Slum compassionate community: expanding access to palliative care in Brazil.

OBJECTIVE: To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro. METHOD: Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines. RESULTS: Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network. CONCLUSION: We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.

Percepção de religiosidade e forças pessoais: Relação entre os construtos em universitários / Perception of religiosity and characters strengths: Relationship between the constructs in university students

Esta pesquisa teve por objetivo investigar as relações entre a percepção de religiosidade e as forças pessoais e as diferenças quanto à idade, ao sexo e nível de religiosidade dos participantes. Para tanto, 92 estudantes, com idades entre 18 e 64 anos (M= 25,13; DP=8,09), de uma universidade particular do estado de São Paulo, responderam à Escala de Avaliação da Percepção de Religiosidade (EAPRE) e à Escala de Forças de Caráter (EFC). Foram encontradas correlações significativas entre 21 forças da EFC, e o fator internalização da EAPRE (r entre 0,21 e 0,49), e três forças pessoais com o fator externalização (r entre 0,25 e 0,53). As mulheres apresentaram maiores médias que os homens no fator internalização da EAPRE e em seis forças de caráter da EFC. Além disso, os participantes que se percebiam com alto nível de religiosidade apresentaram maiores médias na força espiritualidade. Pesquisas com outras amostras são necessárias para permitir o amadurecimento dos conceitos investigados, sobretudo no Brasil, onde os instrumentos que avaliam construtos da psicologia positiva estão em desenvolvimento.

This research aimed to investigate the relationships between the perception of religiosity and the character strengths and the differences in age, gender, and level of religiosity of the participants. To this end, 92 students, aged between 18 and 64 years (M= 25.13; SD=8.09), from a private university in the state of São Paulo, answered the Religiosity Perception Assessment Scale (EAPRE) and the Character Strengths Scale (EFC). Significant correlations were found between 21 EFC forces, and the internalization factor of EAPRE (r between 0.21 and 0.49) and three-character strengths with the externalization factor (r between 0.25 and 0.53). Women presented higher averages than men in the internalization factor of PSAE and in six-character strengths of EFC. In addition, the participants who perceived themselves with a high level of religiosity presented higher averages in the spiritual strength. Research with other samples is necessary to allow the maturation of the concepts investigated, especially in Brazil, where the instruments that evaluate positive psychology constructs are under development.

Experiences of siblings of children with chronic diseases revealed by the dramatic therapeutic play.

OBJECTIVE: To understand, through dramatic therapeutic play, the experiences of siblings of children with chronic diseases. METHOD: Phenomenological study, in the light of Heideggerian philosophical framework, conducted with 12 siblings of children with chronic diseases, aged between three and 11 years, accompanied in a public teaching hospital in the countryside of the state of São Paulo. The phenomenological interviews were audio-recorded and mediated by sessions of dramatic therapeutic play; later, interpreted from the Heideggerianphilosophical framework and thematic literature. RESULTS: The siblings demonstrated that they are affectively touched in the mode of sadness, longing and affection towards the sick child and, by the daily occupations imposed by the disease. CONCLUSION: The dramatic therapeutic play enabled the siblings of children with chronic diseases to expose their experiences permeated by the limitations of the child's chronic disease. Instituting actions for the inclusion of the sibling during the nursing care of the child with chronic disease is urgent to improve its quality.

Health professionals' knowledge about ethical criteria in the allocation of resources in the COVID-19 pandemic.

Due to the rapid advance of the pandemic caused by COVID-19, several countries perceived that human and material resources would be insufficient to meet the demand of infected patients. The aim of this study is to analyze the knowledge of health professionals working in the pandemic about the application of ethical criteria in decision-making in situations of resource scarcity. This is a cross-sectional, descriptive, and quantitative survey study, conducted from June to December 2020, with health professionals working in the COVID-19 pandemic in Brazil. We applied a questionnaire to assess the professionals' knowledge about ethical criteria in decision-making in the allocation of scarce resources during the pandemic, containing 14 questions and possible score from 0 to 70, which was developed by researchers from documents and protocols validated by organizations from various countries, available in the first months of the pandemic, a sociodemographic characterization questionnaire and a self-assessment questionnaire regarding knowledge about bioethics. A total of 197 health professionals participated in the study, 37.6% of whom were nurses and 22.8% of whom were physicians, working in the Family Health Unit (28.4%) with a degree at the level of specialization (46.2%). Moreover, (9.5%) of nurses, (18.2%) of dental surgeons and (24.4%) of physicians reported that they have no prior knowledge about bioethics. Physicians and hospital workers scored higher on the knowledge assessment questionnaire. The mean score of the participants was 45.4 (SD = 7.2). Investments in training and professional education in the field of health focused on Bioethics are necessary, considering models and ethical theories that help professionals, managers and society to better position themselves in the face of pandemic contexts.

