Unleashing Fungicidal Forces: Exploring the Synergistic Power of Amphotericin B-Loaded Nanoparticles and Monoclonal Antibodies.

Fungal infections cause 1.7 million deaths annually, which can be attributed not only to fungus-specific factors, such as antifungal resistance and biofilm formation, but also to drug-related challenges. In this study, the potential of Amphotericin (AmB) loaded polymeric nanoparticles (AmB-NPs) combined with murine monoclonal antibodies (mAbs) (i.e., CC5 and DD11) was investigated as a strategy to overcome these challenges. To achieve this goal, AmB-NPs were prepared by nanoprecipitation using different polymers (polycaprolactone (PCL) and poly(D,L-lactide) (PLA)), followed by comprehensive characterization of their physicochemical properties and in vitro biological performance. The results revealed that AmB-loaded NPs exhibited no cytotoxicity toward mammalian cells (baby hamster kidney cells-BHK and human monocyte cells-THP-1). Conversely, both AmB-NPs demonstrated a cytotoxic effect against C. albicans, C. neoformans, and H. capsulatum throughout the entire evaluated range (from 10 µg/mL to 0.1 µg/mL), with a significant MIC of up to 0.031 µg/mL. Moreover, the combination of AmB-NPs with mAbs markedly intensified antifungal activity, resulting in a synergistic effect that was two to four times greater than that of AmB-NPs alone. These findings suggest that the combination of AmB-NPs with mAbs could be a promising new treatment for fungal infections that is potentially more effective and less toxic than current antifungal treatments.

Totally Spin-Polarized Currents in an Interferometer with Spin-Orbit Coupling and the Absence of Magnetic Field Effects.

The paper studies the electronic current in a one-dimensional lead under the effect of spin-orbit coupling and its injection into a metallic conductor through two contacts, forming a closed loop. When an external potential is applied, the time reversal symmetry is broken and the wave vector k of the circulating electrons that contribute to the current is spin-dependent. As the wave function phase depends upon the vector k, the closed path in the circuit produces spin-dependent current interference. This creates a physical scenario in which a spin-polarized current emerges, even in the absence of external magnetic fields or magnetic materials. It is possible to find points in the system's parameter space and, depending upon its geometry, the value of the Fermi energy and the spin-orbit intensities, for which the electronic states participating in the current have only one spin, creating a high and totally spin-polarized conductance. For a potential of a few tens of meV, it is possible to obtain a spin-polarized current of the order of µA. The properties of the obtained electronic current qualify the proposed device as a potentially important tool for spintronics applications.

Latex proteins from Plumeria pudica reduce ligature-induced periodontitis in rats.

BACKGROUND: Previous studies have shown that latex proteins from Plumeria pudica (LPPp) have anti-inflammatory and antioxidant activity. Therefore, the aim of this study was to evaluate the effects in rats of LPPp on ligature-induced periodontitis, an inflammatory disease. METHODS: The animals were divided into groups: saline (animals without induction of periodontitis), periodontitis (induced periodontitis and untreated) and LPPp (induced periodontitis and treated with 40 mg/kg). The following parameters were evaluated after 20 consecutive days of treatment: gingival bleeding index (GBI), probing pocket depth (PPD), alveolar bone height (ABH) and gingival myeloperoxidase (MPO) activity. In the hepatic tissue, malondialdehyde (MDA), glutathione (GSH) and histopathological alterations were evaluated. Blood levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured. RESULTS: Significant reduction in GBI, PPD and gingival MPO activity and ABH was seen in animals treated with LPPp compared with periodontitis. Values of GSH, MDA, ALT and histopathological evaluation were preserved in animals treated with LPPp. CONCLUSIONS: Treatment with LPPp improved clinical aspects of periodontitis, reduced the blood and hepatic alterations and prevented alveolar bone loss. Data suggest that LPPp have potential for treatment of periodontitis.

Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology.

Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.

Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology / Canabinoides em Neurologia - Artigo de posicionamento dos Departamentos Científicos da Academia Brasileira de Neurologia

ABSTRACT Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.

RESUMO Os canabinoides compreendem os endocanabinoides, fitocanabinoides e os canabinoides sintéticos e desempenham ações no sistema nervoso central e periférico. Uma quantidade enorme de publicações tem sido lançada nos últimos anos, embora a cannabis seja conhecida por milênios. Os Departamentos Científicos da Academia Brasileira de Neurologia descreveram as evidências do uso médico em suas áreas. A literatura está em constantes mudanças e possíveis novas evidências podem surgir nos próximos dias ou meses. A prescrição dessas substâncias deve ser discutida com os pacientes e suas famílias, com conhecimento sobre eventos adversos e sua eficácia.

