systematize data protection. However, they must be confronted with Portuguese legislation that deals with other cross-cutting issues, such as the Portuguese Basic Health Law, the General Archives Law and others, which creates additional difficulties for the user of the law.

Objetivo: analizar la legislación y las principales cuestiones relevantes para el almacenamiento de información relacionada con la salud del paciente en bases de datos, así como las excepciones a la obligación de secreto, de acuerdo con el Reglamento (UE) 2016/679 (nuevo Reglamento General de Protección de Datos) y la Ley n.° 58/2019. Metodología: a través de una revisión legislativa y doctrinaria, confrontamos las disposiciones que atienden el derecho a la intimidad del paciente, la protección del secreto médico y el acceso a los datos, analizando las excepciones al deber de secreto, que se derivande la ley y los estatutos que protegen el ejercicio de las profesiones. Resultados: la dispersión de normas que tratan de la protección de datos puede generar obstáculos para la realización del derecho a la protección de datos y dudas sobre la interpretación del Reglamento. Conclusión: el Nuevo Reglamento y la Ley n.º 58/2019 tienen el alcance de sistematizar la materia relativa a la protección de datos, pero deben confrontarse con la legislación interna portuguesa que aborda otras cuestiones transversales, como las tratadas en el Ley de Salud en Portugal, en el Régimen General de Archivos, entre otros, lo que implica una dificultad añadida para el usuario del derecho.

Insights for Alzheimer's disease pharmacotherapy and current clinical trials.

Over the years, the scientific community has sought improvements in the life quality of patients diagnosed with Alzheimer's disease (AD). Synaptic loss and neuronal death observed in the regions responsible for cognitive functions represent an irreversible progressive disease that is clinically characterized by impaired cognitive and functional abilities, along with behavioral symptoms. Currently, image and body fluid biomarkers can provide early dementia diagnostic, being it the best way to slow the disease's progression. The first signs of AD development are still complex, the existence of individual genetic and phenotypic characteristics about the disease makes it difficult to standardize studies on the subject. The answer seems to be related between Aß and tau proteins. Aß deposition in the medial parietal cortex appears to be the initial stage of AD, but it does not have a strong correlation with neurodegeneration. The strongest link between symptoms occurs with tau aggregation, which antecede Aß deposits in the medial temporal lobe, however, the protein can be found in cognitively healthy older people. The answer to the question may lie in some catalytic effect between both proteins. Amid so many doubts, Aducanumab was approved, which raised controversies and results intense debate in the scientific field. Abnormal singling of some blood biomarkers produced by adipocytes under high lipogenesis, such as TNFα, leptin, and interleukin-6, demonstrate to be linked to neuroinflammation worsens, diabetes, and also severe cases of COVID-19, howsoever, under higher lipolysis, seem to have therapeutic anti-inflammatory effects in the brain, which has increasingly contributed to the understanding of AD. In addition, the relationship of severe clinical complications caused by Sars-CoV-2 viral infection and AD, go beyond the term "risk group" and may be related to the development of dementia long-term. Thus, this review summarized the current emerging pharmacotherapies, alternative treatments, and nanotechnology applied in clinical trials, discussing relevant points that may contribute to a more accurate look.

Uniaxial Strain Control of Bulk Ferromagnetism in Rare-Earth Titanates.

The perovskite rare-earth titanates are model Mott insulators with magnetic ground states that are very sensitive to structural distortions. These distortions couple strongly to the orbital degrees of freedom and, in principle, it should be possible to tune the superexchange and the magnetic transition with strain. We investigate the representative system (Y,La,Ca)TiO_{3}, which exhibits low crystallographic symmetry and no structural instabilities. From magnetic susceptibility measurements of the Curie temperature, we demonstrate direct, reversible, and continuous control of ferromagnetism by influencing the TiO_{6} octahedral tilts and rotations with uniaxial strain. The relative change in T_{C} as a function of strain is well described by ab initio calculations, which provides detailed understanding of the complex interactions among structural, orbital, and magnetic properties in rare-earth titanates. The demonstrated manipulation of octahedral distortions opens up far-reaching possibilities for investigations of electron-lattice coupling, competing ground states, and magnetic quantum phase transitions in a wide range of quantum materials.

Contrasting opioid use for pain management in microvascular head and neck reconstruction: an international study.

