Cuidado à pessoa em fim de vida em unidade de cuidados intensivos: intervenção de enfermagem especializada / Care for people at the end of life in an intensive care unit: specialized nursing intervention

O aumento da espectativa de vida, a evolução social e científica, tem colocado a morte como algo a "combater". No entanto, cada vez mais, os profissionais de saúde se deparam com a necessidade de cuidar de pessoas em situação crítica em processo de fim de vida, com a com o qual se sentem pouco preparados, pela dificuldade na limitação de intervenções do foro curativo e a sua substituição por cuidados em fim de vida que preservem a dignidade e promovam o conforto. Surge assim um apelo à enfermagem, na medida em que, como ciência, se tem vindo a assumir com um cariz diferenciado e complexo, exigindo aos enfermeiros que estejam dotados de competências mais específicas e complexas de forma a dar resposta à multidimensionalidade da pessoa crítica e em fim de vida. O papel competente e especializado do enfermeiro, na abordagem à pessoa em situação crítica (PSC) em fim de vida, é um ponto fulcral para o reconhecimento de que intervenções paliativas podem e devem existir em cenários de cuidados intensivos, necessitando de um exercício de julgamento clínico, em situações que são ambíguas e frequentemente repletas de conflitos de valor. O presente relatório teve como objetivo geral desenvolver competências especializadas de enfermagem na prestação de cuidados à PSC em fim de vida, tendo por base as atividades elaboradas em contexto hospitalar, desenvolvidas numa Unidade de Cuidados Paliativos (UCP), Unidade de Cuidados Intensivos (UCI) e Serviço de Urgência (SU). Toda a prática produzida em contexto de estágio foi sustentada e analisada com base na evidência científica assim como através dos referenciais teóricos Technological Competency as Caring in Nursing, de Rozzano Locsin e da Teoria do Conforto de Kolcaba, e do modelo de Dreyfus aplicado à enfermagem por Benner para o desenvolvimento de competências profissionais. A experiência resultante deste processo possibilitou mobilizar e adquirir novos conhecimentos teóricos, consolidar competências comunicacionais e relacionais e reforçar o raciocínio crítico-reflexivo dos 10 cuidados prestados, desenvolvendo competências de mestre especializadas no cuidar à PSC. O percurso formativo permitiu a mobilização do conhecimento adquirido com base na constante problematização, observando a PSC como um todo, proporcionando o meu crescimento profissional e traduzindo-se na melhoria da qualidade dos cuidados prestados.

The increase in life expectancy, social and scientific evolution, has placed death as something to "fight". However, more and more, health professionals are faced with the need to care for people in a critical condition at the end of life, with which they feel unprepared, due to the difficulty in limiting curative interventions and its replacement by end-of-life care that preserves dignity and promotes comfort. Thus, there is an appeal to nursing, insofar as, as a science, it has been assuming a differentiated and complex nature, requiring nurses to be equipped with more specific and complex skills in order to respond to the multidimensionality of the critical person and at end of life. The competent and specialized role of the nurse, in approaching the person in a critical condition at the end of life, is a key point for the recognition that palliative interventions can and should exist in intensive care settings, requiring an exercise of judgment clinical, in situations that are ambiguous and often fraught with value conflicts. The general objective of this report was to develop specialized nursing skills in the provision of end-of-life critical condition person care, based on activities carried out in a hospital context, developed in a Palliative Care Unit (PCU), Intensive Care Unit (ICU) and Emergency Service (SU). All practice produced in the internship context was supported and analyzed based on scientific evidence as well as through the theoretical references Technological Competency as Caring in Nursing, by Rozzano Locsin and Kolcaba's Theory of Comfort, and the Dreyfus model applied to nursing by Benner for the development of professional skills. The experience resulting from this process made it possible to mobilize and acquire new theoretical knowledge, consolidate communication and relational skills and reinforce critical-reflective reasoning in the care provided, developing specialized master's skills in caring for the critical condition person. The training path allowed for the mobilization of knowledge acquired based on constant problematization, observing the critical condition person as a whole, providing my professional growth and translating into the improvement of the quality of care provided.

Different concentrations of vancomycin with gentamicin loaded PMMA to inhibit biofilm formation of Staphylococcus aureus and their implications.

BACKGROUND: This study aimed to evaluate different concentrations of vancomycin and/or gentamicin loaded polymethylmethacrylate (PMMA) against biofilm formation of Staphylococcus aureus. METHODS: Biofilm production of S. aureus in PMMA loaded with different concentrations of vancomycin and gentamicin were evaluated by quantitative analysis of biofilm cells, scanning electronic microscopy, viability assay, Fourier transform infrared spectroscopy, and checkerboard. Statistical analysis was performed by Mann Whitney test. The difference in colony forming units per mL was significant when p < 0.05. RESULTS: All loaded PMMA presented a reduction in the number of colony forming units per mL (p < 0.05). The gentamicin-loaded PMMA could inhibits the grown of sessile cells (p < 0.05), where the group vancomycin 4 g + gentamicin 500 mg presented a better result. The Fourier transform infrared spectra showed no significant differences, and checkerboard of vancomycin and gentamicin showed synergism. CONCLUSION: Effects against adherence and bacterial development in PMMA loaded with antibiotics were mainly seen in the group vancomycin 4 g + gentamicin 500 mg, and synergic effect can be applied in antibiotic-loaded cement.

