Effect of two suspension training programs on pain and musculoskeletal function in chronic low back pain: study protocol.

The aim of this study is to compare the effects of two suspension training (ST) protocols on pain and musculoskeletal function in women with chronic low back pain (CLBP). The study will be randomized, controlled, blinded clinical trial. Women aged 18-60 years who present CLBP will be selected. They will be randomized into three groups: STG1, which will carry out the program with difficulty progression in the exercises; STG2, in which the progression will be made by increasing the number of sets; and control group. STG1 and STG2 will perform the training two-times a week for 60 min for 12 weeks. It is expected that ST will effectively reduce pain and improve functionality in CLBP and that the best protocol will be verified. Clinical Trial Registration: RBR-10rv3fqt.

Low back pain is one of the most common symptoms encountered in everyday life. One of the indicated treatments is the practice of exercises; among them, we can mention the training that uses suspended tapes, called suspension training. The aim of this study is to compare the effects of two suspension training protocols on individuals with chronic low back pain. Methodology: women aged 18 to 60 years with low back pain for more than 12 weeks will be selected. Pre- and post-treatment pain level, trunk and leg motion range and flexibility, functional capacity, biopsychosocial factors, fears and beliefs, pain catastrophizing scale, trunk and leg muscle strength and endurance, depression and anxiety, self-perception and treatment satisfaction will be assessed. The training will take place twice a week, for 60 min, for 3 months. It is expected to verify pain reduction and functionality improvement in both groups and evaluate the best training protocol.

Níveis de estresse e fatores relacionados em profissionais de saúde da atenção primária: revisão integrativa / Stress levels and related factors in primary care health professionals: an integrative review

Objetivo: Identificar, a partir das evidências da literatura, os níveis de estresse e fatores relacionados em profissionais de saúde atuantes na Atenção Primária à Saúde. Métodos: Foi realizada uma revisão integrativa, tendo como questão norteadora "Quais os níveisde estresse e fatores relacionados em profissionais de saúde atuantes na Atenção Primária à Saúde?''. A pesquisa ocorreu em dezembro de 2022, nas bases de dados Lilacs, MEDLINE, CINAHL e Scopus. Foram incluídos estudos primários disponíveis na íntegra em inglês, português e espanhol.Resultados: Das 1.358 produções inicialmente encontradas, 14 textos foram incluídos como amostra. Observou-se que os profissionais enfrentam diferentes níveis de estresse em seu cotidiano de trabalho. O estresse pode ser relacionado à exaustão física e emocional, insatisfação, sobrecarga e menor engajamento no trabalho, maior tempo de atuação, sexo feminino, atuação na pandemia da COVID-19, problemas organizacionais e de comunicação. Conclusões: As evidências permitem a reflexão crítica acerca da necessidade de maior preocupação e envolvimento por parte das autoridades e órgãos competentes com a saúde dos trabalhadores, a fim de direcionar ações que possam intervir sobre os fatores de risco no ambiente de trabalho e minimizar as vulnerabilidades ocasionadas pelo estresse

Objective: To identify, based on the evidence in the literature, stress levels and related factors in health professionals working in Primary Health Care. Methods: An integrative review was carried out, with the guiding question, "What are the stress levels and related factors in health professionals working in Primary Health Care?''. The search occurred in December 2022 in the Lilacs, MEDLINE, CINAHL, and Scopus databases. Primary studies available in full in English, Portuguese, and Spanish were included. Results: Of the 1,358 productions initially found, 14 texts were included as a sample. It was observed that professionals face different stress levels in their daily work. Stress can be related to physical and emotional exhaustion, dissatisfaction, overload, and less engagement at work, longer working hours, female sex, work in the COVID-19 pandemic, and organizational and communication problems. Conclusions: The evidence allows critical reflection on the need for more concern and involvement on the part of the authorities and competent bodies with the health of workers to direct actions that can intervene on risk factors in the work environment and minimize vulnerabilities caused by stress

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil.

OBJECTIVE: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. METHODS: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. RESULTS: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. CONCLUSION: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.

Quality of life, physical activity and burnout syndrome during online learning period in Brazilian university students during the COVID-19 pandemic: a cluster analysis.

