Digoxin attenuates bisphosphonate related osteonecrosis of the jaws by RORγt-dependent Th17 response in male rats.

OBJECTIVE: The study aimed to evaluate digoxin, an RORγt inhibitor, in Medication-Related Osteonecrosis of the Jaws (MRONJ) in male rats treated with zoledronic acid (ZA). STUDY DESIGN: Forty male Wistar rats were divided into a negative control group (0.1 mL/kg saline), a positive control group (ZA, 0.20 mg/kg), and three test groups treated with ZA and digoxin at 1 (DG1), 2 (DG2), or 4 (DG4) mg/kg. These groups received treatment three times weekly. ZA was administered intravenously on days 0, 7, and 14, followed by extraction of the left lower first molar on day 42, a final ZA dose on day 49, and euthanasia on day 70. Analyses included radiographic, histomorphometric, and immunohistochemical evaluation of the mandibles, western blotting of gingiva, and mechanical tests on femurs. Statistical analysis was performed using ANOVA/Bonferroni tests (P < .05). RESULTS: Digoxin reduced radiolucency of MRONJ (P < .001), inflammatory cells, empty osteocyte lacunae (P < .001), apoptotic osteoclasts (P < .001), and Caspase-3-positive osteocytes (P = .021). ZA increased immunoreactivity for most markers except c-Fos, while digoxin reduced interleukin 17, TNF-α, IL-6, IL-2, FOXP3, c-Jun, NFκB (P < .001), TGF-ß (P = .009), RANKL (P = .035), and OPG (P = .034). Digoxin also reversed RORγt expression (P < .001), increased diarrhea scores (P = .028), renal and cardiac indexes (P < .001), and enhanced femur mechanical properties (P < .013). CONCLUSIONS: Digoxin attenuated MRONJ by inhibiting RORγt and reducing the Th17 response.

Assessment of pathological response of breast cancer in patients undergoing neoadjuvant chemotherapy in a refferal hospital in Amazonas State

Introduction: The therapeutic options for breast cancer are diverse. Increasingly, treatments are established on an individual basis, depending on a series of variables ranging from age to the molecular profile of the tumor. When neoadjuvant chemotherapy (NAC) is necessary, adequate clinical evaluation (CE) and control examinations, such as breast ultrasound (US) and mammography (MMG), are of fundamental importance, as it is necessary to reevaluate the tumor lesion to determine an individualized surgical treatment, with the aim of performing breast-conserving surgery within the available techniques. This study sought to evaluate the pathological response of patients undergoing neoadjuvant chemotherapy, analyzing the presence or absence of tumor reduction by relating the physical examination with imaging methods (MMG and US), taking the anatomopathological examination measurements as the gold standard, thus intending to identify the best method for evaluating the pathological response. Methods: This was a prospective, observational, analytical cohort study. The study included 41 patients diagnosed with breast cancer detected by mammography and ultrasound (MMG and US) followed by biopsy, who underwent neoadjuvant chemotherapy (NAC) and surgery. The measurements of the malignant breast lesions obtained by CE, MMG and US were compared with the anatomopathological measurements on biopsy as the gold standard. Results: Pearson's correlation coefficient was the statistical method used for evaluation, finding a value of 0.49 between the anatomopathological examination and CE, 0.47 between the anatomopathological examination and MMG and 0.48 between the anatomopathological examination and US (p<0.05). Conclusions: CE, MMG and US showed a moderate correlation with anatomopathological measurement, in addition to a moderate correlation between them, demonstrating equivalence in the pre-surgical definition of the size of the breast tumor after NAC, being complementary to each other to define a measure of greater accuracy of the tumor in breast cancer. (AU)

Gastos do próprio bolso de usuários em hemodiálise no sul do Rio Grande do Sul / Gastos de bolsillo de usuarios de hemodiálisis en el sur de Rio Grande do Sul / Out-of-pocket expenses of hemodialysis users in the south of Rio Grande do Sul

Objetivo: relatar os gastos do próprio bolso das pessoas com doença renal crônica em hemodiálise em seis serviços de terapia de substituição renal da metade sul do Rio Grande do Sul, Brasil. Método: estudo descritivo quantitativo, originado de uma macropesquisa, realizado com usuários em hemodiálise, atendidos em seis serviços de terapia renal substitutiva da metade sul do Rio Grande do Sul. As variáveis coletadas do questionário estruturado tiverama finalidade de identificar os gastos do próprio bolso dos usuários. Os dados foram analisados utilizando os softwares Epidata e Stata. Resultados: a maioria dos 336 usuários era sexo masculino, entre 60 e79 anos, com salários-mínimos entre um e dois. Os maiores gastos do próprio bolso encontrados foram o pagamento pelos medicamentos necessários para o tratamento. Conclusões: mesmo com benefícios do sistema de saúde e políticas necessitavam recorrer aos próprios recursos para garantir saúde e uma vida digna.

Objective: to report the out-of-pocket expenses of people with chronic kidney disease undergoing hemodialysis in six renal replacement therapy services in the southern half of Rio Grande do Sul, Brazil. Method: quantitative descriptive studycarried out with hemodialysis users, served in six replacement renal therapy services from the southern half of Rio Grande do Sul. The variables collected from the structured questionnaire had the purpose of identifying the spending of users' own pockets. The data were analyzed using Epidata and Stata software.Results: the majority of the 336 users were male, between 60 and 79 years old, with minimum wages between one and two. The biggest out-of-pocket expenses found were paying for the medicines needed for treatment. Conclusions: even with benefits from the health system and policies, they needed to resort to their own resources to guarantee health and a dignified life.

