Effects of Iron-Fortified Foods on the Nutritional Status of Children Residing in Regions Vulnerable to Parasitic Diseases: A Systematic Review.

Parasitic infections (PIs) remain a public health concern among school-age children living in areas of greater socioeconomic vulnerability, especially in Brazil, Russia, India, China, and South Africa. PIs can promote nutritional deficiencies, increasing the risk of anemia and impaired physical and cognitive development. Thus, fortified foods have been considered as a promising strategy for improving the nutritional status of children and preventing PI complications. This systematic review aimed to present the effects of iron-fortified foods for deworming and improving blood parameters in schoolchildren residing in areas that are vulnerable to PIs. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of randomized clinical trials addressing the use of fortified foods and micronutrients in children living in areas endemic for PIs. The PubMed, LILACS, Scopus, and Cochrane databases were searched to identify articles published between 2000 and 2020. A total of 153 records were retrieved from the databases, 10 of which were considered eligible for this study. On the basis of our analysis, most of the selected studies showed that the inclusion of fortified foods in the diet improved blood and infectious parameters. Therefore, fortified foods can be used as an important tool for controlling the adverse outcomes of PIs among children living in areas of greater vulnerability. However, more studies on this topic are needed to provide more evidence and consolidate strategies using iron-fortified food.

Desinvestimento de tecnologias em saúde no Sistema Único de Saúde: um perfil no período 2012-2022 / Disinvestment of health technologies in the Brazilian Unified Health System: a profile between 2012-2022

O termo "desinvestimento" se refere ao processo de retirada de recursos de intervenções que oferecem pouco ou nenhum ganho em saúde frente a seu custo. O intuito deste processo é reforçar práticas comprovadamente seguras, efetivas ou mais custo-efetivas, otimizando os resultados em saúde e a sustentabilidade econômica dos sistemas de saúde. O objetivo do trabalho foi caracterizar o processo de desinvestimento de medicamentos conduzido pela Comissão Nacional de Incorporação de Tecnologias (CONITEC) no Sistema Único de Saúde (SUS) entre 2012 e 2022, de forma exploratória através de análise documental dos seus relatórios técnicos de recomendações. Foram coletados nome do medicamento; sua classificação pelo sistema ATC; indicação clínica; demandante; realização de Consulta Pública; modalidade de desinvestimento recomendada e justificativa para o desinvestimento. Também foi avaliado o alinhamento das diretrizes de tratamento com as decisões de desinvestimento e o status de registro sanitário das tecnologias desinvestidas em diferentes ocasiões. Foram avaliados 30 relatórios de recomendação, correspondentes a 90 medicamentos. Três relatórios tiveram como recomendação a manutenção de sete tecnologias de perfil diversificado no SUS. Outros três relatórios eram referentes a tecnologias que foram incorporadas sob a modalidade ad experimentum e que, portanto, foram reavaliadas após três anos no SUS. Quanto às tecnologias efetivamente desinvestidas (80), elas se dividiram principalmente pelos grupos L (agentes antineoplásicos e imunomoduladores; 29,3%), J (anti-infecciosos de uso sistêmico; 21,3%) e A (aparelho digestivo e metabolismo; 20%). As principais indicações clínicas dos medicamentos desinvestidos foram: artrite reumatoide; HIV; hepatite C; e doença de Crohn. Justificativas mais mencionadas foram a indisponibilidade de registro ativo do medicamento no país (24,1%), seguida por problemas relacionados à segurança (20,6%) e efetividade (19,9%). Todas as demandas tiveram origem interna do Ministério da Saúde. Em 31,3%, houve exclusão do medicamento para indicação específica e, em 30%, exclusão total do sistema de saúde; em 27,5%, optou-se por excluir apenas determinada apresentação farmacêutica; em 10% as exclusões foram de apresentação para indicação específica; e em 1,2% ocorreu restrição de uso. Consulta Pública foi realizada em 36% dos casos. Após a publicação da Diretriz de Avaliação de Desempenho de Tecnologias em Saúde no final de 2016, o perfil de medicamentos desinvestidos por categoria ATC e por indicações clínicas adquiriram maior diversidade; as justificativas para o desinvestimento, que antes focavam em questões relacionadas a efetividade e segurança, passaram a se concentrar na indisponibilidade do medicamento no mercado; as modalidades de desinvestimento se acumularam mais em exclusões do SUS e exclusões de apresentação, e a Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos se tornou a principal demandante; submissão a consultas públicas subiu de 11,9% para 86,8%. O máximo de adequação estrutural identificado nos relatórios em relação aos tópicos preconizados pela Diretriz foi de 46,2%. Embora as iniciativas de desinvestimento tenham avançado nos últimos anos, o tema ainda enfrenta dificuldades para estabelecer uma agenda sólida no país.

Disinvestment refers to withdrawing resources from interventions that offer little or no health gain compared to their cost, seeking to reinforce practices proven to be safe, effective or more cost-effective and to optimize health outcomes and the economic sustainability of health systems. This study aimed to characterize the drug divestment process conducted by the National Commission for Incorporation of Technologies (CONITEC) in the Brazilian Unified Health System (SUS) between 2012 and 2022, in an exploratory way through their the technical recommendations reports. Drug name and ATC classification, clinical indication, proponents, occurrence of Public Consultation, recommended divestment modality and justifications for disinvestment were evaluated. We also evaluated the agreement of treatment guidelines with disinvestment decisions and the sanitary registration status of technologies disinvested at different times. We evaluated 30 recommendations reports corresponding to 90 drugs. Three reports recommended the maintenance of seven technologies in SUS. Another three reports referred to technologies that were incorporated under the ad experimentum modality and then were reassessed after three years in SUS. As for the technologies effectively disinvested (80), the drugs mainly belonged to the ATC classes L (29.3%), J (21.3%) and A (20%). The main clinical indications of the disinvested drugs were: rheumatoid arthritis, HIV, hepatitis C, and Crohn's disease. The main justifications were absence of market approval for the drug in Brazil (24.1%) and problems related to safety (20.6%) and effectiveness (19.9%). All requests were from the Brazilian Ministry of Health. Public Consultation was carried out in 36% of the situations. There were recommendations to exclude the drug for a specific indication in 31.3% of the cases and total exclusion from the SUS in 30%; exclusion of a particular pharmaceutical presentation and exclusion of presentation for a specific indication occurred in 27.5% and 10%, respectively. After the publication of the Methodological Guideline for Performance Avaliation of Health Technologies ate the end of 2016, the profile of drugs disinvested by ATC category and by clinical indications acquired bigger diversity; the justifications for disinvestment, which previously focused on issues related to effectiveness and safety, passed to focus on the unavailability of the drug on the market; disinvestment modalities concentrated more on SUS exclusions and presentation exclusions; the Secretaria of Science, Technology, Innovation and Strategic Insums became the main proponent of disinvestment demands; submission to public consultations grow up from 11.9% to 86.8%. The maximum structural adequacy identified of the reports in relation to the topics recommended by the Guideline was 46,2%. The lack of standardization and overly simplified reporting formats stood out. Although divestment initiatives have advanced in recent years, this theme still needs to improve in establishing a solid agenda in Brazil.