Bromelain reduces the non-alcoholic fatty liver disease and periodontal damages caused by ligature-induced periodontitis.

OBJECTIVE: The objective of this research was to evaluate the effects of bromelain (derived from Ananas comosus) upon periodontitis in rats. MATERIALS AND METHODS: Twenty-four rats were separated into groups: control, periodontitis, and bromelain treatment. Bromelain was administered daily by intraperitoneal injection for 20 days. Periodontitis was induced by ligature around the first molars. Oral parameters and blood biomarkers were measured. The histopathological evaluation of the hepatic tissue was performed. Bromelain treatment significantly reduced several oral inflammatory parameters, alveolar bone loss, and blood biomarkers compared to the rats on periodontitis. RESULTS: Treatment with bromelain improved the steatosis score. Bromelain used in ligature-induced periodontitis in rats was able to reduce the oral inflammatory parameters Gingival Bleeding Index (GBI), tooth mobility (TM), probing pocket depth (PPD), malondialdehyde (MDA), alveolar bone height (ABH) and gingival myeloperoxidase (MPO) and blood parameters (cholesterol, triglycerides, alanine aminotransferase, and aspartate aminotransferase). Bromelain treatment reduced the impact of periodontitis, such as the reduction of hepatic steatosis and improvement in the dosages of MDA and GSH. CONCLUSION: Bromelain acts as a potential adjunct in the non-surgical treatment of periodontitis and, consequently, reduces the impact of periodontitis, acting as anti-inflammatory and antioxidant.

Efficacy of FLU-v, a broad-spectrum influenza vaccine, in a randomized phase IIb human influenza challenge study.

FLU-v, developed by PepTcell (SEEK), is a peptide vaccine aiming to provide a broadly protective cellular immune response against influenza A and B. A randomized, double-blind, placebo-controlled, single-center, phase IIb efficacy and safety trial was conducted. One hundred and fifty-three healthy individuals 18-55 years of age were randomized to receive one or two doses of adjuvanted FLU-v or adjuvanted placebo subcutaneously on days -43 and -22, prior to intranasal challenge on day 0 with the A/California/04/2009/H1N1 human influenza A challenge virus. The primary objective of the study was to identify a reduction in mild to moderate influenza disease (MMID) defined as the presence of viral shedding and clinical influenza symptoms. Single-dose adjuvanted FLU-v recipients (n = 40) were significantly less likely to develop MMID after challenge vs placebo (n = 42) (32.5% vs 54.8% p = 0.035). FLU-v should continue to be evaluated and cellular immunity explored further as a possible important correlate of protection against influenza.

Características sociodemográficas e ocupacionais e qualidade do sono de docentes de uma faculdade privada / Sociodemographic and occupational characteristics and sleep quality of teachers of a private college / Características sociodemográficas y ocupacionales y calidad del sueño de los docentes de una universidad privada

Objetivo: verificar as características sociodemográficas e ocupacionais e a qualidade do sono de docentes da área de saúde de uma faculdade privada do estado de Goiás. Método: trata-se de um estudo transversal, descritivo e quantitativo realizado entre novembro e dezembro de 2017 por meio de um questionário sociodemográfico e ocupacional e do Índice de Qualidade de Sono Pittsburg. Resultados: predominaram docentes do sexo feminino (61,5%), casados (61,5%), sem filhos (61,5%), que atuam no curso de fisioterapia (46,2%), como horistas (58,3%), com outros vínculos empregatícios (76,9%) e que atuam nos três turnos do dia (76,9%). 53,8% dos docentes apresentam baixa qualidade do sono, sendo essa qualidade mais afetada pelos distúrbios do sono e pela sonolência diurna. Conclusão: os docentes estão expostos a fatores laborais e demográficos que podem contribuir para a baixa qualidade do sono. Necessita-se repensar os aspectos salariais, de carga horária e didáticos para modificar esse panorama

Objective: To verify the sociodemographic and occupational characteristics and sleep quality of health professors of a private college in the state of Goiás. Method: This is a cross-sectional, descriptive and quantitative study conducted between November and December 2017 through of a sociodemographic and occupational questionnaire and the Pittsburg Sleep Quality Index. Results: there was a prevalence of females (61.5%), married (61.5%), childless (61.5%), who work in the physiotherapy course (46.2%), as hourly (58.3 %), with other employment relationships (76.9%) and working in the three shifts of the day (76.9%). 53.8% of teachers have poor sleep quality, and this quality is most affected by sleep disorders and daytime sleepiness. Conclusion: teachers are exposed to occupational and demographic factors that may contribute to poor sleep quality. It is necessary to rethink the salary, workload and didactic aspects to change this scenario.

