High dose cholecalciferol supplementation causing morning blood pressure reduction in patients with type 1 diabetes mellitus and cardiovascular autonomic neuropathy.

We evaluated the association of cardiovascular autonomic neuropathy (CAN), blood pressure (BP) and Vitamin D (VD) levels before and after high-dose cholecalciferol supplementation (4000/10,000) UI/day) for 12 weeks in patients (N = 67) with type 1 diabetes mellitus (T1DM). Based on this prospective controlled pilot study, patients were divided into group 1 (N = 23 with CAN) and group 2 (N = 44 without CAN). At baseline, group 1 had higher systolic BP (SBP) during sleep (115 ± 14 vs. 107 ± 12 mmHg, p = 0.04) and lower nocturnal dipping (3 ± 5 vs. 8 ± 6%, p = 0.009). Among those with loss of nocturnal dipping, 45.4% (20/44) had CAN, while in normal nocturnal dipping group it occurred only in 13% (3/23) (p = 0.007). Non-dipper group had worse CAN parameters when compared to dipper group [Very low frequency (VLF) (2.5 ± 0.5vs.2.8 ± 0.4 s, p = 0.01), total power (TP) (2.9 ± 0.6 vs. 3.3 ± 0.4 s, p = 0.01), Valsalva coefficient (1.5 ± 0.4 vs. 1.8 ± 0.6, p = 0.06)]. After VD, only group 1 improved CAN parameters [TP (2.5 ± 0.4 vs. 2.8 ± 0.6, p = 0.01) and VLF (2.2 ± 0.4 vs. 2.4 ± 0.5, p = 0.03). Group 1 presented a reduction in morning SBP (120 ± 20 vs. 114 ± 17 mmHg, p = 0.038) and in morning SBP surge (13 ± 13 vs. 5 ± 14, p = 0.04). High-dose VD was associated with improved CAN parameters and reduced awake SBP and morning SBP surge. These findings suggest that VD may benefit patients with cardiovascular autonomic neuropathy. ISRCTN32601947, registration date: 31/07/2017.

Mucin (MUC) Family Influence on Acute Lymphoblastic Leukemia in Cancer and Non-Cancer Native American Populations from the Brazilian Amazon.

The mucin (MUC) family includes several genes aberrantly expressed in multiple carcinomas and mediates diverse pathways essentials for oncogenesis, in both solid and hematological malignancies. Acute Lymphoblastic Leukemia (ALL) can have its course influenced by genetic variants, and it seems more frequent in the Amerindian population, which has been understudied. Therefore, the present work aimed to investigate the MUC family exome in Amerindian individuals from the Brazilian Amazon, in a sample containing healthy Native Americans (NAMs) and indigenous subjects with ALL, comparing the frequency of polymorphisms between these two groups. The population was composed of 64 Amerindians from the Brazilian Amazon, from 12 different isolated tribes, five of whom were diagnosed with ALL. We analyzed 16 genes from the MUC family and found a total of 1858 variants. We compared the frequency of each variant in the ALL vs. NAM group, which led to 77 variants with a significant difference and, among these, we excluded those with a low impact, resulting in 63 variants, which were distributed in nine genes, concentrated especially in MUC 19 (n = 30) and MUC 3A (n = 18). Finally, 11 new variants were found in the NAM population. This is the first work with a sample of native Americans with cancer, a population which is susceptible to ALL, but remains understudied. The MUC family seems to have an influence on the development of ALL in the Amerindian population and especially MUC19 and MUC3A are shown as possible hotspots. In addition, the 11 new variants found point to the need to have their clinical impact analyzed.

Correlation between Genomic Variants and Worldwide Epidemiology of Prostate Cancer.

Prostate cancer (PCa) incidence and mortality vary across territories and populations. This can be explained by the genetic factor of this disease. This article aims to correlate the epidemiological data, worldwide incidence, and mortality of PCa with single-nucleotide polymorphisms (SNPs) associated with the susceptibility and severity of this neoplasm in different populations. Eighty-four genetic variants associated with prostate cancer susceptibility were selected from the literature through genome association studies (GWAS). Allele frequencies were obtained from the 1000 Genomes Project, and epidemiological data were obtained from Surveillance, Epidemiology, and End Results (SEER). The PCa incidence, mortality rates, and allele frequencies of variants were evaluated by Pearson's correlation. Our study demonstrated that 12 SNPs (rs2961144, rs1048169, rs7000448, rs4430796, rs2066827, rs12500426, rs6983267, rs11649743, rs2075110, rs114798100, rs855723, and rs2075109) were correlated with epidemiological data in different ethnic groups. Ten SNPs (rs2961144, rs1048169, rs7000448, rs4430796, rs2066827, rs12500426, rs11649743, rs2075110, rs114798100, and rs2075109) were positively correlated with the mortality rate. Seven SNPs (rs1048169, rs2961144, rs7000448, rs4430796, rs2066827, rs12500426, and rs114798100) were positively correlated with incidence. Positive correlations of incidence and mortality rates were more frequent in the African population. The genetic variants investigated here are likely to predispose to PCa and could play a role in its progression and aggressiveness. This genetic study demonstrated here is promising for implementing personalized strategies to screen for prostate cancer in diverse populations.

