Characterization of hepatic fatty acids using magnetic resonance spectroscopy for the assessment of treatment response to metformin in an eNOS-/- mouse model of metabolic nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease worldwide. Liver biopsy remains the gold standard for diagnosis and staging of disease. There is a clinical need for noninvasive diagnostic tools for risk stratification, follow-up, and monitoring treatment response that are currently lacking, as well as preclinical models that recapitulate the etiology of the human condition. We have characterized the progression of NAFLD in eNOS-/- mice fed a high fat diet (HFD) using noninvasive Dixon-based magnetic resonance imaging and single voxel STEAM spectroscopy-based protocols to measure liver fat fraction at 3 T. After 8 weeks of diet intervention, eNOS-/- mice exhibited significant accumulation of intra-abdominal and liver fat compared with control mice. Liver fat fraction measured by 1 H-MRS in vivo showed a good correlation with the NAFLD activity score measured by histology. Treatment of HFD-fed NOS3-/- mice with metformin showed significantly reduced liver fat fraction and altered hepatic lipidomic profile compared with untreated mice. Our results show the potential of in vivo liver MRI and 1 H-MRS to noninvasively diagnose and stage the progression of NAFLD and to monitor treatment response in an eNOS-/- murine model that represents the classic NAFLD phenotype associated with metabolic syndrome.

Assessment of hepatic fatty acids during non-alcoholic steatohepatitis progression using magnetic resonance spectroscopy.

INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver abnormalities including steatosis, steatohepatitis, fibrosis, and cirrhosis. Liver biopsy remains the gold standard method to determine the disease stage in NAFLD but is an invasive and risky procedure. Studies have previously reported that changes in intrahepatic fatty acids (FA) composition are related to the progression of NAFLD, mainly in its early stages. The aim of this study was to characterize the liver FA composition in mice fed a Choline-deficient L-amino-defined (CDAA) diet at different stages of NAFLD using magnetic resonance spectroscopy (MRS). METHODS: We used in-vivo MRS to perform a longitudinal characterization of hepatic FA changes in NAFLD mice for 10 weeks. We validated our findings with ex-vivo MRS, gas chromatography-mass spectrometry and histology. RESULTS: In-vivo and ex-vivo results showed that livers from CDAA-fed mice exhibit a significant increase in liver FA content as well as a change in FA composition compared with control mice. After 4 weeks of CDAA diet, a decrease in polyunsaturated and an increase in monounsaturated FA were observed. These changes were associated with the appearance of early stages of steatohepatitis, confirmed by histology (NAFLD Activity Score (NAS) = 4.5). After 10 weeks of CDAA-diet, the liver FA composition remained stable while the NAS increased further to 6 showing a combination of early and late stages of steatohepatitis. CONCLUSION: Our results suggest that monitoring lipid composition in addition to total water/fat with MRS may yield additional insights that can be translated for non-invasive stratification of high-risk NAFLD patients.

Lipoprotein receptor SR-B1 deficiency enhances adipose tissue inflammation and reduces susceptibility to hepatic steatosis during diet-induced obesity in mice.

Scavenger receptor class B type 1 (SR-B1) is a membrane lipoprotein receptor/lipid transporter involved in the pathogenesis of atherosclerosis, but its role in obesity and fatty liver development is unclear. Here, we determined the effects of SR-B1 deficiency on plasma metabolic and inflammatory parameters as well as fat deposition in adipose tissue and liver during obesity. To induce obesity, we performed high-fat diet (HFD) exposure for 12 weeks in male SR-B1 knock-out (SR-B1-/-, n = 14) and wild-type (WT, n = 12) mice. Compared to HFD-fed WT mice, plasma from HFD-fed SR-B1-/- animals exhibited increased total cholesterol, triglycerides (TG) and tumor necrosis factor-α (TNF-α) levels. In addition, hypertrophied adipocytes and macrophage-containing crown-like structures (CLS) were observed in adipose tissue from HFD-fed SR-B1 deficient mice. Remarkably, liver from obese SR-B1-/- mice showed attenuated TG content, dysregulation in hepatic peroxisome proliferator-activated receptors (PPARs) expression, increased hepatic TG secretion, and altered hepatic fatty acid (FA) composition. In conclusion, we show that SR-B1 deficiency alters the metabolic environment of obese mice through modulation of liver and adipose tissue lipid accumulation. Our findings provide the basis for further elucidation of SR-B1's role in obesity and fatty liver, two major public health issues that increase the risk of advanced chronic diseases and overall mortality.

