Implementation of the WHO Safe Childbirth Checklist: a scoping review protocol.

INTRODUCTION: The WHO Safe Childbirth Checklist (WHO SCC) was developed to accelerate adoption of essential practices that prevent maternal and neonatal morbidity and mortality during childbirth. This study aims to summarise the current landscape of organisations and facilities that have implemented the WHO SCC and compare the published strategies used to implement the WHO SCC implementation in both successful and unsuccessful efforts. METHODS AND ANALYSIS: This scoping review protocol follows the guidelines of the Joanna Briggs Institute. Data will be collected and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews report. The search strategy will include publications from the databases Scopus, PubMed, Embase, CINAHL and Web of Science, in addition to a search in grey literature in The National Library of Australia's Trobe, DART-Europe E-Theses Portal, Electronic Theses Online Service, Theses Canada, Google Scholar and Theses and dissertations from Latin America. Data extraction will include data on general information, study characteristics, organisations involved, sociodemographic context, implementation strategies, indicators of implementation process, frameworks used to design or evaluate the strategy, implementation outcomes and final considerations. Critical analysis of implementation strategies and outcomes will be performed with researchers with experience implementing the WHO SCC. ETHICS AND DISSEMINATION: The study does not require an ethical review due to its design as a scoping review of the literature. The results will be submitted for publication to a scientific journal and all relevant data from this study will be made available in Dataverse. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/RWY27.

Molecular Profile of Important Genes for Radiogenomics in the Amazon Indigenous Population.

Radiotherapy is focused on the tumor but also reaches healthy tissues, causing toxicities that are possibly related to genomic factors. In this context, radiogenomics can help reduce the toxicity, increase the effectiveness of radiotherapy, and personalize treatment. It is important to consider the genomic profiles of populations not yet studied in radiogenomics, such as the indigenous Amazonian population. Thus, our objective was to analyze important genes for radiogenomics, such as ATM, TGFB1, RAD51, AREG, XRCC4, CDK1, MEG3, PRKCE, TANC1, and KDR, in indigenous people and draw a radiogenomic profile of this population. The NextSeq 500® platform was used for sequencing reactions; for differences in the allelic frequency between populations, Fisher's Exact Test was used. We identified 39 variants, 2 of which were high impact: 1 in KDR (rs41452948) and another in XRCC4 (rs1805377). We found four modifying variants not yet described in the literature in PRKCE. We did not find any variants in TANC1-an important gene for personalized medicine in radiotherapy-that were associated with toxicities in previous cohorts, configuring a protective factor for indigenous people. We identified four SNVs (rs664143, rs1801516, rs1870377, rs1800470) that were associated with toxicity in previous studies. Knowing the radiogenomic profile of indigenous people can help personalize their radiotherapy.

Genomic Variants and Worldwide Epidemiology of Breast Cancer: A Genome-Wide Association Studies Correlation Analysis.

Breast cancer (BCa) is the most common cancer and leading cause of cancer death among women globally. This can be explained by the genetic factor of this disease. This article aims to correlate the epidemiological data, worldwide incidence, and mortality of BCa with the Single-Nucleotide Polymorphisms (SNPs) associated with the susceptibility and severity in different populations. Two hundred and forty genetic variants associated with BCa susceptibility/severity were selected from the literature through Genome-Wide Association Studies (GWAS). The allele frequencies were obtained from the 1000 Genomes Project, and the epidemiological data were obtained from the World Health Organization (WHO). The BCa incidence, mortality rates, and allele frequencies of the variants were evaluated using Pearson's correlation. Our study demonstrated that 11 SNPs (rs3817578, rs4843437, rs3754934, rs61764370, rs780092, rs2290203, rs10411161, rs6001930, rs16886165, rs8051542 and rs4973768) were significantly correlated with the epidemiological data in different ethnic groups. Seven polymorphisms (rs3817578, rs3754934, rs780092, rs2290203, rs10411161, rs6001930 and rs16886165) were inversely correlated with the incidence rate and four polymorphisms (rs4843437, rs61764370, rs8051542 and rs4973768) were directly correlated with the incidence rate. African and South-East Asian populations have a lower risk of developing BCa when evaluated in terms of genetic factors since they possess variants characterized as protective, as their higher incidence is associated with a lower frequency of BCa cases. The genetic variants investigated here are likely to predispose individuals to BCa. The genetic study described here is promising for implementing personalized strategies to screen for breast cancer in diverse populations.

Copaifera langsdorffii Desf. tree oleoresin-induced antinociception recruits µ1- and κ -opioid receptors in the ventrolateral columns of the periaqueductal gray matter.

Popular medicine has been using oleoresin from several species of copaíba tree for the treatment of various diseases and its clinical administration potentially causes antinociception. Electrical stimulation of ventrolateral (vlPAG) and dorsolateral (dlPAG) columns of the periaqueductal gray matter also causes antinociception. The aim this study was to verify the antinociceptive effect of oleoresin extracted from Copaifera langsdorffii tree and to test the hypothesis that oleoresin-induced antinociception is mediated by µ1- and κ-opioid receptors in the vlPAG and dlPAG. Nociceptive thresholds were determined by the tail-flick test in Wistar rats. The copaíba tree oleoresin was administered at different doses (50, 100 and 200 mg/kg) through the gavage technique. After the specification of the most effective dose of copaíba tree oleoresin (200 mg/kg), rats were pretreated with either the µ1-opioid receptor selective antagonist naloxonazine (at 0.05, 0.5 and 5 µg/ 0.2 µl in vlPAG, and 5 µg/ 0.2 µl in dlPAG) or the κ-opioid receptor selective antagonist nor-binaltorphimine (at 1, 3 and 9 nmol/ 0.2 µl in vlPAG, and 9 nmol/ 0.2 µl in dlPAG). The blockade of µ1 and κ opioid receptors of vlPAG decreased the antinociception produced by copaíba tree oleoresin. However, the blockade of these receptors in dlPAG did not alter copaíba tree oleoresin-induced antinociception. These data suggest that vlPAG µ1 and κ opioid receptors are critically recruited in the antinociceptive effect produced by oleoresin extracted from Copaifera langsdorffii.

Synthesis of copaiba (Copaifera officinalis) oil nanoemulsion and the potential against Zika virus: An in vitro study.

Zika virus (ZIKV) has spread all over the world since its major outbreak in 2015. This infection has been recognized as a major global health issue due to the neurological complications related to ZIKV infection, such as Guillain-Barré Syndrome and Zika virus Congenital Syndrome. Currently, there are no vaccines or specific treatments for ZIKV infection, which makes the development of specific therapies for its treatment very important. Several studies have been developed to analyze the potential of compounds against ZIKV, with the aim of finding new promising treatments. Herein, we evaluate the ability of a copaiba (Copaifera officinalis) oil nanoemulsion (CNE) to inhibit ZIKV. First, the highest non-cytotoxic concentration of 180 µg/mL was chosen since this concentration maintains 80% cell viability up to 96h after treatment with CNE in VERO cells resulted from MTT assay. The intracellular uptake assay was performed, and confirmed the internalization of the nanoemulsion in cells at all times analyzed. VERO cells were infected with ZIKV and simultaneously treated with CNE and the nanoformulation without oil (ENE) at the highest non-toxic concentration. The results evaluated by plaque assay revealed a viral inhibition of 80% for CNE and 70% for ENE. A dose-dependence assay revealed that the CNE treatment demonstrated a dose-dependent response in the viral RNA levels, whereas all ENE tested concentrations exhibited a similar degree of reduction. Taken together, our results suggest CNE as a promising nano-sized platform to be further studied for antiviral treatments.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Caenorhabditis elegans as a Prediction Platform for Nanotechnology-Based Strategies: Insights on Analytical Challenges.

Nanotechnology-based strategies have played a pivotal role in innovative products in different technological fields, including medicine, agriculture, and engineering. The redesign of the nanometric scale has improved drug targeting and delivery, diagnosis, water treatment, and analytical methods. Although efficiency brings benefits, toxicity in organisms and the environment is a concern, particularly in light of global climate change and plastic disposal in the environment. Therefore, to measure such effects, alternative models enable the assessment of impacts on both functional properties and toxicity. Caenorhabditis elegans is a nematode model that poses valuable advantages such as transparency, sensibility in responding to exogenous compounds, fast response to perturbations besides the possibility to replicate human disease through transgenics. Herein, we discuss the applications of C. elegans to nanomaterial safety and efficacy evaluations from one health perspective. We also highlight the directions for developing appropriate techniques to safely adopt magnetic and organic nanoparticles, and carbon nanosystems. A description was given of the specifics of targeting and treatment, especially for health purposes. Finally, we discuss C. elegans potential for studying the impacts caused by nanopesticides and nanoplastics as emerging contaminants, pointing out gaps in environmental studies related to toxicity, analytical methods, and future directions.

Zein nanoparticles for drug delivery: Preparation methods and biological applications.

Zein, a vegetable protein extracted from corn (Zea mays L.), forms a gastro-resistant and mucoadhesive polymer that is cheap and easy to obtain and facilitates the encapsulation of bioactives with hydrophilic, hydrophobic, and amphiphilic properties. The methods used for synthesizing these nanoparticles include antisolvent precipitation/nanoprecipitation, pH-driven, electrospraying, and solvent emulsification-evaporation methods. Each method has its advantages in the preparation of nanocarriers, nevertheless, all of them enable the production of zein nanoparticles that are stable and resistant to environmental factors, with different biological activities required in the cosmetic, food, and pharmaceutical industries. Therefore, zein nanoparticles are promising nanocarriers that can encapsulate various bioactives with anti-inflammatory, antioxidant, antimicrobial, anticancer, and antidiabetic properties. This article reviews the principal methods for obtaining zein nanoparticles containing bioactives, the advantages and characteristics of each method, as well as the main biological applications of nanotechnology-based formulations.

Evaluation of Biocompatibility, Anti-Inflammatory, and Antinociceptive Activities of Pequi Oil-Based Nanoemulsions in In Vitro and In Vivo Models.

Pequi oil (Caryocar brasiliense) contains bioactive compounds capable of modulating the inflammatory process; however, its hydrophobic characteristic limits its therapeutic use. The encapsulation of pequi oil in nanoemulsions can improve its biodistribution and promote its immunomodulatory effects. Thus, the objective of the present study was to formulate pequi oil-based nanoemulsions (PeNE) to evaluate their biocompatibility, anti-inflammatory, and antinociceptive effects in in vitro (macrophages­J774.16) and in vivo (Rattus novergicus) models. PeNE were biocompatible, showed no cytotoxic and genotoxic effects and no changes in body weight, biochemistry, or histology of treated animals at all concentrations tested (90−360 µg/mL for 24 h, in vitro; 100−400 mg/kg p.o. 15 days, in vivo). It was possible to observe antinociceptive effects in a dose-dependent manner in the animals treated with PeNE, with a reduction of 27 and 40% in the doses of 100 and 400 mg/kg of PeNE, respectively (p < 0.05); however, the treatment with PeNE did not induce edema reduction in animals with carrageenan-induced edema. Thus, the promising results of this study point to the use of free and nanostructured pequi oil as a possible future approach to a preventive/therapeutic complementary treatment alongside existing conventional therapies for analgesia.

Pequi oil (Caryocar brasilense Cambess.) nanoemulsion alters cell proliferation and damages key organelles in triple-negative breast cancer cells in vitro.

Pequi oil is extracted from the fruit of a Brazilian native plant (Caryocar brasiliense Camb) that contains some molecules with anticancer potential. Due to its hydrophobic property, the administration of pequi oil associated with nanoemulsion systems represents a successful strategy to improve oil bioavailability. Breast cancer is the most frequent type of cancer among women and conventional therapies used are frequently associated with several side effects. Thus, the aim of this study was to investigate the effects of pequi oil-based nanoemulsion (PeNE) on triple-negative breast cancer cells (4T1), in vitro. PeNE presented a dose- and time-dependent cytotoxic effect with lower IC50 than free pequi oil after 48 h of exposure (p < 0.001). At 180 µg/mL, PeNE demonstrated numerous cell alterations, when compared to free pequi oil, such as morphological alterations, reduction in cell proliferation and total cell number, damage to plasmatic membrane, induction of lysosomal membrane permeability and depolarization of mitochondrial membrane, alteration of intracellular ROS production and calcium level, and increase in phosphatidylserine exposure. Taken together, the results suggest an interesting induction of cell death mechanisms involving a combined action of factors that impair nucleus, mitochondria, lysosome, and ER function. In addition, more pronounced effects were observed in cells treated by PeNE at 180 µg/mL when compared to free pequi oil, thereby reinforcing the advantages of using nanometric platforms. These promising results highlight the use of PeNE as a potential complementary therapeutic approach to be employed along with conventional treatments against breast cancer in the future.

Physalis angulata concentrated ethanolic extract suppresses nociception and inflammation by modulating cytokines and prostanoids pathways.

Physalins are seco-steroids with a variety of pharmacological activities already described. In this study the pharmacological properties of a standardized concentrated ethanolic extract from Physalis angulata (CEEPA), rich in physalins B, D, F and G, were studied in models of pain and inflammation in mice. Inflammatory mediators were measured by radioimmunoassay and Real-Time PCR in mice paws after the CFA stimuli. Systemic administration of CEEPA produced antinociceptive effect on the writhing test and formalin test. In the writhing test, physalins B, D, F and G showed that the antinociceptive effect of CEEPA is more potent than that of these purified compounds. In addition, CEEPA reduced the levels of TNF-α, IL-1ß, COX-2 and iNOS mRNA in the CFA-induced paw inflammation. Likewise, CEEPA decreased the TNF-α, IL-1ß and PGE2 paw levels. In conclusion, CEEPA induces antinociceptive and anti-inflammatory effects, with improved pharmacological potency relative to pure physalins, associated to modulation of cytokine and cyclooxygenase pathways.

