Comunicação de más notícias em cuidados paliativos: estudo bibliométrico / Communication of bad news in palliative care: bibliometric study / Comunicación de malas noticias en cuidados paliativos: estudio bibliométrico

Os cuidados paliativos compreendem a melhora da qualidade de vida e o alívio dos sintomas de pacientes que enfrentam doenças que ameaçam a continuidade da vida e de seus familiares. Para tal, é necessário habilidade comunicativa, a fim de uma boa condução ao transmitir uma má notícia. Buscou-se compreender como se configura a produção científica nacional e internacional que aborda a comunicação de más notícias em cuidados paliativos. A pesquisa de revisão, de análise bibliométrica, analisou 25 artigos dos últimos cinco anos (entre 2016 e 2020) disponíveis na Biblioteca Virtual em Saúde (BVS/Bireme). Os resultados revelaram publicações de 134 autores em 16 periódicos de diferentes países. Parte dos estudos foi realizadacom profissionais de saúde em hospitais e apresentam abordagem quantitativa. A comunicação de más notícias ainda se mostra um desafio para profissionais, pacientes e familiares.

The palliative care comprises improving the quality of life and relieving the symptoms of patients facing illnesses that threaten the continuity of life and their families. For this, communicative ability is necessary, in order to conduct well when transmitting bad news. We sought to understand how the national and international scientific production on communication of bad news in palliative care is configured. The literature review research, based on bibliometrics, analysed 25 articles from the last five years (between 2016 and 2020) available in the Virtual Health Library (BVS/Bireme). The results revealed publications by 134 authors in 16 journals from different countries. Some of the studies were carried out with health professionals in hospitals and have a quantitative approach. Communicating bad news is still a challenge for professionals, patients and their families.

Los cuidados paliativos comprenden mejorar la calidad de vida y aliviar los síntomas de los pacientes que enfrentan enfermedades que amenazan la continuidad de vida y sus familias. Para ello es necesaria la habilidad comunicativa, a fin de poder transmitir adecuadamente las malas noticias. Buscamos comprender cómo se configura la producción científica nacional e internacional que aborda la comunicación de malas noticias en cuidados paliativos. La investigación de revisión de literatura, basada en el análisis bibliométrico, analizó 25 artículos de los últimos cinco años (entre 2016 y 2020) disponibles en la Biblioteca Virtual en Salud (BVS/Bireme). Los resultados revelaron publicaciones de 134 autores en 16 revistas de diferentes países. Parte de los estudios se realizaron con profesionales de la salud en hospitales y tienen un enfoque cuantitativo. La comunicación de malas noticias sigue siendo un desafío para profesionales, pacientes y sus familiares.

Influence of diimine bidentate ligand in the nitrosyl and nitro terpyridine ruthenium complex on the HSA/DNA interaction and antiviral activity.

Nitric oxide (NO) acts in different physiological processes, such as blood pressure control, antiparasitic activities, neurotransmission, and antitumor action. Among the exogenous NO donors, ruthenium nitrosyl/nitro complexes are potential candidates for prodrugs, due to their physicochemical properties, such as thermal and physiological pH stability. In this work, we proposed the synthesis and physical characterization of the new nitro terpyridine ruthenium (II) complexes of the type [RuII(L)(NO2)(tpy)]PF6 where tpy = 2,2':6',2″-terpyridine; L = 3,4-diaminobenzoic acid (bdq) or o-phenylenediamine (bd) and evaluation of influence of diimine bidentate ligand NH.NHq-R (R = H or COOH) in the HSA/DNA interaction as well as antiviral activity. The interactions between HSA and new nitro complexes [RuII(L)(NO2)(tpy)]+ were evaluated. The Ka values for the HSA-[RuII(bdq)(NO2)(tpy)]+ is 10 times bigger than HSA-[RuII(bd)(NO2)(tpy)]+. The sites of interaction between HSA and the complexes via synchronous fluorescence suppression indicate that the [RuII(bdq)(NO2)(tpy)]+ is found close to the Trp-241 residue, while the [RuII(bd)(NO2)(tpy)]+ complex is close to Tyr residues. The interaction with fish sperm fs-DNA using direct spectrophotometric titration (Kb) and ethidium bromide replacement (KSV and Kapp) showed weak interaction in the system fs-DNA-[RuII(bdq)(NO)(tpy)]+. Furthermore, fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+ system showed higher intercalation constant. Circular dichroism spectra for fs-DNA-[RuII(bd)(NO2)(tpy)]+ and fs-DNA-[RuII(bd)(NO)(tpy)]3+, suggest semi-intercalative accompanied by major groove binding interaction modes. The [RuII(bd)(NO2)(tpy)]+ and [RuII(bd)(NO)(tpy)]3+ inhibit replication of Zika and Chikungunya viruses based in the nitric oxide release under S-nitrosylation reaction with cysteine viral.

