Self-Nanoemulsifying Drug Delivery System (SNEDDS) Using Lipophilic Extract of Viscum album subsp. austriacum (Wiesb.) Vollm.

Background and Purpose: Natural products are potential sources of anticancer components. Among various species, the lipophilic extract of the Viscum album subsp. austriacum (Wiesb.) Vollm. (VALE) has shown promising therapeutic potential. The present work aimed to qualify the plant source and characterize the extract's chemical profile. In addition, a self-nanoemulsifying drug delivery system (SNEDDS) containing VALE (SNEDDS-VALE) was developed. Methods: V. album subsp. austriacum histochemistry was performed, and the chemical profile of VALE was analyzed by GC-MS. After the SNEEDS-VALE development, its morphology was visualized by transmission electron microscopy (TEM), while its stability was evaluated by the average droplet size, polydispersity index (PdI) and pH. Lastly, SNEDDS-VALE chemical stability was evaluated by LC-DAD-MS. Results: The histochemical analysis showed the presence of lipophilic compounds in the leaves and stems. The major compound in the VALE was oleanolic acid, followed by lupeol acetate and ursolic acid. SNEDDS was composed of medium chain triglyceride and Kolliphor® RH 40 (PEG-40 hydrogenated castor oil). A homogeneous, isotropic and stable nanoemulsion was obtained, with an average size of 36.87 ± 1.04 nm and PdI of 0.14 ± 0.02, for 14 weeks. Conclusion: This is the first histochemistry analysis of V. album subsp. austriacum growing on Pinus sylvestris L. which provided detailed information regarding its lipophilic compounds. A homogeneous, isotropic and stable SNEDDS-VALE was obtained to improve the low water solubility of VALE. Further, in vitro and in vivo experiments should be performed, in order to evaluate the antitumoral potential of SNEDDS-VALE.

Bronchodilator administration by pressurized inhaler during invasive mechanical ventilation in adults: A scoping review.

OBJECTIVE: To identify the administration characteristics and connection methods of bronchodilators by pressurized inhalers to the ventilatory circuit of patients under invasive mechanical ventilation. METHODS: A scope review was conducted following the PRISMA for Scoping Review, using the PubMed, Embase Elsevier, Cochrane Library, and Lilacs databases without language restrictions, up to July 2023. Eligible sources included reviews and consensuses (based on clinical studies), experimental and observational studies involving adult patients admitted to the intensive care unit and undergoing invasive mechanical ventilation, regardless of the underlying condition, who used bronchodilator drugs contained in pressurized inhalers. Information regarding inhalation technique, pressurized inhalers connection mode to the circuit, and patient care were collected by 2 researchers independently, with discrepancies resolved by a third reviewer. Studies involving bronchodilators combined with other pharmacological classes in the same device, as well as reviews containing preclinical studies, were excluded. RESULTS: In total, 23 publications were included, comprising 19 clinical trials and 4 non-randomized experimental studies. Salbutamol (albuterol) was the bronchodilator of study in the majority of the articles (n=18), and the spacer device was the most commonly used to connect the pressurized inhaler to the circuit (n=15), followed by an in-line adapter (n=3), and a direct-acting device without chamber (n=3). Concerning the pressurized inhaler placement in the circuit, 18 studies positioned it in the inspiratory limb, and 19 studies synchronized the jet actuation with the start of the inspiratory phase. Agitation of the pressurized inhaler before each actuation, waiting time between actuations, airway suction before administration, and semi-recumbent patient positioning were the most commonly described measures across the studies. CONCLUSIONS: This review provided insights into the aspects related to inhalation technique in mechanically ventilated patients, as well as the most prevalent findings and the existing gaps in knowledge regarding bronchodilator administration in this context. The evidence indicates the need for further research on this subject.

Trauma and Posttraumatic Stress Disorder as Important Risk Factors for Gestational Metabolic Dysfunction.

Gestational metabolic diseases adversely impact the health of pregnant persons and their offspring. Pregnant persons of color are impacted disproportionately by gestational metabolic disease, highlighting the need to identify additional risk factors contributing to racial-ethnic pregnancy-related health disparities. Trauma exposure and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiometabolic disorders in nonpregnant persons, making them important factors to consider when identifying contributors to gestational metabolic morbidity and mortality health disparities. Here, we review current literature investigating trauma exposure and posttraumatic stress disorder as psychosocial risk factors for gestational metabolic disorders, inclusive of gestational diabetes, low birth weight and fetal growth restriction, gestational hypertension, and preeclampsia. We also discuss the physiological mechanisms by which trauma and PTSD may contribute to gestational metabolic disorders. Ultimately, understanding the biological underpinnings of how trauma and PTSD, which disproportionately impact people of color, influence risk for gestational metabolic dysfunction is critical to developing therapeutic interventions that reduce complications arising from gestational metabolic disease. KEY POINTS: · Gestational metabolic diseases disproportionately impact the health of pregnant persons of color.. · Trauma and PTSD are associated with increased risk for cardiometabolic disorders in nonpregnant per.. · Trauma and PTSD impact physiological cardiometabolic mechanisms implicated in gestational metabolic..

