Pheochromocytoma/Paraganglioma (PPGL): A Misdiagnosed Cause of Hypertension during Pregnancy.

Hypertension (HT) during pregnancy is not an infrequent obstetric problem, reaching a prevalence of 5-10%. This condition is highly associated with both maternal and fetal complications if not precisely diagnosed and managed. Even though primary HT, obesity, and preeclampsia are the main causes of HT in this period, other less familiar conditions must be considered during the investigation. Pheochromocytoma and paraganglioma (PPGL) are chromaffin cell tumors that produce, store, and secrete catecholamines, leading to HT and other adrenergic manifestations. Recognition of PPGL is crucial since misdiagnosis and improper management can lead to high morbidity and mortality, particularly during pregnancy. We report on two cases of PPGL diagnosed during pregnancy with different managements. Case 1 is a 25-year-old female at 31 weeks of first pregnancy, whose severe HT and life-threatening symptoms prompted an emergency delivery without previous confirmation or medical treatment of a suspected PPGL. After confirmation, a right adrenal PPGL was surgically resected 4 months later, following 15 days of medical therapy. Case 2 is a 22-year-old female at 18 weeks of pregnancy whose symptomatic PPGL was resected in the second trimester. A next-generation sequencing panel, including 23 PPGL-related genes, found no germline pathogenic variants (GPVs) in case 1 and an exon 1-4 germinative heterozygous deletion of the MAX gene in case 2. Despite the different medical approaches, both cases had satisfactory outcomes. Although uncommon, PPGL should be considered in the differential diagnosis of HT in pregnancy since missing the diagnosis and failing to introduce appropriate and timely treatment may lead to dramatic consequences for the mother and fetus. PPGL diagnosed during reproductive age is likely to result from GPV, prompting genetic investigation and counseling.

Evaluation of Antitumor Activity of Xanthones Conjugated with Amino Acids.

Cancer is a complex disease characterized by several alterations, which confer, to the cells, the capacity to proliferate uncontrollably and to resist cellular death. Multiresistance to conventional chemotherapy drugs is often the cause of treatment failure; thus, the search for natural products or their derivatives with therapeutic action is essential. Chiral derivatives of xanthones (CDXs) have shown potential inhibitory activity against the growth of some human tumor cell lines. This work reports the screening of a library of CDXs, through viability assays, in different cancer cell lines: A375-C5, MCF-7, NCI-H460, and HCT-15. CDXs' effect was analyzed based on several parameters of cancer cells, and it was also verified if these compounds were substrates of glycoprotein-P (Pgp), one of the main mechanisms of resistance in cancer therapy. Pgp expression was evaluated in all cell lines, but no expression was observed, except for HCT-15. Also, when a humanized yeast expressing the human gene MDR1 was used, no conclusions could be drawn about CDXs as Pgp substrates. The selected CDXs did not induce significant differences in the metabolic parameters analyzed. These results show that some CDXs present promising antitumor activity, but other mechanisms should be triggered by these compounds.

Your Happiness Is My Happiness: Predicting Positive Feelings for a Partner's Consensual Extra-Dyadic Intimate Relations.

This quantitative study tested hypotheses derived from a previous qualitative study of the factors that facilitated and hindered compersion (the positive feelings derived from one's partner's intimate relations with others) in consensually non-monogamous (CNM) relationships. A total of 255 participants recruited from online CNM and Alt-Sex communities reported on demographic and relationship characteristics as well as individual, relationship, and metamour-related variables in an online anonymous survey. In Flicker et al. (2022), we identified various factors that predicted three subtypes of compersion: contentment with one's partner's relationships with established metamours (intimate partners of one's partners), excitement sparked by one's partner's new/potentially new intimate connections, and sexual excitement elicited by thinking about one's partner with another person. The current findings were consistent with the Flicker et al. qualitative study, with some hypotheses from the previous study more strongly supported than others. The predictors of compersion most strongly supported by the current data include closeness with one's metamour and knowledge about the partner/metamour relationship, in a positive direction, as well as jealousy, envy, and attachment anxiety, in a negative direction. Individual-level predictors were weak predictors of compersion. The sexual arousal subtype of compersion was weakly endorsed by the current sample and predictors of this subtype were distinct from predictors of the other subtypes of compersion. The findings suggest that the development of new interventions that target reducing jealousy and envy and increasing attachment security within the unique context of CNM relationships could have the added benefit of increasing compersion. The development of these interventions stands to benefit a growing population of individuals involved in CNM relationships.

