Silymarin inhibits dermal gelatinolytic activity and reduces cutaneous inflammation.

Milk thistle (Silybum marianum) is well-known for its antioxidant activity due to the presence of silymarin. Albeit some studies show a potential for skin inflammation, its activity against dermal MMP-9 and MMP-2 remains to be studied. Silymarin isolated from an S. marianum herbal extract was tested for gelatinase inhibition in the presence of isolated MMP-9 and in dermal adenocarcinome HaCaT cells. Silymarin was then further tested in vivo, using a cutaneous inflammation mice model mediated by reactive oxygen species. Silymarin was able to significantly inhibit gelatinolytic activity in vitro without impairing cell growth and viability. Furthermore, inhibition was more pronounced in cells than with the isolated gelatinase, suggesting an additional effect upon metabolic pathways. In vivo, silymarin was able to reduce ear edema up to 74% and attenuated histological lesions. Results highlight silymarin potential for application in skin inflammatory disorders via gelatinase inhibition.

Os efeitos da pandemia no bem-estar dos enfermeiros brasileiros no combate ao Covid-19: uma revisão de escopo / The effects of the pandemic on the well-being of brazilian nurses in the fight against Covid-19: a scoping review / Los efectos de la pandemia en el bienestar de las enfermeras brasileñas en la lucha contra el Covid-19: a scoping review

Introdução: Estudos indicam que os profissionais de saúde têm alto risco de desenvolver sintomas relacionados à saúde mental, especialmente depressão, ansiedade e estresse. Objetivo: identificar e sintetizar os estudos sobre os preditores relacionados a saúde mental entre enfermeiros que atuam na linha de frente no combate ao COVID- 19. Método: Trata-se de uma revisão de escopo, sem limitação de linguagem e ano, nas bases BVS, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES e ProQuest. Foi realizada síntese narrativa. Resultados: A pandemia da COVID-19 trouxe sérios impactos a saúde mental dos profissionais de enfermagem, os achados revelaram cinco temas principais sentimento de insegurança, falta de equipamentos de proteção individual, falta de exames diagnósticos, mudanças no fluxo de atendimento e medo do desconhecido. Existe uma associação significativa entre o bem-estar físico e metal e a produtividade laboral. Conclusão: Destaca-se os desafios enfrentados pelos enfermeiros no combate da COVID-19, mesmo com a repercussões no ambiente de trabalho os enfermeiros ainda padecem de reconhecimento adequado que incluem situações de estresse, ansiedade, depressão e estão diretamente relacionadas à frustração, esgotamento físico e mental, sentimento de impotência e insegurança profissional vivenciados durante a pandemia, principalmente por jovens profissionais sem experiência no cuidado de pacientes críticos.

Introduction: Studies indicate that health professionals are at high risk of developing symptoms related to mental health, especially depression, anxiety and stress. Objective: identify and synthesize studies on mental health-related predictors among nurses who work on the front line in the fight against COVID-19. Method: This is a scope review, without language and year limitations, in the VHL, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES and ProQuest databases. Narrative synthesis was performed. Results: The COVID-19 pandemic had serious impacts on the mental health of nursing professionals, the findings revealed five main themes: feeling of insecurity, lack of personal protective equipment, lack of diagnostic tests, changes in the flow of care and fear of the unknown. There is a significant association between physical and mental well-being and labor productivity. Conclusion: The challenges faced by nurses in the fight against COVID-19 are highlighted, even with the repercussions in the work environment, nurses still suffer from adequate recognition and include situations of stress, anxiety and even depression, which are directly related to frustration , physical and mental exhaustion, feeling of helplessness and professional insecurity experienced during the pandemic, especially by young professionals with no experience in caring for critically ill patients.

