Relationship between early-life stress and trait mindfulness in adulthood: a correlational study.

BACKGROUND: To investigate the relationship between early-life stress (ELS) and the trait mindfulness level in workers. METHOD: This study is quantitative cross-sectional and correlational research with a sample of 929 workers from a Brazilian public university. ELS and mindfulness assessment was performed using the Childhood Trauma Questionnaire (CTQ) and the Five-Facet Mindfulness Questionnaire-BR (FFMQ-BR), respectively. The data were submitted to correlation tests adopting a significance level of .05 and a multivariate linear regression analysis. RESULTS: 50.0% of the participants obtained a score indicative of ELS exposure in at least one subtype among the five proposed by the CTQ, with emotional neglect predominating (63.0%). The group not exposed to emotional abuse had higher scores in the "describe-positive formulation" and "non-reactivity to inner experience" facets. Those that scored for physical abuse had higher values in "acting with awareness-autopilot". However, the group exposed to sexual abuse obtained the highest score in the "acting with awareness-autopilot" and "acting with awareness-distraction" facets. The correlation between FFMQ-BR and CTQ overall scores showed a weak correlation with statistical significance. The multiple linear revealed that the facets of mindfulness were significantly associated by at least one type of early stress; however, no significant association was found between CTQ and FFMQ-BR overall results. CONCLUSION: The results showed that emotional regulation might have effectively occurred in this specific population, even with the presence of some childhood trauma.

Tratamento da UCE refratária aos anti-histamínicos e na impossibilidade do omalizumabe, nos adultos / Treatment of CSU refractory to antihistamines and in the impossibility of omalizumab therapy in adults

Há o empenho contínuo de especialistas no desenvolvimento de tratamentos resolutivos ou eficazes nos controles das doenças, no entanto, a entidade urticária crônica espontânea (UCE), quando refratária à primeira linha de tratamento, os anti-histamínicos, apresenta um prognóstico desfavorável. Existe um arsenal de medicamentos biológicos disponíveis já consolidados como eficazes e seguros, porém eventualmente nos defrontamos com a inacessibilidade a estes medicamentos, devido aos custos dos mesmos e aos trâmites necessários para dar início ao tratamento. Tais fatos fundamentam a discussão sobre terapias alternativas com outros fármacos, visando manter o manejo adequado da doença e a qualidade de vida dos pacientes.

Specialists have made a continuous effort for the development of effective treatments for disease control; however, chronic spontaneous urticaria (CSU), when refractory to the first line of treatment, ie, antihistamines, has an unfavorable prognosis. There are biological medicines available, which have been consolidated as effective and safe, but we are occasionally faced with a lack of access to these medicines due to their costs and the necessary procedures to start treatment. Such facts support the discussion about alternative therapies with other drugs, aiming at maintaining the adequate management of the disease and the quality of life of patients.

Massive iron overload and acute-on-chronic liver failure in a patient with Diamond-Blackfan anaemia: a case report.

BACKGROUND: Genetic anaemias lead us to reflect on the classic 'trolley dilemma', when there are two choices but neither one is satisfactory. Either we do not treat anaemia and the patient suffers from chronic tiredness and fatigue, or we do treat it through blood transfusions, leading to iron overload, which is a quite harmful consequence. CASE PRESENTATION: We present the case of a 34-year-old woman with Diamond-Blackfan anaemia (DBA). Bone marrow stem cell transplantation had not been accessible during her childhood, so she had been submitted to monthly blood transfusions throughout her life, leading to a hepatitis C virus infection (which was treated, achieving a sustained virological response when she was 18 years old), and secondary haemochromatosis. Despite chelation therapy, diffuse iron deposition was occurring in multiple organs, markedly in the heart and liver. Her serum ferritin was higher than 21,000 ng/mL and transferrin saturation reached 102%. When she faced heart decompensation, this congestive condition led to an acute liver injury overlapping pre-existing hepatic fibrosis. She progressed to haemodynamic and hepatic failure, with clinical features of acute-on-chronic liver failure (ACLF). Despite therapeutic optimisation, she died of respiratory insufficiency. An autopsy was performed and revealed the macroscopic and microscopic findings of a massive iron deposition in the liver, heart, lungs, spleen, bone marrow, thyroid and adrenal glands. We found marked advance of liver fibrosis (chronic damage), as well as necrosis of hepatocytes in zone 3 of the Rappaport acinus (acute damage), supporting the hypothesis of ACLF. The main feature responsible for acute liver decompensation seemed to be heart insufficiency. CONCLUSION: This is the first case reporting the sequence: DBA, multiple blood transfusions, secondary haemochromatosis, advanced liver fibrosis, heart failure, ACLF and death. A multidisciplinary team is essential to care for DBA patients, since there is a significant emotional burden related to the disease, which might impair an effective chelation therapy and lead to severe consequences due to iron deposition.

