Children's satisfaction with nursing care during hospitalization: A cross-sectional study.

PURPOSE: To assess hospitalized children's satisfaction with nursing care. DESIGN AND METHODS: Cross-sectional study using the "Children Care Quality at Hospital" questionnaire. 61 children admitted to the Pediatrics Department of a hospital in the Northern Region of Portugal were enrolled. RESULTS: The ranged age of the participants was 6 to 15 (10,61 ± 2,66 years), and most were male (52.46%; n = 32). The mean score in the three domains was 128 (77.11%), reflecting children's high satisfaction with the nursing care provided during hospitalization. The domain most valued was Nurse Characteristics, while the least valued was Nursing Environment. CONCLUSION: Results provide essential input for the dimensions to be considered when planning nursing care for children, managing care, and the physical environment in the wards. IMPLICATIONS FOR PRACTICE: These results highlight the need to hear children's voices. This must encourage nurses to reflect on how children evaluate nursing care and, by doing so, to increase the quality of nursing care provided in Pediatrics settings.

Multispecies and multibiomarker assessment of fish health from Iguaçu River reservoir, Southern Brazil.

This study investigated the impact of micropollutants on fish health from Segredo hydroelectric reservoir (HRS) along the Iguaçu River, Southern Brazil, contaminated by urban, industrial, and agricultural activities. This is the first comprehensive study assessment in the river after the severe drought in the 2020s in three fish species from different trophic levels Astyanax spp. (water column depth/omnivorous), Hypostomus commersoni (demersal/herbivorous), and Pimelodus maculatus (demersal/omnivorous). Animals, water, and sediment samples were collected from three distinct sites within the reservoir: Floresta (upstream), Iratim (middle), and Station (downstream). The chemical analysis revealed elevated concentrations of metals (Al, Cu, Fe) and the metalloid As in water, or Cu, Zn, and As in sediment, surpassing Brazilian regulatory limits, while the organic pollutants as DDT, PAHs, PCBs, and PBDEs were found under the Brazilian regulatory limits. The metal bioaccumulation was higher in gills with no significant differences among sites. The species Astyanax spp. and H. commersoni displayed variations in hepatosomatic index (HSI) and P. maculatus in the condition factor index (K) between sites, while adverse effects due to micropollutants bioaccumulation were observed by biochemical, genotoxic, and histopathological biomarkers. The principal component analysis and integrated biomarker response highlighted the upstream site Floresta as particularly inhospitable for biota, with distinctions based on trophic level. Consequently, this multifaceted approach, encompassing both fish biomarkers and chemical analyses, furnishes valuable insights into the potential toxic repercussions of micropollutant exposure. These findings offer crucial data for guiding management and conservation endeavors in the Iguaçu River.

Immunoproteomic and immunoinformatic approaches identify secreted antigens and epitopes from Staphylococcus saprophyticus.

Urinary tract infections (UTIs) are common human infections that compromise women's health around the world, even though they can affect men and women of all ages. Bacterial species are the primary causative agents of UTIs, while Staphylococcus saprophyticus, a gram-positive bacterium, is especially important for uncomplicated infections in young women. Despite the number of antigenic proteins identified in Staphylococcus aureus and other bacteria of the genus, there is no immunoproteomic study in S. saprophyticus. In this context, since pathogenic microorganisms secrete important proteins that interact with hosts during infection, the present work aims to identify the exoantigens from S. saprophyticus ATCC 15305 by immunoproteomic and immunoinformatic approaches. We identified 32 antigens on the exoproteome of S. saprophyticus ATCC 15305 by immunoinformatic tools. By using 2D-IB immunoproteomic analysis, it was possible to identify 3 antigenic proteins: transglycosylase IsaA, enolase and the secretory antigen Q49ZL8. In addition, 5 antigenic proteins were detected by immunoprecipitation (IP) approach, where the most abundant were bifunctional autolysin and transglycosylase IsaA proteins. The transglycosylase IsaA was the only protein detected by all the tools approaches used in this study. In this work it was possible to describe a total of 36 S. saprophyticus exoantigens. Immunoinformatic analysis allowed the identification of 5 exclusive linear B cell epitopes from S. saprophyticus and 5 epitopes presenting homology with other bacteria that cause UTIs. This work describes, for the first time, the profile of exoantigens secreted by S. saprophyticus and can contribute to the identification of new diagnostic targets of UTIs, as well as to develop vaccines and immunotherapies against bacterial urinary infections.

