KPC-2-producing Enterobacterales from ready-to-eat food to hospitalized patients.

Foodstuffs are a well-documented source of multidrug-resistant bacteria, and hospitalized patients are usually susceptible to hospital infections owing to their immune status. Therefore, this study aimed to investigate the presence of beta-lactamase-producing Enterobacterales in ready-to-eat foods consumed by hospitalized patients. For this purpose, 51 vegetable and meat samples were collected over 2 months and analyzed. Enterobacterales isolates were identified and subjected to antimicrobial susceptibility testing, followed by beta-lactamase gene screening, pH tolerance assays, and whole-genome sequencing (WGS). Isolates harboring genes encoding extended-spectrum beta-lactamases, cephalosporinases, or carbapenemases were detected, and all isolates tolerated pH levels similar to those in the human gastrointestinal tract. The blaKPC-2 carriers were characterized by WGS and lineages closely related to those causing human infections were identified. These results showed that dietary intake is an alternative route for the transmission of antimicrobial-resistant bacteria, which must be considered when designing effective strategies for infection control.

Chemical Composition and Evaluation of Antibacterial, Antibiofilm, and Mutagenic Potentials of a Propolis Sample from the Atlantic Forest of Midwest Brazil.

Sixteen triterpenoids with various skeletal types, five phenylpropanoid derivatives, and two flavonoids were isolated from a propolis sample produced by Apis mellifera collected in the Atlantic Forest of Midwest Brazil. Among these compounds, six triterpenes, namely 3ß,20R-dihydroxylanost-24-en-3-yl-palmitate, (23E)-25-methoxycycloartan-23-en-3-one, 24-methylenecycloartenone, epi-lupeol, epi-α-amyrin, and epi-ß-amyrin are being reported for the first time in propolis, while cycloartenone, (E)-cinnamyl benzoate, and (E)-cinnamyl cinnamate are new findings in Brazilian propolis. The presence of cycloartane- and lanostane-type triterpenoids, the latter being a class of compounds of restricted distribution in propolis worldwide, has not been reported in propolis from Midwest Brazil until now. The ethyl acetate phase obtained from the ethanol extract was effective in preventing biofilm formation by Staphylococcus aureus, with an inhibition rate of about 96 % at 0.5 mg.mL-1 , and with quercetin isolated as one of its active constituents. In contrast, the hexane phase exhibited notable antibacterial activity against Pseudomonas aeruginosa, inhibiting bacterial growth by 92 % at 0.5 mg.mL-1 ; however, none of the triterpenoids isolated from this phase proved active against this pathogen. The ethanol extract was neither toxic nor mutagenic at the concentrations tested, as determined by the in vivo SMART assay on Drosophila melanogaster, even under conditions of high metabolic activation.

Validation evidence of an educational booklet on care measures with vascular accesses for hemodialysis / Evidencias de validez de un folleto educativo sobre precauciones con accesos vasculares para hemodiálisis / Evidências de validade de cartilha educativa sobre cuidados com acessos vasculares para hemodiálise

ABSTRACT Objective: to verify the validation evidence of an educational booklet focused on the care of patients with vascular accesses for hemodialysis. Method: the methodological study was structured into three different aspects: content validity by expert judges based on calculation of the Content Validity Index; face evaluation by design expert judges; and pilot implementation, carried out with the target population, consisting of 30 patients in a nephrology clinic from Picos, Piauí, Brazil. Data collection took place from December 2020 to April 2021, and included a descriptive and inferential analysis of the findings. Results: the final version of the booklet had 32 pages, and its overall Content Validity Index was 0.88, thus proving its content validity and indicating clarity of the language, theoretical relevance and practical pertinence of the educational technology. The design expert judges rated the booklet as adequate or as with superior quality. The mean of the overall agreement rate by the target audience was 0.99. Conclusion: the educational booklet presented satisfactory validation evidence, based on its face and content, with good potential for use in the clinical practice.

