Formação da identidade profissional de enfermeiros para o trabalho no sistema prisional / Development of the professional identity of nurses to work in the prisonal system / Formación de la identidad profesional de los enfermeros para trabajar en el sistema penitenciario

Objetivo:analisar elementos motivadores da construção da identidade profissional de enfermeiros do sistema prisional. Método: estudo histórico-social, qualitativo, sob o método de triangulação de fontes orais e documentais coletados de maio a dezembro de 2020, iluminado pelo referencial foucaultiano. Protocolo de pesquisa aprovado pelo Comitê de Ética e Pesquisa da instituição signatária. Resultados: a realização de concurso público para o sistema prisional foi motivada pela aquisição de estabilidade. Os enfermeiros concursados eram despreparados para cuidar de pessoas presas. A disciplina e os poderes exercidos pelos guardas e presos surpreenderam estes enfermeiros, que precisaram se adaptar ao sistema num contexto social marcado pela violência urbana. Considerações finais: destaca-se, na construção da identidade destes profissionais, a capacidade para contornar medos e inseguranças, exercício de poder disciplinar e normatização do cuidado para o enfrentamento do cotidiano do trabalho. Emerge a necessidade de capacitação de enfermeiros nesta área na formação profissional(AU)

Objective: to analyze elements that motivate the construction of the professional identity of nurses in the prison system. Method: historical-social, qualitative study, under the method of triangulation of oral and documental sources collected from May to December 2020, illuminated by the Foucaultian reference. Approved by the Ethics and Research Committee. Results: the holding of a public tender for the prison system was motivated by the acquisition of stability. The registered nurses were unprepared to take care of prisoners. The discipline and powers exercised by guards and prisoners surprised these nurses, who had to adapt to the system in a social context marked by urban violence. Final considerations: in the construction of the identity of these professionals, the ability to overcome fears and insecurities, exercising disciplinary Power and standardizing care for coping with daily work is highlighted. The need to train nurses in thisarea in professional training emerges(AU)

Objetivo: analizar elementos que motivan la construcción de la identidad profesional de las enfermeras en el sistema penitenciario. Método: estudio histórico-social, cualitativo, iluminado por el referente foucaultiano, que utiliza el método de triangulación de fuentes orales y documentales recolectadas de mayo a 20 de diciembre. El Comité de Ética en Investigación de la institución firmante aprobó el protocolo de investigación. Resultados: la realización de un concurso público para el sistema penitenciario estuvo motivada por la adquisición de estabilidad. Los enfermeros aprobados por ese concurso público no estaban preparados para cuidar a los presos. La disciplina y los poderes que ejercían los guardias y presos sorprendieron a estos enfermeros, que debieron adaptarse al sistema en un contexto social marcado por la violencia urbana. Consideraciones finales: en la construcción de la identidad de estos profesionales se destaca la capacidad de superación de miedos e inseguridades, ejercicio de poder disciplinario y estandarización de los cuidados para hacer frente al cotidiano del trabajo. Surge la necesidad de capacitar a enfermeros en esta área en la formación profesional(AU)

Prenatal exposition to haloperidol: A preclinical narrative review.

Pre-existing maternal mental disorders may affect the early interactions between mother and baby, impacting the child's psychoemotional development. The typical antipsychotic haloperidol can be used during pregnancy, even with some restrictions. Its prescription is not limited to psychotic disorders, but also to other psychiatric conditions of high incidence and prevalence in the woman's fertile period. The present review focused on the preclinical available data regarding the biological and behavioral implications of embryonic exposure to haloperidol. The understanding of the effects of psychotropic drugs during neurodevelopment is important for its clinical aspect since there is limited evidence regarding the risks of antipsychotic drug treatment in pregnant women and their children. Moreover, a better comprehension of the mechanistic events that can be affected by antipsychotic treatment during the critical period of neurodevelopment may offer insights into the pathophysiology of neurodevelopmental disorders. The findings presented in this review converge to the existence of several risks associated with prenatal exposure to such medication and emphasize the need for further studies regarding its dimensions.

Consequences of oxygen deprivation on myelination and sex-dependent alterations.

Oxygen deprivation is one of the main causes of morbidity and mortality in newborns, occurring with a higher prevalence in preterm infants, reaching 20 % to 50 % mortality in newborns in the perinatal period. When they survive, 25 % exhibit neuropsychological pathologies, such as learning difficulties, epilepsy, and cerebral palsy. White matter injury is one of the main features found in oxygen deprivation injury, which can lead to long-term functional impairments, including cognitive delay and motor deficits. The myelin sheath accounts for much of the white matter in the brain by surrounding axons and enabling the efficient conduction of action potentials. Mature oligodendrocytes, which synthesize and maintain myelination, also comprise a significant proportion of the brain's white matter. In recent years, oligodendrocytes and the myelination process have become potential therapeutic targets to minimize the effects of oxygen deprivation on the central nervous system. Moreover, evidence indicate that neuroinflammation and apoptotic pathways activated during oxygen deprivation may be influenced by sexual dimorphism. To summarize the most recent research about the impact of sexual dimorphism on the neuroinflammatory state and white matter injury after oxygen deprivation, this review presents an overview of the oligodendrocyte lineage development and myelination, the impact of oxygen deprivation and neuroinflammation on oligodendrocytes in neurodevelopmental disorders, and recent reports about sexual dimorphism regarding the neuroinflammation and white matter injury after neonatal oxygen deprivation.

