The impact of gestational weight gain on fetal and neonatal outcomes: the Araraquara Cohort Study.

BACKGROUND: Gestational weight gain (GWG) is an important indicator for monitoring maternal and fetal health. OBJECTIVE: To evaluate the effect of GWG outside the recommendations of the Institute of Medicine (IOM) on fetal and neonatal outcomes. STUDY DESIGN: A prospective cohort study with 1642 pregnant women selected from 2017 to 2023, with gestational age ≤ 18 weeks and followed until delivery in the city of Araraquara, Southeast Brazil. The relationship between IOM-recommended GWG and fetal outcomes (abdominal subcutaneous tissue thickness, arm and thigh subcutaneous tissue area and intrauterine growth restriction) and neonatal outcomes (percentage of fat mass, fat-free mass, birth weight and length, ponderal index, weight adequateness for gestational age by the Intergrowth curve, prematurity, and Apgar score) were investigated. Generalized Estimating Equations were used. RESULTS: GWG below the IOM recommendations was associated with increased risks of intrauterine growth restriction (IUGR) (aOR 1.61; 95% CI: 1.14-2.27), low birth weight (aOR 2.44; 95% CI: 1.85-3.21), and prematurity (aOR 2.35; 95% CI: 1.81-3.05), and lower chance of being Large for Gestational Age (LGA) (aOR 0.38; 95% CI: 0.28-0.54), with smaller arm subcutaneous tissue area (AST) (-7.99 g; 95% CI: -8.97 to -7.02), birth length (-0.76 cm; 95% CI: -1.03 to -0.49), and neonatal fat mass percentage (-0.85%; 95% CI: -1.12 to -0.58). Conversely, exceeding GWG guidelines increased the likelihood of LGA (aOR 1.53; 95% CI: 1.20-1.96), with lower 5th-minute Apgar score (aOR 0.42; 95% CI: 0.20-0.87), and increased birth weight (90.14 g; 95% CI: 53.30 to 126.99). CONCLUSION: Adherence to GWG recommendations is crucial, with deviations negatively impacting fetal health. Effective weight control strategies are imperative.

Executive and attentional functions in patients with migraine / Funções executivas e atencionais em pacientes com enxaqueca

INTRODUCTION: Migraine is a disease that affects the overall performance of the patient, especially attention and executive functions (EF), with a direct impact on the person's functionality, highlighting the importance of studies in order to minimize its damage. OBJECTIVE: The objective of this study was to evaluate if there is a link between migraine and executive and attentional functions. METHODOLOGY: Observational study (44 subjects; 29 migraineurs and 15 non-migraineurs) on attentional and executive functioning changes in migraine. Subjects over 18 years of age were included in the study, regardless of gender, recruited for convenience at CAM FAME, FAME and Centro AMA, primary recruitment centers, following the criteria of the International Classification of Headache Disorders (ICHD-3). The participants underwent neuropsychological tests that estimated executive and attentional functioning. For attention, the Psychological Attention the Assessment Battery (AAB) was used, and for EF, the Five-Digit Test (FDT) was used. Student's t test, ANOVA, Mann-Whitney and/or Kruskal-Wallis U test were used, whose analyzes fixed the type I error at 0.05. RESULTS: All AAB subtests pointed to a reduction in the attentional potential in migraineurs when compared to the control group. The FDT showed lowering in the migraineurs group subjects, when compared with the non- migraineurs group. Multivariate analysis identified a relationship between EF, Attention and migraine (p<0.05). CONCLUSION: migraineurs present a decrease in executive functioning and attentional skills and an increase in execution time when compared to non-migraineurs individuals

INTRODUÇÃO: A enxaqueca é uma doença que afeta o desempenho global do paciente, principalmente a atenção e as funções executivas (FE), com impacto direto na funcionalidade da pessoa, destacando a importância de estudos a fim de minimizar seus danos. OBJETIVO: O objetivo deste estudo foi avaliar se existe ligação entre enxaqueca e funções executivas e atencionais. METODOLOGIA: Estudo observacional (44 indivíduos; 29 com enxaqueca e 15 sem enxaqueca) sobre alterações de atenção e funcionamento executivo na enxaqueca. Foram incluídos no estudo indivíduos maiores de 18 anos, independente do sexo, recrutados por conveniência no CAM FAME, FAME e Centro AMA, centros primários de recrutamento, seguindo os critérios da Classificação Internacional de Cefaleias (ICHD-3). Os participantes foram submetidos a testes neuropsicológicos que estimaram o funcionamento executivo e atencional. Para atenção foi utilizada a Bateria de Avaliação da Atenção Psicológica (AAB) e para FE foi utilizado o Teste de Cinco Dígitos (FDT). Foram utilizados teste t de Student, ANOVA, Mann-Whitney e/ou teste U de Kruskal-Wallis, cujas análises fixaram o erro tipo I em 0,05. RESULTADOS: Todos os subtestes da AAB apontaram redução do potencial atencional em enxaquecosos quando comparados ao grupo controle. O FDT apresentou redução nos indivíduos do grupo com enxaqueca, quando comparado com o grupo sem enxaqueca. A análise multivariada identificou relação entre FE, Atenção e enxaqueca (p<0,05). CONCLUSÃO: enxaquecosos apresentam diminuição do funcionamento executivo e das habilidades de atenção e aumento no tempo de execução quando comparados a indivíduos não enxaquecosos

Rivaroxaban versus warfarin in postoperative atrial fibrillation: Cost-effectiveness analysis in a single-center, randomized, and prospective trial.

