A residência em saúde da família e comunidade no fortalecimento do Sistema Único de Saúde / La residencia de salud familiar y comunitaria en el fortalecimiento del Sistema Único de Salud / The family and community health residency in the strengthening of the Unified Health System

Objetivo: compreender a maneira como a residência em saúde da família e comunidade atua como instrumento para o fortalecimento e a defesa do Sistema Único de Saúde sob a ótica da enfermagem. Método: estudo do tipo exploratório-descritivo com abordagem qualitativa, desenvolvido com 13 enfermeiros residentes. Neste estudo, os dados foram coletados de modo remoto por meio de entrevista semiestruturada, processados pelo software IRaMuTeQ e interpretados conforme análise de conteúdo de Bardin. Resultados: os resultados apontam que as residências na área da saúde se expressam com força política, conhecimento teórico e formação na prática, essenciais para fortalecer o controle social. Conclusão: faz-se necessário que a formação dos profissionais seja orientada a partir dos princípios/objetivos do SUS e que ocorra o combate aos ataques iminentes, exemplificados pelo baixo financiamento e má gestão.

Objective: to understand the way in which residency in family and community health acts as an instrument for strengthening and defending the Unified Health System from the perspective of nursing. Method: exploratory-descriptive study with a qualitative approach, developed with 13 resident nurses.In this study, data were collected remotely with semi-structured interviews, processed by the IRAMUTEQ software, and interpreted according to Bardin's content analysis. Results: the results indicate that residencies in the health area express themselves with political force, theoretical knowledge, and training in practice, essential to strengthen social control. Conclusion: the training of professionals must be guided from the principles/objectives of the SUS and the fight against imminent attacks, exemplified by low funding and poor management, must occur.

Objetivo: comprender el modo en que la residencia en salud familiar y comunitaria actúa como instrumento de fortalecimiento y defensa del Sistema Único de Salud (SUS) desde la perspectiva de la enfermería. Método: estudio exploratório descriptivo, con enfoque cualitativo, desarrollado con 13 enfermeras residentes. En este estudio, los datos se recolectaron de forma remota mediante entrevistas semiestructuradas, que, posteriormente, fueron procesadas por el software IRaMuTeQ e interpretadas de acuerdo con el análisis de contenido de Bardin. Resultados: las residencias en el área de la salud se desarrollan con fuerza política, conocimiento teórico y formación práctica, lo que es esencial para fortalecer el control social. Conclusión: es necesario que la formación de los profesionales se base en los principios/objetivos del SUS y que ocurra la lucha contra los inminentes ataques, ejemplificados por una baja financiación y mala gestión.

Prediabetes Induces More Severe Acute COVID-19 Associated With IL-6 Production Without Worsening Long-Term Symptoms.

Aims: Pre-existing conditions, such as age, hypertension, obesity, and diabetes, constitute known risk factors for severe COVID-19. However, the impact of prediabetes mellitus (PDM) on COVID-19 severity is less clear. This study aimed to evaluate the influence of PDM in the acute and long-term phases of COVID-19. Materials and methods: We compared inflammatory mediators, laboratory and clinical parameters and symptoms in COVID-19 patients with prediabetes (PDM) and without diabetes (NDM) during the acute phase of infection and at three months post-hospitalization. Results: Patients with PDM had longer hospital stays and required intensive care unit admission more frequently than NDM. Upon hospitalization, PDM patients exhibited higher serum levels of interleukin 6 (IL-6), which is related to reduced partial pressure of oxygen (PaO2) in arterial blood, oxygen saturation (SpO2) and increased COVID-19 severity. However, at three months after discharge, those with PDM did not exhibit significant alterations in laboratory parameters or residual symptoms; however, PDM was observed to influence the profile of reported symptoms. Conclusions: PDM seems to be associated with increased risk of severe COVID-19, as well as higher serum levels of IL-6, which may constitute a potential biomarker of severe COVID-19 risk in affected patients. Furthermore, while PDM correlated with more severe acute-phase COVID-19, no long-term worsening of sequelae was observed.

DC-SIGN Mediates the Interaction Between Neutrophils and Leishmania amazonensis-Infected Dendritic Cells to Promote DC Maturation and Parasite Elimination.

