Short-term responses of littoral phytoplankton in a large shallow subtropical lake.

The littoral zone is an essential compartment for lake biota because of its high productivity and diversity. Moreover, phytoplankton is expected to have non-equilibrium dynamics on it. The study's aimed to explore phytoplankton in the littoral zone of a shallow lake over a short-term scale. Daily sampling was conducted for 25 consecutive summer days in 2016, at two marginal points of a continuously warm, polymictic, and oligo-mesotrophic subtropical lake (Lake Mangueira, Brazil). Cyanobacteria and Chlorophyta contributed 86% of total biomass. We observed high variability in phytoplankton structure, with species turnover over diel cycles. Redundancy analysis indicated spatial differentiation for phytoplankton structure in relation to abiotic conditions. Nutrient dynamics and humic substances were significant drivers for phytoplankton variability. Phytoplankton was positively correlated with SRP and negatively with humic substances. Our results showed a non- equilibrium state for the littoral phytoplankton of Lake Mangueira, given the high variability of abiotic conditions, even at short distances. Due to its high temporal and spatial variability, the littoralzone seems to contribute to the recruitment and maintenance of phytoplankton biodiversity in shallow lakes. Further studies should consider the functional attributes of species and the complex biological interactions of phytoplankton and macrophytes along the littoral zone.

Changes in dietary carbohydrate and lipid quality indices between 2008 and 2018: Analysis of the Brazilian dietary surveys.

The aim of the study was to evaluate characteristics and changes over a decade in dietary carbohydrate and lipid quality according to socio-demographic variables. Data was obtained from two Brazilian National Dietary Surveys 2008-2009 (n = 34 003) and 2017-2018 (n = 46 164) examining a nationwide representative sample of individuals ≥10 years old. Food intake was assessed by means of two non-consecutive diet records (2008-2009) and 24 h diet recalls (2017-2018). Carbohydrate Quality Index is a score ranging from 4 to 20 calculated from fibre intake, global dietary glycaemic index, solid/total carbohydrate (CHO) and whole grains/total grains CHO. Lipid Quality Index was estimated by dividing the sum of the dietary content of monounsaturated and polyunsaturated fatty acids by the sum of saturated and trans fatty acids. Indices were categorised into five categories (1 for lowest and 5 for highest quality). Socio-demographic variables were sex, age, income, urban/rural area and place of food consumption. The estimates (95% CI) were generated separately for each survey and then compared to identify changes in time. Our main findings refer to changes in diet quality according to income. At the lowest income level, the proportions of individuals in the best carbohydrate and lipid quality categories reduced from 26.9% to 20.6% and from 30.0% to 24.9%, respectively. Alternatively, at the highest income level, these proportions increased from 22.9% to 26.6% and from 11.9% to 15.7%, respectively. Furthermore, the quality of lipids improved in women and among individuals reporting some away-from-home food consumption, while the quality of carbohydrates was reduced among adolescents and in rural areas.

Aging: silencing the PKA and AkT/PKB signaling pathways alters the antioxidant capacity of resveratrol.

One of the theories related to aging is the increase in oxidative stress. Given this, the objective of the study is to evaluate the cellular mechanisms responsible for the resveratrol antioxidant effect on leukocytes from donors aged between 20 and 80 years old. For this, leukocytes from donors of three age groups (20-39, 40-59 and 60-80) were isolated. Image-iT™LIVE Green Reactive Oxygen Species (ROS) Kit was used. Reactive Nitrogen Species (RNS) analysis was performed by measuring nitric oxide and peroxynitrite. The PKA, Akt/PKB and p38-MAPK were evaluated by chemiluminescence. The statistical analysis between age and treatments were performed by Pearson correlation (*p < 0.05). It was possible to observe the antioxidant effect of resveratrol in all age groups. The correlation results show loss of resveratrol effect in decreasing ROS in leukocytes from older donors. We observed an active antioxidant effect of p38-MAPK in all ages, with resveratrol acting on it. The PKA and Akt/PKB were active in leukocytes from donors aged 20-59. In cells from donors older than 60, these pathways are silenced, and an effect is also not observed in cells treated with resveratrol. Therefore, resveratrol showed antioxidant effect in all age, although it was more pronounced in leukocytes from younger. One of resveratrol's mechanisms is due to the activation of the PKA and Akt/PKB, which were activated in younger donor cells.

