Middle-Range Theory of Occupational Stress in Health Professionals.

Introduction: Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals. Methods: Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables. Results: The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress. Conclusion: The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.

Dabrafenib plus Trametinib in Pediatric Glioma with BRAF V600 Mutations.

BACKGROUND: Detection of the BRAF V600E mutation in pediatric low-grade glioma has been associated with a lower response to standard chemotherapy. In previous trials, dabrafenib (both as monotherapy and in combination with trametinib) has shown efficacy in recurrent pediatric low-grade glioma with BRAF V600 mutations, findings that warrant further evaluation of this combination as first-line therapy. METHODS: In this phase 2 trial, patients with pediatric low-grade glioma with BRAF V600 mutations who were scheduled to receive first-line therapy were randomly assigned in a 2:1 ratio to receive dabrafenib plus trametinib or standard chemotherapy (carboplatin plus vincristine). The primary outcome was the independently assessed overall response (complete or partial response) according to the Response Assessment in Neuro-Oncology criteria. Also assessed were the clinical benefit (complete or partial response or stable disease for ≥24 weeks) and progression-free survival. RESULTS: A total of 110 patients underwent randomization (73 to receive dabrafenib plus trametinib and 37 to receive standard chemotherapy). At a median follow-up of 18.9 months, an overall response occurred in 47% of the patients treated with dabrafenib plus trametinib and in 11% of those treated with chemotherapy (risk ratio, 4.31; 95% confidence interval [CI], 1.7 to 11.2; P<0.001). Clinical benefit was observed in 86% of the patients receiving dabrafenib plus trametinib and in 46% receiving chemotherapy (risk ratio, 1.88; 95% CI, 1.3 to 2.7). The median progression-free survival was significantly longer with dabrafenib plus trametinib than with chemotherapy (20.1 months vs. 7.4 months; hazard ratio, 0.31; 95% CI, 0.17 to 0.55; P<0.001). Grade 3 or higher adverse events occurred in 47% of the patients receiving dabrafenib plus trametinib and in 94% of those receiving chemotherapy. CONCLUSIONS: Among pediatric patients with low-grade glioma with BRAF V600 mutations, dabrafenib plus trametinib resulted in significantly more responses, longer progression-free survival, and a better safety profile than standard chemotherapy as first-line therapy. (Funded by Novartis; ClinicalTrials.gov number, NCT02684058.).

Evaluation of the antibacterial activity of hecogenin acetate and its inhibitory potential of NorA and MepA efflux pumps from Staphylococcus aureus.

Antimicrobial drugs are of great importance in the control of bacterial infections. Its indiscriminate use contributes to the consolidation of bacterial resistance. Its applicability is due to its secondary metabolites, such as saponins, which are compounds with relevant antibacterial action. Hecogenin acetate is a saponin present in plants of the agave genus with analgesic, antioxidant, antinociceptive, cardioactive, anticancer, antifungal and antimicrobial activity. The present work aimed to identify the antibacterial activity of hecogenin acetate against strains of E. coli, P. aeruginosa and S. aureus and to investigate the NorA and MepA efflux pump inhibitory activity of S. aureus strains. The Minimum Inhibitory Concentration was evaluated by broth microdilution. The Antibiotic Activity Modifier effect and the assessment of efflux pump inhibition were evaluated by microdilution with sub-inhibitory concentrations. Hecogenin acetate showed minimal inhibitory concentration without significant relevance. In the evaluation of the potentiating activity of the antibiotic action, a greater antagonistic behavior is noticed. In the analyzes performed with the efflux pump, it was noticed that the hecogenin acetate does not interfere in the efflux pump mechanism of the analyzed bacteria.

Cuidados de enfermería al paciente trasplantado renal: scoping review / Cuidados de enfermagem ao paciente transplantado renal: scoping review / Nursing Care for Kidney Transplant Patients: A Scoping Review

Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers' Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.

