Xenobiotics Triggering Acute Intermittent Porphyria and Their Effect on Mouse Brain Respiratory Complexes.

Heme enzyme dysfunction causes a group of diseases called porphyrias. Particularly, a decrease in porphobilinogen deaminase, involved in the third step of heme biosynthesis, leads to acute intermittent porphyria (AIP). Considering our previous works demonstrating the multiplicity of brain metabolisms affected by porphyrinogenic agents, this study aimed to elucidate whether they cause any alteration on the mitochondrial respiratory chain. The activities of respiratory chain complexes (I to IV) were measured in encephalon mitochondria of CF1 male mice receiving volatile anesthetics: isoflurane (2 mL/kg) and sevoflurane (1.5 mL/kg), ethanol (30%), allylisopropylacetamide (AIA) (350 mg/kg), and barbital (167 mg/kg). Moreover, they were compared versus animals with pathological levels of 5-aminolevulinic acid (ALA, 40 mg/kg). Complex I-III activity was induced by isoflurane and decreased by AIA, ethanol, and ALA. Complex II-III activity was increased by sevoflurane and decreased by isoflurane and AIA. Complex II activity was increased by sevoflurane and barbital and decreased by AIA, ethanol, and ALA. Complex IV activity was increased by barbital and ALA and decreased by sevoflurane. The damage to the respiratory chain by ALA could be reflecting the pathophysiological condition of patients with AIP. Better understanding the broad effect of porphyrinogenic drugs and the mechanisms acting on the onset of AIP is vital in translational medicine.

Obesity Contributes to Inflammation in Patients with IBS via Complement Component 3 and C-Reactive Protein.

Irritable Bowel Syndrome (IBS) is usually a lifelong state that disturbs the digestive system. IBS has been linked to low-grade inflammation and the release of inflammatory mediators into the bloodstream. This could be associated with the degree of obesity presented by patients with IBS. Reports imply that IBS is more frequent in obese patients than in the overall population, with a prevalence of up to 31%. Here, we evaluated the serum levels of immunological and inflammation molecules and their correlation with Body Mass Index in IBS patients and the healthy control (HC). Seventy-nine serum samples of the IBS patients and thirty-five of the HC group were analyzed to determine the levels of each molecule and compare them with their BMI. Serum levels of C3 and C4 were significantly increased in IBS patients. C3 and C4 levels were higher in IBS-M and IBS-D subtypes compared with the HC group. When patients were grouped by BMI, a positive correlation between serum C3 (r = 0.49, p < 0.0001) and CRP (r = 0.40, p < 0.001) levels was found. Our results show, for the first time, a correlation between immunological molecules and BMI in IBS patients, suggesting that the inflammatory nature of obesity could contribute to the development of the symptoms in IBS through the stimulation and release of proteins as complement components and CRP.

Profitability determinants of the natural stone industry: Evidence from Spain and Italy.

The natural stone sector is an important driver of the Spanish and Italian economies, which underwent internationalization after the financial crisis of 2008 as part of a survival and development strategy. This article aims to study the financial and economic profitability of this sector in the two leading European production countries, as well as its determinants. For this purpose, the economic-financial data of a sample composed of 453 companies (203 Spanish and 250 Italian) from 2015-2019 were analyzed using the multiple linear regression methodology. To address the problems of possible endogeneity and omission of variables in the model, the dependent variable was used as a regressor with one and two lags, and panel data with fixed effects were considered after performing the Hausman test. The results show significant differences between the two countries, with higher profitability in Italy. Company size, company growth (measured as the change in assets), and the variation in the country's GDP all positively affected profitability. At the same time, the level of indebtedness showed a negative relationship. The country's inflation rate and gender diversity in top management were shown to be non-relevant variables. The research conducted indicates that, to increase profitability, Spanish and Italian companies in the natural stone sector should undergo mergers in order to grow in size, increase efficiency in the use of assets, reduce their dependence on external financing, and promote equity capital. In addition, Italian companies should reduce the average period of payment to suppliers to lower deferral costs, and boost exports to become less dependent on the country's domestic economy.

Reliability and clinical utility of the chronic pain classification in the 11th Revision of the International Classification of Diseases from a global perspective: results from India, Cuba, and New Zealand.

ABSTRACT: Chronic pain affects 1 in 5 persons and contributes substantially to the global burden of disease. The 11th Revision of the International Classification of Diseases (ICD-11) includes a comprehensive classification of chronic pain. The aim of this ecological implementation field study was to evaluate the classification's interrater reliability and clinical utility in countries with different income levels. The study was conducted in 4 pain clinics in Cuba, India, and New Zealand. Twenty-one clinicians used the ICD-11 to diagnose and code n = 353 patients with chronic pain. Of these, 111 were assessed by 2 clinicians, and Fleiss' kappa was calculated to establish interrater reliability for any diagnosis assigned to ≥15 patients. The clinicians rated the clinical utility of all diagnoses. The interrater reliability could be calculated for 11 diagnoses. It was substantial for 10 diagnoses and moderate for 1 (kappa: 0.596-0.783). The mean clinical utility of the ICD-11 chronic pain diagnoses was rated as 8.45 ± 1.69/10. Clinical utility was rated higher for ICD-11 than for the commonly used classification systems (P < 0.001, η2 = 0.25) and differed between all centers (P < 0.001, η2 = 0.60). The utility of the ICD-11 diagnoses was rated higher than the commonly used diagnoses in Dunedin and Havana, and no difference was found in Kolkata and Hyderabad. The study showed the high interrater reliability of the new chronic pain diagnoses. The perceived clinical utility of the diagnoses indicates their superiority or equality compared with the classification systems currently used in pain clinics. These results suggest the global applicability of the classification in specialized pain treatment settings.