Opioids are often the mainstay of postoperative pain management, despite strong evidence of their ill effects and potential for long-term addiction. The goal of this study was to quantify opioid use and contrast pain management strategies of multiple international institutions performing fibula free flap reconstruction. A retrospective multicenter cohort study was designed, including five international centers. For inclusion, the patients had to have undergone a primary fibula free flap reconstruction of the mandible. A total of 185 patients were included. The median opioid use across all centers at 72 hours was 133 oral morphine equivalents. The highest utilization was in the USA (P < 0.001), which was approximately six times that of Italy, four times that of Argentina, and twice that of India, despite all centers performing a similar procedure. Based on this study there are clear differences in prescribing practices and ideologies among surgeons from different countries.

Trimethylamine N-oxide reduction is related to probiotic strain specificity: A systematic review.

Cardiovascular diseases (CVDs) represent the leading cause of death in individuals worldwide. Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) can be metabolized from phosphatidylcholine, choline, and l-carnitine and may play an important role in CVD etiology. Thus, this systematic review aimed to evaluate the effect of probiotics to mitigate TMAO concentrations by gut microbiota modulation. A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol from databases: PubMed, Web of Sciences, CENTRAL, and Scopus. Controlled intervention studies published until January 3, 2022, with a population at cardiovascular risk were included. The risk of bias was assessed by RoB 2.0 and SYRCLE's for humans and animals' studies, respectively. The search in the database returned 5389 studies, of which 8 matched all criteria to final qualitative analysis. Four studies were controlled trials with humans (total population = 115) and 4 were animal model studies. The body of evidence on the use of probiotics to reduce TMAO concentrations shows that only a few strains have this beneficial effect. This review can conclude that Lactobacillus rhamnosus GG were the most efficient strains in reducing the plasma TMAO level in both humans and animals. In addition, it is worth mentioning the promising character of Lactobacillus plantarum ZDY04, Lactobacillus amylovorus LAM 1345, Lactiplantibacillus plantarum LP1145, and Enterobacter aerogenes ZDY01 for having had the same effect in animals.

A atuação da equipe multiprofissional em um paciente idoso cardiopata em cuidados paliativos no hospital / The performance of the multiprofessional team in an elderly patient with heart disease in palliative care at the hospital

INTRODUÇÃO: A população idosa está aumentando e em decorrência os casos de Acidente Vascular Cerebral Hemorrágico (AVCH) o que traz um sofrimento a todos. Frente a esse panorama, os Cuidados Paliativos vêm como uma abordagem para auxiliar no cuidado que tem como objetivo reduzir a dor nas dimensões; psicológicas, sociais, físicas e espirituais. OBJETIVO: O manejo do sofrimento do paciente e de seus familiares no processo de adoecimento. RELATO DE CASO: Lucas fez cirurgia cardíaca de Revascularização do Miocárdio e evoluiu com Acidente Vascular Cerebral Isquêmico em Lobo Occipital Esquerdo em peri-operatório, ficou em intubação orotraqueal prolongada, em consequência fez uso de sonda de alimentação enteral, traqueostomia (TQT) sendo indicado Cuidados Paliativos proporcionais. Após um período, o nível de consciência oscilava o que não contribuiu para a retirada dos dispositivos, sendo indicada a gastrostomia (GTT), qual teve complicações clinicas como inflamação. Na enfermaria, a equipe identificou maior nível de alerta e consciência com a equipe e sua família, sendo assim realizado o trabalho conjunto da psicologia com a fonoaudiologia e com a fisioterapia que tinha como objetivo a melhora da comunicação (desmame da TQT) e deglutição (retirada da via alternativa de alimentação - GTT), havendo sucesso total na retirada dos dispositivos. Nos atendimentos psicológicos Lucas sofreu por estar limitado e dependente e demonstrava quando se contorcia, ao escutar os médicos falando com a família, ao ser cuidado no banho e ao pedir comida porque estava com fome e não podia comer. No processo fomos trabalhando que a inflamação possivelmente era também psicossomático, ou seja, devido as invasões pelos procedimentos no corpo a mente não conseguia pensar e elaborar mas o corpo reagia. Um momento delicado no processo ocorreu quando o filho foi hospitalizado e Lucas sofreu com sua ausência nas visitas e nas videochamadas. RESULTADO: O cuidado integral ao paciente e a família possibilitou a equipe aliviar o sofrimento emocional, respeitar o desejo e propiciar sustentação e condições da ida para casa. A esposa contou que ele sentava a mesa e fazia todas as refeições com os netos. A família unida pode viver, brindar a vida e guardar as memórias das fotos tiradas e dos vídeos, e assim, trabalharam a despedida. CONCLUSÃO: No caso de Lucas mostramos a importância do trabalho eficaz da equipe multiprofissional na reabilitação do paciente conseguindo retirar os dispositivos e a tão sonhada alta hospitalar.

Os desafios da comunicação no paciente em cuidados paliativos com afasia de expressão / The challenges of communication in palliative care patients with expression aphasia

INTRODUÇÃO: O Cuidado Paliativo visa o cuidado integral do paciente desde o diagnóstico de uma doença ameaçadora à vida. A equipe multiprofissional que atua nos Cuidados Paliativos busca o alívio do sofrimento biopsicossocial e espiritual sendo a comunicação um pilar imprescindível no processo do cuidado. OBJETIVO: Relatar a atuação multidisciplinar nas questões relacionadas à comunicação não verbal no caso de M. em Cuidado Paliativo. RELATO DE CASO: M. tem histórico de três Infartos Agudo do Miocárdio prévios e Acidente Vascular Cerebral isquêmico 2021. Indicado Cuidados Paliativos devido Síndrome Coronariana Aguda anterior extenso com angioplastia sem sucesso evoluindo com disfunção ventricular grave. M. foi avaliado quanto à comunicação e apresentava um quadro de Afasia com compreensão preservada e dificuldade importante na expressão verbal e escrita o que o limitava na comunicação com a equipe e familiares. No trabalho fonoaudiológico, durante o período de internação, foram construídas pranchas de comunicação com as demandas do paciente contendo sentimentos, imagens dos verbos principais de ação, alimentos de sua rotina, elementos de vestuário e membros da família. E, desse modo, visou favorecer a comunicação do paciente com os familiares para expressar os seus desejos. Na conferência familiar um dado que a esposa contou foi que ao adoecer M. percebeu a proximidade da morte e gravou uma despedida com mensagens de agradecimentos e perdão. E, nesse momento, ele estava muito angustiado por não conseguir se comunicar pelo verbal. Os atendimentos psicológicos propiciaram uma abertura de escuta da comunicação não verbal que era expressada pelos gestos, o corpo que se agitava, o olhar que comunicava as emoções e com a postura. Os conteúdos trazidos eram a dor, o medo de ser abandonado, de não se recuperar e de ter que retornar à Unidade Terapia Intensiva caso piorasse. Foi realizada a diretiva antecipada respeitando o seu desejo e autonomia de caso piorar que fosse cuidado junto aos familiares sem ter o corpo invadido. A rede de apoio conteve e atendeu suas necessidades diminuindo a angústia. A questão relevante foi trabalhar a melhora do seu quadro e o preparo de M. para casa o que causou grande alívio pois estava menos ansioso e mais próximo à vida do que a morte. Também, a questão da autoimagem e do luto por suas perdas foram abordadas. CONCLUSÃO: Através desse caso mostramos a importância de buscar alternativas de comunicação não verbal na tentativa de melhorar a comunicação e minimizar o sofrimento do paciente, família e equipe.

Palaeoecological data indicates land-use changes across Europe linked to spatial heterogeneity in mortality during the Black Death pandemic.

The Black Death (1347-1352 CE) is the most renowned pandemic in human history, believed by many to have killed half of Europe's population. However, despite advances in ancient DNA research that conclusively identified the pandemic's causative agent (bacterium Yersinia pestis), our knowledge of the Black Death remains limited, based primarily on qualitative remarks in medieval written sources available for some areas of Western Europe. Here, we remedy this situation by applying a pioneering new approach, 'big data palaeoecology', which, starting from palynological data, evaluates the scale of the Black Death's mortality on a regional scale across Europe. We collected pollen data on landscape change from 261 radiocarbon-dated coring sites (lakes and wetlands) located across 19 modern-day European countries. We used two independent methods of analysis to evaluate whether the changes we see in the landscape at the time of the Black Death agree with the hypothesis that a large portion of the population, upwards of half, died within a few years in the 21 historical regions we studied. While we can confirm that the Black Death had a devastating impact in some regions, we found that it had negligible or no impact in others. These inter-regional differences in the Black Death's mortality across Europe demonstrate the significance of cultural, ecological, economic, societal and climatic factors that mediated the dissemination and impact of the disease. The complex interplay of these factors, along with the historical ecology of plague, should be a focus of future research on historical pandemics.