Aging: Change in SIRT1 and Enzymatic Profile Promotes a Decrease in the Antioxidant Capacity of Resveratrol in Human Leukocytes In Vitro.

BACKGROUND: One of the most studied theories about aging comes from the accumulation of free radical generation, leading to oxidative stress. Resveratrol (RSV) is a polyphenolic compound that has been shown to act as an antioxidant in medical practice. OBJECTIVE: To verify the antioxidant action of resveratrol (and its correlation with aging) in leukocytes from donors of different ages, mainly through the analysis of the three main enzymes of the antioxidant complex and the analysis of the SIRT1 signaling pathway. METHODS: Luminol-dependent chemiluminescence assay was used to evaluate ROS and SIRT1. Antioxidant enzymes were evaluated by commercial kits. *p<0.05. RESULTS: In all age groups, there was a reduction in reactive oxygen species (ROS) in cells stimulated with RSV. There was a positive correlation between its antioxidant effect and donor age. In younger individuals (20-39 years old), there was an increase in catalase activity in cells exposed to RSV. In the older groups (40-59 years old and 60-80 years old), RSV was able to increase the activity of the enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx). Through the analysis of SIRT1 it was possible to observe a silencing of the pathway in leukocytes treated with RSV during aging. CONCLUSION: RSV showed antioxidant activity in all age groups, although more pronounced in younger individuals. One of the mechanisms of action of the RSV is due to the increase in the activity of antioxidant enzymes, which varies according to the individual's age, especially through the modulation of important antioxidant pathways.

Impacto do estilo de vida na qualidade de vida de estudantes de ciências da saúde / Impact of lifestyle on the quality of life of health sciences / Impacto del estilo de vida em la calidad de vida de estudiantes de ciências de la salud

Objetivo: Avaliar o impacto do Estilo de Vida (EV) na Qualidade de Vida (QV) de universitários. Método: Pesquisa observacional, longitudinal, prospectiva e quantitativa, com discentes dos cursos de Enfermagem, Fonoaudiologia, Medicina, Tecnologia em Radiologia e em Sistemas Biomédicos. Para avaliação do EV foi utilizado o questionário Fantástico, e para a QV, o WHOQOL-bref. A análise estatística foi realizada utilizando-se a Generalized Estimating Equation. Resultados: O escore total do Fantástico e os domínios sono, tipo de comportamento e trabalho/escola reduziram durante o ano, e o domínio atividade aumentou. No WHOQOL-bref, os domínios físico e psicológico foram maiores no início do curso. Na correlação entre os dois instrumentos, quanto melhor o Estilo de Vida, segundo o Fantástico, maior a Qualidade de Vida, segundo os domínios do WHOQOL-bref. Conclusão: Reconhecer o impacto do EV na QV fortalece o desenvolvimento de programas para a promoção do EV saudável e para a prevenção de doenças (AU).

Objective: To evaluate the impact of Lifestyle on the Quality of Life of students while the first year of graduation. Method: Observational research, longitudinal, prospective and quantitative, with undegraduate students of nursing, speech therapy, medicine, Technology in Radiology and Biomedical systems courses. The Fantastic questionnaire was used to assess the Lifestyle, and the WHOQOL-bref was used for the Quality of Life. The stastistic analisys was made by a Generalized Estimating Equation. Results: The total score of Fantastic questionaire and WHOQOL's domains of sleep, type of behavior and work/school decreased during the year, and the activity domain increased. WHOQOL-bref's physical and psycological domains were higher at beginning of the course. Between both instruments, the better the Lifestyle, according to Fantastic, better the quality of life, as maintained by WHOQOL-bref's domains. Conclusion: Recognizing the impact of Lifestyle on Quality of Life strengthens the development of programs to promote a healthy Lifestyle and to prevent diseases (AU).

