Landscape of Subcutaneous Administration Strategies for Monoclonal Antibodies in Oncology.

In recent decades, subcutaneous (SC) administration of monoclonal antibodies (mAbs) has emerged as a promising alternative to intravenous delivery in oncology, offering comparable therapeutic efficacy while addressing patient preferences. This perspective article provides an in-depth analysis of the technological landscape surrounding SC mAb administration in oncology. It outlines various technologies under evaluation across developmental stages, spanning from preclinical investigations to the integration of established methodologies in clinical practice. Additionally, this perspective article explores emerging trends and prospective trajectories, shedding light on the evolving landscape of SC mAb administration. Furthermore, it emphasizes key checkpoints related to quality attributes essential for optimizing mAb delivery via the SC route. This review serves as a valuable resource for researchers, clinicians, and healthcare policymakers, offering insights into the advancement of SC mAb administration in oncology and its implications for patient care.

Trunk muscle activation in prone plank exercises with different body tilts.

BACKGROUND: Body tilt changes could affect the intensity/difficulty of core stability exercises, but there is still a lack of knowledge about its impact. OBJECTIVE: To analyse the trunk muscles activation during prone plank exercises at different body tilts. METHODS: Twenty-four young adults who performed recreational gymnastic activities participated in this study. Electromyography activity of the rectus abdominis (RA), external oblique (EO), internal oblique (IO) and erector spinae (ES) was recorded during the performance of six variations of the prone plank exercise (planking with feet supported on the ground [conventional horizontal position] and planking with feet supported on wall bars at five different heights increasing the angle tilt) and an inverted position exercise. RESULTS: The RA, EO and IO activation in all prone plank variations were higher than those observed in the conventional prone plank. In addition, the coefficient of variation of the muscle activation increased with the declination angle, reaching the highest values in the inverted position for the RA and ES muscles. CONCLUSION: The results seem to indicate that the body tilt variation could be used as an easy and inexpensive strategy for modulating the neuromuscular demands and the motor control challenge during planking exercises.

Subcutaneous Administration of a Zwitterionic Chitosan-Based Hydrogel for Controlled Spatiotemporal Release of Monoclonal Antibodies.

Subcutaneous (SC) administration of monoclonal antibodies (mAbs) is a proven strategy for improving therapeutic outcomes and patient compliance. The current FDA-/EMA-approved enzymatic approach, utilizing recombinant human hyaluronidase (rHuPH20) to enhance mAbs SC delivery, involves degrading the extracellular matrix's hyaluronate to increase tissue permeability. However, this method lacks tunable release properties, requiring individual optimization for each mAb. Seeking alternatives, physical polysaccharide hydrogels emerge as promising candidates due to their tunable physicochemical and biodegradability features. Unfortunately, none have demonstrated simultaneous biocompatibility, biodegradability, and controlled release properties for large proteins (≥150 kDa) after SC delivery in clinical settings. Here, a novel two-component hydrogel comprising chitosan and chitosan@DOTAGA is introduced that can be seamlessly mixed with sterile mAbs formulations initially designed for intravenous (IV) administration, repurposing them as novel tunable SC formulations. Validated in mice and nonhuman primates (NHPs) with various mAbs, including trastuzumab and rituximab, the hydrogel exhibited biodegradability and biocompatibility features. Pharmacokinetic studies in both species demonstrated tunable controlled release, surpassing the capabilities of rHuPH20, with comparable parameters to the rHuPH20+mAbs formulation. These findings signify the potential for rapid translation to human applications, opening avenues for the clinical development of this novel SC biosimilar formulation.

Human T-cell receptor triggering requires inactivation of Lim kinase-1 by Slingshot-1 phosphatase.

Actin dynamics control early T-cell receptor (TCR) signalling during T-cell activation. However, the precise regulation of initial actin rearrangements is not completely understood. Here, we have investigated the regulatory role of the phosphatase Slingshot-1 (SSH1) in this process. Our data show that SSH1 rapidly polarises to nascent cognate synaptic contacts and later relocalises to peripheral F-actin networks organised at the mature immunological synapse. Knockdown of SSH1 expression by CRISPR/Cas9-mediated genome editing or small interfering RNA reveal a regulatory role for SSH1 in CD3ε conformational change, allowing Nck binding and proper downstream signalling and immunological synapse organisation. TCR triggering induces SSH1-mediated activation of actin dynamics through a mechanism mediated by Limk-1 inactivation. These data suggest that during early TCR activation, SSH1 is required for rapid F-actin rearrangements that mediate initial conformational changes of the TCR, integrin organisation and proximal signalling events for proper synapse organisation. Therefore, the SSH1 and Limk-1 axis is a key regulatory element for full T cell activation.

Engineered T cells secreting anti-BCMA T cell engagers control multiple myeloma and promote immune memory in vivo.

