Controlled Release of the Anticancer Drug Cyclophosphamide from a Superparamagnetic ß-Cyclodextrin Nanosponge by Local Hyperthermia Generated by an Alternating Magnetic Field.

A ß-cyclodextrin (ß-CD) nanosponge (NS) was synthesized using diphenyl carbonate (DPC) as a cross-linker to encapsulate the antitumor drug cyclophosphamide (CYC), thus obtaining the NSs-CYC system. The formulation was then associated with magnetite nanoparticles (MNPs) to develop the MNPs-NSs-CYC ternary system. The formulations mentioned above were characterized to confirm the deposition of the MNPs onto the organic matrix and that the superparamagnetic nature of the MNPs was preserved upon association. The association of the MNPs with the NSs-drug complex was confirmed through field emission scanning electron microscopy, energy dispersive spectroscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, dynamic light scattering, ζ-potential, atomic absorption spectroscopy, X-ray powder diffraction, selected area electron diffraction, and vibrating-sample magnetometer. The superparamagnetic properties of the ternary system allowed the release of CYC by utilizing magnetic hyperthermia upon the exposure of an alternating magnetic field (AMF). The drug release experiments were carried out at different frequencies and intensities of the magnetic field, complying with the "Atkinson-Brezovich criterion". The assays in AMF showed the feasibility of release by controlling hyperthermia of the drug, finding that the most efficient conditions were F = 280 kHz, H = 15 mT, and a concentration of MNPs of 5 mg/mL. CYC release was temperature-dependent, facilitated by local heat generation through magnetic hyperthermia. This phenomenon was confirmed by DFT calculations. Furthermore, the ternary systems outperformed the formulations without MNPs regarding the amount of released drug. The MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assays demonstrated that including CYC within the magnetic NS cavities reduced the effects on mitochondrial activity compared to those observed with the free drug. Finally, the magnetic hyperthermia assays showed that the tertiary system allows the generation of apoptosis in HeLa cells, demonstrating that the MNPs embedded maintain their properties to generate hyperthermia. These results suggest that using NSs associated with MNPs could be a potential tool for a controlled drug delivery in tumor therapy since the materials are efficient and potentially nontoxic.

Fast and easy synthesis of silver, copper, and bimetallic nanoparticles on cellulose paper assisted by ultrasound.

This work focuses on a systematic method to produce Ag, Cu, and Ag/Cu metallic nanoparticles (MNPs) in situ assisted with ultrasound on cellulose paper. By tuning the concentration of AgNO3 and CuSO4 salt precursors and ultrasound time, combined with a fixed concentration of ascorbic acid (AA) as a reducing agent, it was possible to control the size, morphology, and polydispersity of the resulting MNPs on cellulose papers. Notably, high yield and low polydispersity of MNPs and bimetallic nanoparticles are achieved by increasing the sonication time on paper samples pre-treated with salt precursors before reduction with AA. Moreover, mechanical analysis on paper samples presenting well-dispersed and distributed MNPs showed slightly decreasing values of Young's modulus compared to neat papers. The strain at break is substantially improved in papers containing solely Ag or Cu MNPs. The latter suggests that the elastic/plastic transition and deformation of papers are tuned by cellulose and MNPs interfacial interaction, as indicated by mechanical analysis. The proposed method provides insights into each factor affecting the sonochemistry in situ synthesis of MNPs on cellulose papers. In addition, it offers a straightforward alternative to scale up the production of MNPs on paper, ensuring an eco-friendly method.

Review on Generation and Characterization of Copper Particles and Copper Composites Prepared by Mechanical Milling on a Lab-Scale.

