Evaluation of muscle loss by ultrasonography in critically ill patients.

BACKGROUND: Critically ill patients have intense muscle tissue mobilization, and attenuating protein catabolism may contribute to improved outcomes. OBJECTIVE: To evaluate short-term muscle loss in critically ill patients. METHODS: In this prospective observational study, we evaluated the thickness of the rectus femoris muscle by ultrasonography in young and older adults of both sexes admitted to a cardiological intensive care unit within 48 h of admission (baseline) and after 7 days. The results were compared and correlated with anthropometric, clinical, and biochemical parameters. The significance level for all statistical analyses was 0.05. RESULTS: The final sample comprised 88 patients with a mean age of 66.2 ± 11.8 years. There was an average 13.5% reduction in rectus femoris muscle thickness over the study period (P < 0.001), regardless of the thigh circumference maintenance (P = 0.229). This reduction occurred even with improved clinical parameters (C-reactive protein, Simplified Acute Physiology Score) and was greater in patients receiving mechanical ventilation and sedation and in those who died. Regarding nutrition status, malnourished and eutrophic individuals showed greater muscle loss than overweight individuals. There was also an inverse correlation of muscle loss (percentage) with body mass index, arm circumference, and calf circumference (P < 0.05), demonstrating that the lower these anthropometric measurements, the higher the muscle loss obtained by ultrasound. CONCLUSION: Ultrasonography assessment detected muscle mass loss in the short-term more sensitively than the anthropometric method. However, it demands caution and further studies demonstrating this analysis.

The effect of dechitinization on iron absorption from mealworm larvae (Tenebrio molitor) flour added to maize meals: stable-isotope studies in young females with low iron stores.

BACKGROUND: Edible insects have a low ecological footprint and could serve as an alternative dietary iron source. However, chitin, a major component of insects, avidly binds iron and might inhibit iron absorption. OBJECTIVES: We aimed to measure fractional iron absorption (FIA) from Tenebrio molitor-based test meals with and without dechitinization, and to assess the effect of native and low chitin T. molitor on FIA from iron-fortified maize porridge. METHODS: We measured iron absorption in young females with low iron stores (n = 21) from 1) labeled (54FeSO4) fortified maize porridge (maize alone); 2) intrinsically labeled (57Fe added during rearing) T. molitor larvae with native chitin content (NC) added to maize alone; and 3) dechitinized intrinsically labeled (57Fe) T. molitor larvae with low chitin content (LC) added to maize alone. We determined FIA using erythrocyte isotope incorporation and measured in vitro iron dialyzability from the 3 meals. RESULTS: NC and LC T. molitor had similar mean ± SD iron content (12.0 ± 0.1 mg/100 g). Geometric mean (95% CI) FIAs from the 3 test meals were 1) maize alone: 5.8% (3.2%, 10.8%); 2) maize + NC T. molitor: 5.3% (2.5%, 11.3%) and 4.1% (1.9%, 8.7%); and 3) maize + LC T. molitor: 4.6% (2.0%, 10.3%) and 4.0% (1.8%, 9.2%), for extrinsic and intrinsic labels, respectively. FIA from NC and LC T. molitor did not significantly differ, and both were lower (P < 0.005) than FIA from the labeled maize porridge in the 3 meals, which did not significantly differ. The slopes of the relations between FIA and serum ferritin in the different meals and from the intrinsic and extrinsic labels did not significantly differ. CONCLUSIONS: T. molitor biomass does not strongly affect iron absorption when added to maize porridge. Our data suggest T. molitor iron is absorbed from the common nonheme iron pool. Native T. molitor is high in iron which is moderately well absorbed, suggesting it could be a valuable dietary iron source.This trial was registered at clinicaltrials.gov as NCT04510831.

Overexpression of cotton genes GhDIR4 and GhPRXIIB in Arabidopsis thaliana improves plant resistance to root-knot nematode (Meloidogyne incognita) infection.

Gossypium hirsutum L. represents the best cotton species for fiber production, thus computing the largest cultivated area worldwide. Meloidogyne incognita is a root-knot nematode (RKN) and one of the most important species of Meloidogyne genus, which has a wide host range, including cotton plants. Phytonematode infestations can only be partially controlled by conventional agricultural methods, therefore, more effective strategies to improve cotton resistance to M. incognita disease are highly desirable. The present study employed functional genomics to validate the involvement of two previously identified candidate genes, encoding dirigent protein 4-GhDIR4 and peroxiredoxin-2-GhPRXIIB, in cotton defense against M. incognita. Transgenic A. thaliana plant lines overexpressing GhDIR4 and GhPRXIIB genes were generated and displayed significantly improved resistance against M. incognita infection in terms of female nematode abundance in the roots when compared to wild-type control plants. For our best target-gene GhDIR4, an in-silico functional analysis, including multiple sequence alignment, phylogenetic relationship, and search for specific protein motifs unveiled potential orthologs in other relevant crop plants, including monocots and dicots. Our findings provide valuable information for further understanding the roles of GhDIR and GhPRXIIB genes in cotton defense response against RKN nematode. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-022-03282-4.

Cancer patients in Palliative Care: occurrences related to venipuncture and hypodermoclysis. / Pacientes oncológicos sob cuidados paliativos: ocorrências relacionadas à punção venosa e hipodermóclise.

OBJECTIVE: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. METHOD: an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. RESULTS: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). CONCLUSION: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.

Epidemiological profile and temporal trend of exogenous intoxications in children and adolescents.

OBJECTIVE: To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0-19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015. METHODS: Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis. RESULTS: There were 5,539 cases of exogenous intoxication in individuals aged 0-19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0-9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1-25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period. CONCLUSIONS: The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Growth and Persistence of an Aerobic Microbial Community in Wyoming Bentonite MX-80 Despite Anoxic in situ Conditions.

Microbial activity has the potential to enhance the corrosion of high-level radioactive waste disposal canisters, which, in the proposed Swiss deep geological repository, will be embedded in bentonite and placed in the Opalinus Clay (OPA) rock formation. A total of 12 stainless steel cylindrical vessels (referred to as modules) containing bentonite were deployed in an anoxic borehole in OPA for up to 5.5 years. Carbon steel coupons were embedded in the bentonite. Individual modules were retrieved after 1, 1.5, 2.5, and 5.5 years. Enumeration of aerobic and anaerobic heterotrophs and sulfate-reducing bacteria (SRB) revealed microbial growth for 1.5 years followed by a decline or stagnation in microbial viability. It was surprising to observe the growth of aerobic heterotrophs followed by their persistent viability in bentonite, despite the nominally anoxic conditions. In contrast, SRB numbers remained at very low levels. DNA-based amplicon sequencing confirmed the persistence of aerobes and the relatively low contribution of anaerobes to the bentonite microbiome. Bentonite dry density, in situ exposure time, and bioavailable trapped oxygen are observed to shape the bentonite microbial community in the clay.

Science Diplomacy and COVID-19: Future Perspectives for South-South Cooperation.

Apart from economic, political, and cultural cooperation for an equal growth of all developing countries, science and technology are an integral significant component in these levels of engagement for leveraging mutual gains. The current pandemic not only brought about an 1800 shift in the relationship between the government, policy makers, and the scientific community but highlights the importance of South-South Cooperation (SSC). SSC may serve as a mode of cooperation to foster the transfer of need-based technologies among developing and least developing countries and open many fronts for mutual sharing in terms of geopolitical, available resources, and expertise. The cooperation under the SSC does not substitute but complements North-South development cooperation to achieve the Sustainable Development Goals (SDGs). The use of science diplomacy would be an effective tool to bring all the stakeholders of the Global South to a common platform to combat future global challenges. Science policy instruments would need to incorporate scope for international collaborations as a means of furthering the national and global imperatives.

Epidemiological profile and temporal trend of exogenous intoxications in children and adolescents / Perfil epidemiológico e tendência temporal de intoxicações exógenas em crianças e adolescentes

Abstract Objective: To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0-19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015. Methods: Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis. Results: There were 5,539 cases of exogenous intoxication in individuals aged 0-19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0-9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1-25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period. Conclusions: The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Resumo Objetivo: Descrever o perfil epidemiológico e analisar a tendência da taxa de incidência por intoxicações exógenas ocorridas em crianças e adolescentes (0-19 anos) em Arapiraca, Alagoas, Brasil, no período de 2007 a 2015. Métodos: Realizou-se um estudo observacional com dados extraídos do Sistema de Informações de Agravos de Notificação. No componente descritivo, foram analisadas as variáveis sexo, faixa etária, agente tóxico e circunstância mediante estatística descritiva (frequência). Para a análise temporal, foram calculadas as taxas de incidência/10 mil habitantes e foi utilizado o modelo de regressão por pontos de inflexão para a análise. Resultados: Ocorreram 5.539 casos de intoxicações exógenas em indivíduos de 0 a 19 anos em Arapiraca (AL), dos quais 53,1% (n=2.944) eram do sexo feminino e 61,5% (n=3.405) eram crianças de 0 a 9 anos. Os principais agentes responsáveis pelas intoxicações foram medicamentos (28,5%; n=1.580) e a circunstância frequente foi uso acidental (18,2%; n=1.010). Houve variação do coeficiente de incidência geral, o qual apresentou comportamento temporal crescente (average annual percent change: 12,7; intervalo de confiança — IC95% 1,1-25,6; p<0,001) e cuja taxa passou de 56,52/10.000 habitantes para 56,64/10.000 habitantes. A incidência de casos, no sexo feminino, passou de 57,34/10.000 habitantes para 62,27/10.000 habitantes e apresentou tendência crescente. Já no sexo masculino, a incidência de casos passou de 55,69/10.000 habitantes para 50,99/10.000 habitantes e apresentou comportamento temporal estacionário. Conclusões: O estudo demonstrou maior frequência de casos no sexo feminino, na faixa de 0 a 4 anos, e tendência crescente da taxa de incidência. Recomenda-se a implementação de ações e estratégias, com destaque para a educação em saúde, a fim de prevenir casos de intoxicação exógena.

Epidemiological and clinical profile and trend analysis of hospitalizations for fall-related injuries among older adults, Alagoas (Brazil), 2008­2019 / Perfil epidemiológico e clínico e tendência temporal de internações por quedas em idosos, Alagoas (Brasil), 2008­2019

Objective: To analyze the epidemiological and clinical profile and the time trend of hospitalizations for fall-related injuries among older people (aged 60 years or older) in Alagoas between 2008 and 2019. Methods: This is a time series study with data collected from the Hospital Information System of the Unified National Health System (SIHSUS) referring to hospitalizations for fallrelated injuries among older adults in Alagoas (Brazil) between 2008 and 2019. Hospitalization and lethality rates, average annual percent change (AAPC), and annual percent change (APC) were calculated; time trends were analyzed using a Joinpoint Regression Model according to sex, skin color, age range, and causes. A 95% confidence interval (95%CI) was adopted. A p-value<0.01 was adopted for defining statistical significance. Results: In Alagoas, 14 817 cases of hospitalizations due to fall-related injuries were reported among older people in the analyzed period. The highest incidence rate was observed in 2016 (48.39/10 000 inhabitants). There were 517 deaths, and the mean lethality rate was 3.4%. A higher proportion of cases was seen in men (66.36%; n=9832), those aged 80 years or older(34.59%; n=5125), and with Brown skin (54.70%; n=8106). The incidence coefficient varied, showing an upward trend with time (APC: 4.1; 95%CI 0.2­8.2; p<0.01). Conclusion: The study showed a higher incidence in individuals aged 80 years or older, men, and found an upward trend in hospitalizations. We suggest the'

Objetivo: Analisar o perfil epidemiológico e clínico e a tendência temporal das internações por quedas em idosos de 60 anos ou mais, ocorridas em Alagoas, no período de 2008­2019. Metodologia: Realizou-se um estudo de séries temporais com dados coletados no Sistema de Informações Hospitalares do Sistema Único de Saúde, referentes a internações por quedas em idosos de 60 anos ou mais em Alagoas (Brasil), entre 2008 e 2019. Foram calculadas as taxas de incidência de internação e letalidade, a variação percentual anual média (AAPC) e a variação anual percentual (APC). A tendência foi analisada pelo modelo de regressão por pontos de inflexão (joinpoint regression model) segundo sexo, cor, faixa etária e categoria de causas. Adotou-se intervalo de confiança de 95% (IC95%) e, para análise do nível de significância estatística, valor de p < 0,01. Resultados: Foram notificados 14.817 casos de internações por quedas em idosos de 60 anos ou mais no período analisado, em Alagoas. A maior taxa de incidência ocorreu em 2016 (48,39/10 mil habitantes). Ocorreram 517 óbitos, e a taxa média de letalidade foi de 3,4%. Verificou-se maior proporção de casos no sexo masculino (66,36%; n = 9.832), na faixa etária de 80 anos (34,59%; n = 5.125) e na cor parda (54,70%; n = 8.106). Houve variação do coeficiente de incidência, o qual apresentou comportamento temporal crescente (APC: 4,1; IC95% de 0,2 a 8,2; p < 0,01). Conclusão: O estudo mostrou maior incidência na faixa etária de 80 anos ou mais no período analisado, maior frequência no sexo masculino e tendência crescente de internações. Sugere-se otimizar a assistência hospitalar e incentivar programas de prevenção de quedas em idosos.

Pacientes oncológicos sob cuidados paliativos: ocorrências relacionadas à punção venosa e hipodermóclise / Cancer patients in Palliative Care: occurrences related to venipuncture and hypodermoclysis / Pacientes con cáncer en cuidados paliativos: eventos relacionados con la venopunción y la hipodermoclisis

Resumo Objetivo: identificar as ocorrências relacionadas à punção venosa periférica e à hipodermóclise entre pacientes internados em um hospital geral e em um hospital exclusivo de assistência a pacientes em cuidados paliativos oncológicos. Método: estudo observacional, descritivo e multicêntrico. A amostra do tipo consecutiva e não probabilística foi constituída por 160 pacientes oncológicos internados sob cuidados paliativos. A variável desfecho correspondeu às ocorrências e complicações relacionadas a cada tipo de punção. Utilizou-se um questionário contendo as variáveis sociodemográficas e clínicas e um roteiro estruturado para acompanhamento e avaliação diária da punção. Foram utilizadas estatísticas descritivas para a análise dos dados. Resultados: as ocorrências relacionadas à punção venosa no hospital geral foram sujidade de sangue na inserção do cateter (17,4 %) e prazo de uso expirado (15,8%), enquanto no serviço específico para atendimento a pacientes sob cuidados paliativos foram prazo de uso expirado (32%) seguido de infiltração (18,9%). Quanto à hipodermóclise, foram duas punções subcutâneas com sinais flogísticos (1,0%) no hospital geral e um hematoma no local de inserção do cateter (0,5%). No serviço específico para atendimento a pacientes sob cuidados paliativos foram três punções subcutâneas com sinais flogísticos (5,7%). Conclusão: as ocorrências relacionadas à punção venosa periférica foram superiores às relacionadas à hipodermóclise.

Abstract Objective: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. Method: an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. Results: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). Conclusion: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.

Resumen Objetivo: identificar los eventos relacionados con la venopunción periférica y la hipodermoclisis en pacientes hospitalizados en un hospital general y en un hospital que atiende exclusivamente a pacientes en cuidados paliativos oncológicos. Método: estudio observacional, descriptivo y multicéntrico. La muestra consecutiva y no probabilística estuvo compuesta por 160 pacientes oncológicos hospitalizados que reciben cuidados paliativos. La variable resultado correspondió a los eventos y complicaciones relacionados con cada tipo de punción. Se utilizó un cuestionario con variables sociodemográficas y clínicas y una guía estructurada para el seguimiento diario y la evaluación de la punción. Se utilizó estadística descriptiva para el análisis de datos. Resultados: los eventos relacionados con la venopunción en un hospital general fueron contaminación de sangre en la inserción del catéter (17,4%) y catéter vencido (15,8%), mientras que en un hospital específico que atiende exclusivamente a pacientes en cuidados paliativos oncológicos fueron catéter vencido (32%) seguido de infiltración (18,9%). En cuanto a la hipodermoclisis, hubo dos punciones subcutáneas con signos flogísticos (1,0%) en hospital general y un hematoma en el lugar de inserción del catéter (0,5%). En el hospital en un hospital que atiende exclusivamente a pacientes en cuidados paliativos oncológicos hubo tres punciones subcutáneas con signos flogísticos (5,7%). Conclusión: los eventos relacionados con la venopunción periférica fueron mayores que los relacionados con la hipodermoclisis.

Experimental evolution of cowpea mild mottle virus reveals recombination-driven reduction in virulence accompanied by increases in diversity and viral fitness.

Major themes in pathogen evolution are emergence, evolution of virulence, host adaptation and the processes that underlie them. RNA viruses are of particular interest due to their rapid evolution. The in vivo molecular evolution of an RNA plant virus was demonstrated here using a necrotic isolate of cowpea mild mottle virus (CPMMV) and a susceptible soybean genotype submitted to serial inoculations. We show that the virus lost the capacity to cause necrosis after six passages through the host plant. When a severe bottleneck was imposed, virulence reduction occurred in the second passage. The change to milder symptoms had fitness benefits for the virus (higher RNA accumulation) and for its vector, the whitefly Bemisia tabaci. Genetic polymorphisms were highest in ORF1 (viral replicase) and were independent of the symptom pattern. Recombination was a major contributor to this diversity - even with the strong genetic bottleneck, recombination events and hot spots were detected within ORF1. Virulence reduction was associated with different sites in ORF1 associated to recombination events in both experiments. Overall, the results demonstrate that the reduction in virulence was a consequence of the emergence of new variants, driven by recombination. Besides providing details of the evolutionary mechanisms behind a reduction in virulence and its effect under viral and vector fitness, we propose that this recombination-driven switch in virulence allows the pathogen to rapidly adapt to a new host and, potentially, switch back.

