Seroprevalence of Toxoplasma gondii, risk factors and knowledge about toxoplasmosis in undergraduate students from Lima, Peru.

Toxoplasma gondii is the causative agent of toxoplasmosis, a zoonotic disease of worldwide distribution. The aim of this study was to assess the seroprevalence of T. gondii in undergraduate students from Lima, Peru, and to identify the risk factors linked to the infection. For this, serum samples of 100 undergraduate students of the Faculty of Biological Sciences were tested for T. gondii antibodies with a commercially available ELISA. The seroprevalence of T. gondii in these subjects was 7 %. Only the age of students showed a statistical association with T. gondii seropositivity. The level of awareness regarding toxoplasmosis was also investigated. In the sample, 71 % of the students are aware of toxoplasmosis and 64 % that a parasite is the cause of the infection. Most know it is transmitted through undercooked meat (57 %), but are unaware of contaminated vegetables (40 %), organ transplants (17 %), blood transfusions (32 %), and soil contact (39 %). In the epidemiological context it will be valuable to verify toxoplasmosis awareness in other population groups and other regions in Peru.

Hydrogen Sulfide Producers Drive a Diarrhea-Like Phenotype and a Methane Producer Drives a Constipation-Like Phenotype in Animal Models.

BACKGROUND: We recently demonstrated that diarrhea-predominant irritable bowel syndrome (IBS-D) subjects have higher relative abundance (RA) of hydrogen sulfide (H2S)-producing Fusobacterium and Desulfovibrio species, and constipation-predominant IBS (IBS-C) subjects have higher RA of methanogen Methanobrevibacter smithii. AIMS: In this study, we investigate the effects of increased methanogens or H2S producers on stool phenotypes in rat models. METHODS: Adult Sprague-Dawley rats were fed high-fat diet (HFD) for 60 days to increase M. smithii levels, then gavaged for 10 days with water (controls) or methanogenesis inhibitors. To increase H2S producers, rats were gavaged with F. varium or D. piger. Stool consistency (stool wet weight (SWW)) and gas production were measured. 16S rRNA gene sequencing was performed on stool samples. RESULTS: In HFD diet-fed rats (N = 30), stool M. smithii levels were increased (P < 0.001) after 52 days, correlating with significantly decreased SWW (P < 0.0001) at 59 days (R = - 0.38, P = 0.037). Small bowel M. smithii levels decreased significantly in lovastatin lactone-treated rats (P < 0.0006), and SWW increased (normalized) in lovastatin hydroxyacid-treated rats (P = 0.0246), vs. controls (N = 10/group). SWW increased significantly in D. piger-gavaged rats (N = 16) on day 10 (P < 0.0001), and in F. varium-gavaged rats (N = 16) at all timepoints, vs. controls, with increased stool H2S production. 16S sequencing revealed stool microbiota alterations in rats gavaged with H2S producers, with higher relative abundance (RA) of other H2S producers, particularly Lachnospiraceae and Bilophila in F. varium-gavaged rats, and Sutterella in D. piger-gavaged rats. CONCLUSIONS: These findings suggest that increased M. smithii levels result in a constipation-like phenotype in a rat model that is partly reversible with methanogenesis inhibitors, whereas gavage with H2S producers D. piger or F. varium results in increased colonization with other H2S producers and diarrhea-like phenotypes. This supports roles for the increased RA of methanogens and H2S producers identified in IBS-C and IBS-D subjects, respectively, in contributing to stool phenotypes.

Defining Small Intestinal Bacterial Overgrowth by Culture and High Throughput Sequencing.

BACKGROUND& AIMS: Despite accelerated research in small intestinal bacterial overgrowth (SIBO), questions remain regarding optimal diagnostic approaches and definitions. Here, we aim to define SIBO using small bowel culture and sequencing, identifying specific contributory microbes, in the context of gastrointestinal symptoms. METHODS: Subjects undergoing esophagogastroduodenoscopy (without colonoscopy) were recruited and completed symptom severity questionnaires. Duodenal aspirates were plated on MacConkey and blood agar. Aspirate DNA was analyzed by 16S ribosomal RNA and shotgun sequencing. Microbial network connectivity for different SIBO thresholds and predicted microbial metabolic functions were also assessed. RESULTS: A total of 385 subjects with <103 colony forming units (CFU)/mL on MacConkey agar and 98 subjects with ≥103 CFU/mL, including ≥103 to <105 CFU/mL (N = 66) and ≥105 CFU/mL (N = 32), were identified. Duodenal microbial α-diversity progressively decreased, and relative abundance of Escherichia/Shigella and Klebsiella increased, in subjects with ≥103 to <105 CFU/mL and ≥105 CFU/mL. Microbial network connectivity also progressively decreased in these subjects, driven by the increased relative abundance of Escherichia (P < .0001) and Klebsiella (P = .0018). Microbial metabolic pathways for carbohydrate fermentation, hydrogen production, and hydrogen sulfide production were enhanced in subjects with ≥103 CFU/mL and correlated with symptoms. Shotgun sequencing (N = 38) identified 2 main Escherichia coli strains and 2 Klebsiella species representing 40.24% of all duodenal bacteria in subjects with ≥103 CFU/mL. CONCLUSIONS: Our findings confirm ≥103 CFU/mL is the optimal SIBO threshold, associated with gastrointestinal symptoms, significantly decreased microbial diversity, and network disruption. Microbial hydrogen- and hydrogen sulfide-related pathways were enhanced in SIBO subjects, supporting past studies. Remarkably few specific E coli and Klebsiella strains/species appear to dominate the microbiome in SIBO, and correlate with abdominal pain, diarrhea, and bloating severities.

Cytolethal distending toxin B inoculation leads to distinct gut microtypes and IBS-D-like microRNA-mediated gene expression changes in a rodent model.

