Virulence factors, antifungal susceptibility and molecular profile in Candida species isolated from the hands of health professionals before and after cleaning with 70% ethyl alcohol-based gel.

Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.

Discovery of a Novel Bioactive Compound in Orange Peel Polar Fraction on the Inhibition of Trimethylamine and Trimethylamine N-Oxide through Metabolomics Approaches and In Vitro and In Vivo Assays: Feruloylputrescine Inhibits Trimethylamine via Suppressing cntA/B Enzyme.

This study compares the inhibitory effects of orange peel polar fraction (OPP) and orange peel nonpolar fraction (OPNP) on trimethylamine (TMA) and trimethylamine N-oxide (TMAO) production in response to l-carnitine treatment in vivo and in vitro. Metabolomics is used to identify bioactive compounds. The research demonstrates that the OPP effectively regulates atherosclerosis-related markers, TMA and TMAO in plasma and urine, compared to the OPNP. Our investigation reveals that these inhibitory effects are independent of changes in gut microbiota composition. The effects are attributed to the modulation of cntA/B enzyme activity and FMO3 mRNA expression in vitro. Moreover, OPP exhibits stronger inhibitory effects on TMA production than OPNP, potentially due to its higher content of feruloylputrescine, which displays the highest inhibitory activity on the cntA/B enzyme and TMA production. These findings suggest that the OPP containing feruloylputrescine has the potential to alleviate cardiovascular diseases by modulating cntA/B and FMO3 enzymes without directly influencing gut microbiota composition.

Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.

Using multi criteria decision analysis in a geographical information system framework to assess drought risk.

In this study we use the Mun river basin to demonstrate how a Multi Criteria Decision Analysis - Geographical Information Systems (MCDA-GIS) methodology can be used to assess drought risk. This paper not only provides a step forward in considering other elements such as land use change, climate within drought risk but also splits annual risk across three seasons (wet, cool and hot), previously not done. We also investigate how land use change, in the form of a/reforestation and changing crop varieties could potentially mitigate future risk. MCDA rankings from experts found that climatic factors such as rainfall, evapotranspiration and maximum temperature were the most significant. By splitting up the seasons we have been able to observe the temporal and spatial changes in drought risk at an increased detail, an important step in mitigating water security issue in the future. Results for cool months found an increased risk in the north and east (Surin, Si Sa Ket and Rio Et). With hot months finding increased risk in the east (Surin and Si Sa Ket especially) and west in Nakon Ratchasima. Whereas the wet season risk was greatest in the West (Nakon Ratchima, Khon Kean and Mara Sarakham). Differences in future land use scenarios compared to 2017 found that if current trends continued (BAU), the areas at risk from drought will increase. However, by changing land use in the form of a/reforestation (COB) or changing crop types (PRO), drought risk will decrease. Thus, the MCDA-GIS methodology serves as a great starting point, providing a high flexibility in data, meaning the methodology can readily applied to other case studies across the world.

A Three-Monoclonal Antibody Combination Potently Neutralizes BoNT/G Toxin in Mice.

Equine-derived antitoxin (BAT®) is the only treatment for botulism from botulinum neurotoxin serotype G (BoNT/G). BAT® is a foreign protein with potentially severe adverse effects and is not renewable. To develop a safe, more potent, and renewable antitoxin, humanized monoclonal antibodies (mAbs) were generated. Yeast displayed single chain Fv (scFv) libraries were prepared from mice immunized with BoNT/G and BoNT/G domains and screened with BoNT/G using fluorescence-activated cell sorting (FACS). Fourteen scFv-binding BoNT/G were isolated with KD values ranging from 3.86 nM to 103 nM (median KD 20.9 nM). Five mAb-binding non-overlapping epitopes were humanized and affinity matured to create antibodies hu6G6.2, hu6G7.2, hu6G9.1, hu6G10, and hu6G11.2, with IgG KD values ranging from 51 pM to 8 pM. Three IgG combinations completely protected mice challenged with 10,000 LD50s of BoNT/G at a total mAb dose of 6.25 µg per mouse. The mAb combinations have the potential for use in the diagnosis and treatment of botulism due to serotype G and, along with antibody combinations to BoNT/A, B, C, D, E, and F, provide the basis for a fully recombinant heptavalent botulinum antitoxin to replace the legacy equine product.

Analysis of potential nature-based solutions for the Mun River Basin, Thailand.

Despite the growth in research and applications of nature-based solutions (NBS) within the literature, there are limited applications in South East Asia, moreover studies which quantitatively assess the impacts of NBS could have on hazard reduction are scarce. This paper addresses this gap by developing and validating MCDA-GIS analysis to map how potential nature strategies could mitigate flood hazard if applied within the Mun River Basin, Thailand. Through a literature review, the top three solutions for flood and drought hazards were found: wetlands, re/afforestation, and changing crop types. These strategies were reviewed and validated with a MCDA-GIS methodology, through land use change (LUC) maps to depict different future scenarios. The results found that flood hazard did decrease when NBS were implemented in the catchment, especially for A/Reforestation, and to a greater extent when a combination of NBS were applied. This article provides specific insights into the current gaps of NBS publications, specifically considering the case of the Mun River Basin, Thailand.

