Secretome of bone marrow mesenchymal stromal cells cultured in a dynamic system induces neuroprotection and modulates microglial responsiveness in an α-synuclein overexpression rat model.

BACKGROUND AIMS: Parkinson's disease (PD) is the second most common neurodegenerative disorder. The etiology of the disease remains largely unknown, but evidence have suggested that the overexpression and aggregation of alpha-synuclein (α-syn) play key roles in the pathogenesis and progression of PD. Mesenchymal stromal cells (MSCs) have been earning attention in this field, mainly due to their paracrine capacity. The bioactive molecules secreted by MSCs, i.e. their secretome, have been associated with enhanced neuronal survival as well as a strong modulatory capacity of the microenvironments where the disease develops. The selection of the appropriate animal model is crucial in studies of efficacy assessment. Given the involvement of α-syn in the pathogenesis of PD, the evidence generated from the use of animal models that develop a pathologic phenotype due to the action of this protein is extremely valuable. Therefore, in this work, we established an animal model based on the viral vector-mediated overexpression of A53T α-syn and studied the impact of the secretome of bone marrow mesenchymal stromal cells MSC(M) as a therapeutic strategy. METHODS: Adult male rats were subjected to α-syn over expression in the nigrostriatal pathway to model dopaminergic neurodegeneration. The impact of locally administered secretome treatment from MSC(M) was studied. Motor impairments were assessed throughout the study coupled with whole-region (striatum and substantia nigra) confocal microscopy evaluation of histopathological changes associated with dopaminergic neurodegeneration and glial cell reactivity. RESULTS: Ten weeks after lesion induction, the animals received secretome injections in the substantia nigra pars compacta (SNpc) and striatum (STR). The secretome used was produced from bone marrow mesenchymal stromal cells MSC(M) expanded in a spinner flask (SP) system. Nine weeks later, animals that received the viral vector containing the gene for A53T α-syn and treated with vehicle (Neurobasal-A medium) presented dopaminergic cell loss in the SNpc and denervation in the STR. The treatment with secretome significantly reduced the levels of α-syn in the SNpc and protected the dopaminergic neurons (DAn) within the SNpc and STR. CONCLUSIONS: Our results are aligned with previous studies in both α-syn Caenorhabditis elegans models, as well as 6-OHDA rodent model, revealing that secretome exerted a neuroprotective effect. Moreover, these effects were associated with a modulation of microglial reactivity supporting an immunomodulatory role for the factors contained within the secretome. This further supports the development of new studies exploring the effects and the mechanism of action of secretome from MSC(M) against α-syn-induced neurotoxicity.

Optimized operation of a controlled stirred tank reactor system for the production of mesenchymal stromal cells and their extracellular vesicles.

The therapeutic effects of human mesenchymal stromal cells (MSC) have been attributed mostly to their paracrine activity, exerted through small-secreted extracellular vesicles (EVs) rather than their engraftment into injured tissues. Currently, the production of MSC-derived EVs (MSC-EVs) is performed in laborious static culture systems with limited manufacturing capacity using serum-containing media. In this work, a serum-/xenogeneic-free microcarrier-based culture system was successfully established for bone marrow-derived MSC cultivation and MSC-EV production using a 2  l-scale controlled stirred tank reactor (STR) operated under fed-batch (FB) or fed-batch combined with continuous perfusion (FB/CP). Overall, maximal cell numbers of (3.0 ± 0.12) × 108 and (5.3 ± 0.32) × 108 were attained at Days 8 and 12 for FB and FB/CP cultures, respectively, and MSC(M) expanded under both conditions retained their immunophenotype. MSC-EVs were identified in the conditioned medium collected from all STR cultures by transmission electron microscopy, and EV protein markers were successfully identified by Western blot analysis. Overall, no significant differences were observed between EVs isolated from MSC expanded in STR operated under the two feeding approaches. EV mean sizes of 163 ± 5.27 nm and 162 ± 4.44 nm (p > 0.05) and concentrations of (2.4 ± 0.35) × 1011 EVs/mL and (3.0 ± 0.48) × 1011 EVs/mL (p > 0.05) were estimated by nanoparticle tracking analysis for FB and FB/CP cultures, respectively. The STR-based platform optimized herein represents a major contribution toward the development of human MSC- and MSC-EV-based products as promising therapeutic agents for Regenerative Medicine settings.