This review aims to expose mechanical milling as an alternative method for generating copper-based particles (copper particles (CuP) and copper composites (CuC)); more specifically, via a top-down or bottom-up approach, on a lab-scale. This work will also highlight the different parameters that can affect the size distribution, the type, and the morphology of the obtained CuP or CuC, such as the type of mechanical mill, ball-to-powder ratios (BPR), the milling speed, milling time, and the milling environment, among others. This review analyzes various papers based on the Cu-based particle generation route, which begins with a pretreatment step, then mechanical milling, its approach (top-down or bottom-up), and the post-treatment. Finally, the characterization methods of the resulting CuP and CuC through mechanical milling are also discussed.

ß-Cyclodextrin Nanosponges Inclusion Compounds Associated with Silver Nanoparticles to Increase the Antimicrobial Activity of Quercetin.

This work aimed to synthesize and characterize a nanocarrier that consisted of a ternary system, namely ß-cyclodextrin-based nanosponge (NS) inclusion compounds (ICs) associated with silver nanoparticles (AgNPs) to increase the antimicrobial activity of quercetin (QRC). The nanosystem was developed to overcome the therapeutical limitations of QRC. The host-guest interaction between NSs and QRC was confirmed by field emission scanning electron microscopy (FE-SEM), X-ray powder diffraction (XRPD), thermogravimetric analysis (TGA), and proton nuclear magnetic resonance (1H-NMR). Moreover, the association of AgNPs with the NS-QRC was characterized using FE-SEM, energy-dispersive spectroscopy (EDS), transmission electron microscopy (TEM), dynamic light scattering (DLS), ζ-potential, and UV-Vis. Finally, the antimicrobial activity of the novel formulations was tested, which depicted that the complexation of QRC inside the supramolecular interstices of NSs increases the inhibitory effects against Escherichia coli ATCC25922, as compared to that observed in the free QRC. In addition, at the same concentrations used to generate an antibacterial effect, the NS-QRC system with AgNPs does not affect the metabolic activity of GES-1 cells. Therefore, these results suggest that the use of NSs associated with AgNPs resulted in an efficient strategy to improve the physicochemical features of QRC.

Nanomaterials Based on Honey and Propolis for Wound Healing-A Mini-Review.

Wound healing is a public health concern worldwide, particularly in chronic wounds due to delayed healing and susceptibility to bacterial infection. Nanomaterials are widely used in wound healing treatments due to their unique properties associated with their size and very large surface-area-to-volume ratio compared to the same material in bulk. The properties of nanomaterials can be expanded and improved upon with the addition of honey and propolis, due to the presence of bioactive molecules such as polyphenols, flavonoids, peptides, and enzymes. These bionanomaterials can act at different stages of wound healing and through different mechanisms, including anti-inflammatory, antimicrobial, antioxidant, collagen synthesis stimulation, cell proliferation, and angiogenic effects. Biomaterials, at the nanoscale, show new alternatives for wound therapy, allowing for targeted and continuous delivery of beekeeping products at the injection site, thus avoiding possible systemic adverse effects. Here, we summarize the most recent therapies for wound healing based on bionanomaterials assisted by honey and propolis, with a focus on in vitro and in vivo studies. We highlight the type, composition (honey, propolis, and polymeric scaffolds), biological, physicochemical/mechanical properties, potential applications and patents related of the last eight years. Furthermore, we discuss the challenges, advantages, disadvantages and stability of different bionanomaterials related to their clinical translation and insight into the investigation and development of new treatments for wound healing.

Espaço estamira: experiência inovadora em educação permanente com residentes de saúde mental / Espaço estamira: an innovative experience in continuing education with mental health residents / Espacio estamira: innovadora experiencia en educación permanente con residentes de salud mental

