Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions. / Eficácia da Hidratação Oral na Prevenção da Nefropatia Induzida por Contraste em Indivíduos Submetidos a Intervenções Coronárias Eletivas.

BACKGROUND: Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). OBJETIVE: To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. METHODS: In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. RESULTS: In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). CONCLUSION: The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.

FUNDAMENTO: A nefropatia induzida por contraste (NIC) é definida como deterioração da função renal, representada por um aumento da creatinina sérica ≥25% ou ≥0,5 mg/dL até 72 horas após a exposição ao meio de contraste iodado (MCI). A medida preventiva mais eficaz até o momento é a hidratação venosa (HV). Pouco se sabe sobre a eficácia da hidratação oral (HO) ambulatorial. OBJETIVO: Investigar se a HO ambulatorial com água é tão eficaz quanto a HV com solução salina a 0,9% na prevenção de NIC em procedimentos coronarianos eletivos. MÉTODOS: Neste estudo observacional retrospectivo, foram analisados prontuários médicos e dados laboratoriais para coletar dados de indivíduos submetidos a procedimentos coronarianos percutâneos com MCI. Os dados coletados entre 2012 e 2015 avaliaram indivíduos que foram submetidos à HV e entre 2016 e 2020 (após a implementação de um protocolo de HO), os indivíduos que foram submetidos à HO em casa antes e depois de procedimentos coronarianos, conforme orientação da equipe de enfermagem. A significância estatística adotada foi de α=0,05. RESULTADOS: No total, 116 pacientes foram incluídos neste estudo, 58 no grupo HV e 58 no grupo HO. Observou-se incidência de NIC de 15% (9/58) no grupo que recebeu HV e 12% (7/58) no grupo que recebeu HO (p=0,68). CONCLUSÃO: O protocolo de HO realizado pelo paciente parece ser tão eficaz quanto o protocolo de HV hospitalar na proteção renal de indivíduos suscetíveis a desenvolver NIC em intervenções coronarianas eletivas. Essas descobertas devem ser testadas em ensaios mais abrangentes.

Eficácia da Hidratação Oral na Prevenção da Nefropatia Induzida por Contraste em Indivíduos Submetidos a Intervenções Coronárias Eletivas / Effectiveness of Oral Hydration in Preventing Contrast-Induced Nephropathy in Individuals Undergoing Elective Coronary Interventions

Resumo Fundamento A nefropatia induzida por contraste (NIC) é definida como deterioração da função renal, representada por um aumento da creatinina sérica ≥25% ou ≥0,5 mg/dL até 72 horas após a exposição ao meio de contraste iodado (MCI). A medida preventiva mais eficaz até o momento é a hidratação venosa (HV). Pouco se sabe sobre a eficácia da hidratação oral (HO) ambulatorial. Objetivo Investigar se a HO ambulatorial com água é tão eficaz quanto a HV com solução salina a 0,9% na prevenção de NIC em procedimentos coronarianos eletivos. Métodos Neste estudo observacional retrospectivo, foram analisados prontuários médicos e dados laboratoriais para coletar dados de indivíduos submetidos a procedimentos coronarianos percutâneos com MCI. Os dados coletados entre 2012 e 2015 avaliaram indivíduos que foram submetidos à HV e entre 2016 e 2020 (após a implementação de um protocolo de HO), os indivíduos que foram submetidos à HO em casa antes e depois de procedimentos coronarianos, conforme orientação da equipe de enfermagem. A significância estatística adotada foi de α=0,05. Resultados No total, 116 pacientes foram incluídos neste estudo, 58 no grupo HV e 58 no grupo HO. Observou-se incidência de NIC de 15% (9/58) no grupo que recebeu HV e 12% (7/58) no grupo que recebeu HO (p=0,68). Conclusão O protocolo de HO realizado pelo paciente parece ser tão eficaz quanto o protocolo de HV hospitalar na proteção renal de indivíduos suscetíveis a desenvolver NIC em intervenções coronarianas eletivas. Essas descobertas devem ser testadas em ensaios mais abrangentes.

Abstract Background Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). Objetive To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. Methods In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. Results In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). Conclusion The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.

Long term effect of the Pilates method in a reconstructed knee with osteoarthritis: A case report.

BACKGROUND: Osteoarthritis (OA) is one of the most debilitating diseases, and a patient with a reconstructed knee could develop it early and lives with this condition for an average of 30-years. Furthermore, most studies focus on short-term results, not long-term. The purpose of this article is to show how a patient with reconstructed knees and OA improved clinical outcomes using the Pilates Method (PM) in the long term. METHODS AND MATERIALS: The patient was treated with common medical treatment for 10 years and then treated with the PM for 15 years. Authors used the biomechanics-based approaches, radiographic examination of the knees, magnetic resonance imaging, the numeric pain rating scale, range of motion (ROM), the Polestar fitness screening test (PFST), the knee injury and osteoarthritis outcome score questionnaire (KOOS), and the physical function performance-based tests (PFPBT) recommended by Osteoarthritis Research Society International (OARSI). RESULTS: There was an improvement in the evaluated outcomes when using the PM in the long term: a decrease in pain-related scores (constant pain = - 4; worst pain = - 5), improved ROM in 15°, improved stability in both knees (right Lackman Test (LT) = -1; left LT = - 2). When comparing the patient with healthy women in the middle age through the PFPBT her scores are above average, with no restrictions in performing daily activities and a good quality of life according with the KOOS questionnaire. CONCLUSION: This case study suggests that long-term Pilates training may be useful for the treatment of pain, stiffness, and function in patients with reconstructed knees and OA.

