Optimizing EEG Source Reconstruction with Concurrent fMRI-Derived Spatial Priors.

Reconstructing EEG sources involves a complex pipeline, with the inverse problem being the most challenging. Multiple inversion algorithms are being continuously developed, aiming to tackle the non-uniqueness of this problem, which has been shown to be partially circumvented by including prior information in the inverse models. Despite a few efforts, there are still current and persistent controversies regarding the inversion algorithm of choice and the optimal set of spatial priors to be included in the inversion models. The use of simultaneous EEG-fMRI data is one approach to tackle this problem. The spatial resolution of fMRI makes fMRI derived spatial priors very convenient for EEG reconstruction, however, only task activation maps and resting-state networks (RSNs) have been explored so far, overlooking the recent, but already accepted, notion that brain networks exhibit dynamic functional connectivity fluctuations. The lack of a systematic comparison between different source reconstruction algorithms, considering potentially more brain-informative priors such as fMRI, motivates the search for better reconstruction models. Using simultaneous EEG-fMRI data, here we compared four different inversion algorithms (minimum norm, MN; low resolution electromagnetic tomography, LORETA; empirical Bayes beamformer, EBB; and multiple sparse priors, MSP) under a Bayesian framework (as implemented in SPM), each with three different sets of priors consisting of: (1) those specific to the algorithm; (2) those specific to the algorithm plus fMRI task activation maps and RSNs; and (3) those specific to the algorithm plus fMRI task activation maps and RSNs and network modules of task-related dFC states estimated from the dFC fluctuations. The quality of the reconstructed EEG sources was quantified in terms of model-based metrics, namely the expectation of the posterior probability P(model|data) and variance explained of the inversion models, and the overlap/proportion of brain regions known to be involved in the visual perception tasks that the participants were submitted to, and RSN templates, with/within EEG source components. Model-based metrics suggested that model parsimony is preferred, with the combination MSP and priors specific to this algorithm exhibiting the best performance. However, optimal overlap/proportion values were found using EBB and priors specific to this algorithm and fMRI task activation maps and RSNs or MSP and considering all the priors (algorithm priors, fMRI task activation maps and RSNs and dFC state modules), respectively, indicating that fMRI spatial priors, including dFC state modules, might contain useful information to recover EEG source components reflecting neuronal activity of interest. Our main results show that providing fMRI spatial derived priors that reflect the dynamics of the brain might be useful to map neuronal activity more accurately from EEG-fMRI. Furthermore, this work paves the way towards a more informative selection of the optimal EEG source reconstruction approach, which may be critical in future studies.

Cellular Uptake of Three Different Nanoparticles in an Inflammatory Arthritis Scenario versus Normal Conditions.

Nanoparticles (NPs) have wide potential applications in the biomedical field. To promote targeted and controlled delivery of encapsulated drugs, it is fundamentally important to understand the factors regulating NP uptake by different cells. Thus, the goal of the present study is to assess the internalization rates of different NPs under normal and proinflammatory states in primary human articular chondrocytes (hACs), human umbilical vein endothelial cells (EA), and human monocytes (THP-1). Here, we compared chitosan-hyaluronic acid (Ch-HA) polymeric NPs, methoxypolyethylene glycol amine-glutathione-palmitic acid (mPEG-GSHn-PA) micelles, and cholesterol/l-α-phosphatidylcholine/DSPE-PEG-Mal (Chol/EPC/DSPE-PEG-Mal) unilamellar liposomes (LUVs). Our results reveal the importance of surface charge and chemistry in determining the levels of NP internalization. Under normal conditions, the cellular uptake was ≈30% for Ch-HA NPs and ≈100% for mPEG-GSHn-PA micelles and Chol/EPC/DSPE-PEG-Mal LUVs. A proinflammatory cell state promoted a higher uptake of the Ch-HA NPs by EA cells (93% after 24 h). Since the therapeutic efficacy of the NP-loaded cargo is dependent on trafficking routes after cellular internalization, we tested their internalization pathways. Accordingly, caveolae-mediated endocytosis or energy-independent non-endocytic pathways, which circumvent lysosomal degradation, were accomplished in hACs and EA by LUVs and in M1 polarized macrophages by micelles. The present outcomes highlight the importance of considering cellular uptake and internalization pathways by the target cell when designing functional NPs for therapeutic applications.

Emergency department visits for ambulatory care sensitive conditions.

