Renal ischemia/reperfusion induces prominent progressive kidney disease in diabetic mice.

Acute kidney injury (AKI) is a public health concern associated with high rates of mortality, even in milder cases. One of the reasons for the difficulty in managing AKI in patients is due to its association with pre-existing comorbidities, such as diabetes. In fact, diabetes increases the susceptibility to develop more severe AKI after renal ischemia. However, the long-term effects of this association are not known. Thus, an experimental model was designed to evaluate the chronic effects of renal ischemia/reperfusion (IR) in streptozotocin (STZ)-treated mice. We focused on the glomerular and tubulointerstitial damage, as well as kidney function and metabolic profile. It was found that pre-existing diabetes may potentiate progressive kidney disease after AKI, mainly by exacerbating proinflammatory and sustaining fibrotic responses and altering renal glucose metabolism. To our knowledge, this is the first report that highlights the long-term effects of renal IR on diabetes. The findings of this study can support the management of AKI in clinical practice.NEW & NOTEWORTHY This study demonstrated that early diabetes potentiates progressive kidney disease after ischemia/reperfusion (IR)-induced acute kidney injury, mainly by exacerbating pro-inflammatory and sustaining fibrotic responses and altering renal glucose metabolism. Thus, these findings will contribute to the therapeutic support of patients with type 1 diabetes with eventual renal IR intervention in clinical practice.

MicroRNA Transcriptomes Reveal Prevalence of Rare and Species-Specific Arm Switching Events During Zebrafish Ontogenesis.

In metazoans, microRNAs (miRNAs) are essential regulators of gene expression, affecting critical cellular processes from differentiation and proliferation, to homeostasis. During miRNA biogenesis, the miRNA strand that loads onto the RNA-induced Silencing Complex (RISC) can vary, leading to changes in gene targeting and modulation of biological pathways. To investigate the impact of these "arm switching" events on gene regulation, we analyzed a diverse range of tissues and developmental stages in zebrafish by comparing 5p and 3p arms accumulation dynamics between embryonic developmental stages, adult tissues, and sexes. We also compared variable arm usage patterns observed in zebrafish to other vertebrates including arm switching data from fish, birds, and mammals. Our comprehensive analysis revealed that variable arm usage events predominantly take place during embryonic development. It is also noteworthy that isomiR occurrence correlates to changes in arm selection evidencing an important role of microRNA distinct isoforms in reinforcing and modifying gene regulation by promoting dynamics switches on miRNA 5p and 3p arms accumulation. Our results shed new light on the emergence and coordination of gene expression regulation and pave the way for future investigations in this field.

Downregulation of hsa-miR-100-5p May Be a Protective Factor in the Early Stages of Nephropathy in Type 1 Diabetes Mellitus.

Type 1 Diabetes Mellitus (T1DM) can generate severe complications, such as Diabetic Kidney Disease (DKD) or Diabetic Nephropathy (DN), with it emerging as the leading cause of terminal (end-stage) renal disease all over the world. For T1DM, the clinical evaluation of DKD uses markers like the Glomerular Filtration Rate (GFR) and the Urinary Albumin Excretion (UAE). However, early diagnosis of DKD is still a challenge. For this reason, investigating molecular markers, such as microRNAs (miRNAs), offers a promising perspective to an early diagnosis, highlighting the stability and the ability to reflect incipient molecular manifestations. Thus, here we investigated four miRNAs (hsa-let-7i-5p, hsa-miR-143-3p, hsa-miR-501-3p, and hsa-miR-100-5p) regarding nephropathy in patients with T1DM, considering the albuminuria (micro and macro) as a standard to evaluate the groups. As a result, we found a reduced expression of miR-100-5p in patients with MIC, indicating a protective role in nephropathy. Beyond that, expression levels between the groups (Non vs. UAE) were not significant when comparing the miRNAs miR-501-3p and miR-143-3p. Finally, miR-143-3p and miR-100-5p were linked to some target genes such as AKT1, MMP13, and IGF1R, that are connected to signal pathways and cellular metabolism.

Standardization of Semi-Quantitative Dot Blotting Assay-Application in the Diagnosis, Follow-Up, and Relapse of Paracoccidioidomycosis.

INTRODUCTION: This study standardized a semi-quantitative dot blotting assay (DB) and a quantitative real-time polymerase chain reaction (qPCR) to detect specific antibodies for Paracoccidioides brasiliensis and its DNA in PCM patients. METHODOLOGY: We evaluated 42 confirmed PCM patients upon admission using a serological double agar gel immunodiffusion test (DID), DB, and molecular tests (qPCR in total blood). The control groups included 42 healthy individuals and 37 patients with other infectious diseases. The serological progress during treatment was evaluated in eight patients, and there was a relapse diagnosis in ten patients using the Pb B.339 strain antigen. The cut-off points for the serological tests were determined by a receiver operator characteristic curve. RESULTS: The DB and DID tests showed similar accuracy, but the DB identified lower antibody concentrations. Cross-reactions were absent in the DB assay. In the relapse diagnoses, DB exhibited much higher sensitivity (90%) than DID (30%). CONCLUSIONS: A DB assay is easier and faster than a DID test to be performed; DB and DID tests show the same accuracy, while blood qPCR is not recommended in the diagnosis at the time of admission; cross-reactions were not observed with other systemic diseases; DB and DID tests are useful for treatment monitoring PCM patients; and a DB assay is the choice for diagnosing relapse. These findings support the introduction of semi-quantitative DB assays in clinical laboratories.

