Design of Liquid Formulation Based on F127-Loaded Natural Dimeric Flavonoids as a New Perspective Treatment for Leishmaniasis.

Infectious and Parasitic Diseases (IPD) remain a challenge for medicine due to several interconnected reasons, such as antimicrobial resistance (AMR). American tegumentary leishmaniasis (ATL) is an overlooked IPD causing persistent skin ulcers that are challenging to heal, resulting in disfiguring scars. Moreover, it has the potential to extend from the skin to the mucous membranes of the nose, mouth, and throat in both humans and various animals. Given the limited effectiveness and AMR of current drugs, the exploration of new substances has emerged as a promising alternative for ATL treatment. Arrabidaea brachypoda (DC). Bureau is a native Brazilian plant rich in dimeric flavonoids, including Brachydin (BRA), which displays antimicrobial activity, but still little has been explored regarding the development of therapeutic formulations. In this work, we present the design of a low-cost liquid formulation based on the use of Pluronic F127 for encapsulation of high BRA concentration (LF-B500). The characterization techniques revealed that BRA-loaded F127 micelles are well-stabilized in an unusual worm-like form. The in vitro cytotoxicity assay demonstrated that LF-B500 was non-toxic to macrophages but efficient in the inactivation of forms of Leishmania amazonensis promastigotes with IC50 of 16.06 µg/mL. The results demonstrated that LF-B500 opened a new perspective on the use of liquid formulation-based natural products for ATL treatment.

Chemical Characterization, Leishmanicidal Activity and In Vitro Cytotoxicity of the Essential Oil Extracted from Pectis brevipedunculata (Gardner) Sch.Bip. and Its Incorporation into Microemulsion Systems.

Pectis brevipedunculata (Gardner) Sch.Bip., known in Brazil as alecrim do campo, is a small Asteraceae family plant with a calming effect and consumed as tea. This species contains components, such as neral and geranial, that display various biological activities, such as leishmanicidal. The aim was to chemically characterize the essential oil (EO) obtained from P. brevipedunculata (EO-PB) by hydrodistillation and a microemulsion formulated with EO (ME-PB), Tween 80 and Transcutol P, assess the leishmanicidal effect against Leishmania (L.) amazonensis promastigotes and cytotoxicity against RAW 264.7. EO-PB and ME-PB were analyzed by Gas Chromatography Mass Spectrometry (GC/MS). Monoterpene hydrocarbons were noteworthy among the identified compounds. The main EO-PB constituents were α-pinene and limonene, followed by neral and geranial, which were maintained in ME-PB. EO-PB presented an inhibitory concentration (IC50) of 20 µg/mL and ME-PB of 0.93 µg/mL. ME-PB inhibition towards the parasite was 20-fold higher than that of EO-PB. This indicated that EO incorporation to the microemulsion resulted in optimized biological activity. Selectivity indices indicate that ME-PB is more selective concerning parasite inhibition. Thus, ME-PB may comprise an adequate approach against Leishmania, as the inhibitory concentration (IC50) promastigotes was lower than that considered toxic for cells cell cytotoxicity of 50% (CC50).

Influence of postural pattern according to the Godelieve Denys-Struyf method on pain and postpartum depression in the immediate postpartum / Influencia del patrón postural, según el método Godelieve Denys-Struyf, sobre el dolor y la depresión postparto en el puerperio inmediato / Influência do padrão postural segundo o método Godelieve Denys-Struyf na dor e na depressão pós-parto no puerpério imediato

ABSTRACT - This study aimed to evaluate the relation between the postural pattern according to the Godelieve Denys-Struyf (GDS) method with postpartum depression and pain in immediate postpartum women. A cross-sectional study was conducted, including 29 women at 1-3 postpartum days. The Edinburgh Postnatal Depression Scale (EPDS) assessed depression and Visual Numerical Scale assessed pain score (from 0=no pain to 10=the most intense pain). Postural pattern was categorized into groups according to the deviation plane: axial (anteromedial, posteromedial, anteroposterior, and posteroanterior postures) and relational (anterolateral and posterolateral postures) or mixed, considering upper and lower limbs. Participants' age ranged from 19 to 41 years, body mass index from 21.4 to 43.8 kg/m 2 . The EPDS scored from 10 to 26 points. In total, 52% women reported pain, but the pain score was similar among postural pattern groups (p=0.77) and not correlated with EPDS (p=0.88). Women's postural patterns were: mixed (45%), relational (38%), and axial (17%). EPDS score was higher for relational pattern group than axial group (20.45±1.63 vs 15.00±3.24; p=0.01). In conclusion, the mixed postural pattern was the most frequent. The relational postural pattern group (anterolateral and posterolateral posture) presented a higher depression score than the axial postural pattern group. No association was found between postural patterns and the pain score or between pain and postpartum depression.

