Desafios enfrentados por enfermeiros da classificação de risco em urgência e emergência / Challenges faced by risk classification nurses in urgency and emergency / Desafíos enfrentados por enfermeros clasificadores de riesgo en urgencia y emergencia

Objetivo: analisar os desafios enfrentados por enfermeiros da classificação de risco de um serviço de urgência e emergência. Método: pesquisa exploratória e descritiva, com abordagem qualitativa. A coleta de dados ocorreu em março de 2019, por meio de entrevistas semiestruturadas e individuais com enfermeiros atuantes em Unidade de Pronto Atendimento do município de Caruaru, Pernambuco, Brasil. Para a análise, utilizou-se a análise de conteúdo de Bardin. Resultados: foram geradas três categorias: assistência de enfermagem na classificação de risco; desafios do setor de classificação de risco; e desafios da ferramenta que define a classificação de risco. As participantes apontaram questões como falta de compreensão da população, protocolo defasado e discordância com outros membros da equipe como os principais desafios. Conclusão: verificou-se que a atuação da enfermagem na classificação de risco é um processo ainda complexo, que não depende estritamente de protocolos, mas de profissionais motivados, treinados continuamente e em sintonia.

Objective: to analyze the challenges faced by nurses in the risk classification of an urgency and emergency service. Method: exploratory and descriptive research, with a qualitative approach. Data collection took place in March 2019, through semi-structured and individual interviews with nurses working in an Emergency Care Unit in the city of Caruaru, Pernambuco, Brazil. For the analysis, Bardin's content analysis was used. Results: three categories were generated: nursing care in risk classification; challenges of the risk classification industry, and challenges of the tool that defines the risk classification. Participants pointed out issues such as lack of understanding of the population, outdated protocol and disagreement with other team members, as the main challenges. Conclusion: it was found that the role of nursing in risk classification is still a complex process, which does not strictly depend on protocols, but on motivated professionals, continuously trained and in tune.

Image dataset of urine test results on petri dishes for deep learning classification.

Recent advancements in image analysis and interpretation technologies using computer vision techniques have shown potential for novel applications in clinical microbiology laboratories to support task automation aiming for faster and more reliable diagnostics. Deep learning models can be a valuable tool in the screening process, helping technicians spend less time classifying no-growth results and quickly separating the categories of tests that deserve further analysis. In this context, creating datasets with correctly classified images is fundamental for developing and improving such models. Therefore, a dataset of urine test Petri dishes images was collected following a standardized process, with controlled conditions of positioning and lighting. Image acquisition was conducted by applying a hardware chamber equipped with a led lightning source and a smartphone camera with 12 MP resolution. A software application was developed to support image classification and handling. Experienced microbiologists classified the images according to the positive, negative, and uncertain test results. The resulting dataset contains a total of 1500 images and can support the development of deep learning algorithms to classify urine exams according to their microbial growth.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study.

BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

Hipertensão arterial entre idosos: comparação entre indicadores do Ceará, do Nordeste e do Brasil / Hypertension among the elderly: comparison between indicators in Ceará, the Northeast and Brazil / Hipertensión arterial en mayores: comparación de los indicadores de Ceará, del Noreste y de Brasil

Objetivo: Estimar a taxa de prevalência e o número de pessoas com hipertensão e a expectativa de vida livre e com hipertensão arterial da população idosa do estado do Ceará, da Região Nordeste e do Brasil, para o ano de 2008, e apresentar o cenário dos indicadores para o ano de 2020. Métodos: Trata-se de estudo quantitativo, elaborado a partir de dados populacionais da Pesquisa Nacional por Amostra de Domicílios e das Projeções Populacionais disponibilizados pelo Instituto Brasileiro de Geografia e Estatística. Estima-se a prevalência e a população idosa com hipertensão, e utiliza-se o método de Sullivan para calcular a esperança de vida sem e com hipertensão. Resultados: Nos anos de 2008 e 2020, a prevalência de hipertensão entre idosos foi superior a 50% entre o sexo feminino e 40% entre o sexo masculino, assim como a proporção da expectativa de vida aos 60 anos a ser vivida com hipertensão, sendo observados valores mais elevados para o Brasil em comparação com o Nordeste e o Ceará. Nesse período, espera-se um aumento do número de idosos com hipertensão em mais de 40% no Brasil e ao redor de 30% no Nordeste e no Ceará. Conclusão: O ritmo do envelhecimento populacional contribui para o crescimento da população idosa com hipertensão. A prevalência e a expectativa de vida com hipertensão apresentam especificidades regionais. Regra geral, a prevalência de hipertensão é elevada entre os idosos, de modo que parte significativa da expectativa de vida aos 60 anos deverá ser vivida com o problema da hipertensão.

