Metabolomics analysis of human spermatozoa reveals impaired metabolic pathways in asthenozoospermia.

BACKGROUND: Infertility is a major health issue, affecting 15% of reproductive-age couples with male factors contributing to 50% of cases. Asthenozoospermia (AS), or low sperm motility, is a common cause of male infertility with complex aetiology, involving genetic and metabolic alterations, inflammation and oxidative stress. However, the molecular mechanisms behind low motility are unclear. In this study, we used a metabolomics approach to identify metabolic biomarkers and pathways involved in sperm motility. METHODS: We compared the metabolome and lipidome of spermatozoa of men with normozoospermia (n = 44) and AS (n = 22) using untargeted LC-MS and the metabolome of seminal fluid using 1H-NMR. Additionally, we evaluated the seminal fluid redox status to assess the oxidative stress in the ejaculate. RESULTS: We identified 112 metabolites and 209 lipids in spermatozoa and 27 metabolites in the seminal fluid of normozoospermic and asthenozoospermic men. PCA analysis of the spermatozoa's metabolomics and lipidomics data showed a clear separation between groups. Spermatozoa of asthenozoospermic men presented lower levels of several amino acids, and increased levels of energetic substrates and lysophospholipids. However, the metabolome and redox status of the seminal fluid was not altered inAS. CONCLUSIONS: Our results indicate impaired metabolic pathways associated with redox homeostasis and amino acid, energy and lipid metabolism in AS. Taken together, these findings suggest that the metabolome and lipidome of human spermatozoa are key factors influencing their motility and that oxidative stress exposure during spermatogenesis or sperm maturation may be in the aetiology of decreased motility in AS.

Design, Synthesis, Antitumor Activity and NMR-Based Metabolomics of Novel Amino Substituted Tetracyclic Imidazo[4,5-b]Pyridine Derivatives.

Newly prepared tetracyclic imidazo[4,5-b]pyridine derivatives were synthesized to study their antiproliferative activity against human cancer cells. Additionally, the structure-activity was studied to confirm the impact of the N atom position in pyridine nuclei as well as the chosen amino side chains on antiproliferative activity. Targeted amino substituted regioisomers were prepared by using uncatalyzed amination from corresponding chloro substituted precursors. The most active compounds 6 a, 8 and 10 showed improved activity in comparison to standard drug etoposide with IC50 values in a nanomolar range of concentration (0.2-0.9 µM). NMR-based metabolomics is a powerful instrument to elucidate activity mechanism of new chemotherapeutics. Multivariate and univariate statistical analysis of metabolic profiles of non-small cell lung cancer cells before and after exposure to 6 a revealed significant changes in metabolism of essential amino acids, glycerophospholipids and oxidative defense. Insight into the changes of metabolic pathways that are heavily involved in cell proliferation and survival provide valuable guidelines for more detailed analysis of activity metabolism and possible targets of this class of bioactive compounds.

Correlation Between Pedal Acceleration Time and Transcutaneous Oxygen Pressures - A Prognostic Tool for Wound Healing in the Diabetic Foot Population.

BACKGROUND: Pedal arch interrogation by ultrasound through systolic acceleration time measurement (Pedal Acceleration Time [PAT]) is a recently described technique that offers valuable insights into foot hemodynamics. Previous studies have demonstrated a correlation between PAT and the ankle-brachial index and PAT has been proposed as a prognostic tool for wound healing in patients with peripheral artery disease. This study aims to assess the correlation between PAT and Transcutaneous Pressure of Oxygen (TcPO2) in the diabetic foot population. METHODS: In this single-center cross-sectional study PAT and TcPO2 were measured in diabetic patients with ischemic foot ulcers. The assessment of wound status was performed between the 12th and 16th week after the first evaluation. The primary outcome was to assess the correlation between the values obtained for PAT and TcPO2. The secondary outcome was to establish a cut-off value for wound healing. RESULTS: Sixty limbs with ischemic foot ulcers were evaluated. The results showed a correlation between PAT and TcPO2 [F (1.52) = 16.928; R2 = 0.246; P < 0.001]. The receiver operating characteristics curve analysis showed an optimal cut-off value at PAT >186 ms for predicting a nonhealing ulcer with a 96% specificity (area under the curve = 0.774; confidence interval 0.648-0.872; P < 0.001). CONCLUSIONS: PAT showed a significant correlation with TcPO2 with high specificity to identify nonhealing foot ulcers due to insufficient foot perfusion with a potential prognostic value in the diabetic foot population.