Acolhimento institucional para crianças e adolescentes em situação de rua: pesquisa e políticas públicas / Institutional care for street children and adolescent: research and public policies

Neste artigo, analisamos os resultados de uma pesquisa realizada junto a crianças e adolescentes em instituições de acolhimento com trajetória de vida nas ruas. A pesquisa abordou 271 crianças e adolescentes, com idades entre 7 e 18 anos, nas 17 cidades brasileiras com mais de 1 milhão de habitantes. Destacamos o perfil majoritariamente masculino, adolescente e negro dos participantes, assim como seus desafios de inserção escolar e profissional, a violência vivenciada nas ruas, mas também em âmbito familiar, e os limites da rede de proteção na atenção a essa população. Consideramos a importância da inclusão das famílias no atendimento prestado às crianças e aos adolescentes acolhidos, respeitando o caráter provisório e excepcional do serviço de acolhimento institucional, assim como pontuamos as particularidades daqueles com trajetória de vida nas ruas, que exigem estratégias diferenciadas de cuidado. Os parâmetros normativos que hoje amparam o debate estão contemplados no texto, com a intenção de divulgá-los, mas também de chamar pesquisadores e profissionais ao debate acerca de sua implementação e de seu monitoramento.

In this article, the authors analyze the results of a study conducted with children and adolescents in institutional care about their trajectories living on the streets. The study included 271 young people between the ages of seven and eighteen in the seventeen Brazilian cities with populations of more than one million. A majority of our sample was male, adolescent and black. The study includes their difficulties in accessing school and work, the violence experienced on the streets, their family environments, and the limits of the protection provided by the care networks. We examine the importance of involving families in the institutional care of the young people, given the temporary and exceptional nature of institutional care. We also point out the particularities of their street trajectories which demand different strategies for caring. The norms which guide the current debate are considered with the intention of reporting them but also to alert researchers and professionals to the discussions about the implementation and monitoring of existing policies.

Endocarditis due to Trichosporon beigelii 11 years after mitral valve replacement. / Endocardite por Trichosporon beigelii 11 anos após cirurgia de troca valvar mitral.

Trichosporon beigelii is a non-pathogenic fungus that can however become an opportunist agent of disseminating and potentially fatal infections, especially in immunocompromised patients. In the literature, there are only 11 published cases of infective endocarditis due to T. beigelii. Most of these cases involved immunocompetent individuals and the main risk factor was the presence of a prosthetic valve. The longest interval between surgery and endocarditis was eight years. In the present study, a case of prosthetic valve endocarditis due to T. beigelii is reported in an immunocompetent patient 11 years after mitral valve replacement. As with similar cases, low clinical suspicion and negative blood cultures delayed the beginning of antifungal therapy and cardiac surgery. Considering the high mortality and severity of T. beigelii endocarditis, it should be considered when there is a prosthetic valve infection with negative blood cultures, irrespective of the time elapsed since the previous surgery.

Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients.

BACKGROUND: Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. OBJECTIVES: To evaluate the responsiveness of the CCVUQ-Br. METHODS: A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. RESULTS: Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. CONCLUSIONS: The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

Responsividade do questionário de qualidade de vida CCVUQ-Br em portadores de úlcera venosa crônica / Responsiveness of the CCVUQ-Br quality of life questionnaire in chronic venous ulcer patients

Resumo Contexto A responsividade consiste na capacidade de um instrumento em verificar se a pontuação reflete a variabilidade ocorrida na vida do paciente decorrente de uma intervenção. O CCVUQ-Br foi validado na língua portuguesa e necessita ter sua responsividade verificada. Quando finalizado este estudo, o CCVUQ-Br será utilizado como um instrumento capaz de perceber e refletir, na sua pontuação, as mudanças ocorridas na qualidade de vida do portador de úlcera venosa. Objetivos Avaliar a responsividade do CCVUQ-Br. Métodos Estudo de intervenção longitudinal, realizado em centros públicos e privados para pacientes com úlcera venosa. A amostra foi composta por portadores de úlcera venosa crônica submetidos à conduta terapêutica, tendo como variáveis as pontuações do CCVUQ-Br e de seus domínios, da escala visual analógica da dor (EVA dor) e da Escala de Avaliação Global de Mudança, além da classificação CEAP e o tamanho da úlcera. O CCVUQ-Br foi aplicado em 51 indivíduos submetidos a conduta terapêutica, recrutados de forma aleatória. Após 4 semanas, o CCVUQ-Br foi reaplicado. Resultados Houve diminuição das pontuações médias do CCVUQ-Br entre os dois momentos de aplicação, sendo que, no momento basal, a maior média de pontuação foi a do domínio Estado Emocional, com 63,45, diminuindo, após 4 semanas, para 52,00. Ainda apresentou correlações das mudanças com EVA dor e CEAP. Em relação ao tamanho do efeito, pode-se considerar que pontuação total do CCVUQ-Br e tamanho da úlcera apresentaram sensibilidade elevada, enquanto EVA dor e a maioria dos domínios do CCVUQ-Br apresentaram sensibilidade moderada . Conclusões O questionário CCVUQ-Br é sensível na população brasileira, apresentando garantia de resposta à amostra testada.

