Determining factors of service priority in the risk classification of patients with chest pain.

OBJECTIVE: To verify the determining factors of high priority in the risk classification and the outcomes of the care provided to adult patients with chest pain. METHOD: Retrospective study, conducted at an emergency referral service of a public hospital in the interior of São Paulo State, analyzing the records of care performed in the risk classification in 181 medical records of patients with the symptom of chest pain, between August and November 2020. RESULTS: Individuals were most males 98 (54.1%), with moderate pain 133 (73.5), high priority for care 135 (74.5%) and who sought the service spontaneously 139 (76.8%). Of those classified as high priority, 47 (34.8%) were referred to the emergency room and, of these, 27 (17.0%) remained hospitalized. Female gender (p=0.0198; OR=0.40; CI=0.189-0.866) was independently associated with high priority of care. CONCLUSION: Despite the priority classification, few participants were referred to the emergency room and required hospitalization. Female gender was a protective factor in the risk classification as high priority.

Determining factors of service priority in the risk classification of patients with chest pain / Factores determinantes de la prioridad de servicios en la clasificación de riesgo de pacientes con dolor torácico / Fatores determinantes de prioridade de atendimento na classificação de risco a pacientes com dor torácica

ABSTRACT Objective: To verify the determining factors of high priority in the risk classification and the outcomes of the care provided to adult patients with chest pain. Method: Retrospective study, conducted at an emergency referral service of a public hospital in the interior of São Paulo State, analyzing the records of care performed in the risk classification in 181 medical records of patients with the symptom of chest pain, between August and November 2020. Results: Individuals were most males 98 (54.1%), with moderate pain 133 (73.5), high priority for care 135 (74.5%) and who sought the service spontaneously 139 (76.8%). Of those classified as high priority, 47 (34.8%) were referred to the emergency room and, of these, 27 (17.0%) remained hospitalized. Female gender (p=0.0198; OR=0.40; CI=0.189-0.866) was independently associated with high priority of care. Conclusion: Despite the priority classification, few participants were referred to the emergency room and required hospitalization. Female gender was a protective factor in the risk classification as high priority.

RESUMEN Objetivo: Verificar los factores determinantes de prioridad en la clasificación de riesgo y los resultados de las atenciones realizadas a pacientes adultos con dolor torácico. Método: Estudio retrospectivo realizado en urgencias referidas, del hospital público del interior de Sao Paulo, analizando los registros de las atenciones realizadas en la clasificación de riesgo en 181 prontuarios de pacientes con el síntoma dolor torácico, en el período de agosto a noviembre de 2020. Resultados: Los principales hallazgos del estudio deben presentarse de manera concisa y clara, sin excesivos detalles. Los resultados deben estar alineados con la sección de resultados del artículo completo, proporcionando información más detallada sobre los análisis estadísticos realizados y los principales resultados encontrados. Conclusión: A pesar de la clasificación prioritaria, pocos participantes fueron remitidos a la sala de emergencias y evolucionaron con necesidad de ingreso hospitalario. El sexo femenino fue un factor protector en la clasificación de riesgo como alta prioridad.

RESUMO Objetivo: Verificar os fatores determinantes de alta prioridade na classificação de risco e os desfechos deste atendimento realizado a pacientes adultos com dor torácica. Método: Estudo retrospectivo, realizado em pronto-socorro referenciado, de hospital público do interior de São Paulo, analisando-se os registros dos atendimentos realizados na classificação de risco em181 prontuários de pacientes com o sintoma dor torácica, no período de agosto a novembro de 2020. Resultados: Prevaleceram indivíduos do sexo masculino 98 (54,1%), com dor moderada 133 (73,5%), alta prioridade de atendimento 135(74,5%,) e que procuraram o serviço espontaneamente 139 (76,8%). Dos classificados em alta prioridade, 47 (34,8%) foram encaminhados para sala de emergência, e destes 27(17,0%) permaneceram internados. Sexo feminino (p=0,0198; OR=0,40; IC=0,189-0866) associou-se ao atendimento prioritário. Conclusão: Apesar da classificação prioritária, poucos participantes foram encaminhados à sala de emergência e evoluíram com necessidade de internação hospitalar. Sexo feminino foi fator protetor para classificação em alta prioridade de atendimento.

IL17F: A Possible Risk Marker for Spondyloarthritis in HLA-B*27 Negative Brazilian Patients.

