The impact of patient and public involvement in chronic respiratory disease research: the ConectAR experience.

ConectAR has demonstrated the feasibility and value of involving patients with chronic respiratory diseases and caregivers as co-researchers, actively considering their perspectives from project inception to implementation and dissemination https://bit.ly/3Oq13se.

Association Between Follicle-Stimulating Hormone Receptor (FSHR) rs6166 and Estrogen Receptor 1 (ESR1) rs2234693 Polymorphisms and Polycystic Ovary Syndrome Risk, Phenotype, and Reproductive Outcomes in an Infertile Portuguese Population.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common endocrine disorder often leading to anovulatory infertility. PCOS pathophysiology is still unclear and several potential genetic susceptibility factors have been proposed. The effect of polymorphisms in two genesrelated to follicular recruitment and development, the follicle-stimulating hormone receptor (FSHR) and the estrogen receptor 1 (ESR1), have been studied in different populations with contradictory results. AIMS: To evaluate the influence of FSHR rs6166 (c.2039A>G) and of ESR1 rs2234693 (Pvull c.453-397 T > C) polymorphisms on PCOS risk, phenotype, and response to controlled ovarian stimulation (COS). MATERIALS AND METHODS: Genotyping of the FSHR rs6166 and the ESR1 rs2234693 polymorphisms was performed in PCOS women and a control group undergoing in vitro fertilization (IVF). Demographic, clinical, and biochemical data, genotype frequency, and IVF outcomes were compared between groups. RESULTS: We evaluated 88 PCOS women and 80 controls. There was no significant difference in the genotype distribution of FSHR rs6166 polymorphism between PCOS women and controls (AA 31.8%/AS 48.9%/SS 19.3% in PCOS women vs AA 37.5%/AS 40.0%/SS 22.5% in controls; p = 0.522). The same was true for the ESR1 rs2234693 (CC 24.1%/CT 46.0%/TT 29.9% in PCOS women vs CC 18.8%/CT 48.8%/TT 32.5% in controls; p = 0.697). In PCOS women, we found higher follicle-stimulating hormone (FSH) levels on the third day of the menstrual cycle associated with the SS variant of the FSHR polymorphism (9.2 vs 6.2 ± 1.6 and 5.6 ± 1.6 mUI/mL; p = 0.011). We did not find other associations between the baseline hormonal parameters, antral follicle count, and response measures to COS with FSHR or ESR1 genotypes. We found, however, a need for higher cumulative doses of FSH for COS in patients with the SS variant of the FSHR rs6166 polymorphism (1860.5 ± 627.8 IU for SSvs 1498.1 ± 359.3 for AA and 1425.4 ± 474.8 for SA; p = 0.046 and p = 0.046). CONCLUSION: Our data suggest that in the population, FSHR rs6166and ESR1 rs2234693 polymorphisms do not influence the risk of developing PCOS nor do they influence the patient's phenotype and IVF success. However, the SS variant of the FSHR rs6166 polymorphism may be associated with FSH resistance requiring higher FSH doses for COS.

Job satisfaction and dissatisfaction among family health strategy professionals in a small city of Southern Brazil / Aspectos geradores de satisfação e insatisfação dos profissionais da estratégia saúde da família de um município de pequeno porte da região sul do Brasil

ABSTRACT Objective: to identify aspects that generate satisfaction and dissatisfaction among Family Health Strategy professionals working in the city of Cocal do Sul, SC. Methods: a qualitative study, conducted with 15 health professionals of three Family Health Strategy agencies. Data analysis was performed based on content analysis, supported by Atlas.ti software. Results: the results were structured from two macro categories, composed of five subcategories, which added 194 excerpts from 23 codes. The aspects related to satisfaction of the Family Health Strategy professionals were grouped into three subcategories, namely: satisfaction in the identification with the staff and work; satisfaction based on relationships with patients; and, structural work conditions and satisfaction. Within health professional dissatisfaction, two subcategories were created: dissatisfaction related to aspects of health management and the relationship between staff and patients, as promoters of dissatisfaction. Conclusion: the factors contributing to satisfaction and dissatisfaction are associated with working conditions and the work relationships established in professional practice.