The COVID-19 pandemic caused several changes in the teaching-learning process, as it abruptly replaced the conventional classes into online classes despite social distancing requirements. Such changes may be associated with several mental health problems and negatively affect the quality of life and academic performance of university students. We performed a cluster analysis in a large sample of Brazilian undergraduate students, considering sociodemographic data, physical activity frequency, study areas, Burnout Syndrome (BS), Quality of Life (QoL) and perception of online learning (OL) during COVID-19 pandemic. Seven hundred and three students (between 17 and 62 years, from 67 higher education institutions) participated in the study. We identified three different profiles of students regarding psychological aspects and OL perception. The first profile, called as the 'Low QoL' group was composed of younger students, mainly females, with higher frequency of psychological disorders (as evidenced by the self-report of depression and/or anxiety), in addition to higher Burnout scores, lower QoL and worse OL perception. The second profile called 'Intermediate QoL' comprised participants with an average age of 45 years, with a greater number of men, married, with kids and working in addition to studying. They presented better OL scores than the 'Low QoL' group. The third profile called 'Better QoL' comprised students with higher scores in all domains of QoL and better OL perception, with greater frequency of physical activity and lower BS scores. Students from Health courses showed higher scores for general QoL, and also for the psychological and environmental domains in relation to the other areas. Besides, students of the Exact Sciences courses showed higher scores on all OL perception items in comparison to the other courses. Our results provide insights regarding the mental health profile of undergraduate students, allowing educational managers to outline specific coping strategies to assist students during the pandemic.

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil

ABSTRACT Objective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.

Impact of Diamondback Moth Density and Infestation Timing on Broccoli Yield.

The diamondback moth (DBM), Plutella xylostella (L.) (Lep.: Plutellidae), is an important pest of broccoli (Brassica oleracea L. var. italica Plenck). Few studies have focused on the real DBM impact on broccoli yield. We performed greenhouse studies to assess the effect of DBM densities and infestation timing (at pre-heading, heading, or during the entire cycle) on broccoli head weight. Polynomial trend analysis revealed a downward linear response of head weight to DBM densities, indicating that broccoli is susceptible to DBM attack. As for the infestation timing, infestations during the pre-heading stage significantly impacted head weight, whereas the same did not occur for infestations during the heading stage. DBM density did not affect plant height or total leaves but was upward-related to plant defoliation, and head weight correlated negatively with plant defoliation. These findings indicate that pre-heading is the determining stage for head weight loss of plants under DBM attack. In order to prevent quantitative losses, efforts for DBM management should be focused on this particular stage.

Lethal and antifeedant effects of Bordeaux mixture on the marsh slug (Deroceras laeve).

The marsh slug, Deroceras laeve (Müller), is a generalist pest of agricultural crops. Slugs are mainly managed with synthetic pesticides that can also have high toxicity toward vertebrates and nontarget arthropods. Besides, they are not labeled for use in organic crop systems. Bordeaux mixture (BM) is an alternative product often used in organic crops for controlling plant diseases. The molluscicidal activity of BM has been reported; however, to our knowledge, no study has determined its efficacy to control D. laeve. This study aimed to determine the lethal (concentration- and time-mortality curves, and foliar persistence) and antifeedant (reduction in leaf consumption) effects of BM-treated cabbage leaves on D. laeve. The LC50 of BM was 28.15%, and the LT50 was 8.83 h. The BM LC25 reduced D. laeve leaf consumption by 3.31-fold. Furthermore, high control effectiveness (mortality > 90%) was attained until the 7th day after spraying. These findings reveal that BM reduces damage by killing D. laeve in a fast faction and by reducing foliar consumption. Therefore, BM can be an alternative to D. laeve management in both conventional and organic systems.

Generation and Characterization of a Soybean Line with a Vernonia galamensis Diacylglycerol Acyltransferase-1 Gene and a myo-Inositol 1-Phosphate Synthase Knockout Mutation.

Soybean (Glycine max) meal is an important protein source. Soybean meal with lower phytate and oligosaccharides improves meal quality. A single recessive mutation in soybean myo-inositol 1-phosphate synthase (Gm-lpa-TW75-1) confers a seed phenotype with low phytate and increased inorganic phosphate. The mutant was crossed with high oil lines expressing a diacylglycerol acyltransferase1 (DGAT) gene from Vernonia galamensis (VgD). Gm-lpa-TW75-1 X VgD, designated GV, has 21%, and 22% oil and 41% and 43% protein from field and greenhouse seed production, respectively. No significant differences were found in mineral concentrations except for Fe which was 229 µg/g dry mass for GV followed by 174.3 for VgD and 162 for Gm-lpa-TW75-1. Phosphate (Pi) is higher in Gm-lpa-TW75-1 as expected at 5 mg/g, followed by GV at 1.6 mg/g whereas Jack, VgD, and Taiwan75 have about 0.3 mg/g. The Gm-lpa-TW75-1 line has the lowest phytate concentration at 1.4 mg/g followed by GV with 1.8 mg/g compared to Taiwan75, VgD, and Jack with 2.5 mg/g. This work describes a high oil and protein soybean line, GV, with increased Pi and lower phytate which will increase the nutritional value for human and animal feed.