HLA-B*27 is an important marker for spondyloarthritis (SpA), however, many SpA patients are HLA-B*27 negative. Thus, the aim of this study was to investigate the influence of IL17, TNF and VDR gene polymorphisms in SpA patients who were HLA-B*27 negative. This case-control study was conducted in 158 patients [102 patients with ankylosing spondylitis (AS) and 56 with psoriatic arthritis (PsA)] and 184 controls. HLA-B*27 genotyping was performed using PCR-SSP and IL17A (rs2275913), IL17F (rs763780), TNF-308 (rs1800629), TNF-238 (rs361525), FokI C>T (rs2228570), TaqI C>T (rs731236), ApaI A>C (rs7975232), and BsmI C>T (rs1544410) using PCR-RFLP. Statistical analyses were performed by Chi-square and logistic regression using OpenEpi and SNPStats software. The IL17F C allele frequency was higher in patients with SpA, AS and PsA compared to controls. The IL17F T/C genotype frequency was higher in SpA patients in an overdominant inheritance model and when men and women were separately analyzed. IL17A_IL17F AC haplotype was significantly associated to the risk for SpA patients. As for VDR, the ApaI a/a was a potential risk factor for SpA in men. In conclusion, IL17F C variant contributed to the risk of SpA in Brazilian patients who were HLA-B*27 negative and could be a potential marker for SpA.

The Influence of Vitamin D Receptor Gene Polymorphisms in Spondyloarthritis.

Spondyloarthritis (SpA) is an inflammatory rheumatic disease related to low bone mineral density. Because vitamin D plays an important role in bone metabolism and immune system modulation, the aim of this study was to evaluate the influence of polymorphisms in vitamin D receptor genes (VDR) in the development of SpA. In this case-control study, a total of 244 patients with SpA and 197 individuals with no SpA were included. Among the patients, 174 had ankylosing spondylitis (AS) and 66 had psoriatic arthritis (PsA). Genotyping of FokI (rs2228570 C > T), BsmI (rs1544410 C > T), ApaI (rs7975232 A > C), and TaqI (rs731236 T > C) was performed using PCR-RFLP, while genotyping of HLA-B∗27 was performed using PCR-SSP. Serum levels for hydroxy (OH) vitamin D and the clinical activity index of the disease (BASDAI) were also evaluated. SNPStats and OpenEpi software were used for statistical analysis. The ApaI a allele and ApaI a/a genotype were less frequent in PsA compared with controls. The ApaI a/a genotype was associated with a protecting factor for PsA in females, and ApaI A/a was associated with a protecting factor for the disease in HLA-B∗27 positive patients. Notwithstanding, the ApaI a/a genotype was a risk factor for SpA and AS in males. The FokI f/f genotype was associated with a better clinical activity in PsA. When considering the covariates, vitamin D sufficiency, and gender, the FokI F/F genotype was associated with a risk factor in males with SpA and AS compared with females with this same genotype. In conclusion, the ApaI rs7975232 polymorphism was associated with PsA, and the FokI rs2228570 polymorphism was associated with better clinical PsA activity. ApaI and FokI were associated with SpA and AS when considering gender and vitamin D sufficiency.

Phenotypic and functional profile of IFN-α-differentiated dendritic cells (IFN-DCs) from HIV-infected individuals.

Dendritic cell (DC)-based immunotherapy is a promising strategy for the treatment of HIV-infected individuals. Different from the conventional protocol for DC differentiation based on the cytokine IL-4 (IL4-DCs), several studies have suggested obtaining DCs by culturing monocytes with type I IFN (IFN-α) to yield IFN-DCs, as performed in cancer therapy. To evaluate the phenotypic and functional characteristics, monocytes from HIV-infected subjects were differentiated into IFN-DCs or IL4-DCs, pulsed with chemically inactivated HIV and stimulated with pro-inflammatory cytokines. A comparative analysis between both types of monocyte-derived DCs (MoDCs) showed that immature IFN-DCs were phenotypically distinct from immature IL4-DCs at the baseline of differentiation, presenting a pre-activated profile. From the functional profile, we determined that IFN-DCs were capable of producing the cytokine IL-12 p70 and of inducing the production of IFN-γ by CD4 + T lymphocytes but not by TCD8+ lymphocytes. Our results suggest that IFN-DCs derived from HIV-infected individuals are able to recognize and present viral antigens to induce TCD4+ cellular immunity to HIV.

