Assessment of the components of fluid balance in patients with septic shock: a prospective observational study.

BACKGROUND: The optimal amount for initial fluid resuscitation is still controversial in sepsis and the contribution of non-resuscitation fluids in fluid balance is unclear. We aimed to investigate the main components of fluid intake and fluid balance in both survivors and non-survivor patients with septic shock within the first 72 hours. METHODS: In this prospective observational study in two intensive care units, we recorded all fluids administered intravenously, orally, or enterally, and losses during specific time intervals from vasopressor initiation: T1 (up to 24 hours), T2 (24 to 48 hours) and T3 (48 to 72 hours). Logistic regression and a mathematical model assessed the association with mortality and the influence of severity of illness. RESULTS: We included 139 patients. The main components of fluid intake varied across different time intervals, with resuscitation and non-resuscitation fluids such as antimicrobials and maintenance fluids being significant contributors in T1 and nutritional therapy in T2/T3. A positive fluid balance both in T1 and T2 was associated with mortality (p = 0.049; p = 0.003), while nutritional support in T2 was associated with lower mortality (p = 0.040). The association with mortality was not explained by severity of illness scores. CONCLUSIONS: Non-resuscitation fluids are major contributors to a positive fluid balance within the first 48 hours of resuscitation. A positive fluid balance in the first 24 and 48 hours seems to independently increase the risk of death, while higher amount of nutrition seems protective. This data might inform fluid stewardship strategies aiming to improve outcomes and minimize complications in sepsis.

Método Canguru: percepção da equipe de enfermagem em uma maternidade de alto risco / Kangaroo Method: perception of the nursing team in a high-risk maternity hospital / Método Canguro: percepción del equipo de enfermería en una maternidad de alto riesgo

Objetivo: analisar a percepção da equipe de enfermagem sobre o método canguru em uma maternidade de alto risco. Método: estudo exploratório, descritivo, de abordagem qualitativa, realizado por meio de entrevista semiestruturada com enfermeiros de uma maternidade de alto risco de Recife (PE), desenvolvida entre janeiro e fevereiro de 2020. As entrevistas foram transcritas e submetida a análise através da técnica de conteúdo de Bardin. Resultados: ocorreu a formulação de duas categorias, assistência de enfermagem no método canguru e benefícios e desafios encontrados no Método Canguru. As participantes relataram que os cuidados de enfermagem se baseiam principalmente em orientações as mães, a escassez de profissionais e baixa adesão foram evidenciados como principais desafios. Conclusão: constatou-se que a atuação de enfermagem no método canguru é um complexo processo, necessitando de uma equipe de enfermagem motivada e especializada

Objective: analyze the nursing team's perception of the kangaroo method in a high-risk maternity hospital. Method: exploratory, descriptive study, with a qualitative approach, carried out through semi-structured interviews with nurses from a high-risk maternity hospital in Recife (PE), carried out between January and February 2020. The interviews were transcribed and subjected to analysis using the content technique by Bardin. Results: two categories were formulated, nursing care in the kangaroo method and benefits and challenges found in the Kangaroo Method. Participants reported that nursing care is mainly based on guidance from mothers, the shortage of professionals and low adherence were highlighted as main challenges. Conclusion: it was found that nursing practice in the kangaroo method is a complex process, requiring a motivated and specialized nursing team

Objetivos: analizar la percepción del equipo de enfermería sobre el método canguro en una maternidad de alto riesgo. Método: Estudio exploratorio, descriptivo, con enfoque cualitativo, realizado a través de entrevistas semiestructuradas a enfermeros de una maternidad de alto riesgo de Recife (PE), realizado entre enero y febrero de 2020. Las entrevistas fueron transcritas y sometidas a análisis mediante el Técnica de contenidos de Bardin. Resultados: Se formularon dos categorías, los cuidados de enfermería en el método canguro y los beneficios y desafíos encontrados en el Método Canguro. Los participantes informaron que la atención de enfermería se basa principalmente en la orientación de las madres, la escasez de profesionales y la baja adherencia fueron destacados como principales desafíos. Conclusión: se encontró que la práctica de enfermería en el método canguro es un proceso complejo, que requiere de un equipo de enfermería motivado y especializado

IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil.

