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Introducción: el acceso a los servicios de salud en Paraguay, está determinado por varios tipos de barreras. Por ello, es preciso describir el impacto que tienen las políticas públicas y sus implicancias en la mitigación de las mismas. Objetivo: describir el acompañamiento diferenciado y su contribución al apoyo socio emocional, adhesión al tratamiento y acceso a servicios de salud en el área de atención a personas varones que viven con el VIH. Metodología: estudio de carácter cualitativo, descriptivo, con entrevistas semi estructuradas y muestra no probabilística, dirigida e intencional; Resultados: este estudio cualitativo exploró las experiencias de personas viviendo con VIH que recibieron acompañamiento psicosocial diferenciado en un servicio de atención integral. Los participantes destacaron la importancia del acompañamiento para afrontar la crisis posterior al diagnóstico. La orientación presencial, escucha empática y seguimiento facilitaron la vinculación y adherencia al servicio de salud y al tratamiento antirretroviral. El apoyo psicosocial fue clave para desmitificar ideas erróneas sobre el VIH/SIDA, empoderarse sobre su estado serológico y mejorar la calidad de vida. Se enfatizó el rol de los grupos de pares para brindar contención. Algunos participantes reportaron experiencias previas de revelación no consentida y vulneración de confidencialidad. El acompañamiento psicosocial diferenciado resultó fundamental para facilitar la inserción y permanencia de las personas con VIH en los servicios de atención integral (adhesión al tratamiento). Conclusiones: el acompañamiento psicosocial diferenciado resultó clave para facilitar la vinculación y adherencia en personas con VIH. La atención integral requiere identificar situaciones particulares, establecer relaciones de confianza y comunicación efectiva. El apoyo inicial es fundamental brindando contención ante el impacto emocional del diagnóstico. El seguimiento continuo es esencial dada la doble discriminación. La confidencialidad y capacidad de generar vínculos empáticos son elementos centrales. Los factores mencionados favorecen la adhesión al tratamiento. Los resultados sugieren que estas prácticas psicosociales pueden optimizar modelos de atención integral a personas con VIH.
Introduction: access to healthcare services in Paraguay is influenced by various barriers. Thus, it is essential to describe the impact of public policies and their implications in mitigating these barriers. Objective: to describe the differentiated support and its contribution to socio-emotional support, therapeutic adherence, and access to healthcare services in the area of care for males living with HIV. Methodology: a qualitative, descriptive study with semi-structured interviews and a non-probabilistic, directed, and intentional sample. Results: this qualitative study explored the experiences of individuals living with HIV who received differentiated psychosocial support in an integrated care service. Participants emphasized the importance of support in coping with the post-diagnosis crisis. In-person guidance, empathetic listening, and follow-up facilitated engagement and adherence to healthcare services and antiretroviral treatment. Psychosocial support played a critical role in debunking misconceptions about HIV/AIDS, empowering individuals regarding their serostatus, and improving their quality of life. The role of peer groups in providing emotional support was emphasized. Some participants reported previous experiences of non-consensual disclosure and confidentiality breaches. Differentiated psychosocial support was essential in promoting the integration and retention of people with HIV in integrated care services (therapeutic adherence). Conclusions: differentiated psychosocial support was crucial in facilitating the engagement and adherence of individuals with HIV. Comprehensive care necessitates identifying specific situations, establishing trust-based relationships, and effective communication. Initial support is vital for providing emotional support in the face of the diagnostic impact. Ongoing follow-up is essential due to the dual discrimination faced. Confidentiality and the ability to build empathetic relationships are central elements. The aforementioned factors favor adherence to treatment. The results suggest that these psychosocial practices can enhance models of comprehensive care for people with HIV.
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ABSTRACT Background: Helicobacter pylori is an etiologic agent of gastroduodenal diseases. The microorganism, considered a type I carcinogen, affects about 50% of the global population. H. pylori virulence factors are determinant for the clinical outcome of the infection. The outer inflammatory protein A (oipA) gene encodes an outer membrane adhesin and is related to severe gastropathies, such as gastric cancer. Objective: The aim of this study was to evaluate the association of the oipA gene with the severity of gastroduodenal diseases in dyspeptic patients in region Central Brazil. Methods: The polymerase chain reaction (PCR) was used to determine the presence of H. pylori. Samples positives were used for molecular screening of the oipA gene. Gastropathies were categorized as non-severe and severe diseases. Results: Approximately 68% of patients had H. pylori and 36% were infected with H. pylori oipA+ strains. Infection was significantly associated in patients aged over 44 years (P=0.004). However, there was no association between oipA and patients' age (P=0.89). Approximately 46% of patients infected with oipA+ strains had some severe illness. Gastric adenocarcinoma was the most frequent severe gastropathy. The H. pylori oipA genotype was inversely associated with the severity of gastroduodenal diseases (OR=0.247, 95%CI: 0.0804-0.7149 and P=0.007). Conclusion: The characterization of possible molecular markers will contribute to personalized medicine, impacting the prognosis of patients.
