The APE1/REF-1 and the hallmarks of cancer.

APE1/REF-1 (apurinic/apyrimidinic endonuclease 1 / redox factor-1) is a protein with two domains, with endonuclease function and redox activity. Its main activity described is acting in DNA repair by base excision repair (BER) pathway, which restores DNA damage caused by oxidation, alkylation, and single-strand breaks. In contrast, the APE1 redox domain is responsible for regulating transcription factors, such as AP-1 (activating protein-1), NF-κB (Nuclear Factor kappa B), HIF-1α (Hypoxia-inducible factor 1-alpha), and STAT3 (Signal Transducers and Activators of Transcription 3). These factors are involved in physiological cellular processes, such as cell growth, inflammation, and angiogenesis, as well as in cancer. In human malignant tumors, APE1 overexpression is associated with lung, colon, ovaries, prostate, and breast cancer progression, more aggressive tumor phenotypes, and worse prognosis. In this review, we explore APE1 and its domain's role in cancer development processes, highlighting the role of APE1 in the hallmarks of cancer. We reviewed original articles and reviews from Pubmed related to APE1 and cancer and found that both domains of APE1/REF-1, but mainly its redox activity, are essential to cancer cells. This protein is often overexpressed in cancer, and its expression and activity are correlated to processes such as proliferation, invasion, inflammation, angiogenesis, and resistance to cell death. Therefore, APE1 participates in essential processes of cancer development. Then, the activity of APE1/REF-1 in these hallmarks suggests that targeting this protein could be a good therapeutic approach.

Effects of low­power red laser and blue LED on mRNA levels from DNA repair genes in human breast cancer cells.

Photobiomodulation (PBM) induced by non-ionizing radiations emitted from low-power lasers and light-emitting diodes (LEDs) has been used for various therapeutic purposes due to its molecular, cellular, and systemic effects. At the molecular level, experimental data have suggested that PBM modulates base excision repair (BER), which is responsible for restoring DNA damage. There is a relationship between the misfunction of the BER DNA repair pathway and the development of tumors, including breast cancer. However, the effects of PBM on cancer cells have been controversial. Breast cancer (BC) is the main public health problem in the world and is the most diagnosed type of cancer among women worldwide. Therefore, the evaluation of new strategies, such as PBM, could increase knowledge about BC and improve therapies against BC. Thus, this work aims to evaluate the effects of low-power red laser (658 nm) and blue LED (470 nm) on the mRNA levels from BER genes in human breast cancer cells. MCF-7 and MDA-MB-231 cells were irradiated with a low-power red laser (69 J cm-2, 0.77 W cm-2) and blue LED (482 J cm-2, 5.35 W cm-2), alone or in combination, and the relative mRNA levels of the APTX, PolB, and PCNA genes were assessed by reverse transcription-quantitative polymerase chain reaction. The results suggested that exposure to low-power red laser and blue LED decreased the mRNA levels from APTX, PolB, and PCNA genes in human breast cancer cells. Our research shows that photobiomodulation induced by low-power red laser and blue LED decreases the mRNA levels of repair genes from the base excision repair pathway in MCF-7 and MDA-MB-231 cells.

Non-Hodgkin's Anaplastic Large T-Cell Lymphoma: A Case Report.

Anaplastic large T/null cell lymphoma (ALCL) is an aggressive non-Hodgkin's lymphoma (NHL) that most commonly affects young men. Herein, we present a case of a 32-year-old male patient in severe condition with ulcerated right axillary adenopathy, diffuse subcutaneous nodules, and sepsis. He was admitted to the ED, where a bone marrow aspirate and biopsy confirmed the diagnosis of ALCL. The immunohistochemical examination demonstrated neoplastic cells with immunopositivity with antibodies CD3 (focal), CD30 (diffuse), protein ALK-1 (diffuse), and epithelial membrane antigen (EMA) (multifocal). Appropriate chemotherapy treatment was done, and the patient showed a complete response. This article aims to report a rare subtype of NHL to increase awareness and bring up a discussion about the clinical presentation and diagnostic features of ALCL. Moreover, we discuss treatment regimens that are currently used and have shown reasonable disease remission rates.

STAT3 Regulates the Redox Profile in MDA-MB-231 Breast Cancer Cells.

