Desafios do atendimento nutricional em tempos de pandemia: relato de experiência / Challenges of nutritional service in pandemic times: an experience report / Desafíos del cuidado nutricional en tiempos de pandemia: relato de experiencia

Introdução:Considerando o cenário de pandemia ocorrido nos últimos anos (2019-2022) em razão da grande propagação mundial do novo Coronavírus (SARS-CoV-2), tornaram-se necessárias medidas preventivas que corroborasse na diminuição do contágio e disseminação do vírus, dentre estas, o distanciamento social. Com isso, houveram muitas modificações e adaptações de protocolos assistenciais assim como no atendimento nutricional que, embasados em normativas do Conselho Federal de Nutricionistas por meio de resolução, permitiu a utilização do atendimento nutricional de maneira não presencial. Objetivo:Relatar a experiência e desafios vivenciados durante o componente curricular Terapia Ambulatorial Nutricional-Prática II, do curso de Nutrição, por meio de atendimentos nutricionais híbridos, considerando o contexto de pandemia.Metodologia:Trata-se de um relato de experiência construído a partir das vivências do componente curricular Terapia Ambulatorial Nutricional-Prática II (Módulo prático), que integra a grade do Curso de Nutrição, da Faculdade de Ciências da Saúde do Trairi, da Universidade Federal do Rio Grande do Norte, os atendimentos se passaram em um cenário de pandemia, demandando cuidados e alterações.Resultados:Percebeu-se a partir dessa vivência, que diante do cenário atual muitas adaptações precisaram ser realizadas, no entanto, a utilização de estratégias se fez bastante presente de modo que tornasse a proposta viável. Conclusões:São muitos os obstáculos enfrentados quanto ao atendimento nutricional nocontexto de pandemia, haja vista que ajustes foram necessários no cronograma de consultas bem como limitações, os quais dificultaram muitas vezes a realização de uma abordagem igual à planejada. Porém, os obstáculos não tornaram inviável os atendimentos, de modo que foi possível atingir êxito nas consultas, metas e objetivos do paciente (AU).

Introduction:Considering the pandemic scenario that has occurred in recent years (2019-current) due to the great worldwide spread of the new Coronavirus (SARS-CoV-2), preventive measures have become necessary to corroborate the reduction of the contagion and spread of the virus, including social distancing. Thus, there were many changes and adaptations in care protocols as well as in nutritional service as a result of regulations of the Federal Council of Nutritionists through a resolution, which implemented nutritional care in a non-face-to-face manner. Objective:To report the experience and challenges experienced during the curricular component Nutritional Outpatient Therapy-Practice II of the Nutrition course through hybrid nutritional care and considering the pandemic context. Methodology:This is an experience report built from the experiences of the curricular component Nutritional Outpatient Therapy -Practice II (Practical Module), which is part of the Nutrition Course grid, of the Faculty of Health Sciences of Trairi, of the Federal University from Rio Grande do Norte, the calls took place in a pandemic scenario, demanding care and changes.Results:It was noticed from this experience that many adaptations had to be carried out in the face of the current scenario; however, the use of strategies was very present in order to make the proposal viable. Conclusions:There are many obstacles faced regarding nutritional care in the context of a pandemic, given that adjustments as well as limitations were necessary in the consultation schedule, which often made it difficult to carry out an approach equal to what had been planned. However, the obstacles did not make the consultations unfeasible, so it was possible to achieve success in the consultations, goals and objectives of the patient (AU).

