An overview of electrochemical biosensors used for COVID-19 detection.

This short review presents the latest advances in the field of electrochemical biosensors, focusing particularly on impedimetric biosensors for the direct measurement of analytes. As a source of study we have chosen to describe these advances in the latest global health crisis originated from the COVID-19 pandemic, initiated by the SARS-CoV-2 virus. In this period, the necessity for swift and precise detection methods has grown rapidly due to an imminent need for the development of an analytical method to identify and isolate infected patients as an attempt to control the spreading of the disease. Traditional approaches such as the enzyme-linked immunosorbent assay (ELISA), were extensively used during the SARS-CoV-2 pandemic, but their drawbacks, including slow response time, became evident. In this context, the potential of electrochemical biosensors as an alternative for COVID-19 detection was emphasized. These biosensors merge electrochemical technology with bioreceptors, offering benefits such as rapidity, accuracy, portability, and real-time result provision. Additionally, we present instances of electrochemical biosensors modified with conductive polymers, eliminating the necessity for an electrochemical probe. The adaptability of the developed materials and devices facilitated the prompt production of electrochemical biosensors during the pandemic, creating opportunities for broader applications in infectious disease diagnosis.

Impacts of heavy metal exposure on the prostate of murine models: Mechanisms of toxicity.

Heavy metals are elements found into the environment mainly due to anthropogenic activities. Naturally occurring and higher released doses cause disorders in the prostate, which depends on appropriate hormonal regulation, and exposure to heavy metals may impair prostate homeostasis. The current work highlighted the main mechanisms of toxicity of different environmental heavy metal contaminants, such as aluminum, arsenic, cadmium, chromium, lead, mercury, and nickel, and their impacts found in the prostate morphophysiology of murine models. The repercussions triggered by heavy metals on the prostate include hormonal imbalance and oxidative damage, leading to morphological alterations, which can vary according to the chemical properties of each element, exposure time and concentration, and age. The information of altered biological pathways and its impacts on the prostate of exposed murines are related to human outcomes being useful in the real context of human exposure.

Advancements and future directions in cardiac biomarker detection using lateral flow assays.

Lateral flow assays (LFAs) have emerged as one of the most prominent paper-based biosensor platforms for rapidly detecting and quantifying analytes. Their selectivity, cost-effectiveness, efficiency, and simplicity make them ideal candidates for point-of-care (POC) applications, particularly when time-sensitive decisions are needed, such as cardiovascular events. The profound impact of cardiovascular diseases (CVDs), characterized by their high morbidity, mortality, and rehospitalization rates, necessitates an optimized approach for the early detection of cardiac muscle damage. This comprehensive review aims to consolidate the existing scientific literature on LFAs that specifically target cardiovascular biomarkers, including myoglobin and cardiac troponin I, over the past decade. By examining the advancements and findings in this field, valuable insights can be gained regarding the potential and future directions of LFAs in cardiovascular diagnostics.

Acute sublethal exposure to ethiprole impairs physiological and oxidative status in the Neotropical fish Astyanax altiparanae.

Ethiprole, a phenylpyrazole insecticide, has been increasingly used in the Neotropical region to control stink bug pests in soybean and maize fields. However, such abrupt increases in use may have unintended effects on non-target organisms, including those inhabiting freshwater ecosystems. Here, we evaluated the effects of acute (96 h) sublethal exposure to ethiprole (up to 180 µg/L, which is equivalent to 0.013% of the recommended field dose) on biomarkers of stress in the gills, liver, and muscle of the Neotropical fish Astyanax altiparanae. We further recorded potential ethiprole-induced effects on the structural histology of A. altiparanae gills and liver. Our results showed that ethiprole exposure increased glucose and cortisol levels in a concentration-dependent manner. Ethiprole-exposed fish also exhibited higher levels of malondialdehyde and greater activity of antioxidant enzymes, such as glutathione-S-transferase and catalase, in both gills and liver. Furthermore, ethiprole exposure led to increased catalase activity and carbonylated protein levels in muscle. Morphometric and pathological analyses of the gills revealed that increasing ethiprole concentration resulted in hyperemia and loss of integrity of the secondary lamellae. Similarly, histopathological analysis of the liver demonstrated higher prevalence of necrosis and inflammatory infiltrates with increasing ethiprole concentration. Altogether, our findings demonstrated that sublethal exposure to ethiprole can trigger a stress response in non-target fish species, which may lead to potential ecological and economic imbalances in Neotropical freshwater systems.

Exposure to the herbicide atrazine induces oxidative imbalance, morphological damage and decreased survival in juvenile fish

Synthetic herbicides have been intensively used in weed control, although often involved in environmental contamination, critically affecting non-target species. However, never was investigated the effect of commercial formulation using atrazine on developing juvenile fish exposed for 35 days. Juveniles (Astyanax altiparanae) (n = 600) were assigned to the following ATZ-exposed groups: 0 (CTR-control), 0.56 (ATZ0.56), 1.00 (ATZ1.00), 1.66 (ATZ1.66) and 11.66 (ATZ11.66) µg/L. We found a 36.6% decrease in juvenile survival rate in the ATZ11.66 group compared to control and other groups. Juveniles from ATZ11.66 also showed hyperglycemia and increased cortisol levels. Increased the imbalance oxidative with an increase in malondialdehyde (MDA) and Carbonylated proteins levels markers in muscle, gills, and liver. We also found increased activity of the antioxidant enzymes superoxide dismutase (SOD) in gills and SOD and catalase (CAT) in muscles from ATZ11.66 fish, and increased glutathione S-transferase (GST) activities in the liver from all exposed groups compared to control. The morphological consequences of this were loss of secondary lamella integrity, increased mucus-secreting cells, hyperplasia, and lamellar fusion, as well as increased aneurysms percentage. The liver showed vascular congestion associated with endothelial hyperplasia, steatosis, and a decrease in the nuclei percentage. Our results showed that exposure to a commercial formulation of ATZ at 11.66 µg/L can be causing an imbalance in the oxidative markers and morphological damages and decreased survival in a juvenile Neotropical species of great ecological relevance and commercial interest.

Sample Preparation for Lab-on-a-Chip Systems in Molecular Diagnosis: A Review.