Peripheral arterial disease progression and ankle brachial index: a cohort study with newly diagnosed patients with type 2 diabetes.

BACKGROUND: Little is known about the evolution of peripheral arterial disease (PAD) since diagnosis and its association with glycemic and lipid control in patients with Type 2 Diabetes Mellitus (T2DM). OBJECTIVE: Evaluate the actual criteria to start screening PAD with ankle-brachial index (ABI) in T2DM patients and assess its progression and relationship with glycemic and lipid control since diagnosis. METHODS: We performed a 3-year prospective cohort study with two groups: group 1 (978 individuals with T2DM undergoing drug treatment) and group 2 [221 newly diagnosed drug-naive (< 3 months) patients with T2DM]. PAD diagnosis was by ABI ≤ 0.90, regardless any symptoms. RESULTS: As expected, abnormal ABI prevalence was higher in group 1 vs. Group 2 (87% vs. 60%, p < 0.001). However, abnormal ABI prevalence did not differ between patients over and under 50 years in both groups. Our drug-naive group stabilizes ABI (0.9 ± 0.1 vs 0.9 ± 0.1, p = NS) and improved glycemic and lipid control during follow-up [glycated hemoglobin (HbA1c) = 8.9 ± 2.1 vs 8.4 ± 2.3%, p < 0.05; LDL = 132 ± 45 vs 113 ± 38 mg/dL, p < 0.01, respectively]. When compared, patients who evolved with normalization or maintained normal ABI levels at the end [Group A, N = 60 (42%)] with those who decreased ABI to abnormal levels (ABI basal 1.0 ± 0.1 vs final 0.85 ± 0.1, p < 0.001) [Group B, N = 26 (18%)], an improvement in HbA1c (9 ± 2 vs 8 ± 2%, p < 0.05) and a correlation between the final HbA1c with ABI (r = - 0.3, p = 0.01) was found only in the first. In addition, a correlation was found between albuminuria variation and ABI solely in group A (r = - 0.3; p < 0.05). CONCLUSION: Our study suggests that ABI should be measured at diagnosis in T2DM patients, indicating that current criteria to select patients to screen PAD with ABI must be simplified. An improvement in albuminuria and glycemic and lipid control could be related with ABI normalization in newly diagnosed T2DM drug-naive patients.

The Genomic Profile Associated with Risk of Severe Forms of COVID-19 in Amazonian Native American Populations.

Genetic factors associated with COVID-19 disease outcomes are poorly understood. This study aimed to associate genetic variants in the SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1, and ABO genes with the risk of severe forms of COVID-19 in Amazonian Native Americans, and to compare the frequencies with continental populations. The study population was composed of 64 Amerindians from the Amazon region of northern Brazil. The difference in frequencies between the populations was analyzed using Fisher's exact test, and the results were significant when p ≤ 0.05. We investigated 64 polymorphisms in 7 genes; we studied 47 genetic variants that were new or had impact predictions of high, moderate, or modifier. We identified 15 polymorphisms with moderate impact prediction in 4 genes (ABO, CXCR6, FYCO1, and SLC6A20). Among the variants analyzed, 18 showed significant differences in allele frequency in the NAM population when compared to others. We reported two new genetic variants with modifier impact in the Amazonian population that could be studied to validate the possible associations with COVID-19 outcomes. The genomic profile of Amazonian Native Americans may be associated with protection from severe forms of COVID-19. This work provides genomic data that may help forthcoming studies to improve COVID-19 outcomes.

Association of Soy and Exclusive Breastfeeding With Central Precocious Puberty: A Case-Control Study.

Introduction: While soy is suggested as a possible risk factor, exclusive breastfeeding (EBF) has a likely protective effect in precocious puberty. Our aim was to evaluate the association between both of these variables with central precocious puberty (CPP). Methods: We performed a retrospective, case-control study. A total of 161 girls were divided into two groups: 84 patients diagnosed with CPP composed the case group and 77 patients without the diagnosis of CPP (had gone through normal onset of puberty) were the control group. Results: Our control group had a higher presence of EBF >6 months, which was an important protective factor for CPP (OR: 0.5; IC 95%: 0.3-0.9, p = 0.05) and also correlated negatively with the presence of it (r = -0.2; p < 0.05). Oppositely, the use of soy was significantly higher in the CPP group, (OR: 3.8; IC 95%: 1.5-6, p < 0.05) and positively correlating (r = 0.2; p < 0.01) with the presence of CPP. Duration of soy intake (years) correlated with bone age (r = 0.415; p < 0.05). A logistic regression was performed to evaluate the effects of EBF duration and soy on CPP. The model was significant (x² (2) = 20,715, p = <0.001) and explained 12.2% (Nagelkerke R2) of the variance, correctly classifying 62.5% of cases. EBF was associated with a reduction of likelihood of having CPP [OR = 0,187 (CI = 0.055-0,635); Wald = 7,222, p = 0.007], while soy intake increased the risk [OR = 3.505 (CI) = 1,688-7,279, Wald = 11,319, p = 0.001]. Conclusion: Our data found the use of soy was associated with CPP. Additionally, EBF was pointed as a protective factor. However, future prospective studies are needed to clarify this issue.