Introducción:Considerando el escenario de pandemia que se ha presentado en los últimos años (2019-actual) debido a la gran propagación a nivel mundial del nuevo Coronavirus (SARS-CoV-2), las medidas preventivas se han vuelto necesarias para corroborar la reducción del contagio y propagación del virus, incluido el distanciamiento social. Como resultado, hubo muchos cambios y adaptaciones en los protocolos de atención, así como en el servicio nutricional que, con base en la normativa del Consejo Federal de Nutricionistas a través de una resolución, permitió el uso de la atención nutricional en forma no presencial. Objetivo: Relatar la experiencia y los desafíos vividos durante el componente curricular Terapia Ambulatoria Nutricional-Práctica II, de lacarrera de Nutrición, a través del cuidado nutricional híbrido, considerando el contexto de una pandemia. Metodología: Este es un relato de experiencia construido a partir de las experiencias del componente curricular Terapia Nutricional Ambulatoria -Práctica II (Módulo Práctico), que forma parte de la malla del Curso de Nutrición, de la Facultad de Ciencias de la Salud de Trairi, de la Universidad Federal de Río Grande do Norte, las visitas se realizaron en un escenario de pandemia, exigiendo cuidados y cambios.Resultados:A partir de esta experiencia, se percibió que, dado el escenario actual, se tuvieron que realizar muchas adaptaciones, sin embargo, estuvo muy presente el uso de estrategias para viabilizar la propuesta. Conclusiones:Son muchos los obstáculos enfrentados en cuanto a la atención nutricional en el contexto de una pandemia, dado que fueron necesarios ajustes en el horario de consultas así como limitaciones, que muchas veces dificultan realizar un abordaje igual al planificado. Sin embargo, los obstáculos no hicieron inviable las consultas, por lo que se logró alcanzar el éxito en las consultas, metas y objetivos del paciente (AU).

Gastro-protective effects of isobrucein B, a quassinoid isolated from Picrolemma sprucei.

Infusions of Picrolemma sprucei roots, stems and leaves are used in traditional medicine throughout the Amazon region from the Guianas to Brazil and Peru in the treatment of gastritis, intestinal helminths and malaria. As there are no studies describing its mode of action in providing a gastroprotective effect, we determined herein that one of the main constituents found in P. sprucei infusions, the quassinoid isobrucein B (IsoB), reduces some of the pathophysiological effects in a mouse model of non-steroidal anti-inflammatory drug (NSAID)-induced gastritis and provides mechanisms of action. Then, IsoB (1.17 g) was isolated from the roots and stems (6.5 kg) of P. sprucei. Its structure was confirmed by 1D and 2D (1)H and (13)C NMR, ESI-tof-MS, IR and UV. C57BL/6 strain mice were subcutaneously injected with IsoB (0.5-5 mg kg(-1)) or vehicle before oral administration of indomethacin and sacrificed later at different time points. Gastric damage was assessed by measuring lesion length. Leukocyte migration was evaluated based on leukocyte rolling and adhesion using intravital microscopy in the mesenteric microcirculation and tissue MPO activity. Stomach extract cytokine (TNFα, IL-1ß and KC/CXCL1) and prostaglandin E2 (PGE2) levels were measured by ELISA and RIA, respectively. IsoB pre-treatment (0.5-5.0 mg kg(-1)) significantly reduced the formation of indomethacin-induced stomach lesions in a dose-dependent manner. The decrease in stomach lesions was associated with less observed leukocyte rolling, decreased leukocyte adhesion and less neutrophil infiltration (MPO activity). IsoB (1 mg kg(-1)) pre-treatment did not prevent indomethacin-induced decreases in stomach PGE2 levels. However, IL-1ß and KC/CXCL1 levels were inhibited by this same IsoB dosage, whereas TNF-α was unchanged. IsoB may be a prototypic compound to provide protective effects against NSAID-induced gastritis and possibly other gastropathies. Moreover, IsoB gastroprotective action may be due to a reduction in IL-1ß and KC/CXCL1 production/release and leukocyte rolling, adhesion and migration.

Gram-scale isolation of isobrucein B and neosergeolide from Picrolemma sprucei Hook. f. / Isolamento de isobruceina B e neosergeolida de Picrolemma sprucei Hook. f. em escala-grama

Quassinoids neosergeolide and isobrucein B, obtained from Picrolemma sprucei, have proven in vitro antitumor, antimalarial, anthelminthic, cytotoxic, insecticide and leishmanicidal activities. There is interest in the in vivo pharmacological study of these natural compounds and their semi-synthetic derivatives, however, the quantities obtained in previous extraction processes have been shown to be a limiting factor for continuation of these studies. Herein, we describe a method for obtaining grams of these quassinoids whose purification relies only on recrystallization.

