Malignancy Associated with Low-Risk HPV6 and HPV11: A Systematic Review and Implications for Cancer Prevention.

High-risk human papillomavirus (HPV) is etiologically related to cervical cancer, other anogenital cancers and oropharyngeal carcinomas. Low-risk HPV, especially HPV6 and HPV11, cause genital warts and laryngeal papillomas. However, the accumulating data suggests that HPV6 and HPV11 may cause malignant lesions at non-cervical anatomic sites. This review aims to estimate the proportions of single and dual HPV6/11 infections in multiple cancers reported in the last 10 years in the Cochrane, Embasa and PubMed databases. Secondly, the genomes of HPV6/11 were compared with the most common high-risk genotype, HPV16, to determine the similarities and differences. A total of 11 articles were selected, including between one and 334 HPV+ cancer patients. The frequencies of single or dual HPV6/11 infections ranged between 0-5.5% for penile and 0-87.5% for laryngeal cancers and were null for vulvar, vaginal and oral cancers. The genomic similarities between HPV6/11 and HPV16 mainly involved the E7 gene, indicating a limited ability to block cell differentiation. The presence of single or dual HPV6/11 infections in variable proportions of penile and laryngeal cancers support the vaccination strategies that cover these genotypes, not only for preventing genital warts but also for cancer prevention. Other risk factors and co-carcinogens are likely to participate in epithelial carcinogenesis associated with low-risk HPV.

Human Papillomavirus Modulates Matrix Metalloproteinases During Carcinogenesis: Clinical Significance and Role of Viral Oncoproteins.

Human papillomavirus (HPV) infections are associated with cervical cancer and other anogenital cancers. Despite progresses in HPV vaccination and screening, these cancers still show high incidence and mortality, requiring improved prognostic markers and tailored therapies. This review addresses the role of Matrix metalloproteinases (MMPs) in HPV-induced cancers and the modulation of MMP expression by HPV oncoproteins. Scientific literature indexed in PubMed and ScienceDirect about Human papillomavirus modulates matrix metalloproteinases was retrieved and critically analyzed, to obtain an overview of expression patterns and their implications for carcinogenesis and patient prognosis. Matrix metalloproteinases such as MMP1, MMP9 and MMP13 have been associated with patient prognosis in HPV-induced cancers and play a major role in the degradation of the extracellular matrix, tumor invasion and metastasis. The HPV E2 and E7 oncoproteins regulate MMP expression via AKT, MEK/ERK and AP-1 signaling among other mechanisms. Increased expression of MMPs is associated with cancer progression and poor prognosis in multiple HPV-induced cancers, suggesting their potential use as prognostic markers. The identification of specific signaling pathways that mediate MMP regulation by HPV is essential for developing efficient new cancer therapies.

Antimicrobial peptidomes of Bothrops atrox and Bothrops jararacussu snake venoms.

The worrisome emergence of pathogens resistant to conventional drugs has stimulated the search for new classes of antimicrobial and antiparasitic agents from natural sources. Antimicrobial peptides (AMPs), acting through mechanisms that do not rely on the interaction with a specific receptor, provide new possibilities for the development of drugs against resistant organisms. This study sought to purify and proteomically characterize the antimicrobial and antiparasitic peptidomes of B. atrox and B. jararacussu snake venoms against Gram-positive (Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus-MRSA), Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) bacteria, and the protozoan parasites Leishmania amazonensis and Plasmodium falciparum (clone W2, resistant to chloroquine). To this end, B. atrox and B. jararacussu venom peptides were purified by combination of 3 kDa cut-off Amicon® ultracentrifugal filters and reverse-phase high-performance liquid chromatography, and then identified by electrospray-ionization Ion-Trap/Time-of-Flight mass spectrometry. Fourteen distinct peptides, with masses ranging from 443.17 to 1383.73 Da and primary structure between 3 and 13 amino acid residues, were sequenced. Among them, 13 contained unique sequences, including 4 novel bradykinin-potentiating-like peptides (BPPs), and a snake venom metalloproteinase tripeptide inhibitor (SVMPi). Although commonly found in Viperidae venoms, except for Bax-12, the BPPs and SVMPi here reported had not been described in B. atrox and B. jararacussu venoms. Among the novel peptides, some exhibited bactericidal activity towards P. aeruginosa and S. aureus, had low hemolytic effect, and were devoid of antiparasitic activity. The identified novel antimicrobial peptides may be relevant in the development of new drugs for the management of multidrug-resistant Gram-negative and Gram-positive bacteria.

