Early palliative care to decrease suffering in neonatal intensive care unit: narrative review

Objective: The objectives of this review are to ascertain the diseases that result in palliative care in neonates in NICU and whether such care can ease the suffering of the child or the family. Methods: This is a narrative and descriptive literature review carried out in MEDLINE, PUBMED, VHL, and LILACS BVS databases during November 2020 to May 2021. Descriptors used are “Intensive Care Units,” “Ethics,” “Palliative Care,” and “Newborn,” which are related to Boolean descriptor “AND.” Articles published in English and within the last five years were included in this article. Results: The respiratory diseases and distress, prematurity, congenital abnormalities, and patients at risk of neurological injury represents some of the reasons to refer the patient to the ICU. Beyond that, the three most life-timing complex chronic conditions are neurological, neuromuscular, and cardiovascular diseases. The research emphasizes that the relief in the neonatal ICU is an important factor, in this way, palliative care should be focused mostly on the patient. Conclusion: To date, palliative care is appropriate from the moment when a serious diagnosis is made, otherwise it requires the creation of a protocol that guides patients to healthcare professionals. Regardless, to improve the life quality of the neonates during development, their care must be maintained at all moments of the therapeutic intervention

Apoptosis as a prognostic marker in canine mammary tumors by TUNEL

A apoptose, como evento celular, tem uma participação importante na tumorigênese, determinando o crescimento tumoral e sua agressividade. O presente estudo, teve como objetivo, examinar a relação entre a apoptose, o diagnóstico histopatológico e o prognóstico na neoplasia mamária canina. Trinta cadelas foram submetidas a exérese tumoral e o fragmento tumoral submetido ao método de marcação das células apoptóticas, que marca fragmentos de DNA da célula em apoptose, conhecido como desoxinucleotídeo terminal transferase (TdT) mediado pela 5' desoxiuridina trifosfato (dUTP) ou TUNEL. As células em apoptose foram contadas em 10 campos de maior aumento (10HPF) sendo que os resultados estatísticos demonstraram uma correlação positiva entre a apoptose e o prognóstico ruim (p= 0,0005). Dessa forma, a apoptose pode ser considerada um marcador prognóstico nas neoplasias mamárias caninas.Apoptosis plays an important role in oncogenesis determining tumor growth and aggressiveness. The aim of this study was to examine the relationship between apoptosis, diagnosis and prognosis in canine mammary tumors. Thirty bitches were submitted to tumor extirpation and a method of labeling apoptotic cells, that labels DNA fragments, by terminal deoxynucleotidyl-tranferase (TdT) mediated by 5' deoxy-uridine-triphosphate (dUTP) nick and labeling (TUNEL) was used. The apoptotic cells were counted in ten high power fields (10HPF). Statistical results showed that when there are more than 30 apoptotic cells/10HPF the prognosis is worse (p= 0,0005). Thus suggesting that apoptosis can be used as a prognostic marker in canine breast tumors

Early palliative care to decrease suffering in neonatal intensive care unit: narrative review

Objective: The objectives of this review are to ascertain the diseases that result in palliative care in neonates in NICU and whether such care can ease the suffering of the child or the family. Methods: This is a narrative and descriptive literature review carried out in MEDLINE, PUBMED, VHL, and LILACS BVS databases during November 2020 to May 2021. Descriptors used are “Intensive Care Units,” “Ethics,” “Palliative Care,” and “Newborn,” which are related to Boolean descriptor “AND.” Articles published in English and within the last five years were included in this article. Results: The respiratory diseases and distress, prematurity, congenital abnormalities, and patients at risk of neurological injury represents some of the reasons to refer the patient to the ICU. Beyond that, the three most life-timing complex chronic conditions are neurological, neuromuscular, and cardiovascular diseases. The research emphasizes that the relief in the neonatal ICU is an important factor, in this way, palliative care should be focused mostly on the patient. Conclusion: To date, palliative care is appropriate from the moment when a serious diagnosis is made, otherwise it requires the creation of a protocol that guides patients to healthcare professionals. Regardless, to improve the life quality of the neonates during development, their care must be maintained at all moments of the therapeutic intervention

The Effects of Spirituality and Religiosity on Better Symptom Control in Patients With Covid-19