Introducción: Los estudios indican que los profesionales de la salud tienen un alto riesgo de desarrollar síntomas relacionados con la salud mental, especialmente depresión, ansiedad y estrés. Objetivo: identificar y sintetizar estudios sobre predictores relacionados a la salud mental entre enfermeros que trabajan en primera línea en la lucha contra el COVID-19. Método: Se trata de una revisión de alcance, sin limitaciones de idioma y año, en las bases de datos BVS, PubMed, SCIELO, CINAHL, SCOPUS, Web of Science, MedNar, CAPES y ProQuest. Se realizó una síntesis narrativa. Resultados: La pandemia de COVID-19 tuvo graves impactos en la salud mental de los profesionales de enfermería, los hallazgos revelaron cinco temas principales: sensación de inseguridad, falta de equipo de protección personal, falta de pruebas diagnósticas, cambios en el flujo de atención y miedo a lo desconocido. Existe una asociación significativa entre el bienestar físico y mental y la productividad laboral. Conclusiones: Se destacan los retos a los que se enfrentan las enfermeras en la lucha contra la COVID-19, aún con las repercusiones en el ámbito laboral, las enfermeras siguen sufriendo un reconocimiento adecuado e incluyen situaciones de estrés, ansiedad e incluso depresión, que están directamente relacionadas con la frustración , el agotamiento físico y mental, la sensación de impotencia y la inseguridad profesional experimentada durante la pandemia, especialmente por profesionales jóvenes sin experiencia en el cuidado de pacientes críticos.

One Health Perspectives on Food Safety in Minimally Processed Vegetables and Fruits: From Farm to Fork.

While food markets and food production chains are experiencing exponential growth, global attention to food safety is steadily increasing. This is particularly crucial for ready-to-eat products such as fresh-cut salads and fruits, as these items are consumed raw without prior heat treatment, making the presence of pathogenic microorganisms quite frequent. Moreover, many studies on foodborne illnesses associated with these foods often overlook the transmission links from the initial contamination source. The prevention and control of the dissemination of foodborne pathogens should be approached holistically, involving agricultural production, processing, transport, food production, and extending to final consumption, all while adopting a One Health perspective. In this context, our objective is to compile available information on the challenges related to microbiological contamination in minimally handled fruits and vegetables. This includes major reported outbreaks, specific bacterial strains, and associated statistics throughout the production chain. We address the sources of contamination at each stage, along with issues related to food manipulation and disinfection. Additionally, we provide potential solutions to promote a healthier approach to fresh-cut fruits and vegetables. This information will be valuable for both researchers and food producers, particularly those focused on ensuring food safety and quality.

Influence of Particle Size and Extraction Methods on Phenolic Content and Biological Activities of Pear Pomace.

The main goal of this research was to investigate how particle size influences the characteristics of pear (Pyrus Communis L.) pomace flour and to examine the impact of different pre-treatment methods on the phenolic content and associated bioactivities. Pear pomace flour was fractionated into different particle sizes, namely 1 mm, 710 µm, 180 µm, 75 µm and 53 µm. Then two extraction methods, namely maceration with methanol and two-step extraction with hexane via Soxhlet followed by ultrasound extraction with methanol, were tested. Total phenolic and total flavonoid contents ranged from 375.0 to 512.9 mg gallic acid/100 g DW and from 24.7 to 34.6 mg quercetin/100 g DW, respectively. Two-step extraction provided antioxidant activity up to 418.8 (in FRAP assay) and 340.0 mg Trolox/100 g DW (in DPPH assay). In order to explore various bioactive properties, this study assessed the inhibitory effects of enzymes, specifically α-amylase and ß-glucosidase (associated with antidiabetic effects), as well as angiotensin-converting enzyme (linked to potential antihypertensive benefits). Additionally, the research investigated antibacterial potential against both Gram-negative (E. coli) and Gram-positive (S. aureus) bacteria, revealing significant results (p < 0.05), particularly in the case of the two-step extraction method. This investigation underscores the substantial value of certain food industry wastes, highlighting their potential as bioactive ingredients within the framework of a circular economy.

Applications of Essential Oils as Antibacterial Agents in Minimally Processed Fruits and Vegetables-A Review.