Experiencias de telesalud en un hospital especializado en salud mental durante la pandemia de COVID-19 en Perú / Telehealth experiences in a specialized mental health hospital during the COVID-19 pandemic in Peru

RESUMEN El objetivo de este artículo es dar a conocer las experiencias de telesalud en un hospital especializado en salud mental en Lima, Perú durante la pandemia de COVID-19. En concordancia con las disposiciones, como el cierre temporal de la atención presencial y el confinamiento obligatorio entre los meses de marzo a diciembre del 2020, se brindó progresivamente atención a través de llamadas telefónicas, videollamadas o plataformas digitales; se realizaron 57398 atenciones de teleconsultas y telemonitoreos; 4411 orientaciones en salud mental; 295 teleinterconsultas en psiquiatría; 42 actividades de telecapacitación y 29 sesiones educativas en salud mental dirigidas a la población general. Concluimos que la implementación de la telesalud para la atención de los usuarios del Hospital Hermilio Valdizán contribuyó al cuidado de la salud mental y permite reducir las brechas de acceso a la atención especializada en psiquiatría por las consecuencias de la COVID-19.

ABSTRACT The objective of this article is to present the experiences of telehealth in a hospital specialized in mental health in Lima, Peru during 2020. In accordance with the provisions such as the temporary closure of face-to-face care and mandatory confinement between the months of March As of December, care was progressively provided through telephone calls, video calls or digital platforms, with 57,398 teleconsultations and telemonitoring, 4411 mental health orientations, 295 teleinterconsultations in psychiatry, 42 teletraining activities and 29 educational sessions in mental health aimed at the general population. We conclude that the implementation of telehealth for the care of the users of the Hermilio Valdizán Hospital contributed to mental health care and reduces the gaps in access to specialized care in psychiatry due to the consequences of COVID-19.

Clinical, biochemical, and genetic characterization of acute hepatic porphyrias in a cohort of Argentine patients.

BACKGROUND: Acute Hepatic Porphyrias (AHPs) are characterized by an acute neuroabdominal syndrome including both neuropsychiatric symptoms and neurodegenerative changes. Two main hypotheses explain the pathogenesis of nervous system dysfunction: (a) the ROS generation by autooxidation of 5-aminolevulinic acid accumulated in liver and brain; (b) liver heme deficiency and in neural tissues that generate an oxidative status, a component of the neurodegenerative process. METHODS: We review results obtained from Acute Intermittent Porphyria (AIP) and Variegate Porphyria (VP) families studied at clinical, biochemical, and molecular level at the CIPYP in Argentina. The relationship between the porphyric attack and oxidative stress was also evaluated in AHP patients and controls, to identify a marker of neurological dysfunction. RESULTS: We studied 116 AIP families and 30 VP families, 609 and 132 individuals, respectively. Genotype/phenotype relation was studied. Oxidative stress parameters and plasma homocysteine levels were measured in 20 healthy volunteers, 22 AIP and 12 VP individuals. CONCLUSION: No significant difference in oxidative stress parameters and homocysteine levels between the analyzed groups were found.

Erratum to "Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome".

[This corrects the article DOI: 10.1155/2019/6357256.].

Velocidad de la marcha y cognición en adultos mayores en atención secundaria de salud / Velocidade da marcha e cognição em idosos da atenção secundária em saúde / Gait speed and cognition in elderly users of secondary care service

Objetivo: analizar la asociación entre la velocidad de la marcha y la cognición de adultos mayores que se encuentran en asistencia ambulatoria geriátrica y gerontológica. Materiales y método: estudio cuantitativo transversal realizado con 407 adultos mayores (≥ 60 años) atendidos en el Centro Ambulatorio de Geriatría y Gerontología del municipio de São José dos Pinhais, Paraná (Brasil). La condición de fragilidad física se evaluó utilizando el fenotipo de fragilidad y el cribado cognitivo mediante el Mini-Mental State Examination y el test de fluencia verbal semántica. El análisis univariado se realizó mediante una prueba de chi-cuadrado con nivel de significación estadístico de p ≤ 0,05. Resultados: del total de participantes, se observaron 226 (55,5 %) adultos mayores prefrágiles, 238 (58,5 %) reportaron deterioro cogntivo, 90 (22 %) de la fluidez verbal semántica y 205 (50,4 %) presentaron velocidad de la marcha reducida, variable que registró una asociación significativa con el deterioro cognitivo (p = 0,003) y las alteraciones de la fluencia verbal semántica (p < 0,001).Conclusiones: los resultados señalan la necesidad de implementar la evaluación de la velocidad de la marcha en adultos mayores como parte de la práctica clínica de geriatría y gerontología. Este componente revela un posible deterioro cognitivo y permite la realización de acciones que puedan perfeccionar el manejo de los cuidados ante la fragilidad física en adultos mayores.

