Assistência à saúde nos transtornos mentais no período de puerpério: revisão integrativa / Health care in mental disorders in the period of puerperium: Integrative Review / Atención sanitaria en los trastornos mentales en el puerpério: Revisión integradora

No puerpério, a mulher passa por intensas mudanças de ordem familiar e social, como também de adaptações psicológicas e biológicas, que são marcadas por alterações metabólicas e hormonais complexas, sendo a fase de maior risco para o desenvolvimento de algum transtorno mental. Objetivo:Realizar uma revisão da literatura paraidentificar a assistência à saúde nos transtornos mentais no período de puerpério. Metodologia:Estudo descritivo na modalidade revisão integrativa, realizado com artigos originais disponíveis nas línguas portuguesa, inglesa e espanhola, publicados nas bases de dados Scientific Electronic LibraryOnline (SCIELO) e Literatura Latino-Americana em Ciências da Saúde (LILACS), no período de 2015 a 2021 com os seguintes descritores: assistência de enfermagem, transtornos mentais e períodopós-parto. Resultados:Foram encontrados 58artigos, dos quais 17foram selecionados ao final do processo. 10 trabalhos evidenciaram fatores associados com transtorno mental, 4 trabalhos descreveram medidas de proteção e 3 abordaram ações assistenciais de saúde na intervenção dos transtornos mentais no puerpério. Conclusões:Após análise da literatura, observa-seque o baixo suporte social e familiar se mostraram como principais fatores de risco associados aos transtornos mentais para a puérpera. Já os fatores de proteção foram relacionados com aumento do apoio familiar e assistencial por meio dos serviços de saúde, bem como a importância da enfermagem na implementação de estratégias preventivas para os transtornos mentais no puerpério (AU).

In the puerperium, women undergoes intense changes of family and social order, as well as psychological and biological adaptations, which are marked by complex metabolic and hormonal alterations, being the phase of greatest risk for the development of somemental disorder. Objective: Conduct a review of the literature to identify health care in mental disorders in the postpartum period.Methodology:Descriptive study in the integrative review modality, carried out with original articles available in Portuguese, English and Spanish, published in the scientific electronic library online (SCIELO) and Latin American literature in health sciences (LILACS) databases, from 2015 to 2021 with the following descriptors: nursing care, mental disorders and postpartum period.Results:Fifty-eight articles were found, of which 17 were selected at the end of the process. 10 studies showed factors associated with mental disorder, 4 studies described protective measures and 3 addressed health care actions in the intervention of mental disorders in the puerperium.Conclusions:After analyzing the literature, we observed that low social and family support were shown to be the main risk factors associated with mental disorders for the puerperal. On the other hand, the protective factors were related to increased family and care support through health services, as well as the importance of nursing in the implementation of preventive strategies for mental disorders in the puerperium (AU).

En el puerperio, la mujer sufre intensos cambios de orden familiar y social, así como adaptaciones psicológicas y biológicas, que se caracterizan por complejas alteraciones metabólicas y hormonales, siendo la fase de mayor riesgo para el desarrollo de algún trastorno mental.Objetivo:Realizar una revisión de la literatura para identificar la atención médica en los trastornos mentales en el período posparto. Metodología: Estudio descriptivo en la modalidad de revisión integradora, realizado con artículos originales disponibles en portugués, inglés y español, publicados en las bases de datos de la biblioteca científica electrónica en línea (SCIELO) y de la literatura latinoamericana en ciencias de la salud (LILACS), de 2015 a 2021 con los siguientes descriptores: cuidados de enfermería, trastornos mentales y puerperio.Resultados: Se encontraron cincuenta y ocho artículos, de los cuales 17 fueron seleccionados al final del proceso. 10 estudios mostraron factores asociadosal trastorno mental, 4 estudios describieron medidas de protección y 3 abordaron acciones de atención sanitaria en la intervención de los trastornos mentales en el puerperio.Conclusiones: Después de analizar la literatura, observamos que el bajo apoyo social y familiar demostró ser el principal factor de riesgo asociado a los trastornos mentales para el puerperal. Por otro lado, los factores protectores se relacionaron con el aumento del apoyo familiar y asistencial a través de los servicios de salud, asícomo la importancia de la enfermería en la implementación de estrategias preventivas para los trastornos mentales en el puerperio (AU).

Diagnosis of temporomandibular dysfunction subtypes in a population seeking specialized care / Diagnóstico dos subtipos de disfunção temporomandibular em uma população que busca atendimento especializado

ABSTRACT BACKGROUND AND OBJECTIVES: The goal of the present study was to assess the frequency of temporomandibular disorders (TMD) subtypes in individuals that search for specialized care, identifying the subtypes of TMD, muscular and/or articular, in addition to relating each subtype with variables such as gender and age. METHODS: In this context, after a screening, 270 individuals, aged between 18 and 70 years, were selected. All data were acquired using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) instrument. RESULTS: Among the 267 patients, 88.7% (n = 237) were female and 11.3% (n = 30) were male, with a mean age of 42±11.8 years. In this study, the predominance of joint/muscle TMD was evidenced (51.7%; n = 138), followed by only muscle TMD (47.5%; n = 127) and lastly, joint TMD (0.8%; n = 2). Important correlations (p>0.05) were not identified when comparing TMD subtypes with the variables gender and age, according to chi-square test. By relating the diagnosis to the TMD subtype, it was evidenced that bilateral myalgia was the most prevalent in muscle TMD (n = 100; 37.4%) and articular/muscular (n = 112; 41.9%). The other variables did not show significant statistics, neither moderate nor strong correlation. CONCLUSION: In this research, all TMD subtypes were found, with a clear predominance of joint/muscle type of TMD, followed by muscle only, especially in females aged between 39 and 48 years.

RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo do presente estudo foi avaliar a frequência dos subtipos de disfunção temporomandibular (DTM) em indivíduos que buscaram atendimento especializado, identificando os subtipos da DTM, se muscular e/ou articular, além de relacionar cada subtipo com variáveis como sexo e faixa etária. MÉTODOS: Neste contexto, após uma triagem, foram selecionados 270 indivíduos na cidade de Fortaleza/CE, com faixa etária entre 18 anos e 70 anos de idade. Todos os indivíduos foram avaliados por meio do instrumento Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). RESULTADOS: Entre os 267 pacientes, 88,7% (n = 237) foram do sexo feminino e 11,3% (n = 30) do masculino, com média de idade de 42 ± 11,8 anos. Neste estudo evidenciou-se a predominância de DTM articular/muscular (51,7%; n = 138), seguida de indivíduos com DTM somente muscular (47,5%; n = 127) e por último a articular (0,8%; n = 2). Não foram identificadas correlações importantes (p > 0,05), segundo o teste qui-quadrado, quando comparados os subtipos de DTM com as variáveis gênero e idade. Ao relacionar o diagnóstico com o subtipo de DTM, evidenciou-se que a mialgia bilateral foi a mais prevalente na DTM muscular (n = 100; 37,4%) e articular/muscular (n = 112; 41,9%). As demais variáveis não apontaram significância estatística nem correlação moderada ou forte. CONCLUSÃO: Nesta pesquisa, foram encontrados todos os tipos de DTM, havendo um claro predomínio da DTM do tipo articular/muscular, seguida da somente muscular, especialmente em indivíduos do gênero feminino e de idade entre 39 e 48 anos.

DIGEST Scale Predictis More Quality of Life Than PAS: The Residue Influence on Supracricoid Laryngectomy

Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.

Concepções e práticas sobre percurso da formação em saúde mental do enfermeiro / Concepciones y prácticas en la trayectoria de la formación de enfermería en salud mental / Conceptions and practices on the path of nursing training in mental health

Objetivo: analisar, por meio das narrativas de enfermeiros, as concepções e práticas sobre sua atuação produzidas no percurso da formação em saúde mental. Método: estudo qualitativo baseado na Teoria Fundamentada nos Dados realizado por meio de entrevistas semiestruturadas com enfermeiros dos Centros de Atenção Psicossocial de uma capital do Nordeste brasileiro, de agosto a dezembro de 2017. Os dados foram analisados e validados segundo os pressupostos do arcabouço teórico utilizado. Resultados: participaram oito enfermeiros que apontaram a formação universitária como o primeiro ponto de preparação para atuação em saúde mental, concebida como experiência "traumática" e geradora de grande ansiedade, interferindo na percepção, identificação e inserção na área. Conclusões: é necessário refletir criticamente sobre a formação do enfermeiro em saúde mental, por persistir conteúdos teóricos e experiências práticas discordantes com o paradigma psicossocial da Reforma Psiquiátrica brasileira. Tal reflexão é imprescindível para novos modos de formar para o cuidado.(AU)

Objective: to analyze, through the nurses' narratives, the conceptions and practices about their performance produced during mental health education. Method: qualitative study based on Grounded Theory, conducted through semi-structured interviews with nurses from Psychosocial Care Centers of a capital in the Northeast of Brazil, from August to December 2017. Data were analyzed and validated according to the assumptions of the theoretical framework used. Results: eight nurses participated who indicated university education as the first point of preparation for acting in mental health, conceived as a "traumatic" experience, and generating great anxiety, interfering with perception, identification, and insertion in the area. Conclusions: it is necessary to critically reflect on the training of nurses in mental health, due to the persistence of theoretical contents and practical experiences that disagree with the psychosocial paradigm of the Brazilian Psychiatric Reform. Such reflection is essential for new ways of training for care.(AU)

Objetivo: analizar, a través de las narrativas de las enfermeras, las concepciones y prácticas sobre su desempeño producidas en el curso de la formación en salud mental. Método: estudio cualitativo basado en la Teoría Fundamentada, realizado a través de entrevistas con enfermeras de Centros de Atención Psicosocial de una capital del Nordeste de Brasil, de agosto a diciembre de 2017. El análisis fue según marco teórico utilizado. Resultados: participaron ocho enfermeras que señalaron la educación universitaria como primer punto de preparación para actuar en salud mental, concebida como una experiencia "traumática" y generadora de gran ansiedad, interfiriendo con la percepción, identificación e inserción en el área. Conclusiones: es necesario reflexionar críticamente sobre la formación de enfermeros en salud mental, por la persistencia de contenidos teóricos y experiencias prácticas que están en desacuerdo con la Reforma Psiquiátrica Brasileña. Esta reflexión es fundamental para nuevas formas de formación para el cuidado.(AU)

A haplotype in the dipeptidyl peptidase 4 gene impacts glycemic-related traits of Brazilian older adults

Dipeptidyl peptidase 4 (DPP4) regulates various physiological pathways and has a pivotal role in glucose homeostasis. The objective of this study was to verify the association of a haplotype constituted by two single nucleotide polymorphisms (rs2268894 and rs6741949) in the DPP4 gene with type 2 diabetes mellitus (T2DM) and fasting glycemia-related variables in a sample of Brazilian older adults, taking serum levels and enzymatic activity of DPP4 into account. Clinical, biochemical, and anthropometric characteristics as well as DPP4 serum levels and enzymatic activity were determined in 800 elderly (≥60 years old) individuals. Assessment of polymorphic sites was performed by real-time PCR whereas haplotypes were inferred from genotypic frequencies. Statistical analyses compared measures and proportions according to T2DM diagnosis and DPP4 haplotypic groups. The most common haplotype consisted of the T-rs2268894/G-rs6741949 string, which was 20% more frequent among non-diabetics. Considering non-diabetic patients alone, carriers of the T/G haplotype had significantly lower levels of blood glucose, insulin, HOMA-IR index, and DPP4 activity. Among diabetic patients, the T/G haplotype was associated with lower DPP4 levels whereas glycemic scores were not affected by allelic variants. Our results suggested that the genetic architecture of DPP4 affects the glycemic profile and DPP4 serum levels and activity among elderly individuals according to the presence or absence of T2DM, with a possible implication of the T/G haplotype to the risk of T2DM onset.

