Doar ou não doar: significados da negação familiar para a doação de órgãos e tecidos / To donate or not to donate: meanings of family refusal to the refusal to donate organs and tissues

Objetivo: Compreender os significados atribuídos por familiares sobre a negação para a doação de órgãos e tecidos. Métodos: Estudo descritivo, exploratório, com abordagem qualitativa. Utilizou-se um questionário semiestruturado para a coleta de dados e a análise temática de conteúdo para o tratamento dos dados obtidos. A amostragem de 10participantes foi definida pelo critério de saturação teórica. Resultados: Percebeu-se a tendência de os familiares consentirem a doação quando bem orientados sobre a morte encefálica e de a finalidade humanística do doador, mas os principais obstáculos para a negação da doação são a falta de conhecimento sobre a doação de órgãos, o medo da mutilação do corpo por não saber como é realizado o procedimento de retirada de órgãos e tecidos, a burocracia com a demora na liberação do corpo para sepultamento e a discordância entre os familiares. Conclusão: Os significados da negação familiar permeiam o medo, o sentimento de vazio, a falta de informação sobre os processos que envolvem a doação e captação de órgãos e tecidos, bem como aspectos culturais e religiosos, embora o desespero, a dor e a falta de empatia das equipes de saúde também possam corroborar a recusa. Descritores: Obtenção de Tecidos e Órgãos; Transplante; Relações Familiares

Objective: To understand the meanings attributed by family members about the refusal to donate organs and tissues.Methods: Adescriptive and exploratory study with a qualitative approach. A semi-structured questionnaire was used for data collection and thematic content analysis was employed for the treatment of the data obtained. The sample comprised by 10participants was defined by means of the theoretical saturation criterion. Results: There was a tendency for family members to consent to thedonation when well-oriented about brain death and the humanistic purpose of the donor, but the main obstacles to refuse donation are as follows: lack of knowledge about organ donation, fear of body mutilation for not knowing how the procedure for removingorgans and tissues is performed, bureaucracy with the delay in releasing the body for burial and disagreement between family members.Conclusion:The meanings of family refusal permeate fear, a feeling of emptiness and lack of information about the processes involved in organ and tissue donation, as well as cultural and religious aspects, although despair, pain and lack of empathy of the health teams can also corroborate refusal.Descriptors:Tissue and Organ Procurement; Transplant; Family relationships.

Use of exogenous substrate in Chlorella cultivation: Strategy for biomass and polyhydroxybutyrate production.

The aim of this study was to investigate the influence of exogenous carbon supplementation and nitrogen source reduction on Chlorella fusca LEB 111 growth, biomass composition, and polyhydroxybutyrate accumulation. First, assays were performed with 50 % and 25 % reduced nitrogen source concentrations (NaNO3). In the second stage, the influence of culture supplementation with 10, 20, and 30 mg L-1 D-xylose, associated with 50 and 25 % reductions in NaNO3, was evaluated. The experiments conducted with a 25 % reduction in NaNO3 and supplementation with 10 mg L-1 D-xylose resulted in a positive effect on the biomass productivity of C. fusca LEB 111, with production as high as 354.4 mg L-1 d-1. The maximum concentration of PHB extracted from C. fusca LEB 111 was 3.7 % (w w-1) and was obtained when the microalgae were cultivated with a 25 % of reduction in NaNO3 and supplementation of D-xylose at 20 mg L-1. Therefore, this study brings new perspectives regarding reducing the use of nutritional sources and using exogenous carbon sources in using microalgae to produce molecules of high biotechnological potential.

Endoscopic endonasal approach for isolated subarachnoid neurocysticercosis in basal cisterns and its complications: illustrative case.

BACKGROUND: Neurocysticercosis (NCC) is an infectious parasitic disease in which humans are the middle host in the life cycle of Taenia solium. It is currently considered to be a neglected tropical disease. According to their location, cysts can cause epilepsy, hydrocephalus, arachnoiditis, and intracranial hypertension. The subarachnoid is the rarest and most morbid form among all forms of NCC presentation. OBSERVATIONS: The authors report an odd case of subarachnoid NCC (SUBNCC). It was treated with expanded endoscopic endonasal surgery. Unfortunately, the patient developed a high-output nasal leak and meningitis after cyst removal, which demanded additional surgical procedures. Nonetheless, the patient showed a good clinical outcome after surgical interventions. LESSONS: Endoscopic endonasal approach of SUBNCC can be safe and curative. Neverthless, the presented report shows that severe complications can arise from the procedure. The authors hypothesized that placing an early cerebrospinal shunt would reduce the patient's morbidity before difficulties arose.

