RESUMO
Background: Molecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil. Methods: This was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira-Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%. Results: Of a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p < 0.001) and C (p = 0.037). Men who have sex with men (MSM) predominated the cluster in subtype B (51%), C (85.7%), and F1 (63.6%; p < 0.05). The TDR rate in clustered patients was 15.4, 13.6, and 3.1% for subtypes B, F1, and C, respectively. Most of the infections in subtypes B (80%), C (64%), and F1 (59%) occurred within the state of São Paulo. The metropolitan area of São Paulo presented a high level of endogenous clustering for subtypes B and C. The São Paulo city had 46% endogenous clusters of subtype C. Conclusion: Our findings showed that MSM, antiretroviral therapy in Treatment-Naive (ART-naïve) patients, and HIV1-C, played an important role in the HIV epidemic in the São Paulo state. Further studies in transmission clusters are needed to guide the prevention intervention.
Assuntos
Infecções por HIV , HIV-1 , Filogenia , Humanos , Brasil/epidemiologia , HIV-1/genética , HIV-1/classificação , Masculino , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Adulto , Feminino , Pessoa de Meia-Idade , Epidemiologia Molecular , Análise por Conglomerados , Adulto Jovem , Adolescente , Farmacorresistência Viral/genéticaRESUMO
OBJECTIVES: To calculate the direct cost of personal protective equipment (PPE) used during the COVID-19 pandemic from the perspective of a Brazilian tertiary public hospital. METHODS: We evaluated the cost of PPE during the pandemic to the cost before (2021 vs 2019, respectively) using the microcosting method. Cost estimates were converted into US dollars in 2023, taking inflation into account and using purchasing power parity conversion rates. Our expenses included gloves, disposable gowns, head coverings, masks, N95 respirators, and eye protection. The number of PPE used was determined by the hospital's usual protocol, the total number of hospitalized patients, and the number of days of hospitalization. We used the following variables for uncertainty analysis: PPE adherence, an interquartile range of median length of hospitalization, and variance in the cost of each PPE. RESULTS: In 2021, 26 618 individuals were hospitalized compared with 31 948 in 2019. The median length of stay was 6 and 4 days, respectively. The total and per-patient direct cost of PPE were projected to be 2 939 935.47 US dollar (USD) and 110.45 USD, respectively, during the pandemic, and 1 570 124.08 USD and 49.15 USD, respectively, before the pandemic. The individual cost of PPE was the most influential cost variable. CONCLUSIONS: According to the hospital's perspective, the total estimated direct cost of PPE during the COVID-19 pandemic was nearly twice as high as the previous year. This difference might be explained by the 3-fold increase in PPE in the treatment of patients with COVID-19 compared with patients without isolation precautions.
Assuntos
COVID-19 , Equipamento de Proteção Individual , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/economia , Equipamento de Proteção Individual/economia , Equipamento de Proteção Individual/estatística & dados numéricos , Brasil/epidemiologia , SARS-CoV-2 , Pandemias/economia , Pandemias/prevenção & controle , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricosRESUMO
Alcohol use disorder (AUD) is characterized by a set of behavioral, cognitive, nutritional, and physiological phenomena derived from the uncontrolled use of alcoholic beverages. There are cases in which AUD is associated with anxiety disorder, and when untreated, it requires careful pharmacotherapy. Blue Calm® (BC) is a food supplement indicated to aid restorative sleep, which has traces of medicinal plant extracts, as well as myo-inositol, magnesium bisglycinate, taurine, and L-tryptophan as its main chemical constituents. In this context, this study aimed to evaluate the potential of the BC in the treatment alcohol withdrawal-induced anxiety in adult zebrafish (aZF). Initially, BC was submitted to antioxidant activity against 2,2-diphenyl-1-picrylhydrazyl radical. Subsequently, the aZF (n = 6/group) were treated with BC (0.1 or 1 or 10 mg/mL; 20 µL; p.o.), and the sedative effect and acute toxicity (96 h) were evaluated. Then, the anxiolytic-like effect and the possible GABAergic mechanism were analyzed through the Light & Dark Test. Finally, BC action was evaluated for treating alcohol withdrawal-induced anxiety in aZF. Molecular docking was performed to evaluate the interaction of the major chemical constituents of BC with the GABAA receptor. BC showed antioxidant potential, a sedative effect, was not toxic, and all doses of BC had an anxiolytic-like effect and showed potential for the treatment of alcohol withdrawal-induced anxiety in aZF. In addition to the anxiolytic action, the main chemical constituents of BC were confirmed in the molecular docking, thus suggesting that BC is an anxiolytic that modulates the GABAergic system and has pharmacological potential for the treatment of alcohol withdrawal-induced anxiety.