Os quassinóides neosergeolida e isobruceína B, obtidos de Picrolemma sprucei, possuem atividades antitumoral, antimalárica, anti-helmíntica, citotóxica, inseticida e anti-leishmania comprovadas em estudos in vitro. Há interesse no estudo farmacológico in vivo dessas substâncias naturais e de seus derivados semi-sintéticos, porém a quantidade obtida nos processos de extração tem se mostrado um fator limitante à continuação desses estudos. No presente trabalho, descrevemos um método para obtenção de gramas desses quassinóides cuja purificação depende apenas de cristalização fracionada.

In vitro inhibition of Plasmodium falciparum by substances isolated from Amazonian antimalarial plants.

In the present study, a quassinoid, neosergeolide, isolated from the roots and stems of Picrolemma sprucei (Simaroubaceae), the indole alkaloids ellipticine and aspidocarpine, isolated from the bark of Aspidosperma vargasii and A. desmanthum (Apocynaceae), respectively, and 4-nerolidylcatechol, isolated from the roots of Pothomorphe peltata (Piperaceae), all presented significant in vitro inhibition (more active than quinine and chloroquine) of the multi-drug resistant K1 strain of Plasmodium falciparum. Neosergeolide presented activity in the nanomolar range. This is the first report on the antimalarial activity of these known, natural compounds. This is also the first report on the isolation of aspidocarpine from A. desmanthum. These compounds are good candidates for pre-clinical tests as novel lead structures with the aim of finding new antimalarial prototypes and lend support to the traditional use of the plants from which these compounds are derived.

In vitro inhibition of Plasmodium falciparum by substances isolated from Amazonian antimalarial plants

In the present study, a quassinoid, neosergeolide, isolated from the roots and stems of Picrolemma sprucei (Simaroubaceae), the indole alkaloids ellipticine and aspidocarpine, isolated from the bark of Aspidosperma vargasii and A. desmanthum (Apocynaceae), respectively, and 4-nerolidylcatechol, isolated from the roots of Pothomorphe peltata (Piperaceae), all presented significant in vitro inhibition (more active than quinine and chloroquine) of the multi-drug resistant K1 strain of Plasmodium falciparum. Neosergeolide presented activity in the nanomolar range. This is the first report on the antimalarial activity of these known, natural compounds. This is also the first report on the isolation of aspidocarpine from A. desmanthum. These compounds are good candidates for pre-clinical tests as novel lead structures with the aim of finding new antimalarial prototypes and lend support to the traditional use of the plants from which these compounds are derived.

In vitro studies of the anthelmintic activity of Picrolemma sprucei Hook. f. (Simaroubaceae)

1300 ppm (1.3 g / L), water and ethanol extracts prepared from stems or roots of Picrolemma sprucei Hook. f. were lethal (85-90 percent mortality) in vitro to Haemonchus contortus (Barber Pole Worm) larvae, a gastrointestinal nematode parasite found in domestic and wild ruminants. Neosergeolide and isobrucein B were isolated in 0.0083 and 0.0070 percent yield from dry, ground P. sprucei stems (0.89 kg). Neosergeolide, isobrucein B and the anthelmintic drug standard levamisole all caused comparable mortality rates (68-77 percent) in vitro to H. contortus at similar concentrations (81-86 ppm). The anthelmintic activity of P. sprucei infusions (teas), alcohol extracts, and neosergeolide and isobrucein B, has therefore been demonstrated for the first time.

Na concentração de 1300 ppm (1.3 g / L), extratos aquosos e etanólicos preparados a partir dos caules ou raízes de Picrolemma sprucei Hook. f. apresentaram letalidade (85-90 por cento de mortalidade) in vitro para Haemonchus contortus, um nematóide parasítico do aparelho gastrointestinal de ruminantes domesticos e silvestres. Neosergeolida e isobruceina B foram isoladas dos caules em rendimentos de 0.0083 and 0.0070 por cento, respectivamente. Essas últimas e a droga anti-helmíntica levamisole provocaram mortalidade semelhante in vitro (68-77 por cento) em H. contortus em concentrações semelhantes (81-86 ppm). A atividade anti-helmíntica in vitro de infusões e extratos alcoólicos dos caules, bem como da neosergeolida e isobruceina B isoladas de P. sprucei, foi demonstrada pela primeira vez.