Rapid Classification of Serum from Patients with Paracoccidioidomycosis Using Infrared Spectroscopy, Univariate Statistics, and Linear Discriminant Analysis (LDA).

Paracoccidioidomycosis (PCM) is a systemic mycosis that is diagnosed by visualizing the fungus in clinical samples or by other methods, like serological techniques. However, all PCM diagnostic methods have limitations. The aim of this study was to develop a diagnostic tool for PCM based on Fourier transform infrared (FTIR) spectroscopy. A total of 224 serum samples were included: 132 from PCM patients and 92 constituting the control group (50 from healthy blood donors and 42 from patients with other systemic mycoses). Samples were analyzed by attenuated total reflection (ATR) and a t-test was performed to find differences in the spectra of the two groups. The wavenumbers that had p < 0.05 had their diagnostic potential evaluated using receiver operating characteristic (ROC) curves. The spectral region with the lowest p value was used for variable selection through principal component analysis (PCA). The selected variables were used in a linear discriminant analysis (LDA). In univariate analysis, the ROC curves with the best performance were obtained in the region 1551-1095 cm-1. The wavenumber that had the highest AUC value was 1264 cm-1, achieving a sensitivity of 97.73%, specificity of 76.01%, and accuracy of 94.22%. The total separation of groups was obtained in the PCA performed with a spectral range of 1551-1095 cm-1. LDA performed with the eight wavenumbers with the greatest weight from the group discrimination in the PCA obtained 100% accuracy. The methodology proposed here is simple, fast, and highly accurate, proving its potential to be applied in the diagnosis of PCM. The proposed method is more accurate than the currently known diagnostic methods, which is particularly relevant for a neglected tropical mycosis such as paracoccidioidomycosis.

Vaccination hesitation in children under five years of age: a scoping review.

OBJECTIVES: to synthesize scientific evidence on vaccine hesitancy in children under five years of age and its associated factors. METHODS: a scoping review, conducted according to the methodological structure proposed by the JBI. Searches were carried out in the Latin American and Caribbean Center on Health Sciences Information, Scientific Electronic Library Online and PubMed databases, including gray literature. Studies in English, Spanish and Portuguese were included, without temporal delimitation. Editorials, studies that did not address vaccine hesitancy in children under five years of age and were not aligned with the objective and research question were excluded. The sample consisted of 18 articles. RESULTS: misinformation, concern about adverse effects, distrust about efficacy, affliction regarding administration simultaneously, and insecurity in relation to the laboratories were the reported reasons. CONCLUSIONS: strategies are needed to combat the lack of information about immunobiological agents, as misinformation was the main factor in parents' vaccine hesitation.

Educação popular em saúde bucal e integração ensino-serviço-comunidade no contexto da Atenção Primária à Saúde: um relato de experiência / Popular education in oral health and teaching-service-community integration in the context of Primary Health Care: an experience report

A prática predominantemente individual, curativa e de caráter liberal alicerçou, por muitos anos, a Odontologia, afastando-se de aspectos fundamentais de promoção da saúde e do atendimento humanizado. Nesta perspectiva, no cotidiano dos serviços em saúde bucal, ainda é possível perceber abordagens e ações fragmentadas, que prejudicam a prática de humanização e integralização do SUS e o processo de Educação Popular em Saúde. Dessa forma, a promoção da saúde evidenciada pela educação em saúde se torna uma ferramenta essencial, a qual promove a integração do ensino-serviço-comunidade. O objetivo do estudo é descrever um relato de experiência de graduandos em Odontologia da Universidade Federal de Juiz de Fora, desenvolvido por meio de ações de educação em saúde bucal para a população infantil e seus respectivos cuidadores assistidos pela Atenção Primária à Saúde do município de Juiz de Fora, com base nos preceitos de Educação Popular em Saúde, no período de março a setembro de 2022. Além disso, busca realizar uma reflexão crítica sobre a importância da integração ensino-serviço-comunidade. Para isso, foi elaborado um cronograma de visitas, seguido pelo planejamento das ações e o desenvolvimento das atividades educativas em saúde bucal, que incluíram estudos prévios do território, capacitação de funcionárias, além de palestras, atividades, jogos, teatros e cartilhas educativas sobre saúde bucal, utilizando-se de linguagem adequada de acordo com a população-alvo. Conclui-se que a integração ensino-serviço-comunidade representa uma estratégia relevante, ao articular a formação profissional e o serviço de atenção à saúde ofertado no SUS. Além disso, ações de educação em saúde em consonância com os ideais de humanização do SUS favorecem a autonomia dos indivíduos, de modo que devem ser estimuladas.

