The impact of the pandemic on physical and functional disabilities in children and adolescents with spina bifida.

STUDY DESIGN: Retrospective and cross-sectional study. OBJECTIVES: The study aimed to carry out telemonitoring to identify the impact of the pandemic on physical and functional disabilities in children and adolescents with SB, as reported by their caregivers, and to investigate adherence to a teleservice. SETTING: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). METHODS: Retrospective and cross-sectional study. Fifty-three patients with SB (mean age 12.0 (4.0) years; 23 males) participated in the telemonitoring. A questionnaire - 'Health management, health conditions, rehabilitation, interest in teleservice, and the well-being of the main caregiver' - investigated the clinical impact of the coronavirus pandemic. Only three caregivers participated in the teleservice (video call). RESULTS: According to telemonitoring, 62% of the patients discontinued physiotherapy sessions, and 69% reported needing adjustments in locomotion devices. The main complaints were muscle weakness and pain. CONCLUSION: We monitored general health and identified demands related to physical rehabilitation using telemonitoring in 42.4% of children and adolescents with SB monitored at the HCFMRP-USP. Telemonitoring and teleservice may be methods used for monitoring health conditions in patients with SB.

A deficit to reach the isokinetic velocity in youth wheelchair users with spina bifida.

INTRODUCTION: The self-paced adopted by wheelchair users in their postural transfers and locomotion may require sufficient levels of speed-strength in the upper limbs. In clinical practice, we observed limited functional independence and social participation. OBJECTIVES: This study aimed to investigate and compare the speed-strength relationship between wheelchair users with spina bifida (SB) and typically developing youth. In particular, to analyze if SB wheelchair users reached the preset velocities in the isokinetic evaluation of shoulder and elbow. DESIGN: Cross-sectional observational study. SETTING: Ribeirão Preto Medical School of the University of São Paulo. PARTICIPANTS AND PROCEDURES: SB (SB; n = 11) and controls (CT; n = 22) performed the isokinetic assessment of shoulder abductors (SAB), adductors (SAD), flexors (SFL), extensors (SEX), and elbow flexors (EFL) and extensors (EEX) at velocities of 60 and 120degree.s-1. The analysis of covariance was used to identify the intergroup differences in muscle performance. OUTCOME MEASURES: The values of peak torque (PT), power (Pow), time to peak torque (tPT) and the percentage to reach the isokinetic velocity. RESULTS: The percentage to reach 120degree.s-1 was moderate-to-low for both groups (26-75.9%). CT presented a significantly greater relative risk of reaching the preset velocities than SB. SB presented higher PT and Pow for SAB and SFL at 60degree.s-1, higher PT for SFL and EEX at 120degree.s-1, and lower tPT for SFL at 120degree.s-1 compared to CT. CONCLUSION: SB had difficulty reaching 120degree.s-1, probably related to neuromuscular differences. However, arm movements in their daily tasks seem to maintain the ability to produce PT and Pow.

Phytochemical analysis of carotenoid profile in Mentha piperita and Artemisia vulgaris: cytotoxicity in tumoral cells and evaluation of plasmid DNA cleavage.

Several medicinal plants have been administered to cancer patients attributed to their anticarcinogenic and chemoprotective properties, in addition to lower toxicity compared to traditional therapies. The aim was to investigate the antioxidant properties and carotenoid composition of aqueous extracts of Mentha piperita or Artemisia vulgaris which were previously found to exert beneficial effects on human health through diet. aqueous extracts exhibited potent antioxidant activity. A diversity of carotenoids was identified in these extracts using HPLC-PDA-MS/MS. Both extracts contained predominantly all-trans-lutein as the main component within this class. In order to investigate antioxidant properties, the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) techniques were used. The (3-4,5 dimethylthiazol-2, 5 diphenyl tetrazolium bromide) (MTT) and Crystal Violet assays assessed cellular cytotoxicity. Assessments of presence of reactive species were carried out following exposure of oral squamous cell carcinoma cell line (SCC-4) to various aqueous extracts of M piperita or A vulgaris utilizing dichlorofluorescein diacetate (DCFH-DA) and nitric oxide (NO) assays. Exposure to these extracts induced severe cytotoxic effects, which led to investigation of the biochemical and molecular mechanisms underlying this observed effect. Data demonstrated that both solutions induced oxidative stress and DNA damage, especially at higher concentrations using agarose gel subjected to electrophoresis. It is known that exposure to excess amounts of antioxidants results in a prooxidant effect which is beneficial in cancer therapy. Further, the extracts were found to reduce viability of SCC-4 in culture, indicating that this antitumoral activity may be of therapeutic importance and requires further study.

Phytochemical characterization and toxicological activity attributed to the acetonic extract of South American Vassobia breviflora.

