Vascular calcification in peritoneal dialysis patients and its association with bone-derived molecules and bone histomorphometry / Calcificación vascular en pacientes en diálisis peritoneal y su asociación con moléculas derivadas de hueso e histomorfometría ósea

Introduction: Data regarding vascular calcification (VC) in contemporary peritoneal dialysis (PD) patients is scarce. Bone–vascular axis has been demonstrated in hemodialysis (HD). However, studies showing the link between bone disease and VC in PD patients are lacking. The role of sclerostin, dickkopf-related protein 1 (DKK-1), receptor activator for nuclear factor kB ligand and osteoprotegerin (OPG) in VC in PD remains to clarify. Materials and methods: Bone biopsy was performed in 47 prevalent PD patients with histomorphometric analysis. Patients were submitted to pelvis and hands X-ray to evaluate VC using the Adragão score (AS). Relevant clinical and biochemical data was collected. Results: Thirteen patients (27.7%) had positive AS (AS≥1). Patients with VC were significantly older (58.9 vs. 50.4 years, p=0.011), had a lower dialysis dose (KT/V 2.0 vs. 2.4, p=0.025) and a higher glycosylated hemoglobin (7.2 vs. 5.4%, p=0.001). There was not any laboratorial parameter of mineral and bone disease used in clinical practice different between patients with or without VC. All diabetic patients had VC but only 8.1% of non-diabetic had VC (p<0.001). Patients with VC showed significantly higher erythrocyte sedimentation rate (ESR) (91.1 vs. 60.0mm/h, p=0.001), sclerostin (2250.0 vs. 1745.8pg/mL, p=0.035), DKK-1 (1451.6 vs. 1042.9pg/mL, p=0.041) and OPG levels (2904.9 vs. 1518.2pg/mL, p=0.002). On multivariate analysis, only ESR remained statistically significant (OR 1.07; 95% CI 1.01–1.14; p=0.022). Bone histomorphometric findings were not different in patients with VC. There was no correlation between bone formation rate and AS (r=−0.039; p=0.796). Conclusion: The presence of VC was not associated with bone turnover and volume evaluated by bone histomorphometry. Inflammation and diabetes seem to play a more relevant role in VC in PD. (AU)

Introducción Los datos sobre calcificación vascular (CV) en pacientes contemporáneos en diálisis peritoneal (DP) son escasos. En pacientes en hemodiálisis, se ha demostrado la existencia de una conexión entre hueso y sistema vascular; sin embargo, faltan estudios que muestren el vínculo entre la enfermedad ósea y la CV en pacientes en DP. Si la esclerostina, la proteína relacionada con Dickkopf 1 (DKK-1), el ligando del receptor activador para el factor nuclear κB (RANKL) y la osteoprotegerina (OPG) tienen un papel en la CV en pacientes en DP aún no está claro. Materiales y métodos Se realizó biopsia ósea en 47 pacientes prevalentes en DP y se analizó mediante histomorfometría. También se tomaron radiografías de pelvis y manos a los pacientes para evaluar la CV mediante el Índice de Adragão (IA). Además, se analizaron datos clínicos y bioquímicos relevantes. Resultados: Trece pacientes (27,7%) tuvieron IA positivo (IA ≥ 1). Los pacientes con CV eran significativamente mayores (58,9 vs 50,4 años, p=0,011) tenían menor dosis de diálisis (KT/V 2,0 vs 2,4, p=0,025) y niveles más elevados de hemoglobina glicosilada (7,2 vs 5,4%, p=0,001). No hubo ningún parámetro de laboratorio de enfermedad mineral y ósea utilizado en la práctica clínica diferente entre pacientes con o sin CV. Todos los pacientes diabéticos mostraron CV, sin embargo, solo el 8,1% de los no diabéticos tenían CV (p <0,001). Además, los pacientes con CV mostraron una velocidad de sedimentación globular más elevada (VSG) (91,1 vs. 60,0mm/h, p=0,001) y mayores concentraciones séricas de esclerostina (2.250,0 vs. 1.745,8 pg/ml, p=0,035), DKK-1 (1451,6 vs 1042,9 pg/ml, p=0,041) y OPG (2.904,9 vs. 1.518,2 pg/ml, p=0,002). En el análisis multivariante, solo la VSG fue estadísticamente significativa (OR 1,07; IC del 95%: 1,01-1,14; p=0,022)... (AU)

Miconazole-loaded nanoparticles coated with hyaluronic acid to treat vulvovaginal candidiasis.

Miconazole-loaded nanoparticles coated with hyaluronic acid (miconazole-loaded nanoparticles/HA) were developed to overcome the limitations of the conventional therapy of the vulvovaginal candidiasis (VVC). They were synthesized by emulsification and solvent evaporation techniques, characterized by diameter, polydispersity index, zeta potential, encapsulation efficiency, atomic force microscopy (AFM), evaluated in terms of efficacy against C. albicans in vitro, and tested in a murine VVC model. Nanoparticles showed 211nm of diameter with a 0.32 polydispersity index, -53mV of zeta potential, and 90% miconazole encapsulation efficiency. AFM evidenced nanoparticles with a spherical shape. They inhibited the proliferation of C. albicans in vitro and in vivo after a single administration. Nanoparticles released the miconazole directly in the site of action at low therapeutic doses, which was enough to eliminate the fungal burden in the murine VVC model. These systems were rationally designed since the existence of the HA induces their adhesion on the vaginal mucus and their internalization via CD44 receptors, inhibiting the C. albicans. Therefore, miconazole-loaded nanoparticles/HA represent an innovative non-conventional pharmaceutical dosage form to treat the VVC and recurrent VVC.

