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Introdução: os programas liderados por enfermeiros desempenham um papel fundamental no engajamento do indivíduo na autogestão do diabetes mellitus tipo 2 (DM2), pois impactam na melhoria da qualidade de vida. A autogestão apoiada pelo suporte social torna-se crucial, sobretudo por descrever a importância do enfermeiro na promoção da saúde da pessoa com DM2, tendo em vista que essa intervenção pode contribuir para reduzir as consequências e os agravamentos da doença. Objetivo: mapear os programas com foco no suporte social para pessoas com DM2 liderados por enfermeiros. Materiais e método: revisão de escopo que seguiu as diretrizes metodológicas do Joanna Briggs Institute. Utilizou-se como descritores de busca "autocuidado", "intervenção liderada por enfermeiro", "diabetes mellitus tipo 2", com busca nos bancos de dados Web of Science, Medline, CINAHL, Catálogo de Teses e Dissertações da Capes, Scopus, JBI Evidence Synthesis, PsycINFO e Repositórios Científicos de Acesso Aberto de Portugal, entre fevereiro e março de 2022. Os critérios de elegibilidade foram estudos publicados nos últimos 10 anos, em inglês, espanhol e português, abrangendo a experiência do indivíduo em programas com foco na autogestão por meio do suporte social liderados por enfermeiros. Resultados: 12 estudos incluídos, publicados nos Estados Unidos, na Inglaterra e no Irã, com foco no suporte social de apoio à autogestão de pessoas com DM2 e com concentração em locais de atendimento às pessoas com doenças crônicas. Observou-se que a maioria dos programas liderados por enfermeiros é implementada em países desenvolvidos e apresenta como característica principal ênfase na teoria social cognitiva. O público se caracterizou por ser maioria mulheres, faixa etária de adultos maiores de 22 anos, com baixa escolaridade. Conclusões: o estudo respondeu ao objetivo proposto ao demonstrar que, apesar do baixo custo para a implementação com alta devolutiva social e econômica, ainda é considerado escasso o desenvolvimento desses programas. Reitera-se a necessidade de estudos posteriores com ênfase nos níveis emocionais, como depressão e ansiedade.

Introducción: los programas dirigidos por enfermeras desempeñan un papel fundamental a la hora de implicar a las personas en el autocontrol de la diabetes mellitus tipo 2 (DM2), ya que repercuten en la mejora de la calidad de vida. El autocontrol respaldado por el apoyo social es crucial, especialmente porque describe la importancia de los profesionales de enfermería en la promoción de la salud de las personas con diabetes mellitus tipo 2 (DM2), dado que esta intervención puede ayudar a reducir las consecuencias y el empeoramiento de la enfermedad. Objetivo: mapear los programas centrados en el apoyo social para personas con DM2 dirigidos por enfermeros. Materiales y método: una revisión de alcance que siguió las directrices metodológicas del Instituto Joanna Briggs. Los descriptores de búsqueda utilizados fueron "autocuidado", "intervención dirigida por enfermeros", "diabetes mellitus tipo 2", con búsqueda en la Web of Science, Medline, CINAHL, Catálogo de Tesis y Disertaciones de la Capes [Coordinación de Perfeccionamiento de Personal de Nivel Superior], Scopus, JBI Evidence Synthesis, PsycINFO y Repositorios Científicos de Acceso Abierto de Portugal, entre febrero y marzo de 2022. Los criterios de elegibilidad fueron estudios publicados en los últimos 10 años, en inglés, español y portugués, que cubrieran la experiencia individual de programas dirigidos por profesionales de enfermería centrados en la autogestión a través del apoyo social. Resultados: se incluyeron 12 estudios, publicados en Estados Unidos, Inglaterra e Irán, centrados en el apoyo social para la autogestión de personas con DM2 y en entornos de atención a personas con enfermedades crónicas. Se observó que la mayoría de los programas dirigidos por enfermeros se aplican en países desarrollados y tienen como característica principal el énfasis en la teoría cognitiva social. El público se caracterizó por ser mayoritariamente femenino, mayor de 22 años y con bajo nivel de estudios. Conclusiones: el estudio respondió al objetivo propuesto demostrando que, a pesar del bajo costo de implementación con alto retorno social y económico, el desarrollo de estos programas aún es considerado escaso. Se reitera la necesidad de nuevos estudios que enfaticen niveles emocionales como la depresión y la ansiedad.

Introduction: Nurse-led programs have a determinant role in the engagement of individuals in the self-management of type 2 diabetes mellitus (T2DM), as they contribute to improving quality of life. Self-management assisted by social support is vital, especially as it describes the importance of nurses in promoting health for people with T2DM, as this intervention can help reduce the consequences and progression of the disease. Objective: To map programs focused on nurse-led social support for people with T2DM. Materials and Methods: This is a scoping review in line with the methodological guidelines of the Joanna Briggs Institute. The search descriptors used were "autocuidado" (self-care), "intervenção liderada por enfermeiro" (nurse-led intervention), and "diabetes mellitus tipo 2" (type 2 diabetes mellitus), with searches in the Web of Science, Medline, CINAHL, Capes Theses and Dissertations Catalog, Scopus, JBI Evidence Synthesis, PsycINFO, and the Portuguese Open Access Scientific Repositories databases conducted between February and March 2022. The eligibility criteria were studies published within the last 10 years, in English, Spanish, and Portuguese, covering the individual's experience in programs focused on self-management through nurse-led social support. Results: A total of 12 studies were included, all of which were published in the United States, England, and Iran, focusing on social support for self-management in people with T2DM, and centered on care facilities for people with chronic diseases. It was found that most nurse-led programs have been implemented in developed countries and that their main characteristic is their emphasis on social cognitive theory. The population was characterized by being mostly women, aged over 22, with a low level of education. Conclusions: The study met the proposed objective by demonstrating that, despite the low implementation cost with high social and economic returns, the development of these programs is still scarce. The need for further studies focusing on emotional levels, such as depression and anxiety, is highlighted.

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Abstract Background and objectives: Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting. Methods: Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient's motor function improvement. The secondary outcome was patient satisfaction. Results: A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient's global impression of change superior to six. Conclusion: This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients' satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

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The mammarenavirus Junín (JUNV) is the causative agent of Argentine hemorrhagic fever, a severe disease of public health concern. The most abundant viral protein is the nucleoprotein (NP), a multifunctional, two-domain protein with the primary role as structural component of the viral nucleocapsids, used as template for viral polymerase RNA synthesis activities. Here, we report that the C-terminal domain (CTD) of the attenuated Candid#1 strain of the JUNV NP can be purified as a stable soluble form with a secondary structure in line with known NP structures from other mammarenaviruses. We show that the JUNV NP CTD interacts with the viral matrix protein Z in vitro, and that the full-length NP and Z interact with each other in cellulo, suggesting that the NP CTD is responsible for this interaction. This domain comprises an arrangement of four acidic residues and a histidine residue conserved in the active site of exoribonucleases belonging to the DEDDh family. We show that the JUNV NP CTD displays metal-ion-dependent nuclease activity against DNA and single- and double-stranded RNA, and that this activity is impaired by the mutation of a catalytic residue within the DEDDh motif. These results further support this activity, not previously observed in the JUNV NP, which could impact the mechanism of the cellular immune response modulation of this important pathogen.

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Emery-Dreifuss muscular dystrophy is a rare hereditary neuromuscular disease. Its manifestations begin primarily in childhood. The most frequent manifestations are progressive muscle weakness, atrophy that usually begins in the scapula-vertebral region, extending later to the pelvic girdle, and spinal stiffness. Patients can also manifest cardiac involvement as palpitations, syncope, exercise intolerance, congestive heart failure, and variable heart rhythm disturbances. 1 - 3 The presence and severity of these manifestations can vary according to the individual and the disease's subtypes. 2 Cardiac involvement is the most worrisome feature of this disease, and there are some reports of the need for heart transplantation in this dystrophy. 4.

A distrofia muscular de Emery-Dreifuss é uma doença neuromuscular hereditária rara. Suas manifestações começam principalmente na infância. As manifestações mais frequentes são fraqueza muscular progressiva, atrofia que geralmente se inicia na região escápulo-vertebral, estendendo-se posteriormente para a cintura pélvica e rigidez da coluna vertebral. Os pacientes também podem manifestar envolvimento cardíaco como palpitações, síncope, intolerância ao exercício, insuficiência cardíaca congestiva e distúrbios variáveis do ritmo cardíaco. 1 - 3 A presença e a gravidade dessas manifestações podem variar de acordo com o indivíduo e os subtipos da doença. 2 O envolvimento cardíaco é a característica mais preocupante desta doença, havendo alguns relatos da necessidade de transplante cardíaco nesta distrofia. 4.

