Experiences of family caregivers of hospitalized elderlies and the experience of intercorporeality* Vivências de familiares cuidadores de pessoas idosas hospitalizadas e a experiência de intercorporeidade Vivencias de familiares cuidadores de personas anc

AbstrAct Objective: To reveal experiences of family caregivers of hospitalized elderly individuals, having Merleau Ponty's phenomenology and the notion of intercorporeality as theoretical-philosophical reference. Methods: A phenomenological study was conducted with five accompanying family members of hospitalized elderly at a public hospital in the state of Bahia, Northeastern Brazil, in March 2014. The experiences were produced by two rounds of conversation, recorded and submitted to the technique of analytics of ambiguity. Results: By understanding the descriptions of experiences, the category arose: The experience of the other myself in the relationships of care between family members and hospitalized elderly. Conclusion: We understand that care, as it is subjective and dynamic, allows the experience of ambiguities, resulting in transcendence, both for accompanying family members and hospitalized elderly individuals. Thus, the hospitalization context provides opportunities of intercorporeality that can lead to new meanings of life and relationships. resumen Objetivo: Desvelar vivencias de familiares cuidadores de personas ancianas hospitalizadas, teniendo como referencial teórico-filosófico la fenomenología de Merleau-Ponty y la noción de intercorporeidad. Métodos: Estudio fenomenológico, efectuado con cinco familiares acompañantes de personas ancianas hospitalizadas, en el mes de marzo de 2014, en un hospital público en el interior de Bahía, Brasil. Las vivencias fueron producidas a través de dos encuentros de ruedas de conversación, grabadas y sometidas a la técnica analítica de la ambigüedad. Resultados: En la comprensión de las descripciones vivenciales ha emergido la categoría: la experiencia del otro yo mismo en las relaciones de cuidado entre familiares y personas ancianas hospitalizadas. Conclusión: Comprendemos que el cuidado, por el hecho de ser subjetivo y dinámico, permite la vivencia de ambigüedades que resultan en la experiencia de trascendencia, tanto para el familiar acompañante como para la persona anciana hospitalizada. Así, el contexto de la hospitalización proporciona oportunidades de intercorporeidad, que pueden converger hacia resignificaciones de vidas y relaciones

DEC-205(lo) Langerin(lo) neonatal Langerhans' cells preferentially utilize a wortmannin-sensitive, fluid-phase pathway to internalize exogenous antigen

Antigen treatment of neonatal epidermis results in antigen-specific immune suppression. Compared with adult counterparts, neonatal Langerhans' cells (LC) demonstrate an impaired ability to transport antigen to the lymph node (LN). As it is possible that neonatal LC have a reduced ability to endocytose antigen, we evaluated the acquisition of endocytic function, the expression of uptake receptors and the internalization of soluble and small particulate antigens in neonatal, juvenile and adult mice. Although LC from 4-day-old mice were weakly positive for the mannose-type receptor, Langerin, they were capable of internalizing fluorescein isothiocyanate (FITC)-dextran, but to a lesser extent than LC from 6-week-old mice. However, when ratio data were calculated to account for variations in fluorescence intensity at 4°, it was demonstrated that neonatal LC continued to internalize antigen over a longer period of time than adult mice and, as the ratios were much higher, that neonatal cells were also relatively more efficient in antigen uptake. When receptors for mannan and mannose were competitively blocked, LC from neonatal mice, but not adult mice, could still efficiently internalize FITC–dextran. Consequently, the uptake of FITC–dextran, in part, occurred via alternative receptors or a receptor-independent fluid-phase pathway. A feasible pathway is macropinocytosis, as LC from 4-day-old mice demonstrated a reduction in FITC–dextran internalization by the macropinocytosis inhibitor, wortmannin. Evidence of a functional macropinocytosis pathway in neonatal LC was further supported by internalization of the soluble tracer Lucifer Yellow (LY). We conclude that neonatal LC preferentially utilize a wortmannin-sensitive, fluid-phase pathway, rather than receptor-mediated endocytosis, to internalize antigen. As neonatal LC are capable of sampling their environment without inducing immunity, this may serve to avoid inappropriate immune responses during the neonatal period

Lipid management in patients with chronic kidney disease.

An increased risk of cardiovascular disease, independent of conventional risk factors, is present even at minor levels of renal impairment and is highest in patients with end-stage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease (CKD) or ESRD have a characteristic lipid pattern of hypertriglyceridaemia and low HDL cholesterol levels but normal LDL cholesterol levels. In the general population, a clear relationship exists between LDL cholesterol and major atherosclerotic events. However, in patients with ESRD, LDL cholesterol shows a negative association with these outcomes at below average LDL cholesterol levels and a flat or weakly positive association with mortality at higher LDL cholesterol levels. Overall, the available data suggest that lowering of LDL cholesterol is beneficial for prevention of major atherosclerotic events in patients with CKD and in kidney transplant recipients but is not beneficial in patients requiring dialysis. The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in CKD provides simple recommendations for the management of dyslipidaemia in patients with CKD and ESRD. However, emerging data and novel lipid-lowering therapies warrant some reappraisal of these recommendations

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas