Spheroid Model of Mammary Tumor Cells: Epithelial-Mesenchymal Transition and Doxorubicin Response.

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.

Production and characterization of the lipopeptide with anti-adhesion for oral biofilm on the surface of titanium for dental implants.

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.

Prevalência e fatores preditivos de transtornos mentais comuns em estudantes de enfermagem / Prevalence and predictive factors for common mental disorders in nursing students / Prevalencia y factores predictivos de transtornos mentales comunes en estudiantes de enfermería

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

Assessment and indicators of kinematic behavior and perceived fatigability.

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.

Assessment and indicators of kinematic behavior and perceived fatigability

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.

Decisões do governo brasileiro no enfrentamento da covid-19: repercussões para o cuidado clínico de enfermagem / Decisiones del gobierno brasileño en el enfrentamiento de covid-19: repercusiones para el cuidado clínico de enfermería / Brazilian government decisions in the fight against covid-19: repercussions for clinical nursing care

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.

Conhecimento de Estudantes de Enfermagem Sobre Estomias Intestinais de Eliminação / Knowledge of Nursing Students About Intestinal Elimination Stomas / Conocimiento de Estudiantes de Enfermería Sobre Estomas de Eliminación Intestinal

Objetivo:Investigar o conhecimento de estudantes de Enfermagem sobre estomias intestinais de eliminação. Método: Estudo descritivo, exploratório, analítico, com abordagem quantitativa, realizado em instituição de ensino superior pública do Piauí, com 115 estudantes de Enfermagem entre o oitavo e o 10º período do curso. A coleta foi realizada por meio de questionário online composto de dois instrumentos, um sobre o perfil sociodemográfico e escolar dos estudantes, e o outro, acerca do conhecimento sobre estomias intestinais de eliminação. A análise dos dados deu-se por meio de análises descritivas (frequências absolutas e relativas, médias e desvio padrão) e inferenciais, a fim de verificar associação entre as variáveis, com os testes χ2 e exato de Fisher. Resultados: A maioria dos estudantes de Enfermagem possui déficit quanto aos aspectos relacionados às assistências pré-operatória e pós-operatória imediata e mediata. Observou-se diferença significativamente estatística na variável índice de rendimento acadêmico, e viu-se que os estudantes com rendimento acadêmico superior a 9 obtiveram maior número de acertos em comparação aos demais. Conclusão: Existem lacunas de conhecimento entre os estudantes de Enfermagem, sobretudo na assistência de enfermagem nos cuidados pré-operatório e no pós-operatório imediato e mediato, o que por sua vez pode comprometer a qualidade da assistência prestada.

Objective:To investigate the knowledge of nursing students about intestinal elimination stomas. Method: Descriptive, exploratory, analytical study, with a quantitative approach, carried out in a public higher education institution in Piauí, Brazil, with 115 nursing students between the eighth and the tenth period of the course. The data collection was carried out through an online questionnaire composed of two instruments, one about the sociodemographic and school profile of the students, and the other about knowledge on intestinal ostomies for elimination. Data analysis was carried out through descriptive analysis (absolute and relative frequencies, means and standard deviation) and inferential analysis, in order to verify association between variables, with χ2and Fisher's exact tests. Results: Most nursing students have a deficit regarding aspects related to preoperative and immediate and mediate postoperative care. There was a statistically significant difference in the academic performance index variable, and it was observed that students with academic performance greater than 9 obtained a higher number of correct answers compared to the others. Conclusion: There are knowledge gaps among nursing students, especially in nursing care in preoperative care, and in the immediate and mediate postoperative period, which in turn can compromise the quality of care provided.

