Analysis of etiological factors of nursing diagnosis of impaired comfort in children and adolescents with cancer.

AIM: To analyse the etiological factors of the nursing diagnosis of impaired comfort in children and adolescents with cancer. DESIGN: This cross-sectional study was carried out in the referral unit for the treatment of childhood cancer in a tertiary hospital located in northeastern Brazil. METHODS: A total of 200 children and adolescents who were undergoing cancer treatment were included in this study. Data collection instruments and protocols were constructed with operational and conceptual definitions of clinical indicators and etiological factors for the nursing diagnosis of impaired comfort. A latent class model with adjusted random effects was used to determine impaired comfort and measures of sensitivity and specificity of clinical indicators. A univariate logistic regression analysis was performed for each etiological factor of impaired comfort. RESULTS: The analysis of etiological factors for the nursing diagnosis of impaired comfort in children and adolescents with cancer showed the high prevalence of four factors: noxious environmental stimuli, insufficient situational control, insufficient resources and insufficient environmental control. Illness-related symptoms, noxious environmental stimuli, and insufficient environmental control increased the chance of impaired comfort occurring. CONCLUSION: The etiological factors with the highest prevalence and most significant impact on the occurrence of impaired comfort were noxious environmental stimuli, insufficient situational control and illness-related symptoms. IMPACT: The results obtained in this investigation can support more accurate nursing diagnostic inference of impaired comfort in children and adolescents with cancer. Moreover, the results can inform direct interventions for the modifiable factors that trigger this phenomenon to avoid or minimize the signs and symptoms of the nursing diagnosis.

Unraveling the Intrinsic Biocidal Activity of the SiO2-Ag Composite against SARS-CoV-2: A Joint Experimental and Theoretical Study.

The COVID-19 pandemic has emerged as an unprecedented global healthcare emergency, demanding the urgent development of effective materials to inactivate the SARS-CoV-2 virus. This research was planned to disclose the remarkable biocidal activity of SiO2-Ag composites incorporated into low-density polyethylene. For this purpose, a joint experimental and theoretical [based on first-principles calculations at the density functional theory (DFT) level] study is performed. Biological assays showed that this material eliminatesStaphylococcus aureusand SARS-CoV-2 virus in just 2 min. Here, we investigate a previously unexplored process that we postulate may occur along the O2 and H2O adsorption and activation processes of pure and defective SiO2-Ag surfaces for the generation of reactive oxygen species (ROS). The obtained results help us to predict the nature of ROS: superoxide anion radicals, •O2-, hydroxyl radicals, •OH, and hydroperoxyl radicals, •HO2, that destroy and degrade the structure of the SARS-COV-2 virus. This is consistent with the DFT studies, where the energetic, electronic, and magnetic properties of the intermediates show a feasible formation of ROS. Present findings are expected to provide new insights into the relationship among the structure, property, and biocidal activity of semiconductor/metal SiO2-Ag composites.

Unconventional Disorder by Femtosecond Laser Irradiation in Fe2O3.

This paper demonstrates that femtosecond laser-irradiated Fe2O3 materials containing a mixture of α-Fe2O3 and ε-Fe2O3 phases showed significant improvement in their photoelectrochemical performance and magnetic and optical properties. The absence of Raman-active vibrational modes in the irradiated samples and the changes in charge carrier emission observed in the photocurrent density results indicate an increase in the density of defects and distortions in the crystalline lattice when compared to the nonirradiated ones. The magnetization measurements at room temperature for the nonirradiated samples revealed a weak ferromagnetic behavior, whereas the irradiated samples exhibited a strong one. The optical properties showed a reduction in the band gap energy and a higher conductivity for the irradiated materials, causing a higher current density. Due to the high performance observed, it can be applied in dye-sensitized solar cells and water splitting processes. Quantum mechanical calculations based on density functional theory are in accordance with the experimental results, contributing to the elucidation of the changes caused by femtosecond laser irradiation at the molecular level, evaluating structural, energetic, and vibrational frequency parameters. The surface simulations enable the construction of a diagram that elucidates the changes in nanoparticle morphologies.

Role of Surfaces in the Magnetic and Ozone Gas-Sensing Properties of ZnFe2O4 Nanoparticles: Theoretical and Experimental Insights.