RESUMEN - El objetivo de este estudio fue evaluar la relación entre el patrón postural según el método Godelieve Denys-Struyf (GDS), la depresión postparto y el dolor en mujeres en el puerperio inmediato. Se realizó un estudio transversal con 29 mujeres en el período entre 1 y 3 días después del parto. Se evaluaron la depresión mediante la Escala de Depresión Postparto de Edimburgo (EPDS) y el dolor mediante la Escala Numérica Visual del Dolor (0=ningún dolor, 10=dolor intenso). El patrón postural se categorizó según el plano de la alteración postural: axial (planos anteromedial, posteromedial, anteroposterior y posteroanterior), relacional (planos anterolateral y posterolateral) o mixto considerando tanto las extremidades superiores como las inferiores. Los resultados mostraron que las mujeres, de entre 19 y 41 años de edad, tenían un índice de masa corporal entre 21,4 y 43,8 kg/m2. La puntuación de la EPDS osciló entre 10 y 26 puntos. El 52% de las mujeres declararon sentir dolor, pero la puntuación en la escala de dolor fue similar en los tres grupos de patrones posturales (p=0,77) y no hubo correlación con la puntuación de la EPDS (p=0,88). Los patrones posturales presentados fueron mixto (45%), relacional (38%) y axial (17%). La puntuación de la EPDS fue mayor en el grupo de patrón postural relacional en comparación con el axial (20,45±1,63 vs. 15,00±3,24; p=0,01). Se concluye que el patrón postural mixto fue el más frecuente entre las mujeres. El grupo con un patrón postural relacional (planos anterolateral y posterolateral) obtuvo mayores tasas en la EPDS que el axial. No hubo asociación entre el patrón postural y la puntuación en la escala de dolor ni entre el dolor y la depresión.

RESUMO - O objetivo deste estudo foi avaliar a relação entre o padrão postural, de acordo com o método Godelieve Denys-Struyf (GDS), a depressão pós-parto e a dor em mulheres no puerpério imediato. Foi realizado um estudo transversal com 29 mulheres no período de 1 a 3 dias após o parto. A depressão foi avaliada por meio da Escala de Depressão Pós-parto de Edimburgo (EPDS) e a dor pela Escala Visual Numérica de dor (0=ausência de dor, 10=pior dor possível). O padrão postural foi categorizado de acordo com o plano do desvio da postura: axial (posturas ântero-medial, póstero-medial, ântero-posterior e póstero-anterior), relacional (posturas ântero-lateral e póstero-lateral) ou misto, considerando membros superiores e inferiores. Como resultados, as mulheres, entre 19 e 41 anos de idade, apresentaram índice de massa corporal entre 21,4 e 43,8 kg/m 2 . A pontuação na EPDS variou de 10 a 26 pontos. 52% das mulheres relataram sentir dor, porém a pontuação na escala de dor foi similar nos três grupos de padrão postural (p=0,77) e não houve correlação com a pontuação na EPDS (p=0,88). Os padrões posturais apresentados foram: misto (45%), relacional (38%) e axial (17%). A pontuação da EPDS foi maior para o grupo de padrão postural relacional, em comparação com o axial (20,45±1,63 vs 15,00±3,24; p=0,01). Como conclusão, o padrão postural misto foi o mais frequente entre as mulheres. O grupo com padrão postural relacional (posturas ântero-lateral e póstero-lateral) apresentou maior pontuação na EPDS que o axial. Não houve associação entre o padrão postural e a pontuação na escala de dor ou entre a dor e a depressão.

Maternal Th17 Profile after Zika Virus Infection Is Involved in Congenital Zika Syndrome Development in Children.

Brazil is one of the countries that experienced an epidemic of microcephaly and other congenital manifestations related to maternal Zika virus infection which can result in Congenital Zika Syndrome (CZS). Since the Zika virus can modulate the immune system, studying mothers' and children's immune profiles become essential to better understanding CZS development. Therefore, we investigated the lymphocyte population profile of children who developed CZS and their mothers' immune response in this study. The study groups were formed from the Plaque Reduction Neutralization Test (PRNT) (CZS+ group) result. To evaluate the lymphocyte population profile, we performed phenotyping of peripheral lymphocytes and quantification of serum cytokine levels. The immunophenotyping and cytokine profile was correlated between CSZ+ children and their mothers. Both groups exhibited increased interleukin-17 levels and a reduction in the subpopulation of CD4+ T lymphocytes. In contrast, the maternal group showed a reduction in the population of B lymphocytes. Thus, the development of CZS is related to the presence of an inflammatory immune profile in children and their mothers characterized by Th17 activation.