Abstract Background Responsiveness is a measure of an instrument's ability to reflect in its score the variability that has occurred in a patient's life as a result of an intervention. The CCVUQ-Br has been validated in Portuguese, but its responsiveness still needs to be tested. When this study has been completed, the CCVUQ-Br will be available for use as an instrument capable of detecting and reflecting in its score the changes that take place in the quality of life of people with venous ulcers. Objectives To evaluate the responsiveness of the CCVUQ-Br. Methods A longitudinal intervention study was conducted at public and private centers for patients with venous ulcers. The sample comprised people with chronic venous ulcers due to start treatment and the variables analyzed were CCVUQ-Br score and its domain scores, a pain visual analog scale (pain VAS), and the Global Assessment of Change Scale, in addition to CEAP classification, and size of ulcer. The CCVUQ-Br was administered to 51 people about to start treatment who were recruited at random. The CCVUQ-Br was then re-administered 4 weeks after treatment had started. Results Mean CCVUQ-Br scores reduced from the first to the second administration. The highest mean score at baseline was for the Emotional Status domain, at 63.45, which dropped to 52.00 after 4 weeks. There were also correlations between changes in CCVUQ-Br scores and pain VAS ratings and CEAP class. With regard to the effect size, total CCVUQ-Br score and ulcer size exhibited high sensitivity, while pain VAS and the majority of the CCVUQ-Br domains had moderate sensitivity. Conclusions The CCVUQ-Br questionnaire is sensitive in the Brazilian population and exhibited response to change in the sample tested.

Determination of the longitudinal sensitivity of the AVVQ-Brazil Quality of Life Questionnaire to non-surgical treatment of chronic venous disease.

BACKGROUND: Sensitivity determines the efficiency and quality of construction of an assessment measure, but studies of the subject are scarce in the literature. OBJECTIVE: To evaluate the longitudinal sensitivity of the AVVQ-Brazil to clinical changes after treatment for chronic venous disease (CVD). METHODS: A longitudinal intervention study, with 112 chronic venous patients receiving elective treatment, assessed with CEAP, VAPS, AVVQ-Brazil, and VEINES-QOL/Sym at pre-treatment (baseline) and post-treatment (4 weeks). Differences in the scores for the scales at different times were evaluated using Student's t test for paired samples and Wilcoxon's z, which were also used to asses individuals by CEAP grade and assessment time. Effect size, confidence intervals, and partial η2 were used to determine the sensitivity of changes in scale scores over time. Correlations between changes in the scores of the same scales and between different scales were measured using Pearson coefficients, Spearman coefficients, and Kendall's tau-b coefficient. RESULTS: The mean age of the patients was 59.51 years. The majority were female (82.1%), with standing for prolonged periods (49.1%), had completed secondary (22.3%) or higher (25%) education, and had CEAP C2 (28.6%) or C6 (32.1%) clinical severity. The following results were observed: mean scale scores reduced from baseline to post-treatment, except for the Extent of Varicosities domain of the AVVQ-Brazil and the VEINES-QOL/Sym scales; sensitivity was low for the AVVQ-Brazil and its domains and for the VAPS, and was from low to high for the other scales; there were improvements or maintenance of CEAP grade after treatment; and moderate to excellent correlations between changes in scale scores over time. CONCLUSIONS: The AVVQ-Brazil is sensitive to longitudinal clinical changes after treatment for CVD and is an important measure for assessment of QoL and of disease severity in Brazil.

Mitochondrial respiratory chain deficiency inhibits lysosomal hydrolysis.

