Evaluation of the incorporation of an IOTA-ADNEX model in the discrimination of adnexal masses in our third-level hospital centre, taking into account the menopausal status of patients. Five years of experience / Evaluación de la incorporación del IOTA-ADNEX model en la discriminación de las masas anexiales en nuestro centro hospitalario de tercer nivel teniendo en cuenta el estado menopáusico en la predicción de malignidad. Cinco años de experiencia

Objective: The objectives were to estimate the performance of the IOTA-ADNEX model test after its incorporation into the ultrasound tests of our third-grade hospital gynecology service, as well as to assess whether its capacity of accuracy is modified when taking into account the patient's menopausal status. Methods: A cross-sectional study was conducted to clinically evaluate the diagnostic performance of the IOTA-ADNEX model test, which was performed between January 2016 and December 2021. The study included 573 women with an adnexal injury who underwent surgical excision within 180 days after ultrasound diagnosis and histological confirmation (gold standard). After the ultrasound exam, the injuries were classified using the ADNEX model. The study estimated the area under the receiver-operating-characteristics curve (AUC) of the ADNEX model for classifying between benign and malignant adnexal masses and compared the performance by menopausal state. Sensitivity and specificity were determined for different cut-off points. Results: Out of the 573 women, 183 (31.9%) had a malignant tumor. The AUC of the ADNEX model for differentiating between benign and malignant adnexal masses at the time of ultrasound examination was 0.92 and the best malignancy threshold, detected by Youden index, was 22.5%. At this cut-off, the sensitivity of the ADNEX model was 91.8% and the specificity was 76.4%. However, it varies according to menopausal status: in the group of pre-menopausal patient, sensitivity was 86.1% (95% CI, 85.4%–86.8%) and specificity was 81.3% (95% CI, 85.4%–86.8%). In the postmenopausal group, sensitivity was 96.1% (95% CI, 95.6%–96.7%) and specificity was 68.5% (95% CI, 68.1%–68.8%)...(AU)

Objetivo: Los objetivos eran estimar el rendimiento del test IOTA ADNEX model después de su incorporación en el estudio ecográfico en nuestro servicio de ginecología, en un hospital de tercer nivel, así como evaluar si su capacidad de precisión se modifica al tener en cuenta el estado menopáusico de la paciente. Método: Se llevó a cabo un estudio transversal para evaluar clínicamente el rendimiento diagnóstico del test IOTA ADNEX model, el cual se realizó entre enero de 2016 y diciembre de 2021. El estudio incluyó a 573 mujeres con una lesión anexial que se sometieron a tratamiento quirúrgico en un plazo de 180 días después del diagnóstico por ecografía y confirmación histológica (gold standard). Después de realizar la ecografía, las lesiones fueron clasificadas utilizando el modelo ADNEX. El estudio estimó el área bajo la curva (AUC) del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas, y se comparó el rendimiento según el estado menopáusico. Se determinó la sensibilidad y la especificidad para diferentes puntos de corte. Resultados: De las 573 mujeres, 183 (31,9%) tenían un tumor maligno. El AUC del modelo ADNEX para diferenciar entre masas anexiales benignas y malignas en el momento del examen ecográfico fue de 0,92 y el umbral de malignidad óptimo, detectado por el índice de Youden, fue del 22,5%. Con este punto de corte, la sensibilidad (SE) del modelo ADNEX fue del 91,8% y la especificidad (SP) fue del 76,4%. Sin embargo, esto varía según el estado menopáusico: en el grupo de pacientes premenopáusicas, la sensibilidad fue del 86,1% (IC del 95%: 85,4-86,8%) y la especificidad fue del 813% (IC del 95%: 85,4-86,8%). En el grupo de pacientes posmenopáusicas, la sensibilidad fue del 96,1% (IC del 95%: 95,6-96,7%) y la especificidad fue del 68,5% (IC del 95%: 68,1-68,8%)...(AU)

Peripheral neurotrophin levels during controlled crack/cocaine abstinence: a systematic review and meta-analysis.

Cocaine/crack abstinence periods have higher risk of relapse. Abstinence as initial part of the recovery process is affected by learning and memory changes that could preserve the addictive cycle. To further understand how the interruption of cocaine/crack consumption affects neurotrophin level we performed the present systematic review and meta-analysis following the PRISMA statement (number CRD42019121643). The search formula was conducted in PubMed, Web of Science, Embase, ScienceDirect, and Google Scholar databases. The inclusion criterion was cocaine use disorder in 18 to 60-year-old people, measuring at least one neurotrophin in blood before and after a controlled abstinence period. Studies without pre-post design were excluded. Five investigations had nine different reports, four of them were subjected to a meta-analysis (n = 146). GRADE risk of bias method was followed. Individual studies reported increased peripheral brain derived neurotrophic factor (BDNF) after abstinence, evidence pooled by Hedge's g showed no significant change in BDNF after abstinence. Relevant heterogeneity in the length of the abstinence period (12-32 days), last cocaine/crack consumption monitoring and blood processing were detected that could help to explain non-significant results. Further improved methods are suggested, and a potential BDNF augmentation hypothesis is proposed that, if true, would help to understand initial abstinence as a re-adaptation period influenced by neurotrophins such as the BDNF.