Objectives: Postoperative atrial fibrillation is the most common clinical complication after coronary artery bypass graft surgery. It is associated with a high risk of both stroke and death and increases the length of hospital stay and costs. This study aimed to evaluate anticoagulants in postoperative atrial fibrillation. Methods: A single-center, randomized, prospective, and open-label study. The trial was conducted in Heart Institute at University of São Paulo, Brazil. Patients who developed postoperative atrial fibrillation were randomized to anticoagulation with rivaroxaban or warfarin plus enoxaparin bridging. The primary objective was the cost-effectiveness evaluated by quality-adjusted life years, using the SF-6D questionnaire. The secondary end point was the combination of death, stroke, myocardial infarction, thromboembolic events, infections, bleeding, readmissions, and surgical reinterventions. The safety end point was any bleeding using the International Society on Thrombosis and Haemostasis score. Follow-up period was 30 days after hospital discharge. Results: We analyzed 324 patients and 53 patients were randomized. The median cost-effectiveness was $1423.20 in the warfarin group versus $586.80 in the rivaroxaban group (P = .002). The median cost was lower in the rivaroxaban group, $450.20 versus $947.30 (P < .001). The secondary outcome was similar in both groups, 44.4% in warfarin group versus 38.5% in the rivaroxaban group (P = .65). Bleeding occured in 25.9% in the warfarin group versus 11.5% in the rivaroxaban group (P = .18). Conclusions: Rivaroxaban was more cost-effective when compared with warfarin associated with enoxaparin bridging in postoperative atrial fibrillation after isolated coronary artery bypass grafting.

Intervenção educativa de cuidados ao paciente portador de dispositivo cardíaco eletrônico implantável / Educational intervention for patient care with an implantable electronic heart device

Introdução: Entre os tratamentos atuais para controle de arritmias, os mais comuns são os dispositivos cardíacos eletrônicos implantáveis, capazes de controlar o ritmo do coração por meio de diferentes terapias, de acordo com as necessidades do paciente. Embora proporcionem maior longevidade às pessoas, a dependência de um dispositivo biomecânico geralmente exige mudança no estilo de vida do portador. Objetivos: Caracterizar o perfil sociográfico e clínico dos pacientes com dispositivos cardíacos eletrônicos implantáveis e identificar o conhecimento adquirido após intervenção educativa do enfermeiro. Material e Métodos: Pesquisa transversal, quantitativa, descritiva, com correlação entre as variáveis. Participaram 30 portadores de dispositivos, por meio de intervenção educativa do enfermeiro e uso de um folheto ilustrativo sobre cuidados pós-implante, disponibilizado ao paciente. Em seguida, foi realizada entrevista estruturada com questões referentes às orientações feitas sobre os cuidados. Resultados: A maioria dos participantes acertou todas as respostas sobre as recomendações de cuidados pós-operatórios de forma imediata. Quanto às orientações referentes ao tempo de repouso para voltar às atividades cotidianas, 28 (93,3%) acertaram; como proceder diante de detectores de metal 25 (83,3%) acertaram e sobre o uso de colchão magnético, 25 (83,3%) acertaram, demonstrando que estes conhecimentos precisam de maior esclarecimento. Conclusão: A intervenção educativa e o uso de folheto ilustrativo sobre cuidados pós-implante de dispositivos cardíacos implantáveis facilitou a explicação e propiciou a assimilação do conhecimento, sendo um recurso importante para o enfermeiro que atua na área cardiológica

Introduction: Among the current treatments for arrhythmias control, the most common are implantable electronic cardiac devices, capable of controlling the heart rhythm through different therapies, according to the needs of the patient. Although they provide greater longevity to people, dependence on a biomechanical device usually requires a change in the lifestyle of the carrier. Objectives: To characterize the sociographic and clinical profile of patients with implantable electronic cardiac devices and to identify the knowledge acquired after nurses' educational intervention. Material and Methods: Cross-sectional, quantitative, descriptive research, with correlation between variables. Thirty patients with devices participated, through the nurse's educational intervention and the use of an illustrative leaflet on post-implant care, made available to the patient. Then, a structured interview was conducted with questions regarding the guidelines made about care. Results: The majority of the participants answered all the recommendations for postoperative care immediately. Regarding the guidelines regarding rest time to return to daily activities, 28 (93.3%) agreed; how to proceed before metal detectors 25 (83.3%) agreed and on the use of magnetic mattress, 25 (83.3%) proved that this knowledge needs further clarification. Conclusion: The educational intervention and the use of illustrative leaflet on post-implantation care of implantable cardiac devices facilitated the explanation and provided the assimilation of knowledge, being an important resource for the nurse who works in the cardiological area

