Exploring the potential of omics technologies in medicinal plant research: a review in Colombia / Explorando el potencial de las tecnologías ómicas en la investigación de plantas medicinales: una revisión en Colombia

This review presents advances in the implementation of high - throughput se quencing and its application to the knowledge of medicinal plants. We conducted a bibliographic search of papers published in PubMed, Science Direct, Google Scholar, Scopus, and Web of Science databases and analyzed the obtained data using VOSviewer (versi on 1.6.19). Given that medicinal plants are a source of specialized metabolites with immense therapeutic values and important pharmacological properties, plant researchers around the world have turned their attention toward them and have begun to examine t hem widely. Recent advances in sequencing technologies have reduced cost and time demands and accelerated medicinal plant research. Such research leverages full genome sequencing, as well as RNA (ribonucleic acid) sequencing and the analysis of the transcr iptome, to identify molecular markers of species and functional genes that control key biological traits, as well as to understand the biosynthetic pathways of bioactive metabolites and regulatory mechanisms of environmental responses. As such, the omics ( e.g., transcriptomics, metabolomics, proteomics, and genomics, among others) have been widely applied within the study of medicinal plants, although their usage in Colombia is still few and, in some areas, scarce. (185)

El extracto de cloroformo (CE) y las fracciones obtenidas de las raíces de Aldama arenaria se evaluaron para determinar su actividad antiproliferativa in vitro contra 10 líneas ce lulares tumorales humanas [leucemia (K - 562), mama (MCF - 7), ovario que expresa un fenotipo resistente a múltiples fármacos (NCI/ADR - RES), melanoma (UACC - 62), pulmón (NCI - H460), próstata (PC - 3), colon (HT29), ovario (OVCAR - 3), glioma (U251) y riñón (786 - 0)]. CE presentó actividad antiproliferativa débil a moderada (log GI 50 medio 1.07), mientras que las fracciones 3 y 4, enriquecidas con diterpenos de tipo pimarane [ent - pimara - 8 (14), ácido 15 - dien - 19 - oico y ent - 8(14),15 - pimaradien - 3 ß - ol], presentaron activid ad moderada a potente para la mayoría de las líneas celulares, con un log GI 50 medio de 0.62 y 0.59, respectivamente. Los resultados mostraron una acción antiproliferativa in vitro prometedora de las muestras obtenidas de A. arenaria , con los mejores resul tados para NCI/ADR - RES, HT29 y OVCAR - 3, y valores de TGI que van desde 5.95 a 28.71 µg.mL - 1, demostrando que los compuestos de esta clase pueden ser prototipos potenciales para el descubrimiento de nuevos agentes terapéuticos

Olive Oil Components as Novel Antioxidants in Neuroblastoma Treatment: Exploring the Therapeutic Potential of Oleuropein and Hydroxytyrosol.

In this review, we explored the therapeutic potential of oleuropein (OLE) and hydroxytyrosol (HT) in the treatment of neuroblastoma (NB). NB is an extracranial tumour that predominantly affects children aged between 17 and 18 months. Recurrence and drug resistance have emerged as the biggest challenges when treating NB, leading to a crucial need for new therapeutic approaches. Food of the Mediterranean Diet (MD) presents several health benefits, including that of cancer treatment. In this review, we emphasised olive oil since it is one of the main liquid ingredients of the MD. OLE is the principal phenolic compound that constitutes olive oil and is hydrolysed to produce HT. Considering that tumour cells produce increased amounts of reactive oxygen species, this review highlights the antioxidant properties of OLE and HT and how they could result in increased cellular antioxidant defences and reduced oxidative damage in NB cells. Moreover, we highlight that these phenolic compounds lead to apoptosis and cell cycle arrest, reduce the side effects caused by conventional treatments, and activate tumours that become dormant as a resistance mechanism. Future research should explore the effects of these compounds and other antioxidants on the treatment of NB in vivo.