Development, physicochemical evaluation, and in vivo permeation studies of topical formulations containing 0.1% tacrolimus

Abstract The objective of this paper was to develop and evaluate two semi-solid pharmaceutical forms containing 0.1% tacrolimus: cream (CRT01) and gel (GLT01). For the evaluation of physicochemical stability, at times 0, 30, 60 and 90 days, at 23°C and at 40°C, High Performance Liquid Chromatography coupled with a Diode Array Detector (HPLC-DAD) was employed. This method was developed and validated for tacrolimus quantification. The occlusivity test and skin permeation assay were also performed, using an animal model (Wistar rats), and the CRT01 and GLT01 were compared to the 0.1% tacrolimus ointment (PFU01) obtained from the University Pharmacy, Federal University of Rio de Janeiro, Brazil. CRT01 and GLT01 presented a homogeneous aspect and consistency adequate for topical products, along with sensory characteristics above PFU01. They also presented adequate physicochemical stability for 90 days and a lower occlusive effect than PFU01 (p<0.05). CRT01 showed greater affinity for the skin when compared to PFU01 and GLT01, with low systemic absorption. The CRT01 semi-solid formulation was considered the most adequate one to treat patients with atopic dermatitis or other dermatologic inflammatory diseases, promoting rational use of tacrolimus

Atuação Fisioterapêutica nos Efeitos Adversos da Quimioterapia e Radioterapia em Pacientes Oncológicos: Revisão Sistemática da Literatura / Physiotherapeutic Action on Chemotherapy and Radiotherapy Adverse Effects in Cancer Patients: Systematic Literature Review / Papel Fisioterapéutico en los Efectos Adversos de la Quimioterapia y Radioterapia en Pacientes Oncológicos: Revisión Sistemática de la Literatura

Introdução: O câncer surge a partir de séries de mutações genéticas em razão da exposição a agentes cancerígenos que comprometem a defesa imunológica e, com seu avanço, são utilizados tratamentos como a quimioterapia e a radioterapia. Entretanto, ambos os tratamentos provocam efeitos adversos. Dessa forma, a fisioterapia tem o intuito de reabilitar as disfunções cinético-funcionais provenientes desses efeitos. Objetivo: Sistematizar as condutas fisioterapêuticas mais utilizadas para tratar os principais efeitos adversos oriundos da quimioterapia e radioterapia em pacientes oncológicos. Método: Revisão sistemática nas bases de dados PubMed, LILACS, PEDro e SciELO no período de 2017 a 2022. Resultados: Dos 4.190 artigos, foram selecionados 13 que preencheram os critérios de inclusão e nota 6/10 pela Escala PEDro. As condutas fisioterapêuticas relatadas nos estudos foram acupuntura, laser, led, massagem terapêutica, auriculoterapia, crioterapia e osteopatia, que promoveram diminuição e alívio dos efeitos adversos, podendo atuar como atenuantes na ocorrência desses sintomas. Conclusão: Os efeitos adversos como náuseas e vômitos, mucosite, e fadiga, secundários à quimioterapia e radioterapia, poderão ser tratados com condutas fisioterapêuticas como acupuntura, laser, led, massagem terapêutica, auriculoterapia, crioterapia e osteopatia, que são seguras e efetivas para esse perfil de pacientes, além de proporcionar alívio dos sintomas, prevenir e diminuir os processos inflamatórios, aumentar o apetite, melhorar a função gastrointestinal e o condicionamento físico.

Introduction: Cancer arises from a series of genetic mutations due to exposure to carcinogens that compromise the immune defenses and, as it progresses, treatments as chemotherapy and radiotherapy are adopted. However, both treatments cause adverse effects and physiotherapy has the objective of rehabilitating functional kinetic dysfunctions resulting from these effects. Objective: To systematize the most utilized physiotherapeutic approaches to treat the main adverse effects arising from chemotherapy and radiotherapy in cancer patients. Method: A systematic review was carried out in the PubMed, LILACS, PEDro and SciELO databases from 2017 to 2022. Results: Of the 4,190 articles, 13 were selected that met the inclusion criteria and scored 6/10 on the PEDro Scale. The physiotherapeutic procedures reported in the studies were acupuncture, laser, led, therapeutic massage, auriculotherapy, cryotherapy and osteopathy, which promoted a decrease and relief of adverse effects and could act as mitigating factors in the occurrence of these symptoms. Conclusion: Adverse effects as nausea and vomiting, mucositis and fatigue secondary to chemotherapy and radiotherapy can be treated with physiotherapeutic procedures as acupuncture, laser, led, therapeutic massage, auriculotherapy, cryotherapy and osteopathy, which are safe and effective for this profile of patient, in addition to providing symptoms relief, preventing and reducing inflammatory processes, increasing appetite, improving gastrointestinal function and physical conditioning.