RESUMEN Objetivo: verificar las evidencias de validez de un folleto educativo acerca de las precauciones con accesos vasculares para hemodiálisis. Método: estudio metodológico estructurado en tres vertientes: validación de contenido a cargo de jueces especialistas sobre la base de calcular el Índice de Validez de Contenido; evaluación del aspecto estético a cargo de jueces especializados en diseño; y aplicación piloto realizada con la población objetivo, compuesta por 30 pacientes de una clínica de Nefrología de Picos, Piauí, Brasil. La recolección de datos tuvo lugar entre diciembre de 2020 y abril de 2021, con análisis descriptivo e inferencial de los hallazgos. Resultados: la versión final del folleto tuvo 32 páginas, con un Índice de Validez de Contenido general de 0,88, evidenciando su validez en términos de contenido e indicando claridad en el lenguaje, relevancia teórica y pertinencia práctica de la tecnología educativa. Los jueces especializados en diseño calificaron al folleto al menos como adecuado. El valor medio del índice de concordancia total en la población objetivo fue 0,99. Conclusión: el folleto educativo demostró evidencias de validez satisfactorias, basadas en su contenido y apariencia, con potencial para ser usado en la práctica clínica.

RESUMO Objetivo: verificar as evidências de validade de uma cartilha educativa acerca dos cuidados com acessos vasculares para hemodiálise. Método: estudo metodológico estruturado em três vertentes: validação de conteúdo por juízes especialistas com base no cálculo do Índice de Validade de Conteúdo; avaliação de aparência por juízes de design; e aplicação piloto, realizada com a população-alvo, composta por 30 pacientes de uma clínica de nefrologia em Picos, Piauí, Brasil. A coleta de dados ocorreu de dezembro de 2020 a abril de 2021, com análise descritiva e inferencial dos achados. Resultados: a versão final da cartilha contou com 32 páginas, cujo Índice de Validade de Conteúdo geral mostrou-se em 0,88, evidenciando sua validade de conteúdo e sinalizando clareza na linguagem, relevância teórica e pertinência prática da tecnologia educacional. Os juízes de design avaliaram a cartilha como adequada ou superior. A média do índice de concordância total do público-alvo foi de 0,99. Conclusão: a cartilha educativa demonstrou evidências de validade satisfatórias, baseadas no conteúdo e na aparência, com potencial de utilização na prática clínica.

Disclosing azole resistance mechanisms in resistant Candida glabrata strains encoding wild-type or gain-of-function CgPDR1 alleles through comparative genomics and transcriptomics.

The pathogenic yeast Candida glabrata is intrinsically resilient to azoles and rapidly acquires resistance to these antifungals, in vitro and in vivo. In most cases azole-resistant C. glabrata clinical strains encode hyperactive CgPdr1 variants, however, resistant strains encoding wild-type CgPDR1 alleles have also been isolated, although remaining to be disclosed the underlying resistance mechanism. In this study, we scrutinized the mechanisms underlying resistance to azoles of 8 resistant clinical C. glabrata strains, identified along the course of epidemiological surveys undertaken in Portugal. Seven of the strains were found to encode CgPdr1 gain-of-function variants (I392M, E555K, G558C, and I803T) with the substitutions I392M and I803T being herein characterized as hyper-activating mutations for the first time. While cells expressing the wild-type CgPDR1 allele required the mediator subunit Gal11A to enhance tolerance to fluconazole, this was dispensable for cells expressing the I803T variant indicating that the CgPdr1 interactome is shaped by different gain-of-function substitutions. Genomic and transcriptomic profiling of the sole azole-resistant C. glabrata isolate encoding a wild-type CgPDR1 allele (ISTB218) revealed that under fluconazole stress this strain over-expresses various genes described to provide protection against this antifungal, while also showing reduced expression of genes described to increase sensitivity to these drugs. The overall role in driving the azole-resistance phenotype of the ISTB218 C. glabrata isolate played by these changes in the transcriptome and genome of the ISTB218 isolate are discussed shedding light into mechanisms of resistance that go beyond the CgPdr1-signalling pathway and that may alone, or in combination, pave the way for the acquisition of resistance to azoles in vivo.

Fluorescent Multiplex Immunohistochemistry Coupled With Other State-Of-The-Art Techniques to Systematically Characterize the Tumor Immune Microenvironment.

Our expanding knowledge of the interactions between tumor cells and their microenvironment has helped to revolutionize cancer treatments, including the more recent development of immunotherapies. Immune cells are an important component of the tumor microenvironment that influence progression and treatment responses, particularly to the new immunotherapies. Technological advances that help to decipher the complexity and diversity of the tumor immune microenvironment (TIME) are increasingly used in translational research and biomarker studies. Current techniques that facilitate TIME evaluation include flow cytometry, multiplex bead-based immunoassays, chromogenic immunohistochemistry (IHC), fluorescent multiplex IHC, immunofluorescence, and spatial transcriptomics. This article offers an overview of our representative data, discusses the application of each approach to studies of the TIME, including their advantages and challenges, and reviews the potential clinical applications. Flow cytometry and chromogenic and fluorescent multiplex IHC were used to immune profile a HER2+ breast cancer, illustrating some points. Spatial transcriptomic analysis of a luminal B breast tumor demonstrated that important additional insight can be gained from this new technique. Finally, the development of a multiplex panel to identify proliferating B cells, Tfh, and Tfr cells on the same tissue section demonstrates their co-localization in tertiary lymphoid structures.

Cuidados com o acesso vascular para hemodiálise: revisão integrativa / Care with vascular access routes for hemodialysis: integrative

Introdução: As complicações relacionadas ao acesso vascular para hemodiálise podem resultar em intervenções complexas, contudo, cuidados adotados pelos profissionais de saúde e pacientes adultos podem evitá-las. Objetivou-se analisar a produção científica acerca dos cuidados com acessos vasculares utilizados na hemodiálise para elaboração do conteúdo de uma cartilha educativa voltada ao autocuidado do paciente. Método: Revisão integrativa de literatura realizada nas bases de dados: LILACS, PUBMED, BDENF, SciELO e CINAHL. A busca dos estudos deu-se entre setembro e novembro de 2019, nos idiomas português, inglês ou espanhol, utilizando os termos dos DeCS e MeSH. A seleção dos artigos foi realizada por três pesquisadores e foram extraídas informações: país, ano de publicação, delineamento do estudo, número de pacientes, intervenções, desfechos e nível de evidência científica. Selecionaram-se 10 artigos processados no software IRAMUTEQ® e analisados descritivamente pelo modelo de Reinert. Resultados: Organizaram-se sete classes: Cuidados com o cateter após a hemodiálise; Cuidados com a FAV antes da hemodiálise; Cuidados com a FAV após a hemodiálise; Cuidados para evitar a interrupção do funcionamento da FAV; Autocuidado dos pacientes com a FAV; Cuidados realizados pela equipe de enfermagem; Conhecimento do paciente acerca dos cuidados com a pele e punção da FAV. Conclusão: Identificou-se que os cuidados com os acessos vasculares mais frequentes se relacionam com a fístula arteriovenosa, demonstrando sua grande representatividade no tratamento do paciente com doença renal crônica. A síntese do conhecimento proporcionada nesta revisão foi utilizada para a elaboração de uma cartilha educativa já validada por especialistas e por pacientes que realizam hemodiálise.

Introducción: Las complicaciones relacionadas con el acceso vascular a la hemodiálisis pueden resultar en intervenciones complejas, sin embargo, los cuidados prestados por los profesionales de la salud y los pacientes adultos pueden evitarlas. El objetivo es analizar la producción científica sobre los cuidados con accesos vasculares utilizados en la hemodiálisis para la elaboración del contenido de una cartilla educativa para el autocuidado del paciente. Método: Revisión integrativa de la literatura realizada en las bases de datos: LILACS, PUBMED, BDENF, SciELO y CINAHL. La búsqueda de los estudios se realizó entre septiembre y noviembre de 2019, en los idiomas portugués, inglés o español, utilizando los términos del DeCS y MeSH. La selección de los artículos fue realizada por tres investigadores y se extrajo la información: país, año de publicación, diseño del estudio, número de pacientes, intervenciones, resultados y nivel de evidencia científica. Se seleccionaron diez artículos procesados en el software IRAMUTEQ® y analizados descriptivamente mediante el modelo de Reinert. Resultados: Se organizaron siete clases: Cuidados del catéter después de la hemodiálisis; Cuidados de la FAV antes de la hemodiálisis; Cuidados de la FAV después de la hemodiálisis; Cuidados para evitar la interrupción del funcionamiento de la FAV; Autocuidado del paciente con la FAV; Cuidados realizados por el equipo de enfermería; Conocimiento del paciente sobre el cuidado de la piel y la punción de la FAV. Conclusión: Se identificó que los cuidados con los accesos vasculares más frecuentes se relacionan con la fístula arteriovenosa, y su gran representatividad en el tratamiento del paciente con enfermedad renal crónica. La síntesis del conocimiento proporcionada en esta revisión se utilizó para la elaboración de una cartilla educativa ya validada por especialistas y por pacientes que realizan hemodiálisis.