The impact of antidepressants on human neurodevelopment: Brain organoids as experimental tools.

The use of antidepressants during pregnancy benefits the mother's well-being, but the effects of such substances on neurodevelopment remain poorly understood. Moreover, the consequences of early exposure to antidepressants may not be immediately apparent at birth. In utero exposure to selective serotonin reuptake inhibitors (SSRIs) has been related to developmental abnormalities, including a reduced white matter volume. Several reports have observed an increased incidence of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) after prenatal exposure to SSRIs such as sertraline, the most widely prescribed SSRI. The advent of human-induced pluripotent stem cell (hiPSC) methods and assays now offers appropriate tools to test the consequences of such compounds for neurodevelopment in vitro. In particular, hiPSCs can be used to generate cerebral organoids - self-organized structures that recapitulate the morphology and complex physiology of the developing human brain, overcoming the limitations found in 2D cell culture and experimental animal models for testing drug efficacy and side effects. For example, single-cell RNA sequencing (scRNA-seq) and electrophysiological measurements on organoids can be used to evaluate the impact of antidepressants on the transcriptome and neuronal activity signatures in developing neurons. While the analysis of large-scale transcriptomic data depends on dimensionality reduction methods, electrophysiological recordings rely on temporal data series to discriminate statistical characteristics of neuronal activity, allowing for the rigorous analysis of the effects of antidepressants and other molecules that affect the developing nervous system, especially when applied in combination with relevant human cellular models such as brain organoids.

Identidade profissional do enfermeiro do Sistema Prisional do Estado do Rio de Janeiro (1998 ­ 2004) / The nurse's professional identity in the Prison System of Rio de Janeiro state

Pesquisa histórico-social, qualitativa, cujo objeto é o processo de construção da identidade profissional do enfermeiro das unidades hospitalares do sistema prisional do Estado do Rio de Janeiro durante o período de 1998-2004. Tal período corresponde à entrada do primeiro grupo de funcionários estatutários que realizaram concurso para o antigo DESIPE, a partir do tema escolhido para esta tese de doutorado. Levantaram-se os seguintes questionamentos: como foi o ingresso dos enfermeiros concursados para o sistema de saúde prisional do Estado do Rio de Janeiro no espaço institucional? Os enfermeiros estavam preparados para prestar cuidados em unidades de saúde prisionais? É possível identificar características identitárias próprias do enfermeiro do sistema prisional? Os objetivos da pesquisa são: historicizar o início dos cuidados em saúde no sistema prisional brasileiro; descrever as experiências dos primeiros enfermeiros concursados ao ingressarem no sistema de saúde prisional; analisar a identidade profissional do enfermeiro construída a partir do sistema hospitalar-disciplinar prisional. Metodologia: as fontes incluíram documentos escritos, e as fontes orais foram produzidas por meio da História Oral Temática, segundo um roteiro. Foram entrevistados seis colaboradores. Os documentos foram classificados segundo os objetivos a serem alcançados, realizando-se a crítica interna e externa aos documentos. A fundamentação teórica deu-se a partir de Michael Foucault, que trata sobre as prisões e a disciplinarização do corpo. Esta pesquisa tem a aprovação do Comitê de Ética em Pesquisa da Escola de Enfermagem Anna Nery/Instituto de Atenção à Saúde São Francisco de Assis/UFRJ. Resultados: este estudo confirma a tese de que os enfermeiros que ingressaram nos hospitais do sistema prisional por meio do concurso público de 1998 tiveram que se adaptar ao contexto sociocultural de tais espaços disciplinares, o que levou à construção de uma identidade profissional com características inerentes ao cuidado à população encarcerada, o que permitiu ao grupo inserir-se na pirâmide disciplinar e adquirir um saber/poder próprio para tornar plausível o exercício do cuidado de enfermagem, tendo em vista a segurança do paciente e a própria segurança física. Conclusão: o processo de adaptação desses profissionais, a tensão presente no espaço de atendimento e a expectativa de ser agredido pelos pacientes estavam continuamente presentes, ainda mais no contexto histórico social da violência do Rio de Janeiro, dividido em facções criminosas, com elevado poder de controle das comunidades, estendendo-se até o sistema prisional. A identidade do profissional enfermeiro que trabalha em unidades de saúde do sistema prisional é constituída de elementos subjetivos que definem um poder silencioso, gerando incerteza e insegurança aos profissionais, independente da equipe em que está inserido. Destaca-se, na história dos enfermeiros do concurso de 1998, a necessidade de adequação às normas de segurança e às responsabilidades que precisam assumir em relação não somente à saúde das pessoas privadas de liberdade, mas também às questões legais. Diante disso, as atribuições dos enfermeiros são maiores no sistema prisional, pois, junto ao cuidado das pessoas, é preciso desenvolver ações de vigilância e controle do próprio trabalho.

