Rurality of patient residence and access to transplantation among children with kidney failure in the United States.

BACKGROUND: Residence in rural areas is often a barrier to health care access. To date, differences in access to kidney transplantation among children who reside in rural and micropolitan areas of the US have not been explored. METHODS: A retrospective cohort study of children < 18 years who developed kidney failure between 2000 and 2019 according to the United States Renal Data System (USRDS). We examined the association between rurality of patient residence and time to living and/or deceased donor kidney transplantation (primary outcomes) and waitlist registration (secondary outcome) using Fine-Gray models. RESULTS: We included 18,530 children, of whom 14,175 (76.5%) received a kidney transplant (39.8% from a living and 60.2% from a deceased donor). Residence in micropolitan (subhazard ratio (SHR) 1.16; 95% CI 1.06-1.27) and rural (SHR 1.18; 95% CI 1.06-1.3) areas was associated with better access to living donor transplantation compared with residence in metropolitan areas. There was no statistically significant association between residence in micropolitan (SHR, 0.95; 95%CI 0.88-1.03) and rural (SHR, 0.94; 95%CI 0.86-1.03) areas compared with metropolitan areas in the access of children to deceased donor transplantation. There was also no difference in the time to waitlist registration comparing micropolitan (SHR 1.04; 95%CI 0.98-1.10) and rural (SHR 1.05; 95% CI 0.98-1.13) versus metropolitan areas. CONCLUSIONS: In children with kidney failure, residence in rural and micropolitan areas was associated with better access to living donor transplantation and similar access to deceased donor transplantation compared with residence in metropolitan areas.

In-hospital severe COVID-19 in a philanthropic tertiary hospital setting: is asthma a concern? A retrospective study

ABSTRACT BACKGROUND: The frequency of coronavirus disease 2019 (COVID-19) cases among asthmatics has been reported to be reduced. However, the findings regarding the association between asthma and the risk of severe COVID-19 have been divergent. OBJECTIVE: To investigate whether asthma is associated with a reduced risk of development of severe COVID-19. DESIGN AND SETTING: Retrospective analysis on COVID-19 surveillance databases at two tertiary-level hospitals in São Paulo, Brazil. METHODS: The medical records of patients hospitalized due to COVID-19 between March and August 2020 were reviewed in accordance with the clinical, laboratorial, radiological and epidemiological criteria for COVID-19, and for comorbidities. RESULTS: Among the adult patients included (> 18 years of age) there were 52 asthmatics and 1,318 non-asthmatics. Their median ages and interquartile ranges (IQR) were, respectively, 54 (41-69) and 60 (44-72) years. At least one comorbidity was seen in 73% of asthmatics and 56% of the non-asthmatics. Among the asthmatics, most presented mild asthma (92%) and the prevalence of chronic obstructive pulmonary disease (COPD) was high (27%). The asthmatics presented an unadjusted odds ratio (OR) for severe COVID-19 of 0.89 (95% confidence interval, CI 0.5-1.56); and OR 0.88 (95% CI 0.5 -1.68) after multivariable adjustment. Age > 60 years, male sex, hypertension, diabetes, cancer and homelessness were covariates associated with increased odds for severe COVID-19. Kaplan-Meier estimated survival over hospitalization of up to 30 days did not differ between the groups (log-rank P = 0.09). CONCLUSIONS: The association between asthma and decreased risk of severe COVID-19 or increased survival was statistically non-significant.

PEMT variants are associated with nonsyndromic cleft lip with or without cleft palate in Chile.

Aim: To assess the association between PEMT variants and nonsyndromic cleft lip with or without cleft palate in Chile and the effects of these variants on global DNA methylation. Subjects & methods: The authors obtained genotypes for nine variants from 247 cases and 453 controls for genotype-phenotype associations. The effect of significant polymorphisms on global DNA methylation (percentage of long interspersed element-1 methylation) was evaluated in a subsample of 95 controls. Results: After multiple comparison corrections, variants rs7649 and rs4646409 were associated with nonsyndromic cleft lip with or without cleft palate. Carriers of risk alleles presented lower DNA methylation levels than noncarriers. Conclusion: According to functional analysis for risk variants from previous reports, the authors infer that a decrease of methyl group availability is occurring in affected subjects.

This study evaluated if variants in the gene named PEMT confers an increased risk for nonsyndromic cleft lip with or without cleft palate in Chile and its possible effects on methylation of DNA, a variable linked to gene expression modulation. The study found that the variants recognized as rs7649 and rs4646409 increase the risk of nonsyndromic cleft lip with or without cleft palate in the Chilean population and decrease DNA methylation. The authors conclude that this gene may be involved in this birth defect. New studies are needed to confirm the relation between this condition and DNA methylation mediated by these genetic variants.

In-hospital severe COVID-19 in a philanthropic tertiary hospital setting: is asthma a concern? A retrospective study.