Objetivo:Investigar el conocimiento de estudiantes de enfermería sobre estomas de eliminación intestinal. Método: Estudio descriptivo-exploratorio, analítico, con abordaje cuantitativo, realizado en una Institución de Enseñanza Superior (IES) pública de Piauí, con 115 estudiantes de enfermería, entre el octavo y décimo período del curso. La recolección se realizó a través de un cuestionario en línea compuesto por dos instrumentos, uno sobre el perfil sociodemográfico y escolar de los estudiantes, y otro, un instrumento validado sobre conocimientos sobre ostomías intestinales para eliminación. El análisis de los datos se realizó mediante análisis descriptivo (frecuencias absolutas y relativas, medias y desviación estándar) e inferencial, con el fin de verificar la asociación entre las variables, con las pruebas Chi-cuadrado y exacta de Fisher. Resultados: La mayoría de los estudiantes de enfermería presentan un déficit en los aspectos relacionados con los cuidados preoperatorios y postoperatorios inmediatos y medios. Hubo diferencia estadísticamente significativa en la variable índice de rendimiento académico, y se observó que los estudiantes con rendimiento académico superior a 9,0 obtuvieron mayor número de respuestas correctas en comparación con los demás. Conclusión: Existen lagunas de conocimiento entre los estudiantes de enfermería, especialmente en el cuidado de enfermería en el preoperatorio, y en el postoperatorio inmediato y mediato, lo que a su vez puede comprometer la calidad de la atención prestada.

Descarte domiciliar de medicamentos por estudantes de enfermagem / Medication disposal at home by nursing students

Objetivo: Analisar a prática de descarte domiciliar de medicamentos entre estudantes de enfermagem de uma instituição de ensino superior pública. Métodos: Estudo descritivo-exploratório, quantitativo, realizado por meio de questionário online, com 84 estudantes de enfermagem. Os dados foram coletados pelo Google Forms e analisados no Statistical Package for the Social Sciences por meio de estatística descritiva e inferencial. Resultados: A maioria (90,5%) refere que já descartou medicamentos, sobretudo analgésicos (71,4%), e o descarte incorreto, com o lixo domiciliar. Verificou-se desconhecimento acerca de local para coleta de medicamentos vencidos pela maioria dos estudantes, bem como ausência de instruções sobre descarte adequado. Observou-se que grande parte dos participantes da pesquisa destacou que retornaria medicamentos, vencidos ou sem utilidade, para as farmácias ou estabelecimentos de saúde e que é necessário descartar de forma diferenciada do lixo comum. Conclusão: A prática domiciliar de descarte de medicamentos entre estudantes de enfermagem de uma instituição de ensino superior pública é insegura. Descritores: Preparações Farmacêuticas; Estudantes de Enfermagem; Meio Ambiente; Saúde Ambiental.

Objective:To analyze the practice of home disposal of medications among nursing students of a public higher education institution. Methods:A descriptive-exploratory, quantitative study conducted through an online questionnaire with 84 nursing students. Data were collected by Google Forms and analyzed in the Statistical Package for the Social Sciences, through descriptive and inferential statistics. Results:The majority (90.5%) reported that they have already discarded medications, especially analgesics (71.4%), and made the incorrect disposal of the medications together with household waste. There was a lack of knowledge about the place for collection of expired medications by most students, and lack of instructions on proper disposal. It was observed that most of the research participants highlighted that they would return medications, expired or useless, to pharmacies or health establishments and that it is necessary to disposal them differently from ordinary waste.Conclusion:the practice of home disposal of medications among nursing students at a public higher education institution is unsafe. Descriptors: Pharmaceutical Preparations; Nursing students; Environment; Environmental health.

Perfil Biossociodemográfico e Digital de Participantes de uma Intervenção Educativa Online sobre Colostomia / Biosociodemographic and Digital Profile of Participants in an Online Educational Intervention on Colostomy / Perfil Biosociodemográfico y Digital de los Participantes en una Intervención Educativa Online Sobre Colostomía

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

A Strategy Utilizing Protein-Protein Interaction Hubs for the Treatment of Cancer Diseases.

We describe a strategy for the development of a rational approach of neoplastic disease therapy based on the demonstration that scale-free networks are susceptible to specific attacks directed against its connective hubs. This strategy involves the (i) selection of up-regulated hubs of connectivity in the tumors interactome, (ii) drug repurposing of these hubs, (iii) RNA silencing of non-druggable hubs, (iv) in vitro hub validation, (v) tumor-on-a-chip, (vi) in vivo validation, and (vii) clinical trial. Hubs are protein targets that are assessed as targets for rational therapy of cancer in the context of personalized oncology. We confirmed the existence of a negative correlation between malignant cell aggressivity and the target number needed for specific drugs or RNA interference (RNAi) to maximize the benefit to the patient's overall survival. Interestingly, we found that some additional proteins not generally targeted by drug treatments might justify the addition of inhibitors designed against them in order to improve therapeutic outcomes. However, many proteins are not druggable, or the available pharmacopeia for these targets is limited, which justifies a therapy based on encapsulated RNAi.

