Leishmanicidal activity and 4D quantitative structure-activity relationship and molecular docking studies of vanillin-containing 1,2,3-triazole derivatives.

Aim: The assessment of the antileishmanial potential of 22 vanillin-containing 1,2,3-triazole derivatives against Leishmania braziliensis is reported. Materials & methods: Initial screening was performed against the parasite promastigote form. The most active compound, 4b, targeted parasites within amastigotes (IC50 = 4.2 ± 1.0 µmol l-1), presenting low cytotoxicity and a selective index value of 39. 4D quantitative structure-activity relationship and molecular docking studies provided insights into structure-activity and biological effects. Conclusion: A vanillin derivative with significant antileishmanial activity was identified. Enhanced activity was linked to increased electrostatic and Van der Waals interactions near the benzyl ring of the derivatives. Molecular docking indicated the inhibition of the Leishmania amazonensis sterol 14α-demethylase, using Leishmania infantum sterol 14α-demethylase as a model, without affecting the human isoform. Inhibition was active site competition with lanosterol.

Uncovering the wide protective responses in Coffea spp. leaves to single and superimposed exposure of warming and severe water deficit.

Climate changes boosted the frequency and severity of drought and heat events, with aggravated when these stresses occur simultaneously, turning crucial to unveil the plant response mechanisms to such harsh conditions. Therefore, plant responses/resilience to single and combined exposure to severe water deficit (SWD) and heat were assessed in two cultivars of the main coffee-producing species: Coffea arabica cv. Icatu and C. canephora cv. Conilon Clone 153 (CL153). Well-watered plants (WW) were exposed to SWD under an adequate temperature of 25/20°C (day/night), and thereafter submitted to a gradual increase up to 42/30°C, and a 14-d recovery period (Rec14). Greater protective response was found to single SWD than to single 37/28°C and/or 42/30°C (except for HSP70) in both cultivars, but CL153-SWD plants showed the larger variations of leaf thermal imaging crop water stress index (CWSI, 85% rise at 37/28°C) and stomatal conductance index (IG, 66% decline at 25/20°C). Both cultivars revealed great resilience to SWD and/or 37/28°C, but a tolerance limit was surpassed at 42/30°C. Under stress combination, Icatu usually displayed lower impacts on membrane permeability, and PSII function, likely associated with various responses, usually mostly driven by drought (but often kept or even strengthened under SWD and 42/30°C). These included the photoprotective zeaxanthin and lutein, antioxidant enzymes (superoxide dismutase, Cu,Zn-SOD; ascorbate peroxidase, APX), HSP70, arabinose and mannitol (involving de novo sugar synthesis), contributing to constrain lipoperoxidation. Also, only Icatu showed a strong reinforcement of glutathione reductase activity under stress combination. In general, the activities of antioxidative enzymes declined at 42/30°C (except Cu,Zn-SOD in Icatu and CAT in CL153), but HSP70 and raffinose were maintained higher in Icatu, whereas mannitol and arabinose markedly increased in CL153. Overall, a great leaf plasticity was found, especially in Icatu that revealed greater responsiveness of coordinated protection under all experimental conditions, justifying low PIChr and absence of lipoperoxidation increase at 42/30°C. Despite a clear recovery by Rec14, some aftereffects persisted especially in SWD plants (e.g., membranes), relevant in terms of repeated stress exposure and full plant recovery to stresses.

Long-term COVID symptoms, work ability and fitness to work in healthcare workers hospitalized for Sars-CoV-2 infection.

BACKGROUND: COVID-19 can affect the persistence of symptoms and work ability (WA), hence the fitness to work of healthcare workers (HCW). We describe the effects of COVID-19 in hospitalized HCWs of a large Hospital in Lombardy and their implications on WA and fitness to work. METHODS: Fifty-six HCWs of Fatebenefratelli-Sacco Hospital have been hospitalized for COVID-19 since March 2020. Clinical and fitness-to-work data were acquired from Occupational Health Surveillance Program. A structured questionnaire was administered to 53/56 HCWs 18 months after infection to investigate Long-COVID symptoms and WA. RESULTS: Symptoms most reported at recovery (rhino-pharyngeal swab-NPS-negative) were exertional dyspnea (86.8%), asthenia (86.8%), arthro-myalgia (71.7%), sleep disorders (64.2%), resting dyspnea (62.3%), cough (56.6%). 69.6% underwent evaluation at out-patient clinics experienced in Long-COVID. Ten months after recovery, symptoms related to physical well-being decreased while memory and anxiety/depression were more persistent. At recovery, the WA score decreased from 10 to 8, and then an improvement from 8 to 9 was noted during the survey. At the return-to-work examination, fit-to-work judgements with restrictions increased from 31.4% to 58.7%; then, a slight decrease in the rate of judgements with restrictions was observed at the survey's time. CONCLUSION: Post-COVID-19 symptoms can persist for a long time and could impact WA and fitness-to-work of HCW. Adequate health surveillance protocols should guarantee the health protection of HCW with persistent disorders after COVID-19.