Analysis of biogas production from sewage sludge combining BMP experimental assays and the ADM1 model.

The Anaerobic Digestion Model No. 1 (ADM1) was employed to simulate methane (CH4) production in an anaerobic reactor (AR), and the associated bench-scale biochemical methane potential (BMP) assay, having sewage sludge (SWS) from a municipal wastewater treatment plant (WWTP) as feedstock. The SWS presented the following physical-chemical characteristics: pH (7.4-7.6), alkalinity (2,382 ± 100 mg CaCO3 L-1), tCOD (21,903 ± 1,000 mg L-1), TOC (895 ± 100 mg L-1), TS, TVS, and VSS (2.0%, 1.1%, and 0.8%, respectively). The BMP assay was conducted in six replicates under anaerobic mesophilic conditions (37 ± 0.1°C) for 11 days with a CH4 yield registered of 137.6 ± 6.39 NmL CH4 or 124 ± 6.72 CH4 g-1 VS-1. When the results obtained with the BMP bench-scale reactors were compared to the output generated with computational data by the ADM1 model having as input data the same initial sewage tCOD, similar cumulative CH4 production curves were obtained, indicating the accuracy of the ADM1 model. This approach allowed the characterization of the sludge and estimation of its biogas production potential. The combination of BMP assays, experimental data, and ADM1 model simulations provided a framework for studying anaerobic digestion (AD) processes.

The pain reported by postpartum women in rooming-in according to the mode of delivery / Dor relatada por puérperas no alojamento conjunto segundo a via de nascimento

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is the most frequently reported symptom in the immediate puerperium. The aim of this study was to quantify pain levels and sociodemographic, obstetric, and care characteristics associated with severe pain and inadequate analgesia according to the mode of delivery. METHODS: Observational, descriptive, cross-sectional study conducted between October and December 2020, with a sample of 229 postpartum women considered eligible (baby born alive, weighing > 500 g and/or gestational age > 22 weeks) to answer the study questionnaire. RESULTS: The mean reported pain was 5.34 by Visual Analogue Scale (VAS) and there was a difference (p<0.001) between modes of delivery. Cesarean section was associated with severe pain (p=0.006) and pain above eight on the VAS (p=0.02). Vaginal delivery was associated with the perception of inadequate analgesia (p=0.04). Severe pain reported was associated with the admission of the baby to the ICU (p=0.01) and cases of postpartum hemorrhage (p=0.002). Among women who gave birth vaginally, there was an association between severe pain and instrumental delivery (p=0.05). Reported severe pain was associated with difficulties in self-care (p<0.001) and care of the newborn (p= 0.02), sensation of weakness (p<0.001), and fainting (p=0.002). The perception of inadequate analgesia was associated with vaginal birth (p=0.04) end non-white skin color (p=0,03). CONCLUSION: The average reported pain was moderate. Intense pain and the perception of inadequate analgesia were associated with instrumental delivery, newborns being referred to the NICU, postpartum hemorrhage, and non-white skin color.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é o sintoma mais frequentemente relatado no puerpério imediato. O objetivo deste estudo foi quantificar os níveis de dor e as características sociodemográficas, obstétricas e da assistência associadas à dor intensa e à percepção de analgesia inadequada segundo a via de nascimento. MÉTODOS: Estudo observacional, descritivo, transversal, conduzido entre outubro e dezembro de 2020, com uma amostra de 229 puérperas consideradas elegíveis (nativivos com peso > 500g e/ou idade gestacional > 22 semanas) para responder ao questionário do estudo. RESULTADOS: A média de dor relatada foi 5,3 pela Escala Analógica Visual (EAV) e houve diferença (p<0,001) entre as vias de nascimento. A cesariana apresentou associação com dor intensa referida (p=0,006) e dor acima de oito pela EAV (p=0,02). O parto vaginal obteve associação com percepção de analgesia inadequada (p=0,04). Entre as mulheres que referiram dor intensa, houve associação com recém-nascido encaminhado à unidade de terapia intensiva neonatal (UTIN) (p=0,01) e nos casos de hemorragia pós-parto (p=0,002). Entre as mulheres que tiveram parto vaginal, também houve associação entre dor intensa e o parto instrumental (p=0,05). Dor intensa referida teve associação com dificuldades para o autocuidado (p<0,001) e do recém-nascido (p=0,02), sensação de fraqueza (p<0,001) e de desmaio (p= 0,002). A percepção de analgesia inadequada esteve associada a parto vaginal (p=0,04) e cor da pele não branca (p=0,03). CONCLUSÃO: A média de dor relatada foi moderada. Dor intensa e percepção de analgesia inadequada estiveram associadas com parto instrumental, recém-nascido encaminhado à UTIN, hemorragia pós-parto e cor de pele não branca.