RESUMO Objetivo: identificar os aspectos geradores de satisfação e insatisfação nos profissionais que atuam na Estratégia Saúde da Família do município de Cocal do Sul-SC. Métodos: trata-se de um estudo com abordagem qualitativa, realizado com três Estratégia Saúde da Família totalizando 15 profissionais de saúde. A análise de dados foi realizada com base na análise de conteúdo, tendo como suporte o software Atlas.ti. Resultados: os resultados foram estruturados a partir de 2 macro categorias, compostas por 5 subcategorias, as quais agregaram 194 trechos de falas, proveniente de um total 23 códigos. Os aspectos relacionados à satisfação dos profissionais da Estratégia Saúde da Família foram agrupados em três subcategorias, a saber: satisfação na identificação com a equipe e trabalho; satisfação pautada nas relações com os usuários; e, condições de trabalho e a satisfação. A insatisfação dos profissionais de saúde, foram criadas duas subcategorias: a insatisfação relacionada aos aspectos de gestão em saúde; e, a relação entre equipe e usuário como promotores de insatisfação. Conclusão: o estudo concluiu que os fatores que contribuem para satisfação e insatisfação estão vinculados as condições de trabalho e as relações que se estabelecem no exercício da prática profissional.

Ports minimization with mini-port and liver flexible retractor: an ergonomic and aesthetic alternative for single port in laparoscopic gastric bypass.

BACKGROUND: The laparoscopic access, with its classically known benefits, pushed implementation in other components, better ergonomy and aesthetic aspect. AIM: To minimize the number and diameter of traditional portals using miniport and flexible liver retractor on bariatric surgery. METHOD: This prospective study was used in patients with less than 45 kg/m2, with peripheral fat, normal umbilicus implantation, without previous abdominoplasties. Were used one 30° optical device with 5 mm in diameter, four accesses (one mini of 3 mm to the left hand of the surgeon, one of 5 mm to the right hand alternating with optics, one of 12 mm for umbilical for surgical maneuvers as dissection, clipping, in/out of gauze, and one portal of 5 mm for the assistant surgeon), resulting in a total of 25 mm linear incision; additionally, one flexible liver retractor (covered with a nelaton probe to protect the liver parenchyma, anchored in the right diaphragmatic pillar and going out through the surgeon left portal) to visualize the esophagogastric angle. RESULTS: In selected patients (48 operations), gastric bypass was performed at a similar time to the procedures with larger diameters (5 or 6 portals and 10 mm optics, with sum of linear incision of 42 mm) including oversuture line on excluded stomach, gastric tube and mesenteric closing. The non sutured portal of 3 mm and the two of 5 mm with subdermal sutures, were hardly visible in the folds of the skin; the one of 12 mm was buried inside the umbilicus or in the abdominoplasty incision. CONCLUSION: Minimizing portals is safe, effective, good ergonomic alternative with satisfactory aesthetic profile without need for specific instruments, new learning curve and limited movement of the instruments, as required by the single port.

Ports minimization with mini-port and liver flexible retractor: an ergonomic and aesthetic alternative for single port in laparoscopic gastric bypass / Minimização de portais com miniportes e afastador flexível de fígado: alternativa ergonômica e estética ao single port em bypass gástrico laparoscópico

BACKGROUND: The laparoscopic access, with its classically known benefits, pushed implementation in other components, better ergonomy and aesthetic aspect. AIM: To minimize the number and diameter of traditional portals using miniport and flexible liver retractor on bariatric surgery. METHOD: This prospective study was used in patients with less than 45 kg/m2, with peripheral fat, normal umbilicus implantation, without previous abdominoplasties. Were used one 30o optical device with 5 mm in diameter, four accesses (one mini of 3 mm to the left hand of the surgeon, one of 5 mm to the right hand alternating with optics, one of 12 mm for umbilical for surgical maneuvers as dissection, clipping, in/out of gauze, and one portal of 5 mm for the assistant surgeon), resulting in a total of 25 mm linear incision; additionally, one flexible liver retractor (covered with a nelaton probe to protect the liver parenchyma, anchored in the right diaphragmatic pillar and going out through the surgeon left portal) to visualize the esophagogastric angle. RESULTS: In selected patients (48 operations), gastric bypass was performed at a similar time to the procedures with larger diameters (5 or 6 portals and 10 mm optics, with sum of linear incision of 42 mm) including oversuture line on excluded stomach, gastric tube and mesenteric closing. The non sutured portal of 3 mm and the two of 5 mm with subdermal sutures, were hardly visible in the folds of the skin; the one of 12 mm was buried inside the umbilicus or in the abdominoplasty incision. CONCLUSION: Minimizing portals is safe, effective, good ergonomic alternative with satisfactory aesthetic profile without need for specific instruments, new learning curve and limited movement of the instruments, as required by the single port. .

