Nutrologia e nutrição em unidade de terapia intensiva: sinergia em busca de excelência

Objective: Nutritional therapy, in spite of current guidelines, does not seem to be perceived yet as an important therapeutic strategy in critical patients. The objective of this study was to assess the joint action of a team composed of a nutrology specialist and a nutritionist in ICU by measuring quality indicators such as fasting time and adequacy of caloric intake. Methods: This is a prospective descriptive study realized in a mixed adult intensive care unit, with patients that remained stayed for longer than 24h. Patients received nutritional therapy according to a protocol based on guidelines and adapted to the unit. Demographic and clinical data were gathered; nutritional route, time of start of therapy, prescribed volume, and received volume of enteral feeding. Results: Out of 89 patients assessed, 48 (53.9%) started with oral feeding, 2 (2.2%) received parenteral feeding, and 39 (43.8%), enteral feeding. The time for enteral therapy to start was 24h and 25 minutes (QI: 7-44h), and 87.2% of patients received enteral feeding in the first 48h of stay. For surgical patients (n=42), the time to start feeding via any route was 20h and 59 minutes (QI: 14h 45 min - 41h 15 min). 87% of the calories prescribed were instilled via enteral feeding throughout the 284 days of assessment. Conclusion: The presence of a team composed of a nutrology specialist and a nutritionist may be capable of meeting the attention and specific knowledge in nutritional therapy needs, bringing high quality and proven excellence through the indicators measured

Point-of-Care Strategies Applied to Malaria Diagnosis

Rapid and specific diagnosis of malaria remains one of the main strategies to fight the disease. The diagnosis is made primarily by the simple and low-cost thick drop technique, considered the gold standard test. However, the requirement for good quality microscopes and well-trained personnel often lead to inaccurate diagnosis, especially in cases of mixed infections or low parasitemia. Although PCR-based tests can help in these situations, this technique requires large and sensitive equipments, being unsuitable for point of care (POC) settings. A myriad of POC diagnostic tests have being developed in the last years, relying on molecular methods but also on novel strategies. New platforms, miniaturization techniques, and multiplexing possibilities promise great potential to improve disease diagnostics through fast and accurate detection of cases, even at remote places. Here, we will address the main POC strategies developed for the diagnosis of malaria, highlighting their strengths and weakness as POC applications

Pitiose gastrointestinal canina: relato de caso no Pantanal brasileiro a partir de uma abordagem diagnóstica

A pitiose é causada por um organismo aquático semelhante a um fungo (Pythium insidiosum) e considerada um importante problema de saúde pública, pois pode afetar animais e humanos. Este artigo relata um caso de pitiose gastrointestinal em um cão. O paciente ficou internado por quatro dias, período em que o animal recebeu tratamento de suporte e sintomático. No entanto, o tratamento aplicado não teve sucesso e o quadro clínico do cão piorou, culminando com a morte. Exames de imagem complementares, como radiografia e ultrassonografia, bem como exames hematológicos, foram realizados durante o período de internação. O diagnóstico definitivo foi feito na autópsia, pois as características macroscópicas e microscópicas sugeriam a presença de granuloma intestinal e acentuada enterite necrótica multifocal supurativa. Além disso, a avaliação histológica revelou estruturas morfológicas compatíveis com P. insidiosum. Além disso, a nested PCR foi realizada e mostrou amplificação parcial (105 pb) da região ITS1 do gene ribossomal de P. insidiosum.Pythiosis is caused by an aquatic fungus-like organism (Pythium insidiosum). It is considered an important public health issue as it can affect both animals and humans. This paper reports a case of gastrointestinal pythiosis in a dog. The patient was hospitalized for four days, during which the animal received supportive and symptomatic treatment. But the applied treatment was unsuccessful and the dog’s clinical condition worsened, culminating in death. Complementary imaging tests such as radiography and ultrasonography, as well as hematological tests, were performed during the hospitalization period. The definitive diagnosis was reached in the postmortem as macroscopic and microscopic characteristics suggested the presence of intestinal granuloma and accentuated multifocal suppurative necrotic enteritis. Additionally, the histological evaluation revealed morphological structures compatible with P. insidiosum. Also, the results of nested PCR performedshowed partial amplification (105 bp) of the ITS1 region of the ribosomal gene of P. insidiosum