OBJECTIVE: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave. METHODS: This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death. We assessed factors associated with in-hospital mortality using logistic regression models. RESULTS: We included 645 patients with a mean age of 61.4 years. Of those, 387 (60.0%) were male, 12.9% (83/643) had undergone solid organ transplant, and almost 10% (59/641) had nosocomial COVID-19 infection. During ICU stay, 359/644 patients (55.7%) required invasive mechanical ventilation, 225 (34.9%) needed renal replacement therapy, 337 (52.2%) received vasopressors, and 216 (33.5%) had hospital-acquired infections (HAIs), mainly caused by multidrug-resistant gram-negative bacteria. HAIs were independently associated with a higher risk of death. The major causes of death were refractory shock and multiple organ dysfunction syndrome but not ARDS, as previously reported in the literature. CONCLUSIONS: In this study, most of our cohort required invasive mechanical ventilation and almost one third had HAIs, which were independently associated with a higher risk of death. Other factors related to death were Charlson Comorbidity Index, SOFA score at admission, and clinical complications during ICU stay. Nosocomial COVID-19 infection was not associated with death. The main immediate causes of death were refractory shock and multiple organ dysfunction syndrome.

Determinants of death in critically ill COVID-19 patients during the first wave of COVID-19: a multicenter study in Brazil / Determinantes de mortalidade em pacientes com COVID-19 em estado crítico durante a primeira onda da doença: estudo multicêntrico no Brasil

ABSTRACT Objective: To evaluate clinical outcomes and factors associated with mortality, focusing on secondary infections, in critically ill patients with COVID-19 in three Brazilian hospitals during the first pandemic wave. Methods: This was a retrospective observational study involving adult patients with COVID-19 admitted to one of the participating ICUs between March and August of 2020. We analyzed clinical features, comorbidities, source of SARS-CoV-2 infection, laboratory data, microbiology data, complications, and causes of death. We assessed factors associated with in-hospital mortality using logistic regression models. Results: We included 645 patients with a mean age of 61.4 years. Of those, 387 (60.0%) were male, 12.9% (83/643) had undergone solid organ transplant, and almost 10% (59/641) had nosocomial COVID-19 infection. During ICU stay, 359/644 patients (55.7%) required invasive mechanical ventilation, 225 (34.9%) needed renal replacement therapy, 337 (52.2%) received vasopressors, and 216 (33.5%) had hospital-acquired infections (HAIs), mainly caused by multidrug-resistant gram-negative bacteria. HAIs were independently associated with a higher risk of death. The major causes of death were refractory shock and multiple organ dysfunction syndrome but not ARDS, as previously reported in the literature. Conclusions: In this study, most of our cohort required invasive mechanical ventilation and almost one third had HAIs, which were independently associated with a higher risk of death. Other factors related to death were Charlson Comorbidity Index, SOFA score at admission, and clinical complications during ICU stay. Nosocomial COVID-19 infection was not associated with death. The main immediate causes of death were refractory shock and multiple organ dysfunction syndrome.

RESUMO Objetivo: Avaliar desfechos clínicos e fatores associados à mortalidade, com foco em infecções secundárias, em pacientes com COVID-19 em estado crítico em três hospitais brasileiros durante a primeira onda da pandemia. Métodos: Estudo observacional retrospectivo envolvendo pacientes adultos com COVID-19 internados nas UTIs participantes entre março e agosto de 2020. Analisaram-se características clínicas, comorbidades, fonte de infecção por SARS-CoV-2, dados laboratoriais, dados microbiológicos, complicações e causas de óbito. Os fatores associados à mortalidade hospitalar foram avaliados por meio de modelos de regressão logística. Resultados: Foram incluídos 645 pacientes com média de idade de 61,4 anos. Desses, 387 (60,0%) eram do sexo masculino, 12,9% (83/643) haviam sido submetidos a transplante de órgão sólido, e quase 10% (59/641) apresentaram infecção nosocomial por COVID-19. Durante a internação na UTI, 359/644 pacientes (55,7%) necessitaram de ventilação mecânica invasiva, 225 (34,9%) necessitaram de terapia renal substitutiva, 337 (52,2%) receberam vasopressores, e 216 (33,5%) apresentaram infecções hospitalares (IHs), causadas principalmente por bactérias Gram-negativas multirresistentes. As IHs associaram-se de forma independente a maior risco de óbito. As principais causas de óbito foram choque refratário e síndrome de disfunção de múltiplos órgãos, mas não SDRA, como relatado anteriormente na literatura. Conclusões: Neste estudo, a maior parte de nossa coorte necessitou de ventilação mecânica invasiva, e quase um terço apresentou IHs, que se associaram de forma independente a maior risco de óbito. Outros fatores relacionados à mortalidade foram Índice de Comorbidade de Charlson, SOFA na admissão e complicações clínicas durante a internação na UTI. A infecção nosocomial por COVID-19 não se associou à mortalidade. As principais causas imediatas de óbito foram choque refratário e síndrome de disfunção de múltiplos órgãos.

