Avaliação do colírio de brimonidina 0,2% em comparação à nafazolina 0,025% + feniramina 0,3% nas cirurgias de estrabismo / Evaluation of 0.2% brimonidine eye drops compared to 0.025% naphazoline + 0.3% pheniramine in strabismus surgery

RESUMO Objetivo: Avaliar o efeito do colírio de brimonidina 0,2% na redução da hiperemia e do sangramento ocular durante as cirurgias de estrabismo, em comparação com o colírio de nafazolina 0,025% + feniramina 0,3%. Métodos: Foram avaliados 14 pacientes com estrabismo e indicação de correção cirúrgica bilateral. Foi instilado antes do procedimento, de forma aleatória, um colírio em cada olho dos pacientes avaliados. A análise subjetiva da hiperemia conjuntival e do sangramento perioperatório foi realizada de forma duplo-cega, por dois cirurgiões. A avaliação objetiva do nível de hiperemia conjuntival foi realizada por análise das imagens obtidas por meio do software ImageJ®. Resultados: A análise de modelos multivariados de efeito misto indicou diferenças estatisticamente significantes entre os grupos em relação à hiperemia (avaliador 2) e ao sangramento intraoperatório (avaliadores 1 e 2), com maiores escores nos casos tratados com colírio de nafazolina + feniramina. Entretanto, não houve diferença estatística na análise objetiva realizada por meio da saturação de cores obtidas pelo programa ImageJ®. Conclusão: O colírio de brimonidina pode ser superior ao colírio de nafazolina + feniramina na redução do sangramento, levando-se em conta apenas a análise subjetiva.

ABSTRACT Objective: To evaluate the effect of 0.2% brimonidine eye drops in reducing hyperemia and ocular bleeding during strabismus surgeries, in comparison with 0.025% naphazoline + 0.3% pheniramine eye drops. Methods: Fourteen patients with strabismus and indication for bilateral surgical correction were evaluated. Before the procedure, the eye drops were instilled randomly in each eye of the evaluated patients. The subjective analysis of conjunctival hyperemia and perioperative bleeding was performed in a double-blind manner, by 02 surgeons. The objective assessment of the level of conjunctival hyperemia was performed by analyzing the images obtained using the ImageJ® software. Results: The analysis of multivariate mixed effect models indicated statistically significant differences between the groups in relation to hyperemia (rater 2) and intraoperative bleeding (raters 1 and 2) with higher scores in cases treated with naphazoline + pheniramine eye drops. However, there were no statistically significant differences in the objective analysis of color saturation obtained by the ImageJ® program. Conclusion: Brimonidine eye drops may be superior to naphazoline + pheniramine eye drops in reducing bleeding, taking into account the subjective analysis only.

Reliability of nasofibroscopy for the evaluation of adenoid hypertrophy and its correlation with clinical symptoms

Abstract Objective: To analyze the reliability of estimating the percentage of rhinopharyngeal obstruction by the adenoid using nasofibroscopy and its correlation with clinical symptoms. Methods: Cross-sectional observational study was conducted, involving 80 patients between 4 and 14 years old, recruited from Santa Casa of São Paulo general otorhinolaryngology outpatient service during the years of 2020 and 2021. All patients underwent nasal endoscopy examination, and the recorded videos were randomly assigned to four evaluators in two different sessions, with a minimum interval of 1 month. The evaluators estimated the percentage of rhinopharyngeal obstruction caused by the adenoid. Intra- and inter-evaluator correlations were established by comparing the reports from each evaluator. The data were compared to the Pro Image J Software report, that also estimates a percentage of obstruction by computer graphics. To correlate the grading of obstruction with clinical symptoms, all patients completed the OSA (Obstructive Sleep Apnea) 18 questionnaire, a validated tool for assessing sleep apnea in children. The questionnaire data were then compared to the average scores assigned by the evaluators. Results: Satisfactory intra- and inter-rater correlations were observed, and the results were consistent with the Pro Image J Software. However, no correlation was found between the percentage of obstruction and the severity of clinical symptoms. Conclusion: Nasofibroscopy demonstrates good reliability in assessing a percentage of rhinopharyngeal obstruction caused by adenoids. However, there is no correlation between the degree of obstruction of the rhinopharynx and the clinical symptoms. Level of evidence: 4.

Increased expression of matrix metalloproteinases 2 and 9 as poor prognosis factor for Hodgkin's lymphoma patients

Abstract Objective: The aim of our study was to evaluate the expression of MMP-2 and MMP-9 as a prognostic factor in patients diagnosed with Hodgkin Lymphoma (HL). Methods: In the present study, 45 paraffin biopsies from patients up to 19 years old diagnosed with HL were used in two referral hospitals in the state of Pernambuco, Brazil. Risk groups were classified into favorable and unfavorable, according to Ann Arbor. The expression of matrix metalloproteinases 2 and 9 and their inhibitors was performed by immunohistochemistry (IHC). Data were analyzed using the GraphPad Prism 5 program. Results: MMP-2 intensity pattern was stronger (> 10% of the total field) in patients with stage III/ IV and B symptoms. MMP-2 showed an association with the risk group (p = 0.0388). That is, the stronger the MMP-2 marking, the greater the unfavorable risk. However, for MMP-9 there was no difference in the stronger intensity pattern in relation to stages I/II and III/IV, only in the presence of B symptoms. MMP-9 showed an association with B Symptoms (p = 0.0411). Therefore, patients with B symptoms have higher MMP-9 expression. Conclusion: Our results suggest that MMP-2 expression is associated with HL progression. While MMP-9 expression is related to the clinical worsening of these patients. However, further studies are needed to evaluate the exact role of these proteins in hematologic malignancies.