Preputial lymphangioma in a stallion: First report.

This short communication describes a case of a 30-year-old stallion with a mass on the base of the penis causing paraphimosis. The patient was submitted to anti-inflammatory and diuretic therapy with no signs of improvement, so 16 days after the lesion was detected, the animal was euthanized. Necropsy was performed, and histopathological assessment of the lesion was conducted. The mass was composed primarily of channels and cavernous structures, lined by elongated cells of vascular origin, located in the preputium. The lesion was diagnosed as a preputial lymphangioma. To the authors' best knowledge, the anatomical location of this neoplasm (which is rare in veterinary medicine) has not been previously reported.

A case of equine multicentric lymphoma: Clinical, microscopical, and molecular findings.

Background: Although relatively uncommon, lymphoma is the most prevalent haematopoietic neoplasia in horses, and multicentric lymphoma remains the most common presentation of the disease. The pathogenesis of equine lymphoma is still poorly understood and the diagnosis is usually confirmed at an advanced stage of the disease, compromising the prognosis. This study investigated the clinical, pathological, and molecular features of a case of equine multicentric lymphoma. Case Description: An apparently healthy 5-year-old crossbreed mare hospitalized at the Centre of Animal Reproduction of Vairão, Portugal, suddenly presented clinical signs of supraorbital oedema and mandibular lymph node enlargement, developing fever, facial oedema, and generalized lymphadenopathy. The mare ended up dying twenty-four days after the first clinical signs due to multisystem organ failure. Haematological and biochemical analyses, necropsy, and microscopic and molecular evaluation of affected tissues were performed. At necropsy, the main findings were multiple multinodular lesions, distributed along the serous surface of oropharynx, trachea, pericardium, gastrointestinal tract, and mesentery. Microscopically, these consisted of solid proliferations of neoplastic round cells that exhibited immunopositivity for CD3 (T cells). Based on these findings, a medium-grade multicentric T-cell lymphoma was diagnosed. Conclusion: There is still very little research regarding the molecular characterization of lymphoma in horses. As an entity itself is quite heterogeneous, it is important to describe the interspecies particularities to understand its development and behaviour.

Case report: Long term follow-up of a large unilateral epididymal cyst in a stallion used for teaching: Is this condition associated with infertility?

A 30-year-old Lusitano stallion presented with an enlarged right epididymis. The ultrasound scan revealed a cyst-like formation and the histopathological examination was compatible with epididymal cyst located at the body/tail transition, epididymal spermatocele and sperm granuloma and epididymitis. However, these conditions did not seem to affect the animal's reproductive performance, nor did the semen parameters analyzed over the 8 years after the diagnosis show significant changes. Nevertheless, since the ejaculate contains mostly sperm cells from the tail of the epididymis, where fertile spermatozoa are stored until ejaculated, a deep knowledge of the different conditions that can affect this organ is of the utmost importance.

Neurodifferentiation and Neuroprotection Potential of Mesenchymal Stromal Cell-Derived Secretome Produced in Different Dynamic Systems.