Effects of a mindfulness-based intervention on the functional status and mindfulness of primary health care professionals: a before and after study

Abstract Background Contextual factors involving the physical and social environment, as well as personal factors, are closely related to functional status, and they can have positive or negative influences on the health conditions or status of an individual in society. Objectives The objective is to evaluate the effect of a mindfulness-based intervention program on functional status and mindfulness levels in primary health care (PHC) professionals in Ribeirão Preto, Brazil. Methods This is a quasi-experimental study, with 26 PHC professionals, using quantitative methods and an analytical before and after approach of an 8-week mindfulness program. Results There were significant differences in mindfulness facets after the intervention: Observe (p = 0.002); Describe - positive formulation (p = 0.01); Acting with awareness - automatic pilot (p = 0.01) and distraction (p = 0.05); Nonreactivity (p = 0.0005); Nonjudgement (p = 0.01); and in total mindfulness scores (p = 0.0000018). Regarding functional status, significant differences were found: change in health (p = 0.01), overall health (p = 0.007), quality of life (p = 0.04) and feelings (p = 0.01). Discussion The results in improving the functional status and mindfulness of PHC professionals show that mindfulness practices can improve the worker's quality of life and health.

Transcriptomics of Arabidopsis sperm cells at single-cell resolution.

KEY MESSAGE: We present a detailed protocol for isolation of single sperm cells and transcriptome analysis to study variation in gene expression between sperm cells. Male gametophyte development in flowering plants begins with a microspore mother cell, which upon two consecutive cell divisions forms a mature pollen grain containing a vegetative nucleus and two sperm cells. Pollen development is a highly dynamic process, involving changes at both the transcriptome and epigenome levels of vegetative nuclei and the pair of sperm cells that have their own cytoplasm and nucleus. While the overall transcriptome of Arabidopsis pollen development is well documented, studies at single-cell level, in particular of sperm cells, are still lacking. Such studies would be essential to understand whether and how the two sperm cells are transcriptionally different, in particular once the pollen tube grows through the transmitting tissue of the pistil. Here we describe a detailed protocol for isolation of single sperm cells from growing pollen tubes and analysis of their transcriptome.

Sida tuberculata extract reduces the nociceptive response by chemical noxious stimuli in mice: Implications for mechanism of action, relation to chemical composition and molecular docking.

Sida tuberculata R.E.Fr. (Malvaceae) is a medicinal plant widely found in Southern Brazil, and popularly used for inflammatory disorders and to pain relief. A phytochemical analysis followed by an investigation about antinociceptive potential and mechanism of action were performed with leaves and roots extracts. Methanolic extracts, designated as S. tuberculata leaves extract (STLE) and S. tuberculata roots extract, were analyzed both by UHPLC­MS. The in vivo antinociceptive potential of STLE (10­300 mg kg−1) was assessed in mice subjected to the acetic acid­induced abdominal writhes and formalin model. Agonist/antagonist tests and computational docking suggest the involvement of opioid and adenosinergic systems. The main chemical class detected on extracts was the ecdysteroids, and 20­hydoxyecdysone (20HE) was confirmed as the major phytoconstituent. The pretreatment with STLE (100 mg kg−1) reduced more than 70% abdominal contortions induced by acetic acid model and produced significant inhibition on formalin­induced licking response. The mechanism of action study revealed STLE might act through opioid and adenosine systems. Molecular docking suggested kaempferol derivative and 20HE might interacting with µ­opioid receptor. Thus, the results suggest the existence of antinociceptive potential from S. tuberculata extracts being in accordance to the traditional use.

Safflower (Catharmus tinctorius L.) oil supplementation in overnourished rats during early neonatal development: effects on heart and liver function in the adult.

