Safety and efficacy of benralizumab in elderly subjects with severe asthma.

INTRODUCTION: The prevalence of asthma in adults >65 years old is approximately 12-14%, and 10% have severe asthma. A higher mortality rate is observed in subjects with asthma >65 years old and especially >80 years old. OBJECTIVE: To analyze the effectiveness and safety of at least three doses of benralizumab in a subgroup of elderly subjects (>65 years old) with uncontrolled severe eosinophilic asthma in real-life conditions. METHODS: This was a retrospective multicenter study (AUTOBENRA study) conducted in 9 hospitals that included 72 patients aged >18 years old with uncontrolled severe asthma based on the Spanish Asthma Guidelines who were treated with at least three doses of benralizumab, self-administered at home since before April 30, 2021. The recruitment period ended on October 1, 2021. Written consent was obtained before the study commencement. In this subanalysis, we compared the results between patients >65 years old and patients <65 years old. RESULTS: A total of 72 subjects with severe asthma were screened, and 54 were included (MD: 57.3 ± 10 years old). There were 12 subjects aged >65 years old [MD: 69.8 ± 4.3 years old (minimum: 65 years old; maximum: 83 years old)]. Subjects >65 years old experienced statistically significant improvement in lung function, ACT and mini-AQLQ with benralizumab. Additionally, 9 patients (75%) experienced no asthma exacerbation (p = 0.0047), half (3/6) were able to stop OCS (p = 0.08), and no adverse effects with benralizumab were reported during the 20 months of follow-up. CONCLUSIONS: In patients aged >65 years old, benralizumab was an effective and safe therapy for severe eosinophilic asthma in our study, with no significant differences from the younger subgroup. This is especially important since they are a group with numerous comorbidities, medications and worse quality of life.

Cuidar com musica - Intervenção do enfermeiro especialista em enfermagem de saude materna e obstetrica, na promoçao do bem estar da mulher, no trabalho de parto / Caring with music - Intervention by nurses specializing in maternal and obstetric health nursing, in promoting women's well-being during labor

O uso da música no trabalho de parto, constitui uma poderosa ferramenta na promoção do bem-estar da mulher. Consiste num método não farmacológico e uma intervenção autónoma da enfermagem, que vai enriquecer a prestação de cuidados do EESMO, contribuindo para uma experiência de parto positiva. Com o objetivo de mapear a evidência científica sobre o uso da música, como cuidado, na promoção do bem-estar da mulher no trabalho de parto, foi realizada uma Scoping Review partindo da questão "Quais as vantagens do uso da música, como cuidado, no trabalho de parto, na perspetiva do EESMO/ Parturiente?". Na pesquisa realizada na EBSCOhost obtiveram-se 9 artigos, dos quais emergiram temáticas pertinentes relativamente ao uso da música no trabalho de parto. Os resultados apontam como vantagens: alívio da dor/ desconforto; promoção do relaxamento; redução da ansiedade/ stress; e bem-estar físico e psicológico. Face à existência de pouca evidência científica de origem portuguesa, sugere-se um aprofundamento do tema ao nível da investigação bem como da formação.

The use of music, during labor, constitutes a powerful tool in promoting women's well-being. It consists of a non-pharmacological method and an autonomous nursing intervention, which will enrich the provision of care of EESMO, contributing to a positive birth experience. With the aim of mapping the scientific evidence on the use of music, as care, in promoting the well-being of women in labor, a Scoping Review was carried out based on the question "What are the advantages of using music, as care, in labor, from the perspective of EESMO/ Parturient?". In the research carried out at EBSCOhost, 9 articles were obtained, from which pertinent themes emerged regarding the use of music in labor. The results point to the following advantages: pain/discomfort relief, promoting relaxation; reduction of anxiety/ stress; and physical and psychological well-being. Given the existence of little scientific evidence of portuguese origin, it is suggested that the topic be further explored at the level of research as well as training.

Shared Decision-Making in Allergen Immunotherapy (AIT) Options Using a Questionnaire for Respiratory Allergic Patients: A Delphi Consensus Study.

Purpose: The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach. Patients and Methods: A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on "agreement" on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions). Conclusion: This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.

