Factores relacionados a la depresión durante la adolescencia: una revisión integrativa / Factors related to depression during adolescence: an integrative review

INTRODUCCIÓN: La depresión es un problema de salud mental común en la etapa de la adolescencia, se manifiesta por descenso del humor, tristeza y pérdida de interés en actividades cotidianas. Esta etapa es sensible por los grandes cambios biopsicosociales. OBJETIVO: identificar factores relacionados a la depresión en adolescentes que puedan actuar como factores protectores o factores de riesgo. METODOLOGÍA: se realizó una búsqueda bibliográfica en las bases de datos WoS, PUBMED, Scopus, y BVS; se utilizaron descriptores normalizados para la expresión de búsqueda "Adolescente AND factores protectores OR factores de riesgo AND depresión", seleccionando 38 artículos. RESULTADOS: se obtuvieron 34 factores, que pueden actuar como de riesgo y protectores, y agrupados en dimensiones: a) biológica: género, edad, índice de masa corporal, problemas de salud; b) psicológica: autorregulación, autoestima, afecto positivo/negativo, pensamientos negativos, imagen corporal, estrés, alexitimia, calidad de vida, y c) social, subdividida en tres grupos: c.1) hábitos: consumo de sustancias nocivas, actividad física/sedentarismo, adicción a pantallas, rendimiento académico, participación comunitaria, estilo de vida, actividad sexual, sueño; c.2) contexto familiar: experiencias familiares, relación padres-hijos, funcionalidad familiar, composición familiar, nivel socioeconómico; y c.3) entorno: escuela urbana, implicación escolar, bullying, apoyo social, exposición a violencia, eventos vitales negativos, alfabetización en salud y áreas verdes. CONCLUSIÓN: Existen factores relacionados a la depresión en adolescentes que podrán actuar como factores protectores o de riesgo, su conocimiento por parte de los profesionales de la salud y de la enfermera en particular es fundamental para intervenirlos.

INTRODUCTION: Depression is a common mental health problem in adolescence, manifested by poor mood, sadness and loss of interest in daily activities. Adolescents are especially susceptible to depression due to the great biopsychosocial changes in this stage of life. OBJECTIVE: To identify risk factors and protective factors associated with adolescent depression that are evidence-based. METHODOLOGY: a bibliographic search was carried out in the WoS, PUBMED, Scopus, and VHL databases. Standardized descriptors used to conduct the search included Adolescent AND protective factors OR risk factors AND depression. 38 articles were selected. RESULTS: 38 factors were identified, classified as risky and protective, and grouped into the following dimensions: a) biological: gender, age, BMI, health problems; b) psychological: negative or positive affection, negative thoughts, satisfaction with body image, stress, alexhythemia, quality of life, self-regulation, self-esteem; and c) social, subdivided into three groups: c.1) habits, physical activity, consumption of harmful substances, screen addiction, lifestyle that needs to be improved, sexual activity, community participation, sleep duration, academic performance; c.2) family context: experiences, parent-child relationship, composition, socioeconomic level, functionality, educational level of parents; and c.3) environmental:: social support, bullying, exposure to violence, belonging to an urban school, negative life events, school involvement, neighborhood with green areas and health literacy. CONCLUSION: Several factors that affect depression in adolescents are reported by the literature. In the biological dimension, they tend to be risk factors, and in the psychological and social dimensions, they may increase risk or be protective. Knowledge of these factors by the nurse is essential to guide interventions.

Oral manifestations present in patients with COVID-19 Scoping Review / Manifestaciones orales presentes en pacientes con COVID-19. Revisión sistemática exploratoria

The new COVID-19 is caused by the SARS-CoV2 virus, which has a high affinity for the human ACE-2 receptor, those that are in high presence in the oral cavity. There have been various oral manifestations associated with COVID-19, however, the prevalence and etiology of these lesions is still unknown. The objective of the study is to determine in an updated way, the oral manifestations in patients with the disease, identifying type of basic lesion, associated pathology, location and prevalence. In this study the databases used were Scopus, MedLine and Web of Science. 28 articles were included in this review, which included a total of 591 patients with COVID-19 and oral manifestations. Finally, we determined that there are three types of general oral alterations: neurological, oral mucosa and glandular manifestations. The neurological are the most prevalent, followed by those of the oral mucosa and finally the glandular ones. About location, the sites where it is most common to find basic lesions are the tongue and lips.