Consistent patterns of common species across tropical tree communities.

Trees structure the Earth's most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1-6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth's 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world's most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.

A Review of the Leishmanicidal Properties of Lectins.

Lectins are proteins widely distributed among plants, animals and microorganisms that have the ability to recognize and interact with specific carbohydrates. They have varied biological activities, such as the inhibition of the progression of infections caused by fungi, bacteria, viruses and protozoa, which is related to the interaction of these proteins with the carbohydrates present in the cell walls of these microorganisms. Leishmaniasis are a group of endemic infectious diseases caused by protozoa of the genus Leishmania. In vitro and in vivo tests with promastigotes and amastigotes of Leishmania demonstrated that lectins have the ability to interact with glycoconjugates present on the cell surface of the parasite, it prevents their development through various mechanisms of action, such as the production of ROS and alteration of membrane integrity, and can also interact with defense cells present in the human body, thus showing that these molecules can be considered alternative pharmacological targets for the treatment of leishmaniasis. The objective of the present work is to carry out a bibliographic review on lectins with leishmanicidal activity, emphasizing the advances and perspectives of research in this theme. Through the analysis of the selected studies, we were able to conclude that lectins have great potential for inhibiting the development of leishmaniasis. However, there are still few studies on this subject.

Acute kidney injury after endovascular therapy in acute stroke patients: systematic review with meta-analysis.

AIMS: Endovascular therapy (EVT) is a highly effective stroke treatment, but it requires the administration of contrast media which puts patients at risk of acute kidney injury (AKI). AKI is associated with increased morbidity and mortality in cardiovascular patients. METHODS: PubMed, Scopus, ISI and the Cochrane Library were systematically searched for observational and experimental studies assessing the occurrence of AKI in adult acute stroke patients submitted to EVT. Two independent reviewers collected study data regarding study setting, period, source of data, and AKI definition and predictors, the outcomes of interest being AKI incidence and 90-day death or dependency (modified Rankin Scale score ≥3). These outcomes were pooled using random effect models, and heterogeneity was measured using the I2 statistic. RESULTS: 22 studies were identified and included in the analysis, involving 32 034 patients. Pooled incidence of AKI was 7% (95% CI 5% to 10%), but heterogeneity was high across studies (I2=98%), and not accounted for by the definition of AKI used. The most frequently reported AKI predictors were impaired baseline renal function (5 studies) and diabetes (3 studies); 3 studies (2103 patients) reported data on death and 4 studies (2424 patients) reported data on dependency. Overall, AKI was associated with both outcomes, with ORs of 6.21 (95% CI 3.52 to 10.96) and 2.86 (95% CI 1.88 to 4.37), respectively. Heterogeneity was low for both analyses (I2=0%). CONCLUSIONS: AKI affects 7% of acute stroke patients submitted to EVT and identifies a subgroup of patients for which treatment outcomes are suboptimal, with an increased risk of death and dependency.

Focus on adrenal and related causes of hypertension in childhood and adolescence: Rare or rarely recognized?