Background: Leishmaniasis is a neglected arthropod-borne disease that affects millions of people worldwide. Successful Leishmania infections require the mitigation of immune cell functions leading to parasite survival and proliferation. A large body of evidence highlights the involvement of neutrophils (PMNs) and dendritic cells (DCs) in the establishment of immunological responses against these parasites. However, few studies, contemplate to what extent these cells interact synergistically to constrain Leishmania infection. Objective: We sought to investigate how PMNs and infected DCs interact in an in vitro model of Leishmania amazonensis infection. Material and Methods: Briefly, human PMNs and DCs were purified from the peripheral blood of healthy donors. Next, PMNs were activated with fibronectin and subsequently co-cultured with L. amazonensis-infected DCs. Results: We observed that L. amazonensis-infected DC exhibited lower rates of infection when co-cultivated with either resting or activated PMNs. Surprisingly, we found that the release of neutrophil enzymes was not involved in Leishmania killing. Next, we showed that the interaction between PMNs and infected-DCs was intermediated by DC-SIGN, further suggesting that parasite elimination occurs in a contact-dependent manner. Furthermore, we also observed that TNFα and ROS production was dependent on DC-SIGN-mediated contact, as well as parasite elimination is dependent on TNFα production in the co-culture. Finally, we observed that direct contact between PMNs and DCs are required to restore the expression of DC maturation molecules during L. amazonensis infection. Conclusion: Our findings suggest that the engagement of direct contact between PMNs and L. amazonensis-infected DC via DC-SIGN is required for the production of inflammatory mediators with subsequent parasite elimination and DC maturation.

Investigating the Phagocytosis of Leishmania using Confocal Microscopy.

Phagocytosis is an orchestrated process that involves distinct steps: recognition, binding, and internalization. Professional phagocytes take up Leishmania parasites by phagocytosis, consisting of recognizing ligands on parasite surfaces by multiple host cell receptors. Binding of Leishmania to macrophage membranes occurs through complement receptor type 1 (CR1) and complement receptor type 3 (CR3) and Pattern Recognition Receptors. Lipophosphoglycan (LPG) and 63 kDa glycoprotein (gp63) are the main ligands involved in macrophage-Leishmania interactions. Following the initial recognition of parasite ligands by host cell receptors, parasites become internalized, survive, and multiply within parasitophorous vacuoles. The maturation process of Leishmania-induced vacuoles involves the acquisition of molecules from intracellular vesicles, including monomeric G protein Rab 5 and Rab 7, lysosomal associated membrane protein 1 (LAMP-1), lysosomal associated membrane protein 2 (LAMP-2), and microtubule-associated protein 1A/1B-light chain 3 (LC3). Here, we describe methods to evaluate the early events occurring during Leishmania interaction with the host cells using confocal microscopy, including (i) binding (ii) internalization, and (iii) phagosome maturation. By adding to the body of knowledge surrounding these determinants of infection outcome, we hope to improve the understanding of the pathogenesis of Leishmania infection and support the eventual search for novel chemotherapeutic targets.

Obtainment of Macrophages from Human Monocytes to Assess Leishmania braziliensis Infection Rate and Innate Host Immune Response.

Macrophages are multifunctional cells essential to the immune system function, and the primary host cell in Leishmania braziliensis (Lb) infection. These cells are specialized in microorganism recognition and phagocytosis, but also activate other immune cells and present antigens, as well as promote inflammation and tissue repair. Here, we describe a protocol to obtain mononuclear cells from peripheral blood (PBMC) of healthy donors to separate monocytes that then differentiate into macrophages. These cells can then be infected in vitro at different Lb concentrations to evaluate the ability to control infection, as well as evaluate host cell immune response, which can be measured by several methods. PBMCs were first isolated by centrifuging with Ficoll-Hypaque gradient and then plated to allow monocytes to adhere to culture plates; non-adherent cells were removed by washing. Next, adherent cells were cultured with macrophage-colony stimulating factor (M-CSF) for 7 days to induce macrophage differentiation. We suggest plating 2 x 106 cells per well on 24-well plates in order to obtain 2 x 105 macrophages. Fully differentiated macrophages can then be infected with Lb for 4 or 24 hours. This protocol results in a significant percentage of infected cells, which can be assessed by optical or fluorescence microscopy. In addition to infection index, parasite load can be measured by counting the numbers of parasites inside each cell. Further molecular and functional assays can also be performed in culture supernatants or within the macrophages themselves, which allows this protocol to be applied in a variety of contexts and also adapted to other intracellular parasite species.

Oral Tolerance Induced by Heat Shock Protein 65-Producing Lactococcus lactis Mitigates Inflammation in Leishmania braziliensis Infection.

Cutaneous leishmaniasis caused by L. braziliensis induces a pronounced Th1 inflammatory response characterized by IFN-γ production. Even in the absence of parasites, lesions result from a severe inflammatory response in which inflammatory cytokines play an important role. Different approaches have been used to evaluate the therapeutic potential of orally administrated heat shock proteins (Hsp). These proteins are evolutionarily preserved from bacteria to humans, highly expressed under inflammatory conditions and described as immunodominant antigens. Tolerance induced by the oral administration of Hsp65 is capable of suppressing inflammation and inducing differentiation in regulatory cells, and has been successfully demonstrated in several experimental models of autoimmune and inflammatory diseases. We initially administered recombinant Lactococcus lactis (L. lactis) prior to infection as a proof of concept, in order to verify its immunomodulatory potential in the inflammatory response arising from L. braziliensis. Using this experimental approach, we demonstrated that the oral administration of a recombinant L. lactis strain, which produces and secretes Hsp65 from Mycobacterium leprae directly into the gut, mitigated the effects of inflammation caused by L. braziliensis infection in association or not with PAM 3CSK4 (N-α-Palmitoyl-S-[2,3-bis(palmitoyloxy)-(2RS)-propyl]-L-cysteine, a TLR2 agonist). This was evidenced by the production of anti-inflammatory cytokines and the expansion of regulatory T cells in the draining lymph nodes of BALB/c mice. Our in vitro experimental results suggest that IL-10, TLR-2 and LAP are important immunomodulators in L. braziliensis infection. In addition, recombinant L. lactis administered 4 weeks after infection was observed to decrease lesion size, as well as the number of parasites, and produced a higher IL-10 production and decrease IFN-γ secretion. Together, these results indicate that Hsp65-producing L. lactis can be considered as an alternative candidate for treatment in both autoimmune diseases, as well as in chronic infections that cause inflammatory disease.