Unbalanced redox status and constitutive STAT3 activation are related to several aspects of tumor biology and poor prognosis, including metastasis and drug resistance. The triple-negative breast cancer (TNBC) is listed as the most aggressive and exhibits the worst prognosis among the breast cancer subtypes. Although the mechanism of reactive oxygen species (ROS) generation led to STAT3 activation is described, there is no data concerning the STAT3 influence on redox homeostasis in TNBC. To address the role of STAT3 signaling in redox balance, we inhibited STAT3 in TNBC cells and investigated its impact on total ROS levels, contents of hydroperoxides, nitric oxide (NO), and total glutathione (GSH), as well as the expression levels of 3-nitrotyrosine (3NT), nuclear factor (erythroid-derived 2)-like 2 (Nrf2), and nuclear factor kappa B (NF-κB)/p65. Our results indicate that ROS levels depend on the STAT3 activation, while the hydroperoxide level remained unchanged, and NO and 3NT expression increased. Furthermore, GSH levels, Nrf2, and NF-κB/p65 protein levels are decreased in the STAT3-inhibited cells. Accordingly, TNBC patients' data from TCGA demonstrated that both STAT3 mRNA levels and STAT3 signature are correlated to NF-κB/p65 and Nrf2 signatures. Our findings implicate STAT3 in controlling redox balance and regulating redox-related genes' expression in triple-negative breast cancer.

Luteal tissue characteristics of Morada Nova ewes with hCG application 7.5 days after the end of estrus synchronization protocol in the breeding season.

Results with the use of hCG after synchronization protocol are still inconsistent, which may vary according to breed, season, day of application and dose of the drug used. The aim of the present study was to evaluate the functionality of luteal tissue and ovarian perfusion after hCG treatment during early luteal phase. Estrus-synchronized ewes were randomly assigned to receive i.m. injection of 300 IU of hCG (G-hCG; n = 40) or 1 mL of saline (G-Control; n = 32) on Day 7.5 after progesterone withdrawal. Ultrasonographic evaluations of the ovaries and ovarian and iliac arteries were performed on Days 7.5, 10.5, 13.5, and 21.5. The accessory corpus luteum (aCL) formation rate was 52.5% for G-hCG. There was interaction (p > 0.05) for treatment (G-hCG and G-Control), days (7.5, 10.5, 13.5 and 21.5) and PD (Pregnant and Non-pregnant) for the variables of biometric characteristics of the corpus luteum B-Mode and Color Doppler on days 7.5, 10.5, 13.5 and 21.5. There was no difference (p > 0.05) for pregnancy rates and mean fetuses per ewe between the treatment groups. It is concluded that the application of hCG 7.5 days after the hormonal protocol in Morada Nova ewes in a breeding season is efficient in inducing aCL formation and increasing luteal tissue biometry. However, there was no effect on pregnancy rate.

Genomic investigation on genes related to mercury metabolism in Amazonian indigenous populations.

Studies have identified elevated levels of mercury in Amazonian Indigenous individuals, highlighting them as one of the most exposed to risks. In the unique context of the Brazilian Indigenous population, it is crucial to identify genetic variants with clinical significance to better understand vulnerability to mercury and its adverse effects. Currently, there is a lack of research on the broader genomic profile of Indigenous people, particularly those from the Amazon region, concerning mercury contamination. Therefore, the aim of this study was to assess the genomic profile related to the processes of mercury absorption, distribution, metabolism, and excretion in 64 Indigenous individuals from the Brazilian Amazon. We aimed to determine whether these individuals exhibit a higher susceptibility to mercury exposure. Our study identified three high-impact variants (GSTA1 rs1051775, GSTM1 rs1183423000, and rs1241704212), with the latter two showing a higher frequency in the study population compared to global populations. Additionally, we discovered seven new variants with modifier impact and a genomic profile different from the worldwide populations. These genetic variants may predispose the study population to more harmful mercury exposure compared to global populations. As the first study to analyze broader genomics of mercury metabolism pathways in Brazilian Amazonian Amerindians, we emphasize that our research aims to contribute to public policies by utilizing genomic investigation as a method to identify populations with a heightened susceptibility to mercury exposure.

The Thr92Ala polymorphism in the type 2 deiodinase gene is linked to depression in patients with COVID-19 after hospital discharge.