Diarrhea-predominant irritable bowel syndrome (IBS-D), associated with increased intestinal permeability, inflammation, and small intestinal bacterial overgrowth, can be triggered by acute gastroenteritis. Cytolethal distending toxin B (CdtB) is produced by gastroenteritis-causing pathogens and may underlie IBS-D development, through molecular mimicry with vinculin. Here, we examine the effects of exposure to CdtB alone on gut microbiome composition, host intestinal gene expression, and IBS-D-like phenotypes in a rat model. CdtB-inoculated rats exhibited increased anti-CdtB levels, which correlated with increased stool wet weights, pro-inflammatory cytokines (TNFα, IL2) and predicted microbial metabolic pathways including inflammatory responses, TNF responses, and diarrhea. Three distinct ileal microbiome profiles (microtypes) were identified in CdtB-inoculated rats. The first microtype (most like controls) had altered relative abundance (RA) of genera Bifidobacterium, Lactococcus, and Rothia. The second had lower microbial diversity, higher Escherichia-Shigella RA, higher absolute E. coli abundance, and altered host ileal tissue expression of immune-response and TNF-response genes compared to controls. The third microtype had higher microbial diversity, higher RA of hydrogen sulfide (H2S)-producer Desulfovibrio, and increased expression of H2S-associated pain/serotonin response genes. All CdtB-inoculated rats exhibited decreased ileal expression of cell junction component mRNAs, including vinculin-associated proteins. Significantly, cluster-specific microRNA-mRNA interactions controlling intestinal permeability, visceral hypersensitivity/pain, and gastrointestinal motility genes, including several previously associated with IBS were seen. These findings demonstrate that exposure to CdtB toxin alone results in IBS-like phenotypes including inflammation and diarrhea-like stool, decreased expression of intestinal barrier components, and altered ileal microtypes that influenced changes in microRNA-modulated gene expression and predicted metabolic pathways consistent with specific IBS-D symptoms.

Coronavirus Disease 2019 (COVID-19) Pandemic Lifestyle Changes May Have Influenced Small Bowel Microbial Composition and Microbial Resistance.

BACKGROUND: The coronavirus disease 2019 (COVID-19) global pandemic necessitated many severe lifestyle changes, including lockdowns, social distancing, altered food consumption and exercise patterns, and extensive hygiene practices. These extensive changes may have affected the human gut microbiome, which is highly influenced by lifestyle. AIMS: To examine the potential effects of pandemic-related lifestyle changes on the metabolically relevant small bowel microbiome. METHODS: Adult subjects presenting for upper endoscopy without colonoscopy were identified and divided into two matched groups: pre-pandemic (February 2019-March 2020) and intra-pandemic (April 2021-September 2021, all COVID-19 negative). Duodenal aspirates and blood samples were collected. Duodenal microbiomes were analyzed by 16S rRNA sequencing. Serum cytokine levels were analyzed by Luminex FlexMap3D. RESULTS: Fifty-six pre-pandemic and 38 COVID-negative intra-pandemic subjects were included. There were no significant changes in duodenal microbial alpha diversity in the intra-pandemic vs. pre-pandemic group, but beta diversity was significantly different. The relative abundance (RA) of phylum Deinococcus-Thermus and family Thermaceae, which are resistant extremophiles, was significantly higher in the intra-pandemic vs. pre-pandemic group. The RA of several Gram-negative taxa including Bacteroidaceae (phylum Bacteroidetes) and the Proteobacteria families Enterobacteriaceae and Pseudomonadaceae, and the RA of potential disruptor genera Escherichia-Shigella and Rothia, were significantly lower in the intra-pandemic vs. pre-pandemic group. Circulating levels of interleukin-18 were also lower in the intra-pandemic group. CONCLUSIONS: These findings suggest the small bowel microbiome underwent significant changes during the pandemic, in COVID-19-negative individuals. Given the key roles of the small bowel microbiota in host physiology, this may have implications for human health.

Methanogens and Hydrogen Sulfide Producing Bacteria Guide Distinct Gut Microbe Profiles and Irritable Bowel Syndrome Subtypes.

INTRODUCTION: Irritable bowel syndrome (IBS) includes diarrhea-predominant (IBS-D) and constipation-predominant (IBS-C) subtypes. We combined breath testing and stool microbiome sequencing to identify potential microbial drivers of IBS subtypes. METHODS: IBS-C and IBS-D subjects from 2 randomized controlled trials (NCT03763175 and NCT04557215) were included. Baseline breath carbon dioxide, hydrogen (H 2 ), methane (CH 4 ), and hydrogen sulfide (H 2 S) levels were measured by gas chromatography, and baseline stool microbiome composition was analyzed by 16S rRNA sequencing. Microbial metabolic pathways were analyzed using Kyoto Encyclopedia of Genes and Genomes collection databases. RESULTS: IBS-C subjects had higher breath CH 4 that correlated with higher gut microbial diversity and higher relative abundance (RA) of stool methanogens, predominantly Methanobrevibacter , as well as higher absolute abundance of Methanobrevibacter smithii in stool. IBS-D subjects had higher breath H 2 that correlated with lower microbial diversity and higher breath H 2 S that correlated with higher RA of H 2 S-producing bacteria, including Fusobacterium and Desulfovibrio spp. The predominant H 2 producers were different in these distinct microtypes, with higher RA of Ruminococcaceae and Christensenellaceae in IBS-C/CH 4 + (which correlated with Methanobacteriaceae RA) and higher Enterobacteriaceae RA in IBS-D. Finally, microbial metabolic pathway analysis revealed enrichment of Kyoto Encyclopedia of Genes and Genomes modules associated with methanogenesis and biosynthesis of methanogenesis cofactor F420 in IBS-C/CH 4 + subjects, whereas modules associated with H 2 S production, including sulfate reduction pathways, were enriched in IBS-D. DISCUSSION: Our findings identify distinct gut microtypes linked to breath gas patterns in IBS-C and IBS-D subjects, driven by methanogens such as M. smithii and H 2 S producers such as Fusobacterium and Desulfovibrio spp, respectively.

A Single Fasting Exhaled Methane Level Correlates With Fecal Methanogen Load, Clinical Symptoms and Accurately Detects Intestinal Methanogen Overgrowth.