The magnetic properties and ozone (O3) gas-sensing activity of zinc ferrite (ZnFe2O4) nanoparticles (NPs) were discussed by the combination of the results acquired by experimental procedures and density functional theory simulations. The ZnFe2O4 NPs were synthesized via the microwave-assisted hydrothermal method by varying the reaction time in order to obtain ZnFe2O4 NPs with different exposed surfaces and evaluate the influence on its properties. Regardless of the reaction time employed in the synthesis, the zero-field-cooled and field-cooled magnetization measurements showed superparamagnetic ZnFe2O4 NPs with an average blocking temperature of 12 K. The (100), (110), (111), and (311) surfaces were computationally modeled, displaying the different undercoordinated surfaces. The good sensing activity of ZnFe2O4 NPs was discussed in relation to the presence of the (110) surface, which exhibited low (-0.69 eV) adsorption enthalpy, promoting reversibility and preventing the saturation of the sensor surface. Finally, the O3 gas-sensing mechanism could be explained based on the conduction changes of the ZnFe2O4 surface and the increase in the height of the electron-depletion layer upon exposure toward the target gas. The results obtained allowed us to propose a mechanism for understanding the relationship between the morphological changes and the magnetic and O3 gas-sensing properties of ZnFe2O4 NPs.

Integration of experiment and computational modeling on the Tb doping process in CaMoO4 obtained by USP method: An efficient way to obtain photoluminescent materials.

In this paper, we present a combined experimental and theoretical study to disclose, the structure, electronic and optical properties of CaMoO 4 :xTb 3+ ( x = 1%, 2%, and 4%) microspheres. The microspheres were prepared by ultrasonic spray pyrolysis method and characterized by experimental and theoretical techniques. Theoretical calculations and XRD patterns indicate that these crystals have a scheelite-type tetragonal structure. The morphology of the CaMoO 4 :xTb 3+ ( x = 1%, 2% and 4% mol) samples were investigated from the FEG-SEM results and the formation of microspheres with a spherical shape were observed. The optical properties were investigated by UV-Vis and PL spectroscopy, as well as the chromaticity coordinates of these compounds. This also allowed us to understand the charge transfer process that happens in the singlet state and the excited states, generating the photoluminescence emissions of the Tb doping process in CaMoO 4 microspheres.

A face humana do herói: análise do processo saúde-doença de bombeiros a partir de comunidades virtuais / The hero's human face: analyzing firemen's health-disease process based on virtual communities / El rostro humano del héroe: análisis del proceso salud-enfermedad de bomberos a partir de comunidades virtuales

Resumo Poucos estudos na literatura nacional abordam a relação trabalho e saúde dos bombeiros militares; entre tais estudos, muitos focam apenas os indicadores patológicos e/ou consequências físicas, sem colocar em debate suas necessidades de saúde e vida no trabalho. Visando analisar essa relação em uma perspectiva ampliada e humanizada do herói, foi realizado um estudo exploratório e metodologicamente inovador em dois blogs da categoria. Desvelaram-se realidades até então invisíveis ou pouco conhecidas socialmente no tocante ao processo de trabalho do grupo investigado, como precarização das condições laborais, adoecimentos, desvios de função, humilhações e insatisfações, evidenciando a necessidade de reconhecer os bombeiros militares como trabalhadores e que carecem de condições dignas de trabalho e atenção integral à saúde, sobretudo no que diz respeito à saúde mental.(AU)

Abstract Few studies deal with military firemen's work/health relationship in national literature, among which many focus only on pathological indicators and/or physical consequences, not discussing their health and life needs at work. Aiming at analyzing this relationship under a wider, humanized perspective of heroes, an exploratory and methodologically innovative study was conducted in two industry blogs. Invisible or socially little known realities concerning the investigated group's work process were unveiled, such as precarious labor conditions, illnesses, role deviation, humiliation, and dissatisfaction. These realities show the need for acknowledging military firemen as workers who lack decent working conditions and comprehensive healthcare, particularly regarding their mental health.(AU)

Resumen Son pocos los estudios en la literatura nacional que abordan la relación trabajo y salud de los bomberos militares, entre ellos, muchos se enfocan solamente en los indicadores patológicos y/o consecuencias físicas, sin poner en debate sus necesidades de salud y vida en el trabajo. Con el objetivo de analizar esa relación desde una perspectiva ampliada y humanizada del héroe, se realizó un estudio exploratorio y metodológicamente innovador en dos blogs de la categoría. Se revelaron realidades hasta entonces invisibles o poco conocidas socialmente en lo que se refiere al proceso de trabajo del grupo investigado, tales como la precarización de las condiciones laborales, enfermedades, desviaciones de función, humillaciones e insatisfacciones, poniendo en evidencia la necesidad de reconocer a los bomberos militares como trabajadores y que carecen de condiciones dignas de trabajo y de atención integral de la salud, principalmente en lo que se refiere a la salud mental.(AU)