Uso da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas produzidas em ratos Wistar / Use of canine vaginal tunic preserved in 98% glycerin as biological curative in the treatment of skin produced in wound Wistar rats

Na procura por material alternativo no tratamento de feridas cutâneas, buscou-se com este estudo avaliar o comportamento da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas provocadas experimentalmente em ratos. Foram utilizados 16 ratos Wistar, nos quais foram induzidas experimentalmente duas lesões cutâneas na região dorsal, sendo uma cranial e a outra caudal. Uma ferida serviu de controle, a qual não recebeu tratamento, a outra recebeu a túnica vaginal recobrindo toda extensão da lesão. A seleção de qual das feridas, cranial ou caudal, iria receber a membrana foi feita de forma aleatória. Os animais foram distribuídos em quatro grupos de igual número para análises clínicas, macroscópicas e histológicas decorridos três, sete, 14 e 21 dias de pós-operatório. Na avaliação clínica e macroscópica pode-se observar que o processo de reparação teve evolução semelhante tanto no grupo controle quanto no grupo membrana. Na análise histopatológica foi constatada grande quantidade de infiltrado inflamatório nos períodos iniciais, no entanto, decorridos 21 dias, a epiderme já se encontrava reparada, e em todos os momentos foi observada maior presença de tecido conjuntivo no grupo membrana, sugerindo maior precocidade na cicatrização. Deste modo, concluiu-se que a túnica vaginal canina pode ser utilizada como nova alternativa no tratamento de feridas cutâneas.

In the search for alternative material in the treatment of cutaneous wounds, this study aimed to evaluate the behavior of canine vaginal tunic conserved in glycerin 98% as a biological dressing in the treatment of cutaneous wounds provoked experimentally in rats. Sixteen animals were used in which two cutaneous lesions were caused in the dorsal region, one cranial and the other caudal. One wound served as a control which did not receive treatment, the other received the vaginal tunic covering all extension of the lesion. The selection of which of the wounds, cranial or caudal, would receive the membrane was made at random. The animals were divided into four groups of equal numbers for clinical, macroscopic, and histological analyzes after three, seven, 14 and 21 postoperative days. In the clinical and macroscopic evaluation, it can be observed that the healing process had similar evolution in both the control group and the membrane group. In the histopathological analysis, a large amount of inflammatory infiltrate was observed in the initial periods; however, after 21 days the epidermis was already healed, and at all times a greater presence of connective tissue was observed in the membrane group, suggesting a greater precocity in healing. Thus, it was concluded that the canine vaginal tunic can be used as a new alternative in the treatment of cutaneous wounds.

Satisfação profissional e qualidade de vida de enfermeiros de um hospital brasileiro / Satisfacción profesional y calidad de vida de enfermeros en un hospital brasileño / Professional satisfaction and quality of life of nurses in a Brazilian hospital

Objetivo: avaliar a satisfação profissional assim como a qualidade de vida dos enfermeiros de um hospital público brasileiro e analisar a relação entre a satisfação no trabalho e a qualidade de vida dos participantes. Materiais e método: trata-se de uma pesquisa descritiva, quantitativa, realizada com 68 enfermeiros de um hospital onco-hematológico brasileiro. Para a coleta de dados, utilizouse dos questionários: sociodemográfico, World Health Organization Quality of Life (WHoQoL-Bref ) e Índice de Satisfação Profissional. A verifica-ção de associação estatística ocorreu por meio do coeficiente de correlação linear de Pearson (r) e de Spearman (ρ), após a suposição de normalidade realizada pelo teste de Shapiro-Wilk. Resultados:constatouse baixa satisfação profissional percebida (3,44 pontos), com menores escores na remuneração (1,66) e nas normas organizacionais (2,35), podendo representar obstáculos para a assistência, sendo capazes, inclusive, de culminar na intenção de abandono da carreira. Na qualidade de vida, o domínio físico (65,9 %) apresentou maior contribuição e o ambiente (55,1 %), a pior. Observouse interação positiva entre a satisfação profissional e a qualidade de vida, entretanto de fraca magnitude (r = 0,27), não sendo suficiente inferir a relação determinante de uma variável sobre a outra. Conclusões: evidenciouse que avaliar os fatores do trabalho que interferem na qualidade de vida do enfermeiro pode representar alternativa de identificar elementos que comprometem a produtividade e a assistência, melhorando o atendimento.

Objetivo: evaluar la satisfacción profesional y la calidad de vida de los enfermeros de un hospital público brasileño y analizar la relación entre ambas variables. Materiales y método: investigación descriptiva y cuantitativa realizada con 68 enfermeros de un hospital oncohematológico brasileño. Para la recolección de datos se utilizaron los siguientes cuestionarios: sociodemográfico, Calidad de vida de la Organización Mundial de la Salud (WHoQoL-Bref ) y el Índice de satisfacción profesional. La verificación de la asociación estadística se realizó mediante el Coeficiente de Correlación Lineal de Pearson (r) y Spearman (ρ), después de la suposición de normalidad realizada por la prueba de Shapiro-Wilk. Resultados: se encontró una baja satisfacción profesional (3,44 puntos), con puntajes más bajos en lo relacionado con la remuneración (1,66) y las normas organizacionales (2,35), lo que puede representar obstáculos para la asistencia e incluso determinar la intención de abandono de la carrera. En términos de calidad de vida, el dominio físico (65,9 %) representó la mayor contribución, mientras que el medio ambiente (55,1 %) la de menor peso. Además, se evidenció una interacción positiva entre la satisfacción laboral y la calidad de vida, aunque esta fue de baja magnitud (r = 0,27), resultando insuficiente para inferir una relación determinante de una variable sobre otra. Conclusiones: se evidenció que evaluar los factores del trabajo que interfieren en la calidad de vida de los enfermeros puede representar una alternativa para identificar elementos que comprometen la productividad y el servicio, mejoran-do con ello la asistencia prestada por estos profesionales.

