Therapeutic potential of treatment with the flavonoid rutin after cortical focal ischemia in rats

AbstractFlavonoids have known anti-inflammatory and antioxidative actions, and they have been described as neuroprotective and able to reduce damage in CNS diseases. We evaluated the action of the flavonoid rutin in an animal model of focal cortical ischemia induced by unilateral thermocoagulation of superficial blood vessels of motor (M1) and somatosensory (S1) primary cortices. Ischemic rats were submitted to daily injections (i.p.) for five days, starting immediately after induction of ischemia. We tested two doses: 50mg/kg or 100mg/kg of body weight. Sensorimotor tests were used to evaluate functional recovery. Bioavailability in plasma was done by chromatographic analysis. The effect of treatment in lesion volume and neurodegeneration was evaluated 48h and 72h after ischemia, respectively. We observed significant sensorimotor recovery induced by rutin, and the dose of 50mg/kg had more pronounced effect. Thus, this dose was used in further analyses. Plasma availability of rutin was detected from 2h to at least 8h after ischemia. The treatment did not result in reduction of lesion volume but reduced the number of degenerated neurons at the periphery of the lesion. The results suggest rutin as an efficient drug to treat brain ischemia since it was able to promote significant recovery of sensorimotor loss, which was correlated to the reduction of neurodegeneration in the periphery of cortical injury. Increasing studies with rutin and other flavonoids might give support for further clinical trials with these drugs

Implementation of a Management Registry for Storing Clinical Data in a Research Centre

In clinical research, there is great concern about the storage and veracity of electronic data to ensure the accuracy of information. Objective: To implement a management registry for storing study data in the cardiovascular area, conducted in a clinical research centre. Methods: This is a retrospective registry and prospective joint study. An electronic database was developed using REDCap software. Data elements were standardised in accordance with the American College of Cardiology Foundation and American Heart Association. Data were extracted from research participants from the clinical studies conducted in our Institution with records of cardiovascular diagnosis that were monitored by the health team from 2009 to 2015. Results: The registry was composed of eight sections: demographic variables, diagnostic tests, laboratory tests, cardiovascular risk factors (CV), comorbidities and pharmacological treatment used, and outcome of patients. Each session consisted of sub-items, totalling 113 variables. Phase III (57.8%) and phase IV (36.8%) studies with mean follow-up of 2+4 years were predominant. We used data from 490 participants randomised to 25 studies, 63 percent men, aged 63 ą 10 years, hypertensive (81.4%), with dyslipidaemia (56.5%), and diabetes 48 (36.3%). Most had previous myocardial infarction (72.7%) and underwent coronary angioplasty (87.2%). Conclusion: The implementation of an electronic database of research on participants with cardiovascular disease was applicable and reproducible in clinical practice, being a low cost and very useful tool to store and share data from multicentre studies of medium and large scale

Prospective Clinical Registry to Evaluate Clinical Outcomes of Hypertension Patients in a Multidisciplinary Clinic

Introduction: clinical registries are necessary to define public policies for treatment and prevention, by providing highly accurate and interoperable data. Objective: to describe the implementation of a prospective, computerised, interoperable and multidisciplinary clinical registry to evaluate the clinical practice and outcomes of hypertensive patients. Methods: prospective observational study designed as a clinical registry carried out in a multidisciplinary hypertension clinic, in Brazil. A multi-professional team attends the patients. The database included patients with primary hypertension, above 18 years of age. Patients who had undergone surgery, a stroke, myocardial infarction, or renal failure were excluded. Variables were defined in accordance with national and international variables to allow interoperability. Results: the RE-HYPER registry was implemented by following the steps: (1) Data standardisation. The dataset included all applicable standardised data elements published by the American Heart Association / American College of Cardiology, and Brazilian national datasets standards; (2) Development of an initial data collection and clinical research workflow; (3) Development of electronic case reports (CRF) using REDCap (Research Electronic Data Capture) and in accordance with the HIPAA (Health Insurance Portability and Accountability Act) privacy rule; (4) Pilot testing and validation of the data collection and clinical research workflows and CRFs, and (5) Development of automated data quality report using REDCap. Discussion: Due to the magnitude of this disease in the world, this study becomes relevant to clinical practice. Conclusion:  The study showed reproducible standards and solutions that can be applied in the implementation of health records, allowing data integration between health and research services

