Revisiting the utility of identifying nuclear grooves as unique nuclear changes by an object detector model.

BACKGROUND: Among other structures, nuclear grooves are vastly found in papillary thyroid carcinoma (PTC). Considering that the application of artificial intelligence in thyroid cytology has potential for diagnostic routine, our goal was to develop a new supervised convolutional neural network capable of identifying nuclear grooves in Diff-Quik stained whole-slide images (WSI) obtained from thyroid fineneedle aspiration. METHODS: We selected 22 Diff-Quik stained cytological slides with cytological diagnosis of PTC and concordant histological diagnosis. Each of the slides was scanned, forming a WSI. Images that contained the region of interest were obtained, followed by pre-formatting, annotation of the nuclear grooves and data augmentation techniques. The final dataset was divided into training and validation groups in a 7:3 ratio. RESULTS: This is the first artificial intelligence model based on object detection applied to nuclear structures in thyroid cytopathology. A total of 7,255 images were obtained from 22 WSI, totaling 7,242 annotated nuclear grooves. The best model was obtained after it was submitted 15 times with the train dataset (14th epoch), with 67% true positives, 49.8% for sensitivity and 43.1% for predictive positive value. CONCLUSIONS: The model was able to develop a structure predictor rule, indicating that the application of an artificial intelligence model based on object detection in the identification of nuclear grooves is feasible. Associated with a reduction in interobserver variability and in time per slide, this demonstrates that nuclear evaluation constitutes one of the possibilities for refining the diagnosis through computational models.

Multiple basal infusion rates in open-loop insulin delivery systems: is there a metabolic benefit?

Objective: To evaluate glycemic control according to the number of daily basal rates (BRs) in type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII). Subjects and methods: Cross-sectional study of patients treated with an open-loop CSII for at least 6 months and using a flash glucose monitoring system. Patients were divided into 2 groups: group 1 (G1) and group 2 (G2), with ≤4 and >4 BRs/24h, respectively. The groups were compared regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI), glucose variability and data related to hypoglycemia. Regression models were performed. Results: The study included 99 patients (n = 55 in G1; n = 44 in G2). Median (Interquartile range) overall age was 30 (17) years, with 19.5 (48) and 51 (77) months of CSII use, respectively. The median number of different BRs was 3 (2) for G1 and 6 (2) for G2. There were no differences concerning age, sex, educational stage, weight, and insulin analog used. G2 had longer disease duration, longer CSII use, and higher total basal daily dose/kg. No significant differences regarding HbA1c, median glucose, GMI, TIR, TAR, and CV were found. G2 patients had more hypoglycemia, more asymptomatic hypoglycemia, and higher TBR. After adjusting for potential confounders, G1 maintained a lower risk of asymptomatic hypoglycemia. Conclusion: Programming open-loop CSII devices with more than 4 BRs does not improve metabolic control. Additionally, it seems to be a risk factor for hypoglycemia and was an independent predictor for asymptomatic hypoglycemia.

Multiple basal infusion rates in open-loop insulin delivery systems: is there a metabolic benefit?

ABSTRACT Objective: To evaluate glycemic control according to the number of daily basal rates (BRs) in type 1 diabetes patients using continuous subcutaneous insulin infusion (CSII). Subjects and methods: Cross-sectional study of patients treated with an open-loop CSII for at least 6 months and using a flash glucose monitoring system. Patients were divided into 2 groups: group 1 (G1) and group 2 (G2), with ≤4 and >4 BRs/24h, respectively. The groups were compared regarding HbA1c, time in range (TIR), time above range (TAR), time below range (TBR), glucose management indicator (GMI), glucose variability and data related to hypoglycemia. Regression models were performed. Results: The study included 99 patients (n = 55 in G1; n = 44 in G2). Median (Interquartile range) overall age was 30 (17) years, with 19.5 (48) and 51 (77) months of CSII use, respectively. The median number of different BRs was 3 (2) for G1 and 6 (2) for G2. There were no differences concerning age, sex, educational stage, weight, and insulin analog used. G2 had longer disease duration, longer CSII use, and higher total basal daily dose/kg. No significant differences regarding HbA1c, median glucose, GMI, TIR, TAR, and CV were found. G2 patients had more hypoglycemia, more asymptomatic hypoglycemia, and higher TBR. After adjusting for potential confounders, G1 maintained a lower risk of asymptomatic hypoglycemia. Conclusion: Programming open-loop CSII devices with more than 4 BRs does not improve metabolic control. Additionally, it seems to be a risk factor for hypoglycemia and was an independent predictor for asymptomatic hypoglycemia.

