Morphological and ultrastructural changes in fungal agents after LASER application.

BACKGROUND: Onychomycosis is a fungal nail infection of difficult treatment due to the fungal survival capacity and reduced number of effective therapies. The present study aimed to isolate fungal agents that cause onychomycosis in immunocompetent patients and evaluate how LASER treatments affect the growth and ultrastructure of isolates. METHODS: In total, 21 patients with positive direct microscopic examination (DME) for onychomycosis had nail samples collected for cultivation and phenotypic identification of microorganisms. From these patients, 12 underwent LASER treatment, divided in Group 1 (n = 5) treated with Nd: YAG 1,064 nm, and Group 2 (n = 7) treated with Nd: YAG 1,064 nm + Er: YAG 2,940 nm + topical isoconazole. Transmission Electron Microscopy (TEM) was performed to evaluate ultrastructural changes after treatment. RESULTS: DME, cultivation, and phenotypic identification showed that the most identified fungus was Trichophyton rubrum spp. After LASER therapy, sample cultivation showed alterations in the fungal morphology with reduction of hyphae, conidia, and reproductive structures. Alterations in fungal cell wall structure, cytoplasm density, and organelles were observed by TEM. CONCLUSION: LASER irradiation causes changes in the fungal cells, especially in the number of hyphae and the presence of conidia. In addition, it affects fungal growth and reproduction capacity, which interferes with their infection ability and virulence.

Impact of the national shortage of polymyxin B in critically ill patients during the COVID-19 pandemic / Impacto da escassez nacional de polimixina B em pacientes gravemente enfermos durante a pandemia de COVID-19 / Impacto del desabasto nacional de polimixina B en pacientes críticos durante la pandemia de COVID-19

Background and Objectives: during the COVID-19 pandemic, the number of critical patients requiring intensive care increased considerably, resulting in an increase in infections due to multi-resistant microorganisms. In Brazil, in 2021, due to the high demand for polymyxin B use, there was a national shortage of the medication. One strategy used to overcome this situation was aminoglycoside use. The work aimed to analyze the impact of replacing polymyxin B with amikacin and gentamicin in the final stage of patients. Method: an analytical study with an observational, cross-sectional design, with a quantitative approach, through a retrospective analysis through the analysis of medical records, with the primary stages being discharges or deaths. Results: mortality was similar between the group treated with aminoglycoside and the group treated with polymyxin B. Within the aminoglycoside group, mortality was higher in the group that had bacteria resistant to the drug than in the group that had infection with an organism sensitive to this drug. Mortality was not affected by comorbidities, age, or number of hospital infections. The main factor that led to the need for dialysis was the combination of two nephrotoxic medications. Conclusion: two hypotheses emerged: the first would be that replacing polymyxin B with aminoglycosides did not impact mortality; the other would be that, regardless of the antibiotic group used, patients had a high risk of death. Despite sample limitations, the study corroborates the adoption of strategies for the rational use of antimicrobials.(AU)

Justificativa e Objetivos: durante a pandemia de COVID-19, o número de pacientes críticos que necessitaram de cuidados intensivos aumentou consideravelmente, resultando em aumento de infecções por microrganismos multirresistentes. No Brasil, em 2021, devido à grande demanda pelo uso da polimixina B, houve escassez nacional do medicamento. Uma estratégia utilizada para superar essa situação foi o uso de aminoglicosídeos. O trabalho teve como objetivo analisar o impacto da substituição da polimixina B por amicacina e gentamicina na fase final dos pacientes. Método: estudo analítico com desenho observacional, transversal, com abordagem quantitativa, por meio de análise retrospectiva por meio de análise de prontuários, sendo as etapas primárias as altas ou óbitos. Resultados: a mortalidade foi semelhante entre o grupo tratado com aminoglicosídeo e o grupo tratado com polimixina B. Dentro do grupo aminoglicosídeo, a mortalidade foi maior no grupo que apresentava bactérias resistentes ao medicamento do que no grupo que apresentava infecção por organismo sensível a este medicamento. medicamento. A mortalidade não foi afetada por comorbidades, idade ou número de infecções hospitalares. O principal fator que levou à necessidade de diálise foi a combinação de dois medicamentos nefrotóxicos. Conclusão: surgiram duas hipóteses: a primeira seria que a substituição da polimixina B por aminoglicosídeos não impactou a mortalidade; a outra seria que, independentemente do grupo de antibióticos utilizado, os pacientes apresentavam alto risco de morte. Apesar das limitações amostrais, o estudo corrobora a adoção de estratégias para o uso racional de antimicrobianos.(AU)