Percepção de enfermeiros acerca dos processos de cuidado durante a pandemia da covid-19 / Nurses' perception about care processes during the covid-19 pandemic / Percepción de las enfermeras sobre los procesos de atención durante la pandemia de covid-19

Objetivo: analisar a percepção do enfermeiro acerca dos processos de cuidado durante a pandemia da COVID-19. Métodos: estudo de campo, descritivo e abordagem qualitativa, realizado entre dezembro de 2020 a abril de 2021. Participaram 45 enfermeiros atuantes há três anos ou mais na Atenção Primária de municípios paraibanos classificados em urbano, intermediário adjacente e remoto, rural adjacente e remoto. Realizou-se a coleta através de entrevistas semiestruturadas pela plataforma Google Meet, essas eram gravadas pela própria plataforma e transcritas na íntegra para análise. A análise de dados deu-se por meio da Análise de Conteúdo considerando as etapas de pré-análise, codificação do texto e a inferência e interpretação dos resultados. O estudo atendeu ao que preconiza os padrões éticos. Resultados: no contexto pandêmico, os enfermeiros identificaram déficits existentes em suas práticas, elencando desafios e limitações nas condutas, como as de biossegurança e prevenção de doenças, fazendo-os repensar sobre futuras mudanças a serem realizadas após o período de pandemia. Conclusão: infere-se que os enfermeiros atuantes da Atenção Primária obtiveram novas percepções relacionadas ao cuidado, a preocupação com a saúde física e mental no planejamento desse cuidado, não apenas do usuário, mas de si mesmo e às pessoas do convívio. (AU)

Objective: to analyze nurses' perceptions of care processes during the COVID-19 pandemic. Methods: field study, descriptive and qualitative approach, carried out between December 2020 and April 2021. Participated 45 nurses working for three years or more in Primary Care in municipalities in Paraíba classified as urban, intermediate adjacent and remote, rural adjacent and remote. The collection was carried out through semi-structured interviews through the Google Meet platform, these were recorded by the platform itself and transcribed in full for analysis. Data analysis was carried out through Content Analysis considering the pre-analysis steps, text coding and the inference and interpretation of results. The study complied with ethical standards. Results: in the pandemic context, nurses identified existing deficits in their practices, listing challenges and limitations in conduct, such as biosecurity and disease prevention, making them rethink about future changes to be made after the period of pandemic. Conclusion: it is inferred that nurses working in Primary Care obtained new perceptions related to care, the concern with physical and mental health in the planning of this care, not only of the user, but of himself and the people around him. (AU)

Objetivo: analizar las percepciones de los enfermeros sobre los procesos de atención durante la pandemia de COVID-19. Métodos: estudio de campo, de abordaje descriptivo y cualitativo, realizado entre diciembre de 2020 y abril de 2021. Participaron 45 enfermeros que actúan desde hace tres años o más en Atención Básica en municipios de Paraíba clasificados como urbano, intermedio adyacente y remoto, rural adyacente y remoto. La recolección se realizó a través de entrevistas semiestructuradas a través de la plataforma Google Meet, estas fueron grabadas por la propia plataforma y transcritas en su totalidad para su análisis. El análisis de los datos se realizó a través del Análisis de Contenido considerando las etapas del preanálisis, la codificación del texto y la inferencia e interpretación de los resultados. El estudio cumplió con las normas éticas. Resultados: en el contexto de la pandemia, los enfermeros identificaron déficits existentes en sus prácticas, enumerando desafíos y limitaciones en la conducta, como la bioseguridad y la prevención de enfermedades, lo que les hizo repensar sobre los cambios futuros que se deben realizar después del período de pandemia. Conclusión: se infiere que los enfermeros que actúan en la Atención Primaria obtuvieron nuevas percepciones relacionadas con el cuidado, la preocupación por la salud física y mental en la planificación de este cuidado, no sólo del usuario, sino de sí mismo y de las personas que lo rodean. (AU)

Mycobacterium tuberculosis latent infection in healthcare students: systematic review of prevalence / Infecção latente por Mycobacterium tuberculosis em estudantes da área da saúde: revisão sistemática de prevalência / Infección latente por Mycobacterium tuberculosis en estudiantes de la salud: revisión sistemática de la prevalencia

ABSTRACT Objective: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. Methods: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. Results: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. Conclusion: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients.

RESUMO Objetivo: O objetivo deste estudo foi sintetizar as evidências sobre a prevalência de infecção de Mycobacterium tuberculosis (ILTB) entre estudantes de graduação da área da saúde. Método: Foi realizada uma revisão sistemática de prevalência com metanálise. Coortes prospectivas e retrospectivas e estudos transversais envolvendo provável exposição a M. tuberculosis durante a graduação, juntamente com o teste tuberculínico (TT) ou ensaio de liberação de interferon-γ (IGRA) para investigação de tuberculose latente foram pesquisados. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, EMBASE, LILACS, Scopus e Web of Science. Revisores independentes foram responsáveis pela seleção e inclusão dos estudos. Os dados foram extraídos, avaliados criticamente e sintetizados utilizando a abordagem JBI. PRISMA foi usado para relatar o estudo. Resultados: Vinte e dois estudos foram analisados. A prevalência geral em estudantes de graduação da área da saúde foi de 12,53%. Conclusão: A prevalência de ILTB em estudantes de graduação em saúde foi alta para uma população com alto nível de escolaridade. Triagem com TT e/ou IGRA e quimioprofilaxia, quando necessária, deve ser fornecida aos estudantes de graduação da área da saúde quando em contato com pacientes sintomáticos respiratórios.

