Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind?

Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.

Health Services Access Inequalities in Brazil Result in Poorer Outcomes for Stage III NSCLC-RELANCE/LACOG 0118.

Introduction: Stage III NSCLC is a heterogeneous disease, representing approximately one-third of newly diagnosed lung cancers. Brazil lacks detailed information regarding stage distribution, treatment patterns, survival, and prognostic variables in locally advanced NSCLC. Methods: RELANCE/LACOG 0118 is an observational, retrospective cohort study assessing sociodemographic and clinical data of patients diagnosed with having stage III NSCLC from January 2015 to June 2019, regardless of treatment received. The study was conducted across 13 cancer centers in Brazil. Disease status and survival data were collected up to June 2021. Descriptive statistics, survival analyses, and a multivariable Cox regression model were performed. p values less than 0.05 were considered significant. Results: We recruited 403 patients with stage III NSCLC. Most were male (64.0%), White (31.5%), and smokers or former smokers (86.1%). Most patients had public health insurance (67.5%), had stage IIIA disease (63.2%), and were treated with concurrent chemoradiation (53.1%). The median follow-up time was 33.83 months (95% confidence interval [CI]: 30.43-37.50). Median overall survival (OS) was 27.97 months (95% CI: 21.57-31.73), and median progression-free survival was 11.23 months (95% CI: 10.70-12.77). The type of treatment was independently associated with OS and progression-free survival, whereas the types of health insurance and histology were independent predictors of OS only. Conclusions: Brazilian patients with stage III NSCLC with public health insurance are diagnosed later and have poorer OS. Nevertheless, patients with access to adequate treatment have outcomes similar to those reported in the pivotal trials. Health policy should be improved to make lung cancer diagnosis faster and guarantee prompt access to adequate treatment in Brazil.

Chemical composition, antifungal activity, antibiofilm and citotoxicity of the essential oil of Citrus deliciosa tenore.

The leaves of Citrus deliciosa Tenore were collected in southern Brazil, dried, and subjected to the hydrodistillation process to obtain the essential oil. The extraction of essential oil yielded 0.97% ± 0.04. The chromatographic profile of this compound revealed 11 substances, being methyl N-methyl-anthranilate (75.1%), γ-terpinene (13.8%), and Limonene (7%) as major substances. The essential oil shows antifungal action against all tested yeasts, with promising action against Cryptococcus neoformans, Cryptococcus gattii, and Trichosporon asahii. This compound was also able to inhibit the biofilm production of Candida albicans, Candida glabrata, Candida parapsilosis, and T. asahii. The essential oil of tangerine showed weak antioxidant action. It did not show cytotoxicity in human mononuclear cells. It is hoped that these results may guide future studies for the production of formulations that can be used in the treatment of biofilms caused by yeasts, as well as in candidiasis, cryptococcosis, and/or trichosporonosis.

Safety and Efficacy of Triple Therapy With Dolutegravir Plus 2 Nucleoside Reverse Transcriptase Inhibitors in Treatment-Naive Human Immunodeficiency Virus Type 2 Patients: Results From a 48-Week Phase 2 Study.

BACKGROUND: Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking. METHODS: We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48. RESULTS: A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/µL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported. CONCLUSIONS: DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1. CLINICAL TRIALS REGISTRATION: M NCT03224338.

PRO-Act: a healthcare provider workshop outlining the added value of implementing PROs in routine HIV practice.

Patient Reported Outcomes (PROs) are an evidenced way of adding value to routine clinical care. As a source of unique information on the effect of a medical condition and its treatment from the patients' perspective (Mercieca-Bebber et al. in Patient Relat Outcome Meas 9: 353-367, https://doi.org/10.2147/PROM.S156279 , 2018), PROs allow for an improved assessment in routine clinical care of symptoms, side effects, functional outcomes (physical, sexual, social, emotional, cognitive functioning), and health-related quality of life (HRQoL). By helping to align healthcare providers' interventions with what matters most to the patient, PROs contribute to the individualized choice of Anti-Retroviral Therapy (Carfora et al. in PLoS ONE 17(4): e0267030, https://doi.org/10.1371/journal.pone.0267030 , 2022) as a paramount component of tailored and person-centred care management, in routine clinical practice. This article outlines a practical framework and process tested in Portugal to raise awareness of PROs' added value, and to help guide first steps in the implementation and seamless integration of PROs, in routine HIV care.

A Case of Varicella-Zoster Virus Meningomyelitis in an HIV-1-Infected Patient: Facing the Challenges Related to Its Management and Prognosis.