Leukotriene B4 licenses inflammasome activation to enhance skin host defense.

The initial production of inflammatory mediators dictates host defense as well as tissue injury. Inflammasome activation is a constituent of the inflammatory response by recognizing pathogen and host-derived products and eliciting the production of IL-1ß and IL-18 in addition to inducing a type of inflammatory cell death termed "pyroptosis." Leukotriene B4 (LTB4) is a lipid mediator produced quickly (seconds to minutes) by phagocytes and induces chemotaxis, increases cytokine/chemokine production, and enhances antimicrobial effector functions. Whether LTB4 directly activates the inflammasome remains to be determined. Our data show that endogenously produced LTB4 is required for the expression of pro-IL-1ß and enhances inflammasome assembly in vivo and in vitro. Furthermore, LTB4-mediated Bruton's tyrosine kinase (BTK) activation is required for inflammasome assembly in vivo as well for IL-1ß-enhanced skin host defense. Together, these data unveil a new role for LTB4 in enhancing the expression and assembly of inflammasome components and suggest that while blocking LTB4 actions could be a promising therapeutic strategy to prevent inflammasome-mediated diseases, exogenous LTB4 can be used as an adjuvant to boost inflammasome-dependent host defense.

Condições clínicas de pacientes com hemofilia assistidos em um hemocentro regional: um estudo transversal / Clinical conditions of patients with hemophilia assisted in a regional hemocenter: a cross-section study / Condiciones clínicas de pacientes con hemofilia asistidos en hemocentro regional: estudio transversal

O objetivo do estudo foi caracterizar o perfil sociodemográfico e clínico de pacientes com hemofilia acompanhados em um Hemocentro Regional. Estudo epidemiológico de delineamento transversal com coleta de dados por análise documental com 30 prontuários de um Hemocentro Regional da região Centro-Sul do Ceará. Realizou-se análise estatística através do software Microsoft Office Excel® 2016. O trabalho foi aprovado pelo Comitê de Ética de Pesquisa. Predominou o sexo masculino (27), com idade de 20 a 59 anos, estado civil solteiro, ensino fundamental incompleto, residência em zona rural e renda inferior a 01 salário mínimo. Quanto ao perfil clínico, a hemofilia A na forma grave, apresentam sedentarismo, com histórico de procedimentos transfusionais. A maioria com duas ou mais manifestações clínicas associadas. Com a prevalência apontada entre os participantes, evidencia-se a necessidade de uma assistência integral e equânime, com ênfase nas ações de enfermagem.(AU)

The aim of the study was to characterize the sociodemographic and clinical profile of patients with hemophilia followed at a Regional Blood Center. Epidemiological cross-sectional study with data collection by document analysis with 30 records from a Regional Blood Center in the Center-South region of Ceará. Statistical analysis was performed using Microsoft Office Excel® 2016 software. The work was approved by the Research Ethics Committee. There was a predominance of males (27), aged 20 to 59 years, single marital status, incomplete elementary education, residing in rural areas and income below 01 minimum wage. As for the clinical profile, hemophilia A in severe form, has a sedentary lifestyle, with a history of transfusion procedures. Most have two or more associated clinical manifestations. With the prevalence pointed out among the participants, the need for comprehensive and equitable assistance is evident, with an emphasis on nursing actions.(AU)

El objetivo del estudio fue caracterizar el perfil sociodemográfico y clínico de los pacientes con hemofilia seguidos en un Centro Regional de Sangre. Estudio epidemiológico de diseño transversal con recolección de datos por análisis documental con 30 registros de un Centro Regional de Sangre de la región Centro-Sur de Ceará. El análisis estadístico se realizó con el software Microsoft Office Excel® 2016. El trabajo fue aprobado por el Comité de Ética en Investigación. Predominó el sexo masculino (27), de 20 a 59 años, estado civil soltero, educación primaria incompleta, residente en área rural e ingresos por debajo de 01 salario mínimo. En cuanto al perfil clínico, la hemofilia A en forma severa, tiene un estilo de vida sedentario, con antecedentes de procedimientos transfusionales. La mayoría tiene dos o más manifestaciones clínicas asociadas. Con la prevalencia señalada entre los participantes, se evidencia la necesidad de una atención integral y equitativa, con énfasis en las acciones de enfermería.(AU)

Unbalanced production of LTB4/PGE2 driven by diabetes increases susceptibility to cutaneous leishmaniasis.