Introduction: Complications related to vascular access for hemodialysis can result in complex interventions, however, care taken by health professionals and adult patients can avoid them. The objective was to analyze the scientific production about care with vascular access used in hemodialysis for the development of the content of an educational booklet aimed at patient self-care. Method: Integrative literature review carried out in the following databases: LILACS, PUBMED, BDENF, SciELO and CINAHL. The search for studies took place between September and November 2019, in Portuguese, English or Spanish, using the terms of DeCS and MeSH. The selection of articles was performed by three researchers and information was extracted: country, year of publication, study design, number of patients, interventions, outcomes and level of scientific evidence. Ten articles processed in the IRAMUTEQ® software and descriptively analyzed using the Reinert model were selected. Results: Seven classes were organized: Catheter care after hemodialysis; Care of the AVF before hemodialysis; Care with AVF after hemodialysis; Care to avoid interruption of AVF operation; Self-care of patients with AVF; Care performed by the nursing team; Patient knowledge about skin care and AVF puncture. Conclusion: It was identified that the care with the most frequent vascular accesses is related to the arteriovenous fistula, demonstrating its great representation in the treatment of patients with chronic kidney disease. The synthesis of knowledge provided in this review was used to prepare an educational booklet that has already been validated by specialists and by patients undergoing hemodialysis.

Kingella kingae: An Unlikely Cause of Meningitis.

Kingella kingae is the leading cause of osteoarticular infections between 6 and 48 months, a well-known cause of pediatric bacteremia and endocarditis and has been rarely associated with meningitis. We report a case of a healthy 10-year-old boy with meningitis due to Kingella kingae who presented with a history of severe headache, vomiting and prostration.

Factors associated with the knowledge and attitude of adolescents regarding male condom use.

OBJECTIVE: Identify factors associated with the knowledge and attitude regarding male condom use in school adolescents. METHODS: Cross-sectional, quantitative, Knowledge, Attitude, and Practice survey, conducted with 114 adolescents from a public state high school from August to October 2017, in Fortaleza, Ceará, Brazil. RESULTS: The assumption of having sufficient knowledge regarding safe sex, not having a casual/dating partner, and having had three or more sexual partners in the last three months affected adequate knowledge. Higher education of the mother and not talking to the mother about sex were factors that influenced the inappropriate attitude of the participants. CONCLUSION: The knowledge and attitude of adolescents are influenced both by their previous sexual relations and by their relationship with their mother and the level of her schooling. Thus, it is essential that health institutions promote actions aimed at sex education, with support from schools and health professionals in general.

Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates: In Vivo Virulence Assessment in Galleria mellonella and Potential Therapeutics by Polycationic Oligoethyleneimine.

Klebsiella pneumoniae, one of the most common pathogens found in hospital-acquired infections, is often resistant to multiple antibiotics. In fact, multidrug-resistant (MDR) K. pneumoniae producing KPC or OXA-48-like carbapenemases are recognized as a serious global health threat. In this sense, we evaluated the virulence of K. pneumoniae KPC(+) or OXA-48(+) aiming at potential antimicrobial therapeutics. K. pneumoniae carbapenemase (KPC) and the expanded-spectrum oxacillinase OXA-48 isolates were obtained from patients treated in medical care units in Lisbon, Portugal. The virulence potential of the K. pneumonia clinical isolates was tested using the Galleria mellonella model. For that, G. mellonella larvae were inoculated using patients KPC(+) and OXA-48(+) isolates. Using this in vivo model, the KPC(+) K. pneumoniae isolates showed to be, on average, more virulent than OXA-48(+). Virulence was found attenuated when a low bacterial inoculum (one magnitude lower) was tested. In addition, we also report the use of a synthetic polycationic oligomer (L-OEI-h) as a potential antimicrobial agent to fight infectious diseases caused by MDR bacteria. L-OEI-h has a broad-spectrum antibacterial activity and exerts a significantly bactericidal activity within the first 5-30 min treatment, causing lysis of the cytoplasmic membrane. Importantly, the polycationic oligomer showed low toxicity against in vitro models and no visible cytotoxicity (measured by survival and health index) was noted on the in vivo model (G. mellonella), thus L-OEI-h is foreseen as a promising polymer therapeutic for the treatment of MDR K. pneumoniae infections.