Altered serum metabolome as an indicator of paraneoplasia or concomitant cancer in patients with rheumatic disease.

OBJECTIVES: A timely diagnosis is imperative for curing cancer. However, in patients with rheumatic musculoskeletal diseases (RMDs) or paraneoplastic syndromes, misleading symptoms frequently delay cancer diagnosis. As metabolic remodelling characterises both cancer and RMD, we analysed if a metabolic signature can indicate paraneoplasia (PN) or reveal concomitant cancer in patients with RMD. METHODS: Metabolic alterations in the sera of rheumatoid arthritis (RA) patients with (n=56) or without (n=52) a history of invasive cancer were quantified by nuclear magnetic resonance analysis. Metabolites indicative of cancer were determined by multivariable regression analyses. Two independent RA and spondyloarthritis (SpA) cohorts with or without a history of invasive cancer were used for blinded validation. Samples from patients with active cancer or cancer treatment, pulmonary and lymphoid type cancers, paraneoplastic syndromes, non-invasive (NI) precancerous lesions and non-melanoma skin cancer and systemic lupus erythematosus and samples prior to the development of malignancy were used to test the model performance. RESULTS: Based on the concentrations of acetate, creatine, glycine, formate and the lipid ratio L1/L6, a diagnostic model yielded a high sensitivity and specificity for cancer diagnosis with AUC=0.995 in the model cohort, AUC=0.940 in the blinded RA validation cohort and AUC=0.928 in the mixed RA/SpA cohort. It was equally capable of identifying cancer in patients with PN. The model was insensitive to common demographic or clinical confounders or the presence of NI malignancy like non-melanoma skin cancer. CONCLUSIONS: This new set of metabolic markers reliably predicts the presence of cancer in arthritis or PN patients with high sensitivity and specificity and has the potential to facilitate a rapid and correct diagnosis of malignancy.

Standard Doses of Cholecalciferol Reduce Glucose and Increase Glutamine in Obesity-Related Hypertension: Results of a Randomized Trial.

In arterial hypertension, the dysregulation of several metabolic pathways is closely associated with chronic immune imbalance and inflammation progression. With time, these disturbances lead to the development of progressive disease and end-organ involvement. However, the influence of cholecalciferol on metabolic pathways as a possible mechanism of its immunomodulatory activity in obesity-related hypertension is not known. In a phase 2, randomized, single-center, 24-week trial, we evaluated, as a secondary outcome, the serum metabolome of 36 age- and gender-matched adults with obesity-related hypertension and vitamin D deficiency, before and after supplementation with cholecalciferol therapy along with routine medication. The defined endpoint was the assessment of circulating metabolites using a nuclear magnetic resonance-based metabolomics approach. Univariate and multivariate analyses were used to evaluate the systemic metabolic alterations caused by cholecalciferol. In comparison with normotensive controls, hypertensive patients presented overall decreased expression of several amino acids (p < 0.05), including amino acids with ketogenic and glucogenic properties as well as aromatic amino acids. Following cholecalciferol supplementation, increases were observed in glutamine (p < 0.001) and histidine levels (p < 0.05), with several other amino acids remaining unaffected. Glucose (p < 0.05) and acetate (p < 0.05) decreased after 24 weeks in the group taking the supplement, and changes in the saturation of fatty acids (p < 0.05) were also observed, suggesting a role of liposoluble vitamin D in lipid metabolism. Long-term cholecalciferol supplementation in chronically obese and overweight hypertensives induced changes in the blood serum metabolome, which reflected systemic metabolism and may have fostered a new microenvironment for cell proliferation and biology. Of note, the increased availability of glutamine may be relevant for the proliferation of different T-cell subsets.

Do spirituality and emotional intelligence improve the perception of the ability to provide care at the end of life? The role of knowledge and self-efficacy.

