Long chikungunya? An overview to immunopathology of persistent arthralgia.

Chikungunya fever (CF) is caused by an arbovirus whose manifestations are extremely diverse, and it has evolved with significant severity in recent years. The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses. Generally, fever starts abruptly and reaches high levels, followed by severe polyarthralgia and myalgia, as well as an erythematous or petechial maculopapular rash, varying in severity and extent. Around 40% to 60% of affected individuals report persistent arthralgia, which can last from months to years. The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system. The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Β ligand and bone resorption. This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages, leading to local infiltration of CD4+ T cells, which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines. The term "long chikungunya" was used in this review to refer to persistent arthralgia since, due to its manifestation over long periods after the end of the viral infection, this clinical condition seems to be characterized more as a sequel than as a symptom, given that there is no active infection involved.

Sobrecarga del cuidador familiar en Colombia: revisión sistemática exploratoria / Family caregiver's overburden in Colombia: An exploratory systematic review / Sobrecarga do cuidador familiar na Colômbia: revisão sistemática exploratória

Objetivo:describir las tendencias metodológicas, las poblaciones estudiadas y los desafíos futuros reportados en la literatura sobre lasobrecarga delcuidador familiar colombiano.Métodos:revisión sistemática exploratoria en donde se consultaron las bases de datos PubMed, ScienceDirect, Lilacs, Cuiden, SciELO, EBSCO y BVS, específicamente artículos originalespublicados del 2016 al 2021. Resultados:en 20 artículos revisados, se encontró una relación directa entre condiciones socioeconómicas y la sobrecarga del cuidador. El contexto cultural y las condiciones socioeconómicas son factores que influyen en la percepción de la sobrecarga del cuidador. Conclusiones:son necesarias las intervenciones de enfermeríadirigidasa los cuidadores familiares para mejorar su percepción de la sobrecarga y consecuentemente la calidad de vida

Objective: To describe methodological trends, populations studied, and future challenges reported in the literature on Colombian family caregivers' overburden. Methods: An exploratory systematic review using PubMed, ScienceDirect, LILACS, Cuiden, SciELO, EBSCO, and VHL databases was conducted, specifically original articles published between 2016 and 2021 were reviewed. Results:In 20 articles reviewed, a direct relationship was found between socioeconomic conditions and caregiver's overburden. Cultural context and socioeconomic conditions are factors that influence the perception of caregiver's overburden. Conclusions:Nursing interventions aimed at family caregivers are needed to improve their perception of overburden and, consequently, their quality of life

Objetivo:Descrever as tendências metodológicas, as populações estudadas e os desafios futuros relatados na literatura desobrecarga do cuidador familiar colombiano. Métodos:Revisão sistemática exploratória na qual foram consultadas as bases de dados PubMed, ScienceDirect, Lilacs, Cuiden, SciELO, EBSCO e BVS, com artigos originais, publicados de 2016 a 2021. Resultados:Em 20 artigos revisados, foi encontrada uma relação direta entre condições socioeconômicas e a sobrecarga do cuidador. O contexto cultural e as condições socioeconômicas são fatores que influenciam na percepção da sobrecarga do cuidador. Conclusões:As intervenções de enfermagem voltadas a cuidadores familiares são necessárias para melhorar sua percepção de sobrecarga e, consequentemente, sua qualidade de vida.

Dietary polyphenols and their relationship to the modulation of non-communicable chronic diseases and epigenetic mechanisms: A mini-review.

Chronic Non-Communicable Diseases (NCDs) have been considered a global health problem, characterized as diseases of multiple factors, which are developed throughout life, and regardless of genetics as a risk factor of important relevance, the increase in mortality attributed to the disease to environmental factors and the lifestyle one leads. Although the reactive species (ROS/RNS) are necessary for several physiological processes, their overproduction is directly related to the pathogenesis and aggravation of NCDs. In contrast, dietary polyphenols have been widely associated with minimizing oxidative stress and inflammation. In addition to their antioxidant power, polyphenols have also drawn attention for being able to modulate both gene expression and modify epigenetic alterations, suggesting an essential involvement in the prevention and/or development of some pathologies. Therefore, this review briefly explained the mechanisms in the development of some NCDs, followed by a summary of some evidence related to the interaction of polyphenols in oxidative stress, as well as the modulation of epigenetic mechanisms involved in the management of NCDs.