Análise dos conteúdos de alimentação e nutrição nos livros didáticos de Ciências do ensino fundamental da rede pública de ensino / Analysis of food and nutrition information in science textbooks for elementary public education

Objetivo: Analisar conteúdos de alimentação e nutrição nos livros didáticos de Ciências do 5º, 6º e 7° anos do ensino fundamental da rede pública. Método: Foram avaliados 100% dos exemplares (n=39) aprovados nos Guias dos Livros de Ciências do Programa Nacional do Livro Didático de 2016 e 2017. Identificou-se presença ou ausência de oito temas nos livros: Alimentação e desenvolvimento; Hábitos alimentares e influências culturais e sociais; Alimentação, nutrição e saúde; Sistemas alimentares; Rotulagem nutricional; Higiene, conservação e preparo dos alimentos; Mídia e saúde; e Alimentação escolar. Analisou-se a qualidade de textos e imagens por parâmetros como adequação à série, clareza, desenvolvimento e contextualização e/ou grau de relação textual e imagética e nível de atualização. Por meio de pontos atribuídos, os conteúdos foram categorizados em fraco, regular, bom ou excelente. Resultados: A maioria dos livros obteve pouca abordagem alimentar e nutricional. O tema "Alimentação e desenvolvimento" esteve em apenas 55,4% dos livros do quinto ano, não sendo aprofundado posteriormente. Alguns temas apresentaram textos classificados como regulares ou bons. Nenhum texto foi considerado fraco. Notou-se frequente abordagem sobre pirâmides alimentares. Verificou-se ausência e/ou falta de desenvolvimento quanto à higienização dos alimentos. Todos os exemplares apresentaram textos e imagens adequados à série. Conclusão: "Mídia e saúde", "Alimentação escolar", "Alimentação, nutrição e saúde" e "Rotulagem nutricional" são temas pouco presentes nos livros, mas quando abordados, tiveram classificação excelente. Os demais temas, apesar de frequentes, precisam de aprimoramentos na qualidade da abordagem. (AU)

Objective: The food and nutrition content was analyze in science textbooks used the fifth, sixth, and seventh grades in Brazilian public elementary schools. Methods: We evaluated 100% of the texts (n = 39) approved by the Science Book Guides of the National Textbook Program for 2016 and 2017. The presence or absence of eight themes was identified in the books: Food and development; Eating habits and cultural and social influences; Food, nutrition, and health; Food systems; Nutritional labeling; Hygiene, conservation, and preparation of food; Media and health; and School feeding. The quality of texts and images was analyzed by parameters such as suitability for the grade; clarity; development and contextualization; and/or degree of relationship between text and illustration; and level of updating. Through points assigned, the contents were categorized as weak, fair, good, or excellent. Results: Most of the books contained little dietary and nutritional approach. The theme "Food and development" was in only 55.4% of books in the fifth year and not further explored later. Some themes presented texts classified as regular or good. No text was considered weak. A frequent approach to food pyramids was noted. Food hygiene was absence or poorly development. All copies presented texts and illustration suitable for the series. Conclusion: "Media and health", "School feeding", "Food, nutrition, and health" and "Nutritional labeling" are themes that are not often present in the books, but when addressed, they received an excellent rating. The other themes, although frequent, need improvements in the quality of the approach. (AU)

Alterações da campimetria, tomografia de coerência óptica e função visual em pacientes portadores de esclerose múltipla / Campimetry changes, optical coherence tomography and visual function changes in patients with multiple sclerosis

RESUMO Objetivos: Determinar a freqüência e as características das alterações em exame oftalmológico, em exame de Tomografia de coerência óptica (OCT) do nervo e mácula e Campimetria em pacientes com Escrelose Multipla(EM). Métodos: Foram examinados 60 olhos sendo 30 de pacientes com o diagnóstico de EM e 30 de pacientes controles, atendidos no Hospital de Base do Distrito Federal. Os pacientes foram avaliados quanto aos parâmetros: características e alterações do exame oftalmológico, do OCT do nervo e da macula e Campimetria. Resultados: Os pacientes com EM apresentaram piores resultados em todos os parâmetros avaliados. No exame de campo visual Foram encontradas perdas localizadas em 50%. Em relação ao OCT de nervo óptico foi observado redução da camada de fibras nervosas em quadrantes temporal (p=0,0251) e inferior (p=0,0041), o OCT de mácula revelou diminuição da CFN principalmente nos quadrantes nasal interno (p=0,0002) e externo (p=0,0016),inferior interno (p=0,0007) e superior externo (p=0,0108) e interno (p=0,0046). Os pacientes com menores valores de espessura macular também tiveram piores resultados no campo visual (p=0,0001). Conclusão: Este estudo demonstrou que a EM é uma doença capaz de ocasionar alterações nos exames de OCT e Campo visual mesmo na ausência de sintomas visuais relatados pelos pacientes. A realização de exames como campo visual e de OCT de macula e nervo podem ser uma ferramenta útil para estimar o comprometimento pela doença e auxiliar no seguimento desses pacientes.

