Association between extrapolated time in range and large for gestational age infants in pregnant women with type 1 diabetes.

AIMS: To evaluate the association between extrapolated time in range (eTIR), measured by self-monitoring of blood glucose (SMBG), and large-for-gestational-age (LGA) infants in pregnancies with type 1 diabetes (T1D). METHODS: Retrospective cohort analysis including singleton pregnancies with T1D who started antenatal care before 20 gestational weeks and delivered live newborns at a Brazilian hospital between 2010 and 2019, with LGA fetuses as the main outcome. Glycemic records acquired using SMBG were categorized as eTIR, extrapolated time below range (eTBR), and extrapolated time above range (eTAR). Women were divided into two groups (LGA and adequate for gestational age [AGA]) and compared regarding clinical characteristics, obstetric outcomes, and frequencies of eTIR, eTBR, and eTAR. Logistic regression analysis verified the independent predictive variables for LGA infants. RESULTS: Data from 125 pregnancies were analyzed. For the first, second and third trimesters, each 1 % increase in eTIR was associated with a decreased risk of LGA by 2.9 % (OR: 0.971; 95%CI: 0.945-0.998), 2.5 % (OR: 0.975; 95%CI: 0.951-0.999) and 2.3 % (OR: 0.977; 95%CI: 0.955-0.998) and each 1 % increase in eTAR was associated with an increased risk of LGA by 2.7 % (OR: 1.027; 95%CI: 1.005-1.050), 3.9 % (OR: 1.039; 95%CI: 1.014-1.063) and 4.6 % (OR: 1.046; 95%CI: 1.018-1.075), respectively. CONCLUSION: The concept of TIR can be extrapolated to patients undergoing SMBG to assess the risk of LGA infants in pregnant women with T1D.

Piplartine eliminates CD34 + AML stem/progenitor cells by inducing oxidative stress and suppressing NF-κB signalling.

Acute myeloid leukaemia (AML) is a haematological malignancy characterised by the accumulation of transformed myeloid progenitors in the bone marrow. Piplartine (PL), also known as piperlongumine, is a pro-oxidant small molecule extracted from peppers that has demonstrated antineoplastic potential in solid tumours and other haematological malignancies. In this work, we explored the potential of PL to treat AML through the use of a combination of cellular and molecular analyses of primary and cultured leukaemia cells in vitro and in vivo. We showed that PL exhibits in vitro cytotoxicity against AML cells, including CD34+ leukaemia-propagating cells, but not healthy haematopoietic progenitors, suggesting anti-leukaemia selectivity. Mechanistically, PL treatment increased reactive oxygen species (ROS) levels and induced ROS-mediated apoptosis in AML cells, which could be prevented by treatment with the antioxidant scavenger N-acetyl-cysteine and the pancaspase inhibitor Z-VAD(OMe)-FMK. PL treatment reduced NFKB1 gene transcription and the level of NF-κB p65 (pS536), which was depleted from the nucleus of AML cells, indicating suppression of NF-κB p65 signalling. Significantly, PL suppressed AML development in a mouse xenograft model, and its combination with current AML treatments (cytarabine, daunorubicin and azacytidine) had synergistic effects, indicating translational therapeutic potential. Taken together, these data position PL as a novel anti-AML candidate drug that can target leukaemia stem/progenitors and is amenable to combinatorial therapeutic strategies.

Low back pain, pelvic pain, and associated factors in type 1 diabetic pregnant women.

INTRODUCTION: Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). OBJECTIVE: To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. METHOD: An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). RESULTS: The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. CONCLUSION: There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.

Low back pain, pelvic pain, and associated factors in type 1 diabetic pregnant women

Abstract Introduction Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). Objective To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. Method: An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). Results The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02‒124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. Conclusion There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.

Polychaete (Alitta virens) meal inclusion as a dietary strategy for modulating gut microbiota of European seabass (Dicentrarchus labrax).

