Uso das escalas design e autoconfiança na simulação clínica em parada cardiorrespiratória* / Use of the design and self-confidence scales in clinical simulation of cardiac arrest* / Utilización de las escalas de diseño y autoconfianza en la simulación clínica de la parada cardiorrespiratoria*

RESUMO Objetivo: avaliar a percepção dos participantes frente ao design da simulação, satisfação e autoconfiança na aprendizagem pela simulação clínica em parada cardiorrespiratória. Método: Pesquisa de natureza descritiva e exploratória, de abordagem quantitativa, um quase experimento de grupo único, tipo antes e depois, realizada em 2022, na grande São Paulo, Brasil. O estudo foi realizado com 24 participantes profissionais de enfermagem e estagiários da graduação em duas unidades básicas de saúde. Resultados: identificou-se aumento significativo (p<0,05) no nível de conhecimento após a simulação. Na avaliação da escala de design observou-se média de 4,55 na concordância e 4,55 na importância com a simulação clínica. Observou-se uma média de 4,56 na escala de satisfação e autoconfiança percebida pelos participantes na simulação clínica. Conclusão: a simulação clínica potencializa o aprendizado dos participantes, promove satisfação e autoconfiança e o uso de instrumentos para avaliação e aplicação do cenário são norteadores para uma simulação clínica eficaz.

ABSTRACT Objective: To evaluate participants' perception of design satisfaction and self-confidence in learning through clinical simulation in cardiac arrest. Method: This is a descriptive and exploratory study with a quantitative approach, a quasi-experiment of a single group, before and after type, carried out in 2022 in the greater São Paulo area, Brazil. The study was carried out with 24 participants who were nursing professionals and undergraduate trainees at two basic health units. Results: There was a significant increase (p<0.05) in the level of knowledge after the simulation. When evaluating the design scale, an average of 4.55 was found for agreement and 4.55 for importance with the clinical simulation. There was an average score of 4.56 on the scale of satisfaction and self-confidence perceived by the participants in the clinical simulation. Conclusion: Clinical simulation enhances participants' learning, promotes satisfaction and self-confidence, and using instruments to evaluate and apply the scenario are guidelines for effective clinical simulation.

RESUMEN Objetivo: Evaluar la percepción de los participantes sobre el diseño de la simulación, la satisfacción y la autoconfianza en el aprendizaje mediante simulación clínica en parada cardiorrespiratoria. Método: Estudio descriptivo y exploratorio con enfoque cuantitativo, cuasiexperimento con un único grupo, de tipo antes y después, realizado en 2022, en el área metropolitana de São Paulo, Brasil. El estudio se llevó a cabo con 24 participantes que eran profesionales de enfermería y estudiantes de graduación en prácticas en dos unidades básicas de salud. Resultados: se produjo un aumento significativo (p<0,05) del nivel de conocimientos tras la simulación. La evaluación de la escala de diseño mostró una media de 4,55 para el acuerdo y de 4,55 para la importancia con la simulación clínica. Hubo una puntuación media de 4,56 en la escala de satisfacción y autoconfianza percibida por los participantes en la simulación clínica. Conclusión: La simulación clínica mejora el aprendizaje de los participantes, fomenta la satisfacción y la autoconfianza, y el uso de instrumentos para evaluar y aplicar el escenario son pautas para una simulación clínica eficaz.

Association between sitagliptin plus vitamin D3 (VIDPP-4i) use and clinical remission in patients with new-onset type 1 diabetes: a retrospective case-control study