Objetivo: reportar gastos de bolsillo de personas con enfermedad renal crónica en tratamiento de hemodiálisis en seis servicios de terapia de reemplazo renal en la mitad sur de Rio Grande do Sul, Brasil. Método: estudio descriptivo cuantitativo, originado a partir de una macroinvestigación, realizada con usuarios de hemodiálisis, atendidos en seis servicios de terapia renal de reemplazo. Las variables recolectadas del cuestionario estructurado tenían el propósito de identificarel gasto de los usuarios. Los datos se analizaron utilizando el software Epidata y Stata. Resultados: la mayoría de los 336 usuarios eran hombres, entre 60 y 79 años, con salarios mínimos entre uno y dos. Los mayores gastos de bolsillo encontrados fueron el pago de los medicamentos necesarios para el tratamiento. Conclusiones: incluso con beneficios del sistema y las políticas de salud, necesitaban recurrir a recursos propios para garantizar la salud y una vida digna.

In Vitro Evaluation of Antioxidant and Anticancer Activity of Lemongrass (Cymbopogon citratus (D.C.) Stapf).

Cancer is considered a multifactorial disease and its development could be associated with several factors, for example, rotenone exposition. Unfortunately, many cancers are resistant to chemotherapy, as cervical cancer. Regarding this, lemongrass is a remarkable natural product that presents antioxidant and anticancer activities, which could show therapeutic action against rotenone and cervical cancer. Thus, this study aimed to investigate the antioxidant and anticancer action of lemongrass. An in vitro study was conducted using VERO (kidney cells) and SiHa cell lines (cervical cancer cells). VERO cells were exposed to rotenone and lemongrass extract for 24 and 72 h. While SiHa cells were exposed to lemongrass isolated and associated to chemotherapy, 5-fluorouracil, during 24 and 48 h. After, levels of viability, proliferation, and oxidative metabolism were determined. The results showed that lemongrass presents antioxidant activity on VERO cells by increasing cell viability and proliferation and decreasing oxidative stress caused by rotenone. Moreover, lemongrass showed anticancer activity by decreasing cell viability and increasing oxidative stress parameters on SiHa. Besides, lemongrass had no alteration in the chemotherapy activity. Therefore, this study revealed that lemongrass presents antioxidant and anticancer activity since it can protect against the cytotoxicity of rotenone and reduce the cell viability of cervical cancer.

Climatério e Terapia de Reposição Hormonal por mulheres em um município do Sul de Santa Catarina / Climacteric and Hormone Replacement Therapy for women in a city in southern Santa Catarina

RESUMO Introdução: O climatério corresponde ao período de transição entre a etapa reprodutiva e a não reprodutiva, onde há a menopausa caracterizada pela ausência de menstruação por 12 meses consecutivos, resultante da perda da atividade folicular ovariana. A Terapia de Reposição Hormonal (TRH) pode ser uma opção de tratamento com o intuito de melhorar as condições de saúde da mulher. O objetivo, deste estudo, foi investigar o perfil de idosas e sintomas climatéricos, além da utilização da TRH por mulheres em uma cidade do Sul de Santa Catarina. Métodos: Estudo epidemiológico com delineamento transversal quantitativo utilizando-se questionário para coleta de dados que ocorreu entre julho a setembro de 2017 e analisados no EpiInfo®. Resultados: Foram entrevistadas 107 idosas, média de idade 69,7 (± 8,9) anos. Das entrevistadas, 52,3% relataram algum sintoma climatérico, sendo mais frequente o fogacho. Pequena parcela das entrevistadas fez uso de TRH (15,9%), obtendo-se benefícios com a utilização. Destas, maioria foi administração via oral (88,2%), sendo que 35,3% usaram por mais de cinco anos, 82,4% relataram alguma reação adversa, sendo citada a mastalgia e o ganho de peso, e 64,7% realizavam consulta médica semestral. Somente 8,4% fizeram uso de chás, sendo a Amora Branca (Morus alba L) a mais citada. Conclusões: O esquema de TRH prescrito mais frequente foi a associação de estrógenos e progestógenos para administração por via oral, com acompanhamento médico semestral e obtendo-se resultados favoráveis. Medidas não farmacológicas foram adotadas por minoria das mulheres, adotando-se essencialmente o uso de planta medicinal na forma de chá. PALAVRA-CHAVE: Climatério, menopausa, terapia de reposição hormonal, saúde da mulher