RACIONAL: A via de acesso laparoscópica com os seus benefícios classicamente conhecidos impulsionou a busca de outros componentes, de ordem estética e ergonômica. OBJETIVO: Minimizar o número e o diâmetro dos portais tradicionais utilizando miniporte e afastador flexível de fígado. MÉTODO: Estudo prospectivo, destinado a pacientes com IMC menor que 45 kg/m2, perfil de gordura periférica, implantação normal do umbigo, com ou sem abdominoplastia. Foram utilizados ótica de 30 graus de 5 mm de diâmetro, quatro portais (um mini portal de 3 mm para a mão esquerda do cirurgião, um de 5 mm para a mão direita alternando com a ótica, um de 12 mm no umbigo para grampeamento, clipagem, entrada e saída de gaze, um portal de 5 mm para o cirurgião auxiliar), com somatória linear de 25 mm de incisão, um afastador flexível de fígado (fio de seda zero enluvado em 7 cm de sonda de nelaton para proteger o parênquima hepático pelo fio, ancorado no pilar diafragmático direito e saindo pelo portal esquerdo do cirurgião) para visibilizar o ângulo esofagogástrico. RESULTADO: Nos pacientes selecionados (48 operações), o bypass gástrico foi realizado em tempo assemelhado aos de paciente com IMC elevado com portais de diâmetros maiores (5 ou 6 portais e ótica de 10 mm, com somatória linear de 42 mm de incisão), inclusive realizando sobressutura das linhas de grampo do estômago excluso, do tubo gástrico e fechamento das brechas mesentéricas. O portal de 3 mm não suturado e os dois de 5 mm com sutura subdérmica ficaram quase imperceptíveis na dobra da pele; o de 12 mm foi sepultado dentro do umbigo ou na incisão da abdominoplastia. CONCLUSÃO: A minimização de portais é alternativa segura, eficaz, ergonômica, ...

Detection of HIV and HCV RNA in semen from Brazilian coinfected men using multiplex PCR before and after semen washing.

INTRODUCTION: Prolonged survival of patients under HAART has resulted in new demands for assisted reproductive technologies. HIV serodiscordant couples wish to make use of assisted reproduction techniques in order to avoid viral transmission to the partner or to the newborn. It is therefore essential to test the effectiveness of techniques aimed at reducing HIV and HCV loads in infected semen using molecular biology tests. METHODS: After seminal analysis, semen samples from 20 coinfected patients were submitted to cell fractioning and isolation of motile spermatozoa by density gradient centrifugation and swim-up. HIV and HCV RNA detection tests were performed with RNA obtained from sperm, seminal plasma and total semen. RESULTS: In pre-washing semen, HIV RNA was detected in 100% of total semen samples, whereas HCV RNA was concomitantly amplified in only one specimen. Neither HIV nor HCV were detected either in the swim-up or in the post-washing semen fractions. CONCLUSIONS: Reduction of HIV and/or HCV shedding in semen by density gradient centrifugation followed by swim-up is an efficient method. These findings lead us to believe that, although semen is rarely found to contain HCV, semen processing is highly beneficial for HIV/HCV coinfected individuals.

