Overview of Perinatal Palliative Care in Brazil

Abstract Significant attention to palliative care in terminally ill patients has only been effective in Brazil since the year 2000, although there have been isolated actions since the 1980s. When the case involves fetuses or neonates unable to cure, communication and care with the family members only received attention and effective organization starting in 2017. Notably in the years 2015 and 2016 there was an epidemic of microcephaly and along with the persistent crisis of drug users has raised the indices of malformations to a level higher than 3 % of the world average. Here we aim the evaluation of: a) social, educational and spiritual profile of the mothers; b) structure of the specific teams related to palliative care in neonatology; c) recommendations and protocols currently used in the country. The method used is an electronic retrospective on databases and government data; evaluation of the location and composition of palliative care teams in the country. The data found clearly point out that for Brazilian women, the characteristics of regionality in the country, educational level, religiousness and quality of life directly influence pregnancy and the acceptance or not of the possibility of death, directly influencing perinatal palliative care, which, by the way, is still developing methodologies for this type of action.

Evaluation of Depressive and Anxious Behavior with the Use of Propranolol in Melanoma-Bearing Mice

HIGHLIGHTS: Tumor progression and anxiety and depression behaviors under evaluation during propranolol use in murine melanoma. Evaluation of anxiety and depression through forced swimming behavior tests, elevated plus maze, open field and marble-burying test.

Abstract Melanoma, a severe form of skin cancer, has rapid growth and has been prone to behavioral disorders that worsen the patient's prognosis and survival. Among these psychic disorders can occur anxiety and depression, in addition to cognitive deficit. In order to try to elucidate the neuropsychological disorders that occur in melanoma, the objective of this study was to evaluate propranolol in tumor progression and in anxious and depressive behaviors in an animal model with melanoma. B16F10 cells were injected into C57BL6/J mice subsequently treated with propranolol at doses of 1.43 mg/kg and 5.71 mg/kg and evaluated for tumor growth and in open field, forced swimming, elevated plus maze and marble-burying test at initial time and consolidated tumor. As a result, the group treated with propranolol at a dose of 5.71 mg/kg showed less tumor growth. In the initial behavioral tests, melanoma altered the animals' motility, but anxious behavior was not detected. Depressive behavior was detected in the forced swimming test in the two doses of the treatment used. When taking time with consolidated tumor, there was a reduction in the locomotor activity of the animals in the open field test, impairing the analysis of anxious and depressive behavior. The data suggest that there was a reduction in the progression of melanoma, there was no anxious behavior in the animals, only the depressive behavior and the use of propranolol did not improve the evaluated behavior.

Ações extensionistas na prevenção, cuidados e combate à pandemia por Coronavírus nas divisas do Paraná / Acciones extensionistas para prevenir, cuidar y combatir pandemia por Coronavirus en las fronteras de Paraná / Extensionist actions to prevent, care and combat pandemic by Coronavirus on the borders of Paraná

Objetivo: descrever as atividades extensionistas de prevenção, cuidados e combate à pandemia por coronavírus nas divisas do Paraná. Método: estudo observacional, descritivo de dados provenientes das Ações Extensionistas Prevenção, Cuidados e Combate à Pandemia do Novo Coronavírus - Atenção às divisas rodoviárias do Estado, realizadas de abril a junho de 2020. Resultados: o programa contou com três ações diferentes, sendo desenvolvidas por uma equipe multiprofissional: ações educativas no pedágio, no contêiner da saúde, na ronda ao longo da rodovia e no projeto Saúde na Estrada. Conclusões: a ação possibilitou o trabalho de prevenção e promoção de saúde à população, além de proporcionar aos profissionais de saúde uma visão ampliada do trabalho em equipe e de um problema de saúde pública.(AU)

Objective: to describe extensionist actions of prevention, care and cope of pandemic by coronavirus on the borders of Paraná. Method: observational study, descriptive of data from the Extensionist Actions to Prevent, Care and Combat the New Coronavirus Pandemic - Attention to the road boundaries of the State, from April to June 2020. Results: the program had three different actions, being developed by a multiprofessional team: educational actions at the toll, at a mobile outpatient clinic, at rounds on the road and at Health on Road project. Conclusions: the action made it possible to prevent and promote health to the population, besides provided an expanded view of teamwork for professionals and a public health problem.(AU)