ABSTRACT Introduction: The climacteric corresponds to the transition period between the reproductive and non-reproductive stages, where there is the menopause, characterized by the absence of menstruation for 12 consecutive months, resulting from the loss of ovarian follicular activity. Hormone Replacement Therapy (HRT) can be a treatment option with the aim of improving women's health conditions. The aim of this study was to investigate the profile of elderly women and climacteric symptoms, as well as the use of HRT by women in a city in southern Santa Catarina. Methods: Epidemiological study with a quantitative cross-sectional design using a questionnaire for data collection that was answered between July and September 2017 and analyzed in EpiInfo®. Results: 107 elderly women were interviewed, mean age 69.7 (± 8.9) years. Of the interviewees, 52.3% reported some climacteric symptom, with hot flashes being more frequent. A small portion of the interviewees used HRT (15.9%), obtaining benefits from its use. Of these, most were administered orally (88.2%), and 35.3% used it for more than five years, 82.4% reported some adverse reaction, mentioning breast tenderness and weight gain, and 64.7% had medical consultations every six months. Only 8.4% made use of teas, with the white blackberry (Morus alba L) being the most mentioned. Conclusions: The most frequent prescribed HRT regimen was the combination of estrogens and progestins for oral administration, with medical follow-up every six months and obtaining favorable results. Non-pharmacological measures were adopted by a minority of women, essentially adopting the use of medicinal plants in the form of tea. KEYWORDS: Climacteric, menopause, hormone replacement therapy, women's health

Ostomía intestinal: dificultades y estrategias de cuidado tras el alta hospitalaria / Estomia intestinal: adversidades e estratégias de cuidado após alta hospitalar / Intestinal ostomy: Adversities and care strategies after hospital discharge

Objective: To describe the difficulties and advantages encountered by people after undergoing an intestinal ostomy and being discharged from hospital services. Materials and methods:Qualitative, descriptive, and exploratory study conducted at a teaching hospital. The study included people with an intestinal ostomy who were discharged within 60 days from the beginning of data collection, which occurred from March and June 2018. Data collection involved a semi-structured interview and thematic content analysis, resulting in thematic categories. Results: A total of 11 people partic-ipated in the study. Factors such as the delay in defining the diagnosis, difficulties in the continuity of care at home, misinformation, and fear were identified as adversities by participants. Care actions were related to the existence of a support network and hope for the reconstruction of intestinal transit. Conclusions:The care of people with intestinal ostomy requires planning hospital discharge, health education, strengthening care strategies that involve social support, and the involvement of health professionals for the continuity of health care at home.

Objetivo: describir las dificulta-des y ventajas en el cuidado identificadas por personas con ostomía intestinal tras el alta hospitalaria. Materiales y métodos: estudio cualitativo, descriptivo y exploratorio desarrollado en un hospital universitario. La muestra estuvo compuesta por personas con ostomía intestinal que fueron dadas de alta hasta 60 días antes del inicio de la recolección de datos, lo cual ocurrió entre marzo y junio de 2018. La recolección de datos se realizó por medio de una entrevista semiestructurada y análisis de contenido, lo que dio lugar a la formulación de categorías temáticas. Resultados: el estudio contó con la participación de 11 personas, quienes identificaron a modo de dificultades aspectos como un diagnóstico tardío, limitaciones para dar continuidad a los cuidados en casa, desinformación y miedo. Las estrategias de cuidados se relacionaron con la existencia de redes de apoyo y la esperanza de recuperar el tránsito intestinal. Conclusiones: el cuidado de personas con ostomía intestinal requiere planeación para el alta hospitalaria, educación en salud, fortalecimiento de las estrategias de cuidado que involucran redes de apoyo social y la activa participación de los profesionales de salud, con lo cual será posible dar continuidad a las prácticas de cuidado desde casa.

Objetivo: descrever as adversidades vivenciadas e as estratégias de cuidado identificadas por pessoas com estomia intestinal após alta hospitalar. Materiais e métodos:estudo qualitativo, descritivo-exploratório, realizado em um hospital de ensino. Foram incluídas pessoas com estomia intestinal, que tiveram alta hospitalar em um período de até 60 dias a partir do início da coleta dos dados, que ocorreu de março a junho de 2018. Foi utilizada entrevista semies-truturada e a análise foi de conteúdo, resultando em categorias temáticas.Resultados:o estudo contou com a participação de 11 pessoas, que identificaram como adversidades a demora na definição do diagnóstico, as dificuldades na continuidade dos cuidados no domicílio, a desinformação e o medo. As estratégias de cuidado se relacionaram à existência de rede de apoio e da esperança pela reconstrução do trânsito intestinal. Conclusões: o cuidado às pessoas com estomia intestinal requer o planejamento para alta hospitalar, educação em saúde, fortalecimento de estratégias de cuidado que envolvem suporte social e envolvimento dos profissionais de saúde para continuar o cuidado no domicílio.

Antioxidant and cytoprotective effects of avocado oil and extract (Persea americana Mill) against rotenone using monkey kidney epithelial cells (Vero).

Oxidative stress is known to be involved in development of numerous diseases including cardiovascular, respiratory, renal, kidney and cancer. Thus, investigations that mimic oxidative stress in vitro may play an important role to find new strategies to control oxidative stress and subsequent consequences are important. Rotenone, widely used as a pesticide has been used as a model to simulate oxidative stress. However, this chemical was found to produce several diseases. Therefore, the aim of this study was to investigate the antioxidant and cytoprotective effect of avocado (Persea americana Mill) extract and oil in monkey kidney epithelial cells (VERO) exposed to rotenone. VERO cells were exposed to IC50 of rotenone in conjunction with different concentrations of avocado extract and oil (ranging from 1 to 1000 µg/ml), for 24 hr. Subsequently, cell viability and oxidative metabolism were assessed. Data demonstrated that avocado extract and oil in the presence of rotenone increased cellular viability at all tested concentrations compared to cells exposed only to rotenone. In addition, extract and avocado oil exhibited antioxidant action as evidenced by decreased levels of reactive oxygen species (ROS), superoxide ion, and lipid peroxidation, generated by rotenone. Further, avocado extract and oil appeared to be safe, since these compounds did not affect cell viability and or generate oxidative stress. Therefore, avocado appears to display a promising antioxidant potential by decreasing oxidative stress.