Atomoxetine and Fluoxetine Activate AMPK-ACC-CPT1 Pathway in Human SH-SY5Y and U-87 MG Cells

Objective@#Atomoxetine and fluoxetine are psychopharmacologic agents associated with loss of appetite and weight. Adenosine monophosphate-activated protein kinase (AMPK) is the cellular energy sensor that regulate metabolism and energy, being activated by fasting and inhibited by feeding in the hypothalamus. @*Methods@#Human brain cell lines (SH-SY5Y and U-87 MG cells) were used to study the outcome of atomoxetine and fluoxetine treatment in the activity of AMPK-acetyl-CoA carboxylase (ACC)- carnitine palmitoyl transferase 1 (CPT1) pathway and upstream regulation by calcium/calmodulin-dependent kinase kinase β (CaMKKβ) using immunoblotting and CPT1 enzymatic activity measures. @*Results@#Phosphorylation of AMPK and ACC increased significantly after atomoxetine and fluoxetine treatment in the first 30–60 minutes of treatment in the two cell lines. Activation of AMPK and inhibition of ACC was associated with an increase by 5-fold of mitochondrial CPT1 activity. Although the neuronal isoform CPT1C could be detected by immunoblotting, activity was not changed by the drug treatments. In addition, the increase in phospho-AMPK and phospho-ACC expression induced by atomoxetine was abolished by treatment with STO-609, a CaMKKβ inhibitor, indicating that AMPK-ACC-CPT1 pathway is activated through CaMKKβ phosphorylation. @*Conclusion@#These findings indicate that at the cellular level atomoxetine and fluoxetine treatments may activate AMPK-ACC-CPT1 pathways through CaMKKβ in human SH-SY5Y and U-87 MG cells.

Multidrug-resistant Acinetobacter spp. from hospital intensive care units in Brazilian Amazon

Abstract Acinetobacter spp. are one of the main pathogens responsible for healthcare-associated infections and are associated with high rates of morbidity and mortality globally, mainly because of their high capacity to present and develop resistance to antimicrobials. To identify species of the Acinetobacter and their resistance profiles from samples collected from hospitalized patients, health professionals and hospital environmental sources in the intensive care units of different public reference hospitals in Porto Velho City, Rondônia, Western Brazilian Amazon. Isolates were identified using microbiological and molecular techniques. The antimicrobial susceptibility profile was determined by disk diffusion. A total of 201 Acinetobacter spp. isolates were identified, of which 47.3% originated from hospital structures, 46.8% from patients and 6% from healthcare professionals. A. baumannii and A. nosocomialis were the most prevalent, with frequency of 58.7% and 31.8%, respectively. Regarding the susceptibility profile, it was observed that 56.3% were classified as multidrug-resistant and 76.2% of the samples belonging to A. baumannii were resistant to carbapenems. In contrast, 96.9% were susceptible to polymyxin B and 91.3% to doxycycline. The data presented here can be used to guide and strengthen the control of multidrug-resistant infections caused by Acinetobacter spp., in addition to improving providing information from a traditionally unassisted region of Brazil.

Antileishmanial effects of γCdcPLI, a phospholipase A2 inhibitor from Crotalus durissus collilineatus snake serum, on Leishmania (Leishmania) amazonensis

BACKGROUND Leishmaniasis, a neglected disease caused by the parasite Leishmania, is treated with drugs associated with high toxicity and limited efficacy, in addition to constant reports of the emergence of resistant parasites. In this context, snake serums emerge as good candidates since they are natural sources with the potential to yield novel drugs. OBJECTIVES We aimed to show the antileishmanial effects of γCdcPLI, a phospholipase A2 inhibitor from Crotalus durissus collilineatus snake serum, against Leishmania (Leishmania) amazonensis. METHODS Promastigotes forms were exposed to γCdcPLI, and we assessed the parasite viability and cell cycle, as well as invasion and proliferation assays. FINDINGS Despite the low cytotoxicity effect on macrophages, our data indicate that γCdcPLI has a direct effect on parasites promoting an arrest in the G1 phase and reduction in the G2/M phase at the highest dose tested. Moreover, this PLA2 inhibitor reduced the parasite infectivity when promastigotes were pre-treated. Also, we demonstrated that the γCdcPLI treatment modulated the host cell environment impairing early and late steps of the parasitism. MAIN CONCLUSIONS γCdcPLI is an interesting tool for the discovery of new essential targets on the parasite, as well as an alternative compound to improve the effectiveness of the leishmaniasis treatment.

Resistance to diseases of sour, sweet and wild passion fruit genotypes

The cultivation of passion fruit is important for Brazil, since the country is currently the largest producer and consumer of fruit in the world. However, the fields of passion fruit still face important problems due to the incidence and severity of diseases in the field. Thus, the present study aimed to assess resistance to bacterial and fungal diseases in 13 genotypes of sour, sweet and wild passion fruit, in field conditions in the Distrito Federal, Brazil. For this, a field experiment was installed in a randomized block design, with four replications and 13 treatments (genotypes). The characteristics of incidence, severity and degree of resistance for bacteriosis, septoriosis, scab and anthracnose diseases were evaluated in 5 fruits per plot of each genotype. Genetic parameters of the evaluated traits were also estimated. High heritability values and CVg/Cve ratio were observed for most of the evaluated characteristics. The genotypes presented mean values of incidence and severity of bacteriosis, septoriosis, scab and anthracnose different among them, and the one that presented the best results in the degree of resistance for all diseases was F1 (MAR20 # 24 x ECL7 P1 R4).