Revascularização pulpar em dentes permanentes imaturos sem vitalidade pulpar: uma revisão integrativa / Pulp revascularization in immature permanent teeth without pulp vitality: an integrative review

Introdução: Dentes permanentes imaturos que evoluem para necrose pulpar representam um desafio para tratamento endodôntico. A endodontia regenerativa e técnicas de revascularização pulpar surgem como um campo dinâmico e potencialmente ideal para terapia clínica em dentes com desenvolvimento radicular incompleto. Objetivo: Revisar a literatura sobre as técnicas de revascularização pulpar no tratamento de dentes com ausência de vitalidade pulpar com ápice radicular imaturo. Métodos: Os descritores "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp", "regeneration" foram utilizados para obtenção de artigos em língua inglesa, que apresentassem conteúdo disponibilizado na íntegra e publicados nos últimos 15 anos. Foram excluídos os trabalhos de relatos de caso e/ou séries de casos. Conclusão: Artigos revisados apresentaram uma heterogeneidade de resultados quanto à efetividade da técnica de revascularização pulpar, visto que os critérios estabelecidos para determinação do sucesso variavam entre os autores. O material mais comumente utilizado na técnica empregada consiste no Agregado Trióxido Mineral (MTA) em consistência pastosa aplicada sobre coágulo sanguíneo com formação induzida no interior do canal. Foi observada escassez de estudos laboratoriais e clínicos sobre as técnicas e materiais em revascularização pulpar, que suportem sua indicação, o que representa uma lacuna em potencial na literatura e requer cautela na indicação desta técnica.

Introduction: Immature permanent teeth that evolve to pulp necrosis represent a challenge for endodontic treatment. Regenerative endodontics and pulp revascularization techniques appear as a dynamic and potentially ideal field for clinical therapy in teeth with incomplete root development. Objective: To review the literature on pulpal revascularization techniques in the treatment of teeth with absence of pulp vitality with immature root apex. Methods: The descriptors "pulp revascularization", "pulp necrosis", "immature permanent tooth", "revascularization", "revitalization", "dental pulp" and "regeneration" were used to obtain articles in English that presented content available in full and published in the last 15 years. Works of case reports and/or series of cases were excluded. Conclusion: Reviewed articles presented a heterogeneity of results regarding the effectiveness of the pulp revascularization technique, since the established criteria for determining success varied among the authors. The material most commonly used in the technique used consists of the Mineral Trioxide Aggregate (MTA) in paste consistency applied on blood clot with induced formation inside the canal. A shortage of laboratory and clinical studies on pulp revascularization techniques and materials that support its indication has been observed, which represents a potential gap in the literature and requires caution in the indication of this technique.

Association between socioeconomic factors, behavioral, general health and oral mucosa status in elderly. / Associação entre fatores socioeconômicos, comportamentais, saúde geral e condição da mucosa bucal em idosos.

This study aimed to investigate the association between socioeconomic and behavioral factors, general health, oral health, and plaque accumulation and oral mucosa condition outcomes in the elderly. This is a cross-sectional study conducted from 2004 to 2005 with 785 elderly dwellers of the city of Carlos Barbosa (RS), Brasil. We used questionnaires to collect socioeconomic, behavior and health status data. The physical examination of the oral structures comprised the Mucosal-Plaque Index proposed by Henriksen (MPS). A higher prevalence of moderate/severe plaque accumulation was observed in the elderly group, in less educated male elderly. The use of full upper dentures and income under one minimum wage were protective factors for moderate/severe plaque accumulation. Only the variables of the first block of the conceptual structure, male gender (OR = 2.13; 95% CI 1.26-3.61) and lower education (OR = 1.37; 95% CI 1.06-1.78) remained associated with an unacceptable MPS score. The findings suggest that, as per MPS, less educated male elderly are more likely to have poor oral health.

