Palliative Care for SARS-CoV-2 Patients in the Intensive Care Unit: A Comprehensive Study.

OBJECTIVE: To comprehend the multiprofessional actions regarding palliative care for patients in the Intensive Care Unit affected by SARS-CoV-2. METHODS: A comprehensive qualitative study conducted with 31 professionals from the Intensive Care Units of a university hospital, based on the Theory of Peaceful End of Life. RESULTS: The analysis of the discourse led to the identification of two categories: "Multidisciplinary actions to promote comfort at the end of life" and "Palliative care during the pandemic period and the promotion of emotional and spiritual comfort." FINAL CONSIDERATIONS: It became evident that local administration needs to invest in measures that reduce barriers to the implementation of palliative care during times of crisis. Understanding the discourse highlighted that non-specialized professionals can provide basic palliative care appropriately, without diminishing the importance and necessity of the presence of palliative care specialists in various hospital areas.

Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count.

Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence.

Trypanosoma cruzi infection modulates secreted phospholipase A2 expression in the salivary glands of Rhodnius prolixus.

Phospholipases A2 (PLA2) comprise a superfamily of enzymes that specifically catalyze hydrolysis of the ester bond at the sn-2 position of glycerophospholipids, generating lysophospholipids and fatty acids. In Rhodnius prolixus, one of the main vectors of the Chagas's disease etiologic agent Trypanosoma cruzi, it was previously shown that lysophosphatidylcholine, a bioactive lipid, found in the insect's saliva, contributes to the inhibition of platelet aggregation, and increases the production of nitric oxide, an important vasodilator. Due to its role in potentially generating LPC, here we studied the PLA2 present in the salivary glands of R. prolixus. PLA2 activity is approximately 100 times greater in the epithelium than in the contents of salivary glands. Our study reveals the role of the RpPLA2XIIA gene in the insect feeding performance and in the fatty acids composition of phospholipids extracted from the salivary glands. Knockdown of RpPLA2XIIA significantly altered the relative amounts of palmitic, palmitoleic, oleic and linoleic acids. A short-term decrease in the expression of RpPLA2III and RpPLA2XIIA in the salivary glands of R. prolixus was evident on the third day after infection by T. cruzi. Taken together, our results contribute to the understanding of the role of PLA2 in the salivary glands of hematophagous insects and show that the parasite is capable of modulating even tissues that are not colonized by it.

Metastasis of small cell lung cancer to bilateral extraocular muscles: a case report.

BACKGROUND: Orbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature. CASE PRESENTATION: A 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after. CONCLUSION: Bilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.

Association of clinical indicators in TMJ, craniofacial, occlusal, and upper airway changes with symptoms of pediatric obstructive sleep apnea and mouth-breathing.

OBJECTIVE: To assess the association between self-reported symptoms of pediatric OSA and clinical signs in MB children. METHODS: Seventy-three MB children aged 7-14 years answered an interview questionnaire on OSA symptoms in childhood, focusing on chewing, nasal, and sleep disturbances. MB children were checked for changes on the craniofacial, occlusion, TMJ, upper airway, and body posture by a multi-disciplinary team, consisting of medical residents, dental, and psychology postgraduate students. Multiple logistic regression analysis verified the association between clinical signs and self-reported symptoms. RESULTS: Reported symptoms of chewing disturbance as TMD noise, muscle pain, and morning headache were significantly associated with the presence of lip incompetence and Class II malocclusion. Sleep disturbances as snoring, waking up at night, daytime sleepiness, and sleeping with the mouth open were significantly associated with the presence of hypertrophic tonsils and obstructive Mallampati score. CONCLUSION: Symptoms of pediatric OSA were found in mouth-breathing children, which should be carefully investigated in order to prevent OSA in the future.

Social support and suicidality during the COVID-19 pandemic among Brazilian healthcare workers: a longitudinal assessment of an online repeated cross-sectional survey.