Existing as a being-with-heart-disease-who-developed-pressure-wounds: an understanding based on Martin Heidegger.

OBJECTIVE: To understand, using Martin Heidegger's phenomenological framework, the Being who experiences a heart disease and develops a pressure injury. METHOD: Qualitative, phenomenological study using Martin Heidegger's theoretical-philosophical-methodological framework. Nine participants were interviewed at their residences, from October to December 2015, Ceará. RESULTS: Six meaning units were revealed: experiencing difficulties; dealing with the treatment of pressure wounds; not knowing the cardiac disease; being supported by family and friends; experiencing changes caused by disease; and maintaining faith in God. These Daily life was apprehended in an inauthentic life, chatter, curiosity, and ambivalence. Imprisoned to the vigor of having been, they live in anguish, supported by the faith in God and being-with-others in a movement of attentiveness. CONCLUSION: The phenomenon interferes with patients and families' daily lives rendering them vulnerable. There is a need for nursing to reflect on this experience and incorporate care that reaches human existence.

Conhecimentos, atitudes e práticas sobre COVID-19 de estudantes de Odontologia do Estado do Ceará, Brasil / Conocimientos, actitudes y prácticas sobre la COVID-19 de estudiantes de Odontología del Estado de Ceará, Brasil / Knowledge, attitudes and practices about COVID-19 of dental students in Ceará State, Brazil

Estratégias de prevenção e controle da pandemia de COVID-19 incluem abordagens comportamentais e que identifiquem cenários potenciais de intervenção, como o processo formativo de profissionais da saúde. O objetivo do presente estudo foi analisar conhecimentos, atitudes e práticas sobre COVID-19 e fatores associados em estudantes de Odontologia. Trata-se de um estudo transversal com os estudantes de Odontologia regularmente matriculados em instituições de ensino superior do estado do Ceará. Participaram da pesquisa 288 estudantes. Observou-se alta frequência de adequação deconhecimentos, atitudes e práticas para prevenção da COVID-19. A relação entre as características sociodemográficas dos participantes e os conhecimentos, atitudes e práticas mostrou associação com localidade de moradia do estudante e distância da Unidade Básica de Saúde (UBS) mais próxima. A maior parcela de estudantes que reside tanto em zona rural quanto em zona urbana apresenta práticas adequadas a respeito da COVID-19, assim como a maioria dos estudantes que moram circunvizinhos ou distantes da UBS mais próxima também apresentam conhecimentos, atitudes e práticas adequadas. O baixo risco de infecção observado na amostra estudada, assim como o adequado nível de conhecimentos, atitudes e práticas consideradas adequadas sobre a COVID-19 não isenta a necessidade de processos educativos contínuos relacionados aos protocolos de biossegurança (AU).

Las estrategias de prevención y control de la pandemia de COVID-19 incluyen enfoques conductuales que identifican escenarios potenciales de intervención, como el proceso de formación de los profesionales de la salud. El objetivo del presente estudio fue analizar conocimientos, actitudes y prácticas sobre la COVID-19 y factores asociados en estudiantes de odontología. Se trata de un estudio transversal con estudiantes de odontología matriculados regularmente en instituciones de enseñanza superior del estado de Ceará. Participaron en la encuesta 288 estudiantes. Se observó una alta frecuencia de adecuación de conocimientos, actitudes y prácticas para la prevención de la COVID-19. La relación entre las características sociodemográficas de los participantes y los conocimientos, actitudes y prácticas mostró asociación con el lugar de residencia del estudiante y la distancia a la Unidad Básica de Salud (UBS) más cercana. La mayor parte de los estudiantes que viven tanto en zonas rurales como urbanas tienen prácticas adecuadas frente al COVID-19, así como la mayoría de los estudiantes que viven cerca o lejos de la UBS más cercana también tienen conocimientos, actitudes y prácticas adecuadas. El bajo riesgo de contagio observado en la muestra estudiada, así como el adecuado nivel de conocimientos, actitudes y prácticas consideradas adecuadas frente al COVID-19 no eximen la necesidad de procesos de educación continua relacionados con los protocolos de bioseguridad (AU).