Objetivo: Evaluar el impacto del Estilo de Vida (EV) en la Calidad de Vida (CV) de estudiantes universitarios. Método: Investigación observacional, longitudinal, prospectiva y cuantitativa, con estudiantes de las carreras de Enfermería, Fonoaudiología, Medicina, Tecnología Radiológica y Sistemas Biomédicos. Se utilizó el cuestionario Fantástico para evaluar la EV y el WHOQOL-bref para la CV. El análisis estadístico se realizó utilizando la Ecuación de Estimación Generalizada. Resultados: La puntuación total de Fantástico y los dominios sueño, tipo de conducta y trabajo/escuela disminuyeron durante el año, y aumentó el dominio actividad. En el WHOQOL-bref, los dominios físico y psicológico fueron más altos al inicio del curso. En la correlación entre los dos instrumentos, a mejor Estilo de Vida, según Fantástico, mayor Calidad de Vida, según los dominios del WHOQOL-bref. Conclusión: reconocer el impacto de la EV en la calidad de vida fortalece el desarrollo de programas para promover la EV saludable y prevenir enfermedades (AU).

Profile of T and B lymphocytes in individuals resistant to Schistosoma mansoni infection.

The mechanisms involved in the development of resistance to infection/reinfection by Schistosoma mansoni still arouse great interest and controversy. Some authors demonstrate that resistance to infection is attributed to a mixed Th1 and Th2 response and resistance to reinfection after repeated treatments through mechanisms associated with the Th2 response. Through flow cytometry, the phenotypic characterization of B and T lymphocytes in individuals residing in endemic areas with low parasite loads over 10 years was evaluated for the first time in humans. In this study, individuals with low parasite loads for Schistosoma mansoni had a higher proportion of Th1 and Th2 cells. In addition, lymphocytes from these individuals showed a higher degree of expression of costimulatory molecules CD28 and CTLA-4 and regulatory molecules FoxP3 and IL-10, when compared to individuals with high parasite loads. Our data indicate that the control of the parasite load of S. mansoni must be associated with a Th1, Th2, and regulatory response, and that further studies are needed to elucidate the possibility of mechanisms associated with the hyporesponsiveness of lymphocytes from individuals with high parasite loads.

Phenotypic Characterization of CD4+ T Lymphocytes in Periportal Fibrosis Secondary to Schistosomiasis.

Schistosomiasis is a parasitic disease that affects about 166 million people around the world. It is estimated that 5%-10% of individuals with schistosomiasis develop severe forms of the disease, which are characterized by pulmonary hypertension, ascites, periportal fibrosis, and other significant complications. The chronic phase of the disease is associated with a Th2 type immune response, but evidence also suggests there are roles for Th1 and Th17 in the development of severe disease. The aim of this study was to evaluate the CD4+ T lymphocyte profile of patients with different degrees of periportal fibrosis secondary to schistosomiasis. These individuals had been treated for schistosomiasis, but since they live in a S. mansoni endemic area, they are at risk of reinfection. They were evaluated in relation to the degree of periportal fibrosis and classified into three groups: without fibrosis or with incipient fibrosis (WF/IFNE), n=12, possible periportal fibrosis/periportal fibrosis, n=13, and advanced periportal fibrosis/advanced periportal fibrosis with portal hypertension, n=4. We observed in the group without fibrosis a balance between the low expression of Th2 cytokines and high expression of T reg cells. As has already been described in the literature, we found an increase of the Th2 cytokines IL-4, IL-5, and IL-13 in the group with periportal fibrosis. In addition, this group showed higher expression of IL-17 and IL-10 but lower IL-10/IL-13 ratio than patients in the WF/IFNE group. Cells from individuals who present any level of fibrosis expressed more TGF-ß compared to the WF/IFNE group and a positive correlation with left lobe enlargement and portal vein wall thickness. There was a negative correlation between IL-17 and the thickness of the portal vein wall, but more studies are necessary in order to explore the possible protective role of this cytokine. Despite the fibrosis group having presented a higher expression of pro-fibrotic molecules compared to WF/IFNE patients, it seems there is a regulation through IL-10 and T reg cells that is able to maintain the low morbidity of this group.

Adesão ao tratamento medicamentoso em idosos cardiopatas / Adherencia al tratamiento farmacológico en ancianos con enfermedad cardíaca / Adherence to drug treatment in elderly with heart conditions

Objetivo: Avaliar a adesão ao tratamento medicamentoso em idosos cardiopatas. Método: Pesquisa de campo, descritiva e quantitativa. Consentiram em participar da pesquisa 40 idosos atendidos em um Ambulatório de Cardiogeriatria. A coleta de dados ocorreu de agosto a novembro de 2018, com dados sociodemográficos e clínicos, Avaliação Multidimensional da Pessoa Idosa à avaliação da adesão ao tratamento pelo Brief Medication Questionnaire. Resultados: A idade média foi de 74+9,9 anos do sexo feminino em 57,7% dos idosos. Segundo o BMQ, 90% dos idosos apresentaram algum tipo de barreira para a adesão ao tratamento medicamentoso; 66,7% apresentaram barreiras de 'Regime', 10,2% de 'Crenças' e 89,5% de 'Recordação'. Conclusão: Na avaliação da adesão ao tratamento, segundo o BMQ, as barreiras mais frequentes foram as de 'Recordação', seguidas de 'Regime' e de 'Crenças'. A frequência dos idosos com barreira de 'Recordação' foi maior entre os que utilizavam cinco ou mais medicamentos diários(AU)

Purpose: To evaluate adherence to a drug treatment in elderly patients with heart diseases. Method: This is a descriptive, quantitative field research. Forty elderly people assisted in a Cardiogeriatrics Clinic consented to participate in the research. Data collection took place from August to November 2018 and comprised sociodemographic and clinical data, Multidimensional Assessment of the Elderly, and the assessment of adherence to treatment by the Brief Medication Questionnaire. Results: The mean age was 74 ± 9.9 years and 57.7% of the elderly were women. According to the BMQ, 90% of the elderly had some type of resistance to adhering to drug treatment; 66.7% were due to 'Regime', 10.2% due to 'Beliefs' and 89.5% due to 'Recollection'. Conclusion: In assessing adherence to treatment according to the BMQ, the most frequent reasons against adherence were 'Recollection', followed by 'Regime' and 'Beliefs'. The frequency of elderly people in the "Recollection" group was higher among those who took five or more medications per day.(AU)

Objetivo: Evaluar la adherencia al tratamiento farmacológico en pacientes ancianos con cardiopatía. Método: Investigación de campo, descriptiva y cuantitativa. Cuarenta ancianos atendidos en una Clínica de Cardiogeriatría dieron su consentimiento para participar en la investigación. La recolección de datos se realizó de agosto a noviembre de 2018, con datos sociodemográficos y clínicos, Evaluación Multidimensional del Anciano y la evaluación de la adherencia al tratamiento mediante el Cuestionario Breve de Medicación. Resultados: La edad media fue de 74 + 9,9 años y el 57,7% de los ancianos eran mujeres. Según el BMQ, el 90% de los ancianos tenía algún tipo de barrera para la adherencia al tratamiento farmacológico; El 66,7% tenía barreras de "Régimen", el 10,2% de "Creencias" y el 89,5% de "Recuerdo". Conclusión: Al evaluar la adherencia al tratamiento según BMQ, las barreras más frecuentes fueron las de 'Recuerdo', seguidas de 'Régimen' y 'Creencias'. La frecuencia de las personas mayores con una barrera de "recuperación" fue mayor entre los que usaban cinco o más medicamentos al día(AU)

Atitudes de enfermeiros na administração de quimioterápicos em oncologia pediátrica / Nurses' attitudes in the administration of chemotherapy in pediatric oncology / Actitudes de enfermeros en la administración de quimioterápicos en oncología pediátrica

