Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death.

The use of opioids to control pain at the end of life may cause constipation, a symptom that can negatively influence the well-being of patients and caregivers. The main aim of this study was to evaluate the impact of constipation on symptomatic control and patients' overall quality of life at this stage. A particular focus was placed on opioids. We also intended to investigate whether constipation and caregiver fatigue is related to the place of death (hospital vs home). The approach of 121 patients followed in 2021 in their last week of life by a home team specialized in palliative care was analyzed in an observational, retrospective, non-interventional study. The patients were followed up for an average of 39.7 days. A total of 82.6% wished to die at home, which occurred in 74% of the cases. The constipation prevention protocol reduced constipation by 55.1%. It seems that morphine is more related with constipation and tapentadol seems to reduce constipation induced by opioids. Patients tended to die in hospitals when their caregivers were exhausted; however, it was not possible to determine a cutoff point using the Zarit scale, which was used to assess caregiver burden. Constipation in the last week of life does not seem to influence the well-being of patients or their caregivers significantly and the individualization of intensive treatment of constipation is needed. Different opioids have different probabilities of causing adverse effects such as constipation. Future special support mechanisms can be created and activated for the most tired caregivers to avoid exhaustion and promote death at home, if that is the patient's will.

Preliminary pre-clinical studies on the side effects of breast cancer treatment.

Purpose: Technological advancement in the treatment of cancer together with early detection and diagnosis have considerably improved the survival of breast cancer patients. On the other hand, the potential of patients developing side effects from cancer treatment are not negligible. Despite the progress that has been made in terms of early diagnosis, therapy, and survival, including improvements in the chemotherapeutic agents, radiation and molecular targeted therapies, cardiotoxicity of cancer therapy is still cause for concern. Radiation therapy for breast cancer is associated with increased risk of heart disease and myocardial infarction. Furthermore, the association of radiation therapy to chemotherapy is an important aspect to be considered in the development of cardiac disease, as this could play an additional role as a risk factor. Besides the heart effect, other side effects can be observed in the bone, ovary, uteri, and other organs. This paper aims to review the recent literature to present the current understanding of side effects associated with breast cancer treatment. The focus is on recent preclinical studies that have assessed potential changes in different organs that may be injured after breast cancer treatment, both due to both radiation and chemotherapy agents.Conclusion: Radiation-induced heart disease is one important side effect that must be considered during the treatment planning and patient follow-up. The cardiac damage can be potentialized when chemotherapy is associated to radiotherapy, and the literature findings indicate that heart fibrosis plays an important role at the radio-chemotherapy induced cardiac damage. Literature findings also showed important side effects at the bone, that can lead to ospeoporosis, due to the decrease of calcium, after radio or chemotherapy treatments. This decrease could be explained by the ovarian failure observed at rats after chemotherapy treatment. It is of great importance to acknowledge the complications originating from the treatment, so that new strategies can be developed. In this way, it will be possible to minimize side effects and improve the patients' quality of life.

A pilot study of a postal dosimetry system using the Fricke dosimeter for research irradiators.

Cobalt-60 irradiators and soft X-ray machines are frequently used for research purposes, but the dosimetry is not always performed using the recommended protocols. This may lead to confusing and untrustworthy results within the conducted research. Postal dosimetry systems have already been approved by the IAEA, with thermoluminescence dosimeters (TLD) and optically stimulated luminescence (OSL) as the most commonly used dosimeter systems in these cases. The present study tests the Fricke dosimeter properties as a potential system to be used in postal dosimetry for a project using research irradiators. The Fricke solution was prepared according to the literature, and the linearity and fading tests were performed accordingly. All calculated doses were measured using a NE2571 Farmer ionization chamber as a reference. Doses ranging from 25 to 300 Gy were delivered by a research irradiator, with 150 kV and 22 mA to the Fricke solutions inside polyethylene (PE) bags (4 × 4 × 0.2 cm3). The results compared with the ionization chamber showed a linear response to the range of doses used. Fading tests showed no significant difference for the absorbed doses over 9 days, with a maximum difference of 1.5% found between days 0 and 3. The Fricke dosimeter presented good linearity, for low and high doses, and low uncertainties for the fading even for 9 days after irradiation. These preliminary results are motivating, and as the next step, we intend to design a postal dosimetry system using the PE bags of Fricke solution.