Characterization of monocyte-derived dendritic cells used in immunotherapy for HIV-1-infected individuals.

AIMS: A therapeutic vaccine based on monocyte-derived dendritic cells (MDDCs) has been shown to represent a promising strategy for the treatment of cancer and viral infections. Here, we characterized the MDDCs used as an immunogen in a clinical trial for an anti-HIV-1 therapeutic vaccine. PATIENTS & METHODS: Monocytes obtained from 17 HIV-infected individuals were differentiated into MDDCs and, after loading with autologous HIV, the cells were characterized concerning surface molecule expression, migratory and phagocytosis capacity, cytokine production and the induction of an effective cell-mediated immune response. RESULTS: The MDDCs were able to induce antigen-specific responses in autologous CD4+ and CD8+ T lymphocytes. CONCLUSIONS: Despite a large interindividual variability, the results suggested that MDDCs present the potential to promote immune responses in vaccinated patients.

Influence of TNF and IL17 Gene Polymorphisms on the Spondyloarthritis Immunopathogenesis, Regardless of HLA-B27, in a Brazilian Population.

BACKGROUND AND OBJECTIVES: Spondyloarthritis (SpA) represents a heterogeneous group of immune-mediated inflammatory diseases that have overlapping clinical features, genetic predisposition, and pathogenic mechanisms. Hence, we investigated, through a case-control study, whether single-nucleotide polymorphisms of TNF and IL17 genes are associated with SpA, ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in a mixed Brazilian population. METHODS: Genotyping of TNF-308 (rs1800629), TNF-238 (rs361525), IL17A (rs2275913), IL17F (rs763780), and HLA-B27 polymorphisms was performed in 243 patients with SpA and 210 controls from Southern Brazil using SSOP-Luminex (One Lambda) and PCR-SSP assays. RESULTS: Significant associations were confirmed between the HLA-B27 marker and SpA, AS, and PsA diseases. While TNF-308 (rs1800629) AA/GA, IL17A (rs2275913) AA/GA, and IL17F (rs763780) CC/TC genotype frequencies were associated, in the dominance inheritance model, with SpA and AS, regardless of gender, the presence of HLA-B27, TNF-238 (rs361525) GA/AA, IL17A (rs2275913) AA/GA, and IL17F (rs763780) genotypes was associated with PsA. CONCLUSION: In this Brazilian population, TNF and IL17 gene polymorphisms responsible for the expression of important inflammatory cytokines were associated with overall SpA, and, specifically, with AS and PsA, regardless of gender and HLA-B27. However, future larger studies with different ethnicities may be necessary to confirm these genetic associations.

Purification of a membrane-bound trypsin-like enzyme from the gut of the velvetbean caterpillar (Anticarsia gemmatalis Hübner) - doi: 10.4025/actascibiolsci.v34i3.9239

Disruption of protein digestion in insects by specific endoprotease inhibitors is being regarded as an alternative to conventional insecticides for pest control. To optimize the effectiveness of this strategy, the understanding of the endoprotease diversity of the target insect is crucial. In this sense, a membrane-bound trypsin-like enzyme from the gut of Anticarsia gemmatalis fifth-instar larvae was purified. Non-soluble fraction of the gut extract was solubilized with 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS) and subjected to a p-aminobenzamidine affinity chromatography followed by anion-exchange chromatography. The yield of the purified enzyme was 11% with a purification factor of 143 and a final specific activity of 18.6 µM min.-1 mg-1 protein using N--benzoyl-L- Arg-p-nitroanilide (L-BApNA) as substrate. The purified sample showed a single band with proteolytic activity active and apparent molecular mass of 25 kDa on SDS-PAGE. Molecular mass determined by MALDI-TOF mass spectrometry was 28,632 ± 26 Da. Although the low recovery and the difficulties in purifying large enzyme amounts limited its further characterization, the results contribute for the understanding of the proteases present on A. gemmatalis gut, which are potential targets for natural or specifically designed protease inhibitors.

Purification of a membrane-bound trypsin-like enzyme from the gut of the velvetbean caterpillar (Anticarsia gemmatalis Hübner) / Purificação de uma enzima "tipo tripsina" não-solúvel do intestino da lagarta da soja (Anticarsia gemmatalis Hübner)

Disruption of protein digestion in insects by specific endoprotease inhibitors is being regarded as an alternative to conventional insecticides for pest control. To optimize the effectiveness of this strategy, the understanding of the endoprotease diversity of the target insect is crucial. In this sense, a membrane-bound trypsin-like enzyme from the gut of Anticarsia gemmatalis fifth-instar larvae was purified. Non-soluble fraction of the gut extract was solubilized with 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS) and subjected to a p-aminobenzamidine affinity chromatography followed by anion-exchange chromatography. The yield of the purified enzyme was 11% with a purification factor of 143 and a final specific activity of 18.6 µM min.-1 mg-1 protein using N-α-benzoyl-L- Arg-p-nitroanilide (L-BApNA) as substrate. The purified sample showed a single band with proteolytic activity active and apparent molecular mass of 25 kDa on SDS-PAGE. Molecular mass determined by MALDI-TOF mass spectrometry was 28,632 ± 26 Da. Although the low recovery and the difficulties in purifying large enzyme amounts limited its further characterization, the results contribute for the understanding of the proteases present on A. gemmatalis gut, which are potential targets for natural or specifically designed protease inhibitors.

Comprometer a digestão de proteínas dos insetos pelo uso de inibidores específicos de endoproteases tem sido amplamente estudado como um método de controle de pragas alternativo ao uso dos inseticidas convencionais. No processo de otimização desta estratégia, o conhecimento da diversidade das endoproteases do inseto alvo torna-se crucial. Neste sentido, uma enzima "tipo-tripsina" ligada à membrana obtida do intestino de larvas do 5° instar de A. gemmatalis foi purificada. A fração insolúvel do extrato do intestino foi solubilizada com 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS) e submetida à uma cromatografia de afinidade em uma coluna de p-aminobenzamidina, seguida por uma cromatografia de troca-aniônica. O rendimento da enzima purificada foi de 11% com fator de purificação de 143 e uma atividade específica final de 18.6 µM min.-1 mg-1 de proteína usando N-α-benzoyl-L- Arg-p-nitroanilide (L-BApNA) como substrato. Após a separação da amostra purificada por SDS-PAGE e incubação subsequente com caseína, uma única banda ativa com massa molecular aparente de 25 kDa foi observada. A massa molecular determinada por espectrometria de massa (MALDI-TOF) foi de 28,632 ± 26 Da. O baixo rendimento e as dificuldades em purificar grandes quantidades da enzima limitaram caracterização complementar. A observação desta enzima, no entanto, é mais uma etapa no processo de conhecer as endoproteases presentes no intestino de A. gemmatalis, alvos potenciais de inibidores de proteases naturais ou especificamente projetados.

Dor no pós-operatório imediato / Pain in the immediate postoperative / Dolor en el post-operatorio inmediato

Objetivo: avaliar o conhecimento dos auxiliares e técnicos de enfermagem sobre a dor como quinto sinal vital, no POI. Método: estudo descritivo, quantitativo aprovado pelo Comitê de Ética em Pesquisa da Universidade de Taubaté, Taubaté-SP, número de protocolo 521/07. A população foi composta por auxiliares e técnicos de enfermagem que trabalham nas clínicas de cirurgia, ortopedia, UTI adulto e particular de um Hospital de Taubaté-SP. Os dados foram coletados entre janeiro e agosto de 2008, por meio de um questionário. Os resultados foram quantificados pelo Programa Microsoft Excel 2003. Resultados: os pesquisados definiram a dor como algo que não está bem, incômodo, desconforto, ansiedade, sensação desagradável, sofrimento físico e psíquico, e como o 5o sinal vital. Conhecem algum tipo de instrumento para avaliar dor, mas no POI ela foi avaliada somente por meio da queixa, e registraram somente a presença da dor e o local. Salientaram que, se a dor não for tratada corretamente, pode trazer consequências, tanto para o paciente como para a equipe de enfermagem. Conclusão: os pesquisados não estão preparados para avaliar e atender pacientes com dor de forma correta. Diante do exposto, acredita-se que vale a pena investir na formação dos profissionais, para ampliar seu conhecimento e para que venham a atender de forma consciente e humanizada.(AU)