Habilidades Sociais Educativas Parentais de Mães de Adolescentes Apontados Como Tendo Problemas de Comportamento / Parenting Social Educational Skills of Mothers of Teenagers Pointed out as Having Behavioral Problems / Habilidades De Educación Social Parental De Madres De Adolescentes Nombrados Con Problemas De Conducta

As habilidades sociais educativas parentais são estratégias que os pais utilizam para direcionar os comportamentos dos filhos diante de situações de interação social. O presente estudo trata-se de uma pesquisa exploratória descritiva que teve por objetivo avaliar as habilidades sociais educativas parentais de mães de adolescentes estudantes de uma escola pública, apontados como tendo problemas sociais de comportamento. Participaram do estudo 20 mães, selecionadas a partir de uma amostragem por conveniência que considerou a ocorrência de queixas pela escola sobre problemas de comportamento de seus filhos. Utilizou-se como instrumento de coleta de dados o Roteiro de Entrevista das Habilidades Sociais Educativas Parentais. Os resultados encontrados apresentaram uma frequência baixa de práticas parentais positivas, em detrimento a uma frequência mais alta de práticas parentais negativas desempenhadas pelas participantes dessa pesquisa. Dessa forma, pode-se concluir um déficit nas habilidades sociais educativas parentais das mães entrevistadas no presente estudo. Esse estudo sugere a necessidade de maior atenção sobre a elaboração e aplicação de programas de treinamentos de habilidades sociais educativas parentais para mães cuidadoras de adolescentes, visto que um possível melhoramento neste aspecto pode influenciar um aprimoramento das estratégias educativas parentais. (AU)

Parenting educational social skills are strategies that parents use to guide their children's behavior in situations of social interaction. This study is an exploratory descriptive research that aimed to assess the social skills related to the parenting practices of mothers of adolescent students from a public school identified as having social behavior problems. Twenty mothers participated in the study, selected from a convenience sampling that considered the occurrence of complaints by the school about their children's behavior problems. As a data collection instrument, the Parental Social Skills Interview Guide was used. The results found showed a low frequency of positive parenting practices to the detriment of a higher frequency of negative parenting practices performed by the participants in this research. Thus, it is possible to conclude a deficit in the parenting educational social skills of the mothers interviewed in the present study. This study suggests the need for greater attention on the design and implementation of training programs for parenting educational social skills for mothers who care for adolescents, since a possible improvement in this aspect may influence an improvement in parenting educational strategies. (AU)

Las habilidades sociales educativas parentales son estrategias que los padres usan para dirigir el comportamiento de sus hijos en situaciones de interacción social. Este estudio es una investigación exploratorio-descriptiva que tuvo como objetivo evaluar las habilidades sociales relacionadas con las prácticas de crianza de madres de estudiantes adolescentes de una escuela pública, apuntados con problemas de conducta social. Veinte madres participaron en el estudio, seleccionado de una muestra de conveniencia que consideró la aparición de quejas por parte de la escuela sobre los problemas de comportamiento de sus hijos. Como instrumento de recopilación de datos, se utilizó la Guía de entrevista de habilidades sociales de los padres. Los resultados encontrados mostraron una baja frecuencia de prácticas de crianza positivas en detrimento de una mayor frecuencia de prácticas de crianza negativas realizadas por los participantes en esta investigación. Por lo tanto, es posible concluir un déficit en las habilidades sociales educativas parentales de las madres entrevistadas en el presente estudio. Este estudio sugiere la necesidad de una mayor atención en el diseño e implementación de programas de capacitación en habilidades sociales educativas parentales para madres que cuidan a adolescentes, ya que una posible mejora en este aspecto puede influir en una mejora en las estrategias educativas para padres. (AU)

Effect of ScLL and 15d-PGJ2 on viability and cytokine release in LPS-stimulated fibroblasts: an in vitro study.