Recent research has revealed the significant impact of novel feed ingredients on fish gut microbiota, affecting both the immune status and digestive performance. As a result, analyzing the microbiota modulatory capabilities may be a useful method for assessing the potential functionality of novel ingredients. Therefore, this study aimed to evaluate the effects of dietary polychaete meal (PM) from Alitta virens on the autochthonous and allochthonous gut microbiota of European seabass (Dicentrarchus labrax). Two diets were compared: a control diet with 25% fishmeal (FM) and a diet replacing 40% of fishmeal with PM, in a 13-week feeding trial with juvenile fish (initial weight of 14.5 ± 1.0 g). The feed, digesta, and mucosa-associated microbial communities in fish intestines were analyzed using high-throughput sequencing of the 16S rRNA gene on the Illumina MiSeq platform. The results of feed microbiota analyses showed that the PM10 feed exhibited a higher microbial diversity than the FM diet. However, these feed-associated microbiota differences were not mirrored in the composition of digesta and mucosal communities. Regardless of the diet, the digesta samples consistently exhibited higher species richness and diversity than the mucosa samples. Overall, digesta samples were characterized by a higher abundance of Firmicutes in PM-fed fish. In contrast, at the gut mucosa level, the relative abundances of Mycobacterium, Taeseokella and Clostridium genera were lower in the group fed the PM10 diet. Significant differences in metabolic pathways were also observed between the FM and PM10 groups in both mucosa and digesta samples. In particular, the mucosal pathways of caffeine metabolism, phenylalanine metabolism, and sulfur relay system were significantly altered by PM inclusion. The same trend was observed in the digesta valine, leucine, and isoleucine degradation and secretion pathways. These findings highlight the potential of PM as an alternative functional ingredient in aquafeeds with microbiota modulatory properties that should be further explored in the future.

Studying the first order hyperpolarizability spectra in chalcone-based derivatives and the relation with one- and two-photon absorption transitions.

The first-order molecular hyperpolarizability (ß) dispersion was measured in seven chalcone-based molecules utilizing the tunable femtosecond hyper-Rayleigh scattering (tHRS) technique. Additionally, a theoretical model based on photophysical parameters was employed to better understand ß dispersion. Due to the distinct substitution patterns of the aryl/heteroaryl rings within the chalcone structure, varying profiles of one- and two-photon absorption spectra and ß dispersion were observed. The applied model highlighted two important factors contributing to achieving high ß values: (i) the presence of red-shifted one-photon and two-photon absorption bands; and (ii) the number of discernible absorption bands. To contextualize these results with other molecular structures, we employed the HRS figure of merit (FOM). Remarkably, it was revealed that chemically engineered small chalcone molecules exhibit a FOM comparable to larger quadrupolar and octupolar ones. This underscores the significance of tHRS scattering measurements and their correlation with absorptive parameters in the design and characterization of nonlinear optical materials.

Exercise of professional autonomy of intensive care nurses in the pandemic scenario.

OBJECTIVE: To analyze the exercise of professional autonomy of intensive care nurses during times of the new coronavirus pandemic. METHOD: A descriptive, qualitative study, conducted with 19 nurses from Intensive Care Units of two public hospitals and one private hospital. The information was produced from October 2020 to January 2021, through semi-structured interviews, using content analysis in thematic modality, guided by Eliot Freidson's Sociology of Professions. RESULTS: Nursesargued that it was difficult, amidst the pandemic, to act with all the prerogatives assigned to them by their social mandate, for various reasons, such as limited knowledge about the disease, fragile teamwork communication, and scarcity of material and human resources. CONCLUSION: The exercise of professional autonomy is shaped by the confrontation of multiple factors that impact the performance of intensive care nurses, especially in a context of pandemic crisis.

Variant rs17619600 in the gene encoding serotonin receptor 2B (HTR2B) increases the risk of gestational diabetes mellitus: a case-control study.