Eugenol derivatives with 1,2,3-triazole moieties: Oral treatment of cutaneous leishmaniasis and a quantitative structure-activity relationship model for their leishmanicidal activity.

Leishmaniasis is a group of neglected vector-borne tropical diseases caused by protozoan parasites of the genus Leishmania that multiply within phagocytic cells and have a wide range of clinical manifestations. Cutaneous leishmaniasis (CL) is a serious public health that affects more than 98 countries, putting 350 million people at risk. There are no vaccines that have been proven to prevent CL, and the treatment relies on drugs that often have severe side effects, justifying the search for new antileishmanial treatments. In the present investigation, it is demonstrated that 4-(3-(4-allyl-2-methoxyphenoxy)propyl)-1-(4-methylbenzyl)-1H-1,2,3-triazole (7k) presents significant antileishmanial activity (IC50 of 7.4 µmol L-1 and 1.6 µmol L-1 for promastigote and amastigote forms, respectively), low cytotoxicity against macrophage cells (IC50 of 211.9 µmol L-1), and a selective index of 132.5. Under similar conditions, compound 7k outperformed glucantime and pentamidine, two commonly used drugs in clinics. In vivo assays on CL-infected female BALB/c mice demonstrated that compound 7k had activity similar to intralesional glucantime when administered orally, with decreased lesion and parasitic load, and a low systemic toxic effect. Given the importance of understanding the relationship between compound structure and biological activity in the research and development of new drugs, the development of a quantitative structure-activity relationship (QSAR) model for the leishmanicidal activity presented by the eugenol derivatives with 1,2,3-triazole functionalities is also described herein. This study demonstrates the therapeutic potential of orally active eugenol derivatives against CL and provides useful insights into the relationship between the chemical structures of triazolic eugenol derivatives and their biological profile.

Synergistic effects of climate and landscape change on the conservation of Amazonian lizards.

The leading causes of the worldwide decline in biodiversity are global warming, allied with natural habitat loss and fragmentation. Here, we propose an analysis of the synergistic effects of these two factors in 63 species of Amazonian lizards. We predicted that the high-climatic suitability areas of species would be significantly impacted by different deforestation scenarios and the resultant landscape structure and considered that forest-dwelling species would be especially susceptible to deforestation scenarios. We also pointed out species threatened by both drivers and suggested critical areas for their future conservation. According to our results, most species will face future reductions in suitable areas for their occurrence according to five different patterns, two of which represent significant risks for 15 species. Some of these species already deal with severe habitat loss and fragmentation of their current distribution ranges, whereas others will suffer a considerable area reduction related to future range shifts. We emphasize the importance of protected areas (PAs), especially indigenous lands, and the need to plan combined strategies involving PAs' maintenance and possible implementation of ecological corridors. Finally, we highlight eight species of thermoconformer lizards that constitute present and future conservation concerns related to the combined effects of climate change and habitat loss and that should be carefully evaluated in extinction risk assessments.

COVID-19 impact and vaccine effectiveness among healthcare workers of a large University Hospital in Lombardy, Italy.

BACKGROUND: Healthcare Workers (HCWs) are a key element in managing the COVID-19 pandemic, but they are also at high risk of infection. OBJECTIVE: The aim of this study was to describe, in a large university hospital which provided healthcare services to patients with SARS-CoV-2 infection, the course of the epidemic among HCWs and effectiveness of COVID-19 vaccination in reducing SARS-CoV-2 infection and disease. METHODS: Our case series included all "Fatebenefratelli Sacco" University Hospital workers. Data were collected until the 15th of May 2021 and analysed as part of the health surveillance program carried out by the Occupational Health Unit. RESULTS: From March 2020 until May 2021, 14.4% of workers contracted COVID-19, with the highest incidence peak recorded during the second wave of the pandemic. The prevalence of infection was slightly higher in males than in females, and a greater number of cases was found in job categories characterized by direct patient care activities. We reported a higher prevalence of "serious/critical illness" in elder workers. A clear reduction of COVID-19 incidence was found in our population during the third pandemic wave, that coincided with the start of vaccination campaign. DISCUSSION: HCWs have been at high risk of COVID-19 infection. Male sex and advanced age appear to be predisposing factor and negative prognostic factor respectively. An out-of-hospital setting appears to be the main source of COVID-19 confirming that the correct use of protective devices during work counters the risk of infection. Vaccination seems to reduce both documented cases of infection and severe illness.

Endogenous galectin-3 is required for skeletal muscle repair.