ABSTRACT High blood pressure (BP) is not restricted to adults; children and adolescents may also be affected, albeit less frequently. Aside from unfavorable environmental factors, such as obesity and sedentary life leading to early-onset essential hypertension (HT), several secondary causes must be investigated in the occasional hypertensive child/adolescent. Endocrine causes are relevant and multiple, related to the pituitary, thyroid, parathyroid, gonads, insulin, and others, but generally are associated with adrenal disease. This common scenario has several vital components, such as aldosterone, deoxycorticosterone (DOC), cortisol, or catecholamines, but there are also monogenic disorders involving the kidney tubule that cause inappropriate salt retention and HT that simulate adrenal disease. Finally, a blood vessel disease was recently described that may also participate in this vast spectrum of pediatric hypertensive disease. This review will shed some light on the diagnosis and management of conditions, focusing on the most prevalent adrenal (or adrenal-like) disturbances causing HT.

Glycolytic Inhibitors Potentiated the Activity of Paclitaxel and Their Nanoencapsulation Increased Their Delivery in a Lung Cancer Model.

Antiglycolytic agents inhibit cell metabolism and modify the tumor's microenvironment, affecting chemotherapy resistance mechanisms. In this work, we studied the effect of the glycolytic inhibitors 3-bromopyruvate (3BP), dichloroacetate (DCA) and 2-deoxyglucose (2DG) on cancer cell properties and on the multidrug resistance phenotype, using lung cancer cells as a model. All compounds led to the loss of cell viability, with different effects on the cell metabolism, migration and proliferation, depending on the drug and cell line assayed. DCA was the most promising compound, presenting the highest inhibitory effect on cell metabolism and proliferation. DCA treatment led to decreased glucose consumption and ATP and lactate production in both A549 and NCI-H460 cell lines. Furthermore, the DCA pretreatment sensitized the cancer cells to Paclitaxel (PTX), a conventional chemotherapeutic drug, with a 2.7-fold and a 10-fold decrease in PTX IC50 values in A549 and NCI-H460 cell lines, respectively. To increase the intracellular concentration of DCA, thereby potentiating its effect, DCA-loaded poly(lactic-co-glycolic acid) nanoparticles were produced. At higher DCA concentrations, encapsulation was found to increase its toxicity. These results may help find a new treatment strategy through combined therapy, which could open doors to new treatment approaches.

Políticas Públicas de Saúde para a Juventude - Estudo Bibliométrico e Agenda de Pesquisa com base na Web of Science / Public Health Policies for Youth - Bibliometric Study and Research Agenda based on the Web of Science

Resumo A pesquisa descreve o campo de estudo sobre políticas de saúde pública para a juventude com suporte em mapas bibliométricos, na perspectiva de apresentar gaps de pesquisa. A partir do perfil exploratório-descritivo, utilizou-se o software VOSviewer, com dados extraídos em outubro de 2021, e os descritores "public", "youth", "health" com o conectivo "and", que resultou em 172 artigos. Foram descritas redes de: coautorias por países; coocorrência por palavras-chave; cocitação por artigo; cocitação por referência citada; acoplamento bibliográfico; cocitação de autores. Os resultados evidenciam um campo interdisciplinar, representado por estudos da área de educação, trabalho social, direito, ciências sociais, com importante recorrência do tema saúde mental, violência, obesidade, bem como discussão sobre uso e abuso de substâncias, como por exemplo, o cigarro. Observam-se debates sobre a configuração social, definida pela ideia de comunidade, bem como sua prevalência e prevenção se apresentam no escopo desses estudos. Por fim, oito temas de agenda de pesquisa são derivados da discussão sobre o crescente movimento para a promoção da saúde como política pública, ao passo que aspectos socioeconômico-culturais se apresentam com maior ênfase, na busca de compreensão sobre impactos desse cenário para a juventude.