Práticas de enfermeiros na prevenção e rastreio do câncer de mama e de colo uterino / Practices performed by nurses in the prevention and screening of breast and cervical cancer / Prácticas de enfermería en la prevención y detección del cáncer de mama y cervicouterino

Objetivo: Identificar como ocorrem as práticas de prevenção e de rastreio do câncer de mama e de colo uterino realizadas por enfermeiros que atuam na Atenção Primária à Saúde do Rio Grande do Sul. Métodos: Trata-se de um estudo de abordagem qualitativa e de natureza analítica e compreensiva. Realizou-se entrevistas semiestruturadas. Os dados foram submetidos à análise de conteúdo do tipo temática proposta por Minayo. Os colaboradores foram 58 enfermeiros atuantes na Atenção Primária à Saúde. Resultados: Os resultados apontam que as práticas se desenvolvem em um contexto de crescente autonomia profissional e de protagonismo da Enfermagem. Aspectos como proximidade e vínculo com a comunidade, outros procedimentos e ações ofertadas nos atendimentos, incluindo a condução clínica/terapêutica, na vigência de sinais e sintomas de infecção, condizem com uma atenção mais ampla às necessidades de saúde e de cuidado às mulheres. Conclusão: O estudo evidencia a importância do respaldo de protocolos para a atuação segura das práticas dos enfermeiros da Atenção Básica, visando a prevenção e rastreio do câncer de mama e de colo uterino. Esses instrumentos devem ser de fácil acesso e constantemente atualizados a fim de garantir a padronização preconizada pelo Ministério da Saúde. (AU)

Objective: To identify how the breast and cervical cancer prevention and screening practices performed by nurses working in Primary Health Care in the state of Rio Grande do Sul occurs. Methods: This is a qualitative study with an analytical and comprehensive nature. The collaborators were 58 nurses working in Primary Health Care. Results: The results indicate that the practices are developed in a context of increasing professional autonomy and the role of Nursing. Aspects such as proximity and bonding with the community, other procedures and actions offered in the consultations, including clinical/therapeutic management in cases of signs and symptoms of infection, are consistent with a broader attention to women's health and care needs. Conclusion: The study highlights the importance of supporting protocols for the safe performance of Primary Care nurses' practices, aiming at the prevention and screening of breast and cervical cancer. These documents must be easily accessible and constantly updated in order to guarantee the standardization recommended by the Ministry of Health. (AU)

Objetivo: Identificar cómo las prácticas de prevención y detección del cáncer de mama y cervicouterino son realizadas por enfermeros que actúan en la Atención Primaria de Salud en Rio Grande do Sul. Métodos: Se trata de un estudio cualitativo de carácter analítico y comprensivo. Los colaboradores fueron 58 enfermeros que actuaban en la Atención Primaria de Salud. Resultados: Los resultados indican que las prácticas se desarrollan en un contexto de aumento de la autonomía profesional y del papel de la Enfermería. Aspectos como la proximidad y el vínculo con la comunidad, otros procedimientos y acciones que se ofrecen en las consultas, incluido el manejo clínico/terapéutico en casos de signos y síntomas de infección, son consistentes con una atención más amplia a las necesidades de salud y cuidado de las mujeres. Conclusión: El estudio destaca la importancia de protocolos para la actuación segura de las prácticas de los enfermeros de Atención Primaria, con el objetivo de la prevención y el tamizaje del cáncer de mama y de cuello uterino. Estos instrumentos deben ser de fácil acceso y constantemente actualizados para garantizar la estandarización recomendada por el Ministerio de Salud. (AU)

Biomarker RIPK3 Is Silenced by Hypermethylation in Melanoma and Epigenetic Editing Reestablishes Its Tumor Suppressor Function.

For several decades, cancers have demonstrably been one of the most frequent causes of death worldwide. In addition to genetic causes, cancer can also be caused by epigenetic gene modifications. Frequently, tumor suppressor genes are epigenetically inactivated due to hypermethylation of their CpG islands, actively contributing to tumorigenesis. Since CpG islands are usually localized near promoters, hypermethylation of the promoter can have a major impact on gene expression. In this study, the potential tumor suppressor gene Receptor Interacting Serine/Threonine Protein Kinase 3 (RIPK3) was examined for an epigenetic regulation and its gene inactivation in melanomas. A hypermethylation of the RIPK3 CpG island was detected by bisulfite pyrosequencing and was accompanied by a correlated loss of its expression. In addition, an increasing RIPK3 methylation rate was observed with increasing tumor stage of melanomas. For further epigenetic characterization of RIPK3, epigenetic modulation was performed using a modified CRISPR/dCas9 (CRISPRa activation) system targeting its DNA hypermethylation. We observed a reduced fitness of melanoma cells by (re-)expression and demethylation of the RIPK3 gene using the epigenetic editing-based method. The tumor suppressive function of RIPK3 was evident by phenotypic determination using fluorescence microscopy, flow cytometry and wound healing assay. Our data highlight the function of RIPK3 as an epigenetically regulated tumor suppressor in melanoma, allowing it to be classified as a biomarker.