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Abstract Burning mouth syndrome is a poorly understood entity for which current treatment modalities fail to provide effective relieve. Branches of the maxillary and mandibular nerves are responsible for the innervation of the affected area. These are also the nerves involved in trigeminal neuralgia, an entity where sphenopalatine block has proved to be effective. We present a case of a patient with burning mouth syndrome in whom a bilateral sphenopalatine ganglion block was successfully performed for pain treatment. It is an easy and safe technique that can be a valuable treatment option for these patients, although more studies are needed.

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Burning mouth syndrome is a poorly understood entity for which current treatment modalities fail to provide effective relieve. Branches of the maxillary and mandibular nerves are responsible for the innervation of the affected area. These are also the nerves involved in trigeminal neuralgia, an entity where sphenopalatine block has proved to be effective. We present a case of a patient with burning mouth syndrome in whom a bilateral sphenopalatine ganglion block was successfully performed for pain treatment. It is an easy and safe technique that can be a valuable treatment option for these patients, although more studies are needed.

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Resumo A distrofia muscular de Emery-Dreifuss é uma doença neuromuscular hereditária rara. Suas manifestações começam principalmente na infância. As manifestações mais frequentes são fraqueza muscular progressiva, atrofia que geralmente se inicia na região escápulo-vertebral, estendendo-se posteriormente para a cintura pélvica e rigidez da coluna vertebral. Os pacientes também podem manifestar envolvimento cardíaco como palpitações, síncope, intolerância ao exercício, insuficiência cardíaca congestiva e distúrbios variáveis do ritmo cardíaco. 1 - 3 A presença e a gravidade dessas manifestações podem variar de acordo com o indivíduo e os subtipos da doença. 2 O envolvimento cardíaco é a característica mais preocupante desta doença, havendo alguns relatos da necessidade de transplante cardíaco nesta distrofia. 4

Abstract Emery-Dreifuss muscular dystrophy is a rare hereditary neuromuscular disease. Its manifestations begin primarily in childhood. The most frequent manifestations are progressive muscle weakness, atrophy that usually begins in the scapula-vertebral region, extending later to the pelvic girdle, and spinal stiffness. Patients can also manifest cardiac involvement as palpitations, syncope, exercise intolerance, congestive heart failure, and variable heart rhythm disturbances.1 - 3 The presence and severity of these manifestations can vary according to the individual and the disease's subtypes. 2 Cardiac involvement is the most worrisome feature of this disease, and there are some reports of the need for heart transplantation in this dystrophy. 4

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Junín virus (JUNV) belongs to the Arenaviridae family and is the causative agent of Argentine hemorrhagic fever (AHF), a severe human disease endemic to agricultural areas in Argentina. At this moment, there are no effective antiviral therapeutics to battle pathogenic arenaviruses. Cumulative reports from recent years have widely provided information on cellular factors playing key roles during JUNV infection. In this review, we summarize research on host molecular determinants that intervene in the different stages of the viral life cycle: viral entry, replication, assembly and budding. Alongside, we describe JUNV tight interplay with the innate immune system. We also review the development of different reverse genetics systems and their use as tools to study JUNV biology and its close teamwork with the host. Elucidating relevant interactions of the virus with the host cell machinery is highly necessary to better understand the mechanistic basis beyond virus multiplication, disease pathogenesis and viral subversion of the immune response. Altogether, this knowledge becomes essential for identifying potential targets for the rational design of novel antiviral treatments to combat JUNV as well as other pathogenic arenaviruses.