Introducción: El cáncer surge de una serie de mutaciones genéticas debidas a la exposición a agentes cancerígenos que comprometen las defensas inmunitarias, y a medida que avanza se utilizan tratamientos como la quimioterapia y la radioterapia. Sin embargo, ambos tratamientos provocan efectos adversos. De esta forma, la fisioterapia surge con la intención de rehabilitar las disfunciones cinéticas funcionales resultantes de estos efectos. Objetivo: Sistematizar los enfoques fisioterapéuticos más utilizados para tratar los principales efectos adversos derivados de la quimioterapia y radioterapia en pacientes oncológicos. Método: Revisión sistemática en las bases de datos PubMed, LILACS, PEDro y SciELO de 2017 a 2022. Resultados: De los 4190 artículos, solo se seleccionaron 13 que cumplieron con los criterios de inclusión y recibieron una puntuación de 6/10 en la escala PEDro. Los procedimientos fisioterapéuticos reportados en los estudios fueron acupuntura, láser, led, masaje terapéutico, auriculoterapia, crioterapia y osteopatía, que promovieron una disminución y alivio de los efectos adversos y podrían actuar como mitigantes en la aparición de estos síntomas. Conclusión: Los efectos adversos como náuseas y vómitos, mucositis y cansancio secundarios a la quimioterapia y radioterapia pueden ser tratados con procedimientos fisioterapéuticos como acupuntura, láser, led, masaje terapéutico, auriculoterapia, crioterapia y osteopatía, los cuales son seguros y efectivos. en estos perfiles de pacientes, además de proporcionar alivio de síntomas, prevenir y reducir procesos inflamatorios, aumentar el apetito, mejorar la función gastrointestinal y la condición física

Understanding the NEEDS for ACTING: An integrated framework for applying nature-based solutions in Brazil.

Nature-based solutions (NBS) support the provision of multiple benefits for the environment and society. First idealised in 2008, NBS are recommended by worldwide reports and guidelines as strategies to protect, sustainably manage and restore ecosystems. However, their operationalisation is still in the early stages, especially in developing countries, and only a few studies consider their full potential. This article contributes to this context by developing an integrated framework, with spatial and participatory tools, for analysing flood risk mitigation in Brazil. The approach enables a deep understanding of the societal challenges and vulnerabilities of the area (i.e., NEEDS) for subsequently planning the appropriate NBS (i.e., ACTIONS), with the participation of 255 stakeholders of Campina Grande municipality. Results show mappings of flood-prone areas, in which approximately 52% of the flooded areas will see an increase in the future. Hotspots (i.e., hazard, vulnerability, and exposure) are shown and discussed with four application cases. Finally, multiple benefits of seven NBS alternatives are analysed in 53 scenarios of application, in which the higher rates of reductions are found to combined alternatives. The discussion emphasizes the importance of spatially assessing the 'needs' and 'multiple benefits' of NBS, including reducing vulnerabilities and increment of resilience.

Inanimate Surfaces and Air Contamination with Multidrug Resistant Species of Staphylococcus in the Neonatal Intensive Care Unit Environment.

BACKGROUND: Contamination of the hospital environment with multi-resistant (MDR) Staphylococcus increases the risk of infection. The aim of this study is to identify the MDR species of Staphylococcus on inanimate surfaces, in air, and in clinical samples, and analyze the risk factors that correlate with the occurrence of infections in a Neonatal Intensive Care Unit. METHODS: Samples of inanimate surfaces and air were taken using a premoistened swab (0.9% sodium chloride) and spontaneous air sedimentation, respectively. The clinical isolates were recovered from infected neonates. The isolates (environmental and clinical) were identified by matrix-assisted laser desorption ionization-time of flight and the resistance profile was calculated using the disk diffusion agar technique. RESULTS: In total, 181 isolates were obtained, 93 from (surfaces), 18 from the air, and 70 clinical samples. S. epidermidis was the most frequent species (66.8%), and the failure rate in air cleaning was 100%. More than 60% of the isolates were MDR, and the majority of clinical isolates (60.4%) had a resistance profile identical to that of the environmental isolates. CONCLUSION: Staphylococcus spp. were found in most of the analyzed samples, with a high frequency of MDR isolates, demonstrating the importance of the hospital environment as a reservoir, and the need for infection control measures, and rational use of antimicrobials.