Os processos de trabalho em equipes multiprofissionais são permeados de desafios. A Educação Permanente em Saúde é uma estratégia que visa transformar práticas em saúde nos âmbitos de ensino-aprendizagem, gestão, cuidado e controle social. Este artigo é um relato de experiência sobre o Espaço Estamira, projeto criado com o objetivo de implementar, em um programa de residência multiprofissional em saúde mental, um espaço formativo institucional onde os residentes pudessem intensificar o processo de ensino e aprendizagem em serviço de forma colaborativa, horizontal e autogerida, além de fortalecer a criação de vínculos e a qualificação do processo de trabalho. O Espaço Estamira acontece um turno por semana, com encontros para discussões de caso e supervisão compartilhada, discussão de textos, cinedebate, autocuidado e autogestão. Ficou evidente que entre os principais resultados do Espaço Estamira está a mudança de olhares e posturas em serviço das/os residentes, aprimorando a prática profissional e as intervenções em saúde mental. Também houve o estímulo à propagação das reflexões produzidas pelas/os residentes entre as equipes dos serviços em que elas/es atuavam. Concluiu-se que o Espaço Estamira possibilitou às/aos residentes a elaboração de análises críticas acerca dos projetos pedagógicos dos programas de residência, além de se mostrar relevante na construção de práticas profissionais potencializadoras do cuidado, alicerçadas em dimensões teórico-metodológicas, políticas e éticas comprometidas com as necessidades das/os usuárias/os do Sistema Único de Saúde (SUS).

Multiprofessional working processes are fraught with challenges. Continuing Health Education is a strategy that seeks to transform health practices within teaching-learning, management, care and social control. This article is an experience report on Espaço Estamira, a project created to implement, in a multiprofessional residency program in mental health, an institutional formative space where residents could their in-service training in a collaborative, horizontal, and self-managed manner, as well as strengthen the creation of bonds and qualify the working process. Espaço Estamira takes place one shift a week, with meetings for case discussions and shared supervision, texts discussions, cinema debate, self-care and self-management. Results shows that Espaço Estamira contributed greatly to changes in the residents' in-service perspectives and attitudes, improving professional practice and mental health interventions. Moreover, residents were encouraged to disseminate their reflections among their teams. In conclusion, Espaço Estamira enabled residents to elaborate critical analysis regarding pedagogical projects from residency programs, and proved to be relevant for developing professional practices that potentialize care, grounded on theoretical-methodological, political, and ethical dimensions committed to meet SUS users' needs.

Los procesos de trabajo en equipos multiprofesionales están impregnados de desafíos. La Educación Permanente en Salud es una estrategia que tiene como objetivo transformar las prácticas de salud en el ámbito de enseñanza-aprendizaje, gestión, cuidado y control social. Este artículo es un reporte de experiencia sobre el Espacio Estamira, un proyecto creado con el objetivo de implementar, en un programa de residencia multiprofesional en salud mental, un espacio de formación institucional donde los residentes pudieran intensificar el proceso de enseñanza y aprendizaje en servicio que sea colaborativo, horizontal y autogestionado, además de fortalecer la creación de vínculos y capacitación del proceso de trabajo. Espaço Estamira ocurre un turno por semana con reuniones para discusión de casos y supervisión compartida, discusión de texto, debate cinematográfico, autocuidado y autogestión. Se evidenció que uno de los principales resultados de este espacio es el cambio de miradas y actitudes en el servicio de las/los residentes, mejorando la práctica profesional y las intervenciones de salud mental. También se incentivó las reflexiones producidas entre ellas/ellos con los equipos de los servicios de salud por los cuales han pasado. Se concluyó que el Espaço Estamira les permitió a las/los residentes desarrollar análisis críticos sobre los proyectos pedagógicos de los programas de residencia, además de ser relevante en la construcción de prácticas profesionales que potencien el cuidado, basadas en dimensiones teórico-metodológicas, políticas y éticas comprometidas con las necesidades de las/los usuarias/os del Sistema Único de Salud (SUS).