Objective: To evaluate the professional satisfaction and the quality of life of nurses in a Brazilian public hospital and analyze the relationship between both variables. Materiales and method: Descriptive and quantitative research, carried out with 68 nurses from a Brazilian oncohematological hospital. Data collection involved the use of the following questionnaires: sociodemographic, World Health Organization Quality of Life (WHoQoL-Bref ), and the Job Satisfaction Index. The verification of statistical association occurred through Pearson's Linear Correlation Coefficient (r) and Spearman (ρ), after the assumption of normality performed by the Shapiro-Wilk test. Results: A low perceived professional satisfaction (3.44 points) was identified, with lower scores on remuneration (1.66) and organizational norms (2.35), which may represent possible obstacles to assistance, capable of leading to the intention of leaving the career. Regarding the quality of life, the physical domain (65.9 %) reported the highest contribution, while the environment (55.1 %) the lowest. Positive interaction was observed between job satisfaction and quality of life, although with a low magnitude (r = 0.27), which is not enough to infer the determining relationship of one variable over another. Conclusions:The evidence suggests that evaluating work factors that interfere with nurses' quality of life could represent an alternative to identifying elements that compromise productivity and assistance, thus improving care.

Uso da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas produzidas em ratos Wistar / Use of canine vaginal tunic preserved in 98% glycerin as biological curative in the treatment of skin produced in wound Wistar rats

Na procura por material alternativo no tratamento de feridas cutâneas, buscou-se com este estudo avaliar o comportamento da túnica vaginal canina conservada em glicerina a 98% como curativo biológico no tratamento de feridas cutâneas provocadas experimentalmente em ratos. Foram utilizados 16 ratos Wistar, nos quais foram induzidas experimentalmente duas lesões cutâneas na região dorsal, sendo uma cranial e a outra caudal. Uma ferida serviu de controle, a qual não recebeu tratamento, a outra recebeu a túnica vaginal recobrindo toda extensão da lesão. A seleção de qual das feridas, cranial ou caudal, iria receber a membrana foi feita de forma aleatória. Os animais foram distribuídos em quatro grupos de igual número para análises clínicas, macroscópicas e histológicas decorridos três, sete, 14 e 21 dias de pós-operatório. Na avaliação clínica e macroscópica pode-se observar que o processo de reparação teve evolução semelhante tanto no grupo controle quanto no grupo membrana. Na análise histopatológica foi constatada grande quantidade de infiltrado inflamatório nos períodos iniciais, no entanto, decorridos 21 dias, a epiderme já se encontrava reparada, e em todos os momentos foi observada maior presença de tecido conjuntivo no grupo membrana, sugerindo maior precocidade na cicatrização. Deste modo, concluiu-se que a túnica vaginal canina pode ser utilizada como nova alternativa no tratamento de feridas cutâneas.

In the search for alternative material in the treatment of cutaneous wounds, this study aimed to evaluate the behavior of canine vaginal tunic conserved in glycerin 98% as a biological dressing in the treatment of cutaneous wounds provoked experimentally in rats. Sixteen animals were used in which two cutaneous lesions were caused in the dorsal region, one cranial and the other caudal. One wound served as a control which did not receive treatment, the other received the vaginal tunic covering all extension of the lesion. The selection of which of the wounds, cranial or caudal, would receive the membrane was made at random. The animals were divided into four groups of equal numbers for clinical, macroscopic, and histological analyzes after three, seven, 14 and 21 postoperative days. In the clinical and macroscopic evaluation, it can be observed that the healing process had similar evolution in both the control group and the membrane group. In the histopathological analysis, a large amount of inflammatory infiltrate was observed in the initial periods; however, after 21 days the epidermis was already healed, and at all times a greater presence of connective tissue was observed in the membrane group, suggesting a greater precocity in healing. Thus, it was concluded that the canine vaginal tunic can be used as a new alternative in the treatment of cutaneous wounds.

Repercussões negativas e impacto psicológico da pandemia por Covid-19 nas equipes de saúde / Negative repercussions and psychological impact of pandemic by Covid-19 on health teams / Repercusiones negativas e impacto psicológico de la pandemia por Covid-19 en equipos de salud

Objetivo: identificar as repercussões negativas e o impacto psicológico em profissionais de saúde que atuam diretamente no cuidado aos pacientes com coronavírus e possíveis estratégias para minimizar seus efeitos. Método: trata-se de uma revisão integrativa, com busca de estudos nas bases de dados Public Medline, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Cumulative Index to Nursing and Allied Health Literature e TRIP DATABASE, pesquisadas em Abril de 2020. Resultados: Dos 12 estudos incluídos foram abordados os estressores percebidos pelos profissionais de saúde, as repercussões negativas e implicações psicológicas e os fatores de suporte para redução dos estressores. Conclusão: conclui-se que a avaliação da sobrecarga psíquica e a implementação de medidas de suporte aos profissionais de saúde faz parte da complexa rede de ações que determinam o êxito no enfrentamento à COVID-19 nos serviços de saúde

Objective: to identify negative repercussions and the psychological impact on health professionals who work in the care of patients with coronavirus and strategies to minimize its effects. Method: integrative review of publications from 2010 to 2020, in the Public Medline databases, Journal Portal of the Coordination for the Improvement of Higher Education Personnel, Cumulative Index to Nursing and Allied Health Literature and TRIP DATABASE. Results: the analysis of 12 studies related to psychological impacts on workers resulted in three categories: perceived stressors; negative repercussions and psychological implications; and supporting factors for reducing stressors. Conclusion: the coronavirus pandemic can cause psychological distress and the results indicate the need for attention to the mental health of health workers. Assessing psychic overload, offering psychological support and implementing protocols for a safe environment make up the complex network of actions that determine success in coping with COVID-19

Objetivo: identificar repercusiones negativas y el impacto psicológico en los profesionales de la salud que trabajan en la atención de pacientes con coronavirus y estrategias para minimizar sus efectos. Método: revisión integradora de publicaciones de 2010 a 2020, en las bases de datos Public Medline, Portal de Publicaciones Periódicas - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Cumulative Index to Nursing and Allied Health Literature y TRIP DATABASE. Resultados: el análisis de 12 estudios relacionados con el impacto psicológico en los trabajadores resultó en tres categorías: factores de estrés percibido; repercusiones negativas e implicaciones psicológicas; y factores para la reducción de los estresantes. Conclusión: la pandemia por el coronavirus puede causar sufrimiento psicológico y los resultados indican la necesidad de prestar atención a la salud mental de trabajadores de la salud. evaluación de la sobrecarga psicológica, ofrecimiento de apoyo psicológico y la puesta en marcha de protocolos para un entorno seguro, conforman el complejo entramado de acciones que determinan el éxito a la hora de afrontar el COVID-19

Estresse ocupacional e fatores estressores em enfermeiros de unidades de internação clínica / Occupational stress and stressors in clinical inpatient unit nurses / Estrés ocupacional y factores estresores en enfermeros de unidades de hospitalización clínica

A enfermagem destaca-se como uma das profissões com maior risco para desenvolver estresse pela exposição frequente a inúmeros fatores que geram tensão no ambiente de trabalho. O objetivo deste artigo é descrever os níveis de estresse autorreferidos e o perfil sociodemográfico e laboral de enfermeiros, além de discutir os fatores estressores no ambiente laboral dos enfermeiros de unidades de internações clínicas. Após realizar um estudo quantitativo, descritivo e transversal com 39 enfermeiros assistenciais, em um hospital universitário no município do Rio de Janeiro (RJ), os dados foram tratados mediante análise estatística univariada. Os resultados apontam que 87,2% (n = 34) afirmaram ter estresse de moderado a elevado no ambiente laboral. Os estressores autorreferidos mais relatados foram: falta de recursos materiais (insumos e equipamentos) (n = 25, 67,6%), relacionamentos interpessoais (n = 17, 45,9%), falta de estrutura física (n = 12, 32,4%) e a falta de recursos humanos (n = 10, 27%). O estudo é relevante, considerando que o estresse ocupacional pode gerar consequências negativas à saúde física e psíquica dos trabalhadores e, ainda, prejuízos às instituições devido aos afastamentos por motivo de doença dos trabalhadores e à perda de produtividade e qualidade do serviço prestado.

Nursing stands out as one of the professions with the highest risk of developing stress due to frequent exposure to numerous stressors in the work environment. This study describes the self-reported stress levels and the sociodemographic and occupational profile of nurses, besides discussing the stressors in the work environment of clinical inpatient unit nurses. After carrying out a quantitative, descriptive and cross-sectional study with 39 nursing assistants, in a university hospital in the city of Rio de Janeiro, Brazil, data were treated by univariate statistical analysis. Results show that 87.2% (n = 34) of the nurses reported moderate to high stress in the work environment. The most frequently self-reported stressors were lack of material resources (supplies and equipment) (n = 25, 67.6%), interpersonal relationships (n = 17, 45.9%), lack of physical structure (n = 12, 32.4%), and lack of human resources (n = 10, 27%). The study is relevant, as occupational stress can generate negative consequences to the physical and mental health of workers and losses to institutions due to workers' sick leave and loss of productivity and quality of service provided.