Saúde da população LGBT+ no contexto da atenção primária em saúde: relato de oficina realizada no internato integrado de Medicina de Família e Comunidade/Saúde Mental em uma universidade pública / LGBT+ Health on Primary Care: the experience report of a workshop during the medical internship on Family Medicine and Mental Health in a public university / Salud de la población LGBT + en el contexto de la atención primaria en salud: relato de taller realizado en el internado integrado de Medicina de Familia y Comunidad/Salud Mental en una universidad pública

Introdução: A saúde da população LGBT+ apresenta particularidades e vulnerabilidades que requerem atenção diferenciada. Sensibilizar e qualificar profissionais de saúde para as necessidades dessa população é fundamental para garanti-la o direito à saúde. Os currículos das graduações em saúde, que em geral não incorporam tais questões, têm sido interrogados pelo alunado com denúncias de LGBTfobia no curso médico e reivindicação de capacitação prática. Nesse contexto, o Internato Integrado de Medicina de Família e Comunidade e Saúde Mental da Faculdade de Medicina da Universidade Federal do Rio de Janeiro organizou oficina sobre Saúde da População LGBT, apresentada neste artigo. Métodos: Realizada em maio de 2018, teve como público alvo internos em estágio curricular na Atenção Primária em Saúde (APS), no município do Rio de Janeiro. Sensibilizar para o tema e apresentar ferramentas úteis para o cuidado na APS, e em outros cenários, foram os objetivos. Graduandos de medicina autodeclarados LGBT+ foram convidados a assumir a condução da atividade, preparada sob orientação de professoras do internato. O protagonismo dado a esses alunos permitiu articular à expertise científica, promovida nos estudos regulares sobre o tema, a expertise experiencial. A oficina ocorreu em 4 tempos: i) sensibilização; ii) discussão de casos; iii) informação e exposição de orientações para boas práticas em saúde; iv) dúvidas e avaliação. A duração total foi de 4 horas, com metodologias ativas e participativas. Resultados: Os objetivos foram alcançados e a atividade bem avaliada em sua organização e execução. Avaliação narrativa foi realizada com alunos e professores organizadores. Os internos participantes responderam questionário online com perguntas abertas e fechadas e também avaliaram positivamente a atividade nos quesitos metodologia e conteúdo. Conclusão/Desdobramentos: A oficina foi incluída nas atividades regulares do internato. Estão em construção, com vistas a difundir esses conhecimentos a outros estudantes do curso médico e a profissionais da rede de saúde municipal, disciplina eletiva e projeto de extensão. A inclusão longitudinal do tema no currículo permanece como desafio.

Introduction: The LGBT+ healthcare is marked with particularities and vulnerabilities that require differenced attention. Sensitizing and qualifying healthcare professionals to these population's needs is fundamental to guarantee the right to health. The curriculum from health degrees, that usually does not address this issue, have been questioned by students along with LGBTphobia reports among the medical education and revindication for practical capacitation. In this context, the Integrated Family & Community Medicine (MFC) and Mental Health Internship at Faculty of Medicine of the Federal University of Rio de Janeiro, prepared a workshop on LGBT Health, presented in this article. Methods: A workshop took place in May of 2018, having a target audience of interns of MFC. It aimed to sensitize medical students regarding the referred theme and to give practical tools to be used in primary medicine and other healthcare environments. Medical undergrads who identify themselves as LGBT+ were invited to conduct the activity under the orientation of tutors from the internship. Given that those medical students were protagonists in this activity, it was possible to articulate the scientific knowledge, accomplished with regular studies on the theme, and the experiential expertise. The workshop was divided in four acts: i) sensitization; ii) case discussion; iii) information and orientations on good practice; iv) questions and feedback. The workshop lasted 4 hours, using active and participatory learning methods. Results: The objectives were achieved with a highly good evaluation as to the workshop's organization and performance. The students and professors that coordinated the activity prepared a narrative evaluation. The workshop's subjects, the MFC interns, took later an online feedback questionnaire, in which they positively evaluated the methods and acquired knowledge. Conclusion/Future works: The workshop, firstly implemented as an experimental activity, is now part of the regular medical internship curriculum. An optative course and an extension project are being planned, aiming to reach other medical students and public healthcare providers. Including the subject in the medical curriculum as a longitudinal discussion remains a challenge.