Cyanobacteria and cyanotoxins in the environment and water intakes: Reports, diversity of congeners, detection by mass spectrometry and their impact on health.

Cyanobacteria are aquatic microorganisms of high interest for research due to the production of secondary metabolites, among which the most popular are cyanotoxins, responsible for causing severe poisoning in humans and animals through ingestion or contact with contaminated water bodies. Monitoring the number of cyanobacteria in water and concentrations of secreted cyanotoxins with the aid of sensitive and reliable methods is considered the primary action for evaluating potentially toxic blooms. There is a great diversity of methods to detect and identify these types of micro contaminants in water, differing by the degree of sophistication and information provided. Mass Spectrometry stands out for its accuracy and sensitivity in identifying toxins, making it possible to identify and characterize toxins produced by individual species of cyanobacteria, in low quantities. In this review, we seek to update some information about cyanobacterial peptides, their effects on biological systems, and the importance of the main Mass Spectrometry methods used for detection, extraction, identification and monitoring of cyanotoxins.

Multifunctional Nanoparticles with Superparamagnetic Mn(II) Ferrite and Luminescent Gold Nanoclusters for Multimodal Imaging.

Gold nanoclusters (AuNCs) with fluorescence in the Near Infrared (NIR) by both one- and two-photon electronic excitation were incorporated in mesoporous silica nanoparticles (MSNs) using a novel one-pot synthesis procedure where the condensation polymerization of alkoxysilane monomers in the presence of the AuNCs and a surfactant produced hybrid MSNs of 49 nm diameter. This method was further developed to prepare 30 nm diameter nanocomposite particles with simultaneous NIR fluorescence and superparamagnetic properties, with a core composed of superparamagnetic manganese (II) ferrite nanoparticles (MnFe2O4) coated with a thin silica layer, and a shell of mesoporous silica decorated with AuNCs. The nanocomposite particles feature NIR-photoluminescence with 0.6% quantum yield and large Stokes shift (290 nm), and superparamagnetic response at 300 K, with a saturation magnetization of 13.4 emu g-1. The conjugation of NIR photoluminescence and superparamagnetic properties in the biocompatible nanocomposite has high potential for application in multimodal bioimaging.

Postnatal Overfeeding in Rodents Induces a Neurodevelopment Delay and Anxious-like Behaviour Accompanied by Sex- and Brain-Region-Specific Synaptic and Metabolic Changes.

Nutritional disturbances during the early postnatal period can have long-lasting effects on neurodevelopment and may be related to behavioural changes at adulthood. While such neuronal connection disruption can contribute to social and behaviour alterations, the dysregulation of the neuroendocrine pathways involved in nutrient-sensing balance may also cause such impairments, although the underlying mechanisms are still unclear. We aimed to evaluate sex-specific neurodevelopmental and behavioural changes upon postnatal overfeeding and determine the potential underpinning mechanisms at the central nervous system level, with a focus on the interconnection between synaptic and neuroendocrine molecular alterations. At postnatal day 3 (PND3) litters were culled to three animals (small litter procedure). Neurodevelopmental tests were conducted at infancy, whereas behavioural tests to assess locomotion, anxiety, and memory were performed at adolescence, together with molecular analysis of the hippocampus, hypothalamus, and prefrontal cortex. At infancy, females presented impaired acquisition of an auditory response, eye opening, olfactory discrimination, and vestibular system development, suggesting that female offspring neurodevelopment/maturation was deeply affected. Male offspring presented a transitory delay in locomotor performance., while both offspring had lower upper limb strength. At adolescence, both sexes presented anxious-like behaviour without alterations in short-term memory retention. Both males and females presented lower NPY1R levels in a region-specific manner. Furthermore, both sexes presented synaptic changes in the hippocampus (lower GABAA in females and higher GABAA levels in males), while, in the prefrontal cortex, similar higher GABAA receptor levels were observed. At the hypothalamus, females presented synaptic changes, namely higher vGLUT1 and PSD95 levels. Thus, we demonstrate that postnatal overfeeding modulates offspring behaviour and dysregulates nutrient-sensing mechanisms such as NPY and GABA in a sex- and brain-region-specific manner.