Objective: To estimate the prevalence rate and the number of people with hypertension and the free life expectancy and hypertension of the aged population in Ceará, the Northeast Region, and Brazil, for the year 2008, and to present the scenario of indicators for the year 2020. Methods: It is a quantitative study based on population data from the National Household Sample Survey and Population Projections provided by the Brazilian Institute of Geography and Statistics. The prevalence and the aged population with hypertension are estimated, and the Sullivan method is used to calculate life expectancy without and with hypertension. Results: In the years 2008 and 2020, the prevalence of hypertension among the aged was over 50% among females and 40% among males, as well as the proportion of life expectancy at 60 years of age to be experienced with hypertension, being higher values observed for Brazil compared to the Northeast and Ceará. During this period, the number of hypertension-aged people is expected to increase by more than 40% in Brazil and around 30% in the Northeast and Ceará. Conclusion: The pace of population aging contributes to the growth of the aged population with hypertension. The prevalence and life expectancy with hypertension have regional specificities. As a general rule, the prevalence of hypertension is high among the aged, so that a significant part of life expectancy at 60 years old should be lived with the problem of hypertension.

Objetivo: Estimar la tasa de prevalencia y el número de personas con hipertensión y la expectativa de vida libre y con hipertensión arterial de la población de mayores del estado de Ceará, de la Región Noreste y de Brasil del año 2008 y presentar el escenario de los indicadores para el año 2020. Métodos: Se trata de un estudio cuantitativo elaborado a partir de los datos poblacionales de la Investigación Nacional por Muestra de Domicilios y de las Proyecciones Poblacionales disponibles en el Instituto Brasileño de Geografía y Estadística. Se estima la prevalencia y la población de mayores con hipertensión y se utiliza el método de Sullivan para calcular la esperanza de vida de personas sin y con hipertensión. Resultados: En los años 2008 y 2020 la prevalencia de hipertensión entre los mayores ha sido superior al 50% para el sexo femenino y el 40% para el sexo masculino así como la proporción de la expectativa de vida a los 60 años a ser vivida con hipertensión observándose valores más elevados para Brasil comparándose con el Noreste y Ceará. En ese periodo se espera una subida del número de mayores con hipertensión en más del 40% de Brasil y alrededor del 30% en el Noreste y Ceará. Conclusión: El ritmo del envejecimiento poblacional contribuye para el crecimiento de la población de mayores con hipertensión. La prevalencia y la expectativa de vida con hipertensión presentan especificidades regionales. En general, la prevalencia de hipertensión es elevada entre los mayores de manera que parte significativa de la expectativa de vida a los 60 años deberá vivir con el problema de hipertensión.

Metabolic and Appetite Effects of Fructose and Glucose in Subjects with Type 1 Diabetes: A Randomized Crossover Clinical Trial.

BACKGROUND: Fructose has been widely used for producing lower post-infusion glucose increase than other carbohydrates, but it seems that it promotes an increase in post-infusion triglycerides. OBJECTIVE: The present study investigated the effects of fructose and glucose in metabolic variables and appetite sensations in patients with type 1 diabetes mellitus (T1DM). METHODS: This is a single-blind, randomized, and crossover study (washout of 1-5 weeks), which evaluated 16 adult T1DM patients, accompanied at University Hospital. After eight hours of overnight fasting, there was an assessment of capillary blood glucose, anthropometric variables, appetite sensations, and laboratory tests (glycemia, lipemia, leptin and glucagon) were conducted. Subsequently, they received 200mL of solutions with water and 75g of crystal fructose or glucose. Appetite sensations and capillary blood glucose were evaluated in different post-infusion times. Blood was drawn after 180 minutes for the laboratory tests. RESULTS: Blood glucose increased after the intake of both solutions, but glucose induced a higher elevation. None of them increased triglycerides or glucagon. Glucagon maintenance was similar among the solutions. Furthermore, both solutions reduced leptin and increased fullness, but only fructose increased the lack of interest in eating sweets. CONCLUSION: Fructose induced a smaller increase in postprandial blood glucose than glucose, without changes in triglycerides and glucagon. In addition, leptin levels and appetite sensations were similar to glucose. Other studies are needed in order to confirm these findings, especially in the long term, so that their use becomes really reliable.

Exploring charge density distribution and electronic properties of hybrid organic-germanium layers.

Band gap tuning and dielectric properties of small organic ligands adsorbed on bidimensional germanium monolayers (germanene) have been investigated using first-principles calculations. We show that the adsorption of these small groups retains the initially stable free-standing pristine buckled structure form. Charge density and chemical bonding analyses show that the ligands are chemisorbed on the germanium layers. Finally, we demonstrate that the dielectric properties of the bare and ligand adsorbed germanene have a large anisotropy. Our findings of a finite gap open a path for the rational design of nanostructures with possible applications in biosensors and solar cells.

Activated carbon obtained from amazonian biomass tailings (acai seed): Modification, characterization, and use for removal of metal ions from water.

Acai seed was used herein as an Amazon biomass waste for the synthesis of activated and modified carbon in order to find a possible use for the large volume of residues generated during the processing of this fruit and to add value to this residue. Activated carbon materials were used to remove Pb2+, Fe2+, and Mg2+ metal ions from water. The efficiency of removal of these ions by the acai seed activated carbon was compared with that by commercial activated carbon. Activated carbon materials were prepared by carbonization and chemical activation using two KOH impregnation ratios, namely 1:1 (ACK1) and 5:1 (ACK5), by mass. These samples were modified by treatment with nitric acid under microwave heating (ACK1-M) and (ACK5-M), respectively. The result of the elemental analysis indicated that this biomass has carbon and sulfur contents of 43.29% and 0.10% wt, respectively. The textural parameters showed that the obtained activated carbon samples presented high surface areas between 1462 and 2774 m2 g-1. Raman analysis revealed the different degrees of graphitization of the activated carbon materials. Boehm titration identified the presence of phenolic, carboxylic, and lactonic groups in samples that were confirmed by Fourier transform infrared spectroscopy. In the metal adsorption tests, ACK5-M showed better removal efficiency, reaching 86% removal for Pb2+, 69% for Fe2+, and 8% for Mg2+in 1 h of contact time; these results were superior to those obtained for commercial carbon. The results indicated that acai seed can be used for the production of activated carbon and can also be used for metal removal.

Therapeutic efficacy of environmental enrichment on behavioral, endocrine, and synaptic alterations in an animal model of maternal immune activation.

Maternal immune activation (MIA) has been identified as a significant risk factor for several neurodevelopmental disorders. We have previously demonstrated that postpubertal environmental enrichment (EE) rescues and promotes resiliency against MIA in male rats. Importantly, EE protocols have demonstrated clinical relevancy in human rehabilitation settings. Applying some of the elements of these EE protocols (e.g. social, physical, cognitive stimulation) to animal models of health and disease allows for the exploration of the mechanisms that underlie their success. Here, using a MIA model, we further investigate the rehabilitative potential of complex environments with a focus on female animals. Additionally, we expand upon some of our previous work by exploring genetic markers of synaptic plasticity and stress throughout several brain regions of both sexes. In the current study, standard housed female Sprague-Dawley rats were challenged with either the inflammatory endotoxin lipopolysaccharide (LPS; 100 µg/kg) or saline (equivolume) on gestational day 15. On postnatal day 50, male and female offspring were randomized into one of three conditions that differed in terms of cage size, number of cage mates (social stimulation) and enrichment materials. Spatial discrimination ability and social behavior were assessed six weeks later. Similar to our previously published work in males, our results revealed that a single LPS injection during mid gestation disrupted spatial discrimination ability in female rats. Postpubertal EE rescued this disruption. On the endocrine level, EE dampened elevations in plasma corticosterone that followed MIA, which may mediate EE's rehabilitative effects in female offspring. Within the prefrontal cortex, hippocampus, amygdala, and hypothalamus, MIA and EE altered the mRNA expression of several genes associated with resiliency and synaptic plasticity in both sexes. Overall, our findings provide further evidence that EE may serve as a therapeutic intervention for MIA-induced behavioral and cognitive deficits. Moreover, we identify some sexually dimorphic molecular mechanisms that may underlie these impairments and their rescue.