Introducción: Entre los tratamientos actuales para el control de la arritmia, los más comunes son los dispositivos cardíacos electrónicos implantables, capaces de controlar el ritmo cardíaco a través de diferentes terapias, según las necesidades del paciente. Si bien brindan a las personas una mayor longevidad, la dependencia de un dispositivo biomecánico suele requerir un cambio en el estilo de vida del usuario. Objetivos: Caracterizar el perfil sociográfico y clínico de pacientes portadores de dispositivos cardíacos electrónicos implantables e identificar los conocimientos adquiridos después de una intervención educativa por parte de enfermeros. Material y Métodos: Investigación transversal, cuantitativa, descriptiva, con correlación entre variables. Participaron 30 portadores de dispositivos, a través de una intervención educativa por parte de enfermeras y el uso de un tríptico ilustrativo sobre los cuidados post-implante, a disposición del paciente. Luego, se realizó una entrevista estructurada con preguntas sobre las pautas dadas sobre el cuidado. Resultados: La mayoría de los participantes acertaron en todas las recomendaciones de cuidados postoperatorios inmediatos. En cuanto a las orientaciones sobre el tiempo de descanso para la reincorporación a las actividades cotidianas, 28 (93,3%) fueron correctas; cómo proceder frente a los detectores de metales 25 (83,3%) fueron correctos y sobre el uso de un colchón magnético, 25 (83,3%) fueron correctos, lo que demuestra que este conocimiento necesita mayor aclaración. Conclusión: La intervención educativa y el uso de un tríptico ilustrativo sobre cuidados post-implante de dispositivos cardíacos implantables facilitó la explicación y facilitó la asimilación de conocimientos, siendo un recurso importante para los enfermeros que actúan en el área de cardiología

Ethnobotanical knowledge on native Brazilian medicinal plants traditionally used as anthelmintic agents - A review.

Intestinal helminthiasis is a neglected disease that affects a significant portion of the global population, specifically in developing countries, where medicinal plants are widely used for therapeutic purposes. With the purpose to identify the native species used in traditional Brazilian medicine for the management of helminthiasis, ethnopharmacological books edited in Brazil documenting the folk use of medicinal plants were analyzed. The native species cited in at least three studies were selected, and bibliographic research was performed using electronic databases to identify their scientifically validated anthelmintic properties. The search retrieved 133 native species belonging to 88 genera and 43 families from all six Brazilian biomes. Fabaceae (14 Genera and 25 Species) and Asteraceae (7 Genera and 8 Species) were the most frequently cited families. The most reported native species were Baccharis crispa Spreng., Hymenaea courbaril L., Senna occidentalis (L.) Link, Carapa guianensis Aubl., Stachytarpheta cayennensis (Rich.) Vahl, Annona glabra L., Hymenaea stigonocarpa Mart. ex Hayne, Spigelia anthelmia L., Simarouba versicolor A.St.-Hil. and Anacardium occidentale L. Bark (19%) and leaves (17%) were the most commonly used plant parts, and decoction (27%) was the most preferred method of preparation. Evidence of the anthelmintic properties of most species was confirmed using in vitro assays for key human and animal parasites, including Haemonchus contortus, Hymenolepis diminuta, Schistosoma mansoni and Trichostrongylus spp. The species S. alata, S. occidentalis, A. occidentale, and S. anthelmia have been the subject of many biological studies, supporting their use as vermicides. The overall results obtained in this review revealed that Brazil is rich in traditional herbal medicines used to manage helminthiasis; however pharmacological investigations are lacking to confirm their therapeutic properties. Thus, this study could serve as a baseline to validate their use and encourage further clinical investigation of their vermifuge potential.

Cancer care in the COVID-19 era and psychosocial impacts on oncology nursing in Brazil.

INTRODUCTION: Globally, Brazil has the third highest number of confirmed COVID-19 cases and the second highest number of deaths related to COVID-19 at the time of writing. Maintaining cancer care has been a challenge for patient safety and for the physical and mental health of oncology nurses. OBJECTIVES: To describe which effects of the COVID-19 pandemic on cancer care could already be evaluated and to identify the psychosocial impact on cancer nurses in Brazil. METHOD: Reflective, analytical, qualitative study. RESULTS: Although the Brazilian cancer care policy has reached important achievements in overcoming access barriers to cancer diagnosis and treatment over the past decade, the COVID-19 pandemic has caused losses of timely access to health services for patients with cancer, which has compromised screening, early diagnosis and treatment, and patient follow-up. Oncology nurses have actively participated in the management and assistance strategies during the pandemic. This path has generated an increase in oncology nurses' workload, leading to physical and mental stress and anxiety related to the fear of contagion for themselves and their family. CONCLUSION: The pandemic has affected the care of cancer patients, with the potential to suffer greater losses because of reductions in screening, early diagnosis and treatment, and patient follow-up. In addition to the worsening of the cancer setting, the COVID-19 pandemic has overwhelmed Brazilian oncology nurses, physically and mentally.

Effects of aquatic physiotherapy or health education program in women with fibromyalgia: a randomized clinical trial.

