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BACKGROUND/OBJECTIVES: Sickle cell anemia (SCA) is marked by hypoxia, inflammation, and secondary iron overload (IO), which potentially modulate hepcidin, the pivotal hormone governing iron homeostasis. The aim was to evaluate the iron incorporation in red blood cells (RBC) in SCA pediatric patients, considering the presence or absence of IO. SUBJECTS/METHODS: SCA children (n = 12; SCAtotal) ingested an oral stable iron isotope (57Fe) and iron incorporation in RBC was measured after 14 days. Patients with ≥1000 ng/mL serum ferritin were considered to present IO (SCAio+; n = 4) while the others were classified as being without IO (SCAio-; n = 8). Liver iron concentration (LIC) was determined by Magnetic Resonance Imaging (MRI) T2* method. RESULTS: The SCAio+ group had lower iron incorporation (mean ± SD: 0.166 ± 0.04 mg; 3.33 ± 0.757%) than SCAio- patients (0.746 ± 0.303 mg; 14.9 ± 6.05%) (p = 0.024). Hepcidin was not different between groups. Iron incorporation was inversely associated with serum ferritin level (SCAtotal group: r = -0.775, p = 0.041; SCAio- group: r = -0.982; p = 0.018) and sickle hemoglobin (HbS) presented positive correlation with iron incorporation (r = 0.991; p = 0.009) in SCAio- group. LIC was positively associated with ferritin (SCAtotal: r = 0.921; p = 0.026) and C reactive protein (SCAio+: r = 0.999; p = 0.020). CONCLUSION: SCAio+ group had lower iron incorporation in RBC than SCAio- group, suggesting that they may not need to reduce their intake of iron-rich food, as usually recommended. Conversely, a high percentage of HbS may indirectly exacerbate hypoxia and seems to increase iron incorporation in RBC. TRIAL REGISTRATION: This trial was registered at www.ensaiosclinicos.gov.br . Identifier RBR-4b7v8pt.
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Anemia Falciforme , Eritrócitos , Ferritinas , Hepcidinas , Isótopos de Ferro , Sobrecarga de Ferro , Ferro , Humanos , Anemia Falciforme/sangue , Projetos Piloto , Eritrócitos/metabolismo , Criança , Masculino , Feminino , Ferritinas/sangue , Ferro/sangue , Ferro/metabolismo , Sobrecarga de Ferro/sangue , Adolescente , Hepcidinas/sangue , Fígado/metabolismoRESUMO
PURPOSE: Iron absorption in sickle cell anemia (SCA) remains unclear and studies in adults with SCA are scarce. The aim of this study was to evaluate the iron absorption SCA adults and its association with iron status and hepcidin concentration. METHODS: SCA patients (n = 13; SCAtotal) and control participants (n = 10) ingested an oral stable iron isotope (57Fe). Iron absorption was measured by inductively coupled plasma mass spectrometry (ICP-MS) 14 days after isotope administration. Patients with ≥ 1000 ng/mL serum ferritin were considered to present iron overload (IO) (SCAio+; n = 3) and others classified without IO (SCAio-; n = 10). RESULTS: Iron absorption in the control group ranged from 0.3 to 26.5% (median = 0.9%), while it varied from 0.3 to 5.4% in SCAio+ (median = 0.5%) and from 0.3 to 64.2% in the SCAio- (median = 6.9%). Hepcidin median values were 14.1 ng/mL (3.0-31.9 ng/mL) in SCAio-, 6.2 ng/mL (3.3-7.8 ng/mL) in SCAio + and 6.2 ng/mL (0.6-9.3 ng/mL) in control. Iron absorption was associated with ferritin level (r = - 0.641; p = 0.018) and liver iron concentration (LIC; r = - 0.786; p = 0.036) in the SCAtotal group. CONCLUSION: Our data suggest that SCAio- individuals may be at risk of developing primary IO. Simultaneously, secondary IO may induce physiological adaptation, resulting in reduced iron absorption. Further studies evaluating intestinal iron absorption using larger sample sizes should be conducted to help establish a safe nutrition approach to be adopted and to ensure the security of food-fortifying public policies for these patients. TRIAL REGISTRATION: This trial was registered at www.ensaiosclinicos.gov.br (Identifier RBR-4b7v8pt).