Objetivo: analisar as atitudes de enfermeiros acerca da administração de antineoplásicos em oncologia pediátrica. Método: estudo descritivo, com análise estatística dos dados. Participaram 20 enfermeiros de um hospital de ensino, localizado na capital paulista, que administravam quimioterapia (QT) a crianças e adolescentes. Em 2016, mediante questionário autoaplicável, foram coletados dados de caracterização dos participantes e sobre suas atividades profissionais na administração de QT, que incluíam principais receios e preocupações, além dos potenciais eventos adversos associados à quimioterapia. Resultados: poucos participantes eram especialistas na área de oncologia ou pediatria; a maioria dos profissionais buscou conhecimento e capacitação por iniciativa própria; os enfermeiros classificaram a atividade como complexa e específica para quem possui interesse na área. Conclusão: todos os enfermeiros consideraram a QT o principal tratamento para o câncer infanto-juvenil. O risco de extravasamento e a falta de dispositivos adequados para administração das drogas foram os fatores que mais preocuparam os participantes.

Objective: to examine nurses' attitudes to the administration of antineoplastics in pediatric oncology. Method: this descriptive study used statistical data analysis. The participants were twenty nurses, who administered chemotherapy to children and adolescents at a teaching hospital in São Paulo City. In 2016, data were collected using a self-report questionnaire on the participants' characteristics and their experience with chemotherapy administration, which included the main chemotherapyrelated fears, concerns and potential adverse events. Results: few participants were specialists in the field of oncology or pediatrics; most sought knowledge and capacity-building on their own initiative; and the nurses classified the activity as complex and specific to those with an interest in the field. Conclusion: all the nurses considered chemotherapy the main treatment for childhood cancer. The factors that most concerned the participants were the risk of extravasation and the lack of appropriate devices for drug administration.

Objetivo: analizar las actitudes de enfermeros acerca de la administración de antineoplásicos en oncología pediátrica. Método: estudio descriptivo, con análisis estadística de los datos. Participaron 20 enfermeros de un hospital de enseñanza, ubicado en la capital de São Paulo, que administraban quimioterapia (QT) a niños y adolescentes. En 2016, a través de cuestionario autoaplicable, se recopilaron datos sobre la caracterización de los participantes y sobre sus actividades profesionales en la administración de quimioterapia que incluían los principales temores, preocupaciones y potenciales eventos adversos asociados a la quimioterapia. Resultados: pocos participantes eran especialistas en el área de oncología o pediatría; la mayoría de los profesionales buscó conocimiento y capacitación por iniciativa propia; los enfermeros clasificaron la actividad como compleja y específica para quien tiene interés en el área. Conclusión: todos los enfermeros consideraron la quimioterapia como el tratamiento principal para el cáncer infantil. El riesgo de extravasación y la falta de dispositivos adecuados para la administración de las drogas fueron los factores que más preocuparon a los participantes.

Characterization of memory T cells in individuals resistant to Schistosoma mansoni infection.

Schistosomiasis affects about 240 million people worldwide and is estimated that about 700 million people live in areas at risk of infection. In the context of immune response associated with infection by Schistosoma mansoni, the role of memory T cells is not well understood. AIM: To evaluate the frequency of memory CD4+ and CD8+ T cells from individuals resistant and susceptible to Schistosoma mansoni infection. METHODS AND RESULTS: We selected individuals with low (resistant) and high (susceptible) parasite burden using databases generated during previous studies carried out in the same endemic area. The cell surface markers were performed using flow cytometry. In this study, the resistant individuals showed an increase in the CD4+ memory T-cell pool associated with an increase in the central memory cell (TCM) and a decrease in the effector memory cell (TEM ). Individuals susceptible to infection had higher frequencies of effector memory cells compared to resistant individuals. CONCLUSIONS: These data suggest that resistance to S mansoni infection may be associated with an increase in the number of CD4+ memory T cells and susceptibility to infection is associated with a decrease in the central memory cell as well as high proportions of effector memory cells.

Helminths and Asthma: Risk and Protection.