Objetivos: mapear los cuidados de enfermería en pacientes trasplantados renais. Materiales y método: scoping review conducida conforme las recomendaciones del Joanna Briggs Institute Reviewers' Manual. Se recolectaron los datos por medio de 13 bases de datos nacionales e internacionales de diciembre del 2020 a enero del 2021, siguiendo rigor científico en la selección del material. La preselección se dio mediante lectura previa de título, resumen y texto introductorio; los materiales incluidos en esta etapa se leyeron en la íntegra con el fin de definir el contenido para el estudio. Resultados: se incluyeron 15 estudios. De estos, el 60 % es artículo; tesis, manuales, protocolos, directrices y boletines suman 40 % del material estudiado. El 86,6 % del material presenta enfoque cuantitativo. En cuanto al diseño metodológico, el 73,3 % son estudios de tipo descriptivos/transversales. Con relación al mapeo de los cuidados de enfermería, se logró dividirlos en dos categorías: cuidados de enfermería post trasplante renal (inmediato, mediato y tardío) y cuidados de enfermería post trasplante renal en la atención primaria a la salud/extra hospitalaria. Conclusiones: se concluye que el estudio permitió mapear los cuidados de enfermería al paciente trasplantado renal en los posoperatorios inmediato, mediato, tardío y en la atención primaria a la salud.

Objetivos: mapear os cuidados de enfermagem em pacientes transplantados renais. Materiais e método: scoping review conduzida conforme as recomendações do Joanna Briggs Institute Reviewers' Manual. Os dados foram coletados por meio de 13 bases de dados nacionais e internacionais de dezembro de 2020 a janeiro de 2021, seguindo rigor científico na seleção do material. A pré-seleção se deu mediante a leitura prévia de título, resumo e texto introdutório; os materiais incluídos nessa etapa foram lidos na íntegra a fim de definir o conteúdo para o estudo. Resultados: foram incluídos 15 estudos. Destes, 60 % são artigos; dissertações, manuais, protocolos, diretrizes e boletins somaram 40 % do material estudado. 86,6 % do material apresenta abordagem quantitativa. Quanto ao desenho metodológico, 73,3 % eram estudos de tipo descritivos/transversais. Quanto ao mapeamento dos cuidados de enfermagem, pôde dividi-los em duas categorias: cuidados de enfermagem pós- transplante renal (imediato, mediato e tardio) e cuidados de enfermagem pós- transplante renal na atenção primária à saúde/extra-hospitalar. Conclusões: conclui-se que o estudo permitiu mapear os cuidados de enfermagem ao paciente transplantado renal nos pós-operatórios imediato, mediato, tardio e na atenção primária à saúde.

Percepções sobre homeopatia na perspectiva de discentes dos cursos de saúde de um centro universitário de Recife-PE / Healthcare students perceptions about homeopathy at a university of Recife-PE

A homeopatia é um método terapêutico que tem como princípio "semelhante cura semelhante", tendo como base a experimentação das preparações altamente diluídas e sucussionadas, com objetivo de produzir em pessoas sadias sintomas semelhantes aos da doença que devem combater. O interesse da população por ela vem aumentando e há necessidade de formar profissionais qualificados no ensino de práticas integrativas e complementares para que avancem no SUS. Diante disso, o objetivo deste estudo foi descrever as percepções sobre homeopatia na perspectiva de discentes dos cursos de saúde de um centro universitário privado em Recife-PE. Para tanto, foi realizado um estudo transversal, descritivo e quantitativo a partir da aplicação de questionário a 500 estudantes de cursos de saúde, entre outubro e novembro de 2018. Apesar de 65,2% dos discentes relatarem ter ouvido falar sobre homeopatia, 73% declararam ter pouco ou nenhum conhecimento sobre as formas de tratamento. Além disso, 82,8% dos discentes afirmaram não conhecer as PNPIC (Política Nacional de Práticas Integrativas e Complementares no SUS), e nem saber que medicamentos homeopáticos são distribuídos gratuitamente pelo SUS (86%). Existe interesse dos estudantes de saúde em incluir homeopatia como disciplina na grade de seus cursos, afim de estarem aptos para oferecer um atendimento integral aos pacientes. Portanto, há necessidade de instituições de ensino superior investirem e promoverem disciplinas que abordem a homeopatia, para formarem profissionais com maior conhecimento sobre as PIC, o que irá acarretar maior informação para a população, contribuindo na melhoria da saúde individual e coletiva através da saúde pública.