Influence of baseline characteristics and stratification level of patients living with HIV on pharmaceutical interventions developed according to the Capacity-Motivation-Opportunity methodology.

OBJECTIVE: In recent years the therapeutic approach to patients with HIV has gone from being multidisciplinary to multidimensional, being vital to know the different aspects that define patients in order to outline the best care interventions for each patient. The aim of this study was to determine the influence of the individual characteristics (demographic and clinical, pharmacotherapeutic and HIV infection control data) of patients with HIV being followed up using the Capacity-Motivation-Opportunity methodology on the pharmaceutical interventions performed. METHODS: A single-centre prospective observational study was conducted between February 2019 and January 2020. Patients with HIV aged ≥18 years on antiretroviral treatment and who were receiving pharmaceutical care based on the Capacity-Motivation-Opportunity methodology were included. Demographic, clinical and pharmaceutical variables and HIV infection control data were registered at baseline. To identify the independent variables associated with pharmaceutical interventions, a univariate logistic regression was performed. RESULTS: Sixty-five patients were included in the study. A total of 129 pharmaceutical care consultations were performed and 909 pharmaceutical interventions were carried out: 503/909 (55.3%) capacity interventions, 381/909 (41.9%) motivation interventions, 25/909 (2.8%) opportunity interventions. The educational level had a significant influence on the opportunity (p=0.025) and transversal training interventions performed (p=0.001). A relationship was found between the antiretroviral therapy received and the development of safety interventions (p=0.037). The presence of polypharmacy significantly influenced concomitant review and validation (p=0.030) and motivation interventions (p=0.041). Adherence of ≥95% had a significant influence on the motivation interventions carried out (p=0.038). Stratification significantly influenced adherence interventions (p=0.033). The sex and age of the patients, as well as their toxic habits, presence of comorbidities, CD4+ cell count and HIV viral load, did not significantly influence the pharmaceutical interventions performed (p>0.05). CONCLUSIONS: Our study has elucidated the pharmaceutical interventions carried out in a pharmaceutical care consultation for patients with HIV based on the Capacity-Motivation-Opportunity model and ascertained the individual characteristics (demographic and clinical, pharmacotherapeutic and HIV infection control data) that may have conditioned them.

Off-label Use of Oral Immunotherapy for Rhinoconjunctivitis and Asthma due to Grass Pollen: A Safe and Effective Alternative in Patients over 65 Years Old: A Series of Case Reports.

INTRODUCTION: Allergic rhinoconjunctivitis and asthma are the most common IgE-mediated diseases worldwide. Allergen-specific immunotherapy (AIT) is currently the only modifying treatment for these IgE-mediated diseases in both children and adults. Subcutaneous immunotherapy is widely used, but in patients over 65 years old, there may be an increased risk of adverse reactions and a worse response to treatment. Oral immunotherapy (OIT) has been proven to be effective and safe, but currently, in most countries, it has been licensed only for patients up to 65 years old based on its technical datasheet. So far, no studies on the efficacy and safety of this type of immunotherapy in patients older than 65 years old have been published. CASE PRESENTATION: We present four patients older than 65 years old with a diagnosis of moderate seasonal rhinoconjunctivitis and moderate-persistent seasonal pollen-induced asthma. Off-label use of oral immunotherapy (OIT) for grass pollen was prescribed due to the severity of their rhinoconjunctivitis symptoms and the worsening of asthma symptoms during the spring. Improvement in the rhinoconjunctivitis and asthma symptoms was reported by all patients since the first spring season and was maintained during the following two years of follow-up. There were no systemic reactions, and only two patients initially had self-limiting oral pruritus. CONCLUSION: Oral immunotherapy for pollens appears to be a convenient, effective, and safe option in older patients (>65 years) with comorbidities after a three-year treatment. This is, to the best of our knowledge, the first report on the off-label use of OIT in patients over 65 years old with symptoms of allergic rhinoconjunctivitis and asthma.

Alström syndrome: Two clinical cases with two novel pathogenic variants.