Helminth infections may inhibit the development of allergic diseases, including asthma. On the other hand, some helminth species may induce or worsen symptoms of asthma. This article discusses the impact of helminth infections on asthma as well as the potencial of helminth-derived molecules with regulatory characteristics in the prevention or treatment of this disease. The ability to induce regulation has been observed in animal models of asthma or cells of asthmatic individuals in vitro. Potential future clinical applications of helminth antigens or infection for prevention of asthma merit further translational research.

Immune response markers in sera of children infected with Giardia duodenalis AI and AII subassemblages.

In this study, we evaluated serum markers of immune responses in children infected with G. duodenalis and compared them with the characterized parasite isolates. The reactivity indexes (RI) of IgG (1.503 ± 0.819) and IgA (2.308 ± 1.935) antibodies were significantly higher (P < 0.001) in infected children than in non-infected children. There were also statistically significantly higher serum levels (P < 0.05) of IFN-γ (393.10 ± 983.90 pg/mL) as well as serum (30.03 ± 10.92 µmol/L) and saliva nitric oxid derivatives (NOx) (192.4 ± 151.2 µmol/L) in children infected with G. duodenalis compared to the group of non-parasitized children (127.4 ± 274.30 pg/mL; 25.82 ± 7.74 µmol/L and 122.5 ± 105.90 µmol/L, respectively). Regarding the characterized genetic variants of G. duodenalis and the immune response profiles, no differences were observed in terms of antibody reactivity or levels of serum cytokine and NOx among children infected with AI or AII subassemblages. The elevated levels of IFN-γ and NOx indicate that G. duodenalis intestinal infection in humans induces a cellular immune response detectable at the systemic level. Moreover, no significant differences in the antibody reactivity profile or the cytokine and NOx production in the sera of children infected with AI or AII G. duodenalis variants were observed, suggesting that subtypes of the parasite do not influence the immune response profile.

Using bioelectrical impedance analysis to compare the treatment of edema with the Unna's boot and noncompression in individuals with venous ulcers.

Venous insufficiency is related to aging. Edema, pathological evolution of venous insufficiency, favors the appearance of venous ulcers as the main complication. Leg ulcers can be treated with compression, the Unna's boot being one of them, and noncompression therapies (conventional dressing). Bioelectrical impedance analysis accurately measures the patient's body fluids. The objective of this study was to evaluate the edema evolution of the venous ulcer-affected lower limb by means of electric bioimpedance with the use of Unna's boot and noncompressive dressing. Fifteen legs with active ulcers were treated from September 2014 to December 2016. The legs were treated with Unna's boot and noncompression therapies on different days with randomized order of events. Bioimpedance was performed in the morning and afternoon to evaluate the increase in edema over the day. All patients were female with ages ranging from 50 to 76 years (mean age: 63 years). According to bioimpedance, the volume of the legs increased with both types of therapy. However, compression therapy was significantly more effective than noncompression therapy. Bioimpedance confirmed that compression therapy (Unna's boot) gives better results than noncompression therapy in relation to the formation of edema over a day in patients with chronic venous ulcers.

Impaired immunoregulatory network of the CD4 T lymphocytes in refractory asthma.

BACKGROUND: The immunopathogenesis of severe asthma has been associated with an inefficient regulatory response. There are a few studies about the CD4 T cells profile among individuals with severe asthma refractory to treatment. OBJECTIVE: To evaluate the CD4 T lymphocyte profile from individuals with severe asthma according to their response to treatment, relating to their atopy status and age of asthma onset. METHODS: We evaluated nineteen individuals with severe asthma refractory to treatment (SAR), 21 with well-controlled or partly controlled severe asthma (CSA) and 23 with mild-to-moderate asthma (MMA). Lymphocytes were obtained from PBMC, and the frequency of expression of different molecules in this population was assessed using the flow cytometry. RESULTS: We observed the frequency of CD4+ IFN-γ+ T cells was higher in atopic individuals with SAR than with CSA. In addition, among the atopic and early-onset asthma (EOA), the frequency of CD4+ CTLA-4+ T cells was lower in the SAR group than the CSA group. In relation to non-atopic and late-onset asthma (LOA) phenotypes, we noted the frequency of CD4+ FoxP3+ T cells was lower in individuals with SAR than with CSA. We also observed among the LOA patients, the frequency of CD4+ TGF-ß+ T cells was decreased in SAR group than the in CSA group. CONCLUSION AND CLINICAL RELEVANCE: Our data suggest that refractoriness to treatment in asthma is associated with a lower expression of distinct regulatory molecules by CD4 T cells between those who are atopic and have EOA and those who are non-atopic and have LOA. Thus, these results may contribute to the identification of new regulatory strategies to treat asthma according to their phenotypes.