Color matching and color recovery in large composite restorations using single-shade or universal composites

Abstract This study assessed the color-matching ability and color recovery of unprepared teeth when using single-shade composites and a universal composite in large restorations. Buccal and palatine surface colors of molars were measured with a spectrophotometer (CIELAB) before preparing round cavities (6 mm in diameter, 2 mm in depth). The cavities were randomly filled with a single-shade composite (Omnichroma, Diamond One, or Vittra APS Unique) or a universal composite (Filtek Universal). Color measurements of the restored cavities were taken, and overall color differences (ΔEab and ΔE00) and differences in the whitening index for dentistry (ΔWID) from baseline were calculated. Additionally, visual assessments of a color match to the surrounding enamel were performed by forty evaluators (laypersons and undergraduate students of dentistry) in a viewing booth under illuminant D65, with rating scores from 0 (no color mismatch) to 4 (not acceptable). Data were analyzed using RM or one-way ANOVA (α = 0.05). Results showed that the restorations generally exhibited whiter colors (WID ranged from 27.9 to 41.3) than the unprepared teeth (WID ranged from 15.9 to 19.3). The composite Filtek Universal demonstrated the lowest color discrepancy (ΔWID = 8.6; ΔE00 = 10.8; and ΔE00 = 6.2), and no significant differences were observed among the evaluated single-shade composites. Furthermore, all composites showed similar and adequate color matches to the surrounding enamel. However, it is important to note that despite their ability to match the surrounding enamel reasonably, none of the composites evaluated in large restorations fully recovered the color observed in unprepared teeth.

Resumo Este estudo avaliou a habilidade de combinação de cores e recuperação de cor de dentes não preparados ao utilizar resinas compostas de única tonalidade e uma resina composta universal em grandes restaurações. As cores das superfícies bucais e palatinas de molares foram medidas com um espectrofotômetro (CIELAB) antes de preparar cavidades esféricas (6 mm de diâmetro, 2 mm de profundidade). As cavidades foram preenchidas aleatoriamente com uma resina composta de única tonalidade (Omnichroma, Diamond One ou Vittra APS Unique) ou com uma resina composta universal (Filtek Universal). Foram realizadas medições das cores das cavidades restauradas e calculadas as diferenças de cor globais (ΔEab and ΔE00)) e as diferenças no índice de clareamento para odontologia (ΔWID) em relação à cor inicial. Além disso, foram realizadas avaliações visuais da correspondência de cor com o esmalte circundante por quarenta avaliadores (leigos e estudantes de odontologia) em uma cabine de visualização sob iluminante D65, com pontuações de 0 (nenhuma discrepância de cor) a 4 (não aceitável). Os dados foram analisados usando RM ou ANOVA unidirecional (α = 0,05). Os resultados mostraram que as restaurações geralmente apresentavam cores mais brancas (WID variou de 27,9 a 41,3) do que os dentes não preparados (WID variou de 15,9 a 19,3). A resina composta Filtek Universal demonstrou a menor discrepância de cor (ΔWID = 8,6; ΔE00 = 10,8; and ΔE00 = 6,2), e não foram observadas diferenças significativas entre as resinas compostas de única tonalidade avaliadas. Além disso, todas as resinas compostas apresentaram correspondência de cor similar e adequada com o esmalte circundante. No entanto, é importante observar que, apesar de sua capacidade de corresponder razoavelmente com o esmalte circundante, nenhuma das resinas compostas avaliadas em grandes restaurações recuperou completamente a cor observada nos dentes não preparados.