The COVID-19 pandemic and plans for economic reopening in Brazil: a documental analysis

BACKGROUND: In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. In Brazil, the high rate of dissemination made it necessary to adopt restrictive measures nationwide with the discussion regarding the resumption of economic activities starting in April. In mid-December the country had 6,970,034 cases diagnosed and 182,799 deaths from COVID-19. OBJECTIVE: To analyze the content and characteristics of official documents, which guided the period of transition and resumption of economic activities in Brazil based on health indicators. METHODS: This is a documental research, carried out between May and July 2020, using official websites and publications from the state governments of the 27 federative units in Brazil as sources. In the study, only documents that used epidemiological and health indicators were included as determining criteria for decision making in relation to the easing, permanence or regression of social isolation measures adopted during the COVID-19 pandemic. FINDINGS: Plans, decrees and technical notes were identified for 18 Brazilian federal units. In most documents, the scientific team was made up exclusively of technicians (n = 10). The number of indicators found ranged from 2 to 11, being stratified into 5 categories: frequency and distribution of the disease; social and collective adherence; installed capacity or service profile; productive potential; and availability of supplies. MAIN CONCLUSIONS: Knowing governmental strategies, adopted in the easing of restrictive measures, in the face of the coronavirus (SARS-CoV-2) pandemic based on indicators and with the possibility of comparison between different federative units, provides subsidies for understanding the outcome of the disease by place of occurrence, allowing the construction of a panorama pathology in the country. The appropriation of the findings of this study by Brazil and other countries also serves as an instrument for reflection and planning of policies adopted during the COVID-19 pandemic

Sífilis gástrica: desafios do diagnóstico e relato de caso: Gastric syphilis: diagnostic challenges and case report

A sífilis é uma doença de caráter infeccioso, sexualmente transmissível e de manifestações diversas. Dentre elas, a variante gástrica é extremamente rara e de difícil diagnóstico, o que confere elevada morbidade a seus portadores. Nesse sentido, a avaliação criteriosa do histórico médico e dos exames físico, endoscópico e patológico são essenciais para a exclusão de diagnósticos diferenciais, em particular, do Linfoma tipo MALT. Quando diagnosticada corretamente, a sífilis gástrica apresenta bom prognóstico e pode ser tratada de maneira conservadora por meio da antibioticoterapia. Dessa forma, é possível que procedimentos agressivos para a retirada da lesão sejam evitados, o que resulta em uma melhor qualidade de vida para os pacientes e menor lotação dos sistemas de saúde

Distinctive genetic structure and selection patterns in Plasmodium vivax from South Asia and East Africa.

Despite the high burden of Plasmodium vivax malaria in South Asian countries, the genetic diversity of circulating parasite populations is not well described. Determinants of antimalarial drug susceptibility for P. vivax in the region have not been characterised. Our genomic analysis of global P. vivax (n = 558) establishes South Asian isolates (n = 92) as a distinct subpopulation, which shares ancestry with some East African and South East Asian parasites. Signals of positive selection are linked to drug resistance-associated loci including pvkelch10, pvmrp1, pvdhfr and pvdhps, and two loci linked to P. vivax invasion of reticulocytes, pvrbp1a and pvrbp1b. Significant identity-by-descent was found in extended chromosome regions common to P. vivax from India and Ethiopia, including the pvdbp gene associated with Duffy blood group binding. Our investigation provides new understanding of global P. vivax population structure and genomic diversity, and genetic evidence of recent directional selection in this important human pathogen

Técnicas Minimamente Invasivas em Cirurgia Geral: Benefícios, Limitações e Futuras Perspectivas.

