Dificuldades do Cuidador Informal do Idoso Dependente

Introdução: O envelhecimento populacional gera desafios significativos a enfrentar pelas políticas públicas de saúde. Neste sentido, o aumento da esperança média de vida, associado ao aparecimento de patologias crónicas e situações de dependência, fazem com que a família assuma um papel preponderante na prestação de cuidados ao idoso dependente. Os familiares do idoso dependente são quem adota, na maioria das vezes, o papel de cuidador informal (CI), assegurando a prestação de cuidados imprescindíveis à preservação da sua qualidade de vida. Esta realidade acarreta uma série de exigências que permitem a permanência do idoso no seu domicílio, no entanto, é possível que surjam dificuldades ao nível físico, psicológico, emocional, social e financeiro, que podem vir a afetar o seu bem-estar. Objetivo: Caracterizar as dificuldades dos CI’s de idosos dependentes referenciados na Equipa de Cuidados Continuados Integrados da Rede Nacional de Cuidados Continuados Integrados. Métodos: Estudo de natureza quantitativa, descritivo, transversal e correlacional, realizado numa amostra não probabilística, de conveniência, constituída por 35 cuidadores informais de idosos dependentes, que usufruem de cuidados de uma Equipa de Cuidados Continuados Integrados. A colheita de dados fez-se através do preenchimento de um questionário, constituído por questões sociodemográficas, pelo Índice de Barthel (versão portuguesa de Araújo, Ribeiro, Oliveira e Pinto, 2007) e pelo Índice de Avaliação das Dificuldades do Cuidador (CADI), traduzido e validado para a população portuguesa por Barreto e Brito (Brito, 2002). Os dados colhidos do conjunto de questionários foram introduzidos numa folha de cálculo Microsoft Excel (Office 2013) e processados no programa de estatística SPSS (Statistical Package for the Social Sciences) versão 23.0., 2016. Resultados: Os cuidadores informais são, na maioria, do sexo feminino (77,1%), com idades compreendidas entre 34-86 anos, apresentando uma média de idades de 65,03 anos e estado civil de casados/união de facto (77,1%), tendo completado o 1º ciclo do ensino básico (62,9%) e encontrando-se reformados a usufruir de rendimentos mensais, entre 531 a 1060 euros para o agregado familiar. A maioria dos idosos dependentes (60,0%) é do sexo masculino, com uma média de idades de 79,69 anos. A principal patologia apresentada pelos idosos dependentes foi o Acidente Vascular Cerebral (AVC) (54,3%), sendo considerada a base da necessidade da prestação de cuidados por um cuidador informal, verificando-se que a maioria dos idosos (80%) apresenta níveis de dependência total. Em termos da caraterização do contexto da prestação de cuidados, verifica-se que grande parte dos CI’s (60%) representa o cônjuge ou companheiro (a), coabitando quase todos (91,4%) com o idoso. Todos os CI’s prestam cuidados diários, sendo que 45,7% despendem 6 a 10 horas na prestação de cuidados ao idoso dependente, afirmando em cerca de 74,3%, não possuir experiência prévia neste âmbito. De acordo com o CADI, estes percecionaram maiores dificuldades nas reações à prestação de cuidados (x̅: 18,86), seguida das exigências de ordem física na prestação de cuidados (x̅: 14,83) e dos problemas relacionais com o idoso dependente (x̅: 11,94). Os CI’s percecionaram menos dificuldades na dimensão deficiente apoio profissional (x̅: 3,31). As dificuldades manifestadas pelos CI´s aumentam quando o número de horas de cuidados é maior e os CI’s com menores rendimentos, revelam mais dificuldades em cuidar dos idosos dependentes. Conclusão: O conhecimento das dificuldades dos CI’s, em cuidar do idoso dependente, por parte da equipa de enfermagem facilitará o delinear de estratégias adequadas no âmbito da prestação de cuidados domiciliários, impondo-se uma intervenção de enfermagem especializada e direcionada aos CI’s como parte integrante do processo de cuidar, com vista à obtenção de ganhos em saúde

Aplicação da sequenciação de nova geração ao diagnóstico genético do cancro da mama hereditário

