Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service / Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Resumo Introdução As doenças cardiovasculares (DCV) repre-sentam a principal causa de morte global, destacando-se em internações e gastos. Diante disso, é essencial compreender as principais DCV em pacientes admitidos em serviços de emergência hospitalar e a atuação do fisioterapeuta para planejamento e direcionamento dos serviços de saúde e para denotar a participação e incentivar formações fisioterapêuticas específicas no contexto da atenção terciária. Objetivo Traçar o perfil de emergências cardiovasculares e avaliar a atuação fisioterapêutica em pacientes adultos de serviço de emergência de um hospital no interior do estado de São Paulo. Métodos Trata-se de um estudo observacional, em que foram analisadas 1.256 fichas de passagem de plantão, no período de oito meses. Os dados coletados foram idade, sexo, hipótese diagnóstica cardiovascular e tratamento fisioterapêutico realizado. Resultados Foram incluídos 75 pacientes que apresentavam o perfil de emergências cardiovasculares, sendo as mais prevalentes: insuficiência cardíaca (n = 21), síndrome corona-riana aguda (n = 14), infarto agudo do miocárdio (n = 13), bradarritmia (n = 6) e crise hipertensiva (n = 5). Em relação à atuação fisioterapêutica e suas aplicações, as mais frequentes foram manejo da ventilação mecânica invasiva (n = 34), manobras de reexpansão pulmonar (n = 17), auxílio a intubação orotraqueal (n = 17), ventila-ção mecânica não invasiva (n = 14), manobras de higiene brônquica (n = 12), cinesioterapia (n = 10) e sedestação (n = 10). Conclusão A insuficiência cardíaca e a síndrome coronária aguda foram as doenças cardiovasculares que mais ocasionaram internação no serviço de emergência hospitalar e as condutas com ênfase no aparelho respiratório foram as mais aplicadas.

A multi-omics approach to understand the influence of polyphenols in ovarian cancer for precision nutrition: a mini-review.

The impact of polyphenols in ovarian cancer is widely studied observing gene expression, epigenetic alterations, and molecular mechanisms based on new 'omics' technologies. Therefore, the combination of omics technologies with the use of phenolic compounds may represent a promising approach to precision nutrition in cancer. This article provides an updated review involving the current applications of high-throughput technologies in ovarian cancer, the role of dietary polyphenols and their mechanistic effects in ovarian cancer, and the current status and challenges of precision nutrition and their relationship with big data. High-throughput technologies in different omics science can provide relevant information from different facets for identifying biomarkers for diagnosis, prognosis, and selection of specific therapies for personalized treatment. Furthermore, the field of omics sciences can provide a better understanding of the role of polyphenols and their function as signaling molecules in the prevention and treatment of ovarian cancer. Although we observed an increase in the number of investigations, there are several approaches to data acquisition, analysis, and integration that still need to be improved, and the standardization of these practices still needs to be implemented in clinical trials.

Variation of modulation and expression of biomarkers associated with inflammation in bariatric surgery patients: A systematic review and meta-analysis.

BACKGROUND: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery. METHODS: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I2 statistic was used to assess heterogeneity between studies. RESULTS: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I2 = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I2 = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I2 = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I2 = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I2 = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index. CONCLUSION: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months.

Oligosymptomatic long-term carriers of SARS-CoV-2 display impaired innate resistance but increased high-affinity anti-spike antibodies.

The vast spectrum of clinical features of COVID-19 keeps challenging scientists and clinicians. Low resistance to infection might result in long-term viral persistence, but the underlying mechanisms remain unclear. Here, we studied the immune response of immunocompetent COVID-19 patients with prolonged SARS-CoV-2 infection by immunophenotyping, cytokine and serological analysis. Despite viral loads and symptoms comparable to regular mildly symptomatic patients, long-term carriers displayed weaker systemic IFN-I responses and fewer circulating pDCs and NK cells at disease onset. Type 1 cytokines remained low, while type-3 cytokines were in turn enhanced. Of interest, we observed no defects in antigen-specific cytotoxic T cell responses, and circulating antibodies displayed higher affinity against different variants of SARS-CoV-2 Spike protein in these patients. The identification of distinct immune responses in long-term carriers adds up to our understanding of essential host protective mechanisms to ensure tissue damage control despite prolonged viral infection.

Prescribing errors in a Brazilian teaching hospital: Causes and underlying factors from the perspective of junior doctors.

