Nurses' workload during the COVID-19 pandemic: potential for experiences of moral distress / Carga de trabajo de las enfermeras durante la pandemia de COVID-19: potencial para experiencias de sufrimiento moral / Sobrecarga de trabalho de enfermeiros na pandemia de COVID-19: potência para vivências de sofrimento moral

ABSTRACT Objectives: to understand nurses' experiences of moral distress related to work overload during the COVID-19 pandemic in Brazil. Methods: qualitative research, whose data collection occurred through individual interviews with 19 nurses who worked on the front line of COVID-19 in health services in southeastern Brazil. Data were analyzed using thematic content analysis. Results: work overload proved to be a powerful source of experiences of moral distress due to excessive working hours during vaccination, double working hours, a troubled relationship due to pressure from managers and the population and physical and mental exhaustion, which prevented nurses from act according to their judgment. Final Considerations: nurses' work overload reflects on quality patient care and prevents nurses from acting in accordance with their moral principles, generating moral distress in nurses.

RESUMEN Objetivos: comprender las experiencias de angustia moral de los enfermeros relacionadas con la sobrecarga de trabajo durante la pandemia de COVID-19 en Brasil. Métodos: investigación cualitativa, cuya recolección de datos ocurrió a través de entrevistas individuales con 19 enfermeros que actuaron en la primera línea de COVID-19 en servicios de salud de la región Sudeste de Brasil. Los datos fueron analizados mediante análisis de contenido temático. Resultados: la sobrecarga de trabajo resultó ser una poderosa fuente de experiencias de sufrimiento moral por exceso de jornada durante la vacunación, doble jornada laboral, relaciones conflictivas por presiones de los directivos y la población y agotamiento físico y mental, lo que impidió al enfermero actuar según su criterio. Consideraciones Finales: la sobrecarga de trabajo de las enfermeras se refleja en la calidad de la atención al paciente e impide que las enfermeras actúen de acuerdo con sus principios morales, generando sufrimiento moral en las enfermeras.

RESUMO Objetivos: compreender vivências de sofrimento moral de enfermeiros relacionadas à sobrecarga de trabalho durante a pandemia de COVID-19 no Brasil. Métodos: pesquisa qualitativa, cuja coleta de dados ocorreu através de entrevistas individuais com 19 enfermeiros que atuaram na linha de frente da COVID-19 em serviços de saúde da região Sudeste do Brasil. Os dados foram analisados mediante análise temática de conteúdo. Resultados: a sobrecarga de trabalho mostrou-se potente fonte para vivências de sofrimento moral devido à jornada de trabalho excessiva na vacinação, à dupla jornada de trabalho, à relação conturbada por pressão de gestores e população e ao esgotamento físico e mental, os quais impediam o enfermeiro de agir conforme o seu julgamento. Considerações Finais: a sobrecarga de trabalho dos enfermeiros reflete na assistência de qualidade ao paciente, e impede que os enfermeiros atuem conforme os seus princípios morais, gerando sofrimento moral nos enfermeiros.

Vertical sleeve gastrectomy improves glucose-insulin homeostasis by enhancing ß-cell function and survival via FGF15/19.

Vertical sleeve gastrectomy (VSG) restores glucose homeostasis in obese mice and humans. In addition, the increased fibroblast growth factor (FGF)15/19 circulating level postsurgery has been implicated in this effect. However, the impact of FGF15/19 on pancreatic islets remains unclear. Using a diet-induced obese mice model, we demonstrate that VSG attenuates insulin hypersecretion in isolated pancreatic islets, likely due to morphological alterations in the endocrine pancreas such as reduction in islet, ß-cell, and α-cell mass. In addition, VSG relieves gene expression of endoplasmic reticulum (ER) stress and inflammation markers in islets from obese mice. Incubation of INS-1E ß-cells with serum from obese mice induced dysfunction and cell death, whereas these conditions were not induced with serum from obese mice submitted to VSG, implicating the involvement of a humoral factor. Indeed, VSG increased FGF15 circulating levels in obese mice, as well as the expression of FGF receptor 1 (Fgfr1) and its coreceptor ß-klotho (Klb), both in pancreatic islets from VSG mice and in INS-1E cells treated with the serum from these mice. Moreover, exposing INS-1E cells to an FGFR inhibitor abolished the effects of VSG serum on insulin secretion and cell death. Also, recombinant FGF19 prevents INS-1E cells from dysfunction and death induced by serum from obese mice. These findings indicate that the amelioration of glucose-insulin homeostasis promoted by VSG is mediated, at least in part, by FGF15/19. Therefore, approaches promoting FGF15/19 release or action may restore pancreatic islet function in obesity.NEW & NOTEWORTHY Vertical sleeve gastrectomy (VSG) decreases insulin secretion, endoplasmic reticulum (ER) stress, and inflammation in pancreatic islets from obese mice. In addition, VSG increased fibroblast growth factor (FGF)15 circulating levels in obese mice, as well as the expression of FGF receptor 1 (Fgfr1) and its coreceptor ß-klotho (Klb), both in pancreatic islets from VSG mice and in INS-1E ß-cells treated with the serum from these mice. Serum from operated mice protects INS-1E cells from dysfunction and apoptosis, which was mediated by FGF15/19.