Conhecimento dos enfermeiros sobre tratamento de feridas crônicas na atenção primária à saúde / Nursing knowledge in chronicwound management in primary health care settings / Conocimiento de enfermeros sobre el tratamiento de heridas crónicas en la atención primaria de salud

Objetivo: Identificar o conhecimento técnico-científico de enfermeiros da atenção primária à saúde sobre o tratamento de feridas crônicas. Método:Trata-se de um estudo descritivo, transversal, de caráter observacional e com abordagem quantitativa. Para a coleta de dados foi utilizado instrumento validado e traduzido para o Português do tipo survey,sobre o conhecimento deenfermeiros a respeito do tratamento de feridas. O estudofoi realizado nas unidades de atenção primária à saúde da Zona da Mata mineira em Minas Gerais, com a participação de 41 enfermeiros. Resultados:A maioria dos participantes eram do sexo feminino (92,7%), formados em universidade pública (80,5%) e realizavam atendimento aos portadores de feridas em suas unidades (61,%). Os entrevistados afirmaram que fazem uso de leitura de artigos (75,6%) para se atualizar. A maior parte se auto considera regular sobre sua formação em feridas (39%). A média de acertos dasquestões específicas sobre feridas foi considerada boa, em 73,2% dos participantes. Conclusão:Apesar dos enfermeiros não se considerarem suficientemente bons em sua formação eles obtiveram uma elevada taxa de acertos, sendo a média considerada boa nas questões relacionadas à avaliação e tratamento das feridas. O presente resultado salienta a importância do treinamento continuado sobre a prevenção, avaliação e tratamento de feridas para enfermeiros atuantes na atenção primária à saúde.

Objective: To identify the technical-scientific knowledge of nurses in primary health care about chronic wound management. Method:This is a descriptive,cross-sectional, observational study with a quantitative approach. For data collection, a survey type and validated instrument translated into Portuguese was used in order to evaluate the knowledge of nurses regarding wound management. The study was carried out in Primary Health Care Units of Zona da Mata in Minas Gerais, with the participation of 41 nurses.Results:Most of the participants were female (92.7%), graduated from a public university (80.5%) and provided assistance to wounded patients (61,%). The interviewees stated that they use to read articles (75.6%) in order to update themselves. Most of them consider themselves regular on their formation in wounds (39%). The average of corrected answers for specific questions about wounds was considered good, in 73.2% of the participants. Conclusion: Although nurses do not consider themselves good enough in their specific academic training, they achieved a high rate of correct answers, with the average being considered good in questions related to wound healing management. This result highlights the importance of ongoing training on the prevention, assessment and treatment of wounds for nurses working in primary health care settings.

Objetivo: Identificar el conocimiento técnico-científico de los enfermeros de la atención primaria de salud sobre el tratamiento de las heridas crónicas. Método: Se trata de un estudio descriptivo, transversal, observacional con enfoque cuantitativo. Para la recolección de datos, se utilizó un instrumento validado y traducido al portugués de tipo encuesta, sobre el conocimiento de los enfermeros sobre el tratamiento de heridas. El estudio fue realizado en las unidades de atención primaria de salud de la Zona da Mata en Minas Gerais, con la participación de 41 enfermeros. Resultados: La mayoría de los participantes eran del sexo femenino (92,7%), egresados de una universidad pública (80,5%) y brindaban atención a pacientes con heridas en sus unidades (61,%). Los encuestados afirmaron que leen artículos (75,6%) para actualizarse. La mayoría se considera regular sobre su entrenamiento en heridas (39%). El promedio de respuestas correctas para las preguntas específicas sobre heridas fue considerado bueno, en el73,2% de los participantes. Conclusión: Aunque los enfermeros no se consideraron lo suficientemente buenos en su formación, obtuvieron un alto índice de respuestas correctas, siendo el promedio considerado bueno en preguntas relacionadas con la evaluacióny tratamiento de heridas. El presente resultado enfatiza la importancia de la formación continua en prevención, evaluación y tratamiento de heridas para los enfermeros que actúan en la atención primaria de salud.

TOCSY, hydrogen decoupling and computational calculations to an unequivocal structural elucidation of a new sesquiterpene derivative and identification of other constituents from Praxelis sanctopaulensis.

