A-296G variant of THBS1 gene (rs1478605) is associated with a lower frequency of stroke in a Brazilian population with sickle cell anemia.

OBJECTIVES: Stroke is a devastating clinical outcome that significantly contributes to the morbidity and mortality of sickle cell anemia (SCA) patients. Despite its advantages in predicting stroke risk, transcranial Doppler screening has limitations that restrict its applicability, highlighting the need for emerging prognostic tools. Thrombospondin-1 plays a crucial role in endothelial injury, platelet adhesion, and nitric oxide metabolism and may be implicated in stroke pathophysiology. Here, we aimed to evaluate the association of THBS1 genetic variations with the occurrence of stroke in SCA patients MATERIALS AND METHODS: By real-time PCR, 512 SCA patients were fully genotyped for THBS1 A-296G (rs1478605) polymorphism RESULTS: THBS1 GG genotype was associated with a lower risk for stroke occurrence [odds ratio (OR): 0.30; 95% confidence interval (CI): 0.11-0.78; P = 0.011], although these findings were not consistent with multivariate logistic regression analysis (OR: 0.73, 95% CI: 0.12 - 4.37; P = 0.736). In agreement, the cumulative incidence of stroke for patients with AG/AA genotypes was higher when compared to the GG genotype (P = 0.018). However, the association was not maintained in the multivariate proportional hazards model (hazard ratio: 0.67, 95% CI: 0.12-3.61; P = 0.643) CONCLUSIONS: In summary, the present study shows that the THBS1 A-296G (rs1478605) polymorphism may be a potential modifier for stroke in SCA.

Prognostic value of response evaluation based on breast MRI after neoadjuvant treatment: a retrospective cohort study.

OBJECTIVE: To investigate the impact of response evaluation after neoadjuvant chemotherapy (NAC) in breast cancer patients, assessed by both magnetic resonance imaging (MRI) and pathology, on disease-free survival (DFS). METHODS: This single-center, retrospective cohort study included consecutive breast cancer patients who underwent NAC and preoperative breast MRI. Resolution of invasive carcinoma in the breast and axilla was defined as complete pathological response (pCR). Radiological complete response (rCR) was defined as the absence of abnormal enhancement in the tumor site. Kaplan-Meier estimator was used to estimate the disease-free survival on 60 months. Cox regression analysis was used to estimate hazard ratio (HR) values. RESULTS: In total, 317 patients were included with a mean age of 47.3 years and a mean tumor size of 39.8 mm. The most common immunophenotype was luminal (44.9%), followed by triple-negative (26.8%). Overall, 126 patients (39.7%) had an rCR, while 119 (37.5%) had pCR; the radiological and pathological responses agreed in 252 cases (79.5%). During follow-up, patients who had rCR and pCR had a better DFS curve compared to patients with non-rCR and non-pCR, while those who had rCR or pCR presented an intermediate curve (Log-rank p = 0.003). Multivariate analysis showed a higher risk of recurrence in patients with non-rCR and non-pCR (HR: 5,626; p = 0.020) and those who had a complete response on MRI or pathology only (HR: 4,369; p = 0.067), when compared to patients with rCR and pCR. CONCLUSIONS: The association of MRI and pathological responses after NAC might better stratify the risk of recurrence and prognosis in breast cancer patients. KEY POINTS: • Association of response evaluation after neoadjuvant chemotherapy by pathology and MRI allows better stratification of prognosis. • Complete response to neoadjuvant chemotherapy on pathology and MRI was related to better disease-free survival. • Complete response on MRI or pathology only had a greater risk of recurrence.

Polymeric Nanoparticles: Production, Characterization, Toxicology and Ecotoxicology.

Polymeric nanoparticles (NPs) are particles within the size range from 1 to 1000 nm and can be loaded with active compounds entrapped within or surface-adsorbed onto the polymeric core. The term "nanoparticle" stands for both nanocapsules and nanospheres, which are distinguished by the morphological structure. Polymeric NPs have shown great potential for targeted delivery of drugs for the treatment of several diseases. In this review, we discuss the most commonly used methods for the production and characterization of polymeric NPs, the association efficiency of the active compound to the polymeric core, and the in vitro release mechanisms. As the safety of nanoparticles is a high priority, we also discuss the toxicology and ecotoxicology of nanoparticles to humans and to the environment.