A prática do cuidado do enfermeiro com famílias de criança à luz de Jean Watson

Objective To know the facilities and the difficulties of nurses in caring practice of hospitalized children’s families in the light of Jean Watson’s Theory of Human Caring. Method It was used the descriptive qualitative approach. The data collection was conducted in three stages: presentation of theoretical content; engagement with families in the light of Watson’s theory; and semi-structured interview with 12 pediatric nurses. The interviews were analysed using inductive thematic analysis, being possible to form three themes: Recognizing a framework for care; Considering the institutional context; and Challenges in family’s relationship. Results The theory favored reflections about self, about the institutions and about nurses’ relationship with the family of the child, normalized by a consciousness toward caring attitudes. Conclusion In this process, it is imperative that nurses recognize the philosophical-theoretical foundations of care to attend the child’s family in hospital.

Objetivo Analizar la violencia contra los adolescentes a la luz de las categorías de género y generación. Método It was used the descriptive qualitative approach. The data collection was conducted in three stages: presentation of theoretical content; engagement with families in the light of Watson’s theory; and semi-structured interview with 12 pediatric nurses. The interviews were analysed using inductive thematic analysis, being possible to form three themes: Recognizing a framework for care; Considering the institutional context; and Challenges in family’s relationship. Resultados The theory favored reflections about self, about the institutions and about nurses’ relationship with the family of the child, normalized by a consciousness toward caring attitudes. Conclusión In this process, it is imperative that nurses recognize the philosophical-theoretical foundations of care to attend the child’s family in hospital.

Objetivo Conhecer as facilidades e as dificuldades do enfermeiro na prática do cuidado das famílias de crianças internadas, à luz da Teoria do Cuidado Humano de Jean Watson. Método Utilizou a abordagem qualitativa descritiva. A coleta dos dados foi realizada em três etapas: apresentação do conteúdo teórico; engajamento com as famílias à luz da teoria de Watson; e entrevista semiestruturada com 12 enfermeiras de pediatria. As entrevistas foram submetidas à análise temática indutiva, sendo possível formar três temas: Reconhecendo um referencial para o cuidado; Considerando o contexto institucional; e Desafios no relacionamento com a família. Resultados A teoria favoreceu reflexões sobre o self, sobre as instituições e sobre o relacionamento com a família da criança, normalizadas por uma consciência voltada para atitudes de cuidado. Conclusão Nesse processo, é imperativo que o enfermeiro reconheça os fundamentos teórico-filosóficos do cuidado para atender à família da criança no hospital.
University of São Paulo School of NursingUniversity of São Paulo Department of Mother-Child and Psychiatric Nursing School of NursingFederal University of São Paulo Program of Graduation in Health SciencesUniversity of São Paulo Department of Collective Health Nursing School of NursingUNIFESP, Program of Graduation in Health SciencesSciEL

