Hospital Resilience in Three COVID-19 Referral Hospitals in Brazil.

Health crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience-the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil-one public, one private, and one philanthropic hospital-by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.

Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study.

The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.

Mise en œuvre de la capacité de réponse à la COVID-19 dans un hôpital au Brésil.

After the declaration of a public health emergency of international importance, hospitals have become a benchmark in the response to the pandemic. It is important to assess health professionals' response capacity to the COVID-19 pandemic at a referral hospital in Pernambuco, in northeastern Brazil. This study deals with qualitative evaluative research, of the case study type. Three methods were used to identify critical events: interviews with 18 healthcare professionals who had worked on the "front line" of care for people with COVID-19; direct observation in the sectors of this hospital; and literature review. The interviews were transcribed and analyzed using MaxQDA Analytics pro 2020® software, using the Actor-Network Theory for analysis; and to interpret the critical events the categories of resilience: absorption, adaptation and transformation. It was found that the response capacity of professionals was influenced by five critical events: the arrival of cases, new ways to connect the patients with their social support network, social and personal impact on the daily life of professionals, insufficient supplies, essential equipment and confirmatory tests, and shortage and illness of professionals. In everyday experiences, the response capacity of professionals has led to a process of priority adaptation, which can accelerate important changes in the health system.

Alpha-Lipoic Acid and Its Enantiomers Prevent Methemoglobin Formation and DNA Damage Induced by Dapsone Hydroxylamine: Molecular Mechanism and Antioxidant Action.

Dapsone (DDS) therapy can frequently lead to hematological side effects, such as methemoglobinemia and DNA damage. In this study, we aim to evaluate the protective effect of racemic alpha lipoic acid (ALA) and its enantiomers on methemoglobin induction. The pre- and post-treatment of erythrocytes with ALA, ALA isomers, or MB (methylene blue), and treatment with DDS-NOH (apsone hydroxylamine) was performed to assess the protective and inhibiting effect on methemoglobin (MetHb) formation. Methemoglobin percentage and DNA damage caused by dapsone and its metabolites were also determined by the comet assay. We also evaluated oxidative parameters such as SOD, GSH, TEAC (Trolox equivalent antioxidant capacity) and MDA (malondialdehyde). In pretreatment, ALA showed the best protector effect in 2.5 µg/mL of DDS-NOH. ALA (1000 µM) was able to inhibit the induced MetHb formation even at the highest concentrations of DDS-NOH. All ALA tested concentrations (100 and 1000 µM) were able to inhibit ROS and CAT activity, and induced increases in GSH production. ALA also showed an effect on DNA damage induced by DDS-NOH (2.5 µg/mL). Both isomers were able to inhibit MetHb formation and the S-ALA was able to elevate GSH levels by stimulating the production of this antioxidant. In post-treatment with the R-ALA, this enantiomer inhibited MetHb formation and increased GSH levels. The pretreatment with R-ALA or S-ALA prevented the increase in SOD and decrease in TEAC, while R-ALA decreased the levels of MDA; and this pretreatment with R-ALA or S-ALA showed the effect of ALA enantiomers on DNA damage. These data show that ALA can be used in future therapies in patients who use dapsone chronically, including leprosy patients.

Governamentalidade neoliberal, estratégias e seus efeitos: problematizações em torno dos biobancos de células-tronco / Neoliberal governmentality, strategies and their effects: problematizations around stem cell biobanks

O artigo visa abordar uma análise, em formato de ensaio analítico a respeito das práticas de guarda de célulastronco. A chamada medicina personalizada e regenerativa emerge ligada ao capitalismo neoliberal e a uma modalidade de governo das condutas baseada na biomedicina e em uma política de gestão da vida focada no mercado neoliberal securitário. A saúde foi transformada em um comércio de células e sustentada nas táticas da bioeconomia, do biovalor e das biotecnologias, articuladas em um dispositivo de governamentalidade reguladora do ser saudável, a partir da compra e venda de materiais biomoleculares e genéticos. Concluindo, buscase interrogar o modo de organizar e funcionar dos biobancos públicos e privados de células-tronco do cordão umbilical e os efeitos destes mecanismos biopolíticos.

The article aims to approach an analysis, in the form of an analytical essay regarding the practices of guarding stem cells. The so-called personalized and regenerative medicine emerges linked to neoliberal capitalism and to a modality of conduct based on biomedicine and a life management policy focused on the neoliberal insurance market. Health was transformed into a trade in cells and sustained by the tactics of bioeconomics, biovalue and biotechnologies, articulated in a governmental device that regulates healthy being, based on the purchase and sale of biomolecular and genetic materials. In conclusion, we seek to question the way of organizing and functioning of public and private umbilical cord stem cell banks and the effects of these biopolitical mechanisms.