PURPOSE: To report two clinical cases of Alström syndrome (AS) with novel pathogenic variant of the ALMS1 gene not previously reported. CASE DESCRIPTION: Patient 1 was a 6-year-old female presenting with poor vision. Ophthalmic examination only showed a visual field (VF) with diffusely decreased sensitivity in both eyes. At age of 15, vision and ophthalmic examination remain stable. Patient 2 was a 2-year-old male with poor vision, photophobia, and nystagmus. ERG showed a severe decrease in cone and rod responses. At age of 6, his vision is lower than 0.1 (decimal scale) and VF is severely constricted. Both of them presented with dilated cardiomyopathy in their first's months of life and patient 2 developed sensorineural deafness along with follow-up. Research genetic testing revealed two loss-of-function heterozygous genetic variants in the ALMS1 gene in both patients, so the diagnosis of AS was made. CONCLUSIONS: AS is a rare disease caused by pathogenic variants of ALMS1 gene that causes ocular manifestations in almost 100% of patients. There are many genetic variants of AMLS1 described, but novel pathogenic variants can still be found. Ophthalmologists play an important role in the diagnosis, and AS should be included in the differential diagnosis when retinal dystrophy is suspected.

Reliability, Satisfaction and Effectiveness of Benralizumab Home Self-Administration in Patients with Severe Eosinophilic Asthma in Real-World Practice: The Auto-Benra Study.

Introduction: The increase in drugs available for severe uncontrolled asthma and the lifestyle of these patients make it necessary to implement self-administration programs of these therapies at home. Benralizumab, a monoclonal antibody targeting IL5R, was authorized in Spain for poorly controlled severe eosinophilic asthma. The possibility of administration at home was approved in March 2020 in Spain. The aim of the Auto-Benra study was to evaluate the usability and satisfaction of the benralizumab prefilled syringe and autoinjector and assessing the effectivity of these devices in uncontrolled severe eosinophilic asthma (SEA) in home-self administration. Methods: This is a retrospective, observational multicenter study uncontrolled SEA patients treated with benralizumab at least with 3 doses self-administered at home before April 30, 2021. Reliability and satisfaction with benralizumab at home were evaluated with subcutaneous administration assessment questionnaire (SQAAQ) and visual analogic scales (VAS). Effectiveness was evaluated in all patients with asthma control test (ACT), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), annual exacerbation rate, oral corticosteroid treatment (OCS) and asthma-related hospitalizations and emergency visits. Results: Fifty-four patients across 9 hospitals in Spain were included. The mean SQAAQ score was 6.89 (±0.16) points. Patients and their caregivers and doctors report excellent satisfaction by VAS, with no differences between benralizumab devices used (prefilled syringe and autoinjector). Severe exacerbation rate decreased by 65% (p = 0.0007) after benralizumab treatment. ACT score improved on average 6.27 ± 5.35 points (p < 0.0001) and the mean MiniAQLQ increased up to 1.58 ± 1.47 points (p < 0.0001). Twenty-four patients were OCS-dependent and at the end of study 14 patients get complete OCS withdrawal. Conclusion: AUTO-BENRA study supports the use of benralizumab at home given the excellent results of satisfaction and usability by patients and their caregivers.

No evidence that relatedness or familiarity modulates male harm in Drosophila melanogaster flies from a wild population.

Sexual selection frequently promotes the evolution of aggressive behaviors that help males compete against their rivals, but which may harm females and hamper their fitness. Kin selection theory predicts that optimal male-male competition levels can be reduced when competitors are more genetically related to each other than to the population average, contributing to resolve this sexual conflict. Work in Drosophila melanogaster has spearheaded empirical tests of this idea, but studies so far have been conducted in laboratory-adapted populations in homogeneous rearing environments that may hamper kin recognition, and used highly skewed sex ratios that may fail to reflect average natural conditions. Here, we performed a fully factorial design with the aim of exploring how rearing environment (i.e., familiarity) and relatedness affect male-male aggression, male harassment, and overall male harm levels in flies from a wild population of Drosophila melanogaster, under more natural conditions. Namely, we (a) manipulated relatedness and familiarity so that larvae reared apart were raised in different environments, as is common in the wild, and (b) studied the effects of relatedness and familiarity under average levels of male-male competition in the field. We show that, contrary to previous findings, groups of unrelated-unfamiliar males were as likely to fight with each other and harass females than related-familiar males and that overall levels of male harm to females were similar across treatments. Our results suggest that the role of kin selection in modulating sexual conflict is yet unclear in Drosophila melanogaster, and call for further studies that focus on natural populations and realistic socio-sexual and ecological environments.