Residue localization and risk for aspiration in partial laryngectomy: the relevance of assertive therapeutic strategies and resources

ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.

Panorama de saúde mental de discentes em um programa de residência multiprofissional / Panorama de la salud mental de los estudiantes en un programa de residencia multiprofesional / Panorama of mental health of students in a multiprofessional residence program

Objetivo: mensurar a situação de saúde mental dos discentes de um programa de residência multiprofissional. Método: estudo descritivo, quantitativo, usando amostra não probabilística, com profissionais residentes do Programa de Residência Multiprofissional da Escola de Saúde Pública do Ceará. A coleta de dados foi por meio do Google Docs, durante o período de março a maio de 2019. Utilizou-se questionário com informações socioeconômicas e Escala Transversal de Sintomas de Nível 1. Procedeu-se a análise descritiva dos dados através do programa Statistical Package for the Social Sciences, versão 20.0. Resultados: as principais características sociodemográficas foram faixa etária entre 22 e 30 anos, cor parda, solteiros, com orientação heterossexual e identidade de gênero mulher cis. Evidenciou-se escores elevados nos domínios ansiedade, depressão e sintomas psicóticos. Conclusões: recomenda-se a criação de projetos de intervenção em saúde mental para mitigar os problemas apresentados.(AU)

Objective: to measure the mental health situation of students from a multiprofessional residency program. Method: descriptive study, quantitative, using a non-probabilistic sample, with professionals from the Multiprofessional Residency Program of the School of Public Health of Ceará. The data was gathered through Google Forms, during the period from March to May 2019. Questionnaire with socioeconomic information and Level 1 Symptom Cross Scale were used. The descriptive analysis of the data was carried out using the Statistical Package for the Social Sciences program, version 20.0. Results: the main sociodemographic characteristics were age group between 22 and 30 years old, black, single, with heterosexual orientation and female cisgender identity. High scores were evidenced in the domain's anxiety, depression and psychotic symptoms. Conclusions: it is recommended to create mental health intervention projects to mitigate the problems presented.(AU)

Objetivo: medir la situación de salud mental de los estudiantes de un programa de residencia multiprofesional. Método: estudio descriptivo, cuantitativo, utilizando muestra no probabilística, con profesionales residentes del Programa de Residencia Multiprofesional de la Escuela de Salud Pública de Ceará. La recopilación de datos se realizó por Google Forms, de marzo a mayo de 2019. Se utilizó cuestionario con información socioeconómica y Escala Cruzada de Síntomas de Nivel1. El análisis descriptivo de los datos se realizó utilizando el Statistical Package for the Social Sciences, versión 20.0. Resultados: las principales características sociodemográficas fueron grupo de edad entre 22 y 30 años, negra, soltero, con orientación heterosexual e identidad de mujer cisgénero. Se evidenciaron altas puntuaciones en los dominios ansiedad, depresión y síntomas psicóticos. Conclusiones: se recomienda crear proyectos de intervención de salud mental para mitigar los problemas presentados.(AU)

Supracricoid laryngectomy: the impact of senescence on swallowing safety / Laringectomia supracricóidea: o impacto da senescência na segurança da deglutição

ABSTRACT: Objective: To investigate the association between aging and the functional aspects of swallowing (laryngeal penetration and laryngotracheal aspiration) in individuals who underwent supracricoid laryngectomy in the late period and without complaints. Methods: A total of 70 patients, 56 (80%) aged >60 years and 14 (20%) <60 years, under outpatient follow-up, after cancer treatment and with no complaints of swallowing, performed functional evaluation using the swallowing videofluoroscopy. Image classification was performed using the penetration-aspiration scale developed by Rosenbek. The χ2 test and logistic regression were applied to associate the age categories to the outcomes (penetration and aspiration). Results: Patients aged over 60 years had a higher prevalence of penetration (24.29%) and aspiration (48.57%) than patients aged under 60 years. In this sample, aspiration was associated with age. Patients aged over 60 years were more likely to present penetration (27% more) during swallowing than patients under 60 years. Patients aged over 60 years had an approximately four-fold greater probability of laryngotracheal aspiration than patients aged under 60 years. Conclusion: In patients without complaints of swallowing in the late postoperative period of supracricoid laryngectomy, there is a greater probability of laryngotracheal aspiration in elderly aged over 60 years than in individuals under 60 years.