Introducción: La atención médica LGBT + está señalada con particularidades y vulnerabilidades que requieren una atención diferenciada. Sensibilizar y calificar a los profesionales de la salud de las necesidades de esta población es fundamental para garantizar su derecho a la salud. El plan de estudios de las carreras de salud, que en general no abordan este tema, ha sido cuestionado por los estudiantes junto con los informes de LGBTphobia entre la educación médica y la reivindicación de la capacitación práctica. En este contexto, la Pasantía Integrada de la Medicina de la Família y la Comunidad y Salud Mental de la graduación en medicina de la Universidad Federal de Rio de Janeiro elaboró un taller sobre salud LGBT+, presentado en este artículo. Métodos: Realizado en mayo de 2018 con los internos en pasantía curricular en la APS como el público-objetivo. Los objetivos eran sensibilizar a los estudiantes de medicina sobre el tema presentado y ofrecer herramientas prácticas para que las utilicen en la medicina primaria y en otros entornos de atención médica. Se invitó a los estudiantes de medicina que se identifican a sí mismos como LGBT+, para realizar la actividad bajo la orientación de tutores de la pasantía. Como los estudiantes de medicina fueron los protagonistas de esta actividad, fue posible articular el conocimiento científico, realizado con estudios regulares sobre el tema y la vivencia experiencial. El taller se dividió en cuatro partes: i) sensibilización; ii) discusión del caso; iii) información y orientaciones sobre buenas prácticas; iv) preguntas y comentarios. El taller tuvo una duración de cuatro horas, utilizando métodos de aprendizaje activo y participativo. Resultados: Los objetivos se lograron con una evaluación muy buena de la organización y el desempeño del taller. Los estudiantes y profesores que coordinaron la actividad realizaron una evaluación narrativa. Los pasantes presentes contestaron a un cuestionario en línea con preguntas objetivas y abiertas y evaluaron positivamente la actividad tanto por su metodología como por el contenido. Conclusión/Desarrollo: El taller, implementado como una actividad experimental, ahora forma parte del plan de estudios de prácticas médicas regulares. Se está planificando un curso optativo y un proyecto de extensión, con el objetivo de llevar eses conocimientos a otros estudiantes de medicina y proveedores de la salud pública. Incluir el tema en los planes de estudios médicos como una discusión longitudinal sigue siendo un desafío.

Investigação de marcadores de resposta a quimioterapia neoadjuvante em pacientes com carcinoma de orofaringe / Investigation of molecular biomarkers to predict neoadjuvant chemotherapy response in patients with oropharyngeal carcinoma