Assuntos
Alcoolismo , Ansiolíticos , Síndrome de Abstinência a Substâncias , Animais , Peixe-Zebra/fisiologia , Ansiolíticos/farmacologia , Ansiolíticos/uso terapêutico , Ansiedade/induzido quimicamente , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Alcoolismo/tratamento farmacológico , Simulação de Acoplamento Molecular , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Receptores de GABA-A , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Suplementos Nutricionais , Hipnóticos e SedativosRESUMO
Byrsonima sericea is a species native to Brazil that is widely used in traditional medicine. The seed ethanol extract (SEE) had the highest content of total phenols (179.35â mg GAE g-1 extract) and flavonoids (10.42â mg QE g-1 extract) and was the most active in relation to antioxidant activity (DPPH: IC50 =4.25â µg mL-1 and ABTS: IC50 =4.82â µg mL-1 ). The peel/pulp ethanol extract (PEE) had the best anticholinesterase activity (IC50 =6.02â µg mL-1 ). Chromatographic investigation identified gallic acid, isoquercitrin, quercetin and amentoflavone in SEE, and gallic acid, isoquercitrin, quercetin and rutin in PEE. Six fatty acid methyl esters and seven triterpenes were identified, highlighting oleic acid in the seed hexane extract (61.85 %) and in the peel/pulp hexane extract (52.61 %), and betulin in the peel/pulp hexane extract (5.25 %). The substances and biological activities identified in B.â sericea characterize this fruit as a functional food for future studies.
Assuntos
Antioxidantes , Quercetina , Antioxidantes/química , Frutas/química , Hexanos , Fenóis/química , Flavonoides/química , Etanol , Ácido Gálico , Extratos Vegetais/químicaRESUMO
Objetivo: conhecer a experiência de manejo familiar da criança à espera de um transplante de órgãos sólidos de acordo com o Modelo de estilos de manejo familiar. Método: foi realizado um estudo qualitativo que utilizou o modelo supracitado como referencial teórico. Foram aplicadas entrevistas, de forma remota, a nove familiares de crianças que aguardavam por um transplante de órgãos. Os dados foram analisados através do modelo híbrido de análise temática. Resultados: as famílias definem que essa fase oscila entre o medo do transplante, da rejeição do órgão e possibilidade de morte em fila de espera, e a esperança na melhora do quadro clínico. Considerações finais: identificar as necessidades da família que aguarda por um transplante possibilita ao profissional de saúde implementar intervenções
Objective: to understand the family management experience of children waiting for a solid organ transplant in accordance with the Family Management Styles Model. Method: a qualitative study was carried out using the aforementioned model as a theoretical framework. Interviews were conducted remotely with nine family members of children waiting for an organ transplant. Data were analyzed using the hybrid thematic analysis model. Results: families define that this phase oscillates between fear of transplantation, organ rejection and the possibility of death on the waiting list, and hope for an improvement in the clinical condition. Final considerations: identifying the needs of the family waiting for a transplant allows the health professional to implement interventions
Objetivos:comprender la experiencia de gestión familiar de niños en espera de trasplante de órgano sólido de acuerdo con el Modelo de Estilos de Gestión Familiar. Método: se realizó un estudio cualitativo utilizando como marco teórico el modelo antes mencionado. Las entrevistas se realizaron de forma remota con nueve familiares de niños que esperaban un trasplante de órgano. Los datos se analizaron utilizando el modelo de análisis temático híbrido. Resultados: las familias definen que esta fase oscila entre el miedo al trasplante, el rechazo del órgano y la posibilidad de muerte en lista de espera, y la esperanza de mejora del cuadro clínico. Consideraciones finales: identificar las necesidades de la familia en espera de un trasplante permite al profesional de la salud implementar intervenciones
Assuntos
Humanos , Masculino , Feminino , Adulto , Enfermagem Pediátrica , Transplante de Órgãos , Familiares AcompanhantesRESUMO
Objetivo: conhecer a experiência de manejo familiar da criança à espera de um transplante de órgãos sólidos de acordo com o Modelo de estilos de manejo familiar. Método: foi realizado um estudo qualitativo que utilizou o modelo supracitado como referencial teórico. Foram aplicadas entrevistas, de forma remota, a nove familiares de crianças que aguardavam por um transplante de órgãos. Os dados foram analisados através do modelo híbrido de análise temática. Resultados: as famílias definem que essa fase oscila entre o medo do transplante, da rejeição do órgão e possibilidade de morte em fila de espera, e a esperança na melhora do quadro clínico. Considerações finais: identificar as necessidades da família que aguarda por um transplante possibilita ao profissional de saúde implementar intervenções
Objective: to understand the family management experience of children waiting for a solid organ transplant in accordance with the Family Management Styles Model. Method: a qualitative study was carried out using the aforementioned model as a theoretical framework. Interviews were conducted remotely with nine family members of children waiting for an organ transplant. Data were analyzed using the hybrid thematic analysis model. Results: families define that this phase oscillates between fear of transplantation, organ rejection and the possibility of death on the waiting list, and hope for an improvement in the clinical condition. Final considerations: identifying the needs of the family waiting for a transplant allows the health professional to implement interventions