Background: The Thr92Ala-DIO2 polymorphism has been associated with clinical outcomes in hospitalized patients with COVID-19 and neuropsychiatric diseases. This study examines the impact of the Thr92Ala-DIO2 polymorphism on neuropsychological symptoms, particularly depressive symptoms, in patients who have had moderate to severe SARS-CoV-2 infection and were later discharged. Methods: Our prospective cohort study, conducted from June to August 2020, collected data from 273 patients hospitalized with COVID-19. This included thyroid function tests, inflammatory markers, hematologic indices, and genotyping of the Thr92Ala-DIO2 polymorphism. Post-discharge, we followed up with 68 patients over 30 to 45 days, dividing them into depressive (29 patients) and non-depressive (39 patients) groups based on their Beck Depression Inventory scores. Results: We categorized 68 patients into three groups based on their genotypes: Thr/Thr (22 patients), Thr/Ala (41 patients), and Ala/Ala (5 patients). Depressive symptoms were less frequent in the Thr/Ala group (29.3%) compared to the Thr/Thr (59.1%) and Ala/Ala (60%) groups (p = 0.048). The Thr/Ala heterozygous genotype correlated with a lower risk of post-COVID-19 depression, as shown by univariate and multivariate logistic regression analyses. These analyses, adjusted for various factors, indicated a 70% to 81% reduction in risk. Conclusion: Our findings appear to be the first to show that heterozygosity for Thr92Ala-DIO2 in patients with COVID-19 may protect against post-COVID-19 depression symptoms up to 2 months after the illness.

Molecular Profile of Important Genes for Radiogenomics in the Amazon Indigenous Population.

Radiotherapy is focused on the tumor but also reaches healthy tissues, causing toxicities that are possibly related to genomic factors. In this context, radiogenomics can help reduce the toxicity, increase the effectiveness of radiotherapy, and personalize treatment. It is important to consider the genomic profiles of populations not yet studied in radiogenomics, such as the indigenous Amazonian population. Thus, our objective was to analyze important genes for radiogenomics, such as ATM, TGFB1, RAD51, AREG, XRCC4, CDK1, MEG3, PRKCE, TANC1, and KDR, in indigenous people and draw a radiogenomic profile of this population. The NextSeq 500® platform was used for sequencing reactions; for differences in the allelic frequency between populations, Fisher's Exact Test was used. We identified 39 variants, 2 of which were high impact: 1 in KDR (rs41452948) and another in XRCC4 (rs1805377). We found four modifying variants not yet described in the literature in PRKCE. We did not find any variants in TANC1-an important gene for personalized medicine in radiotherapy-that were associated with toxicities in previous cohorts, configuring a protective factor for indigenous people. We identified four SNVs (rs664143, rs1801516, rs1870377, rs1800470) that were associated with toxicity in previous studies. Knowing the radiogenomic profile of indigenous people can help personalize their radiotherapy.

Thr92Ala-DIO2 heterozygosity is associated with skeletal muscle mass and myosteatosis in patients with COVID-19.

Introduction: The type 2 deiodinase and its Thr92Ala-DIO2 polymorphism have been linked to clinical outcomes in acute lung injury and coronavirus disease 2019 (COVID-19). Objective: The objective was to identify a potential association between Thr92Ala-DIO2 polymorphism and body composition (appendicular muscle mass, myosteatosis, and fat distribution) and to determine whether they reflect the severity or mortality associated with the disease. Methods: In this prospective cohort study (June-August 2020), 181 patients hospitalized with moderate-to-severe COVID-19 underwent a non-contrast-enhanced computed tomography (CT) of the thorax to assess body composition, laboratory tests, and genotyping for the Thr92Ala-DIO2 polymorphism. Results: In total, 181 consecutive patients were stratified into three subgroups according to the genotype: Thr/Thr (n = 64), Thr/Ala (n = 96), and Ala/Ala (n = 21). The prevalence of low muscle area (MA) (< 92 cm²) was 52.5%. Low MA was less frequent in Ala/Thr patients (44.8%) than in Thr/Thr (60.9%) or Ala/Ala patients (61.9%) (P = 0.027). Multivariate logistic regression analysis confirmed that the Thr/Ala allele was associated with a reduced risk of low MA (41% to 69%) and myosteatosis (62% to 72%) compared with Thr/Thr + Ala/Ala (overdominant model). Kaplan-Meier curves showed that patients with low muscle mass and homozygosity had lower survival rates than the other groups. Notably, the heterozygotes with MA ≥92 cm² exhibited the best survival rate. Conclusion: Thr92Ala-DIO2 heterozygosity is associated with increased skeletal MA and less myosteatosis in patients with COVID-19. The protective effect of Thr92Ala-DIO2 heterozygosity on COVID-19 mortality is restricted to patients with reduced MA.