INTRODUCTION: In university hospital settings most prescriptions are written by junior doctors, who are more likely to make prescribing errors than experienced doctors. Prescribing errors can cause serious harm to patients and drug harm differs among low, middle and high-income countries. In Brazil, few studies have investigated the causes of these errors. Our aim was to explore medication prescribing errors in a teaching hospital, their causes, and underlying factors from the perspective of junior doctors. METHOD: Qualitative, descriptive and exploratory study that used a semi-structured individual interview with questions related to the planning and execution of prescriptions. It was conducted with 34 junior doctors who graduated from twelve different universities located in six Brazilian states. The data were analyzed according to the Reason's Accident Causation model. RESULTS: Among the 105 errors reported, medication omission stood out. Most errors resulted from unsafe acts during execution, followed by mistakes and violations. Many errors reached the patients; unsafe acts of rule violations and slips accounted for the majority. Work overload and time pressure were the most frequently reported causes. Difficulties faced by the National Health System and organizational problems were identified as latent conditions. CONCLUSION: The results reaffirm international findings about the severity of prescribing errors and the multifactorial aspect of their causes. Unlike other studies, we found a large number of violations, which, from the interviewees' perspectives, are related to socioeconomic and cultural patterns. The violations were not seen or mentioned by the interviewees as violations, but as difficulties in accomplishing their tasks on time. Knowing these patterns and perspectives is important for implementing strategies to improve the safety of both patients and professionals involved in the medication process. It is suggested that the exploitation culture of junior doctors' work be discouraged and that their training be improved and prioritized.

MiR-495-3p regulates cell migration and invasion in papillary thyroid carcinoma.

Background: Papillary thyroid carcinoma (PTC) is the most prevalent histotype of thyroid cancer and the presence of BRAFV600E mutation in these tumors is related to the malignancy and prognosis of the disease. In recent years attention has been focused on the role of microRNAs in the biology of PTC cells, especially in their role in the modulation of pathways related to tumorigenesis. DLK1-DIO3-derived miRNAs have been shown to play important roles in tumor context and are globally downregulated in PTC. Methods: Based on a previous in silico target prediction and gene enrichment analysis, we identified miR-495-3p as the candidate with the highest tumor suppressor potential role in PTC among DLK1-DIO3-derived miRNAs. We used bioinformatics and an in vitro model of miR-495-3p overexpression to further understand the influence of this molecule on the tumorigenic processes of PTC. Results: Overexpression of miR-495-3p impaired cell migration and invasion of PTC cells harboring the BRAFV600E mutation and affected the expression of targets predicted in the bioinformatic analysis, such as TGFB2, EREG and CCND1. Conclusion: Overall, our results indicate that the loss of miR-495-3p expression during PTC development might play an important role in its progression.

Análise da segurança do paciente na maternidade no contexto da pandemia de COVID-19 na perspectiva de profissionais de saúde / Analysis of patient safety in the maternity ward in the context of the COVID-19 pandemic from the perspective of health professionals