Microbial foodborne diseases are a major health concern. In this regard, one of the major risk factors is related to consumer preferences for "ready-to-eat" or minimally processed (MP) fruits and vegetables. Essential oil (EO) is a viable alternative used to reduce pathogenic bacteria and increase the shelf-life of MP foods, due to the health risks associated with food chlorine. Indeed, there has been increased interest in using EO in fresh produce. However, more information about EO applications in MP foods is necessary. For instance, although in vitro tests have defined EO as a valuable antimicrobial agent, its practical use in MP foods can be hampered by unrealistic concentrations, as most studies focus on growth reductions instead of bactericidal activity, which, in the case of MP foods, is of utmost importance. The present review focuses on the effects of EO in MP food pathogens, including the more realistic applications. Overall, due to this type of information, EO could be better regarded as an "added value" to the food industry.

Extended Cheese Whey Fermentation Produces a Novel Casein-Derived Antibacterial Polypeptide That Also Inhibits Gelatinases MMP-2 and MMP-9.

Our previous works produced a whey fermentation methodology that yielded antibacterial activity and potential inhibition of matrix metalloproteases (MMP)-2 and -9. Here, we evaluated if these activities were due to fermentation-produced peptides. Prolonged fermentation was carried out in the presence of our specific lactic acid bacteria (LAB) consortium. LAB fermentation yielded a total of 11 polypeptides, which were predominantly produced after 6 days of fermentation. One which was derived from beat casein presented a particularly high antibacterial activity against food pathogenic bacteria and was more effective than standard food disinfectants. This polypeptide was further studied and was also found to be active against several strains of pathogenic bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), in a dose-dependent manner. It also inhibited MMP-2 and MMP-9 whilst reducing HT29 cancer cell migration in vitro. Overall, this novel whey-derived polypeptide presents dual antibacterial and anti-inflammatory activity, revealing a strong potential to be used in functional foods or as a nutraceutical. Its identification and further characterization can open novel perspectives in the field of preventive/curative diets related to gut microbiota, gut inflammation, and cancer prevention, particularly if used in in vivo studies.

Socio-economic urban scaling properties: Influence of regional geographic heterogeneities in Brazil.

The recent efforts dedicated to understanding important features and consequences of city growth have profited from the scaling approach to urban indicators. This kind of analysis can be conveniently used to investigate the impact of geo-economic transformations, like fast urbanization and industrial development, which occurred in continental size countries (e.g., India, China, and Brazil) during the past half-century. Profiting from high quality data, this work explores how scaling relationships among urban indicators are influenced by strong regional heterogeneities in Brazil. It is based on economic, infrastructure and violence related data sets for the time interval 2002-2016. Results indicate that regional specificities related to infrastructure, economic development, and geography have a larger influence on the absolute value of the urban indexes. Regional scaling similarities and differences among Brazilian regions were also uncovered. Interesting enough, the results indicate that the richest and poorest Brazilian regions share similar scaling behavior, despite all huge different local influences. By contrast, the results for the two richest regions, with similar average values of urban indexes and the same kind of local influences have rather different scaling properties. Thus, scaling analysis suggests that distinct political solutions might be necessary to improve life's quality, even for two regions with similar average values of urban indicators.

Cryo-EM structures and functional properties of CALHM channels of the human placenta.

The transport of substances across the placenta is essential for the development of the fetus. Here, we were interested in the role of channels of the calcium homeostasis modulator (CALHM) family in the human placenta. By transcript analysis, we found the paralogs CALHM2, 4, and 6 to be highly expressed in this organ and upregulated during trophoblast differentiation. Based on electrophysiology, we observed that activation of these paralogs differs from the voltage- and calcium-gated channel CALHM1. Cryo-EM structures of CALHM4 display decameric and undecameric assemblies with large cylindrical pore, while in CALHM6 a conformational change has converted the pore shape into a conus that narrows at the intracellular side, thus describing distinct functional states of the channel. The pore geometry alters the distribution of lipids, which occupy the cylindrical pore of CALHM4 in a bilayer-like arrangement whereas they have redistributed in the conical pore of CALHM6 with potential functional consequences.