Objetivos:comprender la experiencia de gestión familiar de niños en espera de trasplante de órgano sólido de acuerdo con el Modelo de Estilos de Gestión Familiar. Método: se realizó un estudio cualitativo utilizando como marco teórico el modelo antes mencionado. Las entrevistas se realizaron de forma remota con nueve familiares de niños que esperaban un trasplante de órgano. Los datos se analizaron utilizando el modelo de análisis temático híbrido. Resultados: las familias definen que esta fase oscila entre el miedo al trasplante, el rechazo del órgano y la posibilidad de muerte en lista de espera, y la esperanza de mejora del cuadro clínico. Consideraciones finales: identificar las necesidades de la familia en espera de un trasplante permite al profesional de la salud implementar intervenciones
Assuntos
Humanos , Masculino , Feminino , Enfermagem Pediátrica , Transplante de Órgãos , Apoio Familiar , CriançaRESUMO
OBJECTIVE: to assess the effectiveness and safety of the peripherally inserted central catheter for hematopoietic stem cell transplantation. METHOD: this review will follow the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and the search steps will be presented through the flow diagram. The search strategy aims to locate both published and unpublished studies. No time or language restrictions will be applied. The review will consider experimental and observational studies that include adult and pediatric patients undergoing hematopoietic stem cell transplantation. Patients using peripherally inserted central catheters will be compared with those using other central catheters.
Assuntos
Cateterismo Periférico , Transplante de Células-Tronco Hematopoéticas , Condicionamento Pré-TransplanteRESUMO
Ouratea fieldingiana, popularly known as batiputá, is a tree species easily found in the coastal part of northeastern Brazil. Its leaves are rich in biflavonoids, its major compound being amentoflavone. Biflavonoids are well studied due to their high antioxidant capacity. Alzheimer's disease (AD) is a disease characterized by the progressive loss of neurons. Currently, the pharmacological treatment of AD has four drugs: donepezil, galantamine, rivastigmine and memantine. Where these drugs, with the exception of memantine, are inhibitors of acetylcholinesterase, thus inhibiting the enzyme that destroys acetylcholine, thus increasing the availability of this neurotransmitter. This article aims to determine in vitro and in silico the antioxidant and anticholinesterase action of amentoflavone isolated from the leaves of Ouratea fieldingiana. The antioxidant capacity of amentoflavone was evaluated using the DPPH* free radical scavenging method, with an IC50 of 5.73 ± 0.08 µg/mL. The antiradical properties of the molecule were also studied in silico through several HAT, SET-PT and SPLET mechanisms via DFT M06-2X/6-311++G(d,p). It was found that in the hydrogen atom transfer mechanism (HAT) the best trend was obtained as an anti-radical mechanism. Amentoflavone has the ability to inhibit acetylcholinesterase when tested in vitro, having an IC50 of 8.68 ± 0.73 µg/mL, corroborating its effect in the in silico test, presenting four strong covalent hydrogen bonds for having a bond length up to 2.5 Å. Thus, amentoflavone is an important target for further testing against Alzheimer's disease. Communicated by Ramaswamy H. Sarma.
Assuntos
Doença de Alzheimer , Biflavonoides , Ochnaceae , Inibidores da Colinesterase/farmacologia , Antioxidantes/química , Biflavonoides/farmacologia , Biflavonoides/uso terapêutico , Doença de Alzheimer/tratamento farmacológico , Acetilcolinesterase , Memantina/uso terapêuticoRESUMO
BACKGROUND: Renal resistive index (RRI) and renal pulsatility index (RPI) are Doppler-based variables proposed to assess renal perfusion at the bedside in critically ill patients. This study aimed to assess the accuracy of such variables to predict acute kidney injury (AKI) in mechanically ventilated children. METHODS: Consecutive children aged <14 years underwent kidney Doppler ultrasound examination within 24 h of invasive mechanical ventilation. Renal resistive index (RRI) and renal pulsatility index (RPI) were measured. The primary outcome was severe AKI (KDIGO stage 2 or 3) on day 3. RESULTS: On day 3, 22 patients were classified as having AKI, of which 12 were severe. RRI could effectively predict severe AKI (area under the ROC curve [AUC] = 0.94) as well as RPI (AUC = 0.86). The optimal cut-off for RRI was 0.85 (sensitivity, 91.7%; specificity, 84.7%; PPV, 50.0%; and NPV, 98.4%). Similar results were obtained when the accuracy to predict AKI on day 5 was assessed. Significant correlations were observed between RRI and estimated glomerular filtration rate at enrollment (ρ = -0.495) and on day 3 (ρ = -0.467). CONCLUSIONS: Renal Doppler ultrasound may be a promising tool to predict AKI in critically ill children under invasive mechanical ventilation. IMPACT: Early recognition of acute kidney injury (AKI) is essential to promptly initiate supportive care aimed at restoring renal perfusion, which may prevent or attenuate acute tubular necrosis. Renal arterial Doppler-based parameters are rapid, noninvasive, and repeatable variables that may be promising for the prediction of AKI in children. To the best of our knowledge, this is the first study to evaluate the use of renal Doppler-based variables to predict AKI in critically ill children. The present study found that Doppler-based variables could accurately predict the occurrence of severe AKI and were correlated with urinary output and diuretic use.