This is a historical-social, qualitative research whose object is the process of construction of the professional identity of nurses in the hospital units of the prison system of the State of Rio de Janeiro during the period 1998-2004. This period corresponds to the entry of the first group of statutory employees who took part in the competition for the former DESIPE, based on the theme chosen for this doctoral thesis. The following questions were raised: how did the nurses who applied to the prison health system of the State of Rio de Janeiro enter the institutional space? Were the nurses prepared to provide care in prison health units? Is it possible to identify the identity characteristics of nurses in the prison system? The objectives of the research are: to historicize the beginning of health care in the Brazilian prison system; to describe the experiences of the first registered nurses when they entered the prison health system; to analyze the professional identity of nurses built from the prison hospitaldisciplinary system. Methodology: The sources included written documents, and the oral sources were produced through Thematic Oral History, according to a script. Six collaborators were interviewed. The documents were classified according to the objectives to be achieved, performing internal and external criticism of the documents. The theoretical basis was based on Michael Foucault, who deals with prisons and the disciplinarization of the body. This research has the approval of the Research Ethics Committee of the Anna Nery School of Nursing/Institute of Health Care São Francisco de Assis/UFRJ. Results: This study confirms the thesis that nurses who entered prison hospitals through the 1998 public examination had to adapt to the sociocultural context of such disciplinary spaces, which led to the construction of a professional identity with characteristics inherent to the care of the incarcerated population, which allowed the group to insert itself into the disciplinary pyramid and acquire its own knowledge/power to make the exercise of nursing care plausible, with a view to patient safety and physical safety itself. Conclusion: the adaptation process of these professionals, the tension present in the care space and the expectation of being attacked by patients were continuously present, even more so in the historical social context of violence in Rio de Janeiro, divided into criminal factions, with high power of control of communities, extending to the prison system. The identity of the professional nurse working in health units of the prison system is made up of subjective elements that define a silent power, generating uncertainty and insecurity to professionals, regardless of the team in which they are inserted. In the history of the nurses of the 1998 competition, the need to adapt to safety standards and the responsibilities they need to assume in relation not only to the health of people deprived of their liberty, but also to legal issues is highlighted. In view of this, the duties of nurses are greater in the prison system, because, along with the care of people, it is necessary to develop surveillance and control actions of their own work.

Se trata de una investigación cualitativa, histórico-social, cuyo objeto es el proceso de construcción de la identidad profesional de los enfermeros de las unidades hospitalarias del sistema penitenciario del Estado de Río de Janeiro durante el período 1998-2004. Este período corresponde al ingreso del primer grupo de empleados estatutarios que participaron en el concurso de la antigua DESIPE, a partir del tema elegido para esta tesis doctoral. Se plantearon las siguientes cuestiones: ¿cómo ingresaron en el espacio institucional los enfermeros que se presentaron al sistema de salud penitenciario del Estado de Río de Janeiro? ¿Los enfermeros estaban preparados para prestar cuidados en las unidades de salud penitenciaria? ¿Es posible identificar las características identitarias de los enfermeros del sistema penitenciario? Los objetivos de la investigación son: historizar el inicio de los cuidados de salud en el sistema penitenciario brasileño; describir las experiencias de las primeras enfermeras registradas al ingresar en el sistema de salud penitenciario; analizar la identidad profesional de las enfermeras construidas a partir del sistema hospitalariodisciplinario penitenciario. Metodología: Las fuentes incluyeron documentos escritos, y las fuentes orales fueron producidas a través de la Historia Oral Temática, de acuerdo con un guión. Se entrevistó a seis funcionarios. Se clasificaron los documentos en función de los objetivos que se pretendía alcanzar y se realizó una crítica interna y externa de los mismos. La base teórica se basó en Michael Foucault, que trata de las prisiones y la disciplinarización del cuerpo. Esta investigación fue aprobada por el Comité de Ética en Investigación de la Escuela de Enfermería Anna Nery/Instituto de Salud São Francisco de Assis/UFRJ. Resultados: Este estudio confirma la tesis de que los enfermeros que ingresaron en los hospitales penitenciarios a través del concurso público de 1998 tuvieron que adaptarse al contexto sociocultural de tales espacios disciplinares, lo que llevó a la construcción de una identidad profesional con características inherentes al cuidado de la población encarcelada, que permitió al grupo insertarse en la pirámide disciplinar y adquirir un saber/poder propio para hacer plausible el ejercicio del cuidado de enfermería, con vistas a la seguridad del paciente y de la propia seguridad física. Conclusión: el proceso de adaptación de estos profesionales, la tensión presente en el espacio asistencial y la expectativa de ser agredidos por los pacientes estuvieron continuamente presentes, más aún en el contexto social histórico de violencia en Río de Janeiro, dividido en facciones criminales, con alto poder de control de las comunidades, extendiéndose al sistema carcelario. La identidad del profesional de enfermería que trabaja en unidades de salud del sistema carcelario está constituida por elementos subjetivos que definen un poder silencioso, generando incertidumbre e inseguridad a los profesionales, independientemente del equipo en el que estén insertos. En la historia de las enfermeras del concurso de 1998, se destaca la necesidad de adaptarse a las normas de seguridad y las responsabilidades que deben asumir en relación no sólo a la salud de las personas privadas de libertad, sino también a las cuestiones jurídicas. Ante esto, los deberes de las enfermeras son mayores en el sistema penitenciario, ya que, junto con el cuidado de las personas, es necesario desarrollar acciones de vigilancia y control de su propio trabajo.

