Exploring tea and herbal infusions consumption patterns and behaviours: The case of Portuguese consumers.

Consumption of tea and herbal infusions (THIs) have a long history in traditional medicine and cultural practices. The health-promoting benefits attributed to THIs are considered influential factors in consumer choices. However, there is limited data on consumer choices and attitudes that might interfere with the positive effects associated with THIs consumption. The aim of this study was to investigate the consumption pattern and behavior of THIs consumers in Portugal, assessing the influence of socio-demographic factors on the selection of THIs products and consumer practices related to these beverages. An online survey was conducted, and from the collected data, 720 responses met the aim of the study and were further analyzed. Most of the respondents were female, 74.4%, belonging to the 40-60 age group (40.6%) and were medium consumers of THIs (47.2%). Green tea was the most consumed type among participants, and its consumption was associated not only with age but also with the pattern of THIs consumption. Despite that, participants preferred herbal infusions, with citronella, chamomile, and lemon verbena being the most consumed types. For certain types of herbal infusions, consumption was associated with age, while other types were preferred by moderate or heavy consumers. Most participants purchased THIs in supermarkets, registered trademark and brand stores, in the form of THIs bag. Light consumers use only bag, while medium/heavy consumers indicated the use of other forms. Almost half of the respondents admitted to not reading the information on product labels before consumption and using THIs after the expiry date, while only one-third of them declared paying attention to the label instructions. This study revealed the impact of socio-demographic factors as age on the consumption patterns and preferences of THIs of consumers. Of concern is the neglect of label usage among Portuguese consumers. This emphasizes the urgency of implementing interventions to guide proper label use and promote good consumption practices to ensure the quality of THIs products.

Adherence to the Mediterranean diet in young male soccer players.

INTRODUCTION: Nutrition is vital in health and sports performance by improving anthropometric-related parameters and dietary habits, especially in the youngest ages. The Mediterranean diet (MD) has been highly recognized for its positive health effects and low adverse environmental impact. OBJECTIVES: We aimed to characterize adherence to the MD and analyze its association with anthropometric parameters in young soccer players. METHODOLOGY: In the present study, 132 male young soccer players from under 9 to under 15 categories (aged 7 to 15 years) from a Portuguese football club participated. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) questionnaire was applied to assess adherence to the MD. Anthropometric-related parameters, including body mass, height, triceps skinfold thickness (TSKF), suprailiac skinfold thickness (SISKF), body mass index (BMI) and body fat percentage (%BF), were determined. The differences between groups were performed accordingly to normal and non-normal distribution. Spearman's correlations were performed to analyze the hypothetical correlation between KIDMED and BMI. RESULTS: Players reached an average KIDMED score of 8.36 ± 1.92, showing that 68.2% (n = 90) reached high adherence to the MD, 31.1% (n = 41) had moderate adherence to the MD, and 0.78% (n = 1) had poor adherence to the MD. When the analysis was made for age group and BMI classification, no significant differences were observed in adherence to the MD. Considering the main characteristics of the MD, 50.8% consumed fruit (vs. 49,2%), 52.3% consumed vegetables (vs. 47,7%), and only 20% consumed oleaginous dried fruits (vs. 80%). Dairy consumption throughout the day was 49,2% (vs. no: 50,8%). CONCLUSION: Data from the present study showed that many soccer players adhered to the MD, and no differences were observed for age group or BMI classification.

Pharmacy on the front lines: A century of pandemic response in America.

The history of American pharmacy contributions to pandemic responses can be described for five pandemics: 1918 (influenza A/H1N1 virus), 1957-1958 (H2N2 virus), 1968 (H3N2 virus), 2009 (H1N1pdm09 virus), and 2019-2023 (syndrome coronavirus-2 virus). Using historical surveillance data and published literature, this article provides opportunities to reflect on how the pharmacy profession played a role in preparedness and response.

Chromatographic Methods for Detection and Quantification of Pyrrolizidine Alkaloids in Flora, Herbal Medicines, and Food: An Overview.