RESUMEN Objetivo: El objetivo de este estudio fue sintetizar la evidencia sobre la prevalencia de infección latente por Mycobacterium tuberculosis (ILTB) entre estudiantes universitarios de la salud. Métodos: Se realizó una revisión sistemática de la prevalencia con metanálisis. Cohortes prospectivas y retrospectivas y estudios transversales que involucran exposición probable a M tuberculosis durante la educación universitaria, junto con la prueba cutánea de tuberculina (TST) o el ensayo de liberación de interferón-γ (IGRA) para la investigación de tuberculosis latente. Las búsquedas se realizaron en las bases de datos MEDLINE, CINAHL, EMBASE, LILACS, Scopus y Web of Science. Revisores independientes fueron responsables de la selección e inclusión de los estudios. Los datos se extrajeron, se evaluaron críticamente y se sintetizaron utilizando el enfoque JBI. Se utilizó PRISMA para informar el estudio. Resultados: Se analizaron veintidós estudios. La prevalencia global en estudiantes universitarios en salud fue del 12,53%. Conclusión: La prevalencia de LTBI en estudiantes universitarios de salud fue alta para una población con un nivel educativo tan alto. Se debe proporcionar tamizaje con TST y/o IGRA y quimioprofilaxis, cuando sea necesario, a los estudiantes universitarios en salud cuando estén en contacto con pacientes sintomáticos respiratorios.

A percepção dos trabalhadores de enfermagem sobre o atendimento psiquiátrico em um hospital geral / Nursing workers' perception of psychiatric care in a general hospita / Percepciones de los trabajadores de enfermería sobre la atención psiquiátrica en un hospital genera

Objetivo: Analisar a produção do cuidado de enfermagem às pessoas em sofrimento psíquico atendidas em um hospital geral na perspectiva da corresponsabilidade e integralidade. Método:Foi realizado estudo qualitativo, exploratório, por meio da análise documental, observação participante e entrevista semiestruturada com 12 técnicos de enfermagem e 15 enfermeiros do Hospital Municipal de Serrinha-Bahia/Brasil. Os dados foram analisados apartir análise de conteúdo. Resultados:O atendimento psiquiátrico no hospital geral é visto pela maioria da equipe como porta de entrada para o primeiro atendimento, porém demonstram sentir receio, insegurança e despreparo para lidar com estes pacientes,sinalizando a necessidade de educação permanente para elaboração e integração de novos saberes. Considerações finais: Para efetivação do novo modelo de assistência à saúde mental, faz-se necessário a promoção de reflexão direcionada a desconstrução de preconceitos e estigmas previamente estabelecidos. Nesse sentido, torna-se imprescindível a compreensão das novas práticas para o enfrentamento do processo de transição de paradigma, que demanda dos profissionais, a disponibilidade para rever suas próprias percepções e práticas diante dos desafios advindos do processo de aproximação da pessoa em sofrimento psíquico no serviço de saúde.

Objective: To analyze the production of nursing care for people in psychological distress treated in a general hospital from the perspective of co-responsibility and comprehensiveness. Method:A qualitative, exploratory study was carried out using document analysis, participant observation and semi-structured interviews with 12 nursing technicians and 15 nurses from the Municipal Hospital of Serrinha-Bahia/Brazil. The data was analyzed using content analysis. Results:Psychiatric care in the general hospital is seen by most of the team as the gateway to first aid, but they feel afraid, insecure and unprepared to deal with these patients, signaling the need for ongoing education to develop and integrate new knowledge.Final considerations: In order to implement the new mental health care model, it is necessary to promote reflection aimed at deconstructing previously established prejudices and stigmas. In this sense, it is essential to understand the new practices in order to cope with the process of paradigm transition, which requires professionals to be willing to review their own perceptions and practices in the face of the challenges arising from the process of approaching people in psychological distress in the health service.

Objetivo: analizar la producción de cuidados de enfermería a personas en situación de malestar psíquico atendidas en un hospital general desde la perspectiva de la corresponsabilidad y la integralidad. Método:Se realizó un estudio cualitativo y exploratorio mediante análisis de documentos, observación participante y entrevistas semiestructuradas con 12 técnicos de enfermería y 15 enfermeros del Hospital Municipal de Serrinha-Bahia/Brasil. Los datos se analizaron mediante análisis de contenido. Resultados:La atención psiquiátrica en el hospital general es vista por la mayoría del equipo como la puerta de entrada a los primeros auxilios, pero se sienten temerosos, inseguros y poco preparados para tratar con estos pacientes, lo que señala la necesidad de una formación continua para desarrollar e integrar nuevos conocimientos. Consideraciones finales: Para implementar el nuevo modelo de atención en salud mental es necesario promover una reflexión orientada a deconstruir prejuicios y estigmas previamente establecidos. En este sentido, es esencial comprender las nuevas prácticas para hacer frente al cambio de paradigma, lo que requiere que los profesionales estén dispuestos a revisar sus propias percepciones y prácticas frente a los desafíos derivados del proceso de acercamiento a las personas que sufren enfermedades mentales en el servicio de salud.