A resistência a quimioterapia é um dos principais fatores para falhas no tratamento dos pacientes com carcinoma epidermóide de orofaringe (CCEO). O regime mais frequentemente utilizado nestes casos é a quimioterapia de indução (IC) com taxano, platina e 5-fluorouracil. Apesar da maioria dos pacientes responderem satisfatoriamente ao tratamento, uma parcela deles apresenta resposta insatisfatória podendo ocorrer progressão tumoral. Outro fator crítico é a alta taxa de toxicidade, especialmente no grupo de pacientes que não se beneficia do tratamento. Até o momento, não há marcadores moleculares capazes de auxiliar na predição da resposta e evolução da doença disponíveis na prática clínica desses tumores. Este estudo teve como objetivo desenvolver um painel de marcadores para predizer a resposta da quimioterapia de indução. Para isso, investigamos o perfil de expressão gênica (22 CCEO) e proteica (20 CCEO) e comparamos os grupos de acordo com a resposta a IC (resposta satisfatória, RS vs insatisfatória, RI). A análise de transcritos revelou 200 genes diferencialmente expressos entre os grupos, sendo 87 com expressão diminuída e 113 com aumento de expressão nos pacientes não respondedores em relação aos respondedores. A partir desses genes desenvolvemos um modelo de predição com cinco marcadores (GPSM2, CPNE2, FOXRED2, BCHE e KLKB1), o qual foi capaz de classificar 100% dos pacientes de acordo com a resposta a IC. Esse algoritimo foi aplicado aos dados de expressão do TCGA e apresentou bom desempenho como marcador de prognóstico independente do tratamento. Os genes com aumento de expressão foram utilizados para identificar proteínas potencialmente secretadas possíveis de serem utilizadas como marcadores detectáveis em biópsia líquida. Esta análise resultou em quatro potenciais marcadores secretados em RI (CR1, KLKB1, FBLN1 e MOB1A) e cinco em RS (PCSK5, RET, PRPH2, CST6 e BCHE). A análise proteômica por espectrometria de massas revelou 183 proteínas diferencialmente expressas entre os grupos, sendo 127 com expressão diminuída e 56 com expressão aumentada nos pacientes RI em relação ao grupo RS. A partir dessas proteínas, desenvolvemos um classificador de predição de IC com quatro marcadores (CDKN2A, HNRNPA0, MYO1B e TXNL1), os quais foram capazes de classificar corretamente todas as amostras de acordo com a resposta ao tratamento. As proteínas com aumento de expressão nos tumores foram investigadas quanto ao potencial de serem secretadas, sendo possível identificar oito potenciais marcadores secretados em RI e 19 em RS. A análise integrada dos transcritos e proteínas diferencialmente expressas revelou apenas uma molécula em comum, o MOB1A. Uma análise in silico das vias biológicas associadas às moléculas entre os grupos em ambas as análises moleculares revelou diversas vias de regulação comuns entre os grupos de proteínas e transcritos. As principais vias canônicas alteradas estão associadas a regulação do ciclo celular, incluindo ciclo celular, transição G1/S e fase S. Este estudo revelou diversos marcadores com potencial para ser aplicado na prática clinica, auxiliando na tomada de decisões terapêuticas de forma mais personalizada. Esses achados embora promissores necessitem ser validados em uma coorte maior de pacientes (AU)

Resistance to chemotherapy is one of the main causes for treatment failure in patients with oropharyngeal squamous cell carcinoma (OSCC). The induction to chemotherapy treatment with taxane, platinum and 5-fluoracil has been widely used. Although most patients shows good response to treatment (RS), a set of cases present unsatisfactory response (RI) and tumor progression may occur. An additional critical issue is the high toxicity rate, especially for patients who will not benefit from the treatment. To date, there are no molecular markers available in the clinical practice capable to predict response and disease progress. This study aimed to develop a panel of markers capable of predicting induction to chemotherapy response. We investigated gene and protein expression profile of 22 and 20 OSCC, respectively, and compared the groups according to the response to IC (satisfactory response vs. unsatisfactory response). Gene expression data analysis from a previous study of our group, revealed 200 differentially expressed genes, 87 downregulated and 113 genes with overexpression in nonresponders compared to responders cases. Using these genes, we developed a prediction model with five markers (GPSM2, CPNE2, FOXRED2, BCHE and KLKB1) able to classify 100% of the patients according to the response to IC. This algorithm was applied to the TCGA expression data and presented good performance as a prognostic marker independent of the treatment. Overexpressed genes were used to identify potentially secreted proteins with potential to be used as detectable markers in liquid biopsy. This analysis revealed four potencial markers in RI (CR1, KLKB1, FBLN1 and MOB1A) and five in RS (PCSK5, RET, PRPH2, CST6 and BCHE). Proteomic analysis using mass spectrometry revealed 183 differentially expressed proteins between the groups, 127 downexpressed and 56 overexpressed in RI patients compared to RS group. Using these proteins, we developed a prediction algorithm using four biomarkers (CDKN2A, HNRNPA0, MYO1B and TXNL1) able to correctly classify all tumors according to the response to treatment. Overexpressed proteins with potential to be secreted were investigated revealing eight potential markers secreted in IR and 19 in RS. The integrative analysis of differentially expressed transcripts and proteins revealed one molecule in common, MOB1A. In silico pathway analysis resulted in common biological pathways in both group of cases. The major altered canonical pathways are associated with cell cycle regulation, being Cell cycle, G1 / S Transition and S Phase. Our study revealed several candidate markers with potential to be applied in the clinical practice, assisting in therapeutic decisions. Although promisor, these findings need to be validated in a larger cohort of patients (AU)

Implications on the Pb bioaccumulation and metallothionein levels due to dietary and waterborne exposures: The Callinectes danae case.