Multiple myeloma is the second most common hematological malignancy in adults and remains an incurable disease. B cell maturation antigen (BCMA)-directed immunotherapy, including T cells bearing chimeric antigen receptors (CARs) and systemically injected bispecific T cell engagers (TCEs), has shown remarkable clinical activity, and several products have received market approval. However, despite promising results, most patients eventually become refractory and relapse, highlighting the need for alternative strategies. Engineered T cells secreting TCE antibodies (STAb) represent a promising strategy that combines the advantages of adoptive cell therapies and bispecific antibodies. Here, we undertook a comprehensive preclinical study comparing the therapeutic potential of T cells either expressing second-generation anti-BCMA CARs (CAR-T) or secreting BCMAxCD3 TCEs (STAb-T) in a T cell-limiting experimental setting mimicking the conditions found in patients with relapsed/refractory multiple myeloma. STAb-T cells recruited T cell activity at extremely low effector-to-target ratios and were resistant to inhibition mediated by soluble BCMA released from the cell surface, resulting in enhanced cytotoxic responses and prevention of immune escape of multiple myeloma cells in vitro. These advantages led to robust expansion and persistence of STAb-T cells in vivo, generating long-lived memory BCMA-specific responses that could control multiple myeloma progression in xenograft models, outperforming traditional CAR-T cells. These promising preclinical results encourage clinical testing of the BCMA-STAb-T cell approach in relapsed/refractory multiple myeloma.

Cambios en la composición corporal y ángulo de fase durante la pretemporada en jugadores de fútbol profesional / Changes in body composition and phase angle during pre-season in professional soccer players

RESUMEN: El análisis y el control de la composición corporal son claves en el fútbol por su implicación en el rendimiento. El objetivo de este estudio fue identificar, en jugadores de futbol profesional, el ángulo de fase (PhA) de miembros inferiores con los posibles patrones de mejora del componente magro en los mismos medido por DEXA. Al mismo tiempo, se estudió mediante BIA la evolución de parámetros hídricos de los jugadores, sometidos a un entrenamiento intenso y a un control nutricional de su alimentación y suplementación. Se evaluaron a 18 jugadores (26,28 ± 5,1 años; 85,09 ± 9,16 kg; 185,5 ± 4,32 cm) de un equipo de la primera división de fútbol italiana. Se llevó a cabo el estudio durante cuatro semanas, entre el 11 de julio (pre-test) y el 11 de agosto de 2021 (post-test). La intervención se llevó a cabo en su totalidad en pretemporada, con un confinamiento en modalidad de aislamiento o burbuja total por prevención al contagio del COVID-19, dónde se monitorizaba en un alto porcentaje la vida del jugador, incluyendo factores como la alimentación, el entrenamiento y el descanso. La suplementación estuvo basada en antioxidantes, multivitamínicos, minerales y ácidos grasos poliinsaturados y dos productos en polvo (uno a base de creatina, glutamina y leucina, y otro, a base de aminoácidos esenciales). Los jugadores presentaron una mejora del PhA y del componente magro en los miembros inferiores, con una moderada correlación (r = 0,6). Con respecto al agua intracelular y extracelular, señalar que, a pesar de la alta intensidad del ejercicio durante cuatro semanas, éstas se han mantenido constantes sin presentar variaciones significativas durante el periodo de estudio, lo que indica que no se ha producido un proceso de deshidratación del jugador.

SUMMARY: The analysis and control of body composition is essential in soccer due to its implication in performance. The aim of this study was to identify, in professional soccer players, the phase angle (PhA) of the lower limbs with possible patterns of improvement of the lean component measured by DEXA. At the same time, the evolution of hydric parameters of the players, subjected to intense training and nutritional control of their diet and supplementation, was studied by means of BIA. Eighteen players (26.28 ± 5.1 years; 85.09 ± 9.16 kg; 185.5 ± 4.32 cm) from an Italian first division football team were evaluated. The study was conducted for four weeks, between 11th July (pre- test) and 11th August of 2021 (post-test). The intervention was carried out entirely in pre-season, with confinement in isolation or total bubble mode for prevention of COVID-19 infection, where a high percentage of the player's life was monitored, including factors such as diet, training and rest. Supplementation was based on antioxidants, multivitamins, minerals and polyunsaturated fatty acids and two powdered products (one based on creatine, glutamine and leucine, and the other one, on essential amino acids). The players showed an improvement in PhA and in the lean component in the lower limbs, with a moderate correlation (r = 0.6). With regard to intracellular and extracellular water, it should be noted that, despite the high intensity of exercise during four weeks, these have remained constant without significant variations during the study period, indicating that there has not been a process of dehydration of the player.

The impact of the stratification by degree of clinical severity and abandonment risk of tuberculosis treatment / O impacto da estratificação por grau de risco clínico e de abandono do tratamento da tuberculose

ABSTRACT Objective: Evaluate the impact of the instrument of the "Stratification by Degree of Clinical Severity and Abandonment Risk of Tuberculosis Treatment" (SRTB) on the tuberculosis outcome. Methods: This study was a pragmatic clinical trial involving patients with a confirmed diagnosis of tuberculosis treated at one of the 152 primary health care units in the city of Belo Horizonte, Brazil, between May of 2016 and April of 2017. Cluster areas for tuberculosis were identified, and the units and their respective patients were divided into intervention (use of SRTB) and nonintervention groups. Results: The total sample comprised 432 participants, 223 and 209 of whom being allocated to the nonintervention and intervention groups, respectively. The risk of treatment abandonment in the nonintervention group was significantly higher than was that in the intervention group (OR = 15.010; p < 0.001), regardless of the number of risk factors identified. Kaplan-Meier curves showed a hazard ratio of 0.0753 (p < 0.001). Conclusions: The SRTB instrument was effective in reducing abandonment of tuberculosis treatment, regardless of the number of risk factors for that. This instrument is rapid and easy to use, and can be adapted to different realities. Its application showed characteristics predisposing to a non-adherence to the treatment and established bases to mitigate its impact.