Mitochondria are key organelles for cellular metabolism, and regulate several processes including cell death and macroautophagy/autophagy. Here, we show that mitochondrial respiratory chain (RC) deficiency deactivates AMP-activated protein kinase (AMPK, a key regulator of energy homeostasis) signaling in tissue and in cultured cells. The deactivation of AMPK in RC-deficiency is due to increased expression of the AMPK-inhibiting protein FLCN (folliculin). AMPK is found to be necessary for basal lysosomal function, and AMPK deactivation in RC-deficiency inhibits lysosomal function by decreasing the activity of the lysosomal Ca2+ channel MCOLN1 (mucolipin 1). MCOLN1 is regulated by phosphoinositide kinase PIKFYVE and its product PtdIns(3,5)P2, which is also decreased in RC-deficiency. Notably, reactivation of AMPK, in a PIKFYVE-dependent manner, or of MCOLN1 in RC-deficient cells, restores lysosomal hydrolytic capacity. Building on these data and the literature, we propose that downregulation of the AMPK-PIKFYVE-PtdIns(3,5)P2-MCOLN1 pathway causes lysosomal Ca2+ accumulation and impaired lysosomal catabolism. Besides unveiling a novel role of AMPK in lysosomal function, this study points to the mechanism that links mitochondrial malfunction to impaired lysosomal catabolism, underscoring the importance of AMPK and the complexity of organelle cross-talk in the regulation of cellular homeostasis. Abbreviation: ΔΨm: mitochondrial transmembrane potential; AMP: adenosine monophosphate; AMPK: AMP-activated protein kinase; ATG5: autophagy related 5; ATP: adenosine triphosphate; ATP6V0A1: ATPase, H+ transporting, lysosomal, V0 subbunit A1; ATP6V1A: ATPase, H+ transporting, lysosomal, V0 subbunit A; BSA: bovine serum albumin; CCCP: carbonyl cyanide-m-chlorophenylhydrazone; CREB1: cAMP response element binding protein 1; CTSD: cathepsin D; CTSF: cathepsin F; DMEM: Dulbecco's modified Eagle's medium; DMSO: dimethyl sulfoxide; EBSS: Earl's balanced salt solution; ER: endoplasmic reticulum; FBS: fetal bovine serum; FCCP: carbonyl cyanide-p-trifluoromethoxyphenolhydrazone; GFP: green fluorescent protein; GPN: glycyl-L-phenylalanine 2-naphthylamide; LAMP1: lysosomal associated membrane protein 1; MAP1LC3B/LC3B: microtubule associated protein 1 light chain 3 beta; MCOLN1/TRPML1: mucolipin 1; MEF: mouse embryonic fibroblast; MITF: melanocyte inducing transcription factor; ML1N*2-GFP: probe used to detect PtdIns(3,5)P2 based on the transmembrane domain of MCOLN1; MTORC1: mechanistic target of rapamycin kinase complex 1; NDUFS4: NADH:ubiquinone oxidoreductase subunit S4; OCR: oxygen consumption rate; PBS: phosphate-buffered saline; pcDNA: plasmid cytomegalovirus promoter DNA; PCR: polymerase chain reaction; PtdIns3P: phosphatidylinositol-3-phosphate; PtdIns(3,5)P2: phosphatidylinositol-3,5-bisphosphate; PIKFYVE: phosphoinositide kinase, FYVE-type zinc finger containing; P/S: penicillin-streptomycin; PVDF: polyvinylidene fluoride; qPCR: quantitative real time polymerase chain reaction; RFP: red fluorescent protein; RNA: ribonucleic acid; SDS-PAGE: sodium dodecyl sulfate polyacrylamide gel electrophoresis; shRNA: short hairpin RNA; siRNA: small interfering RNA; TFEB: transcription factor EB; TFE3: transcription factor binding to IGHM enhancer 3; TMRM: tetramethylrhodamine, methyl ester, perchlorate; ULK1: unc-51 like autophagy activating kinase 1; ULK2: unc-51 like autophagy activating kinase 2; UQCRC1: ubiquinol-cytochrome c reductase core protein 1; v-ATPase: vacuolar-type H+-translocating ATPase; WT: wild-type.

Educação permanente em saúde na emergência de um hospital universitário do Rio de Janeiro / Permanent health education in the emergency room of a university hospital in Rio de Janeiro

A Educação Permanente em Saúde (EPS) é uma proposta de educação no trabalho, de forma permanente e centrada no enfrentamento dos problemas que emergem do cotidiano nos serviços de saúde. Os objetivos do estudo foram: analisar as práticas de EPS no setor de emergência de um Hospital Universitário, na Região Metropolitana do Rio de Janeiro; conhecer o que os profissionais do setor de emergência compreendem sobre a EPS; analisar a possibilidade da prática de EPS das equipes do setor, investigando as dificuldades que envolvem a realização de EPS; e propor práticas interdisciplinares de EPS utilizando o método de oficinas com uso do Arco de Maguerez. Após revisão integrativa, foi realizada uma abordagem qualitativa do tipo descritiva, cujo cenário foi a emergência de um hospital universitário do Estado do Rio de Janeiro com 11 servidores da equipe multidisciplinar. Foi utilizado um roteiro estruturado com entrevista, gravação e transcrição na íntegra. Para a análise dos dados, optou-se pela Análise de Conteúdo na modalidade temática segundo Bardin (2009) e Minayo (2010). A maior parte dos participantes entende a EPS como oportunidade de atualização e aprimoramento, e apesar da Educação Continuada (EC) e Educação Permanente (EP) produzirem uma relação complementar e não excludente, fica explícito o conflito entre esses dois conceitos. Esporadicamente acontecem cursos e treinamentos, entretanto são restritos à equipe de enfermagem, fogem do conceito de EP, além de acontecerem fora do setor e horário de trabalho. Na perspectiva da interdisciplinaridade, os participantes entendem a sua importância para o trabalho, entretanto não a contemplam em seu cotidiano. Há grande dificuldade para o tratamento dos problemas no setor, as falas dos participantes traduzem todo o sentimento gerado pelo trabalho exaustivo na emergência. Os participantes sugerem clube de revista, grupos semanais ou mensais; encontros para reflexão e mudanças relacionadas à superlotação e deficiência de RH. Atualmente, a emergência apresenta melhora importante na qualidade de atendimento, sendo agora de fato referenciada e o quantitativo de recursos humanos hoje é satisfatório. Proponho com esse estudo oficinas, através de rodas de conversa com utilização do Arco de Maguerez, dando voz a todos os trabalhadores, permitindo que sejam protagonistas e sujeitos ativos do processo de mudança na emergência. Espera-se que os resultados possam contribuir de forma significativa para os gestores no sentindo de implantar efetivamente as reuniões de EPS nos hospitais através de rodas de conversa, de forma sistemática, interdisciplinar e centrada nos problemas que emergem do cotidiano dos serviços, além de acrescentar novos subsídios para prementes debates sobre a prática da EPS, particularmente em âmbito hospitalar.