Abstract The scope of this research outlines the field of study on public health policies for youth supported by bibliometric maps, from the perspective of identifying research gaps. VOSviewer software was used based on the exploratory-descriptive profile, with data located in October 2021, using the key words "public", "youth", "health" with the connecting "and", which resulted in 172 articles. The following groupings were located: co-authorship by country; co-authorship by key words; co-quote by article; co-quote by reference cited; bibliographic coupling; co-quote of authors. The results reveal an interdisciplinary field, represented by studies in the areas of education, social work, law, and social sciences, with a significant recurrence of the themes of mental health, violence, and obesity, as well as discussions on substance use and abuse, such as cigarette smoking for example. Debates about the social configuration, defined by the idea of community, as well as its prevalence and prevention are present in the scope of these studies. Finally, eight research agenda topics are derived from the discussion about the growing movement towards health promotion as a public policy, while socio-economic and cultural aspects are presented with greater emphasis, in the quest to understand the impacts of this scenario for youth.

[Public Health Policies for Youth - Bibliometric Study and Research Agenda based on the Web of Science]. / Políticas Públicas de Saúde para a Juventude - Estudo Bibliométrico e Agenda de Pesquisa com base na Web of Science.

The scope of this research outlines the field of study on public health policies for youth supported by bibliometric maps, from the perspective of identifying research gaps. VOSviewer software was used based on the exploratory-descriptive profile, with data located in October 2021, using the key words "public", "youth", "health" with the connecting "and", which resulted in 172 articles. The following groupings were located: co-authorship by country; co-authorship by key words; co-quote by article; co-quote by reference cited; bibliographic coupling; co-quote of authors. The results reveal an interdisciplinary field, represented by studies in the areas of education, social work, law, and social sciences, with a significant recurrence of the themes of mental health, violence, and obesity, as well as discussions on substance use and abuse, such as cigarette smoking for example. Debates about the social configuration, defined by the idea of community, as well as its prevalence and prevention are present in the scope of these studies. Finally, eight research agenda topics are derived from the discussion about the growing movement towards health promotion as a public policy, while socio-economic and cultural aspects are presented with greater emphasis, in the quest to understand the impacts of this scenario for youth.

A pesquisa descreve o campo de estudo sobre políticas de saúde pública para a juventude com suporte em mapas bibliométricos, na perspectiva de apresentar gaps de pesquisa. A partir do perfil exploratório-descritivo, utilizou-se o software VOSviewer, com dados extraídos em outubro de 2021, e os descritores "public", "youth", "health" com o conectivo "and", que resultou em 172 artigos. Foram descritas redes de: coautorias por países; coocorrência por palavras-chave; cocitação por artigo; cocitação por referência citada; acoplamento bibliográfico; cocitação de autores. Os resultados evidenciam um campo interdisciplinar, representado por estudos da área de educação, trabalho social, direito, ciências sociais, com importante recorrência do tema saúde mental, violência, obesidade, bem como discussão sobre uso e abuso de substâncias, como por exemplo, o cigarro. Observam-se debates sobre a configuração social, definida pela ideia de comunidade, bem como sua prevalência e prevenção se apresentam no escopo desses estudos. Por fim, oito temas de agenda de pesquisa são derivados da discussão sobre o crescente movimento para a promoção da saúde como política pública, ao passo que aspectos socioeconômico-culturais se apresentam com maior ênfase, na busca de compreensão sobre impactos desse cenário para a juventude.

Focus on adrenal and related causes of hypertension in childhood and adolescence: Rare or rarely recognized?

High blood pressure (BP) is not restricted to adults; children and adolescents may also be affected, albeit less frequently. Aside from unfavorable environmental factors, such as obesity and sedentary life leading to early-onset essential hypertension (HT), several secondary causes must be investigated in the occasional hypertensive child/adolescent. Endocrine causes are relevant and multiple, related to the pituitary, thyroid, parathyroid, gonads, insulin, and others, but generally are associated with adrenal disease. This common scenario has several vital components, such as aldosterone, deoxycorticosterone (DOC), cortisol, or catecholamines, but there are also monogenic disorders involving the kidney tubule that cause inappropriate salt retention and HT that simulate adrenal disease. Finally, a blood vessel disease was recently described that may also participate in this vast spectrum of pediatric hypertensive disease. This review will shed some light on the diagnosis and management of conditions, focusing on the most prevalent adrenal (or adrenal-like) disturbances causing HT.