RELATIONSHIP BETWEEN PARVOVIRUS B19 AND OSTEOARTHRITIS: LITERATURE REVIEW.

Osteoarthritis and Parvovirus B19 infection present silent and gradual evolution, since the former is a degenerative process while the latter is often asymptomatic and may persist in the individual's body during their life. This study aims to analyze clinical studies that establish a correlation between degenerative osteoarthritis and Parvovirus B19 infection. Of the 62 studies found, 25 were chosen for reading in full. Analyzing only the studies that establish the correlation between the pathologies, seven confirm this relationship between Parvovirus B19 and Osteoarthritis, while one reports no relationship. No objective correlation could be found between the other articles studied. Our findings suggest that there is a close relationship between Parvovirus B19 and Osteoarthritis, with a higher prevalence of acquired causes, women and older adults, but it can manifest during life. However, it is essential to carry out new studies involving family history of patients with Osteoarthritis with positivity of Parvovirus B19, cohort studies between childhood and adult-old adult, so that it can elucidate this duality of congenital-acquired cause and, finally, raise treatment alternatives. Level of Evidence II, Systematic Review of Level II Studies.

Tanto a osteoartrite quanto a infecção pelo parvovírus B19 apresentam evolução muitas vezes silenciosa e gradual, uma vez que a primeira é um processo degenerativo, e a segunda é geralmente assintomática, podendo persistir no corpo do indivíduo por toda a sua vida. Esta revisão bibliográfica visa analisar estudos clínicos que estabeleceram a correlação entre a osteoartrite degenerativa e a infecção pelo parvovírus B19. Dos 62 artigos encontrados, foram eleitos 25 para leitura em sua totalidade. Analisando apenas os artigos que estabelecem a relação entre as patologias, temos sete que confirmaram essa relação, enquanto um deles afirmou que não há relação. Não houve correlação objetiva entre os demais artigos estudados. Nossos resultados sugerem que há estreita relação entre a osteoartrite e o parvovírus B19, que tende a ser uma doença de causa adquirida com maior prevalência em mulheres e idosos, porém que pode se manifestar durante toda a vida. Contudo, é crucial a realização de novos estudos envolvendo antecedentes familiares de pacientes com osteoartrite e com positividade para o parvovírus B19 e estudos de coorte entre a infância e o adulto-idoso, a fim de elucidar essa dualidade de causa congênita-adquirida e, enfim, levantar alternativas de tratamento. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

Relationship between parvovirus b19 and osteoarthritis: literature review / Relação entre parvovírus b19 e osteoartrite: revisão bibliográfica

ABSTRACT Osteoarthritis and Parvovirus B19 infection present silent and gradual evolution, since the former is a degenerative process while the latter is often asymptomatic and may persist in the individual's body during their life. This study aims to analyze clinical studies that establish a correlation between degenerative osteoarthritis and Parvovirus B19 infection. Of the 62 studies found, 25 were chosen for reading in full. Analyzing only the studies that establish the correlation between the pathologies, seven confirm this relationship between Parvovirus B19 and Osteoarthritis, while one reports no relationship. No objective correlation could be found between the other articles studied. Our findings suggest that there is a close relationship between Parvovirus B19 and Osteoarthritis, with a higher prevalence of acquired causes, women and older adults, but it can manifest during life. However, it is essential to carry out new studies involving family history of patients with Osteoarthritis with positivity of Parvovirus B19, cohort studies between childhood and adult-old adult, so that it can elucidate this duality of congenital-acquired cause and, finally, raise treatment alternatives. Level of Evidence II, Systematic Review of Level II Studies.

RESUMO Tanto a osteoartrite quanto a infecção pelo parvovírus B19 apresentam evolução muitas vezes silenciosa e gradual, uma vez que a primeira é um processo degenerativo, e a segunda é geralmente assintomática, podendo persistir no corpo do indivíduo por toda a sua vida. Esta revisão bibliográfica visa analisar estudos clínicos que estabeleceram a correlação entre a osteoartrite degenerativa e a infecção pelo parvovírus B19. Dos 62 artigos encontrados, foram eleitos 25 para leitura em sua totalidade. Analisando apenas os artigos que estabelecem a relação entre as patologias, temos sete que confirmaram essa relação, enquanto um deles afirmou que não há relação. Não houve correlação objetiva entre os demais artigos estudados. Nossos resultados sugerem que há estreita relação entre a osteoartrite e o parvovírus B19, que tende a ser uma doença de causa adquirida com maior prevalência em mulheres e idosos, porém que pode se manifestar durante toda a vida. Contudo, é crucial a realização de novos estudos envolvendo antecedentes familiares de pacientes com osteoartrite e com positividade para o parvovírus B19 e estudos de coorte entre a infância e o adulto-idoso, a fim de elucidar essa dualidade de causa congênita-adquirida e, enfim, levantar alternativas de tratamento. Nível de Evidência II, Revisão Sistemática de Estudos de Nível II.

Beta distribution misspecification tests with application to Covid-19 mortality rates in the United States.

The beta distribution is routinely used to model variables that assume values in the standard unit interval, (0, 1). Several alternative laws have, nonetheless, been proposed in the literature, such as the Kumaraswamy and simplex distributions. A natural and empirically motivated question is: does the beta law provide an adequate representation for a given dataset? We test the null hypothesis that the beta model is correctly specified against the alternative hypothesis that it does not provide an adequate data fit. Our tests are based on the information matrix equality, which only holds when the model is correctly specified. They are thus sensitive to model misspecification. Simulation evidence shows that the tests perform well, especially when coupled with bootstrap resampling. We model state and county Covid-19 mortality rates in the United States. The misspecification tests indicate that the beta law successfully represents Covid-19 death rates when they are computed using either data from prior to the start of the vaccination campaign or data collected when such a campaign was under way. In the latter case, the beta law is only accepted when the negative impact of vaccination reach on death rates is moderate. The beta model is rejected under data heterogeneity, i.e., when mortality rates are computed using information gathered during both time periods.

Incidence of falls in long-stay hospitals: risk factors and strategies for prevention.

INTRODUCTION: Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE: To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS: We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS: A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS: Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.

Historia de las políticas de salud mental en Brasil: implicaciones para la identidad profesional de la enfermera / History of mental health policies in Brazil: implications for the nurse's professional identity

Los cambios ocurridos a lo largo de la historia en el campo de la Enfermería en Salud Mental están directamente ligados a las reformulaciones en los campos político-ideológico y social de cada época, que redundan en la reconfiguración continua de sus procesos de trabajo. Del período del asilo al movimiento de Lucha Anti-Asilo, pasando por el momento actual reconocido como movimiento de contrarreforma psiquiátrica, el trabajo de las enfermeras ha sido llamado a reformularse constantemente, en un campo conflictivo de disputas entre modelos antagónicos de salud mental [Fragmento de texto] (AU)

Associação entre fatores sociodemográficos e consumo de álcool, tabaco e hipnóticos em mulheres rurais / Asociación entre factores sociodemográficos y consumo de alcohol, tabaco e hipnóticos en mujeres rurales / Association between sociodemographic factors and consumption of alcohol, tobacco and hypnotics in rural women

Objetivo: investigar a associação entre fatores sociodemográficos e consumo de álcool, tabaco e hipnóticos em mulheres rurais. Método: estudo transversal realizado com 259 mulheres rurais. Para a coleta dos dados, utilizou-se formulário estruturado e o Alcohol, Smoking and Substance Involvement Screening Test. Para a análise empregou-se o Teste qui-quadrado e/ou Exato de Fisher com intervalo de confiança de 95%. Resultados: observou-se associação entre o uso do tabaco e a cor (p=0,041), a crença religiosa (p=0,001) e benefício governamental (p=0,006). Houve associação entre o consumo de álcool e a crença religiosa (p≤0,001). Quanto a necessidade de intervenção, observou-se associação entre tabaco e cor (p=0,009), renda (p=0,001) e benefício governamental (p=0,006), assim como álcool e idade (p=0,035), crença religiosa (p=0,006) e renda (p=0,002). Conclusão: fatores como religião, cor, renda, idade e benefício governamental estão associados ao uso de álcool e tabaco em mulheres rurais.

Objetivo: investigar la asociación entre factores sociodemográficos y consumo de alcohol, tabaco e hipnótico en mujeres rurales. Método: estudio transversal realizado con 259 mujeres rurales. Para la recolección de datos, se utilizó un formulario estructurado y se utilizó la Prueba de Detección de Alcohol, Smoking and Substance Involvement Screening Test. Para el análisis se utilizó el Chi-Cuadrado y/o la Prueba Exacta de Fisher con un intervalo de confianza del 95%. Resultados: hubo asociación entre el consumo de tabaco y el color (p=0,041), la creencia religiosa (p=0,001) y el beneficio gubernamental (p=0,006). Hubo una asociación entre el consumo de alcohol y las creencias religiosas (p≤0,001). En cuanto a la necesidad de intervención, hubo una asociación entre el tabaco y el color (p=0,009), los ingresos (p=0,001) y el beneficio del gobierno (p=0,006), así como el alcohol y la edad (p=0,035), las creencias religiosas (p=0,006) y los ingresos (p=0,002). Conclusión: factores como la religión, el color, los ingresos, la edad y el beneficio del gobierno están asociados con el consumo de alcohol y tabaco en las mujeres rurales.

Objective: to investigate the association between sociodemographic factors and alcohol, tobacco and hypnotic consumption in rural women. Method: cross-sectional study conducted with 259 rural women. For data collection, a structured form was used and the Alcohol, Smoking and Substance Involvement Screening Test was used. For the analysis, the Chi-Square and/or Fisher's Exact Test with a 95% confidence interval was used. Results: there was an association between tobacco use and color (p=0.041), religious belief (p=0.001) and governmental benefit (p=0.006). There was an association between alcohol consumption and religious belief (p≤0.001). Regarding the need for intervention, there was an association between tobacco and color (p=0.009), income (p=0.001) and government benefit (p=0.006), as well as alcohol and age (p=0.035), religious belief (p=0.006) and income (p=0.002). Conclusion: factors such as religion, color, income, age and government benefit are associated with alcohol and tobacco use in rural women.

Impacto da drenagem linfática manual nos sintomas relacionados ao edema de membros inferiores de gestantes / Impacto del drenaje linfático manual sobre los síntomas relacionados con el edema de miembros inferiores en mujeres embarazadas / Impact of the manual lymphatic drainage on symptoms related to lower-extremity edema in pregnant women

RESUMO O objetivo deste artigo é analisar os efeitos da drenagem linfática manual sobre os sintomas de sensação de peso, dor, edema e formigamento nos membros inferiores de gestantes, assim como na redução da perimetria. A amostra foi composta por 23 voluntárias, e foram realizados 35 atendimentos. Foram incluídas gestantes com idade gestacional acima de 26 semanas, que apresentavam sensação de peso, dor, edema e formigamento nos membros inferiores, com autorização escrita do médico obstetra para que fossem submetidas a drenagem linfática manual utilizando o método Leduc. Foram excluídas gestantes que apresentaram pressão arterial superior a 140/100mmHg no momento da realização da drenagem linfática manual, lesão de continuidade da epiderme, doenças dermatológicas, linfáticas e cardíacas, infecções e varizes volumosas e/ou sintomáticas. As avaliações foram realizadas imediatamente após a aplicação da drenagem linfática manual e duas horas depois, por meio de questionário estruturado pelas pesquisadoras. Diferenças estatisticamente significativas foram encontradas antes, imediatamente após e após duas horas da intervenção no que se refere à melhora da dor (p=0,001*), do formigamento (p=0,01*), da sensação de peso (p=0,000*) e do inchaço (p=0,000*). Em relação à perimetria antes e após o tratamento, houve diminuição na maioria das mensurações realizadas. A técnica de drenagem linfática manual tem papel fundamental na melhora da qualidade de vida da gestante devido ao relaxamento e bem-estar proporcionado, componentes considerados essenciais para redução da ansiedade e com benefícios que podem perdurar até o parto.

RESUMEN El objetivo de este estudio es analizar los efectos del drenaje linfático manual sobre los síntomas de pesadez, dolor, edema y hormigueo en miembros inferiores de mujeres embarazadas, así como sobre la reducción de la perimetría. La muestra estuvo conformada por 23 voluntarias, y se realizaron 35 consultas. Se incluyeron a mujeres embarazadas con edad gestacional superior a 26 semanas, que presentaban sensación de pesadez, dolor, edema y hormigueo en miembros inferiores, y que habían sido autorizadas por el obstetra para someterse al drenaje linfático manual con el método Leduc. Se excluyeron a mujeres embarazadas con presión arterial superior a 140/100mmHg en el momento del drenaje linfático manual, lesión de continuidad de la epidermis, enfermedades dermatológicas, linfáticas y cardíacas, infecciones y varices grandes y/o sintomáticas. Las evaluaciones se realizaron tras aplicar el drenaje linfático manual y dos horas después, por medio de un cuestionario estructurado por las investigadoras. Se encontraron diferencias estadísticamente significativas antes, inmediatamente después y después de dos horas de la intervención en relación a la mejoría del dolor (p=0,001*), hormigueo (p=0,01*), sensación de pesadez (p=0,000*) e hinchazón (p=0,000*). La perimetría antes y después del tratamiento disminuyó en la mayoría de las mediciones realizadas. La técnica de drenaje linfático manual juega un papel fundamental en la mejora de la calidad de vida de mujeres embarazadas por provocar relajación y bienestar, componentes claves para reducir la ansiedad, con beneficios que pueden durar hasta el parto.

ABSTRACT This article aims to analyze the effects of manual lymphatic drainage on symptoms related to gestational edema in the lower limbs, such a sensation of heaviness, pain, swelling, and tingling, as well as on perimetry. The sample consisted of 23 pregnant women with gestational age above 26 weeks, who were submitted to 35 sessions of drainage based on Leduc's method upon the authorization of their physicians. Participants with blood pressure above 140/100 mmHg at the time of drainage and presenting with skin continuity wound, heart disease, dermatological disease, lymphatic disease, infections, and voluminous or symptomatic varicose veins were excluded from the study. Symptoms were evaluated immediately and two hours after drainage by means of questionnaires. Improvements in pain (p=0.001*), tingling (p=0.01*), sensation of heaviness (p=0.000*), and swelling (p=0.000*) showed statistically significant differences before, immediately after, and two hours after intervention. Most perimetry measurements also presented a decrease after treatment. The technique of manual lymphatic drainage is very important to provide well-being and a better quality of life in pregnant women. The benefits arising from such a method are essential to decrease anxiety, enduring up until childbirth.

Metabolomics by UHPLC-HRMS reveals the impact of heat stress on pathogen-elicited immunity in maize.

INTRODUCTION: Studies investigating crop resistance to abiotic and biotic stress have largely focused on plant responses to singular forms of stress and individual biochemical pathways that only partially represent stress responses. Thus, combined abiotic and biotic stress treatments and the global assessment of their elicited metabolic expression remains largely unexplored. In this study, we employed targeted and untargeted metabolomics to investigate the molecular responses of maize (Zea mays) to abiotic, biotic, and combinatorial stress. OBJECTIVE: We compared the inducible metabolomes of heat-stressed (abiotic) and C. heterostrophus-infected (biotic) maize and examined the effects of heat stress on the ability of maize to defend itself against C. heterostrophus. METHODS: Ultra-high-performance liquid chromatography-high-resolution mass spectrometry was performed on plants grown under control conditions (28 °C), heat stress (38 °C), Cochliobolus heterostrophus infection, or combinatorial stress [heat (38 °C) + C. heterostrophus infection]. RESULTS: Multivariate analyses revealed differential metabolite expression between heat stress, C. heterostrophus infection, and their respective controls. In combinatorial experiments, treatment with heat stress prior to fungal inoculation negatively impacted maize disease resistance against C. heterostrophus, and distinct metabolome separation between combinatorial stressed plants and the non-heat-stressed infected controls was observed. Targeted analysis revealed inducible primary and secondary metabolite responses to abiotic/biotic stress, and combinatorial experiments indicated that deficiency in the hydroxycinnamic acid, p-coumaric acid, may contribute to the heat-induced susceptibility of maize to C. heterostrophus. CONCLUSION: These findings demonstrate that abiotic stress can predispose crops to more severe disease symptoms, underlining the increasing need to investigate defense chemistry in plants under combinatorial stress.

Simbolismos do coração: a relação entre conteúdo onírico e a espera pela cirurgia cardíaca / Heart symbolisms: the relationship between dream content and waiting for cardiac surgery

A espera pela cirurgia cardíaca pode vir a ser prolongada, provocando vulnerabilidade psicológica aos pacientes. A análise dos sonhos facilita o acesso à linguagem simbólica e temáticas que se relacionam ao adoecimento cardíaco, internação e tratamento. O objetivo deste estudo é compreender a relação entre o conteúdo onírico e a espera pela cirurgia cardíaca, a partir do referencial teórico da Psicologia Analítica. Foi realizado um estudo qualitativo e exploratório em pacientes internados em uma Unidade de Internação de Cirurgia Cardíaca. Participaram da pesquisa seis pacientes internados na unidade. Para coleta de dados, foi utilizado o prontuário multiprofissional, assim como um formulário de Registro de Sonhos e Associações. A análise dos dados aconteceu em duas etapas: análise categorial de conteúdo e ampliação simbólica. Os sonhos analisados proporcionaram um aprofundamento na vivência psíquica dos pacientes participantes e uma maior conexão com temáticas que são latentes durante o processo de hospitalização: medo da morte, fuga e transformação. Foi possível perceber a conexão dos pacientes com a possibilidade de finitude, diante da fragilidade do corpo e do coração. A falta de autonomia e controle das situações durante o processo de hospitalização fortalecem o medo da morte e a vontade de retomar a vida segura, estável, fluída, que era supostamente mais viável antes da internação, através da fuga da realidade. Entretanto, os pacientes se defrontam com o chamado da transformação em suas vidas, para além dos cortes e ajustes carnais, uma mudança de perspectiva, atitude, o que provoca mais uma vez o medo.

The wait for cardiac surgery may be prolonged, causing psychological vulnerability to patients. The analysis of dreams facilitates access to symbolic language and themes related to heart disease, hospitalization and treatment. The aim of this study is to understand the relationship between dream content and waiting for cardiac surgery, based on the theoretical framework of Analytical Psychology. A qualitative and exploratory study was performed on patients admitted to a Cardiac Surgery Inpatient Unit. Six patients in the unit participated in the research. For data collection, a multidisciplinary medical record was used, as well as a Dream and Associations Record form. Data analysis took place in two stages: categorical content analysis and symbolic expansion. The analyzed dreams provided a deepening in the psychic experience of the participating patients and a greater connection with themes that are latent during the hospitalization process: fear of death, escape and transformation. It was possible to perceive the connection of patients with the possibility of finitude, given the fragility of the body and the heart. The lack of autonomy and control of situations during the hospitalization process strengthens the fear of death and the desire to resume a safe, stable, fluid life, which was supposedly more viable before hospitalization, through the escape from reality. However, patients are faced with the call of transformation in their lives, in addition to cuts and carnal adjustments, a change in perspective, attitude, which again causes fear.