Compression therapy: Unna boot applied to venous injuries: an integrative review of the literature. / Terapia compressiva: bota de Unna aplicada a lesões venosas: uma revisão integrativa da literatura.

OBJECTIVE: To analyze the literature related to the types of therapies for venous injuries with emphasis on use of the Unna boot, and to investigate and discuss the main aspects related to its use compared to other techniques. METHOD: Integrative review of the literature of the last five years through searches in the following databases: VHL, LILACS, BDENF, SciELO, MEDLINE/PubMed. RESULTS: Twenty-two publications were identified, with 15,931 cases among adult or elderly individuals, whose mean age was 60 (35-78) years or greater with no sex differences. The Unna boot presented a shorter healing time than the single and two-layer elastic bandage. CONCLUSION: Although other compression techniques may prove to be more efficient than the Unna boot by adding more technology, the boot stands out as a traditional low-cost dressing. Multilayer bandage is a gold standard technique. This review demonstrated the best option may not be the Unna boot, because it requires a higher healing time compared to the multilayer bandage, but it meets the expectation with a high rate of treatment efficiency, also when compared to simple dressing, single or two-layer bandage.

Percepção dos profissionais de saúde mental sobre maconha / The perception of mental health professionals about marijuana

RESUMO Objetivo A percepção sobre a maconha entre profissionais de saúde mental é desconhecida no Brasil. Este estudo teve como objetivo comparar padrões de percepções e de conhecimento sobre maconha entre profissionais da área da saúde mental em três instituições de diferentes perfis. Métodos Setenta profissionais (psiquiatras, psicólogos, assistentes sociais, terapeutas ocupacionais e enfermeiros) de três serviços da área de saúde mental - Hospital Nossa Senhora de Fátima (hospital filantrópico), CAPS-AD (Serviço público especializado no atendimento de álcool e drogas) e Instituto de Psiquiatria do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (Serviço acadêmico e assistencial) - foram avaliados por meio de um questionário elaborado pelos pesquisadores, composto de 31 afirmativas. Resultados Psiquiatras tendem a discordar mais que os outros profissionais quanto à necessidade de tratamento para o uso de maconha e que a maconha traz prejuízos cognitivos. Os profissionais do Hospital Nossa Senhora de Fátima apresentaram percepção mais favorável à proibição de maconha e valorizaram mais os possíveis prejuízos associados ao uso quando comparados aos profissionais das outras duas instituições. Conclusões A percepção sobre a maconha entre servidores da saúde mental varia de acordo com a profissão e o local de trabalho.

ABSTRACT Objective The perception of marijuana among mental health professionals is unknown in Brazil. The aim of this study was to compare mental health professionals' perception and knowledge standards about marijuana in three institutions with different profiles. Methods Seventy professionals (psychiatrists, psychologists, social workers, occupational therapists and nurses) from three mental health services - Nossa Senhora de Fátima Hospital (philanthropic hospital), CAPS-AD (public specialized service on treating drugs and alcohol dependents), and the Institute of Psychiatry at the Clinics Hospital, Medical School, University of São Paulo (academic and assistance service) were evaluated through a 31 affirmatives questionnaire created by researchers. Results Psychiatrists disagree more often than other health professionals on the need to treat marijuana users and on the idea that it causes cognitive damages. The professionals from Nossa Senhora de Fátima Hospital are more in favor of the prohibition of marijuana use and consider more the possible damages associated with its use, when compared to professionals from the other two institutions. Conclusions The perception of marijuana among mental health providers may vary according to their profession and work place.