Detection of HIV and HCV RNA in semen from Brazilian coinfected men using multiplex PCR before and after semen washing / Detecção do RNA do HIV e HCV em sêmen de homens brasileiros, usando PCR multiplex antes e depois do "semen washing"

INTRODUCTION: Prolonged survival of patients under HAART has resulted in new demands for assisted reproductive technologies. HIV serodiscordant couples wish to make use of assisted reproduction techniques in order to avoid viral transmission to the partner or to the newborn. It is therefore essential to test the effectiveness of techniques aimed at reducing HIV and HCV loads in infected semen using molecular biology tests. METHODS: After seminal analysis, semen samples from 20 coinfected patients were submitted to cell fractioning and isolation of motile spermatozoa by density gradient centrifugation and swim-up. HIV and HCV RNA detection tests were performed with RNA obtained from sperm, seminal plasma and total semen. RESULTS: In pre-washing semen, HIV RNA was detected in 100 percent of total semen samples, whereas HCV RNA was concomitantly amplified in only one specimen. Neither HIV nor HCV were detected either in the swim-up or in the post-washing semen fractions. CONCLUSIONS: Reduction of HIV and/or HCV shedding in semen by density gradient centrifugation followed by swim-up is an efficient method. These findings lead us to believe that, although semen is rarely found to contain HCV, semen processing is highly beneficial for HIV/HCV coinfected individuals.

O aumento da sobrevida dos pacientes que utilizam terapêutica antiretroviral altamente eficaz (HAART- Highly Active Antiretroviral Therapy) trouxe uma nova demanda de casais sorodiscordantes que desejam filhos. Como esses casais não podem abandonar o uso de preservativos, torna-se indispensável tratar o sêmen infectado com técnicas laboratoriais eficazes que além de isolar os melhores espermatozóides, reduzam a carga viral do HIV e HCV a níveis indetectáveis. Para isso, são utilizadas técnicas de semen washing, associadas a testes ultra sensíveis de biologia molecular. Após análise seminal, sêmen de 20 pacientes co-infectados HIV-HCV foram submetidos a fracionamento celular e isolamento de espermatozóides móveis através de método de densidade de gradiente descontínuo e swim-up. Posteriormente, testes para detecção do RNA do HIV e HCV foram aplicados nos sêmens totais e frações seminais obtidas. Em fase pré semen washing, o HIV foi detectado em 100 por cento dos semens totais. Contrariamente, o HCV foi detectado em apenas uma amostra. Em fase pós semen washing, o HIV e HCV não foram detectados em nenhuma das frações seminais. A redução do HIV e do HCV através de semen washing mostra-se um método eficaz a indivíduos co-infectados HIV-HCV, apesar do encontro do HCV no sêmen ser raro.

Analysis of HIV- type 1 protease and reverse transcriptase in Brazilian children failing highly active antiretroviral therapy (HAART).

The aim of this study was to evaluate the genotypic resistance profiles of HIV-1 in children failing highly active antiretroviral therapy (HAART). Forty-one children (median age = 67 months) receiving HAART were submitted to genotypic testing when virological failure was detected. cDNA was extracted from PBMCs and amplified by nested PCR for the reverse transcriptase and protease regions of the pol gene. Drug resistance genotypes were determined from DNA sequencing. According to the genotypic analysis, 12/36 (33.3%) and 6/36 (16.6%) children showed resistance and possible resistance, respectively, to ZDV; 5/36 (14%) and 4/36 (11.1%), respectively, showed resistance and possible resistance to ddI; 4/36 (11.1%) showed resistance to 3TC and D4T; and 3/36 (8.3%) showed resistance to Abacavir. A high percentage (54%) of children exhibited mutations conferring resistance to NNRTI class drugs. Respective rates of resistance and possible resistance to PIs were: RTV (12.2%, 7.3%); APV (2.4%, 12.1%); SQV(0%, 12.1%); IDV (14.6%, 4.9%), NFV (22%, 4.9%), LPV/RTV (2.4%, 12.1%). Overall, 37/41 (90%) children exhibited virus with mutations related to drug resistance, while 9% exhibited resistance to all three antiretroviral drug classes.