Mitochondrial dysfunction on Leishmania (Leishmania) amazonensis induced by ketoconazole: insights into drug mode of action

BACKGROUND Leishmania parasites cause leishmaniasis that range from self-limiting cutaneous lesions to more serious forms of the disease. The search for potential drug targets focusing on biochemical and metabolic pathways revealed the sterol biosynthesis inhibitors (SBIs) as a promising approach. In this class of inhibitors is found ketoconazole, a classical inhibitor of 14α-methysterol 14-demethylase. OBJECTIVE The present study aimed to better understand the biological response of Leishmania (Leishmania) amazonensis promastigotes at the cellular level after ketoconazole treatment. METHODS Herein, techniques, such as fluorimetry, flow cytometry, fluorescence microscopy, electron and scanning microscopy were used to investigate the cellular structures and to identify organelles affected by ketoconazole treatment. FINDINGS The study demonstrated, for the first time, the effect of ketoconazole on mitochondrion functioning and its probable relationship to cell cycle and death on L. (L.) amazonensis promastigotes (IFLA/BR/67/PH8 strain). MAIN CONCLUSIONS Ketoconazole-induced mitochondrial damages led to hyperpolarisation of this single organelle and autophagic vacuoles formation, as a parasite survival strategy. These damages did not reflect directly on the parasite cell cycle, but drove the parasites to death, making them susceptible to ketoconazole treatment in in vitro models.

Aprimoramento em grupoterapia: adaptação ao contexto on-line / Group therapy improvement: adaptation to the online context / Formación profesional en terapia de grupo: adaptación al contexto online

Este é um Relato de Experiência de Aprimoramento em Coordenação e Manejo de Grupos. A experiência ocorreu durante a pandemia da COVID-19, sendo assim, desafios e adaptações estiveram presentes na vida cotidiana e acadêmica. A adaptação do aprimoramento para a modalidade on-line e em contexto pandêmico, provocou questionamentos a respeito do êxito da tarefa. O emprego dos dispositivos on-line para o aprimoramento de grupoterapeutas é um campo relativamente novo, justificando a relevância deste trabalho. Foi utilizado Diário de Campo para a coleta de dados e optou-se pelo referencial teórico de Pichon-Rivière, e outros autores da Psicanálise das Configurações Vinculares que discutem a questão da virtualidade na atualidade. Entendemos que a adaptação ao modelo on-line possibilitou a continuidade das atividades grupais programadas e a existência de um espaço de formação, troca e suporte entre pares. O Grupo Psicanalítico de Reflexão foi fundamental neste contexto, favoreceu a aprendizagem e o desenvolvimento de competências, oportunizou a construção e fortalecimento de vínculos, estimulou a postura crítica e criativa diante dos desafios, limites e potencialidades da adaptação ao modelo on-line, além de acolher as experiências decorrentes dos aprimoramentos do estado de pandemia.

This is an Experience Report on the Improvement Group Coordination and Management. The Experience occurred during the COVID-19 pandemic; therefore, challenges and adaptations were present in daily and academic life. Questions about the success of the task were raised after the adaptation of the Group Therapy to the modality due to the pandemic context. The usage of online devices to enhance group therapists is a relatively new field, justifying the relevance of this work. Field Diary was used for data collection. We opted for the theoretical framework of Pichon-Rivière, and the Psychoanalysis of Binding Configurations' authors, who discuss the issue of virtuality today. We understand that the adaptation to the online model enabled the continuity of scheduled group activities and the existence of training spaces, exchanges, and support peers. The Psychoanalytic Reflection Group was fundamental in this context, it favored learning and the development of skills. It provided the opportunity to build, strengthen bonds, and encourage critical and creative stances in the face of the challenges, limits, and potentials of adapting to the online model; and welcomed the experiences of improvements resulting from the pandemic state.

Este es un informe de Experiencia de Formación Profesional en la Coordinación y Gestión de Grupos. En el año de esta experiencia ocurrió la pandemia del COVID-19, desafíos y adaptaciones se hicieron presentes en la vida cotidiana y académica. La adaptación de la formación a la modalidad en línea y el contexto de pandemia, planteó interrogantes sobre el éxito de la tarea. El uso de dispositivos en línea para la formación de terapeutas grupales es un campo relativamente nuevo, que justifica la relevancia de este trabajo. Se utilizó Diario de Campo para recoger datos. Optamos por el marco teórico de Pichon-Rivière y autores del Psicoanálisis de las Configuraciones Vinculantes que discuten el tema de la virtualidad en la actualidad. Entendemos que la adaptación al modelo en línea permitió la continuidad de las actividades grupales programadas y la existencia de un espacio de formación, intercambio y apoyo entre pares. El Grupo de Reflexión Psicoanalítica fue fundamental en este contexto, favoreció el aprendizaje y el desarrollo de habilidades, brindó la oportunidad de construir y fortalecer lazos, estimuló una actitud crítica y creativa frente a los desafíos, límites y potencialidades de la adaptación al modelo en línea y acogió las experiencias de la formación derivadas del estado de pandemia.

Influência da ventilação assistida e dos ajustes do ventilador mecânico sobre o volume corrente e as pressões alveolares na síndrome do desconforto respiratório agudo: um estudo de bancada / Influences of assisted breathing and mechanical ventilator settings on tidal volume and alveolar pressures in acute respiratory distress syndrome: a bench study

RESUMO Objetivo: Avaliar a influência dos esforços musculares respiratórios e do ajuste da frequência respiratória no ventilador sobre o volume corrente e as pressões de distensão alveolar ao final da inspiração e expiração com ventilação sob os modos controle por volume e controle por pressão na síndrome do desconforto respiratório agudo. Métodos: Utilizou-se um simulador mecânico de pulmão (ASL 5000™) conectado a cinco tipos de ventiladores utilizados em unidade de terapia intensiva, em um modelo de síndrome do desconforto respiratório agudo. Os esforços musculares respiratórios (pressão muscular) foram configurados de três formas distintas: sem esforço (pressão muscular: 0cmH2O), apenas esforços inspiratórios (pressão muscular: - 5cmH2O, tempo inspiratório neural de 0,6 segundos) e esforços musculares inspiratórios e expiratórios (pressão muscular:-5/+5cmH2O). Foram configuradas ventilação sob os modos controle por volume e ventilação com controle por pressão para oferecer um volume corrente de 420mL e pressão positiva expiratória final de 10cmH2O. Avaliaram-se o volume corrente fornecido aos pulmões, as pressões alveolares no final da inspiração e as pressões alveolares no final da expiração. Resultados: Quando disparado pelo paciente simulado, o volume corrente mediano foi 27mL menor do que o volume corrente ajustado (variação-63 a +79mL), e ocorreu uma variação nas pressões alveolares com mediana de 25,4cmH2O (faixa de 20,5 a 30cmH2O). Nos cenários simulados com esforço muscular tanto inspiratório quanto expiratório e com frequência respiratória mandatória inferior à dos esforços do paciente simulado, o volume corrente mediano foi maior com ventilação controlada. Conclusão: O ajuste do esforço muscular respiratório e da frequência respiratória no ventilador em um valor acima da frequência respiratória do paciente nos modos de ventilação assistida/controlada gerou maiores variações no volume corrente e nas pressões pulmonares, enquanto o modo controlado não mostrou variações nesses desfechos.

