Envelhecimento e qualidade de vida em idosos da Atenção Básica de Saúde

Buscou-se avaliar o Envelhecimento e Qualidade de Vida dos idosos da Atenção Básica de Saúde. Para tanto, pesquisa de campo, exploratória-descritiva, com abordagem quantitativa, comparativo, realizada após aprovação do Comitê de Ética e Pesquisa da Faculdade Santa Maria, sob nº 1.589.310. A população foi constituída por 118 idosos cadastrados em uma Unidade Básica de Saúde, tendo como amostra 100 idosos. Dos entrevistados, 68% são do sexo feminino, 49% com ensino fundamental incompleto e com média da idade de 74,22 anos. Verificou-se melhor qualidade de vida psicológica e social (média=66,83 e 66,25), correlação positiva significativa entre os domínios e negativa entre a idade. Concluiu-se que a qualidade de vida apresentou-se associada a um conjunto de fatores, como exemplo da idade e nível de escolaridade. O estudo ainda demonstra a possibilidade de apresentar qualidade de vida apesar do processo de envelhecimento

Neurostimulation Combined With Cognitive Intervention in Alzheimer’s Disease (NeuroAD): Study Protocol of Double-Blind, Randomized, Factorial Clinical Trial

Despite advances in the treatment of Alzheimer’s disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02772185—May 5, 2016

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p

SARS-CoV-2 uses CD4 to infect T helper lymphocytes

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the agent of a major global outbreak of respiratory tract disease known as Coronavirus Disease 2019 (COVID-19). SARS-CoV-2 infects mainly lungs and may cause several immune-related complications, such as lymphocytopenia and cytokine storm, which are associated with the severity of the disease and predict mortality. The mechanism by which SARS-CoV-2 infection may result in immune system dysfunction is still not fully understood. Here, we show that SARS-CoV-2 infects human CD4+ T helper cells, but not CD8+ T cells, and is present in blood and bronchoalveolar lavage T helper cells of severe COVID-19 patients. We demonstrated that SARS-CoV-2 spike glycoprotein (S) directly binds to the CD4 molecule, which in turn mediates the entry of SARS-CoV-2 in T helper cells. This leads to impaired CD4 T cell function and may cause cell death. SARS-CoV-2-infected T helper cells express higher levels of IL-10, which is associated with viral persistence and disease severity. Thus, CD4-mediated SARS-CoV-2 infection of T helper cells may contribute to a poor immune response in COVID-19 patients.</p

Tamponamento intrauterino induzido por vácuo para hemorragia pós-parto: uma revisão sistemática

A hemorragia pós-parto (HPP) é uma complicação grave e uma das principais causas de mortalidade materna global, respondendo por aproximadamente 25% de todos os óbitos maternos. A busca por intervenções eficazes e seguras é crítica para melhorar os desfechos maternos. O tamponamento intrauterino induzido por vácuo (VHD) surgiu como uma abordagem promissora, oferecendo potencial para rápido controle do sangramento e redução da necessidade de procedimentos invasivos. Nesse sentido, o presente estudo tem como objetivo analisar a eficácia, segurança e aplicabilidade na prática clínica moderna. Foi realizada uma revisão sistemática da literatura de 2016 a 2024 nas bases de dados PubMed (Medline), Cochrane Library e SciELO. A seleção dos estudos foi baseada em critérios de inclusão e exclusão rigorosos, focando na eficácia, segurança e aplicabilidade do VHD para tratamento da HPP. Três estudos chave foram analisados, com pacientes submetidos ao tratamento com VHD para HPP. Os resultados demonstraram uma taxa de sucesso no tratamento variando de 73% a 94%, com um controle do sangramento alcançado em uma média de 3 minutos. Foi observada uma redução significativa na necessidade de transfusões maciças de sangue e na perda de sangue estimada quando comparado com o tamponamento com balão uterino. Eventos adversos foram relatados, mas todos resolveram-se sem sequelas graves. O tamponamento intrauterino induzido por vácuo apresenta-se como uma opção promissora no tratamento da hemorragia pós-parto, com resultados consistentes indicando eficácia no controle do sangramento e redução na necessidade de transfusões sanguíneas. Embora os resultados sejam encorajadores, mais estudos são necessários para confirmar essas descobertas e explorar plenamente o potencial do VHD na prática clínica. O VHD emerge como uma alternativa eficaz e segura, com potencial para melhorar significativamente os desfechos maternos e reduzir a morbimortalidade associada à HPP

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Electrochemical study and development of new electroanalytical methodologies for the determination of tricyclic antidepressants and neurotransmiters