OBJECTIVES: Spirituality, emotional intelligence, and palliative care (PC) knowledge have a positive and direct influence on self-efficacy and on perception of preparation and ability to provide end-of-life (EOL) care. The aim of this work is to propose a conceptual model that relates spirituality, emotional intelligence, PC knowledge, self-efficacy, and the preparation and ability to provide EOL care by doctors and nurses. METHODS: Quantitative, exploratory, descriptive, and inferential study applied to doctors and nurses in a hospital in the north of Portugal, between May and July 2022. The data collection instrument includes a questionnaire. The relationships between latent variables were evaluated using structural equation models by the partial least squares method using the Smart PLS 3.0 software. It was obtained the previous authorization of the ethics committee. RESULTS: The results (n = 380) indicate that self-efficacy, spirituality, and PC knowledge have a positive influence on the ability to provide EOL care. Emotional intelligence and spirituality have a direct and positive effect on self-efficacy. There is no direct influence of emotional intelligence on the ability to provide EOL care, but emotional intelligence has an indirect effect mediated by self-efficacy. SIGNIFICANCE OF RESULTS: Spirituality, self-efficacy, and emotional intelligence are very important for the ability of doctors and nurses to provide EOL care. The identification of predictive factors of the ability to provide EOL care and the determination of the relationship between them can improve the provision of EOL care, reduction of health costs, timely and early referral of people to PC, and increase life quality.

Z-suture scleral fixation intraocular lenses: A refractive and safety report.

PURPOSE: Scleral fixation of intraocular lenses constitutes a surgical option in cases where there is inadequate capsular support or zonular insufficiency. Knotless techniques, such as the z-suture technique, avoid suture-related complications, such as conjunctival erosion or exposure. The purpose of this study was to evaluate the visual outcomes and postoperative complications of patients who underwent scleral z-suture fixation of the Akreos AO® intraocular lenses. METHODS: A retrospective, observational study was conducted, including 22 eyes of 20 patients who underwent Akreos AO® intraocular lenses using the z- suture scleral fixation technique. RESULTS: The mean age of the patients was 55,64 ± 28,47 years old, and the mean follow-up time was 25,64 months. The most common indication for surgery was previous complicated cataract surgey. The mean postoperative spherical equivalent was +0,058D ± 0,79D, with values ranging from - 1,50D to +1,00D. Mean best-corrected visual acuity was 0,178 ± 0,15 logMAR. Intraocular pressure was 15,07 ± 2,56 mmHg on the day after surgery, and 16 ± 2,15 mmHg 1 month after. No suture-related complications were observed in any patient postoperatively. One patient had a slight inferonasal lens dislocation and another patient had a severe case of herpetic keratitis posoperatively. DISCUSSION: The knotless z-suture technique appears to be a reliable and safe way to fix an intraocular lens in the sclera, regardless of the patient's age. Our results show good visual results and predictable refractive outcomes. Decades of follow-up may be necessary to assess the long-term risk of lens dislocation.

Leg dystrophic calcification as a consequence of chronic diabetic foot infection: a case report.

Foot ulceration and infection is associated with a substantial increase in morbidity and mortality in patients with diabetes. We present a clinical case of recurrent diabetic foot infection with an atypical clinical evolution. A 58-year-old male patient with type 1 diabetes and a history of bilateral Charcot foot neuroarthropathy was followed at our Diabetic Foot Clinic for an unhealed plantar foot ulcer for >1.5 years with recurrent episodes of infection. He was admitted to hospital due to foot ulcer reinfection with sepsis and ipsilateral lower limb cellulitis. The foot infection was found to be associated with an underlying abscess in the anterior compartment of the leg, with a cutaneous fistulous course with extensive alterations of an inflammatory nature. Exudate from the lesion was drained and tissue biopsied, revealing Serratia marcescens and Klebsiella oxytoca with dystrophic calcification (DC). Surgical excision of dystrophic tissue with debridement of the fistulous tracts was performed. The excised material corroborated the presence of fibroadipose connective tissue with marked DC, as well as areas of mixed inflammation compatible with a chronic infectious aetiology. Targeted long-term antibiotic therapy was implemented, for a total of six weeks, with a favourable clinical evolution and complete closure of the lesion at the final follow-up. DC results from calcium deposition in degenerated tissues without evidence of systemic mineral imbalance and is a potential cause of non-healing ulcers. Few cases of DC have been reported in diabetic foot patients and its treatment remains challenging and controversial. A longer follow-up period is necessary to verify the effectiveness of our approach.