Metabolite cycled liver 1 H MRS on a 7 T parallel transmit system.

INTRODUCTION: Single-voxel 1 H MRS in body applications often suffers from respiratory and other motion induced phase and frequency shifts, which lead to incoherent averaging and hence to suboptimal results. METHODS: Here we show the application of metabolite cycling (MC) for liver STEAM-localized 1 H MRS on a 7 T parallel transmit system, using eight transmit-receive fractionated dipole antennas with 16 additional, integrated receive loops. MC-STEAM measurements were made in six healthy, lean subjects and compared with STEAM measurements using VAPOR water suppression. Measurements were performed during free breathing and during synchronized breathing, for which the subjects did breathe in between the MRS acquisitions. Both intra-session repeatability and inter-session reproducibility of liver lipid quantification with MC-STEAM and VAPOR-STEAM were determined. RESULTS: The preserved water signal in MC-STEAM allowed for robust phase and frequency correction of individual acquisitions before averaging, which resulted in in vivo liver spectra that were of equal quality when measurements were made with free breathing or synchronized breathing. Intra-session repeatability and inter-session reproducibility of liver lipid quantification were better for MC-STEAM than for VAPOR-STEAM. This may also be explained by the more robust phase and frequency correction of the individual MC-STEAM acquisitions as compared with the VAPOR-STEAM acquisitions, for which the low-signal-to-noise ratio lipid signals had to be used for the corrections. CONCLUSION: Non-water-suppressed MC-STEAM on a 7 T system with parallel transmit is a promising approach for 1 H MRS applications in the body that are affected by motion, such as in the liver, and yields better repeatability and reproducibility compared with water-suppressed measurements.

Factors associated with occupational stress among nursing professionals in health services of medium complexity.

OBJECTIVE: To analyze the factors associated with occupational stress among nursing workers in health services of medium complexity. METHODS: Epidemiological, cross-sectional, exploratory study. A randomly selected sample of 126 nursing professionals from medium complexity services in three cities in the state of Bahia (Santo Antônio de Jesus, Feira de Santana and Itabuna) was investigated. Data were collected in 2011 and 2012. The demand-control model proposed by Karasek was used to assess occupational stress. Simultaneous analysis of occupational stressors was performed using Poisson regression with robust variance. RESULTS: The prevalence of occupational stress among nursing professionals was 77%. Occupational stress was associated with the professional category of nursing technician (p=0.01). CONCLUSION: The data indicates a concerning situation of exposure to occupational stressors, which requires coping strategies in order to protect the health of the worker.

Factors associated with occupational stress among nursing professionals in health services of medium complexity / Factores asociados al estrés laboral entre profesionales de enfermería en servicios de salud de mediana complejidad / Fatores associados ao estresse ocupacional entre profissionais de enfermagem em serviços de saúde de média complexidade

ABSTRACT Objective: To analyze the factors associated with occupational stress among nursing workers in health services of medium complexity. Methods: Epidemiological, cross-sectional, exploratory study. A randomly selected sample of 126 nursing professionals from medium complexity services in three cities in the state of Bahia (Santo Antônio de Jesus, Feira de Santana and Itabuna) was investigated. Data were collected in 2011 and 2012. The demand-control model proposed by Karasek was used to assess occupational stress. Simultaneous analysis of occupational stressors was performed using Poisson regression with robust variance. Results: The prevalence of occupational stress among nursing professionals was 77%. Occupational stress was associated with the professional category of nursing technician (p=0.01). Conclusion: The data indicates a concerning situation of exposure to occupational stressors, which requires coping strategies in order to protect the health of the worker.

RESUMEN Objetivo: analizar los factores asociados al estrés laboral entre trabajadores de enfermería de servicios de salud de mediana complejidad. Métodos: estudio epidemiológico, de diseño transversal y exploratorio. Se investigó una muestra de 126 profesionales de enfermería en tres municipios de Bahía. Los datos se recogieron durante los años 2011 y 2012. Para evaluar el estrés laboral, se utilizó el modelo demanda-control propuesto por Karasek. El análisis simultáneo de los factores laborales estresores se llevó a cabo mediante la regresión de Poisson con variancia robusta. Resultados: La prevalencia del estrés laboral entre profesionales de enfermería era del 77%. Dicho estrés estaba asociado a la categoría profesional de técnico/a de enfermería (p=0,01). Conclusión: Los datos demuestran la existencia de una situación preocupante en ese grupo, con exposición a estresores laborales, haciéndose necesario la adopción de estrategias de enfrentamiento a fin de garantizar una protección integral para la salud de los trabajadores.