Lack of Major Involvement of Common CYP2C Gene Polymorphisms in the Risk of Developing Cross-Hypersensitivity to NSAIDs.

Cross-hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a relatively common, non-allergic, adverse drug event triggered by two or more chemically unrelated NSAIDs. Current evidence point to COX-1 inhibition as one of the main factors in its etiopathogenesis. Evidence also suggests that the risk is dose-dependent. Therefore it could be speculated that individuals with impaired NSAID biodisposition might be at increased risk of developing cross-hypersensitivity to NSAIDs. We analyzed common functional gene variants for CYP2C8, CYP2C9, and CYP2C19 in a large cohort composed of 499 patients with cross-hypersensitivity to NSAIDs and 624 healthy individuals who tolerated NSAIDs. Patients were analyzed as a whole group and subdivided in three groups according to the main enzymes involved in the metabolism of the culprit drugs as follows: CYP2C9, aceclofenac, indomethacin, naproxen, piroxicam, meloxicam, lornoxicam, and celecoxib; CYP2C8 plus CYP2C9, ibuprofen and diclofenac; CYP2C19 plus CYP2C9, metamizole. Genotype calls ranged from 94 to 99%. No statistically significant differences between patients and controls were identified in this study, either for allele frequencies, diplotypes, or inferred phenotypes. After patient stratification according to the enzymes involved in the metabolism of the culprit drugs, or according to the clinical presentation of the hypersensitivity reaction, we identified weak significant associations of a lower frequency (as compared to that of control subjects) of CYP2C8*3/*3 genotypes in patients receiving NSAIDs that are predominantly CYP2C9 substrates, and in patients with NSAIDs-exacerbated cutaneous disease. However, these associations lost significance after False Discovery Rate correction for multiple comparisons. Taking together these findings and the statistical power of this cohort, we conclude that there is no evidence of a major implication of the major functional CYP2C polymorphisms analyzed in this study and the risk of developing cross-hypersensitivity to NSAIDs. This argues against the hypothesis of a dose-dependent COX-1 inhibition as the main underlying mechanism for this adverse drug event and suggests that pre-emptive genotyping aiming at drug selection should have a low practical utility for cross-hypersensitivity to NSAIDs.

Vitreociliary Block in a Patient With Uveitis and Previous Laser Posterior Capsulotomy.

PURPOSE: To report a case of vitreociliary block (VCB) six months after a laser posterior capsulotomy (LPC). CASE REPORT: A 25-year-old man with uveitis, retinal vasoproliferative tumor, cataract, and acute angle-closure glaucoma due to pupillary seclusion, which required laser iridotomies, implantation of an Ahmed valve, phacoemulsification, and LPC. Six months after capsulotomy, he presented a generalized flattening of the anterior chamber (AC) and ocular hypertension, with patent iridotomies. Hyperechoic anterior hyaloid and hypoechoic spaces in the vitreous were seen in ultrasound imaging. The VCB did not respond to pharmacological treatment and was solved immediately after laser hyaloidotomy. CONCLUSION: There are three cases of VCB after LPC described in the literature. Our patient presented a chronic inflammatory process that generated an inflammatory membrane at the level of the anterior hyaloid with adhesion to the ciliary processes, causing posterior misdirection of the aqueous humor, decreased permeability of the anterior hyaloid, and finally, VCB.

Comprehensive analysis of the clinicopathological features, targetable profile, and prognosis of mucinous adenocarcinoma of the lung.

