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Titanium implants are subject to bacterial adhesion and peri-implantitis induction, and biosurfactants bring a new alternative to the fight against infections. This work aimed to produce and characterize the biosurfactant from Bacillus subtilis ATCC 19,659, its anti-adhesion and antimicrobial activity, and cell viability. Anti-adhesion studies were carried out against Streptococcus sanguinis, Staphylococcus aureus, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Proteus mirabilis as the minimum inhibitory concentration and the minimum bactericidal concentration. Cell viability was measured against osteoblast and fibroblast cells. The biosurfactant was classified as lipopeptide, with critical micelle concentration at 40 µg mL- 1, and made the titanium surface less hydrophobic. The anti-adhesion effect was observed for Staphylococcus aureus and Streptococcus sanguinis with 54% growth inhibition and presented a minimum inhibitory concentration of 15.7 µg mL- 1 for Streptococcus sanguinis and Aggregatibacter actinomycetemcomitans. The lipopeptide had no cytotoxic effect and demonstrated high potential application against bacterial biofilms.
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Aderência Bacteriana , Biofilmes , Implantes Dentários , Lipopeptídeos , Testes de Sensibilidade Microbiana , Titânio , Titânio/farmacologia , Titânio/química , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Aderência Bacteriana/efeitos dos fármacos , Implantes Dentários/microbiologia , Lipopeptídeos/farmacologia , Humanos , Antibacterianos/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/fisiologia , Bacillus subtilis/efeitos dos fármacos , Porphyromonas gingivalis/efeitos dos fármacos , Porphyromonas gingivalis/fisiologia , Porphyromonas gingivalis/crescimento & desenvolvimento , Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Propriedades de Superfície , Fibroblastos/efeitos dos fármacos , Fusobacterium nucleatum/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Osteoblastos/efeitos dos fármacos , Tensoativos/farmacologiaRESUMO
Breast cancer is the most prevalent cancer among women worldwide. Therapeutic strategies to control tumors and metastasis are still challenging. Three-dimensional (3D) spheroid-type systems more accurately replicate the features of tumors in vivo, working as a better platform for performing therapeutic response analysis. This work aimed to characterize the epithelial-mesenchymal transition and doxorubicin (dox) response in a mammary tumor spheroid (MTS) model. We evaluated the doxorubicin treatment effect on MCF-7 spheroid diameter, cell viability, death, migration and proteins involved in the epithelial-mesenchymal transition (EMT) process. Spheroids were also produced from tumors formed from 4T1 and 67NR cell lines. MTSs mimicked avascular tumor characteristics, exhibited adherens junction proteins and independently produced their own extracellular matrix. Our spheroid model supports the 3D culturing of cells isolated from mice mammary tumors. Through the migration assay, we verified a reduction in E-cadherin expression and an increase in vimentin expression as the cells became more distant from spheroids. Dox promoted cytotoxicity in MTSs and inhibited cell migration and the EMT process. These results suggest, for the first time, that this model reproduces aspects of the EMT process and describes the potential of dox in inhibiting the metastatic process, which can be further explored.
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OBJECTIVE: To evaluate the foot-health-related quality of life in individuals with versus without lower-limb lymphedema. METHODS: A case-control study was carried out in an academic clinic in Lisbon, Portugal. Eighty participants (40 controls and 40 with lymphedema) were included in the study. The researchers examined sociodemographic and clinical data and foot-health-related quality of life in both groups. In the group with lymphedema, lower-limb lymphedema was also characterized. RESULTS: Individuals with lower-limb lymphedema had significantly lower scores on all dimensions of the Foot Health Status Questionnaire in comparison with the control group. CONCLUSIONS: Individuals with lower-limb lymphedema appear to have a poorer foot-health-related quality of life than the general population.