Maternal Immune Response to ZIKV Triggers High-Inflammatory Profile in Congenital Zika Syndrome.

The immunological mechanisms involved in the development of congenital Zika syndrome (CZS) have yet to be fully clarified. This study aims to assess the immuno-inflammatory profile of mothers and their children who have been diagnosed with CZS. Blood samples, which were confirmed clinically using the plaque reduction neutralization test (PRNT), were collected from children with CZS and their mothers (CZS+ group). Samples were also collected from children who did not develop CZS and had a negative PRNT result and from their mothers (CZS- group). The data demonstrated a correlation between the leukocyte profile of CZS+ children and their mothers, more evident in monocytes. Monocytes from mothers of CZS+ children showed low expression of HLA and elevated hydrogen peroxide production. CZS+ children presented standard HLA expression and a higher hydrogen peroxide concentration than CZS- children. Monocyte superoxide dismutase activity remained functional. Moreover, when assessing the monocyte polarization, it was observed that there was no difference in nitrite concentrations; however, there was a decrease in arginase activity in CZS+ children. These data suggest that ZIKV infection induces a maternal immuno-inflammatory background related to the child's inflammatory response after birth, possibly affecting the development and progression of congenital Zika syndrome.

Associação entre declínio cognitivo, sintomas depressivos e do medo de cair com a velocidade da marcha confortável em idosos comunitários / Association between cognitive decline, depressive symptoms and the fear of falling with the speed gait in community-dwelling older adults

Diminuições na velocidade da marcha (VM) estão associadas a desfechos adversos na saúde física e mental em idosos. Assim, torna-se relevante identificar fatores que podem associar-se com a VM confortável em idosos, de forma a propor estratégias para prevenção de alterações na mobilidade. Objetivo: verificar a associação entre declínio cognitivo, sintomas depressivos e do medo de cair com a VM confortável em idosos comunitários. Métodos: tratou-se de um estudo transversal, com amostra probabilística, incluindo 308 idosos comunitários. O desfecho do estudo foi a VM confortável, sendo considerado como baixo desempenho VM < 0,8m/s. As variáveis preditoras foram 1) declínio cognitivo avaliado pelo Mini Exame do Estado Mental, 2) sintomas depressivos avaliados com a Escala de Depressão Geriátrica Abreviada e 3) medo de cair avaliado pela Falls Efficacy Scale ­ Brasil. Para analisar a associação entre as variáveis foi utilizada a Regressão Logística Multivariada. Resultados: idosos tiveram chances significativamente maiores de apresentar baixo desempenho na VM confortável quando apresentaram declínio cognitivo (OR: 4,67; IC95%: 1,68; 12,94), sintomas depressivos (OR: 2,90; IC95%: 1,42; 5,92) e medo de cair (OR: 4,08; IC95%: 1,72; 9,71) quando comparados aos que não tiveram essas condições. Conclusão: o declínio cognitivo, sintomas depressivos e medo de cair foram associados ao baixo desempenho na VM confortável nos idosos amostrados. Esses achados podem servir para identificação precoce dos fatores que estão associados a alterações na VM confortável, contribuindo para a proposição de estratégias públicas em saúde e no direcionamento de atividades de promoção em saúde para idosos comunitários.(AU)

Decreases in gait speed (GS) are associated with adverse outcomes in the physical and mental health of the elderly. Thus, it is relevant to identify factors that can be associated with comfortable GS in community-dwelling older adults, to propose strategies to prevent changes in mobility. Objective: To verify the association between cognitive decline, depressive symptoms, and fear of falling with comfortable GS in community-dwelling older adults. Methods: This was a cross-sectional study with a probabilistic sample, including 308 community-dwelling older adults. The study outcome was comfortable GS, being considered as low-performance MV < 0.8m/s. Predictive variables were 1) cognitive decline assessed by the Mini-Mental State Examination, 2) depressive symptoms assessed by the Abbreviated Geriatric Depression Scale, and 3) fear of falling assessed by the Falls Efficacy Scale - Brasil. Multivariate Logistic Regression was used to verify the association between the variables. Results: Community-dwelling older adults were significantly more likely to have poor performance in comfortable GS when they presented cognitive decline (OR: 4.67; 95%CI: 1.68; 12.94), depressive symptoms (OR: 2.90; 95%CI: 1 .42; 5.92), and fear of falling (OR: 4.08; 95%CI: 1.72; 9.71) when compared to those who did not have these conditions. Conclusion: Cognitive decline, depressive symptoms, and fear of falling were associated with poor performance in comfortable GS in the community-dwelling older adults sampled. These findings can serve for early identification of factors that are associated with changes in comfortable GS, contributing to the proposition of public health strategies and in directing health promotion activities for community-dwelling older adults.(AU)