Objetivo: Verificar las características sociodemográficas y ocupacionales y la calidad del sueño de los profesores de salud de una universidad privada en el estado de Goiás Método: Este es un estudio transversal, descriptivo y cuantitativo realizado entre noviembre y diciembre de 2017 a través de de un cuestionario sociodemográfico y ocupacional y el índice de calidad del sueño de Pittsburg. Resultados: predominantemente docentes (61.5%), casados (61.5%), sin hijos (61.5%), que trabajan en el curso de fisioterapia (46.2%), por hora (58.3 %), con otras relaciones laborales (76.9%) y trabajando en los tres turnos del día (76.9%). El 53.8% de los maestros tienen mala calidad del sueño, y esta calidad es más afectada por los trastornos del sueño y la somnolencia diurna. Conclusión: los maestros están expuestos a factores ocupacionales y demográficos que pueden contribuir a la mala calidad del sueño. Es necesario repensar el salario, la carga de trabajo y los aspectos didácticos para cambiar este escenario.

Health alterations in nursing students after a year from admission to the undergraduate course.

OBJECTIVE: To identify health alterations in nursing students after a year from admission to a nursing undergraduate course. METHOD: A longitudinal prospective study with a quantitative approach was carried out in 2016 with first-year nursing students from two universities in the state of São Paulo. The following instruments were applied at the beginning and the end of the first school year: an instrument for Assessment of Stress in Nursing Students, the Center for Epidemiologic Studies Depression Scale, and the Pittsburgh Sleep Quality Index. The ANOVA test for mixed models was used for analysis. RESULTS: The sample was made up of 117 students in March and 100 students in December. A significant increase in stress in all dimensions of the instrument, a reduction in the duration and subjective quality of sleep, and an increase in general stress and depressive symptoms were observed. CONCLUSION: The nursing academic environment presents the potential for students to become ill. Institutions should rethink their curricular elements, promote resilience, and create spaces to promote students' health.

Health alterations in nursing students after a year from admission to the undergraduate course / Alteraciones de salud en estudiantes de enfermería un año después del ingreso en la carrera universitaria / Alterações de saúde em estudantes de enfermagem um ano depois do ingresso no curso de graduação

ABSTRACT Objective: To identify health alterations in nursing students after a year from admission to a nursing undergraduate course. Method: A longitudinal prospective study with a quantitative approach was carried out in 2016 with first-year nursing students from two universities in the state of São Paulo. The following instruments were applied at the beginning and the end of the first school year: an instrument for Assessment of Stress in Nursing Students, the Center for Epidemiologic Studies Depression Scale, and the Pittsburgh Sleep Quality Index. The ANOVA test for mixed models was used for analysis. Results: The sample was made up of 117 students in March and 100 students in December. A significant increase in stress in all dimensions of the instrument, a reduction in the duration and subjective quality of sleep, and an increase in general stress and depressive symptoms were observed. Conclusion: The nursing academic environment presents the potential for students to become ill. Institutions should rethink their curricular elements, promote resilience, and create spaces to promote students' health.

RESUMEN Objetivo: Identificar las alteraciones de salud en estudiantes de enfermería un año después del ingreso en la carrera universitaria. Método: Investigación longitudinal, prospectiva y cuantitativa, llevada a cabo en 2016 con estudiantes de enfermería del primer año de dos universidades de São Paulo. En el inicio y el fin del año lectivo, se aplicaron: Instrumento para Evaluación del Estrés en Estudiantes de Enfermería, Center for Epidemiologic Studies Depression Scale e Índice de Calidad de Sueño de Pittsburgh. Para el análisis, se utilizó la prueba ANOVA para modelos mixtos. Resultados: Compusieron la muestra 117 estudiantes en marzo y 100 en diciembre. Se verificó aumento significativo del estrés en todos los dominios del instrumento, reducción de la duración y la calidad subjetiva del sueño y aumento del estrés general y de los síntomas depresivos. Conclusión: El entorno académico de enfermería presenta potencial para que el estudiante se enferme. Se sugiere que los centros repiensen sus elementos curriculares, promuevan la resiliencia y creen espacios de promoción a la salud de los estudiantes.