BACKGROUND: The frequency of coronavirus disease 2019 (COVID-19) cases among asthmatics has been reported to be reduced. However, the findings regarding the association between asthma and the risk of severe COVID-19 have been divergent. OBJECTIVE: To investigate whether asthma is associated with a reduced risk of development of severe COVID-19. DESIGN AND SETTING: Retrospective analysis on COVID-19 surveillance databases at two tertiary-level hospitals in São Paulo, Brazil. METHODS: The medical records of patients hospitalized due to COVID-19 between March and August 2020 were reviewed in accordance with the clinical, laboratorial, radiological and epidemiological criteria for COVID-19, and for comorbidities. RESULTS: Among the adult patients included (> 18 years of age) there were 52 asthmatics and 1,318 non-asthmatics. Their median ages and interquartile ranges (IQR) were, respectively, 54 (41-69) and 60 (44-72) years. At least one comorbidity was seen in 73% of asthmatics and 56% of the non-asthmatics. Among the asthmatics, most presented mild asthma (92%) and the prevalence of chronic obstructive pulmonary disease (COPD) was high (27%). The asthmatics presented an unadjusted odds ratio (OR) for severe COVID-19 of 0.89 (95% confidence interval, CI 0.5-1.56); and OR 0.88 (95% CI 0.5 -1.68) after multivariable adjustment. Age > 60 years, male sex, hypertension, diabetes, cancer and homelessness were covariates associated with increased odds for severe COVID-19. Kaplan-Meier estimated survival over hospitalization of up to 30 days did not differ between the groups (log-rank P = 0.09). CONCLUSIONS: The association between asthma and decreased risk of severe COVID-19 or increased survival was statistically non-significant.

Diseño y validación de una lista de intercambio de alimentos peruanos para la confección de dietas y planificación de menús / Design and validation of a peruvian food exchange list for meal planning

Objetivo: La finalidad del estudio fue diseñar y validar una lista de intercambio de alimentos peruanos (LIA) para la confección de dietas y planificación de menús. Material y métodos: Se tomó como base la metodología para diseñar listas de intercambio descrita en trabajos previos, desarrollándose en seis fases realizadas en múltiples intervenciones en laboratorio, en donde se evaluaron 273 alimentos, que fueron estudiados a través de un análisis descriptivo cualitativo. Se realizó una validación con 12 nutricionistas que elaboraron un plan nutricional y luego se comparó la composición nutricional obtenida usando la tabla peruana de composición de alimentos 2017 (TPCA) con la composición nutricional aplicando LIA. Para la comparación de métodos se aplicó la prueba de Wilcoxon. Resultados: Se elaboró una lista de intercambio de alimentos peruanos (LIA) que incluyó 273 alimentos categorizados en siete grupos de intercambio. Se estimó la media del aporte de energía y macronutrientes por cada grupo de intercambio y se compiló un álbum fotográfico con las porciones de intercambio. Respecto a la validación de la LIA, en la comparación de la cantidad de energía, carbohidratos, proteínas y grasas de los planes alimentarios usando TPCA versus LIA no se encontraron diferencias significativas. Conclusión: Se obtuvo una LIA válida que permite la confección y planificación de dietas de forma eficiente, dentro de un margen de error adecuado, se recomiendan nuevos estudios que incorporen otras poblaciones más específicas y nuevos alimentos.(AU)

Objective: The purpose of the study was to design andvalidate a Peruvian food portions exchange list (LIA) for thepreparation of diets and menu planning. Methodology: The methodology for designing exchangelists described in previous studies was used as a basis, devel-oped in six phases carried out in multiple laboratory interven-tions, where 273 foods were evaluated and studied through aqualitative descriptive analysis. A validation was performedwith 12 nutritionists who elaborated a nutritional plan andthen the nutritional composition obtained using the Peruviantable of food composition 2017 (TPCA) was compared withthe nutritional composition applying LIA. For the comparisonof methods, the Wilcoxon test was applied. Results: A Peruvian food exchange list (LIA) was devel-oped that included 273 foods categorized into seven ex-change groups. The mean energy and macronutrient intakefor each exchange group was estimated and a photographicalbum was compiled with the exchange portions. Regardingthe validation of the LIA, in the comparison of the amount ofenergy, carbohydrates, proteins and fats of the meal plans us-ing TPCA versus LIA no significant differences were found. Conclusion: A valid LIA was obtained that allows thepreparation and planning of diets in an efficient way, withinan adequate margin of error, new studies incorporating othermore specific populations and new foods are recommended.(AU)

Vitamin B12 Transport Genes and Nonsyndromic Cleft Lip With or Without Cleft Palate in Chile.