Vascular calcification in peritoneal dialysis patients and its association with bone-derived molecules and bone histomorphometry.

INTRODUCTION: Data regarding vascular calcification (VC) in contemporary peritoneal dialysis (PD) patients is scarce. Bone-vascular axis has been demonstrated in hemodialysis (HD). However, studies showing the link between bone disease and VC in PD patients are lacking. The role of sclerostin, dickkopf-related protein 1 (DKK-1), receptor activator for nuclear factor kB ligand and osteoprotegerin (OPG) in VC in PD remains to clarify. MATERIALS AND METHODS: Bone biopsy was performed in 47 prevalent PD patients with histomorphometric analysis. Patients were submitted to pelvis and hands X-ray to evaluate VC using the Adragão score (AS). Relevant clinical and biochemical data was collected. RESULTS: Thirteen patients (27.7%) had positive AS (AS≥1). Patients with VC were significantly older (58.9 vs. 50.4 years, p=0.011), had a lower dialysis dose (KT/V 2.0 vs. 2.4, p=0.025) and a higher glycosylated hemoglobin (7.2 vs. 5.4%, p=0.001). There was not any laboratorial parameter of mineral and bone disease used in clinical practice different between patients with or without VC. All diabetic patients had VC but only 8.1% of non-diabetic had VC (p<0.001). Patients with VC showed significantly higher erythrocyte sedimentation rate (ESR) (91.1 vs. 60.0mm/h, p=0.001), sclerostin (2250.0 vs. 1745.8pg/mL, p=0.035), DKK-1 (1451.6 vs. 1042.9pg/mL, p=0.041) and OPG levels (2904.9 vs. 1518.2pg/mL, p=0.002). On multivariate analysis, only ESR remained statistically significant (OR 1.07; 95% CI 1.01-1.14; p=0.022). Bone histomorphometric findings were not different in patients with VC. There was no correlation between bone formation rate and AS (r=-0.039; p=0.796). CONCLUSION: The presence of VC was not associated with bone turnover and volume evaluated by bone histomorphometry. Inflammation and diabetes seem to play a more relevant role in VC in PD.

Closing the Gap: A Case Report on a Blood Patch Solution for Cerebrospinal Fluid Leak.

Spontaneous intracranial hypotension is a condition resulting from cerebrospinal fluid leaks at the spinal level that disrupt the regulation of intracranial pressure. This disorder is an uncommon cause of debilitating headaches but can have variable clinical manifestations, which contributes to delayed diagnosis and potentially severe consequences. The standard treatment consists of conservative measures such as bed rest, hydration, and a pharmacological approach with paracetamol, caffeine, ergotamine, and dexamethasone. When conservative measures fail, an epidural blood patch is the gold standard treatment, where a small amount of blood is injected into the epidural space to form a clot to seal any existing leak. Recent studies showed a success rate of 64% without the need for further intervention. The authors report a case of a 55-year-old woman with a three-month history of daily severe headaches. Imaging exams showed subdural collections, suggesting the hypothesis of cerebrospinal fluid hypotension. After the failure of conservative measures, an epidural blood patch was performed with progressive clinical improvement.  This case demonstrates the potential effectiveness of an epidural blood patch in the management of spontaneous intracranial hypotension and its complications, offering an encouraging option for those unresponsive to conservative measures. It also highlights the importance of a multidisciplinary approach involving neurologists and anesthesiologists.

Impacto da pandemia na saúde mental dos discentes de enfermagem no contexto da COVID-19 / Impact of the pandemic on the mental health of nursing students in the context of COVID-19 / Impacto de la pandemia en la salud mental de los estudiantes de enfermería en el contexto del COVID-19

Objetivo: Investigar os impactos da pandemia da COVID-19 na saúde mental dos discentes de enfermagem e avaliar a relação entre o evento e os indicadores para transtorno de estresse pós-traumático (TEPT). Método: estudo exploratório, analítico, transversal, com abordagem quantitativa. A amostra estudada foi constituída por 164 estudantes de uma instituição de ensino superior privada, matriculado no curso de Enfermagem, convidado por meio eletrônico, que responderam ao questionário on-line sobre dados sociodemográficos, percepção de risco pela pandemia COVID-19 e sintomas de estresse pós-traumático avaliados pela Impact of Event Scale (IES-R) em sua versão brasileira validada. Resultados: A maioria dos participantes eram da faixa etária de 18 a 23 anos (70,8%), do sexo feminino (91,5%), sem filhos (86%), residem com 2 a 4 pessoa (75%). 51,2% apresentam indicação alta para TEPT, 14,0% apresentam preocupação clínica para TEPT. Houve associação do escore da IES-R com a idade, quantidade de filhos e quantidade de pessoas com quem reside. Conclusão: O evento da pandemia da Covid-19 provocou um impacto na saúde mental dos discentes de Enfermagem, com uma elevada classificação de participantes com indicação alta para TEPT. Esses dados são importantes para futuras intervenções psicológicas e pedagógicas entre estudantes.