The antineoplastic potential of crotoxin isolated from Crotalus durissus terrificus snake venom on oral squamous cell carcinoma.

This study investigated the antineoplastic effects of crotoxin isolated from snake venom of the South American Crotalus durissus terrificus in oral cancer cell lines and in an animal model of chemically induced oral cancer. We analyzed cell viability and death, clonogenic formation, DNA fragmentation, migration assay, and gene expression of MMP2, MMP9, COL1A1, and CASP3. In the animal model, after induction of oral cancer by 4-nitroquinoline-1-oxide carcinogen, mice were treated with crotoxin to investigate its effects on tumor development in tongue and oral mucosa. Crotoxin inhibited cell proliferation, viability, colony formation, and migration, favoring cell death. Furthermore, crotoxin increased caspase-3 expression, decreased Ki-67 protein and mRNA expression of MMP2, MMP9, and COL1A1. Mice treated with crotoxin at 10 µg/kg did not alter biochemical parameters total cholesterol, very-low-density lipoprotein, high-density lipoprotein, liver transaminases, glycemia, creatinine, and urea. Crotoxin treatment significantly reduced the frequency of oral squamous cell carcinoma lesions by 50%. Thus, this study highlights crotoxin as a promising chemotherapeutic substance, considering its effects on controlling the neoplastic cell population, reducing cell migration, and inhibiting tumor development. Clinical studies are necessary to understand better the impact of crotoxin as a potential adjuvant therapeutic agent for oral cancer patients.

Gallic acid has an inhibitory effect on skin squamous cell carcinoma and acts on the heat shock protein HSP90AB1.

Differences in the features of aggressiveness of non-melanoma skin cancer (NMSC) subtypes, between basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are relevant characteristics. Comparing the characteristics between NMSC subtypes might help identify molecules associated with cancer metastasis and invasion. Considering these facts, the current study aimed to identify a molecular target for inhibiting skin cancer metastasis and invasion. Proteomic analysis suggested that heat shock protein 90 kDa, alpha, class B member 1 (HSP90AB1), pentaxin (PTX3), caspase-14 (CASP14), S100, actin-1, and profilin were the primary targets related to metastasis and invasion. However, after a differential expression comparison between BCC and SCC, HSP90AB1 was identified as the best target to repress metastasis and invasion. Based on molecular docking results, gallic acid (GA) was selected to inhibit HSP90AB1. A specific Hsp90ab1 siRNA targeting was designed and compared to GA. Interestingly, GA was more efficient in silencing HSP90AB1 than siRNAhsp90ab1. Hence, our data suggest that HSP90AB1 is a crucial biomarker for identifying invasion and metastasis and that its inhibition may be a viable strategy for treating skin cancer.

Identification of potential biomarkers and survival analysis for oral squamous cell carcinoma: A transcriptomic study.

OBJECTIVE: Oral squamous cell carcinoma (OSCC) is one of the most common neoplasms worldwide. The current study aimed to identify potential biomarkers associated with OSCC survival. MATERIALS AND METHODS: Differentially expressed genes (DEGs) in atypical OSCC cases were identified using two public datasets: The Cancer Genome Atlas and the Gene Expression Omnibus database. Receiver operating characteristic (ROC) analysis was performed to identify the cutoff, and the candidate DEGs related to survival. Kaplan-Meier and Cox regression analysis using the categorized genes were employed to identify genes that impact the overall survival in OSCC. RESULTS: A total of 263 OSCC samples and 105 healthy tissues were used to identify 295 upregulated and 131 downregulated genes expressed only in non-smokers. ROC analyses identified 25 candidate genes associated with death. Survival analyses demonstrated that the following DEGs, namely CSTA, FGFR2, MMP19, OLR1, PCSK1, RAMP2, and CGB5, are potential OSCC prognostic factors. CONCLUSION: We found that CSTA, FGFR2, MMP19, OLR1, PCSK1, RAMP2, and CGB5 are associated with a low survival rate in OSCC. However, further studies are needed to validate our findings and facilitate the development of these factors as potential biomarkers for OSCC survival.

Experiences of siblings of children with chronic diseases revealed by the dramatic therapeutic play / Experiencias de hermanos de niños con enfermedades crónicas reveladas por eljuego terapéutico dramático / Vivências de irmãos de crianças com doenças crônicas reveladas pelo brinquedo terapêutico dramático

ABSTRACT Objective To understand, through dramatic therapeutic play, the experiences of siblings of children with chronic diseases. Method Phenomenological study, in the light of Heideggerian philosophical framework, conducted with 12 siblings of children with chronic diseases, aged between three and 11 years, accompanied in a public teaching hospital in the countryside of the state of São Paulo. The phenomenological interviews were audio-recorded and mediated by sessions of dramatic therapeutic play; later, interpreted from the Heideggerianphilosophical framework and thematic literature. Results The siblings demonstrated that they are affectively touched in the mode of sadness, longing and affection towards the sick child and, by the daily occupations imposed by the disease. Conclusion The dramatic therapeutic play enabled the siblings of children with chronic diseases to expose their experiences permeated by the limitations of the child's chronic disease. Instituting actions for the inclusion of the sibling during the nursing care of the child with chronic disease is urgent to improve its quality.

