RESUMO
El espectro acretismo placentario es una patología que cursa con una alta morbimortalidad, viéndose en los últimos años un incremento en su incidencia y cobrando relevancia por la tasa de cesáreas en aumento, siendo su principal factor de riesgo. Se describe el caso de una paciente de 32 años, portadora de acretismo placentario, diagnosticado mediante ecografía a las 31 semanas de edad gestacional, donde se logró planificar paso a paso la cirugía con equipo, colocando previo a la cirugía balones en arterias hipogástricas y catéter doble Jota, haciendo una estadificación intraoperatoria detallada. A propósito del caso clínico se realiza una revisión y actualización de la patología, enfatizando en la planificación detallada de la cirugía y el abordaje con equipos de referencia.
Placenta Accreta Spectrum is a condition associated with high morbidity and mortality. In recent years, there has been an increase in its incidence, highlighting its importance due to the rising rate of cesarean sections which is its main risk factor. A case is described of a 32-year-old patient with placenta accreta, diagnosed via ultrasound at 31 weeks of gestation. The surgery was meticulously planned with the team, including the placement of balloons in the hypogastric arteries and a double-J catheter, allowing for detailed intraoperative staging. In relation to the clinical case, a review and update of the pathology is carried out, emphasizing the detailed planning of the surgery and the approach in specialized teams.
O Espectro do Acretismo Placentário é uma patologia de alta morbimortalidade, com incidência crescente nos últimos anos e ganhando relevância devido ao aumento da taxa de cesarianas, sendo este o seu principal fator de risco. Descrevemos o caso de uma paciente de 32 anos com acretismo placentário, diagnosticado por ultrassonografia com 31 semanas de idade gestacional, na qual a cirurgia foi planejada passo a passo com a equipe multidisciplinar, com a colocação de balões nas artérias hipogástricas e um cateter duplo jack antes da cirurgia e realizando um estadiamento intraoperatório detalhado. Uma revisão e atualização da bibliografia, enfatizando o planejamento detalhado da cirurgia e a abordagem em equipes composta por profissionais de várias especialidades médicas.
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Introducción. El íleo biliar es una complicación rara de la colelitiasis y su incidencia varía del 1 al 4 %. Consiste en la migración de un cálculo de la vesicular biliar al tracto gastrointestinal, generando obstrucción intestinal. Presenta síntomas inespecíficos dependiendo del nivel de la obstrucción, lo que hace que su diagnóstico no suela ser precoz, repercutiendo en el deterioro clínico del paciente. Es especialmente grave en pacientes de edad avanzada y con comorbilidades. Casos clínicos. Se reportan los casos de dos pacientes con dolor abdominal difuso, en quienes se diagnosticó íleo biliar por tomografía. Se realizó manejo quirúrgico, el primero mediante técnica abierta y estrategia de dos pasos, y el otro mediante técnica laparoscópica. Discusión. El íleo biliar es una etiología rara de obstrucción intestinal. El cálculo migra debido a una fistula colecisto-entérica y el nivel de obstrucción es con mayor frecuencia la válvula ileocecal. Los síntomas son inespecíficos y dependen del nivel de obstrucción: dolor abdominal difuso mal caracterizado, náuseas, vómito, ausencia de flatos. El diagnóstico se hace mediante tomografía abdominal, en la cual se evidencia la tríada de Rigler. El manejo es quirúrgico, con enterotomía para extraer el cálculo y resolver la obstrucción. Conclusión. El íleo biliar es una patología que debe ser considerada en el abordaje de la obstrucción intestinal, aunque sea poco frecuente. El manejo quirúrgico es clave para resolver el cuadro de obstrucción intestinal; aún así genera importante morbimortalidad en especial en pacientes de avanzada edad.
Introduction. Gallstone ileus is a rare complication of cholelithiasis, its incidence varies from 1% to 4%. It consists of the migration of a stone from the gallbladder to the gastrointestinal tract, causing intestinal obstruction. It presents with non-specific symptoms depending on the level of the obstruction, which means that its diagnosis is not usually early, with repercussions on the clinical deterioration of the patient, being serious especially in elderly patients and with comorbidities. Clinical cases. Two patients with diffuse abdominal pain are reported. A tomographic diagnosis was made showing gallstone ileus. Surgeries were performed, in the first case using an open technique and a 2-step strategy, and on the second one using a laparoscopic technique. Discussion. Gallstone ileus is a rare etiology of intestinal obstruction. Symptoms are usually poorly characterized: diffuse abdominal pain, nausea, vomiting, absence of flatus. The diagnosis is made by abdominal tomography in which Rigler's triad is evident. Management is surgical through enterotomy to remove the stone and resolve the obstruction. Conclusion. Gallstone ileus is a rare pathology that should be considered in the approach to intestinal obstruction. Surgical management is key to resolving intestinal obstruction. Even so, it generates significant morbidity and mortality, especially in elderly patients.