Molecular Profile of Variants Potentially Associated with Severe Forms of COVID-19 in Amazonian Indigenous Populations.

Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2. Genome-wide association studies (GWASs) have suggested a strong association of genetic factors with the severity of the disease. However, many of these studies have been completed in European populations, and little is known about the genetic variability of indigenous peoples' underlying infection by SARS-CoV-2. The objective of the study is to investigate genetic variants present in the genes AQP3, ARHGAP27, ELF5L, IFNAR2, LIMD1, OAS1 and UPK1A, selected due to their association with the severity of COVID-19, in a sample of indigenous people from the Brazilian Amazon in order to describe potential new and already studied variants. We performed the complete sequencing of the exome of 64 healthy indigenous people from the Brazilian Amazon. The allele frequency data of the population were compared with data from other continental populations. A total of 66 variants present in the seven genes studied were identified, including a variant with a high impact on the ARHGAP27 gene (rs201721078) and three new variants located in the Amazon Indigenous populations (INDG) present in the AQP3, IFNAR2 and LIMD1 genes, with low, moderate and modifier impact, respectively.

Descriptions of new species and new records of water bugs (Hemiptera: Heteroptera: Gerromorpha & Nepomorpha) from southeastern Brazil.

Although most of the diversity of true bugs (Hemiptera: Heteroptera) is terrestrial, over 550 species of water bugs (Heteroptera: Gerromorpha, Leptopodomorpha & Nepomorpha) have been recorded from Brazil alone. Southeastern Brazil, composed of the states of Esprito Santo, Minas Gerais, Rio de Janeiro and So Paulo, is the best studied region of the country, but there are still knowledge gaps in the area. Here, two new species are described from Esprito Santo: Hydrometra ruschii Cordeiro, Rodrigues & Moreira, sp. nov. and H. tuberculata Cordeiro, Rodrigues & Moreira, sp. nov. (Gerromorpha: Hydrometridae). Furthermore, new records from southeastern Brazil are provided for 78 species of water bugs, of which 19 are firstly recorded from Esprito Santo, four from Minas Gerais, eight from Rio de Janeiro, and seven from So Paulo.

Quality of systematic reviews on the treatment of vesiculobullous skin diseases. A meta-epidemiological study

Abstract Background Systematic reviews of Randomized Controlled Trials (RCTs) are considered high-level evidence to support a decision on therapeutic interventions, and their methodological quality is essential to provide reliable and applicable results. Objective This meta-epidemiological study aimed to map and critically appraise systematic reviews assessing treatments for vesiculobullous skin diseases. Methods We conducted a comprehensive search strategy on MEDLINE (via Pubmed) in December 2022 without restrictions to find systematic reviews evaluating pharmacological interventions for vesiculobullous skin diseases. The methodological quality was assessed using the AMSTAR-2 tool, and additional information was extracted. We identified nine systematic reviews published between 2002 and 2021, seven assessing pemphigus. Results According to the AMSTAR-2 tool, 55.6% were classified as critically low quality, 22.2% as moderate quality, 11.1% as low and 11.1% as high quality. No review assessed the certainty of the evidence (GRADE); 86% of pemphigus reviews had at least two overlapping RCTs. There were some limitations regarding methodological flaws and the AMSTAR-2 tool use Conclusions These findings reveal a frail methodological quality of systematic reviews about vesiculobullous diseases treatment that may impact the results. Therefore, methodological rigor is mandatory for future systematic reviews to avoid duplication of effort and increase the certainty of the evidence supporting decision-making.

Mulheres em hemodiálise: mudança na ocupação laboral e resiliência / Women on hemodialysis: change in work occupation and resilience