Skeletal muscle has the intrinsic ability to self-repair through a multifactorial process, but many aspects of its cellular and molecular mechanisms are not fully understood. There is increasing evidence that some members of the mammalian ß-galactoside-binding protein family (galectins) are involved in the muscular repair process (MRP), including galectin-3 (Gal-3). However, there are many questions about the role of this protein on muscle self-repair. Here, we demonstrate that endogenous Gal-3 is required for: (i) muscle repair in vivo by using a chloride-barium myolesion mouse model and (ii) mouse primary myoblasts myogenic programming. Injured muscle from Gal-3 knockout mice (GAL3KO) showed persistent inflammation associated with compromised muscle repair and the formation of fibrotic tissue on the lesion site. In GAL3KO mice, osteopontin expression remained high even after 7 and 14 d of the myolesion, while Myoblast differentiation transcription factor (MyoD) and myogenin had decreased their expression. In GAL3KO mouse primary myoblast cell culture, Paired Box 7 (Pax7) detection seems to sustain even when cells are stimulated to differentiation and MyoD expression is drastically reduced. The detection and temporal expression levels of these transcriptional factors appear to be altered in Gal-3-deficient myoblast. Gal-3 expression in wild-type mice for GAL3KO states, both in vivo and in vitro, in sarcoplasm/cytoplasm and myonuclei; as differentiation proceeds, Gal-3 expression is drastically reduced, and its location is confined to the sarcolemma/plasma cell membrane. We also observed a change in the temporal-spatial profile of Gal-3 expression and muscle transcription factors levels during the myolesion. Overall, these results demonstrate that endogenous Gal-3 is required for the skeletal muscle repair process.

Violência obstétrica: experiência da equipe multidisciplinar em saúde / Obstetric violence: experience of a multidisciplinary health team / Violencia obstétrica: experiencia de un equipo multidisciplinario de Salud

Objetivo: Descrever a compreensão, a experiência e as proposições da equipe multidisciplinar em saúde em relação à violência obstétrica. Método: Estudo qualitativo, descritivo, desenvolvido em maternidade pública do interior paulista. Entrevistaram-se 43 participantes profissionais de diversas categorias. Coleta de dados realizada por meio de entrevista semiestruturada. Dados analisados e fundamentados na Análise de Conteúdo de Bardin, modalidade temática. Resultados: Emergiram a partir das falas transcritas as categorias: 1 ­ Desconhecimento da violência obstétrica; 2 - Relato sobre violência obstétrica; 3 - Práticas de violência obstétrica; 4 - Necessidade de capacitações sobre violência obstétrica; 5 - Necessidade da inserção de enfermeiras obstetras; 6 ­ Necessidade de reestruturação física e inserção de quarto para Pré-parto, Parto e Pós-parto (PPP). Conclusão: Alguns participantes demonstraram desconhecimento sobre o tema. Ressalta-se a importância do conhecimento da equipe de saúde sobre a violência obstétrica, para que possam identificar, intervir e prestar assistência humanizada. A violência obstétrica é favorecida por falta de reestruturação do ambiente e de materiais, escassez de recursos humanos e sobrecarga de trabalho dos profissionais envolvidos. Considera-se oportuna a promoção de capacitações que aproximem os profissionais de saúde de condutas baseadas em evidências científicas.(AU)

Objective: To describe a multidisciplinary health team's understanding, experience, and propositions regarding obstetric violence. Method: A qualitative, descriptive study was carried out in a public maternity hospital in the countryside of São Paulo. Forty-three professionals from different categories were interviewed. Data collection was performed through semi-structured interviews. The data analysis was based on Bardin's Content Analysis framework. Results: From the transcribed speeches, the following categories emerged: 1 ­ Unfamiliarity with obstetric violence; 2 - Obstetric violence reports; 3 - Obstetric violence practices; 4 -Need for training on obstetric violence; 5 - Need for insertion of obstetric nurses; 6 ­ Need for physical restructuring and insertion of prepartum, delivery, and postpartum (PDP) rooms. Conclusion: Some participants demonstrated ignorance about the topic. The importance of the health team's knowledge about obstetric violence is highlighted to identify, intervene, and provide humanized care. Obstetric violence is favored by the lack of restructuring of the environment and materials, shortage of human resources, and work overload of professionals. It is considered opportune to promote training to help health professionals adopt evidence-based conducts.(AU)

Objetivo: Describir el entendimiento, la experiencia y las propuestas de un equipo de salud multidisciplinario sobre la violencia obstétrica. Método: Se realizó un estudio descriptivo cualitativo en una maternidad pública del interior de São Paulo. Se entrevistó a 43 profesionales de diferentes categorías. La recolección de datos se realizó mediante entrevistas semiestructuradas. El análisis de datos se basó en el marco de análisis de contenido de Bardin. Resultados: De los discursos transcritos surgieron las siguientes categorías: 1 - Desconocimiento de la violencia obstétrica; 2 - Informes de violencia obstétrica; 3 - Prácticas de violencia obstétrica; 4 -Necesidad de formación sobre violencia obstétrica; 5 - Necesidad de inserción de enfermeras obstétricas; 6 - Necesidad de reestructuración física e inserción de salas de preparto, parto y posparto (PPP). Conclusión: Algunos participantes demostraron desconocimiento sobre el tema. Se destaca la importancia del conocimiento del equipo de salud sobre la violencia obstétrica, para que pueda identificar, intervenir y brindar atención humanizada. La violencia obstétrica se ve favorecida por la falta de reestructuración del entorno y materiales, escasez de recursos humanos y sobrecarga de trabajo de los profesionales. Se considera oportuno promover la formación para ayudar a los profesionales de salud a adoptar conductas basadas en evidencia.(AU)

Effect of glucocorticoids on glyceroneogenesis in adipose tissue: A systematic review.