Inventory of tiger- and ground-beetles (Coleoptera, Caraboidea, Cicindelidae and Carabidae) in two sampling seasons of the Gorongosa National Park, Mozambique.

Background: The Gorongosa National Park (Mozambique) is one of the most emblematic protected areas in Africa, well known for its vertebrate biodiversity and restoration ecology efforts following the Mozambican civil war in 1992. The invertebrate biodiversity of Gorongosa National Park is still poorly studied, although the scarce information available indicates the existence of a rich number of species, namely in the case of tiger- and ground-beetles (Coleoptera, Caraboidea). Moreover, the study of arthropod assemblages is key for designing conservation practices since they are potentially accurate biodiversity and ecological indicators. Hence, the diversity assessment of Caraboidea beetles using standardised methodologies is likely to provide a new insight for future conservation planning and help to quantify the effects of climate change in areas identified as vulnerable to anthropogenic pressures, such as the Gorongosa National Park. New information: We report the occurrence of five tiger beetles (Cicindelidae) and 93 ground-beetles (Carabidae) species/morphospecies in Gorongosa National Park from a field survey funded by the ECOASSESS project. Sampling was performed in the four main habitat types present in the Park (miombo tropical forest, mixed dry forest, transitional forest and grasslands) between 25 October and 25 November 2019. In this sampling window, the turnover of Caraboidea species from the dry season to the wet season was recorded for the first time. Twenty-eight species of ground-beetles are new records to Mozambique, including three new subgenera and three new genera. Additional information on species phenology and habitat preferences is also provided.

When the Party Goes Wrong: A Case Report of Recurrent Valsalva Retinopathy Treated With Pars Plana Vitrectomy.

Valsalva retinopathy is a preretinal hemorrhage caused by a sudden increase in intrathoracic or intra-abdominal pressure, which generally happens after sudden and intense physical effort. This case report describes a case of Valsalva preretinal hemorrhage first treated with laser membranotomy, which subsequently recurred and was retreated with a pars plana vitrectomy. An 18-year-old male was admitted due to complaints of decreased visual acuity in his right eye for three days. He had been practicing strength training in the gymnasium before the complaints started but denied trauma or other precipitating factors. Fundoscopy revealed a central preretinal hemorrhage, and he underwent laser membranotomy, which successfully released the blood from the sub-hyaloid space into the vitreous cavity. However, the following night, he went to a nightclub party and then returned with the same initial symptoms of decreased visual acuity in his right eye. Fundoscopy revealed a relapse of the hemorrhage, which was now too central for membranotomy. He was proposed for a pars plana vitrectomy, with an aspiration of the blood, which was found to be under the inner limiting membrane. The patient achieved complete functional recovery after two weeks, with visual acuities of 20/20 on his right eye. Valsalva retinopathy may be treated with a conservative non-interventional approach, but laser membranotomy and surgery may be beneficial in selected cases, promoting faster visual rehabilitation and avoiding potential long-term toxicity effects of the prolonged presence of preretinal blood. Compliance with the postoperative rest period is essential after a laser membranotomy is performed, and failure to do it may result in the recurrence of the hemorrhage.

Pediatric Microspherophakia Treatment With Scleral Fixated IOL Using a Z-suture Technique.

Microspherophakia constitutes a rare, mostly bilateral anomaly of the crystalline lens, which is characterized by the presence of an increased lens thickness and reduced equatorial diameter. It is frequently associated with lens subluxation, translating into a high degree of variable lenticular myopia and defective accommodation. The purpose of this report is to describe the treatment of a three-year-old female patient with microspherophakia, with the scleral fixation of an intraocular lens using the z-suture technique. A three-year-old female patient with Marfan Syndrome presented with high bilateral myopia and esotropia. Lens subluxation was perceived, and she was proposed for bilateral surgery. Scleral fixation of the intraocular lens was performed using the z-suture technique. During the five-year follow-up period, she maintained a best-corrected visual acuity of 20/20 in both eyes wearing bifocal glasses.  Microspherophakia is a rare but impactful condition, frequently related to severe and variable refractive error due to the lens shape and zonule instability. Intraocular lens implantation in the capsular bag is usually impossible, and scleral fixation is a valid alternative. The z-suture technique avoids suture knots and the need for intrascleral flaps, reducing the risk of suture-related complications.