Cuidar de famílias de idosos em final de vida na Estratégia Saúde da Família

OBJECTIVE: To understand the process of end-of-life care delivery to the families of elderly patients according to a Family Health Strategy (FHS) team, to identify the meanings the team attributes to the experience and to build a theoretical model. METHOD: Symbolic Interactionism and Grounded Theory were applied. Fourteen professionals working in an FHS located in a country town in the state of São Paulo were interviewed. RESULTS: Through comparative analysis, the core category overcoming challenges to assist the family and the elderly during the dying process was identified, and it was composed of the following sub-processes: Identifying situational problems, Planning a new care strategy, Managing the care and Evaluating the care process. CONCLUSION: the team faces difficulties to achieve better performance in attending to the biological and emotional needs of families, seeking to ensure dignity to the elderly at the end of their lives and expand access to healthcare.OBJETIVO: comprender, por medio del equipo de la Estrategia Salud de la Familia (ESF), el proceso de cuidar de familias con ancianos que se encuentran en situación de final de vida, tratamos de identificar los significados que el equipo atribuye a la experiencia y con ellos construir un modelo teórico. MÉTODO: se utilizó el interaccionismo simbólico y la teoría fundamentada en los datos. Fueron entrevistados 14 profesionales de la ESF de un municipio del interior del estado de São Paulo. RESULTADOS: el análisis comparativo identificó la categoría central "superando los desafíos para acoger a la familia y al anciano durante el proceso de morir", compuesta por los subprocesos: Identificando la problemática de la situación, Planificando una nueva estrategia para el cuidar, Manejando el cuidado y Evaluando la trayectoria de cuidado. CONCLUSIÓN: el equipo enfrenta dificultades para alcanzar un mejor desempeño, acogiendo las necesidades biológicas y emocionales de las familias y buscando ofrecer dignidad a los ancianos en situación de final de vida, ampliando el acceso a la salud.OBJETIVOS: compreender o processo de cuidar de famílias de idosos em situação de final de vida para a equipe da Estratégia Saúde da Família (ESF), identificar os significados que a equipe atribui à experiência e construir um modelo teórico. MÉTODO: utilizaram-se o interacionismo simbólico e a teoria fundamentada nos dados. Foram entrevistados 14 profissionais da ESF de um município do interior paulista. RESULTADOS: a análise comparativa identificou a categoria central superando os desafios para acolher a família e o idoso durante o processo de morrer, composta pelos subprocessos: identificando a problemática da situação, planejando uma nova estratégia para o cuidar, manejando o cuidado e avaliando a sua trajetória de cuidado. CONCLUSÃO: a equipe enfrenta dificuldades para alcançar melhor desempenho, acolhendo as necessidades biológicas e emocionais das famílias e buscando oferecer dignidade aos idosos em situação de final de vida, ampliando o acesso à saúde

Nano-scale hydrogen-bond network improves the durability of greener cements

More than ever before, the world's increasing need for new infrastructure demands the construction of efficient, sustainable and durable buildings, requiring minimal climate-changing gas-generation in their production. Maintenance-free “greener” building materials made from blended cements have advantages over ordinary Portland cements, as they are cheaper, generate less carbon dioxide and are more durable. The key for the improved performance of blends (which substitute fine amorphous silicates for cement) is related to their resistance to water penetration. The mechanism of this water resistance is of great environmental and economical impact but is not yet understood due to the complexity of the cement's hydration reactions. Using neutron spectroscopy, we studied a blend where cement was replaced by ash from sugar cane residuals originating from agricultural waste. Our findings demonstrate that the development of a distinctive hydrogen bond network at the nano-scale is the key to the performance of these greener materials

Factors influencing Intensive Care Units nurses in end-of-life decisions

OBJETIVOIdentificar los factores que influencian al enfermero de Unidad de Cuidados Intensivos en el proceso de toma de decisión en las situaciones de final de vida.MÉTODOEstudio de caso etnográfico que tuvo como marco de referencia teórico la antropología médica. Se recogieron los datos mediante entrevista semiestructurada con 10 enfermeros.RESULTADOSEl análisis temático inductivo posibilitó identificar cuatro temas:El marco cultural de la Unidad de Cuidados Intensivos: la toma de decisión en las situaciones de final de vida,Creencias y subjetividades en el cuidado en las situaciones de final de vida, Experiencias profesionales y características del contexto de cuidado en las situaciones de final de vida y Prácticas de humanización en las situaciones de final de vida: el cuidado centrado en el paciente y la familia.CONCLUSIÓNLa madurez profesional, la habilidad para transmitir las informaciones y la capacidad para la negociación están directamente relacionadas con la inserción del enfermero en el proceso de toma de decisión.OBJECTIVETo identify the factors that influence the Intensive Care Unit nurse in the decision-making process in end-of-life situations.METHODEthnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with 10 nurses.RESULTSThe inductive thematic analysis enabled us to identify four themes:The cultural context of the Intensive Care Unit: decision-making in situations of end-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations: the patient and family centered care.CONCLUSIONProfessional maturity, the ability to transmit information and the ability to negotiate are directly related to the inclusion of nurses in the decision-making process.OBJETIVOIdentificar os fatores que influenciam o enfermeiro de Unidade de Terapia Intensiva no processo de tomada de decisão nas situações de final de vida.MÉTODOEstudo de caso etnográfico que teve como referencial teórico a antropologia médica. Os dados foram coletados por meio de entrevista semiestruturada com 10 enfermeiros.RESULTADOSA análise temática indutiva possibilitou identificar quatro temas: O contexto cultural da Unidade de Terapia Intensiva: a tomada de decisão nas situações de final de vida, Crenças e subjetividades no cuidado nas situações de final de vida,Experiências profissionais e características do contexto de cuidado nas situações de final de vida e Práticas de humanização nas situações de final de vida: o cuidado centrado no paciente e na família.CONCLUSÃOA maturidade profissional, a habilidade para transmitir as informações e a capacidade para a negociação, estão diretamente relacionadas com a inserção do enfermeiro no processo de tomada de decisão