Prevention and control strategies for the COVID-19 pandemic include behavioral approaches and that identify potential intervention scenarios, such as the training process for health professionals. The aim of the present study was to analyze knowledge, attitudes and practices about COVID-19 and associated factors in dentistry students. This is a cross-sectional study with dentistry students from Higher Education Institutions in the state of Ceará, Brazil. 288 students regularly enrolled in Higher Education Institutions participated in the research. The sample showed a high frequency of adequacy of knowledge, attitudes and practices for the prevention of COVID-19. The relationship between the sociodemographic characteristics of the participants and their knowledge, attitudes and practices showed an association between the student's place of residence and distance from the nearest Basic Health Unit. Most students who live in both rural and urban areas have adequate practices regarding COVID-19, as well as most students who live near or far from the nearest Basic Health Unit also have knowledge, attitudes and practices appropriate. The low risk of infection observed in the studied sample, as well as the adequate level of knowledge, attitudes and practices considered adequate about COVID-19 do not exempt the need for continuous educational processes related to biosafety protocols (AU).

Clinical Profile Among Brazilian Mucopolysaccharidosis type II Patients: Subgroup Analysis from the Hunter Outcome Survey

Abstract Mucopolysaccharidosis type II (MPS II) is a rare genetic, multiorgan disease. Little information about the Brazilian context is available to date; thus, this descriptive subgroup analysis was conducted on Brazilian data from the Hunter Outcome Survey (HOS), including clinical characteristics among MPS II patients from Brazil. HOS is a global, multi-center, long-term, observational registry of patients with MPS II (NCT03292887). Variables related to organ system involvement, signs and symptoms, surgical procedures and survival among Brazilian patients were extracted from HOS database. Data from 153 Brazilian patients with MPS II were analyzed. Musculoskeletal (96.6%), abdomen/gastrointestinal (95.2%), neurological (88.7%), pulmonary (86.2%), and ear (81.3%) were the most frequently observed organ/systems involved. Regarding signs and symptoms, the most prevalent symptom was coarse facial features consistent with the disease (94.6%), followed by joint stiffness and limited function (89.3%), hernia (84.2%) and hepatomegaly (82.2%). Median survival time was 22.0 years, and the major cause of death was respiratory failure (31.8%). These data may be helpful to understand disease characteristics and to help improve the quality of MPS II patient care in Brazil.

Análise da evolução espacial e fatores associados à morbimortalidade por Covid-19 nas regiões geográficas do Brasil: um estudo ecológico / Analysis of spatial evolution and factors associated with Covid-19 morbidity and mortality in the geographic regions of Brazil: an ecological study

Resumo Objetivo Este estudo analisou a evolução do padrão de distribuição espacial dos coeficientes de morbimortalidade por Covid-19 e fatores associados nas Regiões Intermediárias de Articulação Urbana do Brasil. Métodos Estudo ecológico com variáveis de bancos secundários, com dados de incidência e mortalidade por Covid-19 acumulados no intervalo de três meses, o que corresponde ao aumento das medidas de flexibilização do isolamento social. As variáveis independentes representaram fatores socioeconômicos. Foram realizadas análise de dependência espacial, regressão clássica e espacial. Resultados Houve um aumento da morbimortalidade por Covid-19 entre os dois períodos analisados. Foi encontrada uma autocorrelação positiva com formação de cluster em áreas de maior incidência de Covid-19 e com maior significância em Regiões Intermediárias de Articulação Urbana na região Norte do Brasil, com agrupamentos maiores em relação à mortalidade após a flexibilização das medidas de isolamento. A ocorrência da morbimortalidade apresentou associação significativa com variáveis étnicas com maiores coeficientes de determinação na região Norte. Conclusão Determinantes sociais demonstraram um comportamento preditivo no aumento da autocorrelação positiva para a mortalidade por Covid-19 durante os períodos observados, com aumento da morbimortalidade na região Norte após a flexibilização do isolamento social.