Efetividade dos programas de reabilitação cardíaca home based / Efetividade dos programas de reabilitação cardíaca home based

Introdução: A evidência científica infere que o risco de novos eventos cardiovasculares em doentes com história de doença cardíaca isquémica, que realizam adequados programas de reabilitação cardíaca, é inferior ao risco dos que não usufruem desta resposta em saúde. Por conseguinte, assume-se como relevante a universalidade da implementação de programas de reabilitação cardíaca home based a nível nacional. Neste contexto, o objetivo deste estudo consiste em determinar a efetividade dos programas de reabilitação cardíaca home based na redução da taxa de reinternamento, na redução dos fatores de risco cardiovasculares modificáveis e na melhoria da qualidade de vida relacionada com a saúde em doentes com doença cardíaca isquémica. Métodos: Realizou-se uma revisão sistemática da literatura sobre estudos que avaliavam a efetividade dos programas de reabilitação cardíaca home based em doentes com doença cardíaca isquémica. Fez-se pesquisa na PUBMED, EBSCO, Google Académico e SciELO de estudos publicados entre 2012 a 2018, avaliados de acordo com os critérios de inclusão e exclusão, que posteriormente foram avaliados por dois investigadores de forma independente, respeitando os critérios de inclusão e exclusão previamente estabelecidos. O corpus da revisão ficou constituído por 3 artigos Resultados: A análise dos estudos demonstra que os programas de reabilitação cardíaca home based baseada em exercícios contribuem para a redução da taxa de reinternamento e associam-se à redução dos fatores de risco cardiovasculares modificáveis, incluindo o tabagismo, pressão arterial, peso corporal e perfil lipídico. Ficou demonstrada uma ligeira adesão de doentes para a reabilitação cardíaca home based do que para a reabilitação centre-based (1,04, IC 95% 1,01 a 1,07). O número de fatores de risco modificáveis apresentou correlação significativa com a reabilitação cardíaca home based, com uma redução dos fatores de risco cardiovasculares modificáveis. Houve diferenças significativas na atividade física (F=4,2, p=0,02), vitalidade (F=10,7, p<0,001) e saúde mental (F=15,9, p <0,001). No que respeita ao efeito sobre os índices de qualidade de vida de vida relacionada com a saúde, a reabilitação cardíaca home based oferece benefícios similares à reabilitação cardíaca centre-based. Conclusão: Partindo dos resultados obtidos, poderá inferir-se que os programas de reabilitação cardíaca home based se constituem como um recurso terapêutico com efeitos, transversalmente positivos, na reabilitação de pessoas com doença cardíaca isquémica, o que implica desafios constantes à enfermagem de reabilitação. Apesar dos benefícios clínicos, a oferta de programas de reabilitação cardíaca home-based ainda é uma realidade sub-representada em Portugal, daí a necessidade da sua promoção e implementação

Introduction: The scientific evidence infers that the risk of new cardiovascular events in patients with a history of ischemic heart disease, who perform adequate cardiac rehabilitation programs, is lower than the risk of those who do not benefit from this health response. Therefore, the universality of the implementation of home-based cardiac rehabilitation programs at national level is assumed to be relevant. In this context, the purpose of this study is to determine the effectiveness of home-based cardiac rehabilitation programs in reducing re-hospitalization rate, reducing modifiable cardiovascular risk factors, and improving health-related quality of life in patients with heart disease ischemic. Methods: A systematic review of the literature was conducted on studies evaluating the effectiveness of home-based cardiac rehabilitation programs in patients with ischemic heart disease. We searched PUBMED, EBSCO, Google Academic and SciELO for studies published between 2012 and 2018, evaluated according to the inclusion and exclusion criteria, which were subsequently evaluated by two researchers independently, respecting the inclusion and exclusion criteria previously established. The corpus of the review consisted of 3 articles Results: Analysis of the studies demonstrates that exercise-based home-based cardiac rehabilitation programs contribute to reduced rehospitalization rate and are associated with a reduction in modifiable cardiovascular risk factors, including smoking, blood pressure, body weight and profile lipid. There was a slight adherence of patients to home-based cardiac rehabilitation than to center-based rehabilitation (1.04, 95% CI 1.01 to 1.07). The number of modifiable risk factors showed a significant correlation with home-based cardiac rehabilitation, with a reduction in modifiable cardiovascular risk factors. There were significant differences in physical activity (F=4.2, p=0.02), vitality (F=10.7, p<0.001) and mental health (F=15.9, p<0.001). With regard to the effect on health-related life quality of life indices, home-based cardiac rehabilitation offers similar benefits to center-based cardiac rehabilitation. Conclusion: Based on the results obtained, it can be inferred that home-based cardiac rehabilitation programs constitute a therapeutic resource with transversely positive effects on the rehabilitation of people with ischemic heart disease, which implies constant challenges to rehabilitation nursing. Despite the clinical benefits, the offer of home-based cardiac rehabilitation programs is still underrepresented in Portugal, hence the need for its promotion and implementation.

Capacitação de trabalhadores em suporte básico de vida / Training workers in basic life support / Capacitación de trabajadores en soporte básico de vida

Resumo Introdução A capacitação dos cidadãos no auxílio a vítimas em risco de vida é fundamental em qualquer sociedade. Objetivo avaliar os conhecimentos sobre Suporte Básico de Vida dos trabalhadores de uma Câmara Municipal do norte de Portugal, antes e após a implementação do programa de intervenção "Capacitar para Salvar" e avaliar as competências demonstradas, após a participação no programa de intervenção. Materiais e Métodos Trata-se de um estudo do tipo quase-experimental e longitudinal, onde foi utilizado um questionário, constituído por 2 partes (caraterização sociodemográfica e avaliação de conhecimentos) e uma grelha de avaliação de competências. No 1º momento foram avaliados os conhecimentos sobre Suporte Básico de Vida e implementado um programa de intervenção, sendo que no 2º momento, foram avaliados os conhecimentos e competências sobre Suporte Básico de Vida. Resultados Participaram no estudo 97 trabalhadores. Os resultados mostraram que os trabalhadores possuem conhecimentos e competências insuficientes em Suporte Básico de Vida. Discussão e Conclusões Verificaram-se diferenças estatisticamente significativas nos conhecimentos e competências em Suporte Básico de Vida. Implicações para a prática: implementação de estratégias que promovam a formação em Suporte Básico de Vida a todos cidadãos, quer ao nível da transmissão de conhecimentos, quer da formação prática.

Abstract Introduction Training citizens to help victims in life-threatening situations is fundamental in any society. Objective to evaluate the knowledge on Basic Life Support by workers in a Municipal Council of the north of Portugal, before and after implementing the intervention program "Train to Save" and assess the skills shown after participating in the intervention program. Materials and Methods This was a quasi-experimental longitudinal study, using a questionnaire, which comprised two parts (sociodemographic characterization and evaluation of knowledge) and a skills-assessment grid. In the first moment, knowledge on Basic Life Support was evaluated and an intervention program was implemented; the second moment evaluated the knowledge and skills on Basic Life Support. Results The study had the participation of 97 workers. The results revealed that the workers had insufficient knowledge and skills in Basic Life Support. Discussion and Conclusions Statistically significant differences were verified of knowledge and skills in Basic Life Support. Implications for the practice: implementation of strategies that promote training in Basic Life Support for all citizens at knowledge transmission level and in practical formation.

Resumen Introducción La capacitación de los ciudadanos en la ayuda a las víctimas en riesgo de vida es fundamental en cualquier sociedad. Objetivo evaluar los conocimientos sobre Soporte Básico de Vida de los trabajadores de una Cámara Municipal del Norte de Portugal, antes y después de la implementación del programa de intervención "Capacitar para Salvar" y evaluar las competencias demostradas, después de la participación en el programa de intervención. Materiales y Métodos Se trata de un estudio de tipo cuasi-experimental y longitudinal, donde se utilizó un cuestionario, constituido por 2 partes (caracterización sociodemográfica y evaluación de conocimientos) y una plantilla de evaluación de competencias. En el 1° momento fueron evaluados los conocimientos sobre Soporte Básico de Vida e implementado un programa de intervención, siendo que en el 2º momento fueron evaluados los conocimientos y competencias sobre Soporte Básico de Vida. Resultados Participaron en el estudio 97 trabajadores. Los resultados mostraron que los trabajadores poseen conocimientos y competencias insuficientes en Soporte Básico de Vida. Discusión y Conclusiones Se verificaron diferencias estadísticamente significativas en los conocimientos y competencias en Soporte Básico de Vida. Implicaciones para la práctica: implementación de estrategias que promuevan la formación en Soporte Básico de Vida a todos los ciudadanos, tanto en el nivel de la transmisión de conocimientos como en la formación práctica.