ABSTRACT Objective: To evaluate the influences of respiratory muscle efforts and respiratory rate setting in the ventilator on tidal volume and alveolar distending pressures at end inspiration and expiration in volume-controlled ventilation and pressure-controlled ventilation modes in acute respiratory distress syndrome. Methods: An active test lung (ASL 5000™) connected to five intensive care unit ventilators was used in a model of acute respiratory distress syndrome. Respiratory muscle efforts (muscle pressure) were configured in three different ways: no effort (muscle pressure: 0cmH2O); inspiratory efforts only (muscle pressure:-5cmH2O, neural inspiratory time of 0.6s); and both inspiratory and expiratory muscle efforts (muscle pressure:-5/+5cmH2O). Volume-controlled and pressure-controlled ventilation modes were set to deliver a target tidal volume of 420mL and positive end-expiratory pressure of 10cmH2O. The tidal volume delivered to the lungs, alveolar pressures at the end of inspiration, and alveolar pressures at end expiration were evaluated. Results: When triggered by the simulated patient, the median tidal volume was 27mL lower than the set tidal volume (range-63 to +79mL), and there was variation in alveolar pressures with a median of 25.4cmH2O (range 20.5 to 30cmH2O). In the simulated scenarios with both spontaneous inspiratory and expiratory muscle efforts and with a mandatory respiratory rate lower than the simulated patient's efforts, the median tidal volume was higher than controlled breathing. Conclusion: Adjusting respiratory muscle effort and pulmonary ventilator respiratory rate to a value above the patient's respiratory rate in assisted/controlled modes generated large variations in tidal volume and pulmonary pressures, while the controlled mode showed no variations in these outcomes.

Distanciamento social e COVID-19: estratégias adotadas por estudantes de Enfermagem / Social distancing and COVID-19: strategies adopted by Nursing students / Distanciamiento social y COVID-19: estrategias adoptadas por estudiantes de Enfermería

OBJETIVO: identificar quais estratégias de enfrentamento foram adotadas por estudantes de Enfermagem de uma universidade pública perante as dificuldades vivenciadas no decorrer do distanciamento social e da pandemia da COVID-19. MÉTODO: estudo transversal, realizado com 148 estudantes, a partir de questionário on-line. A análise estatística foi realizada por meio de análise descritiva dos dados, apresentando os resultados por frequências absolutas e relativas e medidas de tendência central. RESULTADOS: constatou-se que uma pequena parcela foi infectada por SARS-CoV-2 (6,1%). Em contrapartida, 39,9% relataram que algum familiar foi infectado. Em relação aos que utilizaram estratégias de enfrentamento (91,2%), destacam-se a adoção de hobbies (49,3%) e a realização de atividades físicas (26,4%). Nota-se que ambas estiveram relacionadas também a meios para o afastamento da situação vivida e/ou na tentativa de fuga de pensamentos negativos. CONCLUSÃO: os resultados apontam ser necessário o apoio da universidade, a partir de ações com enfoque na saúde mental dos estudantes de Enfermagem, potencializando as estratégias que sejam eficazes na melhoria do bem-estar e na diminuição do estresse dos alunos, suscetíveis ao adoecimento psíquico, a partir das vivências e receios do meio universitário.

OBJECTIVE: identify which coping strategies have been adopted by Nursing students at a public university in the face of the difficulties experienced during the social distancing and the COVID-19 pandemic. METHOD: cross-sectional study, conducted with 148 students, from an online questionnaire. The statistical analysis was carried out through descriptive analysis of the data, presenting the results by absolute and relative frequencies and measures of central tendency. RESULTS: a small portion was found to be infected with SARS-CoV-2 (6.1%). In contrast, 39.9% reported that some family member was infected. In relation to those who used coping strategies (91.2%), the adoption of hobbies (49.3%) and the performance of physical activities (26.4%) stand out. It is noted that both were also related to means to get away from the lived situation and/or in the attempt to escape negative thoughts. CONCLUSION: the results indicate that the support of the university is necessary, based on actions focused on the mental health of nursing students, enhancing strategies that are effective in improving the well-being and reducing the stress of students, susceptible to psychic illness, from the experiences and fears of the university environment.

OBJETIVO: identificar qué estrategias de afrontamiento fueron adoptadas por estudiantes de enfermería en una universidad pública en vista de las dificultades experimentadas durante la distancia social y la pandemia de Covid-19. MÉTODO: estudio transversal, realizado con 148 alumnos, utilizando un cuestionario en línea. El análisis estadístico se realizó a través del análisis de datos descriptivos, presentando los resultados por frecuencias absolutas y relativas y medidas de tendencia central. Para el análisis de asociación, se utilizó la prueba de chi-cuadrado, adoptando un nivel de significación del 5%. RESULTADOS: se encontró que una pequeña porción estaba infectada con SARS-CoV-2 (6.1%). En contraste, el 39.9% informó que algún miembro de la familia estaba infectado. Con respecto a quienes usaron estrategias de afrontamiento (91.2%), se destaca la adopción de pasatiempos (49.3%) y actividades físicas (26.4%). Cabe señalar que ambos también estaban relacionados con formas de eliminar la situación experimentada y/o en un intento de escapar de los pensamientos negativos. CONCLUSIÓN: los resultados apuntan a la necesidad de apoyo universitario, basado en acciones enfocadas en la salud mental de los estudiantes de enfermería, lo que permite mejorar las estrategias que son efectivas para mejorar el bienestar y reducir el estrés de los estudiantes, previamente susceptibles a enfermedades psíquico basado en las experiencias y temores del entorno universitario.