This study evaluated the effect of a cyclopentenone-type PG, 15-Deoxy-Δ12,14-PG J2 (15d-PGJ2), and lectin (ScLL) on the viability of human gingival fibroblasts (HGFs), and on IL-6 and TGFß-1 release by these fibroblasts, stimulated with lipopolysaccharide (LPS). HGFs were stimulated with LPS 10 µg/ml and treated with 15d-PGJ2 1 and 2 µg/ml, and ScLL 2 and 5 µg/ml, for 1 and 3h, and then evaluated for viability by MTT assay. Supernatant was collected to detect IL-6 and TGFß-1 release, by ELISA. Positive control was cells kept in Dulbecco's Modified Eagle's Medium, and negative control was those kept in LPS. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found in viability among experimental groups at 1h (p > 0.05). Percentage of ScLL 5 µg/ml viable cells was similar to that of positive control at evaluated periods (p > 0.05), whereas the other groups had lower levels than the positive control (p < 0.05). IL-6 release was statistically higher for ScLL 5 µg/ml and 15d-PGJ2 2 µg/ml at 1h, compared with the other treated groups and positive control (p < 0.05). No significant differences were found among the groups at 3h (p > 0.05), except for ScLL 2 µg/ml and 15d-PGJ2 1 µg/ml, which showed lower IL-6 release compared with that of negative control (p < 0.05). No significant difference was found among the groups for TGFß-1 release (p > 0.05). Results indicated that ScLL 5 µg/ml did not interfere in viability, and ScLL 2 µg/ml and 15d-PGJ2 1 µg/ml demonstrated reduced IL-6 release. Tested substances had no effect on TGFß-1 release.

Human B cells infected by Trypanosoma cruzi undergo F-actin disruption and cell death via caspase-7 activation and cleavage of phospholipase Cγ1.

B cells contribute to the immune system in many ways such as antigen presentation to CD4+ T cells, secretion of cytokines and lymphoid tissue organogenesis. Furthermore, they are the only cell type capable of producing immunoglobulins. B cells also account for critical aspects of the resistance against intracellular pathogens. Trypanosoma cruzi is an intracellular parasite that sabotages humoral response by depletion of immature B cells. Polyclonal activation and secretion of non-specific antibodies are also other mechanisms used by T cruzi to evade and subvert the mammalian host immune system, leading to increased parasitemia and susceptibility to Chagas' disease. It remained unclear whether B cell depletion occurs due to direct contact with T. cruzi or results from a global increase in inflammation. Unlike previous reports, we demonstrated in this study that T. cruzi infects human B cells, resulting in parasite-induced activation of caspase-7 followed by proteolytic cleavage of phospholipase Cγ1 and cell death. These data contribute to explain the mechanisms ruling B-cell depletion and evasion of the immune response by T. cruzi.

Human B cells infected by Trypanosoma cruzi undergo F-actin disruption and cell death via caspase-7 activation and cleavage of phospholipase Cgama1

B cells contribute to the immune system in many ways such as antigen presentation to CD4+ T cells, secretion of cytokines and lymphoid tissue organogenesis. Furthermore, they are the only cell type capable of producing immunoglobulins. B cells also account for critical aspects of the resistance against intracellular pathogens. Trypanosoma cruzi is an intracellular parasite that sabotages humoral response by depletion of immature B cells. Polyclonal activation and secretion of non-specific antibodies are also other mechanisms used by T cruzi to evade and subvert the mammalian host immune system, leading to increased parasitemia and susceptibility to Chagas’ disease. It remained unclear whether B cell depletion occurs due to direct contact with T. cruzi or results from a global increase in inflammation. Unlike previous reports, we demonstrated in this study that T. cruzi infects human B cells, resulting in parasite-induced activation of caspase-7 followed by proteolytic cleavage of phospholipase Cgama1 and cell death. These data contribute to explain the mechanisms ruling B-cell depletion and evasion of the immune response by T. cruzi.

Human B cells infected by Trypanosoma cruzi undergo F-actin disruption and cell death via caspase-7 activation and cleavage of phospholipase Cgama1

B cells contribute to the immune system in many ways such as antigen presentation to CD4+ T cells, secretion of cytokines and lymphoid tissue organogenesis. Furthermore, they are the only cell type capable of producing immunoglobulins. B cells also account for critical aspects of the resistance against intracellular pathogens. Trypanosoma cruzi is an intracellular parasite that sabotages humoral response by depletion of immature B cells. Polyclonal activation and secretion of non-specific antibodies are also other mechanisms used by T cruzi to evade and subvert the mammalian host immune system, leading to increased parasitemia and susceptibility to Chagas’ disease. It remained unclear whether B cell depletion occurs due to direct contact with T. cruzi or results from a global increase in inflammation. Unlike previous reports, we demonstrated in this study that T. cruzi infects human B cells, resulting in parasite-induced activation of caspase-7 followed by proteolytic cleavage of phospholipase Cgama1 and cell death. These data contribute to explain the mechanisms ruling B-cell depletion and evasion of the immune response by T. cruzi.

