A relação de ajuda ao doente em fim de vida e família: o enfermeiro e o cuidar em fim de vida

Os cuidados ao doente em fim de vida tornam-se difíceis de suportar pelas pessoas envolvidas, pois, para além da sobrecarga física, existe um grande desgaste psicológico e emocional, pelo que se torna importante um acompanhamento e apoio por parte dos profissionais de saúde. A relação de ajuda é um elemento decisivo na atividade dos enfermeiros, desempenhando um papel central na resposta às necessidades concretas do doente em fim de vida e sua família. O objectivo do estudo foi identificar necessidades e dificuldades que os enfermeiros enfrentam no contexto da relação de ajuda ao doente em fim de vida e família. A metodologia utilizada foi a Revisão Sistemática da Literatura sendo aplicada a metodologia PICO. Recorreu-se às bases de dados B-on, LILACS e Scielo, tendo sido reunidos 14 artigos e analisados 7. Os resultados mostraram que muitos enfermeiros sentem dificuldade em comunicar com doentes terminais, apesar de valorizarem as relações interpessoais relacionadas com a comunicação, o conforto, o apoio e acompanhamento e as técnicas de alívio do sofrimento do doente e família, direcionadas para a gestão da dor e sofrimento. A falta de formação em cuidados paliativos é evidente, sendo que o desempenho das competências relacionais de ajuda está correlacionado com a formação que os enfermeiros desenvolvem acerca da relação de ajuda. As principais conclusões a que o estudo chegou foram que apesar da dedicação dos enfermeiros a relação de ajuda ao doente terminal e família nem sempre é conseguida. O desenvolvimento pessoal e profissional, o modo como gerem as dificuldades pessoais e relacionais com o doente e família no contexto de fim de vida, são considerados como os ingredientes major ao nível do cuidar e da relação de ajuda profissional.info:eu-repo/semantics/publishedVersio

The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region

Objective. To analyse survival in patients with pulmonary tuberculosis (PTB) and factors associated with such survival. Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004–2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression. Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years) and treatment duration (under six months) were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant. Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years

Setups microfluídicos dedicados al cultivo celular

El desarrollo de nuevas herramientas de cultivo celular basadas en microtecnologías permitecontrolar el escenario mecánico, químico y eléctrico de las muestras biológicas, así comomonitorizar sus reacciones de una manera que hasta ahora era imposible. Como consecuencia,es posible generar nuevas vías para la realización de tests “in-vitro” en condiciones muysimilares a las “in-vivo”. Se espera que dicho avance permita reducir la experimentación conanimales y optimizar el desarrollo de nuevos fármacos a través de pruebas de test masivo (highthroughput).Hasta la fecha, los dispositivos microfluídicos para cultivo celular han estado basados entecnología de litografía blanda (soft-lithography), utilizando materiales como el PDMS. Latecnología basada en el material polimérico SU-8 ha sido ya previamente desarrollada y testeadapara aplicaciones del diagnóstico clínico, permitiendo no solo la construcción robusta demicrocanales, sino la posibilidad de integrar sensores y de crear redes de canales en tresdimensiones entre otras características interesantes.Tras la fabricación de los primeros dispositivos microfluídicos en SU-8 y la realización de lainserción de células en su interior, se ha podido corroborar la viabilidad del crecimiento celularen dichos dispositivos, aplicando un flujo de nutrientes continuo y controlado. Este control deflujo y el ambiente biomimético buscado se consiguen mediante el establecimiento de todo unsetup microfluídico consistente en encapsulado para el chip, reservorio, válvulas y microbomba.En este tipo de experimentación es muy importante tener un control preciso del flujo que se leestá aplicando a las células, por lo que el control de la microbomba es uno de los aspectosfundamentales en el desarrollo de setup microfluídicos para cultivo celular

Force Spectroscopy Imaging and Constriction Assays Reveal the Effects of Graphene Oxide on the Mechanical Properties of Alginate Microcapsules

Microencapsulation of cells in hydrogel-based porous matrices is an approach that has demonstrated great success in regenerative cell therapy. These microcapsules work by concealing the exogenous cells and materials in a robust biomaterial that prevents their recognition by the immune system. A vast number of formulations and additives are continuously being tested to optimize cell viability and mechanical properties of the hydrogel. Determining the effects of new microcapsule additives is a lengthy process that usually requires extensive in vitro and in vivo testing. In this paper, we developed a workflow using nanoindentation (i.e., indentation with a nanoprobe in an atomic force microscope) and a custom-built microfluidic constriction device to characterize the effect of graphene oxide (GO) on three microcapsule formulations. With our workflow, we determined that GO modifies the microcapsule stiffness and surface properties in a formulation-dependent manner. Our results also suggest, for the first time, that GO alters the conformation of the microcapsule hydrogel and its interaction with subsequent coatings. Overall, our workflow can infer the effects of new additives on microcapsule surfaces. Thus, our workflow can contribute to diminishing the time required for the validation of new microcapsule formulations and accelerate their clinical translation

Diversity of HLA Class I and Class II blocks and conserved extended haplotypes in Lacandon Mayans.

Here we studied HLA blocks and haplotypes in a group of 218 Lacandon Maya Native American using a high-resolution next generation sequencing (NGS) method. We assessed the genetic diversity of HLA class I and class II in this population, and determined the most probable ancestry of Lacandon Maya HLA class I and class II haplotypes. Importantly, this Native American group showed a high degree of both HLA homozygosity and linkage disequilibrium across the HLA region and also lower class II HLA allelic diversity than most previously reported populations (including other Native American groups). Distinctive alleles present in the Lacandon population include HLA-A*24:14 and HLA-B*40:08. Furthermore, in Lacandons we observed a high frequency of haplotypes containing the allele HLA-DRB1*04:11, a relatively frequent allele in comparison with other neighboring indigenous groups. The specific demographic history of the Lacandon population including inbreeding, as well as pathogen selection, may have elevated the frequencies of a small number of HLA class II alleles and DNA blocks. To assess the possible role of different selective pressures in determining Native American HLA diversity, we evaluated the relationship between genetic diversity at HLA-A, HLA-B and HLA-DRB1 and pathogen richness for a global dataset and for Native American populations alone. In keeping with previous studies of such relationships we included distance from Africa as a covariate. After correction for multiple comparisons we did not find any significant relationship between pathogen diversity and HLA genetic diversity (as measured by polymorphism information content) in either our global dataset or the Native American subset of the dataset. We found the expected negative relationship between genetic diversity and distance from Africa in the global dataset, but no relationship between HLA genetic diversity and distance from Africa when Native American populations were considered alone

Resistencia a la insulina y Enfermedad de Alzheimer prodrómica en la Comunidad de La Rioja: primeras impresiones

Trabajo presentado en la XLIII Reunión de la Sociedad de Neurología del País Vasco, celebrada en Vitoria (España), el 6 de mayo de 202

Decision making impairment: A shared vulnerability in obesity, gambling disorder and substance use disorders?

Introduction: Addictions are associated with decision making impairments. The present study explores decision making in Substance use disorder (SUD), Gambling disorder (GD) and Obesity (OB) when assessed by Iowa Gambling Task (IGT) and compares them with healthy controls (HC). Methods: For the aims of this study, 591 participants (194 HC, 178 GD, 113 OB, 106 SUD) were assessed according to DSM criteria, completed a sociodemographic interview and conducted the IGT. Results: SUD, GD and OB present impaired decision making when compared to the HC in the overall task and task learning, however no differences are found for the overall performance in the IGT among the clinical groups. Results also reveal some specific learning across the task patterns within the clinical groups: OB maintains negative scores until the third set where learning starts but with a less extend to HC, SUD presents an early learning followed by a progressive although slow improvement and GD presents more random choices with no learning. Conclusions: Decision making impairments are present in the studied clinical samples and they display individual differences in the task learning. Results can help understanding the underlying mechanisms of OB and addiction behaviors as well as improve current clinical treatments