Personality Predictors of Prejudicial Attitudes, Willingness to Engage, and Actual Engagement in Consensual Non-Monogamy.

Personality variables, including sensation-seeking, interpersonal trust, avoidance of uncertainty, endorsement of social conformity, and love styles (Ludus, Eros, Pragma, Storge, Mania, and Agape), were examined as predictors of prejudicial attitudes toward individuals who practice polyamory and personal interest in engaging in consensual non-monogamy (CNM) among 1831 participants who completed anonymous surveys online. Personality characteristics were also compared between individuals who currently practice CNM (n = 67) and case-matched controls involved in monogamous relationships. As predicted, prejudicial attitudes and willingness to engage in CNM were positively and moderately correlated and there was substantial overlap in the predictors of both variables. However, the strongest predictors differed: prejudicial attitudes were best predicted, in a positive direction, by endorsement of social conformity and, to a lesser extent, Pragma love style, while willingness to engage in CNM was best predicted by the Ludus (positive) and Eros (negative) love styles. Individuals who practice monogamy and CNM were more similar than different: only two of the 12 variables tested significantly differed. CNM individuals are more ludic and more tolerant of cognitive uncertainty. Difficulty interpreting some of the results laid bare the need for relationship measures that are valid for individuals who practice CNM. Improving our understanding of the relation between personality traits and CNM may help us develop better interventions for clients who seek to transition from monogamy to CNM but struggle to adapt to the new challenges as well as design better efforts to increase acceptance and reduce discrimination against those who practice CNM.

Anti-SARS-CoV-2 equine F (Ab')2 immunoglobulin as a possible therapy for COVID-19.

The new outbreak of coronavirus disease 2019 (COVID-19) has infected and caused the death of millions of people worldwide. Intensive efforts are underway around the world to establish effective treatments. Immunoglobulin from immunized animals or plasma from convalescent patients might constitute a specific treatment to guarantee the neutralization of the virus in the early stages of infection, especially in patients with risk factors and a high probability of progressing to severe disease. Worldwide, a few clinical trials using anti-SARS-CoV-2 immunoglobulins from horses immunized with the entire spike protein or fragments of it in the treatment of patients with COVID-19 are underway. Here, we describe the development of an anti-SARS-CoV-2 equine F(ab')2 immunoglobulin using a newly developed SARS-CoV-2 viral antigen that was purified and inactivated by radiation. Cell-based and preclinical assays showed that the F(ab')2 immunoglobulin successfully neutralizes the virus, is safe in animal models, and reduces the severity of the disease in a hamster model of SARS-CoV-2 infection and disease.

Classic and current concepts in adrenal steroidogenesis: a reappraisal.

Adrenal steroid biosynthesis and its related pathology are constant evolving disciplines. In this paper, we review classic and current concepts of adrenal steroidogenesis, plus control mechanisms of steroid pathways, distribution of unique enzymes and cofactors, and major steroid families. We highlight the presence of a "mineralocorticoid (MC) pathway of zona fasciculata (ZF)", where most circulating corticosterone and deoxycorticosterone (DOC) originate together with 18OHDOC, under ACTH control, a claim based on functional studies in normal subjects and in patients with 11ß-, and 17α-hydroxylase deficiencies. We emphasize key differences between CYP11B1 (11ß-hydroxylase) and CYP11B2 (aldosterone synthase) and the onset of a hybrid enzyme - CYP11B1/CYP11B2 -, responsible for aldosterone formation in ZF under ACTH control, in "type I familial hyperaldosteronism" (dexamethasone suppressible). In "apparent MC excess syndrome", peripheral conversion of cortisol to cortisone is impaired by lack of 11ß-hydroxysteroid dehydrogenase type 2, permitting free cortisol access to MC receptors resulting in severe hypertension. We discuss two novel conditions involving the synthesis of adrenal androgens: the "backdoor pathway", through which dihydrotestosterone is formed directly from androsterone, being relevant for the fetoplacental setting and sexual differentiation of male fetuses, and the rediscovery of C19 11-oxygenated steroids (11-hydroxyandrostenedione and 11-ketotestosterone), active androgens and important markers of virilization in 21-hydroxylase deficiency and polycystic ovaries syndrome. Finally, we underline two enzyme cofactor deficiencies: cytochrome P450 oxidoreductase which partially affects 21- and 17α-hydroxylation, producing a combined clinical/hormonal picture and causing typical skeletal malformations (Antley-Bixler syndrome), and PAPSS2, coupled to SULT2A1, that promotes sulfation of DHEA to DHEAS, preventing active androgens to accumulate. Its deficiency results in reduced DHEAS and elevated DHEA and androgens with virilization. Future and necessary studies will shed light on remaining issues and questions on adrenal steroidogenesis.

