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BACKGROUND: Vitamin C is a micronutrient present in high concentrations in normal skin and a highly prescribed cosmeceutical, well known for protecting against ultraviolet-induced pigmentation and regulating collagen production. However, there is a lack of studies evaluating the efficacy of topical vitamin C in photoaging and melasma, with this systematic review being the first to assess the existing evidence. AIM: This systematic review aims to assess whether topical vitamin C could be effective in reversing photoaging signs and treating melasma. METHODS: Prospective, randomized controlled trials assessing protocols with topically applied vitamin C in patients with melasma or photodamage were searched in Medline, CENTRAL, and Scopus databases until the 12th of May 2022. Risk of bias was conducted in accordance with Cochrane Collaboration's tool for assessing the risk of bias in randomized trials, using RevMan 5.0. RESULTS: Seven publications were included, with 139 volunteers in total. Studies that evaluated the topography of skin indicated that the treated skin appeared smoother and less wrinkled, which was supported by biopsies data. On objective assessments of pigmentation, there was a significant lightening of the skin treated. Hydration improved equally in the vitamin C and placebo-treated sites. CONCLUSIONS: This study revealed that vitamin C is effective in treating uneven, wrinkled skin and has depigmenting properties, but long-term use may be needed to achieve noticeable changes. Q-switched Nd:YAG laser-associated protocols appear beneficial in enhancing vitamin C effects. Topical vitamin C may be a suitable alternative for melasma and photoaging, but more studies are needed to confirm these results and assess the ideal vitamin C concentration.

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Post-traumatic stress disorder (PTSD) is a common anxiety mental disorder and can be manifested after exposure to a real or perceived life-threatening event. Increased noradrenaline and adrenaline in plasma and urine have been documented in PTSD. Dopamine-ß-hydroxylase (DBH) catalyzes the conversion of dopamine to noradrenaline and consequently, DBH inhibition reduces catecholamines. Our aim was to evaluate if nepicastat treatment decreases PTSD signs in an animal model. Wild-type (129x1/SvJ) female mice were submitted to PTSD induction protocol. DBH-inhibitor nepicastat (30 mg/kg) or vehicle (0.2% HPMC) were administered once daily since day 0 until day 7 or 12. The percentage of freezing was calculated on days 0, 1, 2, and 7, and behavioral tests were performed. Quantification of nepicastat in plasma and DBH activity in the adrenal gland was evaluated. Catecholamines were quantified by HPLC with electrochemical detection. mRNA expression of Npas4 and Bdnf in hippocampus was evaluated by qPCR.Mice in the PTSD-group and treated with nepicastat showed a decrease in freezing, and an increase in the time spent and entries in open arms in elevated plus maze test. In mice treated with nepicastat, adrenal gland DBH activity was decreased, and catecholamines were also decreased in plasma and tissues. On day 7, in mice treated with nepicastat, there was an increase of Npas4 and Bdnf mRNA expression in the hippocampus.In conclusion, DBH inhibitor nepicastat has an effect consistent with a decrease in the persistence of traumatic memories and anxiety-like behavior in this PTSD mice model. The disruption of traumatic memories through interference with the formation, consolidation, retrieval, and/or expression processes may be important to decrease PTSD symptoms and signs. The increase in Npas4 and Bdnf mRNA expression in the hippocampus may be important to develop a weaker traumatic contextual memory after nepicastat treatment.