Introdução: A doença renal crônica traz algumas restrições e limitações ao corpo, para as realizações de algumas atividades, como as profissionais, diárias e de lazer, devido as mudanças que a doença e o tratamento podem acarretar. Objetivo: Identificar como as mulheres lidam com as mudanças em suas ocupações laborais após o início do tratamento hemodialítico e sua influência com a resiliência. Método: Estudo exploratório, discursivo, de natureza mista (quali-quanti), desenvolvido em serviço de hemodiálise no município de São Paulo, com 32 mulheres com doença renal crônica, entre Maio e Agosto de 2018. Foi realizada entrevista com questionário estruturado. A análise qualitativa seguiu a estrutura proposta por Minayo e os dados quantitativos foram submetidos ao teste Shapiro-Wilk <0,05, Mann-Whitney e KruskalWallis. Resultados: O estudo revelou que as mulheres apresentaram uma característica de resiliência média. Para a maioria delas sem nenhuma atividade laboral, identificou-se sentimentos de dependência, desconforto, revolta e desânimo. Conclusão: Foi possível observar a importância da atividade laboral, como um fator de proteção e fortalecimento da resiliência, bem como evidenciou um importante aspecto do cuidado a ser explorado na atuação das equipes multiprofissionais de tal modo que favoreça o construto da resiliência

Introduction: Chronic kidney disease brings some restrictions and limitations to the body for carrying out some activities, such as professional, daily and leisure activities and due to the changes that the disease and treatment can bring about. Objects: Identify how women deal with changes in their work occupations after starting hemodialysis treatment and its influence on resilience. Method: Exploratory, discursive study, of a mixed nature (quali-quanti), developed in a hemodialysis service in the city of São Paulo, with 32 women with chronic kidney disease, between May and August 2018. An interview was carried out with a structured questionnaire. The qualitative analysis followed the structure proposed by Minayo and the quantitative data were submitted to the Shapiro-Wilk test <0.05, Mann-Whitney and KruskalWallis. Results: The study revealed that women had a characteristic of average resilience. For most of them without any work activity, feelings of dependence, discomfort, revolt and discouragement were identified. Conclusion: It was possible to observe the importance of work activity, as a factor of protection and strengthening of resilience, as well as showing an important aspect of care to be explored in the work of multidisciplinary teams in such a way that it favors the resilience construct

Introducción: La enfermedad renal crónica trae algunas restricciones y limitaciones al organismo, para la realización de algunas actividades, como las profesionales, cotidianas y de ocio y debido a los cambios que la enfermedad y el tratamiento pueden traer. Objetivo: Identificar cómo las mujeres afrontan los cambios en sus ocupaciones laborales luego de iniciar el tratamiento de hemodiálisis y su influencia en la resiliencia. Método: Estudio exploratorio, discursivo, de carácter mixto (quali-quanti), desarrollado en un servicio de hemodiálisis de la ciudad de São Paulo, con 32 mujeres con enfermedad renal crónica, entre mayo y agosto de 2018. Se realizó una entrevista mediante un cuestionario estructurado. El análisis cualitativo siguió la estructura propuesta por Minayo y los datos cuantitativos se sometieron a la prueba de Shapiro-Wilk <0,05, Mann-Whitney y Kruskal-Wallis. Resultados: El estudio reveló que las mujeres presentaron una característica de resiliencia media. Para la mayoría de ellos sin actividad laboral, se identificaron sentimientos de dependencia, malestar, enojo y desánimo. Conclusión: Se pudo observar la importancia de la actividad laboral, como factor de protección y fortalecimiento de la resiliencia, además de resaltar un aspecto importante del cuidado a explorar en el desempeño de equipos multidisciplinarios de manera que favorezca el constructo de resiliencia

Efeitos do consumo de chá verde ou extrato de chá verde como emagrecedor: revisão da literatura / Effects of consumption of green tea or green tea extract as slimming: literature review

O uso de espécies vegetais com a finalidade de auxiliar na perda de peso vem sendo amplamente disseminado, por ser considerada uma terapêutica de fácil acesso, menor custo e menor incidência de efeitos colaterais graves. Neste cenário, o chá de Camellia sinensis (L.) Kuntze (Theaceae), popularmente chamado chá verde, tem se destacado no cenário mundial como emagrecedor. O presente trabalho objetivou realizar uma revisão da literatura acerca da utilização de chá verde ou extrato de chá verde como emagrecedor, por meio da busca nos bancos de dados PubMed (NCBI), Biblioteca Virtual em Saúde (BVS), Scientific Eletronic Library Online (SciELO), além dos portais oficiais da Agência Nacional de Vigilância Sanitária (ANVISA) e da Organização Mundial de Saúde (OMS). Foram identificados diversos ensaios clínicos que apresentaram resultados positivos para a perda de peso induzida pelo chá verde, principalmente quando associado a hábitos saudáveis. Porém, a literatura ainda diverge quanto à concentração efetiva de bioativos para promoção do efeito antiobesidade dessa espécie vegetal. Desta forma, embora a perda de peso tenha sido observada em parte dos estudos analisados, ainda se faz necessária a realização de mais ensaios clínicos para comprovar a eficiência do chá verde ou extrato de chá verde como emagrecedor.