INTRODUCTION: A 2-hour breath test is the gold standard for diagnosing intestinal methanogen overgrowth (IMO). This method can be cumbersome especially if used repetitively to monitor treatment response. Therefore, we aimed to assess the reliability of a fasting single methane measurement (SMM) in diagnosing IMO and its utility as a biomarker to monitor treatment response in subjects with IMO. METHODS: First, we calculated the test characteristics of SMM compared with lactulose and glucose breath test in 2 large-scale retrospective cohorts. Second, the symptomology associated with SMM using various cutoffs was analyzed. Third, in a double-blind randomized control trial, the temporal stability of SMM levels in subjects taking placebo was analyzed. Fourth, stool Methanobrevibacter smithii loads were quantified using quantitative polymerase chain reaction and compared with SMM levels. Last, the change in SMM over time during antibiotic therapy was analyzed. RESULTS: Using the cutoff of SMM ≥10 ppm, SMM had a sensitivity of 86.4% and specificity of 100% for diagnosing IMO on the glucose and lactulose breath tests and was associated with constipation (5.65 ± 3.47 vs 4.32 ± 3.62, P = 0.008). SMM remained stable for 14 weeks without treatment (P = 0.45), and antibiotics lead to a decrease in SMM after 2 days (P < 0.0001). SMM was positively associate with stool M. smithii load (R = 0.65, P < 0.0001). DISCUSSION: Fasting SMM ≥10 ppm seems to accurately diagnose IMO, is associated with constipation, and correlates with stool M. smithii. SMM seems to be stable without treatment and decreases after antibiotics. SMM may be a useful test to diagnose IMO and monitor treatment response.

Effects of Proton Pump Inhibitors on the Small Bowel and Stool Microbiomes.

BACKGROUND: Proton pump inhibitor (PPI) use is extremely common. PPIs have been suggested to affect the gut microbiome, and increase risks of Clostridium difficile infection and small intestinal bacterial overgrowth (SIBO). However, existing data are based on stool analyses and PPIs act on the foregut. AIMS: To compare the duodenal and stool microbiomes in PPI and non-PPI users. METHODS: Consecutive subjects presenting for upper endoscopy without colonoscopy were recruited. Current antibiotic users were excluded. Subjects taking PPI were age- and gender-matched 1:2 to non-PPI controls. Subjects completed medical history questionnaires, and duodenal aspirates were collected using a validated protected catheter. A subset also provided stool samples. Duodenal and stool microbiomes were analyzed by 16S rRNA sequencing. RESULTS: The duodenal microbiome exhibited no phylum-level differences between PPI (N = 59) and non-PPI subjects (N = 118), but demonstrated significantly higher relative abundances of families Campylobacteraceae (3.13-fold, FDR P value < 0.01) and Bifidobacteriaceae (2.9-fold, FDR P value < 0.01), and lower relative abundance of Clostridiaceae (88.24-fold, FDR P value < 0.0001), in PPI subjects. SIBO rates were not significantly different between groups, whether defined by culture (> 103 CFU/ml) or 16S sequencing, nor between subjects taking different PPIs. The stool microbiome exhibited significantly higher abundance of family Streptococcaceae (2.14-fold, P = 0.003), and lower Clostridiaceae (2.60-fold, FDR P value = 8.61E-13), in PPI (N = 22) versus non-PPI (N = 47) subjects. CONCLUSIONS: These findings suggest that PPI use is not associated with higher rates of SIBO. Relative abundance of Clostridiaceae was reduced in both the duodenal and stool microbiomes, and Streptococcaceae was increased in stool. The clinical implications of these findings are unknown.

Functional and chemical qualities of Vitis labrusca grape seed oil extracted by supercritical CO 2 / Calidad funcional y química del aceite de semilla de Vitis labrusca extraído mediante CO 2 supercrítico / Qualidade funcional e química do óleo de semente de Vitis labrusca extraído por CO 2 supercrítico

Abstract Grape seed oil, which is usually extracted with highly toxic organic solvents that are harmful to human health, is produced from tons of grape pomace waste, generated during winemaking. Sometimes, this waste is used to make compost or is burnt, which causes environmental contamination. The functional qualities, antioxidant capacity (AC), α-tocopherol and total phenolic compounds content (TPC) of Black Borgoña (Vitis labrusca) grape seed oil, extracted by supercritical CO2, were evaluated. The high content of linoleic acid (ω-6) and monounsaturated fatty acids contributed to the beneficial effect on the functional quality indices, which were 0.20, 0.23, 11.80 for IA, IT and H:H, respectively. In addition, a POV of 6.23 ± 0.08 milliequivalents of peroxide/kg oil and an anisidine index of 2.70 ± 0.05 indicated a good quality oil. Also, a high concentration of a-tocopherol (9.82 ± 0.02 mg/100 g oil) and a high TPC ("4.14 ± 3.24 mg GAE/kg oil) were obtained. This study demonstrated that supercritical CO2 extraction is a suitable method for the delivery of a high-quality grape seed oil.

Resumen El aceite de semilla de uva que generalmente se extrae con disolventes orgánicos altamente tóxicos y perjudiciales para la salud humana, se produce a partir de toneladas de residuos de orujo de uva, generados durante la elaboración del vino. A veces, estos residuos se utilizan para hacer compost o se queman, lo que provoca la contaminación del medio ambiente. Se evaluaron las cualidades funcionales, la capacidad antioxidante (AC), el contenido de a-tocoferol y los compuestos fenólicos totales (TPC) del aceite de semilla de uva Borgoña Negra (Vitis labrusca), extraído mediante CO2 supercrítico. El alto contenido de ácido linoleico (ω-6) y de ácidos grasos monoinsaturados contribuyó al efecto beneficioso sobre los índices de calidad funcional que fueron de 0.20, 0.23, ''.80 para IA, IT y H:H, respectivamente. Además, un POV de 6.23 ± 0.08 miliequivalentes de peróxido/ kg de aceite y un índice de anisidina de 2.70 ± 0.05 indicaban una buena calidad del aceite. También se obtuvo una alta concentración de α-tocoferol (9.82 ± 0.02 mg/100 g de aceite) y un alto TPC ("4.14 ± 3.24 mg de GAE/ kg de aceite). Este estudio demostró que la extracción con CO2 supercrítico es un método adecuado para obtener un aceite de semilla de uva de alta calidad.