Rapid and low-cost molecular analysis is especially required for early and specific diagnostics, quick decision-making, and sparing patients from unnecessary tests and hospitals from extra costs. One way to achieve this objective is through automated molecular diagnostic devices. Thus, sample-to-answer microfluidic devices are emerging with the promise of delivering a complete molecular diagnosis system that includes nucleic acid extraction, amplification, and detection steps in a single device. The biggest issue in such equipment is the extraction process, which is normally laborious and time-consuming but extremely important for sensitive and specific detection. Therefore, this Review focuses on automated or semiautomated extraction methodologies used in lab-on-a-chip devices. More than 15 different extraction methods developed over the past 10 years have been analyzed in terms of their advantages and disadvantages to improve extraction procedures in future studies. Herein, we are able to explain the high applicability of the extraction methodologies due to the large variety of samples in which different techniques were employed, showing that their applications are not limited to medical diagnosis. Moreover, we are able to conclude that further research in the field would be beneficial because the methodologies presented can be affordable, portable, time efficient, and easily manipulated, all of which are strong qualities for point-of-care technologies.

El COVID-19 en barrios populares. Características del COVID-19 en el área de responsabilidad de un centro de salud de la Ciudad de Buenos Aires / COVID-19 in informal settlements. COVID-19´s characteristics in the area of responsibility of a primary health care center in Buenos Aires City

Introducción: El objetivo de este trabajo es caracterizar y describir los casos de COVID-19 según residan en barrios populares o en el resto del área de un centro de salud. Materiales y métodos: Estudio descriptivo, observacional y transversal. La unidad de análisis son los casos confirmados de COVID-19 residentes en el área de responsabilidad del Centro de Salud y Acción Comunitaria 28 (en adelante CeSAC 28) de la Ciudad Autónoma de Buenos Aires entre abril y diciembre de 2020. Las variables categóricas fueron expresadas como frecuencia y porcentaje, la variable numérica como mediana. Resultados: Se confirmaron 953 casos, el 57,29 % residentes en barrios populares, entre estos la mediana de edad fue menor y el porcentaje de extranjeros fue mayor en relación al resto del área, probablemente por la estructura demográfica de cada población. Los casos de residentes de barrios populares registraron menor prevalencia de comorbilidades y menor porcentaje de hospitalizaciones. La curva de casos residentes en barrios populares evidenció un desarrollo más precoz y concentrado que la del resto del área. El sistema público de salud tuvo impacto en el diagnóstico de toda el área, siendo alto el diagnóstico a través del Operativo Detectar en los barrios populares. Conclusiones: La epidemia de COVID-19 mostró características específicas en los barrios populares, como mayor velocidad de trasmisión y curvas de casos más concentradas, motivo por lo cual es imprescindible disponer de datos sobre la salud de estas poblaciones para poder identificar necesidades y prioridades en salud y adecuar los servicios a través de la estrategia de atención primaria

Introduction: The aim of this work is to characterize and describe the characteristics of COVID-19 cases according to whether they reside in informal settlements or in the rest of the area of a primary health care center. Materials and methods: Observational, cross-sectional descriptive study. Confirmed cases of COVID-19 living in the area of responsibility of the primary health care center 28 in Buenos Aires City from April to December 2020 were analyzed. Categorical variables were expressed as frequency count and percentages, numerical variable as median. Results: 953 cases were confirmed, 57,29% living in informal settlements. COVID-19 cases living in informal settlements were younger and with more percentage of migrants, probably affected by demographic structure. COVID-19 cases living in informal settlements showed lower comorbidity prevalence and hospitalization. COVID-19 curve was earlier and focused in informal settlements than in the rest of the area. Public health services had impact in the diagnosis in the whole area, in informal settlements was high the diagnosis through Operativos Detectar. Conclusions: COVID-19 epidemic showed specific characteristics in informal settlements, with faster speed of transmission and more concentrated curves. It is essential to have available data about those populations, identify health needs and priorities and update services through primary health care strategy

Routine workflow in a reference clinical research center in face of COVID-19.

OBJECTIVE: To develop and validate the content of workflows for trial participants care in a clinical research center during the Covid-19 pandemic. METHOD: development study by consensus of experts carried out from March to July 2020 in southern Brazil. The flowcharts were developed following literature and validated by specialists considering comprehensiveness, clarity and pertinence, obtaining a 100% agreement index on each item of the developed instruments. The study was approved by the Ethics Committee of the institution. RESULTS: two flowcharts of care were elaborated and validated: "Flow diagram to conduct protocols with research participant " and "Flow diagram in protocols with research participant with suspected or confirmed COVID-19 infection"; which describes activities to ensure continuity of care. FINAL CONSIDERATIONS: a routine workflow can promote the continuity and safety of clinical research protocols. It is expected that the adopted flowcharts in this study can guide other institutions with a similar research profile.

[Interobserver agreement in using a checklist for the safe administration of enteral nutrition]. / Concordancia entre observadores en la aplicación de la lista de verificación para la administración segura de la nutrición enteral.

INTRODUCTION: Objective: to describe an evaluation of interobserver agreement in the use of a checklist related to the use of nasoenteral tube (NSS) as a presupposition for quality in obtaining data. Method: a methodological study conducted in 2018 in a Brazilian hospital, preceding the data collection of an open-label clinical trial. Independent observers, blinded to the evaluation of their peers, evaluated patients with NSS through a 25-item checklist. The data collected by eight previously trained research assistants (RA) were compared to those obtained by an experienced nurse (reference standard). Agreement was measured using the kappa coefficient and PABAK. Results: a total of 451 observations were made in pairs. Considering the total items on the checklist there was almost perfect agreement (k > 0.80) in all observation pairs (nurse vs. each RA): RA 1 (k = 0.91; 95 % CI = 0.89-0.93); RA 2 (k = 0.83; 95 % CI = 0.80-0.85); RA 3 (k = 0.92; 95 % CI = 0.90-0.94); RA 4 (k = 0.83; 95 % CI = 0.80-0.86); RA 5 (k = 0.94; 95 % CI = 0.92-0.96); RA 6 (k = 0.94; 95 % CI = 0.92-0.96); RA 7 (k = 0.96; 95 % CI = 0.95-0.98); RA 8 (k = 0.73; 95 % CI = 0.70-0.77). However, for isolated items, and in specific RAs, there were fair agreements, unacceptable to effectively collect data from a clinical trial. Retraining and supervision of RAs were able to improve agreement between observers. Conclusion: an evaluation of interobserver agreement proved to be fundamental to ensure the reliability of data collection and, therefore, to avoid measurement biases.