Varicella-zoster virus (VZV) myelitis is a rare complication of herpes zoster. Diagnosing and treating this entity may be challenging. Clinical outcomes vary and neurological sequelae may be seen despite treatment. We report a case of a 43-year-old woman with human immunodeficiency virus type 1 (HIV-1) infection (CD4 cell count 191 cells/µL - 14%; undetectable viral load) who was started on antiretroviral treatment eight months before. She presented with VZV meningitis and transverse myelitis and concomitant thoracic vesicular rash at the dermatomal level T6. Neurological examination revealed neck stiffness, paraplegia, sensory level below T4, and autonomic dysfunction. Magnetic resonance imaging (MRI) revealed signs of myelitis from C4 to T10 and VZV DNA by polymerase chain reaction (PCR) was positive (20,00,000 cp/mL) in the cerebrospinal fluid (CSF). The patient completed four weeks of intravenous acyclovir and systemic corticosteroids. Repeat lumbar puncture returned negative for VZV PCR and MRI showed spinal cord improvement. However, only partial neurological improvement was observed after six months. Some features of the present case may be associated with an unfavorable outcome, including high VZV viral load in the CSF and rapid progression of neurological deficits to paraplegia and sphincter dysfunction. Moreover, the recovery of CD4+ cells from 4% to 14% after starting antiretroviral treatment might also have contributed to the extension of myelopathy. Further studies are needed to improve the understanding of VZV myelitis course and optimize its treatment.

HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019.

Objective: To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods: Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results: In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion: Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.

Non-Small-Cell Lung Cancer With CNS Metastasis: Disparities From a Real-World Analysis (GBOT-LACOG 0417).

PURPOSE: Despite the advances in the approach to non-small-cell lung cancer (NSCLC) with CNS metastasis, access to timely diagnosis and treatment may not be optimal in many instances. Our main objective was to describe a cohort of patients with NSCLC with brain metastases from public and private cancer centers, and the differences between patients' presentation, treatment, and outcomes. METHODS: GBOT-LACOG 0417 is a multi-institutional retrospective cohort study of patients diagnosed with NSCLC and CNS metastasis in Brazil. All patients had confirmed diagnosis of NSCLC between January 2010 and December 2015. CNS metastases were identified by imaging. RESULTS: A total of 273 patients were included. Patients treated at public institutions were more often Black or Brown (38.8% v 15.4%), current or former smoker (88.6% v 60.0%), of squamous cell histology (25.0% v 9.1%), EGFR- and ALK-negative (95.9% v 74.9%), and were less frequently assessed by using brain magnetic resonance imaging (38.8% v 83.6%). At public institutions, patients were more often symptomatic (78.1% v 44.6%) and had worse performance status (Eastern Cooperative Oncology Group 2 or higher 61.5% v 10.3%). CNS metastases were larger (median size 25 v 15 mm) and more often surrounded by edema (67.7% v 55.2%) at public institutions. Patients at public institutions were more frequently treated with whole-brain radiation therapy (72.9% v 45.4%) and less frequently with radiosurgery (6.3% v 24.1%). Among patients from private care, median overall survival was 24.2 months (95% CI, 20.0 to 30.6), significantly higher than in public care (median 12.1 months; 95% CI, 6.7 to 13.6; P < .001). CONCLUSION: Our results demonstrate the discrepancy between public and private health care system in the critical setting of patients with CNS metastasis from NSCLC.

Real-World Characterization of the Portuguese Population Living with HIV who Initiated Raltegravir Based-Regimens: The REALITY Study.

INTRODUCTION: Although raltegravir has been available since 2007, data are lacking on the Portuguese population living with HIV who initiated this antiretroviral therapy. Hence, this study aimed to characterize the patients who initiated raltegravir-based regimens between January 2015 and December 2017, on sociodemographics, clinical features, and treatment satisfaction. MATERIAL AND METHODS: Observational, retrospective, multicentre study conducted at 11 reference sites. Sociodemographic and clinical data were collected retrospectively from hospital medical records. For participants continuing raltegravir at study inclusion, the HIV Treatment Satisfaction Questionnaire was administered to assess satisfaction with raltegravir-based therapy. Descriptive statistics were performed. Treatment-naïve and treatment-experienced subgroups were compared for demographic and clinical variables. RESULTS: A total of 302 patients were included; mostly men (69.5%) with a mean age of 49 years old. Approximately half of the patients had at least one non-AIDS-related comorbidity at baseline (53.3%), such as hypercholesterolemia, arterial hypertension, diabetes mellitus, and depression. Moreover, 52.3% were treatment-experienced patients with up to two treatments prior to raltegravir. Across the study time points, there was a reduction in the viral load and improvement in CD4 counts in both the treatment-naïve and treatment-experienced subgroups. Continuing users of raltegravir reported high treatment satisfaction (55.4 ± 7.2 points). CONCLUSION: Raltegravir-based regimens seem like a valid therapeutic option in heterogeneous populations of HIV-infected patients, in patients with previous ART experience and as part of first-line therapeutic options alongside with the latest generation of drugs from its class.