ABSTRACT Objective: The occurrence of partial remission (honeymoon phase) in type 1 diabetes (T1D) has been associated with a reduced risk of chronic microvascular complications of diabetes. We have published case reports showing that a combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3 (VIDPP-4i) can prolong the honeymoon phase in patients with new-onset T1D. In the present case-control study, we investigated the frequency of occurrence of clinical remission (CR) in patients with new-onset T1D after VIDPP-4i treatment. Subjects and methods: In this case-control study, we collected data spanning 10 years from medical records of 46 patients (23 females) recently diagnosed with T1D. Overall, 27 participants with CR (insulin dose-adjusted glycated hemoglobin [IDAA1c] ≤ 9) at 12 or 24 months composed the case group, and 19 participants without CR served as the control group. Chi-square with Yates correction was used to analyze the association between VIDPP-4i use and CR, and odds ratio (OR) was used to determine the chance of CR due to VIDPP-4i treatment exposure. Results: In all, 37 patients (80.4%) experienced CR at some time over 24 months. The mean CR duration was 13.15 ± 9.91 months. Treatment with VIDPP-4i was significantly associated with CR. At 24 months, the OR of CR after VIDPP-4i exposure was 9.0 (95% confidence interval [CI] 2.21-30.18, p = 0.0036). Additionally, 9 (33.6%) and 4 (14.8%) patients in the VIDPP-4i group experienced insulin-free CR at 12 and 24 months, respectively. Conclusion: Therapy with VIDPP-4i was associated with a higher frequency and duration of the honeymoon phase. Randomized controlled trials are needed to confirm these findings.

Homeopathy on cultures of Saccharomyces cerevisiaeand impact on fermentation

Studies have shownthat homeopathy modulates the activity of both single-and multi-celled organisms;therefore, we propose a study into the action of Arnica Montanaand S. cerevisiae fungus nosode on growth "in vitro", and on the fermentation of S. cerevisiaeon brewer's wort. Methods:250 µL of medication in 30% alcohol were placed in 5 mL of Sabouraud Broth (SB) or wort, with 20 µL of fungus ata McFarland standard of 0.5 and in a dilution of 1:100. Fungal growth was evaluated via spectrophotometry at 600 nm or a cell count in a Neubauer chamber in a kinetic of 1 to 5 days' incubation at 25ºC. The production of alcohol by the fungus was evaluated using the BRIX index in the samekinetic. 1x107fungi/mL were previously incubated with medication for 5 days and, afterwards, placed in 20 mL of fresh wort, incubated at 25ºC for 7 days and evaluated for growth and sugar consumption. Resultsand Discussion: The SB results revealed that after 2days incubation with Arnica30CH, an increase in fungal growth was observed (p<0.0001), whilewith nosode 6 and 30CH there was a reduction in growth after 2 and 5 days incubation (p<0.001). The fungi incubated with Arnica30CH exhibited increased sugar consumption after 2 and5 days incubation (p<0.05), while the nosode 30CH resulted in lower sugar consumption after 2 and 3 days incubation (p<0.05). The results for fungal growth and sugar consumption with the wort were similar to those using SB.The fungalcultures previously incubated with homeopathic medication and subsequent incubation with fresh wortindicated a loss of distinction, bothin terms of fungal growth and sugar consumption. This piece of data may suggest action by the homeopathic medication only when in contact with the cells. Conclusion: The treatment of the S. cerevisiae fungus using Arnica and the S. cerevisiae nosode produced a significant modulation in fungal growth and sugar consumption.