Factors associated with the knowledge and attitude of adolescents regarding male condom use / Factores relacionados al conocimiento y conducta de adolescentes cuanto al uso del preservativo masculino / Fatores associados ao conhecimento e atitude de adolescentes quanto ao uso de preservativo masculino

ABSTRACT Objective: Identify factors associated with the knowledge and attitude regarding male condom use in school adolescents. Methods: Cross-sectional, quantitative, Knowledge, Attitude, and Practice survey, conducted with 114 adolescents from a public state high school from August to October 2017, in Fortaleza, Ceará, Brazil. Results: The assumption of having sufficient knowledge regarding safe sex, not having a casual/dating partner, and having had three or more sexual partners in the last three months affected adequate knowledge. Higher education of the mother and not talking to the mother about sex were factors that influenced the inappropriate attitude of the participants. Conclusion: The knowledge and attitude of adolescents are influenced both by their previous sexual relations and by their relationship with their mother and the level of her schooling. Thus, it is essential that health institutions promote actions aimed at sex education, with support from schools and health professionals in general.

RESUMEN Objetivo: Identificar factores relacionados al conocimiento y conducta sobre el uso del preservativo masculino por adolescentes escolares. Métodos: Estudio cuantitativo, transversal, del tipo investigación Conocimiento, Conducta y Práctica, realizado con 114 adolescentes de escuela estatal de educación secundaria en el período de agosto a octubre de 2017, en Fortaleza, Ceará. Resultados: Considerar conocimiento sobre sexo seguro suficiente, no tener pareja ocasional y haber tenido tres o más parejas sexuales en los últimos tres meses, afectaron el conocimiento adecuado. Mayor escolaridad de la madre y no charlar con ella sobre sexo han sido factores que influenciaron la conducta inadecuada de los participantes. Conclusión: El conocimiento y la conducta de los adolescentes son influenciados tanto por sus relaciones sexuales previas como por la relación con la madre y por la escolaridad de ella. Así, se vuelve imprescindible que instituciones de salud promuevan acciones vueltas a la educación sexual, mediante apoyo de las escuelas y de profesionales de salud en general.

RESUMO Objetivo: Identificar fatores associados ao conhecimento e atitude sobre uso do preservativo masculino em adolescentes escolares. Método: Estudo quantitativo, transversal, do tipo inquérito Conhecimento, Atitude e Prática, realizado com 114 adolescentes de escola estadual de ensino médio no período de agosto a outubro de 2017, em Fortaleza, Ceará. Resultados: Considerar seu conhecimento sobre sexo seguro suficiente, não ter parceiro casual/ficante, e ter tido três ou mais parceiros sexuais nos últimos três meses afetaram o conhecimento adequado. Maior escolaridade da mãe e não conversar com a mãe sobre sexo foram fatores que influenciaram a atitude inadequada dos participantes. Conclusão: O conhecimento e a atitude dos adolescentes são influenciados tanto por suas relações sexuais prévias como pela relação com a mãe e pela escolaridade dela. Assim, torna-se imprescindível que as instituições de saúde promovam ações voltadas à educação sexual, mediante apoio das escolas e dos profissionais de saúde em geral.