Amitriptilina e exercício aeróbico ou amitriptilina isolada no tratamento da migrânea crônica: um estudo randomizado e comparativo

To compare the preventive treatment benefits of amitriptyline and aerobic exercise or amitriptyline alone in patients with chronic migraine.Method Sixty patients, both genders, aged between 18 and 50 years, with a diagnosis of chronic migraine, were randomized in groups called amitriptyline and aerobic exercise or amitriptyline alone. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores. Results In the evaluated parameters, was observed decrease in headache frequency (p=0.001), moderate intensity (p=0.048), in headache duration (p=0.001), the body mass index (p=0.001), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001), when groups were compared in the end of third month. Conclusion In this study, the amitriptyline was an effective treatment for chronic migraine, but its efficacy was increased when combined with aerobic exercise.Comparar os benefícios do tratamento preventivo em pacientes com migrânea crônica utilizando a amitriptilina associada ao exercício aeróbico ou amitriptilina isolada.Método Sessenta pacientes de ambos os sexos com idade entre 18 e 50 anos e com diagnóstico de migrânea crônica foram randomizados para receber amitriptilina e orientados a: praticar exercícios aeróbicos ou somente a amitriptilina isolada. Os seguintes parâmetros foram avaliados: frequência, intensidade e duração da cefaleia, dias de uso de medicação analgésica, índice de massa corporal (IMC), e pontuação nas escalas de Beck Depression Inventory (BDI) e Beck Anxiety Inventory (BAI). Resultados Nos parâmetros avaliados, houve redução na frequência da cefaleia (p=0,001), intensidade moderada (p=0,048), na duração (p=0,001), no índice de massa corporal (p=0,001), e pontuação nas escalas Beck Depression Inventory (p=0,001) e Beck Anxiety Inventory (p=0,001), quando os grupos foram comparados ao final do terceiro mês. Conclusão A amitriptilina foi um tratamento eficaz para a migrânea crônica, mas sua eficácia foi maior quando combinada com exercício aeróbio.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Hot water treatment effect in the elephant grass ashes calcinated at different temperatures

In recent years, agro-industrial residues have focused attention in the scientific community as a new source ofpozzolans. In Brazil, for example, one of the wastes generated from agro-industrial activities comes fromelephant grass that is cultivated as biomass for energy cogeneration. This study evaluated the effect of hotwater treatment on the crystalline structure of elephant grass ashes calcinated in two different temperature(700 and 900°C). To study the chemical structure and the composition of the ashes the X-ray fluorescence(XRF) and X-ray diffractions (XRD) analyses were carried out. The results achieved in the present workshown that, elephant grass ashes meet the ASTM C-618 standard, for the minimum sum content of the silica(SiO2), aluminum (Al2O3) and iron (Fe2O3) oxides, of 50% to be considered as a pozzolanic material. Thepresence of an amorphous phase has been detected in all XRD patterns. The ashes calcinated at 700°Cshowed lower crystallinity and the treatment with hot water decreased crystallite size, i.e., the material becamemore amorphous. On the other hand, the ashes calcinated at 900°C, less reactive, had a lower content ofK2O. Therefore, the hot water treatment was effective to reduce the potassium content in the ashes. Additionally,it contributed to reduce the crystallite size of silica in the ash calcinated at 700°C, while the effect iscontrary to the ash calcinated at 900°C.Keywords: Mineral addition, biomass, amorphous formation, potassium leaching, crystallite size