RESUMO Contexto: Helicobacter pylori é um agente etiológico de doenças gastroduodenais. O microrganismo, considerado cancerígeno tipo I, afeta cerca de 50% da população mundial. Os fatores de virulência do H. pylori são determinantes para o desfecho clínico da infecção. O gene da proteína inflamatória externa A (oipA) codifica uma adesina da membrana externa e está relacionado a gastropatias severas, como o câncer gástrico. Objetivo: O objetivo deste estudo foi avaliar a associação do gene oipA com a gravidade das doenças gastroduodenais em pacientes dispépticos na região Brasil Central. Métodos: A reação em cadeia da polimerase (PCR) foi utilizada para determinar a presença de H. pylori. Amostras positivas foram utilizadas para triagem molecular do gene oipA. As gastropatias foram categorizadas como doenças não severas e severas. Resultados: Aproximadamente 68% dos pacientes apresentaram H. pylori e 36% estavam infectados com cepas H. pylori oipA+. A infecção foi significativamente associada em pacientes com idade superior a 44 anos (P=0,004). No entanto, não houve associação entre oipA e a idade dos pacientes (P=0,89). Aproximadamente 46% dos pacientes infectados com cepas oipA+ tiveram alguma doença severa. O adenocarcinoma gástrico foi a gastropatia severa mais frequente. O genótipo oipA de H. pylori foi inversamente associado à gravidade das doenças gastroduodenais (OR=0,247, IC95%: 0,0804-0,7149 P=0,007). Conclusão: A caracterização de possíveis marcadores moleculares contribuirá para a medicina personalizada, impactando no prognóstico dos pacientes.
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Objective@#To investigate the effects of electrochemically dealloying of Ti6Al4V abutments on human gingival fibroblasts (HGFs) and to provide experimental evidence for surface modification of implant abutments.@*Methods@#The samples were divided into an NC group (negative control, no other treatment on a smooth surface), an NM-1 group (nanomesh-1, electrochemical dealloying treatment in 1 mol/L NaOH 1 h on 2 V voltage), and an NM-2 group (nanomesh-2, electrochemical dealloying treatment in 5 mol/L NaOH 1 h on 2 V voltage). The surface morphologies of the samples and the adhesion of HGFs on the sample surfaces were observed with scanning electron microscopy (SEM). The surface hydrophilicities of the samples were measured with a contact angle measuring instrument. The proliferation of HGFs on the different samples were evaluated with CCK-8, and the expression of adhesion-related genes, including collagen Ⅰ (COL1A1), collagen Ⅲ (COL3A1), fibronectin 1 (FN1), focal adhesion kinase (FAK), vinculin (VCL), integrin α2 (ITGA2), and integrin β1 (ITGB1), on the different samples was measured with qRT-PCR. The expression of vinculin on the surfaces of HGFs was observed via confocal laser scanning microscopy (CLSM) after immunofluorescent staining. Collagen fiber secretion and syntheses of HGFs from different samples were evaluated via Sirius red staining.@*Results@#SEM revealed the formation of ordered and uniform three-dimensional mesh structures on the surfaces of the NM-1 and NM-2 groups, with grid diameters of approximately 30 nm for the NM-1 group and approximately 150 nm for the NM-2 group. Compared with that of the NC group, the water contact angles of the NM-1 group and NM-2 groups were significantly lower (P<0.000 1). Cell proliferation in the NM-1 group was significantly greater than that in the NC group (P<0.01). Moreover, there was no significant difference in the water contact angles or cell proliferation between the NM-1 group and the NM-2 group. SEM revealed that HGFs were adhered well to the surfaces of all samples, while the HGFs in the NM-1 and NM-2 groups showed more extended areas, longer morphologies, and more developed pseudopodia than did those in the NC group after 24 h. qRT-PCR revealed that the expression levels of the adhesion-related genes COL1A1, COL3A1, FN1, FAK and VCL in the NM-1 group were significantly greater than those in the NC and NM-2 groups (P<0.01). The expression of vinculin protein in the NM-1 group was the highest, and the number of focal adhesions was greatest in the NM-1 group (P<0.01). The results of Sirius red staining showed that the NM-1 group had the highest secretion and syntheses of collagen fibers (P<0.000 1).@*Conclusion@#The three-dimensional nanomechanical structure of Ti6Al4V modified by electrochemical dealloying promoted the adhesion, proliferation, collagen fiber secretion and syntheses of HGFs, and electrochemical dealloying of Ti6Al4V with a grid diameter of approximately 30 nm obviously promoted HGF formation.
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Ischemia-reperfusion injury (IRI) is an extremely complicated pathophysiological process, which may occur during the process of myocardial infarction, stroke, organ transplantation and temporary interruption of blood flow during surgery, etc. As key molecules of immune system, macrophages play a vital role in the pathogenesis of IRI. M1 macrophages are pro-inflammatory cells and participate in the elimination of pathogens. M2 macrophages exert anti-inflammatory effect and participate in tissue repair and remodeling and extracellular matrix remodeling. The balance between macrophage phenotypes is of significance for the outcome and treatment of IRI. This article reviewed the role of macrophages in IRI, including the balance between M1/M2 macrophage phenotype, the mechanism of infiltration and recruitment into different ischemic tissues. In addition, the potential therapeutic strategies of targeting macrophages during IRI were also discussed, aiming to provide reference for alleviating IRI and promoting tissue repair.
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@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.