La enfermería es una de las profesiones con mayor riesgo de desarrollar estrés debido a la exposición frecuente a muchos factores estresores en el ambiente de trabajo. El objetivo de este artículo es describir los niveles de estrés autoinformados por los enfermeros y su perfil sociodemográfico y laboral, además de discutir los factores estresores en el ambiente laboral de los enfermeros de unidades de hospitalizaciones clínicas. Se realizó un estudio cuantitativo, descriptivo y transversal, a 39 enfermeros asistenciales, en un hospital universitario en el municipio de Río de Janeiro, y los datos fueron tratados mediante análisis estadístico univariado. Los resultados muestran que el 87,2% (n = 34) reportaron tener estrés de moderado a alto en el ambiente laboral. Los factores estresantes más autoinformados fueron: falta de recursos materiales (insumos y equipo) (n = 25; 67,6%), relaciones interpersonales (n = 17; 45,9%), falta de estructura física (n = 12; 32,4%) y falta de recursos humanos (n = 10; 27%). El estudio es relevante, considerando que el estrés ocupacional puede generar consecuencias negativas a la salud física y psíquica de los trabajadores y aún perjuicios a las organizaciones e instituciones, por los alejamientos por motivo de enfermedad de los trabajadores, pérdida de la productividad y de la calidad del servicio prestado.

Early computed tomography for acute post-traumatic diffuse axonal injury: a systematic review.

PURPOSE: Diffuse axonal injury (DAI) is the rupture of multiple axons due to acceleration and deceleration forces during a closed head injury. Most traumatic brain injuries (TBI) have some degree of DAI, especially severe TBI. Computed tomography (CT) remains the first imaging test performed in the acute phase of TBI, but has low sensitivity for detecting DAI, since DAI is a cellular lesion. The aim of this study is to search in the literature for CT signs, in the first 24 h after TBI, that may help to differentiate patients in groups with a better versus worst prognosis. METHODS: We searched for primary scientific articles in the PubMed database, in English, indexed since January 1st, 2000. RESULTS: Five articles were selected for review. In the DAI group, traffic accidents accounted 70% of the cases, 79% were male, and the mean age was 41 years. There was an association between DAI and intraventricular hemorrhage (IVH) and traumatic subarachnoid hemorrhage (tSAH); an association between the IVH grade and number of corpus callosum lesions; and an association between blood in the interpeduncular cisterns (IPC) and brainstem lesions. CONCLUSION: In closed TBI with no tSAH, severe DAI is unlikely. Similarly, in the absence of IVH, any DAI is unlikely. If there is IVH, patients generally are clinically worse; and the more ventricles affected, the worse the prognosis.

Satisfação laboral e a repercussão na qualidade de vida do profissional de enfermagem / Job satisfaction and the repercussion in the quality of life of the nursing professional

Diante da importância do trabalho na vida dos indivíduos, a relação que se estabelece entre o profissional e o ambiente laboral podem implicar repercussões em sua maneira de viver e ser saudável. Não obstante, a qualidade de vida do trabalhador pode estar associada à satisfação profissional, e dentro do contexto da enfermagem, favorecer a uma assistência de qualidade. Portanto, o presente ensaio teve por objetivo identificar publicações sobre satisfação no trabalho e qualidade de vida do profissional de enfermagem; verificar evidências de relação direta entre a satisfação profissional e a qualidade de vida. Esta revisão integrativa compilou artigos através da Base de Dados em Enfermagem (BDENF), Public Medline (PubMed) e o Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). A partir do material analisado, emergiram três categorias temáticas: 1) Fatores que influenciam a satisfação profissional; 2) Importância da satisfação no trabalho e qualidade de vida do profissional para a assistência de enfermagem; 3) Relação do trabalho com a qualidade de vida do trabalhador de enfermagem. Após a análise, não se verificou relação direta entre satisfação no trabalho e qualidade de vida, entretanto, evidenciou-se que insatisfações laborais desencadeiam, potencialmente, problemas físicos e psíquicos, com impacto à qualidade de vida e do serviço prestado.

In view of the importance of work in individuals' lives, the relationship established between the professional and the work environment may imply repercussions on the way they live and be healthy. Nevertheless, the worker's quality of life may be associated with job satisfaction, and within the context of Nursing, favor quality care. Therefore, the present study objective to identify publications about job satisfaction and quality of life of the nursing professional; to verify evidence of a direct relationship between professional satisfaction and quality of life. The integrative review compiled articles through the Nursing Database (BDENF), Public Medline (PubMed) and the Portal of Periodicals of the Coordination of Improvement of Higher Education Personnel (CAPES). From the material analyzed, three thematic categories emerged: 1) Factors that influence professional satisfaction; 2) Importance of work satisfaction and professional quality of life in nursing care; 3) Relationship of work with quality of life of the nursing worker. After the analysis, there was no direct relationship between job satisfaction and quality of life of the professionals, however, it was evidenced that job dissatisfactions trigger, potentially, physical and psychic problems, impacting the quality of life and service provided.

Estressores ocupacionais vivenciados por enfermeiros da estratégia saúde da família / Occupational stressors experienced by nurses of the family health strategy

Revisão integrativa com o objetivo de analisar os principais estressores ocupacionais relacionados ao trabalho dos enfermeiros da estratégia Saúde da Família. Realizada nas bases de dados MEDLINE, LILACS E BDENF, identificadas 149 publicações, sendo selecionados 10 artigos. Os principais estressores ocupacionais encontrados foram multiplicidade de tarefas/sobrecarga de trabalho (n=7); recursos materiais e estruturais escassos (n=4) e falta de suporte institucional e social (n=4). A diversidade de estressores presentes no ambiente de trabalho predispõe os indivíduos ao estresse ocupacional, ocasionando danos à saúde, seja na esfera física e /ou psíquica. Assim, são importantes a discussão e a implementação de estratégias para minimizar agravos à saúde do trabalhador, decorrentes do estresse ocupacional nas unidades de Estratégia Saúde da Família. Sugere-se a realização de novos estudos, dada a relevância da temática.