RESUMO Objetivo: Avaliar o impacto do instrumento denominado "Estratificação por Grau de Risco Clínico e de Abandono do Tratamento da Tuberculose" (ERTB) nos desfechos da tuberculose. Métodos: Ensaio clínico pragmático envolvendo pacientes com diagnóstico confirmado de tuberculose atendidos em uma das 152 unidades de atenção primária à saúde na cidade de Belo Horizonte (MG) entre maio de 2016 e abril de 2017. Foram identificadas áreas de cluster para tuberculose, e as unidades e os respectivos pacientes foram divididos em grupos intervenção (uso do instrumento ERTB) e não intervenção. Resultados: A amostra total foi composta por 432 participantes, dos quais 223 e 209 foram alocados nos grupos não intervenção e intervenção, respectivamente. O risco de abandono do tratamento no grupo não intervenção foi significativamente maior do que no grupo intervenção (OR = 15,010; p < 0,001), independentemente do número de fatores de risco identificados. As curvas de Kaplan-Meier mostraram uma razão de risco de 0,0753 (p < 0,001). Conclusões: O instrumento ERTB foi eficaz em reduzir o abandono do tratamento da tuberculose, independentemente do número de fatores de risco identificados. Esse instrumento é rápido e fácil de utilizar e pode ser adaptado a diferentes realidades.

Avaliação do desempenho dos serviços de atenção primária à saúde no controle da tuberculose em metrópole do Sudeste do Brasil / Performance assessment of primary healthcare services in tuberculosis control in a city in Southeast Brazil / Evaluación del desempeño de los servicios de atención primaria en salud para el control de la tuberculosis en metrópolis del sudeste de Brasil

Resumo: A Organização Mundial da Saúde destaca a importância da organização e do desempenho dos serviços de saúde nas ações de controle da tuberculose. O objetivo deste estudo foi avaliar o desempenho dos serviços de atenção primaria à saúde em Belo Horizonte, Minas Gerais, Brasil, em relação às ações de controle da tuberculose nos eixos Estrutura e Processo, antes e após a utilização do instrumento validado denominado Estratificação por Grau de Risco Clínico e de Abandono do Tratamento da Tuberculose (ERTB). Estudo descritivo e prospectivo, no qual foram realizadas duas entrevistas (455 profissionais), tendo a segunda ocorrido após a ERTB. A classificação do desempenho seguiu os valores: ≤ 49,9%, críticos; entre 50% e 79,9%, insatisfatórios; e, ≥ 80%, satisfatórios. Na avaliação comparativa, foi utilizado o teste estatístico de McNemar, com p < 0,05. Após a estratificação de risco, a maior parte das variáveis de cada eixo melhorou significativamente. Nós concluímos que, por meio de um questionário padronizado, foi possível identificar o desempenho satisfatório dos serviços de atenção primária à saúde em Belo Horizonte em relação às ações de controle da tuberculose, na maioria das variáveis avaliadas nos eixos Estrutura e Processo.

Abstract: The World Health Organization highlights the importance of health services organization and performance in tuberculosis (TB) control activities. This study aimed to assess the performance of primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, in TB control activities in the dimensions Structure and Process, before and after the use of a validated instrument called Stratification by Degree of Clinical Risk and Tuberculosis Treatment Dropout (ERTB). This was a descriptive and prospective study with two interviews (455 professionals), the second of which after the ERTB. Performance classification was: ≤ 49.9%, critical; 50-79.9%, unsatisfactory, and ≥ 80%, satisfactory. The comparative assessment used the McNemar statistical test with p < 0.05. After risk stratification, most of the variables in each dimension improved significantly. The authors conclude that it was possible to identify satisfactory performance in most of the variables assessed in the Structure and Process dimensions in primary healthcare services in Belo Horizonte in relation to TB control activities, using a standardized questionnaire.

Resumen: La Organización Mundial de la Salud destaca la importancia de la organización y del desempeño de los servicios de salud en acciones de control de la tuberculosis. El objetivo de este estudio fue evaluar el desempeño de los servicios de atención primaria en salud en Belo Horizonte, Minas Gerais, Brasil, en relación con las acciones de control de la tuberculosis respecto a los ejes Estructura y Proceso, antes y después de la utilización del instrumento validado, denominado Estratificación por Grado de Riesgo Clínico y de Abandono del Tratamiento de la Tuberculosis (ERTB). Se trata de un estudio descriptivo y prospectivo, donde se realizaron dos entrevistas (455 profesionales), siendo que la segunda se produjo tras la ERTB. La clasificación del desempeño siguió los valores: ≤ 49,9%, críticos; entre 50 y 79,9%, insatisfactorios; y, ≥ 80%, satisfactorios. En la evaluación comparativa, se utilizó el test estadístico de McNemar, con p < 0,05. Tras la estratificación de riesgo, la mayor parte de las variables de cada eje mejoró significativamente. Concluimos que fue posible identificar el desempeño satisfactorio en la mayoría de las variables evaluadas en los ejes Estructura y Proceso de los servicios de atención primaria en salud en Belo Horizonte, en relación con las acciones de control de la tuberculosis mediante un cuestionario estandarizado.