Antimicrobial peptidomes of Bothrops atrox and Bothrops jararacussu snake venoms

The worrisome emergence of pathogens resistant to conventional drugs has stimulated the search for new classes of antimicrobial and antiparasitic agents from natural sources. Antimicrobial peptides (AMPs), acting through mechanisms that do not rely on the interaction with a specific receptor, provide new possibilities for the development of drugs against resistant organisms. This study sought to purify and proteomically characterize the antimicrobial and antiparasitic peptidomes of B. atrox and B. jararacussu snake venoms against Gram-positive (Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus—MRSA), Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) bacteria, and the protozoan parasites Leishmania amazonensis and Plasmodium falciparum (clone W2, resistant to chloroquine). To this end, B. atrox and B. jararacussu venom peptides were purified by combination of 3 kDa cut-off Amicon® ultracentrifugal filters and reverse-phase high-performance liquid chromatography, and then identified by electrospray-ionization Ion-Trap/Time-of-Flight mass spectrometry. Fourteen distinct peptides, with masses ranging from 443.17 to 1383.73 Da and primary structure between 3 and 13 amino acid residues, were sequenced. Among them, 13 contained unique sequences, including 4 novel bradykinin-potentiating-like peptides (BPPs), and a snake venom metalloproteinase tripeptide inhibitor (SVMPi). Although commonly found in Viperidae venoms, except for Bax-12, the BPPs and SVMPi here reported had not been described in B. atrox and B. jararacussu venoms. Among the novel peptides, some exhibited bactericidal activity towards P. aeruginosa and S. aureus, had low hemolytic effect, and were devoid of antiparasitic activity. The identified novel antimicrobial peptides may be relevant in the development of new drugs for the management of multidrug-resistant Gram-negative and Gram-positive bacteria.

Antileishmanial and Immunomodulatory Effect of Babassu-Loaded PLGA Microparticles: A Useful Drug Target to Leishmania amazonensis Infection.

The immunological and the anti-Leishmania amazonensis activity of babassu-loaded poly(lactic-co-glycolic acid) [PLGA] microparticles was evaluated. The anti-Leishmania activity was evaluated against promastigotes or amastigotes forms, in Balb/c macrophages. The size of the microparticles ranged from 3 to 6.4 µm, with a zeta potential of -25 mV and encapsulation efficiency of 48%. The anti-Leishmania activity of the PLGA microparticles loaded with the aqueous extract of babassu mesocarp (MMP) (IC50) was 10-fold higher than that free extract (Meso). MMP exhibited overall bioavailability and was very effective in eliminating intracellular parasites. MMP also reduced ex vivo parasite infectivity probably by the increased production of nitric oxide, hydrogen peroxide, and TNF-α indicating the activation of M1 macrophages. The overexpression of TNF-α did not impair cell viability, suggesting antiapoptotic effects of MMP. In conclusion, babassu-loaded microparticles could be useful for drug targeting in the treatment of leishmaniasis, due to the immunomodulatory effect on macrophage polarization and the increased efficacy as an anti-Leishmania product after the microencapsulation. These findings are of great relevance since the development of new drugs for the treatment of neglected diseases is desirable, mainly if we consider the high morbidity and mortality rates of leishmaniasis worldwide.

Nurses in post-operative heart surgery: professional competencies and organization strategies.