Technical Note: Fricke dosimetry for blood irradiators.

PURPOSE: The Fricke dosimeter has been shown to be a viable option as an absorbed dose standard. This work aims to provide the dose distribution in an irradiator container during blood irradiation using Fricke dosimetry. METHODS: Measurements were performed using a Gammacell Elan 3000 blood irradiator at Hemocenter in Rio de Janeiro, Brazil. A specific phantom was constructed and patented by the authors to perform these measurements. Fricke solution was prepared according to international protocols, and polyethylene bags filled with Fricke solution (n = 19) were spatially distributed within the phantom. Control bags were also submitted to the same process, except the irradiation. The irradiation time was calculated to give 25.7 Gy to the central portion of the phantom, the same dose used for blood bags. RESULTS: Encouraging results were obtained with an overall uncertainty of 2.1% (k = 1). The obtained results were compared with the doses calculated by the physicist from Hemocenter based on parameters provided by the manufacturer. The mean dose delivered to the Fricke bag in the center of the phantom (cavity 2) was 28.7 ± 0.5 Gy, which is 12% higher than the planned dose of 25.7 Gy. CONCLUSIONS: The obtained results showed that the setup (Fricke and phantom) is able to perform dosimetry for blood irradiators. The delivered dose was higher than expected. This highlights the importance in controlling all the parameters during irradiation to ensure the correct dose for all irradiated bags.

Determination of the absorbed dose to water for medium-energy x-ray beams using Fricke dosimetry.

PURPOSE: For x-ray beams in the low and medium energy range, reference dosimetry is established in terms of air kerma. Fricke dosimetry has shown great potential in the absolute measurements of the absorbed dose to water for high-energy ranges. Therefore, the main purpose of this work was to compare the absorbed dose to water for medium-energy x-ray beams obtained through Fricke dosimetry with that obtained from the air kerma rate. METHODS: To determine the absorbed dose to water using Fricke dosimetry, the polyethylene bags methodology was chosen. Fricke solution was irradiated at four different beam qualities. The absorbed dose to water values obtained using Fricke dosimetry were compared to those obtained using the standard protocol, using the Z-score. RESULTS: Values of the Z-score were <2 for all measurements of absorbed dose to water, which means that the values obtained using Fricke dosimetry are equivalent to those obtained using the reference protocol. The combined standard uncertainty for the absorbed dose to water obtained by Fricke dosimetry was lower than that obtained with the ionization chamber. CONCLUSIONS: Chemical dosimetry using a standard FeSO4 solution has been demonstrated to be a potential option as a standard for the quantity absorbed dose to water for medium kV x-ray qualities.

Effects of soft X-ray radiation damage on paraffin-embedded rat tissues supported on ultralene: a chemical perspective.

Radiation damage is an important aspect to be considered when analysing biological samples with X-ray techniques as it can induce chemical and structural changes in the specimens. This work aims to provide new insights into the soft X-ray induced radiation damage of the complete sample, including not only the biological tissue itself but also the substrate and embedding medium, and the tissue fixation procedure. Sample preparation and handling involves an unavoidable interaction with the sample matrix and could play an important role in the radiation-damage mechanism. To understand the influence of sample preparation and handling on radiation damage, the effects of soft X-ray exposure at different doses on ultralene, paraffin and on paraffin-embedded rat tissues were studied using Fourier-transform infrared (FTIR) microspectroscopy and X-ray microscopy. Tissues were preserved with three different commonly used fixatives: formalin, glutaraldehyde and Karnovsky. FTIR results showed that ultralene and paraffin undergo a dose-dependent degradation of their vibrational profiles, consistent with radiation-induced oxidative damage. In addition, formalin fixative has been shown to improve the preservation of the secondary structure of proteins in tissues compared with both glutaraldehyde and Karnovsky fixation. However, conclusive considerations cannot be drawn on the optimal fixation protocol because of the interference introduced by both substrate and embedding medium in the spectral regions specific to tissue lipids, nucleic acids and carbohydrates. Notably, despite the detected alterations affecting the chemical architecture of the sample as a whole, composed of tissue, substrate and embedding medium, the structural morphology of the tissues at the micrometre scale is essentially preserved even at the highest exposure dose.