BACKGROUND: During pregnancy, the increase in maternal insulin resistance is compensated by hyperplasia and increased function of maternal pancreatic beta cells; the failure of this compensatory mechanism is associated with gestational diabetes mellitus (GDM). Serotonin participates in beta cell adaptation, acting downstream of the prolactin pathway; the blocking of serotonin receptor B (HTR2B) signaling in pregnant mice impaired beta cell expansion and caused glucose intolerance. Thus, given the importance of the serotoninergic system for the adaptation of beta cells to the increased insulin demand during pregnancy, we hypothesized that genetic variants (single nucleotide polymorphisms [SNPs]) in the gene encoding HTR2B could influence the risk of developing GDM. METHODS: This was a case-control study. Five SNPs (rs4973377, rs765458, rs10187149, rs10194776, and s17619600) in HTR2B were genotyped by real-time polymerase chain reaction in 453 women with GDM and in 443 pregnant women without GDM. RESULTS: Only the minor allele C of SNP rs17619600 conferred an increased risk for GDM in the codominant model (odds ratio [OR] 2.15; 95% confidence interval [CI] 1.53-3.09; P < 0.0001) and in the rare dominant model (OR 2.32; CI 1.61-3.37; P < 0.0001). No associations were found between the SNPs and insulin use, maternal weight gain, newborn weight, or the result of postpartum oral glucose tolerance test (OGTT). In the overall population, carriers of the XC genotype (rare dominant model) presented a higher area under the curve (AUC) of plasma glucose during the OGTT, performed for diagnostic purposes, compared with carriers of the TT genotype of rs17619600. CONCLUSIONS: SNP rs17619600 in the HTR2B gene influences glucose homeostasis, probably affecting insulin release, and the presence of the minor allele C was associated with a higher risk of GDM.

Predicting insulin use among women with gestational diabetes diagnosed in oral glucose tolerance test.

BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most common complications affecting pregnant women. While most women will achieve adequate glycemic levels with diet and exercise, some will require pharmacological treatment to reach and maintain glucose levels between the desired thresholds. Identifying these patients early in pregnancy could help direct resources and interventions. METHODS: This retrospective cohort of women with GDM diagnosed with an abnormal 75g-OGTT presents data from 869 patients (724 in the diet group and 145 in the insulin group). Univariate logistic regression was used to compare the groups, and multivariable logistic regression was used to identify independent factors associated with the need for insulin. A log-linear function was used to estimate the probability of requiring pharmacological treatment. RESULTS: Women in the insulin group had higher pre-pregnancy BMI index (29.8 vs 27.8 kg/m2, odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09), more frequent history of previous GDM (19.4% vs. 7.8%, OR 2.84, 95% CI 1.59-5.05), were more likely to have chronic hypertension (31.7% vs. 23.2%, OR 1.54, 95% CI 1.04-2.27), and had higher glucose levels at all three OGTT points. Multivariable logistic regression final model included age, BMI, previous GDM status, and the three OGTT values as predictors of insulin requirement. CONCLUSIONS: We can use regularly collected data from patients (age, BMI, previous GDM status, and the three OGTT values) to calculate the risk of a woman with GDM diagnosed in OGTT needing insulin. Identifying patients with a greater risk of requiring pharmacological treatment could help healthcare services to better allocate resources and offer closer follow-up to high-risk patients.

Emerging drugs targeting cellular redox homeostasis to eliminate acute myeloid leukemia stem cells.

Acute myeloid leukemia (AML) is a very heterogeneous group of disorders with large differences in the percentage of immature blasts that presently are classified according to the specific mutations that trigger malignant proliferation among thousands of mutations reported thus far. It is an aggressive disease for which few targeted therapies are available and still has a high recurrence rate and low overall survival. The main reason for AML relapse is believed to be due to leukemic stem cells (LSCs) that have unlimited self-renewal capacity and long residence in a quiescent state, which promote greater resistance to traditional therapies for this cancer. AML LSCs have low oxidative stress levels, which appear to be caused by a combination of low mitochondrial activity and high activity of ROS-removing pathways. In this sense, oxidative stress has been thought to be an important new potential target for the treatment of AML patients, targeting the eradication of AML LSCs. The aim of this review is to discuss some drugs that induce oxidative stress to direct new goals for future research focusing on redox imbalance as an effective strategy to eliminate AML LSCs.

Iron Limitation Restores Autophagy and Increases Lifespan in the Yeast Model of Niemann-Pick Type C1.