INTRODUCCIÓN: Objetivo: describir una evaluación de la concordancia entre observadores en el uso de una lista de verificación en la atención a pacientes con sonda nasoenteral (SNE) como premisa de la recogida de datos. Método: este estudio de fiabilidad se realizó en 2018 en un hospital brasileño, antes de la recogida de datos para un ensayo clínico abierto. Ocho observadores independientes, previamente capacitados y "cegados" con respecto a las evaluaciones de los demás, evaluaron a pacientes con SNE por medio de una lista de comprobación de 25 elementos. Los datos obtenidos por estos asistentes de investigación (AI) se compararon con los obtenidos por una enfermera experimentada. Se midió la concordancia mediante los coeficientes kappa y PABAK. Resultados: se realizaron 451 observaciones por pares. Considerando la totalidad de los elementos, hubo una concordancia casi perfecta (k > 0,80) en todos los pares de observación (enfermera vs. cada AI): AI 1 (k = 0,91; IC95 % = 0,89-0,93); AI 2 (k = 0,83; IC95 % = 0,80-0,85); AI 3 (k = 0,92; IC95 %= 0,90-0,94 ); AI 4 (k = 0,83; IC95 % = 0,80-0,86); AI 5 (k = 0,94; IC95 % = 0,92-0,96); AI 6 (k = 0,94; IC95 % = 0,92-0,96); AI 7 (k = 0,96; IC95 % = 0,95-0,98); AI 8 (k = 0,73; IC95 % = 0,70-0,77). Se identificó un menor número de concordancia en los elementos individuales y en determinados AI. La recapacitación y supervisión de los AI mejoró su desempeño y la concordancia entre observadores. Conclusión: la evaluación de la concordancia entre observadores resultó fundamental para asegurar la fiabilidad de la recogida de datos y, por consiguiente, evitar sesgos de medición en los estudios clínicos de enfermería.

Effects of subchronic exposure to environmentally relevant concentrations of the herbicide atrazine in the Neotropical fish Astyanax altiparanae.

Atrazine (ATZ) is among the most widely used herbicides in the world, and yet it has a potential to contaminate aquatic environments due to pesticide leaching from agricultural areas. In the Neotropical region, studies about the effects of this herbicide in native aquatic wildlife is scarce.Our study aimed at investigating the effects of a 30-day exposure to a commercial atrazine formulation on oxidative stress parameters, histopathology in testis and liver, and hormone levels in males and female of yellow-tailed tetra fish (Astyanax altiparanae). Adults were exposed to low but environmentally relevant concentrations of atrazine as follows: 0 (CTL-control), 0.5 (ATZ0.5), 1 (ATZ1), 2 (ATZ2) and 10 (ATZ10) µg/L. Our results showed decreased GST activity in gills in all groups of exposed animals and increased CAT activity in gills from the ATZ10 group. In the liver, there was an increase in lipid peroxidation in fish from ATZ1 and ATZ2 groups. Histological analysis of the liver showed increased percentage of sinusoid capillaries in ATZ2 fish, increased vascular congestion in ATZ1 and increased leukocyte infiltration in the ATZ10 group. Hepatocyte diameter analysis revealed a decrease in cell size in all groups exposed to ATZ, and a decrease in hepatocyte nucleus diameter in ATZ1, ATZ2 and ATZ10 groups. Endocrine parameters did not show significant changes following ATZ exposure, although an increase of triiodothyronine/thyroxine (T3/T4) ratio was observed in ATZ2 fish. Our results provide evidence that even low, environmentally relevant concentrations of ATZ produced oxidative damage and histological alterations in adult yellow-tailed tetra.

Effects of a solid formulation containing lectin-rich fraction of Moringa oleifera seeds on egg hatching and development of Aedes aegypti larvae.

The measures currently used to minimize the spread of arboviruses, comprising dengue, Chikungunya, and Zika virus, involve controlling the size of population of the mosquito Aedes aegypti. However, the search for formulations containing new insecticides is gaining pace due to reports of mosquito populations showing resistance to commonly used compounds. In this study, tablets containing a protein fraction of Moringa oleifera seeds enriched in the WSMoL lectin, known to show larvicidal and ovicidal activities against A. aegypti, were developed. The compatibility between the fraction and the excipients used in obtaining the tablets was evaluated by thermogravimetry (TG), differential scanning calorimetry (DSC), and Fourier transform infrared (FTIR) absorption spectroscopy. The larvicidal and ovicidal activities of the resulting tablets [5%, 10%, and 15% (w/w) of the fraction] were evaluated, as well as their effect on mosquito oviposition. Assays were also performed using a placebo tablet. According to the TG, DSC, and FTIR results, the protein composition of the fraction did not change when mixed with the components of the formulation. Tablets containing 10% and 15% WSMoL-rich fraction caused mortality of 42.5% and 95% of the larvae after 48 h, respectively, with larvae incubated with these tablets showing reduced acetylcholinesterase activity. All tablets inhibited egg hatching after 72 h (36-74%), and tablets containing 15% fraction were found to exert a repellent effect on oviposition. Our results show that the formulation developed in this study interfered with the life cycle of A. aegypti, and thus show potential for use in the control of this mosquito.

Concordância interobservadores em um checklist de cuidados em terapia nutricional enteral / Concordancia interobservadores en una checklist de cuidados en terapia nutricional enteral / Interobserver agreement in a checklist of care in enteral nutrition therapy

Resumo Objetivo Avaliar a concordância interobservadores na aplicação um checklist de cuidados em Terapia Nutricional Enteral (TNE). Métodos Estudo de confiabilidade que precedeu um ensaio clínico (NCT03497221), realizado em hospital universitário do sul do Brasil (junho e julho de 2017). Checklist de 25 itens relacionado aos cuidados em TNE foi realizado por uma enfermeira (Padrão de Referência) e por nove Assistentes de Pesquisa (AP). As avaliações foram feitas concomitantemente e de modo independente. A concordância foi testada utilizando-se o Statistical Package for the Social Sciences versão 21.0. Valores de Kappa (k) foram considerados como concordância entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); substancial (0,60 e 0,79); quase perfeita (0,80 a 0,99); e perfeita (1). O estudo foi aprovado pelo Comitê de Ética da Instituição (nº 16-0534). Resultados Foram realizadas 351 observações em duplicata, sendo o menor número de observações foi com a AP 5 (n=35) e o maior com a AP 8 (n=45). Foram avaliados itens relacionados a TNE em três blocos: identificação dos frascos de infusões e bomba de infusão; materiais de apoio para administração da terapia; e cuidados ao paciente em uso de TNE. Houve concordância quase perfeita ou perfeita em todos os pares de observação, com o menor Kappa para AP 6 (k=0,890; IC95%=0.86, 0.92) e o maior para AP 3 (k=0,965; IC95%=0.93, 0.99). Conclusão A concordância interobservadores ao aplicar um checklist contendo 25 itens foi excelente, o que minimiza a ocorrência de viés de aferição nas etapas subsequentes.