Perfil medicamentoso e frequência de polifarmácia em idosos de uma Unidade Básica de Saúde / Drug profile and frequency of polypharmacy in elderly people in a Primary Care Unit / Perfil farmacológico y frecuencia de polifarmacia en ancianos en una Unidad Básica de Salud

Objetivo: identificar o perfil medicamentoso e a frequência de polifarmácia em idosos cadastrados e que fazem acompanhamento em uma unidade básica de saúde. Método: estudo observacional e retrospectivo, realizado em uma unidade básica de saúde de um município do Triângulo Mineiro, Minas Gerais. Foi realizada amostragem aleatória e estratificada para coleta de dados de prontuários físicos e eletrônicos de idosos atendidos nos anos de 2019 e 2020, analisados por meio de estatística descritiva. Resultados: entre 448 prontuários foram analisados, porém somente 208 (46,4%) foram válidos. Os medicamentos mais prescritos foram losartana (n=72; 34,6%), sinvastatina (n=60; 28,8%) e metformina (n=51; 24,5%). Observou-se 24,0% de frequência de polifarmácia (n=51), maior frequência de mulheres (n=42; 30,2%) e com significativa associação com diabetes mellitus (p=0,034). Conclusão: a polifarmárcia foi detectada, mais presente nas mulheres, sendo que medicamentos mais utilizados foram relacionados à hipertensão arterial, dislipidemias e diabetes mellitus. Destaca-se a incompletude de informações nos prontuários analisados.

Objective: to identify the medication profile and frequency of polypharmacy in registered elderly people who are followed up at a primary care unit. Method: observational and retrospective study, carried out in a primary care unit in a municipality in Triângulo Mineiro, Minas Gerais. Random and stratified sampling was carried out to collect data from the physical and electronic medical records of the elderly assisted in the years 2019 and 2020, analyzed using descriptive statistics. Results: among 448 medical records analyzed, 208 (46.4%) were considered valid for inclusion in the study. The most prescribed drugs were losartan (n=72; 34.6%), simvastatin (n=60; 28.8%) and metformin (n=51; 24.5%). There was a 24.0% frequency of polypharmacy (n=51), a higher frequency of wome (n=42; 30.2%) and with a significant association with diabetes mellitus (p=0.034). Conclusion: polypharmacy was detected, more present in women, and the most used drugs were related to arterial hypertension, dyslipidemia and diabetes mellitus. The incompleteness of information in the analyzed medical records stands out. Descriptors: Health of the Elderly; Aged; Primary Health Care; Polypharmacy.

Objetivo: identificar el perfil farmacológico y frecuencia de polifarmacia en ancianos registrados en seguimiento en una unidad básica de salud. Método: estudio observacional y retrospectivo, realizado en una unidad básica de salud de un municipio del Triângulo Mineiro, Minas Gerais. Se realizó un muestreo aleatorio y estratificado para recolectar datos de las historias clínicas físicas y electrónicas de los ancianos atendidos en los años 2019 y 2020, analizados mediante estadística descriptiva. Resultados: de 448 historias clínicas analizadas, 208 (46,4%) fueron consideradas válidas para su inclusión en el estudio. Los fármacos más prescritos fueron Losartán (n=72; 34,6%), Simvastatina (n=60; 28,8%) y Metformina (n=51; 24,5%). La frecuencia de polifarmacia estuvo en el 24,0% (n=51), mayor frecuencia de mujeres (n=42; 30,2%) y con asociación significativa con diabetes mellitus (p=0,034). Conclusión: se detectó la polifarmacia, más presente en las mujeres; los fármacos más utilizados estuvieron relacionados con hipertensión arterial, dislipidemia y diabetes mellitus. Se destaca la incompletitud de la información en las historias clínicas analizadas.

Molecular BCR::ABL1 Quantification and ABL1 Mutation Detection as Essential Tools for the Clinical Management of Chronic Myeloid Leukemia Patients: Results from a Brazilian Single-Center Study.

Chronic myeloid leukemia (CML) is a well-characterized oncological disease in which virtually all patients possess a translocation (9;22) that generates the tyrosine kinase BCR::ABL1 protein. This translocation represents one of the milestones in molecular oncology in terms of both diagnostic and prognostic evaluations. The molecular detection of the BCR::ABL1 transcription is a required factor for CML diagnosis, and its molecular quantification is essential for assessing treatment options and clinical approaches. In the CML molecular context, point mutations on the ABL1 gene are also a challenge for clinical guidelines because several mutations are responsible for tyrosine kinase inhibitor resistance, indicating that a change may be necessary in the treatment protocol. So far, the European LeukemiaNet and the National Comprehensive Cancer Network (NCCN) have presented international guidelines on CML molecular approaches, especially those related to BCR::ABL1 expression. In this study, we show almost three years' worth of data regarding the clinical treatment of CML patients at the Erasto Gaertner Hospital, Curitiba, Brazil. These data primarily comprise 155 patients and 532 clinical samples. BCR::ABL1 quantification by a duplex-one-step RT-qPCR and ABL1 mutations detection were conducted. Furthermore, digital PCR for both BCR::ABL1 expression and ABL1 mutations were conducted in a sub-cohort. This manuscript describes and discusses the clinical importance and relevance of molecular biology testing in Brazilian CML patients, demonstrating its cost-effectiveness.

Sleeve Gastrectomy-Induced Weight Loss Increases Insulin Clearance in Obese Mice.

