Application of CytoPath®Easy Vials in Cervical Cancer Screening: Self-Sampling Approach.

Context: CytoPath®Easy kit (DiaPath S.p.A.) offers a major advantage compared to other commercially available kits available for the screening of cervical cancer, as it does not require additional equipment for sample processing. Using this methodology, collected epithelial cells are immersed in a preservative liquid before setting as a thin layer on a slide via gravity sedimentation. Aims: To evaluate the suitability of the CytoPath®Easy kit for the processing of cervical samples, detection of pre-neoplastic lesions, and nucleic preservation and extraction for HR-HPV diagnosis. Materials and Methods: A total of 242 self-sampled cervical specimens were utilized, with 192 collected in CytoPath®Easy vials and 50 collected and processed using the ThinPrepTM for comparative analysis. The samples underwent processing, Papanicolaou staining, and microscopic evaluation for morphological parameters. The extracted nucleic acids were assessed for purity and integrity, and the detection of high-risk human papillomavirus (HR-HPV) was carried out using the Alinitym HR HPV system kit (Abbott Laboratórios Lda). Results: Both methods demonstrated effective performance, enabling the morphological assessment of the cervical epithelium. Statistical analysis indicated that ThinPrepTM yielded significantly better results in terms of cellularity. Conversely, CytoPath®Easy exhibited superior performance in terms of the quantity of extracted DNA and its degree of purification. Concerning the time consumed during processing, both methods were comparable, with the CytoPath®Easy methodology standing out for its cost-effectiveness, as it does not necessitate additional instruments and consumables. Conclusions: The novel CytoPath®Easy methodology proves effective in preserving both nucleic acids and cell morphology characteristics, two crucial features for cervical cancer screening.

Challenges and Efficacy of Astrocyte-to-Neuron Reprogramming in Spinal Cord Injury: In Vitro Insights and In Vivo Outcomes.

Traumatic spinal cord injury (SCI) leads to the disruption of neural pathways, causing loss of neural cells, with subsequent reactive gliosis and tissue scarring that limit endogenous repair. One potential therapeutic strategy to address this is to target reactive scar-forming astrocytes with direct cellular reprogramming to convert them into neurons, by overexpression of neurogenic transcription factors. Here we used lentiviral constructs to overexpress Ascl1 or a combination of microRNAs (miRs) miR124, miR9/9*and NeuroD1 transfected into cultured and in vivo astrocytes. In vitro experiments revealed cortically-derived astrocytes display a higher efficiency (70%) of reprogramming to neurons than spinal cord-derived astrocytes. In a rat cervical SCI model, the same strategy induced only limited reprogramming of astrocytes. Delivery of reprogramming factors did not significantly affect patterns of breathing under baseline and hypoxic conditions, but significant differences in average diaphragm amplitude were seen in the reprogrammed groups during eupneic breathing, hypoxic, and hypercapnic challenges. These results show that while cellular reprogramming can be readily achieved in carefully controlled in vitro conditions, achieving a similar degree of successful reprogramming in vivo is challenging and may require additional steps.

Betulinic Acid for Glioblastoma Treatment: Reality, Challenges and Perspectives.

Betulinic acid is a naturally occurring compound that can be obtained through methanolic or ethanolic extraction from plant sources, as well as through chemical synthesis or microbial biotransformation. Betulinic acid has been investigated for its potential therapeutic properties, and exhibits anti-inflammatory, antiviral, antimalarial, and antioxidant activities. Notably, its ability to cross the blood-brain barrier addresses a significant challenge in treating neurological pathologies. This review aims to compile information about the impact of betulinic acid as an antitumor agent, particularly in the context of glioblastoma. Importantly, betulinic acid demonstrates selective antitumor activity against glioblastoma cells by inhibiting proliferation and inducing apoptosis, consistent with observations in other cancer types. Compelling evidence published highlights the acid's therapeutic action in suppressing the Akt/NFκB-p65 signaling cascade and enhancing the cytotoxic effects of the chemotherapeutic agent temozolomide. Interesting findings with betulinic acid also suggest a focus on researching the reduction of glioblastoma's invasiveness and aggressiveness profile. This involves modulation of extracellular matrix components, remodeling of the cytoskeleton, and secretion of proteolytic proteins. Drawing from a comprehensive review, we conclude that betulinic acid formulations as nanoparticles and/or ionic liquids are promising drug delivery approaches with the potential for translation into clinical applications for the treatment and management of glioblastoma.