RESUMO Objetivo: Analisar os fatores associados ao estresse ocupacional entre trabalhadores de enfermagem dos serviços de saúde de média complexidade. Métodos: Estudo epidemiológico, transversal, exploratório. Investigou-se amostra, aleatoriamente selecionada, de 126 profissionais de enfermagem dos serviços de média complexidade de três municípios na Bahia: Santo Antônio de Jesus, Feira de Santana e Itabuna. Os dados foram coletados nos anos de 2011 e 2012. Para avaliar o estresse ocupacional, utilizou-se o modelo demanda-controle, proposto por Karasek. A análise simultânea dos fatores ocupacionais estressores foi feita com emprego de regressão de Poisson com variância robusta. Resultados: A prevalência de estresse ocupacional entre profissionais de enfermagem foi de 77%. Estresse ocupacional associou-se à categoria profissional de técnico/a de enfermagem (p=0,01). Conclusão: Os dados evidenciam situação preocupante de exposição desse grupo a estressores ocupacionais, sendo necessária a adoção de estratégias de enfrentamento a fim de garantir proteção integral à saúde do/a trabalhador/a.

"Waiting for a miracle": Spirituality/Religiosity in coping with sickle cell disease / "Esperando un milagro": Espiritualidad/Religiosidad en el afrontamiento de la enfermedad de célula falciforme / "À espera de um milagre": espiritualidade/religiosidade no enfrentamento da doença falciforme

ABSTRACT Objective: To understand spirituality/religiosity as experienced by people with sickle cell disease, and its influence on coping with the disease. Method: A qualitative, descriptive, and exploratory study conducted in the State of Bahia. Twenty-nine respondents participated in semi-structured interviews. Content analysis was used to analyze the empirical material. Results: Individuals with sickle cell disease experience spirituality/religiosity motivated by their hope for a miracle, and fear of death; among their rites are: reading religious materials, individual and group prayer, and attendance at worship services. The effects on their health include: comfort by means of coping by comparing two evils, anxiety relief, social support, and lifestyle changes; however, spirituality/religiosity may be impaired. Final considerations: This study demonstrates the need to qualify health professionals to address spiritual issues of these individuals during illness, with the aims of diagnosing suffering and anguish, and providing care, comfort and strengthening of the spiritual bonds of these individuals.

RESUMEN Objetivo: Entender la espiritualidad / religiosidad como la experimentan las personas con enfermedad de células falciformes y su influencia en el afrontamiento de la enfermedad. Método: Un estudio cualitativo, descriptivo y exploratorio realizado en el estado de Bahía. Veintinueve encuestados participaron en entrevistas semiestructuradas. Se utilizó análisis de contenido para analizar el material empírico. Resultados: Las personas con enfermedad de células falciformes experimentan espiritualidad / religiosidad motivadas por su esperanza de un milagro y el miedo a la muerte; entre sus ritos se encuentran: lectura de materiales religiosos, oración individual y grupal, y asistencia a los servicios de adoración. Los efectos en su salud incluyen: comodidad mediante el manejo del afrontamiento, alivio de la ansiedad, apoyo social y cambios en el estilo de vida; sin embargo, la espiritualidad / religiosidad puede verse afectada. Consideraciones finales: Este estudio demuestra la necesidad de preparar a los profesionales de la salud para abordar los problemas espirituales de estos individuos durante la enfermedad, con el objetivo de diagnosticar el sufrimiento y la angustia, y de brindar atención, comodidad y fortalecimiento de los vínculos espirituales de estos individuos.

RESUMO Objetivo: Compreender a Espiritualidade/Religiosidade vivenciadas por pessoas com doença falciforme e sua influência sobre o enfrentamento da doença. Método: Estudo qualitativo, descritivo, exploratório, realizado no Estado da Bahia. Participaram 29 pessoas que responderam a entrevistas semiestruturadas. O material empírico foi submetido a análise de conteúdo. Resultados: Pessoas com doença falciforme vivenciam a Espiritualidade/Religiosidade motivadas pela esperança de um milagre e por medo da morte; seus ritos são as leituras de textos religiosos, orações individuais e em grupo, e frequência a cultos; os efeitos sobre sua saúde são: conforto através do coping de comparação, alívio da ansiedade, apoio social, mudança no estilo de vida, porém a Espiritualidade/Religiosidade podem manifestar-se prejudicadas. Considerações finais: Este estudo ressalta a necessidade da qualificação dos profissionais de saúde para a abordagem das questões espirituais dessas pessoas adoecidas, com a preocupação de diagnosticar possíveis sofrimentos, angústias e assim prestar auxílio, conforto e fortalecer os vínculos espirituais desses indivíduos.