Antecedentes y Objetivos: durante la pandemia de COVID-19, el número de pacientes críticos que requirieron cuidados intensivos aumentó considerablemente, resultando en un aumento de infecciones por microorganismos multirresistentes. En Brasil, en 2021, debido a la alta demanda del uso de polimixina B, hubo escasez nacional del medicamento. Una estrategia utilizada para superar esta situación fue el uso de aminoglucósidos. El trabajo tuvo como objetivo analizar el impacto de la sustitución de la polimixina B por amikacina y gentamicina en la etapa final de los pacientes. Método: estudio analítico con diseño observacional, transversal, con enfoque cuantitativo, mediante un análisis retrospectivo mediante el análisis de historias clínicas, siendo las etapas primarias las altas o defunciones. Resultados: la mortalidad fue similar entre el grupo tratado con aminoglucósido y el grupo tratado con polimixina B. Dentro del grupo de aminoglucósido, la mortalidad fue mayor en el grupo que tenía bacterias resistentes al fármaco que en el grupo que tenía infección con un organismo sensible a este. droga. La mortalidad no se vio afectada por las comorbilidades, la edad o el número de infecciones hospitalarias. El principal factor que llevó a la necesidad de diálisis fue la combinación de dos medicamentos nefrotóxicos. Conclusión: surgieron dos hipótesis: la primera sería que la sustitución de polimixina B por aminoglucósidos no impactó la mortalidad; la otra sería que, independientemente del grupo de antibióticos utilizado, los pacientes tenían un alto riesgo de muerte. A pesar de las limitaciones de la muestra, el estudio corrobora la adopción de estrategias para el uso racional de antimicrobianos.(AU)

Cervical carcinoma induces NLRP3 inflammasome activation and IL-1ß release in human peripheral blood monocytes affecting patients' overall survival.

PURPOSE: Our group previously demonstrated that genetic variants in inflammasome genes contribute to protection against the establishment of human papilloma virus (HPV)-associated cervical carcinoma (CC). The objective of this study was to better understand the contribution of inflammasome and its cytokines in the CC microenvironment. METHODS: The inflammasome activation was analyzed in CC tumoral cell lines and healthy donors (HD)' monocytes in co-culture. In vitro results were then compared to CC patients' public databases. RESULTS: CC cells did not produce IL-1ß or IL-18 themselves, however, when in co-culture with HD monocytes, induced IL-1ß release in those leucocytes. Inflammasome activation appears to be partially dependent on the NLRP3 receptor. Public data analysis revealed that IL1B expression is increased in the CC compared to normal uterine cervix, and that patients with high IL1B expression had a shorter overall survival. CONCLUSION: CC microenvironment can activate the inflammasome and IL-1ß release in surrounding monocytes, which could be detrimental for CC prognosis.

Impact of e-cigarettes as cancer risk: A protocol for systematic review and meta-analysis.

BACKGROUND: The use of electronic cigarettes is one of the current public health problems on increasing alert, has been growing at an accelerating rate, and has become a public health emergency. Its importance is explained by the continuous growth and acceleration of oncological rates among all ages versus the absence of high-quality evidence, correlated to the use of nicotine derived products, being at their regular versions or the new ones. Available preclinical data indicate that activation of the sympathetic nervous system by nicotine inhaled from e-cigarettes may stimulate cancer development and growth by several mechanisms, which results can significantly reduce life's quality. This systematic review and meta-analysis protocol aims to clarify the connection between the use of electronic cigarettes by adults over the age of 18 and the development of malignant neoplastic diseases. METHOD: The proposed systematic review and meta-analysis will be reported conforming to the preferred reporting items for systematic reviews and meta-analyses guidelines. Will include the following studies: case-control or cohort studies showing adults (18 years old age) using e-cigarettes. There will be no language or publication period restrictions. Articles published, but not peer-reviewed, will not be included in the review. Data will be entered in the Review Manager software (RevMan5.2.3). For dichotomous outcomes, we extracted or calculated the OR and 95% CI for each study. In case of heterogeneity (I²>50%), the random-effects model will be used to combine the studies to calculate the OR and 95% CI.

Clinical and demographic features of minor salivary gland tumors: A collaborative study of 480 cases.