Objective: To investigate the impacts of the COVID-19 pandemic on the mental health of nursing students and to assess the relationship between the event and the indicators for post-traumatic stress disorder (PTSD). Method: exploratory, analytical, cross-sectional study with a quantitative approach. The sample studied consisted of 164 students from a private higher education institution, enrolled in the Nursing course, invited by electronic means, who answered the online questionnaire on sociodemographic data, risk perception by the COVID-19 pandemic and symptoms of stress. trauma assessed by the Impact of Event Scale (IES-R) in its validated Brazilian version. Results: Most participants were aged between 18 and23 years (70.8%), female (91.5%), without children (86%), living with 2 to 4 people (75%). 51.2% have a high indication for PTSD, 14.0% have clinical concern for PTSD. There was an association of the IES-R score with age, number of children and number of people with whom they live. Conclusion: The Covid-19 pandemic event had an impact on the mental health of Nursing students, with a high rating of participants with a high indication for PTSD. These data are important for future psychological and pedagogical interventions among students.

Objetivo: Investigar los impactos de la pandemia de COVID-19 en la salud mental de estudiantes de enfermería y evaluar la relación entre el evento y los indicadores de trastorno de estrés postraumático (TEPT). Método: estudio exploratorio, analítico, transversal con enfoque cuantitativo. La muestra estudiada estuvo conformada por 164 estudiantes de una institución de educación superior privada, matriculados en la carrera de Enfermería, invitados por medios electrónicos, quienes respondieron el cuestionario en línea sobre datos sociodemográficos, percepción de riesgo por la pandemia del COVID-19 y síntomas de estrés y trauma evaluados por la Escala de Impacto de Evento (IES-R) en su versión brasileña validada. Resultados: La mayoría de los participantes tenían entre 18 y 23 años (70,8%), sexo femenino (91,5%), sin hijos (86%), viviendo con 2 a 4 personas (75%). El 51,2% tiene una alta indicación de TEPT, el 14,0% tiene preocupación clínica por TEPT. Hubo asociación del puntaje IES-R con la edad, número de hijos y número de personas con las que conviven. Conclusión: El evento pandémico de la Covid-19 tuvo impacto en la saludmental de los estudiantes de Enfermería, con alta calificación de participantes con alta indicación para TEPT. Estos datos son importantes para futuras intervenciones psicológicas y pedagógicas entre los estudiantes.

Evaluation of Renal Osteodystrophy and Serum Bone-Related Biomarkers in a Peritoneal Dialysis Population.

The spectrum of renal osteodystrophy (ROD) in peritoneal dialysis (PD) patients remains to be clarified. Ideal intact parathormone (iPTH) levels range is still not defined. The role of sclerostin, dickkopf-related protein 1, osteoprotegerin, and receptor activator for nuclear factor κB ligand for the diagnosis of ROD needs to be elucidated. In this cross-sectional study, tetracycline double-labeled bone biopsy was performed in 49 patients with histomorphometric analysis according Kidney Disease Improving Global Outcomes (KDIGO) guidelines. All patients were treated with biocompatible PD solutions, with calcium concentration of 1.25 mmol/L. Adynamic bone was the most frequent diagnosed pattern (42.9%) followed by hyperparathyroid-related bone disease (28.6%). Twenty-two percent of patients had normal bone. In patients with iPTH within the KDIGO recommended range for dialysis patients, adynamic bone was found in 59% of cases. Median (range) iPTH in patients with adynamic bone was 312 (60-631) pg/mL. Median (range) levels of sclerostin varied from 1511.64 (458.84-6387.70) pg/mL in patients with hyperparathyroid bone disease to 2433.1 (1049.59-11354.52) pg/mL in patients with adynamic bone. Sclerostin/iPTH ratio was the best marker of low turnover disease but iPTH performed best in the diagnosis of high turnover disease. Calcium mass transfer was positive in patients with low bone volume. Adynamic bone is the most frequent ROD pattern in contemporary PD. Our results suggest the need to review the iPTH target range for this population. The sclerostin/iPTH ratio showed improved performance compared to iPTH for the diagnosis of low turnover bone. © 2022 American Society for Bone and Mineral Research (ASBMR).

The Acute Impact of the Early Stages of COVID-19 Pandemic in People with Pre-Existing Psychiatric Disorders: A Systematic Review.