Influence of repositioning guides' color and usage on precision in tooth color measurement with a clinical spectrophotometer

Abstract Repositioning guides are commonly employed in clinical studies to ensure consistent tooth color measurements. Yet, their influence on measured color remains uncertain. Objective This study evaluated the impact of repositioning guides' color and usage on tooth color measurement using a clinical spectrophotometer. Methodology In total, 18 volunteers participated in this study, in which the color of their upper left central incisor and upper left canine was measured with or without repositioning guides (control). The guides were made from pink, blue, or translucent silicone, as well as an acetate-based bleaching tray. Tooth color was measured in triplicates using a clinical spectrophotometer based on the CIELAB system. The standard deviations of these readings were used to estimate reproducibility, and color differences (ΔE00) between the measurements with guides and the control were calculated. Results Repositioning guides had a minimal effect on L* values and no effect on b* values. The use of pink silicone increased a* values, whereas blue or translucent silicone reduced them. Irrespective of the evaluated tooth, the lowest ΔE00 values were observed for the translucent silicone and bleaching tray. The usage of guides only affected data variability for the L* color coordinate. Conclusion Using repositioning guides can significantly impact the precision of tooth color measurement with a clinical spectrophotometer.

Construction and validity of educational technology about the human papillomavirus vaccine for adolescents.

OBJECTIVES: to construct and validate an educational technology in comic book format about the human papillomavirus vaccine aimed at adolescents. METHODS: a methodological study, with a quantitative approach, through the agreement method. It was carried out in two phases: educational technology construction and content validity. Participants are expert judges in the health field. Data collection took place in a virtual environment, through a questionnaire. Data analysis was performed by calculating the Content Validity Index. A Content Validity Index of at least 80% was accepted. RESULTS: the comic book's overall Content Validity Index was 82%, reaching the minimum limit established to be validated. CONCLUSIONS: comics are fundamental in the teaching-learning process, aiming to catch adolescents' attention. Therefore, it is characterized as a valid tool to inform, in a playful manner, about the human papillomavirus vaccine.

Zebrafish Model Insights into Mediterranean Diet Liquids: Olive Oil and Wine.

In this review, we explored the potential of a zebrafish model to investigate the antioxidant effects of key components of the Mediterranean diet, namely, olive oil and wine, in the context of preventing age-related diseases, particularly cardiovascular conditions. This paper explores the spectrum of observational studies to preclinical investigations and ultimately converges toward potential translational insights derived from animal experimentation. This review highlights the potential and underutilization of zebrafish as an experimental model in this domain. We highlighted the genetic proximity of zebrafish to humans, offering a unique opportunity for translational insights into the health benefits of olive oil and wine. Indeed, we wanted to focus on the potential of zebrafish to elucidate the health benefits of olive oil and wine while calling for continued exploration to unlock its full potential to advance our knowledge of age-related disease prevention within the Mediterranean diet framework.

Cardiovascular adverse effects associated with the use of anti-HER2 in breast cancer treatment.

Background: Cancer represents an important public health problem with increasing incidence, prevalence, and mortality, affecting the entire Western population, especially in developed and developing countries. The use of monoclonal antibodies has revolutionized the treatment of cancer, but this treatment can cause adverse cardiovascular effects (AE). Objective: The objective of this paper is to identify and classify AE in breast cancer patients in the use of Trastuzumab in two health institutions. Methods: Retrospective study of medical records of patients with breast cancer Her 2+ submitted the therapy with trastuzumab in early and advanced stage of the disease. Review conducted in a university hospital and a private clinic, both located in Rio de Janeiro State, Brazil. Results: Cardiovascular events were late for trastuzumab, with predominance of moderate reactions. There was a predominance of dyspnea, increased blood pressure, fatigue and reduced left ventricular ejection. Conclusion: The results resemble similarities in the pattern of the institutions' reactions. Identify possible AE and know the toxicity profile of trastuzumab can contribute to a safer therapy.

Effect of Systemic and Auricular Acupuncture with a 2/100 Hz Frequency and Nogier Frequency in Fibromyalgia: a Randomized Clinical Trial, Pilot Study.