OBJECTIVE: To analyze nurses' competencies with regard to their work in post-operative heart surgery and the strategies implemented to mobilize these competencies. METHOD: This was an exploratory study with a qualitative approach and a methodological design of collective case study. It was carried out in three post-operative heart surgery units, consisting of 18 nurses. Direct observation and semi-structured interviews were employed to collect data. Data were construed through thematic analysis. RESULTS: nine competencies were found, as follows: theoretical-practical knowledge; high-complexity nursing care; nursing supervision; leadership in nursing; decision making; conflict management; personnel management; material and financial resources management; and on-job continued education. Organizational and individual strategies were employed to develop and improve competencies such as regular offerings of courses and lectures, in addition to the individual pursuit for knowledge and improvement. CONCLUSION: the study is expected to lead future nurses and training centers to evaluate the need for furthur training required to work in cardiac units, and also the need for implementing programs aimed at developing the competencies of these professionals. OBJETIVO: Analisar as competências dos enfermeiros para atuarem no pós-operatório de cirurgia cardíaca e estratégias implementadas para a mobilização dessas competências. MÉTODO: Estudo exploratório, com abordagem qualitativa e desenho metodológico estudo de caso coletivo. Foi realizado em três unidades pós-operatórias de cirurgias cardíacas, com 18 enfermeiros. Na coleta de dados utilizou-se observação direta e entrevista semiestruturada. Para interpretação dos dados optou-se pela análise temática. RESULTADOS: Foram identificadas nove competências, sendo: conhecimento teórico-prático, cuidados de enfermagem de alta complexidade, supervisão e liderança em enfermagem, tomada de decisão, gerenciamento de conflitos, de recursos humanos, materiais, financeiros e educação continuada em serviço. Estratégias organizacionais e individuais são realizadas a fim de desenvolver e aprimorar competências, tais como: oferecimento de cursos e palestras periodicamente, além da busca individual por conhecimento e aperfeiçoamento. CONCLUSÃO: O estudo deve provocar a reflexão de futuros enfermeiros e dos centros formadores quanto à formação necessária para atuar em unidades cardíacas e sobre a necessidade de implementação de programas que visam desenvolver competências nestes profissionais.

Nurses in post-operative heart surgery: professional competencies and organization strategies / El enfermero en el posoperatorio de cirugía cardiaca: competencias profesionales y estrategias de la organización / O enfermeiro no pós-operatório de cirurgia cardíaca: competências profissionais e estratégias da organização

Abstract OBJECTIVE To analyze nurses' competencies with regard to their work in post-operative heart surgery and the strategies implemented to mobilize these competencies. METHOD This was an exploratory study with a qualitative approach and a methodological design of collective case study. It was carried out in three post-operative heart surgery units, consisting of 18 nurses. Direct observation and semi-structured interviews were employed to collect data. Data were construed through thematic analysis. RESULTS nine competencies were found, as follows: theoretical-practical knowledge; high-complexity nursing care; nursing supervision; leadership in nursing; decision making; conflict management; personnel management; material and financial resources management; and on-job continued education. Organizational and individual strategies were employed to develop and improve competencies such as regular offerings of courses and lectures, in addition to the individual pursuit for knowledge and improvement. CONCLUSION the study is expected to lead future nurses and training centers to evaluate the need for furthur training required to work in cardiac units, and also the need for implementing programs aimed at developing the competencies of these professionals.

Resumen OBJETIVO Analizar las competencias de los enfermeros para actuar en el posoperatorio de cirugía cardiaca y las estrategias implantadas para la movilización de dichas competencias MÉTODO Estudio exploratorio, con abordaje cualitativo y diseño metodológico estudio de caso colectivo. Se llevó a cabo en tres unidades posoperatorias de cirugías cardiacas, con 18 enfermeros. En la recolección de datos se utilizó observación directa y entrevista semiestructurada. Para la interpretación de los datos se optó por el análisis temático. RESULTADOS Fueron identificadas nueve competencias, siendo: conocimiento teórico-práctico, cuidados de enfermería de alta complejidad, supervisión y liderazgo en enfermería, toma de decisiones, gestión de conflictos, de recursos humanos, materiales, financieros y educación continuada en servicio. Estrategias organizativas e individuales se realizan a fin de desarrollar y mejorar competencias, tales como: ofrecimiento de cursos y conferencias periódicamente, además de la búsqueda individual por conocimiento y perfeccionamiento. CONCLUSIÓN El estudio debe provocar la reflexión de futuros enfermeros y los centros formadores en cuanto a la formación necesaria para actuar en unidades cardiacas y acerca de la necesidad de implantación de programas que tienen como fin desarrollar competencias en esos profesionales.

Resumo OBJETIVO Analisar as competências dos enfermeiros para atuarem no pós-operatório de cirurgia cardíaca e estratégias implementadas para a mobilização dessas competências. MÉTODO Estudo exploratório, com abordagem qualitativa e desenho metodológico estudo de caso coletivo. Foi realizado em três unidades pós-operatórias de cirurgias cardíacas, com 18 enfermeiros. Na coleta de dados utilizou-se observação direta e entrevista semiestruturada. Para interpretação dos dados optou-se pela análise temática. RESULTADOS Foram identificadas nove competências, sendo: conhecimento teórico-prático, cuidados de enfermagem de alta complexidade, supervisão e liderança em enfermagem, tomada de decisão, gerenciamento de conflitos, de recursos humanos, materiais, financeiros e educação continuada em serviço. Estratégias organizacionais e individuais são realizadas a fim de desenvolver e aprimorar competências, tais como: oferecimento de cursos e palestras periodicamente, além da busca individual por conhecimento e aperfeiçoamento. CONCLUSÃO O estudo deve provocar a reflexão de futuros enfermeiros e dos centros formadores quanto à formação necessária para atuar em unidades cardíacas e sobre a necessidade de implementação de programas que visam desenvolver competências nestes profissionais.

O trabalho da enfermagem no pós-operatório de cirurgia cardíaca: uma revisão integrativa / The work of nursing in the postoperative period of cardiac surgery: an integrative review

Este estudo teve o objetivo de identificar, por meio de produções científicas nacionais e internacionais, os cuidados desenvolvidos pela equipe de enfermagem durante a assistência ao paciente no pósoperatório de cirurgia cardíaca. Trata-se de uma revisão integrativa realizada por meio de busca às bases PubMed, LILACS, CINAHL, SCOPUS e BDENF no período de fevereiro a junho de 2014, com o seguinte questionamento: “Quais os cuidados realizados pela equipe de enfermagem ao paciente no pós-operatório de cirurgia cardíaca?” Utilizou-se como critério de inclusão artigos científicos publicados nos últimos cinco anos, em português, inglês e espanhol, disponíveis na íntegra. Foram selecionados 21 artigos e, mediante a sua leitura criteriosa, foi realizada análise descritiva, possibilitando o agrupamento dos dados em um núcleo temático: cuidando do paciente no pós-operatório de cirurgia cardíaca, que apontou subcategorias: assistindo o paciente após cirurgia cardíaca, gerenciando a dor e a comunicação como ferramenta no cuidado de enfermagem. Os cuidados desenvolvidos no pós-operatório de cirurgia cardíaca demonstram a necessidade de organização do processo de trabalho da equipe de enfermagem bem como competências específicas dos profissionais para atuarem nesse cenário, com intuito de promover um cuidado individualizado e qualificado.

This study aimed to identify, through national and international scientific production, the care provided by the nursing staff during patient care in the postoperative period of cardiac surgery. It is an integrative review accomplished through searching PubMed, LILACS, CINAHL, SCOPUS and BDENF in the period from February to June 2014, with the question: “What is the care provided to the patient by nursing staff in the postcardiac surgery?” It was used as a criterion for inclusion scientific articles published in the last five years, in Portuguese, English and Spanish, available in its entirety. Twenty-one articles were selected and, by careful reading, descriptive analysis was performed, enabling the pooling of data on a theme: caring for the patient during the postoperative period of cardiac surgery, which yielded subcategories: taking care of the patient in the postoperative period of cardiac surgery, managing pain and communication as a tool in nursing care. The care in the postoperative period of cardiac surgery demonstrate the necessity of organization of the work process of the nursing staff as well as specific professional skills to work in this scenario, in order to promote individualized and qualified care.

Biofilm on artificial pacemaker: fiction or reality?

Cardiac pacing through cardiac pacemaker is one of the most promising alternatives in the treatment of arrhythmias, but it can cause reactions natural or complex reactions, either early or late. This study aimed to describe the scientific evidence on the risk of infection and biofilm formation associated with cardiac pacemaker. This is a study of integrative literature review. It included 14 publications classified into three thematic categories: diagnosis (microbiological and/or clinical), complications and therapy of infections. Staphylococcus epidermidis and Staphylococcus aureus were the microorganisms most frequently isolated. It was not possible to determine the incidence of infection associated with pacemakers, since the studies were generally of prevalence. In terms of therapy, the complete removal of pacemakers stood out, especially in cases of suspected biofilm. Still controversial is the use of systemic antibiotic prophylaxis in reducing the incidence of infection associated with implantation of a pacemaker.

Biofilme em marca-passo artificial: ficção ou realidade? / Biofilm on artificial pacemaker: fiction or reality? / Biofilm en marcapaso artificial: ¿ ficción o realidad?

A estimulação cardíaca artificial por meio de marca-passo cardíaco representa uma das alternativas mais promissoras no tratamento das arritmias, entretanto pode ocasionar reações singulares ou complexas, precoces ou tardias. Neste estudo, objetivou-se descrever as evidências científicas sobre o risco de infecção e formação de biofilme associado ao marca-passo cardíaco. Trata-se de um estudo de revisão integrativa da literatura. Totalizaram-se 14 publicações classificadas em três categorias temáticas: diagnóstico (microbiológico e/ou clínico), complicações e terapêutica das infecções. Os Staphylococcus epidermidis e os Staphylococcus aureus foram os microrganismos mais frequentemente isolados. Não foi possível determinar a incidência da infecção associada aos marca-passos, uma vez que os estudos eram em geral de prevalência. Em termos de terapêutica destacou-se a remoção completa dos marca-passos, especialmente nos casos de suspeita de biofilme. Ainda é controverso o uso da profilaxia antibiótica sistêmica na redução da incidência da infecção associada ao implante de marca-passo.

Cardiac pacing through cardiac pacemaker is one of the most promising alternatives in the treatment of arrhythmias, but it can cause reactions natural or complex reactions, either early or late. This study aimed to describe the scientific evidence on the risk of infection and biofilm formation associated with cardiac pacemaker. This is a study of integrative literature review. It included 14 publications classified into three thematic categories: diagnosis (microbiological and/or clinical), complications and therapy of infections. Staphylococcus epidermidis and Staphylococcus aureus were the microorganisms most frequently isolated. It was not possible to determine the incidence of infection associated with pacemakers, since the studies were generally of prevalence. In terms of therapy, the complete removal of pacemakers stood out, especially in cases of suspected biofilm. Still controversial is the use of systemic antibiotic prophylaxis in reducing the incidence of infection associated with implantation of a pacemaker.

La estimulación cardíaca artificial por medio de marcapaso cardíaco representa una de las alternativas más promisorias en el tratamiento de las arritmias, sin embargo, puede ocasionar reacciones singulares o complejas, precoces o tardías. En este estudio, el objetivo fue describir las evidencias científicas sobre el riesgo de infección y formación de biofilm asociado al marcapaso cardíaco. Se trata de un estudio de revisión integrante de la literatura. Se totalizaron 14 publicaciones clasificadas en tres categorías temáticas: diagnóstico (microbiológico y/o clínico), complicaciones y terapéutica de las infecciones. Los Staphylococcus epidermidis y los Staphylococcus aureus fueron los microorganismos más a menudo aislados. No se pudo determinar la incidencia de la infección asociada a los marcapasos, pues los estudios eran en general de prevalencia. En términos de terapéutica se destacó la retirada completa de los marcapasos, especialmente en los casos en que se sospechaba de biofilm. Todavía es algo controvertido el uso de la profilaxis antibiótica sistémica para la reducción de la incidencia de la infección asociada al implante de marcapaso.