Perfil de pacientes obstétricas admitidas na unidade de terapia intensiva de um hospital público / Perfil de pacientes obstétricas ingresadas en la unidad de cuidados intensivos de un hospital público / Profile of obstetric patients admitted to the intensive care unit of a public hospital

Objetivo: analisar o perfil de pacientes obstétricas admitidas na Unidade de Terapia Intensiva Adulto. Método: estudo quantitativo, descritivo-retrospectivo, desenvolvido por meio da busca e obtenção dos dados referentes ao perfil socioeconômico e clínico dos prontuários das pacientes gestantes ou puérperas internadas por causa obstétrica, entre janeiro 2017 e dezembro de 2018, na Unidade de Terapia Intensiva de um hospital público de Pernambuco, Brasil. Os resultados foram analisados pelo programa Statistical Package for the Social Science. Resultados: as mulheres tinham, em sua maioria, idade entre 19 e 29 anos (56,1%), e cor parda (88,6%). A maioria foi internada no pós-parto (75,6%), o tipo de parto mais prevalente foi o cesáreo (87,2%), as síndromes hipertensivas foram a maior causa do internamento (61,8%). O principal distúrbio hipertensivo apresentado é pré-eclâmpsia (39,8%). Conclusão: as pacientes adultas jovens, puérperas de parto cesáreo, com síndromes hipertensivas são internadas com mais frequência na Unidade de Terapia Intensiva.

Objetivo: analizar el perfil de las pacientes obstétricas ingresadas en la Unidad de Cuidados Intensivos. Método: estudio cuantitativo, descriptivo y retrospectivo, desarrollado por medio de la búsqueda y la recuperación de los datos del perfil socioeconómico y clínico del registro médico de pacientes embarazadas o en posparto ingresadas por causa obstétrica, entre enero de 2017 y diciembre de 2018, en la Unidad de Cuidados Intensivos de un hospital público en el estado de Pernambuco, Brasil. Los resultados fueron analizados mediante el Statistical Package for the Social Sciences. Resultados: las mujeres tenían, en su mayoría, edades comprendidas entre los 19 y 29 años (56,1%), y pardas (88,6%). La mayoría fue hospitalizada en el posparto (75,6%), el tipo de parto por cesárea fue el más frecuente (87,2%), síndromes hipertensivos fueron la principal causa de hospitalización (61,8%). El principal trastorno hipertensivo presentado es la pre-eclampsia (39,8%). Conclusión: las pacientes adultas jóvenes, puérperas, cuyo parto fue cesárea, con síndromes hipertensivos son hospitalizadas con mayor frecuencia en las Unidades de Cuidados Intensivos.

Objective: to analyze the profile of obstetric patients admitted to the Intensive Care Unit. Method: quantitative, descriptive and retrospective study, developed through searches and retrieval of data referring to socioeconomic and clinical profile of pregnant or postpartum patients' records admitted for obstetric cause, between January 2017 and December 2018, in the Intensive Care Unit of a public hospital in Pernambuco, Brazil. The results were analyzed using the Statistical Package for the Social Sciences. Results: most women were between 19 and 29 years (56.1%), and pardas (88.6%). The majority was hospitalized in the postpartum (75.6%), the most prevalent delivery type was cesarean section (87.2%), hypertensive syndromes were the major cause of hospitalization (61.8%). The main hypertensive disorder was pre-eclampsia (39.8%). Conclusion: the young adult puerperal patients, whose delivery route was cesarean section, with hypertensive syndromes are hospitalized more frequently in the Intensive Care Unit.

Effect of ScLL and 15d-PGJ2 on viability and cytokine release in LPS-stimulated fibroblasts: an in vitro study