Protein content and amino acids profile of pseudocereals.

Quinoa (Chenopodium quinoa), amaranth (Amaranthus caudatus) and buckwheat (Fagopyrum esculentum) represent the main protein source in several diets, although these pseudocereals are not currently present in the FCDB nutrient profile information. The aim of this work is to characterise the AA profile of these pseudocereals and compare them with rice. Total protein content revealed to vary from 16.3g/100g (quinoa Salta) to 13.1g/100g (buckwheat) and lower values were found in rice samples (6.7g/100g). For pseudocereals the most abundant essential AA was leucine. Quinoa-Salta evidences the highest leucine content (1013mg/100g) and the minor methionine content (199mg/100g). Buckwheat was the cereal with the highest phenylalanine content (862mg/100g). Rice (Oryza sativa) presents the lowest content for all AA. Results showed pseudocereals as the best source of AA. EuroFIR guidelines where strictly followed and proved to be a crucial tool to guarantee data interchangeability and comparability.

Characterisation of nutrient profile of quinoa (Chenopodium quinoa), amaranth (Amaranthus caudatus), and purple corn (Zea mays L.) consumed in the North of Argentina: proximates, minerals and trace elements.

Quinoa, amaranth and purple corn are Andean cereals largely consumed in North of Argentina. Nutrient analysis with the purpose of inclusion in the Argentinean FCDB and e-search EuroFIR has become urgent matter. In this work proximate and mineral profile of Andean cereals cultivated in the North of Argentina were determined and compared with rice. Proximate analysis showed that Andean cereals have similar profile but significantly higher (p<0.05) than rice. Andean cereals are rich sources of iron, copper, manganese and zinc and better than rice. Phosphorus and magnesium quinoa content could contribute up to 55% of consumers DRI. Andean cereals and rice are poor sources of potassium. To guarantee the interchange of data among users and producers of FCDB component values were obtained in compliance with EuroFIR guidelines for compilation process. Present work provides necessary information to FCDB users who wish to have access to food reference analytical parameters.

[Oral life history as a humanistic strategy for the approach between caregivers and the elderly]. / A metodologia da história oral de vida como estratégia humanizadora de aproximação entre cuidador/idoso.

This study describes the use of oral life history as a strategy for the approach between caregivers and the elderly. The aim is to contribute to humanization of the relationship between health professionals and patients. A qualitative descriptive study included a sample of seven elderly individuals of both sexes and 65 years or older. Open, semi-structured interviews were conducted, producing narratives of the patients' life histories. The narratives were later returned to the participants in the form of personalized booklets for use as they saw fit. The approach contributed to the formation and strengthening of bonds between the nursing staff and the elderly and enhanced both the human and therapeutic aspects of this relationship.

Câncer infantil: sentimentos manifestados por crianças em quimioterapia durante sessões de brinquedo terapêutico / Childhood cancer: feelings expressed by children in chemotherapy during therapeutic toy sessions

Este estudo objetivou compreender os sentimentos vivenciados pela criança com câncer manifestados durante sessões de Brinquedo Terapêutico. Trata-se de pesquisa qualitativa com cinco crianças com idade entre três e doze anos, de ambos os sexos. A coleta de dados foi realizada através de uma observação sistemática e participativa, associada a uma entrevista intermediada pelo Brinquedo Terapêutico. Os dados foram trabalhados utilizando-se a análise do discurso. A criança com câncer configurou-se como um ser repleto de sentimentos. O medo da morte, as dores, a tristeza diante das limitações impostas pela doença, o retraimento e revolta com os procedimentos, a angústia perante as incertezas constituíram sentimentos negativos expressos pelas crianças nas dramatizações. No entanto, a evolução do tratamento, a manifestação de um bom prognóstico e o desfecho de cura faziam emergir sentimentos de esperança e felicidade diante do tratamento, otimismo em retornar às atividades habituais e superação em meio às dificuldades vivenciadas.

