The essential neurological examination in telemedicine consultations in the context of COVID 19/ O exame neurológico essencial nas consultas de telemedicina no contexto da COVID 19

Introduction: In clinical evaluation, the neurological area is one of the most complex and extensive to be analyzed, besides that, when added with Neurophobia it becomes even more difficult. With the COVID-19 Pandemic, there was an accelerated process of migration from outpatient clinics to digital platforms, requiring doctors to update their way of examining patients. The essential neurological examination, the tool that collaborates in this updated assessment, demonstrates greater objectivity in confirming the normality of the neurological system. The practice of checklists is a tool that helps these doctors to better evaluate their patients, optimizing their time and exams, contributing to its clinical diagnosis. Methodology: Review study integrative process that culminated in the elaboration and adaptation of new measures for essential neurological therapy in patients in the context of COVID-19 through Telemedicine. Results and Discussion: When comparing the essential neurological exam with the knowledge experienced by the authors of this article and the global pandemic context, were recommendations on the application of telemedicine were made. In addition to the need for doctor-patient communication to be audible and visible, without external interference so as not to impair the exams, the participation of a patient's companion is important to assist the doctor in exams. With that done, we identified that some of the exams essential neurological conditions become difficult to perform digitally, being: Indirect fundoscopy and reflexes (Biceps, Brachioradialis, Triceps, Patellar, Aquileu). However, exams such as direct fundoscopy, pupillary reflex, eye chase, mimic facial, gait, and plantar reflex can be examined via digital platforms as long as always the patient is accompanied. Conclusion: It is concluded that, amid pandemic, essential neurological examination becomes outdated, but useful in several areas, helping the doctor to take more informed measures

Densidade populacional e dinâmica do perfilhamento em capim-marandu submetido a estratégias de pastejo rotativo e adubação nitrogenada

The objective of this experiment was to evaluate tiller population density and the dynamics of the tillering process in marandu palisade grass subjected to strategies of rotational stocking management and nitrogen fertilization. Treatments corresponded to combinations between two targets of pre-grazing conditions (sward surface height of 25 and 35 cm) and two rates of nitrogen application (50 and 200 kg ha-1 year-1), and were allocated to experimental units according to a 2 x 2 factorial arrangement in a randomised complete block design, with four replications. The following response variables were studied: initial (TPDi), intermediate (TPDm) and final (TPDf) tiller population density as well as the rates of tiller appearance (TAR) and death (TDR) and the tiller population stability index (SI). TPDi was similar to all treatments, with differences in tiller population density becoming more pronounced as the experiment progressed, resulting in larger TPDf on swards managed at 25 cm pre-grazing height. Tiller death was larger on swards managed at 35 cm, with differences in tiller appearance being recorded only from February 2010 onwards. Stability of tiller population was higher on swards managed at 25 cm pre-grazing height. Overall, there was no effect of nitrogen on the studied variables, and the most adequate grazing strategy corresponded to the pre-grazing height of 25 cm, regardless of the nitrogen application rate used

Weight gain and animal productivity on Marandu palisade grass under rotational stocking and nitrogen fertilization

O objetivo deste trabalho foi avaliar metas de manejo para capim-marandu (Urochloa brizantha cv. Marandu) submetido a pastejo rotativo e a doses de nitrogênio, de janeiro de 2009 a abril de 2010. Os tratamentos consistiram da combinação de duas frequências de pastejo (altura pré-pastejo de 25 e 35 cm) e de duas doses de fertilizante nitrogenado (50 e 200 kg ha-1 por ano) em delineamento de blocos ao acaso com arranjo fatorial 2x2 e quatro repetições. A altura de pós-pastejo estipulada foi de 15 cm. Maiores valores de ganho de peso médio por animal por dia (0,629 e 0,511 kg dia-1) e por hectare (886 e 674 kg ha-1), bem como de taxa de lotação (3,13 e 2,85 UA ha-1), foram observados nos pastos manejados com altura pré-pastejo de 25 cm. A aplicação de 200 kg ha-1 de N resultou em aumentos na percentagem de folhas na massa de forragem pós-pastejo, nas taxas de acúmulo de forragem, na taxa de lotação e no ganho de peso por área. A mais adequada estratégia de manejo corresponde à altura pré-pastejo de 25 cm, independentemente da dose de nitrogênio utilizada.The objective of this work was to assess management targets for marandu palisade grass (Urochloa brizantha cv. Marandu) subjected to rotational stocking and to nitrogen fertilization rates, from January 2009 to April 2010. Treatments consisted of a combination of two grazing frequencies (pre-grazing heights of 25 and 35 cm) and two levels of nitrogen application (50 and 200 kg ha-1 per year). in a completely randomized block design, in a 2x2 factorial arrangement, with four replicates. The established post-grazing height was 15 cm. Greater values of daily weight gain per animal per day (0.629 and 0.511 kg day-1), weight gain per hectare (886 and 674 kg ha-1), and stocking rate (3.13 and 2.85 AU ha-1) were found for pre-grazing height of 25 cm. The application of 200 kg ha-1 of N increased the percentage of leaves in post-grazing forage mass, forage accumulation rate, stocking rate, as well as weight gain per hectare. The best grazing strategy corresponds to the pre-grazing height of 25 cm, regardless of the nitrogen application

Benefits of the flipped classroom in health education - a systematic review / Benefícios da sala de aula virada ao contrário na educação sanitária - uma revisão sistemática interrelationship

Introduction: The flipped classroom method is characterized by its contents presentation to the learners before classes and online, reserving the face-to-face meetings to deepen and apply these contents. Objective: To search through literature for the most recent flipped classroom method benefits in the health area. Method: The guidelines for the preparation of systematic reviews were followed, collecting relevant studies, searching for published data sources, selecting the terms for the research, evaluating the eligibility of studies, and extracting relevant data. Results and Discussion: 20 articles published between 2016 and 2020 were selected from the PUBMED, SCIELO, ERIC and MEDLINE databases, according to the eligibility criteria. The main benefits of flipped classroom for students were language development, greater interaction between learners, greater engagement in activities and involvement in projects, flexibility in learning styles, better use of time and better performance in assessments. The professors agreed with such benefits but pointed out that a longer time for the preparation of activities would be a limitation. Conclusion: Flipped classroom method has shown itself to be a promising strategy with many health benefits. More research is needed on its implementation in the current context of the Coronavirus Pandemic in 2020. 

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Óxido nítrico sintase induzida (iNOS) e indoleamina 2,3 dioxigenase (IDO) em monócitos CD14+CD16+/- após infecção pelo vírus Dengue

Submitted by Gilvan Almeida ([email protected]) on 2017-05-17T14:37:11Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 72990.pdf: 4130033 bytes, checksum: 103ea68ab9d2bc59b623251363d1bac5 (MD5)Approved for entry into archive by Raquel Dinelis ([email protected]) on 2017-10-24T17:39:55Z (GMT) No. of bitstreams: 2 72990.pdf: 4130033 bytes, checksum: 103ea68ab9d2bc59b623251363d1bac5 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2017-10-24T17:39:55Z (GMT). No. of bitstreams: 2 72990.pdf: 4130033 bytes, checksum: 103ea68ab9d2bc59b623251363d1bac5 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Os monócitos humanos em condições fisiopatológicas podem ser ativados, passando a produzir diversos mediadores inflamatórios, além de induzir enzimas como iNOS (óxido nítrico sintase induzida) e IDO (Indoleamina 2,3 dioxigenase). Sabe-se que monócitos não clássicos, CD14+CD16+ estão mais associados à produção de citocinas pró-inflamatórias, enquanto que os monócitos clássicos, CD14+CD16-, tendem a possuir um papel mais protetor na dengue. Considerando-se que as enzimas iNOS e IDO podem estar envolvidas na infecção pelo DENV e que o vírus é capaz de ativar os monócitos, buscamos determinar as diferentes subpopulações de monócitos expressando iNOS e IDO e sua associação com algumas citocinas/quimiocinas produzidas durante a infecção pelo DENV-4 e DENV-2. Foram utilizadas amostras de pacientes da epidemia de DENV-4 ocorrida em 2013, MS, além de células de doadores saudáveis, infectadas in vitro pelo DENV-2. Observamos que pacientes com DENV-4 apresentam aumento na detecção de iNOS e IDO em ambas subpopulações de monócitos, além de uma leve expansão de células CD14+CD16+ e redução de CD14+CD16-. Estes pacientes também mostraram aumento nos níveis de NO, IL-10, IP-10, MCP-1, IFN-\03B3 e TNF-\03B1 no plasma durante a fase aguda da infecção. Nossos resultados mostraram, pela primeira vez, a associação da enzima IDO com a subpopulação de monócitos CD14+CD16+ e de iNOS com a subpopulação CD14+CD16-. A subpopulação de monócitos clássicos, CD14+CD16- mostrou estar inversamente correlacionado com os níveis de IL-10 e IP-10/CXCL10, enquanto que monócitos não-clássicos, CD14+CD16+ estão positivamente correlacionados com a citocina IL-10. TNF-\03B1, IL-10 e a quimiocina IP-10/CXL10 estão positivamente correlacionadas com a população de monócitos CD14+iNOS+ Ambas as células CD14+ - CD16-iNOS+ e CD16+iNOS+ apresentaram correlação positiva com IL-10, IP-10/CXL10 e MCP-1/CCL2, além do TNF-\03B1 estar associado às células CD16-iNOS+. As populações CD14+CD16-IDO+ e CD16+IDO+ correlacionaram-se positivamente com IL-10. Além disso, a subpopulação de monócitos CD16-IDO+ também apresentou uma correlação positiva com TNF-\03B1 e IP-10/CXCL10. Avaliamos também a infecção in vitro de monócitos humanos pelo DENV-2 e, novamente observamos uma associação da iNOS com a subpopulação CD14+CD16-. Não foram observadas alterações na frequência das subpopulações de monócitos, bem como nenhum aumento detectável destas enzimas nem produção de citocinas/quimiocinas na análise realizada 24h após a infecção. Entretanto, o estímulo das culturas com LPS+IFN-\03B3 foi associado à presença de IDO e reduziu a replicação viral e a taxa de infecção em ambas subpopulações estudadas, além de aumentar a produção das citocinas/quimiocinas IL-10, MCP-1 e TNF- \03B1. O uso de um inibidor de NO (L-NMMA), aumentou a detecção de IDO e a produção destes mediadores inflamatórios, além dos níveis de produção de NS1. Já o uso de um doador de NO (SNAP), foi capaz de reduzir a infecção nas subpopulações celulares avaliadas. Confirmamos, assim, a ação antiviral da molécula NO na dengue e sua possível ação sobre a enzima IDO, na doença. Ainda, nossos dados sugerem um papel regulador e antiviral da enzima IDO durante a infecção pelo DENV, que merece ser melhor investigado.Under physiopathological conditions, the human monocytes can be activated, producing several inflammatory and inducing enzymes such as iNOS (induced nitric oxide synthase) and IDO (Indoleamine 2,3 dioxigenase). It is known that non-classical monocytes, CD14+CD16+ are more associated with the production of pro-inflammatory cytokines, whereas the classical monocytes, CD14+CD16-, tend to have a more protective role in dengue. Considering that iNOS and IDO enzymes may be involved in DENV infection and that the virus is capable of activating monocytes, we determined monocyte subsets that express iNOS and IDO and identified their association with some cytokines/chemokines produced during DENV-4 infection and DENV-2. Patient samples from a DENV-4 epidemic occurred in 2013, MS, were analyzed, as well as cells from healthy donors, infected in vitro by DENV-2. We observed that patients with DENV-4 had increased iNOS and IDO detection in both monocyte subsets, in addition to a mild expansion of CD14+CD16+ cells and a reduction in CD14+CD16-. These patients also showed increased NO, IL-10, IP-10, MCP-1, IFN-\03B3 and TNF-\03B1 levels in plasma during the acute phase of infection. Our results showed, for the first time, the association of the IDO enzyme with the CD14+CD16+ subpopulation and iNOS with the CD14+CD16- subpopulation. The classical monocyte subset, CD14+CD16- was shown to be inversely correlated with IL-10 and IP-10/CXCL10 levels, while the non-classical CD14+CD16+ is positively correlated with the IL-10 cytokine. TNF-\03B1, IL-10 cytokines and IP-10/CXL10 chemokine are positively correlated with the CD14+iNOS+ monocyte population. Both CD14+ cells -CD16-iNOS+ and CD16+iNOS+ subsets - presented positive correlation with IL-10, IP-10/CXL10 and MCP-1/CCL2, besides TNF-\03B1 associated with CD16-iNOS+ cells The CD14+CD16-IDO+ and CD16+IDO+ populations correlated positively with IL-10. Futhermore, the CD16-IDO+ monocyte subset also presented a positive correlation with TNF-\03B1 and IP-10/CXCL10. We also evaluated the in vitro infection of human monocytes by DENV-2 and, once again, it was observed an association of iNOS with the CD14+CD16- subset. No changes in frequencies of the monocyte subsets were observed, no detectable increase in these enzymes nor the production of cytokines/chemokines, in analyses performed at 24 hours after infection. However, the cultures stimulation with LPS+IFN-\03B3 was associated with IDO presence and reduced viral replication and infection rate in both monocyte subsets studied; in addition, it increased the production of IL-10, MCP-1 and TNF-\03B1 cytokines/chemokines. The use of an NO inhibitor (L-NMMA) increased IDO detection and the production of these inflammatory mediators, besides elevating NS1. On the other hand, the use of an NO donor (SNAP) could reduce infection in the cell subsets evaluated. We thus confirmed the antiviral action of the NO molecule on dengue and its possible action on the IDO enzyme in the disease. Furthermore, our data suggest a regulatory and antiviral role of the IDO enzyme during DENV infection that deserves to be better investigated

Resveratrol Modifies Lipid Composition of Two Cancer Cell Lines

Resveratrol (Resv) offers health benefits in cancer and has been reported to modulate important enzymes of lipid metabolism. Studies of its effects on lipid composition in different subtypes of breast-cancer cells are scarce. Thus, we investigated the alterations in phospholipids (PL), fatty acids (FA), and lipid metabolism enzymes in two breast-cancer cell lines after Resv treatment. MCF-7 and MDA-MB-231 cells were treated with 80 and 200 μM of Resv, respectively, for 24 hours. We analyzed PL with radiolabeled inorganic phosphate (32Pi) by thin-layer chromatography, FA by gas chromatography-mass spectrometry, and lipid metabolism enzymes (DGAT2, FAS, ρACCβ, pAMPKα, and AMPK) by Western blot. Resv treated MDA-MB-231 phospholipids showed a reduction in phosphatidylcholine (63%) and phosphatidylethanolamine (35%). We observed an increase in eicosapentaenoic acid (EPA) (73%) and docosahexaenoic acid (DHA) (65%) in MCF-7 cells after Resv treatment. Interestingly, the same treatment caused 50% and 90% increases in EPA and DHA, respectively, in MDA-MB-231 cells. In MCF-7 cells, Resv increased the expression of ρACCβ (3.3-fold) and AMPKα/ρAMPKα (1.5-fold) and in MDA-MB-231 cells it inhibited the expression of ρACCβ (111.8-fold) and AMPKα/ρAMPKα (1.2 fold). Our results show that Resv modified PL and saturated and unsaturated FA especially in MDA-MB-231 cells, and open new perspectives to the understanding of the reported anticancer effect of Resv on these cells