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Objective@#To deposit degradable amino-hybrid mesoporous silica (AHMS) in situ on the surface of titanium nanotube (TNT) and explore its protective effect on nanomorphology and osteogenesis.@*Methods@#TNT and TNT@AHMS were sequentially prepared via an anodizing method: the oil-water two-phase method (experimental group) and the acid-etched titanium method [control group (Ti)]. The parameters for synthesis were explored by changing the silicon source dosage ratio (3∶1, 1∶1, 1∶3); the surface morphology was observed by scanning electron microscope(SEM), hydrophilicity was detected by Water Contact Angle Tester, elemental composition was detected by X-ray photoelectron spectroscopy (XPS); nanoindentation test and ultrasonic oscillator were used to observe the morphological holding effect as mechanical strength of TNT@AHMS in vitro; simulated immersion experiments in vitro was used to observe the degradation behavior of the material. the MC3T3-E1 cell line was used to observe the effect of cell adhesion, proliferation and differentiation on the material; and an SD rat femoral implant model and micro-CT were used to verify the protective effect and osseointegration effect of AHMS on TNT morphology.@*Results@#The morphologies of TNT and TNT@AHMS were successfully prepared, and the silicon source ratio was 1:3. SEM showed that the titanium nanotubes were uniformly covered with AHMS coating, and the mesoporous pore size was about 4 nm. After AHMS was incorporated, the surface of the material was hydrophilic (12.78°), the presence of amino groups (NH2-) was detected, the material was completely degraded within 12 h in vitro, and the active morphology of the TNT was re-exposed with a cumulative silicon release of 10 ppm. Nanoindentation test showed that TNT@AHMS exhibited more ideal surface mechanical strength. SEM revealed that TNT maintains its own morphology under the protection of AHMS, and the TNT group suffered severe exfoliation. In addition, the early adhesion and proliferation rates, ALP activity, and bone volume fraction of cells on the TNT@AHMS surface 4 weeks after implantation were significantly higher than those in the TNT group.@*Conclusion@#By depositing AHMS on the surface of TNT, the nanotopography can be protected. It not only prevents the active base topography from exerting subsequent biological effects but also further endows the material with the ability to promote bone regeneration, laying a foundation for the future development of nanotopography-modified titanium implants.
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Introducción: la adherencia a estándares de manejo en insuficiencia cardiaca como la iniciativa Get With the Guidelines (GWTG) de la AHA puede disminuir los reingresos y mortalidad. Objetivo: describir las características clínicas de pacientes hospitalizados por insuficiencia cardiaca aguda y evaluar la adherencia a estándares de práctica clínica del programa "Get With The Guidelines", en un hospital universitario de Bogotá. Materiales y métodos: estudio observacional de la cohorte retrospectiva HUN-ICA correspondiente a 493 pacientes adultos hospitalizados entre abril 2016 y diciembre 2018 por insuficiencia cardiaca aguda, se registraron variables clínicas, tratamiento, mortalidad, reingresos y se evaluó adherencia a estándares de calidad del programa GWTG. Resultados: 52,1 % de la población fueron mujeres con una media de edad 75 años y el 67,8 % con FEVI >40 %. La etiología más común fue hipertensiva 58,5 % y la mayor causa de descompensación infecciosa (28,8 %). Aumentó la adherencia al uso de betabloqueadores en pacientes con fracción de eyección reducida al egreso de 46 % respecto al ingreso y al uso de antagonistas de receptor mineralocorticoide en pacientes con FEVI reducida de 61,1 %. Discusión: la cohorte evaluada presentó un perfil hemodinámico, clínico y adherencia en el manejo similar a cohortes nacionales. Las dosis subóptimas de la medicación al egreso justifican la necesidad de clínicas ambulatorias de insuficiencia cardíaca. Conclusiones: Se encontró menor adherencia para uso y dosis óptimas de betabloqueadores y antagonista mineralocorticoide que la de la cohorte GWTG, con incremento del uso de terapia farmacológica entre el ingreso y el egreso hospitalario.
Introduction: adherence to management standards in heart failure such as the AHA´s Get With the Guidelines-Heart failure initiative can reduce readmissions and mortality. Objective: To describe the clinical characteristics of patients hospitalized for acute heart failure and to assess adherence to program quality standards of the Get With The Guidelines Program in a university hospital in Bogotá. Methods: observational, descriptive and retrospective HUN-ICA cohort study. 493 adult patients hospitalized for acute heart failure, between April 2016 to December 2018. Clinical variables, treatment, mortality, readmissions and adherence to program quality standards defined by the GWTG program criteria were evaluated. Results: 52,1 % of the population were women, mean age was 75 years, (67,8 %) cases of heart failure with LVEF > 40 %. The most common etiology of heart failure was hypertensive (58,5 %). The most frequent etiology of decompen- sation was infectious (28,8 %). Adherence to beta-blockers use increased in patients with reduced ejection fraction at discharge of 46 %, and to the use of mineralocorticoid receptor antagonists in 61,1 %, compared to admission. Discussion: the evaluated cohort presented a hemodynamic, clinical profile and adherence similar to colombian cohorts. Suboptimal doses of medication upon discharge justify the need for outpatient heart failure clinics. Conclusions: lower adherence for use and optimal doses of beta-blockers and mineralocorticoid receptor antagonists than GWTG cohort was found, with increased use of guidelines recommended pharmacological therapy between hospital admission and discharge.