People with pre-pandemic health conditions are more vulnerable and more likely to suffer greater psychosocial impact due to the current COVID-19 pandemic and the lockdown measures. Thus, the objective of this work was to systematically review the impact of the early stages COVID-19 pandemic on people with pre-existing psychiatric disorders. The search was performed between 23 January and 2 September 2021 in PubMed, PsycINFO, and EMBASE. A total of 4167 published results were identified; however, only 49 were included in this review. Results show that there was considerable heterogeneity among studies, which resulted in a low consensus. However, it seems that the impact of the first stage of the COVID-19 pandemic on psychiatric disorders was two-fold: (1) an overall effect, in which people suffering from psychiatric disorders in general experienced more psychological distress and anxiety when compared to people who had no psychiatric diagnosis, and (2) a condition-specific effect, namely in people suffering from eating disorders and obsessive compulsive disorders. Moreover, the current work highlights that there were also some external factors that were related to worsening symptoms. For instance, unemployment or experiencing work and financial difficulties can be a trigger for greater distress during the pandemic for people with mood disorders, and being alone and in social isolation during the COVID-19 pandemic may actually increase substance use and relapse rates. Further studies are needed to prospectively investigate the long-term effects of the current COVID-19 pandemic on people with (pre)-existing psychiatric conditions and on the onset or deterioration of psychiatric-related symptoms in a larger number of participants, as well as exploring the long-term effects of the current pandemic on mental health.

General versus regional anaesthesia for hip fracture surgery - impact on mortality and length of stay.

BACKGROUND: Hip fractures are extremely common and are considered a public health problem. The best anaesthetic technique for this surgery remains controversial. The aim of this study is to determine the impact of anaesthesia on perioperative and 30-day mortality and length of stay, in patients undergoing hip fracture surgery. MATERIAL: Adults undergoing hip fracture surgery, between January 1st, 2017 and December 31st, 2018, were retrospectively identified and categorized according to the anaesthetic technique. Perioperative and 30-day mortality rates and the length of stay were analysed. RESULTS: We identified 562 patients who underwent hip fracture surgery, 361 of whom were submitted to general anaesthesia and 201 to regional anaesthesia. The adjusted analysis showed no statistically significant difference in the risk of perioperative and 30-day mortality (odds ratio 1.12, 95% CI: 0.62-2.03; odds ratio 1.17, 95% CI: 0.72-1.92) or length of stay (0, 9 days [-1.6 to 3.4], P = 0.301). CONCLUSIONS: Our results were similar to those of studies already published in other countries. Within the limitations of our study, we concluded that there is no impact of the anaesthetic technique on perioperative and 30-day mortality rates and on the length of stay, for hip fracture surgery. In future studies, it will be opportune to investigate factors that influence the safety of anaesthetic techniques and that are subject to intervention by the anaesthesiologist.

Minute Zero: an essential assessment in peri-operative ultrasound for anaesthesia.

In recent years, ultrasonography has gained unmatched importance in medical practice. After the initial use for central vascular access placement and regional anaesthesia, its application has expanded to airway, ocular, abdominal, lung and cardiac ultrasound, with the concept of point of care ultrasound (POCUS) gaining acceptability and applicability in the most diverse situations. In fact, it has recently been acclaimed as the fifth pillar to bedside evaluation [1]. Performing a POCUS-guided eva-luation has proved to be of value in emergency medicine, with studies demonstrating improved diagnosis and better outcomes [2]. Similarly, in critical care, systematic ultrasound evaluation has been shown to decrease the use of conventional diagnostic imaging tools and time on mechanical ventilation and improve the management of fluid therapy [3]. Recognition of the benefit of ultrasound evaluation in the perioperative period has been increasing. In fact, the need to master clinical ultrasound evaluation has led the Canadian anaesthesiology academic centres to issue recommendations regarding the scope of practice and required training for perioperative POCUS [4].

Effect of vitamin D sterols on bone histology in pre-dialysis patients: A prospective controlled study.

BACKGROUND: Abnormalities related to mineral and bone metabolism are a common finding in chronic kidney disease (CKD). Vitamin D compounds are often prescribed to CKD patients with the purpose to control secondary hyperparathyroidism and reduce the risk of high-turnover bone disease. However, data on the effect of vitamin D sterols on bone histology in non-dialysis CKD is limited. MATERIALS AND METHODS: A prospective controlled study was conducted on a cohort of 56 patients with CKD stages 3 and 4. 19 patients on calcitriol and 12 patients on cholecalciferol were compared to a group of 25 age- and sex-matched controls. Participants underwent a tetracycline double-labelled transiliac bone biopsy before starting therapy and again 12 months later. Changes from baseline in circulating biomarkers and bone histomorphometric parameters were analyzed. RESULTS: Low-turnover bone disease was the most common pattern of renal osteodystrophy on the initial biopsy. There was no difference in biochemical or histomorphometric values between the three study groups at baseline. Serum intact parathormone (iPTH) and bone formation rate decreased significantly in calcitriol-treated patients, with prevalence of low-turnover bone disease doubling from baseline. In contrast, no significant changes were noted in cholecalciferol-treated and control subjects. CONCLUSION: Calcitriol was effective in preventing secondary hyperparathyroidism and high-turnover bone disease. However, it was associated with an increased risk of developing or aggravating low-turnover bone disease. In the absence of a bone biopsy, calcitriol use in pre-dialysis CKD should be reserved for patients with a progressive rise in iPTH levels, in whom high-turnover bone disease is suspected.

Could Bone Biomarkers Predict Bone Turnover after Kidney Transplantation?-A Proof-of-Concept Study.