General surgery has been undergoing a revolution with the introduction and refinement of minimally invasive techniques (MITs), which are distinguished by offering lower postoperative morbidity and faster recovery when compared to conventional open techniques. This article reviews the current state, benefits, limitations, and future perspectives of MITs in general surgery, with an emphasis on laparoscopy, robotic surgery, and endoscopy. A detailed search strategy was carried out in academic databases, focusing on studies that report the clinical outcomes of MITs. The review synthesizes findings from relevant studies, assessing the efficacy of MITs in different clinical contexts. Comprehensive discussions are provided on the outcomes, with attention to current limitations, such as the learning curve and associated costs, and recommendations for future research are offered. Notably, the analysis of studies demonstrates that laparoscopy continues to be the gold standard for many procedures, while robotic surgery is growing, although its costs remain a limiting factor. Endoscopy has proven particularly promising for diagnostic and therapeutic gastrointestinal procedures. The article concludes by emphasizing the need for ongoing training, technological development, and cost-benefit assessments to maximize the potential of MITs.A cirurgia geral tem passado por uma revolução com a introdução e aperfeiçoamento das técnicas minimamente invasivas (TMIs), que se destacam por oferecer menor morbidade pós-operatória e recuperação mais rápida quando comparadas às técnicas convencionais abertas. Este artigo revisa o estado atual, os benefícios, limitações e perspectivas futuras das TMIs em cirurgia geral, com ênfase em laparoscopia, cirurgia robótica e endoscopia. Uma estratégia de busca detalhada foi realizada em bancos de dados acadêmicos, focando em estudos que relatam os resultados clínicos de TMIs. A revisão sintetiza descobertas de estudos relevantes, avaliando a eficácia das TMIs em diferentes contextos clínicos. Discussões abrangentes são fornecidas sobre os resultados, com atenção às limitações atuais, como a curva de aprendizado e os custos associados, e são oferecidas recomendações para pesquisa futura. Notavelmente, a análise de estudos demonstra que a laparoscopia continua a ser o padrão-ouro para muitos procedimentos, enquanto a cirurgia robótica está em crescimento, embora seus custos ainda sejam um fator limitante. A endoscopia mostrou-se particularmente promissora para procedimentos diagnósticos e terapêuticos gastrointestinais. O artigo conclui enfatizando a necessidade de treinamento contínuo, desenvolvimento tecnológico e avaliações de custo-benefício para maximizar o potencial das TMIs. &nbsp

Hipotireoidismo e suas Implicações no Período Gestacional: uma Revisão de Literatura