Background: Different treatments have been proposed for Fibromyalgia, but only few studies have compared their effects on multiples outcomes over time. Objective: The objective of this study was to investigate the effects of aquatic physiotherapy (AP) or a health education program (HEP) in a sample of women with Fibromyalgia (FM). Methods: Forty-six women with FM, aged between 25 and 60 years old, whose BMI was less than 30, were assigned to either AP (27 women) or HEP (19 women) groups in a blind randomized clinical trial lasting eleven weeks. Pain (McGill Pain questionnaire), fatigue (Piper Fatigue Scale-Revised), functional capability (Fibromyalgia Impact questionnaire), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and quality of sleep (Pittsburgh Sleep Quality Index) data were collected at baseline, after six weeks and post intervention. Two-factor mixed-model analysis of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable. Results: The AP and HEP interventions showed statistically significant within-group differences on all outcome measures except reducing the pain. Between-group differences was statistically significant only for impact of FM on the participant's life [F(1.82,80.41) = 31,99; p ≤ 0.01] indicating that patients receiving HEP experienced a greater decrease in FIQ than those treated with AP. Conclusion: The findings do not allow to affirm that one intervention is superior to the other for the treatment of people with FM. Future studies should investigate whether the combination of HEP and PA can be effective and long-lasting.

Pharmacological therapy and cardiovascular risk reduction for type 2 diabetes.

The pharmacological therapy for type 2 diabetes mellitus has presented important advances in recent years, which has impacted the treatment of patients with established cardiovascular disease or with high cardiovascular risk. In this scenario, two drug classes have emerged and demonstrated clear clinical benefits: SGLT-2 inhibitors and GLP-1 agonists. The present review discusses the pharmacology, adverse effects, and clinical trials that have demonstrated the benefits of these medications in reducing cardiovascular risk.

Pharmacological therapy and cardiovascular risk reduction for type 2 diabetes

SUMMARY The pharmacological therapy for type 2 diabetes mellitus has presented important advances in recent years, which has impacted the treatment of patients with established cardiovascular disease or with high cardiovascular risk. In this scenario, two drug classes have emerged and demonstrated clear clinical benefits: SGLT-2 inhibitors and GLP-1 agonists. The present review discusses the pharmacology, adverse effects, and clinical trials that have demonstrated the benefits of these medications in reducing cardiovascular risk.

RESUMO A terapia farmacológica do diabetes mellitus tipo 2 apresentou avanços importantes nos últimos anos, impactando principalmente o tratamento dos pacientes com doença cardiovascular estabelecida ou com alto risco cardiovascular. Nesse cenário, surgiram duas classes de fármacos com claros benefícios clínicos; os inibidores da SGLT-2 e os agonistas do GLP-1. Na presente revisão os autores discutem desde a farmacologia, efeitos adversos e também os estudos clínicos que demonstraram os benefícios dessas medicações na redução de risco cardiovascular.

A importância da humanização do cuidado em centro cirúrgico / The importance of humanization of care in surgical centre

Objetivos: relatar a experiência de um projeto de extensão que visou discutir com a equipe de enfermagem de um hospital universitário a humanização da assistência no centro cirúrgico. Métodos: pesquisa de campo exploratória, sendo utilizada de coleta de dados em grupo focal e aplicação de questionário. O cenário foi enfermarias cirúrgicas, masculina e feminina, e centro cirúrgico de um hospital universitário no município de Niterói/RJ, período de abril a dezembro de 2015. Os sujeitos foram 23 profissionais da equipe de enfermagem do centro cirúrgico e 8 pacientes em pós- operatório. Com os profissionais da equipe de enfermagem realizou­ se 4 encontros com a técnica de grupo focal, abordando temáticas de humanização. Para os pacientes em pós - operatório realizou­ se aplicação de questionário referente ao acolhimento pelos profissionais no centro cirúrgico. Os dados foram analisados e os resultados agrupados em categorias. Resultados: o acolhimento do usuário no centro cirúrgico é um cuidado fundamental, na medida em que se reconhece o ser humano valorizando seus sentimentos e emoções. A mecanização da assistência pode comprometer o atendimento humanizado e a tecnologia parece contribuir de forma pouco significava para a prática do cuidado humanizado. A busca de melhoria da qualidade da assistência contribui para que novos modelos sejam adotados, nos quais o conceito de humanização tem lugar garantido. Conclusões: o projeto permitiu sensibilizar a equipe de enfermagem em centro cirúrgico acerca da humanização, facilitando a discussão e reflexão em relação a maneiras de se desenvolver uma prática humanizada que atenda às necessidades holísticas daqueles sob hospitalização.

Objectives: to report the experience of an extension project that aimed to discuss with the nursing staff of a university hospital the humanization of assistance in the surgical centre. Methods: exploratory field research, using focal group data collection and questionnaire application. The scenario was surgical wards, male and female, and surgical centre of a university hospital in the city of Niterói/RJ, from April to December 2015. The subjects were 23 professionals from the surgical centre nursing team and 8 patients in the postoperative period. With the nursing team professionals, there were 4 meetings with the focal group technique, addressing humanization issues. For patients in the postoperative period there was application of a questionnaire regarding the reception by professionals in the surgical centre. The data were analysed and the results grouped into categories. Results: the reception of the user in the surgical centre is a fundamental care, as it recognizes the human being valuing his feelings and emotions. The mechanization of care can compromise humanized care and technology seems to contribute little to the practice of humanized assistance. The search for improvement in the quality of care contributes to the adoption of new models in which the concept of humanization is guaranteed. Conclusions: The project has made it possible to sensitize the surgical centre nursing team about humanization, facilitating discussion and reflection on ways to develop a humanized practice that meets the holistic needs of those under hospitalization.