ALVES, L. Análise da segurança do paciente na maternidade no contexto da pandemia de COVID-19 na perspectiva de profissionais de saúde. 2023. Dissertação (Mestrado) - Universidade Federal de Minas Gerais, Belo Horizonte, 2023. Introdução: a segurança do paciente (SP) é compreendida como a capacidade de reduzir, a um mínimo aceitável, o risco de dano desnecessário à saúde. Nos últimos 30 anos, o Brasil exibiu profundas mudanças em diferentes áreas da assistência à saúde, impactando a segurança do cuidado a mulheres e bebês. Os avanços evidenciados na assistência obstétrica contribuíram para a melhoria dos indicadores de morbimortalidade materna e perinatais em todo o mundo. A pandemia de COVID-19 mostrou-se um complicador para o cuidado à saúde materna e neonatal seguro. O Brasil ocupou o maior número de óbitos maternos das Américas por COVID-19. Esse contexto apresentou reflexos importantes na organização dos serviços de saúde, incluindo as maternidades. Estudos evidenciam a importância da SP na qualidade da assistência prestada pelos serviços obstétricos. No entanto, observa-se escassez de estudos que se propõem analisar o processo da SP na maternidade no contexto da pandemia de COVID-19 na perspectiva de profissionais de saúde. Objetivo geral: analisar a SP na maternidade no contexto da pandemia de COVID-19 na perspectiva de profissionais de saúde. Objetivos específicos: compreender o significado da SP para os profissionais de saúde; descrever como os profissionais de saúde vivenciaram a busca pela SP no contexto da pandemia de COVID-19; avaliar a SP na maternidade no contexto da pandemia de COVID-19 na perspectiva de profissionais de saúde, considerando a estrutura, o processo e os resultados alcançados; descrever aspectos facilitadores e dificultadores para a promoção da SP na maternidade no contexto da pandemia de COVID-19. Metodologia: trata-se de um estudo de caso de abordagem qualitativa que adotou a tríade estrutura, processo e resultado de Avedis Donabedian como fundamentação teórica. A coleta de dados foi realizada por meio de entrevistas presenciais com roteiro semiestruturado e observação em campo em uma maternidade de um hospital metropolitano de Belo Horizonte/Minas Gerais. Os critérios de inclusão adotados foram o profissional de saúde ser integrante da equipe da maternidade e atuar na assistência ou gestão de março de 2020 a abril de 2022. O critério de exclusão adotado foi a interrupção da entrevista pelo profissional. Os dados qualitativos foram analisados a partir da análise temática reflexiva, conforme proposta por Braun e Clark, com suporte do software MAXQDA®. Foram seguidas as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos, conforme Resoluções no 466/12 e no 510/2016. Resultados: participaram 27 profissionais de saúde, sendo dois gestores e 25 profissionais de saúde da assistência da maternidade. A pandemia de COVID-19 proporcionou mudanças na organização da estrutura, do processo e resultado da maternidade. A compreensão dos participantes sobre SP vincula-se às metas internacionais de SP e vai ao encontro do conceito de SP da Organização Mundial da Saúde. Em relação à estrutura, a estrutura física foi apresentada de forma negativa e considerada um grande desafio. A cultura institucional de SP foi apontada como um aspecto de relevância positiva na instituição. A sobrecarga dos profissionais de saúde participantes ficou evidente. Em relação ao processo, a existência de educação permanente em saúde, a discussão dos protocolos e a maior atenção aos riscos foram ressaltados. Em relação aos resultados, o reconhecimento da importância da SP, o aprendizado da COVID-19 para o cuidado, o trabalho em equipe e a avaliação dos indicadores assistenciais foram os principais pontos de destaque. Os aspectos facilitadores mencionados para a promoção da SP foram oferta e uso de equipamentos de proteção individual, atualização de protocolos, cultura de SP, trabalho em equipe, protagonismo do paciente em sua segurança, melhora da comunicação e reorganização dos fluxos. Os principais aspectos dificultadores apresentados foram área física inadequada, absenteísmo dos profissionais, mudanças nos fluxos e protocolos, dificuldade em orientar pacientes e acompanhantes e sentimentos despertados nos profissionais. As principais estratégias apontadas pelos participantes foram a disponibilidade e o estímulo ao uso correto de máscara, o isolamento adequado, a triagem universal para COVID-19, a reorganização de fluxos de atendimento e a capacitação/discussão de protocolos. Conclusão: identificou-se que o contexto da pandemia de COVID-19 apresentou mudanças na organização da estrutura, do processo e do resultado da maternidade. Para os profissionais de saúde da maternidade, a estrutura física apresentou-se de forma negativa para prestar um cuidado seguro. Organizar fluxos de atendimento a mulheres e bebês foi necessário para garantir a segurança das pacientes e criar novos protocolos. Discutir sobre os mesmos se tornou frequente e indispensável. Trabalhar em equipe foi tratado como primordial, e o papel do gestor de saúde foi atribuído como essencial para o desenvolvimento de processos de trabalho seguros. E a atuação efetiva do Núcleo de Segurança do Paciente, a sobrecarga dos profissionais de saúde e o sofrimento psíquico ficaram evidentes. Palavras-chave: segurança do paciente; pessoal de saúde; maternidades; COVID-19; enfermagem.

Introduction: patient safety (PS) is understood as the ability to reduce, to an acceptable minimum, the risk of unnecessary harm to health. Over the last 30 years, Brazil has exhibited profound changes in different areas of health care, impacting the safety of care for women and babies. Advances in obstetric care have contributed to improving maternal and perinatal morbidity and mortality indicators across the world. The COVID-19 pandemic proved to be a complicating factor for safe maternal and neonatal health care. Brazil had the highest number of maternal deaths in the Americas due to COVID-19. This context had important consequences for the organization of health services, including maternity wards. Studies highlight the importance of PS in the quality of care provided by obstetric services. However, there is a lack of studies that propose to analyze the PS process in maternity hospitals in the context of the COVID-19 pandemic from health professionals' perspective. General objective: to analyze PS in maternity hospitals in the context of the COVID-19 pandemic from health professionals' perspective. Specific objectives: to understand the meaning of PS for health professionals working in maternity wards; to describe how health professionals working in the maternity ward experienced the search for PS in the context of the COVID-19 pandemic; to assess PS in maternity hospitals in the context of the COVID19 pandemic from health professionals' perspective, considering the structure, process and results achieved; to describe facilitating and hindering aspects for promoting PS in maternity hospitals in the context of the COVID-19 pandemic. Methodology: this is a case study with a qualitative approach that adopted Avedis Donabedian's triad, structure, process and result, as a theoretical framework. Data collection was carried out through on-site interviews with a semi-structured script and field observation in a maternity ward of a metropolitan hospital in Belo Horizonte/Minas Gerais. The inclusion criteria adopted were that the health professional was a member of the maternity team and worked in care or management from March 2020 to April 2022. The exclusion criterion adopted was the interruption of the interview by the professional. Qualitative data were analyzed using reflective thematic analysis, as proposed by Braun and Clark, with support from the MAXQDA® software. The guidelines and regulatory standards for research involving human beings were followed, in accordance with Resolutions 466/12 and 510/2016. Results: A total of 27 health professionals participated, including two managers and 25 health professionals from maternity care during the COVID-19 pandemic. The COVID-19 pandemic led to changes in the organization of maternity hospitals' structure, process and results. Participants' understanding of PS is linked to international PS goals and is in line with the World Health Organization's concept of PS. In relation to structure, physical structure was presented in a negative way and considered a major challenge. PS' institutional culture was highlighted as an aspect of positive relevance in the institution. Participating health professionals' overload was evident. In relation to process, the existence of ongoing health education, discussion of protocols and greater attention to risks were highlighted. In relation to results, the recognition of the importance of PS, learning about COVID-19 for care, teamwork and assessment of care indicators were the main highlights. The facilitating aspects mentioned for promoting PS were supply and use of personal protective equipment, updating protocols, PS culture, teamwork, patient leadership in their safety, improved communication and reorganization of flows. The main hindering aspects presented were inadequate physical area, absences and absences of professionals, changes in flows and protocols, difficulty in guiding patients and companions and feelings aroused in professionals. The main strategies highlighted by participants were the availability and encouragement of correct use of masks, adequate isolation, universal screening for COVID-19, reorganization of care flows and training/discussion of protocols. Conclusion: it was identified that the context of the COVID-19 pandemic presented changes in the organization of maternity hospitals' structure, process and results. For maternity health professionals, physical structure was detrimental to providing safe care. Organizing care flows for women and babies was necessary to ensure patient safety and create new protocols. Discussing them has become frequent and indispensable. Working as a team was treated as essential, and health managers' role was considered essential for developing safe work processes. And the effective Patient Safety Center's performance, health professional overload and psychological distress were evident.