Permanent Education in Health (EPS) is a proposition of education at work, permanently and focused on the problems that emerge from everyday health services. The objectives of the study were: to analyze EPS practices in the emergency department of a university hospital in the Rio de Janeiro Metropolitan Area; to know what emergency professionals understand about EPS; to analyze the possibilities of EPS practice by emergency teams , while investigating the difficulties involved on accomplishing EPS; and to suggest interdisciplinary practices of EPS through the workshop method using Maguerez' Arch. After producing an integrative review, we applied a qualitative descriptive approach to the research, whose scenario was the emergency sector of a university hospital in the State of Rio de Janeiro, with 11 multidisciplinary staff. A structured script containing interview, recording and full transcription was used. For data analysis, we chose the Content Analysis in the thematic modality, according to Bardin (2009) and Minayo (2010). Most participants understand EPS as an opportunity for updating and improvement, and although the relationship between Continuing Education (EC) and Permanent Education (EP) is a complementary and not an excluding one, the conflict between these two concepts is evident. Courses and trainings take place occasionally, however, they are restricted to the nursing staff, evade the concept of PE and happen outside the sector and not during working hours. Concerning interdisciplinarity, the participants understand its importance for the work, but do not contemplate it in their daily lives. There is great difficulty in dealing with problems in the sector; the participants' speeches reflect all the emotions generated by exhaustive work in the emergency. Participants suggest weekly or monthly magazine club groups; meetings for reflection; and changes concerning overcrowding and HR deficiency. Currently, the emergency presents a significant improvement in the quality of care, now being truly areference, and the amount of human resources is satisfactory. With this study I propose workshops through conversation circles, using the Maguerez' Arch, that would give voice to all workers, allowing them to be protagonists and active subjects of the emergency sector process of change. We hope that the results contribute significantly to managers, in the sense of effectively implementing EPS meetings in hospitals through conversation circles, in a systematic, interdisciplinary manner and centered on the problems that emerge from the daily routine of services. Also, that it may subside pressing debates on the practice of EPS, particularly in hospitals.

Use of transfer factor in immunosuppressed surgical patients.

OBJECTIVE: to evaluate the action of Transfer Factor on the immune response of patients with malignant neoplasm submitted to surgery, chemotherapy and radiotherapy. METHOD: we analyzed the variations of leukocytes, total lymphocytes, T-lymphocytes and CD4 counts in 60 patients submitted to immunostimulation with a single, daily dose of 0.5mg sublingual Transfer Factor, started simultaneously with chemotherapy and/or radiotherapy. RESULTS: there were statistically significant increases in the counts of all cell lines studied, more pronounced after 12 months of use of the medication. CONCLUSION: the Transfer Factor restored immune response and showed no side effects.

Use of transfer factor in immunosuppressed surgical patients / Avaliação do uso de fator de transferência na resposta imunológica de pacientes cirúrgicos imunodeprimidos

ABSTRACT Objective : to evaluate the action of Transfer Factor on the immune response of patients with malignant neoplasm submitted to surgery, chemotherapy and radiotherapy. Method: we analyzed the variations of leukocytes, total lymphocytes, T-lymphocytes and CD4 counts in 60 patients submitted to immunostimulation with a single, daily dose of 0.5mg sublingual Transfer Factor, started simultaneously with chemotherapy and/or radiotherapy. Results: there were statistically significant increases in the counts of all cell lines studied, more pronounced after 12 months of use of the medication. Conclusion: the Transfer Factor restored immune response and showed no side effects.

RESUMO Objetivo: avaliar a ação do Fator de Transferência na resposta imunológica de pacientes portadores de neoplasia maligna submetidos à cirurgia, quimioterapia e radioterapia. Método: análise das variações dos valores dos leucócitos, linfócitos totais, linfócitos T e CD4 em 60 pacientes submetidos à imunoestimulação com Fator de Transferência administrado em dose única de 0,5mg por via sublingual, diariamente e iniciada simultaneamente à quimioterapia e/ou radioterapia. Resultados: houve um aumento no número de todas as linhagens celulares estudadas que foi mais acentuada após 12 meses de uso da medicação. A análise estatística realizada com o software Graph Pad Instat, testadas pelo método Kolmogorov and Smirnov, mostrou que os resultados foram significativos. Conclusão: o Fator de Transferência restabeleceu a resposta imune e não apresentou efeitos colaterais.