Sleeve gastrectomy (SG) successfully recovers metabolic homeostasis in obese humans and rodents while also resulting in the normalization of insulin sensitivity and insulinemia. Reduced insulin levels have been attributed to lower insulin secretion and increased insulin clearance in individuals submitted to SG. Insulin degradation mainly occurs in the liver in a process controlled, at least in part, by the insulin-degrading enzyme (IDE). However, research has yet to explore whether liver IDE expression or activity is altered after SG surgery. In this study, C57BL/6 mice were fed a chow (CTL) or high-fat diet (HFD) for 10 weeks. Afterward, the HFD mice were randomly assigned to two groups: sham-surgical (HFD-SHAM) and SG-surgical (HFD-SG). Here, we confirmed that SG improves glucose-insulin homeostasis in obese mice. Additionally, SG reduced insulinemia by reducing insulin secretion, assessed by the analysis of plasmatic C-peptide content, and increasing insulin clearance, which was evaluated through the calculation of the plasmatic C-peptide:insulin ratio. Although no changes in hepatic IDE activity were observed, IDE expression was higher in the liver of HFD-SG compared with HFD-SHAM mice. These results indicate that SG may be helpful to counteract obesity-induced hyperinsulinemia by increasing insulin clearance, likely through enhanced liver IDE expression.

Genetic counseling and carrier screening in candidates for gamete donation at a Portuguese center.

OBJECTIVE: Genetic counseling and carrier screening are part of the gamete donation process by healthy individuals. We aim to review the findings of genetic counseling and carrier screening of a cohort of candidates at our public gametes bank. METHODS: Thirty-four male and 64 female candidates had genetic counseling with a medical geneticist before donation. Of these, one female candidate voluntarily dropped-out. Thirty-four males and 63 females performed karyotype and screening for the more common pathogenic variants for CFTR-related cystic fibrosis and spinal muscular atrophy (SMN1) in the Portuguese population. In addition, all females also performed Fragile X expansion screening (FMR1). Thirty candidates with known or assumed African ancestry performed hemoglobinopathies screening. RESULTS: Six candidates were definitely or temporarily withheld from the donation process given their family or personal history that required further investigation. Of 97 candidates tested, 16.5% presented anomalous laboratory results (16/97): ten candidates were carriers for an autosomal recessive disorder - cystic fibrosis (5/97), sickle cell anemia (3/30), and spinal muscular atrophy (2/97). One female was an FMR1 pre-mutation carrier (1/63). One female candidate presented with triple X mosaicism: 47,XXX[2]/46,XX[50]. Two candidates presented with chromosomal instability of unknown origin. In one candidate, a mosaic for the Philadelphia chromosome was detected, revealing the diagnosis of chronic myeloid leukemia. CONCLUSIONS: From a cohort of 97 candidates, 21.7% had a family/personal history or an anomalous laboratory result that required additional genetic counseling, stressing the importance of performing pre-donation genetic counseling in this population.

Perfil sociodemográfico e fragilidade de prontuários de idosos atendidos em uma unidade básica de saúde / Sociodemographic profile and fragility of medical records of elderly people treated at a basic health unit / Perfil sociodemográfico y fragilidad de los prontuarios de ancianos en una unidad básica de salud

Objetivo: identificar o perfil sociodemográfico de idosos de uma Unidade Básica de Saúde e detectar o provimento de informações nos prontuários da unidade. Métodos: Estudo quantitativo, descritivo, retrospectivo, realizado em uma Unidade Básica de Saúde de um município do Triângulo Sul de Minas Gerais. A coleta de dados ocorreu de abril a agosto de 2021, após amostragem probabilista com prontuários físicos e eletrônicos de idosos atendidos em 2019/2020. Foi utilizado instrumento validado por juízes contendo variáveis sociodemográficas e realizado análise descritiva. Resultados: A amostra foi composta por 448 prontuários, predominaram mulheres, brancas, aposentadas, casadas/com companheiro(a), com ensino fundamental incompleto, que não faziam uso de bebida alcoólica e não fumantes. Na maioria destas variáveis, havia ausência de informações nos prontuários. Conclusões: A falta de dados chama a atenção ao reconhecer fragilidades no provimento de informações de saúde da população nos prontuários desta unidade.

Objective: to identify the sociodemographic profile of the elderly in a Basic Health Unit and detect the provision of information in the unit's medical records. Methods: Quantitative, descriptive, retrospective study, carried out in a Basic Health Unit in a municipality in the Southern Triangle of Minas Gerais. Data collection took place from April to August 2021, after probabilistic sampling with physical and electronic medical records of elderly people assisted in 2019/2020. An instrument validated by judges containing sociodemographic variables was used and a descriptive analysis was performed. Results: The sample consisted of 448 medical records, predominantly women, white, retired, married/with a partner, with incomplete primary education, who did not use alcohol and non-smokers. In most of these variables, there was no information in the medical records. Conclusions: The lack of data draws attention when recognizing weaknesses in the provision of health information to the population in the medical records of this unit.