Assuntos
Humanos , Cálculos Biliares , Obstrução Intestinal , Complicações Pós-Operatórias , Colelitíase , Fístula do Sistema Digestório , Fístula BiliarRESUMO
Interleukin-2 (IL-2) engineered versions, with biased immunological functions, have emerged from yeast display and rational design. Here we reshaped the human IL-2 interface with the IL-2 receptor beta chain through the screening of phage-displayed libraries. Multiple beta super-binders were obtained, having increased receptor binding ability and improved developability profiles. Selected variants exhibit an accumulation of negatively charged residues at the interface, which provides a better electrostatic complementarity to the beta chain, and faster association kinetics. These findings point to mechanistic differences with the already reported superkines, characterized by a conformational switch due to the rearrangement of the hydrophobic core. The molecular bases of the favourable developability profile were tracked to a single residue: L92. Recombinant Fc-fusion proteins including our variants are superior to those based on H9 superkine in terms of expression levels in mammalian cells, aggregation resistance, stability, in vivo enhancement of immune effector responses, and anti-tumour effect.
Assuntos
Evolução Molecular Direcionada , Subunidade beta de Receptor de Interleucina-2 , Interleucina-2 , Biblioteca de Peptídeos , Humanos , Subunidade beta de Receptor de Interleucina-2/química , Interleucina-2/química , Interleucina-2/genética , Interleucina-2/metabolismo , Proteínas Recombinantes de Fusão/química , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Evolução Molecular Direcionada/métodos , Domínios Proteicos , Animais , Camundongos , Linhagem Celular TumoralRESUMO
La fibromialgia es un síndrome polisintomático caracterizado por dolor crónico generalizado no articular e idiopático, cuya terapia, tanto farmacológica como no farmacológica, debe ser individualizada a cada paciente e involucrar equipos multidisciplinarios de trabajo. Objetivo del Estudio: Realizar una base de datos para agrupar los recursos comunitarios disponibles para llevar a cabo las terapias no farmacológicas con evidencia en el tratamiento del dolor crónico no oncológico en las comunas de San Joaquín, Macul, Puente Alto, La Florida, La Pintana y San Miguel, Región Metropolitana, Chile. Materiales y Métodos: Se llevó a cabo una búsqueda en internet mediante palabras clave de recursos comunitarios dentro de las comunas antes mencionadas que cumplieran criterios de evidencia en el tratamiento de fibromialgia, además de contactar a servicios municipales y fundaciones orientadas al manejo del dolor no oncológico en la Región Metropolitana, para la confección de una base de datos y un mapa interactivo de fácil acceso y uso con los recursos encontrados. Resultados: Nuestra búsqueda arrojó un total de 78 recursos comunitarios, tanto públicos como privados, que ofrecen alternativas de tratamiento no farmacológico para el manejo del dolor crónico no oncológico y fibromialgia en las cinco comunas descritas. Conclusiones: La fibromialgia es un síndrome polisintomático de difícil manejo frecuente en nuestro país, que incluye como parte de su tratamiento integral diversas medidas no farmacológicas con evidencia reciente, que gracias a la confección de las herramientas creadas para este estudio se espera facilitar el acceso a los recursos disponibles en una zona determinada del Gran Santiago, tanto a los pacientes que padecen estas dolencias como a los profesionales de la salud que indican este tipo de terapias.