Introdução: Apesar de o raltegravir estar disponível desde 2007, os dados na população portuguesa com VIH que iniciou esta terapêutica antirretroviral são escassos. Deste modo, este estudo teve por objetivo caracterizar os doentes que iniciaram um regime terapêutico baseado em raltegravir entre janeiro de 2015 e dezembro de 2017, relativamente a dados sociodemográficos, características clínicas e satisfação com o tratamento. Material e Métodos: Estudo observacional, retrospetivo, multicêntrico conduzido em 11 centros de referência. Os dados sociodemográficos e clínicos foram recolhidos retrospetivamente nos processos clínicos. Os participantes que continuaram o regime com raltegravir após a inclusão no estudo preencheram o HIV Treatment Satisfaction Questionnaire para avaliar a satisfação com a terapêutica. Foram efetuadas análises de estatística descritiva e comparações para as variáveis sociodemográficas e clínicas nos subgrupos de doentes naïve de tratamento e de doentes com experiência terapêutica. Resultados: Foram incluídos 302 doentes, maioritariamente do sexo masculino (69,5%) com idade média de 49 anos. Aproximadamente metade dos doentes tinha pelo menos uma comorbilidade não relacionada com SIDA no início do estudo (53,3%), tais como hipercolesterolemia, hipertensão arterial, diabetes mellitus ou depressão. Adicionalmente, 52,3% eram doentes com experiência terapêutica com até dois tratamentos anteriores ao raltegravir. Ao longo do estudo verificou-se uma redução na carga viral e uma melhoria nas contagens de CD4 em ambos os subgrupos de doentes (doentes naïve de tratamento e doentes com experiência terapêutica). Os doentes com uso continuado de raltegravir reportaram uma elevada satisfação com o tratamento (55,4 ± 7,2 pontos). Conclusão: Os regimes terapêuticos baseados em raltegravir parecem ser uma opção terapêutica válida em populações heterogéneas de doentes infetados com VIH, em doentes com experiência em ART e como tratamento de primeira linha, em paralelo com outras terapêuticas de última geração.

Comprehensive genomic profiling of Brazilian non-small cell lung cancer patients (GBOT 0118/LACOG0418).

BACKGROUND: The aim of this study was to carry out a descriptive analysis of the somatic genetic profile and co-occurring mutations of non-small cell lung cancer (NSCLC) samples from patients tested with comprehensive genomic profiling (CGP). METHODS: This was a retrospective cross-sectional study of patients diagnosed with NSCLC from 2013 to 2018 in Brazil and whose samples were submitted to CGP (FoundationOne or FoundationACT) using either tumor or circulating tumor DNA (ctDNA) from plasma. RESULTS: We recovered 513 CGP results from patients, 457 (89.1%) of which were from tumors and 56 (10.9%) from plasma. The median age of patients was 64 years old, of which 51.6% were males. TP53 mutations were identified in 53.6% of tumor samples, KRAS mutations in 24.2%, EGFR activating mutations were detected in 22.5%, STK11 mutations in 11.6%, PIK3CA mutations in 8.8%, ALK rearrangements in 5.4%, BRAF mutations in 5.2%, and ERBB2 alterations in 4.9%. The most commonly comutated gene was TP53. TP53 p.R337H was observed in 4.3% of samples and was associated with somatic mutations in EGFR and ERBB2 (P < 0.00001). Tumor mutational burden (TMB) analysis was available for 80.5% of samples tested, and 5.5% of samples had high TMB (≥ 20 mutations/Mb). In conclusion, this retrospective analysis of genomic data from NSCLC patients obtained by CGP showed that common abnormalities such as EGFR mutations and ALK rearrangements had similar frequency to those previously described by other groups using others strategies. Additionally, our data confirm an association between TP53 p.R337H, supposedly germline in nature, and somatic mutations in genes of the HER family. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: This is the first report of the prevalence of driver mutations in Brazilian NSCLC patients using comprehensive genomic profiling (CGP). The frequency of the most common driver mutations in this population was similar to that previously described in Brazil. WHAT THIS STUDY ADDS: TP53 was the most commonly comutated gene across samples. TP53 p.R337H was associated with somatic mutations in EGFR and ERBB2. Most samples had low TMB; only 5.5% of samples had high TMB.