Classic and current concepts in adrenal steroidogenesis: a reappraisal

ABSTRACT Adrenal steroid biosynthesis and its related pathology are constant evolving disciplines. In this paper, we review classic and current concepts of adrenal steroidogenesis, plus control mechanisms of steroid pathways, distribution of unique enzymes and cofactors, and major steroid families. We highlight the presence of a "mineralocorticoid (MC) pathway of zona fasciculata (ZF)", where most circulating corticosterone and deoxycorticosterone (DOC) originate together with 18OHDOC, under ACTH control, a claim based on functional studies in normal subjects and in patients with 11β-, and 17α-hydroxylase deficiencies. We emphasize key differences between CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) and the onset of a hybrid enzyme - CYP11B1/CYP11B2 -, responsible for aldosterone formation in ZF under ACTH control, in "type I familial hyperaldosteronism" (dexamethasone suppressible). In "apparent MC excess syndrome", peripheral conversion of cortisol to cortisone is impaired by lack of 11β-hydroxysteroid dehydrogenase type 2, permitting free cortisol access to MC receptors resulting in severe hypertension. We discuss two novel conditions involving the synthesis of adrenal androgens: the "backdoor pathway", through which dihydrotestosterone is formed directly from androsterone, being relevant for the fetoplacental setting and sexual differentiation of male fetuses, and the rediscovery of C19 11-oxygenated steroids (11-hydroxyandrostenedione and 11-ketotestosterone), active androgens and important markers of virilization in 21-hydroxylase deficiency and polycystic ovaries syndrome. Finally, we underline two enzyme cofactor deficiencies: cytochrome P450 oxidoreductase which partially affects 21- and 17α-hydroxylation, producing a combined clinical/hormonal picture and causing typical skeletal malformations (Antley-Bixler syndrome), and PAPSS2, coupled to SULT2A1, that promotes sulfation of DHEA to DHEAS, preventing active androgens to accumulate. Its deficiency results in reduced DHEAS and elevated DHEA and androgens with virilization. Future and necessary studies will shed light on remaining issues and questions on adrenal steroidogenesis.

Larval Density, Sex, and Allocation Hierarchy Affect Life History Trait Covariances in a Bean Beetle.

AbstractLife history theory aims to understand how different environments result in differential investment in fitness-related traits. While trade-offs between traits are expected, many studies show positive or no correlation between pairs of costly traits. One hypothesis that may explain the inconsistency of trade-offs in the literature is that trait investment may occur in a dichotomous hierarchy (the tree model), which allows for differential trait investment weighted by the traits' respective positions within the hierarchy. Previous mathematical models predict different covariances between traits depending on their position on the allocation tree. While hierarchical differential investment is often used to discuss findings in life history theory, the role of an allocation hierarchy in trait covariances has not been directly tested. In turn, this study aims to identify trait covariances between behavioral and morphological phenotypes on different branches of an allocation tree for the bean beetle, Callosobruchus maculatus. While trade-offs between copulatory behaviors and morphology were found for both males and females, only traits at the base and far from each other in the hierarchy negatively covaried. This study empirically shows that trade-offs may be the result of hierarchical investment.