For many years, dentistry was based on predominantly individual, curative and liberal practices, moving away from the fundamental aspects of health promotion and humanized care. From this perspective, in the daily routine of oral health services, it is still possible to see fragmented approaches and actions, which hinder the practice of humanization and integralization of the SUS and the process of Popular Health Education. In this way, health promotion, as evidenced by health education, becomes an essential tool, which promotes the integration of teaching-service-community. The aim of the study is to describe an experience report of undergraduate students in Dentistry at the Federal University of Juiz de Fora, developed through oral health education actions for the child population and their respective caregivers assisted by Primary Health Care in the municipality of Juiz de Fora, based on the precepts of Popular Education in Health, from March to September 2022. It also seeks to critically reflect on the importance of teaching-service-community integration. To this end, a schedule of visits was drawn up, followed by action planning and the development of oral health education activities, which included previous studies of the area, training of staff, as well as lectures, activities, games, plays and educational booklets on oral health, using appropriate language according to the target population. The conclusion is that teaching-service-community integration is an important strategy for linking professional training and the health care services offered by the SUS. In addition, health education actions in line with the humanization ideals of the SUS favour the autonomy of individuals and should therefore be encouraged.

Saúde mental na atenção básica: metassíntese da produção do cuidado no território brasileiro / Mental health in primary care: meta-synthesis of care production in the brazilian territory / Salud mental en la atención primaria: metasíntesis de la producción del cuidado en el territorio brasileño

Este estudo objetivou compreender as concepções que guiam a produção do cuidado em saúde mental na atenção básica (AB) por meio de uma metassíntese da literatura. Por meio das bases de dados e bibliotecas virtuais Scopus, LILACS, BDENF, SciELO, BVS e PubMed e utilizando os Descritores em Ciências da Saúde (DeCS), buscaram-se textos qualitativos em português, inglês e espanhol, publicados no Brasil entre 2010 e 2020, que abordassem como a produção do cuidado em saúde mental está sendo desenvolvida na AB do país; cujos objetivos se referissem a atos e saberes desenvolvidos em saúde mental na AB; que abordassem o conceito de integralidade do cuidado em saúde mental desenvolvido na AB do Brasil; e que tratassem do entendimento quanto à mudança da prática profissional a partir dessas iniciativas. Foram selecionados 66 trabalhos, a partir dos quais se identificou que a saúde mental ainda sofre com as consequências herdadas do modelo hospitalocêntrico e asilar de produção do cuidado. Além disso, evidenciaram-se impactos das questões e experiências pessoais na saúde mental dos sujeitos, negligência e visão restrita do cuidado psicossocial, predomínio de práticas biomédicas, centralização nas ações intramuros e psiquiatrização das práticas de saúde mental na AB, os quais constituem barreiras ao processo de desinstitucionalização e integralidade do cuidado em saúde mental. Assim, é importante reconhecer a legitimidade dos saberes e repensar práticas menos cristalizadas, a fim de enfrentar e problematizar modelos hegemônicos, para que se avance na produção do cuidado em saúde mental na AB.

This study aimed to understand the concepts that guide the production of mental health care developed in Primary Care (PC), with a meta-synthesis of the literature. From the databases and virtual libraries Scopus, LILACS, BDENF, SciELO, VHL, and PubMed and using Descriptors in Health Sciences (DeCS), qualitative texts in Portuguese, English, and Spanish, published in Brazil between 2010 and 2020 were sought., which addressed how the production of mental health care is being developed in PC in the country; works whose objectives refer to acts and knowledge developed in mental health in PC; works that address the concept of comprehensive mental health care developed in PC in Brazil; and works on understanding the change in professional practice based on these initiatives. A total of 66 papers were selected, from which it was identified that mental health still suffers from the consequences inherited from the hospital-centered and asylum model of care production. In addition, the impacts of personal issues and experiences on the subjects' mental health, negligence and restricted view of psychosocial care, predominance of biomedical practices, centralization in intramural actions, and psychiatrization of mental health practices in PC were evidenced, which constitute barriers to process of deinstitutionalization and integrality of mental health care. Thus, it is important to recognize the legitimacy of knowledge and rethink less crystallized practices, to face and problematize hegemonic models, so that the production of mental health care in PC can advance.