Sexualidad de la mujer con cáncer de mama en fase perioperatoria: consulta de enfermería / Sexuality of women with perioperative breast cancer: nursing consultation

Objetivo: Proponer una consulta de enfermería en sexualidad para mujeres con cáncer de mama en fase perioperatoria para una institución oncológica. Metodología: Revisión integrativa de literatura. Se llevó a cabo una búsqueda de literatura en las bases de datos LILACS, SpringerLink, ClinicalKey, Biblioteca Virtual en Salud (BVS), Scopus, SAGE Journals y búsquedas secundarias en revistas científicas en Taylor & Francis Online. Se encontraron 35 artículos, los cuales se organizaron y se caracterizaron por año de publicación, idioma, país, edad promedio de la muestra, tipos de tratamiento, metodología, perspectiva disciplinar, enfoque, diseño y tendencia temática. Esta estrategia permitió desarrollar los objetivos. Resultados: La tendencia de investigación identificada se agrupó en cuatro categorías de necesidades en cuanto a la sexualidad: Respuesta sexual fisiológica; Adaptación psicológica a los sentimientos; Pérdida del atractivo físico y Salud sexual y reproductiva. Se propuso una consulta de enfermería con base en el modelo PLISSIT para abordar la sexualidad, de modo que fuera factible otorgar respuestas a las necesidades reales de la mujer con cáncer de mama. Conclusiones: La sexualidad en mujeres con cáncer de mama es un factor importante en la fase perioperatoria, pues permanentemente se ve alterada por la enfermedad y los tratamientos, afectando tanto a la mujer como a su pareja. De este modo, se requiere realizar intervenciones en una consulta de enfermería especializada en sexualidad para mujeres con cáncer de mama.

Objective: To propose a sexuality nursing consultation for women with breast cancer in the perioperative phase in an oncological institution. Methodology: Integrative literature review. A literature search was carried out in databases LILACS, SpringerLink, ClinicalKey, Virtual health Library (BVS), Scopus, and SAGE Journals; a secondary literature searches also was carried out in several scientific journals in Taylor & Francis Online. 35 articles were found and they were put together and characterized in accordance with publication year, language, publication country, average age of the sample, forms of treatment, methodology, field of study outlook, approach, design, and trending topic. This framework enabled to sort the objective out. Results: The trending research topic identified was clustered into four categories of requirements about sexuality: Physiological sexual response; Psychological adjustment to feelings; Loss of attractiveness; and Sexual and reproductive health. A nursing consultation was proposed based on the PLISSIT model of sex therapy in order to give responses to the real needs of women with breast cancer. Conclusions: Sexuality of women with breast cancer is a significant feature in the perioperative phase; it is permanently disrupted by disease and treatments, impacting both the woman and her partner. Therefore, it is necessary to carry out interventions in a sexuality nursing consultation for women with breast cancer

Avaliação positiva da assistência às pessoas com Diabetes Mellitus na atenção básica / Positive evaluation of the assistance provided to people with Diabetes Mellitus in primary care

Objetivo: Verificar os fatores associados à avaliação positiva da assistência prestada às pessoas com diabetes tipo 2 na Atenção Primária. Método:Estudo descritivo transversal, no qual foram entrevistadas 408 pessoas com diabetes tipo 2, da zona urbana de um município da região Sul do Brasil, de 65 equipes da Estratégia Saúde da Família. Foi utilizado questionário contendo variáveis sociodemográficas, clínicas, comportamentais e indicadores da assistência e do acesso ao serviço de saúde na atenção básica; realizado o teste qui-quadrado de Pearson, regressão logística múltipla e cálculo do Odds Ratio para análise dos fatores relacionados à avaliação positiva da assistência. Resultados:A prevalência da avaliação positiva da assistência prestada foi de 81,9%. Os fatores que apresentaram associação significativa com a avaliação positiva foram: sexo masculino (OR=2,96), atividade física (OR=2,54), ser atendido no mesmo dia em que vai à Unidade Básica (OR=2,60), receber os antidiabéticos orais e/ou insulina (OR=0,12) e orientações sobre alimentação adequada (OR=2,72); e conseguir mostrar os resultados de exames com maior facilidade (OR=3,09). Conclusão:O diabetes tipo 2 pode ser um indicador da qualidade do serviço prestado pelas equipes da ESF e a satisfação dos usuários está relacionada ao serviço de qualidade, ao acolhimento às demandas e ao cuidado contínuo.