Construção e validação de gerontecnologias cuidativo-educacionais: revisão integrativa / Construction and validation of care-educational gerontechnologies: integrative review

Resumo Objetivo identificar na literatura como as gerontecnologias cuidativo-educacionais (GTEC) têm sido construídas e validadas, e propor recomendações para o seu desenvolvimento. Método revisão integrativa da literatura realizada nas bases de dados Web of Science, LILACS, CINAHL, BDENF, MEDLINE e SciELO seguindo a recomendação Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Selecionaram-se estudos com os objetivos de construir e/ou validar gerontecnologias disponíveis na íntegra. Para extração dos dados, utilizou-se instrumento contendo variáveis acerca do nível de evidência dos estudos, ano de publicação e país de origem, objetivos, tipo de gerontecnologia desenvolvida e métodos de construção e validação. Resultados foram analisados 17 estudos. O ano de 2019 obteve maior número de publicações sobre a temática, sendo a maioria proveniente do Brasil. Evidenciou-se o desenvolvimento das gerontecnologias materiais, representadas por cartilhas, folhetos, manuais, jogos, softwares e materiais multimídia. Em relação ao método de construção das gerontecnologias adotado nos estudos destacaram-se diagnóstico situacional por meio de entrevistas, diálogos e escalas, e revisões da literatura acerca das temáticas. Na maioria dos estudos a validação foi realizada junto às pessoas idosas e, em alguns artigos, realizou-se a validação também com especialistas. Conclusão constatou-se que o processo de desenvolvimento de GTEC é recente e requer aprimoramento quanto à etapa de validação, a qual nem sempre é realizada pelos pesquisadores. Com relação às recomendações para o seu desenvolvimento, destacam-se o uso da linguagem acessível aos idosos e a associação de conhecimentos teóricos e práticos.

Abstract Objective identify in the literature how care-educational gerontechnologies have been constructed and validated and recommended propositions for their development. Method integrative literature review carried out in the Web of Science, LILACS, CINAHL, BDENF, MEDLINE and SciELO databases following the recommendation of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We selected studies that presented the construction and validation of gerontechnologies. For data extraction, we used an instrument adapted from the international RedENSO. We also classified the level of evidence of the studies according to Melnyk and Fineout-Overholt Results We analyzed 17 studies. The year 2019 had the highest number of publications on the subject, with the majority coming from Brazil. The development of material gerontechnologies, as booklets, leaflets, manuals, games, software and multimedia materials, was more reported. Regarding the method of construction of gerontechnologies adopted in the studies, situational diagnosis through interviews, dialogues and scales, and literature reviews on the themes stood out. In most studies, validation was performed with the elderlies and, in some studies, validation was also performed with specialists. Conclusion We found that the process of development of care-educational gerontechnologies is recent and requires improvement in the validation stage and not always performed by researchers. Regarding the recommendations for their development, we highlight the use of language accessible to older people and the association of theoretical and practical knowledge.

Fatores associados à fragilidade em idosos acompanhados na Atenção Primária à Saúde / Factores asociados a la fragilidad en ancianos acompañados en la Atención Primaria de Salud / Factors associated with frailty in elderly patients followed up in primary health care

Resumo Objetivo Verificar a associação entre os marcadores de fragilidade e as características sociodemográficas e clínicas em idosos na Atenção Primária à Saúde. Método Pesquisa transversal, realizada com 356 idosos cadastrados em unidades de saúde da família, no Nordeste do Brasil. Os instrumentos de coleta utilizados foram o Índice de Vulnerabilidade Clínico-Funcional e outro de perfil socioeconômico e de saúde. Analisaram-se os dados pela estatística inferencial, utilizando o teste do Qui-quadrado, com nível de significância 0,05. Resultados A média de idade foi de 72,85 anos (±8,965); 63,8% eram do sexo feminino, 39% apresentaram risco de fragilização e 22,5% demonstraram fragilidade. Houve associação entre fragilidade, sexo, faixa etária, estado civil, escolaridade, renda, presença de doença cardíaca e hipertensão. Conclusões e implicações para a prática Os marcadores de fragilidade nos idosos evidenciaram associação entre as características sociodemográficas e clínicas, indicando a necessidade de rastreio precoce no nível primário de atenção à saúde.