PURPOSE: The clinicopathological or genetic features related to the prognosis of mucinous adenocarcinoma are unknown because of its rarity. The clinicopathological or targetable features were investigated for better management of patients with mucinous adenocarcinoma of the lung. METHODS: We comprehensively evaluated the clinicopathological and genetic features of 60 completely resected mucinous lung adenocarcinomas. Targetable genetic variants were explored using nCounter and polymerase chain reaction, PD-L1 and TTF-1 expression were evaluated using immunohistochemistry. We analyzed the prognostic impact using the Kaplan-Meier method and log-rank test. RESULTS: Of the 60 enrolled patients, 13 (21.7%) had adenocarcinoma in situ/minimally invasive adenocarcinoma, and 47 (78.3%) had invasive mucinous adenocarcinoma (IMA). Fifteen patients (25%) showed a pneumonic appearance on computed tomography (CT). CD74-NRG1 fusion, EGFR mutations, and BRAF mutation were detected in three (5%), four (6.7%), and one (1.7%) patient(s), respectively. KRAS mutations were detected in 31 patients (51.7%). Two patients (3.5%) showed immunoreactivity for PD-L1. No in situ or minimally invasive cases recurred. IMA patients with pneumonic appearance had significantly worse recurrence-free survival (RFS) and overall survival (OS) (p < 0.001). Furthermore, IMA patients harboring KRAS mutations had worse RFS (p = 0.211). Multivariate analysis revealed that radiological pneumonic appearance was significantly associated with lower RFS (p < 0.003) and OS (p = 0.012). KRAS mutations served as an unfavorable status for RFS (p = 0.043). CONCLUSION: Mucinous adenocarcinoma had a low frequency of targetable genetic variants and PD-L1 immunoreactivity; however, KRAS mutations were frequent. Pneumonic appearance on CT imaging and KRAS mutations were clinicopathological features associated with a worse prognosis.

Deep sequencing of prostaglandin-endoperoxide synthase (PTGE) genes reveals genetic susceptibility for cross-reactive hypersensitivity to NSAID.

BACKGROUND AND PURPOSE: Cross-reactive hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) is a relatively common adverse drug event caused by two or more chemically unrelated drugs and that is attributed to inhibition of the COX activity, particularly COX-1. Several studies investigated variations in the genes coding for COX enzymes as potential risk factors. However, these studies only interrogated a few single nucleotide variations (SNVs), leaving untested most of the gene sequence. EXPERIMENTAL APPROACH: In this study, we analysed the whole sequence of the prostaglandin-endoperoxide synthase genes, PTGS1 and PTGS2, including all exons, exon-intron boundaries and both the 5' and 3' flanking regions in patients with cross-reactive hypersensitivity to NSAIDs and healthy controls. After sequencing analysis in 100 case-control pairs, we replicated the findings in 540 case-control pairs. Also, we analysed copy number variations for both PTGS genes. KEY RESULTS: The most salient finding was the presence of two PTGS1 single nucleotide variations, which are significantly more frequent in patients than in control subjects. Patients carrying these single nucleotide variations displayed a significantly and markedly lower COX-1 activity as compared to non-carriers for both heterozygous and homozygous patients. CONCLUSION AND IMPLICATIONS: Although the risk single nucleotide variations are present in a small proportion of patients, the strong association observed and the functional effect of these single nucleotide variations raise the hypothesis of genetic susceptibility to develop cross-reactive NSAID hypersensitivity in individuals with an impairment in COX-1 enzyme activity.

Functional Endoscopic Sinus Surgery for Nasal Polyposis in Asthma PATIENTS: Impact on Bronchial Inflammation / Cirugía endoscópica nasosinusal para la poliposis nasal en pacientes con asma: impacto en la inflamación bronquial

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A influência da autoestima no consumo de substâncias, ansiedade, stresse e depressão nos estudantes da licenciatura de enfermagem / The influence of self-esteem on substance use, anxiety, stress and depression in undergraduate nursing students

As transições suscitam diferentes emoções que surgem muitas das vezes pelas dificuldades encontradas nos próprios processos de transição e das situações que as originam, podendo causar instabilidade, alterações na autoestima, mudanças no desempenho de papéis, ansiedade, depressão e insegurança, até que encontre um novo equilíbrio (Tavares, 2014). Esta investigação propôs-se determinar a influência da autoestima no consumo de substâncias, ansiedade, depressão e stresse nos estudantes do ensino superior com o intuito de sensibilizar para a possível necessidade de intervenção no âmbito da saúde mental e psiquiatria e particularmente do Enfermeiro Especialista em Saúde Mental e Psiquiatria (EESMP), assumindo este um papel essencial na promoção da saúde e na prevenção da doença. Este estudo, descritivo-correlacional e transversal, utiliza como instrumento de recolha de dados o ASSIST ­ Alcohol Smoking and Substance Involvement Screening Test, EADS- 21 ­ Escalas de Ansiedade, Depressão e Stresse versão de 21 itens e RSES ­ Rosenberg Self-esteem Scale (escalas devidamente validadas para a população portuguesa). Utiliza uma amostra constituída por 66 estudantes do 1º ano da licenciatura em enfermagem. Os resultados evidenciaram que: os estudantes com idades superiores apresentam uma autoestima mais alta; a autoestima correlaciona-se de modo muito significativo e inverso com o stresse, depressão e ansiedade; a autoestima correlaciona-se significativamente e inversamente com o risco de consumo de ansiolíticos/sedativos/hipnóticos; a autoestima apresenta uma correlação estatisticamente significativa com o risco de consumo de estimulantes do tipo anfetamina e de outras substâncias. Estes resultados evidenciam que existe efetivamente campo de intervenção no âmbito da saúde mental e psiquiatria e especificamente para o Enfermeiro Especialista em Saúde Mental e Psiquiatria.

Transitions evoque diferente emotions that often arise from the difficulties found in the transition processes themselves and from the situations that originate them, wich can cause instability, changes in self-esteem, changes in role performance, anxiety, depression and insecurity, until a new balance is found (Tavares, 2014). This investigation aimed to determine the influence of self-esteem on substance use, anxiety, depression and stress in univeristy students in order to raise awareness of the possible need for intervention in the field of mental health and psychiatry and particulary the Specialist Nurse in Mental Health and Psychiatry, assuming an essential role in health promotion and disease prevention. This descreptive-correlational and cross-sectional study uses ASSIST ­ Alcohol Smoking and Substance Involvement Screening Test, EADS-21 ­ Anxiety, Depession and Stress Scales 21-item version and RSES ­ Rosenberg Self-esteem Scale (scales properly validated as a data collection instrument for the Portuguese population). It uses a sample consisting of 66 students from the 1st year of the nursing degree. The results showed that: older students have a higher self-esteem; self-esteem correlates in a very significant and inverse way with stress, depression and anxiety; self-esteem correlates significantly and inversely with the risk of consumption of anxiolytics/sedatives/hypnotics; self-esteem has a statistically significant correlation with the risk of consuming amphetamine-type stimulants and other substances. These results show that there is an effective field of intervention in the scope of mental health and psychiatry and specifically for the Nurse Specialist in Mental Health and Psychiatry.

A influência da autoestima no consumo de substâncias, ansiedade, stresse e depressão nos estudantes da licenciatura de enfermagem / The influence of self-esteem on substance use, anxiety, stress and depression in undergraduate nursing students

As transições suscitam diferentes emoções que surgem muitas das vezes pelas dificuldades encontradas nos próprios processos de transição e das situações que as originam, podendo causar instabilidade, alterações na autoestima, mudanças no desempenho de papéis, ansiedade, depressão e insegurança, até que encontre um novo equilíbrio (Tavares, 2014). Esta investigação propôs-se determinar a influência da autoestima no consumo de substâncias, ansiedade, depressão e stresse nos estudantes do ensino superior com o intuito de sensibilizar para a possível necessidade de intervenção no âmbito da saúde mental e psiquiatria e particularmente do Enfermeiro Especialista em Saúde Mental e Psiquiatria (EESMP), assumindo este um papel essencial na promoção da saúde e na prevenção da doença. Este estudo, descritivo-correlacional e transversal, utiliza como instrumento de recolha de dados o ASSIST ­ Alcohol Smoking and Substance Involvement Screening Test, EADS- 21 ­ Escalas de Ansiedade, Depressão e Stresse versão de 21 itens e RSES ­ Rosenberg Self-esteem Scale (escalas devidamente validadas para a população portuguesa). Utiliza uma amostra constituída por 66 estudantes do 1º ano da licenciatura em enfermagem. Os resultados evidenciaram que: os estudantes com idades superiores apresentam uma autoestima mais alta; a autoestima correlaciona-se de modo muito significativo e inverso com o stresse, depressão e ansiedade; a autoestima correlaciona-se significativamente e inversamente com o risco de consumo de ansiolíticos/sedativos/hipnóticos; a autoestima apresenta uma correlação estatisticamente significativa com o risco de consumo de estimulantes do tipo anfetamina e de outras substâncias. Estes resultados evidenciam que existe efetivamente campo de intervenção no âmbito da saúde mental e psiquiatria e especificamente para o Enfermeiro Especialista em Saúde Mental e Psiquiatria.

Evidências preliminares de validade da Escala de Projetos de Vida para Adolescentes / Preliminary evidence of validity for the Purpose in Life Scale for Adolescents / Evidencias preliminares de validez de la Escala de Proyectos de Vida para Adolescentes

O objetivo deste estudo é investigar as evidências de validade da Escala de Projetos de Vida para Adolescentes (EPVA) por meio de sua estrutura interna e da fidedignidade de seus fatores. A amostra foi composta por 352 estudantes com faixa etária entre 14 a 17 anos matriculados em escolas públicas e particulares de Campinas e região. As análises realizadas mostraram evidências de validade de estrutura interna da EPVA por meio da análise fatorial exploratória com uma solução fatorial composta por cinco fatores: religiosidade, estudo, aspirações positivas, bens materiais e relacionamentos afetivos. Todos os cinco fatores apresentaram coeficientes alfa superiores a 0,70. Conclui-se que a EPVA é um intrumento com propriedades psicométricas aceitáveis e que pode ser usado em amostras de adolescentes. (AU)

The aim of this study was to investigate the evidence of validity for the Purpose in Life Scale for Adolescents (EPVA) through its internal structure and the reliability of its factors. The sample consisted of 352 students aged between 14 and 17 years, enrolled in public and private schools in Campinas and the region. Exploratory factor analysis showed evidence of validity for the internal structure of the EPVA, presenting a structure composed of five factors: religiosity, study, positive aspirations, material goods and affective relationships. All five factors presented alpha coefficients above 0.70. It was concluded that the EPVA is an instrument with acceptable psychometric properties that can be used in samples of adolescents. (AU)

El objetivo de este estudio es investigar las evidencias de validez de la Escala de Proyectos de Vida para Adolescentes (EPVA) a través de su estructura interna y de la confiabilidad de sus factores. La muestra fue compuesta por 352 estudiantes de edades comprendidas entre 14 y 17 años inscritos en institutos públicos y privados en Campinas y proximidades. Los análisis realizados mostraron evidencias de validez de la estructura interna de la EPVA a través del análisis factorial exploratorio con una solución factorial compuesta por cinco factores: religiosidad, estudio, aspiraciones positivas, bienes materiales y relaciones afectivas. Los cinco factores presentaron coeficientes alfa por encima de 0.70. Se concluye que la EPVA es un instrumento con propiedades psicométricas aceptables y se puede utilizar en muestras de adolescentes. (AU)

N-acetylcysteine blocks SOS induction and mutagenesis produced by fluoroquinolones in Escherichia coli.

BACKGROUND: Fluoroquinolones such as ciprofloxacin induce the mutagenic SOS response and increase the levels of intracellular reactive oxygen species (ROS). Both the SOS response and ROS increase bacterial mutagenesis, fuelling the emergence of resistant mutants during antibiotic treatment. Recently, there has been growing interest in developing new drugs able to diminish the mutagenic effect of antibiotics by modulating ROS production and the SOS response. OBJECTIVES: To test whether physiological concentrations of N-acetylcysteine, a clinically safe antioxidant drug currently used in human therapy, is able to reduce ROS production, SOS induction and mutagenesis in ciprofloxacin-treated bacteria without affecting antibiotic activity. METHODS: The Escherichia coli strain IBDS1 and its isogenic mutant deprived of SOS mutagenesis (TLS-) were treated with different concentrations of ciprofloxacin, N-acetylcysteine or both drugs in combination. Relevant parameters such as MICs, growth rates, ROS production, SOS induction, filamentation and antibiotic-induced mutation rates were evaluated. RESULTS: Treatment with N-acetylcysteine reduced intracellular ROS levels (by ∼40%), as well as SOS induction (by up to 75%) and bacterial filamentation caused by subinhibitory concentrations of ciprofloxacin, without affecting ciprofloxacin antibacterial activity. Remarkably, N-acetylcysteine completely abolished SOS-mediated mutagenesis. CONCLUSIONS: Collectively, our data strongly support the notion that ROS are a key factor in antibiotic-induced SOS mutagenesis and open the possibility of using N-acetylcysteine in combination with antibiotic therapy to hinder the development of antibiotic resistance.

Quality of Life in Patients with Allergic Reactions to Medications: Influence of a Drug Allergy Evaluation.

BACKGROUND: Suspicion of allergic drug reaction can cause important disturbances in the patient's life. OBJECTIVE: We evaluated in a prospective multicenter study the quality of life of patients who suffered a possible allergic drug reaction, and analyzed the effect of a drug allergy evaluation. METHODS: Patients (>18 years old) answered the specific questionnaire twice: before the drug allergy evaluation, and 1 month after it was completed. Statistics were performed using STATA. RESULTS: A total of 360 patients (240, 66.6% female; mean age, 45.4 years; standard deviation [SD], 15.6 years) completed the first questionnaire. After the evaluation, 150 of 346 patients (43.4%) were diagnosed as allergic to the drug (115 of 150 immediate; 35 of 150 delayed) and 196 of 346 patients (56.6%) as nonallergic. The mean value of the first questionnaire was 32.14 (SD, 11.84); patients with anaphylaxis, nonanaphylactic immediate reaction, with more than 1 drug reaction, or a chronic osteoarticular disease, had a statistically significant higher score in Q0 (worse quality of life). After the allergy study, the mean of the second questionnaire was 27.27 (SD, 9.96), showing a global improvement (P < .001). No statistically significant difference was found between drug allergic and non-drug allergic patients (P = .340); however, being >40 years old (P = .030), having a chronic osteoarticular disease (P = .003) and having more than 1 reaction to drugs (P < .001) were associated with a statistically significant worse quality of life after the evaluation. CONCLUSIONS: Having suffered anaphylaxis, more than 1 reported drug allergy or presenting a musculoskeletal disease are factors that worsen the quality of life. Quality of life improved significantly after completing a drug allergy evaluation.

Prospective analysis of liquid biopsies of advanced non-small cell lung cancer patients after progression to targeted therapies using GeneReader NGS platform.

BACKGROUND: In a significant percentage of advanced non-small cell lung cancer (NSCLC) patients, tumor tissue is unavailable or insufficient for genetic analyses at time to progression. We prospectively analyzed the appearance of genetic alterations associated with resistance in liquid biopsies of advanced NSCLC patients progressing to targeted therapies using the NGS platform. METHODS: A total of 24 NSCLC patients were included in the study, 22 progressing to tyrosine kinase inhibitors and two to other treatments. Liquid biopsies samples were obtained and analyzed using the GeneReadTM QIAact Lung DNA UMI Panel, designed to enrich specific target regions and containing 550 variant positions in 19 selected genes frequently altered in lung cancer tumors. Previously, a retrospective validation of the panel was performed in clinical samples. RESULTS: Of the 21 patients progressing to tyrosine kinase inhibitors with valid results in liquid biopsy, NGS analysis identified a potential mechanism of resistance in 12 (57%). The most common were acquired mutations in ALK and EGFR, which appeared in 8/21 patients (38%), followed by amplifications in 5/21 patients (24%), and KRAS mutations in one patient (5%). Loss of the p.T790M was also identified in two patients progressing to osimertinib. Three of the 21 (14%) patients presented two or more concomitant alterations associated with resistance. Finally, an EGFR amplification was found in the only patient progressing to immunotherapy included in the study. CONCLUSIONS: NGS analysis in liquid biopsies of patients progressing to targeted therapies using the GeneReader platform is feasible and can help the oncologist to make treatment decisions.