Effect of GR205171 on autonomic dysreflexia induced by colorectal distension in spinal cord injured rats.

STUDY DESIGN: Preclinical pharmacology. OBJECTIVES: To determine whether blocking substance P signaling attenuates the hypertension and bradycardia evoked by colorectal distension (CRD) in spinal cord injured (SCI) rats. SETTING: University laboratory in Pennsylvania, U.S.A. METHODS: Tachykinin NK1 receptor antagonists were administered 30 min prior to CRD three weeks after complete spinal cord transection at the 4th thoracic (T4) level. The dose range, route of administration, and pretreatment time was based on published data demonstrating occupancy of brain NK1 receptors in rodents. RESULTS: Subcutaneous (SC) administration of 10-30 mg/kg GR205171 ((2S,3S)-N-[[2-methoxy-5-[5-(trifluoromethyl)tetrazol-1-yl]phenyl]methyl]-2-phenylpiperidin-3-amine dihydrochloride) reduced CRD-induced hypertension and bradycardia by 55 and 49%, respectively, compared with pretreatment values. There was no effect of GR205171 on resting blood pressure or heart rate. In contrast, the same dose range of CP-99,994 ((2S,3S)-N-[(2-methoxyphenyl)methyl]-2-phenyl-3-piperidinamine dihydrochloride) had no effect on CRD-induced cardiovascular responses. CONCLUSIONS: The effective dose range of GR205171 to alleviate autonomic dysreflexia is consistent with the blockade of NK1 receptors on pelvic sensory afferents in the lumbosacral spinal cord, which may in turn prevent the over-excitation of sympathetic preganglionic neurons (SPNs) that regulate blood pressure and heart rate. The findings provide preclinical support for the utility of NK1 receptor antagonists to treat autonomic dysreflexia in people with SCI. The difference in the effects of the two NK1 receptor antagonists may reflect the ~200-fold lower affinity of CP-99,994 than GR205171 for the rat NK1 receptor.

The susceptibility of cardiac arrhythmias after spinal cord crush injury in rats.

High-level spinal cord injury (SCI) often interrupts supraspinal regulation of sympathetic input to the heart. Although it is known that dysregulated autonomic control increases the risk for cardiac disorders, the mechanisms mediating SCI-induced arrhythmias are poorly understood. Here, we employed a rat model of complete spinal cord crush injury at the 2nd/3rd thoracic (T2/3) level to investigate cardiac rhythm disorders resulting from SCI. Rats with T9 injury and naïve animals served as two controls. Four weeks after SCI, rats were implanted with a radio-telemetric device for electrocardiogram and blood pressure monitoring. During 24-h recordings, heart rate variability in rats with T2/3 but not T9 injury exhibited a significant reduction in the time domain, and a decrease in power at low frequency but increased power at high frequency in the frequency domain which indicates reduced sympathetic and increased parasympathetic outflow to the heart. Pharmacological blockade of the sympathetic or parasympathetic branches confirmed the imbalance of cardiac autonomic control. Activation of sympatho-vagal input during the induction of autonomic dysreflexia by colorectal distention triggered various severe arrhythmic events in T2/3 injured rats. Meanwhile, intravenous infusion of the ß1-adrenergic receptor agonist, dobutamine, caused greater incidence of arrhythmias in rats with T2/3 injury than naïve and T9 injured controls. Together, the results indicate that high-level SCI increases the susceptibility to developing cardiac arrhythmias likely owing to compromised autonomic homeostasis. The T2/3 crush model is appropriate for studying abnormal cardiac electrophysiology resulting from SCI.

SHORT-TERM EFFECT OF WHEY PROTEIN SUPPLEMENTATION ON THE QUALITY OF LIFE OF PATIENTS WAITING FOR LIVER TRANSPLANTATION: A DOUBLE BLINDED RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). AIM: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. METHODS: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. RESULTS: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. CONCLUSION: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

Validation of CINtec® PLUS Cytology Kit in the Diagnosis of Persistent HPV Infections - Cohort Study in the Portuguese Population.