Prevalência de sintomas depressivos pós-parto e sua associação com a violência: estudo transversal, Cariacica, Espírito Santo, 2017 / Prevalencia de síntomas depresivos posparto y su asociación con la violencia: estudio transversal, Cariacica, Espírito Santo, Brasil, 2017 / Prevalence of postpartum depression symptoms and their association with violence: a cross-sectional study, Cariacica, Espírito Santo, Brazil, 2017

Objetivo: Analisar a prevalência de sintomas depressivos pós-parto entre puérperas e sua associação com a violência. Métodos: Estudo transversal com puérperas atendidas em uma maternidade pública de Cariacica, ES, Brasil, em 2017. Utilizou-se questionário elaborado pelos autores e instrumentos validados. Na análise, realizou-se teste qui-quadrado de Pearson e a associação foi apresentada por razão de prevalências (RP) e intervalo de confiança de 95% (IC95%). Resultados: A prevalência de sintomas depressivos pós-parto foi 36,7% (IC95% 31,6;42,0). Renda familiar total associou-se inversamente com essa prevalência (p<0,05). Puérperas solteiras (RP=1,75 - IC95% 1,17;2,64), que desejaram abortar (RP=1,96 - IC95% 1,50;2,56), que consumiram bebida alcoólica na gestação (RP=1,37 - IC95% 1,00;1,86), que vivenciaram violência por parceiro íntimo na vida (RP=1,94 - IC95% 1,38;2,73) e na gravidez (RP=1,41 - IC95% 1,07;1,85) tiveram maiores prevalências de sintomas depressivos. Conclusão: Sintomas depressivos pós-parto associam-se a situação conjugal, desejo de realizar aborto, consumo de álcool na gestação e violência por parceiro íntimo.

Objetivo: Analizar la prevalencia de síntomas depresivos posparto en puérperas y su asociación con la violencia. Métodos: Estudio transversal con puérperas atendidas en una maternidad pública de Cariacica, ES, Brasil, en 2017. Se utilizó un cuestionario elaborado por los autores e instrumentos validados. En el análisis se realizó la prueba de chi-cuadrado de Pearson y la asociación se presentó por razón de prevalencia (RP) e intervalo de confianza del 95% (IC95%). Resultados: La prevalencia de síntomas depresivos posparto fue del 36,7% (IC95% 31,6;42,0). El ingreso familiar total se asoció inversamente con esta prevalencia (p<0,05). Madres solteras (RP=1,75 - IC95% 1,17;2,64), que deseaban abortar (RP=1,96 - IC95% 1,50;2,56), que consumieron alcohol durante el embarazo (RP=1,37 - IC95% 1,00;1,86), que experimentaron violencia de pareja íntima en la vida (RP=1,94 - IC95% 1,38;2,73) y durante el embarazo (RP=1,41 - IC95% 1,07;1,85) tuvieron una mayor prevalencia de síntomas depresivos. Conclusión: Los síntomas depresivos posparto están asociados con el estado civil, el deseo de abortar, el consumo de alcohol durante el embarazo y la violencia de la pareja íntima.

Objective: To assess the prevalence of postpartum depression symptoms among puerperal women and their association with violence. Methods: This was a cross-sectional study with puerperal women cared for at a public maternity hospital in Cariacica, ES, Brazil, in 2017. A questionnaire prepared by the authors and validated instruments were used. Pearson's chi-square test was performed in the analysis and association was expressed in prevalence ratios (PR) and 95% confidence intervals (95%CI). Results: Postpartum depression symptom prevalence was 36.7% (95%CI 31.6;42.0). Total family income was inversely associated with this prevalence (p<0.05). Mothers who were single (PR=1.75 - 95%CI 1.17;2.64), wished to abort (PR=1.96 - 95%CI 1.50;2.56), drank alcohol during pregnancy (PR=1.37 - 95%CI 1.00;1.86), experienced intimate partner violence in their lifetime (PR=1.94 - 95%CI 1.38;2.73), and during pregnancy (PR=1.41 - 95%CI 1.07;1.85), had higher prevalence of depression symptoms. Conclusion: Postpartum depression symptoms are associated with marital status, wanting to abort, alcohol consumption during pregnancy and intimate partner violence.

Anemia grave no puerpério / Severe anemia in the puerperium

A anemia no puerpério é bastante prevalente, estando principalmente relacionada à ocorrência de anemia não corrigida durante a gestação e às hemorragias agudas durante o parto. Essas situações aumentam significativamente a probabilidade de anemia grave no período pós-parto, gerando manifestações orgânicas e psicológicas que trazem prejuízo ao binômio materno-fetal. A forma grave da doença é caracterizada laboratorialmente por hemoglobina < 7 g/dL e suas manifestações clínicas variam na dependência de diversos fatores. O objetivo do tratamento é corrigir a hipóxia tecidual, revertendo as alterações adaptativas relacionadas à carência de oxigênio. Enquanto o tratamento agressivo de perdas volêmicas agudas diminui a morbimortalidade por esses eventos, políticas restritivas de transfusão sanguínea em pacientes hemodinamicamente estáveis mostram-se benéficas. Se não houver indicação de transfusão, a reposição de ferro atuará na correção das principais etiologias, pelas vias endovenosa ou oral, na dependência de disponibilidade, custo e tolerância individual aos medicamentos disponíveis.(AU)