Impactos psicossociais sobre trabalhadores da saúde: narrativas 10 anos após o desastre / Psychosocial impacts on health workers: narratives 10 years after the disaster

Resumo O artigo tem como objetivo compreender os impactos psicossociais vivenciados por trabalhadores de saúde após situação de desastre no estado de Santa Catarina, na região Sul do Brasil. Para tal, realizou-se estudo qualitativo de múltiplos casos e entrevistas narrativas com profissionais de serviços de saúde mental, atenção primária à saúde e gestores municipais em Itajaí, Blumenau e Rio do Sul. A análise das narrativas seguiu as etapas do método de Fritz Schütze. Descreveram-se os impactos psicossociais sobre a saúde e o trabalho dos entrevistados, afetados direta e/ou indiretamente pelo desastre natural ocorrido em 2008 na região, e subsequentes eventos de menor intensidade. Nos três casos, os impactos foram percebidos semelhantemente, ainda que as consequências do evento na rede municipal tenham sido enfrentadas de formas diferentes em cada localidade. Os resultados revelam a importância da promoção da saúde no trabalho e do desenvolvimento de habilidades pessoais, a resiliência frente a situações adversas e a necessidade de educação contínua e permanente.

Abstract The article aims to understand the psychosocial impacts experienced by health workers after a disaster situation in the state of Santa Catarina in Southern region of Brazil. To that end, a qualitative study of multiple cases and narrative interviews with professionals from mental health services, primary health care, and municipal managers in Itajaí, Blumenau, and Rio do Sul was carried out. The analysis of the narratives followed the steps of the Fritz Schütze method. The psychosocial impacts on the health and work of respondents, directly and/or indirectly affected by the natural disaster that happened in 2008 in the region, and subsequent events of lesser intensity, were described. In the three cases the impacts were perceived similarly, although the consequences of the event in the municipal network were faced differently in each location. The results reveal the importance of promoting health at work and developing personal skills, resilience in the face of adverse situations, and need for continuing and constant education.

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

ABSTRACT Objective: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Materials and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low- and intermediate-risk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer.

Introduction: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Subjects and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low- and intermediaterisk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

Nuclear score evaluation in follicular-patterned thyroid lesions using optical and digital environments.

INTRODUCTION: The subjective evaluation of nuclear features in follicular-patterned lesions of the thyroid is a reason for diagnosis discordance. The assessment of nuclear features also varies whether the observation is performed optically or digitally. Our objective was to study the concordance among pathologists regarding the nuclear score (NS) evaluation in a series of follicular-patterned lesions, using optical versus three digital scanning protocols. METHODS: Three pathologists evaluated the NS in a 3mm2 area randomly selected from 20 hematoxylin-eosin slides representative of the respective 20 follicular-patterned thyroid lesions. The NS evaluation was performed using optical and three different scanning protocols in two scanners: P1000_20x, P1000_40x and DP200_20x. Kappa statistic (κ) and intraclass correlation coefficient (ICC) were obtained for intra- and interpathologist concordance. RESULTS: We recorded a good agreement among pathologists in the optical evaluation of the NS (ICC of 0.73). The concordance between optical versus digital observation had an almost perfect agreement for P1000_20x [κ = 0.85 (0.67-1.02); p < 0.0001] and a substantial agreement for both P1000_40x [κ = 0.69 (0.43-0.95) p = 0.002] and DP200_20x [κ = 0.77 (0.57-0.97); p = 0.001]. The P1000_20x protocol had the best intrapathologist concordance with the optical method, classified as almost perfect agreement for pathologists A (80%) and B (85%), and substantial agreement for pathologist C (70%). CONCLUSION: Digital observation of the WSI is valid for the NS evaluation in follicular-patterned thyroid lesions, with good agreement among pathologists and between optical and scanning protocols. Performance studies and validation procedures cannot be avoided in this setting to prevent diagnostic discordance due to the scanning process.