This study aimed to assess the bioaccumulation of Pb and induction of metallothionein-like proteins (MT) in Callinectes danae through single and combined dietary and waterborne exposures. Male C. danae individuals were collected in the south area of the Cananéia-Iguape-Peruíbe Protected Area (APA-CIP), in São Paulo State, Brazil. After an acclimatization period, exposure assays were performed during 7 and 14 days, at two Pb concentrations (0.5 e 2.0 µg/g) in 4 treatments: 1) control; 2) contaminated water only; 3) contaminated food only; 4) contaminated water and food. The results indicate that C. danae is highly tolerant to Pb exposure at the evaluated concentrations. In gills, Pb bioaccumulation is more dependent of water efflux and time of exposure (higher Pb values). However, pathways act simultaneously in the induction of MT expression in this tissue. The decreases in Pb accumulation in the combined treatments and MT increases after 14 days in gills suggests that these proteins play a detoxification function in the presence of Pb. In hepatopancreas, depending on the predominance of a certain pathway or combined pathways, accumulation occured at different times. For muscle tissue, bioaccumulation was observed due to contaminated water exposure, but not dietary exposure, probably because Pb concentrations were low.

Fatores associados à adesão dos pacientes HIV+ à terapia antirretroviral / Factors associated with adherence of HIV+ patients to antiretroviral therapy / Los factores asociados con la adherencia de los pacientes VIH+ a la terapia antirretroviral

Objetivo: Analisar os fatores associados à adesão dos pacientes HIV+ ao tratamento antirretroviral segundo as evidências científicas. Método: Trata-se de um estudo de revisão integrativa, realizado nas bases de dados LILACS, MEDLINE E BDENF, através dos descritores: adesão à medicação, antirretrovirais e HIV, em novembro de 2016. Resultados: Foram identificadas 156 publicações, sendo nove selecionadas e analisadas no estudo. O tempo entre o diagnóstico de HIV e a manifestação da Aids, a manifestação de reações adversas aos medicamentos, a idade, a escolaridade, o uso de drogas ilícitas, a depressão e a expectativa de morte iminente são fatores importantes que interferem na adesão dos pacientes à terapia antirretroviral. Conclusão: É primordial promover e fortalecer a participação mais ativa dos pacientes na dinâmica do tratamento. O profissional de saúde deve compreender e considerar as dificuldades dos pacientes e juntamente com eles criar alternativas de enfrentamento e superação dos fatores limitadores (AU).

Objective: To analyze the factors associated with adherence of HIV+ patients to antiretroviral treatment according to scientific evidence. Method: It is an integrative review study, carried out in the databases LILACS, MEDLINE and BDENF, through the descriptors: adherence to medication, antiretrovirals and HIV, in November 2016. Results: 156 publications were identified, nine of which were selected and analyzed in the study. The time between the diagnosis of HIV and the manifestation of AIDS, the manifestation of adverse drug reactions, age, schooling, use of illicit drugs, depression and the imminent expectation of death are important factors that interfere in patients' adherence to antiretroviral therapy. Conclusion: It is essential to promote and strengthen the more active participation of patients in the dynamics of treatment. The health professional must understand and consider the patients' difficulties and, together with them, create alternatives for coping with and overcoming the limiting factors (AU).

Objetivo: Analizar los factores asociados con la adherencia de los pacientes con VIH al tratamiento antirretroviral de acuerdo con la evidencia científica. Método: Se trata de un estudio de revisión integradora, llevado a cabo en las bases de datos LILACS, MEDLINE y BDENF a través de los descriptores: adherencia a la medicación, medicamentos antirretrovirales y el VIH en noviembre de 2016. Resultados: Se identificaron 156 publicaciones, siendo nueve seleccionadas y analizadas en el estudio. El tiempo entre el diagnóstico del VIH y la manifestación del SIDA, la manifestación de reacciones adversas a los medicamentos, la edad, la educación, el uso de drogas ilícitas, la depresión y la expectativa de una muerte inminente, son factores importantes que afectan a la adherencia del paciente a la terapia antirretroviral. Conclusion: Es esencial para promover y fortalecer la participación más activa de los pacientes en la dinámica del tratamiento. El profesional de la salud debe comprender y tener en cuenta las dificultades de los pacientes y con ellos crear alternativos de lidiar y superar los factores limitantes (AU).