"Waiting for a miracle": Spirituality/Religiosity in coping with sickle cell disease.

OBJECTIVE: To understand spirituality/religiosity as experienced by people with sickle cell disease, and its influence on coping with the disease. METHOD: A qualitative, descriptive, and exploratory study conducted in the State of Bahia. Twenty-nine respondents participated in semi-structured interviews. Content analysis was used to analyze the empirical material. RESULTS: Individuals with sickle cell disease experience spirituality/religiosity motivated by their hope for a miracle, and fear of death; among their rites are: reading religious materials, individual and group prayer, and attendance at worship services. The effects on their health include: comfort by means of coping by comparing two evils, anxiety relief, social support, and lifestyle changes; however, spirituality/religiosity may be impaired. FINAL CONSIDERATIONS: This study demonstrates the need to qualify health professionals to address spiritual issues of these individuals during illness, with the aims of diagnosing suffering and anguish, and providing care, comfort and strengthening of the spiritual bonds of these individuals.

Intrahepatic fatty acids composition as a biomarker of NAFLD progression from steatosis to NASH by using 1H-MRS.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world and it is becoming one of the most frequent cause of liver transplantation. Unfortunately, the only available method that can reliably determine the stage of this disease is liver biopsy, however, it is invasive and risky for patients. The purpose of this study is to investigate changes in the intracellular composition of the liver fatty acids during the progression of the NAFLD in a mouse model fed with Western diet, with the aim of identify non-invasive biomarkers of NAFLD progression based in 1H-MRS. Our results showed that the intracellular liver fatty acid composition changes as NAFLD progresses from simple steatosis to steatohepatitis (NASH). Using principal component analysis with a clustering method, it was possible to identify the three most relevant clinical groups: normal, steatosis and NASH by using 1H-MRS. These results showed a good agreement with the results obtained by GC-MS and histology. Our results suggest that it would be possible to detect the progression of simple steatosis to NASH using 1H-MRS, that has the potential to be used routinely in clinical application for screening high-risk patients.

Repercussões da dor social, gênero e pessoas com doença falciforme: um estudo exploratório / Social pain, gender, and people with sickle cell disease: an exploratory study / Dolor social, género y personas con enfermedad falciforme: estudio exploratorio

OBJETIVO: compreender as repercussões da dor social sobre os papéis de gênero de mulheres e homens com doença falciforme. MÉTODO: estudo qualitativo, exploratório, realizado num Centro de Referência em doença falciforme de um município do interior da Bahia. Os dados obtidos de desenhos estória-tema e entrevistas com 16 pessoas foram submetidos à análise de conteúdo temática. RESULTADOS: emergiram duas categorias: "A dor social nas mulheres com doença falciforme se expressa na impossibilidade de ser dona de casa, mãe e mulher sexuada" e "A dor social de homens com doença falciforme se expressa na dificuldade de manter-se trabalhador, ser provedor e homem sexualmente ativo". DISCUSSÃO: a exclusão do trabalho, as alterações da sexualidade e parentalidade interferem nos projetos de vida e mantém a reprodução de estereótipos de gênero. CONCLUSÃO: a escuta sensível numa abordagem de cuidado multiprofissional deve fazer parte do plano terapêutico de pessoas com doença falciforme.

AIM: Social pain, gender, and people with sickle cell disease: an exploratory study. METHOD: this is a qualitative and exploratory study and it was conducted in a Sickle Cell Disease Reference Center in a municipality in the interior of Bahia. The data obtained from theme-story drawings and interviews with 16 people were submitted to thematic content analysis. RESULTS: two categories have emerged: "Social pain in women with sickle cell disease is expressed in the impossibility of being a housewife, mother and woman sexually" and "The social pain of men with sickle cell disease is expressed in the difficulty of being a worker, a provider and a sexually active man". DISCUSSION: the exclusion of work, changes in sexuality and parenting interfere in life projects and maintain the reproduction of gender stereotypes. CONCLUSION: sensitive listening in a multiprofessional care approach should be part of the therapeutic plan for people with sickle cell disease.