OBJECTIVE: To describe the frequency, clinical, and demographic features of minor salivary gland tumors and possible associated factors. MATERIALS AND METHODS: A cross-sectional study was conducted. Clinical and demographic data were collected from biopsy records of two oral pathology services. Chi-square test, Fisher's exact test, and descriptive statistical analysis were performed. RESULTS: A total of 480 (0.89%) minor salivary gland tumors were retrieved, 272 (56.7%) benign and 147 (30.7%) malignant. Sixty-one (12.6%) had no subtype specification. Most patients were women (307/64.0%), in sixth decade of life (80/16.7%), with a mean age of 45.32 years. Palate was the most common site (336/70.1%). Pleomorphic adenoma (PA; 245/51.1%), mucoepidermoid carcinoma (MEC; 70/14.6%), and adenoid cystic carcinoma (ACC; 43/8.9%) were the most frequent tumors. Symptomatic case, recurrence, and tobacco use were associated with malignancy (p < 0.05). PA and MEC were more frequent in palate (p < 0.05). No association between the three most frequent histological types and gender or age group was observed (p > 0.05). CONCLUSIONS: This represents one of the largest exclusive series of minor salivary gland tumors in Brazil and worldwide. PA, MEC, and ACC were the most frequent tumors. Clinical and demographic data are similar from Brazilian studies or from other countries.

The Ala134Thr variant in TMEM176B exerts a beneficial role in colorectal cancer prognosis by increasing NLRP3 inflammasome activation.

PURPOSE: TMEM176B was recently described as a negative modulator of Nlrp3 inflammasome activation in mice. In the mouse model, the inhibition of TMEM176B leads to an increased anti-tumoral activity which is dependent on Nlrp3. Since we have recently shown that single nucleotide variants (SNPs) in inflammasome genes, including NLRP3, significantly affect colorectal cancer (CRC) prognosis, we proposed to investigate here the association between genetic variants in TMEM176B and CRC prognosis. METHODS: Considering that, up to now, no genetic study analyzing this gene in humans exists, we selected possible functional SNPs and genotyped them in a cohort of CRC patients submitted to surgery and followed up for more than 10 years. Genotype-guided assays were realized to evaluate the effect of the variant on NLRP3 inflammasome activation. Gene expression from The Cancer Genome Atlas (TCGA) cohort was analyzed to valid possible prognostic and predictive features. RESULTS: We identified the Ala134Thr variant (rs2072443) in TMEM176B as a protective factor for CRC prognosis. This SNP is associated with decreased gene expression and with an increased activation of NLRP3 inflammasome, at least in monocytes and dendritic cells. Furthermore, low TMEM176B expression is associated with higher overall survival. CONCLUSION: Altogether, these findings supported the role of TMEM176B in NLRP3 inflammasome biology and for the first time demonstrated the genetic association between rs2072443 and CRC in humans.

A peculiar case of onychomycosis caused by Cladosporium halotolerans

ABSTRACT A 49-year-old patient with changes in the nails of the hallux for 10 years was diagnosed with onychomycosis. The identity of the causative agent was confirmed as Cladosporium halotolerans from the Cladosporium sphaerospermum species complex using molecular techniques. MALDI-TOF identified the agent as C. sphaerospermum complex species. Overall, species such as onychomycosis agents should attract special attention to avoid mistakes in the identification process while considering a probable contaminant as responsible for the disease. These species deserve attention since there are rare descriptions of them as causes of onychomycosis. It is important to recognize them as causes of disease and not just as a probable contaminant.

A importância do conhecimento técnico e científico do enfermeiro no procedimento de intubação traqueal / La importancia del conocimiento técnico y científico de la enfermera en el procedimiento de intubación traqueal / The importance of the technical and scientific knowledge of the nurse in the tracheal intubation procedure

Objetivo: identificar o grau do conhecimento técnico e científico dos enfermeiros no procedimento intubação traqueal. Método: pesquisa de campo com caráter descritivo-exploratória e quantitativa tendo identificado, através do resultado de um questionário aplicado a 23 profissionais enfermeiros, em um Hospital Geral do Vale do Paraíba, o grau de conhecimento técnico e científico sobre o procedimento de intubação traqueal. A coleta dos dados foi realizada nos meses de setembro e outubro de 2021. Resultados: a enfermagem participa e desempenha papel importante no procedimento de intubação, desde os diagnósticos até a avaliação contínua dos principais sinais e sintomas, estabelecendo um plano de cuidados, intervenções e atividades que permitirão fornecer o melhor atendimento ao paciente. Conclusão: O conhecimento do enfermeiro durante o procedimento de intubação traquel é de extrema importância, visando a qualidade da assistência, e a segurança do paciente.(AU)

Objective: To identify the degree of technical and scientific knowledge of nurses in the tracheal intubation procedure. Method: descriptive-exploratory and quantitative field research, having identified, through the result of a questionnaire applied to 23 nursing professionals, in a General Hospital of the Paraíba Valley, the degree of technical and scientific knowledge about the tracheal intubation procedure. Data were collected in September and October 2021. Results: nursing participates and plays an important role in the intubation procedure, from diagnoses to continuous evaluation of the main signs and symptoms, establishing a care plan, interventions and activities that will allow providing the best patient care. Conclusion: The knowledge of nurses during the traquel intubation procedure is extremely important, aiming at the quality of care, and patient safety.(AU)