The particular plant species found in southern Brazil, Vassobia breviflora (Solanaceae) has only a few apparent studies examining its biological effect. Thus, the aim of the present study was to determine the activity of the acetone extract fraction derived from V. breviflora. Four compounds were identified by ESI-qTOF-MS: eucalrobusone R, aplanoic acid B, pheophorbide A, and pheophytin A. In addition, 5 compounds were identified by HPLC-PDA-MS/MS: all-trans-lutein, 15-cis-lutein, all-trans-ß-carotene, 5,8-epoxy-ß-carotene, and cis-ß-carotene. Cell lines A549 (lung cancer), A375 (melanoma cancer) and HeLa (cervical cancer) were incubated with different concentrations of each studied extract using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), lactate dehydrogenase (LDH), and 2'-7'dichlorofluorescin diacetate (DCFH-DA) assays. The acetonic extract exhibited cytotoxic activity at a concentration of 0.03 mg/ml in the HeLa strain and 0.1 mg/ml in the others. In addition to increased production of reactive oxygen species (ROS). Antibacterial activity was assessed utilizing minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in 9 ATCCs strains and 7 clinical isolates, as well as determination of biofilm production. Data demonstrated that MIC and MBC were approximately 256 mg/ml in most of the strains tested and antibiofilm effect at S. aureus, S. epidermidis, A. baumannii, and E. faecalis, concentrations below the MIC. Genotoxic activity on plasmid DNA did not produce significant elevated levels in breaks in the isolated genetic material.

Teste de fadiga de preensão manual usando contrações dinâmicas em crianças típicas / Handgrip fatigue test using dynamic contractions in typical children

Objective: To verify the development of fatigue and sex-influence on the handgrip during dynamic contractions in typical children. Methods: Cross-section study. Fifty-eight children, distributed into two groups according to sex (30 boys), aged 8 to 12 years, of both sexes, performed successive dynamic contractions with a bulb dynamometer until they reached maximum perceived effort. The values from the first, the last contractions of the fatigue test, and the measure after 30-s of the last contraction (recovery contraction) were recorded and compared using the linear regression model with mixed effects. T-Student test was used to compare the perceived effort scores and time-to-fatigue between groups. Results: The handgrip values significantly decreased, and perceived effort scores significantly increased in the final measure in relation to the initial measure of the fatigue test. After the fatigue handgrip test, 30-sec of recovery was insufficient to restore the baseline handgrip values. There were no differences between the female and male groups for all variables. Conclusion: The handgrip fatigue test using dynamic contractions showed it efficiently induces motor and perceived fatigue in children, without differences between sexes.

Objetivo: Verificar o desenvolvimento da fadiga e a influência do sexo na preensão manual durante contrações dinâmicas em crianças típicas. Métodos: Estudo transversal. Cinquenta e oito crianças, distribuídas em dois grupos de acordo com o sexo (30 meninos), com idades entre 8 e 12 anos, de ambos os sexos, realizaram sucessivas contrações dinâmicas com um dinamômetro de bulbo até atingirem o esforço máximo percebido. Os valores da primeira, da última contração do teste de fadiga e da medida após 30 segundos da última contração (contração de recuperação) foram registrados e comparados usando o modelo de regressão linear com efeitos mistos. O teste T-Student foi usado para comparar os escores de esforço percebido e o tempo até a fadiga entre os grupos. Resultados: Os valores de preensão palmar e os escores de esforço percebido diminuíram significativamente durante o teste de fadiga. Não houve diferenças entre os grupos para todas as variáveis. Conclusão: O teste de fadiga de preensão palmar utilizando contrações dinâmicas mostrou-se eficaz na indução da fadiga motora e percebida em crianças, sem diferenças entre os sexos.

Validação de conteúdo e análise da adesão ao uso da cartilha "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" em crianças e adolescentes deambuladores e não deambuladores com espinha bífida / Content validit and analysis of adherence to the use of the booklet "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" in ambulator and non-ambulator children and adolescents with spina bifida

Objetivo: A partir da produção de uma cartilha de exercícios domiciliares "Orientações para a Manutenção da Qualidade de Vida Espinha Bífida", objetivou-se validar o conteúdo, realizar a avaliação do material (cartilha) pelos cuidadores, e analisar a adesão ao uso da cartilha. Métodos: Para validação do conteúdo, 8 juízes especialistas avaliaram a cartilha por meio de um questionário adaptado e foi estabelecido o índice de validade de conteúdo (IVC) para cada aspecto abordado. Na avaliação do material realizada pelos cuidadores e na análise da adesão ao uso da cartilha, participaram 10 crianças e adolescentes com espinha bífida e seus cuidadores. O pesquisador leu a cartilha e treinou os exercícios na presença do paciente e de seu cuidador, indicando como deveriam ser realizados em domicílio. Após a entrega foi marcado um retorno presencial, em 15 dias, para que os cuidadores pudessem relatar sobre a avaliação do material assim como, descrever sobre a adesão desses participantes ao uso da cartilha. Por fim, foi agendado um segundo encontro - follow-up ­ para analisar a adesão em longo prazo. Resultados: Dos 27 aspectos abordados na validação do conteúdo, 24 destes receberam pontuação acima do índice aceitável (IVC = 1,00). A maior parte dos cuidadores responderam "concordo" ou "concordo totalmente" para todos os itens analisados referente à avaliação do material. Em curto prazo foi observada uma taxa de adesão de 25% dos participantes e em longo prazo de 12,5%. Conclusão: A cartilha "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" por apresentar clareza dos itens apresentados, facilidade de leitura e adequada compreensão, segundo a avaliação dos juízes especialistas e dos cuidadores, mostrou ser um ótimo recurso para incrementar o tratamento fisioterapêutico de criança e adolescentes com espinha bífida, porém evidenciou uma moderada/baixa adesão por parte dos participantes. [au]