Efeitos de Abordagens não Farmacológicas nos Sintomas Físicos de Indivíduos com Câncer Avançado: Revisão Sistemática / Effects of non-Phamarcological Approaches on Physical Symptoms of Individuals with Advanced Cancer: Systematic Review / Efectos de los Enfoques no Farmacológicos sobre los Síntomas Físicos de las Personas con Cáncer Avanzado: Revisión Sistemática

Introdução: O câncer é um problema de saúde pública que, em estágios avançados, pode ocasionar desconfortos físicos, psicossociais e espirituais. Assim, abordagens fisioterapêuticas e as Práticas Integrativas e Complementares em Saúde (PICS) surgem como ferramentas importantes para o controle e melhora de sintomas físicos nesses indivíduos. Objetivo: Descrever os efeitos de abordagens não farmacológicas, envolvendo técnicas fisioterapêuticas e PICS, nos sintomas físicos de indivíduos com câncer avançado. Método: Revisão sistemática da literatura composta por ensaios clínicos randomizados que abordassem os efeitos de abordagens fisioterapêuticas ou PICS nos sintomas físicos de indivíduos diagnosticados com câncer avançado. Foram selecionadas as bases de dados PubMed, LILACS, PEDro, Cochrane, SciELO, e a última busca ocorreu em abril de 2021. A avaliação da qualidade metodológica dos estudos foi realizada por meio da escala PEDro. Resultados: Vinte e dois estudos foram incluídos, e demonstraram que ambas as abordagens têm efeitos positivos para os sintomas físicos, como fadiga e dor, na população estudada. Conclusão: A fisioterapia e as PICS têm efeitos positivos nos sintomas físicos em indivíduos com diagnóstico de câncer avançado. No entanto, existem poucos estudos com qualidade metodológica suficiente para confirmar a eficácia das duas abordagens nos desfechos estudados para essa população

Introduction: Cancer is a public health problem, which, in advanced stages, can cause physical, psychosocial and spiritual discomfort. Thus, physiotherapeutic approaches and Complementary Integrative Practices (CIPS) appear as important tools for the control and improvement of physical symptoms of these individuals. Objective: To describe the effects of non-pharmacological approaches, involving physiotherapy techniques and CIPs, on the physical symptoms of individuals with advanced cancer. Method: Systematic review of the literature with randomized controlled trials addressing the effects of physiotherapy approaches or CIPS on the physical symptoms of individuals diagnosed with advanced cancer. The PubMed, LILACS, PEDro, Cochrane, SciELO databases were selected, and the last search occurred in April 2021. PEDro scale was applied to evaluate the methodological quality of the studies. Results: Both approaches can have positive effects on physical symptoms, such as fatigue and pain, in the population investigated as demonstrated in the twenty-two studies included. Conclusion: Physical therapy and CIPS have positive effects on physical symptoms in individuals diagnosed with advanced cancer. However, there are few studies with sufficient methodological quality to confirm their effectiveness in the outcomes for this population

Introducción: El cáncer es un problema de salud pública que, en etapas avanzadas, puede causar malestar físico, psicosocial y espiritual. Así, los enfoques fisioterapéuticos y las Prácticas Integradoras y Complementarias en Salud (PICS) aparecen como herramientas importantes para el control y mejoría de los síntomas físicos en estos individuos. Objetivo: Describir los efectos de los enfoques no farmacológicos, que incluyen técnicas de fisioterapia e PICS, sobre los síntomas físicos de las personas con cáncer avanzado. Método: Revisión sistemática de la literatura, que incluyó ensayos controlas aleatorios que abordaron los efectos de los enfoques de fisioterapia o PICS en los síntomas físicos de las personas diagnosticas con cáncer avanzado. Se seleccionaron las bases de datos PubMed, LILACS, PEDro, Cochrane, SciELO y la última búsqueda se realizó en abril de 2021. La evaluación de calidad metodológica de los estudios se realizó mediante la escala PEDro. Resultados: Se incluyeron veintidós estudios que demostraron que ambos enfoques pueden tener efectos positivos sobre los síntomas físicos, como la fatiga y el dolor, en la población estudiada. Conclusión: La fisioterapia y las PICS tienen efectos positivos sobre los síntomas físicos en personas diagnosticadas con cáncer avanzado. Sin embargo, existen pocos estudios con suficiente calidad metodológica para confirmar la efectividad de ambos en los desenlaces estudiados para esta población

Métodos e Técnicas Não Farmacológicos no Tratamento da Dor Oncológica: Revisão Sistemática da Literatura / Non-Pharmacological Methods and Techniques in the Treatment of Cancer Pain: Literature Systematic Review / Métodos y Técnicas no Farmacológicos en el Tratamiento del Dolor por Cáncer: Revisión Sistemática de la Literatura