Residência multiprofissional em saúde mental: atuação de enfermeiros no processo de ensino-aprendizagem / Residencia multiprofesional en salud mental: el papel del enfermero en el proceso de enseñanza-aprendizaje / Multiprofessional residence in mental health: nursing of the nurses in the teaching-learning process

Na saúde mental nos deparamos com desafios ao longo dos anos, avançamos com políticas públicas direcionadas ao atendimento dos pressupostos da Reforma Psiquiátrica Brasileira. Com a ampliação de redes substitutivas a psiquiatria, novas práticas foram produzidas, influenciando o processo de formação de enfermeiros desde a graduação quanto na pós-graduação. Objetivo: analisar estratégias de enfermeiros para a integração ensino-assistência junto à residentes multiprofissionais em Saúde Mental. Métodos: Estudo qualitativo, descritivo, com dez enfermeiros de uma instituição psiquiátrica universitária. Os dados foram coletados de fevereiro/17 a maio/17, por entrevista semiestruturada e submetidos à análise de conteúdo, na modalidade temática. Resultados: Identificamos como estratégias: interação interprofissional; trabalho em equipe; estímulo ao cuidado psicossocial. Conclusão: Os enfermeiros atuam como facilitadores do processo de ensino-aprendizagem independentemente de serem preceptores ou não, porquanto permanentemente atuam na assistência. Sugerimos a formalidade no preparo de enfermeiros-preceptores utilizadores de metodologias de ensino apropriadas para o campo da saúde mental.(AU)

In mental health we have faced challenges over the years, we have advanced with public policies aimed at meeting the assumptions of the Brazilian Psychiatric Reform. With the expansion of substitutive networks for psychiatry, new practices were produced, influencing the process of training nurses from undergraduate and graduate levels. Objective: to analyze nurses' strategies for teaching-care integration with multiprofessional residents in Mental Health. Methods: Qualitative, descriptive study with ten nurses from a university psychiatric institution. Data were collected from February/17 to May/17, through semi-structured interviews and submitted to content analysis, in the thematic mode. Results: We identified as strategies: interprofessional interaction; team work; stimulus to psychosocial care. Conclusion: Nurses act as facilitators of the teaching-learning process regardless of whether they are preceptors or not, as they permanently work in care. We suggest formality in the preparation of nurse-preceptors who use appropriate teaching methodologies for the field of mental health.(AU)

En salud mental hemos enfrentado desafíos a lo largo de los años, hemos avanzado con políticas públicas dirigidas a cumplir con los presupuestos de la Reforma Psiquiátrica Brasileña. Con la expansión de las redes sustitutivas de la psiquiatría, se produjeron nuevas prácticas que influyeron en el proceso de formación de enfermeros de pregrado y posgrado. Objetivo: analizar las estrategias de los enfermeros para la integración enseñanza-cuidado con residentes multiprofesionales en Salud Mental. Métodos: Estudio cualitativo, descriptivo con diez enfermeras de una institución psiquiátrica universitaria. Los datos fueron recolectados del 17/02 al 17/05, por medio de entrevista semiestructurada y sometidos a análisis de contenido, en la modalidad temática. Resultados: Identificamos como estrategias: interacción interprofesional; trabajo en equipo; estímulo a la atención psicosocial. Conclusión: Los enfermeros actúan como facilitadores del proceso de enseñanza-aprendizaje independientemente de que sean preceptores o no, ya que actúan permanentemente en el cuidado. Sugerimos formalidad en la preparación de enfermeros-preceptores que utilicen metodologías de enseñanza adecuadas al campo de la salud mental.(AU)

Impact of neonatal anoxia and hypothermic treatment on development and memory of rats.

Therapeutic hypothermia (TH) is well established as a standard treatment for term and near-term infants. However, therapeutic effects of hypothermia following neonatal anoxia in very premature babies remains inconclusive. The present rodent model of preterm neonatal anoxia has been shown to alter developmental milestones and hippocampal neurogenesis, and to disrupt spatial learning and memory in adulthood. These effects seem to be reduced by post-insult hypothermia. Epigenetic-related mechanisms have been postulated as valuable tools for developing new therapies. Dentate gyrus neurogenesis is regulated by epigenetic factors. This study evaluated whether TH effects in a rodent model of preterm oxygen deprivation are based on epigenetic alterations. The effects of TH on both developmental features (somatic growth, maturation of physical characteristics and early neurological reflexes) and performance of behavioral tasks at adulthood (spatial reference and working memory, and fear conditioning) were investigated in association with the possible involvement of the epigenetic operator Enhancer of zeste homolog 2 (Ezh2), possibly related to long-lasting effects on hippocampal neurogenesis. Results showed that TH reduced both anoxia-induced hippocampal neurodegeneration and anoxia-induced impairments on risk assessment behavior, acquisition of spatial memory, and extinction of auditory and contextual fear conditioning. In contrast, TH did not prevent developmental alterations caused by neonatal anoxia and did not restore hippocampal neurogenesis or cause changes in EZH2 levels. In conclusion, despite the beneficial effects of TH in hippocampal neurodegeneration and in reversing disruption of performance of behavioral tasks following oxygen deprivation in prematurity, these effects seem not related to developmental alterations and hippocampal neurogenesis and, apparently, is not caused by Ezh2-mediated epigenetic alteration.