Berberine-induced cardioprotection and Sirt3 modulation in doxorubicin-treated H9c2 cardiomyoblasts.

Doxorubicin (DOX) is one of the most widely used anti-neoplastic agents. However, treatment with DOX is associated with cumulative cardiotoxicity inducing progressive cardiomyocyte death. Sirtuin 3 (Sirt3), a mitochondrial deacetylase, regulates the activity of proteins involved in apoptosis, autophagy and metabolism. Our hypothesis is that pharmacological modulation by berberine (BER) pre-conditioning of Sirt3 protein levels decreases DOX-induced cardiotoxicity. Our results showed that DOX induces cell death in all experimental groups. Increase in Sirt3 content by transfection-mediated overexpression decreased DOX cytotoxicity, mostly by maintaining mitochondrial network integrity and reducing oxidative stress. p53 was upregulated by DOX, and appeared to be a direct target of Sirt3, suggesting that Sirt3-mediated protection against cell death could be related to this protein. BER pre-treatment increased Sirt3 and Sirt1 protein levels in the presence of DOX and inhibited DOX-induced caspase 9 and 3-like activation. Moreover, BER modulated autophagy in DOX-treated H9c2 cardiomyoblasts. Interestingly, mitochondrial biogenesis markers were upregulated in in BER/DOX-treated cells. Sirt3 over-expression contributes to decrease DOX cytotoxicity on H9c2 cardiomyoblasts, while BER can be used as a modulator of Sirtuin function and cell quality control pathways to decrease DOX toxicity.

Targeting Mitochondria in Cardiovascular Diseases.

BACKGROUND: Cardiovascular diseases (CVDs) are one of the main factors responsible for human morbidity and mortality. Since mitochondria play a critical role in the regulation of cardiac tissue homeostasis, this organelle is a critical target for the protective effects of several pharmaceuticals. Although specific mitochondria-targeted antioxidants and some pharmacological agents are described as potential cardioprotective agents, there are still a few effective mitochondrial therapies for the treatment of CVDs. Agents which have potential cardioprotective effects by directly targeting mitochondria in vitro and in vivo are still in pre-clinical or clinical trials, hence their widespread use in the clinic is still far. Also, some of these agents have a decreased bioavailability or show some intrinsic toxicity, which also limits their working mitochondrial concentrations. METHODS: By initially using PubMed specific queries for literature search, we review here cardiac mitochondrial effects of specific targeted and non-targeted antioxidants and pharmacological agents, including MitoE, MitoQ, MitoSNO, Mito-TEMPOL, SkQ1, SkQR1, carvedilol, trimetazidine, ranolazine, diazoxide and propofol. RESULTS: The present review emphasizes new mitochondrial-targeting strategies which have emerged to address difficulties arising from current approaches. We also describe the strengths and weaknesses of these cardioprotective approaches. CONCLUSION: Although effective therapies to target mitochondria in the context of CVDs are not under widespread clinical use, the new strategies proposed constitute a real promise for the development of therapies which may effectively prevent CVDs in the near future.

Tratamento fisioterapêutico vascular para a doença venosa crônica: artigo de revisão / Vascular physiotherapy for treatment of chronic venous disease: review article

A fisioterapia tem papel importante no processo de prevenção e recuperação de danos causados pela doença venosa crônica (DVC), com técnicas adequadas e focadas no quadro clínico da doença, sendo então denominada de fisioterapia vascular. O tratamento fisioterapêutico vascular precoce pode aliviar os sintomas da doença, reduzir o risco de úlceras venosas e melhorar a qualidade de vida do portador de DVC. O objetivo desta revisão de literatura foi elaborar um protocolo de tratamento fisioterapêutico vascular, mostrando evidências e benefícios das técnicas da fisioterapia vascular e sugerindo como podem ser utilizadas no tratamento da DVC. Trata-se de um estudo de revisão de literatura através de referências sobre o tema, considerando os materiais disponíveis nas bases de dados bibliográficos LILACS e SciELO, publicados no período de 1990 a 2014. Esse protocolo constitui uma proposta de tratamento direcionada às necessidades dos indivíduos com DVC, a fim de proporcionar uma melhor qualidade de vida.

Physiotherapy has an important role to play in prevention of and recovery from the damage cause by chronic venous disease (CVD), employing techniques that are adapted to and focused on clinical disease status, in which form it is known as vascular physiotherapy. Early initiation of treatment with vascular physiotherapy can relieve symptoms of the disease, reduce the risk of venous ulcers and improve the quality of life of CVD patients. The objective of this literature review was to develop a protocol for treatment with vascular physiotherapy, compiling evidence of the benefits of each vascular physiotherapy technique and suggesting how they can be used for treatment of CVD. This is a review of literature investigating the subject that is listed on the LILACS and SciELO bibliographic databases and was published from 1990 to 2014. The resulting protocol is a proposal for treatment oriented towards the requirements of people with CVD, with the objective of achieving better quality of life.