The aims of this study were to assess the association between polymorphisms within genes involved in vitamin B12 transport and nonsyndromic cleft lip with or without cleft palate (NSCL/P) and global DNA methylation in Chile. From 247 cases and 453 controls, we obtained variant genotypes for CBLIF, CUBN, AMN, ABCC1, CD320, and TCN2 from a single nucleotide polymorphisms array. Global DNA methylation in 95 controls was obtained through LINE-1 methylation. After multiple comparison corrections, only rs780807 in CUBN remains associated with NSCL/P at dominant model (OR 0.564, p-value = 0.0006, q-value = 0.0450). Carriers of protective allele showed lower levels of DNA methylation than non-carriers (p = 0.0259). Further studies are necessary in order to explain relations with the phenotype and DNA methylation due to the absence of functional evidence for rs780807 in CUBN.

International trends in incidence of osteosarcoma (1988-2012).

Osteosarcoma (OS) is the most common primary bone tumor in children and adolescents. The etiology of OS is largely unknown but may be informed by comparisons of incidence and trends between geographic regions. Using the Cancer Incidence in Five Continents (CI5) data from 1988 to 2012, we present OS age-standardized incidence rates (ASRs; cases/million) and average annual percent change (AAPC) and 95% confidence interval (CI) by geographic region among the age groups 0-9, 10-19, 20-29, 30-59, 60-79, 0-79. Among the 10-19 age group, we also used the most recent data (2008-2012) to present the ASRs for each country. We observed little variation in OS incidence between geographic regions in 2008-2012 across all age groups. Overall, the ASR for 0-79 ranged from 2 cases per million in Southern Asia to 4.2 in Sub-Saharan Africa. A bimodal distribution in incidence was observed with peaks in the 10-19 and 60-79 age groups across all regions over time. Overall, OS incidence was relatively stable across 1988-2012 with the only statistically significant increases in the 0-79 age group observed in Eastern Asia (AAPC: 1.8; 95% CI: 0.6, 1.9) and Sub-Saharan Africa (AAPC: 3.1; 95% CI: 0.5, 5.8). The small variation in incidence between regions and the stability in incidence over time suggests that OS carcinogenesis is not influenced by environmental or time-varying exposures.

Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit / Perfil de usuarios que reciben atención fonoaudiológica en una unidad de paciente crítico

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

RESUMEN Objetivo: describir el perfil de usuarios atendidos por fonoaudiólogos en una unidad de paciente crítico. Métodos: se realizó un estudio observacional descriptivo con temporalidad ex post facto. Se analizaron los resúmenes estadísticos mensuales de usuarios internados durante los meses de enero a diciembre de 2018, en la unidad de cuidados intensivos de un hospital público. Se describieron los datos a partir de análisis de frecuencia y medidas de tendencia central. La distribución de las variables se determinó mediante skewness-kurtosis test, considerando un nivel de significancia p<0,05. Resultados: 217 sujetos recibieron 868 atenciones fonoaudiológicas. Los hombres (57,26%) mayores de 65 años requirieron una intervención más frecuente. Los principales diagnósticos médicos de ingreso a la unidad correspondieron a patologías inespecíficas (57,14%), enfermedades respiratorias (15,21%) y cerebrovasculares (12,79%). Las funciones de fonoaudiología se relacionaron con la evaluación de la deglución (54,31%) y de la voz (32,4%). En cuanto a la intervención, el tratamiento de la disfagia (25,82%) y las funciones motoras orales (25,04%) dominaron la carga laboral. Las funciones asociadas con el lenguaje, el habla y la cognición fueron secundarias. Conclusión: el perfil del paciente crítico y las labores fonoaudiológicas en este ámbito representan un primer paso para caracterizar el rol profesional del fonoaudiólogo en el contexto de los equipos de medicina intensiva.

Nonsyndromic orofacial clefts in Chile: LINE-1 methylation and MTHFR variants.

Aim: To evaluate the risk of nonsyndromic orofacial clefts (NSOFCs) associated with LINE-1 methylation, as a marker of global DNA methylation, and the effect of MTHFR functional variants on this variable. Patients & methods: LINE-1 methylation was evaluated by bisulfite modification coupled to DNA pyrosequencing in 95 NSOFC cases and 95 controls. In these subjects, MTHFR genotypes for variants c.C677T (rs1801133) and c.A1298C (rs1801131) were obtained. Results: Middle levels (second tertile) of LINE-1 methylation increase the risk of NSOFCs. In addition, LINE-1 methylation depends on c.A1298C genotypes in controls but not in cases. Conclusion: A nonlinear association between global DNA methylation and NSOFCs was detected in this Chilean population, which appears to be influenced by MTHFR functional variants.