Flash glucose monitoring system: impact on glycemic control and body mass index in type 1 diabetes mellitus.

OBJECTIVE: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. METHODS: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. RESULTS: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. CONCLUSION: FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.

Flash glucose monitoring system: impact on glycemic control and body mass index in type 1 diabetes mellitus

ABSTRACT Objective: Flash glucose monitoring (FGM) is increasingly used in type 1 diabetes mellitus (T1D) management. This study aimed to assess glycated hemoglobin (HbA1c) and body mass index (BMI) in the first year of FGM use in patients with T1D and to identify predictive factors of benefit associated with its use. Subjects and methods: Retrospective study of T1D patients, using FGM for ≥ 6 months and under intensive insulin therapy with multiple daily injections. Results: In 179 patients with a median (Md) age of 43.0 years (P25 31.0; P75 52.0) and disease duration of 18.0 years (P25 10.0; P75 28.0), initial HbA1c was 7.9% (P25 7.2; P75 8.8) and initial BMI was 24.0 kg/m2 (P25 21.9; P75 26.2). With FGM, HbA1c improved significantly to 7.6% (P25 7.0; P75 8.3) at 6 months and 7.7% (P25 6.95; P75 8.5) at 12 months (p < 0.05), with more patients with HbA1c < 7% (16.1% vs 22.5%) and fewer patients with HbA1c ≥ 8% (49.1% vs 35.8%) (p < 0.05). Initial HbA1c 8.0-8.9% (HR 1.886; 95% CI 1.321-2.450) and ≥ 9.0% (HR 3.108, 95% CI 2.454-3.761) predicted greater HbA1c reduction. BMI increased significantly, especially between 6 and 12 months (BMI Md 23.8 [P25 21.9; P75 26.2] kg/m2 and 24.0 [P25 22.0; P75 26.2] kg/m2, respectively) (p < 0.05). Overweight (HR 4.319, 95% CI 3.185-5.453) and obesity (HR 8.112, 95% CI 3.919-12.306) predicted greater weight gain. Conclusions: FGM use was associated with significant improvement in HbA1c, mainly in patients with worse previous glycemic control. It was also associated with increased BMI, especially if baseline BMI ≥ 25 kg/m2, so weight control strategies should be emphasized.

Aplicativos de celular na prevenção do comportamento suicida / Mobile applications in the prevention of suicidal behavior / Aplicaciones de celular en la prevención del comportamiento suicida

OBJETIVO: identificar aplicativos de celulares utilizados na prevenção e/ou apoio à pessoa com comportamento suicida publicados em produções científicas internacionais e suas funcionalidades. MÉTODO: trata-se de uma revisão integrativa da literatura que seguiu o método de Ganong. Foi realizada uma adaptação de método em que foram incluídos critérios de inclusão e exclusão para os aplicativos de celular encontrados nas produções. Foram selecionados os aplicativos e os mesmos foram analisados individualmente para serem mapeadas as suas funcionalidades. RESULTADOS: foram estudados sete aplicativos encontrados a partir da revisão de literatura. Foram mapeadas 71 funcionalidades. Pode-se avaliar que ainda não existem métodos específicos e protocolos para o desenvolvimento de aplicativos para a prevenção do comportamento suicida. CONCLUSÃO: foi possível conhecer quais os aplicativos existentes que contribuem na prevenção do comportamento suicida, bem como suas principais funcionalidades. Vê-se a necessidade de que estudos sejam feitos para avaliar o impacto desses aplicativos na prevenção do comportamento suicida, possibilitando o desenvolvimento de pesquisas e dispositivos que previnam o comportamento suicida no Brasil.