Objetivo: identificar el grado de conocimiento técnico y científico de las enfermeras en el procedimiento de intubación traqueal. Método: investigación de campo descriptiva-exploratoria y cuantitativa, habiendo identificado, a través del resultado de un cuestionario aplicado a 23 profesionales de enfermería, en un Hospital General del Valle de Paraíba, el grado de conocimiento técnico y científico sobre el procedimiento de intubación traqueal. Los datos fueron recolectados en septiembre y octubre de 2021. Resultados: La enfermería participa y juega un papel importante en el procedimiento de intubación, desde el diagnóstico hasta la evaluación continua de los principales signos y síntomas, estableciendo un plan de cuidados, intervenciones y actividades que permitan brindar la mejor atención al paciente. Conclusión: El conocimiento de las enfermeras durante el procedimiento deintubación de traquel es extremadamente importante, apuntando a la calidad de la atención y la seguridad del paciente.(AU)

Metaplastic Breast Carcinoma in a 37-Year-Old Female: A Case Report.

Metaplastic breast carcinoma (MBC) is a rare and aggressive histologic subtype of cancer. Because of its rarity and heterogeneity, the management of these patients is challenging. Here, we present the case of a rapidly progressive MBC with mesenchymal differentiation in a 37-year-old female, treated with trimodal therapy consisting of neoadjuvant chemotherapy with paclitaxel and carboplatin, followed by dose-dense cyclophosphamide and doxorubicin (ddAC), modified radical left mastectomy, and adjuvant radiotherapy. Despite the need to anticipate the surgery after the first cycle of ddAC, because of a life-treating adverse event, there was a pathologic complete response. Nevertheless, 6.2 months after completing adjuvant radiotherapy, the patient had a recurrence on the central nervous system (CNS) (two lesions), which was managed with excisional biopsy and stereotactic body radiation therapy. The patient also started "complementary" chemotherapy with capecitabine. Still, 18 months after being diagnosed, she died due to CNS disease progression.

Systemic Effects of Photobiomodulation on Blood Components in the Treatment of Community-Acquired Pneumonia.

Background: The analysis of the complete blood count (CBC) of patients with community-acquired pneumonia (CAP) is an essential practice both for diagnosing the disease and for evaluating the patient's clinical evolution. It is proposed in the present study to analyze the hematological alterations resulting from photobiostimulation using near-infrared light-emitting diodes (LEDs) in patients with CAP. Methods: This was a clinical, prospective, blinded, and descriptive longitudinal study that involved 21 patients undergoing CAP treatment who were divided into two groups: LED, 11 patients who were treated with infrared LED and conventional treatment; and CON (control), 10 patients who received only conventional treatment (antibiotic therapy and physiotherapy). Physiotherapy was applied before LED irradiation in the LED group. The patients' CBCs were obtained before and after treatment, and erythrocyte counts, hemoglobin and hematocrit concentrations, and leukocyte and platelet counts were assessed. The phototherapy was performed with a vest with an array of 300 LEDs (940 nm) mounted on an area of 36 × 58 cm and positioned in the patient's anterior thoracic and abdominal regions. The total power was 6 W, with 15 min of irradiation time. The patients were treated daily for seven consecutive days. Statistical analyses of the intra- and intergroups of CBC data were done using Student's t-test and one-way ANOVA (analysis of variance), respectively, both at the significance level of α = 0.05. Results: There was a statistically significant recovery difference after treatment in the LED group compared with the CON group for erythrocytes, hemoglobin, leukocytes, segmented and band neutrophils, lymphocytes, and monocytes (p < 0.05). The greatest differences between the LED and CON groups were lymphocyte count reduction (60% vs. 16%), erythrocyte increase (86% vs. 35%), and leukocyte reduction (28% vs. 15%). Conclusions: The hematologic components of CAP patients recovered their normal values faster with conventional treatment associated with infrared LED therapy, thus indicating greater treatment efficiency when compared with the conventional therapy. This study was registered with the Brazilian Registry of Clinical Trials (ReBeC) under Universal Trial Number (UTN) U1111-1229-1296 (2019/06/05).

Betulinic acid exerts antigenotoxic and anticarcinogenic activities via inhibition of COX-2 and PCNA in rodents.