Objective: to assess the knowledge of the nursing staff about pain as a fifth vital sign, in the IPO. Method: this is a descriptive, quantitative study, approved by the Ethics Committee of the University of Taubaté, Taubaté-SP, protocol number 521/07. The population was consisted of nursing assistants and nursing technicians who work in orthopedic, surgery clinics, adult UTI and private Hospital of Taubaté-SP. Data were collected between January and August 2008, through a questionnaire. The results were quantified using the program Microsoft Excel 2003. Results: respondents defined pain as something that is not right, discomfort, anxiety, unpleasant feeling, physical and mental suffering, and as the 5th vital sign. They know some kind of instrument to assess pain, but, in the IPO, it was assessed only through the complaint, and reported only the presence of pain and location. They stressed that, if the pain is not treated properly, there might be consequences for both patient and nursing staff. Conclusion: the respondents are not prepared to assess and treat patients with pain correctly. In this light, it is believed that it is worth investing in training professionals to expand their knowledge and to give medical treatment consciously and humanized.(AU)

Objetivo: evaluar el conocimiento de los auxiliares y técnicos de enfermería sobre el dolor como quinta señal vital, en el POI. Método: estudio descriptivo, cuantitativo aprobados por el Comité de Ética de la Universidad Taubaté, Taubaté-SP, número de protocolo 521/07. La población fue compuesta por auxiliares y técnicos de enfermería que trabajan em las clínicas de cirurgia, ortopedía, UTI adulto y privado de un Hospital de Taubaté-SP. Los datos fueron recigidos entre enero y agosto de 2008, por medio de um cuestionario. Los resultados fueron cuantificados por el Programa Microsoft Excel. Resultados: los investigados definieron el dolor como algo que no está bien, incómodo, desconforto, ansiedad, sensación desagradable, sufrimiento físico y psíquico, y como la 5ª. señal vital. Conocen algun tipo de instrumento para evaluar dolor, pero em el POI ella fue evaluada solamente por medio de la queja, y registraron solamente la presencia del dolor y el sitio. Destacaron que, si el dolor no es tratado correctamente, puede traer consecuencias, tanto para elo paciente como para el equipo de enfermería. Conclusión: los investigados no están preparados para evaluar y atender pacientes con dolor de forma correcta. Delante de lo expusto, se cree que vale la pena investir em la formación de los profisionales, para ampliar su conocimiento y para que vengan a atender de forma consciente y humanizada.(AU)

Estudo da associação entre dor e desempenho funcional do membro superior de jogadores de vôlei / Study of association between pain and function upper limb of the volleyball athletes

Objetivo: Associar o desempenho funcional e presença de dor em ombros de atletas da categoria juvenil de vôlei. Metodologia: Quinze atletas de vôlei da categoria juvenil de um Centro Esportivo de Betim (média de idade: 17,85 ± 0,89 anos) foram submetidos à avaliação da dor durante e após a atividade através da Escala Análoga Visual (EVA) e a avaliação do desempenho funcional através de um questionário funcional. Resultados: Os resultados demonstraram ausência a leve limitação do desempenho funcional do ombro destes atletas. Quanto à dor, foi observado baixo nível de dor avaliado através da EVA. Além disso, foi encontrada associação estatisticamente significativa entre dor e limitação do desempenho funcional geral dos atletasavaliados (r=0,77). A diferença entre dor durante e após o treinamento não demonstrou resultado estatisticamente significativo (p = 0,579). A diferença entre o desempenho funcional gerale o desempenho funcional específico relacionado ao esporte não demonstrou diferença estatisticamente significativa (p= 0,406). Conclusão: Os resultados do presente estudo indicaramassociação entre baixo nível de dor após o treinamento e limitação leve do desempenho funcional dos atletas de vôlei categoria juvenil.

Objective: To associate between the functional performance of the athlete´s shoulders of the volleyball juvenile category with the pain during and after training. Methods: Fifteen athletes of the volleyball of the juvenile category of the Sports Center at Betim ( age mean: 17,85 ± 0,89 years) were submitted to evaluate of the pain during and after training using the Visual Analogue Scale (VAS) and one questionnaire of the performance functional. Results: The relative demonstrated absence or light limitation of the performance functional of the athletes. That the pain, were observed little levels of the pain in VAS. Moreover, was observed statistic difference between the pain and the limitation of the general functional performance of the athletes evaluating(r=0,77). The difference between the pain during and before training didn’t demonstrated results statistic significance (p = 0,579). The difference between general functional performance functional and specific functional performance didn’t demonstrated difference statistic significance(p= 0,406). Conclusion: The results of the study present indicated association between little levels of the pain before training and the light functional performance limitation of thejuvenile athletes of the volleyball evaluating.