Influenza A virus propagation requires the activation of the unfolded protein response and the accumulation of insoluble protein aggregates.

Influenza A virus (IAV) employs multiple strategies to manipulate cellular mechanisms and support proper virion formation and propagation. In this study, we performed a detailed analysis of the interplay between IAV and the host cells' proteostasis throughout the entire infectious cycle. We reveal that IAV infection activates the inositol requiring enzyme 1 (IRE1) branch of the unfolded protein response, and that this activation is important for an efficient infection. We further observed the accumulation of virus-induced insoluble protein aggregates, containing both viral and host proteins, associated with a dysregulation of the host cell RNA metabolism. Our data indicate that this accumulation is important for IAV propagation and favors the final steps of the infection cycle, more specifically the virion assembly. These findings reveal additional mechanisms by which IAV disrupts host proteostasis and uncovers new cellular targets that can be explored for the development of host-directed antiviral strategies.

Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital.

Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role. Methods: Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%. Results: A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/psychology consultation. Conclusions: Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.

Steroid-Quinoline Hybrids for Disruption and Reversion of Protein Aggregation Processes.

Reversing protein aggregation within cells may be an important tool to fight protein-misfolding disorders such as Alzheimer's, Parkinson's, and cardiovascular diseases. Here we report the design and synthesis of a family of steroid-quinoline hybrid compounds based on the framework combination approach. This set of hybrid compounds effectively inhibited Aß1-42 self-aggregation in vitro by delaying the exponential growth phase and/or reducing the quantity of fibrils in the steady state. Their disaggregation efficacy was further demonstrated against preaggregated Aß1-42 peptides in cellular assays upon their endocytosis by neuroblastoma cells, as they reverted both the number and the average area of fibrils back to basal levels. The antiaggregation effect of these hybrids was further tested and demonstrated in a cellular model of general protein aggregation expressing a protein aggregation fluorescent sensor. Together, our results show that the new cholesterol-quinoline hybrids possess wide and marked disaggregation capacities and are therefore promising templates for the development of new drugs to deal with conformational disorders.

m5U54 tRNA Hypomodification by Lack of TRMT2A Drives the Generation of tRNA-Derived Small RNAs.

Transfer RNA (tRNA) molecules contain various post-transcriptional modifications that are crucial for tRNA stability, translation efficiency, and fidelity. Besides their canonical roles in translation, tRNAs also originate tRNA-derived small RNAs (tsRNAs), a class of small non-coding RNAs with regulatory functions ranging from translation regulation to gene expression control and cellular stress response. Recent evidence indicates that tsRNAs are also modified, however, the impact of tRNA epitranscriptome deregulation on tsRNAs generation is only now beginning to be uncovered. The 5-methyluridine (m5U) modification at position 54 of cytosolic tRNAs is one of the most common and conserved tRNA modifications among species. The tRNA methyltransferase TRMT2A catalyzes this modification, but its biological role remains mostly unexplored. Here, we show that TRMT2A knockdown in human cells induces m5U54 tRNA hypomodification and tsRNA formation. More specifically, m5U54 hypomodification is followed by overexpression of the ribonuclease angiogenin (ANG) that cleaves tRNAs near the anticodon, resulting in accumulation of 5'tRNA-derived stress-induced RNAs (5'tiRNAs), namely 5'tiRNA-GlyGCC and 5'tiRNA-GluCTC, among others. Additionally, transcriptomic analysis confirms that down-regulation of TRMT2A and consequently m5U54 hypomodification impacts the cellular stress response and RNA stability, which is often correlated with tiRNA generation. Accordingly, exposure to oxidative stress conditions induces TRMT2A down-regulation and tiRNA formation in mammalian cells. These results establish a link between tRNA hypomethylation and ANG-dependent tsRNAs formation and unravel m5U54 as a tRNA cleavage protective mark.