Sociodemographic and clinical characteristics of patients with diabetic foot ulcer / Características sociodemográficas e clínicas de doentes com pé diabético

Summary Introduction: Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. Methods: A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. Results: Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years in average, and diagnosed with diabetic foot ulcer in average 3 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly interfered with all areas of their functioning. Conclusion: The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patient's daily life activities and whether the patient has family or caregiver support.

Resumo Introdução: o pé diabético é uma das complicações mais graves da diabetes, afetando cerca de 15% dos indivíduos com diabetes, e é a maior causa de amputação de membros inferiores de origem não traumática. Este estudo apresenta uma caracterização sociodemográfica e clínica de doentes com pé diabético indicados para cirurgia de amputação. Método: estudo transversal com 206 doentes com diabetes tipo 2 e pé diabético indicados para cirurgia de amputação. Foram recolhidos dados sociodemográficos e clínicos. Intensidade e interferência da dor foram avaliadas por meio do Brief Pain Inventory e os descritores da dor, pelo Douleur Neuropathique 4. Resultados: a maioria dos doentes era do sexo masculino, com baixa escolaridade e uma média de idade de 66 anos. Apresentava diagnóstico de diabetes tipo 2 havia 18 anos e pé diabético havia 4 anos. Cerca de 59% dos doentes apresentavam dor no membro inferior, interferindo significativamente em todas as áreas de funcionamento. Conclusão: as variáveis sociodemográficas desempenham um papel importante na ulceração do pé diabético. As úlceras neuropáticas são mais facilmente preveníveis; portanto, é importante o acompanhamento sistemático dos doentes com neuropatia. Nos doentes com pé neuroisquêmico, estratégias para lidar/gerir a dor de forma mais eficaz são necessárias. A intervenção deve ser multidisciplinar e considerar os fatores sociodemográficos e clínicos, a presença, intensidade e interferência da dor nas atividades de vida diária do doente, bem como a presença de suporte da família ou de um cuidador.

Phytochemical study and evaluation of the antimicrobial activity and cytotoxicity of Cuscuta racemosa

Cuscuta racemosa Mart. is a parasitic plant of the Convolvulaceae family, used in popular medicine as an anti-inflammatory and a diuretic, for stomach and hepatic disorders, and for treating fresh wounds. This plant is popularly known as "cipó-chumbo" and "fios-de-ovos". In this study, it was chemically investigated and tested for its antimicrobial activity and cytotoxicity. The flavonoid and tannin content of the dried plant were 2.79 percent and 2.01 percent, respectively. Furthermore, the 4'-methoxyquercetin flavanoid compound was isolated from the ethanolic fraction. The minimum inhibiting concentration in the antimicrobial test was 2.0 mg/ml for Staphylococcus aureus, and a DL50 of 0.231 mg/mL was obtained in the cytotoxicity experiment. The fraction directed to alkaloids was able to eliminate 100 percent of the brine shrimp used for the test.

Avaliação pré-operatória e cuidados em cirurgia eletiva: recomendações baseadas em evidências / Preoperative assessment and care in elective surgery: evidence-based recommendations

Estas recomendações elaboradas por equipe multidisciplinar propõem critérios baseados em evidências na avaliação pré-operatória de pacientes adultos e pediátricos candidatos a cirurgias eletivas, bem como sugerem cuidados

These recommendations have been developed by a multidisciplinar team, in which an evidence based criteria are proposed on pre-surgery assessment in adults and children who are candidates for an elective surgery, as well as the management that are more suitable

Estreptococo do grupo B na gestação: diagnóstico e conduta / Group B streptococcus during pregnancy: diagnosis and management

O estreptococo do grupo B é um agente conhecido de infecção neonatal grave. O rastreio pré-natal com pesquisa de colonização anal/genital materna e uso de quimioprofilaxia intraparto são medidas de grande impacto para redução dos casos de sepse precoce nos neonatos. Neste artigo fazemos uma breve revisão da epidemiologia, diagnostico e condutas em relação a colonização por estreptococo B nas gestantes.