Leishmania spp. amastigotes surrounding sensory nerve fibers in human painless skin ulcers: Evidence of pathogen-neuron proximity and absence of neuronal apoptosis.

In this present study, carried out between November 2020 and July 2023 at Londrina's University Hospital, patients with active lesions of cutaneous leishmaniasis (CL) were analyzed regarding pain perception and anatomopathological aspects of the ulcers. Pain was assessed using a numerical rating scale (NRS) to compare five patients diagnosed with CL with four control patients diagnosed with vascular skin ulcers. Histopathological evaluations were used to investigate the nociceptor neuron-Leishmania interface. Patients with CL ulcers reported less pain compared to patients with vascular ulcers (2.60 ± 2.30 and 7.25 ± 0.95, respectively, p = 0.0072). Histopathology evidenced Leishmania spp. amastigote forms nearby sensory nerve fibers in profound dermis. Schwann cells marker (S100 protein) was detected, and caspase-3 activation was not evidenced in the in the nerve fibers of CL patients' samples, suggesting absence of apoptotic activity in nerve endings. Additionally, samples taken from the active edge of the lesion were negative for bacilli acid-alcohol resistant (BAAR), which excludes concomitant leprosy, in which painless lesions are also observed. Thus, the present data unveil for the first time anatomopathological and microbiological details of painless ulcers in CL patients, which has important clinical implications for a better understanding on the intriguing painless clinical characteristic of CL.

Puberty and sex in pediatric thyroid cancer: could expression of estrogen and progesterone receptors affect prognosis?

Objective: A sharp increase in pediatric thyroid cancer incidence is observed during adolescence, driven mainly by girls. Differences in disease presentation across sexual maturity stages raise the question of whether sex steroids have a role in the heterogeneity. The aims of this study were to analyze the influence of puberty and sex on clinical presentation and prognosis and to evaluate the correlation between the expression of sex hormone receptors. Design and methods: Clinical records and immunohistochemical of specimens from 79 patients were analyzed. Puberty was analyzed by two criteria: end of puberty and beginning, in which the age of 10 was the cutoff. Results: Postpubertal were more frequently classified as having low-risk disease and a lower frequency of persistent disease, especially when the completion of puberty was used as the criteria. Male sex was associated with a higher risk of persistent disease at the end of the observation period. Estrogen receptor α positivity was low in the entire sample, while progesterone receptor positivity was positive in 30% of the cases. Female hormone receptor expression was not associated with sex, American Thyroid Association risk score, persistent structural disease, or pubertal status. Conclusion: Our study showed that the completion of puberty correlated best with the clinical behaviour of pediatric thyroid cancer. It was also shown that postpubertal patients have a less aggressive initial presentation and better outcomes. However, this observation could not be explained by the expression of estrogen and progesterone receptors in the primary tumors.

Evaluation of Predisposing Factors of Necrotic Enteritis in Experimentally Challenged Broiler Chickens.

Clostridium perfringens is the etiological agent of NE, a disease that greatly affects the poultry industry. Experiments on the induction of NE are difficult to carry out, as it is a multifactorial disease, and thus different predisposing factors have been used. This study evaluated the effect of the Gumboro disease vaccine virus vaccine (IBDV-vac) associated or not with infection by Eimeria spp. in broilers, as a predisposing factor for NE. Broilers (n = 99) were divided into groups (11) challenged with IBDV-vac, Eimeria spp. CP type G (CP13, CP14 and CP03) or both. The macroscopic evaluation revealed that the highest average (3.45) of injury occurred for the CP13 + IBDV-vac group. The microscopic analysis showed that Eimeria spp. increased the population of intraepithelial lymphocytes and reduced the villus/crypt ratio in duodenum and jejunum when associated with CP13 or CP14. There was a synergistic effect between the CP strain used and the predisposing factors; nevertheless, it was not clear which was the most effective predisposing factor to potentiate the lesions, suggesting that the association of the strain with the factors should first be evaluated for each experimental protocol.

Absence of Trichinella spp. larvae in carcasses of road-killed wild animals in Paraná state, Brazil.