AAV process intensification by perfusion bioreaction and integrated clarification.

Adeno-associated viruses (AAVs) demand for clinical trials and approved therapeutic applications is increasing due to this vector's overall success and potential. The high doses associated with administration strategies challenges bioprocess engineers to develop more efficient technologies and innovative strategies capable of increasing volumetric productivity. In this study, alternating tangential flow (ATF) and Tangential Flow Depth filtration (TFDF) techniques were compared as to their potential for 1) implementing a high-cell-density perfusion process to produce AAV8 using mammalian HEK293 cells and transient transfection, and 2) integrating AAV harvest and clarification units into a single step. On the first topic, the results obtained demonstrate that AAV expression improves with a medium exchange strategy. This was evidenced firstly in the small-scale perfusion-mocking study and later verified in the 2 L bioreactor operated in perfusion mode. Fine-tuning the shear rate in ATF and TFDF proved instrumental in maintaining high cell viabilities and, most importantly, enhancing AAV-specific titers (7.6 × 104 VG/cell), i.e., up to 4-fold compared to non-optimized perfusion cultures and 2-fold compared with batch operation mode. Regarding the second objective, TFDF enabled the highest recovery yields during perfusion-based continuous harvest of extracellular virus and lysate clarification. This study demonstrates that ATF and TFDF techniques have the potential to support the production and continuous harvest of AAV, and enable an integrated clarification procedure, contributing to the simplification of operations and improving manufacturing efficiency.

Scalable Process for High-Yield Production of PfCyRPA Using Insect Cells for Inclusion in a Malaria Virosome-Based Vaccine Candidate.

Plasmodium falciparum cysteine-rich protective antigen (PfCyRPA) has been identified as a promising blood-stage candidate antigen to include in a broadly cross-reactive malaria vaccine. In the last couple of decades, substantial effort has been committed to the development of scalable cost-effective, robust, and high-yield PfCyRPA production processes. Despite insect cells being a suitable expression system due to their track record for protein production (including vaccine antigens), these are yet to be explored to produce this antigen. In this study, different insect cell lines, culture conditions (baculovirus infection strategy, supplementation schemes, culture temperature modulation), and purification strategies (affinity tags) were explored aiming to develop a scalable, high-yield, and high-quality PfCyRPA for inclusion in a virosome-based malaria vaccine candidate. Supplements with antioxidants improved PfCyRPA volumetric titers by 50% when added at the time of infection. In addition, from three different affinity tags (6x-His, 4x-His, and C-tag) evaluated, the 4x-His affinity tag was the one leading to the highest PfCyRPA purification recovery yields (61%) and production yield (26 mg/L vs. 21 mg/L and 13 mg/L for 6x-His and C-tag, respectively). Noteworthy, PfCyRPA expressed using High Five cells did not show differences in protein quality or stability when compared to its human HEK293 cell counterpart. When formulated in a lipid-based virosome nanoparticle, immunized rabbits developed functional anti-PfCyRPA antibodies that impeded the multiplication of P. falciparum in vitro. This work demonstrates the potential of using IC-BEVS as a qualified platform to produce functional recombinant PfCyRPA protein with the added benefit of being a non-human expression system with short bioprocessing times and high expression levels.

Efeito de um treinamento com realidade virtual não imersiva sobre a execução da tarefa motora real em idosos: relato de casos / Effect of training with non-imersive virtual reality on the performance of the real motor task in the elderly: case reports

| INTRODUÇÃO: No contexto de reabilitação em gerontologia surge como destaque a melhoria da capacidade de execução de tarefas motoras a fim de promover a autonomia, dessa maneira, é preciso investigar ferramentas para viabilizar esse objetivo clinico. OBJETIVO: Avaliar o efeito de um treino com realidade virtual não imersiva sobre a execução da tarefa motora real em idosos. MATERIAIS E MÉTODO: Trata-se de um relato de casos, com intervenção única, utilizando o Nintendo® Wii com sujeitos de idade superior a 60 anos submetidos à intervenção com treinamento de arremesso no jogo wii sports resort, e avaliados com analise cinemática angular de vídeo com o software Kinovea®, antes e depois da intervenção, protocolo composto por uma bateria de dez arremessos, antes e após a intervenção, além da avaliação subjetiva da melhora pós-treino. RESULTADOS: Participaram da pesquisa 4 sujeitos, sendo 3 do sexo feminino, com média de idade 70,7 anos ± 7,13 e escolaridade 8 anos ± 6,16. Para as variáveis angulares verificou-se que, após o treino com Wii, houve acentuação na flexão de ombro e decréscimo no cotovelo para na postura inicial do arremesso; já na posição final do arremesso, ocorreu decréscimo na extensão de cotovelo e aumento da flexão de punho. Também foi verificado aumento do salto e diminuição no tempo de execução da tarefa. CONSIDERAÇÕES FINAIS: Diante disso é possível concluir que o Nintendo® Wii se mostra um recurso potencial para melhoria de gestos no âmbito real para idosos.