Maternidade modelo com atendimento exclusivo de enfermeiros: representações sociais / Materrnidad institución modelo con atención exclusiva de enfermeras: representaciones sociales / Model maternity with exclusive care by nurses: social representations

OBJETIVO: Determinar, com base na percepção das usuárias, o tipo de modelo de atenção de uma maternidade cujo atendimento é exclusivamente realizado por enfermeiras. MÉTODO: Pesquisa de abordagem qualitativa e descritiva, baseada na teoria das representações sociais de Moscovici, cujo cenário foi uma maternidade. Os atores sociais foram 34 usuárias atendidas durante a fase perinatal. RESULTADOS: os dados foram codificados a partir das informações coletadas das entrevistadas, extraindo as categorias: educação, cultura, humanismo, trinômio, gênero e administração, como elementos integrativos. DISCUSSÃO: na perspectiva global, novas perspectivas de atenção podem ser oferecidas, tanto para a teoria quanto para a prática, criando assim políticas públicas de saúde. CONCLUSÃO: as usuárias percebem o modelo que atenta ao parto natural como cuidado baseado na educação e interculturalidade, o que possibilita a assistência humanizada de gênero e personalizada pelas enfermeiras para o trinômio.

OBJETIVO: Determinar con base en la percepción de las usuarias el tipo de modelo de atención en una maternidad atendida exclusivamente por enfermeras. MÉTODO: Investigación con enfoque cualitativo, descriptivo, direccionada por la teoría de las representaciones sociales de Moscovici; cuyo escenario fue una maternidad donde los actores sociales fueron treinta y cuatro usuarias que recibieron la atención durante la etapa perinatal. RESULTADOS: a partir de la información obtenida de las entrevistas se codificaron los datos, extrayendo las categorías: educación, cultura, humanismo, trinomio, género y administración como elementos integrativos. DISCUSIÓN: en perspectiva global puede brindarse nuevas perspectivas de cuidado, tanto para la teoría como para la práctica y así generar políticas públicas de salud. CONCLUSIÓN: las usuarias perciben el modelo con atención del parto natural con cuidado basado en la educación, interculturalidad, que posibilita el cuidado humanizado de género y personalizado por las enfermeras para el trinomio.

AIM: Determine, based on the perception of the users, the type of model of attention of a maternity hospital whose care is exclusively performed by nurses. METHOD: Research of qualitative and descriptive approach, based on Moscovici's theory of social representations, whose scenario was a maternity hospital. The social actors were 34 users assisted during the perinatal phase. RESULTS: The data were coded from the information collected from the interviewees, extracting the categories: education, culture, humanism, trinomial, gender and administration, as integrative elements. DISCUSSION: From a global perspective, new perspectives of attention can be offered for both theory and practice, thus creating public health policies. CONCLUSION: the users perceive the model that pays attention to natural childbirth as care based on education and interculturality, which enables the humanized assistance of gender and personalized by nurses for the trinomial.

Autonomía profesional de la enfermería perinatal: percepción social de competencias conquistadas / Autonomia profissional na enfermagem perinatal: percepção social de competências conquistadas / Professional autonomy for perinatal nurses: social perception of competences gained

Objetivo: determinar el tipo de autonomía que ejerce la enfermera perinatal en una maternidad con intervención exclusiva por enfermeras según la percepción de las usuarias. Metodología: investigación con enfoque cualitativo, descriptivo, orientado por la teoría de representaciones de Moscovici, se desarrolló de junio a agosto de 2016, siendo el escenario de una maternidad. Como actores sociales tuvimos treinta y cuatro pacientes que recibieron atención en la fase perinatal. A partir de la información obtenida de las entrevistas se codificaron los datos extrayendo las categorías que fueron discutidas. Resultados: emergieron educación, cultura, humanismo, género y administración. Conclusión las usuarias percibieron un modelo de atención del parto natural de acuerdo a cuidados basado en la educación intercultural, que posibilitan un cuidado humanizado personalizado de las enfermeras para madre, padre e hijo.

Objetivo: Determinar o tipo de autonomia que exerce a enfermeira perinatal em uma maternidade com atendimento exclusivamente, realizada por enfermeiras, segundo a percepção das clientes. Metodologia: pesquisa realizada de junho a agosto de 2016, sendo o cenário em uma Maternidade, com enfoque qualitativo, descritivo, orientada pela teoria das representações sociais de Moscovici. As participantes foram 34 clientes que receberam o atendimento durante a fase perinatal. A partir das informações obtidas, por meio das entrevistas, codificaram-se os dados e emergiram-se as categorias. Resultados: apontou como categorias a educação, a cultura, o humanismo, o género e administração. Conclusão: As clientes percebem um modelo de atendimento do parto natural assente em cuidados baseados na educação intercultural, que possibilita um cuidado humanizado pessoalizado pelas enfermeiras para mãe, pai e filho.

Objective: to determine, according to user perceptions, the type of autonomy exercised by perinatal nurses at a maternity facility with care provided exclusively by nurses. Methodology: this qualitative, descriptive study, conducted at a maternity facility from June to August 2016, was guided by Moscovici's theory of social representations. The participants were 34 patients who received care during the perinatal phase. Data were codified from information obtained in interviews. Results: from the study, the following categories emerged; education, culture, humanism, gender and administration. Conclusion: users perceived a natural birth care model resting on care based on intercultural education, which made for humanized nursing care for mother, father and child.