The Role of Digital Technology and New Strategies in Engagement and Adherence Among Patients With Cardiometabolic Disease

Abstract This article explores challenges and barriers to managing cardiometabolic conditions, highlighting strategies and technologies for improving patient adherence. Approaches such as simplifying prescriptions, patient empowerment, health education, setting short-term goals, understanding social context, self-monitoring, and gamification have been effective in promoting adherence. The use of health apps for chronic diseases has also been increasing, facilitating medication adherence and self-monitoring. Integrating these approaches into clinical practice can lead to consistent outcomes and reduce care-associated costs.

Correlation between sarcopenia, risk of falls and mortality in the elderly - systematic review and meta- analysis of observational studies / Correlação entre sarcopenia, risco de queda e mortalidade em idosos ­ revisão sistemática e metanálise de estudo observacional / Correlación entre sarcopenia, riesgo de caídas y mortalidad en ancianos - revisión sistemática y metanálisis de estudios observacionales

Introduction: Sarcopenia is a progressive and generalized disorder of the skeletal muscles with multifactorial and complex causes. It involves an accelerated loss of skeletal muscle mass and is associated with increased negative outcomes in older adults, such as functional decline, frailty, falls, and death. Objective: to correlate sarco- penia with the risk of falls and mortality in the elderly. Method: A systematic review of the literature was carried out, considering the publication of observational articles as clas- sified for inclusion. The studies considered eligible were the results of searches in the PubMed, Web of Science, EMBASE and LILACS databases. The descriptors were used for searching. The same descriptors in Portuguese and Spanish provided by DECS (health sciences descriptors) were also included. Results: Of the 922 articles selected, 14 were included in the review. The results were similar in most of the articles identified: there is a positive manifestation between sarcopenia, risk of falls (p < 0.0001) and sarcopenia and mortality (p = 0.009) in the elderly population. Conclusion: It is concluded that sarcopenia is a risk factor for falls and increased general mortality in the elderly.

Introdução: A sarcopenia é um distúrbio progressivo e generalizado da musculatura esquelética de causas multifatoriais e complexas. Envolve uma perda acelerada de massa muscular esquelética e está associada ao aumento de desfechos negativos em idosos, como declínio funcional, fragilidade, quedas e morte. Objetivo: correlacionar a sarcopenia com o risco de quedas e mortalidade em idosos. Método: Foi realizada uma revisão sistemática da literatura, considerando a publicação de artigos observacionais como critério de inclusão. Os estudos considerados elegíveis foram resultados das buscas nas bases de dados PubMed, Web of Science, EMBASE e LILACS. Os descritores foram utilizados para busca. Também foram incluídos os mesmos descritores em português e espanhol fornecidos pelo DECS (descritores em ciências da saúde). Resultados: Dos 922 artigos selecionados, 14 foram incluídos na revisão. Os resultados foram semelhantes na maioria os artigos identificados: existe correlação positiva entre sarcopenia, risco de quedas (p < 0,0001) e sarcopenia e mortalidade (p = 0,009) na população idosa. Conclusão: Conclui-se que a sarcopenia é fator de risco para quedas e aumento da mortalidade geral em idosos.

Introducción: La sarcopenia es un trastorno progresivo y generalizado de los músculos esqueléticos con causas multifactoriales y complejas. Implica una pérdida acelerada de masa muscular esquelética y se asocia con mayores resultados negativos en los adultos mayores, como deterioro funcional, fragilidad, caídas y muerte. Objetivo: correlacionar la sarcopenia con el riesgo de caídas y mortalidad en ancianos. Método: Se realizó una revisión sistemática de la literatura, considerando como clasificadas para su inclusión la publicación de artículos observacionales. Los estudios considerados elegibles fueron los resultados de búsquedas en las bases de datos PubMed, Web of Science, EMBASE y LILACS. Los descriptores se utilizaron para la búsqueda. También se incluyeron los mismos descriptores en portugués y español proporcionados por los DECS (descriptores de ciencias de la salud). Resultados: De los 922 artículos seleccionados, 14 fueron incluidos en la revisión. Los resultados fueron similares en la mayoría de los artículos identificados: hay manifestación positiva entre sarcopenia, riesgo de caídas (p < 0,0001) y sarcopenia y mortalidad (p = 0,009) en la población anciana. Conclusión: Se concluye que la sarcopenia es un factor de riesgo de caídas y aumento de la mortalidad general en el adulto mayor.