Proton Pump Inhibitors and Oncologic Treatment Efficacy: A Practical Review of the Literature for Oncologists.

Proton pump inhibitors (PPIs) are the most commonly used anti-acid drugs worldwide, including among cancer patients. However, drug-drug interactions between PPIs and other agents may lead to decreased drug absorption with possible reduced therapeutic benefit, or even increased toxicity. Unfortunately, only scarce data exist regarding the safety of concomitant PPI use with anti-cancer agents. We aim at reviewing current evidence on this possible interaction by dividing anti-cancer agents by class. Until further data is available, we encourage healthcare providers to limit unnecessary PPI overuse.

Lemongrass (Cymbopogon citratus (D.C.) Stapf) Presents Antitumoral Effect and Improves Chemotherapy Activity in Prostate Cancer Cells.

BACKGROUND: Prostate cancer is the most common visceral neoplasia in men and frequently presents chemotherapy resistance. In this context, lemongrass (Cymbopogon citratus (D.C.) Stapf) has been studied since it presents many important biological activities, such as anticancer. OBJECTIVE: We investigated the antitumor effect of lemongrass and in chemotherapy activity using prostate cancer cells line (DU-145). METHODS: DU-145 cells were exposed to different concentrations of aqueous extract of lemongrass (30; 100; 300; 500 and 1000 µg/mL), isolated and in combination with docetaxel, during 24 and 72 hours. After, cell viability and proliferation, oxidative metabolism, colony formation and cell cycle analyses were performed. Also, we exposed the African green monkey kidney cell line (VERO) to the same lemongrass concentrations to investigate a possible toxicity of this extract. RESULTS: Our findings suggested that lemongrass presented an antitumor effect and improved docetaxel chemotherapy activity by decreasing cell viability and proliferation as well as colony formation. Moreover, we found an oxidative stress increased and cell cycle arresting in G0 /G1 phase. In addition, this extract presented selectivity action for cancer cells, since it did not cause cytotoxicity in normal cells, ensuring non-toxic therapeutic concentrations. CONCLUSION: Lemongrass is a promising medicinal plant that could be used during chemotherapeutic treatment, in order to potentiate the antitumor response and decrease the resistance of prostate cancer.

Distance education in dentistry in Brazil: a critical STROBE-based analysis

Abstract The COVID-19 pandemic has forced dentistry schools (DSs) to adapt their teaching techniques to digital platforms. Therefore, we aimed to evaluate distance classes in the Brazilian DS curriculum. After an online search of higher education institutions (HEIs) with DS on the e-Ministry of Education (MEC) platform, we included institutions with at least one graduated class to extract the age/localization of the DS, funding, number of authorized seats, MEC-grade, ENADE-score, and workload. HEIs' webpages were consulted to identify the curriculum, subjects offered in the distance education (DE) format, extracurricular programs, scientific events, postgraduate programs, and institutional YouTube channels. Chi-square/Fisher's tests plus binary logistic regression were performed (SPSS 20.0, p < 0.05). Of the 241 DSs evaluated, 82 (34.0%) offered distance classes, and a high prevalence was observed in the southeast region (p <0.001) and private HEIs (p = 0.001). HEIs with distance classes had lower ENADE scores (p = 0.004), lower workload (p = 0.007), and higher workload for optional subjects (p = 0.016), doctoral programs (p = 0.041), specialization courses (p = 0.017), and institutional YouTube channels (p < 0.001). Southern dental schools (p < 0.001), lower workload (p = 0.022), optional subjects (p = 0.033), and institutional YouTube channels (p = 0.005) were independently associated with distance classes. In one-third of the Brazilian DSs, distance classes and institutional YouTube channels were strongly associated variables. The association of distance learning with lower workload and low academic performance draws attention to the need for regulatory bodies for controlling the quality of DE.

Care skill and overload of the family caregiver of patients in cancer treatment / Habilidades de cuidado y sobrecarga del cuidador familiar de pacientes en tratamiento oncológico / Habilidade de cuidado e sobrecarga do cuidador familiar de pacientes em tratamento oncológico

ABSTRACT Objective: to analyze the relationship between the characteristics of patients in cancer treatment, their family caregivers, the care provided with the overload, as well as between overload and the care skills. Method: a cross-sectional study conducted at the chemotherapy and radiotherapy services of a university hospital in Rio Grande do Sul (Brazil) from March to August 2017, with 132 family caregivers of patients in cancer treatment. Data was collected by an instrument that characterizes patients, caregivers and care (the Brazilian version of the Caring Ability Inventory) and the Zarit Overload Scale. The following coefficients were used: Spearman correlation, Mann-Whitney or Kruskal-Wallis. Results: there was a significant relationship between the total overload and the patient's level of dependence (p=0.021) and help from others (p=0.009). The "care impact" factor was significantly related with the patient's level of dependence (p=0.006), the caregiver's gender (p=0.035) and the care help (p=0.043). Regarding the "perception of self-efficacy" factor, there was a significant relationship involving the caregiver's age (p=0.036) and, in the "caregiver expectation" factor, a significant relationship was observed with the care help (p=0.002). There was a significant and negative correlation between the total care skill and the overload factor related to interpersonal relationship (p=0.035); and between the "courage" dimension and the "perception of self-efficacy" (p=0.032) and "interpersonal relationship" (p=0.008) factors. Conclusion: the characteristics of the patient, the caregiver and the care provided influence the overload of the family caregiver, and this overload, in turn, interferes with the care skills. These results should be considered when planning interventions that aim to guide and prepare family caregivers for home care.