"ciência sem fronteiras" como acontecimento discursivo e dispositivo de poder/saber / "science without borders" as a discoursive event and power/knowledge device

RESUMO: A ideia de que internacionalizar a educação é tarefa da qual o ensino superior no país não pode escapar mobiliza as discussões realizadas ao longo deste artigo. Assim, a partir da premissa de que o chamado Programa Ciência sem Fronteiras se configura como um dispositivo de poder/saber, refletimos sobre as regularidades discursivas e os efeitos de poder vinculados a um conjunto de enunciados que tem como referencial a internacionalização da educação. Primeiramente, discutimos o programa como acontecimento discursivo e dispositivo de governamentalidade; em seguida, analisamos sequências enunciativas retiradas de um arquivo mais abrangente, composto por documentos e entrevistas feitas a sujeitos que tiveram uma experiência educacional com esse programa. As discussões encontram-se calcadas em levantamento bibliográfico, pesquisa documental e entrevistas narrativas (BAUER & GASKEL, 2002), Também valemo-nos do método arquegenealógico, com base em Foucault (1999, 2008, 2014, 2015), bem como Deleuze (2011), Veyne (2011) e Navarro (2004, 2011, 2015).

ABSTRACT: The idea that internationalizing education is a task that higher education in Brazil can't escape from mobilizes discussions carried out throughout this article. Based on the premise that Science Without Borders Program is configured as a power/knowledge device, we reflect on discursive regularities and power effects linked to a set of statements that have the internationalization of education as a reference. At first, we discussed the program as a discursive event and as a device of governmentality; afterwards, we analyzed some enunciative sequences taken from a more comprehensive database, composed of documents and interviews done to subjects who had educational experience with this program. The discussions are based on bibliographical research, documentary research and narrative interviews (BAUER & GASKEL, 2002). In addition to the discursive analysis of this material, we use the archegenealogical method developed by Foucault (1999, 2008, 2014, 2015), as well as Deleuze (2011), Veyne (2011) and Navarro (2004, 2011, 2015).

Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients / Prevalência da infecção latente por Mycobacterium tuberculosis em transplantados renais

ABSTRACT Objective: To estimate the prevalence of latent Mycobacterium tuberculosis infection (LTBI) in renal transplant recipients and to assess sociodemographic, behavioral, and clinical associations with positive tuberculin skin test (TST) results. Methods: This was a cross-sectional study of patients aged ≥ 18 years who underwent renal transplantation at the Renal Transplant Center of the Federal University of Minas Gerais Hospital das Clínicas, located in the city of Belo Horizonte, Brazil. We included renal transplant recipients who underwent the TST between January 2011 and July 2013. If the result of the first TST was negative, a second TST was administered. Bivariate and multivariate analyses using logistic regression were used to determine factors associated with positive TST results. Results: The sample included 216 patients. The prevalence of LTBI was 18.5%. In the multivariate analysis, history of contact with a tuberculosis case and preserved graft function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were associated with positive TST results. TST induration increased by 5.8% from the first to the second test, which was considered significant (p = 0.012). Conclusions: The prevalence of LTBI was low in this sample of renal transplant recipients. The TST should be administered if renal graft function is preserved. A second TST should be administered if the first TST is negative.

RESUMO Objetivo: Estimar a prevalência da infecção latente por Mycobacterium tuberculosis (ILTB) em transplantados renais e avaliar as associações sociodemográficas, comportamentais e clínicas com a prova tuberculínica (PT) positiva. Métodos: Estudo transversal, com pacientes com idade ≥ 18 anos, transplantados renais no Centro de Transplante Renal do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte (MG). Foram incluídos os pacientes submetidos a transplante renal que realizaram a PT no período entre janeiro de 2011 e julho de 2013. Quando o resultado da primeira PT foi negativo, uma segunda PT foi realizada. As análises bivariada e multivariada, por meio de regressão logística, foram utilizadas para determinar os fatores associados com PT positiva. Resultados: A amostra incluiu 216 pacientes. A taxa de prevalência para ILTB foi de 18.5%. Na análise multivariada, história de contato com caso de tuberculose e função do enxerto preservada (taxa de filtração glomerular estimada ≥ 60 ml/min/1,73 m2) foram associadas com PT positiva. O incremento da primeira PT para a segunda PT foi de 5,8%, considerado significante (p = 0,012). Conclusões: A prevalência da ILTB foi baixa nessa amostra de pacientes transplantados renais. A PT deve ser efetuada quando a função do enxerto renal estiver preservada. Uma segunda PT deve ser realizada quando a primeira PT for negativa.