Effect of Diterpene Manool on the Arterial Blood Pressure and Vascular Reactivity in Normotensive and Hypertensive Rats. / Efeito do Diterpeno Manool sobre a Pressão Arterial e Reatividade Vascular em Ratos Normotensos e Hipertensos.

BACKGROUND: Many studies have shown that the diterpenoid classes exert a significant effect on the cardiovascular system. Diterpenes, in particular, are among the main compound links to cardiovascular properties such as vasorelaxant, inotropic, diuretic and hypotensive activity. While the manool vasorelaxation mechanism is visible, its effect on blood pressure (BP) is still unknown. OBJECTIVE: To evaluate the in vivo hypotensive effect of manool and check the ex vivo vasorelaxation effect in rat aortic rings. METHODS: The animals were divided randomly into two groups: normotensive and hypertensive. The normotensive group was sham-operated, and the 2K1C model was adopted for the hypertensive group. Invasive BP monitoring was performed for manool tests at different doses (10, 20 and 40 mg/kg). Concentration-response curves for manool were obtained in the aorta rings, with endothelium, pre-contracted with phenylephrine (Phe) after incubation with Nω-nitro-L-arginine methyl ester(L-NAME) or oxadiazole [4,3-a]quinoxalin-1-one (ODQ). Nitric oxide (NOx) plasma levels were measured by chemiluminescence assay. RESULTS: After manool administration, BP was reduced in normotensive and hypertensive groups, and this effect was inhibited by L-NAME in hypertensive animals only in 10 mg/kg dose. Ex vivo manool promoted vasorelaxation, which was inhibited by L-NAME and ODQ incubation or endothelium removal. NOx plasma levels increased in the hypertensive group after manool administration. Manool elicits endothelium-dependent vascular relaxation in rat aorta mediated by the NO/cGMP signaling pathway and BP reduction, also by NOx plasma increase. These combined effects could be involved in modulating peripheral resistance, contributing to the antihypertensive effect of diterpene. CONCLUSION: These effects together could be involved in modulating peripheral resistance, contributing to the antihypertensive effect of diterpene.

FUNDAMENTO: Diversos estudos têm mostrado que as classes de diterpenos exercem efeito significativo no sistema cardiovascular. Os diterpenos, em particular, estão entre os principais compostos associados às propriedades cardiovasculares, como a propriedade vasorrelaxante, inotrópica, diurética e a atividade hipotensora. Embora o mecanismo de vasorrelaxamento do manool seja visível, seu efeito sobre a pressão arterial (PA) ainda é desconhecido. OBJETIVO: Avaliar o efeito hipotensor in vivo do manool e verificar o efeito de vasorrelaxamento ex vivo em anéis aórticos de ratos. MÉTODOS: Os animais foram divididos aleatoriamente em dois grupos: normotensos e hipertensos. O grupo normotenso foi submetido à cirurgia sham e adotou-se o modelo 2R1C para o grupo hipertenso. Realizou-se monitoramento invasivo da PA para testes com manool em diferentes doses (10, 20 e 40 mg/kg). Foram obtidas curvas de concentração-resposta para o manool nos anéis aórticos, com endotélio pré-contraído com fenilefrina (Phe) após incubação com Nω-nitro-L-arginina metil éster (L-NAME) ou oxadiazolo[4,3-a]quinoxalina-1-ona (ODQ). Os níveis plasmáticos de óxido nítrico (NOx) foram medidos por ensaio de quimioluminescência. RESULTADOS: Após a administração de manool, a PA se reduziu nos grupos normotenso e hipertenso, e esse efeito foi inibido pelo L-NAME em animais hipertensos apenas na dose de 10 mg/kg. O manool ex vivo promoveu vasorrelaxamento, inibido pela incubação de L-NAME e ODQ ou remoção do endotélio. Os níveis plasmáticos de NOx aumentaram no grupo hipertenso após a administração de manool. O manool induz o relaxamento vascular dependente do endotélio na aorta de ratos, mediado pela via de sinalização NO/cGMP e redução da PA, e também pelo aumento plasmático de NOx. Esses efeitos combinados podem estar envolvidos na modulação da resistência periférica, contribuindo para o efeito anti-hipertensivo do diterpeno. CONCLUSÃO: Esses efeitos em conjunto podem estar envolvidos na modulação da resistência periférica, contribuindo para o efeito anti-hipertensivo do diterpeno.

Effects of maternal protein restriction on central and peripheral renin-angiotensin systems in male rat offspring.

AIMS: We investigated the involvement of the renin angiotensin system (RAS) on the cardiorespiratory control in rats from dams fed with a low-protein diet. MAIN METHODS: Male offspring were obtained from dams fed a normoprotein diet (NP, 17% casein) and low-protein diet (LP, 8% casein) during pregnancy and lactation. Direct measurements of arterial pressure (AP), heart rate (HR) and respiratory frequency (RF) were recorded in awake 90-day-old at resting and after losartan potassium through either intracerebroventricular (ICV) microinjections or intravenous (IV) administration. Cardiovascular variability was evaluated by spectral analysis. Peripheral chemoreflex sensitivity was assessed through the potassium cyanide (KCN; 40 µg/0.1 ml/rat, IV). Gene expression was evaluated by qPCR, and MAPK (Mitogen Activated Protein Kinase) expression was evaluated by western blot. KEY FINDINGS: The LP offspring had higher mean AP (MAP) and RF than NP offspring. In the spectral analysis, the LP rats also showed higher low frequency of systolic AP (NP: 2.7 ± 0.3 vs. LP: 5.0 ± 1.0 mmHg). After ICV losartan, MAP and RF in LP rats remained higher than those in NP rats, but without changes in HR. The peripheral chemoreflex was similar between the groups. LP group had lower gene expression of Rac1 (Ras-related C3 botulinum toxin substrate 1) (NP: 1.13 ± 0.06 vs. LP: 0.88 ± 0.08). Peripherally, LP rats had larger delta of MAP after IV losartan (NP: -9.8 ± 2 vs. LP: -23 ± 6 mmHg), without changes in HR and RF. SIGNIFICANCE: In rats, the RAS participates peripherally, but not centrally, in the maintenance of arterial hypertension in male offspring induced by maternal protein restriction.

Efeito do Diterpeno Manool sobre a Pressão Arterial e Reatividade Vascular em Ratos Normotensos e Hipertensos / Effect of Diterpene Manool on the Arterial Blood Pressure and Vascular Reactivity in Normotensive and Hypertensive Rats

Resumo Fundamento: Diversos estudos têm mostrado que as classes de diterpenos exercem efeito significativo no sistema cardiovascular. Os diterpenos, em particular, estão entre os principais compostos associados às propriedades cardiovasculares, como a propriedade vasorrelaxante, inotrópica, diurética e a atividade hipotensora. Embora o mecanismo de vasorrelaxamento do manool seja visível, seu efeito sobre a pressão arterial (PA) ainda é desconhecido. Objetivo: Avaliar o efeito hipotensor in vivo do manool e verificar o efeito de vasorrelaxamento ex vivo em anéis aórticos de ratos. Métodos: Os animais foram divididos aleatoriamente em dois grupos: normotensos e hipertensos. O grupo normotenso foi submetido à cirurgia sham e adotou-se o modelo 2R1C para o grupo hipertenso. Realizou-se monitoramento invasivo da PA para testes com manool em diferentes doses (10, 20 e 40 mg/kg). Foram obtidas curvas de concentração-resposta para o manool nos anéis aórticos, com endotélio pré-contraído com fenilefrina (Phe) após incubação com Nω-nitro-L-arginina metil éster (L-NAME) ou oxadiazolo[4,3-a]quinoxalina-1-ona (ODQ). Os níveis plasmáticos de óxido nítrico (NOx) foram medidos por ensaio de quimioluminescência. Resultados: Após a administração de manool, a PA se reduziu nos grupos normotenso e hipertenso, e esse efeito foi inibido pelo L-NAME em animais hipertensos apenas na dose de 10 mg/kg. O manool ex vivo promoveu vasorrelaxamento, inibido pela incubação de L-NAME e ODQ ou remoção do endotélio. Os níveis plasmáticos de NOx aumentaram no grupo hipertenso após a administração de manool. O manool induz o relaxamento vascular dependente do endotélio na aorta de ratos, mediado pela via de sinalização NO/cGMP e redução da PA, e também pelo aumento plasmático de NOx. Esses efeitos combinados podem estar envolvidos na modulação da resistência periférica, contribuindo para o efeito anti-hipertensivo do diterpeno. Conclusão: Esses efeitos em conjunto podem estar envolvidos na modulação da resistência periférica, contribuindo para o efeito anti-hipertensivo do diterpeno.

Abstract Background: Many studies have shown that the diterpenoid classes exert a significant effect on the cardiovascular system. Diterpenes, in particular, are among the main compound links to cardiovascular properties such as vasorelaxant, inotropic, diuretic and hypotensive activity. While the manool vasorelaxation mechanism is visible, its effect on blood pressure (BP) is still unknown. Objective: To evaluate the in vivo hypotensive effect of manool and check the ex vivo vasorelaxation effect in rat aortic rings. Methods: The animals were divided randomly into two groups: normotensive and hypertensive. The normotensive group was sham-operated, and the 2K1C model was adopted for the hypertensive group. Invasive BP monitoring was performed for manool tests at different doses (10, 20 and 40 mg/kg). Concentration-response curves for manool were obtained in the aorta rings, with endothelium, pre-contracted with phenylephrine (Phe) after incubation with Nω-nitro-L-arginine methyl ester(L-NAME) or oxadiazole [4,3-a]quinoxalin-1-one (ODQ). Nitric oxide (NOx) plasma levels were measured by chemiluminescence assay. Results: After manool administration, BP was reduced in normotensive and hypertensive groups, and this effect was inhibited by L-NAME in hypertensive animals only in 10 mg/kg dose. Ex vivo manool promoted vasorelaxation, which was inhibited by L-NAME and ODQ incubation or endothelium removal. NOx plasma levels increased in the hypertensive group after manool administration. Manool elicits endothelium-dependent vascular relaxation in rat aorta mediated by the NO/cGMP signaling pathway and BP reduction, also by NOx plasma increase. These combined effects could be involved in modulating peripheral resistance, contributing to the antihypertensive effect of diterpene. Conclusion: These effects together could be involved in modulating peripheral resistance, contributing to the antihypertensive effect of diterpene.