CONTEXT: The use of the CINtec® PLUS Cytology Kit as a complementary method of diagnosis is intended to contribute to a risk assessment of CIN II+ cervical lesions development, thus avoiding unnecessary colposcopy in negative cases. This method has proved to be effective in the follow-up of cervical lesions, although there is need for consistency in the approach of equivocal or negative cytological results, with persistent positive High-Risk Human Papillomavirus (HR-HPV) test. AIMS: The present study intends to retrospectively evaluate the capacity of the CINtec® to add information to the clinical practice within the screening and follow-up of cervical lesions. Additionally, this study intends to define criteria for CINtec® referral in order to maximize its utilization in the Portuguese context. MATERIALS AND METHODS: For this purpose, 225 cases with CINtec® PLUS Cytology Kit and histology results were used, and data were analysed and compared according to the cytology and HR-HPV molecular test results. RESULTS: The data of this study show that CINtec® PLUS Cytology Kit is a valid test for the diagnosis of persistent HPV lesions (p = 0.0005), with excellent sensitivity and reliable values of specificity. Relevant patient groups to apply the kit are in agreement with the manufacturer recommendations: women with ASC-US/LSIL result and NILM cytology with HPV-positive test, essentially over 30 years old. CONCLUSIONS: Although clinical data and previous cytological information must help guiding, authors considered that CINtec® is a really valid test for the prognosis of persistent HPV infections in the female population.

Short-term effect of whey protein supplementation on the quality of life of patients waiting for liver transplantation: a double blinded randomized clinical trial / Efeito a curto prazo da suplementação com proteína do soro do leite sobre a qualidade de vida de pacientes em fila de espera para o transplante hepático: ensaio clínico randomizado

ABSTRACT Background: Chronic liver disease is associated with malnutrition that negatively impacts a patient's health-related quality of life (HRQoL). Aim: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. Methods: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

RESUMO Racional: A doença hepática crônica está associada à desnutrição que afeta negativamente a qualidade de vida relacionada à saúde (QVRS). Objetivo: Avaliar o efeito da suplementação aguda de proteína do soro de leite na QVRS e no estado nutricional e funcional dos pacientes em lista de espera para o transplante hepático. Métodos: Ensaio clínico randomizado com pacientes à espera do transplante hepático que foram randomizados em dois grupos: PS (suplementação com proteína do soro de leite) e Controle (suplementação com caseína). Ambos os grupos receberam 40 g das proteínas (20 g pela manhã e 20 g à noite) por 15 dias. O estado nutricional e funcional foi avaliado. O balanço energético foi calculado como a diferença entre a ingestão energética (recordatório de 24 horas) e o gasto energético total (avaliado por calorimetria indireta). O questionário de doença hepática crônica (CDLQ) foi utilizado para avaliar a QVRS. Todas as medidas foram realizadas antes e após a intervenção. Resultados: Cinquenta e seis pacientes foram avaliados. A desnutrição esteve presente em 56,9% e, diretamente associada à baixa QVRS (p<0,05). A suplementação, com ambas as proteínas, não alterou o estado nutricional e funcional dos pacientes (p>0,05). Entretanto, a QVRS melhorou após a suplementação com PS e caseína, sem diferenças entre os grupos (p>0,05). Pacientes que alcançaram as necessidades proteicas e com balanço energético positivo tiveram maior escore de QVRS (4,9; p<0,05), sem diferenças entre os grupos (p>0,05). Conclusão: A desnutrição reduz substancialmente a QVRS. A suplementação aguda com PS ou caseína melhorou de forma similar a QVRS.

Reuma.pt/vasculitis - the Portuguese vasculitis registry.