Resumo O óleo de semente de uva é geralmente extraído com solventes orgânicos altamente tóxicos que são prejudiciais à saúde humana, é produzido a partir de toneladas de resíduos de bagaço de uva, gerados durante a vinificação. Às vezes, esses resíduos são usados para fazer adubo ou são queimados, o que causa contaminação ambiental. Foram avaliadas as qualidades funcionais, capacidade antioxidante (AC), a-tocoferol e o teor total de compostos fenólicos (TPC) do óleo de semente de uva Borgoña Negra (Vitis labrusca), extraído por CO2 supercrítico. O alto teor de ácido linoleico (ω-6) e ácidos graxos monoinsaturados contribuiu para o efeito benéfico sobre os índices de qualidade funcional que foram 0.20, 0.23, 11.80 para IA, IT e H:H, respectivamente. Além disso, um POV de 6.23 ± 0.08 miliequivalentes de peróxido/ kg de óleo e um índice de anisidina de 2.70 ± 0.05 indicava uma boa qualidade de óleo. Também foi obtida uma alta concentração de α-tocoferol (9.82 ± 0.02 mg/100 g de óleo) e um alto TPC ("4.14 ± 3.24 mg de óleo GAE/ kg). Este estudo mostrou que a extração de CO2 supercrítico é um método adequado para a entrega de um óleo de semente de uva de alta qualidade.

Ensino-aprendizagem na disciplina de Gerência de Enfermagem no contexto hospitalar / Teaching-learning in the nursing management discipline in the hospital context

Objetivo: apresentar a metodologia de ensino desenvolvida com os alunos da disciplina teórico-prática Gerência de Enfermagem no Contexto Hospitalar, e destacar os resultados positivos e os fatores que dificultam seu desenvolvimento e interferem no processo de aprendizado dos alunos. Métodos: estudo qualitativo, do tipo relato de experiência, realizado no ano de 2019, na Escola de Enfermagem da Universidade Federal Fluminense. Resultados: A vivência da disciplina de gerência proporciona ao acadêmico de enfermagem o desenvolvimento de diferentes habilidades e competências imprescindíveis à sua formação, estimulando sua autonomia, responsabilidade, liberdade, criatividade, compromisso, domínio da prática e de seu papel social, além do aprofundamento e contextualização dos conhecimentos, adquiridos durante a sua formação acadêmica e observam diretamente a forma de atuar do enfermeiro. Conclusão: A experiência demonstra que há um bom aproveitamento em decorrência da integração ensino-serviço, que proporciona uma multiplicidade de ações assistenciais e gerenciais, passíveis de intervenções de diversa natureza e isso estimula os alunos e professores a buscarem contribuir com a organização da unidade e com ferramentas que auxiliem o processo de trabalho do enfermeiro e sua equipe, assim como incitar enfermeiros quanto a necessidade de constante aprimoramento em cursos formais e na sua prática que qualifiquem suas ações. (AU)

Objective: To present the teaching methodology developed with the students of the theoretical-practical discipline Nursing Management in the Hospital context, and to highlight the positive results and the factors that hinder their development and interfere in the students' learning process. Métodos: Qualitative study, of the type of experience report, carried out in 2019, at the School of Nursing of Federal Fluminense University. Results: The experience of the management discipline provides the nursing student with the development of different skills and competencies essential to their training, stimulating their autonomy, responsibility, freedom, creativity, commitment, mastery of practice and their social role, in addition to deepening and contextualization of knowledge, acquired during their academic training and directly observe the way nurses act. Conclusion: Experience shows that there is a good use due to the teaching-service integration, which provides a multiplicity of care and management actions, subject to interventions of different nature and this encourages students and teachers to seek to contribute to the organization of the unit and with tools that assist the work process of the nurse and his team, as well as encourage nurses as to the need for constant improvement in formal courses and in their practice that qualify their actions. (AU)

Objetivo: Presentar la metodologia de enseñanza desarrollada con los estudiantes de la disciplina teórico-práctica en la Gestión de la Atención de Enfermería en la Red Hospitalaria, resaltar los resultados positivos y los factores que dificultan su desarrollo e interfieren en el proceso de aprendizaje de los estudiantes. Métodos: Estudio cualitativo, tipo informe de experiencia, realizado en el año de 2019, en la Escuela de Enfermería de la Universidad Federal Fluminense. Resultados: La experiencia de la disciplina de gestión proporciona al estudiante de enfermería el desarrollo de diferentes habilidades y competencias esenciales para su formación, estimulando su autonomía, responsabilidad, libertad, creatividad, compromiso, dominio de la práctica y su papel social, además de profundizar y contextualizar el conocimiento adquirido durante su formación académica y observar directamente la forma en que trabaja el enfermero. Conclusión: La experiencia muestra que hay una buena utilización de la integración del servicio y la enseñanza, que proporciona una multiplicidad de acciones de atención y gestión, sujetas a intervenciones de diferente naturaleza y esto alienta a los estudiantes y profesores a buscar contribuir con la organización de la unidad, con herramientas que ayudan al proceso de trabajo del enfermero y su equipo y alientan a los enfermeros en cuanto a la necesidad de una mejora constante en los cursos formales y en su práctica que califiquen sus acciones. (AU)

O processo legal de incorporação da Policlínica Piquet Carneiro à Universidade do Estado do Rio de Janeiro (1995-2008) / Th e legal process of incorporation of the Piquet Carneiro Polyclinic to the Rio de Janeiro State University (1995­2008)