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Anemia Falciforme , Hepcidinas , Absorção Intestinal , Isótopos de Ferro , Humanos , Anemia Falciforme/sangue , Adulto , Masculino , Feminino , Isótopos de Ferro/farmacocinética , Hepcidinas/sangue , Adulto Jovem , Ferritinas/sangue , Ferro/sangue , Ferro/farmacocinética , Ferro/metabolismo , Sobrecarga de Ferro , Ferro da Dieta/farmacocinética , Ferro da Dieta/administração & dosagem , Pessoa de Meia-Idade , Estado NutricionalRESUMO
The DNA and RNA aptamers D4 and R4, respectively, emerged from the modification of PC-3 cell-binding aptamer A4. Our objective was to characterize the aptamers in silico and in vitro and begin to identify their target molecules. We represented their structures using computational algorithms; evaluated their binding to several prostate cell lines and their effects on the viability and migration of these cells; and determined their dissociation constant by flow cytometry. We analyzed circulating prostate tumor cells from patients using D4, R4, anti-CD133 and anti-CD44. Finally, the target proteins of both aptamers were precipitated and identified by mass spectrometry to simulate their in silico docking. The aptamers presented similar structures and bound to prostate tumor cells without modifying the cellular parameters studied, but with different affinities. The ligand cells for both aptamers were CD44+, indicating that they could identify cells in the mesenchymal stage of the metastatic process. The possible target proteins NXPE1, ADAM30, and MUC6 need to be further studied to better understand their interaction with the aptamers. These results support the development of new assays to determine the clinical applications of D4 and R4 aptamers in prostate cancer.
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Aptâmeros de Nucleotídeos , Neoplasias da Próstata , Humanos , Masculino , Aptâmeros de Nucleotídeos/química , Aptâmeros de Nucleotídeos/farmacologia , Aptâmeros de Nucleotídeos/metabolismo , Neoplasias da Próstata/patologia , Neoplasias da Próstata/metabolismo , Linhagem Celular Tumoral , Simulação de Acoplamento MolecularRESUMO
In this study, the main agents associated with endometritis in cows in the state of Santa Catarina, Brazil, were identified and the resistance profile and virulence mechanisms of the bacterial isolates were evaluated. Isolates of Escherichia coli and Trueperella pyogenes were tested for their biofilm forming ability and the antimicrobial action of bromhexine hydrochloride in combination with other antimicrobials. A total of 37 uterine lavage samples were collected from cows with endometritis. Of the 55 bacteria isolated, 25.4% were identified as T. pyogenes and 16.3% as E. coli. The bacterial isolates showed greater resistance to sulfamethoxazole + trimethoprim (58.2%) and tetracycline (56.3%). Among the species, E. coli showed the highest resistance rates, with 100% of isolates showing resistance to amoxicillin, streptomycin, and gentamicin. The results of the minimum inhibitory concentration for the T. pyogenes isolates showed that 91.6% of the isolates were resistant to enrofloxacin and tetracycline, and 75% were resistant to ceftiofur and sulfamethoxazole + trimethoprim. All E. coli and T. pyogenes isolates showed biofilm forming ability. The plo, fimA, and nanH genes were identified in 100% of T. pyogenes isolates. In parallel, 100% of E. coli isolates had the fimH gene, and 11.1% had the csgD gene. Bromhexine hydrochloride showed antimicrobial activity against 100% of E. coli isolates and 66.6% of T. pyogenes isolates. Furthermore, when associated with antimicrobials, bromhexine hydrochloride has a synergistic and additive effect, proving to be an option in the treatment of endometritis in cows and an alternative for reducing the use of antimicrobials.
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Actinomycetaceae , Infecções por Actinomycetales , Antibacterianos , Doenças dos Bovinos , Endometrite , Infecções por Escherichia coli , Escherichia coli , Testes de Sensibilidade Microbiana , Bovinos , Animais , Endometrite/microbiologia , Endometrite/veterinária , Endometrite/tratamento farmacológico , Feminino , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Antibacterianos/farmacologia , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/tratamento farmacológico , Actinomycetaceae/efeitos dos fármacos , Actinomycetaceae/genética , Actinomycetaceae/isolamento & purificação , Actinomycetaceae/classificação , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/veterinária , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Actinomycetales/microbiologia , Infecções por Actinomycetales/veterinária , Infecções por Actinomycetales/tratamento farmacológico , Biofilmes/efeitos dos fármacos , Brasil , Farmacorresistência BacterianaRESUMO
The development of wound dressings from biomaterials has been the subject of research due to their unique structural and functional characteristics. Proteins from animal origin, such as collagen and chitosan, act as promising materials for applications in injuries and chronic wounds, functioning as a repairing agent. This study aims to evaluate in vitro effects of scaffolds with different formulations containing bioactive compounds such as collagen, chitosan, N-acetylcysteine (NAC) and ε-poly-lysine (ε-PL). We manufactured a scaffold made of a collagen hydrogel bioconjugated with chitosan by crosslinking and addition of NAC and ε-PL. Cell viability was verified by resazurin and live/dead assays and the ultrastructure of biomaterials was evaluated by SEM. Antimicrobial sensitivity was assessed by antibiogram. The healing potential of the biomaterial was evaluated in vivo, in a model of healing of excisional wounds in mice. On the 7th day after the injury, the wounds and surrounding skin were processed for evaluation of biochemical and histological parameters associated with the inflammatory process. The results showed great cell viability and increase in porosity after crosslinking while antimicrobial action was observed in scaffolds containing NAC and ε-PL. Chitosan scaffolds bioconjugated with NAC/ε-PL showed improvement in tissue healing, with reduced lesion size and reduced inflammation. It is concluded that scaffolds crosslinked with chitosan-NAC-ε-PL have the desirable characteristics for tissue repair at low cost and could be considered promising biomaterials in the practice of regenerative medicine.