Objective: From the production of a booklet of home exercises "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida", the aim was to validate the content, carry out the evaluation of the material (booklet) by caregivers, and analyze the adherence to the use of the booklet. Methods: For content validation, 8 expert judges evaluated the booklet through an adapted questionnaire, and the content validity index (CVI) was established for each aspect addressed. In the evaluation of the material carried out by the caregivers and in the analysis of adherence to the use of the booklet, 10 children and adolescents with spina bifida participated in this study. The booklet was read with the patients and their caregivers,who were trained to perform the exercises that are in the booklet at home. After delivery, a face-to-face return was scheduled, in 15 days, so that caregivers could report on the evaluation of the material as well as describe the adherence of these participants to the use of the booklet. Finally, a second meeting was scheduled - follow-up - to analyze long-term adherence. Results: Of the 27 aspects addressed in the content validation, 24 of these received scores above the acceptable index (CVI = 1.00). Most caregivers answered "agree" or "strongly agree" to all items analyzed regarding the evaluation of the booklet. In the short term, there was an adherence rate of 25% of the participants, and in the long term, 12.5%. Conclusion: The booklet "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" proved to be a great resource to increase the physical therapy treatment of children and adolescents with spina bifida, according to the evaluation of expert judges and caregivers, for presenting adequate content, language and appearance, but showed moderate/low adherence by the participants. [au]

Protective Effect of Indomethacin-loaded Polymeric Nanoparticles Against Oxidative Stress-Induced Cytotoxicity in Human Breast Adenocarcinoma Cell Model / Efeito Protetor de Nanopartículas Poliméricas com Indometacina contra Citotoxicidade Induzida por Estresse Oxidativo em Modelo Celular de Adenocarcinoma de Mama Humano / Efecto Protector de Nanopartículas Poliméricas con Indometacina contra la Citotoxicidad Inducida por Estrés Oxidativo en Modelo de Células de Adenocarcinoma de Mama Humano

Anti-inflammatory drugs are being utilized to treat cancer because of its inflammatory microenvironment. Objective: The objective of this study is to investigate the antioxidant potential of indomethacin and its genotoxicity, since free or loaded in polymeric nanocapsules using MCF-7 (human breast cancer) cells as an in vitro model. Method: Development of indomethacin-loaded polyepsilon-caprolactone (PCL) nanocapsules by interfacial deposition method. It is characterized by pH determination by potentiometer, mean diameter and polydispersity index by dynamic light scattering; zeta potential by electrophoretic mobility; encapsulation efficacy by high performance liquid chromatography method; corona effect formation; 2',7'-dichlorofluorescin diacetate (DCFH-DA) method by spectrofluorimetric assay; nitric oxide (NO) determination by spectrophotometric and genotoxicity assay by plasmid DNA cleavage method. Results: The results showed a mild acidic pH (4.78 ± 0.10), sizes around 200 nm and PDI PDI<0.2 with a zeta potential around -20 mV and encapsulation efficiency of 99% (1 mg mL-1), showing a dose-dependent corona formation profile in 24h incubation. Conclusion: DCFH-DA assay showed no production of reactive oxygen species (ROS) while NO determination showed that Ind-OH-NC from 26.7 to 100 µM increased reactive nitrogen species (RNS), demonstrating antioxidant potential against MCF-7 cells. No sample at the concentrations evaluated induced DNA cleavage, being considered a safe treatment