Análise ultrassonográfica do quadríceps femoral de pacientes críticos sob ventilação mecânica / Ultrasound analysis of the quadricepsfemoris of critically ill patients on mechanical ventilation

Resumo Introdução: Devido aos diversos danos gerados pela imobilidade no leito, faz-se necessária uma avaliação precoce do estado muscular dos pacientes críticos. Objetivo: Comparar as imagens ultrassonográficas e correlacionar a espessura muscular com a ecointensidade do músculo reto femoral (RF) e vasto intermédio (VI) em 48 horas e com 7 dias de ventilação mecânica invasiva (VMI). Métodos: Trata-se de um estudo observacional prospectivo, com 53 imagens obtidas numa Unidade de Terapia Intensiva. Resultados: Houve redução na espessura muscular de RF, VI e espessura total. Observamos uma correlação negativa entre a espessura muscular e ecointensidade do RF nas primeiras 48 horas e 7 dias após a VMI. Já em relação ao VI, não observamos associação da espessura do VI com a ecointensidade nesse mesmo período. Conclusão: Evidenciamos uma relevante redução na espessura muscular do RF, VI e espessura total do quadríceps. Observamos uma alteração na composição da fibra muscular do RF, entretanto este comportamento não foi evidenciado no músculo VI.

Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope.

PURPOSE: This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. METHODS: We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. RESULTS: This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. CONCLUSIONS: The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.

HEPATOPROTECTIVE EFFICACY OF METHANOLIC EXTRACT OF INDIGOFERA SUFFRUTICOSA (MILL) ON PARACETAMOL-INDUCED LIVER DAMAGE IN MICE.

BACKGROUND: Indigofera suffruticosa Mill (Fabaceae) is abundant in northeastern Brazil and popularly used in the treatment of infectious and inflammatory processes. Several biological properties, such as anti-inflammatory, anticancer, antitumor, hepatoprotective and low toxicity, are reported for this plant. OBJECTIVE: This study investigated hepatoprotective activity and the antioxidant effect of methanolic extract of I. suffruticosa leaves (MEIS) on Swiss albino mice submitted to experimental models of acetaminophen-induced liver injury. METHODS: MEIS (50 mg/kg; p.o.) was standardized according to the LD50 and its hepatoprotective property on Swiss albino mice evaluated during a 7-day period. On the eighth day, the acetaminophen-induced hepatic injury was performed. Histomorphometric analysis of liver tissue, antioxidant activity and serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT) and bilirubin were measured. RESULTS: MEIS (50 mg/kg; p.o.) restored serum enzyme levels and results were close to those of positive control (silymarin) when compared to the negative control. Histopathological and histomorphometric analyzes confirmed MEIS hepatoprotective activity, showing reorganization of structural units of cells, nuclei and sinusoidal capillaries of hepatocytes, reducing the damage on liver tissue and increasing organ regeneration rate. MEIS showed high antioxidant potential at concentrations of 1000 and 500 µg/mL. CONCLUSION: This study suggests that MEIS has hepatoprotective activity and high antioxidant potential.

Eficácia hepatoprotetora do extrato metanólico de Indigofera suffruticosa (Mill) em lesão hepática induzido por paracetamol em camundongos / Hepatoprotective efficacy of methanolic extract of indigofera suffruticosa (mill) on paracetamol-induced liver damage in mice