ABSTRACT Objectives: To determine the frequency and characteristics of alterations in ophthalmologic examinations of optic nerve and macula coherence tomography (OCT), and Campimetry in multiple sclerosis (MS) patients. Methods: Sixty eyes were examined, 30 of which were diagnosed with MS and 30 of the control patients, all attended at the General Hospital of the Federal District of Brazil. The patients were evaluated regarding the parameters: characteristics and alterations of the ophthalmological examination, OCT of the nerve and macula and Campimetry. Results: Patients with MS presented worse results in all parameters evaluated. On visual field examination localized losses were found in 50% of the cases . In relation to OCT of the optic nerve it was observed a reduction of the nerve fiber layer in temporal quadrants (p = 0.0251) and lower (p = 0.0041). The macular OCT revealed a decrease in the CFN, mainly in the internal nasal quadrants (p = 0.0002) and external (p = 0.0016), internal inferior (p = 0.0007) and external superior (p = 0.0108) plus internal (p = 0.0046). Patients with lower values of macular thickness also had worse results in the visual field (p = 0.0001). Conclusion: This study demonstrated that MS is a disease capable of causing changes in OCT and visual field tests even in the absence of visual symptoms reported by patients. Examinations such as visual field and OCT of macula and nerve can be a useful tool to estimate the damage by the disease and to assist in the follow-up of these patients

Transumbilical videolaparoscopic (single site) liver biopsy with laparoscopy equipment.

INTRODUCTION: Liver diseases have a high incidence in the whole world. In order to diagnose, stage and follow these diseases it is often necessary the execution of liver biopsy. There are many possible ways to perform the procedure and the rise of transumbilical endoscopic surgery (TUES) brings to the medical practice an additional good option. MATERIALS AND METHODS: The study is prospective, nonrandomised and cohort type. It involves 42 patients who underwent liver biopsy through TUES using conventional video laparoscopic material. RESULTS: Among the patients 18 (42.86%) underwent isolated liver biopsy and 24 (57.14%) to liver biopsy associated with umbilical hernia repair. Within those, 27 (64.28%) were male and 15 (35.71%) female. The average body mass index (BMI) was of 27.26 kg/m(2), 10 were in the normal BMI range, 24 (57.14%) were in the overweight range, 6 (14.28%) had class I obesity and 2 (4.76%) had class II obesity. In none of the cases the procedure was converted to regular video laparoscopy, all the patients were discharged in the day after the procedure and reported a satisfactory aesthetic result. CONCLUSIONS: The study shows that liver biopsy using TUES has applicability and good results, including in obese patients that would have a contraindication to other methods.

Intervenção fonoaudiológica na esclerose sistêmica: relato de casos / Speech therapy in sclerosis systemic: a case report

RESUMO A Esclerose Sistêmica é uma doença reumática autoimune do tecido conjuntivo, progressiva, pouco frequente, de etiologia desconhecida e com evolução variável. Atinge órgãos nobres e tecidos periorais, causando limitação na abertura da boca, hipertonia dos órgãos fonoarticulatórios, face com "aparência de máscara", dificuldades na mastigação e deglutição. Com o objetivo de comparar os resultados pré e pós-intervenção fonoaudiológica miofuncional orofacial em sujeitos com esclerose sistêmica, realizou-se estudo clínico exploratório qualiquantitativo no setor de Reumatologia do Hospital Universitário e na Clínica escola de Fonoaudiologia da Universidade Federal de Sergipe, no período de julho/2012 a dezembro/2013. A amostra foi composta por cinco indivíduos, de ambos os gêneros, com faixa etária entre 24 e 60 anos e diagnóstico médico confirmado da referida afecção. Os indivíduos passaram por avaliação por meio do protocolo MBGR e 36 sessões de terapia fonoaudiológica (miofuncional e mioterápica). Ao término, os resultados iniciais e finais foram comparados a partir dos indicadores clínicos trabalhados. Diante da análise dos resultados obtidos, foram observadas melhoras em todos os aspectos trabalhados. A avaliação anterior à fonoterapia revelou restrição na abertura da boca em todos os indivíduos e os resultados finais apresentaram ganhos entre 5.3 e 14.2 mm de abertura (média: 9,26 mm). Com relação à tonicidade, mobilidade dos órgãos fonoarticulatórios e dormência orofacial, observaram-se melhoras e evidências de adequação das funções orais. Pode-se concluir que, apesar de alguns pacientes ainda apresentarem alterações, a reabilitação fonoaudiológica promoveu melhoras significativas no quadro clínico e qualidade de vida dos indivíduos do grupo de estudo.