OBJECTIVE: To describe emergency department visits for ambulatory care sensitive conditions. METHOD: Exploratory, descriptive, ecological, quantitative study. From January 2015 to December 2016, was accessed the database with information of visits performed in an emergency department located in the region of Campo Limpo, municipality of São Paulo. A 99% confidence interval was considered for the incidence of visits with identification of ambulatory care sensitive conditions, and a margin of error of 0.4%. The analyzes were performed with use of the statistical package SPSS. RESULTS: We found 434,883 visits, of which 17.1% were due to ambulatory care sensitive conditions, mostly of women and children up to 4 years of age. The reason for most visits were ear, nose and throat infections (45.4%). There was a higher chance of visits for the indicator in chronic patients (p<0.001). CONCLUSION: This study demonstrated the emergency department ambulatory care sensitive conditions visits that may indicate poor access to primary care.

Distribution and diversity of earthworms in different land use systems in Rio Grande do Sul, Brazil.

The southernmost state of Brazil, Rio Grande do Sul, includes both the Pampa and Atlantic Forest biomes, and covers an area of around 284 thousand km2. Since the last checklist for the state, published in 2012, many additional sites have been sampled. Hence, we provide here a full list of earthworm species and their distribution in different municipalities and land use systems in the state. Data were obtained from the literature, museums, and other earthworm collections and recent sampling efforts. Records for 19 additional species are reported here for the first time, raising the total to 78 species/subspecies currently known from Rio Grande do Sul, from the families Acanthodrilidae (5), Benhamiidae (3), Lumbricidae (13), Megascolecidae (11), Ocnerodrilidae (22), Almidae (2), Glossoscolecidae (18) and Rhinodrilidae (5). Alexidrilus Righi, 1971 is synonymized with Urobenus Benham, 1886, as both species in the genus (A. littoralis Ljungström, 1972 and A. lourdesae Righi, 1971) have similar morphology to the type species Urobenus brasiliensis Benham, 1886. Most of the native species/subspecies in the state (39), including an important number of new species, were found in native vegetation with lesser disturbance, such as swamps, native forests and pastures. On the other hand, the three peregrine and 27 exotic species (especially Pontoscolex corethrurus, Eukerria spp., lumbricids, megascolecids, Dichogaster spp., and Microscolex spp.) dominated in disturbed sites, such as compost piles, urban areas, rice and other crops, and cultivated pastures. Considering the geographic extension and the many unsampled sites in the state, further collection efforts are necessary and will certainly reveal new species, as evidenced here.

Task-based functional MRI challenges in clinical neuroscience: Choice of the best head motion correction approach in multiple sclerosis.

Introduction: Functional MRI (fMRI) is commonly used for understanding brain organization and connectivity abnormalities in neurological conditions, and in particular in multiple sclerosis (MS). However, head motion degrades fMRI data quality and influences all image-derived metrics. Persistent controversies regarding the best correction strategy motivates a systematic comparison, including methods such as scrubbing and volume interpolation, to find optimal correction models, particularly in studies with clinical populations prone to characterize by high motion. Moreover, strategies for correction of motion effects gain more relevance in task-based designs, which are less explored compared to resting-state, have usually lower sample sizes, and may have a crucial role in describing the functioning of the brain and highlighting specific connectivity changes. Methods: We acquired fMRI data from 17 early MS patients and 14 matched healthy controls (HC) during performance of a visual task, characterized motion in both groups, and quantitatively compared the most used and easy to implement methods for correction of motion effects. We compared task-activation metrics obtained from: (i) models containing 6 or 24 motion parameters (MPs) as nuisance regressors; (ii) models containing nuisance regressors for 6 or 24 MPs and motion outliers (scrubbing) detected with Framewise Displacement or Derivative or root mean square VARiance over voxelS; and (iii) models with 6 or 24 MPs and motion outliers corrected through volume interpolation. To our knowledge, volume interpolation has not been systematically compared with scrubbing, nor investigated in task fMRI clinical studies in MS. Results: No differences in motion were found between groups, suggesting that recently diagnosed MS patients may not present problematic motion. In general, models with 6 MPs perform better than models with 24 MPs, suggesting the 6 MPs as the best trade-off between correction of motion effects and preservation of valuable information. Parsimonious models with 6 MPs and volume interpolation were the best combination for correcting motion in both groups, surpassing the scrubbing methods. A joint analysis regardless of the group further highlighted the value of volume interpolation. Discussion: Volume interpolation of motion outliers is an easy to implement technique, which may be an alternative to other methods and may improve the accuracy of fMRI analyses, crucially in clinical studies in MS and other neurological populations.