Inclusion4EU: Co-Designing a Framework for Inclusive Software Design and Development.

Digital technology is now pervasive, however, not all groups have uniformly benefitted from technological changes and some groups have been left behind or digitally excluded. Comprehensive data from the 2017 Current Population Survey shows that older people and persons with disabilities still lag behind in computer and internet access. Furthermore unique ethical, privacy and safety implications exist for the use of technology for older persons and people with disabilities and careful reflection is required to incorporate these aspects, which are not always part of a traditional software lifecycle. In this paper we present the Inclusion4EU project that aims to co-design a new framework, guidelines and checklists for inclusive software design and development with end-users from excluded categories, academics with expertise in human-computer interaction and industry practitioners from software engineering.

COVID-19 infection in patients on long-term home parenteral nutrition for chronic intestinal failure.

BACKGROUND AND AIMS: To investigate the incidence and the severity of COVID-19 infection in patients enrolled in the database for home parenteral nutrition (HPN) for chronic intestinal failure (CIF) of the European Society for Clinical Nutrition and Metabolism (ESPEN). METHODS: Period of observation: March 1st, 2020 March 1st, 2021. INCLUSION CRITERIA: patients included in the database since 2015 and still receiving HPN on March 1st, 2020 as well as new patients included in the database during the period of observation. Data related to the previous 12 months and recorded on March 1st 2021: 1) occurrence of COVID-19 infection since the beginning of the pandemic (yes, no, unknown); 2) infection severity (asymptomatic; mild, no-hospitalization; moderate, hospitalization no-ICU; severe, hospitalization in ICU); 3) vaccinated against COVID-19 (yes, no, unknown); 4) patient outcome on March 1st 2021: still on HPN, weaned off HPN, deceased, lost to follow up. RESULTS: Sixty-eight centres from 23 countries included 4680 patients. Data on COVID-19 were available for 55.1% of patients. The cumulative incidence of infection was 9.6% in the total group and ranged from 0% to 21.9% in the cohorts of individual countries. Infection severity was reported as: asymptomatic 26.7%, mild 32.0%, moderate 36.0%, severe 5.3%. Vaccination status was unknown in 62.0% of patients, non-vaccinated 25.2%, vaccinated 12.8%. Patient outcome was reported as: still on HPN 78.6%, weaned off HPN 10.6%, deceased 9.7%, lost to follow up 1.1%. A higher incidence of infection (p = 0.04), greater severity of infection (p < 0.001) and a lower vaccination percentage (p = 0.01) were observed in deceased patients. In COVID-19 infected patients, deaths due to infection accounted for 42.8% of total deaths. CONCLUSIONS: In patients on HPN for CIF, the incidence of COVID-19 infection differed greatly among countries. Although the majority of cases were reported to be asymptomatic or have mild symptoms only, COVID-19 was reported to be fatal in a significant proportion of infected patients. Lack of vaccination was associated with a higher risk of death.

Decision-making styles during stressful scenarios: The role of anxiety in COVID-19 pandemic.

Introduction: Decision-making is not purely rational but highlighted by the influence of intuitive and emotional processes. Recently, researchers have focused more attention on understanding which environmental and personal features influence decision-making processes, and how. Objective and methods: On this study, we investigate whether Trait Anxiety moderates the impact of Post-Traumatic Stress (PTS) symptoms reported during COVID-19 pandemic on decision-making styles. Results: The study included 1,358 Brazilian participants (80% women) aged between 20 and 74 (M = 41.11; SD = 11.23) who responded to an online survey between May and August of the year 2021 of COVID-19 pandemic to The State-Trait Anxiety Inventory, The Decisions Styles Scale, The Impact of Event Scale - Revised and questions related to COVID-19. Through moderation analysis, we observed that experiencing PTS is associated with a higher tendency to biased/heuristic decision-making processes. Discussion: Trait Anxiety seems to influence how people respond to PTS symptoms on decision-making related processes. Subjects with higher Trait Anxiety reported lower tendency to appeal to rationality, especially under higher reported levels of PTS. Meanwhile, lower Trait Anxiety subjects exhibited more reason-based decision-making under higher rates of PTS. This work contributes to a deeper understanding of the interplay among environmental and individual differences on decision-making styles and helps to identify factors of vulnerability for poorer cognitive functioning on stressful scenarios.

Sex-specificities in offspring neurodevelopment and behaviour upon maternal glycation: Putative underlying neurometabolic and synaptic changes.

AIM: Lactation is an important programming window for metabolic disease and neuronal alterations later in life. We aimed to study the effect of maternal glycation during lactation on offspring neurodevelopment and behaviour, assessing possible sex differences and underpinning molecular players. METHODS: Female Wistar rats were treated with Glyoxalase-1 inhibitor S-p-Bromobenzylguthione cyclopentyl diester (BBGC 5 mg/kg). A control and vehicle group treated with dimethyl sulfoxide were also considered. Male and female offspring were tested at infancy for neurodevelopment hallmarks. After weaning, triglycerides and total antioxidant capacity were measured in breast milk. At adolescence, offspring were tested for locomotor ability, anxious-like behaviour, and recognition memory. Metabolic parameters were assessed, and the hippocampus and prefrontal cortex were collected for molecular analysis. KEY FINDINGS: Maternal glycation reduced triglycerides and total antioxidant capacity levels in breast milk. At infancy, both male and female offspring presented an anticipation on the achievement of neurodevelopmental milestones. At adolescence, male offspring exposed to maternal glycation presented hyperlocomotion, whereas offspring of both sexes presented a risk-taking phenotype, accompanied by increase GABAA receptor levels in the hippocampus. Females also demonstrated GABAA and PSD-95 changes in prefrontal cortex. Furthermore, lower levels of GLO1 and consequently higher accumulation of AGES were also observed in both male and female offspring hippocampus. SIGNIFICANCE: Early exposure to maternal glycation induces changes in milk composition leading to neurodevelopment changes at infancy, and sex-specific behavioural and neurometabolic changes at adolescence, further evidencing that lactation period is a critical metabolic programming window and in sculpting behaviour.

Exposure to Obesogenic Environments during Perinatal Development Modulates Offspring Energy Balance Pathways in Adipose Tissue and Liver of Rodent Models.

Obesogenic environments such as Westernized diets, overnutrition, and exposure to glycation during gestation and lactation can alter peripheral neuroendocrine factors in offspring, predisposing for metabolic diseases in adulthood. Thus, we hypothesized that exposure to obesogenic environments during the perinatal period reprograms offspring energy balance mechanisms. Four rat obesogenic models were studied: maternal diet-induced obesity (DIO); early-life obesity induced by postnatal overfeeding; maternal glycation; and postnatal overfeeding combined with maternal glycation. Metabolic parameters, energy expenditure, and storage pathways in visceral adipose tissue (VAT) and the liver were analyzed. Maternal DIO increased VAT lipogenic [NPY receptor-1 (NPY1R), NPY receptor-2 (NPY2R), and ghrelin receptor], but also lipolytic/catabolic mechanisms [dopamine-1 receptor (D1R) and p-AMP-activated protein kinase (AMPK)] in male offspring, while reducing NPY1R in females. Postnatally overfed male animals only exhibited higher NPY2R levels in VAT, while females also presented NPY1R and NPY2R downregulation. Maternal glycation reduces VAT expandability by decreasing NPY2R in overfed animals. Regarding the liver, D1R was decreased in all obesogenic models, while overfeeding induced fat accumulation in both sexes and glycation the inflammatory infiltration. The VAT response to maternal DIO and overfeeding showed a sexual dysmorphism, and exposure to glycotoxins led to a thin-outside-fat-inside phenotype in overfeeding conditions and impaired energy balance, increasing the metabolic risk in adulthood.

Violência por parceiro íntimo na gestação e repercussão na saúde da mulher e do concepto / Violence by intimate partner in pregnancy and repercussion on women's and concept health / Violencia por parte de la pareja íntima en el embarazo y repercusión en la salud de la mujer y del concept

Objetivo: Identificar as evidências científicas sobre as repercussões da Violência do Parceiro Íntimo (VPI) na gravidez sobre a saúde da mulher e do feto. Método: Trata-se de uma revisão integrativa da literatura. As buscas na literatura foram realizadas na Biblioteca Virtual de Saúde; Medline via Pubmed e Web of Science. Resultados: Foram incluídos 21 artigos. Os estudos demonstram que mulheres vítimas na gravidez apresentam maior vulnerabilidade a sofrimento psicológico, apresentando elevação nos níveis de estresse, tristeza, angústia, transtorno mental comum e ideação suicida. Elas são mais suscetíveis abaixa adesão ao pré-natal e a problemas ginecológicos e obstétricos, apresentando chances elevadas de infecção no trato urinário e vaginais, aumento do risco de internações pré-natais e maiores chances de evoluírem para morbidade materna aguda grave. Para a saúde do concepto, exposição a violência está relacionada a chance aumentada a ocorrência de aborto espontâneo, crescimento intrauterino restrito, parto prematuro, baixo peso ao nascer, morte perinatal, mortalidade infantil e na infância. Ainda foi demonstrado que a violência materna no período gestacional está associada a baixa adesão a imunização da criança, menor duração do aleitamento materno e com a necessidade de encaminhar a criança para o acompanhamento especializado para a triagem neonatal auditiva. Conclusão: O impacto da VPI em mulheres grávidas e em seus filhos evidencia a importância de uma maior atenção a essa problemática. No entanto, a desigualdade de gênero representa o cerne das possibilidades de romper o ciclo da VPI no período gestacional e suas consequências para saúde do binômio mãe-bebê.