Estrategias de prevención de la obstrucción en catéteres centrales totalmente implantados en pacientes oncológicos / Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos / Strategies for preventing obstruction in central catheters fully implanted in oncological patients

OBJETIVO: Analizar las producciones científicas que abordan las estrategias de prevención y atención en la obstrucción de los catéteres venosos centrales totalmente implantados en pacientes con cáncer. MATERIAL Y MÉTODO: Esta es una revisión bibliográfica integradora, que se realizó en las bases de datos MEDLINE, LILACS, CINAHL y EMBASE, del 20 de julio de 2019 al 31 de julio de 2019, utilizando los siguientes descriptores: Cateterización venosa central; Obstrucción del catéter y oncología, más el uso de términos libres: catéter completamente implantado y neoplasia. RESULTADOS: En total, se seleccionaron e incluyeron 10 estudios. Después del análisis, surgieron las siguientes categorías de análisis: Estrategias para prevenir la obstrucción en CVC-TI y Atención establecidas en el despacho de CVC-TI; teniendo como principales temas abordados: la comparación entre la eficacia en el uso de heparina y solución salina para el mantenimiento y el intervalo de tiempo entre ellos; métodos de despacho y evaluación de permeabilidad CVC-IT. CONCLUSIÓN: A pesar de la aparición de nuevas formas posibles de prevención de obstrucciones y estrategias de atención en la eliminación de CVC-IT, la literatura no presenta consenso sobre el uso de soluciones con o sin heparina y el intervalo de tiempo entre el mantenimiento para la efectividad de permeabilidad de estos dispositivos en pacientes con cáncer

OBJETIVO: Analisar produções científicas que abordem a prevenção e estratégias de cuidado na obstrução de cateteres venosos centrais totalmente implantados em pacientes oncológicos. MATERIAL E MÉTODO: Trata-se de uma revisão integrativa da literatura, que ocorreu nas bases de dados MEDLINE, LILACS, CINAHL e EMBASE, no período 20 de Julho de 2019 a 31 de Julho de 2019, utilizando-se como descritores: Cateterismo venoso central; Obstrução de cateter e Oncologia, além do uso dos termos livres: Cateter totalmente implantado e Neoplasia. RESULTADOS: Ao total, 10 estudos foram selecionados e incluídos. Após a análise, emergiram as seguintes categorias de análise: Estratégias de prevenção da obstrução em CVC-TI e Cuidados estabelecidos na desobstrução do CVC-TI; tendo então como principais assuntos abordados: a comparação entre a eficácia no uso da heparina e solução salina para manutenções e tempo de intervalo entre as mesmas; métodos de desobstrução e avaliação de permeabilidade dos CVC-TI. CONCLUSÃO: Apesar do surgimento de novas formas possíveis de prevenção de obstrução e estratégias de cuidado na desobstrução dos CVC-TI, a literatura não apresenta consenso sobre o uso de soluções com ou sem heparina e o tempo de intervalo entre as manutenções para a efetividade da permeabilidade desses dispositivos em pacientes oncológicos

OBJECTIVE: To analyze scientific productions that address prevention and care strategies in the obstruction of central venous catheters that are fully implanted in cancer patients. MATERIAL AND METHOD: This is an integrative literature review, which took place on the MEDLINE, LILACS, CINAHL and EMBASE databases, from 20 July 2019 to 31 July 2019, using as descriptors: Central venous catheterization; Catheter obstruction and Oncology, in addition to the use of free terms: Catheter fully implanted and Neoplasia. RESULTS: In total, 10 studies were selected and included. After the analysis, the following analysis categories emerged: Strategies for preventing obstruction in CVC-TI and Care established in clearing the CVC-TI; having as main subjects approached: the comparison between the effectiveness in the use of heparin and saline solution for maintenance and time interval between them; unblocking methods and permeability assessment of CVC-TI. CONCLUSION: Despite the emergence of new possible ways of preventing obstruction and care strategies for clearing CVC-TI, the literature does not have a consensus on the use of solutions with or without heparin and the time interval between maintenance for the effectiveness of the permeability of these devices in cancer patients

Chronic hepatitis C treatment in HIV co-infection in Portugal: Results from a cohort OF 2133 patients presented by GEPCOI (Portuguese Coinfection Study Group).