Pyrrolizidine alkaloids (PAs) are natural toxins produced by some plants that gained special interest due to their potential hazardous effects in humans and animals. These substances have been found in wild flora, herbal medicines and food products raising health concerns. Recently, maximum concentration levels of PAs were established for some food products; however, maximum daily intake frequently surpasses the upper limit set by the competent authorities posing a health risk. Given the scarcity or absence of occurrence data on PAs in many products, there is an urgent need to measure their levels and establish safety intake levels. Analytical methods have been reported to detect and quantify PAs in different matrices. The commonly used chromatographic methodologies provides accurate and reliable results. Analytical methods include diverse steps as extraction and sample preparation procedures that are critical for sensitivity and selectivity of the analytical method. Great efforts have been directed toward optimization of extraction procedures, clean up and chromatographic conditions to improve recovery, reduce matrix effects, and achieve low limits of detection and quantification. Therefore, this paper aims to give a general overview about the occurrence of PAs in flora, herbal medicines, and foodstuff; and discuss the different chromatographic methodologies used for PAs analysis, namely extraction and sample preparation procedures and chromatographic conditions.

Donor oocyte cycle characteristics and outcomes: factors potentially linked with successful endings.

OBJECTIVE: The use of donor oocytes in assisted reproduction has seen a significant rise worldwide in the last two decades. Postponement of motherhood and premature ovarian insufficiency are the main reasons for the increase in the number of in vitro fertilization cycles with donor oocytes. The present study aims to characterize donor oocyte cycles to analyze factors that may have an effect on live births and clinical pregnancy outcomes. METHODS: Data were obtained from a single Assisted Reproduction Center in southern Brazil. Recipient demographics (n=148 patients) and cycle characteristics (n=213 cycles; 50 patients did more than one IVF attempt) were analyzed. Statistical analysis was performed using chi-squared and t-test as appropriate. RESULTS: On average, recipients that reached gestation were significantly younger than the ones that did not. We also observed a significant positive effect of constant dose estrogen therapy on pregnancies. CONCLUSIONS: Patient age and response to estradiol therapy are important factors in the attainment of the best possible outcomes in cycles with donor oocytes.

Desafios do puerpério: visão de mulheres nas mídias sociais / Postpartum challenges: vision of women in social media / Desafíos posparto: visión de la mujer en las redes sociales

Objetivo: investigar, por meio das redes sociais, quais são os desafios das mulheres frente ao puerpério. Métodos: abordagem qualitativa do tipo etnografia, com 36 mulheres. Realizada em dois grupos do Facebook: 1) Página pública com 305.531 seguidores; 2) Grupo privado com 11.541 membros. Os grupos visavam troca de experiências, informações e apoio entre mães puérperas. Coleta de dados por meio de observação dos grupos e por instrumento eletrônico no modelo Google Forms. Utilizada análise de conteúdo. Resultados: na análise emergiram três categorias: cuidados e problemas de saúde no puerpério; aprender a viver depois ser mãe; e cuidar do recém-nascido. Conclusão: dentre os desafios da maternidade destacam-se: amamentação, banho do bebê, exaustão e privação do sono. Cabe à enfermagem a reflexão de como assistir mulheres que estão puerpério, considerando a tecnologia da informação, as mídias sociais e as necessidades individuais de cada uma, visando a promoção de experiência positiva neste período. (AU)

Objective: to investigate, through social network, what are the challenges of women facing the puerperium. Methods: qualitative approach of the ethnography type, with 36 women. Carried out in two Facebook groups: 1) Public page with 305,531 followers; 2) Private group with 11,541 members. The groups aimed at exchanging experiences, information and support among postpartum mothers. Data collection through observation of groups and electronic instrument in the Google Forms model. Used content analysis. Results: in the analysis, three categories emerged: care and health problems in the puerperium; learn to live after being a mother; and care for the newborn. Conclusion: among the challenges of motherhood, the following stand out: breastfeeding, bathing the baby, exhaustion and sleep deprivation. It is up to nursing to reflect on how to assist women who are in the puerperium, considering information technology, social media and the individual needs of each one, aiming at promoting a positive experience in this period. (AU)