Abstract Background This study analyzed the evolution of the spatial distribution pattern of Covid-19 morbidity and mortality coefficients and associated factors in the Intermediate Regions of Urban Articulation in Brazil. Method Ecological study with secondary bank variables with Covid-19 incidence and mortality data accumulated over the three-month interval, which corresponds to an increase in the measures for easing social isolation. The independent variables represented socioeconomic factors. Spatial dependence analysis, classical regression and spatial regression were performed. Results There was an increase in Covid-19 morbidity and mortality between the two periods analyzed. A positive autocorrelation with cluster formation was found in areas with a higher incidence of Covid-19 and with greater significance in the Intermediate Regions of Urban Articulation in the North of Brazil, with larger clusters in relation to mortality after the relaxation of isolation measures. The occurrence of morbidity and mortality was significantly associated with ethnic variables, with higher coefficients of determination in the North. Conclusion Social determinants demonstrated a predictive behavior in the increase of positive autocorrelation for mortality due to Covid-19 during the observed periods, with an increase in morbidity and mortality in the North region after the relaxation of social isolation.

Reflections based on the Tidal Model about the concept of psychosis.

OBJECTIVE: To reflect on the concept of psychosis using the Tidal Model framework. METHOD: Reflective study developed from the bookEl modelo Tidal: salud mental, reivindicación y recuperación by Phil Barker and Poppy Buchanan-Barker and other texts. RESULTS: The reflection was organized into three axes of discussion: "The Tidal Model", "The metaphor, psychosis and the domain of the self" and "The Tidal Model, nonlinearity and psychosis: synergisms with the Brazilian mental health policy". FINAL CONSIDERATIONS: The Tidal Model encompasses the concept of psychosis, in addition to being synergistic with aspects of psychiatric reform and mental health policies in Brazil. The limitations of the study are the fact that it only presents initial and general approximations about the relationship between the concept of psychosis and the Tidal Model, and it is necessary to deepen this knowledge in the specific context of care practice.

Perfil de pacientes com trombose venosa cerebral internados em um Hospital Universitário / Profile of patients with cerebral venous thrombosis hospitalized in a University Hospital

Objetivo: Caracterizar o perfil clínico e epidemiológico dos pacientes diagnosticados com trombose venosa cerebral em um Hospital Universitário de Teresina. Métodos: Trata-se de um estudo retrospectivo, transversal e descritivo, realizado através da avaliação de prontuários eletrônicos dos pacientes internados no Serviço de Neurologia de um Hospital Universitário de Teresina/PI, no período de maio a julho de 2021. Resultados: A amostra foi composta por 13 pacientes. A maioria era do sexo feminino (69,2%), com idade média de 39,2 anos. A cefaléia (92%) foi a manifestação clínica mais observada. O uso de contraceptivo oral foi o fator de risco mais associado à TVC, com 46%. A média de internação observada foi de 18,1 dias. Conclusão: Apesar de ser uma doença potencialmente grave, não foi observado óbito na população do estudo, que pode estar atrelado ao diagnóstico adequado e o tratamento em tempo hábil, capaz de refletir no êxito do desfecho de pacientes com TVC.

Objective: Characterize the clinical and epidemiological profile of patients diagnosed with cerebral venous thrombosis (CVT) in a University Hospital from Teresina. Methods: This is a retrospective, cross-sectional, and descriptive study, performed through the evaluation of electronic medical records of patients hospitalized in the Neurology Service of a University Hospital in Teresina/PI, from May to July 2021. Results: The sample consisted of 13 patients. The majority were female (69.2%), with an average age of 39.2 years. Cephalea (92%) was the most observed clinical manifestation. The use of oral contraceptives was the risk factor most associated with CVT, with 46%. The average of hospitalization observed was 18.1 days. Conclusion: Despite being a potentially serious disease, no death was observed in the study population, which may be tied to the appropriate diagnosis and timely treatment, capable of reflecting on the success of the outcome of patients with CVT.