Direct-acting antiviral drugs (DAAs) have recently changed the paradigm of hepatitis C therapy, significantly improving treatment response rates, patient life expectancy and quality of life. In Portugal, sofosbuvir (SOF) and SOF/ledipasvir (SOF/LDV) were fully reimbursed by the National Health System since early 2015 and generalized use of interferon-free DAA based regimens became current practice. During 2016, the remaining DAAs were sequentially added and covered by the same health access policy. The Portuguese Study Group of Hepatitis and HIV Co-infection (GEPCOI) collected data from 15 clinical centres in Portugal, pertaining to the HCV treatment experience with DAA regimens. A cohort of 2133 patients was analysed, representing one of the largest DAA treated HCV/HIV co-infected individuals. The global sustained virologic response (SVR) achieved was 95% in this real-life cohort setting. Linear regression analysis showed significant differences in treatment response rates when using SOF plus ribavirin (RBV) combination in genotype 2 or 3 infected individuals (P < .002) and in those with liver cirrhosis (P < .002). These findings corroborate that early treatment is mandatory in HIV/HCV co-infected patients, as response rates may be negatively influenced by higher fibrosis stages and suboptimal DAA regimens. The current national Portuguese health policy should continue to promote wider treatment access and individualized therapy strategies, aiming at the elimination of HCV infection in this high-risk co-infected population.

Cuidados paliativos e sua relação com os diagnósticos de enfermagem das taxonomias NANDA-I e NIC / Palliative care and its relationship with the nursing diagnoses of NANDA-I and NIC taxonomies / Cuidados paliativos y su relación con los diagnósticos de enfermería de las taxonomias NANDA-I y NIC

Objetivo: identificar quais diagnósticos de enfermagem da taxonomia da North American Nursing Diagnosis Association Internacional (NANDA-I) descritos ou indicados nas produções científicas possuem relação com os pacientes em cuidados paliativos e quais são as intervenções de enfermagem mais adequadas segundo a Classificação das Intervenções de Enfermagem (NIC). Método: revisão integrativa da literatura, que consiste na construção de uma análise ampla da literatura tendo como propósito inicial obter entendimento de um determinado fenômeno baseando-se em estudos anteriores. Resultados: realizou-se um levantamento sobre os estudos relacionados ao tema em fontes bibliográficas através de três sistemas informatizados. Dos artigos encontrados, apenas dez tornavam possível a identificação de Diagnósticos de Enfermagem, ou sua inferência. Estes diagnósticos foram contabilizados e relacionados às intervenções mais adequadas de acordo com a literatura. Conclusão: foi identificada uma produção científica pouco expressiva, mas, ainda assim, foi possível identificar diagnósticos e inferências diagnósticas que permitiram determinar quais intervenções de enfermagem seriam as mais adequadas

Objective: to identify which nursing diagnoses of the North American Nursing Diagnosis Association Internacional (NANDA-I) taxonomy described or indicated in the scientific productions are related to patients in palliative care and which are the most appropriate nursing interventions according to the Nursing Interventions Classification (NIC). Method: an integrative review of the literature, which consists of the construction of a comprehensive literature review, with the initial purpose of obtaining an understanding of a given phenomenon based on previous studies. Results: a survey of the studies related to the subject was carried out in bibliographic sources through three computerized systems. Of the articles found, only ten made possible the identification of Nursing Diagnostics, or their inference. These diagnoses were counted and related to the most appropriate interventions according to the literature. Conclusion: little expressive scientific production was identified, but it was still possible to identify diagnoses and diagnostic inferences that allowed to determine which nursing interventions would be the most adequate

Objetivo: identificar qué diagnósticos de enfermería de la taxonomía de la North American Nursing Diagnosis Association Internacional (NANDA-I) descritos o indicados en las producciones científicas, poseen relación con los pacientes en cuidados paliativos y cuáles son las intervenciones de enfermería más adecuadas según la Clasificación de las intervenciones en enfermería (NIC). Método: revisión integrativa de la literatura, que consiste en la construcción de un análisis amplio de la literatura teniendo como propósito inicial obtener entendimiento de un determinado fenómeno basándose en estudios anteriores. Resultados: se realizó un relevamiento sobre los estudios relacionados al tema en fuentes bibliográficas a través de tres sistemas informatizados. De los artículos encontrados, sólo diez hicieron posible la identificación de Diagnósticos de Enfermería, o su inferencia. Estos diagnósticos fueron contabilizados y relacionados con las Intervenciones más adecuadas de acuerdo con la literatura. Conclusión: se identificó una producción científica poco expresiva, pero aún así fue posible identificar diagnósticos e inferencias diagnósticas que permitieron determinar qué intervenciones de enfermería serían las más adecuadas

Sinais/sintomas de emergência na perspectiva dos pacientes em quimioterapia ambulatorial / Emergency signs / symptoms from the perspective of patients undergoing patient chemotherapy

Objectives: to identify the knowledge of oncological patients undergoing outpatient chemotherapy regarding emergency signs and symptoms.Methods: It is a descriptive, qualitative study. Two instruments were used: a questionnaire to characterize the participants and an open interview. The analysis of the first instrument was based on simple descriptive statistics; the second by thematic analysis. Results: The symptoms described by the participants were: fever, nausea, vomiting, constipation, inability/difficulty with food intake, headache, generalized pain or pain in places that refer to the tumor, dyspnea, vertigo, loss of consciousness, loss of ability to walk, chest pain and sudden changes in systemic pressure level (increase or decrease). As conditions that can interfere with the decision to seek emergency services, the manifestation of abnormal symptoms for the patient, the patient's knowledge about the pathology and treatment, as well as the patient's previous experience with the emergency service was identified.Conclusion: In short, the reasons that lead cancer patients to seek emergency are linked to the "severity" that it attributes to the effects of treatment.