RESUMO Objetivo: Identificar as alterações ocorridas na saúde de estudantes de enfermagem um ano depois do ingresso no curso. Método: Pesquisa longitudinal, prospectiva e quantitativa, realizada em 2016 junto a estudantes de enfermagem do primeiro ano de duas universidades de São Paulo. No início e no final do ano letivo, aplicaram-se: Instrumento para Avaliação do Estresse em Estudantes de Enfermagem, Center for Epidemiologic Studies Depression Scale e Índice de Qualidade de Sono de Pittsburgh. Para a análise, utilizou-se do teste ANOVA para modelos mistos. Resultados: Compuseram a amostra 117 estudantes em março e 100 em dezembro. Verificou-se aumento significativo do estresse em todos os domínios do instrumento, redução da duração e da qualidade subjetiva do sono e aumento do estresse geral e dos sintomas depressivos. Conclusão: O ambiente acadêmico de enfermagem apresenta potencial para o adoecimento do estudante. Sugere-se que as instituições repensem seus elementos curriculares, promovam a resiliência e criem espaços de promoção à saúde dos estudantes.

Absenteísmo em profissionais de unidade de estratégia de saúde da família- estudo documental / Absenteeism in workers of a family healthcare unitdocumental research

O objetivo desta investigação foi verificar a ocorrência de absenteísmo na equipe de Estratégia de Saúde da Família (ESF) urbana de um município do Noroeste de Mato Grosso. Estudo documental, realizado no mês de março de 2015, por meio de consulta documental a registros dos trabalhadores que integram a equipe do perímetro urbano. Houve registro total de 35 ausências por profissionais e o principal motivo do absenteísmo esteve relacionado a doenças osteomusculares, o que corrobora com a literatura disponível na área. Destaca-se o levado número de atestados sem número do CID especificado (63%), fator que dificultou traçar o perfil do absenteísmo nessa população. Descritores: Saúde do trabalhador. Absenteísmo. Estratégia de saúde da família.

Estresse ocupacional e qualidade do sono em docentes da área da saúde / Occupational stress and sleep quality in professors of the health area

Objetivo: analisar a relação entre estresse ocupacional e qualidade do sono em docentes da área da saúde. Métodos: estudo transversal realizado por meio de um questionário sociodemográfico, ocupacional e da Escala de Estresse no Trabalho e Índice de Qualidade de Sono Pittsburg. Resultados: predominaram docentes homens (57,9%), casados (47,4%), com filhos (52,6%), que residem com a família (89,5%) e com 34,7 anos em média. Da amostra, 63,2% apresentaram baixo nível de estresse e 57,9%, baixa qualidade do sono, sendo essa mais afetada pela sonolência diurna, distúrbios do sono e duração do sono. Houve correlação significativa e positiva entre nível de estresse geral e uso de medicações para dormir. Conclusão: baixo nível de estresse e baixa qualidade do sono. Constata-se que, a sonolência diurna, os distúrbios do sono e a duração do sono os fatores que mais contribuem para a baixa qualidade do sono dos docentes da área de saúde. (AU)

Clinical and Epidemiological Aspects of Scorpionism in the World: A Systematic Review.

OBJECTIVE: Scorpion stings are registered worldwide, but the incidence and the features of the envenomations vary depending on the region. The aim of this review was to summarize the epidemiological, clinical, diagnostic, and therapeutic data worldwide regarding humans stung by scorpions. METHODS: A systematic review of the literature was conducted through the online databases of the Virtual Health Library (VHL), which hosts Medline and the Latin American and Caribbean Center on Health Sciences Informational (LILACS) database. We selected articles published between January 1, 2002 and July 31, 2014. RESULTS: Scorpion envenomation reports were found throughout the world, mainly in subtropical and tropical regions. The clinical manifestations were sympathetically and parasympathetically mediated, depending on the species of scorpion. Some of the most common severe complications of scorpionism included respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. Scorpion envenomation could be classified as mild, moderate, and severe, and the therapeutic approach was based on the case severity. The treatment comprised 3 components: symptomatic measures, vital functions support, and injection of antivenom. Moreover, the time that elapsed between the sting and administration of the appropriate medical care was extremely important to the patient's prognosis. CONCLUSIONS: The large number of scorpion stings worldwide is concerning and reaffirms the need for new prevention measures and policies to reduce the incidence, prevalence, morbidity, and mortality rates from these poisonous arachnids.