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Dental fluorosis can cause changes in the enamel surface, conditioning its functionality and esthetics. The application of dental adhesives is a treatment option; however, their use on fluorotic teeth can result in limitations. The aim of this study was to compare the shear bond strength of two different adhesives, one with 10-MDP and one without 10-MDP, in different degrees of dental fluorosis.This is an in vitro study on dental enamel samples, a total of 180 samples with the inclusion criteria were treated, randomly divided into two groups of 90, according to the type of dental adhesive, where each group was again divided into three groups of 30 samples, representing different degrees of dental fluorosis according to the Thylstrup-Fejerskov index (Group I: TF1 and TF2; Group II: TF3; Group III: TF4). Normality tests, two-factor ANOVA, and post-hoc tests were used to determine differences between the groups, with a significance level of 95%. As results, a statistically significant difference was shown between the use of dental adhesive with 10-MDP and the three groups of dental fluorosis (p=0.011), in addition, a Tukey post-hoc test on the groups treated with 10-MDP adhesive revealed a statistically significant difference between group I versus group II, and group I versus group III, (p=<0.05). It is concluded that the use of adhesive systems with 10-MDP presents a better shear bond strength on enamel with dental fluorosis grades I and II in the Thylstrup-Fejerskov index.
La fluorosis dental puede ocasionar cambios en la superficie del esmalte, condicionando su funcionalidad y estética, la aplicación de adhesivos dentales es una opción de tratamiento, sin embargo, su uso en dientes fluoroticos puede resultar en limitaciones. El objetivo de este estudio consistió en comparar la fuerza de adhesión a la cizalladura de dos diferentes adhesivos, uno con 10-MDP y otro sin 10-MDP, en diferentes grados de fluorosis dental. Se trata de un estudio in vitro en muestras de esmalte dental, un total de 180 muestras con los criterios de inclusión fueron tratadas, aleatoriamente divididas en dos grupos de 90, de acuerdo al tipo de adhesivo dental, donde cada grupo fue dividido nuevamente en tres grupos de 30 muestras, representando diferentes grados de fluorosis dental según el índice de Thylstrup- Fejerskov (Grupo I: TF1 y TF2; Grupo II: TF3; Grupo III: TF4). Para determinar diferencias entre los grupos se utilizaron pruebas de normalidad, ANOVA de dos factores, y pruebas post-hoc, con un nivel de significancia de 95%. Como resultados, se mostró una diferencia estadísticamente significativa entre el uso de adhesivo dental con 10- MDP y los tres grupos de fluorosis dental (p=0.011), además, una prueba post hoc de Tukey sobre los grupos tratados con adhesivo 10-MDP revelaron una diferencia estadísticamente significativa entre el grupo I frente al grupo II, y el grupo I frente al grupo III, (p=<0.05) Se concluye que el uso de sistemas adhesivos con 10-MDP presentan una mejor resistencia de adhesión al cizallamiento en esmalte con grados de fluorosis dental I y II en el índice de Thylstrup-Fejerskov
Subject(s)
Dentin-Bonding Agents/therapeutic use , Fluorosis, Dental/diagnosis , Resin CementsABSTRACT
Objetivo: construir e validar uma escala de verificação da adesão às recomendações das Diretrizes Brasileiras de Ventilação Mecânica por profissionais da saúde. Método: estudo metodológico, conduzido no período entre setembro e dezembro de 2019 em um hospital público com 87 pacientes. Para a validação de conteúdo, adotou-se o Índice de Validação de Conteúdo; para a validade de critério, o Coeficiente de Correlação de Pearson; para a consistência interna, o alfa de Cronbach; e, para a confiabilidade interobservador, o Coeficiente Kappa e o Coeficiente de Correlação Intraclasse. Resultados: a escala identificou uma validade de conteúdo e consistência interna aceitável. A correlação de Pearson indicou uma correlação do escore de adesão com a saturação (r = 0,31; p≤0,005), o escore médio para o observador A e B resultou, respectivamente, em 88,89(±5,23) e 88,86(±5,34), e o intervalo de confiança foi de 0,96. Conclusão: a escala apresentou validade e confiabilidade para verificar a adesão às Diretrizes Brasileiras de Ventilação Mecânica dos profissionais.(AU)
Objective: to construct and validate a scale for verifying adherence to the recommendations of the Brazilian Guidelines for Mechanical Ventilation by healthcare professionals. Method: methodological study, conducted between September and December 2019 in a public hospital with 87 patients. For content validation, the Content Validation Index was adopted; for criterion validity, Pearson's Correlation Coefficient; for internal consistency, Cronbach's alpha; and, for interobserver reliability, the Kappa Coefficient, and the Intraclass Correlation Coefficient. Results: the scale identified acceptable content validity and internal consistency. Pearson's correlation indicated a correlation between adherence score and saturation (r = 0.31; p≤0.005), the average score for observer A and B resulted, respectively, in 88.89(±5.23) and 88.86(±5.34), and the confidence interval was 0.96. Conclusion: the scale showed validity and reliability to verify adherence to the Brazilian Guidelines for Mechanical Ventilation by professionals.(AU)
Objetivo: construir y validar una escala para verificar la adherencia a las recomendaciones de las directrices brasileñas sobre ventilación mecánica por parte de los profesionales de la salud. Método: estudio metodológico, realizado entre septiembre y diciembre de 2019 en un hospital público con 87 pacientes. Se adoptó el Índice de Validación de Contenido para la validación de contenido, para la validez de criterio, el Coeficiente de Correlación de Pearson, para la consistencia interna, el alfa de Cronbach y, para la fiabilidad interobservador, el Coeficiente Kappa y el Coeficiente de Correlación Intraclase. Resultados: la escala presentó una validez de contenido y una consistencia interna aceptables. La correlación de Pearson indicó una correlación de la puntuación de adherencia con la saturación (r = 0,31; p≤0,005), la puntuación media para el observador A y B resultó de 88,89(±5,23) y 88,86(±5,34), respectivamente, y el intervalo de confianza fue de 0,96. Conclusión: la escala presentó validez y confiabilidad para verificar la adherencia a las Directrices Brasileñas de Ventilación Mecánica de los profesionales.(AU)
Subject(s)
Humans , Ventilators, Mechanical/standards , Practice Guidelines as Topic , Validation StudyABSTRACT
Quais as mudanças e descobertas que revolucionaram a Odontologia ao longo do tempo? A adesão, osseointegração, ortodontia e a tecnologia CAD/CAM estão entre essas grandes mudanças. Neste primeiro editorial de 2023 trazemos essa reflexão para o período que se inicia.