Glyceroneogenesis is important for the maintenance of fat content in white adipose tissue (WAT). An increase in WAT, and especially the pattern of fat distribution, specifically in visceral depots, potentially contributes to cardiovascular and metabolic diseases, such as type 2 diabetes mellitus, myocardial infarction and hypertension. Recent studies have shown important differences in glyceroneogenesis of different fat sites under the administration of glucocorticoids (GCs). Such differences need to be analysed with criteria evidencing the parameter studied, the type of corticoid, the form of administration and also the tissue studied. PubMed, Scopus and Virtual Health Library were used to search for articles that analysed the effect of GCs on glyceroneogenesis in different sites of adipose tissue in mammals and primary cultures. GCs decrease the glyceroneogenesis in epididymal WAT (EWAT) and also decrease the expression of the mRNA, content and activity of phosphoenolpyruvate carboxykinase (PEPCK-C), key enzyme of glyceroneogenesis. However, in retroperitoneal WAT (RWAT), although there is no consensus about the effect of GCs on PEPCK mRNA, GCs increase PEPCK-C activity and glyceroneogenesis flux. In inguinal WAT (IWAT) an in vitro study showed an increase in the PEPCK mRNA induced by dexamethasone. However, prednisolone does not change glyceroneogenesis flux. In interscapular brown adipose tissue (IBAT) prednisolone or dexamethasone does not change PEPCK-C activity in control diet-fed rats but led to a decrease in PEPCK-C activity in fasted- or high-fat/low-carbohydrate diet-fed rats, as well as in suckling rats. Despite that fact that GCs have different potencies, the same dose of dexamethasone reduces PEPCK-C activity in EWAT, but not in RWAT and IBAT from control-diet fed rats. In summary, the data presented in this article show that GCs differentially regulate glyceroneogenesis in different sites of adipose tissue. Further experiments are needed to firmly establish our hypothesis and clarify the mechanisms involved.

Problem-Based Learning in a Medical School: Implementations Challenges / Aprendizagem Baseada em Problemas em um Curso de Medicina: Desafios na sua Implementação

Abstract: Introduction: Considering an integrated curriculum that is guided by dialogical competence according to the National Curriculum Guidelines, the Systematized Educational Unit (UES) and the Professional Practice Unit (UPP) constitutes the curriculum of a medical course in a municipality in the countryside of the state of São Paulo, Brazil. Problem-Based Learning (PBL) is used in the UES and the problematization is used in the Professional Practice Unit as teaching methodologies, seeking an organization that leads to a training that is coherent with the public health sector and the national education scenario. The UES is the focus of this study because we observed that there are divergences among teachers regarding their role as tutors. Thus, we observed that the teaching methodology currently employed at Famema led us to some questions: Do the teachers consider themselves qualified to work with the PBL method? How do evaluations contribute to the teaching-learning process? Thus, this study aimed to analyze the teachers' understanding of their ability to work with the PBL and the relevance of evaluations for the teaching-learning process in the UES. Method: This is an exploratory-descriptive study with a qualitative approach. Data collection was carried out using a semi-structured interview with teachers who work with the 1st to 4th years in the UES of the medical course, and the selection of the participants was carried out from a non-probabilistic sample of intention, totaling 16 teachers, including four teachers of each of the first four years of the course. The analysis of the data was performed by Content Analysis in the thematic modality, which allowed the definition of two thematic axes: Challenges for teacher training and Potentials and limits of the implemented evaluation process. Results: The trajectory of the PBL in the teaching-learning process from the point of view of teachers showed us a variety of understandings. As for teacher training, weaknesses were identified in the development of the tutoring process, and that the strategies used for training need to be reviewed regarding their implementation and the inclusion of the professionals into the process. Regarding the evaluation, it was observed that the teachers demonstrate difficulties in carrying out an evaluation of the students while integrating the affective, cognitive and psychomotor dimensions. Conclusion: Therefore, regardless the time of the curriculum implementation, Permanent Education should constitute a powerful space for teacher training and process management.