Objetivo: investigar, a través de las redes sociales, cuáles son los desafíos de las mujeres frente al puerperio. Métodos: abordaje cualitativo del tipo etnografía, con 36 mujeres. Realizado en dos grupos de Facebook: 1) Página pública con 305.531 seguidores; 2) Grupo privado con 11.541 miembros. Los grupos tenían como objetivo el intercambio de experiencias, información y apoyo entre las madres posparto. Recopilación de datos mediante observación de grupos e instrumento electrónico en el modelo Google Forms. Análisis de contenido utilizado. Resultados: en el análisis surgieron tres categorías: cuidados y problemas de salud en el puerperio; aprender a vivir después de ser madre; y cuidar al recién nacido. Conclusión: entre los desafíos de la maternidad se destacan: amamantar, bañar al bebé, agotamiento y falta de sueño. Corresponde a la enfermería reflexionar sobre cómo asistir a la mujer que está en el puerperio, considerando la tecnología de la información, las redes sociales y las necesidades individuales de cada una, con el objetivo de promover una experiencia positiva en este período. (AU)

Tramadol and Tapentadol Induce Conditioned Place Preference with a Differential Impact on Rewarding Memory and Incubation of Craving.

Tramadol and tapentadol, synthetic opioids commonly prescribed for moderate-to-severe pain, have a unique pharmacology that optimizes their analgesia and safety. However, they are not devoid of risks, presenting addictive, abuse, and dependence potential. While tramadol-reinforcing properties have been documented by various studies with human and animal models, including conditioned place preference (CPP) assays, no similar studies have been performed with tapentadol. In the present study, we performed CPP assays by intraperitoneally administering Wistar rats with a tramadol/tapentadol therapeutic dose. Animal permanence and the number of entries in the CPP compartments were recorded in the preconditioning phase and then 1 (T1), 7 (T7), and 14 (T14) days after conditioning. Both opioids induced a change in place preference (T1), suggesting that they have short-term reinforcing properties. However, only tramadol was associated with place preference retention (T7 and T14), with an increase in the number of entries in the opioid-paired compartment (T1 and T7), showing that it causes rewarding memory and incubation of craving. The results indicate that at therapeutic doses: (1) both drugs cause short-term rewarding effects and (2) as opposed to tramadol, tapentadol does not cause CPP retention, despite its higher central nervous system activity and stricter scheduling.

Implantação de time de terapia intravenosa a partir de pesquisa convergente-assistencia / Implementation of an intravenous therapy team based on convergent-assistance research / Implementación de un equipo de terapia intravenosa basado en investigación convergente-asistencial

Objetivo: Implantar um time de terapia intravenosa em um hospital de grande porte. Método: Estudo de abordagem qualitativa realizado a partir de encontros de grupo de convergência, utilizando o referencial metodológico da pesquisa convergente-assistencial. Foram realizadas entrevis-tas semiestruturadas, a apuração dos dados obtidos por meio da análise de conteúdo e a formação de três categorias, que originaram os assuntos para a capacitação dos profissionais. Resultados: Participaram nove enfermeiros e, após a realização de quatro encontros de capacitação, foi implantado um time de terapia intravenosa e desenvolvido documento norteador para a execução do trabalho. Conclusão: O estudo resultou na implantação do time de terapia intravenosa em um hospital de grande porte a partir da pesquisa desenvolvida e da experiência de trabalho dos enfermeiros que atuam na prá-tica assistencial. O referencial metodológico possibilitou aos enfermeiros serem ouvidos enquanto promotores da ação e implementadores da inovação.Palavras-chave: Infecção hospitalar. Cateteres de demora. Infecções relacionadas a cateteres. Segurança do paciente.