Assuntos
Injúria Renal Aguda , Estado Terminal , Humanos , Criança , Rim/diagnóstico por imagem , Injúria Renal Aguda/diagnóstico por imagem , Injúria Renal Aguda/terapia , Ultrassonografia Doppler/métodos , UltrassonografiaRESUMO
Vitamin A is an essential micronutrient, especially during pregnancy. We aimed to assess the prevalence of vitamin A deficiency in Brazilian women of childbearing age. We conducted a systematic review with meta-analysis of studies that assessed vitamin A deficiency in women of childbearing age following the registered protocol (CRD42020171856). Independent peer researchers selected the studies retrieved from MEDLINE, Embase, Scopus and other sources. Data from the eligible studies were extracted in pairs and assessed for methodological quality. The prevalence of vitamin A deficiency (< 0·70 µmol/l or <0·20 µg/dl) and 95 % CI was combined by meta-analysis, and heterogeneity was estimated by I2. Out of 3610 screened records, thirty-two studies were included, which assessed 12 577 women from 1965 to 2017, mostly in maternity hospitals. Main limitations of the studies were in sample frame (30/32) and sampling method (29/32). Deficiency occurred in 13 % (95 % CI 9·4, 17·2 %; I² = 97 %) of all women and was higher in pregnant women (16·1 %; 95 % CI 5·6, 30·6 %; I² = 98 %) than non-pregnant women (12·3 %; 95 % CI 8·4, 16·8 %; I² = 96 %). The prevalence increased according to the decade, from 9·5 % (95 % CI 1·921·6 %; I² = 98 %) up to 1990, 10·8 % (95 % CI 7·9, 14·2 %; I² = 86 %) in the 2000s and 17·8 % (95 % CI 8·7, 29·0 %; I² = 98 %) in the 2010s. Over 10 % of Brazilian women in childbearing age were deficient in vitamin A. Higher prevalence was observed in pregnant women, and deficiency seemed to be increasing over the decades. Low representativeness of the studies, mainly based on convenience sampling that included pregnant, postpartum, lactating and non-pregnant women, as well as high heterogeneity, limits the findings.
Assuntos
Deficiência de Vitamina A , Humanos , Feminino , Gravidez , Deficiência de Vitamina A/epidemiologia , Brasil/epidemiologia , Vitamina A , Lactação , PrevalênciaRESUMO
Resumo Objetivo Adaptar e validar a The Humpty Dumpty Falls Scale para a cultura brasileira. Métodos Estudo metodológico, que seguiu, para a adaptação transcultural, os estágios de tradução, síntese, retrotradução, avaliação por especialistas, pré-teste e avaliação pela autora do instrumento original. Foram selecionadas 103 crianças/adolescentes internados em um hospital público do interior do estado de São Paulo. Foram utilizados ficha de caracterização, The Humpty Dumpty Falls Scale e o Instrumento de Classificação de Pacientes Pediátricos, o qual foi utilizado para avaliar a validade de construto, com o coeficiente de correlação de Spearman. A confiabilidade interobservador foi avaliada pelo Coeficiente de Correlação Intraclasse e pelo coeficiente Kappa. Resultados O comitê de 12 especialistas avaliou as equivalências, a clareza e a relevância dos itens e, após três rodadas, foi alcançado o percentual de 100% de concordância. As reformulações tornaram os itens mais compreensíveis e, após avaliação da autora, foi obtida a versão final do instrumento. Correlações positivas e significantes foram encontradas entre a Escala Humpty Dumpty e os domínios Paciente (r=0,5184; p<0,0001) e Procedimentos terapêuticos (r=0,2143; p<0,0332) do instrumento de classificação de pacientes. Com o domínio Família (r=0,0676; p=0,5060), não foram alcançadas relações significantes. Evidências satisfatórias de confiabilidade (Coeficiente de Correlação Intraclasse de 0,93 e coeficiente Kappa de 0,80) foram observadas. Conclusão The Humpty Dumpty Falls Scale foi adaptada transculturalmente, sendo denominada Ferramenta de Avaliação de Risco de Queda - Escala Humpty Dumpty. Demonstrou evidências satisfatórias de validade e confiabilidade para avaliar o risco de queda em crianças e adolescentes, no cenário brasileiro.