INTRODUCTION: Healthcare workers (HCWs) are at an increased risk of suicide compared to non-healthcare workers. This study aims to investigate the association between social support and suicidal ideation and behavior (SIB) during the COVID-19 pandemic among Brazilian HCWs. METHODS: This study utilizes data from 10,885 participants who answered the first (time point 1 - between May and June of 2020) and second (time point 2 - between December 2020 and February 2021) assessments of an online repeated cross-sectional survey for evaluating mental health and quality of life of HCWs during the COVID-19 pandemic in Brazil. Logistic regression analysis was conducted to investigate the relationship between social support as the independent variable (time point 1) and SIB as the outcomes (time point 2). RESULTS: Higher social support was associated with a significantly lower chance of reporting SIB in the month prior to follow-up assessment (adjusted odds ratio [AOR]: 0.71, CI 95% 0.66 - 0.76 and AOR 0.61, CI 95% 0.54 - 0.68, respectively). These associations were independent of sex, age, feelings of loneliness, and self-reported psychiatric disorders. CONCLUSION: Social support is associated with a lower chance of suicidality among HCWs, a protective role that is probably more evident for suicidal behavior.

Giant Conjunctival Cyst of the Orbit in a Patient with Previous Enucleation.

Introduction: Conjunctival cysts of the orbit development are a rare complication in enucleated patients. They result from the entrapment of conjunctival epithelium within the orbit. Case Presentation: We report the case of a 25-year-old man with a history of enucleation for a retinoblastoma of the right eye who presented with difficulty in fitting his eye prothesis. On his past medical records, there was no reference to the placement of any orbital implant at the time of the surgery. Biomicroscopy of the right eye revealed a thickened bulbar conjunctiva, an inferior symblepharon, and a translucid central area with vascularization. Imaging was remarkable for a cystic cavity filling the whole right orbit. Biopsy revealed the diagnosis of a conjunctival cyst, and drainage was performed, alleviating the patient's symptoms. Conclusion: Orbital conjunctival cysts may pose a clinical problem, and treatment modalities include surgical excision, absolute alcohol injection, and trichloroacetic acid injection.

Traces of oil in sea turtle feces.

In 2019, an oil spill hit the Brazilian Northeast coast causing impact to several ecosystems, including sea turtles' breeding and feeding areas. This study aimed to investigate whether sea turtles were impacted by this oil disaster, correlating the oil found inside feces with a sandy-oiled sample collected on the beach some days after the accident. The fecal samples were collected in the upper mid-littoral reef areas during three consecutive days in February 2020. The results suggested that sea turtles consumed algae contaminated by petroleum. Hydrocarbons composition of oil inside feces was similar to the sandy-oiled sample, suggesting they were the same. Lighter aliphatic and polycyclic aromatic compounds were missing, indicating both sandy-oiled and oil inside the feces had experienced significant evaporation prior to collection. Although the long-term damage is still unknown, the data are novel and relevant to support future research and alert authorities about the risks to sea turtles.

Electrochemical Diselenation of BODIPY Fluorophores for Bioimaging Applications and Sensitization of 1 O2.

Invited for the cover of this issue are the groups of Holger Braunschweig at the Julius-Maximilians-Universität Würzburg, Germany and Eufrânio N. da Silva Júnior at the Universidade Federal de Minas Gerais, UFMG, Brazil. The image depicts the electrochemical synthesis of selenium-containing BODIPY molecules with lightning symbolizing the electrifying synthetic process, while the surrounding elemental chaos hints at the red-shifted absorption and emission and the transformative photophysical properties of these new compounds. Read the full text of the article at 10.1002/chem.202303883.

Orthodontics in the oral health care network of the Unified Health System (SUS).

This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023).

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.

Diagnosis and treatment of active charcot neuro-osteoarthropathy in persons with diabetes mellitus: A systematic review.