RhoA, Claudin 18, and c-MET in Gastric Cancer: Clinicopathological Characteristics and Prognostic Significance in Curative Resected Patients.

Background: Recently, markers related to molecular classification were suggested as promising therapeutic targets for treatment and prediction of prognosis in gastric cancer (GC), including c-MET, RhoA, and Claudin-18 (CLDN18). This study aimed to investigate their expression in GC and its correlation with clinicopathological characteristics and survival. Methods: We retrospectively evaluated GC patients who underwent curative gastrectomy. c-MET, RhoA, and CLDN18 were analyzed through immunohistochemistry (IHC), and groups for analysis were determined according to the median values obtained for each marker. Results: Among the 349 GC evaluated, 180 (51.6%), 59 (16.9%), and 61 (17.5%) patients were completely negative for c-MET, RhoA, and CLDN18, respectively. Total gastrectomy, D1 lymphadenectomy, poorly differentiated histology, and greater inflammatory infiltrate were more frequent in the c-MET-negative group. Diffuse type, greater inflammatory infiltrate, and advanced pT and pTNM stage were associated with low-RhoA GC. The venous invasion was more frequent in the low-CLDN18 group. Furthermore, c-MET was positively correlated with RhoA and negatively with CLDN18. HER2 expression was associated with c-MET-positive and high-CLDN18 GC; and loss of E-cadherin expression in c-MET-negative and low-RhoA GC. c-MET-negative and Low-RhoA were significantly associated with worse disease-free survival. Conclusions: c-MET, RhoA, and CLD18 expression occurred frequently in GC. RhoA GC had distinct clinicopathological characteristics related to prognosis. c-MET and RhoA were associated with survival but were not independent predictors of prognosis.

Association of kinesin family member 2A with increased disease risk, deteriorative clinical characteristics, and shorter survival profiles in acute myeloid leukemia

This study aimed to explore the correlation of kinesin family member 2A (KIF2A) expression with disease risk, clinical characteristics, and prognosis of acute myeloid leukemia (AML), and investigate the effect of KIF2A knockdown on AML cell activities in vitro. Bone marrow samples were collected from 176 AML patients and 40 healthy donors, and KIF2A expression was measured by real-time quantitative polymerase chain reaction. Treatment response, event-free survival (EFS), and overall survival (OS) were assessed in AML patients. In vitro, KIF2A expression in AML cell lines and CD34+ cells (from healthy donors) was measured, and the effect of KIF2A knockdown on AML cell proliferation and apoptosis in HL-60 and KG-1 cells was detected. KIF2A expression was greater in AML patients compared to healthy donors, and receiver operating characteristic curve indicated that KIF2A expression predicted increased AML risk (area under curve: 0.793 (95%CI: 0.724-0.826)). In AML patients, KIF2A expression positively correlated with white blood cells, monosomal karyotype, and high risk stratification. Furthermore, no correlation of KIF2A expression with complete remission or hematopoietic stem cell transplantation was found. Kaplan-Meier curves showed that KIF2A expression was negatively correlated with EFS and OS. In vitro experiments showed that KIF2A was overexpressed in AML cell lines (KG-1, HL-60, ME-1, and HT-93) compared to CD34+ cells, moreover, cell proliferation was reduced but apoptosis was increased by KIF2A knockdown in HL-60 and KG-1 cells. In conclusion, KIF2A showed potential to be a biomarker and treatment target in AML.