El nuevo COVID-19 es originado por el virus SARS-CoV2, el cual posee alta afinidad por el receptor humano ACE-2, los que se encuentran en alta presencia en la cavidad oral. Se han presentado diversas manifestaciones orales asociadas a COVID-19, no obstante, aún se desconoce la prevalencia y la etiología de estas lesiones. El objetivo del estudio es determinar de manera actualizada, las manifestaciones orales en pacientes que se encuentran cursando la enfermedad, identificando el tipo de lesión básica, patología asociada, ubicación y prevalencia. En este estudio las bases de datos utilizados fueron Scopus, MedLine y Web of Science. Se incluyeron 28 artículos en esta revisión, los que engloban un total de 591 pacientes con COVID-19 y manifestaciones orales. Finalmente, determinamos que existen tres tipos de alteraciones orales generales: manifestaciones neurológicas, de mucosa oral y glandulares. Las neurológicas son las más prevalentes, seguidas por las de mucosa oral y finalmente las glandulares. Con respecto a la ubicación, los sitios en donde es más frecuente encontrar lesiones básicas vienen siendo lengua y labios.

Efectos del entrenamiento sensoriomotor en balance, deambulación y calidad de vida en personas con enfermedad de Parkinson / Effects of sensorimotor training on balance, ambulation and quality of life in people with Parkinson's disease

La enfermedad de Parkinson (EP) es el segundo trastorno neurodegenerativo más frecuente del envejecimiento y el trastorno del movimiento más común. En Chile, de un total de 17.514.003 habitantes un 11,4% de la población es adulto mayor, y aproximadamente un 1-2% de la población de 65 años vive con EP, cifra que se eleva a un 3-5% en aquellos mayores de 85 años. Dentro de las alteraciones del movimiento que genera, se describen trastornos de la marcha y caídas, afectando la calidad de vida de los pacientes, por lo tanto, es fundamental generar estrategias que combatan estas alteraciones. La investigación tuvo como objetivo evaluar la efectividad de un plan de entrenamiento sensoriomotor para mejorar el balance, deambulación y calidad de vida en personas con Parkinson de la ciudad de Valdivia. Estudio cuasiexperimental con medida pre-post test tras 18 sesiones de entrenamiento sensoriomotor de 45 minutos, 3 veces por semana en días no consecutivos, durante 6 semanas. Se evaluó 8 participantes utilizando los test Timed Up and Go (TUG), Gait Speed (GS), Sharpened Romberg (SR) y la escala Unified Parkinson's Disease Rating Scale (UPDRS). Los resultados revelaron que se obtuvo una mejora significativa en las pruebas TUG y GS, con un porcentaje de cambio de 32,1% y 84,61% respectivamente, disminución de compensaciones en test SR y disminución de 2 puntos en la UPDRS. Se concluye que el entrenamiento sensoriomotor a corto plazo logra mejoras significativas en las variables de balance deambulación y calidad de vida(Au)

Introduction. Parkinson's disease (PD) is the second most common neurodegenerative disorder of aging and the most common movement disorder. In Chile, there is a total of 17,574,003 inhabitants, where 11.4% of the total population is older adult, and approximately 1-2% of the population of 65 years lives with PD, a figure that rises to 3-5% in those over 85 years old. Within the alterations of the movement that it generates, disorders of the gait and falls are described, affecting the quality of life of the patients, therefore, it is fundamental to generate strategies that combat these alterations. Objective: Evaluate the effectiveness of a sensorimotor training plan to improve balance, walking and quality of life in people with Parkinson's disease in the city of Valdivia. Methods: Quasi-experimental study with pre-post measurement after 18 sessions of sensorimotor training of 45 minutes, 3 times a week on nonconsecutive days, for 6 weeks. Eight 2 participants were evaluated using the Timed Up and Go (TUG), Gait Speed (GS), Sharpened Romberg (SR) and the escalation of the Unified Parkinson's Disease Classification Scale (UPDRS). Results: A significant improvement was obtained in the TUG and GS tests, with a percentage of change of 32.1% and 84.61% respectively, decrease of compensations in SR test and decrease of 2 points in the UPDRS. Conclusion: Short-term sensorimotor training in the short term achieved significant improvement in variables of balance, ambulation and quality of life(AU)

Lessons to Learn From Low-Dose Cyclosporin-A: A New Approach for Unexpected Clinical Applications.