BACKGROUND: There are uncertainties regarding the diagnostic criteria, optimal treatment methods, interventions, monitoring and determination of remission of Charcot neuro-osteoarthropathy (CNO) of the foot and ankle in people with diabetes mellitus (DM). The aims of this systematic review are to investigate the evidence for the diagnosis and subsequent treatment, to clarify the objective methods for determining remission and to evaluate the evidence for the prevention of re-activation in people with CNO, DM and intact skin. METHODS: We performed a systematic review based on clinical questions in the following categories: Diagnosis, Treatment, Identification of Remission and Prevention of Re-Activation in people with CNO, DM and intact skin. Included controlled studies were assessed for methodological quality and key data from all studies were extracted. RESULTS: We identified 37 studies for inclusion in this systematic review. Fourteen retrospective and observational studies relevant to the diagnosis of active CNO with respect to clinical examination, imaging and blood laboratory tests in patients with DM and intact skin were included. We identified 18 studies relevant to the treatment of active CNO. These studies included those focused on offloading (total contact cast, removable/non-removable knee high devices), medical treatment and surgical treatment in the setting of active CNO. Five observational studies were identified regarding the identification of remission in patients who had been treated for active CNO. We did not identify any studies that met our inclusion criteria for the prevention of re-activation in patients with DM and intact skin who had been previously treated for active CNO and were in remission. CONCLUSIONS: There is a paucity of high-quality data on the diagnosis, treatment, and prognosis of active CNO in people with DM and intact skin. Further research is warranted to address the issues surrounding this complex disease.

Electrochemical Diselenation of BODIPY Fluorophores for Bioimaging Applications and Sensitization of 1 O2.

We report a rapid, efficient, and scope-extensive approach for the late-stage electrochemical diselenation of BODIPYs. Photophysical analyses reveal red-shifted absorption - corroborated by TD-DFT and DLPNO-STEOM-CCSD computations - and color-tunable emission with large Stokes shifts in the selenium-containing derivatives compared to their precursors. In addition, due to the presence of the heavy Se atoms, competitive ISC generates triplet states which sensitize 1 O2 and display phosphorescence in PMMA films at RT and in a frozen glass matrix at 77 K. Importantly, the selenium-containing BODIPYs demonstrate the ability to selectively stain lipid droplets, exhibiting distinct fluorescence in both green and red channels. This work highlights the potential of electrochemistry as an efficient method for synthesizing unique emission-tunable fluorophores with broad-ranging applications in bioimaging and related fields.

Cardiac scintigraphy and echocardiography assessment in the diagnosis of transthyretin cardiac amyloidosis.

The aim is to evaluate the diagnostic yield of echocardiography and [99mTc]Tc-DPD scintigraphy in the detection of amyloid cardiomyopathy (CM) and define potential prognostic echocardiographic parameters. 133 patients were retrospectively studied, from 2016 to 2021, with a mean age of 80.2 ± 7.5 years. The final diagnosis was established according to international consensus. Patients had a transthoracic echocardiogram (TTE) and [99mTc]Tc-DPD scintigraphy; RWT, E/e, LS, TAPSE, SAB, and IWT scores were calculated. All patients with ATTR-CM were classified into 3 prognostic stages and were compared with Perugini grades and echocardiographic parameters. CM was confirmed in 85 cases (63.9%), 76 (57.1%) ATTR-CM, and 9 (6.8%) AL-CM. The diagnostic yield of [99mTc]Tc-DPD scintigraphy and echocardiography were calculated, with a sensitivity of 90.7%, specificity of 100%, PPV of 100%, and NPV of 87.2% in myocardial scintigraphy, versus 74.6%, 62.5%, 75.6%, 61.2% in the echocardiogram. According to the IWT score, most patients were classified in the intermediate group; 33 presented with grade 2-3 uptakes. Significant results were obtained when comparing Perugini score with IWT (p: 0.02) and SAB (p: 0.03); and between biomarkers stages and LVEF (p: 0.028), E/e´ (p: 0.001), and GLS% (p: 0.022). [99mTc]Tc-DPD scintigraphy is superior in diagnosing CA. SAB could be the most reliable parameter in an early diagnostic phase, showing a strong correlation with Perugini grades 2 and 3.

Effect of coating material on microencapsulated phenolic compounds extracted from agroindustrial ciriguela peel residue.