Comunicación de Enfermería con el adulto mayor o su cuidador en una comunidad del Municipio 10 de Octubre, 2018 / Communication in nursing care with elderly people or their caregivers in a community of 10 de Octubre Municipality, 2018

Introducción: Vivir la mayor cantidad de años posibles con mejor calidad de vida es interpretada como un logro de la sociedad moderna en lo económico, social y de las políticas públicas, pero resulta también una fuente de conflictos Objetivo: conocer las percepciones que sobre la comunicación de los profesionales de enfermería poseen los adultos mayores/cuidadores en la comunidad donde reciben los cuidados. Material y método: Se trata de un estudio cualitativo. Se emplearon método histórico-lógico, la entrevista a seis adultos mayores y cinco cuidadores. Se transcribió textualmente la información y las voces del discurso fueron codificadas. Se recoge información relacionada con la edad, escolaridad, convivencia de la persona mayor y la comunicación de enfermería. Resultados: Se identificaron elementos mediadores que favorecen o no la comunicación y se identifican dificultades en el proceso de comunicación en familiares/cuidadores y enfermeros; como principales proveedores de cuidados se encuentran las mujeres de la propia familia del adulto mayor que comparten las labores de cuidado con las tareas domésticas lo que comprime el tiempo dedicado a la comunicación. Conclusiones: Se verifica la necesidad de una nueva mirada de la comunicación como elemento esencial del cuidado al adulto mayor desde el punto de vista social y sanitario si consideramos que las mujeres suelen hacer labores que son invisibilizadas y poco reconocidas socialmente que refuerzan las desigualdades de género en el uso del tiempo y en los cuidados que se proveen durante el envejecimiento(AU)

Introduction: Living as much and as well as possible is interpreted as an achievement of modern society in the economic and social public policies; however, it is also a source of conflicts. Objective: To know the perceptions of elderly people or their caregivers on the communication in nursing care in the community where they are assisted. Material and Method: A qualitative study was conducted. The historical-logical method was used and six elderly people and five caregivers were interviewed. The information was literally transcribed and the speeches were encoded. The information related to age, schooling, elderly coexistence and communication in nursing care was collected. Results: Elements of mediation that favor the communication or not and the difficulties in the communication process between family members, caregivers and nurses were identified. The main care providers are women who are family members caring for elderly people that are involved in domestic and caring tasks, which reduces the time dedicated to communication. Conclusions: The need for a new look at communication as a key element in elderly care is assessed from a social and health point of view considering that women tend to perform tasks that are invisible and little recognized socially, which reinforces gender inequalities in the use of time and the care provided during aging(AU)

Avaliação da qualidade de vida de familiares de crianças atendidas no setor de neurologia infantil do centro de referência em reabilitação de um município da região sudeste do Brasil / Family members' quality of life assessment of children assisted in the child neurology sector of a Brazil's southeast city rehabilitation reference center

O surgimento de alterações neurológicas em crianças, seja ao nascimento ou nos primeiros anos de vida pode gerar, nos familiares, uma série de reações diante do inesperado, tornando-os susceptíveis ao desenvolvimento de problemas relacionados à depressão, angústia, fuga e rejeição ou superproteção. A criança que participa de atendimentos com especialistas em reabilitação e suporte apropriado apresenta maiores oportunidades de viver independente, e isso poderia minimizar os níveis de estresse dos pais. A Organização Mundial de Saúde (OMS) define qualidade de vida (QV) como "a percepção do indivíduo de sua posição na vida, no contexto da cultura e sistema de valores nos quais ele vive e em relação aos seus objetivos, expectativas, padrões e preocupações. " Este estudo teve como objetivos analisar a relação do tratamento de reabilitação de crianças com alterações neurológicas com a percepção de QV do familiar cuidador de crianças atendidas no setor de Neurologia Infantil do Centro de Referência em Reabilitação (CRR) de Betim-MG; descrever o perfil sociodemográfico e avaliar a QV destes familiares; identificar os pontos críticos que impactam negativamente na percepção de QV dos familiares; avaliar a mudança percebida na vida dos familiares em função do tempo de tratamento da criança; propor estratégias promotoras de QV para familiares cuidadores de criança em tratamento no CRR. A pesquisa constituiu um estudo de caso exploratório, analítico, de abordagem quantitativa, realizada no setor de Neurologia Infantil do CRR de um município de médio porte da região sudeste do Brasil, com os familiares cuidadores, ou seja, aqueles familiares que acompanham as crianças nos atendimentos de reabilitação, seja de fisioterapia, terapia ocupacional ou fonoaudiologia. O instrumento usado para avaliar a QV foi o World Health Organization Quality of Life - versão curta (WHOQOL-Bref). Em complementação, foi aplicada a Escala de Mudança Percebida (EMP) - versão usuário. Os familiares responderam, também, a um questionário sociodemográfico semi-estruturado. Foram avaliados 32 familiares cuidadores, sendo 30 mães, um pai e uma avó. Os piores escores de QV avaliados pelo WHOQOL-Bref foram no domínio Meio Ambiente, sendo esse o ponto crítico de piora da QV. A mudança positiva percebida na vida do familiar avaliada pela EMP foi observada de forma significante após 12 meses de reabilitação. Acredita-se que esse período de um ano se deva à melhora funcional de crianças com alterações leves e moderadas e, também, para melhor adaptação e aceitação dos familiares de crianças mais graves. Propõe-se medidas de intervenção terapêutica focada na família, afim de melhorar a QV dos familiares e das crianças, e sugere-se novos estudos longitudinais para verificar se a mudança percebida pode ocorrer em período inferior a 12 meses com a intervenção na família.