ABSTRACT Systemic sclerosis is a rare, progressive of unknown etiology and variable evolution, autoimmune rheumatic connective tissue disease. It reaches vital organs and perioral tissues, causing limitation of mouth opening, hypertonia of the phonoarticulatory organs, face with the appearance of a mask, difficulty in chewing and swallowing. Aiming to compare the pre and post miofuncional orofacial intervention in subjects with systemic sclerosis, it was performed a quali quantitative exploratory clinical study in the Rheumatology department of the University Hospital and in the School Clinic of Speech, Language and Hearing Sciences of the Federal University of Sergipe (UFS), from July/2012 to December/2013. The sample consisted of five individuals, of both genders, aged between 24 and 60 years and with confirmed medical diagnosis of that condition. The subjects underwent through evaluation by MBGR protocol and 36 sessions of speech therapy (myofunctional and myotheray). At the end, the initial and final results were compared from the clinical indicators worked. After analyzing the results obtained, improvements in all aspects were observed. The previous Speech Therapy evaluation revealed restriction of mouth opening in all subjects and the final results presented gains between 5.3 and 14.2mm of opening (average: 9.26). Regarding muscle tonus, mobility of the phonoarticulatory organs and orofacial dormancy, improvements and evidences of adequacy of oral functions were observed. It can be concluded that, although some patients still show changes, the rehabilitation promoted significant improvements in the clinical condition and quality of life of the individuals of the study group.

Antinociceptive properties of physalins from Physalis angulata.

Pain is the most common reason a patient sees a physician. Nevertheless, the use of typical painkillers is not completely effective in controlling all pain syndromes; therefore further attempts have been made to develop improved analgesic drugs. The present study was undertaken to evaluate the antinociceptive properties of physalins B (1), D (2), F (3), and G (4) isolated from Physalis angulata in inflammatory and centrally mediated pain tests in mice. Systemic pretreatment with 1-4 produced dose-related antinociceptive effects on the writhing and formalin tests, traditional screening tools for the assessment of analgesic drugs. On the other hand, only 3 inhibited inflammatory parameters such as hyperalgesia, edema, and local production of TNF-α following induction with complete Freund's adjuvant. Treatment with 1, 3, and 4 produced an antinociceptive effect on the tail flick test, suggesting a centrally mediated antinociception. Reinforcing this idea, 2-4 enhanced the mice latency reaction time during the hot plate test. Mice treated with physalins did not demonstrate motor performance alterations. These results suggest that 1-4 present antinociceptive properties associated with central, but not anti-inflammatory, events and indicate a new pharmacological property of physalins.

Impacto da intervenção fonoaudiológica na Esclerose Sistêmica / Impact of speech therapy intervention in systemic sclerosis / Impacto de la intervención fonoaudiológica en la Esclerosis Sistémica

Introdução: A literatura é escassa em relatar as alterações miofuncionais orofaciais em sujeitos com esclerose sistêmica progressiva e as possibilidades de intervenção fonoaudiológica nesta afecção. Objetivo: Apresentar os resultados clínicos advindos de proposta terapêutica miofuncional orofacial. Métodos: Paciente de 43 anos de idade, gênero feminino, encaminhada pelo reumatologista para avaliação e procedimentos fonoaudiológicos. Apresentou como queixa principal restrição na abertura da boca. Na avaliação fonoaudiológica foi constatado valor da abertura máxima de boca em 26,9 mm; face enrijecida, com aparência de máscara; movimentos limitados de língua devido à rigidez e ao frênulo sublingual anteriorizado; lábios finos com postura habitual de repouso entreabertos; tensão do orbicular da boca e rigidez de laringe ao deglutir. Constou dos objetivos terapêuticos: estimular e possibilitar a execução de movimentos mandibulares minimizando a restrição muscular. Procedimentos quanto ao aumento da amplitude da boca por meio de relaxamentos, alongamentos, massagens, movimentos isotônicos, isométricos e manobras específicas foram essenciais para estabilizar a abertura da boca, liberar os movimentos mandibulares e coordená-los, melhorando a funcionalidade do sistema estomatognático. Resultados: Após 35 sessões: ganho de 10 mm na abertura passando para 36,9 mm; melhora da higiene oral, da articulação da fala, das funções de mastigação e deglutição, do selamento labial (embora assistemático) e da estética facial. Conclusão: A terapia fonoaudiológica miofuncional orofacial mostrou-se eficiente na esclerose sistêmica progressiva e mais estudos devem ser efetivados para possibilitar maior aproximação entre a Fonoaudiologia e a Reumatologia.(AU)(AU)