Parkinson's disease (PD) is the second most common neurodegenerative disorder and is characterized by the degeneration of the dopamine (DA) neurons in the substantia nigra pars compacta, leading to a loss of DA in the basal ganglia. The presence of aggregates of alpha-synuclein (α-synuclein) is seen as the main contributor to the pathogenesis and progression of PD. Evidence suggests that the secretome of mesenchymal stromal cells (MSC) could be a potential cell-free therapy for PD. However, to accelerate the integration of this therapy in the clinical setting, there is still the need to develop a protocol for the large-scale production of secretome under good manufacturing practices (GMP) guidelines. Bioreactors have the capacity to produce large quantities of secretomes in a scalable manner, surpassing the limitations of planar static culture systems. However, few studies focused on the influence of the culture system used to expand MSC, on the secretome composition. In this work, we studied the capacity of the secretome produced by bone marrow-derived mesenchymal stromal cells (BMSC) expanded in a spinner flask (SP) and in a Vertical-Wheel™ bioreactor (VWBR) system, to induce neurodifferentiation of human neural progenitor cells (hNPCs) and to prevent dopaminergic neuron degeneration caused by the overexpression of α-synuclein in one Caenorhabditis elegans model of PD. Results showed that secretomes from both systems were able to induce neurodifferentiation, though the secretome produced in the SP system had a greater effect. Additionally, in the conditions of our study, only the secretome produced in SP had a neuroprotective potential. Lastly, the secretomes had different profiles regarding the presence and/or specific intensity of different molecules, namely, interleukin (IL)-6, IL-4, matrix metalloproteinase-2 (MMP2), and 3 (MMP3), tumor necrosis factor-beta (TNF-ß), osteopontin, nerve growth factor beta (NGFß), granulocyte colony-stimulating factor (GCSF), heparin-binding (HB) epithelial growth factor (EGF)-like growth factor (HB-EGF), and IL-13. Overall, our results suggest that the culture conditions might have influenced the secretory profiles of cultured cells and, consequently, the observed effects. Additional studies should further explore the effects that different culture systems have on the secretome potential of PD.

Fatal congenital and traumatic cervical spine injuries in a captive newborn plains zebra (Equus quagga).

Background: In this report, we describe the clinical, macro-, and microscopic findings of a newborn zebra victim of a fatal trauma and its possible causes are discussed in detail. Case Description: A plains zebra (Equus quagga) born in a Portuguese zoo was found in hypothermia and unable to get up. The animal was admitted to the hospital 36 hours later and, after the first hour of treatment and no attempts to get up, it began to convulse and died. At necropsy, subdural hematoma and atlantoaxial dislocation were the main findings. Conclusion: The inability to pinpoint the exact moment of the lesions' onset determines the importance of a thorough surveillance of the periparturient period and parturition of captive animals. Furthermore, literature concerning zebras, their reproduction, and neonatal period is scarce, reinforcing the need to report these cases.

Práticas de avaliação psicológica em suspeitas de abuso sexual infantil intrafamiliar no contexto do judiciário do estado do Rio de Janeiro / Psychological assessment practices in cases of suspected intrafamilial child sexual abuse in the context of the judiciary power in the state of Rio de Janeiro / Les pratique s de l'évaluation psychologique en cas de suspicion d e violence sexuel intrafamilial chez l' enfant dans le contexte judiciaire de l'état de Rio de Janeiro / Prácticas de evaluación psicológica en presuntas víctimas de abuso sexual infantil intrafamiliar en el Poder Judicial del estado de Río de Janeiro

Resumo: O artigo apresenta os resultados da pesquisa que investigou as práticas em avaliação psicológica realizadas pelos psicólogos forenses do judiciário fluminense nos processos judiciais envolvendo suspeita de abuso sexual infantil intrafamiliar. Foram realizadas entrevistas qualitativas com quatro analistas judiciários do Tribunal de Justiça do Estado do Rio de Janeiro (TJRJ) e duas psicólogas peritas judiciais. A partir da análise de conteúdo de Bardin, emergiram três categorias: avaliação psicológica: percepções e recursos; perícias psicológicas em casos de abuso sexual infantil intrafamiliar; e dificuldades dos psicólogos forenses no contexto do TJRJ. Concluiu-se que as práticas avaliativas são diversas e que há pouca abertura por parte dos psicólogos forenses e da instituição judiciária fluminense para a utilização de instrumentos psicológicos além das entrevistas. O espaçamento temporal entre a ocorrência da violência e a perícia, o alto volume de trabalho e os curtos prazos processuais foram complicadores referidos por todos os participantes.

Abstract: This study investigated the practices in Psychological Assessment carried out by Rio de Janeiro judiciary forensic psychologists in judicial proceedings involving suspected intrafamilial child sexual abuse. For that, six forensic psychologists linked to the Court of Justice of the State of Rio de Janeiro were interviewed. Participants included four judicial analysts occupying positions of psychologists and two psychologists who are judicial experts. Based on Bardin's content analysis, three categories emerged. Psychological Assessment: perceptions and resources; psychological expertise in cases of intrafamilial child sexual abuse and difficulties faced by forensic psychologists in the context of the Court of Justice. We found diverse evaluative practices and scarce spaces for the use of psychological instruments besides interviews. The temporal spacing between the occurrence of violence and expertise, the high volume of work, and the short procedural deadlines configured complicating factors according to all participants.

Résumé : L'article expose les résultats de la recherche qui a enquêté sur les pratiques d'évaluation psychologique réalisées par des psychologues légistes de la justice de Rio de Janeiro dans le cadre de procédures judiciaires impliquant des violences sexuels intrafamiliaux présumés chez des enfants. Des entretiens qualitatifs ont été réalisés avec quatre analystes judiciaires du Tribunal de Justiça do Rio de Janeiro (TJRJ) [Cour d'Appel de l'État de Rio de Janeiro] et deux psychologues judiciaires experts. De l'analyse de contenu de Bardin, trois catégories ont émergé : évaluation psychologique : perceptions et ressources ; expertise psychologique dans les cas de violence sexuel intrafamiliaux chez les enfants ; et difficultés des psychologues judiciaires dans le cadre du TJRJ. Nous concluons que les pratiques évaluatives sont diverses et qu'il y a peu d'ouverture pour l'utilisation d'instruments psychologiques en dehors des entretiens. L'espacement temporel entre la survenance de la violence et l'expertise, le volume de travail important et les courts délais de procédure ont été des facteurs de complication mentionnés par tous les participants.

Resumen: Este artículo expone los resultados de la investigación que tuvo como objetivo conocer las prácticas de evaluación psicológica realizadas por psicólogos forenses del Poder Judicial de Río de Janeiro en procesos judiciales que involucran a presuntas víctimas de abuso sexual infantil intrafamiliar. Se realizaron entrevistas cualitativas a cuatro analistas judiciales del Tribunal de Justicia del Estado de Río de Janeiro (TJRJ) y dos peritos psicólogos judiciales. Del análisis de contenido de Bardin surgieron tres categorías: evaluación psicológica: percepciones y recursos; pericia psicológica en casos de abuso sexual infantil intrafamiliar; y dificultades de los psicólogos forenses en el contexto del TJRJ. Se concluyó que las prácticas evaluativas son diversas y que hay poco espacio para el uso de herramientas psicológicas más allá de las entrevistas. El espaciamiento temporal entre la ocurrencia de la violencia y la pericia, el alto volumen de trabajo y los cortos plazos procesales fueron los factores de complicación mencionados por todos los participantes.

Isolation of aerobic cultivable cellulolytic bacteria from different regions of the gastrointestinal tract of giant land snail Achatina fulica.

The enzymatic hydrolysis of cellulose by cellulases is one of the major limiting steps in the conversion of lignocellulosic biomass to yield bioethanol. To overcome this hindrance, significant efforts are underway to identify novel cellulases. The snail Achatina fulica is a gastropod with high cellulolytic activity, mainly due to the abundance of glycoside hydrolases produced by both the animal and its resident microbiota. In this study, we partially assessed the cellulolytic aerobic bacterial diversity inside the gastrointestinal tract of A. fulica by culture-dependent methods and evaluated the hydrolytic repertoire of the isolates. Forty bacterial isolates were recovered from distinct segments of the snail gut and identified to the genus level by 16S rRNA gene sequence analysis. Additional phenotypic characterization was performed using biochemical tests provided by the Vitek2 identification system. The overall enzymatic repertoire of the isolated strains was investigated by enzymatic plate assays, containing the following substrates: powdered sugarcane bagasse, carboxymethylcellulose (CMC), p-nitrophenyl-ß-D-glucopyranoside (pNPG), p-nitrophenyl-ß-D-cellobioside (pNPC), 4-methylumbelliferyl-ß-D-glucopyranoside (MUG), 4-methylumbelliferyl-ß-D-cellobioside (MUC), and 4-methylumbelliferyl-ß-D-xylopyranoside (MUX). Our results indicate that the snail A. fulica is an attractive source of cultivable bacteria that showed to be valuable resources for the production of different types of biomass-degrading enzymes.

Fast and efficient Drosophila melanogaster gene knock-ins using MiMIC transposons.

Modern molecular genetics studies necessitate the manipulation of genes in their endogenous locus, but most of the current methodologies require an inefficient donor-dependent homologous recombination step to locally modify the genome. Here we describe a methodology to efficiently generate Drosophila knock-in alleles by capitalizing on the availability of numerous genomic MiMIC transposon insertions carrying recombinogenic attP sites. Our methodology entails the efficient PhiC31-mediated integration of a recombination cassette flanked by unique I-SceI and/or I-CreI restriction enzyme sites into an attP-site. These restriction enzyme sites allow for double-strand break-mediated removal of unwanted flanking transposon sequences, while leaving the desired genomic modifications or recombination cassettes. As a proof-of-principle, we mutated LRRK, tau, and sky by using different MiMIC elements. We replaced 6 kb of genomic DNA encompassing the tau locus and 35 kb encompassing the sky locus with a recombination cassette that permits easy integration of DNA at these loci and we also generated a functional LRRK(HA) knock in allele. Given that ~92% of the Drosophila genes are located within the vicinity (<35 kb) of a MiMIC element, our methodology enables the efficient manipulation of nearly every locus in the fruit fly genome without the need for inefficient donor-dependent homologous recombination events.

Avaliação de rótulos para verificar a presença de edulcorantes em produtos tradicionais / Evaluation of labels to verify the presence of sweeteners in traditional products

Produtos com edulcorantes em sua composição já é esperado em produtos diet e light, entretanto, nota-se a presença mais freqüente desses aditivos em produtos tradicionais. Assim, o objetivo do trabalho foi avaliar a presença de edulcorantes em produtos tradicionais através da análise de rótulos. A pesquisa foi realizada em 2018, em supermercados de Fortaleza (CE), nas categorias de bebidas industrializadas, laticínios e sobremesas, totalizando 50 produtos. A partir das análises dos rótulos verificou-se que 28 não continham edulcorantes e 22 apresentaram esse aditivo. Dentre os produtos com edulcorantes os tipo sutilizados variaram de um a quatro no mesmo alimento. Na categoria sobremesa foi encontrado edulcorante em todos os produtos avaliados. E o edulcorante de maior prevalência nos produtos foi o acessulfame de potássio.

Development of an enzyme-linked immunosorbent assay for detection of cellular and in vivo LRRK2 S935 phosphorylation.

After the discovery of kinase activating mutations in leucine-rich repeat kinase 2 (LRRK2) as associated with autosomal dominant forms of Parkinson's disease, inhibition of the kinase is being extensively explored as a disease modifying strategy. As signaling properties and substrate(s) of LRRK2 are poorly documented, autophosphorylation has been an important readout for the enzyme's activity. Western blotting using anti-phospho-S910 or S935 LRRK2 antibodies showed effectiveness in demonstrating inhibitory effects of compounds. In this communication we describe two types of enzyme-linked immunosorbent assays (ELISA) to determine LRRK2 protein levels and kinase activity. Both assays take advantage of the sensitivity of the earlier described total and pS935 antibodies for detection (Nichols et al., Biochem. J. 2010) [10]. The first assay is based on anti-GFP-based capturing of overexpressed LRRK2 and is highly suitable to show cellular effects of kinase inhibitors in a 96-well format. In the other platform anti-LRRK2-based capturing allows detection of endogenously expressed LRRK2 in rat tissue with no significant signal in tissue from LRRK2 knockout rats. Furthermore, both assays showed a significant reduction in pS935 levels on cellular and transgenic R1441C/G LRRK2. With the anti-LRRK2 ELISA we were able to detect LRRK2 phosphorylation in human peripheral blood mononuclear cells (PBMC). To conclude, we report two sensitive assays to monitor LRRK2 expression and kinase activity in samples coming from cellular and in vivo experimental settings. Both can show their value in drug screening and biomarker development but will also be useful in the elucidation of LRRK2-mediated signaling pathways.