The appearance of neurological changes in children, either at birth or in the early years of life, can bring about a series of behavioral reactions to the unexpected in their family members, making them susceptible to the development of problems related to depression, anguish, escape and rejection or over-protection. The child who is assisted by rehabilitation specialists and has appropriate support, presents greater opportunities for independent living, and this could minimize parental stress levels. The World Health Organization (WHO) defines quality of life (QoL) as "the individual's perception of their position in life, in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". This study aimed to analyze the association between the rehabilitation treatment of children with neurological changes and the QoL perception of these children's family caregivers assisted in the Child Neurology Sector of a Rehabilitation Reference Center (RRC) in the City of Betim, state of Minas Gerais, Brazil; To describe the sociodemographic profile and assess the QoL of these family members; To identify critical points that negatively impact the family members' QoL perception; To assess the perceived change in family members lives according to the child's treatment length; to propose strategies to promote QoL for family caregivers of children in the RRC treatment. The research was an exploratory, analytical and quantitative approach case study carried out in the Child Neurology sector of the RRC of a medium-sized city in southeastern Brazil with the family caregivers, that is, the family member who accompanies the child in rehabilitation care, whether Physical Therapy, Occupational Therapy or Speech Therapy. The instrument used to assess QoL was the World Health Organization Quality of Life - short version (WHOQOL-Bref). In addition, the Perceived Change Scale (PCS) was applied - user version. Family members also answered a sociodemographic semi-structured questionnaire. 32 family caregivers were evaluated, 30 mothers, a father and a grandmother. The worst QoL scores assessed by WHOQOL-Bref were in the domain Environment, this being the critical point of worsening in QoL. The perceived positive change in a family member's life assessed by the PCS was observed significantly after 12 months of rehabilitation treatment. This oneyear period is believed to be due to the functional improvement of children with mild and moderate changes and also for better adaptation and acceptance of family members of children with more severe cases. Therapeutic intervention measures focused on the family are proposed, in order to improve the QoL of these family members and children, and further longitudinal studies are suggested to check if the perceived change can occur in less than 12 months with a family intervention

Blood cells and endothelial barrier function.

The barrier properties of endothelial cells are critical for the maintenance of water and protein balance between the intravascular and extravascular compartments. An impairment of endothelial barrier function has been implicated in the genesis and/or progression of a variety of pathological conditions, including pulmonary edema, ischemic stroke, neurodegenerative disorders, angioedema, sepsis and cancer. The altered barrier function in these conditions is often linked to the release of soluble mediators from resident cells (e.g., mast cells, macrophages) and/or recruited blood cells. The interaction of the mediators with receptors expressed on the surface of endothelial cells diminishes barrier function either by altering the expression of adhesive proteins in the inter-endothelial junctions, by altering the organization of the cytoskeleton, or both. Reactive oxygen species (ROS), proteolytic enzymes (e.g., matrix metalloproteinase, elastase), oncostatin M, and VEGF are part of a long list of mediators that have been implicated in endothelial barrier failure. In this review, we address the role of blood borne cells, including, neutrophils, lymphocytes, monocytes, and platelets, in the regulation of endothelial barrier function in health and disease. Attention is also devoted to new targets for therapeutic intervention in disease states with morbidity and mortality related to endothelial barrier dysfunction.