Resumen Objetivo Evaluar la concordancia interobservadores en la aplicación de una checklist de cuidados en terapia nutricional enteral (TNE). Métodos Estudio de fiabilidad que precedió un ensayo clínico (NCT03497221), realizado en un hospital universitario de la región Sur de Brasil (junio y julio de 2017). Una checklist de 25 ítems relacionados con los cuidados en TNE fue realizada por una enfermera (Estándar de Referencia) y por nueve Asistentes de Investigación (AI). Las evaluaciones fueron llevadas a cabo simultánea e independientemente. La concordancia se comprobó utilizando el Statistical Package for the Social Sciences versión 21.0. Los valores de Kappa (k) se consideraron como concordancia entre: pobre (0 a 0,19); relativa (0,20 a 0,39); moderada (0,40 a 0,59); considerable (0,60 a 0,79); casi perfecta (0,80 a 0,99); y perfecta (1). El estudio fue aprobado por el Comité de Ética de la institución (n.° 16-0534). Resultados Se realizaron 351 observaciones duplicadas, de las cuales el menor número de observaciones fue de la AI 5 (n=35) y el mayor de la AI 8 (n=45). Se evaluaron ítems relacionados con la TNE en tres grupos: identificación de los frascos de infusiones y bomba de infusión, material de apoyo para la administración de la terapia y cuidados del paciente en uso de TNE. Se observó concordancia casi perfecta o perfecta en todos los pares de observación, con el menor Kappa de la AI 6 (k=0,890; IC95 %=0.86, 0.92) y el mayor de la AI 3 (k=0,965; IC95 %=0.93, 0.99). Conclusión La concordancia interobservadores al aplicar una checklist de 25 ítems fue excelente, lo que minimiza la ocurrencia de sesgo de medición en las etapas subsiguientes.

Abstract Objective To assess interobserver agreement in the application of a checklist of care in enteral nutritional therapy (ENT). Methods This is a reliability study that preceded a clinical trial (NCT03497221), carried out at a university hospital in southern Brazil (June and July 2017). A checklist of 25 items related to care in ENT was performed by a nurse (reference standard) and nine research assistants (RA). Assessments were carried out concurrently and independently. Agreement was tested using the Statistical Package for the Social Sciences, version 21.0. Kappa values (k) were considered as poor (0 to 0.19), relative (0.20 to 0.39), moderate (0.40 to 0.59), substantial (0.60 and 0.79), almost perfect (0.80 to 0.99), and perfect (1). The study was approved by an Institutional Review Board (number 16-0534). Results Three hundred fifty-one observations were made in duplicate; the lowest number of observations was with RA, 5 (n = 35) and the highest with RA, 8 (n = 45). Items related to ENT were assessed in three blocks: identification of infusion bottles and infusion pump; support materials for administering the therapy; care for patients using ENT. There was almost perfect or perfect agreement in all observation pairs, with lowest Kappa for RA 6 (k = 0.890; 95% CI = 0.86, 0.92) and the highest for RA 3 (k = 0.965; 95% CI = 0.93, 0.99). Conclusion Interobserver agreement, when applying a checklist containing 25 items, was excellent, which minimizes the occurrence of measurement bias in subsequent steps.

Percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral: simulação clínica / Perception of nursing technicians about care in enteral nutritional therapy: clinical simulation / Percepción de los técnicos de enfermería sobre el cuidado en terapia nutricional enteral: simulación clínica

Objetivo: analisar a percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral, durante um cenário de simulação clínica. Método: estudo qualitativo, com base em um cenário de simulação clínica, realizado com 64 técnicos de enfermagem, em um hospital universitário do Sul do Brasil, em agosto de 2017. As falas foram audiogravadas, transcritas e, posteriormente, submetidas a análise de conteúdo. Resultados: foram evidenciadas quatro categorias sobre o cuidado em terapia nutricional enteral nas etapas de: administração da TNE; manutenção da sonda nasoenteral; registros de enfermagem e orientações ao paciente em uso de TNE. Conclusão: refletir sobre o cuidado prestado, por meio de um cenário de simulação clínica, pode colaborar com melhorias acerca do processo de trabalho da equipe de enfermagem e com o fortalecimento e segurança dos cuidados prestados

Objective: to analyze the perception of nursing technicians about care in enteral nutritional therapy, during a clinical simulation scenario. Method: qualitative study, based on a clinical simulation scenario, carried out with 64 nursing technicians, at a university hospital in southern Brazil, in August 2017. The statements were audio-recorded, transcribed and, subsequently, submitted to content analysis. Results: four categories were highlighted regarding care in enteral nutritional therapy in the stages of: administration of NET; maintenance of the nasoenteral tube; nursing records and guidelines for patients using NET. Conclusion: reflecting on the care provided, through a clinical simulation scenario, can collaborate with improvements regarding the work process of the nursing team and with the strengthening and safety of the care provided

Objetivo: analizar la percepción de los técnicos de enfermería sobre el cuidado en la terapia nutricional enteral, durante un escenario de simulación clínica. Método: estudio cualitativo, basado en un escenario de simulación clínica, realizado con 64 técnicos de enfermería, en un hospital universitario del sur de Brasil, en agosto de 2017. Las declaraciones fueron grabadas en audio, transcritas y, posteriormente, sometidas a análisis de contenido. Resultados: se destacaron cuatro categorías con respecto a la atención en terapia nutricional enteral en las etapas de: administración de TNE; mantenimiento de la sonda nasoenteral; registros y pautas de enfermería para pacientes que utilizan NET. Conclusión: Reflexionar sobre el cuidado brindado, a través de un escenario de simulación clínica, puede colaborar con mejoras en el proceso de trabajo del equipo de enfermería y con el fortalecimiento y seguridad del cuidado brindado

Simulação clínica: educação para equipe de enfermagem no cuidado aos pacientes com sonda nasoenteral / Simulación clínica: educación para el equipo de enfermería en el cuidado de pacientes con sonda nasoenteral / Clinical simulation: education for nursing team in the care of patients with nasoenteral tube

Objetivo compreender como os técnicos de Enfermagem percebem a simulação clínica como metodologia de educação no cuidado ao paciente hospitalizado em uso de sonda nasoenteral. Método trata-se de estudo exploratório, descritivo e de abordagem qualitativa, realizado com 64 técnicos de Enfermagem em um hospital de Porto Alegre, Sul do Brasil, em agosto e setembro de 2017. Realizou-se uma intervenção de educação por meio de simulações clínica, gravadas e transcritas. Utilizou-se a análise de conteúdo para tratamento dos dados. Resultados foram estabelecidas duas categorias: as potencialidades da simulação clínica como metodologia de educação e os desafios da simulação clínica para a prática da educação. Conclusão os profissionais de Enfermagem perceberam as potencialidades da atividade de simulação e mostraram-se colaborativos e receptivos a revisar as práticas de cuidados em terapia nutricional enteral. A simulação clínica é uma metodologia promissora a ser utilizada na educação permanente em serviço.

Objetivo entender cómo los técnicos de enfermería perciben la simulación clínica como una metodología educativa en la atención de pacientes hospitalizados utilizando sondas nasoenterales. Método se trata de un estudio exploratorio, descriptivo y cualitativo, realizado con 64 técnicos de enfermería en un hospital de Porto Alegre, sur de Brasil, en agosto y septiembre de 2017. Se llevó a cabo una intervención educativa a través de simulaciones clínicas, registradas y transcritas. El análisis de contenido se utilizó para el procesamiento de datos. Resultados se establecieron dos categorías: las potencialidades de la simulación clínica como metodología educativa y los desafíos de la simulación clínica para la práctica de la educación. Conclusión los profesionales de enfermería percibieron las potencialidades de la actividad de simulación y fueron colaborativos y receptivos para revisar las prácticas de atención en la terapia nutricional enteral. La simulación clínica es una metodología prometedora que se utilizará en la educación continua en el servicio.

Objective to understand Nursing technicians' perception of clinical simulation as an education methodology in the care of hospitalized patients using nasoenteral tubes. Method this is an exploratory, descriptive and qualitative study, conducted with 64 Nursing technicians from a hospital in Porto Alegre, Southern Brazil, in August and September 2017. An education intervention was carried out through clinical simulations, recorded and transcribed. Content analysis was used for data processing. Results two categories were established: the potentialities of clinical simulation as an education methodology and the challenges of clinical simulation for the practice of education. Conclusion Nursing professionals realized the potentialities of the simulation activity and were collaborative and receptive to review care practices in enteral nutritional therapy. Clinical simulation is a promising methodology to be used in continuing education in service.

Investigation of the ability of the oviposition-stimulant lectin from Moringa oleifera seeds (WSMoL) to bind with membrane proteins present in the legs of Aedes aegypti.

The mosquito Aedes aegypti L. is a vector transmitting diseases such as dengue, chikungunya and Zika virus fever. The water-soluble lectin from Moringa oleifera Lam. seeds (WSMoL) is larvicidal, ovicidal and can stimulate oviposition in A. aegypti. This study aimed to investigate whether WSMoL could bind to membrane proteins from A. aegypti legs. Initially, proteins from the legs were extracted using sodium deoxycholate, digitonin, dodecyl sodium sulfate (SDS) or Triton X-100. The protein concentration was found to be higher in the extract obtained using Triton X-100, which was applied to a WSMoL-Sepharose column. The adsorbed proteins were evaluated using gel filtration chromatography and polyacrylamide gel electrophoresis (PAGE) in presence of SDS. The similarity in the sequences of adsorbed proteins with those available in databases was determined. The proteins adsorbed on the matrix were eluted forming a single peak. Gel filtration chromatography and SDS-PAGE revealed the presence of proteins with molecular masses of approximately 20 kDa and polypeptide bands of 17.0 and 23.7 kDa, respectively. MS/MS analysis indicated similarity between these proteins and ABC carriers, which are expressed in the legs of mosquitos. WSMoL could bind to membrane proteins in the legs of A. aegypti females and induce oviposition through these interactions.

¿Es el fenotipo molecular determinante del ganglio centinela positivo? / Is the molecular phenotype determinant of the positive centinel gangly?

Introducción Durante años, la correlación directa entre el tamaño tumoral y el compromiso ganglionar fue uno de los parámetros de mayor importancia a la hora del diagnóstico del cáncer de mama. La biopsia del ganglio centinela permite estadificar la axila en pacientes con cáncer de mama y axila clínicamente negativa. Mediante este procedimiento, se evita la linfadenectomía axilar en una proporción de pacientes. Se han identificado variables independientes de compromiso ganglionar, como la edad de la paciente, el tamaño y grado tumoral, la invasión vasculolinfática, el alto índice de proliferación (Ki67), el estado de los receptores de estrógeno (re), de receptores de progesterona (rp) y de her2. Objetivo El objetivo de nuestro estudio fue estimar si existe relación entre el compromiso del ganglio centinela y el fenotipo molecular. Material y método Este es un estudio observacional, retrospectivo, transversal y analítico, en el cual se incluyeron 1.034 mujeres con diagnóstico de cáncer de mama en estadio temprano tratadas entre junio de 2008 y junio 2016 en la Sección de Mastología del Servicio de Ginecología del Hospital de Agudos Dr. Ignacio Pirovano y del consultorio de práctica privada. Los datos clínicos y anatomopatológicos fueron recabados de la base de datos de ambos centros ingresados en el Registro de Cáncer de Mama de la Sociedad Argentina de Mastología (rcm). Resultados El análisis multivariado demostró correlación estadísticamente significativa entre el compromiso del ganglio centinela y los fenotipos Luminal B (or 1,546; ic 95%, 1,065 - 2,244; p=0,022), her2 (or 2,23; ic 95%, 1,060 - 4,691; p=0,035) y Triple Negativo (or 0,247; ic 95%, 0,055 - 1,098; p=0,066) con respecto a los Luminales A en cáncer de mama estadio temprano. A mayor tamaño tumoral mayor compromiso del ganglio centinela: en tumores pT1b: or 3,154 (ic 95%, 1,231- 8,078; p= 0,017); en tumores pT1c: or 4,973 (ic 95%, 2,086 - 11,856; p<0,05) y en tumores pT2: or 6,180 (ic 95%, 2,458 - 15,536; p<0,05) con respecto al pT1a. No hubo diferencias significativas con respecto a la invasión linfovascular en nuestra población. Conclusiones En el análisis de nuestro estudio podemos concluir que existe relación estadísticamente significativa entre el fenotipo molecular (Luminales, her2) y el compromiso del ganglio centinela