Violência no trabalho contra os trabalhadores de enfermagem e seus imbricamentos com a saúde mental / Violencia en el trabajo contra los trabajadores de enfermería y sus imbricaciones con la salud mental / Violence at work against nursing workers and their imbrications with mental health

Objetivo: Conhecer a percepção da violência experienciada por trabalhadores de enfermagem no ambiente de trabalho e seus imbricamentos com a saúde mental. Método: Foi conduzido um estudo de cunho qualitativo, tendo como suporte técnico conceitual os preceitos da teoria do Interacionismo Simbólico, em um hospital público de grande porte. A coleta de dados foi realizada, por meio de entrevista semiestruturada, a partir do referencial de Minayo, no qual utilizou-se a Análise de Conteúdo. Resultados: Observa-se, com base nas falas dos profissionais, que a violência é um fenômeno presente no trabalho, o que gera revolta e sofrimento. Como consequência, emergem sentimentos de culpa, preocupação, tensão, estresse, desespero, raiva, sendo diversas as repercussões no trabalho. Conclusões: A violência, no ambiente de trabalho dos profissionais de enfermagem, produz sofrimento e riscos à saúde mental do trabalhador, assim, surge a preocupação em relação à saúde mental dos trabalhadores da enfermagem e a necessidade de ações articuladas e focadas na saúde do trabalhador e na prevenção da violência(AU)

Objective: To acquaint with the perception of violence experienced by nursing workers in the work environment and their consequences on mental health. Method: A qualitative study was conducted in a large public hospital, using the precepts of the theory of Symbolic Interactionism as technical-conceptual support. Data collection was performed through semi-structured interviews based on Minayo's reference, followed by content analysis. Results: The professionals' testimonials evidence that violence is a phenomenon present at work, which generates indignation and suffering. As a consequence, feelings of guilt, concern, tension, stress, despair, and anger emerge, as well as several repercussions at work. Conclusions: Violence in the nursing environment causes suffering and risks to the mental health of workers, thus, it arises to concern about the mental health of nursing workers and the need for coordinated actions focused on workers' health and violence prevention.(AU)

Objetivo: Conocer la percepción de violencia que experimentan los trabajadores de enfermería en el entorno laboral y sus imbricaciones con la salud mental. Método: Se realizó un estudio cualitativo con el apoyo técnico-conceptual de los preceptos de la teoría del interaccionismo simbólico en un gran hospital público. La recopilación de datos se realizó a través de entrevistas semiestructuradas basadas en la referencia de Minayo, en las que se utilizó el análisis de contenido. Resultados: De los discursos de los profesionales se observa que la violencia es un fenómeno presente en el trabajo, que genera revuelta y sufrimiento. Como consecuencia, surgen sentimientos de culpa, preocupación, tensión, estrés, desesperación e ira, siendo varias las repercusiones en el trabajo. Conclusiones: La violencia en el entorno laboral de los profesionales de enfermería produce sufrimiento y riesgos para la salud mental de estos, por lo tanto, surge la preocupación por la salud mental de los trabajadores de enfermería y la necesidad de acciones articuladas centradas en la salud de los trabajadores y la prevención de la violencia(AU)

Real-world assessment of the effect of impact of tumor size on pathological complete response rates in triple negative breast cancer after neoadjuvant chemotherapy.

BACKGROUND: Triple negative breast cancer (TNBC) is characterized rapid tumor growth, and increased metastatic potential compared to other breast cancer subtypes. However, pathological complete response (pCR) to neoadjuvant chemotherapy (NACT) can predict patients with a better prognosis. Clinical predictors of pCR such as tumor size (TS) are controversial. This study aims to evaluate the influence of TS on achieving pCR, and the associated survival outcomes. METHODS: Medical records from 310 TNBC patients treated with NACT between 2010 and 2013 in National Cancer Institute Brazil were screened. The aim study was to examine the impact of TS on pCR. We used descriptive statistics to organize and summarize TS data and all the other variables of interest. Logistic regression has done to assess if any of these variables were associated with pCR. Survival data were extrapolated using Kaplan-Meier analysis and log-rank tests. RESULTS: Thirty-nine (21%) of 187 enrolled patients achieved pCR. Median age was 48 years, 50.27% were postmenopausal, 93.03% T3/T4 and 75.39% axillar clinical node-positive; 92.51% received an anthracycline regimen followed by a taxane. Age >40 years (P=0.04, OR 0.45, 95% CI, 0.20-0.95) and tumor infiltrating lymphocytes (TILs) presence (P<0.01, OR 3.71, 95% CI, 1.60-8.60) were factors significantly associated with increased rates of pCR. Neither the TS (IQR: 4; P=0.22, OR 0.93, 95% CI, 0.83-1.03) nor the other subgroups analysed demonstrated any association with achieving pCR. Median follow-up was 36 months. The 5-year OS and RFS of the study population was 71.20% and 61.10% respectively. CONCLUSIONS: Preoperative TS did not significantly impact pCR rate in our cohort of patients receiving NACT for TNBC. Characteristics associated with higher pCR rate included TILs and age >40 years. In addition, pCR, was indicative of better survival outcomes.