High prevalence of mental disorder symptoms among medical and other health specialties residents during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic put healthcare professionals, including residents (postgraduate trainees of health professions), under intense physical and psychological stress, hence at risk for mental disorders. We evaluated the prevalence of mental disorders among healthcare residents during the pandemic. METHODS: From July to September 2020, residents in medicine and other healthcare specialties in Brazil were recruited. The participants completed electronic forms with validated questionnaires (DASS-21, PHQ-9, BRCS) to screen for depression, anxiety, and stress, and to evaluate resilience. Data on potential predisposing factors for mental disorders were also collected. Descriptive statistics, chi-squared, students t, correlation and logistic regression models were applied. The study received ethical approval, and all participants provided informed consent. RESULTS: We included 1313 participants (51.3% medical; 48.7% nonmedical) from 135 Brazilian hospitals; mean (SD) age: 27.8 (4.4) years; 78.2% females; 59.3% white race. Of all participants, 51.3%, 53.4% and 52.6% presented symptoms consistent with depression, anxiety, and stress, respectively; 61.9% showed low resilience. Nonmedical residents exhibited higher anxiety compared to medical residents (DASS-21 anxiety score, mean difference: 2.26; 95% CI: 1.15-3.37; p < 0.001). In multivariate analyses, having any pre-existent, nonpsychiatric chronic disease was associated with higher prevalence of symptoms indicative of depression (odds ratio, OR: 2.05; 95% CI: 1.47-2.85, on DASS-21 | OR: 2.26; 95% CI: 1.59-3.20, on PHQ-9), anxiety (OR: 2.07; 95% CI: 1.51-2.83, on DASS-21), and stress (OR: 1.53; 95% CI: 1.12-2.09, on DASS-21); other predisposing factors were identified; by contrast, high resilience (BRCS score) was protective against symptoms of depression (OR 0.82; 95% CI: 0.79-0.85, on DASS-21 | OR 0.85; 95% CI: 0.82-0.88, on PHQ-9), anxiety (OR 0.90; 95% CI: 0.87-0.93, on DASS-21), and stress (OR 0.88; 95% CI: 0.85-0.91, on DASS-21); p < 0.05 for all outcomes. CONCLUSIONS: We found a high prevalence of mental disorder symptoms among healthcare residents during COVID-19 pandemic in Brazil. Nonmedical residents exhibited higher levels of anxiety than medical ones. Some predisposing factors for depression, anxiety and stress among residents were identified.

The new WHO air quality guidelines for PM2.5: predicament for small/medium cities.

The global burden of disease estimated that approximately 7.1 million deaths worldwide were related to air pollution in 2016. However, only a limited number of small- and middle-sized cities have air quality monitoring networks. To date, air quality in terms of particulate matter is still mainly focused on mass concentration, with limited compositional monitoring even in mega cities, despite evidence indicating differential toxicity of particulate matter. As this evidence is far from conclusive, we conducted PM2.5 bioaccessibility studies of potentially harmful elements in a medium-sized city, Londrina, Brazil. The data was interpreted in terms of source apportionment, the health risk evaluation and the bioaccessibility of inorganic contents in an artificial lysosomal fluid. The daily average concentration of PM2.5 was below the WHO guideline, however, the chemical health assessment indicated a considerable health risk. The in vitro evaluation showed different potential mobility when compared to previous studies in large-sized cities, those with 1 million inhabitants or more (Curitiba and Manaus). The new WHO guideline for PM2.5 mass concentration puts additional pressure on cities where air pollution monitoring is limited and/or neglected, because decision making is mainly revenue-driven and not socioeconomic-driven. Given the further emerging evidence that PM chemical composition is as, or even more, important than mass concentration levels, the research reported in the paper could pave the way for the necessary inter- and intra-city collaborations that are needed to address this global health challenge.