Microcystin-LR at sublethal concentrations induce rapid morphology of liver and muscle tissues in the fish species Astyanax altiparanae (Lambari).

The process of eutrophication and consequent proliferation of cyanobacteria in rivers and lakes leads to increasing numbers of harmful algal blooms and higher concentration of toxic metabolites in freshwater bodies. Microcystin is a toxic metabolite produced by cyanobacteria that is frequently detected and can pose health risks to important freshwater species including fish. The aim of the present study was to evaluate the effects of microcystin-LR on the morphology of Astyanax altiparanae's liver and muscle. One hundred (n = 100) Astyanax altiparanae were divided into 5 groups (n = 20) with 24 h and 96 h of microcystin exposition at two doses of 0.5 and 1.0 µg/L. Differences were observed in the microcystin treatment with respect to histopathological analyses including cytoplastic degradation, displacement, and increase in nuclei volume and area of hepatocytes. Hyperemia and dilation of blood capillaries were seen in the liver. There were also observable changes in the size of muscle fibers and muscle inflammation. Our results demonstrate that microcystins can impact the integrity of both tissues even at sublethal concentrations. Low doses of microcystins are therefore sufficient to intoxicate fish livers and muscle tissues.

Liver glutathione S-transferase expression is decreased by 3,5,3-triiodothyronine in hypothyroid but not in euthyroid mice.

As previously reported, the activity of liver glutathione S-transferases, an important family of enzymes for detoxification processes, is regulated by thyroid hormone levels. Here, we specifically studied glutathione S-transferase α (Gsta) gene expression in livers of mice. First, in wild-type (WT) mice, hypothyroidism was induced by 5 weeks of a diet containing 5-propyl-2-thiouracil plus water containing metimazole, whereas hyperthyroidism was induced by daily injections of 50 µg (100 g body weight)(-1) of 3,3, 5-triiodo-L-thyronine (L-T(3)) for 15 days. Importantly, hypothyroidism induced liver Gsta mRNA (>500%) and protein levels (70%; P < 0.01), indicating an important role of baseline thyroid hormone levels to repress this gene; however, surprisingly, no differences were seen in hyperthyroid mice. To further investigate Gsta repression by T(3), we used animals expressing a naturally occurring mutation of the gene for thyroid hormone receptor (TR)-ß (Δ337T), which prevents T(3) binding and causes a general resistance to thyroid hormone. At baseline, homozygous animals showed increased Gsta levels (mRNA 3.5 times, protein 1.3 times) similar to those found in hypothyroid animals. After a T(3) suppression test, we found a blunted response of liver Gsta after the lower doses of T(3) in homozygous animals, as expected. However, after the highest dose of T(3), we observed a decrease in Gsta expression (80%), similar to normal animals, explained by a higher expression of TR-α1 (60%; P < 0.01) and a lower expression of Src1 (steroid coactivator receptor) in the mutant animals (50% decrease). In summary, a decrease in Gsta expression caused by T(3) was observed only in the hypothyroid state. In addition, an essential role of TR-ß1 is to mediate Gsta suppression in response to T(3) and, in the absence of a functional TR-ß, there is a compensatory action of TR-α1 that depends on low levels of Src1.

Glutathione Reductase-Sensitive Polymeric Micelles for Controlled Drug Delivery on Arthritic Diseases.

Inflammation plays an essential role in arthritis development and progression. Despite the advances in the pharmaceutical field, current treatments still present low efficacy and severe side effects. Considering the high activity of the glutathione reductase (GR) enzyme in inflamed joints, a distinctive drug delivery system sensitive to the GR enzyme was designed for efficient drug delivery on arthritic diseases. A linear amphiphilic polymer composed of methoxypolyethylene glycol amine-glutathione-palmitic acid (mPEG-GSHn-PA) was synthesized and the intermolecular oxidation of the thiol groups from GSHs retain the drug inside the resulting micelles. Stable polymeric micelles of 100 nm of size presented a loading capacity of dexamethasone (Dex) up to 65%. Although in physiological conditions the Dex release presented slow and sustained kinetics, in the presence of the GR enzyme, there was a burst release (stimuli-responsive properties). Biological assays demonstrated their cytocompatibility in contact with human articular chondrocytes, macrophages, and endothelial cells as well as their hemocompatibility. Importantly, in an in vitro model of inflammation, the polymeric micelles promoted a controlled drug release in the presence of GR, exhibiting a higher efficacy than the free Dex while reducing the negative effects of the drug into normal cells. In conclusion, this formulation is a promising approach to treat arthritic diseases and other inflammatory conditions.

Modulating inflammation through the neutralization of Interleukin-6 and tumor necrosis factor-α by biofunctionalized nanoparticles.

Biological agents that neutralize the activity of pro-inflammatory cytokines are revolutionizing the treatment of inflammatory conditions. However, the antibodies (Abs) short half-life and off-target distribution critically limit their efficacy and safety. Therefore, this work proposes the immobilization of anti-TNF-α and anti-IL-6 Abs at the surface of polymeric nanoparticles (NPs) in order to extend and increase the Abs therapeutic efficacy, owing to the protection from degradation that the NPs provide, and to avoid off-target side effects through local administration. In an in vitro model of inflammation, biofunctionalized NPs were able to reduce the harmful effects on human chondrocytes provided by inflammatory macrophages, being demonstrated the additive effects of the dual neutralization. Significantly, biofunctionalized NPs ameliorated inflammation more efficiently than soluble Abs in an in vivo experimental model of inflammation, exhibiting a safe profile, a prolonged action, and a stronger efficacy. Hence, as this strategy is able to increase the therapeutic efficacy of the currently available treatments, it is a promising potential therapeutic option for inflammatory conditions.

Biofunctionalized Liposomes to Monitor Rheumatoid Arthritis Regression Stimulated by Interleukin-23 Neutralization.

Even after the revolution of rheumatoid arthritis (RA) treatment with biologic agents, this debilitating disease remains a major clinical problem. The outstanding outcomes of the systemic administration of antibodies (Abs) are narrowed by the risk of serious side effects and limited efficacy due to their short half-life. Interleukin-23 (IL-23) is a crucial pro-inflammatory cytokine involved in inflammation that potently enhances the generation of T-helper type-17 (Th17) cells. Hence, in this work, anti-IL-23 Abs are immobilized at the surface of liposomes to increase their therapeutic efficacy, being gold nanoparticles (AuNPs) incorporated to allow monitoring the biodistribution of the liposomes after systemic administration as well as due to their anti-inflammatory and antioxidant effects. A stable monodispersed liposomes' suspension with around 130 nm is produced and efficiently biofunctionalized with anti-IL-23 Abs. IL-23 capture and neutralization capacity are confirmed using activated macrophages. Biological assays demonstrate their hemocompatibility and cytocompatibility with human articular chondrocytes, macrophages, and endothelial cells. Moreover, the neutralization of IL-23 by the biofunctionalized liposomes efficiently decreases the production of IL-17A by peripheral blood mononuclear cells of healthy donors and RA patients who are activated to Th17 differentiation. Therefore, the developed formulation may be a promising strategy to treat RA.

A biocompatible and injectable hydrogel to boost the efficacy of stem cells in neurodegenerative diseases treatment.

AIMS: Stem cell therapies emerged as treatment modalities with potential to cure neurodegenerative diseases (NDs). However, despite high expectations, their clinical use is still limited. Critical issues in treatment outcomes may be related to stem cells formulation and administration route. We develop a hydrogel as a cell carrier, consisting of compounds (phospholipids and hyaluronic acid-HA) naturally present in the central nervous system (CNS). The HA-based hydrogel physically crosslinked with liposomes is designed for direct injection into the CNS to significantly increase the bone marrow mesenchymal stem cells (BMSCs) bioavailability. MATERIALS AND METHODS: Hydrogel compatibility is confirmed in vitro with BMSCs and in vivo through its intracerebroventricular injection in rats. To assess its efficacy, the main cause of chronic neurologic disability in young adults is selected, namely multiple sclerosis (MS). The efficacy of the developed formulation containing a lower number of cells than previously reported is demonstrated using an experimental autoimmune encephalomyelitis (EAE) rat model. KEY FINDINGS: The distribution of the engineered hydrogel into corpus callosum can be ideal for NDs treatment, since damage of this white matter structure is responsible for important neuronal deficits. Moreover, the BMSCs-laden hydrogel significantly decreases disease severity and maximum clinical score and eliminated the relapse. SIGNIFICANCE: The engineering of advanced therapies using this natural carrier can result in efficacious treatments for MS and related debilitating conditions.