Este estudio tuvo como objetivo comprender los conceptos que orientan la producción del cuidado en salud mental en la atención primaria (AP), mediante una metasíntesis de la literatura. Desde las bases de datos y bibliotecas virtuales Scopus, LILACS, BDENF, SciELO, BVS y PubMed, y utilizando los Descriptores en Ciencias de la Salud (DeCS), se buscaron textos cualitativos en portugués, inglés y español, publicados en Brasil entre 2010 y 2020, que abordaron cómo la producción de atención a la salud mental se desarrolla en AP en el país; trabajos cuyos objetivos se refieran a actos y saberes desarrollados en salud mental en AP; los que abordaron el concepto de atención integral a la salud mental desarrollado en AP en Brasil; y aquellos que trataron de la comprensión del cambio en la práctica profesional a partir de estas iniciativas. Se seleccionaron 66 artículos, y se identificó que la salud mental aún sufre las consecuencias heredadas del modelo hospitalario y el aislamiento de la producción del cuidado. Además, los impactos de los problemas y experiencias personales en la salud mental de los sujetos, la negligencia y la visión restringida de la atención psicosocial, el predominio de las prácticas biomédicas, la centralización en las acciones intramuros y la psiquiatrización de las prácticas de salud mental en AP constituyen barreras para el proceso de desinstitucionalización e integralidad de la atención en salud mental. Así, es importante reconocer la legitimidad de los saberes y repensar las prácticas menos cristalizadas para enfrentar modelos hegemónicos y problematizarlos para que la producción de cuidados en salud mental en AP pueda avanzar.

Fatores que impactam na estética do sorriso: uma revisão integrativa da literatura / Factors that impact on smile aesthetics an integrative literature review

Ter um sorriso harmônico é uma das prioridades dos pacientes dentro da odontologia, que procuram os profissionais da área para melhorar nos requisitos estéticos, tanto dos dentes, quanto da gengiva. Com os diversos avanços tecnológicos, o cirurgião-dentista pôde ampliar sua capacidade de diagnóstico e prognóstico, podendo realizar um planejamento de intervenção mais criterioso e com maior possibilidade de sucesso. Por meio desta revisão de literatura integrativa propomos elencar de forma minuciosa quais são essas características que podem desarmonizar um sorriso e ainda apresentamos como restabelecer a harmonia do sorriso por meio de procedimentos e elementos odontológicos. Foi realizada uma pesquisa nos portais eletrônicos PubMed, Biblioteca Virtual em Saúde (BVS), Ebsco host e Scielo, utilizando os descritores: "smile", "periodontal plastic", "aesthetics", "black triangles" e "interdental papila", além dos seus termos relacionados em português, incluído publicações de 2019 a 2022. Foi possível observar que por meio de um quadro multifatorial, a estética e harmonia do sorriso pode ser comprometida por fatores gengivais, faciais e dentários. Assim, um planejamento assertivo deve ser realizado por um profissional capacitado, que identifique os pontos que interferem positivamente e negativamente no equilíbrio do sorriso, com o propósito de gerar soluções clínicas. Com uma abordagem multidisciplinar, pode-se ratificar que é possível restabelecer a harmonia do sorriso e conseguir a satisfação do paciente, por meio de procedimentos plásticos cirúrgicos e restauradores.

Having a harmonious smile is one of the priorities of patients in dentistry, who seek professionals in the area to improve the aesthetic requirements of both teeth and gums. With the various technological advances, the dental surgeon was able to expand his diagnostic and prognostic capacity, being able to carry out a more judicious intervention planning and with greater possibility of success. Through this integrative literature review, we propose to list in detail what are these characteristics that can disharmonize a smile and we also present how to restore the harmony of the smile through dental procedures and elements. A search was carried out in the electronic portals PubMed, Biblioteca Virtual em Saúde (BVS), Ebsco host and Scielo, using the descriptors: "smile", "periodontal plastic", "aesthetics", "black triangles" and "interdental papilla", in addition to of its related terms in Portuguese, including publications from 2017 to 2022. It was possible to observe that through a multifactorial framework, the esthetics and harmony of the smile can be compromised by gingival, facial and dental factors. Thus, assertive planning must be carried out by a trained professional, who identifies the points that interfere positively and negatively in the balance of the smile, with the purpose of generating clinical solutions. With a multidisciplinary approach, it can be confirmed that it is possible to restore the harmony of the smile and achieve patient satisfaction, through plastic surgical and restorative procedures.

DNA methylation enzymes in the kidneys of male and female BTBR ob/ob mice.

Diabetic kidney disease (DKD) is the leading cause of the end-stage renal disease. Recent studies have shown that epigenetic modifications contribute to alterations in gene expression and the development of DKD. This study aimed to show an expression profile of key DNA (de)methylation enzymes (DNMT, TET proteins) and their differences between sexes under obesity and diabetic condition. Male and female black and tan brachyury (BTBR) ob/ob mice and their corresponding wild-type littermates (BTBR WT) were studied until 16 weeks of age. Metabolic parameters, kidney morphophysiology and the expression of fibrotic markers and epigenetic enzymes were studied in whole kidney tissue or specifically in the glomerulus. The results showed sexual dimorphism in the development of metabolic disease and in kidney morphophysiology. Female mice have a different profile of DNMTs expression in both WT and obese/diabetic condition. Furthermore, metabolic condition negatively modulated the glomerular expression of TET1 and TET3 only in females. To our knowledge, this is the first study that shows a kidney profile of the expression of key (de)methylation enzymes, DNMTs and TETs, in the BTBR ob/ob experimental model of DKD and its association with sex. The knowledge of this epigenetic profile may help future research to understand the pathophysiology of DKD in males and females.

Adolescents who practice physical activity have adequate food choices, regardless of the level of somatic maturation and adiposity.

OBJECTIVES: Regular physical activity and adequate food are part of a healthy lifestyle for the maintenance of physical and metabolic health. To verify the moderating role of physical activity (PA) in the relationship between dietary patterns and body adiposity in adolescents, according to somatic maturation. METHODS: Study with cross-sectional design, sample of 336 adolescents of both sexes, aged between 11 and 17 years. Body mass, height, and waist circumference (WC) were evaluated. Body mass index (BMI), BMI z-score (BMI-z), waist-to-height ratio (WHtR), and somatic maturation by peak height velocity (PHV) were calculated. The level of PA was measured by the International Physical Activity Questionnaire and dietary pattern by the Food Frequency Questionnaire ELSA - Brazil (short version). Moderation analyzes were tested using multiple linear regression models, by PROCESS macro for SPSS. RESULTS: An inverse interaction of PA was observed in the relationship between food consumption factor 5 (ultra-processed foods category) and WC in boys categorized as pre-pubertal and pubertal PHV (ß=-5.344; CI95 % -10.108 -0.580; p=0.028). For girls, no interaction was observed in any of the models analyzed. CONCLUSIONS: It was observed that the level of PA can influence food choices in prepubertal and pubertal boys, since the active boys showed better dietary pattern and lower central adiposity. Therefore, the findings reinforce the need to encourage the regular practice of physical activities from an early age, mainly aimed at preventing obesity in children and adolescents.

Aberrant right subclavian artery: case report and literature review.

The aberrant right subclavian artery, also known as the arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5 to 1% of the population. There is a higher prevalence in women and it is usually associated with other anatomical variations, such as the non-recurrent laryngeal nerve, present in 86.7% of cases. In the majority of cases, the aberrant right subclavian artery causes no symptoms. We describe this anomaly in an 82-year-old, hypertensive, and asymptomatic patient who had undergone a thoracoabdominal angiography to investigate a chronic DeBakey type III aortic dissection with dilation of the descending aorta. The aberrant right subclavian artery followed a retroesophageal course and was associated with a Kommerell diverticulum. In view of its rarity, we conducted an integrative bibliographic review of literature from the last 6 years indexed on the Medline, UpToDate, Lilacs, Scielo, and Portal Capes databases and discuss the most frequent anatomical changes, symptomatology, and therapeutic management adopted.

Perspectivas sobre a morte em pacientes com doença renal crônica e seus cuidadores familiares: um olhar sobre a relação com a saúde mental e o suporte social / Perspectives on death in patients with chronic kidney disease and their family caregivers: a look at the relationship with mental health and social support

Introdução: A doença renal crônica (DRC) consiste em um contexto de diversas perdas para pacientes e cuidadores. Essa realidade corresponde a processos de elaboração de perdas e lutos com impactos sobre a saúde mental de ambos. Objetivo: Avaliar as perspectivas sobre a morte e correlacionar com aspectos de saúde mental e suporte social. Materiais e Métodos: Estudo transversal com 31 participantes, sendo 14 pacientes com doença renal crônica em diálise em um Hospital Universitário no interior de Minas Gerais, Brasil, e 17 familiares. Os instrumentos utilizados foram: questionário sociodemográfico e de saúde, o Questionário de Qualidade de Vida (SF-36); Escala Hospitalar de Ansiedade e Depressão (HADS), Escala de Percepção do Suporte Social (SPSS), Pictograma de Fadiga (PF), Inventário de Sintomas de Estresse de Lipp (ISSL) e Escalas Breves de Perspectivas Sobre Morte (EBPM). Para a análise estatística as variáveis foram descritas como média, desvio padrão, mediana ou frequência conforme sua característica. Foi realizada a correlação de Pearson ou Spearman, considerando p<0,05. O software estatístico SPSS 17.0. Resultados: Os pacientes eram 50% (n= 7) do sexo feminino com idade média de 54,71 (±15,96) anos e os cuidadores eram 70,58% (n= 12) do sexo feminino, com idade média de 50,82 (±14,88) anos. Na avaliação geral (n= 31), houve uma associação negativa do domínio físico do SF-36 com a perspectiva de "morte como coragem" (r= -0,37, p= 0,04), uma associação positiva dos sintomas de ansiedade (r= 0,36, p= 0,04) e de depressão (r= 0,46, p= 0,01) com a perspectiva de morte como "sofrimento e solidão" (EBPM-1). Nos pacientes (n= 14), houve uma associação negativa entre o suporte social prático e a EBPM-1 (r= -0,719, p= ,006). Nos cuidadores, houve uma associação positiva entre as fases do estresse e a EBPM-1 (r= 0,48, p= 0,05). Conclusão: As perspectivas sobre a morte se relacionam com aspectos de saúde mental e suporte social em pacientes com DRC e cuidadores.

Introduction: Chronic kidney disease (CKD) is a context of diverse losses for patients and caregivers. This reality corresponds to processes of processing losses and mourning with impacts on the mental health of both. Objective: To evaluate perspectives on death and correlate with aspects of mental health and social support. Materials and Methods: Cross-sectional study with 31 participants, 14 patients with chronic kidney disease undergoing dialysis at a University Hospital in Minas Gerais, Brazil, and 17 family members. The instruments used were: sociodemographic and health questionnaire, the Quality of Life Questionnaire (SF-36), Hospital Anxiety and Depression Scale (HADS), Perceived Social Support Scale (SPSS), Fatigue Pictogram (PF), Lipp Stress Symptom Inventory (ISSL) and Brief Perspectives on Death Scales (EBPM). For statistical analysis, variables were described as mean, standard deviation, median or frequency according to their characteristics. Pearson or Spearman correlation was performed, considering p<0.05. SPSS 17.0 statistical software. Results: Patients were 50% (n= 7) female with a mean age of 54.71 (±15.96) years and caregivers were 70.58% (n= 12) female, with a mean age of 50. 82 (±14.88) years. In the general assessment (n= 31), there was a negative association between the physical domain of the SF-36 and the perspective of "death as courage" (r= -0.37, p= 0.04), a positive association with symptoms of anxiety (r= 0.36, p= 0.04) and depression (r= 0.46, p= 0.01) with the prospect of death as "suffering and loneliness" (EBPM-1). In patients (n= 14), there was a negative association between practical social support and EBPM-1 (r= -0.719, p= .006). In caregivers there was a positive association between the phases of stress and EBPM-1 (r= 0.48, p= 0.05). Conclusion: Perspectives on death are related to aspects of mental health and social support in CKD patients and caregivers.

Reproducibility of double agar gel immunodiffusion test using stored serum and plasma from paracoccidioidomycosis patients.

Background: Serological evaluation performed by double agar gel immunodiffusion test (DID) is used for diagnosis, evaluation of severity, management of paracoccidioidomycosis patients, and development of new clinical studies. For these reasons, the Botucatu Medical School of UNESP maintains a serum bank at the Experimental Research Unit with patient clinical data. This study aimed to evaluate the influence of the freeze-thaw cycle and different blood matrices on the titration of circulating antibodies. Methods: The study included 207 patients with confirmed (etiology-demonstrated) or probable (serology-demonstrated) paracoccidioidomycosis, and DID was performed with culture filtrate from Paracoccidioides brasiliensis B339 as antigen. First experiment: the antibody levels were determined in serum samples from 160 patients with the chronic form and 20 with the acute/subacute form, stored at -80oC for more than six months. Second experiment: titers of 81 samples of serum and plasma with ethylenediaminetetraacetic acid (EDTA) or heparin, from 27 patients, were compared according to matrix and effect of storage at -20oC for up to six months. Differences of titers higher than one dilution were considered discordant. Results: First experiment: test and retest presented concordant results in serum stored for up to three years, and discordant titers in low incidence in storage for four to six years but high incidence when stored for more than six years, including conversion from reagent test to non-reagent retest. Second experiment: serum, plasma-EDTA and plasma-heparin samples showed concordant titers, presenting direct correlation, with no interference of storage for up to six months. Conclusions: Storage at -80oC for up to six years has no or little influence on the serum titers determined by DID, permitting its safe use in studies depending on this parameter. The concordant titrations in different blood matrices demonstrated that the plasma can be used for immunodiffusion test in paracoccidioidomycosis, with stability for at least six months after storage at -20oC.

La potencia de los espacios colectivos como estrategia frente a la vulneración de derechos / O poder dos espaços coletivos como estratégia contra a violação de direitos / The power of collective spaces as a strategy against the violation of rights

Resumen Se propone desarrollar la articulación entre los aportes teórico-metodológicos de la terapia ocupacional social y la experiencia de los proyectos Timbó em Movimento y ResisTO, dentro del núcleo de la Rede Metuia perteneciente a la Universidad Federal de Paraíba, Brasil. Se reconoce la importancia de las prácticas territoriales y del campo de la terapia ocupacional social para el fortalecimiento y acompañamiento a poblaciones con diversas condiciones de vulnerabilidad. Se articula lo observado en los proyectos Timbó em Movimento y ResisTO con conceptos como la interseccionalidad de los marcadores sociales de diferencia, sus implicancias en el derecho a la ciudad y sus efectos en el cotidiano de los jóvenes. Se desarrolla la implicancia de los marcadores sociales en los cotidianos de les participantes, así como el potencial de los espacios colectivos de referencia y la articulación intersectorial para enfrentar las violencias. Se concluye que los espacios de pertenencia poseen gran relevancia para el abordaje de conflictos en el campo social, potenciando la participación de les sujetes y el ejercicio de ciudadanía, rechazando la tendencia de buscar soluciones individuales a problemáticas colectivas. Se identifica el desafío de llevar estos diálogos a los contextos cotidianos en que las violencias tienen lugar, incorporando actores que también puedan estar involucrados en su reproducción.