The new coronavirus (SARS-CoV-2), whose disease is COVID-19, in March 2020, spread around the world. To minimize the deleterious effects of emotional vulnerability, many strategies are in use worldwide, such as support groups, online courses, use of social networks, web meetings, yoga practice, meditation, and other contemplative religious and spiritual activities. Religious and spiritual beliefs have been used to deal with tough situations and, through scientific literature is still not so clear about the role of spirituality and religiosity (S/R) in physical and mental health during the pandemic. Therefore, this article proposes a discussion about the physiopathological mechanisms of COVID-19 and how S/R could be useful in this context. In this sense, religious faith can be a powerful resource for good health and well-being with a positive impact verified in mental health outcomes it is plausible to suggest that S/R should be an important tool in minimizing the population suffering at this moment. Spiritual care has long been recognized as one of the domains of quality palliative care, but every health care professional is ultimately responsible for ensuring spiritual care to deal with spiritual distress and improve quality of life in the scenarios inherent to COVID-19

Witnessing death does not necessarily relieve the dis-comfort of death: analysis of the relationship between religiosity and thanatophobia in medicine undergraduate students

Introduction: It is known that very few issues related to death and religiosity/spirituality are addressed during medical graduation. Understanding the process of death and dying is still a problem for medical students before the terminal condition of a patient. Probably the medical students of the fifth graders overestimate their abilities, probably because they have not yet had contact with terminally ill patients or because they have not graduated, they do not take responsibility for the death of a patient they are following. In Brazil, many students believe that the topic of spirituality influences health, but they do not feel prepared to address this issue with patients. Objective: It was to analyze whether there is a relationship between religiosity and thanatophobia in medical students. It also analyzed whether there was a correlation between fear of death and specific religions, sex and age, and the index of religiosity with sex and age. Methods: Followed a prospective observational cross-sectional model, following the STROBE clinical research rules. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 2,031,705, and obtaining the patient's consent. Results: A total of 542 students (61.2% of the total) answered the questionnaire. Most were female (65.7%) and with a mean age of 22.31 (ranging from 17 to 39 years). The majority of students have a religion (90.1%) and 90.4% considered it important to address the issue of death and religiousness during graduation. In this study, it was observed that most students, in addition to having some kind of religion, consider it important to address the themes highlighted during the course. This was similar to the findings in other studies. There was no statistically significant relationship between having a religion and being less afraid of death. However, students with higher levels of intrinsic religiosity showed greater discomfort when dealing with terminal patients. Furthermore, no studies comparing these two subjects were found. It was also found in this research that students with high levels of religiosity consider it more important to address the issues in question, with the majority being female students. Conclusion: It is necessary to include the topic in the medical academy, and it is essential to prepare a more humanistic and dedicated professional for patients, whether active or palliative treatment

Avaliação global: uma iniciativa na avaliação de competências em estudantes de medicina

Este artigo apresenta um relato de experiência sobre a implementação de uma avaliação global multimodal no curso de medicina. Focado na integração de conhecimento teórico e habilidades práticas, este estudo inovador envolveu estudantes do primeiro ao oitavo semestre, avaliados por colegas dos semestres finais. A avaliação abrangeu três modalidades: provas escritas para conhecimento teórico, estações práticas para habilidades médicas, e o Exame Clínico Objetivo Estruturado (OSCE) para atitudes. Descrever a metodologia e implementação da avaliação global multimodal no curso de graduação em medicina. Utilizou-se uma abordagem qualitativa, coletando dados por meio de observações, feedback de estudantes e professores, e análise documental. A análise enfocou as implicações práticas, desafios operacionais e reações dos envolvidos. Os resultados revelaram que a avaliação global multimodal efetivamente integrou conhecimento teórico e habilidades práticas. Os estudantes demonstraram uma compreensão aprofundada e aplicação das competências médicas, traduzindo-se em maior engajamento e entendimento holístico da medicina. Os professores notaram um avanço significativo no processo de aprendizagem e preparo dos alunos para enfrentar desafios clínicos. A avaliação global multimodal emergiu como uma inovação relevante na educação médica, desafiando o modelo tradicional de ensino e avaliação. Este estudo contribui para o debate sobre práticas eficazes de avaliação na educação médica, evidenciando a importância desta abordagem no desenvolvimento de competências médicas adaptadas às exigências contemporâneas do campo

Terapia auxiliar com o tranilast pré-operatório na cirurgia do pterígio primário com um ano de seguimento