Objective: To implement an intravenous therapy team in a large hospital. Method: Qualitative study carried out based on convergence group meetings, using the methodological framework of convergent-assistance research. Semi-structured interviews were carried out, data were collected through content analysis and three categories were formed, which originated the subjects for the training of professionals. Results: Nine nurses par-ticipated in the research and, after four training meetings, an intravenous therapy team was implemented and a guiding document was developed for carrying out the work. Conclusion: The study resulted in the implementation of an intravenous therapy team in a large hospital based on the research developed and the work experience of nurses who work in care practice. The methodological framework allowed nurses to be heard as promoters of action and implementers of innovation.

Objetivo: Implementar un equipo de terapia intravenosa en un gran hospital. Método: Estudio cualitativo realizado a partir de reuniones de grupos de convergencia, utilizando el marco metodológico de investigación convergente-asistencial. Fueron realizadas entrevistas semiestructuradas, reco-gida de datos a través del análisis de contenido y la formación de tres categorías, que originaron los temas para la formación de profesionales. Resultados:Participaron nueve enfermeros y, después de cuatro reuniones de capacitación, se implementó un equipo de terapia intravenosa y se elaboró un docu-mento guía para la realización del trabajo. Conclusión: El estudio resultó en la implementación de un equipo de terapia intravenosa en un hospital de gran porte a partir de la investigación desarrollada y la experiencia laboral de los enfermeros que actúan en la práctica asistencial. El marco metodológico permitió que los enfermeros sean escuchados como promotores de la acción e implementadores de la innovación.

Association between Elevated Iodine Intake and IQ among School Children in Portugal.

The goal of this work was to examine whether elevated iodine intake was associated with adverse effects on IQ among school-age children in Portugal. In a representative sample of children from the north of the country, IQ percentiles by age (assessed with Raven's Colored Progressive Matrices) were dichotomized to <50 ("below-average" IQs) and ≥50. Morning urine iodine concentrations, corrected for creatinine, were dichotomized to <250 µg/g and ≥250 µg/g, according to the European Commission/Scientific Committee on Food's tolerable upper level of daily iodine intake for young children. Data were examined with Chi-square tests, logistic regression, and GLM univariate analysis. The sample (N = 1965) was classified as generally iodine-adequate (median urinary iodine concentration = 129 µg/L; median iodine-to-creatinine ratio = 126 µg/g) according to the WHO's criteria. A greater proportion of children in the ≥250 µg/g group had below-average IQs, compared to children with less than 250 µg/g (p = 0.037), despite a sizable (though non-significant) proportion of children in the less-than-250 µg/g group also presenting below-average IQs, at the bottom of the iodine distribution (<50 µg/g). The proportion of below-average IQs increased with increasingly elevated iodine concentrations (p = 0.047). The association remained significant after the adjustment for confounders, with the elevated iodine group showing increased odds of having below-average IQs when compared with the non-elevated iodine group (OR 1.55; 95% CI 1.11−2.17; p = 0.011). Consistently, the former group presented a lower mean IQ than the latter (p = 0.006). High iodine intake was associated with lower IQs even in a population classified as iodine-adequate. These results bear on child cognition and on initiatives involving iodine supplementation.

Unhealthy Diets Induce Distinct and Regional Effects on Intestinal Inflammatory Signalling Pathways and Long-Lasting Metabolic Dysfunction in Rats.

The intestinal epithelium is a principal site for environmental agents' detection. Several inflammation- and stress-related signalling pathways have been identified as key players in these processes. However, it is still unclear how the chronic intake of inadequate nutrients triggers inflammatory signalling pathways in different intestinal regions. We aimed to evaluate the impact of unhealthy dietary patterns, starting at a younger age, and the association with metabolic dysfunction, intestinal inflammatory response, and obesity in adulthood. A rat model was used to evaluate the effects of the consumption of sugary beverages (HSD) and a Western diet (WD), composed of ultra-processed foods. Both diets showed a positive correlation with adiposity index, but a positive correlation was found between the HSD diet and the levels of blood glucose and triglycerides, whereas the WD diet correlated positively with triglyceride levels. Moreover, a distinct inflammatory response was associated with either the WD or HSD diets. The WD induced an increase in TLR2, TLR4, and nuclear factor-kappa B (NF-κB) intestinal gene expression, with higher levels in the colon and overexpression of the inducible nitric oxide synthase. In turn, the HSD diet induced activation of the TLR2-mediated NF-κB signalling pathway in the small intestine. Altogether, these findings support the concept that early intake of unhealthy foods and nutrients are a main exogenous signal for disturbances of intestinal immune mechanisms and in a region-specific manner, ultimately leading to obesity-related disorders in later life.