OBJECTIVE: to identify cell phone applications used in the prevention and/or support of suicidal behavior published in international scientific productions and their functionalities. METHOD: this is an integrative review of the literature that followed the Ganong method. An adaptation of the method was made in which inclusion and exclusion criteria were included for the cellular applications found in the productions. The applications were selected and analyzed individually to map their functionalities. RESULTS: seven applications found from the literature review were studied. 71 functionalities were mapped. It can be evaluated that there are still no specific methods and protocols for the development of applications for the prevention of suicidal behavior. CONCLUSION: it was possible to know which existing applications contribute to the prevention of suicidal behavior, as well as their main functionalities. It is necessary that studies are done to evaluate the impact of these applications in the prevention of suicidal behavior, enabling the development of research and devices that prevent suicidal behavior in Brazil.

OBJETIVO: identificar aplicaciones de celulares utilizados en la prevención y/o apoyo a la persona con comportamiento suicida publicados en producciones científicas internacionales y sus funcionalidades. MÉTODO: se trata de una revisión integrativa de la literatura que siguió el método de Ganong. Se realizó una adaptación de método donde se incluyeron criterios de inclusión y exclusión para las aplicaciones de celular encontradas en las producciones. Se seleccionaron las aplicaciones y los mismos fueron analizados individualmente para asignar sus características. RESULTADOS: se estudiaron 7 aplicaciones encontradas a partir de la revisión de literatura. Se asignaron 71 funcionalidades. Se puede evaluar que aún no existen métodos específicos y protocolos para el desarrollo de aplicaciones para la prevención del comportamiento suicida. CONCLUSIÓN: fue posible conocer cuáles las aplicaciones existentes que contribuyen en la prevención del comportamiento suicida, así como sus principales funcionalidades. Se ve la necesidad de que los estudios se realicen para evaluar el impacto de estas aplicaciones en la prevención del comportamiento suicida. Habilitando el desarrollo de investigaciones y dispositivos que previenen el comportamiento suicida en Brasil.

Uniportal video-assisted thoracic surgery bullectomy in vanishing lung syndrome - What about giant bullae?

A 36-year-old-woman, smoker, without other relevant medical history, presented with symptoms of dyspnea, right localized chest pain, and non-productive cough. On the emergency department, the chest X-ray was interpreted as a giant right pneumothorax and a chest drain was inserted. Thoracic computed tomography demonstrated a giant emphysematous bulla with 23 cm on her right upper lobe. We report the first uniportal video-assisted thoracic surgery bullectomy for a bulla greater than 20 cm, in a patient with vanishing lung syndrome.

Una mujer de 36 años de edad, fumadora, se presentó en la sala de emergencias por disnea, tos y dolor torácico derecho. La radiografía fue interpretada como neumotórax y se colocó un tubo de drenaje. La tomografía computarizada del tórax mostró una bulla enfisematosa gigante, de aproximadamente 23 cm. Reportamos el primer caso de bullectomía por uniportal VATS en una paciente con síndrome del pulmón evanescente que presentaba una bulla mayor de 20 cm.

Schwannoma mediastínico gigante / Giant mediastinal schwannoma

El schwannoma es un tumor neurogénico que se presenta más frecuentemente en el ángulo costovertebral del mediastino posterior, pero también en otras localizaciones dentro del tórax. Habitualmente suele ser una masa única, encapsulada, bien definida, con un tamaño aproximado 2 a 10 cm. Presentamos el caso de un paciente de 66 años, derivado a nuestro hospital por una masa de 13 cm localizada en el hemitórax inferior izquierdo. Se realizó una biopsia, y la resonancia magnética corroboró el diagnóstico de un tumor mediastínico gigante de la vaina neural. Se procedió a su resección completa sin complicaciones.

Schwannomas are neurogenic tumors, commonly located in the costovertebral angle of the posterior mediastinum, but with many intrathoracic locations. They usually present as a solitary, well-circumscribed and encapsulated mass with a size between 2 and 10 cm. We report a case of a 66-year-old male, referred to our hospital for a mass located at the left lower hemithorax with 13 cm in size. A percutaneous biopsy was performed, and magnetic resonance imaging confirmed the diagnosis of a resectable giant mediastinal nerve sheath tumor. Surgery was performed without complications.

De seniores para seniores, Proalfa: um projeto de alfabetização com dinâmicas de animação / From seniors to seniors Proalfa: a literacy project with socio-educational animation dynamics

Num contexto de transformações demográficas, de incentivo à educação ao longo da vida, de necessidade de valorizar o papel dos seniores na sociedade e de promover a convivência entre gerações, foi criado o projeto ProAlfa, para utentes de uma estrutura residencial para pessoas idosas de Leiria ­ Portugal. O objetivo é potenciar a aprendizagem da leitura e da escrita, a partir de estratégias de animação socioeducativa, e promover a interação social. As oficinas decorrem uma vez por semana, no espaço da instituição, sendo dinamizadas, voluntariamente, por quatro estudantes seniores do Programa 60+ do Politécnico de Leiria. O presente artigo apresenta parte da investigação realizada no âmbito do ProAlfa, com os seguintes objetivos: conhecer os motivos que levam os seniores a participar no projeto, identificar as atividades que realizam e as que mais valorizam, além de conhecer as expetativas dos participantes sobre o mesmo. Em nível metodológico, a pesquisa é um estudo de caso, de abordagem mista concretizado a partir de um inquérito por entrevista, de cariz estruturado, aplicado a dezesseis participantes no ProAlfa. Estes são maioritariamente mulheres, têm idades compreendidas entre os 58 e os 102 anos, e são pouco escolarizados. Os resultados evidenciam que a oportunidade para a realização de aprendizagens valiosas e para conviver são os motivos apontados para a participação no projeto. Realizam semanalmente atividades de leitura, escrita e pintura, sendo esta última a mais valorizada. Apre- sentam expectativas reduzidas quanto à sua participação no projeto, nomeadamente em relação à aquisição de competências de leitura.(AU)

In a context of demographic changes, of encouraging lifelong education, of valuing the role of seniors in society and of promoting coexistence between generations, the ProAlfa project was created for users of a residential structure for elderly people in Leiria ­ Portugal. The objective is to enhance the learning of reading and writing, based on socio-educational animation strategies, and to promote social interaction. The workshops take place once a week, in the institution's space, being voluntarily promoted by four senior students of the Programa 60+ of the Polytechnic of Leiria. This article presents part of the research carried out within the scope of ProAlfa, with the following objectives: know the reasons that lead seniors to participate in the project, identify the activities they carry out and those that they value most, and to know the expectations of the participants about the project. At a methodological level, the research is a case study, with a mixed approach, obtained through an interview survey, of a structured nature, applied to 16 participants in ProAlfa. These are mostly women, ages between 58 and 102 years old, and with low level of education. The results show that the opportunity to learn valuable skills and to enjoy their time together are the reasons given for participating in the project. They carry out weekly reading, writing and painting sessions, the latter being the most valued. They have low expectations regarding their participation in the project, namely in relation to the acquisition of reading skills.(AU)

Projeto en-red-versad@s-clube de poesia on- line- relato de uma experiência de utilização de um blogue por seniores portugueses e espanhóis / En-red- versad@s project-online poetry club- report of an experience of ising a blog by portuguese and spanish seniors

O presente relato é parte de um projeto mais vasto de intervenção e investigação em curso no âmbito do Projeto En­Red­Versad@s.Clube de poesia on line, dinamizado pela Universidade Sénior da Universidade da Corunha e pelo seu parceiro Programa 60+ do Politécnico de Leiria. Este clube visa, através da dinamização de um blogue, a divulgar a língua e a poesia portuguesas, bem como desenvolver competências linguísticas, culturais e digitais, através do domínio e uso das Tecnologias da Informação e Comunicação (TIC). O projeto desenvolve-se no quadro de uma educação plurilinguística, poética e digital, ao longo da vida, em ordem a um envelhecimento ativo e saudável, bem como à construção de uma cidadania consciente e comprometida por parte dos estudantes seniores. Através deste relato, pretende-se apresentar os objetivos, participantes, metodologias de ação e os primeiros dados de participação dos seniores, decorrentes do registo de acesso ao blogue e aos conteúdos partilhados, cuja análise se insere num paradigma quantitativo. Os resultados obtidos, através de estatístisca descritiva, sugerem que o projeto tem potencialidades formativas que impulsionam o envolvimento dos participantes seniores no clube de poesia on line, abrindo a discussão sobre as vantagens de um alargamento da sua participação e sobre as estratégias pedagógicas para a promover. Afirma-se como uma resposta socioeducativa válida, em ordem à valorização pessoal e intergeracional dos participantes.(AU)