Objective:To verify the factors associated with the positive evaluation of the assistance provided to people with type 2 diabetes in Primary Health Care. Method:Descriptive cross-sectional study with interview of 408 people with type 2 diabetes from the urban area of a city in the southern region of Brazil covered by 65 Family Health Strategy teams. A questionnaire containing sociodemographic, clinical, behavioral variables and indicators of assistance and access to health services in primary care was used; the Pearson's chi-square test, multiple logistic regression and Odds Ratio were performed to analyze which factors were related to a positive evaluation of the care provided. Results:The prevalence of positive evaluation of the care provided was 81.9%. The factors that showed a significant association with a positive evaluation were: male gender (OR = 2.96), physical activity (OR = 2.54), receiving care on the same day the person goes to the Basic Unit (OR = 2.60), receiving oral antidiabetics and/or insulin (OR = 0.12), receiving guidance on proper nutrition (OR = 2.72), and being able to show test results more easily (OR = 3.09). Conclusion:Type 2 diabetes can be an indicator of the quality of service provided by FHS teams and user satisfaction is related to the quality of the service, embracement of demands, and continuous care.

Easy, Quick, and Reproducible Sonochemical Synthesis of CuO Nanoparticles.

Copper oxide nanoparticles (CuO NPs) were synthesized in air by reducing copper (II) sulfate pentahydrate salt (CuSO4·5H2O) in the presence of sodium borohydride. The reaction was stabilized with Hexadecyltrimethylammonium bromide (CTAB) in a basic medium and using ultrasound waves. Different molar ratios of CTAB:Cu2+ and NaBH4:Cu2+ were explored, to optimize the synthesis conditions, and to study the stability, size, and Zeta potential of the colloidal suspension. Optimum conditions to generate spherical, stable, and monodispersed nanoparticles with hydrodynamic diameters of 36 ± 1.3 nm were obtained, using 16 mM CTAB and 2 M NaBH4 (molar ratios Cu2+:CTAB:NaBH4 of 1:6:10). X-ray diffraction (XRD) was implemented, and a monoclinic CuO crystal system was formed. This demonstrated a monoclinic crystal system corresponding to CuO. The diffraction peaks were identified and confirmed according to their selected area electron diffraction (SAED) patterns.

Photothermally Controlled Methotrexate Release System Using ß-Cyclodextrin and Gold Nanoparticles.

The inclusion compound (IC) of cyclodextrin (CD) containing the antitumor drug Methotrexate (MTX) as a guest molecule was obtained to increase the solubility of MTX and decrease its inherent toxic effects in nonspecific cells. The IC was conjugated with gold nanoparticles (AuNPs), obtained by a chemical method, creating a ternary intelligent delivery system for MTX molecules, based on the plasmonic properties of the AuNPs. Irradiation of the ternary system, with a laser wavelength tunable with the corresponding surface plasmon of AuNPs, causes local energy dissipation, producing the controlled release of the guest from CD cavities. Finally, cell viability was evaluated using MTS assays for ß-CD/MTX and AuNPs + ß-CD/MTX samples, with and without irradiation, against HeLa tumor cells. The irradiated sample of the ternary system AuNPs + ß-CD/MTX produced a diminution in cell viability attributed to the photothermal release of MTX.

Comparison of the catalytic activity for O2 reduction of Fe and Co MN4 adsorbed on graphite electrodes and on carbon nanotubes.