RESUMEN Objetivo: analizar la asociación de las características de pacientes en tratamiento oncológico, las de sus cuidadores familiares y las de los cuidados prestados con la sobrecarga, y entre esta última y la habilidade de cuidado. Método: estudio transversal desarrollado en los servicios de quimioterapia y radioterapia de un hospital universitario de Rio Grande do Sul (Brasil), entre marzo y agosto de 2017, con 132 cuidadores familiares de pacientes en tratamiento oncológico. Los datos se recolectaron por medio de un instrumento para caracterizar a los pacientes, a los cuidadores y a los cuidados, la versión brasileña del Caring Ability Inventory, y por medio de la Escala de Sobrecarga de Zarit. Se utilizaron los siguientes coeficientes: correlación de Spearman, Mann-Whitney o Kruskal-Wallis. Resultados: se observó una asociación significativa de la sobrecarga total con el grado de dependencia del paciente (p=0,021) y la ayuda de terceros para prestar los cuidados (p=0,009). El factor "impacto de los cuidados" se asoció de manera significativa con el grado de dependencia del paciente (p=0,006), el sexo del cuidador (p=0,035) y la ayuda para ofrecer los cuidados (p=0,043). En el factor "percepción de la autoeficiencia" se registró una asociación significativa con la edad del cuidador (p=0,036) y en el factor "expectativa con respecto a ofrecer los cuidados" se observó una asociación significativa con la ayuda para ofrecerlos (p=0,002). Se registró una asociación significativa y negativa entre la habilidad total de los cuidados y el factor de la sobrecarga relacionado con la relación interpersonal (p=0,035); y de la dimensión "coraje" y los factores "percepción de la autoeficiencia" (p=0,032) y relación interpersonal (p=0,008). Conclusión: las características del paciente, del cuidador y de los cuidados prestados influyen sobre la sobrecarga del cuidador familiar; y dicha sobrecarga, a su vez, interfiere en la habilidade de cuidar. Estos resultados deben ser considerados al planificar intervenciones destinadas a orientar y preparar a los cuidadores familiares para prestar cuidados domiciliarios.

RESUMO Objetivo: analisar a associação entre as características de pacientes em tratamento oncológico, de seus cuidadores familiares e do cuidado prestado com a sobrecarga, e desta com a habilidade de cuidado. Método: estudo transversal desenvolvido nos serviços de quimioterapia e radioterapia de um hospital universitário do Rio Grande do Sul (Brasil), no período de março a agosto de 2017, com 132 cuidadores familiares de pacientes em tratamento oncológico. Os dados foram coletados por instrumento de caracterização dos pacientes, dos cuidadores e do cuidado, - versão brasileira do Caring Ability Inventory e a Escala de Sobrecarga de Zarit. Os seguintes coeficientes foram utilizados: correlação de Spearman, Mann-Whitney ou Kruskal-Wallis. Resultados: foi observada associação significativa da sobrecarga total com o grau de dependência do paciente (p=0,021) e auxílio de terceiros para o cuidado (p=0,009). O fator impacto de cuidado associou-se de modo significativo com o grau de dependência do paciente (p=0,006), sexo do cuidador (p=0,035) e auxílio para o cuidado (p= 0,043). No fator percepção de autoeficácia houve associação significativa com a idade do cuidador (p=0,036) e, no fator expectativa face ao cuidar, observou-se associação significativa com o auxílio para o cuidado (p=0,002). Houve correlação significativa e negativa entre a habilidade de cuidado total e o fator da sobrecarga relacionado à relação interpessoal (p=0,035); e da dimensão coragem e os fatores percepção de autoeficácia (p=0,032) e relação interpessoal (p=0,008). Conclusão: as características do paciente, do cuidador e do cuidado prestado influenciam na sobrecarga do cuidador familiar e esta, por sua vez, interfere na habilidade de cuidado. Esses resultados devem ser considerados no planejamento de intervenções que visem orientar e preparar os cuidadores familiares para cuidados domiciliares.

Antibiotics, cancer risk and oncologic treatment efficacy: a practical review of the literature.

Antibiotics have been extensively used to treat infectious diseases over the past century and have largely contributed to increased life expectancy over time. However, antibiotic use can impose profound and protracted changes to the diversity of the microbial ecosystem, affecting the composition of up to 30% of the bacterial species in the gut microbiome. By modifying human microbiota composition, antibiotics alter the action of several oncologic drugs, potentially leading to decreased efficacy and increased toxicities. Whether antibiotics interfere with cancer therapies or even increase the risk of cancer development has been under investigation, and no randomised trials have been conducted so far. The aim of the current review is to describe the possible effects of antibiotic therapies on different oncologic treatments, especially immunotherapies, and to explore the link between previous antibiotics use and the development of cancer.