Quantitative proteome and phosphoproteome analyses highlight the adherent population during Trypanosoma cruzi metacyclogenesis.

Trypanosoma cruzi metacyclogenesis is a natural process that occurs inside the triatomine vector and corresponds to the differentiation of non-infective epimastigotes into infective metacyclic trypomastigotes. The biochemical alterations necessary for the differentiation process have been widely studied with a focus on adhesion and nutritional stress. Here, using a mass spectrometry approach, a large-scale phospho(proteome) study was performed with the aim of understanding the metacyclogenesis processes in a quantitative manner. The results indicate that major modulations in the phospho(proteome) occur under nutritional stress and after 12 and 24 h of adhesion. Significant changes involve key cellular processes, such as translation, oxidative stress, and the metabolism of macromolecules, including proteins, lipids, and carbohydrates. Analysis of the signalling triggered by kinases and phosphatases from 7,336 identified phosphorylation sites demonstrates that 260 of these sites are modulated throughout the differentiation process, and some of these modulated proteins have previously been identified as drug targets in trypanosomiasis treatment. To the best of our knowledge, this study provides the first quantitative results highlighting the modulation of phosphorylation sites during metacyclogenesis and the greater coverage of the proteome to the parasite during this process. The data are available via ProteomeXchange with identifier number PXD006171.

Comparative Proteomics of Tumor and Paired Normal Breast Tissue Highlights Potential Biomarkers in Breast Cancer.

BACKGROUND/AIM: Breast cancer is the most common type of cancer among women worldwide, and about 57,000 new cases are expected for the Brazilian population in 2015. Elucidation of protein expression and modification is essential for the biological understanding, early diagnosis and therapeutics of breast cancer. The main objectives of the study are comparison between the proteome of tumor and paired non-tumor breast cancer tissues, describing all identified proteins, highlighting the ones most differentially expressed and comparing the data with existing literature. MATERIALS AND METHODS: The five paired samples from patients with invasive ductal carcinoma were analyzed by 2-DE and MS. RESULTS: We collected 161 identified spots corresponding to 110 distinct proteins. Forty-three differentially-expressed spots were common to at least two samples, and the ten proteins with the highest-fold changes were CASPE, ENOG, TPM1, CAPG, VIME, TPM3, TRFE, PDIA6, WDR61 and PDIA3. Metabolic enzymes and proteins with binding functions were the most representative functional classes of proteins with increased and decreased expression in tumor tissue respectively. CONCLUSION: Taking the fold change as a parameter, we point to future targets to be studied by functional methods in a search for biomarkers for initiation and progress of breast cancer.

Comparative proteomics of primary breast carcinomas and lymph node metastases outlining markers of tumor invasion.

BACKGROUND: Lymph node metastasis is an important clinicopathological parameter for breast cancer prognostication and treatment. Although the development of metastasis is common in axillary lymph nodes, the mechanisms underlying the locoregional spread are yet poorly understood. In the present study, we outline the involvement of proteins in tumor invasion by comparing the proteome profile of primary breast tumors (PBT) against that of lymph node metastasis (LNM). PATIENTS AND METHODS: The comparative proteome analyses of seven paired samples were performed using two-dimensional gel electrophoresis (2DE) and mass spectrometry (MS). RESULTS: Recurrent proteins were differentially expressed in PBT and LNM across patients. Higher levels of 1433G, 1433T, K2C8, PSME2, SNAA, TPM4, TRFE and VIME were observed in primary tumors compared to the metastatic site. On the other hand, higher levels of ALDH2 and GDIR2 were identified in metastasis related to tumors. These proteins provide a new insight on breast cancer research. CONCLUSION: Our achievements strengthened previous omics-based studies and also support the validation of potential markers of tumor invasion and metastasis.

Acute superoxide scavenging restores depressed baroreflex sensitivity in renovascular hypertensive rats.