Fibromyalgia is a polysymptomatic syndrome characterizedby chronic generalized non-articular and idiopathic pain, whose pharmacological and non-pharmacological therapy must be individualized for each patient and involve multidisciplinary work teams. Objective of the study: To create a database to group the community resources available to carry out non- pharmacological therapies with evidence in the treatment of chronic non-cancer pain in the communes of San Joaquín, Macul, Puente Alto, La Florida, La Pintana and San Miguel, from Metropolitan Region, Chile. Materials and Methods: An internet search was carried out using keywords of community resources within the aforementioned communes that met evidence criteria in the treatment of fibromyalgia, in addition to contacting municipal services and foundations oriented to non- oncological pain management in the Metropolitan Region, for the preparation of a database and an interactive map of easy access and use with the resources found. Results: Our search yielded a total of 78 community resources, both public and private, that offer non- pharmacological treatment alternatives for the management of chronic non-cancer pain and fibromyalgia in the five districts described. Conclusions: Fibromyalgia is a polysymptomatic syndrome of difficult management, common in our country, which includes as part of its comprehensive treatment various non-pharmacological measures with recent evidence, which, thanks to the preparation of the tools created for this study, is expected to facilitate access to resources available in a given area of Santiago de Chile, both to patients suffering from these ailments and to health professionals who indicate this type of therapy.
Assuntos
Humanos , Fibromialgia/terapia , Dor Crônica , Reabilitação , AutogestãoRESUMO
Fossil discoveries can transform our understanding of plant diversification over time and space. Recently described fossils in many plant families have pushed their known records farther back in time, pointing to alternative scenarios for their origin and spread. Here, we describe two new Eocene fossil berries of the nightshade family (Solanaceae) from the Esmeraldas Formation in Colombia and the Green River Formation in Colorado (USA). The placement of the fossils was assessed using clustering and parsimony analyses based on 10 discrete and five continuous characters, which were also scored in 291 extant taxa. The Colombian fossil grouped with members of the tomatillo subtribe, and the Coloradan fossil aligned with the chili pepper tribe. Along with two previously reported early Eocene fossils from the tomatillo genus, these findings indicate that Solanaceae were distributed at least from southern South America to northwestern North America by the early Eocene. Together with two other recently discovered Eocene berries, these fossils demonstrate that the diverse berry clade and, in turn, the entire nightshade family, is much older and was much more widespread in the past than previously thought.
Assuntos
Capsicum , Solanum , Fósseis , Frutas , América do Sul , FilogeniaRESUMO
In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.
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Humanos , Psiquiatria , Estudantes de Medicina , Educação de Graduação em Medicina , Autogestão , COVID-19 , SARS-CoV-2RESUMO
INTRODUCTION: Early administration of oral colostrum has been recommended in very-low-birth-weight (VLBW) preterm infant care. OBJECTIVE: To evaluate the clinical effect of early colostrum administration on in-hospital outcome and lactation of VLBW preterm infants compared with historical control in an Intensive Care Unit. SUBJECTS AND METHOD: descriptive cohort study with historical control of VLBW preterm infants who did or did not receive early oral colostrum, born 1.6 years before and 1.4 years after this protocol, with information collected from the database of infants under 1500 grams at birth and in the colostrum protocol registry. Children born to HIV+ mothers, with hepatitis, chemothe rapy, and those born with malformations incompatible with life were excluded. The main perinatal, morbidity, nutritional, and breastfeeding data at discharge were compared. RESULTS: 94 patients were born pre-colostrum and 64 in the protocol period (post-colostrum). The groups were comparable in perinatal history. No difference was observed in infectious, respiratory, or gastrointestinal morbidity, progress in enteral feeding, days of parenteral nutrition, and length of hospital stay. There were signi ficant differences in the percentage breastfeeding at discharge (52 vs. 69%, p < 0.037) and in average breast milk volume at discharge (70 vs. 102 ml/k/day, p < 0.012) in the post-colostrum group. Con clusions: Early colostrum administration to preterm infants was associated with a higher volume of maternal milk at discharge, being a good benefit in VLBW preterm infant care.