Orofacial clefts associated with cardiac anomalies: 27 years of experience of a multidisciplinary group in a tertiary hospital in Portugal / Fendas orofaciais associadas a anomalias cardíacas: 27 anos de experiência de um grupo multidisciplinar em um hospital terciário em Portugal

AIMS: Orofacial clefts (OFC) are a heterogeneous group of birth defects arising in about 1.7/1000 newborns. They can occur with other congenital anomalies, including heart defects. We aim to describe a population with orofacial clefts and associated cardiac anomalies. METHODS: Retrospective study of patients attended in the Cleft Lip and Palate Multidisciplinary Group outpatient clinic at Hospital Universitario São João, Porto-Portugal. Medical records from January 1992 through December 2018 were reviewed. Patients were divided into four groups according to the Spina classification: cleft lip (CL), cleft lip and palate (CLP), isolated cleft palate (CP) and atypical cleft (AC). Further categorization included gender, affected relatives, associated congenital anomalies and syndromes. RESULTS: From the 588 patients included, 77 (13%) presented cardiac anomalies. Of those with orofacial cleft and cardiac anomalies, 53% were males and 17% had known affected relatives. CP was the most common cleft among patients with cardiac anomaly (~56%). Additional congenital anomalies were found in 89.7% of patients, namely facial defects, central nervous system, renal and skeletal malformations. A recognizable syndrome was identified in 61.5%, being Pierre-Robin the most common (n=22), followed by 22q11.2 microdeletion (n=9). Bothadditional congenital anomalies and recognizable syndromes were significantlymore prevalent in patients with heart disease (p<0.05). The main groups of cardiac anomalies were left-to-right shunt (n=47) and right ventricular outflow tractobstruction (n=14). From these, 26 had a ventricular septal defect, 15 atrial septal defect and seven patients had tetralogy of Fallot. Five patients had dysrhythmias. CONCLUSIONS: Due to the high prevalence of cardiac anomalies in the cleft population, a routine cardiac evaluation should be performed in all these patients.

INTRODUÇÃO: As fendas lábio-palatinas são um grupo heterogêneo de defeitos congênitos que ocorrem em cerca de 1,7 / 1000 recém-nascidos. Eles podem ocorrer com outras anomalias congênitas, incluindo defeitos cardíacos. O nosso objetivo é descrever uma população com fendas lábio-palatinas e anomalias cardíacas associadas. MÉTODOS: Estudo retrospectivo de doentes seguidos pelo Grupo Multidisciplinar de Fendas Lábio-Palatinas no Hospital Universitário São João, Porto-Portugal. Foram analisados os prontuários médicos de janeiro de 1992 a dezembro de 2018. Os doentes foram divididos em quatro grupos, de acordo com a classificação de Spina: fenda labial (CL), fenda labial e palatina (CLP), fenda palatina isolada (PC) e fenda atípica (CA). Outras categorizações incluíram sexo, parentes afetados, anomalias e síndromes congênitas associadas. RESULTADOS: Dos 588 pacientes incluídos, 77 (13%) apresentaram anomalias cardíacas. Daqueles com fenda e anomalias cardíacas, 53% eram do sexo masculino e 17% tinham parentes afetados. A PC foi a fenda mais comum entre os doentes com anomalia cardíaca (aproximadamente 56%). Anomalias congénitas adicionais, como defeitos faciais, malformações do sistema nervoso central, renais e esqueléticas foram encontradas em 89,7%. Síndromes foram identificadas em 61,5%, sendo Pierre-Robin a mais comum (n = 22), seguida pela microdeleção 22q11.2 (n = 9). Anomalias congénitas adicionais e a presença de uma síndrome genética foram significativamente mais prevalentes em doentes com doença cardíaca associada (p <0,05). Os principais grupos de anomalias cardíacas foram shunt da esquerda para a direita (n = 47) e obstrução da via de saída do ventrículo direito (n = 14). Destes, 26 apresentaram comunicação interventricular, 15 comunicação interauricular e sete pacientes apresentaram tetralogia de Fallot. Cinco pacientes apresentaram disritmias. CONCLUSÕES: Devido à elevada prevalência de anomalias cardíacas na população de doentes com Fenda Lábio-Palatina, aconselhamos uma avaliação cardíaca de rotina em todos.