Niemann-Pick type C1 (NPC1) is an endolysosomal transmembrane protein involved in the export of cholesterol and sphingolipids to other cellular compartments such as the endoplasmic reticulum and plasma membrane. NPC1 loss of function is the major cause of NPC disease, a rare lysosomal storage disorder characterized by an abnormal accumulation of lipids in the late endosomal/lysosomal network, mitochondrial dysfunction, and impaired autophagy. NPC phenotypes are conserved in yeast lacking Ncr1, an orthologue of human NPC1, leading to premature aging. Herein, we performed a phosphoproteomic analysis to investigate the effect of Ncr1 loss on cellular functions mediated by the yeast lysosome-like vacuoles. Our results revealed changes in vacuolar membrane proteins that are associated mostly with vesicle biology (fusion, transport, organization), autophagy, and ion homeostasis, including iron, manganese, and calcium. Consistently, the cytoplasm to vacuole targeting (Cvt) pathway was increased in ncr1∆ cells and autophagy was compromised despite TORC1 inhibition. Moreover, ncr1∆ cells exhibited iron overload mediated by the low-iron sensing transcription factor Aft1. Iron deprivation restored the autophagic flux of ncr1∆ cells and increased its chronological lifespan and oxidative stress resistance. These results implicate iron overload on autophagy impairment, oxidative stress sensitivity, and cell death in the yeast model of NPC1.

Validation of the Brazilian version of the Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement: a cross-sectional study

ABSTRACT BACKGROUND: The Hip Sports Activity Scale (HSAS) is a hip-specific instrument for assessing the present levels of physical activity among patients with femoroacetabular impingement (FAI) syndrome. When evaluating treatment outcomes in patients with FAI syndrome, it is necessary to use joint-specific instruments and ones that can evaluate the levels of physical activity in these patients, such as the HSAS-Brazil. OBJECTIVE: To validate the HSAS-Brazil among a group of physically active patients after arthroscopic treatment of FAI syndrome. DESIGN AND SETTING: Cross-sectional research of quantitative and qualitative types using data obtained from July 2018 to October 2019. METHODS: A total of 58 patients of both genders diagnosed with FAI syndrome and who had undergone hip arthroscopy participated in this research. To establish reliability and validity, patients first answered the Brazilian versions of the 12-Item Short-Form Health Survey (SF-12), Nonarthritic Hip Score (NAHS), and HSAS; after a 48-hour interval, they answered the HSAS-Brazil again. RESULTS: For test-retest reliability, the interclass correlation was 0.908 (P < 0.001). The HSAS-Brazil correlated to the NAHS-Brazil (r = 0.63, P < 0.001), as well as the SF-12 (Physical Health) (r = 0.42, P = 0.001). CONCLUSION: The HSAS-Brazil was validated and proved to be a reliable and valid scale to assess sports activity levels in physically active patients with FAI syndrome after arthroscopic treatment.

Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile.

OBJECTIVES: To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women. METHOD: This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation. RESULTS: There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance. CONCLUSIONS: PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.

Exercise of professional autonomy of intensive care nurses in the pandemic scenario / Ejercicio de la autonomía profesional de los enfermeros intensivistas en el escenario de pandemia / Exercício da autonomia profissional de enfermeiros intensivistas no cenário pandêmico

ABSTRACT Objective: To analyze the exercise of professional autonomy of intensive care nurses during times of the new coronavirus pandemic. Method: A descriptive, qualitative study, conducted with 19 nurses from Intensive Care Units of two public hospitals and one private hospital. The information was produced from October 2020 to January 2021, through semi-structured interviews, using content analysis in thematic modality, guided by Eliot Freidson's Sociology of Professions. Results: Nursesargued that it was difficult, amidst the pandemic, to act with all the prerogatives assigned to them by their social mandate, for various reasons, such as limited knowledge about the disease, fragile teamwork communication, and scarcity of material and human resources. Conclusion: The exercise of professional autonomy is shaped by the confrontation of multiple factors that impact the performance of intensive care nurses, especially in a context of pandemic crisis.