HOPX functions as a tumour suppressor in head and neck cancer.

Head and neck squamous cell carcinoma (HNSCC) is generalized term that encompasses a diverse group of cancers that includes tumours of the oral cavity (OSCC), oropharynx (OPSCC) and nasopharynx (NPC). Genetic alterations that are common to all HNSCC types are likely to be important for squamous carcinogenesis. In this study, we have investigated the role of the homeodomain-only homeobox gene, HOPX, in the pathogenesis of HNSCC. We show that HOPX mRNA levels are reduced in OSCC and NPC cell lines and tissues and there is a general reduction of HOPX protein expression in these tumours and OPSCCs. HOPX promoter methylation was observed in a subset of HNSCCs and was associated with a worse overall survival in HPV negative tumours. RNAseq analysis of OSCC cells transfected with HOPX revealed a widespread deregulation of the transcription of genes related to epithelial homeostasis and ectopic over-expression of HOPX in OSCC and NPC cells inhibited cell proliferation, plating efficiency and migration, and enhanced sensitivity to UVA-induced apoptosis. Our results demonstrate that HOPX functions as a tumour suppressor in HNSCC and suggest a central role for HOPX in suppressing epithelial carcinogenesis.

Home Delivery Medicament Program: access, inactivity and cardiovascular risk.

Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

Aberrant expression of the S1P regulating enzymes, SPHK1 and SGPL1, contributes to a migratory phenotype in OSCC mediated through S1PR2.

Oral squamous cell carcinoma (OSCC) is a lethal disease with a 5-year mortality rate of around 50%. Molecular targeted therapies are not in routine use and novel therapeutic targets are required. Our previous microarray data indicated sphingosine 1-phosphate (S1P) metabolism and signalling was deregulated in OSCC. In this study, we have investigated the contribution of S1P signalling to the pathogenesis of OSCC. We show that the expression of the two major enzymes that regulate S1P levels were altered in OSCC: SPHK1 was significantly upregulated in OSCC tissues compared to normal oral mucosa and low levels of SGPL1 mRNA correlated with a worse overall survival. In in vitro studies, S1P enhanced the migration/invasion of OSCC cells and attenuated cisplatin-induced death. We also demonstrate that S1P receptor expression is deregulated in primary OSCCs and that S1PR2 is over-expressed in a subset of tumours, which in part mediates S1P-induced migration of OSCC cells. Lastly, we demonstrate that FTY720 induced significantly more apoptosis in OSCC cells compared to non-malignant cells and that FTY720 acted synergistically with cisplatin to induce cell death. Taken together, our data show that S1P signalling promotes tumour aggressiveness in OSCC and identify S1P signalling as a potential therapeutic target.

Epidemiological study of alendronate-related osteonecrosis of the jaw in the southeast of Scotland.

We aimed to establish the incidence of alendronate-related osteonecrosis of the jaw (ONJ) in the southeast of Scotland, and to assess the effect of corticosteroids on it. We studied a prospective case series of patients between June 2004 and March 2012 separated into steroid and non-steroid groups. There were 34 cases of alendronate-related ONJ and 78732 drug patient years (DPY) of alendronate, making the overall occurrence 43.1 cases/100000 DPY. There were 12 patients in the steroid group (mean (range) age 68.2 (48-87) years) making 42.5 cases/100000 DPY, and 22 in the non-steroid group (mean (range) age 76.2 (63-91) years) making 119.6 cases/100000 DPY. The mean (range) age at presentation of alendronate-related ONJ was significantly lower in the steroid group (68.2 (48-87) compared with 76.2 (63-91) years, p=0.019) as was the duration of exposure to alendronate before it developed (28.9 (6-120) compared with 61.3 (13-168) months, p=0.03). The overall incidence seems to be higher in the southeast of Scotland than elsewhere. Concurrent use of corticosteroids is not associated with an increased incidence of alendronate-related ONJ, but it seems to reduce the duration of exposure before it develops. Age is likely to be a confounding factor.

Home Delivery Medicament Program: access, inactivity and cardiovascular risk / Programa Remédio em Casa: acesso, inatividade e risco cardiovascular / Programa Medicamento en Casa: acceso, inactividad y riesgo cardiovascular

ABSTRACT Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

RESUMO Objetivo: verificar causas de inatividade no Programa Remédio em Casa, referidas por usuários de Unidade Básica de Saúde de São Paulo, comparando-as às registradas pelo programa e analisando-as no modelo teórico Conceito de Acesso à Saúde. Métodos: estudo transversal entrevistando 111 usuários inativos; e documental, nos registros do programa. Resultados: metade dos usuários desconhecia a condição de inatividade. Constatadas discrepâncias nas informações usuário versus programa, observando-se diferentes níveis de concordância: Falta de médico e funcionário administrativo 0%; Transferência para outra unidade 25%; Óbito 50%; Opção desistir 50%; Mudança de endereço 57% e Mudança de esquema terapêutico 80%. Observados sentimentos de aceitação do programa pelos usuários. No conceito de acesso à saúde, a inatividade pode ser explicada na dimensão Informação, no grau de assimetria entre o conhecimento do paciente e do profissional de saúde, identificada pelos indicadores: escolaridade, conhecimento e fontes de informação. Conclusões: devido ao baixo nível de escolaridade, o usuário não assimila as informações sobre as etapas do fluxograma do programa, não retorna para a avaliação que garante sua continuidade. Consequentemente, para de receber medicamentos e permanece longo tempo sem tratamento, o que aumenta o risco cardiovascular dos hipertensos (92% da amostra), diabéticos (44%) e dislipidêmicos (31%).

RESUMEN Objetivo: verificar causas de inactividad en el Programa Medicamento en Casa, referidas por usuarios de Unidad Básica de Salud de São Paulo, comparándolas a las registradas por el programa y analizándolas en el modelo teórico Concepto de Acceso a la Salud. Métodos: estudio trasversal entrevistando 111 usuarios inactivos; y documental, en los registros del programa. Resultados: la mitad de los usuario desconocía la condición de inactividad. Constatadas discrepancias en las informaciones usuario versus programa, observándose diferentes niveles de concordancia: Falta de médico y funcionario administrativo 0%; Trasferencia para otra unidad 25%; Óbito 50%; Opción desistir 50%; Cambio de dirección 57% y Cambio de esquema terapéutico 80%. Observados sentimientos de aceptación del programa por los usuarios. En el concepto de acceso a la salud, la inactividad puede ser explicada en la dimensión Información, en el grado de asimetría entre el conocimiento del paciente y del profesional de salud, identificada por los indicadores: escolaridad, conocimiento y fuentes de información. Conclusiones: debido al bajo nivel de escolaridad, el usuario no asimila las informaciones sobre las etapas del diagrama de flujo del programa, no regresa para la evaluación que garantiza su continuidad. Consecuentemente, deja de recibir medicamentos y sigue largo tiempo sin tratamiento, lo que aumenta el riesgo cardiovascular de los hipertensivos (92% de la muestra), diabéticos (44%) y dislipidémicos (31%).

Gene expression profiling reveals biological pathways responsible for phenotypic heterogeneity between UK and Sri Lankan oral squamous cell carcinomas.

OBJECTIVES: It is well recognized that oral squamous cell carcinoma (OSCC) cases from Asia that are associated with betel quid chewing are phenotypically distinct to those from Western countries that are predominantly caused by smoking/drinking, but the molecular basis of these differences are largely unknown. The aim of this study is to examine gene expression, related carcinogenic pathways and molecular processes that might be responsible for the phenotypic heterogeneity of OSCC between UK and Sri Lankan population groups. METHODS: We have compared the gene expression profiles of OSCCs and normal oral mucosal tissues from both Sri Lankan and UK individuals using Affymetrix gene expression arrays. The generated data was interrogated using significance analysis of microarrays and Ingenuity Pathway Analysis (IPA). RESULTS: The gene expression profiles of UK and Sri Lankan OSCC are similar in many respects to other oral cancer expression profiles reported in the literature and were mainly similar to each other. However, genes involved in tumor invasion, metastasis and recurrence were more obviously associated with UK tumors as opposed to those from Sri Lanka. CONCLUSION: The development of OSCCs in both UK and Sri Lankan populations appears largely mediated by similar biological pathways despite the differences related to race, ethnicity, lifestyle, and/or exposure to environmental carcinogens. However, IPA revealed a highly activated "Cell-mediated Immune Response" in Sri Lankan normal and tumor samples relative to UK cohorts. It seems likely, therefore, that any future attempts to personalize treatment for OSCC patients will need to be different in Western and Asian countries to reflect differences in gene expression and the immune status of the patients.