Occurrence and diversity of ciliated protozoa in the most commonly consumed leafy greens in Brazil: a qualitative study / Ocorrência e diversidade de protozoários ciliados nos vegetais folhosos mais consumidos no Brasil: um estudo qualitativo

Ciliated protozoa are an ubiquitous group of eukaryotes that have been poorly reported on leafy greens. The present study aimed to verify the occurrence and diversity of ciliated protozoa in the leaves and roots of three of the most commonly consumed leafy greens in Brazil – lettuce, rocket and coriander. The vegetable samples were washed by manual agitation (3 minutes) in two different media (mineral water and Page ́s Amoeba Saline solution). After washing, the contents were incubated in Petri dishes and aliquots were removed for microscopic identification and in vivo observation. A total of 21 ciliated protozoa species were found, most of which were bacterivorous. Leafy greens have commonly been associated with foodborne outbreaks and ciliated protozoa, which although they are not a Public Health concern, can act as “Trojan Horses” harboring bacteria, viruses and other protozoa cysts and oocysts and can suggest a new route towards microbiological quality related to the food chain. This is the first report of ciliated protozoa on leafy greens consumed in Brazil.

Os protozoários ciliados constituem um grupo onipresente de eucariotos pouco relatados em vegetais folhosos. O presente estudo teve como objetivo verificar a ocorrência e a diversidade de protozoários ciliados nas folhas e raízes de três dos vegetais folhosos mais consumidos no Brasil - alface, rúcula e coentro. As amostras de vegetais foram lavadas por agitação manual (3 minutos) em dois meios diferentes (água mineral e Solução Salina para Ameba). Após a lavagem, o conteúdo foi incubado em placas de Petri e alíquotas foram retiradas para identificação microscópica e observação in vivo dos organismos. Um total de 21 espécies de protozoários ciliados foi encontrado, a maioria das quais era bacterívora. Tais hortaliças têm sido comumente associadas a surtos transmitidos por alimentos e os protozoários ciliados que, embora não sejam um problema de saúde pública, podem atuar como “Cavalos de Tróia” ao abrigar bactérias, vírus além de cistos e oocistos de protozoários o que pode sugerir uma nova rota para a avaliação da qualidade microbiológica relacionada à cadeia alimentar. Este é o primeiro relato de protozoários ciliados em folhas verdes consumidas no Brasil.

Occurrence and diversity of ciliated protozoa in the most commonly consumed leafy greens in Brazil: a qualitative study

Ciliated protozoa are an ubiquitous group of eukaryotes that have been poorly reported on leafy greens. The present study aimed to verify the occurrence and diversity of ciliated protozoa in the leaves and roots of three of the most commonly consumed leafy greens in Brazil ­ lettuce, rocket and coriander. The vegetable samples were washed by manual agitation (3 minutes) in two different media (mineral water and Page ́s Amoeba Saline solution). After washing, the contents were incubated in Petri dishes and aliquots were removed for microscopic identification and in vivo observation. A total of 21 ciliated protozoa species were found, most of which were bacterivorous. Leafy greens have commonly been associated with foodborne outbreaks and ciliated protozoa, which although they are not a Public Health concern, can act as "Trojan Horses" harboring bacteria, viruses and other protozoa cysts and oocysts and can suggest a new route towards microbiological quality related to the food chain. This is the first report of ciliated protozoa on leafy greens consumed in Brazil. (AU)

Os protozoários ciliados constituem um grupo onipresente de eucariotos pouco relatados em vegetais folhosos. O presente estudo teve como objetivo verificar a ocorrência e a diversidade de protozoários ciliados nas folhas e raízes de três dos vegetais folhosos mais consumidos no Brasil - alface, rúcula e coentro. As amostras de vegetais foram lavadas por agitação manual (3 minutos) em dois meios diferentes (água mineral e Solução Salina para Ameba). Após a lavagem, o conteúdo foi incubado em placas de Petri e alíquotas foram retiradas para identificação microscópica e observação in vivo dos organismos. Um total de 21 espécies de protozoários ciliados foi encontrado, a maioria das quais era bacterívora. Tais hortaliças têm sido comumente associadas a surtos transmitidos por alimentos e os protozoários ciliados que, embora não sejam um problema de saúde pública, podem atuar como "Cavalos de Tróia" ao abrigar bactérias, vírus além de cistos e oocistos de protozoários o que pode sugerir uma nova rota para a avaliação da qualidade microbiológica relacionada à cadeia alimentar. Este é o primeiro relato de protozoários ciliados em folhas verdes consumidas no Brasil. (AU)