X-ray fluorescence with synchrotron radiation to elemental analysis of lead and calcium content of primary teeth.

Primary teeth were analyzed by micro-SRXRF. The aim of this study was to determine the elemental distribution of lead and calcium in different regions of primary incisor of children living in a notoriously contaminated area (Santo Amaro da Purificação, Bahia State, Brazil). The measurements were performed in standard geometry of 45 degrees incidence, exciting with a white beam and using a conventional system collimation (orthogonal slits) in the XRF beamline at the Synchrotron Light National Laboratory (Campinas, Brazil).

Avaliação de multielementos em amostras de sangue humano usando SR-TXRF / Evaluation of multielements in human blood samples using synchrotron radiation

A técnica de fluorescência de raios X por reflexão total usando radiação síncrotron (SR-TXRF) é uma poderosa ferramenta utilizada para a determinação das concentrações elementares presentes em amostras biológicas. O objetivo deste estudo é avaliar as possíveis alterações causadas por processos de irradiação na concentração de elementos-traço em amostras de sangue humano. As amostras de sangue foram coletadas no Laboratório de Análises Clínicas Dr. Elilel Figueiredo, Rio de Janeiro, e divididas em dois grupos. O primeiro grupo foi irradiado com doses de 1.500, 2.500 e 3.000 cGy, utilizando o irradiador Gammacell 220 Excel, e o segundo foi irradiado com doses que variaram de 2 cGy a 100 cGy, utilizando uma bomba de cobalto Theratron 780 C do Inca, Rio de Janeiro. Todas as amostras de sangue total, plasma e matriz celular foram então liofilizadas e, em seguida, passaram pelo procedimento padrão de digestão. Todas as medidas foram realizadas na linha de fluorescência de raios X do Laboratório Nacional de Luz Síncrotron (LNLS), em Campinas, Brasil. Não se verificou variação significativa na concentração de Ca e, em contrapartida, o K foi o único elemento que sofreu alterações significativas para todas as amostras analisadas em função da dose. A concentração de Fe diminuiu apenas para as amostras de sangue total e plasma. A concentração de Zn apresentou uma diminuição significativa somente para as amostras de sangue total.

Total-reflection X-ray fluorescence using synchrotron radiation (SR-TXRF) is a powerful analytical technique to study trace elements in biomedical samples. The aim of this study was to investigate possible changes in essential trace element concentrations caused by irradiation procedures. Fresh blood samples were obtained from the Dr. Eliel Figueiredo Laboratory, Rio de Janeiro. The samples were separated in two groups. The first was irradiated with doses of 1500, 2500 and 3000cGy, using a Gammacell 220 Exce irradiator, and the second was irradiated with doses of from 2 to 100 cGy, using gamma radiation in a Theraton 780 C irradiator. After irradiation, all samples were lyophilized to remove the water and then submitted to standard chemical digestion by adding nitric acid. All the measurements were carried out by X-Ray Fluorescence beamline at the Brazilian Synchrotron Light Laboratory (LNLS) in Campinas. While no positive association was found for variations in calcium, the variations in potassium were positively associated with the radiation dose for all analyzed samples. On the other hand, iron levels decreased for whole blood and plasma and zinc levels decreased only in whole blood as the dose increased.

Estudo imunológico e genético de 10 isolados do vírus da raiva de morcegos do Rio de Janeiro, Sudeste do Brasil / Immunological and genetic study of 10 bat rabies virus isolates from Rio de Janeiro State, Southeast