Objetivo: identificar el perfil sociodemográfico de los ancianos en una Unidad Básica de Salud y detectar la provisión de información en los prontuarios de la unidad. Métodos: Estudio cuantitativo, descriptivo, retrospectivo, realizado en una Unidad Básica de Salud de un municipio del Triángulo Sur de Minas Gerais. La recolección de datos ocurrió de abril a agosto de 2021, después de un muestreo probabilístico con prontuario físico y electrónico de ancianos atendidos en 2019/2020. Se utilizó un instrumento validado por jueces que contiene variables sociodemográficas y se realizó un análisis descriptivo. Resultados: La muestra estuvo constituida por 448 historias clínicas, predominantemente mujeres, blancas, jubiladas, casadas/con pareja, con instrucción primaria incompleta, que no consumieran alcohol y no fumadoras. En la mayoría de estas variables no había información en las historias clínicas. Conclusiones: Llama la atención la falta de datos al reconocer debilidades en la provisión de información de salud a la población en las historias clínicas de esta unidad.

Síndrome de Melkersson-Rosenthal como diagnóstico diferencial de edema labial / Melkersson-Rosenthal syndrome as a differential diagnosis of lip swelling

A síndrome de Melkersson-Rosenthal é uma condição rara caracterizada pela tríade clássica: edema orofacial, língua fissurada e paralisia facial. Pode haver apenas uma ou duas manifestações por tempo prolongado, dificultando o diagnóstico. É denominada queilite de Miescher quando a única manifestação é o edema orofacial, com histologia característica. O presente relato tem como objetivo alertar para o diagnóstico da síndrome de Melkersson- Rosenthal em casos de angioedema labial crônico, com revisão da literatura. Mulher de 40 anos apresentando edema labial desde os 23 anos de idade, sem regressão há cinco anos, sem prurido, sem desencadeantes. Observou-se língua fissurada ao exame físico. Sem alterações aos exames complementares. O edema orofacial persistente, a língua fissurada, a biópsia de lábio inferior evidenciando queilite crônica (hiperqueratose e infiltração linfocítica perivascular) e a exclusão de diagnósticos diferenciais através de exames complementares permitiram o diagnóstico da síndrome de Melkersson-Rosenthal. A paciente foi então encaminhada à Cirurgia Plástica, que orientou retirada cirúrgica do excesso labial. O diagnóstico da síndrome é essencialmente clínico. O tratamento deve ser individualizado, visando o alívio das manifestações clínicas apresentadas em cada caso. É importante o acompanhamento multiprofissional tentando minimizar danos psicológicos e melhorar o prognóstico. A síndrome de Melkersson- Rosenthal pode apresentar-se como angioedema labial crônico e língua fissurada, sem paralisia facial, podendo retardar o diagnóstico, como no presente caso. É necessária a lembrança da síndrome para o diagnóstico e conduta mais precoce, para melhor qualidade de vida destes pacientes.

Melkersson-Rosenthal syndrome is a rare condition characterized by the classic triad: orofacial edema, fissured tongue, and facial paralysis. Only 1 or 2 manifestations of the triad may be present for a prolonged time, making diagnosis difficult. It is called Miescher's cheilitis when the only manifestation is orofacial edema, with characteristic histology. The present report aims to alert to the diagnosis of Melkersson-Rosenthal syndrome in cases of chronic lip angioedema, with a review of the literature. A 40- year-old woman presented with lip swelling since the age of 23, with no regression of the swelling for 5 years, without pruritus or triggers. A fissured tongue was observed on physical examination. Complementary tests showed no abnormalities. Persistent orofacial edema, fissured tongue, lower lip biopsy showing chronic cheilitis (hyperkeratosis and perivascular lymphocytic infiltration) and the exclusion of differential diagnoses through complementary tests led to the diagnosis of Melkersson-Rosenthal syndrome. The patient was then referred to the Plastic Surgery Service, which recommended surgical removal of excess lip tissue. The diagnosis of the syndrome is essentially clinical. Treatment should be individualized, aiming to alleviate the clinical manifestations in each case. Multidisciplinary follow-up is important to minimize psychological damage and improve prognosis. Melkersson- Rosenthal syndrome can present as chronic lip angioedema and fissured tongue, without facial paralysis, which may delay the diagnosis, as in the present case. It is necessary to consider the syndrome to allow earlier diagnosis and management and to provide a better quality of life for these patients.

Rosiglitazone protects INS-1E cells from human islet amyloid polypeptide toxicity.

Human islet amyloid polypeptide (hIAPP or amylin) is a hormone co-secreted with insulin by pancreatic ß-cells, and is the main component of islet amyloid. Islet amyloid is found in the pancreas of patients with type 2 diabetes and may be involved in ß-cell dysfunction and death, observed in this disease. Thus, counteracting islet amyloid toxicity represents a therapeutic approach to preserve ß-cell mass and function. In this sense, thiazolidinediones (TZDs), as rosiglitazone, have shown protective effects against other harmful insults to ß-cells. For this reason, we investigated whether rosiglitazone could protect ß-cells from hIAPP-induced cell death and the underlying mechanisms mediating such effect. Here, we show that rosiglitazone improved the viability of hIAPP-exposed INS-1E cells. This benefit is not dependent on the insulin-degrading enzyme (IDE) since rosiglitazone did not modulate IDE protein content and activity. However, rosiglitazone inhibited hIAPP fibrillation and decreased hIAPP-induced expression of C/EBP homologous protein (CHOP) (CTL 100.0 ± 8.4; hIAPP 182.7 ± 19.1; hIAPP + RGZ 102.8 ± 9.5), activating transcription factor-4 (ATF4) (CTL 100.0 ± 3.1; hIAPP 234.9 ± 19.3; hIAPP + RGZ 129.6 ± 3.0) and phospho-eukaryotic initiation factor 2-alpha (p-eIF2α) (CTL 100.0 ± 31.1; hIAPP 234.1 ± 36.2; hIAPP + RGZ 150.4 ± 18.0). These findings suggest that TZDs treatment may be a promising approach to preserve ß-cell mass and function by inhibiting islet amyloid formation and decreasing endoplasmic reticulum stress hIAPP-induced.