Introdução: A dor é uma sensação desagradável e responsável por diversos prejuízos na vida dos pacientes oncológicos. Esse sintoma pode estar relacionado a diversos fatores, ter múltiplos níveis de intensidade e tempo de aparecimento, podendo ser associada à disseminação invasiva de células cancerosas no corpo ou em decorrência do tratamento antineoplásico. Objetivo: Verificar quais são as técnicas e os métodos não farmacológicos utilizados no tratamento da dor do câncer, assim como descrever sobre sua eficácia terapêutica. Método: Revisão sistemática da literatura, registrada com o número CRD42021244286 no PROSPERO. Os artigos científicos sobre a temática foram pesquisados nas bases de dados eletrônicas: LILACS, PubMed, PEDro, Cochrane/CENTRAL, em português, inglês e espanhol, de 2010 a 2020, de acordo os critérios de inclusão; ensaios clínicos randomizados controlados, com amostra composta por adultos com mais de 18 anos, de ambos os sexos, com dor relacionada ao câncer, que utilizaram métodos e técnicas não farmacológicas para tratar o quadro álgico. Resultados: Foram incluídos para análise 12 artigos com amostra total de 885 pacientes submetidos a protocolos de técnicas não farmacológicas com: acupuntura, acupuntura auricular, acupressão, eletroterapia, yoga, exercícios de terapia manual, reflexologia, massagem, programa de educação para gerenciamento da dor. Todos os artigos analisados apresentaram bons resultados no tratamento da dor do câncer. Conclusão: As modalidades de terapias complementares, educação em saúde e a eletroestimulação podem contribuir na redução do quadro álgico; no entanto, programas de exercícios só possibilitam melhorias durante o período do tratamento

Introduction: Pain is an unpleasant sensation and responsible for several harms in the lives of cancer patients. This symptom can be related to several factors, has multiple levels of intensity and time of onset, it may be associated with the invasive spread of cancer cells in the body or as a result of anticancer treatment. Objective: Check which are the non-pharmacological techniques and methods adopted in the treatment of cancer pain, as well as describe their therapeutic efficacy. Method: Systematic literature review registered at PROSPERO, number CRD42021244286. Scientific articles on the subject were searched in electronic databases LILACS, PubMed, PEDro, Cochrane/CENTRAL, in Portuguese, English and Spanish, from 2010 to 2020, according to the inclusion criteria; randomized controlled clinical trials, whose sample consisted of adults over 18 years old, of both sexes, with cancer-related pain, who used non-pharmacological methods and techniques to treat the pain. Results: Twelve articles were included for analysis with a total sample of 885 patients submitted to protocols of non-pharmacological techniques with acupuncture, auricular acupuncture, acupressure, electrotherapy, yoga, manual therapy exercises, reflexology, massage and education program for pain management. All articles analyzed showed good results in the treatment of cancer pain. Conclusion: The modalities of complementary therapies, health literacy and electrical stimulation can contribute to reduce pain, however, exercise programs are effective only during the treatment period

Introducción: El dolor es una sensación desagradable y responsable de varios daños en la vida de los pacientes con cáncer. Este síntoma puede estar relacionado con varios factores, tener múltiples niveles de intensidad y tiempo de aparición, y puede estar asociado con la diseminación invasiva de células cancerosas en el cuerpo o como resultado de un tratamiento contra el cáncer. Objetivo: Comprobar cuáles son las técnicas y los métodos no farmacológicos empleados en el tratamiento del dolor oncológico, así como describir su eficacia terapéutica. Método: Revisión sistemática de la literatura, registrada con el número CRD42021244286 nel PROSPERO. Se realizaron búsquedas de artículos científicos sobre el tema en las bases de datos electrónicas: LILACS, PubMed, PEDro, Cochrane/CENTRAL, en los idiomas portugués, inglés y español, desde 2010 hasta 2020, según los criterios de inclusión; ensayos clínicos controlados aleatorizados, cuya muestra estuvo constituida por adultos mayores de 18 años, de ambos sexos, con dolor relacionado con el cáncer, que utilizaron métodos y técnicas no farmacológicas para el tratamiento del dolor. Resultados: Se incluyeron para el análisis 12 artículos con una muestra total de 885 pacientes sometidos a protocolos de técnicas no farmacológicas con: acupuntura, acupuntura auricular, acupresión, electroterapia, yoga, ejercicios de terapia manual, reflexología, masaje, programa de educación para el manejo del dolor. Todos los artículos analizados mostraron buenos resultados en el tratamiento del dolor oncológico. Conclusión: Las modalidades de terapia complementaria, educación para la salud y estimulación eléctrica pueden contribuir a la reducción del dolor, sin embargo, los programas de ejercicio solo permiten mejoras durante el período de tratamiento

Cryptococcus liquefaciens isolated from the hand of a healthcare professional in a neonatal intensive care unit.