Prevalência e fatores associados a atividades que levam ao nervosismo no trabalho no Brasil: estudo com dados da Pesquisa Nacional de Saúde, 2013 / Prevalence and factors associated with activities that lead to nervousness at work in Brazil: study with data from the National Health Survey, 2013

Resumo Objetivos: descrever a prevalência de atividades que levam ao nervosismo e analisar os fatores associados a essa condição em trabalhadores brasileiros. Métodos: estudo transversal realizado com dados da Pesquisa Nacional de Saúde (PNS), edição de 2013. A variável dependente foi o envolvimento em atividades que levam ao nervosismo e as independentes foram características sociodemográficas, ocupacionais e situação de saúde. Empregou-se análise de regressão de Poisson com variância robusta. Resultados: participaram deste estudo 36.442 trabalhadores, 53,4% do sexo masculino. A prevalência de atividades que levam ao nervosismo no trabalho foi de 33,8% (Intervalo de Confiança de 95% [IC95%]: 33,2; 34,2). Na análise ajustada, raça/cor da pele preta (Razão de Prevalência [RP]: 0,84; IC95%: 0,77;0,92) e parda (RP:0,86; IC95%: 0,82;0,91), idade maior que 60 anos (RP:0,74; IC95%: 0,64;0,85) e trabalhar em ambientes abertos (RP: 0,82; IC95%: 0,77;0,87) foram significativamente associados a uma menor prevalência de atividades que levam ao nervosismo. Ruído (RP: 1,96; IC95%: 1,86;2,06), material radioativo (RP: 1,28; IC95%: 1,16;1,41), trabalho noturno (RP: 1,31; IC95%: 1,24; 1,38), idade de 30 a 39 anos (RP: 1,10; IC95%: 1,03;1,17) e depressão (RP: 1,36; IC95%: 1,26;1,47) associaram-se a uma maior probabilidade do desfecho. Conclusão: características sociodemográficas, ambientais e aspectos de saúde estão associados a atividades que levam ao nervosismo em trabalhadores brasileiros.

Abstract Objective: to describe the prevalence of activities leading to nervousness and analyze the factors associated with this condition in Brazilian workers. Methods: cross-sectional study using data from the National Health Survey (PNS) - 2013. The dependent variable was involvement in activities leading to nervousness, and the independent variables included sociodemographic, occupational, and health-related characteristics. We calculated the Poisson regression with robust variance. Results: 36,442 workers participated in this study, 53.4% male. The prevalence of activities leading to nervousness at work was 33.8% (95% of Confidence Interval [95%CI]: 33.2; 34.2). In the adjusted analysis, black (Prevalence Ratio [PR]: 0.84; 95%CI: 0.77;0.92) and mixed race (PR: 0.86; 95%CI: 0.82;0.91) individuals, aged over 60 years (PR: 0.74; 95% CI: 0.64;0.85), and those working in open environments (PR: 0.82; 95%CI: 0.77;0.87) were significantly associated with a lower prevalence of activities leading to nervousness. Noise (PR: 1.96; 95%CI: 1.86;2.06), radioactive materials (PR: 1.28; 95% CI: 1.16;1.41), night work (PR: 1.31; 95%CI: 1.24;1.38), age 30 to 39 years (PR: 1.10; 95%CI: 1.03;1.17), and depression (PR: 1.36; 95%CI: 1.26;1.47) were associated with a higher probability of the outcome. Conclusion: sociodemographic, environmental, and health-related characteristics are associated with activities leading to nervousness in Brazilian workers.

Relato de experiência multiprofissional com grupo de gestantes de alto-risco / Report on a multiprofessional experience with a group of high-risk pregnant women / Relato de experiencia multiprofesional con un grupo de gestantes de alto riesgo

