Intervenções promotoras da capacidade de mentalização e função reflexiva: uma revisão integrativa

This scoping review explores research conducted between 2008 to 2019, that aims to understand the conceptual use of mentalization (M) and reflective functioning (RF) and explore possibilities for interventions that promote these skills. The review utilized the descriptors “reflective functioning OR mentalizing OR mentalization AND intervention”. Reviewed papers were written in English, Portuguese or Spanish, and covered several research areas. The analysis considered several categories, including aims, study design, participants, type of intervention, intervention assessments and outcomes. Thirty-four papers were considered, most of them using a quantitative approach and addressed to adults and parents/caregivers-infants.  The present review highlights the need to develop specific assessments procedures to evaluate RF and M, as well as studies that consider the Brazilian context. The study also emphasizes the need for theoretical systematization of M and RF concepts, considering they are frequently used as synonyms.La presente revisión integrativa exploró investigaciones realizadas entre 2008 y 2019 para sistematizar información acerca del uso conceptual de capacidad de mentalización (CM) y función reflexiva (FR), así como las posibilidades de intervenciones para su promoción. Los descriptores fueron “reflective functioning OR mentalizing OR mentalization AND intervention” en la búsqueda artículos empíricos en inglés, portugués o español, de distintas áreas del conocimiento. El análisis de los datos consideró las categorías: objetivos, diseños, participantes, tipo de intervención utilizada, instrumentos de evaluación de la intervención y resultados. Treinta y cuatro artículos fueron elegidos, en su mayoría cuantitativos, destinados a adultos y padres-bebés. La revisión destaca la necesidad del desarrollo de instrumentos de evaluación específicos para evaluar FR y CM, así como la necesidad de investigaciones que exploren la realidad de países como Brasil. Otro aspecto es la sistematización de los conceptos, ya que, en su mayoría, fueron referidos como sinónimos.Esta revisão integrativa da literatura objetivou sistematizar as possibilidades de intervenções promotoras da Capacidade de Mentalização (CM) e Função Reflexiva (FR), publicadas entre 2008 a 2019. Utilizou-se os descritores “reflective functioning OR mentalizing OR mentalization AND intervention” e incluiu-se artigos empíricos, disponibilizados em Inglês, Português ou Espanhol, provenientes de diferentes áreas. Analisou-se os dados através das categorias: objetivos; delineamentos; participantes; tipo de intervenção utilizada; instrumentos de avaliação da intervenção empregados; resultados. Encontrou-se 34 artigos que predominantemente verificaram a eficácia das intervenções, possuíam delineamento quantitativo, voltados para adultos e, ainda, intervenções com potencial para fortalecer os vínculos pais/cuidadores-criança. Concluiu-se sobre a necessidade de se desenvolver instrumentos específicos para avaliar FR e CM, estudos que abordem a realidade brasileira e, ainda, a sistematização desses conceitos, que na maioria dos artigos, se apresentaram como sinônimos

Trichomonas vaginalis e candida spp. em amostras de urina : isolamento, suscetibilidade a fármacos e determinação da virulência