What changes and discoveries have revolutionized dentistry over time? Adhesion, osseointegration, orthodontics and CAD/CAM technology are among these major changes. In this first editorial of 2023, we bring this reflection to the period that begins.
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Resumo Diretivas antecipadas de vontade permitem que pacientes designem um representante legal e manifestem seus desejos a serem cumpridos quando se tornarem incapazes de se comunicar. Neste estudo, objetivou-se avaliar o conhecimento e as preferências de pacientes oncológicos sobre essas diretivas. Trata-se de pesquisa quantitativa e transversal realizada por meio do preenchimento de dois modelos de diretivas antecipadas de vontade e da aplicação de um questionário. Constatou-se que 87,38% dos pacientes nunca tinham ouvido falar em tais diretivas, 97,2% desconheciam os modelos e 95% não referiram dificuldade de preenchimento. Após o esclarecimento, 93,46% consideraram importante que todas as pessoas elaborem as diretivas, 94,86% que elas sejam disponibilizadas aos pacientes e 91,12% que seja aprovada uma lei federal. O esclarecimento sobre o conceito de diretivas antecipadas de vontade contribuiu para aumentar o interesse de pacientes oncológicos pela utilização desse direito, que fortalece sua autonomia pessoal quando incapazes de se comunicar.
Abstract Advance directives allow patients to assign a legal representative and express their wishes to be fulfilled when they can no longer communicate. This study evaluated cancer patients' knowledge and preferences regarding these directives. A cross-sectional quantitative research was conducted by filling out two advance directive models and a questionnaire. Of the total sample, 87.38% had never heard of such document, 97.2% ignored the two models available and 95% had no difficulties filling it out. After clarifications, 93.46% considered it important for all patients to write a directive, 94.86% expressed that advance directives should be made available to patients and 91.12% argued that a federal law should be passed. Explaining the concept of advanced directives increased the interest of cancer patients in exercising this right which strengthen their autonomy.
Resumen Las directivas anticipadas permiten a los pacientes designar a un representante legal y manifestar sus decisiones cuando no puedan comunicarse. Este estudio evaluó el conocimiento y las preferencias de los pacientes oncológicos sobre este documento. Se realizó una investigación cuantitativa y transversal, mediante la respuesta a dos modelos de directivas anticipadas y la aplicación de un cuestionario. El 87,38% de los pacientes no conocían este documento, el 97,2% de ellos desconocían los modelos y el 95% declararon no tener dificultades para responderlos. Tras la aclaración, el 93,46% de los entrevistados consideraban importante que todos elaboraran el documento, el 94,86% que debían ponerlo a disposición de los pacientes y el 91,12% que se aprobara una ley federal. La aclaración del concepto de voluntades anticipadas contribuye a incrementar el interés de los pacientes oncológicos por hacer uso de este derecho, que refuerza su autonomía personal cuando ya no pueden comunicarse.
Subject(s)
Palliative Care , Patient Rights , Advance Directive Adherence , Medical OncologyABSTRACT
Abstract Background Ectodermal dysplasia syndactyly syndrome 1 (EDSS1) is a rare hereditary disorder characterized by defects in teeth, hair, and nails in association with a fusion of the digits. Genetically, the disease phenotypes are caused by homozygous and compound heterozygous variants in NECTIN4 gene. Objective The main objective of the study was to identify the pathogenic sequence variant(s) for family screening and identification of carriers. Methods In the present study, the authors have investigated a large consanguineous family of Pakistani origin segregating autosomal recessive EDSS1. All the coding exons of the NECTIN4 gene were directly sequenced using gene-specific primers. Results The affected individuals presented the classical EDSS1 clinical features including sparse hair, hypoplastic nails with thick flat discolored nail plates, peg-shaped, conical, and widely spaced teeth with enamel hypoplasia, proximal cutaneous syndactyly of fingers and toes. Sequence analysis of the coding region of the NECTIN4 identified a novel nonsense variant [c.163C>T; p.(Arg55*)] in exon-2 of the gene. Computational analysis of protein structure revealed that the variant induced premature termination at Arg55 located in Ig-like V-loop region leading to loss of Ig-C2 type domains and transmembrane region, and most likely Nectin-4 function will be lost. Study limitation Gene expression studies are absent that would have strengthened the findings of computational analysis. Conclusion The present study expanded the phenotypic and mutation spectrum of the NECTIN4 gene. Further, the study would assist in carrier testing and prenatal diagnosis of the affected families.
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G‐quadruplexes (G4) are structures formed at the ends of telomeres rich in guanines and stabilized by molecules that bind to specific sites. TMPyP4 and thymoquinone (TQ) are small molecules that bind to G4 and have drawn attention because of their role as telomerase inhibitors. The aim of this study was to evaluate the effects of telomerase inhibitors on cellular proliferation, senescence, and death. Two cell lines, LC‐HK2 (non-small cell lung cancer - NSCLC) and RPE‐1 (hTERT-immortalized), were treated with TMPyP4 (5 μM) and TQ (10 μM). Both inhibitors decreased telomerase activity. TMPyP4 increased the percentage of cells with membrane damage associated with cell death and decreased the frequency of cells in the S‐phase. TMPyP4 reduced cell adhesion ability and modified the pattern of focal adhesion. TQ acted in a concentration-dependent manner, increasing the frequency of senescent cells and inducing cell cycle arrest in G1 phase. Thus, the present results showed that TMPyP4 and TQ, although acting as telomerase inhibitors, had a broader effect on other signaling pathways and processes in cells, differing from each other. However, they act both on malignant and immortalized cells, and further studies are needed before their anti-cancer potential can be considered.
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At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.
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Introdução: O uso contínuo da terapia antirretroviral é eficiente para interromper a replicação viral causada pelo Vírus da Imunodeficiência Humana impedindo o comprometimento do sistema imunológico e o aparecimento das infecções oportunistas. Estima-se que em 2021, 10,2 milhões de pessoas infectadas pelo HIV não se beneficiaram com o uso dos antirretrovirais em todo o mundo. No mesmo ano esse indicador atingiu 333 mil pessoas, e na esfera municipal de Londrina, 288 pessoas vivendo com HIV encontravam-se em abandono do tratamento. Objetivo: Apreender as representações sociais de pessoas vivendo com HIV acerca do abandono do tratamento e a motivação para a retomada. Percurso metodológico: Trata-se de um estudo qualitativo pautado na Teoria das Representações Sociais de Serge Moscovici. O cenário foi um Serviço de Atendimento Especializado em HIV/aids localizado na região Sul do Brasil. A população foi composta por 288 pessoas diagnosticadas com HIV em abandono do tratamento por período superior a 100 dias. Destas, 250 foram excluídas em função de critérios relacionados a informações cadastrais incompletas ou equivocadas, e aspectos impeditivos do comparecimento ao serviço e de contato. Outras 18 pessoas foram consideradas perdas por desistência. A amostra foi composta por 20 pessoas que se enquadraram aos critérios de elegibilidade e aceitaram participar do estudo. A coleta das informações ocorreu entre junho de 2021 e junho de 2022 em entrevistas semiestruturadas audiogravadas e transcritas na íntegra. Para análise das falas foi utilizado o discurso do sujeito coletivo. Resultados: Participaram do estudo 20 pessoas vivendo com HIV, sendo 12 homens e oito mulheres, com idade entre 27 e 55 anos. O tempo de abandono variou entre 210 e 1580 dias. A análise das entrevistas permitiu a emersão de 18 ideias centrais e duas ancoragens, as quais foram agrupadas em quatro grandes temas: 1) Abandono do tratamento por questões intrínsecas à pessoa vivendo com HIV; 2) Abandono do tratamento por questões ligadas à terapia medicamentosa; 3) Abandono do tratamento por dogmas sociais; 4) Forças propulsoras para a retomada do tratamento. Considerações finais: A análise qualitativa das representações sociais das pessoas vivendo com HIV indicou que o abandono da terapia antirretroviral é multifatorial, e envolve questões socioculturais, geográficas, familiares e biológicas. É essencial considerar todas as questões que permeiam e impactam as vidas das pessoas vivendo com HIV em abandono do tratamento para além das questões biológicas, viabilizando a implementação de ações que contribuam para a efetividade das políticas públicas de saúde no intuito de estimular a adesão e encorajar a retomada ao tratamento. Almeja-se que esta investigação possa despertar para as questões subjetivas ao universo da pessoa que vive com HIV e estas respeitadas na prática humanizada, voltadas ao incentivo do tratamento contínuo para controle da infecção e promoção da qualidade de vida.