Introdução: Anti-inflamatórios estão sendo empregados para tratamento de câncer por causa do seu ambiente inflamado. Objetivo: Investigar o potencial antioxidante da indometacina e sua genotoxicidade, livre ou carreada em nanocápsulas poliméricas, usando como modelo in vitro células MCF-7 (câncer de mama humano). Método: Desenvolvimento de nanocápsulas de poliepsilon-caprolactona (PCL) por método de deposição interfacial, caracterizada por determinação de pH por potenciômetro; diâmetro médio e índice de polidispersão por espalhamento dinâmico de luz; potencial zeta por mobilidade eletroforética; eficiência de encapsulação por cromatografia líquida de alta eficiência; formação de efeito corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensaio espectrofluorimétrico; determinação de óxido nítrico (NO) por espectrometria e ensaio de genotoxicidade por método de clivagem do DNA plasmidial. Resultados: Os resultados mostraram leve pH ácido (4,78 ± 0,10), tamanhos em torno de 200 nm e PDI<0,2 com potencial zeta em torno de -20 mV e eficiência de encapsulação de 99% (1 mg mL-1), apresentando perfil de formação de corona dose-dependente em 24 horas de incubação. Conclusão: O ensaio DCFH-DA mostrou que não há produção de espécies reativas de oxigênio (ROS), enquanto a determinação de NO mostrou que Ind-OH-NC de 26,7 a 100 µM aumentou as espécies reativas de nitrogênio (RNS), demonstrando potencial antioxidante contra MCF-7. Nenhuma amostra nas concentrações avaliadas induziu clivagem do DNA, sendo considerado um tratamento seguro

Introducción: Se están utilizando antiinflamatorios para tratamiento de cáncer debido a su entorno inflamado. Objetivo: Investigar el potencial antioxidante de la indometacina y su genotoxicidad, libre o acarreada en nanocápsulas poliméricas utilizando como modelo in vitro células MCF7 (cáncer de mama humano). Método: Desarrollo de nanocápsulas de poli epsilon-caprolactona (PCL) por método de deposición interfacial, caracterizada por determinación de pH por potenciómetro; diámetro medio e índice de polidispersión por esparcimiento dinámico de luz; potencial zeta por movilidad electroforética; eficiencia de encapsulación por cromatografía líquida de alta eficiencia; formación de efecto corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensayo espectrofluorímetro; determinación de óxido nítrico (NO) por espectrometría y ensayo de genotoxicidad por método de clivaje del ADN plasmídico. Resultados: Los resultados mostraron ligero pH ácido (4,78 ± 0,10), tamaños alrededor de 200 nm y PDI<0,2 con potencial zeta alrededor de -20 mV y eficiencia de encapsulación de 99% (1 mg mL-1), presentando perfil de formación de corona dosis-dependiente en 24h de incubación. Conclusión: El ensayo DCFDA mostró que no hay producción de especies reactivas de oxígeno (ROS) mientras que la determinación de NO mostró que Ind-OH-NC de 26,7 a 100 µM aumentó las especies reactivas de nitrógeno (RNS), demostrando potencial antioxidante contra MCF-7. Ninguna muestra en las concentraciones evaluadas indujo clivaje del ADN, siendo considerado un tratamiento seguro

Protective Effect of Indomethacin-loaded Polymeric Nanoparticles Against Oxidative Stress-Induced Cytotoxicity in Human Breast Adenocarcinoma Cell Model / Efeito Protetor de Nanopartículas Poliméricas com Indometacina contra Citotoxicidade Induzida por Estresse Oxidativo em Modelo Celular de Adenocarcinoma de Mama Humano / Efecto Protector de Nanopartículas Poliméricas con Indometacina contra la Citotoxicidad Inducida por Estrés Oxidativo en Modelo de Células de Adenocarcinoma de Mama Humano

Introduction: Anti-inflammatory drugs are being utilized to treat cancer because of its inflammatory microenvironment. Objective: The objective of this study is to investigate the antioxidant potential of indomethacin and its genotoxicity, since free or loaded in polymeric nanocapsules using MCF-7 (human breast cancer) cells as an in vitro model. Method: Development of indomethacin-loaded polyepsilon-caprolactone (PCL) nanocapsules by interfacial deposition method. It is characterized by pH determination by potentiometer, mean diameter and polydispersity index by dynamic light scattering; zeta potential by electrophoretic mobility; encapsulation efficacy by high performance liquid chromatography method; corona effect formation; 2',7'-dichlorofluorescin diacetate (DCFH-DA) method by spectrofluorimetric assay; nitric oxide (NO) determination by spectrophotometric and genotoxicity assay by plasmid DNA cleavage method. Results: The results showed a mild acidic pH (4.78 ± 0.10), sizes around 200 nm and PDI<0.2 with a zeta potential around -20 mV and encapsulation efficiency of 99% (1 mg mL-1), showing a dose-dependent corona formation profile in 24h incubation. Conclusion: DCFH-DA assay showed no production of reactive oxygen species (ROS) while NO determination showed that Ind-OH-NC from 26.7 to 100 µM increased reactive nitrogen species (RNS), demonstrating antioxidant potential against MCF-7 cells. No sample at the concentrations evaluated induced DNA cleavage, being considered a safe treatment

Introdução: Anti-inflamatórios estão sendo empregados para tratamento de câncer por causa do seu ambiente inflamado. Objetivo: Investigar o potencial antioxidante da indometacina e sua genotoxicidade, livre ou carreada em nanocápsulas poliméricas, usando como modelo in vitrocélulas MCF-7 (câncer de mama humano). Método: Desenvolvimento de nanocápsulas de poliepsilon-caprolactona (PCL) por método de deposição interfacial, caracterizada por determinação de pH por potenciômetro; diâmetro médio e índice de polidispersão por espalhamento dinâmico de luz; potencial zeta por mobilidade eletroforética; eficiência de encapsulação por cromatografia líquida de alta eficiência; formação de efeito corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensaio espectrofluorimétrico; determinação de óxido nítrico (NO) por espectrometria e ensaio de genotoxicidade por método de clivagem do DNA plasmidial. Resultados: Os resultados mostraram leve pH ácido (4,78 ± 0,10), tamanhos em torno de 200 nm e PDI<0,2 com potencial zeta em torno de -20 mV e eficiência de encapsulação de 99% (1 mg mL-1), apresentando perfil de formação de corona dose-dependente em 24 horas de incubação. Conclusão: O ensaio DCFH-DA mostrou que não há produção de espécies reativas de oxigênio (ROS), enquanto a determinação de NO mostrou que Ind-OH-NC de 26,7 a 100 µM aumentou as espécies reativas de nitrogênio (RNS), demonstrando potencial antioxidante contra MCF-7. Nenhuma amostra nas concentrações avaliadas induziu clivagem do DNA, sendo considerado um tratamento seguro

Introducción: Se están utilizando antiinflamatorios para tratamiento de cáncer debido a su entorno inflamado. Objetivo: Investigar el potencial antioxidante de la indometacina y su genotoxicidad, libre o acarreada en nanocápsulas poliméricas utilizando como modelo in vitro células MCF-7 (cáncer de mama humano). Método: Desarrollo de nanocápsulas de poli epsilon-caprolactona (PCL) por método de deposición interfacial, caracterizada por determinación de pH por potenciómetro; diámetro medio e índice de polidispersión por esparcimiento dinámico de luz; potencial zeta por movilidad electroforética; eficiencia de encapsulación por cromatografía líquida de alta eficiencia; formación de efecto corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensayo espectrofluorímetro; determinación de óxido nítrico (NO) por espectrometría y ensayo de genotoxicidad por método de clivaje del ADN plasmídico. Resultados: Los resultados mostraron ligero pH ácido (4,78 ± 0,10), tamaños alrededor de 200 nm y PDI<0,2 con potencial zeta alrededor de -20 mV y eficiencia de encapsulación de 99% (1 mg mL-1), presentando perfil de formación de corona dosis-dependiente en 24h de incubación. Conclusión: El ensayo DCFDA mostró que no hay producción de especies reactivas de oxígeno (ROS) mientras que la determinación de NO mostró que Ind-OH-NC de 26,7 a 100 µM aumentó las especies reactivas de nitrógeno (RNS), demostrando potencial antioxidante contra MCF-7. Ninguna muestra en las concentraciones evaluadas indujo clivaje del ADN, siendo considerado un tratamiento seguro

Alternative Strategies for the Estimation of a Disease's Basic Reproduction Number: A Model-Agnostic Study.

This work presents a model-agnostic evaluation of four different models that estimate a disease's basic reproduction number. The evaluation presented is twofold: first, the theory behind each of the models is reviewed and compared; then, each model is tested with eight impartial simulations. All scenarios were constructed in an experimental framework that allows each model to fulfill its assumptions and hence, obtain unbiased results for each case. Among these models is the one proposed by Thompson et al. (Epidemics 29:100356, 2019), i.e., a Bayesian estimation method well established in epidemiological practice. The other three models include a novel state-space method and two simulation-based approaches based on a Poisson infection process. The advantages and flaws of each model are discussed from both theoretical and practical standpoints. Finally, we present the evolution of Covid-19 outbreak in Colombia as a case study for computing the basic reproduction number with each one of the reviewed methods.

Inclusion of soybean and linseed oils in the diet of lactating dairy cows makes the milk fatty acid profile nutritionally healthier for the human diet.