Resumo Propõe-se desenvolver a articulação entre as contribuições teórico-metodológicas da terapia ocupacional social e a experiência dos projetos Timbó em Movimento e ResisTO, dentro do núcleo da Rede Metuia pertencente à Universidade Federal da Paraíba, Brasil. Reconhece-se a importância das práticas territoriais e do campo da terapia ocupacional social para o fortalecimento e acompanhamento de populações com diversas condições de vulnerabilidade. Articula-se a prática dos projetos Timbó em Movimento e ResisTO com conceitos como a interseccionalidade dos marcadores sociais da diferença, suas implicações para o direito à cidade e seus efeitos no cotidiano dos jovens. Desenvolve-se a implicação dos marcadores sociais nos cotidianos dos participantes, assim como o potencial dos espaços coletivos de referência e a articulação intersetorial para o enfrentamento das violências. Conclui-se que os espaços de pertencimento têm grande relevância para o enfrentamento de conflitos no campo social, promovendo a participação dos sujeitos e o exercício da cidadania, rejeitando a tendência de buscar soluções individuais para problemas coletivos. Identifica-se o desafio de levar esses diálogos aos contextos cotidianos em que as violências ocorrem, incorporando atores que também podem estar envolvidos em sua reprodução.

Abstract This paper articulates the theoretical-methodological contributions of social occupational therapy and the experience of "Timbó em Movimento'' and "ResisTO" projects, which are part of the Rede Metuia nucleus belonging to the Federal University of Paraíba (UFPB), Brazil. It recognizes the importance of territorial practices and the social occupational therapy field for the strengthening and support of populations with diverse conditions of vulnerability. Articulation of what was observed in the Timbó em Movimento and ResisTO projects with concepts such as the intersectionality of social markers of difference, their implications for the right to the city and their effects in the daily life of youths. The article elaborates the implications of social markers in the daily life of the participants, as well as the potential of collective reference spaces and intersectoral articulation to confront violence. It is concluded that the spaces of belonging have great relevance for addressing conflicts in the social field, promoting the participation of people and the exercise of citizenship, rejecting the tendency to seek individual solutions to collective problems. Remains the challenge of taking these dialogues to the daily contexts in which violence takes place, incorporating actors that may also be involved in its reproduction.

Vaccination hesitation in children under five years of age: a scoping review / Vacunación vacuna en niños menores de cinco años: una revisión del alcance / Hesitação vacinal em crianças menores de cinco anos: revisão de escopo

ABSTRACT Objectives: to synthesize scientific evidence on vaccine hesitancy in children under five years of age and its associated factors. Methods: a scoping review, conducted according to the methodological structure proposed by the JBI. Searches were carried out in the Latin American and Caribbean Center on Health Sciences Information, Scientific Electronic Library Online and PubMed databases, including gray literature. Studies in English, Spanish and Portuguese were included, without temporal delimitation. Editorials, studies that did not address vaccine hesitancy in children under five years of age and were not aligned with the objective and research question were excluded. The sample consisted of 18 articles. Results: misinformation, concern about adverse effects, distrust about efficacy, affliction regarding administration simultaneously, and insecurity in relation to the laboratories were the reported reasons. Conclusions: strategies are needed to combat the lack of information about immunobiological agents, as misinformation was the main factor in parents' vaccine hesitation.

RESUMEN Objetivos: sintetizar la evidencia científica sobre la reticencia vacunal en menores de cinco años y sus factores asociados. Métodos: revisión de alcance, realizada según la estructura metodológica propuesta por el JBI. Las búsquedas se realizaron en el Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud, Scientific Electronic Library Online y PubMed, incluida la literatura gris. Se incluyeron estudios en inglés, español y portugués, sin delimitación temporal. Se excluyeron editoriales, estudios que no abordaran la reticencia vacunal en menores de cinco años y que no estuvieran alineados con el objetivo y pregunta de investigación. La muestra estuvo compuesta por 18 artículos. Resultados: la desinformación, la preocupación por los efectos adversos, la desconfianza en la eficacia, la angustia por la administración simultánea y la inseguridad por los laboratorios fueron los motivos informados. Conclusiones: se necesitan estrategias para combatir la falta de información sobre inmunobiológicos, ya que la desinformación fue el principal factor en la duda vacunal de los padres.