Protocolo de enfermagem para assistência à mulher em processo de lactação / Protocolo de enfermería para asistencia a mujeres en proceso de lactancia / Nursing protocol for assistance to women in lactation process

Objetivo: Elaborar um protocolo para a assistência à mulher em processo de lactação contendo diagnósticos, resultados e intervenções de enfermagem. Método: Trata-se de um estudo descritivo, desenvolvido com base nos termos do Modelo de Sete Eixos da Classificação Internacional para a Prática de Enfermagem (Cipe), complementados com os da literatura da área. Resultado: Elaboraram-se sete diagnósticos: lactação adequada, lactação diminuída, lactação aumentada, lactação ausente, risco para lactação diminuída, risco para lactação aumentada, risco para lactação ausente, e 86 intervenções de enfermagem referentes a esses diagnósticos. Conclusão: Conclui-se que o protocolo de diagnósticos, resultados e intervenções apresenta um alcance amplo do papel da enfermagem junto à mulher no período da lactação, sendo compatível com a visão integral e interativa da Teoria Interativa de Amamentação e o enfermeiro tem multidimensões para o seu agir.

Objective: To develop a nursing protocol for assistance to women in lactation process containing the diagnoses, outcomes and nursing interventions. Method: Descriptive study developed based on the terms of the Seven Axis Model of the International Classification for Nursing Practice, complemented to the area of literature. Results: Seven diagnoses were developed: adequate lactation, decreased lactation, increased lactation, no lactation, risk for decreased lactation, risk for increased lactation, risk for no lactation, and 86 nursing interventions related to these diagnoses. Conclusion: The protocol of diagnoses, outcomes and interventions presents a wide range of nursing role with the assistance of woman in the period of lactation and it is compatible with the full and interactive view of the Interactive Theory of Breastfeeding and the nurse has multiple dimensions to their act.

Objetivo: Desarrollar un protocolo para la asistencia a las mujeres en el proceso de lactancia que contiene diagnósticos, resultados e intervenciones de enfermería. Método: Estudio descriptivo desarrollado con base en los términos del Modelo de Siete Ejes de la Clasificación Internacional para la Práctica de Enfermería, complementadas con el área de la literatura. Resultados: Se desarrollaron siete diagnósticos: lactancia adecuada, lactancia disminuida, lactancia aumentada, sin lactancia, riesgo de lactancia disminuida, riesgo de lactancia aumentada, riesgo de sin lactancia, y 86 intervenciones de enfermería relacionados con estos diagnósticos. Conclusión: El protocolo de diagnóstico, resultados e intervenciones presenta una amplia gama de funciones de la enfermería con la mujer en el período de lactancia, y es compatible con la vista integral e interactiva de la Teoría interactiva of lactancia materna y la enfermera tiene múltiples dimensiones a su acto.

Preventing, treating, and predicting barbering: A fundamental role for biomarkers of oxidative stress in a mouse model of Trichotillomania.

Barbering, where a "barber" mouse plucks hair from its cagemates or itself, is both a spontaneously occurring abnormal behavior in mice and a well validated model of Trichotillomania (TTM). N-Acetylcysteine, (NAC) a cysteine derived food additive, is remarkably effective in treating TTM patients, but its mechanism of action is unknown. Reactive Oxygen Species (ROS), also known as free radicals, form as a natural byproduct of the normal metabolism of oxygen. Under normal circumstances, cells are able to defend themselves against ROS damage with antioxidant pathways. NAC is the precursor to the main antioxidant produced to defend the brain. Therefore, we hypothesized that barbering is a disease of oxidative stress, whereby ROS and/or a failure of antioxidant defenses leads to neuronal damage that induces barbering in susceptible animals. We tested this hypothesis in 32 female C57BL/6J mice by treating half with 1g/kg BW/day of NAC in their diet, and testing for protection against developing barbering behavior and curing of barbering behavior, and simultaneously testing for a panel of biomarkers of oxidative stress. NAC reduced the chance that mice would be barbers, and this effect did not differ between healthy (i.e. prevention) and affected animals (i.e. cure). Barbering animals had elevated urinary antioxidant capacity, indicative of oxidative stress, at all timepoints. Additionally, after treatment the risk of barbering increased with decreasing hydroxy-2'-deoxyguanosine (8-OHdG) levels, and with increasing glutathione (GSH) and oxidized glutathione (GSSG) levels, further indicating that barbering mice were under oxidative stress regardless of treatment with NAC. We did not find compelling evidence that urinary total antioxidant capacity, or urinary 8-OHdG, could predict response to NAC treatment. We conclude that NAC is effective in preventing and/or curing barbering at least in part by promoting GSH synthesis, thereby preventing oxidative damage.