Cyclosporin-A has been known and used for a long time, since its "fast track" approval in the early 80's. This molecule has rapidly demonstrated unexpected immunosuppressive properties, transforming the history of organ transplantation. Cyclosporin's key effect relies on modulation on T-lymphocyte activity, which explains its role in the prevention of graft rejection. However, whether cyclosporin-A exerts other effects on immune system remains to be determined. Until recently, cyclosporin-A was mainly used at a high-dose, but given the drug toxicity and despite the fear of losing its immunosuppressive effects, there is nowadays a tendency to decrease its dose. The literature has been reporting data revealing a paradoxical effect of low dosage of cyclosporin-A. These low-doses appear to have immunomodulatory properties, with different effects from high-doses on CD8+ T lymphocyte activation, auto-immune diseases, graft-vs.-host disease and cancer. The aim of this review is to discuss the role of cyclosporin-A, not only as a consecrated immunosuppressive agent, but also as an immunomodulatory drug when administrated at low-dose. The use of low-dose cyclosporin-A may become a new therapeutic strategy, particularly to treat cancer.

Vaccination-induced skin-resident memory CD8+ T cells mediate strong protection against cutaneous melanoma.

Memory CD8+ T cell responses have the potential to mediate long-lasting protection against cancers. Resident memory CD8+ T (Trm) cells stably reside in non-lymphoid tissues and mediate superior innate and adaptive immunity against pathogens. Emerging evidence indicates that Trm cells develop in human solid cancers and play a key role in controlling tumor growth. However, the specific contribution of Trm cells to anti-tumor immunity is incompletely understood. Moreover, clinically applicable vaccination strategies that efficiently establish Trm cell responses remain largely unexplored and are expected to strongly protect against tumors. Here we demonstrated that a single intradermal administration of gene- or protein-based vaccines efficiently induces specific Trm cell responses against models of tumor-specific and self-antigens, which accumulated in vaccinated and distant non-vaccinated skin. Vaccination-induced Trm cells were largely resistant to in vivo intravascular staining and antibody-dependent depletion. Intradermal, but not intraperitoneal vaccination, generated memory precursors expressing skin-homing molecules in circulation and Trm cells in skin. Interestingly, vaccination-induced Trm cell responses strongly suppressed the growth of B16F10 melanoma, independently of circulating memory CD8+ T cells, and were able to infiltrate tumors. This work highlights the therapeutic potential of vaccination-induced Trm cell responses to achieve potent protection against skin malignancies.

Potassic zeolites from Brazilian coal ash for use as a fertilizer in agriculture.

Brazilian coal has an ash content ranging from 30 to 50% by weight. Consequently, its use in coal-fired thermoelectric for power production generates a lot of waste. The construction sector is the largest consumer of coal ash, but it cannot absorb the entire amount generated. Thus, other applications for coal ash should be studied in aim to optimize the use of this industrial waste. This research had as focus to synthesize potassic zeolite from of the coal ash into on potassium fertilizer for the grown wheat plant. In this work, it was used a subbituminous coal from Mina do Leão (RS, Brazil) presenting 48.7% ash content on a dry basis. Concerning the synthesis of potassic zeolite, it was adopted the conventional method of hydrothermal treatment with potassium hydroxide. A schedule of experiments was conducted in order to define the optimum condition of zeolite synthesis that was then used an alkaline solution of 5M KOH with a reaction time of 24h at 150°C. According to this procedure, it was obtained a zeolite with a single crystalline phase, identified through X-ray diffraction as Merlinoite. Subsequently, it was performed a set of tests using potassic zeolite asa fertilizer for plants in a greenhouse. The synthesized potassic zeolite showed a good potential for its use as fertilizer in agriculture.

A short hairpin RNA-based adjuvant targeting NF-κB repressor IκBα promotes migration of dermal dendritic cells to draining lymph nodes and antitumor CTL responses induced by DNA vaccination.