Endometriosis de pared abdominal. Caso clínico y revisión / Abdominal wall endometriosis. Clinical case and review

Se presenta un caso de endometriosis de pared abdominal, en una mujer de 33 años, G1C1, con cesárea 13 años antes. Apareció nódulo subcutáneo cerca de la cicatriz de Pfannenstiel de la cesárea 6 años antes, y presentó dolor cíclico en la zona, desde hacía 6 meses. En la ecografía abdominal tenía nódulo irregular de 12x25 mm, que ya se había visto en una tomografía computadorizada. El diagnóstico clínico de edema pulmonar agudo, se confirmó con la anatomía patológica de biopsia con anestesia local, viendo tejido adiposo y fragmentos de endometriosis, y posteriormente en la resección del nódulo (AU)

We present a rare case of abdominal wall endometriosis in a 33 year-old woman, G1C1, with cesarean section 13 years before. She had a subcutaneous mass near to Pfannenstiel surgical scar 6 years before, and she presented cyclic pain in the area from 6 months back. In the transabdominal sonography there was a hypoechoic mass of 12x25 mm, déjà vu in the computed tomography. The clinical diagnostic of abdominal wall endometriosis was confirmed in the Pathology of local anesthesic biopsy, showing adipose tissue and endometriosis fragments, and was confirmed after resection of the mass (AU)

Prevalence of hypothyroidism in major psychiatric disorders in hospitalised patients in Montserrat Hospital during the period March to October 2010 / Prevalencia de hipotiroidismo en trastorno psiquiátrico mayor de pacientes hospitalizados en la Clínica Montserrat en el periodo de marzo a octubre de 2010

Abstract Introduction: Hypothyroidism results from inadequate production of thyroid hormone. It is known that there is a relationship between the major psychiatric disorders and hypothyroidism. Objective: To determine the prevalence of hypothyroidism in patients admitted due to major psychiatric disorders in Montserrat Hospital during the period from March to October 2010. Material and methods: A descriptive cross-sectional study was conducted on 105 patients admitted to Montserrat Hospital with a primary diagnosis of major psychiatric disorder (major depression, bipolar affective disorder, generalised panic disorder, panic disorder, mixed anxiety-depressive disorder, and schizophrenia) in the aforementioned period. Thyroid stimulating hormone (TSH) was performed to assess the evidence of hypothyroidism. Results: The overall prevalence of hypothyroidism was found to be 10.5% (95%CI, 5-16%). It was 12.5% in anxiety disorder, 11.1% in depressive disorder, with a lower prevalence of 10.3% for bipolar disorder, and 9.9% for schizophrenia. Conclusions: The overall prevalence of hypothyroidism was found to be less than in the general population, which is between 4.64% and 18.5%, and hypothyroidism was found in disorders other than depression.

Resumen Introducción: El hipotiroidismo resulta de una inadecuada producción de hormonas tiroideas. Es conocido que existe una relación entre los trastornos psiquiátricos mayores y el hipotiroidismo. Objetivo: Determinar la prevalencia de hipotiroidismo en los pacientes hospitalizados por trastorno psiquiátrico mayor en la Clínica Montserrat en el periodo de marzo a octubre de 2010. Material y métodos: Se realizó un estudio descriptivo transversal, para el que se seleccionó una muestra de 105 pacientes que ingresaron a la Clínica Montserrat con diagnóstico de trastorno psiquiátrico mayor (depresión mayor, trastorno afectivo bipolar, trastorno de ansiedad generalizada, trastornos de ansiedad, trastorno mixto ansioso-depresivo y esquizofrenia) en el periodo mencionado. Para evaluar el hipotiroidismo se realizó una prueba de Hormona Estimulante del Tiroides (TSH). Resultados: La prevalencia general del hipotiroidismo fue del 10,5% (intervalo de confianza del 95%, 5%-16%). Al determinar el hipotiroidismo por diagnóstico, se encontró que había mayor prevalencia en los trastorno de pánico (12,5%) y depresivo (11,1%) y menor en el trastorno bipolar (10,3%) y la esquizofrenia (9,9%). Conclusiones: La prevalencia general del hipotiroidismo fue menor que en la población general (18,5-4,6%) y se encontró hipotiroidismo en otros trastornos diferentes de la depresión.

Valoración de la adopción de embriones humanos congelados desde el punto de vista de la filosofía moral, la ética laica y dos religiones monoteístas / Valuating frozen human embryo adoption from a moral philosophical point of view, lay ethics and two monotheist religions / Valoração da adoção de embriões humanos congelados do ponto de vista da filosofia moral, a ética laica e duas religiões monoteístas

La búsqueda de la eficacia en la fecundación in vitro hace que se produzcan más embriones que los que se implantarán, lo que produce un excedente de embriones, que es congelado. Esto hace que ineludiblemente el número de embriones humanos congelados aumente. Entre las soluciones para dichos embriones humanos congelados está la donación/adopción de los mismos. Ineludiblemente esta práctica conlleva objetivos problemas éticos. En este trabajo se evalúa la eticidad de la donación/adopción de embriones humanos congelados desde la perspectiva de la filosofía moral, lo que podríamos llamar una "ética laica" y dos de las religiones monoteístas: la musulmana y la judía.