Analysis of HIV- type 1 protease and reverse transcriptase in Brazilian children failing highly active antiretroviral therapy (HAART)

O objetivo deste estudo foi avaliar o perfil de resistência genotípica do HIV-1 em crianças com falha terapêutica ao tratamento anti-retroviral (HAART). Quarenta e uma crianças (idade mediana = 67 meses) em uso de HAART foram submetidas ao teste de genotipagem no momento da detecção de falha ao tratamento. Foi realizada extração de cDNA de células periféricas mononucleares e amplificação do mesmo (regiões da transcriptase reversa e protease do gene pol) através de PCR-nested. O perfil genotípico foi determinado através do seqüenciamnto de nucleotídeos. De acordo com a análise genotípica, 12/36 (33,3%) e 6/36 (16,6%) crianças apresentaram, respectivamente, resistência e possível resistência ao AZT; 5/36 (14%) e 4/36 (11,1%), respectivamente, eram resistentes e possivelmente resistentes ao ddI; 4/36 %11,1%) apresentaram resistência ao 3TC e D4T, e 3/36 (8,3%) eram resistentes ao ABC. Uma alta porcentagem de crianças (54%) apresentou mutações relacionadas à resistência aos inibidores da trancriptase reversa não-análogos de nucleosídeos. As taxas de resistência e possível resistência aos inibidores da protease foram, respectivamente: RTV (12,2%; 7,3%); APV (2,4%; 12,1%); SQV (0%; 12,1%); IDV (14,6%; 4,9%); NFV (22%; 4,9%); LPV/RTV (2,4%; 12,1%). No total, 37/41 (90%) crianças apresentaram vírus com mutações relacionadas à resistência a alguma droga, sendo que 9% delas tinham vírus resistentes às três classes de drogas anti-retrovirais disponíveis.

Identification of Pseudomonas aeruginosa, Burkholderia cepacia complex, and Stenotrophomonas maltophilia in respiratory samples from cystic fibrosis patients using multiplex PCR.

A multiplex PCR method was developed to identify P. aeruginosa, B. cepacia complex, and S. maltophilia directly in sputum and oropharyngeal samples from CF patients. One hundred and six patients (53 male, and 53 female) attending our pulmonology clinic were studied from September 2000-April 2001. Two hundred and fifty-seven samples were cultured in selective media and submitted to multiplex PCR reactions, using three primer pairs targeting specific genomic sequences of each species, with an additional primer pair targeting a stretch of ribosomal 16S DNA, universal for bacteria, to act as a control. P. aeruginosa was isolated by culture in 56% of samples, B. cepacia complex in 4.3%, and S. maltophilia in 2.7%, while multiplex PCR identified P. aeruginosa in 78.7%, B. cepacia complex in 3.9%, and S. maltophilia in 3.1% of samples. Multiplex PCR results were verified by PCR reactions using different species-specific primers described in the literature and DNA sequencing of amplicons from a few samples. Comparing to culture results, the sensitivity and specificity values of multiplex PCR for bacterial identification were, respectively, 97.2% and 45.5% for P. aeruginosa, 45.5% and 97.9% for B. cepacia complex, and 40% and 97.6% for S. maltophilia. All 10 multiplex PCR-positive results for B. cepacia complex were confirmed using other species-specific primers described in the literature, while this approach confirmed results for S. maltophilia identification in 7/8 samples (87.5%). Sequencing of amplicons from samples culture-negative but multiplex PCR-positive for P. aeruginosa and B. cepacia complex confirmed their identity, while minor nucleotide differences among amplicons ruled out the hypothesis of PCR contamination.

Use of an immunoglobulin G avidity test to discriminate between primary and secondary dengue virus infections.

An enzyme-linked immunosorbent assay-based immunoglobulin G (IgG) antibody avidity test was evaluated by using sera from 57 patients with acute dengue infection. Overall, 55 of 57 patients were correctly classified (27 of 27 with primary dengue and 28 of 30 with secondary dengue). We conclude that the IgG avidity test can be useful for differentiating between acute, primary, and secondary dengue infections.

Presence of multiple human papillomavirus types in cervical samples from HIV-infected women.

