Nurses' Role in the Control and Treatment of Asthma in Adults: A Systematic Literature Review.

Bronchial asthma is a chronic pathology and a global public health problem. However, asthma can be controlled and treated for the most part by patients, so the Portuguese General Directorate of Health recommends shared medical appointments in primary health care (PHC). The present study aims to identify the role of PHC nurses in the control and treatment of asthma in adults. Using the MeSH platform, the following descriptors were validated: asthma, nurses, adults. An individual search was carried out in the following databases: CINAHL (ESBSCO host), MEDLINE (Pubmed host), Web of Science, and Scopus. Out of a total of 280 publications, 79 of which were duplicates and 185 publications which did not meet the inclusion criteria, 16 publications remained readable. Of the eligible articles, there were 13 specialist reports, one mixed study, one quasi-experimental study, and one randomized trial. Education was the intervention most identified in the scientific evidence analyzed, and patient assessment, application of an asthma control questionnaire, verification and training of inhalation technique, empowerment for self-management of the disease, support, promotion of seasonal influenza vaccination, and use of written action plans were also identified. The results reveal that, although the scientific evidence on the intervention of these professionals is poorly developed, nurses play a crucial role in the control and treatment of asthma. The scientific evidence analyzed allowed the identification of interventions that can help the organization of a nursing health appointment, providing nurses with a crucial role in the control and treatment of asthma in adults in the context of PHC.

Comparison of diuretics and fluid expansion in the initial treatment of patients with normotensive acute pulmonary embolism: a systematic review and meta-analysis.

BACKGROUND: Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines considering only RTCs. The authors searched the traditional and grey literature through 1 November 2022. Meta-analysis used open source packages in R. Inverse variance fixed-effects models with OR as the effect measure were used for primary analyses. The main outcomes defined in this review protocol included pulmonary arterial systolic pressure (PASP), creatinine value changes and N-terminal pro-B-type natriuretic peptide during the first 24 hours. RESULTS: Four studies with a total of 452 patients met the inclusion criteria. The baseline characteristics of patients were similar across all studies. Overall, patients receiving diuretics had a significant 24 hours reduction in pro-B-type natriuretic peptide (standard mean difference of -41.97; 95% CI -65.79 to -18.15), and PASP (standard mean difference of -5.96; 95% CI -8.06 to -3.86). This group had significantly higher creatinine levels (standard mean difference of 7.74; 95% CI 5.04 to 10.45). The quality of the studies was heterogeneous; two had a low risk of bias, and the other two had a high risk of bias. CONCLUSIONS: Very few studies have compared the efficacy and safety of diuretics and fluid expansion in normotensive patients with acute PE with RV failure. Overall, furosemide appears to reduce RV dysfunction in this subset of patients compared with fluid expansion. Further research is required to confirm these findings.

Relatório de Estágio: Desenvolvimento de competências especializadas em enfermagem de saúde comunitária e de saúde pública / Internship Report: Development of specialized skills in community health and public health nursing

Enquadramento: O presente relatório é o colminar formal da conclusão do Mestrado em Enfermagem Comunitária: Área de Enfermagem de Saúde Comunitária e de Saúde Pública e contempla duas partes principais: a reflexiva e a de investigação. Deste modo, confronta as oportunidades vivencia evidência científica recente, demonstrando o percurso formativo de construção de um enfermeiro especialista e reflexão contínua como processo dinâmico e imprescindível à tomada de decisão. Por sua vez, em contexto de e nas lesões musculoesqueléticas relacionadas com de Saúde Primários. Objetivos: Determinar os dados sociodemográficos, clínicos e determinantes da saúde Enfermeiros do ACES Médio Tejo; quanto ao impacto da Pandemia por COVID incidência de LMERT e desenvolver um projeto de intervenção de acordo com os resultados obtidos. Metodologia: Visando responder à questão de investigação " de Intervenção Comunitária para promover a melhoria da saúde dos enfermeiros do ACES Médio Tejo, em contexto pandémico por COVID Planeamento em Saúde, tendo por base o Modelo dos aplicados questionários via GoogleForms dados foram tratados com recurso ao programa SPSS e a sua análise baseou estatística descritiva. Resultados: A maioria da amostra sintomatologia associada a lesões musculoesqueléticas em pelo menos um local d nos últimos 12 meses, sendo que n COVID-19 e a prevalência deste tipo de lesões. Conclusão: Com base nos resultados obtidos é planeado um projeto "LMERT/OUT". Sugere-se a sua implementação e avaliação, quanto em ganhos em saúde.