Objetivo: analisar a associação entre a velocidade da marcha e a cognição de idosos em assistência ambulatorial de geriatria e gerontologia. Materiais e método: estudo quantitativo transversal, realizado com 407 idosos (≥ 60 anos), atendidos no Ambulatório de Geriatria e Geron-tologia, do município de São José dos Pinhais, Paraná, Brasil. A condição de fragilidade física foi avaliada mediante o fenótipo de fragilidade e o rastreio cognitivo pelo Mini-Exame do Estado Mental e Teste de Fluência Verbal Semântica. A análise univariada foi realizada por teste de quiquadrado com nível de significância estatístico de p ≤ 0,05. Resultados:do total de participantes, foram observados 226 (55,5 %) idosos pré-frágeis, 238 (58,5 %) apresentaram declínio cognitivo, 90 (22 %) comprometimento na fluência verbal semântica e 205 (50,4 %) velocidade da marcha reduzida, variável que registrou associação significativa com o comprometimento cognitivo (p = 0,003) e alterações da fluência verbal semântica (p < 0,001). Conclusões: os resultados apontam para a necessidade de implementar na prática clínica de geriatria e gerontologia a avaliação da velocidade da marcha em idosos. Esse componente revela possibilidades de comprometimento cognitivo e faculta ações que possam aprimorar a gestão de cuidados diante da fragilidade física em idosos

Objective: To study the association between gait speed and cognition in elderly patients undergoing geriatric and gerontological outpatient treatment. Materials and method:Quantitative and cross-sectional study with 407 elderly patients (≥60 years) treated at the Geriatrics and Gerontology Outpatient Clinic in the town of São José dos Pinhais, Paraná (Brazil). Physical frailty condi-tion was assessed using the frailty phenotype and the cognitive assessment by means of the Mini Mental State Examination and the Semantic Verbal Fluency Test. The univariate analysis was performed using a chisquare test with a level of statistical significance of p ≤ 0.05. Results: Out of the total participants, we observed that 226 (55.5%) elderly patients were pre-frail, 238 (58.5%) had cognitive impairments, 90 (22%) showed impaired semantic verbal fluency, and 205 (50.4%) decreased gait speed. This last variable showed a significant association with cognitive decline (p = 0.003) and changes in semantic verbal fluency (p < 0.001). Conclusions: Our results indicate the need of implementing gait speed assessment in elderly patients in the geriatrics and gerontology clinical practice. This component reveals a possible cognitive deterioration and enables us to develop actions that may improve care management in the face of physical frailty in elderly individuals.

[Telehealth experiences in a specialized mental health hospital during the COVID-19 pandemic in Peru]. / Experiencias de telesalud en un hospital especializado en salud mental durante la pandemia de COVID-19 en Perú.

The objective of this article is to present the experiences of telehealth in a hospital specialized in mental health in Lima, Peru during 2020. In accordance with the provisions such as the temporary closure of face-to-face care and mandatory confinement between the months of March As of December, care was progressively provided through telephone calls, video calls or digital platforms, with 57,398 teleconsultations and telemonitoring, 4411 mental health orientations, 295 teleinterconsultations in psychiatry, 42 teletraining activities and 29 educational sessions in mental health aimed at the general population. We conclude that the implementation of telehealth for the care of the users of the Hermilio Valdizán Hospital contributed to mental health care and reduces the gaps in access to specialized care in psychiatry due to the consequences of COVID-19.

El objetivo de este artículo es dar a conocer las experiencias de telesalud en un hospital especializado en salud mental en Lima, Perú durante la pandemia de COVID-19. En concordancia con las disposiciones, como el cierre temporal de la atención presencial y el confinamiento obligatorio entre los meses de marzo a diciembre del 2020, se brindó progresivamente atención a través de llamadas telefónicas, videollamadas o plataformas digitales; se realizaron 57398 atenciones de teleconsultas y telemonitoreos; 4411 orientaciones en salud mental; 295 teleinterconsultas en psiquiatría; 42 actividades de telecapacitación y 29 sesiones educativas en salud mental dirigidas a la población general. Concluimos que la implementación de la telesalud para la atención de los usuarios del Hospital Hermilio Valdizán contribuyó al cuidado de la salud mental y permite reducir las brechas de acceso a la atención especializada en psiquiatría por las consecuencias de la COVID-19.