Resumen Objetivo Verificar la asociación entre los marcadores de fragilidad y las características sociodemográficas y clínicas en ancianos en Atención Primaria de Salud. Método Investigación transversal realizada con 356 ancianos registrados en unidades de salud familiar en Nordeste de Brasil. Los instrumentos de recolección utilizados fueron el Índice de Vulnerabilidad Clínico-Funcional y otro de perfil socioeconómico y de salud. Los datos se analizaron mediante estadística inferencial utilizando la prueba de Chi-cuadrado, con nivel de significancia de 0.05. Resultados La edad media fue de 72,85 años (± 8,965), el 63,8% eran mujeres, el 39% tenían riesgo de fragilidad y el 22,5% eran frágiles. Hubo asociación entre fragilidad, sexo, edad, estado civil, educación, ingresos, presencia de cardiopatía e hipertensión. Conclusiones e implicaciones para la práctica Los marcadores de fragilidad en ancianos se asociaron con características sociodemográficas y clínicas, lo que indica la necesidad de rastreo precoz en el nivel primario de atención a la salud.

Abstract Objective to verify the association between frailty markers and sociodemographic and clinical characteristics in elderly people in Primary Health Care. Method cross-sectional research, carried out with 356 elderly people registered in family health units in the Northeast of Brazil. The collection instruments used were the Index of Clinical-Functional Vulnerability and another of socioeconomic and health profile. The data were analyzed by inferential statistics, using the chi-square test, with a significance level of 0.05. Results the mean age was 72.85 years (±8.965); 63.8% were female, 39% were at risk of frailty and 22.5% were frail. There was an association between frailty, gender, age group, marital status, education, income, presence of heart disease and hypertension. Conclusions and implications for practice the markers of frailty in the elderly showed an association between sociodemographic and clinical characteristics, indicating the need for early screening at the primary health care level.

Construção de tecnologia educacional: promoção do conhecimento sobre dieta DASH / Educational technology building up: promoting knowledge on DASH diet

Objetivo: descrever o processo de construção de um vídeo educacional como ferramenta de promoção da saúde sobre dieta DASH. Método: trata-se de um estudo descritivo, do tipo relato de experiência, concretizado em cinco etapas: orientação dos acadêmicos sobre tema do vídeo; levantamento bibliográfico; construção e validação do roteiro; gravação e edição do vídeo. Os dados foram analisados sob a perspectiva descritiva. Resultados: obteve-se vídeo educacional que abordou a dieta DASH de forma clara e compreensível, abrangendo definições, aplicações, benefícios, possibilidade de seguir e incentivo à atividade física Conclusão: acredita-se que o vídeo demonstrou ser ferramenta que auxilia a população na aquisição de conhecimentos imprescindíveis à adoção de estilo de vida saudável, pois se constitui forma de disseminar informações de forma atrativa, simples, dinâmica e democrática.(AU)

Objective: to describe the process for building up an educational vídeo as health promotion tool on DASH diet. Method: this is a descriptive study, of the experience report type, carried out in five stages: orientation of academics on the topic of the video; bibliographic survey; construction and validation of the script; video recording and editing. The data was analyzed from a descriptive perspective. Results: an educational video was obtained that addressed the DASH diet in a clear and understandable way, covering definitions, applications, benefits, possibility of following and encouraging physical activity. Conclusion: it is believed that the video proved to be a tool that helps the population in the acquisition knowledge essential to the adoption of a healthy lifestyle, as it is a way to disseminate information in an attractive, simple, dynamic and democratic way.(AU)

Objetivo: describir el proceso de construcción de un video educativo como una herramienta de promoción de la salud en la dieta DASH. Método: se trata de un estudio descriptivo, tipo de informe de experiencia, realizado en cinco etapas: orientación de académicos sobre el tema del video; encuesta bibliográfica; construcción y validación del guión; grabación y edición de video. Los datos fueron analizados desde una perspectiva descriptiva. Resultados: se obtuvo un video educativo que abordaba la dieta DASH de una manera clara y comprensible, cubriendo definiciones, aplicaciones, beneficios, la posibilidad de seguir y fomentar la actividad física. Conclusión: se cree que el video demostró ser una herramienta que ayuda a la población en la adquisición de conocimiento esencial para la adopción de un estilo de vida saludable, ya que es una forma de difundir información de una manera atractiva, simple, dinámica y democrática.(AU)

Immune Checkpoint Molecules on Tumor-Infiltrating Lymphocytes and Their Association with Tertiary Lymphoid Structures in Human Breast Cancer.