INTRODUCTION: Praxelis genus comprises 24 species, however, only two species of this genus have been chemically investigated. Here we investigated Praxelis sanctopaulensis, a native plant from Brazil, that occurs mainly in Cerrado regions. OBJECTIVE: The goal was to identify the specialised metabolites from P. sanctopaulensis, and compare with those described from Praxelis and Chromolaena species. METHODS: The phytochemical study of P. sanctopaulensis was performed through different chromatography techniques, including high-performance liquid chromatography (HPLC), gas chromatography flame ionisation detector (GC-FID), and ultra-high-performance liquid chromatography high-resolution tandem mass spectrometry (UHPLC-HRMS/MS). The structures of the compounds were established based on spectroscopic analysis, total correlated spectroscopy (TOCSY), hydrogen decoupling and computational calculations was used to an unequivocal structural elucidation of a new sesquiterpene. The antioxidant activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl (DPPH) and ferric reducing antioxidant power (FRAP), and antimicrobial assay was performed by the microdilution method. Comparison of the flavonoids described P. sanctopaulensis was carried out using principal component analysis. RESULTS: The phytochemical investigation of P. sanctopaulensis led to the isolation of a pair of diastereomers, praxilone A and praxilone B. Seven known compounds were isolated from this species, another 14 fatty acids were detected in hexane fraction, and 26 compounds were identified from ethyl acetate fraction. All these compounds are being described for the first time in this species, with the exception of viridifloric acid. The ethyl acetate fraction showed potent antioxidant activity. CONCLUSIONS: Forty-seven compounds are described from P. sanctopaulensis. The combination of different techniques of nuclear magnetic resonance (NMR) spectroscopy and computational calculations allowed the unequivocal structure elucidation of a new cadinene. The clustering analysis showed similarities between the flavonoids identified in P. sanctopaulensis and in Chromolaena species.

Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected.

The diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected

Abstract The diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

Chemical profile, antioxidant and anti-inflammatory properties of Miconia albicans (Sw.) Triana (Melastomataceae) fruits extract.

ETHNOPHARMACOLOGICAL RELEVANCE: Miconia albicans (Sw.) Triana has been widely used in Brazilian popular medicine for the treatment of several diseases. Aerial parts are used as an infusion to treat arthrosis and arthritis, to relieve rheumatic and stomach pains, and intestinal disorders due to its anti-inflammatory, anti-mutagenic anti-nociceptive, digestive and hepatoprotective properties. AIM OF THE STUDY: This study aimed to characterize the of M. albicans (Sw.) Triana fruits extract (MAFRE) chemical profile and to evaluate its antioxidant, anti-inflammatory and antitumor activities, as well as its toxicity. MATERIALS AND METHODS: Maceration with methanol as liquid extractor was used to prepare MAFRE. M. albicans (Sw.) Triana fruits chemical composition was characterized by UHPLC-QTOF-MS/MS and GC-FID (fatty acid methyl esters composition from lyophilized fruits). MAFRE antioxidant potential was evaluated in vitro using a combination of assays: Folin-Ciocalteu reducing capacity, DPPH• and ABTS radical scavenging ability and ferric reducing antioxidant power (FRAP). In vitro antiproliferative activity was investigated in four human tumor cell lines (U251, 786-0, HT29 and MDA-MB-231) while the effect on the non-tumor cell viability was assessed in the VERO cell line using the on-step MTT assay. In addition, in vivo anti-inflammatory effect was assessed by Croton oil-induced ear edema in mice followed by myeloperoxidase (MPO) activity evaluation. RESULTS: Thirty-five compounds were identified by UHPLC-QTOF-MS/MS. Among it flavonoids derived from quercetin (8), myricetin (1), kaempferol (2), terpenoids (6) and other compounds (18). GC-FID analysis identified and quantified nine fatty acids: palmitic, stearic, arachidic, behenic, elaidic, oleic, eicosenoic, and linoleic acids. The most abundant fatty acids were polyunsaturated fatty acids (5.33 ± 0.17 mg g-1), followed by saturated fatty acids (2.38 ± 0.07 mg g-1) and monounsaturated fatty acids (1.74 ± 0.09 mg g-1). The extract revealed high content of phenolic compounds (43.68 ± 0.50 mg GAE/g of extract), potent antioxidant, and ferrous chelating capacities. Morever, it proved to be non-toxic to the VERO cells, not affecting cells viability (95% of viable cells). No antiproliferative effect against human tumor cell lines were found. Furthermore, MAFRE significantly (p<0.05) reduced ear edema (≈35%) and MPO activity (84.5%) having a statistical effect similar to traditional steroidal and non-steroidal anti-inflammatory drugs. CONCLUSIONS: Taken together, the results evidenced that M. albicans fruit extract has antioxidant properties, a higher concentration of phenolic compounds, flavonoids, fatty acids, and also topical anti-inflammatory activity with low toxicity of extract on VERO cells. Through the ethnomedicinal study, these findings supporting the popular use of M. albicans, but also highlight that not only aerial parts and leaves deserve attention, but the fruits also have anti-inflammatory proprieties and can be a source of phenolic compounds and other substances with potential health benefices.

Questionnaires and scales for assessment of ankle function: a systematic review of instruments translated and validated for Brazilian Portuguese.

PURPOSE: Several questionnaires have been used for functional evaluation. They must be translated and adapted transculturally, these instruments need to be valid, reliable, and sensitive according to the population. This review identified the questionnaires which were adapted transculturally in Brazilian Portuguese, to verify the methodological quality. METHODS: A search was performed in the PubMed, BIREME, SportDiscus, SciELO, Scopus, Science Direct, and Web of Science. The methodological quality was evaluated by the COnsensus-based Standards for Health Measurement INstruments (COSMIN) Risk of Bias checklist. For cross-cultural translation and adaptation studies, the properties of measurement of structural validity, internal consistency (IC), cross-cultural validity, reliability, measurement error, and criterion validity were analyzed. RESULTS: A total of 4564 articles were found; 10 fulfilled the inclusion criteria. The psychometrics properties verified were IC; criterion validity; reproducibility; floor/ceiling effect and responsiveness. Criterion validity was the best criterion evaluated. The main failures were related to sample size, and the most deficient properties were IC, reliability, and error of measure. CONCLUSIONS: The studies verified presented "inadequate" final score using COSMIN. Although specific questionnaires for ankle evaluation have been cross culturally validated in Brazilian Portuguese, their methodological quality was generally low, as verified through the analysis of their psychometric properties. IMPLICATIONS FOR REHABILITATION The questionnaires which were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality. In using them careful consideration needs to be given to the psychometrics of each measure. Caution should be exercised in making clinical decisions drawn from the results.