O objetivo deste estudo foi investigar a associação entre fatores socioeconômicos, comportamentais, saúde geral, saúde bucal e os desfechos de acúmulo de placa e condição de mucosa bucal em idosos. Este estudo transversal, conduzido entre 2004 e 2005, incluiu 785 idosos de Carlos Barbosa, RS. Questionários foram utilizados para coleta de dados socioeconômicos, comportamentais e estado de saúde. O exame físico das estruturas bucais e o Índice de Mucosa e de Placa de Henriksen (MPS) foram utilizados para categorizar os desfechos. Observou-se maior prevalência de acúmulo de placa moderado/grave entre os idosos mais velhos, do sexo masculino e com menor escolaridade. O uso de prótese dental total superior e renda de até 1 salário mínimo foram fatores de proteção para acúmulo de placa moderado/grave. Apenas as variáveis do primeiro bloco da estrutura conceitual, sexo masculino (OR = 2,13; IC95% = 1,26-3,61) e menor escolaridade (OR = 1,37; IC95% = 1,06-1,78) permaneceram associados como risco à presença de escore inaceitável do MPS. Os achados sugerem que idosos do sexo masculino e com menor escolaridade têm maior chance de saúde bucal precária, conforme o MPS.

Work and health dialogues: analysis of interactive activity in Rio de Janeiro, Brazil, firefighters' blogs. / Diálogos sobre trabalho e saúde: análise da movimentação interativa nos blogs dos bombeiros do Rio de Janeiro, Brasil.

Advances in the techniques of automatic document analysis allow the understanding of objectives and subjective aspects in texts extracted from social media. This paper proposes a study on the work-health relationship of military firefighters of the Prehospital Care in the city of Rio de Janeiro, through publications in the blogs SOS Bombeiros and SOS Bombeiros RJ. Thanks to the methodological approach, through network analysis, a strong correlation between the words used by the stakeholders was uncovered, revealing precarious working conditions and the need for increased attention to workers' health.

Avanços nas técnicas de análise automática de documentos permitiram a compreensão de aspectos objetivos e subjetivos em textos extraídos de mídias sociais. Este artigo propôs analisar a relação trabalho e saúde dos bombeiros militares do Atendimento pré-hospitalar do município do RJ, por meio das publicações nos blogs SOS Bombeiros e SOS Bombeiros RJ. Graças ao percurso metodológico, através da análise de redes, evidenciou-se forte correlação entre as palavras utilizadas pelos atores, revelando precárias condições de trabalho e necessidade de atenção ampliada à saúde dos trabalhadores.

Diálogos sobre trabalho e saúde: análise da movimentação interativa nos blogs dos bombeiros do Rio de Janeiro, Brasil / Work and health dialogues: analysis of interactive activity in Rio de Janeiro, Brazil, firefighters' blogs

Resumo Avanços nas técnicas de análise automática de documentos permitiram a compreensão de aspectos objetivos e subjetivos em textos extraídos de mídias sociais. Este artigo propôs analisar a relação trabalho e saúde dos bombeiros militares do Atendimento pré-hospitalar do município do RJ, por meio das publicações nos blogs SOS Bombeiros e SOS Bombeiros RJ. Graças ao percurso metodológico, através da análise de redes, evidenciou-se forte correlação entre as palavras utilizadas pelos atores, revelando precárias condições de trabalho e necessidade de atenção ampliada à saúde dos trabalhadores.

Abstract Advances in the techniques of automatic document analysis allow the understanding of objectives and subjective aspects in texts extracted from social media. This paper proposes a study on the work-health relationship of military firefighters of the Prehospital Care in the city of Rio de Janeiro, through publications in the blogs SOS Bombeiros and SOS Bombeiros RJ. Thanks to the methodological approach, through network analysis, a strong correlation between the words used by the stakeholders was uncovered, revealing precarious working conditions and the need for increased attention to workers' health.

Associação entre fatores socioeconômicos, comportamentais, saúde geral e condição da mucosa bucal em idosos / Association between socioeconomic factors, behavioral, general health and oral mucosa status in elderly

Resumo O objetivo deste estudo foi investigar a associação entre fatores socioeconômicos, comportamentais, saúde geral, saúde bucal e os desfechos de acúmulo de placa e condição de mucosa bucal em idosos. Este estudo transversal, conduzido entre 2004 e 2005, incluiu 785 idosos de Carlos Barbosa, RS. Questionários foram utilizados para coleta de dados socioeconômicos, comportamentais e estado de saúde. O exame físico das estruturas bucais e o Índice de Mucosa e de Placa de Henriksen (MPS) foram utilizados para categorizar os desfechos. Observou-se maior prevalência de acúmulo de placa moderado/grave entre os idosos mais velhos, do sexo masculino e com menor escolaridade. O uso de prótese dental total superior e renda de até 1 salário mínimo foram fatores de proteção para acúmulo de placa moderado/grave. Apenas as variáveis do primeiro bloco da estrutura conceitual, sexo masculino (OR = 2,13; IC95% = 1,26-3,61) e menor escolaridade (OR = 1,37; IC95% = 1,06-1,78) permaneceram associados como risco à presença de escore inaceitável do MPS. Os achados sugerem que idosos do sexo masculino e com menor escolaridade têm maior chance de saúde bucal precária, conforme o MPS.

Abstract This study aimed to investigate the association between socioeconomic and behavioral factors, general health, oral health, and plaque accumulation and oral mucosa condition outcomes in the elderly. This is a cross-sectional study conducted from 2004 to 2005 with 785 elderly dwellers of the city of Carlos Barbosa (RS), Brasil. We used questionnaires to collect socioeconomic, behavior and health status data. The physical examination of the oral structures comprised the Mucosal-Plaque Index proposed by Henriksen (MPS). A higher prevalence of moderate/severe plaque accumulation was observed in the elderly group, in less educated male elderly. The use of full upper dentures and income under one minimum wage were protective factors for moderate/severe plaque accumulation. Only the variables of the first block of the conceptual structure, male gender (OR = 2.13; 95% CI 1.26-3.61) and lower education (OR = 1.37; 95% CI 1.06-1.78) remained associated with an unacceptable MPS score. The findings suggest that, as per MPS, less educated male elderly are more likely to have poor oral health.

The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function.

BACKGROUND: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. METHODS: We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. RESULTS: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81-4.75; p < 0.001). CONCLUSION: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge.

Avaliação da qualidade do sono e atores associados em pacientes diabéticos tipo 2 / Evaluation of sleep quality and associated factors in type 2 diabetespatients

Analisar a qualidade do sono e possíveis fatores associados em pacientes diabéticos tipo 2. Estudo descritivo transversal e quantitativo com 74 pacientes. Foram utilizados o Índice de Qualidade de Sono de Pittsburgh (PSQI) para avaliação da qualidade do sono e um questionário com informações socioeconômicas e clínicas. As análises multivariadas foram conduzidas por meio de regressão logística. A maioria dos pacientes tinha 50 anos ou mais de idade (54,1%). Quase 80% tinham diagnóstico de hipertensão arterial, 60,3% eram obesos e 61,6% usavam insulina. Observou-se que 64,9% dos pacientes referiram má qualidade do sono. Ter diagnóstico de diabetes mellitus por 10 anos ou mais esteve associado à má qualidade do sono (OR=3,0;IC=1,045-8,394). A hemoglobina glicada apresentou correlação positiva e significativa para frequência de uso de medicamentos para dormir (r=0,27; p=0,02). Os resultados demonstraram alto percentual de pacientes diabéticos com má qualidade do sono. Ressalta-se a importância de direcionar ações de prevenção e enfrentamento ao cuidado desses pacientes, principalmente aqueles com maior tempo de diagnóstico e os que utilizam medicamentos para dormir

To analyze the sleep quality and possible associated factors in patients diagnosed with type II Diabetes, a quantitative, descriptive cross-sectional study involving 74 patients was performed. The Pittsburg Sleep Quality Index (PSQI) was used for the evaluation of Sleep Quality, and a questionnaire was applied for socioeconomic and clinical information. Multivariate analyses were conducted through logistic regression. Most patients were 50 years old or older (54.1%). Almost 80% were diagnosed with arterial hypertension, 60.3% were obese, and 61.6% used of insulin. The results showed that 64% of patients reported poor sleep quality. Having type II Diabetes diagnosed for 10 years or more was associated with poor sleep quality (OR=3.0; CI=1.045-8.394). Glycated haemoglobin showed a positive and significant correlation with the frequency of sleep medication use (r=0.27; p=0.02). The results demonstrated a high percentage of diabetic patients reporting poor sleep quality. It is necessary to emphasize the importance of directing preventive actions and facing the challenges concerning the care of these patients; especially of those who have been diagnosed for a longer period and those using sleep medication

Outcomes from a cohort of patients with acute kidney injury subjected to continuous venovenous hemodiafiltration: The role of negative fluid balance.