O presente trabalho visou estudar 10 isolados de vírus da raiva de morcegos hematófagos e não-hematófagos do Estado do Rio de Janeiro em suas características genéticas quanto aos genes N e G, além da resposta de camundongos vacinados com a vacina anti-rábica produzida pela replicação da amostra Pitman-Moore em cultivo celular, frente ao desafio com estes isolados virais, utilizando-se um ensaio imunológico baseado no teste de potência NIH. A vacina anti-rábica utilizada na imunização dos camundongos ofereceu proteção em mais de 80% dos camundongos vacinados com a diluição 1:5 da vacina, frente à maioria dos isolados. A análise filogenética do gene da proteína N apresentou um padrão de agregação dividido em variante de morcego hematófago e variante de morcego insetívoro, com todos os isolados de morcegos frugívoros Artibeus sp. tendo sido segregados com a variante característica de morcegos Desmodus rotundus. Foram observadas diferenças filogenéticas entre as variantes do vírus da raiva de morcego hematófago isoladas na Região Noroeste do Estado do Rio de Janeiro e aquelas isoladas nas Regiões Metropolitana e Sul do Estado. A substituição do resíduo ácido aspártico por ácido glutâmico na posição 118, encontradas na caracterização genética da proteína G dos isolados 704/97BR-DR e 151/98BR-DR, permite inferir que esta posição esteja relacionada à antigenicidade viral. Não foram observadas diferenças genéticas temporais entre os isolados estudados. A vacina anti-rábica utilizada ofereceu proteção satisfatória contra a maioria dos isolados estudados.

In the present study we analyzed 10 bats rabies viruses isolated from Rio de Janeiro State, focusing on its genetic characteristics from genes N and G, and also in the response of mice vaccinated with cell-culture rabies vaccine, produced with the Pitman-Moore strain, after viral challenge with bat rabies isolates, using an immunologic essay based on NIH vaccine potency test. The vaccine used conferred protection in more than 80% of the mice vaccinated with 1:15 vaccine dilution, after viral challenge. N gene genetic analysis divided the rabies virus isolates into haematophagous and insectivorous bat variants, with all isolates from Artibeus sp. frugivorous bats being clustered with the variant characteristic of the Desmodus rotundus vampire bat. Phylogenetic differences between isolates from Northeast Region and those from the Metropolitan and South Regions of Rio de Janeiro State were observed. The substitution of an aspartic acid to a glutamic acid found in the position 118 of G gene genetic characterization from samples 704/97BR-DR and 151/98BR-DR seems to be related to viral antigenicity. There were no time-related genetic differences between the studied samples. The vaccine employed was found with satisfactory protection against the majority of the isolates used.

Genetic analysis of phosphoprotein and matrix protein of rabies viruses isolated in Brazil.

To investigate the genetic characteristics of phosphoprotein (P) and matrix protein (M) genes of variable rabies virus (RV) prevalent in Brazil, the authors genetically characterized the P and M genes from 30 Brazilian RV field isolates. Phylogenetic analysis based on the P and M genes revealed the presence of six RV variants that consisted primarily of three insectivorous bats, the vampire bat, dog and fox in Brazil. Specific amino acid substitutions corresponding to these phylogenetic lineages were observed, with Asp(42) and Glu(62) in the P protein found to be characteristic of Brazilian chiroptera- and carnivora-related RVs, respectively. Amino acid sequence motifs predicted to associate with a viral function in the P and M proteins were conserved among Brazilian RV variants.

Phylogenetic characterization of rabies virus isolates from Carnivora in Brazil.

The incidence of canine rabies has been widely reported in Brazil, and new rabies virus (RV) variants, genetically similar to canine RV, have recently been isolated from foxes. In order to derive the epidemiological characteristics of Brazilian Carnivora RV, Brazilian RVs isolated from dogs, cats, and foxes were genetically analyzed. Brazilian Carnivora RV isolates were divided into 2 main lineages. The predominant lineage was found in dogs and cats, which included the Argentinean and Bolivian Carnivora RV isolates, and was extensively distributed throughout Brazil and surrounding countries. The other lineage consisted of three sublineages containing Brazilian dog and fox RV isolates, with the dog sublineages located on an internal branch of 2 fox sublineages, suggesting that RV transmission events might have occurred between foxes and dogs in the past. These results suggest that contact between dogs and wildlife has the potential to generate new rabies variants and that it is important to control RV infection cycles in both dogs and wildlife to prevent spread of rabies infection.