Limiar pressórico de dor no assoalho pélvico de mulheres idosas com e sem fibromialgia: um estudo transversal / Pressure threshold of pelvic floor pain in elderly women with and without fibromyalgia: a cross-sectional study

Objetivo: Este estudo teve como objetivo comparar o limiar de pressão dolorosa no assoalho pélvico de mulheres idosas com e sem fibromialgia. Métodos: Foi realizado um estudo duplo-cego com 28 idosas de 60 a 75 anos, divididas em dois grupos, com diagnóstico médico de fibromialgia (GF) e sem fibromialgia (GWF). A avaliação foi realizada em uma única reunião, de forma individual, na qual os dados do histórico ginecológico, obstétrico-clínico e médico e informações sobre o assoalho pélvico foram obtidos por voluntários previamente treinados. A avaliação do limiar de dor à pressão foi realizada com o uso de algômetro por um dos pesquisadores. Foram utilizados os testes t de Student bicaudal, teste U de Mann-Whitney e qui-quadrado. Todos os testes foram realizados com nível de significância de 5%. Resultados: O limiar de pressão da dor mostrou que o GF apresentou menores valores de percepção da dor em relação à GWF (p <0,001 para o lado esquerdo) e (p <0,001 para o lado direito). Conclusão: O GF apresentou limiar de dor à pressão mais baixa, o que pode estar relacionado à patologia, que causa dor generalizada e sensibilização central

Objective: This study aimed to compare the painful pressure threshold in the pelvic floor of elderly women with and without fibromyalgia. Methods: A double blind study was performed with 28 elderly women aged 60 to 75 years, divided into two groups, with medical diagnosis of fibromyalgia (FG) and without fibromyalgia (GWF). The evaluation was performed in a single meeting, on an individual basis, in which data on the gynecological, obstetrical, and medical history and information regarding the pelvic floor were obtained by previously trained volunteers. The evaluation of pressure pain threshold was performed with the use of an algometer by one of the researchers. Two-tailed Student t test, Mann-Whitney U Test and Chi-square tests were used. All tests were performed with a significance level of 5%. Results: The pain pressure threshold showed that FG presented lower values ​​for pain perception in relation to the GWF (p<0.001 for the left side) and (p<0.001 for the right side). Conclusion: FG had lower pressure pain threshold, which may be related to the pathology, which causes generalized pain and central sensitization

Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: The effects of adding moderate-to-high intensity inspiratory muscle training (IMT) to short-term aerobic and resistance exercise (combined training [CT]), after coronary artery bypass grafting (CABG) are not established. This study aimed to determine the effects of moderate-to-high intensity IMT + CT on exercise capacity, respiratory muscle strength, inspiratory muscle endurance, quality of life (QoL), and laboratory biomarkers in patients after CABG who were participants of a phase II cardiac rehabilitation program. METHODS: Twenty-four patients were randomly assigned to either the IMT + CT group (n = 12), who performed moderate-to-high intensity IMT with CT or the sham-IMT + CT group (n = 12). Patients completed two sessions per week for 12 weeks. Each patient underwent a cardiopulmonary exercise test, six-minute walk test (6MWT), respiratory muscle strength and endurance evaluation, QoL questionnaire, and serum advanced oxidation protein products, ferric reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity C-reactive protein, before and after the 12-week intervention. RESULTS: The IMT + CT group showed significantly greater improvements in peak oxygen uptake (1.3 mL∙kg-1∙min-1; 95% confidence interval [95% CI], 0.5 to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5), maximal inspiratory pressure (23.0 cmH2O; 95% CI, 9.3 to 36.7), QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 µmol/L; 95% CI, 20.2 to 147.1) compared to the sham-IMT + CT group as a result of the intervention. CONCLUSIONS: Short-term moderate-to-high intensity IMT with CT provided additional benefits in exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile in patients after CABG. Trial Registration clinicaltrials.gov Identifier: NCT02885077.