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Acetilcisteína , Anti-Infecciosos , Quitosana , Animais , Camundongos , Anti-Infecciosos/farmacologia , Materiais Biocompatíveis/química , Quitosana/química , Colágeno/química , Alicerces Teciduais/química , Cicatrização , Polilisina/químicaRESUMO
Iron is an essential element for human life and its nutritional status in the human body is directly linked to human health. More than 1015 atoms of iron per second are necessary for the maintenance of haemoglobin formation. To predict iron bioavailability three approaches are normally employed: (a) faecal recovery; (b) plasma appearance; and (c) erythrocyte incorporation (the most used). Isotope Pattern Deconvolution (IPD) is a mathematical tool that allows the isolation of distinct isotope signatures from mixtures of natural abundance and enriched tracers. In this work we propose a novel strategy to assess erythrocyte iron incorporation, based on the use of an iron stable isotope (57Fe) and the IPD concept. This strategy allows direct calculation of the exogenous concentration of 57Fe incorporated into RBCs after supplementation. In this way, to determine the mass of iron incorporated into erythrocytes, the unique prediction that must be made is the blood volume, estimate to reproduce the natural dilution of the tracer (57Fe) in the blood. This novel bioanalytical approach was applied for the measurements of iron incorporation and further iron absorption studies in humans, using a group of twelve healthy participants, that should be further evaluated for the assessment of other chemical elements that could be of health concerns and directly impact society.
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Eritrócitos , Ferro , Humanos , Ferro/metabolismo , Isótopos de Ferro/metabolismo , Eritrócitos/metabolismo , Plasma , Disponibilidade BiológicaRESUMO
RESUMO: Objetivo: compreender a percepção dos profissionais atuantes em um hospital universitário sobre a cultura de segurança do paciente. Método: estudo descritivo, com abordagem qualitativa, realizado em um hospital universitário do Nordeste do Brasil no mês de janeiro de 2023. Participaram 56 profissionais da equipe multidisciplinar: enfermeiro, farmacêutico, fisioterapeuta, fonoaudiólogo, médico, psicólogo e técnico de enfermagem. Os dados foram obtidos por entrevistas semiestruturadas. O conteúdo textual foi submetido à análise lexicográfica e literatura atual e relevante. Resultados: foram analisadas cinco classes: percepções acerca da segurança do paciente e a cultura de segurança; ações para fortalecer a segurança do paciente; percepções acerca da atuação do Núcleo de Segurança do Paciente; contribuições para fortalecer a cultura de segurança e atuação profissional na segurança do paciente. Considerações finais: a cultura de segurança do paciente no hospital tem trilhado trajetórias promissoras. O estudo pode direcionar intervenções que fortaleçam a cultura de segurança do paciente.
ABSTRACT Objective: to understand the perception of professionals working in a university hospital about the patient safety culture. Method: a descriptive study with a qualitative approach, carried out at a university hospital in the Brazilian Northeast region in January 2023. The participants were 56 professionals from the multidisciplinary, namely: nurses, pharmacists, physiotherapists, speech therapists, physicians, psychologists and nursing technicians. The data were obtained through semi-structured interviews. The text content was subjected to lexicographic analysis and against the current and relevant literature. Results: five classes were analyzed: Perceptions about patient safety and the safety culture; Actions to strengthen patient safety; Perceptions about the work of the Patient Safety Center; Contributions to strengthening the safety culture; and Professional performance in patient safety. Final considerations: the patient safety culture in the hospital has been on a promising path. The study can direct interventions that strengthen the patient safety culture.