The search for IVF efficacy leads to a higher embryo production than it is necessary for implantation; this results in an excess of embryos which are kept frozen. This amount of frozen embryos inevitably increases. The donation/adoption are among the possible solutions for these frozen embryos. However, this practice has objective ethical problems. This article considers the ethical aspects of the donation / adoption of frozen human embryos from the point of view of moral philosophy, from what we could call "secular ethics" and from two monotheistic religions: Muslim and Jewish.

A busca da eficácia na fecundação in vitro faz com que se produzam mais embriões dos que se implantarão, o que produz um excedente de embriões, que é congelado. Isto faz com que inquestionavelmente o número de embriões humanos congelados aumente. Entre as soluções para os ditos embriões humanos congelados está na doação/adoção dos mesmos. Ineludivelmente esta prática implica objetivos problemas éticos. Neste trabalho se avalia a eticidade da doação/adoção de embriões humanos congelados a partir da perspectiva da filosofia moral, o que poderíamos chamar uma "ética laica" e duas religiões monoteistas: a mulçumana e a judia.

Prevalence of latent Mycobacterium tuberculosis infection in prisoners / Prevalência da infecção latente por Mycobacterium tuberculosis em pessoas privadas de liberdade

ABSTRACT Objective: To determine the prevalence of and the factors associated with latent Mycobacterium tuberculosis infection (LTBI) in prisoners in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional cohort study conducted in two prisons in Minas Gerais. Tuberculin skin tests were performed in the individuals who agreed to participate in the study. Results: A total of 1,120 individuals were selected for inclusion in this study. The prevalence of LTBI was 25.2%. In the multivariate analysis, LTBI was associated with self-reported contact with active tuberculosis patients within prisons (adjusted OR = 1.51; 95% CI: 1.05-2.18) and use of inhaled drugs (adjusted OR = 1.48; 95% CI: 1.03-2.13). Respiratory symptoms were identified in 131 (11.7%) of the participants. Serological testing for HIV was performed in 940 (83.9%) of the participants, and the result was positive in 5 (0.5%). Two cases of active tuberculosis were identified during the study period. Conclusions: Within the prisons under study, the prevalence of LTBI was high. In addition, LTBI was associated with self-reported contact with active tuberculosis patients and with the use of inhaled drugs. Our findings demonstrate that it is necessary to improve the conditions in prisons, as well as to introduce strategies, such as chest X-ray screening, in order to detect tuberculosis cases and, consequently, reduce M. tuberculosis infection within the prison system.

RESUMO Objetivo: Determinar a prevalência e os fatores associados à infecção latente por Mycobacterium tuberculosis (ILTB) em pessoas privadas de liberdade no Estado de Minas Gerais. Métodos: Estudo de coorte transversal realizado em duas penitenciárias em Minas Gerais. Foi realizada a prova tuberculínica nos indivíduos que aceitaram participar do estudo. Resultados: Foram selecionados 1.120 indivíduos para a pesquisa. A prevalência da ILTB foi de 25,2%. Na análise multivariada, a ILTB esteve associada com relato de contato com caso de tuberculose ativa dentro da penitenciária (OR ajustada = 1,51; IC95%: 1,05-2,18) e uso de drogas inaláveis (OR ajustada = 1,48; IC95%: 1,03-2,13). Foram identificados 131 pacientes sintomáticos respiratórios (11,7%). O teste anti-HIV foi realizado em 940 (83,9%) dos participantes, sendo positivo em 5 indivíduos (0,5%). Dois casos de tuberculose ativa foram identificados no período do estudo. Conclusões: A prevalência de ILTB dentro das penitenciárias estudadas foi alta. Além disso, a ILTB estava associada ao relato de contato com casos de tuberculose e ao uso de drogas inaláveis. Nossos achados demonstram que é necessária a melhoria das condições de encarceramento e a utilização de outras estratégias, como a triagem por radiografia de tórax, para a descoberta de casos de tuberculose e redução da infecção pelo M. tuberculosis no sistema penitenciário.

Estructura y tipología familiar en pacientes con dependencia o abuso de sustancias psicoactivas en un centro de rehabilitación de adicciones en el Municipio de Chía, Cundinamarca / Structure and Family Type in Patients With Substance Abuse or Dependence Psychoactive Rehabilitation Center of Addiction in the Municipality of Chia Cundinamarca