Objetivo: describir extensionistas acciones de prevención, cuidado y frente al pandemia por el coronavirus en las fronteras de Paraná. Método: estudio observacional, descriptivo de los dados del Acciones extensionistas de prevención, atención y combate de pandemia por el nuevo coronavirus - Atención a los límites de las carreteras del Estado, de abril a junio de 2020. Resultados: el programa tenía tres acciones diferentes desarrolladas por un equipo multiprofesional: acciones educativas en el peaje, en el contenedor de salud, en la ronda a lo largo de la carretera y en el proyecto Saúde na Estrada. Conclusiones: la acción permitió el trabajo de prevención y promoción de la salud de la población, además de proporcionar a los profesionales de la salud una visión ampliada del trabajo en equipo y un problema de salud pública.(AU)

Assessment of Experimental Models for Obtaining Adipose-Derived Mesenchymal Stem Cells

Abstract Creating experimental models for obtaining stem cells from adipose tissue is necessary to elucidate their peculiar features. Objective: This study proposed a reliable reproducible and consistent experimental model for obtaining mesenchymal stem cells from adipose tissue. Material and Method: Lines of New Zealand rabbits, Wistar rats and CaviaPorcellus guinea pigs (4 animals per species) were used. Fatty tissue mesenchymal stem cells were removed from dorsal, epididymal and inguinal regions. Percentage viable cells and percentage cells expanded and submitted to chondrogenic differentiation were compared by animal species and collection site. Results: Chondrogenic differentiation occurred in a similar manner across all samples, independently of animal species or collection site. Among samples assessed, the inguinal region of rats yielded the highest percentage of viable and expanded cells. Conclusion: A reliable, reproducible and consistent model for obtaining mesenchymal stem cells was produced. Of the several variables analysed, the best results were obtained from the inguinal region of the rat.

Gut: Key Element on Immune System Regulation

Abstract The gut is the main organ that mediates the contact between antigens with our organism, controlling the immune response against environmental factors, such as microbiota and food. Innate lymphoid cells participate in the gut-associated lymphoid tissue (GALT) maturation during the prenatal and early postnatal periods. After birth, breast milk provides the essential elements for the continuity of development of this tissue, leading to structural changes and healthy microbiota installation. The microbiota participates in the organogenesis of the GALT, as in the formation of intestinal villi, stimulating the proliferation of stem cells and maintaining the integrity of epithelial barrier. Foods are also involved in maturation of the GALT, where the protein source depletion reduced the number of resident lymphocytes. This unique microenvironment present in the intestinal lamina propria (LP) and mesenteric lymph nodes (mLN) induce tolerance to innocuous antigens from the diet, known as Oral Tolerance. Antigens sampled by intestinal epithelium cells are transferred to specialized dendritic cells, residing in the LP, which migrate to the mesenteric lymph nodes where they participate in the induction of regulatory T cells (Treg). Understanding these phenomena may establish the intestinal mucosa as a tool in therapy of inflammatory bowel diseases and immunological disorders.

Preliminary analysis of interleukin-6 changes in pre- and postoperative in diabetic patients with bmi <35 submitted to partial duodenal switch / Análise preliminar da variação dos níveis de interleucina-6 no pré e pós-operatório de pacientes diabéticos com imc <35 submetidos ao desvio duodenal parcial

ABSTRACT Background: Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process. Aim: To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI <35 kg/m2 in the pre and postoperative of partial duodenal switch. Method: Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered. Results: The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period. Conclusion: The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI <35 by dropping the IL6 levels and bringing the HbA1c to normal.

RESUMO Racional: Os estudos relacionados à obesidade têm evidenciado sua associação com a síndrome metabólica. A descoberta que a obesidade é capaz de promover inflamação, sem os sinais clássicos, tem levado vários grupos de pesquisa a caracterizar os tipos celulares que agem e o mecanismo envolvido neste processo. Objetivo: Avaliar a variação da hemoglobina glicada e a secreção da citocina inflamatória, interleucina-6, em indivíduos diabéticos com IMC<35 kg/m² no pré e pós-operatório da técnica de desvio duodenal parcial. Métodos: Nove pacientes foram avaliados antes e um ano após a operação e a variação da concentração da interleucina-6 foi avaliada pela metodologia de Elisa. Também foi avaliada a variação da HbA1c. Resultados: A quantificação de interleucina-6 apresentou no pré-operatório valor de 65,50436±2,911993 pg/ml e de 39,47739+3,410057 pg/ml após um ano da operação e a hemoglobina glicada apresentou média de 10,67 no pré-operatório e de 5,8 após um ano da operação. Conclusão: O desvio duodenal parcial foi capaz de, um ano após o procedimento, diminuir os efeitos da inflamação crônica demonstrada pela diminuição da concentração da interleucina-6 plasmática e normalizar a hemoglobina glicada em pacientes diabéticos com IMC<35 kg/m2.