Background: Fibromyalgia is a syndrome of chronic, generalized muscular pain, accompanied by sleep disturbances, fatigue and cardic autonomic dysfunction that will affect the quality of life. There is currently no gold standard treatment. There are limitations of studies with electroacupuncture in auricular acupuncture. Objectives: We evaluate the effects of systemic electroacupuncture (EA) with frequencies of 2/100 Hz associated of auricular acupuncture with a Nogier frequency (2.28, 4.56 and 9.12 Hz) for pain intensity, heart rate variability (HRV), and quality of life in fibromyalgia. Methods: Randomized clinical trial, a pilot study. Eighteen volunteers were randomized into a control group (CG, n = 9) and an experimental group (EG, n = 9). Six systemic EA sessions systemic and auricular were applied in the EG for 20 min, twice a week, for six weeks consecutive. The Numerical Pain Assessment Scale (NPRS), 2010 diagnostic criteria of the American College of Rheumatology (FDC 2010), Fibromyalgia Impact Questionnaire (FIQ) and analysis of HRV were the instruments used. The independent t-test compared to the groups was applied. Results: There was no statistically significant difference for the primary outcome for NPRS (p > 0.05). In the secondary outcome there was a significant difference in the total score and in some FIQ domains (p = 0.008) and some variables such as pain (p = 0.02) and anxiety (p = 0.006). There was no significant difference for the FDC 2010 and HRV variables (p > 0.05). Conclusion: 2/100 Hz systemic EA associated with the Nogier frequency positively influenced some quality of life variables; however, pain intensity, diagnostic criteria, and HRV variables did not change.

Non-Ulcerated and Ulcerated Necrotizing Sialometaplasia: Report of an Additional Case and Literature Review.

Necrotizing sialometaplasia (NS) is a rare, self-limiting, necrotizing inflammatory lesion, often involving the minor salivary glands of the palate. NS occurs often in men (60%) older than 45 years. Commonly, it presents as an ulcerative lesion, measuring 1 to 3 cm in diameter, with an evolution time of a few weeks or days, simulating malignancy. However, in some instances, the mucosal surface is intact, thus emphasizing the importance of considering NS in the differential diagnosis of oral ulcerative and non-ulcerative lesions. To date, 12 cases of non-ulcerated NS in the palate have been reported. Here, we report a 50-year-old male patient who presented a non-ulcerated, asymptomatic, nodular swelling 3 months ago, located on the hard palate, clinically suggesting salivary gland tumor or lymphoproliferative disorder. After biopsy, a diagnosis of non-ulcerated NS was established. After 4 weeks, the lesion evolved with complete resolution. After literature review, notably, unlike ulcerated NS, the non-ulcerated NS affected patients a decade younger (33 years vs. 45 years), with marked female predilection (83% vs. 40%) and not uncommon bilateral presentation (33% vs. 10%). NS should be considered in the differential diagnosis of ulcerative and non-ulcerative lesions affecting the palate.

Reconstrução óssea de defeito crítico com a utilização de tela de titânio: relato de caso / Bone reconstruction of a critical defect using titanium mesh: case report / Reconstrucción ósea de un defecto crítico con malla de titanio: reporte de caso

Introdução: O uso de membranas de barreira de exclusão de epitélio para regeneração óssea guiada tem sido apresentado na literatura como abordagem de tratamento bem sucedida, essas barreiras irão impedir a incorporação de células de tecidos moles no enxerto ósseo ou no es paço criado pelo defeito e permitir que apenas as células osteogênicas estejam presentes. Relato de caso: Trata-se de um caso clinico de um paciente que evoluiu com perda óssea significativa por lesão Endo-periodontal levando a perda dentaria, para a reabilitação com implantes se fez necessário uma reconstrução de um defeito crítico com a utilização de tela de titânio para arcabouço ósseo de mistura de enxerto autógeno e biomaterial e recobrimento com membrana de colágeno, o enxerto autógeno foi removido de área doadora na mandíbula e utilizado de forma particulada. Conclusão: As telas de titânio apresentam viabilidade e previsibilidade no aumento ósseo vertical, horizontal e tridimensional em decorrência da sua ampla aplicabilidade, elasticidade, plasticidade adequadas e boas propriedades mecânicas. Avanços na diminuição de suas taxas de exposição e risco de complicações no período de cicatrização melhoram a cada dia a previsibilidade da técnica, bem como a associação com outros materiais como os hemoderivados... (AU)