Intraoperative ultrasonography in nine dogs with intra-abdominal neoplasm suspect / Ultrassonografia intraoperatória em nove cães com suspeita de neoplasia intra-abdominal

ABSTRACT: Intraoperative ultrasonography (IOUS) is used in medicine for diagnosis and guidance during oncologic surgery. The aims of this study were to assess the performance, feasibility, advantages and difficulties of the IOUS technique in dogs with suspected intra-abdominal tumors. The study included nine client-owed dogs that had suspected intra-abdominal tumors (spleen, liver or bowel) based on transabdominal ultrasound examination and that were subsequently referred for exploratory laparotomy surgery. During surgery, IOUS was performed; results of preoperative transabdominal ultrasonography, inspection by the surgeon and IOUS were compared on a case-by-case basis. IOUS was helpful in determining lesion resection in all cases. Lesions detected solely by the use of IOUS were observed in seven out of nine cases. Analysis of these cases demonstrated that IOUS can be a tool to assist during oncology surgery on the liver, spleen or bowel. Dogs with hepatic tumors can have small non-palpable intraparenchymal nodules, which may be visible by IOUS.

RESUMO: A ultrassonografia intraoperatória (USIO) é usada na medicina como método de diagnóstico e orientação para procedimentos em cirurgia oncológica. Os objetivos desse estudo foram avaliar a performance, viabilidade, vantagens e dificuldades da técnica de USIO em cães com suspeita de neoplasia intra-abdominal. O estudo incluiu nove cães com suspeita de neoplasia intra-abdominal (baço, fígado ou intestino) baseada em exame ultrassonográfico transabdominal e que foram subsequentemente encaminhados para laparotomia exploratória. Durante o procedimento cirúrgico, a USIO foi realizada e os resultados da ultrassonografia transabdominal pré-operatória, inspeção e palpação realizada pelo cirurgião e USIO foram comparados com base em uma avaliação caso-a-caso. A USIO contribuiu para determinar a área de ressecção das lesões em todos os casos. Lesões detectadas somente pela USIO foram observadas em sete dos nove casos. A análise dos casos demostrou que a USIO pode auxiliar durante a cirurgia oncológica do fígado, baço e intestino. Cães com neoplasia hepática podem ter lesões pequenas intraparenquimatosas e não palpáveis pelo cirurgião, mas que podem ser verificadas pela USIO.

Antioxidant Therapies for Ulcerative Dermatitis: A Potential Model for Skin Picking Disorder.

Skin Picking Disorder affects 4% of the general population, with serious quality of life impacts, and potentially life threatening complications. Standard psychoactive medications do not help most patients. Similarly, Mouse Ulcerative Dermatitis (skin lesions caused by excessive abnormal grooming behavior) is very common in widely used inbred strains of mice, and represents a serious animal welfare issue and cause of mortality. Treatment options for Ulcerative Dermatitis are largely palliative and ineffective. We have proposed mouse Ulcerative Dermatitis as a model for human Skin Picking Disorder based on similar epidemiology, behavior, and its comorbidity and mechanistic overlap with hair pulling (trichotillomania). We predicted that mouse Ulcerative Dermatitis would be treated by N-Acetylcysteine, as this compound is highly effective in treating both Skin Picking Disorder and Trichotillomania. Furthermore, we hypothesized that N-Acetylcysteine's mode of action is as a precursor to the production of the endogenous antioxidant glutathione in the brain, and therefore intranasal glutathione would also treat Ulcerative Dermatitis. Accordingly, we show in a heterogenous prospective trial, the significant reduction in Ulcerative Dermatitis lesion severity in mice receiving either N-acetylcysteine (oral administration) or glutathione (intranasal). The majority of mice treated with N-acetylcysteine improved slowly throughout the course of the study. Roughly half of the mice treated with glutathione showed complete resolution of lesion within 2-4 weeks, while the remainder did not respond. These findings are the first to show that the use of N-acetylcysteine and Glutathione can be curative for mouse Ulcerative Dermatitis. These findings lend additional support for mouse Ulcerative Dermatitis as a model of Skin Picking Disorder and also support oxidative stress and glutathione synthesis as the mechanism of action for these compounds. As N-Acetylcysteine is poorly tolerated by many patients, intranasal glutathione warrants further study as potential therapy in Skin Picking, trichotillomania and other body-focused repetitive behavior disorders.

Prótesis coxofemoral en caninos: reacción tisular y métodos de evaluación radiográfica / Coxal-femoral prosthesis in dogs: tissue reaction and x-ray evaluation methods

El uso de prótesis coxofemorales en el canino viene constituyendo una de las técnicas más utilizadas y eficientes en el tratamiento de pacientes con displasia coxofemoral. Las complicaciones consecuentes de su uso son generalmente diagnosticadas mediante la ayuda de la radiología y radican en los materiales utilizados y la reacción de los tejidos hacia el implante. La remodelación ósea, osteoporosis, las fracturas y el desprendimiento aséptico son las reacciones tisulares más comúnmente encontradas en los pacientes sometidos a la técnica quirúrgica. En este trabajo son revisadas las diferentes manifestaciones radiológicas de caninos hacia los implantes coxofemorales y el método de evaluación radiográfico en el postoperatorio de pacientes implantados con la prótesis coxofemoral...