Resumo: Introdução: Considerando um currículo integrado e orientado por competência dialógica de acordo com o exposto nas Diretrizes Curriculares Nacionais, a Unidade Educacional Sistematizada (UES) e a Unidade de Prática Profissional (UPP) compõem o currículo de um curso de Medicina de um município do interior paulista. Utilizam-se a Aprendizagem Baseada em Problemas (ABP) na UES e a problematização na UPP como metodologias de ensino, com o objetivo de buscar uma organização que conduza a uma formação coerente com o setor de saúde pública e o cenário de educação nacional. A UES é o foco deste estudo, pois notamos que há divergências entre os docentes sobre o papel do tutor. Com base nisso, a metodologia de ensino vigente na Faculdade de Medicina de Marília (Famema) nos levou aos seguintes questionamentos: "O professor se considera capacitado para atuar no método ABP?" e "De que forma as avaliações contribuem com o processo de ensino-aprendizagem?". Assim, este trabalho teve por objetivo analisar a compreensão do docente acerca de sua capacitação para atuar na ABP e da pertinência das avaliações no processo ensino-aprendizagem na UES. Método: Trata-se de estudo do tipo exploratório-descritivo com abordagem de natureza qualitativa. A coleta de dados se deu pela realização de entrevista semiestruturada com professores que desenvolvem atividades na UES do primeiro ao quarto ano do curso de Medicina, selecionaram-se os participantes a partir de uma amostra não probabilística de intenção, totalizando 16 professores, sendo quatro de cada um dos quatro primeiros anos do curso.No exame dos dados, adotou-se a análise de conteúdo na modalidade temática que permitiu a definição de dois eixos temáticos: desafios para a formação docente e potencialidades e limites do processo de avaliação instituído. Resultados: A trajetória da ABP no processo de ensino-aprendizagem sob a ótica dos docentes nos mostrou uma variedade de compreensões. Em relação à formação docente, identificaram-se fragilidades no desenvolvimento do processo tutorial. Além disso, constatou-se que as estratégias utilizadas para a capacitação precisam ser revistas quanto à implementação e à inserção dos profissionais nelas. Observou-se que os docentes demonstram dificuldades em realizar uma avaliação dos estudantes integrando as dimensões afetivas, cognitivas e psicomotoras. Conclusão: Assim, independentemente do tempo de implementação do currículo, a educação permanente deve se constituir como espaço potente para a capacitação docente e a gestão do processo.

Quantification of mineral composition of Brazilian bee pollen by near infrared spectroscopy and PLS regression.

Bee pollen consumption has increased in the last years, mainly due to its nutritional value and therapeutic applications. The quantification of mineral constituents is of great importance in order to evaluate both, the toxicity and the beneficial effect of essential elements. The purpose of this work was to quantify the essential elements, Ca, Mg, Zn, P and K, by diffuse reflectance spectra in the near infrared region (NIR) combined with partial least squares regression (PLS), which is a clean and fast method. Reference method used was ICP OES. The determination coefficients for calibration models (R2) were above 0.87 and the mean percent calibration error varied from 5 to 10%. For external validation R2 values were higher than 0.76. The results indicated that NIR spectroscopy can be useful for an approximate quantification of these minerals in bee pollen samples and can be used as a faster alternative to the standard methodologies.

Classificação Internacional de Funcionalidade Incapacidade e Saúde (CIF) aplicada à trabalhadores de higienização e limpeza / International Classification of Functioning Disability and Health (ICF) applied on health of hygiene and cleaning worker

Introdução. A Revolução Tecnológica trouxe repercussões em aspectos coletivos e individuais no mundo do trabalho, porém, no Brasil ainda persistem atividades caracterizadas por significativo desgaste físico, como é o caso dos serviços de higienização e limpeza. Objetivo. Estabelecer um perfil funcional de higienizadores com base na CIF. Método. Dados foram coletados de um serviço de Medicina do Trabalho, para codificação com base na CIF. Resultados. No componente Funções do Corpo identificaram-se as categorias b28010 (dor em cabeça e pescoço), b28014 (dor em membro superior), 28013 (dor nas costas), e 28015 (dor em membro inferior). Nas Estruturas do Corpo, destacou-se o código s76002 (coluna lombar). Identificou-e em atividades e participação, os códigos d2200 (limpeza e desinfecção), d4109 (postura inadequada), fatores ambientais com e1358 (risco químico), 298 (risco biológico) e 2251(umidade). Conclusão. As informações subsidiaram um perfil funcional que será utilizado para o aprimoramento da aquisição de dados em saúde pela equipe de saúde.

Introduction. The Technological Revolution brought repercussions on collective and individual aspects in the world of work, however. In Brazil there are still activities characterized by significant physical exhaustion, such as hygiene and cleaning services. Goal.To establish a functionality profile of sanitation workers based on the ICF. Method. Data were collected from an occupational health service and coded based on the CIF. Results. On Body Functions component were identified categories b28010 (pain in the head and neck), b28014 (pain in upper limb), 28013 (back pain), and 28015 (leg pain). On Body Structures component was the highlight for s76002 code (lumbar spine). Were extracted codes relating to the activities and participation, with D2200 (cleaning and disinfection), and d4109 (poor posture), and environmental factors with the e1358 code (chemical risk / sanitizers and disinfectants), and 298 (biological risk) and 2251 (humidity). Conclusion. The Informations subsidized a functional profile that will be used to improve the acquisition of health data by the health team.