Introduction: The use of epithelial exclusion barrier membranes for guided bone regeneration has been presented in the literature as a successful treatment approach, these barriers will prevent the incorporation of soft tissue cells into the bone graft or the space created by the defect and allow that only osteogenic cells are present. Case report: This is a clinical case of a patient who evolved with significant bone loss due to an endo-periodontal lesion leading to tooth loss, for rehabilitation with implants it was necessary to reconstruct a critical defect using mesh titanium for bone framework of mixture of autogenous graft and biomaterial and covering with collagen membrane, the autogenous graft was removed from the donor area in the mandible and used in a particulate form. Conclusion: Titanium meshes are viable and predictable in vertical, horizontal and three-dimensional bone augmentation due to their wide applicability, adequate elasticity and plasticity, good mechanical properties. Advances in reducing their exposure rates and risk of complications during the healing period improve the predictability of the technique every day, as well as the association with other materials such as blood products... (AU)

Introducción: El uso de membranas de barrera de exclusión epitelial para la regeneración ósea guiada se ha presentado en la literatura como un enfoque de tratamiento exitoso, estas barreras evitarán la incorporación de células de tejido blando al injerto óseo o el espacio creado por el defecto y permitirán que solo presencia de células osteogénicas. Reporte de caso: Este es un caso clínico de un paciente que evolucionó con una pérdida ósea importante debido a una lesión endo-periodontal que lo llevó a la pérdida de un diente, para rehabilitación con implantes fue necesario reconstruir un defecto crítico utilizando malla de titanio para armazón óseo de mezcla de injerto autógeno y biomaterial y cubriendo con membrana de colágeno, el injerto autógeno se extrajo del área donante en la mandíbula y se usó en forma de partículas. Conclusión: Las mallas de titanio son viables y predecibles en el aumento óseo vertical, horizontal y tridimensional debido a su amplia aplicabilidad, adecuada elasticidad y plasticidad, buenas propiedades mecánicas. Los avances en la reducción de sus tasas de exposición y riesgo de complicaciones durante el periodo de cicatrización mejoran día a día la predictibilidad de la técnica, así como la asociación con otros materiales como los hemoderivados... (AU)

Gamma radiation effect on the chemical, mechanical and thermal properties of PCL/MCM-48-PVA nanocomposite films.

In this work, poly (vinyl alcohol) (PVA) was employed to produce a Mesoporous Composition of Matter-48 Modified (MCM-48-M or MCM-48-PVA). After surface modification, MCM-48-M was used to produce nanocomposite (NC) films with polycaprolactone (PCL) as a matrix at room temperature. PCL and MCM-48 nanoparticles (NPs) were chosen due to their great biocompatibility and low toxicity. However, MCM-48-M is more compatible with PCL than MCM-48. NC films were sterilized by gamma radiation with a dose of 25 kGy and characterized by experimental techniques to investigate their chemical, mechanical (tensile) and thermal properties. Scanning electron microscopy (SEM) and transmission electronic microscopy (TEM) results indicated that MCM-48-M exhibited a random distribution in the PCL matrix. The PCL chemical structure was preserved in NC films as described by Fourier transform infrared (FT-IR) spectroscopy as well as the tensile and thermal properties of NC films. FT-IR and thermogravimetric analysis (TGA) results showed surface modification. X-ray diffraction (XRD) and differential scanning calorimetry (DSC) showed that crystalline symmetries were preserved and the crystallinity of NC films had small variations in all samples before and after irradiation, respectively. But, our results did not indicate major changes showing that this method is successful for the sterilization of PCL/MCM-48-PVA NC films.