Background: This report is the formal culmination of the completion of the Master's Degree in Community Nursing: Area of Community Health and Public Health Nursing and includes two main parts: reflective and investigative. In this way, you confront the opportunities you experience recent scientific evidence, demonstrating the training path of building a specialist nurse and continuous reflection as a dynamic and essential process for decision-making. In turn, in the context of and in primary health-related musculoskeletal injuries. Objectives: Determine sociodemographic, clinical and health determinant data Nurses from ACES Médio Tejo; regarding the impact of the COVID Pandemic on the incidence of LMERT and developing an intervention project according to the results obtained. Methodology: Aiming to answer the research question " of Community Intervention to promote the improvement of the health of nurses at ACES Médio Tejo, in a COVID pandemic context Health Planning, based on the Health Care Model questionnaires were administered via GoogleForms, data were processed using the SPSS program and their analysis was based on descriptive statistics. Results: The majority of the sample had symptoms associated with musculoskeletal injuries in at least one location in the last 12 months, with COVID-19 being the prevalence of this type of injury. Conclusion: Based on the results obtained, a project is planned "LMERT/OUT". Its implementation and evaluation is suggested, in terms of health gains.

Exercício físico na prevenção de quedas do idoso da comunidade: revisão baseada na evidência / Physical exercise for preventing falls in elder people living in the community / Ejercicio físico en la prevención de caídas del anciano de la comunidad: revisión basada en la evidencia

Introdução: A prevenção de quedas do idoso é um urgente desafio de saúde pública. O exercício físico tem-se comprovado uma intervenção preventiva eficaz. Objetivo: Rever a evidência científica mais recente, relativa à recomendação do exercício físico na prevenção de quedas do idoso da comunidade. Identificar modalidade física e regimes de frequência com maior benefício. Métodos: Efetuou-se uma pesquisa bibliográfica, utilizando os termos MeSH "aged", "accidental falls/prevention and control" e "exercise", nas bases de dados PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine e NICE Evidence Search, nos últimos 5 anos. Foram incluídos artigos que avaliassem o exercício como intervenção isolada na prevenção de quedas do indivíduo da comunidade, com ≥60 anos. Resultado avaliado: incidência de quedas. Resultados: De 637 potenciais artigos, 4 cumpriam critérios de inclusão: 2 ensaios clínicos aleatorizados controlados (ECACs), 1 estudo coorte e 1 meta-análise (MA). Globalmente, os resultados demonstram um efeito protetor do exercício físico. A MA obteve uma razão de taxas de incidência (RTI) de 0,79 (p<0,001), com o treino de equilíbrio (RTI=0,85, p=0,04) e maior dose semanal (RTI=0,77, p=0,03) a demonstrarem-se mais efetivos. Contrariamente, um ECAC demonstrou superioridade na marcha. O estudo coorte revelou maior benefício em participações ≥3 anos (RTI=0,90; p=0,03). Conclusão: O exercício físico é efetivo na prevenção de quedas do idoso da comunidade. Treinos de equilíbrio e práticas semanais ≥3 horas demonstraram melhores resultados (SORT A). A sua manutenção deve ser incentivada a longo prazo (SORT B).

Introduction: The prevention of falls among elder people is an urgent public health challenge. Physical exercise has proven an effective preventive intervention. Objective: Review the latest scientific evidence, concerning the recommendation of physical exercise in the prevention of falls of the elderly of the community. Identify the optimal type and frequency of exercise with better benefits. Methods: A bibliographic search was carried out using the terms MeSH "aged", "accidental falls/prevention and control" and "exercise", in PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine e NICE Evidence Search databases, in the last five years. We included articles evaluating the exercise as an isolated intervention in the prevention of falls of the individual of the community, with ≥60 years. Rated result: incidence of falls. Results: Of 637 potential articles, 4 fulfilled inclusion criteria: 2 randomized controlled trials (RCT), 1 cohort study and 1 meta- analysis (MA). Overall, the results demonstrate a protective effect of exercise. The MA obtained a ratio of incidence rates (IR) was 0.79 (p<0.001), with the training of balance (IR=0.85, p=0.04) and greater weekly dose (IR=0.77, p=0.03) has demonstrated more effective. Contrarily, one RCT suggested that hike can be more effective. The cohort study revealed greater benefit in ≥3 years participations (IR=0.90; p=0.03). Conclusion: Physical exercise is effective in preventing falls in the community elder. Balancing training and weekly ≥3 hours practices showed better results (SORT A). Its maintenance must be encouraged in the long term (SORT B).