Concentrations of iron and chromium in free-ranging common marmosets (Callithrix jacchus) from Pernambuco, Brazil.

Common marmosets (Callithrix jacchus) are widely distributed in Northeast Brazil and often inhabit urban and peri-urban forest areas close to human settlements. Given its wide territorial distribution, its proximity to human populations, and its exposure to environmental degradations originating from urbanization, common marmosets have a high potential for environmental biomonitoring. The concentrations of iron (Fe) and chromium (Cr) were quantified in the liver, hair, and bone of 22 free-ranging common marmosets' bodies from nine cities from Pernambuco State, Brazil, using inductively coupled plasma optical emission spectrometry (ICP OES). The liver showed the highest concentrations of Fe and Cr (3773.2 ± 3715.8 mg/kg and 19.4 ± 41.6 mg/kg, respectively); the lowest concentration of Fe was detected in the bone (111.6 ± 97.6 mg/kg) and of Cr in the hair (3.3 ± 1.5 mg/kg). There was a moderate positive correlation between Fe and Cr in the liver (r = 0.64) and a high negative correlation for Cr between bone and hair (r = -0.65). This study demonstrated the bioaccumulation of Fe and Cr in hair, liver, and bone in common marmosets. The highest average concentration of Fe and Cr occurred in animals from Recife, Jaboatão dos Guararapes, and Paulista, respectively, the 1st, the 2nd, and the 5th most populated cities in the state of Pernambuco. The presence of high concentrations of metals in animals from Recife and nearby cities can indicate alarming levels of environmental pollution in these locations.

Toxoplasma gondii infection in goats: serological, pathological, and clinical monitoring during gestation.

This study aimed to evaluate Toxoplasma gondii infection in pregnant goats. The goats were divided into two groups: group one (G1) comprised of 31 pregnant goats naturally infected with T. gondii, and group two (G2) comprised of seven uninfected pregnant goats from a flock with a history of abortion due to toxoplasmosis. Serological investigation, ultrasonography, and clinical testing were performed on all goats during gestation. Serum samples from goats and their offspring (precolostral) were collected to evaluate the vertical transmission of T. gondii. Samples from placentas and aborted fetuses were also collected for molecular and histopathological analysis. Results showed that in G1, estrus recurrence occurred in 22.6% (7/31) of the goats, embryonic death in 3.3% (1/31), and abortion in 19.4% (6/31). An increase in anti-T. gondii antibodies was observed in G1 goats at day 150 of pregnancy. T. gondii DNA was detected in 42.8% (3/7) of aborted fetuses and was associated with histopathological lesions caused by this parasite. Moreover, toxoplasmosis in field conditions caused by genotype ToxoDB #1 in pregnant goats resulted in severe reproductive loss in the flock.

Two-year study on the application of the Paris system for urinary cytology in a cancer centre.

INTRODUCTION: The Paris system for reporting urinary cytology (TPS) was published in order to provide clear cytomorphological criteria for urine cytology specimens, focusing on high-grade urothelial lesions. The aim of this study was to evaluate the impact of implementing TPS and to correlate with available concomitant histological samples, accessing overall sensitivity and specificity. METHODS: A retrospective analysis of urine cytology reports from 2017 to 2018 using TPS was carried out, with histological correlation to concomitant samples (up to 3 months). Statistical analysis was performed with calculation of sensitivity and specificity, positive and negative predictive values and risk of malignancy (ROM) for all TPS categories. RESULTS: A total of 1660 specimens were evaluated. Histological specimens were available for 611 (36.8%) cases. Urine cytology categorised by TPS had 2.4% non-diagnostic cases, 87.1% negative for high-grade urothelial carcinoma (HGUC), 4.6% atypical urothelial cells, 2.7% suspicious for HGUC, 2.7% HGUC and 0.5% cases of other malignancies. Sensitivity, specificity, negative predictive value and positive predictive value were 40.0%, 99.3%, 88.2% and 92.3%, respectively. ROM of each category was 0% for non-diagnostic, 11.1% for negative for HGUC, 32.4% for atypical, 64.9% for suspicious for HGUC and 87.9% for HGUC and other malignancies. CONCLUSION: Our findings indicated that implementation of TPS provided a high specificity and predictive positive value for the detection of high-grade urothelial lesions, with proportionally increasing ROMs as categories progress from negative to positive.

Functional dependence among older adults: a cross-sectional study with a rural population of southern Brazil.

INTRODUCTION: Brazil has a rapidly aging population, yet little is known about the occurrence of functional dependence in the rural older adult population. The objective of this study was to estimate the prevalence of functional dependence and its associated factors among community-dwelling older adults in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. METHODS: This was a cross-sectional, population-based study. A systematic random sampling of households was used. Eighty percent of households in the rural area were selected, which included 1131 older adults. The outcome analyzed in this study was functional dependence. This was measured by and data were collected using the Katz Index for Activities of Daily Living (ADL) and Lawton and Brody's Scale for Instrumental Activities of Daily Living (IADL). Descriptive analysis was used to estimate the prevalence of functional dependence in ADL and IADL and to describe the sample. Crude and adjusted analysis was performed by Poisson regression with robust adjustment of variance. Prevalence ratios (PRs) and 95% confidence intervals (95%CIs) were reported. RESULTS: A total of 1029 older adults took part in this study, corresponding to an 8.9% rate of losses and refusals. Prevalence of functional dependence in ADL was 8.1% (95%CI 6.4-9.7), while prevalence of functional dependence in IADL was 32.4% (95%CI 29.5-35.2). The occurrence of functional dependence in one or more of ADL or IADL was 6.7% (95%CI 5.2-8.2). The following categories were associated with functional dependence in ADL: female sex (PR=1.70; 95%CI 1.10-2.62), age group 80 years or more (PR=3.68; 95%CI 2.20-6.16), no schooling (PR=2.61; 95%CI 1.26-5.37) and 1-4 years of schooling (PR=2.49; 95%CI 1.28-4.84), having diabetes (PR=1.85; 95%CI 1.21-2.83), depression in the previous year (PR=1.90; 95%CI 1.09-3.31), urinary incontinence (PR=3.26; 95%CI 2.06-5.16), history of stroke (PR=2.26; 95%CI 1.35-3.76) and poor/very poor self-rated health (PR=2.36; 95%CI 1.29-4.32). The following categories were associated with functional dependence in IADL: female sex (PR=1.40; 95%CI 1.19-1.65), age groups of 70-79 years (PR=1.92; 95%CI 1.51-2.43) and 80 years or more (PR=3.80; 95%CI 3.07-4.72), no schooling (PR=1.87; 95%CI 1.46-2.41) and 1-4 years of schooling (PR=1.55; 95%CI 1.22-1.96), medical diagnosis of diabetes (PR=1.33; 95%CI 1.10-1.60), urinary incontinence (PR=1.40; 95%CI 1.17-1.68), history of stroke (PR=1.41; 95%CI 1.10-1.81) and regular self-rated health (PR=1.27; 95%CI 1.06-1.52) or poor/very poor self-rated health (PR=1.80; 95%CI 1.41-2.30). CONCLUSION: Older adults in rural areas have a high prevalence of functional dependence. Knowledge of functional dependence and associated factors in rural populations is necessary for the planning and developing actions, especially in the routine of primary care, which promote health and prevent or postpone the decline in functional capacity.

Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures.

OBJECTIVE: To assess factors associated with favorable outcome in refractory insular epilepsy treated by volume-based stereotactic radiofrequency thermocoagulation (RFTC). METHODS: We performed volume-based RFTC in 19 patients (11 males, 7-44 years old). The volume for thermocoagulation was identified by multimodal data including electroencephalography (EEG)-video, magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (PET) in all patients, and epileptogenic zone (EZ) was assessed by stereo-electroencephalography (SEEG) in 16. MRI showed insular lesions in four patients (benign tumors, n = 2; focal cortical dysplasia [FCD], n = 1; polymicrogyria, n = 1). MRI was negative in 15 cases; however, PET was positive in 18, and FCD pattern was detected by SEEG in nine cases. The dominant hemisphere was involved in 12 cases. RFTC was performed as a separate procedure after SEEG, or as a single MRI-guided procedure. The insular volume to be coagulated was determined by a tridimensional identification of the epileptogenic cortex using MRI, PET, and SEEG, and was destroyed with coalescent thermal lesions. RESULTS: Seizure-free outcome was achieved in 10 patients (53%), including Engel class IA in three (follow-up = 1-12 years, mean = 5.4). The responder rate (including Engel classes I-III) was 89%. Transient postoperative deficits (mild hemiparesia, dysarthria, hypoesthesia, dysgeusia) were observed in eight patients (42%), with rapid and total recovery in all but one with persistent mild dysarthria. Neurological deficits were related to higher number of RFTC procedures (P = .036) and greater volume of RFTC (P = .028). Neuropsychological status was unchanged or improved in all; however, psychiatric status transitorily worsened in three patients. Factors contributing to seizure-free outcome were the detection of FCD pattern (P = .009), localized EZ (P = .038), low RFTC volume (P = .002), low number of RFTC procedures (P = .001), and low RFTC volume/number ratio (P = .012). Optimal volume of RFTC around 2 cm3 offered the best compromise between efficacy and safety. SIGNIFICANCE: RFTC may be curative in insular epilepsy after accurate localization of EZ with SEEG. Best outcome was associated with low volume of thermolesions.

Invasive fungal infection by Cryptococcus neoformans var. grubii with bone marrow and meningeal involvement in a HIV-infected patient: a case report.

BACKGROUND: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/µL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. CASE PRESENTATION: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/µL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. CONCLUSIONS: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/µL.

First description of clonal lineage type II (genotype #1) of Toxoplasma gondii in abortion outbreak in goats.

The purpose of this study was to perform genotypic characterization and to evaluate the virulence of Toxoplasma gondii obtained from aborted fetuses in an abortion outbreak in goats from northeastern Brazil. Brain samples from 32 fetuses were submitted to mouse bioassay for T. gondii isolation. Two isolates were obtained and subjected to genotypic characterization. Isolate virulence was evaluated using murine model in different doses (from 105 to 101 tachyzoites/mL). In genotyping, both isolates were classified as clonal lineage type II (genotype #1 ToxoDB) and showed to be virulent for mice. This is the first description of genotype #1 in cases of goat abortion, showing the circulation of virulent T. gondii isolate producing reproductive disorders in pregnant goat.

Fusion of a New World Alphavirus with Membrane Microdomains Involving Partially Reversible Conformational Changes in the Viral Spike Proteins.

Alphaviruses are enveloped arboviruses mainly proposed to infect host cells by receptor-mediated endocytosis followed by fusion between the viral envelope and the endosomal membrane. The fusion reaction is triggered by low pH and requires the presence of both cholesterol and sphingolipids in the target membrane, suggesting the involvement of lipid rafts in the cell entry mechanism. In this study, we show for the first time the interaction of an enveloped virus with membrane microdomains isolated from living cells. Using Mayaro virus (MAYV), a New World alphavirus, we verified that virus fusion to these domains occurred to a significant extent upon acidification, although its kinetics was quite slow when compared to that of fusion with artificial liposomes demonstrated in a previous work. Surprisingly, when virus was previously exposed to acidic pH, a condition previously shown to inhibit alphavirus binding and fusion to target membranes as well as infectivity, and then reneutralized, its ability to fuse with membrane microdomains at low pH was retained. Interestingly, this observation correlated with a partial reversion of low pH-induced conformational changes in viral proteins and retention of virus infectivity upon reneutralization. Our results suggest that MAYV entry into host cells could alternatively involve internalization via lipid rafts and that the conformational changes triggered by low pH in the viral spike proteins during the entry process are partially reversible.