Functional Role of Intracellular Calcium Receptor Inositol 1,4,5-Trisphosphate Type 1 in Rat Hippocampus after Neonatal Anoxia.

Anoxia is one of the most prevalent causes of neonatal morbidity and mortality, especially in preterm neonates, constituting an important public health problem due to permanent neurological sequelae observed in patients. Oxygen deprivation triggers a series of simultaneous cascades, culminating in cell death mainly located in more vulnerable metabolic brain regions, such as the hippocampus. In the process of cell death by oxygen deprivation, cytosolic calcium plays crucial roles. Intracellular inositol 1,4,5-trisphosphate receptors (IP3Rs) are important regulators of cytosolic calcium levels, although the role of these receptors in neonatal anoxia is completely unknown. This study focused on the functional role of inositol 1,4,5-trisphosphate receptor type 1 (IP3R1) in rat hippocampus after neonatal anoxia. Quantitative real-time PCR revealed a decrease of IP3R1 gene expression 24 hours after neonatal anoxia. We detected that IP3R1 accumulates specially in CA1, and this spatial pattern did not change after neonatal anoxia. Interestingly, we observed that anoxia triggers translocation of IP3R1 to nucleus in hippocampal cells. We were able to observe that anoxia changes distribution of IP3R1 immunofluorescence signals, as revealed by cluster size analysis. We next examined the role of IP3R1 in the neuronal cell loss triggered by neonatal anoxia. Intrahippocampal injection of non-specific IP3R1 blocker 2-APB clearly reduced the number of Fluoro-Jade C and Tunel positive cells, revealing that activation of IP3R1 increases cell death after neonatal anoxia. Finally, we aimed to disclose mechanistics of IP3R1 in cell death. We were able to determine that blockade of IP3R1 did not reduced the distribution and pixel density of activated caspase 3-positive cells, indicating that the participation of IP3R1 in neuronal cell loss is not related to classical caspase-mediated apoptosis. In summary, this study may contribute to new perspectives in the investigation of neurodegenerative mechanisms triggered by oxygen deprivation.

Determining the Roles of Inositol Trisphosphate Receptors in Neurodegeneration: Interdisciplinary Perspectives on a Complex Topic.

It is well known that calcium (Ca2+) is involved in the triggering of neuronal death. Ca2+ cytosolic levels are regulated by Ca2+ release from internal stores located in organelles, such as the endoplasmic reticulum. Indeed, Ca2+ transit from distinct cell compartments follows complex dynamics that are mediated by specific receptors, notably inositol trisphosphate receptors (IP3Rs). Ca2+ release by IP3Rs plays essential roles in several neurological disorders; however, details of these processes are poorly understood. Moreover, recent studies have shown that subcellular location, molecular identity, and density of IP3Rs profoundly affect Ca2+ transit in neurons. Therefore, regulation of IP3R gene products in specific cellular vicinities seems to be crucial in a wide range of cellular processes from neuroprotection to neurodegeneration. In this regard, microRNAs seem to govern not only IP3Rs translation levels but also subcellular accumulation. Combining new data from molecular cell biology with mathematical modelling, we were able to summarize the state of the art on this topic. In addition to presenting how Ca2+ dynamics mediated by IP3R activation follow a stochastic regimen, we integrated a theoretical approach in an easy-to-apply, cell biology-coherent fashion. Following the presented premises and in contrast to previously tested hypotheses, Ca2+ released by IP3Rs may play different roles in specific neurological diseases, including Alzheimer's disease and Parkinson's disease.

Prevalence of anemia in non-severe malaria cases in Mâncio Lima, Acre

Malaria, a parasitic disease, is a serious public health problem. In Brazil, the majority of cases are found in the Amazon. The clinical manifestations of malaria depend on several factors and they may be related to the development of anemia. This study evaluated the prevalence of anemia in malaria cases and its associated factors. The study was conducted in Mâncio Lima (Acre, Brazil). Participants were chosen through passive detection of malaria cases in the municipal health services. They were interviewed and blood samples analyzed for Plasmodium detection and for hemoglobin measurement. SPSS 13.0, software was applied for statistical analysis. One hundred and twenty patients with malaria were studied, of which 58.3% male and 41.7% female. There was a 25% prevalence of anemia, mainly among the women, and in those presenting symptoms for more than four days as well as headaches. The prevalence of anemia and its associated factors in these malaria patients may be connected, not only to the infection, but also to previous or overlapping diseases

Dengue fever as a cause of hemophagocytic lymphohistiocytosis.