A saúde mental da enfermagem de Unidade Básica de Saúde em tempos de pandemia / The mental health of Basic Health Unit nurses in times of pandemic

Objetivo: Conhecer a saúde mental dos profissionais de enfermagem de uma Unidade Básica de Saúde exclusiva para pacientes com COVID-19 no Município de Boa vista, Roraima. Métodos: Trata-se de um estudo exploratório e descritivo, de abordagem qualitativa e quantitativa,realizado com 19 profissionais da enfermagem. Os dados foram coletados entre os meses de abril e junho de 2022, por intermédio de um roteiro semiestruturado de 21 perguntas mistas. As entrevistas foram analisadas a partir do método de Bardin e as variáveis quantitativas submetidas ao Statistical Package for the Social Sciences (SPSS) versão 23.0. Resultados: Evidenciou-se a questão dos fatores estressores que interferem na saúde mental, associados a atividade laboral durante pandemia de COVID-19. Esses fatores tiveram como consequência a prevalência de alterações psicológicas como medo, insegurança, ansiedade e estresse. Em relação aos diagnósticos de transtornos mentais, ansiedade e depressão foram os que se sobressaíram. A atividade física, o acompanhamento psicoterápico e a religião foram as medidas de enfrentamento adotadas pelos profissionais entrevistados. Conclusão: No transcorrer da pandemia e durante a prática laboral, os profissionais do estudo foram expostos a vários fatores estressores,desenvolveram patologias psicológicas, mas buscaram manter algum nível de saúde mental. Descritores: COVID-19. Saúde Mental. Enfermagem.

Objective: To know the mental health of nursing professionals from a Basic Health Unit exclusively for patients with COVID-19 in the municipality of Boa Vista, Roraima. Methods: This is an exploratory and descriptive study, with a qualitative and quantitative approach, carried out with 19 nursing professionals. The data was collected between April and June 2022, using a semi-structured script of 21 mixed questions. The interviews were analyzed using Bardin's method and the quantitative variables were submitted to the Statistical Package for the Social Sciences (SPSS) version 23.0. Results: The issue of stressors that interfere with mental health, associated with work activity during the COVID-19 pandemic, became evident. These factors had as a consequence the prevalence of psychological alterations such as fear, insecurity, anxiety,and stress. Concerningthe diagnoses of mental disorders, anxiety and depression were the ones that stood out. Physical activity, psychotherapy,and religion were the coping measures adoptedby the professionals interviewed.Conclusion: During the pandemic and their work practice, the professionals in this study were exposed to various stressors, developed psychological pathologies, but sought to maintain some level of mental health. Descriptors: COVID-19. Mental Health. Nursing.

Brazilian Berry Extract Differentially Induces Inflammatory and Immune Responses in Androgen Dependent and Independent Prostate Cancer Cells.