Premature Vascular Aging in Guinea Pigs Affected by Fetal Growth Restriction.

Cardiovascular risk associated with fetal growth restriction (FGR) could result from an early impaired vascular function. However, whether this effect results in premature vascular aging has not been addressed. We studied the ex vivo reactivity of carotid and femoral arteries in fetal (near term), adults (eight months-old) and aged (16 months-old) guinea pigs in normal (control) and FGR offspring. Additionally, an epigenetic marker of vascular aging (i.e., LINE-1 DNA methylation) was evaluated in human umbilical artery endothelial cells (HUAEC) from control and FGR subjects. Control guinea pig arteries showed an increased contractile response (KCl-induced) and a progressive impairment of NO-mediated relaxing responses as animals get older. FGR was associated with an initial preserved carotid artery reactivity as well as a later significant impairment in NO-mediated responses. Femoral arteries from FGR fetuses showed an increased contractility but a decreased relaxing response compared with control fetuses, and both responses were impaired in FGR-adults. Finally, FGR-HUAEC showed decreased LINE-1 DNA methylation compared with control-HUAEC. These data suggest that the aging of vascular function occurs by changes in NO-mediated responses, with limited alterations in contractile capacity. Further, these effects are accelerated and imposed at early stages of development in subjects exposed to a suboptimal intrauterine environment.

Percepción social de usuarias atendidas exclusivamente por enfermeras en la etapa perinatal / Social perception of users served exclusively by nurses at the perinatal stage / Percepção social de usuários atendidos exclusivamente por enfermeiros no estágio perinatal

Resumen 19. El artículo muestra la atención exclusiva de enfermeras en una maternidad, cuyo objetivo fue analizar las representaciones sociales de las usuarias acerca de la atención brindada por las enfermeras obstetras en la institución. Es una investigación con enfoque cualitativo, descriptivo; direccionado por la teoría de las representaciones sociales de Moscovici. Se entrevistó a 34 mujeres atendidas en la maternidad. El análisis de datos se efectuó mediante marco interpretativo, seleccionando las ideas destacadas por medio de técnica cromática; en seguida, se discute los datos empíricos confrontados con la teoría. Las usuarias señalan que la atención recibida se inscribió en un marco de humanización, responsabilidad y confianza, lo cual posibilita la atención de un parto de acuerdo con sus costumbres que, con base en la teoría, refleja autonomía profesional. Se concluye que el modelo de atención muestra que el cuidado de enfermería se basa en conocimientos, experiencia y valores que potencializan la práctica, desde la que se aprecia el cuidado humano, cálido y personalizado.

Abstract 23. The article shows the exclusive attention of nurses in a maternity, whose objective was to analyze the social representations of the users about the attention given by the obstetric nurses in the institution. It is a research with a qualitative, descriptive approach; Directed by the theory of social representations of Moscovici. 34 women attended in the maternity were interviewed. The data analysis was carried out through an interpretative framework, selecting the ideas highlighted by means of chromatic technique; next, the empirical data confronted with the theory is discussed. The users point out that the care received was part of a framework of humanization, responsibility, and trust, which makes it possible to attend a delivery according to their customs, which, based on theory, reflects professional autonomy. It is concluded that the care model shows that nursing care is based on knowledge, experience, and values ​​that potentiate the practice, from which human care is appreciated, warm and personalized.

Resumo 27. O artigo mostra a atenção exclusiva dos enfermeiros em uma maternidade, cujo objetivo foi analisar as representações sociais dos usuários sobre os cuidados prestados pelas enfermeiras obstétricas na instituição. Trata-se de uma pesquisa com abordagem qualitativa, descritiva; dirigido pela teoria das representações sociais de Moscovici. Participaram 34 mulheres atendidas na maternidade. A análise dos dados é realizada através de um quadro interpretativo, selecionando as ideias destacadas por meio da técnica cromática; em seguida, os dados empíricos confrontados com a teoria são discutidos. Os usuários indicaram que o atendimento recebido fazia parte de um quadro de humanização, responsabilidade e confiança, que possibilita atender a um parto de acordo com seus costumes, o que, baseado na teoria, reflete a autonomia profissional. Conclui-se que o modelo assistencial mostra que o cuidado de enfermagem é baseado no conhecimento, experiência.

Correction: Phytometabolite Dehydroleucodine Induces Cell Cycle Arrest, Apoptosis, and DNA Damage in Human Astrocytoma Cells through p73/p53 Regulation.

[This corrects the article DOI: 10.1371/journal.pone.0136527.].