Trabalho noturno e alterações de peso corporal autopercebidas pelos profissionais de enfermagem / Night work and self-perceived body weight changes among nursing professionals / Trabajo nocturno y alteraciones en el peso corporal según los trabajadores de enfermería

Objetivo: avaliar as alterações de peso corporal em trabalhadores de enfermagem do turno noturno. Metodologia: estudo quantitativo, exploratório, descritivo, realizado em um hospital federal de grande porte do Rio de Janeiro. Foram estudadas variáveis sóciodemográficas; influências do turno noturno sobre o organismo e índice de massa corporal, após aprovação do Comitê de Ética em Pesquisa da instituição. Resultados: os 89 trabalhadores de enfermagem apresentaram ganho de peso médio de aproximadamente 20Kg a partir da admissão no turno noturno, sendo que os enfermeiros referiram maior influência da ausência de sono sobre o organismo, e maior exaustão quando comparados aos dados das demais categorias. Conclusão: considerando as desordens hormonais e os impactos sociais do serviço noturno, é imprescindível a implementação de mudanças para uma cultura prevencionista, seja por programas institucionais ou pesquisas intervencionistas, capazes de desenvolver medidas que conduzam ao autorreconhecimento e à promoção do bem-estar físico, mental e social dos trabalhadores de enfermagem.

Objective: to evaluate body weight changes in nursing workers on the night shift. Methodology: this quantitative, exploratory, descriptive study, conducted at a large federal hospital in Rio de Janeiro, after approval of the institution's research ethics committee, considered socio-demographic variables, influence of the night work on the organism, and body mass index. Results: average weight gain among the 89 nursing workers was approximately 20kg since admission to night work, and nurses reported greater influence of lack of sleep on the body, and greater exhaustion as compared with data on the other categories. Conclusion: considering the hormonal disorders and social impacts of night work, it is essential to implement changes towards a culture of prevention, through either institutional programs or interventionist research able to develop measures that lead to self-recognition and promotion of nursing workers' physical, mental and social wellbeing.

Objetivo: evaluar las alteraciones de peso corporal en trabajadores de enfermería del turno nocturno. Metodología: estudio cuantitativo, exploratorio, descriptivo, realizado en un gran hospital federal en Río de Janeiro. Se estudiaron las variables sociodemográficas, la influencia reportada de la guardia nocturna en el organismo y el índice de masa corporal, tras la aprobación del Comité de Ética de Investigación de la Institución. Resultados: Los 89 trabajadores de enfermería tuvieron un aumento de peso promedio de aproximadamente 20 kg desde el ingreso en el turno nocturno, y los enfermeros informaron una mayor influencia de la falta de horas dormidas sobre el cuerpo y un mayor agotamiento en comparación con los datos de las otras categorías. Conclusión: Teniendo en cuenta los trastornos hormonales y los impactos sociales del servicio nocturno, es esencial implementar cambios hacia una cultura de prevención, ya sea a través de programas institucionales o de investigación intervencionista, capaces de desarrollar medidas que conduzcan al auto reconocimiento y a la promoción del bienestar físico, mentales y social de los trabajadores de enfermería.

Primary care physicians' decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research.

INTRODUCTION: Good patient outcomes correlate with the physicians' capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians' perspectives, views or experiences on decision-making with patients with multimorbidity. METHODS AND ANALYSIS: This will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians' perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis. ETHICS AND DISSEMINATION: This review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s). PROSPERO REGISTRATION NUMBER: ID 91978.

Absenteísmo como indicador para estratégia preventiva na gerência de enfermagem na saúde do trabalhador / Absenteeism as an indicator for the preventive strategy of the nursing management to worker health

Trata-se de estudo de absenteísmo em uma empresa privada de terceirização de serviços localizada na cidade do Rio de Janeiro, com propósito de levantar os índices de afastamento do trabalhador para indicar estratégias de prevenção, através das funções gerenciais da Enfermeira do Trabalho, atuando no Serviço Especializado em Engenharia de Segurança e em Medicina do Trabalho (SESMT) da empresa. Utilizou-se o método quantitativo, descritivo do tipo censo dos afastamentos no período de 13 meses (abril de 2017 a abril de 2018), a partir das informações contidas no banco de dados da empresa, traçando-se as variáveis sociodemográficas, econômicas e profissionais dos trabalhadores. O projeto foi submetido à apreciação do Comitê de Ética em Pesquisa (CEP) da instituição de origem, através da Plataforma Brasil, cujo parecer foi aprovado em outubro de 2018 na versão 03, CAAE: 93038218.6.0000.5282, Número do Parecer: 2.929.353. O A análise foi realizada através de uma planilha em Excel versão 97-2003, com base nos indicadores selecionados, tendo como objetivos mapear o absenteísmo por atestados médicos até 15 dias de trabalhadores da empresa para: identificar o perfil ocupacional dos trabalhadores, levantar os dados do absenteísmo e os custos desses afastamentos; e indicar estratégias de prevenção. O estudo teve como limitação a identificação das causas dos afastamentos devido à falta de registros do CID no banco de dados da epresa. Foi analisada a média de 9.478 trabalhadores ao mês, o que evidenciou a maior faixa etária de 31 a 40 anos, de etnia parda, com escolaridade até o 9° ano, sendo 68% mulheres. Quanto ao absenteísmo, evidenciou-se a média de 748 trabalhadores afastados por mês, com maiores índices nos meses de agosto/17 - equivalente a 1305 trabalhadores, março e abril de 2018 com os respectivos valores 2.376 e 3.478, não sendo possível fazer uma correlação com as causas por falta de registros do CID. O custo direto desses afastamentos chegou a R$ 907.436,00 nos treze meses, o que já evidencia um gasto elevado que poderia ser direcionado para a promoção da saúde e da melhoria de qualidade de vida no trabalho. Como não foi possível associar as causas específicas dos afastamentos, os resultados direcionam para estratégias de controle e redução do absenteísmo a partir da literatura estudada, tendo como suporte a proposta de um Protocolo de Enfermagem embasado na filosofia da Enfermagem do Trabalho, desenvolvendo um processo de controle do absenteísmo, através do trabalho integrado com todos os pofissionais responsáveis pela prevenção de riscos a Saúde do Trabalhador, visando a Promoção da Saúde dos Trabalhadores do SESMT da empresa.

The present work is a study of absenteeism in a private outsourcing service company located in the city of Rio de Janeiro, with the purpose of assemble absenteeism rates and indicate causes prevention strategies through the managerial functions of the Work Nurse acting in the Service Specialized in Safety Engineering and Occupational Medicine (SESMT). The descriptive quantitative method of removals was used in the 13-month period (April 2017 to April 2018), based on the information contained in the company's database, with the sociodemographic and economic variables of the workers being drawn. The analysis was carried out through an Excel spreadsheet, version 97-2003, based on the selected indicators, with the objective of mapping absenteeism by medical certificates up to 15 days of company employees to: identify the professional occupational profile of employees, absenteeism data and the costs of such absences; and indicate prevention strategies based on the evidenced causes. The study had as a limitation the non-registration of the ICDs in the database on departures. We analyzed the average of 9,478 workers per month that showed the highest age group of 31 to 40 years of age, of brown ethnicity, with education up to the 9th year, being 68% women. As for absenteeism, the average number of workers was 748 out of work per month, with the highest rates in August / 17 - 1305 workers, in March and April 2018, with the respective values of 2,376 and 3,478, and it is not possible to make a correlation for lack of ICDs. The direct cost of these departures reached R $ 907,436.00 from the thirteen months, which already shows a high expenditure that could be directed to the promotion of health and improvements in quality of life at work. As it was not possible to associate the specific causes of withdrawal, the results lead to strategies for control and reduction of these, having as support the proposal of a Nursing Protocol based on the philosophy of Nursing at work, developing in a process of absenteeism control, through of the integrated work of Health Promotion of Workers in the SESMT of the company.

Genotyping of HBV and tracking of resistance mutations in treatment-naïve patients with chronic hepatitis B.

BACKGROUND AND AIMS: Resistance mutation analogs to nucleos(t)ides have been described in treatment-naïve patients with chronic hepatitis B (CHB), with clinical implications. The aim of this study was to investigate primary resistance mutations and genotypes circulating in patients naïve to chronic hepatitis B, in the Northern and Northeastern regions of Brazil. METHODS: We conducted a study of resistance mutations and genotypic characterization of hepatitis B virus (HBV) in 189 treatment-naïve patients chronically infected with HBV. RESULTS: Drug resistance-associated mutations located in the RT domain of the P gene (rtHBV) were found in 6% of the treatment-naïve patients from the Northeastern Region. The mutations were rtA194T, rtL180M + rtM204V, rtS202I, rtM204I, and rtA181S. No patient in the Northern Region had the resistance mutation. In the gene S region, the frequency of vaccine escape mutations was 2.4% in the Northeastern Region and 8.6% in the Northern Region. CONCLUSION: This information before the start of treatment may contribute to clinical decision making, reducing treatment failure and the risk of progression to cirrhosis and hepatocellular carcinoma for CHB.