Objetivo: identificar o conhecimento de pacientes oncológicos em tratamento quimioterápico ambulatorial sobre os sinais e sintomas de emergência. Métodos: Estudo descritivo, qualitativo. Utilizaram-se dois instrumentos: um questionário de caracterização dos participantes e uma entrevista aberta. A análise do primeiro instrumento foi por estatística descritiva simples; o segundo por análise temática. Resultados: Os sintomas descritos pelos participantes foram: febre, náuseas, vômitos, constipação, incapacidade/dificuldade de ingestão alimentar, cefaleia, dor generalizada ou dor nos locais que remetem ao tumor, dispneia, vertigem, perda de consciência, perda da capacidade de andar, dor no peito e variações bruscas de nível de pressão sistêmica (aumento ou diminuição).Como condições que podem interferir na decisão da busca pelo serviço de emergência, foi identificada a manifestação de sintomas anormais para o paciente, o conhecimento do paciente sobre a patologia e tratamento, além da experiência prévia do paciente com o serviço de emergência. Conclusão: Em suma, os motivos que levam o paciente oncológico a buscar a emergência estão ligados à "gravidade" que o mesmo atribui aos efeitos do tratamento.

Artemether/Lumefantrine for the Treatment of P. malariae in a Patient on Hemodialysis.

The combination of artemether/lumefantrine is indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria. There have been no clinical trials to assess the efficacy of this medication in patients with renal impairment. While it is unlikely that artemether/lumefantrine would be removed during dialysis, clinical experience regarding drug use in this setting is limited. In this article, the authors report successful treatment of Plasmodium malariae malaria on a patient with end-stage kidney disease undergoing hemodialysis.

Globalization and the Transition to Adulthood in a Maya Community in Mexico: Communication Technologies, Social Networks, and Views on Gender.

The present article examines continuity and change in views on gender in a Maya community before and after a communication tower was installed in 2010. Interview data were collected in 2009 when participants were adolescents (n = 80) and then again in 2015 when they were young adults (n = 68). Values and beliefs for gender were measured using vignettes that were created through previous fieldwork (Manago, 2014). Young adults were also asked about their use of mobile phones and social media, and completed a social network mapping activity (Antonucci, 1986). Results showed continuities across time in self-expression values for gender roles and relations, which was predicted by high school attendance during adolescence. Young adult men and those who had been to high school were more likely to use the internet and Facebook. Internet use did not predict values beyond the effects of schooling; however, it predicted greater proportions of nonkin in participants' social network maps, which predicted greater self-expression values for gender relations. Qualitative analyses of participants' emic perspectives of the affordances of communication technologies illustrate how education and cultural values shape perceptions of the opportunities and risks of media use.

Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.

OBJECTIVE: To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS: This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS: Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS: A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.

Nivel de estrés en padres de niños hospitalizados en unidades críticas pediátricas y neonatales / Stress level in parents of hospitalized children in pediatric and neonatal critical care units / Nível de estresse em pais de crianças internadas em unidades críticas pediátricas e neonatais

RESUMEN Introducción: Enfermedad y hospitalización son eventos críticos que enfrenta un niño, donde la reacción de estrés en toda la familia es común durante la enfermedad o una estancia hospitalaria grave. Objetivo: Determinar el nivel de estrés en padres de niños hospitalizados en las unidades críticas de pediatría y neonatología y su relación con características sociodemográficas del padre y/o niño/a. Material y método: Estudio cuantitativo, descriptivo-correlacional, de corte transversal. Se estudió una muestra de 41 padres, que fueron elegibles y estuvieron presentes durante mayo de 2017 en las unidades críticas de pediatría y neonatología de un hospital ubicado en la Región de Ñuble, Chile. Se aplicó un cuestionario de caracterización y la versión en español de la Escala de Estrés Parental adaptada por Polaino-Lorente y Ochoa. Los datos fueron procesados con SPSS 15.0, realizando pruebas t-student y ANOVA de un factor. Resultados: En relación al puntaje global de estrés, 48,8% clasificó el grado de estrés como extremadamente estresante; 29,3% muy estresante; 12,2% moderadamente estresante y los demás poco y nada estresante. El estrés en padres es mayor durante la primera semana de hospitalización del niño, en ámbitos de comunicación del personal sanitario y la alteración del rol de padres, siendo ambas significativas. Conclusión: El estrés en padres con un hijo hospitalizado en unidades críticas resulta en la mayoría de los casos extremo, siendo mayor durante la primera semana de hospitalización del niño.