Carthamus tinctorius L. (common name: safflower) is an herb whose extracted oil (safflower oil) has been employed in both alternative and conventional medicine in the treatment of disease. Overnutrition during early postnatal life can increase the lifetime risk of obesity and metabolic syndrome. Here we investigate the effect of safflower oil supplementation given during a critical early developmental stage on the eventual occurrence of metabolic disease in overnourished rats. Groups of overnourished or adequately nourished rats were randomly assigned into 2 additional groups for supplementation with either safflower oil (SF) or vehicle for 7 to 30 days. Murinometric data and weights were examined. Serum was collected for measurement of glucose, cholesterol, high-density lipoprotein cholesterol, and triglycerides. Heart and liver oxidative status were also measured. Overnutrition for 7-30 days induced a significant increase in body weight and in values for abdominal circumference, thoracic circumference, body length, and body mass index. SF supplementation did not attenuate the effect of overnutrition on any of these parameters. In addition, overnutrition increased levels of glucose, triglycerides, and very low-density lipid compared with normal controls, but SF supplementation had no effect on these parameters. Measures of oxidative status in heart or liver were not influenced by overnutrition. However, oxidative measures were altered by SF supplementation in both of these organs. The present study reveals that nutritional manipulation during early development induces detrimental effects on metabolism in the adult that are not ameliorated by supplemental SF.

The Effect of Ursolic Acid on Leishmania (Leishmania) amazonensis Is Related to Programed Cell Death and Presents Therapeutic Potential in Experimental Cutaneous Leishmaniasis.

Among neglected tropical diseases, leishmaniasis is one of the most important ones, affecting more than 12 million people worldwide. The available treatments are not well tolerated, and present diverse side effects, justifying the search for new therapeutic compounds. In the present study, the activity of ursolic acid (UA) and oleanolic acid (OA) were assayed in experimental cutaneous leishmaniasis (in vitro and in vivo). Promastigote forms of L. amazonensis were incubated with OA and UA for 24h, and effective concentration 50% (EC50) was estimated. Ultraestructural alterations in Leishmania amazonensis promastigotes after UA treatment were evaluated by transmission electron microscopy, and the possible mode of action was assayed through Annexin V and propidium iodide staining, caspase 3/7 activity, DNA fragmentation and transmembrane mitochondrial potential. The UA potential was evaluated in intracellular amastigotes, and its therapeutic potential was evaluated in L. amazonensis infected BALB/c mice. UA eliminated L. amazonensis promastigotes with an EC50 of 6.4 µg/mL, comparable with miltefosine, while OA presented only a marginal effect on promastigote forms at 100 µg/mL. The possible mechanism by which promastigotes were eliminated by UA was programmed cell death, independent of caspase 3/7, but it was highly dependent on mitochondria activity. UA was not toxic for peritoneal macrophages from BALB/c mice, and it was able to eliminate intracellular amastigotes, associated with nitric oxide (NO) production. OA did not eliminate amastigotes nor trigger NO. L. amazonensis infected BALB/c mice submitted to UA treatment presented lesser lesion size and parasitism compared to control. This study showed, for the first time, that UA eliminate promastigote forms through a mechanism associated with programed cell death, and importantly, was effective in vivo. Therefore, UA can be considered an interesting candidate for future tests as a prototype drug for the treatment of cutaneous leishmaniasis.

A medicina centrada na pessoa: o componente espiritual naabordagem pelo Médico de Família e Comunidade / The medicine centered on the person: the spiritual component in addressing the GP and Community

A espiritualidade das pessoas parece influenciar a forma como elas constroem as suas narrativas relativas ao processo-saúde doença, incluindo estratégias de enfrentamento de situações adversas.Portanto, questões relativas à espiritualidade podem ser abordadas durante os encontros entre profissionais de saúde e a pessoa. Esse estudo explora, sobretudo, como os médicos de família e comunidade (MFC) percebem essas questões na sua prática, como e quando fazem sua abordagem e quais julgam ser a sua contribuição para a clínica. Esse trabalho apresenta um a análise documental do tema espiritualidade e saúde, seguida de entrevistas semi-estruturadas com10 (dez) MFC. Participaram médicos de diversas nacionalidades, o que foi oportuno para avaliara espiritualidade e o entendimento do processo de adoecimento em contextos sociais e culturais distintos. A análise de conteúdo das entrevistas identificou que os MFC reconhecem a importância das questões espirituais nas narrativas das pessoas, incluindo o processo saúde doença, mesmo não tendo recebido treinamento formal para abordá-las dentro da prática clínica.O fator preponderante para realizar essa abordagem foi a competência que os MFC possuem em realizar a medicina centrada na pessoa (MCP) baseada na narrativa...

No caso dos MFC entrevistados, os facilitadores para desenvolver essa competência foram seus interesses pessoais em disciplinas diversas que possuem áreas de interseção com a medicina, como comunicação, psicologia, antropologia e sociologia. Houve entre os MFC concordância quanto a abordagem da espiritualidade contribuir para a criação e o fortalecimento do vínculo entre o médico e a pessoa, através do aprofundamento do diálogo. O próximo passo parece ser oferecer treinamento formal para o desenvolvimento da abordagem da espiritualidade tanto de forma não-estruturada (baseada na narrativa com desenvolvimento de competência em comunicação), quanto associada à estruturada (com uso de ferramentas e instrumentos validados), e verificar se há modificação na sensibilidade do médico para o assunto e suas repercussões na MCP e na relação médico-pessoa...

Revisão sistemática da literatura sobre a utilização da meditação e meditação Mindfulness no Brasil

A meditação, estudada há mais de 2500 anos, tem tido reconhecimento e ocupado espaços distintos na atualidade, ultrapassando os muros dos retiros tradicionais de práticas meditativas e abrangendo desde a busca espiritual até a autorregulação do corpo e da mente. Mindfulness (Atenção Plena ou Mente Presente, em português) é um tipo de meditação que consiste na tentativa de prestar atenção, intencionalmente e de maneira consciente, no momento atual, sem fazer julgamentos ou tentar modificar pensamentos, sentimentos ou sensações. John Kabat-Zinn iniciou seus estudos sobre esta prática meditativa no início da década de 70 e a adicionou às terapias clínicas ocidentais, desenvolvendo o Programa de Redução de Estresse Baseado em Mindfulness com a intenção de auxiliar as pessoas a lidarem melhor com situações geradores de estresse, depressão, problemas cardíacos, gastrointestinais, dermatológicos e hipertensão arterial. Atualmente, este programa está disseminado em países como Estados Unidos, Austrália, Inglaterra, e já alcançou resultados benéficos e significativos na saúde dos praticantes. O objetivo da presente pesquisa foi realizar uma revisão bibliográfica sistemática para delimitar o campo de estudos sobre o assunto meditação e meditação Mindfulness no Brasil. Realizou-se o levantamento bibliográfico em revisão sistemática da literatura nos bancos de dados PubMed, PsycInfo e Lilacs, utilizando como descritores Meditation and Brazil e Mindfulness and Brazil. Dentre os critérios de inclusão estava o de utilizar somente estudos empíricos referentes à população brasileira. Foram incluídos 18 estudos, dentre os 45 encontrados....

Hepatoprotective effect of the aqueous extract of Simarouba amara Aublet (Simaroubaceae) stem bark against carbon tetrachloride (CCl4)-induced hepatic damage in rats.

Simarouba amara stem bark decoction has been traditionally used in Brazil to treat malaria, inflammation, fever, abdominal pain, diarrhea, wounds and as a tonic. In this study, we investigate the hepatoprotective effects of the aqueous extract of S. amara stem bark (SAAE) on CCl4-induced hepatic damage in rats. SAAE was evaluated by high performance liquid chromatography. The animals were divided into six groups (n = 6/group). Groups I (vehicle-corn oil), II (control-CCl4), III, IV, V and VI were pretreated during 10 consecutive days, once a day p.o, with Legalon® 50 mg/kg b.w, SAAE at doses 100, 250 and 500 mg/kg b.w, respectively. The hepatotoxicity was induced on 11th day with 2 mL/kg of 20% CCl4 solution. 24 h after injury, the blood samples were collected and their livers were removed to biochemical and immunohistochemical analyzes. The SAAE decreased the levels of liver markers and lipid peroxidation in all doses and increased the catalase levels at doses 250 and 500 mg/kg. Immunohistochemical results suggested hepatocyte proliferation in all doses. These results may be related to catechins present in SAAE. Thus, SAAE prevented the oxidative damage at the same time that increased regenerative and reparative capacities of the liver.