Ensino e Aprendizagem da Prática Profissional: Perspectiva de Estudantes de Medicina / Teaching and Learning Professional Practice: Medical Students’ Perspective

RESUMO A Faculdade de Medicina de Marília (Famema) construiu um currículo integrado e orientado por competência dialógica, sendo a Unidade de Prática Profissional (UPP) uma das unidades educacionais desenvolvida por meio da Problematização. Este estudo tem como objetivo analisar o processo de ensino-aprendizagem na Unidade de Prática Profissional (UPP) na perspectiva dos estudantes do curso de Medicina. Trata-se de um estudo qualitativo, em que foi realizada entrevista com 16 estudantes escolhidos aleatoriamente, abrangendo todas as séries do curso de Medicina. Na análise de dados utilizou-se a análise de conteúdo, na modalidade temática. Obtiveram-se três categorias temáticas: compreensão da proposta da UPP; o processo ensino-aprendizagem; organização do espaço de construção do conhecimento. Apesar de serem identificadas lacunas quanto à organização dessa unidade educacional, considera-se que essa proposta curricular possibilita formar um profissional definido pelas Diretrizes Nacionais e que atenda às necessidades do SUS, contribuindo para que outras escolas possam adequar seus currículos e buscar a formação de profissionais mais críticos e reflexivos.

ABSTRACT Marília Medical School has built an integrated and dialogic curriculum, with the Professional Practice Unit (PPU) developed through problem-based learning. This study aims to analyze the teaching and learning process in the Professional Practice Unit (PPU) from the medical students’ perspective. This is a qualitative study based on interviews with 16 randomly chosen students, encompassing all series of the Medical Course. The data was subjected to content analysis, with three thematic categories: Understanding of the proposed PPU; The teaching-learning process; and the organization of knowledge construction. Despite some gaps in the educational unit organization, the proposed curriculum enables professional training according to National Guidelines, and meets the needs of the Unified Health System, thus helping other schools to adapt their curricula and seek a more critical and reflective professional education.

Assessing Endothelial Responsiveness After Cardiopulmonary Bypass: Insights on Different Perfusion Modalities.

OBJECTIVE: Cardiopulmonary bypass (CPB) exerts several deleterious effects on inflammatory pathways. Most of these can be related to an endothelial insult leading to endothelial dysfunction. To date, the degree of endothelial damage only has been evaluated on a cellular and molecular level, but no studies exist looking at the functional effects of CPB on the endothelium. DESIGN: Previous studies hypothesized a negative effect of continuous flow as opposed to the physiologic pulsatile flow. The aim of the present retrospective study was to investigate how different perfusion modalities during CPB (ie, continuous v pulsatile flow) or its avoidance differently impact endothelial function. SETTING: Cardiovascular operating room and intensive care unit of a large tertiary University Hospital in Monza, Italy. PARTICIPANTS: Flow-mediated dilatation (FMD) of the brachial artery was assessed in 29 patients undergoing elective myocardial revascularization. Ten patients receiving continuous-flow CPB, 10 receiving pulsatile-flow CPB, and 9 scheduled for beating-heart revascularization were studied. INTERVENTIONS: Patients were studied at baseline (after induction of general anesthesia), after CPB upon intensive care unit (ICU) admission after surgery, and on the first postoperative day before discharge from the ICU (on average, 24 hours after CPB discontinuation). MEASUREMENTS AND MAIN RESULTS: The continuous-flow CPB group demonstrated a significant reduction in FMD after CPB, (12.8% ± 9.7% v 1.6% ± 1.5%, p<0.01), which lasted up to the first postoperative day (5.9% ± 4.1%). On the other hand, FMD did not change in the pulsatile-flow group (12.5% ± 10.5%, 11.0% ± 7.2%, and 16.6% ± 11.7%, respectively). FMD also was unaffected in the beating-heart group, thus suggesting a direct effect of CPB itself on endothelial function. CONCLUSIONS: In conclusion, in this study population of adult patients undergoing elective coronary revascularization, continuous-flow CPB markedly impaired endothelial function, although this was not the case with pulsatile-flow CPB. This study posed the rationale for further investigations on the potential value of FMD to predict cardiovascular events in these patients.

Competency-base training in nursing: limits and possibilities / La formación en enfermería por área de competencia: límites y posibilidades / A formação em enfermagem por área de competência: limites e possibilidades

Objective To analyze the possibilities and limits of competency-based training in nursing. Method An integrative review of the literature on the subject was carried out, and an analysis was made of the results of a survey evaluating a nursing course based on areas of competency. A dialog was then established between the review and the results of the research. Results On the question of which theoretical type of competency the articles from the literature relate to, there is a predominance of the constructivist perspective, followed by the functionalist approach and the dialog-based approach. In the dialog between the literature and the research, limits and possibilities were observed in the development of a training by areas of competency. Conclusion The dialog-based approach to competency is the proposition that most approximates to the profile defined by the National Curriculum Guidelines for training in nursing, and this was also identified in the evaluation survey that was studied. However, it is found that there are aspects on better work is needed, such as: partnership between school and the workplace, the role of the teacher, the role of the student, and the process of evaluation. .