RESUMEN Objetivo: comprender la percepción de los profesionales que trabajan en un hospital universitario sobre la cultura de seguridad del paciente. Método: estudio descriptivo, con enfoque cualitativo, realizado en un hospital universitario de la región Nordeste de Brasil, en enero de 2023. Participaron 56 profesionales del equipo multidisciplinario: enfermero, farmacéutico, fisioterapeuta, fonoaudiólogo, médico, psicólogo y técnico en enfermería. Los datos se obtuvieron mediante entrevistas semiestructuradas. El contenido textual se sometió a análisis lexicográfico y de la literatura actual y relevante. Resultados: se analizaron cinco clases: percepciones sobre la seguridad del paciente y la cultura de seguridad; acciones para fortalecer la seguridad del paciente; percepciones sobre el desempeño del Centro de Seguridad del Paciente; aportes para fortalecer la cultura de seguridad y el desempeño profesional en seguridad del paciente. Consideraciones finales: la cultura de seguridad del paciente en el hospital ha recorrido una trayectoria prometedora. El estudio puede orientar intervenciones que fortalezcan la cultura de seguridad del paciente.
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BACKGROUND: Herbal medicine is a low-cost treatment and has been increasingly applied in obesity treatment. Gut microbiota (GM) is strongly associated with obesity pathogenesis. METHODS: We conducted a systematic review guided by the question: "Does the use of herbal medicine change the GM composition in obese individuals?" Randomized clinical trials with obese individuals assessing the effects of herbal medicine intervention in GM were retrieved from the Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, including the Cochrane Controlled Trials Register. Two reviewers independently extracted data using standardized piloted data extraction forms and assessed the study-level risk of bias using an Excel template of the Cochrane "Risk of bias" tool 2-RoB 2. RESULTS: We identified 1094 articles in the databases. After removing duplicates and reading the title and abstract, 14 publications were fully evaluated, of which seven publications from six studies were considered eligible. The herbs analyzed were Moringa oleifera, Punica granatum, Scutellaria baicalensis, Schisandra chinensis, W-LHIT and WCBE. The analysis showed that Schisandra chinensis and Scutellaria baicalensis had significant effects on weight loss herbal intervention therapy composed by five Chinese herbal medicines Ganoderma lucidum, Coptis chinensis, Astragalus membranaceus, Nelumbo nucifera gaertn, and Fructus aurantii (W-LHIT) and white common bean extract (WCBE) on GM, but no significant changes in anthropometry and laboratory biomarkers. CONCLUSIONS: Herbal medicine modulates GM and is associated with increased genera in obese individuals.
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Microbioma Gastrointestinal , Plantas Medicinais , Humanos , Sobrepeso/tratamento farmacológico , Obesidade/tratamento farmacológico , Extratos Vegetais/uso terapêuticoRESUMO
BACKGROUND: Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels. OBJECTIVE: This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services. METHODS: This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O'Malley and Levac, Colquhoun, and O'Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol. RESULTS: A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS. CONCLUSIONS: Studies mostly included physicians (34/55, 61.8%) and nurses (24/55, 43.6%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population.
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Objective: To assess healthcare resource utilization and hospitalization costs of patients with chronic obstructive pulmonary disease (COPD) exacerbations in the Brazilian private healthcare system. Methods: A retrospective cohort study, considering data from an administrative database of a private company (Orizon). Patients aged ≥40 years old and with at least one COPD-related claim identified by the ICD-10 code (J40 to J44) at any time during the eligibility period (January/2010 to December/2013) were included in the analysis. Follow-up was performed until December/2014, death or inactivation of a health plan. Sociodemographic characteristics, number of emergency visits, hospital admissions (number and length of stay), length of hospital stay in an intensive care unit (ICU), number of severe COPD exacerbations, therapeutic approach, and hospitalization costs were assessed. Results: The analysis included 8,254 COPD patients. Emergency visits, hospital admission, and exacerbation rates were 0.4, 0.2, and 0.1 per person-year, respectively. The mean length of hospital stays and the length of stay of patients requiring or not ICU stay were 16.6 (SD = 77.0), 8.7 (SD = 36.9), and 27.6 (SD = 109.7), respectively. Mean costs associated to emergency department visits and hospitalizations were 258.2 BRL (SD = 383.1) and 38,165.4 BRL (SD = 124,683.5), respectively. Hospitalizations costs without ICU stay were 11,810.1 BRL (SD = 31,144.1) and 74,585.3 BRL (SD = 182,808.1) for those with ICU utilization. Conclusion: Costs for COPD management during disease exacerbation are very high and may reach almost 75 thousand BRL per hospitalization. The prevention of COPD exacerbations and better disease control may reduce the economic burden on the private healthcare system in Brazil.