Fluid milk and its derivatives are important dietary ingredients that contribute to daily nutrient intake of the modern Homo sapiens. To produce milk that is healthier for human consumption, the present study evaluated the effect of adding soybean oil and linseed oil in the diet of lactating cows. The fatty acid profile of milk, milk composition, and the blood parameters of cows were evaluated. Eighteen Holstein cows were distributed in a replicated Latin square design and distributed according to the following treatments: 1) Control (CC): traditional dairy cow diet, without addition of oil; 2) Soybean oil (SO): 2.5% addition of soybean oil to the traditional diet, as a source of omega-6; 3) Linseed oil (LO): 2.5% addition of linseed oil in the diet as a source of omega-3. Milk production was not affected, but oil supplementation decreased feed intake by 1.93 kg/cow/day. The milk fat percentage was significantly lower when cows were supplemented with vegetable oil (3.37, 2.75 and 2.89% for CC, SO and LO, respectively). However, both soybean and linseed oils decreased the concentration of saturated fatty acids (66.89, 56.52 and 56.60 g/100g for CC, SO and LO respectively), increased the amount of unsaturated fatty acids in milk (33.05, 43.39, and 43.35 g/100g for CC, SO and LO respectively) and decreased the ratio between saturated/unsaturated fatty acids (2.12, 1.34, and 1.36 for CC, SO and LO respectively). Furthermore, SO and LO increased significantly the concentration of monounsaturated fatty acids (29.58, 39.55 and 39.47 g/100g for CC, SO and LO respectively), though it did not significantly alter the level of polyunsaturated fatty acids in milk fat (3.57, 3.93 and 3.98 g/100g for CC, SO and LO respectively). Supplementation with LO enhanced the concentration of omega-3 fatty acids on milk (0.32, 0.36, and 1.02 for CC, SO and LO respectively). Blood variables aspartate aminotransferase, gamma glutamyl transferase, urea, albumin, creatinine and total proteins were not altered. On the other hand, total cholesterol, HDL and LDL were greater in the group supplemented with vegetable oils. Supplementation with vegetable oils reduced the dry matter intake of cows, the fat content of milk, and improved saturated/unsaturated fatty acid ratio of milk fat. Compared to the SO treatment, animals fed LO produced milk with greater content of omega-3, and a more desirable omega-6/omega-3 ratio on a human nutrition perspective. Thus, the inclusion of SO and LO in the diet of lactating dairy cows makes the milk fatty acid profile nutritionally healthier for the human consumption.

Deepening the teaching and learning of clinical communication: the importance of reflection and feedback in health education / Aprofundando o ensino e aprendizagem de comunicação clínica: a importância da reflexão e do feedback no ensino em saúde

Aims: clinical communication (CC) relates to health professionals' interaction with patients/families. CC is fundamental for the physicians' role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC. Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC. Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship's technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants' needs. Therefore, teaching CC must go beyond asking the appropriate question or applying specific checklist-based behaviours. In teaching CC, it is crucial to give medical students support to discuss personal and institutional barriers and attitudes and explore how to transfer their learning to clinical practice. To that end, reflection should be encouraged to allow students to express difficulties and feelings and enhance their understanding of themselves and others. Within this process, feedback is essential to moving beyond skill-based teaching to reflection-based learning. Conclusion: the move from skills-based learning requires using reflective processes and feedback to allow students to learn about their communication tendencies and needs to become more flexible and attuned to different patient's needs in clinical encounters.

Objetivos: a comunicação clínica (CC) está relacionada à interação entre profissionais de saúde e pacientes ou familiares, sendo fundamental para prática médica. Este artigo tem como objetivo contribuir para a discussão sobre reflexão e feedback no ensino e aprendizagem significativos de CC. Métodos: os autores realizaram uma breve revisão e discussão conceitual da história e da natureza do ensino do CC, seguida pela exploração do papel da reflexão e do feedback no ensino de CC. Resultados: comunicar-se bem pode ser desafiador, pois exige que os estudantes de medicina e profissionais adaptem sua comunicação a cada paciente/família enquanto obtêm todas as informações necessárias, transmitindo confiabilidade, cuidado e compaixão. O ensino do CC para estudantes de medicina envolve o aprofundamento de elementos técnicos, relacionais e emocionais da relação médico-paciente. A CC requer um ensino flexível e adaptado às necessidades dos estudantes. Portanto, ensinar CC deve ir além de fazer a pergunta apropriada ou aplicar comportamentos específicos baseados em listas de verificação. No ensino do CC, é crucial dar aos estudantes de medicina apoio para discutir as barreiras e atitudes pessoais e institucionais e explorar como transferir seu aprendizado para a prática clínica. Para tanto, deve-se estimular a reflexão para permitir que os alunos expressem dificuldades e sentimentos e ampliem sua compreensão de si e dos outros. Nesse processo, o feedback é essencial para ir além do ensino baseado em habilidades para o aprendizado baseado em reflexão. Conclusão: a mudança de uma aprendizagem baseada em habilidades requer o uso de um processo reflexivo e feedback para permitir que os alunos aprendam sobre si, assim como, sobre se tornarem mais flexíveis e sintonizados com as diferentes necessidades do paciente nos encontros clínicos.

Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres.

OBJECTIVES: This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN: Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS: The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES: The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS: The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS: Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.

Frequency of bovine cysticercosis in the state of Rondônia, Brazil.

Bovine cysticercosis remains as one of the most important cause of carcasses and viscera condemnation in Brazilian slaughterhouses. However, the efficiency of post-mortem inspection for the diagnosis of this zoonotic disease is relatively low, and few available studies were performed through serological exams. This study evaluated the frequency of bovine cysticercosis in cattle herds located in different farms of the state of Rondônia, Brazil. Among the 987 animals slaughtered from 33 farms, 21 animals (Frequency: 2.13%; 95C.I. 1.23-3.03) were considered as positive through indirect ELISA and confirmed by Immunoblot tests and the cysticercosis was detected in 12 farms (36.36% - C.I. 95% 19.95-52.78). The disease was detected in the municipalities Vale do Paraíso (12.50%), Theobroma (8.11%), Guaporé (7.27%), Rolim de Moura (5.71%), Presidente Médici (5.0%), Ouro Preto do Oeste (4.69%), Nova União (1.77%), Nova Brasilândia d'Oeste (1.14%) and Ministro Andreazza (1.01%). Therefore, prophylactic measures should be taken to improve beef production, control bovine cysticercosis and reduce costs to public health in this Brazilian state.