Validation methods of nursing protocols: an integrative review.

OBJECTIVE: to identify scientific production about validation methods of nursing care protocols. METHOD: an integrative review with search at Scielo, Pubmed/MEDLINE, Virtual Health Library, Web of Science, Scopus, and EBSCOhost. The descriptors "validation studies", "validation studies as topic", "protocols", "clinical protocols", "practice guidelines as topic", "nursing" and "nursing assessment" and the uncontrolled descriptor "validation" were used. RESULTS: thirty-two articles were selected, most of them Brazilian. Content validation by experts was the most frequent method, with no consensus on the number of participants for the process. The collection instruments were mostly created by the authors. Data analysis was performed using descriptive statistics and Content Validity Index, with a variable consensus rate in the analyzed articles. CONCLUSION: protocols validated by experts are robust tools for use in clinical practice, with methodological rigor in development essential for its quality.

Polyhydroxybutyrate production and increased macromolecule content in Chlamydomonas reinhardtii cultivated with xylose and reduced nitrogen levels.

The aim of the current study was to evaluate the production of macromolecules such as polyhydroxybutyrate under pentose supplementation and reduced nitrogen levels in Chlamydomonas reinhardtii. Two batches of experiments were carried out: (1) reduction in the nitrogen (NH4Cl) concentration to 6 and 4 g L-1 and (2) supplementation of 10, 20 and 30 mg L-1 D-xylose together with a reduction in the NH4Cl concentration (6 and 4 g L-1). The addition of 20 mg L-1 D-xylose together with 6 g L-1 NH4Cl resulted in polyhydroxybutyrate production (206.0 mg L-1). The reduction of 8 to 6 g L-1 NH4Cl did not trigger a reduction in the production of either proteins (68.3% w w-1) or carbohydrates (23.3% w w-1) in the cells. The current study demonstrated that nutritional modifications, which until now have been unexplored in C. reinhardtii, triggered the production of macromolecules (polymers, carbohydrates and proteins) with high biotechnological potential.

Innovative development of membrane sparger for carbon dioxide supply in microalgae cultures.

The present study was aimed to develop a membrane sparger (MS) integrated into a tubular photobioreactor to promote the increase of the carbon dioxide (CO2 ) fixation by Spirulina sp. LEB 18 cultures. The use of MS for the CO2 supply in Spirulina cultures resulted not only in the increase of DIC concentrations but also in the highest accumulated DIC concentration in the liquid medium (127.4 mg L-1 d-1 ). The highest values of biomass concentration (1.98 g L-1 ), biomass productivity (131.8 mg L-1 d-1 ), carbon in biomass (47.9% w w-1 ), CO2 fixation rate (231.6 mg L-1 d-1 ), and CO2 use efficiency (80.5% w w-1 ) by Spirulina were verified with MS, compared to the culture with conventional sparger for CO2 supply. Spirulina biomass in both culture conditions had high protein contents varying from 64.9 to 69% (w w-1 ). MS can be considered an innovative system for the supply of carbon for the microalgae cultivation and biomass production. Moreover, the use of membrane system might contribute to increased process efficiency with a reduced cost of biomass production.

Progress in the physicochemical treatment of microalgae biomass for value-added product recovery.

Interest in microalgae-derived products is growing, mostly due to their unique characteristics and range of industrial applications. To obtain different products, one must employ specific pretreatments that retain the properties of the biologically active compounds extracted from microalgae biomass; thus, new extraction techniques require frequent upgrades. Due to increased interest in economically viable and ecologically friendly processes, new extraction methods that can be incorporated into microalgae biorefinery systems have become the main focus of research. Therefore, this review aims to address the potential applications, future prospects, and economic scenario of the new physicochemical treatments used in the extraction of bioactive microalgae compounds.

Systemic Inflammatory Protein Profiles Distinguish Irritable Bowel Syndrome (IBS) and Ulcerative Colitis, Irrespective of Inflammation or IBS-Like Symptoms.