Early unhealthy eating habits underlie morpho-functional changes in the liver and adipose tissue in male rats.

Early-life consumption of high-fat and sugar-rich foods is recognized as a major contributor for the onset of metabolic dysfunction and its related disorders, including diabetes and nonalcoholic fatty liver disease. The lifelong impact of early unhealthy eating habits that start at younger ages remains unclear. Therefore, to better understand the effects of diet, it is essential to evaluate the structural and functional changes induced in metabolic organs and potential mechanisms underlying those changes. To investigate the long-term effects of eating habits, young male rats were exposed to high-sugar and high-energy diets. After 14 weeks, body composition was assessed, and histopathological changes were analyzed in the liver and adipose tissue. Serum biochemical parameters were also determined. Expression of inflammatory markers in the liver was evaluated by immunohistochemistry. Our results revealed that serum levels of glucose, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), and lipid profile were increased in rats red high-sugar and high-energy diets. Histopathological alterations were observed, including abnormal hepatocyte organization and lipid droplet accumulation in the liver, and abnormal structure of adipocytes. In both unhealthy diet groups, hepatic expression of Toll-like receptor 4 (TLR4), cyclooxygenase 2 (COX-2), and E-selectin were increased, as well as a biomarker of oxidative stress. Together, our data demonstrated that unhealthy diets induced functional and structural changes in the metabolic organs, suggesting that proinflammatory and oxidative stress mechanisms trigger the hepatic alterations and metabolic dysfunction.

Mulheres em situação de violência sexual: validação de um fluxograma / Women in situations of sexual violence: validation of a flowchart / Mujeres en situación de violencia sexual: validación de un diagrama de flujo

Objetivo: Validar um Fluxograma para Atendimento à Mulher em Situação de Violência Sexual. Métodos: Estudo metodológico de validação de conteúdo por meio da técnica Delphi. Constituíram a amostra do estudo 14 juízes selecionados intencionalmente. O instrumento de coleta foi um formulário e a coleta de dados ocorreu no período de janeiro a fevereiro de 2020. Análise estatística, para verificar a concordância realizou-se por meio do Índice de Validade de Conteúdo e, para a confiabilidade da concordância da avaliação foi utilizado o índice Kappa (K). Resultados: Os itens validados, na parte 1 do fluxograma, apresentaram Kappa de 100% na relevância, concordância 85,71% e clareza 63,74%. Já o Índice de Validade de Conteúdo na relevância e concordância foi de 100%; e clareza 0,78%. Na parte 2, o Kappa foi de 73,63% na relevância, concordância 85,71% e clareza 100%. O Índice de Validade de Conteúdo na relevância, concordância e clareza de 100%. E na parte 3, a relevância apresentou Kappa de 85,71%, concordância 100% e clareza 63,74%. O Índice de Validade de Conteúdo na relevância e concordância foi de 100% e clareza 0,78%. Conclusão: A validação do Fluxograma possibilita a integralidade no atendimento por meio da articulação dos serviços intersetoriais e por sua vez estruturar a rede de atendimento. (AU)