RESUMO Objetivo: Investigar a associação entre o envelhecimento e os aspectos funcionais da deglutição (penetração laríngea e aspiração laringotraqueal) em indivíduos submetidos à laringectomia supracricóidea no período tardio e sem queixas. Métodos: Setenta pacientes, sendo 56 (80%) >60 anos e 14 (20%) <60 anos, em acompanhamento ambulatorial, após tratamento oncológico e sem queixas de deglutição, realizaram avaliação funcional por meio da videofluoroscopia da deglutição. A classificação das imagens foi realizada por meio da escala de penetração-aspiração desenvolvida por Rosenbek. O teste do χ2 e a regressão logística foram aplicados para associação das categorias de idade aos desfechos (penetração e aspiração). Resultados: Os pacientes com idade acima de 60 anos apresentaram maior prevalência de penetração (24,29%) e aspiração (48,57%) do que aqueles com idade inferior a 60 anos. Nesta amostra, a aspiração se mostrou associada à idade. Pacientes acima de 60 anos tiveram chance 27% maior de penetração durante a deglutição do que os com menos de 60 anos. Pacientes acima de 60 anos tiveram chance aproximadamente quatro vezes maior de aspiração laringotraqueal do que pacientes com menos de 60 anos. Conclusão: Em pacientes sem queixas de deglutição no pós-operatório tardio de laringectomia supracricóidea, há maior chance de aspiração laringotraqueal em idosos acima de 60 anos do que em indivíduos abaixo de 60 anos.

Symptoms and factors associated with symptom clusters among older adults with oral and oropharyngeal cancers at diagnosis / Sintomas e fatores associados a clusters de sintomas entre idosos com câncer de cavidade oral e orofaringe no momento do diagnóstico

OBJECTIVE: Describe differences in pretreatment symptoms and the composition of symptom clusters in older patients with oral and oropharyngeal cancer. METHODS: In this cross-sectional study, quality of life (QoL) assessments for cancer patients (EORCT QLQ-C30 and QLQ-H & N35) were applied to 161 cases of oral and oropharyngeal cancer at the time of enrollment in an outpatient clinic. They were used to evaluate QoL-related symptoms reported by patients, according to their occurrence. To identify symptom clusters, an exploratory factor analysis (EFA) was performed, and the relationships between these clusters and independent variables were assessed with linear regression models. RESULTS: The most prevalent symptoms were pain (52%), worry (48%), and weight loss (44%). Five factors were extracted from the EFA, of which 3 were noteworthy. The dysphagia cluster was common to both cancer sites, although more frequent in oropharyngeal cancer patients, and included symptoms such as difficulty swallowing, pain, and weight loss. The psychological cluster included symptoms related to feeling worried, nervous, and depressed. The asthenia cluster, in addition to being age-related, may represent the advanced stage or progression of the disease. CONCLUSION: The dysphagia cluster loaded the most symptoms and was common to both cancers. In addition to pain (one of the main symptoms of the dysphagia cluster), psychological symptoms were also important in both groups of patients. Adequate and early control of these symptom clusters at diagnosis could favor better management of symptoms during treatment.

OBJETIVO: Descrever diferenças nos sintomas pré-tratamento e na composição de clusters de sintomas em pacientes idosos com câncer oral e orofaríngeo. METODOLOGIA: Neste estudo seccional, avaliações de qualidade de vida (QV) para pacientes com câncer (EORCT QLQ-C30 e QLQ-H & N35) foram aplicadas a 161 casos incidentes de câncer oral e orofaríngeo no momento da inscrição no ambulatório. Essas avaliações foram utilizadas para analisar os sintomas relatados pelos pacientes quanto à QV, de acordo com a ocorrência. Para identificar agrupamentos de sintomas, uma análise fatorial exploratória (AFE) foi realizada, e a relação entre esses agrupamentos de sintomas e variáveis independentes foi avaliada com modelos de regressão linear. RESULTADOS: Os sintomas mais prevalentes foram dor (52%), preocupação (48%) e perda de peso (44%). Cinco fatores foram extraídos do AFE, três dignos de nota. Embora mais relatado por pacientes orofaríngeos, o agrupamento de disfagia foi comum a ambos os locais de câncer e incluiu sintomas como dificuldade para engolir, dor e perda de peso. O agrupamento psicológico incluiu sintomas relacionados a sentir-se preocupado, nervoso e deprimido. O agrupamento da astenia, além de relacionado à idade, pode representar o estágio avançado ou progressão da doença. CONCLUSÕES: O cluster de disfagia carregou a maioria dos sintomas e foi comum a ambos os tipos de câncer. Além da dor, que era um dos principais sintomas desse cluster, os sintomas psicológicos também foram importantes em ambos os grupos de pacientes. O controle adequado e precoce desses grupos de sintomas no diagnóstico pode favorecer o melhor manejo dos sintomas durante o tratamento.

Flowers and thorns in pregnancy: experiences during the COVID-19 pandemic / Flores y espinas en el embarazo: experiencias durante la pandemia del COVID-19 / Flores e espinhos na gestação: experiências durante a pandemia de COVID-19

ABSTRACT Objective: To understand the repercussions of COVID-19 on the path of pregnancy. Method: Qualitative, participatory action research (PAR) study, based on Paulo Freire's Research Itinerary. A virtual culture circle was held in October 2020, with the participation of 12 pregnant women, living in the South and Southeast regions of Brazil. Results: In the virtual culture circle, pregnant women talked and critically reflected on two generating themes: flowers and thorns in the course of pregnancy. They meant living in the virtual culture circle as spaces for sharing experiences, welcoming and learning, among others. Conclusions: For the participants, pregnancy during the pandemic brought difficulties such as social isolation, absence from work and the university, fears, anxieties, loneliness and insecurities. However, it also improved health care, intensifying self-care and investment in family relationships.

RESUMEN Objetivo: Comprender las repercusiones del COVID-19 en la trayectoria del embarazo. Método: Estudio cualitativo, acción-participante, basado en el Itinerario de Investigación de Paulo Freire. En octubre de 2020 se realizó un círculo de cultura virtual, con la participación de 12 mujeres embarazadas, residentes en las regiones Sur y Sudeste de Brasil. Resultados: En el círculo de cultura virtual, las gestantes dialogaron y reflexionaron críticamente sobre dos temas generadores: flores y espinas en el transcurso del embarazo. Significaron vivir en el círculo de cultura virtual como espacios para compartir experiencias, acoger y aprender, entre otros. Conclusiones: Para las participantes, el embarazo durante la pandemia trajo dificultades como aislamiento social, ausencia del trabajo y de la universidad, miedos, ansiedades, soledad e inseguridades. Pero también mejoró la atención médica, intensificando el autocuidado e invirtiendo en las relaciones familiares.

RESUMO Objetivo: Compreender as repercussões da COVID- 19 no caminho da gestação. Método: Estudo qualitativo, do tipo ação-participante, com fundamentação no Itinerário de Pesquisa de Paulo Freire. Realizou-se um círculo de cultura virtual em outubro de 2020, com a participação de 12 gestantes, residentes nas regiões Sul e Sudeste do Brasil. Resultados: No círculo de cultura virtual, as gestantes dialogaram e refletiram criticamente sobre dois temas geradores: flores e espinhos no caminhar da gestação. Significaram a vivência no círculo de cultura virtual como espaços para compartilhar experiências, acolhimento e aprendizado, dentre outros. Conclusões: Para as participantes, a gestação durante a pandemia trouxe dificuldades como isolamento social, afastamento do trabalho e da universidade, medos, angústias, solidão e inseguranças. Mas, também, melhorou os cuidados com a saúde, intensificando o autocuidado e o investimento nas relações familiares.

Osteossíntese femoral associada ao biovidro 60S em tamanduá-bandeira: relato de caso / Femoral osteosynthesis associated with 60s bioglass in tamanduá bandeira: case report

Atropelamentos de animais silvestres são frequentes e muitas vezes causam fraturas ósseas que, se não tratadas adequadamente, levam à morte do animal por complicações ou por inabilidade de sobrevivência no seu habitat natural. O objetivo do presente trabalho foi relatar o uso de placa associada ao pino intramedular e ao biovidro 60S (BV60S) para o tratamento de fratura de fêmur em tamanduá-bandeira. O animal foi resgatado pela polícia ambiental com suspeita de atropelamento. Foi sedado para avaliação clínica e radiográfica, que revelou fratura em fêmur direito. Utilizou-se dexmedetomidina como medicação pré-anestésica, midazolam e cetamina para indução, e isoflurano para manutenção. Também foi realizado bloqueio peridural com bupivacaína e morfina. A osteossíntese foi feita com placa bloqueada 2,7 e pino intramedular 2,5. Colocaram-se 4g de BV60S no foco de fratura para favorecer a osteogênese. O paciente teve recuperação funcional imediata do membro acometido. A reparação óssea ocorreu por segunda intenção, observando-se ossificação completa do calo com consolidação clínica, aos 30 dias, e remodelação quase completa, aos 180 dias. Conclui-se que o uso de placa e pino associado ao BV60S é eficiente no tratamento de fratura de fêmur em tamanduá, permitindo a rápida recuperação e a reintrodução do animal na natureza.(AU)

Roadblocks of wild animals are frequent and often cause bone fractures that if not properly treated lead to the death of the animal due to complications or inability to survive in its natural habitat. The objective of the present study was to report the use of plate rod and bioglass 60S (BG60S) for the treatment of femoral fracture in anteater. The animal was rescued by environmental police on suspicion of being hit. It was sedated for clinical and radiographic evaluation, which revealed a fracture in the right femur. Dexmedetomidine was used as preanesthetic medication, midazolam and ketamine for induction, and isoflurane for maintenance. Epidural blockade with bupivacaine and morphine was also performed. Osteosynthesis was done with a locking plate 2.7 and 2.5 intramedullary pin. 4G of BG60S was placed in the focus of fracture to favor osteogenesis. The patient had immediate functional recovery of the affected limb. The bone repair occurred by second intention, with complete ossification of the callus with clinical consolidation at 30 days, and near complete remodeling at 180 days. It is concluded that the use of plate rod to the BG60S is efficient in the treatment of femur fracture in anteater, allowing the rapid recovery and reintroduction of the animal in the wild.(AU)

Análise ultraestrutural do colágeno de feridas cutâneas de coelhos tratadas com plasma rico em plaquetas de equino / Ultrastructural analysis of the collagen of rabbit skin wounds treated with platelet-rich equine plasma

O colágeno é sintetizado e segregado no espaço extracelular e organizados em fibrilas estriadas de acordo com o tipo de tecido. Utilizaram-se 24 coelhos brancos da raça Nova Zelândia, com idade de 12 meses e com 3,0kg de peso corporal, para avaliar a porcentagem de colágeno das feridas cutâneas tratadas com plasma rico em plaquetas de equino e pomada contendo gentamicina, sulfanilamida, sulfadiazina, ureia e vitamina A. Os animais foram separados em quatro grupos de igual número e submetidos à remoção de pele na região das linhas médias dorsal torácica (feridas tratadas) e lombar (feridas controle). As feridas torácicas foram tratadas com plasma rico em plaqueta de equino e pomada contendo gentamicina, sulfanilamida, sulfadiazina, ureia e vitamina A, e as do grupo controle somente com a pomada. Dos animais do grupo I, foi coletado tecido cutâneo, para a avaliação histológica e a ultraestrutural, com três dias de pós-operatório; dos animais do grupo II, com sete dias; do grupo III, com 14 dias; e do grupo IV, com 21 dias. Decorrido o período de avaliação de cada grupo, foi coletado fragmento de pele para avaliação da porcentagem de colágeno, bem como do diâmetro e da densidade da fibrila de colágeno por microscopia eletrônica de transmissão. O tratamento com PRP de equino associado à aplicação tópica da pomada mostrou-se eficaz na maturação das fibrilas colágenas e na antecipação do processo cicatricial.(AU)