BACKGROUND: Several factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT. RESULTS: This was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55-76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50-74) and 10 (7-12), respectively. The dialysis dose delivered was 33.2 (28.9-38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1-4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.44[1.14-10.4; p = 0.028]), hematologic malignancy (OR = 5.14[1.66-15.95; p = 0.005]), oliguria (OR = 2.36[1.15-4.9; p = 0.02]), positive daily fluid balance during CVVHDF (OR = 4.55[2.75-13.1; p<0.001]), and total SOFA score on first dialysis day (OR = 1.27[1.12-1.45; p<0.001]). CONCLUSIONS: Dialysis-related factors may influence the outcomes. In our cohort, positive daily fluid balance during CRRT was associated with lower survival. Multicenter, randomized studies are needed to assess fluid balance as a primary outcome to define the best strategy in this patient population.

OSBPL10, RXRA and lipid metabolism confer African-ancestry protection against dengue haemorrhagic fever in admixed Cubans.

Ethnic groups can display differential genetic susceptibility to infectious diseases. The arthropod-born viral dengue disease is one such disease, with empirical and limited genetic evidence showing that African ancestry may be protective against the haemorrhagic phenotype. Global ancestry analysis based on high-throughput genotyping in admixed populations can be used to test this hypothesis, while admixture mapping can map candidate protective genes. A Cuban dengue fever cohort was genotyped using a 2.5 million SNP chip. Global ancestry was ascertained through ADMIXTURE and used in a fine-matched corrected association study, while local ancestry was inferred by the RFMix algorithm. The expression of candidate genes was evaluated by RT-PCR in a Cuban dengue patient cohort and gene set enrichment analysis was performed in a Thai dengue transcriptome. OSBPL10 and RXRA candidate genes were identified, with most significant SNPs placed in inferred weak enhancers, promoters and lncRNAs. OSBPL10 had significantly lower expression in Africans than Europeans, while for RXRA several SNPs may differentially regulate its transcription between Africans and Europeans. Their expression was confirmed to change through dengue disease progression in Cuban patients and to vary with disease severity in a Thai transcriptome dataset. These genes interact in the LXR/RXR activation pathway that integrates lipid metabolism and immune functions, being a key player in dengue virus entrance into cells, its replication therein and in cytokine production. Knockdown of OSBPL10 expression in THP-1 cells by two shRNAs followed by DENV2 infection tests led to a significant reduction in DENV replication, being a direct functional proof that the lower OSBPL10 expression profile in Africans protects this ancestry against dengue disease.

Fragmentos das Análises de Dois Casos de Esquizofrenia / Fragments of Two Cases of Schizophrenia Analysis / Fragmentos de los Análisis de dos Casos de Esquizofrenia / Fragments de L'analyse de deux Cas de Schizophrénie

O presente texto foi construído a partir de fragmentos das análises de duas pacientes. A primeira apresentou-se como esquizofrênica na sessão inicial. A segunda foi diagnosticada ao longo do tratamento. Aspectos transferenciais em ambos os tratamentos impulsionaram esta escrita que partiu do texto de Freud sobre "O Caso Dora" e se utilizou da linguagem cinematográfica, pela semelhança entre a montagem de um filme e sessões de psicanálise. O enunciado da primeira sessão de ambas as mulheres e seus sonhos são os fragmentos que nos fizeram recorrer ao estudo de Freud "Suplemento metapsicológico à teoria dos Sonhos" visando análise, interpretação e considerações sobre a estruturação psicótica.

The present text was constructed from fragments of two patients' analysis. The first presented as schizophrenic in the initial session. The second was diagnosed throughout the treatment. Transferential aspects in both treatments stimulated this writing that started from Freud's text on "The Dora Case" and used the cinematographic language, for the similarity between the assembly of a film and sessions of psychoanalysis. The statement of the first session of both women and their dreams are the fragments that have made us resort to Freud's study "Metapsychological Supplement to Dream Theory" aiming analysis, interpretation and considerations on psychotic structuring.

Este texto fue construido partiendo de fragmentos de los análisis de dos pacientes. La primera se presentó como esquizofrenia en la sesión inicial. La segunda fue diagnosticada a lo largo del tratamiento. Aspectos transferenciales en ambos los tratamientos impulsaron este trabajo basado en el texto Freud acerca del "Caso Dora" y se utilizó del lenguaje cinematográfico, por la semejanza entre el montaje de una película y sesiones de psicoanálisis. El enunciado de la primera sesión de ambas las mujeres y sus sueños son los fragmentos que nos hicieron recurrir al estudio de Freud "Suplemento metapsicológico de la teoría de los sueños" teniendo en vista el análisis, la interpretación y las consideraciones acerca de la estructura psicótica.

Ce texte a été construit à partir de fragments des analyses de deux patientes. La première patiente s'est présentee comme schizophrène dans la session initiale. La seconde a été diagnostiquée pendant le traitement. Les aspects transferéntiels dans les deux traitements ont stimulé cette écrituret qui a eu comme point de départ le texte de Freud sur «l'affaire Dora¼ et a utilisé le langage cinématographique grâce à la similitude entre le montage d'un film et les sessions de psychanalyse. Le libellé de la première session des deux femmes et leurs rêves sont les fragments qui nous ont fait tourner vers l'étude de Freud « complément métapsychologique à la science des rêves¼ dont le cible est analyser, interpréter et donner des considérations sur la structuration psychotiques.

Anemia in patients undergoing ambulatory peritoneal dialysis: prevalence and associated factors.

INTRODUCTION: Anemia is a common complication in dialysis patients, scare studies have evaluated anemia in patients undergoing peritoneal dialysis (PD). OBJECTIVE: This study aimed to investigate the prevalence of anemia and its associated factors in patients undergoing PD in a single center where patients have free access to agents stimulating erythropoiesis (ESA) and intravenous iron supplementation. METHODS: Cross-sectional study analyzing the demographic, clinical and laboratory variables of 120 patients. Anemia was defined as hemoglobin (Hb) < 11 g/dl. RESULTS: Patients were on PD for 17 months, and the majority of them (86%) received automated PD. The mean age was 58 ± 16.5 years, and 52% were female and 29% were diabetes. Anemia was present in 34 (28%) patients. When compared with those without anemia, patients with anemia received a higher dose of iron (p = 0.02) and had a lower concentration of triglycerides (p = 0.01). Hb levels correlated negatively with iron (r = -0.20;p = 0.03) and ESA (r = -0.23; p = 0.01) doses and positively with albumin (r = 0.38; p = 0.01), triglycerides (r = 0.24; p = 0.01) and transferrin saturation (r = 0.20; p = 0.03). In multiple analyses, only the albumin concentration (beta = 0.84; 95% IC = 0.38-1.31;p < 0.001) and ESA dose (beta = -0.06; 95% IC = 0.00-0.00; p = 0.02) were independently associated with Hb levels. CONCLUSIONS: Almost 30% of PD patients had anemia, even with free access to erythropoietin and intravenous iron. The transferrin saturation and nutritional status assessed by albumin, were the factors associated with the occurrence of anemia in this population.

Anemia em pacientes submetidos à diálise peritoneal ambulatorial: prevalência e fatores associados / Anemia in patients undergoing ambulatory peritoneal dialysis: prevalence and associated factors

Resumo Introdução: A anemia é uma complicação frequente em pacientes em diálise e poucos estudos avaliaram sua ocorrência em pacientes submetidos à diálise peritoneal (DP). Objetivo: Este estudo teve como objetivo investigar a prevalência e fatores associados à presença de anemia em pacientes submetidos à DP de um único centro onde havia acesso irrestrito a agentes estimulantes da eritropoiese (AEE) e a suplementação de ferro intravenoso. Métodos: Estudo transversal que analisou variáveis demográficas, clínicas e laboratoriais de 120 pacientes. Anemia foi definida como hemoglobina (Hb) < 11g/dl. Resultados: Os pacientes estavam em DP por 17 meses, sendo 86% automatizada. A idade média foi de 58 ± 16,5 anos, 52% dos pacientes eram do sexo feminino e 29% diabéticos. Anemia esteve presente em 34 pacientes (28%). Quando comparados com pacientes sem anemia, aqueles com anemia recebiam maior dose de ferro (p = 0,02) e apresentavam menores triglicérides (p = 0,01). A Hb se correlacionou negativamente com as doses de ferro (r = -0,20;p = 0,03) e AEE (r = -0,23; p = 0,01), e positivamente com albumina (r = 0,38; p = 0,01), triglicérides (r = 0,24; p = 0,01) e índice de saturação da transferrina (r = 0,20; p = 0,03). Na análise múltipla, a concentração de albumina (coefβ = 0,84; 95% IC = 0,381,31;p < 0,001) e a dose de AEE (coefβ = -0,06; 95% IC = 0,00-0,00; p = 0,02) foram associadas de forma independente com a Hb. Conclusões: No presente estudo, anemia foi observada em aproximadamente 30% dos pacientes em programa de diálise peritoneal, com uso irrestrito de AEE e suplementação intravenosa de ferro. A saturação de transferrina e o estado nutricional, avaliado pela albumina, foram os fatores independentes associados à concentração de hemoglobina nesta população.