Objective: To validate a Flowchart for Care of Women in Situations of Sexual Violence. Methods: Methodological study of content validation using the Delphi technique. The study sample consisted of 14 intentionally selected judges. The collection instrument was a form and data collection occurred from January to February 2020. Statistical analysis, to verify the agreement was performed through the Content Validity Index and, for the reliability of the agreement of the evaluation, the Kappa index (K) was used. Results: The validated items, in part 1 of the flowchart, presented Kappa of 100% in relevance, agreement 85.71% and clarity 63.74%. The Content Validity Index in relevance and agreement was 100%; and clarity 0.78%. In part 2, kappa was 73.63% in relevance, agreement 85.71% and clarity 100%. The Content Validity Index in relevance, agreement and clarity of 100%. And in part 3, the relevance presented Kappa of 85.71%, 100% agreement and clarity 63.74%. The Content Validity Index in relevance and agreement was 100% and clarity 0.78%. Conclusion: The validation of the Flowchart enables integrality in care through the articulation of intersectoral services and in turn to structure the service network. (AU)

Objetivo: Validar un Diagrama de Flujo para la Atención a Mujeres en Situación de Violencia Sexual. Métodos: Estudio metodológico de validación de contenido mediante la técnica Delphi. La muestra del estudio consistió en 14 jueces intencionalmente seleccionados. El instrumento de recolección fue un formulario y la recolección de datos ocurrió de enero a febrero de 2020. El análisis estadístico, para verificar el acuerdo se realizó a través del Índice de Validez de Contenido y, para la confiabilidad de la concordancia de la evaluación, se utilizó el índice Kappa (K). Resultados: Los ítems validados, en la parte 1 del diagrama de flujo, presentaron Kappa de 100% en relevancia, concordancia 85,71% y claridad 63,74%. El Índice de Validez de Contenido en relevancia y acuerdo fue del 100%; y claridad 0,78%. En la parte 2, kappa fue 73,63% en relevancia, concordancia 85,71% y claridad 100%. El Índice de Validez de Contenido en relevancia, acuerdo y claridad del 100%. Y en la parte 3, la relevancia presentada Kappa de 85.71%, 100% de acuerdo y claridad 63.74%. El Índice de Validez de Contenido en relevancia y acuerdo fue del 100% y la claridad del 0,78%. Conclusión: La validación del Diagrama de Flujo permite la integralidad en el cuidado a través de la articulación de servicios intersectoriales y a su vez estructurar la red de servicios. (AU)

Gut Microbiome Composition and Metabolic Status Are Differently Affected by Early Exposure to Unhealthy Diets in a Rat Model.

Childhood is a critical stage of development during which diet can have profound influence on the microbiota-host interactions, leading to potentially lifelong impacts. This study aimed to investigate whether the consumption of cafeteria diet (CAFD) and sugary drinks during early rat life alters the structure of the gut microbial community and the metabolic activity. Four-week-old male Wistar rats (n = 27) were fed a standard chow diet with ad libitum access to water (CD) or to sucrose solution (HSD), and a third group was fed with CAFD and a sucrose solution for 14 weeks. HSD and CAFD consumption induced alterations in Firmicutes to Bacteroidetes ratio, Proteobacteria, and Verrucomicrobia. HSD increased the abundance of Barnesiella, whereas CAFD induced a depletion of Saccharibacteria. CAFD increased total white adipose tissue (WAT) weight (p < 0.0005) compared to CD. When CAFD was compared to HSD, a significant difference was found only for retroperitoneal WAT (p < 0.0005). Unhealthy diet-fed groups presented higher glucose (p < 0.0005), total cholesterol and creatinine serum levels (p < 0.005) compared to the CD rats. Early-life consumption of HSD, and of CAFD even more so, can have long-lasting negative effects on metabolic function. The gut microbiota communities were distinctively perturbed by diet composition.

Nursing care for patient in post operatory heart surgery in the Intensive Care Unit.

OBJECTIVE: To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery. METHODS: Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis. RESULTS: Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery. FINAL CONSIDERATIONS: Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.

Development and validation of a liquid chromatography method using UV/fluorescence detection for the quantitative determination of metabolites of the kynurenine pathway in human urine: Application to patients with heart failure.