Inherited human Apollo deficiency causes severe bone marrow failure and developmental defects.

Inherited bone marrow failure syndromes (IBMFSs) are a group of disorders typified by impaired production of 1 or several blood cell types. The telomere biology disorders dyskeratosis congenita (DC) and its severe variant, Høyeraal-Hreidarsson (HH) syndrome, are rare IBMFSs characterized by bone marrow failure, developmental defects, and various premature aging complications associated with critically short telomeres. We identified biallelic variants in the gene encoding the 5'-to-3' DNA exonuclease Apollo/SNM1B in 3 unrelated patients presenting with a DC/HH phenotype consisting of early-onset hypocellular bone marrow failure, B and NK lymphopenia, developmental anomalies, microcephaly, and/or intrauterine growth retardation. All 3 patients carry a homozygous or compound heterozygous (in combination with a null allele) missense variant affecting the same residue L142 (L142F or L142S) located in the catalytic domain of Apollo. Apollo-deficient cells from patients exhibited spontaneous chromosome instability and impaired DNA repair that was complemented by CRISPR/Cas9-mediated gene correction. Furthermore, patients' cells showed signs of telomere fragility that were not associated with global reduction of telomere length. Unlike patients' cells, human Apollo KO HT1080 cell lines showed strong telomere dysfunction accompanied by excessive telomere shortening, suggesting that the L142S and L142F Apollo variants are hypomorphic. Collectively, these findings define human Apollo as a genome caretaker and identify biallelic Apollo variants as a genetic cause of a hitherto unrecognized severe IBMFS that combines clinical hallmarks of DC/HH with normal telomere length.

Frequência de queixas de deglutição e alimentação durante consulta compartilhada em cuidados paliativos oncológicos / Frequency of swallowing and food complaints during shared consultation in oncological palliative care

RESUMO Objetivo identificar a frequência de queixas de deglutição e alimentação em pacientes oncológicos em cuidados paliativos e associá-las com os dados clínicos e funcionais. Métodos estudo transversal e descritivo, realizado com pacientes oncológicos atendidos durante consulta compartilhada em ambulatório de cuidados paliativos, por meio de triagem fonoaudiológica, protocolos e escalas, com análise estatística dos dados obtidos. Resultados amostra constituída de 52 indivíduos, atendidos durante 8 meses, com média de idade de 66,7 anos, Palliative Performance Scale (PPS) média de 57,5. A topografia da neoplasia mais frequente foi trato gastrointestinal e o tratamento foi cirurgia, quimioterapia e radioterapia associadas. As queixas da triagem foram categorizadas em deglutição e alimentação. Dessa forma, as de deglutição foram as mais frequentes e grande parte da amostra necessitou de avaliação funcional da deglutição. Apenas a associação entre queixas de deglutição e a topografia de trato gastrointestinal apresentou relação estatisticamente significativa. As queixas de deglutição foram mais frequentes nos pacientes submetidos à radioterapia e com menores porcentagens na escala PPS. Conclusão as queixas de deglutição foram as mais frequentes e as associações permitiram relacioná-las à localização do tumor e identificar sua frequência, conforme o tratamento oncológico e declínio funcional da terminalidade.

ABSTRACT Purpose to identify the frequency of swallowing and feeding complaints in cancer patients in palliative care, and to associate them with clinical and functional data. Methods cross-sectional and descriptive study, carried out with cancer patients treated during shared consultation in a palliative care outpatient clinic, through speech-language pathology screening, protocols and scales, with statistical analysis of the obtained data. Results Sample consisted of 52 subjects, seen during 8 months, with a mean age of 66.7 years, PSS (Palliative Performance Scale) a mean of 57.5. The topography of the most frequent neoplasm was the gastrointestinal tract and the treatment was surgery and associated chemotherapy and radiotherapy . Complaints identified at screening were categorized into swallowing and feeding. Thus, swallowing was the most frequent and a large part of the sample required a functional assessment of swallowing. Only the association between swallowing complaints and the topography of the gastrointestinal tract showed a significant statistical relationship. Swallowing complaints were more frequent in those undergoing radiotherapy and with lower percentages on the PPS scale. Conclusion swallowing complaints were the most frequent and the associations made it possible to relate them to the location of the tumor, and to identify their frequency according to cancer treatment and terminal functional decline.

Energy homeostasis deregulation is attenuated by TUDCA treatment in streptozotocin-induced Alzheimer's disease mice model.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the most common cause of dementia. While cognitive deficits remain the major manifestation of AD, metabolic and non-cognitive abnormalities, such as alterations in food intake, body weight and energy balance are also present, both in AD patients and animal models. In this sense, the tauroursodeoxycholic acid (TUDCA) has shown beneficial effects both in reducing the central and cognitive markers of AD, as well as in attenuating the metabolic disorders associated with it. We previously demonstrated that TUDCA improves glucose homeostasis and decreases the main AD neuromarkers in the streptozotocin-induced AD mouse model (Stz). Besides that, TUDCA-treated Stz mice showed lower body weight and adiposity. Here, we investigated the actions of TUDCA involved in the regulation of body weight and adiposity in Stz mice, since the effects of TUDCA in hypothalamic appetite control and energy homeostasis have not yet been explored in an AD mice model. The TUDCA-treated mice (Stz + TUDCA) displayed lower food intake, higher energy expenditure (EE) and respiratory quotient. In addition, we observed in the hypothalamus of the Stz + TUDCA mice reduced fluorescence and gene expression of inflammatory markers, as well as normalization of the orexigenic neuropeptides AgRP and NPY expression. Moreover, leptin-induced p-JAK2 and p-STAT3 signaling in the hypothalamus of Stz + TUDCA mice was improved, accompanied by reduced acute food intake after leptin stimulation. Taken together, we demonstrate that TUDCA treatment restores energy metabolism in Stz mice, a phenomenon that is associated with reduced food intake, increased EE and improved hypothalamic leptin signaling. These findings suggest treatment with TUDCA as a promising therapeutic intervention for the control of energy homeostasis in AD individuals.

Effects of growth hormone-releasing hormone agonistic analog MR-409 on insulin-secreting cells under cyclopiazonic acid-induced endoplasmic reticulum stress.

The endoplasmic reticulum (ER) stress is one of the mechanisms related to decreased insulin secretion and beta cell death, contributing to the progress of type 2 diabetes mellitus (T2D). Thus, investigating agents that can influence this process would help prevent the development of T2D. Recently, the growth-hormone-releasing hormone (GHRH) action has been demonstrated in INS-1E cells, in which it increases cell proliferation and insulin secretion. As the effects of GHRH and its agonists have not been fully elucidated in the beta cell, we proposed to investigate them by evaluating the role of the GHRH agonist, MR-409, in cells under ER stress. Our results show that the agonist was unable to ameliorate or prevent ER stress. However, cells exposed to the agonist showed less oxidative stress and greater survival even under ER stress. The mechanisms by which GHRH agonist, MR-409, leads to these outcomes require further investigation.

Aging Reduces Insulin Clearance in Mice.

Hyperinsulinemia is frequently associated with aging and may cause insulin resistance in elderly. Since insulin secretion and clearance decline with age, hyperinsulinemia seems to be maintained, primarily, due to a decrease in the insulin clearance. To investigate these aging effects, 3- and 18-month-old male C57BL/6 mice were subjected to intraperitoneal glucose and insulin tolerance tests (ipGTT and ipITT) and, during the ipGTT, plasma c-peptide and insulin were measure to evaluate in vivo insulin clearance. Glucose-stimulated insulin secretion in isolated pancreatic islets was also assessed, and liver samples were collected for molecular analyses (western blot). Although insulin sensitivity was not altered in the old mice, glucose tolerance, paradoxically, seems to be increased, accompanied by higher plasma insulin, during ipGTT. While insulin secretion did not increase, insulin clearance was reduced in the old mice, as suggested by the lower c-peptide:insulin ratio, observed during ipGTT. Carcinoembryonic antigen-related cell adhesion molecule-1 (CEACAM1) and insulin-degrading enzyme (IDE), as well as the activity of this enzyme, were reduced in the liver of old mice, justifying the decreased insulin clearance observed in these mice. Therefore, loss of hepatic CEACAM1 and IDE function may be directly related to the decline in insulin clearance during aging.

Propriedades físico-químicas dos cimentos AH Plus e Sealer Plus: tempo de endurecimento e escoamento / Physicochemical properties of AH Plus and Sealer Plus cements: hardening and flow time

Introdução: O tratamento endodôntico busca sanificar o sistema de canais radiculares para permitir adequada obturação tridimensional. Para tanto, necessita-se de materiais plásticos, como a guta-percha, associados a cimentos endodônticos com adequadas características físico-químicas. Métodos: Comparação das propriedades físico-químicas tempo de endurecimento e escoamento dos cimentos endodônticos AH Plus e Sealer Plus, de acordo com a especificação 57 da American National Standard Institute/American Dental Association para materiais obturadores. Resultados: O tempo de endurecimento do AH Plus foi de 1178 minutos e do Sealer Plus foi de 422 minutos. O escoamento do APlus foi de 3259 milímetros e do Sealer Plus, 3150 milímetros. Conclusões: O tempo de endurecimento do AH Plus foi maior quando comparado ao do cimento Sealer Plus, e não houve diferença estatística no escoamento entre os cimentos estudados (AU).

Introduction: Endodontic treatment seeks to sanitize the root canal system to allow adequate three-dimensional filling, for which plastic materials such as guttapercha are required, associated with endodontic cements with adequate physico-chemical characteristics. Methods: Comparison of the physico-chemical properties hardening and flow time of the AH Plus and Sealer Plus endodontic sealers according to the American Dental Association / American Dental Association Specification 57 for sealing materials. Results: The hardening time of the AH Plus was 1178 minutes and the Sealer Plus was 422 minutes. The AH Plus flow was 3259 millimeters and the Sealer Plus was 3150 millimeters. Conclusions: The AH Plus hardening time was higher when compared to the Sealer Plus cement and there was no statistical difference in the flow between the cements studied (AU).

Nurse knowledge about potentially inappropriate medications for elderly

Due to the consequences of changes in fertility and mortality rates, there is an increase in population aging. In this context, the use of potentially inappropriate medications in this population makes nurses important agents in the identification of adverse reactions, requiring their knowledge about these drugs and their effects. The study aimed to verify nurses knowledge about the 2015 AGS BeersCriteria, regarding the potentially inappropriate medications for the elderly, and their adverse effects. It is a cross-sectional, descriptive, and analytical study with a quantitative and qualitative approach performed in a teaching hospital in the Triângulo Mineiro, Minas Gerais. Of the 80 professionals, 74.1% reported attending the elderly frequently, and only 3.8% had a specialization course in elderly health. Only 13.8% reported knowing the Beers Criteria. And 69% believe that adverse drug reactions can be confused as a new symptom and because of this, new drugs can be inserted into the therapeutic plan. Three categories emerged: The importance of assertive knowledge about PIMs, The nurse as a fundamental character in ADR, and Knowledge as a reinforcer of care. There is evidence of the need to train nurses to better identify adverse drug reactions so that they can act on these events avoiding the worsening of the individual.

Hybridoma technology: is it still useful?

The isolation of single monoclonal antibodies (mAbs) against a given antigen was only possible with the introduction of the hybridoma technology, which is based on the fusion of specific B lymphocytes with myeloma cells. Since then, several mAbs were described for therapeutic, diagnostic, and research purposes. Despite being an old technique with low complexity, hybridoma-based strategies have limitations that include the low efficiency on B lymphocyte-myeloma cell fusion step, and the need to use experimental animals. In face of that, several methods have been developed to improve mAb generation, ranging from changes in hybridoma technique to the advent of completely new technologies, such as the antibody phage display and the single B cell antibody ones. In this review, we discuss the hybridoma technology along with emerging mAb isolation approaches, taking into account their advantages and limitations. Finally, we explore the usefulness of the hybridoma technology nowadays.

Processos de subjetivação em arte e saúde mental em um manicômio judiciário / Subjectivation processes in art and mental health in a judiciary asylum / Procesos de subjetivación en el arte y salud mental en un manicomio judicial

Este artigo é um recorte de uma pesquisa-intervenção realizada em um Hospital de Custódia e Tratamento Psiquiátrico (HCTP). Por meio da cartografia, como método e modo de fazer pesquisa qualitativa em psicologia, e da utilização de objetos relacionais da arte em rodas de conversa, tenda do conto e círculos de cultura para a produção dos dados com "pacientes", agentes penitenciários e técnicos, objetivou-se: a) cartografar processos de subjetivação em arte e saúde mental de pacientes no cotidiano do HCTP; b) mapear a produção de subjetividades custodiadas e seus efeitos nos modos de subjetivação de pacientes; c) analisar modos de sujeição e resistência frente à produção de subjetividades custodiadas. A análise cartográfica dos dados mostra que há, nos processos de subjetivação dos "pacientes": a) problematização dos modos de sujeição às instituições que agenciam a produção de subjetividades custodiadas, principalmente do poder médico que decide quem está, ou não, apto para a vida em "liberdade"; b) modos de resistência à produção de subjetividades custodiadas, principalmente à excessiva medicalização e às grandes limitações na produção em saúde que atingem o HCTP. As conclusões apontam a arte como dispositivo, principalmente, e a poesia como objeto relacional com o fora da clausura para anunciar que o HCTP é visto pelos "pacientes", pelos agentes penitenciários e (passa a ser visto) também pelos cartógrafos como prisão, manicômio judiciário, e não como hospital; sendo cada participante da pesquisa não apenas um preso que utiliza psicotrópicos, mas também sujeito que pode devir autor para testemunhar o fracasso/sucesso da psiquiatrização da loucura.(AU)

This article is part of a broader intervention research conducted at a Custody and Psychiatric Treatment Hospital (HCTP). This study aimed to (a) map the processes of subjectivation in art and mental health in the daily life of patients of the HCTP; (b) to map the production of incarcerated subjectivities and its effects on subjectivation modes; and (c) to analyze subjection and resistance modes as a result of the production of incarcerated subjectivities. Data was collected using cartography and relational art objects in conversation circles and tale tents, based on the narratives of "patients", correctional officers and technicians of the custody unit. According to the cartographic analysis, patients problematize the subjection modes of the institutions responsible for producing their incarcerated subjectivities, especially in regard to the medical power that gets to decide who is apt for life in "freedom". Patients also showed resistance towards producing incarcerated subjectivities, mainly considering the excessive medicalization and major limitations in the healthcare provided by HCTP. The results indicate that "patients", penitentiary agents, and even cartographers perceive the HCTP as a prison (Judicial Asylum) rather than as a hospital. Each participant is not only a prisoner who use psychotropic drugs, but also a subject capable of testifying the failure/success of the psychiatrization of madness.(AU)

Este artículo es parte de una investigación-acción realizada en el Hospital de Custodia y Tratamiento Psiquiátrico (HCTP). Por medio de la cartografía como método y modo de hacer investigación cualitativa en psicología, y de la utilización de objetos relacionales del arte en ruedas de conversación, tienda del cuento y círculos de narrativas de la cultura para la producción de datos con "pacientes", agentes penitenciarios y técnicos del HCTP, se tuvo por objetivo: a) cartografiar los procesos de subjetivación en el arte y en la salud mental de pacientes en el cotidiano del HCTP; b) trazar la producción de subjetividades custodiadas y sus efectos en los modos de subjetivación de pacientes; c) analizar modos de sujeción y resistencia frente a la producción de subjetividades custodiadas. El análisis de la cartografía revela que existe en los procesos de subjetivación de los "pacientes": a) problemática de los modos de sujeción a las instituciones que gerencian la producción de subjetividades custodiadas, sobre todo el poder médico que decide quién está apto o no para vivir en "libertad"; b) formas de resistencia a la producción de subjetividades custodiadas, especialmente la medicalización excesiva y las grandes limitaciones a la producción en salud que afecta el HCTP. Las conclusiones apuntan al arte como dispositivo, principalmente la poesía como objeto relacional con el fuera de la clausura para anunciar que el HCTP es visto por los "pacientes", por los agentes penitenciarios y pasa a ser visto también por los cartógrafos como una prisión, un manicomio judicial, pero no como un hospital, siendo cada participante de la investigación no solo un detenido que utiliza psicotrópicos, sino también un sujeto que puede devenir autor para testimoniar el fracaso/éxito de la psiquiatrización de la locura.(AU)

Cartografia da saúde do homem em conflito com a lei / Cartography of the health of men in conflict with the law / Cartografía de la salud del hombre en conflicto con la ley

Neste estudo, apresentamos um recorte de uma pesquisa-intervenção realizada em um Hospital de Custódia e Tratamento Psiquiátrico, com o objetivo de cartografar processos de subjetivação da saúde do homem com transtorno mental em conflito com a lei. Para a produção das informações, utilizamos a cartografia e realizamos encontros com participantes da pesquisa por meio de práticas integrativas grupais e uso de objetos relacionais da arte. Para a discussão e os resultados, utilizamos a esquizoanálise, que aponta: a) as ações do cuidado em custódia são reduzidas à medicalização do confinamiento e à atenção de urgência e emergência, quando não é adiado ao máximo esse direito humano; b) a promoção da saúde do homem privado de liberdade é associada a ações de humanização e direitos humanos vinculados à determinação social. Conclui-se que os processos de subjetivação denunciam as instituições de violência e anunciam modos de desinstitucionalização da saúde mental custodiada.

In this study, we present a cutout of an intervention research performed in a Hospital of Custody and Psychiatric Treatment, with the objective of mapping subjectivation processes of the health of men with mental disorders in conflict with the law. For data production, we used cartography and held meetings with research participants through group integrative practices and the use of relational art objects. For discussion and results, we used schizoanalysis, which points out that: a) actions of care in custody are restricted to the medicalization of the confinement and the urgent and emergency attention, when this human right is not deferred to the maximum; b) the promotion of the health of men deprived of freedom is associated with humanization and human rights actions linked to social determination. We concluded that the subjectivation processes denounce institutional violence and announce ways of deinstitutionalizing mental health in custody.

En este estudio, presentamos un recorte de una investigación-intervención realizada en el Hospital de Custodia y Tratamiento Psiquiátrico, con el objetivo de mapear los procesos de subjetivación de la salud del hombre con trastorno mental en conflicto con la ley. Para la producción de información, utilizamos cartografía y realizamos reuniones con los participantes de la investigación a través de prácticas de integración grupal y el uso de objetos relacionales del arte. Para la discusión y los resultados, utilizamos el esquizoanálisis, que señala: a) las acciones de cuidado en custodia se reducen a la medicalización del encarcelamiento y a la atención de urgencia y emergencia, cuando este derecho humano no se extiende al máximo; b) la promoción de la salud del hombre privado de libertad está asociada a acciones de humanización y derechos humanos vinculadas a la determinación social. Se concluye que los procesos de subjetivación denuncian a las instituciones de violencia y anuncian formas de desinstitucionalización de la salud mental vigilada.

DUODENAL-JEJUNAL BYPASS REDUCES LIPID ACCUMULATION IN THE BROWN ADIPOSE TISSUE OF HYPOTHALAMIC OBESE RATS.

BACKGROUND: Effects of duodenal-jejunal bypass surgery (DJB) on the proliferation of nuclei and the area of adipocytes in the brown adipose tissue of obese rats. Thermogenic activity in the brown adipose tissue (BAT) of obese individuals is reduced, and this condition may be modified by bariatric surgery (BS). AIM: To characterize fat deposition in BAT from hypothalamic obese (HyO) rats submitted to duodenal-jejunal-bypass (DJB) surgery. METHODS: For induction of hypothalamic obesity, newborn male Wistar rats were treated with subcutaneous injections of monosodium glutamate (MSG). The control (CTL) group received saline solution. At 90 days, the HyO rats were submitted to DJB or sham operation, generating the HyO-DJB and HyO-SHAM groups. At 270 days, the rats were euthanized, and the BAT was weighed and submitted to histological analysis. RESULTS: Compared to BAT from CTL animals, the BAT from HyO-SHAM rats displayed increased weight, hypertrophy with greater lipid accumulation and a reduction in nucleus number. DJB effectively increased nucleus number and normalized lipid deposition in the BAT of HyO-SHAM rats, similar to that observed in CTL animals. CONCLUSION: DJB surgery avoided excessive lipid deposition in the BAT of hypothalamic obese rats, suggesting that this procedure could reactivate thermogenesis in BAT, and contribute to increase energy expenditure.