Manejo de pacientes oncológicos na prática odontológica: uma revisão de literatura / Management of cancer patients in dental practice: a literature review / Manejo de pacientes con cáncer en la práctica odontológica: una revisión de la literatura

O manejo odontológico adaptado ao paciente que é diagnosticado com câncer é fundamental para a melhoria e manutenção da qualidade de vida dos mesmos. Esses indivíduos devem ser submetidos a uma avaliação odontológica prévia ao tratamento anticancerígeno, a fim de estabelecer as etapas necessárias às intervenções e o que pode ser realizado antes, durante e pós-tratamento, sendo essas fases executadas na clínica diária ou até mesmo no ambiente hospitalar, exercendo um trabalho multidisciplinar. A presente revisão de literatura tem como objetivo direcionar a atenção dos cirurgiões dentistas para o planejamento e atendimento personalizado dos pacientes oncológicos, de acordo com suas necessidades e particularidades.

Dental management adapted to patients diagnosed with cancer is essential for improving and maintaining their quality of life. These individuals must undergo a dental evaluation prior to anticancer treatment, in order to establish the necessary steps for interventions and what can be done before, during and after treatment, these phases being performed in the daily clinic or even in the hospital environment, exercising multidisciplinary work. This literature review aims to direct the attention of dentists to the planning and personalized care of cancer patients, according to their needs and particularities.

El manejo odontológico adaptado a los pacientes diagnosticados de cáncer es esencial para mejorar y mantener su calidad de vida. Estas personas deben someterse a una evaluación odontológica previa al tratamiento anticanceroso, con el fin de establecer los pasos necesarios para las intervenciones y lo que se puede hacer antes, durante y después del tratamiento, siendo estas fases realizadas en la clínica diaria o incluso en el ámbito hospitalario, ejerciendo un trabajo multidisciplinar. Esta revisión bibliográfica pretende dirigir la atención de los odontólogos a la planificación y atención personalizada de los pacientes con cáncer, de acuerdo con sus necesidades y particularidades.

Investigating Perceptual Subgroups in Speakers With Ataxic Dysarthria: An Auditory Free Classification Approach.

PURPOSE: Ataxic dysarthria has presented with considerable heterogeneity in the presentation of speech characteristics. Converging evidence supports the existence of subgroups, specifically related to the instability and inflexibility of motor patterns as a possible explanation of this variability. METHOD: To further examine the alignment of the speech characteristics of ataxic dysarthria with the instability/inflexibility framework, 23 graduate student listeners participated in an auditory free classification task and a guided classification task. Listeners grouped 15 speakers with ataxic dysarthria based on their judgment of the most salient perceptual characteristics during two speaking tasks: alternating motion rates (AMRs) and connected speech (one to two sentences). Listener ratings were then compared with a priori determinations of speakers who fit the instability subgroup profile and the inflexibility subgroup profile. RESULTS: Results of both the free classification and guided classification listening paradigms provided supportive evidence of subgroups, particularly for the AMR task, in the context of strong inter- and intrarater reliability. CONCLUSION: This study adds to the growing evidence of the existence of instability and inflexibility subgroups in ataxic dysarthria and serves as a proof of concept for use of the auditory free classification paradigm in dysarthria subgroup research.

Momordica charantia L. improves airway hyperresponsiveness and suppresses inflammation in a murine model of allergic asthma.

OBJECTIVE: To evaluate the effect of a hydroethanolic extract of Momordica charantia L. ("bitter melon", Cucurbitaceae) leaves (MCHA) on ovalbumin (OVA)-induced asthma model. Balb/c mice were sensitized twice and challenged for 4 alternate days with OVA and then treated with MCHA (500 mg/kg) for 7 consecutive days. METHODS: Control groups received treatment with normal saline or dexamethasone (2 mg/kg) on the same day. We assessed in vivo bronchial hyperresponsiveness and ex-vivo inflammation and mucus production in bronchoalveolar lavage (BAL), lung homogenates, and lung tissue. RESULTS: MCHA significantly improved airway hyperresponsiveness near baseline levels. MCHA administration significantly improved airway and lung inflammation, demonstrated by decreased total and inflammatory cells in BAL, lower levels of IL-5 and IL-13 in lung homogenate, and fewer inflammatory cells in lung tissue. Additionally, MCHA significantly diminished goblet cells in lung tissue. CONCLUSIONS: Administration of a hydroethanolic extract of M. charantia leaves was effective in treating OVA-induced asthma in an animal model.