RESUMEN Objetivo: Analizar el ejercicio de la autonomía profesional de los enfermeros de cuidados intensivos en tiempos de la pandemia del nuevo coronavirus. Método: Estudio descriptivo, cualitativo, realizado con 19 enfermeros de Unidades de Cuidados Intensivos de dos hospitales públicos y un hospital privado. La información fue producida de octubre de 2020 a enero de 2021, a través de entrevistas semiestructuradas, utilizando análisis de contenido en la modalidad temática, a la luz de la Sociología de las Profesiones de Eliot Freidson. Resultados: Los enfermeros argumentaron que hubo dificultad, en medio de la pandemia, para actuar con todas las prerrogativas que les atribuye su mandato social, por diversas causas, como conocimiento limitado sobre la enfermedad, comunicación frágil en el trabajo en equipo y escasez de recursos materiales y humanos. Conclusión: El ejercicio de la autonomía profesional se configura a partir del enfrentamiento de múltiples factores que impactan la actuación de los enfermeros de cuidados intensivos, especialmente en un contexto de crisis pandémica.

RESUMO Objetivo: Analisar o exercício da autonomia profissional de enfermeiros intensivistas em tempos de pandemia do novo coronavírus. Método: Estudo descritivo, de natureza qualitativa, realizado com 19 enfermeiros de Unidades de Terapia Intensiva de dois hospitais públicos e um privado. As informações foram produzidas de outubro de 2020 a janeiro de 2021, mediante entrevistas semiestruturadas, utilizando a análise de conteúdo na modalidade temática, à luz da Sociologia das Profissões de Eliot Freidson. Resultados Os enfermeiros argumentaram que houve dificuldade, em meio à pandemia, de atuarem com todas as prerrogativas que seu mandato social lhes atribui, devido a várias causas,tais como: o conhecimento limitado acerca da doença, a comunicação frágil no trabalho em equipe e a escassez de recursos materiais e humanos. Conclusão: O exercício da autonomia profissional se configura a partir do enfrentamento de múltiplos fatores que impactam a atuação dos enfermeiros intensivistas, sobretudo numa conjuntura de crise pandêmica.

Impacto do uso de imunonutrientes no desfecho clínico de pacientes críticos: uma revisão sistemática de estudos clínicos / Impact of immunonutrient use on clinical out comes in critical patients: a systematic review of clinical trials

Objetivo: Descrever os resultados da influência de imunonutrientes na taxa de mortalidade, tempo de internação, tempo de permanência na Unidade de Terapia Intensiva (UTI) e incidência de infecções em pacientes críticos adultos e idosos. Método: Revisão integrativa da literatura realizada nas bases de dados PubMed, LILACS, SciELO, Medline e Google Scholar, usando os descritores: ("immunomodulation" OR "immunonutrients") AND ("fattyAcids, Omega-3" OR "eicosapentaenoic Acid") AND ("glutamine") AND ("criticalillness" OR "criticalillnesses" OR "criticallyill"), sem restrição de idioma, com pesquisas realizadas no período de 2012 a 2022. Resultados: Nas buscas realizadas, foram encontradas 15 publicações, das quais 11 atenderam a todos os critérios estabelecidos ao início do estudo. Apesar de alguns estudos com indivíduos suplementados com fórmulas imunomoduladoras demonstrarem melhora no tempo de internação de UTI, redução de ocorrência de sepse e choque séptico, e redução de taxa de infecções, em sua maioria os estudos avaliados não mostraram diferença entre os grupos suplementados e os grupos controle, ou não apresentaram resultados estatisticamente significativos. Conclusão: O manejo do cuidado em pacientes críticos deve ser cuidadoso e individualizado, sendo imprescindível que a conduta clínica tenha como base evidências científicas. No presente estudo, a análise dos estudos clínicos que compuseram esta pesquisa verificou que os efeitos da imunomodulação na mortalidade, tempo de internação na UTI e hospitalização total e incidência de infecções, demonstrou ausência de resultados significativos para a prática de uso de imunonutrientes em pacientes críticos, sendo necessário realizar outros estudos para comprovar os reais benefícios da adoção dessa conduta.