Jaboticaba is a Brazilian berry, which is rich in fibers and bioactive compounds and shows high antioxidant and antiproliferative activities. Prostate cancer (PCa) is the second most common type of cancer among men and its progression is influenced by androgens and inflammation. Previous studies reported the ability of the jaboticaba to modulate pathways involved in prostate diseases. The main objective of this study was to provide significant data about molecular targets of the jaboticaba peel extract (JPE) and its mechanisms of action in PCa cell lines with different androgenic status (LNCaP and PC-3). The results showed that JPE was able to decrease cell viability in both cell lines. LNCaP showed more sensitivity to JPE exposure, indicating the efficacy of the JPE treatment in terms of androgen responsiveness. JPE showed a distinct hormone dependent effect on the NF-κB signaling, with reduced NF-κB levels for LNCaP and increased NF-κB levels in PC-3 cells. Mechanisms related to cell death by apoptosis were stimulated after the JPE treatment, modulating B-cell lymphoma 2 and BAX for LNCaP and PC-3. Particularly for PC-3, the JPE treatment resulted in cytokine-cytokine receptor interaction activation mostly by up regulating pro-inflammatory, pro-angiogenic, immunostimulatory and immunosuppressive genes. Also, a set of genes related to angiogenesis and metastasis were down-regulated by JPE. In conclusion, JPE exerted an antitumor effect on PCa for both cell lines which can be enhanced if androgenic reliance is considered.

A assistência de enfermagem no centro cirúrgico: Cuidado humanizado e científico / Asistencia de enfermería en el centro quirúrgico: Atención humanizada y científica / Nursing assistance in the surgical center: Humanized and scientific care

Objetivo: Relatar a assistência de enfermagem no centro cirúrgico na perspectiva do cuidado humanizado. Método: É um estudo de revisão sistemática da literatura, onde foram utilizados elementos da estratégia PICO, mediante perguntas norteadoras. Foram selecionados artigos nos bancos de dados online LILACS, MEDLINE e SciELO, realizada no mês de março de 2022 e destes, 10 artigos foram escolhidos para nossa pesquisa. Resultados: A literatura aponta a importância do acolhimento no centro cirúrgico de maneira humanizada, como modo de acolher os usuários de forma holística, proporcionando assim, uma relação de confiança. Observou-se também algumas ações que tornam a prática de humanização falha pelos profissionais: a sobrecarga de trabalho, exigências burocráticas, alta rotatividade dos usuários. Conclusão: Conclui-se que a prática da humanização no centro cirúrgico ofertada pela equipe multidisciplinar oferece ao paciente mais segurança, acolhimento e um olhar holístico, favorecendo a confiança e a proximidade com esses profissionais.(AU)

Objective: To report the nursing care in the surgical center from the perspective of humanized care. Method: This is a systematic literature review study, where elements of the PICO strategy were used, through guiding questions. Articles were selected in the online databases LILACS, MEDLINE and SciELO, held in March 2022 and of these, 10 articles were chosen for our research. Results: The literature points to the importance of welcoming in the surgical center in a humanized way, as a way of welcoming users in a holistic way, thus providing a relationship of trust. It was also observed some actions that make the practice of humanization fail by professionals: work overload, bureaucratic requirements, high user turnover. Conclusion: It is concluded that the practice of humanization in the surgical center offered by the multidisciplinary team offers the patient more security, reception and a holistic view, favoring trust and proximity to these professionals.(AU)

Objetivo: Relatar el cuidado de enfermería en el centro quirúrgico bajo la perspectiva del cuidado humanizado. Método: Se trata de un estudio de revisión sistemática de la literatura, donde se utilizaron elementos de la estrategia PICO, a través de preguntas orientadoras. Se seleccionaron artículos en las bases de datos en línea LILACS, MEDLINE y SciELO, realizadas en marzo de 2022 y de estos, 10 artículos fueron elegidos para nuestra investigación. Resultados: La literatura señala la importancia de la acogida en el centro quirúrgico de forma humanizada, como forma de acoger a los usuarios de forma holística, propiciando así una relación de confianza. También se observaron algunas acciones que hacen fracasar la práctica de la humanización por parte de los profesionales: sobrecarga de trabajo, requisitos burocráticos, alta rotación de usuarios. Conclusión: Se concluye que la práctica de humanización en el centro quirúrgico ofrecida por el equipo multidisciplinario ofrece al paciente más seguridad, acogida y una visión holística, favoreciendo la confianza y cercanía con estos profesionales.(AU)

SARS-CoV-2 Infection and Possible Neonatal Neurological Outcomes: A Literature Review.