Segurança do paciente na assistência ao parto: o que é debatido nos grupos de Facebook? / Patient safety in childbirth care: what is discussed in Facebook groups? / Seguridad del paciente en la asistencia al parto: ¿de qué se habla en los grupos de Facebook?

A segurança do paciente no contexto da assistência ao parto é um tema que vem ocupando as pautas de discussão sobre qualidade do cuidado materno-infantil ao redor do mundo. Discutir os eventos adversos na assistência ao parto e seus fatores contribuintes, na percepção dos pacientes e familiares, reportados em grupos de Facebook. Trata-se de um estudo qualitativo que utilizou a plataforma de mídia digital Facebook como fonte de dados. Foram analisadas 55 postagens relacionadas à assistência ao parto nos meses de setembro e outubro de 2019, quanto ao conteúdo. Os achados foram classificados em duas categorias: (i) eventos adversos incluindo óbitos do recém-nascido, fetal e materno, hemorragias, infecções, lesões neurológicas, problemas relacionados à cirurgia e ao uso de medicamentos; e (ii) fatores contribuintes como atraso no atendimento, diagnóstico ou tratamento, violência obstétrica, erro diagnóstico e identificação do paciente. As plataformas de mídias digitais, podem se constituir espaços legitimados para debates e manifestações acerca de questões relacionadas à saúde incluindo aquelas ligadas à qualidade do cuidado obstétrico. Valorizar a percepção das pacientes, oriundas dessas ou de outras fontes é fundamental, mas requer o envolvimento de lideranças institucionais e profissionais na operacionalização de estratégias que facilitem a identificação precoce de fatores de risco, e possibilitem o diagnóstico e implementação do tratamento adequado oportuno com a participação ativa de pacientes e familiares.

Patient safety in childbirth care is a current topic on the agendas of discussion about the quality of maternal and child care around the world. This qualitative study sought to discuss the adverse events in childbirth care and its contributing factors, as perceived by patients and family members, using data collected from posts in Facebook groups. A total of 55 posts related to childbirth care made in September and October 2019 underwent content analysis. The findings were classified into two categories: (i) adverse events, including infant, fetal and maternal death, hemorrhages, infections, neurological lesions, surgery-related problems and use of medications; and (ii) contributing factors such as delay in care, diagnosis or treatment, obstetric violence, misdiagnosis and patient identification. Digital media platforms can be legitimate spaces for debating and opining on health-related issues, including those about the quality of obstetric care. Valuing patients' perceptions, whether from these or other sources, is fundamental, but requires the involvement of institutional and professional leaders to operationalize strategies that facilitate the early identification of risk factors, and enable the diagnosis and implementation of timely appropriate treatment with the active participation of patients and families. n the reduction of hospital stay, which is so impactful on the functional condition of the elderly.

La seguridad del paciente en el contexto de la asistencia al parto es un tema que viene ocupando las pautas de discusión sobre la calidad del cuidado maternoinfantil en todo el mundo. El objetivo fue discutir los eventos adversos en la atención al parto y sus factores contribuyentes, en la percepción de pacientes y familiares, reportados en grupos de Facebook. Se trata de un estudio cualitativo que utilizó la plataforma de medios digitales Facebook como fuente de datos. Se analizaron 55 publicaciones relacionados con la asistencia al parto en los meses de septiembre y octubre del 2019, en cuanto al contenido. Los hallazgos se clasificaron en dos categorías: (i) eventos adversos que incluyen muertes del recién nacido, fetal y materna, hemorragias, infecciones, lesiones neurológicas, problemas relacionados con la cirugía y con el uso de medicamentos; y (ii) factores contribuyentes tales como retraso en la atención, diagnóstico o tratamiento, violencia obstétrica, error diagnóstico e identificación del paciente. Las plataformas de medios digitales pueden constituir espacios legítimos para debates y manifestaciones sobre temas relacionados con la salud, incluidos los relacionados con la calidad del cuidado obstétrico. Valorar la percepción de las pacientes, provenientes de estas o de otras fuentes es fundamental, pero requiere la participación de los líderes institucionales y de los profesionales en la operativización de estrategias que faciliten la identificación temprana de los factores de riesgo, y permitan el diagnóstico y la implementación del tratamiento adecuado y oportuno con la participación activa de pacientes y familiares.