Objective: To describe the outcomes regarding the impact of immunonutrients on mortality rates, length of hospitalization, duration of Intensive Care Unit (ICU) stays, and the incidence of infections in adult and elderly critical patients. Method: An integrative literature review was conducted using the PubMed, LILACS, SciELO, Medline, and Google Scholar databases, using the descriptors: ("immunomodulation" OR "immunonutrients") AND ("fatty acids, Omega-3" OR "eicosapentaenoic Acid") AND ("glutamine") AND ("critical illness" OR "critical illnesses" OR "critically ill"), without language restrictions. The search encompassed studies that were published between 2012 and 2022. Results: Fifteen publications were identified in the conducted searches, of which eleven met all the established criteria at the outset of the study. Although some studies involving individuals supplemented with immunomodulatory formulas demonstrated improvements in ICU leng­th of stay, a reduced incidence of sepsis and septic shock, and a lower infection rate, most of the evaluated studies did not reveal significant differences between the supplemented groups and the control groups or did not yield statistically significant outcomes. Conclusion: The management of care for critical patients necessitates a cautious and individualized approach, underpinned by scientific evidence. The analysis of clinical studies forming part of this research revealed an absence of statistically significant  results pertaining to the practice of immunomodulation  utilization in critical patients with respect to effects on mortality, ICU length of stay, total hospitalization, and the incidence of infections. Further studies are required to validate the genuine benefits of adopting this approach.

Polimorfismo Genético TP53 Arg72Pro e Câncer de Mama em Mulheres Jovens: Estudo Caso-Controle no Brasil / TP53 Arg72Pro Genetic Polymorphism and Young Women with Breast Cancer: Case-Control Study in Brazil / Polimorfismo Genético TP53 Arg72Pro y Cáncer de Mama en Mujeres Jóvenes: Estudio de Casos y Controles en el Brasil

Introduction: Breast cancer is the most common cancer in women and incidence and mortality rates are increasing among young women worldwide, including Brazil. TP53 Arg72Pro polymorphism (rs1042522) has been associated with breast cancer, due to its important role in cell cycle that impacts the development of cancer. Objective: To determine the magnitude of the association between TP53 Arg72Pro polymorphism and breast cancer development in young Brazilian women. Method: Hospital-based case-control study conducted in Rio de Janeiro with 268 confirmed breast cancer cases and 277 controls with women enrolled among hospitalized patients without neoplastic diseases or their companions at three public hospitals. Results: The genotype frequency was 46.57% for Arg/Pro, 35.74% for Arg/Arg, and 17.69% for Pro/Pro among healthy controls and 41.04% for Arg/Pro, 46.64% for Arg/Arg, and 12.31% for Pro/Pro among breast cancer cases. The genotypes Pro/Pro (OR=0.46; 95% CI=0.27-0.80, in comparison with Arg/Arg genotype) and Pro allele in dominant model (OR=0.65; 95% CI=0.45-0.92, in comparison with Arg/Arg genotype) were statistically associated with a protective effect for breast cancer among young Brazilian women. Also, family history of breast or ovary cancer (OR=2.18; 95% CI=1.37-3.46) and tobacco use (OR=1.74; 95% CI=1.14-2.68) were statistically associated with breast cancer. Conclusion: Further studies are necessary to confirm that Arg72Pro polymorphism can be a protective factor for breast cancer development among young women, since ethnicity can influence genotypes frequencies and the risk of developing breast cancer

Introdução: O câncer de mama é o mais comum em mulheres e as taxas de incidência e mortalidade estão aumentando entre mulheres jovens em todo o mundo, inclusive no Brasil. O polimorfismo TP53 Arg72Pro (rs1042522) tem sido associado ao câncer de mama em razão do seu importante papel no ciclo celular que pode impactar o desenvolvimento do câncer. Objetivo: Determinar a magnitude da associação entre o polimorfismo TP53 Arg72Pro e o desenvolvimento de câncer de mama em mulheres jovens brasileiras. Método: Estudo caso-controle de base hospitalar realizado no Rio de Janeiro com 268 casos confirmados de câncer de mama e 277 controles com mulheres cadastradas entre pacientes internados sem doenças neoplásicas ou seus acompanhantes em três hospitais públicos. Resultados: A frequência genotípica foi de 46,57% para Arg/Pro, 35,74% para Arg/Arg e 17,69% para Pro/Pro entre controles saudáveis e 41,04% para Arg/Pro, 46,64% para Arg/ Arg e 12,31% para Pro /Pro entre os casos de câncer de mama. Os genótipos Pro/Pro (OR=0,46; IC 95%=0,27-0,80, em comparação ao genótipo Arg/ Arg) e o alelo Pro no modelo dominante (OR=0,65; IC 95%=0,45-0,92, em comparação com o genótipo Arg/Arg) foram estatisticamente associados a um efeito protetor para o câncer de mama em mulheres jovens brasileiras. Além disso, história familiar de câncer de mama ou ovário (OR=2,18; IC 95%=1,37-3,46) e tabagismo (OR=1,74; IC 95%=1,14-2,68) foi estatisticamente associada ao câncer de mama. Conclusão: Novos estudos são necessários para confirmar que o polimorfismo Arg72Pro pode ser um fator de proteção para o desenvolvimento de câncer de mama em mulheres jovens, uma vez que a etnia pode influenciar tanto as frequências desses genótipos quanto o risco de desenvolver câncer de mama