Trichomonas vaginalis é o agente etiológico da tricomonose, a doença sexualmente transmissível não viral mais comum no mundo. Segundo a OMS 276,4 milhões de novos casos ocorrem anualmente no mundo e falhas no tratamento e resistência ao metronidazol têm sido relatadas. A presença de fungos leveduriformes no exame de urina pode ser definida como candidúria, no entanto, outros parâmetros são necessários para auxiliar no diagnóstico. O gênero Candida é o patógeno mais frequentemente isolado em infecções nosocomiais do trato urinário, tendo importantes implicações clínicas, principalmente em pacientes cateterizados. Neste estudo, investigamos a associação entre resistência ao metronidazol, expressão da enzima piruvato ferredoxina oxidoredutase (PFOR) e a presença de infecção de Mycoplasma hominis e trichomonasvirus (TVV) em isolados de T. vaginalis, ATCC (2), de longo tempo de cultivo em laboratório (2) e isolados frescos obtidos de amostras de urina (30). Além disso, a suscetibilidade de 25 isolados de Candida spp. a cinco diferentes antifúngicos foi avaliada e comparada com a capacidade de formar biofilme em placa de poliestireno, sendo oito isolados fortemente produtores de biofilme selecionados para ensaios de capacidade de formação de biofilme em corpo de prova e comparação da concentração inibitória mínima (CIM) de células planctônicas, células em biofilme (CMEB) e células pós-formação de biofilme (CIMPB). Quinhentas e trinta amostras de urina foram analisadas para a presença de T. vaginalis (21 positivas) e Candida spp. (25 positivas). Dos 34 isolados de T. vaginalis avaliados, 61,8% estavam infectados por M. homnis e 88,2% por diferentes espécies de TVVs. Todos os isolados foram sensíveis ao metronidazol e expressaram a PFOR. O perfil de sensibilidade foi observado na maioria dos isolados de Candida e 92% das leveduras foram produtoras de biofilme em placa, não sendo encontrada correlação entre a capacidade de formar biofilme e o perfil de suscetibilidade a fármacos. Todas as leveduras selecionadas para o ensaio de biofilme em corpo de prova foram capazes de formar biofilme em sonda urinária e o ensaio para determinação da CMEB demonstrou a alta resistência das células leveduriformes quando na forma de biofilme. A partir dos resultados obtidos, podemos inferir que a relação simbiótica entre o T. vaginalis e os micro-organismos pesquisados não está correlacionada com sua resistência a fármacos. Nossos resultados demonstram também a alta prevalência de isolados de T. vaginalis infectados com M. hominis e diferentes espécies de TVVs, além disso, foi observado um perfil de sensibilidade ao metronidazol. Quanto aos resultados encontrados para Candida, podemos observar a alta capacidade de formação de biofilme deste gênero e o aumento significativo da resistência de células em biofilme a diferentes classes de antifúngicos. Portanto, nosso estudo aponta resultados relevantes para o conhecimento de fatores de virulência e do perfil de isolados de T. vaginalis e Candida spp. do Sul do Brasil, contribuindo para a profilaxia e conduta terapêutica da tricomonose e da candidúria.Trichomonas vaginalis is the causative agent of trichomonosis, the non-viral sexually transmitted disease most common in the world. According to WHO 276.4 million new cases occur annually worldwide and treatment failures and resistance to metronidazole have been reported. The presence of yeasts in urine tests may be defined as candiduria, however, other parameters are needed to assist in diagnosis. The genus Candida is the pathogen most frequently isolated in nosocomial urinary tract infections, with important clinical implications, especially in catheterized patients. In this study, we investigated the association between metronidazole resistance, pyruvate ferredoxin oxireductase (PFOR) enzyme expression and the presence of M. hominis and TVVs infection of ATCC, long-term grown, and fresh clinical T. vaginalis isolates from urine samples. Five different antifungal agents were evaluated in the susceptibility assay of 25 isolates of Candida spp. The ability to form biofilm on polystyrene plate was compared to antifungal susceptibility and eight Candida isolates strongly biofilm producers were selected for testing the ability of biofilm formation in the specimen and comparing the minimum inhibitory concentration (MIC) of planktonic cells, biofilm cells (MBEC), and post-biofilm cells (PBC). Five hundred and thirty urine samples were analyzed for the presence of T. vaginalis (21 positive) and Candida spp. (25 positive). Among the 34 T. vaginalis isolates included in this study, 61.8% were infected by M. homnis and 88.2% by different TVVs species. All isolates were metronidazole sensitive and did express PFOR. Sensitivity profile was observed in most Candida isolates and 92% of the yeasts produced plate biofilm, and no correlation between the ability to form biofilm and the drug susceptibility profile was found. All yeasts selected for testing biofilm on the test specimen were able to form biofilm on urinary catheter. The determination of MBEC demonstrated high resistance in yeast cells when in biofilm form. Overall, our results show that the symbiotic relationship between T. vaginalis and the microorganisms screened is not correlated with drug resistance. Our results also demonstrate the high prevalence of T. vaginalis isolates infected with M. hominis and different species of TVVs. Also, in our study it was observed a metronidazole sensitivity profile. Considering Candida spp., we can observe the high capacity of biofilm formation of this genus and the significant increase in the resistance of biofilm cells to different classes of antifungal. Furthermore, our study originated relevant results to the knowledge of virulence factors and the profile of T. vaginalis and Candida spp. isolates of the South of Brazil, contributing for the prophylaxis and therapeutic management of trichomonosis and candiduria

Helicobacter pylori eradication : influence of interleukin-1beta –31 C/T polymorphism

Aim: To analyze the influence of the –31 C/T polymorphism of the interleukin-1 gene on Helicobacter pylori eradication therapy success in patients with functional dyspepsia. Methods: Functional dyspepsia was diagnosed according to the Rome III criteria. All patients underwent upper gastrointestinal endoscopy, and gastric biopsies were obtained at screening and 12 months after randomization (last follow-up visit). Urease test and histological examination were performed to define the H. pylori status. Patients received twice-daily amoxicillin, clarithromycin and omeprazole for 10 days. Genotyping of the interleukin-1beta –31 C/T polymorphism (rs1143627)was performed using polymerase chain reaction-restriction fragment length polymorphism. Results: One hundred forty-nine patients received treatment with triple therapy for H. pylori eradication. Only one patient was lost to follow-up, and adherence to study medication was 94.6%. A total of 148 patients (mean age 46.08±12.24 years; 81.8% women) were evaluated for the influence of the interleukin-1beta –31 C/T polymorphism on the outcome of H. pylori eradication therapy. After treatment, bacteria were eradicated in 87% of patients (129/148). Genotype frequencies of the polymorphism were as follows: CC, 38/148 (25.7%); CT, 71/148 (47.9%); and TT, 39/148 (26.4%). Successful eradication rate was 78.9%, 94.4% and 82.1% for the CC, CT and TT genotypes, respectively. The CT genotype was significantly associated with successful H. pylori eradication (p = 0.039). Conclusion: This study suggests that the CT genotype of the interleukin-1beta –31 C/T polymorphism plays a role in the successful eradication of H. pylori among patients with functional dyspepsia