Purpose: To determine the efficacy of tranilast as an adjunctive therapy in conjunctival autograft. Methods: Twenty-nine patients were randomly allocated to the Tranilast Group (n=15) or the Control Group (n=14). The Tranilast Group received a subconjunctival injection of 0.5% tranilast 30 days prior to surgery. Conjunctival autograft was performed in both groups using fibrin sealant and 0.02% subconjunctival mitomycin C at the end of the surgery. After the resection of the pterygium, immunohistochemistry was performed with 100 cells to identify epithelial cells positive for transforming growth factor-β (TGF-β). Subjective symptoms were evaluated using a 5-point scale, and the recurrence rate was assessed. Results: Both groups showed improvements in their symptoms and similar clinical results. Compared with the Control Group, the Tranilast Group failed to show a decreased recurrence rate (p=0.59). However, the number of epithelial cells expressing TGF-β was lower in the Tranilast Group (5 cells; 95% CI: 2.56-13.15; Control Group, 16 cells, 95% CI: 11.53-24.76; p=0.01). Minimal but reversible complications, including glaucoma secondary to corticosteroids and granuloma, occurred during the study. Conclusion: Tranilast was effective in decreasing the number of pterygium epithelial cells expressing TGF-β.Objetivo: Determinar a eficácia do tranilast, como terapia auxiliar no transplante autólogo de conjuntiva. Métodos: Vinte e nove pacientes foram randomizados em dois grupos: Grupo Tratado (15) e Grupo Controle (14). Trinta dias antes da cirurgia, o Grupo Tratado recebeu uma injeção subconjuntival de tranilast a 0,5%. O transplante autólogo de conjuntiva foi realizado em ambos os grupos, usando-se a cola de fibrina e a mitomicina 0,02% subconjuntival, ao final da cirurgia. Cada paciente foi examinado por 12 meses de acompanhamento. A imuno-histoquímica foi realizada, mediante um total de 100 células, a fim de que se contassem as células epiteliais positivas, para o fator de crescimento transformador beta (TGF-β), após a cirurgia do pterígio. Os sintomas subjetivos foram avaliados usando-se uma escala de cinco pontos, e a taxa de recorrência foi avaliada. Resultados: Os 2 grupos apresentaram melhora dos sintomas e com resultados clínicos similares. Quando comparado com o Grupo Controle, o Grupo Tratado falhou em mostrar uma diminuição da taxa de recorrência (p=0,59). Entretanto o número de células epiteliais expressando o TGF-β foi menor no Grupo Tratado (5 células; 95% CI=2,56-13,15; Grupo Controle, 16 células; 95% CI: 11,53-24,76, p=0,01). Complicações mínimas, mas reversíveis, ocorreram durante o estudo, incluindo glaucoma secundário ao uso de corticoide e granuloma. Conclusão: O tranilast foi efetivo em diminuir o número células epiteliais do pterígio expressando o TGF-β.Faculdade de Medicina de São José do Rio Preto Department of SurgeryFaculdade de Medicina de São José do Rio Preto Department of PathologyUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of OphthalmologyUniversity of São Paulo Department of OphthalmologyFaculdade de Medicina de São José do Rio Preto Deparftment of Anatomy, Histology and EmbryologyUNIFESP, EPM, Department of OphthalmologySciEL

Síndrome de Hunter: uma revisão da literatura / Hunter Syndrome: a literature review

INTRODUÇÃO: A síndrome de Hunter é causada por mutações genéticas que causam diminuição ou ausência de uma enzima específica, gerando acúmulo intracelular de mucopolissacarídeos nos tecidos e órgãos do corpo. METODOLOGIA: O presente estudo é uma revisão bibliográfica narrativa de literatura, realizada nas bases de dados MEDLINE, SciELO e LILACS em agosto e setembro de 2020, com os descritores “Mucopolysaccharidosis II’’, “child” e “pathology”, combinados com operador boleano AND. Foram incluídos artigos em inglês publicados nos últimos 5 anos. RESULTADOS: Os artigos analisados foram publicados em periódicos internacionais. Desse modo, foram selecionados três relatos de casos, dois estudos transversais, dois estudos retrospectivos, uma análise duplo-cega e um estudo prospectivo e retrospectivo. DISCUSSÃO: A Síndrome de Hunter é uma mutação genética recessiva ligada ao cromossomo X, causando deficiência de uma enzima lisossomal cuja função normal é degradar glicosamidoglicanos (GAGs). Esse aumento de GAGs nos tecidos ficará retido principalmente nos retículos endoplasmáticos e causará disfunção celular grave. Além disso, essa patologia afeta principalmente jovens. CONCLUSÃO: O acúmulo de GAGs é responsável pela diminuição do aporte de oxigênio adequado nas células neuronais, modificações respiratórias, alterações cardíacas e abdominais, fatores que influenciam na gravidade da doença e também na qualidade e sobrevida dos pacientes