Homeopathic medicine activity on the growth of Gram-negative bacteria

Homeopathy is a therapy that uses medications prepared with infinitesimal and dynamized dilutions. Current studies demonstrate in vitro activity of homeopathy on gram-positive bacteria such as Staphylococcus aureusand Streptococcus pyogenes. Among bacterial infections, urinary tract infection (UTI) is frequent, leads to later consequences and the main causal agent is Escherichia coli(E. coli). In other publications, it has been reported inactivity of homeopathy on E. colicultures. Due to the divergence in the literature, the objective of this study was to evaluate gram-negative bacteria growth under homeopathy treatment. Methods:The medicines Atropabelladona, Cantharis, Staphysagria,and Colibacillinumwere tested at 6CH, 12CH and 30CH inE. coliATCC 25922 and EPEC (Enteropathogenic Escherichia coli) ATCC 43887. Two hundred and fifty microliters of the medicines in alcohol 30% were incubated at 37ºC with 3 mL of Müller Hinton broth (MH), 10 µL of cultures at 0.5 Macfarland and subsequent dilution at 1/10. Bacterial growth was evaluated in a spectrophotometer at 600nm, in the periods of 6, 12,and 20 hours of incubation. Resultsand Discussion:The results showed no inhibition of bacterial growth under the studied conditions. These data corroborate with studies already published that indicate the absence of action of homeopathy on E. colicultures. Considering other studies, it can be suggested that homeopathic medicines have direct activity on the growth of Gram-positive and not Gram-negative bacteria. Evaluating the two bacterial groups, it is possible to assume that the difference in homeopathy activity could be linked to differences in the bacterial wall structure. This hypothesis should be evaluated by other tests with the same bacterialstrains. Conclusion:The homeopathic medicines tested have no direct activity on Gram-negative bacteria cultures.

The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

INTRODUCTION: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). OBJECTIVE: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. METHODS: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. RESULTS: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH) D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. CONCLUSION: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

INTRODUÇÃO: Os níveis séricos ideais de vitamina D são de grande importância, especialmente na população com comorbidades como o Diabetes Mellitus (DM). OBJETIVO: O estudo avaliou a relação entre hipovitaminose D e controle glicêmico em idosos com DM tipo 2. MÉTODOS: Estudo transversal e prospectivo, parte do projeto EELO (Estudo sobre Envelhecimento e Longevidade), no Sul do Brasil. A hemoglobina glicada (diabetes ≥6,5%) e os níveis séricos de vitamina D (25(OH)D) foram avaliados. Hipovitaminose D foi determinada usando ponto de corte <20 e <30 ng/mL. Regressão logística multivariada foi utilizada para avaliar o risco de ter DM descompensado. RESULTADOS: Dos 120 idosos incluídos no estudo, idade entre 60 a 87 anos, 74,2% eram mulheres, 66,7% faziam uso de medicamentos hipoglicemiantes e 75,8% apresentavam diabetes descompensada. Uma correlação inversa foi observada entre os níveis de 25(OH)D e hemoglobina glicada (rS=-0,19; p=0.037), sugerindo que baixos níveis de vitamina D está associado a um pior controle glicêmico em diabéticos. A prevalência de hipovitaminose D quando se utiliza ponto de corte <20 e <30 ng/mL foi de 34,2% e 75,0%, respectivamente. A análise Odds ratio (OR) mostrou que indivíduos com 25(OH)D<20 ng/mL tem quase 4 vezes mais risco de ter DM descompensado (OR:3,94; IC95%:1,25­12,46; p=0,02) quando comparado aos idosos com níveis suficientes de vitamina D. CONCLUSÃO: Os resultados indicam que os níveis sérios ideais atualmente recomendados para 25(OH)D maior ou igual a 30 ng/ml contribuem para o melhor controle glicêmico na população idosa com DM tipo 2.

MicroRNAs: understanding their role in gene expression and cancer / MicroRNAs: entendendo seu papel como reguladores da expressão gênica e seu envolvimento no câncer

ABSTRACT MicroRNAs are small RNA molecules that regulate gene expression in cells. These small molecules comprise 17 to 25 nucleotides and are able to recognize target messenger RNAs by sequence complementarity and regulate their protein translation. Different microRNAs are expressed in all human cells. There is over 2,500 microRNAs described in humans that are involved in virtually all biological processes. Given their role as gene expression regulators, these molecules have been widely investigated and are thought to be associated with some specific physiological and pathological conditions, being proposed as biomarkers. It has recently been reported that microRNAs are secreted outside cells and are involved in intercellular communication. MicroRNAs in biological fluids are named circulating and have been detected in all body fluids, although the expression profile is specific for each type. The major advantages of using circulating microRNAs as biological markers are the high stability of those molecules and the wide availability of samples. Also, given the individual nature of microRNA expression changes, these molecules have a high potential for use in personalized medicine. In fact, microRNA expression profile determination may support disease recognition and diagnosis, and can be used to monitor therapeutic responses and establish patient prognosis, assisting in choice of treatment. This review provides a general overview of microRNAs and discusses the importance of those molecules in cancer, for deeper understanding of their role in this disease.