Tumor necrosis factor alpha mediates orofacial discomfort in an occlusal dental interference model in rats: The role of trigeminal ganglion inflammation.

BACKGROUND: Tumor necrosis factor alpha (TNF-α) is a proinflammatory cytokine that plays an important role in the early stages of inflammation. In this study, we investigated its role in orofacial discomfort in rats subjected to occlusal dental interference (ODI). METHODS: Female Wistar rats (180-200 g) were divided in three groups (n = 30/group): sham group, without ODI, and two experimental groups with ODI pre-treated with 0.1 mL/kg saline (ODI + SAL) or 5 mg/kg infliximab (ODI + INF) and treated every 3 days. The animals were euthanized after 1, 3, and 7 days. The number of bites and scratches and grimace scale scores were determined daily, and the bilateral trigeminal ganglion was histomorphometrically (neuronal body area) analyzed and submitted for immunohistochemistry for TNF-α, nitric oxide synthesis (NOS) neuronal (nNOS) and inducible (iNOS), peroxisome proliferator-activated receptors (PPAR) y (PPARy) and δ/ß (PPARδ/ß), and glial fibrillary acidic protein (GFAP). One-way/two-way ANOVA/Bonferroni tests were used (P < .05, GraphPad Prism 5.0). RESULTS: ODI + SAL showed a large number of bites (P = .002), scratches (P = .002), and grimace scores (P < .001) in the firsts days, and ODI + INF partially reduced these parameters. The contralateral and ipsilateral neuronal body area was significantly reduced on day 1 in ODI + SAL, but returned to the basal size on days 3 and 7, by increase in TNF-α, nNOS, PPARy, PPARδ/ß, and GFAP immunostaining. The infliximab treatment attenuated these alterations (P < .05). There was no iNOS immunostaining. CONCLUSION: Occlusal dental interference induced transitory orofacial discomfort by trigeminal inflammatory mediator overexpression, and TNF-α blockage attenuated these processes.

Prevalência de fatores predisponentes de baixa visual em uma população de jovens do Colégio Universitário Geraldo Reis em Niterói - RJ / Prevalence of predisposing factors of low visual acuity in a youth population of the Geraldo Reis University College in Niterói - RJ

Resumo Objetivo: Determinar a prevalência de fatores predisponentes de baixa acuidade visual entre os alunos do Colégio Universitário Geraldo Reis em Niterói-RJ. Métodos: Trata-se de um estudo observacional transversal realizados em duas etapas. A primeira realizou-se a medida da acuidade visual dos alunos voluntários que aderiram ao termo de assentimento. Na segunda etapa foram selecionados aqueles alunos cuja acuidade visual não ultrapassaram 0,8 em pelo menos um dos olhos ou que apresentaram diferença de acuidade visual entre os olhos de duas linhas ou mais na tabela de Snellen, sendo encaminhados para avaliação oftalmológica completa no Serviço de Oftalmologia do Hospital Universitário Antônio Pedro / Universidade Federal Fluminense. Resultados: Do total de 325 alunos matriculados, 134 (41,2%) participaram da primeira etapa do estudo e, destes, apenas 39 (29%) apresentaram baixa visão. Dos 39 alunos selecionados para a segunda etapa do estudo, apenas 14 (36%) se voluntariaram a prosseguir para avaliação oftalmológica completa, tendo as ametropias (57,14%), a ambliopia (21,42%) e o estrabismo (14,28%) como as principais causas de baixa visual identificadas. Conclusão: A prevalência de baixa visão(low vision=baixa visão tem definição, não se chama baixa visual) para essa comunidade foi de 29% e as principais causas identificadas foram as ametropias, as ambliopias e o estrabismo. Campanhas de conscientização e os problemas de adesão aos programas de triagem devem ser considerados em novos estudos.

Abstract Purpose: To determine the prevalence of predisposing factors of low visual acuity among the students of the Geraldo Reis University College in Niterói-RJ. Methods: This was a cross-sectional observational study during which the visual acuity of the volunteer students who adhered to the assent term was measured. Those students whose visual acuity did not exceed 0.8 in at least one eye or who presented a difference between the eyes of two lines or more in the Snellen table were selected for the next stage of the study and were referred for complete ophthalmologic evaluation in the Service of Ophthalmology of the Antônio Pedro University Hospital / Fluminense Federal University. Results: Of the total of 325 students enrolled, 134 (41.2%) participated in the first stage of the study and of these, only 39 (29%) presented visual impairment. Of the 39 students selected for the second phase of the study, only 14 (36%) volunteered to proceed for a complete ophthalmologic evaluation, with ametropias (57.14%), amblyopia (21.42%) and strabismus (14, 28%) as the main causes of visual impairment identified. Conclusion: The prevalence of visual impairment for this community was 29% and the main causes identified were ametropias, amblyopia and strabismus. Awareness campaigns and problems of adherence to screening programs should be considered in new studies.