Efeitos da doença e adequação da hemodiálise em pacientes com rigidez arterial / Efectos de la enfermedad y adecuación de la hemodiálisis en pacientes con rigidez arterial / Effects of disease and hemodialysis adequacy in patients with arterial stiffness

RESUMO Objetivos Analisar a adequação do tratamento hemodialítico em pacientes com rigidez arterial e associar os efeitos da doença renal com os fatores sociodemográficos e clínicos. Método Estudo epidemiológico, transversal realizado com 149 renais crônicos em tratamento de hemodiálise em hospital escola do interior do Estado de São Paulo. Utilizou-se para medida da rigidez arterial o aparelho de Dyna-MAPA®. Foram aplicados os testes de regressão linear multivariada, t Student e o qui-quadrado para os biomarcadores e a ocorrência de rigidez arterial. Resultados A maioria dos pacientes encontrava em idade produtiva, inativa profissionalmente, do sexo masculino, união estável, fazendo restrição hídrica e alimentar, com menos de 48 meses de tratamento dialítico; 36,9% dos pacientes apresentavam rigidez arterial. Os biomarcadores creatinina, ureia e fósforo estavam aumentados; hematócrito e hemoglobina estavam diminuídos, média de peso interdialítico de 2,34 ± 1,4 kg, e a maioria do Kt/V inadequado. Quanto aos efeitos da doença renal observou-se significância estatística com os inscritos na lista de transplantes, maior tempo de tratamento e aumento da creatinina. Conclusão Estes resultados podem proporcionar a diminuição da morbimortalidade cardiovascular nestes pacientes.

RESUMEN Objetivos Analizar la adecuación del tratamiento hemodialítico en pacientes con rigidez arterial y asociar los efectos de la enfermedad renal con los factores sociodemográficos y clínicos. Método Estudio epidemiológico, transversal realizado con 149 renales crónicos en tratamiento de hemodiálisis, en el interior del Estado de São Paulo. Utilizaron el instrumento para medir la rigidez arterial el aparato de Dyna-MAPA®. Se aplicaron los pruebas de Regresión Lineal Multivaria, t Student y el Chi-Cuadrado para los biomarcadores y la ocurrencia de rigidez arterial. Resultados La mayoría estaba en edad productiva, inactiva profesionalmente, del sexo masculino, en unión estable, haciendo restricción hídrica y alimentar y con menos de 48 meses de tratamiento dialítico y 36,9% de los pacientes presentaban rigidez arterial. Los biomarcadores creatinina, urea y fósforo estaban aumentados, hematocrito y hemoglobina estaban disminuidos, media de peso interdialítico de 2,34 ± 1,4 kg, y la mayoría del Kt / V inadecuado. En cuanto a los efectos de la enfermedad renal se observó significancia estadística con los inscritos en la lista de trasplantes, mayor tiempo de tratamiento y aumento de la creatinina. Conclusión: Se espera que estos resultados proporcionen la disminución de la morbimortalidad cardiovascular de estos pacientes.

ABSTRACT Objectives To analyze the adequacy of hemodialysis treatment in patients with arterial stiffness and to associate the effects of renal disease with sociodemographic and clinical factors. Method A cross-sectional epidemiological study with 149 chronic renal patients undergoing hemodialysis treatment, in the interior of the State of São Paulo. They used to measure arterial stiffness with the Dyna-MAPA® device. The tests statistical were multivariate linear regression, t Student and chi-square were applied to the biomarkers and the occurrence of arterial stiffness. Results Most were of productive age, professionally inactive, male, in a stable union, water, and food restriction, and with less than 48 months of dialysis treatment and 36.9% of patients had arterial stiffness. The biomarkers creatinine, urea, and phosphorus were increased, hematocrit and hemoglobin were decreased, mean interdialytic weight was 2.34 ± 1.4kg, and most of the Kt / V inadequate. The effects of renal disease were statistically significant with those enrolled in the transplant list, longer treatment time, and increased creatinine. Conclusion These results are expected to reduce cardiovascular morbidity and mortality in these patients.

Local and systemic effects caused by Crotalus durissus terrificus, Crotalus durissus collilineatus, and Crotalus durissus cascavella snake venoms in swiss mice.

INTRODUCTION: Crotalus envenomations cause serious complications and can be fatal without appropriate treatment. Venom isoforms present and inter/intraspecific variations in the venom composition can result in different symptoms presented by bites by snakes from the same species but from different geographical regions. We comparatively evaluated the local and systemic effects caused by Crotalus durissus terrificus (Cdt), C.d. collilineatus (Cdcolli), and C.d. cascavella (Cdcasc) envenomation. METHODS: Venom chromatography was performed. Proteolytic, phospholipase, and LAAO activities were analyzed. Edema, myotoxicity, hepatotoxicity, nephrotoxicity, and coagulation alterations were evaluated. RESULTS: The venom SDS-PAGE analyses found the presence of convulxin, gyroxin, crotoxin, and crotamine in Cdt and Cdcolli venoms. Crotamine was not present in the Cdcasc venom. Cdt, Cdcollli, and Cdcasc venoms had no proteolytic activity. Only Cdcasc and Cdt venoms had phospholipase activity. LAAO activity was observed in Cdcolli and Cdcasc venoms. Cdcolli and Cdcasc venoms caused 36.7% and 13.3% edema increases, respectively. Cdt venom caused a 10% edema induction compared to those by other venoms. All venoms increased TOTAL-CK, MB-CK, and LDH levels (indicating muscle injury) and ALT, AST, GGT, and ALP levels (markers of liver damage) and were able to induce a neuromuscular blockade. Urea and creatinine levels were also altered in both plasma and urine, indicating kidney damage. Only Cdcolli and Cdcasc venoms increased TAPP and TAP. CONCLUSIONS: Together, these results allow us to draw a distinction between local and systemic effects caused by Crotalus subspecies, highlighting the clinical and biochemical effects produced by their respective venoms.