Objetivo: Avaliar a utilização de recursos e custos de pacientes com exacerbação da doença pulmonar obstrutiva crônica (DPOC) no sistema de saúde suplementar (SSS) do Brasil. Métodos: Estudo de coorte retrospectiva, considerando banco de dados administrativo de uma empresa privada (Orizon). Pacientes com ≥40 anos e pelo menos um registro de admissão relacionado à DPOC identificado com CID-10 J40-J44, entre janeiro/2010 e dezembro/2013, foram incluídos e acompanhados até dezembro/2014, morte ou inativação no plano. Características sociodemográficas, número de visitas de emergência, admissões hospitalares (número e tempo de hospitalização), tempo de hospitalização em unidade de terapia intensiva (UTI), número de exacerbações graves, estratégias terapêuticas e custos hospitalares foram as variáveis analisadas. Resultados: A análise incluiu 8.254 pacientes com DPOC. As taxas de visita à emergência, internação hospitalar e exacerbação da doença foram de 0,4, 0,2 e 0,1 por pessoa-ano, respectivamente. Os tempos médios de hospitalização, hospitalização sem utilização de UTI e hospitalização com necessidade de UTI foram de 16,6 (DP = 77,0), 8,7 (DP = 36,9) e 27,6 (DP = 109,7) dias, respectivamente. Os custos médios relacionados à visita de emergência e por hospitalização foram de 258,2 BRL (DP = 383,1) e 38.165,4 BRL (DP = 124.683,5), respectivamente. Os custos para pacientes que não utilizaram UTI foram de 11.810,1 BRL (DP = 31.144,1) e de 74.585,3 BRL (DP = 182.808,1) para aqueles com necessidade desse serviço. Conclusão: Os custos para o manejo dos pacientes com exacerbação da DPOC são muito elevados, podendo chegar a 75.000 BRL por hospitalização. A prevenção de exacerbações e o melhor controle da doença podem reduzir esse impacto econômico no SSS.
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Custos e Análise de Custo , Doença Pulmonar Obstrutiva Crônica , Saúde SuplementarRESUMO
Sickle cell anemia (SCA) is a genetic and hemolytic disease globally characterized by social vulnerability. Food consumption has been insufficiently analyzed in SCA. Secondary iron overload is often observed. This leads to unreliable recommendations for dietary iron restriction. We assessed food consumption and iron intake among adults with SCA. Considering the guidelines for healthy eating, foods were grouped according to the NOVA classification. This transversal study included 74.4% of eligible patients who were registered in the reference center for SCA treatment in Rio de Janeiro, Brazil, in 2019. Data on food consumption were collected through 24 h recall. The monthly household income of 82.3% of patients was less than $770. The consumption of fresh or minimally processed foods was directly associated with monthly household income (p < 0.0001; η2 = 0.87). Ultra-processed foods provided more than one-third of the total energy intake (35.2%). The prevalence of inadequate iron intake was about 40% among women, while that of iron intake above the tolerable upper limit was 0.8%. People from lower socioeconomic classes had the lowest iron intake. Strategies to encourage the consumption of fresh or minimally processed foods are needed considering the requirement of an antioxidant diet in SCA. These findings highlight the need for health equity to ensure food security and healthy eating in SCA.
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Anemia Falciforme , Ingestão de Energia , Adulto , Humanos , Feminino , Brasil/epidemiologia , Dieta/efeitos adversos , Estado Nutricional , Manipulação de Alimentos , Anemia Falciforme/epidemiologia , Fast FoodsRESUMO
To assess healthcare resource utilization and costs of patients with asthma in Brazilian Supplementary Healthcare System, focusing on hospitalization data. Retrospective cohort study, using data from an administrative database of a private company (Orizon). Patients agedâ ≥â 12 years with at least one record of emergency visit/hospitalization in the database with the ICD-10 J45 between January/2010 and June/2015 were included and followed until June/2016, death or inactivation of health plan. Sociodemographic characteristics, emergency visit and hospital admission per patient per year (exacerbation rate), physician visit with a procedure, exams, length of hospitalization (with/without intensive care unit (ICU)), and in-hospital treatments were assessed. A total of 54,568 patients were included in this analysis. Regarding resource utilization, emergency visit and hospital admission rates of 0.34 and 0.04 per person-year were observed, respectively. Mean length of hospital stay were 8.82 (SDâ =â 36.48), 5.24 (SDâ =â 19.06) and 19.53 (63.89) days for hospitalizations in general, without and with ICU, respectively. An exacerbation rate of 0.36 per person year was observed with a mean cost per episode of 3178 Brazilian Real (BRL) (SDâ =â 31,667). Mean cost related to emergency department visits was estimated at 293 BRL (SDâ =â 328). Hospitalization costs were stratified by the need of ICU and values observed were of 9307 BRL (SDâ =â 18,979) without ICU, and 75,252 BRL (SDâ =â 174,248) with ICU need. Asthma exacerbations may cost ~75,000 BRL for an ICU-dependent event in the Supplementary Healthcare System. To improve disease control may reduce disease burden for both healthcare system and patients.