RESUMEN Objetivo Comprender, a través del juego dramático terapéutico, las experiencias de los hermanos de niños con enfermedades crónicas. Método Estudio fenomenológico, a la luz del referente filosófico heideggeriano, realizado con 12 hijos de niños con enfermedades crónicas, de edades comprendidas entre los tres y los 11 años, acompañados en el hospital público de enseñanza, en el interior del estado de São Paulo. Las entrevistas fenomenológicas fueron grabadas en audio y mediadas por sesiones de juego terapéutico dramático; luego, interpretada desde el marco filosófico heideggeriano y la literatura temática. Resultados Los hermanos demostraron que están tocados afectivamente en el modo de la tristeza, la añoranza y el afecto en relación con el niño enfermo y, por las ocupaciones diarias impuestas por la enfermedad. El brinco terapéutico dramático permitió que los hijos de los niños con enfermedades crónicas expusieran su vida a las limitaciones de la enfermedad crónica del niño. Conclusión Es urgente instituir medidas para la inclusión del hermano durante la asistencia de enfermera al niño con enfermedades crónicases urgente para mejorar su calidad.

RESUMO Objetivo Compreender por meio do brinquedo terapêutico dramático, vivências de irmãos de crianças com doenças crônicas. Método Estudo fenomenológico heideggeriano, realizado com 12 irmãos de crianças com doenças crônicas, com idades entre três e 11 anos, acompanhadas em hospital público de ensino, no interior do estado de São Paulo. As entrevistas fenomenológicas foram audiogravadas e mediadas por sessões de brinquedo terapêutico dramático; posteriormente, interpretadas a partir do referencial filosófico hedeggeriano e literatura temática. Resultados Os irmãos demonstraram que são tocados afetivamente no modo da tristeza, saudade e carinho em relação à criança doente e, pelas ocupações diárias impostas pela doença. Conclusão O brinquedo terapêutico dramático possibilitou que os irmãos de crianças com doenças crônicas expusessem suas vivências permeadas pelas limitações da doença crônica da criança. Instituir ações para a inclusão do irmão durante a assistência de enfermagem à criança com doença crônica faz-se urgente para melhoria da sua qualidade.

Intervenções educativas de planejamento antecipado de cuidados na adesão às diretivas antecipadas de vontade: revisão integrativa / Intervenciones educativas para la planificación anticipada de cuidados en la adherencia a las voluntades anticipadas: revisión integradora / Educational interventions for advance care planning in adherence to advance directives of will: integrative review

The Advance Care Planning (ACP) is an approach that allows the individual to definegoals and preferences regarding future treatments and health care, in the face of serious illnesses.Objective: To summarize the literature on ACP educational interventions to support adherence toAdvance Directives (AD) in Palliative Care (PC). Methods: Integrative literature review carried outin MEDLINE, Web of Science, CINAHL and Cochrane Library databases, from 2016 to 2020; in Portuguese, English and Spanish. Results: Twelve articles were selected, which used different strategiesfor educational interventions. From the analysis of the data obtained, three categories emerged: importance of the family approach in the adherence to AD; professional-patient communication in theadherence to AD; in-hospital and out-of-hospital context of the ACP. Conclusion: it is recommendedthat ACP educational interventions use an early approach to patients diagnosed with chronic diseases, that they are centered on the patient-family unit and that they make use of effective and opencommunication. Thus, knowledge about these interventions will help nurses to develop effectivebonding and communication strategies in approaching palliative care patients and their families.(AU)

La Planificación Anticipada de Cuidados (PAC) es un enfoque que permite al individuodefinir metas y preferencias con respecto a futuros tratamientos y cuidados de salud, frente a enfermedades graves. Objetivo: Resumir la literatura sobre las intervenciones educativas de la ACP paraapoyar la adherencia a las Directivas Anticipadas (DA) en Cuidados Paliativos (CP). Métodos: Revisión integrativa de la literatura realizada en las bases de datos MEDLINE, Web of Science, CINAHL y Cochrane Library, de 2016 a 2020; en portugués, inglés y español. Resultados: Se seleccionaron 12 artículos, que utilizaron diferentes estrategias de intervención educativa. Del análisis delos datos obtenidos surgieron tres categorías: importancia del abordaje familiar en la adherencia ala DA; comunicación profesional-paciente en la adherencia a las DA; contexto intrahospitalario yextrahospitalario de la PAC. Conclusión: se recomienda que las intervenciones educativas de la PACutilicen un abordaje temprano de los pacientes diagnosticados con enfermedades crónicas, que esténcentradas en la unidad paciente-familia y que hagan uso de una comunicación efectiva y abierta.Por lo tanto, el conocimiento sobre estas intervenciones ayudará a las enfermeras a desarrollar estrategias efectivas de vinculación y comunicación en el abordaje de los pacientes de cuidados paliativos y sus familias.(AU)