Longitudinal profiling of the vaccination coverage in Brazil reveals a recent change in the patterns hallmarked by differential reduction across regions.

OBJECTIVE: Vaccination coverage is decreasing worldwide, favoring the potential reemergence of vaccine-preventable diseases. In this study, we performed a longitudinal characterization of vaccination coverage in Brazil and compared the profiles between the distinct regions in the country to test whether there has been a substantial change over the last 5 years. METHODS: De-identified publicly available data were retrieved from the repository of the Brazilian Ministry of Health, comprising detailed information on vaccination coverage in all age groups between 1994 and 2019. The vaccination coverage for the whole country and for each Brazilian region, by year, was examined, and a time-series pattern analysis was performed. RESULTS: A significant decrease in overall vaccination coverage across the country regions was observed between 2017 and 2019, especially in childhood immunization. A reduction in BCG, hepatitis B, influenza, and rotavirus vaccine coverage was observed. Conversely, vaccines against measles, mumps, rubella, varicella, and meningococcus showed an increase in coverage. Region-specific changes in vaccination patterns within the study period were observed. CONCLUSIONS: A substantial reduction in vaccination coverage was detected in Brazil, a country already highly susceptible to the emergence of epidemic infectious diseases. Continuing evaluation of the immunization program actions may help to improve vaccination coverage and prevent new epidemics.

Biodegradable polymers: an update on drug delivery in bone and cartilage diseases.

Introduction: The unique structure of bone and cartilage makes the systemic delivery of free drugs to those connective tissues very challenging. Consequently, effective and targeted delivery for bone and cartilage is of utmost importance. Engineered biodegradable polymers enable designing carriers for a targeted and temporal controlled release of one or more drugs in concentrations within the therapeutic range. Also, tissue engineering strategies can allow drug delivery to advantageously promote the in situ tissue repair. Areas covered: This review article highlights various drug delivery systems (DDS) based on biodegradable biomaterials to treat bone and/or cartilage diseases. We will review their applications in osteoporosis, inflammatory arthritis (namely osteoarthritis and rheumatoid arthritis), cancer and bone and cartilage tissue engineering. Expert opinion: The increased knowledge about biomaterials science and of the pathophysiology of diseases, biomarkers, and targets as well as the development of innovative tools has led to the design of high value-added DDS. However, some challenges persist and are mainly related to an appropriate residence time and a controlled and sustained release over a prolonged period of time of the therapeutic agents. Additionally, the poor prediction value of some preclinical animal models hinders the translation of many formulations into the clinical practice.

Soil quality assessment in rice production systems: establishing a minimum data set.

Soil quality, as a measure of the soil's capacity to function, can be assessed by indicators based on physical, chemical, and biological properties. Here we report on the assessment of soil quality in 21 rice (Oryza sativa) fields under three rice production systems (semi-direct, pre-germinated, and conventional) on four soil textural classes in the Camaquã region of Rio Grande do Sul, Brazil. The objectives of our study were: (i) to identify soil quality indicators that discriminate both management systems and soil textural classes, (ii) to establish a minimum data set of soil quality indicators and (iii) to test whether this minimum data set is correlated with yield. Twenty-nine soil biological, chemical, and physical properties were evaluated to characterize regional soil quality. Soil quality assessment was based on factor and discriminant analysis. Bulk density, available water, and micronutrients (Cu, Zn, and Mn) were the most powerful soil properties in distinguishing among different soil textural classes. Organic matter, earthworms, micronutrients (Cu and Mn), and mean weight diameter were the most powerful soil properties in assessing differences in soil quality among the rice management systems. Manganese was the property most strongly correlated with yield (adjusted r2 = 0.365, P = 0.001). The merits of sub-dividing samples according to texture and the linkage between soil quality indicators, soil functioning, plant performance, and soil management options are discussed in particular.

Interleukin-6 Neutralization by Antibodies Immobilized at the Surface of Polymeric Nanoparticles as a Therapeutic Strategy for Arthritic Diseases.