Introdução: A gestação é um período onde as atitudes e escolhas da mãe irão refletir no crescimento e desenvolvimento do bebê, por isso as ações educativas e promocionais da saúde são fundamentais. Essas ações, desenvolvidas por uma equipe multiprofissional, são ainda mais eficientes, por ter uma diversidade maior de informações para a gestante. Objetivo: Descrever a experiência multiprofissional de ações de promoção da saúde com gestantes de alto risco e seus acompanhantes. Métodos: Trata-se de um relato de experiência que contempla encontros realizados semanalmente em um Hospital Universitário, no setor de alojamento conjunto, que comporta quatro leitos para gestantes de alto risco. Os momentos dialógicos ocorreram em rodas de conversa, com as gestantes e acompanhantes, discentes e docentes de fonoaudiologia e enfermeiros da equipe local. Foram desenvolvidos materiais informativos para os participantes e um pôster que permaneceu disponível ao público no setor. Resultados: Notou-se que os participantes se apresentaram receptivos e interessados nos assuntos da roda de conversa propostos, que foram gradativamente trabalhados, cada um contribuindo com suas vivências, bem como com suas dúvidas e questionamentos. Conclusão: O trabalho multiprofissional gerou reflexões sobre a amamentação e o sistema estomatognático, expandindo o diálogo sobre outros temas de abordagem fonoaudiológica. Ações promotoras da saúde podem empoderar os participantes para intervir como agentes na compreensão das necessidades de saúde, como o cuidado com o binômio mãe-bebê.

Introduction: The mother's attitudes and choices during pregnancy reflect on the baby's growth and development, which makes it essential to have educational and health promotion actions. When developed by a multiprofessional team, such actions are even more efficient, as they have a greater diversity of information for pregnant women. Objective: To describe the multiprofessional experience of health promotion actions with high-risk pregnant women and their companions. Methods: This is an experience report of meetings held weekly in the rooming-in ward of a university hospital, in which four beds are available to high-risk pregnant women. Conversation groups were organized with pregnant women and their companions, speech-language-hearing students and professors, and the hospital's nurses. Informational material was developed for the participants, as well as a poster exposed to the public in the rooming-in ward. Results: Participants were receptive to and interested in the conversation group topics, which were gradually developed as each one shared their experiences and questions. Conclusion: The multiprofessional work led to reflections on breastfeeding and the stomatognathic system, expanding the dialog about other speech-language-hearing topics. Health-promotion actions empower participants to actively contribute to their understanding of health needs, such as mother/baby care.

Introducción: El embarazo es un período en el que las actitudes y elecciones de la madre se reflejarán en el crecimiento y desarrollo del bebé, por lo que las acciones educativas y promocionales de la salud son fundamentales. Estas acciones, desarrolladas por un equipo multiprofesional, son aún más eficientes, ya que cuentan con una mayor diversidad de información para la gestante. Objetivo: Describir la experiencia multiprofesional de acciones de promoción de la salud con gestantes de alto riesgo y sus acompañantes. Métodos: Se trata de un relato de experiencia que incluye reuniones que se realizan semanalmente en un Hospital Universitario, en el sector de alojamiento conjunto, que comprende cuatro camas para gestantes de alto riesgo. Los momentos dialógicos se desarrollaron en círculos de conversación, con gestantes y acompañantes, estudiantes y profesores de logopedia y enfermeras del equipo. Se desarrollaron materiales informativos para los participantes y una pancarta que quedó a disposición del público del sector. Resultados: Se notó que los participantes se mostraron receptivos e interesados en los temas del círculo de conversación propuesto, los cuales se fueron trabajando paulatinamente, cada uno aportando con sus vivencias, así como con sus dudas y preguntas. Conclusión: El trabajo multiprofesional generó reflexiones sobre la lactancia materna y el sistema estomatognático, ampliando el diálogo sobre otros temas. Las acciones de promoción de la salud pueden empoderar a los participantes para que intervengan como agentes en la comprensión de las necesidades de salud, como el cuidado del binomio madre-bebé.

A Nurse-Pharmacist Collaborative Approach to Reducing Financial Toxicity in Cancer Care.

Financial toxicity is well recognized as a sequela of surviving cancer. As the number of survivors is expected to increase, so are costs associated with cancer treatments. Using a nurse-pharmacist collaborative model, efforts between oncology pharmacists and nurses may inform real-world practice solutions to improve medication access. Increased medication access may reduce out-of-pocket expenses for patients with cancer.

Dificuldade auditiva autorreferida em trabalhadores expostos à poeira industrial no sul do Brasil / Self-reported hearing difficulty in workers exposed to industrial dust in southern Brazil

RESUMO Objetivo Investigar a associação entre dificuldade auditiva autorreferida e exposição ocupacional à poeira industrial em trabalhadores do sul do Brasil. Método Trata-se de um estudo transversal analítico, realizado com dados do inquérito da Pesquisa Nacional de Saúde (2013). A variável dependente foi a dificuldade auditiva autorreferida e a variável independente principal foi a exposição ocupacional à poeira industrial. As covariáveis foram: sexo, cor da pele, idade em anos completos, exposição a ruído e exposição à substâncias químicas. As variáveis de exposição ocupacional a ruído e substâncias químicas foram utilizadas como variáveis de ajuste (variáveis de confusão) e as análises foram estratificadas por cada estado (Santa Catarina, Paraná e Rio Grande do Sul), com o intuito de verificar a diferença na magnitude dos resultados por região. Tanto para a análise bruta quanto para a ajustada, a razão de chance foi utilizada como medida de associação, estimada por meio da análise de regressão logística. Os dados foram analisados no software Stata, versão 14. Resultados Com relação a exposição principal, 10,1% da amostra (n=490) afirmou estar exposta à poeira industrial em ambiente ocupacional, ao passo que 7,0% afirmou ter dificuldade auditiva. Na análise final, trabalhadores expostos a poeira industrial apresentaram 1,77 vezes mais chance de mencionar dificuldade auditiva, quando comparados a indivíduos não expostos a este agente. Conclusão Houve associação entre dificuldade auditiva e exposição à poeira industrial em trabalhadores da região Sul do Brasil.

ABSTRACT Purpose To investigate the association between self-reported hearing difficulties and occupational exposure to industrial dust in workers in southern Brazil. Methods This is a cross-sectional analytical study conducted with data from the National Health Survey (Pesquisa Nacional de Saúde, 2013). The dependent variable was self-reported hearing impairment, and the primary independent variable was occupational exposure to industrial dust. The covariables were: sex, skin color, age in complete years, exposure to noise, and exposure to chemical substances. The variables of occupational exposure to noise and chemical substances were used as adjustment variables (confounding variables), and the analyses were stratified per state (Santa Catarina, Paraná, and Rio Grande do Sul) to verify the difference in magnitude results per region. For the crude and adjusted analysis, the odds ratio (OR) was used as a measure of association, estimated through the logistic regression analysis. The data were analyzed through the software Stata, version 14. Results Regarding the main exposure, 10.1% of the sample (n = 490) reported being exposed to industrial dust in an occupational environment, while 7.0% reported hearing impairment. In the final analysis, workers exposed to industrial dust were 1.77 times more likely to report hearing impairment when compared to individuals not exposed to this agent. Conclusion There was an association between hearing impairment and exposure to industrial dust in workers in the southern region of Brazil.

Self-reported hearing difficulty in workers exposed to industrial dust in southern Brazil. / Dificuldade auditiva autorreferida em trabalhadores expostos à poeira industrial no sul do Brasil.

PURPOSE: To investigate the association between self-reported hearing difficulties and occupational exposure to industrial dust in workers in southern Brazil. METHODS: This is a cross-sectional analytical study conducted with data from the National Health Survey (Pesquisa Nacional de Saúde, 2013). The dependent variable was self-reported hearing impairment, and the primary independent variable was occupational exposure to industrial dust. The covariables were: sex, skin color, age in complete years, exposure to noise, and exposure to chemical substances. The variables of occupational exposure to noise and chemical substances were used as adjustment variables (confounding variables), and the analyses were stratified per state (Santa Catarina, Paraná, and Rio Grande do Sul) to verify the difference in magnitude results per region. For the crude and adjusted analysis, the odds ratio (OR) was used as a measure of association, estimated through the logistic regression analysis. The data were analyzed through the software Stata, version 14. RESULTS: Regarding the main exposure, 10.1% of the sample (n = 490) reported being exposed to industrial dust in an occupational environment, while 7.0% reported hearing impairment. In the final analysis, workers exposed to industrial dust were 1.77 times more likely to report hearing impairment when compared to individuals not exposed to this agent. CONCLUSION: There was an association between hearing impairment and exposure to industrial dust in workers in the southern region of Brazil.

OBJETIVO: Investigar a associação entre dificuldade auditiva autorreferida e exposição ocupacional à poeira industrial em trabalhadores do sul do Brasil. MÉTODO: Trata-se de um estudo transversal analítico, realizado com dados do inquérito da Pesquisa Nacional de Saúde (2013). A variável dependente foi a dificuldade auditiva autorreferida e a variável independente principal foi a exposição ocupacional à poeira industrial. As covariáveis foram: sexo, cor da pele, idade em anos completos, exposição a ruído e exposição à substâncias químicas. As variáveis de exposição ocupacional a ruído e substâncias químicas foram utilizadas como variáveis de ajuste (variáveis de confusão) e as análises foram estratificadas por cada estado (Santa Catarina, Paraná e Rio Grande do Sul), com o intuito de verificar a diferença na magnitude dos resultados por região. Tanto para a análise bruta quanto para a ajustada, a razão de chance foi utilizada como medida de associação, estimada por meio da análise de regressão logística. Os dados foram analisados no software Stata, versão 14. RESULTADOS: Com relação a exposição principal, 10,1% da amostra (n=490) afirmou estar exposta à poeira industrial em ambiente ocupacional, ao passo que 7,0% afirmou ter dificuldade auditiva. Na análise final, trabalhadores expostos a poeira industrial apresentaram 1,77 vezes mais chance de mencionar dificuldade auditiva, quando comparados a indivíduos não expostos a este agente. CONCLUSÃO: Houve associação entre dificuldade auditiva e exposição à poeira industrial em trabalhadores da região Sul do Brasil.