Anti-biofilm Action of Chenopodium ambrosioides Extract, Cytotoxic Potential and Effects on Acrylic Denture Surface.

Considering the challenge to control Candida-associated denture stomatitis, the search for antifungal substances derived from natural sources has become a trend in the literature. In this study the following effects of Chenopodium ambrosioides extract (CAE) were investigated: action against biofilms of Candida albicans, its cytotoxic potential, and changes caused in acrylic resin. The CAE was characterized by High Performance Liquid Chromatography (HPLC). The susceptibility of C. albicans to CAE was investigated by Minimum Inhibitory Concentration and Minimum Fungicidal Concentration (MIC and MFC) tests. Acrylic resin disks were fabricated, and C. albicans biofilms were developed on these for 48 h. Afterward the disks were immersed for 10 min in: PBS (Negative Control); 1% Sodium Hypochlorite (1% SH, Positive Control) or CAE at MIC or 5xMIC. The biofilms were investigated relative to counts and metabolic activity. The cytotoxic potential in keratinocytes and fibroblasts was verified by MTT test. Change in color and roughness of the acrylic resin was analyzed after 28 days of immersion in CAE. The data were analyzed by the ANOVA considering a 5% level of significance. The main compounds detected by HPLC were kaempferol and quercetin. Both MIC and MFC obtained the value of 0.25 mg/mL. The MIC was sufficient to significantly reduce the counts and activity of the biofilm cells (p < 0.0001), while 5xMIC resulted in almost complete eradication, similar to 1% SH. Keratinocytes and fibroblasts exposed to the MIC and 5xMIC presented cell viability similar to that of the Control Group (p > 0.05). No important changes in acrylic resin color and roughness were detected, even after 28 days. It could be concluded that the immersion of acrylic resin in C. ambrosioides extract in its minimum inhibitory concentration was effective for the reduction of C. albicans biofilms without any evidence of cytotoxic effects or changes in roughness and color of this substrate.

Local and systemic effects caused by Crotalus durissus terrificus, Crotalus durissus collilineatus, and Crotalus durissus cascavella snake venoms in swiss mice

Abstract INTRODUCTION: Crotalus envenomations cause serious complications and can be fatal without appropriate treatment. Venom isoforms present and inter/intraspecific variations in the venom composition can result in different symptoms presented by bites by snakes from the same species but from different geographical regions. We comparatively evaluated the local and systemic effects caused by Crotalus durissus terrificus (Cdt), C.d. collilineatus (Cdcolli), and C.d. cascavella (Cdcasc) envenomation. METHODS: Venom chromatography was performed. Proteolytic, phospholipase, and LAAO activities were analyzed. Edema, myotoxicity, hepatotoxicity, nephrotoxicity, and coagulation alterations were evaluated. RESULTS: The venom SDS-PAGE analyses found the presence of convulxin, gyroxin, crotoxin, and crotamine in Cdt and Cdcolli venoms. Crotamine was not present in the Cdcasc venom. Cdt, Cdcollli, and Cdcasc venoms had no proteolytic activity. Only Cdcasc and Cdt venoms had phospholipase activity. LAAO activity was observed in Cdcolli and Cdcasc venoms. Cdcolli and Cdcasc venoms caused 36.7% and 13.3% edema increases, respectively. Cdt venom caused a 10% edema induction compared to those by other venoms. All venoms increased TOTAL-CK, MB-CK, and LDH levels (indicating muscle injury) and ALT, AST, GGT, and ALP levels (markers of liver damage) and were able to induce a neuromuscular blockade. Urea and creatinine levels were also altered in both plasma and urine, indicating kidney damage. Only Cdcolli and Cdcasc venoms increased TAPP and TAP. CONCLUSIONS: Together, these results allow us to draw a distinction between local and systemic effects caused by Crotalus subspecies, highlighting the clinical and biochemical effects produced by their respective venoms.

Inserção do acompanhante no processo gravídico-puerperal / Insertion of the companion in the pregnant-puerperal process

Objetivo: identificar as evidências científicas que apresentam a importância do acompanhante durante o processo gravídico-puerperal. Método: trata-se de um estudo bibliográfico, descritivo, do tipo revisão integrativa, que inclui artigos publicados em português, encontrados na íntegra, entre os anos de 2013 e 2019, indexados nas bases de dados BDENF e LILACS e na biblioteca virtual SciELO. Analisaram-se os dados a partir do agrupamento em categorias analíticas. Resultados: selecionaram-se e classificaram-se dez artigos em duas categorias: "Preparação do acompanhante durante o pré-natal para a sua atuação ativa no contexto do nascimento" e "Aspectos relevantes para a inserção do acompanhante no processo gravídico-puerperal". Conclusão: constatou-se que a inserção do acompanhante no processo gravídico-puerperal é fundamental para a garantia e efetividade de etapas que garantem à parturiente diferentes benefícios, como a redução de tensões, medos, da duração do trabalho de parto, da incidência de depressão pós-parto e de cesariana.(AU)