ABSTRACT BACKGROUND: Indigofera suffruticosa Mill (Fabaceae) is abundant in northeastern Brazil and popularly used in the treatment of infectious and inflammatory processes. Several biological properties, such as anti-inflammatory, anticancer, antitumor, hepatoprotective and low toxicity, are reported for this plant. OBJECTIVE: This study investigated hepatoprotective activity and the antioxidant effect of methanolic extract of I. suffruticosa leaves (MEIS) on Swiss albino mice submitted to experimental models of acetaminophen-induced liver injury. METHODS: MEIS (50 mg/kg; p.o.) was standardized according to the LD50 and its hepatoprotective property on Swiss albino mice evaluated during a 7-day period. On the eighth day, the acetaminophen-induced hepatic injury was performed. Histomorphometric analysis of liver tissue, antioxidant activity and serum levels of alanine aminotransferase (AST), aspartate aminotransferase (ALT) and bilirubin were measured. RESULTS: MEIS (50 mg/kg; p.o.) restored serum enzyme levels and results were close to those of positive control (silymarin) when compared to the negative control. Histopathological and histomorphometric analyzes confirmed MEIS hepatoprotective activity, showing reorganization of structural units of cells, nuclei and sinusoidal capillaries of hepatocytes, reducing the damage on liver tissue and increasing organ regeneration rate. MEIS showed high antioxidant potential at concentrations of 1000 and 500 µg/mL. CONCLUSION: This study suggests that MEIS has hepatoprotective activity and high antioxidant potential.

RESUMO CONTEXTO: Indigofera suffruticosa Mill (Fabaceae) é abundante no nordeste do Brasil e popularmente utilizada no tratamento de processos infecciosos e inflamatórios. Várias propriedades biológicas, como anti-inflamatório, anticâncer, antitumoral, hepatoprotetor e baixa toxicidade, são relatadas para esta planta. OBJETIVO: Este estudo investigou a atividade hepatoprotetora e o efeito antioxidante do extrato metanólico de folhas de I. suffruticosa (MEIS) em camundongos albinos suíços submetidos a modelos experimentais de lesão hepática induzida por paracetamol. MÉTODOS: O MEIS na dose de 50 mg/kg (via oral) foi padronizado de acordo com a LD50 e sua propriedade hepatoprotetora em camundongos albinos Swiss avaliados durante um período de sete dias. No oitavo dia, a lesão hepática foi induzida por paracetamol em todos grupos pre-tratados. Foram medidos os níveis sericos enzimaticos, alanina aminotransferase, aspartato aminotransferase e bilirrubina, análise histomorfométrica do tecido hepático e atividade antioxidante. RESULTADOS: O MEIS restaurou os níveis séricos de enzimas e os resultados foram próximos aos do controle positivo (silimarina) quando comparados ao controle negativo. As análises histopatológicas e histomorfométricas confirmaram a atividade hepatoprotetora do MEIS, mostrando reorganização das unidades estruturais das células, núcleos e capilares sinusoidais dos hepatócitos, reduzindo os danos no tecido hepático e aumentando a taxa de regeneração de órgãos. O MEIS apresentou alto potencial antioxidante nas concentrações de 1000 e 500 µg/mL. CONCLUSÃO: Este estudo sugere que I. suffruticosa tem atividade hepatoprotetora e alto potencial antioxidante.

Reorganização da agenda e do modelo de acesso em Unidade de Saúde da Família 24 horas: relato de experiência / Reorganization of the 24-hour Family Health Unit agenda and access model: experience report / Reorganización de la agenda y del modelo de acceso en Unidad de Salud de la Familia de 24 horas: informe de experiencia

Problema: As longas filas e a dificuldade de atendimento nas Unidades de Saúde da Família (USF) são uma realidade conhecida no Brasil. O acesso avançado representa uma nova proposta de acolhimento e gestão da oferta de vagas para consultas. Neste contexto de dificuldade de acesso, foi inaugurada em março de 2016 em Recife, uma nova Unidade de Saúde da Família 24 horas. Após 6 meses de atendimento neste serviço, a equipe Alfa, nome fictício, sentia-se desmotivada pelas reclamações relativas à dificuldade de acesso. Mobilizada pela insatisfação da população foi proposta uma intervenção para reorganização da oferta de vagas para consultas e do modelo de agendamento com base no acesso avançado. O objetivo deste trabalho é relatar a experiência de reorganização da agenda e da oferta de vagas para consultas; as mudanças do número e do tipo dos atendimentos da equipe após implantação deste novo modelo de acesso; e a percepção dos integrantes da equipe quanto à experiência. Métodos: A primeira etapa da iniciativa incluiu a identificação da viabilidade da intervenção a partir do cálculo da demanda diária de atendimentos. Em seguida, foi criado um novo modelo de agenda desenvolvido fora do e-SUS e que utilizava o Google® Drive e disponibilizados três tempos para as consultas: 5 minutos, 10 minutos e 20 minutos, denominadas respectivamente de rápida, intermediária e estendida. Resultados: No terceiro mês após a mudança foi observado o desaparecimento dos atendimentos classificados como urgência pelo antigo modelo, a ampliação de 65% no número de atendimentos da equipe Alfa com transformação do perfil de atendimento de 70% de consultas agendadas para 70% de consultas do dia. Conclusão: A experiência mostrou ser possível uma ampliação no acesso através do incremento no número de atendimentos a partir da reorganização da agenda baseada no modelo de acesso avançado.