Representaciones y prácticas socioculturales asociadas al destete precoz en un grupo de madres adolescentes venezolanas / Sociocultural Practices and Representations Associated with Early Weaning Among a Group of Venezuelan Adolescent Mothers

Resumen Antecedentes: en Venezuela, la práctica de la lactancia materna entre las adolescentes ha derivado en pautas inadecuadas, originando un destete precoz. Es importante estudiar este fenómeno desde una orientación pluridimensional, puesto que el análisis de los procesos socioculturales sirve para dilucidar estas pautas y poder preservar una práctica alimentaria fundamental. Objetivo: identificar las prácticas socioculturales asociadas al destete precoz en un grupo de madres adolescentes venezolanas desde la dimensión subjetiva de las representaciones mentales. Materiales y métodos: se diseñó un estudio cualitativo, haciendo uso de la teoría fundamentada para crear una teoría sustantiva. Fueron entrevistadas en profundidad 13 madres adolescentes con el apoyo de la observación participante. Resultados: las representaciones y prácticas socioculturales se expresaron a través de tres principales vinculaciones que reproducen la pauta de abandono de la lactancia. La conformación identitaria de la adolescente en torno a la lactancia estuvo relacionada con la aprehensión de lo que constituye para los otros la maternidad. Se evidenció una discrepancia entre lo dicho a nivel de discurso y la puesta en práctica de estos saberes. Los médicos y familiares desempeñaron una función influyente al sugerir la introducción de fórmulas lácteas a partir del primer mes. Conclusiones: el amamantamiento es un acto aprendido que requiere del apoyo familiar para que sea una práctica efectiva. El abandono de la lactancia es un fenómeno que se vincula con la percepción que tiene la adolescente sobre sí misma y cómo construye una identidad.

Abstract Background: In Venezuela, the practice of breastfeeding among adolescent mothers has been based on inadequate guidelines which has resulted in early weaning. It is important to study this phenomenon from a multi-dimensional orientation, as the analysis of the sociocultural processes serves to clarify these guidelines and may help preserve a fundamental feeding practice. Objective: To understand the sociocultural practices associated with early weaning among a group of Venezuelan adolescent mothers from the subjective dimension of mental representations. Materials and Methods: A qualitative study is designed, using Grounded Theory to create a substantive theory. Additionally, participant observation and in-depth interviews were performed with 13 adolescent mothers. Results: Representations and sociocultural practices expressed themselves through three main linkages that highlight the pattern of abandonment of breastfeeding. First, the identity reconfiguration of the adolescent concerning breastfeeding was closely related to the apprehension of what maternity constitutes for others. Second, a discrepancy emerged between what is mentioned at the level of discourse and the putting in practice of this knowledge. Finally, the doctors and relatives played an influential role by suggesting the introduction of milk formulas from the first month of age. Conclusions: Breastfeeding is an acquired knowledge that requires the support from the family so it can be a successful event. The abandonment of breastfeeding is a phenomenon related with the perception the adolescent has about herself and how an identity is constructed.

Influence of scheduling in clinical dental care on indicators of oral health / Indicadores de saúde bucal como instrumento na organização da demanda

Objective: Assess the oral health indicators in the Family Health Units (Unidades de Saúde da Família - USFs) with scheduled demand in comparison with Family Health Units with spontaneous demand in oral health care, in Piracicaba.Methods: 10 Family Health Units located in Piracicaba, were randomly chosen: 5 Units with spontaneous demand and 5 Units with scheduled demand. Secondary data in daily production spreadsheets were collected from the information system, from February to September 2013. These were organized into indicators: 1) access; 2) resolutivity; 3) ratio of dental emergency per inhabitant; 4) mean number of individual preventive and curative dental procedures; 5) ratio of dental extraction per dental procedure; 6) ratio of dental extraction per inhabitant; 7) mean number of supervised toothbrushing sessions. Data were compared and statistically analyzed with the BioStat 5.0 program, by applying the Student's-t test (p ≤ 0.05).Results: There were significant differences in the indicators of dental emergency, dental extraction per clinical procedure, and dental extractions per inhabitant, and these values were higher in Family Health Units with spontaneous demand.Conclusion: The model of scheduling the demand for dental care adopted by the USFs interferes in the number of users seeking dental emergency treatments and reasons for extractions.

Objetivo: Analisar a influência de dois modelos de organização do atendimento odontológico clínico em indicadores de saúde bucal para as Equipes de Saúde Bucal.Métodos: Dez Unidades de Saúde da Família (USF) localizadas em Piracicaba foram escolhidas aleatoriamente. Cinco Unidades com modelo de demanda espontânea e 5 Unidades com modelo de demanda organizada em Saúde Bucal. Dados secundários da produção odontológica ambulatorial foram coletados a partir do sistema de informação, de fevereiro a setembro de 2013. Depois foram organizados em indicadores: a) acesso; b) resolutividade; c) razão de urgência odontológica; d) procedimentos clínicos individuais preventivos e curativos e) razão de exodontias por procedimentos clínicos individuais preventivos e curativos f) razão de exodontias por habitante g) média de escovação dental supervisionada. Os dados foram comparados e analisados estatisticamente através do BioStat 5.0 através da aplicação do teste t de Student (p ≤0,05).Resultados: Houve diferenças significativas nos indicadores de razão de urgências, razão de exodontia por procedimentos clínicos e razão de exodontias por habitante, sendo estes valores maiores no modelo da demanda espontânea.Conclusão: O modelo de organização da demanda odontológica adotado pelas Equipes de Saúde Bucal interfere na procura de urgências odontológicas e razão de exodontias.