Assuntos
Colostro , Recém-Nascido Prematuro , Criança , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Leite Humano , GravidezRESUMO
Estudios previos han caracterizado la disfagia en pacientes críticos hospitalizados que requieren intubación y ventilación mecánica invasiva. A raíz de la pandemia COVID-19 es necesario conocer las características deglutorias de pacientes diagnosticados con la enfermedad para su manejo. El objetivo de este estudio es analizar las características deglutorias de pacientes críticos extubados con y sin diagnóstico de COVID-19. Se llevó a cabo un estudio de cohorte retrospectivo con una muestra a conveniencia de 43 sujetos mayores de 15 años, ingresados al Hospital San Juan de Dios (Santiago, Chile) entre el 01 de junio y el 31 de agosto de 2020, intubados con o sin diagnóstico de COVID-19. Del total de sujetos, 22 padecieron de COVID-19 quienes estuvieron significativamente más días intubados que aquellos sin la patología (p=0,002). Inmediatamente posterior a la extubación orotraqueal, más del 90% de la muestra presentó disfagia. No hubo diferencia significativa en el nivel FILS ni asociación significativa en el grado de severidad de la disfagia entre sujetos con y sin COVID-19. Tampoco hubo diferencia significativa en el nivel FILS entre los grupos a los 10 días post-extubación. El nivel FILS a los 10 días aumentó significativamente en aquellos sujetos con COVID-19 (p=0,016) y sin COVID-19 (p=0,004). En la muestra, el nivel FILS y grado de severidad de la disfagia de los pacientes con y sin COVID-19 no mostraron diferencias estadísticas, siendo alto el porcentaje de disfagia en ambos grupos, lo que se podría asociar a la intubación orotraqueal y al tubo orotraqueal. Es necesaria la incorporación del fonoaudiólogo dentro de los equipos de Unidades de Pacientes Críticos para el manejo de los pacientes con COVID-19 y disfagia. Además, se recomienda continuar con más estudios en el área.
Previous research have described the deglutition disorders in critical hospitalised patients who required intubation and mechanical ventilation. In the pandemic context, it is mandatory to study both level and grade of dysphagia in patients suffering from COVID-19. The aim of this study is to analyse the deglutition features of extubated critical patients with and without COVID-19. A retrospective cohort study was performed, considering a convenience sample of 43 patients from 15 years old hospitalised at 'Hospital San Juan de Dios' between June 1st and August 31th 2020, who were intubated, with and without the diagnosis of COVID-19. 22of out 43 patients were diagnosed with COVID-19 who were intubated for significantly more days in comparison with those without COVID-19 (p=.002). After the intratracheal extubation, 90% of the sample was diagnosed with dysphagia. There was no significant difference in the FILS score nor significant association in dysphagia severity between patients with and without COVID-19. After 10 days post extubation, there was no significant difference in the FILS score between both groups. The FILS score increased significantly in the COVID-19 (p=.016) and non-COVID-19 (p=.004) patients after 10 days post extubation. Post extubation, there are no statistical differences in the FILS score and dysphagia severity in critical ill patients with and without COVID-19, with a high percentage of dysphagia in both groups which could be associated with intratracheal intubation and endotracheal tubes. The incorporation of speech and language therapists in Critical Care Units is mandatory. Furthermore, it is recommended to perform extra research in the area.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Extubação/efeitos adversos , COVID-19/complicações , Respiração Artificial/efeitos adversos , Índice de Gravidade de Doença , Estudos Retrospectivos , Estado Terminal , Deglutição , COVID-19/terapia , Intubação/efeitos adversosRESUMO
Resumen: Introducción: la hemofilia es una enfermedad hereditaria, ligada al cromosoma X, debida al déficit de factor VIII (tipo A) o IX (tipo B). La prevalencia estimada al nacimiento es de 24,6 casos cada 100.000 varones para hemofilia A y 5 casos cada 100.000 para hemofilia B. El Departamento de Medicina Transfusional (DMT) del Centro Hospitalario Pereira Rossell (CHPR) es el Centro de Referencia Nacional (CDRN) para los menores de 18 años. El abordaje integral, inter-disciplinario del paciente con hemofilia en un centro especializado disminuye la morbi-mortalidad y contribuye a mejorar la calidad de vida. Objetivo: describir las características epidemiológicas y clínicas de los menores de 18 años con hemofilia asistidos en el DMT-CHPR entre el 1 enero de 2016 y el 31 de diciembre de 2018. Metodología: estudio descriptivo, retrospectivo, de todos los menores de 18 años con hemofilia. Se describió: edad y circunstancias del diagnóstico, tipo y severidad de la hemofilia, controles en salud, estudios complementarios, complicaciones, frecuencia y motivos de hospitalización, tratamiento. El protocolo de estudio fue aprobado por el Comité de Ética Institucional. Resultados: se asistieron 67 pacientes, 57 con hemofilia A y 10 con hemofilia B. La mediana de edad fue 8 años. Presentaban hemofilia severa 61 pacientes, moderada 2 y leve 4. Presentaban antecedentes familiares de coagulopatía 41. La mediana de edad al diagnóstico fue 2 meses. Se diagnosticaron en el período neonatal 24 de los pacientes con hemofilia A y 5 con hemofilia B. Desarrollaron inhibidores 7 pacientes, todos con hemofilia severa. Conclusiones: en esta serie, predominaron los pacientes con hemofilia A, severa, antecedentes familiares conocidos de coagulopatía, en tratamiento profiláctico con factores de la coagulación. Esta comunicación aporta información valiosa sobre las características de estos pacientes, lo que contribuye a la gestión clínica y a planificar estrategias de mejora de la calidad asistencial.