Objetivo: Determinar la estructura y la tipología familiar de un grupo de pacientes con dependencia o abuso de sustancias que se encontraban en un centro de rehabilitación de adicciones durante el periodo comprendido entre agosto y octubre de 2009. Métodos: A través de una metodología descriptiva cualitativa-interpretativa, se estudió a 10 pacientes y sus familias que cumplían los criterios de inclusión por dependencia o abuso de sustancias; el trabajo de campo y las transcripciones se realizaron durante 3 meses mediante observación no participante, entrevista no estructurada y revisión de la historia clínica del paciente. Resultados: De las familias entrevistadas, siete eran monoparentales, con una organización no convencional respecto a «roles de género¼. La familia monoparental favorece la soledad, la dificultad para poner reglas, la desidealización del lugar del padre en la estructura familiar y la búsqueda de una complicidad constante. En el análisis por categorías, se concluyó que en las 10 familias del estudio de personas con adicciones son frecuentes características de la estructura familiar como la comunicación inadecuada, la ausencia de autoridad, reglas y límites, la presencia de triangulaciones, la falta de cohesión dada por la existencia de un patrón de relación desligado y el cambio de roles convencionales con respecto a género. La búsqueda del afecto de la madre ante su ausencia emocional por la sobrecarga en los roles y la falta del padre, suscitada por la separación de la pareja, se encontró como un aspecto esencial subyacente al comportamiento adictivo. Se configura un patrón de abandono parental. Conclusiones: Se confirma lo mencionado por diversos autores acerca de las características de la tipología y la estructura familiar encontradas en pacientes con adicciones, además de su necesidad de afecto junto con la premura por una figura maternal. La tipología familiar no determina por sí misma el abuso de sustancias psicoactivas, sino la influencia de otros factores como la estructura familiar, especialmente las interacciones afectivas deficientes, lo cual debe considerarse en el desarrollo de las estrategias terapéuticas.

Objective: To determine the family type, family structure in a group of patients with a diagnosis of substance abuse or dependence who were at a rehabilitation center for addiction during the period between August and October 2009. Methods: Through a descriptive qualitative-interpretative methodology 10 patients who met inclusion criteria for substance dependence or abuse were studied. The fieldwork and transcripts were made for three months by non-participant observation, non-structured interviews and examination of patients' clinical history. Results: Seven of the families interviewed were single-parent families with an unconventional organization on "gender roles". Single-parent families favored loneliness, difficulty in rule-setting, de-idealization of the place of the father in the family structure and a constant search for complicity. In the analysis by categories, we found that in 10 families in the study of individuals with addictions it is common to find family structure characteristics such as inadequate communication, lack of authority rules and limits, presence of triangulations, the lack of cohesion due to the existence of a disconnected relationship pattern and changed roles compared to conventional gender. The search for the affection of the mother at her emotional overload absence of roles and lack of father, raised by the separation of the couple, was found as an essential aspect underlying the addictive behavior. A pattern of parental abandonment is configured. Conclusion: The findings confirmed what has been mentioned by various authors regarding the characteristics of the family typology structure and personal factors in patients with addictions, in addition to their need for affection combined with the desire for the mother's presence. The family typology does not determine for itself the abuse of psychoactive substances, but the influence of other factors such as family structure, especially deficient affective interactions, which should be considered in the development of therapeutic strategies.

Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias / Prevalence of Chronic Obstructive Pulmonary Disease in the Canary Islands

Introducción: La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) varía considerablemente entre las diferentes áreas geográficas estudiadas. En España hay 2 estudios epidemiológicos que muestran una prevalencia entre el 9 y el 10% en población mayor de 40 años. No obstante, ninguno de ellos ha incluido a las Islas Canarias, región de interés por sus características climáticas y su alta prevalencia de tabaquismo. Material y métodos: A partir de una muestra poblacional de 596.478 personas se seleccionó una muestra aleatorizada de 1.353 individuos entre 40 y 70 años. Los participantes rellenaron un cuestionario y posteriormente realizaron una espirometría con test de broncodilatación si existía obstrucción. Se diagnosticó EPOC cuando el cociente FEV1/FVC después de la broncodilatación era menor de 0,70. Resultados: La prevalencia de EPOC fue del 7,3% (IC 95%: 5,5-9,5), siendo mayor en varones que en mujeres (8,7% vs. 6,3%, p = 0,134). La tasa de tabaquismo fue del 29,4% (IC 95%: 25,4-33,1), también mayor en los varones que en las mujeres (35,1% vs 25,4%, p < 0,001). La prevalencia de EPOC estratificada según la gravedad de la obstrucción, en base a los criterios GOLD, fue del 16% en el grupo I , del 69,9% en el II , del 10,4% en el III y del 3,3% en el IV . El infradiagnóstico fue del 71,6% y el infratratamiento, del 63,5%. Conclusiones: A pesar de tener una de las tasas de tabaquismo más altas de España, la prevalencia de EPOC en las Islas Canarias es menor que en la mayoría de las zonas españolas estudiadas

Introduction: The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. Materials and methods: A random group of 1353 subjects aged between 40 and 70 years was selected from a sample population of 596 478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. Results: The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs 6.3%, P = .134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P < 0.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in group I, 69.9% in group II, 10.4% in group III and 3.3% in group IV. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. Conclusions: Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied

Why do patients undergoing anterior cruciate ligament reconstruction in Brazil stay in hospital for longer periods than in other countries? Prospective evaluation of 30 patients and presentation of possible discharge criteria / Por que o paciente submetido a reconstrucao do Ligamento Cruzado Anterior no Brasil permanece internado por um periodo superior a outros paises? Avaliacao Prospectiva de 30 pacientes e apresentacao de possiveis criterios de alta hospitalar