Canine gastrointestinal pythiosis: a case report in Brazilian Pantanal from a diagnostic approach / Pitiose gastrointestinal canina: relato de caso no Pantanal brasileiro a partir de uma abordagem diagnóstica

Pythiosis is caused by an aquatic fungus-like organism (Pythium insidiosum). It is considered an important public health issue as it can affect both animals and humans. This paper reports a case of gastrointestinal pythiosis in a dog. The patient was hospitalized for four days, during which the animal received supportive and symptomatic treatment. But the applied treatment was unsuccessful and the dog's clinical condition worsened, culminating in death. Complementary imaging tests such as radiography and ultrasonography, as well as hematological tests, were performed during the hospitalization period. The definitive diagnosis was reached in the postmortem as macroscopic and microscopic characteristics suggested the presence of intestinal granuloma and accentuated multifocal suppurative necrotic enteritis. Additionally, the histological evaluation revealed morphological structures compatible with P. insidiosum. Also, the results of nested PCR performed showed partial amplification (105 bp) of the ITS1 region of the ribosomal gene of P. insidiosum.(AU)

A pitiose é causada por um organismo aquático semelhante a um fungo (Pythium insidiosum) e considerada um importante problema de saúde pública, pois pode afetar animais e humanos. Este artigo relata um caso de pitiose gastrointestinal em um cão. O paciente ficou internado por quatro dias, período em que o animal recebeu tratamento de suporte e sintomático. No entanto, o tratamento aplicado não teve sucesso e o quadro clínico do cão piorou, culminando com a morte. Exames de imagem complementares, como radiografia e ultrassonografia, bem como exames hematológicos, foram realizados durante o período de internação. O diagnóstico definitivo foi feito na autópsia, pois as características macroscópicas e microscópicas sugeriam a presença de granuloma intestinal e acentuada enterite necrótica multifocal supurativa. Além disso, a avaliação histológica revelou estruturas morfológicas compatíveis com P. insidiosum. Além disso, a nested PCR foi realizada e mostrou amplificação parcial (105 pb) da região ITS1 do gene ribossomal de P. insidiosum.(AU)

Induction of accessory corpus luteum in goats and sheep: From physiological basis to reproductive effects / Indução de corpo lúteo acessório em caprinos e ovinos: Das bases fisiológicas aos efeitos reprodutivos

A identificação das ondas foliculares ovarianas e de seu padrão hormonal revelou que os folículos ovarianos dominantes da onda ovulatória (FDOO) crescem em ambiente hormonal com predominância crescente de estradiol, diferentemente daqueles da primeira (FDPO) e das ondas foliculares intermediárias (FDOI), que crescem sob forte impacto da progesterona (P4). O hormônio luteinizante (LH) é considerado o hormônio gonadotrófico decisivo para direcionar se um folículo dominante ovulará (↑ LH) ou não (↓ LH). Estratégias foram desenvolvidas para aumentar o LH endógeno (administração de GnRH) ou fornecer LH exógeno de origem suína (pLH) ou, ainda, gonadotrofinas semelhantes ao LH, como gonadotrofina coriônica humana (hCG). Estas medidas são capazes de disponibilizar LH para maturação final, ovulação e/ou luteinização de FDPO ou FDOI, formando corpos lúteos acessórios (CLa). Como consequência, a P4 aumenta e favorece o estabelecimento da gestação, sobretudo em condições em que a P4 for o fator limitante para a implantação e manutenção embrionária. Em ovelhas e cabras, em diferentes estudos, a hCG foi administrada de cinco a sete dias após o início do estro e revelou que o FDPO responde positivamente à administração de hCG, formando CLa e/ou promovendo a hipertrofia do CL formado originalmente, aumentando a área luteal. O incremento da P4 normalmente acompanha o aumento de área do tecido luteal. Como efeito final e mais desejável, a gestação e o nascimento de cordeiros/cabritos também aumentam. Esses conceitos serão discutidos na presente revisão sobre indução de CLa em ovinos e caprinos.