In some pathological conditions such as hypertension, there is an impairment in the autonomic control of blood pressure resulting in changes in baroreflex sensitivity. In the present study we tested the hypothesis that acute superoxide scavenging would restore the reduced baroreflex sensitivity in renovascular hypertension. Male Wistar rats underwent 2-Kidney-1-Clip (2K1C) or sham surgery and were maintained untouched for six weeks to develop hypertension. After six weeks, animals from the 2K1C group were hypertensive when compared to the sham group (165±9 vs. 108±7mm Hg, P<0.05). As a proof of principle for the hypertension model adopted, animals from the 2K1C group presented increased non-clipped kidney and cardiac mass index and reduced clipped kidney mass index. Regarding baroreflex, 2K1C rats presented diminished baroreflex sensitivity when compared to the sham group (2K1C+saline: -1.61±0.15 vs. sham+saline: -2.79±0.24bpm mm Hg(-1), p<0.05). Moreover, acute administration of Vitamin C (150mg/Kg, i.v.) restored baroreflex sensitivity in 2K1C rats (2K1C+Vit C: -3.08±0.37 vs. 2K1C+saline: -1.61±0.15bpm mm Hg(-1), p<0.05). Furthermore, administration of apocynin (30µg/Kg, i.v.), a NADPH oxidase inhibitor, also improved baroreflex sensitivity in the 2K1C group (2K1C+apocynin: -2.81±0.24 vs. 2K1C+saline: -1.61±0.15bpm mm Hg(-1), p<0.05). In addition, autonomic blockade with either methylatropine or propranolol reduced the changes in heart rate to the same extent in all groups suggesting that improved baroreflex sensitivity by antioxidants were mediated by improvement in autonomic function. Taken together, these data suggest that NADPH oxidase-derived reactive oxygen species are involved in the blunted baroreflex sensitivity in renovascular hypertension and that acute scavenging of superoxide restores baroreflex sensitivity.

Ditos, não ditos e entreditos: a comunicação em cuidados paliativos / Said, unsaid and what is said in between: the comuinication in palliative care / Dichos, no dichos y entredichos: la comunicación en cuidados paliativos

Os cuidados paliativos têm como característica fundamental a humanização da morte, e o trabalho em equipe interdisciplinar é outra marca dessa atuação, uma vez que o paciente é compreendido e tratado em sua totalidade. O objetivo deste artigo é apresentar parte de uma pesquisa exploratória realizada em uma enfermaria de cuidados paliativos no que concerne à comunicação. O método utilizado foi o qualitativo exploratório, e o instrumento consiste em entrevistas semiestruturadas com os profissionais que, transcritas, passaram por análise de conteúdo. Notou-se grande facilidade de comunicação, que é garantida por um procedimento técnico bem estruturado, e alguns aspectos a serem mais bem trabalhados, tais como: diálogo sobre morte, relação pessoalizada entre profissionais e reuniões que abarquem todos os profissionais, inclusive os técnicos.(AU)

The fundamental characteristic of palliative care is the humanization of death and the interdisciplinary team work is the mark of this actuation, since the patient is understood and treated as a whole in this context. The objective of this article is to present a part of an exploratory research about communication, which was done at a palliative care nursery. The methodology adopted was qualitative exploratory, this instrument consist on semi structured interviews with professionals, that were later transcripted and analyzed concerning it's content. It was observed that the well-structures technicals procedures ensure the process of communication. It was also noticed that are still some aspects that need to be worked on, ass: dialogues about death, relationship among co-workers and meetings with all professionals, including technicians.(AU)

Los cuidados paliativos tienen como característica fundamental la humanización de la muerte, y el trabajo en equipo interdisciplinario es otra característica de esta actuación, una vez que se percibe y se trata el paciente en su totalidad. El objetivo de este trabajo ES presentar parte de un estudio de investigación llevado a cabo en una enfermería de cuidados paliativos en lo que concierne a la comunicación. El método utilizado fue el cualitativo-exploratorio y el instrumento consiste en entrevistas semi-estructuradas con los profesionales que, transcriptas se fueron sometidas a análisis de contenido. Se observó gran facilidad de comunicación que fue garantizada por un procedimiento técnico bien estructurado y algunos aspectos a ser mejor elaborados, como el diálogo sobre la muerte, la relación personalizada entre los profesionales y reuniones que abarquen todos los profesionales, incluyendo los técnicos.(AU)

Ditos, não ditos e entreditos: a comunicação em cuidados paliativos / Said, unsaid and what is said in between: the comuinication in palliative care / Dichos, no dichos y entredichos: la comunicación en cuidados paliativos

Os cuidados paliativos têm como característica fundamental a humanização da morte, e o trabalho em equipe interdisciplinar é outra marca dessa atuação, uma vez que o paciente é compreendido e tratado em sua totalidade. O objetivo deste artigo é apresentar parte de uma pesquisa exploratória realizada em uma enfermaria de cuidados paliativos no que concerne à comunicação. O método utilizado foi o qualitativo exploratório, e o instrumento consiste em entrevistas semiestruturadas com os profissionais que, transcritas, passaram por análise de conteúdo. Notou-se grande facilidade de comunicação, que é garantida por um procedimento técnico bem estruturado, e alguns aspectos a serem mais bem trabalhados, tais como: diálogo sobre morte, relação pessoalizada entre profissionais e reuniões que abarquem todos os profissionais, inclusive os técnicos.