Objective: to identify the scientific evidences that present the importance of the companion during the pregnancypuerperal process. Method: this is a descriptive bibliographic, integrative review study, which includes articles published in Portuguese, found in full between 2013 and 2019, indexed in the BDENF and LILACS databases and in the SciELO virtual library. Data was analyzed from grouping into analytical categories. Results: ten articles were selected and classified into two categories: "Preparation of the companion during prenatal care for her active performance in the context of birth" and "Relevant aspects for the insertion of the companion in the pregnancy-puerperal process". Conclusion: it was found that the insertion of the companion in the pregnancy-puerperal process is fundamental for the guarantee and effectiveness of steps that guarantee the parturient different benefits, such as reduction of tensions, fears, duration of labor, incidence of postpartum depression and caesarean section.(AU)

Objetivo: identificar las evidencias científicas que presentan la importancia del acompañante durante el proceso embarazo-puerperal. Método: este es un estudio descriptivo de revisión bibliográfica e integradora, que incluye artículos publicados en portugués, encontrados en su totalidad entre 2013 y 2019, indexados en las bases de datos BDENF y LILACS y en la biblioteca virtual SciELO. Los datos se analizaron desde la agrupación en categorías analíticas. Resultados: se seleccionaron diez artículos y se clasificaron en dos categorías: "Preparación del acompañante durante el prenatal para su desempeño activo en el contexto del nacimiento" y "Aspectos relevantes para la inserción del acompañante en el proceso embarazo-puerperal". Conclusión: se comprobó que la inserción del acompañante en el proceso embarazo-puerperal es fundamental para la garantía y efectividad de los pasos que garantizan a la parturienta los diferentes beneficio, como la reducción de tensiones, miedos, duración del parto, incidencia de depresión postparto y cesárea.(AU)

Thromboembolic Events Related to Treatment with Checkpoint Inhibitors: Report of Two Cases.

Despite the significant clinical benefits, checkpoint inhibition is associated with a unique spectrum of immune-related adverse events. It is sometimes difficult to distinguish some rare adverse effects from a cancer progression; thus, such effects should be reported in clinical trials to be diagnosed by physicians. Only a few cases of arterial embolic events have been described in studies related to patients treated by immunotherapy. In this article, we report the cases of 2 patients who presented rare and severe thromboembolic events after using checkpoint inhibitors. The first case describes multiple organ embolism at the same time, associated with other autoimmune symptoms. In the second case, distal digital necrosis emerged after the initiation of immunotherapy. There is insufficient data about the real incidence of thromboembolic and rheumatological events related to checkpoint inhibition. Future trials should be done to establish preventive strategies.

Local and systemic effects of BdipTX-I, a Lys-49 phospholipase A2 isolated from Bothrops diporus snake venom.

The present work aimed to isolate a basic phospholipase A2 (PLA2) from Bothrops diporus snake venom (BdV), evaluate and compare the myotoxic and oedema-inducing activities, as well as the systemic effects caused by both the isolated PLA2 and BdV on Swiss mice. A Lys-49 PLA2 (BdipTX-I) was obtained through two chromatographic steps: an ion-exchange and a reverse phase. The local (oedema and myotoxicity) and systemic (hepatic and renal functions) effects were then assessed for BdipTX-I and BdV. Results showed that the oedema-inducing activity was significant in all tested doses (5 and 20 µg/paw) for both BdipTX-I and BdV. Myotoxicity was evaluated by the increase of serum CK, CK-MB and LDH, and results showed that BdV effect is more prominent than BdipTX-I effect. The systemic effects were evaluated by determining specific laboratory markers: AST, ALT, GGT, ALP, urea, creatinine, protein and calcium. BdipTX-I and BdV were able to induce renal changes in the experimental model, leading to proteinuria (induced both by BdipTX-I and by BdV) and uremia (induced only by BdV). Thus, it is concluded that the systemic effects of BdV and BdipTX-I occur differently.

Movimento social de bairro: potencialidades e limites da participação em conselhos locais de saúde num município de interior no nordeste brasileiro / Social movement of neighborhood: potentialities and limits of participation in local health councils in a municipality of interior in the brazilian northeast

Objetivo: Compreender potencialidades e limites da experiência de ser conselheiro local de saúde, segundo a realidade de um município de interior, no nordeste brasileiro, e de acordo com as próprias representações desses cidadãos quanto à participação popular e controle social. Metodologia: Estudo qualitativo, exploratório, com técnica de observação sistemática e entrevista semiestruturada realizado com 14 conselheiros, em Feira de Santana/BA. Os dados foram submetidos à análise de conteúdo temático-categorial. Resultados: Dos participantes da pesquisa, nove eram homens e cinco eram mulheres. A ocupação predominante foi a de agentes comunitários de saúde. O desenvolvimento da autonomia em manifestações sociais de interesse às políticas públicas, a construções de relações interpessoais de convivência coletiva, o sentimento de representar uma comunidade de pessoas e liderar a manifestação de interesses sociais locais foram as principais potencialidades identificadas. Os limites experienciados residem na pouca assiduidade dos conselheiros às reuniões, pouco apoio da comunidade onde o conselho está implantado, ações de cooptação política que tentam inviabilizar as atividades deliberativas do conselho, autoritarismo e pouca transparência da gestão municipal, além da precária estrutura física, que dificulta o desenvolvimento das atividades do conselho. Considerações finais: O desenvolvimento de atividades de educação permanente pode ser considerado como uma estratégia para a superação dos limites evidenciados pelo estudo. Tais atividades podem produzir afetividade nas pessoas em prol da maior participação no Conselho Local de Saúde, como induzir os gestores a refletirem sobre a responsabilidade com a transparência dos atos administrativos e com a construção de políticas participativas. Cabe ainda explorar outros mecanismos de participação social que podem ser agenciados, principalmente aqueles implicados em ações externas à estrutura estatal, como os Fóruns Populares de Saúde, que não configuram instâncias previstas em lei. (AU)