INTRODUCTION: In the context of rehabilitation in gerontology, the improvement of the ability to perform motor tasks is highlighted to promote autonomy, so it is necessary to investigate tools to achieve this clinical objective. OBJECTIVE: To evaluate the effect of training with non-immersive virtual reality on the execution of the real motor task in the elderly. MATERIALS AND METHOD: This is a case report, with a single intervention using the Nintendo® Wii, with subjects over 60 years old who underwent intervention with throw training in the game Wii sports resort and evaluated with video angular kinematic analysis with the Kinovea® software before and after the intervention, a protocol consisting of a battery of ten shots before and after the intervention, in addition to the subjective assessment of posttraining improvement. RESULTS: Four subjects participated in the research, 3 females, with a mean age of 70.7 years ± 7.13 and schooling 8 years ± 6.16. For the angular variables, it was found that, after training with the Wii, in the initial throwing posture, there was an accentuation in the shoulder flexion and a decrease in the elbow for the same movement in the final position. There was a decrease in the elbow extension and an increase in the wrist flexion. It was also verified an increase in the jump and a decrease in the task execution time. FINAL CONSIDERATIONS: Given this, it is possible to conclude that the Nintendo® Wii is a potential resource for improving gestures in real life for the elderly

Adaptive laboratory evolution of stable insect cell lines for improved HIV-Gag VLPs production.

Adaptive laboratory evolution (ALE) has been extensively used to modulate the phenotype of industrial model organisms (e.g. Escherichia. coli and Saccharomyces cerevisae) towards a specific trait. Nevertheless, its application to animal cells, and in particular to insect cell lines, has been very limited. In this study, we describe employing an ALE method to improve the production of HIV-Gag virus-like particles (VLPs) in stable Sf-9 and High Five cell lines. Serial batch transfer was used for evolution experiments. During the ALE process, cells were cultured under controlled hypothermic conditions (22 °C instead of standard 27 °C) for a prolonged period of time (over 3 months), which allowed the selection of a population of cells with improved phenotype. Adapted cells expressed up to 26-fold (Sf-9 cells) and 10-fold (High Five cells) more Gag-VLPs than non-adapted cells cultured at standard conditions. The production of HIV Gag-VLPs in adapted, stable insect Sf-9 cell lines was successfully demonstrated at bioreactor scale. The Gag-VLPs produced at 22 °C and 27 °C were comparable, both in size and morphology, thus confirming the null impact of adaptation process and hypothermic culture conditions on VLP's quality. This work demonstrates the suitability of ALE as a powerful method for improving yields in stable insect cell lines producing VLPs.

Recent advances in the discovery of small molecules targeting glioblastoma.

Glioblastoma (GBM) is one of the most common central nervous system cancers. It is characterized as a fast-growing tumor that arises from multiple cell types with neural stem-cell-like properties. Additionally, GBM tumors are highly invasive, which is attributed to the presence of glioblastoma stem cells that makes surgery ineffective in most cases. Currently, temozolomide is the unique chemotherapy option approved by the U.S. Food and Drug Administration for GBM treatment. This review analyzes the emergence and development of new synthetic small molecules discovered as promising anti-glioblastoma agents. A number of compounds were described herein and grouped according to the main chemical class used in the drug discovery process. Importantly, we focused only on synthetic compounds published in the last 10 years, thus excluding natural products. Furthermore, we included in this review only those most biologically active compounds with proven in vitro and/or in vivo efficacy.

Quedas entre crianças e adolescentes internados em hospitais: revisão integrativa de literatura Empatia em saúde: revisão integrativa / Caídas entre niños y adolescentes internos en hospitales: revisión integradora de literatura / Falls among children and teenagers in hospitals: an integrative literature review

Objetivo: investigar as taxas, as características, os fatores associados e as medidas preventivas relacionadas às quedas entre crianças e adolescentes em hospitais. Método: revisão integrativa de literatura realizada nas bases Scientific Electronic Library Online, Biblioteca Virtual em Saúde, National Library of Medicine e Google Scholar. Resultados: dez estudos atenderam aos critérios estabelecidos. As taxas variaram de 0.6 a 1.7 quedas por 1000 pacientes/dia. Grande parte das quedas ocorrem entre crianças do sexo masculino; com idade inferior a 9 anos. A maioria desses incidentes ocorrem na presença de um adulto. São fatores de risco para a ocorrência de quedas: idade da criança (p<0.01); tempo de internação (p<0.05); hiperatividade (p<0.01); distúrbios hematológicos (p<0.05); quedas anteriores (p<0.01); dimensionamento da enfermagem (p<0.00); escolaridade do cuidador (p<0.01) e o fato de o mesmo ser tabagista (p<0.01). As medidas preventivas adotadas foram: uso de berço e camas adequados para a idade, avaliação do risco de quedas, intervenções educacionais e uso de identificadores de alerta. Conclusão: A grande variação nas taxas de quedas entre os estudos sugere diferentes modos de organização do cuidado. A ocorrência de quedas no ambiente hospitalar entre crianças pode estar relacionada a fatores intrínsecos do paciente, do cuidador, ambientais e de organização do cuidado.

Objective: to investigate rates, characteristics, associated factors and preventive measures related to falls among children and adolescents in hospitals. Method: integrative literature review on the Scientific Electronic Library Online, Virtual Health Library, National Library of Medicine and Google Scholar. Results: ten studies met the established criteria. Rates ranged from 0.6 to 1.7 falls per 1000 patients / day. Most falls occur among male children; under the age of nine years old. Most of these incidents occur in the presence of an adult. Risk factors for falls are: age of the child (p <0.01); length of hospital stay (p <0.05); hyperactivity (p <0.01); hematological disorders (p <0.05); previous falls (p <0.01); nursing design (p <0.00); (p <0.01) and the fact that it was smoker (p <0.01). The preventive measures adopted were: use of cots and adequate beds for the age, evaluation of the risk of falls, educational interventions and use of alert identifiers. Conclusion: The large variation in falls rates between studies suggests different modes of care organization. The occurrence of falls in the hospital environment among children may be related to intrinsic patient, caregiver, environmental and care organization factors