We have compared the electrocatalytic activity of several substituted and unsubstituted Co and Fe N4-macrocyclic complexes (MN4) for the electro-reduction of oxygen with the complexes directly adsorbed on the edge plane of pyrolytic graphite or adsorbed on carbon nanotubes (CNTs). In the presence of CNTs, one order of magnitude higher surface concentrations of MN4 catalysts per geometric area unit could be adsorbed leading to a lower overpotential for the oxygen electro-reduction and activities in the same order of magnitude as the commercially available Pt/C catalysts in basic pH. From Koutecky-Levich regression analysis, the total number of electrons transferred was approximately 2 for all the Co complexes and 4 for all the Fe ones, both in the presence and in the absence of the carbon nanotubes. Furthermore, the Tafel slopes did not vary due to the presence of the CNTs and presented values in the range of -0.06 V decade-1 for the CoN4 compounds and in the range of -0.04 V decade-1 for FeN4. When plotting the log of kinetic current densities (i.e. log jk) at a constant potential for each complex divided by the surface concentration Γ, and the number of electrons transferred n for the ORR for each catalyst, versus the difference between the redox potential of the metal active site of the Co(ii)/(i) or Fe(iii)/(ii) catalyst and the reversible potential of the reaction they promote, the catalytic activity increases when the formal potential of the complex becomes more positive and the data obtained with complexes adsorbed on graphite are in agreement with the data obtained when using CNTs indicating that the increase in jk when CNTs are present is only due to an increase in the number of active sites per geometric area of the electrode.

Evidence of the Disassembly of α-Cyclodextrin-octylamine Inclusion Compounds Conjugated to Gold Nanoparticles via Thermal and Photothermal Effects.

Cyclodextrin (CD) molecules form inclusion compounds (ICs), generating dimers that are capable of encapsulating molecules derived from long-chain hydrocarbons. The aim of this study is to evaluate the structural changes experienced by ICs in solution with increasing temperatures. For this, a nuclear magnetic resonance (¹H-NMR) titration was performed to determinate the stoichiometric α-cyclodextrin (α-CD):octylamine (OA) 2:1 and binding constant (k = 2.16 M-2) of ICs. Solution samples of α-CD-OA ICs conjugated with gold nanoparticles (AuNPs) were prepared, and ¹H-NMR spectra at different temperatures were recorded. Comparatively, ¹H-NMR spectra of the sample irradiated with a laser with tunable wavelengths, with plasmons of conjugated AuNPs, were recorded. In this work, we present evidence of the disassembly of ICs conjugated with AuNPs. Thermal studies demonstrated that, at 114 °C, there are reversible rearrangements of the host and guests in the ICs in a solid state. Migration movements of the guest molecules from the CD cavity were monitored via temperature-dependent ¹H-NMR, and were verified comparing the chemical shifts of octylamine dissolved in deuterated dimethylsulfoxide (DMSO-d6) with the OA molecule included in α-CD dissolved in the same solvent. It was observed that, at 117 °C, OA exited the α-CD cavity. CD IC dimer disassembly was also observed when the sample was irradiated with green laser light.

In Situ Visualization of the Local Photothermal Effect Produced on α-Cyclodextrin Inclusion Compound Associated with Gold Nanoparticles.

Evidence of guest migration in α-cyclodextrin-octylamine (α-CD-OA) inclusion compound (IC) generated via plasmonic heating of gold nanoparticles (AuNPs) has been studied. In this report, we demonstrate local effects generated by laser-mediated irradiation of a sample of AuNPs covered with inclusion compounds on surface-derivatized glass under liquid conditions by atomic force microscopy (AFM). Functionalized AuNPs on the glass and covered by the ICs were monitored by recording images by AFM during 5 h of irradiation, and images showed that after irradiation, a drastic decrease in the height of the AuNPs occurred. The absorption spectrum of the irradiated sample showed a hypsochromic shift from 542 to 536 nm, evidence suggesting that much of the population of nanoparticles lost all of the parts of the overlay of ICs due to the plasmonic heat generated by the irradiation. Mass spectrometry matrix-assisted laser desorption/ionization-time-of-flight (MALDI-TOF) performed on a sample containing a collection of drops obtained from the surface of the functionalized glass provided evidence that the irradiation lead to disintegration of the ICs and therefore exit of the octylamine molecule (the guest) from the cyclodextrin cavity (the matrix). Graphical Abstract Atomic Force Microscopy observation of the disintegration of a cyclodextrin inclusion compound by gold nanoparticles photothermal effect.