Introduction The relation between tumor size and nodal involvement was one of the most important parameters. The sentinel node biopsy allows staging the axilla in patients with breast cancer and clinically negative axilla. It is possible to avoid the axillary dissection in a proportion of patients. It´s has been identified independent variables of nodal involvement as age, size and tumor grade, vascular and lymphatic invasion, high proliferation index (Ki67), status of estrogen receptors (er), progesterone receptors (pr) and her2. Objective The aim of our study was to estimate the correlation between the involvement of the sentinel node and the molecular phenotype. Materials and method This is an observational, retrospective, transversal and analytical study, in which 1,034 women presented diagnosis of early stage breast cancer between June 2008 and June 2016 in the Mastology Section of Hospital Dr. Ignacio Pirovano and private practice. Clinical and pathological data were collected from the database of both centers entered in the Register of Breast Cancer of the Society of Argentina Mastology (rcm). Results Multivariate analysis showed statistically significant correlation between the involvement of sentinel node and phenotypes Luminal B (or 1.546; ci 95%, 1.065 - 2.244; p=0.022), her2 (or 2.23; ci 95%. 1.060 - 4.691; p=0.035) and Triple Negative Breast Cancer (tnbc) (or 0.247; ci 95%, 0.055 - 1.098; p=0.066) in comparison with Luminal A phenotype in early stage breast cancer. Furthermore, if the tumor size is bigger the chance of the involvement of the sentinel node is greater. With tumors pT1b: or 3,154 (95% ci, 1.231- 8.078; p = 0.017); pT1c: or 4,973 (95% ci, 2.086 to 1.856; p <0.05) and pT2: or 6,180 (95% ci, 2.458 to 15.536; p <0.05) in comparison with pT1a. There were no significant differences regarding lymphovascular invasion in our population. Conclusions In the analysis of our study we can conclude that there is a statistically significant relationship between the molecular phenotype (Luminal, her2) and the involvement of the sentinel node

Exposure of mosquito (Aedes aegypti) larvae to the water extract and lectin-rich fraction of Moringa oleifera seeds impairs their development and future fecundity.

Aedes aegypti control is a key component of the prophylaxis of dengue fever and other diseases. Moringa oleifera seeds contain a water-soluble lectin (WSMoL) with larvicidal and ovicidal activities against this insect. In this study, A. aegypti individuals were exposed at the third larval instar for 24 h to the water extract (0.1-1.0 mg/mL of protein) or lectin-rich fraction (0.05-0.6 mg/mL of protein) containing WSMoL, and then their survival and development were followed for 9 days post-exposure. The feeding capacity of adult females that developed from the treated larvae and the hatching success of eggs laid by them were also evaluated. Further, any alterations to the midgut histology of treated larvae, pupae, and adults were investigated. The extract and fraction induced the death of A. aegypti larvae along the post-exposure period. Both preparations also delayed the developmental cycle. The midguts of treated larvae and pupae showed disorganization and epithelial vacuolization, while in treated adults, the epithelium was underdeveloped compared to control. Unlike in control mosquitos, proliferating cells were not detected in treated larvae, and appeared in lower numbers in treated pupae than in control pupae. Adult females that developed from larvae treated with the fraction gained less weight after a blood meal compared with control. The amount of eggs laid by females that developed from larvae treated with both the extract and fraction was significantly lower than in control. In addition, the eggs showed lower hatching rates. In conclusion, females that developed from larvae treated with both the water extract and lectin-rich fraction showed reduced engorgement after a blood meal, with the consequent impairment of their fertility and fecundity. These results were probably due to the damage to midgut organization and impairment of the remodeling process during metamorphosis.

Comparative evaluation of anesthetic efficacy of 1.8 mL and 3.6 mL of articaine in irreversible pulpitis of the mandibular molar: A randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the anesthetic efficacy of two volumes of articaine in conventional inferior alveolar nerve block (IANB) of mandibular molars with irreversible pulpitis, and in cases of anesthetic failure, its complementation with periodontal ligament injection (PDL). METHODS: Ninety patients with irreversible pulpitis in mandibular molars received conventional IANB with 1.8 mL or 3.6 mL of 4% articaine with 1:100,000 epinephrine. In cases of IANB failure, the same volumes were administered in the PDL. Presence of pulpal anesthesia and absence/presence of pain during pulpectomy were evaluated by electric pulp stimulation and verbal analogue scale, respectively. Relative risks (RR) with corresponding 95% confidence intervals (95% CI) were calculated for each outcome. RESULTS: 27% and 42% of the patients achieved pulpal anesthesia following IANB with 1.8 mL and 3.6 mL, respectively (RR = 0.63, CI 95% 0.35 to 1.14, p = 0.12). Analgesia during pulpectomy was present in 64% and 73% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.87, CI 95% 0.66 to 1.16, p = 0.36). In cases of IANB failure, 75% and 42% of the patients that received 1.8 mL and 3.6 mL of PDL injection, respectively, achieved pulpal anesthesia (RR = 1.80, CI 95% 0.87 to 3.72, p = 0.11). During a new attempt at the pulpectomy procedure, analgesia was present in 69% and 75% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.91, CI 95% 0.57 to 1.45, p = 0.71). CONCLUSION: Increasing the volume from 1.8 mL to 3.6 mL of the 4% articaine with 1:100,000 epinephrine in the IANB and in the PDL, did not significantly increase the success rate of pulpal anesthesia and clinical analgesia during the pulpectomy procedure. Therefore, both volumes presented a similar efficacy, though neither resulted in effective pain control during irreversible pulpitis treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT02422823.