BACKGROUND: Extract of ciriguela residue was microencapsulated by spray-drying and freeze-drying using maltodextrin (M), gum arabic (GA) and their mixture (50% M; 50% GA on dry basis) as encapsulating agents. Total phenolic compounds (TPC), antioxidant activity, physicochemical properties, profile of phenolic compounds by HPLC with diode-array detection and storage stability were evaluated. RESULTS: TPC content of powders ranged from 306.9 to 451.2 mg gallic acid equivalent g-1 dry powder. The spray-dried powder prepared using GA as encapsulating agent had higher TPC content and antioxidant activity, whereas the freeze-dried powder had lower moisture and water activity. Spray-dried microcapsules had spherical shape, whereas freeze-dried products had irregular structures. The profile of phenolic compounds identified in samples was similar, with rutin (342.59 and 72.92 µg g-1 ) and quercetin (181.02 and 43.24 µg g-1 ) being the major compounds in liquid and freeze-dried extracts, respectively, whereas myricetin (97.41 µg g-1 ) was predominant in spray-dried ones. Storage stability tests carried out for 45 days at 7 or 25 °C revealed no statistically significant difference in TPC. CONCLUSION: Ciriguela residue can be considered a source of TPC and used as ingredient with good antioxidant activity in the food industry. © 2023 Society of Chemical Industry.

Polysaccharides from exudate gums of plants and interactions with the intestinal microbiota: A review of vegetal biopolymers and prediction of their prebiotic potential.

Polysaccharides in plant-exuded gums are complex biopolymers consisting of a wide range of structural variability (linkages, monosaccharide composition, substituents, conformation, chain length and branching). The structural features of polysaccharides confer the ability to be exploited in different industrial sectors and applications involving biological systems. Moreover, these characteristics are attributed to a direct relationship in the process of polysaccharide enzymatic degradation by the fermentative action in the gut microbiota, through intrinsic interactions connecting bacterial metabolism and the production of various metabolites that are associated with regulatory effects on the host homeostasis system. Molecular docking analysis between bacterial target proteins and arabinogalactan-type polysaccharide obtained from gum arabic allowed the identification of intermolecular interactions provided bacterial enzymatic mechanism for the degradation of several arabinogalactan monosaccharide chains, as a model for the study and prediction of potential fermentable polysaccharide. This review discusses the main structural characteristics of polysaccharides from exudate gums of plants and their interactions with the intestinal microbiota.

Quality of Nursing Care Perceived by People With HIV in Brazil: A Cross-Sectional Study.

ABSTRACT: We evaluated the quality of care provided by the nursing team within specialized care services (SCS) from the perspective of persons with HIV (PWH). A cross-sectional study was conducted in 25 SCS selected by a single-stage cluster sampling in 21 municipalities in Brazil. Systematic sampling was performed between October 2019 and March 2020 in the reception areas of SCS locations to choose the study population ( N = 377). The adapted and validated Quality of Care Through the Patient's Eyes-HIV (QUOTE-HIV) questionnaire was used to measure the quality of perceived care, and the Mann-Whitney test to compare the scores between men and women. Of the 377 PWH, most were women (57.71%), Black or Brown (85.9%), heterosexual (67.1%), and cisgendered (96.0%); the mean age was ≥30 years (76.1%). Users' evaluation of the care provided by SCS according to scores of importance and performance of the QUOTE-HIV instrument ranged from 5.60 to 8.95 and 0.03 to 0.76, respectively. The perception of PWH about the quality of care provided by the nursing team in SCS suggests that there are opportunities to improve.

Weight stigma is a predictor of disordered eating in Brazilian college students during the COVID-19 pandemic: A 16-month cohort follow-up.

This study examined the relationship between weight stigma and disordered eating behaviors in university students during the COVID-19 pandemic, considering individuals with and without overweight. A national sample of 738 college students completed an online questionnaire at three time points between July 2020 and December 2021, reporting their experiences of weight stigma, perceived increase in weight stigma during the pandemic, internalized weight stigma, and disordered eating behaviors. The findings showed that the trajectories of disordered eating behaviors varied depending on participants' anthropometric status. Among those with overweight, there was a decrease over time in binge eating, food restriction, and purging. Conversely, the non-overweight group experienced a slight increase in binge eating from T2 to T3. Using the Generalized Estimating Equations model, the study revealed that weight stigma predicted disordered eating behaviors in both weight spectrums during the pandemic. Experiences of weight stigma and the perceived increase in weight stigma significantly increased the likelihood of engaging in binge eating, food restriction, and purging among individuals with overweight. Furthermore, the internalization of weight stigma was longitudinally associated with all examined eating behaviors, regardless of anthropometric status. These findings highlight the importance of addressing weight stigma to prevent disordered eating in college students.

Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count

ABSTRACT Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence.