Efficacy of automated insulin delivery in pregnant women with type 1 diabetes: a meta-analysis and trial sequential analysis of randomized controlled trials.

BACKGROUND: Automated insulin delivery (AID) devices have shown to be a promising treatment to improve glycemic control in patients with type 1 diabetes mellitus (T1DM). However, its efficacy in pregnant women with T1DM remains uncertain. METHODS: PubMed, Scopus, Cochrane Central and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing AID to standard care (SC), defined as use of sensor-augmented pump and multiple daily insulin injections. Outcomes included time in range (TIR), nocturnal TIR, time in hypoglycemic and hyperglycemic ranges, among others. Sensitivity and trial sequential analyses (TSA) were performed. PROSPERO ID: CRD42023474398. RESULTS: We included five RCTs with a total of 236 pregnant women, of whom 117 (50.6%) received AID. There was a significant increase in nocturnal TIR (mean difference [MD] 12.69%; 95% CI 8.74-16.64; p < 0.01; I2 = 0%) and a decrease in glucose variability (standard deviation of glucose; MD -2.91; 95% CI -5.13 to -0.69; p = 0.01; I2 = 0%). No significant differences were observed for TIR, HBGI, LGBI, mean glucose and time spent in hyperglycemia and hypoglycemia. Regarding TSA, the statistical significance obtained in nocturnal TIR was conclusive and with minimal risk of a type I error. CONCLUSION: Our findings suggest that AID systems can significantly improve nocturnal glycemic control and potentially reduce glycemic variability in pregnant women with T1DM, with no effect in the risk of hypoglycemia and hyperglycemia compared with current insulin treatments.

Cytotoxic Potential of the Monoterpene Isoespintanol against Human Tumor Cell Lines.

Cancer is a disease that encompasses multiple and different malignant conditions and is among the leading causes of death in the world. Therefore, the search for new pharmacotherapeutic options and potential candidates that can be used as treatments or adjuvants to control this disease is urgent. Natural products, especially those obtained from plants, have played an important role as a source of specialized metabolites with recognized pharmacological properties against cancer, therefore, they are an excellent alternative to be used. The objective of this research was to evaluate the action of the monoterpene isoespintanol (ISO) against the human tumor cell lines MDA-MB-231, A549, DU145, A2780, A2780-cis and the non-tumor line MRC-5. Experiments with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and fluorescence with propidium iodide (PI), 4',6-diamidino-2-phenylindole dilactate (DAPI) and green plasma revealed the cytotoxicity of ISO against these cells; furthermore, morphological and chromogenic studies revealed the action of ISO on cell morphology and the inhibitory capacity on reproductive viability to form colonies in MDA-MB-231 cells. Likewise, 3D experiments validated the damage in these cells caused by this monoterpene. These results serve as a basis for progress in studies of the mechanisms of action of these compounds and the development of derivatives or synthetic analogues with a better antitumor profile.

Food Consumption of People with Sickle Cell Anemia in a Middle-Income Country.

Sickle cell anemia (SCA) is a genetic and hemolytic disease globally characterized by social vulnerability. Food consumption has been insufficiently analyzed in SCA. Secondary iron overload is often observed. This leads to unreliable recommendations for dietary iron restriction. We assessed food consumption and iron intake among adults with SCA. Considering the guidelines for healthy eating, foods were grouped according to the NOVA classification. This transversal study included 74.4% of eligible patients who were registered in the reference center for SCA treatment in Rio de Janeiro, Brazil, in 2019. Data on food consumption were collected through 24 h recall. The monthly household income of 82.3% of patients was less than $770. The consumption of fresh or minimally processed foods was directly associated with monthly household income (p < 0.0001; η2 = 0.87). Ultra-processed foods provided more than one-third of the total energy intake (35.2%). The prevalence of inadequate iron intake was about 40% among women, while that of iron intake above the tolerable upper limit was 0.8%. People from lower socioeconomic classes had the lowest iron intake. Strategies to encourage the consumption of fresh or minimally processed foods are needed considering the requirement of an antioxidant diet in SCA. These findings highlight the need for health equity to ensure food security and healthy eating in SCA.