Adherence to oral oncolytics filled through an internal health-system specialty pharmacy compared with external specialty pharmacies.

BACKGROUND: Oral oncolytics are becoming increasingly common in the treatment of solid and hematological malignancies. Medication adherence is especially important to ensure adequate drug levels to treat active malignancies, notably in curative-intent therapy. Further data are needed to quantify and confirm the effects of internal health-system specialty pharmacies (HSSPs) on medication adherence. OBJECTIVE: To confirm the effect of an internal HSSP compared with external specialty pharmacies on oncolytic adherence as measured by proportion of days covered (PDC), medication possession ratio (MPR), and time to treatment (TTT). METHODS: This single-center retrospective cohort study included patients receiving oral oncolytics through an internal HSSP or external specialty pharmacies between January 2019 and June 2020. Fill data were extracted from pharmacy claims databases and electronic medical records. The primary adherence outcome was patient-level PDC. Secondary adherence outcomes included patient-level MPR and TTT. For PDC and MPR analyses, patients with at least 3 fills per oncolytic were included. All patients were included for the TTT analysis. Chi-square or Fisher's exact tests were used to analyze categorical differences between pharmacy groups. Differences in continuous variables across pharmacy groups were evaluated using Wilcoxon rank-sum tests. RESULTS: 871 prescriptions met inclusion criteria: 549 patients were included in the PDC/MPR analysis, and 758 patients were included in the TTT analysis (patients might have multiple prescriptions). Patients who filled at an internal HSSP had a higher median PDC compared with those who filled at external specialty pharmacies (0.99 [IQR = 0.89-1.00] vs 0.91 [IQR = 0.76-0.98]; P < 0.01). The adherence rate as measured by MPR was higher for patients who used an internal HSSP compared with those who used external specialty pharmacies (MPR = 1.00 [IQR = 0.90-1.00] vs 0.93 [IQR = 0.76-1.00]; P < 0.01). Median TTT was lower for patients using the internal HSSP vs an external specialty pharmacy (5 days [IQR = 2-13] vs 27 days [IQR = 2-82], respectively; P < 0.01). CONCLUSIONS: Internal HSSP services improved adherence as measured by PDC and MPR. Significantly lower TTT was seen with the internal HSSP compared with external pharmacies. These data confirm and support use of internal HSSPs to dispense oral oncolytics for treatment of solid and hematological malignancies. DISCLOSURES: This study received no financial support. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The immunomodulatory activity of Chenopodium ambrosioides reduces the parasite burden and hepatic granulomatous inflammation in Schistosoma mansoni-infection.

ETHNOPHARMACOLOGICAL RELEVANCE: Folk medicine reports have described the use of Chenopodium ambrosioides as an anti-inflammatory, analgesic, and anthelmintic herb. These effects, including its activity against intestinal worms, are already scientifically observed. However, the immunological mechanisms of this species in the treatment of Schistosoma mansoni infection are unknown. AIM OF THE STUDY: To evaluate the immunological and anti-Schistosoma mansoni effects of a crude Chenopodium ambrosioides hydro-alcoholic extract (HCE). MATERIALS AND METHODS: For the in vitro analysis, cercariae and adult worms were exposed to different concentrations (0 to 10,000 µg/mL) of the HCE. For the in vivo evaluation, Swiss mice were infected with 50 cercariae of S. mansoni and separated into groups according to treatment as follows: a negative control (without treatment), a positive control (treated with Praziquantel®), HCE1 Group (treated with HCE during the cutaneous phase), HCE2 Group (treated with HCE during the lung phase), HCE3 Group (treated with HCE during the young worm phase), and HCE4 Group (treated with HCE during the adult worm phase). The animals treated with HCE received daily doses of 50 mg/kg, by gavage, for seven days, corresponding to the different developmental stages of S. mansoni. For comparison, a clean control group (uninfected and untreated) was also included. All animals were euthanized 60 days post-infection to allow the following assessments to be performed: a complete blood cells count, counts of eggs in the feces and liver, the quantification of cytokines and IgE levels, histopathological evaluations of the livers, and the analysis of inflammatory mediators. RESULTS: HCE treatment increased the mortality of cercariae and adult worms in vitro. The HCE treatment in vivo reduced the eggs in feces and liver. The number and area of liver granulomas, independent of the phase of treatment, were also reduced. The treatment with HCE reduced the percentage of circulating eosinophils, IgE, IFN-γ, TNF-α, and IL-4. In contrast, the treatment with the HCE, dependent on the phase, increased IL-10 levels and the number of peritoneal and bone marrow cells, mainly of T lymphocytes, B lymphocytes, and macrophages. This effect could be due to secondary compounds presents in this extract, such as kaempferol, quercetin and derivatives. CONCLUSIONS: This study demonstrates that Chenopodium ambrosioides has antiparasitic and immunomodulatory activity against the different phases of schistosomiasis, reducing the granulomatous inflammatory profile caused by the infection and, consequently, improving the disease prognosis.