Introducción: La prevención de caídas del anciano es un urgente desafío de salud pública. El ejercicio físico se ha comprobado una intervención preventiva eficaz. Objetivo: Revisar la evidencia científica más reciente, relativa a la recomendación del ejercicio físico en la prevención de caídas del anciano de la comunidad. Identificar modalidad física y regímenes de frecuencia con mayor beneficio. Métodos: Se realizó una investigación bibliográfica, utilizando los términos MeSH "aged", "accidental falls/prevention and control" y "exercise", en las bases de datos PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine y NICE Evidence Search, en los últimos 5 años. Se incluyeron artículos que evaluasen el ejercicio como intervención aislada en la prevención de caídas del individuo de la comunidad, con ≥60 años. Resultado evaluado: incidencia de caídas. Resultados: De 637 potenciales artículos, 4 cumplían criterios de inclusión: 2 ensayos clínicos aleatorizados controlados (ECACs), 1 estudio cohorte y 1 meta-análisis (MA). Globalmente, los resultados demuestran un efecto protector del ejercicio físico. La MA obtuvo una proporción de tasas de incidencia (RTI) de 0,79 (p<0,001), con el entrenamiento de equilibrio (RTI=0,85, p=0,04) y la mayor dosis semanal (RTI=0,77, p=0,03) se demostraron más efectivos. Contrariamente, un ECAC demostró superioridad en la marcha. El estudio cohorte reveló un mayor beneficio en participaciones ≥3 años (RTI=0,90, p=0,03). Conclusión: El ejercicio físico es efectivo en la prevención de caídas del anciano de la comunidad. Los entrenamientos de equilibrio y las prácticas semanales ≥3 horas demostraron mejores resultados (SORT A). Su mantenimiento debe ser incentivado a largo plazo (SORT B).

Sequence determinants for DNA packaging specificity in the S. aureus pathogenicity island SaPI1.

The SaPIs and their relatives are a family of genomic islands that exploit helper phages for high frequency horizontal transfer. One of the mechanisms used by SaPIs to accomplish this molecular piracy is the redirection of the helper phage DNA packaging machinery. SaPIs encode a small terminase subunit that can be substituted for that of the phage. In this study we have determined the initial packaging cleavage sites for helper phage 80α, which uses the phage-encoded small terminase subunit, and for SaPI1, which uses the SaPI-encoded small terminase subunit. We have identified a 19nt SaPI1 sequence that is necessary and sufficient to allow high frequency 80α transduction of a plasmid by a terminase carrying the SaPI1-encoded small subunit. We also show that the hybrid enzyme with the SaPI1 small terminase subunit is capable of generalized transduction.

Farnesol induces cell detachment from established S. epidermidis biofilms.

Antibiotic resistance is a serious problem in Staphylococcus epidermidis infections as many clinical isolates of this organism are resistant to up to eight different antibiotics. The increased resistance to conventional antibiotic therapy has lead to the search for new antimicrobial therapeutic agents. Farnesol, an essential oil found in many plants, has been shown to be active against S. epidermidis. Using a type control strain we recently described that although farnesol was not efficient at killing biofilm bacteria, a strong reduction on biofilm biomass was detected, and we hypothesize that farnesol could, somehow, induce biofilm detachment. In this report, to test our hypothesis we used 36 representative clinical strains of S. epidermidis from different geographic locations and characterized them in terms of genetic variability by multilocus sequence typing and staphylococcal chromosome cassette mec. Strains were tested for biofilm formation, and the presence of ica, bhp and aap genes was determined. Stronger biofilms had always the presence of ica operon but often co-harbored bhp and aap genes. Farnesol was then used in biofilm-forming strains, and biofilm detachment was detected in half of the strains tested. Furthermore, we also showed that farnesol inability to kill biofilm bacteria was not the result of the biofilm structure but was related to high cell density. Our results demonstrate, for the first time, that the biomass reduction previously found by us, and many other groups, is the result not of cell killing but instead is the result of biofilm detachment.