Problem: The long queues and the difficulty of care in the Family Health Units (FHU) are a reality known in Brazil. Advanced access represents a new proposal to host and manage the supply of vacancies for consultations. In this context of difficulty of access, was inaugurated in March 2016 in Recife, a new 24-hour Family Health Unit. After 6 months of service in operation, the Alfa team, a fictitious name, felt discouraged by complaints about the difficulty of access. Mobilized by the population dissatisfaction, an intervention was proposed to reorganize the offer of places for consultations and the scheduling model based on advanced access. The objective of this work is to report the experience of reorganization of the agenda and the offer of vacancies for consultations; the changes in the number and type of staff attendance after implementation of this new access model; and the perception of the team members regarding the experience. Methods: The first stage of the initiative included the identification of the viability of the intervention based on the calculation of the daily demand for care. Next, a new calendar template was created that was developed outside of e-SUS and used Google® Drive, and three times were available for the queries: 5 minutes, 10 minutes and 20 minutes, called respectively fast, intermediate and extended. Results: In the third month after the change, the disappearance of the appointments classified as urgency by the old model was observed, the 65% increase in the number of appointments of the Alpha team with transformation of the attendance profile from 70% of scheduled appointments to 70% of consultations of the day. Conclusion: The experience showed that it is possible to increase access by increasing the number of calls from the reorganization of the agenda based on the advanced access model.

Problema: Las largas filas y la dificultad de atención en las Unidades de Salud de la Familia (USF) son una realidad conocida en Brasil. El acceso avanzado representa una nueva propuesta de acogida y gestión de la oferta de vacantes para consultas. En este contexto de dificultad de acceso, fue inaugurada en marzo de 2016 en Recife, una nueva Unidad de Salud de la Familia 24 horas. Después de 6 meses de atención en este servicio, el equipo Alfa, nombre ficticio, se sentía desmotivado por las reclamaciones relativas a la dificultad de acceso. Movilizada por la insatisfacción de la población se propuso una intervención para reorganizar la oferta de plazas para consultas y el modelo de programación basado en el acceso avanzado. El objetivo de este trabajo es relatar la experiencia de reorganización de la agenda y de la oferta de vacantes para consultas; los cambios del número y del tipo de las atenciones del equipo después de la implantación de este nuevo modelo de acceso; y la percepción de los integrantes del equipo en cuanto a la experiencia. Métodos: La primera etapa de la iniciativa incluyó la identificación de la viabilidad de la intervención a partir del cálculo de la demanda diaria de atención. A continuación, se creó un nuevo modelo de agenda desarrollado fuera de e-SUS y que utilizaba Google® Drive y se disponía de tres tiempos para las consultas: 5 minutos, 10 minutos y 20 minutos, denominados respectivamente de rápida, intermedia y extendida. Resultados: En el tercer mes después del cambio se observó la desaparición de las atenciones clasificadas como urgencia por el antiguo modelo, la ampliación del 65% en el número de atenciones del equipo Alfa con transformación del perfil de atención del 70% de consultas programadas para el 70% de consultas del día. Conclusión: La experiencia ha demostrado ser posible una ampliación en el acceso a través del incremento en el número de atendimientos a partir de la reorganización de la agenda basada en el modelo de acceso avanzado.

Absorbable suture. Best aesthetic outcome in cesarian scar1.

PURPOSE: To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section. METHODS: This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar. RESULTS: At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019). CONCLUSION: The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.

Absorbable suture. Best aesthetic outcome in cesarian scar

Abstract Purpose: To compare two suture threads, poliglecaprone 25 and nylon, used as intradermal suture for skin closure in women undergoing their first cesarean section. Methods: This is a randomized clinical trial. A total of 60 women undergoing their first cesarean section were enrolled and prospectively assessed. They were randomly allocated to group I (n=30), which received an intradermal suture with nylon 4.0 or to group II (n=30), which had an intradermal suture with poliglecaprone 25, 4.0. The main author took standardized photographs of the scar 6 months after the operation. Four independent raters, two senior obstetricians and two senior plastic surgeons (a male and a female physician from each specialty) assessed the photographs.The panelists rated the scar according to Trimbos scale, composed by the subscales hypertrophy, color and width of the scar. Results: At baseline, patients in both groups were similar regarding age and body mass index. Five patients withdraw the study, four from group and one from group II. Scars of patients from group II were significantly less hypertrophic (p=0.001), thinner (p=0.019) and had more acceptable color (p=0.019). Conclusion: The intradermal suture with poliglecaprone 25 for skin closure after cesarean incision provides better aesthetic result.