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La vacunación contra la COVID-19 es una medida de prevención clave para reducir la tasa de contagios, contribuir con la inmunidad de rebaño y disminuir la severidad del cuadro clínico. Objetivos: Investigar la aceptación a la vacunación contra la COVID-19 y los factores determinantes en usuarios desde 18 años en el Ambulatorio Urbano tipo I "El Ujano" en Barquisimeto, Venezuela. Métodos: Se realizó un estudio descriptivo transversal, con una muestra no probabilística accidental de 276 usuarios en octubre-noviembre de 2021. La técnica de recolección utilizada fue la entrevista guiada y se formuló como instrumento de recolección de datos un cuestionario estructurado. El análisis fue de tipo descriptivo, usando medidas de frecuencia absolutas y relativas. Resultados: El 87,3 % aceptó la vacuna, prevaleciendo en ambos sexos y todos los grupos etarios. Independientemente del grado de instrucción de los encuestados, predominó el alto nivel de conocimiento sobre la COVID-19 y su prevención en un 60,2 %. La principal fuente de información fue la televisión (54,8 %). La presencia del antecedente patológico de infección por la COVID-19 personal, familiar o de conocidos se demostró en 81,2 % de los usuarios, de los cuales 53,3 % reportaron familiares o conocidos fallecidos debido a esta enfermedad. La principal causa de rechazo (12,7 %) a la vacunación fue "las personas enferman de COVID-19 cuando se vacunan" (31,4 %). Conclusiones: Este estudio aporta datos para la elaboración de planes que incentiven la aceptación de la vacunación como medida de prevención y de esta manera influir positivamente en el control de la pandemia.

Vaccination against COVID-19 is a key preventive measure to reduce the rate of infection, contribute to herd immunity and reduce the severity of the clinical presentation. Objectives: To investigate the acceptance of vaccination against COVID-19 and the determining factors in users from 18 years of age in the Urban Ambulatory type I "El Ujano" in Barquisimeto, Venezuela. Methods: A cross-sectional descriptive study was conduced with an accidental non-probabilistic sample made up of 276 users in October-November 2021. The collection technique used was the guided interview and a structured questionnaire was formulated as a data collection tool. The analysis was descriptive, using absolute and relative frequency measures. Results: 87,3 % accepted the vaccine, prevailing in both sexes and all age groups. Regardless of the level of education of the respondents, the high level of knowledge about COVID-19 and its prevention prevailed in 60,2 %. The main source of information was television (54,8 %). The presence of a pathological history of infection by personal, family or known COVID-19 was demonstrated in 81,2 % of users, of which 53,3 % reported relatives or acquaintances who died due to this disease. The main cause of rejection (12,7 %) to vaccination was "people get sick with COVID-19 when they are vaccinated" (31,4 %). Conclusions: this study provides data for the development of plans that encourage the acceptance of vaccination as a prevention measure and thus positively influence the control of the pandemic.

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Resumo Este artigo trata da comunicação que os Tribunais de Contas (TCs) e os Ministérios Públicos (MPs) brasileiros promovem nas redes sociais Facebook, Twitter e Instagram, desde a abertura de suas contas. Inova na discussão a respeito do controle democrático sobre a administração pública com foco na chamada "democracia digital", mostrando que os controladores também precisam se preocupar com a transparência e responsabilização nesses espaços. Tendo verificado que os TCs e os MPs mantêm departamentos profissionais de comunicação que operam intensamente nas redes sociais, com destaque para o TC da União (TCU) e o MP Federal (MPF) no Twitter, este trabalho analisa, de forma específica, o conteúdo da comunicação das duas instituições nessa rede, com a ajuda do software Iramuteq. Tanto o TCU como o MPF mantiveram intensa atividade de postagem de conteúdos diversos no Twitter, desde a abertura de suas contas e em momentos importantes da história política recente. A pergunta que orienta o trabalho é: ampliar os canais de comunicação significa necessariamente maior accountability? O que se constatou é que, ao se apresentar mais à sociedade pelos meios digitais, esses órgãos de controle não necessariamente responderam aos requisitos de responsabilização pública presentes na teoria democrática.

Resumen Este artículo trata de la comunicación que los Tribunales de Cuentas (TC) y los Ministerios Públicos (MP) brasileños promueven en las redes sociales Facebook, Twitter e Instagram, desde la apertura de sus cuentas. Innova en la discusión acerca de los controles democráticos sobre la administración pública en la llamada "democracia digital", mostrando que los controladores también deben preocuparse por su transparencia y rendición de cuentas. Habiendo comprobado que mantienen departamentos de comunicación profesional que operan intensamente en las redes sociales, con énfasis en el Tribunal de Cuentas de la Unión (TCU) y el Ministerio Público Federal (MPF) en Twitter, el artículo analiza específicamente el contenido de la comunicación entre las dos instituciones en esta red con la ayuda del software Iramuteq. Tanto el TCU como el MPF mantuvieron sus intensas actividades de publicación de contenidos varios en Twitter desde la apertura de sus cuentas y en momentos importantes de la historia política reciente. La pregunta que guía el trabajo es: ¿expandir los canales de comunicación significa necesariamente una mayor accountability? Lo que se encontró es que, al presentarse más a la sociedad a través de los medios digitales, estos organismos de control no respondían necesariamente a los requerimientos de rendición pública de cuentas presentes en la teoría democrática.

Abstract This article deals with the communication of Brazilian Courts of Accounts and Prosecution Services on social media platforms Facebook, Twitter, and Instagram, since the opening of their accounts. The study innovates in the discussion about democratic controls over public administration in the so-called "digital democracy," focusing on institutional communication of Courts of Accounts and Prosecution Services, showing that controllers also need to be concerned about their transparency and accountability. Having verified that they maintain professional communication departments that operate intensively on social media, with emphasis on the Federal Court of Accounts (TCU) and the Federal Prosecution Service (MPF) on Twitter, the article specifically analyzes the content of the two institutions' communication in this platform by using the Iramuteq software. Both TCU and MPF kept posting a variety of content on Twitter since first opening their accounts and at important moments in recent political history. The research question addressed was: Does expanding communication channels necessarily mean greater accountability? The study found that these institutions, when communicating with society on social media, did not necessarily respond to the public accountability requirements that democratic theory implies.

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Viruses have evolved precise mechanisms for using the cellular physiological pathways for their perpetuation. These virus-driven biochemical events must be separated in space and time from those of the host cell. In recent years, granular structures, known for over a century for rabies virus, were shown to host viral gene function and were named using terms such as viroplasms, replication sites, inclusion bodies, or viral factories (VFs). More recently, these VFs were shown to be liquid-like, sharing properties with membrane-less organelles driven by liquid-liquid phase separation (LLPS) in a process widely referred to as biomolecular condensation. Some of the best described examples of these structures come from negative stranded RNA viruses, where micrometer size VFs are formed toward the end of the infectious cycle. We here discuss some basic principles of LLPS in connection with several examples of VFs and propose a view, which integrates viral replication mechanisms with the biochemistry underlying liquid-like organelles. In this view, viral protein and RNA components gradually accumulate up to a critical point during infection where phase separation is triggered. This yields an increase in transcription that leads in turn to increased translation and a consequent growth of initially formed condensates. According to chemical principles behind phase separation, an increase in the concentration of components increases the size of the condensate. A positive feedback cycle would thus generate in which crucial components, in particular nucleoproteins and viral polymerases, reach their highest levels required for genome replication. Progress in understanding viral biomolecular condensation leads to exploration of novel therapeutics. Furthermore, it provides insights into the fundamentals of phase separation in the regulation of cellular gene function given that virus replication and transcription, in particular those requiring host polymerases, are governed by the same biochemical principles.

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BACKGROUND AND OBJECTIVES: Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting. METHODS: Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient's motor function improvement. The secondary outcome was patient satisfaction. RESULTS: A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient's global impression of change superior to six. CONCLUSION: This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients' satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

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Mammarenaviruses are enveloped and segmented negative-stranded RNA viruses that comprise several pathogenic members associated with severe human hemorrhagic fevers. Tacaribe virus (TCRV) is the prototype for the New World group of mammarenaviruses and is not only naturally attenuated but also phylogenetically and antigenically related to all South American pathogenic mammarenaviruses, particularly the Junín virus (JUNV), which is the etiological agent of Argentinian hemorrhagic fever (AHF). Moreover, since TCRV protects guinea pigs and non-human primates from lethal challenges with pathogenic strains of JUNV, it has already been considered as a potential live-attenuated virus vaccine candidate against AHF. Here, we report the development of a reverse genetic system that relies on T7 polymerase-driven intracellular expression of the complementary copy (antigenome) of both viral S and L RNA segments. Using this approach, we successfully recovered recombinant TCRV (rTCRV) that displayed growth properties resembling those of authentic TCRV. We also generated a chimeric recombinant TCRV expressing the JUNV glycoproteins, which propagated similarly to wild-type rTCRV. Moreover, a controlled modification within the S RNA 5' non-coding terminal sequence diminished rTCRV propagation in a cell-type dependent manner, giving rise to new perspectives where the incorporation of additional attenuation markers could contribute to develop safe rTCRV-based vaccines against pathogenic mammarenaviruses.

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Lassa virus (LASV) is the causative agent of Lassa fever, a human hemorrhagic disease associated with high mortality and morbidity rates, particularly prevalent in West Africa. Over the past few years, a significant amount of novel information has been provided on cellular factors that are determinant elements playing a role in arenavirus multiplication. In this review, we focus on host proteins that intersect with the initial steps of the LASV replication cycle: virus entry and genome replication. A better understanding of relevant virus⁻host interactions essential for sustaining these critical steps may help to identify possible targets for the rational design of novel therapeutic approaches against LASV and other arenaviruses that cause severe human disease.

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El Síndrome del Anillo del Cromosoma 18 (18 [(r)18]) es un trastorno cromosómico que se incluye dentro de las anomalías estructurales desequilibradas donde dicho cromosoma se encuentra en forma de anillo el cual resulta de la pérdida simultánea de ambos segmentos terminales de los brazos corto y largo con la subsecuente fusión de sus extremos, constituyendo una estructura circular que microscópicamente se asemeja a un anillo, de allí su nomenclatura r (del inglés ring, que significa anillo). Tiene una incidencia de 1/40.000 nacidos vivos y hasta la fecha se han reportado aproximadamente entre 80 a 100 casos a nivel mundial sin embargo sólo existen alrededor de nueve reportes de r(18) en mosaico, aislado o asociado con otras alteraciones cromosómicas. A continuación, se presenta el caso de una paciente pediátrica con Síndrome del Anillo del cromosoma 18 estudiado y diagnosticado en la Unidad de Genética Médica de la Universidad Centroccidental Lisandro Alvarado en Barquisimeto, Venezuela, con la correspondiente revisión de la literatura relacionada con este síndrome(AU)

Chromosome 18 Ring Syndrome (18 [(r) 18]) is a chromosomal disorder that is included among the unbalanced structural anomalies in which chromosome 18 has a ring form which results from the simultaneous loss of both terminal segments of the short and long arms with the subsequent fusion of their ends forming a circular structure that microscopically resembles a ring, hence its nomenclature r (of the English ring, which means ring).18r Syndrome has an incidence of 1/40,000 live births; to date approximately 80-100 cases worldwide have been reported. There are only about nine reports of r(18) in mosaic, isolated or associated with other chromosomal alterations. We present a case of a pediatric patient with Chromosome 18 Ring Syndrome, evaluated and diagnosed in the Unidad de Genética Médica of the Universidad Centroccidental Lisandro Alvarado in Barquisimeto, Venezuela with the corresponding review of the literature(AU)

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Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL) and depot (vial) methylprednisolone (20 mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Resumo Justificativa e objetivos: O bloqueio da fáscia do músculo quadrado lombar foi descrito por R. Blanco nas suas duas abordagens (I e II). A deposição de anestésico local nessa localização pode conferir bloqueio dos dermátomos T6-L1. Os autores fizeram esse bloqueio de fáscia, guiado por ultrassom, para tratamento de uma dor crônica neuropática da parede abdominal. Relato de caso: Paciente do gênero masculino, 61 anos, 83 kg, com antecedentes de trombocitopenia por hepatopatia alcoólica, entre outros, apresentava dor crônica da parede abdominal após hernioplastias abdominais múltiplas havia um ano e meio, com má resposta ao tratamento com neuromoduladores e opioides. No exame clínico, apresentava uma dor neuropática, com predomínio de alodinia ao toque, que abrangia toda a parede abdominal anterior, desde os dermátomos T7 a T12. Optou-se pela realização de um bloqueio do quadrado lombar tipo II bilateral, guiado por ultrassom, com administração de 25 mL de ropivacaína 0,2% e 20 mg de metilprednisolona depot (ampola) em cada um dos lados. O procedimento conferiu alívio imediato da sintomatologia e, após seis meses, o paciente mantinha redução significativa da alodinia, sem compromisso da qualidade de vida. Conclusões: Os autores consideram que a realização do bloqueio do quadrado lombar tipo II foi uma opção analgésica relevante no tratamento de um paciente com dor crônica pós-hernioplastia abdominal e salientaram os efeitos da dispersão do anestésico local até o espaço paravertebral torácico. A técnica mostrou ser segura e bem tolerada. É desejável a publicação de mais casos clínicos que reproduzam a eficácia desse bloqueio no contexto de dor crônica.

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RESUMO

BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient; 61 years old; 83kg; with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

RESUMO

BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient, 61 years old, 83kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

Assuntos