BACKGROUND: The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vasculitis Society collaborative network, enabling prospective collection and central storage of encrypted data from patients with this condition. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, assessment tools, and treatment were collected. We aim to describe the structure of Reuma.pt/vasculitis and characterize the patients registered since its development. RESULTS: A total of 687 patients, with 1945 visits, from 13 centres were registered; mean age was 53.4 ± 19.3 years at last visit and 68.7% were females. The most common diagnoses were Behçet's disease (BD) (42.5%) and giant cell arteritis (GCA) (17.8%). Patients with BD met the International Study Group criteria and the International Criteria for BD in 85.3 and 97.2% of cases, respectively. Within the most common small- and medium-vessel vasculitides registered, median [interquartile range] Birmingham Vasculitis Activity Score (BVAS) at first visit was highest in patients with ANCA-associated vasculitis (AAV) (17.0 [12.0]); there were no differences in the proportion of patients with AAV or polyarteritis nodosa who relapsed (BVAS≥1) or had a major relapse (≥1 major BVAS item) during prospective assessment (p = 1.00, p = 0.479). Biologic treatment was prescribed in 0.8% of patients with GCA, 26.7% of patients with AAV, and 7.6% of patients with BD. There were 34 (4.9%) deaths reported. CONCLUSIONS: Reuma.pt/vasculitis is a bespoke web-based registry adapted for routine care of patients with this form of rare and complex diseases, allowing an efficient data-repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking.

Diagnóstico e tratamento precoce da DPOC: contributos da enfermagem de reabilitação / Early diagnosis and treatment of COPD: contributions of rehabilitation nursing

Em Portugal, e no mundo, as doenças respiratórias, nomeadamente as doenças respiratórias crónicas, continuam a ser uma das principais causas de morbilidade e mortalidade, com tendência clara para o aumento da sua prevalência, constituindo uma das principais preocupações de todas as entidades de saúde a nível mundial. De entre essas doenças destaca-se a Doença Pulmonar Obstrutiva Crónica (DPOC), sendo reconhecida pela OMS como a única doença crónica, a nível mundial, com tendência a aumentar. Em Portugal a DPOC afeta cerca de 800 mil pessoas, no entanto, esta é uma doença subdiagnosticada e subtratada, em que os estudos epidemiológicos apontam para que afete 14,2 % da população com mais de 40 anos (ONDR, 2018). A DPOC é uma doença que se integra plenamente no conceito de Ambulatory Care Sensitive Conditions (ACSC), segundo um estudo de caraterização da utilização hospitalar nos anos compreendidos entre 2004 e 2012, realizado em 2013 pela IASIST. Estando consciente para esta problemática, e lembrando que esta é uma doença prevenível e tratável, cuja deteção precoce e um tratamento adequado numa fase inicial da doença leva ao atraso das complicações da mesma, sendo a única forma de evitar a sua progressão natural, o investigador pretende despertar a atenção para a importância do "Diagnóstico e Tratamento Precoce da DPOC", destacando os "Contributos da Enfermagem de Reabilitação" que é o impulsionador deste trabalho, dado que se insere no âmbito do IV Curso de Mestrado de Enfermagem de Reabilitação. O objetivo geral deste estudo é compreender os ganhos em saúde obtidos a partir do diagnóstico e tratamento precoce na DPOC, nomeadamente através da educação para a saúde. O presente estudo enquadra-se na metodologia do tipo investigação-ação com recurso ao paradigma qualitativo, que recorreu à entrevista semiestruturada a 10 utentes com DPOC recentemente diagnosticado, que pertencem a uma USF, sendo realizadas duas entrevistas, uma antes das sessões de educação para a saúde e outra depois das sessões. Nesta esteira foram planeadas e realizadas 3 sessões de educação para a saúde sobre a DPOC. Os resultados demonstram um aumento da literacia, através da compreensão dos fatores de risco, das medidas terapêuticas e preventivas a adotar no sentido de evitar complicações e exacerbações e, ainda, da informação sobre os recursos da comunidade existentes e consequentemente uma maior consciencialização para a doença e para a auto-gestão da mesma. No final do estudo verificamos que todos os participantes valorizaram o papel do enfermeiro especialista de reabilitação, compreendendo as suas competências e a importância do seu contributo