Local and systemic production of proinflammatory chemokines in the pathogenesis of HAM/TSP.

BACKGROUND: HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is related with high proviral load, high proinflammatory cytokine levels, and passage of infected cell from the blood to the central nervous system. We aimed to evaluate the participation of chemokines and adhesion molecules in HAM/TSP pathogenesis. METHODS: CXCL9, CXCL10, sICAM-1, and sVCAM-1 were determined by ELISA in serum and cerebrospinal fluid (CSF) of HTLV-1 infected individuals. The frequency and median fluorescence intensity (MFI) of lymphocytes and monocytes expressing ligands of adhesion molecules (CD11a and CD49d) and a chemokine receptor (CXCR3) were analyzed by flow cytometry. RESULTS: The levels of CXCL9 and CXCL10 in serum of definite HAM/TSP were higher than in serum of probable HAM/TSP and HTLV-1 carriers. Considering the production of chemokines by patients with definite HAM/TSP, CXCL9 levels were higher in serum than in CSF, and CXCL10 production was higher in CSF than in serum. Levels of adhesion molecules in serum and CSF of HTLV-1 infected individuals did not differ. The MFI of CD11a on CD4+, CD8+ and CD14+ cells was lower in definite HAM/TSP than in HTLV-1 carriers and did not differ from probable HAM/TSP and healthy subjects (HS). The frequency of lymphocytes expressing CXCR3 was lower in definite HAM/TSP than in cells of probable HAM/TSP and did not differ from carrier and HS. CONCLUSION: These data point to the participation of proinflammatory chemokines, especially CXCL10, in the pathogenesis of definite HAM/TSP.

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings.

OBJECTIVE: To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database. RESULTS: The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9-60.5%) followed by that in men (52.9%; 95% CI 52.6-53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5-62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.

Susceptibility of dendritic cells from individuals with schistosomiasis to infection by Leishmania braziliensis.

Coinfection with leishmaniasis and schistosomiasis has been associated with increased time to healing of cutaneous lesions of leishmaniasis. The objective of this study was to evaluate the effect of Leishmania braziliensis infection on co-cultures of monocyte-derived dendritic cells (MoDCs) with autologous lymphocytes from patients with schistosomiasis and patients with cutaneous leishmaniasis. MoDCs were differentiated from peripheral blood monocytes, isolated by magnetic beads, infected with L. braziliensis, and co-cultured with autologous lymphocytes. Expression of HLA-DR, CD1a, CD83, CD80, CD86, CD40, and the IL-10 receptor (IL-10R) on MoDCs as well as CD28, CD40L, CD25, and CTLA-4 on lymphocytes were evaluated by flow cytometry. The production of the cytokines IL-10, TNF, IL-12p40, and IFN-γ were evaluated by sandwich ELISA of the culture supernatant. The infectivity evaluation was performed by light microscopy after concentration of cells by cytospin and Giemsa staining. It was observed that the frequency of MoDCs expressing CD83, CD80, and CD86 as well as the MFI of HLA-DR were smaller in the group of patients with schistosomiasis compared to the group of patients with leishmaniasis. On the other hand, the frequency of IL-10R on MoDCs was higher in patients with schistosomiasis than in patients with leishmaniasis. CD4+ and CD8+ T lymphocytes from patients with schistosomiasis presented a lower frequency of CD28 and a higher frequency of CTLA-4 compared to lymphocytes from patients with leishmaniasis. Levels of IL-10 were higher in the supernatants of co-cultures from individuals with schistosomiasis compared to those with leishmaniasis. However, levels of TNF, IL-12p40, and IFN-γ were lower in the group of individuals with schistosomiasis. Regarding the frequency of MoDCs infected by L. braziliensis after 72h in culture, it was observed that higher frequencies of cells from patients with schistosomiasis were infected compared to cells from patients with leishmaniasis. It was concluded that MoDCs from patients with schistosomiasis are more likely to be infected by L. braziliensis, possibly due to a lower degree of activation and a regulatory profile.