Adolescent nursing consultation: an important excerpt from care provided by nurses in a Brazilian state.

OBJECTIVE: the care of adolescents with or without a chronic disease must complete, standardized and focused on individual demands and the transition process to adult care and adherence to treatment. This study aimed to characterize the care provided by nurses from the state of São Paulo who work with adolescents. METHOD: this is a cross-sectional and descriptive study on the care provided to adolescents by nurses in São Paulo, based on the answers to a self-administered questionnaire, available in the REDCap tool between August 2018 and October 2019. RESULTS: participants answered 1632 questionnaires. Only 38% of nurses work with adolescents, 11.2% exclusively. Professionals were divided according to the median length of professional experience in groups A and B (≤5 years and >5 years). Drug addiction (p=0.01) and working with a multidisciplinary team (p=0.04) were significantly more reported in group B. Routine follow-up (p=0.02) and questioning about sexual or physical violence (p=0.03) were significantly more performed by professionals from group A. CONCLUSION: this study identified the need for a care protocol that can be replicated on a large scale and that includes the treatment and the particularities of adolescents to improve adherence and the transition into adult care. KEYPOINTS: (1) Nursing consultation is essential for adolescents. (2) Care protocols must address the particularities of adolescents. (3) The transition to adult care is important and deserves attention. (4) Remuneration can impact the performance of nurses' activities, updates and training.

Increased platelet activation and platelet-inflammasome engagement during chikungunya infection.

Chikungunya fever is a viral disease transmitted by mosquitoes of the genus Aedes. The infection is usually symptomatic and most common symptoms are fever accompanied by joint pain and swelling. In most cases symptoms subside within a week. However, severe prolonged and disabling joint pain, that may persist for several months, even years, are reported. Although the pathogenesis of Chikungunya infection is not fully understood, the evolution to severe disease seems to be associated with the activation of immune mechanisms and the action of inflammatory mediators. Platelets are recognized as inflammatory cells with fundamental activities in the immune response, maintenance of vascular stability and pathogenicity of several inflammatory and infectious diseases. Although the involvement of platelets in the pathogenesis of viral diseases has gained attention in recent years, their activation in Chikungunya has not been explored. The aim of this study was to analyze platelet activation and the possible role of platelets in the amplification of the inflammatory response during Chikungunya infection. We prospectively included 132 patients attended at the Quinta D'Or hospital and 25 healthy volunteers during the 2016 epidemic in Rio de Janeiro, Brazil. We observed increased expression of CD62P on the surface of platelets, as well as increased plasma levels of CD62P and platelet-derived inflammatory mediators indicating that the Chikungunya infection leads to platelet activation. In addition, platelets from chikungunya patients exhibit increased expression of NLRP3, caspase 4, and cleaved IL-1ß, suggestive of platelet-inflammasome engagement during chikungunya infection. In vitro experiments confirmed that the Chikungunya virus directly activates platelets. Moreover, we observed that platelet activation and soluble p-selectin at the onset of symptoms were associated with development of chronic forms of the disease. Collectively, our data suggest platelet involvement in the immune processes and inflammatory amplification triggered by the infection.

Malignant syphilis in a patient with acquired human immunodeficiency virus (HIV) infection

Abstract Malignant syphilis is an uncommon variant of syphilis, most often (but not always) found in immunosuppressed individuals. This report describes the case of a 57-year-old man, infected with the acquired human immunodeficiency virus (HIV), with a generalized picture of erythematous-squamous papules that rapidly progressed to painful and ulcerated plaques and nodules, some covered with a black rupioid crust. The analytical study performed revealed positive VDRL (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin). The skin biopsy was nonspecific; however, the immunohistochemical analysis disclosed the presence of spirochetes. The patient was then treated with benzathine penicillin G 2.4 MU once a week IM for three weeks, with progressive resolution of the lesions. Considering its rarity, this atypical form of syphilis that needs to be known to better recognize its clinical presentation and provide more prompt treatment to patients.