Validação do questionário de qualidade de vida na úlcera venosa crônica em língua portuguesa (Charing Cross Venous Ulcer Questionnaire -CCVUQ-Brasil) / Validation of the Portuguese language version of a chronic venous ulcer quality of life questionnaire (Charing Cross Venous Ulcer Questionnaire - CCVUQ-Brazil)

CONTEXTO: Instrumentos de qualidade de vida vêm sendo usados nos últimos anos. Para a úlcera venosa, há um importante questionário específico, o Charing Cross Venous Ulcer Questionnaire (CCVUQ), já traduzido para português em recente estudo, mas necessitando do teste de suas propriedades psicométricas e da consequente validação para ser utilizado no Brasil. OBJETIVOS: Validar o questionário de qualidade de vida na úlcera venosa em língua portuguesa, o CCVUQ-Brasil. MÉTODOS: A versão traduzida do questionário foi aplicada em 50 indivíduos. Sua consistência interna foi analisada, sendo posteriormente reaplicado (30 minutos e entre 7 e 15 dias após a primeira aplicação) para testar a reprodutibilidade. Os resultados foram comparados com o 36-Item Short Form Health Survey (SF-36) para testar a validade. RESULTADOS: A versão em português é semântica e culturalmente semelhante à versão original em inglês, tendo consistência interna satisfatória, alta correlação na verificação da reprodutibilidade e validade de constructo significativa. CONCLUSÕES: O CCVUQ-Brasil encontra-se validado na língua portuguesa.

BACKGROUND: The use of quality of life instruments has become widespread over recent years. There is an important questionnaire specifically designed for patients with venous ulcers, the Charing Cross Venous Ulcer Questionnaire (CCVUQ), which has already been translated into Portuguese as part of a recent study, but its psychometric properties still need to be tested to complete its validation for use in Brazil. OBJECTIVES: To validate the Portuguese version of a venous ulcer quality of life questionnaire, the CCVUQ-Brazil. METHODS: The translated version of the questionnaire was administered to 50 individuals and its internal consistency was analyzed. It was re-administered (30 minutes and 7 to 15 days after the first administration) in order to test its reproducibility. RESULTS: were compared with results for the 36-Item Short Form Health Survey (SF-36) to test validity. Results: The Portuguese version is semantically and culturally similar to the original version in English. It has satisfactory internal consistency, it exhibited high correlations in tests of reproducibility and it has significant construct validity. CONCLUSIONS: The Portuguese version of the CCVUQ-Brazil has been validated for use.

Análise dos efeitos dos exercícios aquáticos na qualidade de vida de indivíduos com doença venosa crônica / Analysis of the effects of aquatic exercise on the quality of life of people with chronic venous disease

CONTEXTO: O uso dos exercícios aquáticos se tornou uma modalidade terapêutica muito importante na doença venosa crônica (DVC). Tais exercícios têm sido apontados pela literatura como um mecanismo favorável ao retorno venoso, sendo importantes na reeducação vascular. Também contribuem para a diminuição da hipertensão venosa ocasionada pela doença, melhorando a qualidade de vida dos indivíduos acometidos. OBJETIVOS: Analisar os efeitos dos exercícios aquáticos na qualidade de vida de pacientes com DVC. MÉTODOS: Trata-se de um estudo-piloto, interventivo prospectivo longitudinal, composto por 16 indivíduos com DVC classificados de C1 a C5. Os participantes foram avaliados através de um formulário de coleta de dados e instruídos a responder dois questionários sobre qualidade de vida: SF-36 (Geral) e AVVQ-Brasil (específico para DVC), além da Escala Visual Analógica da dor (EVA). Em seguida, foram submetidos a 10 sessões de exercícios aquáticos, três vezes por semana, tendo respondido novamente aos questionários de qualidade de vida e EVA após o termino de todas as sessões. RESULTADOS: Os dados coletados foram tratados estatisticamente, com nível de significância de p < 0,05. Os pacientes apresentaram melhora na qualidade de vida medida pelo SF-36 nos domínios capacidade funcional, limitação e dor (p < 0,05). O nível de dor nos pacientes tratados reduziu segundo a EVA (p = 0,007). Em relação ao questionário AVVQ-Brasil, apenas o domínio Dor e Disfunção apresentou melhora significativa (p = 0,013). CONCLUSÃO: Os exercícios aquáticos foram capazes de melhorar aspectos da qualidade de vida e de reduzir a dor, demonstrando trazer benefícios para pacientes com DVC.