In Portugal, and in the world, respiratory diseases, such as chronic respiratory diseases, continue to be a major cause of morbidity and mortality, with a clear trend towards increasing their prevalence, being a major concern of all health entities worldwide. Among these diseases, Chronic Obstructive Pulmonary Disease (COPD) stands out, being recognized by the WHO as the only chronic disease worldwide, with a tendency to increase. In Portugal, COPD affects around 800,000 people. However, this is an underdiagnosed and under-treated disease, epidemiological studies indicating that it affects 14.2% of the population over 40 years old (ONDR, 2018). COPD is a disease that is fully integrated into the concept of Ambulatory Care Sensitive Conditions (ACSC), according to a study concerning the characterization of hospital use from 2004 to 2012, conducted in 2013 by IASIST. Being aware of this problem, and remembering that this is a preventable and treatable disease, whose early detection and proper treatment at an early stage leads to delays in its, this being the only way to avoid its natural progression, the investigator aims to raise awareness of the importance of the "Early Diagnosis and Treatment of COPD", highlighting the "Rehabilitation Nursing Contributions", which is the driving force behind this work, since it is part of the IV Master's Degree Course in Rehabilitation Nursing. The general objective of this study is to understand the health gains obtained from the diagnosis and early treatment in COPD, namely through health education. The present study is part of a research-action methodology using the qualitative paradigm, which resorted to the semi-structured interview to 10 patients with newly diagnosed COPD, who belong to a FHU (Family Health Unit). Two interviews were conducted, one prior to the health education sessions and another after them. In this context, 3 health education sessions on COPD were planned and conducted. The results demonstrate an increase in literacy, through the understanding of risk factors, the therapeutic and preventive measures to be adopted in order to avoid complications and exacerbations, as well as information about the existing community resources and, consequently, greater awareness of the disease and of its self-management. At the end of the study, we verified that all the participants valued the role of rehabilitation nurses, understanding their skills and the importance of their contribution

Niobium Oxide Films Deposited by Reactive Sputtering: Effect of Oxygen Flow Rate.

Reactive sputtering is a versatile technique used to form compact films with excellent homogeneity. In addition, it allows easy control over deposition parameters such as gas flow rate that results in changes on composition and thus in the film required properties. In this report, reactive sputtering is used to deposit niobium oxide films. A niobium target is used as metal source and different oxygen flow rates to deposit niobium oxide films. The oxygen flow rate was changed from 3 to 10 sccm. The films deposited under low oxygen flow rates show higher electrical conductivity and provide better perovskite solar cells when used as electron transport layer.

A pessoa em situação crítica submetida a ventilação não invasiva num serviço de urgência / The critically ill person submitted to non-invasive ventilation in an emergency department / La persona en estado crítico que se somete a ventilación no invasiva en un servicio de urgencias

Enquadramento: A eficácia da ventilação não invasiva (VNI), pode decorrer com possíveis complicações que exigem atenção preventiva por parte da enfermagem. Objetivo: Identificar as complicações da pessoa em situação crítica, submetida a terapia VNI, internada no serviço de urgência. Metodologia: Estudo exploratório-descritivo, observacional, de caráter quantitativo, realizado através da aplicação de dois instrumentos de recolha de dados: um questionário e uma grelha de observação, a uma amostra de 35 doentes, na sua maioria do sexo feminino (57,14%) e com idade superior a 85 anos (37,14%). Resultados: O diagnóstico clínico mais frequente foi a insuficiência respiratória (45,71%). As complicações mais frequentes foram a sensação de claustrofobia, as ulcerações da face, a dor e a acumulação de secreções. As complicações menos frequentes foram a congestão nasal, a conjuntivite, a distensão gástrica, a aerofagia e a sensação de vómitos. Conclusão: Defende-se a divulgação dos resultados, no sentido de abrir a discussão intra e inter equipas, para reforçar a pertinência da formação de enfermagem relativamente aos cuidados em doentes com VNI.

Background: The effectiveness of non-invasive ventilation (NIV) may be impacted by potential complications that require preventive nursing attention. Objective: To identify the complications of critically ill patients undergoing NIV therapy admitted to the Emergency Department of ULS-Bragança. Methodology: Exploratory-descriptive, observational, quantitative study conducted through the application of two data collection instruments, between November 2017 and March 2018: A Questionnaire and an Observation Grid of a sample of 35 patients, mostly female (57.14%) over the age of 85 (37.14%). Results: The most frequent clinical diagnosis was respiratory failure (45.71%). The most frequent complications were the sensation of claustrophobia, ulcerations of the face, pain, and accumulation of secretions. Less frequent complications were nasal congestion, conjunctivitis, gastric distension, aerophagia, and vomiting. Conclusion: The dissemination of the results is advocated, in order to open the discussion within and between teams, to reinforce the relevance of nursing training regarding the care of patients with NIV.