Objetivo: investigar las tasas, las características, los factores asociados y las medidas preventivas relacionadas con las caídas entre niños y adolescentes en hospitales. Método: revisión integrativa de literatura realizada en las bases Scientific Electronic Library Online, Biblioteca Virtual en Salud, National Library of Medicine y Google Scholar. Resultados: diez estudios atendieron a los criterios establecidos. Las tasas variaron de 0.6 a 1.7 caídas por 1000 pacientes / día. Gran parte de las caídas ocurren entre los varones; con una edad inferior a 9 años. La mayoría de estos incidentes ocurren en presencia de un adulto. Son factores de riesgo para la ocurrencia de caídas: edad del niño (p <0.01); tiempo de internación (p <0.05); hiperactividad (p <0.01); trastornos hematológicos (p <0.05); caídas anteriores (p <0.01); el tamaño de la enfermería (p <0.00); escolaridad del cuidador (p <0.01) y el hecho de que el mismo sea tabacal (p <0.01). Las medidas preventivas adoptadas fueron: uso de cuna y camas adecuadas para la edad, evaluación del riesgo de caídas, intervenciones educativas y uso de identificadores de alerta. Conclusión: La gran variación en las tasas de caídas entre los estudios sugiere diferentes modos de organización del cuidado. La ocurrencia de caídas en el ambiente hospitalario entre niños puede estar relacionada a factores intrínsecos del paciente, del cuidador, ambientales y de organización del cuidado.

Nitensidine B affects proteins of the glycolytic pathway and induces apoptosis in cervical carcinoma cells immortalized by HPV16.

BACKGROUND: Cervical cancer, the fourth most common type of cancer among women worldwide, accounts for approximately 12% of all types of malignancies that affect women. Natural products have contributed significantly to the development of modern therapies; approximately 70% of the drugs available for chemotherapy are naturally based products. PURPOSE: The purpose of this study was to examine the biological activities of nitensidine B (NTB), a guanidinic alkaloid isolated from the leaves of Pterogyne nitens Tul. (Fabaceae) in a cervical cancer cell line. METHODS: In vitro experiments were performed using cervical carcinoma cells immortalized by human papillomavirus type 16 (HPV16, SiHa cells), since epidemiological and molecular studies have demonstrated robust associations between the etiologies of cervical cancer and HPV infection. Cytotoxicity as well as the effect of NTB treatment on intracellular signals of apoptosis, fragmentation of internucleosomal DNA via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and levels of apoptosis effectors (Caspase 3/7) were evaluated. In addition, differential proteomic analysis (iTRAQ) and protein validation using western blot were performed. RESULTS: The cytotoxicity of NTB treatment in the SiHa cell line was concentration-dependent, with the minimum inhibitory concentration of 50% of the cells of 40.98 µM. In the TUNEL assay, SiHa cell apoptosis with 3/7 caspase activation was reported at 12 h following treatment. Differential proteomic analysis by iTRAQ demonstrated that proteins of the glycolytic pathway, aldolase A, alpha-enolase, pyruvate kinase, and glyceraldehyde 3-phosphate dehydrogenase were underexpressed. CONCLUSION: These results indicated that NTB could play a role in decreasing glycolysis . Since tumor cells prefer the glycolytic pathway to generate energy, these findings suggest that NTB may be a reliable model for the study of human cervical cancer cell lines immortalized by HPV16, however more experiments can be performed.

Emodin, Physcion, and Crude Extract of Rhamnus sphaerosperma var. pubescens Induce Mixed Cell Death, Increase in Oxidative Stress, DNA Damage, and Inhibition of AKT in Cervical and Oral Squamous Carcinoma Cell Lines.

There have been few studies on the pharmacological properties of Rhamnus sphaerosperma var. pubescens, a native Brazilian species popularly known as "fruto-de-pombo." The aim of this study was to investigate the scavenging capacity of emodin, physcion, and the ethanolic crude extract of Rhamnus sphaerosperma var. pubescens against reactive oxygen and nitrogen species, as well as their role and plausible mechanisms in prompting cell death and changes in AKT phosphorylation after cervical (SiHa and C33A) and oral (HSC-3) squamous cell carcinoma treatments. Emodin was shown to be the best scavenger of NO• and O2•-, while all samples were equally effective in HOCl/OCl- capture. Emodin, physcion, and the ethanolic extract all exhibited cytotoxic effects on SiHa, C33A, HSC-3, and HaCaT (immortalized human keratinocytes, nontumorigenic cell line), involving mixed cell death (apoptosis and necrosis) independent of the caspase activation pathway. Emodin, physcion, and the ethanolic extract increased intracellular oxidative stress and DNA damage. Emodin decreased the activation of AKT in all tumor cells, physcion in HSC-3 and HaCaT cells, and the ethanolic extract in C33A and HaCaT cells, respectively. The induction of cancer cell death by emodin, physcion, and the ethanolic crude extract of Rhamnus sphaerosperma var. pubescens was related to an increase in intracellular oxidative stress and DNA damage and a decrease in AKT activation. These molecules are therefore emerging as interesting candidates for further study as novel options to treat cervical and oral carcinomas.

Avaliação da intervenção telefônica em diabetes mellitus tipo 2: ensaio clínico

A intervenção telefônica é considerada uma tecnologia inovadora em saúde, de baixo custo e de fácil acesso, apresentando resultados positivos e promissores com relação à melhora das condições de saúde dos usuários com diabetes mellitus. Objetivo: Avaliar a efetividade da intervenção telefônica em diabetes mellitus tipo 2 associada à autoeficácia psicossocial, às práticas do autocuidado e ao controle glicêmico. Método: Ensaio clínico com cluster randomizado realizado em seis Unidades Básicas de Saúde com usuários com diabetes mellitus tipo 2, alocadas por meio de sorteio para o Grupo Controle (GC= 94) ou Grupo Experimental (GE=69). A coleta dos dados ocorreu em três momentos: o primeiro antes do início da intervenção (T0), considerado como pré-teste e o segundo após 12 meses (T12) e o terceiro após 12 meses (T12). No T0 e T12 foi realizada coleta das variáveis clínicas, sociodemográficas, autoeficácia e autocuidado em diabetes mellitus e as medidas antropométricas. A intervenção telefônica para o GE foi dividida em quatro ciclos, com intervalos de três meses entre os ciclos. No primeiro ciclo, os usuários com diabetes mellitus participaram de um encontro face-a-face e de uma intervenção telefônica com a finalidade de aproximar e fortalecer o vínculo entre o usuário e os profissionais da área da Saúde, conhecer o contexto de vida bem como as expectativas dos usuários com diabetes com relação à participação na pesquisa e esclarecer o significado do plano de metas. Nos segundo e terceiro ciclos cada usuário com diabetes mellitus recebeu quatro intervenções telefônicas cujo objetivo foi apoiar o usuário do GE a identificar as barreiras para a realização das práticas de autocuidado relacionado à prática de atividade física e alimentação, bem como estabelecer um plano de metas para supera-las...