Mental health in the era of COVID-19 : prevalence of psychiatric disorders in a cohort of patients with type 1 and type 2 diabetes during the social distancing

Background: In patients with diabetes, the prevalence of depression and anxiety symptoms is about two to four times greater than in the general population. The association between diabetes and mental health disorders could be exacerbated in a stressful environment, and psychological distress could increase depressive symptoms and cause adverse diabetes outcomes. Objectives: To assess the prevalence of mental health disorders in patients with diabetes during the social distancing period due to COVID-19 pandemic. Methods: This is a cross-sectional study developed to assess the impact of social distancing on a cohort of adults with type 1 (n = 52) and type 2 diabetes (n = 68) in Brazil. Inclusion criteria involved having an HbA1c test collected in the past 3 months and having a valid telephone number in electronic medical records. The primary outcome was the prevalence of minor psychiatric disorders, assessed by survey (SRQ-20). Secondary outcomes included the prevalence of diabetes related emotional distress, eating and sleeping disorders, all assessed by validated surveys at the moment of the study. Statistical analyses included unpaired t-test for continuous variables and χ2 test for categorical variables. Results: Overall (n = 120), participants had a mean age of 54.8 ± 14.4 years-old, and HbA1c of 9.0 ± 1.6% (75 ± 17.5 mmol/mol); 93% of patients showed signs of current mental suffering based on the surveys measured. Almost 43% of patients showed evidence of significant psychological distress, with a significant greater tendency in patients with type 2 diabetes. The presence of diabetes related emotional distress was found in 29.2% of patients; eating disorders in 75.8%; and moderate/severe sleeping disorders in 77.5%. Conclusions: We found a high prevalence of evidence of psychological distress among patients with diabetes during the COVID-19 pandemic and this highlights the need for mental health access and support for patients with type 1 and type 2 diabetes

Susceptibilidade antifúngica em biofilme de Candida isolada a partir da urina pacientes ambulatoriais

Background and Objectives: the association between the biofilm formations an antifungal resistance has been suggested to be an important factor in the pathogenesis of several Candida species. Besides, studies have included invasive candidiasis from hospitalized patients; however there are few studies that evaluated the species distribution, antifungal susceptibility and biofilm formation of Candida species isolated from ambulatory patients. Thus, the aim of this study was to evaluate whether biofilm producing contributes to antifungal resistance in Candida isolates from urine sample obtained from ambulatory patients. Methods: During one year, 25 urine samples positive for yeast were collected, stored and plated on agar supplemented with chloramphenicol and Sabouread left at room temperature for 5 days for subsequent: 52% (13/25) were C. albicans, 36% (9/25) C. tropicalis, 8% (2/25) C. krusei and 4% (1/25) C. parapsilosis. Results: The ability to form biofilm was detected in 23 (92%) of the yeast studied and 15.4% (2/13) of C. albicans were fluconazole (FLU) and ketoconazole (KET) resistant, while 11.1% (1/9) of C. tropicalis were ketoconazole resistant and were anidulafungin (ANI) non-susceptible. Conclusion: our results showed the high capacity for biofilm formation among Candida isolates from ambulatory patients.Justificativa e objetivos: a associação entre as formações biofilme uma resistência antifúngica foi sugerido para ser um fator importante na patogênese de diversas espécies de Candida. Além disso, estudos têm incluído candidíase invasiva de pacientes hospitalizados; no entanto, existem poucos estudos que avaliaram a distribuição das espécies, suscetibilidade aos antifúngicos e formação de biofilme de espécies de Candida isoladas de pacientes ambulatoriais. Assim, o objetivo deste estudo foi avaliar se a produção de biofilme contribui para a resistência antifúngica em Candida isoladas de amostras de urina obtidas de pacientes de ambulatório. Métodos: Durante um ano, 25 amostras de urina positivas para leveduras, foram coletadas, armazenadas e semeadas em agar Sabouread suplementado com cloranfenicol e deixadas a temperature ambiente por 5 dias, para posterior identificação: 52% (13/25) foram C. albicans, 36% (9/25) C. tropicalis, 8% (2/25) C. krusei e 4% ( 1/25) C. parapsilosis. Resultados: A capacidade de formar biofilme foi detectada em 23 (92%) da levedura estudados e 15,4% (2/13) de C. albicans foram fluconazol (FLU) e cetoconazol (PET) resistente, enquanto que 11,1% (1/9 ) de C. tropicalis foram resistentes cetoconazol e foram anidulafungina (ANI) não-suscetíveis. Conclusão: nossos resultados mostraram a alta capacidade de formação de biofilme entre Candida isoladas de pacientes ambulatoriais. Conclusão: nossos resultados mostraram a alta capacidade de formação de biofilme entre Candida isoladas de pacientes ambulatoriais