Marco contextual: La eficacia de la ventilación no invasiva (VNI) puede dar lugar a posibles complicaciones que requieren cuidados preventivos de enfermería. Objetivo: Identificar las complicaciones de los pacientes en estado crítico sometidos a terapia de VNI ingresados en el servicio de urgencias. Metodología: Se realizó un estudio exploratorio-descriptivo, observacional, de carácter cuantitativo, mediante la aplicación de dos instrumentos de recogida de datos: un cuestionario y una parrilla de observación a una muestra de 35 pacientes, la mayoría de los cuales eran mujeres (57,14%) y con una edad superior a los 85 años (37,14%). Resultados: El diagnóstico clínico más frecuente fue la insuficiencia respiratoria (45,71%). Las complicaciones más frecuentes fueron la sensación de claustrofobia, las ulceraciones faciales, el dolor y la acumulación de secreciones. Las complicaciones menos frecuentes fueron la congestión nasal, la conjuntivitis, la distensión gástrica, la aerofagia y la sensación de vómitos. Conclusión: Se aboga por la difusión de los resultados, con el fin de abrir el debate dentro de los equipos y entre ellos para reforzar la pertinencia de la formación de enfermería en relación con la atención de los pacientes con VNI.

Complicações do doente crítico submetido a ventilação não invasiva no serviço de urgência / Complications of the critically ill patient undergoing non-invasive ventilation in the emergency department

A utilização da ventilação não invasiva (VNI) é um dos desafios que o enfermeiro, em contexto do serviço de urgência (SU), enfrenta na execução das suas funções enquanto cuidador, uma vez que esta é uma técnica indispensável no tratamento de várias patologias em situações de emergência do foro respiratório. O objetivo geral deste trabalho consiste em identificar as complicações dos doentes críticos submetidos a terapia com VNI, internados no SU da Unidade Local de Saúde de Bragança. Trata-se de um estudo observacional, de caráter exploratório, quantitativo e descritivo, realizado através da aplicação de uma grelha de observação a uma amostra de 35 doentes críticos sujeitos a terapia com VNI, no período de novembro de 2017 a março de 2018. Dos 35 doentes estudados, 57.14% eram do sexo feminino e a faixa etária com maior frequência correspondia a mais de 85 anos (37.14%). As Comorbilidades mais prevalentes foram as perturbações do tipo cardiovascular (85.71%) e perturbações respiratórias (51.43%). Os diagnósticos clínicos de maior frequência no momento de admissão do doente crítico no SU foram: insuficiência respiratória (45.71%), insuficiência cardíaca (34.29%) e 37.14% dos doentes foram diagnosticados com pneumonia. Verificou-se a utilização do modo Bilevel positive pressure airway pressure (BPAP) em maior incidência em todos os momentos de avaliação definidos pela investigadora. As complicações mais frequentes dos doentes submetidos a VNI, encontradas neste estudo, foram: secura da boca, sensação de claustrofobia, ulcerações da face ou desconforto causado pela máscara, com dor presente no nariz, marcas e rubor no local de contacto, alguma evidência para distensão abdominal, aerofagia e acumulação de secreções. Sugerimos a realização de outros estudos com amostras maiores, onde seja possível determinar outras associações e a sensibilização da equipe multidisciplinar para a identificação precoce das complicações inerentes a este tipo de tratamento.

The use of noninvasive ventilation (NIV) is one of the challenges nurses face in the context of the emergency department (ED), in the execution of their functions as caregiver, since the use of NIV is an indispensable technique in the treatment of several pathologies in respiratory emergencies. The aim of this study is to identify the complications of patients submitted to emergency NIV in the Emergency Department of Bragança. Quantitative study of descriptiveexploratory and correlational character. Thirty-five patients, subject to NIV, were studied from November 2017 to March 2018. Of the 35 patients studied 57.14% were female, and the age group with the highest frequency corresponded to more than 85 years (37.14%). The most prevalent comorbidities were cardiovascular disorders, 85.71% and respiratory disorders, 51.43%. The most frequent clinical diagnoses at the time of admission were: respiratory failure (45.71%), heart failure (34.29%) and 37.14% of the patients were diagnosed with pneumonia. The use of the Bilevel positive pressure airway pressure (BPAP) mode was verified at higher incidence at all times and evaluated. The complications of the most frequent NIV patients observed this study were dry mouth, claustrophobia, facial ulcerations or discomfort caused by the mask, pain in the nose, and marks and flushing at the site of contact, some evidence for distension abdominal, aerophagia, accumulation of secretions. We suggest other studies with larger samples, where it is possible to determine other associations and the sensitization of the multidisciplinary team for the early identification of the complications inherent to this type of treatment.