The telephone intervention is considered an innovative technology in health; it is low cost and easy access. This kind of intervention points out positive and promising results in relation to improvement of health conditions of users with diabetes mellitus. Aim: To evaluate the effectiveness of telephone intervention of diabetes mellitus type 2 with psychosocial self-efficacy, self-care practices and glycemic control. Method: The cluster randomized clinical trial was conducted in six Basic Health Units with users with diabetes mellitus type 2. The units were allocated by drawing Control Group (CG=94) or Experimental Group (EG=69).The data were collected in three phases: the first phase occurred before the start of the intervention (T0), it was considered the pre-test and the second phase occurred after 12 months (T12). Clinical variables, socio demographic data, anthropometric measurements, self-efficacy and self-care data about diabetes mellitus were collected at T0 and T12.The telephone intervention for EG was divided into four cycles with three months intervals between each one. In the first cycle, the users with diabetes mellitus attended to face-to-face meeting and telephone intervention. These occurred with the purpose to approximate and strengthen the link between user and health professionals, to know the context of life that users live and their expectations about research, and to clarify the meaning of plan of goals. In the second and third cycles, each user with diabetes mellitus received four telephone interventions. These interventions were used to assist the user of EG in the identification of barriers that were disturbing to practice a physical activity and follow a diet, and to establish a plan of goals to overcome those barriers...

Construção, validação e adequação cultural do protocolo COMPASSO: Adesão ao autocuidado em diabetes / Development, validation and cultural adaptation of the Compasso protocol: Adherence to self-care in diabetes

Resumo Objetivo Realizar a construção, validação de conteúdo e adequação cultural do protocolo Compasso para promover a adesão às práticas de autocuidado em diabetes via intervenção telefônica. Métodos Pesquisa metodológica de elaboração de instrumentos abrangendo as etapas: construção do protocolo; validação de conteúdo; adequação cultural. Participaram das fases de construção e validação um total de 14 profissionais das áreas da Saúde, Linguística e Estatística, e, da fase de adequação, 341 usuários com diabetes Mellitus. Os dados para validação e adequação foram coletados através da plataforma web e-Surv e analisados no ambiente R. Resultados O protocolo Compasso aborda os seguintes domínios: aspectos comportamental e psicossocial, rede de apoio, barreiras e práticas do autocuidado. A avaliação do protocolo apresentou boa concordância entre os avaliadores, com IVC médio de 0,96. Conclusão Considera-se validado o conteúdo do protocolo Compasso e adequado culturalmente para promover a adesão às práticas de autocuidado em diabetes via intervenção telefônica.

Abstract Objective To develop, validate the content and conduct the cultural adaptation of the Compasso protocol for promoting adherence to self-care practices in diabetes via telephone intervention. Methods Methodological research for tool development, following three stages: protocol development; content validation; and cultural adaptation. Fourteen professionals affiliated to the fields of healthcare, applied linguistics and statistics participated in the stages of development and content validation, while 341 individuals with diabetes mellitus took part in the adaptation stage. Data for validation and adaptation were collected through the web platform e-Surv and analyzed in the R environment. Results The Compasso protocol includes the following domains: behavioral and psychosocial aspects, support network, barriers, and self-care practices. The assessment of the protocol presented good agreement between the evaluators, with a mean CVI 0.96. Conclusion The content of the Compasso protocol was considered to be validated and culturally adequate to promote adherence to the practices of diabetes self-care via telephone intervention.

Avaliação in situ e in vitro do efeito antimicrobiano de um nanofilme experimental de dióxido de silício com nanopartículas de prata / In situ and in vitro evaluation of the antimicrobial effect of an experimental nanofilm of silicon dioxide with silver nanoparticles

A difusão da nanotecnologia a fim de projetar novos materiais em escala nanométrica conduziu ao desenvolvimento de uma ampla variedade de nanopartículas fabricadas para aplicações comerciais. Tendo por objetivo buscar um produto que aprimore as características dos materiais dentários em voga, optou-se por pesquisar um novo material que não é utilizado em Odontologia, mas que tem uma extensa aplicabilidade em diversos campos, como na indústria alimentícia, na superfície de bancadas de hospitais, em instrumentais cirúrgicos, paredes, pisos, roupas e no setor automobilístico, de aviação e naval. Assim, buscou-se avaliar um nanofilme de dióxido de silício, comercializado como vidro líquido, e seu possível aperfeiçoamento com a incorporação de nanopartículas de prata à sua composição quanto ao seu comportamento microbiológico utilizando como substrato amostras de resina acrílica autopolimerizável. Primeiramente foram realizados ensaios para caracterização da solução do vidro líquido através da avaliação do teor de sólidos presentes e da sua densidade, além da superfície dos nanofilmes formados por meio de microscópio eletrônico de varredura (MEV) acoplado a espectrômetro de energia dispersiva (EDS). Depois, foi averiguado o comportamento microbiológico dos nanofilmes quanto à citotoxicidade e à formação de biofilme in vitro e in situ. Na caracterização do vidro líquido identificou-se uma pequena discrepância quanto ao teor de sólidos e a densidade obtida em relação aos dados do fabricante. Análises semiquantitativas por MEV e EDS confirmaram a presença da prata no nanofilme experimental e permitiu a observação da configuração de nanoaglomerados formados após a polimerização de ambos os filmes. O ensaio de citotoxicidade mostrou que após a formação do nanofilme este não é citotóxico, mas que as soluções de sílica e experimental apresentam citotoxicidade em baixas diluições. Quanto à formação de biofilme, independente do substrato e do tipo de ensaio, in situ ou in vitro, o nanofilme experimental inibiu a adesão bacteriana. Conclui-se então que o nanofilme experimental de sílica com nanopartículas de prata desenvolvido neste trabalho apresenta o potencial de diminuir o crescimento bacteriano em materiais dentários aplicados provisoriamente em áreas críticas onde é necessária a cicatrização tecidual