There is an exponentially growing interest in targeting immune checkpoint molecules in breast cancer (BC), particularly in the triple-negative subtype where unmet treatment needs remain. This study was designed to analyze the expression, localization, and prognostic role of PD-1, PD-L1, PD-L2, CTLA-4, LAG3, and TIM3 in primary BC. Gene expression analysis using the METABRIC microarray dataset found that all six immune checkpoint molecules are highly expressed in basal-like and HER2-enriched compared to the other BC molecular subtypes. Flow cytometric analysis of fresh tissue homogenates from untreated primary tumors show that PD-1 is principally expressed on CD4+ or CD8+ T cells and CTLA-4 is expressed on CD4+ T cells. The global proportion of PD-L1+, PD-L2+, LAG3+, and TIM3+ tumor-infiltrating lymphocytes (TIL) was low and detectable in only a small number of tumors. Immunohistochemically staining fixed tissues from the same tumors was employed to score TIL and tertiary lymphoid structures (TLS). PD-L1+, PD-L2+, LAG3+, and TIM3+ cells were detected in some TLS in a pattern that resembles secondary lymphoid organs. This observation suggests that TLS are important sites of immune activation and regulation, particularly in tumors with extensive baseline immune infiltration. Significantly improved overall survival was correlated with PD-1 expression in the HER2-enriched and PD-L1 or CTLA-4 expression in basal-like BC. PD-1 and CTLA-4 proteins were most frequently detected on TIL, which supports the correlations observed between their gene expression and improved long-term outcome in basal-like and HER2-enriched BC. PD-L1 expression by tumor or immune cells is uncommon in BC. Overall, the data presented here distinguish PD-1 as a marker of T cell activity in both the T and B cell areas of BC associated TLS. We found that immune checkpoint molecule expression parallels the extent of TIL and TLS, although there is a noteworthy amount of heterogeneity between tumors even within the same molecular subtype. These data indicate that assessing the levels of immune checkpoint molecule expression in an individual patient has important implications for the success of therapeutically targeting them in BC.

Influência do software de pausa nos sintomas de distúrbios osteomusculares em trabalhadores de escritório / Influence of break software on musculoskeletal symptoms in office workers

Introdução: As pausas são estratégias de intervenção frequentemente utilizadas para prevenir doenças ocupacionais. Objetivo: Verificar o efeito do Postural Awareness Software na prevalência de sintomas de distúrbios osteomusculares em trabalhadores. Métodos: Vinte e nove trabalhadores de escritório foram distribuídos aleatoriamente em grupo controle e grupo experimental. Os primeiros não realizaram nenhuma intervenção, enquanto o segundo grupo foi submetido a um protocolo de intervenção com o software durante 8 semanas. Foram utilizados como medida para a avaliação do desconforto o Questionário Nórdico de Sintomas Osteomusculares e um breve questionário para avaliar a satisfação com o software. Resultados: Os sintomas de dor musculoesquelética não foram reduzidos após a aplicação do software. Ainda assim, 9 (64,29%) dos 14 participantes relataram estar satisfeitos ou muito satisfeitos com a utilização do software. Conclusão: O software foi satisfatório para a maioria dos trabalhadores, porém, não foi eficaz na redução de sintomas de distúrbio osteomusculares em trabalhadores de escritório. (AU)

Introduction: Pauses are intervention strategy often used to prevent the musculoskeletal disorders. Objective: Investigate the effect of Postural Awareness Software in the prevalence of symptoms of musculoskeletal disorders in workers. Methods: Twenty nine office workers were randomly allocated in control group (n=15) and in intervention group (n=14). The former weren´t submitted to any intervention, while the latter were submitted to an intervention protocol with the software during 8 weeks. To evaluate the symptoms, it was applied the Nordic Musculoskeletal Questionnaire and a brief questionnaire to assess the satisfaction with the software. Results: Symptoms of musculoskeletal pain weren´t reduced after the software´s application. In the other hand, 9 (64.29%) of the 14 participants reported being satisfied or very satisfied with the use of software. Conclusion: The software was satisfactory for most workers; however, it was not effective in reducing symptoms of musculoskeletal disorders in office workers. (AU)