Objetivo: descrever o processo legal de incorporação da Policlínica Piquet Carneiro à Universidade do Estado do Rio de Janeiro, no período de 1995-2008. Método: pesquisa na perspectiva histórica, do tipo documental. O acervo documental foi composto de documentos escritos. Foi aplicada às fontes a análise documental. Resultados: delineou-se três categorias: as circunstâncias do processo; processo administrativo legal da cessão da unidade à Universidade do Estado do Rio de Janeiro e a reformulação assistencial da Policlínica pelas suas Unidades Acadêmicas. Conclusão: A incorporação ocorreu em uma época de fortalecimento do Sistema Único de Saúde, com a transferência da gestão de unidades ambulatoriais federais. A universidade e o Ministério da Saúde se comprometeram com a cogestão da Policlínica Piquet Carneiro com a assinatura do Termo de Cessão de Uso em 1999. A partir de 2008, professores de Unidades Acadêmicas da área da saúde da universidade reformularam a assistência da unidade, ampliando dos campos de ensino-pesquisa-extensão.

Judicialization of health arising from prepaid insurance plans and health law: an integrative review.

OBJECTIVE: To analyze publications regarding judicial demands related to the violation of the rights of the client who uses private health insurance in Brazil. METHOD: Integrative review, from September to October 2017, of national character, with complete texts online, in Portuguese and English, published between 2012 and 2017 in the Virtual Health Library portal, excluding studies that were duplicated or with indiscriminate methodology. RESULTS: The judicial demands were for: medication (32%); ward hospitalization (11%); surgical procedures (9%); orthosis, prothesis and special materials (9%); others (9%); and diagnostic procedures, outpatient service, hospitalization in Intensive Care Units, food formulas and disposable diapers (30%). CONCLUSION: The prevalence of legal disputes arising from the failure in providing health service by private health insurances was observed, which makes it easier for the administrators to identify the sought health products and services in order to reorganize the administrative sphere and provide quality care.

Mapping the Segmental Microbiomes in the Human Small Bowel in Comparison with Stool: A REIMAGINE Study.

BACKGROUND: Most gut microbiome studies have been performed using stool samples. However, the small intestine is of central importance to digestion, nutrient absorption, and immune function, and characterizing its microbial populations is essential for elucidating their roles in human health and disease. AIMS: To characterize the microbial populations of different small intestinal segments and contrast these to the stool microbiome. METHODS: Male and female subjects undergoing esophagogastroduodenoscopy without colon preparation were prospectively recruited. Luminal aspirates were obtained from the duodenum, jejunum, and farthest distance reached. A subset also provided stool samples. 16S rRNA sequencing was performed and analyses were carried out using CLC Genomics Workbench. RESULTS: 16S rRNA sequencing identified differences in more than 2000 operational taxonomic units between the small intestinal and stool microbiomes. Firmicutes and Proteobacteria were the most abundant phyla in the small intestine, and Bacteroidetes were less abundant. In the small intestine, phylum Firmicutes was primarily represented by lactic acid bacteria, including families Streptococcaceae, Lactobacillaceae, and Carnobacteriaceae, and Proteobacteria was represented by families Neisseriaceae, Pasteurellaceae, and Enterobacteriaceae. The duodenal and FD microbial signatures were markedly different from each other, but there were overlaps between duodenal and jejunal and between jejunal and FD microbial signatures. In stool, Firmicutes were represented by families Ruminococcaceae, Lachnospiraceae, Christensenellaceae, and Proteobacteria by class Deltaproteobacteria. CONCLUSIONS: The small bowel microbiome is markedly different from that in stool and also varies between segments. These findings may be important in determining how compositional changes in small intestinal microbiota contribute to human disease states.

Effect of tomato (Solanum lycopersicum L.) lycopene-rich extract on the kinetics of rancidity and shelf-life of linseed (Linum usitatissimum L.) oil.

The effect of tomato lycopene-rich extract (TLE) addition on shelf-life of linseed oil was evaluated. Linseed oil was extracted by cold pressing and TLE by supercritical CO2. Linseed oils with and without TLE addition were characterized for moisture, color, refractive index, fatty acid composition and antioxidants. Adding TLE to 80 mg lycopene/kg oil improved linseed oil stability, showing the same induction time at 110 °C (by Rancimat) of control linseed oil with 200 mg/kg butylhydroxytoluene. The increase of free fatty acid, peroxide value, p-anisidine value, K232 and K268 at 40, 50, and 60 °C until 90 days followed first-order kinetics. Rancidity rate augmented with temperature. TLE addition slowed oil degradation without changing the mechanism since the Arrhenius lines were parallel. Mean Ea were respectively 38.2, 24.7, 38.0, 38.2, 41.5 kJ/mol. TLE addition increased linseed oil shelf-life by 31% (Rancimat) and by 42% (stability kinetics during storage).

O processo de trabalho gerencial do enfermeiro no setor de hiperdia na atenção básica: relato de experiência / The nurse's management work process in the hyperdia sector in basic care: experience report

Objetivo: analisar a organização do processo de trabalho gerencial do enfermeiro no setor do Programa de Hiperdia em uma Policlínica Regional do município de Niterói-RJ. Metodologia: trata-se de um relato de experiência, de abordagem qualitativa, desenvolvido a partir da observação da organização do processo de trabalho dos enfermeiros que trabalham no setor do Programa de Hiperdia de uma Policlínica Regional do município de Niterói-RJ. Realizada durante o segundo semestre acadêmico de 2019. Levaram-se em consideração os seguintes componentes do processo: objeto, agentes, instrumentos, finalidade, método e produto. Resultados: foi possível analisar o processo de trabalho exercido pela enfermagem no setor do Programa de Hiperdia. Observou-se a implementação de rotina, utilização de diversos instrumentos, organização de registros de enfermagem e implementação de controle diário de atendimento, cabe ressaltar o bom relacionamento enfermeiro-paciente, que possibilita o cuidado adequado com a necessidade do usuário. Considerações finais: o Programa de Hiperdia se mostra importante para a Policlínica ofertando um atendimento dentro das perspectivas do Sistema Único de Saúde (SUS). No processo de trabalho gerencial o enfermeiro ao coordenar esse setor, realiza função de gestor, pesquisador, educador e prestador de assistência, funções estas que são os pilares construtores do processo de trabalho da enfermagem. (AU)