Swim training and the genetic expression of adipokines in monosodium glutamate-treated obese rats

Objective The aim of this study was to evaluate the genetic expression of adipokines in the adipocytes of monosodium glutamate (MSG)-treated obese rats submitted to physical activity.Materials and methods Obesity was induced by neonatal MSG administration. Exercised rats (MSG and control) were subjected to swim training for 30 min for 10 weeks, whereas their respective controls remained sedentary. Total RNA was obtained from sections of the mesenteric adipose tissue of the rats. mRNA levels of adiponectin (Adipoq), tumor necrosis factor alpha (Tnf), peroxisome proliferator-activated receptor alpha (Ppara), and peroxisome proliferator-activated receptor gamma (Pparg) adipokines were quantified by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR).Results In the exercise-trained control group, the expression of Adipoq increased compared to the sedentary control, which was not observed in the MSG-obese rats. Increased levels of Tnf in MSG-obese rats were not reversed by the swim training. The expression of Ppara was higher in sedentary MSG-obese rats compared to the sedentary control. Swimming increased this adipokine expression in the exercise-trained control rats compared to the sedentary ones. mRNA levels of Pparg were higher in the sedentary MSG-rats compared to the sedentary control; however, the exercise did not influenced its expression in the groups analyzed.Conclusions In conclusion, regular physical activity was not capable to correct the expression of proinflammatory adipokines in MSG-obese rat adipocytes.

Influence of arterial hypertension on colonic healing in rats / Influência da hipertensão arterial na cicatrização colônica em ratos

PURPOSE: Evaluation of colonic healing in spontaneously hypertensive rats. METHODS: Fifty male, young and inbred rats were used. Twenty-five Wistar Kyoto rats (WKY) as control and twenty-five spontaneously hypertensive rats (SHR) as an experimental group. Colotomy and bowel suture at 2.5 cm from the peritoneal reflection were performed. All animals were allocated randomly into sub-groups for review at the third, seventh and fourteenth days after surgery. We evaluated the concentration of angiotensin II, the burst pressure, epithelialization, the organization of the tunics of the bowel wall, inflammatory response and collagen deposition. RESULTS: The burst pressure, epithelialization, organization of the tunics and collagen deposition was not significant between groups. The inflammatory reaction was more intense in the control group on the third postoperative day (p=0.023) as the experimental group on the remaining time. CONCLUSION: Systemic arterial hypertension in rats did not influence significantly the healing process of colonic anastomoses.

OBJETIVO: Avaliar a cicatrização colônica em ratos espontaneamente hipertensos. MÉTODOS: Cinquenta ratos machos, jovens e isogênicos. Vinte e cinco ratos da linhagem Wistar Kyoto (WKY) como controle e vinte e cinco ratos espontaneamente hipertensos (SHR) como grupo experimento. Realizou-se colotomia e colorrafia a 2,5 cm da reflexão peritoneal. Alocaram-se os animais aleatoriamente em sub-grupos para avaliação no terceiro, sétimo e décimo quarto dias de pós-operatório. Foram avaliados a concentração de angiotensina II, a resistência da anastomose à insuflação, a epitelização, a organização das túnicas da parede intestinal, a reação inflamatória e a deposição de colágeno. RESULTADOS: A avaliação da resistência da anastomose, epitelização, organização das túnicas e deposição de colágeno não foi significativa entre os grupos. A reação inflamatória foi mais intensa no grupo controle na avaliação do terceiro dia de pós-operatório (p=0,023) igualando-se ao grupo experimento nos demais tempos. CONCLUSÃO: A hipertensão arterial sistêmica, em ratos, não influenciou de forma significante no processo cicatricial de anastomoses do cólon.