Resumen Objetivo Adaptar y validar The Humpty Dumpty Falls Scale para la cultura brasileña. Métodos Estudio metodológico, en el que se realizaron las siguientes etapas para la adaptación transcultural: traducción, síntesis, retrotraducción, evaluación por especialistas, prueba piloto y evaluación por la autora del instrumento original. Se seleccionaron 103 infantes/adolescentes internados en un hospital público del interior del estado de São Paulo. Se utilizó la ficha de caracterización, The Humpty Dumpty Falls Scale y el Instrumento de Clasificación de Pacientes Pediátricos, que se usó para evaluar la validad del constructo, con el coeficiente de correlación de Spearman. La fiabilidad interobservador fue evaluada por el coeficiente de correlación intraclase y por el coeficiente Kappa. Resultados El comité de 12 especialistas evaluó las equivalencias, la claridad y la relevancia de los ítems y, después de tres rondas, se llegó al 100 % de concordancia. Con las reformulaciones los ítems quedaron más comprensibles y, luego de la evaluación de la autora, se obtuvo la versión final de instrumento. Se observaron correlaciones positivas y significativas entre la Escala Humpty Dumpty y los dominios Paciente (r=0,5184; p<0,0001) y Procedimientos terapéuticos (r=0,2143; p<0,0332) del instrumento de clasificación de pacientes. En el dominio Familia (r=0,0676; p=0,5060) no se encontraron relaciones significativas. Se observaron evidencias satisfactorias de fiabilidad (coeficiente de correlación intraclase de 0,93 y coeficiente Kappa de 0,80). Conclusión The Humpty Dumpty Falls Scale fue adaptada transculturalmente y se la denominó Herramienta de Evaluación de Riesgo de Caída - Escala Humpty Dumpty. Demostró evidencias satisfactorias de validez y de fiabilidad para evaluar el riesgo de caída en infantes y adolescentes, en el contexto brasileño.
Abstract Objective To adapt and validate The Humpty Dumpty Scale for Brazilian culture. Methods Methodological study that followed the steps of translation, synthesis, back-translation, evaluation by specialists, pre-test and evaluation by the author of the original instrument for the cross-cultural adaptation. A total of 103 children/adolescents admitted to a public hospital in the countryside of the state of Sao Paulo were selected. We used a characterization form, The Humpty Dumpty Scale and the Pediatric Patient Classification Instrument, which was used to assess construct validity, with Spearman's correlation coefficient. Interobserver reliability was assessed using the Intraclass Correlation Coefficient and the Kappa coefficient. Results The committee of 12 experts evaluated the equivalence, clarity and relevance of the items and after three rounds, the percentage of 100% agreement was reached. The reformulations made the items more understandable and, after the author's evaluation, the final version of the instrument was obtained. Positive and significant correlations were found between The Humpty Dumpty Scale and the Patient (r=0.5184; p<0.0001) and Therapeutic Procedures (r=0.2143; p<0.0332) domains of the patient classification instrument. With the Family domain (r=0.0676; p=0.5060), no significant relationships were achieved. Satisfactory evidence of reliability (Intraclass Correlation Coefficient of 0.93 and Kappa coefficient of 0.80) was observed. Conclusion The Humpty Dumpty Scale was cross-culturally adapted and is now called (in Portuguese) the Ferramenta de Avaliação de Risco de Quedas - Escala Humpty Dumpty. It demonstrated satisfactory evidence of validity and reliability to assess the risk of falling in children and adolescents in the Brazilian context.
RESUMO
This study reports the biotechnological importance of seven Lippia albaspecimens collected in different places in Brazil, and evaluation of some activities as larvicidal against Aedes spp., antifungal against dermatophytes; cytotoxicity against SNB-19 (astrocytoma), HCT-116 (human colon) and PC-3 (human prostate) cancer cell lines, and inhibition of the enzyme acetylcholinesterase (AChE). The essential oils, whose extraction yield was about 1.24 w/w ± 0.9%, showed differences in their chemical composition and considered as chemotypes. The essential oils containing neral and geranial as main constituents showed better action against HCT-116 cell lines (IC50 value was 9.22 µg/mL), larvicidal activity against arbovirus vectors (LC50 value against A. aegypti was 1.59 µg/mL) and inhibition of AChE (halo inhibition zone was 1 cm). The essential oils containing mainly monoterpenoids showed better antifungal action with MIC values range from 0.15 to 1.25 mg/mL. This chemical and biological characterization may be useful for biotechnological applications.