Use of portfolios in teaching communication skills and professionalism for Portuguese-speaking medical students.

OBJECTIVES: This study aimed to analyse the effect of a portfolio with three activities fostering students' reflection, self-efficacy and teaching of communication skills and professionalism. METHODS: A cross-sectional study was applied with a sample of third- and fourth-year medical students in one Portuguese and three Brazilian universities. A three-activity portfolio (course evaluation and learning, self-efficacy activity and free reflective writing) was used during a two-month course on communication skills and professionalism. The 69 students enrolled in the course were invited to complete the three-activity portfolio via Likert-type questionnaires, open-ended questions and narrative. Content and lexical analysis and the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) were used for assessing the qualitative data. The questionnaires were evaluated using principal components analysis and Cronbach's α. Pearson's correlation was applied to portfolio activities. RESULTS: Of the 69 participants, 85.5% completed at least one activity. Reflecting on what they learned in the communication module, the students did not mention professionalism themes. In the self-efficacy activity on communication, 25% of the fragments were related to professionalism themes. There was a negative correlation between students' self-efficacy and the REFLECT rubric score (r(19)=-0.744; p< 0.0001). CONCLUSIONS: Teachers must consider the activity's influence on the reflections when assessing the portfolio. This model of a three-activity portfolio provided diverse ways of encouraging and assessing reflections, supporting teaching improvement and adaptation, evaluating students' self-efficacy and showing that students' higher reflective capacity may promote feelings of low effectiveness.

The assessment of personality traits and its association with learning communication skills / Avaliação dos traços de personalidade e sua associação com a aprendizagem de habilidades de comunicação

Aims: The aim of this study was to investigate the association between personality traits and attitudes toward learning communication skills in undergraduate medical students. The relation between students' attitudes and personality trait could help us identify those who those who will need more support to develop communication skills, based on their personality traits. Methods: The data was collected data from an intentional and cross-sectional sample composed of 204 students from three Brazilian universities. The students answered questionnaires containing the Communication Skills Attitude Scale (CSAS-BR) and the Big Five Mini-Markers (BFMM) for personality. Data were analyzed using frequency calculations, principal components analysis, and the multiple linear regression model. Results: Seven among 26 items of the original Communication Skills Attitude Scale (CSAS) presented factor loads lower than |0.30| and must be excluded in the CSAS -BR that showed one domain including positive and negative attitudes. The value of Cronbach's alpha of the 19-item scale was 0.894. The BFMM showed similar dimensional results with five domains with Cronbach's alpha values of 0.804 for Extroversion, 0.753 for agreeableness, 0.755 for conscientiousness, 0.780 for neuroticism and 0.668 for openness. There were positive and statically significant linear associations with the CSAS-BR and agreeableness (ß: 0.230, p<0.001), extraversion (ß: 0.150, p=0.030), and openness to experience (ß: 0.190, p=0.010). These personality factors drive social interactions and interpersonal relations, which involve the tendency to be friendly, flexible, and cooperative; to show a willing disposition; and the ability to actively engage with others. Conclusions: Based on the methods applied in this study, the results demonstrated a relation between agreeableness, extraversion and openness to experience with attitudes on communication skills in students from three Brazilian universities. Our results suggest that the evaluation of personality traits can contribute to the recognition of students for whom the establishment of special teaching strategies can improve communication skills.