DNA vaccination is an attractive approach to elicit tumor-specific cytotoxic CD8+ T lymphocytes (CTL), which can mediate protective immunity against tumors. To initiate CTL responses, antigen-encoding plasmids employed for DNA vaccination need to activate dendritic cells (DC) through the stimulation of DNA-sensing innate immune receptors that converge in the activation of the master transcription factor NF-κB. To this end, NF-κB repressor IκBα needs to be degraded, allowing NF-κB to translocate to the nucleus and transcribe proinflammatory target genes, as well as its repressor IκBα. Therefore, NF-κB activation is self-limited by de novo synthesis of IκBa, which sequesters NF-κB in the cytosol. Hence, we tested whether co-delivering a shRNA-based adjuvant able to silence IκBα expression would further promote DNA-induced NFκB activation, DC activation and tumor-protective CTL responses induced by DNA vaccination in a preclinical model. First, an IκBα-targeting shRNA plasmid (shIκBα) was shown to reduce IκBα expression and promote NFκB-driven transcription in vitro, as well as up-regulate inflammatory target genes in vivo. Then, we showed that intradermal DNA electroporation induced the migration of skin migratory dendritic cells to draining lymph nodes and maturation of dermal dendritic cells (dDC). Interestingly, shIκBα further promoted the migration of mature skin migratory dendritic cells, in particular dDC, which are specialized in antigen cross-presentation and activation of CD8+ T cells. Consistently, mice vaccinated with a plasmid encoding the melanoma-associated antigen tyrosinase-related protein 2 (TRP2) in combination with shIκBα enhanced TRP2-specific CTL responses and reduced the number of lung melanoma foci in mice challenged with intravenous injection of B16F10 cells. Moreover, therapeutic vaccination with pTRP2 and shIκBα delayed the growth of B16F10 melanoma subcutaneous tumors. Our data suggest that adjuvants promoting NF-κB activation represent an attractive strategy to boost DC activation and promote the generation of tumor-protective CTL responses elicited by DNA vaccines.

Dual Inhibition of Bruton's Tyrosine Kinase and Phosphoinositide-3-Kinase p110δ as a Therapeutic Approach to Treat Non-Hodgkin's B Cell Malignancies.

Although new targeted therapies, such as ibrutinib and idelalisib, have made a large impact on non-Hodgkin's lymphoma (NHL) patients, the disease is often fatal because patients are initially resistant to these targeted therapies, or because they eventually develop resistance. New drugs and treatments are necessary for these patients. One attractive approach is to inhibit multiple parallel pathways that drive the growth of these hematologic tumors, possibly prolonging the duration of the response and reducing resistance. Early clinical trials have tested this approach by dosing two drugs in combination in NHL patients. We discovered a single molecule, MDVN1003 (1-(5-amino-2,3-dihydro-1H-inden-2-yl)-3-(8-fluoro-3,4-dihydro-2H-benzo[b][1,4]oxazin-6-yl)-1H-pyrazolo[3,4-d]pyrimidin-4-amine), that inhibits Bruton's tyrosine kinase and phosphatidylinositol-3-kinase δ, two proteins regulated by the B cell receptor that drive the growth of many NHLs. In this report, we show that this dual inhibitor prevents the activation of B cells and inhibits the phosphorylation of protein kinase B and extracellular signal-regulated kinase 1/2, two downstream mediators that are important for this process. Additionally, MDVN1003 induces cell death in a B cell lymphoma cell line but not in an irrelevant erythroblast cell line. Importantly, we found that this orally bioavailable dual inhibitor reduced tumor growth in a B cell lymphoma xenograft model more effectively than either ibrutinib or idelalisib. Taken together, these results suggest that dual inhibition of these two key pathways by a single molecule could be a viable approach for treatment of NHL patients.

Immunophenotyping of Stage III Melanoma Reveals Parameters Associated with Patient Prognosis.

Stage III metastatic melanomas require adequate adjuvant immunotherapy to prevent relapses. Prognostic factors are awaited to optimize the clinical management of these patients. The magnitude of metastatic lymph node invasion and the BRAF(V600) activating mutation have clinical significance. Based on a comprehensive immunophenotyping of 252 parameters per patient in paired blood and metastatic lymph nodes performed in 39 metastatic melanomas, we found that blood markers were as contributive as tumor-infiltrated lymphocyte immunotypes, and parameters associated with lymphocyte exhaustion/suppression showed higher clinical significance than those related to activation or lineage. High frequencies of CD45RA(+)CD4(+) and CD3(-)CD56(-) tumor-infiltrated lymphocytes appear to be independent prognostic factors of short progression-free survival. High NKG2D expression on CD8(+)tumor-infiltrated lymphocytes, low level of regulatory T-cell tumor-infiltrated lymphocytes, and low PD-L1 expression on circulating T cells were retained in the multivariate Cox analysis model to predict prolonged overall survival. Prospective studies are needed to determine whether such immunological markers may guide adjuvant therapies in stage III metastatic melanomas.