Mutations associated with drug resistance and prevalence of vaccine escape mutations in patients with chronic hepatitis B infection.

The Brazilian public health system (SUS) has provided antiviral drugs for chronic hepatitis B treatment for over 10 years, but a system for monitoring for drug-related resistance mutations is not available. Determine the presence of HBV mutations associated with resistance to nucleos(t)ide analogs among 81 patients with chronic HBV infection in Salvador-BA-Brazil. HBV-DNA was PCR amplified with primers deduced from the rt domain at the HBV P gene, the sequence extended 1032 bp (from amino acid 1 to 344-rt domain). Those sequences were submitted to the HBV drug resistance database to retrieve each mutation according to the genotype. HBV genotype A1 (85.2%) was the most prevalent, followed by genotype A2 (4.9%), F (6.2%), and C1, D2, and D4 (1.2% each). Six patients (7%) exhibited resistance mutations to LAM, ETV, and TDF: two with patterns L180M + M204V and four with other different patterns: L80I + L180M + M204I; L80V + L180M + M204V; M204I; A194T. All of these mutations were present in patients with genotype A (four A1 and two A2). In addition, four mutations in gene S (three cases with the sI195M mutation and one with the W196L mutation), were detected, corresponding to a rate of 6% of vaccine escape mutations. Althougth the small sample size, an association was found between the occurrence of HBV resistance mutations and HBeAg positivity, co-infection with HIV and a history of treatment for HBV and/or HIV.

Avaliação do protocolo clínico e diretrizes terapêuticas para o tratamento para hepatite B crônica nas regiões nordeste e norte do Brasil / Analysis of clinical protocol and guidelines therapeutic for treatment for chronic hepatitis B in northeast Brazil and regions north

No Brasil o tratamento para Hepatite B cônica, tem sido disponibilizado pelo Sistema Único de Saúde há mais de 10 anos. O objetivo foi analisar o tratamento dos pacientes com hepatite B crônica, em dois Centros de Referência em Hepatites Virais na Região Nordeste e Norte do Brasil, comparando com o Protocolo Clínico e Diretrizes Terapêuticas da Hepatite B do Ministério da Saúde. Foram incluídos no estudo 527 pacientes em atendimento ambulatorial. No algoritmo 4.1 foi observado que existe uma dificuldade em seguir a recomendação do Ministério da Saúde, nos dois serviços de referência, 78,9% e 72% Região Nordeste e Norte respectivamente. O algoritmo 4.2, foi o algoritmo que apresentou no geral mais de 90% de seguimento na recomendação do Protocolo Clínico, devido que os pacientes são na sua grande maioria AgHBe negativo. O algoritmo 4.3 aproximadamente 85% dos pacientes da Região Nordeste estava dentro da recomendação do Protocolo Clínico para Hepatite B crônica, entretanto, nenhum paciente da Região Norte. O Protocolo Clínico de Diretrizes Terapêuticas para Hepatite B foi um grande passo e avanço. Uma ferramenta importantíssima dentro da realidade do tratamento para Hepatite B e foi possível incorporar novas drogas e indicadores de tratamento embasados na Medicina Baseada em Evidencias e nos Consensos Internacionais pelo Ministério da Saúde.