Introdução: O cancro da mama hereditário (CMH) constitui 5-10% dos casos de cancro da mama, dos quais cerca de 30% se devem a mutações germinais de elevada penetrância nos genes BRCA1 e BRCA2. Embora tenham sido identificadas mutações noutros genes de suscetibilidade para cancro da mama, estas são raras, pelo que a análise sequencial de múltiplos genes se torna ineficaz e dispendiosa pelos métodos convencionais(1,2). A determinação da causa genética subjacente ao CMH permite não só identificar os indivíduos com risco aumentado de cancro da mama, como oferecer uma medicina personalizada, mais eficaz na redução da incidência de cancro da mama assim como da morbilidade e mortalidade associadas(3). A sequenciação de nova geração (NGS) veio possibilitar a pesquisa de mutações em múltiplos genes em simultâneo, permitindo um diagnóstico molecular rápido, eficaz e com custo inferior ao da sequenciação de Sanger. Objetivos: Otimizar o diagnóstico molecular do CMH através da implementação de um protocolo de NGS baseado num painel abrangente de genes de suscetibilidade para cancro da mama. A 1ª fase de concretização deste objetivo consistiu em validar a utilização da NGS na deteção de mutações nos genes BRCA1, BRCA2 e TP53. Material e métodos: Foram analisadas por NGS 12 amostras de doentes com cancro da mama, previamente sequenciadas pelo método de Sanger para os genes BRCA1, BRCA2 e TP53. As bibliotecas de sequências-alvo foram preparadas a partir de DNA genómico pelo método de captura por hibridação, num protocolo que integrou o Trusight Cancer Sequencing Panel e o kit TruSight Rapid Capture (Illumina), e sequenciadas numa plataforma MiSeq com leituras paired-end de 150 bp. A análise bioinformática incluiu os softwares MiSeq Reporter, VariantStudio e Isaac Enrichment (Illumina). Resultados: Foram detetadas por NGS um total de 97 variantes de sequência nos genes BRCA1, BRCA2 e TP53, das quais 35 são variantes únicas (33 single nucleotide variants e 2 deleções), numa concordância de 100% com a sequenciação de Sanger. Conclusões: Estes resultados preliminares comprovam a eficiência da NGS na deteção de variantes em 3 genes de elevada penetrância para cancro da mama e abrem caminho para a oferta de um painel de genes de suscetibilidade para cancro da mama que permitirá um diagnóstico molecular do CMH mais abrangente, rápido e com custos reduzidos relativamente à sequenciação de Sanger. Bibiografia 1. Tung N, Batteli C, Allen B et al. (2015). Frequency of mutations in individuals with breast cancer referred for BRCA1 and BRCA2 testing using next-generation sequencing with a 25-gene panel. Cancer, 121: 25-33. 2. Apostolou P, Fostira F (2013). Hereditary breast cancer: the era of new susceptibility genes. BioMed Res Int, 2013: 747318. 3. Ellsworth R, Decewicz D, Shriver C, Ellsworth D (2010). Breast cancer in the personal genomics era. Curr Genomics, 11: 146-161

Subsyndromal delirium in critically ill patients: cognitive and functional long-term outcomes

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Subsyndromal delirium (SSD) in the Intensive Care Unit (ICU) is associated with an increased morbidity with unknown post-discharge functional and cognitive outcomes. We performed a prospective multicenter study to analyze the mental status of patients during their first 72 h after ICU admission and its trajectory, with follow-ups at 3 and 6 months after hospital discharge. Amongst the 106 included patients, SSD occurred in 24.5% (n = 26) and was associated with the duration of mechanical ventilation (p = 0.003) and the length of the ICU stay (p = 0.002). After the initial 72 h, most of the SSD patients (30.8%) improved and no longer had SSD; 19.2% continued to experience SSD and one patient (3.8%) progressed to delirium. The post-hospital discharge survival rate for the SSD patients was 100% at 3 months and 87.5% at 6 months. At admission, 96.2% of the SSD patients were fully independent in daily living activities, 66.7% at 3-month follow-up, and 100% at 6-month follow-up. Most SSD patients demonstrated a cognitive decline from admission to 3-month follow-up and improved at 6 months (IQCODE-SF: admission 3.13, p < 0.001; 3 months 3.41, p = 0.019; 6 months 3.19, p = 0.194). We concluded that early SSD is associated with worse outcomes, mainly a transitory cognitive decline after hospital discharge at 3 months, with an improvement at 6 months. This highlights the need to prevent and identify this condition during ICU stays.info:eu-repo/semantics/publishedVersio