Associação entre cognição, velocidade da marcha e habilitação veicular em idosos / Relación entre cognición, velocidad de la marcha y licencia de conducir en adultos mayores / Association between cognition, gait speed and vehicle habilitation in elderly people

Resumo Objetivo: Investigar a associação entre cognição, velocidade da marcha e resultado final da habilitação veicular de idosos candidatos à Carteira Nacional de Habilitação. Métodos: Estudo quantitativo de corte transversal desenvolvido em 12 clínicas de trânsito de Curitiba/Paraná/Brasil. A amostra do tipo probabilística foi constituída por 421 idosos (≥ 60 anos). Para a coleta de dados foram aplicados o Mini-Exame do Estado Mental (MEEM), teste de velocidade da marcha e realizadas consultas ao formulário Registro Nacional de Condutores Habilitados. A relação entre as variáveis foi identificada por meio do teste de regressão linear múltipla, método stepwise, utilizando-se o programa estatístico R versão 3.4.0. Resultados: Observou-se que, ao aumentar o escore no MEEM em uma unidade a chance do idoso ser considerado inapto temporariamente para dirigir diminui em 54,96% (95%; IC 28,47% - 92,69%; p<0,0001), e ao aumentar uma unidade no escore do MEEM houve um aumento na velocidade da marcha (VM) de 0,0091 (95%; IC 0,0005 - 0,0174; p=0,0366). Conclusão: O elevado escore no MEEM diminuiu a probabilidade do idoso ser considerado inapto temporariamente para dirigir veículos automotores e houve uma tendência de aumento da VM com o aumento dos escores do MEEM. A VM é um importante indicador a ser avaliado em idosos motoristas, logo, é um tópico a ser incluído nas avaliações das clínicas de trânsito, assim como o rastreamento cognitivo, fundamental para avaliar um conjunto de atividades mentais necessárias à direção veicular segura.

Resumen Objetivo: Investigar la relación entre cognición, velocidad de la marcha y obtención del permiso de conducir en adultos mayores que tramitan la licencia de conducir. Métodos: Estudio cuantitativo de corte transversal llevado a cabo en 12 centros médicos de evaluación de tránsito de Curitiba, estado de Paraná, Brasil. La muestra probabilística fue formada por 421 adultos mayores (≥ 60 años). Para la recolección de datos se aplicó el Mini Examen del Estado Mental (MEEM), la prueba de velocidad de la marcha y se realizaron consultas al formulario del Registro Nacional de Conductores Habilitados. La relación entre las variables fue identificada mediante la prueba de regresión lineal múltiple, método stepwise, con el programa de estadística R versión 3.4.0. Resultados: Se observó que, al aumentar la puntuación del MEEM una unidad, la probabilidad de que el adulto mayor sea considerado no apto temporalmente para conducir se redujo un 54,96 % (95 %; IC 28,47 % - 92,69 %; p<0,0001), y al aumentar una unidad la puntuación del MEEM, hubo un aumento en la velocidad de la marcha (VM) de 0,0091 (95 %; IC 0,0005 - 0,0174; p=0,0366). Conclusión: La puntuación del MEEM elevada redujo la probabilidad de que el adulto mayor sea considerado no apto temporalmente para conducir automóviles y hubo una tendencia de aumento de la VM con un aumento de la puntuación del MEEM. La VM es un indicador importante que debe ser evaluado en adultos mayores conductores. Por lo tanto, es un tema que deberá ser incluido en las evaluaciones de los centros médicos de evaluación de tránsito, así como también el rastreo cognitivo, fundamental para analizar un conjunto de actividades mentales necesarias para una conducción vehicular segura.

Abstract Objective: To investigate the association between cognition, gait speed and the result of vehicle habilitation of elderly candidates for the National Driver's License. Methods: Quantitative cross-sectional study developed in 12 traffic agencies in Curitiba, state of Paraná, Brazil. The probabilistic sample consisted of 421 elderly people (≥ 60 years). The Mini-Mental State Examination (MMSE), gait speed testing and consultations to forms of the National Qualified Drivers Registration were used for data collection. The relationship between variables was identified through the multiple linear regression test, stepwise method, using the statistical program R, version 3.4.0. Results: When increasing a unit in the MMSE score, the chance of the elderly person being considered as temporarily unfit to drive decreased by 54.96% (95% CI; 28.47% - 92.69%I; p<0.0001). When increasing a unit in the MMSE score, there was an increase in gait speed (GS) of 0.0091 (95% CI: 0.0005 - 0.0174; p=0.0366). Conclusion: The high MMSE score decreased the probability of the elderly participant being considered temporarily unfit to drive motor vehicles. There was a trend of higher GS with the increase in MMSE scores. As GS is an important indicator to be assessed in elderly drivers, this topic should be included in evaluations of traffic agencies, as well as cognitive screening, which is essential to assess a set of mental activities necessary for safe driving.

Asociación entre el nivel de soledad percibido y el uso de Internet en las personas sin hogar / Association between perceived loneliness and Internet use among homeless people

Resumen El objetivo de este estudio fue explorar la asociación entre los niveles de soledad percibida y el acceso a Internet en personas sin hogar. La muestra estuvo compuesta por un total de 129 personas sin hogar que asistieron a un albergue en Monterrey, México (n=129). Para medir las variables del estudio (uso de Internet y niveles de soledad de las personas sin hogar que asisten a albergues) se administró un cuestionario a cada participante, que contenía tres secciones principales: (1) datos de control; (2) uso de Internet y tecnologías de información; y (3) niveles de soledad social y emocional. Los resultados mostraron que: (1) los niveles de soledad están muy por encima del promedio reportado en estudios con otras poblaciones vulnerables; (2) el 51.9% de los participantes han usado Internet en algún momento y lo usan principalmente para contactar a familiares y amigos; y (3) existe una diferencia nominal, aunque no estadísticamente significativa, entre los niveles de soledad de los que usan Internet y los que no. Los resultados de esta investigación sugieren que proporcionar acceso a Internet en los albergues tiene potencial de impactar positivamente la calidad de vida de sus beneficiarios.