Este estudio reporta la importancia biotecnológica de siete especímenes de Lippia alba recolectados en diferentes lugares de Brasil, y evaluación de algunas actividades como larvicida contra Aedes spp., Antifúngico contra dermatofitos; citotoxicidad contra líneas celulares de cáncer SNB-19 (astrocitoma), HCT-116 (colon humano) y PC-3 (próstata humana), e inhibición de la enzima acetilcolinesterasa (AChE). Los aceites esenciales, cuyo rendimiento de extracción fue de aproximadamente 1,24 p/p ± 0,9%, mostraron diferencias en su composición química y se consideraron quimiotipos. Los aceites esenciales que contienen neral y geranial como constituyentes principales mostraron una mejor acción contra las líneas celulares HCT-116 (el valor de CI50 fue de 9.22 µg/mL), actividad larvicida contra los vectores de arbovirus (el valor de LC50 contra A. aegypti fue de 1.59 µg/mL) e inhibición de AChE (la zona de inhibición del halo era de 1 cm). Los aceites esenciales que contienen principalmente monoterpenoides mostraron una mejor acción antifúngica con valores de CMI en el rango de 0.15 a 1.25 mg/mL. Esta caracterización química y biológica puede ser útil para aplicaciones biotecnológicas.
Assuntos
Óleos Voláteis/farmacologia , Óleos Voláteis/química , Lippia/química , Plantas Medicinais , Terpenos/análise , Biotecnologia , Brasil , Controle Biológico de Vetores , Inibidores da Colinesterase , Aedes/efeitos dos fármacos , Linhagem Celular Tumoral/efeitos dos fármacos , Larvicidas , Antifúngicos , Antineoplásicos/farmacologia , Antineoplásicos/químicaRESUMO
BACKGROUND: The use of checklists in the pediatric intensive care unit can help improve the quality of care and patient safety. OBJECTIVES: To build and validate a checklist for use in interprofessional rounds in a pediatric intensive care unit. METHODS: This methodological study was conducted in a 20-bed pediatric intensive care unit serving children up to 14 years old. A checklist prototype was constructed through review of the literature and achievement of consensus among the professionals providing care in the unit. Content validation was performed using a modified Delphi technique involving specialists with more than 5 years of experience in pediatric intensive care, methodological studies, and patient safety. Content validity ratios were calculated for the elements of the checklist, which were considered valid when they reached values greater than 0.78. The checklist was tested for usability, application time, and effects on patient care, and feedback was obtained from potential users. RESULTS: Before content validation, the checklist contained 11 domains, 32 items, and 6 daily goals. The invitation to validate content was sent to 86 specialists, and content validity was achieved after 2 rounds of evaluation, with the checklist elements having content validity ratios ranging from 0.94 to 0.97. The mean application time of the checklist was 5 minutes. The final version consisted of 11 domains, 33 items, and 8 daily goals. CONCLUSIONS: This study resulted in a useful and valid instrument for application in interprofessional rounds that was tailored to the needs of local health care professionals.
Assuntos
Lista de Checagem , Visitas de Preceptoria , Lista de Checagem/métodos , Criança , Cuidados Críticos/métodos , Humanos , Unidades de Terapia Intensiva Pediátrica , Segurança do PacienteRESUMO
OBJECTIVE: This review will evaluate the effectiveness of checklist use in multidisciplinary rounds, compared with multidisciplinary rounds without checklists, for improving mortality and patient safety in the pediatric intensive care unit. INTRODUCTION: Single studies have demonstrated that checklists can potentially improve communication of care between health professionals, reduce adverse events, and increase adherence to best practice guidelines. However, no systematic review of the literature has explored the use of checklists in the pediatric intensive care unit. INCLUSION CRITERIA: This review will consider studies that include pediatric patients, under 18âyears of age, admitted to a pediatric intensive care unit. Identified studies will compare the use of checklists in multidisciplinary rounds with multidisciplinary rounds with no checklists. The studies will also evaluate mortality and patient safety outcomes. We will consider experimental and observational studies, published in any language, with no date restrictions. METHODS: The search strategy will aim to locate both published and unpublished studies. Databases to be searched include MEDLINE, the Cochrane Library, Web of Science, LILACS, Scopus, Embase, CINAHL, the Center for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and Epistemonikos. The studies will be screened and those meeting the inclusion criteria will be retained by two independent researchers. Assessment of methodology and data extraction will then be carried out. The data will be presented using a narrative synthesis and the studies will be pooled with a statistical meta-analysis, where possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021233798.
Assuntos
Segurança do Paciente , Visitas de Preceptoria , Adolescente , Lista de Checagem , Criança , Hospitalização , Humanos , Unidades de Terapia Intensiva Pediátrica , Metanálise como Assunto , Literatura de Revisão como Assunto , Revisões Sistemáticas como AssuntoRESUMO
Leishmaniasis is a group of neglected diseases caused by parasites of the Leishmania genus. The treatment of Leishmaniasis represents a great challenge, because the available drugs present high toxicity and none of them is fully effective. Caryocar is a botanical genus rich in phenolic compounds, which leaves extracts have already been described by its antileishmanial action. Thus, we investigated the effect of pulp and peel extracts of the Caryocar coriaceum fruit on promastigote and amastigote forms of Leishmania amazonensis. Both extracts had antipromastigote effect after 24, 48, and 72 h, and this effect was by apoptosis-like process induction, with reactive oxygen species (ROS) production, damage to the mitochondria and plasma membrane, and phosphatidylserine exposure. Knowing that the fruit extracts did not alter the viability of macrophages, we observed that the treatment reduced the infection of these cells. Thereafter, in the in vitro infection context, the extracts showed antioxidant proprieties, by reducing NO, ROS, and MDA levels. Besides, both peel and pulp extracts up-regulated Nrf2/HO-1/Ferritin expression and increase the total iron-bound in infected macrophages, which culminates in a depletion of available iron for L. amazonensis replication. In silico, the molecular modeling experiments showed that the three flavonoids presented in the C. coriaceum extracts can act as synergistic inhibitors of Leishmania proteins, and compete for the active site. Also, there is a preference for rutin at the active site due to its greater interaction binding strength.Communicated by Ramaswamy H. Sarma.
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Antiprotozoários , Leishmania , Leishmaniose , Malpighiales , Animais , Antioxidantes/farmacologia , Antiprotozoários/farmacologia , Ferritinas/metabolismo , Ferritinas/farmacologia , Ferritinas/uso terapêutico , Flavonoides/farmacologia , Frutas , Humanos , Ferro/metabolismo , Leishmaniose/tratamento farmacológico , Malpighiales/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Fator 2 Relacionado a NF-E2/metabolismo , Fosfatidilserinas/metabolismo , Fosfatidilserinas/farmacologia , Fosfatidilserinas/uso terapêutico , Espécies Reativas de Oxigênio/metabolismo , Rutina/farmacologia , Rutina/uso terapêuticoRESUMO
Insect resistance and environmental pollution are among the drawbacks of continuous use of synthetic insecticides against the vectors of dengue, Aedesaegypti and Aedes albopictus. The objective of this study was to analyze the composition of the essential oil of Lippia grata Schauer collected from plants, in three periods of the year, to compare the larvicidal activity and enzymatic inhibition of the dengue vectors. The oilsanalyzed by gas chromatography coupled to mass spectrometry (GC-MS), presented thymol and 1,8-cineole, as the main constituents, in all three periods. This composition was different from that found in previous studies of the species from different places, thus, suggesting a new chemotype of Lippia grata. Larvicidal tests were performed at concentrations of 100, 75, 50, 25, and 12.5 µg.mL-1 and the essential oil from the rainy season showed the best results, with LC50 of 22.79 µg.mL-1 and 35.36 µg.mL-1 against Ae. aegypti and Ae. albopictus, respectively; this result was better than other reports. In the rainy period, however, there was a greater variety of components, which led to a better larvicidal effect, possibly due to synergistic action with minor constituents. Total proteins, amylases, and acetylcholinesterase of both species were inhibited by the oils.
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AIM: To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes. DESIGN: A cross-sectional and correlational study, using a structural equation model. METHODS: One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R2 ), the predictive validity coefficient (Q2 ) and the effect size (f2 ). RESULTS: The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10). CONCLUSION: The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations. IMPACT: This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.
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Esgotamento Profissional , Recursos Humanos de Enfermagem Hospitalar , Médicos , Brasil , Estudos Transversais , Humanos , Satisfação no Emprego , Liderança , Relações Médico-Enfermeiro , Recursos HumanosRESUMO
STATEMENT OF PROBLEM: Data comparing the fatigue performance of adhesively luted glass or polycrystalline ceramic systems for computer-aided design and computer-aided manufacturing (CAD-CAM) are scarce. PURPOSE: The purpose of this in vitro study was to evaluate and compare the fatigue performance of monolithic crowns manufactured from glass or polycrystalline CAD-CAM ceramic systems adhesively luted to a dentin analog. MATERIALS AND METHODS: Fifty-four pairs of standardized preparations of dentin analog (NEMA Grade G10) and simplified ceramic crowns of 1.5-mm thickness were obtained with 3 ceramic materials: lithium disilicate (LD) glass-ceramic (IPS e.max CAD); zirconia-reinforced lithium silicate (ZLS) glass-ceramic (Vita Suprinity); and translucent yttrium fully stabilized polycrystalline zirconia (Trans YZ) (Prettau Anterior). The simplified crowns (n=15) were adhesively cemented onto the preparations and subjected to step-stress fatigue test (initial load of 400 N, 20 Hz, 10 000 cycles, followed by 100-N increment steps until failure). Collected data (fatigue failure load [FFL] and cycles for failure [CFF]) were submitted to survival analysis with the Kaplan-Meier and Mantel-Cox post hoc tests (α=.05) and to Weibull analysis (Weibull modulus and its respective 95% confidence interval). Failed crowns were submitted to fractography analysis. The surface characteristics of the internal surface (roughness, fractal dimension) of additional crowns were accessed, and the occlusal cement thickness obtained in each luted system was measured. RESULTS: Trans YZ crowns presented the highest values of FFL, CFF, and survival rates, followed by ZLS and LD (mean FFL: 1740 N>1187 N>987 N; mean CFF: 149 000>92 613>73 667). Weibull modulus and cement thickness were similar for all tested materials. LD presented the roughest internal surface, followed by ZLS (mean Ra: 226 nm>169 nm>93 nm). The LD and ZLS internal surfaces also showed higher fractal dimension, pointing to a more complex surface topography (mean fractal dimension: 2.242=2.238>2.147). CONCLUSIONS: CAD-CAM monolithic crowns of Trans YZ show the best fatigue performance. In addition, ZLS crowns also showed better performance than LD crowns.
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Cerâmica , Porcelana Dentária , Desenho Assistido por Computador , Coroas , Falha de Restauração Dentária , Análise do Estresse Dentário , Teste de Materiais , Propriedades de SuperfícieRESUMO
The frequency of Alzheimer's disease (AD) is growing rapidly with longer life expectancy and the consequent increase of people with a high risk of neurodegenerative diseases. Anacardic acid (AA) has several pharmacological actions, such as antioxidants, anticholinesterase, and anti-inflammatory, which are related to the protection against aging disorders. Also, the metals copper and zinc are co-factors of antioxidant enzymes that can be associated with AA to improve brain-protective action. This study aimed to evaluate the potential of AA metal complexes using copper and zinc chelators to produce potential agents against Alzheimer's disease. For this purpose, Cu and Zn were linked to AA in the ratio of 1:1 in a basic medium. The complexes' formation was confirmed by ultraviolet and visible spectroscopy. The toxicity was evaluated in the zebrafish model, and other information related to AD was obtained using the zebrafish model of anxiety. AA-Zn and AA-Cu complexes showed better antioxidant action than free AA. In the anti-AChE activity, AA was like the AA-Cu complex. In models using adult zebrafish, no toxicity for AA complexes was found, and in the locomotor model, AA-Cu demonstrated possible anxiolytic action. In in silico experiments comparing AA and AA-Cu complex, the coupling energy with the enzyme was lower for the AA-Cu complex, showing better interaction, and also the distances of the active site amino acids with this complex were lower, similar to galantamine, the standard anti-AChE inhibitor. Thus, AA-Cu showed interesting results for more detailed study in experiments related to Alzheimer's disease.
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Ácidos Anacárdicos/administração & dosagem , Antioxidantes/administração & dosagem , Inibidores da Colinesterase/administração & dosagem , Doença de Alzheimer , Ácidos Anacárdicos/química , Animais , Antioxidantes/química , Quelantes/química , Quelantes/farmacologia , Inibidores da Colinesterase/química , Cobre/química , Cobre/farmacologia , Simulação de Acoplamento Molecular , Peixe-Zebra , Zinco/química , Zinco/farmacologiaRESUMO
Essential oils (EOs) are bioactive compounds with therapeutic potential for use as alternatives or as support to conventional treatments. However, EOs present limitations, such as sensibility to environmental factors, which can be overcome through microencapsulation. The objective of this study was to produce, by spray drying, chitosan microparticles (CMs) loaded with EO of Lemongrass (Cymbopogon flexuosus), Geranium (Pelargonium x ssp) and Copaiba (Copaifera officinalis). Physicochemical and biological characterization of these microparticles showed that CMs presented spherical morphology, had an average size range of 2-3 µm with positive zeta potential (ZP) values, and enhanced thermal stability, compared to free EO. The encapsulation efficiency (EE) ranged from 4.8-58.6%, depending on the oil's properties. In vitro EO release from CMs was determined at different pHs, with 94% release observed in acid media. All microparticles were non-hemolytic at concentrations of up to 0.1 mg·mL-1. EOs and CMs presented acetylcholinesterase (AChE) inhibition activity (IC 50 ranged from 11.92 to 28.18 µg·mL-1). Geranium and Copaiba EOs presented higher toxicity against Artemia salina, and greater inhibition of acetylcholinesterase, indicating potential bioactivity for Alzheimer's disease (AD). Our findings demonstrate that CM systems may show promise for the controlled release of these EOs.