Pandemia de Covid-19 e atendimento especializado em oncologia: relato de experiência / Pandemia de Covid-19 y la atención especializada en oncología: relato de experiencia / The COVID-19 pandemic and specialized oncology care: An experience report

Resumo Introdução A pandemia de Covid-19 trouxe muitos desafios para a assistência oncológica, gerando novos desenhos operacionais nas esferas da gestão e da assistência. Objetivo Descrever experiências de implantação de processos administrativos e assistenciais de instituições prestadoras de atendimento oncológico durante a pandemia da Covid-19. Método Relato de caso, descritivo, qualitativo. As experiências contidas nos relatos compreendem o período de 05 de março a 31 de janeiro de 2021. Os relatos são provenientes de instituições distintas do município de São Paulo, São Paulo, Brasil. Resultados Os 3 relatos descrevem ações como: triagem dos pacientes para a incorporação de estratégias de telemedicina e tele-enfermagem; preparação de ambientes livres de Covid-19 para a segurança de profissionais e pacientes; reforço às ações educativas na geração de conhecimentos e adoção de comportamentos seguros para equipes de saúde e pacientes, entre outras. Discussão Os relatos descreveram como eixo comum a implementação de ações para viabilizar a segurança dos pacientes, dos profissionais e do meio ambiente, bem como a continuidade da assistência oncológica. A literatura científica e as recomendações dos conselhos, sociedades e organizações foram subsidiárias das medidas instituídas. Conclusão O ineditismo da situação de isolamento social devido ao risco da disseminação da COVID-19 demonstrou-se um campo fecundo para a incorporação de novas estratégias de gestão e assistência em Oncologia. Perdas e danos certamente ocorrerão no processo de assistência oncológica na vigência desta pandemia. Neste contexto, o mapeamento da queda de diagnósticos de câncer bem como das interrupções de tratamento é fundamental para mitigação de suas consequências.

Abstract Introduction The COVID-19 pandemic has brought many challenges to oncology care, leading to the implementation of new operational models in health management and care. Objective To describe the experiences related to the implementation of health management and care models in cancer treatment centers during the COVID-19 outbreak. Materials and Methods A qualitative descriptive case report was conducted including experiences from March 5 to January 31, 2021. Reports were provided by different cancer treatment centers in São Paulo, Brazil. Results Actions such as identification of patients eligible for telemedicine and telenursing strategies, preparation of COVID-19-free environments for healthcare professionals and patients, and support for educational actions to increase knowledge and adoption of safety behavior for healthcare professionals and patients were observed in the three reports. Discussion A common element described in the reports is the implementation of actions to improve the safety of healthcare professionals, patients and the environment, as well as the continuity of cancer care. Scientific literature and recommendations of advisory boards, associations and organizations were supplementary to the measures applied. Conclusions Social distancing due to the risk of COVID-19 spread proved to a successful field for the introduction of new health management and care in cancer treatment. Although there will certainly be loss and damage to cancer treatment processes during this pandemic, mapping the drop in cancer diagnosis, as well as treatment interruptions, is essential to mitigate any consequences.