Abstract This study aimed to identify the association between the level of perceived loneliness and Internet use among homeless people. The sample consisted of 129 homeless people who were assisted at a shelter in Monterrey (Mexico). To measure the variables of the study, a survey with three main sections was conducted: demographic data, use of Internet and information technologies, and perceived levels of emotional and social loneliness. The results showed: (1) their levels of loneliness were above the average reported in studies with other vulnerable populations; (2) 51.9% of participants have used the Internet at some point in time and use it mainly to contact family and friends; (3) there is a nominal difference, although not statistically significant, between the levels of loneliness of those who use the Internet and those who do not. These results suggest that providing Internet access in shelters may positively influence the quality of life of its beneficiaries.

Partial and Transient Clinical Response to Omalizumab in IL-21-Induced Low STAT3-Phosphorylation on Hyper-IgE Syndrome.

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency characterized by elevated levels of immunoglobulin E (IgE), eczematous dermatitis, cold abscesses, and recurrent infections of the lung and skin caused by Staphylococcus aureus. The dominant form is characterized by nonimmunologic features including skeletal, connective tissue, and pulmonary abnormalities in addition to recurrent infections and eczema. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Several studies reported clinical improvement with omalizumab in patients with severe atopic eczema with high serum IgE level. We present the case of a 37-year-old male with HIES and cutaneous manifestations, treated with humanized recombinant monoclonal antibodies efalizumab and omalizumab. After therapy for 4 years, we observed diminished eczema and serum IgE levels.

Actividad cicatrizante in vivo del polvo carbonizado de Punica granatum Linn y Eichhornia crassipes / In vivo healing activity of the charred powder of Punica granatum Linn and Eichhornia crassipes

Introducción: Las especies vegetales constituyen el remedio primero a los problemas de salud que aquejan a las personas. La granada es rica en ácido ascórbico, mejora la barrera epidérmica y reduce la contracción de las heridas. La flor de agua posee actividad antibacteriana. Objetivo: Evaluar el efecto cicatrizante del polvo carbonizado de Punica granatum Linn (granada) y de Eichhornia crassipes (flor de agua), en un modelo experimental en ratas. Métodos: Estudio analítico experimental con el empleo 30 ratas macho distribuidas en 3 grupos (n= 10). Grupo I y II; tratadas con el polvo carbonizado de la granada y flor de agua respectivamente. Grupo III: Tratadas con cloruro de sodio al 0,9 por ciento. Se realizó un modelo de herida por escisión en el dorso. La evolución de la cicatrización fue seguida por la velocidad de contracción de la herida en milímetros. Se realizó histología sobre biopsias de tejido cicatrizado. Para el análisis estadístico se empleó la prueba no paramétrica de Mann- Whitney. El nivel de significación se fijó en p < 0,05. Resultados: Se comprobó el efecto cicatrizante de los polvos carbonizados de la granada y flor de agua; disminuyó el área de las heridas de manera significativa respecto al grupo control. El estudio histológico mostró dermis madura grado III en los grupos I y II. Conclusiones: La aplicación tópica del polvo carbonizado de granada y de flor de agua influyó sobre el cierre de las heridas y en la maduración de la dermis, por lo cual favoreció la cicatrización(AU)

ABSTRACT Introduction: Plant species are the first remedy to the people's health problems. The pomegranate is rich in ascorbic acid, improves the epidermal barrier and reduces the contraction of wounds. The water hyacinth has antibacterial activity. Objective: To evaluate the healing effect of the charred powder of Punica granatum Linn (pomegranate) and Eichhornia crassipes (water hyacinth), in an experimental model in rats. Methods: Experimental analytical study with 30 male rats distributed in 3 groups (n = 10). Group I and II; treated with the charred powder of the pomegranate and water hyacinth respectively. Group III: treated with 0.9 percent sodium chloride. An incision wound model was made on the back. The evolution of healing was followed by the speed of contraction of the wound in millimeters. Histology was performed on biopsies of scar tissue. For the statistical analysis, the nonparametric Mann-Whitney test was used. The level of significance was set at p < 0.05. Results: The healing effect of the charred powders of the pomegranate and water hyacinth was verified; decreased the wound area significantly compared to the control group. The histological study showed mature grade III dermis in groups I and II. Conclusions: The topical application of the charred powder of pomegranate and water hyacinth influenced the closure of the wounds and the maturation of the dermis, which favored healing(AU)

Evaluación de la actividad inmunomoduladora del polvo seco de Punica granatum Linn en un modelo experimental de inmunosupresión / Evaluation of the immunomodulatory activity of dry powder of Punica granatum Linn in an experimental model of immunosuppression