O Planejamento Antecipado de Cuidados (ACP) é uma abordagem que per-mite ao indivíduo definir objetivos e preferências quanto a futuros tratamentos e cuidados em sa-úde, mediante a doenças graves. Objetivo: Sumarizar a literatura sobre intervenções educativas ACPpara apoiar a adesão às Diretivas Antecipadas de Vontade (DAV) em Cuidados Paliativos (CP).Métodos: Revisão integrativa de literatura realizada nas bases MEDLINE, Web of Science, CINAHLe Biblioteca Cochrane, no espaço temporal de 2016 a 2020; nos idiomas português, inglês e espanhol.Resultados: Foram selecionados 12 artigos, que se utilizaram de diferentes estratégias para as intervenções educativas. A partir da análise dos dados obtidos, emergiram três categorias: importânciada abordagem familiar na adesão à DAV; comunicação profissional-paciente na adesão à DAV; contexto hospitalar e extra-hospitalar do ACP. Conclusão: recomenda-se que as intervenções educativas de ACP utilizem-se da abordagem precoce em pacientes diagnosticados com doenças crônicas,que sejam centralizadas na unidade paciente-familiar e que façam uso de comunicação efetiva eaberta. Dessa forma, o conhecimento acerca destas intervenções auxiliará o enfermeiro no desenvolvimento de estratégias de vinculação e comunicação efetivas na abordagem a pacientes em cuidadospaliativos e seus familiares.(AU)

The antineoplastic potential of crotoxin isolated from Crotalus durissus terrificus snake venom on oral squamous cell carcinoma

This study investigated the antineoplastic effects of crotoxin isolated from snake venom of the South American Crotalus durissus terrificus in oral cancer cell lines and in an animal model of chemically induced oral cancer. We analyzed cell viability and death, clonogenic formation, DNA fragmentation, migration assay, and gene expression of MMP2, MMP9, COL1A1, and CASP3. In the animal model, after induction of oral cancer by 4-nitroquinoline-1-oxide carcinogen, mice were treated with crotoxin to investigate its effects on tumor development in tongue and oral mucosa. Crotoxin inhibited cell proliferation, viability, colony formation, and migration, favoring cell death. Furthermore, crotoxin increased caspase-3 expression, decreased Ki-67 protein and mRNA expression of MMP2, MMP9, and COL1A1. Mice treated with crotoxin at 10 μg/kg did not alter biochemical parameters total cholesterol, very-low-density lipoprotein, high-density lipoprotein, liver transaminases, glycemia, creatinine, and urea. Crotoxin treatment significantly reduced the frequency of oral squamous cell carcinoma lesions by 50%. Thus, this study highlights crotoxin as a promising chemotherapeutic substance, considering its effects on controlling the neoplastic cell population, reducing cell migration, and inhibiting tumor development. Clinical studies are necessary to understand better the impact of crotoxin as a potential adjuvant therapeutic agent for oral cancer patients.

Slum compassionate community: expanding access to palliative care in Brazil / Comunidad de favela compasiva: ampliar el acceso a los cuidados paliativos en Brasil / Comunidade compassiva de favela: ampliando o acesso aos cuidados paliativos no Brasil

ABSTRACT Objective: To describe the implementation of a compassionate community in Rocinha and Vidigal slums, located in the city of Rio de Janeiro. Method: Report on the experience of implementing a Compassionate Community based on the World Health Organization conceptual bases, supported by university extension guidelines. Results: Initially, local leaders and residents were recruited and trained in palliative care. Subsequently, health professionals from different specialties engaged in the project through volunteering. Home visits were instituted in the form of interconsultation and "sponsorships" by residents and health professionals to people in palliative care and family members. Finally, the health care network in the territory was integrated in order to recognize the project as a support network. Conclusion: We highlight the experience as living work in health, which involves relationships and creative processes, which mobilize structured technical knowledge and relationships between people and soft-hard and soft technologies, making it possible to recognize powers in the territory.

RESUMEN Objetivo: Describir la implementación de una comunidad compasiva en las favelas de Rocinha y Vidigal, ubicadas en la ciudad de Río de Janeiro. Método: Relato de la experiencia de implementación de una Comunidad Compasiva a partir de las bases conceptuales de la Organización Mundial de la Salud, sustentada en lineamientos de extensión universitaria. Resultados: Inicialmente, se reclutaron y capacitaron a líderes locales y residentes en cuidados paliativos. Posteriormente, profesionales de la salud de diferentes especialidades se involucraron en el proyecto a través del voluntariado. Se instituyeron visitas domiciliarias en la modalidad de interconsulta y "patrocinios" por parte de residentes y profesionales de salud a personas en cuidados paliativos y familiares. Finalmente, se integró la Red de Atención a la Salud del territorio para reconocer el proyecto como una red de apoyo. Conclusión: Destacamos la experiencia como trabajo vivo en salud, que involucra relaciones y procesos creativos, que movilizan saberes técnicos estructurados y relaciones entre personas y tecnologías ligeras-duras y ligeras, posibilitando el reconocimiento de poderes en el territorio.

RESUMO Objetivo: Descrever a implementação de uma comunidade compassiva nas favelas da Rocinha e Vidigal, localizadas na cidade do Rio de Janeiro. Método: Relato da experiência da implementação de uma Comunidade Compassiva a partir das bases conceituais da Organização Mundial da Saúde, amparada pelas diretrizes da extensão universitária. Resultados: Inicialmente, lideranças locais e moradores foram recrutados e receberam treinamento sobre cuidados paliativos. Posteriormente, profissionais de saúde de diferentes especialidades engajaram-se no projeto por meio da prática do voluntariado. Foram instituídas visitas domiciliares na modalidade interconsulta e "apadrinhamentos" por moradores e profissionais de saúde às pessoas em cuidados paliativos e familiares. Por fim, a Rede de Atenção à Saúde do território foi integrada de forma a reconhecer o projeto como rede de apoio. Conclusão: Destacamos a experiência como trabalho vivo em saúde, que envolve relações e processos criativos, os quais mobilizam o saber técnico estruturado e as relações entre as pessoas e as tecnologias leve-duras e leves, tornando factível o reconhecimento de potências no território.

Differential Allele-Specific Expression Revealed Functional Variants and Candidate Genes Related to Meat Quality Traits in B. indicus Muscle.

Traditional transcriptomics approaches have been used to identify candidate genes affecting economically important livestock traits. Regulatory variants affecting these traits, however, remain under covered. Genomic regions showing allele-specific expression (ASE) are under the effect of cis-regulatory variants, being useful for improving the accuracy of genomic selection models. Taking advantage of the better of these two methods, we investigated single nucleotide polymorphisms (SNPs) in regions showing differential ASE (DASE SNPs) between contrasting groups for beef quality traits. For these analyses, we used RNA sequencing data, imputed genotypes and genomic estimated breeding values of muscle-related traits from 190 Nelore (Bos indicus) steers. We selected 40 contrasting unrelated samples for the analysis (N = 20 animals per contrasting group) and used a beta-binomial model to identify ASE SNPs in only one group (i.e., DASE SNPs). We found 1479 DASE SNPs (FDR ≤ 0.05) associated with 55 beef-quality traits. Most DASE genes were involved with tenderness and muscle homeostasis, presenting a co-expression module enriched for the protein ubiquitination process. The results overlapped with epigenetics and phenotype-associated data, suggesting that DASE SNPs are potentially linked to cis-regulatory variants affecting simultaneously the transcription and phenotype through chromatin state modulation.

Allele-specific expression reveals functional SNPs affecting muscle-related genes in bovine.

Single nucleotide polymorphisms showing allele-specific expression (ASE SNPs) are useful for cis-regulatory variants discovery. Despite this potential, there are expensive costs involved in genome-level ASE analysis for large sample sizes. If different data resolutions are available, genotype imputation can be used to mitigate this limitation. Aiming to increase the power to detect regulatory variants, we used a large dataset (>4 million) of imputed SNP genotypes and RNA-Seq data from 190 Nelore steers. Differences between major and minor allele expressions in muscle were tested with a Binomial Test. We identified 38,177 ASE SNPs (FDR ≤ 0.05) within 7304 linkage disequilibrium blocks. After that, we searched for aseQTLs (i.e., neighboring SNPs potentially regulating the ASE SNPs' allelic expression) by comparing the ASE of heterozygous to homozygous sample groups under a Wilcoxon Rank Sum test. We identified 21,543 aseQTLs potentially regulating 430 ASE SNPs (FDR ≤ 0.05). A total of 3333 cis-eQTLs (being 2098 ASE SNPs and 1075 aseQTLs) were associated with the expression of 758 transcripts (FDR ≤ 0.05), demonstrating the cis-regulatory effect of these ASE SNPs and aseQTLs. Data integration showed reproducibility with previous studies in bovine ASE and genomic imprinting. Furthermore, we identified 36,756 novel ASE regions due to the imputation approach. Comparisons with epigenetics data from Functional Annotation of Animal Genomes (FAANG) suggest a regulatory potential of the ASE-related SNPs. The affected genes were enriched in metabolic pathways essential for muscle homeostasis. These findings reinforce the potential of using ASE for discovering cis-regulatory SNPs that may affect muscle-related traits.

Comparação de desfechos clínicos e correlação entre funcionalidade e tempo de ventilação mecânica de pacientes em uti / Comparison of clinical outcomes and correlation between functionality and time of mechanical ventilation in icu patients / Comparación de los resultados clínicos y correlación entre la funcionalidad y el tiempo de ventilación mecánica de los pacientes en uti

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.

The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.

El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.

Effect of low-level light therapy before radiotherapy in oral squamous cell carcinoma: An in vitro study.

Radiation therapy for head and neck squamous cell carcinoma (HNSCC) is associated with several complications. Although photobiomodulation (PBM) has radioprotective effects in normal tissue, it could also enhance the growth of neoplastic cells. Thus, the present study aimed to investigate the cellular response of oral squamous cell carcinoma with pre-exposure to low-level phototherapy before radiotherapy. SCC9, Cal-27, A431, and HaCaT cell lines were subjected to low-level light therapy and radiotherapy. The cells were treated with a single energy density (300 J/cm2) of a light-emitting diode (660 nm) prior to ionizing radiation at different doses (0, 2, 4, and 6 Gy). After 24 h, wound scratch, proliferation, clonogenic cell survival, cell death, and reactive oxygen species (ROS) analyses were performed to evaluate cell response. The cell lines pre-exposed to PBM at the analyzed dosage were radiosensitive. The treatment significantly reduced cell proliferation and clonogenic cell survival. Migration and cell death assays also revealed positive results, with the treatment group showing lower rate of migration and higher cell death than did the control group. Moreover, PBM effectively increased the intracellular levels of ROS. PBM at 300 J/cm2 is a promising radiosensitizing modality to reduce the radiation dose and avoid the intolerable side effects of radiotherapy for HNSCC, thus increasing the probability of successful treatment. However, further studies are needed to support and confirm the results.

Dilemas éticos no direito de acesso aos cuidados paliativos na pandemia da COVID-19 / Dilemes ètics sobre el dret d'accés a les cures pal·liatives durantla pandèmiade laCOVID-19 / Dilemas éticos sobre el derecho de acceso a los cuidados paliativos en la pandemiade laCOVID-19 / Ethical dilemmas on the right of access to palliative care in the COVID-19 pandemic

La revisió del tema té com a objectiu enumerar alguns dilemes ètics que involucren l'equitat, relacionats amb el dret d'accés a les cures pal·liatives(CP) en el context de la pandèmia causada per la COVID-19. Aquesta és una reflexió teòrica que pren com a referència l'enfocament de Norman Daniels a Accountability for Reasonableness. Els dilemes ètics sorgits per l'assignació d'escassos recursos als pacients de CP van involucrar el dret a l'accés: respiradors artificials, tractament de diàlisi, analgèsics, tractament psicosocial i accés a llocs per a l'exercici de l'espiritualitat. És fonamental discutir els dilemes assenyalats perquè el procés de deliberació en l'assignació dels recursos de salut es realitzi de manera equitativa, en la direcció del principi d'equitat, podent utilitzar referències bioètiques per a dotar de major transparència a les decisions i que la població pugui valorar-les com a justes i justificades.(AU)

A revisão do tema objetiva elencar alguns dilemas éticos, envolvendo à equidade, relacionados ao direito de acesso aos Cuidados Paliativos (CP) no contexto da pandemia da COVID-19. Trata-se de uma reflexão teórica, utilizando-se como referencial a abordagem de “Responsabilização pela Razoabilidade”, de Norman Daniels. Os dilemas éticos levantados na alocação de recursos escassos a pacientes em CP envolveram o direito ao acesso a: respiradores artificiais, tratamento dialítico, medicações para alívio da dor, tratamento psicossocial e acesso aos locais para o exercício da espiritualidade. É imprescindível a discussão dos dilemas apontados de modo que o processo de deliberação na alocação de recursos em saúde seja feito de maneira equitativa, como direciona o princípio da equidade, que possa se utilizar de referenciais bioéticos para dar maior transparência às decisões e que a populaçãopossa entendê-las como justas e justificadas.(AU)

The review of the topic aims to list some ethical dilemmas, involving equity, relatedto the right of access to Palliative Care (PC) in the context of the COVID-19 pandemic. This is a theoretical reflection, using the Accountability for Reasonableness approach, by Norman Daniels, as a reference. The ethical dilemmas raised in the allocation of scarce resources to PC patients involved the right to access artificial respirators, dialysis treatment, pain relief medications, psychosocial treatment and access to places for the exercise of spirituality. It is essential to discuss the dilemmas pointed out so that the deliberation process in the allocation of health resources is carried out in an equitable manner, as directed by the principle of equity, which can use bioethical references to give greater transparency to decisions and that the population can understand them as just and justified.(UA)

La revisión del tema tiene como objetivo enumerar algunos dilemas éticos, que involucran la equidad, relacionados con el derecho de acceso a los Cuidados Paliativos (CP) en el contexto de la pandemia de COVID-19. Esta es una reflexión teórica, tomando como referencia el enfoque de Accountability for Reasonableness, de Norman Daniels. Los dilemas éticos planteados en la asignación de escasos recursos a los pacientes de CP involucraron el derecho al acceso: respiradores artificiales, tratamiento de diálisis, analgésicos, tratamiento psicosocial y acceso a lugares para el ejercicio de la espiritualidad. Es fundamental discutir los dilemas señalados para que el proceso de deliberación en la asignación de los recursos de salud se realice de manera equitativa, en la dirección del principio de equidad, que puede utilizar referencias bioéticas para dar mayor transparencia a las decisiones y que la la población puede entenderlos como justos y justificados.(AU)

Mulheres em situação de rua: Uma análise sobre a violência e machismo estrutural / Mujeres en situación de calle: Un análisis de la violencia y el masculinismo estructural / Women in street situations: An analysis of violence and structural malesm

Objetivo: descrever como as mulheres em situação de rua vivenciam o machismo estrutural. Método: trata-se de uma revisão integrativa da literatura utilizando o fluxograma PRISMA. A busca foi realizada no período de 2018 a 2022, nas bases de dados, SCIELO, LILACS e BDENF, sendo selecionado 09 artigos. Para a pergunta norteadora, utilizou-se a estratégia PICO e, para análise dos resultados foram elaborados 03 eixos temáticos para síntese de conteúdo. Resultados: A análise dividiu-se e, 03 (três) categorias: Por quê essas mulheres foram morar na rua; Os ambientes em que essas mulheres são encontradas com maior frequência e a Vulnerabilidades das mulheres em situação de rua relacionadas ao machismo. Conclusão: conclui-se que a população de mulheres em situação de rua apresenta uma realidade distante da desejada, demonstra muitas vezes precarização social e no acesso à saúde.(AU)

Objective: the objective was to describe how homeless women experience structural machismo, Method: this is an integrative literature review using the PRISMA flowchart. The search was carried out from 2018 to 2022, in the databases, SCIELO, LILACS and BDENF. For the guiding question, the PICO strategy was used and, for analysis of the results, 03 thematic axes were elaborated for content synthesis.Results: The analysis was divided into 03 (three) categories: Why did these women live on the street; The environments in which these women are most often found and the Vulnerability of homeless women related to machismo.Conclusion: the population of homeless women presents a reality that is far from the desired, often demonstrating social precariousness and access to health street situation.(AU)

Objetivo: el objetivo fue describir cómo las mujeres que no tienen donde vivir viven el machismo estructural. Método: Esta es una revisión integradora de la literatura utilizando el diagrama de flujo PRISMA. La búsqueda se llevó a cabo de 2018 a 2022, en las bases de datos, SCIELO, LILACS y BDENF. Para la pregunta orientadora, se utilizó la estrategia PICO y, para análisis de resultados, se elaboraron 03 ejes temáticos para la síntesis de contenidos.Resultados: El análisis se dividió en 03 (tres) categorías: Por qué estas mujeres se fueron a vivir a la calle; Los entornos en los que se encuentran más a menudo estas mujeres y las vulnerabilidades de las mujeres sin hogar relacionadas con el machismo.Conclusión: La población de mujeres sin hogar presenta una realidad lejos de la deseada, a menudo demuestra precariedad social y acceso a la salud.(AU)

DNA methylation may affect beef tenderness through signal transduction in Bos indicus.

BACKGROUND: Beef tenderness is a complex trait of economic importance for the beef industry. Understanding the epigenetic mechanisms underlying this trait may help improve the accuracy of breeding programs. However, little is known about epigenetic effects on Bos taurus muscle and their implications in tenderness, and no studies have been conducted in Bos indicus. RESULTS: Comparing methylation profile of Bos indicus skeletal muscle with contrasting beef tenderness at 14 days after slaughter, we identified differentially methylated cytosines and regions associated with this trait. Interestingly, muscle that became tender beef had higher levels of hypermethylation compared to the tough group. Enrichment analysis of predicted target genes suggested that differences in methylation between tender and tough beef may affect signal transduction pathways, among which G protein signaling was a key pathway. In addition, different methylation levels were found associated with expression levels of GNAS, PDE4B, EPCAM and EBF3 genes. The differentially methylated elements correlated with EBF3 and GNAS genes overlapped CpG islands and regulatory elements. GNAS, a complex imprinted gene, has a key role on G protein signaling pathways. Moreover, both G protein signaling pathway and the EBF3 gene regulate muscle homeostasis, relaxation, and muscle cell-specificity. CONCLUSIONS: We present differentially methylated loci that may be of interest to decipher the epigenetic mechanisms affecting tenderness. Supported by the previous knowledge about regulatory elements and gene function, the methylation data suggests EBF3 and GNAS as potential candidate genes and G protein signaling as potential candidate pathway associated with beef tenderness via methylation.