Experimental caprine neosporosis: the influence of gestational stage on the outcome of infection.

Here, we assessed outcome of experimental infection by Neospora caninum in goats intravenously inoculated with 10(6) tachyzoites of the Nc-Spain7 isolate at 40 (G1), 90 (G2) and 120 (G3) days of gestation. Infected goats had fever between 5 and 9 days post inoculation (dpi); all were seropositive at the time of abortion/birth. Foetal death occurred in G1 from 10 to 21 dpi (n = 7) and in G2 from 27 to 35 dpi (n = 4). Goats in G2 also had seropositive stillbirth (n = 1) and healthy kids (n = 2). G3 goats (n = 7) had 3 seropositive and 3 seronegative weak kids, and 2 seronegative healthy kids. Parasite DNA detection in placentomes was 100% in G2, 85.7% in G3 and in G1 was detected only in placentomes from the goats with foetal losses from 17 dpi (100%). Parasites were detected in foetal/kid brain (>85.7%) and liver (≥ 50%) of G2 and G3, and in G1 after 17 dpi (100%). The highest parasite loads were detected in the placentomes of G1 from 17 dpi and G2, and in foetal tissues of G1 from 17 dpi and G3. Multifocal necrotic lesions were observed in the placentas of the three groups, but they were larger and more frequent in G1 and G2. Similar lesions were observed in foetal tissues, but they were more frequent in G3. These findings suggest that, as observed in cattle and sheep, the clinical consequences of N. caninum in pregnant goats are dependent in part on the time of gestation when animals were infected.

Pressure-Inactivated Virus: A Promising Alternative for Vaccine Production.

In recent years, many applications in diverse scientific fields with various purposes have examined pressure as a thermodynamic parameter. Pressure studies on viruses have direct biotechnological applications. Currently, most studies that involve viral inactivation by HHP are found in the area of food engineering and focus on the inactivation of foodborne viruses. Nevertheless, studies of viral inactivation for other purposes have also been conducted. HHP has been shown to be efficient in the inactivation of many viruses of clinical importance and the use of HHP approach has been proposed for the development of animal and human vaccines. Several studies have demonstrated that pressure can result in virus inactivation while preserving immunogenic properties. Viruses contain several components that can be susceptible to the effects of pressure. HHP has been a valuable tool for assessing viral structure function relationships because the viral structure is highly dependent on protein-protein interactions. In the case of small icosahedral viruses, incremental increases in pressure produce a progressive decrease in the folding structure when moving from assembled capsids to ribonucleoprotein intermediates (in RNA viruses), free dissociated units (dimers and/or monomers) and denatured monomers. High pressure inactivates enveloped viruses by trapping their particles in a fusion-like intermediate state. The fusogenic state, which is characterized by a smaller viral volume, is the final conformation promoted by HHP, in contrast with the metastable native state, which is characterized by a larger volume. The combined effects of high pressure with other factors, such as low or subzero temperature, pH and agents in sub-denaturing conditions (urea), have been a formidable tool in the assessment of the component's structure, as well as pathogen inactivation. HHP is a technology for the production of inactivated vaccines that are free of chemicals, safe and capable of inducing strong humoral and cellular immune responses. Here we present a current overview about the pressure-induced viral inactivation and the production of inactivated viral vaccines.

Nursing workload and occurrence of adverse events in intensive care: a systematic review.