Trichinella spp. are zoonotic parasites that are widely distributed in warm-blooded carnivores and omnivores, including humans. Until the present moment, Brazil has been considered by World Animal Health Organization free from the domestic cycle of trichinellosis, whereas the parasite's sylvatic cycle has the status of infection in limited zones. However, neighboring countries such as Argentina have reports of parasite larvae in the wild fauna. The present study aimed to determine the occurrence of Trichinella spp. in road-killed wild animals in Paraná, Brazil. Biological samples from 71 wild animals-29 Didelphis albiventris, 11 Nasua nasua, ten Cerdocyon thous, seven Dasypus novemcinctus, six Leopardus guttulus, six Sphiggurus spinosus and two Puma concolor-collected from November 2016 to November 2021 were subjected to artificial digestion, following the methodology described in the REGULATION (EC) No. 2075/2005. No Trichinella spp. larvae were detected in the carcasses of the road-killed wild animals. However, considering the wide spectrum of possible reservoirs that could act as a link between the sylvatic and domestic cycles and considering the current Brazilian status of sylvatic trichinellosis in limited zones, frequent monitoring of wild fauna remains necessary.

Synthesis and testing of novel alternative oxidase (AOX) inhibitors with antifungal activity against Moniliophthora perniciosa (Stahel), the causal agent of witches' broom disease of cocoa, and other phytopathogens.

BACKGROUND: Moniliophthora perniciosa (Stahel) Aime & Phillips-Mora is the causal agent of witches' broom disease (WBD) of cocoa (Theobroma cacao L.) and a threat to the chocolate industry. The membrane-bound enzyme alternative oxidase (AOX) is critical for M. perniciosa virulence and resistance to fungicides, which has also been observed in other phytopathogens. Notably AOX is an escape mechanism from strobilurins and other respiration inhibitors, making AOX a promising target for controlling WBD and other fungal diseases. RESULTS: We present the first study aimed at developing novel fungal AOX inhibitors. N-Phenylbenzamide (NPD) derivatives were screened in the model yeast Pichia pastoris through oxygen consumption and growth measurements. The most promising AOX inhibitor (NPD 7j-41) was further characterized and displayed better activity than the classical AOX inhibitor SHAM in vitro against filamentous fugal phytopathogens, such as M. perniciosa, Sclerotinia sclerotiorum and Venturia pirina. We demonstrate that 7j-41 inhibits M. perniciosa spore germination and prevents WBD symptom appearance in infected plants. Finally, a structural model of P. pastoris AOX was created and used in ligand structure-activity relationships analyses. CONCLUSION: We present novel fungal AOX inhibitors with antifungal activity against relevant phytopathogens. We envisage the development of novel antifungal agents to secure food production. © 2018 Society of Chemical Industry.

[Disseminated sporotrichosis - clinical case and discussion]. / Esporotricose disseminada - Caso clínico e discussão.

The authors report a case of a patient with a prior history of alcohol abuse who developed nodules and ulcerated skin lesions on his trunk and lower extremities along the line of the lymphatic draining area. The patient's X-ray showed reticular nodular intersticial infiltrates at the lung bases. There was a positive culture of supraclavicular lymph node for Sporothrix schenckii. After specific treatment using mainly potassium iodide, there was regression of cutaneous lesions and lung infiltrates. The authors present a discussion on the deseases' forms of presentation, highlighting the lung involvement ans further discuss the diagnosis and treatment of sporotrichosis.

Nurse work environment: comparison between private and public hospitals.

OBJECTIVE: To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations. METHODS: A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index - Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities. RESULTS: The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals. CONCLUSION: The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

Canine morbillivirus (canine distemper virus) with concomitant canine adenovirus, canine parvovirus-2, and Neospora caninum in puppies: a retrospective immunohistochemical study.