ABSTRACT Introduction: Illness and hospitalization are critical events for a child. It is common that the whole family experiences a stress reaction while the child is seriously ill or hospitalized. Objective: The purpose of this research is to determine the stress level in parents whose children have been hospitalized in neonatal and pediatric critical care units, and how this relates to the socio-demographic characteristics of the parent and/or child. Materials and Methods: Quantitative, descriptive correlational and cross-sectional study, using a sample of 41 suitable parents, who were present in May 2017 in the pediatric and neonatal critical care units of a hospital located in the Ñuble Region, Chile. A characterization questionnaire and the Spanish version of the Parental Stress Scale adapted by Polaino-Lorente and Ochoa were applied. The data were processed using SPSS 15.0, performing Student's t and one-way ANOVA tests. Results: According to the overall stress score, 48.8% classified the level as extremely stressful; 29.3% as very stressful; 12.2% as moderately stressful and the rest as little and not stressful at all. Stress in parents is higher during the child's first week of hospitalization, both in areas of communication with the health professionals and the alteration of the parental role. Conclusion: Stress in parents with a hospitalized child in critical care units can be extreme, being higher during the child's first week of hospitalization.

RESUMO Introdução: A doença e a hospitalização são eventos críticos que enfrenta uma criança, onde a reação de estresse é comum em toda a família durante a doença ou uma internação grave. Objetivo: Determinar o nível de estresse em pais de crianças internadas em unidades críticas de pediatria e neonatologia e a relação com características sociodemográficas do pai e/ou a criança. Material e método: Estudo quantitativo, descritivo-correlacional, de corte transversal. A amostra estudada foi de 41 pais, que foram elegíveis e estiveram presentes em maio de 2017 nas unidades críticas de pediatria e neonatologia de um hospital localizado na Región del Ñuble, Chile. Foi aplicado um instrumento de caracterização e a versão em espanhol da Escala de Estresse Parental adaptada por Polaino-Lorente e Ochoa. Os dados foram processados com SPSS 15.0, realizando testes t-student e ANOVA de um fator. Resultados: Em relação à pontuação global de estresse, 48,8% classificou o grau de estresse como extremadamente estressante; 29,3% muito estressante; 12,2% moderadamente estressante e o restante pouco e nada estressante. O estresse em pais é maior na primeira semana de hospitalização da criança, nas áreas de comunicação do pessoal de saúde e a alteração do rol dos pais, sendo ambas significativas. Conclusão: O estresse em pais com um filho internado em unidades críticas resulta na maioria dos casos extremo e é ainda maior durante a primeira semana de hospitalização da criança.

Nivel de estrés en padres de niños hospitalizados en unidades críticas pediátricas y neonatales / Nível de estresse em pais de crianças internadas em unidades críticas pediátricas e neonatais / Stress level in parents of hospitalized children in pediatric and neonatal critical care units

RESUMEN Introducción: Enfermedad y hospitalización son eventos críticos que enfrenta un niño, donde la reacción de estrés en toda la familia es común durante la enfermedad o una estancia hospitalaria grave. Objetivo: Determinar el nivel de estrés en padres de niños hospitalizados en las unidades críticas de pediatría y neonatología y su relación con características sociodemográficas del padre y/o niño/a. Material y método: Estudio cuantitativo, descriptivo-correlacional, de corte transversal. Se estudió una muestra de 41 padres, que fueron elegibles y estuvieron presentes durante mayo de 2017 en las unidades críticas de pediatría y neonatología de un hospital ubicado en la Región de Ñuble, Chile. Se aplicó un cuestionario de caracterización y la versión en español de la Escala de Estrés Parental adaptada por Polaino-Lorente y Ochoa. Los datos fueron procesados con SPSS 15.0, realizando pruebas t-student y ANOVA de un factor. Resultados: En relación al puntaje global de estrés, 48,8% clasificó el grado de estrés como extremadamente estresante; 29,3% muy estresante; 12,2% moderadamente estresante y los demás poco y nada estresante. El estrés en padres es mayor durante la primera semana de hospitalización del niño, en ámbitos de comunicación del personal sanitario y la alteración del rol de padres, siendo ambas significativas. Conclusión: El estrés en padres con un hijo hospitalizado en unidades críticas resulta en la mayoría de los casos extremo, siendo mayor durante la primera semana de hospitalización del niño.