Objective: to analyze the organization of the managerial work process of nurses in the sector of the Hiperdia Program in a Regional Polyclinic in the city of Niterói-RJ. Methodology: it is an experience report, with a qualitative approach, developed from the observation of the organization of the work process of nurses who work in the sector of the Hiperdia Program of a Regional Polyclinic in the city of Niterói-RJ. Held during the second academic semester of 2019. The following components of the process were taken into account: object, agents, instruments, purpose, method and product. Results: it was possible to analyze the work process performed by nursing in the sector of the Hiperdia Program. It was observed the routine implementation, the use of several instruments, the organization of nursing records and the implementation of daily care control, it is worth mentioning the good nurse-patient relationship, which enables adequate care with the user's need. Final considerations: the Hiperdia Program is important for the Polyclinic, offering care within the perspective of the Unified Health System (SUS). In the managerial work process, the nurse, when coordinating this sector, performs the function of manager, researcher, educator and care provider, functions that are the building blocks of the nursing work process. (AU)

Objetivo: analizar la organización del proceso de trabajo gerencial de las enfermeras en el sector del Programa Hiperdia en un Policlínico Regional en la ciudad de Niterói-RJ. Metodología: este es un informe de experiencia, con un enfoque cualitativo, desarrollado a partir de la observación de la organización del proceso de trabajo de las enfermeras que trabajan en el sector del Programa Hiperdia de una Policlínica Regional en la ciudad de Niterói-RJ. Se llevó a cabo durante el segundo semestre académico de 2019. Se tomaron en cuenta los siguientes componentes del proceso: objeto, agentes, instrumentos, propósito, método y producto. Resultados: fue posible analizar el proceso de trabajo realizado por enfermería en el sector del Programa Hiperdia. Se observó la implementación de rutina, el uso de varios instrumentos, la organización de los registros de enfermería y la implementación del control de atención diaria, vale la pena mencionar la buena relación enfermera-paciente, que permite una atención adecuada a las necesidades del usuario. Consideraciones finales: el Programa Hiperdia es importante para la Policlínica, ya que ofrece atención desde la perspectiva del Sistema Único de Salud (SUS). En el proceso de trabajo gerencial, la enfermera, al coordinar este sector, desempeña la función de gerente, investigador, educador y proveedor de atención, funciones que son los componentes básicos del proceso de trabajo de enfermería. (AU)

Judicialization of health arising from prepaid insurance plans and health law: an integrative review / Judicialización de la salud resultante de los planes de prepago y el derecho sanitario: revisión integrativa / Judicialização da saúde decorrente dos planos de pré-pagamento e o direito sanitário: revisão integrativa

ABSTRACT Objective: To analyze publications regarding judicial demands related to the violation of the rights of the client who uses private health insurance in Brazil. Method: Integrative review, from September to October 2017, of national character, with complete texts online, in Portuguese and English, published between 2012 and 2017 in the Virtual Health Library portal, excluding studies that were duplicated or with indiscriminate methodology. Results: The judicial demands were for: medication (32%); ward hospitalization (11%); surgical procedures (9%); orthosis, prothesis and special materials (9%); others (9%); and diagnostic procedures, outpatient service, hospitalization in Intensive Care Units, food formulas and disposable diapers (30%). Conclusion: The prevalence of legal disputes arising from the failure in providing health service by private health insurances was observed, which makes it easier for the administrators to identify the sought health products and services in order to reorganize the administrative sphere and provide quality care.

RESUMEN Objetivo: Analizar las publicaciones acerca de las demandas judiciales relacionadas con la infracción a los derechos del usuario que utiliza un plan privado de salud en Brasil. Método: Revisión integrativa realizada entre septiembre y octubre de 2017, en ámbito nacional en los idiomas portugués e inglés, con textos completos y publicados en línea de 2012 a 2017 en el Portal de la Biblioteca Virtual en Salud, con la exclusión de los duplicados y de metodología indiscriminada. Resultados: Las demandas judiciales fueron: un 32% por medicamentos; un 11% por internación en enfermería; un 9% por procedimientos quirúrgicos; un 9% por ortesis, prótesis y materiales especiales; un 9% por otros; y un 30% por procedimientos diagnósticos, de atención ambulatoria, de internación en un Centro de Terapia Intensiva, de fórmulas alimentarias y pañales desechables. Conclusión: Se demostró una prevalencia de los litigios judiciales resultantes de una falla en la prestación del servicio de salud por los planes privados, lo que les facilita a los gestores identificar los productos y servicios de salud necesarios para reorganizar la esfera administrativa y la prestación de una asistencia con calidad.

RESUMO Objetivo: Analisar as publicações a respeito de demandas judiciais relacionadas à infração aos direitos do usuário que utiliza plano privado de saúde no Brasil. Método: Revisão integrativa de setembro a outubro de 2017, com caráter nacional em português e inglês, textos online completos e publicados entre 2012 e 2017 no Portal da Biblioteca Virtual em Saúde, excluindo os duplicados e com metodologia indiscriminada. Resultados: As demandas judiciais foram: 32% medicamentos; 11% internação em enfermaria; 9% procedimentos cirúrgicos; 9% órtese, prótese e materiais especiais; 9% outros; e 30% de procedimentos diagnósticos, atendimento ambulatorial, internação em Centro de Terapia Intensiva, fórmulas alimentares e fraldas descartáveis. Conclusão: Demonstra-se a prevalência dos litígios judiciais decorrentes da falha na prestação do serviço de saúde pelos planos privados, o que facilita aos gestores identificar produtos e serviços de saúde pleiteados para reorganização da esfera administrativa e prestação de assistência com qualidade.

Glutathione Directly Intercepts DNA Radicals To Inhibit Oxidative DNA-Protein Cross-Linking Induced by the One-Electron Oxidation of Guanine.