Abstract Introduction: Anemia is a common complication in dialysis patients, scare studies have evaluated anemia in patients undergoing peritoneal dialysis (PD). Objective: This study aimed to investigate the prevalence of anemia and its associated factors in patients undergoing PD in a single center where patients have free access to agents stimulating erythropoiesis (ESA) and intravenous iron supplementation. Methods: Cross-sectional study analyzing the demographic, clinical and laboratory variables of 120 patients. Anemia was defined as hemoglobin (Hb) < 11 g/dl. Results: Patients were on PD for 17 months, and the majority of them (86%) received automated PD. The mean age was 58 ± 16.5 years, and 52% were female and 29% were diabetes. Anemia was present in 34 (28%) patients. When compared with those without anemia, patients with anemia received a higher dose of iron (p = 0.02) and had a lower concentration of triglycerides (p = 0.01). Hb levels correlated negatively with iron (r = -0.20;p = 0.03) and ESA (r = -0.23; p = 0.01) doses and positively with albumin (r = 0.38; p = 0.01), triglycerides (r = 0.24; p = 0.01) and transferrin saturation (r = 0.20; p = 0.03). In multiple analyses, only the albumin concentration (beta = 0.84; 95% IC = 0.38-1.31;p < 0.001) and ESA dose (beta = -0.06; 95% IC = 0.00-0.00; p = 0.02) were independently associated with Hb levels. Conclusions: Almost 30% of PD patients had anemia, even with free access to erythropoietin and intravenous iron. The transferrin saturation and nutritional status assessed by albumin, were the factors associated with the occurrence of anemia in this population.

Efeitos do deslocamento da noção de intimidade: o êxtimo na sala de jantar / Effects of displacement of intimacy notion: the “extimate” in the dining room / Effets de déplacement de la notion d'intimité: l’extime dans la salle à manger

O deslocamento da noção de intimidade nas relações amorosas, observado em um caso clínico, suscitou a questão de estarem em curso novas formas de expressão destes laços. A tradição filosófica da amizade resgatada por Derrida aponta que da fusão associada ao amor surgiria o estranho, conceito freudiano, manifestado na angústia. Como o amor situa-se no registro imaginário e o sujeito ao se relacionar com os objetos – mercadoria do capitalismo exclui o outro do laço social, o estranhamento ocorreria pelo duplo no lugar de objeto. As modalidades da alteridade nos registros psíquicos são discutidas a partir de formulações como Mistura de Outreidade, proposta por Lacan, assim como imisção de sujeitos e multidão freudiana no Sonho da Injeção de Irma. A assimetria das relações seria condição de quebra do duplo, este como anunciador da morte, com o que estão preocupadas as pessoas da sala de jantar, conforme referência ao excerto clínico trabalhado(AU)

The displacement of the notion of intimacy in romantic relationships, observed in a clinical case, raised a new course for the expression of these bonds. The philosophical tradition of friendship brought back by Derrida points out that due to the fusion associated with love,“ the uncanny”, Freudian concept, manifested in anxiety, would appear. As love is situated in the imaginary register and the subject when relating to objects - capitalist merchandise - excludes the other of the social bond, the uncanny may occur by the placing of the double where the object should be. The forms of otherness in psychic records are discussed by Lacan’s formulation mixing of Otherness, as well as Inmixing of subjects and Freudian crowd at the Dream of Irma's Injection. The asymmetry of the relationship would be the condition to break the double, the announcer of death, with is a main object of concern for the people in the dining room, as a reference to the studied clinical excerpt(AU)

Le déplacement de la notion d’intimité dans les relations amoureuses, observé dans un cas clinique, a soulevé la question de savoir si des nouvelles formes d’expression de ces relations, sont en cours. La tradition philosophique de l'amitié reprise par Derrida souligne que de la fusion associé à l'amour, sortirait l'étrangeté, concept freudien qui se manifeste en angoisse. Comme l'amour se trouve dans le registre imaginaire et le sujet se rapporte à des objets - marchandise capitaliste exclut l'autre du lien social, l'étrangeté se produirait par le double à la place de l'objet. Les modalités de l'altérité dans les registres psychiques sont discutées à partir des formulations comme mélange d'altérité, proposé par Lacan, ainsi que l’immixtion des sujets et de la foule freudienne au rêve de l'injection d'Irma. L'asymétrie des relations serait la condition d'interruption du double, ceci comme annonciateur de la mort, avec qui, les gens de la salle à manger, sont préoccupés, en référence à l'extrait clinique travaillé(AU)