Fungal infections are responsible for high morbidity and mortality in neonatal patients, especially in premature newborns. Infections in neonates caused by Cryptococcus spp. are rare, but it has occurred in an immunocompromised population. This study aims to describe the isolation of Cryptococcus liquefaciens from the hands of a health professional in a neonatal intensive care unit, and to evaluate the production of biofilm and virulence factors and susceptibility to antifungals. Antifungal susceptibility tests were performed according to Clinical and Laboratory Standard Institute document M27-A3. Thermotolerance virulence factors and DNase, phospholipase, proteinase, and hemolytic activities were verified through phenotypic tests; biofilm was evaluated by determining the metabolic activity and biomass. The isolate did not produce any of the tested enzymes and was susceptible to all antifungals (amphotericin B, fluconazole, and micafungin). The growth at 37 °C was very weak; however, the isolate showed a strong biomass production and low metabolic activity. This is the first report of C. liquefaciens isolated from the hands of a health professional. The isolate did not express any of the studied virulence factors in vitro, except for the low growth at 37 °C in the first 48 h, and the strong production of biofilm biomass. Cryptococcus liquefaciens can remain in the environment for a long time and is a human pathogen because it tolerates temperature variations. This report draws attention to the circulation of rare species in critical locations, information that may help in a fast and correct diagnosis and, consequently, implementation of an appropriate treatment.

Impact of alcohol gel on hand bacteria in healthcare professionals / Impacto del gel de alcohol en las bacterias de las manos en los profesionales sanitarios / Impacto do álcool gel nas bactérias das mãos de profissionais de saúde

Background and objectives: Healthcare-Associated Infections are a problem reported by hospitals worldwide, increasing patient morbidity and mortality, prolonging hospitalization, and increasing health care costs. The hands of health professionals are still the main source of infections, making hand hygiene extremely important for spreading infection control. The objective of this study was to analyze the presence of bacteria on the hands of health professionals after hygiene with alcohol gel in a Neonatal Unit and describe the resistance of microorganisms to antimicrobials. Methods: Hand samples were collected using the modified glove-juice method on both occasions, before and after hand hygiene with alcohol gel. Bacteria were identified by MALDI-TOF and susceptibility tests according to Clinical and Laboratory Standards Institute document M100-E29. Results: A total of 214 samples were obtained, of which 104 (48.6%) showed bacterial growth before hand hygiene and 52 (24.3%) after hand hygiene with alcohol gel. There were 217 isolates from the cultures, of which coagulase-negative Staphylococcus was the most frequent with 41 (27.2%) and 24 (36.4%) positive cultures, respectively before and after hand hygiene. The second most frequent microorganism was Klebsiella pneumoniae with 32 (21.2%) and 16 (24.2%), respectively before and after hand hygiene. Multidrug resistance to antimicrobials was detected in 58.1% of gram-positive bacteria and in 34.3% of gram-negative bacteria. Conclusion: A decrease was observed, but not an elimination of the microbial load after hand hygiene with alcohol gel, demonstrating the need for improvements in hand hygiene.(AU)

Justificativa e objetivos: As Infecções Relacionadas à Assistência à Saúde são um problema relatado por hospitais em todo o mundo, aumentando a morbimortalidade dos pacientes, prolongando a hospitalização e aumentando os custos dos cuidados de saúde. As mãos dos profissionais de saúde ainda são a principal fonte de infecções, tornando a higienização das mãos extremamente importante para a disseminação do controle de infecções. O objetivo deste estudo foi analisar a presença de bactérias nas mãos de profissionais de saúde após higienização com álcool gel em uma Unidade Neonatal e descrever a resistência dos microrganismos aos antimicrobianos. Métodos: Amostras de mãos foram coletadas pelo método luva-suco modificado em ambas as ocasiões, antes e após a higienização das mãos com álcool gel. As bactérias foram identificadas por MALDI-TOF e testes de suscetibilidade de acordo com o documento M100-E29 do Clinical and Laboratory Standards Institute. Resultados: Obteve-se um total de 214 amostras, das quais 104 (48,6%) apresentaram crescimento bacteriano antes da higienização das mãos e 52 (24,3%) após a higienização das mãos com álcool gel. Foram 217 isolados das culturas, sendo Staphylococcus coagulase-negativo o mais frequente com 41 (27,2%) e 24 (36,4%) culturas positivas, respectivamente antes e após a higienização das mãos. O segundo microrganismo mais frequente foi Klebsiella pneumoniae com 32 (21,2%) e 16 (24,2%), respectivamente antes e após a higienização das mãos. A multirresistência aos antimicrobianos foi detectada em 58,1% das bactérias gram-positivas e em 34,3% das bactérias gram-negativas. Conclusão: Observou-se diminuição, mas não eliminação da carga microbiana após higienização das mãos com álcool gel, demonstrando a necessidade de melhorias na higienização das mãos.(AU)