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Asma , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , Asma/epidemiologia , Asma/terapia , Atenção à Saúde , HospitalizaçãoRESUMO
Malnutrition is considered one of the most common problems in the elderly population worldwide and can significantly interfere in health evolution in these individuals, predisposing them to increased infection susceptibility. The immune response triggered by infections comprises several mechanisms, and macrophages play important roles in this response. This study aimed to evaluate mechanisms related to macrophage function in a model of protein malnutrition in the elderly. Two age groups (young: 3-5 months and elderly: 18-19 months) male C57BL/6NTac mice were subjected to protein malnutrition with a low-protein diet (2 %). The nutritional status, hemogram and number of peritoneal cells were affected by both age and nutritional status. Additionally, the spreading capacity as well as the phagocytic and fungicidal activity of peritoneal macrophages were affected by the nutritional status and age of the animal. Interestingly, the percentages of F4/80+/CD11b+ and CD86+ cells were reduced mostly in elderly animals, while the TLR-4+ population was more affected by nutritional status than by age. The production of pro-inflammatory cytokines such as TNF-α, IL-1α, and IL-6 was also influenced by nutritional status and/or by age, and malnourished animals of advanced age produced higher amounts of the anti-inflammatory cytokine IL-10. Furthermore, the phosphorylation ratio of the transcription factor NFκB (pNFκB/NFκB) was directly affected by the nutritional status, independently of age. Thus, these results allow us to conclude that aging and protein malnutrition compromise macrophage function, likely affecting their immune function, and in aged protein-malnourished animals, this impairment tends to be more pronounced.
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Macrófagos Peritoneais , Desnutrição , Idoso , Humanos , Camundongos , Masculino , Animais , Macrófagos Peritoneais/metabolismo , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Fator de Necrose Tumoral alfa/metabolismoRESUMO
This study aimed to assess the impact of prepartum maternal diphenyl diselenide (PhSe)2 supplementation on the development, biochemical, immune, and antioxidant parameters of calves. Eighteen Holstein breed calves were used, born to females who were or were not subjected to supplementation, at 42, 28, and 14 days prior to calving. The (PhSe)2 group (DDG) was administered 3 µmol/kg of (PhSe)2 in 4 mL of dimethyl sulfoxide (DMSO), while the DMSO and NaCl groups were administered 4 mL of DMSO and 0.9% NaCl, subcutaneously. The calves were evaluated based on their weight, withers height, body condition score 24 h post-birth (0), as well on days 14, 28, 42, 56, 70. Blood samples were also taken to determine serum variables. Calves on the DDG showed higher average levels of total protein, albumin, and globulins on day 0, and the immunoglobulin G level was significantly higher than the other groups on days 0, 14, 56, 70. Maternal supplementation showed immunomodulatory effect on calves, evidenced by the exceptional rates of passive immunity transfer, as well as the enhancement of humoral immunity. Our research offers fresh insights into the immunomodulatory potential of (PhSe)2, making it a viable alternative in facing this challenging phase, rearing dairy calves.
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Resumo Este artigo analisa as ofertas de cuidado da APS na cidade de Campinas-SP, durante a pandemia de COVID-19, tendo as mudanças no processo de trabalho como um guia condutor. Tratou-se de uma pesquisa descritiva de caráter qualitativo, incluindo observação participante e entrevistas em profundidade com trabalhadores e usuários de quatro Unidades Básicas de Saúde (de junho/2021 a janeiro/2022). As análises apontam uma diferença significativa entre o primeiro e o segundo ano da pandemia. No primeiro momento, houve desorganização das estratégias de cuidado e restrição do atendimento aos casos de COVID-19. Já no segundo ano, foram retomadas atividades como visitas domiciliares e atendimentos de rotina, que, somadas ao agravamento do contexto sociossanitário e às novas demandas, como a vacinação, provocaram sobrecarga de trabalho e acirramento das relações entre profissionais e usuários. Além disso, constatou-se a fragilização dos espaços coletivos e de cogestão, tanto no nível da gestão municipal, quanto em reuniões de equipe e espaços de participação social. A retomada de tais espaços e o cuidado aos trabalhadores desgastados por esse período constituem-se desafios para a Atenção Primária em Saúde no contexto pós-pandemia.
Abstract This article examines supply of Primary Health Care in the city of Campinas (São Paulo state) during the COVID-19 pandemic, taking changes in the work process as its guide. This descriptive, qualitative study included participant observation and in-depth interviews of workers and users at four PHC facilities, from June 2021 to January 2022. The analyses found significant differences between the first and second years of the pandemic. At first, care strategies were disorganised and care for COVID-19 cases, limited. In the second year, home visits and routine care were resumed. This, added to the worsening social and public health context and new demands, such as vaccination, caused overwork and strained relations between health personnel and users. Also, collective and co-management arrangements were found to weaken, both at the municipal management level and at staff meetings and for social participation. In the post-pandemic context, Primary Health Care is challenged to restore these arrangements and care for health workers exhausted by the pandemic.