Oxidative DNA damage can lead to cancer, and as enzymatic DNA repair systems become compromised during the aging process, the role of exogenous antioxidants becomes more critical. Here, we examined whether such non-enzymatic DNA repair can be effected by the common cellular antioxidant glutathione, investigating both permanent DNA damage products and the guanine radical intermediates that form them, using the flash-quench technique to carry out the one-electron oxidation of guanine. In gel-shift assays, the presence of reduced glutathione at physiological (millimolar) concentrations strongly inhibits oxidative DNA-protein cross-linking. In contrast, the oxidized glutathione dimer affords only a minimal amount of protection, even at elevated pH where there is more of the strongly reducing thiolate form. In flash photolysis experiments, the formation and decay of the guanine neutral radical were monitored at 510 nm. Transient absorption measurements with a guanine-rich 22-mer DNA duplex on the millisecond time scale show that the yield of this long-lived signal is significantly diminished in the presence of reduced glutathione, suggesting a reduction process that is fast relative to the measurement. Indeed, transient absorption experiments carried out on faster time scales show that the microsecond decay of the guanine radical signal is visibly faster with glutathione present. Glutathione is perhaps best known as an electron source in enzymatic reactions, to maintain cysteines in reduced states in proteins and to deactivate reactive oxygen species. However, these results show that another important task for glutathione may be to directly intercept DNA radicals before permanent DNA damage can occur.

Educação permanente em saúde: estratégia de prevenção e controle de infecção hospitalar / Permanent health education: hospital infection prevention and control strategy / Educación Permanente en salud: estrategia de prevención y control de infección hospitalaria

Objetivo: analisar através da literatura as estratégias da educação permanente que contribuem para a mudança de condutas de prevenção e controle de infecção em assistência à saúde pela equipe multidisciplinar. Método: Revisão integrativa com busca nas bases de dados LILACS, MEDLINE e BDENF. Elaborou-se um instrumento de coleta de dados que sinaliza as características para análise dos estudos. Resultados: Incluíram-se 12 artigos e foram agrupados por similaridade didática de acordo com as estratégias implementadas quanto à prevenção e controle em assistência à saúde. Conclusão: Ficou evidente que a utilização de diversas estratégias da educação permanente, na assistência à saúde, traz melhorias à medida que estimulam os profissionais no aperfeiçoamento, qualificação e na atualização de conceitos e ações práticas, contribuindo também para o desenvolvimento da reflexão crítica, trazendo mudança comportamental, favorecendo desta forma o crescimento pessoal e profissional e a interação da equipe multidisciplinar, propiciando assim a melhora na qualidade da assistência.(AU)

Objective: analyze through the literature the strategies of the permanent education that contribute in the change of conduits of prevention and control of infection in health care by the multidisciplinary team. Method: Integrative revision with search in LILACS, MEDLINE and BDENF databases. Elaborated an instrument of data collection that signals the characteristics for analysis of the studies. Results: Were included 12 articles and grouped by didactic similarity according to the strategies implemented regarding prevention and control in health care. Conclusion: It was evident that the use of several strategies of permanent education in health care, brings improvements as they stimulate professionals in the improvement, qualification and updating of concepts and practical actions, also contributing to the development of critical reflection, bringing change behavioral, thus favoring personal and professional growth and the interaction of the multidisciplinary team, thus improving the quality of care.(AU)

Objetivo: analizar a través de la literatura las estrategias de la educación permanente que contribuyen en el cambio de conductas de prevención y control de infección en asistencia a la salud por el equipo multidisciplinario. Método: Revisión integrativa con búsqueda en las bases de datos LILACS, MEDLINE y BDENF. Elaboró un instrumento de recolección de datos que señaliza las características para el análisis de los estudios. Resultados: Se incluyeron 12 artículos y fueron agrupados por similitud didáctica de acuerdo con las estrategias implementadas en cuanto a la prevención y control en asistencia a la salud. Conclusión: Es evidente que la utilización de diversas estrategias de la educación permanente en la asistencia a la salud, trae mejoras a medida que estimulan a los profesionales en el perfeccionamiento, calificación y actualización de conceptos y acciones prácticas, contribuyendo también al desarrollo de la reflexión crítica, trayendo cambio comportamental, favoreciendo de esta forma el crecimiento personal y profesional y la interacción del equipo multidisciplinario propiciando así la mejora en la calidad de la asistencia.(AU)

Compuestos fenólicos y actividad antioxidante de los extractos de la hoja de chirimoya (Annona cherimola Mill) / Phenolic compounds and antioxidant activity of extracts from chirimoya (Annona cherimola Mill) leaf / Compostos fenólicos e atividade antioxidante dos extratos da folha de cherimoya (Annona cherimola Mill)

Resumen Después de la cosecha del fruto chirimoya, los árboles liberan enormes cantidades de hojas, las cuales son quemadas por los agricultores. Este trabajo muestra que las hojas pueden ser usadas para nuestro beneficio como antioxidante. Se determinaron los compuestos fenólicos (CF) y la actividad antioxidante (AA) de los extractos de la hoja seca de Annona cherimola Mill en etanol al 70% v/v, agua a 80 °C, y agua subcrítica (AS) a 110, 120 y 130 °C, siguiendo un diseño factorial con el programa Minitab. Los CF se cuantificaron con la metodología de Folin Ciocalteu y la AA con el 2,2-difenil-1-picrilhidrazilo (DPPH) y con el poder antioxidante reductor del hierro (FRAP). Los resultados indicaron que el tipo de solvente y el tiempo de extracción presentaron un efecto significativo en el contenido de CF y AA de los extractos. Se concluyó que el extracto de hoja de chirimoya es un potencial antioxidante. El extracto de AS a 130 °C presentó el mayor contenido de CF (5,6 g EAG/100 g de hoja seca) y el extracto etanólico presentó mayor AA (0,86 mg equivalente trolox/mg extracto seco; IC50=0,020 mg de extracto seco/mL de extracto de hoja seca y FRAP de 1710,14 μmol equivalente trolox /g de hoja seca) y los extractos obtenidos con AS a menor temperatura presentaron mayores valores de AA.

Abstract After harvesting cherimoya fruit, the trees release huge amounts of leaves, which are burned by farmers. This work shows that the leaves can be used as a source of antioxidants. Total phenolic compounds (TPC) and antioxidant activity (AA) of extracts of the dry leaf of Annona cherimola Mill in 70% v/v ethanol, water at 80 °C, subcritical water (SW) at 110 °C, 120 °C and 130 °C were determined, following a factorial design with the Minitab program. The TPC was quantified with the Folin Ciocalteu methodology, and the AA with 2,2-diphenyl-1-picrilhidrazil (DPPH) and Ferric Reducing Antioxidant Power (FRAP). Results indicate that the type of solvent and the extraction time had a significant effect on the TPC and AA of the extracts. Extracts of cherimoya leaves were found to be a potential antioxidant. The extract of SW at 130 °C presented the highest content of TPC (5.6 g EAG/100 g dry leaves) and the ethanolic extract had the highest AA (0.86 mg trolox equivalent/mg dry extract, IC50 = 0.020 mg dry extract/mL extract of dry leaves and FRAP of 1710.14 μmol ET/g dry leaves) and the extracts obtained with SW at a lower temperature presented a higher AA value.

Resumo Depois da colheita da fruta Cherimoya, as árvores liberam grandes quantidades de folhas, que são queimadas pelos agricultores. Este trabalho mostra que as folhas podem ser usadas para nosso benefício como um antioxidante. Compostos fenólicos (FC) e a actividade antioxidante (AA) de extractos de folha seca Annona cherimola Mill em etanol a 70% v/v água a 80 °C, água subcrítica (AS) 110, 120, 130 °C, foram determinados seguindo um planejamento fatorial com o programa Minitab. Os FC foram quantificados com a metodologia Folin Ciocalteu; e a capacidade antioxidante (AA) com 2,2-difenil-1-picrilhidrazil (DPPH) e poder antioxidante redutor de ferro (FRAP). Os resultados indicaram que o tipo de solvente e o tempo de extração tiveram um efeito significativo no conteúdo deCFeAA dos extratos. Conclui-se que o extracto de folha de cherimoya é um potencial antioxidante, o extracto de AS 130 °C tinha o maior conteúdo de CF (5,6 g EAG/100 g folha seca) e o extracto etanólico mostraram maior AA (0,86 mg equivalente Trolox/mg extrato seco, IC50 = 0,020 mg extrato seco/mL extracto de folha seca e FRAP de 1710,14 μmol ET/g folha seca). Os extratos obtido com AS a uma temperatura mais baixa apresentaram um maior valor de AA.

Processo de planejamento realizado pelos enfermeiros: atenção básica em saúde / Planning process performed by nurses: primary health care

Objetivo: analisar os reflexos do processo do planejamento na assistência prestada em duas unidades da atenção básica de saúde. Método: trata-se de um estudo qualitativo, descritivo, tipo pesquisa de campo, tendo, como cenários, uma Unidade Básica de Saúde e uma Policlínica. Coletaram-se os dados em 2017, utilizando-se, como instrumento, um roteiro de entrevista semiestruturado, com quatro enfermeiros. Apresentaram-se os resultados por meio da Análise de Conteúdo. Resultados: evidenciou-se a categoria "Os reflexos do processo do planejamento na assistência prestada na atenção básica em saúde". Conclusão: demonstrou-se o conhecimento, por parte dos enfermeiros, sobre o planejamento ao analisar os discursos, refletindo a preocupação do envolvimento de todos para alcançar as metas institucionais. Possibilitou-se, ao ser empregado pelos enfermeiros, refletir sobre a importância da sua utilização para otimizar os serviços de Enfermagem e das instituições onde estes profissionais estão inseridos, porém, a existência de fragilidades, tais como a falta de recursos humanos, materiais, além da falta de reconhecimento de seu trabalho, dificultam, algumas vezes, o alcance dos objetivos.(AU)

Objective: to analyze the effects of the planning process in the assistance provided in two basic health care units. Method: this is a qualitative study, descriptive, field-research type, whose scenarios were a Basic Health Unit and a Polyclinic. Data were collected in 2017, using as instrument a semistructured interviews with four nurses. The results were presented by means of content analysis. Results: the category "Consequences of the planning process in the assistance provided in primary health care" emerged. Conclusion: the nurses demonstrated knowledge about planning when analyzing their speeches, reflecting the concern about the involvement of everyone to achieve the institutional goals. When used by nurses, it allowed reflecting on the importance of its use to optimize the nursing services and institutions where these professionals are inserted, however, the existence of weaknesses, such as the lack of human, material resources, in addition to the lack of recognition of their work, sometimes hinder achieving the objectives.(AU)

Objetivo: analizar los efectos del proceso de planificación en la asistencia que se presta en dos unidades de atención básica de la salud. Método: se trata de un estudio cualitativo, descriptivo, del tipo investigación de campo, teniendo como escenarios una unidad básica de salud y un policlínico. Los datos fueron recolectados en el 2017, usando como instrumento una entrevista semiestructurada con cuatro enfermeras. Los resultados fueron presentados por medio de análisis de contenido. Resultados: se evidenció la categoría "Reflexiones del proceso de planificación en la asistencia prestada en la atención primaria de la salud". Conclusión: Se demostró el conocimiento, por parte de enfermeras, acerca de la planificación cuando se analizaron los discursos, reflejando la preocupación de la participación de todos para lograr los objetivos institucionales. Se utilizado por las enfermeras, reflexiona sobre la importancia de su uso para optimizar los servicios de enfermería e instituciones donde estos profesionales se insertan, sin embargo, la existencia de deficiencias, como la falta de recursos humanos, materiales, además de la falta de reconocimiento de su trabajo, hacen difícil, a veces, lograr los objetivos.(AU)