The propagation of nanotechnology in order to design new nanoscale materials led to the development of a wide variety of nanoparticles manufactured for commercial applications. With the objective of seeking a product that enhances the characteristics of dental materials in vogue, it was decided to search for a new material that is not used in dentistry, but has a wide applicability in various fields, such as in the food industry, surface countertops of hospitals, surgical instruments, walls, floors, clothing and automotive, aviation and shipbuilding industry. Thus, it sought to evaluate a silicon dioxide nanofilm, commercially available as liquid glass, and its possible improvement with the addition of silver nanoparticles to its composition using samples of acrylic resin as substrate. Initially tests were carried out to characterize the liquid glass solution by evaluating the solids content and their density, beyond the surface of nanofilms formed by means of a scanning electron microscope (SEM) coupled with energy dispersive spectrometer (EDS). Then it was examined microbiological behavior of nanofilms for cytotoxicity and in vitro and in situ biofilm formation. In the liquid glass characterization it was identified a small discrepancy in the solids content and the density obtained compared to manufacturer's data. The SEM and EDS analysis confirmed the presence of silver in the experimental nanofilm and allowed the observation of the nanoclusters configuration formed after polymerization of both films. The cytotoxicity assay showed that after the formation of nanofilm this is not cytotoxic, but the silica and the experimental solutions exhibit cytotoxicity at lower dilutions. As to the formation of biofilm regardless of the type of substrate and the assay in situ or in vitro, experimental nanofilm inhibit bacterial adhesion. It follows then that the silica experimental nanofilm with silver nanoparticles developed in this work has the potential to reduce bacterial growth in dental materials provisionally applied in critical areas where tissue healing is required

Evaluation of the telephone intervention in the promotion of diabetes self-care: a randomized clinical trial / Avaliação da intervenção telefônica na promoção do autocuidado em diabetes: ensaio clínico randomizado / Evaluación de la intervención telefónica en la promoción del autocuidado en diabetes: ensayo clínico aleatorio

ABSTRACT Objective: to evaluate the effectiveness of the telephone intervention for promoting self-care related to physical activity and following a diet plan in users with diabetes, compared to conventional monitoring of users over a six-month period. Method: this was a randomized clinical trial, which included 210 users with diabetes, linked to eight Primary Health Units of Belo Horizonte, Minas Gerais. The experimental group (104 members) received six telephone interventions over the six-month monitoring; the control group (106 members) received conventional monitoring. To evaluate the self-care practices related to physical activity and following a healthy eating plan, in both groups, the self-care questionnaire was applied before the intervention and at three and six months after its start. Results: the mean effect of self-care scores in the experimental group was 1.03 to 1.78 higher than the control group, with progressive and significant improvement (p<0.001). Conclusion: the results indicate that the telephone intervention had a beneficial effect on diabetes self-care. The primary identifier of the clinical trials registry was: RBR-8wx7qb.

RESUMO Objetivo: avaliar a efetividade da intervenção telefônica na promoção do autocuidado relacionado à atividade física e ao seguimento de um plano alimentar, em usuários com diabetes, quando comparada ao acompanhamento convencional dos usuários, durante o período de seis meses. Métodos: trata-se de um ensaio clínico randomizado, no qual participaram 210 usuários com diabetes, vinculados a oito Unidades Básicas de Saúde de Belo Horizonte, Minas Gerais. O grupo-experimental (104 usuários) recebeu seis intervenções telefônicas em seis meses de acompanhamento; o grupo-controle (106 usuários) recebeu acompanhamento convencional. Para avaliar as práticas de autocuidado, relacionada à atividade física e ao seguimento do plano alimentar saudável, em ambos os grupos, aplicou-se o questionário de autocuidado antes das intervenções, três e seis meses após o seu início. Resultados: o efeito médio dos escores de autocuidado no grupo-experimental a pontuação foi de 1,03 a 1,78 maior do que o grupo-controle, apresentando melhora progressiva e significativa (valor-p<0,001). Conclusão: os resultados apontam que a intervenção telefônica tem efeito benéfico sobre o autocuidado em diabetes. O registro clínico obteve identificador primário: RBR-8wx7qb.

RESUMEN Objetivo: evaluar la efectividad de la intervención telefónica en la promoción del autocuidado relacionado a la actividad física y al seguimiento de un plan alimentario, en usuarios con diabetes, cuando comparada al acompañamiento convencional de los usuarios, durante el período de seis meses. Métodos: se trata de un ensayo clínico aleatorio, en el cual participaron 210 usuarios con diabetes, vinculados a ocho Unidades Básicas de la Salud de Belo Horizonte, Minas Gerais. El grupo experimental (104 usuarios) recibió seis intervenciones telefónicas en seis meses de acompañamiento; el grupo control (106 usuarios) recibió acompañamiento convencional. Para evaluar las prácticas de autocuidado, relacionadas a la actividad física y al seguimiento del plan alimentario saludable, en los dos grupos, se aplicó el cuestionario de autocuidado antes de las intervenciones, tres y seis meses después de su inicio. Resultados: el efecto promedio de los puntajes de autocuidado en el grupo experimental fue de 1,03 a 1,78 mayor que el grupo control, presentando mejoría progresiva y significativa (valor-p<0,001). Conclusión: los resultados apuntan que la intervención telefónica tiene efecto benéfico sobre el autocuidado en diabetes. El registro clínico obtuvo identificador primario: RBR-8wx7qb.