BACKGROUND: Inflammatory mechanisms of ulcerative colitis (UC) and irritable bowel syndrome (IBS) may overlap or are part of different spectrums. However, potential links between inflammation and IBS-like symptoms in these patient groups are still unclear. The aim of this study was to determine if the systemic inflammatory protein (SIP) profiles differ between UC patients, with presence of inflammation or in remission with or without IBS-like symptoms, and IBS patients. METHODS: Serum from patients with active UC (UCA), UC patients in remission with or without IBS-like symptoms (UCR + IBS, UCR-IBS), IBS patients (IBS), and healthy subjects (HS) was analyzed using the ProSeek Multiplex Inflammation kit, which detects 92 proteins. RESULTS: The exploratory cohort consisted of 166 subjects (UCA, n = 40; UCR-IBS, n = 45; UCR + IBS, n = 20; IBS, n = 40; HS, n = 21). Systemic inflammatory protein profiles separated UC from non-UC (HS and IBS) patients in multivariate analysis, revealing caspase 8, axin 1, sulfotransferase 1A1, and tumor necrosis factor superfamily member 14 as the variables most important to clustering. Although minor differences were detected between UCR + IBS and UCR-IBS, SIP profiles discriminated UCA from UCR, and interleukin (IL) 17C, IL17A, chemokine ligand 9, and transforming growth factor-α characterized active inflammation. SIP profiles weakly discriminated HS from IBS, although fibroblast growth factor 21 and IL6 serum levels were higher in IBS. Results were confirmed in a validation cohort (UCA, n = 15; UCR + IBS, n = 9; IBS, n = 14). CONCLUSIONS: SIP profiles distinguish UC patients from IBS patients, irrespective of inflammation or IBS-like symptoms, suggesting that inflammatory mechanisms of the diseases are part of different spectrums.

Bioprocess strategies for enhancing biomolecules productivity in Chlorella fusca LEB 111 using CO2 a carbon source.

The aim of this study was to evaluate the influence of different carbon dioxide (CO2 ) concentrations on the distribution of carbon forms in the culture medium and the biomass production and biomolecules productivity of the strain Chlorella fusca LEB 111. In this study, experiments were carried out in which C. fusca cultures were exposed to different CO2 concentrations, 0.03% (0.08 mlCO2 mlmedium-1 days-1 ), 5% (0.18 mlCO2 mlmedium-1 days-1 ), and 15% vol/vol CO2 (0.54 mlCO2 mlmedium-1 days-1 ). Among the carbon chemical species distributions in the culture medium, bicarbonate was predominant (94.2-98.9%), with the highest quantitative percentage in the experiment receiving a 15% CO2 injection. C. fusca LEB 111 cultivated with 15% CO2 showed the highest biomass productivity (194.3 mg L-1 days-1 ) and CO2 fixation rate (390.9 mg L-1 days-1 ). The carbohydrate productivity in the culture that received 15% CO2 was 46.2% higher than the value verified for the culture with the addition of CO2 from the air (0.03% CO2 ). In addition, CO2 concentration providing increases of 0.03-15% to C. fusca cultures resulted in a 31.6% increase in the lipid productivity. These results showed that C. fusca can be used for CO2 bioconversion and for producing biomass with potential applications for biofuels and bioproducts.

Fatty Acid Biosynthesis from Chlorella in Autotrophic and Mixotrophic Cultivation

Abstract Microalgae are photosynthetic microorganisms whose composition and biomass production can be influenced by manipulating the cultivation conditions employed. However, few studies have evaluated the effects of various cultivation conditions in autotrophic and mixotrophic conditions. The present work aimed to evaluate the effects of cultivation conditions on the cell growth and biosynthesis of fatty acids (FAs) by microalgae of the genus Chlorella in autotrophic and mixotrophic cultivation. Evaluation of the effects of the conditions was performed using an experimental design methodology. The highest values of maximum biomass concentration (Xmax) and maximum biomass productivity (Pmax) were obtained in autotrophic cultures. Palmitic acid was the FA obtained at the highest concentration in both cultivation modes. The concentrations of polyunsaturated FAs (PUFAs) ranged from 12.2 to 41.2% in autotrophic cultures and from 11 to 34.3% in the mixotrophic cultures. The variables photoperiod and sodium bicarbonate concentration showed the greatest influence on the Xmax, Pmax, and PUFA concentration in autotrophic and mixotrophic cultivations, respectively. This study verified that the selection of conditions and mode of cultivation contribute to the production of microalgal biomass and FA biosynthesis.