Introduction: The literature is scarce in orofacial myofunctional changes report in subjects with progressive systemic sclerosis and the possibilities of speech therapy intervention in this disorder. Purpose: Show the results from the proposed miofunctional therapeutic. Methods: A 43 years old female patient was forwarded by the rheumatologist for evaluation and speech therapy procedures. She presented, as main complaint, restricted opening of the mouth. Speech therapy evaluation found 26.9 mm as maximum aperture value of mouth, face stiffened, looking mask, limited movements of the tongue due to the rigidity and the anterior sublingual frenulum, thin lips with the usual position of rest parted, tension of the orbicularis oris and stiffness of the larynx during swallowing. The therapeutic objectives were: stimulate and enable the execution of mandibular movements minimizing muscle constraint. Procedures regarding the increase of the amplitude of mouth through relaxation, stretching, massage, isotonic and isometric movements and specific maneuvers were essential to stabilize the opening of the mouth, releasing the mandibular movements and coordinate them, improving the functionality of the stomatognathic system. Results: After 35 sessions: 10 mm gain at the opening, improvement of oral hygiene, better articulation of speech, improvements on the functions of chewing and swallowing, lip seal (though unsystematic) and in facial aesthetics. Conclusion: The orofacial miofunctional speech therapy was effective in systemic sclerosis and more studies should be performed to allow greater approximation between Speech Therapy and Rheumatology.(AU)(AU)

Introducción: La literatura es escasa en reportar cambios miofuncionales orofaciales en sujetos con esclerosis sistémica progresiva y las posibilidades de intervención fonoaudiológica bajo esta condición. Objetivo: Presentar los resultados clínicos derivados de la propuesta terapéutica miofuncional orofacial. Métodos: Paciente de 43 años, género femenino, remitido por el reumatólogo para evaluación y los procedimientos fonoaudiológicos. Presentó como queja la principal restricción de apertura de la boca. En la evaluación fonoaudiológica fue constatado el valor de apertura máxima de de boca de 26,9 mm, cara rígida con apariencia de máscara, movimientos limitados de la lengua debido a la rigidez y al frenillo sublingual en posición anterior, labios finos con postura habitual de descanso entreabiertos, tensión del orbicular de la boca y rigidez de la laringe durante la deglución. Constó de los objetivos terapéuticos: estimular y posibilitar la ejecución de los movimientos mandibulares minimizando la restricción muscular. Procedimientos cuanto al aumento de la amplitud de la boca por medios de relajamiento, estiramientos, masajes, movimientos isotónicos, isométricos y maniobras específicas fueran esenciales para estabilizar la apertura de la boca, liberar los movimientos de la mandíbula y coordinarlos, mejorando la funcionalidad del sistema estomatognático. Resultados: Después de 35 sesiones: ganancia de 10 mm de apertura pasando para 36,9 mm; mejora de la higiene oral, de la articulación del habla, de las funciones de masticación y deglución, del sellamiento labial (aunque asistemático) y de la estética facial. Conclusión: La terapia fonoaudiológica miofuncional orofacial se mostró eficiente en la esclerosis sistémica progresiva y más estudios deben ser realizados para posibilitar mayor aproximación entre la Fonoaudiología y la Reumatología.(AU)(AU)

Impacto da intervenção fonoaudiológica na esclerose sistêmica / Impact of speech therapy intervention in systemic sclerosis / Impacto de la intervención fonoaudiológica en la esclerosis eistémica

Introdução: A literatura é escassa em relatar as alterações miofuncionais orofaciais em sujeitos com esclerose sistêmica progressiva e as possibilidades de intervenção fonoaudiológica nesta afecção. Objetivo: Apresentar os resultados clínicos advindos de proposta terapêutica miofuncional orofacial. Métodos: Paciente de 43 anos de idade, gênero feminino, encaminhada pelo reumatologista para avaliação e procedimentos fonoaudiológicos. Apresentou como queixa principal restrição na abertura da boca. Na avaliação fonoaudiológica foi constatado valor da abertura máxima de boca em 26,9 mm; face enrijecida, com aparência de máscara; movimentos limitados de língua devido à rigidez e ao frênulo sublingual anteriorizado; lábios finos com postura habitual de repouso entreabertos; tensão do orbicular da boca e rigidez de laringe ao deglutir. Constou dos objetivos terapêuticos: estimular e possibilitar a execução de movimentos mandibulares minimizando a restrição muscular. Procedimentos quanto ao aumento da amplitude da boca por meio de relaxamentos, alongamentos, massagens, movimentos isotônicos, isométricos e manobras específicas foram essenciais para estabilizar a abertura da boca, liberar os movimentos mandibulares e coordená-los, melhorando a funcionalidade do sistema estomatognático. Resultados: Após 35 sessões: ganho de 10 mm na abertura passando para 36,9 mm; melhora da higiene oral, da articulação da fala, das funções de mastigação e deglutição, do selamento labial (embora assistemático) e da estética facial. Conclusão: A terapia fonoaudiológica miofuncional orofacial mostrou-se eficiente na esclerose sistêmica progressiva e mais estudos devem ser efetivados para possibilitar maior aproximação entre a Fonoaudiologia e a Reumatologia.