Recent evidence indicates the relevant role of the tryptophan (TRP) metabolites in the pathophysiology of cardiovascular diseases via inflammatory and oxidative stress mechanisms. Therefore, quantification of TRP and its metabolites in biological samples can be a powerful tool to elucidate the disease mechanisms. The aim of this work was to develop and validate a liquid chromatography with ultraviolet (UV) and fluorescence detection (FD) (LCUV/FD) method for the quantification of TRP and its metabolites (L-kynurenine (KYN) and kynurenic acid (KA)) in urine samples from heart failure (HF) patients. Biochemical parameters and inflammatory markers were quantified, and data correlated with urinary concentrations of TRP and its metabolites. Optimized chromatographic conditions were achieved using a Luna® 3 µm PFP(2) analytical column, a mobile phase of 20 mM of ammonium formate in ultra-pure water (with 0.01 % of formic acid), acetonitrile and ethanol (95/2/3, v/v/v), a flow rate of 0.7 mL/min and a column oven temperature set at 25 °C. The method was validated according to the European Medicines Agency (EMA) guidelines and showed to be linear (r2 >0.99), accurate (82-116%) and precise (%RSD below 15 %). The limits of quantification varied between 50 and 125 ng/mL. The method was applied to the quantification of TRP, KYN and KA in healthy volunteers and male HF patients. The results obtained through this pilot study (small group of patients) showed a relationship between biochemical parameters, inflammatory markers and changes in the concentration of TRP, KYN and KA. The KYN/TRP and KA/KYN ratios were calculated. Results support the hypothesis that KYN/TRP ratio is related with enzymatic activity and that KA/KYN ratio can be a good neuroprotection indicator. The potential of the LCUV/FD method for the monitoring of the selected compounds in cardiac patients was also demonstrated.

How Should Physicians and Pharmacists Collaborate to Motivate Health Equity in Underserved Communities?

Physicians, pharmacists, and other health professionals play an important role in addressing social determinants of health and health disparities. Pharmacists have been addressing social determinants of health for years in all populations that experience health disparities by working as vital members of their communities and interacting on a regular basis with patients. The case presented in this article highlights social determinants' roles in health outcomes and how pharmacists contribute to improving them. In collaboration, pharmacists and physicians can help reduce costs and optimize health outcomes.

Repeated Administration of Clinically Relevant Doses of the Prescription Opioids Tramadol and Tapentadol Causes Lung, Cardiac, and Brain Toxicity in Wistar Rats.

Tramadol and tapentadol, two structurally related synthetic opioid analgesics, are widely prescribed due to the enhanced therapeutic profiles resulting from the synergistic combination between µ-opioid receptor (MOR) activation and monoamine reuptake inhibition. However, the number of adverse reactions has been growing along with their increasing use and misuse. The potential toxicological mechanisms for these drugs are not completely understood, especially for tapentadol, owing to its shorter market history. Therefore, in the present study, we aimed to comparatively assess the putative lung, cardiac, and brain cortex toxicological damage elicited by the repeated exposure to therapeutic doses of both prescription opioids. To this purpose, male Wistar rats were intraperitoneally injected with single daily doses of 10, 25, and 50 mg/kg tramadol or tapentadol, corresponding to a standard analgesic dose, an intermediate dose, and the maximum recommended daily dose, respectively, for 14 consecutive days. Such treatment was found to lead mainly to lipid peroxidation and inflammation in lung and brain cortex tissues, as shown through augmented thiobarbituric acid reactive substances (TBARS), as well as to increased serum inflammation biomarkers, such as C reactive protein (CRP) and tumor necrosis factor-α (TNF-α). Cardiomyocyte integrity was also shown to be affected, since both opioids incremented serum lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) activities, while tapentadol was associated with increased serum creatine kinase muscle brain (CK-MB) isoform activity. In turn, the analysis of metabolic parameters in brain cortex tissue revealed increased lactate concentration upon exposure to both drugs, as well as augmented LDH and creatine kinase (CK) activities following tapentadol treatment. In addition, pneumo- and cardiotoxicity biomarkers were quantified at the gene level, while neurotoxicity biomarkers were quantified both at the gene and protein levels; changes in their expression correlate with the oxidative stress, inflammatory, metabolic, and histopathological changes that were detected. Hematoxylin and eosin (H & E) staining revealed several histopathological alterations, including alveolar collapse and destruction in lung sections, inflammatory infiltrates, altered cardiomyocytes and loss of striation in heart sections, degenerated neurons, and accumulation of glial and microglial cells in brain cortex sections. In turn, Masson's trichrome staining confirmed fibrous tissue deposition in cardiac tissue. Taken as a whole, these results show that the repeated administration of both prescription opioids extends the dose range for which toxicological injury is observed to lower therapeutic doses. They also reinforce previous assumptions that tramadol and tapentadol are not devoid of toxicological risk even at clinical doses.