Variability of RNA quality extracted from biofilms of foodborne pathogens using different kits impacts mRNA quantification by qPCR.

The biofilm formation by foodborne pathogens is known to increase the problem related with surface disinfection procedure in the food processing environment and consequent transmission of these pathogens into the population. Messenger RNA has been increasingly used to understand the action and the consequences of disinfectants in the virulence on such biofilms. RNA quality is an important requirement for any RNA-based analysis since the quality can impair the mRNA quantification. Therefore, we evaluated five different RNA extraction kits using biofilms of the foodborne pathogens Listeria monocytogenes, Escherichia coli, and Salmonella enterica. The five kits yielded RNA with different quantities and qualities. While for E. coli the variability of RNA quality did not affect the quantification of mRNA, the same was not true for L. monocytogenes or S. enterica. Therefore, our results indicate that not all kits are suitable for RNA extraction from bacterial biofilms, and thus, the selection of RNA extraction kit is crucial to obtain accurate and meaningful mRNA quantification.

Monte Carlo simulation of the movement and detection efficiency of a whole-body counting system using a BOMAB phantom.

This study reports on the computational analysis and experimental calibration of the whole-body counting detection equipment at the Nuclear and Technological Institute (ITN) in Portugal. Two state-of-the-art Monte Carlo simulation programmes were used for this purpose: PENELOPE and MCNPX. This computational work was undertaken as part of a new set of experimental calibrations, which improved the quality standards of this study's WBC system. In these calibrations, a BOMAB phantom, one of the industry standards phantoms for WBC calibrations in internal dosimetry applications, was used. Both the BOMAB phantom and the detection system were accurately implemented in the Monte Carlo codes. The whole-body counter at ITN possesses a moving detector system, which poses a challenge for Monte Carlo simulations, as most codes only accept static configurations. The continuous detector movement was approximately described in the simulations by averaging several discrete positions of the detector throughout the movement. The computational efficiency values obtained with the two Monte Carlos codes have deviations of less than 3.2 %, and the obtained deviations between experimental and computational efficiencies are less than 5 %. This work contributes to demonstrate the great effectiveness of using computational tools for understanding the calibration of radiation detection systems used for in vivo monitoring.

[Granzymes A and B in pulmonary sarcoidosis (experimental study)].

Sarcoidosis is a systemic disease of unknown aetiology, morphologically characterized by well-formed epithelioid granulomas, which show little or no central necrosis. These may be present in any organ or tissue. The lung is the most frequently and prominently involved target. The granuloma is often very sharply demarcated from the adjacent tissue and is surrounded by a mantle of lymphocytes, which mediate lysis of target cells by various mechanisms, including exocytosis of lytic proteins, perforins and granzymes. Sarcoidosis laboratorial diagnosis is usually made by SACE and Lisozyme dosages. The granzymes A and B could be two other markers of the disease, since the sarcoidosis granuloma is rich in cytotoxic and NK cells. An ELISA Kit was used to measure Granzyme A and B in serum of a normal control group (NC) (n=30), and in two groups with lung pathology: one without sarcoidosis, disease control (DC) (n=21) and other with sarcoidosis (S) (n=11). Our results showed that SACE activity is significantly augmented in S group comparing with NC and DC, respectively: 82,6+/-32,7/31,9+/-17,8 - p=0,00017 and 82,6+/-32,7/31,9+/-17,8 - p=0,00024. Lisozyme activity is significantly augmented in S and DC groups comparing with NC. Granzyme B showed a significant decrease in DC and S groups comparing with NC. Granzyme A showed a significant decrease between S/NC groups. Our results suggest that the decrease of Granzyme A and B in sarcoidotic patients could be related to an ineffective inflammatory local response related to the formation of sarcoidosis granulomas. More studies are needed, particularly in BAL.