In Brazil the treatment for Hepatitis B conical, has been provided by the National Health System for over 10 years. The aim was to analyze the treatment of patients with chronic hepatitis B in two reference centers in Viral Hepatitis in the Northeast and North of Brazil, compared to the Clinical Protocol and Therapeutic Guidelines Hepatitis B of the Ministry of Health. The study included 527 patients in outpatient care. In algorithm 4.1 it was observed that there is a difficulty in following the recommendation of the Ministry of Health in two reference centers, 78.9% and 72% northeast and north respectively. The 4.2 algorithm, the algorithm was presented in general more than 90% follow-up on the recommendation of the Clinical Protocol because patients are mostly negative HBeAg. The algorithm 4.3 approximately 85% of patients in the Northeast was in the recommendation of the Clinical Protocol for chronic hepatitis B, however, no patients in the Northern Region. The Clinical Protocol Therapeutic Guidelines for Hepatitis B was a big step and advance. An important tool within the reality of treatment for hepatitis B and it was possible to incorporate new drugs and treatment indicators grounded in Evidence-Based Medicine and the International Consensus by the Ministry of Health.

Brief Report: Preliminary Proposal of a Conceptual Model of a Digital Environment for Developing Mathematical Reasoning in Students with Autism Spectrum Disorders.

There is clear evidence that in typically developing children reasoning and sense-making are essential in all mathematical learning and understanding processes. In children with autism spectrum disorders (ASD), however, these become much more significant, considering their importance to successful independent living. This paper presents a preliminary proposal of a digital environment, specifically targeted to promote the development of mathematical reasoning in students with ASD. Given the diversity of ASD, the prototyping of this environment requires the study of dynamic adaptation processes and the development of activities adjusted to each user's profile. We present the results obtained during the first phase of this ongoing research, describing a conceptual model of the proposed digital environment. Guidelines for future research are also discussed.

Perfil das mutações de resistência do vírus da Hepatite B aos análogos de nucleos(t)ídeos entre pacientes com hepatite B crônica / Profile of resistance mutations of hepatitis B virus to analogs of nucleos (t) ide among patients with chronic hepatitis B

Introdução: A doença causada pelo vírus da hepatite B (HBV) é um problema de saúde pública mundial. No Brasil, o sistema único de saúde (SUS) tem disponibilizado drogas antivirais para o tratamento de hepatite B crônica há mais de 10 anos, mas um sistema para o monitoramento e avaliação de resistência a estas drogas ainda não está disponível. Objetivo: Este estudo teve como objetivo determinar o perfil de mutações do HBV associadas com a resistência aos análogos de nucleos(t)ídeos entre 81 pacientes com infecção crônica pelo HBV: virgens de tratamento para hepatite B e tratados com diferentes análogos de nucleosídeos e nucleotídeos, no Hospital Professor Edgar Santos (HUPES-UFBA)- Salvador-BA. Metodologia: O HBV-DNA foi isolado de amostras de soro, amplificado por nested-PCR, utilizando-se primers deduzidos da região flaqueadora da domínio rt do gene P e sequenciados (ABI Prism 3730, Applied Biosystems, EUA). Duas a seis sequências de cada isolado foram alinhados e os sítios conflitantes foram resolvidos usando o software CLC Main Workbench v. 5.0 por inspeção visual dos eletroferogramas. As sequências consenso tinham um tamanho de 1032 pb (compreendendo os aminoácido 1-344 da rt)...

Introduction: Hepatitis B virus (HBV) infection is a public health issue. The Brazilian public health system (SUS) has provided antiviral drugs for chronic hepatitis B treatment for over 10 years, but a system for monitoring for drug-related resistance mutations is not available. Objective: This study aims to determine the presence of HBV mutations associated with resistance to nucleos(t)ide analogs among 81 patients with chronic HBV infection-naïve and treated from University Hospital Professor Edgard Santos, Salvador-BA (HUPES-UFBA). Methods: Briefly, HBV-DNA was PCR amplified with primers deduced from the flanking of the rt domain at the HBV P gene and sequenced using ABI Prism 3730 (Applied Biosystems, USA). From two to six forward and reverse sequences of each isolate were assembled and conflicting sites were resolved using software CLC Main Workbench v. 5.0 by visual inspection of the electropherograms. Consensus sequence extended 1032 bp and encompassed the entire rt domain (from amino acid 1 to 344)...

3-Ishwarone, a rare ishwarane sesquiterpene from Peperomia scandens Ruiz & Pavon: structural elucidation through a joint experimental and theoretical study.

3-Ishwarone, (1), a sesquiterpene with a rare ishwarane skeleton, was isolated from Peperomia scandens Ruiz & Pavon (Piperaceae). Its structure was unambiguously determined by 1D- and 2D-NMR and infrared analyses, as well as by comparative theoretical studies which involved calculations of 13C-NMR chemical shifts, using the Density Functional Theory (DFT) with the mPW1PW91 hybrid functional and Pople's 6-31G(d) basis set, and of vibrational frequencies, using the B3LYP hybrid functional and triple ζ Dunning's correlation consistent basis set (cc-pVTZ), of (1) and three of its possible diastereomers, compounds 2-4.

Altered sterol profile induced in Leishmania amazonensis by a natural dihydroxymethoxylated chalcone.

OBJECTIVES: The effects of the antileishmanial chalcone 2',6'-dihydroxy-4'-methoxychalcone (DMC) on Leishmania amazonensis sterol composition and biosynthesis were investigated to obtain information about the mechanism of growth inhibition by DMC on this parasite. METHODS: The interference of sterol biosynthesis by DMC was studied in drug-treated promastigotes by two different methods. (i) Newly synthesized sterols from parasites grown in the presence of [(3)H]mevalonate were analysed by thin layer chromatography (TLC)/fluorography. (ii) Total sterols extracted from the parasites grown with or without DMC were characterized by gas chromatography coupled to mass spectroscopy (GC/MS). RESULTS: TLC and GC/MS analyses of sterols extracted from DMC-treated promastigotes revealed the accumulation of early precursors and a reduction in the levels of C-14 demethylated and C-24 alkylated sterols, as well as a reduction in exogenous cholesterol uptake. CONCLUSIONS: This study demonstrates that the natural chalcone DMC alters the sterol composition of L. amazonensis and suggests that the parasite target is different from other known sterol inhibitors.

C-glycosyl flavones from Peperomia blanda.

The methanol extract from aerial parts of the Peperomia blanda (Piperaceae) yielded two C-glycosyl-flavones. Their structures were elucidated on the basis of extensive spectroscopic analysis, including 1D and 2D NMR, chemical transformation and comparison with the related known compounds. The structure of the new flavonoids were established as 4'-methoxy-vitexin 7-O-beta-D-xylopyranoside (1) (7-O-beta-D-xylopyranosyl-8-C-beta-D-glucopyranosyl-4'-methoxy-apigenin) and vicenin-2 (2). The antioxidant activity of both compounds was investigated using the DPPH assay. Both compounds showed only modest activity, with IC50 values of 357.2 microM for 1, and 90.5 microM for 2.

Changing patterns of drug and alcohol use in fatally injured drivers in Washington State.

We have previously reported on patterns of drug and alcohol use in fatally injured drivers in Washington State. Here we revisit that population to examine how drug use patterns have changed in the intervening 9 years. Blood and serum specimens from drivers who died within 4 h of a traffic accident between February 1, 2001, and January 31, 2002, were analyzed for illicit and therapeutic drugs and alcohol. Drugs when present were quantitated. Samples suitable for testing were obtained from 370 fatally injured drivers. Alcohol was detected above 0.01 g/100 mL in 41% of cases. The mean alcohol concentration for those cases was 0.17 g/100 mL (range 0.02-0.39 g/100 mL). Central nervous system (CNS) active drugs were detected in 144 (39%) cases. CNS depressants including carisoprodol, diazepam, hydrocodone, diphenhydramine, amitriptyline, and others were detected in 52 cases (14.1%), cannabinoids were detected in 47 cases (12.7%), CNS stimulants (cocaine and amphetamines) were detected in 36 cases (9.7%), and narcotic analgesics (excluding morphine which is often administered iatrogenically in trauma cases) were detected in 12 cases (3.2%). For those cases which tested positive for alcohol c. 40% had other drugs present which have the potential to cause or contribute to the driver's impairment. Our report also considers the blood drug concentrations in the context of their interpretability with respect to driving impairment. The data reveal that over the past decade, while alcohol use has declined, some drug use, notably methamphetamine, has increased significantly (from 1.89% to 4.86% of fatally injured drivers) between 1992 and 2002. Combined drug and alcohol use is a very significant pattern in this population and is probably overlooked in DUI enforcement programs.