Desafios enfrentados por enfermeiros da classificação de risco em urgência e emergência / Challenges faced by risk classification nurses in urgency and emergency / Desafíos enfrentados por enfermeros clasificadores de riesgo en urgencia y emergencia

Objetivo: analisar os desafios enfrentados por enfermeiros da classificação de risco de um serviço de urgência e emergência. Método: pesquisa exploratória e descritiva, com abordagem qualitativa. A coleta de dados ocorreu em março de 2019, por meio de entrevistas semiestruturadas e individuais com enfermeiros atuantes em Unidade de Pronto Atendimento do município de Caruaru, Pernambuco, Brasil. Para a análise, utilizou-se a análise de conteúdo de Bardin. Resultados: foram geradas três categorias: assistência de enfermagem na classificação de risco; desafios do setor de classificação de risco; e desafios da ferramenta que define a classificação de risco. As participantes apontaram questões como falta de compreensão da população, protocolo defasado e discordância com outros membros da equipe como os principais desafios. Conclusão: verificou-se que a atuação da enfermagem na classificação de risco é um processo ainda complexo, que não depende estritamente de protocolos, mas de profissionais motivados, treinados continuamente e em sintonia.

Objective: to analyze the challenges faced by nurses in the risk classification of an urgency and emergency service. Method: exploratory and descriptive research, with a qualitative approach. Data collection took place in March 2019, through semi-structured and individual interviews with nurses working in an Emergency Care Unit in the city of Caruaru, Pernambuco, Brazil. For the analysis, Bardin's content analysis was used. Results: three categories were generated: nursing care in risk classification; challenges of the risk classification industry, and challenges of the tool that defines the risk classification. Participants pointed out issues such as lack of understanding of the population, outdated protocol and disagreement with other team members, as the main challenges. Conclusion: it was found that the role of nursing in risk classification is still a complex process, which does not strictly depend on protocols, but on motivated professionals, continuously trained and in tune.

Hematological Changes in Gas Station Workers.

(1) Background: Benzene, toluene, and xylene isomers (BTX) are present in gasoline. Exposure to benzene may lead to the appearance of a series of signs, symptoms, and complications, which are characterized by benzene poisoning, which is an occupational disease. This study evaluated the presence of signs and symptoms related to occupational exposure and whether occupational exposure to BTX is associated with the development of hematological changes. (2) Material and Methods: This cross-sectional epidemiological study included 542 participants, in which 324 were gas station workers (GSWs) and 218 were office workers (OWs) with no occupational exposure to benzene. To characterize the type of exposure (exposed and not exposed), trans,trans-Muconic acid (tt-MA), Hippuric acid (HA), and Methylhippuric acid (MHA) were used as exposure biomarkers. The tt-MA analysis revealed that the GSWs had 0.29 mg/g of urinary creatinine and the OWs had 0.13 mg/g of urinary creatinine. For HA, the GSWs presented 0.49 g/g of creatinine while the OWs presented 0.07. MHA analysis revealed that the GSWs had 1.57 g/g creatinine and the OWs had 0.01 g/g creatinine. Occupation habits and clinical symptoms were collected by questionnaire and blood samples were analyzed for hematological parameters. The persistence of hematological changes was evaluated with three serial blood collections every 15 days followed by laboratory hematological analysis. A descriptive analysis by the Chi-square test method was performed to evaluate the association between occupational exposure to fuels and the occurrence of changes in hematological parameters. (3) Results: In the GSWs, the most described signs and symptoms were somnolence (45.1%), headache (38.3%), dizziness (27.5%), tingling (25.4%), and involuntary movement (25%). Twenty GSWs that presented hematological alterations performed serial collections fifteen days apart. In addition, these workers presented total leukocyte counts above the upper limit and lymphocyte counts close to the lower limit. Leukocytosis and lymphopenia are hematological alterations present in chronic benzene poisoning. (4) Conclusions: The results found an initial change in different hematological parameters routinely used in clinics to evaluate health conditions. These findings reveal the importance of valuing clinical changes, even in the absence of disease, during the health monitoring of gas station workers and other groups that share the same space.

Risk and characteristics of attacks occurring after vaccination in patients with neuromyelitis optica spectrum disorders: A systematic review and meta-analysis.