Death education: sensibility for caregiving.

OBJECTIVE: to report the application of a participatory teaching-learning method on the themes death, dying, and associate care to highlight its applicability to the students. METHOD: report of application of participatory method in 22 students from the 6th period of the undergraduate program in Nursing and Obstetrics of a public university. The first stage focused on personal experiences of the students and the second on professional prospects. As resources for data collection we used music, drawing, drama, and photography. RESULTS: after applying the method, the students assigned meanings to death and nursing care, reflected, criticized, and resignified experiences on the theme. CONCLUSION: the method was considered applicable and effective to achieve the objective, that is, it enables learners to act as protagonists of the teaching-learning process, building together a new perspective of end-of-life care.

Características do desenvolvimento neuropsicomotor de lactentes filhos de mães que fizeram uso de drogas durante a gestação / Neuropsychomotor development characteristics of the infants who born from women who used drugs during pregnancy

INTRODUCTION: The use of street drugs during pregnancy, due to their deleterious effects on the health of the infant, may have clinical implications for neuropsychomotor development. OBJECTIVE: The aim of this study was to analyse the characteristics of the neuropsychomotor development of infants born from women who used street drugs during pregnancy. METHODS: A cross-sectional retrospective study was carried out. A total of 51 medical records of infants weighing less than 1.500 grams, who were born in the Hospital de Clínicas da Universidade Federal de Uberlândia (HC/UFU), Minas Gerais, Brazil, from January 2014 to December 2015 were analysed. Using the Development Screening test Denver II at 6 or 9 months of corrected age performed the neuropsychomotor development evaluation. Statistical analysis included quantitative variables that were described by means of average, medians and standard deviation. Groups were compared by the t test or Mann-Whitney test. The associations of the qualitative variables were evaluated by means of the likelihood ratio test. RESULTS: Of the 51 records analysed, 39.2% belong to the group of children of mothers who used street drugs and 60.8% belong to the group of children of nonuser mothers. The neuropsychomotor development was predominantly abnormal and with a significant difference in the general performance classification (p<0.001) and, specifically, in the coarse motor area (p = 0.003) in the group of infants born to mothers who used street drugs. CONCLUSION: Infants of mothers who used street drugs had a greater delay in neuropsychomotor development.

INTRODUÇÃO: O uso de drogas de abuso durante a gestação, em decorrência dos seus efeitos deletérios à saúde do lactante, pode acarretar implicações clínicas para o desenvolvimento neuropsicomotor OBJETIVO: Analisar as características do desenvolvimento neuropsicomotor de lactentes filhos de mães usuárias de drogas de abuso na gestação. MÉTODO: Estudo retrospectivo transversal, que analisou 51 prontuários de lactentes nascidos com peso inferior a 1500 gramas, no Hospital de Clínicas da Universidade Federal de Uberlândia (HC/UFU), entre janeiro de 2014 a dezembro de 2015. A avaliação do desenvolvimento neuropsicomotor foi realizada por meio do teste de Triagem do Desenvolvimento Denver II aos 6 ou 9 meses de idade corrigida. A análise estatística incluiu variáveis quantitativas que foram descritas por meio de médias, medianas e desvios-padrão e grupos comparados pelo teste t ou Mann-Whitney. As associações das variáveis qualitativas foram avaliadas por meio do teste de razão de verossimilhança. RESULTADOS: Dos 51 prontuários analisados, 39,2% pertenciam ao grupo de filhos de mães usuárias de drogas de abuso e 60,8% ao grupo de filhos de mães não usuárias. O desenvolvimento neuropsicomotor foi predominantemente anormal e com diferença significante na classificação geral de desempenho (p<0,001) e, especificamente, na área motor grosseira (p=0,003) do grupo de lactentes filhos de mães usuárias de drogas de abuso. CONCLUSÃO: Lactentes filhos de mães usuárias de drogas de abuso apresentaram maior atraso no desenvolvimento neuropsicomotor.