Resumen Introducción La pandemia de Covid-19 trajo muchos desafíos para la atención oncológica, generando nuevos diseños operativos en las esferas de gestión y atención. Objetivo Describir las experiencias de implementación de procesos administrativos y de atención de instituciones proveedoras de atención oncológica durante la pandemia de Covid-19. Métodos Reporte de caso, descriptivo, cualitativo. Las experiencias del reporte cubren el período del 5 de marzo al 31 de enero de 2021. Los informes provienen de diferentes instituciones en el municipio de São Paulo, São Paulo, Brasil. Resultados Los 3 reportes describen acciones tales como: detección de pacientes para las estrategias de telemedicina y tele enfermería; preparación de entornos libres de Covid-19 para la seguridad de profesionales y pacientes; refuerzo de acciones educativas para generación de conocimiento y adopción de comportamientos seguros para profesionales y pacientes, entre otros. Discusión Los reportes describen como eje común la implementación de acciones para la seguridad de los pacientes, los profesionales y el medio ambiente, así como la continuidad de la atención oncológica. La literatura científica, las recomendaciones de consejos, sociedades y organizaciones fueron subsidiarias de las medidas instituidas. Conclusión La novedad del confinamiento social debido al riesgo de propagación de COVID-19 demostró ser un campo fructífero para la incorporación de nuevas estrategias de gestión y asistencia oncológica. Ciertamente, habrá pérdidas y daños en el proceso de atención oncológica durante esta pandemia. En este contexto, el mapeo de la caída del diagnóstico de cáncer, así como de las interrupciones del tratamiento, es esencial para mitigar sus consecuencias.

Pandemia de Covid-19 e atendimento especializado em oncologia: relato de experiência / The COVID-19 pandemic and specialized oncology care: An experience report

Introdução: A pandemia de Covid-19 trouxe muitos desafios para a assistência oncológica, gerando novos desenhos operacionais nas esferas da gestão e da assistência. Objetivo: Descrever experiências de implantação de processos administrativos e assistenciais de instituições prestadoras de atendimento oncológico durante a pandemia da Covid-19. Método: Relato de caso, descritivo, qualitativo. As experiências contidas nos relatos compreendem o período de 05 de março a 31 de janeiro de 2021. Os relatos são provenientes de instituições distintas do município de São Paulo, São Paulo, Brasil. Resultados: Os 3 relatos descrevem ações como: triagem dos pacientes para a incorporação de estratégias de telemedicina e tele-enfermagem; preparação de ambientes livres de Covid-19 para a segurança de profissionais e pacientes; reforço às ações educativas na geração de conhecimentos e adoção de comportamentos seguros para equipes de saúde e pacientes, entre outras. Discussão: Os relatos descreveram como eixo comum a implementação de ações para viabilizar a segurança dos pacientes, dos profissionais e do meio ambiente, bem como a continuidade da assistência oncológica. A literatura científica e as recomendações dos conselhos, sociedades e organizações foram subsidiárias das medidas instituídas. Conclusão: O ineditismo da situação de isolamento social devido ao risco da disseminação da COVID-19 demonstrou-se um campo fecundo para a incorporação de novas estratégias de gestão e assistência em Oncologia. Perdas e danos certamente ocorrerão no processo de assistência oncológica na vigência desta pandemia. Neste contexto, o mapeamento da queda de diagnósticos de câncer bem como das interrupções de tratamento é fundamental para mitigação de suas consequências.

Introduction: The COVID-19 pandemic has brought many challenges to oncology care, leading to the implementation of new operational models in health management and care. Objective: To describe the experiences related to the implementation of health management and care models in cancer treatment centers during the COVID-19 outbreak. Materials and Methods: A qualitative descriptive case report was conducted including experiences from March 5 to January 31, 2021. Reports were provided by different cancer treatment centers in São Paulo, Brazil. Results: Actions such as identification of patients eligible for telemedicine and telenursing strategies, preparation of COVID-19-free environments for healthcare professionals and patients, and support for educational actions to increase knowledge and adoption of safety behavior for healthcare professionals and patients were observed in the three reports. Discussion: A common element described in the reports is the implementation of actions to improve the safety of healthcare professionals, patients and the environment, as well as the continuity of cancer care. Scientific literature and recommendations of advisory boards, associations and organizations were supplementary to the measures applied. Conclusions: Social distancing due to the risk of COVID-19 spread proved to a successful field for the introduction of new health management and care in cancer treatment. Although there will certainly be loss and damage to cancer treatment processes during this pandemic, mapping the drop in cancer diagnosis, as well as treatment interruptions, is essential to mitigate any consequences.