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Linfedema , Qualidade de Vida , Humanos , Qualidade de Vida/psicologia , Linfedema/psicologia , Estudos de Casos e Controles , Feminino , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto , Idoso , Portugal , Doenças do Pé , Nível de SaúdeRESUMO
Objetivo: identificar a prevalência e os fatores preditivos para os transtornos mentais comuns entre estudantes de enfermagem de uma instituição de ensino superior pública. Método:estudo observacional, constituído por 68 estudantes de enfermagem. Incluíram-se discentes do 2º, 7º, 9º e 10º blocos que frequentassem regularmente as aulas. A coleta de dados ocorreu entre novembro e dezembro de 2022, de forma remota, por meio de questionário onlineque abordava perfil sociodemográfico, escolar,de saúdeeum instrumento validado. Realizou-se análise univariada e, para a análise de associações, o teste qui-quadrado de Wald. Resultados: aprevalência relacionou-se ao uso de álcool, acompanhamento ou tratamento psicológico após o início da graduação e autoavaliação negativa da saúde.Os fatores preditivos foram uso de álcool e autoavaliação negativa da saúde. Conclusões: a alta prevalência de suspeição para transtornos mentais comunsindica a necessidade de assistência integral e equânime à comunidade acadêmica.
Objective: to identify the prevalence and predictive factors for common mental disorders among nursing students at a public higher education institution. Method: observational study, consisting of 68 nursing students. Students from the 2nd, 7th, 9th, and 10th blocks who regularly attended classes were included. Data collection took place between November and December 2022, remotely, using an online questionnaire that addressed the sociodemographic, school, and health profile and a validated instrument. Univariate analysis was performed and, for the analysis of associations, the Wald chi-square test was used. Results: the prevalence was related to the use of alcohol, monitoring or psychological treatment after the beginning of graduation, and negative self-evaluation of health. Conclusions: the high prevalence of suspicion for common mental disorders indicates the need for comprehensive and equitable assistance to the academic community.
Objetivo: identificar la prevalencia y los factores predictivos de trastornos mentales comunes entre estudiantes de enfermería de una institución pública de educación superior. Método: estudio observacional, compuesto por 68 estudiantes de enfermería. Se incluyeron estudiantes de los bloques 2, 7, 9 y 10 que asistían regularmente a clases. La recolección de datos se realizó entre noviembre y diciembre de 2022, de forma remota, medianteun cuestionario en línea que abordó el perfil sociodemográfico, escolar y de salud y un instrumento validado. Se realizó análisis univariante y, para el análisis de asociaciones, se utilizó la prueba chi-cuadrado de Wald. Resultados: la prevalencia estuvo relacionada con el consumo de alcohol, seguimiento o tratamiento psicológico posterior al inicio de la graduación y autoevaluación negativa de la salud. Conclusiones: la alta prevalencia de sospecha de trastornos mentales comunes indica la necesidad de una asistencia integral y equitativa a la comunidad académica
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Transtornos Mentais , Estudantes de Enfermagem , Universidades , Saúde Mental , Saúde do EstudanteRESUMO
We examined the relation between transcranial Doppler (TCD) markers of cerebral blood flow regulation and cognitive performance in hypertension (HT) patients to evaluate the predictive value of these markers for cognitive decline. We assessed dynamic cerebral autoregulation (dCA), vasoreactivity to carbon dioxide, and neurovascular coupling (NVC) in the middle (MCA) and posterior (PCA) cerebral arteries of 52 patients. Neuropsychological evaluation included the Montreal Cognitive Assessment and tests covering attention, executive function, processing speed, and memory. Notably, reduced rate time in the PCA significantly predicted better processing speed (p = 0.003). Furthermore, reduced overshoot systolic cerebral blood velocity in the PCA and reduced phase in the VLF range in the MCA (p = 0.021 and p = 0.017, respectively) significantly predicted better memory. Intriguingly, enhanced dCA in the MCA predicted poorer memory performance, while reduced NVC in the PCA predicted both superior processing speed and memory performance. These findings suggest that HT-induced changes in cerebral hemodynamics impact cognitive performance. Further research should verify these observations and elucidate whether these changes represent adaptive responses or neurovascular inefficiency. TCD markers might provide insights into HT-related cognitive decline.