Nursing care for patient in post operatory heart surgery in the Intensive Care Unit / Cuidados de enfermería al paciente en el postoperatorio de cirugía cardíaca, en la Unidad de Cuidados Intensivos / Cuidados de enfermagem ao paciente no pósoperatório de cirurgia cardíaca, na Unidade de Terapia Intensiva

ABSTRACT Objective: To investigate the critical nodes related to nursing care for patients in the postoperative period of cardiac surgery. Methods: Exploratory study with a qualitative approach. Data collected through semi-structured interviews with 27 members of the nursing team working in the Intensive Care Unit. Material submitted to thematic analysis. Results: Three categories emerged: Flaws in the professional qualification for patient care in the postoperative period of cardiac surgery; Team challenges concerning specific patient care in the postoperative period of cardiac surgery; and (dis) organization of work in the Intensive Care Unit and its impact on nursing care for patients in the postoperative period of cardiac surgery. Final considerations: Given the identification of the critical nodes, the professionals presented suggestions to overcome daily difficulties: investments in strategies for Permanent Education in Health; creation of tools to guide patient assistance in the postoperative of cardiac surgery; and provision of adequate human resources.

RESUMEN Objetivo: Investigar nudos críticos relacionados al cuidado de enfermería al paciente en postoperatorio de cirugía cardíaca. Métodos: Estudio exploratorio con abordaje cualitativo. Datos recogidos por medio de entrevista semiestructurada con 27 integrantes del equipo de enfermería, actuantes en Unidad de Cuidados Intensivos. Material sometido al análisis temático. Resultados: Emergieron tres categorías: Fragilidades en cualificación profesional para el cuidado al paciente en postoperatorio de cirugía cardíaca; Desafíos del equipo en relación a los cuidados específicos al paciente en postoperatorio de cirugía cardíaca; y La (des)organización del trabajo en Unidad de Cuidados Intensivos y su repercusión en el cuidado de enfermería al paciente en postoperatorio de cirugía cardíaca. Consideraciones finales: Delante la identificación de nudos críticos, los profesionales presentaron sugestiones para suplir dificultades cotidianas: inversiones en estrategias de Educación Permanente en Salud; creación de instrumentos que orienten la asistencia al paciente en postoperatorio de cirugía cardíaca; y provisión de recursos humanos adecuados.

RESUMO Objetivo: Investigar os nós críticos relacionados ao cuidado de enfermagem ao paciente no pósoperatório de cirurgia cardíaca. Métodos: Estudo exploratório com abordagem qualitativa. Dados coletados por meio de entrevista semiestruturada com 27 integrantes da equipe de enfermagem, atuantes na Unidade de Terapia Intensiva. Material submetido à análise temática. Resultados: Emergiram três categorias: Fragilidades na qualificação profissional para o cuidado ao paciente no pós-operatório de cirurgia cardíaca; Desafios da equipe em relação aos cuidados específicos ao paciente no pós-operatório de cirurgia cardíaca; e A (des)organização do trabalho na Unidade de Terapia Intensiva e sua repercussão no cuidado de enfermagem ao paciente no pósoperatório de cirurgia cardíaca. Considerações finais: Diante da identificação dos nós críticos, os profissionais apresentaram sugestões para suprir dificuldades cotidianas: investimentos em estratégias de Educação Permanente em Saúde; criação de instrumentos que orientem a assistência ao paciente em pós-operatório de cirurgia cardíaca; e provisão de recursos humanos adequados.