Understand the potentialities and experience limits to be a local counselors of health, in the reality from city of countryside, in Brazilian northeast, according to the representations of these people about popular participation and social control. Methodology: Qualitative study, exploratory, with observation technical systemic and semi structure interview realized with 14 counselors, in Feira de Santana/BA. The dates were submitted for analysis of content thematic- categorial. Results: The Research participants, nine were men and five were women. The predominant occupation was of community agents of health. The development of autonomy in the social manifestations of interest public policy, the construction of interpersonal relationship of collective coexistence, the feeling of represent a community of people and lead the manifestation of social interest local were the main potentialities identified. The limits experienced living in the low attendance of counselors on the meeting, low support of community where the council is it, actions of political cooptation that try to impede the deliberative activities of the council, authoritarianism and low transparency of municipal management, beyond of precarious physical structure that hinders the development of council activities. Final considerations: The development of education activities can be considerate ass a strategy for overcoming of limits evidenced on study. Such actions can produce affectivity on people to better participation on local council of health, like to induce managers to reflect on responsibility for the transparency of administrative acts and with the construction of participatory politics. Still exploring other mechanisms of social participation that can be agitated, mainly those implicated in extern actions on state structure, like the popular health forum, and that not configure instances in law.(AU)

Percepções de estudantes de enfermagem referente à qualidade de vida na trajetória acadêmica / Undergraduate nursing students' perceptions in relation to quality of life in academic trajectory

Objetivo: compreender as percepções dos estudantes de enfermagem relacionadaà Qualidade de Vida (QV) durante a trajetória acadêmica em uma Universidade PúblicaFederal. Método: estudo exploratório, qualitativo, realizado com 14 estudantes de umaUniversidade Pública Federal, entre agosto e outubro de 2012. Os instrumentos de coleta dedados foram a entrevista semiestruturada e o diário de campo, com posterior análise deconteúdo. Resultados: Emergiram duas categorias: “A universidade... Entre promotora e nãopromotora da qualidade de vida” e “Estágio Supervisionado e Trabalho de Conclusão deCurso como causa dos problemas de saúde”. As dimensões promotoras da QV foram:atividades em grupo, interação entre comunidade científica-comunidade e, conhecimentostransformados na universidade. Quanto às não promotoras da QV percebe-se: alimentaçãoinadequada; exigência dos docentes; extensa carga horária e demanda de tempo elevada; eatividades práticas das disciplinas. Conclusão: Infere-se a necessidade de adaptações natrajetória acadêmica para assegurar uma melhoria na QV.

Aim: to understand the perceptions of nursing students related to Quality ofLife (QL) during the academic trajectory at a Federal Public University. Method: anexploratory, qualitative study carried out with 14 students from a Federal Public Universitybetween August and October 2012. The instruments of data collection were thesemistructured interview and the field diary, with subsequent content analysis. Results: Twocategories emerged: "The university ... either promoter and non-promoter of quality of life"and "Supervised Internship and Course Conclusion Paper as the cause of health problems".The promoting dimensions of QL are: group activities, interaction between communityscientificcommunity, and the knowledge transformed in the university. Regarding the nonpromotersof QL, we can see: inadequate feeding; Teachers' requirements; Extensiveworkload and high time demand; and, practical activities of the subjects. Conclusion: Thereis a need for adaptation in the academic journey to obtain an improvement in the QL.

Objetivo: Comprender las percepciones de los estudiantes de enfermeríarelacionadas a la Calidad de Vida (CV) durante la trayectoria académica en unaUniversidad Pública Federal. Método: estudio exploratorio, cualitativo, realizado con 14estudiantes de una Universidad Pública Federal, entre agosto y octubre de 2012. Losinstrumentos de recolección de datos fueron la entrevista semiestructurada y el diario decampo, con posterior análisis del contenido. Resultados: fueron identificadas dos categorías:"La universidad ... Entre promotora y no promotora de la calidad de vida" y "PrácticaSupervisada y Trabajo de Conclusión de Curso como causas de los problemas de salud". Lasdimensiones promotoras de la CV fueron: actividades en grupo, interacción entre comunidadcientífica-comunidad y conocimientos transformados en la universidad. Mientras las nopromotoras de la CV fueron: alimentación inadecuada; exigencia de los docentes; extensacarga horaria y demanda de tiempo elevado; así como actividades prácticas de lasdisciplinas. Conclusión: Se infiere la necesidad de adaptaciones en la trayectoria académicapara asegurar una mejoría en la CV.