The ARP2/3 complex prevents excessive formin activity during cytokinesis.

Cytokinesis completes cell division by constriction of an actomyosin contractile ring that separates the two daughter cells. Here we use the early Caenorhabditis elegans embryo to explore how the actin filament network in the ring and the surrounding cortex is regulated by the single cytokinesis formin CYK-1 and the ARP2/3 complex, which nucleate nonbranched and branched filaments, respectively. We show that CYK-1 and the ARP2/3 complex are the predominant F-actin nucleators responsible for generating distinct cortical F-actin architectures and that depletion of either nucleator affects the kinetics of cytokinesis. CYK-1 is critical for normal F-actin levels in the contractile ring, and acute inhibition of CYK-1 after furrow ingression slows ring constriction rate, suggesting that CYK-1 activity is required throughout ring constriction. Surprisingly, although the ARP2/3 complex does not localize in the contractile ring, depletion of the ARP2 subunit or treatment with ARP2/3 complex inhibitor delays contractile ring formation and constriction. We present evidence that the delays are due to an excess in formin-nucleated cortical F-actin, suggesting that the ARP2/3 complex negatively regulates CYK-1 activity. We conclude that the kinetics of cytokinesis are modulated by interplay between the two major actin filament nucleators.

Impact of tRNA Modifications and tRNA-Modifying Enzymes on Proteostasis and Human Disease.

Transfer RNAs (tRNAs) are key players of protein synthesis, as they decode the genetic information organized in mRNA codons, translating them into the code of 20 amino acids. To be fully active, tRNAs undergo extensive post-transcriptional modifications, catalyzed by different tRNA-modifying enzymes. Lack of these modifications increases the level of missense errors and affects codon decoding rate, contributing to protein aggregation with deleterious consequences to the cell. Recent works show that tRNA hypomodification and tRNA-modifying-enzyme deregulation occur in several diseases where proteostasis is affected, namely, neurodegenerative and metabolic diseases. In this review, we discuss the recent findings that correlate aberrant tRNA modification with proteostasis imbalances, in particular in neurological and metabolic disorders, and highlight the association between tRNAs, their modifying enzymes, translational decoding, and disease onset.

Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review.

The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review / Achados de radiografia e de TC de tórax em pacientes transplantados de órgãos sólidos e diagnosticados com tuberculose pulmonar: uma revisão sistemática

ABSTRACT The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

RESUMO O objetivo desta revisão sistemática foi selecionar artigos com achados radiográficos e/ou tomográficos de tórax em pacientes que desenvolveram tuberculose pulmonar após transplante de órgãos sólidos (pulmão, rim ou fígado). Os descritores utilizados para a pesquisa foram: "tuberculosis", "transplants", "transplantation", "mycobacterium" e "lung". As bases de dados utilizadas nesta revisão foram PubMed e Biblioteca Virtual em Saúde. Foram selecionados artigos em inglês, português e espanhol, independentemente do ano de sua publicação, que possuíam em seu título, resumo ou corpo do texto os aspectos selecionados quanto ao objetivo da pesquisa. Foram excluídos artigos sem dados sobre achados de radiografia ou de TC de tórax e aqueles não relacionados com transplantes de órgão sólido ou tuberculose pulmonar. Foram selecionados 29 artigos para o estudo, somando 219 pacientes. As maiores amostras vieram de estudos realizados no Brasil e na Coreia do Sul (78 e 35 pacientes, respectivamente). Os achados de imagem foram subdivididos em cinco padrões mais comuns. Os achados de imagem nesses pacientes variaram dependendo do órgão transplantado. O padrão mais comum foi o clássico para tuberculose pulmonar (escavação e nódulos em árvore em brotamento) nos transplantados de fígado e pulmão, que é similar ao acometimento da doença na população em geral. Transplantados de rim apresentaram um maior número de casos de acometimento miliar e de linfonodomegalia, que é mais similar aos casos de pacientes coinfectados com tuberculose e HIV. Estudos que avaliem dados clínicos, como o esquema farmacológico de imunossupressão, são necessários para um melhor entendimento da distribuição desses padrões de imagem nessa população.