The effect of losartan on angiotensin II-induced cell proliferation in a rat aorta smooth muscle cell line

The success of revascularization procedures is limited by recurrent stenosis, which is a narrowing of a blood vessels that results from neo-intimal hyperplasia. The renin-angiotensin-aldosterone system has been implicated in the pathogenesis of neo-intimal hyperplasia, and a role for angiotensin II in vascular smooth muscle cell proliferation has been proposed. There are at least two high-affinity subtypes of angiotensin II receptors, AT1 and AT2, both of which are seven-transmembrane G protein-coupled receptors. We investigated the effect of losartan, an AT1 receptor antagonist, on vascular smooth muscle cell proliferation using the A7r5 smooth cell line derived from rat aorta. Losartan was shown to prevent angiotensin II-induced cell proliferation, thereby suggesting that the effect of angiotensin II was mediated via AT1 receptors. These data strengthen the concept that inhibitors of the renin-angiotensin system can effectively prevent recurrent stenosis.

Influência da alimentação sobre o hemograma / Influence of feeding in hemogram

Os exames laboratoriais são susceptíveis à variáveis pré-analíticas, analíticas e pós-analíticas hemograma e um dos exames pedidos com maior requêcia na clínica médica, porém, ainda e controversa a necessidade do jejum para sua realização. 0 presente trabalho teve como objetivo avaliar o comportamento dos diversos parâmetros hematológicos avaliados no hemograma em dois períodos distintos, jejum e pós-prandial. Para tanto foram realizadas contagens em aparelho hematológico marca Coulter T-890 para avaliação das possíveis variações no eritrograma, leucograma e contagem de plaquetas. Demonstrou-se que no período pós-prandial existe um aumento da contagem de leucócitos, provavelmente devido a uma re-orientação destas células do pool marginal para o pool circulante. No grupo feminino, observou-se diminuição na contagem de hemácias, na concentração de hemoglobina e no hematócrito, o que nao foi estatisticamente significante para o grupo masculino. A contagem de plaquetas não apresentou diferenças entre os dois períodos estudados. As variações encontradas entre os dois períodos não foram suficientes para a mudança da interpretação clínica do exame, porém, e de suma importância o conhecimento da influência que a ingestão alimentar pode causar nos parâmetros analisados pelo hemograma.

A number of factors may affect hematologic measurements. Hemogram is one of the most requested clinical assays in medicine, but overnight fasting is still controversy. The aim of this work is to verify the influence of overnight fasting versus post prandial in the hematological parameters. We have made cell counts with automated hematology analyzer to observe abnormalities in hemogram.After post prandial period we have found increased in white blood cell (WBC), probably due to a shift of leukocytes from the marginal pool to circulating pool. About gender, female have decreased red blood cells (RBC) count, hemoglobin and hematocrit. There is no significantly difference in platelet count between fasting and after lunch. The fluctuations in cells counts for fasting and post-prandial are not fundamental to change the diagnostic interpretation, but is mandatory the knowledge about the influence offood ingestion may cause in hemogram parameters.

Nanoemulsão contendo 7-cetocolesterol (LDE/7KC) promove inibição do crescimento de malanoma em camundongos e aumento de sobrevida / A 7-ketocholesterol containing-nanoemulsion (LDE/7KC) inhibits growth of melanoma tumor in mice and increases survival rate

7-cetocoleterol (7KC) é um oxisterol conhecido por inibir a proliferação celular e por ser citotóxico. Uma nanoemulsão contendo 7KC (LDE/7KC) demonstrou efeito anti-proliferativo sobre as linhagens RPMI 8226 (mieloma) e melanoma (B16F10), in vitro. Sendo preferencialmente captada via receptores de LDL. No presente trabalho, avaliamos, in vivo, a cinética plasmática, biodistribuição e ação anti-tumoral em camundongos portadores de melanoma. A nanoemulsão dirigiu-se principalmente no fígado e ao tumor, demonstrando direcionamento a tecidos com alta expressão de receptores para LDL. LDE/7KC promoveu uma redução superior a cinqüenta por cento do tamanho do tumor, que apresentou maior área de necrose e menor quantidade de vasos e aumentou a sobrevida dos camundongos, sem causar toxicidade.

7-ketocholesterol (7KC) is an oxysterol known to inhibit cell proliferation and to be cytotoxic. A nanoemulsion containing-7KC (LDE/7KC) was shown to had antiproliferative effects on RPMI 8226 myeloma cell line and melanoma (B16F10), in vitro. This particle is taken up mainly by LDL receptors. Here we have evaluated the plasma kinetic, biodistribution and the anti-tumoral action of LDE/7KC in melanoma bearing mice. The nanoemulsion accumulated in the liver and tumor, tissues with a high expression of LDL receptors. LDE/7KC promoted a tumor size reduction over fifty percent. A increased necrosis area and a decreased amount of blood vessels was found. A increased survival rate was observed, together with a lack of toxicicity.