Phytometabolite Dehydroleucodine Induces Cell Cycle Arrest, Apoptosis, and DNA Damage in Human Astrocytoma Cells through p73/p53 Regulation.

Accumulating evidence supports the idea that secondary metabolites obtained from medicinal plants (phytometabolites) may be important contributors in the development of new chemotherapeutic agents to reduce the occurrence or recurrence of cancer. Our study focused on Dehydroleucodine (DhL), a sesquiterpene found in the provinces of Loja and Zamora-Chinchipe. In this study, we showed that DhL displayed cytostatic and cytotoxic activities on the human cerebral astrocytoma D384 cell line. With lactone isolated from Gynoxys verrucosa Wedd, a medicinal plant from Ecuador, we found that DhL induced cell death in D384 cells by triggering cell cycle arrest and inducing apoptosis and DNA damage. We further found that the cell death resulted in the increased expression of CDKN1A and BAX proteins. A marked induction of the levels of total TP73 and phosphorylated TP53, TP73, and γ-H2AX proteins was observed in D384 cells exposed to DhL, but no increase in total TP53 levels was detected. Overall these studies demonstrated the marked effect of DhL on the diminished survival of human astrocytoma cells through the induced expression of TP73 and phosphorylation of TP73 and TP53, suggesting their key roles in the tumor cell response to DhL treatment.

Lipomas múltiples en colon. A propósito de un caso / MULTIPLE LIPOMAS COLON. REPORT OF A CASE

Los lipomas del colon son neoplasias benignas subepiteliales,poco frecuentes en este órgano, solo un 10% se presenta como lesiones múltiples y su localización predominante es el colon derecho. Su prevalencia es similar tanto en hombre y en mujeres, suelen ser lesiones asintomáticas y son diagnosticadas incidentalmente; ocasionalmente cuando son mayores de 2 cm la sintomatología es dolor abdominal, obstrucción intestinal, rectorragia o alteración del hábito evacuatorio. Se presenta el caso de paciente femenino de 78 años quien inicia enfermedad actual 12 meses previos a la consulta, presentando cambio de hábito evacuatorio caracterizado por estreñimiento, dolor abdominal difuso tipo cólico, y pérdida de peso no cuantificada asociada a hiporexia. Exámenes de laboratorio reportaron: hemoglobina 10.9 g/dl, hematocrito 38.6% (VCM: 72), leucocitos 9.600 ml/mm3, eosinófilos 21% (eosinofilia moderada), coproanálisis sin alteraciones. Debido a la eosinofilia se le solicita serología para toxocariasis resultando positiva. Endoscopia digestiva superior: hernia hiatal tipo I y gastropatía eritematosa antral, Biopsia: gastritis crónica no atrófica. Endoscopia digestiva inferior: se observan 5 lesiones elevadas entre 3 y 5 cms de diámetro, redondeadas, péndulas, cubierta con mucosa de aspecto normal, de color amarillo, con signo del “cojín”presente, distribuidas en colon transverso, descendente y sigmoides sugestivas de lipoma, además diverticulosis en sigmoides. Se indicó tratamiento con laxante osmótico y antiparasitario presentando mejoría de los síntomas. Actualmente la paciente presenta hemoglobina en 12g/dl, eosinófilos 3% y normalización de la frecuencia evacuatoria y remisión del dolor abdominal.

Colonic lipomas are rare benign neoplasms; approximately 10% present as multiple lesions. The prevalence is equal in both men and women, presenting usually as asymptomatic lesions, which are diagnosed incidentally. However, when they are large (> 2cm) they may present with abdominal pain, intestinal obstruction, rectal bleeding or altered bowel habits. We report on a 78 years old female patient with a 12 months history of changing bowel habits characterized by constipation, diffuse colic abdominal pain, and weight loss associated with hiporexia. Her laboratory tests report eosinophilia: 21% of 9600/mm3 WBC, hemoglobin 10.9 g/dl, hematocrit 38.6%, stool tests were normal. Serology for toxocariasis was positive. Upper gastrointestinal endoscopy revealed hiatal hernia and erythematous gastric mucosa; biopsy was compatible with chronic atrophic gastritis. Colonoscopy revealed 5 raised lesions between 3 and 5cm in diameter, round, pendulous, covered with normal-appearing yellowish mucosa, ("pad sign"). This distribution in the transverse, descending and sigmoid colon is suggestive of lipomas coexisting with sigmoid diverticulosis. Treatment was indicated: osmotic laxative and anti-parasitic medications with symptomatic improvement. Currently the patient has 12g/dl of hemoglobin, and 3% eosinophils with normalization of her bowel movements.