Desafios do usuário frente a estomia: entre o real e o almejado / Challenges of the user against the stoma: between the real and the desired / Desafíos del usuario frente a la estomia: entre lo real y lo anhelado

Conhecer os desafios enfrentados pelos usuários com estomia fornece subsídios para a enfermagem atuar de forma efetiva no auxilio frente as demandas dessas pessoas. A partir disso indaga-se: Qual a percepção da pessoa com estomia intestinal após a alta hospitalar? O objetivo foi identificar as dificuldades e facilidades encontradas pelas pessoas com estomia intestinal após alta hospitalar. É de natureza qualitativa, de caráter descritivo e exploratório. Foi desenvolvido em um hospital universitário e contou com a participação de 11 pessoas com estomias intestinais. A técnica de coleta de dados foi a entrevista semiestruturada, e a análise de conteúdo temático. Os resultados possibilitaram a construção das categorias (in)compreensão com os cuidados da estomia no domicílio e entre o real e o almejado. Conclui-se que a assistência prestada às pessoas com estomia ainda possui um foco curativista, fazendo com que recebam a alta carentes de informações cruciais para que possam dar continuidade ao cuidado no domicílio.(AU)

Knowing the challenges faced by users with stomies provides subsidies for nursing to act effectively in the face of the demands of these people. From this we ask: What is the perception of the person with intestinal stomies after discharge from hospital? The objective was to identify the difficulties and facilities found by people with intestinal stomies after discharge. It is qualitative, descriptive and exploratory in character. It was developed in a university hospital and counted on the participation of 11 people with intestinal stomies. The technique of data collection was the semistructured interview, and the thematic content analysis. The results allowed the construction of the categories (in) comprehension with the care of the stoma in the home and between the real and the desired one. It is concluded that the care provided to people with stomies still has a curative focus, making them receive the lack of crucial information so that they can continue the care at home.(AU)

Conocer los desafíos enfrentados por los usuarios con estomia proporciona subsidios para la enfermería actuar de forma efectiva en el auxilio frente a las demandas de esas personas. A partir de eso se indaga: ¿cuál es la percepción de la persona con estomía intestinal después del alta hospitalaria? El objetivo fue identificar las dificultades y facilidades encontradas por las personas con estomía intestinal después del alta hospitalaria. Es de naturaleza cualitativa, de carácter descriptivo y exploratorio. Fue desarrollado en un Hospital Universitario y contó con la participación de 11 personas con estomias intestinales. La técnica de recolección de datos fue la entrevista semiestructurada, y el análisis de contenido temático. Los resultados posibilitar la construcción de las categorías (in) comprensión con los cuidados de la estomia en el domicilio, y entre lo real y lo anhelado. Se concluye que la asistencia prestada a las personas con estomia todavía tiene un foco curativista, haciendo que reciban la alta carencia de informaciones cruciales para que puedan dar continuidad al cuidado en el domicilio.(AU)

The roles of PTEN, cMET, and p16 in resistance to cetuximab in head and neck squamous cell carcinoma.

There is no established biomarker for cetuximab efficacy in recurrent head and neck squamous cell carcinoma (HNSCC). The aim of the present study was to evaluate the prognostic and predictive impact of PTEN, cMET, and p16 expression in recurrent HNSCC. In this retrospective study, 112 patients with recurrent HNSCC received chemotherapy (CT) alone (n = 37) or chemotherapy with cetuximab (n = 75). PTEN, cMET, and p16 protein expression were evaluated by immunohistochemistry. The median overall survival (mOS) for the patients treated with cetuximab + CT versus CT alone was 11.4 months and 7.0 months, (p = 0.949). The median progression-free survival (mPFS) was 6.2 months versus 3.0 months (p = 0.154). Patients with PTEN loss exhibited a mOS of 5.8 months versus 10.5 months (p = 0.002) and a mPFS of 3.2 months versus 4.7 months (p = 0.019). A multivariate analysis identified an independent association between PTEN loss and OS (HR 2.27; 95% confidence 95% CI 1.27-4.08; p = 0.006) and with PFS (HR 1.85; 95% CI 1.09-2.99; p = 0.022). A negative prognostic impact of PTEN loss was observed in the patients treated with cetuximab + CT, and not in the CT only group. Expression of cMET and p16 showed no impact on OS or PFS. The present findings confirm that PTEN is a prognostic factor for metastatic HNSCC and they support further studies of PTEN expression to evaluate its predictive value to cetuximab response.

Evaluation of antimicrobial, cytotoxic, and hemolytic activities from venom of the spider Lasiodora sp.

This study characterized the protein/peptide profile of venom isolated from the spider Lasiodora sp. (Mygalomorphae, Theraphosidae) found in northeastern Brazil and determined its antimicrobial activity, toxicity against human cells, and hemolytic activity. Protein concentration of the Lasiodora sp. venom was 4.53 ± 0.38 mg/mL. SDS-PAGE showed proteins with molecular masses up to 75 kDa, some of which contained disulfide bridges. RP-HPLC analysis separate at least 12 peaks that were identified by mass spectrometry as peptides U1-theraphotoxin-Lp1a (lasiotoxin-1), U1-theraphotoxin-Lp1c (lasiotoxin-3), U3-theraphotoxin-Lsp1a (LTx5), and ω-theraphotoxin-Asp3a as well as the proteins phospholipase A2 (PLA2) and hyaluronidase. The crude venom exhibited bactericidal effect against Aeromonas sp., Bacillus subtilis, and Micrococcus luteus and fungicidal effect against Candida parapsilosis and Candida albicans. In addition, the venom exerted bacteriostatic effect against Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus and fungistatic effect against Candida tropicalis and Candida krusei. The minimum inhibitory (MIC), minimum bactericidal (MBC), and minimum fungicidal (MFC) concentrations ranged from 3.9 to 500 µg/mL. The Lasiodora sp. venom decreased the viability of human peripheral blood mononuclear cells (PBMCs) by 50%-90% at concentrations of 0.1, 1, 10, and 100 µg/mL, promoting apoptosis of these cells. On the other hand, the venom showed weak hemolytic activity against Mus musculus erythrocytes (EC50: 757 µg/mL). In conclusion, the Lasiodora sp. spider venom is a rich source of antimicrobial agents. Future studies will focus on identifying antimicrobial agents present in this venom and evaluating whether these agents contribute to its cytotoxic effects against PBMCs.