Introducción: La inmunosupresión es uno de los principales obstáculos en el tratamiento de cáncer, por esta razón, diversos inmunomoduladores naturales y sintéticos son estudiados, con el fin de atenuar los efectos de la terapia convencional. Objetivo: Evaluar la actividad inmunomoduladora del polvo seco de Punica granatum Linn (granada). Métodos: Ratas machos Wistar fueron divididas en cuatro grupos: grupo I (control), II (inmunizado con glóbulos rojos de carnero), III (inmunosuprimido con ciclofosfamida e inmunizado con glóbulos rojos de carnero) y IV (tratado con polvo de granada, inmunosuprimido con ciclofosfamida e inmunizado con glóbulos rojos de carnero). Las variables estudiadas fueron el peso corporal y detección de anticuerpos hemoaglutinantes. Resultados: Se observó ligera tendencia al aumento del peso corporal en los grupos I, II y III, con respuesta diferente en el grupo IV, donde hubo una leve disminución. El título de anticuerpos del grupo III disminuyó con respecto al II y IV, tanto en la respuesta primaria como secundaria. En el grupo IV el título de anticuerpos resultó ser estadísticamente significativo con relación al del grupo III (p= 0,000) para ambas respuestas. Conclusiones: La Púnica granatum mostró efecto inmunomodulador, al incrementar el nivel de anticuerpos hemaglutinantes(AU)

Introduction: Immunosuppression is one of the main obstacles in the treatment of cancer, for this reason, several natural and synthetic immunomodulators are studied, in order to attenuate the effects of conventional therapy. Objective: To evaluate the immunomodulator activity of Punica granatum Linn (pomegranade). Methods: Wistar male rats were divided into four groups: group I (control), II (immunized with red blood cells of sheep), III (immunosuppressed with cyclophosphamide and immunized with red blood cells of sheep) and IV (treated with pomegranate powder, immunosuppressed with cyclophosphamide and immunized with red blood cells of sheep). The variables studied were body weight and detection of haemagglutinating antibodies. Results: A slight tendency to increase body weight was observed in groups I, II and III, with a different response in group IV, where there was a slight decrease. The antibody titre of group III decreased with respect to II and IV, both in the primary and secondary response. In group IV the antibody titer was found to be statistically significant in relation to group III (p = 0.000) for both responses. Conclusions: Punic granatum showed immunomodulatory effect, increasing the level of haemagglutinating antibodies(AU)

Gait speed associated factors in elderly subjects undergoing exams to obtain the driver's license. / Fatores associados à velocidade da marcha em idosos submetidos aos exames para habilitação veicular.

OBJECTIVE: to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. METHOD: a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. RESULTS: there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). CONCLUSION: elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.

Fatores associados à velocidade da marcha em idosos submetidos aos exames para habilitação veicular / Gait speed associated factors in elderly subjects undergoing exams to obtain the driver's license / Factores asociados a la velocidad de la marcha en los adultos mayores sometidos a los exámenes para habilitación vehicular

Objetivo analisar os fatores associados à velocidade da marcha em idosos submetidos aos exames de aptidão física e mental para habilitação veicular. Método estudo quantitativo de corte transversal realizado nas clínicas de trânsito, no qual fizeram parte da amostra do tipo probabilística 421 idosos (≥ 60 anos). O estudo foi desenvolvido mediante aplicações de questionários e testes que constituem o fenótipo da fragilidade. Para avaliar a velocidade da marcha, cronometrou-se o tempo gasto pelo participante para percorrer uma distância de 4,6 metros, de maneira habitual e em superfície plana. Os dados foram analisados utilizando a regressão linear múltipla por meio do método stepwise. Adotou-se o programa estatístico R versão 3.4.0. Resultados houve associação significativa entre velocidade da marcha e trabalho remunerado (<0,0000), índice de massa corporal (<0,0000), escore do Mini-Exame de Estado Mental (=0,0366), fragilidade física (pré-frágeis =0,0063 e não frágeis <0,0000), idade (<0,0000), sexo (=0,0255) e força de preensão manual (<0,0000). Conclusão idosos motoristas que não trabalham, mulheres, com idade avançada, elevado índice de massa corporal, baixo escore no Mini-Exame de Estado Mental, baixa força de preensão manual e frágeis possuem tendência de diminuição da velocidade da marcha e devem ser prioridade das intervenções.

Objective to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. Method a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. Results there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). Conclusion elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.

Objetivo analizar los factores asociados a la velocidad de la marcha en adultos mayores sometidos a los exámenes de aptitud física y mental para habilitación vehicular. Método estudio cuantitativo de corte transversal realizado en las clínicas de tránsito, en el cual hicieron parte de la muestra del tipo probabilística 421 adultos mayores (≥ 60 años). El estudio fue desarrollado mediante aplicaciones de cuestionarios y pruebas que constituyen el fenotipo de fragilidad. Para evaluar la velocidad de la marcha fue cronometrado el tiempo gasto por el participante para andar una distancia de 4,6 metros, de manera habitual y en una superficie plana. Los datos fueron analizados utilizándose la regresión linear múltiple por medio del método stepwise. Fue adoptado el programa estadístico R versión 3.4.0. Resultados hubo una asociación significativa entre velocidad de la marcha y trabajo remunerado (<0,0000), índice de masa corporal (<0,0000), puntaje del Mini-Examen de Estado Mental (=0,0366), fragilidad física (pre-frágiles =0,0063 y no frágiles <0,0000), edad (<0,0000), sexo (=0,0255) y fuerza de prensión manual (<0,0000). Conclusión adultos mayores conductores que no trabajan, mujeres, con edad avanzada, elevado índice de masa corporal, bajo puntaje en el Mini-Examen de Estado Mental, baja fuerza de prensión manual y frágil poseen tendencia de disminución de la velocidad de la marcha y deben ser prioridad de las intervenciones.