LRRK2 controls an EndoA phosphorylation cycle in synaptic endocytosis.

LRRK2 is a kinase mutated in Parkinson's disease, but how the protein affects synaptic function remains enigmatic. We identified LRRK2 as a critical regulator of EndophilinA. Using genetic and biochemical studies involving Lrrk loss-of-function mutants and Parkinson-related LRRK2(G2019S) gain-of-kinase function, we show that LRRK2 affects synaptic endocytosis by phosphorylating EndoA at S75, a residue in the BAR domain. We show that LRRK2-mediated EndoA phosphorylation has profound effects on EndoA-dependent membrane tubulation and membrane association in vitro and in vivo and on synaptic vesicle endocytosis at Drosophila neuromuscular junctions in vivo. Our work uncovers a regulatory mechanism that indicates that reduced LRRK2 kinase activity facilitates EndoA membrane association, while increased kinase activity inhibits membrane association. Consequently, both too much and too little LRRK2-dependent EndoA phosphorylation impedes synaptic endocytosis, and we propose a model in which LRRK2 kinase activity is part of an EndoA phosphorylation cycle that facilitates efficient vesicle formation at synapses.

Insights into the role of extracellular polysaccharides in Burkholderia adaptation to different environments.

The genus Burkholderia comprises more than 60 species able to adapt to a wide range of environments such as soil and water, and also colonize and infect plants and animals. They have large genomes with multiple replicons and high gene number, allowing these bacteria to thrive in very different niches. Among the properties of bacteria from the genus Burkholderia is the ability to produce several types of exopolysaccharides (EPSs). The most common one, cepacian, is produced by the majority of the strains examined irrespective of whether or not they belong to the Burkholderia cepacia complex (Bcc). Cepacian biosynthesis proceeds by a Wzy-dependent mechanism, and some of the B. cepacia exopolysaccharide (Bce) proteins have been functionally characterized. In vitro studies showed that cepacian protects bacterial cells challenged with external stresses. Regarding virulence, bacterial cells with the ability to produce EPS are more virulent in several animal models of infection than their isogenic non-producing mutants. Although the production of EPS within the lungs of cystic fibrosis (CF) patients has not been demonstrated, the in vitro assessment of the mucoid phenotype in serial Bcc isolates from CF patients colonized for several years showed that mucoid to non-mucoid transitions are relatively frequent. This morphotype variation can be induced under laboratory conditions by exposing cells to stress such as high antibiotic concentration. Clonal isolates where mucoid to non-mucoid transition had occurred showed that during lung infection, genomic rearrangements, and mutations had taken place. Other phenotypic changes include variations in motility, chemotaxis, biofilm formation, bacterial survival rate under nutrient starvation and virulence. In this review, we summarize major findings related to EPS biosynthesis by Burkholderia and the implications in broader regulatory mechanisms important for cell adaptation to the different niches colonized by these bacteria.

Effects of prenatal and postnatal exposure to a low dose of bisphenol A on behavior and memory in rats.

Endocrine disruptors (EDs) are increasingly common chemicals in the environment. Bisphenol A (BPA), used to manufacture polycarbonate plastics, is an ED recognized for its estrogenic, anti-estrogenic, and anti-androgenic effects. Behavior is considered a vital characteristic for an animal's life cycle. This study evaluated the effect of exposure to low doses of BPA during pregnancy and/or lactation on several aspects of rat behavior, including memory, locomotion, and the exploratory instinct. Pups at 16 weeks of age (females and males) were divided into groups according to the mother's exposure to BPA (40µg/kg/day): CON (vehicle only); PRE (during pregnancy); LAC (during lactation); PRE-LAC (during both pregnancy and lactation). In the PRE-LAC group, exposure to BPA impaired both short-term (STM) and long-term memory (LTM) in inhibitory avoidance and the object recognition task, and also affected locomotor activity and spatial memory. Some sex-specific behavioral characteristics disappeared in the LAC group. Sex-specific memory and behavior impairment were caused by BPA exposure during brain organogenesis and differentiation.