Justificación y objetivos: Las Infecciones Asociadas a la Atención de la Salud son un problema reportado por los hospitales a nivel mundial, aumentando la morbimortalidad de los pacientes, prolongando la hospitalización y aumentando los costos de la atención médica. Las manos de los profesionales de la salud siguen siendo la principal fuente de infecciones, por lo que la higiene de manos es extremadamente importante para el control de infecciones. El objetivo de este estudio fue analizar la presencia de bacterias en las manos de los profesionales de la salud después de la higiene con alcohol en gel en una Unidad Neonatal y describir la resistencia de los microorganismos a los antimicrobianos. Métodos: Se recogieron muestras de manos mediante el método guante-jugo modificado en ambas ocasiones, antes y después de la higiene de manos con alcohol en gel. Las bacterias se identificaron mediante MALDI- -TOF y pruebas de susceptibilidad de acuerdo con el documento M100-E29 del Clinical and Laboratory Standards Institute. Resultados: Se obtuvieron un total de 214 muestras, de las cuales 104 (48,6%) presentaron crecimiento bacteriano antes de la higiene de manos y 52 (24,3%) después de la higiene de manos con alcohol en gel. Hubo 217 aislamientos de los cultivos, de los cuales el Staphylococcus coagulasa negativo fue el más frecuente con 41 (27,2%) y 24 (36,4%) cultivos positivos, respectivamente antes y después de la higiene de manos. El segundo microorganismo más frecuente fue Klebsiella pneumoniae con 32 (21,2%) y 16 (24,2%), respectivamente antes y después de la higiene de manos. Se detectó multirresistencia a los antimicrobianos en el 58,1% de las bacterias grampositivas y en el 34,3% de las bacterias gramnegativas. Conclusión: Se observó una disminución, pero no una eliminación de la carga microbiana después de la higiene de manos con alcohol en gel, lo que demuestra la necesidad de mejoras en la higiene de manos.(AU)

Quercetin Ameliorates Insulin Resistance and Restores Gut Microbiome in Mice on High-Fat Diets.

Quercetin is a flavonoid that has been shown to have health-promoting capacities due to its potent antioxidant activity. However, the effect of chronic intake of quercetin on the gut microbiome and diabetes-related biomarkers remains unclear. Male C57BL/6J mice were fed HF or HF supplemented with 0.05% quercetin (HFQ) for 6 weeks. Diabetes-related biomarkers in blood were determined in mice fed high-fat (HF) diets supplemented with quercetin. Mice fed the HFQ diet gained less body, liver, and adipose weight, while liver lipid and blood glucose levels were also lowered. Diabetes-related plasma biomarkers insulin, leptin, resistin, and glucagon were significantly reduced by quercetin supplementation. In feces, quercetin supplementation significantly increased the relative abundance of Akkermansia and decreased the Firmicutes/Bacteroidetes ratio. The expression of genes Srebf1, Ppara, Cyp51, Scd1, and Fasn was downregulated by quercetin supplementation. These results indicated that diabetes biomarkers are associated with early metabolic changes accompanying obesity, and quercetin may ameliorate insulin resistance.

Cooked Black Turtle Beans Ameliorate Insulin Resistance and Restore Gut Microbiota in C57BL/6J Mice on High-Fat Diets.

Colored common beans are associated with health promoting and chronic disease prevention effects. Male C57BL/6J mice were fed high-fat (HF) diets supplemented with cooked black turtle beans (HFB) to prevent obesity related insulin resistance. Mice on both HF and HFB were obese compared to mice fed a low-fat (LF) diet. Plasma low density lipoprotein (LDL) and triglyceride concentrations of mice fed HFB diet were 28% and 36.6% lower than those on HF diet. Homeostatic model assessment of insulin resistance (HOMA-IR) index of mice fed HFB diet was 87% lower than that of mice fed HF diet. Diabetes related biomarkers, gastric inhibitory polypeptide (GIP), leptin, glucagon, and inflammatory cytokines interleukin 4 (IL-4) and IL-5, 10 and 12, IFN-g and TNF-α were significantly affected by HFB diet. Pparα, Cyp7a1 and Fasn were down-regulated by HFB diet while LDL-R, Srebp-2, Adipoq and Slc2a4 were up-regulated by HFB diet. The ratio of Firmicutes/Bacteroidetes (F/B) was also decreased 64.1% by HFB diet compared to HF diet. The results indicated that cooked black turtle bean consumption could ameliorate insulin resistance and lower plasma LDL in mice fed HF diet through glucose signaling pathway and JNK/c-Jun pathway. Meanwhile, cooked black turtle bean consumption restored the gut microbiome.

Healthcare-associated infections in high-risk neonates: Temporal trends in a national surveillance system.