Momordica charantia L. improves airway hyperresponsiveness and suppresses inflammation in a murine model of allergic asthma

Objective To evaluate the effect of a hydroethanolic extract of Momordica charantia L. (“bitter melon”, Cucurbitaceae) leaves (MCHA) on ovalbumin (OVA)-induced asthma model. Balb/c mice were sensitized twice and challenged for 4 alternate days with OVA and then treated with MCHA (500 mg/kg) for 7 consecutive days.Methods Control groups received treatment with normal saline or dexamethasone (2 mg/kg) on the same day. We assessed in vivo bronchial hyperresponsiveness and ex-vivo inflammation and mucus production in bronchoalveolar lavage (BAL), lung homogenates, and lung tissue.Results MCHA significantly improved airway hyperresponsiveness near baseline levels. MCHA administration significantly improved airway and lung inflammation, demonstrated by decreased total and inflammatory cells in BAL, lower levels of IL-5 and IL-13 in lung homogenate, and fewer inflammatory cells in lung tissue. Additionally, MCHA significantly diminished goblet cells in lung tissue.Conclusions Administration of a hydroethanolic extract of M. charantia leaves was effective in treating OVA-induced asthma in an animal model (AU)

Experimental and Theoretical DFT Study of Cu(I)/N,N-Disubstituted-N'-acylthioureato Anticancer Complexes: Actin Cytoskeleton and Induction of Death by Apoptosis in Triple-Negative Breast Tumor Cells.

Six complexes with the general formula [Cu(acylthioureato)(PPh3)2] were synthesized and characterized using spectroscopic techniques (IR, UV/visible, and 1D and 2D NMR), mass spectrometry, elemental analysis, and X-ray diffraction. Interpretation of the in vitro cytotoxicity data of Cu(I) complexes took into account their stability in cell culture medium. DFT calculations showed that NMR properties, such as the shielding of carbon atoms, are affected by relativistic effects, supported by the ZORA Hamiltonian in the theoretical calculations. Additionally, the calculation of the energies of the frontier molecular orbitals predicted that the structural changes of the acylthiourea ligands did not cause marked changes in the reactivity descriptors. All complexes were cytotoxic to the evaluated tumor cell lines [MDA-MB-231 (triple-negative breast cancer, TNBC), MCF-7 (breast cancer), and A549 (lung cancer)]. In the MDA-MB-231 cell line, complex 1 significantly altered the cytoskeleton of the cells, reducing the density and promoting the condensation of F-actin filaments. In addition, the compound caused an increase in the percentage of cells in the fragmented DNA region (sub-G0) and induced cell death via the apoptotic pathway starting at the IC50 concentration. Taken together, the results show that complex 1 has cytotoxic and apoptotic effects on TNBC cells, which is a cell line originating from an aggressive, difficult-to-treat breast cancer.

Stabilization and operational selectivity alteration of Lipozyme 435 by its coating with polyethyleneimine: Comparison of the biocatalyst performance in the synthesis of xylose fatty esters.

Differently modified Lipozyme 435 (L435) (immobilized lipase B from Candida antarctica) preparations were used as biocatalysts in the esterification reaction to synthesize sugar fatty acid esters (SFAEs) from xylose (acyl acceptor) and lauric/palmitic acids (acyl donors) in methyl ethyl ketone (MEK) solvent. The L435 treatment with polyethyleneimine (PEI) (2; 25; and 750 KDa) prevented the enzyme leakage in the crude sugar ester reaction product. The 2 KDa PEI coating of this enzyme preparation produced the highest enzyme stability in MEK, buffer solutions (pHs 5 and 7), and methanol aqueous phosphate buffer at pH 7. Using an excess of the acyl donor (1:5 xylose: fatty acid molar ratio), high xylose conversions (70-84%) were obtained after 24 h-reaction using both, non-modified and PEI (2 KDa) coated L435, but the PEI treated biocatalyst afforded a higher xylose modification degree. After 5 reuse cycles with the L435 coated with PEI 2 KDa, the xylose conversions only decreased 10%, while with the non-treated biocatalyst they decreased by 37%. The formation of SFAEs was confirmed by mass spectrometry, which showed the presence of xylose mono-, di-, and triesters. They exhibited emulsion capacities close to that of a commercial sucrose monolaurate.