RESUMO Os microRNAs são pequenas moléculas de RNAs que regulam a expressão gênica das células. Com entre 17 e 25 nucleotídeos, essas pequenas moléculas reconhecem RNA mensageiro-alvo, por meio da complementariedade entre as sequências, e regulam sua tradução proteica. Todas as células humanas expressam diversos microRNAs. De fato, existem mais de 2.500 microRNAs descritos em humanos, relacionados com praticamente todos os processos biológicos. Devido ao seu papel como reguladores da expressão gênica, essas moléculas têm sido estudadas e relacionadas com algumas condições fisiológicas e patológicas específicas, sendo propostas como biomarcadores. Recentemente, foi descoberto que os microRNAs são normalmente liberados para fora da célula, onde participam da comunicação intercelular. MicroRNAs presentes nos fluidos biológicos são chamados de circulantes e têm sido encontrados em todos os fluidos corporais, porém o perfil de expressão é específico para cada tipo. O uso de microRNAs circulantes como marcadores biológicos apresenta vantagens relacionadas com a alta estabilidade dessas moléculas e a facilidade de obtenção de amostra. Adicionalmente, considerando que as alterações em microRNAs são dependentes das condições individuais, essas moléculas apresentam alto potencial de uso na medicina personalizada. De fato, a determinação do perfil de expressão de microRNAs pode auxiliar na identificação e diagnóstico de doenças, no monitoramento de respostas terapêuticas e na definição do prognóstico dos pacientes, auxiliando na escolha do tratamento. Nesta revisão são apresentados aspectos gerais dos microRNAs, e discute-se a importância dessas moléculas no câncer, visando a uma melhor compreensão de seu papel nessa doença.

Aspectos laboratoriais evolutivos de crianças em tratamento da paracoccidioidomicose / Laboratory evolutive aspects of children under paracoccidioidomycosis treatment

Estudo de 38 crianças com paracoccidioidomicose, até 14 anos de idade, tratados por 24-30 meses, com um derivado sulfamídico ou cetoconazol, desde o início do tratamento ou em seguida ao uso da anfotericina B. Dados laboratoriais à admissão foram analisados e comparados com exames seqüenciais até 30 meses de acompanhamento. Anemia, eosinofilia e bilirrubinas e aminotransferases elevadas normalizaram-se, na maioria, até os três meses de tratamento e, hipoalbuminemia, até os seis meses, sugerindo que esses achados sejam bons parâmetros para o monitoramento da resposta terapêutica inicial. Leucócitos periféricos, velocidade de hemossedimentação, IgG e títulos sorológicos para o Paracoccidioides brasiliensis estavam elevados e normalizaram-se, freqüentemente, após nove a 12 meses de tratamento, o que sugere utilidade desses exames no monitoramento de todo o tratamento e enfatiza a necessidade de curso terapêutico prolongado da paracoccidioidomicose na infância.

The study of 38 children with paracoccidioidomycosis, aged up to 14, treated for 24 to 30 months with either a sulfonamide derivative or ketoconazole either alone or, after the use of amphotericin B. Laboratory data at admission were analyzed and compared with those of sequential tests after up to 30 months follow-up. Anemia, eosinophilia, increased bilirubin and aminotransferases normalized, in most patients, after three months treatment and hypoalbuminemia normalized after six months, suggesting that these laboratory findings are useful for monitoring early therapeutic response. Peripheral leucocytes, erythrocyte sedimentation rate, IgG, and serological titers for Paracoccidioides brasiliensis were increased and frequently normalized after nine to 12 months of treatment. They may be useful for monitoring the entire treatment and emphasize the need for long term treatment of paracoccidioidomycosis in children.