Anemia is quite prevalent in puerperium; in this population, the disease is mainly related to the occurrence of uncorrected anemia during pregnancy and to acute bleeding during childbirth. These situations significantly increase the likelihood of severe anemia in the postpartum period, generating organic and psychological manifestations that cause damage to the maternal-fetal binomial. The severe form of anemia is characterized by hemoglobin < 7 g/dL and its clinical manifestations vary depending on several factors. The goal of treatment is to correct tissue hypoxia, reversing adaptive changes related to oxygen deficiency. While the aggressive treatment of acute blood losses decreases the morbidity and mortality of these events, restrictive blood transfusion policies in hemodynamically stable patients are beneficial. If there is no indication for transfusion, iron replacement will act to correct the main etiologies, through the intravenous or oral routes, depending on availability, cost and individual tolerance to the available drugs.(AU)

Oficinas de Criatividade: atendimento à população de rua / Creativity Workshop: service to the homeless population

O presente trabalho é um relato de experiência do estágio curricular de Oficina de Criatividade, realizado com população de rua. Esta modalidade de intervenção visa atender populações que normalmente estão à margem dos serviços tradicionais de psicologia. Utiliza técnicas expressivas como meio de acesso às experiências humanas e sua finalidade é favorecer a transformação das relações e ampliar o horizonte existencial de cada integrante. A perspectiva teórica adotada a respeito do trabalho com população de rua pressupõe o distanciamento da patologização dos comportamentos desviantes e moralmente estabelecidos e prioriza a valorização, a aproximação e o reconhecimento dos diferentes modos de ser e estar no mundo. A experiência aqui descrita atendeu a este propósito na medida em que os participantes puderam refletir e compartilhar seus saberes, histórias e cultura, sentindo-se valorizados para reconhecer ou construir e comunicar seu posicionamento crítico a respeito de certa institucionalização concreta e cultural dos serviços socioassistenciais e psicológicos direcionados a este público. Desde modo, entendemos que a Oficina de Criatividade favoreceu mútuas afetações entre pesquisador, pesquisado e instituição, num exercício de ressignificação sobre o fazer psicológico e seu potencial transformador.(AU)

This work is a traineeship experience report of Creativity Workshop, conducted with homeless people. This type of intervention needs to serve populations that are frequently beyond the traditional psychology services. Uses expressive techniques as a means to human experience and its purpose is to promote the transformation of relationships and expand the existential horizon of each participant. The theoretical perspective adopted about work with homeless people sought to distance from the pathologizing of different behavior and morally established and prioritize the valuation, approximation and recognition of different ways of being in the world. The experience described here has served this purpose insofar as the participants were able to reflect and share their knowledge, histories and culture, feeling appreciated recognizing or constructing and communicating their critical position regarding a certain concrete and cultural institutionalization of social welfare and psychological services directed to this public. Thus, we understand that the Creativity Workshop favored common affectations between researcher, researched and institution, in an exercise of ressignification about the psychological doing and its transforming potential.(AU)

Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS / Esquizofrenia e violência: estudo em um hospital psiquiátrico clínico com o HCR-20 e a MOAS

Abstract Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.

Resumo Objetivo: Este estudo preliminar tem por objetivo identificar e comparar características relacionadas ao comportamento violento em pacientes com esquizofrenia internados em um hospital psiquiátrico utilizando o Historical, Clinical, and Risk Management 20 (HCR-20), a Modified Overt Aggression Scale (MOAS), e dados sociodemográficos. Método: Foram selecionados participantes com e sem histórico de comportamento violento, referidos nos relatórios de internação hospitalar. Participantes violentos e com escore total do HCR-20 ≥ 21 na internação foram selecionados para o grupo violento. Participantes não violentos com escore total do HCR-20 < 21 na internação foram selecionados para o grupo não violento. A MOAS foi aplicada para caracterizar o grau de severidade do comportamento violento. Resultados: O HCR-20 e suas subescalas foram eficazes na diferenciação entre os participantes dos grupos. Doze dos 20 itens do HCR-20 foram úteis na diferenciação entre os grupos, apesar do escore total do HCR-20 ter sido mais confiável quando aplicado ao grupo não violento. A MOAS não apresentou graus de severidade elevados para os tipos de agressividade observados nos participantes. Conclusão: O HCR-20 foi útil e confiável na distinção entre pacientes esquizofrênicos violentos e não violentos em ambiente psiquiátrico clínico, já que a análise dos itens identificou as características mais relevantes em cada grupo. O uso do HCR-20 em ambientes psiquiátricos clínicos deveria ser encorajado.

Caracterização de Escherichia coli enteroagregativa entre crianças com diarreia na Amazônia ocidental brasileira / Characterization of enteroaggregative escherichia coli among diarrheal childrenin western brazilian amazon

ABSTRACT BACKGROUND: Enteroaggregative Escherichia coli (EAEC) is one of the main acute and chronic diarrhea causes both in children and adults, mainly in developing countries. OBJECTIVE: The aim of the present study is to characterize EAEC strains isolated from faecal samples and to identify genes potentially contributing to virulence, biofilm production and antimicrobial resistance in children admitted to a pediatric hospital in Porto Velho, Rondônia State. METHODS: The total of 1,625 E. coli specimens were isolated from 591 children in the age group 6 years or younger who were hospitalized in Cosme and Damião Children Hospital in Porto Velho, between February 2010 and February 2012, with acute gastroenteritis. Colonies suggestive of E. coli were subjected to polymerase chain reaction testing in order to identify the virulence factors. The in vitro adhesion assays using HEp-2 adherence were tests. Biofilm detection through spectrophotometry and antimicrobial susceptibility tests were conducted in the disk diffusion method. RESULTS: The mentioned study examined 591 stool samples from children with diarrhea. Diarrheogenic E. coli was found in 27.4% (162/591) of the children. EAEC was the diarreagenic E. coli most frequently associated with diarrhea 52.4% (85/162), which was followed by enteropathogenic E. coli 43.8% (71/162), enterotoxigenic E. coli 2.4% (4/162), and enterohemorrhagic E. coli 1.2% (2/162). The aggR gene was detected in 63.5% (54/85) of EAEC isolates; moreover, statistically significant correlation was observed among typical EAEC (aggR) and aatA (P<0.0001), irp2 (P=0.0357) and shf (P=0.0328). It was recorded that 69% (59/85) of the 85 analyzed EAEC strains were biofilm producers; 73% (43/59) of the biofilm producers carried the aggR gene versus 42.3% (11/26) of non-producers (P=0.0135). In addition, there was association between the aatA gene and biofilm production; 61% (36/59) of the samples presented producer strains, versus 19.2% (5/26) of non-producers (P<0.0004). Antibiotic sensitivity test evidenced that most EAEC were ampicillin 70.6% (60/85), sulfamethoxazole 60% (51/85), tetracycline 44.7% (38/85) and cefotaxime 22.4% (19/85) resistant. CONCLUSION: As far as it is known, the present study is pioneer in Northern Brazil to investigate EAEC virulence factors and to show the antimicrobial susceptibility of EAEC strains isolated from children with diarrhea.