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The importance of catecholamines in post-traumatic stress disorder (PTSD) still needs to be explored. We aimed to evaluate epinephrine's (EPI) causal role and molecular mechanism for the persistence of PTSD traumatic memories. Wild-type (WT) and EPI-deficient mice (phenylethanolamine-N-methyltransferase-knockout mice, Pnmt-KO) were induced with PTSD and behavioral tests were performed. Some Pnmt-KO mice were administered with EPI or vehicle. Catecholamines were quantified by HPLC-ED. Nr4a1, Nr4a2, and Nr4a3 mRNA expression were evaluated by real-time PCR in hippocampus samples. It was observed an increase in EPI and freezing behavior, and a decrease in open arm entries in the elevated plus-maze test and time spent in the light in the light-dark test in WT mice in the PTSD-induction group compared to control. After induction of PTSD, Pnmt-KO mice showed a decrease in freezing, as well as an increase in open arm entries and transitions between compartments compared to WT. After PTSD induction, Pnmt-KO mice administered with EPI showed an increase in freezing compared with the vehicle. On day 0 of PTSD induction, it was observed an increase in mRNA expression of Nr4a2 and Nr4a3 genes in the hippocampus of WT mice compared to control, contrary to Pnmt-KO mice. In conclusion, our data suggest that EPI may be involved in the persistence of traumatic memories in PTSD, possibly through enhancement of the expression of Nr4a2 and Nr4a3 genes in the hippocampus. Peripheral administration of EPI restored contextual traumatic memories in Pnmt-KO mice, which suggests a causal role for EPI. The persistence of contextual traumatic memories may contribute to anxiety-like behavior and resistance of traumatic memory extinction in this PTSD mice model.

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O Delirium na Pessoa em Situação Crítica é uma realidade subdiagnosticada nas Unidades de Cuidados Intensivos, condicionando significativamente o prognóstico e recuperação da pessoa. Confrontados com o Delirium na Pessoa em Situação Crítica no âmbito do Estágio, decidiu-se explorar o tema e a realidade na Unidade de Cuidados Intensivos, tendo-se verificado que na unidade não são utilizadas medidas para a identificação, avaliação, prevenção e tratamento desta disfunção. Atendendo que os enfermeiros têm responsabilidades acrescidas na sua identificação, avaliação, intervenção e prevenção, nomeadamente os enfermeiros especialistas, por deterem competências na área da criação e manutenção de ambientes terapêuticos seguros, optou-se pela Metodologia de Projeto e desenvolveu-se um Projeto de Intervenção em Serviço sobre o Delirium na Pessoa em Situação Crítica com os objetivos de sensibilizar a equipa de enfermagem para a importância da identificação, da avaliação, da intervenção de enfermagem na prevenção e tratamento do Delirium na Pessoa em Situação Crítica; e desenvolver um algoritmo de prevenção, identificação, avaliação e tratamento do Delirium. De forma a dar resposta aos objetivos definidos foi planeada uma atividade formativa e após a sua apresentação, a equipa de enfermagem procedeu à avaliação da mesma e do formador, considerando o tema pertinente e bem apresentado. Realça-se, ainda, o facto da atividade formativa ter permitido à equipa de enfermagem a aquisição de conhecimentos para o seu quotidiano profissional. Posteriormente, foi lançado à equipa de enfermagem o desafio de desenvolver intervenções específicas de enfermagem na prevenção, identificação, avaliação e tratamento do Delirium, iniciando a aplicação da escala de identificação e avaliação do Delirium e implementar, conjuntamente com a equipa médica, o algoritmo apresentado. Este algoritmo permite a implementação de uma monitorização eficiente do Delirium na Unidade de Cuidados Intensivos podendo despoletar uma mudança na ação face ao problema.

Delirium in Critical Person is an underdiagnosed reality in Intensive Care Units, significantly conditioning the person's prognosis and recovery. Faced with Delirium in the Critical Person in the context of the Internship, it was decided to explore the theme and the reality in the Intensive Care Unit, having found that the unit doesn't use measures for the identification, evaluation, prevention and treatment of this dysfunction. Given that nurses have increased responsibilities in their identification, evaluation, intervention and prevention, namely specialist nurses, as they have competences in the area of creating and maintaining safe therapeutic environments, the Project Methodology was chosen and a Intervention Project in Service on Delirium in Critical Person was developed with the objectives of sensitizing the nursing team to the importance of identifying, evaluating, and nursing intervention in the prevention and treatment of Delirium in Critical Person; and develop an algorithm for the prevention, identification, evaluation and treatment of Delirium. In order to respond to the defined objectives, a training activity was planned and after its presentation, the nursing team proceeded to evaluate it and the trainer, considering the relevant and well presented theme. It is also emphasized that the training activity allowed the nursing team to acquire knowledge for their daily professional life. Subsequently, the challenge of developing specific nursing interventions in the prevention, identification, evaluation and treatment of Delirium was launched to the nursing team, initiating the application of the Delirium identification and evaluation scale and implementing, together with the medical team, the algorithm presented. This algorithm allows the implementation of an efficient monitoring of Delirium in the Intensive Care Unit and can trigger a change in the action in the face of the problem.