The history of neurosurgery at the University of Sao Paulo.

The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time) organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

The history of neurosurgery at the University of Sao Paulo / A historia da neurocirurgia na Universidade de Sao Paulo

The history of neurosurgery at University of São Paulo comes from 1918, since its origins under the Department of Neurology from Chair of Psychiatric Clinic and Nervous Diseases. Professor Enjolras Vampré was the great inspiration for such medical specialty in the State of Sao Paulo. In 1929, the first neurosurgical procedures were performed in the recently (at time) organized Section of Neurosurgery. The official inauguration of the Division of Functional Neurosurgery occurred at June 1977, with the presence of worldwide well-known neuroscientists. The division suffered a deep streamlining under the leadership of Professor Raul Marino Jr., between the decades of 1990 and 2000. At this time, it was structured with the sections of neurological surgery, functional neurosurgery and neurosurgical emergency. Since 2008, Professor Manoel Jacobsen Teixeira is the Chairman of the Division and has provided the Division with the best available technological resources, performing more than 3,000 surgeries a year and training professionals who will, certainly, be some of the future leaders of brazilian neurosurgery.

A história da neurocirurgia na Universidade de São Paulo remonta a 1918, quando surge sob o Departamento de Neurologia da cadeira de Clínica Psiquiátrica e Doenças Nervosas. O Professor Enjolras Vampré foi o grande inspirador da especialidade no estado de São Paulo. Em 1929, foram realizadas as primeiras intervenções neurocirúrgicas na então recentemente organizada Seção de Neurocirurgia. A fundação oficial da Divisão de Neurocirurgia Funcional data de junho de 1977 e contou com a participação de diversos cientistas de renome internacional. A Divisão passou por profunda reorganização sob a direção do Professor Raul Marino Jr. entre as décadas de 1990 e 2000, quando foi estruturada com os setores de neurocirurgia geral, neurocirurgia funcional e emergência neurocirúrgica. Desde 2008, o Professor Manoel Jacobsen Teixeira é responsável pela Divisão, que conta com os melhores recursos tecnológicos disponíveis, realizando mais de 3.000 cirurgias por ano e formando profissionais que certamente serão futuros líderes na neurocirurgia brasileira.

Gênese dos aneurismas intracranianos / The genesis of intracranial aneurysm

O vasoespasmo tem sido causador de grande numero de sequelas e óbitos após o evento da hemorragia subaracnóide.Várias hipóteses fisiopatológicas para seu desenvolvimento vêm sendo estudadas na literatura, todavia o envolvimento do magnésio na gênese e como substância terapêutica vem ganhando destaque cada vez maior. Os autores procuram identificar os pontos de relevância da cadeia de equilíbrio entre o cálcio e magnésio nas bombas de membrana endoteliais e o beneficio do mesmo na terapêutica, baseando-se na literatura revisada. A infusão de sulfato de magnésio endovenosa no período em que o vasoespasmo se instala parece ser um conduta extremamente útil e necessária no relaxamento da musculatura endotelial e faz parte hoje da maior parte dos protocolos de tratamento do vasoespasmo pós hemorragia subaracnóide.

Clipagem e oclusão endovascular de aneurismas: o debate permanece / Clipping versus coil: the debate remanis

Introdução: atualmente dois métodos estão disponíveis para o tratamento dos aneurismas intracranianos, endovascular e microcirurgia. A publicação do ISAT tem tem gerado uma tendência em favor da embolização apesar de erros metodológicos e de interpretação. O objetivo deste estudo é discutir o tratamento atual dos aneurismas cerebrais com foco nas conclçusões do ISAT. Materiais e métodos: os autores executaram resultados do ISAT com o objetivo de fazer uma análise crítica acerca da metodologia, interpretações e aplicações destes resultados. Resultados: Devido a falhas metodológicas, a critérios de seleção incongruentes, a não qualificação de parâmentros secundários de prognóstico e a seguimento clínico curto, o ISAT está longe de fornecer uma resposta definitiva sobre o tratamento ideal para os aneurismas intracranianos. Conclusões: Nenhuma conclusão pode ser formulada confirmando a superioridade da embolização sobre a clipagem. A generalização e aceitação dos resultados do ISAT é precoce e é uma medida que não beneficia a maioria dos pacientes com aneurismas cerebrais.