Objective: To identify the scientific evidence on the repercussions of Intimate Partner Violence (IPV) in pregnancy on the health of the woman and the fetus. Method: This is an integrative literature review. Literature searches were performed in the Virtual Health Library; Medline via Pubmed and Web of Science. Results: 21 articles were included. Studies show that women victims of pregnancy are more vulnerable to psychological distress, with increased levels of stress, sadness, anguish, common mental disorder and suicidal ideation. They are more susceptible to poor adherence to prenatal care and to gynecological and obstetric problems, presenting high chances of urinary tract and vaginal infections, increased risk of prenatal hospitalizations and greater chances of progressing to severe acute maternal morbidity. For the health of the fetus, exposure to violence is related to an increased chance of spontaneous abortion, restricted intrauterine growth, premature birth, low birth weight, perinatal death, infant and childhood mortality. It has also been shown that maternal violence in the gestational period is associated with low adherence to the child's immunization, shorter duration of breastfeeding and the need to refer the child to specialized monitoring for neonatal hearing screening. Conclusion: The impact of IPV on pregnant women and their children highlights the importance of greater attention to this problem. However, gender inequality represents the coreof the possibilities of breaking the cycle of IPV in the gestational period and its consequences for the health of the mother-baby binomial.

Objetivo: Identificar la evidencia científica sobre las repercusiones de la Violencia de Pareja (VPI) en el embarazo sobre la salud de la mujer y el feto. Método: Esta es una revisión integradora de la literatura. Se realizaron búsquedas bibliográficas en la Biblioteca Virtual en Salud; Medline vía Pubmed y Web of Science. Resultados: se incluyeron 21 artículos. Los estudios muestran que las mujeres víctimas del embarazo son más vulnerables al malestar psicológico, con mayores niveles de estrés, tristeza, angustia, trastorno mental común e ideación suicida. Son más susceptibles a la mala adherencia al control prenatal ya los problemas ginecológicos y obstétricos, presentando altas posibilidades de infecciones urinarias y vaginales, mayor riesgo de hospitalizaciones prenatales y mayores posibilidades de progresar a morbilidad materna aguda severa. Para la salud del feto, la exposición a la violencia está relacionada con una mayor probabilidad de aborto espontáneo, crecimiento intrauterino restringido, parto prematuro, bajo peso al nacer, muerte perinatal, mortalidad infantil y en la niñez. También se ha demostrado que la violencia materna en el período gestacional está asociada con la baja adherencia a la vacunación del niño, la menor duraciónde la lactancia materna y la necesidad de derivar al niño a seguimiento especializado para el tamizaje auditivo neonatal. Conclusión: El impacto de la VPI en las mujeres embarazadas y sus hijos destaca la importancia de una mayor atención a este problema.Sin embargo, la desigualdad de género representa el núcleo de las posibilidades de romper el ciclo de la VPI en el período gestacional y sus consecuencias para la salud del binomio madre-bebé.

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.

BACKGROUND AND OBJECTIVES: COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS: This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION: The study was registered under ClinicalTrials.gov identifier NCT04895462.

Aprendizado de máquina nos serviços farmacêuticos: uma revisão integrativa / Machine learning in pharmaceutical services: an integrative review

A crescente digitalização e aplicação de inteligência artificial (IA) em problemas complexos do mundo real, tem potencial de melhorar os serviços de saúde, inclusive da atuação dos farmacêuticos no processo do cuidado. O objetivo deste estudo foi identificar na literatura científica, estudos que testam algoritmos de aprendizado de máquina (Machine Learning ­ ML) aplicados as atividades de farmacêuticos clínicos no cuidado ao paciente. Trata-se de uma revisão integrativa, realizada nas bases de dados, Pubmed, Portal BVS, Cochrane Library e Embase. Artigos originais, relacionados ao objetivo proposto, disponíveis e publicados antes de 31 de dezembro de 2021, foram incluídos, sem limitações de idioma. Foram encontrados 831 artigos, sendo 5 incluídos relacionados as atividades inseridas nos serviços de revisão da farmacoterapia (3) e monitorização terapêutica (2). Foram utilizadas técnicas supervisionadas (3) e não supervisionadas (2) de ML, com variedade de algoritmos testados, sendo todos os estudos publicados recentemente (2019-2021). Conclui-se que a aplicação da IA na farmácia clínica, ainda é discreta, sinalizando os desafios da era digital.

The growing application of artificial intelligence (AI) in complex real-world problems has shown an enormous potential to improve health services, including the role of pharmacists in the care process. Thus, the objective of this study was to identify, in the scientific literature, studies that addressed the use of machine learning (ML) algorithms applied to the activities of clinical pharmacists in patient care. This is an integrative review, conducted in the databases Pubmed, VHL Regional Portal, Cochrane Library and Embase. Original articles, related to the proposed topic, which were available and published before December 31, 2021, were included, without language limitations. There were 831 articles retrieved 5 of which were related to activities included in the pharmacotherapy review services (3) and therapeutic monitoring (2). Supervised (3) and unsupervised (2) ML techniques were used, with a variety of algorithms tested, with all studies published recently (2019­2021). It is concluded that the application of AI in clinical pharmacy is still discreet, signaling the challenges of the digital age.

Pluronic® F127 Thermoresponsive Viscum album Hydrogel: Physicochemical Features and Cellular In Vitro Evaluation.

Viscum album L., popularly known as mistletoe, is well known for its anti-cancer properties, and the pharmaceutical application of hydroalcoholic dry extracts is still limited due to its low solubility in aqueous media, and physicochemical instability. The Pluronic® F127 is an amphiphilic polymer, which permits the solubilization of lipophilic and hydrophilic compounds. In this investigation, physicochemical features of hydrogel containing V. album dry extract (VADE-loaded-hydrogel) were performed by: dynamic light scattering (DLS), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and transmission electron microscopy (TEM). VADE-loaded-hydrogel presented nanometer-size micelles with volume distribution ranging from 10.58 nm to 246.7 nm, and a polydispersity index of 0.441. The sample thermal analyses (TG and DSC) showed similar decomposition curves; however, the thermal events indicated an increase in thermal stability in relation to the presence of the extract. In addition to these interesting pharmaceutical features, IC50 values of 333.40 µg/mL and >1000 µg/mL were obtained when tumor (SCC-25) and non-tumor (L929) cells were incubated with VADE-loaded-hydrogel, respectively. The optical and ultrastructural cellular analysis confirmed the tumor selectivity since the following alterations were detected only in SCC-25 cells: disorganization of plasmatic membrane; an increase of cytoplasmatic vacuole size; alteration in the cristae mitochondrial shape; and generation of amorphous cellular material. These results emphasize the promising antitumoral potential of VADE-loaded-hydrogel as an herbal drug delivery system via in vitro assays.

Measurement of the prevalence of intervention/complication in puerperal women attending a university hospital during the pandemic of COVID-19 by the maternity safety thermometer / Medida da prevalência de intervenção/complicação em puérperas atendidas em hospital universitário durante a pandemia de COVID-19 pelo termômetro de segurança da maternidade

Abstract Objectives: measuring the prevalence of interventions and/or complications based on the Maternity Safety Thermometer (MST) criteria and verifying associations with sociodemographic, clinical, and obstetric factors. Methods: prospective observational study conducted with postpartum women admitted to the maternity ward of a tertiary hospital, from October 10th to December 30th, 2020. Data were collected from medical records and self-administered questionnaires from 260 patients. Results: harm-free care was detected in 17.7% of participants, 66.9% had low-temperature damage (one or less intervention/complication) and 33.1% of patients had elevated temperature damage (two or more intervention/complication). The most frequent intervention was the "scar", given that 38.5% had abdominal scarring (cesarean section) and 26.5% had perineal scarring (2nd-degree tear or greater - spontaneous or by episiotomy). The second most frequent MST item was related to the perception of safety (30%), followed by complications to the newborn (12.3%), infection (11.2%), and hemorrhage (9.2%). Factors related to high temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy. Conclusions: one-third of the participating women had two or more complications/interventions (high temperature by the MST), factors that are related to this temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy.