Pathologic rupture of the spleen in a patient with acute myelogenous leukemia and leukostasis.

Rupture of the spleen can be classified as spontaneous, traumatic, or pathologic. Pathologic rupture has been reported in infectious diseases such as infectious mononucleosis, and hematologic malignancies such as acute and chronic leukemias. Splenomegaly is considered the most relevant factor that predisposes to splenic rupture. A 66-year-old man with acute myeloid leukemia evolved from an unclassified myeloproliferative neoplasm, complaining of fatigue and mild upper left abdominal pain. He was pale and presented fever and tachypnea. Laboratory analyses showed hemoglobin 8.3g/dL, white blood cell count 278×10(9)/L, platelet count 367×10(9)/L, activated partial thromboplastin time (aPTT) ratio 2.10, and international normalized ratio (INR) 1.60. A blood smear showed 62% of myeloblasts. The immunophenotype of the blasts was positive for CD117, HLA-DR, CD13, CD56, CD64, CD11c and CD14. Lactate dehydrogenase was 2384U/L and creatinine 2.4mg/dL (normal range: 0.7-1.6mg/dL). Two sessions of leukapheresis were performed. At the end of the second session, the patient presented hemodynamic instability that culminated in circulatory shock and death. The post-mortem examination revealed infiltration of the vessels of the lungs, heart, and liver, and massive infiltration of the spleen by leukemic blasts. Blood volume in the peritoneal cavity was 500mL. Acute leukemia is a rare cause of splenic rupture. Male gender, old age and splenomegaly are factors associated with this condition. As the patient had leukostasis, we hypothesize that this, associated with other factors such as lung and heart leukemic infiltration, had a role in inducing splenic rupture. Finally, we do not believe that leukapheresis in itself contributed to splenic rupture, as it is essentially atraumatic.

Pathologic rupture of the spleen in a patient with acute myelogenous leukemia and leukostasis

Rupture of the spleen can be classified as spontaneous, traumatic, or pathologic. Pathologic rupture has been reported in infectious diseases such as infectious mononucleosis, and hematologic malignancies such as acute and chronic leukemias. Splenomegaly is considered the most relevant factor that predisposes to splenic rupture. A 66-year-old man with acute myeloid leukemia evolved from an unclassified myeloproliferative neoplasm, complaining of fatigue and mild upper left abdominal pain. He was pale and presented fever and tachypnea. Laboratory analyses showed hemoglobin 8.3 g/dL, white blood cell count 278 × 109/L, platelet count 367 × 109/L, activated partial thromboplastin time (aPTT) ratio 2.10, and international normalized ratio (INR) 1.60. A blood smear showed 62% of myeloblasts. The immunophenotype of the blasts was positive for CD117, HLA-DR, CD13, CD56, CD64, CD11c and CD14. Lactate dehydrogenase was 2384 U/L and creatinine 2.4 mg/dL (normal range: 0.7-1.6 mg/dL). Two sessions of leukapheresis were performed. At the end of the second session, the patient presented hemodynamic instability that culminated in circulatory shock and death. The post-mortem examination revealed infiltration of the vessels of the lungs, heart, and liver, and massive infiltration of the spleen by leukemic blasts. Blood volume in the peritoneal cavity was 500 mL. Acute leukemia is a rare cause of splenic rupture. Male gender, old age and splenomegaly are factors associated with this condition. As the patient had leukostasis, we hypothesize that this, associated with other factors such as lung and heart leukemic infiltration, had a role in inducing splenic rupture. Finally, we do not believe that leukapheresis in itself contributed to splenic rupture, as it is essentially atraumatic...