Ezh1 and Ezh2 differentially regulate PSD-95 gene transcription in developing hippocampal neurons.

Polycomb Repressive Complex 2 (PRC2) mediates transcriptional silencing by catalyzing histone H3 lysine 27 trimethylation (H3K27me3), but its role in the maturation of postmitotic mammalian neurons remains largely unknown. We report that the PRC2 paralogs Ezh1 and Ezh2 are differentially expressed during hippocampal development. We show that depletion of Ezh2 leads to increased expression of PSD-95, a critical plasticity gene, and that reduced PSD-95 gene transcription is correlated with enrichment of Ezh2 at the PSD-95 gene promoter; however, the H3K27me3 epigenetic mark is not present at the PSD-95 gene promoter, likely due to the antagonizing effects of the H3S28P and H3K27Ac marks and the activity of the H3K27 demethylases JMJD3 and UTX. In contrast, increased PSD-95 gene transcription is accompanied by the presence of Ezh1 and elongation-engaged RNA Polymerase II complexes at the PSD-95 gene promoter, while knock-down of Ezh1 reduces PSD-95 transcription. These results indicate that Ezh1 and Ezh2 have antagonistic roles in regulating PSD-95 transcription.

Genetic analysis of the ELOVL6 gene polymorphism associated with type 2 diabetes mellitus

Recent animal studies have indicated that overexpression of the elongation of long-chain fatty acids family member 6 (Elovl6) gene can cause insulin resistance and β-cell dysfunction. These are the major factors involved in the development of type 2 diabetes mellitus (T2DM). To identify the relationship between single nucleotide polymorphisms (SNP) of ELOVL6 and T2DM pathogenesis, we conducted a case-control study of 610 Han Chinese individuals (328 newly diagnosed T2DM and 282 healthy subjects). Insulin resistance and islet first-phase secretion function were evaluated by assessment of insulin resistance in a homeostasis model (HOMA-IR) and an arginine stimulation test. Three SNPs of the ELOVL6 gene were genotyped with polymerase chain reaction-restriction fragment length polymorphism, with DNA sequencing used to confirm the results. Only genotypes TT and CT of the ELOVL6 SNP rs12504538 were detected in the samples. Genotype CC was not observed. The T2DM group had a higher frequency of the C allele and the CT genotype than the control group. Subjects with the CT genotype had higher HOMA-IR values than those with the TT genotype. In addition, no statistical significance was observed between the genotype and allele frequencies of the control and T2DM groups for SNPs rs17041272 and rs6824447. The study indicated that the ELOVL6 gene polymorphism rs12504538 is associated with an increased risk of T2DM, because it causes an increase in insulin resistance.

Viver o estado terminal de um familiar: leitura salutogénica de resultados de um estudo de caso / Living the terminal state of a family member: salutogenic interpretation of the results of a case study

O objetivo deste artigo é interpretar dados obtidos num estudo de caso de tipo fenomenológico, que pesquisou o sofrimento de dezesseis cuidadores principais (familiares) de doentes em estado terminal, hospitalizados. Os dados desse estudo são aqui interpretados à luz do pré-paradigma salutogénico de A. Antonovsky, que promove a saúde, e não a doença, cumprindo finalidades proclamadas pela OMS, nomeadamente em Ottawa. A metodologia utilizada foi qualitativa, com recurso a interpretação hermenêutica, em conjugação com análise de conteúdo (baseada nas categorias mais importantes da conceptualização salutogénica). Os resultados obtidos revelam que todos os familiares identificaram e utilizaram vários Recursos Gerais de Resistência (GRR), passíveis de serem compreendidos à luz das três metacategorias: "compreensibilidade", "gerenciamento" e "significação". Verificou-se também que a utilização/criação dos GRR tem implícita a existência de sentidos de coerência fortes, por parte dos entrevistados, tal como enunciado por Antonovsky. Os resultados possibilitam compreender que existem áreas de formação de profissionais de saúde que podem ser estimuladas em situações similares à estudada. Algumas dessas áreas são a comunicação e a gestão emocional. Os resultados apontam também para a necessidade de investimento em ações de educação para a saúde que promovam o empoderamento psicológico e comunitário dos indivíduos e dos grupos, em geral.