Validation methods of nursing protocols: an integrative review / Métodos de validación de los protocolos de atención de enfermería: revisión integrativa / Métodos de validação de protocolos assistenciais de enfermagem: revisão integrativa

ABSTRACT Objective: to identify scientific production about validation methods of nursing care protocols. Method: an integrative review with search at Scielo, Pubmed/MEDLINE, Virtual Health Library, Web of Science, Scopus, and EBSCOhost. The descriptors "validation studies", "validation studies as topic", "protocols", "clinical protocols", "practice guidelines as topic", "nursing" and "nursing assessment" and the uncontrolled descriptor "validation" were used. Results: thirty-two articles were selected, most of them Brazilian. Content validation by experts was the most frequent method, with no consensus on the number of participants for the process. The collection instruments were mostly created by the authors. Data analysis was performed using descriptive statistics and Content Validity Index, with a variable consensus rate in the analyzed articles. Conclusion: protocols validated by experts are robust tools for use in clinical practice, with methodological rigor in development essential for its quality.

RESUMEN Objetivo: identificar la producción científica sobre los métodos de validación de los protocolos de atención de enfermería. Método: revisión integradora, búsqueda en las bases de datos Scielo, PubMed/MEDLINE, Biblioteca Virtual en Salud, Web of Science, Scopus y EBSCOhost, utilizando los descriptores validation studies, validation studies as topic, protocols, clinical protocols, practice guidelines as topic, nursing e nursing assessment y el descriptor no controlado validation. Resultados: se seleccionaron 32 artículos, la mayoría de ellos brasileños. La validación del contenido por expertos fue el método más frecuente, sin consenso sobre el número de participantes para el proceso. Los instrumentos de colección fueron elaborados principalmente por los autores. El análisis de datos se realizó utilizando estadísticas descriptivas e índice de validez de contenido, con una tasa de acuerdo variable en los artículos analizados. Conclusión: los protocolos validados por especialistas son herramientas robustas para su uso en la práctica clínica, y el rigor metodológico en el desarrollo es esencial para su calidad.

RESUMO Objetivo: identificar a produção científica acerca dos métodos de validação de protocolos assistenciais de enfermagem. Método: revisão integrativa, com busca nas bases de dados Scielo, PubMed/MEDLINE, Biblioteca Virtual em Saúde, Web of Science, Scopus e EBSCOhost, utilizando os descritores validation studies, validation studies as topic, protocols, clinical protocols, practice guidelines as topic, nursing e nursing assessment e o descritor não controlado validation. Resultados: foram selecionados 32 artigos, sendo a maioria brasileiros. A validação de conteúdo por especialistas foi o método mais frequente, sem consenso sobre o número de participantes para o processo. Os instrumentos de coleta foram majoritariamente elaborados pelos autores. A análise dos dados foi realizada por estatística descritiva e Índice de Validade de Conteúdo, com taxa de concordância variável nos artigos analisados. Conclusão: protocolos validados por especialistas constituem ferramentas robustas para o uso na prática clínica, sendo o rigor metodológico no desenvolvimento imprescindível para a qualidade do mesmo.

Operational and economic aspects of Spirulina-based biorefinery.

Microalgae biorefinery systems have been extensively studied from the perspective of resources, energy expenditure, biofuel production potential, and high-added value products. The genus Spirulina (Arthrospira) stands out among the microalgae of commercial importance. It accounts for over 30% of biomass produced globally because of high protein concentration and, carotenoid and phycocyanin content. Spirulina cultivation can be used to reduce greenhouse gases and for effluent treatment. Furthermore, its cellular morphology facilitates biomass recovery, which contributes to the process cost reduction. Spirulina biomass is widely applicable in food, feed, cosmetics, biofertilizers, biofuels, and biomaterials. A feasibility analysis of Spirulina biorefinery would provide specific information for the decision-making for the improvement of the Spirulina production process. In that context, this review aimed to present a parameter assessment to contribute to the economic viability of Spirulina production in a biorefinery system.