Abstract This study evaluated the effect of a cyclopentenone-type PG, 15-Deoxy-Δ12,14-PG J2 (15d-PGJ2), and lectin (ScLL) on the viability of human gingival fibroblasts (HGFs), and on IL-6 and TGFβ-1 release by these fibroblasts, stimulated with lipopolysaccharide (LPS). HGFs were stimulated with LPS 10 μg/ml and treated with 15d-PGJ2 1 and 2 μg/ml, and ScLL 2 and 5 μg/ml, for 1 and 3h, and then evaluated for viability by MTT assay. Supernatant was collected to detect IL-6 and TGFβ-1 release, by ELISA. Positive control was cells kept in Dulbecco's Modified Eagle's Medium, and negative control was those kept in LPS. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found in viability among experimental groups at 1h (p > 0.05). Percentage of ScLL 5 µg/ml viable cells was similar to that of positive control at evaluated periods (p > 0.05), whereas the other groups had lower levels than the positive control (p < 0.05). IL-6 release was statistically higher for ScLL 5 μg/ml and 15d-PGJ2 2 µg/ml at 1h, compared with the other treated groups and positive control (p < 0.05). No significant differences were found among the groups at 3h (p > 0.05), except for ScLL 2 µg/ml and 15d-PGJ2 1 µg/ml, which showed lower IL-6 release compared with that of negative control (p < 0.05). No significant difference was found among the groups for TGFβ-1 release (p > 0.05). Results indicated that ScLL 5 μg/ml did not interfere in viability, and ScLL 2 µg/ml and 15d-PGJ2 1 µg/ml demonstrated reduced IL-6 release. Tested substances had no effect on TGFβ-1 release.

Processo de implantação e estruturação do Núcleo de Inovação Tecnológica

A implementação dos Núcleo de Inovação Tecnológica (NITs) ainda é apontada como um desafio no Brasil. Assim, este trabalho tem como objetivo avaliar o processo de implantação e estruturação do NIT no Instituto Pasteur (IP), indicando os resultados aferidos neste processo. Foi escolhido o modelo organizacional híbrido, com atividades voltadas para prestação de serviço e Pesquisa & Desenvolvimento. As ações de implantação e estruturação do NIT-IP promoveram alguns resultados positivos na instituição como institucionalização, reconhecimento e sensibilização do NIT-IP frente a comunidade científica; e o acompanhamento e avaliação do potencial inovador dos projetos e resultados científicos da instituição pelo NIT-IP. Devido aos resultados obtidos este modelo pode ser utilizado como uma referência em outros institutos com a estrutura semelhante ou não ao IP. Contudo, o NIT-IP encontra-se em um processo de amadurecimento, devendo transpor gargalos relacionados com a ausência de verba destinada aos NITs e recursos humanos insuficientes.

Trypanosoma cruzi modulates gene expression of plasma membrane repair-related proteins.

Plasma membrane injury and repair is particularly prevalent in muscle cells. Here, we aimed to verify dysferlin, acid sphingomyelinase and transcriptional factor EB gene expression during Trypanosoma cruzi infection in vitro and in vivo. Our results showed that the parasite modulates gene expression of these proteins in a way dependent on the number of plasma membrane interacting parasites and in a rapamycin-sensitive manner.

Effect of lectin (ScLL) on fibroblasts stimulated with LPS - an in vitro study.

The lectin (ScLL) extracted from the Synadenium carinatum plant has been evaluated as an immunomodulator in diseases such as asthma, neosporosis and leishmaniasis. However, it has not yet been evaluated in the oral cavity. This study evaluated the effect of ScLL on viability, proliferation and release of IL-10 in human gingival fibroblasts (HGF) stimulated with lipopolysaccharide (LPS). HGF were stimulated with LPS 1 µg/ml and treated with ScLL in concentrations of 10, 5 and 2 µg/ml for 1 and 5 h, and evaluated by flow cytometry for viability, apoptosis (initial/advanced) and necrosis. The supernatant was collected to detect release of IL-10 by ELISA. The proliferation was assessed with the BrdU assay. Positive control consisted of cells maintained in Dulbecco's Modified Eagles Medium (DMEM), and the negative control, of those kept in tap water. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found for ScLL concentrations regarding viability or initial and advanced apoptosis (p=0.455). All the groups, including the positive control, had a significantly lower necrosis parameter than negative control at 5 h (p < 0.001). No difference was found for proliferation among the experimental groups (p = 0.832). ScLL at 5 and 2 µg/ml resulted in a lower release of IL-10 than positive and negative controls at 5 h (p = 0.047). The results indicated that ScLL concentrations tested were not cytotoxic, and had no effect on proliferation and release of IL-10 parameters. A thorough understanding of ScLL, regarding its immunomodulatory potential, may open the door to new perspectives for dentistry.

IL-17 Induction by ArtinM is Due to Stimulation of IL-23 and IL-1 Release and/or Interaction with CD3 in CD4+ T Cells.