Summary: Introduction: hemophilia is a hereditary disease, linked to chromosome X and caused by the deficit of factor VIII (type A) and IX (type B). Estimated prevalence at birth is 24.6 cases every 100,000 boys for hemophilia A and 5 cases every 100,000 cases for hemphilia B. The Transfusion Medical Department (TMD) of the Pereira Rossell Children's Hospital Center (CHPR, acronym in Spanish) is the national reference center (NRC) for patients under 18 years of age. A comprehensive, inter-disciplinary approach to hemophilic patients at a specialized center decreases morbidity and mortality and contributes to improving quality of life. Objective: to describe the epidemiologic, clinical and progression characteristics of hemophilic patients of under 18 years of age assisted at the TMD-CHPR between January 1st 2016 and December 31st, 2018. Methodology: descriptive, retrospective study of all hemophilic patients of under 18 years of age. Variables described: age, circumstances of diagnosis, type and severity of hemophilia, health check-ups, tests, complications, frequency and reasons for hospital admittance, treatment. The study protocol was approved by the Institutional Ethics Committee. Results: 67 patients were assisted, 57 with hemophilia A and 10 with hemophilia B. Median age was 8 years. Severe hemophilia was present in 61 patients, moderate in 2 and mild in 4. 41 had a family history of coagulopathy. Median age at diagnosis was 2 months. 24 patients with hemophilia A and 5 patients with hemophilia B were diagnosed during the neonatal period. 7 patients developed inhibitors, all of them with severe hemophilia. Conclusions: in this study there is a predominance of patients with severe hemophilia A, known family history of coagulopathy, under prophylactic treatment with coagulation factors. This study provides valuable information about the characteristics of these patients, which contributes to improved clinical management and planning strategies to improve their quality of care.
Resumo: Introdução: o Departamento de Medicina Transfusional (DMT) do Centro Hospitalar Pereira Rossell (CHPR) é o Centro Nacional de Referência (CNR) para menores de 18 anos de idade. A abordagem abrangente e interdisciplinar do paciente com hemofilia em um centro especializado reduz a morbimortalidade e contribui para a melhoria da qualidade de vida. Objetivo: descrever as características epidemiológicas, clínicas e evolutivas em crianças menores de 18 anos com hemofilia atendidas no DMT-CHPR entre 1 de janeiro de 2016 e 31 de dezembro de 2018. Metodologia: estudo descritivo, retrospectivo, de todos os menores de 18 anos com hemofilia. Descrevemos: idade e circunstâncias do diagnóstico, tipo e gravidade da hemofilia, controles de saúde, estudos complementares, complicações, frequência e motivos de hospitalização, tratamento. O protocolo do estudo foi aprovado pelo Comitê de Ética Institucional. Resultados: 67 pacientes foram atendidos, 57 com hemofilia A e 10 com hemofilia B. A media de idade foi de 8 anos. Houve 61 pacientes com hemofilia grave, moderada 2 e leve 4. 41 tiveram história familiar de coagulopatia. A media de idade no diagnóstico foi de 2 meses. 24 dos pacientes com hemofilia A e 5 com hemofilia B foram diagnosticados no período neonatal e 7 desenvolveram inibidores, todos com hemofilia grave. Conclusões: neste estudo, predominaram pacientes com hemofilia A grave, história familiar conhecida de coagulopatia, em tratamento profilático com fatores de coagulação. O estudo fornece informações valiosas sobre as características desses pacientes, o que contribui para o manejo clínico e estratégias de planejamento para melhorar a qualidade do atendimento deles.