Collagen is synthesized and secreted into the extracellular space and organized into striated fibrils according to the tissue type. This study evaluated the concentration of collagen in rabbit skin wounds treated with equine platelet-rich plasma (PRP) and ointment containing gentamicin, sulfanilamide, sulfadiazine, urea, and vitamin A. Twenty-four New Zealand white rabbits aged 2 to 12 months and weighing 3.0kg were included. The animals were allocated equally into four groups and the skin was removed from the thoracic dorsal midline (treated wound) and lumbar (control wound) regions. The thoracic wounds were treated with equine PRP and ointment containing gentamicin, sulfanilamide, sulfadiazine, urea, and vitamin A, and the control group was treated with the ointment alone. For histological and ultrastructural assessment, cutaneous tissue was collected on postoperative days 3 (group I), 7 (group II), 14 (group III), and 21 (group IV). After the evaluation period, in each group, a skin fragment was collected for analysis of the collagen concentration, as well as the collagen fibril diameter and density by transmission electron microscopy. The results indicated that treatment with equine PRP combined with topical application of the ointment was effective in facilitating the maturation of collagen fibrils and the wound healing process.(AU)

In silico analysis of mismatches in RT-qPCR assays of 177 SARS-CoV-2 sequences from Brazil

Abstract INTRODUCTION: Quantitative reverse transcription polymerase chain reaction (RT-qPCR) can detect the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) in a highly specific manner. However, a decrease in the specificity of PCR assays for their targets may lead to false negative results. METHODS: Here, 177 high-coverage complete SARS-CoV-2 genome sequences from 13 Brazilian states were aligned with 15 WHO recommended PCR assays. RESULTS: Only 3 of the 15 completely aligned to all Brazilian sequences. Ten assays had mismatches in up to 3 sequences and two in many sequences. CONCLUSION: These results should be taken into consideration when using PCR-based diagnostics in Brazil.

Ultrasonography for long-term evaluation of hyaluronic acid filler in the face: A technical report of 180 days of follow-up

Purpose@#In this study, we used ultrasonography to monitor the use of hyaluronic acid (HA) as a filler in the face for esthetic reasons. We monitored changes in the filler shape, distribution, and relationship with adjacent anatomical structures over a 180-day period. @*Materials and Methods@#Two patients each received an ultrasound-guided injection of HA, with different products and application sites for each patient. In 1 patient, the injection was administered in the angle of the mandible, while in the other, it was administered in the zygomatic region. The injection sites were monitored via ultrasonography at 24 hours, 30 days, and 180 days, at which times the imaging characteristics of the filler were observed. All injections were performed by the same professional, as were the ultrasound exams, which were conducted using the same equipment. @*Results@#In both cases, the HA fillers were visualized using ultrasound at all time points. Some differences were observed between the cases in the images and the distribution of the pockets of filler. In 1 case, the filler appeared as a dark hypoechoic region with well-defined contours, and the material was observed to have moved posteriorly by the 180-day mark. In the other case, the material appeared hyperechoic relative to the previous case and presented no noticeable changes in its anteroposterior distribution over time. @*Conclusion@#Based on these 2 cases, ultrasonography can be a complementary tool used to monitor facial fillers over the long term, allowing for the dynamic observation of different fillers.

Swallowing, voice and quality of life of patients submitted to extended supratracheal laryngectomy / Deglutição, voz e qualidade de vida de pacientes submetidos à laringectomia supratraqueal alargada

ABSTRACT Objective To describe functional and quality of life results after extended supratracheal laryngectomy. Methods In the period from September 2009 to January 2018, 11 male subjects were submitted to extended supratracheal laryngectomy. Swallowing abilities were assessed through videofluoroscopy and the clinical scale Functional Communication Measures of Swallowing. The voices were classified by means of the perceptual-auditory analysis Consensus Auditory-Perceptual Evaluation of Voice. All subjects completed a self-assessment questionnaire for voice and swallowing. Results Aspiration was found in four patients and all presented stasis in different structures. All subjects in this study were exclusively orally fed and hydrated. In the evaluation of quality of life in swallowing, patients had mean >80 in all areas (83.47 mean of scores). The general degree and the presence of roughness were the highest means present in Consensus Auditory-Perceptual Evaluation of Voice (37.81 and 49.36, respectively). The mean of 33.36 (±22.56) had little impact on quality of life under the perspective of vocal aspects. Conclusion After supratracheal laryngectomy, swallowing was sufficiently restored and the quality of life was satisfactory. The voice presents severely impaired quality and preserved oral communication, with low impact on the activities of daily living. All individuals who maintained two cricoarytenoid units presented better functional results in swallowing and voice.

RESUMO Objetivo Descrever os resultados funcionais e de qualidade de vida após a laringectomia supratraqueal alargada. Métodos No período de setembro de 2009 a janeiro de 2018, 11 indivíduos do sexo masculino foram submetidos à laringectomia supratraqueal alargada. As habilidades de deglutição foram avaliadas por meio da videofluoroscopia e da escala clínica Functional Communication Measures . As vozes foram classificadas por análise perceptivo-auditiva da Consensus Auditory-Perceptual Evaluation of Voice . Todos os voluntários preencheram um questionário de autoavaliação para voz e deglutição. Resultados A aspiração foi encontrada em quatro pacientes, e todos apresentaram estase em diferentes estruturas. Todos os sujeitos deste estudo apresentavam alimentação e hidratação exclusivas por via oral. Na avaliação da qualidade de vida na deglutição, os pacientes demonstraram médias >80 em todas as áreas (83,47 média dos escores). O grau geral e a presença de rugosidade foram os maiores escores médios na avaliação perceptivo-auditiva da voz (37,81 e 49,36 consecutivamente). A média de 33,36 (±22,56) demonstrou pouco impacto na qualidade de vida sob a perspectiva dos aspectos vocais. Conclusão Após a laringectomia supratraqueal, a deglutição foi suficientemente restaurada, e a qualidade de vida foi satisfatória. A voz apresenta qualidade gravemente comprometida com comunicação oral preservada, demonstrando baixo impacto nas atividades da vida diária. Todos os indivíduos que mantiveram duas unidades cricoaritenóideas apresentaram melhores resultados funcionais na deglutição e na voz.