Immunopathogenesis of inflammatory bowel disease and mechanisms of biological therapies.

Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with a multifactorial pathophysiology. Full comprehension of IBD pathology is still out of reach and, therefore, treatment is far from ideal. Nevertheless, components involved in IBD pathogenesis including environmental, genetic, microbial, and immunological factors are continuously being investigated and the improved knowledge contributes to the development of new therapies. In this article we review the aspects of the immunopathogenesis of IBD, with focus on mucosal immunity, and discuss mechanisms of action for current and emerging biological therapies.

Carbon Dioxide Biofixation and Production of Spirulina sp. LEB 18 Biomass with Different Concentrations of NaNO3 and NaCl

ABSTRACT Microalgae are efficient at using solar energy to turn CO2 and nutrients into biomass containing lipids, proteins, carbohydrates and other compounds that may be used to produce bioproducts for human and animal consumption and pharmaceutical use. The aim of this study was to assess the effect of the NaNO3 and NaCl concentration on the growth kinetics, the biomass composition and the ability to biofix CO2 using the microalga Spirulina sp. LEB 18. The assays were carried out according to a 22 central composite design (CCD) with different concentrations of NaNO3 (1.25, 1.88 and 2.50 g L-1) and NaCl (1.00, 15.0 and 30.0 g L-1). The assays were carried out in 2 L vertical tubular photobioreactors at 30°C, 12 h light/dark and an injection of 12.0% v/v of CO2 at 0.3 vvm. The best growing results (Xmax = 1.60 g L-1, Pmax = 0.109 g L-1 d-1, μmax = 0.208 d-1) and CO2 biofixation rate (197.4 mg L-1 d-1) were observed in the assay with 1.25 g L-1 NaNO3 and 1.00 g L-1 NaCl. Increasing the NaCl concentration produced biomass with a higher carbohydrate content, while increasing the NaNO3 concentration reduced the protein concentration. According to the results, in addition to using Spirulina as a source of protein, it can also be used as a source of carbohydrates and to biologically remove CO2 from the atmosphere.

Prevalência e fatores associados à anemia em gestantes de alto risco de Maceió, Alagoas / Prevalence and factors associated with anemia in high-risk pregnant women in Maceió, Alagoas

Introdução: Alguns agravos ou doenças na gravidez apresentam relação com o aumento da incidência de anemia. Além disso, a anemia pode agravar os sintomas de certas doenças durante esse período. Portanto, a atenção a esse grupo de gestantes quanto a esse aspecto deveria ser redobrada. Objetivo: O objetivo do estudo foi avaliar a prevalência e os fatores associados à anemia em gestantes de alto risco. Método: Estudo transversal envolvendo amostra (n=129) obtida, considerando a prevalência de anemia em gestantes (50%), intervalo de confiança (IC) de 90%, erro de 8%, sendo elegíveis gestantes de alto risco internadas no hospital universitário do município no ano de 2013, por meio de coleta de dados socioeconômicos, de pré-natal, clínicos, antropométricos e medida de hemoglobina. A anemia foi identificada por um nível de hemoglobina < 11 g/dL e sua associação com os fatores de risco foi testada por meio de análise de regressão múltipla de Poisson, com os resultados expressos pela Razão de Prevalência e IC95%. Resultado: A prevalência de anemia foi de 49,6%, com associação dessa variável com: estado nutricional de baixo peso (RP=1,77; IC=1,21; 2,60; p=0,003) e ganho ponderal gestacional insuficiente (RP=0,55; IC=0,38; 0,81; p=0,002). Conclusões: A anemia em gestantes de alto risco de Maceió é um problema de magnitude elevada; no entanto, não ultrapassou os valores esperados para gestantes saudáveis. Somado a isso, essa condição se associou a um estado nutricional comprometido, o que pode elevar ainda mais as taxas de morbimortalidade materna e fetal nesse grupo.(AU)