Introduction: The literature is scarce in orofacial myofunctional changes report in subjects with progressive systemic sclerosis and the possibilities of speech therapy intervention in this disorder. Purpose: Show the results from the proposed miofunctional therapeutic. Methods: A 43 years old female patient was forwarded by the rheumatologist for evaluation and speech therapy procedures. She presented, as main complaint, restricted opening of the mouth. Speech therapy evaluation found 26.9 mm as maximum aperture value of mouth, face stiffened, looking mask, limited movements of the tongue due to the rigidity and the anterior sublingual frenulum, thin lips with the usual position of rest parted, tension of the orbicularis oris and stiffness of the larynx during swallowing. The therapeutic objectives were: stimulate and enable the execution of mandibular movements minimizing muscle constraint. Procedures regarding the increase of the amplitude of mouth through relaxation, stretching, massage, isotonic and isometric movements and specific maneuvers were essential to stabilize the opening of the mouth, releasing the mandibular movements and coordinate them, improving the functionality of the stomatognathic system. Results: After 35 sessions: 10 mm gain at the opening, improvement of oral hygiene, better articulation of speech, improvements on the functions of chewing and swallowing, lip seal (though unsystematic) and in facial aesthetics. Conclusion: The orofacial miofunctional speech therapy was effective in systemic sclerosis and more studies should be performed to allow greater approximation between Speech Therapy and Rheumatology.

Introducción: La literatura es escasa en reportar cambios miofuncionales orofaciales en sujetos con esclerosis sistémica progresiva y las posibilidades de intervención fonoaudiológica bajo esta condición. Objetivo: Presentar los resultados clínicos derivados de la propuesta terapéutica miofuncional orofacial. Métodos: Paciente de 43 años, género femenino, remitido por el reumatólogo para evaluación y los procedimientos fonoaudiológicos. Presentó como queja la principal restricción de apertura de la boca. En la evaluación fonoaudiológica fue constatado el valor de apertura máxima de de boca de 26,9 mm, cara rígida con apariencia de máscara, movimientos limitados de la lengua debido a la rigidez y al frenillo sublingual en posición anterior, labios finos con postura habitual de descanso entreabiertos, tensión del orbicular de la boca y rigidez de la laringe durante la deglución. Constó de los objetivos terapéuticos: estimular y posibilitar la ejecución de los movimientos mandibulares minimizando la restricción muscular. Procedimientos cuanto al aumento de la amplitud de la boca por medios de relajamiento, estiramientos, masajes, movimientos isotónicos, isométricos y maniobras específicas fueran esenciales para estabilizar la apertura de la boca, liberar los movimientos de la mandíbula y coordinarlos, mejorando la funcionalidad del sistema estomatognático. Resultados: Después de 35 sesiones: ganancia de 10 mm de apertura pasando para 36,9 mm; mejora de la higiene oral, de la articulación del habla, de las funciones de masticación y deglución, del sellamiento labial (aunque asistemático) y de la estética facial. Conclusión: La terapia fonoaudiológica miofuncional orofacial se mostró eficiente en la esclerosis sistémica progresiva y más estudios deben ser realizados para posibilitar mayor aproximación entre la Fonoaudiología y la Reumatología.

Larvicidal and cytotoxic potential of squamocin on the midgut of Aedes aegypti (Diptera: Culicidae).

Acetogenins are secondary metabolites exclusively produced by Annonaceae, which have antitumor, cytotoxic, and pesticide activities. In this study, we evaluated the larvicidal and cytotoxic effect of squamocin from Annona squamosa on Aedes aegypti (Diptera: Culicidae) midgut. The compound was solubilized in 2% Tween 20 at 10, 20, 50, 80 and 100 ppm. The assay was conducted in a completely randomized design with four replications, each with 20 third-instar larvae. Larval mortality was assessed every hour until total mortality, and the data were subjected to Probit analysis. Cellular damage was evaluated every 30 min in groups comprising five larvae subjected to squamocin at 50 and 100 ppm for 240 min. The total larval mortality occurred after 360 min following application of 50, 80, and 100 ppm squamocin, and 600 min after applying other concentrations with LC50 at 6.4 ppm. Both 50 and 100 ppm of squamocin showed cytotoxic activity in the midgut epithelium of A. aegypti after 240 min with 50 ppm resulting in midgut cells with light cytoplasm containing small vacuoles, whereas at 100 ppm were found cells with cytoplasm highly vacuolated, damaged apical surface and cell protrusion toward the gut lumen. In conclusion, squamocin has the potential to control A. aegypti.