The virus responsible for COVID-19 is designated "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), a highly transmissible and pathogenic coronavirus. Although people of all ages are susceptible to SARS-CoV-2 infection, clinical manifestations may vary with age. The response of neonates to SARS-CoV-2 infection or exposure differs from that of children and adults. Encephalitis due to viral infections in the central nervous system (CNS) and childhood multisystem inflammatory syndrome (MIS-C) are some of the possible neonatal consequences of SARS-CoV-2 infection. This review aims to verify possible neonatal neurological outcomes after SARS-CoV-2 infection. Overall, the cellular and molecular basis of the neurological sequelae of SARS-CoV-2 in neonates remains unclear, and attempts to elucidate the pathophysiology of COVID-19 involve a comparison with the mechanism of other viral diseases. There are a considerable number of case reports in the literature exploring neurological outcomes in the neonatal period. In this review, we present possible effects of SARS-CoV-2 in neonates, emphasizing the importance of monitoring this group. The mechanisms of SARS-CoV-2 entry into the CNS have not yet been fully elucidated, and the potential severity of SARS-CoV-2 infection in neonates, as well as the possible short- and long-term neurological sequelae, remain unclear.

According to Revised EWGSOP Sarcopenia Consensus Cut-Off Points, Low Physical Function Is Associated With Nutritional Status and Quality of Life in Maintenance Hemodialysis Patients.

OBJECTIVE: The aim of this study is to assess the association of nutritional status and quality of life with low physical function, according to the revised European Working Group on Sarcopenia in Older People (EWGSOP) - sarcopenia consensus cut-offs in maintenance hemodialysis patients. DESIGN AND METHODS: This is a cross-sectional study including patients on maintenance hemodialysis. Participants were submitted to a single evaluation of physical function, nutritional status, and quality of life. Handgrip strength, Short Physical Performance Battery (SPPB), sit-to-stand test, and gait speed were performed to evaluate physical function. Cut-offs proposed by the revised EWGSOP consensus were considered. Malnutrition Inflammation Score was used to assess nutritional status. Quality of life was assessed by the 36-Item Short Form Health Survey. RESULTS: Seventy-seven patients were enrolled, 64.9% male, mean age 55 ± 14 years. According to the cut-offs proposed by the most recent EWGSOP consensus, 55.8% of patients presented SPPB <8, 48.1% gait speed test ≤0.8 m/seconds, sit-to-stand test >15 seconds, and 39.0% handgrip strength <27 kg and <16 kg for men and women, respectively. Malnutrition Inflammation Score was significantly associated with all physical function parameters, except gait speed, in receiver operating characteristic curve and logistic regression. The 36-Item Short Form Health Survey domains or component summary were associated with SSPB, gait speed, and handgrip strength in logistic regression. CONCLUSION: Poor nutritional status and quality of life are associated with low physical function (according to the cut-offs proposed by EWGSOP) in hemodialysis patients.

Perfil sociodemográfico e de dependência química dos usuários de um Centro de Atenção Psicossocial especializado / Sociodemographic and chemical-dependency profile of users at a specialized Psychosocial Care Center / Perfil sociodemográfico y de dependencia química de los usuarios de un Centro de Atención Psicosocial especializado

OBJETIVO: identificar o perfil sociodemográfico e de dependência química dos usuários de um Centro de Atenção Psicossocial Álcool e Outras Drogas. MÉTODO: estudo transversal e retrospectivo realizado por meio de consulta a 360 prontuários. RESULTADOS: a maioria dos usuários era do sexo masculino (91,1%; n = 328), analfabeta/Ensino Fundamental (70,8%; n = 255), vivia sem companheira(o) (76,9%; n = 277) e morava na zona urbana (63,3%; n = 228). O uso simultâneo de múltiplas drogas foi encontrado em 43,5% (n = 157) e a dependência exclusiva de álcool em 40,4% (n = 146). CONCLUSÃO: evidenciou-se predomínio de homens solteiros com baixa escolaridade e em dependência de múltiplas drogas e/ou de álcool. Esse conhecimento é relevante para propostas de estratégias baseadas em evidências.

OBJECTIVE: to identify the sociodemographic and chemical-dependency profile of users at a Psychosocial Care Center - Alcohol and Other Drugs. METHOD: a retrospective and cross-sectional study carried out by referring to 360 medical records. RESULTS: the majority of users were males (91.1%, n = 328), illiterate/Elementary School (70.8%, n = 255), without a partner (76.9%, n = 277), and lived in urban areas (63.3%, n = 228). Simultaneous use of multiple drugs was found in 43.5% (n = 157) and exclusive alcohol dependency in 40.4% (n = 146). CONCLUSION: the predominance of single men with low schooling and dependency on multiple drugs and/or alcohol was found. This knowledge is relevant to evidence-based strategy proposals.

OBJETIVO: identificar el perfil sociodemográfico y de dependencia química de los usuarios de un centro de atención psicosocial alcohol y otras drogas. MÉTODO: estudio retrospectivo y transversal realizado por medio de consulta a 360 prontuarios. RESULTADOS: la mayoría de los usuarios eran del sexo masculino (91,1%, n = 328), analfabeto/enseñanza fundamental (70,8%, n = 255), vivía sin compañera (76,9%; n = 277) y vivía en la zona urbana (63,3%, n = 228). El uso simultáneo de múltiples drogas se encontró en el 43,5% (n = 157) y la dependencia exclusiva de alcohol en el 40,4% (n = 146). CONCLUSIÓN: se evidenció predominio de hombres solteros con baja escolaridad y en dependencia de múltiples drogas y/o de alcohol. Este conocimiento es relevante para propuestas de estrategias basadas en evidencias.