Introducción: La pandemia de Covid-19 trajo muchos desafíos para la atención oncológica, generando nuevos diseños operativos en las esferas de gestión y atención. Objetivo: Describir las experiencias de implementación de procesos administrativos y de atención de instituciones proveedoras de atención oncológica durante la pandemia de Covid-19. Métodos: Reporte de caso, descriptivo, cualitativo. Las experiencias del reporte cubren el período del 5 de marzo al 31 de enero de 2021. Los informes provienen de diferentes instituciones en el municipio de São Paulo, São Paulo, Brasil. Resultados: Los 3 reportes describen acciones tales como: detección de pacientes para las estrategias de telemedicina y tele enfermería; preparación de entornos libres de Covid-19 para la seguridad de profesionales y pacientes; refuerzo de acciones educativas para generación de conocimiento y adopción de comportamientos seguros para profesionales y pacientes, entre otros. Discusión: Los reportes describen como eje común la implementación de acciones para la seguridad de los pacientes, los profesionales y el medio ambiente, así como la continuidad de la atención oncológica. La literatura científica, las recomendaciones de consejos, sociedades y organizaciones fueron subsidiarias de las medidas instituidas. Conclusión: La novedad del confinamiento social debido al riesgo de propagación de COVID-19 demostró ser un campo fructífero para la incorporación de nuevas estrategias de gestión y asistencia oncológica. Ciertamente, habrá pérdidas y daños en el proceso de atención oncológica durante esta pandemia. En este contexto, el mapeo de la caída del diagnóstico de cáncer, así como de las interrupciones del tratamiento, es esencial para mitigar sus consecuencias.

Ruthenium (II)/allopurinol complex inhibits breast cancer progression via multiple targets.

Metal complexes based on ruthenium have established excellent activity with less toxicity and great selectivity for tumor cells. This study aims to assess the anticancer potential of ruthenium(II)/allopurinol complexes called [RuCl2(allo)2(PPh3)2] (1) and [RuCl2(allo)2(dppb)] (2), where allo means allopurinol, PPh3 is triphenylphosphine and dppb, 1,4-bis(diphenylphosphino)butane. The complexes were synthesized and characterized by elemental analysis, IR, UV-Vis and NMR spectroscopies, cyclic voltammetry, molar conductance measurements, as well as the X-ray crystallographic analysis of complex 2. The antitumor effects of compounds were determined by cytotoxic activity and cellular and molecular responses to cell death mechanisms. Complex 2 showed good antitumor profile prospects because in addition to its cytotoxicity, it causes cell cycle arrest, induction of DNA damage, morphological and biochemical alterations in the cells. Moreover, complex 2 induces cell death by p53-mediated apoptosis, caspase activation, increased Beclin-1 levels and decreased ROS levels. Therefore, complex 2 can be considered a suitable compound in antitumor treatment due to its cytotoxic mechanism.

Cancer care in the COVID-19 era and psychosocial impacts on oncology nursing in Brazil.

INTRODUCTION: Globally, Brazil has the third highest number of confirmed COVID-19 cases and the second highest number of deaths related to COVID-19 at the time of writing. Maintaining cancer care has been a challenge for patient safety and for the physical and mental health of oncology nurses. OBJECTIVES: To describe which effects of the COVID-19 pandemic on cancer care could already be evaluated and to identify the psychosocial impact on cancer nurses in Brazil. METHOD: Reflective, analytical, qualitative study. RESULTS: Although the Brazilian cancer care policy has reached important achievements in overcoming access barriers to cancer diagnosis and treatment over the past decade, the COVID-19 pandemic has caused losses of timely access to health services for patients with cancer, which has compromised screening, early diagnosis and treatment, and patient follow-up. Oncology nurses have actively participated in the management and assistance strategies during the pandemic. This path has generated an increase in oncology nurses' workload, leading to physical and mental stress and anxiety related to the fear of contagion for themselves and their family. CONCLUSION: The pandemic has affected the care of cancer patients, with the potential to suffer greater losses because of reductions in screening, early diagnosis and treatment, and patient follow-up. In addition to the worsening of the cancer setting, the COVID-19 pandemic has overwhelmed Brazilian oncology nurses, physically and mentally.

Oncology nursing workforce: challenges, solutions, and future strategies.

The global oncology nursing workforce is essential to achieving Sustainable Development Goals 3.4 (reduce non-communicable disease morbidity by a third by 2030) and 3.8 (universal health coverage). Unfortunately, challenges to a robust oncology nursing workforce include nursing shortages, recruitment barriers (eg, perceptions of a demanding specialty with complex care and hazardous work environments), and burnout. Innovative recruitment strategies, onboarding and continuing education programmes, occupational safety measures, and burnout prevention interventions are documented solutions. The long-term effect of COVID-19 on oncology care worldwide is unknown, but immediate therapy interruptions, workforce consequences, and threats to standard oncology nursing practice are addressed here. Retention of experienced oncology nurses is crucial for future cancer control in all countries and must be addressed, particularly in resource-constrained countries with few oncology nursing staff and continuing out-migration of nurses to resource-rich countries. As the cancer burden worldwide increases, the future of the oncology nursing workforce is reflected in the call from the International Council of Nurses, Nursing Now, and WHO for nurses to move to higher levels of leadership, advocacy, and policy making (ie, national cancer control planning) and assume responsibility for their key role in achieving global goals for cancer control.

COVID-19 Pandemic: Preparing to Care for Patients With Cancer From the Perspective of Low- and Middle-Income Countries.

As the coronavirus spread from Asia to Western Europe and North America, healthcare institutions in the Middle East, Africa, South Asia, and Latin America prepared for the COVID-19 pandemic. Interprofessional task forces were established to coordinate institutions' responses, inventory supplies of personal protective equipment, educate staff and patients, develop procedures for triaging patients and prioritizing care, and provide support to nurses to mitigate their stress. Despite challenges, nurses continued to deliver quality care to patients with cancer.

Determination of eccentric deposition thickness on offshore horizontal pipes by gamma-ray densitometry and artificial intelligence technique.

The extraction of oil is accompanied by water and sediments that, mixed with the oil, cause the formation of scale depositions in the pipelines walls promoting the reduction of the inner diameter of the pipes, making it difficult for the fluids to pass through interest. In this sense, there is a need to control the formation of these depositions to evaluate preventive and corrective measures regarding the waste management of these materials, as well as the optimization of oil extraction and transport processes. Noninvasive techniques such as gamma transmission and scattering can support the determination of the thickness of these deposits in pipes. This paper presents a novel methodology for prediction of scale with eccentric deposition in pipes used in the offshore oil industry and its approach is based on the principles of gamma densitometry and deep artificial neural networks (DNNs). To determine deposition thicknesses, a detection system has been developed that utilizes a 1 mm narrow beam geometry of collimation aperture comprising a source of 137Cs and three properly positioned 2″×2″ NaI(Tl) detectors around the system, pipe-scale-fluid. Crude oil was considered in the study, as well as eccentric deposits formed by barium sulfate, BaSO4. The theoretical models adopted a static flow regime and were developed using the MCNPX mathematical code and, secondly, used for the training and testing of the developed DNN model, a 7-layers deep rectifier neural network (DRNN). In addition, the hyperparameters of the DRNN were defined using a Baysian optimization method and its performance was validated via 10 experiments based on the K-Fold cross-validation technique. Following the proposed methodology, the DRNN was able to achieve, for the test sets (untrained samples), an average mean absolute error of 0.01734, mean absolute relative error of 0.29803% and R2 Score of 0.9998813 for the scale thickness prediction and an average accuracy of 100% for the scale position prediction. Therefore, the results show that the 7-layers DRNN presents good generalization capacity and is able to predict scale thickness with great precision, regardless of its position inside the tube.

A new application of radioactive particle tracking using MCNPX code and artificial neural network.