Hypothyroidism during pregnancy is a serious health concern, increasing the risk of complications such as miscarriage and neurointellectual disability in offspring. Careful regulation of thyroid hormones is crucial for optimal fetal development. This article is an integrative review that seeks to clarify thyroid disorders in pregnancy and their treatment options. 175 articles from the PubMed database were analyzed, limited to human studies published in English between 2018 and 2023. Eleven articles were selected for analysis. Fetal consumption of maternal thyroid hormone and physiological changes during pregnancy demand an increase in maternal secretion of this hormone. Iodine deficiency can cause thyroid dysfunction, resulting in serious complications in pregnancy and child development. Diagnosing hypothyroidism is challenging, especially in pregnant women. Serum TSH is used as an initial test, and levothyroxine therapy is recommended to prevent complications. Hypothyroidism in pregnancy requires careful regulation of thyroid hormones. Diagnostic complexity highlights the need to consider physiological and ethnic variations. Treatment recommendations vary between organizations, highlighting the need for consensus. Close monitoring and adjustments in therapy are essential, but challenges remain, highlighting the need for more research into treatment limits and the potential benefit of combination therapy to improve long- term quality of life. Keywords: Pregnancy, Hypothyroidism, Thyroid Gland Disease.El hipotiroidismo durante el embarazo es un problema de salud grave que aumenta el riesgo de complicaciones como aborto espontáneo y discapacidad neurointelectual en la descendencia. La regulación cuidadosa de las hormonas tiroideas es crucial para el desarrollo fetal óptimo. Este artículo es una revisión integradora que busca esclarecer los trastornos tiroideos en el embarazo y sus opciones de tratamiento. Se analizaron 175 artículos de la base de datos PubMed, limitados a estudios en humanos publicados en inglés entre 2018 y 2023. Se seleccionaron once artículos para el análisis. El consumo fetal de hormona tiroidea materna y los cambios fisiológicos durante el embarazo exigen un aumento en la secreción materna de esta hormona. La deficiencia de yodo puede causar disfunción tiroidea, lo que resulta en complicaciones graves en el embarazo y el desarrollo infantil. Diagnosticar el hipotiroidismo es un desafío, especialmente en mujeres embarazadas. La TSH sérica se utiliza como prueba inicial y se recomienda el tratamiento con levotiroxina para prevenir complicaciones. El hipotiroidismo durante el embarazo requiere una regulación cuidadosa de las hormonas tiroideas. La complejidad diagnóstica resalta la necesidad de considerar variaciones fisiológicas y étnicas. Las recomendaciones de tratamiento varían entre organizaciones, lo que destaca la necesidad de consenso. La monitorización estrecha y los ajustes en la terapia son esenciales, pero persisten desafíos, lo que destaca la necesidad de realizar más investigaciones sobre los límites del tratamiento y el beneficio potencial de la terapia combinada para mejorar la calidad de vida a largo plazo. Palabras clave: Embarazo, Hipotiroidismo, Enfermedad de la Glándula Tiroides.O hipotireoidismo durante a gravidez pode ocasionar sérios problemas à saúde, aumentando o risco de complicações como aborto espontâneo e deficiência neurointelectual na descendência. A regulação cuidadosa dos hormônios tireoidianos é crucial para o desenvolvimento fetal ideal. Este artigo é uma revisão integrativa que busca esclarecer distúrbios tireoidianos na gravidez e suas opções de tratamento. Foram analisados 175 artigos da base PubMed, limitados a estudos em humanos publicados em inglês entre 2018 e 2023. Onze artigos foram selecionados para a análise. O consumo fetal de hormônio tireoidiano materno e alterações fisiológicas na gravidez demandam um aumento na secreção materna desse hormônio. A deficiência de iodo pode causar disfunção tireoidiana, resultando em complicações graves na gravidez e no desenvolvimento infantil. O diagnóstico do hipotireoidismo é desafiador, especialmente em mulheres grávidas. O TSH sérico é usado como teste inicial, e a terapia com levotiroxina é recomendada para prevenir complicações. O hipotireoidismo na gravidez requer regulação cuidadosa dos hormônios tireoidianos. A complexidade diagnóstica destaca a necessidade de considerar variações fisiológicas e étnicas. Recomendações de tratamento variam entre organizações, destacando a necessidade de consenso. O monitoramento rigoroso e ajustes na terapia são essenciais, mas persistem desafios, evidenciando a necessidade de mais pesquisas sobre limites de tratamento e o potencial benefício da terapia combinada para melhorar a qualidade de vida a longo prazo. Palavras-chave: Gravidez, Hipotireoidismo, Doenças da Glândula Tireoide

Microglia/Astrocytes–Glioblastoma Crosstalk: Crucial Molecular Mechanisms and Microenvironmental Factors

In recent years, the functions of glial cells, namely, astrocytes and microglia, have gained prominence in several diseases of the central nervous system, especially in glioblastoma (GB), the most malignant primary brain tumor that leads to poor clinical outcomes. Studies showed that microglial cells or astrocytes play a critical role in promoting GB growth. Based on the recent findings, the complex network of the interaction between microglial/astrocytes cells and GB may constitute a potential therapeutic target to overcome tumor malignancy. In the present review, we summarize the most important mechanisms and functions of the molecular factors involved in the microglia or astrocytes–GB interactions, which is particularly the alterations that occur in the cell’s extracellular matrix and the cytoskeleton. We overview the cytokines, chemokines, neurotrophic, morphogenic, metabolic factors, and non-coding RNAs actions crucial to these interactions. We have also discussed the most recent studies regarding the mechanisms of transportation and communication between microglial/astrocytes – GB cells, namely through the ABC transporters or by extracellular vesicles. Lastly, we highlight the therapeutic challenges and improvements regarding the crosstalk between these glial cells and GB