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This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Fosfomycin is an antibiotic frequently used to treat uncomplicated urinary tract infections. It is normally well-tolerated, but there are some reports of clinically relevant liver injury. We present the case of a 73-year-old female who presented with paucisymptomatic hepatocellular acute liver injury six days after taking fosfomycin. After ruling out viral, ischemic, and autoimmune hepatitis, as well as Wilson disease and biliary disorders, she was diagnosed with drug-induced liver injury (DILI) related to fosfomycin. The patient showed major improvement during the first week and the resolution of liver injury one month after onset. This case report aims to underscore the potential hepatotoxicity of fosfomycin.
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Acute myeloid leukaemia (AML) management remains a significant challenge in oncology due to its low survival rates and high post-treatment relapse rates, mainly attributed to treatment-resistant leukaemic stem cells (LSCs) residing in bone marrow (BM) niches. This review offers an in-depth analysis of AML progression, highlighting the pivotal role of extracellular vesicles (EVs) in the dynamic remodelling of BM niche intercellular communication. We explore recent advancements elucidating the mechanisms through which EVs facilitate complex crosstalk, effectively promoting AML hallmarks and drug resistance. Adopting a temporal view, we chart the evolving landscape of EV-mediated interactions within the AML niche, underscoring the transformative potential of these insights for therapeutic intervention. Furthermore, the review discusses the emerging understanding of endothelial cell subsets' impact across BM niches in shaping AML disease progression, adding another layer of complexity to the disease progression and treatment resistance. We highlight the potential of cutting-edge methodologies, such as organ-on-chip (OoC) and single-EV analysis technologies, to provide unprecedented insights into AML-niche interactions in a human setting. Leveraging accumulated insights into AML EV signalling to reconfigure BM niches and pioneer novel approaches to decipher the EV signalling networks that fuel AML within the human context could revolutionise the development of niche-targeted therapy for leukaemia eradication.
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Progressão da Doença , Vesículas Extracelulares , Leucemia Mieloide Aguda , Nicho de Células-Tronco , Humanos , Vesículas Extracelulares/metabolismo , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Microambiente Tumoral , Animais , Células-Tronco Neoplásicas/metabolismo , Células-Tronco Neoplásicas/patologia , Medula Óssea/patologia , Medula Óssea/metabolismo , Comunicação Celular , Transdução de Sinais , Resistencia a Medicamentos AntineoplásicosRESUMO
The biological barriers existing in the human body separate the blood circulation from the interstitial fluid in tissues. The blood-brain barrier (BBB) isolates the central nervous system from the bloodstream, presenting a dual role: the protection of the human brain against potentially toxic/harmful substances coming from the blood, while providing nutrients to the brain and removing metabolites. In terms of architectural features, the presence of junctional proteins (that restrict the paracellular transport) and the existence of efflux transporters at the BBB are the two major in vivo characteristics that increase the difficulty in creating an ideal in vitro model for drug permeability studies and neurotoxicity assessments. The purpose of this work is to provide an up-to-date literature review on the current in vitro models used for BBB studies, focusing on the characteristics, advantages, and disadvantages of both primary cultures and immortalized cell lines. An accurate analysis of the more recent and emerging techniques implemented to optimize the in vitro models is also provided, based on the need of recreating as closely as possible the BBB microenvironment. In fact, the acceptance that the BBB phenotype is much more than endothelial cells in a monolayer has led to the shift from single-cell to multicellular models. Thus, in vitro co-culture models have narrowed the gap between recreating as faithfully as possible the human BBB phenotype. This is relevant for permeability and neurotoxicity assays, and for studies related to neurodegenerative diseases. Several studies with these purposes will be also presented and discussed.
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Introduction: Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia. Methods: A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13). Results: Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild. Conclusions: Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.