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O presente trabalho tem como objetivo geral identificar as dificuldades que as mães-profissionais que atuavam na área da saúde pública enfrentaram, a partir de uma crítica ao patriarcalismo, interpretando os desafios para conciliar os afazeres domésticos, o cuidado com os filhos e a vida profissional, durante o primeiro ano da pandemia no Brasil, 2020. As medidas impostas pelas autoridades do Brasil e do mundo acarretaram a reorganização na estrutura familiar e no ambiente de trabalho, em que devido as necessidades de isolamento, as famílias passaram a ficar mais tempo dentro de casa, provocando um aumento de trabalho doméstico. Essa sobrecarga de trabalho doméstico recaiu, principalmente, em cima das mulheres, porém em intensidades diferentes, de acordo com a raça/cor e a classe social em que estão inseridas, reafirmando a ideia de que vivemos em um país com uma estrutura patriarcal, classista e racista. O estudo foi realizado a partir de uma amostra extraída no universo das trabalhadoras-mães que, independente do vínculo profissional e da área de atuação, atuavam no Instituto Nacional da saúde da Criança, da Mulher e do Adolescente Fernandes Figueira e tinham filhos com idade entre 0 e 12 anos, no período em questão. Através da entrevista dirigida e a utilização do método de amostragem bola de neve foram obtidos relatos das trabalhadoras que permitiram fazer uma análise do quanto e de que forma a pandemia afetou a vida dessas trabalhadoras nas mais variadas condições sociais e profissionais, além de concluir para a necessidade de ter um Estado de bem-estar social ampliado e sensível às questões femininas. (AU)
The current paper aims to identify the struggles, from an opposing patriarchal point of view, that working moms who were a part of the public healthcare system faced and to understand the challenges of balancing household chores, taking care of their children and their professional lives, during the first year of the pandemic in Brazil in 2020. The measures imposed by Brazilian and world authorities led to a new organizational structure in home and work-life, in which the need of isolation, resulted in families spending more time indoors thus increasing the domestic workload. This fell, mainly, on women, but in varying degrees, according to the race/skin color and social class they are inserted, reaffirming the idea that we live in a country with a patriarchal, classicist and racist foundation. The study was conducted with working moms that, regardless their professional ties or areas, worked at the Instituto Nacional da Saúde da Criança, da Mulher e do Adolescente Fernandes Figueira and had children from ages that ranged from 0 to 12 years old during that time. Account from workers were acquired through guided interviews and the use of the snowball sample method, which allowed an analysis of how much and how the pandemic affected the lives of those workers in the most diverse social and working conditions, besides inferring the need of a wider welfare system and one more sensitive to women's issues. (AU)
Assuntos
Mulheres Trabalhadoras , Direitos da Mulher , Jornada de Trabalho , Pessoal de Saúde , COVID-19 , Relações Mãe-Filho , Condições Sociais , Trabalho , Brasil , Saúde Pública , Estudos de Amostragem , Poder Familiar , Grupos Raciais , População Negra , Estrutura FamiliarRESUMO
Tecnologia: Felbamato. Indicação: Tratamento de epilepsia refratária. Pergunta: O Felbamato é mais eficaz e seguro comparado a anticonvulsivantes disponíveis no Sistema Único de Saúde (SUS) em pacientes com epilepsia refratária? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas 2 revisões sistemáticas, que atendiam aos critérios de inclusão. Conclusão: O felbamato não demonstrou ser uma opção mais benéfica que os demais medicamentos disponíveis no SUS no tratamento de epilepsia refratária a medicamentos. Salienta-se que a maior parte das evidências eram de baixa certeza
Technology: Felbamate. Indication: Treatment of refractory epilepsy. Question: Is felbamate more effective and safer compared to anticonvulsants available in Brazilian Public Health System in patients with refractory epilepsy? Methods: A rapid review of evidence (overview) of systematic reviews, with bibliographic survey carried out in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Results: Two systematic reviews that met the inclusion criteria were selected. Conclusion: Felbamate did not prove to be a more beneficial option than the other drugs available in the Brazilian Public Health System in the treatment of drug-refractory epilepsy. It should be noted that most of the evidence was of low certainty
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Convulsões/tratamento farmacológico , Epilepsia Resistente a Medicamentos/terapia , Anticonvulsivantes/uso terapêutico , Pesquisa Comparativa da Efetividade , Síndrome de Lennox-GastautRESUMO