The fundamental characteristic of palliative care is the humanization of death and the interdisciplinary team work is the mark of this actuation, since the patient is understood and treated as a whole in this context. The objective of this article is to present a part of an exploratory research about communication, which was done at a palliative care nursery. The methodology adopted was qualitative exploratory, this instrument consist on semi structured interviews with professionals, that were later transcripted and analyzed concerning it's content. It was observed that the well-structures technicals procedures ensure the process of communication. It was also noticed that are still some aspects that need to be worked on, ass: dialogues about death, relationship among co-workers and meetings with all professionals, including technicians.

Los cuidados paliativos tienen como característica fundamental la humanización de la muerte, y el trabajo en equipo interdisciplinario es otra característica de esta actuación, una vez que se percibe y se trata el paciente en su totalidad. El objetivo de este trabajo ES presentar parte de un estudio de investigación llevado a cabo en una enfermería de cuidados paliativos en lo que concierne a la comunicación. El método utilizado fue el cualitativo-exploratorio y el instrumento consiste en entrevistas semi-estructuradas con los profesionales que, transcriptas se fueron sometidas a análisis de contenido. Se observó gran facilidad de comunicación que fue garantizada por un procedimiento técnico bien estructurado y algunos aspectos a ser mejor elaborados, como el diálogo sobre la muerte, la relación personalizada entre los profesionales y reuniones que abarquen todos los profesionales, incluyendo los técnicos.

Borderline personality features possibly related to cingulate and orbitofrontal cortices dysfunction due to schizencephaly.

Prefrontal cortex dysfunction has been associated with a series of behavioral symptoms, such as impulsivity and affective instability, which are the defining features of several personality disorders, notably, borderline personality disorder. We report on a 27-year-old patient with schizencephaly in the right frontal lobe (cingulate cortex lesion and secondary orbitofrontal cortex dysfunction) presenting with prominent borderline features and compromise of executive functions, decision-making and attention. We hypothesize that the personality disorder of our patient could be related to cingulate cortex lesion and secondary orbitofrontal cortex dysfunction associated with schizencephaly.

Estudos de associação entre transtorno obsessivo-compulsivo e genes candidatos: uma revisão / Studies of association between the obsessive-compulsive disorder and candidate genes: a review

OBJETIVO: Nos últimos anos, o papel dos genes dos sistemas serotoninérgicos e dopaminérgicos tem sido sistematicamente investigado em pacientes com transtorno obsessivo-compulsivo (TOC), uma vez que esses neurotransmissores apresentam uma provável implicação na fisiopatologia do TOC. Este artigo objetiva revisar os principais resultados de estudos de associação entre genes candidatos e TOC. MÉTODOS: Revisão da literatura na base de dados Medline até agosto de 2006, utilizando as palavras-chave obsessive-compulsive disorder (OCD) e/ou gene(s), polymorphism(s), genetics. RESULTADOS: Inúmeros estudos têm apresentado resultados negativos ao compararem pacientes com TOC e controles, entretanto resultados positivos têm sido observados em pacientes com TOC com características clínicas particulares (sexo, idade de início, dimensão ou gravidade dos sintomas obsessivos ou compulsivos e presença de tiques). CONCLUSÃO: Para garantir a continuidade do avanço de estudos genéticos, é necessária a identificação de subgrupos homogêneos de pacientes com TOC. Diante desses grupos, será possível delinear endofenótipos confiáveis que permitam explorar de forma mais específica a contribuição dos diferentes genes na patogênese da doença.

OBJECTIVE: The obsessive compulsive-disorder (OCD) is a psychiatric disorder characterized by the presence of obsessions and compulsions. Its prevalence is of approximately 2 percent-3 percent in the general population. In the last years, genes of the serotoninergic and dopaminergic systems have been investigated as these neurotransmitters are probably involved in the pathophysiology of the OCD. This article aims at revising the results of studies of association between candidate genes and OCD. METHODS: Review of the literature in the Medline database until August of 2006, using the key words: obsessive-compulsive disorder, OCD and/or gene(s), polymorphism(s), genetics. RESULTS: A series of studies presented negative results when comparing OCD patients and controls. Nevertheless, positive results have been observed, when studying among OCD patients, distinct clinical features (gender, age of beginning, dimension and/or severity of the obsessive and/or compulsive symptoms, presence of tics). CONCLUSION: For the advance of genetic studies in OCD, it would be necessary to identify homogeneous subgroups of OCD patients. Based on these subgroups, it may be possible to define reliable endophenotypes that could lead to a more rational search for genes possibly involved in OCD pathogenesis.