Case report of a coral snake bite (Micrurus ibiboboca) in the state of Pernambuco, northeast Brazil / Relato de caso de picada de cobra coral (Micrurus ibiboboca) no estado de Pernambuco, nordeste do Brasil / Informe de caso de mordedura de serpiente coral (Micrurus ibiboboca) en el estado de Pernambuco, noreste de Brasil

The Elapidae family comprises 35 snake species in Brazil, with Micrurus ibiboboca being widely distributed in the northeast of the country. Despite the high number of Micrurus species in Brazil, there are few cases of human envenomation in literature. This study describes a clinical report of envenomation due to the bite of M. ibiboboca in the State of Pernambuco, Northeast Brazil, that took place in 2017. The patient presented symptoms of muscle paralysis and sweating. He was admitted to the intensive care unit. A total of 10 ampoules of anti-elapidic serum were administered. The patient complained of local pain that extended through the arm, paresthesia in the lower limbs, headache, and chest pain. Changes in the visual, respiratory, and neurological systems were not observed. This clinical case report on coral snake poisoning is useful for increasing the knowledge on the toxicological action of snake poison and its effect on injured individuals, thereby helping in the clinical evaluation and treatment.(AU)

A família Elapidae compreende 35 espécies de serpentes no Brasil, com Micrurus ibiboboca amplamente distribuída no Nordeste. Apesar do elevado número de espécies de Micrurus no Brasil, são poucos os casos de envenenamento humano na literatura. Descrevemos aqui um relato clínico de envenenamento por picada de M. ibiboboca no Estado de Pernambuco, Nordeste do Brasil, ocorrido em 2017. O paciente apresentava sintomas de paralisia muscular e sudorese. Ele foi internado na Unidade de Terapia Intensiva. Um total de 10 ampolas de soro anti-elapídico foi administrado. O paciente queixava-se de dor local que se estendia pelo braço, parestesia em membros inferiores, cefaleia e dor torácica. Não foram observados alterações nos sistemas de visão, respiratório e neurológico. Este relato de caso clínico de intoxicação por cobra coral é útil para aumentar o conhecimento sobre a ação toxicológica da peçonha da serpente e seu efeito sobre os acidentados, auxiliando na avaliação clínica e no tratamento.(AU)

La familia Elapidae comprende 35 especies de serpientes en Brasil como la Micrurus ibiboboca ampliamente distribuidas en el Noreste. A pesar de lo alto número de especies de Micrurus en Brasil, hay pocos casos de envenenamiento humano en la literatura. Describimos aquí un informe clínico de envenenamiento por mordedura de M. ibiboboca en el estado de Pernambuco, Noreste de Brasil, ocurrido en 2017. El paciente presentaba síntomas de parálisis muscular y sudoración. Fue ingresado en la unidad de cuidados intensivos. Se administraron un total de 10 ampollas de suero antielapídico. El paciente se quejaba de dolor local que se extendía por el brazo, parestesias en las extremidades inferiores, cefalea y dolor torácico. No se observaron cambios en los sistemas visual, respiratorio y neurológico. Este informe de caso clínico sobre la intoxicación por serpiente coral es útil para aumentar el conocimiento sobre la acción toxicológica del veneno de serpientes y su efecto en los individuos lesionados, ayudando así en la evaluación clínica y el tratamiento.(AU)

Lipozyme 435-Mediated Synthesis of Xylose Oleate in Methyl Ethyl Ketone.

In this paper, we have performed the Lipozyme 435-catalyzed synthesis of xylose oleate in methyl ethyl ketone (MEK) from xylose and oleic acid. The effects of substrates' molar ratios, reaction temperature, reaction time on esterification rates, and Lipozyme 435 reuse were studied. Results showed that an excess of oleic acid (xylose: oleic acid molar ratio of 1:5) significantly favored the reaction, yielding 98% of xylose conversion and 31% oleic acid conversion after 24 h-reaction (mainly to xylose mono- and dioleate, as confirmed by mass spectrometry). The highest Lipozyme 435 activities occurred between 55 and 70 °C. The predicted Ping Pong Bi Bi kinetic model fitted very well to the experimental data and there was no evidence of inhibitions in the range assessed. The reaction product was purified and presented an emulsion capacity close to that of a commercial sugar ester detergent. Finally, the repeated use of Lipozyme 435 showed a reduction in the reaction yields (by 48 and 19% in the xylose and oleic acid conversions, respectively), after ten 12 h-cycles.