Mathematical modeling of dengue epidemic: control methods and vaccination strategies.

Dengue is, in terms of death and economic cost, one of the most important infectious diseases in the world. So, its mathematical modeling can be a valuable tool to help us to understand the dynamics of the disease and to infer about its spreading by the proposition of control methods. In this paper, control strategies, which aim to eliminate the Aedes aegypti mosquito, as well as proposals for the vaccination campaign are evaluated. In our mathematical model, the mechanical control is accomplished through the environmental support capacity affected by a discrete function that represents the removal of breedings. Chemical control is carried out using insecticide and larvicide. The efficiency of vaccination is studied through the transfer of a fraction of individuals, proportional to the vaccination rate, from the susceptible to the recovered compartments. Our major find is that the dengue fever epidemic is only eradicated with the use of an immunizing vaccine because control measures, directed against its vector, are not enough to halt the disease spreading. Even when the infected mosquitoes are eliminated from the system, the susceptible ones are still present, and infected humans cause dengue fever to reappear in the human population.

Impacto de uma campanha de identidade visual sobre o processo de administração de dieta por sonda nasoenteral e sobre a segurança do paciente: ensaio clínico aberto / Impacto de una campaña de identidad visual en el proceso de administración de la dieta de la sonda nasoenteral y la seguridad del paciente: ensayo clínico abierto / Impact of a visual identity campaign on the diet administration process by nasoenteral tube and the patient safety: open clinical trial

Introdução: Apesar do uso de Sonda Nasoenteal (SNE) possibilitar a manutenção do estado nutricional, pacientes em uso destes dispositivos estão expostos a riscos e incidentes relacionados às diferentes etapas que envolvem a Terapia Nutricional Enteral (TNE). Dessa forma, torna-se importante que os profissionais de enfermagem não só conheçam as melhores práticas disponíveis para o cuidado em TNE, mas também adotem práticas seguras a fim de minimizar os riscos. Considerando que em outras áreas da saúde, intervenções no formato de campanhas, com pôsteres e recursos visuais, mostraram-se efetivas na melhoria da segurança do paciente, tornou-se relevante a implementação de uma campanha de identidade visual, com lembretes e alertas sobre os cuidados básicos a serem prestados ao paciente em uso de TNE por SNE, bem como a avaliação de seu efeito. Objetivo: Avaliar o impacto da implantação de uma campanha de identidade visual sobre a segurança do paciente recebendo dieta por SNE. Método: Trata-se de um ensaio clínico aberto, cuja intervenção foi uma campanha de identidade visual aplicada às equipes de enfermagem de unidades de internação (UI) adulto de um hospital público universitário de referência (Hospital de Clínicas de Porto Alegre). Os grupos intervenção e controle (GI e GC) foram compostos pelos pacientes usuários de SNE de quatro unidades de internação (clínica e cirúrgica). O estudo apresentou as seguintes etapas: 1) avaliação da concordância interobservadores; 2) avaliação de pacientes (baseline); 3) Intervenção da campanha de identidade visual com as equipes das unidades do GI; e 4) avaliação de pacientes pós-intervenção. As equipes de enfermagem do GI (uma UI clínica e uma UI cirúrgica) foram convidadas a participar da campanha "CUIDE", que constituiu-se de: a) sensibilização das equipes com distribuição de crachás com "lembretes" de cuidados aos pacientes com SNE; b) um cartaz semelhante ao crachá foi fixado à beira do leito do paciente; e c) sensibilização para adesão ao uso de etiquetas de vias "Enteral" a serem fixadas às conexões da SNE e do equipo da dieta. O GC (uma UI clínica e uma UI cirúrgica) não recebeu nenhuma intervenção. Os pacientes elegíveis de ambos os grupos foram acompanhados, diariamente, sendo avaliadas conformidades e não conformidades em relação aos cuidados com SNE por meio de um checklist. Os dados foram coletados em Formulários do Google®, cujas respostas constituem planilhas em formato Microsoft Excel®. A análise de dados foi realizada por meio do Statistical Package for the Social Sciences ­ SPSS versão 20.0®. A comparação da concordância foi obtida a partir do coeficiente Kappa e, a comparação entre as proporções do cumprimento de rotinas entre grupos (GI e GC), pré e pós intervenção e sua interação foi procedida por meio de Modelo de Equações de Estimações Generalizada (GEE). O estudo é derivado de um estudo matriz que foi aprovado quanto a seus aspectos éticos e metodológicos (CAE: 63247916.5.0000.5327) e com registro no Clinical Trials (NCT 03497221). Resultados: Conforme etapas do estudo, verificaram-se os seguintes resultados: 1) houve boa concordância entre avaliadores previamente capacitados (k ≥ 0,83); 2) no baseline observou-se que pacientes do GI e do GC eram semelhantes diferenciando-se nos motivos de internação e indicação da SNE; 3) a intervenção de campanha "CUIDE" não teve impacto relevante na rotina assistencial, havendo baixa adesão ao uso das etiquetas de vias ("Enteral"); 4) a intervenção apresentou poucos itens específicos com melhora, não sendo possível afirmar que a campanha, isoladamente, tenha apresentado efeito na adesão de protocolos de cuidados ao paciente em TNE. Conclusões: A intervenção de campanha de identidade visual não teve impacto em melhorar a adesão aos cuidados de pacientes usuários de SNE. Isso sugere que uma intervenção isolada não é suficiente para mudar o comportamento dos profissionais.