ArtinM is a D-mannose-binding lectin extracted from the seeds of Artocarpus heterophyllus that interacts with TLR2 N-glycans and activates antigen-presenting cells (APCs), as manifested by IL-12 production. In vivo ArtinM administration induces Th1 immunity and confers protection against infection with several intracellular pathogens. In the murine model of Candida albicans infection, it was verified that, in addition to Th1, ArtinM induces Th17 immunity manifested by high IL-17 levels in the treated animals. Herein, we investigated the mechanisms accounting for the ArtinM-induced IL-17 production. We found that ArtinM stimulates the IL-17 production by spleen cells in BALB/c or C57BL/6 mice, a response that was significantly reduced in the absence of IL-23, MyD88, or IL-1R. Furthermore, we showed that ArtinM directly induced the IL-23 mRNA expression and the IL-1 production by macrophages. Consistently, in cell suspensions depleted of macrophages, the IL-17 production stimulated by ArtinM was reduced by 53% and the exogenous IL-23 acted synergistically with ArtinM in promoting IL-17 production by spleen cell suspensions. We verified that the absence of IL-23, IL-1R, or MyD88 inhibited, but did not block, the IL-17 production by ArtinM-stimulated spleen cells. Therefore, we investigated whether ArtinM exerts a direct effect on CD4+ T cells in promoting IL-17 production. Indeed, spleen cell suspensions depleted of CD4+ T cells responded to ArtinM with very low levels of IL-17 release. Likewise, isolated CD4+ T cells under ArtinM stimulus augmented the expression of TGF-ß mRNA and released high levels of IL-17. Considering the observed synergism between IL-23 and ArtinM, we used cells from IL-23 KO mice to assess the direct effect of lectin on CD4+ T cells. We verified that ArtinM increased the IL-17 production significantly, a response that was inhibited when the CD4+ T cells were pre-incubated with anti-CD3 antibody. In conclusion, ArtinM stimulates the production of IL-17 by CD4+ T cells in two major ways: (I) through the induction of IL-23 and IL-1 by APCs and (II) through the direct interaction with CD3 on the CD4+ T cells. This study contributes to elucidation of mechanisms accounting for the property of ArtinM in inducing Th17 immunity and opens new perspectives in designing strategies for modulating immunity by using carbohydrate recognition agents.

Effect of lectin (ScLL) on fibroblasts stimulated with LPS - an in vitro study

Abstract: The lectin (ScLL) extracted from the Synadenium carinatum plant has been evaluated as an immunomodulator in diseases such as asthma, neosporosis and leishmaniasis. However, it has not yet been evaluated in the oral cavity. This study evaluated the effect of ScLL on viability, proliferation and release of IL-10 in human gingival fibroblasts (HGF) stimulated with lipopolysaccharide (LPS). HGF were stimulated with LPS 1 µg/ml and treated with ScLL in concentrations of 10, 5 and 2 µg/ml for 1 and 5 h, and evaluated by flow cytometry for viability, apoptosis (initial/advanced) and necrosis. The supernatant was collected to detect release of IL-10 by ELISA. The proliferation was assessed with the BrdU assay. Positive control consisted of cells maintained in Dulbecco's Modified Eagles Medium (DMEM), and the negative control, of those kept in tap water. Data were analyzed by ANOVA and Dunnett's test (α = 0.05). No significant difference was found for ScLL concentrations regarding viability or initial and advanced apoptosis (p=0.455). All the groups, including the positive control, had a significantly lower necrosis parameter than negative control at 5 h (p < 0.001). No difference was found for proliferation among the experimental groups (p = 0.832). ScLL at 5 and 2 µg/ml resulted in a lower release of IL-10 than positive and negative controls at 5 h (p = 0.047). The results indicated that ScLL concentrations tested were not cytotoxic, and had no effect on proliferation and release of IL-10 parameters. A thorough understanding of ScLL, regarding its immunomodulatory potential, may open the door to new perspectives for dentistry.

[Determinants of maternal near miss in an obstetric intensive care unit]. / Fatores determinantes do near miss materno em uma unidade de terapia intensiva obstétrica.

PURPOSE: To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital. METHODS: Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used. RESULTS: The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2). CONCLUSIONS: The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.