Octahedral ruthenium and magnesium naringenin 5-alkoxide complexes: NMR analysis of diastereoisomers and in-vivo antibacterial activity against Xylella fastidiosa.

Although many copper-based antimicrobial compounds have been developed to control pathogenic bacteria and fungi in plants and applied for crop protection, there is evidence that several plant pathogens have developed resistance to copper-based antimicrobial compounds, including some Xanthomonas species. Xylella is a bacterial genus belonging to the Xanthomonas family; and X. fastidiosa, which is responsible for citrus variegated chlorosis (CVC) in sweet orange, may develop resistance to one or more copper-based antimicrobials. Because of the time required for the development and approval of new antimicrobials for commercial use, the discovery of novel bactericidal compounds is essential before the development of resistance to the antimicrobials currently in use becomes widespread. Here, we explored the antimicrobial potential of two newly synthesized antimicrobials complexes and one natural compound against X. fastidiosa. Several nuclear magnetic resonance (NMR) assays with high resolution and sensitivity were developed to identify new diastereoisomers in the context of octahedral ruthenium - [Ru(narin)(phen)2]PF6-and magnesium naringenin 5-alkoxide - [Mg(narin)(phen)2]OAc - complexes, obtained in the present work. The NMR assays proved to be powerful tools for the identification of isomers in metal complexes. Moreover, a protocol for the in-vivo determination of the effects of these complexes against X. fastidiosa was developed. The main trunks of X. fastidiosa infected plants were injected with the two complexes as well as with the limonoid azadirachtin using a syringe; the number of bacterial cells in the plants following treatment was estimated via real-time quantitative PCR (qPCR). Importantly, the administration of both complexes and of azadirachtin drastically reduced the number of X. fastidiosa cells in vivo.

Cultural Adaptation and Validation of the Methotrexate Intolerance Severity Score in Brazilian Portuguese for Adults With Rheumatoid Arthritis.

INTRODUCTION: The Methotrexate Intolerance Severity Score (MISS) questionnaire is used to identify intolerance to methotrexate (MTX), but it is not available in the Brazilian Portuguese language. OBJECTIVE: The aim of this study was to adapt and validate the MISS in Brazilian Portuguese. METHODS: The Brazilian Portuguese version of the MISS was developed following the Guidelines for the Process of Cross-cultural Adaptation of Self-report Measures. The new version was tested in 120 patients with rheumatoid arthritis. For the reliability assessment, the Cronbach α coefficient was used. The receiver operating characteristic curve was constructed with the objective of finding the best cutoff point for MTX intolerance and weighing the sensitivity and specificity. The concordance among the results was analyzed using the κ coefficient and factorial analysis with varimax rotation. RESULTS: This methodological study developed and applied a culturally acceptable Brazilian Portuguese version of the MISS. The MISS questionnaire presented internal consistency classified as "very good" because Cronbach α is equal to 0.83 (95% confidence interval, 0.79-0.87). The suitability of the data for factorial analysis was demonstrated using the Kaiser-Meyer-Olkin sample adequacy test (KMO = 0.723) and Bartlett sphericity test (χ2 = 499.98, p < 0.001). It was observed that a factorial analysis with 3 factors is preferred; the receiver operating characteristic curve of the MISS score was considered the cutoff point at 6 points (sensitivity 100% and specificity 89.4%). CONCLUSIONS: The Brazilian Portuguese version of the MISS is valid and reliable for the detection of MTX intolerance in clinical practice.