Correlação entre qualidade de vida e independência funcional de idosos institucionalizados / Correlation between Quality of life and Functional independence of institutionalized elderly / Correlación entre calidad de vida y funcionalidad independiente de institucionalizados

O presente estudo teve por objetivo investigar a possível relação entre a qualidade de vida e a independência funcional em idosos institucionalizados de Santa Maria, RS. Trata-se de um estudo observacional, transversal, quantitativo, realizado em seis instituições de longa permanência, filantrópicas e privadas, localizadas no município de Santa Maria, RS. Após aprovação do Comitê de Ética e Pesquisa com Seres Humanos da Universidade Federal de Santa Maria (parecer n.º 1.737.474), foram utilizados os questionários WHOQOL-bref e Índice de Katz. A satisfação com a saúde (WHOQOL-bref) apresentou uma correlação negativa moderada com a independência funcional (índice de Katz), ou seja, quanto mais satisfeito com a saúde era o idoso, maior era sua independência funcional.

The present study objective to investigate the possible relationship between quality of life and functional independence in institutionalized elderly in Santa Maria, RS. This is an observational, cross-sectional, quantitative study carried out in six long-term philanthropic and private institutions, located in the municipality of Santa Maria, RS. After approval by the Ethics and Human Research Committee of the Federal University of Santa Maria (opinion nº. 1.737.474), the WHOQOL-bref questionnaire and Katz Index were used. Health satisfaction (WHOQOL-bref) showed a moderate negative correlation with functional independence (Katz index), that is, the more satisfied the patient was with health, the greater his functional independence.

El presente estudio tuvo por objetivo investigar la posible relación entre la calidad de vida y la Independencia funcional en ancianos institucionalizados de Santa María, RS. Se trata de un estudio observacional, transversal, cuantitativo, realizado en seis instituciones de larga permanencia, filantrópicas y privadas, ubicadas en el municipio de Santa Maria, RS. Después de la aprobación del Comité de Ética e Investigación con Seres Humanos de la Universidad Federal de Santa Maria (dictamen nº 1.737.474), se utilizaron los cuestionarios WHOQOL-bref e Índice de Katz. La satisfacción con la salud (WHOQOL-bref) presentó una correlación negativa moderada con la independencia funcional (índice de Katz), o sea, cuanto más satisfecho con la salud era el anciano, mayor era su independencia funcional.

A Fluorescence-Based Sensor Assay that Monitors General Protein Aggregation in Human Cells.

Protein conformational disorders are characterized by disruption of protein folding and toxic accumulation of protein aggregates. Here we describe a sensitive and simple method to follow and monitor general protein aggregation in human cells. Heat shock protein 27 (HSP27) is an oligomeric small heat shock protein that binds and keeps unfolded proteins in a folding competent state. This high specificity of HSP27 for aggregated proteins can be explored to monitor aggregation in living cells by fusing it to a fluorescent protein as Green Fluorescent Protein (GFP). We have constructed a HeLa stable cell line expressing a HSP27:GFP chimeric reporter protein and after validation, this stable cell line is exposed to different agents that interfere with proteostasis, namely Arsenite, MG132, and Aß-peptide. Exposure to proteome destabilizers lead to re-localization of HSP27:GFP fluorescence to foci, confirming that our reporter system is functional and can be used to detect and follow protein aggregation in living cells. This reporter is a valuable tool to setup wide-genetic screens to identify genes and pathways involved in protein misfolding and aggregation.

Observações sistemáticas em Instituições de Longa Permanência para Idosos (ILPI): Considerações arquitetônicas / Systematic observations in Long Term Institutions of Elderly (ILPIs): Architectural considerations / Observaciones sistemáticas en Instituciones de larga permanencia para ancianos (ILPI): Consideraciones arquitectónicas

Este estudo foi realizado em ILPIs de Santa Maria, RS, com o objetivo de analisar seus dormitórios, a partir de observações sistemáticas, e propor contribuições arquitetônicas. Estudo transversal do tipo descritivo exploratório em seis ILPIs, sendo três privadas e três filantrópicas. Instrumentos de pesquisa: observações sistemáticas do comportamento e do ambiente físico. Os resultados demonstraram a necessidade de projetar dormitórios capazes de atender os aspectos afetivos e funcionais dos idosos, com base nos critérios legais, arquitetônicos e do ponto de vista dos usuários.

A study carried out in ILPIs of Santa Maria-RS, with the objective of analyzing the dormitories, from systematic observations and propose architectural contributions. The cross-sectional study was descriptive exploratory type, using six ILPIs, three private and three philanthropic. Research instruments: systematic observations of behavior and the physical environment. The results demonstrated the need to design dormitories capable of attending the affective and functional aspects of the elderly, based on legal, architectural and from the users' point of view.

Este estudio fue realizado en ILPIs de Santa María, RS, con el objetivo de analizar sus dormitorios, a partir de observaciones sistemáticas, y proponer contribuciones arquitectónicas. Estudio transversal del tipo descriptivo exploratorio en seis ILPIs, siendo tres privadas y tres filantrópicas. Instrumentos de investigación: observaciones sistemáticas del comportamiento y del ambiente físico. Los resultados demostraron la necesidad de proyectar dormitorios capaces de atender los aspectos afectivos y funcionales de los ancianos, con base en los criterios legales, arquitectónicos y desde el punto de vista de los usuarios.

Perfil dos estudos de quedas com idosos: revisão integrativa / Profile of studies of falls with the elderly: integrative review / Perfil de estudios de caídas con mayores: revisión integrativa

A população idosa vem crescendo, e episódios de quedas são cada vez mais frequentes. Neste artigo, procedeu-se uma revisão integrativa nas bases de dados SciELO e LILACS entre os anos de 2010 e 2015, com o objetivo de verificar o perfil dos estudos envolvendo quedas em idosos. Foram incluídos 149 artigos em que se percebeu a relação positiva do exercício físico. Os fatores de risco mais encontrados foram sexo feminino, depressão, idade avançada, entre outros. A fratura foi a consequência mais encontrada.

The elderly population is growing and episodes of falls are becoming more frequent. In this article, an integrative review of the SciELO and LILACS databases was carried out between 2010 and 2015, in order to verify the profile of studies involving falls in the elderly. A total of 149 articles were included where the positive relation of the physical exercise was perceived. The most common risk factors were female sex, depression, old age, among others. The fracture was the most common consequence.

La población anciana está creciendo y los episodios de caídas son cada vez más frecuentes. En este artículo se realizó una revisión integradora de las bases de datos SciELO y LILACS entre 2010 y 2015, con el objetivo de verificar el perfil de los estudios de caídas en ancianos. Se incluyeron 149 artículos donde se percibió la relación positiva del ejercicio físico. Los factores de riesgo más comunes fueron el sexo femenino, la depresión, la vejez, entre otros. La fractura fue la consecuencia más común.

High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients / Achados de tuberculose pulmonar na tomografia computadorizada de alta resolução em transplantados de pulmão

ABSTRACT Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

RESUMO Objetivo: As infecções respiratórias constituem a principal causa de morbidade e mortalidade em transplantados de órgãos sólidos. A incidência de tuberculose pulmonar é alta entre esses pacientes. Em exames de imagem, a tuberculose tem diferentes apresentações. Uma maior compreensão dessas apresentações poderia reduzir o impacto da doença ao facilitar o diagnóstico precoce. Portanto, buscamos descrever os padrões de tuberculose pulmonar na TCAR em transplantados de pulmão. Métodos: De dois hospitais no sul do Brasil, foram coletados os seguintes dados sobre transplantados de pulmão que desenvolveram tuberculose pulmonar: sexo; idade; sintomas; doença pulmonar que levou ao transplante; padrão na TCAR; distribuição dos achados; tempo entre transplante e tuberculose pulmonar; e taxa de mortalidade. Os achados na TCAR foram classificados como nódulos miliares; cavitação e nódulos centrolobulares com padrão de árvore em brotamento; atenuação em vidro fosco com consolidação; linfonodomegalia mediastinal; ou derrame pleural. Resultados: Foram avaliados 402 transplantados de pulmão, dos quais 19 desenvolveram tuberculose pulmonar após o transplante. Entre esses 19 pacientes, os padrões mais comuns na TCAR foram atenuação em vidro fosco com consolidação (em 42%); cavitação e nódulos centrolobulares com padrão de árvore em brotamento (em 31,5%); e linfonodomegalia mediastinal (em 15,7%). Entre os pacientes com cavitação e nódulos centrolobulares com padrão de árvore em brotamento, esses achados se distribuíam nos lobos superiores em 66,6%. Não se observou derrame pleural. Apesar do tratamento, a mortalidade em um ano foi de 47,3%. Conclusões: O padrão predominante na TCAR foi atenuação em vidro fosco com consolidação, seguido por cavitação e nódulos centrolobulares com padrão de árvore em brotamento. Esses achados são semelhantes aos relatados para pacientes imunocompetentes com tuberculose pulmonar e consideravelmente diferentes dos relatados para portadores de AIDS com a mesma doença.

High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients.

OBJECTIVE: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. METHODS: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. RESULTS: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. CONCLUSIONS: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

Óbitos e Internações por Quedas em Idosos Brasileiros: Revisão Integrativa da Literatura / Deaths and Hospitalizations for Falls in the Brazilian Elderly: Integrative Literature Review / Muertes y hospitalizaciones por caídas en los ancianos brasileños: Integral Revisión de la literatura

As quedas tornaram-se parte significativa dos problemas de saúde pública e ocupam posição de destaque nas estatísticas de saúde na maioria dos países, inclusive no Brasil. Este estudo trata-se de uma revisão integrativa da literatura cuja metodologia busca a investigação sistematizada sobre a problemática das quedas, com o propósito de identificação das possíveis lacunas do conhecimento. Verificou-se que o sexo feminino representa maior proporção de internações e atendimentos em serviços de urgências e emergências, enquanto que, no sexo masculino, a queda normalmente tem como principal desfecho o óbito. As dimensões de ocorrências envolvendo idosos que sofrem quedas são múltiplas e reforçam a necessidade de estudos para fundamentar a formulação de políticas públicas de prevenção desse agravo.

Falls have become a significant part of public health problems and occupy a prominent position in health statistics in most countries, including Brazil. This study is an integrative review of the literature whose methodology seeks the systematized research on the problem of falls, with the purpose of identifying possible knowledge gaps. It was verified that the female sex represents a greater proportion of hospitalizations and attendances in emergency and emergency services, whereas in males the fall usually has as main outcome the death. The dimensions of occurrences involving elderly people who suffer falls are multiple and reinforce the need for studies to support the formulation of public policies to prevent this disease.

Las caídas se han convertido en una parte importante de los problemas de salud pública y ocupar un lugar destacado en las estadísticas de salud en la mayoría de los países, incluyendo Brasil. Este estudio se ocupa de una metodología de revisión integradora de la literatura que trata la investigación sistemática sobre el problema de las caídas, con el fin de identificar posibles lagunas en el conocimiento. Se encontró que la hembra es mayor proporción de hospitalizaciones y visitas a urgencias en los servicios de atención de emergencia, mientras que en los hombres la caída por lo general tiene como principal resultado la muerte. Las dimensiones de los incidentes que involucran a personas de edad avanzada que sufren caídas son múltiples y refuerzan la necesidad de estudios para apoyar la formulación de políticas públicas para la prevención de estos eventos.