Fatores determinantes do near miss materno em uma unidade de terapia intensiva obstétrica / Determinants of maternal near miss in an obstetric intensive care unit

OBJETIVO:Avaliar os fatores determinantes da morbimortalidade em unidade de terapia intensiva obstétrica de um hospital universitário.MÉTODOS:Estudo observacional de corte transversal com 492 gestantes ou puérperas. Foram selecionadas pacientes internadas na unidade de terapia intensiva obstétrica no período de um ano, sendo informadas sobre as propostas do estudo e realizada aplicação do questionário. A análise foi feita através do Microsoft Excel 2013 e GraphPad Prism 6. Foram empregados testes do χ2 para verificar associação entre os fatores de risco para morbimortalidade materna grave.RESULTADOS: Foram encontrados como riscos relativos significativamente elevados para desenvolvimento de near missquando comparada à morbidade materna grave, a raça não branca (OR=2,5; RP=2,3); pacientes casadas (OR=7,9; RP=7,1), escolaridade até 2º grau incompleto (OR=3,1; RP=2,8), procedente do interior (OR=4,6; RP=4,0), renda familiar menor que 1 salário mínimo (OR=7,0; RP=5,5), distúrbios hipertensivos gestacionais (OR=16,3; RP=13,2), realização do pré-natal (OR=5,0; RP=4,2) e a via de parto cesárea (OR=39,2; RP=31,2).CONCLUSÕES: Questões socioeconômicas, clínicas e assistenciais mostraram-se relacionados à prevalência de near miss, revelando a importância de intervenções amplas para melhorar esses indicadores. Reforça-se a importância da realização de pré-natal para identificação de riscos potenciais, garantia de um suporte nutricional à gestante, tratamento de doenças e estabelecimento de programa de imunização materna, assim como uma melhor assistência no que tange aos aspectos clínicos das pacientes, objetivando diminuir o risco obstétrico e neonatal.

PURPOSE: To evaluate the risk factors for morbidity and mortality in an obstetric intensive care unit at a university hospital.METHODS: Observational cross-sectional study with 492 pregnant/puerperal women. Patients were admitted to the obstetric intensive care unit over a period of one year, being informed about the proposals of the study and a questionnaire was applied. The analysis was performed using Microsoft Excel 2013 and GraphPad Prism 6. To evaluate risk factors, χ2 tests were used.RESULTS: The main risk factors to near miss were: non-white race (OR=2.5; PR=2.3); marital status (married women) (OR=7.9; PR=7.1), schooling (primary) (OR=3.1; PR=2.8), being from the countryside (OR=4.6; PR=4.0), low income (OR=70; PR=5.5), gestational hypertensive disorders (OR=16.3; PR=13.2), receiving prenatal care (OR=5.0; PR=4.254) and C-section before labor (OR=39.2; PR=31.2).CONCLUSIONS: The prevalence of near miss was associated with socioeconomic/clinical factors and care issues, revealing the importance of interventions to improve these indicators. Additionally, we suggest a better curriculum insertion of this subject in the discipline of the medical course due to the importance of avoiding the near miss using adequate medical education. The importance of correct prenatal care is emphasized in order to identify potential risks, to provide nutritional support to pregnant women, to treat potential diseases and to establish a maternal immunization program, as well as providing better care regarding the clinical features of the patients, in order to reduce obstetrical and neonatal risk.

Activation of spleen cells by ArtinM may account for its immunomodulatory properties.

ArtinM is a D-mannose-binding lectin extracted from Artocarpus heterophyllus that promotes interleukin-12 production by macrophages and dendritic cells. This property is considered responsible for T helper 1 immunity induced in vivo after ArtinM administration. In this study, we investigated the effect of native (jArtinM) and recombinant (rArtinM) forms of lectin on murine spleen cells and isolated T lymphocytes. We found that ArtinM binds to the surface of spleen cells. This interaction, which was blocked by D-mannose, induced cell activation, as manifested by increased mitochondrial activity, interleukin-2 production, and cell proliferation. We verified that a 30-times higher concentration of rArtinM was required to trigger optimal activation of spleen cells compared with that needed with jArtinM, although these proteins have identical sugar recognition properties and use the same signaling molecules to trigger cell activation. Because the distinction between native and recombinant is restricted to their tertiary structure (tetrameric and monomeric, respectively), we postulated that the multi-valence of jArtinM accounts for its superiority in promoting clustering of cell surface glycoreceptors and activation. The jArtinM and rArtinM activation effect exerted on spleen cells was reproduced on purified CD4(+) T cells. Our results suggest that ArtinM interaction with T cells leads to responses that may act in concert with the interleukin-12 produced by antigen-presenting cells to modulate immunity toward the T helper 1 axis. Further studies are necessary to dissect ArtinM/T-cell interactions to more fully understand the immunomodulation induced by carbohydrate recognition.