Physical frailty and gait speed in community elderly: a systematic review. / Fragilidade física e velocidade da marcha em idosos da comunidade: uma revisão sistemática.

OBJECTIVE: To identify the outcomes of studies on gait speed and its use as a marker of physical frailty in community elderly. METHOD: Systematic review of the literature performed in the following databases: LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus and ProQuest. The studies were evaluated by STROBE statement, and the PRISMA recommendations were adopted. RESULTS: There were 6,303 studies, and 49 of them met the inclusion criteria. Of the total number of studies, 91.8% described the way of measuring gait speed. Of these, 28.6% used the distance of 4.6 meters, and 34.7% adopted values below 20% as cutoff points for reduced gait speed, procedures in accordance with the frailty phenotype. Regarding the outcomes, in 30.6% of studies, there was an association between gait speed and variables of disability, frailty, sedentary lifestyle, falls, muscular weakness, diseases, body fat, cognitive impairment, mortality, stress, lower life satisfaction, lower quality of life, napping duration, and poor performance in quantitative parameters of gait in community elderly. CONCLUSION: The results reinforce the association between gait speed, physical frailty and health indicator variables in community elderly.

Conocimientos necesarios para que el enfermero trabaje en la unidad de cuidados intensivos oncológicos / Conhecimentos necessários para que a enfermeira trabalhe na unidade de terapia intensiva oncológica / Knowledge required for the nurse to work in the oncological intensive care unit

Objetivo: determinar los conocimientos básicos de enfermería para los profesionales que trabajan en la unidad de cuidados intensivos oncológicos. Método: estudio cualitativo realizado con siete actores sociales, basado en la teoría de las competencias de Candela; para tanto se utilizó el método de estudio de casos múltiples, apoyados por una guía de entrevista y cédula de captación de datos; estos instrumentos fueron validados por expertos en el área. La recolección de datos ocurrió entre septiembre y diciembre de 2016, y el análisis de enero a febrero de 2017. Resultados: las mayores trascendencias se agrupan en categorías clasificadas por aparatos y sistemas, las cuales son: respiratorio, cardiovascular, nervioso central, tegumentario, inmunológico y sistema hidroelectrolítico, bien como los conocimientos relacionados a la limitación del esfuerzo terapéutico y medicamentos citotóxicos. Consideraciones finales: el profesional de enfermería para ofrecer atención de calidad al paciente debe tener conocimientos relacionados con los límites terapéuticos, tanatología, cuidados paliativos y orientación espiritual del paciente oncológico en fase terminal.

Objetivo: determinar os conhecimentos da enfermeira para trabalhar na unidade de terapia Intensiva oncológica. Método: estudo qualitativo realizado com sete atores sociais, baseado na teoria das competências de Candela. Utilizou-se o método de estudo de casos múltiplos, apoiados por uma guia de entrevista e cédula de captação de dados; estes instrumentos foram validados por expertos na área. A coleta de dados foi de setembro a dezembro de 2016, posteriormente as análises de janeiro a fevereiro de 2017. Resultados: as maiores transcendências se aglutinam em categorias, sendo classificados por sistemas tais como: o respiratório, cardiovascular, nervoso central, tegumentário, imunológico e sistema hidroeletrolítico, assim como os conhecimentos relacionados com a limitação do esforço terapêutico e medicamentos citotóxicos. Considerações finais: o profissional de enfermagem, para oferecer um ótimo atendimento ao cliente, requer conhecimentos relacionados com os limites terapêuticos, tanatologia, cuidados paliativos e orientação espiritual do paciente oncológico em fase terminal.

Aim: to determinate the nurse's knowledge in order to work in the Intensive Care Unit. Method: qualitative study carried out with seven social actors, based on Candela's teory of competences; the multiple case study method was used, supported by an interview guide and a data capture card; such instruments were validated by experts in the area. Data collection was from september to december 2016, then the analysis were made from January to February 2017. Results: the most important transcendences were classified into categories, such as: respiratory, cardiovascular, central nervous, integumentary, immunological and electrolyte system, as well as the information related to the limitation of therapeutic effort and cytotoxic drugs. Final considerations: to offer optimal care to their patients, the nursing professionals require experience related to the therapeutic limits, thanatology, palliative care and spiritual orientation of the end-stage cancer patient.

Effects of volatile anaesthetics on heme metabolism in a murine genetic model of Acute Intermittent Porphyria. A comparative study with other porphyrinogenic drugs.