Resumo Objetivos: mensurar a prevalência de intervenções e/ou complicações a partir dos critérios estabelecidos pelo Termômetro de Segurança da Maternidade (TSM) e avaliar associações com fatores sociodemográficos, clínicos e obstétricos. Métodos: estudo observacional prospectivo realizado com puérperas internadas na maternidade de hospital terciário, de 10 de outubro a 30 de dezembro de 2020. Foram coletados dados do prontuário e de questionários autoaplicáveis de 260 pacientes. Resultados: um cuidado livre de intervenções/complicações foi detectado em 17,7% das participantes, 66,9% apresentaram baixa temperatura (até uma intervenção/complicação) e 33,1% tiveram alta temperatura de intervenções/complicações (2 ou mais). A intervenção mais frequente foi a denominada "cicatriz", sendo que 38,5% tiveram cicatriz abdominal (cesariana) e 26,5% tiveram "cicatriz" perineal (laceração de 2º grau ou mais - espontânea ou por episiotomia). O segundo dano mais frequente foi o relacionado à percepção de segurança (30%), seguido de complicações do recémnascido (12,3%), infecção (11,2%), e hemorragia (9,2%). Houve associação de ter alta temperatura com ser de classe social A ou B, ter cesárea anterior e ser internada na gestação. Conclusões: das mulheres participantes, um terço teve duas ou mais complicações/intervenções (alta temperatura no TSM), estiveram relacionados a essa temperatura: ser de classe social A ou B, ter cesárea anterior e ser internada ao longo da gestação.

Satisfação de gestantes atendidas na atenção primária à saúde / Satisfaction of pregnant women attended in primary health care / Satisfacción de gestantes atendidas en atención primaria de salud

Objetivo: Analisar produção científica sobre satisfação de gestantes atendidas na Atenção Primária à Saúde. Métodos: Revisão integrativa, realizada em setembro de 2020, na Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature e Excerpta Medica Database, cruzando descritores com operadores booleanos. Foram incluídos estudos primários, excluídos estudos realizados em hospitais, mulheres não gestantes, resumos de congresso, teses e artigos duplicados. Não houve delimitação temporal ou de idioma. A busca gerou 355 artigos. Após leitura de títulos e resumos, exclusão dos duplicados e leitura completa, incluiuse 20 artigos. Os dados foram discutidos com bibliografias atualizadas. Por se tratar de revisão, não houve necessidade de parecer em Comitê de Ética. Resultados: A maioria dos artigos foi publicada em 2012 e realizada fora do Brasil. Os resultados indicam satisfação das gestantes pela assistência recebida na Atenção Primária à Saúde, considerando algumas lacunas: continuidade do cuidado após o parto, acolhimento e aspectos da estrutura física das unidades. Conclusão: As pesquisadas apresentaram satisfação pela assistência, atestando a qualidade do atendimento. (AU)

Objective: To analyze scientific production on satisfaction of pregnant women attended in Primary Health Care. Methods: Integrative review, carried out in September 2020, at the Virtual Health Library, Online Medical Literature Analysis and Retrieval System, Cumulative Index to Nursing and Allied Health Literature and Excerpta Medica Database, crossing descriptors with Boolean operators. Primary studies were included, studies performed in hospitals, non-pregnant women, congress abstracts, theses and duplicate articles were excluded. There was no temporal or language delimitation. The search generated 355 articles. After reading the titles and abstracts, excluding duplicates and completely reading, 20 articles were included. Data were discussed with updated bibliographies. As this is a review, there was no need for an opinion from the Ethics Committee. Results: Most articles were published in 2012 and carried out outside Brazil. The results indicate the satisfaction of pregnant women with the assistance received in Primary Health Care, considering some gaps: continuity of care after childbirth, reception and aspects of the physical structure of the units. Conclusion: The respondents were satisfied with the care, attesting to the quality of care. (AU)

Objetivo: Analizar la producción científica sobre la satisfacción de gestantes atendidas en Atención Primaria de Salud. Métodos: Revisión integradora, realizada en septiembre de 2020, en la Biblioteca Virtual en Salud, Sistema de Análisis y Recuperación de Literatura Médica en Línea, Índice Acumulativo de Enfermería y Literatura en Salud Afín. y Excerpta Medica Database, cruzando descriptores con operadores booleanos. Se incluyeron estudios primarios, se excluyeron estudios realizados en hospitales, mujeres no embarazadas, resúmenes de congresos, tesis y artículos duplicados. No hubo delimitación temporal ni lingüística. La búsqueda generó 355 artículos. Después de leer los títulos y resúmenes, excluyendo duplicados y lectura completa, se incluyeron 20 artículos. Los datos se discutieron con bibliografías actualizadas. Al tratarse de una revisión, no fue necesaria la opinión del Comité de Ética. Resultados: La mayoría de los artículos se publicaron en 2012 y se realizaron fuera de Brasil. Los resultados indican la satisfacción de las gestantes con la atención recibida en Atención Primaria de Salud, considerando algunas brechas: continuidad de la atención posparto, recepción y aspectos de la estructura física de las unidades. Conclusión: Los encuestados se mostraron satisfechos con la atención, lo que da fe de la calidad de la atención. (AU)