Exploring the Properties of Niobium Oxide Films for Electron Transport Layers in Perovskite Solar Cells.

In this work, niobium oxide films were deposited by reactive magnetron sputtering under different oxygen flow rate and applied as electron transport layer in perovskite solar cells. It was found that the deposition made using 3.5 sccm of oxygen flow resulted in films with better electrical properties which helped the extraction of the photogenerated electrons to the external circuit, improving the Jsc and consequently the device efficiency. In addition, by photoluminescence measurements, we found a better charge transfer from perovskite to TiO2/niobium oxide film deposited at 3.5 sccm of oxygen flow.

Hereditary spastic paraplegia: gain-of-function mechanisms revealed by new transgenic mouse.

Mutations of the SPAST gene, which encodes the microtubule-severing protein spastin, are the most common cause of hereditary spastic paraplegia (HSP). Haploinsufficiency is the prevalent opinion as to the mechanism of the disease, but gain-of-function toxicity of the mutant proteins is another possibility. Here, we report a new transgenic mouse (termed SPASTC448Y mouse) that is not haploinsufficient but expresses human spastin bearing the HSP pathogenic C448Y mutation. Expression of the mutant spastin was documented from fetus to adult, but gait defects reminiscent of HSP (not observed in spastin knockout mice) were adult onset, as is typical of human patients. Results of histological and tracer studies on the mouse are consistent with progressive dying back of corticospinal axons, which is characteristic of the disease. The C448Y-mutated spastin alters microtubule stability in a manner that is opposite to the expectations of haploinsufficiency. Neurons cultured from the mouse display deficits in organelle transport typical of axonal degenerative diseases, and these deficits were worsened by depletion of endogenous mouse spastin. These results on the SPASTC448Y mouse are consistent with a gain-of-function mechanism underlying HSP, with spastin haploinsufficiency exacerbating the toxicity of the mutant spastin proteins. These findings reveal the need for a different therapeutic approach than indicated by haploinsufficiency alone.

Factors associated with asthma expression in adolescents.

OBJECTIVE: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. METHODS: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. RESULTS: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). CONCLUSIONS: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

Factors associated with asthma expression in adolescents / Fatores associados à expressão da asma em adolescentes

ABSTRACT Objective: To evaluate risk factors associated with asthma symptoms in adolescents in the 13- to 14-year age bracket. Methods: This was a cross-sectional study involving adolescents enrolled in randomly selected public schools in the city of Belo Horizonte, Brazil, and conducted with the use of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and its supplementary module for risk factor assessment. The ISAAC questionnaire was completed by the students themselves, whereas the supplementary questionnaire was completed by their parents or legal guardians. Variables showing p ≤ 0.25 in the univariate analysis were included in the multivariate analysis. Stepwise regression with backward elimination was used for variable selection. Results: We evaluated 375 adolescents, 124 (33.1%) of whom had asthma symptoms. The final multivariate analysis model revealed that asthma symptoms were associated with birth weight < 2,500 g (p < 0.001), day care center or nursery attendance (p < 0.002), maternal history of asthma (p < 0.001), contact with animals during the first year of life (p < 0.027), current contact with animals outside the home (dogs, cats, or farm animals; p < 0.005), and more than 20 cigarettes per day smoked by parents or other household members (p < 0.02). Conclusions: Exposure to animals in and outside the home is associated with asthma symptoms, as is environmental tobacco smoke exposure. Families, health professionals, and administrators of health care facilities should take that into account in order to prevent asthma and reduce asthma morbidity.