Phytochemicals have been suggested as an effective strategy for cancer prevention. Within this context, triterpene betulinic acid (BA) exhibits several biological properties but its chemopreventive effect has not been fully demonstrated. The present study investigated the antigenotoxic potential of BA against doxorubicin (DXR)-induced genotoxicity using the mouse peripheral blood micronucleus assay, as well as its anticarcinogenic activity against 1,2dimethylhydrazine (DMH)-induced colorectal lesions in rats. Micronuclei (MN) assay and aberrant crypt foci assay were used to assess the antigenotoxic and the anticarcinogenic potential, respectively. The molecular mechanisms underlying the anticarcinogenic activity of BA were evaluated by assessing anti-inflammatory (COX-2) and antiproliferative (PCNA) pathways. The results demonstrated that BA at the dose of 0.5 mg/kg bodyweight exerted antigenotoxic effects against DXR, with a reduction of 70.2% in the frequencies of chromosomal damage. Animals treated with BA showed a 64% reduction in the number of preneoplastic lesions when compared to those treated with the carcinogen alone. The levels of COX-2 and PCNA expression in the colon were significantly lower in animals treated with BA and DMH compared to those treated with the carcinogen alone. The chemopreventive effect of BA is related, at least in part, to its antiproliferative and anti-inflammatory activity, indicating a promising potential of this triterpene in anticancer therapies, especially for colorectal cancer.

Effects of Stryphnodendron adstringens extracts on murine 4T1 tumor line

Breast cancer appears as the main gynecological cancer and presents high morbidity and mortality. Because most diagnoses are made belatedly, it is necessary to seek therapeutic options that aim for advanced stages of the disease. This study aims to evaluate the antitumoral action of Stryphnodendron adstringens fruit extracts on 4T1 murine mammary carcinoma cell culture. The inhibitory potential of S. adstringens fruit extract on the metalloproteinases (MMPs) 2 and 9 was evaluated through zymography. From these results, MTT assays were performed to evaluate the extracts' effects on the murine mammary carcinoma 4T1 line cell viability. From the crude extract, the following extracts were obtained: hydroalcoholic (SAFCEA), hexane (SAFCEB), chloroform (SAFCEC), and ethyl acetate (SAFCED). Lastly, the migration of the cells treated with extracts SAFCEA and SAFCED was verified. The hydroalcoholic extract (SAFCEA) was the most efficient in inhibiting gelatinases. During the phytochemical study, it was noted that alkaloids were present in all partitions. The 50 % growth inhibition (IC50) concentrations found were: 40.1 µg/mL (SAFCEA) and 70.14 µg/mL (SAFCED). After the cellular cytotoxicity assay, cell morphology was altered by treatment with the selected partitions (SAFCEA and SAFCED), obtaining morphology consistent with apoptosis. The results demonstrate that S. adstringens extracts exhibit the inhibitory activity of MMP-2 and MMP-9 as well as cytotoxicity toward 4T1 tumor cells. These findings indicate that follow-up studies of the partitions from S. adstringens may lead to the development of novel chemotherapeutics for oncological treatments.

Protocolo de avaliação de habilidades pragmáticas de crianças com transtornos do espectro do autismo / Assessment of pragmatic abilities of children with autism spectrum disorders

RESUMO Objetivo Propor um protocolo de avaliação das habilidades pragmáticas da comunicação de crianças incluídas no espectro do autismo, aplicá-lo e comparar seus resultados com os do Perfil Funcional da Comunicação. Métodos Participaram deste estudo 62 crianças entre 2 e 12 anos de idade, com diagnóstico incluído no espectro do autismo e sem perdas sensoriais ou síndromes genéticas diagnosticadas. A partir de amostras em vídeo, fonoaudiólogos responderam ao protocolo proposto e os resultados foram analisados em relação a protocolos já usados no serviço em que o estudo foi realizado. Resultados Apenas os dados referentes à interatividade da comunicação e ao uso do meio comunicativo verbal apresentaram correlações significativas com o desempenho nos aspectos pragmáticos da linguagem, conforme verificado pelo protocolo proposto. O protocolo foi capaz de constatar que maiores possibilidades de interação com a criança possibilitam mais dados a respeito de seu desempenho pragmático. A análise do uso do protocolo para acompanhar os resultados de seis meses de intervenção também possibilitou a identificação de correlações relevantes. Apenas uma das 29 questões não apresentou associação com nenhuma das variáveis estudadas. Conclusão Os resultados obtidos até o momento não são suficientes para determinar que o uso isolado do Protocolo de Avaliação de Habilidades Pragmáticas de Crianças com Transtorno do Espectro do Autismo fornece todos os elementos necessários para a avaliação ou o acompanhamento da intervenção fonoaudiológica.