Background: Even though using Nasoenteal Tube Feeding (NTF) enables the maintenance of nutritional status, patients using these devices are exposed to risks and incidents related to different stages of the Enteral Nutrition Therapy (ENT). Thus, it is important for nursing professionals to know the best practices available for care in ENT, and to adopt safe practices for minimizing the risks. Considering that in other areas of health interventions in the format of campaigns with posters and visual resources were shown to be effective at improving patient safety, it became relevant to implement a "campaign of visual identity", with includes reminders and warnings about the basic care to be provided to patients using ENT by NTF. Objective: To assess the impact of the implementation of a visual identity campaign on the safety of the patient receiving a diet by NTF. Methods: This is an open clinical trial, which had an intervention in the form of a campaign of visual identity that was implemented with the nursing personnel of admission units (AU) of a reference university public hospital (Hospital de Clínicas de Porto Alegre). The intervention and control groups (IG and CG) were composed of patients using NTF in four admission units (clinical and surgical). The study presented the following steps: 1) evaluation of interobserver agreement; 2) evaluation of patients (baseline); 3) intervention with the visual identity campaign with the personnel of the GI units; and 4) evaluation of post-intervention patients. The nursing personnel from the IG (a clinical AU and a surgical AU) were invited to participate in the campaign "CUIDE" (Portuguese for "care"), which consisted of a) raising awareness of teams through the distribution of badges with "reminders" of care steps for patients with NTF; b) a poster similar to the badge was fixed at the bedside of the patient; and c) raising awareness to compliance with the use of "Enteral" labels to be fixed to the connections of the NTF and the infusion equipment of the diet. The CG (a clinical IU and a surgical IU) did not receive any intervention. The eligible patients of both groups were monitored daily, and conformities and nonconformities were assessed concerning care with ENT through a checklist. Data was collected through Google Forms®, and the responses were listed in spreadsheets in Microsoft Excel®. Data analysis was performed using the Statistical Package for the Social Sciences ­ SPSS version 20.0®. The comparison of the agreement was obtained from the Kappa coefficient and, the comparison between the proportions of routine compliance between groups (IG and GC), pre and post intervention and their interaction were provided through the Generalized Estimation Equation Model (GEE). This study derives from a matrix study that had approval for its ethical and methodological aspects (CAE: 63247916.5.0000.5327) and registered with Clinical Trials (NCT 03497221). Results: According to the stages of the study, the following results were observed: 1) we found good agreement between previously trained evaluators (k ≥ 0.83); 2) in the baseline, we observed that patients from GI and CG were similar, and differentiating aspects included reason for admission and indication for NTF. 3) "CUIDE" campaign intervention had no impact on the daily assistance routine, with low compliance with the use of labels ("Enteral"); 4) the intervention led to improvements in a few specific items, but it was not possible to affirm that the campaign alone influenced the compliance to patient care protocols in ENT. Conclusions: The intervention through the visual identity campaign had no impact on improving compliance to patient care protocols to NTF. This suggests that an isolated intervention is not enough to change the behavior of professionals.

Introducción: Aunque el uso del Tubo Nasoenteal (TN) permita el mantenimiento del estado nutricional, los pacientes que utilizan estos dispositivos están expuestos a riesgos e incidentes relacionados con las diferentes etapas que implican la terapia de nutrición enteral (TNE). Por lo tanto, es importante que los profesionales de enfermería no sólo conozcan las mejores prácticas disponibles para cuidados en TNE, sino que también adopten prácticas seguras para minimizar los riesgos. Teniendo en cuenta que, en otras áreas de la salud, se demostró que las intervenciones en el formato de las campañas con carteles y recursos visuales eran eficaces para mejorar la seguridad del paciente, se hizo importante aplicar una campaña de identidad visual, con recordatorios y advertencias sobre la atención básica que se debe proporcionar al paciente que utiliza TNE por TN. Objetivo: Evaluar el impacto de la implantación de una campaña de identidad visual en la seguridad del paciente que recibe una dieta por tubo nasoenteral (TN). Método: Se trata de un ensayo clínico abierto, cuya intervención fue una campaña de identidad visual aplicada a los equipos de enfermería de unidades de hospitalización para adultos (UH) de un hospital público universitario de referencia (Hospital de Clínicas de Porto Alegre). Los grupos de intervención y control (IG y CG) estaban compuestos por pacientes usuarios de TN de cuatro unidades de hospitalización (clínica sin cirugía y quirúrgica). El estudio presentó los siguientes pasos: 1) evaluación del acuerdo ínter-observadores; 2) evaluación de pacientes (baseline); 3) intervención de la campaña de identidad visual con los equipos de las unidades GI; 4) evaluación de los pacientes después de la intervención. Se invitó a los equipos de enfermería del IG (una UH clínica sin cirugía y una UH quirúrgica) a participar de la campaña Cuide, que consistía en: a) sensibilización de equipos con distribución de insignias con recordatorios de atención a pacientes con TN; a) un cartel similar a la placa se fijó en la cabecera del paciente; y c) sensibilización sobre la adhesión al uso de etiquetas viales Enteral para fijarlas a las conexiones del TN y el equipo de la dieta. El CG (una UH clínica sin cirugía y una UH quirúrgica) no recibió ninguna intervención. Los pacientes elegibles de ambos grupos fueron monitoreados diariamente y se evaluaron las conformidades y las inconformidades en relación con la atención de TN mediante una lista de verificación. Los datos se recopilaron en Google Forms®, las respuestas están en formato ® Microsoft Excel. El análisis de datos se realizó utilizando el Paquete Estadístico para la versión 20.0® de Ciencias Sociales-SPSS. La comparación del acuerdo se obtuvo del coeficiente Kappa y, la comparación entre las proporciones de cumplimiento rutinario entre grupos (GI y CG), la intervención previa y posterior y su interacción se proporcionó a través del Modelo de Ecuación de Estimación Generalizada (GEE). Este estudio se deriva de un estudio de matriz que fue aprobado por sus aspectos éticos y metodológicos (CAE: 63247916.5.0000.5327) y registrado en Clinical Trials (NCT 03497221). Resultados: Según las etapas del estudio, se observaron los siguientes resultados: 1) hubo un buen acuerdo entre evaluadores previamente capacitados (k x 0,83); 2) en el inicio del baseline, se observó que los pacientes de IG y del CG eran similares, divisándose en las razones de la hospitalización y para la indicación de TN; 3) la intervención de la campaña Cuide no tuvo ningún impacto en la rutina de la asistencia, hubo poca adherencia al uso de etiquetas ("Enteral"); 4) la intervención presentó pocos elementos específicos con mejoría y no fue posible afirmar que la campaña, por sí sola, tuvo un efecto en la adherencia de los protocolos de atención al paciente en TNE. Conclusiones: La intervención de la campaña de identidad visual no tuvo ningún impacto a la mejora de la adherencia a la atención de los pacientes con los usuarios de TN. Esto sugiere que una intervención aislada no es suficiente para cambiar el comportamiento de los profesionales.