Homeopathy is a type of therapy method that follows the principle of "like cures like", based on the experimentation of high diluted preparations, with the aim of of producing in a healthy person, symptoms most 'like' the symptoms the person is suffering from. There has been increasing interest in these therapies and, therefore, is important to train qualified professionals focused on homeopathy and complementary and alternative medicine for work in the SUS. The aim of this study was to describe the perceptions about homeopathy from the perspective of healthcare students at a private university in Recife-PE. A cross-sectional, descriptive and quantitative study was conducted, between the months of October and November 2018. To assess opinions about homeopathy, 500 students were asked questions in a questionnaire. Although 65.2% of the students report having heard/read about homeopathy, 73% have little or no knowledge about this alternative therapie. In addition, 82.8% did not know the PNPIC (National Policy for Integrative and Complementary Practices in the SUS), nor that homeopathic medicines are distributed free of charge by the SUS (86%). Healthcare students are interested in including homeopathy as a discipline in their graduations, in order to be able to offer comprehensive care to patients. Therefore, there is a need for universities to invest and promote disciplines that address homeopathy, to train professionals with greater knowledge about alternative and complementary medicine, which will lead to more information for the population, contributing to the improvement of individual and collective health through public health.

Comparative Analysis of the Antibacterial Activity and HPLC Phytochemical Screening of the Brazilian Red Propolis and the Resin of Dalbergia ecastaphyllum.

The aim of this study was to investigate the antibacterial activity of red propolis and resin and their association with standard antibiotics to evaluate possible differences of activity. We also submitted red propolis and the resin to a HPLC analysis to confirm the botanical origin. The extracts were tested against P. aeruginosa and S. aureus alone and in association with gentamicin and imipenem. The HPLC analysis identified seven compounds with six of them present in both substances. The lowest MIC values obtained in this study were observed against S. aureus. In general, MIC values showed to be lower for red propolis against all species tested in comparison to resin. Despite the synergistic behavior to be similar for both substances, we observed that inhibitory concentrations of drugs were lower when associated with red propolis in comparison to resin.

Body fat modulated activity of Gallus gallus domesticus Linnaeus (1758) and Meleagris gallopavo Linnaeus (1758) in association with antibiotics against bacteria of veterinary interest.

In the Northeast of Brazil, ethnoveterinary studies have shown that the body fat from Gallus gallus domesticus and Meleagris gallopavo are used for diseases that affect domestic animals. The objective of this study was to identify the chemical composition and to evaluate the antibacterial activity of the Gallus gallus domesticus (OFGG) and Meleagris gallopavo (OFMG) fixed oils in isolation and in association with antibiotics. The OFGG and OFMG from the poultry's body fat were extracted using hexane as a solvent in Soxhlet. Their composition was indirectly determined using fatty acid methyl esters. The OFGG and OFMG antibacterial and modulatory activities against standard and multi-resistant bacterial strains were performed through the broth microdilution test. In the OFGG chemical composition, 4 constituents were identified. The saturated fatty acid (AGS) and unsaturated fatty acid (AGI) percentages were 35.1% and 64.91% respectively, with linoleic acid being the major component. In the OFMG, 3 constituents were identified. The AGS percentage was 27.71% and 72.29% for AGI, with oleic acid as the most abundant component. The oils did not present antibacterial activity when tested in isolation, presenting Minimum Inhibitory Concentrations (MICs) > 512 µg/mL. However, when associated with antibiotics the OFGG showed synergistic activity with the antibiotics Amikacin, Amoxicillin, Norfloxacin and Oxytetracycline, while the OFMG promoted a synergistic action with the antibiotics Amikacin, Amoxicillin and Norfloxacin.

Effectiveness of conventional physical therapy and Pilates' method in functionality, respiratory muscle strength and ability to exercise in hospitalized chronic renal patients: A study protocol of a randomized controlled trial.

BACKGROUND: Patients with chronic kidney disease can present compromised functional abilities, and hospitalization may further contribute to their health deterioration and loss of functional independence. OBJECTIVES: To compare the effectiveness between Pilates Method and Conventional Physical Therapy in functionality, exercise capacity and respiratory muscle strength in hospitalized patients with chronic kidney disease. METHODS: 56 patients will be randomized into Control (usual care) or Pilates groups. Functionality (Barthel Index), exercise capacity (Step Test) and respiratory muscle strength (Manovacuometry) will be evaluated during pre-intervention, after the 5th and 10th sessions or at discharge in both groups. The statistical analysis will be calculated using linear mixed models and based on intention-to-treat. The level of significance will be set at α = 5%. This study is the first to develop a Pilates protocol for hospitalized chronic renal failure patients and the results will provide additional treatment options for these patients and for physiotherapists.