Differences between quality of life and occupational coping of tenured and outsourced nurses / Diferencias entre calidad de vida y Coping Ocupacional de Enfermeros concursados y subcontratados / Diferenças entre qualidade de vida e coping ocupacional de enfermeiros concursados e terceirizados

ABSTRACT Objectives: To compare the relation of quality of life to occupational coping and verify the association of these indicators with sociodemographic variables of tenured and outsourced nurses. Methods: Cross-sectional study, carried out from June to November 2014, with 145 outsourced nurses and 45 tenured nurses. We applied an identification instrument (WHOQOL-bref) and Occupational Coping Scale. Student's t-tests and Pearson's correlation coefficient were used. Results: Tenured nurses had better quality of life (p=0.011) and a mean in the Avoidance factor with a strong correlation (p=0.001). Female public servants (p=0.006; p<0.0001), between 40 and 66 years old (p=0.005; p=0.031), specialists (p=0.028; p=0.005), with a family income from 2.5 to 6.8 minimum wages (p=0.021; p=0.006) and working in the morning or afternoon (p=0.043; p=0.020) and morning and afternoon (p=0.038; p=0.007) showed a difference in quality of life and in Avoidance factor, respectively. Conclusion: Tenured nurses demonstrated better quality of life, and some variables trigger differences in the groups, demonstrating the need to promote occupational health.

RESUMEN Objetivos: Comparar la calidad de vida y el coping ocupacional y verificar la asociación de esos indicadores con variables sociodemográficas de enfermeros concursados y subcontratados. Métodos: Estudio transversal, realizado de junio a noviembre de 2014, con 145 enfermeros subcontratados y 45 concursados. Se ha aplicado instrumento de identificación, (WHOQOL-bref) y Escala de Coping Ocupacional. Se ha utilizado los testes t de Student y coeficiente de correlación de Pearson. Resultados: Enfermeros concursados han presentado mejor calidad de vida (p=0,011) y media en el factor esquiva", con fuerte correlación (p=0,001). Los concursados del sexo femenino (p=0,006; p<0,0001), entre 40 y 66 años (p=0,005; p=0,031), especialistas (p=0,028; p=0,005), con renta familiar de 2,5 a 6,8 salarios (p=0,021; p=0,006) y actuantes por la mañana o tarde (p=0,043; p=0,020) y mañana y tarde (p=0,038; p=0,007) han presentado diferencia en la calidad de vida y en el factor "esquivas, respectivamente. Conclusión: Enfermeros concursados han demostrado mejor calidad de vida, y hay variables que desencadenan diferencias en los equipos, habiendo necesidad de promoción de la salud ocupacional.

RESUMO Objetivo: Comparar a qualidade de vida e o coping ocupacional e verificar a associação desses indicadores com variáveis sociodemográficas de enfermeiros concursados e terceirizados. Métodos: Estudo transversal, realizado de junho a novembro de 2014, com 145 enfermeiros terceirizados e 45 concursados. Aplicou-se instrumento de identificação (WHOQOL-bref) e Escala de Coping Ocupacional. Utilizou-se os testes t de Student e coeficiente de correlação de Pearson. Resultados: Enfermeiros concursados apresentaram melhor qualidade de vida (p=0,011) e média no fator Esquiva, com forte correlação (p=0,001). Os concursados do sexo feminino (p=0,006; p<0,0001), entre 40 e 66 anos (p=0,005; p=0,031), especialistas (p=0,028; p=0,005), com renda familiar de 2,5 a 6,8 salários (p=0,021; p=0,006) e atuantes pela manhã ou tarde (p=0,043; p=0,020) e manhã e tarde (p=0,038; p=0,007) apresentaram diferença na qualidade de vida e no fator Esquiva, respectivamente. Conclusão: Enfermeiros concursados demonstraram melhor qualidade de vida, e existem variáveis que desencadeiam diferenças nos grupos, havendo necessidade de promoção da saúde ocupacional.

The APOB rs693 polymorphism impacts the lipid profile of Brazilian older adults

The apolipoprotein B (APOB) gene contains several polymorphic sites described as risk modifiers for cardiovascular events. The objective of this study was to verify the association of the classic APOB Xba I polymorphism (rs693) with atherosclerotic risk factors in a segment of the Brazilian elderly population considering their usual dietary intake. Clinical and biochemical characteristics as well as total caloric and fat intake data were determined from 644 elderly individuals. Polymorphism analysis was performed by conventional polymerase chain reaction followed by enzyme restriction. Statistical analyses compared measures and proportions according to different APOB genotypic combinations. Statistically significant association was found between Xba I polymorphism and serum LDL, total cholesterol, and total lipid levels, with important elevations among T homozygotes compared to the other genotypes. There was homogeneity in all other parameters analyzed (including intake pattern), with a tendency for reduced levels of circulating apolipoprotein B among TT individuals. Our results pointed out that genetic variation in APOB affected the lipemic profile of elderly individuals in a context not biased by diet, generating a pattern suggestive of secretory disorder of lipoprotein particles, with possible implication in atherosclerotic risk.