OBJECTIVE: Evaluate a better moment by the medical team and patient to be discharged and relate to possible medical discharge criteria. METHODS: 31 anterior cruciate ligament reconstructed patients under similar conditions prospectively evaluated about the possibility of discharge with 24 and 48 hours after surgery and possibles discharges criteria such as pain, range of motion and capacity quadriceps contraction, besides the use of a validated scale to measure the patient's functional independence. RESULTS: 50% and 6.4% of patients prefer remain hospitalized after 24 and 48 hours of surgery, respectively. The average of the visual analogue scale of pain was 2.63 and 1.76 points, and the range of motion of 79º and 86,7º after 24 and 48 hours, respectively. 100% of patients were able to quadriceps contraction in every evaluated moments. CONCLUSION: In Brazil, possible discharged criteria as pain, range of motion, quad contraction and motor independence motor function scale show that anterior cruciate reconstruction reconstructed patients could be discharged after 24 hours of surgery. However, 50% of patients still prefer to remain hospitalized for longer periods. .

OBJETIVO: Avaliar o momento considerado ideal pela equipe médica e pelo paciente para receber alta e relacioná-lo com possíveis critérios de alta médica. MÉTODOS: Foram submetidos à reconstrução do ligamento cruzado anterior sob condições semelhantes 31 pacientes avaliados prospectivamente sobre a possibilidade de alta médica com 24 e 48 horas de cirurgia e possíveis critérios de alta, como dor, arco de movimento e capacidade de contração do quadríceps, além do uso de uma escala validada para medir a independência funcional motora do paciente. RESULTADOS: A permanência hospitalar após 24 horas de cirurgia é preferida por 50% dos pacientes, enquanto que 6,3% preferem permanecer por mais de 48 horas após a cirurgia. A média do valor da escala visual analógica de dor foi de 2,63 e 1,76 pontos; e o arco de movimento de 79º e 86,7º após 24 e 48 horas, respectivamente. Todos os pacientes foram capazes de contrair o quadríceps em todos os momentos avaliados. CONCLUSÃO: No Brasil, critérios possíveis de alta, como avaliação da dor, do arco de movimento, do controle do quadríceps e da independência funcional motora, mostram que seria possível o paciente submetido à reconstrução artroscópica do LCA receber alta com 24 horas. Entretanto, 50% dos pacientes ainda preferem permanecer internados no hospital por período mais prolongado. .

Estresores psicosociales y depresión mayor recurrente / Psychosocial stressors and major recurrent depression

En este trabajo se examinan los estresores psicosociales y la depresión recurrente a través de la revisión de la literatura básica en la materia. Se define el estrés y se clasifica desde diferentes perspectivas. El estrés es una causa de tensión y exigencia o mecanismo de adaptación.El estrés y la presentación del primer episodio depresivo están directamente relacionados, sin embargo cuando se presentan recurrencias el estrés significativo pierde fuerza dentro de los factores que lo desencadenan. Los estresores, especialmente los psicosociales, están relacionados con la presentación de recurrencias. Entre estos se destacan estresores internos y externos, por sucesos vitales, estrés de rol y las contrariedades cotidianas, la alta exigencia y el perfeccionismo. El no cumplimiento de metas es otro factor provocador de crisis en la transición del ciclo vital. El neuroticismo y el perfeccionismo, como actitudes disfuncionales provocan aislamiento y falta de soporte social. Los esquemas cognitivos disfuncionales conducen a un procesamiento erróneo de la información. La depresión es una pauta de relación que no permite encontrar formas adaptativas de enfrentar la vida y conducir las relaciones interpersonales. Aunque hay nuevas visiones que la consideran como un esfuerzo adaptativo. La comorbilidad puede hacer recurrir la depresión. Se ha sugerido que patrones maladaptativos cognitivos, en particular en interacción con estresores, podrían llevar a pobres resultados en el tratamiento de sujetos con trastorno depresivo mayor en comorbilidad con trastornos de personalidad. Estos, independientemente del estado de la depresión, han sido asociados con elevadas actitudes disfuncionales.

This paper examines psychosocial stressors and recurrent depression through a review of the basic literature on the subject. Stress is defined and classified from different perspectives. Stress is a cause of tension and demand or an adaptive mechanism. Stress and the presentation of the first episode of depression are directly related, however when recurrences are present significant stress loses strength among the factors that trigger it. Stressors, especially the psychosocial, are related to recurrences. Chief among these are internal and external stressors, and life events, role stress and annoyances of daily living, high demands and perfectionism. Failure to accomplish goals is another factor provoking crisis in the life cycle transition. Neuroticism and perfectionism, and dysfunctional attitudes lead to isolation and lack of social support. Dysfunctional cognitive schemes lead to erroneous information processing. Depression is a pattern of relationship failing to find adaptive ways of coping with life and conduct relationships, although there are new visions that consider it as an adaptive effort. Comorbidity can lead the recurrence of depression. It has been suggested that maladaptive cognitive patterns, in particular in interaction with stressors, could lead to poor results in the treatment of patients with major depressive disorder comorbidity with personality disorder. These, regardless of the state of depression have been associated with high dysfunctional attitudes.