AIM: Bone disease after kidney transplant (KT) results from multiple factors, including previous bone and mineral metabolism disturbances and effects of transplant-related medications. New biomolecules have been recently associated with the development and progression of the chronic kidney disease-associated bone and mineral disorder (CKD-MBD). These include sclerostin and the soluble receptor activator of nuclear factor-kB ligand (sRANKL). METHODS: To better understand the role of biomarkers in post-transplant bone disease, this study was designed to prospectively evaluate and correlate results from the histomorphometric analysis of bone biopsies after KT with emerging serum biomarkers of the CKD-MBD: sclerostin, Dickkopf-related protein 1 (Dkk-1), sRANKL and osteo-protegerin (OPG). RESULTS: Our data shows a significant increase in plasma levels of bioactive sclerostin after KT accompanied by a significant reduction in plasma levels of Dkk-1, suggesting a promotion of the inhibition of bone formation by osteoblasts through the activation of these inhibitors of the Wnt signaling pathway. In addition, we found a significant increase in plasma levels of free sRANKL after KT accompanied by a significant reduction in plasma levels of its decoy receptor OPG, suggesting an enhanced bone resorption by osteoclasts mediated by this mechanism. CONCLUSIONS: Taken together, these results suggest that the loss of bone volume observed after KT could be explain mainly by the inhibition of bone formation mediated by sclerostin accompanied by an enhanced bone resorption mediated by sRANKL.

Perfil epidemiológico dos casos de sífilis congênita e gestacional no Estado do Piauí, Brasil / Epidemiological profile of congenital and gestational syphilis cases in the State of Piauí, Brazil

O estudo buscou conhecer o perfil epidemiológico da sífilis congênita e em gestantes residentes no Estado do Piauí no período de 2007 a 2017. Realizou-se um estudo epidemiológico do tipo ecológico entre os meses de janeiro e fevereiro de 2019 no Sistema de Informação de Agravos de Notificação e Sistema de Informação Sobre Nascidos Vivos. A incidência de sífilis congênita foi crescente durante o período estudado (2007 a 2017) com destaque para a Região de Saúde "Entre Rios". Em relação aos neonatos, são prevalentemente diagnosticados com até 6 dias de vida (94,5%), sexo masculino (49,9%), raça/cor parda (66,4%), sífilis recente (82,8%) e evolução vivos (91,9%). As gestantes têm faixa etária de 20 a 39 anos (69,9%), cor parda (70,5%), baixa escolaridade (28,9%), realizaram pré-natal (85,4%), receberam diagnóstico durante pré-natal (46,6%), não realizaram teste treponêmico (46,2%), o teste não-treponêmico foi reativo (86,8%), apresentaram forma primária da doença (30,5%) e parceiros sem tratamento (60,8%). Faz-se necessário melhorar as ações de vigilância e assistência pré-natal que resultem no planejamento e adoção de intervenções a fim de modificar o quadro epidemiológico.

This study aimed to identify the epidemiological profile of congenital syphilis in pregnant women residing in the State of Piauí from 2007 to 2017. An ecological epidemiological study was carried out between January and February 2019 in the Notifiable Diseases Information System and the Live Births Information System. The incidence of congenital syphilis increased during the period studied (2007 to 2017), with an emphasis in the "Entre Rios" Health Region. Regarding neonates, they were predominantly diagnosed with up to 6 days of life (94.5%), males (49.9%), mixed race/color (66.4%), recent syphilis (82.8%), and evolved to live (91.9%). Pregnant women are aged between 20 and 39 years (69.9%), brown color (70.5%), low schooling (28.9%), underwent prenatal care (85.4%), received diagnosis during prenatal care (46.6%), did not undergo a treponemal test (46.2%), the non-treponemal test was reactive (86.8%), had a primary form of the disease (30.5%), and partners without treatment (60.8%). It is necessary to improve surveillance and prenatal care actions that result in the planning and adoption of interventions in order to change this epidemiological picture.

Diagnósticos e intervenções de enfermagem em crianças com transtorno do espectro autista: perspectiva para o autocuidado / Diagnósticos e intervenciones de enfermería en niños con trastorno del espectro autista: perspectiva para el autocuidado / Nursing diagnoses and interventions in children with autism spectrum disorder: perspective for self-care

Objetivo: descrever os diagnósticos e as intervenções de enfermagem em crianças com transtorno do espectro autista fundamentados em taxonomias de enfermagem e na teoria do autocuidado. Método: estudo exploratório e descritivo, com abordagem qualitativa com 11 crianças e embasado na aplicação do processo de enfermagem. Utilizou-se taxonomia International Nursing Diagnoses: definitions and classification, para definição dos diagnósticos de enfermagem, a teoria do autocuidado e as recomendações da Nursing Interventions Classification para planejamento das intervenções. Resultados: isolamento social, falta de motivação e dependência para execução de atividades constituíram os principais problemas levantados. As afirmativas diagnósticas que possibilitaram a estruturação de 27 intervenções de enfermagem, compreenderam o déficit no autocuidado para alimentação, banho e higiene íntima; o isolamento social; e a disposição para melhora do autocuidado. Considerações finais: a capacidade para o autocuidado esteve comprometida, requerendo estratégias de enfermagem efetivas voltadas para a criança e para os familiares.