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Considering the profound transformation affecting pathology practice, we aimed to develop a scalable artificial intelligence (AI) system to diagnose colorectal cancer from whole-slide images (WSI). For this, we propose a deep learning (DL) system that learns from weak labels, a sampling strategy that reduces the number of training samples by a factor of six without compromising performance, an approach to leverage a small subset of fully annotated samples, and a prototype with explainable predictions, active learning features and parallelisation. Noting some problems in the literature, this study is conducted with one of the largest WSI colorectal samples dataset with approximately 10,500 WSIs. Of these samples, 900 are testing samples. Furthermore, the robustness of the proposed method is assessed with two additional external datasets (TCGA and PAIP) and a dataset of samples collected directly from the proposed prototype. Our proposed method predicts, for the patch-based tiles, a class based on the severity of the dysplasia and uses that information to classify the whole slide. It is trained with an interpretable mixed-supervision scheme to leverage the domain knowledge introduced by pathologists through spatial annotations. The mixed-supervision scheme allowed for an intelligent sampling strategy effectively evaluated in several different scenarios without compromising the performance. On the internal dataset, the method shows an accuracy of 93.44% and a sensitivity between positive (low-grade and high-grade dysplasia) and non-neoplastic samples of 0.996. On the external test samples varied with TCGA being the most challenging dataset with an overall accuracy of 84.91% and a sensitivity of 0.996.
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OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.
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Fadiga , Extremidade Superior , Idoso , Feminino , Humanos , Masculino , Fenômenos Biomecânicos , Extremidade Superior/fisiologiaRESUMO
Introduction: Human behavior significantly contributes to environmental problems, making the study of pro-environmental behavior an important task for psychology. In this context, it is crucial to understand the pro-environmental behavior of adolescents, as young people play a fundamental role in facilitating long-term changes in environmental consciousness and encouraging decision-makers to take action. However, little is currently known about the pro-environmental behavior of adolescents. Recently, there has been growing interest in examining the influence of personality traits and emotional intelligence on pro-environmental behavior. Methods: We conducted a systematic review to enhance our understanding of adolescent pro-environmental behavior. Thus, this systematic review was designed to enhance understanding of adolescent's pro-environmental behavior by summarizing existing evidence on how it relates to personality and emotional intelligence. Results: Our findings suggest associations between specific personality traits and dimensions of emotional intelligence with adolescent pro-environmental behavior, aligning with similar studies conducted on adults. Discussion: While our findings offer valuable insights, further research is needed to establish causality and deepen our understanding of the interplay between multiple variables influencing pro-environmental behavior among adolescents. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023387836], identifier [CRD42023387836].
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PURPOSE: Fran is one of the most popular CrossFit benchmark workouts used to control CrossFitters' improvements. Detailed physiological characterization of Fran is needed for a more specific evaluation of CrossFitters' training performance improvements. The aim of the study was to analyze the oxygen uptake (VËO2) kinetics and characterize the energy system contributions and the degree of postexercise fatigue of the unbroken Fran. METHODS: Twenty trained CrossFitters performed Fran at maximal exertion. VËO2 and heart-rate kinetics were assessed at baseline and during and post-Fran. Blood lactate and glucose concentrations and muscular fatigue were measured at baseline and in the recovery period. RESULTS: A marked increase in VËO2 kinetics was observed at the beginning of Fran, remaining elevated until the end (VËO2peak: 49.2 [3.7] mL·kg-1·min-1, VËO2 amplitude: 35.8 [5.2] mL·kg-1·min-1, time delay: 4.7 [2.5] s and time constant: 23.7 [11.1] s; mean [SD]). Aerobic, anaerobic lactic, and alactic pathways accounted for 62% (4%), 26% (4%), and 12% (2%) of energy contribution. Reduction in muscle function in jumping ability (jump height: 8% [6%], peak force: 6% [4%], and maximum velocity: 4% [2%]) and plank prone test (46% [20%]) was observed in the recovery period. CONCLUSIONS: The Fran unbroken workout is a high-intensity effort associated with an elevated metabolic response. This pattern of energy response highlights the primary contribution of aerobic energy metabolism, even during short and very intense CrossFit workouts, and that recovery can take >24 hours due to cumulative fatigue.