RESUMO CONTEXTO: A Escherichia coli enteroagregativa (EAEC) é um dos principais agentes causadores de diarreia aguda e crônica em crianças e adultos, principalmente em países em desenvolvimento. OBJETIVO: Caracterizar cepas de EAEC isoladas de amostras fecais e identificar genes que potencialmente contribuem para a virulência, produção de biofilme e resistência antimicrobiana em crianças internadas em um hospital pediátrico em Porto Velho, Rondônia. MÉTODOS: Um total de 1.625 cepas de E. coli foram isolados de 591 crianças com gastroenterite aguda na faixa etária de 6 anos que foram internadas no Hospital Infantil Cosme e Damião na cidade de Porto Velho, entre fevereiro de 2010 e fevereiro de 2012. Colônias sugestivas de E. coli foram submetidas a reação em cadeia da polimerase para identificação de fatores de virulência. O ensaio de adesão in vitro foi desenvolvido com célula HEp-2. A detecção de biofilme foi realizada através do teste de espectrofotometria e os testes de susceptibilidade aos antimicrobiana foram realizados através do método de difusão em disco. RESULTADOS: A E. coli diarreiogênica foi encontrada em 27,4% (162/591) das crianças e a EAEC foi a E. coli diarreiogênica mais frequentemente associada à diarreia com 52,4% (85/162), seguida pela E. coli enteropatogênica 43,8% (71/162), E. coli enterotoxigênica 2,4% (4/162) e E. coli enterohemorrágica 1,2% (2/162). O gene aggR foi detectado em 63,5% (54/85) dos isolados de EAEC com correlação estatisticamente significante entre esse gene com os genes aatA (P<0,0001), irp2 (P=0,0357) e shf (P=0,0328). Neste estudo 69% (59/85) das cepas de EAEC eram produtoras de biofilme, destas 73% (43/59) possuíam o gene aggR, ao passo que entre as não produtoras 42,3% (11/26) possuíam o gene (P=0,0135). Essa associação também foi observada com o gene aatA, presente em 61% (36/59) das cepas produtoras e em 19,2% (5/26) das não produtoras (P<0,0004). O teste de sensibilidade aos antibimicrobianos evidenciou que a maioria das EAEC eram resistentes a ampicilina 70,6% (60/85), ao sulfametoxazol 60% (51/85), a tetraciclina 44,7% (38/85) e a cefotaxima 22,4% (19/85). CONCLUSÃO: Este é o primeiro estudo no Norte do Brasil sobre a investigação dos fatores de virulência de EAEC mostrando a susceptibilidade antimicrobiana de cepas de EAEC isoladas de crianças com diarreia.

Peptidomic investigation of Neoponera villosa venom by high-resolution mass spectrometry: seasonal and nesting habitat variations

Background: Advancements in proteomics, including the technological improvement in instrumentation, have turned mass spectrometry into an indispensable tool in the study of venoms and toxins. In addition, the advance of nanoscale liquid chromatography coupled to nanoelectrospray mass spectrometry allows, due to its high sensitivity, the study of venoms from species previously left aside, such as ants. Ant venoms are a complex mixture of compounds used for defense, predation or communication purposes. The venom from Neoponera ants, a genus restricted to Neotropical regions, is known to have cytolytic, hemolytic, antimicrobial and insecticidal activities. Moreover, venoms from several Neoponera species have been compared and differences in their toxicity related to nesting habitat variation were reported. Therefore, the present study aimed to perform a deep peptidomic analysis of Neoponera villosa venom and a comparison of seasonal and nesting habitat variations using high-resolution mass spectrometry. Methods: Specimens of N. villosa ants were captured in Panga Natural Reserve (Uberlândia, MG, Brazil) from arboreal and ground-dwelling nests during summer and winter time. The venom glands were dissected, pooled and disrupted by ultra-sonic waves. The venom collected from different habitats (arboreal and ground-dwelling) and different seasons (summer and winter) was injected into a nanoACQUITY ULPC hyphened to a Q-Exactive Orbitrap mass spectrometer. The raw data were analyzed using PEAKS 7. Results: The results showed a molecular diversity of more than 500 peptides among these venoms, mostly in the mass range of 8004000 Da. Mutations and post-translational modifications were described and differences among the venoms were observed. Part of the peptides matched with ponericins, a well-known antimicrobial peptide family...