Objetivo Analizar posibilidades y límites de la formación en enfermería por competencia. Método Revisión integrativa de la literatura sobre el asunto y análisis de los resultados de una investigación de evaluación de un curso de enfermería desarrollada por áreas de competencia, estableciendo un diálogo entre la revisión y los resultados de esa investigación. Resultados Cuanto a la vertiente teórica de competencia de esos artículos, hubo un predominio de la matriz constructivista, seguida de la funcionalista y de la dialógica. En el diálogo entre la literatura y la investigación se observaron límites y posibilidades en el desarrollo de una formación por áreas de competencia. Conclusión El abordaje dialógico de competencia es la proposición que más se aproxima del perfil definido por las DCN para la formación en enfermería, identificada también en la investigación de evaluación analizada. Aunque, se verificó que hay aspectos que precisan ser más bien trabajados, como: aparcería escuela y servicio, papel del docente, papel del estudiante y proceso de evaluación. .

Objetivo Analisar possibilidades e limites da formação em enfermagem por competência. Método Revisão integrativa da literatura acerca do assunto e analise dos resultados de uma pesquisa de avaliação de um curso de enfermagem desenvolvida por áreas de competência, estabelecendo um diálogo entre a revisão e os resultados dessa pesquisa. Resultados Quanto à vertente teórica de competência desses artigos, houve um predomínio da matriz construtivista, seguida da funcionalista e da dialógica. No diálogo entre a literatura e a pesquisa observaram-se limites e possibilidades no desenvolvimento de uma formação por áreas de competência. Conclusão A abordagem dialógica de competência é a proposição que mais se aproxima do perfil definido pelas DCN para a formação em enfermagem, identificada também na pesquisa de avaliação analisada. No entanto, verificou-se que há aspectos que precisam ser mais bem trabalhados, como: parceria escola e serviço, papel do docente, papel do estudante e processo avaliativo. .

Impact of inocula and operating conditions on the microbial community structure of two anammox reactors.

The microbial community structure of the biomass selected in two distinctly inoculated anaerobic oxidation of ammonium (anammox) reactors was investigated and compared with the help of data obtained from 454-pyrosequencing analyses. The anammox reactors were operated for 550 days and seeded with different sludges: sediment from a constructed wetland (reactor I) and biomass from an aerated lagoon part of the oil-refinery wastewater treatment plant (reactor II). The anammox diversity in the inocula was evaluated by 16S rRNA gene-cloning analysis. The diversity of anammox bacteria was greater in the sludge from the oil-refinery (three of the five known genera of anammox were detected) than in the wetland sludge, in which only Candidatus Brocadia was observed. Pyrosequencing analysis demonstrated that the community enriched in both reactors had differing compositions despite the nearly similar operational conditions applied. The dominant phyla detected in both reactors were Proteobacteria, Chloroflexi, Planctomycetes, and Acidobacteria. The phylum Bacteroidetes, which is frequently observed in anammox reactors, was not detected. However, Acidobacteria and GN04 phyla were observed for the first time, suggesting their importance for this process. Our results suggest that, under similar operational conditions, anammox populations (Ca. Brocadia sinica and Ca. Brocadia sp. 40) were selected in both reactors despite the differences between the two initial inocula. Taken together, these results indicated that the type of inoculum and the culture conditions are key determinants of the general microbial composition of the biomass produced in the reactors. Operational conditions alone might play an important role in anammox selection.

[Meanings of social support for people submitted to coronary artery by-pass graft surgery: ethnographic study]. / Significados de apoio social de acordo com pessoas submetidas a revascularizacao do miocardio: estudo etnografico.

The aim of this ethnographic study was to understand the meanings of social support according to a group of people submitted to coronary artery bypass graft surgery. Semi structured interview and direct observations were the techniques used for data collection, which took place at the participants' homes and during outpatient return appointments. Data were collected between April/2010 and April/2011, involving eleven individuals, mostly married, between 49 and 73 years of age. The main reported source of support came from relatives. Religious support was another type mentioned, considered fundamental when making decisions about the surgery. The meaning of support was related to direct help from relatives, concerning instrumental (accomplishment of domestic and self-care activities) as well as emotional and religious help (focus on coping with the disease and surgery and explanations for the disease and surgery as a moment of threat and rupture).

Significados de apoio social de acordo com pessoas submetidas a revascularizacao do miocardio: estudo etnografico / Meanings of social support for people submitted to coronary artery by-pass graft surgery: ethnographic study / Significados de apoyo social de acuerdo con personas sometidas a revascularizacion miocardica: estudio etnografico

Estudo etnográfico com objetivo de compreender os significados de apoio social segundo um grupo de pessoas submetidas a revascularização do miocárdio. As técnicas empregadas na coleta de dados foram entrevista semiestruturada e observações diretas, realizadas na residência dos participantes e durante o retorno ambulatorial. Os dados foram coletados no período de abril/2010 a abril/2011, com onze indivíduos, a maioria casada, com idade entre 49 e 73 anos. A principal fonte de apoio reportada foi os familiares. Outro tipo de apoio mencionado foi o religioso, considerado fundamental no momento de tomada de decisão sobre a cirurgia. O significado do apoio foi relacionado ao auxílio direto dos familiares, tanto instrumental (realização de atividades domésticas e de autocuidado) quanto emocional e religioso (focalização no enfrentamento da doençae da cirurgia e nas explicações para a enfermidade e cirurgia, um momento de ameaça e ruptura).