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Fadiga , Consumo de Oxigênio , Humanos , Consumo de Oxigênio/fisiologia , Fadiga Muscular/fisiologia , Oxigênio , MúsculosRESUMO
SUMMARY OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.
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Objetivo: analisar as repercussões das decisões do Governo Federal brasileiro no enfrentamento da COVID-19 no cuidado clínico de enfermagem. Método: estudo documental baseado nas publicações de janeiro de 2020 a junho de 2021 divulgadas no site oficial do governo federal. Obtiveram-se 144 documentos que foram analisados na íntegra, apresentados em fluxograma e em Classificação Hierárquica Descendente, esta gerada pelo software IRaMuTeQ. Resultados: a Classificação Hierárquica Descendente gerou seis classes condensadas em: COVID-19 no Brasil, âmbito social, gestão pública, economia na pandemia e direcionamento da assistência em saúde. As decisões centraram-se em reconhecer a existência do cenário pandêmico e estabelecer criação de comitês para gestão e enfrentamento, gestão de insumos hospitalares, redefinição de metas relacionadas aos indicadores de saúde e combate à violência. Considerações finais: as determinações para enfrentamento da pandemia apresentaram ações circunscritas, prioritariamente aos aspectos curativistas, que impactaram na oferta dos cuidados clínicos de enfermagem ao reforçarem o modelo biomédico de atenção à saúde.
Objetivo: analizar las repercusiones de las decisiones del Gobierno Federal brasileño en el enfrentamiento de la COVID-19 en el cuidado clínico de enfermería. Método: estudio documental basado en las publicaciones de enero de 2020 a junio de 2021 divulgadas en el sitio oficial del gobierno federal. Se obtuvieron 144 documentos que fueron analizados en su totalidad, presentados en diagrama de flujo y en Clasificación Jerárquica Descendente, esta generada por el softwareIRaMuTeQ. Resultados: La Clasificación Jerárquica Descendente generó seis clases condensadas en: COVID-19 en Brasil, ámbito social, gestión pública, economía en la pandemia y direccionamiento de la asistencia en salud. Las decisiones se centraron en reconocer la existencia del escenario pandémico y establecer comités para gestión y enfrentamiento, gestión de insumos hospitalarios, redefinición de metas relacionadas a los indicadores de salud y combate a la violencia. Consideraciones finales: las determinaciones para enfrentar la pandemia presentaron acciones circunscritas, prioritariamente a los aspectos curativos, que impactaron en la oferta de los cuidados clínicos de enfermería al reforzar el modelo biomédico de atención a la salud.
Objective: analyzing the repercussions of the decisions of the Brazilian Federal Government in confronting COVID-19 in clinical nursing care. Method: documentary study based on publications from January 2020 to June 2021 published on the official website of the federal government. We obtained 144 documents that were analyzed in full, presented in flowchart and Descending Hierarchical Classification, this generated by IRaMuTeQ software. Results: the Descending Hierarchical Classification generated six classes condensed into: COVID-19 in Brazil, social scope, public management, economy in the pandemic and direction of health care. The decisions focused on recognizing the existence of the pandemic scenario and establishing the creation of committees for management and coping, management of hospital inputs, redefinition of goals related to health indicators and combating violence. Final considerations: the determinations for coping with the pandemic presented limited actions, primarily to curative aspects, which impacted the provision of clinical nursing care by reinforcing the biomedical model of health care.
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Humanos , Masculino , Feminino , COVID-19/prevenção & controle , Capacidades de Enfrentamento/normas , Política de Saúde , Governança em Saúde , Análise DocumentalRESUMO
N-butyl-2-cyanoacrylate (NB2CYA) is frequently used in the treatment of variceal hemorrhage with a success rate in hemostatic control of 87%-100%. Although rare, complications include esophageal perforation, infection, or arterial and venous embolization. We present the case of a 67-year-old male with chronic ethanolic liver disease hospitalized due to melena and hematemesis. He had anemia requiring transfusion support, octreotide, and pantoprazole infusion. Upper digestive endoscopy was performed showing gastric varices with a hemorrhagic rupture point treated with cyanoacrylate. The patient developed respiratory failure over the next 48 hours with chest computed tomography (CT) angiography showing several dense, scattered linear images, with arterial vascular trajectories suggestive of cyanoacrylate embolization. It was decided to provide ventilatory support with invasive mechanical ventilation, initiate systemic corticosteroid therapy, and transfer the patient to the intensive care unit (ICU). The patient was ventilated for 11 days with initial favorable evolution, but after two episodes of decompensation of his chronic liver disease (CLD) (hepatic encephalopathy and hepatorenal syndrome) and a new nosocomial pneumonia, he ended up dying. The present case illustrates a rare but potentially fatal complication associated with cyanoacrylate, highlighting the importance of a high suspicion index in cases of respiratory failure and dyspnea after this therapy.
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Objetivo:Identificar o perfil biossociodemográfico e digital das pessoas com colostomia e dos cuidadores que participaram da intervenção educativa online sobre colostomia. Método: Estudo transversal realizado com 20 pessoas com colostomia e 32 cuidadores, no período de setembro/novembro de 2020, em um centro integrado de saúde de Teresina, Piauí. Utilizaram-se instrumentos de caracterização sociodemográfica e clínica, acesso ao computador e à internet e proficiência digital básica, todos submetidos à análise estatística. Resultados: Das pessoas com colostomia e cuidadores, 60% eram do sexo masculino e 75% do feminino. Predominou a colostomia temporária (55%) de cor vermelho vivo e formato regular (80%). A maioria dos cuidadores tinha ocupação laboral (46,9%), e 8 horas/semanais eram dedicadas ao cuidado. O grau de proficiência digital foi baixo (76,9%). Conclusão: A identificação do perfil biossociodemográfico e digital dos participantes pode contribuir na adoção de estratégias educativas conforme a maturidade digital ou a necessidade de suporte para o uso de tecnologias, para otimização do cuidado em saúde e qualificação da assistência prestada.
Objective:To identify the biosociodemographic and digital profile of people with colostomy and caregivers who participated in the online educational intervention on colostomy. Method: Cross-sectional study carried out with 20 people with colostomy and 32 caregivers, in the period of September/November 2020, in an integrated health center in Teresina, Piauí, Brazil. Sociodemographic and clinical characterization instruments, computer and internet access, and basic digital proficiency submitted to statistical analysis were used. Results: Among people with colostomy and caregivers, 60% were male and 75% female. Temporary colostomy (55%) with bright red color and regular shape (80%) predominated. Most caregivers had a job (46.9%), and 8 hours/week were dedicated to care. The degree of digital proficiency was low (76.9%). Conclusion: The identification of the biosociodemographic and digital profile of the participants can contribute to the adoption of educational strategies according to digital maturity or the need for support for the use of technologies, to optimize health care and qualify the assistance provided.
Objetivo:Identificar el perfil biosociodemográfico y digital de personas con colostomía y cuidadores que participarían de la intervención educativa en línea sobre colostomía. Método: Estudio transversal, realizado con 20 personas con colostomía y 32 cuidadores, en el período de septiembre/noviembre de 2020, en un Centro Integrado de Salud de Teresina, Piauí. Se utilizaron instrumentos de caracterización sociodemográfica y clínica, acceso a computador e internet y competencia digital básica sometidos a análisis estadístico. Resultados: La mayoría de las personas con colostomía y cuidadores eran hombres (60%) y mujeres (75%), respectivamente. Predominó la colostomía temporal (55%) de color rojo vivo y forma regular (80%). La mayoría de los cuidadores tenían trabajo (46,9%), y se dedicaban al cuidado 8 horas/semana. El grado de competencia digital fue bajo (76,9%). Conclusión: La identificación del perfil biosociodemográfico y digital de los participantes puede contribuir para la adopción de estrategias educativas de acuerdo con la madurez digital o la necesidad de apoyo para el uso de tecnologías, para optimizar la atención en salud y calificar la asistencia brindada