Peptidomic investigation of Neoponera villosa venom by high-resolution mass spectrometry: seasonal and nesting habitat variations

Advancements in proteomics, including the technological improvement in instrumentation, have turned mass spectrometry into an indispensable tool in the study of venoms and toxins. In addition, the advance of nanoscale liquid chromatography coupled to nanoelectrospray mass spectrometry allows, due to its high sensitivity, the study of venoms from species previously left aside, such as ants. Ant venoms are a complex mixture of compounds used for defense, predation or communication purposes. The venom from Neoponera ants, a genus restricted to Neotropical regions, is known to have cytolytic, hemolytic, antimicrobial and insecticidal activities. Moreover, venoms from several Neoponera species have been compared and differences in their toxicity related to nesting habitat variation were reported. Therefore, the present study aimed to perform a deep peptidomic analysis of Neoponera villosa venom and a comparison of seasonal and nesting habitat variations using high-resolution mass spectrometry. Methods: Specimens of N. villosa ants were captured in Panga Natural Reserve (Uberlândia, MG, Brazil) from arboreal and ground-dwelling nests during summer and winter time. The venom glands were dissected, pooled and disrupted by ultra-sonic waves. The venom collected from different habitats (arboreal and ground-dwelling) and different seasons (summer and winter) was injected into a nanoACQUITY ULPC hyphened to a Q-Exactive Orbitrap mass spectrometer. The raw data were analyzed using PEAKS 7. Results: The results showed a molecular diversity of more than 500 peptides among these venoms, mostly in the mass range of 800-4000 Da. Mutations and post-translational modifications were described and differences among the venoms were observed. Part of the peptides matched with ponericins, a well-known antimicrobial peptide family. In addition, smaller fragments related to ponericins were also identified, suggesting that this class of antimicrobial peptide might undergo enzymatic cleavages. Conclusion: There are substantial differences among the venom of N. villosa ants collected in different seasons and from different nest habitats. The venom composition is affected by climate changes that influence prey availability and predator presence. Clearly, nano-LC-MS boosted the knowledge about ant venom, a rich source of unexplored and promising bioactive compounds.(AU)

Efetividade do processo de doação de órgãos para transplantes / Effectiveness of the organ donation process

Resumo Objetivo: Verificar a efetividade do processo de doação de órgãos para transplantes no Estado do Paraná. Métodos: Estudo transversal realizado com dados disponibilizados pelo Sistema Estadual de Transplantes do Paraná referentes ao processo de doação de órgãos, no período de 2011 a 2016. Das 3.872 notificações de potenciais doadores em morte encefálica, 2.600 foram incluídas neste estudo por se constituírem em doadores elegíveis de órgãos. Avaliou-se os desfechos dos protocolos e variáveis relacionadas aos doadores elegíveis, aos centros notificantes e às notificações. Os dados foram analisados descritivamente por frequências absolutas e relativas, e calculou-se odds ratio verificando-se a associação pelo teste de Qui-Quadrado de Wald, em que considerou-se p<0,05 como significância estatística. Resultados: Entre os 2.600 doadores elegíveis, 1.267 (48,7%) tornaram-se doadores efetivos de órgãos. Como principais obstáculos do processo destacaram-se a parada cardiorrespiratória, a sepse e a recusa familiar. As chances de efetivação da doação foram significativamente maiores nos indivíduos com menos de 60 anos (p<0,001), do sexo masculino (p=0,001) e notificados pelas Macrorregionais Leste e Oeste do Estado (p<0,001). O percentual de doações de órgãos aumentou de 38,8% para 66,5% no período estudado. Conclusão: O Paraná apresentou crescimento expressivo no número de notificações e doações de órgãos nos últimos seis anos. As fragilidades identificadas no processo se referiram às questões clínicas e culturais, que indicam a necessidade de intervenções gerenciais de capacitação dos profissionais de saúde na identificação e manutenção do potencial doador, bem como na sensibilização da sociedade quanto a importância do consentimento à doação.

Abstract Objective: to verify the effectiveness of the organ donation process in the State of Paraná. Methods: Cross-sectional study carried out with data provided by the Department of Transplantation of the State of Paraná referred to the organ donation process, from 2011 to 2016. Of the 3,872 notifications of potential donors with brain death, 2,600 were included in this study since they were eligible organ donors. The outcome of the protocols and variables related to eligible donors, notifying centers and notifications were evaluated. Data were analyzed descriptively by absolute and relative frequencies, and odds ratio was calculated through the Wald Chi-square test, with p<0.05 considered as statistically significant. Results: Out of the 2,600 eligible donors, 1,267 (48.7%) became effective organ donors. The main obstacles of the process were cardiopulmonary arrest, sepsis and family refusal. The odds of donation were significantly higher in the individuals younger than 60 years old (p<0.001), male (p=0.001) and in the East and West Macro-regions of the State (p<0.001). The percentage of organ donations increased from 38.8% to 66.5% in the period studied. Conclusion: The state of Parana presented a significant increase in the number of notifications and organ donations in the last six years. The weaknesses identified in the process refer to clinical and cultural issues, which indicate the need for interventions to train health professionals in the identification and maintenance of the potential donor, as well as in raising awareness of the importance of the consent to donation.

Síndrome de diógenes: relato de caso / Diogenes syndrome: case report

O transtorno de acumulação (TA) pode ser definido como uma dificuldade persistente com o descarte de itens devido ao sofrimento associado à eliminação ou à necessidade percebida de guardá-los independente de seu valor real. Nos idosos, o TA está relacionado a uma outra condição, denominada imundície doméstica. A acumulação está ligada a uma forma específica de autonegligência patológica nessa população referida como síndrome de Diógenes (SD), que consiste em higiene extremamente pobre e inabilidade de manutenção das rotinas adequadas de autocuidado, juntamente com a silogomania. Os autores descrevem um caso de TA, aqui referido como SD, em paciente idoso, ressaltando a importância da detecção precoce, diagnóstico diferencial, investigação, intervenção multidisciplinar e farmacoterapia.

Hoarding disorder (HD) can be defined as a persistent difficulty with the disposal of items due to the suffering associated with the elimination or the perceived need to keep them, regardless of their real value. In the elderly, HD is related to another condition called domestic squalor. Accumulation is associated with a specific form of pathological self-neglect in this population referred as Diogenes syndrome (DS), which consists of extremely poor hygiene and inability to maintain adequate self-care routines, along with compulsive collectionism. The authors describe a case of HD, referred here as DS, in an elderly patient, emphasizing the importance of early detection, differential diagnosis, investigation, multidisciplinary intervention, and pharmacotherapy