Dengue is endemic in more than 100 countries in Southeast Asia, the Americas, the western Pacific, Africa and the eastern Mediterranean regions. The virus is transmitted by Aedes mosquitoes. Dengue disease is the most prevalent arthropod-borne viral disease in humans and is a global and national public health concern in several countries. A seasonal pattern of dengue disease is consistently observed. The highest incidences usually correspond to the period of highest rainfall and humidity, providing suitable conditions for Aedes aegypti breeding and survival. In Brazil for instance it is from January to June. Dengue may cause marked changes in bone marrow that result in hypocellularity and, consequently, thrombocytopenia and leucopenia, along with an increase in hematocrit, which is secondary to capillary leakage. However, those abnormalities are usually self-limited, and do not warrant further investigations, such as a marrow biopsy or a myelogram. The occurrence of persistent reactive hemophagocytosis is uncommon and usually leads to serious adverse outcomes. The authors report the case of an 8-year old girl complaining of high-grade fever, malaise, headache, abdominal pain and a cutaneous rash. Laboratory examination revealed atypical lymphocytosis on peripheral blood count, hyperbilirrunemia, abnormal liver enzymes and clotting tests. Serology was positive for dengue. Because of the persistence of fever and laboratory examinations were consistent with hemophagocytic lymphohistiocytosis (HLH) a bone marrow aspiration was performed, which confirmed the presence of hemophagocytosis. Hence we report a rare presentation of dengue accompanied by self-limited HLH that hopefully evolve to favorable outcome.

Acute Hemorrhagic Edema of Infancy: an unusual diagnosis for the general pediatrician.

Acute Hemorrhagic Edema of Infancy (AHEI) is a rare leukocytoclastic vasculitis, clinically characterized by the classical triad: palpable purpuric skin lesions, edema and fever, and is commonly misdiagnosed as Henoch-Schönlein purpura. In addition to its sudden onset, AHEI is also characterized by its self-limited course with complete and spontaneous recovery occurring between 1 and 3 weeks. Because of the scarcity of studies on therapy with corticosteroids, the conservative approach is usually recommended. The authors report an unusual case of an one-year-old boy who presented with typical cutaneous rash of AHEI and orchitis, the latter showing complete resolution after less than 24 hours of prednisolone therapy. The authors call attention to this entity mainly as a differential diagnosis of Henoch-Schönlein purpura and to the importance of new studies to establish the benefits of corticosteroid therapy for AHEI.

Quality of life index for the municipalities of Minas Gerais

This study aims to build a Relative Index of Quality of Life (IRQL) for Minas Gerais' municipalities using data for the year 2010. The objective is hierarchize them and determine how a municipality is more or less developed according to the level of quality of life. To build the IRQL we used principal component factor analysis. The results indicated Belo Horizonte as the most developed in relation to the others and, at the opposite extreme, the city of São João das Missões. The study also suggests the division of Minas Gerais according to socioeconomic aspects in the North (less developed) and South (more developed).

Este estudio trata de construir un índice relativo de Calidad de Vida (IRQL) para los mineros municipios que utilizan datos para el año 2010. El objetivo es jerarquizarlos y determinar cómo está más o menos desarrollado un municipio de acuerdo con el nivel de calidad de vida. Para construir el IRQL utilizó el análisis factorial. Los resultados indicaron que el municipio de Belo Horizonte como los más desarrollados en relación con los demás y, en el extremo opuesto, la ciudad de San Juan de las Misiones. El trabajo también confirma la división de la minera estatal de acuerdo con los aspectos socioeconómicos en el norte (menos desarrollados) y el sur (más desarrollada).

Este estudo buscou construir um u-se a análise fatorial. Os resultados indicaram o município de Belo Horizonte como o mais desenvolvido relativamente aos demais, e no extremo oposto o município de São João das Missões. O trabalho ainda sugere a divisão do estado mineiro segundo aspectos socioeconômicos em Norte (menos desenvolvido) e Sul (mais desenvolvido).

Impacto do uso de técnicas microbiológicas para o estreptococo beta hemolítico do grupo a no diagnóstico e tratamento das faringotonsilites

INTRODUÇÃO: A Faringotonsilite é doença comum nos consultórios e prontosocorros de pediatria. OBJETIVOS: Avaliar o impacto da realização rotineira da prova rápida para pesquisa de estreptococo do grupo A (PRE) no diagnóstico e tratamento da faringotonsilite aguda em crianças e adolescentes atendidos em um Hospital Geral. MÉTODOS: Trata-se de um estudo prospectivo, observacional, de protocolo de atendimento, instituído no Pronto-Socorro do Hospital Universitário da Universidade de São Paulo para o atendimento de crianças e adolescentes com diagnóstico de faringotonsilite aguda. RESULTADOS: Foram estudadas 1039 crianças e adolescentes. Com base no quadro clínico, antibiótico seria prescrito em 530 pacientes (51%), e com o uso da PRE e/ou cultura de orofaringe foi prescrito em 268 (25,8%) pacientes. Das 509 crianças que não receberiam antibiótico pelo quadro clínico, 157 tiveram PRE e/ou cultura de orofaringe positiva. O diagnóstico baseado no quadro clínico apresentou sensibilidade de 63,06% (IC-95%:62,95-63,17%); especificidade de 57,33% (IC-95%:57,25-57,41%); valor preditivo positivo de 50,57% (IC-95%:50,47-50,66%) e valor preditivo negativo de 69,16% (IC-95%: 50,47-50,66%). CONCLUSÕES: Neste estudo o diagnóstico clínico da faringotonsilite estreptocócica mostrou baixa sensibilidade e especificidade. O uso rotineiro da prova rápida para pesquisa de estreptococo permitiu uma redução do uso de antibiótico e a identificação de crianças e adolescentes com faringotonsilite estreptocócicas que não receberiam antibiótico e estariam sob o risco das complicações da infecção estreptocócica.