This report is part of a broader intervention and research project integrated within the scope of the En­Red­Versad@s Project. Online poetry club. Such project is developed by the Senior University of the University of A Coruña and its partner Program 60+ at the Polytechnic of Leiria. Through a blog, this club aims to promote the Portuguese language and poetry, as well as develop linguistic, cultural and digital competences, increasing proficiency with technologies and computers. The project is developed within the framework of a multilingual, poetic and digital education, through the life course, in order to achieve an active and healthy aging, as well as construct a conscious and committed citizenship by the senior students. This report intends to present the aims, participants and methods of action, as well as the first data of participation from the seniors, including their access records to the blog and the contents shared. The analysis is based on a quantitative paradigm. The results, obtained through, descriptive statisticssuggest that the project has training opportunities that can enhance the involvement of senior participants in the online poetry club. This opens the discussion about the advantages of widening their participation and the pedagogical ways of promoting it. This arises as a valid socio-educational response, in order to enhance the personal and intergenerational value of the participants.(AU)

Cardiac autonomic denervation and expression of neurotrophins (NGF and BDNF) and their receptors during experimental Chagas disease.

Although cardiac dysautonomia is a distinctive feature of Chagas disease, its clinical and functional significance is still being speculated. Neurotrophic factors are potentially involved; however, studies of their effect in this infection are rare. Ultrastructural abnormalities in autonomic varicosities, levels of both nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF), as well as the expression of their receptors, were analysed in the heart of a rat model of Trypanosoma infection. Predominantly, at the early stage of the infection, cardiac autonomic varicosities displayed several signs of degeneration parallel to the elevation of cardiac levels of NGF, as well as expression of the receptors TrkA and p75NTR. For BDNF and TrkB, the changes were less conspicuous. Data obtained here can contribute to further clarify the factors related to the autonomic nervous system's adaptive changes that could determine the evolution of different clinical forms of Chagas disease; mainly, the cardiac form.

Influência do formato da desepitelização corneana sobre a acuidade visual no pós-operatório da ceratectomia fotorrefrativa (PRK) / Influence of the change in the shape of the corneal epithelium removal in postoperative PRK visual acuity.

RESUMO Objetivo: Verificar se a modificação no formato da desepitelização corneana na ceratectomia fotorrefrativa (PRK), de circular para oval, modifica a recuperação da acuidade visual (AV) no pós-operatório. Métodos: Foram avaliados prospectivamente 43 pacientes submetidos ao PRK bilateral e simultâneo. De forma randomizada em cada paciente, um olho foi desepitelizado no formato circular e o outro no formato oval. No sexto dia de pós-operatório (D6) foram registradas a percepção subjetiva pelo paciente da qualidade de visão comparativa entre os olhos, a AV objetiva monocular e o aspecto do empilhamento epitelial corneano. Resultados: Em relação à percepção subjetiva da qualidade de visão, observou-se que 48,8% dos pacientes não perceberam diferença entre os olhos e 51,2% perceberam diferença (41,9% referiram melhor qualidade de visão no olho da desepitelização oval e 9,3% referiram melhor visão no olho da desepitelização circular). Em relação à AV (Snellen), a média na desepitelização oval, de 0,62, foi significativamente superior (p<0,001) que na circular, de 0,53. Quanto ao empilhamento epitelial, em 64,3% houve menor densidade do empilhamento nos olhos submetidos à desepitelização oval, em 31,0% não foi identificada diferença e em 4,8% dos olhos submetidos à desepitelização oval o empilhamento foi maior. Tais resultados se devem ao fato de que na desepitelização oval as células epiteliais provêm de bordas não equidistantes do centro da córnea e percorrem uma área menor, determinando um empilhamento epitelial central mais suave. Conclusão: Verificou-se que a modificação no formato da desepitelização corneana no PRK para oval, determinou uma significativa melhora da recuperação da AV.