The identification of ovarian follicular waves and associated hormonal milieux has revealed that dominant follicles of the ovulatory wave (OWDF) grow in a hormonal environment where there is an increasing predominance of estradiol, unlike first-wave dominant follicles (FWDF) and intermediatewave dominant follicles (IWDF), which grow under increasing progesterone (P4) concentrations. The luteinizing hormone (LH) is considered the decisive gonadotropic hormone to direct whether a dominant follicle will (↑ LH) or will not (↓ LH) ovulate. Based on this, strategies have been developed to either increase endogenous LH (GnRH administration) or provide exogenous LH of porcine origin (pLH) or LH-like gonadotropins, such as human chorionic gonadotropin (hCG). Such strategies are able to provide LH for final maturation, ovulation, and/or luteinization of the FWDF or IWDF, forming accessory corpora lutea (aCL). As a consequence, P4 increases and favors the establishment of pregnancy, particularly when P4 is the limiting factor for the success of the conceptus implantation and maintenance. In sheep and goats, previous studies have administered hCG five to seven days after the onset of estrus and revealed that FWDF positively respond to hCG administration by either forming aCLs and/or promoting hypertrofia of the original CL which, in turn, increases its luteal tissue area. Normally, P4 synthesis increases along with the increase in luteal tissue area. As a final and most desirable outcome, pregnancy and the birth of lambs/kids also increase. These concepts will be discussed in this review, focusing on aCL induction in sheep and goats.

Caminhos e Contornos: o Acolhimento na Atenção Básica em São Bernardo do Campo - SP / Pathways and Outlines: User Embracement in Primary Health Care in São Bernardo do Campo - SP

Frente aos desafios para a consolidação do Sistema Único de Saúde (SUS) e o reconhecimento da Atenção Básica (AB) como porta de entrada preferencial e ordenadora da rede de atenção, esse artigo trata do acolhimento na AB como dispositivo da Política Nacional de Humanização (PNH) reorientador da atenção e da gestão do cuidado na produção de saúde. Por meio de revisão bibliográfica, documentação, questionários, entrevistas e análise de dados constatou-se que significativo investimento da gestão na busca pela mudança no modelo de atenção entre 2009 e 2016 repercutiu na ampliação e qualificação do acesso, no fortalecimento de vínculos e na capacidade resolutiva. Reforçando a indissociabilização entre gestão e atenção, o acolhimento se apresentou capaz de contribuir na mudança dos processos de trabalho e no modelo de atenção no marco da AB e na consolidação do SUS. A preocupação com a aplicabilidade e o diálogo permeou todas as etapas da pesquisa a fim de contribuir em ações e atividades envolvendo a AB e a rede municipal, tais como: inserção do tema e participação na formação dos profissionais da Residência Multriprofissional em Saúde da Família; estratégias de implantação de Núcleos de Regulação nas UBS; além da elaboração de uma Mostra Municipal de Saúde coordenada pela primeira autora cujo tema central trata da importância da articulação em rede na integralidade do cuidado.

Agenda para a pesquisa sobre o cuidado centrado no paciente no Brasil / Agenda for patient-centered care research in Brazil

Resumo O cuidado centrado no paciente se constitui em um movimento incipiente e sua prática ainda encontra obstáculos no sistema de saúde brasileiro, onde é pouco identificado como uma dimensão da qualidade dos cuidados de saúde. Baseado nisso, este artigo se propõe a estabelecer uma agenda de pesquisa sobre o cuidado centrado no paciente/pessoa, com vistas a subsidiar a sua implementação em serviços de saúde do país. Foi realizado um painel com nove especialistas, a fim de apreender diferentes olhares sobre o tema. A discussão presencial foi subsidiada por um documento sistematizando uma proposta inicial de agenda e uma breve apresentação sobre o conceito de cuidado centrado no paciente e elementos teóricos que conformam sua prática. Os participantes do painel definiram um conjunto de itens a serem explorados em estudos no sentido da identificação de estratégias de implementação, fortalecimento e medição do cuidado centrado no paciente no contexto brasileiro.

Abstract Patient-centered care is an incipient movement and its practice still faces obstacles in the Brazilian health system, where it is not extensively identified as healthcare quality realm. Thus, this paper aims to establish a patient/person-centered care research agenda to support its implementation in the country's healthcare services. A panel was held with nine experts to grasp different views on the subject. The face-to-face discussion was supported by a document systematizing an initial agenda proposal and a brief presentation of the patient-centered care concept and theoretical elements that underpin its practice. Panel participants defined a set of items to be explored in studies to identify implementation and to strengthen and to measure strategies for patient-centered care in the Brazilian context.