OBJECTIVE: To identifyevidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). METHOD: A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. RESULTS: Of 594 potential studies, eight comprised the final sample of the review. TheNursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System(TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medicationerrors. An investigation found that the NAS was a protective factor for PU. CONCLUSION: The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care. OBJETIVO: Identificar evidências sobre a influência da carga de trabalho de enfermagem na ocorrência de eventos adversos (EA) em pacientes adultos internados em Unidade de Terapia Intensiva (UTI). MÉTODO: Revisão sistemática da literatura realizada nas bases de dados MEDLINE, CINAHL, LILACS, SciELO, BDENF e Cochrane deestudosem inglês, português ou espanhol, publicados até 2015. Os EA analisados foram infecção, úlcera por pressão (UPP), quedas e erros associados a medicamentos. RESULTADOS: Das 594 pesquisas potenciais identificadas, oito compuseram a amostra final da revisão. O NursingActivities Score -NAS (37,5%) e o TherapeuticInterventionScoring System -TISS (37,5%) foram os instrumentos mais utilizados para avaliação da carga de trabalho de enfermagem. Seis pesquisas (75,0%) identificaram influência da sobrecarga de trabalho na ocorrência de infecção, UPP e uso de medicamentos. Uma investigação identificou que o NAS foi fator de proteção para UPP. CONCLUSÃO: A carga de trabalho de enfermagem requerida por pacientes na UTI influenciou a ocorrência de EA, e os enfermeiros devem monitorar diariamente esta variável para garantir o correto dimensionamento da equipe e a segurança da assistência prestada.

Association between Y haplogroups and autosomal AIMs reveals intra-population substructure in Bolivian populations.

For the correct evaluation of the weight of genetic evidence in a forensic context, databases must reflect the structure of the population, with all possible groups being represented. Countries with a recent history of admixture between strongly differentiated populations are usually highly heterogeneous and sub-structured. Bolivia is one of these countries, with a high diversity of ethnic groups and different levels of admixture (among Native Americans, Europeans and Africans) across the territory. For a better characterization of the male lineages in Bolivia, 17 Y-STR and 42 Y-SNP loci were genotyped in samples from La Paz and Chuquisaca. Only European and Native American Y-haplogroups were detected, and no sub-Saharan African chromosomes were found. Significant differences were observed between the two samples, with a higher frequency of European lineages in Chuquisaca than in La Paz. A sample belonging to haplogroup Q1a3a1a1-M19 was detected in La Paz, in a haplotype background different from those previously found in Argentina. This result supports an old M19 North-south dispersion in South America, possibly via two routes. When comparing the ancestry of each individual assessed through his Y chromosome with the one estimated using autosomal AIMs, (a) increased European ancestry in individuals with European Y chromosomes and (b) higher Native American ancestry in the carriers of Native American Y-haplogroups were observed, revealing an association between autosomal and Y-chromosomal markers. The results of this study demonstrate that a sub-structure does exist in Bolivia at both inter- and intrapopulation levels, a fact which must be taken into account in the evaluation of forensic genetic evidence.

The action of p-synephrine on hepatic carbohydrate metabolism and respiration occurs via both Ca(2+)-mobilization and cAMP production.

Citrus aurantium extracts, which contain large amounts of p-synephrine, are widely used for weight loss purposes and as appetite suppressants. In the liver, C. aurantium (bitter orange) extracts affect hemodynamics, carbohydrate metabolism, and oxygen uptake. The purpose of the present work was to quantify the action of p-synephrine and also to obtain indications about its mechanism of action, a task that would be difficult to accomplish with C. aurantium extracts due to their rather complex composition. The experimental system was the isolated perfused rat liver. p-Synephrine significantly stimulated glycogenolysis, glycolysis, gluconeogenesis, and oxygen uptake. The compound also increased the portal perfusion pressure and the redox state of the cytosolic NAD(+)/NADH couple. A Ca(2+)-dependency for both the hemodynamic and the metabolic effects of p-synephrine was found. p-Synephrine stimulated both cAMP overflow and the initial Ca(2+) release from the cellular stores previously labeled with (45)Ca(2+). The metabolic and hemodynamic actions of p-synephrine were strongly inhibited by α-adrenergic antagonists and moderately affected by ß-adrenergic antagonists. The results allow to conclude that p-synephrine presents important metabolic and hemodynamic effects in the liver. These effects can be considered as both catabolic (glycogenolysis) and anabolic (gluconeogenesis), they are mediated by both α- and ß-adrenergic signaling, require the simultaneous participation of both Ca(2+) and cAMP, and could be contributing to the overall stimulation of metabolism that usually occurs during weight loss periods.