Ação trófica de aditivos fitogênicos, glutamina e ácido glutâmico sobre a Bursa de Fabrícius e intestino delgado de frangos de corte / Trophic action of phytogenic additives, glutamine and glutamic acid on Bursa Fabricii and small intestine of broilers

The aim of this study was to evaluate the effect of phytogenic additives and glutamine plus glutamic acid, associated or not, on histomorphometry of bursa of Fabricius and small intestine, oocyst count and lesion scores, and carbon turnover of duodenal mucosa of broiler chickens infected with Eimeria acervulina. A total of 450 male broiler chickens was distributed into a completely randomized design with six treatments and three replications. Treatments consisted of control diet (CD); CD + coccidiosis vaccine; CD + antibiotic performance enhancers and anticoccidial (APE/AC); CD + glutamine and glutamic acid (Gln/Glu); CD + phytogenic additives (PA); CD + Gln/Glu + PA. Birds on treatment CD + vaccine were vaccinated via drinking water at three days of age against coccidiosis. At 16 days of age all birds of all treatments were inoculated orally and individually with 500,000 oocysts of Eimeria acervulina. There was no treatment effect on lesion score in the intestinal epithelium of birds. The smaller number of excreted oocysts was observed in groups of birds fed diets containing APE/AC and PA. Were observed better results of villus height and crypt depth for duodenum and ileum of birds of treatments containing Gln/Glu at 7 days of age, and Gln/Glu and PA at 21 days of age. Higher percentage of cortical area from bursa follicles was observed in birds fed diets supplemented with Gln/Glu and PA at 7, 14 and 21 days of age. Increased turnover of intestinal mucosa was observed in treatments containing Gln/Glu, indicating acceleration in development and regeneration of damaged tissue. Glutamine plus glutamic acid and phytogenic additives can provide improvements to structure, and thus to intestinal function, as well as to better immune response against the infectious challenges. Phytogenic additives can be used for coccidiosis control of broiler chickens where the use of antibiotic performance enhancers and anticoccidials is prohibited...

O objetivo deste trabalho foi avaliar o efeito dos aditivos fitogênicos e da glutamina mais ácido glutâmico, associados ou não, sobre a histomorfometria da Bursa de Fabricius e intestino delgado, sobre contagem de oocistos e escores de lesão e sobre o turnover do carbono da mucosa intestinal de frangos de corte experimentalmente infectadas com Eimeria acervulina. Para isso foram utilizados 450 pintos de corte machos distribuídos em delineamento inteiramente casualisado, com seis tratamentos e três repetições. Os tratamentos consistiram de dieta controle (DC); DC + Vacina de coccidiose; DC + antibióticos melhoradores de desempenho e anticoccidiano (AMD/AC); DC + glutamina e ácido glutâmico (Gln/Glu); DC + sditivos fitogênicos (AFs); DC + Gln/Glu + AFs. As aves do tratamento DC + Vacina foram vacinadas via água de bebida, aos três dias de idade, contra coccidiose. Aos 16 dias de idade todas as aves de todos os tratamentos foram inoculadas oralmente e individualmente com 500.000 oocistos de Eimeria acervulina. Não houve efeito dos tratamentos para escore de lesão no epitélio intestinal das aves. O menor número de oocistos excretados foi observado nos grupos de aves alimentadas com dieta contendo AMD/AC e AFs. Foram observados melhores resultados para altura das vilosidades e profundidade das criptas do duodeno e ílio das aves dos tratamentos contendo Gln/Glu, aos 7 dias de idade e Gln/Glu e AFs aos 21 dias de idade. Maior porcentagem de área cortical dos folículos bursais foi observada em aves alimentadas com dieta suplementada com Gln/Glu e AFs aos 7, 14 e 21 dias de idade. Maior turnover da mucosa intestinal foi observada em aves dos tratamentos contendo Gln/Glu, indicando aceleração do desenvolvimento e regeneração do tecido lesado. Glutamina mais ácido glutâmico e aditivos fitogênicos podem oferecer melhorias à estrutura e, consequentemente, à função do intestino, bem como melhores condições para resposta imune frente à desafios infecciosos...

Case for diagnosis. Pemphigoid gestationis.

Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestational age babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.

Efeitos do treinamento em natação sobre propriedades mecânicas e estruturais do fêmur de ratas ovariectomizadas / Effects of swimming training on femoral mechanical and structural properties in ovariectomized female rats

Investigamos os efeitos do treinamento em natação (TN) sobre propriedades mecânicas e estruturais do fêmur de ratas ovariectomizadas. Ratas Wistar com peso corporal (PC) de 271,42 ± 17,6 g e 20 semanas de idade foram submetidas à ovariectomia (OVX) ou laparotomia (SHAM) e alocadas em grupos: natação OVX (NO, n=12), controle OVX (CO, n=12), natação SHAM (NS, n=12) e controle SHAM (CS, n=12). Quinze dias pós-cirurgia NO e NS foram submetidos ao TN (60 min/dia, 5 dias/semana, sobrecarga progressiva até 3% do PC) por 10 semanas. Análises da atividade de fosfatase alcalina óssea demonstraram ser menores para os animais OVX comparados com os SHAM (23,91 ± 11,64 pg/mL vs. 57,29 ± 16,24 pg/mL, respectivamente) não foram alteradas pelo TN. As ratas SHAM apresentaram mais osso trabecular no colo do fêmur que as OVX (255,50 ± 38,27 vs 288,75 ± 39,63 pontos, respectivamente). As ratas exercitadas exibiram mais osso trabecular que as controles (292,00 ± 33,54 vs 251,54 ± 38,99 pontos, respectivamente) nesta região e no trocanter maior (281,50 ± 34,42 vs 237,23 ± 53,03 pontos; respectivamente). A densidade mineral óssea e a massa de osso cortical do terço médio do fêmur não foram alteradas pela OVX ou TN. A força máxima e a tenacidade do terço médio e do colo do fêmur não foram afetadas pela OVX ou TN. Concluiu-se que o treinamento em natação aplicado beneficiou a massa óssea na região proximal do fêmur de ratas, independentemente da ovariectomia, o que não refletiu em melhora das propriedades mecânicas, seja no colo ou na diáfise do fêmur.