Perfil de pacientes HIV-AIDS que evoluíram ao óbito em um hospital de referência em Belém-Pa / Profileof HIV-AIDS patients who died at an university hospital in Belém-Pa

Objetivo: analisar o perfil de pacientes com HIV-AIDS que evoluíram ao óbito em um hospital de referência emBelém-PA.Método:estudo transversal, incluindo 142 prontuários de pacientes com sorologia positiva para o vírusHIV internados no Hospital Universitário João de Barros Barreto que evoluíram ao óbito no período de janeirode 2011 a janeiro de 2012. Em 64 pacientes foi possível a análise da contagem dos linfócitos TCD4 no banco dedados do Sistema de Controle de Exames Laboratoriais da Rede Nacional de contagem de linfócitos CD4+/CD8+ eCarga viral (SISCEL). Resultados: operfil sócio demográfico foi constituído principalmente por uma população dehomens (71,1%), com faixa etária de 30 a 39 anos (39,4%), solteiros (67,6%), pardos(79.6%) e procedentes de Belém(59,2%). O sistema mais acometido na admissão e no óbito foi o respiratório com 71,1% e 42,% respectivamente,apresentandooutras pneumonias que não por Pneumocistis carinii (29,6%) e tuberculose pulmonar (24,6%) comomais frequentes de acordo com declaração de óbito contida no prontuário do paciente. A última internação teve tempopredominante menor que 7dias (26.1%).A correlação entre a contagem de linfócitos CD4 a as infecções oportunistas,verificou-se que a toxoplasmose cerebral apresentou a maior média de CD4 175,5 células/mm³.Conclusão:A amostrapredominante foi constituída por homens, na faixa etária de 30 a 39 anos, solteiros, cor parda e procedente domunicípio de Belém.

Objective: To analyze the profile of HIV-AIDS patients who died in a referral hospital in Belém-PA. Method:cross-sectional study, including 142 patients with HIV, admitted to the University HospitalJoão de Barros Barreto,who died between January 2011 to January 2012. In the analysis of 64 patients, it was possible the count of TCD4lymphocytes in the Database System Laboratory Tests Control of the National Network lymphocyte count of CD4+ / CD8 + and viral load (SISCEL). Results: The socio-demographic profile was primarily a population of men(71.1%), age between 30 and 39 years (39.4%), single (67.6%), brown color(79.6%) and born inBelém (59.2%).The system most affected at admission and death was the respiratory system with 71.1% and 42% respectively, withpneumonia (29.6%) and pulmonary tuberculosis (24.6%) as the most frequent according to the death certificate inthe patient's record. The last hospitalization was less prevalent long as seven days (26.1%). The correlation betweenCD4 lymphocyte counts to opportunistic infections, it was found that a toxoplasmosebrain had the highest average175.5 CD4 cells / mm³. Conclusion: The predominant sample was incorporated by men, aged 30-39 years old, single,brown color and founded the city of Belém.