ABSTRACT Introduction: Illness and hospitalization are critical events for a child. It is common that the whole family experiences a stress reaction while the child is seriously ill or hospitalized. Objective: The purpose of this research is to determine the stress level in parents whose children have been hospitalized in neonatal and pediatric critical care units, and how this relates to the socio-demographic characteristics of the parent and/or child. Materials and Methods: Quantitative, descriptive correlational and cross-sectional study, using a sample of 41 suitable parents, who were present in May 2017 in the pediatric and neonatal critical care units of a hospital located in the Ñuble Region, Chile. A characterization questionnaire and the Spanish version of the Parental Stress Scale adapted by Polaino-Lorente and Ochoa were applied. The data were processed using SPSS 15.0, performing Student's t and one-way ANOVA tests. Results: According to the overall stress score, 48.8% classified the level as extremely stressful; 29.3% as very stressful; 12.2% as moderately stressful and the rest as little and not stressful at all. Stress in parents is higher during the child's first week of hospitalization, both in areas of communication with the health professionals and the alteration of the parental role. Conclusion: Stress in parents with a hospitalized child in critical care units can be extreme, being higher during the child's first week of hospitalization.

RESUMO Introdução: A doença e a hospitalização são eventos críticos que enfrenta uma criança, onde a reação de estresse é comum em toda a família durante a doença ou uma internação grave. Objetivo: Determinar o nível de estresse em pais de crianças internadas em unidades críticas de pediatria e neonatologia e a relação com características sociodemográficas do pai e/ou a criança. Material e método: Estudo quantitativo, descritivo-correlacional, de corte transversal. A amostra estudada foi de 41 pais, que foram elegíveis e estiveram presentes em maio de 2017 nas unidades críticas de pediatria e neonatologia de um hospital localizado na Región del Ñuble, Chile. Foi aplicado um instrumento de caracterização e a versão em espanhol da Escala de Estresse Parental adaptada por Polaino-Lorente e Ochoa. Os dados foram processados com SPSS 15.0, realizando testes t-student e ANOVA de um fator. Resultados: Em relação à pontuação global de estresse, 48,8% classificou o grau de estresse como extremadamente estressante; 29,3% muito estressante; 12,2% moderadamente estressante e o restante pouco e nada estressante. O estresse em pais é maior na primeira semana de hospitalização da criança, nas áreas de comunicação do pessoal de saúde e a alteração do rol dos pais, sendo ambas significativas. Conclusão: O estresse em pais com um filho internado em unidades críticas resulta na maioria dos casos extremo e é ainda maior durante a primeira semana de hospitalização da criança.

Protective effect of gedunin on TLR-mediated inflammation by modulation of inflammasome activation and cytokine production: Evidence of a multitarget compound.

Activation of toll-like receptors (TLRs) by pathogen-associated molecular patterns (PAMPs) triggers an innate immune response, via cytokine production and inflammasome activation. Herein, we have investigated the modulatory effect of the natural limonoid gedunin on TLR activation in vitro and in vivo. Intraperitoneal (i.p.) pre- and post-treatments of C57BL/6 mouse with gedunin impaired the influx of mononuclear cells, eosinophils and neutrophils, as well as the production of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and nitric oxide (NO), triggered by lipopolysaccharide (LPS) in mouse pleura. Accordingly, in vitro post-treatment of immortalized murine macrophages with gedunin also impaired LPS-induced production of such mediators. Gedunin diminished LPS-induced expression of the nucleotide-binding domain and leucine-rich repeat protein-3 (NLRP3) on pleural leukocytes in vivo and in immortalized macrophages in vitro. In line with this, gedunin inhibited LPS-induced caspase-1 activation and the production of IL-1ß in vivo and in vitro. In addition, gedunin treatment triggered the generation of the anti-inflammatory factors IL-10 and heme oxigenase-1 (HO-1) at resting conditions or upon stimulation. We also demonstrate that gedunin effect is not restricted to TLR4-mediated response, since this compound diminished TNF-α, IL-6, NO, NLRP3 and IL-1ß, as well as enhanced IL-10 and HO-1, by macrophages stimulated with the TLR2 and TLR3 agonists, palmitoyl-3-Cys-Ser-(Lys)4 (PAM3) and polyriboinosinic:polyribocytidylic acid (POLY I:C), in vitro. In silico modeling studies revealed that gedunin efficiently docked into caspase-1, TLR2, TLR3 and to the myeloid differentiation protein-2 (MD-2) component of TLR4. Overall, our data demonstrate that gedunin modulates TLR4, TLR3 and TLR2-mediated responses and reveal new molecular targets for this compound.