Objetivo: describir diagnósticos e intervenciones de enfermería en niños con trastorno del espectro autista basados en taxonomías de enfermería y teoría del autocuidado. Método: estudio exploratorio y descriptivo, con abordaje cualitativo con 11 niños y basado en la aplicación del proceso de enfermería. International Nursing Diagnoses: se utilizó la taxonomía de definitions and classification para definir los diagnósticos de enfermería, la teoría del autocuidado y las recomendaciones de Nursing Interventions Classification para la planificación de la intervención. Resultados: el aislamiento social, la falta de motivación y la dependencia para realizar actividades fueron los principales problemas planteados. Las declaraciones diagnósticas que permitieron la estructuración de 27 intervenciones de enfermería comprendieron el déficit en el autocuidado de la alimentación, el baño y la higiene íntima; aislamiento social; y la voluntad de mejorar el autocuidado. Consideraciones finales: la capacidad de autocuidado se vio comprometida, requiriendo estrategias de enfermería efectivas dirigidas al niño y a los miembros de la familia.

Objective: to describe nursing diagnoses and interventions in children with autism spectrum disorder based on nursing taxonomies and self-care theory. Method: exploratory and descriptive study, with a qualitative approach with 11 children and based on the application of the nursing process. International Nursing Diagnoses: definitions and classification taxonomy was used to define nursing diagnoses, self-care theory and nursing interventions classification recommendations for intervention planning. Results: social isolation, lack of motivation and dependence to perform activities were the main problems raised. The diagnostic statements that allowed the structuring of 27 nursing interventions comprised the deficit in self-care for food, bathing and intimate hygiene; social isolation; and the willingness to improve self-care. Final considerations: the capacity for self-care was compromised, requiring effective nursing strategies aimed at the child and family members.

Experiences of family members of children diagnosed with autism spectrum disorder.

OBJECTIVE: To describe, in the mothers' perception, the experiences lived by families in the care of children with autism spectrum disorder. METHOD: Qualitative study, carried out with 20 mothers of children diagnosed with autistic disorder accompanied by an institution in Teresina-Piauí, Brazil. Semi-structured interviews were conducted between February and March 2019 and subjected to content analysis. RESULTS: Five central ideas related to the stages experienced by family members after the diagnosis were identified, ranging from denial to acceptance. Family members and caregivers experience feelings of sadness and mourning for the discovery of the impossibility of curing the syndrome, revealing the need for care for this family. The search for help and adaptations of the routine are constant experiences. CONCLUSION: Caring for children who live with autistic disorder involves learning ranging from structural to emotional aspects, such as dealing with limitations and impossibility of cure, pointing out to the need for family care.

Sclerostin and DKK1 circulating levels associate with low bone turnover in patients with chronic kidney disease Stages 3 and 4.

BACKGROUND: Disordered mineral and bone metabolism is a common complication of chronic kidney disease (CKD). Bone biopsy remains the gold standard tool for evaluating renal osteodystrophy (ROD), but it is an invasive procedure. Despite a growing interest in the ability of newer bone biomarkers to discriminate between different forms of ROD, data on pre-dialysis patients are scarce. METHODS: A cross-sectional study was conducted in a cohort of 56 patients with CKD Stages 3 and 4. Participants underwent a transiliac bone biopsy after a course of double tetracycline labelling. Circulating levels of Wnt signalling inhibitors sclerostin and Dickkopf-1 (DKK1), soluble receptor activator of nuclear factor-κB ligand (sRANKL) and osteoprotegerin were measured and correlated with histomorphometric analysis results. RESULTS: Most patients had abnormal bone histology and low-turnover bone disease was the predominant form of ROD. Characteristics associated with high bone turnover were worse renal function, lower serum calcium and higher intact parathyroid hormone and fibroblast growth factor-23 levels. Patients with low bone turnover, on the other hand, presented with higher sclerostin along with lower DKK1 and sRANKL levels. In the multivariable logistic regression analysis, sclerostin and DKK1 levels were independently associated with low-turnover bone disease. CONCLUSIONS: Our results suggest that circulating levels of Wnt signalling inhibitors sclerostin and DKK1 are predictive of low-turnover bone disease in patients not yet on dialysis. Further research is needed to assess the performance of these bone turnover biomarkers, compared with histomorphometric analysis, in the diagnosis and treatment monitoring of ROD.

Low bone turnover is associated with plain X-ray vascular calcification in predialysis patients.