OBJECTIVES: The aim of this study was to detect and identify human papillomavirus (HPV) genotypes on a population of women infected by the human immunodeficiency virus (HIV) and to investigate the role of multiple infections on cervical dysplasia. METHODS: Two hundred and fifty-five HIV-infected women were enrolled on a study to evaluate the prevalence of HPV and cervical intra-epithelial neoplasia (CIN). A group of HIV-negative women with confirmed CIN diagnosis was included for comparison. A polymerase chain reaction (PCR)-reverse hybridization method was applied to detect and precisely identify HPV types, specifically multiple infections. RESULTS: On HIV patients, an altered Pap smear confirmed by biopsy was observed on 45 (18%); HPV-DNA prevalence was 87% (223/255), with 45% (116/255) infected by more than two types. In contrast, HPV-DNA was detected in all 36 women of the control group but only 3 were infected by more than two types. Cervical dysplasia was associated with low CD4 counts and elevated high-risk HPV viral load. However, the presence of multiple HPV types did not correlate with the degree of immune suppression or the presence of cervical lesions. CONCLUSIONS: Infection with multiple HPV types is a rather frequent finding on Brazilian HIV-infected women. On this population, concomitant infection with three or more HPV types does not seem to confer an additional risk of cervical dysplasia in comparison to single/double infections, nor to be related to more severe immunesuppresion.

Dor no doente com AIDS: prevalência e características / Pain in the sick with AIDS: prevalence and characteristics

Este estudo objetivou determinar a prevalência e as características da dor em doentes com AIDS, analisar as relaçöes entre dor e variáveis sócio-demográficas, de características da doença e do tratamento e avaliar o impacto da dor nas atividades de vida diária. A populaçäo foi composta por doentes com AIDS, em acompanhamento no Setor de Internaçäo e Ambulatório de Moléstias Infecciosas do Hospital de Clínicas de Marília, com idade superior a dezoito anos e condiçöes físicas e cognitivas adequadas para participar do estudo. Atenderam aos critérios de inclusäo noventa e quatro doentes. Os dados foram coletados por entrevista individual e análise do prontuário, entre agosto de 1998 e outubro de 1999. Os instrumentos para coleta de dados continham questöes abertas e fechadas. A populaçäo foi predominantemente masculina (68,1 porcento), com idade entre 21 a 40 anos (80,9 porcento), escolaridade superior a 5 anos em 3/4 dos casos, e 51,1 porcento dos avaliados informaram ser solteiros. Observou-se ocorrência de dor na última semana em 44,7 porcento dos doentes. Destes, 73,8 porcento referiram dor nas últimas vinte e quatro horas e cerca de 1/5 disse ter dor no momento da entrevista. A dor foi predominantemente torácica (23,8 porcento), diária (69,0 porcento), constante (47,7 porcento), e a magnitude foi entre moderada a intensa em 73,8 porcento dos doentes. Infecçöes como candidíase (14,3 porcento), tuberculose (14,3 porcento) e herpes zoster (7,2 porcento) foram as mais freqüentes. Da análise das relaçöes entre as variáveis, observou-se associaçäo (p<0,05) entre dor e: tipo de ocupaçäo, tipo de atendimento, número de internaçöes, contagem de células CD4, número de infecçöes e presença de candidíase oral e tuberculose pulmonar. Isto é, queixas álgicas mais freqüentes naqueles que desempenhavam serviços gerais, nos internados, naqueles com maior número de internaçöes, entre os que apresentaram contagem de células CD4 inferior a 100 cél/mm3, nos com maior número de infecçöes, e nos doentes com candidíase oral e tuberculose pulmonar. O impacto da dor nas atividades de vida diária, ...

Falar em público: visäo do mestrando de enfermagem / Public speaking: view from master's students in nursing

A comunicaçäo é um instrumento básico de trabalho dos enfermeiros, no entanto falar em público é uma situaçäo temida por muitos profissionais. Este trabalho teve como objetivos descrever as emoçöes sentidas pelos enfermeiros mestrandos e identificar como planejam a apresentaçäo e o que consideram importante para falar em público. Participaram do estudo cinquenta enfermeiros matriculados no mestrado da EEUSP. A coleta de dados deu-se através de questionário com perguntas abertas. Os resultados mostraram que a ansiedade foi a emoçäo mais frequente citada pelos enfermeiros, no planejamento o domínio do conteúdo foi o aspecto mais relatado e falar com clareza foi a característica mais valorizada para quem fala em público.