Development and application of green and sustainable analytical methods for flavonoid extraction from Passiflora waste.

Brazilian biodiversity and favourable environmental conditions open up possibilities not yet explored, showing potential to shift the country's monochromatic economy into an emancipated, diversified and sustainable economic environment. This can be made possible through the integral use of its resources, exploring every functional fraction to create novel solutions to modern problems. Biorefineries present an interesting strategy to fully use the potential of agricultural feedstocks and together with green separation methods can contribute to the generation of sustainable processes and products. Passion Fruit (Passiflora edulis Sims f. flavicarpa Deg species) is produced on a large scale in Brazil and in other tropical countries, and its processing plants generate tons of residues that basically consist of peel, seeds and bagasse, which account for around 75% of its mass. These fractions of P. edulis can contain significant amounts of flavonoids, secondary metabolites that are the main compounds responsible for the fruit's bioactivity (antioxidant, anti-inflammatory, pesticide and biocide, in general). Therefore, this work aims to develop, apply and compare the best conditions for the extraction of isoorientin, orientin and isovitexin from passion fruit applying solid-liquid methodologies, followed by analyte quantification using UHPLC-PDA. Homogenizer-assisted (HAE), ultrasound-assisted (UAE) and microwave-assisted (MAE) extraction techniques were used, as well as a full factorial design to reach optimal parameters concerning the extraction yield and energy and solvent efficiencies. According to the results, the procedure based on HAE presented the best conditions for the extraction of selected flavonoids (1.07, 0.90 and 0.33 mg g-1 of isoorientin, orientin and isovitexin, respectively) and was considered the best method according to the green and sustainable described factors.

Mutual Authentication Protocol for D2D Communications in a Cloud-Based E-Health System.

The development of the Internet of Things (IoT) predicts several new applications, some of which are designed to be incorporated into e-health systems, and some technologies, like cloud computing and device-to-device communication (D2D), are promising for use in the support of resource-constrained devices employed in Mobile-health (m-health) and Telecare Medicine Information Systems (TMIS). In a scenario with billions of devices predicted for the IoT, it is essential to avoid performance and security problems, among others. Security is fundamental for the achievement of optimal performance regarding the sensibility of e-health shared data and, especially, the anonymity of patients and other entities, while it is also essential to consider the scarcity of bandwidth in wireless networks. This paper proposes a new mutual authentication protocol for m-health systems, which supports D2D communication, ensuring security and surpassing the performance and security of other authentication procedures reported in the literature.

Leflunomide-hydroxychloroquine combination therapy in patients with primary Sjögren's syndrome (RepurpSS-I): a placebo-controlled, double-blinded, randomised clinical trial.

BACKGROUND: Primary Sjögren's syndrome is a systemic autoimmune disease characterised by secretory gland dysfunction, for which no effective therapy is available. Based on the complementary properties of leflunomide and hydroxychloroquine in inhibiting activation of key immune cells in primary Sjögren's syndrome, we aimed to evaluate the clinical efficacy and safety of leflunomide-hydroxychloroquine combination therapy in patients with primary Sjögren's syndrome. METHODS: We did a placebo-controlled, double-blinded, phase 2A randomised clinical trial in patients with primary Sjögren's syndrome at the University Medical Center Utrecht (Utrecht, Netherlands). Eligible patients were aged 18-75 years, had a European League Against Rheumatism (EULAR) Sjögren's syndrome disease activity index (ESSDAI) score of 5 or higher, and a lymphocytic focus score of 1 or higher in labial salivary gland biopsy specimens. Patients were randomly assigned (2:1) with block randomisation (block size of six) to receive leflunomide 20 mg and hydroxychloroquine 400 mg daily or placebo for 24 weeks. The primary endpoint was the between-group difference in change in ESSDAI scores from 0 to 24 weeks, adjusted for baseline ESSDAI score. Patients were analysed according to the intention-to-treat principle. This study is registered with EudraCT, 2014-003140-12. FINDINGS: Between March 7, 2016, and Nov 30, 2017, 37 patients were screened, of whom 29 patients (28 women and one man) were enrolled. 21 patients were assigned to receive leflunomide-hydroxychloroquine and eight patients were assigned to receive placebo. One patient in the placebo group required high-dose prednisone to treat polymyalgia rheumatica at week 13 and was excluded from the primary analysis. From 0 to 24 weeks, the mean difference in ESSDAI score, adjusted for baseline values, in the leflunomide-hydroxychloroquine group compared with the placebo group was -4·35 points (95% CI -7·45 to -1·25, p=0·0078). No serious adverse events occurred in the leflunomide-hydroxychloroquine group and two serious adverse events occurred in the placebo group (hospital admission for pancreatitis and hospital admission for nephrolithiasis). The most common adverse events in the leflunomide-hydroxychloroquine group were gastrointestinal discomfort (11 patients [52%] vs two [25%] in the placebo group), modest transient increases in alanine aminotransferase (ten [48%] vs one [13%]), and short episodes of general malaise and shivering (nine [43%] vs one [13%]). INTERPRETATION: Leflunomide-hydroxychloroquine was safe and resulted in a clinical response in patients with primary Sjögren's syndrome. These results warrant further evaluation of leflunomide-hydroxychloroquine combination therapy in larger clinical trials. FUNDING: ZonMw.

Fatty acid composition and nutritional profiles of Brycon spp. from central Amazonia by different methods of quantification.

This study evaluated the fatty acid composition and the nutritional profile of Brycon cephalus and Brycon microlepis, fish species from the central Amazon basin, by different methods of quantification. The methods applied were: area normalization (MAN), internal standard (MIS), alternative theoretical (MAT) and alternative experimental (MAE). Significant differences were observed between the methods applied and the species studied. MAN supplied poor information about fatty acids composition and diet formulation, presenting only fatty acid profiles. MIS, MAT and MAE supplied fatty acids composition information on a mass basis. MAT and MAE overestimated results, whereas MIS presented the most accurate results. B. cephalus and B. microlepis showed high contents of approximately 65 mg g-1 of n-3 fatty acids. Eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3) content totaled, 104.37 mg 100 g-1 and 117.89 mg 100 g-1 for B. cephalus and B. microlepis, respectively. The nutritional profile of both fish species showed favorable indices for nutritional quality of the lipid fraction, indicating that both Brycon species are healthy dietary choices.

Evaluation of Bone Repair in the Mandible of Rabbits Using Biphasic Calcium Phosphate Micro-Macroporous Hydroxyapatite Bioceramics and Beta-Tricalcium Phosphate

Objective: To perform a clinical and histological evaluation, characterizing and proving the feasibility of the use of beta tricalcium phosphate (HA/ßTCP) bioceramics as a bone defect repair material, comparing it with autogenous bone and blood clot in terms of osteoinductive, conductive, and genic capacities. Material and Methods: The experiment was based on 3 critical defects in the mandible of 11 New Zealand rabbits. The defects were filled with HA/ßTCP bioceramics and autogenous bone, respectively, collected and ground during the development of defects and blood clots. The animals were euthanized after the 90-day experiment and samples were collected for histomorphological examination. To evaluate differences between the groups, a one-way analysis of variance (ANOVA) was performed with Tukey's post hoc test. An α value lower than 0.05 was considered statistically significant. Results: Microscopy revealed the presence of osteoblasts, osteoclasts, and osteocytes associated or not associated with the presence of mature or immature bone. All the studied materials presented bone neoformation in all cases, with the presence of mature and immature bone. Regarding the presence of HA/ßTCP bioceramic residual material, the same was found in 7 of 11 slides. Conclusion: HA/ßTCP bioceramics were shown to be a biocompatible bone substitute, with osteoinductive and osteoconductive characteristics, accelerating the process of new bone formation when compared with autogenous and blood clotted bone, thereby showing promise for bone defect repair with safety and efficacy.

Three-Dimensional Stable Alginate-Nanocellulose Gels for Biomedical Applications: Towards Tunable Mechanical Properties and Cell Growing.

Hydrogels have been studied as promising materials in different biomedical applications such as cell culture in tissue engineering or in wound healing. In this work, we synthesized different nanocellulose-alginate hydrogels containing cellulose nanocrystals, TEMPO-oxidized cellulose nanocrystals (CNCTs), cellulose nanofibers or TEMPO-oxidized cellulose nanofibers (CNFTs). The hydrogels were freeze-dried and named as gels. The nanocelluloses and the gels were characterized by different techniques such as Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), transmission electron microscopy (TEM), thermogravimetric analysis (TGA), and dynamic mechanical thermal analysis (DMTA), while the biological features were characterized by cytotoxicity and cell growth assays. The addition of CNCTs or CNFTs in alginate gels contributed to the formation of porous structure (diameter of pores in the range between 40 and 150 µm). TEMPO-oxidized cellulose nanofibers have proven to play a crucial role in improving the dimensional stability of the samples when compared to the pure alginate gels, mainly after a thermal post-treatment of these gels containing 50 wt % of CNFT, which significantly increased the Ca2+ crosslinking density in the gel structure. The morphological characteristics, the mechanical properties, and the non-cytotoxic behavior of the CNFT-alginate gels improved bioadhesion, growth, and proliferation of the cells onto the gels. Thus, the alginate-nanocellulose gels might find applications in tissue engineering field, as for instance, in tissue repair or wound healing applications.

Impact of a High-Intensity Training on Ventricular Function in Rats After Acute Myocardial Infarction / Repercussão do Treinamento de Alta Intensidade sobre a Função Ventricular de Ratos após Infarto Agudo do Miocárdio

Abstract Background: Physical exercise should be part of the treatment of post-acute myocardial infarction (AMI) patients. Objective: To evaluate the effects of two training prescription models (continuous x interval) and its impact on ventricular function in rats after AMI with normal ventricular function. Methods: Forty Wistar rats were evaluated by echocardiography 21 days after the AMI. Those with LVEF = 50% (n = 29) were included in the study and randomized to control group (CG n = 10), continuous training group (CTG n = 9) or interval training group (ITG, n = 10). Then, a swimming test with control of lactate production was performed. Based on its result, the lactate threshold (LT) was established to define the training intensities. After six weeks, the animals were reassessed by echocardiography and lactate production. Outcome measures were end-diastolic diameter (EDD), end-systolic diameter (ESD), left ventricular ejection fraction (LVEF, %) lactate at rest, lactate without overload, and lactate with 12g and 13.5g of additional load. Group comparisons of quantitative variables of the study were performed by one-factor analysis of variance (ANOVA). The Newman-Keuls test was used for multiple comparisons of the groups. Within-group comparisons of dependent variables between the two training protocols were performed by Student's t-test. Normality of the variables was tested by the Shapiro-Wilks test. Values of p < 0.05 indicated statistical significance. Results: EDD, ESD, and LVEF before and after the training period were similar in within-group comparisons. However, EDD was significantly different (p=0.008) in the CG. Significant differences were found for L12g (p=0.002) and L13.5g (p = 0.032) in the ITG, and for L12g (p = 0.014) in the CG. No differences were found in the echocardiographic parameters between the groups. Significant differences were found in lactate without overload (p = 0.016) and L12 (p = 0.031) in the second assessment compared with the first, and between the groups - ITG vs. CG (p = 0.019) and CTG vs. CG (p = 0.035). Conclusion: Both methods produced a training effect without altering ventricular function.

Resumo Fundamento: O exercício físico deve fazer parte do tratamento de pacientes pós-infarto agudo do miocárdio (IAM). Objetivo: Avaliar os efeitos de treinamento produzidos por dois modelos distintos (contínuo x intervalado) e sua repercussão sobre a função ventricular de ratos pós-IAM com função ventricular normal. Métodos: Quarenta ratos Wistar pós-IAM foram avaliados ecocardiograficamente 21 dias após o evento. Aqueles com FEVE = 50% (n = 29) foram incluídos e randomizados: controle (GC n = 10), treinamento contínuo (GTC n = 9) e treinamento intervalado (GTI n = 10). Após, foi realizado um teste de natação com controle de lactato. A partir do resultado foi definido o limiar de lactato (LL) para determinar as intensidades do treinamento. Após seis semanas, foram reavaliados com ecocardiografia e controle de lactato. Como desfecho, foram avaliados: diâmetros diastólico e sistólico final (DDF, DSF, mL), fração de ejeção do ventrículo esquerdo (FEVE, %), lactato de repouso, livre de carga (LC), lactato com 12 g e 13,5 g de carga adicional. Para a comparação dos grupos em relação às variáveis quantitativas do estudo, foi considerado o modelo de análise da variância com um fator (ANOVA). Nas comparações múltiplas dos grupos foi usado o teste de Newman-Keuls. Na comparação entre as duas avaliações, dentro de cada grupo, foi usado o teste t de Student para amostras dependentes. A condição de normalidade das variáveis foi avaliada pelo teste de Shapiro-Wilks. Valores de p < 0,05 indicaram significância estatística. Resultados: Com relação à análise intragrupos, entre o período pré- e pós-treinamento foi identificado semelhança para DDF, DSF, FEVE, porém o GC apresentou diferença significativa para a variável DDF (p = 0,008). Houve diferença do GTI para L12g (p = 0,002) e L13,5g (p = 0,032) e para o GTC na variável L12g (p = 0,014). Não houve diferença para as variáveis ecocardiográficas entre os grupos. Houve diferença nas variáveis LC e L12g na segunda avaliação (p = 0,016 e p = 0,031, respectivamente) e entre os grupos: GTI vs. GC (p = 0,019) e GTC vs. GC (p = 0,035). Conclusão: Os dois métodos produziram efeito de treinamento sem alterar a função ventricular.

Impact of a High-Intensity Training on Ventricular Function in Rats After Acute Myocardial Infarction.

BACKGROUND: Physical exercise should be part of the treatment of post-acute myocardial infarction (AMI) patients. OBJECTIVE: To evaluate the effects of two training prescription models (continuous x interval) and its impact on ventricular function in rats after AMI with normal ventricular function. METHODS: Forty Wistar rats were evaluated by echocardiography 21 days after the AMI. Those with LVEF = 50% (n = 29) were included in the study and randomized to control group (CG n = 10), continuous training group (CTG n = 9) or interval training group (ITG, n = 10). Then, a swimming test with control of lactate production was performed. Based on its result, the lactate threshold (LT) was established to define the training intensities. After six weeks, the animals were reassessed by echocardiography and lactate production. Outcome measures were end-diastolic diameter (EDD), end-systolic diameter (ESD), left ventricular ejection fraction (LVEF, %) lactate at rest, lactate without overload, and lactate with 12g and 13.5g of additional load. Group comparisons of quantitative variables of the study were performed by one-factor analysis of variance (ANOVA). The Newman-Keuls test was used for multiple comparisons of the groups. Within-group comparisons of dependent variables between the two training protocols were performed by Student's t-test. Normality of the variables was tested by the Shapiro-Wilks test. Values of p < 0.05 indicated statistical significance. RESULTS: EDD, ESD, and LVEF before and after the training period were similar in within-group comparisons. However, EDD was significantly different (p=0.008) in the CG. Significant differences were found for L12g (p=0.002) and L13.5g (p = 0.032) in the ITG, and for L12g (p = 0.014) in the CG. No differences were found in the echocardiographic parameters between the groups. Significant differences were found in lactate without overload (p = 0.016) and L12 (p = 0.031) in the second assessment compared with the first, and between the groups - ITG vs. CG (p = 0.019) and CTG vs. CG (p = 0.035). CONCLUSION: Both methods produced a training effect without altering ventricular function.

Use of focus assessed transthoracic echocardiography (FATE) in the veterinary emergency room / Aplicabilidade da avaliação ecocardiográfica transtorácica focada (FATE) na sala de emergência veterinária

ABSTRACT: The use of bedside focus assessed transthoracic echocardiography (FATE) is widespread in human medicine, and the potential for veterinary medicine has only recently been investigated. Focused echocardiographic examination can be beneficial in critically ill patients compared to other bedside diagnostic methods, as well as facilitating rapid therapeutic approaches in the emergency room. The aim of this review is to discuss FATE and identify its main applications in veterinary medicine. In this context, FATE has proved to be benefical even when carried out by a non-cardiologist physician or veterinarian. However, a few references on this subject exist in the veterinary literature and there is still a need for standardization of this technique for use in animals.

RESUMO: A avaliação ecocardiográfica transtorácica focada (FATE) utilizada em pacientes à beira leito já é bastante difundida na medicina, e apenas, recentemente tem se discutido a respeito deste assunto na medicina veterinária. Este exame pode trazer diversos benefícios aos pacientes críticos comparado aos outros métodos diagnósticos, além de facilitar e agilizar condutas terapêuticas na sala de emergência. O objetivo desta revisão é abordar a respeito desta modalidade de exame e identificar quais são suas principais aplicabilidades na medicina veterinária. Dentro deste contexto, a FATE tem se mostrado benéfica inclusive quando realizada por médicos ou veterinários não cardiologistas. No entanto, poucas são as referêcias veteriárias a respeito deste assunto e ainda há necessidade de uma padronização desta técnica para uso em animais.

Representações sociais da cura divina no contexto neopentecostal / Social representations of divine healing on the neopentecostal context / Representaciones sociales de la cura divina en el contexto neopentecostal

Considerando o crescimento vertiginoso do neopentecostalismo no Brasil nas últimas décadas e seu consequente impacto sociocultural, este estudo buscou investigar os bens simbólicos produzidos no contexto religioso com base na análise das representações sociais da doença e da cura divina, compartilhadas por membros da Igreja Universal do Reino de Deus (IURD). Foram realizadas cinco entrevistas semidirigidas com membros da IURD que relataram ter vivenciado a cura divina. A análise, desenvolvida mediante a utilização do método da hermenêutica de profundidade, revelou a presença de princípios da teologia da prosperidade permeando as representações sociais de cura bem como diferenças importantes entre o discurso oficial da igreja e o reproduzido pelos fiéis. Essa pesquisa evidencia a complexidade e as contradições que caracterizam o processo da cura divina, o que justifica a necessidade de realização de novos estudos nesse campo.

In the light of the rapid growth of neo-Pentecostalism in Brazil in recent decades and its consequent social-cultural impact, the present study sought to investigate relevant aspects of the symbolic effects brought about in a religious context by investigating the social representations of disease and divine healing shared by members of the Universal Church of the Kingdom of God (UCKG). Five UCKG members who reported divine healing experiences were interviewed. The analysis used the methodology of depth hermeneutics and revealed the presence of elements of prosperity theology throughout the social representations of healing, as well as a significant difference between official church discourse and the one portrayed by the churchgoers. This research shows the complexity and contradictions present in the divine healing process, justifying the need for further studies in this field.

Teniendo en cuenta el rápido crecimiento del neopentecostalismo en Brasil en las últimas décadas y su consiguiente impacto sociocultural, este estudio buscó investigar los aspectos relevantes de los bienes simbólicos producidos en el contexto religioso basándose en el análisis de las representaciones sociales de la enfermedad y la curación divina, compartidas por los miembros de la Iglesia Universal del Reino de Dios (IURD). Se realizaron cinco entrevistas semidirigidas con miembros de la IURD que relataron haber vivido la experiencia de curación divina. El análisis realizado con la utilización del método de la hermenéutica de profundidad reveló la presencia de los principios de la teología de la prosperidad que impregnan las representaciones sociales de curación, así como diferencias importantes entre el discurso de la iglesia oficial y el reproducido por los fieles. Esta investigación evidencia la complejidad y las contradicciones que caracterizan el proceso de curación divina, lo que justifica la necesidad de realizar nuevos estudios en este campo.