Avaliação in vitro do efeito da incorporação de clorexidina nas propriedades físicas e na atividade antibacteriana de resinas acrílicas autopolimerizáveis / Effect of the incorporation of chlorhexidine in provisional crown and bridge acrylic resins on their physical properties

Objetivo. O objetivo do presente estudo foi avaliar o efeito da incorporação de diacetato de clorexidina (CDA), em diferentes concentrações e tempos de armazenamento, nas propriedades físicas e na atividade antibacteriana de resinas acrílicas, utilizadas na confecção de coroas e pontes provisórias. Métodos. Fase I: Foram confeccionados 150 corpos de prova retangulares (3,0 mm X 10 mm X 64 mm), de acordo com a norma ISO 1567 e 150 corpos de prova quadrados (10 mm X 10 mm X 2,0 mm), utilizando-se duas resinas acrílicas autopolimerizáveis, Duralay (Reliance Dental Mfg. Co.) e Dencor (Clássico). Os corpos de prova foram distribuídos em 30 grupos (n=10/grupo) de acordo com a concentração de CDA incorporada às resinas (p/p) (A) 0%, (B) 1%, (C) 2%, (D) 4%, (E) 5%, em função do tempo de armazenamento em água destilada, a 37°C (T0 – 2h, T1 – 7 dias, T2 – 30 dias). Foram realizados os ensaios de microdureza Knoop, em microdurômetro Micromet 5104, Buehler (N), rugosidade superficial (Ra), em rugosímetro digital Mitutoyo Surftest SJ-201 (n=5) e resistência à flexão em três pontos (MPa), em uma máquina de ensaio universal EMIC MF 200 DL (n=5). Fase II: Adicionalmente, a atividade antibacteriana dos materiais sobre Streptococcus mutans foi determinada através da realização de testes de difusão em meio BHI, sendo para isso confeccionados 30 corpos de prova em forma de disco (12 mm X 3,0 mm) com as mesmas 5 concentrações (n=3/grupo). Os resultados foram tabulados e submetidos à análise estatística three-way ANOVA (Fase I) e two-way ANOVA (Fase II). Resultados. ANOVA mostrou que a adição de CDA não provocou alteração significativa na resistência à flexão dos materiais testados. A resistência à flexão é inversamente proporcional ao tempo para a resina Dencor e diretamente proporcional ao tempo para a resina Duralay. Houve aumento da microdureza com o acréscimo de CDA ao material Dencor com relação ao grupo controle, enquanto que no material Duralay a CDA não ...

Objectives. This study evaluated the effect of the incorporation of chlorhexidine diacetate salt hydrate (CDA) on the hardness, roughness and flexural strength (FS) of provisional crown and bridge acrylic resins. Methods. Step I: One hundred fifty specimens (3,0 mm X 10 mm X 64 mm) and one hundred fifty specimens (10 mm X 10 mm X 2,0 mm) of the autopolymerizing resins: Duralay (Reliance Dental Mfg. Co.) and Dencor (Clássico) were prepared, according to the ISO 1567 specification. The specimens were divided into 30 groups (n=10/group) according to the concentration of CDA (w/w): (A) 1%, (B) 2%, (C) 4%, (D) 5%, (E) 0% and the storage time in distilled water at 37°C, after mixing (T0 – 2h, T1 – 7 days, T2 – 30 days). The surface hardness was assessed using a Knoop Hardness test (KHN), the surface roughness measurements (Ra) were made using a surface roughness tester Mitutoyo Surftest SJ-201 (n=5) and the FS were tested using a 3-point bending test (n=5). Step II: Additionally, antibacterial study was performed by observing the presence of inhibition zone against Streptococcus mutans. For this test, 30 set disc-shaped specimens (12 mm X 3 mm) were prepared with the same 5 concentrations of chlorhexidine (n=3/group). Results. ANOVA showed that the addition of CDA had not a significantly lower effect on flexural strength of the tested materials. The flexural strength is inversely proportional to the time for Dencor and directly proportional for Duralay. There was a decrease of microhardness with the increase of CDA concentration on Dencor samples in relation to the control group, whereas the addition of CDA did not interfere in this property for Duralay. Surface roughness significantly increased (p<0,001) over time and increasing concentration of CDA for Dencor and did not cause significant change in Duralay. The agar diffusion test showed that all the tested groups had significant antibacterial activity against S. mutans, compared ...

In vitro antifungal activity of coumarin extracted from Loeselia mexicana Brand.

The bis-coumarin daphnoretin and its monomeric precursors scopoletin and umbelliferone were isolated for the first time from the aerial part of Loeselia mexicana Brand (a vegetal species used in Mexican traditional medicine) using chromatographic techniques. The structures of these compounds were determined by (1) H and (13) C NMR analyses. These coumarins were evaluated for in vitro antifungal activity. The three compounds tested showed significant antifungal activity.