Stirrers and mixers are highly used in chemical, food, pharmaceutical, cosmetic, concrete industries and others. During the fabrication process, the equipment may fail to appropriately stir or mix the solution. Besides that, it is also important to determine when the right homogeneity of the mixture is attained. Thus, it is very important to have a diagnosis tool for these industrial units to assure the quality of the product and maintain market competitiveness. Nuclear techniques, such as gamma densitometry, are widely used in industry to overcome a sort of difficulties, as they are minimally non-invasive techniques. This paper presents a method based on the principles of the radioactive particle tracking technique to predict the instantaneous position of a radioactive particle to monitor a concrete mixture inside an industrial unit by means of Monte Carlo method and artificial neural network. Counts obtained by an array of detectors properly positioned around the mixing canister will be correlated to each other, by means of an appropriate mathematical search location algorithm, in order to predict the instantaneous positions occupied by an inserted radioactive particle. The simulation consists of a detection geometry of eight NaI(Tl) scintillator detectors, a 662 keV 137Cs point source with isotropic emission of gamma-rays and a polyvinyl chloride tank. At first, the tank is air filled and, afterwards, filled with concrete made with Portland cement. The modeling of the detection system is performed using the MCNPX code. For both medium, the correlation coefficient was 0.99 for all coordinates, which indicates that this methodology could be a good tool to evaluate industrial mixers.

Inorganic scale thickness prediction in oil pipelines by gamma-ray attenuation and artificial neural network.

Scale can be defined as chemical compounds that are inorganic, initially insoluble, and precipitate accumulating on the internal walls of pipes, surface equipment, and/or parts of components involved in the production and transport of oil. These compounds, when precipitating, cause problems in the oil industry and consequently result in losses in the optimization of the extraction process. Despite the importance and impact of the precipitation of these compounds in the technological and economic scope, there remains difficulty in determining the methods that enable the identification and quantification of the scale at an initial stage. The use of gamma transmission technique may provide support for a better understanding of the deposition of these compounds, making it a suitable tool for the noninvasive determination of their deposition in oil transport pipelines. The geometry used for the scale detection includes a 280-mm diameter steel tube containing barium sulphate (BaSO4) scale ranging from 0.5 to 6 cm, a gamma radiation source with divergent beam, and a NaI(Tl) 2 × 2″ scintillation detector. The opening size of the collimated beam was also evaluated (2-7 mm) to quantify the associated error in calculating the scale. The study was done with computer simulation, using the MCNP-X code, and the results were validated using analytical equations. Data obtained by the simulation were used to train an artificial neural network (ANN), thereby making the study system more complex and closer to the real one. The input data provided for the training, testing, and validation of the network consisted of pipes with 4 different internal diameters (D1, D2, D3, and D4) and 14 different scale thicknesses (0.5 to 7 cm, with steps of 0.5 cm). The network presented generalization capacity and good convergence, with 70% of cases with less than 10% relative error and a linear correlation coefficient of 0.994, which indicates the possibility of using this study for this purpose.

Infelcção pelo papilomavírus humano alterações citológicas colposcópicas e histopatológicas em diferentes faixas etárias / Human papillomavirus infection cytological colposcopical and histopathological abnormalities in different age groups

A formulação de protocolos diferenciados de conduta nas pacientes com anormalidades citológicas do colo uterino requer o conhecimento da influência da idade nestas anormalidades, nos achados colposcópicos e nas alterações histopatológicas. Objetiva avaliar a distribuição das anormalidades citológicas, colposcópicas e histopatológicas segundo faixas etárias e o valor preditivo das LIEBG, das LIEAG e dos achados colposcópicos menor e maior

Performance da citologia e colposcopia frente a histopatologia no rastreamento e diagnóstico das lesöes precursoras do cancer do colo uterino / Performance of the cytology and colposcopy compared to histopathology in screening and diagnosis of cancer precursor lesions

Avalia a concordåncia e o valor preditivo positivo daLIEAG e do achado colposcópico maior com a histopatologia. Foram estudadas 794 pacientes com anormalidades citológicas e colposcópicas por meio de biópsia dirigida, curetagem de canal e conizaçäo eletrocirúrgica, quando indicados