Arthritic diseases are disabling conditions affecting millions of patients worldwide. Pro-inflammatory cytokines, particularly interleukin-6 (IL-6), plays a crucial role in inflammation and cartilage destruction. Although the beneficial effects of antibody therapy, its efficacy is limited. Therefore, this work proposes the immobilization of antibodies at the surface of biodegradable polymeric nanoparticles (NPs) to capture and neutralize IL-6. Our system is intended to protect, extend and enhance the therapeutic efficacy after delivery. Chitosan-hyaluronic acid NPs are synthesized as a stable monodisperse population. After determining the maximum immobilization capacity (10 µg/mL), the capture ability was confirmed. Biological assays demonstrate the NPs cytocompatibility with human articular chondrocytes (hACs) and human macrophages. hACs stimulated with macrophage conditioned medium shows the beneficial role of IL-6 capture and neutralization. Biofunctionalized NPs exhibit a prolonged action and stronger efficacy than the free antibody. In conclusion, this system can be an effective and long lasting treatment for arthritic diseases.

Importância do cirurgião-dentista na Unidade de Terapia Intensiva / Importance of the dental surgeon in the Intensive Care

O Cirurgião-Dentista assume um novo papel no desafio de somar esforços, atuando de modo incisivo no ambiente hospitalar. A busca por dignidade e conforto ao paciente, nesse momento tão delicado e vulnerável, deve ser sempre levado em conta pelas equipes de um hospital. O cuidado com a saúde integral do paciente em estado crítico se faz necessário para evitar que infecções em outros órgãos e sistemas, que não são ligados ao problema inicial, como aumento da quantidade e complexidade da placa dental, na qual pode tornar-se habitat para microrganismos potencialmente patogênicos e propiciar o surgimento de infecções bacterianas, bucais, digestivas e respiratórias que prejudiquem seu quadro clínico. Dessa maneira, o objetivo do trabalho é descrever sobre atuação do Cirurgião-Dentista como parte da equipe multidisciplinar na UTI. Foi realizada uma pesquisa através da busca em base de dados como: LILACS, BIREME, SciELO, Google Acadêmico, BVS, para identificar artigos científicos com abordagem a respeito da Importância do Cirurgião-Dentista na Unidade de Terapia Intensiva. As infecções hospitalares ainda causam grande impacto clínico nos pacientes internados aumentando o tempo de internação e diminuição da perspectiva da sobrevida, o que varia conforme ao tipo de infecção e o nível de saúde do hospedeiro. Portanto, a participação do Cirurgião-Dentista se faz necessário na equipe de terapia intensiva a fim de reduzir a incidência das infecções hospitalares do trato respiratório... (AU)

The Surgeon-Dentist assumes a new role in the challenge of adding efforts, acting incisively in the hospital environment. The search for dignity and comfort to the patient, in this delicate and vulnerable moment, must always be taken into account by the staff of a hospital. Care with the critical health of the patient is necessary to prevent infections in other organs and systems, which are not linked to the initial problem, such as an increase in the quantity and complexity of dental plaque, in which it can become habitat for potentially pathogenic microorganisms and provide the appearance of bacterial, oral, digestive and respiratory infections that harm their clinical condition. In this way, the objective of the study is to describe the performance of the Dentist-Surgeon as part of the multidisciplinary team in the ICU. A search was conducted through a database search, such as: LILACS, BIREME, SciELO, Google Academic, VHL, to identify scientific articles with an approach regarding the Importance of the Dentist in the Intensive Care Unit. Hospital infections still have a great clinical impact on hospitalized patients, increasing hospitalization time and decreasing survival prospects, which varies according to the type of infection and the level of health of the host. Therefore, the participation of the Dentist-Surgeon is necessary in the intensive care team in order to reduce the incidence of hospital respiratory tract infections... (AU)

O binômio morte e vida para idosos em cuidados paliativos / The binomial death and life for elderly in palliative care / El binomio muerte y vida para mayores en cuidados paliativos

RESUMO A sociedade contemporânea caracteriza-se por um processo de envelhecimento permeado por estereótipos relacionados à proximidade da morte, negada pela sociedade ocidental. Para descortinar essa temática, objetivou-se identificar os significados que idosos em cuidados paliativos atribuem à morte e à vida. Realizou-se dois grupos focais com 18 idosos em cuidados paliativos, compreendidos por análise textual no software IRaMuTeQ. Os resultados organizaram-se em quatro classes: "Significações sobre a morte" retrata sua aceitação, "As relações entre vida e morte na velhice" apresenta a ambivalência dessa díade, "Significações sobre a vida na velhice" avalia essa fase da vida, "Atividades diárias e ressignificação da vida" aborda seus novos papeis. Conclui-se que a rede de apoio e a espiritualidade influenciam a significação da morte pelo idoso.