BACKGROUND: Vascular calcification (VC) is a common finding in chronic kidney disease (CKD) patients and predicts subsequent cardiovascular morbidity and mortality in this population. Vascular calcification is linked to disordered mineral metabolism and has been associated with bone histomorphometry changes in CKD. However, data on predialysis patients is scarce. METHODS: A cross-sectional study was conducted on a cohort of 56 CKD patients not yet on dialysis, who underwent a transiliac bone biopsy for histomorphometric evaluation after double tetracycline labeling. Patients had no previous exposure to calcium salts, vitamin D agents, steroids or bisphosphonates. Vascular calcification was assessed at the time of biopsy, using Kauppila (plain X-ray of the lateral lumbar spine) and Adragão (plain X-ray of the pelvis and hands) scores. RESULTS: Vascular calcification was seen in two-thirds of the cohort. Subjects with VC were more likely to be male and have diabetes, and had significantly higher sclerostin and osteoprotegerin circulating levels than those without VC. The histomorphometric analysis showed that bone formation rate was significantly lower in VC compared to non-VC patients. In the multivariable logistic regression analysis, bone formation rate was independently associated with the presence of VC. CONCLUSIONS: Vascular calcification is highly prevalent in predialysis patients, especially in those with diabetes. The independent association between bone formation rate and VC provides evidence of an important interaction between bone and vessel in CKD. Our results suggest that low bone turnover is a non-traditional risk factor for cardiovascular disease in predialysis patients.

Optimization of bioprocess of Schleiferilactobacillus harbinensis Ca12 and its viability in frozen Brazilian berries (Açai, Euterpe oleracea Mart.).

Amazonian palm berries (açaí, Euterpe oleracea Mart.) are fruits with high nutritional value and antioxidant activity and have aroused the interest of consumers, popularizing fruit pulps enriched with probiotics. Amazonian palm berries (açaí, Euterpe oleracea Mart.) are fruits with high nutritional potential, providing a source of carbohydrates, fibers, proteins, lipids, vitamins, and minerals. Furthermore, açai provides several health benefits, including antioxidant activity. Nutritionally enhanced foods have aroused the interest of consumers, popularizing fruit pulps enriched with probiotics. Probiotics are dietary supplements consisting of live, beneficial microorganisms in the host which improve the intestinal microbiota. The objective of this study was to isolate, identify, and characterize the probiotic potential of an isolated Schleiferilactobacillus harbinensis strain (dubbed Ca12) and provide an optimized bioprocess for its production, using the complete factorial and central rotational compound design to supplement the frozen açai pulp. The isolated strain S. harbinensis Ca12 presented adequate resistance to gastric juice and bile salts, microbial activity against different Candida strains, self-aggregation and coaggregation properties, high adhesion in HT-29 cells, and 35% inhibition of Salmonella in HT-29 cells. When optimized, the cellular biomass production of the S. harbinensis Ca12 strain was approximately 600% higher than the unsupplemented whey, with a production of 3.6 × 1010 CFU mL-1. The S. harbinensis Ca12 strain's viability in the creamy and traditional frozen açai pulp was shown to be stable for up to 6 months at 20 °C. The impact of this study involved for the first time the S. harbinensis Ca12 described in the Brazilian cocoa pulp with activity against Candida albicans of clinical importance, creating the potential of a new functional food with important benefits to human health as prevention for candidiasis.

Detecção precoce da depressão pós-parto na atenção básica / Detección precoz de depresión posparto en atención primaria de salud / Early detection of postpartum depression in primary health care

Objetivo: detectar a prevalência de depressão pós-parto e fatores sociodemográficos em puérperas atendidas em uma unidade por equipes de Saúde da Família. Método: estudo observacional descritivo, com abordagem quantitativa. Participaram 92 puérperas atendidas pelas Equipes Saúde da Família do município de Teresina, Piauí. A coleta ocorreu de dezembro 2018 a abril 2019. Aplicou-se um questionário envolvendo variáveis socioeconômicas, junto Escala Edimburgo. Os resultados foram analisados por meio de estatística descritiva. Resultados: a prevalência de depressão pós-parto nas puérperas foi 39,13%. Predominaram as puérperas com união estável (36,96%), na faixa etária 18 a 22 anos (44,57%), a maioria declarou cor/raça parda (76,9%) e ocupação do lar (77,17%). Conclusão: a elevada prevalência da Depressão Pós-Parto aponta para a necessidade de provocar mudanças no modelo assistencial destinado à mulher no ciclo gravídico-puerperal, com ênfase na promoção de intervenções que possam minimizar os fatores de risco para este agravo.(AU)

Objective: to detect the prevalence of postpartum depression in puerperal women attended in a unit by Family Health teams. Method: descriptive observational study, with a quantitative approach. The participants were 92 puerperal women attended by the Family Health Strategy Teams of the municipality of Teresina, Piaui. Data was collected from December 2018 to April 2019. A questionnaire socioeconomic was applied, in addition to the Edinburgh Postnatal Depression Scale. The results were analyzed by means of descriptive statistics. Results: the prevalence of postpartum depression was verified in 39.13%. Puerperal women with a stable union predominated (36.96%), aged between 18 and 22 years old (44.57%), the majority declared color / brown race (76.9%) and home occupation (77.17%). Conclusion: the high prevalence of Postpartum Depression points to the need to provoke changes in the model of care for women in the pregnancy-puerperal cycle, with emphasis on the promotion of interventions that can minimize this condition.(AU)