Anti-SARS-CoV-2 equine F (Ab′)2 immunoglobulin as a possible therapy for COVID-19

The new outbreak of coronavirus disease 2019 (COVID-19) has infected and caused the death of millions of people worldwide. Intensive efforts are underway around the world to establish effective treatments. Immunoglobulin from immunized animals or plasma from convalescent patients might constitute a specific treatment to guarantee the neutralization of the virus in the early stages of infection, especially in patients with risk factors and a high probability of progressing to severe disease. Worldwide, a few clinical trials using anti-SARS-CoV-2 immunoglobulins from horses immunized with the entire spike protein or fragments of it in the treatment of patients with COVID-19 are underway. Here, we describe the development of an anti-SARS-CoV-2 equine F(ab′)2 immunoglobulin using a newly developed SARS-CoV-2 viral antigen that was purified and inactivated by radiation. Cell-based and preclinical assays showed that the F(ab′)2 immunoglobulin successfully neutralizes the virus, is safe in animal models, and reduces the severity of the disease in a hamster model of SARS-CoV-2 infection and disease.

Crianças com condições crônicas complexas de saúde moradoras de uma pediatria: por que é tão difícil desospitalizar? / Children with complex chronic health conditions living in a pediatric ward: why is it so difficult to dehospitalize?

O estudo pretende promover uma discussão sobre a desospitalização de crianças com condições crônicas complexas de saúde que vivem uma internação prolongada e poderiam se beneficiar com o tratamento em casa. Almeja-se também, dar maior visibilidade à situação das crianças que aguardam a efetivação da transição do cuidado seguro para o ambiente familiar. Tem-se como principal objetivo conhecer e analisar a situação de hospitalização por tempo prolongado e a proposta de desospitalização do Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) vinculado a Universidade Federal do Rio de Janeiro, visando a contribuir com propostas de adequação desse processo. O trabalho consiste num estudo exploratório de cunho qualitativo, que busca responder às seguintes questões: estratégias utilizadas pela equipe de saúde e pela gestão do hospital para propiciar a redução do tempo da internação e viabilizar a desospitalização; organização do processo de desospitalização nessa instituição de saúde; fatores que interferem direta e indiretamente no processo de desospitalização e impedem a ida dessas crianças para casa; os obstáculos existentes para as famílias receberem a criança, como elas se organizam e suas percepções sobre sua situação; e o que poderia ser feito para melhorar esse processo. Entre os meses de dezembro de 2021 e janeiro de 2022 foram entrevistados 31 profissionais de saúde, 2 gestores e 5 familiares. O estudo foi aprovado pelo comitê de ética em pesquisa do IPPMG. Os resultados da pesquisa mostraram que o conceito de desospitalização está claro para a maioria dos profissionais e para a gestão, no entanto, as ações são ainda incipientes. São necessárias condições externas (familiares, de acesso a insumos, equipamentos, medicamentos, de apoio dos serviços locais de saúde, da comunidade, das condições das moradias) e internas (uma liderança do processo e uma equipe multiprofissional em dedicação de tempo necessário) para promover a desospitalização prevista pelo Ministério da Saúde. Observa-se a falta de prioridade por parte da gestão de se institucionalizar o processo de desospitalização na unidade sob a escusa de que faltam pessoal e condições objetivas. Nenhuma das crianças citadas realmente conseguiu ainda ir para casa com o devido acompanhamento. Em geral, os familiares têm muitas dúvidas e passam por muitos caminhos tortuosos e sofrimentos para promover o retorno da criança ao lar, entretanto, querem os filhos de volta em casa. Há obstáculos estruturais que contradizem o que propugnam as políticas de proteção: o desamparo por parte do Estado que deixa de prover pessoal, transporte, medicamentos, insumos, alimentação especial, equipamentos e serviços de atendimento domiciliar, além dos longos processos judiciais para a aquisição destes itens. A desospitalização traz um benefício inequívoco para a criança, colocando-a de forma assistida no ambiente familiar, o que significa teoricamente mais qualidade de vida para ela e seus familiares e, para a unidade hospitalar, a redução de custos de internação, diminuição de gastos e maior rotatividade de pacientes, liberando vagas para outras crianças No entanto, tudo isso só pode ser devidamente tratado e equacionado quando há um programa que focalize todas as dimensões e interfaces de um processo de desospitalização adequado.