Educação em saúde: representação social eagir cotidiano de profissionais de saúde / Health education: social representation and everyday act ofhealth professionals

A educação e a saúde são campos de produção e aplicação de saberes destinados ao desenvolvimento humano. O objetivodeste estudo é apreender a estrutura das representações sociais de profissionais de saúde sobre educação em saúdee identificar as práticas educativas realizadas em unidades de referência especializadas da Secretaria de Estado de SaúdePública do Pará na cidade de Belém. Estudo descritivo e exploratório, norteado pela abordagem estrutural da Teoria dasRepresentações Sociais. Os sujeitos foram 56 profissionais de saúde de cinco unidades de referência e um Centro de Saúde.A análise dos dados sócio – demográficos e práticas educativas se deu através da estatística descritiva com o Programa Excel2007; os dados obtidos por meio de evocações livres de palavra foram processados pelo Programa Evoc 2003. Concluiu-seque a centralidade da representação social é objetivada na prevenção por meio de orientação com vistas à qualidade de vidae saúde. As práticas cotidianas se pautam em orientações individuais nos consultórios voltadas para as especialidades deatendimento destas instituições. São indivíduos- centradas, biológico- centradas e não superam as fronteiras institucionais.

Education and health are fields of production and application of knowledge for human development. The aim of this studyis to understand the structure of social representations of health professionals on health education and identify educationalpractices performed by them in specialized reference units of the Secretary of State Public Health of the city of Belém.This is a descriptive and exploratory study guided by the Theory of Social Representations. The subjects were 56 healthprofessionals from five units of reference and a health center in Belém, Pará. The analysis was through descriptive statisticsProgram Excel 2007; the data obtained was processed by Evoc 2003. The centrality of the social representation is basedon prevention by means of orientation, aiming at quality of life and health. The everyday practices are based in individualorientations on the offices of the health professionals facing to the specialties of care of these institutions.

Unexpected soft tissue changes in response to root coverage using an acellular dermal matrix allograft: 12­year follow up.

A woman undergoing orthodontic treatment presented with recession and reduced keratinized gingiva on teeth 31 and 41. The patient declined creation of a donor site for conventional autogenous connective soft tissue grafting and opted for an acellular dermal matrix soft tissue substitute for root coverage. Orthodontic treatment followed, and the patient returned for orthognatic surgery after 12 years. Long-term follow up revealed that root coverage remained stable over time and creeping attachment on both teeth was observed. Unexpectedly, an increase in the width of keratinized gingiva was observed. No adverse effects of orthodontic treatment carried out after grafting were observed.

A interdisciplinaridade necessária à educação médica / The need for interdisciplinarity in medical education

Nas Diretrizes Curriculares nacionais, a saúde é considerada uma área interdisciplinar, pois seu objeto "o processo saúde-doença humano " envolve as relações sociais, a biologia e as expressões emocionais. Este estudo analisa os programas e atividades do currículo implantado na Faculdade de Medicina da PUC-Campinas a partir de 2001, no tocante às ações interdisciplinares e multiprofissionais que envolvem os demais cursos da saúde. Procedeu-se à análise documental e de depoimentos de diferentes atores envolvidos no curso. Na perspectiva dos entrevistados, apesar das dificuldades relativas à fragmentação dos saberes e práticas, ao desconhecimento e preconceito acerca dos campos e núcleos das profissões da saúde e à precarização do vínculo docente, tem havido iniciativas de integração, destacando-se os ciclos morfofisiológicos, de correlação clínica e as práticas de Saúde da Família e Comunidade. Concluiu-se que a interdisciplinaridade está presente na proposta curricular e como intenção da Universidade, mas acontece por iniciativas individuais, nas quais se viabilizam "encontros" entre discentes, docentes, funcionários e usuários, que se tornam significativos e demonstram um processo em construção, ainda distante da transdisciplinaridade.

The National Curricular Guidelines consider health an interdisciplinary area seen that its object " the process of human health and disease " involves social relations, biology and emotional expressions. This study aims to analyze the programs and activities of the curriculum implanted at the Medical School of PUC-Campinas since 2001 with respect to interdisciplinary and multiprofessional actions involving other health courses. Documents and personal statements from different participants involved in the course were analyzed. From the point of view of the interviewed persons, in spite of some difficulties related to fragmentation of knowledge and practices, lack of knowledge and prejudice regarding the fields and core areas of the health professions and the precarious employment conditions of the faculty, integration initiatives have taken place, above all the morphophysiological cycles, the clinical correlation and the Family and Community Health practices. We conclude that interdisciplinary is present in the curricular proposal and as an intention of the University, but that it is carried on by individual initiatives, in "meetings" of students, teachers, employees and patients, winning significance and demonstrating a process in construction but still far away from transdisciplinarity.