Evolução da disfagia em um caso de síndrome MELAS: o olhar dos cuidados paliativos / Dysphagia progression in a MELAS syndrome case: a palliative care perspective

RESUMO Este artigo teve por objetivo descrever a progressão da disfagia e a decisão pela via de alimentação em um caso de síndrome MELAS, sob o olhar dos cuidados paliativos. Trata-se de um caso do sexo feminino, que, por volta dos 26 anos de idade sofreu os primeiros sintomas da doença e teve sua função de deglutição progressivamente impactada. Foi realizado acompanhamento fonoaudiológico durante seis meses, com aplicação do protocolo de Avaliação da Segurança da Deglutição, da Functional Oral Intake Scale (FOIS) e gerenciamento da deglutição, com retornos ambulatoriais semanais e mensais. Em seis meses de seguimento, a paciente evoluiu de disfagia moderada a disfagia moderada a grave e variou entre os níveis 5 e 1 da FOIS. Manteve a alimentação por via oral, com restrição de consistências, manobra de deglutições múltiplas e controle de volume para ingestão de líquido, até que, ao final dos seis meses de seguimento, foi realizada gastrostomia. A alimentação por via oral em mais de uma consistência, porém com compensações, foi reduzida a uma alimentação exclusiva por via alternativa, ao longo do acompanhamento fonoaudiológico. Optou-se por manter a via oral de alimentação até a colocação da gastrostomia. A não sugestão de sonda nasoenteral se embasou no respeito à vontade da paciente e na possibilidade de alimentar-se, minimamente, de uma consistência por via oral.

ABSTRACT This article aims to describe a dysphagia progression and a choice of the feeding options in a case of MELAS syndrome, under the perspective of palliative care. It is a case in which a woman at the age of 26 years suffered the first symptoms of the disease and had the swallowing functionality progressively impacted. Speech-Language Therapy follow-up was performed at 6 months with the application of a swallowing safety assessment protocol, Functional Oral Intake Scale (FOIS) and swallowing management, with weekly and monthly outpatient returns. At six months of follow-up, the patient progressed from moderate dysphagia to moderate to severe dysphagia and ranged from levels 5 to 1 of FOIS. The patient maintained oral feeding with consistency restriction, dry swallowing maneuver, and control of volume for liquid intake until the end of the six months of follow-up, when gastrostomy was made. Oral feeding in more than one consistency but with compensations was reduced to exclusive non-oral feeding. We chose to maintain oral feeding until the gastrostomy was placed. Non-suggestion of nasoenteral tube was based on the patient's desire and the possibility of oral feeding in at least one food consistency.

Hereditary Pancreatitis Associated With the N29T Mutation of the PRSS1 Gene in a Brazilian Family: A Case-Control Study.

Hereditary pancreatitis (HP) is an autosomal-dominant disease with incomplete penetrance manifesting as early-onset chronic relapsing pancreatitis. A mutation in the PRSS1 gene is present in greater than 70% of HP kindreds and leads to a gain-of-function characterized by the increased autocatalytic conversion of trypsinogen to active trypsin, promoting autodigestion and damage to acinar cells. Other genetic defects observed in the pathogenic mechanism of pancreatitis include mutations in the genes encoding SPINK1, CTRC, and CPA1. There are few reports of HP in Latin America, and no families have been investigated in Brazil. A case-control observational study was conducted at Clementino Fraga Filho University Hospital in Brazil. Patients with suspected HP and healthy controls were enrolled in this study, and a detailed questionnaire was administered to patients with HP. PRSS1 and SPINK1 genes were analyzed by DNA sequencing, and a family that fit the HP diagnostic criteria was identified. The neutral polymorphism c.88-352A > G in the SPINK1 gene was found to be prevalent in the individuals studied, but no important alterations were found in this gene. Ten out of 16 individuals in this family carried the N29T mutation in the PRSS1 gene, with 2 clinically unaffected mutation carriers. The median age of HP onset was 6 years. Pancreatic exocrine failure occurred in 6 patients, 5 of whom also had diabetes mellitus. Surgical procedures were performed on 3 affected members, and no cases of pancreatic cancer have been reported thus far. This study identified the first PRSS1 gene mutation in a Brazilian family with HP.

[Oral health and perceptions regarding dental care in patients with mental disorders living in therapeutic residences]. / Saúde bucal e percepção sobre o atendimento odontológico em pacientes com transtorno psíquico moradores de residências terapêuticas.