A retrospective immunohistochemical study was designed to investigate the frequency of concomitant traditional infectious disease pathogens in puppies that died suddenly and review the aspects of associated pathogenesis. Fifteen puppies were evaluated; the pathology reports and histopathologic slides of these animals were reviewed to determine the pattern of histopathologic lesions. The intralesional identification of antigens of canine (distemper) morbillivirus (CDV), canine adenovirus-1 and -2 (CAdV-1 and -2), canine parvovirus-2 (CPV-2), Toxoplasma gondii, and Neospora caninum was evaluated by IHC within the histopathologic patterns observed. All puppies contained CDV nucleic acid by molecular testing. The most frequent histopathologic patterns were intestinal crypt necrosis (n = 8), white matter cerebellar demyelination (n = 7), necrohaemorrhagic hepatitis (n = 7), interstitial pneumonia (n = 7), and gallbladder oedema (n = 5). All puppies contained intralesional antigens of CDV in multiple tissues resulting in singular (n = 3), and concomitant dual (n = 3), triple (n = 5) and quadruple (n = 4) infections by CAdV-1, and -2, CPV-2, and N. caninum; T. gondii was not identified. Concomitant infections by CDV was observed with N. caninum (100%; 1/1), CPV-2 (100%; 8/8), CAdV-1 (100%; 8/8), and CAdV-2 (100%; 8/8). Intralesional antigens of CDV and not CAdV-1 were identified in cases of gallbladder oedema. The "blue eye" phenomenon was histologically characterized by corneal oedema and degenerative lesions to the corneal epithelium, without inflammatory reactions.

Assessment of arterial stiffness in type 1 diabetes using digital pulse contour analysis: Is it a reliable method?

AIMS: The aim of this study was to assess the arterial stiffness in patients with type 1 diabetes compared with a control group and determine the associated potential risk factors for its occurrence. METHODS: Fifty-seven subjects with type 1 diabetes and fifty-three healthy controls were submitted to clinical and laboratory evaluation. The peripheral waveform pressure was analyzed to assess arterial stiffness according to the reflection and stiffness index. RESULTS: Arterial stiffness did not differ between the controls and patients with type 1 diabetes. Pulse pressure showed no difference among both groups. In the group of patients with type 1 diabetes, the stiffness index was correlated with diabetes duration (r = 0.59, p < 0.001), body mass index (r = 0.27, p = 0.03), diastolic blood pressure (r = 0.33, p = 0.001), triglycerides (r = 0.35, p = 0.007), and age (r = 0.46, p < 0.001). The reflection index was correlated with the systolic blood pressure (r = 0.29, p = 0.02), diastolic blood pressure (r = 0.30, p = 0.02), and cardiac frequency (r = 0.48, p < 0.001). In the stepwise multivariate analysis, disease duration, diastolic blood pressure, and HDL cholesterol were the most important independent variables associated with arterial stiffness in patients with type 1 diabetes. CONCLUSIONS: We concluded that in the studied population, arterial stiffness showed no difference between patients with diabetes and controls; thus, the use of this method should not be indicated for routine clinical practice in type 1 diabetes.

Treinadoras e auxiliares do futebol de mulheres no Brasil: subversão e resistência na liderança esportiva / Women's football coaches and assistant coaches in Brazil: subversion and resistance in sports leadership / Entrenadoras y auxiliares del fútbol femenino en Brasil: subversión y resistencia en el liderazgo deportivo

Resumo Fundamentada nos estudos culturais e de gênero, esta pesquisa analisa a representatividade de mulheres em cargos de treinadora e auxiliar no futebol de mulheres, buscando identificar as estratégias de subversão e resistência adotadas para sua inserção e permanência. Os materiais de análise foram os discursos das participantes aliados a fontes documentais, como notícias e produções acadêmicas. A análise evidencia que as profissionais conquistaram o acesso aos cargos em decorrência das experiências como líderes enquanto atletas e/ou estagiárias e por seus altos níveis de capacitação. Elas asseguram sua permanência ao atestarem diariamente sua competência, mantendo o nível de capacitação e superando estereótipos de gênero. Elas personificam a eminente resistência oferecida pelas mulheres em espaços tradicionalmente reservados aos homens, tensionando as relações de poder. Contudo, a consolidação de uma condição equânime requer investimento financeiro e, sobretudo, empenho na desconstrução de estereótipos de gênero.

Abstract Based on cultural and gender studies, this research analyzes women's representativeness as coaches and assistant coaches in women's football, seeking to identify the subversion and resistance strategies adopted for their inclusion and permanence. The analysis focused on participants' speeches and document sources such as news articles and academic works. It shows how professionals gained access to the roles resulting from their leadership experiences as athletes and/or interns and for their high capacity. They ensure their permanence by attesting their competence on a daily basis, maintaining their level of ability and overcoming gender stereotypes. They personify the eminent resistance offered by women in spaces traditionally reserved for men, thus tensioning power relations. However, the consolidation of equal conditions requires financial investment and, above all, a commitment to deconstructing gender stereotypes.