Objetivo: detectar prevalencia de depresión posparto en puérperas atendidas en una unidad por equipos de Salud de la Familia. Método: estudio observacional descriptivo, con abordaje cuantitativo. Los participantes fueron 92 puérperas atendidas por los Equipos de Estrategia de Salud de la Familia en la ciudad de Teresina, Piauí. La recolección de datos se llevó a cabo desde diciembre de 2018 hasta abril de 2019. Se aplicó un cuestionario socioeconómico, además de la Escala de Depresión Posparto de Edimburgo, los resultados se analizaron mediante estadística descriptiva. Resultados: la prevalencia de depresión posparto en 39,13%. Predominaron las mujeres puerperales con unión estable (36,96%), con edades comprendidas entre 18 y 22 años (44,57%), la mayoría declaró color / raza morena (76,9%) y ocupación domiciliaria (77,17%). Conclusión: la alta prevalencia de depresión posparto apunta a la necesidad de generar cambios en el modelo de atención a la mujer en el ciclo embarazo-puerperal, con énfasis en promover intervenciones que minimicen esta condición.(AU)

Contribuição da musicoterapia no transtorno do espectro autista: revisão integrativa da literatura / Contribución de la musicoterapia al trastorno del espectro autista: una revisión integradora de la literatura / Contribution of music therapy to autism spectrum disorder: an integrative literature review

Objetivo: verificar as evidências científicas sobre a contribuição da musicoterapia como intervenção no tratamento da criança com Transtorno Espectro Autista. Métodos: Trata-se de uma revisão integrativa da literatura, realizada na base de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde e na Medical Literature Analysis and Retrieval System Online. A busca dos artigos foi realizada de janeiro a março de 2019, utilizando os seguintes descritores controlados: Musicoterapia, Terapêutica e Transtorno autístico que que atenderam aos critérios de inclusão e exclusão do estudo. Resultados: Doze artigos evidenciaram o valor da música e o seu papel como recurso terapêutico em crianças. Conclusão: Analisou doze estudos que enfatizam o uso da musicoterapia como ferramenta de tratamento no TEA, tendo em vista que onze estudos descrevem a forma significativa na melhora do quadro clínico e/psicológico de crianças com Transtorno do Espectro Autista, ao proporcionar melhora na comunicação e na socialização.(AU)

Objective: To analyze the scientific evidence on the contribution of music therapy as an intervention in the treatment of children with autism apectrum disorder. Methods: integrative literature review, carried out in the database: Latin American and Caribbean Literature in Health Sciences and in the Medical Literature Analysis and Retrieval System Online. The search for the articles was carried out from January to March 2019, using the following controlled descriptors: Music Therapy, Treatment, Child, Disorder, Autistic Spectrum that met the inclusion and exclusion criteria of the study. Results: twelve articles showed the value of music and its role as a therapeutic resource in children. Conclusion: Analyzed twelve studies that emphasize the use of music therapy as a treatment tool in autism apectrum disorder, considering that eleven studies describe the significant way in improving the clinical and / psychological condition of children with Autism Spectrum Disorder, by providing improved communication and in socialization.(AU)

Objetivo: analizar la evidencia científica sobre la contribución de la musicoterapia como intervención en el tratamiento de niños con trastorno del espectro autista. Métodos: revisión integradora de la literatura, realizada en la base de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud y en el Sistema de Análisis y Recuperación de Literatura Médica en Línea. La búsqueda de los artículos se realizó de enero a marzo de 2019, utilizando los siguientes descriptores controlados: Musicoterapia, Tratamiento, Niño, Trastorno, Espectro autista que cumplieron con los criterios de inclusión y exclusión del estudio. Resultados: doce artículos mostraron el valor de la música y su papel como recurso terapéutico en los niños. Conclusión: se analizaron doce estudios que enfatizan el uso de la musicoterapia como herramienta de tratamiento en el trastorno del espectro autista, considerando que once estudios describen la forma significativa en la mejora de la condición clínica y / psicológica de los niños con Trastorno del Espectro Autista, al proporcionar una mejor comunicación y socialización.(AU)

Vancomycin-loaded N,N-dodecyl,methyl-polyethylenimine nanoparticles coated with hyaluronic acid to treat bacterial endophthalmitis: Development, characterization, and ocular biocompatibility.

Vancomycin-loaded N,N-dodecyl,methyl-polyethylenimine nanoparticles coated with hyaluronic acid (VCM-DMPEI nanoparticles/HA) were synthesized as an adjuvant for the treatment of bacterial endophthalmitis. The nanoparticles were formulated by experimental statistical design, thoroughly characterized, and evaluated in terms of bactericidal activity and both in vitro and in vivo ocular biocompatibility. The VCM-DMPEI nanoparticles/HA were 154 ± 3 nm in diameter with a 0.197 ± 0.020 polydispersity index; had a + 26.4 ± 3.3 mV zeta potential; exhibited a 93% VCM encapsulation efficiency; and released 58% of the encapsulated VCM over 96 h. VCM and DMPEI exhibited a synergistic bactericidal effect. The VCM-DMPEI nanoparticles/HA were neither toxic to ARPE-19 cells nor irritating to the chorioallantoic membrane. Moreover, the VCM-DMPEI nanoparticles/HA did not induce modifications in retinal functions, as determined by electroretinography, and in the morphology of the ocular tissues. In conclusion, the VCM-DMPEI nanoparticles/HA may be a useful therapeutic adjuvant to treat bacterial endophthalmitis.