Consumption of fructose rich industrialized beverages in patients with biopsy-proven non-alcoholic fatty liver disease: a cross-sectional study

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and liver fibrosis. Recently, consumption of high fructose corn syrup (HFCS) has been associated with NAFLD development. OBJECTIVE: The aim of this study was to investigate the relationship between consumption of HFCS and NAFLD associated metabolic factors and disease progression. METHODS: This cross-sectional study included 51 patients with biopsy-proven NAFLD who underwent biochemical tests, anthropometrical assessment and full-day dietary evaluation including industrialized beverages quantification. RESULTS: Individuals were 80% female, with 54 ± 12 years old, 96% with central obesity, 75% with insulin resistance or diabetes mellitus and were separated according to industrialized beverage intake: < 7 and ≥ 7 coups/week (i.e., daily). Daily consumption of HFCS was associated with obesity (P = 0.04), hypertriglyceridemia (P = 0.05), higher serum triglycerides (P = 0.03) and VLDL (P = 0.01). There was a significant correlation (R = 0.29; P = 0.04) between consumption of industrialized beverages and increased serum triglycerides. We found no association between daily HFCS intake and NASH diagnosis or presence of fibrosis. CONCLUSION: Excessive consumption of HFCS in industrialized beverages was associated with obesity, hypertriglyceridemia and high levels of blood triglycerides in patients with NAFLD

No disponible

Acetylation of Eugenol over 12-Molybdophosphoric Acid Anchored in Mesoporous Silicate Support Synthesized from Flint Kaolin.

A new prepared catalyst, 12-molybdophosphoric acid (HPMo) anchored to the mesoporous aluminosilicate AlSiM, synthesized from Amazon kaolin, was characterized and used as a heterogeneous acid catalyst for the production of eugenyl acetate by acetylation of eugenol with acetic anhydride. The effect of various reaction parameters, such as catalyst concentration, eugenol/acetic anhydride molar ratio, temperature and reaction time, was studied to optimize the conditions of maximum conversion of eugenol. The kinetics studies showed that in eugenol acetylation, the substrate concentration follows a first order kinetics. The results of activation energy was 19.96 kJ mol-1 for HPMo anchored to AlSiM. The reuse of the catalyst was also studied and there was no loss of catalytic activity after four cycles of use (from 99.9% in the first cycle to 90% in the fifth cycle was confirmed), and an excellent stability of the material was observed. Based on catalytic and kinetic studies, HPMo anchored to AlSiM is considered an excellent catalyst.

Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial.

OBJECTIVE: To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. SUBJECTS AND METHODS: The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. RESULTS: Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. CONCLUSIONS: Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Structural and topological phase transitions induced by strain in two-dimensional bismuth.

We employ first-principles density-functional calculations to study structural and topological electronic transitions in two-dimensional bismuth layers. Our calculations reveal that a free-standing hexagonal bismuthene phase (the most stable one in the absence of strain) should become thermodinamically unstable against transformation to a putative 'pentaoctite' phase (composed entirely of pentagonal and octagonal rings), under biaxial tensile strain. Moreover, our results indicate that 2D bismuth layers in the pentaoctite phase should undergo a topological electronic phase transition under either a biaxial or uniaxial tensile strain. More specifically, at its equilibrium lattice parameters the pentaoctite lattice is a topologically trivial system with a direct band gap. Strain-induced parity inversion of valence and conduction bands is obtained, and the pentaoctite structure undergoes a transition to a topological-insulator phase at a biaxial tensile strain of 5%. In the case of uniaxial tensile strains, the topological transition happens at a tensile strain of 6% along the armchair direction of the pentaoctite lattice, and at a 5% tensile strain in the zigzag direction. Our study indicates that 2D bismuth layers may prove themselves a rich platform to realize topologically non-trivial 2D materials upon strain engineering.

Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial

ABSTRACT Objective To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. Subjects and methods The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. Results Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. Conclusions Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.

Cost of illness and program of dengue: A systematic review.

BACKGROUND: Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS: This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS: A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION: This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.

Quantitativo Microbiano em Superfícies e Equipamentos de uma Unidade de Pronto Atendimento da Região Metropolitana de Curitiba ­ PR / Microbial Quantification in Surfaces and Equipment of the Service Unit of the Metropolitan Region of Curitiba ­ PR

Objetivo: quantificar o número de unidades formadoras de colônias por cm2 (UFC/cm2 ) por meio da contagem de colônias bacterianas que se fazem presentes nas superfícies e nos equipamentos de salas de uma Unidade de Pronto Atendimento da Região Metropolitana de Curitiba ­ PR. Material e Métodos: trata-se de um estudo quantitativo realizado em uma Unidade Pronto Atendimento na Região Metropolitana de Curitiba ­ PR. Realizou-se amostragem por conveniência, sendo incluídos 14 superfícies inanimadas (bancadas, leitos) e 6 equipamentos (computadores, válvulas, desfibrilador e eletrocardiógrafo) totalizando 20 amostras. Para coleta das amostras, utilizou-se a técnica de contato que mede a carga microbiana através da placa Rodac® e para a contagem das colônias, utilizou-se o LF Equipamento (Contador de Colônias Eletrônico). Resultados: no grupo de equipamentos 66,6% corresponderam aos níveis aceitáveis de colônias; os níveis satisfatórios e não satisfatórios corresponderam ambos, a 16,6%. Enquanto no grupo de superfícies os resultados apontam o mesmo percentual em níveis satisfatórios e não satisfatórios, perfazendo um total de 35,71% e 28,57% encontraram-se dentro dos níveis aceitáveis. Conclusão: os resultados do estudo apresentam valores dentro dos parâmetros pelo Protocolo de Microbiologia Ambiental do quantitativo de colônias presentes em superfícies e equipamentos. Com os resultados obtidos sugere-se que os gestores possam incorporar estratégias educacionais que visem reduzir os índices de contaminação dos profissionais que ali prestam assistência, como também da clientela assistida. (AU)

Objective: to quantify the number of Colony Forming Units per cm2 (CFU/cm2) by counting bacterial colonies that are present on the surfaces and equipment of rooms of an Emergency Care Unit in the metropolitan region of Curitiba - PR. Material and methods: this is a quantitative study carried out in a Ready Care Unit in the metropolitan region of Curitiba - PR. Sampling was carried out by convenience, including 14 inanimate surfaces (benches, beds) and 6 equipments (computers, valves, defibrillator and electrocardiograph) totaling 20 samples. To collect the samples, the contact technique was used to measure the microbial load through the Rodac® plate and for the counting of the colonies, the LF Equipment (Electronic Colony Counter) was used. Results: in the equipment group, 66.6% corresponded to acceptable levels of colonies; the satisfactory and unsatisfactory levels corresponded to 16.6%. While in the group of surfaces the results indicate the same percentage in satisfactory and unsatisfactory levels, making a total of 35.71%; and 28.57% were within acceptable levels. Conclusion: the results of the study presented values within the parameters by the Protocol of Environmental Microbiology of the quantitative of colonies present in surfaces and equipment. With the results obtained, it is suggested that managers can incorporate educational strategies aimed at reducing the contamination rates of the professionals who provide assistance, as well as the assisted clientele. (AU)

HOPX homeobox methylation in differentiated thyroid cancer and its clinical relevance.

BACKGROUND: The inactivation of the tumor-suppressor homeodomain-only protein X (HOPX) usually involves promoter methylation in several cancer types. This study aimed to investigate the HOPX-ß mRNA expression and promoter methylation and their clinical relevance in differentiated thyroid cancer (DTC). PATIENTS AND METHODS: Clinicopathological data and paraffin-embedded thyroid tumor tissues from 21 patients with DTC and 6 with benign tumors (T) and their non-tumor parenchyma (NT) were investigated. Tumor cell lines (FTC238, FTC236 and WRO) were treated with demethylating agent. HOPX-ß mRNA expression was assessed by qRT-PCR and methylation status by Q-MSP. Thyroid cancer data from Cancer Genome Atlas (TCGA) was also collected. RESULTS: HOPX-ß mRNA re-expression in two cell lines treated with demethylating agent was observed concomitantly with reduced promoter methylation. Reduced mRNA expression in T group compared to their NT was observed, and reduced protein expression in T compared to NT was observed in three cases. Low mRNA expression with high methylation status was detected in 6/14 DTC samples. High methylation status was associated with older age at diagnosis, recurrent or progressive disease and with the presence of new neoplasm event post initial therapy while hyper-methylation correlated with worse overall survival, worse disease-free status and older age. CONCLUSION: A moderate coupling of downregulation of HOPX-ß mRNA expression in DTC followed by high HOPX-ß promoter methylation was observed however; high HOPX promoter methylation status was associated with the worse prognosis of DTC patients.