The study aims to promote a discussion about the dehospitalization of children with complex chronic health conditions who experience a prolonged hospitalization and could benefit from treatment at home. It is also intended to give greater visibility to the situation of children who are waiting for the effective transition from safe care to the family environment. The main objective is to know and analyze the situation of hospitalization for a long time and the proposal of dehospitalization of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) linked to the Federal University of Rio de Janeiro (UFRJ), aiming to contribute with proposals for the adequacy of this process. The work consists of an exploratory study of a qualitative nature, which seeks to answer the following questions: strategies used by the health team and hospital management to reduce the length of hospital stay and enable dehospitalization; organization of the dehospitalization process in this health institution; factors that interfere directly and indirectly in the dehospitalization process and prevent these children from going home; the existing obstacles for families to receive the child, how they organize themselves and their perceptions of their situation; and what could be done to improve this process. Between December 2021 and January 2022, 31 health professionals, 2 managers and 5 family members were interviewed. The study was approved by the Research Ethics Committee (CEP/IPPMG). The survey results showed that the concept of dehospitalization is clear to most professionals and management, however, the actions are still incipient. External conditions (family members, access to supplies, equipment, medicines, support from local health services, the community, housing conditions) and internal conditions (a process leader and a multiprofessional team dedicating the necessary time) are needed to promote the dehospitalization provided by the Ministry of Health. There is a lack of priority on the part of the management to institutionalize the process of dehospitalization in the unit under the excuse that there is a lack of personnel and objective conditions. None of the children mentioned actually managed to go home with the proper follow-up. In general, family members have many doubts and go through many tortuous paths and suffering to promote the child's return home, however, they want their children back home. There are structural obstacles that contradict what protection policies advocate: the helplessness on the part of the State that fails to provide professionals, transport, medicines, supplies, special food, equipment and home care services, in addition to the long legal processes for the acquisition of these items. Dehospitalization brings an unequivocal benefit to the child, placing him in an assisted way in the family environment, which theoretically means better quality of life for him and his family and for the hospital unit, the reduction of hospitalization costs, reduction of expenses and greater patient turnover, freeing up spaces for other children. However, all of this can only be properly addressed and equated when there is a program that focuses on all dimensions and interfaces of an adequate dehospitalization process.

Morphology of the Cutaneous Poison and Mucous Glands in Amphibians with Particular Emphasis on Caecilians (Siphonops annulatus).

Caecilians (order Gymnophiona) are apodan, snake-like amphibians, usually with fossorial habits, constituting one of the most unknown groups of terrestrial vertebrates. As in orders Anura (frogs, tree frogs and toads) and Caudata (salamanders and newts), the caecilian skin is rich in mucous glands, responsible for body lubrication, and poison glands, producing varied toxins used in defence against predators and microorganisms. Whereas in anurans and caudatans skin gland morphology has been well studied, caecilian poison glands remain poorly elucidated. Here we characterised the skin gland morphology of the caecilian Siphonops annulatus, emphasising the poison glands in comparison to those of anurans and salamanders. We showed that S. annulatus glands are similar to those of salamanders, consisting of several syncytial compartments full of granules composed of protein material but showing some differentiated apical compartments containing mucus. An unusual structure resembling a mucous gland is frequently observed in lateral/apical position, apparently connected to the main duct. We conclude that the morphology of skin poison glands in caecilians is more similar to salamander glands when compared to anuran glands that show a much-simplified structure.