ABSTRACT Purpose To propose a protocol to the assessment of pragmatic abilities of children with autism spectrum disorders, test it and compare the results with those of the Functional Communicative Profile. Methods Participants were 62 children, ages 2 to 12 years without prior diagnosis of any sensorial loss or genetic syndrome. Based on video samples, speech-language pathologists answered to the proposed protocol. The results were analyzed according to their association with other protocols used in the service where the study was carried-out. Results Only data about communication interactivity and use of verbal communicative mean presented significant correlations with the pragmatic aspects of language performance verified by the proposed protocol. The protocol allowed the supposition that larger experience with the child may provide more information about the child's pragmatic performance. The analysis of the use of the protocol to verify the outcomes of six-month language intervention processes also lead to relevant correlations. Just one of the 29 questions did not result in associations with any of the studied variables. Conclusion So far, the results are not enough to consider that the isolated use of this tool will provide the necessary information to language assessment of intervention follow-up.

Desempenho da gestão hospitalar por parcerias público-privadas no Sistema Único de Saúde (SUS) / Performance of hospital management through public-public partnerships in the Unified Health System (SUS)

Introdução: As Parcerias Público-Privadas (PPP) são um modelo de gestão que visa transferir para um parceiro privado a execução dos serviços públicos. Na área da saúde, as PPPs estão presentes em alguns países desde a década de 1990. No Brasil a lei que regulamenta as PPPs foi promulgada em 2004, mas a gestão por PPP na saúde teve início com a construção do Hospital do Subúrbio em Salvador (Bahia) em 2010. Objetivo: Comparar indicadores de desempenho dos hospitais com gestão por Parceria Público-Privada versus hospitais de mesmo porte com outros modelos de gestão vinculados ao Sistema Único de Saúde (SUS). Métodos: Estudo descritivo, com base em dados secundários do Sistema de Internações Hospitalares (SIH/SUS) e do Cadastro Nacional dos Estabelecimentos de Saúde (CNES), referentes ao biênio 2018-2019, que avaliou os 3 hospitais com gestão por PPPs no país: Hospital do Subúrbio (HS), Instituto Couto Maia (ICM), ambos na Bahia, e o Hospital Metropolitano Dr. Célio de Castro (HMDCC) em Minas Gerais. Cada hospital foi comparado com outros três hospitais de mesma tipologia, e porte semelhante, situados na mesma unidade da federação da PPP. O ICM foi comparado com o Hospital Manoel Victorino, o Hospital Regional da Chapada e o Hospital Sarah Salvador. O HS foi comparado com o Hospital Santo Antônio, o Hospital Geral Roberto Santos e o Hospital Geral do Estado. O HMDCC foi comparado com o Hospital Metropolitano Odilon Bherens Hob, o Hospital de Clínicas de Uberlândia e o Hospital das Clínicas da Universidade Federal de Minas Gerais EBSERH. Os indicadores avaliados foram: tempo médio de permanência (TMP), taxa de ocupação de leitos (TOL), taxa de mortalidade hospitalar (TMH) e valor médio da internação (VMI). Resultados: Os resultados dos indicadores de desempenho dos hospitais geridos por PPPs (TMP, TMH e TOL) não se mostraram superiores em relação aos hospitais com outros modelos de gestão, sendo que no caso do ICM o desempenho superior aos demais foi apenas no indicador de taxa de ocupação de leitos, do HS foi apenas no indicador de tempo médio de permanência, e o HMDCC não se mostrou superior em nenhum dos indicadores de desempenho. O VMI foi apresentado como um parâmetro, visto que o valor efetivamente pago pelos governos às PPPs se mostrou muito superior. Conclusões: Neste estudo a gestão por PPP não mostrou desempenho superior aos outros modelos com características semelhantes existentes no SUS.

Introduction: Public-Private Partnerships (PPP) are a management model that aims to transfer the execution of public services to a private partner. In the health area, PPPs have been present in some countries since the 1990s. In Brazil, the law regulating PPPs was enacted in 2004, but PPP management in health began with the construction of the Hospital do Subúrbio in Salvador (Bahia) in 2010. Objective: To compare performance indicators of hospitals managed by a Public-Private Partnership versus hospitals of the same size with other management models linked to the Unified Health System (SUS). Methods: Descriptive study, based on secondary data from the Hospital Admissions System (SIH/SUS) and the National Register of Health Establishments (CNES), for the 2018-2019 biennium, which evaluated the 3 hospitals managed by PPPs in the country: Hospital do Subúrbio (HS), Instituto Couto Maia (ICM), both in Bahia, and the Metropolitan Hospital Dr. Célio de Castro (HMDCC) in Minas Gerais. Each hospital was compared with three other hospitals of the same type, and similar size, located in the same PPP's federation unit. The ICM was compared with Hospital Manoel Victorino, Hospital Regional da Chapada and Hospital Sarah Salvador. HS was compared with Hospital Santo Antônio, Hospital Geral Roberto Santos and Hospital Geral do Estado. The HMDCC was compared with the Hospital Metropolitano Odilon Bherens Hob, the Hospital de Clínicas de Uberlândia and the Hospital das Clínicas da Universidade Federal de Minas Gerais EBSERH. The indicators evaluated were: mean length of stay (LOS), bed occupancy rate (BOR), hospital mortality rate (HMR) and mean hospital stay (MHS). Results: The results of the performance indicators of hospitals managed by PPPs (LOS, HMR and BOR) were not superior in relation to hospitals with other management models, and in the case of the ICM the performance superior to the others was only in the indicator of HS bed occupancy rate was only in the indicator of average length ofstay, and the HMDCC was not superior in any of the performance indicators. The MHS was presented as a parameter, as the amount effectively paid by governments to PPPs was much higher. Conclusions: In this study, management by PPP did not show superior performance compared to other models with similar characteristics existing in the SUS.