Screening for Toxoplasma gondii antibodies in 2, 513 consecutive parturient women and evaluation of newborn infants at risk for congenital toxoplasmosis / Triagem para anticorposanti-Toxoplasma gondii em 2. 513 parturientes consecutivas e avaliação dos recém-nascidos comrisco de toxoplasmose congênita

Aims: To determine the prevalence of seropositivity for toxoplasmosis in pregnant women, to assess the outcome and the prevalence of congenital toxoplasmosis, and to evaluate the usefulness of routine screening for Toxoplasma gondii antibodies in parturient women.Methods: Prospective cross-sectional study of consecutive mothers and their liveborn infants within the first 12 months of the implementation in a maternity ward of a routine consisting in screening for toxoplasmosis at delivery.Results: Serologic status for toxoplasmosis were assessed in 2,477 (98.5%) of 2,513 mothers of liveborn infants throughout the study period. Of the 2,477 mothers, 810 (32.7%; 95%CI 30.9-34.6%) were susceptible and 1,667 (67.3%; 95%CI 65.4-69.1%) were immune. Three newborn infants with congenital toxoplasmosis were identified because of the maternal serum tests at delivery, and all of them had The prevalence of congenital toxoplasmosis was 12/10,000 (CI 95%: 6/10,000-21/10,000).Conclusions: Maternal serologic screening at delivery was useful for the early detection of cases of congenital toxoplasmosis that would have otherwise gone undetected in the neonatal period, and allowed for earlier treatment of newborns with retinochoroiditis. The high prevalence of Toxoplasma gondii antibodies in pregnant women and of congenital toxoplasmosis justify a prenatal screening program in this population.The prevalence of congenital toxoplasmosis was 12/10,000 (CI 95%: 6/10,000-21/10,000).Conclusions: Maternal serologic screening at delivery was useful for the early detection of cases of congenital toxoplasmosis that would have otherwise gone undetected in the neonatal period, and allowed for earlier treatment of newborns with retinochoroiditis. The high prevalence of Toxoplasma gondii antibodies in pregnant women and of congenital toxoplasmosis justify a prenatal screening program in this population.

Objetivos: Avaliar a prevalência de soropositividade para toxoplasmose em gestantes, investigar os desfechos clínicos e a prevalência da toxoplasmose congênita e verificar a utilidade da triagem de rotina para Toxoplasma gondii em parturientes.Métodos: Estudo prospectivo incluindo todas as mães e seus respectivos recém-nascidos vivos, durante os 12 primeiros meses de implantação, em uma maternidade, de uma rotina de triagem para toxoplasmose em parturientes.Resultados: Foi avaliado o estado imunológico para toxoplasmose em 2.477 (98,5%) entre as 2.513 mães de recém-nascidos vivos durante o período do estudo. Destas, 810 (32,7%; IC 95% 30,9-34,6%) eram suscetíveis e 1.667 (67.3%; IC 95% 65,4-69,1%) eram imunes. Foram diagnosticados três casos de toxoplasmose congênita apenas pela sorologia materna na hora do parto, sendo que os três pacientes apresentavam lesões ativas de retinocoroidite toxoplásmica A prevalência de toxoplasmose congênita foi de 12/10.000 (IC 95%: 6/10.000-21/10.000).Conclusões: A sorologia materna no momento do parto foi útil na identificação precoce de casos de toxoplasmose congênita que teriam passado despercebidos no período neonatal, permitindo o tratamento precoce de bebês com retinocoroidite. Nesta população, a elevada prevalência encontrada, tanto de anticorpos anti-Toxoplasma gondii nas gestantes, quanto de toxoplasmose congênita, justificam um programa de triagem pré-natal.

Infecção por HIV e sífilis na gestação: aspectos obstétricos e neonatais / HIV infection and syphilis in pregnancy: obstetric and neonatal aspects

Este artigo propõe-se a apresentar duas das infecções congênitas mais prevalentes e que apresentam epidemiologia semelhante: infecção por HIV e sífilis. Abordaremos as condutas obstétricas e neonatais para o manejo dessas doenças.