Quality of life in patients submitted to total laryngectomy.

BACKGROUND: Laryngeal carcinoma accounts for about 80 000 deaths annually worldwide. Despite its aggressiveness, total laryngectomy (TL) is a treatment option with curative intent. This article aims to evaluate its impact on these patients quality of life (QoL). MATERIAL AND METHODS: Thirty-four patients who underwent TL with bilateral neck dissection between 2003 and 2012 responded to the European Organization for Research and Treatment of Cancer QoL Core Questionnaire, the Self-Evaluation of Communication Experiences after Laryngeal Cancer Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: Data revealed that QoL is lower in these patients compared with general population. Regarding alaryngeal speech modalities, esophageal speech is associated with a significantly higher physical functional capacity. CONCLUSIONS: TL results in a permanent disability with decreased functional capacity and psychological distress. Close monitoring of these patients and investing in speech rehabilitation are essential to preserve their QoL.

Osteogénesis imperfecta e hipoacusia. Descripción de 3 casos / Osteogenesis Imperfecta and Hearing Loss-Description of Three Case Reports

La osteogénesis imperfecta es la enfermedad hereditaria del tejido conectivo más frecuente. Su presentación clínica tiene un amplio espectro de características que incluyen deformidades esqueléticas e hipoacusia. Se describen 3 casos clínicos de pacientes portadores de esta enfermedad, que se presentan con diferentes patrones de hipoacusia. La prevalencia y los patrones de la hipoacusia son variables y no tienen una relación clara con el genotipo. Su evaluación en la exploración inicial y posterior seguimiento es esencial para ofrecer las mejores alternativas terapéuticas (AU)

Osteogenesis imperfecta is the commonest connective tissue hereditary disease. Its clinical presentation has a wide spectrum of characteristics, which includes skeletal deformities and hearing loss. We describe three case reports of individuals carriers of this disease presenting with different patterns of hearing loss. Hearing loss prevalence and patterns are variable and have no clear relation with genotype. Its assessment at initial evaluation and posterior monitoring is essential to provide the best therapeutic alternatives (AU)

Osteogenesis imperfecta and hearing loss--description of three case reports.

Osteogenesis imperfecta is the commonest connective tissue hereditary disease. Its clinical presentation has a wide spectrum of characteristics, which includes skeletal deformities and hearing loss. We describe three case reports of individuals carriers of this disease presenting with different patterns of hearing loss. Hearing loss prevalence and patterns are variable and have no clear relation with genotype. Its assessment at initial evaluation and posterior monitoring is essential to provide the best therapeutic alternatives.

Mitochondrial bioenergetic alterations in mouse neuroblastoma cells infected with Sindbis virus: implications to viral replication and neuronal death.

The metabolic resources crucial for viral replication are provided by the host. Details of the mechanisms by which viruses interact with host metabolism, altering and recruiting high free-energy molecules for their own replication, remain unknown. Sindbis virus, the prototype of and most widespread alphavirus, causes outbreaks of arthritis in humans and serves as a model for the study of the pathogenesis of neurological diseases induced by alphaviruses in mice. In this work, respirometric analysis was used to evaluate the effects of Sindbis virus infection on mitochondrial bioenergetics of a mouse neuroblastoma cell lineage, Neuro 2a. The modulation of mitochondrial functions affected cellular ATP content and this was synchronous with Sindbis virus replication cycle and cell death. At 15 h, irrespective of effects on cell viability, viral replication induced a decrease in oxygen consumption uncoupled to ATP synthesis and a 36% decrease in maximum uncoupled respiration, which led to an increase of 30% in the fraction of oxygen consumption used for ATP synthesis. Decreased proton leak associated to complex I respiration contributed to the apparent improvement of mitochondrial function. Cellular ATP content was not affected by infection. After 24 h, mitochondria dysfunction was clearly observed as maximum uncoupled respiration reduced 65%, along with a decrease in the fraction of oxygen consumption used for ATP synthesis. Suppressed respiration driven by complexes I- and II-related substrates seemed to play a role in mitochondrial dysfunction. Despite the increase in glucose uptake and glycolytic flux, these changes were followed by a 30% decrease in ATP content and neuronal death. Taken together, mitochondrial bioenergetics is modulated during Sindbis virus infection in such a way as to favor ATP synthesis required to support active viral replication. These early changes in metabolism of Neuro 2a cells may form the molecular basis of neuronal dysfunction and Sindbis virus-induced encephalitis.