New dextrin nanomagnetogels: production, characterization and in vivo performance as dual modality imaging bioprobe

Dual modality contrast agents, such as radiolabelle d magnetic nanoparticles, are promising candidates for a number of diagnostic applications, since they combine two complementing imaging modalities, namely photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). The benefit of such combin ation lies on the ability to interpret more accurately abnormalities in vivo , by integrating the high sensitivity of SPECT with the superb spatial resolution and anatomical information provi ded by MRI [1]. Superparamagnetic iron oxide nanoparticles (SPION) have been extensively s tudied as MRI contrast agents [2]. SPIONs need to be coated in order to allow formulation in aqueous solutions and to increase in vivo stability [3]. Dextrin nanomagnetogels consists on superparamagnet ic iron oxide nanoparticles ( γ -Fe 2 O 3 ) stabilized within hydrophobized-dextrin nanogel (sc heme 1). The nanomagnetogel formulation, with about 4 mM of iron and a diameter of 100 nm, p resents relevant features such as superparamagnetic behaviour, high stability, narrow size distribution and potential for magnetic guidance to target areas by means of an external ma gnetic field [4]. The functionalization of the dextrin nanomagnetogel with a DOTA-monoamide ω -thiol metal chelator and radiolabelling with 111 In were used to ascertain its in vivo stability and behavior (blood clearance rate and o rgan distribution) after intravenous administration in m ice model. The surface modification of the nanomagnetogel with PEG 5,000 was accomplished in a n attempt to escape the phagocytic system. The unloaded radiolabeled dextrin nanogel ( around 30 nm) showed lower uptake in the liver, spleen and kidneys than the nanomagnetogel l oaded with SPIONs (around 110 nm). This difference in biodistribution profile can be ascrib ed to the differences in the particle size. Nanomagnetogel pegylation resulted in lower liver a nd spleen accumulation. The blood half-life obtained was approximately 4 hours for all formulat ions. A good correlation between the amount of polymer (quantified through radioactivity) and t he amount of iron (ICP measurement) in the spleen was observed, indicating that leakage of iro n from the nanomagnetogels after intravenous administration was negligible. The pilo t imaging study demonstrated good performance of dextrin nanomagnetogels as dual moda lity imaging (MRI and SPECT) bioprobes as expected by the high transverse relaxi vity (215-248 mM -1 s -1 ) obtained in vitro , higher than those of commercial available formulati ons (160-177 mM -1 s -1 ). The production of the nanomagnetogel is simple and easy to scale up, thus offering great technological potential

Bacterial cellulose nanocrystals or nanofibrils as Pickering stabilizers in low-oil emulsions: A comparative study

Supplementary data to this article can be found online at https://doi. org/10.1016/j.foodhyd.2024.110427.This investigation assessed the potential of bacterial cellulose (BC) in two distinct forms, nanocrystals (BC-NC) and oxidized nanofibrils (BC-NF), as stabilizers for low oil-in-water emulsions (1 % v/v). The research explored the impact of ionic strength and BC concentration on the physico-chemical characteristics, stability, and rheological properties of those emulsions. Nanofibrils had diameters ranging from 25 to 146 nm and lengths in the micrometer range, while nanocrystals varied in length from 133 to 870 nm and in diameter from 20 to 60 nm. Both BC-NF and BC-NC exhibited high zeta potential values (>45 mV) and contact angles of 30-31°, indicating stability. Both nanocelluloses were effectively used as stabilizers in Pickering emulsions, namely in low-oil systems, producing small emulsion droplets with sizes between 1.42 and 4.13 m. Further results revealed that ionic strength influenced emulsion stability, with both BC-NF and BC-NC preferentially located on the surfaces of emulsion droplets in the presence of salt, as demonstrated by microscopy images. The presence of BC at the interface contributed to creating a more robust barrier against coalescence and Ostwald ripening, influencing droplet size and rheological properties. Higher BC concentrations (1 %) increased emulsion stability in the absence of salt, while at lower BC concentrations (0.5 %), salt concentration was determinant for the long-term stability of the emulsions. These findings provide valuable insights into the production of Pickering emulsions using nanocelluloses, highlighting the advantages of bio-based nanomaterials for applications in the food industry.The author Ana Isabel Bourbon acknowledges FCT funding, through the individual scientific employment program contract (2020.03447.CEECIND). The authors Morsyleide de Freitas Rosa and Nayra de Oliveira Frederico Pinto acknowledges funding by FCT/CAPES 99999.008530/2014–09.info:eu-repo/semantics/publishedVersio

Bird taxonomic and functional diversity, group- and species-level effects on a gradient of weevil-caused damage in eucalypt plantations

The relative contribution of bird communities to insect pest control has been seldom estimated using trait-based functional diversity indices, in opposition to the general usage of taxonomic indices simply based on the presence and abundance of species. Moreover, few studies attempted to quantify the explicit contribution of functional groups or species of birds to the control of insect pests. We investigated eucalypt plantations under a gradient of defoliation caused by the eucalyptus weevil Gonipterus platensis to assess how avian insectivory links with (1) taxonomic and (2) functional diversity indices, and with (3) groups and (4) species of functional insectivores. In agreement with our hypothesis, weevil-caused damage was negatively correlated to avian insectivory in the four studied approaches. Taxonomic diversity indices consistently presented a negative correlation with weevil- caused damage, but, contrary to our expectation, functional diversity indices were defective predictors of weevil-caused damage in eucalypt stands. Results were further explicit in the analyses conducted with groups and species of functional insectivores, wherein significant lower levels of weevil-caused damage in eucalypt stands were mainly associated with the higher abundance of canopy foragers, even though ground- and understory-gleaning species also provided competitive models at the species-level. This study establishes the importance of using multivariate trait-based approaches to understand how functional diversity drives ecosystem services, as it is here demonstrated for avian insectivory in eucalypt plantations. Top-down trophic control of the eucalyptus weevil by birds can reduce damage in areas where functional insectivorous birds aggregate.info:eu-repo/semantics/publishedVersio

Beta-hemolytic Streptococcus dysgalactiae strains isolated from horses are a genetically distinct population within the Streptococcus dysgalactiae taxon

The pathogenic role of beta-hemolytic Streptococcus dysgalactiae in the equine host is increasingly recognized. A collection of 108 Lancefield group C (n=96) or L (n=12) horse isolates recovered in the United States and in three European countries presented multilocus sequence typing (MLST) alleles, sequence types and emm types (only 56% of the isolates could be emm typed) that were, with few exceptions, distinct from those previously found in human Streptococcus dysgalactiae subsp. equisimilis. Characterization of a subset of horse isolates by multilocus sequence analysis (MLSA) and 16S rRNA gene sequence showed that most equine isolates could also be differentiated from S. dysgalactiae strains from other animal species, supporting the existence of a horse specific genomovar. Draft genome information confirms the distinctiveness of the horse genomovar and indicates the presence of potentially horse-specific virulence factors. While this genomovar represents most of the isolates recovered from horses, a smaller MLST and MLSA defined sub-population seems to be able to cause infections in horses, other animals and humans, indicating that transmission between hosts of strains belonging to this group may occur

Dextrin-based nanomagnetogel: in vivo biodistribution and stability

The biodistribution profile of a new dextrin nanomagnetogel, which consists on -Fe2O3 superparamagnetic nanoparticles loaded within a polymeric matrix of modified dextrin, was studied in mice. The nanomagnetogel bear a monomodal size distribution profile (average diameter 110 nm) close to neutral surface charge and higher relaxivity (r2 = 215-248 mM-1s-1 and r2/r1 = 13-11) than those of commercial formulations (r2 = 160-177 mM-1s-1 and r2/r1 = 4-7). Also the observed blood half-life - approximately 4 hours - is superior to that of similar commercially available formulations, which remain few minutes in circulation. Pegylation resulted in 1.7 and 1.2-fold lower accumulation in the liver and spleen, respectively, within the first 24 h. Noteworthy, a good correlation was obtained between the amount of polymer (quantified by scintigraphy) in the spleen, 48 h after administration, and the amount of iron physically loaded through hydrophobic interactions (quantified by ICP) indicating the absence of iron leakage from the polymeric matrix. This study provides evidence on the in vivo stability of a self-assembled nanomagnetogel, a much relevant feature which is seldom reported in the literature.The authors thank the Project “strong>BioHealth - Biotechnology and Bioengineering approaches to improve health quality”, Ref. NORTE-07-0124-FEDER-000027, co-funded by the Programa Operacional Regional do Norte (ON.2 O Novo Norte), QREN, FEDER. The authors thank the Magnisense Corporation for providing a MIAplex Reader and CFGCG the EU COST TD1004 Action “Theragnostics Imaging and Therapy”. The authors thank Professor Cidália Botelho for the iron analysis by Atomic Absorbance Spectroscopy at the Oporto University, Chemical Engineering Department. C. Gonçalves, J. P. Silva, J. A. Martins, and M. F. M. Ferreira acknowledge FCT Portugal, for postdoc grants SFRH/BPD/70524/2010 and SFRH/BPD/64958/2009, sabbatical grant SFRH/BSAB/ 1328/2013 and PhD grant SFRH/BD/63994/2009, respectively

Low energy nanoemulsions as a carrier of thyme and lemon balm essential oils

The aim of this work was to produce monomodal and stable thyme and lemon balm-loaded nanoemulsions (NE), through a low energy approach. NEs were prepared by the emulsion phase inversion method using sunflower oil as carrier and Tween 80 as surfactant. Different surfactant-to-oil ratios (SOR) and essential oil (EO) loadings were evaluated. Nanoemulsions presented a monomodal diameter distribution below 200 nm and high negative zeta potential (>-40 mV). Nanoemulsions loaded with EOs were physically stable for 3 months at 4 degrees C and 20 degrees C. Nanoemulsions with thyme EO presented the highest radical scavenging activity by DPPH and ABTS tests. Loaded nanoemulsions were not effective against Escherichia coli but could inhibit Staphylococcus aureus. Cytotoxicity studies using cell counting kit-8 and resazurin assays revealed a dose-responsive effect of nanoemulsions on Caco-2 cells after incubation for 24 h. A concentration of 100 mu g oil/mL of NE for unloaded and thyme loaded and 50 mu g oil/mL of NE for lemon balm loaded showed to be safe to use.This research received funding from the H2020 research and inno-vation programme under the Marie Sklodowska-Curie grant agreement No 778388 (H2020 MSCA-RISE-2017, FODIAC) , and MICRODIGEST project (grant agreement 037716) co-funded by FCT and ERDF through COMPETE2020. We would like to thank the Earth Essences for its kind supply of essential oils

The veterinary medicinal products market supply gap: A practical insight based on the Regulation (EU) 2019/6

The Regulation (EU) 2019/6 establishes that the veterinary prescriptions should follow a cascade, according to their availability of the market. In sum, the veterinarian is authorized to use a medicine for human use only if there is no product available for the same or other therapeutic indication, in the same or another animal species. This study aims to analyse the application of Regulation (EU) 2019/6 in the pharmacological prescription at the Veterinary Hospital of the University of León. A total of 121 clinical cases, 89 dogs (73.55%) and 32 cats (26.45%) were included. Results revealed that 95 medicines were prescribed, 51 (53.68 %) as veterinary medicines and 44 (46.32 %) as human medicines. From the human medicines, 22 (50.00%) did not have a veterinary alternative in the market; four (9.00%) presented a veterinary medicine in the appropriate formulation for the species; 10 (23.00%) had no alternative in the desired formulation; and 8 (18.00%) had no alternatives for the target species. This study suggested that the cascade was not strictly followed, and several reasons may justify it, such as the lack of veterinary products, different formulations, and differences in costs. An effective, safe and sustainable use of the therapeutic option available can only be accomplished with a rational use of the prescription cascade and a correct use of the Regulation (EU) 2019/6