Percepção materna sobre a participação do pai na hospitalização do filho em unidade intensiva pediátrica / Percepción materna sobre la participación del padre en la hospitalización del hijo en la unidad de cuidados intensivos pediátricos / Maternal perception of the father's participation in the child's hospitalization in a pediatric intensive care unit

RESUMO Objetivo: compreender a percepção materna sobre a participação do pai durante a hospitalização do filho em Unidade de Terapia Intensiva Pediátrica. Métodos: pesquisa qualitativa de inspiração fenomenológica, cujo referencial metodológico para análise dos discursos, advindos de 12 entrevistas com mães de crianças hospitalizadas no interior do estado de São Paulo, foi a análise da estrutura do fenômeno situado. Resultados: emergiram três categorias temáticas: Participando do processo de adoecimento do filho - a essencialidade da presença do pai; Sofrendo pelo filho - o pai sendo afetado pela hospitalização; Não podendo estar com o filho - o pai sendo impedido de ser acompanhante durante a hospitalização. As mães reconhecem a participação dos pais durante hospitalização do filho por meio de apoio, compartilhamento de atividades e na importância para a recuperação da criança. Contudo, o sofrimento advindo do adoecimento e da hospitalização, a necessidade de se dedicar ao trabalho, questões organizacionais do hospital e a ausência de legislações trabalhistas impedem a permanência dos pais no serviço de saúde. Conclusão: as unidades pediátricas precisam modificar as normas institucionais, acolhendo mãe e pai, oferecendo condições de permanência e apoiando-os durante a hospitalização do filho. É mister que a área de Enfermagem familiar discuta a participação do pai na vida do filho, em especial no ambiente hospitalar e de cuidados intensivos, de modo a impulsionar a elaboração de leis que garantam a manutenção do emprego em caso de acompanhamento do filho durante a hospitalização.

RESUMEN Objetivo: comprender la percepción materna sobre la participación del padre durante la hospitalización del hijo en la Unidad de Terapia Intensiva Pediátrica. Métodos: investigación cualitativa de inspiración fenomenológica, cuyo referente metodológico para el análisis de los discursos provenientes de 12 entrevistas con madres de niños hospitalizados en el interior del estado de São Paulo, fue el análisis de la estructura del fenómeno situado. Resultados: surgieron tres categorías temáticas: Participar en el proceso de enfermedad del hijo - la esencialidad de la presencia del padre; Sufrir por el hijo - el padre afectado por la hospitalización; No poder estar con el hijo: el padre impedido de ser acompañante durante la hospitalización. Las madres reconocieron la participación de los padres durante la hospitalización del hijo mediante el apoyo, compartir actividades y la importancia para la recuperación del niño. Sin embargo, el sufrimiento derivado de la enfermedad y la hospitalización, la necesidad de dedicarse al trabajo, los problemas de organización de los hospitales y la falta de leyes laborales impiden que los padres sigan en el servicio sanitario. Conclusión: las unidades pediátricas necesitan modificar las normas institucionales, acogiendo a la madre y al padre, ofreciendo condiciones de permanencia y ayudando durante la hospitalización del hijo. Es fundamental que el área de Enfermería de la familia discuta la participación del padre en la vida del hijo, especialmente en el ambiente hospitalario y de cuidados intensivos, para incentivar el desarrollo de leyes que garanticen el mantenimiento del empleo en el caso de acompañar a um hijo durante la hospitalización.

ABSTRACT Objective: to understand the maternal perception of the father's participation during the child's hospitalization in the Pediatric Intensive Care Unit. Methods: this is a qualitative research of phenomenological inspiration, whose methodological reference for the analysis of the speeches was the analysis of the structure of the situated phenomenon, arising from 12 interviews with mothers of hospitalized children in the countryside of the state of São Paulo. Results: three thematic categories emerged: Participating in the child's illness process - the essentiality of the father's presence; Suffering for the child - the father affected by the hospitalization; Not being able to be with the child - the father prevented from being a companion during hospitalization. Mothers recognize the fathers' participation during the child's hospitalization through support, sharing activities, and the importance of the child's recovery. However, the suffering resulting from illness and hospitalization, the need to dedicate themselves to their jobs, organizational issues at the hospital, and the absence of labor laws prevent parents from staying in the health service. Conclusion: pediatric units need to modify institutional norms, welcome mother and father, offer permanence conditions, and support them during the child's hospitalization. The Family Nursing area must discuss the father's participation in the child's life, especially in the hospital and intensive care environment, to promote the elaboration of laws that guarantee the maintenance of the job in case of accompanying the child during the hospitalization.