BACKGROUND: Vaccination in patients with neuromyelitis optica spectrum disorders (NMOSD) is challenging because there is a concern that vaccines can lead to clinical attacks. However, little is known about the risk and the characteristics of attacks occurring after vaccination. METHODS: We performed a systematic review and meta-analysis using PubMed and Embase databases to estimate a summary frequency of attacks occurring after vaccination and describe the clinical features of theses attacks. We defined attacks occurring after vaccination as typical NMOSD attacks that occurred up to 30 days after vaccine administration.  For the frequency of attacks occurring after vaccination, we selected observational studies that reported the number of attacks and total number of patients that received vaccines; for the clinical description of the attacks, case reports and case series were also included. RESULTS: We included 377 participants from 5 studies to estimate the frequency of NMOSD attacks occurring after vaccination. We found a summary frequency of of 2% (95% CI 1-4%, I2 = 0%). We evaluated 17 studies to identify that 13 different vaccines were associated with NMOSD attacks. A higher-than-expected proportion of males, simultaneous optic neuritis and transverse myelitis attacks, and anti-aquaporin 4 antibody negative cases were identified in vaccine-associated attacks from 24 participants from 17 studies. Nearly two-thirds of attacks occurring after vaccination were an initial event of NMOSD. CONCLUSION: The frequency of NMOSD attacks occurring after vaccination is low and non-specific to different vaccine technologies. Our work reinforces the safety of vaccine recommendations in patients with NMOSD.

COVID-19-Related Acalculous Groove Pancreatitis.

Introduction: Groove pancreatitis is a rare form of chronic pancreatitis. Its radiological diagnosis is challenging and it can be difficult to distinguish from pancreaticoduodenal malignancy. Case description: A 64-year-old woman was admitted to our internal medicine ward after she contracted severe COVID-19 pneumonia requiring mechanical ventilation. She presented with right upper abdominal pain, and a CT scan showed pancreaticoduodenal inflammatory tissue; malignancy was ruled out. Conclusion: Diagnosing groove pancreatitis is challenging and malignancy must be quickly excluded. No cases of COVID-19-associated groove pancreatitis have been previously described. LEARNING POINTS: Groove or paraduodenal pancreatitis is a rare form of chronic pancreatitis, and usually associated with alcohol use.The differential diagnosis includes pancreaticobiliary and duodenal malignancies.Radiological diagnosis is challenging and treatment is usually supportive.

Lymphomatoid Papulosis "Type E" Affecting the Palate: A Detailed Case Report and Review of Literature.

ABSTRACT: Lymphomatoid papulosis (LyP) belongs to the spectrum of primary cutaneous CD30 + lymphoproliferative disorders, characterized by chronic, recurrent, self-healing papules, small nodules, or ulcers. The clinicopathological features of LyP can mimic overt lymphomas. To date, about 27 intraoral LyP cases have been reported. Of them, only 2 cases were diagnosed as angioinvasive LyP (type E). Herein, we report a 24-year-old Brazilian man who presented a large ulcerated lesion on the hard palate with rapid evolution. Remarkably, there was no involvement of the skin or other mucous membranes. Microscopy revealed a lymphoid infiltrate constituted by medium-sized to large atypical cells, with angiocentric and angiodestructive features. The atypical cells showed immunopositivity for CD3, CD8, CD30, CD56, granzyme B, perforin, and focally for MUM1/IRF4. Ki-67 highlighted almost all atypical lymphoid cells, whereas EBER1/2 was negative. After 2 months of follow-up, the lesion healed completely. Although rare, LyP type E should be included in the differential diagnosis of oral ulcers.

Association of Tumor Necrosis Factor-α (-G308A) Polymorphism with risk of Upper Gastrointestinal Bleeding from Schistosomiasis in Pernambuco.

BACKGROUND: We evaluated the association between polymorphisms in the tumor necrosis factor alpha (TNF-α) (-G308A) gene and upper gastrointestinal bleeding (UGIB) in schistosomiasis. METHODS: This was a transverse study involving 294 Brazilian patients infected with Schistosoma mansoni. RESULTS: The homozygous A/A genotype in TNF-α (-G308A) showed a risk association (prevalence ratio = 1.90, p = 0.008) with UGIB. There was no statistically significant difference in serum TNF-α levels between the clinical groups. CONCLUSIONS: The polymorphic TNF-α (-G308A) can be a risk factor for UGIB, in addition to being a potentially predictive factor for the severity of UGIB in schistosomiasis.