Introdução: Náuseas e vômitos induzidos por quimioterapia (NVIQ) são importantes efeitos colaterais dos tratamentos antineoplásicos. Algumas plantas medicinais vêm sendo estudadas no manejo desses efeitos, como o gengibre (Zingiber officinale). Objetivo: Realizar uma revisão acerca do uso via oral do gengibre no manejo de NVIQ em pacientes com câncer. Método: Revisão integrativa da literatura realizada na base de dados MEDLINE, em setembro de 2022, adotando a combinação das palavras-chave "Zingiber officinale" e "Cancer". Foram também aplicados filtros na seleção para incluir ensaios clínicos aleatórios publicados entre 2012 e 2022. Resultados: Ao todo, foram analisados nove estudos. O gengibre apresenta potencial de reduzir NVIQ em pacientes com câncer, refletindo positivamente na qualidade de vida e na melhora do apetite e da fadiga. Os estudos não observaram efeitos adversos da administração do gengibre. Conclusão: O uso por via oral do gengibre demonstra ser uma estratégia segura para o manejo de NVIQ em pacientes com câncer, na dose de 1 g/dia do gengibre em pó, podendo ser utilizado como terapia complementar juntamente com regimes antieméticos padrões
Introduction: Chemotherapy-induced nausea and vomiting (CINV) are important side effects of antineoplastic treatments. Some medicinal plants have been studied in the management of these effects, such as ginger (Zingiber officinale). Objective: Review the oral use of ginger in the management of CINV in cancer patients. Method: Integrative literature review carried out at the MEDLINE database, in September 2022, utilizing the combination of the keywords "Zingiber officinale" and "Cancer", filters were also applied to include randomized clinical trials published between 2012 and 2022. Results: In all, nine studies were analyzed. Ginger has the potential to reduce CINV in cancer patients, reflecting positively on quality-of-life, improved appetite and fatigue. The studies have not found any adverse effect after administering ginger. Conclusion: The oral use of ginger proves to be an effective strategy for the management of CINV in cancer patients, in the dosage regimen of 1 g/day of powdered ginger, and can be used as a complementary therapy along with standard antiemetic regimens
Introducción: Las náuseas y los vómitos inducidos por la quimioterapia (NVIQ) son efectos secundarios importantes de los tratamientos antineoplásicos. Se han estudiado algunas plantas medicinales en el manejo de estos efectos, como el jengibre (Zingiber officinale). Objetivo: Realizar una revisión integradora de la literatura sobre el uso oral del jengibre en el manejo de las NVIQ en pacientes oncológicos. Método: Revisión integradora de la literatura realizada en la base de datos MEDLINE, en septiembre de 2022, adoptando la combinación de las palabras clave "Zingiber officinale" y "Cancer". También se aplicaron filtros en la selección para incluir ensayos clínicos aleatorizados publicados entre 2012 y 2022. Resultados: En total, se analizaron nueve estudios. El jengibre tiene el potencial de reducir las NVIQ en pacientes con cáncer, lo que se refleja positivamente en la mejora de la calidad de vida, apetito y fatiga. Los estudios no han observado ningún efecto adverso por la administración del jengibre. Conclusión: El uso del jengibre por vía oral demuestra ser una estrategia segura para el manejo de NVIQ en pacientes con cáncer, usando una dosis de 1 g/día de jengibre en polvo, y puede usarse como terapia complementaria junto con los regímenes antieméticos estándar
Assuntos
Humanos , Masculino , Feminino , Plantas Medicinais , Zingiber officinale/efeitos adversos , Fitoterapia , Neoplasias/tratamento farmacológicoRESUMO
BACKGROUND: Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments. OBJECTIVE: This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. METHODS: This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services. RESULTS: This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication. CONCLUSIONS: This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42338.
RESUMO
Circulating tumor cells (CTCs) have been identified as responsible for the spread of tumors to other organs of the body. In this sense, the development of sensitive and specific assays for their detection is important to reduce the number of deaths due to metastases. Here, we assessed whether the detection of CTCs in peripheral blood can serve in the construction of a panel of diagnosis and monitoring treatments of breast cancer (BC), focusing on the expression of markers of epithelial-mesenchymal transition. Through analyzing the blood from women without breast alterations (control), women with benign alterations, women with breast cancer without chemotherapy, and women with breast cancer with chemotherapy, we identified the best markers by transcriptional levels and determined three profiles of CTCs (mesenchymal, intermediate, and epithelial) by flow cytometry which, combined, can be used for diagnosis and therapy monitoring with sensitivity and specificity between 80% and 100%. Therefore, we have developed a method for detecting breast cancer based on the analysis of CTC profiles by epithelial-mesenchymal transition markers which, combined, can be used for the diagnosis and monitoring of therapy.