A Comunicação de más notícias numa unidade de cuidados continuados integrados / The Communication of Bad News in an Integrated Long Term Care Unit

Comunicar é parte integrante da vida, é uma partilha do que somos e do que idealizamos ser. Envolve troca de informações e utiliza sistemas simbólicos como suporte para este fim. A habilidade para estabelecer uma boa comunicação é parte essencial em todas as áreas dos cuidados de saúde. Para existir uma boa comunicação é necessário: criar relações, dar valor à outra pessoa, reduzir o isolamento, recolher informações, transmitir informações, permitir a expressão de sentimentos, reduzir a incerteza. Pensamos muitas vezes que comunicar é apenas transmitir a nossa mensagem, a verdade é que ouvir é tão importante quanto falar, sobretudo em áreas como a saúde. O reconhecimento destes aspectos, assume especial relevância quando se trata de comunicar uma má notícia, considerada uma das tarefas mais difíceis e complexas que os profissionais de saúde têm que enfrentar no contexto das relações interpessoais com o doente/família. Neste contexto surge este estudo que tem como principal objectivo conhecer a perspectiva do Enfermeiro de uma Unidade de Cuidados Continuados Integrados face á comunicação de más notícias, de modo a suscitar nos profissionais de saúde a necessidade de desenvolvimento de competências nesta área e contribuir para uma melhor intervenção a este nível. Metodologia: O estudo insere-se num paradigma qualitativo, de natureza descritiva e exploratória. A estratégia de recolha de dados foi a entrevista semiestruturada dirigida a Enfermeiros de uma Unidade de Cuidados Continuados Integrados na zona norte do país. A análise de conteúdo segundo Bardin (2008) foi a técnica utilizada para o tratamento de dados. Principais resultados: Os resultados obtidos através da análise dos discursos dos enfermeiros que participaram neste estudo permitiram-nos concluir que estes consideram que uma má notícia é uma informação desagradável, que tem um impacto emocional no doente e nas actividades quotidianas e informação de uma condição diferente. São tipos de más notícias a morte, doença grave, agudização da situação clínica e a perda de autonomia. A comunicação de más notícias gera nos enfermeiros sentimentos como tristeza, ansiedade, angustia, medo, insegurança ou frustração. Várias foram as estratégias referidas pelos profissionais para facilitar a comunicação de más notícias, destacando-se a necessidade de criar empatia, ser objectivo e utilizar um tom calmo. Como factores que interferem no processo de comunicação de más notícias foram referidos, factores relacionados com o modo de comunicação, com a situação de doença, com o doente/família e com o próprio profissional. A existência de formação contínua na área e reuniões com os familiares foram sugestões apresentadas para melhorar a comunicação de más notícias.

Communicating is a integrating part of life, it is a share of what we are and of what we see ourselves as. Involves an exchange of informations and uses symbolic systems as a support for that end. The ability for establishing a good communication is an essential part in all health care areas. For a good communication to exist it's necessary: create relations, give value to other person, reduce isolation, collect informations, transmit informations, allow feelings expression, reduce uncertainty. We think many times that communicating is just transmitting our message, the truth is that listening is as important as speaking, especially in areas as health. The acknowledge of this aspects, takes on special relevance when it comes to communicating a bad news, considered one of the most hard and complex that the health professionals have to deal with in the context of interpersonal relations with the patient/family. In this context comes up this study that has as primary objective knowing the Nurse of a Integrated Continued Care Unit perspective facing the communication of bad news, in a way that it will raise in the health professionals the need to develop skills in this areas and contribute to a better intervention to this level. Methodology: The study inserts in a qualitative paradigm, of descriptive and exploratory nature, being the direct care to the patient prestating nurses in an Integrated Continued Care Unit in the north area of the country, for at least a year, the target population, excluding the nurses that are on prolonged license situation when the data was collected. For the data collection we used the interview. Principal Results: The results obtained through the analysis of the speech of the nurses who participated in this study allow us to conclude that they consider that a bad news is an unpleasant information, that as an emotional impact on the patient and in the daily activities and an information of a different condition. Bad news types are death, serious illness, worsening of clinic situation and loss of autonomy. The communication of bad news generates on the nurses feelings like sadness, anxiety, anguish, fear, insecurity or frustration. Several are the strategies referred by the professionals to ease the communication of bad news, highlighting the need to create empathy, being objective and using a calm tone. As factors that interfere in the process of communication of bad news were referred, factors related to the way of communicating, with the disease situation, with the patient/family and with the professional himself. The existence of continuous formation in the area and reunions with the family members is some of the suggestions presented to improve the communication of bad news.