OBJETIVO: compreender las repercusiones del dolor social sobre los papeles de género de mujeres y hombres con enfermedad de las células falciforme. MÉTODO: estudio cualitativo, exploratorio, realizado en un Centro de Referencia en enfermedad falciforme de un municipio del interior de Bahía. Los datos obtenidos de los dibujos historietas-tema y entrevistas con 16 personas se sometieron al análisis de contenido temático. RESULTADOS: emergieron dos categorías: "El dolor social en las mujeres con enfermedad falciforme se expresa en la imposibilidad de ser ama de casa, madre y mujer sexuada" y "El dolor social de hombres con enfermedad falciforme se expresa en la dificultad de mantenerse trabajando, ser proveedor y hombre sexualmente activo". DISCUSIÓN: la exclusión del trabajo, las alteraciones de la sexualidad y la vida parental, interfieren en los proyectos de vida y mantienen la reproducción de estereotipos de género. CONCLUSIÓN: la escucha sensibilizada en el abordaje de cuidado multiprofesional debe hacer parte del plan terapéutico de personas con enfermedad de células falciforme.

Self-care of men with priapism and sickle cell disease.

OBJECTIVE: To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory. METHOD: This is a descriptive exploratory study with qualitative approach conducted with nine men with a history of sickle cell disease and priapism. Data were analyzed using Orem's Self-Care Theory. RESULTS: Some demands were identified: from universal self-care - difficulty in social interaction and solitude, changes in self-image, self-esteem and sexual activity; from development - the experience with priapism and little knowledge about the pathophysiology of the disease; regarding health deviations - pain crises. CONCLUSION: Orem's theory allowed to identify self-care demands, which are essential for the nursing care provided for men with priapism. Nursing has an essential role in the measures for the different demands presented.

Self-care of men with priapism and sickle cell disease / Autocuidado de hombres con priapismo y enfermedad falciforme / Autocuidado de homens com priapismo e doença falciforme

ABSTRACT Objective: To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory. Method: This is a descriptive exploratory study with qualitative approach conducted with nine men with a history of sickle cell disease and priapism. Data were analyzed using Orem's Self-Care Theory. Results: Some demands were identified: from universal self-care - difficulty in social interaction and solitude, changes in self-image, self-esteem and sexual activity; from development - the experience with priapism and little knowledge about the pathophysiology of the disease; regarding health deviations - pain crises. Conclusion: Orem's theory allowed to identify self-care demands, which are essential for the nursing care provided for men with priapism. Nursing has an essential role in the measures for the different demands presented.

RESUMEN Objetivo: Identificar las demandas sobre autocuidado de hombres con enfermedad falciforme y priapismo y describir las medidas del autocuidado a la luz de la Teoría de Orem. Método: Se trata de una investigación descriptiva, exploratoria, de abordaje cualitativo, realizada entre nueve hombres con historia clínica de enfermedad falciforme y priapismo. El análisis de los datos se llevó a cabo según la Teoría del Autocuidado de Orem. Resultados: se identificaron algunas demandas: del autocuidado universal: dificultad de interacción social y soledad, alteraciones de la autoimagen y autoestima y actividad sexual; del desarrollo: la experiencia con el priapismo y el conocimiento insuficiente sobre la fisiopatología de la enfermedad; sobre desviaciones de la salud: crisis de dolor. Conclusión: La teoría de Orem permitió identificar las demandas del autocuidado, esenciales para la atención de enfermería en hombres con priapismo y resaltó la importancia de la enfermería acerca de las medidas a ser tomadas en las diferentes demandas.

RESUMO Objetivo: Identificar as demandas de autocuidado de homens com doença falciforme e priapismo e descrever as medidas de autocuidado à luz da Teoria do Autocuidado de Orem. Método: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa, com nove homens com história clínica de doença falciforme e priapismo. A análise dos dados foi realizada por meio da Teoria do Autocuidado de Orem. Resultados: Foram identificadas algumas demandas: de autocuidado universal - dificuldade de interação social e solidão, alterações na autoimagem e autoestima e atividade sexual; de desenvolvimento - a experiência com o priapismo o e pouco conhecimento sobre a fisiopatologia da doença; em relação a desvios de saúde - crises de dor. Conclusão: A teoria de Orem possibilitou identificar as demandas de autocuidado, que são essenciais para cuidado de enfermagem a homens com priapismo, e a importância da enfermagem frente às medidas para diferentes demandas apresentadas.

Antitumor activity and toxicity of volatile oil from the leaves of Annona leptopetala

Abstract Annona leptopetala (R.E.Fr.) H. Rainer, Annonaceae, is used in folk medicine like antitumor and anti-inflammatory. The aim of this study was to determine chemical composition, toxicity and antitumor activity of A. leptopetala leaves volatile oil. Fresh leaves were hydrodistilled and then the volatile oil chemical composition was assessed by gas chromatography and mass spectrometry. Toxicity was assessed using haemolysis, micronucleus and acute toxicity protocols. Antitumor effects were determined in vitro and in vivo, using sulforhodamine B assay and sarcoma 180 murine tumor model, respectively. Spathulenol was the major component identified (12.56%). The volatile oil showed in vitro antitumor activity mainly in leukemia cell line (K-562), with Total growth inhibit (TGI) (concentration producing TGI) of 0.64 µg/ml. In other hand, the volatile oil <250 µg/ml did not inhibit HaCat non-tumor cell line growth. The concentration that produced 50% haemolysis was 372.8 µg/ml. The 50% lethal dose in mice was approximately 447.2 mg/kg intraperitoneally. Sarcoma 180 tumor growth inhibition rates were 59.29% and 58.77% at 100 and 150 mg/kg intraperitoneally, respectively. The volatile oil presented moderate gastrointestinal toxicity and no genotoxicity was observed at 350 mg/kg. Thus, the volatile oil shows antitumor activity with moderate toxicity.

Characterization of pain resulting from perineal trauma in women with vaginal delivery / Caracterização da dor decorrente de traumas perineais em mulheres com parto vaginal

ABSTRACT BACKGROUND AND OBJECTIVES: Perineal pain in the puerperium of women with perineal traumas can affect the quality of life and interfere with normal activities and physiological needs. In addition, many obstetric practitioners neglect this symptom and an incipient scientific production about the characterization of this pain is observed. Therefore, this study aimed to compare the characteristics of perineal pain in women with perineal traumas due to episiotomy and laceration, according to the Brazilian Version of the McGill Pain Questionnaire, in a public maternity hospital in the interior of Bahia. METHODS: A cross-sectional study was carried out with 499 postpartum women who had a vaginal delivery and who presented with perineal pain associated with local traumas. RESULTS: The characterization of perineal pain was the same for both traumas, being described as "that jerk", "boring" and "uncomfortable". CONCLUSION: Perineal pain has considerable intensity and causes discomfort in women. Therefore, it is important that the episiotomy is performed in a restricted way and that the professionals seek to use techniques of perineal protection, as this will reduce the frequency of perineal pain and provide greater comfort to the woman in the immediate puerperium.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor perineal no puerpério de mulheres com traumas perineais pode afetar a qualidade de vida e interferir nas atividades habituais e necessidades fisiológicas. Além disso, muitos profissionais da prática obstétrica negligenciam esse sintoma e observa-se uma incipiente produção científica acerca da caracterização dessa dor. Sendo assim, este estudo teve o objetivo de comparar as características da dor perineal em mulheres com traumas perineais decorrentes de episiotomia e laceração, conforme dimensões da Versão Brasileira do Questionário de dor de McGill, em uma maternidade pública do interior da Bahia. MÉTODOS: Estudo transversal realizado com 499 puérperas que tiveram parto vaginal e que apresentaram dor perineal associada a traumas locais. RESULTADOS: A caracterização da dor perineal foi igual para ambos os traumas, sendo descrita como "que repuxa", "chata" e "incômoda". CONCLUSÃO: A dor perineal possui intensidade considerável e causa desconforto nas mulheres. Sendo assim, é importante que a episiotomia seja realizada de forma restrita e que os profissionais procurem utilizar técnicas de proteção perineal, pois, dessa forma, reduzirá a frequência de dor perineal e proporcionará maior conforto à mulher no puerpério imediato.

Caracterização das pessoas com doença falciforme em uma cidade do estado da bahia / Caracterización de las personas con la enfermedad falciforme en una ciudad del estado de bahia / Characterization of persons with falciform disease in a city of the state of bahia

Objetivo caracterizar as pessoas assistidas em um Centro de Referência em doença falciforme em uma cidade do estado da Bahia. Método estudo quantitativo, descritivo e retrospectivo, realizado entre agosto de 2016 e fevereiro de 2017. Os dados secundários coletados em 326 prontuários foram processados no STATA, versão 12.0. Resultados prevalência de adultos jovens, do sexo feminino, solteiras, pretas, com renda de até um salário mínimo, não alfabetizadas, protestantes, com até três filhos. As complicações prevalentes foram crise álgica, icterícia e alterações do baço. As medicações mais utilizadas foram ácido fólico, hidroxiureia, ibuprofeno e dipirona. Permaneceram em tratamento 67,79% das pessoas, enquanto 4,60% foram a óbito. Conclusão pessoas com doença falciforme assistidas em um centro de referência possuíam elevado grau de vulnerabilidade e estavam sujeitas à variabilidade clínica.