BACKGROUND: Acute Intermittent Porphyria (AIP) is an inherited disease produced by a deficiency of Porphobilinogen deaminase (PBG-D). The aim of this work was to evaluate the effects of Isoflurane and Sevoflurane on heme metabolism in a mouse genetic model of AIP to further support our previous proposal for avoiding their use in porphyric patients. A comparative study was performed administering the porphyrinogenic drugs allylisopropylacetamide (AIA), barbital and ethanol, and also between sex and mutation using AIP (PBG-D activity 70% reduced) and T1 (PBG-D activity 50% diminished) mice. METHODS: The activities of 5-Aminolevulinic synthetase (ALA-S), PBG-D, Heme oxygenase (HO) and CYP2E1; the expression of ALA-S and the levels of 5-aminolevulinic acid (ALA) were measured in different tissues of mice treated with the drugs mentioned. RESULTS: Isoflurane increased liver, kidney and brain ALA-S activity of AIP females but only affected kidney AIP males. Sevoflurane induced ALA-S activity in kidney and brain of female AIP group. PBG-D activity was further reduced by Isoflurane in liver male T1; in AIP male mice activity remained in its low basal levels. Ethanol and barbital also caused biochemical alterations. Only AIA triggered neurological signs similar to those observed during human acute attacks in male AIP being the symptoms less pronounced in females although ALA-S induction was greater. Heme degradation was affected. DISCUSSION: Biochemical alterations caused by the porphyrinogenic drugs assayed were different in male and female mice and also between T1 and AIP being more affected the females of AIP group. GENERAL SIGNIFICANCE: This is the first study using volatile anaesthetics in an AIP genetic model confirming Isoflurane and Sevoflurane porphyrinogenicity.

Fragilidade física e velocidade da marcha em idosos da comunidade: uma revisão sistemática / Fragilidad física y velocidad de la marcha en personas mayores de la comunidad: una revisión sistemática / Physical frailty and gait speed in community elderly: a systematic review

RESUMO Objetivo: Identificar os desfechos dos estudos sobre velocidade da marcha e seu emprego como marcador de fragilidade física em idosos da comunidade. Método: Revisão sistemática da literatura realizada nas bases de dados LILACS, SciELO, MEDLINE/ PubMed, ScienceDirect, Scopus e ProQuest. Os estudos foram avaliados pelo STROBE e adotaram-se as recomendações do PRISMA. Resultados: Obtiveram-se 6.303 estudos, e 49 deles atenderam aos critérios de inclusão. Do total de estudos, 91,8% descreveram a forma de mensuração da velocidade da marcha. Desses, 28,6% utilizaram a distância de 4,6 metros, e 34,7% adotaram valores abaixo de 20% como pontos de corte para velocidade da marcha reduzida, procedimentos que seguem o fenótipo de fragilidade. Quanto aos desfechos, em 30,6% dos estudos houve associação entre a velocidade da marcha e as variáveis incapacidades, fragilidade, sedentarismo, quedas, fraqueza muscular, doenças, gordura corporal, comprometimento cognitivo, mortalidade, estresse, menor satisfação com a vida, menor qualidade de vida, duração dos cochilos e baixo desempenho em parâmetros quantitativos da marcha em idosos da comunidade. Conclusão: Os resultados reforçam a associação da velocidade da marcha, fragilidade física e variáveis indicadoras de saúde em idosos da comunidade.

RESUMEN Objetivo: Identificar los resultados de los estudios acerca de la velocidad de la marcha y su empleo como marcador de fragilidad física en personas mayores de la comunidad. Método: Revisión sistemática de la literatura realizada en las bases de datos LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus y ProQuest. Los estudios fueron evaluados por el STROBE y se adoptaron las recomendaciones del PRISMA. Resultados: Se lograron 6.303 estudios, y 49 de ellos atendieron a los criterios de inclusión. Del total de estudios, el 91,8% describieron la forma de medición de la velocidad de la marcha. De esos, el 28,6% utilizaron la distancia de 4,6 metros, y el 34,7% adoptaron valores por debajo del 20% como puntos de corte para velocidad de la marcha reducida, procedimientos que siguen el fenotipo de fragilidad. En cuanto a los resultados, en el 30,6% de los estudios hubo asociación entre la velocidad de la marcha y la variables incapacidades, fragilidad, sedentarismo, caídas, debilidad muscular, enfermedades, grasa corporal, compromiso cognitivo, mortalidad, estrés, menor satisfacción con la vida, menor calidad de vida, duración de las siestas y bajo desempeño en parámetros cuantitativos de la marcha en personas mayores de la comunidad. Conclusión: Los resultados refuerzan la asociación entre la velocidad de la marcha, la debilidad física y las variables indicadoras de salud en personas mayores de la comunidad.

ABSTRACT Objective: To identify the outcomes of studies on gait speed and its use as a marker of physical frailty in community elderly. Method: Systematic review of the literature performed in the following databases: LILACS, SciELO, MEDLINE/PubMed, ScienceDirect, Scopus and ProQuest. The studies were evaluated by STROBE statement, and the PRISMA recommendations were adopted. Results: There were 6,303 studies, and 49 of them met the inclusion criteria. Of the total number of studies, 91.8% described the way of measuring gait speed. Of these, 28.6% used the distance of 4.6 meters, and 34.7% adopted values below 20% as cutoff points for reduced gait speed, procedures in accordance with the frailty phenotype. Regarding the outcomes, in 30.6% of studies, there was an association between gait speed and variables of disability, frailty, sedentary lifestyle, falls, muscular weakness, diseases, body fat, cognitive impairment, mortality, stress, lower life satisfaction, lower quality of life, napping duration, and poor performance in quantitative parameters of gait in community elderly. Conclusion: The results reinforce the association between gait speed, physical frailty and health indicator variables in community elderly.