Perfil Socioeconômico de Pessoas com Câncer de Laringe e Cavidade Oral em Tratamento no Instituto Nacional de Câncer / Socioeconomic Profile of People with Cancer of the Larynx and Oral Cavity Being Treated at National Cancer Institute / Perfil Socioeconómico de las Personas con Cáncer de Laringe y Cavidad Oral en Tratamiento en el Instituto Nacional de Cáncer

Introdução: O câncer é um dos principais problemas de saúde pública do mundo. O câncer de cabeça e pescoço apresenta como principais fatores de risco o tabagismo, o etilismo, entre outros fatores associados ao modelo econômico vigente, explicitando a associação entre desigualdades socioeconômicas e incidência/mortalidade. Objetivo: Conhecer o perfil socioeconômico das pessoas com câncer de laringe e cavidade oral, matriculadas na clínica de cabeça e pescoço do HCI/INCA no período de fevereiro a julho de 2017. Método: O caminho metodológico empregado se divide em dois eixos: revisão de literatura narrativa e definição conceitual de terminologias utilizadas na pesquisa; e questionário aplicado com pessoas adoecidas. Trata-se de uma pesquisa exploratória que visa levantar elementos qualitativos para a construção do perfil socioeconômico. Resultados: Os resultados apresentam o perfil socioeconômico, demonstram a magnitude das condições socioeconômicas e como estas podem impactar no processo de tratamento oncológico. Conclusão: Tais questões são desafiadoras para o trabalho em equipes de saúde, que, diante de situações complexas, precisam desenvolver a interlocução entre diferentes saberes para subsidiar decisões compartilhadas.

Introduction: Cancer is one of the main public health problems in the world. The main risk factors for head and neck cancer are smoking, alcoholism, and others associated with the current economic model, explaining the association between socioeconomic inequalities and incidence/mortality. Objective: To know the socioeconomic profile of people with cancer of the larynx and oral cavity, enrolled in the head and neck clinic at HCI/INCA from February to July 2017. Method: The methodological path used is divided into two axes: the narrative literature review and conceptual definition of terminologies used in the research and the questionnaire applied with sick people. This is an exploratory investigation that aims to raise qualitative elements for the construction of the socioeconomic profile. Results: The results describe the socioeconomic profile, demonstrate the magnitude of socioeconomic conditions and how these can impact the oncology treatment process. Conclusion: These issues are challenging for the work of health teams that, when faced with complex situations, need to develop the dialogue between different types of expertise to support shared decisions.

Introducción: El cáncer es uno de los principales problemas de salud pública en el mundo. El cáncer de cabeza y cuello presenta como principales factores de riesgo el tabaquismo, alcoholismo, entre otros asociados al modelo económico actual, explicando la asociación entre desigualdades socioeconómicas e incidencia/mortalidad. Objetivo: Conocer el perfil socioeconómico de las personas con cáncer de laringe y cavidad oral, inscritas en la clínica de cabeza y cuello del HCI/INCA de febrero a julio de 2017. Método: La ruta metodológica utilizada se divide en dos ejes: la revisión bibliográfica narrativa y definición conceptual de terminologías utilizadas en la investigación y el cuestionario aplicado a las personas enfermas. Se trata de una investigación exploratoria que pretende levantar elementos cualitativos para la construcción del perfil socioeconómico. Resultados: Los resultados presentan el perfil socioeconómico, demuestran la magnitud de las condiciones socioeconómicas y cómo estas pueden impactar en el proceso de tratamiento del cáncer. Conclusión: Tales cuestiones son desafiantes para el trabajo de los equipos de salud que frente a cuestiones complejas necesitan desarrollar la interlocución entre diferentes conocimientos para subvencionar las decisiones compartidas

Predominantly antibody deficiency: case report / Deficiência predominantemente de anticorpos: relato de caso

Abstract Objectives: present a case of Inborn errors of immunity (IEI) as a potential diagnosis in pediatric patients with recurrent infections. Description: male patient, 13 years old, since he was eight months old had recurrent diarrhea, sinusitis, otitis, abscesses and urinary tract infections. At the age of ten, he presented mastoiditis progressing to meningitis, he was admitted to a tertiary hospital, where an immunological evaluation was performed, which led to the diagnosis of Predominantly Antibody Deficiency (PAD), with suspected X-linked Agammaglobulinemia (XLA). Treatment was initiated with administration of intravenous gamma globulin 400 mg/kg every four weeks, with a significant improvement of the condition. Discussion: usually, the diagnosis of XLA tends to be made in the first three years of life. However, in this report, although the first manifestations started at eight months of age, there was a delay of ten years before starting the treatment. In fact, the diagnosis of children and adults with IEI can be delayed if healthcare professionals are unable to find the true cause of recurrent infections. Therefore, the relevance of considering such pathologies in the presence of risk signs is highlighted, as early diagnosis being essential in treating and preventing morbidities.

Resumo Objetivos: apresentar um caso de Erro Inato da Imunidade (EII) como diagnóstico em potencial de pacientes pediátricos com infecções de repetição. Descrição: paciente masculino, 13 anos, desde os oito meses de idade apresentou quadros repetidos de diarreias, sinusites, otites, abscessos e infecções do trato urinário; destacando-se a otite, sinusite e diarreia pela maior recorrência. Aos dez anos, quando apresentou mastoidite evoluindo para meningite, foi internado em um hospital terciário, onde foi realizada avaliação imunológica, a qual levou ao diagnóstico de Deficiência Predominantemente de Anticorpos (DPAs), tendo como suspeita a agamaglobulinemia ligada ao cromossomo X (ALX). Foi iniciado tratamento com administração de gamaglobulina endovenosa 400 mg/kg a cada quatro semanas, ocorrendo melhora significativa do quadro. Discussão: normalmente, o diagnóstico da ALX tende a ser feito nos primeiros três anos de vida. Neste relato, entretanto, embora as primeiras manifestações tenham iniciado aos oito meses de idade, ocorreu um atraso de dez anos até o início do tratamento. De fato, o diagnóstico de crianças e adultos com EII pode ser retardado se os profissionais de saúde não conseguirem encontrar a causa das infecções recorrentes. Destaca-se, portanto, a relevância de se considerar tais patologias na vigência de sinais de riscos, pois o diagnóstico precoce é fundamental para tratar e prevenir morbidades.

HPV vaccination in Latin America: Coverage status, implementation challenges and strategies to overcome it.

Cervical cancer remains a leading cause of morbidity and mortality amongst females in Latin America (LATAM). Cervical cancer is a preventable disease and HPV vaccination is a main key strategy towards its elimination. This study analyzes HPV vaccine implementation current status and the main barriers to achieve adequate coverage in the region. Data from the nineteen sovereign states of LATAM (comprised of all Portuguese and Spanish-speaking nations located south of the United States) were collected, including year of HPV vaccine implementation, gender and age targets, the number of doses included in the public program and coverage by dose. Sixteen out of the 19 evaluated countries have already implemented HPV vaccination programs. However, despite its proven efficacy and safety, HPV vaccine uptake in LATAM has been lower than expected. There is an evident decline in adhesion, mainly regarding the second dose. Several reasons are probably involved, of note: limited knowledge of HPV and HPV vaccine, misguided safety concerns, high cost, cultural barriers, and the Covid19 pandemic. Proper strategies to overcome these barriers are needed to ensure successful uptake. Effective policies are: adopting the one dose schedule, delivering the vaccine on both health center and schools, and advising health professionals to recommend the vaccine. Further research regarding HPV vaccine hesitancy in Latin America is needed.

Biogenic metallic nanoparticles (Ag, TiO2, Fe) as potential fungicides for agriculture: are they safe for the freshwater mussel Anodontites trapesialis?

Silver (Ag), titanium dioxide (TiO2), and iron (Fe) nanoparticles (NPs) synthesized using the fungus Trichoderma harzianum are effective against the agriculture pathogen Sclerotinia sclerotiorum. However, their effects should be evaluated in aquatic organisms, as agriculture practices can contaminate the aquatic environment. Thus, this work evaluated sublethal effects of acute exposure (24 h) to AgNP, TiO2NP and FeNP, synthesized with T. harzianum, on the Neotropical freshwater bivalve Anodontites trapesialis, considering the hypothesis that suspension-feeding bivalves are susceptible to NPs toxicity. Individuals of A. trapesialis were divided into four groups (n = 8/group): a control group, kept in water only; a group exposed to AgNP; a group exposed to TiO2NP; and a group exposed to FeNP. The bioaccumulation of Ag, Ti, and Fe was evaluated in the gills, hemolymph, mantle, digestive gland, and muscle (foot). Lipoperoxidation, activities of the glutathione S-transferase, catalase, and superoxide dismutase, and glycogen concentration were quantified in the gills, mantle, and digestive gland. Ions (Na+, K+, Cl-, Ca2+, and Mg+2) and glucose concentrations were quantified in the hemolymph. Na+/K+-ATPase, H+-ATPase, Ca2+-ATPase, and carbonic anhydrase activities were assessed in the gills and mantle. Acetylcholinesterase activity was determined in the foot and adductor muscle. The mussels exposed to AgNP accumulated Ag in the gills, hemolymph, and foot, and showed a decrease in hemolymph concentrations of Na+ and Cl-, which was associated with the action of Ag ion (Ag+). The exposures to TiO2NP and FeNP led to the accumulation of Ti and Fe in the hemolymph, respectively, but did not promote additional effects. Accordingly, A. trapesialis showed bioaccumulation potential and susceptibility to AgNP, but was not susceptible to TiO2NP and FeNP. Thus, the preferential agricultural use of TiO2NP and FeNP over AgNP is highlighted.

Clinical, radiographic, and genetic observations in 2 families with cleidocranial dysplasia.

The clinical, radiographic, and molecular alterations in 7 individuals belonging to 2 families with clinical characteristics of cleidocranial dysplasia (CCD) were investigated. The patients underwent karyotype and genetic sequencing examinations. Cytogenetic analysis did not demonstrate any alterations. The next-generation sequencing technique employed for the molecular analysis revealed sequence variations in the RUNX2 gene: c.568C>T (p.Arg190Trp) in exon 4 in family A and c.1205del (p.Pro402Argfs*82) in exon 9 in family B. Incomplete closure of anterior fontanels, hypoplastic clavicles, and dental changes were observed in all 7 patients. Uncommon clinical findings, such as partial hearing loss and bilateral clavicular agenesis, were noted in some patients. According to the literature consulted, this is the first time that the total absence of the pubic bone in a study subject is being reported. The variable expression among individuals of the same family and between families A and B suggests the absence of a genotype-phenotype relationship. Early diagnosis allows the dentist to minimize the effects of changes associated with CCD by monitoring and providing appropriate treatment, and the identification of genetic sequence variations enables appropriate family genetic counseling.

Effects of biogenic silver and iron nanoparticles on soybean seedlings (Glycine max).