Introduction: The continuous use of antiretroviral therapy is efficient to interrupt viral replication caused by the Human Immunodeficiency Virus, preventing the compromise of the immune system and the appearance of opportunistic infections. It is estimated that in 2021, 10.2 million people infected with HIV did not benefit from the use of antiretrovirals worldwide. In the same year, this indicator reached 333,000 people, and at the municipal level of Londrina, 288 people living with HIV were abandoning treatment. Objective: To apprehend the social representations of people living with HIV about abandoning treatment and the motivation for resuming it. Methodological path: This is a qualitative study based on Serge Moscovici's Theory of Social Representations. The setting was a Specialized Care Service for HIV/AIDS located in the south of Brazil. The population consisted of 288 people diagnosed with HIV who had abandoned treatment for more than 100 days. Of these, 250 were excluded due to criteria related to incomplete or wrong registration information, and aspects that impeded attendance at the service and contact. Another 18 people were considered dropout losses. The sample consisted of 20 people who met the eligibility criteria and agreed to participate in the study. Data collection took place between June 2021 and June 2022 in semi-structured interviews that were audio-recorded and transcribed in full. For the analysis of the speeches, the collective subject discourse was used. Results: 20 people living with HIV participated in the study, 12 men and eight women, aged between 27 and 55 years. The abandonment time varied between 210 and 1580 days. The analysis of the interviews allowed the emergence of 18 central ideas and two anchors, which were grouped into four major themes: 1) Abandonment of treatment due to issues intrinsic to the person living with HIV; 2) Abandonment of treatment due to issues related to drug therapy; 3) Abandonment of treatment by social dogmas; 4) Driving forces for the resumption of treatment. Final considerations: The qualitative analysis of the social representations of people living with HIV indicated that the abandonment of antiretroviral therapy is multifactorial, and involves sociocultural, geographic, family and biological issues. It is essential to consider all the issues that permeate and impact the lives of people living with HIV who abandon treatment in addition to biological issues, enabling the implementation of actions that contribute to the effectiveness of public health policies in order to stimulate adherence and encourage resumption of treatment. It is hoped that this investigation may awaken to the subjective issues of the universe of the person living with HIV and these respected in humanized practice, aimed at encouraging continuous treatment to control the infection and promote quality of life.
Introducción: El uso continuo de la terapia antirretroviral es eficaz para interrumpir la replicación viral provocada por el Virus de la Inmunodeficiencia Humana, previniendo el compromiso del sistema inmunológico y la aparición de infecciones oportunistas. Se estima que en 2021, 10,2 millones de personas infectadas por el VIH no se beneficiaron del uso de antirretrovirales en todo el mundo. En el mismo año, este indicador alcanzó a 333.000 personas, ya nivel municipal de Londrina, 288 personas viviendo con VIH estaban abandonando el tratamiento. Objetivo: Aprehender las representaciones sociales de personas viviendo con VIH sobre el abandono del tratamiento y la motivación para retomarlo. Camino metodológico: Se trata de un estudio cualitativo basado en la Teoría de las Representaciones Sociales de Serge Moscovici. El escenario fue un Servicio de Atención Especializada en VIH/SIDA ubicado en el sur de Brasil. La población estuvo conformada por 288 personas diagnosticadas con VIH que habían abandonado el tratamiento por más de 100 días. De estos, 250 fueron excluidos por criterios relacionados con información de registro incompleta o incorrecta, y aspectos que impidieron la asistencia al servicio y contacto. Otras 18 personas fueron consideradas pérdidas por deserción. La muestra estuvo conformada por 20 personas que cumplieron con los criterios de elegibilidad y aceptaron participar en el estudio. La recolección de datos ocurrió entre junio de 2021 y junio de 2022 en entrevistas semiestructuradas que fueron grabadas en audio y transcritas en su totalidad. Para el análisis de los discursos se utilizó el discurso del sujeto colectivo. Resultados: Participaron del estudio 20 personas viviendo con VIH, 12 hombres y ocho mujeres, con edades entre 27 y 55 años. El tiempo de abandono varió entre 210 y 1580 días. El análisis de las entrevistas permitió el surgimiento de 18 ideas centrales y dos anclas, que fueron agrupadas en cuatro grandes temas: 1) Abandono del tratamiento por cuestiones intrínsecas a la persona que vive con VIH; 2) Abandono del tratamiento por cuestiones relacionadas con la farmacoterapia; 3) Abandono de tratamiento por dogmas sociales; 4) Fuerzas impulsoras de la reanudación del tratamiento. Consideraciones finales: El análisis cualitativo de las representaciones sociales de las personas viviendo con VIH indicó que el abandono de la terapia antirretroviral es multifactorial, e involucra cuestiones socioculturales, geográficas, familiares y biológicas. Es fundamental considerar todas las cuestiones que permean e impactan la vida de las personas que viven con el VIH que abandonan el tratamiento además de las cuestiones biológicas, posibilitando la implementación de acciones que contribuyan a la efectividad de las políticas públicas de salud para estimular la adherencia y alentar la reanudación. De tratamiento se espera que esta investigación pueda despertar a las cuestiones subjetivas del universo de la persona que vive con VIH y estas respetadas en la práctica humanizada, con el objetivo de incentivar el tratamiento continuo para el control de la infección y promover la calidad de vida.
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Abstract Objective This study aimed to analyze the effect of irradiation on the push-out bond strength of mineral trioxide aggregate (MTA) and Biodentine to radicular dentin. Methodology A total of 60 extracted mature human teeth with single root canals were categorized into two groups (irradiated and non-irradiated) (n=30). Each group was further divided into two sub-groups based on cements used (Biodentine and MTA). Then, a cumulative radiation dose of 60 Gy was divided into 30 fractions (two Gy for every fraction) and administered for five successive days per week over six weeks. Obturation was then performed using MTA and Biodentine. Afterwards, 1.5 mm thick horizontal sections were procured from the middle one-third of all the specimens and then subjected to push-out bond test. Results were analyzed using one-way analysis of variance with post-hoc Tukey's test. Results The bond strength of Biodentine and MTA to irradiated teeth was lower than non-irradiated teeth. Highest push-out bond strength was observed in non-irradiated specimens filled with Biodentine (p=0), followed by irradiated specimens filled with Biodentine (p=0); non-irradiated specimens filled with MTA (p=0); and irradiated specimens filled with MTA (p=0.9). Conclusion The push-out bond strength of Biodentine and MTA to root canal dentin decreased significantly post irradiation.
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ABSTRACT Objective: To identify the clinicopathological correlation of E-cadherin expression in metastatic and non-metastatic oral squamous cell carcinoma (OSCC). Material and Methods: A total of 90 paraffin-embedded tissue sections of OSCC were retrieved from the registry. The total selected samples were 45 cases each from the primary lesions of metastatic and non-metastatic OSCC. One section was subjected to routine Hematoxylin and eosin stain and another to immunohistochemical analysis for E-cadherin expression. Results: A non-significant (p˃0.05) increased expression is seen in the non-metastatic group compared to the metastatic group, with predominantly membrane as the staining site in either group. However, the expression of E-cadherin did not reveal any statistically significant association with independent variables such as age, gender, and adverse habits of the patients (p>0.05). On the other hand, with respect to the histological differentiation of OSCC, a significant association (p<0.001) was observed with the well-differentiated type of metastatic OSCC. Conclusion: E-cadherin was useful to some extent in predicting regional metastasis. However, further studies using a panel of biomarkers with increased sample size may help us understand the process involved in metastasis.
Subject(s)
Male , Female , Biomarkers/analysis , Cadherins , Cell Adhesion/immunology , Squamous Cell Carcinoma of Head and Neck/pathology , Immunohistochemistry/methods , Carcinoma, Squamous Cell/pathology , Cross-Sectional Studies/methodsABSTRACT
As the number of patients suffering from cardiovascular diseases and peripheral vascular diseases rises, the constraints of autologous transplantation remain unavoidable. As a result, artificial vascular grafts must be developed. Adhesion of proteins, platelets and bacteria on implants can result in stenosis, thrombus formation, and postoperative infection, which can be fatal for an implantation. Polyurethane, as a commonly used biomaterial, has been modified in various ways to deal with the adhesions of proteins, platelets, and bacteria and to stimulate endothelium adhesion. In this review, we briefly summarize the mechanisms behind adhesions, overview the current strategies of surface modifications of polyurethane biomaterials used in vascular grafts, and highlight the challenges that need to be addressed in future studies, aiming to gain a more profound understanding of how to develop artificial polyurethane vascular grafts with an enhanced implantation success rate and reduced side effect.
Subject(s)
Humans , Polyurethanes , Biocompatible Materials , Blood Vessel Prosthesis/adverse effects , Cardiovascular DiseasesABSTRACT
Mucosal vaccines that stimulate both mucosal and systemic immune responses are desirable, as they could prevent the invading pathogens at their initial infection sites in a convenient and user-friendly way. Nanovaccines are receiving increasing attention for mucosal vaccination due to their merits in overcoming mucosal immune barriers and in enhancing immunogenicity of the encapsulated antigens. Herein, we summarized several nanovaccine strategies that have been reported for enhancing mucosal immune responses, including designing nanovaccines that have superior mucoadhesion and mucus penetration capacity, designing nanovaccines with better targeting efficiency to M cells or antigen-presenting cells, and co-delivering adjuvants by using nanovaccines. The reported applications of mucosal nanovaccines were also briefly discussed, including prevention of infectious diseases, and treatment of tumors and autoimmune diseases. Future research progresses in mucosal nanovaccines may promote the clinical translation and application of mucosal vaccines.
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OBJECTIVE@#Although there have been improvements in targeted therapy and immunotherapy, the majority of lung adenocarcinoma (LUAD) patients still lack effective therapies. Consequently, it is urgent to screen for new diagnosis biomarkers and pharmacological targets. Junctional adhesion molecule-like protein (JAML) was considered to be an oncogenic protein and may be a novel therapeutic target in LUAD. Kaempferol is a natural flavonoid that exhibits antitumor activities in LUAD. However, the effect of kaempferol on JAML is still unknown.@*METHODS@#Small interfering RNA was used to knockdown JAML expression. The cell viability was determined using the cell counting kit-8 assay. The proliferation of LUAD cells was evaluated using the 5-ethynyl-2'-deoxyuridine incorporation assay. The migration and invasion of LUAD cells were evaluated by transwell assays. Molecular mechanisms were explored by Western blotting.@*RESULTS@#JAML knockdown suppressed proliferation, migration and invasion of LUAD cells, and JAML deficiency restrained epithelial-mesenchymal transition (EMT) via inactivating the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway. Using a PI3K activator (740Y-P), rescue experiments showed that phenotypes to JAML knockdown in LUAD cells were dependent on the PI3K/AKT/mTOR pathway. Kaempferol also inhibited proliferation, migration and invasion of A549 and H1299 cells and partially suppressed EMT through the PI3K/AKT/mTOR pathway. Knockdown of JAML ameliorated the inhibitory effect of kaempferol on LUAD cells. Kaempferol exerted anticancer effects by targeting JAML.@*CONCLUSION@#JAML is a novel target for kaempferol against LUAD cells. Please cite this article as: Wu Q, Wang YB, Che XW, Wang H, Wang W. Junctional adhesion molecule-like protein as a novel target for kaempferol to ameliorate lung adenocarcinoma. J Integr Med. 2023; 21(3): 268-276.