BACKGROUND: Sore throat is a common disease in the pediatric emergency room. OBJECTIVES: The objective of this study was to evaluate the impact of routine performance of rapid antigen detection test (RADT) in the diagnosis and treatment of acute pharyngitis in children treated at an academic hospital. METHODS: This is a prospective, observational, protocol compliance, established at the Emergency of Hospital Universitário - Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS: We studied 1039 children and adolescents. Based on clinical findings, antibiotic would be prescribed in 530 patients (51%) and using the RADT or sore throat culture was prescribed in 268 patients. Of the 509 children who did not receive antibiotics for the clinical, 157 had positive RADT or sore throat culture. The diagnosis based on clinical sensitivity was 63,06% (IC 95% 62,95- 63,17%), specificity 57,3% (IC 95% 57,25-57,41%), positive predictive value of 50,57% (IC 95% 50,47-50,66%) and negative predictive value of 69,16% (IC 95% 50,47-50,66%). CONCLUSIONS: In this study the clinical diagnosis of streptococcal pharyngitis had low sensitivity and specificity. The routine use of rapid test for streptococcal research led to a reduction of antibiotic use and the identification of a risk group for complication of streptococcal infection.

Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review.

Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditis associated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis. Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated.

Equipe de enfermagem no sistema prisional: a percepção sociopoetizadora da comunicação nos cuidados na Unidade Hospitalar / Nursing team on the prision system: the social poeticizing perception of the communiction on a Hospital Care Unit

Este estudo trata da dissertação de mestrado que foi desenvolvida na Escola de Enfermagem Anna Nery/ Universidade Federal do Rio de Janeiro, iniciada em 2011 e com término em 2013, cujo objeto é a comunicação da equipe de enfermagem sobre o cuidado prestado aos apenados em uma unidade hospitalar prisional do Estado do Rio de Janeiro. Delineamos três questões norteadoras, a saber: a comunicação no cuidado de enfermagem é influenciada pela estrutura do sistema prisional? Como as sensações e os sentimentos vivenciados pela equipe de enfermagem se manifestam na comunicação durante o cuidado de enfermagem prestado ao apenado? Quais são os desafios da comunicação encontrados durante o cuidado de enfermagem prestado no sistema penitenciário? Os objetivos traçados foram identificar as expressões verbais e não verbais dos profissionais de enfermagem sobre cuidado ao apenado; levantar as condições de interação no cuidado de enfermagem ao apenado e analisar como as condições do sistema penitenciário influenciam a comunicação da equipe de enfermagem na realização do cuidado. Método: Estudo exploratório em hospital penitenciário, com três etapas de produção de dados, descritivo com abordagem e dispositivos qualitativos da sociopoética. Foram observadas durante os cuidados às manifestações não verbais e verbais de 52 pessoas (40 funcionários) e 12 (pacientes), no primeiro momento da pesquisa. Nos outros momentos coletivos e com dispositivos lúdicos participaram 21 copesquisadores A análise foi pautada em unidades temáticas e foram trianguladas e discutida a luz do referencial sobre prisões Focault (2004), Coelho (2000) e Goffman (1961). A comunicação teve com principais fontes Silva (2008) e Araújo (2000). Resultados: As expressões faciais manifestadas indicaram que os profissionais vivenciam sentimentos como medo, dor, ansiedade, repulsa e insegurança, que por algumas vezes são represados...

Analysis of FHS community health agents knowledge about oral health / Análise do conhecimento sobre saúde bucal de agentes comunitários de saúde da ESF

The community health agents (CHA) are considered health promoters in Brazilian communities teaching them about health promotion and disease prevention, including oral health. According to the Ministry of Health, CHAs must know about seven major oral health issues in Brazil. Thus, the objective of this study was to evaluate the oral health knowledge level of CHAs in the city of Belem, Pará State, Brazil. The study was based on a self-guided script, through a pre-prepared questionnaire containing 16 multiple- choice questions related to oral health knowledge. The survey was conducted with 94 agents from seven Family Health stations featuring oral health teams in Belem. It was concluded that community agents should be better prepared about oral care, as not all oral health issues were known by the CHAs oral health teams in Belem.

Os agentes comunitários de saúde (ACS) são considerados promotores de saúde nas comunidades brasileiras instruindo-as sobre promoção de saúde e prevenção de doenças, inclusive em saúde bucal. De acordo com o Ministério da Saúde, os ACS's devem conhecer sete principais agravos bucais no Brasil. Dessa forma, o objetivo deste trabalho foi avaliar o nível de conhecimento dos ACS's em Belém, Estado do Pará, Brasil sobre saúde oral. O estudo foi baseado em um roteiro auto gerenciado, por meio de um questionário pré-elaborado, contendo 16 questões objetivas referentes ao conhecimento sobre saúde bucal. A pesquisa foi realizada com 94 agentes em sete Unidades de Saúde da Família com equipes de saúde bucal do município de Belém. E concluiu-se, portanto, que os agentes comunitários devem ser melhor preparados acerca dos cuidados bucais, pois não são todos os agravos em saúde bucal que são conhecidos pelos ACS's das equipes de saúde bucal em Belém.