Neste trabalho, são abordados os estudos eletroquímicos e químico-quânticos, bem como o desenvolvimento de metodologias analíticas para o antidepressivo tricíclico imipramina e para o neurotransmissor dopamina. Os experimentos foram realizados em solução tampão Britton Robinson (BR) 0,10 mol L-1 no pH de melhor resposta analítica para os referidos compostos. Com base nos parâmetros eletroquímicos extraídos das técnicas de voltametria cíclica e de onda quadrada, utilizando-se um eletrodo de grafite-poliuretana (GPU), foi possível diagnosticar o grau de reversibilidade das reações, a presença ou não de processos de adsorção e também o número de prótons e elétrons envolvidos nas reações eletroquímicas. Quanto aos cálculos químico-quânticos, a representação gráfica do HOMO (orbital molecular de mais alta energia ocupado) e os cálculos das cargas atômicas derivadas do potencial eletrostático forneceram uma estimativa do provável sítio de oxidação dos compostos. Os resultados indicaram que a reação de oxidação da imipramina é irreversível e dependente da adsorção do reagente na superfície do eletrodo, ocorrendo a formação subseqüente de um dímero em uma etapa química posterior à transferência de dois elétrons e um próton. O provável sítio de oxidação da molécula abrange a região do átomo de nitrogênio do anel, salientando que após a transferência de dois elétrons há uma deslocalização de cargas pelo anel aromático, fato este que sugere a formação do dímero na posição 2. Paralelamente, experimentos de eletrólise a potencial controlado foram realizados com o objetivo de gerar produtos de reação para serem analisados pela técnica de espectroscopia de massa com ionização por electrospray (ESI-MS). Tomando-se por base os resultados obtidos pelas técnicas voltamétricas, pelos cálculos químico-quânticos e pelos espectros de massa, foi sugerido o provável mecanismo de oxidação da imipramina nas condições estudadas. A metodologia analítica desenvolvida para a imipramina é rápida, sensível e exata para a análise de rotina em comprimidos de Tofranil®. A sensibilidade alcançada pela metodologia permitiu ainda a análise direta de concentrações plasmáticas terapêuticas do antidepressivo e de seu metabólito (desipramina) em amostra de soro humano sintético. No entanto, a seletividade da metodologia ficou comprometida pela proximidade dos potenciais de pico dos dímeros formados após a oxidação da imipramina (-41 mV) e da desipramina (23 mV). A aplicação de um método matemático de deconvolução (Origin 6.0) tornou possível a determinação simultânea da imipramina e da desipramina. A dopamina, por sua vez, é oxidada a dopamina orto quinona em um processo reversível com a adsorção de reagente e produto na superfície do eletrodo. O processo envolve a participação de dois elétrons e dois prótons. A metodologia analítica desenvolvida para a dopamina foi aplicada na análise de rotina em ampolas de Revivan® com boa exatidão e precisão. Além disso, a sensibilidade e a seletividade alcançada pela metodologia resultou na determinação de dopamina em fluído cerebrospinal sintético. A separação dos picos de oxidação da dopamina (Ep = 200 mV) e do ácido ascórbico (Ep = 40 mV) deve-se, provavelmente, às interações eletrostáticas favoráveis entre a superfície do eletrodo de GPU e o ânion ascorbato. De maneira geral, os resultados obtidos foram bastante satisfatórios para as determinações pretendidas, concluindo que o eletrodo de GPU é um material promissor para a análise de moléculas de interesse biológico.In this work, the electrochemical and quantum-chemical studies are discussed, as well as the development of analytical methodologies for the imipramine tricyclic antidepressant and for the dopamine neurotransmitter. Experiments were performed in 0.10 mol L-1 Britton Robinson (BR) buffer solution at the best analytical response pH for the mentioned compounds. From the electrochemical parameters extracted of cyclic and square wave voltammetric techniques, using a graphite-polyurethane electrode (GPU), it was possible to diagnose the reactions reversible degree, the presence or not of adsorptions processes and also the number of protons and electrons involved in the electrochemical reactions. Concerning to the quantum-chemical calculations, the graphic representation of HOMO (Highest Occupied Molecular Orbital) and the calculation of the atomic charge derived from electrostatic potential provided an estimation of the probable oxidation sites of the compounds. The results indicated that the oxidation reaction of imipramine is reversible and dependent of the reagent adsorption at the electrode surface, occuring the formation of a dimer in a chemical step after the transference of two electrons and one proton. The probable oxidation site of the molecule includes the nitrogen atom region of the ring, emphasizing that after the transference of the two electrons there is a deslocalization of the charges though the aromatic ring, suggesting the formation of the dimeric specie at postion 2. At the same time, experiments of controlled potential electrolysis were carried out in order to generate reaction products to be analysed by electrospray ionization mass espectrosmmetry (ESI-MS). From the results obtained by voltammetric techniques, by quantum-chemical calculations and by mass spectroscopy, it was suggested a probable mechanism for the imipramine oxidation in the studied conditions. The analytical methodology developed for imipramine is fast, sensible and accurate for routine analysis in Tofranil® tablets. The reached sensibility also allowed the direct analysis of therapeutical plasmatic concentrations of the antidepressant and its methabolic (desipramine) in synthetic human serum sample. However, the selectivity of the methodology was compromised by the peak potentials proximity of the dimers formed after the oxidation of imipramine (-41 mV) and of desipramine (23 mV). The application of a deconvolution mathematical xviii method (Origin 6.0) permitted the simultaneous analysis of imipramine and desipramine. On the other hand, dopamine is oxidized to dopamine ortho-quinone in a reversible process with the adsorption of reagent and product at the electrode surface. The process involves the participation of two electrons and two protons. The analytical methodology developed for dopamine was applied in the routine analysis in Revivan® injections with good accuracy and precision. Besides that, the sensitivity and the selectivity reached by the methodology resulted in the determination of dopamine in synthetic cerebrospinal fluid. The separation of the oxidation peaks of dopamine (Ep = 200 mV) and of ascorbic acid (Ep = 40 mV) is probably due to the favorable electrostatic interactions between the GPU electrode surface and the ascorbate anion. In general way, the obtained results were very satisfatory for the desirable determinations, concluding that the GPU electrode is a promissing material for the analysis of biological interest molecules