Introduction: Some injuries or illnesses during pregnancy have relationship with the increased incidence of anemia. Further, anemia can aggravate the symptoms of some diseases during this period. Therefore, attention to this group of pregnant women in this regard should be redoubled. Objective: The objective of the study was to evaluate the prevalence and associated factors with anemia in high-risk pregnant women. Methods: Cross-sectional study conducted on a sample (n=129) obtained on the basis of the estimated prevalence of anemia during pregnancy (50%), a 90% confidence interval (CI), an error of 8%, being eligible high-risk pregnant women admitted to university hospital in the city in 2013, of which were collected socioeconomic, prenatal care and clinical data, anthropometric measure and hemoglobin held. Anemia was identified by a hemo- globin level <11 g / dL and its association with risk factors was tested using multivariate Poisson regression analysis, with the results expressed by the prevalence ratio (PR) and 95% CI. Results: The prevalence of anemia was 49.6%, with association of this variable with: nutritional status of low birth weight (PR=1.77, CI=1.21, 2.60; p=0.003) and insufficient gestational weight gain (PR=0.55, CI=0.38, 0.81; p=0.002). Conclusions: Anemia in high-risk pregnant women from the Maceió is a high magnitude problem; however, did not exceed the expected values for healthy pregnant women. Added to this, this condition was associated with a compromised nutritional status, which can further increase the maternal and fetal morbidity and mortality rates in this group.(AU)

Spirulina cultivation with a CO2 absorbent: Influence on growth parameters and macromolecule production.

The objective of this study was to select a concentration of CO2 absorbents to supplement Spirulina sp. LEB 18 cultivation and to evaluate the effect of these compounds on the growth and production of macromolecules. Three initial biomass concentrations (X0), eight concentrations of monoethanolamine (MEA), and three NaOH concentrations were tested. The selected MEA concentrations did not inhibit the growth of Spirulina and doubled the dissolved inorganic carbon concentration in the assay medium in relation to the concentration of NaOH. The protein concentration in the biomass grown with MEA was, on average, 17% higher than that obtained with NaOH. Thus, it was found that MEA did not reduce the productivity of Spirulina sp. LEB 18, and its use can be further explored as a means for converting the carbon dissolved in the medium to biomolecules.

Chemical absorption and CO2 biofixation via the cultivation of Spirulina in semicontinuous mode with nutrient recycle.

The chemical absorption of carbon dioxide (CO2) is a technique used for the mitigation of the greenhouse effect. However, this process consumes high amounts of energy to regenerate the absorbent and to separate the CO2. CO2 removal by microalgae can be obtained via the photosynthesis process. The objective of this study was to investigate the cultivation and the macromolecules production by Spirulina sp. LEB 18 with the addition of monoethanolamine (MEA) and CO2. In the cultivation with MEA, were obtained higher results of specific growth rate, biomass productivity, CO2 biofixation, CO2 use efficiency, and lower generation time. Besides this, the carbohydrate concentration obtained at the end of this assay was approximately 96.0% higher than the control assay. Therefore, Spirulina can be produced using medium recycle and the addition of MEA, thereby promoting the reduction of CO2 emissions and showing potential for areas that require higher concentrations of carbohydrates, such as in bioethanol production.

Effect of the carbon concentration, blend concentration, and renewal rate in the growth kinetic of Chlorella sp.

The microalgae cultivation can be used as alternative sources of food, in agriculture, residual water treatment, and biofuels production. Semicontinuous cultivation is little studied but is more cost-effective than the discontinuous (batch) cultivation. In the semicontinuous cultivation, the microalga is maintained in better concentration of nutrients and the photoinhibition by excessive cell is reduced. Thus, biomass productivity and biocompounds of interest, such as lipid productivity, may be higher than in batch cultivation. The objective of this study was to examine the influence of blend concentration, medium renewal rate, and concentration of sodium bicarbonate on the growth of Chlorella sp. during semicontinuous cultivation. The cultivation was carried out in Raceway type bioreactors of 6 L, for 40 d at 30°C, 41.6 µmol m(-2) s(-1), and a 12 h light/dark photoperiod. Maximum specific growth rate (0.149 d(-1)) and generating biomass (2.89 g L(-1)) were obtained when the blend concentration was 0.80 g L(-1), the medium renewal rate was 40%, and NaHCO3 was 1.60 g L(-1). The average productivity (0.091 g L(-1) d(-1)) was achieved with 0.8 g L(-1) of blend concentration and NaHCO3 concentration of 1.6 g L(-1), independent of the medium renewal rate.