Bacterial-binding chitosan microspheres for gastric infection treatment and prevention.

Helicobacter pylori (H. pylori) colonizes the gastric mucosa of over 50% of the world population, causing several pathologies, such as gastric ulcers and gastric cancer. Since current antibiotic treatments are inefficient in 20% of cases alternative therapies are needed. This work reports the ability of chitosan microspheres to adhere to H. pylori and prevent/remove H. pylori colonization. Adhesion of H. pylori strains with different functional adhesins (BabA and/or SabA) to chitosan microspheres (diameter 167 ± 27 µm) occurs at both pH 2.6 and 6.0, but is higher at pH 6.0. Bacterial adhesion to a gastric cell line expressing sialylated carbohydrates (SabA receptors) was performed at the same pH values using H. pylori strains with and without SabA. At both pH values addition of microspheres to gastric cells before and after pre-incubation with H. pylori decreased bacterial adhesion to cells. Furthermore, the chitosan microspheres were non-cytotoxic. These findings reveal the potential of chitosan microspheres as an alternative or complementary treatment for H. pylori gastric eradication or prevention of H. pylori colonization.

Antinociceptive activity of carvacrol (5-isopropyl-2-methylphenol) in mice.

OBJECTIVES: Carvacrol (5-isopropyl-2-methylphenol) is a monoterpenic phenol which is present in the essential oil of oregano and thyme. We have investigated the behavioural effects of carvacrol in animal models of pain, such as acetic acid-induced abdominal constriction, formalin and hot-plate tests in mice. The spontaneous motor activity of animals treated with carvacrol was investigated using open-field and rotarod tests. METHODS: Carvacrol was administered orally, at single doses of 50 and 100 mg/kg while indometacin (5 mg/kg), morphine (7.5 mg/kg) and diazepam (2 mg/kg) were used as standard drugs. Naloxone (1 mg/kg) and l-arginine (150 mg/kg) were used to elucidate the possible antinociceptive mechanism of carvacrol on acetic acid-induced abdominal constriction and formalin tests. KEY FINDINGS: The results showed that carvacrol produced significant inhibitions on nociception in the acetic acid-induced abdominal constriction, formalin and hot-plate tests. In the open-field and rotarod tests carvacrol did not significantly impair the motor performance. The effect of the highest dose of carvacrol in mice in the acetic acid-induced abdominal constriction and formalin tests were not reversed by naloxone or l-arginine. CONCLUSIONS: Based on these results, it has been suggested that carvacrol presents antinociceptive activity that may not act through the opioid system nor through inhibition of the nitric oxide pathway.

A 15-year study on the treatment of undernourished children at a nutrition rehabilitation centre (CREN), Brazil.

OBJECTIVE: To build a life table and determine the factors related to the time of treatment of undernourished children at a nutrition rehabilitation centre (CREN), São Paulo, Brazil. DESIGN: Nutritional status was assessed from weight-for-age, height-for-age and BMI-for-age Z-scores, while neuropsychomotor development was classified according to the milestones of childhood development. Life tables, Kaplan-Meier survival curves and Cox multiple regression models were employed in data analysis. SETTING: CREN (Centre of Nutritional Recovery and Education), São Paulo, Brazil. SUBJECTS: Undernourished children (n 228) from the southern slums of São Paulo who had received treatment at CREN under a day-hospital regime between the years 1994 and 2009. RESULTS: The Kaplan-Meier curves of survival analysis showed statistically significant differences in the periods of treatment at CREN between children presenting different degrees of neuropsychomotor development (log-rank = 6·621; P = 0·037). Estimates based on the multivariate Cox model revealed that children aged ≥24 months at the time of admission exhibited a lower probability of nutritional rehabilitation (hazard ratio (HR) = 0·49; P = 0·046) at the end of the period compared with infants aged up 12 months. Children presenting slow development were better rehabilitated in comparison with those exhibiting adequate evolution (HR = 4·48; P = 0·023). No significant effects of sex, degree of undernutrition or birth weight on the probability of nutritional rehabilitation were found. CONCLUSIONS: Age and neuropsychomotor developmental status at the time of admission to CREN are critical factors in determining the duration of treatment.