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INTRODUCTION: Squamous cell carcinomas (SqCCs) are the most common solid tumors in humans and are found across multiple organ systems. Although, integrated analysis of genetic alterations divulge similarities between SqCCs from various body sites, certain genes appear to be more frequently mutated in a given SqCC. These subtle differences may hold the key to determining the differentiation characteristics and predicting aggressiveness of tumors. MATERIALS AND METHOD: Fifty-four cases of SqCCs, in which the primary location of the tumor could be ascertained by clinical and radiological findings, were included in this study. Next generation sequencing data was analyzed for recurrent genetic abnormalities. RESULTS: Genetic alterations were found in 219 genes in the 54 cases studied. TP53 mutations were found to be more frequent in pulmonary SqCCs (86.5%) as compared to non-pulmonary SqCCs (58.8%) (p<0.05). NOTCH gene family mutations and CREBBP mutations were limited to non-pulmonary SqCC (p<0.005) and were mutated in 41.2% and 17.6% cases. CONCLUSION: A detailed comparative analysis of the genetic alterations identified by sequencing identified higher frequency of TP53 mutations in lung SqCCs as compared to non-pulmonary SqCCs. NOTCH and CREBPP mutations were found to be absent in lung and head and neck SqCCs and more frequent in SqCCs from other locations.
Assuntos
Carcinoma de Células Escamosas/genética , Genômica/métodos , Idoso , Feminino , Humanos , Masculino , FenótipoRESUMO
Introducción: El cuidado que realizan los familiares de adultos mayores dependientes los conduce a estados de sobrecarga por desgaste físico, emocional, social y económico que siguen presentes durante las hospitalizaciones. Objetivo: Evaluar el efecto de una intervención de enfermería basada en la dinámica del cuidado, comparada con el cuidado convencional, sobre el nivel de sobrecarga de cuidadores familiares de adultos mayores dependientes hospitalizados. Metodología: Diseño cuasi experimental pre test post test, con grupo experimental y grupo de comparación, con una muestra de 68 cuidadores. Resultados: El nivel de sobrecarga de los cuidadores del grupo experimental tuvo una media pre test de 63,2 y 52,8 post test, y el grupo de comparación tuvo una media pre test de 56,9 y 59,6 post test. Conclusiones: La aplicación de la intervención diseñada generó cambios significativos en el cuidador que permitieron modular los niveles de sobrecarga durante la hospitalización del adulto mayor dependiente
Introduction: The care provided by relatives of dependent elderly adults leads them to states of burden due to physical, emotional, social and economic wear and tear that are still present during hospitalizations. Objective: To assess the effect of a nursing intervention based on the dynamics of care, compared to conventional care, on the level of overload of family caregivers of elderly dependents in hospital. Methodology: Quasi-experimental pre-test - post-test design, with an experimental group and a comparison group, with a sample of 68 caregivers. Results: The level of caregiver overload in the experimental group had a pre-test mean of 63,2 and 52,8 post-test, and the comparison group had a pre-test mean of 56,9 and 59,6 post-test. Conclusions: The application of the designed intervention generated significant changes in the caregiver that allowed modulating the levels of overload during the hospitalization of the dependent older adult
Assuntos
Humanos , Masculino , Feminino , Idoso , Sobrecarga do Cuidador , Cuidados de Enfermagem , Cuidadores , Avaliação de Eficácia-Efetividade de Intervenções , Estado Funcional , HospitalizaçãoRESUMO
The P2X7 receptor is a ligand-gated purinergic receptor activated by extracellular ATP. The receptor is highly expressed in immune cells and in the brain, and, upon activation, the P2X7 receptor allows a cation flux, leading to the distinct activation of intracellular signalling pathways as the secretion of pro-inflammatory cytokines, and modulation of cell survival. Through these molecular mechanisms, P2X7 is known to play important roles in physiology and pathophysiology of a wide spectrum of diseases, including cancer, inflammatory diseases, neurological, respiratory and more recently cardiovascular diseases. Recent studies demonstrated that the P2X7 could modulate the assembly of the NLRP3 inflammasome, leading to the secretion of pro-inflammatory factors and worsen the cardiac disease phenotypes. This review discusses the critical molecular function of P2X7 in the modulation of the onset, progression and resolution of cardiovascular diseases and analyses the putative future use of P2X7-based therapies that modulate the IL-1ß secretion arm and direct P2X7 antagonists.