Complex Environmental Rearing Enhances Social Salience and Affects Hippocampal Corticotropin Releasing Hormone Receptor Expression in a Sex-Specific Manner.

Methods for understanding the neurocircuitry of ethologically relevant behaviors have advanced substantially; however renovations to standard animal laboratory housing, in the form of enhanced enrichment, have lagged behind. This is despite evidence that environmental enrichment (EE) reduces stress, stereotypy, and promotes healthy species typical behaviors. While many scientists express interest for increased EE as a standard for animal caging systems, there are concerns that its effects on brain, behavior, and cognition are not well characterized. In the present study, male and female Sprague-Dawley rats were housed for six weeks in either EE, Colony Nesting (CN), or Standard Housing (SD) conditions. We show that adolescent exposure to environmental complexity changed the dynamics of social interactions, sensory processing, and underlying basal stress neurocircuitry, in a sex- and enrichment-type-dependent manner. Specifically, EE and CN increased prosocial engagement and the social saliency of male and female rats while the profile of hippocampal Crhr2 expression was affected only in EE males. Hippocampal Crh was associated with anxiety-like behavior in SD males - this did not extend to EE or CN groups, nor to females. Observations such as these are an important consideration for the validity of translational research investigating the neurocircuitry of stress resiliency, and for understanding the mechanisms of psychiatric disorders. Future work must focus on characterizing how individual environmental enhancements (e.g. novelty, social enrichment, physical activity) shape phenotypic differences, how they vary as a function of species, strain and sex, and (if warranted) how to meaningfully implement this knowledge into biomedical research designs.

Bilayers of Ni3C12S12 and Pt3C12S12: graphene-like 2D topological insulators tunable by electric fields.

In the present work we predict, through first-principles calculations, that bilayers of the recently synthesized Ni3 [Formula: see text] [Formula: see text] and Pt3 [Formula: see text] [Formula: see text] layered materials are topological insulators upon electron doping, and that their topological insulator properties can be modulated by the application of electric fields with magnitudes achievable in devices. The electronic structures of both bilayers are characterized by spin-orbit split graphene-like bands, with gap magnitudes that are three orders of magnitude larger than graphene's. In ribbon geometries, chiral edge modes develop at each side with band dispersions similar to that of Kane-Mele graphene model. Surprisingly, the edge states' spin-propagation locking occurs even for very thin ribbons. We also find that the response of the electronic structure of both materials to applied electric fields are similar to both graphene and the Kane-Mele model with a Rashba term. All these findings indicate that these bilayer systems can be considered as large-spin-orbit graphene analogues with a strong sensitivity to applied electric fields.

Topologically Protected Metallic States Induced by a One-Dimensional Extended Defect in the Bulk of a 2D Topological Insulator.

We report ab initio calculations showing that a one-dimensional extended defect generates topologically protected metallic states immersed in the bulk of two-dimensional topological insulators. We find that a narrow extended defect, composed of periodic units consisting of one octagonal and two pentagonal rings (a 558 extended defect), embedded in the hexagonal bulk of a bismuth bilayer, introduces two pairs of one-dimensional counterpropagating helical-Fermion electronic bands with the opposite spin-momentum locking characteristic of the topological metallic states that appear at the edges in two-dimensional topological insulators. Each one of these pairs of helical-Fermion bands is localized, respectively, along each one of the zigzag chains of bismuth atoms at the core of the 558 extended defect, and their hybridization leads to the opening of very small gaps (6 meV or less) in the helical-Fermion dispersions of these defect-related modes. We discuss the connection between the defect-induced metallic modes and the helical-Fermion edge states that occur on bismuth bilayer ribbons.