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Due to the poor outcomes associated with the impairment of physical function and muscle strength in patients on maintenance dialysis, it is important to understand the factors that may influence physical function and muscle strength. The aim of this study was to explore the factors associated with physical function in hemodialysis and peritoneal dialysis patients. METHODS: Patients with chronic kidney disease on dialysis for at least 3 months, aged 18 years old or above, were enrolled. Physical function was assessed by handgrip strength, gait and sit-to-stand tests, and the Short Physical Performance Battery (SPPB). Clinical and laboratory data were collected to verify the association with physical function parameters through binary logistic regression. RESULTS: One-hundred ninety patients on maintenance dialysis were included; 140 patients (73.7%) on hemodialysis and 50 (26.3%) on peritoneal dialysis. The mean age was 57.3 ± 14.9 years, 109 (57.4%) were male, and 87 (45.8%) were older than 60 years. The median SPPB was 8.0 points (6.0-10.0 points) and the mean ± standard deviation of handgrip strength was 24.7 ± 12.2 kg. Binary logistic regression showed that age, type of renal replacement therapy, diabetes mellitus, and serum creatinine were significantly associated with both higher 4-meter gait test times and lower SPPB scores. Only age and diabetes mellitus were associated with higher sit-to-stand test times, while age and ferritin were associated with lower handgrip strength. CONCLUSION: Age, diabetes mellitus, serum creatinine, and hemodialysis modality are factors related to physical function in dialysis patients.

Intestinal obstruction following gastric bypass.

PURPOSE: To draw the attention of the medical community to a differential diagnosis of intestinal obstruction due to bezoar in the late postoperative period of gastric bypass that requires diagnosis and emergency management. METHODS: We report 8 cases of patients with intestinal obstruction due to bezoar in the late postoperative period of gastric bypass who required surgical intervention. CONCLUSION: Intestinal obstruction due to fruit pomace is a late complication that may require urgent surgical intervention and should be considered in the differential diagnosis.

Vitamin B12 supplementation orally and intramuscularly in people with obesity undergoing gastric bypass.

PURPOSE: Although bariatric surgery can facilitate weight loss and improve many diseases, it impairs the absorption of many vitamins and micronutrients. Vitamin B12 is important for these patients and should be controlled and supplemented postoperatively. The aim of this paper is to compare serum vitamin B12 levels in two forms of supplementation (oral vs. intramuscular) for 6 months after gastric bypass. METHODS: In a prospective controlled cohort study, people with obesity patients undergoing gastric bypass received vitamin B12 supplementation either orally or intramuscularly. The patients were followed for 6 months, receiving serial doses of vitamin B12 and methylmalonic acid assessment at 6 months. RESULTS: A total of 53 patients were divided into two homogeneous groups: an oral group (n=24) and an intramuscular group (n=29). Serum vitamin B12 was measured preoperatively and postoperatively at 1, 2, 3, and 6 months. Serum methylmalonic acid was measured at 6 months. At each point, the serum vitamin B12 level remained within reference values in both groups, although it was higher in the oral group (p<0.001). Methylmalonic acid also remained within reference values in both groups, with no significant differences. CONCLUSION: Despite the anatomical and functional alterations that impair vitamin B12 absorption after gastric bypass, oral vitamin B12 supplementation was as effective as intramuscular in this population.

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life.

BACKGROUND: The term sepsis is used to designate a systemic condition of infection and inflammation associated with hemodynamic changes that result in organic dysfunction. Gestational sepsis can impair the development of the central nervous system and may promote permanent behavior alterations in the offspring. The aim of our work was to evaluate the effects of maternal sepsis on inflammatory cytokine levels and synaptic proteins in the hippocampus, neocortex, frontal cortex, and cerebellum of neonatal, young, and adult mice. Additionally, we analyzed the motor development, behavioral features, and cognitive impairments in neonatal, young and adult offspring. METHODS: Pregnant mice at the 14th embryonic day (E14) were intratracheally instilled with saline 0.9% solution (control group) or Klebsiella spp. (3 × 108 CFU) (sepsis group) and started on meropenem after 5 h. The offspring was sacrificed at postnatal day (P) 2, P8, P30, and P60 and samples of liver, lung, and brain were collected for TNF-α, IL-1ß, and IL-6 measurements by ELISA. Synaptophysin, PSD95, and ß-tubulin levels were analyzed by Western blot. Motor tests were performed at all analyzed ages and behavioral assessments were performed in offspring at P30 and P60. RESULTS: Gestational sepsis induces a systemic pro-inflammatory response in neonates at P2 and P8 characterized by an increase in cytokine levels. Maternal sepsis induced systemic downregulation of pro-inflammatory cytokines, while in the hippocampus, neocortex, frontal cortex, and cerebellum an inflammatory response was detected. These changes in the brain immunity were accompanied by a reduction of synaptophysin and PSD95 levels in the hippocampus, neocortex, frontal cortex, and cerebellum, in all ages. Behavioral tests demonstrated motor impairment in neonates, and depressive-like behavior, fear-conditioned memory, and learning impairments in animals at P30 and P60, while spatial memory abilities were affected only at P60, indicating that gestational sepsis not only induces an inflammatory response in neonatal mouse brains, but also affects neurodevelopment, and leads to a plethora of behavioral alterations and cognitive impairments in the offspring. CONCLUSION: These data suggest that maternal sepsis may be causatively related to the development of depression, learning, and memory impairments in the litter.