Poorly controlled diabetes mellitus leads to several comorbidities, including susceptibility to infections. Hyperglycemia increases phagocyte responsiveness, however immune cells from people with diabetes show inadequate antimicrobial functions. We and others have shown that aberrant production of leukotriene B4 (LTB4) is detrimental to host defense in models of bacterial infection. Here, we will unveil the consequences of high glucose in the outcome of Leishmania braziliensis skin infection in people with diabetes and determine the role of LTB4 in human phagocytes. We show that diabetes leads to higher systemic levels of LTB4, IL-6 and TNF-α in cutaneous leishmaniasis. Only LTB4 correlated with blood glucose levels and healing time in diabetes comorbidity. Skin lesions of people with leishmaniasis and diabetes exhibit increased neutrophil and amastigote numbers. Monocyte-derived macrophages from these individuals showed higher L. braziliensis loads, reduced production of Reactive Oxygen Species and unbalanced LTB4/PGE2 ratio. Our data reveal a systemic inflammation driven by diabetes comorbidity in opposition to a local reduced capacity to resolve L. braziliensis infection and a worse disease outcome.

Participação universitária em defesa do Sistema Único de Saúde / University participation in defense of the Unified Health System

RESUMO Uma das conquistas essenciais da Reforma Sanitária foi a participação social, o principal motor para promoção da igualdade, haja vista que, por meio desta, diferentes grupos na saúde obtiveram voz, preceito valioso da base democrática. No contexto universitário, a temática tem sido incorporada sob diversos aspectos, conformando um ambiente que polariza opiniões e proporciona reflexões que corroboram, ou destoam, os da reforma e consolidação do Sistema Único de Saúde (SUS). Dessa forma, este estudo teve por objetivo investigar e discutir a participação dos universitários visando à defesa e ao fortalecimento do SUS. Trata-se de um estudo de campo, do tipo exploratório descritivo com abordagem qualitativa, sendo utilizada uma entrevista semiestruturada para coleta de dados, e o software IRaMuTeQ para o processamento. Para a apreciação, seguiu-se a análise categorial temática proposta por Minayo. Observou-se um conhecimento satisfatório quanto à importância da participação social em um contexto de movimentos sociais, porém, a participação ativa não ocorre de forma desejada ainda que seja em conferências e conselhos de saúde. Apesar das fragilidades, vislumbra-se um novo horizonte no qual a universidade seja um espaço que consolide este princípio do SUS.

ABSTRACT One of the essential achievements of Health Reform was social participation, the main driver for promoting equality, given that, through this, different groups in health have gained a voice, a valuable precept of the democratic base. In the university context, the theme has been incorporated in several aspects, forming an environment that polarizes opinions and provides reflections that corroborate, or contradict, those of the reform and consolidation of the Unified Health System (SUS). Thus, this study aimed to investigate and discuss the participation of university students in order to defend and strengthen the SUS. This is a field study, of the exploratory descriptive type with a qualitative approach, using a semi-structured interview for data collection, and the IRaMuTeQ software for processing. For the appreciation, the thematic categorical analysis proposed by Minayo was followed. Satisfactory knowledge was observed regarding the importance of social participation in a context of social movements, however, active participation does not occur in a desired way even if it is at conferences and health councils. Despite the weaknesses, a new horizon is envisaged in which the university is a space that consolidates this principle of SUS.

Atuação de médicos e enfermeiros no atendimento de emergência ao paciente hemofílico / Performance of doctors and nurses in emergency care for hemophiliac patients

Objetivo: descrever a atuação de médicos e enfermeiros no atendimento de emergência ao paciente hemofílico. Metodologia: estudo exploratório e qualitativo, realizado com enfermeiros e médicos do setor de emergência de uma Unidade Hospitalar de referência e de uma Unidade de Pronto Atendimento na região Centro-Sul do Ceará. Os dados foram coletados em setembro e outubro de 2018 por meio de questionário semiestruturado composto por questões abertas e fechadas. As respostas foram submetidas à análise de conteúdo. O estudo foi aprovado pelo Comitê de Ética. Resultados: evidenciou-se uma fragilidade no conhecimento dos profissionais acerca da hemofilia e uma insuficiência no suporte das unidades para oferta do cuidado ao hemofílico. As unidades não possuem um protocolo de atendimento para atender esses pacientes, dificultando a execução do cuidado direcionado ao hemofílico. A falta de capacitação dos profissionais, medicamentos específicos para hemofilia e de hematologista na equipe constituem dificuldades em ofertar a assistência. Conclusão: o estudo identificou a necessidade de educação permanente em saúde no atendimento aos pacientes hemofílicos, desburocratizar e tornar menos fragmentado o cuidado em redes, com vista a garantir a integralidade do cuidado.

Objective: to describe the role of doctors and nurses in emergency care for hemophiliac patients. Methodology: exploratory and qualitative research, carried out with nurses and doctors in the emergency department of a referral Hospital Unit and an Emergency Care Unit in the Center-South region of Ceará. Data collection took place from September to October 2018 using a semi-structured questionnaire composed of open and objective questions. The responses were submitted to content analysis. The study was approved by the Ethics Committee. Results: there was a weakness in the professionals' expertise about hemophilia and insufficiency in the support of units to provide care to the hemophiliac. The units do not have a flow protocol to assist these patients, making it difficult to carry out care directed to hemophiliacs. The lack of training of professionals, specific medications for hemophilia and a hematologist in the team represent difficulties in assisting. Conclusion: the research identified the need for permanent health education in the care of hemophiliac patients, reducing bureaucracy and making care in networks less fragmented, aimed at guaranteeing comprehensive care

Granzyme B Produced by Natural Killer Cells Enhances Inflammatory Response and Contributes to the Immunopathology of Cutaneous Leishmaniasis.

BACKGROUND: Skin lesions from patients infected with Leishmania braziliensis has been associated with inflammation induced by cytotoxic CD8+ T cells. In addition, CD8+ T cell-mediated cytotoxicity has not been linked to parasite killing. Meanwhile, the cytotoxic role played by natural killer (NK) cells in cutaneous leishmaniasis (CL) remains poorly understood. METHODS: In this study, we observed higher frequencies of NK cells in the peripheral blood of CL patients compared with healthy subjects, and that NK cells expressed more interferon-γ, tumor necrosis factor (TNF), granzyme B, and perforin than CD8+ T cells. RESULTS: We also found that most of the cytotoxic activity in CL lesions was triggered by NK cells, and that the high levels of granzyme B produced in CL lesions was associated with larger lesion size. Furthermore, an in vitro blockade of granzyme B was observed to decrease TNF production. CONCCLUSIONS: Our data, taken together, suggest an important role by NK cells in inducing inflammation in CL, thereby contributing to disease immunopathology.

Uso de Webrádio na construção de saberes e fazeres em Saúde Coletiva junto a jovens escolares como dispositivo de cuidado no Sistema Único de Saúde / Use of Internet radio service in the construction of knowledge and practices in collective health along the school as young care device in the Unified Health System

Objetivo: descrever a experiência da parceria de duas instituições de ensino e a importância da relação extensão-escola-universidade com vistas a integralidade do cuidado em saúde coletiva no âmbito do Sistema Único de Saúde- SUS. Método: A experiência aconteceu por meio de um projeto de extensão com canal interativo intermediado pela Universidade Estadual do Ceará- UECE em parceria com uma Escola de Educação Profissional da Região do Cariri no ano de 2018, por meio do Projeto de Extensão/Pesquisa, intitulado: Em sintonia com a saúde ­ S@S, através da Web Rádio AJIR na UECE, realizado pelo Laboratório de Práticas Coletivas em Saúde ­ LAPRACS. Resultados: Evidencia-se que trabalho dos profissionais de saúde e, em especial, da enfermagem, quando apoiado em dispositivos de tecnologia podem provocar forte transformação na prática social, sobretudo, na saúde coletiva. Deste modo, a ligação com esta temática ocorre a partir de uma experiência de promover através da extensão programas de educação em saúde por meio da web-rádio, com pautas da saúde com temas relevantes no Sistema Único de Saúde tais como: Dengue, Hanseníase, Hepatites Virais, Síndrome da Imunodeficiência Adquirida, Tuberculose e Tabagismo, trazendo como protagonistas as juventudes estudantes de escolas públicas, além de comunidades, Organizações não Governamentais, associações e outras instituições. Conclusões: Percebemos com essa experiência através do tripé extensão-escola-universidade possibilita a melhor formação do profissional em Enfermagem e Saúde. Nesse sentido, a web rádio apresenta-se tecnologia do cuidado em saúde mostrando-se na enfermagem como um grande dispositivo para as práticas de cuidado em saúde coletiva no SUS através do dialogo com as juventudes

Use of Web Radio in the construction of knowledge and practices in Collective Health with young students as a care device in the Unified Health System / Uso de Webrádio na construção de saberes e fazeres em Saúde Coletiva junto a jovens escolares como dispositivo de cuidado no Sistema Único de Saúde

Objective: to describe the experience of two educational institutions' partnership in the extensionschooluniversity relationship with a view to comprehensive public health care within the Unified Health System UHS. Method: The experience took place through an interactive channel extension Project brokered by the State University of Ceará UECE in partnership with Cariri Regional School of Vocational Education, in 2018, through the Extension/Research Project entitled In Tune with HealthS@ S, by Web Radio AJIR Irajá Youth Association, at UECE, conducted by the Laboratory of Collective Practices in Health in Portuguese LAPRACS. Results: It is evident that the work of health professionals and especially of nursing, when supported by technology devices, can provoque a strong transformation in social practice, especially in collective health. Thus, the connection with this theme comes from na experience of promoting, through extension, health education programs through Web radio, with health guidelines as relevant topics in health care in UHS. Topics such as Dengue, Leprosy, Viral Hepatitis, Acquired Immunodeficiency Syndrome, Tuberculosis and Smoking are discussed, with the protagonists being young students from public schools, as well as communities, nongovernmental organizations, associations and other institutions. Conclusions: Based on this experience, and considering the extensionschooluniversity tripod, Web radio is perceived as health care technology, proving to be an important device for nursing and collective health care practices in UHS, through dialogue with young people

Integrated Analysis Reveals That miR-193b, miR-671, and TREM-1 Correlate With a Good Response to Treatment of Human Localized Cutaneous Leishmaniasis Caused by Leishmania braziliensis.

Localized cutaneous leishmaniasis (LCL) is a chronic disease characterized by ulcerated skin lesion(s) and uncontrolled inflammation. The mechanisms underlying the pathogenesis of LCL are not completely understood, and little is known about posttranscriptional regulation during LCL. MicroRNAs (miRNAs) are non-coding small RNAs that regulate gene expression and can be implicated in the pathogenesis of LCL. We investigated the involvement of miRNAs and their targets genes in human LCL using publicly available transcriptome data sets followed by ex vivo validation. Initial analysis highlighted that miRNA expression is altered during LCL, as patients clustered separately from controls. Joint analysis identified eight high confidence miRNAs that had altered expression (-1.5 ≤ fold change ≥ 1.5; p < 0.05) between cutaneous ulcers and uninfected skin. We found that the expression of miR-193b and miR-671 are greatly associated with their target genes, CD40 and TNFR, indicating the important role of these miRNAs in the expression of genes related to the inflammatory response observed in LCL. In addition, network analysis revealed that miR-193b, miR-671, and TREM1 correlate only in patients who show faster wound healing (up to 59 days) and not in patients who require longer cure times (more than 60 days). Given that these miRNAs are associated with control of inflammation and healing time, our findings reveal that they might influence the pathogenesis and prognosis of LCL.

A Qualidade de Vida de Idosos com Obesidade ou Sobrepeso / The Quality of Life of Elderly Peoplewith Obesity or Overweight

Objetivo: avaliar a qualidade de vida de idosos com obesidade ou sobrepeso acompanhados na Atenção Primária à Saúde. Material e Métodos: estudo descritivo transversal, Os dados foram coletados no período de fevereiro a maio de 2016, na residência dos idosos utilizando para a coleta de dados um formulário sociodemográfico e clínico e um questionário específico desenvolvido pela Organização Mundial da Saúde para avaliar qualidade de vida em idosos ­ World Health Organization Quality of Life GroupOld. A amostra foi constituída de 27 idosos com obesidade ou sobrepeso Resultados: Os resultados sociodemográficos mostraram uma predominância do sexo feminino (81,48%), média de 69,70 anos (desvio-padrão= 7,33), baixa escolaridade (40,74%), casados (55,56%), negros (44,44%) e aposentados (74,04%). Pelas variáveis antropométricas a maioria das mulheres apresentava obesidade moderada (50%), em que 100% das idosas estavam com risco muito elevado relacionado a circunferência abdominal e 40% dos idosos estavam com risco muito elevado da circunferência abdominal e a maioria dos homens com sobrepeso (60%). A Relação Cintura Quadril mostrou que 86,36% das idosas estavam com valores >85 e 100% dos homens com valores >90. A maioria dos idosos apresentou uma qualidade de vida regular, com menos comprometimento nos domínios intimidade, autonomia, funcionamento do sensório e atividades passadas presentes e futuras e mais comprometimento nos de morte e morrer e participação social. Conclusão: a qualidade de vida encontrou-se afetada no contexto que envolve a finitude do ser e sua inserção e interação social. (AU)

Objective: To evaluate the quality of life of elderly people with obesity or over weight followed-up at the Primary Care Level. Material and Methods: This was a descriptive cross-sectional study carried out from February to May 2016. The data were collected using a socio demographic and clinical form and a specific questionnaire developed by the World Health Organization to evaluate the quality of life of elderly people - World Health Organization Quality of Life Group. Results: The socio demographic results showed a predominance of females (81.48%); with a mean age of 69.70 years (standard deviation = 7.33);low education level (40.74%);married (55.56%); black race (44.44%);and retirees (74.04%). According to anthropometric variables, the majority of females presented moderate obesity (50%), in which 100% of the elderly women were at a very high risk related to abdominal circumference. As for males,40% of the elderly were found to be at a very high risk of abdominal circumference and the majority of them were overweight (60%). The Hip: Waist Ratio showed that 86.36% of the elderly women hadvalueshigherthan85 and 100% of the men had values high erth an 90. The majority of the elderly presented a regular quality of life, with less impairment in the do mains of intimacy, autonomy, functioning of the sensorium and past and present activities, and a greater impairment in the domains of death and dying and social participation. Conclusion: The quality of life was affected in the context that involves the finitude of the being and social integration and interaction. (AU)

Self-care practice in people with sickle cell anemia / Prática do autocuidado em pessoas com anemia falciforme / Práctica del autocuidado en personas con anemia falciforme

Objective: To identify the application of Orem's self-care theory in patients with sickle cell anemia (SCA) at a regional hematology center. Methods: It is a study of a descriptive nature, with an exploratory and qualitative approach, held at the regional hematology center of an inland municipality of Ceará, Brazil, with patients diagnosed and treated for SCA. The data collection was carried out in May 2014, through an interview applied to patients with sickle cell anemia or their respective legal guardians, conducted while they were in the waiting room for medical care in the institution. The following guiding question was asked: "What are the main precautions you take to prevent the complications of sickle cell disease?". Data were analyzed according to Bardin's content analysis technique. Results: It was evidenced that patients lack an accurate knowledge about their disease, thus disadvantaging the primary foundation for self-care. The discovery of the disease usually occurs due to the need for clinical interventions in repeated episodes of pain. The painful events represent the main difficulties and causes of hospitalizations with the search for emergency medical services. Conclusion: The educational actions provided by the multidisciplinary health team make it possible for the SCA patient and caregiver to provide better care by means of self-care activities and actions.

Objetivo: Identificar a aplicação da teoria do autocuidado de Orem em pacientes portadores de anemia falciforme (AF) em um hemocentro regional. Métodos: Trata-se de estudo de natureza descritiva, com caráter exploratório e abordagem qualitativa, realizado no hemocentro regional de um município do interior do Ceará, Brasil, com os pacientes diagnosticados e em tratamento para AF. A coleta de dados se deu em 2014, sendo utilizada entrevista aplicada na sala de espera para atendimento médico na própria instituição. Os dados foram analisados conforme técnica de análise de conteúdo de Bardin. Resultados: Evidenciou-se que o paciente não apresenta um saber apurado sobre a sua patologia, desfavorecendo, portanto, as bases primárias para o autocuidado. A descoberta da doença geralmente se dá pela necessidade de intervenções clínicas em episódios repetidos de dor. Os eventos dolorosos representam as principais dificuldades e causas de internação hospitalar com a busca pelos serviços de pronto atendimento médico. Conclusão: As ações educativas fornecidas pela equipe de saúde multidisciplinar possibilitam ao paciente e cuidador de AF condições para uma melhor assistência por meio das atividades e ações de autocuidado.

Objetivo: Identificar la aplicación de la Teoría del Auto Cuidado de Orem en pacientes con anemia falciforme (AF) de un centro regional de hematología. Métodos: Estudio descriptivo de abordaje cualitativo y exploratorio en el centro regional de hematología de un pueblo del municipio de Ceará, Brasil, con pacientes con diagnóstico y tratamiento para la AF. Los datos fueron recogidos en mayo de 2014 a través de una entrevista a los pacientes con AF y sus respectivos representantes legales y realizadas en la sala de espera mientras esperaban la consulta médica en la institución. Se aplicó la siguiente pregunta guía: "Cuales son las principales precauciones realizadas por ti para la prevención de complicaciones de la AF?" Los datos fueron analizados según la técnica de Análisis de Contenido de Bardin. Resultados: Se evidenció que los pacientes no tienen un conocimiento exacto sobre su enfermedad lo que es una desventaja para los cuidados primarios. El diagnóstico de la enfermedad se da en general por la necesidad de intervenciones clínicas en repetidos episodios de dolor. Los eventos de dolor representan las principales dificultades y causas de ingresos hospitalarios en los servicios de urgencias. Conclusión: Las acciones de educación del equipo de salud multidisciplinario hicieron posible para el paciente con AF y su cuidador la mejoría de la asistencia a través de actividades y acciones de autocuidado.

Dendritic Cells and Leishmania Infection: Adding Layers of Complexity to a Complex Disease.

Leishmaniasis is a group of neglected diseases whose clinical manifestations depend on factors from the host and the pathogen. It is an important public health problem worldwide caused by the protozoan parasite from the Leishmania genus. Cutaneous Leishmaniasis (CL) is the most frequent form of this disease transmitted by the bite of an infected sandfly into the host skin. The parasites can be uptook and/or recognized by macrophages, neutrophils, and/or dendritic cells (DCs). Initially, DCs were described to play a protective role in activating the immune response against Leishmania parasites. However, several reports showed a dichotomic role of DCs in modulating the host immune response to susceptibility or resistance in CL. In this review, we discuss (1) the interactions between DCs and parasites from different species of Leishmania and (2) the crosstalk of DCs and other cells during CL infection. The complexity of these interactions profoundly affects the adaptive immune response and, consequently, the disease outcome, especially from Leishmania species of the New World.