Thermoplastic elastomer with advanced hydrophilization and bonding performances for rapid (30 s) and easy molding of microfluidic devices

One of the most important area of research in microfluidic technologies focuses on the identification and characterisation of novel materials with enhanced properties and versatility. Here we present a fast, easy and inexpensive microstructuration method for the fabrication of novel, flexible, transparent and biocompatible microfluidic devices. Using a simple hot-press, we demonstrate the rapid (30s) production of various microfluidic prototypes embossed in a commercially-available soft thermoplastic elastomer (sTPE). This styrenic block copolymer (BCP) material is as flexible as PDMS and as thermoformable as classical thermoplastics. It exhibits high fidelity in replication using SU–8 and epoxy master molds in a highly convenient low-isobar (0.4 bar) and iso-thermal process. Microfluidic devices can then be easily sealed using either a simple hot plate or even room-temperature assembly, allowing them so sustain liquid pressure of 2 and 0.6 bars respectively. The excellent sorption and biocompatibility properties of the microchips were validated via a standard rhodamine dye assay as well as a sensitive yeast cell-based assay. The morphology and composition of the surface area after plasma treatment for hydrophilization purposes are stable and show constant and homogenous distribution of the block nanodomains (∼ 22° after 4 days). These domains, which are evenly distributed at the nanoscale, therefore account for a uniform and convenient surface at a “microfluidic scale device”. To our knowledge, this is the first thermoplastic elastomer material that can be used for fast and reliable fabrication and assembly of microdevices while maintaining a high and stable hydrophilicity

Dynamic arrest in charged colloidal systems exhibiting large-scale structural heterogeneities

Suspensions of charged liposomes are found to exhibit typical features of strongly repulsive fluid systems at short length scales, while exhibiting structural heterogeneities at larger length scales that are characteristic of attractive systems. We model the static structure factor of these systems using effective pair interaction potentials composed of a long-range attraction and a shorter range repulsion. Our modeling of the static structure yields conditions for dynamically arrested states at larger volume fractions, which we find to agree with the experimentally observed dynamics

Binding Potassium to Improve Treatment With Renin-Angiotensin-Aldosterone System Inhibitors: Results From Multiple One-Stage Pairwise and Network Meta-Analyses of Clinical Trials.

This manuscript presents findings from the first dichotomous data pooling analysis on clinical trials (CT) regarding the effectiveness of binding potassium. The results emanated from pairwise and network meta-analyses aiming evaluation of response to commercial potassium-binding polymers, that is, to achieve and maintain normal serum potassium (n = 1,722), and the association between this response and an optimal dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) needing individuals affected by heart failure (HF) or resistant hypertension, who may be consuming other hyperkalemia-inducing drugs (HKID) (e.g., β-blockers, heparin, etc.), and frequently are affected by chronic kidney disease (CKD) (n = 1,044): According to the surface under the cumulative ranking area (SUCRA), sodium zirconium cyclosilicate (SZC) (SUCRA >0.78), patiromer (SUCRA >0.58) and sodium polystyrene sulfonate (SPS) (SUCRA <0.39) were different concerning their capacity to achieve normokalemia (serum potassium level (sK+) 3.5-5.0 mEq/L) or acceptable kalemia (sK+ ≤ 5.1 mEq/L) in individuals with hyperkalemia (sK+ >5.1 mEq/L), and, when normokalemia is achieved, patiromer 16.8-25.2 g/day (SUCRA = 0.94) and patiromer 8.4-16.8 g/day (SUCRA = 0.41) can allow to increase the dose of spironolactone up to 50 mg/day in subjects affected by heart failure (HF) or with resistant hypertension needing treatment with other RAASi. The potential of zirconium cyclosilicate should be explored further, as no data exists to assess properly its capacity to optimize dosing of RAASi, contrarily as it occurs with patiromer. More research is also necessary to discern between benefits of binding potassium among all type of hyperkalemic patients, for example, patients with DM who may need treatment for proteinuria, patients with early hypertension, etc. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020185614, CRD42020185558, CRD42020191430