RESUMO Objetivo: Avaliar os fatores de risco associados aos sintomas relacionados à asma em adolescentes de 13 e 14 anos. Métodos: Estudo transversal realizado com alunos matriculados em escolas públicas de Belo Horizonte (MG), selecionadas aleatoriamente, com a utilização dos questionários International Study of Asthma and Allergies in Childhood e de seu módulo complementar para a avaliação dos potenciais fatores de risco. O primeiro questionário foi respondido pelos alunos, e o segundo foi respondido pelos pais e/ou responsáveis. Após a análise univariada, todas as variáveis cujo valor de p foi igual ou inferior a 0,25 foram submetidas à análise multivariada. A seleção das variáveis foi realizada pelo método passo a passo com eliminação retrógrada de variáveis. Resultados: Foram avaliados 375 adolescentes, dos quais 124 (33,1%) apresentavam sintomas de asma. O modelo final da análise multivariada revelou que sintomas de asma estiveram associados a peso ao nascimento < 2.500 g (p < 0,001), frequência a creches ou berçários (p < 0,002), história materna de asma (p < 0,001), contato com animais durante o primeiro ano de vida (p < 0,027), contato atual com animais fora da residência (cão, gato ou outros animais em fazenda; p < 0,005) e consumo de mais que 20 cigarros por dia por residentes no mesmo domicílio que o adolescente (p < 0,02). Conclusões: As exposições intra e extradomiciliar a animais domésticos e ao tabaco estiveram associadas à presença de sintomas de asma. Esses resultados devem ser considerados tanto pelos familiares como pelos profissionais e gestores dos serviços de saúde na prevenção da asma e na redução do seu impacto na morbidade.

Vitamin D status in spondyloarthritis: results of the ASAS-COMOSPA international study.

OBJECTIVES: Spondyloarthritis (SpA) encompasses both bone production and bone loss, and the latter is particularly linked to inflammation. Vitamin D deficiency has been associated with several inflammatory conditions (i.e. cardiovascular disease, rheumatoid arthritis), but it has been poorly evaluated in SpA patients. We aimed to a) describe the prevalence of vitamin D deficiency in SpA patients worldwide; b) compare SpA patients with and without vitamin D deficiency in terms of disease phenotype, activity severity and comorbidities. METHODS: This is an ancillary study of the ASAS-COMOSPA study initiative, an international cross-sectional study of patients with SpA. Demographics, patients' phenotype, disease activity/severity measures and comorbidities were assessed. Serum 25-hydroxyvitamin D (25OHD) deficiency was defined as <20 ng/mL (<50 nmol/L). STATISTICAL ANALYSIS: a) prevalence of vitamin D deficiency; b) comparison of the disease presentation/activity/severity and comorbidities in the group of patients with and without vitamin D deficiency by bi-variable and multivariable analysis. RESULTS: Vitamin D deficiency was observed in 527(51.2%) of the 1030 patients with available data who were not receiving any supplementation. Vitamin D deficiency was independently associated with the presence of radiographic sacroiliitis (OR=2.1 [95%CI1.3; 3.3]) and a 25OHD measured in winter and spring (OR=1.88 [95%CI 1.2; 2.9]). No independent association between vitamin D deficiency and comorbidities was found. CONCLUSIONS: This study suggests that vitamin D deficiency is common in SpA worldwide and is associated with season but also with more severe forms of SpA.

Epidemiological trends of allergic diseases in adolescents.

OBJECTIVE: To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here. METHODS: This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002. RESULTS: The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002). CONCLUSIONS: The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.

Pneumonitis in Adult Onset Still's Disease: Uncommon or Under Diagnosed?

The adult onset Still's Disease is an uncommon entity characterized by multiple clinical manifestations. Pneumonitis, less often considered, deserves particular emphasis given the need for differential diagnosis and because it can progress to severe respiratory failure. With the aim to highlight the pulmonary parenchyma involvement in patients with adult onset Still's Disease, we present a case report which progresses with pneumonitis.

A doença de Still do adulto é uma entidade pouco comum que se caracteriza por manifestações clínicas muito variadas. A pneumonite, menos frequente, merece particular destaque dado a necessidade do seu diagnóstico diferencial e pela possível progressão para insuficiência respiratória grave. Com o objetivo de destacar a relevância do envolvimento do parênquima pulmonar na doença de Still do adulto, descrevemos um caso clinico que cursou com pneumonite.