Introducción: El cáncer de mama es el cáncer más común en la mujer y las tasas de incidencia y mortalidad están aumentando entre las mujeres jóvenes en todo el mundo, incluido Brasil. El polimorfismo TP53 Arg72Pro (rs1042522) se ha asociado con el cáncer de mama, debido a su importante papel en el ciclo celular que puede afectar el desarrollo del cáncer. Objetivo: Determinar la magnitud de la asociación entre el polimorfismo TP53 Arg72Pro y el desarrollo de cáncer de mama en mujeres jóvenes brasileñas. Método: Estudio de casos y controles de base hospitalaria realizado en Río de Janeiro con 268 casos confirmados de cáncer de mama y 277 controles con mujeres inscritas entre pacientes hospitalizadas sin enfermedades neoplásicas o sus acompañantes en tres hospitales públicos. Resultados: La frecuencia de genotipos fue del 46,57% para Arg/Pro, 35,74% para Arg/Arg y 17,69% para Pro/Pro entre controles sanos y 41,04% para Arg/Pro, 46,64% para Arg/Arg y 12,31% para Pro/Pro entre los casos de cáncer de mama. El genotipo Pro/Pro (OR=0,46; IC 95%=0,27-0,80, en comparación con el genotipo Arg/Arg) y el alelo Pro en el modelo dominante (OR=0,65; IC del 95 %=0,45-0,92, en comparación con el genotipo Arg/Arg) se asociaron estadísticamente con un efecto protector frente el cáncer de mama entre mujeres jóvenes brasileñas. Además, los antecedentes familiares de cáncer de mama o de ovario (OR=2,18; IC 95%=1,37-3,46) y el hábito del tabaquismo (OR=1,74; IC 95%=1,14-2,68) se asociaron estadísticamente con el cáncer de mama. Conclusión: Son necesarios nuevos estudios para confirmar que el polimorfismo Arg72Pro puede ser un factor de protección para el desarrollo del cáncer de mama en mujeres jóvenes, ya que la etnia puede influir r tanto en las frecuencias de estos genotipos como en el riesgo de desarrollar cáncer de mama

Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile

ABSTRACT Objectives: To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women. Method: This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation. Results: There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance. Conclusions: PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.

Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome.

Prone positioning (PP) improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Data regarding feasibility and effectiveness of PP in pregnancy are lacking. This subgroup analysis of a cohort study that included mechanically ventilated pregnant women presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who underwent PP aims to assess the efficacy and safety of PP. Ventilatory and gasometric parameters were evaluated at baseline (T0) and in prone (T1) and supine (T2) positions. Obstetric outcomes were also assessed. Sixteen cases at an average of 27.0 (22.0−31.1) gestational weeks of pregnancy were included. Obesity and hypertension were frequent comorbidities. PP was associated with a >20% increase in PaO2 levels and in PaO2/FiO2 ratios in 50% and 100% of cases, respectively. The PaO2/FiO2 ratio increased 76.7% (20.5−292.4%) at T1 and 76.9% (0−182.7%) at T2. PP produced sustained improvements in mean PaO2/FiO2 ratio (p < 0.001) and PaCO2 level (p = 0.028). There were no cases of emergency delivery or suspected fetal distress in pregnancies ≥25 weeks during the 24 h period following PP. PP is safe and feasible during pregnancy, improving PaO2/FiO2 ratios and helping to delay preterm delivery in severe ARDS.