Contemporary society is characterized by an aging process permeated by stereotypes related to the proximity of death, denied by Western society. To unveil this theme, the objective was to identify the meanings that elderly in palliative care attribute to death and life. Two focus groups were held with 18 elderly in palliative care, understood by textual analysis in the IRaMuTeQ software. The results were organized into four classes: "Meanings about death" portrays their acceptance, "The relationships between life and death in old age" presents the ambivalence of this dyad, "Meanings about life in old age" assesses this phase of life, "Daily activities and life resignification" addresses their new roles. It is concluded that the support network and spirituality influence the meaning of death by the elderly.

RESUMEN La sociedad contemporánea es demarcada por proceso de envejecimiento impregnado de estereotipos respecto a la proximidad con la muerte. En este entorno, el objetivo de este estudio fue identificar los significados que las personas mayores, en cuidados paliativos, atribuyen a la muerte y la vida. Así, se realizaron dos grupos focales con 18 personas mayores en cuidados paliativos para la recogida de datos, y luego sometida a análisis textual en el software IRaMuTeQ. Los resultados se organizaron en cuatro clases: "Significados sobre la muerte" retrata su aceptación, "Las relaciones entre la vida y la muerte en la vejez" presenta la ambivalencia de esta díada, "Significados sobre la vida en la vejez" evalúa esta fase de la vida, "Actividades diarias y la resignificación de la vida "aborda sus nuevos roles. Se concluye que la red de apoyo y la espiritualidad influyen en el significado de la muerte de los ancianos.

Patients with severe accidental tetanus admitted to an intensive care unit in Northeastern Brazil: clinical-epidemiological profile and risk factors for mortality.

INTRODUCTION: Tetanus, an acute infectious disease, is highly prevalent worldwide, especially in developing countries. Due to respiratory failure and hemodynamic instability associated with dysautonomia, severe cases require intensive care, but little has been published regarding the management in the Intensive Care Unit. OBJECTIVE: To draw a 10-year clinical-epidemiological profile of Intensive Care Unit patients with severe tetanus, observe their evolution in the Intensive Care Unit and identify risk factors for mortality. METHODS: In this retrospective study, we used a standardized questionnaire to collect information from the records of patients with severe tetanus admitted to the intensive care unit of a referral hospital for infectious and contagious diseases in Northeastern Brazil. RESULTS: The initial sample included 144 patients, of whom 29 were excluded due to incomplete information, leaving a cohort of 115 subjects. The average age was 49.6±15.3 years, most patients had no (or incomplete) vaccination against tetanus, and most were male. The main intensive care-related complications were pneumonia (84.8%) and dysautonomia (69.7%). Mortality (44.5%) was higher than expected from the mean APACHE II score (11.8), with shock/multiple organ failure as the main cause of death (72.9%). The independent factors most predictive of mortality were APACHE II score, dysautonomia, continuous neuromuscular blockade and age. CONCLUSION: A high mortality rate was observed in our cohort of Intensive Care Unit patients with severe tetanus and a number of risk factors for mortality were identified. Our results provide important insights for the development of intervention protocols capable of reducing complications and mortality in this patient population.

Clinical-epidemiological evaluation of respiratory syncytial virus infection in children attended in a public hospital in midwestern Brazil.

UNLABELLED: Respiratory syncytial virus (RSV) is responsible for annual respiratory infection outbreaks in infants and young children worldwide, frequently causing bronchiolitis and pneumonia. We evaluated clinical and epidemiological features of acute respiratory infections (ARIs) caused by respiratory syncytial virus (RSV) in children less than five years old. Nasopharyngeal aspirate samples from children with ARI symptoms, attended at the 'Hospital das Clínicas'--Federal University of Uberlândia, MG, Brazil, were collected and tested for RSV by the immunofluorescence assay (IFA). Patients' clinical and epidemiological data were also obtained. From April 2000 to June 2003, 317 nasopharyngeal samples were collected from children less than 54 months old. Seventy-six samples (24.0%) were positive for RSV, with 53% (40/76) obtained from male patients. Hospitalization occurred in 50% (38/76) of the cases, with an average period of 10.6 days, in most cases (87%, 33/38) occurring in children less than 12 months of age. Although an association between this age group and the presentation of more severe clinical symptoms was observed, such as bronchiolitis in 51% (27/53) of the patients and pneumonia in 19% (10/53), no patients died. RSV was found from February to August, with the highest incidence in May. CONCLUSIONS: RSV is an important agent that causes ARIs; the clinical manifestations varied from mild to severe and patients frequently required hospitalization; RSV mostly affected children less than one year old.