Resumen Fundamentada en los estudios culturales y de género, esta investigación analiza la representatividad de mujeres en cargos de entrenadora y auxiliar en el fútbol femenino, buscando identificar las estrategias de subversión y resistencia adoptadas para lograr su inserción y permanencia. Los materiales de análisis fueron los discursos de las participantes, aliados a fuentes documentales, como noticias y producciones académicas. El análisis muestra que las profesionales conquistaron su acceso a los cargos debido a sus experiencias de liderazgo como atletas y por sus altos niveles de capacitación. Aseguran su permanencia probando diariamente su competencia y superando los estereotipos de género. Encarnan la resistencia ofrecida por las mujeres en espacios tradicionalmente reservados a los hombres, tensando las relaciones de poder. Sin embargo, la consolidación de una condición de ecuanimidad requiere inversión financiera y, sobre todo, un compromiso con la deconstrucción de los estereotipos de género.

Prognostic Factors for Early and Long-Term Remission in Pediatric Differentiated Thyroid Carcinoma: The Role of Sex, Age, Clinical Presentation, and the Newly Proposed American Thyroid Association Risk Stratification System.

BACKGROUND: The incidence of pediatric differentiated thyroid carcinoma (DTC) has been rising in recent years, and the main risk factors for recurrence are lymph node and distant metastasis at diagnosis. Other clinical features remain unclear, such as the impact of age, sex, and puberty. Furthermore, until now, this population has been treated using the same strategies used to treat adults. In 2015, the American Thyroid Association (ATA) published the first guidelines targeted at this age group. The aims of this study were to investigate the prognostic factors for early and long-term remission and also to validate the ATA risk stratification proposal in a population outside the United States. METHODS: Clinical records from 118 patients <18 years old followed in two referral centers were reviewed. The median age was 12 years (range 4-18 years), and 20.3% (24 patients) were <10 years old at diagnosis. The median follow-up was 9.1 years. The majority were female (72%) and received total thyroidectomy and radioiodine therapy (RAI), and 61.8% were treated with more than one dose of RAI. The majority were classified as high risk (48.3%) by the new ATA pediatric guidelines due to distant metastasis (30 patients) or extensive lymph node involvement (27 patients). The remained were classified as low risk (31.3%) and intermediate risk (20.4%). RESULTS: Females with no lymph node or distant metastasis and low ATA pediatric risk were more likely to have no evidence of disease (p < 0.05) within the first year and also in the long term. In this study, age did not significantly predict outcomes. Furthermore, patients also benefitted from multiple doses of RAI, but when the cumulative activity was >400 mCi, this benefit was diminished. CONCLUSIONS: This study shows that the ATA risk stratification proposal for pediatric patients is useful in predicting early and long-term outcomes in pediatric patients with DTC. In addition, it shows that sex and metastatic disease are important prognostic factors in pediatric populations.

O legado das regulações esportivas. Diagnóstico e consentimento na elegibilidade da categoria feminina / The legacy of sports regulations. Diagnosis and consent in the female category eligibility / El reglamento del legado del deporte. Diagnóstico y consentimiento para la elegibilidad de la categoría femenina

Resumo As regulações esportivas para definir a elegibilidade na categoria feminina são políticas antigas, datadas do começo do século XX, que atravessam disputas sobre o corpo, suas inscrições e possibilidades de futuro. De modo que a definição de um diagnóstico, com suas articulações de saúde, doença e cuidado terapêutico, concentram alguns atributos significativos para essa determinação de elegibilidade. Acompanhando um pouco da história da ex-judoca brasileira Edinanci Silva, vamos compreender como tais regulações constituem estratégias normativas de controle do corpo e da população, assim como mobilizam os cenários em que os sujeitos existem, se individualizam e cuidam de si. Essa difícil tarefa de consentir num contexto de crise, de risco e de humilhação diz muito sobre os limites dessas mesmas inclusões pelo esporte. No fim, também vamos entender porque a virilização feminina continua a ser medicalizada e importa mais do que a eficiência do rendimento esportivo propriamente dito.