Immunotherapy in Gliomas.

OBJECTIVES: To describe the immunotherapy approaches currently under investigation for the treatment of gliomas. To discuss the management of immune-related adverse effects. DATA SOURCES: Published literature, clinical trials, and oncology association guidance documents. CONCLUSION: There are numerous modalities of immune treatment currently being evaluated in patients with glioma, including peptide vaccines, dendritic cell vaccines, oncolytic viruses, CAR-T cells, and checkpoint inhibitor therapy. Immunotherapy utilizes new mechanisms of treatment that may lead us to the eradication of gliomas. IMPLICATIONS FOR NURSING PRACTICE: Immunotherapy is a rapidly growing field in the treatment of gliomas. Oncology nurses are often involved in the safe administration of these therapies, as well as the identification and management of immune-related toxicities.

Assessment of fibrosis and vascularization of bone marrow stroma of chronic myeloid Leukemia patients treated with imatinib mesylate and their relationship with the cytogenetic response / Avaliação da fibrose e vascularização do estroma da medula óssea de pacientes com leucemia mielóide crônica tratados com mesilato de imatinibe e sua relação com a resposta citogenética

Chronic Myeloid Leukemia (CML) is a myeloproliferative disease characterized by the presence of the Philadelphia chromosome (translocation between chromosomes 9 and 22), resulting in the formation of the hybrid BCR-ABL protein. Currently, the treatment of CML patients is performed with imatinib mesylate (IM), which promotes the elimination of leukemic cells by inhibiting the kinase activity of BCR-ABL. This study evaluated the effectiveness of IM by monitoring 22 CML patients in a chronic phase treated at the CEPON/SC with IM for a minimum follow-up period of two years. Cytogenetic Response (CR) and bone marrow biopsies (BMB) were evaluated before and after IM treatment. BMB were evaluated by detection of reticulin degree and vascularization. The results were correlated to the CR. Mean time to achieve CR was 9 months and was attained by 77.27 percent of the patients. The results from the initial BMB analysis showed that 59.09 percent presented reticulin of between 2+ and 4+ whereas after treatment, only 27.17 percent presented this degree. With regard to vascularization of the initial sample, 90.91 percent were graded between II and IV, whereas after treatment, 40.91 percent had this degree. The results suggest a positive correlation of degree of reticulin and vascularization with CR.

A Leucemia Mielóide Crônica (LMC) é uma doença mieloproliferativa caracterizada pela presença do cromossomo Filadélfia (translocação entre os cromossomos 9 e 22), que resulta na formação da proteína híbrida BCR-ABL. Atualmente o tratamento de pacientes com LMC é realizado com mesilato de imatinibe (MI), o qual promove a eliminação das células leucêmicas pela inibição da atividade quinase de BCR-ABL. O presente estudo avaliou a eficácia do MI por meio do acompanhamento de pacientes portadores de LMC em fase crônica, atendidos no CEPON/SC tratados com MI pelo tempo mínimo de dois anos. Foram avaliadas a Resposta Citogenética (RC) e as biópsias de medula óssea (BMO) antes e após o tratamento com MI. As BMO foram avaliadas quanto ao grau de reticulina e vascularização. Os resultados correlacionaram-se com a RC cujo tempo médio para obtenção da RC foi de 9 meses, sendo atingida por 77.27 por cento dos pacientes. Na primeira BMO, 59.09 por cento dos pacientes apresentaram grau de reticulina entre 2+ e 4+ e após o tratamento, apenas 27.17 por cento apresentaram esta graduação. Quanto à vascularização da primeira amostra, 90.91 por cento foram graduadas entre II e IV e após o tratamento, 40.91 por cento apresentaram esta graduação. Os resultados sugerem uma correlação diretamente proporcional entre os graus de reticulina e vascularização com a RC.