Communicative skills of children with autistic spectrum disorder: clinical and family perception / Habilidades comunicativas em crianças com transtorno do espectro autista: percepção clínica e familiar

ABSTRACT Objective: to describe the communication skills of children with autistic spectrum disorder (ASD), considering the clinical and family perspective. Methods: from the point of view of parents and therapists, the language of ten children with ASD was analyzed. All children underwent speech therapy at the outpatient clinic of a Speech Therapy School. Two protocols were used for data collection. Autism Treatment Evaluation Checklist (ATEC), which was applied to the children's parents, and Protocol for Assessment of Pragmatic Skills of Children with Autism Spectrum Disorders - called Pragmatic Protocol (PP), which was answered by therapists. The data were examined through a descriptive statistical analysis, considering absolute and relative frequency, and inferential statistics, through the Chi-square test, with a 5% of significance for all analyses. Results: an expressive presence of communicative deficits, in the answers presented by the therapists, was seen. In the protocol answered by the parents, it was also possible to observe the same trend, since the children failed to score in several items of Subscale I. Conclusion: parents and therapists evidenced changes in the communicative skills of the children surveyed, and emphasized that therapists, who have technical linguistic knowledge, like parents, can also be good informants about their children's communicative development process.

RESUMO Objetivo: descrever as habilidades de comunicação de crianças com TEA considerando a perspectiva clínica e familiar. Métodos: foi analisada, a partir do ponto de vista dos pais e terapeutas, a linguagem de 10 crianças com TEA. Todas as crianças estavam em acompanhamento fonoaudiológico no ambulatório de uma Clínica Escola de Fonoaudiologia. Foram utilizados dois protocolos para coleta dos dados. O Autism Treatment Evaluation Checklist- ATEC, o qual foi aplicado com os pais das crianças, e o Protocolo de Avaliação de Habilidades Pragmáticas de Crianças com Transtornos do Espectro do Autismo - PAHPEA, o qual foi respondido pelos terapeutas. Após aplicação dos protocolos, os dados foram examinados por meio de uma análise estatística descritiva, utilizando-se da frequência absoluta e relativa, e inferencial por meio do teste de associação Qui-quadrado, com significância de 5% para todas as análises. Resultados: de acordo com as respostas apresentadas pelos terapeutas, uma expressiva presença de déficits comunicativos foi observada. No protocolo respondido pelos pais também foi possível observar a mesma tendência, uma vez que as crianças deixaram de pontuar em vários itens da Subescala I. Conclusão: os pais e terapeutas evidenciaram alterações nas habilidades comunicativas das crianças pesquisadas, ressaltando que, assim como os terapeutas, os quais possuem conhecimento técnico linguístico, os pais também podem ser bons informantes sobre o processo de desenvolvimento comunicativo de seus filhos.

Anti-Melanoma Activity of Indomethacin Incorporated into Mesoporous Silica Nanoparticles.

Melanoma is the deadliest type of skin cancer. Treatments that directly address tumor survival are required. Indomethacin (IND) is a well-known drug used worldwide. Although widely used as a therapeutic agent, IND has undesirable gastrointestinal effects. PURPOSE: To investigate the antitumor efficacy of IND incorporated into mesoporous silica nanoparticles (MSNPs+IND), as well as its toxic potential in a syngeneic murine B16 melanoma model. METHODS: Antitumor activity was evaluated by measuring tumor size and weight and by histopathological analysis. Possible molecular signaling pathways involved in the antitumor activity were analyzed by Western blot in liver tissue and by immunohistochemistry in tumor tissue. The potential toxicity was evaluated by determining body and organ weights and by biochemical and genotoxic analysis. RESULTS: MSNPs+IND treatments inhibited tumor growth by up to 70.09% and decreased the frequency of mitosis in tumor tissues, which was up to 37.95% lower compared to the IND groups. In hepatic tissue, COX-2 levels decreased significantly after treatment with MSNPs+IND and IND. Additionally, MSNPs+IND and IND increased the levels of cleaved caspase-3 (156.25% and 137.50%, respectively), inducing tumor cell apoptosis. Genotoxicity was limited to the group treated with the higher concentration of IND, while MSNPs prevented IND-induced genotoxicity. CONCLUSIONS: MSNPs may be promising for future applications in cancer therapy.