Abstract The sports regulations to define the eligibility in the female category are old policies, dating from the beginning of the 20th century, which go through disputes over the body, its inscriptions and possibilities for the future. In this sense, the definition of a diagnosis, with its articulations of health, disease and therapeutic care, concentrate some significant attributes for this eligibility. Following a bit of the history of former Brazilian judoka Edinanci Silva, we'll understand how such regulations constitute normative strategies for controlling the body, the population, as well as mobilizing the scenarios in which the subjects exist, individualize and take care of themselves. This difficult task of consenting in a context of crisis, risk and humiliation says a lot about the limits of these same inclusions by sport. In the end, we'll also understand why female virilization continues to be medicalized and matters more than the efficiency of sports performance itself.

Resumen La normativa deportiva para definir la elegibilidad en la categoría femenina son políticas antiguas, fecha del comienzo del siglo 20, que pasan por disputas sobre el cuerpo, sus inscripciones y posibilidades de futuro. De modo que la definición de un diagnóstico, con sus articulaciones de salud, enfermedad y atención terapéutica, concentre algunos atributos significativos para esta determinación de elegibilidad. Siguiendo un poco de la historia de la ex-judoca brasileña Edinanci Silva, entenderemos cómo estas regulaciones constituyen estrategias normativas para controlar el cuerpo y la población, así como movilizar los escenarios en que los sujetos existen, se individualizan y se cuidan. Esta difícil tarea de consentir en un contexto de crisis, riesgo y humillación dice mucho sobre los límites de estas mismas inclusiones para el deporte. Al final, también entenderemos por qué la virilización femenina sigue medicalizada y es más importante que la eficacia del rendimiento deportivo en sí.

Intervenção comunitária recovery: Impacto na qualidade de vida, suporte social e satisfação de necessidades da pessoa com doença mental / Community intervention & recovery: Impact on quality of life, social support and needs' satisfaction of the person with mental illness / Intervención comunitaria & recuperación: Impacto en la calidad de vida, soporte social y satisfación de las necesidades de la persona con enfermedad mental

CONTEXTO: O recovery é entendido como um processo subjetivo que pressupõe as dimensões clínica e pessoal. Os programas de intervenção comunitária na promoção do recovery devem basear-se em aspetos importantes como a qualidade de vida, suporte social e necessidades. OBJETIVOS: Avaliar o impacto de um programa de intervenção individualizado na qualidade de vida, suporte social e satisfação das necessidades, em pessoas com doença mental. MÉTODOS: Estudo quase-experimental com desenho antes-após de grupo único, com três momentos de avaliação com 16 sessões implementadas durante 4 meses. A amostra é constituída por 25 pessoas com doença mental selecionadas a partir da alta clínica de um hospital psiquiátrico da região Norte de Portugal. Utilizaram-se como instrumentos: Questionário de Avaliação Sociodemográfica e Clínica; Instrumento de Avaliação de Necessidades, construídos pelos investigadores; EQ-5D e; Escala de Satisfação com o Suporte Social. A Investigação foi aprovada pela Comissão de Ética da instituição onde foram recolhidos os dados. Foi utilizado o SPSS, versão 25.0, com recurso a medidas descritivas e testes de diferenças de médias não paramétricos - Friedman e de Wilcoxon - com um valor de significância de p<.05. RESULTADOS: Verificou-se uma evolução positiva relativamente às variáveis avaliadas, com diferenças estatisticamente significativas ao longo dos três momentos de avaliação para: qualidade de vida - EQ-5D; Dimensão Doença do IAN, e Dimensão Ambiente. CONCLUSÕES: Intervir no recovery da pessoa com doença mental é uma intervenção morosa e exigente, mas com resultados positivos desde que a intervenção seja direcionada às necessidades das pessoas.

BACKGROUND: Recovery is understood as a subjective process that presupposes clinical and personal dimensions. Community intervention programs in the promotion of recovery should be based on important aspects such as their needs, quality of life and social support. AIM: To evaluate the impact of an individualized intervention program on quality of life, social support and needs satisfaction in people with mental illness. METHODS:Quasi-experimental study with before-after design of single group, with three evaluation moments with 16 sessions implemented during 4 months. The sample consists of 25 people with mental illness selected from the high clinic of a psychiatric hospital in the Northern region of Portugal. The sociodemographic and clinical evaluation questionnaire, the Needs Assessment Instrument (NAI)., constructed by the researchers, the EQ-5D and the Social Support Satisfaction Scale were used as instruments. The investigation was approved by the Ethics Committee of the institution where the data were collected. SPSS, version 25.0 was used, using descriptive measures and tests of non-parametric mean differences - Friedman and Wilcoxon - with a significance level of p<.05. RESULTS: There was a positive evolution regarding the evaluated variables, with statistically significant differences during the three evaluation moments for: quality of life - EQ-5D; Dimension Disease of the NAI, and Environment Dimension. CONCLUSIONS: Intervening in the recovery of the person with mental illness is a time-consuming and demanding intervention, but with positive results if the intervention is directed to the needs of the people.

CONTEXTO:La recuperación es un proceso subjetivo que presupone las dimensiones clínica y personal. Los programas de intervención comunitaria en la recuperación deben basarse en la calidad de vida, el apoyo social y las necesidades. OBJETIVOS: Evaluar el impacto de un programa de intervención individualizado en la calidad de vida, apoyo social y satisfacción de las necesidades, en personas con enfermedad mental. METODOLOGÍA: Estudio casi experimental con diseño antes-después de grupo único, con tres momentos de evaluación con 16 sesiones implementadas durante 4 meses. La muestra se compone de 25 personas con enfermedad mental seleccionados a partir del alta clínica de un hospital psiquiátrico en el norte de Portugal.Se utilizaron como instrumentos un cuestionario sociodemográfico y clínico, el Instrumento de Evaluación de Necesidades, construidos por los investigadores, el EQ-5D y la Escala de Satisfacción con el soporte social. La investigación fue aprobada por la Comisión de Ética de la institución donde se recogieron los datos. Se utilizó el SPSS, versión 25.0, con medidas descriptivas y pruebas de diferencias de promedios no paramétricos - Friedman y Wilcoxon - con un valor de significancia de p<.05. RESULTADOS: Se observó una evolución positiva con respecto a las variables evaluadas, con diferencias estadísticamente significativas a lo largo de los tres momentos de evaluación para: calidad de vida - EQ-5D; Dimensión de la enfermedad del IAN, y la dimensión ambiental. CONCLUSIONES: Intervenir en la recuperación de la persona con enfermedad mental es algo moroso y exigente, pero con resultados positivos desde que la intervención se dirija a las necesidades de las personas.

Hypoparathyroidism after Roux-en-Y gastric bypass--a challenge for clinical management: a case report.

INTRODUCTION: In this report, we describe challenges we encountered in the clinical management of a patient with hypoparathyroidism who had previously undergone a bariatric procedure. CASE PRESENTATION: We report the case of a 38-year-old Caucasian woman who had undergone a Roux-en-Y gastric bypass procedure for treatment of obesity. She also had a past history of right lobectomy to treat a benign thyroid nodule. Another thyroid nodule was diagnosed after her bariatric surgery, so a new thyroid surgery was performed. Permanent hypoparathyroidism occurred after the second thyroid surgery. A Roux-en-Y gastric bypass resulted in important weight loss, but the preferential site of calcium absorption was bypassed. The lack of endogenous parathyroid hormone secretion due to post-surgical hypoparathyroidism abolished the physiological mechanism that compensates the reduced calcium absorption, which was a challenge for us to overcome. In this report, we describe our clinical therapeutic choices to maintain normocalcemia and normophosphatemia in this patient. Higher doses of exogenous calcium citrate, calcitriol and cholecalciferol were used, but hypocalcemia was still present. To improve vitamin D absorption with resultant improvement of calcium homeostasis, we speculated that adding pancrelipase to meals would increase lipid absorption and possibly fat-soluble vitamins, including vitamin D. Only after the addition of pancrelipase did the patient improve without weight regain according to clinical and laboratory assessments. CONCLUSION: The use of exogenous pancreatic enzymes improved calcium homeostasis in this bariatric patient. The role of these enzymes on vitamin D absorption and subsequent rise in calcium levels in hypoparathyroid patients who undergo bariatric procedures need further investigation.

Nurse work environment: comparison between private and public hospitals / Ambiente de trabalho do enfermeiro: comparação entre hospitais privados e público

ABSTRACT Objective To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations. Methods A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index − Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities. Results The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals. Conclusion The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

RESUMO Objetivo Comparar as características do ambiente de trabalho que favorecem a prática profissional do enfermeiro em instituições privadas e pública. Métodos Estudo quantitativo, exploratório, transversal, realizado em quatro instituições de saúde, sendo uma pública e três privadas, com 188 enfermeiros. Os participantes responderam a versão brasileira do Nursing Work Index − Revised , que tem por objetivo avaliar a presença de características que favorecem o desenvolvimento das atividades do enfermeiro por meio de 15 itens distribuídos em três subescalas: autonomia, controle sobre o ambiente de trabalho e relações entre médicos. A escala de medida utilizada é do tipo Likert e menores pontuações representam melhor avaliação do ambiente, ou seja, mais características favoráveis estão presentes para auxiliar o desenvolvimento das atividades da enfermagem. Resultados As médias das respostas dos participantes dos hospitais privados foram menores em todas as subescalas do instrumento, quando comparadas às do hospital público. Conclusão Os ambientes dos hospitais privados demonstraram possuir mais características favoráveis à prática profissional do enfermeiro do que o ambiente do hospital público.

As políticas de verificação de sexo/gênero no esporte: Intersexualidade, doping, protocolos e resoluções / Sex / Gender verification policies in sport: intersexuality, doping, protocols and resolutions / Las políticas de verificación de sexo/género en el deporte: intersexualidad, dopaje, protocolos y resoluciones

Resumo: Este artigo analisa alguns casos de atletas intersexuais que passaram pelo crivo das políticas de verificação de gênero, que comitês e federações esportivas implementam enquanto resoluções para a determinação da elegibilidade do sexo de atletas a fim de competirem em uma única categoria esportiva. A busca pela verificação e a confirmação do sexo/gênero de uma atleta articula muitas questões, como performance, testosterona, doping, medicamentos, por um lado, e marcadores sociais da diferença, do outro lado. De modo geral, tento entender como a validação e a legitimação de certos critérios para instituir corpos como saudáveis, elegíveis e capitalizáveis destituem diversos outros sujeitos da vida social - no caso, de suas profissões e capacidades de rendimento esportivo. Por fim, atento para como essas atletas passam por avaliações coercitivas, procedimentos invasivos e cirurgias irreversíveis para assegurar inteligibilidades e privilégios de uma suposta coerência biomédica sobre a diferenciação sexual e uma elegibilidade esportiva que mais discrimina do que iguala.

Abstract: This article analyzes cases of intersex athletes who experienced the sieve of gender verification policies that sports organizations and committees implement as resolutions to determine the sex of athletes eligible to compete in a unique sports category. The search for verification and confirmation of the sex and gender of an athlete mobilizes many issues, such as performance, testosterone, doping and drugs on one hand, and markers of social difference on the other. More broadly, I try to understand how the validation and legitimacy of certain criteria to establish bodies as healthy, eligible, and capitalizable, strips many other subjects of their social life - in this case, of their professions and their sports performance capabilities. Finally, I consider how these athletes go through coercive reviews, invasive procedures and irreversible surgery to ensure intelligibilities and privileges of an alleged biomedical logic on sexual differentiation and on sports eligibility that discriminates more than promotes equality.

Resumen: Este artículo analiza algunos casos de atletas intersexuales, que pasaron por la criba de las políticas de verificación de género que comités y federaciones deportivas implementan como resoluciones para la determinación da la elegibilidad del sexo de los atletas, para competir en una única categoría deportiva. La verificación y confirmación del sexo/género de una atleta articula varios asuntos, como performance, testosterona, dopaje, medicamentos, de un lado, y marcadores sociales de la diferencia, de otro lado. De modo general, intento entender como la validación y legitimación de ciertos criterios para instituir cuerpos como saludables, elegibles y capitalizables, destituyen otros diversos sujetos de la vida social - en este caso, sus profesiones y capacidades de rendimiento deportivo - . Finalmente, analizo como estas atletas pasan por evaluaciones coercitivas, procedimientos invasivos y cirugías irreversibles para garantizar inteligibilidades y privilegios de una supuesta coherencia biomédica sobre la diferenciación sexual y una elegibilidad deportiva que más discrimina envés de igualar.