Objetivo caracterizar a las personas asistidas en un Centro de Referencia tratamiento de la enfermedad falciforme en una ciudad del estado de Bahía. Método estudio cuantitativo, descriptivo y retrospectivo, realizado entre agosto de 2016 y febrero de 2017. Los datos secundarios colectados en 326 prontuarios fueron procesados en el STATA, versión 12.0. Resultados prevalencia de adultos jóvenes, del sexo femenino, solteras, negras, con renta de hasta un salario mínimo, no alfabetizadas, protestantes, con hasta tres hijos. Las complicaciones prevalentes fueron crisis álgicas, ictericia y alteraciones en el bazo. Los medicamentos más utilizados fueron el ácido fólico, hidroxiurea, ibuprofeno y dipirona. Permanecieron en tratamiento 67,79% de las personas, y 4,60% terminaron en óbito. Conclusión las personas con enfermedad falciforme asistidas en un centro de referencia tenían un grado elevado de vulnerabilidad y estaban sujetas a la variabilidad clínica.

Objective to characterize people assisted in a sickle cell disease referral center in a city in the state of Bahia. Method quantitative, descriptive and retrospective study, performed between August 2016 and February 2017. Secondary data collected in 326 medical records were processed in STATA, version 12.0. Results prevalence of young adults, female, single, black, with income of up to one minimum wage, non-literate, Protestant, with up to three children. The prevalent complications were pain, jaundice, and spleen changes. The most commonly used medications were folic acid, hydroxyurea, ibuprofen and dipyrone. 67.79% of the patients remained in treatment, while 4.60% died. Conclusion people with sickle cell disease attended at a referral center had a high degree of vulnerability and were subject to clinical variability.

Brown Algae Padina sanctae-crucis Børgesen: A Potential Nutraceutical.

Padina sanctae-crucis Børgesen is distributed worldwide in tropical and subtropical seas; belongs to the Dictyotaceae family, and has proven to be an exceptional source of biologically active compounds. Four compounds were isolated and identified, namely: dolastane diterpene new for the genus Padina; phaeophytin and hidroxy-phaeophytin new for the family Dictyotaceae, and; mannitol first described in this species. Saturated fatty acids as compared to the percentages of unsaturated fatty acids were shown to be present in greater abundance. Palmitic and linolenic acid were the main saturated and unsaturated acids, respectively. Cytotoxic and antioxidant activities were evaluated using human erythrocytes. In vivo evaluations of acute toxicity and genotoxicity were performed in mice. Methanolic extract of P.sanctae-crucis presented antioxidant activity and did not induce cytotoxicity, genotoxicity or acute toxicity. Since Padina sanctae-crucis is already used as food, has essential fatty acids for the nutrition of mammals, does not present toxicity and has antioxidant activity, it can be considered as a potential nutraceutical.

Toxicity and antitumor potential of Mesosphaerum sidifolium (Lamiaceae) oil and fenchone, its major component.

BACKGROUND: The essential oil from Mesosphaerum sidifolium (L'Hérit.) Harley & J.F.B.Pastore (syn. Hyptis umbrosa), Lamiaceae (EOM), and its major component, have been tested for toxicity and antitumor activity. METHODS: EOM was obtained from aerial parts of M. sidifolium subjected to hydro distillation, and gas chromatography-mass spectrometry was used to characterize the EOM chemical composition. The toxicity was evaluated using haemolysis assay, and acute toxicity and micronucleus tests. Ehrlich ascites carcinoma model was used to evaluate the in vivo antitumor activity and toxicity of EOM (50, 100 and 150 mg/kg), and fenchone (30 and 60 mg/kg) after 9 d of treatment. RESULTS: The EOM major components were fenchone (24.8%), cubebol (6.9%), limonene (5.4%), spathulenol (4.5%), ß-caryophyllene (4.6%) and α-cadinol (4.7%). The HC50 (concentration producing 50% haemolysis) was 494.9 µg/mL for EOM and higher than 3000 µg/mL for fenchone. The LD50 for EOM was approximately 500 mg/kg in mice. The essential oil induced increase of micronucleated erythrocytes only at 300 mg/kg, suggesting moderate genotoxicity. EOM (100 or 150 mg/kg) and fenchone (60 mg/kg) reduced all analyzed parameters (tumor volume and mass, and total viable cancer cells). Survival also increased for the treated animals with EOM and fenchone. For EOM 150 mg/kg and 5-FU treatment, most cells were arrested in the G0/G1 phase, whereas for fenchone, cells arrested in the S phase, which represents a blockage in cell cycle progression. Regarding the toxicological evaluation, EOM induced weight loss, but did not induce hematological, biochemical or histological (liver and kidneys) toxicity. Fenchone induced decrease of AST and ALT, suggesting liver damage. CONCLUSIONS: The data showed EOM caused in vivo cell growth inhibition on Ehrlich ascites carcinoma model by inducing cell cycle arrest, without major changes in the toxicity parameters evaluated. In addition, this activity was associated with the presence of fenchone, its major component.