BACKGROUND: Increased survival of preterm neonates who require hospitalization at the Neonatal Intensive Care Unit has led to an increase in infections. This study aims to describe the temporal trend, risk factors, and outcome of healthcare-associated infections in a NICU of a high complexity hospital, with emphasis on the differences of incidence between bacterial and fungal infections. METHODS: The study was carried out from January 2013 to December 2016, with daily follow-up of the newborns by the National Healthcare Safety Network. RESULTS: The study included 881 newborns, of whom 214 had a bacterial infection, 19 had fungi infection, and 12 bacterial and fungal infections associated. The hospital infection rate was 12/1000 patient-days. SNAPPE>24, days of hospitalization and PICC days were independent risk factors for the development of fungal and bacterial infection, respectively, with statistical significance for bacterial and fungal infections. The mortality rate was 2.6 times higher in those who had fungal infection than in those who had a bacterial infection. The occurrence of invasive infections was higher in the years 2015 and 2016 and Gram-negative bacteria and yeasts were more frequent, impacting morbidity and mortality. CONCLUSIONS: The use of invasive devices is a risk factor for the occurrence of HAI caused by bacteria and fungi. The frequency of deaths was higher in the group of neonates with fungal infection. These results point to the importance of constant epidemiological surveillance and measures of effective control of infections in NICU.

Quantification of biofilm produced by clinical, environment and hands' isolates Klebsiella species using colorimetric and classical methods.

Some species of Klebsiella, such as Klebsiella pneumoniae and Klebsiella oxytoca, are important nosocomial pathogens frequently involved in outbreaks in Neonatal Intensive Care Units (NICU) and have the ability to form a biofilm. This study aims to evaluate the biofilm production of K. pneumoniae and K. oxytoca isolates collected from the hands of health professionals, neonates' blood and the environment of a Brazilian NICU, using three colorimetric methods and a classical method of counting the colony-forming units and compare the analysis among these techniques. The biofilm formation was carried out by the microplate technique, using three colorimetric assays: crystal violet, safranin and 2,3-bis (2-methoxy-4-nitro-5-sulfophenyl) -5 [(phenylamino) arbonyl] - 2H-tetrazolium hydroxide (XTT). Also, colony-forming units were determined. Twenty-eight isolates of K. pneumoniae were collected from the blood, hands and environment and five of K. oxytoca from the hands and environment. All of them were strong biofilm producers, but K. pneumoniae isolates produced more biofilm than K. oxytoca when compared to the American Type Culture Collection (ATCC) strains used as positive controls. The number of viable cells in the biofilm produced by K. pneumoniae isolated from blood was significantly higher than in the control sample. Regarding the three colorimetric tests used in the study, the violet crystal obtained a higher absorbance average. The use of crystal-violet and XTT in the evaluation of biofilm in vitro make possible a complete analysis, since that it can quantify the total biomass (including the extracellular matrix) and evaluate the metabolic activity. In conclusion, this study identified isolates of K. pneumoniae and K. oxytoca that produce biofilms in the NICU and the bloodstream of neonates. This fact deserves attention since these patients are immunocompromised. The best methods will be chosen to answer research questions by always adopting more than one method so that more than one parameter or component of the biofilm is analyzed.

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis.

PURPOSE: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients' quality of life (QoL). AIMS: to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. METHODS: we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). RESULTS: the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. CONCLUSION: the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis / Resultados cirúrgicos e qualidade de vida de pacientes submetidos à proctocolectomia total e reservatório ileoanal

ABSTRACT Purpose: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients' quality of life (QoL). Aims: to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. Methods: we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). Results: the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. Conclusion: the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

RESUMO Objetivo: a Proctocolectomia com reservatório ileoanal (PCT-RIA) é método de escolha em alguns casos de Polipose Adenomatosa Familiar (PAF) e Retocolite Ulcerativa (RCU). Embora tenha potencial curativo, apresenta morbidade considerável e pode afetar a qualidade de vida (QV) dos pacientes. Objetivos: avaliar resultados cirúrgicos e impacto das complicações pélvicas na função intestinal e QV. Métodos: foram avaliados retrospectivamente 55 pacientes submetidos a PCT-RIA, de janeiro de 2003 até abril de 2017, com ênfase na técnica operatória e morbidade. Quarenta pacientes responderam aos questionários Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ) e Short Form 36 Health Survey Questionnaire (SF36). Resultados: A média de idade foi 42,1±14,1 anos, sendo 63,6% do sexo masculino e 69,1% com diagnóstico de PAF. A mortalidade cirúrgica foi 1,8% e morbidade 76,4%. Fístula anastomótica foi a complicação precoce mais frequente (34,5%) e, as tardias foram bolsite (10,8%) e obstrução intestinal (9,1%). As complicações precoces mais graves foram mais frequentes em pacientes com RCU (p=0,014). Não houve impacto das complicações na função intestinal nem na QV. As mulheres apresentaram menor frequência evacuatória e noturna, menor interferência dos sintomas intestinais na QV (p=0,012) e CGQL mais elevado (p=0,04). Melhor QV foi referida pelos pacientes com maior escolaridade e, foi observada piora em pacientes com mais de cinco anos de confecção do RIA. Conclusões: não se evidenciou impacto das complicações na função intestinal nem na QV. A função intestinal é satisfatória e a QV é boa na maioria dos pacientes, sendo influenciada pelo sexo, escolaridade e tempo de confecção do RIA.