RESUMO Objetivos: sintetizar evidências científicas sobre hesitação vacinal em crianças menores de cinco anos e seus fatores associados. Métodos: revisão de escopo, conduzida conforme a estrutura metodológica proposta pelo JBI. Realizaram-se buscas nas bases Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde, Scientific Electronic Library Online e PubMed, incluindo literatura cinzenta. Foram incluídos estudos em inglês, espanhol e português, sem delimitação, temporal. Foram excluídos editoriais, estudos que não abordaram hesitação vacinal em menores de cinco anos e não estiveram alinhadas com o objetivo e questão de pesquisa. A amostra foi composta por 18 artigos. Resultados: desinformação, preocupação com efeitos adversos, desconfiança sobre eficácia, aflição quanto à administração simultaneamente e insegurança em relação aos laboratórios foram os motivos relatados. Conclusões: são necessárias estratégias de combate à carência de informações acerca dos imunobiológicos, pois a desinformação foi o fator principal na hesitação vacinal dos pais.

Artéria subclávia direita aberrante: relato de caso e revisão de literatura / Aberrant right subclavian artery: case report and literature review

Resumo A artéria subclávia direita aberrante, também conhecida como artéria lusória, é a anomalia do arco aórtico mais comum, ocorrendo entre 0,5 e 1% da população. Possui prevalência em mulheres e normalmente está associada a outras variações anatômicas, como o nervo laríngeo não recorrente, presente em 86,7% dos casos. Em sua maioria, a artéria subclávia direita aberrante não apresenta sintomas. Descrevemos essa alteração em uma paciente de 82 anos, hipertensa e assintomática, que havia sido submetida a uma angiotomografia toracoabdominal para a avaliação de uma dissecção crônica tipo III (DeBakey) associada à dilatação de aorta descendente. No achado, a artéria subclávia direita aberrante apresentava percurso retroesofágico associado a um divertículo de Kommerell. Devido à raridade, realizamos revisão bibliográfica integrativa das bases de dados MEDLINE, UpToDate, LILACS, SciELO e Portal CAPES dos últimos 6 anos e discutimos as alterações anatômicas mais frequentes, a sintomatologia e as condutas terapêuticas adotadas.

Abstract The aberrant right subclavian artery, also known as the arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5 to 1% of the population. There is a higher prevalence in women and it is usually associated with other anatomical variations, such as the non-recurrent laryngeal nerve, present in 86.7% of cases. In the majority of cases, the aberrant right subclavian artery causes no symptoms. We describe this anomaly in an 82-year-old, hypertensive, and asymptomatic patient who had undergone a thoracoabdominal angiography to investigate a chronic DeBakey type III aortic dissection with dilation of the descending aorta. The aberrant right subclavian artery followed a retroesophageal course and was associated with a Kommerell diverticulum. In view of its rarity, we conducted an integrative bibliographic review of literature from the last 6 years indexed on the Medline, UpToDate, Lilacs, Scielo, and Portal Capes databases and discuss the most frequent anatomical changes, symptomatology, and therapeutic management adopted.

Reproducibility of double agar gel immunodiffusion test using stored serum and plasma from paracoccidioidomycosis patients

Background: Serological evaluation performed by double agar gel immunodiffusion test (DID) is used for diagnosis, evaluation of severity, management of paracoccidioidomycosis patients, and development of new clinical studies. For these reasons, the Botucatu Medical School of UNESP maintains a serum bank at the Experimental Research Unit with patient clinical data. This study aimed to evaluate the influence of the freeze-thaw cycle and different blood matrices on the titration of circulating antibodies. Methods: The study included 207 patients with confirmed (etiology-demonstrated) or probable (serology-demonstrated) paracoccidioidomycosis, and DID was performed with culture filtrate from Paracoccidioides brasiliensis B339 as antigen. First experiment: the antibody levels were determined in serum samples from 160 patients with the chronic form and 20 with the acute/subacute form, stored at ­80o C for more than six months. Second experiment: titers of 81 samples of serum and plasma with ethylenediaminetetraacetic acid (EDTA) or heparin, from 27 patients, were compared according to matrix and effect of storage at ­20o C for up to six months. Differences of titers higher than one dilution were considered discordant. Results: First experiment: test and retest presented concordant results in serum stored for up to three years, and discordant titers in low incidence in storage for four to six years but high incidence when stored for more than six years, including conversion from reagent test to non-reagent retest. Second experiment: serum, plasma-EDTA and plasma-heparin samples showed concordant titers, presenting direct correlation, with no interference of storage for up to six months. Conclusions: Storage at ­80o C for up to six years has no or little influence on the serum titers determined by DID, permitting its safe use in studies depending on this parameter. The concordant titrations in different blood matrices demonstrated that the plasma can be used for immunodiffusion test in paracoccidioidomycosis, with stability for at least six months after storage at ­20o C.(AU)