Inhibition of energy-producing pathways of HepG2 cells by 3-bromopyruvate.

3-BrPA (3-bromopyruvate) is an alkylating agent with anti-tumoral activity on hepatocellular carcinoma. This compound inhibits cellular ATP production owing to its action on glycolysis and oxidative phosphorylation; however, the specific metabolic steps and mechanisms of 3-BrPA action in human hepatocellular carcinomas, particularly its effects on mitochondrial energetics, are poorly understood. In the present study it was found that incubation of HepG2 cells with a low concentration of 3-BrPA for a short period (150 microM for 30 min) significantly affected both glycolysis and mitochondrial respiratory functions. The activity of mitochondrial hexokinase was not inhibited by 150 microM 3-BrPA, but this concentration caused more than 70% inhibition of GAPDH (glyceraldehyde-3-phosphate dehydrogenase) and 3-phosphoglycerate kinase activities. Additionally, 3-BrPA treatment significantly impaired lactate production by HepG2 cells, even when glucose was withdrawn from the incubation medium. Oxygen consumption of HepG2 cells supported by either pyruvate/malate or succinate was inhibited when cells were pre-incubated with 3-BrPA in glucose-free medium. On the other hand, when cells were pre-incubated in glucose-supplemented medium, oxygen consumption was affected only when succinate was used as the oxidizable substrate. An increase in oligomycin-independent respiration was observed in HepG2 cells treated with 3-BrPA only when incubated in glucose-supplemented medium, indicating that 3-BrPA induces mitochondrial proton leakage as well as blocking the electron transport system. The activity of succinate dehydrogenase was inhibited by 70% by 3-BrPA treatment. These results suggest that the combined action of 3-BrPA on succinate dehydrogenase and on glycolysis, inhibiting steps downstream of the phosphorylation of glucose, play an important role in HepG2 cell death.

Mitochondrial and bioenergetic dysfunction in human hepatic cells infected with dengue 2 virus.

Dengue virus infection affects millions of people all over the world. Although the clinical manifestations of dengue virus-induced diseases are known, the physiopathological mechanisms involved in deteriorating cellular function are not yet understood. In this study we evaluated for the first time the associations between dengue virus-induced cell death and mitochondrial function in HepG2, a human hepatoma cell line. Dengue virus infection promoted changes in mitochondrial bioenergetics, such as an increase in cellular respiration and a decrease in DeltaPsim. These alterations culminated in a 20% decrease in ATP content and a 15% decrease in the energy charge of virus-infected cells. Additionally, virus-infected cells showed several ultrastructural alterations, including mitochondria swelling and other morphological changes typical of the apoptotic process. The alterations in mitochondrial physiology and energy homeostasis preceded cell death. These results indicate that HepG2 cells infected with dengue virus are under metabolic stress and that mitochondrial dysfunction and alterations in cellular ATP balance may be related to the pathogenesis of dengue virus infection.

Purification of betulinic acid from Eugenia florida (Myrtaceae) by high-speed counter-current chromatography.

A high yield of betulinic acid (up to 17% from the ethanolic extract) was found in the leaves of Eugenia florida collected in south-eastern Brazil, making this species a potential commercial source of the title compound. Extracts of E. florida were subjected to solvent partition, and rapid high-speed counter-current chromatography (HSCCC) was applied to the semi-crude extracts to afford betulinic acid in high purity. The mobile and stationary phases were derived from the two-phase solvent system composed of n-hexane-ethyl acetate-methanol-water (10:5:2.5:1). The developing solvent system (stationary and mobile phases) for optimum HSCCC separation was chosen by dissolving the fraction to be chromatographed in the proposed solvent mixture and determining the amount of betulinic acid in each phase by densitometric TLC. Purified betulinic acid was characterized by 13C-NMR, GC-MS and co-injection of its methyl ester with standards in GC-FID. The HSCCC technique is commonly employed to isolate triterpene glycosides, but is applied in this study to an aglycone.