Infestación de mucosa gástrica por Strongyloides Stercoralis y su correlación con hallazgos endoscópicos: presentación de un caso clínico y revisión

La Estrongiloidiasis es una parasitosis intestinal de distribución mundial, generalmente paucisintomática que puede producir ocasionalmente cuadros intestinales severos, así como enteritis invasiva e hiperinfección en pacientes inmunosuprimidos e inmunocompetentes. La biopsia gástrica y duodenal es poco empleada, su sensibilidad aumenta en la hiperinfección (hasta un 90%), aún si se compara con los métodos coprológicos convencionales, por lo que la endoscopia puede ser considerada como un marcador de severidad, permitiendo establecer el diagnóstico y las características endoscópicas de las lesiones en el tracto gastrointestinal. El presente caso trata de paciente masculino de 52 años, quien consultó por dolor epigástrico, concomitantemente flatulencias y eructos fétidos, nauseas, vómitos y diarreas líquidas autolimitadas. Examen físico: dolor en marco colónico izquierdo y epigastrio. Hallazgos paraclínicos de eosinofilia, se realiza endoscopia que reporta: Gastropatía Antral Nodular y biopsia con diagnóstico de infestación gástrica por Ss. Se indica tratamiento con Albendazol 400mg/d por 3 días, mejorando la sintomatología. La infestación por Ss en mucosa gástrica es un hallazgo infrecuente.

Strongyloidiasis(Ss) is an intestinal parasitosys of global distribution, usually causing few symptoms although can occasionally cause severe intestinal manifestations, as well as invasive enteritis and hyperinfection in immunosuppressed and immunocompetent patients. Gastric and duodenal biopsies are rarely used, their sensitivity increases in the presence of hyperinfection (up 90%), even when compared with the conventional coprologic methods, so endoscopy can be seen as a marker of severity, allowing to establish the diagnosis and characteristics of lesions in the gastrointestinal tract. The following case is about a 52-year-old male with epigastric pain, flatulence and belching, nausea, vomiting and acute watery diarrhea. At physical examination there was pain at the epigastrium and left hemiabdomen. Para - clinical findings revealed eosinophilia; endoscopy report: Antral Nodular gastropathy with the biopsy reporting Ss gastric infestation. Treatment with Albendazole 400mg / d for 3 days was indicated, improving the symptoms. Gastric mucosal infestation by Ss is a rare finding.

Uso da bola terapêutica no equilíbrio estático e dinãmico de pacientes com hemiparesia / Use of therapeutic ball to improve static and dynamic balance in hemiparesis patients

Introdução: O acidente vascular cerebral (AVC) é descrito pela Organização Mundial de Saúde como um sinal clínico de rápido desenvolvimento de perturbação focal cerebral, de suposta origem vascular e com mais de 24 horas de duração; pode apresentar como sequela a hemiplegia ou hemiparesia. A bola suíça é um instrumento útil no tratamento da hemiparesia, podendo ser utilizada para avaliar e tratar problemas de equilíbrio. Objetivo: O objetivo deste estudo foi verificar a eficácia da utilização da bola terapêutica para melhora do equilíbrio estático e dinâmico em pacientes hemiparéticos. Metodologia: A amostra constitui-se de 09 pacientes, com diagnóstico de AVE na fase crônica, que apresentam hemiparesia e que foram submetidos a um programa de fisioterapia com bola terapêutica durante 02 meses. Para avaliação dos pacientes foi utilizada a Escala de Tinetti. Resultados: Foram avaliadas as condições de equilíbrio estático e dinâmico (marcha), sendo que estas apresentaram resultado satisfatório. Todos os pacientes apresentaram aumento do escore ao final do tratamento, demonstrando resultado positivo na aplicação do protocolo. Conclusão: Concluímos que o protocolo utilizado neste estudo apresentou um resultado significativo com relação à melhora do equilíbrio estático e dinâmico.