BACKGROUND: Biogenic metallic nanoparticles have been emerging as a promising alternative for the control of phytopathogens and as nanofertilizers. In this way, it is essential to investigate the possible impacts of these new nanomaterials on plants. In this study, the effects of soil contamination with biogenic silver (AgNPs) and iron (FeNPs) with known antifungal potential were investigated on morphological, physiological and biochemical parameters of soybean seedlings. RESULTS: The exposure of plants/seedlings to AgNPs induced the reduction of root dry weight followed by oxidative stress in this organ, however, adaptive responses such as a decrease in stomatal conductance without impacts on photosynthesis and an increase in intrinsic water use efficiency were also observed. The seedlings exposed to FeNPs had shown an increase in the levels of oxygen peroxide in the leaves not accompanied by lipid peroxidation, and an increase in the expression of POD2 and POD7 genes, indicating a defense mechanism by root lignification. CONCLUSION: Our results demonstrated that different metal biogenic nanoparticles cause different effects on soybean seedlings and these findings highlight the importance of investigating possible phytotoxic effects of these nanomaterials for the control of phytopathogens or as nanofertilizers.

Hyperacute transplantation of umbilical cord mesenchymal stromal cells in a model of severe intracerebral hemorrhage.

Aim: Intracerebral hemorrhage (ICH) has limited therapeutic options. We have shown that an intravenous injection of human umbilical cord-derived mesenchymal stromal cells (hUC-MSC) 24 h after an ICH in rats reduced the residual hematoma volume after a moderate hemorrhage but was inefficient in severe ICH. Here, we investigated whether a treatment in the hyperacute phase would be more effective in severe ICH. Materials & methods: Wistar rats were randomly selected to receive an intravenous injection of hUC-MSC or the vehicle 1 h after a severe ICH. Results: The hyperacute treatment with hUC-MSC did not affect the 22-day survival rate, the motor function or the residual hematoma volume. Conclusion: These results indicate the need for optimization of hUC-MSC-based therapies for severe ICH.

Using Chitosan-Coated Polymeric Nanoparticles-Thermosensitive Hydrogels in association with Limonene as Skin Drug Delivery Strategy.

Topical delivery of local anesthetics (LAs) is commonly used to decrease painful sensations, block pain throughout procedures, and alleviate pain after surgery. Dermal and/or transdermal delivery of LAs has other advantages, such as sustained drug delivery and decreased systemic adverse effects. This study reports the development of poly(D,L-lactide-co-glycolide) (PLGA) nanoparticles coated with chitosan for the sustained release and topicality of benzocaine (BZC) and topical delivery. BZC PLGA nanoparticles or nonencapsulated drugs were further incorporated into Poloxamer hydrogels (Pluronic™ F-127). The nanoparticles showed a mean diameter of 380 ± 4 nm, positive zeta potential after coating with chitosan (23.3 ± 1.7 mV), and high encapsulation efficiency (96.7 ± 0.02%). Cellular viability greater than 70% for both fibroblasts and keratinocytes was observed after treatment with nanoparticles, which is in accordance with the preconized guidelines for biomedical devices and delivery systems. Both the nanoparticles and hydrogels were able to modulate BZC delivery and increase drug permeation when compared to the nonencapsulated drug. Furthermore, the incorporation of limonene into hydrogels containing BZC-loaded nanoparticles increased the BZC permeation rates. Non-Newtonian and pseudoplastic behaviors were observed for all hydrogel nanoformulations with or without nanoparticles. These results demonstrate that the hydrogel-nanoparticle hybrids could be a promising delivery system for prolonged local anesthetic therapy.

Eosinophil plays a crucial role in intestinal mucositis induced by antineoplastic chemotherapy.

Mucositis is a major clinical complication associated with cancer treatment and may limit the benefit of chemotherapy. Leukocytes and inflammatory mediators have been extensively associated with mucositis severity. However, the role of eosinophils in the pathophysiology of chemotherapy-induced mucositis remains to be elucidated. Here, using GATA-1-deficient mice, we investigated the role of eosinophils in intestinal mucositis. There was marked accumulation of eosinophils in mice given irinotecan and eosinophil ablation inhibited intestinal mucositis. Treatment with Evasin-4, a chemokine receptor antagonist, reduced the recruitment of eosinophils and decreased irinotecan-induced mucositis. Importantly, Evasin-4 did not interfere negatively with the antitumour effects of irinotecan. Evasin-4 was of benefit for mice given high doses of irinotecan once Evasin-4-treated mice presented delayed mortality. Altogether, our findings suggest that Evasin-4 may have significant mucosal-protective effects in the context of antineoplastic chemotherapy and may, therefore, be useful in combination with anticancer treatment in cancer patients.

Uso de serviços de saúde bucal entre idosos brasileiros: mediação pela perda dentária / Use of oral health services among elderly Brazilians: mediation by tooth loss

Resumo Analisaram-se fatores associados ao uso de serviços de saúde bucal (USSB) entre idosos brasileiros. Estudo transversal, que considerou a amostra de 7.619 idosos (65-74 anos) do SB Brasil 2010. Utilizou-se modelagem com equações estruturais (MEE), investigando associação entre variáveis latentes ou observadas, de forma direta ou mediada, em relação ao USSB. Utilizaram-se estimadores de mínimos quadrados ajustados pela média e variância, por meio de coeficientes padronizados, erro padrão e intervalos de confiança, com o método bootstrapping com 1.500 iterações. Idosos com melhor condição socioeconômica, menor número de dentes perdidos e presença de impactos das condições de saúde bucal em sua vida foram associados de forma direta ao desfecho. Ainda estiveram associados ao USSB de forma mediada, a condição socioeconômica, sexo e idade; bem como o uso de próteses; além de se encontrar correlação entre uso de próteses e dentes perdidos. A perda dentária exerceu papel de destaque, apontando para a necessidade de ampliação do acesso às próteses dentárias na atenção básica.

Abstract The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Anafilaxia a alfa-gal: um relato de caso paraibano / Alpha-gal anaphylaxis: a case report from Paraíba, Brazil

O presente relato apresenta um caso de anafilaxia tardia ao carboidrato alfa-gal em um adolescente da cidade de Belém, na Paraíba, Brasil. O paciente desenvolveu reação tardia à ingesta de carne e vísceras de animais. Ele mora em fazenda e tem contato próximo com animais potencialmente contaminados por carrapatos. Essa causa de reação alérgica é nova, e estudos começaram a atribuí-la a casos antes ditos idiopáticos. A anafilaxia é uma reação potencialmente fatal, que deve ser prontamente diagnosticada e tratada. Sendo assim, a descoberta de seu fator desencadeante é um dos principais itens que direcionam o tratamento. No Brasil, nenhum caso de anafilaxia por alfa-gal foi antes descrito na literatura local.

This report presents a case of late anaphylaxis to alpha-gal carbohydrate in a teenager living in the city of Belém, Paraíba, Brazil. The patient developed a late reaction to eating meat and offal of animals; he lives on a farm and has close contact with animals potentially contaminated by ticks. This cause of allergic reaction is new, and studies have started to attribute it to cases previously said to be idiopathic. Anaphylaxis is a potentially fatal reaction that must be promptly diagnosed and treated. Thus, the discovery of its triggering factor is one of the main items that guide treatment. In Brazil, no case of alpha-gal anaphylaxis had been described in the local literature.

Zein based-nanoparticles loaded botanical pesticides in pest control: An enzyme stimuli-responsive approach aiming sustainable agriculture.

Nanoencapsulation of biopesticides is an important strategy to increase the efficiency of these compounds, reducing losses and adverse effects on non-target organisms. This study describes the preparation and characterisation of zein nanoparticles containing the botanical compounds limonene and carvacrol, responsive to proteolytic enzymes present in the insects guts. The spherical nanoparticles, prepared by the anti-solvent precipitation method, presented in the nanoparticle tracking analysis (NTA) a concentration of 4.7 × 1012 ± 1.3 × 1011 particles.mL-1 and an average size of 125 ± 2 nm. The formulations showed stability over time, in addition to not being phytotoxic to Phaseolus vulgaris plants. In vivo tests demonstrated that formulations of zein nanoparticles containing botanical compounds showed higher mortality to Spodoptera frugiperda larvae. In addition, the FTIC probe (fluorescein isothiocyanate) showed wide distribution in the larvae midgut, as well as being identified in the feces. The trypsin enzyme, as well as the enzymatic extract from insects midgut, was effective in the degradation of nanoparticles containing the mixture of botanical compounds, significantly reducing the concentration of nanoparticles and the changes in size distribution. The zein degradation was confirmed by the disappearance of the protein band in the electrophoresis gel, by the formation of the lower molecular weight fragments and also by the greater release of FTIC after enzymes incubation. In this context, the synthesis of responsive nanoparticles has great potential for application in pest management, increasing the selectivity and specificity of the system and contributing to a more sustainable agriculture.

Efficacy of exercise on balance, fear of falling, and risk of falls in patients with diabetic peripheral neuropathy: a systematic review and meta-analysis

ABSTRACT Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Our objective was to evaluate the efficacy of exercise interventions in DPN patients from randomized controlled trials. The primary outcomes were the risk of falls, fear of falling, balance and quality of life. Two reviewers independently selected studies from Embase, Medline, LILACS, CENTRAL, and PEDro. They assessed the risk of bias and extracted data from the trials. The relative risk (RR) and the differences between means (MD) were calculated with a 95% confidence interval (CI) and used as the effect size. We used a random-effects model to pool results across studies, and the Grading of Recommendations Assessment, Development, and Evaluation system to evaluate the certainty of evidence. Eight trials were included. No clear effect was observed in the risk of falls (RR: 0.93, 95% CI: 0.41 to 2.09, 79 participants, 1 trial, low-certainty evidence). Regarding fear of falling, using the Falls Efficacy Scale, a small difference in favor of the intervention was observed (MD: −2.42, 95%, CI: −4.7 to −0.15, 3 trials, 185 participants, low-certainty evidence). The meta-analysis of balance using the unipedal stance test showed a small difference in favor of the intervention. One study evaluated quality of life, and in the mental score there was a MD in favor of the intervention. In DPN patients, a combination of gait, balance, and functional training improved balance, the fear of falling, quality of life in the mental score, but not the risk of falls.