ABSTRACT Objective: To determine if the change in the shape of the corneal epithelial removal in photorefractive keratectomy (PRK), from circular to oval shape, modifies the recovery of the postoperative visual acuity (VA). Methods: Forty-three(43) patients subjected to bilateral simultaneous PRK were prospectively evaluated. Randomly for each patient, one eye underwent epithelial removal in circular shape and the other in oval shape. On the sixth day of postoperative period (D6) the follow items were recorded: the subjective comparative perception, informed by the patient, of the quality of vision between the eyes, the objective monocular VA and the appearance of the central corneal epithelial suture line. Results: With regard to subjective quality of vision perception, it was observed that 48.8% of patients did not realize the difference between the eyes, while 51.2% did (41.9% reported better quality of vision in the eye with the oval shape and 9.3% reported better vision in the eye with the circular shape). With regard to the VA (Snellen), the average in the oval shape of 0.62 was significantly higher (p < 0.001) than the circular shape of 0.53. As for the appearance of the epithelial suture line, in 64.3% of the cases there was a lower density of the suture line in the eyes submitted to the oval shape, 31.0% did not demonstrate difference and in 4.8% of eyes submitted to oval shape the suture line was denser. These results are due to the fact that in the oval shape the epithelial cells come from non-equidistant edges of the corneal periphery to the center and run across a smaller area, determining a smoother, sometimes off-center, epithelial suture line. Conclusion: The change in the shape of the corneal epithelial removal in photorefractive keratectomy (PRK), from circular to oval shape, determines a better recovery of the postoperative visual acuity (VA).

Antileishmanial activity of the essential oil from Tetradenia riparia obtained in different seasons

The herbaceous shrub Tetradenia riparia has been traditionally used to treat inflammatory and infectious diseases. Recently, a study showed that T. riparia essential oil (TrEO) obtained in summer has antileishmanial effects, although these results could be influenced by seasonal variation. This study evaluated the activity of the TrEO obtained in different seasons against Leishmania (Leishmania) amazonensis, in vitro and in vivo. The compounds in the TrEO were analysed by gas chromatography-mass spectrometry; terpenoids were present and oxygenated sesquiterpenes were the majority compounds (55.28%). The cytotoxicity and nitric oxide (NO) production were also tested after TrEO treatment. The TrEO from all seasons showed a 50% growth inhibitory concentration for promastigotes of about 15 ng/mL; at 30 ng/mL and 3 ng/mL, the TrEO reduced intracellular amastigote infection, independently of season. The TrEO from plants harvested in summer had the highest 50% cytotoxic concentration, 1,476 ng/mL for J774.A1 macrophages, and in spring (90.94 ng/mL) for murine macrophages. NO production did not change in samples of the TrEO from different seasons. The antileishmanial effect in vivo consisted of a reduction of the parasite load in the spleen. These results suggest that the TrEO has potential effects on L. (L.) amazonensis, consonant with its traditional use to treat parasitic diseases.

Antileishmanial activity of the essential oil from Tetradenia riparia obtained in different seasons.

The herbaceous shrub Tetradenia riparia has been traditionally used to treat inflammatory and infectious diseases. Recently, a study showed that T. riparia essential oil (TrEO) obtained in summer has antileishmanial effects, although these results could be influenced by seasonal variation. This study evaluated the activity of the TrEO obtained in different seasons against Leishmania (Leishmania) amazonensis, in vitro and in vivo. The compounds in the TrEO were analysed by gas chromatography-mass spectrometry; terpenoids were present and oxygenated sesquiterpenes were the majority compounds (55.28%). The cytotoxicity and nitric oxide (NO) production were also tested after TrEO treatment. The TrEO from all seasons showed a 50% growth inhibitory concentration for promastigotes of about 15 ng/mL; at 30 ng/mL and 3 ng/mL, the TrEO reduced intracellular amastigote infection, independently of season. The TrEO from plants harvested in summer had the highest 50% cytotoxic concentration, 1,476 ng/mL for J774.A1 macrophages, and in spring (90.94 ng/mL) for murine macrophages. NO production did not change in samples of the TrEO from different seasons. The antileishmanial effect in vivo consisted of a reduction of the parasite load in the spleen. These results suggest that the TrEO has potential effects on L. (L.) amazonensis, consonant with its traditional use to treat parasitic diseases.

Activity of synthetic chalcones in hamsters experimentally infected with Leishmania (Viannia) braziliensis.

The purpose of this study is to evaluate the toxicity of synthetic chalcones 1 and 2 in uninfected hamsters and anti-Leishmania activity of synthetic chalcones 1 and 2 in hamsters infected with Leishmania (Viannia) braziliensis. For the toxicity test, uninfected animals were treated with chalcones 1 and 2, and clinical and biochemical parameters and histological aspects of the liver and kidneys were assessed. Chalcones 1 and 2 were then intraperitoneally or topically administered (10 mg/kg body weight) three times per week in animals infected with promastigotes of L. (V.) braziliensis. We monitored the thickness of the infected footpads, determined parasitic load, performed histological analysis, and detected apoptosis in situ. The results were analyzed using Student's t test and Mann-Whitney test at a significance level of 5%. Neither of the chalcones showed toxicity. Chalcone 2 administered intraperitoneally significantly reduced the thickness of the infected footpad compared with the beginning of treatment. The parasite load of the lymph node and spleen was reduced in the groups treated with chalcones 1 (topical) and 2 (intraperitoneal). Chalcone 2 (topical) reduced parasite burden only in the lymph node. The histological analysis revealed reconstitution of the tissue and reductions of inflammation and apoptosis in the infected footpad in these groups. The synthetic chalcones 1 (topical) and 2 (intraperitoneal and topical) at a dose of 10 mg/kg showed anti-Leishmania activity in vivo, no renal or hepatic toxicity, and a reduction of apoptosis of the cells in the lesions. These chalcones may have substantial potential for the treatment of cutaneous leishmaniasis.

Potencialidades da educação permanente para a transformação das práticas de saúde / Potentialities of permanent education for the transformation of healthcare practices

A implantação dos sistemas de saúde na América Latina apresenta carências estruturais, principalmente na formação e desenvolvimento dos profissionais do setor. Neste contexto, a Organização Pan-Americana da Saúde (OPAS) iniciou um conjunto de pesquisas na década de 70 para compreender a lógica prevalente de formação e desenvolvimento profissional e institucional dos trabalhadores da saúde, além de propor estratégias para aproximar o ensino no campo da saúde à realidade dos serviços. A proposta da educação permanente foi difundida como um dispositivo adequado para a mudança. Estudos sobre desenvolvimento de novas formas de abordar problemas de saúde com vistas à capacitação de pessoal do setor saúde propagaram-se pela América Latina, estimulando discussões e produção de trabalhos no Brasil. Os trabalhos, as discussões e as propostas em fóruns de pactuação na saúde culminaram na criação da política de educação permanente em saúde em 2003. Para compreender a evolução da educação permanente como estratégia de mudança nas práticas de saúde e como política de formação para o Sistema Único de Saúde no Brasil, foi traçada uma trajetória conceitual da educação permanente no período de 1970 a 2005. Um levantamento bibliográfico foi realizado por meio da revisão das bases de dados do SCIELO e PAHO. A pesquisa preliminar foi baseada nos seguintes unitermos: educação permanente, políticas de educação em saúde, educação em saúde, nos idiomas português e espanhol. Foi pesquisado um total de 43 documentos. O levantamento bibliográfico teve como objetivo embasar argumentos para propor a educação permanente como estratégia para a transformação das práticas de saúde.Palavras-chave: educação em saúde, políticas de saúde e recursos humanos em saúde.