Matriz porosa do BV60S associada a células osteoprogenitoras alógenas no tratamento de defeitos ósseos críticos em rádios de cães / Porous matrix of BG60S associated with allogenic osteoprogenitor cells in the treatment of critical bone defects in the radius of dogs

O objetivo do estudo foi avaliar o efeito da matriz porosa do biovidro 60S (BV60S) associada a células osteoprogenitoras (CO) alógenas no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos de idade e massa corporal média de 25kg. Com os cães sob anestesia geral, foram criados defeitos ósseos críticos no terço médio dos ossos rádios. Procedeu-se à fixação óssea com uma placa em ponte, e os defeitos foram tratados de acordo com cada grupo experimental. Constituíram-se três grupos experimentais, em que os defeitos ósseos foram preenchidos com: BV60S associado a CO alógenas (grupo BV60S+CO), osso autógeno (grupo C+), ou não preenchidos (grupo C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. Os grupos C- e BV60S+CO mostraram preenchimento ósseo parcial do defeito de, no máximo, 56,68% e 35,23%, respectivamente, sem a formação de ponte óssea entre as extremidades, e o controle positivo (C+) mostrou regeneração óssea completa. Conclui-se que a matriz porosa do BV60S associada às células osteoprogenitoras não é eficiente no tratamento de defeitos ósseos críticos em rádios de cães.(AU)

The objective of this study was to evaluate the effect of the porous matrix of bioglass 60S (BV60S) associated with allogenic osteoprogenitor cells (CO) in the treatment of critical bone defects of dogs. 20 male mongrel dogs at two years old and mean weight of 25kg were used. Dogs were anesthetized and critical bone defects were created in the middle third of the radios bones. With dogs under general anesthesia, critical bone defects were created in the middle third of bone radios. Bone fixation was done with a bridge plate and defects treated according to each experimental group. Three experimental groups were formed according to the treatment. The defects filled with BV60S associated with allogenic CO (Group-BV60S+CO), autogenous bone (Group-C+) or unfilled (Group-C-). Bone regeneration was evaluated by radiography, bone densitometry and histomorphometry over 90 days. The BV60S+CO and C- groups showed partial bone filling of the defect of at most 56.68% and 35.23%, respectively. No bone bridge formation was observed between the extremities in the BV60S+CO and C- groups. Positive control showed complete bone regeneration at 90 days. It was concluded that the porous matrix of BV60S associated with osteoprogenitor cells was not effective in the treatment of critical bone defects in the radius of dogs.(AU)

Different Concentrations of Ethanol as Dentin Pre-treatment to Bonding of an Etch-and-rinse Adhesive / Diferentes Concentrações de Etanol como Pré-Tratamento da Dentina na adesão de um Adesivo Convencional

Objective: to evaluate the bond strength (BS) to dentin pre-treated with ethanol in single application for 20 s after etching and before application of a two-step etch-and-rinse adhesive and to analyze the morphological features at the resin-dentin interface. Methods: twenty four third molars were collected and randomly assigned into four groups (n=5) according to the ethanol concentration: control (traditional water-wet technique), 50vol%, 70vol% and 100vol%. In experimental groups, ethanol was applied for 20 s and gently air-dried for 5 s. Bonding procedures were performed and resin composite was built up incrementally. Bonded teeth were sectioned into 0.8mm2 sticks on average. These specimens were submitted to microtensile bond strength test (µTBS). One-way ANOVA and post hoc Tukey's test were applied to analyze statistical data (α=0 05). Light microscopy (LM) assisted by Masson's trichrome staining was used to observe the features of resin/dentin interfaces. Results: control BS was not different from ethanol 50vol% (p>0.05). However, the pre-treatment using ethanol 70vol% and 100vol% showed increase on BS (p<0.001 and p=0.003 respectively) with no difference between these two groups. LM Showed a discrete decrease in denuded collagen fibrils to teeth treated with 70vol% and 100vol%. Conclusion: the pre-treatment of dentin using ethanol may increase the initial BS of resin/dentin interface when applied using 70vol% or 100vol% ethanol. Ethanol 70vol% is also able to decrease the thickness of the resin-sparse collagen fibrils.

Objetivo: avaliar a resistência de união (RU) à dentina pré-tratada com etanol em aplicação única por 20 s após condicionamento e antes da aplicação de um adesivo convencional de dois passos e analisar as características morfológicas na interface resina-dentina. Métodos: vinte e quatro terceiros molares foram coletados e distribuídos aleatoriamente em quatro grupos (n = 5) de acordo com a concentração de etanol: controle (técnica tradicional - úmida), 50%, 70% e 100%. Em grupos experimentais, o etanol foi aplicado por 20 s e gentilmente seco ao ar por 5 s. Procedimentos de colagem foram realizados e a restauração em resina composta foi construída de forma incremental. Os espécimes foram seccionados em palitos com média de 0,8 mm2 e submetidos ao teste de resistência à microtração (µTBS). One-way ANOVA e teste post hoc de Tukey foram aplicados para analisar os dados (α = 0,05). Microscopia ótica (MO) auxiliada pela coloração tricrômica de Masson foi usada para observar as características das interfaces resina-dentina. Resultados: a RU do controle não foi diferente do etanol a 50% (p > 0,05). No entanto, o pré-tratamento utilizando etanol a 70% e 100% apresentou aumento na RU (p < 0,001 e p = 0,003 respectivamente) sem diferença entre esses dois grupos. MO apresentou uma diminuição discreta nas fibrilas de colágeno desnudadas nos dentes tratados com 70% e 100%. Conclusão: o pré-tratamento da dentina usando etanol pode aumentar a RU inicial da interface resina-dentina quando aplicado nas concentrações de 70% ou 100%. O etanol a 70% também é capaz de diminuir a espessura das fibrilas de colágeno-resina esparsas.