Physical performance of military personnel before and during the Covid-19 pandemic / Desempenho físico de militares antes e durante a pandemia Covid-19 / Desempeño físico de militares antes y durante la pandemia Covid-19

ABSTRACT This investigation aimed to compare the level of physical performance of the military of the 3rd Military Police Battalion before and during the COVID-19 pandemic. The participants were 82 military personnel (76 men) who were submitted to the Physical Fitness Test (PFT) in November 2019 and repeated it in September 2020. The 12-minute and VO2max tests were selected for cardiorespiratory evaluation and push-ups and sit-up tests to assess localized muscle resistance. The results showed a decrease in the performance of these soldiers, both in cardiorespiratory variables and in localized muscular resistance (p ≤ 0.05). The pandemic may have negatively influenced the physical performance of the military.

RESUMO O objetivo desta investigação foi comparar o nível de desempenho físico dos militares do 3º Batalhão de Polícia do Exército antes e durante a pandemia COVID-19. Os participantes foram 82 militares (76 homens) que foram submetidos ao Teste de Avaliação Física (TAF) em novembro de 2019 e setembro de 2020. Os testes de 12 minutos e VO2máx foram selecionados para avaliação cardiorrespiratória e flexão de braço e abdominais para avaliar a resistência muscular localizada. Os resultados mostraram uma diminuição no desempenho desses militares, tanto nas variáveis cardiorrespiratórias quanto na resistência muscular localizada (p ≤ 0,05). A pandemia pode ter influenciado negativamente o desempenho físico dos militares.

RESUMEN El propósito de esta investigación fue comparar el nivel de desempeño físico de los soldados del 3er Batallón de Policía del Ejército antes y durante la pandemia de COVID-19. Los participantes fueron 82 militares (76 hombres) que se sometieron a la Prueba de Evaluación Física (PEF) en noviembre de 2019 y septiembre de 2020. Se seleccionaron las pruebas de 12 minutos y VO2max para evaluación cardiorrespiratoria y flexión de brazo y abdomen para evaluar la resistencia muscular localizada. Los resultados mostraron una disminución en el desempeño de estos soldados, tanto en las variables cardiorrespiratorias como en la resistencia muscular localizada (p ≤ 0.05). La pandemia puede haber influido negativamente en el desempeño físico de los militares.

High frequency of methotrexate intolerance in longstanding rheumatoid arthritis: using the methotrexate intolerance severity score (MISS).

BACKGROUND: Methotrexate (MTX) intolerance is frequent, and its early identification may impact treatment, leading to timely changes in medication that may promote patient compliance and better control of rheumatoid arthritis (RA). The objective of this study was to identify the frequency of, and risk factors for, MTX intolerance using the Brazilian Portuguese version of the Methotrexate Intolerance Severity Score (MISS) questionnaire in patients with RA. METHODS: This cross-sectional study was performed between April 2018 and April 2019 and enrolled patients with RA in regular use of oral or subcutaneous MTX for at least 3 months. Patients were invited to answer the Brazilian Portuguese version of the MISS questionnaire, and MTX intolerance was defined by a score ≥ 6 points. Age, sex, disease duration, time of MTX use, dose, route of administration, concomitant medications, comorbidities, smoking, and Disease Activity Score for 28joint (DAS28) data were collected from institutional medical records. RESULTS: Among 120 patients, 103 (85.8%) were female, the mean age was 61 (±12.5) years, the mean duration of disease was 16 (±10.3) years, and the average duration of MTX use was 7 (±5.5) years. The frequency of MTX intolerance was 21.6%. The most frequent symptoms reported after the use of MTX were nausea (92.3%), abdominal pain (46.1%), and vomiting (30.7%). Behavioral symptoms occurred in 96.1% of patients with MTX intolerance, the most frequent being restlessness and irritability. Patients who used corticosteroids were more likely to develop MTX intolerance than those not using corticosteroids (odds ratio = 2.73; 95% confidence interval, 1.06 to 7.06; p = 0.038). Conversely, increasing age showed marginally significant association with decreased risk of MTX intolerance (p = 0.059). CONCLUSIONS: The use of the MISS questionnaire disclosed high frequencies of anticipatory, associative, and behavioral symptoms in MTX-intolerant patients, and the use of corticosteroid increases the risk of MTX intolerance. We suggest that the MISS questionnaire be used routinely in clinical practice.

A new case of envenomation by neotropical opisthoglyphous snake Philodryas olfersii (Lichtenstein, 1823) in Recife, State of Pernambuco, Brazil.