The aim of this ethnographic study was to understand the meanings of social support according to a group of people submitted to coronary artery bypass graft surgery. Semi structured interview and direct observations were the techniques used for data collection, which took place at the participants' homes and during outpatient return appointments. Data were collected between April/2010 and April/2011, involving eleven individuals, mostly married, between 49 and 73 years of age. The main reported source of support came from relatives. Religious support was another type mentioned, considered fundamental when making decisions about the surgery. The meaning of support was related to direct help from relatives, concerning instrumental (accomplishment of domestic and self-care activities) as well as emotional and religious help (focus on coping with the disease and surgery and explanations for the disease and surgery as a moment of threat and rupture).

Estudio etnográfico con objeto de comprender los significados de apoyo social según un grupo de personas sometidas a la revascularización miocárdica. Las técnicas usadas en la recolecta de datos fueron la entrevista semi estructurada y observaciones directas, llevadas a cabo en la residencia de los participantes y durante el regreso ambulatorio. Los datos fueron recolectados entre abril/2010 y abril/2011, con once individuos, la mayoría casada, con edad entre 49 y 73 años. La principal fuente de apoyo reportada fue de los familiares. Otro tipo de apoyo mencionado fue el religioso, considerado fundamental en el momento de toma de decisión sobre la cirugía. El significado del apoyo fue relacionado al auxilio directo de los familiares, tanto instrumental (realización de actividades domésticas y de autocuidado) como emocional y religioso (focalización en el enfrentamiento de la enfermedad y cirugía y explicaciones para la enfermedad y cirugía como un momento de amenaza y ruptura).

Competency-based training in nursing: limits and possibilities.

Objective To analyze the possibilities and limits of competency-based training in nursing. Method An integrative review of the literature on the subject was carried out, and an analysis was made of the results of a survey evaluating a nursing course based on areas of competency. A dialog was then established between the review and the results of the research. Results On the question of which theoretical type of competency the articles from the literature relate to, there is a predominance of the constructivist perspective, followed by the functionalist approach and the dialog-based approach. In the dialog between the literature and the research, limits and possibilities were observed in the development of a training by areas of competency. Conclusion The dialog-based approach to competency is the proposition that most approximates to the profile defined by the National Curriculum Guidelines for training in nursing, and this was also identified in the evaluation survey that was studied. However, it is found that there are aspects on better work is needed, such as: partnership between school and the workplace, the role of the teacher, the role of the student, and the process of evaluation.

Evaluation of the genotoxicity of zinc oxide-eugenol cement to Allium cepa L / Avaliação da genotoxicidade do cimento de óxido de zinco e eugenol em Allium cepa L

Dental materials can induce local and systemic effects. The Allium cepa assay was used to evaluate the genotoxicity and/or cytotoxicity of zinc oxide and eugenol (ZOE) at different proportions. The ZOE solution was tested at the concentration of 1 drop of eugenol (in each drop of liquid, the approximate concentration of eugenol is 85%) and 1 portion of zinc oxide cement (treatment I), and twice the concentration of eugenol (treatment II) . Treated roots appeared to be yellowish-brown, fewer in number, thicker and less turgid compared with the control, suggesting a cytotoxic activity of ZOE. A significant difference was found in the root size between the control and treatment II. This treatment reduced by 79% the size of the root compared with the control, and the mitotic index was 66%, indicating a 22.4% reduction relative to the control, which in turn evidenced the cytotoxicity of ZOE. The significant increase in anaphase bridges suggests a genotoxic effect.

Materiais dentários podem induzir diversos efeitos, tanto local quanto sistêmico. Objetivou-se avaliar a ocorrência de danos genéticos e de alterações nucleares degenerativas indicativas de genotoxicidade e citotoxicidade em células de cebola em mitose, expostas a óxido de zinco e eugenol (ZOE) em diferentes proporções. Os bulbos foram postos a germinar, com a parte inferior mergulhada na solução de ZOE + água destilada. A solução de ZOE foi testada na concentração de uma gota de eugenol (aproximadamente 85%) e 1 porção do cimento de óxido de zinco (tratamento I) e o dobro da concentração do eugenol (tratamento II). As raízes do controle apresentaram coloração esbranquiçada e eram túrgidas, enquanto as raízes dos tratamentos se mostraram de cor amarela ­ amarronzada, em menor quantidade, mais grossas e menos túrgidas, sugerindo ação citotóxica de ZOE. Houve diferença significativa do tamanho das raízes entre o controle e o tratamento II. O tratamento II reduziu 79% do tamanho da raiz e o índice mitótico foi 66%. Isto mostra redução de 22,4% quando comparado com o controle, evidenciando a ação citotóxica de ZOE. O aumento significante de pontes anafásicas sugere efeito genotóxico.