Assuntos
Doenças Cardiovasculares/metabolismo , Miocárdio/metabolismo , Receptores Purinérgicos P2X7/metabolismo , Animais , Doenças Cardiovasculares/tratamento farmacológico , Humanos , Antagonistas do Receptor Purinérgico P2X/farmacologia , Antagonistas do Receptor Purinérgico P2X/uso terapêuticoRESUMO
Abstract The objective of this article is to turn the practices used by Occupação Coletiva da Mamá Cultiva visible to advocate to the right to access health, which would be limited by a context of occupational apartheid. A qualitative research was carried out, with a phenomenological approach, in which the information is produced by semi-structured interviews and discussion groups, with 6 groups participants. The information obtained is organized through a categorical matrix and analyzed through simple categories. The main conclusion is that the resistance practices are strongly rooted in a collective identity. This is related to the shared experiences of group individuals, especially those associated with the experience of psychosocial suffering caused by stigmatization, criminalization and prevalent medicalization.
Resumo O objetivo deste artigo é tornar visíveis as práticas utilizadas pela Ocupação Coletiva da Mama Cultiva para exercer o direito à saúde, o que seria limitado por um contexto de apartheid ocupacional. Neste estudo optou-se por pesquisa qualitativa, com abordagem fenomenológica, na qual a informação é produzida por meio de entrevistas semiestruturadas e grupos de discussão, com 6 participantes do grupo. A informação obtida é ordenada através de uma matriz categorial e é analisada através de categorias simples. A principal conclusão é que as práticas de resistência estão fortemente enraizadas na identidade coletiva. Isto está relacionado às experiências compartilhadas pelos sujeitos do grupo, especialmente aqueles associados à experiência de sofrimento psicossocial causado pela estigmatização, criminalização e a medicalização prevalente.
Resumén El objetivo de este artículo es hacer visibles las prácticas realizadas por la Ocupación Colectiva Mama Cultiva, para defender el derecho al acceso a la salud, que estaría limitado por un contexto de apartheid ocupacional. Se realizó una investigación cualitativa, con un enfoque fenomenológico, en la que la información se produce mediante entrevistas semiestructuradas y grupos de discusión, con 6 participantes. La información obtenida se organiza a través de una matriz categorial y se analiza a través de categorías simples. La conclusión principal es que las prácticas de resistencia están fuertemente arraigadas en una identidad colectiva. Esto se relaciona con las experiencias compartidas de los sujetos del grupo, especialmente aquellos asociados con la experiencia del malestar psicosocial causado por la estigmatización, la criminalización y la medicalización prevalente.
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Autoantibodies against the M2 subtype of muscarinic acetylcholine receptors with functional activities have been found in the sera of patients with dilated cardiomyopathy (DCM), and the second extracellular loop has been established as the predominant epitope. However, it has been shown that the third intracellular loop is recognized by Chagas disease patients with severe cardiac dysfunction. In this work, BALB/c mice were immunized with plasmids encoding these two epitopes, and a control group received the empty plasmid (pcDNA3 vector). Serum from these DNA-immunized animals had elevated and persistent titres of antibodies against respective antigens. Heart echocardiography indicated diminished left ventricular wall thickness and reduced ejection fraction for both epitope-immunized groups, and ergospirometry tests showed a significant decrease in the exercise time and oxygen consumption. Transfer of serum from these immunized mice into naïve recipients induced the same alterations in cardiac structure and function. Furthermore, electron microscopy analysis of donor-immunized animals revealed several ultrastructural alterations suggestive of autophagy and mitophagy, suggesting novel roles for these autoantibodies. Overall, greater functional and structural impairment was observed in the donor and recipient epitope groups, implicating the third intracellular loop epitope in the pathological effects for the first-time. Therefore, the corresponding peptides could be useful for autoimmune DCM diagnosis and targeted therapy.
Assuntos
Autoanticorpos , Autofagia/imunologia , Cardiomiopatia Dilatada/imunologia , Miocárdio/imunologia , Receptor Muscarínico M2/imunologia , Animais , Cardiomiopatia Dilatada/patologia , Modelos Animais de Doenças , Epitopos/imunologia , Feminino , Vetores Genéticos/administração & dosagem , Vetores Genéticos/genética , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Microscopia Eletrônica , Miocárdio/patologia , Miocárdio/ultraestrutura , Peptídeos/genética , Peptídeos/imunologia , Plasmídeos/genética , Receptor Muscarínico M2/genéticaRESUMO
Establecer un protocolo para la obtención de bloques de hongos utilizando agarosa como matriz. Métodos: los hongos se incluyeron en agarosa, el proceso se estandarizó y se probaron los protocolos en horno microondas, convencional y en el procesador automático para la obtención de láminas siguiendo la técnica histológica usual. Conclusiones: el protocolo del procesador para obtener múltiples láminas es reproducible y las preparaciones permitieron la visualización fácil de los hongos con coloraciones de H&E y Gomori...