Incidence of Cervical Human Papillomavirus and Cervical Intraepithelial Neoplasia in Women with Positive and Negative HIV Status / Incidência de infecção cervical pelo vírus papiloma humano e neoplasia intraepitelial cervical em mulheres com sorologia positiva e negativa para o HIV

Abstract Objectives To evaluate the incidence and factors associated with cervical intraepithelial neoplasia (CIN) and cervical infection by human papillomavirus (HPV) among HIV-positive and HIV-negative women. Methods A cohort of 103 HIV positive and 113 HIV negative women were monitored between October 2008 and February 2012, for at least one year. Procedures included cervical cytology, DNA/HPV detection by polymerase chain reaction, colposcopy with biopsy if necessary, followed by an interview for exposure characteristics data. CIN was based on the histopathological results. Results The incidence of CIN was of 8.8 and 4.6 cases/100 women-years in HIVpositive and HIV-negative women, respectively. HIV-positive women presented a hazard ratio (HR) of 2.8 for CIN and developed lesions earlier (0.86 year) than HIVnegative women (2 years) (p = 0.01). The risk of developing CIN decreased with age (HR = 0.9) and marital status (HR = 0.4). HPV patients presented a higher incidence of CIN when compared HIV-positive and HIV-negative women (p = 0.01). The incidence of HPV cervical infection was 18.1 and 11.4 cases/100 women-years in HIV-positive and HIV-negative women, respectively. Those HIV-positive presented earlier HPV infection (p = 0.002). The risk of developing HPV infection decreased with age and was higher among HIV-positive women. HPV 16 was the most common type in HIV-positive women, and also the type most closely associated with CIN in HIV-negative women. Conclusions HIV-positive women had a greater incidence of HPV and CIN, and in a shorter time interval. More rigorous and timely clinical control is required for this group.

Resumo Objetivos Avaliar a incidência e fatores associados com neoplasia intraepitelial cervical (NIC) e infecção cervical pelo Papiloma Vírus Humano (HPV) entre mulheres HIV positivas e negativas. Métodos Coorte de 103 mulheres positivas para o HIV e 113 negativas, que foram acompanhadas entre outubro de 2008 a fevereiro de 2012, com seguimento mínimo de um ano. Os procedimentos realizados foram coleta de material cervical para citologia oncótica e detecção do DNA/HPV pela reação em cadeia da polimerase, colposcopia seguida de biópsia, se necessário, e entrevista para obter dados e características de exposição. O diagnóstico de NIC foi baseado no resultado histopatológico das biópsias. Resultados A incidência pessoas-tempo de NIC foi de 8,8 e 4,6 casos/100 mulheresano para as mulheres HIV-positivas e HIV-negativas, respectivamente. As HIV-positivas apresentaram uma razão de risco (HR) de 2,8 para NIC e desenvolveram lesões mais precocemente (0,86 ano) do que as negativas (2 anos) (p = 0,01). O risco de desenvolver NIC diminuiu com a idade (HR = 0,9) e o estado civil (HR = 0,4). Pacientes com HPV apresentaram maior incidência de NIC, quando comparadas as mulheres HIVpositivas e as negativas (47,6 10,5%) (p = 0,01). A incidência de infecção cervical pelo HPV, por pessoa/tempo, foi de 18,1 e 11,4 casos/100 mulheres-ano, respectivamente para mulheres HIV-positivas e negativas. As HIV-positivas apresentaram HPV mais precocemente (p = 0,002). O risco de apresentar HPV diminuiu com a idade e foi maior entre as HIV-positivas. O HPV 16 foi o tipo mais comum entre as mulheres HIVpositivas. Conclusões As mulheres HIV-positivas tiveram maior incidência de HPV e NIC, e um menor intervalo de tempo. Controle clínico mais rigoroso e oportuno é requerido para este grupo.

Incidence of Cervical Human Papillomavirus and Cervical Intraepithelial Neoplasia in Women with Positive and Negative HIV Status.

Objectives To evaluate the incidence and factors associated with cervical intraepithelial neoplasia (CIN) and cervical infection by human papillomavirus (HPV) among HIV-positive and HIV-negative women. Methods A cohort of 103 HIV positive and 113 HIV negative women were monitored between October 2008 and February 2012, for at least one year. Procedures included cervical cytology, DNA/HPV detection by polymerase chain reaction, colposcopy with biopsy if necessary, followed by an interview for exposure characteristics data. CIN was based on the histopathological results. Results The incidence of CIN was of 8.8 and 4.6 cases/100 women-years in HIV-positive and HIV-negative women, respectively. HIV-positive women presented a hazard ratio (HR) of 2.8 for CIN and developed lesions earlier (0.86 year) than HIV-negative women (2 years) (p = 0.01). The risk of developing CIN decreased with age (HR = 0.9) and marital status (HR = 0.4). HPV patients presented a higher incidence of CIN when compared HIV-positive and HIV-negative women (p = 0.01). The incidence of HPV cervical infection was 18.1 and 11.4 cases/100 women-years in HIV-positive and HIV-negative women, respectively. Those HIV-positive presented earlier HPV infection(p = 0.002). The risk of developing HPV infection decreased with age and was higher among HIV-positive women. HPV 16 was the most common type in HIV-positive women, and also the type most closely associated with CIN in HIV-negative women. Conclusions HIV-positive women had a greater incidence of HPV and CIN, and in a shorter time interval. More rigorous and timely clinical control is required for this group.