BACKGROUND: Aquatic exercises have become a very important therapeutic option for chronic venous disease (CVD). There is evidence in the literature showing that this type of exercise is a mechanism that improves venous return and is important in vascular reeducation. These exercises also help to reduce the venous hypertension caused by CVD, improving patients’ quality of life. OBJECTIVES: To analyze the effects of aquatic exercises on the quality of life of patients with CVD. METHODS: This was a longitudinal, prospective, interventional pilot study conducted with 16 people with CVD classified from C1 to C5. Participants were assessed at baseline using a data collection form and administration of two quality of life questionnaires, the SF-36 (Generic) and the AVVQ-Brazil (CVD-specific), and an Analog Visual Pain Scale (AVPS). They then undertook a program of 10 sessions of aquatic exercises, three times per week. The quality of life questionnaires and the AVPS were administered once more after all sessions had been conducted. RESULTS: The data collected were subjected to statistical analysis to a significance level of p < 0.05. Patients exhibited improved quality of life as measured by the SF-36 in the domains Physical functioning, Physical role limitation and Pain (p < 0.05). The patient's pain levels reduced after treatment according to the AVPS (p = 0.007). Only scores for the Pain and dysfunction domain of the AVVQ-Brazil questionnaire exhibited significant improvement (p = 0.013). CONCLUSIONS: Aquatic exercises were capable of improving aspects of quality of life and of reducing pain, demonstrating that they benefit patients with CVD.

Measuring p66Shc Signaling Pathway Activation and Mitochondrial Translocation in Cultured Cells.

The adaptor protein p66Shc links membrane receptors to intracellular signaling pathways, with downstream consequences on mitochondrial metabolism and reactive oxygen species production. Moreover, p66Shc has also been implicated in cancer development, progression, and metastasis. Increased phosphorylation of serine 36 residue of p66Shc very often correlates with oxidative stress-associated pathologies. The pro-oxidative role of p66Shc also appears to be involved in chemical toxicity, being an important component of stress responses triggered by xenobiotics. Here, we present a protocol that can be used: (a) for isolation of mitochondrial, cytosolic, and mitochondrial-associated membrane fractions from adherent cells lines; (b) to perform p66Shc detection with specific antibodies in order to monitor its translocation between different cellular compartments in response to the oxidative stress; and (c) to modulate the p66Shc pathway with the use of pharmacological approaches or gene-silencing methods.

Fisioterapia vascular no tratamento da doença venosa crônica / Vascular physiotherapy in treatment of chronic venous disease

A aplicação da fisioterapia vascular através dos exercícios terapêuticos e da drenagem linfática manual (DLM) na Doença Venosa Crônica (DVC) contribui para a minimização das alterações vasculares, com melhora do retorno venoso, diminuindo a estase sanguínea e contribuindo para a melhora do quadro clínico.ObjetivoVerificar a eficácia da fisioterapia vascular no tratamento da DVC.MétodosEstudo-piloto prospectivo longitudinal, que avaliou dez pacientes com DVC, com classificação CEAP (1-5), que responderam aos questionários de qualidade de vida (QV) SF-36 e AVVQ, sendo submetidos a pletismografia a água e goniometria dos membros inferiores. Finalizada a avaliação inicial, receberam tratamento fisioterapêutico vascular, com exercícios terapêuticos e DLM, em dez sessões de 60 minutos. Após tratamento, foram novamente avaliadas pela aplicação dos questionários iniciais e realização dos métodos de mensuração volumétrica e de amplitude de movimento articular (ADM).ResultadosPacientes do gênero feminino, com idade média de 43,1 anos. Nas atividades de vida prática (AVPs), a posição predominante foi ortostatismo prolongado. Na classificação CEAP, a maioria das pacientes apresentou C3 e apenas 10% delas eram C2. Nos questionamentos sobre suas principais queixas, relataram sensação de peso e cansaço nos membros, dor nas pernas, prurido e edema. Após as sessões de fisioterapia vascular, todas as pacientes encontravam-se sem queixas. A ADM e a QV apresentaram melhora significativa após intervenção da fisioterapia vascular.ConclusãoA fisioterapia vascular contribui para o controle do quadro clínico da DVC, melhorando edema e ADM, e favorecendo a melhora da QV dos acometidos pela doença.

In chronic venous disease (CVD), vascular physiotherapy in the form of therapeutic exercises and manual lymph drainage (MLD) contributes to reducing vascular disorders, with improved venous return, reduced venous stasis and improved clinical status.ObjectiveTo investigate the efficacy of vascular physiotherapy in treatment of CVD.MethodsA prospective, longitudinal pilot study that assessed ten patients with CVD, with CEAP classifications from 1 to 5. Patients were administered the SF-36 and AVVQ quality of life questionnaires and underwent water plethysmography and goniometry of the lower limbs. After initial assessments they were given ten 60-minute sessions of vascular physiotherapy consisting of therapeutic exercises and MLD. After treatment they were once more assessed using the same questionnaires and methods for volumetric measurement and assessment of joint movement amplitude (JMA).ResultsThe patients were all female, with a mean age of 43.1 years. Their predominant positions during practical activities of life was prolonged and orthostatic. The majority of the patients had a CEAP classification of C3 and just 10% were C2. When questioned about their principal complaints, they reported feelings of heaviness and tiredness in their limbs, pain in their legs, itching and swelling. After the vascular physiotherapy sessions all patients were free from complaints. Both JMA and quality of life improved significantly after the intervention with vascular physiotherapy.ConclusionsVascular physiotherapy contributed to controlling the clinical manifestations of CVD, improving edema and JMA, and promoting improved quality of life for patients.