To establish a protocol to obtain fungi blocks in an agarose matrix. Methods: fungi were embedded in agarose, the process was standardized and protocols were tested using a microwave oven, a conventional oven and an automated processor to obtain slides following the usual histological technique. Conclusions: the multiple slides processor protocol is reproducible and preparations allowed easy visualization of fungi with H&E and Gomori stains. Key words: agarose cell block technique, fungi, hematoxylin and eosin, Gomori...
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Humanos , Técnicas Citológicas , Sefarose , Fungos , HematoxilinaRESUMO
Sulfentrazone is amongst the most widely used herbicides for treating the main crops in the State of São Paulo, Brazil, but few studies are available on the biotransformation of this compound in Brazilian soils. Soil samples of Rhodic Hapludox soil were supplemented with sulfentrazone (0.7 µg active ingredient (a.i.) g-1 soil) and maintained at 27ºC. The soil moisture content was corrected to 30, 70 or 100 percent water holding capacity (WHC) and maintained constant until the end of the experimental period. Herbicide-free soil samples were used as controls. Another experiment was carried out using soil samples maintained at a constant moisture content of 70 percent WHC, supplemented or otherwise with the herbicide, and submitted to different temperatures of 15, 30 and 40º C. In both experiments, aliquots were removed after various incubation periods for the quantitative analysis of sulfentrazone residues by gas chromatography. Herbicide-degrading microorganisms were isolated and identified. After 120 days a significant effect on herbicide degradation was observed for the factor of temperature, degradation being higher at 30 and 40º C. A half-life of 91.6 days was estimated at 27º C and 70 percent WHC. The soil moisture content did not significantly affect sulfentrazone degradation and the microorganisms identified as potential sulfentrazone degraders were Nocardia brasiliensis and Penicillium sp. The present study enhanced the prospects for future studies on the bio-prospecting for microbial populations related to the degradation of sulfentrazone, and may also contribute to the development of strategies for the bioremediation of sulfentrazone-polluted soils.
Assuntos
Biodegradação Ambiental , Herbicidas/análise , Herbicidas/isolamento & purificação , Nocardia/isolamento & purificação , Penicillium/isolamento & purificação , Solo , Umidade do Solo , Sulfetos/análise , Cromatografia Gasosa , Métodos , População , Estudos de Amostragem , MétodosRESUMO
The aim of this work was to study herbicide degradation through selected microorganisms from humus and soil subjected to different plantation systems. The following bacterial species were identified: Klebsiella pneumoniae pneumoniae GC s.B strain 1, Pseudomonas alcaligenes, Enterobacter aerogenes GC s.A and Klebsiella pneumoniae pneumoniae GC s.B strain 2. Growth studies yet suggested the possibility of a very long lag phase. Although, culture with the herbicide presented biofilm formation and there were color changes in the herbicide that could have interfered with the espectrophotometry readings. After 5 days of incubation at 35°C, the difference in the concentration of herbicide was 14.42 percent on average and after 10 days, 35.01 percent.
Os herbicidas representam 65 por cento do consumo geral, sendo que o S-Metolachlor é um dos mais utilizados e está trazendo preocupações ambientais. Objetivamos detectar a degradação do S-Metolachlor por microorganismos de solos sob plantio. Foram identificadas as espécies bacterianas: Klebsiella pneumoniae pneumoniae GC s.B linhagem 1, Pseudomonas alcaligenes, Enterobacter aerogenes GC s.A e Klebsiella pneumoniae pneumoniae GC s.B linhagem 2. Resultados da curva de crescimento por espectrofotometria não permitiram definir diferentes fases, levando a pensar em uma fase Lag longa. Frascos de cultura demonstraram a formação de biofilme, provocando mudança na cor do herbicida, interferindo na leitura do crescimento. É possível a existência de fase Log, mas não detectável pelo método. Após 5 dias de incubação a 35°C, a diferença média de concentração do S-Metolachlor foi de 14.42 por cento, e em 10 dias, 35.01 por cento. Observou-se o aparecimento de um halo em volta das colônias, o que corrobora a hipótese de degradação microbiana do herbicida.