Degranulating Neutrophils Promote Leukotriene B4 Production by Infected Macrophages To Kill Leishmania amazonensis Parasites.

Neutrophils mediate early responses against pathogens, and they become activated during endothelial transmigration toward the inflammatory site. In the current study, human neutrophils were activated in vitro with immobilized extracellular matrix proteins, such as fibronectin (FN), collagen, and laminin. Neutrophil activation by FN, but not other extracellular matrix proteins, induces the release of the granules' contents, measured as matrix metalloproteinase 9 and neutrophil elastase activity in culture supernatant, as well as reactive oxygen species production. Upon contact with Leishmania amazonensis-infected macrophages, these FN-activated neutrophils reduce the parasite burden through a mechanism independent of cell contact. The release of granule proteases, such as myeloperoxidase, neutrophil elastase, and matrix metalloproteinase 9, activates macrophages through TLRs, leading to the production of inflammatory mediators, TNF-α and leukotriene B4 (LTB4), which are involved in parasite killing by infected macrophages. The pharmacological inhibition of degranulation reverted this effect, abolishing LTB4 and TNF production. Together, these results suggest that FN-driven degranulation of neutrophils induces the production of LTB4 and TNF by infected macrophages, leading to the control of Leishmania infection.

Depression and suicide risk among nursing professionals: an integrative review / Depresión y riesgo de suicidio entre profesionales de enfermería: revisión integradora / Depressão e risco de suicídio entre profissionais de Enfermagem: revisão integrativa

Abstract OBJECTIVE Discussing the factors associated with major depression and suicide risk among nursing professionals. METHOD An integrative review in PubMed/MEDLINE, LILACS, SciELO and BDENF databases, between 2003 and 2015. RESULTS 20 published articles were selected, mostly from between 2012 and 2014, with significant production in Brazil. Nursing professionals are vulnerable to depression when young, married, performing night work and having several jobs, and when they have a high level of education, low family income, work overload, high stress, insufficient autonomy and a sense of professional insecurity and conflict in the family and workrelationship. Suicide risk was correlated with the presence of symptoms of depression, high levels of emotional exhaustion, depersonalization and low personal accomplishment; characteristics of Burnout Syndrome. CONCLUSION Suicide risk among nursing professionals is associated with symptoms of depression and correlated with Burnout Syndrome, which can affect work performance.

Resumen OBJETIVO Discutir sobre los factores asociados con la depresión mayor y el riesgo de suicidio entre profesionales de enfermería. MÉTODO Revisión integradora en las bases de datos PubMed/MEDLINE, LILACS, SciELO y BDENF, entre el año 2003 y el 2015. RESULTADOS Se seleccionaron 20 artículos publicados, la mayoría entre el 2012 y el 2014, con significativa producción en Brasil. Los profesionales de enfermería son vulnerables a la depresión cuando jóvenes, casados, realizan trabajo nocturno y tienen varios empleos, y cuando presentan alto nivel educativo, bajos ingresos familiares, sobrecarga de trabajo, estrés elevado, insuficiente autonomía y sentimiento de inseguridad profesional, conflictos en la relación familiar y laboral. El riesgo de suicidio fue correlacionado con la presencia de síntomas de depresión, alto nivel de agotamiento emocional, despersonalización y baja realización personal; características del Síndrome de Burnout. CONCLUSIÓN El riesgo de suicidio entre los profesionales de enfermería está asociado con los síntomas depresivos y los correlacionados con el Síndrome de Burnout, perjudicando el desempeño profesional.

Resumo OBJETIVO Discutir sobre os fatores associados à depressão maior e risco de suicídio entre profissionais de enfermagem. MÉTODO Revisão integrativa em bases de dados PubMed/MEDLINE, LILACS, SciELO e BDENF, entre 2003 e 2015. RESULTADOS Selecionaram-se 20 artigos publicados, a maioria entre 2012 e 2014, com significativa produção no Brasil. Os profissionais de enfermagem são vulneráveis à depressão quando jovens, casados, realizam trabalho noturno e possuem vários empregos, e quando apresentam alto nível educacional, baixa renda familiar, sobrecarga de trabalho, estresse elevado, insuficiente autonomia e sentimento de insegurança profissional, conflitos no relacionamento familiar e no trabalho. Risco de suicídio foi correlacionado com a presença de sintomas de depressão, alto nível de exaustão emocional, despersonalização e baixa realização pessoal; características da Síndrome de Burnout. CONCLUSÃO Risco de suicídio entre os profissionais de enfermagem está associado a sintomas depressivos e os correlacionados com a Síndrome de Burnout, prejudicando o desempenho profissional.