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Objetivo: O estudo objetivou traçar um perfil neuropsicológico breve de pacientes com amputação maior de membros inferiores por etiologia vascular e investigar a existência de correlações dos aspectos cognitivos com fatores sociodemográficos e clínicos. Método: Trata-se de um estudo transversal descritivo, realizado em um centro de reabilitação física de São Paulo - Brasil, em que foram aplicados: um instrumento de avaliação neuropsicológica breve (Neupsilin), um questionário de caracterização da amostra próprio e a Escala de Ansiedade e Depressão Hospitalar (HAD). Resultados: O desempenho cognitivo foi pior em funções que requerem habilidades aritméticas (42,2% dos pacientes com desempenho abaixo do esperado); percepção (46,3% dos pacientes abaixo do esperado); funções executivas, notadamente nas tarefas praxia construtiva (40,6% abaixo do esperado) e fluência verbal (35,9% abaixo do esperado), e linguagem (31,2% abaixo do esperado). Conclusão: O perfil cognitivo dos pacientes deste estudo revelou dificuldades relevantes das funções cognitivas avaliadas, especialmente em funções diretamente relacionadas à funcionalidade do paciente.

Objective: To describe the neuropsychological profile of patients with major lower limb amputation and to investigate the existence of correlations between these cognitive aspects, socio-demographic and clinical aspects. Method: This is a cross-sectional, analytic, descriptive study carried out at an outpatient rehabilitation center. The instruments used were Hospital Anxiety and Depression Scale (HADS), a brief neuropsychological assessment instrument (Neupsilin) along with a questionnaire to characterize the sample. Results: Cognitive performance was worse in functions that require arithmetic skills (42,2% of the patients underperformed); perception (46,3% underperformed); executive functions, notably in constructive praxis (40,6% underperformed) and verbal fluency (35,9% underperformed) and language (31,2% underperformed). The best performances were in spacial orientation (92,2% performed as expected) and verbal memory (87,5% performed as expected). Conclusion: The cognitive profile of these patients revealed alterations in most of the assessed cognitive functions, especially in functions directly related to functionalities of the patient.

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O artigo enfoca a heterogeneidade no uso de benzodiazepínicos, sob o enfoque farmacêutico, observada nos Centros de Atenção Psicossocial e Unidades Básicas de Saúde da Família. Os benzodiazepínicos estão incluídos entre os medicamentos mais prescritos para tratar distúrbios de ansiedade. Os avanços da reforma psiquiátrica, a criação dos Centros de Atenção Psicossocial (Caps) e o redirecionamento das atividades de saúde primária tornam imperiosa a adequação da prática farmacêutica através de atividades de orientação e acolhimento ao usuário de benzodiazepínicos.

This article focuses on the discrepancies in the use of benzodiazepines, under the pharmaceutical approach, observed daily in Centers of Psychosocial Care (Caps) and in Basic Units of Family Health. Benzodiazepines are among the most prescribed medications for the treatment of anxiety disorders. Advances in psychiatric reform, the creation of Caps and the new approach to primary health activities make imperative the adequacy of pharmaceutical practice through guidance and care activities to benzodiazepines' users.

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A fluoresceína endovenosa é associada a pequenos efeitos adversos durante a angiografia da retina, a maioria deles sem gravidade e não relacionada a mecanismos imunológicos. Entretanto, em raras ocasiões, pode ocorrer reação anafilactoide; fatalidades envolvendo o uso de fluoresceína têm sido descritas. Complicações graves após injeção endovenosa de fluoresceína requerem ação imediata da equipe envolvida, assim como treinamento regular para padronizar o tratamento.

Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.

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Fluorescein is associated with minor adverse effects during retinal angiography, and most of these effects are not severe and not related to immunological mechanism. However, on rare occasions, anaphylatoid reaction can occur, and fatalities involving fluorescein have been described. Life threatening complications after intravenous injection of sodium fluorescein require immediate intervention. Trainings for professionals are needed to standardize treatment for this event.

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