Pharmacokinetic properties of tramadol and M1 metabolite in Northeast Brazilian donkeys (Equus asinus).

There is currently little information available on the pharmacokinetics and pharmacodynamics of the analgesic opioid tramadol when used in the veterinary medicine of domestic species. In this study, we aimed to determine the pharmacokinetics of tramadol and its active metabolite M1 following intravenous administration of 2 (T2) and 4 (T4) mg/kg to Northeast Brazilian donkeys. Tramadol and M1 plasma levels were quantified using a validated liquid chromatography-tandem mass spectrometry method. We found that plasma levels of tramadol and M1 were higher than those reported as clinically meaningful in humans for at least 3 hr. However, the pharmacokinetic parameter calculation corrected by dose analysis identified no proportional increase with dose for the AUC of tramadol (T2: 2,663 ± 1,827 vs. T4: 2,964 ± 1,038 ng*h/ml) and M1 (T2: 378 ± 237 vs. T4: 345 ± 142 ng*h/ml). This finding appears to be attributable to a significant increase in clearance and a reduction in the terminal half-life of tramadol. The frequency of adverse effects observed at the higher dose indicates that 2 mg/kg administered intravenously would be suitable for donkeys. Clinical studies are required to determine the implications of these observations regarding the pharmacodynamic response to tramadol in Northeast Brazilian donkeys.

Bariatric patient's body composition: An option to BMI?

BACKGROUND: Bariatric surgery is one of the best treatments for obesity. This indication includes an evaluation of body mass index (BMI) that does not consider the body composition of an individual. AIM: To determine the body composition of bariatric surgery candidates. METHODS: Patients treated at a tertiary care centre for obesity were evaluated. Body composition was measured by bioelectrical impedance analysis (BIA). All measures of BIA and surgical indication were analysed. RESULTS: We evaluated 407 subjects, 87 (21.4%) men, with a mean age of 36 years. In men with indications for bariatric surgery, the mean ± SD body fat percentage (%BF) was 45.1 ± 5.39%, and the mean ± SD visceral fat area was 243.6 ± 33.79 cm2. In women with indications for bariatric surgery, the mean ± SD %BF was 50.7 ± 3.3%, and the mean ± SD visceral fat area was 241.7 ± 24.77 cm2. CONCLUSION: This study showed different body compositions between men and women and parameters of %BF and visceral fat area evaluated by BIA.

Mitochondrial Reactive Oxygen Species Participate in Signaling Triggered by Heme in Macrophages and upon Hemolysis.

Hemolysis causes an increase of intravascular heme, oxidative damage, and inflammation in which macrophages play a critical role. In these cells, heme can act as a prototypical damage-associated molecular pattern, inducing TLR4-dependent cytokine production through the MyD88 pathway, independently of TRIF. Heme promotes reactive oxygen species (ROS) generation independently of TLR4. ROS and TNF production contribute to heme-induced necroptosis and inflammasome activation; however, the role of ROS in proinflammatory signaling and cytokine production remains unknown. In this study, we demonstrate that heme activates at least three signaling pathways that contribute to a robust MAPK phosphorylation and cytokine expression in mouse macrophages. Although heme did not induce a detectable Myddosome formation, the TLR4/MyD88 axis was important for phosphorylation of p38 and secretion of cytokines. ROS generation and spleen tyrosine kinase (Syk) activation induced by heme were critical for most proinflammatory signaling pathways, as the antioxidant N-acetyl-l-cysteine and a Syk inhibitor differentially blocked heme-induced ROS, MAPK phosphorylation, and cytokine production in macrophages. Early generated mitochondrial ROS induced by heme was Syk dependent, selectively promoted the phosphorylation of ERK1/2 without affecting JNK or p38, and contributed to CXCL1 and TNF production. Finally, lethality caused by sterile hemolysis in mice required TLR4, TNFR1, and mitochondrial ROS, supporting the rationale to target these pathways to mitigate tissue damage of hemolytic disorders.