We investigated the effects of swimming training (ST) on femoral mechanical and structural properties in ovariectomized female rats. Female Wistar rats [age = 20 weeks; body weight (BW) = 271,42 ± 17,6 g] were subjected to ovariectomy (OVX) or laparotomy (SHAM) and allocated to one of the following groups: swimming OVX (SO, n=12), control OVX (CO, n=12), swimming SHAM (SS, n=12) and control SHAM (CS, n=12). Fifteen days after surgery SO and SS groups were subjected to a ST (60 min/day, 5 days/week, overload of 3% of BW) for 10 weeks. Alkalin phosfatase was reduced in OVX as compared to SHAM (18,87 pg/mL vs. 53,93 pg/mL, respectively), but not altered by ST. Animals SHAM showed more cancellous bone than OVX (255,50 ± 38,27 vs 288,75 ± 39,63 points, respectively). Exercised animals exhibited more cancellous bone than controls (292,00 ± 33,54 vs 251,54 ± 38,99 points, respectively) in this region and in the grater trochanter (281,50 ± 34,42 vs 237,23 ± 53,03 points; respectively). Bone mineral density and cortical bone in the femur midshaft were not altered either by OVX or ST. The maximum force and thoughness of the femoral neck and midshaft were not affected either by OVX or ST. It was concluded that ST benefits cancellous bone mass in the femoral proximal region (i.e. femoral neck and greater trochanter), independently of ovariectomy, which did not reflect in improved mechanical properties either in the femoral neck or midshaft.

Case for diagnosis

Pemphigoid gestationis is a rare, autoimmune blistering dermatosis of pregnancy. No increase in fetal or maternal mortality has been demonstrated, but a greater prevalence of premature and small-for-gestationalage babies has been reported. Topical and systemic corticosteroids and antihistamines are the manstay of treatment. The authors report a case of a 27-year-old woman at 28-weeks gestation with sudden onset of pruriginous vesicles and blisters in the abdomen and limbs. Systemic corticosteroids were introduced and maintained throughout gestation to prevent flares and tapered after the birth of a healthy child.

Free activity in the cage associated with body weight gain restores bone structural and mechanical properties in growing rats after hindlimb unloading / pAtividade livre na gaiola associada ao ganho de peso corporal restaura as propriedades mecânicas e estruturais ósseas em ratos em crescimento após o descarregamento dos membros posteriores

We investigated the importance of daily free activity in the cage and body weight gain during the recovering of bone structural and mechanical properties in growing rats after hindlimb unloading. Eight-week-old male Wistar rats were randomly divided into control (CG, n=24) and suspended (SG, n=24) groups. Animals from SG underwent a four-week hindlimb unloading period by tail-suspension. Animals from CG and those from SG after release were kept in collective cages and sacrificed at the age of 12, 16 and 20 weeks. Both femurs were removed and its area, bone mineral density (BMD), resistance to failure and stiffness were determined. Four-week hindlimb unloading decreased (p<0.05) body weight (CG, 373.00 ± 9.47 vs. SG, 295.86 ± 9.19 g), BMD (CG, 0.19 ± 0.01 vs. SG, 0.15 ± 0.01 g/cm2 ), bone resistance to failure (CG, 147.75 ± 5.05 vs. SG, 96.40 ± 5.95 N) and stiffness (CG, 0.38 ± 0.01 vs. SG, 0.23 ± 0.02 N/m). Eight weeks of free activity in cage recovered (p>0.05) the body weight (CG, 472.75 ± 14.11 vs. SG, 444.75 ± 18.91 g), BMD (CG, 0.24 ± 0.01 vs. SG, 0.22 ± 0.01 g/cm2 ), bone resistance to failure (CG, 195.73 ± 10.06 vs. SG, 178.45 ± 8.48 N) and stiffness (CG, 0.56 ± 0.02 vs. SG, 0.47± 0.03 N/m) of SG animals. Body weight correlated strongly with bone structural and mechanical properties (p<0.0001). In conclusion, free activity in the cage associated with body weight gain restored bone structural and mechanical properties in growing rats after hindlimb unloading.

Investigou-se a importância das atividades diárias na caixa e o ganho de peso durante a recuperação das propriedades ósseas estruturais e mecânicas em ratos jovens após hiposinesia de membros pélvicos. Ratos Wistar com oito semanas de idade foram divididos em grupos controle (CG, n=24) e suspensos (SG, n=24). Animais do SG permaneceram quatro semanas suspensos pela cauda. Animais do CG e aqueles do SG após a liberação foram alojados em caixas coletivas e sacrificados com 12, 16 e 20 semanas de idade. Foram mensuradas área, densidade mineral (DMO), resistência de fratura e rigidez do fêmur. Quatro semanas de hiposinesia reduziu (p<0.05) o peso corporal (CG: 373,00 ± 9,47 vs. SG: 295,86 ± 9,19 g), DMO (CG: 0,19 ± 0,01 vs. SG: 0,15 ± 0,01 g/cm2 ), resistência de fratura (CG: 147,75 ± 5,05 vs. SG: 96,40 ± 5,95 N) e rigidez óssea (CG: 0,38 ± 0,01 vs. SG: 0,23 ± 0,02 N/m). Oito semanas de atividade na caixa recuperou (p>0.05) o peso corporal (CG: 472,75 ± 14,11 vs. SG: 444,75 ± 18,91 g), BMO (CG: 0,24 ± 0,01 vs. SG: 0,22 ± 0,01 g/cm2 ), resistência de fratura (CG: 195,73 ± 10,06 vs. SG: 178,45 ± 8,48 N) e rigidez óssea (CG: 0,56 ± 0,02 vs. SG: 0,47± 0,03 N/m) do SG. Peso corporal correlacionou fortemente com as propriedades ósseas, estrutural e mecânica, (p<0.0001). Concluiu-se que a atividade livre na caixa associada ao ganho de peso restaurou as propriedades ósseas estruturais e mecânicas em ratos jovens após hiposinesia dos membros pélvicos.