Objetivos: Este estudo teve como objetivo determinar se se existe uma associação entre traços de personalidade e atitudes quanto à aprendizagem de habilidades de comunicação em estudantes de medicina. A relação entre as atitudes dos alunos e o traço de personalidade pode nos ajudar a identificar aqueles que necessitarão maior apoio para desenvolver habilidades de comunicação, a partir da identificação inicial do traço de personalidade. Métodos: Os dados foram coletados em uma amostra intencional em um corte transversal composta por 204 estudantes de três universidades brasileiras. Os alunos responderam a questionários contendo a Communication Skills Attitude Scale (CSAS-BR) e o Big Five Mini-Markers (BFMM) para personalidade. Os dados foram analisados usando cálculos de frequência, análise de componentes principais e o modelo de regressão linear múltipla. Resultados: Sete dos 26 itens do Communication Skills Attitude Scale (escala original - CSAS) apresentaram cargas fatoriais inferiores a |0.30|e foram excluídos no CSAS-BR, que mostrou um domínio contendo atitudes positivas e negativas. O valor do alfa de Cronbach na escala de 19 itens foi 0,894. O BFMM mostrou resultados dimensionais semelhantes com cinco domínios com valores alfa de Cronbach de 0,804 para extroversão, 0,753 para amabilidade, 0,755 para conscienciosidade, 0,780 para neuroticismo e 0,668 para abertura. Houve associações lineares positivas e estatisticamente significativas do CSAS-BR com amabilidade (ß: 0,230, p <0,001), extroversão (ß: 0,150, p = 0,030) e abertura à experiência (ß: 0,190, p = 0,010). Esses fatores de personalidade promovem interações sociais e relações interpessoais com tendência de serem amigáveis, flexíveis e cooperativas; bem como estarem disponíveis; e com capacidade de se envolver ativamente com as outras pessoas. Conclusões: Este estudo, com a metodologia empregada, mostrou que traços amabilidade, extroversão e abertura à experiência estiveram associados com habilidades de comunicação em acadêmicos de três universidades brasileiras. Os resultados sugerem que a avaliação dos traços de personalidade possa contribuir para o reconhecimento de alunos para os quais o estabelecimento de estratégias especiais de ensino possa melhorar as habilidades de comunicação.

Intoxicación por acetaminofén. Nuevo esquema con N acetil cisteína / Acetaminophen intoxication. New regimen with N-Acetylcysteine

Resumen La intoxicación por acetaminofén es una intoxicación frecuente en Colombia y en su tratamiento es fundamental la administración de un antídoto. El manejo convencional con N acetil cisteína presenta potenciales eventos adversos. El objetivo de este reporte de caso es evidenciar la utilidad de un nuevo esquema de tratamiento en un paciente masculino de 19 años quien ingirió 16,5 gramos de acetaminofén y luego de seis horas inició con dolor abdominal y episodios de emésis, para lo cual se inició manejo con N acetil cisteína en la forma tradicionalmente recomendada con la cual desarrolló reacción de hipersensibilidad. Ante la necesidad de continuar con este medicamente se inició un esquema diferente del antídoto con un resultado exitoso y sin nuevas reacciones de hipersensibilidad.

Abstract Toxicity due to Acetaminophen is a very common type of intoxication in Colombia, and in its treatment is essential the administration of an antidote. Conventional management with N acetyl cysteine presents potential adverse events. The objective of this case report is to demonstrate the usefulness of a new treatment scheme in a 19-year-old male patient who ingested 16.5 grams of acetaminophen and after six hours started with abdominal pain and episodes of emesis, for which management was started with N acetyl cysteine in the recommended form and then developed a hypersensitivity reaction. Given the need to continue with this medication, a different antidote scheme was started with a successful result and without new hypersensitivity reactions.

Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians.

BACKGROUND: The Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes. METHODS: Brazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests. RESULTS: A total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies - 66.7%) or during residency (seven out of thirty competencies - 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study. CONCLUSION: The authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.

Arginylglycylaspartic Acid-Surface-Functionalized Doxorubicin-Loaded Lipid-Core Nanocapsules as a Strategy to Target Alpha(V) Beta(3) Integrin Expressed on Tumor Cells.

Doxorubicin (Dox) clinical use is limited by dose-related cardiomyopathy, becoming more prevalent with increasing cumulative doses. Previously, we developed Dox-loaded lipid-core nanocapsules (Dox-LNC) and, in this study, we hypothesized that self-assembling and interfacial reactions could be used to obtain arginylglycylaspartic acid (RGD)-surface-functionalized-Dox-LNC, which could target tumoral cells overexpressing αvß3 integrin. Human breast adenocarcinoma cell line (MCF-7) and human glioblastoma astrocytoma (U87MG) expressing different levels of αvß3 integrin were studied. RGD-functionalized Dox-LNC were prepared with Dox at 100 and 500 mg·mL-1 (RGD-MCMN (Dox100) and RGD-MCMN (Dox500)). Blank formulation (RGD-MCMN) had z-average diameter of 162 ± 6 nm, polydispersity index of 0.11 ± 0.04, zeta potential of +13.2 ± 1.9 mV and (6.2 ± 1.1) × 1011 particles mL-1, while RGD-MCMN (Dox100) and RGD-MCMN (Dox500) showed respectively 146 ± 20 and 215 ± 25 nm, 0.10 ± 0.01 and 0.09 ± 0.03, +13.8 ± 2.3 and +16.4 ± 1.5 mV and (6.9 ± 0.6) × 1011 and (6.1 ± 1.0) × 1011 particles mL-1. RGD complexation was 7.73 × 104 molecules per nanocapsule and Dox loading were 1.51 × 104 and 7.64 × 104 molecules per nanocapsule, respectively. RGD-functionalized nanocapsules had an improved uptake capacity by U87MG cells. Pareto chart showed that the cell viability was mainly affected by the Dox concentration and the period of treatment in both MCF-7 and U87MG. The influence of RGD-functionalization on cell viability was a determinant factor exclusively to U87MG.