Emergency department visits for ambulatory care sensitive conditions / Perfil de las atenciones por condiciones sensibles a la atención primaria de salud en una unidad de urgencias / Perfil dos atendimentos por condições sensíveis à Atenção Primária à Saúde em uma Unidade de Pronto Atendimento

ABSTRACT Objective: To describe emergency department visits for ambulatory care sensitive conditions. Method: Exploratory, descriptive, ecological, quantitative study. From January 2015 to December 2016, was accessed the database with information of visits performed in an emergency department located in the region of Campo Limpo, municipality of São Paulo. A 99% confidence interval was considered for the incidence of visits with identification of ambulatory care sensitive conditions, and a margin of error of 0.4%. The analyzes were performed with use of the statistical package SPSS. Results: We found 434,883 visits, of which 17.1% were due to ambulatory care sensitive conditions, mostly of women and children up to 4 years of age. The reason for most visits were ear, nose and throat infections (45.4%). There was a higher chance of visits for the indicator in chronic patients (p<0.001). Conclusion: This study demonstrated the emergency department ambulatory care sensitive conditions visits that may indicate poor access to primary care.

RESUMEN Objetivo: Describir las atenciones por condiciones sensibles a la Atención Primaria de Salud en una unidad de urgencias. Método: Estudio descriptivo, exploratorio y ecológico, con abordaje cuantitativo. Se accedió a un banco de datos con informaciones de las atenciones realizadas, de enero de 2015 a diciembre de 2016, en una Unidad de Urgencias ubicada en la región de Campo Limpo, municipio de São Paulo. Se consideró intervalo de confianza del 99% para la incidencia de atenciones con identificación de condición sensible a la Atención Primaria de Salud, con margen de error del 0,4%. Los análisis se llevaron a cabo con la ayuda del paquete estadístico SPSS. Resultados: Fueron realizadas 434.883 atenciones, el 17,1% de ellas por condiciones sensibles a la Atención Primaria de Salud, constituidas mayoritariamente en el sexo femenino y niños de hasta cuatro años de edad. Gran parte de las atenciones ocurrió en virtud de infecciones de oído, nariz y garganta (45,4%). Hubo incremento de la probabilidad de atención por el indicador en pacientes crónicos (p<0,001). Conclusión: Se observó prevalencia relativamente baja de atenciones por condiciones sensibles a la Atención Primaria de Salud en la unidad de urgencias, lo que puede sugerir mejor acceso, cobertura y calidad de la Atención Primaria.

RESUMO Objetivo: Descrever os atendimentos por condições sensíveis à Atenção Primária à Saúde em uma unidade de pronto atendimento. Método: Estudo descritivo, exploratório e ecológico, com abordagem quantitativa. Acessou-se um banco de dados com informações dos atendimentos realizados, de janeiro de 2015 a dezembro de 2016, em uma Unidade de Pronto Atendimento localizada na região do Campo Limpo, município de São Paulo. Considerou-se intervalo de confiança de 99% para a incidência de atendimentos com identificação de condição sensível à Atenção Primária à Saúde, com margem de erro de 0,4%. As análises foram realizadas com o auxílio do pacote estatístico SPSS. Resultados: Foram realizados 434.883 atendimentos, 17,1% deles por condições sensíveis à Atenção Primária à Saúde, constituídos majoritariamente pelo sexo feminino e por crianças com até 4 anos de idade. Grande parte dos atendimentos ocorreu em razão de infecções de ouvido, nariz e garganta (45,4%). Houve aumento da chance de atendimento pelo indicador em pacientes crônicos (p<0,001). Conclusão: Os achados deste estudo apontam a presença de um perfil de pacientes de uma Unidade de Pronto Atendimento que poderiam ser atendidos por Unidades Básicas de Saúde ressaltando as fragilidades do acesso e do cuidado continuado na Atenção Primária à Saúde.