Human envenomation by the snakes Colubridae and Dipsadidae are reported in Brazil, and envenomation by the Opisthoglyphous snake Philodryas olfersii could be dangerous. Here, we present the second record of an envenomation by Philodryas olfersii in Pernambuco, northeast Brazil. The male victim presented with mild erythema pain, paraesthesia, local numbness, and swollen lymph nodes. The symptoms were similar to those of a pit viper bite, and disappeared completely after 15 days.

Advances in the Biosynthesis of Pyranocoumarins: Isolation and 13C-Incorporation Analysis by High-Performance Liquid Chromatography-Ultraviolet-Solid-Phase Extraction-Nuclear Magnetic Resonance Data.

Citrus sinensis and Citrus limonia were obtained by germination from seeds, and isotopic-labeling experiments using d-[1-13C]glucose were performed with the seedlings. After 60 days, the seedlings were analyzed by high-performance liquid chromatography-ultraviolet-solid-phase extraction-nuclear magnetic resonance, data and the 13C enrichment patterns of xanthyletin and seselin indicated that the pyran ring was formed by the methylerythritol phosphate pathway and that the coumarin moiety was derived from the shikimate pathway in both compounds. This information regarding the biosynthetic pathway can be used to increase resistance against phytopathogens, because xanthyletin and seselin are reported to have antimicrobial activity on the growth of Xylella fastidiosa, which causes citrus variegated chlorosis in orange.

Professional practice of nurses and influences on moral sensitivity.

OBJECTIVE: To understand the professional practice of nurses and their influence on the development of moral sensibility. METHODS: A qualitative and descriptive study, conducted between November 2015 and February 2016 in the hospitalization units of the medical clinic of two large hospitals located in Belo Horizonte, Minas Gerais. 14 nurses participated. Data collection was done through interviews, guided by semi-structured scripts. The data were submitted to content analysis. RESULTS: Two categories emerged: Professional practice of the nurse: internal and external goods and Moral sensitivity and the interface with the professional practice of nurses. The development of the moral sensitivity of nurses is influenced by factors related to professional practice, such as interpersonal relations, ethical education and management activities. Final considerations: In the professional practice, moral sensibility is an integral part of the ethical decision-making process in services, being essential for quality care.

Rapid differentiation of graft Citrus sinensis with and without Xylella fastidiosa infection by mass spectrometry.

RATIONALE: Xylella fastidiosa causes citrus variegated chlorosis (CVC) in sweet orange trees. A diagnostic method for detecting CVC before the symptoms appear, which would inform citrus producers in advance about when the plant should be removed from the orchard, is essential for reducing pesticide application costs. METHODS: Chemometrics was applied to high-performance liquid chromatography diode array detector (HPLC-DAD) data to evaluate the similarities and differences between the chromatographic profiles. A liquid chromatography/atmospheric pressure chemical ionization mass spectrometry selected reaction monitoring (LC/APCI-MS-SRM) method was developed to identify the major compounds and to determine their amounts in all samples. RESULTS: We evaluated the effect of this bacterium on the variation in the chemical profile in citrus plants. The organs of C. sinensis grafted on C. limonia were analyzed. Chemometrics was applied to the obtained data, and two major groups were differentiated. Flavonoids were observed in one group (leaves) and coumarins in the second (roots), both at higher concentrations in the plants with CVC symptoms than in those without the symptoms and those in the negative control. The rootstocks also interfered in the metabolism of the scion. CONCLUSIONS: The developed LC/APCI-MS-SRM method for detecting CVC before the symptoms appear is simple and accurate. It is inexpensive, and many samples can be screened per hour using 1 mg of leaves. Knowledge of the influence of the rootstock on the chemical profile of the graft is limited. This study demonstrates the effect of the rootstock in synthesizing flavonoids and increasing its content in all parts of the graft.

A new case of envenomation by neotropical opisthoglyphous snake Philodryas olfersii (Lichtenstein, 1823) in Recife, State of Pernambuco, Brazil

Abstract Human envenomation by the snakes Colubridae and Dipsadidae are reported in Brazil, and envenomation by the Opisthoglyphous snake Philodryas olfersii could be dangerous. Here, we present the second record of an envenomation by Philodryas olfersii in Pernambuco, northeast Brazil. The male victim presented with mild erythema pain, paraesthesia, local numbness, and swollen lymph nodes. The symptoms were similar to those of a pit viper bite, and disappeared completely after 15 days.

High frequency of methotrexate intolerance in longstanding rheumatoid arthritis: using the methotrexate intolerance severity score (MISS)

Abstract Background: Methotrexate (MTX) intolerance is frequent, and its early identification may impact treatment, leading to timely changes in medication that may promote patient compliance and better control of rheumatoid arthritis (RA). The objective of this study was to identify the frequency of, and risk factors for, MTX intolerance using the Brazilian Portuguese version of the Methotrexate Intolerance Severity Score (MISS) questionnaire in patients with RA. Methods: This cross-sectional study was performed between April 2018 and April 2019 and enrolled patients with RA in regular use of oral or subcutaneous MTX for at least 3 months. Patients were invited to answer the Brazilian Portuguese version of the MISS questionnaire, and MTX intolerance was defined by a score ≥ 6 points. Age, sex, disease duration, time of MTX use, dose, route of administration, concomitant medications, comorbidities, smoking, and Disease Activity Score for 28joint (DAS28) data were collected from institutional medical records. Results: Among 120 patients, 103 (85.8%) were female, the mean age was 61 (±12.5) years, the mean duration of disease was 16 (±10.3) years, and the average duration of MTX use was 7 (±5.5) years. The frequency of MTX intolerance was 21.6%. The most frequent symptoms reported after the use of MTX were nausea (92.3%), abdominal pain (46.1%), and vomiting (30.7%). Behavioral symptoms occurred in 96.1% of patients with MTX intolerance, the most frequent being restlessness and irritability. Patients who used corticosteroids were more likely to develop MTX intolerance than those not using corticosteroids (odds ratio = 2.73; 95% confidence interval, 1.06 to 7.06; p = 0.038). Conversely, increasing age showed marginally significant association with decreased risk of MTX intolerance (p = 0.059). Conclusions: The use of the MISS questionnaire disclosed high frequencies of anticipatory, associative, and behavioral symptoms in MTX-intolerant patients, and the use of corticosteroid increases the risk of MTX intolerance. We suggest that the MISS questionnaire be used routinely in clinical practice.(AU)

Professional practice of nurses and influences on moral sensitivity / Práctica profesional del enfermero e influencias sobre la sensibilidad moral / Prática profissional do enfermeiro e influências sobre a sensibilidade moral

ABSTRACT Objective: To understand the professional practice of nurses and their influence on the development of moral sensibility. Methods: A qualitative and descriptive study, conducted between November 2015 and February 2016 in the hospitalization units of the medical clinic of two large hospitals located in Belo Horizonte, Minas Gerais. 14 nurses participated. Data collection was done through interviews, guided by semi-structured scripts. The data were submitted to content analysis. Results: Two categories emerged: Professional practice of the nurse: internal and external goods and Moral sensitivity and the interface with the professional practice of nurses. The development of the moral sensitivity of nurses is influenced by factors related to professional practice, such as interpersonal relations, ethical education and management activities. Final considerations: In the professional practice, moral sensibility is an integral part of the ethical decision-making process in services, being essential for quality care.

RESUMEN Objetivo: Comprender la práctica profesional de la enfermera y su influencia en el desarrollo de la Sensibilidad moral. Métodos: Estudio cualitativo y descriptivo realizado entre noviembre de 2015 y febrero de 2016 en unidades de internación de la clínica médica de dos hospitales de gran porte, ubicados en Belo Horizonte, Minas Gerais. Participaron 14 enfermeras. La recolección de datos se efectuó por medio de entrevistas, guiadas por guiones semiestructurados. Los datos se sometieron a análisis de contenido. Resultados: Surgieron dos categorías: Práctica profesional de la enfermera: bienes internos y externos y Sensibilidad moral y la interfaz con la práctica profesional de las enfermeras. El desarrollo de la sensibilidad moral de las enfermeras sufre la influencia de factores relacionados con la práctica profesional, como las relaciones interpersonales, la educación ética y las actividades de gestión. Consideraciones finales: En la práctica profesional, la Sensibilidad moral es parte integrante del proceso de toma de decisiones éticas en los servicios, siendo esencial para un cuidado de calidad.