Para além da legitimidade: a necessidade da Educação Física escolar / For beyond of legitimacy: the need for Physical Education at school / Más allá de la legitimidad: la necesidad de la Educación Física escolar

A obra "A necessidade histórica da Educação Física na Escola: impasses atuais", de Rosângela Aparecida Mello, está pautada nos pressupostos da teoria do materialismo histórico e busca recolocar esta concepção nas discussões sobre a Educação Física. O objetivo central da obra é investigar a necessidade histórica da Educação Física escolar no contexto atual de crise e renovação do capital. Mello expõe um debate acerca da legitimidade da disciplina, deslocando-o para a questão de sua necessidade histórica, elevando a discussão a um novo patamar. Considera que as necessidades são construções histórico-sociais que buscam, tanto na Educação Física como em qualquer outro campo social, a construção de uma sociedade emancipada. Todavia, dentro de seus limites e possibilidades, a escola e a Educação Física pouco podem contribuir para a superação social radical, visto que só é possível pensar a cultura corporal para a emancipação humana se, de fato, esta for a intenção social.

The book, entitled "The historical need for Physical Education in school: current deadlocks", written by Rosângela Aparecida Mello, is based on the assumptions of the theory of historical materialism and seeks put again this conception in discussions about Physical Education. The objective is to investigate the historical necessity of Physical Education at school in the current context of crisis and capital renewal. The author exposes a debate about the legitimacy of the discipline, presenting the question of its historical necessity, raising the discussion to a new level. The book considers that needs are historical-social constructions that seek the construction of an emancipated society, both in Physical Education and in any other social field. However, through their limits and possibilities, school and Physical Education can contribute little to radical social overcoming, because it is only possible to think of body culture for human emancipation if this is the social intention.

El "La necesidad histórica de la Educación Física en la escuela: impases actuales", de Rosângela Aparecida Mello, se basa en los pressupoestos del materialismo histórico y repiensa esta concepción en las discusiones sobre Educación Física. El objetivo es investigar la necesidad histórica de la Educación Física en lo contexto actual de crisis y renovación de lo capital. Mello expone un debate sobre la legitimidad de la disciplina, desplazándola a la cuestión de su necesidad histórica, elevando la discusión a otro nivel. Considera que las necesidades son construcciones histórico-sociales que buscan, en la Educación Física como en cualquier otro campo social, la construcción de una sociedad emancipada. Sin embargo, dentro de sus límites y posibilidades, la educación escolar y la Educación Física puede contribuir poco a la superación social radical, ya que solo es posible pensar en la cultura corporal para la emancipación humana si este es la intención social.

Inflammasome genetics and complex diseases: a comprehensive review.

The inflammasome is a cytoplasmic multiprotein complex responsible for the activation of inflammatory caspases (caspase-1, -4, and -5) in response to pathogen- and/or damage-associated molecular patterns or to homeostasis-altering molecular pathways, and for the consequent release of the pro-inflammatory cytokines interleukin (IL)-1ß and IL-18. Taking in account the complexity of inflammasome activation and that several regulatory steps are involved in maintaining its physiologic role in homeostasis and innate immune response, it does not surprise that several genetic variants in inflammasome components have been associated with common pathologies in the general population, such as autoimmune disorders, cardiovascular diseases, obesity and associated metabolic syndrome, neurodegenerative diseases, and cancer. Moreover, the susceptibility to infectious agents and/or to develop severe complications during infections also has been related to inflammasome genetics. In this work, we revised genetic association studies about polymorphisms of main inflammasome genes in sterile as well as infectious diseases, trying to depict the genetic contribution of inflammasome in disease pathogenesis.

Double-edged sword of inflammasome genetics in colorectal cancer prognosis.

Inflammation is a colorectal cancer (CRC) hallmark. Inflammasome-dependent cytokines IL-1ß and IL-18 can play a beneficial or detrimental role in tumorigenesis depending on cancer type. Variants in inflammasome genes were associated with tumor development and/or outcome, and have been proposed as potential biomarkers for population screening. In this study, 215 CRC patients followed-up for 10 years were examined for 9 polymorphisms in selected inflammasome genes. Multivariate association analysis and survival analysis were performed to evaluate the association between the polymorphisms and CRC prognosis. Variants associated with lower levels of IL-18 (rs1834481, rs5744256), or with increased activation of inflammasome receptors NLRP1 (rs12150220) and NLRP3 (rs35829419) resulted detrimental to CRC prognosis and may be used as prognostic markers.