Patients with mental disorders have considerable difficulty in access to dental care, including the refusal of oral health professionals to offer care to this clientele and the inadequate professional training of oral health professionals regarding this issue. The present study was carried out in therapeutic residences in order to assess the oral health conditions of the residents as well as their perceptions regarding the dental care they have received. Thirty-eight individuals participated in the study. Data were collected through clinical examinations and a semi-structured interview. Data analysis revealed a high number of caries and the need for dentures, with 42.5% of the individuals needing complete dentures and 30.3% needing partial dentures. Regarding periodontal conditions, 28.5% of the dental elements exhibited losses of over 4 mm of periodontal insertion. Data from the interviews were submitted to content analysis, which enabled the establishment of two categories: the association of pain with the presence of teeth and mutilating dental care. Oral health was associated to dental extraction, which was considered the only solution to oral health disturbances, indicating that, for this population, oral health signifies not having teeth.

Saúde bucal e percepção sobre o atendimento odontológico em pacientes com transtorno psíquico moradores de residências terapêuticas / Oral health and perceptions regarding dental care in patients with mental disorders living in therapeutic residences

Os pacientes portadores de transtornos psíquicos têm grande dificuldade de acesso ao tratamento dentário. Os problemas enfrentados vão desde a recusa dos profissionais em atender a essa clientela à inapropriada formação profissional dos mesmos. Este estudo, realizado em residências terapêuticas, objetivou avaliar as condições de saúde bucal dos moradores, assim como a percepção dos mesmos em relação ao atendimento odontológico recebido. Fizeram parte do estudo 38 indivíduos, sendo os dados coletados através de exame clínico e entrevista semiestruturada. A análise dos dados indicou elevado índice de cárie e de necessidade protética, com 42,5 por cento dos indivíduos necessitando de prótese total e 30,3 por cento, de próteses parciais. Com relação às condições periodontais, 28,5 por cento dos elementos dentários apresentaram perda de inserção periodontal maior que 4 mm. Os dados da entrevistas foram averiguados pela análise de conteúdo temática, possibilitando a construção de duas categorias: associação de dor com a presença de dentes e o atendimento odontológico mutilador. A presença de saúde bucal foi associada à extração dentária, sendo esta a única solução para os incômodos na boca, indicando que, para esta população, ter saúde bucal é não ter dentes.

Patients with mental disorders have considerable difficulty in access to dental care, including the refusal of oral health professionals to offer care to this clientele and the inadequate professional training of oral health professionals regarding this issue. The present study was carried out in therapeutic residences in order to assess the oral health conditions of the residents as well as their perceptions regarding the dental care they have received. Thirty-eight individuals participated in the study. Data were collected through clinical examinations and a semi-structured interview. Data analysis revealed a high number of caries and the need for dentures, with 42.5 percent of the individuals needing complete dentures and 30.3 percent needing partial dentures. Regarding periodontal conditions, 28.5 percent of the dental elements exhibited losses of over 4 mm of periodontal insertion. Data from the interviews were submitted to content analysis, which enabled the establishment of two categories: the association of pain with the presence of teeth and mutilating dental care. Oral health was associated to dental extraction, which was considered the only solution to oral health disturbances, indicating that, for this population, oral health signifies not having teeth.

Inclusões ectópicas em apófise coronóide: relato de casos geneticamente associados / Ectopic Inclusions in Coronoid Apophisis: Report of Cases with Familial Association

As inclusões ectópicas ocorrem em cerca de 1% da população em geral e podem estar associadas a diversaslocalizações. No presente artigo, os autores realizam uma breve revisão da literatura das inclusões ectópicase relatam um caso clínico incomum de duas pacientes, mãe e filha, que apresentavam inclusão do elemento 48na apófise coronóide. Chama atenção a semelhança das inclusões, fato que leva a crer em correlação genética.O tratamento realizado foi a remoção dos elementos

Inclusão horizontal ectópica de canino inferior em sínfise mentoniana - relato de caso / Lower canine horizontal ectopic embedding in menton symphysis - a case report

As inclusões ectópicas ocorrem em cerca de 1% da população em geral e podem estar associadas a diversas localizações. No presente artigo os autores realizam uma breve revisão da literatura das inclusões ectópicas e relatam um caso clínico incomum de um canino incluso ectópico localizado em sínfise mentoniana. O tratamento realizado foi a exérese.

Ectopic tooths occur in about 1% of the population and may appears in many locates. In the present article the authors carry through one brief revision of the literature of the ectopic tooth and tell an uncommon clinical case of lower caninee horizontal ectopic embedding in menton sysphysis. The carried through treatment was the surgical remove.