RESUMO Objetivo: Compreender a prática profissional do enfermeiro e suas influências para o desenvolvimento da sensibilidade moral. Métodos: Estudo qualitativo, descritivo, realizado entre novembro de 2015 e fevereiro de 2016, em unidades de internação da clínica médica, de dois hospitais de grande porte, localizados em Belo Horizonte, Minas Gerais. Participaram 14 enfermeiros. A coleta de dados ocorreu por meio de entrevistas, guiadas por roteiros semiestruturados. Os dados foram submetidos à análise de conteúdo. Resultados: Emergiram duas categorias: Prática profissional do enfermeiro: bens internos e externos e; Sensibilidade moral e a interface com a prática profissional de enfermeiros. O desenvolvimento da Sensibilidade moral dos enfermeiros, sofre influência de fatores relacionados à prática profissional, como as relações interpessoais, a educação ética e as atividades de gestão. Considerações finais: Na prática profissional, a Sensibilidade moral é parte integrante do processo de tomada de decisão ética nos serviços, sendo essencial para o cuidado de qualidade.

Impacto da escleroterapia com espuma de polidocanol guiada por ultrassom em pacientes com úlcera venosa / Impact of ultrasound-guided polidocanol foam sclerotherapy in patients with venous ulcers

Contexto: A escleroterapia com espuma de polidocanol guiada por ultrassom tem sido utilizada no tratamento de pacientes com úlceras venosas. É um procedimento minimamente invasivo e de fácil execução, porém apresenta taxas de recidiva elevadas. Objetivos: Relatar a evolução a curto e médio prazo de pacientes com úlcera venosa tratados com escleroterapia com espuma de polidocanol guiada por ultrassom. Métodos: Foram reavaliados 19 pacientes submetidos ao tratamento de escleroterapia com espuma de polidocanol guiada por ultrassom no período de janeiro de 2013 a dezembro de 2014. Foram analisados tempo de cicatrização da úlcera, melhora de sintomas clínicos, recanalização das veias tratadas, recidiva dos sintomas e da úlcera venosa. Resultados: Foram analisados 15 pacientes do sexo feminino (78,9%) e quatro do sexo masculino (21,1%). A média geral de idade foi de 53 anos. O tempo de seguimento dos pacientes variou de 448 dias a 1.276 dias (média de 791 dias). O tempo médio de presença das úlceras foi de 53 meses. Na avaliação pós-procedimento, foram observadas recanalização total em 15,7%, recanalização parcial em 21% e oclusão em 47,3% das veias tratadas. Apenas em um caso foi observada recidiva da úlcera. Pela avaliação das médias do Venous Clinical Severity Score (VCSS), houve diferença significativa antes e após o procedimento, com variação entre os grupos de 11,2 (p < 0,01). Conclusões: A escleroterapia por espuma guiada por ultrassom apresenta altas taxas de sucesso terapêutico, com índices de cicatrização de úlceras venosas elevados

Background: Ultrasound-guided polidocanol foam sclerotherapy is used to treat patients with venous ulcers. It is a minimally invasive procedure and is simple to perform, but it has high relapse rates. Objectives: To report short to medium term results in patients with venous ulcers treated using ultrasound-guided polidocanol foam sclerotherapy. Methods: A sample of 19 patients who had been treated with ultrasound-guided polidocanol foam sclerotherapy between January 2013 and December 2014 were followed-up. Time taken for ulcers to heal, improvement of clinical symptoms, recanalization of treated veins, and relapse of symptoms and of venous ulcers were analyzed. Results: Fifteen of the patients analyzed were female (78.9%) and four were male (21.1%). Overall mean age was 53 years. Follow-up times ranged from 448 days to 1,276 days (mean of 791 days). The mean duration of active ulcers was 53 months. At postoperative follow-up assessments, total recanalization was observed in 15.7%, partial recanalization in 21%, and occlusion in 47.3% of the veins that had been treated. There was only one case of ulcer relapse. Analysis of mean Venous Clinical Severity Scores (VCSS) revealed a significant difference from before to after the procedure, with a variation of 11.2 (p < 0.01). Conclusions: Ultrasound-guided foam sclerotherapy has high rates of therapeutic success and achieves high rates of venous ulcer healing