Study on patient dosimetry and image quality in digital mammography

Abstract Introduction Digital mammography present many advantages in comparison to conventional mammography, such as high dynamic range and the post-processing of acquired images. One problem is that protocols may not be optimized, resulting in higher absorbed doses to patients. The objective of this work is to evaluate image quality and to estimate mean glandular doses (MGD) in patients submitted to mammography examinations with three digital systems and one screen-film system in Recife, Brazil. Methods To estimate the MGD, the parameters used to acquire images of 5475 patients, with ages between 40 and 64 years and compressed breasts between 2 and 9 cm, were registered. The MGD was calculated by multiplying the incident air kerma with conversion coefficients depending on the anode/filter, breast glandularity and half-value layer. The image quality evaluation of the digital systems was made using objective and subjective European criteria. Results The results showed MGDs in the range of 0.4-10.3 mGy and the higher values were observed with digital systems. It was also observed that in the digital systems the use of compression force is not adequate and the irradiation parameters are not optimized. The images failed to reproduce the pectoral muscle and the contrast-to-noise ratio was not adequate for one system, indicating the need to improve the patient's positioning and the exposure parameters. Conclusion It can be concluded that the use of non-optimized irradiation parameters is causing the higher doses with digital systems, highlighting the insufficient compression force.

A expansão de vagas de residência de medicina de família e comunidade por municípios e o Programa Mais Médicos / Expanding family and community medicine residency vacancies by municipalities and the More Doctors Program / La expansión de plazas de residencia de medicina de familia y comunidad por municipios y el Programa Más Médicos

Este estudo visa identificar estratégias para criação ou expansão de vagas de seis programas de residência de Medicina de Família e Comunidade coordenados por gestores municipais do Sistema Único de Saúde (SUS) que podem contribuir para a universalização de vagas em residência médica e para o provimento médico em longo prazo previstos no Programa Mais Médicos (PMM). Foram analisados relatórios, legislação, publicações e registro de oficinas promovidas pelo Ministério da Saúde. Identificaram-se as seguintes estratégias: expansão da cobertura e melhoria da infraestrutura na Atenção Básica; qualificação e valorização da preceptoria; planejamento de legislação e do orçamento; integração com a graduação e outras residências. Conclui-se que iniciativas inovadoras de acordo com a realidade de cada município, combinadas com políticas nacionais, favoreceram o protagonismo de gestores municipais em mudanças na formação médica.(AU)

The aim of this study was to identify strategies to create or expand vacancies in six family and community medicine residency programs coordinated by municipal managers in the Brazilian National Health System (SUS). The aim of these strategies is to contribute to the universalization of medical residency vacancies and the long-term supply of physicians foreseen by the More Doctors Program. The researchers analyzed reports, legislation, publications, and records of workshops promoted by the Ministry of Health. The following strategies were identified: expanding coverage and improving infrastructure at the primary care level; qualifying and recognizing the importance of preceptorship; planning legislation and budgets; integration with undergraduate programs and residencies in other areas. The protagonist role of municipal managers in transforming medical education is favored by innovative national policies coupled with initiatives adapted to the reality of each municipality.(AU)

l objetivo de este estudio es identificar estrategias para la creación o expansión de plazas de seis programas de residencia de Medicina de Familia y Comunidad coordinados por gestores municipales del Sistema Brasileño de Salud (SUS) que pueden contribuir para la universalización de plazas de residencia médica y para la provisión médica a largo plazo previstos en el Programa Más Médicos. Se analizaron informes, legislación, publicaciones y registro de talleres promovidos por el Ministerio de la Salud. Se identificaron las estrategias siguientes: expansión de la cobertura y mejora de la infraestructura en la atención básica, calificación y valorización de la preceptoría, planificación de la legislación y del presupuesto, integración con la graduación y otras residencias. Se concluye que iniciativas innovadoras de acuerdo con la realidad de cada municipio, combinadas con políticas nacionales, favorecieron el protagonismo de gestores municipales en cambios en la formación médica.(AU)